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The prescriber’s guide to classic MAO inhibitors (phenelzine, tranylcypromine, isocarboxazid) for treatment-resistant depression
- Vincent Van den Eynde, Wegdan R. Abdelmoemin, Magid M. Abraham, Jay D. Amsterdam, Ian M. Anderson, Chittaranjan Andrade, Glen B. Baker, Aartjan T.F. Beekman, Michael Berk, Tom K. Birkenhäger, Barry B. Blackwell, Pierre Blier, Marc B.J. Blom, Alexander J. Bodkin, Carlo I. Cattaneo, Bezalel Dantz, Jonathan Davidson, Boadie W. Dunlop, Ryan F. Estévez, Shalom S. Feinberg, John P.M. Finberg, Laura J. Fochtmann, David Gotlib, Andrew Holt, Thomas R. Insel, Jens K. Larsen, Rajnish Mago, David B. Menkes, Jonathan M. Meyer, David J. Nutt, Gordon Parker, Mark D. Rego, Elliott Richelson, Henricus G. Ruhé, Jerónimo Sáiz-Ruiz, Stephen M. Stahl, Thomas Steele, Michael E. Thase, Sven Ulrich, Anton J.L.M. van Balkom, Eduard Vieta, Ian Whyte, Allan H. Young, Peter K. Gillman
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- Journal:
- CNS Spectrums / Volume 28 / Issue 4 / August 2023
- Published online by Cambridge University Press:
- 15 July 2022, pp. 427-440
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- Article
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This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.
92741 Racial differences in patient-reported distress among women with endometrial cancer
- Hadley Reid, Mary Katherine Montes de Oca, Oluwadamilola M. Fayanju, Laura J. Havrilesky, Brittany A. Davidson
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- Journal:
- Journal of Clinical and Translational Science / Volume 5 / Issue s1 / March 2021
- Published online by Cambridge University Press:
- 31 March 2021, pp. 86-87
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ABSTRACT IMPACT: This work will inform and improve the way we assess and treat distress in women with endometrial cancer. OBJECTIVES/GOALS: Distress from cancer is associated with worse processes of care. Differences in outcomes by race/ethnicity in endometrial cancer (EC) are well documented, but differences in distress have not been previously explored. Here we characterize the association between race/ethnicity, distress scores, and stressors reported by patients with EC. METHODS/STUDY POPULATION: Patients presenting to a single academic outpatient gynecologic oncology practice for initial evaluation of known EC from January 2013-May 2020 were included. The electronic health record was used to abstract demographics, National Comprehensive Cancer Network Distress Thermometer and Problem List (NCCN DT) scores and stressor categories (physical, emotional, spiritual, practical, and family) from the initial encounter. Referral to support services occurs at NCCN DT score ≥4. We excluded women who received prior cancer-directed therapy and those without an initial NCCN DT score. Summary statistics were tabulated for demographics. Mann-Whitney U tests were used for inter-group difference on continuous variables and 2-sample tests for equality of proportions were used for binary variables. RESULTS/ANTICIPATED RESULTS: 412 non-Hispanic White (NHW, mean age 63) and 149 non-Hispanic Black (NHB, mean age 65) women were included in our analysis. More NHB women presented with high-grade EC (53.7%) vs NHW women (21.9%) and fewer NHB women were privately insured (32% vs 52%). Median distress scores were higher in NHW women compared to their NHB counterparts (4 vs. 2, p<0.001) and NHB women were more likely to report a distress score of 0 compared to their NHW counterparts (32% vs 19%, p=0.001). 50.5% NHW women had a score ≥4 and thus qualified for referral to services compared to 20.7% of NHB women (p=0.02). Of those referred, NHB and NHW women declined referral to support services at similar rates (35.1% vs 34.5%; NS). There was a significant difference in the median number of stressors reported by NHW and NHB women, (4 vs 3 stressors; p=0.02). DISCUSSION/SIGNIFICANCE OF FINDINGS: The NCCN DT, a widely used tool in cancer clinics, may fail to adequately measure distress in NHB women presenting with a diagnosis of EC, despite >30% more high-risk histology cancers in this cohort. This difference leads to disparities in referral to additional support services, which may affect quality of care and quality of life.
16 - Psychophysiological aspects of chronic stress following trauma
- from Part IV - Responses to trauma across the life cycle
- Edited by Robert J. Ursano, Uniformed Services University of the Health Sciences, Maryland, Brian G. McCaughey, Uniformed Services University of the Health Sciences, Maryland, Carol S. Fullerton, Uniformed Services University of the Health Sciences, Maryland
- Foreword by Beverley Raphael
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- Book:
- Individual and Community Responses to Trauma and Disaster
- Published online:
- 13 October 2009
- Print publication:
- 24 February 1994, pp 360-377
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Summary
Exposure to traumatic events has been associated with a range of phenomena ranging from mild distress to more severe outcomes such as posttraumatic stress disorder (PTSD). At the heart of many of these outcomes is the stress process, which under acute conditions can be considered adaptive and essential for survival. To be sure, stress due to trauma is a normal response, despite the fact that emotional and psychophysiological processes may be at abnormal levels for a period of time. Disordered responses may follow an event which is outside the realm of normal human experience and which involves extreme threat or privation, including natural disasters, humanmade events such as war, fires, airplane crashes, chemical, nuclear, or toxic accidents, and more individual level traumas such as victimization by crime, rape, or automobile accidents. The vast majority of victims of these events experience only transient symptoms and recover readily. However, some victims appear to experience long-lasting stress following some kinds of trauma. Under some conditions, stress appears to persist and may form the basis of PTSD. In such cases, abnormal levels of response persist for abnormally long periods of time. Davidson and Baum (1986) suggested that situations which are not necessarily intense, but which pose lasting threats, may be associated with persistent symptoms of stress, arid that these chronic stress reactions are very similar to posttraumatic stress disorder, and may differ only in the intensity of the symptoms.