Serotonin Reuptake Inhibitor Use, Depression, and Long-Term Outcomes After an Acute Coronary Syndrome: A Prospective Cohort Study.

Serotonin Reuptake Inhibitor Use, Depression, and Long-Term Outcomes After an Acute Coronary Syndrome: A Prospective Cohort Study.

JAMA Intern Med. 2013 May 13; 1-2
Rieckmann N, Kronish IM, Shapiro PA, Whang W, Davidson KW

HubMed – depression

Rapid Improvement of Acute Schizophrenia Symptoms After Intravenous Sodium Nitroprusside: A Randomized, Double-blind, Placebo-Controlled Trial.

JAMA Psychiatry. 2013 May 8; 1-9
Hallak JE, Maia-de-Oliveira JP, Abrao J, Evora PR, Zuardi AW, Crippa JA, Belmonte-de-Abreu P, Baker GB, Dursun SM

IMPORTANCE The treatment of schizophrenia remains a challenge, and the currently available antipsychotic drugs are slow acting and produce a number of adverse effects. OBJECTIVE To examine the effectiveness and safety of a single intravenous administration of sodium nitroprusside (0.5 ?g/kg/min for 4 hours) on the positive, negative, anxiety, and depressive symptoms in patients with schizophrenia. DESIGN Single-center, randomized, double-blind, placebo-controlled trial performed from March 9, 2007, to March 12, 2009. SETTING University teaching hospital in São Paulo, Brazil. PARTICIPANTS Twenty inpatients aged 19 to 40 years with a diagnosis of schizophrenia who were in the first 5 years of the disease who are taking antipsychotics. INTERVENTION Sodium nitroprusside administration. MAIN OUTCOME MEASURES The 18-item Brief Psychiatric Rating Scale and the negative subscale of the Positive and Negative Syndrome Scale. RESULTS After the infusion of sodium nitroprusside, a rapid (within 4 hours) improvement of symptoms was observed. The placebo and experimental groups had significant differences in the 18-item Brief Psychiatric Rating Scale total score and subscale scores, which persisted for 4 weeks after infusion. CONCLUSIONS The results clearly show a therapeutic effect of sodium nitroprusside. If this drug is approved for routine clinical use in patients with schizophrenia, this discovery will be an important advance in the pharmacologic treatment of this devastating disorder. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01548612. HubMed – depression

An Unusual Case of Dyspnea Solved by Multidisciplinary Approach.

Chest. 2012 Oct 1; 142(4_MeetingAbstracts): 1029A
Rangarajan S, Luckhardt T, Wille K, Nath H, Alexander B

SESSION TYPE: Miscellaneous Cases IIPRESENTED ON: Tuesday, October 23, 2012 at 11:15 AM – 12:30 PMINTRODUCTION: Challenging cases are gratifying when they are solved by pooling of inputs by experts in multiple disciplines. We present one such case of a young woman who was breathless for two years.CASE PRESENTATION: A 40 year old Caucasian female presented to our pulmonary clinic for evaluation of shortness of breath on exertion which she had had for two years. She had been extensively worked up elsewhere previously and given a diagnosis of cryptogenic organizing pneumonia after an open lung biopsy. She had been on steroid for a year, followed by Azathioprine currently, but had had no resolution of symptoms. The patient denied fevers, weight loss, night sweats, joint pains or skin rashes. She was a homemaker and had no pets. She denied exposure to birds, dusts or molds. Her past medical history was significant for hypothyroidism, depression and esophageal reflux. Family history was noncontributory. She denied tobacco or alcohol or recreational drug use. Examination was unremarkable except for scattered bibasilar crackles. Routine blood counts and complete metabolic profile were unremarkable. Connective tissue disease panel was negative for all markers. Pulmonary Function Testing revealed a severe restrictive defect. High Resolution CT of the chest followed by VATS lung biopsy were repeated, representative cuts of which are shown in Figures 1 and 2. As features were concerning for aspiration, the patient was interviewed again. She admitted to applying liberal quantities of Vicks VapoRub(TM) cream to her nostrils at bed-time for several years to date. A diagnosis of Chronic Exogenous Lipoid Pneumonia was made. The patient was advised to stop using the cream the way she did. Azathioprine was stopped and steroid was tapered.DISCUSSION: Chronic Exogenous Lipoid Pneumonia (LP) is an uncommon condition occuring due to recurrent inhalation exposure to oil present in food, oil based medications or laxatives. Clinical symptoms are nonspecific. HRCT may show presence of consolidations with areas of fat attenuation. The opacities are typically peribronchovascular with predominant lower lobe involvement. The condition is characterized by presence of lipid-laden macrophages that fill and distend the alveoli and interstitium, where there may be accumulation of lipid material, inflammatory cellular infiltration and variable amount of fibrosis. Open lung biopsy is usually needed only when transbronchial biopsy is unrevealing. There is no clear therapeutic option. The key measure is identifying and discontinuing exposure to the offending agent.CONCLUSIONS: Diagnosis of chronic exogenous LP is difficult as the history is often missed. A high index of suspicion and meticulous history-taking are rewarding.1) Marchiori E et al. Exogenous lipoid pneumonia. Clinical and radiological manifestations. Respir Med (2011) 105, 659-6662) Betancourt SL et al. Lipoid Pneumonia: Spectrum of Clinical and Radiologic Manifestations. Am J Roentgenol. 2010; 194(1):103-9DISCLOSURE: The following authors have nothing to disclose: Sunad Rangarajan, Tracy Luckhardt, Keith Wille, Hrudaya Nath, Bruce AlexanderNo Product/Research Disclosure InformationUniversity of Alabama at Birmingham, Birmingham, AL. HubMed – depression