Archive for November, 2015

Dealing with Dementia

November 28th, 2015

As the population ages worldwide, society must bear a series of burdens. One set stems from the increasing rate of dementia: Alzheimer, vascular, frontotemporal, Lewy body, mixed, and others. Medical science has found preventions for a few diseases, cures for a few more, and symptomatic relief for many others. But so far, science has been stymied in attempts to understand and cure the ravages of dementia. An upcoming issue of BTP will review current medications for Alzheimer disease and other dementias, but alas, efficacy is very limited. Someday we can expect preventions and cures, but today’s interventions are modest.

Doctors should seek to diagnose and treat coincident conditions that can trouble dementia patients and lead to disruptive behavior. Common examples are urinary tract and other infections, arthritic and other sources of pain, bedsores, and various ailments of the frail and elderly. Specific treatments like antimicrobials and nonspecific approaches like analgesics sometimes quell aggressive behavior. Of course, identifying environmental and interpersonal factors that can aggravate patients may allow for constructive intervention. Music, activities, and aromatherapies can soothe and comfort even advanced cases. We do what we can and always remember primum non nocere.

-Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Professor Emeritus, University of Arizona
Editor-in-Chief, Journal of Clinical Psychiatry

Clozapine

November 26th, 2015

I recently wrote about lithium as a “double-edged sword.” Clozapine is another—powerful, potentially life saving but, at the same time, life threatening. I am sad when I see young psychiatrists afraid of drugs like lithium, clozapine, and MAO inhibitors. They must be respected and prescribed with caution. But they have unsurpassed potential to help and to heal. Upcoming issues of BTP will feature new information about clozapine: including risks and possible benefits. Stay tuned.

-Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Professor Emeritus, University of Arizona
Editor-in-Chief, Journal of Clinical Psychiatry

Lithium

November 25th, 2015

Many people believe that natural products are safe and turn to compounds labeled “natural” (often erroneously) in the hope of symptom relief or cure. I often point to a host of medicines—old, highly efficacious, and potentially toxic—that come from plants or the earth. Examples are aspirin, digitalis, opium—and lithium. One of the oldest therapeutic agents in psychiatry, lithium is a salt of the earth and mined for a variety of uses, including batteries. In medicine, lithium is the proverbial double-edged sword: potentially life saving and, at the same time, potentially lethal. BTP will soon feature research highlighting some of this ion’s organ toxicity, as well as unexpected benefits for people who take it.

-Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Professor Emeritus, University of Arizona
Editor-in-Chief, Journal of Clinical Psychiatry