Medical Update for Psychiatrists最新文献

{"title":"Etigy and screening of cervical cancer","authors":"MD Joanna M Cain","doi":"10.1016/S1082-7579(97)00002-2","DOIUrl":"https://doi.org/10.1016/S1082-7579(97)00002-2","url":null,"abstract":"<div><p>The etiology of cervical carcinoma is intrinsically linked to multiple interactions of viral products, particularly from human papillomavirus, with cellular DNA over time. Additional destabilization and interaction with circulating nicotine metabolites and with human-immunodeficiency-virus effects further increase the likelihood of a sustained neoplastic process. Protection of patients from the development of cervical carcinoma includes recommendations to not smoke and to avoid exposure to sexually transmitted diseases. Screening for the presence of a neoplastic process will decrease the incidence of the disease, but barriers to successful screening must be addressed and appropriate intervals for screening must be clinically driven. Recognition that infection with human immunodeficiency virus changes the time course of the neoplastic process is essential to the screening process.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 3","pages":"Pages 67-71"},"PeriodicalIF":0.0,"publicationDate":"1997-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00002-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89991700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical care of the dying patient","authors":"MD Steven K. Rothschild","doi":"10.1016/S1082-7579(97)00003-4","DOIUrl":"10.1016/S1082-7579(97)00003-4","url":null,"abstract":"<div><p>The vast majority of Americans die in hospitals or in nursing homes. Al-though doctors and hospitals can provide state-of-the-art curative medical care, they are often ill-equipped to work with the dying patient. As a result, dying patients suffer needlessly from uncontrolled symptoms including pain, dyspnea, nausea and vomiting, and agitation. In addition, family members are often excluded from the care of the patient, and the natural process of death becomes an alienating and anger-provoking event</p><p>Hospices can provide an alternative approach to the care of dying patients Typically, hospices consist of an interdisciplinary team of nurses, social workers, chaplains, and others, who provide services in the patient's own home. Hospice care is covered by Medicare, as well as most state and commercial insurance plans</p><p>Physicians can be effective in working with hospices to provide humane care to dying patients. The first key step is to accurately establish the diagnosis and prognosis for the patient, anticipating the likely complications which will occur. The second step is to assess and relieve the patient's major symptoms Fortunately, we currently have the ability to relieve most terminal symptoms such as pain and dyspnea very effectively. Finally, physicians must elicit the values and beliefs of the dying patient and family and attempt to honor them whenever possible</p><p>Death is inevitable, and most people fear that the end of life must be associated with pain and indignity. There is considerable public anger regarding the role of physicians in perpetuating this situation. Physicians can do much to correct this situation by making greater use of hospices', and utilizing the principles of care outlined in the article</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 3","pages":"Pages 62-66"},"PeriodicalIF":0.0,"publicationDate":"1997-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00003-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84682409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Torsade de Pointes ventricular tachycardia, QT interval, and psychotropic drugs","authors":"W. Victor,&nbsp;MD R. Vieweg,&nbsp;MD Christopher S. Nicholson","doi":"10.1016/S1082-7579(96)00010-6","DOIUrl":"10.1016/S1082-7579(96)00010-6","url":null,"abstract":"<div><p><em>Torsade de pointes</em> (“twisting of the points”) ventricular tachycardia is a rare, but potentially life-threatening, cardiac arrhythmia. The sinusoidal morphology of the QRS complexes is very unusual and places this rhythm disturbance in the category of polymorphic ventricular tachycardia. Early afterdepolarization during phases 2 or 3 of the Purkinje fiber action potential is the mechanism most commonly used to explain electrocardiographic QT interval prolongation and subsequent <em>torsade de pointes</em>.</p><p>Type IA class antiarrhythmic drugs like quinidine and the newer type 3 antiarrhythmic drugs constitute the most common agents inducing this arrhythmia. Many psychotropic drugs, particularly tricyclic antidepressants and standard antipsychotic drugs, have quinidine-like properties and have been associated with <em>torsade de pointes</em>. Of the antipsychotic agents, thioridazine and haloperidol—particularly intravenous administration of large doses of haloperidol—may induce polymorphic ventricular tachycardia in up to 1% of cases. The selective serotonin reuptake inhibitors (SSRIs) and nefazodone through drug-drug interactions may produce <em>torsade de pointes</em>.</p><p>Clinically, subjects with <em>torsade de pointes</em> are usually free of symptoms or only experience mild presyncopal symptoms. Overt syncope, however, can be part of this tachyarrhythmia. Occasionally, polymorphic ventricular tachycardia degenerates into ventricular fibrillation that may be fatal. Risk factors for <em>torsade de pointes</em> ventricular tachycardia include coronary artery disease, heart muscle disease, valvular heart disease, baseline QT interval prolongation, cardiac conduction disturbances, cardiac bradyarrhythmias, and electrolyte and metabolic disturbances.</p><p>Identifying and withdrawing the offending agent or reversing and correcting predisposing conditions remain the cornerstone of treating <em>torsade de pointes</em> ventricular tachycardia. Because treatment of <em>torsade de pointes</em> ventricular tachycardia differs from treatment of monomorphic ventricular tachycardia, distinguishing between mono- and polymorphic ventricular tachycardia is very important. Psychiatrists should become familiar with the risk factors, causes, and pathophysiology of polymorphic ventricular tachycardia. Such efforts will best protect psychiatrists and their patients from facing this rhythm disturbance.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 2","pages":"Pages 48-54"},"PeriodicalIF":0.0,"publicationDate":"1997-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(96)00010-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75313516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short stature","authors":"MD Peter J. Jennings","doi":"10.1016/S1082-7579(97)00009-5","DOIUrl":"https://doi.org/10.1016/S1082-7579(97)00009-5","url":null,"abstract":"<div><p>Short stature is a common problem among children and adolescents. For clinicians faced with a short child, a review of the prior growth data may not be possible. Understanding of normal growth and growth parameters will allow correct diagnosis of short stature. The child must have accurately-obtained height and be plotted on growth curves appropriate for age and sex. Based on history and physical exam findings, a likely etiology may be obtained and confirmed by laboratory data. Based on etiology, appropriate counseling in regard to growth prognosis, and a decision regarding referral may be made. Early diagnosis of short stature may reduce the level of behavioral and psychologic disorders that can develop in short individuals.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 2","pages":"Pages 44-47"},"PeriodicalIF":0.0,"publicationDate":"1997-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00009-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136938844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of early endometrial carcinoma","authors":"MD William A. Peters III","doi":"10.1016/S1082-7579(97)00008-3","DOIUrl":"10.1016/S1082-7579(97)00008-3","url":null,"abstract":"<div><p>Endometrial cancer is the most common gynecologic malignancy. In 1989, the FIGO staging changed from a clinical to a surgical system. Lymphadenectomy for at least some patients has been widely adopted. The risk of extrauterine disease and of treatment failure is predictable, based on factors known preoperatively: 1) tumor histology, 2) tumor grade, and 3) cervical involvement. With the use of these factors, patients can be selected for lymphadenectomies. Based on the results of surgical staging, patients can be separated into low-, intermediate-, and high-risk groups, and adjuvant therapy can be rationally and economically selected.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 2","pages":"Pages 39-43"},"PeriodicalIF":0.0,"publicationDate":"1997-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00008-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82354785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical complications of cocaine abuse","authors":"MD Cynthia M. Shappell ,&nbsp;MD Thomas A. Grieger ,&nbsp;MD Deborah L. Warden","doi":"10.1016/S1082-7579(97)00007-1","DOIUrl":"10.1016/S1082-7579(97)00007-1","url":null,"abstract":"<div><p>Cocaine use has increased dramatically in the past ten years and brings with it a broad range of medical complications. Cardiac, pulmonary, neurologic, and infectious complications are common. They may present during evaluation in the emergency department or during psychiatric evaluation of comorbid conditions. Sudden death and severe morbidity are possible during periods of intoxication and withdrawal. Other conditions create long-term health problems that must be addressed in cocaine abusing patients. By understanding the range and significance of possible medical problems, psychiatrists can ensure timely and appropriate evaluation, treatment, and referral to other specialists.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 2","pages":"Pages 34-38"},"PeriodicalIF":0.0,"publicationDate":"1997-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00007-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76306366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mirtazapine overdose: A case report","authors":"BS Louise Kao,&nbsp;PharmD MBA FAC Robert L. Barkin,&nbsp;MD FACT FACEP DABMT Jerrold B. Leikin","doi":"10.1016/S1082-7579(97)00012-5","DOIUrl":"10.1016/S1082-7579(97)00012-5","url":null,"abstract":"<div><p>A case report involving mirtazapine ingestion (total of 360 mg) is discussed. Major toxic effects noted were drowsiness and sinus tachycardia with near complete revolvement within twenty-four hours. It appears that the course of mirtazapine overdose is relatively benign compared to the tricyclic antidepressant agents and selective serotonin reuptake inhibitors.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 2","pages":"Pages 58-59"},"PeriodicalIF":0.0,"publicationDate":"1997-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00012-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88833806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A fatality due to serotonin syndrome","authors":"MD Monique M. van Berkum,&nbsp;MD Julie M. Thiel,&nbsp;MD, FACP, FACEP Jerrold B. Leikin ,&nbsp;MD Adrienne Segovia,&nbsp;MD, FACEP Paul K. Hanashiro","doi":"10.1016/S1082-7579(97)00011-3","DOIUrl":"10.1016/S1082-7579(97)00011-3","url":null,"abstract":"<div><p>Serotonin syndrome is most commonly seen in patients receiving two agents that increase the availability of serotonin by different methods, commonly a serotonin reuptake inhibitor (SSRI) and a monamine oxidase inhibitor (MAOI). We report a rare fatality in a patient who ingested Isocarboxazid in addition to a SSBI and a tricyclic antidepressant (TCA). A 56-year-old woman with a history of depression on Nortriptyline, Sertraline, and Fluoxetine presented after several hours of diaphoresis and tremulousness. On physical examination, her temperature was 100°F, heart rate was 108, respiratory rate was 28, and blood pressure was 110/60. She had rigors and was agitated; she was also diaphoretic but her mental status was intact. The remainder of her physical examination was unremarkable. The initial electrocardiogram was within normal limits except for sinus tachycardia. The laboratory data were normal except for a CPK of 922 with a MB index of 2. Within four hours her temperature climbed to 106.8°F. Aggressive supportive therapy was instituted that included acetaminophen, antibiotics, benzodiazepines, fluids, intubation, and passive cooling. A second electrocardiogram showed right bundle branch block and changes consistent with an acute inferior ischemic injury that was followed by refractory ventricular fibrillation and death. Autopsy revealed mild to moderate atherosclerotic lumen narrowing without coronary occlusion. Prior to her demise we were told she had also taken Isocarboxazid. Postmortem blood levels were: 97 ng/ml for benzylhydrazine (an isocarboxazid metabolite) 1.24 mcg/ml N-desmethysertraline, .33 mcg/ml fluoxeline, 1.79 mcg/ml sertraline, and 0.58 mcg/ml nortriptyline. We document a patient coingesting a MAOI, a TCA, and two SSRIs, and postulate this combination may have caused hyperthermia complicated by coronary vasospasm. A fatal case of serotonin syndrome is reported in which coronary vasospasm secondary to drug interaction is suspected.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 2","pages":"Pages 55-57"},"PeriodicalIF":0.0,"publicationDate":"1997-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00011-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89534624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"About this issue","authors":"MD Nada L. Stotland","doi":"10.1016/S1082-7579(97)00022-8","DOIUrl":"https://doi.org/10.1016/S1082-7579(97)00022-8","url":null,"abstract":"","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 2","pages":"Page 33"},"PeriodicalIF":0.0,"publicationDate":"1997-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00022-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136938845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"About this issue","authors":"MD Nada L. Stotland","doi":"10.1016/S1082-7579(97)80926-0","DOIUrl":"https://doi.org/10.1016/S1082-7579(97)80926-0","url":null,"abstract":"","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 1","pages":"Page 1"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)80926-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137336275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}