Treatment of fibromyalgia.

In this article, we investigate the range of treatments prescribed for fibromyalgia. The data suggest that the majority of those treated, 72 percent, receive only one pharmaceutical. An additional 18 percent of patients were prescribed two products and 10% received three products. Pregabalin (Lyrica(R)) monotherapy was the most commonly prescribed regimen (28% of patients) followed by duloxetine (Cymbalta(R)) monotherapy (6%). From a therapeutic class perspective, fibromyalgia patients received pain therapies (42%), antiepileptics (40%), antidepressants (28%), muscle relaxants (14%), and sleep agents (8%). An expert commentary is also included.

Mifepristone, a glucocorticoid antagonist for the potential treatment of psychotic major depression.

Corcept Therapeutics Inc is developing mifepristone (as C-1073, Corlux), an orally available progesterone and glucocorticoid antagonist originally launched as an abortifacient by Aventis Pharma AG, for the potential treatment of the psychotic features of psychotic major depression (PMD) and for Alzheimer's disease (AD). In August 2004, a pivotal phase III trial was initiated in the US for psychotic features of PMD, a second trial began in October 2004 and these were followed by a European phase III trial in May 2005. However, in August 2006, September 2006 and March 2007, respectively, these phase III trials failed to meet their endpoints. A further phase III trial was to commence later in 2007. By August 2006, Corcept expected to file an NDA for PMD in 2007. In addition, in March 2005 a phase II study of mifepristone as a cognitive enhancer in AD was underway, and in May 2006 a proof-of-concept study in alleviating the weight gain associated with olanzapine had begun.

Diabetic ketoacidosis among patients receiving clozapine: a case series and review of socio-demographic risk factors.

BACKGROUND: Diabetic ketoacidosis (DKA) has been associated with clozapine. The purpose of this study is to examine the clinical-demographic correlates of DKA among outpatients receiving clozapine. METHODS: A literature search was conducted from 1966 to present using Medline to identify 23 case reports of clozapine-associated DKA. In addition, a cohort of twenty-six patients with clozapine-associated diabetes at the University of Rochester Medical Center Department of Psychiatry were examined for histories of DKA through review of medical records. Based on a total sample of 26 case reports including three unpublished cases at University of Rochester, associations between clinical and demographic variables and DKA were examined. RESULTS: African American patients were significantly more likely than other patients to have DKA (p < 0.0001). Clozapine treatment duration was significantly shorter among patients with DKA than those without DKA (p < 0.0001), with 61.5% of patients developing DKA within three months of clozapine initiation. Also, presence of antidiabetic medications was negatively correlated with DKA (p < 0.0001). Trends were noted toward an association between low doses of clozapine (p < 0.0583) and toward a negative association between family history of diabetes (p < 0.0696). CONCLUSION: Clozapine is associated with DKA that usually presents in patients who have not previously been diagnosed with diabetes. DKA typically occurs early in the course of treatment, when clozapine treatment duration is short and doses are low.

How should psychiatrists dress?--a survey.

Personal attire is an important part of being a professional. This survey is an attempt to determine the patient's and psychiatrists view point about how a psychiatrist should dress to work. A human subjects research board approved survey of seven questions was offered to patients and a similar survey of nine questions was offered to psychiatrists. The replies obtained were combined and tabulated. One hundred patients and 77 psychiatrists responded to the survey. Both the patients and psychiatrists considered dress to be an important part of the doctor-patient relationship. The psychiatrists appear to be more concerned and critical about their dress as compared to patients.

Fibromyalgia-: a review for the psychiatrist.

UNLABELLED: This paper is a review article that collects and synthesizes up-to-date information about the complex etiological theories and treatment regimens associated with Fibromyalgia. The authors have written the paper in an evidence-based model in order to show the reader where adequate data exist in regards to these pharmacological, psychological, and physical strategies. A thorough MEDLINE search was utilized to collect many papers dedicated to this topic spanning 1970-2005. MEASUREMENTS: The relevant papers were divided, based upon intervention used for the treatment of FM (pharmacological vs. non-pharmacological). They were also divided based on their scientific merit; randomized controlled trials were given the most evidence-based weight and the case studies the least. RESULTS: The authors first review current epidemiologic and etiologic theories regarding fibromyalgia. A formal literature review is next presented to allow the reader to understand the evidence base that supports treatment of this disorder. In conclusion, a commentary regarding the treatment of this disorder in psychiatric practice occurs where pharmacodynamics and management strategy is discussed. CONCLUSION: There is much literature available regarding treatment of fibromyalgia. This complex illness has reasonable controlled studies for monotherapy treatments; however, multimodal treatments are the usual norm.

Neuroleptic Malignant Syndrome: A Primary Care Perspective.

In recent years, there has been an increased use of neuroleptic agents in the primary care setting. Neuroleptic malignant syndrome (NMS) is a rare complication of neuroleptic therapy that can be missed if not suspected. This manuscript reviews the diagnosis and management of NMS in the primary care setting. There is a lack of prospective data, and most of the information is obtained from case series. Physicians need to have a high index of suspicion with regard to excluding NMS in patients taking neuroleptics and presenting with hyperthermia.

Medical screening in the emergency department for psychiatric admissions: a procedural analysis.

Patients who are admitted to psychiatric inpatient wards often undergo a medical screening examination in the emergency department to rule out serious or underlying medical conditions that may be better treated elsewhere. Unfortunately, prior research has been conflicting on the relative merits of various screening procedures, making it difficult to implement guidelines. A systematic review of the literature was undertaken to research the current state of knowledge in medical screening procedures. Electronic searches were conducted in PubMed, MEDLINE, and the Cochrane Library for publication years 1966-2003. No restrictions were placed on language or on quality of publications. Twelve studies were found that reported specific yields of various screening procedures. Results indicate that medical history, physical examination, review of systems, and tests for orientation have relatively high yields for detecting active medical problems in patients presenting with psychiatric complaints. Routine laboratory investigations generally have a low yield for clinically significant findings. However, these should be added selectively for four groups at higher risk of serious medical conditions, i.e., the elderly, substance users, patients with no prior psychiatric history, and patients with preexisting medical disorders and/or concurrent medical complaints.