Underrecognized Zieve's syndrome, A case report.

Zieve's syndrome (ZS) is a triad of hemolytic anemia, cholestatic jaundice and hyperlipidemia that presents in the setting of alcohol abuse and liver disease. ZS is not well known and remains underdiagnosed. We present a case of ZS in a 38-year-old female with a history of chronic alcohol abuse and pancreatitis to raise awareness of ZS. It is important for ZS to be recognized promptly to avoid unnecessary and possibly harmful interventions.

'Less like a drug than a drug': the use of St John's wort among people who self-identify as having depression and/or anxiety symptoms.

OBJECTIVE: St John's wort (SJW) is one of the most commonly used complementary medicines (CM) for the self-treatment of depression which can be accessed with or without health professional advice. While there is evidence to support its effectiveness in depression it has potential for serious side effects and interactions with many pharmaceuticals and herbs. Despite the potential risks, we know little about consumer perspectives on the use of SJW. Our research aimed to understand, from their own perspective, how and why people use SJW for management of self-identified 'depression, stress or worries'. DESIGN: A qualitative design, focusing on understanding the reasons for SJW use. A purposive sampling strategy was used to recruit 41 people who self-identified as having used SJW for 'depression stress or worries' from the community in Melbourne, Australia. In-depth face-to-face interviews were conducted. Interviews were taped, transcribed and analysed thematically. RESULTS: Three themes emerged as to why participants used SJW - ease of access of SJW, perceptions of effectiveness and safety of SJW enabling control over its use, and the perceived benefits of using a natural product. Generally, participants did not reserve use of SJW only for mild depressive symptoms. CONCLUSIONS: People use many self-care strategies to manage symptoms of depression, including more severe symptoms. While there is often a preference for more natural approaches like SJW, people experiment and continue to use what they perceive is most effective for them.

St John's wort use in Australian general practice patients with depressive symptoms: their characteristics and use of other health services.

BACKGROUND: While depression is frequently managed by general practitioners, often patients self-manage these symptoms with alternative therapies, including St John's wort (SJW). We tested whether use of SJW was associated with different patterns of conventional and complementary health service use, strategies used for management of depression, or user dissatisfaction with or lack of trust in their general practitioner or clinic overall. METHODS: Secondary analysis of data collected from an Australian population screened for a longitudinal cohort study of depression. Main outcome measures were CES-D for depressive symptoms, satisfaction with their general practitioner (GPAQ), Trust in Physician scale, self-report of health services usage and strategies used to manage depression, stress or worries. RESULTS: Response rate was 7667/17,780 (43.1%). Of these, 4.3% (320/7,432) had used SJW in the past 12 months (recent 'SJW users'). SJW users were significantly more likely to be depressed and to have a higher CES-D score. There were no statistically significant differences between recent SJW users and non-SJW users in satisfaction with their general practice or in trust in their general practitioner (GP) when adjusted for multiple factors. SJW users were significantly more likely to use all health services, whether conventional or complementary, as well as other strategies used for mental health care. SJW users were also more likely to consider themselves the main carer for their depression. CONCLUSIONS: Primary care attendees with symptoms of depression who use SJW appear not to be rejecting conventional medicine. Rather, they may be proactive care seekers who try both conventional and complementary strategies to manage their depressive symptoms. If GPs enquire and find that their depressed patients are using SJW, this may indicate that they might explore for unrelieved symptoms of depression and also consider the issue of potential for interactions between SJW and other medicines.