Volume 15 • 2013 • Number 2
Articles
Psychiatric Disorders and Quality of Life in Patients With Implantable Cardioverter Defibrillators: A Systematic Review
Ana Claudia C. de Ornelas Maia, Gastão Soares-Filho, Valeska Pereira, Antonio Egidio Nardi, and Adriana Cardoso Silva
[Abstract] [Full Text] [Clinical Points] [Listen]
- Implantable cardioverter defibrillators, while potentially effective for the prevention of sudden death, may have serious psychological effects for patients and their families.
- The frequency and intensity of shocks may promote anxiety and depression and may worsen depressive and anxiety disorders among those who already have them.
- New strategies should be developed to improve quality of life and minimize psychiatric disorders that can be triggered with the implant of a cardioverter defibrillator or the first shock.
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A Review of Antidepressant Therapy in Primary Care: Current Practices and Future Directions [Free Access]
Sidney H. Kennedy
[Abstract] [Full Text] [Clinical Points] [Listen]
- Symptom presentation, level of severity, and response to antidepressants are equivalent between patients treated in primary care and specialty psychiatric clinics.
- There should be some evidence of improvement of symptoms after 2 weeks; if not, then dose adjustment or other interventions should be considered to achieve virtual absence of all symptoms; evidence supporting add-on therapies is inconclusive, and they may increase side effects.
- New research to find biomarkers of depression subtypes may help to select specific targets for new and existing antidepressants; the novel antidepressant vortioxetine may provide favorable outcomes as a monotherapy for a wider range of depressed patients.
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Depression and Chronic Diseases: It Is Time for a Synergistic Mental Health and Primary Care Approach
Boris Voinov, William D. Richie, and Rahn K. Bailey
[Abstract] [Full Text] [Clinical Points] [Listen]
- The mean life span in depressed patients is 25 to 30 years shorter than that in the general population, and the impact of depression on public health is on par with that of smoking and obesity.
- Depression can be reliably diagnosed and treated in the primary care setting.
- There are evidence-based, simple, and cost-effective screening tools to identify depression.
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A Review of Butyrylcholinesterase as a Therapeutic Target in the Treatment of Alzheimer’s Disease
Agneta Nordberg, Clive Ballard, Roger Bullock, Taher Darreh-Shori, and Monique Somogyi
[Abstract] [Full Text] [Clinical Points] [Listen]
- Evidence for a role of butyrylcholinesterase (BuChE), including an effect of BuChE genotype, in the pathology of Alzheimer’s disease is increasing.
- There are pharmacologic differences between the 3 main cholinesterase inhibitors approved for the symptomatic treatment of Alzheimer’s disease, which may affect the clinical response; rivastigmine inhibits both acetylcholinesterase (AChE) and BuChE, while donepezil and galantamine are AChE-selective.
- An increased understanding of the relative importance of BuChE versus AChE over the disease course will help inform treatment decisions and optimize outcomes for each patient.
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Rounds From Banner Alzheimer's Institute
As Time Goes By [CME]
Roy Yaari, Geri Hall, Helle Brand, Jan Dougherty, Adam S. Fleisher, James D. Seward, and Pierre N. Tariot
[Full Text] [Posttest] [Clinical Points] [Listen]
- To improve the quality of life of those with dementia and of their caregivers, clinicians need to treat the symptoms that can be managed, as well as comorbid depression and agitation, and provide caregivers with management strategies.
- Medication management of behavioral manifestations of dementia is often beneficial.
- Caregiver counseling and support is a vital part of treating behavioral manifestations of dementia.
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Rounds in the General Hospital
Using Stimulants for Attention-Deficit/Hyperactivity Disorder: Clinical Approaches and Challenges
Jonathan R. Stevens, Timothy E. Wilens, and Theodore A. Stern
[Full Text] [Clinical Points] [Listen]
- Attention-deficit/hyperactivity disorder (ADHD) is a common disorder of children, adolescents, and adults; moreover, it coexists with a bevy of other psychiatric and medical disorders. Pharmacotherapy of ADHD with stimulants is a mainstay of evidence-based treatment for ADHD across the lifespan.
- Stimulants have relatively few serious interactions with commonly prescribed medications.
- Certain adverse effects of stimulants (eg, decreased appetite, insomnia) can be anticipated by virtue of their known pharmacologic properties, whereas others (eg, tics, mood changes, sudden death) are idiosyncratic.
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Psychotherapy Casebook
Revisiting the Role of a Palliative Care Psychiatrist
Dean Schuyler
[Full Text] [Listen]
Letters to the Editor
“K2/Spice”: Have You Updated Your Differentials? A Case Report
Roopa Sethi, Neha Thapa, Ashwini Saxena, and Ritu Chahil
[Full Text]
Psychiatric Features in High-Functioning Adult Brothers With Fragile X Spectrum Disorders
Andrea Schneider, Andreea Seritan, Flora Tassone, Susan M. Rivera, Randi Hagerman, and David Hessl
[Full Text]
A Case of Amelioration of Venlafaxine-Discontinuation “Brain Shivers” With Atomoxetine
Jose A. Cortes and Rajiv Radhakrishnan
[Full Text]
Relationship Between Rages and Criminal Behavior in an Internal Medicine Outpatient Sample
Randy A. Sansone, Charlene Lam, and Michael W. Wiederman
[Full Text]
Are “Bath Salts” on Your Differential List? A Case Report of Delirium and Agitation After Use of Illicit Bath Salts
Roopa Sethi and Sachinder Vasudeva
[Full Text]