Lege Artis Medicinae

[Interdisciplinary aspects of alcoholism and smoking from the perspective of primary care]

DARVAI László, RIHMER Zoltán, BALCZÁR Lajos, CSERHÁTI Zoltán, TÚRI Gergő, BÉLTECZKI Zsuzsa, KALABAY László, TORZSA Péter

JULY 20, 2017

Lege Artis Medicinae - 2017;27(06-07)

[There is a complex and multi-directional relationship between alcoholism, smoking, depression, anxiety disorders, cardiovascular disorders and type 2 diabetes. They are risk factors not only for each other but - because of their relationship with depression - also for suicide. The effect of successful therapy of depression and anxiety plays a role not only in reducing suicide but also in reduction of alcoholism, cardiovascular morbidity and mortality, and smoking. Therefore, the effect of the appropriate specific treatments appears (even to a lesser extent) also in the field of another medical discipline. On the other hand, the reduction of smoking may be - in addition to decreasing mortality and morbidity of chronic obstructive pulmonary disease, lung cancer, ischemic heart disease, and so on - a causal factor in decreasing suicidal morbidity and mortality, as well as in decreasing morbidity of depression. The purpose of this article is to raise awareness of the relevant professions and healthcare financiers and decision-makers to these hidden benefits (appearing in other fields of expertise). The presented data justify not only the better funding for Mental Health Services but also the extension of the competence of primary care physicians to the mild and moderate (not psychotic and not suicidal) depression and anxiety disorders. ]

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[INTRODUCTION - There are lot of evidence showing the efficacy of fulvestrant therapy in HER-2 negative, HR-positive advanced metastatic breast cancer. CASE REPORT - A 75-year-old female had a mastectomy, followed by series of adjuvant and radiotherapy about 30 years ago. Later cutan metastases were removed several times. The endocrine therapy had to be stopped because of intolerance. An ER, PR positive, HER-2 negative cutan metastasis was resected 7 years ago for the last time. During regular checkup, 5 years ago pulmonary nodule and bone metastases were found, - PET-CT disclosed multiple metastatic lymph nodes as well. We started fulvestrant and bisphosphonate therapy. Thereafter, as imaging revealed, the malignant disease has stabilized, the patient has a good performance status, her musculo-skeletal pain has a presumably degenerative origin. DISCUSSION - Reported case corroborates the potential efficacy of fulvestrant and ibandronate in hormone sensitive breast cancer with good prognostic markers, even in the case of metastases in soft tissue and bone. This case supports the data, that in patients with not progressive bone metastases the frequency of administration of parenteral bisphosphonates may be reduced to every 3 months. Advanced metastatic breast cancer may be converted to a chronic disease in properly selected cases, and it could mean long-term survival with a good quality of life.]

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[Objective - Although the primary purpose of the study reported here was to identify stroke risk factors among the residents of a village in eastern Hungary, the study also included a multi-faceted survey conducted in 1992-94 to ascertain the somatic, mental and socio-economic conditions of the residents. Here we report data from the survey on prevalence of mental disorders (a cross-sectional descriptive study). Method - The screenings included the following tests administered to 535 subjects: anxiety, depression, dementia, neurosis were measured; recent medical records were compared to survey data for 330 of the same subjects. Findings - The summary of prevalence of mental disorders measured in this study was as follows: anxiety 34.7% (severe), dementia 44.68% (mild), depression 66% (mild), 15.94% (medium), 7.88% (severe), neurosis 66.73% (mild, medium, and severe). Medical records maintained by village physicians since 1960 differed from the results obtained in the present study. A treatment gap was observed between mental health treatment for neurosis, as indicated by medical records, and the diagnostic prevalence of neurosis as measured by the survey instruments: there were three times as many people diagnosed as neurotic in the survey as had been noted in village medical records. Additionally, the unique position of cerebrovascular alteration was established between the mental and somatic factors. Conclusion - The study demonstrates the successful simultaneous collection of a wide spectrum of data on somatic conditions, mental disorders, and socio-economic status of the subjects. The study showed that 1. patientcentered medical care can simultaneously address both somatic and mental factors; 2. it is possible to decrease the treatment gap in mental health; 3. there is value in systematic collection of data in order to optimize the planning of prevention, health care costs and decision making.]

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[Alcoholism is one of the best-known addictions. The results of both international and national surveys illustrate the health consequences of the excessive consumption of alcoholic beverages, and its link with alcoholic disease and the associated dangers, but we still find a high proportion of people who show unrestrained consumption. Is there a genuine desire to recover, is there motivation, and where should one look for help? Such assistance could take the form of a self-help group, where addicts who want to quit, those in the various stages of recovery, or those who have already recovered, can meet up. The aim is to achieve and maintain abstinence, and prevent a relapse. The author presents the process and benefits of self-help, from the perspective of addiction. Her study proves that the treatment of alcoholism requires a complex approach, and one in which we can ascribe a key role to self-help groups.]

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Lege Artis Medicinae

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[Diabetes and depression are frequent comorbidities. They are a heavy burden by themselves, however, as comorbidities increase additionally the number of diabetes-related complications, morbidity, and mortality. In the background of interrelations, there are both well-known and hypothetical mechanisms. The aim of the present review is to outline these interrelations between antidepressants and diabetes and to discuss the effect of medications on carbohydrate metabolism respectively. Anti­depressant treatment on the one hand may improve mood, cognitive function and medication adherence leading to an improved glucose metabolism, on the other hand through their metabolic side effects, they may worsen carbohydrate metabolism. Concerning metabolic side effects, selec­tive serotonin reuptake inhibitors are the sa­fest, while tricyclic antidepressants and mo­noamine oxidase inhibitors should be administered under close monitoring. Se­rotonin and noradrenaline reuptake inhibitors may deteriorate gly­cae­mic control via increased noradre­nergic activation. Novel antidepressants, how­ever, have a neutral or positive impact on gly­caemic measures. Screening for and temporally adjusted treatment of depres­sion may decrease the risk of comorbidities ge­nerated complications. While caring for diabetic patients with depression, one should consider metabolic side effects of antidepressants and close monitoring of carbohydrate metabolism.]