Abstract:
:Our review describes potential weight-altering effects of psychotropic medications (antipsychotics, antidepressants, anti-anxiety medications, mood stabilizers, sedative-hypnotics, medications for attention-deficit/hyperactivity disorder, and other psychotropic medications) and offers guidance on switching a medication if its weight-altering effect becomes problematic. For second-generation antipsychotics, the risk of weight gain is high with clozapine and olanzapine, low with amisulpride, aripiprazole, and ziprasidone, and medium with other second-generation antipsychotics. Switching from a high-risk antipsychotic to a low-risk antipsychotic usually mitigates or reverses weight gain. For second-generation antidepressants, there may be modest weight loss with bupropion and modest weight gain with mirtazapine and paroxetine. Other second-generation antidepressants are weight neutral but individual variations can occur. If significant change in weight occurs, switching to or adding a low-risk second-generation antidepressant should be considered. Mood stabilizers include lithium, valproate, carbamazepine, lamotrigine, oxcarbazepine, and most second-generation antipsychotics. Risk of weight gain is high with lithium and valproate and low with carbamazepine, lamotrigine, and oxcarbazepine. Given the complexity of bipolar disorder and its management, a switch of a mood stabilizer would be best done by a psychiatrist. Benzodiazepines, non-benzodiazepine and melatonergic hypnotics, doxepin, and trazodone are weight neutral. Diphenhydramine may cause weight-gain and can be switched to a weight-neutral hypnotic if needed. Stimulants can cause varying degrees of weight loss and switching to atomoxetine or bupropion may reverse this problem. If that fails, switching to clonidine or guanfacine can be tried. Switching must be evidence-based and take into account status of the condition being treated, efficacy, side effect profile, potential drug-drug interactions, required laboratory monitoring and cost of the drug(s) being considered, and patient's pregnancy status or plan. Non-pharmacological interventions both for mental disorders and overweight/obesity must be fully availed.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Hasnain M,Vieweg WVdoi
10.3810/pgm.2013.09.2706subject
Has Abstractpub_date
2013-09-01 00:00:00pages
117-29issue
5eissn
0032-5481issn
1941-9260journal_volume
125pub_type
杂志文章,评审abstract::In the past decade, significant progress has been made in the understanding and treatment of Alzheimer's disease. Modest success has been achieved using new drugs in treatment of mild symptoms of the disease. Vitamin E, estrogen, and NSAIDs may slow the progression of Alzheimer's disease, but their routine use is not ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1999.10.15.746
更新日期:1999-10-15 00:00:00
abstract::Although a great deal of investigation has led to some novel approaches in treating primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC), no method has been proven to definitively alter the long-term outcome of either disease. In addition, many of the medical regimens reviewed in this article have ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1993-11-01 00:00:00
abstract::Patients with chronic pelvic pain are challenging, from both diagnostic and therapeutic viewpoints. At the pain clinic at the Medical College of Georgia School of Medicine, Augusta, we have discovered over the past 3 years that psychiatric disease is probably underrecognized in these patients and that physicians are o...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1993-12-01 00:00:00
abstract:BACKGROUND:Prescription opioids have substantial abuse potential. This study compared the positive subjective drug effects of a newly developed extended-release (ER) oxycodone (OC)/acetaminophen (acetyl-para-aminophenol [APAP]) formulation with those of immediate-release (IR) OC/APAP. METHODS:This randomized, double-b...
journal_title:Postgraduate medicine
pub_type: 杂志文章,随机对照试验
doi:10.3810/pgm.2014.07.2780
更新日期:2014-07-01 00:00:00
abstract::Systolic dysfunction of the heart represents a state of "prerenal" azotemia, in which the excess of total body salt and water is redistributed to venous and interstitial fluid compartments. This results in a diminished effective circulating blood volume and thereby decreases tissue perfusion. The kidneys perceive the ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-06-01 00:00:00
abstract::Systolic hypertension, especially isolated systolic hypertension (ISH) is very common in older subjects aged ≥ 65 years and is a major risk factor for cardiovascular disease (CVD), strokes, heart failure (HF) and chronic kidney disease (CKD). It is also, directly and linearly related with these complications irrespect...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2018.1433434
更新日期:2018-03-01 00:00:00
abstract::While the appropriateness of giving medical advice on the telephone could be debated, this discussion is based on the assumption that few physicians can avoid providing this service to their patients. In fact, most physicians must respond often to telephone requests for advice. A large portion of these "emergency" cal...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11699699
更新日期:1987-02-01 00:00:00
abstract::Sleep is increasingly being recognized as an important factor in the homeostasis of multiple body functions, including blood glucose metabolism. One of the most common sleep disorders, obstructive sleep apnea, is not only highly prevalent in patients with type 2 diabetes mellitus, but may contribute to the development...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2012.07.2573
更新日期:2012-07-01 00:00:00
abstract::Runny noses, sneezing, nasal congestion, and other nuisance symptoms are part and parcel of primary care practice. But how can you quickly discern which symptoms are related to common colds and which stem from allergic rhinitis? Careful history taking usually provides clues, but allergy testing may be needed when trig...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1997.05.240
更新日期:1997-05-01 00:00:00
abstract::Stroke survivors can be plagued by numerous medical complications, including aspiration pneumonia, heart disease, depression, and venous thromboembolism. Given the impairment already caused by stroke itself, these patients require careful management by a comprehensive rehabilitation team. Dr Harvey discusses common st...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1998.08.552
更新日期:1998-08-01 00:00:00
abstract::A 15-year-old boy who had sharp pains in the right side of the chest and was unable to breathe deeply was tentatively diagnosed as having congenital cystic disease of the lung on the basis of chest x-ray studies and bronchography. The diagnosis was confirmed after thoracotomy and right lower lobectomy, carried out bec...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1984.11697960
更新日期:1984-03-01 00:00:00
abstract::Hepatitis C virus (HCV) is responsible for most cases of non-A non-B hepatitis and is primarily spread by a parenteral route, although familial, sexual, and maternal transmission may occur rarely. Second-generation assays and the polymerase chain reaction facilitate detection of HCV infection. The association between ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-05-01 00:00:00
abstract::The primary care physician can often delineate the cause of chest pain in a patient under 21 years of age after a thoughtful, careful, and thorough history and physical examination. Occasionally, an ECG and a chest x-ray film may be helpful. Noncardiac causes for the chest pain should be explored, and if found, the ch...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1983.11697888
更新日期:1983-06-01 00:00:00
abstract:BACKGROUND:In October 2012, the American College of Rheumatology (ACR) published recommendations for chronic gout treatment goals and pharmacotherapy. OBJECTIVES:Identify potential gaps between real-world chronic gout treatment, ACR guideline recommendations, and physicians' perceived guideline adherence by evaluating...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2014.05.2774
更新日期:2014-05-01 00:00:00
abstract::Non-steroidal anti-inflammatory drugs (NSAIDs) have been widely used to treat inflammatory pain for decades. More recently, newer NSAIDs were developed to target the inducible isoform of cyclooxygenase (COX), COX-2, with the aim of reducing gastrointestinal toxicity. While the COX-2 selective inhibitors were effective...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2018.1412799
更新日期:2018-01-01 00:00:00
abstract::In this review, we focus on current trends in the management of male lower urinary tract symptoms (LUTS), defined here as LUTS, namely, storage, voiding, and post-micturition symptoms presumed secondary to benign prostatic hyperplasia (BPH), and discuss possible novel approaches toward better care. According to result...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2018.1487238
更新日期:2018-06-01 00:00:00
abstract::Patients "lucky" enough to have a nondisabling transient ischemic attack as a warning sign of impending stroke deserve the best possible prophylactic treatment in an attempt to avert that catastrophe. Dr Edmeads provides a step-by-step discussion of diagnostic studies and therapeutic regimens that help avoid stroke in...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1992.11701427
更新日期:1992-08-01 00:00:00
abstract::There are three key goals in current management of the diabetic pregnancy. Normal diabetes control before conception and during the first trimester in an attempt to reduce the incidence of congenital abnormalities. This implies that all diabetic women of childbearing age should have counseling before pregnancy. Routin...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1985.11698879
更新日期:1985-02-01 00:00:00
abstract::Carotid endarterectomy for carotid artery stenosis is valuable for some patients, but not all. Results of clinical trials in symptomatic and asymptomatic patients provide guidance on use of this common vascular procedure. The authors of this article describe the controversies and concerns with the procedure and give t...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2000.5.15.1093
更新日期:2000-05-15 00:00:00
abstract::Phencyclidine (PCP) is a dissociative anesthetic whose abuse is a growing problem. Historically, its effects have been considered remarkably like those of the schizophrenic state, but in vitro and in vivo neuropharmacologic data are somewhat inconsistent with the dopaminergic hypothesis of schizophrenia. The physiolog...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715603
更新日期:1980-11-01 00:00:00
abstract::Cluster headache is a syndrome of severe head and facial pain accompanied by autonomic abnormalities. Men are affected more frequently than women. Headaches occur daily during periods of susceptibility, which may be followed by periods of remission. The etiology of cluster headache is uncertain. Recent work suggests t...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1992.11701227
更新日期:1992-02-15 00:00:00
abstract::Evidence from epidemiologic, lipid intervention, and coronary angiographic studies demonstrates the importance of high-density lipoprotein cholesterol (HDL-C) in coronary artery disease (CAD) risk. Data from these studies strongly support the measurement of HDL-C in all patients screened for CAD. Patients with low lev...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1990.11704654
更新日期:1990-05-15 00:00:00
abstract::Many medical conditions that clearly have a strong genetic component are not transmitted in a straightforward dominant, recessive, or X-linked pattern. Recent progress in understanding other modes of inheritance, such as imprinting, trinucleotide repeat expansion, mitochondrial inheritance, and mosaicism, has allowed ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2000.09.1.1210
更新日期:2000-09-01 00:00:00
abstract::Pregabalin is one of the first-line treatments approved for the management of neuropathic pain (NeP). While many patients benefit from treatment with pregabalin, they are often treated with suboptimal doses, possibly due to unfamiliarity around prescribing the drug and/or side effects that can occur with up-titration....
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2020.1857992
更新日期:2021-01-01 00:00:00
abstract:OBJECTIVES:There are no evidence-based recommendations to screen for iron deficiency in non-anemic patients, even though symptoms may be present. The aim of this study is to measure the prevalence of iron deficiency (ID) without anemia in the general population aged 18-50 presenting to primary care along with the incid...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2020.1715701
更新日期:2020-04-01 00:00:00
abstract::All patients with chronic stable angina presumed to be due to coronary artery disease should undergo exercise stress testing early in evaluation for evidence of high-risk coronary disease. If the exercise stress test shows early positive findings, patients should undergo cardiac catheterization to exclude left main co...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1986.11699599
更新日期:1986-11-01 00:00:00
abstract::Gastroesophageal reflux disease is a very common condition that is usually manifested by heartburn or regurgitation. Reflux esophagitis, caused by mucosal exposure to the backflow of caustic gastric contents, is primarily a result of lower esophageal sphincter dysfunction. Diagnostic workup varies but commonly include...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1991.11700938
更新日期:1991-05-15 00:00:00
abstract::Politicians may have written a temporary obituary for healthcare reform, but as anyone in medicine knows, reform is alive and (debatably) well. Mergers, acquisitions, and practice changes are happening all across the land, and many a physician is going from being a small-business owner to being an employee. Difficult ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:
更新日期:1994-11-15 00:00:00
abstract::Stenosis in the right common iliac artery of a 61-year-old man was manifested as pain in the right leg and foot and cyanosis of the second and third toes. Dilatation of the lesion was performed using a Grüntzig catheter; arteriography and measurement of femoral artery pressure confirmed a successful result. The patien...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715543
更新日期:1980-09-01 00:00:00
abstract::The cause, depth, and location of a laceration are major determining factors in its treatment. In all cases, the wound must be completely cleansed with irrigation under pressure and then examined radiographically if necessary and debrided. Successful repair depends on understanding and using the principles of wound he...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1988.11700310
更新日期:1988-06-01 00:00:00