Folks,
We were pleased to be in Miami this past weekend to see the coronation of Carol Alter , who many of you know, as the new President of the Academy of Psychosomatic Medicine . She follows “Ketsos” Lyketsos who many of you know.
In a study reported at the Academy, giving olanzapine 5 mg wafer just prior to orthopedic surgery and again soon after hip and knee surgery [i.e., 5 mg twice in the same day] in 1] pts who have had delirium in the past or 2] who were > 65 years old found: 40% of those on placebo developed delirium and 14% of those receiving olanzapine developed delirium. The olanzapine pts had some cognitive dulling. The authors pointed out that the study doesn’t clarify which olanzapine dose level is best and doesn’t preclude another antipsychotic doing as well. Olanzapine was selected because it is in wafers and has so few EP signs. Also, knee replacement was found to more likely produce delirium than hip.
At the Academy, another study found that exercise reduces the incidence of cognitive impairment in the elderly, mild exercise did better than none, and moderate did better than mild, but in this study intense exercise did worst. This last finding was attributed to that portion of the sample having such a small N, so no excuse to avoid intense because of this study.
Eli Lilly continues to fund studies on the usefulness of duloxetine: Use of 60 to 120 mg/d for osteoarthritis was effective in reducing knee pain without significant side effects in comparison to placebo, but placebo did have fewer drop outs.
A review in last week’s JAMA as to the40thies anniversary of methadone maintenance notes that the
results have been very positive for those remaining on the maintenance, 60-120 mg/d, but the results have been disappointing as to the ability to cease at some point. About 0.1% of the population is on methadone maintenance. Buprenorphine is facing the=2 0same issue. Not easy to cease, but I gather in general, within the County’s private sector, there are many who are willing to take buprenorphine indefinitely.
In next week’s JAMA, another article on the relationship between depression and cardiovascular events. This article suggests that the association is a function of lack of physical exercise, although not pointing to what is causing what, since physical exercise decreased both the occurrence of depression and cardiovascular events, “increase activity has the potential to reduce the excess risk of cardiovascular events associated with depressive symptoms in pts with stable coronary heart disease.”
Last week’s media had articles saying that antipsychotics were being over-prescribed by psychiatrists for children – and that the FDA should do more to discourage psychiatrists from doing so. The FDA indicated that they were limits to what they could do, and said that specialty organizations should address this issue through their educational efforts. While the FDA should certainly not be allowed to duck their responsibilities, I do agree that APA should feel responsible for explicating the treatment of people with psychiatric illnesses, a major reason I’m running for APA President this year as motions over the past years have not made as much progress as we would like to see on this issue. To AACAP’s credit, they immediately sent a letter to the NY Times pointing out that their
Practice Parameters addressed the issue adequately.
As most of you saw, Bethesda ’s Fred Goodwin got some space in the media for payments of more than a million over a number of years from pharm firms, while conducting his award-winning Public Radio program. To his credit, unlike some others who Senator Grassley has attacked, Fred agreed immediately to an interview by the NY Times. Given it was so clear to many in the field that Fred was giving talks supported by pharm firms, it was surprising to read that his Public Radio boss was unaware
Roger Peele, MD
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