Search

Background: Our study examines depression and anxiety in patients with immunoglobulin light chain (AL) amyloidosis, and determines the associations between the mental health problems and patient characteristics (age, gender, race, marital status, alcohol consumption, smoking status and cardiac involvement)., Methods: Patients with AL amyloidosis who completed the 36-item Short Form General Health Survey (SF-36) during initial evaluation at a single center were studied. The SF-36 included assessments of depression, anxiety, role limitation due to emotional problems and the mental health subscale score., Results: From 1226 patients with AL amyloidosis, 37.0% reported depression and 46.7% reported anxiety. Patients with cardiac amyloidosis reported more anxiety (odds ratio (OR) = 1.29, 95% confidence interval (CI) 1.03-1.61) and role limitation due to emotional problems (OR = 1.32, 95%CI 1.05-1.65). No significant association between cardiac involvement and depression was found (OR = 1.22, 95%CI 0.97-1.54). Men reported less anxiety (OR = 0.72, 95%CI 0.57-0.91). Patients  ≥65 years experienced greater role limitation (OR = 1.36, 95%CI 1.08-1.71). Smokers (p = 0.019) and women (p = 0.006) scored lower on mental health subscales., Conclusions: Many patients with AL amyloidosis suffer from depression, anxiety and functional limitations. Psychiatric assessment and treatment is important, and further research is needed to clarify the long-term effects of depression and anxiety in AL amyloidosis. This current study was registered in ClinicalTrials.gov as NCT00898235.

As the number of psychotropics on the market expands, the likelihood increases that a patient requiring anticoagulation with warfarin will receive concurrent treatment with a psychotropic drug. Because warfarin undergoes hepatic metabolism and is highly protein bound, it is particularly prone to drug interactions; in addition, its relatively narrow therapeutic window places patients at risk of either hemorrhagic or thrombotic complications. Although warfarin's interactions with other drugs have long been studied, the most recent review of the literature of warfarin's interactions with psychotropics was over a decade ago. Thus, we conducted a systematic review of the literature documenting the interaction between warfarin and psychotropics, with a focus on interactions mediated through the cytochrome P450 system and protein binding. A search of the MEDLINE database was performed, and reports of warfarin interactions with psychotropics were identified. The results suggest that interactions between warfarin and psychotropic drugs are important and likely underrecognized. They also have notable implications for both safety and drug compliance. When certain psychotropics are started or discontinued in patients receiving warfarin therapy, or when warfarin is introduced to a patient receiving a stable dose of a psychotropic, clinicians should monitor a patient's international normalized ratio (INR) closely to ensure it remains within therapeutic range. Psychotropics that pose a particular risk of increasing the INR when used with warfarin include fluoxetine, fluvoxamine, quetiapine, and valproic acid. Psychotropics that may significantly decrease the INR when used with warfarin include trazodone, St. John's wort, carbamazepine, and the polycyclic aromatic carbons in tobacco cigarettes; however, nicotine itself, as in nicotine replacement strategies, is not known to alter warfarin's anticoagulant effect. In certain cases, the need for anticoagulation may also necessitate switching to a different psychotropic., (© 2012 Pharmacotherapy Publications, Inc.)

Drug interaction between Warfarin and psychiatric agents may have important therapeutic effects for patients undergoing cardiac surgery. We present a case of a patient in whom concurrent treatment with Warfarin and valproic acid resulted in supratherapeutic international normalized ratio values. A discussion of the possible mechanisms for this interaction as well as a review of interactions between Warfarin and other psychiatric medications is the subject of this case report., (© 2011 Wiley Periodicals, Inc.)

The authors surveyed 356 family medicine residency training directors to determine the role of psychiatrists in family medicine training. Two hundred five responses were received, covering the training experiences of 3696 residents. Psychiatrists were actively involved in the training programs, but their role was circumscribed to areas of traditional, demonstrated expertise. Most of the program directors rated psychiatrists as highly useful. Programs rating psychiatrists highly useful differed from low usefulness raters only in having both general psychiatry and consultation-liaison rotations available. This lends support to the hypothesis that consultation-liaison activities provide the most useful method of integrating psychiatrists into family medicine training programs.

The authors in this article describe a 12-week primary care elective for third-year medical students. The administrative and teaching resources of the Boston University School of Medicine, clinical sites at three Boston community health centers, and federal/state and private foundation funding are coordinated to provide a longitudinal, integrated experience in ambulatory pediatrics and medicine. A literature review revealed no prior medical student programs combining psychiatric, pediatric, and internal medicine teaching in a community setting. Case vignettes and questionnaire results indicate that the program has been a success at introducing students to primary care and the biopsychosocial model. The implications of bridging disciplines as well as academic and community health centers and providing funding resources are discussed. The authors recommend this integrative model for enhancing the development of future primary care physicians.