RESUMO
COMMON PHYSICAL HEALTH PROBLEMS IN PSYCHIATRY. Somatic psychiatric care is particularly important as life expectancy declines of 13 to 16 years among individuals with severe mental disorders, primaly due to cardiovascular and cancer-related diseases. They face a triple burden: their mental disorders, reduced life expectancy and limited healthcare access. Common comorbidities related to psychotropic medications, lifestyle and the mental condition itself, affect various organs with complex clinical expressions. The multidimensional vulnerability is attributable to the side-effects of psychotropic drugs, mental disorders, and healthcare system fragmentation, hindering access to care. The proposed solutions aim for a better integration of mental health into general healthcare, with increased awareness among caregivers for a holistic approach to health.
PROBLÈMES COURANTS DE SANTÉ PHYSIQUE EN PSYCHIATRIE. Les soins somatiques en psychiatrie revêtent une importance particulière en raison de la réduction de treize à seize ans de l'espérance de vie chez les personnes atteintes de troubles mentaux sévères, principalement à cause de pathologies cardiovasculaires et cancéreuses. Elles sont exposées à une triple peine : leurs troubles psychiques, la réduction de leur espérance de vie et un accès limité aux soins. Les comorbidités courantes, liées aux psychotropes, au mode de vie et à la pathologie mentale elle-même, touchent divers organes, avec des expressions cliniques complexes. La vulnéra bilité multidimensionnelle de ces patients est attribuable aux effets indésirables des psychotropes, aux troubles psychiques et au cloisonnement du système de santé nuisant à l'accès aux soins. Les solutions proposées visent une meilleure intégration du volet santé mentale dans les soins généraux, avec une sensibilisation accrue des soignants à une approche holistique de la santé.
Assuntos
Transtornos Mentais , Humanos , Transtornos Mentais/terapia , Psicotrópicos/uso terapêutico , Psicotrópicos/efeitos adversos , Doenças Cardiovasculares , Comorbidade , Neoplasias/complicaçõesRESUMO
BACKGROUND: Blood transfusion is the cornerstone treatment to reduce the clinical severity of sickle cell disease (SCD), but we need to maintain the haematocrit (Hct) within an acceptable range to avoid a deleterious increase in blood viscosity. The aim of this study was to compare the effects of manual versus automated red blood cell (RBC) Exchange on haematological parameters and blood viscosity. STUDY DESIGN AND METHODS: This prospective, single-centre, open nonrandomized observational study included forty-three sickle cell patients: 12 had automated RBC Exchange and 31 manual RBC Exchange. Samples were collected in EDTA tubes just before and within one hour after the end of the RBC Exchange to measure the haematological parameters and blood viscosity. RESULTS: Both automated and manual RBC Exchange decreased haemoglobin S levels and leucocyte and platelet counts, but the decrease was greater for automated RBC Exchange. Manual RBC Exchange caused a significant rise in haematocrit and haemoglobin levels and did not change blood viscosity. In contrast, automated RBC Exchange decreased blood viscosity without any significant change in haematocrit and only a very slight increase in haemoglobin levels. The change in blood viscosity correlated with the modifications of haematocrit and haemoglobin levels, irrespective of the RBC Exchange procedure. When adjusted for the volume of RBC Exchange, the magnitude of change in each biological parameter was not different between the two procedures. CONCLUSION: Our study demonstrates that the automated RBC Exchange provided greater haematological and haemorheological benefits than manual RBC Exchange, mainly because of the higher volume exchanged, suggesting that automated RBC Exchange should be favoured over manual RBC Exchange when possible and indicated.
