Editorial Septembrie 2011 - Prof.Dr.Aurel ROMILA

CERCETARI ASUPRA STRUCTURII PSIHICULUI  UMAN

Dealungul timpului au fost propusi diversi factori care ar motiva psihicul. Cea mai mare conributie i se atribue lui FREUD pentru considerarea inconstientului ca principal factor de motivatie.

Voi incerca sa discut si sa arat cu scheme, care este conceptia noastra asupra acestui subiect la sedinta APLR de simbata 29 octombrie dar si pe 3 sept.ora 9 la policlinica TITAN la sedinta de psihologie a persoanei.

In esenta este vorba de un lant de diviziuni: psihicul in ego-sine, sinele in inconstient si spirit, inconstientul in psiho si somatic, spiritual in orientari, credinte, mentalitati, atitudini, caracter.

Sinteza acestor date pot fi intelese in dinamica lor daca le reprezentam clar in scheme morfologice, ceeace voi incerca la 29 oct.a.c.

Aceste concepte sunt importante pentru psihoterapie, ca sa stim ce component vizam!

                                                               Prof. A. ROMILA

Up to Date Medicale

*clozapina si reinternarile

Werneck AP et al. – Clozapine was significantly associated with lower rehospitalization risk compared with risperidone. The risk of rehospitalization in patients on olanzapine and amisulpride, and oral first generation antipsychotics (FGA), was similar to that of patients in use of clozapine. These results however, are limited by the heterogeneity of illness severity across the groups.

Noutati Medicale

 

* migrena

Two studies suggest that migraine with aura increases risk for CVD and CHD mortality.

 

 

* migrena
Dizziness, and vertigo are common in the general population and are often a patient complaint. These symptoms occur more commonly with, and may be part of the migraine attack. Look for migraine in your patients complaining of dizziness or vertigo. Treating migraine may relieve these symptoms.

 

 

*dementa

  • In the past few years, a small number of controlled studies have explored the effectiveness of some of the more popular herbal and CAM remedies, including gingko biloba, phosphatidylcholine, phosphatidylserine, and omega–3 fatty acids.
  • To date, the bulk of evidence suggests that such approaches are not successful in preventing or delaying cognitive decline or dementia, and there is little reason to prescribe these remedies for the treatment of established cognitive impairment.

 

 

*clozapina si reinternarile

Werneck AP et al. – Clozapine was significantly associated with lower rehospitalization risk compared with risperidone. The risk of rehospitalization in patients on olanzapine and amisulpride, and oral first generation antipsychotics (FGA), was similar to that of patients in use of clozapine. These results however, are limited by the heterogeneity of illness severity across the groups

 

 

 

*antidepresivele la batrini

August 5, 2011 — Use of antidepressant medication in those over age 65 is risky, new research suggests.

A population-based cohort study in the United Kingdom published online August 2 in the British Medical Journal showed significant associations between the use of antidepressants and adverse outcomes, including falls, stroke, seizures, and all-cause mortality in elderly people with depression.
 
 

MDLinx - Recent Articles

Efficacy of frovatriptan in the acute treatment of menstrually related migraine: analysis of a double-blind, randomized, cross-over, multicenter, Italian, comparative study versus rizatriptan
The Journal of Headache and Pain, 08/17/11
Savi L et al. – These results need to be confirmed by randomized, double–blind, prospective, large clinical trials. Methods
  • A multicenter, randomized, double blind, cross–over study.
  • Each patient received frovatriptan 2.5 mg or rizatriptan 10 mg in a randomized sequence: after treating 3 episodes of migraine in not more than 3 months with the first treatment, the patient had to switch to the other treatment.
  • Menstrually related migraine was defined according to the criteria listed in the Appendix of the last IHS Classification of Headache disorders.
  • 99 out of the 125 patients included in the intention–to–treat analysis of the main study were of a female gender: 93 had regular menstrual cycles and were, thus, included in this analysis.
Results
  • A total of 49 attacks classified as menstrually related migraine were treated with frovatriptan and 59 with rizatriptan.
  • Rate of pain relief at 2 h was 58% for frovatriptan and 64% for rizatriptan (p = NS), while rate of pain free at 2 h was 31 and 34% (p = NS), respectively.
  • At 24 h, 67 and 81% of frovatriptan–treated, and 61 and 74% of rizatriptan–treated patients were pain free and had pain relief, respectively (p = NS).
  • Recurrence at 24 h was significantly (p < 0.01) lower with frovatriptan (10 vs. 32% rizatriptan).
  • Frovatriptan was as effective as rizatriptan in the immediate treatment of menstrually related migraine attacks while showing a favorable sustained effect with a lower rate of migraine recurrence.

 

 

 

 

The endocannabinoid system in anxiety, fear memory and habituation
Journal of Psychopharmacology, 08/19/11
Ruehle S et al. – In fear memory paradigms, the endocannabinoid system (ECS) is mostly involved in the two opposing processes of reconsolidation and extinction of the fear memory. Whereas ECS activation deteriorates reconsolidation, proper extinction depends on intact cannabinoid type 1 (CB1) receptor signalling. Thus, both for anxiety and fear memory processing, endocannabinoid signalling may ensure an appropriate reaction to stressful events. Therefore, the ECS can be considered as a regulatory buffer system for emotional response

 

 

 

 

Treatment of severe borderline personality disorder with clozapine
Indian Journal of Psychiatry, 11/02/10
Vohra AK – Patients with borderline personality disorder (BPD) show significant impairment in the domain of interpersonal and social functioning and may use the resources of health and social services extensively, with little beneficial outcome. At present there are no clear guidelines in literature for the use of pharmacotherapy in the management of BPD. According to the scanty literature available in the form of case reports and small studies, clozapine has been demonstrated to be effective in the management of BPD.

 

 

 

 

Oral versus depot antipsychotic drugs for schizophrenia--A critical systematic review and meta-analysis of randomised long-term trials
Schizophrenia Research, 02/08/11
Leucht C et al. – Non–adherence is a major problem in the treatment of schizophrenia. Depot antipsychotic drugs are thought to reduce relapse rates by improving adherence, but a systematic review of long–term studies in outpatients is not available. Depot antipsychotic drugs significantly reduced relapse. Due to a number of methodological problems in the single trials the evidence is, nonetheless, subject to possible bias.

 

 

 

 

 

Treatment-Refractory Generalized Anxiety Disorder
Psychiatric Annals, 02/21/11
Starcevic V et al. – It has been reported that about half of patients with generalized anxiety disorder (GAD) do not respond adequately to standard pharmacological treatments, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and imipramine, with or without a benzodiazepine.

 

 

 

 

 

Clinical potential of lurasidone in the management of schizophrenia
Therapeutics and Clinical Risk Management, 06/29/11

Samalin L et al. - The efficacy of lurasidone with regard to cognitive functions and depressive symptoms seems good, but requires further work. Lurasidone differs from the other second-generation antipsychotics by having a good tolerability profile, in particular for cardiometabolic tolerability. However, it seems to have a significant although moderate link with the occurrence of akathisia, extrapyramidal symptoms, and hyperprolactinemia at the start of treatment. This tolerance profile greatly broadens the scope of second-generation antipsychotics and so supports the view of some authors that the term ?second-generation antipsychotic? is now outdated.
  • Lurasidone is a new second-generation antipsychotic approved in October 2010 by the Food and Drug Administration for the treatment of schizophrenia.
  • Like other second-generation antipsychotics, lurasidone is a powerful antagonist of D2 dopamine and 5HT2A serotonin receptors, but differs from the other second-generation antipsychotics in its action profile for certain receptors.
  • Lurasidone is the second-generation antipsychotic with the greatest affinity for 5HT7 receptors and has a high affinity for 5HT1A serotonin receptors, compatible with favorable effects on cognitive function and an antidepressant action.
  • By contrast, lurasidone has a low affinity for α1 and α2C-adrenergic and 5HT2C serotonin receptors, and no affinity for histaminergic H1 or muscarinic M1 receptors, suggesting a better tolerability profile than the other second-generation antipsychotics.
  • Lurasidone has demonstrated its efficacy in several short-term trials in acute schizophrenia, promptly and significantly reducing total Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale scores compared with placebo.
  • Several long-term studies are in progress to assess its efficacy in the maintenance treatment of schizophrenic patients.

 

 

 

 

Valproate v. lithium in the treatment of bipolar disorder in clinical practice: observational nationwide register-based cohort study
British Journal of Psychiatry, 07/27/11
Kessing LV et al. ? In daily clinical practice, treatment with lithium seems in general to be superior to treatment with valproate. Methods
  • An observational cohort study with linkage of nationwide registers of all people with a diagnosis of bipolar disorder in psychiatric hospital settings who were prescribed valproate or lithium in Denmark during a period from 1995 to 2006.
Results
  • A total of 4268 participants were included among whom 719 received valproate and 3549 received lithium subsequent to the diagnosis of bipolar disorder.
  • The rate of switch/add on to the opposite drug (lithium or valproate), antidepressants, antipsychotics or anticonvulsants (other than valproate) was increased for valproate compared with lithium (hazard ratio (HR) = 1.86, 95% CI 1.59?2.16).
  • The rate of psychiatric hospital admissions was increased for valproate v. lithium (HR = 1.33, 95% CI 1.18–1.48) and regardless of the type of episode leading to a hospital admission (depressive or manic/mixed).
  • Similarly, for participants with a depressive index episode, a manic index episode and a mixed index episode, the overall rate of hospital admissions was significantly increased for valproate compared with lithium.

 

 

 

 

Benzodiazepine Use Among Patients With Schizophrenia in Taiwan: A Nationwide Population-Based Survey
Psychiatric Services, 08/10/11
Wu CS et al. – The study showed that benzodiazepine use was highly prevalent among patients with schizophrenia in Taiwan and that a substantial proportion of users (62.9%) were long–term users. Because long–term use was associated with longer duration of illness and with use of concomitant psychotropic medications, long–term users may be at higher risk of neurocognitive side effects caused by benzodiazepines and interactions with other psychotropic medications. Therefore, this group should be closely monitored for drug–drug interactions and the benefits and risks of benzodiazepine use.

 

 

 

 

What is the optimal dose of escitalopram for the treatment of obsessive-compulsive disorder? A naturalistic open-label study
International Clinical Psychopharmacology, 08/11/11
Shim G et al. ? These results imply that doses less than or equal to 40 mg/day ESC are sufficient for symptomatic improvement with good tolerability for most patients. Very high doses of ESC, on the other hand, can be considered for patients with inadequate therapeutic responses to the administration of 40 mg/day ESC. Methods
  • Explored efficacy and tolerability of very high doses (maximum dose of >40 mg/day), high doses (maximum dose of 25?40 mg/day), and standard doses (maximum dose of &le20 mg/day) of escitalopram (ESC) as an anti-obsessive?compulsive disorder treatment in a naturalistic clinical setting
  • Reviewed medical records of all patients with OCD (n=246) who had taken ESC between May 2006 and September 2009, and assigned Clinical Global Impression (CGI) scores
  • Of total sample, 24.4, 38.2, and 37.4% patients received very high, high, and standard doses of ESC, and the mean daily maximum doses of ESC were 57.3�12.0 mg, 33.9�5.4 mg, and 13.4�5.8 mg
Results
  • CGI-Severity scores in each group decreased significantly after treatment with ESC, as evidenced by response rates (i.e. CGI-Improvement scores of 1 or 2) of 46.3, 43.2, and 26.2%

 

 

 

 

What is the optimal dose of escitalopram for the treatment of obsessive-compulsive disorder? A naturalistic open-label study
International Clinical Psychopharmacology, 08/11/11
Shim G et al. ? These results imply that doses less than or equal to 40 mg/day ESC are sufficient for symptomatic improvement with good tolerability for most patients. Very high doses of ESC, on the other hand, can be considered for patients with inadequate therapeutic responses to the administration of 40 mg/day ESC. Methods
  • Explored efficacy and tolerability of very high doses (maximum dose of >40 mg/day), high doses (maximum dose of 25?40 mg/day), and standard doses (maximum dose of &le20 mg/day) of escitalopram (ESC) as an anti-obsessive?compulsive disorder treatment in a naturalistic clinical setting
  • Reviewed medical records of all patients with OCD (n=246) who had taken ESC between May 2006 and September 2009, and assigned Clinical Global Impression (CGI) scores
  • Of total sample, 24.4, 38.2, and 37.4% patients received very high, high, and standard doses of ESC, and the mean daily maximum doses of ESC were 57.3�12.0 mg, 33.9�5.4 mg, and 13.4�5.8 mg
Results
  • CGI-Severity scores in each group decreased significantly after treatment with ESC, as evidenced by response rates (i.e. CGI-Improvement scores of 1 or 2) of 46.3, 43.2, and 26.2%

 

 

 

 

Efficacy of pregabalin in preventing relapse in patients with generalized social anxiety disorder: results of a double-blind, placebo-controlled 26-week study
International Clinical Psychopharmacology, 08/16/11
Greist JH et al. – The results of this study suggest that pregabalin (450 mg/day) is safe, well tolerated, and has significant relapse–prevention efficacy over 26 weeks in patients with social anxiety disorder (SAD) who responded to an initial course of the pregabalin treatment.

 

 

 

 

Tolerability profile of aripiprazole in patients with Tourette syndrome
Journal of Psychopharmacology, 08/16/11
Cavanna AE et al. – The discontinuation rate of 20.7% suggests that aripiprazole is safe and reasonably well tolerated for use in TS. The prevalence of adverse effects appears to increase with treatment duration.

 

 

MDLinx - New Articles

The Effect of Pharmacotherapy on Suicide Rates in Bipolar Patients
CNS Neuroscience & Therapeutics, 08/02/11
Rihmer Z et al. – Several clinical trials provide evidence that effective acute and long–term treatment of bipolar depression provides a strong protection against suicide, suicide attempts, and probably against other complications of this disorder. Current major mood disorder is the most important risk factor of suicide, and bipolar II patients carry the highest risk. In bipolar patients suicidal behavior is most likely to occur during pure or mixed depressive episodes. Since bipolar disorder is a highly recurrent illness, adequate long–term pharmacotherapy is needed to prevent suicidal behavior.

 

 

 

 

Pregabalin augmentation in treatment-resistant obsessive-compulsive disorder
International Clinical Psychopharmacology, 06/16/11
Oulis P et al. – Despite the several limitations of the study, its results suggest that adjunctive pregabalin might be a safe and efficacious new augmentation agent in the treatment of drug–resistant obsessive?compulsive disorder (OCD). The authors hypothesize that pregabalin's mechanism of action in OCD might consist in its inhibition of glutamatergic neurotransmission.

 

 

 

 

Life expectancy among persons with schizophrenia or bipolar affective disorder
Schizophrenia Research, 07/12/11
Laursen TM et al. ? Life-expectancy was much shorter in persons with schizophrenia or bipolar disorder. Excess mortality from physical diseases and medical conditions exerts a far greater influence on the curtailed life-expectancy, when compared against the impact of death by external causes. Methods
  • Life-expectancy was calculated by means of survival analysis techniques using entire Danish population as a cohort
Results
  • Life-expectancy 18.7years shorter for schizophrenic men compared to men in general population
  • Corresponding numbers for schizophrenic women 16.3years, for bipolar men 13.6years, and for bipolar women 12.1years

 

 

 

 

Waist circumference, abdominal obesity, and depression among overweight and obese U.S. adults: National Health and Nutrition Examination Survey 2005-2006
BMC Psychiatry, 08/12/11
Zhao G et al. ? Among overweight and obese U.S. adults, waist circumference or abdominal obesity was significantly associated with increased likelihoods of having major depressive symptoms or moderate-to-severe depressive symptoms. Thus, mental health status should be monitored and evaluated in adults with abdominal obesity, particularly in those who are overweight. Methods
  • Cross-sectional, nationally representative sample from 2005-2006 National Health and Nutrition Examination Survey was used
  • Analyzed data from 2,439 U.S. adults (1,325 men and 1,114 nonpregnant women) aged [greater than or equal to]20 years who were either overweight or obese with BMI of [greater than or equal to]25.0 kg/m2
  • Abdominal obesity defined as waist circumference of >102 cm for men and >88 cm for women
  • Depressive symptoms (defined as having major depressive symptoms or moderate-to-severe depressive symptoms) were assessed by Patient Health Questionnaire-9 diagnostic algorithm
  • Prevalence and ORs with 95% CIs for having major depressive symptoms and moderate-to-severe depressive symptoms were estimated using logistic regression analysis
Results
  • After multivariate adjustment for demographics and lifestyle factors, waist circumference was significantly associated with both major depressive symptoms (OR: 1.03, 95% CI: 1.01-1.05) and moderate-to-severe depressive symptoms (OR: 1.02, 95% CI: 1.01-1.04), and adults with abdominal obesity were significantly more likely to have major depressive symptoms (OR: 2.18, 95% CI: 1.35-3.59) or have moderate-to-severe depressive symptoms (OR: 2.56, 95% CI: 1.34-4.90) than those without
  • These relationships persisted after further adjusting for coexistence of multiple chronic conditions and persisted in participants who were overweight (BMI: 25.0-<30.0 kg/m2) when stratified analyses were conducted by BMI status

 

 

 

 

Insight in schizophrenia and risk of suicide: a systematic update
Comprehensive Psychiatry, 08/15/11
Lopez–Morinigo JD et al. – There is little evidence to support the suggestion that insight may represent a risk factor for suicide in patients with schizophrenia. If there is an association between such risk and insight, it appears to be mediated by other variables such as depression and, above all, hopelessness. Methods
  • Articles assessing insight and suicidality in patients with schizophrenia spectrum disorders published between 1977 and 2010 were reviewed.
  • A MEDLINE search strategy was used to identify studies using keywords.
  • Application of meta–analytic techniques to selected studies was not possible because of important methodological differences between them.
Results
  • Fifteen studies met predetermined selection criteria.
  • Ten failed to demonstrate a positive association between insight and risk for suicid

 

 

 

Aspirin failure in patients presenting with acute cerebrovascular ischaemia
Thrombosis and Haemostasis, 08/03/11

Halawani SHM et al. – Incomplete platelet inhibition is common around the time of acute cerebrovascular ischaemic events in patients prescribed aspirin. Up to 50% of these observations appear due to incomplete adherence to aspirin therapy. Methods
  • The authors studied 51 adults admitted with suspected ischaemic stroke and already prescribed daily aspirin.
  • Within 48 hours (h) of onset, blood and urine samples were collected to assess platelet aggregation, activation and aspirin response by a range of methods.
  • All tests were then repeated on a second sample taken 24 h after witnessed administration of 75 mg or 150 mg aspirin.
Results
  • At entry to the study, incomplete response to aspirin, measured by arachidonic acid (AA)–stimulated platelet aggregation, was found in 43% of patients.
  • Following in–hospital aspirin administration, there was a significant decrease in AA–aggregation (p=0.001) suggesting poor adherence to therapy prior to admission.
  • However, residual aggregation (10?15%) persisted in 11 subjects ? suggesting alternative causes.
  • In incomplete responders on admission, platelet aggregation with adenosine diphosphate (ADP) was significantly higher compared with responders (p<0.05) but there were no significant differences in collagen aggregation, platelet fibrinogen binding or P–selectin expression, plasma von Willebrand factor, fibrinogen, high–sensitivity C–reactive protein, or the urinary metabolite, 11–dehydro–TxB2.

 

 

 

 

Sertraline or mirtazapine for depression in dementia (HTA-SADD): A randomised, multicentre, double-blind, placebo-controlled trial
The Lancet - Early Online Publication, 07/25/11
Banerjee S et al. ?Depression is common in dementia but the evidence base for appropriate drug treatment is sparse and equivocal. The authors aimed to assess efficacy and safety of two of the most commonly prescribed drugs, sertraline and mirtazapine, compared with placebo. Because of the absence of benefit compared with placebo and increased risk of adverse events, the present practice of use of these antidepressants, with usual care, for first-line treatment of depression in Alzheimer's disease should be reconsidered. Methods
  • We undertook the parallel-group, double-blind, placebo-controlled, Health Technology Assessment Study of the Use of Antidepressants for Depression in Dementia (HTA-SADD) trial in participants from old-age psychiatry services in nine centres in England
  • Participants were eligible if they had probable or possible Alzheimer's disease, depression (lasting &ge4 weeks), and a Cornell scale for depression in dementia (CSDD) score of 8 or more
  • Participants were ineligible if they were clinically critical (eg, suicide risk), contraindicated to study drugs, on antidepressants, in another trial, or had no carer
  • Clinical trials unit at King's College London (UK) randomly allocated participants with computer-generated block randomisation sequence, stratified by centre, with varying block sizes, in a 1:1:1 ratio to receive sertraline (target dose 150 mg per day), mirtazapine (45 mg), or placebo (control group), all with standard care
  • Primary outcome reduction in depression (CSDD score) at 13 weeks (outcomes to 39 weeks were also assessed), assessed with mixed linear-regression model adjusted for baseline CSDD, time, and treatment centre
Results
  • Decreases in depression scores at 13 weeks did not differ between 111 controls and 107 participants allocated to receive sertraline (mean difference 1�17, 95% CI -0�23 to 2�58; p=0�10) or mirtazapine (0�01, -1�37 to 1�38; p=0�99), or between participants in mirtazapine and sertraline groups (1�16, -0�25 to 2�57; p=0�11); these findings persisted to 39 weeks
  • Fewer controls had AE (29 of 111 [26%]) than did participants in sertraline group (46 of 107, 43%; p=0�010) or mirtazapine group (44 of 108, 41%; p=0�031), and fewer serious AE rated as severe (p=0�003)
  • 5 patients in every group died by week 39

 

 

 

 

Aripiprazole versus placebo for schizophrenia
Cochrane Reviews, 08/15/11
Belgamwar RB et al. – Aripiprazole may be effective for the treatment of schizophrenia. Aripiprazole has a lower risk of raised prolactin and prolongation of the QTc interval. Methods
  • The authors searched the Cochrane Schizophrenia Group Trials Register (January 2008) which is based on regular searches of BIOSIS, CENTRAL, CINAHL, EMBASE, MEDLINE and PsycINFO.
  • The authors included all randomised trials comparing aripiprazole with placebo in people with schizophrenia or schizophrenia–like psychosis.
  • The authors extracted data independently.
  • For dichotomous data the authors calculated risk ratios (RR) and their 95% confidence intervals (CI) on an intention–to–treat basis based on a fixed–effect model.
  • The authors calculated numbers needed to treat/harm (NNT/NNH) where appropriate.
  • For continuous data, the authors calculated mean differences (MD) again based on a fixed–effect model.
Results
  • Despite the fact that 2585 people participated in nine randomised aripiprazole studies, the authors were unable to extract any usable data on death, service outcomes, general functioning, behaviour, engagement with services, satisfaction with treatment; economic outcomes or cognitive functioning.
  • In general, study attrition was very large for all studies over four weeks' duration.
  • There was high attrition in most of the included studies.
  • Fewer people left the aripiprazole group compared with those in the placebo group (n = 2585, 9 RCTs, RR 0.73 CI 0.60 to 0.87).
  • Compared with placebo, aripiprazole significantly decreased relapse in both the short (n = 310, 1 RCT, RR 0.59 CI 0.45 to 0.77) and medium term (n = 310, 1 RCT, RR 0.66 CI 0.53 to 0.81).
  • It also produced better compliance with study protocol (n = 2275, 8 RCTs, RR 0.74 CI 0.59 to 0.93).
  • Aripiprazole may decrease prolactin levels below those expected from placebo (n = 305, 2 RCT, RR 0.21 CI 0.11 to 0.37).
  • Insomnia (~23%) and headaches (~15%) were commonly reported in both groups, with no significant difference.

 

 

Medscape - New Articles

 

Prescribing Lifestyle Medicine
Medscape Public Health, 2011-08-15

Most Emailed Articles on Medscape
1. A Matter of Respect and Dignity: Bullying in the Nursing Profession Medscape Nurses
2. Overhauling Nursing Education Medscape Nurses
3. Vitamin D Supplementation: An Update US Pharmacist
4. The 2010 AHA Guidelines: The 4 Cs of Cardiac Arrest Care Medscape Emergency Medicine
5. Propoxyphene Withdrawn From US Market Medscape Medical News

 

 

 

 

ADHD Rates Continue to Rise in the United States
Medscape Medical News, 2011-08-22

Most Emailed Articles on Medscape
1. A Matter of Respect and Dignity: Bullying in the Nursing Profession Medscape Nurses
2. Overhauling Nursing Education Medscape Nurses
3. Vitamin D Supplementation: An Update US Pharmacist
4. The 2010 AHA Guidelines: The 4 Cs of Cardiac Arrest Care Medscape Emergency Medicine
5. Propoxyphene Withdrawn From US Market Medscape Medical News

 

 

 

 

Managing Comorbid Cardiovascular Disease and Depression
Medscape Education Psychiatry & Mental Health, 2011-07-27

Most Emailed Articles on Medscape
1. 2010 AHA Guidelines: The ABCs of CPR Rearranged to "CAB" Medscape Education
2. IDSA Issues First Guidelines for Treatment of MRSA Medscape Education
3. The Last Hours of Living: Practical Advice for Clinicians MedscapeCME Nurses
4. New Guidelines for Exercise in Type 2 Diabetes Medscape Education
5. Updated USDA Dietary Guidelines Released Medscape Education

The British Journal of Psychiatry - Up to Date

 

AlA new future TOC for The British Journal of Psychiatry is available online for the issue:

October 2011; Vol. 199, No. 4

This Future Table of Contents is available online at: http://bjp.rcpsych.org/future/199.4.shtml

These articles have been accepted for this issue. Change is possible before publication.






Editorials

No psychiatry without psychopharmacology
P. J. Harrison, D. S. Baldwin, T. R. E. Barnes, T. Burns, K. P. Ebmeier, I. N. Ferrier and D. J. Nutt
The British Journal of Psychiatry 2011 199 (4)

The rise and fall of the atypical antipsychotics
T. Kendall
The British Journal of Psychiatry 2011 199 (4)

Are all antipsychotic drugs the same?
S. Leucht and J. M. Davis
The British Journal of Psychiatry 2011 199 (4)

Unipolar and bipolar depression: different or the same?
D. J. Smith and N. Craddock
The British Journal of Psychiatry 2011 199 (4)


Review article
Time course of improvement with antipsychotic medication in treatment-resistant schizophrenia
T. Suzuki, G. Remington, T. Arenovich, H. Uchida, O. Agid, A. Graff-Guerrero and D. C. Mamo
The British Journal of Psychiatry 2011 199 (4)


Papers
Clozapine v. Chlorpromazine in treatment-naive, first-episode schizophrenia: 9-year outcomes of a randomised clinical trial
R. R. Girgis, M. R. Phillips, X. Li, K. Li, H. Jiang, C. Wu, N. Duan, Y. Niu and J. A. Lieberman
The British Journal of Psychiatry 2011 199 (4)

Safety of antipsychotics in people with intellectual disability
V. Frighi, M. T. Stephenson, A. Morovat, I. E. Jolley, M. Trivella, C. A. Dudley, E. Anand, S. J. White, C. V. Hammond, R. A. Hockney, B. Barrow, R. Shakir, and G. M. Goodwin
The British Journal of Psychiatry 2011 199 (4)

Course of auditory vocal hallucinations in childhood: 5-year follow-up study
A. A. Bartels-Velthuis, G. van de Willige, J. A. Jenner, J. van Os and D. Wiersma
The British Journal of Psychiatry 2011 199 (4)

Comparison of depressive episodes in bipolar disorder and in major depressive disorder within bipolar disorder pedigrees
P. B. Mitchell, A. Frankland, D. Hadzi-Pavlovic, G. Roberts, J. Corry, A. Wright, C. K. Loo and M. Breakspear
The British Journal of Psychiatry 2011 199 (4)

Problem-solving therapy for people who present to hospital with self-harm: Zelen randomised controlled trial
S. Hatcher, C. Sharon, V. Parag and N. Collins
The British Journal of Psychiatry 2011 199 (4)

Rumination-focused cognitive-behavioural therapy for residual depression: phase II randomised controlled trial
E. R. Watkins, E. Mullan, J. Wingrove, K. Rimes, H. Steiner, N. Bathurst, R. Eastman and J. Scott
The British Journal of Psychiatry 2011 199 (4)

Premorbid risk markers for chronic fatigue syndrome in the 1958 British birth cohort
C. Clark, L. Goodwin, S. A. Stansfeld, M. Hotopf and P. D. White
The British Journal of Psychiatry 2011 199 (4)

Premarital mental disorders and physical violence in marriage: cross-national study of married couples
E. Miller, J. Breslau, M. Petukhova, J. Fayyad, J. Greif Green, L. Kola, S. Seedat, D. J. Stein, A. Tsang, M. C. Viana, L. H. Andrade, K. Demyttenaere, G. De Girolamo, J. M. Haro, C. Hu, E. G. Karam, V. Kovess-Masfety, T. Tomov and R. C. Kessler
The British Journal of Psychiatry 2011 199 (4)


Short report
Pre-conception inter-pregnancy interval and risk of schizophrenia
L. Gunawardana, G. D. Smith, S. Zammit, E. Whitley, D. Gunnell, S. Lewis and F. Rasmussen
The British Journal of Psychiatry 2011 199 (4)
 

Arsenie Boca - O Parabola

Dumnezeu nu ne cere minuni, acelea le face El (O parabola de Arsenie Boca)

Dumnezeu nu ne cere minuni, acelea le face El

Astazi este pentru mine o zi cu o inalta insemnatate sufleteasca. "Schimbarea la Fata" inseamna intoarcerea catre adancul fiintei noastre, intoarcerea cu toata fiinta catre Dumnezeu, catre Adevarul cel mai Inalt. Astazi sunt recunoscatoare pentru toate darurile pe care le-am primit si dau Slava lui Dumnezeu pentru toate!
Parintele Arsenie Boca ne transmite o pilda foarte frumoasa legata de aceste trairi, mesajul acesteia fiind raspunsul lui Dumnezeu la rugaciunile noastre.
"Un om dormea in coliba lui, cand dintr-odata, intr-o noapte, camera s-a umplut de Lumina si i-a aparut Dumnezeu. Domnul i-a cerut sa faca o munca pentru el si i-a aratat o stanca mare din fata colibei. I-a explicat ca va trebui sa impinga piatra zilnic, cu toate puterile sale, ceea ce omul a si facut.
Multi ani a muncit din greu, de la rasaritul la apusul soarelui, impingea din toate puterile, cu umerii proptiti pe suprafata masiva si rece a stancii de neclinitit. In fiecare noapte barbatul se intorcea trist si istovit in coliba lui, simtind ca intreaga zi a irosit-o degeaba.
Tocmai cand barbatul era mai descurajat, "adversarul" (Satana) a decis sa-si faca aparitia in gandurile plicitisite ale acestuia : - De atata timp impingi piatra si ea nici nu s-a clintit.
Asa incat omul a ramas cu impresia ca sarcina lui este imposibil de realizat si ca toata munca lui va fi un esec. Aceste idei l-au deprimat si descurajat pe barbat. "Adversarul" i-a spus: - De ce te distrugi singur pentru asta? Petrece-ti timpul facand doar un efort minim si te vei simti mai bine.
Barbatul ostenit tocmai asa isi propusese sa faca, dar inainte de asta a decis sa se roage si sa-si spuna pasul lui Domnului. - Doamne, a spus, am muncit mult si greu pentru Tine, adunandu-mi toate puterile sa fac ce mi-ai cerut. Acuma, dupa atata timp, nu am reusit sa misc piatra nici cu jumatate de milimetru. Cu ce am gresit? De ce am esuat?"
Domnul i-a raspuns intelegator:
- Prietene, cand ti-am cerut sa-mi slujesti si tu ai acceptat, ti-am spus ca sarcina ta era sa impingi cu toate puterile in stanca, ceea ce ai si facut. Niciodata nu am spus ca astept ca tu sa o misti. Sarcina ta era doar sa impingi. Si acum vii la Mine obosit spunand ca ai esuat. Dar chiar asta e realitatea??? Priveste la tine… Bratele iti sunt puternice si musculoase, spatele e vanjos si bronzat, mainile iti sunt batatorite de atata apasare, picioarele ti-au devenit solide si puternice. Te-ai dezvoltat mult si capacitatile tale sunt peste ce te-ai fi putut astepta sa ai. Adevarat, nu ai miscat stanca. Dar vocatia ta a fost sa ma asculti si sa impingi, ca sa-ti pui la incercare credinta si increderea in intelepciunea Mea. Ceea ce ai si facut. Acum Eu, prietene, voi muta stanca.
"
Cateodata, cand auzim cuvantul lui Dumnezeu, avem tendinta sa ne folosim gandirea pentru a descifra ce vrea El, cand, de obicei, El nu ne cere decat simpla ascultare si incredere in El. Cu toate ca noi credem ca prin credinta mutam muntii, de fapt tot Dumnezeu este cel care ii muta din loc.
"Dumnezeu nu ne cere minuni. Acelea le face El." – Arsenie Boca

Plesu - non-dilematic

Plesu...non-dilematic, in DILEMA VECHE...

În douã dintre Evanghelii (Matei si Luca) ni se oferã parabola slujitorului (robului) credincios si întelept. E vorba despre un om care, urmînd sã plece pentru o perioadã de timp nedeterminatã, îl pune pe unul dintre slujitorii sãi, mai mare peste toti ceilalti, cu îndatorirea „sã le dea hranã la timp". Dacã îsi va face treaba constiincios, slujitorul acesta va binemerita, la întoarcerea stãpînului, sã fie pus „peste toate avutiile sale". Dacã nu, dacã se va comporta asemenea unui vãtaf brutal si se va lãsa ademenit de plãcerile sefiei, slujitorul va plãti cu viata si cu sufletul (va fi „despicat în douã" – spune textul – si azvîrlit în iad, laolaltã cu fãtarnicii).
Ca toate parabolele, si aceasta are mai multe straturi de înþeles. E o referintã la Judecata de Apoi, la venirea (de neanticipat) a lui Dumnezeu, la datoria de a fi pregãtit, clipã de clipã, pentru „evaluarea" finalã. Adresatã ucenicilor, parabola aceasta spune însã ceva si despre oficiul încredintat de Dumnezeu preoþilor. Ei sînt „pusi" (adicã au un „mandat", o „delegatie") sã pãstoreascã comunitatea semenilor lor în intervalul, saturat de asteptare, dintre ziua de azi si ziua Judecãtii. Esential e faptul cã ei nu sînt pusi în postura unor cãpetenii severe, a unor distribuitori de porunci, a unor „stãpîni". Ceea ce li se cere e sã dea hranã la timp celor pe care îi pãstoresc, adicã sã le fie de folos, sã-i slujeascã, sã-i gospodãreascã, sã le întretinã metabolismul spiritual. Atît. „Stãpînul" nu le-a încredintat, cu alte cuvinte, rolul sãu, ci i-a fãcut „mai mari" într-o activitate subalternã: nobilã, de neînlocuit, dar auxiliarã. A operat, asadar, un transfer, temporar, de responsabilitate. Cei care înteleg acest transfer drept legitimare personalã, drept „electiune" care îndeamnã la stãbie arbitrarã si vanitoasã, vor cãdea în pãcatul fãtãrniciei si vor fi evacuati.
Parabola aceasta îmi vine în minte ori de cîte ori slujitorii Bisericii mele alunecã spre triumfalism, suficientã, mîndrie lumeascã si eficientã lucrativã. Cînd aud, de pildã, cã un preot din Ardeal, lîngã corpul neînsufletit al unui enorias (întîmplãtor un mare poet), comunicã apropiatilor cã defunctul e în urmã cu plata cotizatiei parohiale. Sau cînd vãd, cum am vãzut cu ceva timp în urmã, un alt preot snopindu-l în bãtaie pe unul dintre reprezentantii turmei sale. De asemenea, cînd unele publicatii religioase sau posturi de televiziune „de profil" adoptã tonul si limbajul discursului omagial. O sumedenie de parohi si teologi vorbesc despre „Biserica noastrã" cum vorbeau activistii de pe vremuri despre partid, sau cum vorbesc gaitele patriotice despre tãrisoarã: exaltat, encomiastic, lacrimogen. Triste probe de slavã desartã. Ca si cum rostul Bisericii pe lume ar fi sã-si facã chip cioplit, sã se înalte pe sine, iar rostul slujitorilor ei – sã-si înfloreascã portretul. Stiu cît de antipatic devin, pentru unii, spunînd astfel de lucruri. Dar, în fond, sînt parte a acestei Biserici si pot fi mîhnit de unele semne de nevrednicie, asa cum pot fi bucuros de vredniciile ei. Sînt si eu dintre „robii" care trebuie hrãniti de alti robi, chemati, „sezonier", la dregãtorii veghetoare si slujitoare. Sînt îndreptãtit, deci, sã mã plîng cînd nu-mi primesc hrana „la timp" sau cînd primesc hranã nepotrivitã. Am fost martor, în aceste zile, la aniversarea celor 60 de ani de viatã ai Prea Fericitului Daniel, patriarhul crestinãtãtii românesti. Mã adaug, sincer, celor care i-au spus, cu acest prilej, „La multi si spornici ani!". M-am numãrat, la începutul mandatului sãu, printre cei care s-au bucurat public de ceea ce mi se pãrea o alegere optimã. Îi stiu calitãþile, vigoarea si tenacitatea organizatoricã, zelul. Dar trebuie sã mãrturisesc cã desfãsurarea momentului aniversar m-a întristat. Lucrurile au cãpãtat o turnurã excesivã, pe care Prea Fericitul ar fi putut-o ajusta. Aniversarea în sine era fireascã. Dar stilul ei mi-a amintit de o nu prea fericitã „traditie omagialã" autohtonã. „Album aniversar", „Volum omagial", film documentar realizat de Trinitas, ceremonii ample, discursuri înaripate, texte riscînd idolatria, cînd nu frizau prostul gust (ziarul Lumina a recurs, flasc, la toate cliseele acestui tip de eveniment: Patriarhul s-a nãscut „în zilele fierbinti ale lunii lui Cuptor", la Dobresti, „un sat binecuvîntat de Dumnezeu cu oameni credinciosi". „Încã de la o vîrstã fragedã…" etc. etc.). Nu cred cã asa se sãrbãtoreste un slujitor, un rob al lui Dumnezeu, un om care a ales, prin cãlugãrie, nu doar lepãdarea de lume, ci si lepãdarea de sine. Cei care asmut asupra lui toate hergheliile preamãririi lumesti nu-i fac nici un serviciu.

Bancuri ....

 
*BANCURI  MEDICALE

 
O calugarita tinerica se duce la doctor :
- Doctore, nu pot scapa de sughit , ma chinuie de 5 zile !!!
Doctorul o consulta rapid  si-i spune :
- Esti  insarcinata  !!!!!!!!
Calugarita se intoarce la manastire si comunica plangand verdictul.....
A doua zi stareta se adreseaza doctorului :
- De ce i-ati spus asta calugaritei noastre ?
- Am vrut  sa o sperii si sa scape de sughit ...
- Cel care s-a speriat a fost episcopul, s-a aruncat din turn !!!   
 
 
 
 
 
 
La un cabinet stomatologic particular,  o doamna din lumea buna :
- Cum?  300 Ron  pentru extractia unei masele?
       Doar pentru 5 minute de munca?
- Daca doriti, o extrag intr-o ora !
 
 
 
 
 
 
În sala de operatie, chirurgul striga la  asistent:
-Anestezie  !!!
-De-a noastrã, sau de import?
-De import!
-De import s-a terminat....
-Atunci, de-a noastrã !!!
-Nani, nani...

 
 
Bolnavul:
-Doctore, dupa operatia la amigdale ma doare rau de tot in spate, jos, spre mijloc...insuportabil  !!!!!
-Eh, e normal, sa te doara putin - o vreme  ....   Ti-am scos un rinichi !!!!
-Mie ??????   ,  eu n-aveam probleme cu rinichii  !!!!!
-Oh, stiu, dar aveam eu o obligatie....
 
 
 
 
 
 
Un pacient  slab / palid  merge la medicul care l-a operat de curand cu rezultatul analizelor de  laborator .
Doctorul studiaza si zice:
-Domnule, am doua vesti pentru dumneata: una buna si una rea.
Pe care vrei sa ti-o spun prima?
-Pai....p-aia rea, doctore.
-Cazul dumitale e foarte grav. Practic mai ai de trait cateva zile.
-Si vestea buna?
-Ai venit la timp ! De maine spitalul se transforma in azil ..........
 
 
 
 
O doamnã intrã in  farmacie si îi cere farmacistului un flacon cu arsenic. Farmacistul intrigat întreabã:
- Doamnã, la ce vã trebuie arsenicul?
- Vreau  sã-l omor pe sosul meu!
- Doamnã, nu pot sã vã vînd arsenic pentru acest motiv, îmi pare rãu,
spune farmacistul.
Atunci doamna scotoceste zgomotos  în posetã si scoate o fotografie cu sotul ei care fãcea dragoste cu sotia farmacistului.
Acesta se uitã la fotografie si spune:
- Ah, scuzati-mã, n-am stiut cã aveti retetã.....
 
 
 
 
 
 
La consultatie medicul ii spune pacientului:
-Nu-mi place deloc cum arati! Cred ca ai deja o grava afectiune pulmonara.
Cate tigari mai fumezi?
-10, cate mi-ati prescris ! Nici una mai mult ....
-Si inainte cate fumai?
-Inainte nu fumam deloc .........
 
 
 
 
 
O prostituata  consultata  la ginecolog... Acesta o intreaba: 
- Domnisoara, aveti pierderi mari in timpul menstruatiilor?
- Ei, as!... Cinci-sase  sute de euro!...
 

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