The challenges of clinical psychopharmacological management.

Collaboration among health care providers in the treatment of mental health patients with comorbid medical and neurological conditions can be very challenging, especially with pharmacotherapy management where medications are prescribed by multiple providers. An individual example of a patient with a number of comorbid conditions taking multiple concurrent medical and psychotropic medications is described to highlight how challenging such situations can be. Medical conditions or medical medications might trigger or exacerbate symptoms of mental disorders. Psychotropic drugs may cause adverse effects that come to the attention of medical providers. Accurate communication among providers-and between the patient and providers-is important to avoid misinformation or misunderstandings in the care of patients with complicated problems.

Diagnóstico bioquímico de la hiperprolactinemia monometrica / Biochemical diagnosis of monomeric hyperprolactinemia

Fundamento. La prolactina se puede presentar bajo varias formas moleculares siendo la forma monométrica (PRLm) la biológicamente activa. La presencia de macroprolactina (MPRL) puede originar un falso diagnóstico de hiperprolactinemia debido a la interferencia en el procedimiento de medida. El objetivo ha sido desarrollar un protocolo que permita diagnosticar la hiperprolactinemia monométrica, que además sea complementario al procedimiento que detecta MPRL. Material y métodos. La población de referencia para PRLm estaba formada por 122 mujeres y 140 hombres aparentemente sanos a los que se les extrajo sangre para la cuantificación de PRL. Además, se recogieron49 sueros (33 mujeres y 16 hombres) hiperprolactinémicos. Se cuantificó PRL en todas las muestras en un Immulite 2000. La detección de MPRL y de PRLm se realiza tras precipitación con polietilenglicol. Se confirmó el resultado por cromatografía de filtración en gel. Para la obtención de los valores de referencia se siguieron las indicaciones del Panel de Expertos de la IFCC. Resultados. Los valores de referencia de PRLm fueron 3,4-26,6 ¦Ìg/L y 4,6-16,4 ¦Ìg/L en mujeres y varones, respectivamente. De los 49 pacientes hiperprolactinémicos, en el57 % la concentración de PRLm tras PEG se encontraba fuera del intervalo de referencia previamente obtenido, confirmándosela presencia de hiperprolactinemia monométrica. Conclusiones. Se ha desarrollado e implantado un protocolo para la cuantificación de PRLm. La obtención del os valores de referencia de PRLm permite el diagnóstico de la hiperprolactinemia monométrica o activa de forma complementaria a la identificación de MPRL (AU)

Background. Prolactin can take several molecular forms of which the most biologically active is the monomericform (PRLm). The presence of macroprolactin (MPRL) can give rise to a false diagnosis of hyperprolactinemia due to interference in the measuring procedure. The aim was to develop a protocol that enables diagnosis of monomeric hyperprolactinemia, which should also be complementary to the procedure for detecting MPRL. Material and methods. The reference population for PRLm was made up of 122 healthy women and 140healthy men, from whom blood was extracted for PRL quantification. Additionally, 49 hyperprolactinemic serums (33 women and 16 men) were collected. PRL was quantified in all the samples in an Immulite 2000.The detection of MPRL and PRLm was carried out following precipitation with polyetylenglicol (PEG). The result was confirmed by gelatin filtration chromatography. The reference values were obtained following theindications of the Expert Panel of the IFCC. Results. The PRLm reference values were 3,4-26,6¦Ìg/L and 4,6-16,4 ¦Ìg/L in women and men, respectively. In 57% of the 49 hyperprolactinemic patients the concentration of PRL m following PEG fell outside the previously obtained reference interval, confirming the presence of monomeric hyperprolactinemia. Conclusions. A protocol for quantifying PRL m has been developed and implemented. Obtaining PRLm reference values makes it possible to diagnose monomeric oractive hyperprolactinemia in a complementary form to the identification of MPRL(AU)