Folks,
In last month’s Amer. J. Addictions, in detoxifying opioid withdrawal using methadone, adding very low doses of naltrexone [0.125/d o 0.250/d – yes, very low] produced less pt complaints, higher abstinent rates on discharge, and greater participation in aftercare follow-up.
This month’s Psychosomatics reviews paraneoplastic limbic encephalitis, an encephalitis that is thought to be caused by an autoimmune mechanism stimulated by malignancy. About two-thirds of the time, psychiatric signs arise before the pt is known to have a malignancy. Like other etiologically-based psychiatric disorders, the signs are very polymorphic, but the authors do suggest we considered it in patients with an acute-to-subacute dementia. After the neurologist has made the dx, what meds are recommended to address the psychiatric signs? PubMed had not a single paper on that,
so we are on our own.
Yesterday’s JAMA focuses on diabetes, and has two items of interests to us.
1. Later this year, Amer Diabetes Ass is likely recommend that HbA1c become the preferred test for diabetes, in place of fasting glucose. There remains a debate on cutoffs. Some advocate <6.1% = normal, 6.1-6.9% = prediabetes and 7.0% = diabetes.&n bsp;
2. Another article, an editorial, advocates that bariatric surgery for diabetes be seen as effective, not because of fat reduction per se, but be conceptualized as the hormonal changes produced by gastric bypass. This suggests that gastric bypass achieves its diabetic impact independent of obesity, and, thus, could be the treatment of choice in some who are not obese.
Two nonpharmacological interventions appear to be more effective in treating depression and preventing relapse than usual care in patients who have undergone recent coronary artery bypass graft surgery: 1] cognitive-behavior therapy (CBT) and 2] supportive stress management.
As study out of Denmark concluded that clozapine increases the likelihood of infections. From Ann of Intern Med, for smoking, adding SR bupropion 150 mg/d and PRN nicotine oral inhaler added to nicotine patch treatment got better results than the patch alone, although even all three failed in the majority of pts. |
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