RESUMEN
Obsessive-compulsive disorder (OCD) is a chronic illness that can cause marked distress and disability. It is a complex disorder with a variety of manifestations and symptom dimensions, some of which are underrecognized. Early recognition and treatment with OCD-specific therapies may improve outcomes, but there is often a delay in diagnosis. Patients can experience significant improvement with treatment, and some may achieve remission. Recommended first-line therapies are cognitive behavior therapy, specifically exposure and response prevention, and/or a selective serotonin reuptake inhibitor (SSRI). Patients with OCD require higher SSRI dosages than for other indications, and the treatment response time is typically longer. When effective, long-term treatment with an SSRI is a reasonable option to prevent relapse. Patients with severe symptoms or lack of response to first-line therapies should be referred to a psychiatrist. There are a variety of options for treatment-resistant OCD, including clomipramine or augmenting an SSRI with an atypical antipsychotic. Patients with OCD should be closely monitored for psychiatric comorbidities and suicidal ideation.
Asunto(s)
Antipsicóticos/uso terapéutico , Enfermedad Crónica/tratamiento farmacológico , Terapia Cognitivo-Conductual , Trastorno Obsesivo Compulsivo/diagnóstico , Trastorno Obsesivo Compulsivo/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Quimioterapia Combinada , Educación Médica Continua , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
Most patients with cancer-related pain are managed using opioids; cancer-related pain in the setting of pregnancy can be challenging to address owing to risk to the fetus associated with in utero opioid exposure. Buprenorphine is a unique opioid with potential benefits over other opioids for use in pregnancy and is often used for management of cancer-related pain in nonpregnant adults. There are limited data on cancer-related pain management in pregnant patients and no data supporting the use of buprenorphine for cancer-related pain in pregnant patients. This case describes a rapid buprenorphine induction using a microdosing regimen in a pregnant patient and highlights the potential of buprenorphine for cancer-related pain in this population.
Asunto(s)
Buprenorfina , Dolor en Cáncer , Neoplasias , Trastornos Relacionados con Opioides , Complicaciones del Embarazo , Adulto , Analgésicos Opioides/uso terapéutico , Buprenorfina/uso terapéutico , Dolor en Cáncer/tratamiento farmacológico , Femenino , Humanos , Neoplasias/tratamiento farmacológico , Trastornos Relacionados con Opioides/tratamiento farmacológico , Manejo del Dolor , Embarazo , Complicaciones del Embarazo/tratamiento farmacológicoRESUMEN
In the United States more than 1 out of 3 women experiences lifetime intimate partner violence (IPV) victimization. Short screening instruments such as HITS or the AAS can identify IPV victimization. Nonjudgmental statements that validate an IPV victim's experience should be followed by safety assessment and planning. Intervention includes referral to services, treatment of associated health conditions, mandatory reporting if required, and documentation. Counseling has been shown to reduce IPV victimization. Clinical guidelines recommend IPV screening for all or most women, and providing or referring victims to intervention. The Affordable Care Act will increase coverage of screening and counseling for IPV victims.