Drug and Alcohol Rehabilitation: New Drug Development for Cognitive Enhancement in Mental Health: Challenges and Opportunities.
New drug development for cognitive enhancement in mental health: challenges and opportunities.
Filed under: Drug and Alcohol Rehabilitation
Neuropharmacology. 2013 Jan; 64: 2-7
Insel T, Krystal J, Ehlers M
Evaluating and managing patients with thyrotoxicosis.
Filed under: Drug and Alcohol Rehabilitation
Aust Fam Physician. 2012 Aug; 41(8): 564-72
Campbell K, Doogue M
Background Thyrotoxicosis is common in the Australian community and is frequently encountered in general practice. Graves disease, toxic multinodular goitre, toxic adenoma and thyroiditis account for most presentations of thyrotoxicosis. Objective This article outlines the clinical presentation and evaluation of a patient with thyrotoxicosis. Management of Graves disease, the most frequent cause of thyrotoxicosis, is discussed in further detail. Discussion The classic clinical manifestations of thyrotoxicosis are often easily recognised by general practitioners. However, the presenting symptoms of thyrotoxicosis are varied, with atypical presentations common in the elderly. Following biochemical confirmation of thyrotoxicosis, a radionuclide thyroid scan is the most useful investigation in diagnosing the underlying cause. The selection of treatment differs according to the cause of thyrotoxicosis and the wishes of the individual patient. The preferred treatment for Graves disease is usually antithyroid drug therapy, almost always carbimazole. The primary treatment of a toxic multinodular goitre or toxic adenoma is usually radioactive iodine therapy. Specific therapy is usually not warranted in cases of thyroiditis, however, treatment directed at symptoms may be required. Referral to an endocrinologist is recommended if thyroiditis is unlikely or has been excluded.
HubMed – drug
Hypothyroidism.
Filed under: Drug and Alcohol Rehabilitation
Aust Fam Physician. 2012 Aug; 41(8): 556-62
So M, Maclsaac RJ, Grossmann M
Background Hypothyroidism is a common endocrine disorder that mainly affects women and the elderly. Objective This article outlines the aetiology, clinical features, investigation and management of hypothyroidism. Discussion In the Western world, hypothyroidism is most commonly caused by autoimmune chronic lymphocytic thyroiditis. The initial screening for suspected hypothyroidism is thyroid stimulating hormone (TSH). A thyroid peroxidase antibody assay is the only test required to confirm the diagnosis of autoimmune thyroiditis. Thyroid ultrasonography is only indicated if there is a concern regarding structural thyroid abnormalities. Thyroid radionucleotide scanning has no role in the work-up for hypothyroidism. Treatment is with thyroxine replacement (1.6 ?g/kg lean body weight daily). Poor response to treatment may indicate poor compliance, drug interactions or impaired absorption. The significance of elevated TSH associated with thyroid hormones within normal range is controversial; thyroxine replacement may be beneficial in some cases. Unless contraindicated, iodine supplementation should be prescribed routinely in women planning a pregnancy. Where raised TSH levels are detected periconceptually or during pregnancy, specialist involvement should be sought.
HubMed – drug
Overview of serotonin syndrome.
Filed under: Drug and Alcohol Rehabilitation
Ann Clin Psychiatry. 2012 Nov; 24(4): 310-8
Iqbal MM, Basil MJ, Kaplan J, Iqbal MT
Serotonin syndrome (SS) is a rare and potentially life-threatening toxic state caused by an adverse drug reaction that leads to excessive central and peripheral serotonergic activity. This excessive serotonin hyperstimulation may be secondary to 1 standard therapeutic dose of a single agent, inadvertent interactions between various drugs, intentionally or unintentionally excessive use of particular drugs, deliberate self-harm, or recreational use of certain drugs. This review article serves as an overview of the epidemiology, pathophysiology, clinical features, diagnosis, differential diagnosis, management, and prevention of SS.The authors conducted a MEDLINE search for the period covering 1955 to 2011.SS commonly occurs after the use of serotonergic agents alone or in combination with monoamine oxidase inhibitors. SS classically consists of a triad of signs and symptoms broadly characterized as alteration of mental status, abnormalities of neuromuscular tone, and autonomic hyperactivity. However, all 3 triads of SS may not occur simultaneously. Clinical manifestations are diverse and nonspecific, which may lead to misdiagnosis. SS can range in severity from mild to life-threatening. Most cases of SS are mild and resolve with prompt recognition and supportive care. Management of SS involves withdrawal of the offending agent(s), aggressive supportive care to treat hyperthermia and autonomic dysfunction, and occasionally the administration of serotonin antagonists–cyproheptadine or chlorpromazine. Patients with moderate and severe cases of SS require inpatient hospitalization.Psychiatrists, clinicians, and general practitioners must develop increased awareness of SS due to the current increase in the use of serotonergic agents in clinical practice. As SS is a manifestation of adverse pharmacology, it is not considered an idiosyncratic drug reaction, making it predictable and highly preventable. Most cases of SS are mild and easily managed. With prompt recognition and supportive care, more severe cases of SS have a favorable prognosis.
HubMed – drug
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