The PD blues | Neurology | 08-2010
Depression is, unfortunately, very common in Parkinson s disease and patients with PD need monitoring for depressive symptoms. Randomized controlled trials of treatment are, however, few and far between. It ...
Best antidepressant with drinks | Psychiatry | 05-2010
There are no anti-depressants which stand out from others in patients with alcohol abuse. As with anyone suffering from depression, you should start with an SSRI. Recent studies have shown ...
Anti-depressant bias | Psychiatry | 05-2010
Treatment refusal is a difficult problem that s somewhat different from simple non-compliance. The reasons may be numerous and they must be explored. Common reasons for not wanting to use ...
ADHD and sleep | Psychiatry | 04-2010
It appears that there s an association between increased sleep disorders in children with ADHD although, as with so many questions, there are very few well-designed studies with solid evidence. ...
Antipsychotics for depression? | Psychiatry | 03-2010
More and more studies are being done on the use of antipsychotics in major depression. The vast majority of these are on the use of atypicals as an augmentation strategy ...
Alternatives for anxiety | Psychiatry | 02-2010
There is a 2009 Cochrane meta-analysis of the use of azapirones in the treatment of anxiety. There aren t enough studies, however, to allow a comparison of buspirone to antidepressants. ...
Best antidepressant in cocaine addiction | Psychiatry | 01-2010
No studies have been done on the differential efficacy of antidepressants in cocaine-induced depression or comorbid depression in cocaine abusers. Studies have been done on the use of antidepressants for ...
Magnesium in migraine | Neurology | 11-2009
The roles of magnesium in cortical spreading depression, neurotransmitter release, and platelet aggregation suggest an involvement in the pathogenesis of migraine. Some studies have found that patients with migraine may ...
Quitting tobacco can be depressing | Psychiatry | 10-2009
Major depression and dysthymia are common illnesses. Incidence among the general population range from 10 15 , some say even higher. There does appear to be a link between smoking ...
What pulls the migraine trigger? | Neurology | 10-2009
Many environmental factors have been reported to trigger headaches in some migraineurs. These include foods rich in nitrites hot dogs, other prepared meats , monosodium glutamate, octopamine, phenylethylamine, or tyramine ...
Vitamin D for a sunny mood | Psychiatry | 09-2009
There are only a few studies that have looked at the relationship between vitamin D and depression, and very few trying to establish whether vitamin D supplementation is helpful. There ...
Seniors with sore feet | Geriatrics | 06-2009
Diabetes mellitus is certainly the commonest cause of peripheral neuropathy causing burning feet. But this symptom can occur with many other peripheral neuropathies and it would be reasonable to screen ...
How antidepressants can ‘flip’ unipolar patients | Psychiatry | 06-2009
It s long been assumed that antidepressants can flip patients into mania hypomania. I don t think this is disputed. There isn t uniform agreement, however, about whether this is ...
Long-term shock treatment | Psychiatry | 05-2009
Indications for maintenance ECT M-ECT as developed by the American Psychological Association Task Force Report on the Practice of Electroconvulsive Therapy are history of ECT-responsive illness either a patient preference ...
Suspicious slimming | Oncology | 05-2009
Weight loss is a non-specific complaint that can mean a number of things. As always, start off with a careful history focusing initially on food intake and energy output. A ...
Citalopram for behaviour issues in dementia? | Geriatrics | 03-2009
I believe the study you rsquo re referring to is one in which risperidone is compared to citalopram in the treatment of psychotic symptoms and agitation associated with dementia American ...
SSRIs for behaviour issues in dementia | Geriatrics | 03-2009
I believe the study you rsquo re referring to is one in which risperidone is compared to citalopram in the treatment of psychotic symptoms and agitation associated with dementia American ...
Vitamin D for SAD? | Psychiatry | 01-2009
Generally, populations that live in northern climates suffer from vitamin D deficiency in winter. A study comparing vitamin D levels in those with seasonal affective disorder versus the general population ...
Bipolar disorder easier to treat | Psychiatry | 01-2009
A recent collaborative study with over 600 subjects on the relationship between bipolar disorder and borderline personality disorder BPD has established that although there appears to be a link between ...
Can psychiatry work by video link? | Psychiatry | 12-2008
There are case reports of telehealth psychotherapy, as well as a few review papers, that report on telepsychiatry in all of its uses. By far, the most common use is ...
Avoid the temptation to over-prescribe ADHD meds | Psychiatry | 11-2008
If the teacher is pushing you to prescribe more stimulants for a child, he or she obviously feels that the treatment isn t working. The best thing to do in ...
Prescribe exercise to lift depression | Psychiatry | 05-2008
In many cases, the results are quite impressive, i.e. the antidepressant effects are as good as medication. I'd suggest continued use of both.Although there haven't been very many rigorous studies ...
Is bipolar disorder overdiagnosed? | Psychiatry | 04-2008
In the 10-year period from 1994 to 2003, there's been a 2-fold increase in the diagnosis of BD in adults, and a 40-fold increase in youth. Does this represent overdiagnosis ...
How long before testosterone kicks in? | Urology | 02-2008
I checked this question with Peter Chan, our urologist-andrologist at the McGill University Health Centre. He tells me that he checks for benefits at 3 months, and often again at ...
Saving sexual function while on SSRIs | Psychiatry | 02-2008
Atomoxetine is a selective norepinephrine reuptake inhibitor SNRI , initially marketed as an antidepressant, but now used for patients with ADHD. There are no reports in the literature about the ...
When to treat high TSH in the elderly | Endocrinology, Geriatrics | 02-2008
I recommend replacement of thyroid hormone in all patients when there's evidence of overt hypothyroidism -- elevated TSH and low free thyroxine FT4 , or low free triiodothyronine FT3 regardless ...
Should antiplatelet agents be lifelong? | Cardiology | 12-2007
Antiplatelet therapy following an MI reduces mortality by 10 and re-infarction rates by about 25 . Most of the data is derived from studies on ASA. Currently, I recommend 81 ...
Difficulty recovering from dysthymia | Psychiatry | 11-2007
Dysthymia is often seen as a milder form of depression yet it causes more significant impairment in occupational, interpersonal, marital and family functioning. In other words, the morbidity associated with ...
Melatonin and bupropion for sleep disorders and ADHD | Psychiatry | 10-2007
This is actually three questions in one. A recent meta-analysis of randomized controlled trials of melatonin looked carefully at efficacy in the treatment of primary and secondary sleep disorders as ...
Delusions or cultural icons? | Psychiatry | 10-2007
Studies show that there's a continuum of hallucinatory experiences within the general population, so that at any one time, a certain percentage will experience auditory hallucinations without any other symptoms ...
Does depression predispose to Alzheimer's? | Psychiatry | 09-2007
The attempt to explain the relationship between depression and AD has been ongoing. There's no doubt of an association, but it's unclear whether or not the depression is an early ...
Distinguishing Asperger's from autism | Psychiatry | 07-2007
The classical triad in autism occurs in the areas of communication and language, social interaction and behaviour. Autistic children have impaired and delayed development in language, they're uninterested in social ...
Can cataracts act as SAD in the elderly? | Geriatrics | 05-2007
Data on the prevalence of SAD is limited. The average age of onset seems to be in the third decade and the risk decreases with age. After the age of ...
Dealing with activity addictions | Psychiatry | 05-2007
Addictions involve an overstimulation of brain pleasure reward circuits, down-regulation of dopamine receptors, escalated use due to tolerance, depression, anxiety and novelty-seeking in the absence of the addictive activity, and ...
Can cataracts act as SAD in the elderly? | Psychiatry | 05-2007
The literature does describe an association between the loss if vision in the elderly and the incidence of depression. The studies mainly look at visual impairment due to macular degeneration, ...
Premature ejaculation in teenagers | Psychiatry | 04-2007
An excellent review of the assessment and management of premature ejaculation appears in amp lt i amp gt J Sex Marital Ther amp lt i amp gt 2000 26 293-320. ...
Best treatments for essential tremor | Neurology, Geriatrics | 03-2007
Essential hand tremor ET is sometimes referred to as senile tremor when the onset is late in life. It's extremely common. Beta-blockers are usually the first line of drug treatment, ...
Are ADHD drugs an option for moody teens? | Psychiatry | 03-2007
I'm not aware of using amphetamines like methylphenidate to treat mood lability and impulsive behaviour. A few studies in the 1980s looked at an amphetamine challenge in borderline personality disorder ...
Are anxiety and depression linked? | Psychiatry | 02-2007
Although there's a very high comorbidity, not all depressed individuals are anxious and not all anxious patients are depressed. Studies suggest co-occurrence rates of as much as 60 , but ...
How to diagnose psychosis in the office | Psychiatry | 01-2007
Psychosis is a symptom cluster and not a specific disease. What characterizes psychosis are abnormalities of thought content e.g. delusions , perceptual disturbances e.g. hallucinations , disturbances of thought processes ...
Pruritus in the elderly | Geriatrics | 12-2006
Pruritus isn't unusual in the elderly. It may be due to physiologic, emotional, environmental, cognitive and social factors, as well as a myriad of disease processes and medications. Xerosis, or ...
Is bipolar disorder overdiagnosed? | Psychiatry | 12-2006
Experts in bipolar disorder overwhelmingly believe that, if anything, BD is underdiagnosed. They feel that this is particularly true in children and adolescents -- that many with attention deficit hyperactivity ...
Is massage indicated in the presence of varicose veins? | Cardiology | 10-2006
There's not much data to answer your question -- a computer search offered very little insight. My personal advice is to keep your patient as mobile as possible. Regular exercise ...
Does zolpidem induce sleepwalking? | Clinical Pharmacology | 10-2006
Undesired behaviours are a potentially serious side effect of many psychoactive medications. While they're generally uncommon on the whole, and in particular in most sedative hypnotics, they're very troubling when ...
Fetal renal lobulation | Nephrology | 10-2006
Embryologically, the kidney develops in several lobules. Incomplete fusion of these lobules can persist postnatally and may be observed in 7 of adults. This fetal lobulation is recognized incidentally on ...
ST depression after coronary bypass | Cardiology | 09-2006
Persistent ST depression is a nonspecific finding and may be related to the bypass surgery itself. It could also indicate myocardial damage, so a nuclear medicine study to look for ...
Should schizophrenics smoke? | Psychiatry | 09-2006
Studies have shown that schizophrenic patients have a 3-4-fold increase in addiction to cigarettes as compared to the general population, and that approximately 80-90 of them smoke. In addition, they're ...
Can lupus mimic MS? | Neurology | 07-2006
Most patients with SLE have neurologic involvement at some point in their illness. This may result as complications from drugs given to treat the disease, as well as from opportunistic ...
Serotonin syndrome: what's the risk? | Psychiatry | 07-2006
The usual cause of serotonin syndrome is excess serotonergic agonism, both centrally and peripherally. There are three principal causes. One is the therapeutic use of drugs, another is intentional self-poisoning ...
How do SNRIs relieve pain? | Psychiatry | 05-2006
Venlafaxine and duloxetine are dual-action antidepressants amp amp 151 i.e. they inhibit the reuptake of both serotonin and norepinephrine, thereby increasing the availability of both neurotransmitters. The ascending pathways of ...
What's the best scale for depression? | Psychiatry | 04-2006
None of these tests is diagnostic amp amp 151 they're screening instruments. Recently, the HAM-D7 has been tested by 50 family practitioners who found it extremely useful, but it was ...
Shedding light on winter blues | Psychiatry | 03-2006
There's a review of research on light therapy in a recent journal of psychiatry Golden RN et al. amp lt i amp gt Am J Psychiatry amp lt i amp ...
A stand on testosterone replacement therapy | Urology | 02-2006
Testosterone replacement makes sense when there are appropriate symptoms and the testosterone level is below normal. By the way, the only test that seems worthwhile is the bioavailable testosterone level ...
Can mercury go to someone's head? | Psychiatry | 01-2006
There are two ways of measuring mercury and cadmium levels. For acute exposure, a whole blood test is indicated. For chronic exposure, either a 24-hour urine collection or a random ...
Do women fare better on SSRIs? | Psychiatry | 12-2005
This is a very controversial subject at the moment and experts don't agree on the answer. A seminal study found that younger women responded better to SSRIs while their male ...
Depersonalization after major depression | Psychiatry | 12-2005
If depersonalization symptoms persist after successfully treating a major depression, this suggests that the patient is suffering from depersonalization disorder DPD as well as major depression. If the patient does ...
Evidence for St. John's wort | Psychiatry | 12-2005
Until recently, the evidence in favour of St. John's wort hypericum extract in the treatment of depression suggested that it was effective in mild to moderate depression, but not in ...
Can cure for depression relieve capsulitis? | Psychiatry | 10-2005
This is an interesting question. Certainly, don't treat the depression in lieu of the capsulitis. This woman should be thoroughly worked up for factors that may affect her ability to ...
Feeling the heat of burning feet | Endocrinology | 09-2005
Paresthesias such as burning feet are a common symptom of diabetic neuropathy and can be difficult to alleviate. If sleeping is a problem, amitriptyline in low doses may be helpful ...
The many faces of celiac disease | Gastroenterology | 09-2005
Celiac disease can appear at any stage of life. I've seen patients in their 60s and 70s present with this illness. Yes, it can remain undiagnosed for years and perhaps ...
What will quiet the screams in long-term care? | Geriatrics | 08-2005
In long-term care facilities, behaviour symptoms such as screaming are extremely common and may occur in up to 85 of individuals with advanced dementia. Specific drug treatment can be tried, ...
Withdrawal from pot smoking | Psychiatry | 08-2005
There've been almost no pharmacologic studies for the treatment of marijuana dependence. Most research has focused on cognitive behavioural interventions. Interestingly in these, brief motivational therapies were usually as effective ...
The optimal workup for fatigue | Psychiatry | 05-2005
You would certainly want to rule out any physical cause, for instance, an endocrine abnormality, infection or neoplasm. As well, it's important to complete a detailed psychiatric history. I would ...
Teenager at high breast Ca risk | Obstetrics Gynecology | 03-2005
The history of injectable medroxyprogesterone is interesting in that studies in dogs on this medication have shown an increased risk of breast cancer, but this has never been proven to ...
Are all SSRIs the same? | Psychiatry | 03-2005
In terms of efficacy, there's very little difference, although an individual may respond to one SSRI and not to others. Some tend to be more alerting than others, e.g. fluoxetine. ...
How does the Hamilton Depression Scale rate? | Psychiatry | 11-2004
The Hamilton Depression Rating Scale is a 17-item clinician-administered scale that evaluates mood, vegetative and cognitive symptoms of depression and comorbid anxiety symptoms. It doesn't look at concentration indecision and ...
Fibromyalgia and 5-HTP | Psychiatry | 10-2004
From a psychiatric point of view, the question would be whether 5-HTP would relieve any depression associated with fibromyalgia. Although 5-HT is a precursor of serotonin, there's no good evidence ...
The bottom line on SSRIs and kids | Psychiatry | 09-2004
This is a very contentious topic at the moment. There are definite concerns about the use of paroxetine in adolescents. Recently, official bodies in the U.S. and Great Britain have ...
The low-down on anorexia Tx | Psychiatry | 06-2004
Treatment of anorexia nervosa requires a comprehensive approach. As some of the symptoms are due to the effects of starvation, nutritional rehabilitation is essential, but this is insufficient on its ...
Legal conundrum: off-label drugs vs health | Psychiatry | 06-2004
Even though the parents are lawyers, they shouldn't be treated any differently from others. They need to be educated about what we know and don't know about medication and, specifically, ...
Recommendations for recurring adult acne | Dermatology | 05-2004
Adult acne vulgaris can be notoriously difficult to manage, in part because of its long-standing nature. Many people suffer from the cosmetic and physical effects of unopposed acne. Isotretinoin, however, ...
Psychotherapy effect seen on PET scans | Psychiatry | 05-2004
Cognitive behaviour therapy CBT relieves depression by improving positive thinking and questioning and altering negative cognitions. It seems to raise the levels of neurotransmitters that are deficient in this condition ...
Tx for hair-pulling | Psychiatry | 05-2004
Trichotillomania or recurrent pulling out of a person's own hair has been viewed as both a type of obsessive-compulsive disorder and an impulse disorder. In the majority of cases, it's ...
Prescription addiction | Psychiatry | 04-2004
I'm sure that you've spoken to your patient about the dangers of this addiction and tried to get him to consider a substance abuse program. Perhaps by talking to him ...
Depression and anxiety in pregnancy | Psychiatry | 04-2004
Altered levels of reproductive hormones can precipitate mood changes, particularly among susceptible women who have a genetic vulnerability to depression. These people may also have a higher risk of postpartum ...
Antidepressants: do they increase the risk of breast cancer? | Psychiatry | 02-2004
One epidemiological study AmJ Epidemiol 2000 151 952-7 suggested that some antidepressants, such as paroxetine and TCAs, may be associated with an increased risk of breast disease. This research, however, ...
Does diabetes control curb mood swings? | Psychiatry | 02-2004
There's some evidence for a higher risk of depression in diabetes that may be related to the impaired metabolic control. It's not clear, however, that the risk is higher than ...
Can treating depression help arthritis? | Psychiatry | 02-2004
Epidemiologic studies have found associations between depression and chronic inflammatory conditions, such as asthma and rheumatoid arthritis. It's been shown that administering substances that increase the production of inflammatory cytokines ...
Psychotic symptoms after smoking pot | Psychiatry | 02-2004
Episodic use of marijuana doesn't cause persistent delusions or hallucinations, but can unmask a vulnerability to psychosis. Consequently, there are a number of possibilities to consider. First, the psychosis may ...
Can treating depression help arthritis? | Rheumatology | 02-2004
There's definitely a link between depression and pain amplification in most chronic illness. As such, these responses may reflect improvement in noninflammatory and or neuropathic pain manifestations and perception. LR
