摘要:

Depressive symptoms are extremely common in the general population and, particularly, in the medically ill. The diagnostic criteria for a major depressive disorder set a clinical threshold for the forms of depression requiring specific treatment. However, the criteria require a specialised psychiatric interview and are difficult to use outside of psychiatry. For screening purposes, self-rating questionnaires have been proposed, but none have appeared to be completely satisfactory. There is much evidence that depression in the medically ill is frequently unrecognised and untreated.The diagnostic criteria for major depression are the essential tools for case identification and inclusion in studies (particularly if involving experiments in therapeutics, such as drug trials). However, they do not provide an adequate threshold for intensity of symptoms and, in some cases, should be supplemented by other instruments.It is only in recent years that it has become apparent that, despite effective treatments, the longer term outcome in depression is still problematic. Current treatment protocols appear to be largely inadequate in relapse prevention. Screening for depressive relapse and subclinical symptomatology that entails considerable prognostic value thus becomes of considerable value. Such screening requires a conceptual shift from current oversimplified views on assessment and course of depressive episodes based on psychometric principles to multimodal, clinically derived approaches according to clinimetric principles. Depression appears to be more and more a potentially chronic and greatly invalidating disease that represents a major challenge to modern healthcare.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

The prevalence of cardiovascular morbidity and mortality can be decreased by artificially lowering arterial blood pressure (BP), even in asymptomatic individuals. However, the actual impact of such intervention has not been as great as that predicted from epidemiological studies.The earlier estimates of benefit from reducing BP have concerned reductions in diastolic BP, with the effect of reductions in systolic BP, and in particular interventions for isolated systolic hypertension, being less well investigated. Moreover, the advent of oscillometric BP recording, ambulatory BP monitoring and home-based self-assessment, and the phasing out of mercury sphygmomanometers, will all require a number of assumptions to be made about the equivalence of historical BP data with values measured by different, newer techniques.A number of studies using newer antihypertensive agents or aimed at specific therapeutic questions are under way or planned. These are summarised in this review. Although the traditional and most straightforward assessment of response to treatment is by regular auscultatory sphygmomanometric assessment of brachial BP, the availability of more advanced techniques should be factored into studies and may prove useful in clinical routine.Any reduction in either diastolic or systolic BP is beneficial to vascular health. Therefore, interventions that are known to reduce BP should be encouraged in all hypertensive patients. Pharmacological intervention should commence when nonpharmacological treatment has not achieved target BP. Delay must be avoided in ‘high risk’ patients in whom early therapy is indicated. Other cardiovascular risk factors should be attended to, especially cigarette smoking.The results of the Treatment of Mild Hypertension Study suggest that most antihypertensive agents achieve comparable results in lowering BP. Therefore, drug choice can be made on the basis of avoidance of adverse effects or other benefits, provided that outcomes data on mortality and morbidity are available for the drug being considered. If the target BP is not achieved by the first choice drug, a second drug should be added.Elevated BP is only one modifiable cardiovascular risk factor and should not be treated in isolation; concurrent treatment of hyperglycaemia and dyslipidaemias should be actively pursued.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Alcoholism is a source of enormous morbidity and mortality. Depressive disorders occur commonly in the course of alcoholism and affect its outcome. While the exact relationship of depression and alcoholism for most patients is controversial, it is probably heterogenous, with much depression resulting from the toxic effects of alcohol and at least some representing an independent disorder.Studies to date have shown that antidepressant medication is efficacious both in patients who are alcohol dependent with primary depression, and who are alcohol dependent with secondary depression which persists during abstinence. Antidepressants are not effective in reducing drinking in nondepressed patients. Among depressed patients who are alcohol dependent, antidepressants appear to decrease drinking among those whose depression responds. In the case of selective serotonin reuptake inhibitors (SSRIs), one study suggests that they may possibly also decrease drinking by a direct mechanism. Currently, SSRIs appear to be the treatment of choice for patients who are alcohol dependent with comorbid depression.Effective management of alcoholism with depression requires accurate syndromal diagnosis of depressive and other comorbid disorders. Ideally, this is done during a period of abstinence. Even when this is not possible, antidepressant treatment can be administered effectively. Careful monitoring and concurrent psychosocial treatment is essential for optimal outcomes. Treatment-resistant depression is managed as in non-comorbid cases. Treatment-resistant alcoholism may be managed by more intensive psychosocial treatment, addition of naltrexone, supervised disulfiram treatment or inpatient treatment. Future studies should further clarify the genetic relationship of the disorders and the optimal psychopharmacological and psychotherapeutic treatment strategies.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Asthma is a chronic inflammatory disease of the airways characterised by circadian and episodic symptoms, including wheezing, breathlessness, chest tightness and/or cough. It is one of the most common chronic diseases in adults and children, affecting approximately 15 million people in the US alone. Asthma is associated with considerable direct costs (e.g. hospitalisation, emergency care and drug therapy) and indirect costs (e.g. loss of income, loss of school days and premature death).Patient education and objective parameters of assessment are important aspects of asthma management. With the recognition of the need to reduce the underlying airways inflammation, the regular use of anti-inflammatory drugs [e.g. inhaled corticosteroids, nedocromil or sodium cromoglycate (cromolyn sodium)] is currently recommended for prophylaxis of asthma. Inhaled short-acting bronchodilators are used intermittently for relief of acute asthma symptoms.Salmeterol is a long-acting inhaled&bgr;2-agonist that produces significant bronchodilation and protects against asthma induced by a number of broncho-constricting stimuli (including exercise) for at least 12 hours. In clinical trials of up to 12 months' duration in patients with mild to moderate asthma, inhaled salmeterol 50&mgr;g twice daily was more effective than short-acting inhaled&bgr;2-agonists [salbutamol (albuterol) and terbutaline] in improving lung function, alleviating symptoms and reducing the requirement for additional inhaled salbutamol. Salmeterol was at least as effective as sustained-release theophylline in controlling nocturnal asthma symptoms. Recent studies have shown that addition of salmeterol to existing low dosage inhaled corticosteroid therapy is more beneficial than increasing the dosage of inhaled corticosteroids in patients with inadequate control of asthma symptoms. Salmeterol has been well tolerated in clinical trials and there is no convincing evidence to suggest that long term use of salmeterol increases asthma morbidity or mortality. Regular use of long-acting&bgr;2-agonists such as salmeterol may result in some decreased protection against induced bronchoconstriction, but clinically significant tachyphylaxis to broncho-dilatory response has not been demonstrated.It is important to emphasise that inhaled long-acting&bgr;2-agonists, including salmeterol, should be used in conjunction with, and not as a replacement for, oral or inhaled corticosteroids. Long-acting&bgr;2-agonists should always be used in conjunction with anti-inflammatory drugs (and short-acting&bgr;2-agonists for symptom relief).In conclusion, available data and recommendations from recent UK and US asthma guidelines suggest that inhaled salmeterol is effective in preventing exercise-induced asthma and, when added to low dose inhaled corticosteroids, is a useful alternative to increasing the inhaled corticosteroid dosage for long term control of symptoms (especially those occurring at night).

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS