{"title":"Drugs for alcohol dependence","authors":"Julia Sinclair","doi":"10.1016/j.mpmed.2024.06.013","DOIUrl":"10.1016/j.mpmed.2024.06.013","url":null,"abstract":"<div><p>There is good evidence for the use of pharmacological treatments to improve outcomes in patients with alcohol dependence. The management of acute withdrawal should include a high risk of suspicion for Wernicke–Korsakoff syndrome, necessitating treatment with parenteral thiamine. Benzodiazepines in reducing doses should be used in conjunction with a continuing treatment plan after medically assisted withdrawal (detoxification). The relapse prevention medications acamprosate and naltrexone should be considered in all patients with moderate to severe alcohol dependence wishing to maintain abstinence. Disulfiram can be considered as a second-line treatment, but should be initiated by a specialist. Nalmefene has been shown to be effective in patients with mild dependence wishing to reduce their alcohol consumption. Baclofen remains off licence in much of the world: it may have a role in patients with co-morbid liver disease and anxiety symptoms.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"52 9","pages":"Pages 589-591"},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089081","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":"Perinatal psychiatry","authors":"Marisa Casanova Dias, Ian Jones","doi":"10.1016/j.mpmed.2024.06.007","DOIUrl":"10.1016/j.mpmed.2024.06.007","url":null,"abstract":"<div><p>Perinatal psychiatric disorders are common and can result in significant suffering for women and their families: suicide is a leading cause of maternal death. The most severe form of postpartum mood disorder – postpartum psychosis – follows approximately 1 in 1000 deliveries. Women who have a history of bipolar disorder or who have suffered a previous severe postpartum episode have a many-hundred-fold increased risk, and identifying them in the antenatal period is a key aspect of management. Decisions regarding the use of psychotropic medication in pregnancy must be made after a full risk–benefit analysis. The risks of taking many medications remain unknown but include teratogenic effects, withdrawal or toxic symptoms in the newborn and long-term developmental effects. However, these must be balanced against the risks of untreated mental illness and the risk of recurrence from stopping or switching well-established and efficacious medications. More data are needed to inform the difficult choices regarding medication that women with severe mental illness have to make in regard to pregnancy.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"52 9","pages":"Pages 547-551"},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850567","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":"Adverse psychiatric effects of drugs prescribed for physical illness","authors":"Caroline Parker, Adrian Tait","doi":"10.1016/j.mpmed.2024.06.009","DOIUrl":"10.1016/j.mpmed.2024.06.009","url":null,"abstract":"<div><p>Psychiatric adverse drug reactions (ADRs) have been reported with a diverse range of medicines used to treat physical illness. Whereas some are mild (e.g. transient sleep disturbances), others (e.g. psychosis) are severe and warrant discontinuing the suspected causal agents. Some reactions are predictable, while others are unpredictable. The mechanism by which they are mediated is often unclear. It is essential that serious psychiatric ADRs observed during routine clinical practice in the UK are reported via the Yellow Card reporting scheme as relatively uncommon ADRs may only be detected through post-marketing surveillance in the wider population. Patients have reported finding symptoms of psychiatric ADRs extremely distressing and sometimes frightening, and can be hesitant to mention these to clinicians.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"52 9","pages":"Pages 596-602"},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844041","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":"Alcohol use disorders, including alcohol dependence","authors":"NJ Kalk","doi":"10.1016/j.mpmed.2024.07.001","DOIUrl":"10.1016/j.mpmed.2024.07.001","url":null,"abstract":"<div><p>Alcohol dependence is commonly encountered in clinical practice. Accurate diagnosis using structured screening tools facilitates appropriate intervention, early screening for liver disease and referral to specialist services and mutual aid. For patients admitted to hospital, assessment of the risk of withdrawal and assertive treatment with benzodiazepines, particularly in the first 24 hours, improves patient safety by preventing withdrawal complications such as seizures and delirium. Similarly, detecting individuals at risk of, or who have, Wernicke–Korsakoff syndrome, and prescribing parenteral thiamine in adequate quantities, prevents the development of long-standing cognitive impairment. Hospital admission is an opportunity for reflection and building motivation for behaviour change, and efforts to engage with patients, establish what successes they have had in their recovery journey, and link them into local specialist and peer-led support structures ensures they have the best chance of lasting recovery.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"52 9","pages":"Pages 530-534"},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847342","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":"Ethics of genomic technologies in medicine","authors":"Amanda Courtright-Lim, Mary Drago","doi":"10.1016/j.mpmed.2024.04.007","DOIUrl":"https://doi.org/10.1016/j.mpmed.2024.04.007","url":null,"abstract":"<div><p>This article explores the rapid shift of genomic technologies from biomedical research to medical applications. This has led to the development of precision medicine, which can use genetic testing, gene therapy and gene editing for targeted care based on genetic information. The evolution of this targeted approach has advanced from using genetic information to inform care to developing care tailored to individual genomic information. Physicians are compelled to integrate genomic technologies for optimal patient care. Through multiple case studies, the authors highlight ethical considerations that physicians face when incorporating these technologies, emphasizing informed consent for transparent integration. Subsequently, addressing broader societal concerns, the article underscores the importance of equitable access. This exploration aims to provide physicians with a foundation to ethically facilitate access to these technologies that meet the needs of all patients.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"52 7","pages":"Pages 444-449"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141539917","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":"Religion, culture, conscience and chaplaincy","authors":"Joshua Hordern","doi":"10.1016/j.mpmed.2024.05.002","DOIUrl":"10.1016/j.mpmed.2024.05.002","url":null,"abstract":"<div><p>Religion, belief and culture should be recognized as potential sources of moral purpose and personal strength in healthcare, enhancing the welfare of both clinicians and patients amidst the experience of ill-health, healing, suffering and dying. Communication between doctors and patients and between healthcare staff should attend sensitively to the welfare benefits of religion, belief and culture. Doctors should respect personal religious and cultural commitments, taking account of their significance for treatment and care preferences. Good doctors understand their own beliefs and those of others. They hold that patient welfare is best served by understanding the importance of religion, belief and culture to patients and colleagues. The sensitive navigation of differences between people's religions, beliefs and cultures is part of doctors' civic obligations and in the UK should follow the guidance of the General Medical Council and Department of Health and Social Care. In particular, apparent conflict between clinical judgement or normal practices and a patient's culture, religion and belief should be considered carefully. Doctors' own religion or culture may play an important role in promoting adherence to this good practice, complementing the role of chaplaincy. In all matters, doctors' conduct should be governed by the law and arrangements for conscientious objection that are in effect. The strongest ethical arguments in favour of conscientious objection provisions concern the moral integrity of professionals, the objectives and values of the medical profession, the nature of healthcare in liberal democracy and the welfare of patients. In practice, arguments mounted against conscientious objection have not been found persuasive.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"52 7","pages":"Pages 415-419"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141412952","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":"The relevance of Kant's philosophy for contemporary medical ethics","authors":"Andrew Jones","doi":"10.1016/j.mpmed.2024.04.014","DOIUrl":"https://doi.org/10.1016/j.mpmed.2024.04.014","url":null,"abstract":"<div><p>In this article I briefly consider the limitations of principlism, before considering how elements of Kant's philosophy can support medical ethics. I highlight the difference between the medical profession and other jobs, and consider how Kant's political philosophy potentially offers support to universal healthcare. I then consider how science and technology studies are essential for a more robust approach toward biomedical ethics.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"52 7","pages":"Pages 413-414"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141539909","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":"Informed consent and Montgomery implications for clinical practice","authors":"Chantal Patel","doi":"10.1016/j.mpmed.2024.04.009","DOIUrl":"https://doi.org/10.1016/j.mpmed.2024.04.009","url":null,"abstract":"<div><p>Consent is central to the delivery of healthcare, and all healthcare professionals must obtain consent before proceeding with any interventions. The nature of informed consent allows the patient to fully participate in any proposed healthcare interventions. Informed consent requires high-quality information to be given that enables the patient to fully understand all the benefits as well as the risks associated with proposed interventions. This approach respects the right of the patient to self-determine what happens to their body provided they have the relevant capacity to understand the nature of the proposed intervention. Although consent may be seen as a procedural ‘must’, the importance of the dialogue that takes place between the patient and the clinician is what determines the validity of the consent as advocated by the Supreme Court ruling in Montgomery v Lanarkshire Health Board (Scotland) [2015]. It is noted that the number of legal cases related to consent has risen since the Montgomery decision.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"52 7","pages":"Pages 406-408"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141541156","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":"Ethical aspects of risk communication","authors":"Jill Gordon","doi":"10.1016/j.mpmed.2024.04.010","DOIUrl":"https://doi.org/10.1016/j.mpmed.2024.04.010","url":null,"abstract":"<div><p>The essence of risk communication is to provide patients with a clear understanding of the benefits, harms, trade-offs and uncertainties of any proposed treatment. Doctors often assume that they do this well but can overestimate the comprehension of even well-educated patients. We all make complex decisions using intuitive and deliberative thinking and there are hidden sources of bias in decision-making that apply to both doctor and patient. Recent research suggests that patients are best equipped to understand risk when they are simply able to ‘get the gist’ of the risks involved in their treatment as accurately as possible. This can be achieved by a process of thinking out loud in which the doctor outlines the nature of the problem and the factors they think might be important to the individual patient, while checking carefully for shared understanding along the way. We have an ethical obligation to keep on developing skills in how to convey knowledge with honesty, empathy and respect.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"52 7","pages":"Pages 429-431"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141539914","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":"Transplantation and consent","authors":"John Saunders","doi":"10.1016/j.mpmed.2024.04.015","DOIUrl":"https://doi.org/10.1016/j.mpmed.2024.04.015","url":null,"abstract":"<div><p>This is an overview of issues relating to consent in donation and transplantation, including the types of consent currently in use in organ donation. There is a discussion of altruistic consent, opt-in, opt-out and deemed consent, and mandated choice. Donation of organs after cardiac death and after brain death is described. Reference is made to current guidance from the UK National Health Service, the Human Tissue Authority, the UK Government and the Spanish model of Organ Donation and Transplantation.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"52 7","pages":"Pages 404-405"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141539345","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}
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