Blog

Medical Complications In Anorexia And Bulimia Nervosa

6/12/2018

SOURCE: DocGuide

BACKGROUND AND OBJECTIVE
Anorexia Nervosa (AN), Bulimia Nervosa (BN) and their variants are characterized by persistent alteration of eating behaviour, such as restricted intake or bingeing and purging, as well as excessive concerns about body shape and body weight. Purging behaviour may include self induced vomiting and/or abuse of laxatives, diuretics and physical hyperactivity. Unlike other psychiatric disorders, patients suffering from AN and BN have a high prevalence of many different medical complications, through the sequelae of undernutrition and purging, often with a serious impairment of health status and quality of life. This article describes the main diagnostic and clinical aspects of medical complications in AN and BN.

RESULTS
The medical complications of ED are extremely variable and can occur with only modest biological and physical damage up to extremely serious and life-threatening conditions; the mortality rate of young subjects with AN is 4 - 11% with a risk of death about 12 times higher than that of subjects of the same age of the general population. The management of the medical-internship aspects of AN and BN is rightly placed within complex and articulated programs of interdisciplinary treatment with different levels of intensity of care (outpatient, semi-residential/residential, hospital in cases of emergency/medical and/or psychiatric emergency).

CONCLUSION
The results of the investigations carried out, describe the functions of the various organs and apparatuses and the alterations detected, the possible complications and physiological adaptations to malnutrition.

REFERENCE:
Gravina G, Milano W, Nebbiai G, Piccione C, Capasso A; Endocrine, in Metabolic & Immune Disorders Drug Targets (May 2018)

FDA: Lamotrigine Linked to Potentially Life-Threatening Adverse Reaction

5/18/2018

SOURCE: MPR

The Food and Drug Administration (FDA) has issued a safety alert regarding the use of lamotrigine and the possibility of hemophagocytic lymphohistiocytosis (HLH), a rare but serious immune system reaction.

According to the FDA, 8 cases of confirmed or suspected HLH associated with lamotrigine have been reported worldwide (2 in the US). All of these cases were reported to have serious outcomes, with 1 reported death. Symptoms of HLH had occurred within 8 to 24 days after starting treatment with lamotrigine. In the 6 cases that reported dosing information, the doses ranged from 25mg every other day to 250mg once daily. In all but one case, HLH had improved after treatment (i.e., steroids, intravenous immunoglobulin, blood products, chemotherapy) and discontinuation of lamotrigine. While all 8 cases reported concomitant medications, none of these medications were associated with HLH.

Prompt recognition of HLH is important as severe inflammation can lead to multi-organ failure resulting in hospitalization and death. As per the FDA communication, a diagnosis of HLH can be made if a patient has ≥5 of the following symptoms:

Fever and rash
Splenomegaly
Cytopenias affecting ≥2 of 3 lineages in the peripheral blood (hemoglobin <90g/L [in infants <4 weeks: hemoglobin <100g/L; platelets <100 x 109/L; neutrophils <1.0 x 109/L)
Hypertriglyceridemia (fasting triglycerides ≥265mg/dL) and/or hypofibrinogenemia (≤1.5g/L)
High levels of blood ferritin (≥500µg/L)
Hemophagocytosis identified through bone marrow, spleen, or lymph node biopsy
Decreased or absent Natural Killer Cell activity
Elevated blood levels of CD25 showing prolonged immune cell activation (≥2400 U/mL)

Lamotrigine is indicated for the treatment of seizure disorders as well as bipolar I disorder. The FDA is requiring that a new warning be added to the prescribing information for all lamotrigine products to alert of this possible side effect. Patients should be counseled on the symptoms associated with HLH and should be advised to seek medical attention immediately if they experience these symptoms while on lamotrigine therapy.

The Origin of Spousal Resemblance for Alcohol Use Disorder

5/12/2018

SOURCE: JAMA Psychiatry

Key Points
What causes spouses to resemble one another in their risk for alcohol use disorder?

Findings
In this population-based registry study, the increase in risk for a first onset of alcohol use disorder in a married individual after the onset of alcohol use disorder onset in his or her spouse was large and rapid. When an individual was married in either order to serial partners with vs without alcohol use disorder, the risk for alcohol use disorder was substantially increased when the partner had an alcohol use disorder registration and decreased when the partner did not have an alcohol use disorder registration.

Meaning
A married individual’s risk for alcohol use disorder is likely directly and causally affected by the presence of alcohol use disorder in his or her spouse.

Abstract
Importance Although spouses strongly resemble one another in their risk for alcohol use disorder (AUD), the causes of this association remain unclear.

Objectives
To examine longitudinally, in first marriages, the association of a first registration for AUD in one spouse with risk of registration in his or her partner and to explore changes in the risk for AUD registration in individuals with multiple marriages as they transition from a spouse with AUD to one without or vice versa.

Design, Setting, and Participants
Population-wide Swedish registries were used to identify individuals born in Sweden between 1960 and 1990 who were married before the end of study follow-up on December 31, 2013. The study included 8562 marital pairs with no history of AUD registration prior to their first marriage and an AUD registration in 1 spouse during marriage and 4891 individuals with multiple marriages whose first spouse had no AUD registration and second spouse did or vice versa. Final statistical analyses were conducted from August 15 to September 1, 2017.

Exposures
A spousal onset or history of AUD registration.

Main Outcomes and Measures
Alcohol use disorder registration in national medical, criminal, or pharmacy registries.

Results
Among the 8562 marital pairs (5883 female probands and 2679 male probands; mean [SD] age at marriage, 29.2 [5.7] years) in first marriages, the hazard ratio of AUD registration in wives immediately after the first AUD registration in their husbands was 13.82, which decreased 2 years later to 3.75. The hazard ratio of AUD registration in husbands after the first AUD registration in their wives was 9.21, which decreased 2 years later to 3.09. Among the 4891 individuals with multiple marriages (1439 women and 3452 men; mean [SD] age at first marriage, 25.5 [4.2] years), when individuals transitioned from a first marriage to a spouse with AUD to a second marriage to a spouse without AUD, the hazard ratio for AUD registration was 0.50 (95% CI, 0.42-0.59) in women and 0.51 (95% CI, 0.44-0.59) in men. After a first marriage to a spouse without AUD, the hazard ratio for AUD with a second marriage to a spouse with AUD was 7.02 (95% CI, 5.34-9.23) in women and 9.06 (95% CI, 7.55-10.86) in men. These patterns were modestly attenuated when moving from second to third marriages. Controlling for AUD registration prior to first marriage or between first and second marriages produced minimal changes in risk.

Conclusions and Relevance
The increase in risk for AUD registration in a married individual following a first AUD registration in the spouse is large and rapid. When an individual with serial spouses is married, in either order, to partners with vs without an AUD registration, the risk for AUD registration is substantially increased when the partner has an AUD registration and decreased when the partner does not have an AUD registration. These results suggest that a married individual’s risk for AUD is directly and causally affected by the presence of AUD in his or her spouse.

KETO DIET IN HEALTHCARE - # 16 Summary & Conclusions

5/8/2018

Recently, as I've been exploring the role of an individual's diet in Integrated Psychiatry, I've seen a growing body of research to support the use of a Ketogenic-style diet to enhance brain functioning and help people achieve a healthy weight. There is additional research, which theorizes such a diet could be helpful for a number of mental health conditions from ADHD and depression to Alzheimer's Disease.

Just a few of the articles I've been looking at:

Dr. David Unwin, a family physician in England, has been treating patients with low carb diets since 2012. He is offering this online course that will cover very practical tips for doctors, like how to effectively discuss the low-carb lifestyle with patients, how to handle medications, safety, patient motivation, etc.

Transcript for Video #16 is HERE
The full course can be found: HERE

KETO DIET IN HEALTHCARE - # 15 Common problems & Troubleshooting

5/1/2018

Recently, as I've been exploring the role of an individual's diet in Integrated Psychiatry, I've seen a growing body of research to support the use of a Ketogenic-style diet to enhance brain functioning and help people achieve a healthy weight. There is additional research, which theorizes such a diet could be helpful for a number of mental health conditions from ADHD and depression to Alzheimer's Disease.

Just a few of the articles I've been looking at:

Dr. David Unwin, a family physician in England, has been treating patients with low carb diets since 2012. He is offering this online course that will cover very practical tips for doctors, like how to effectively discuss the low-carb lifestyle with patients, how to handle medications, safety, patient motivation, etc.

Transcript for Video #15 is HERE
The full course can be found: HERE

KETO DIET IN HEALTHCARE - # 14 Convincing colleagues

4/25/2018

Recently, as I've been exploring the role of an individual's diet in Integrated Psychiatry, I've seen a growing body of research to support the use of a Ketogenic-style diet to enhance brain functioning and help people achieve a healthy weight. There is additional research, which theorizes such a diet could be helpful for a number of mental health conditions from ADHD and depression to Alzheimer's Disease.

Just a few of the articles I've been looking at:

Dr. David Unwin, a family physician in England, has been treating patients with low carb diets since 2012. He is offering this online course that will cover very practical tips for doctors, like how to effectively discuss the low-carb lifestyle with patients, how to handle medications, safety, patient motivation, etc.

Transcript for Video #14 is HERE
The full course can be found: HERE

Curcumin: A Review of Its’ Effects on Human Health

4/23/2018

SOURCE: PubMed
AUTHORS: Susan J. Hewlings, Douglas S. Kalman

Abstract
Turmeric, a spice that has long been recognized for its medicinal properties, has received interest from both the medical/scientific world and from culinary enthusiasts, as it is the major source of the polyphenol curcumin. It aids in the management of oxidative and inflammatory conditions, metabolic syndrome, arthritis, anxiety, and hyperlipidemia. It may also help in the management of exercise-induced inflammation and muscle soreness, thus enhancing recovery and performance in active people. In addition, a relatively low dose of the complex can provide health benefits for people that do not have diagnosed health conditions. Most of these benefits can be attributed to its antioxidant and anti-inflammatory effects. Ingesting curcumin by itself does not lead to the associated health benefits due to its poor bioavailability, which appears to be primarily due to poor absorption, rapid metabolism, and rapid elimination. There are several components that can increase bioavailability. For example, piperine is the major active component of black pepper and, when combined in a complex with curcumin, has been shown to increase bioavailability by 2000%. Curcumin combined with enhancing agents provides multiple health benefits. The purpose of this review is to provide a brief overview of the plethora of research regarding the health benefits of curcumin.

Managing Geriatric Bipolar Disorder: Use of Lithium and Anticonvulsants

4/21/2018

SOURCE: Psychopharmacology Institute

If a patient is presenting with a first manic episode in late life, a medical cause should be considered.

In the case of a primary mania, the patient will have a history of treatment with first-line drugs and that history will give you some guidance as to what was effective in the past and what adverse effects could be expected. It is an unfortunate fact, however, that most elders will have to be treated with more than one drug to achieve remission from mania.

Treatment algorithms for mania and bipolar depression in geriatrics are the same as for the general adult population.

For mania, valproate, lithium and atypical antipsychotics are first line drugs. Drug combinations are introduced early and ECT is considered when first line combinations have failed.

For bipolar depression, valproate and atypical antipsychotics are first-line drugs with lithium and lamotrigine used early in combination therapy

For maintenance phase treatment, acute treatments that were well tolerated can be continued for prophylaxis. For this purpose, atypical antipsychotics, valproate and lithium are used. It is important that you look at published treatment algorithms for further details.

When mood stabilizers are used chronically in older patients, a gradual reduction in dose over time (meaning years) usually is required because of reduced renal and hepatic function.

In general, drug interactions are very problematic for mood stabilizers. For valproate and lithium, treatment is closely monitored with trough drug levels. Adverse effects of mood stabilizers are common and can be serious.

This is a first line drug for the treatment of acute mania in geriatrics and this is despite concerns about renal effects and toxicity with rapid dose escalation.

Clearance of lithium is directly proportional to GFR. You are advised to dose this drug in the elderly on a once nightly basis with an immediate acting formulation to allow the kidneys time to recover before the next nightly dose.

Serum levels are checked seven days after a dose change from eight to 12 hours after the last dose. That is a trough level.

In geriatrics, lithium serum levels are kept on the low side, between 0.4 and 0.8 mEq/L, even for the treatment of acute mania. This is so despite a poor correlation of serum levels with brain levels in elders.

Valproate. This also is a first line drug for bipolar disorder in elders.

The drug is very rapidly absorbed. Both food and the use of the enteric-coated form of Depakote slow absorption.

The extended-release formulation that is Depakote ER and sprinkles provide steadier serum levels with reduced peak level adverse effects.

Lamotrigine. It has actually been controversial whether lamotrigine should be considered a first line drug in the treatment of bipolar depression and for maintenance treatment in elders. The titration period for initiating this drug is lengthy in elderly patients and this limits its value as monotherapy

Carbamazepine. Now, this is not in fact a first-line drug for the treatment of elderly patients because of its adverse effects and drug interactions. The pharmacokinetics of this drug are complicated because of auto-induction.

The drug is also the great inducer, a significant CYP450 enzyme inducer, and so affects the levels of many other drugs, both psychotropic and non-psychotropic.

And then further, carbamazepine is associated with blood dyscrasias and dermatologic reactions, among many, many other adverse effects.

Alternative formulations of mood stabilizers. Alternative formulations include several IV products that are generally not used in psychiatric practice and oral solutions and suspensions and orally disintegrating form of lamotrigine.

So these latter formulations are probably better avoided in elders because of the rapid onset of action which puts frail elders at risk of adverse effects.

Key Points
For lithium, serum levels are kept low, even for the treatment of mania in elders. Between 0.4 and 0.8 mEq/L. Lithium should be dosed on a once nightly basis with an immediate-acting formulation.

For valproate, the extended-release formulation, Depakote ER and sprinkles, provide steadier serum levels with reduced peak level side effects.

For lamotrigine, the long titration period in elderly patients limits its value as monotherapy but it can be very useful used early in combination therapy.

References

Al Jurdi RK, Marangell LB, Petersen NJ, et al: Prescription patterns of psychotropic medications in elderly compared with younger participants who achieved a “recovered” status in the systematic treatment enhancement program for bipolar disorder. Am J Geriatr Psychiatry 16:922-933, 2008
Jacobson SA. Clinical Manual of Geriatric Psychopharmacology, 2nd Ed. Washington, DC: American Psychiatric Publishing, Inc., 2014.
D’Souza R, Rajji TK, Mulsant BH, et al: Use of lithium in the treatment of bipolar disorder in late-life. Curr Psychiatry Rep 13:488-492, 2011
Singh LK, Nizamie SH, Akhtar S, et al.: Improving tolerability of lithium with a once-daily dosing schedule. Am J Ther 18:288-291, 2011

KETO DIET IN HEALTHCARE - # 13 Cholesterol and Low Carb

4/18/2018

Recently, as I've been exploring the role of an individual's diet in Integrated Psychiatry, I've seen a growing body of research to support the use of a Ketogenic-style diet to enhance brain functioning and help people achieve a healthy weight. There is additional research, which theorizes such a diet could be helpful for a number of mental health conditions from ADHD and depression to Alzheimer's Disease.

Just a few of the articles I've been looking at:

Dr. David Unwin, a family physician in England, has been treating patients with low carb diets since 2012. He is offering this online course that will cover very practical tips for doctors, like how to effectively discuss the low-carb lifestyle with patients, how to handle medications, safety, patient motivation, etc.

Transcript for Video #13 is HERE
The full course can be found: HERE

FDA approves first once-monthly buprenorphine injection

4/16/2018

SOURCE: FDA

FDA approves first once-monthly buprenorphine injection, a medication-assisted treatment option for moderate-to-severe opioid use disorder

Agency encourages safe adoption and more widespread use of FDA-approved treatments to help combat opioid addiction

The U.S. Food and Drug Administration today approved Sublocade, the first once-monthly injectable buprenorphine product for the treatment of moderate-to-severe opioid use disorder (OUD) in adult patients who have initiated treatment with a transmucosal (absorbed through mucus membrane) buprenorphine-containing product. It is indicated for patients that have been on a stable dose of buprenorphine treatment for a minimum of seven days.

Buprenorphine for the treatment of OUD is currently approved to administer as a tablet or film that dissolves in the mouth, or as an implant. Sublocade provides a new treatment option for patients in recovery who may value the benefits of a once-monthly injection compared to other forms of buprenorphine, such as reducing the burden of taking medication daily as prescribed (medical adherence). An independent FDA advisory committee supported the approval of Sublocade at a meeting held last month.

"Given the scale of the opioid crisis, with millions of Americans already affected, the FDA is committed to expanding access to treatments that can help people pursue lives of sobriety. Everyone who seeks treatment for opioid use disorder deserves the opportunity to be offered the treatment best suited to the needs of each individual patient, in combination with counseling and psychosocial support, as part of a comprehensive recovery plan,” said FDA Commissioner Scott Gottlieb, M.D. “As part of our ongoing work in supporting the treatment of those suffering from addiction to opioids, the FDA plans to issue guidance to expedite the development of new addiction treatment options. We’ll continue to pursue efforts to promote more widespread use of existing, safe and effective FDA-approved therapies to treat addiction.”

Improving access to prevention, treatment and recovery services, including the full range of medication-assisted treatments (MAT), is a focus of the FDA’s ongoing work to reduce the scope of the opioid crisis and one part of the U.S. Department of Health and Human Services’ Five-Point Strategy to Combat the Opioid Crisis.

OUD is the diagnostic term used for a chronic neurobiological disease characterized by a problematic pattern of opioid use leading to significant impairment or distress and includes signs and symptoms that reflect compulsive, prolonged self-administration of opioid substances for no legitimate medical purpose or, if another medical condition is present that requires opioid treatment, the opioid is used in doses far greater than the amount needed for treatment of that medical condition.

MAT is a comprehensive approach that combines approved medications (currently, methadone, buprenorphine or naltrexone) with counseling and other behavioral therapies to treat patients with OUD. Regular adherence to MAT with buprenorphine reduces opioid withdrawal symptoms and the desire to use opioids, without causing the cycle of highs and lows associated with opioid misuse or abuse. At proper doses, buprenorphine also decreases the pleasurable effects of other opioids, making continued opioid abuse less attractive. According to the Substance Abuse and Mental Health Services Administration, patients receiving MAT for their OUD cut their risk of death from all causes in half.

Sublocade should be used as part of a complete treatment program that includes counseling and psychosocial support. Sublocade is a drug-device combination product that utilizes buprenorphine and the Atrigel Delivery System in a pre-filled syringe. It is injected by a health care professional (HCP) under the skin (subcutaneously) as a solution, and the delivery system forms a solid deposit, or depot, containing buprenorphine. After initial formation of the depot, buprenorphine is released by the breakdown (biodegradation) of the depot. In clinical trials, Sublocade provided sustained therapeutic plasma levels of buprenorphine over the one-month dosing interval.

The safety and efficacy of Sublocade were evaluated in two clinical studies (one randomized controlled clinical trial and one open-label clinical trial) of 848 adults with a diagnosis of moderate-to-severe OUD who began treatment with buprenorphine/naloxone sublingual film (absorbed under the tongue). Once the dose was determined stable, patients were given Sublocade by injection. A response to MAT was measured by urine drug screening and self-reporting of illicit opioid use during the six-month treatment period. Results indicated that Sublocade-treated patients had more weeks without positive urine tests or self-reports of opioid use, and a higher proportion of patients had no evidence of illicit opioid use throughout the treatment period, compared to the placebo group.

The most common side effects from treatment with Sublocade include constipation, nausea, vomiting, headache, drowsiness, injection site pain, itching (pruritus) at the injection site and abnormal liver function tests. The safety and efficacy of Sublocade have not been established in children or adolescents less than 17 years of age. Clinical studies of Sublocade did not include participants over the age of 65.

The FDA is requiring postmarketing studies to assess which patients would benefit from a higher dosing regimen, to determine whether Sublocade can be safely initiated without a dose stabilization period of sublingual buprenorphine, to assess the feasibility of administering Sublocade at a longer inter-dose interval than once-monthly and to determine a process for transitioning patients with long-term stability on a transmucosal buprenorphine dose to a monthly dose of Sublocade without the use of a higher dose for the first two months of treatment (loading dose).

Sublocade has a boxed warning that provides important safety information, including the risks of intravenous self-administration. If the product were to be administered intravenously rather than subcutaneously, the solid mass could cause occlusion (blockage), tissue damage or embolus (solid material that is carried in the blood and can become lodged in a blood vessel, which can lead to death). Sublocade must be prescribed and dispensed as part of a Risk Evaluation and Mitigation Strategy (REMS) to ensure that the product is not distributed directly to patients. Sublocade will be provided to HCPs through a restricted program, administered only by HCPs in a health care setting, and will require health care settings and pharmacies that dispense Sublocade to complete an enrollment form attesting that they have procedures in place to ensure that Sublocade is dispensed only to HCPs and not directly to patients.

KETO DIET IN HEALTHCARE - # 12 Side Effects of Low Carb Diet

4/15/2018

Recently, as I've been exploring the role of an individual's diet in Integrated Psychiatry, I've seen a growing body of research to support the use of a Ketogenic-style diet to enhance brain functioning and help people achieve a healthy weight. There is additional research, which theorizes such a diet could be helpful for a number of mental health conditions from ADHD and depression to Alzheimer's Disease.

Just a few of the articles I've been looking at:

Dr. David Unwin, a family physician in England, has been treating patients with low carb diets since 2012. He is offering this online course that will cover very practical tips for doctors, like how to effectively discuss the low-carb lifestyle with patients, how to handle medications, safety, patient motivation, etc.

Transcript for Video #12 is HERE
The full course can be found: HERE

Association of Co-prescription Antimigraine Drugs and Antidepressants With Serotonin Syndrome

4/11/2018

SOURCE: JAMA
DATE: February 26, 2018

Association of Coprescription of Triptan Antimigraine Drugs and Selective Serotonin Reuptake Inhibitor or Selective Norepinephrine Reuptake Inhibitor Antidepressants With Serotonin Syndrome

Key Points
Questions  What is the risk of serotonin syndrome associated with concomitant use of triptans and selective serotonin reuptake inhibitor or selective norepinephrine reuptake inhibitor antidepressants and how did the use of these drugs change after the 2006 US Food and Drug administration warning about this risk?
Findings  In this data registry study of 47 968 patients prescribed triptans, the incidence of serotonin syndrome was 0 to 4 cases per 10 000 person-years of exposure to coprescription of triptans and selective serotonin reuptake inhibitor or selective norepinephrine reuptake inhibitor antidepressants. The proportion of patients who were coprescribed these drugs ranged from 21% to 29% and remained stable before and after the warning.
Meaning  Serotonin syndrome was rare in patients who were coprescribed triptans and selective serotonin reuptake inhibitor or selective norepinephrine reuptake inhibitor antidepressants; those with coexisting affective disorders and migraine need not forgo management of one condition to treat the other.

KETO DIET IN HEALTHCARE - # 11 Low Carb & Diabetes Medications

4/11/2018

Recently, as I've been exploring the role of an individual's diet in Integrated Psychiatry, I've seen a growing body of research to support the use of a Ketogenic-style diet to enhance brain functioning and help people achieve a healthy weight. There is additional research, which theorizes such a diet could be helpful for a number of mental health conditions from ADHD and depression to Alzheimer's Disease.

Just a few of the articles I've been looking at:

Dr. David Unwin, a family physician in England, has been treating patients with low carb diets since 2012. He is offering this online course that will cover very practical tips for doctors, like how to effectively discuss the low-carb lifestyle with patients, how to handle medications, safety, patient motivation, etc.

Transcript for Video #11 is HERE
The full course can be found: HERE

Comorbid Psychiatric Disease Is Associated With Lower Rates of Thrombolysis in Ischemic Stroke

4/7/2018

SOURCE: DocGuide - Stroke
DATE: January 2018

BACKGROUND AND PURPOSE
Intravenous thrombolysis (IVT) improves outcomes after acute ischemic stroke but is underused in certain patient populations. Mental illness is pervasive in the United States, and patients with comorbid psychiatric disease experience inequities in treatment for a range of conditions. We aimed to determine whether comorbid psychiatric disease is associated with differences in IVT use in acute ischemic stroke.
METHODS
Acute ischemic stroke admissions between 2007 and 2011 were identified in the Nationwide Inpatient Sample. Psychiatric disease was defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes for secondary diagnoses of schizophrenia or other psychoses, bipolar disorder, depression, or anxiety. Using logistic regression, we tested the association between IVT and psychiatric disease, controlling for demographic, clinical, and hospital factors.
RESULTS
Of the 325 009 ischemic stroke cases meeting inclusion criteria, 12.8% had any of the specified psychiatric comorbidities. IVT was used in 3.6% of those with, and 4.4% of those without, psychiatric disease (P<0.001). Presence of any psychiatric disease was associated with lower odds of receiving IVT (adjusted odds ratio, 0.80; 95% confidence interval, 0.76-0.85). When psychiatric diagnoses were analyzed separately individuals with schizophrenia or other psychoses, anxiety, or depression each had significantly lower odds of IVT compared to individuals without psychiatric disease.
CONCLUSIONS
Acute ischemic stroke patients with comorbid psychiatric disease have significantly lower odds of IVT. Understanding barriers to IVT use in such patients may help in developing interventions to increase access to evidence-based stroke care.

KETO DIET IN HEALTHCARE - # 10 Low carb & Blood Pressure Medications

4/4/2018

Recently, as I've been exploring the role of an individual's diet in Integrated Psychiatry, I've seen a growing body of research to support the use of a Ketogenic-style diet to enhance brain functioning and help people achieve a healthy weight. There is additional research, which theorizes such a diet could be helpful for a number of mental health conditions from ADHD and depression to Alzheimer's Disease.

Just a few of the articles I've been looking at:

Dr. David Unwin, a family physician in England, has been treating patients with low carb diets since 2012. He is offering this online course that will cover very practical tips for doctors, like how to effectively discuss the low-carb lifestyle with patients, how to handle medications, safety, patient motivation, etc.

Transcript for Video #10 is HERE
The full course can be found: HERE