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Cureus Nov 2023Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder widely recognized for its recurrent obsessions and compulsions, which may cause severe impairment... (Review)
Review
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder widely recognized for its recurrent obsessions and compulsions, which may cause severe impairment worldwide. This review explores the difficulties in diagnosing OCD, its comorbidities, and its treatment approaches. Psychiatry and neuroscience face noteworthy obstacles in treating OCD, which is frequently misdiagnosed and inadequately addressed. This illness, which causes upsetting symptoms that interfere with day-to-day living, affects not only adults but also children and adolescents to a great extent. Despite the availability of multiple therapy methods, such as pharmacological and psychological approaches, many patients exhibit resistance, emphasizing the necessity for alternative therapies. OCD and other psychiatric conditions like bipolar disorder, schizophrenia, and attention deficit hyperactivity disorder substantially overlap, highlighting the complexity of mental health diagnoses. Furthermore, its comorbidity with these diseases further highlights OCD's intricacy. Several therapy considerations have been mentioned, such as using larger dosages of medications and combining different therapeutic approaches. Their association suggests possible common pathogenic pathways between OCD and other psychiatric illnesses. The review concludes that, given the significant number of people who still struggle with chronic symptoms, new treatment techniques and ongoing research are necessary, even in the face of improvements in the understanding and treatment of OCD.
PubMed: 38111433
DOI: 10.7759/cureus.48960 -
Advances in Therapy Oct 2023Atrial fibrillation (AF) and renal insufficiency often coexist and are increasingly prevalent with advancing age. Both the risk of thromboembolic events and bleeding... (Review)
Review
Atrial fibrillation (AF) and renal insufficiency often coexist and are increasingly prevalent with advancing age. Both the risk of thromboembolic events and bleeding propensity are higher in patients with AF and impaired renal function versus those with good renal health. Direct oral anticoagulants (DOACs) are being increasingly preferred over vitamin K antagonists (VKAs) in the treatment of patients with AF and impaired renal function as VKAs may accelerate progression of chronic kidney disease. DOACs, however, are eliminated by the kidneys to varying degrees, and their dosages must be adapted in accordance with renal function. Since creatinine clearance (CrCl) monitoring is recommended in patients with AF receiving DOAC therapy, CrCl must be routinely monitored in patients at the start and during the course of anticoagulation to avoid deviation from Summary of Product Characteristics dosage specifications. This review article provides an overview of current knowledge on the selection and dose of DOACs including apixaban, dabigatran, edoxaban and rivaroxaban in AF patients at different stages of renal insufficiency, with a special focus on elderly patients with comorbidities and receiving multiple medications. The groups discussed in this review include patients with varying levels of CrCl including hyperfiltration or CrCl > 90 ml/min, CrCl < 90-50 ml/min, CrCl < 50-30 ml/min, CrCl < 30-15 ml/min and end-stage renal disease or on dialysis.
Topics: Aged; Humans; Atrial Fibrillation; Renal Insufficiency; Kidney; Renal Insufficiency, Chronic; Prescriptions; Anticoagulants; Fibrinolytic Agents
PubMed: 37594666
DOI: 10.1007/s12325-023-02544-8