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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Atypical antipsychotic medications are associated with different adverse effects and efficacy profiles compared with conventional antipsychotics (i.e. less extrapyramidal symptoms, improved-efficacy against negative symptoms and cognitive deficits, and most often a greater ability to improve patients' quality of life). However, the atypical antipsychotics may be associated with clinically significant bodyweight gain, increasing the risk of medical comorbidity, including diabetes mellitus, hypertension, cardiovascular disease and hyperlipidaemia. This literature review assesses the various bodyweight gain liabilities associated with atypical antipsychotics, as well as the effects of bodyweight gain on quality of life. The issue of prevention and management of this often neglected adverse effect is also examined. Most studies reviewed indicate that clozapine and olanzapine are associated with more bodyweight gain than the other atypical antipsychotics. There are potential factors that place certain patients at greater risk for bodyweight gain, including low pretreatment body mass index, young age and being of female gender. Furthermore, bodyweight gain associated with the use of atypical antipsychotics has been reported to be associated with clinical improvement, although this has not been substantiated widely. It is unclear whether increased medical comorbidity, including diabetes mellitus, coronary artery disease and/or elevated triglyceride levels, is secondary to the bodyweight gain associated with atypical antipsychotics, or the result of the agents themselves. A patient's quality of life may be greatly affected by excessive bodyweight gain; either by increased comorbid medical illness, an increased relapse rate associated with noncompliance, or the social stigma associated with being obese. However, most studies reveal that treatment with atypical antipsychotic medications is associated with improved quality of life compared with that achieved with conventional antipsychotic medications. Because bodyweight is an important health risk associated with atypical antipsychotics, prevention and effective management of bodyweight are paramount in preventing comorbid medical illness, relapse and possible noncompliance.
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PMID:Bodyweight gain associated with atypical antipsychotics: epidemiology and therapeutic implications. 1151 Jun 24

This paper reviews the available scientific evidence that relates racism to the elevated rates of hypertension for African Americans. Societal racism can indirectly affect the risk of hypertension by limiting socioeconomic opportunities and mobility for African Americans. Racism can also affect hypertension by 1) restricting access to desirable goods and services in society, including medical care; and 2) creating a stigma of inferiority and experiences of discrimination. This paper evaluates the available evidence for perceptions of discrimination. African Americans frequently experience discrimination and these experiences are perceived as stressful. Several lines of evidence suggest that stressors are positively related to hypertension risk. Exposure to racial stressors under laboratory conditions reliably predicts cardiovascular reactivity and such responses have been associated with longer-term cardiovascular risk. Few population-based studies have examined the association between exposure to racial discrimination and hypertension, and the findings, though suggestive of a positive association between racial bias and blood pressure, are neither consistent nor clear. However, the existing literature identifies important new directions for the comprehensive measurement of discrimination and the design of rigorous empirical studies that can evaluate theoretically derived ideas about the association between discrimination and hypertension.
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PMID:Racism, discrimination and hypertension: evidence and needed research. 1176 5

Erectile dysfunction (ED) is defined as the inability to achieve and maintain a penile erection which is adequate for satisfactory sexual intercourse. It is a significant male health problem affecting approximately 150 million men worldwide. This value is expected to more than double by the year 2025. The incidence of ED increases sharply with age since it is a common cross-cultural denominator, affecting 19 to 64% of men aged 40 to 80 years, both in developing and industrialized countries. Epidemiological studies may underestimate the true dimensions of the problem because of the embarrassment or stigma that is associated with ED. Men with ED may experience diminished self-image and self-esteem, anxiety and fears of rejection, and even depression as psychogenic factors. Pathologic conditions which are commonly encountered in the ageing male (diabetes, hypertension, atherosclerosis, cardiovascular disease, etc) as well as chronic diseases (arthritis, renal and hepatic failure, pulmonary disease) represent a frequent cause of organic ED and are often treated with medications that can interfere with sexual function at central and/or peripheral level. In addition, incorrect lifestyle--i.e. obesity, cigarette smoking, alcohol or drug abuse--may all contribute to the onset of ED. Finally, trauma or surgery affecting either the nervous system or interfering with the blood supply to the penis are associated with increased incidence of ED.
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PMID:Pathology of erection. 1283 29

We assessed stigma affecting employment, health insurance, and friendships in 1,187 depressed patients from 46 U.S. primary care clinics. We compared stigma associated with depression, HIV, diabetes, and hypertension. Finally, we examined the association of depression-related stigma with health services use and unmet need for mental health care during a 6-month follow-up. We found that 67% of depressed primary care patients expected depression related stigma to have a negative effect on employment, 59% on health insurance, and 24% on friendships. Stigma associated with depression was greater than for hypertension or diabetes but not HIV. Younger men reported less stigma affecting employment. Women had more employment-related stigma but this was somewhat mitigated by social support. Other factors associated with stigma included ethnicity (associated with health insurance stigma) and number of chronic medical conditions (associated with health insurance and friendship related stigma). Stigma was not associated with service use, but individuals with stigma concerns related to friendships reported greater unmet mental health care needs. In summary, stigma was common in depressed primary care patients and related to age, gender, ethnicity, social support and chronic medical conditions. The relationship between stigma and service use deserves further study in diverse settings and populations.
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PMID:Stigma and depression among primary care patients. 1297 21

Obesity is an epidemic disease that threatens to inundate health care resources by increasing the incidence of diabetes, heart disease, hypertension, and cancer. These effects of obesity result from two factors: the increased mass of adipose tissue and the increased secretion of pathogenetic products from enlarged fat cells. This concept of the pathogenesis of obesity as a disease allows an easy division of disadvantages of obesity into those produced by the mass of fat and those produced by the metabolic effects of fat cells. In the former category are the social disabilities resulting from the stigma associated with obesity, sleep apnea that results in part from increased parapharyngeal fat deposits, and osteoarthritis resulting from the wear and tear on joints from carrying an increased mass of fat. The second category includes the metabolic factors associated with distant effects of products released from enlarged fat cells. The insulin-resistant state that is so common in obesity probably reflects the effects of increased release of fatty acids from fat cells that are then stored in the liver or muscle. When the secretory capacity of the pancreas is overwhelmed by battling insulin resistance, diabetes develops. The strong association of increased fat, especially visceral fat, with diabetes makes this consequence particularly ominous for health care costs. The release of cytokines, particularly IL-6, from the fat cell may stimulate the proinflammatory state that characterizes obesity. The increased secretion of prothrombin activator inhibitor-1 from fat cells may play a role in the procoagulant state of obesity and, along with changes in endothelial function, may be responsible for the increased risk of cardiovascular disease and hypertension. For cancer, the production of estrogens by the enlarged stromal mass plays a role in the risk for breast cancer. Increased cytokine release may play a role in other forms of proliferative growth. The combined effect of these pathogenetic consequences of increased fat stores is an increased risk of shortened life expectancy.
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PMID:Medical consequences of obesity. 1518 Oct 27

Weight gain is associated with the use of many psychotropic medications, including antidepressants, mood stabilizers, antipsychotic drugs, and may have serious long term consequences: it can increase health risks, specifically from overweight (BMI = 25-29.9 kg/m2) to obesity (BMI > or =30 kg/m2), according to Body Mass Index (BMI), and the morbidity associated therewith in a substantial part of patients (hypertension, coronary heart desease, ischemic stroke, impaired glucose tolerance, diabetes mellitus, dyslipidemia, respiratory problems, osteoarthritis, cancer); according to patients, psychosocial consequences such as a sense of demoralization, physical discomfort and being the target of substantial social stigma are so intolerable that they may discontinue the treatment even if it is effective. The paper reviews actual epidemiological data concerning drug induced weight gain and associated health problems in psychiatric patients : there is a high risk of overweight, obesity, impaired glucose tolerance, diabetes mellitus, premature death, in patients with schizophrenia or bipolar disorder; and the effects of specific drugs on body weight: Tricyclic Antidepressants (TCA) induced weight gain correlated positively with dosage and duration of treatment, more pronounced with amitriptyline ; Selective Serotonin Reuptake Inhibitors (SSRI) decrease transiently bodyweight during the first few weeks of treatment and may then increase bodyweight; weight gain appears to be most prominent with some mood stabilizers (lithium, valproate); atypical antipsychotics tend to cause more weight gain than conventional ones and weight gain, diabetes, dyslipidemia, seem to be most severe with clozapine and olanzapine. Conceming the underlying mechanisms of drug induced weight gain, medications might interfere with central nervous functions regulating energy balance; patients report about: increase of appetite for sweet and fatty foods or "food craving" (antidepressants, mood stabilizers, antipsychotic drugs) and weight gain despite reduced appetite which can be explained by an altered resting metabolic rate (TCA, SSRI, Monoaminoxidase Inhibitors MAO I). According to current concepts, appetite and feeding are regulated by a complex of neurotransmitters, neuromodulators, cytokines and hormones interacting with the hypothalamus, including the leptin and the tumor necrosis factor system. The pharmacologic mechanisms underlying weight gain are presently poorly understood: maybe the different activities at some receptor systems may induce it, but also genetic predisposition. Understanding of the metabolic consequences of psychotropic drugs (weight gain, diabetes, dyslipidemia) is essential: the insulin-like effect of lithium is known; treatment with antipsychotic medications increases the risk of impaired glucose tolerance and diabetes mellitus. Several management options of weight gain are available from choosing or switching to another drug, dietary advices, increasing physical activities, behavioural treatment, but the best approach seems to attempt to prevent the weight gain : patients beginning maintenance therapy should be informed of that risk, and nutritional assessment and counselling should be a routine part of treatment management, associated with monitoring of weight, BMI, blood pressure, biological parameters (baseline and three months monitoring of fasting glucose level, fasting cholesterol and triglyceride levels, glycosylated haemoglobin). Psychiatrics must pay attention to concomitant medications and individual factors underlying overweight and obesity. Weight gain has been described since the discovery and the use of the firstpsychotropic drugs, but seems to intensify with especially some of the second generation antipsychotic medications ; understanding of the side effects of psychotropic drugs, including their metabolic consequences (weight gain, diabetes, dyslipidemia) is essential for the psychiatrics to avoid on the one hand a risk of lack of compliance, a discontinuation of the pharmacological medication and also a risk of relapse and rehospitalization, and on the other hand to avoid acute life threatening events (diabetic ketoacidocetosis and non ketotic hyperosmolar coma, long term risk complications of diabetes and overweight).
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PMID:[Psychotropic drugs induced weight gain: a review of the literature concerning epidemiological data, mechanisms and management]. 1638 18

The aim of this study was to explore and compare explanatory models (EMs) of hypertension in native-Dutch, first-generation Ghanaian and African-Surinamese (Surinamese) hypertensives in Amsterdam, the Netherlands. Through semi-structured interviews, we elicited accounts of the nature, causes and consequences of hypertension in a purposive sample of 46 patients (aged 35-65 years, treated for hypertension in general practice >1 year). All three groups had difficulty in describing hypertension. All groups mentioned culturally specific nutritional habits as possible causes of hypertension (Dutch liquorice; Ghanaians fufu; Surinamese salty diet). Most respondents, particularly those of Ghanaian and Surinamese background, perceived stress as the main cause of hypertension and experienced symptoms of hypertension. Many Ghanaian and Surinamese respondents attributed hypertension to migration-related factors: changes in diet or climate, stress owing to adaptation to the Dutch society or obligations towards family in their homelands. Many immigrants felt a return to their homeland could cure hypertension and were concerned about the consequences of hypertension. Half of the Dutch and almost all Ghanaian and Surinamese respondents believed uncontrolled hypertension could cause immediate damage. Some Ghanaians expressed reservations sharing their concerns with community members because it might cause social stigma. Few respondents associated hypertension with obesity, even though many were overweight. Confirming findings from UK and US studies, this study reveals that EMs of hypertension in patients from three ethnic groups differ from the common medical perspective. These differences are greater for patients from migrant groups. Our findings can be useful in developing patient-centred hypertension interventions, particularly in new migrant populations.
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PMID:'Under pressure': How Ghanaian, African-Surinamese and Dutch patients explain hypertension. 1705 Dec 38

Many medical conditions are caused or exacerbated by heavy drinking, necessitating alcohol screening and discussion in primary care practices. This is particularly true of hypertension, the most common primary diagnosis in the United States, which has been linked to the regular consumption of 3 or more standard alcoholic beverages a day. The Accelerating Alcohol Screening-Translating Research into Practice (AA-TRIP) project was designed to improve detection and management of alcohol problems in primary care patients with hypertension. Medical providers are being trained using the Practice Partner Research Network's- Translating Research into Practice (PPRNet-TRIP) quality improvement model. This includes a multi-method intervention (electronic medical records, on-site academic detailing, practice feedback reports and annual network meetings) to help practices increase adherence to clinical guidelines. Qualitative analyses of initial steps taken by nine primary care practices toward the routine implementation of alcohol screening guidelines are presented. Organizational factors and provider and patient characteristics all influenced the method and consistency of alcohol screening and intervention. Perceived time constraints, patient sensitivity to questions about alcohol, and possible stigma associated with a diagnosis of alcoholism were also relevant barriers requiring problem solving.
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PMID:Initial steps taken by nine primary care practices to implement alcohol screening guidelines with hypertensive patients: the AA-TRIP project. 1706 46

We examined AIDS stigma among male inmates and male and female staff at a state prison in the southern region of the USA. Inmates and staff rated people with AIDS more negatively than someone with other diseases (diabetes, cancer, heart disease and high blood pressure). Inmates and staff were concerned about being treated differently if they tested seropositive. They also described AIDS stigma as a barrier to seeking HIV testing. Both instrumental (inaccurate beliefs about casual contact causing transmission of the virus) and symbolic factors (negative attitudes about injection drug use) predicted AIDS stigma. Negative attitudes about homosexuality predicted AIDS stigma among Caucasian prison staff and inmates, but not among African American staff and inmates. The results indicate the need to address HIV/AIDS stigma in developing HIV treatment, care and prevention programs in the prison environment.
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PMID:AIDS stigma among inmates and staff in a USA state prison. 1848 46

This article addresses the challenge of developing HIV prevention interventions that not only prove to be efficacious but also are designed from the outset to overcome obstacles to reaching priority populations. We describe how community input has informed development of Keep It Up (KIU), a community health screening and behavioral prevention program for young Black men. KIU embeds HIV prevention in a broader health promotion campaign, with the goal of reducing stigma and reaching a population that bears a disproportionate burden of HIV/AIDS and other health problems-hypertension, high cholesterol, diabetes, asthma, and obesity. Information from community partners, expert advisers, and focus groups was collected at key junctures and incorporated into four core components: social marketing, a computerized behavioral learning module, biological testing for HIV and other conditions, and a personalized health profile and risk reduction plan. A pilot with 116 participants provided evidence that the KIU model of integrating HIV prevention with other health screening is acceptable and has the potential to reach Black men at risk for HIV as well as other chronic health conditions.
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PMID:Keep It Up: development of a community-based health screening and HIV prevention strategy for reaching young African American men. 1967 Sep 66


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