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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obesity is a chronic and highly prevalent medical condition associated with increased risk for the development of numerous and sometimes fatal diseases. Despite its severity, there are few anti-obesity agents available on the market. Although psychotropic agents are not approved for the treatment of obesity, they have been used by clinicians as a therapeutic tool in daily clinical practice. The purpose of this article is to review the rationale, as well as the evidence, for the potential use of these agents in obesity treatment. Evidence for the efficacy of psychotropic agents in obesity treatment comes from different sources. The first type of evidence is weight loss observed with treatment in clinical trials of patients with neuropsychiatric syndromes (e.g. mood disorders, epilepsy). A recent example of such findings is the weight reduction reported in clinical trials involving obese patients with binge eating disorder. While randomised, controlled trials specifically designed to investigate the weight loss properties of psychotropic agents in obese patients are the most appropriate source of evidence of anti-obesity action, such trials remain scarce. The most studied psychotropic agents in obesity trials are drugs used in the treatment of mood disorders, i.e. mainly antidepressants and antiepileptics. SSRIs (e.g. fluoxetine, sertraline and fluvoxamine) were amongst the first psychotropic agents investigated in the treatment of obesity. Additional data have also been published for other antidepressants (e.g. venlafaxine, citalopram and bupropion) and antiepileptics (e.g. topiramate and zonisamide). Based on the available data for the efficacy of psychotropic agents in obesity and other related conditions, SSRIs may be considered for the management of certain subgroups of obese individuals with comorbid conditions such as depression, binge eating disorder and type 2 diabetes mellitus. In addition, some newer agents, such as bupropion, topiramate and zonisamide, appear to be promising candidates for selective use in the treatment of obesity. However, further studies are needed to define their possible role as new pharmacological options in the treatment of obesity.
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PMID:Psychotropic drugs in the treatment of obesity: what promise? 1527 May 93

Diabetes places an immense burden on U.S. healthcare delivery systems. The Centers for Disease Control and Prevention estimates the economic impact of diabetes at nearly 100 billion dollars a year. Diabetes affects 17 million people in the United States and ranks as the sixth leading cause of death. Diabetes is among the most psychologically and behaviorally demanding chronic medical illnesses and the presence of diabetes doubles the odds of comorbid depression. In addition, recent research demonstrates that depressive symptoms serve as a predictor of type 2 diabetes. Case managers should maintain a high index of suspicion for the possibility of depression in chronically ill clients, as the severity of depressive symptoms is associated with poorer treatment adherence and higher healthcare costs. Three valid and reliable tools available to support depression screening in the case management setting are presented.
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PMID:The relationship between diabetes and depression: improving the effectiveness of case management interventions. 1527 3

The purpose of this study was to test the reliability of the Well-being and Diabetes Treatment Satisfaction Questionnaires among clinic patients with type 2 diabetes as well as determine the clinical correlates of these measures. A cross-sectional survey was conducted using the Well-being Questionnaire and the Diabetes Treatment Satisfaction Questionnaire. Other demographic and clinical indices of age, sex, body mass index, disease duration and blood glucose levels were also recorded. 83 responses were analysed. Subjects were aged between 25 and 75 years, mean 55.5+/-11.1 years. 50.6% were males while 49.4% were females. Mean diabetes duration was 4.9+/-6.5 years. 67 (80.7%) were receiving oral agents and dietary modification while 16 (19.3%) were on insulin therapy. The internal consistency for responses to the well-being subscales and treatment satisfaction scale produced satisfactory alpha coefficients ranging from 0.73 to 0.88 and 0.74 respectively. Inter-item correlations were ranged between 0.19 and 0.45 for depression subscale; 0.22-0.78 for anxiety subscale; 0.33-0.58 for energy subscale; 0.33-0.79 for positive well-being subscale; and -0.22 to 0.79 for the treatment satisfaction scale. Item-total correlations ranged between 0.39 and 0.87 across the two scales: well-being (0.59-0.87) and treatment satisfaction (0.39-0.78). Mean scale scores were similar in both insulin and oral hypoglycaemic drug treated patients. Positive well-being was higher in males 13.4+/-4.1 vs. 11.5+/-4.3 in females p = 0.04. None of the well-being subscale scores, or treatment satisfaction correlated with age, disease duration, body mass index or glycaemic control. The well-being and treatment satisfaction scales are reliable instruments for the measurement of diabetes specific quality of life and treatment satisfaction in Nigerians although they were originally designed and developed among a UK population. It is hoped that our data would provide the basis for future comparisons and improving diabetes care.
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PMID:A test of the reliability and validity of a diabetes specific quality of life scale in a Nigerian hospital. 1547 7

The obese are subject to health problems directly relating to the carriage of excess adipose tissue. These problems range from arthritis, aches and pains, sleep disturbance, dyspnea on mild exertion, and excessive sweating to social stigmatization and discrimination, all of which may contribute to low quality of life and depression (Table 1). The most serious medical consequences of obesity are a result of endocrine and metabolic changes, most notably type 2 diabetes mellitus, cardiovascular disease, and increased risk of cancer. Not all obesity comorbidities are fully reversed by weight loss. The degree and duration of weight loss required may not be achievable by an individual patient. Furthermore, "weight cycling" may be more detrimental to both physical and mental health than failure to achieve weight loss targets with medical and lifestyle advice.
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PMID:Medical consequences of obesity. 1547 29

Although people age at different rates, changes to the composition of the human body are a hallmark of aging. As a result of such changes, disease can present differently in a person over 65 years old than it would in a younger adult or child. This article identifies the critical indicators of underlying conditions, including changes in mental status, loss of function, decrease in appetite, dehydration, falls, pain, dizziness, and incontinence. It also describes the presentation of diseases common to older adults, including depression, infection, cardiac disease, gastrointestinal disorders, thyroid disease, and type 2 diabetes.
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PMID:Presentation of illness in older adults. 1549 36

Hispanics in the United States have a disproportionately high risk for non-insulin-dependent diabetes mellitus (type 2 diabetes) compared with non-Hispanic whites. Little is known of the attitudes and beliefs about diabetes in this group. Using data from six focus groups of 42 Mexican Americans (14 men and 28 women), we characterized perceptions about the causes of and treatments for type 2 diabetes. Many participants believed diabetes is caused by having a family history of the disease, eating a diet high in fat or sugar, and engaging in minimal exercise. Experiencing strong emotions such as fright (susto), intense anger (coraje), or sadness and depression (tristeza) was also thought to precipitate diabetes. Nearly all participants expressed the belief that it is important to follow doctors' recommendations for diet and exercise, oral medication or insulin; many also cited herbal therapies, such as prickly pear cactus (nopal) and aloe vera (savila) as effective treatments. These findings may be useful in designing interventions to reduce the burden of diabetes in Hispanic populations.
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PMID:Attitudes and beliefs among Mexican Americans about type 2 diabetes. 1553 16

The prevalence of overweight and obesity in children is increasing rapidly. This is alarming because obesity is associated with severe chronic diseases, such as type 2 diabetes mellitus. Obesity at young age is related to obesity at adult age. Consequently, the prevention of overweight from childhood onwards is an important issue. Apart from diabetes mellitus type 2 there is an increased risk of orthopaedic complications, respiratory problems, fertility problems, cardiovascular diseases and psychosocial consequences in the form of a negative self-image, emotional and behavioural problems and depression. Environmental and behavioural factors are regarded as the most important causes of the rapid increase in the prevalence of overweight and as the most important starting points for prevention. Most prevention programmes are still in the initial stages. Prevention programmes aimed at stimulating breast feeding and daily physical activity (playing outside) and the restriction of sweetened drinks and watching TV are very promising. With such preventive measures the involvement of both the school and the parents is important.
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PMID:[Overweight and obesity in children and adolescents and preventative measures]. 1553 27

This paper represents a review of current opinion and information on the effective diagnosis of restless legs syndrome (RLS) in a primary care setting. RLS can be a distressing condition--it can cause serious sleep disturbance and has a significant impact on quality of life comparable to that of depression or type 2 diabetes. The prevalence of adults whose RLS is severe enough to warrant medical advice has been estimated to be approximately 3%, but only a small proportion of these patients currently report having been diagnosed in primary care, despite stating that they have presented to their GP. The benefits of increased understanding of the symptoms of RLS and how patients present in primary care are discussed, with emphasis on how this will help GPs more effectively diagnose and manage the patients affected. Guidelines on how to diagnose RLS in a primary care setting are given--when a patient presents with sleep disturbance, RLS should be routinely considered and, where existing, be readily diagnosed in a primary care setting on the basis of the patient's clinical history, a physical examination and with the aid of four questions based on the International RLS Study Group (IRLSSG) four essential diagnostic criteria.
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PMID:Diagnosing restless legs syndrome (RLS) in primary care. 1553 79

To examine the relationship between demographic, clinical and psychosocial variables and diabetes self-care management in Mexican type 2 diabetic patients. Cross-sectional study of 176 consecutive patients with type 2 diabetes aged 30-75 years, attending a tertiary health-care center in Mexico City. A brief medical history and previously validated questionnaires were completed. The study group consisted of 64 males/112 females, aged 55 +/- 11 years, mean diabetes duration of 12 +/- 8 years and HbA1c of 9.0 +/- 2.0%, 78.4% reported following the correct dose of diabetes pills or insulin, 58% ate the recommended food portions, and 44.3% did exercise three or more times per week. A good adherence to these three recommendations was observed in only 26.1% of the patients. These patients considered as a group were characterized by a greater knowledge about the disease (P < 0.00001), regular home blood glucose monitoring (P < 0.01), an inner perception of better diabetes control (P = 0.007), good health (P = 0.004) and better communication with their physician (P < 0.02). A poor adherence to two or the three main diabetes care recommendations was associated with a depressive state (OR 2.38, 95% CI 1.1-4.9, P < 0.01) and a history of excessive alcohol intake (OR 4.03, 95% CI 1.1-21.0, P = 0.03). Poor adherence to standard diabetes care recommendations is frequently observed in patients with type 2 diabetes attending a specialized health care center in Mexico City. Depression must be identified and treated effectively.
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PMID:Psychosocial factors associated with poor diabetes self-care management in a specialized center in Mexico City. 1558 64

Weight gain during treatment with psychotropic drugs is frequently observed and is assumed to be responsible for non-compliance and for an elevated risk to develop a number of somatic co-morbidities including cardiovascular disorders and type 2 diabetes. Absence of weight inducing effects is therefore a major objective for the development of new compounds. Recently, R121919, the first corticotropin releasing hormone receptor 1 (CRH1R) antagonist, was tested in major depression. Clinical efficacy, safety, and tolerability of this compound could be demonstrated. Since CRH is discussed to be involved in the regulation of appetite and weight, directly and via interaction with leptin, CRH1R antagonists are suspected to influence body weight. Effects of 30 days of treatment with the CRH1R antagonist R121919 on weight and leptin levels in 20 patients suffering from major depression were investigated. No significant weight changes during treatment with R121919 were observed. Furthermore, noeffects on plasma leptin concentrations were found. We conclude that treatment with the CRH1R antagonist R121919 does not affect weight or plasma leptin concentrations in patients with major depression. Together with previous findings indicating safety, tolerability, and clinical efficacy CRH1R antagonists are highly promising as a new treatment option in depression.
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PMID:Treatment with a CRH-1-receptor antagonist (R121919) does not affect weight or plasma leptin concentration in patients with major depression. 1558 65


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