Eric H Decloedt1, Dan J Stein21Department of Internal Medicine, Division of Clinical Pharmacology, 2Department of Psychiatry, University of Cape Town, South AfricaAbstract: This article aims to highlight current trends in the pharmacologic management of obsessive–compulsive disorder (OCD). A systematic search of the electronic database MEDLINE was conducted. The first case report of clomipramine efficacy in the management OCD more than 40 years ago gave new hope for the treatment of this debilitating disorder. Selective serotonin reuptake inhibitors (SSRIs) proved to have a similar efficacy profile compared with clomipramine but had a superior tolerability profile. While many patients with OCD respond to SSRIs or clomipramine, the treatment of those with refractory OCD remains challenging. Different augmentation agents in treatment-resistant OCD have been explored, with antipsychotic agents having the largest supporting evidence base. Nevertheless, new pharmacologic treatment options are required and are under investigation.Keywords: obsessive–compulsive disorder, pharmacology, treatment, drug
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Read moreForeldre redder mer enn 100 spedbarn hvert år i Norge fordi de lar dem sove på ryggen. Medisinsk fødselsregister har vært sentral i å vise at krybbedød økte allerede på slutten av 1970-tallet, at økningen skyldtes den populære sovestillingen mageleie, at ryggleie hindrer krybbedød, og at vi fortsatt må overvåke hyppigheten av krybbedød og forekomsten av risikofaktorene i spedbarnspopulasjonen. Epidemiologiske studier danner det viktigste bevisgrunnlaget for årsaken til krybbedød
Read moreInternalization of stigma, disempowerment and loss of self-esteem are not inevitable consequences for all individuals with a mental illness. Nevertheless, perceived stigma is significantly associated with social withdrawal and experienced discrimination.
Read moreB vitamins and polymorphisms in genes coding for enzymes involved in one-carbon metabolism may affect DNA synthesis and methylation and thereby be implicated in carcinogenesis. Previous data on vitamins B2 and B6 and genetic polymorphisms other than those involving MTHFR as risk factors for gastric cancer (GC) are sparse and inconsistent. In this case-control study nested within the European Prospective Investigation into Cancer and Nutrition cohort, cases (n = 235) and controls (n = 601) were matched for study center, age, sex, and time of blood sampling. B2 and B6 species were measured in plasma, and the sum of riboflavin and flavin mononucleotide was used as the main exposure variable for vitamin B2 status, whereas the sum of pyridoxal 5'-phosphate, pyridoxal, and 4-pyridoxic acid was used to define vitamin B6 status. In addition, we determined eight polymorphisms related to one-carbon metabolism. Relative risks for GC risk were calculated with conditional logistic regression, adjusted for Helicobacter pylori infection status and smoking status. Adjusted relative risks per quartile (95% confidence interval, P(trend)) were 0.85 (0.72-1.01, 0.06) for vitamin B2 and 0.78 (0.65-0.93, <0.01) for vitamin B6. Both relations were stronger in individuals with severe chronic atrophic gastritis. The polymorphisms were not associated with GC risk and did not modify the observed vitamin-cancer associations. In summary, results from this large European cohort study showed an inverse association between vitamin B2 and GC risk, which is borderline significant, and a significant inverse association between vitamin B6 and GC risk.
Read moreIn BD, variations in glutamatergic genes may influence phenotypes related to the severity of illness. Speculatively, newly derived genes associated with various evolutionary advantages, may also increase the risk for more severe BD. These preliminary findings deserve validation in a larger cohort.
Read moreBipolar disorder is clinically characterized by fluctuating affect, and neuropsychologically by impairment in executive functions. Such phenomena are consistent with the centrality of emotional dysregulation and impulsivity to bipolar disorder. They are also consistent with a key role for prefrontal-subcortical (striatal-thalamic) and associated limbic circuitry in its mediation. Furthermore, there is growing data on the cellular mechanisms contributing to neuronal vulnerability in this mediating circuitry.
Read moreThe patterns of mortality and morbidity in Canada reflect an aging population and improving patterns of population health. If current trends continue, Canada will continue to face challenges of increasing population morbidity and disability alongside decreasing premature mortality.
Read more<b>Background:</b> Mild obstructive sleep apnoea (OSA) is highly prevalent; however its association with important clinical outcomes like arterial hypertension remains unknown. <b>Aims:</b> To investigate the association between mild OSA and hypertension in the European Sleep Apnoea Database (ESADA) cohort after adjusting for relevant confounding factors. <b>Methods:</b> A multicentric sample of 7995 adults from the ESADA cohort with simple snoring or mild OSA at PG or PSG was studied. We compared the predictive value of mild OSA (AHI 5-<15n/h) compared to non-apnoeic snorers on prevalent hypertension after adjustment for gender, age, smoking, obesity, daytime sleepiness, and comorbidities. Further we tried to identify cut-offs of AHI with the highest odds ratio for prevalent hypertension. <b>Results:</b> Arterial hypertension prevalence was 37% in mild OSA (n=1566) compared to 22% in non-apnoeic snorers (n=793, p<0.001). Mild OSA independently predicted hypertension (OR = 1.290, 95% CI = 1.138-1.462, P <0.001). Other factors were waist-hip ratio (OR = 4.851, 95% CI = 1.931-12.182, P=0.001), type 2 diabetes (OR=2.876, 95% CI =2.325-3.557, P<0.001) and hyperlipidemia (OR=2.507, 95% CI = 2.147-2.927, P<0.001). Furthermore, mild OSA, in the AHI range of 11-15 remained a significant predictor in PG (OR=1.249, 95% CI=1.023-1.525, P=0.029) and in PSG group (OR=1.282, 95% CI=1.026-1.602, P =0.029). <b>Conclusion:</b> Our results suppport the hypothesis that mild OSA is an independent risk factor for Hypertension, mainly in the 11-15 AHI range.
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