Sensitivity, specificity, and cut-off points in the Brief Questionnaire for Measuring Disordered Eating Behaviors in Mexican Women.

BACKGROUND: Evidence suggests that disordered eating behaviors can result in eating disorders, which is already a reality for the Mexican population, representing an increasingly complex public health problem. Early detection is therefore essential. AIM OF THE STUDY: To obtain the sensitivity, specificity, and cut-off points of the Brief Questionnaire for Measuring Disordered Eating Behaviors to identify eating disorders in Mexican women. METHODS: The Eating Disorders Examination-Questionnaire and the Brief Questionnaire for Disordered Eating Behaviors were applied to patients diagnosed with eating disorders at two public health institutions and university students. ROC analysis was performed to determine sensitivity, specificity, predictive values, and cut-off points. RESULTS: Three cut-off points were obtained: first: eight points (Sensitivity = 60.7%, Specificity = 92.2%), showing low risk; second: 11 points (sensitivity = 24.1%; specificity = 98.9%), detecting moderate risk; and, finally, 15 points and over (sensitivity = 4.46%; specificity = 100%), indicating high risk. CONCLUSIONS: The instrument adequately identifies those individuals who are not at risk for eating disorders, making it possible to channel prevention efforts towards those who do have DEB, thus optimizing resources. LEVEL OF EVIDENCE: Level III: case-control analytic study.

The impact of work-related stress on medication errors in Eastern Region Saudi Arabia.

OBJECTIVE: To examine the relationship between overall level and source-specific work-related stressors on medication errors rate. DESIGN: A cross-sectional study examined the relationship between overall levels of stress, 25 source-specific work-related stressors and medication error rate based on documented incident reports in Saudi Arabia (SA) hospital, using secondary databases. SETTING: King Abdulaziz Hospital in Al-Ahsa, Eastern Region, SA. PARTICIPANTS: Two hundred and sixty-nine healthcare professionals (HCPs). MAIN OUTCOME MEASURES: The odds ratio (OR) and corresponding 95% confidence interval (CI) for HCPs documented incident report medication errors and self-reported sources of Job Stress Survey. RESULTS: Multiple logistic regression analysis identified source-specific work-related stress as significantly associated with HCPs who made at least one medication error per month (P < 0.05), including disruption to home life, pressure to meet deadlines, difficulties with colleagues, excessive workload, income over 10 000 riyals and compulsory night/weekend call duties either some or all of the time. Although not statistically significant, HCPs who reported overall stress were two times more likely to make at least one medication error per month than non-stressed HCPs (OR: 1.95, P = 0.081). CONCLUSION: This is the first study to use documented incident reports for medication errors rather than self-report to evaluate the level of stress-related medication errors in SA HCPs. Job demands, such as social stressors (home life disruption, difficulties with colleagues), time pressures, structural determinants (compulsory night/weekend call duties) and higher income, were significantly associated with medication errors whereas overall stress revealed a 2-fold higher trend.

What quantifies good primary care in the United States? A review of algorithms and metrics using real-world data.

Primary care physicians (PCPs) play an indispensable role in providing comprehensive care and referring patients for specialty care and other medical services. As the COVID-19 outbreak disrupts patient access to care, understanding the quality of primary care is critical at this unprecedented moment to support patients with complex medical needs in the primary care setting and inform policymakers to redesign our primary care system. The traditional way of collecting information from patient surveys is time-consuming and costly, and novel data collection and analysis methods are needed. In this review paper, we describe the existing algorithms and metrics that use the real-world data to qualify and quantify primary care, including the identification of an individual's likely PCP (identification of plurality provider and major provider), assessment of process quality (for example, appropriate-care-model composite measures), and continuity and regularity of care index (including the interval index, variance index and relative variance index), and highlight the strength and limitation of real world data from electronic health records (EHRs) and claims data in determining the quality of PCP care. The EHR audits facilitate assessing the quality of the workflow process and clinical appropriateness of primary care practices. With extensive and diverse records, administrative claims data can provide reliable information as it assesses primary care quality through coded information from different providers or networks. The use of EHRs and administrative claims data may be a cost-effective analytic strategy for evaluating the quality of primary care.

Electroencephalographic signatures of dogs with presumptive diagnosis of canine cognitive dysfunction.

Canine cognitive dysfunction (CCD) is a highly prevalent neurodegenerative disease considered the canine analog of early Alzheimer's disease (AD). Unfortunately, CCD cannot be cured. However, early therapeutic interventions can slow the progression of cognitive decline and improve quality of life of the patients; therefore, early diagnosis is ideal. In humans, electroencephalogram (EEG) findings specific to AD have been described, and some of them have successfully detect early stages of the disease. In this study we characterized the EEG correlates of CCD, and we compared them with the EEGs of healthy aging dogs and dogs at risk of developing CCD. EEG recordings were performed in 25 senior dogs during wakefulness. Dogs were categorized in normal, at risk of CCD or with CCD according to their score in the Rofina questionnaire. We demonstrated that, quantitative EEG can detect differences between normal dogs and dogs with CCD. Dogs with CCD experience a reduction in beta and gamma interhemispheric coherence, and higher Joint Lempel Ziv complexity. Dogs at risk of developing CCD, had higher alpha power and interhemispheric coherence, making these features potential markers of early stages of the disease. These results demonstrate that quantitative EEG analysis could aid the diagnosis of CCD, and reinforce the CCD as a translational model of early AD.

The Management of Diabetes in Everyday Life (MODEL) program: development of a tailored text message intervention to improve diabetes self-care activities among underserved African-American adults.

Tailoring health-related materials is an effective mechanism to encourage behavior change; however, little research has described processes and critical characteristics for effective tailoring in underserved populations. The purpose of this study is to describe a process using input from content experts and lay patient advisors to tailor text messages focused on improving self-care behaviors of African-American adults with diabetes and identify characteristics of messages perceived to be most effective. An initial library of tailorable messages was created using theory-based approaches, expert opinion, and publicly available materials. A study-specific advisory council representing the program's intended population provided sequential individual and focus group review of a sample of draft messages focused on medication use, healthy eating, and physical activity. Messages were reviewed for content, tone, and applicability to African-American adults with diabetes from underserved communities. Based on this feedback, messages were revised and a final library of tailorable messages was constructed for use in a text messaging intervention. The initial library had over 5,000 tailorable messages. Participants preferred messages that included: (1) encouraging statements without condescension; (2) short sentences in lay language; (3) specific, actionable instructions; and (4) content relatable to daily activities of living. When possible, messages with similar themes should be repeated over short periods of time to improve the odds of material being absorbed and action being taken. Input from patient participants and advisors is essential for designing deeply tailored messages that honor the preferences, values, and norms of the population under study and promote health behavior change. TRIAL REGISTRATION: NCT02957513.

When clean eating isn't as faultless: the dangerous obsession with healthy eating and the relationship between Orthorexia nervosa and eating disorders in Mexican University students.

BACKGROUND: Orthorexia Nervosa is an eating disorder that has been scarcely studied in characteristics, causes and symptoms, as well as in consequences and the relationship with other eating disorders. The present study had as its main objective the analysis of said relationship and inquisition of the possibility of predicting the development of an eating disorder from the presence of orthorexia nervosa. Also, it analyzed the differences by sex in Mexican university students. METHODS: The sample consisted of 911 university students (65.4% women and 34.6% men), between an age range of 18 to 28 years old (M = 21 and SD = 1.9). Two questionnaires were responded: the ORTO14MX, a version of the ORTO-15 instrument previously validated in Mexican students, and the EDE-Q in its short version. Besides, sociodemographic data of interest was obtained and used for this study. RESULTS: The Pearson's correlation analysis demonstrated statistically significant relations, from mild to moderate, between the factors that make up both scales, while the linear regression analysis demonstrated that 40% of the variance is explained with the factors from the ORTO-14MX scale in the overall sample for the study. Additionally, statistically significant differences were found between men and women regarding all the subscales conforming the instruments that measured orthorexia and eating disorders. CONCLUSION: These results show a moderate predictive degree, that as promising as it is, isn't conclusive. Likewise, it was confirmed that women are still more vulnerable to develop orthorexia or another eating disorder. It can be concluded that there's a vast necessity for more studies measuring the relationship between orthorexia nervosa and eating disorders, in Latinamerican samples with diverse characteristics in sociocultural backgrounds, and clinical samples.

INTRODUCCIÓN: La ortorexia nervosa es un trastorno de la conducta alimentaria que ha sido poco estudiado, tanto en sus características, causas y síntomas, como en sus consecuencias y en la relación con otros trastornos de la conducta alimentaria. El presente estudio tuvo como objetivo analizar dicha relación e indagar si es posible predecir la aparición de un trastorno de la conducta alimentaria a partir de la presencia de ortorexia nervosa, además de analizar diferencias por sexo en estudiantes universitarios mexicanos. MÉTODO: Participaron en el estudio 911 estudiantes universitarios (65.4% fueron mujeres y el 34.6% hombres), en un rango de edades entre 18 y 28 años (M = 21 y DE = 1.9) que respondieron dos cuestionarios que son: ORTO-14MX, una versión del instrumento ORTO-15 previamente validada en estudiantes mexicanos y el EDE-Q en su versión corta, además de proporcionar algunos datos sociodemográficos de interés para este estudio. RESULTADOS: El análisis de correlación de Pearson reveló relaciones estadísticas significativas de leves a moderadas entre los factores que componen ambas escalas, mientras que el análisis de regresión lineal mostró un que un 40% de la varianza es explicada a partir de los factores que componen la escala ORTO-14MX en la muestra de estudio. Adicionalmente se encontraron diferencias estadísticamente significativas entre hombres y mujeres con respecto a todas las subescalas de los instrumentos que midieron ortorexia y trastornos de la conducta alimentaria. CONCLUSIONES: Estos resultados mostraron un grado de predicción moderada que sí bien es prometedora, no resulta totalmente concluyente. Asimismo, se confirmó que las mujeres siguen siendo más vulnerables a padecer ortorexia o un TCA. Se concluye la necesidad de continuar estudiando la relación entre la ortorexia y los TCAs, en muestras latinoamericanas con otras características socio demográficas y en población clínica.

Resilience of aquatic systems: Review and management implications.

Our understanding of how ecosystems function has changed from an equilibria-based view to one that recognizes the dynamic, fluctuating, nonlinear nature of aquatic systems. This current understanding requires that we manage systems for resilience. In this review, we examine how resilience has been defined, measured and applied in aquatic systems, and more broadly, in the socioecological systems in which they are embedded. Our review reveals the importance of managing stressors adversely impacting aquatic system resilience, as well as understanding the environmental and climatic cycles and changes impacting aquatic resources. Aquatic resilience may be enhanced by maintaining and enhancing habitat connectivity as well as functional redundancy and physical and biological diversity. Resilience in aquatic socioecological system may be enhanced by understanding and fostering linkages between the social and ecological subsystems, promoting equity among stakeholders, and understanding how the system is impacted by factors within and outside the area of immediate interest. Management for resilience requires implementation of adaptive and preferably collaborative management. Implementation of adaptive management for resilience will require an effective monitoring framework to detect key changes in the coupled socioecological system. Research is needed to (1) develop sensitive indicators and monitoring designs, (2) disentangle complex multi-scalar interactions and feedbacks, and (3) generalize lessons learned across aquatic ecosystems and apply them in new contexts.

The management of diabetes in everyday life study: Design and methods for a pragmatic randomized controlled trial comparing the effectiveness of text messaging versus health coaching.

Background African American patients with uncontrolled diabetes living in medically underserved areas need effective clinic-based interventions to improve self-care behaviors. Text messaging (TM) and health coaching (HC) are among the most promising low-cost population-based approaches, but little is known about their comparative effectiveness in real-world clinical settings. Objective Use a pragmatic randomized controlled trial design to determine the comparative effectiveness of TM and HC with enhanced usual care (EC) in African American adults with uncontrolled diabetes and multiple chronic health conditions. Methods/design The Management of Diabetes in Everyday Life (MODEL) study is randomizing 646 patients (n = 581with anticipated 90% retention) to 3 intervention arms: TM, HC, and EC. Participants are African American adults living in medically underserved areas of the Mid-South, age ≥ 18, with uncontrolled diabetes (A1c ≥ 8), one or more additional chronic conditions, and who have a phone with texting and voicemail capability. Primary outcome measures: the general diet, exercise, and medication adherence subscales of the revised Summary of Diabetes Self-Care Activities questionnaire assessed at one year. Secondary outcomes: diabetes-specific quality of life, primary care engagement, and average blood sugar (A1c). The study will also assess heterogeneity of treatment effects by six key baseline participant characteristics. Conclusions We describe the design and methods of the MODEL study along with design revisions required during implementation in a pragmatic setting. This trial, upon its conclusion, will allow us to compare the effectiveness of two promising low-cost primary care-based strategies for supporting self-care behaviors among African Americans individuals with uncontrolled diabetes. ClinicalTrials.gov registration number: NCT02957513.

[Influence of daily and weekly activities in the physical activity levels of school children: a cross-sectional study]. / Influencia de las actividades del día y la semana en los niveles de actividad física de los escolares: estudio de corte transversal.

INTRODUCTION: Introduction: the distinct activities related to an active lifestyle that schoolchildren perform during the day and week interact to influence the children's total level of physical activity. Objective: to identify the influence that the activities developed by school children during the different times of the day and the week have on the levels of physical activity. Method: a cross-sectional study conducted in 3,598 public school students aged between 10 and 14 years. The demographic characteristics were evaluated, as well as the levels of physical activity through the Physical Activity Questionnaire for Schoolchildren (PAQ-C). A multivariate logistic regression analysis was performed as statistical analysis using the SPSS v.24 software program. The raw odds ratio (OR) was estimated. Results: in all, 64.3% of the students failed to comply with physical activity recommendations. Students who are more inactive include those who do not perform enough physical activity during the weekend [OR: 3.7 (95% CI: 2.9-4.5)], those who are not physically active after school [OR: 3.1 (95% CI: 2.3-4.2)], those who do not practice activities such as jumping in their free time [OR: 3.2 (95% CI: 1.9-5.2)], and those who do not ride a bicycle [OR: 3.7 (95% CI: 2.7-5.1)]. Conclusions: the levels of physical activity in students depend on the integration of different contexts and periods during the day and the week. The influence of weekend activities and physical education shows the role that the family and school play in the acquisition and practice of an active lifestyle.

INTRODUCCIÓN: Introducción: las diversas actividades relacionadas con un estilo activo que los escolares realizan durante el día y la semana interactúan para influir en el nivel total de actividad física de los niños. Objetivo: identificar la influencia que tienen las actividades ejecutadas por los escolares durante los diferentes momentos del día y la semana sobre los niveles de actividad física. Métodos: estudio de corte transversal analítico sobre 3598 estudiantes de escuelas públicas de entre 10 y 14 años de edad. Se aplicó una encuesta que midió las características sociodemográficas. Mediante el Cuestionario de Actividad Física para Escolares (PAQ-C) se evaluaron los niveles de actividad física. Se realizó una regresión logística multivariante como análisis estadístico a través del programa SPSS v.24. Resultados: el 64,3% de los estudiantes no cumplen con las recomendaciones de actividad física. Son más inactivos los escolares que no realizan suficiente actividad física (AF) durante el fin de semana [OR: 3,7 (IC 95%: 2,9-4,5)], los que no son activos físicamente después de la escuela [OR: 3,1 (IC 95%: 2,3-4,2], los que no practican actividades como saltar en su tiempo libre [OR: 3,2 (IC 95%: 1,9-5,2] y los que no usan la bicicleta [OR: 3,7 (IC 95%: 2,7-5,1]. Conclusiones: los niveles de AF de los escolares dependen de la integración de diferentes contextos y periodos del día y la semana. La influencia de las actividades durante el fin de semana y la educación física muestra la función que tienen la familia y la escuela sobre la adquisición y práctica de estilos de vida activos.

Development and psychometric testing of a multidimensional instrument of perceived discrimination among African Americans in the Jackson Heart Study.

OBJECTIVE: Assessing the discrimination-health disparities hypothesis requires psychometrically sound, multidimensional measures of discrimination. Among the available discrimination measures, few are multidimensional and none have adequate psychometric testing in a large, African American sample. We report the development and psychometric testing of the multidimensional Jackson Heart Study Discrimination (JHSDIS) Instrument. METHODS: A multidimensional measure assessing the occurrence, frequency, attribution, and coping responses to perceived everyday and lifetime discrimination; lifetime burden of discrimination; and effect of skin color was developed and tested in the 5302-member cohort of the Jackson Heart Study. Internal consistency was calculated by using Cronbach alpha coefficient. Confirmatory factor analysis established the dimensions, and intercorrelation coefficients assessed the discriminant validity of the instrument. SETTING: Tri-county area of the Jackson, MS metropolitan statistical area. RESULTS: The JHSDIS was psychometrically sound (overall alpha = .78, .84 and .77, respectively, for the everyday and lifetime subscales). Confirmatory factor analysis yielded 11 factors, which confirmed the a priori dimensions represented. CONCLUSIONS: The JHSDIS combined three scales into a single multidimensional instrument with good psychometric properties in a large sample of African Americans. This analysis lays the foundation for using this instrument in research that will examine the association between perceived discrimination and CVD among African Americans.

Use of virtual games for interactive learning in a pharmacy curriculum.

BACKGROUND AND PURPOSE: To evaluate student pharmacists' attitudes and satisfaction toward playing educational virtual games in the classroom. EDUCATIONAL ACTIVITY AND SETTING: Virtual games were played in the classroom setting. First year student pharmacists participated in two Mimycx quests in the Healthcare Communication and the Psychiatry/Neurology courses. Students were randomly assigned into teams and worked together to complete the assigned quest games. Completion of the pre- and post-quest questionnaires via Qualtrics was voluntary. FINDINGS: A total of 79 student pharmacists played the Mimycx quests. Only 66 students completed both pre- and post-quest questionnaires. Students indicated their familiarity with game concepts related to the virtual environment and avatars used in the study. The change in their attitudes and satisfaction about the Mimycx virtual learning experience was significant between the two learning time points. SUMMARY: The use of virtual gaming technology could enhance student pharmacists' learning and engagement in the classroom. Students benefitted from increased familiarity with virtual, educational gaming concepts in their experiences with Mimycx, although no statistically significant differences were found regarding their attitudes toward communication and teamwork.

Production of a Dibrominated Aromatic Secondary Metabolite by a Planctomycete Implies Complex Interaction with a Macroalgal Host.

The roles of the majority of bacterial secondary metabolites, especially those from uncommon sources, are still elusive even though many of these compounds show striking biological activities. To further investigate the secondary metabolite repertoire of underexploited bacterial families, we chose to analyze a novel representative of the yet untapped bacterial phylum Planctomycetes for the production of secondary metabolites under laboratory culture conditions. Development of a planctomycetal high density cultivation technique in combination with high resolution mass spectrometric analysis revealed Planctomycetales strain 10988 to produce the plant toxin 3,5-dibromo-p-anisic acid. This molecule represents the first secondary metabolite reported from any planctomycete. Genome mining revealed the biosynthetic origin of this doubly brominated secondary metabolite, and a biosynthesis model for the compound was devised. Comparison of the biosynthetic route to biosynthetic gene clusters responsible for formation of polybrominated small aromatic compounds reveals evidence of an evolutionary link, while the compound's herbicidal activity points toward a complex interaction of planctomycetes with their macroalgal host.

Unmet Primary Care Needs in Diabetic Patients with Multimorbidity in a Medically Underserved Area.

BACKGROUND: Diabetic patients with multimorbidity in medically underserved minority communities are less engaged in primary care and experience high emergency department (ED) utilization. This study assesses unmet primary care needs among diabetic patients in a medically underserved area (MUA). COMMUNITY CONTEXT: A suburb of Memphis-Whitehaven, Tennessee (Shelby County, ZIP codes 38109 and 38116)-majority African American (96.6%) with 30.5% below the poverty level. METHODS: Community case study using multiple data sources including diabetes registry, individual interviews, focus groups, and a survey of 30 ED patients with diabetes and multimorbidity. RESULTS: Diabetes registry data indicated that 95.5% of 5723 diabetic patients had multimorbidity. Over 91.5% were uncontrolled at some point in 2014 to 2015. Only 83% of patients with diabetes and multimorbidity reported having a primary care provider (PCP) and those without a PCP were more likely to report delays in needed care. Patients expressed strong interest in health coaching (88%) and receiving text messages from the doctor's office (73%). Individual patient interviews (n = 9) and focus groups (n = 11) revealed common primary care and self-care experiences and needs including diabetes education, improved patient-provider communication, health-care access and coverage, and strengthened primary care and community. CONCLUSION: This study demonstrates that almost 1 in 5 ED complex diabetic patients in an MUA do not have a PCP, and that difficulty accessing primary care often results in patients forgoing needed care. Qualitative findings support these conclusions. These results suggest that primary care capacity and infrastructure to support diabetes self-care need strengthening in MUAs.

RiceAtlas, a spatial database of global rice calendars and production.

Knowing where, when, and how much rice is planted and harvested is crucial information for understanding the effects of policy, trade, and global and technological change on food security. We developed RiceAtlas, a spatial database on the seasonal distribution of the world's rice production. It consists of data on rice planting and harvesting dates by growing season and estimates of monthly production for all rice-producing countries. Sources used for planting and harvesting dates include global and regional databases, national publications, online reports, and expert knowledge. Monthly production data were estimated based on annual or seasonal production statistics, and planting and harvesting dates. RiceAtlas has 2,725 spatial units. Compared with available global crop calendars, RiceAtlas is nearly ten times more spatially detailed and has nearly seven times more spatial units, with at least two seasons of calendar data, making RiceAtlas the most comprehensive and detailed spatial database on rice calendar and production.

Case-control study of vaccination history in relation to pertussis risk during an outbreak among school students.

BACKGROUND: Between September and December 2003, an outbreak of pertussis occurred in Cass County, MO, mostly among adolescent school children. METHODS: We conducted a 1:2 matched case-control study among school children and used conditional logistic regression to evaluate risk factors for pertussis, including the total number of vaccine doses received, age at administration of each dose of vaccine and the type of vaccine (whole cell or acellular). RESULTS: Of all 127 pertussis cases reported in this outbreak, the majority were adolescents (10-19 years of age, 50%) and adults (20 years or older, 22%); only 10% were infants and children less than 5 years of age. Because the focus of our investigation was on school-aged children, we enrolled 237 students (79 cases and 158 controls) in our study. Students missing at least one dose of the vaccine had higher risk for pertussis than those who received all 5 doses (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.17-4.77). Early administration of the fifth dose of the vaccine at age 4 years was significantly associated with risk for pertussis compared with vaccination at age 5 years (adjusted OR, 2.45; 95% CI, 1.16-5.16). A short time interval (<36 months) between the fourth and fifth doses of the vaccine also tended to increase the risk for pertussis, although this association was not statistically significant. The type of vaccine was not a significant risk factor. CONCLUSION: Administering all 5 doses of pertussis vaccine and the fifth dose at age 5 years with at least 36 months between the fourth and fifth doses provided the best protection against pertussis among children and adolescents in this outbreak.

Counseling patients about sexual issues.

In recent years, the frequency of antidepressant drug-induced sexual dysfunction has increased, along with the use of new drugs for the treatment of erectile dysfunction and premature ejaculation. It has thus become common for pharmacists to counsel patients about sexual issues. Pharmacists must not only become knowledgeable about these drugs and their indications, but they must also become skilled and comfortable with counseling patients and answering questions from both patients and other health care providers. In addition to therapeutic information, pharmacists' discussions with patients should take into account factors that contribute to treatment nonadherence and treatment failure. Patient education is essential to ensure optimum outcomes for pharmacologic treatments for both erectile dysfunction and premature ejaculation. Improper use of phosphodiesterase-5 inhibitor drugs for erectile dysfunction accounts for most nonresponsiveness and discontinuation of treatment. Drug-induced sexual dysfunction is common with some psychotropic drugs. Up to 50% of men will experience delayed ejaculation, and at least 30% of men and women will experience anorgasmia from antidepressant drugs with serotonin agonist activity. Trazodone is the drug most commonly associated with the rare but very serious adverse effect of priapism. The pharmacist who is both competent and comfortable discussing sexual function and dysfunction with patients can make positive contributions to their therapeutic outcomes as well as their quality of life.

Sexual dysfunction and psychotropic medications.

Psychotropic drugs are often associated with sexual dysfunction. The frequency of antidepressant-associated sexual dysfunction is greatly underestimated in clinical trials that rely on patient self-report of these adverse events. Direct inquiry reveals that delayed orgasm/ejaculation occurs in >50% and anorgasmia in at least one third of patients given selective serotonin reuptake inhibitors. Antidepressant-induced sexual dysfunction can be successfully managed. A different antidepressant without significant sexual effects, such as bupropion or mirtazapine, can often be substituted. Other strategies involve drug holidays or adjunctive therapy with drugs such as sildenafil. Dopamine antagonist antipsychotic drugs are most commonly associated with decreased libido. The newer atypical antipsychotics, with less effect on dopamine, are less commonly associated with sexual dysfunction. Sexual dysfunction is commonly reported with seizure disorders, and many anticonvulsant drugs affect levels of sex hormones. Because sexual dysfunction can be related to many factors, care must be taken to establish the patient's baseline sexual functioning before the initiation of psychotropic drug therapy and to rule out other etiologies before drugs are implicated as causative.

Pharmacologic treatment strategies for sexual dysfunction in patients with epilepsy and depression.

Sexual dysfunction is a frequently encountered comorbid condition in patients with many medical and psychiatric conditions, such as epilepsy and depression. Most depressed patients experience some type of sexual dysfunction, decreased sexual desire being the most common. The association of sexual dysfunction with epilepsy is less clear. Changes in sex hormone levels are common in patients with epilepsy and may be attributable to the disease or to antiepileptic drugs (AEDs). Sexual dysfunction associated with depression or epilepsy is generally treated according to standard guidelines for the management of sexual disorders, since data from special populations are not available. The most common forms of female sexual dysfunction are lack of sexual desire and difficulty achieving orgasm. There are no approved pharmacotherapies for female hypoactive sexual desire disorder or female orgasmic disorder. Female sexual arousal disorder is treated with estrogen replacement therapy when indicated or vaginal lubricants. The most common male sexual dysfunction disorders are premature ejaculation and erectile dysfunction. Phosphodiesterase type-5 inhibitor drugs are now the first-line treatment for erectile dysfunction, and selective serotonin reuptake inhibitors and topical anesthetic creams are nonapproved but effective treatments for premature ejaculation. Testosterone and aromatase inhibitors have been used investigationally to treat sexual dysfunction in men taking AEDs. Patient education and follow-up appointments are essential to ensure optimal outcomes of pharmacologic treatments for sexual dysfunction.

Detecting and Managing Adverse Effects of Antipsychotic Medications: Current State of Play.

Antipsychotics are some of the most frequently prescribed medications not only for psychotic disorders and symptoms but also for a wide range of on-label and off-label indications. Because second-generation antipsychotics have largely replaced first-generation antipsychotics as first-line options due to their substantially decreased risk of extrapyramidal side effects, attention has shifted to other clinically concerning adverse events associated with antipsychotic therapy. The focus of this article is to update the nonextrapyramidal side effects associated with second-generation antipsychotics. Issues surrounding diagnosis and monitoring as well as clinical management are addressed.

Ziprasidone: an atypical antipsychotic drug for the treatment of schizophrenia.

BACKGROUND: Over the past decade, use of the atypical antipsychotic drugs clozapine, risperidone, olanzapine, and quetiapine has significantly changed the treatment of schizophrenia in the United States. The ability to make optimal drug choices will depend on determining whether there are clinically important differences between these drugs. OBJECTIVE: This review describes ziprasidone, the most recently introduced antipsychotic drug. Its mechanism of action, pharmacokinetics, and adverse-effect profile are discussed, and the results of clinical efficacy trials are summarized. METHODS: This review of ziprasidone is based on data from premarketing clinical efficacy and safety trials, a briefing document from the US Food and Drug Administration Psychopharmacological Drugs Advisory Committee, published studies, and abstracts presented at national and international meetings. International Pharmaceutical Abstracts and MEDLINE were searched for relevant citations, with no limitation on year. RESULTS: Ziprasidone has been reported to be an effective antipsychotic drug for both positive and negative symptoms of schizophrenia, and long-term use has been effective in preventing relapse. Its 5-hydroxytryptamine (HT)1D-antagonist and 5-HT(1A)-agonist activity are consistent with a potential for antidepressant and anxiolytic activity beyond its antipsychotic effects. Ziprasidone has been associated with a low incidence of sedative effects, a low likelihood of extrapyramidal symptoms and postural hypotension, and no anticholinergic effect, although it may cause transient hyperprolactinemia. Unlike most atypical antipsychotic drugs, ziprasidone is not associated with weight gain, hyperlipidemia, or elevated plasma glucose levels. It is, however, more likely than other atypical antipsychotic drugs to increase the QTc interval (QT interval corrected for heart rate). For acute psychotic symptoms in patients with schizophrenia, schizoaffective disorder, or acute mania, ziprasidone is administered twice daily at a usual daily dose of 80 to 160 mg, whereas 40 mg/d may be an effective maintenance dose. CONCLUSIONS: Differences in efficacy and tolerability between existing atypical antipsychotic drugs allow individualization of drug therapy for patients with schizophrenia or schizoaffective disorder. Ziprasidone differs from other atypical antipsychotic drugs in several clinically important ways, although further experience is necessary to clarify the significance of these differences.