1,721,064 research outputs found
The effects of undertreated chronic medical illnesses in patients with severe mental disorders
No full textSevere mental disorders such as bipolar disorder and schizophrenia often co-occur with chronic medical illnesses, especially cardiovascular disease and diabetes. These comorbidities are associated with a more severe course of mental illness, reduced quality of life, and premature mortality. Although the association between mental disorders and physical health complications has long been recognized, medical conditions remain undertreated in clinical psychiatric practice, and the life expectancy for individuals with serious psychiatric disorders is approximately 30% shorter than that of the general US population. Factors that are related to the mental illness (eg, cognitive impairment, reduced ability to function, and a lack of communication skills) as well as factors such as the high cost of medical care may make accessing general health care a difficult task for patients. Even when medical care is received by patients, the quality is often poor, and dangerous illnesses may be undiagnosed and untreated. In addition, harmful side effects of medications used to treat psychiatric disorders, unhealthy habits and lifestyles, and a possible genetic susceptibility to medical conditions increase the likelihood of comorbid physical conditions in patients with severe mental illness. Implementing behavioral interventions into clinical practice may help patients improve their overall health and prevent chronic medical conditions
Le diverse espressioni dell'ansia e della paura: per iniziare a comprendere il mondo di coloro che soffrono di disturbi d'ansia
No full textEndocrine and metabolic effects of medications used for bipolar disorder [Effetti endocrini e metabolici dei farmaci utilizzati nel disturbo bipolare]
No full textObjective: Patients with bipolar disorder suffer a disproportionate burden of cardiovascular and endocrine illness compared to the general population. While the exact pathogenesis of this excess morbidity is not completely known, biologic, behavioral, and sociodemographic factors have been implicated. Among biologic factors, a growing body of evidence suggests that several of the medications that are commonly used to treat bipolar disorder can contribute to several of the illnesses above. While the balance between risks and benefits of medication treatment in bipolar disorder is usually favorable, an increased knowledge of these risks is imperative, in order to avoid the impression that a disruption in physical health is an inevitable token for the patient to pay in order to achieve and maintain his or her mental health. The goal of this paper is to review the endocrine and metabolic effects of medications used for the treatment of bipolar disorder. Methods: This paper selectively reviews the literature on the endocrine risks of the medications used to treat patients with bipolar disorder. The manuscript focuses on the most practical and clinically relevant data and describes the possible strategies to prevent, monitor and treat the common endocrine illnesses that patients with bipolar disorder frequently develop during the course of treatment. Results: Most of the medications that are used to treat bipolar disorder can affect the endocrine system. However, differences exist from one medication to another. The potential endocrine and metabolic risks of olanzapine, clozapin risperidone, quetiapine, aripiprazole, ziprasidone, lithium, valproate, carbamazepine, lamotrigine, and topiramate are reviewed and discussed. A particular attention is given to the risks of weight gain, obesity, dyslipidemia, diabetes mellitus, hyperprolactinemia, thyroid and parathyroid illness, diabetes insipidus, and sexual and reproductive dysfunctions. Medications such as clozapine and olanzapine carry a high risk of weight gain and metabolic problems but most of the other drugs are not completely free from these risks. For instance, lithium, which remains one of the mainstay of treatment of bipolar disorder is associated with a considerable risk of weight gain and other metabolic and endocrine disturbances such as hypothyroidism, hyperparathyroidism and diabetes insipidus. Carbamazepine, which is not associated to a high risk of weight gain, carries a significant risk for dyslipidemia and electrolytic disturbances. Valproate is frequently associated with significant weight gain and may increase the risk of polycystic ovary syndrome. Conclusions: Almost all medications used to treat bipolar disorder carry a risk to cause or worsen endocrine or metabolic syndromes. However, the degree of risk is different for different agents and may be different from one patient to another. Particular attention in selecting the medication with the best risk/benefit ratio for each particular case is warranted. There is a general agreement that all patients identified as having, or developing, severe endocrine problems, such as the metabolic syndrome, should be referred to appropriate services such as a general practitioner, diabetologist, dietologist and other specialist service. The possibility switching medication should be considered even in the early stages of the development of endocrine/metabolic problems (e.g. in a patient whose weight increases more than 5% from initial weight) and balanced against the risk of losing efficacy
Castel di Pietra (Gavorrano – GR): relazione preliminare della campagna 2001 e revisione dei dati delle precedenti
No full textcura dell'articolo con testi di M. Belli, C. Cicali, C. Citter, M. Goracci, A. Magazzini, M. Pistolesi, H. SAlvadori, A. Sebastiani, E. Vaccar
L' impatto della psicopatologia affettiva (sia conclamata che sottosoglia) sulla qualità della vita
No full text
Mood stabilisers and pregnancy outcomes - a review
Full text linkThe purpose of this review is to give useful information to guide clinicians when treating pregnant women affected by bipolar disorder. This review focuses on mood stabilizers including lithium, sodium valproate, carbamazepine, oxcarbazepine, gabapentin, lamotrigine and topiramate. Data have been extracted from a MEDLINE search. Data from prospective, retrospective and case-control studies as well as systematic reviews, meta-analysis and data from Pregnancy Registry were included. Major congenital malformations as well as specific malformations were reported for each drug. Preliminary findings seem to identify lamotrigine as one ofthe safest antiepileptic drugs to be used in pregnancy. Teratogenity risk oftopiramate is still largely unknown and there are not enough studies to draw even preliminary conclusions. Preliminary studies failed to report an increased risk for major congenital malformations among gabapentin or.oxcarbazepine exposed pregnancies. Even if raising less concern when compared to valproate, carbamazepine should be avoided for its documented teratogenity risk. Valproate seems to be the worst considering major congenital malformations, specific malformations as,well as its detrimental effects on neurodevelopment. On the other hand, lithium might be considered a good option when treating pregnant women affected by bipolar disorder. Given the limited research on mood stabilizers in pregnancy, clinicians need to be very careful when treating child bearing age women. Clinicians have to balance the potential teratogenityrisk against that of untreated mental illness considering individual circumstances such as severity of illness and risk of relapse
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