Positive Outcome After Intentional Overdose of Dabigatran.

Positive Outcome After Intentional Overdose of Dabigatran.

Filed under: Depression Treatment

J Med Toxicol. 2012 Dec 5;
Woo JS, Kapadia N, Phanco SE, Lynch CA

INTRODUCTION: Dabigatran (Pradaxa™), an orally active direct thrombin inhibitor, was approved by the United States Food and Drug Administration for the prevention of stroke in patients with atrial fibrillation in October 2010. Life-threatening consequences from dabigatran therapy include hemorrhage and bleeding complications, but they typically occur after renal impairment. We describe the first case report of intentional, acute overdose with dabigatran. CASE REPORT: A 57-year-old woman with a medical history of depression and atrial fibrillation presented to the emergency department after ingesting 11.25 g of dabigatran in a suicide attempt. Despite an ecchymosis indicative of prior trauma, there was no evidence of acute bleeding. After receiving gastric lavage and activated charcoal therapy in the emergency department, she was admitted to the ICU. On presentation, dabigatran blood levels measured 970 ng/mL and thrombin clot times measured above the testable limits (>120 s) until 52 h post-arrival. The remainder of her clinical course was uncomplicated, and the patient was transferred to an inpatient psychiatric unit for depression follow-up. DISCUSSION: This case shows the clinical course of a patient with an acute, massive dabigatran overdose with no significant clinical consequences. Currently, there is no ideal method to monitor anticoagulation levels; there is no pharmacologic reversal method, and hemodialysis is an undesirable treatment option.
HubMed – depression

Longitudinal measurement in health-related surveys. A Bayesian joint growth model for multivariate ordinal responses.

Filed under: Depression Treatment

Stat Med. 2012 Dec 5;
Verhagen J, Fox JP

Longitudinal surveys measuring physical or mental health status are a common method to evaluate treatments. Multiple items are administered repeatedly to assess changes in the underlying health status of the patient. Traditional models to analyze the resulting data assume that the characteristics of at least some items are identical over measurement occasions. When this assumption is not met, this can result in ambiguous latent health status estimates. Changes in item characteristics over occasions are allowed in the proposed measurement model, which includes truncated and correlated random effects and a growth model for item parameters. In a joint estimation procedure adopting MCMC methods, both item and latent health status parameters are modeled as longitudinal random effects. Simulation study results show accurate parameter recovery. Data from a randomized clinical trial concerning the treatment of depression by increasing psychological acceptance showed significant item parameter shifts. For some items, the probability of responding in the middle category versus the highest or lowest category increased significantly over time. The resulting latent depression scores decreased more over time for the experimental group than for the control group and the amount of decrease was related to the increase in acceptance level. Copyright © 2012 John Wiley & Sons, Ltd.
HubMed – depression

The influence of cognitive reserve on cognition in Parkinson’s disease.

Filed under: Depression Treatment

J Neural Transm. 2012 Dec 2;
Koerts J, Tucha L, Lange KW, Tucha O

There are considerable differences in cognition between individuals with Parkinson’s Disease (PD) which might be explained by the theory of cognitive reserve. This theory states that premorbid factors, such as high intellectual capacities, provide a buffer against cognitive impairments. This study determines whether cognitive reserve influences cognition in PD. Forty-eight PD patients were included. All were assessed with two proxies of cognitive reserve, tests of cognition and both measures of disease characteristic and symptoms of depression. After accounting for age, gender, disease characteristics and depression, cognitive reserve was an independent predictor of cognitive performance. In conclusion, cognitive reserve influences cognition in PD, i.e. PD patients with a high premorbid intellectual ability show fewer cognitive impairments than patients with a low premorbid ability. This indicates that cognitive reserve needs to be taken into account when monitoring the evolution of cognition in PD, however, verification of results on a larger patient sample would be desirable.
HubMed – depression

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