Diabetes, Depression and Doctor-Patient Relationship / 당뇨병

Although diabetes mellitus (DM) is treatable, it is still not curable. Its chronicity is associated with a high prevalence of psychiatric disorders, especially depression in type 2 DM and learned helplessness in type 1 DM. In turn, this depression and helplessness may affect a patient's adherence to medical appointments, compliance to treatment, and effective doctor-patient relationships, which are vital to promising outcomes. This study reviews the existing literature regarding the interactional relationships between depression, DM and the doctor/patient relationship, and also suggests certain aspects of the doctor/patient relationship which can contribute to more successful treatment outcomes.

Fluoxetine-induced Acute Toxic Hepatitis / 대한간학회지

Fluoxetine (Prozac ) is a antidepressant that inhibits the reuptake of serotonin in central nervous system, and has lesser adverse effects than the tricyclic antidepressants. The adverse effects of this drug are various, and the most common side effects are headache and nausea. The hepatic injury caused by fluoxetine is reported but very rare and not well known. Literature review has shown only 3 cases of hepatotoxicity from fluoxetine. We regard our case as the first of the hepatotoxicity from fluoxetine in Korea. The patient that we experienced showed normal aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values before fluoxetine administration. 15 days after she took fluoxetine, AST and ALT values were increased and gradually increased as she took fluoxetine daily. We studied about viral hepatitis, metabolic liver disease, and autoimmune liver disease, but the cause of hepatic injury was not established. After the patient stopped to take fluoxetine, AST and ALT values decreased. A liver biopsy showed a moderate infiltration within the portal tracts with lymphocytes and ballooning degeneration of hepatocytes. We concluded fluoxetine-induced acute toxic hepatitis had occured. We must keep in mind that fluoxetine may cause hepatitis without cholestasis and suggest taking liver function tests regularly.