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PURPOSE OF REVIEW: It is necessary, in every-day clinical life when treating pregnant women with mental diseases, to reach quick decisions derived from recent comprehensive information. The knowledge of the use of antipsychotics in pregnancy has increased considerably in the last years. This review tries to summarize important considerations and facilitate clinical decisions. RECENT FINDINGS: This review will cover not only the effects of exposure during pregnancy on outcomes, postnatal adaption syndrome and lactation, but also pharmacokinetic considerations on the use of antipsychotics during pregnancy. SUMMARY: The recent publications have found only minimally increased risks for certain malformations, after using ever more sophisticated statistical models of analysis and reassuring amounts of data. Taken together, the quality of the studies has greatly improved and the results are reassuring with respect to the safety of the use of antipsychotics during pregnancy. The rates of weight gain and gestational diabetes warrant closer attention in the clinical setting.
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Antipsicóticos/efectos adversos , Lactancia Materna , Desarrollo Infantil/efectos de los fármacos , Enfermedades del Recién Nacido/inducido químicamente , Complicaciones del Embarazo/tratamiento farmacológico , Esquizofrenia/tratamiento farmacológico , Adulto , Antipsicóticos/farmacocinética , Femenino , Humanos , Lactante , Recién Nacido , EmbarazoRESUMEN
OBJECTIVE: Little is known about the prevalence and correlates of eating disorders (ED) in middle-aged women. METHOD: We mailed anonymous questionnaires to 1,500 Austrian women aged 40-60 years, assessing ED (defined by DSM-IV), subthreshold ED, body image, and quality of life. We broadly defined "subthreshold ED" by the presence of either (1) binge eating with loss of control or (2) purging behavior, without requiring any of the other usual DSM-IV criteria for frequency or severity of these symptoms. RESULTS: Of the 715 (48%) responders, 33 [4.6%; 95% confidence interval (CI): 3.3-6.4%] reported symptoms meeting full DSM-IV criteria for an ED [bulimia nervosa = 10; binge eating disorder = 11; eating disorder not otherwise specified (EDNOS) = 12]. None displayed anorexia nervosa. Another 34 women (4.8%; CI: 3.4-6.6%) displayed subthreshold ED. These women showed levels of associated psychopathology virtually equal to the women with full-syndrome diagnoses. DISCUSSION: ED appear common in middle-aged women, with a preponderance of binge eating disorder and EDNOS diagnoses as compared to the "classical" diagnoses of anorexia and bulimia nervosa. Interestingly, middle-aged women with even very broadly defined subthreshold ED showed distress and impairment comparable to women with full-scale ED.
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Imagen Corporal/psicología , Trastornos de Alimentación y de la Ingestión de Alimentos/epidemiología , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Calidad de Vida/psicología , Adulto , Austria/epidemiología , Índice de Masa Corporal , Intervalos de Confianza , Interpretación Estadística de Datos , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Trastornos de Alimentación y de la Ingestión de Alimentos/clasificación , Trastornos de Alimentación y de la Ingestión de Alimentos/diagnóstico , Femenino , Humanos , Persona de Mediana Edad , Prevalencia , Psicometría , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Latissimus dorsi flap breast reconstruction is associated with a high incidence of donor site seromas. After using several preventive operative techniques, we were able to reduce postoperative complications in a standard operation procedure. The aim of this study was to evaluate the effect of various risk factors related to incidence, volume and frequency of seroma aspiration. METHODS: A retrospective review of 87 latissimus dorsi breast reconstructions over a 10-year period was carried out. Associations between potential risk factors and outcome (total drainage volume, number of aspirations and total seroma volume) were investigated on a descriptive level by means of correlation analysis and on an analytical level by multiple linear regression analysis. RESULTS: Correlation analysis showed that co-morbidity and higher body mass index (BMI, in kilograms per square metre) were associated with larger seroma volumes. BMI remained a significant risk factor also after adjustment for other co-variates (p<0.001, linear regression). Moreover, patients receiving selective serotonin reuptake inhibitors (SSRIs) presented significantly higher seroma volumes (p=0.047, linear regression). At a trend level (p<0.1), post-operative hypertension, lower Ca ± - levels and a reduction in haemoglobin levels (before vs. after operation) were also associated with larger seroma volumes. DISCUSSION: This study, besides observing the effects of well-established risk factors such as age, BMI and surgical operation techniques, identified new risk factors, in particular the perioperative use of SSRIs and the calcium balance, which should be considered in patients in pre- and postoperative care.
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Mamoplastia/efectos adversos , Músculo Esquelético/cirugía , Seroma/epidemiología , Colgajos Quirúrgicos/efectos adversos , Donantes de Tejidos/estadística & datos numéricos , Adulto , Distribución por Edad , Neoplasias de la Mama/cirugía , Neoplasias de la Mama Masculina/cirugía , Estudios de Cohortes , Drenaje/métodos , Femenino , Estudios de Seguimiento , Rechazo de Injerto , Supervivencia de Injerto , Humanos , Incidencia , Modelos Lineales , Masculino , Mamoplastia/métodos , Mamoplastia/estadística & datos numéricos , Persona de Mediana Edad , Análisis Multivariante , Músculo Esquelético/irrigación sanguínea , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Seroma/etiología , Seroma/terapia , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/estadística & datos numéricos , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: The aim of the study is to examine eating behavior and body attitude in elderly women. METHOD: A randomly selected nonclinical sample of 1,000 women, aged 60-70 years, was contacted for our questionnaire survey covering current eating behavior, weight history, weight control, body attitude, and disordered eating (DSM-IV). RESULTS: The 475 (48%) women included in our analyses had a mean BMI of 25.1 but desired a mean BMI of 23.3. More than 80% controlled their weight and over 60% stated body dissatisfaction. Eighteen women (3.8%; 95% confidence interval: 2.3-5.9%) met criteria for eating disorders (ED; N = 1 anorexia nervosa, N = 2 bulimia nervosa, and N = 15 EDNOS) and 21 (4.4%) reported single symptoms of an ED. CONCLUSION: Although EDs and body dissatisfaction are typical for young women, they do occur in female elderly and therefore should be included in the differential diagnosis of elderly presenting with weight loss, weight phobia, and/or vomiting.
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Trastornos de Alimentación y de la Ingestión de Alimentos/epidemiología , Satisfacción Personal , Trastornos Somatomorfos/epidemiología , Factores de Edad , Anciano , Imagen Corporal , Servicios Comunitarios de Salud Mental , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Trastornos de Alimentación y de la Ingestión de Alimentos/diagnóstico , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Femenino , Humanos , Persona de Mediana Edad , Prevalencia , Índice de Severidad de la Enfermedad , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/psicologíaRESUMEN
Six second-generation antipsychotics (SGAs), aripiprazole, clozapine, olanzapine, quetiapine, risperidone and ziprasidone, are currently US FDA approved. The aim of this review is to investigate whether sex differences exist for efficacy and adverse effects of these drugs.Sex-related differences have been shown in the pharmacokinetics of cytochrome P450 (CYP), with a higher activity in females for CYP3A4 and CYP2D6. However, even if there are pharmacokinetic differences between females and males, significantly higher plasma concentrations in women have been demonstrated only for olanzapine and clozapine. To date, sex differences in adverse effects have not been well studied, but some adverse effects such as weight gain, hyperprolactinaemia and cardiac effects are reported to be particularly problematic for women. Most of the studies reviewed indicate that clozapine and olanzapine are associated with greater bodyweight gain than the other atypical antipsychotics, and that serious adverse effects such as metabolic syndrome, which includes increased visceral adiposity, hyperglycaemia, hypertension and dyslipidaemia induced by SGAs, are more frequent in females. According to most studies, the risk for cardiac adverse effects induced by SGAs is the same in male and female patients. Although women are at a lower risk of sudden cardiac death, they have a higher risk of induced long QT syndrome from antiarrhythmic and, probably, antipsychotic drugs. The propensity of sexual dysfunctions is higher with conventional antipsychotics than with SGAs. Additionally, there is some evidence that female sexual dysfunction is associated with high prolactin levels; however, whether the degree of prolactin level elevation is different between female and male patients remains controversial. There is no evidence for sex differences for any of the SGAs to cause a higher rate of extrapyramidal symptoms, acute dystonia or any other movement disturbance. Knowledge of the risks and benefits associated with the use of SGAs during pregnancy and lactation is limited, although the direction of dose adjustments during pregnancy depends on the drug and the enzyme that is responsible for its metabolism. In general, data on sex differences were mostly obtained by posthoc analysis and, therefore, the conclusions that can be drawn are limited. For a better understanding of the basic mechanisms of sex differences, future studies with a primary focus on this topic are required. Data that are more specific will help determine the extent to which these differences will have implications for clinical management.
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Antipsicóticos/efectos adversos , Antipsicóticos/farmacocinética , Femenino , Humanos , Hiperprolactinemia/inducido químicamente , Lactancia , Síndrome de QT Prolongado/inducido químicamente , Masculino , Síndrome Metabólico/inducido químicamente , Embarazo , Factores Sexuales , Torsades de Pointes/inducido químicamente , Aumento de PesoRESUMEN
In this longitudinal study we compared brain volume changes in first- and multiple-episode patients with schizophrenia to normal aging changes observed in healthy control subjects scanned at comparable times. Two to four years after an initial examination including MRI volumetry, we followed up 21 first episode patients, 17 patients after multiple episodes of schizophrenia, and 20 healthy controls. Volumetric measurements of left and right hemispheres, total brain volume, lateral ventricles, hippocampus and amygdala as well as a clinical evaluation were performed. Patients with schizophrenia showed significant ventricular enlargement and volume reduction of the hippocampus-amygdala complex compared with healthy control subjects both at baseline and follow-up. While there were no differences between patients and controls with respect to mean annual volume changes in the measured regions, patients with schizophrenia showed higher between-subject variability in ventricular volume change. These data are consistent with cross-sectional studies demonstrating ventricular enlargement and hippocampal volume deficits in schizophrenia. However, we were not able to demonstrate a difference in the rate of volume changes over time that distinguished patients with schizophrenia from healthy controls for any of the brain structures measured. Drawbacks of the study are that the follow-up was done after a relatively short interval and that there was a difference in time to follow-up and age between patients and controls. Our results do not support the hypothesis that schizophrenia leads to progressive volume reduction in these areas, although there may be a subset of patients with morphologically visible disease progression.
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Encéfalo/anatomía & histología , Imagen por Resonancia Magnética , Esquizofrenia/diagnóstico , Esquizofrenia/rehabilitación , Adulto , Amígdala del Cerebelo/anatomía & histología , Estudios de Seguimiento , Lateralidad Funcional , Hipocampo/anatomía & histología , Hospitalización , Hospitales Psiquiátricos , Humanos , Masculino , Admisión del Paciente/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Resultado del TratamientoAsunto(s)
Antidepresivos Tricíclicos/farmacocinética , Lactancia Materna/estadística & datos numéricos , Depresión Posparto/tratamiento farmacológico , Mianserina/análogos & derivados , Mianserina/farmacocinética , Leche Humana/metabolismo , Adulto , Antidepresivos Tricíclicos/sangre , Antidepresivos Tricíclicos/uso terapéutico , Depresión Posparto/sangre , Femenino , Humanos , Recién Nacido , Mianserina/sangre , Mianserina/uso terapéutico , Leche Humana/química , Leche Humana/efectos de los fármacos , MirtazapinaRESUMEN
BACKGROUND: Recall of autobiographical memories (AM) has shown to predict the course of depression during psychiatric treatment [British Journal of Psychiatry 162 (1993)]; therefore, we assume that AM also predicts the remissive course of depression during detoxification therapy in alcohol dependent men. METHODS: In a longitudinal study, 65 patients were assessed twice: at admission to a detoxification unit and about 3 weeks later for follow-up. AM scores at the beginning of the detoxification program were used as predictors in hierarchical regression analyses. RESULTS: After controlling for initial depression, mental status and degree of alcohol dependence, AM in response to positive and aggressive cue words significantly predicted affective change. These results validate the assumption that AM is a psychological depression marker. LIMITATIONS: No data are reported on depression prior to drinking onset. CONCLUSIONS: As a practical consequence, AM can assist the physician with the decision for concomittant antidepressive therapy during detoxification and rehabilitation of alcohol dependent men.