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1.
Liver Transpl ; 30(2): 213-222, 2024 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-37486958

RESUMO

Liver transplantation (LT) teams must be adept at detecting, evaluating, and treating patients' alcohol use, given its prominence among psychological and behavioral phenomena which cause and contribute to liver diseases. Phosphatidylethanol (PEth) is a highly useful alcohol biomarker increasingly recommended for routine use in hepatology and LT. PEth is unique among alcohol biomarkers because of its wide detection window, high sensitivity and specificity, and the correlation of its numerical value with different patterns of alcohol use. Alongside myriad clinical opportunities in hepatology and LT, PEth also confers numerous challenges: little guidance exists about its clinical use; fearing loss of LT access and the reactions of their clinicians and families, candidates and recipients are incentivized to conceal their alcohol use; and liver clinicians report lack of expertise diagnosing and treating substance-related challenges. Discordance between patient self-reported alcohol use and toxicology is yet another common and particularly difficult circumstance. This article discusses the general toxicological properties of PEth; explores possible scenarios of concordance and discordance among PEth results, patient history, and self-reported drinking; and provides detailed clinical communication strategies to explore discordance with liver patients, a key aspect of its use.


Assuntos
Consumo de Bebidas Alcoólicas , Transplante de Fígado , Humanos , Consumo de Bebidas Alcoólicas/efeitos adversos , Transplante de Fígado/efeitos adversos , Glicerofosfolipídeos , Etanol , Biomarcadores
2.
Curr Psychiatry Rep ; 2024 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-39305360

RESUMO

PURPOSE OF REVIEW: Psychosocial considerations in transplant candidacy evaluation, waitlist, and post-transplant period is tremendously important to overall transplant care. Integration of mental health services in multidisciplinary transplant teams improves adherence to medical regimens, enhances quality of life, and reduces the risk of post-transplant complications. RECENT FINDINGS: Despite this, psychiatrists are often under-utilized by transplant centers, with engagement typically limited to transplant candidacy evaluations or reactive consults in a traditional CL model. In this review, we aim to 1) highlight the relevance of psychiatry throughout the transplant course, 2) outline the role of a CL psychiatrist in advancing patient care and supporting multidisciplinary teams in transplant, 3) develop an understanding of CL service models in both the inpatient and ambulatory setting and 4) consider the utility of innovating current transplant psychiatry practices.

3.
Curr Psychiatry Rep ; 26(8): 436-446, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38941032

RESUMO

PURPOSE OF REVIEW: Traditional, complementary, and integrative medicine (TCIM) modalities are widely employed. However, TCIM, specifically herbal and non-herbal dietary supplements, can pose challenges in the context of organ transplantation. In this review, we discuss common supplements used for psychiatric purposes and highlight important considerations for candidates and recipients of liver transplants. RECENT FINDINGS: Ashwagandha, kava kava, green tea extract, skullcap, turmeric, and valerian have known idiosyncratic hepatotoxic potential and may complicate the liver transplantation course. Multiple supplements reportedly carry a lower risk of hepatotoxicity, though evidence for widespread use in those at risk for or with hepatic impairment is limited. Psychiatrists caring for candidates and recipients of liver transplants must recognize that patients may find supplements helpful in alleviating psychiatric symptoms, despite an overall limited evidence base. Evaluating benefit versus risk ratios and reviewing drug-drug interactions is essential to promote transplant candidacy and mitigate the possibility of native or graft liver dysfunction.


Assuntos
Suplementos Nutricionais , Transplante de Fígado , Humanos , Transtornos Mentais/tratamento farmacológico , Fitoterapia/métodos , Preparações de Plantas/uso terapêutico
4.
Clin Liver Dis (Hoboken) ; 23(1): e0210, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38872776
5.
Curr Drug Saf ; 14(2): 167-170, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30767750

RESUMO

BACKGROUND: Selective Serotonin Reuptake Inhibitors (SSRIs) are the first-line treatments for various psychiatric disorders. SSRIs offer an improved side effect profile compared to older treatments, which improves patients' adherence and quality of life. CASE REPORT: Here we discuss a case of an uncommon, but a distressing side effect of citalopram. A 76-year old woman was referred to the psychiatry clinic for bizarre behavior. The patient was diagnosed with behavioral variant frontotemporal dementia and was started on citalopram 20 mg and aripiprazole 5 mg daily. At 3.5 months the patient complained of diffuse hair thinning on her scalp. Citalopram was considered the offending agent and was discontinued. Within a few months, the patient regained most of her hair. Although drug-induced alopecia is common among other SSRIs, it is relatively rare with citalopram. RESULTS AND CONCLUSION: Early recognition, withdrawal of offending agent, and reassurance to the patient that hair loss is reversible can help alleviate patient distress and avoid relapse.


Assuntos
Alopecia em Áreas/etiologia , Citalopram/efeitos adversos , Idoso , Feminino , Humanos , Qualidade de Vida
6.
Transl Pediatr ; 6(4): 383-396, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29184819

RESUMO

Diabetes mellitus (DM) is a debilitating chronic illness with complex pathophysiological, psychological, and quality of life (QoL) implications creating a constant state of turbulence. Some of these interconnections are apparent to healthcare providers and are easily addressed in a routine diabetic clinical care. However, a large number of these hidden factors that interplay with each other and impact on the physical outcomes of DM goes unnoticed by health care providers. This is a frustrating and lonely predicament for DM patients making it very difficult for them to manage their illness well. At times these patients are mislabeled as "difficult patients". In other cases they are considered to have and unnecessarily treated for psychiatric illness like depression, other mood or anxiety spectrum disorders which they may not need. In recent years clinical researcher are making strides in understanding the emotional distress a DM patient may feel and the factors contributing or perpetuating diabetes distress. This article focuses on understanding the diabetes distress and how it impacts our patients, how to screen, assess, treat and eventually prevent it from happening. The paper also attempt to bring out the major differences between diabetes distress and common psychiatric comorbidities of DM including but not limiting to major depressive disorder and other depression spectrum disorders.

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