ABSTRACT
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss the diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.Prim Care Companion CNS Disord 2024;26(3):23f03684. Author affiliations are listed at the end of this article.
Subject(s)
Mental Disorders , Humans , Mental Disorders/therapy , Disabled PersonsSubject(s)
COVID-19 , Hotlines , Mental Health , Preventive Medicine , Self-Help Groups , Students, Medical , Telemedicine , Education, Distance , Education, Medical, Undergraduate , Humans , Mental Disorders/diagnosis , Mental Disorders/therapy , Physical Distancing , Primary Health Care , SARS-CoV-2 , Social Isolation , TelecommunicationsABSTRACT
A 45 year old executive presents to your office for risk assessment after learning that his sister required an ascending aortic aneurysm repair. He is a well-informed man, concerned about his personal risk for aortic disease, and undergoes a cardiac screen which reveals a dilated ascending aortic aneurysm, measuring a maximal diameter of 4.4 cm. His aortic valve is tricuspid. He is non-Marfanoid and asymptomatic. He realizes that he does not yet meet guideline criteria for aortic surgery, but he is also cognizant of the fact that he is approaching the cut-off for surgical intervention. He wishes to minimize his future risk of aortic rupture, dissection and aortic expansion and seeks your input. Should 'medical treatment' should be employed at this stage? Is there sufficient basis to initiate any form of pharmacotherapy? Would you start a beta-adrenergic receptor blocker, an angiotensin receptor blocker, a matrix metalloproteinase inhibitor (doxycycline), or a statin to reduce his aortic risk for rupture, dissection or need for surgical repair? Does your clinical decision match evidence from existing data? Our paper will address these issues among other questions relevant to the role of medical therapy for thoracic aortic disease.
Subject(s)
Aortic Aneurysm, Thoracic/drug therapy , Cardiovascular Agents/therapeutic use , Aortic Aneurysm, Thoracic/diagnosis , Cardiovascular Agents/adverse effects , Evidence-Based Medicine , Humans , Male , Middle Aged , Patient Selection , Practice Guidelines as Topic , Risk Assessment , Risk Factors , Treatment OutcomeABSTRACT
Since 1994, when a small 70-patient study seemed to demonstrate that ß-blocker treatment could help prevent aortic aneurysms in patients with Marfan syndrome, ß-adrenergic-blocking drugs have been increasingly believed to reduce the progression of aortic aneurysms in the general population with aortic disease. This literature review examines the scientific evidence of this treatment and questions whether ß-blocker treatment for aortic aneurysms should continue to be uniformly recommended. Five separate clinical trials studying the effects of ß-blockade therapy in patients with Marfan syndrome are analyzed, in addition to four other clinical trials studying the effects of ß-blockade therapy in patients without Marfan syndrome. The analysis suggests that the scientific evidence for ß-blocker treatment is unconvincing, because ß-blockade therapy fails to consistently reduce aortic aneurysm growth in patients with or without Marfan syndrome. It is alarmingly clear that prospective, multicenter clinical trials are greatly needed to test the efficacy of this now conventional therapy in a more robust scientific fashion.
