RESUMO
OBJECTIVE: Hyponatremia is the most common electrolyte imbalance encountered in clinical practice and is associated with negative healthcare outcomes and cost. SIADH is thought to account for one third of all hyponatremia cases and is typically an insidious process. Psychotropic medications are commonly implicated in the etiology of drug induced SIADH. There is limited guidance for clinicians on management of psychotropic-induced SIADH. METHODS: After an extensive review of the existing literature, clinical-educators from the Association of Medicine and Psychiatry developed expert consensus recommendations for management of psychotropic-induced SIADH. A risk score was proposed based on risk factors for SIADH to guide clinical decision-making. RESULTS: SSRIs, SNRIs, antipsychotics, carbamazepine, and oxcarbazepine have moderate to high level of evidence demonstrating their association with SIADH. Evaluation for an avoidance of medications that cause hyponatremia is particularly important. Substitution with medication that is less likely to cause SIADH should be considered when appropriate. We propose an algorithmic approach to monitoring hyponatremia with SIADH and corresponding treatment depending on symptom severity. CONCLUSIONS: The proposed algorithm can help clinicians in determining whether psychotropic medication should be stopped, reduced or substituted where SIADH is suspected with recommendations for sodium (Na+) monitoring. These recommendations preserve a role for clinical judgment in the management of hyponatremia with consideration of the risks and benefits, which may be particularly relevant for complex patients that present with medical and psychiatric comorbidities. Further studies are needed to determine whether baseline and serial Na+ monitoring reduces morbidity and mortality.
Assuntos
Hiponatremia , Síndrome de Secreção Inadequada de HAD , Psiquiatria , Consenso , Humanos , Hiponatremia/induzido quimicamente , Hiponatremia/terapia , Síndrome de Secreção Inadequada de HAD/induzido quimicamente , Psicotrópicos/efeitos adversosAssuntos
Dissuasores de Álcool/uso terapêutico , Alcoolismo/reabilitação , Transtornos Disruptivos, de Controle do Impulso e da Conduta/reabilitação , Jogo de Azar/psicologia , Taurina/análogos & derivados , Acamprosato , Alcoolismo/psicologia , Antidepressivos de Segunda Geração/uso terapêutico , Comorbidade , Cicloexanóis/uso terapêutico , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/reabilitação , Transtornos Disruptivos, de Controle do Impulso e da Conduta/psicologia , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Taurina/uso terapêutico , Resultado do Tratamento , Cloridrato de VenlafaxinaAssuntos
Antipsicóticos/uso terapêutico , Casas de Saúde , Padrões de Prática Médica , Feminino , Humanos , MasculinoAssuntos
Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Hemospermia/induzido quimicamente , Propilaminas/efeitos adversos , Adulto , Cloridrato de Atomoxetina , Esquema de Medicação , Humanos , Masculino , Metilfenidato/uso terapêuticoAssuntos
Derivação Gástrica/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Transtornos Psicóticos/diagnóstico , Doença Aguda , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/etiologia , Transtornos Psicóticos/etiologia , Redução de Peso , Encefalopatia de Wernicke/diagnóstico , Encefalopatia de Wernicke/etiologiaRESUMO
Psychopharmacology is widely used in the treatment of borderline personality disorder. However, support for this form of treatment has been largely based on case reports, case series, and open-label clinical trials. This evidence-based review examines the most recent randomized controlled trials of psychopharmacology in the treatment of borderline personality disorder, with a goal of highlighting the most promising pharmacotherapy for use in current clinical practice, as well as for future large-scale research testing. The results and limitations of the randomized controlled trial data are presented along with case vignettes illustrating the complexity of the disorder and the heterogeneity of its treatment. To date, there is at least some evidence-based support for the use of antipsychotics (conventional and atypical), monoamine oxidase inhibitors, serotonin reuptake inhibitors, and omega-3 fatty acids in the treatment of borderline personality disorder.