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Microsoft word - understanding your medicine.doc
UNDERSTANDING YOUR MEDICINE The mainstay of treatment for those with severe mental illnesses is medication. This is not to undermine the value of psychotherapy, group therapy, case management, and other kinds of interventions. In fact, the evidence supporting the combination of psychotherapy with antidepressants as improving the outcome of depressive illnesses than either of the two treatments alone is quite compelling. The use of psychotherapy in schizophrenia is less beneficial but not without merit. It can improve compliance and problem solving. This article will focus on medications used for psychiatric illnesses. However, a person suffering from a mental illness would want to take advantage of appropriate services available to them to augment their treatment and improve the outcome. It is now commonly accepted that mental illnesses such as schizophrenia, bipolar disorder, depressives disorders, anxiety disorders, obsessive-compulsive disorder and others have a basis in faulty neurotransmitter activity in the brain. That is, the tiny amounts of chemicals carrying impulses from cell to cell are not functioning properly but there now are medicines to improve the brain chemistry. (Each of these illnesses is discussed in some detail under “FEATURED TOPICS” on the homepage of the Access Behavioral Health website.) SCHIZOPHRENIA Schizophrenia (and psychotic disorders in general) were originally treated with drugs that were effective in reducing the primary symptoms of hallucinations and delusions. These drugs came into being nearly five decades ago. The first such drug was Thorazine. Following this drug were many others. Haldol, Stelazine, Prolixin, Mellaril just to name a few. These original drugs came with an abundance of side-effects. Sedation, diminished alertness, cognitive slowing, tremor, restless legs, blood pressure changes, and, long term, a potentially irreversible continuous movement of some facial and truncal muscle groups know as tardive dyskinesia, just to name a few. Beginning in the 1990’s, introduced into the treatment of this illness was a new generation of medications. These medications included Zyprexa, Geodon, Risperdal, Seroquel, Abilify and the re-introduction of a very effective drug from the 1960’s, Clozaril. These medications did not cause the degree of cognitive slowing, sedation, restlessness, diminished alertness, and ran a far less risk of causing tardive dyskinesia. Treatment with these improved the outcome of the illness and the quality of life. They are not perfect drugs. They do come with a downside that must be appreciated and minimized as much as possible. If you have a mental illness or a family member, loved one or friend for whom you are a caretaker has a mental illness, and one of these medications is used in treatment, becoming a partner in the care with your doctor is very important. Know these things about the new generation of drugs:
One, they are very expensive. They are worth the cost when used appropriately, though. They can keep the ill person out of the hospital. Life’s quality is enhanced. If you find yourself on a combination of more than one of these drugs, ask your doctor to explain why you are on more than one. Certainly, some illnesses are difficult to treat and require polypharmacy. Others may respond to just one. Never alter your meds without consulting your doctor, though. Two, these medications as a group have the possibility of raising cholesterol and triglycerides in your blood. Proper monitoring and treatment can lower the risk of this happening. Always comply with lab tests ordered by your doctor. Thirdly, some of these medications can cause a rise in blood sugar. Again, complying with your doctor’s monitoring procedures is important. Fourth on the list of things to know is that with some of these medications weight gain is possible. Track this with your doctor. Abide by prescribed diets and exercise regimens. BIPOLAR DISORDER The interesting thing about the new generation of medications listed above as treatments for schizophrenia is that most of them are also effective for treating bipolar disorder. If these are prescribed for this illness, the same side-effects listed above are possible. Keep these in mind as you work with your doctor. One of the most frequently used medication treatments for mania is lithium carbonate. It was approved by the FDA nearly four decades ago. It remains a commonly used treatment because of its proven effectiveness. It is necessary to monitor the use of lithium not only by physical examination but also by laboratory tests. If the blood level gets too high it can lead to gait disturbance, confusion and even changes in consciousness. An overdose could be fatal. Also routine monitoring of kidney functions, thyroid functions and heart rhythm is necessary because in some cases it can lead to hypothyroidism (low thyroid), impaired kidney functioning and changes in the electrocardiogram. These are less likely to become severe and in some cases can be managed if compliance with the doctor’s prescribed monitoring is followed. Anticonvulsants (medicines known to control seizures) have been shown to be effective in treating manic depressive illness. The FDA has approved Depakote, Lamictal and Tegretol plus there are others that are effective and used legitimately as off label indications. These are in general well tolerated medications when dosing is in proper order. There are some take home points. Depakote can cause some bruising. Let your doctor know about that. Lamictal can cause a rash. Report that immediately. Tegretol decreases the effectiveness of birth control pills so an alternative may be needed if it is used. The above is a limited list of side-effects and is not intended to be complete.
Always ask your doctor for an explanation of this or your pharmacist for a handout on the side effect profile of the medications you take. DPRESSION The most prescribed medications in psychiatry are the antidepressants and the most prescribed antidepressants are the selective serotonin reuptake inhibitors. These include Paxil, Prozac, Zoloft, Celexa, Lexapro, and Luvox. Other very commonly used medications that are effective but work on either different brain chemicals (neurotransmitters) than serotonin, or serotonin plus additional neurotransmitters are Effexor, Cymbalta, Wellbutrin and Remeron. The first generations of antidepressants are also still used but much less frequently these days. These drugs such as Elavil, Tofranil, Sinequan, trazodone….just to name a few…are effective but tend to have more side-effects than the newer ones so are rarely used first line anymore. Here is the good news for those with depression. Statistically, if one took all of the illnesses in all the fields of medicine (heart disease, diabetes, etc) the success rate of treating depression rivals or is higher than the others when compliance is high with prescribed treatment. Add to this psychotherapy and the rate of improvement goes up further still. The underlying theme of being a partner with your doctor when treated with medication continues with this group of drugs as well. While these medications are not without side effects, they are easier to monitor and than others and generally well tolerated. Get drug profiles on these as well. ANXIETY DISORDERS The final group of illnesses discussed are the anxiety disorders. Panic attacks, generalized anxiety disorder, obsessive-compulsive disorder, phobias, etc. to name a few. These are highly treatable. Interestingly enough, several of the medications used for treating depression cross over and are used here as well. SSRIs are highly effective for OCD and panic attacks. Effexor XR and Lexapro have the FDA indication for generalized anxiety disorder. Other drugs in this family are also quite effective for treating these illnesses. Minor tranquilizers (Xanax, Ativan, etc.), while effective, have to be used with caution because they are habit forming (addictive) and are usually for short term usage. It is best to pursue treatment that can be used for extended periods. Again, psychotherapy can be quite effective for these illness in some cases and can shorten the time medications are used. With these medications always inquire about side effects and adverse events.
This has been an overview of medication treatment for the major psychaitric illnesses for which people present to a psychiatrist or other practioners hoping for effective treatment. Armed with this kind of knowledge, talking with your doctor will hopefully be facilitated. The next in this series of articles will be on ways to effectively communicate with your doctor.
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