scholarly journals A History of Cerebrovascular Disease Is Independently Associated with Increased Morbidity and Mortality in Patients with COVID-19: A Cohort Study of 369,563 COVID-19 Cases in the USA

2021 ◽  
pp. 1-9
Author(s):  
Anna M. Nia ◽  
Visish M. Srinivasan ◽  
Miranda K. Hayworth ◽  
Rishi R. Lall ◽  
Peter Kan
Keyword(s):  
Critical Care ◽  
Cerebrovascular Disease ◽  
Morbidity And Mortality ◽  
Prior History ◽  
Care Services ◽  
Relative Risks ◽  
Previous Diagnosis ◽  
Increased Risk ◽  
The Usa ◽  
History Of

<b><i>Objectives:</i></b> We set out to evaluate the risk for severe coronavirus disease 2019 (COVID-19) infection and subsequent cerebrovascular disease (CVD) in the population with a prior diagnosis of CVD within the past 10 years. <b><i>Methods:</i></b> We utilized the TriNetX Analytics Network to query 369,563 CO­VID-19 cases up to December 30, 2020. We created 8 cohorts of patients with COVID-19 diagnosis based on a previous diagnosis of CVD. We measured the odds ratios, relative risks, risk differences for hospitalizations, ICU/critical care services, intubation, mortality, and CVD recurrence within 90 days of COVID-19 diagnosis, compared to a propensity-matched cohort with no prior history of CVD within 90 days of COVID-19 diagnosis. <b><i>Results:</i></b> 369,563 patients had a confirmed diagnosis of COVID-19 with a subset of 22,497 (6.09%) patients with a prior diagnosis of CVD within 10 years. All cohorts with a CVD diagnosis had an increased risk of hospitalization, critical care services, and mortality within 90 days of COVID-19 diagnosis. Additionally, the data demonstrate that any history of CVD is associated with significantly increased odds of subsequent CVD post-COVID-19 compared to a matched control. <b><i>Conclusions:</i></b> CVD, a known complication of CO­VID-19, is more frequent in patients with a prior history of CVD. Patients with any previous diagnosis of CVD are at higher risks of morbidity and mortality from COVID-19 infection. In patients admitted to the ED due to COVID-19 symptoms, these risk factors should be promptly identified as delayed or missed risk stratification and could lead to an ineffective and untimely diagnosis of subsequent CVD, which would lead to protracted hospitalization and poor prognosis.

Introduction of Routine Screening for Cerebrovascular Abnormailities in Sickle Cell Disease (SCD) Using Transcranial Doppler Ultrasonography (TCD).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3786-3786
Author(s):  
David C. Rees ◽  
Susan E. Height ◽  
Moira C. Dick ◽  
Swee Lay Thein ◽  
Josef Jarosz ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Cerebrovascular Disease ◽  
Routine Screening ◽  
Blood Transfusions ◽  
College Hospital ◽  
Medical College ◽  
Increased Risk ◽  
The Usa ◽  
Vascular Laboratory ◽  
History Of

Abstract It is recommended both in the USA and Europe that children with SCD are scanned by TCD to identify increased risk of stroke and allow primary prevention. Although there are convincing trial data to support this, there is relatively little information on how this works in practice, with concerns about false positives, false negatives, implications of transfusion/chelation regimes. 20 months ago, a routine screening service was started for children with SCD attending Kings’s College Hospital (350 children). Scans were organised at clinic appointments and performed in the vascular laboratory by staff who had attended the training course at Medical College of Georgia. Scans followed the STOP protocol, and used TCD imaging, to visualise the vessels. 178 children without a history of stroke stroke have been scanned. 143 (80%) were normal, 12 (6.7%) had conditional results (TAMX&gt;170cm/s, &lt;200cm/s), 4 (2.2%) had abnormal results (TAMX&gt;200cm/s), 11 (6.2%) were unsatisfactory (not all vessels were seen), and 8 (4.5%) showed other abnormalities. Of the 12 with conditional scans, 8 have been repeated so far; of these, 3 were subsequently normal, and 5 persistently elevated; MRI/MRA scans were normal in 2 of these, and showed a probable right MCA stenosis in the 3rd; 2 are awaiting MRI/MRA. Of the 4 with abnormal scans, all were repeated and confirmed abnormal. On MRI/MRA two were shown to have extensive cerebrovascular disease with appearances of Moya Moya, and large, but clinically silent, cerebral infarcts. One had a normal MRI/MRA scan and decided against starting regular blood transfusions. One presented with left-hemiparesis before the repeat TCD, and MRI/MRA showed the new infarct and the stenosis also seen on TCD. Of the 11 unsatisfactory scans, 3 are awaiting repeat, 5 were normal on repeat, 1 was persistently unsatisfactory but had a normal MRI/MRA. 2 were persistently unsatisfactory and had abnormal MRI/MRA scans with stenosed vessels; one of these children presented with an extensive, hemiplegic stroke before repeat scanning or MRI/MRA was performed. All of the non-STOP abnormalities consisted of increased velocities and tortuosity/kinking in the proximal ICA and were not associated with significant intracranial abnormalities in any case. During the 20 months, 3 children presented with new overt strokes: two were identified on TCD, as mentioned above (1 with raised velocities and stroke prior to repeat scan, and 1 with unsatisfactroy examination). One presented with nephrotic syndrome and acute hemiplegia following normal TCD, and MRI/MRA showed normal blood vessels and an old infarct. 5 (2.8%) children started on regular blood transfusions: 3 presenting with strokes, and 2 with abnormal TCDs (who both had infarcts and Moya Moya on MRA/MRI). TCD is useful in routine service screening for cerebrovascular disease, in SCD. We found no patients who fulfilled typical STOP criteria for primary prevention, and our rate of abnormal scans was lower than predicted (2.2%); absent TCD traces/vessel images proved as significant as increased velocity in our patients. TCD also identified 2 pateints with clinically silent but extensive cerebrovascular disease, facilitating secondary prevention.

scholarly journals Predictors of clinical deterioration in patients with suspected COVID-19 managed in a ‘virtual hospital’ setting: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e045356
Author(s):  
Nick A Francis ◽  
Beth Stuart ◽  
Matthew Knight ◽  
Rama Vancheeswaran ◽  
Charles Oliver ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Hospital Setting ◽  
Health Problems ◽  
Clinical Deterioration ◽  
Care Services ◽  
Increased Risk ◽  
Remote Assessment ◽  
History Of

ObjectiveIdentify predictors of clinical deterioration in a virtual hospital (VH) setting for COVID-19.DesignReal-world prospective observational study.SettingVH remote assessment service in West Hertfordshire NHS Trust, UK.ParticipantsPatients with suspected COVID-19 illness enrolled directly from the community (postaccident and emergency (A&E) or medical intake assessment) or postinpatient admission.Main outcome measureDeath or (re-)admission to inpatient hospital care during VH follow-up and for 2 weeks post-VH discharge.Results900 patients with a clinical diagnosis of COVID-19 (455 referred from A&E or medical intake and 445 postinpatient) were included in the analysis. 76 (8.4%) of these experienced clinical deterioration (15 deaths in admitted patients, 3 deaths in patients not admitted and 58 additional inpatient admissions). Predictors of clinical deterioration were increase in age (OR 1.04 (95% CI 1.02 to 1.06) per year of age), history of cancer (OR 2.87 (95% CI 1.41 to 5.82)), history of mental health problems (OR 1.76 (95% CI 1.02 to 3.04)), severely impaired renal function (OR for eGFR <30=9.09 (95% CI 2.01 to 41.09)) and having a positive SARS-CoV-2 PCR result (OR 2.0 (95% CI 1.11 to 3.60)).ConclusionsThese predictors may help direct intensity of monitoring for patients with suspected or confirmed COVID-19 who are being remotely monitored by primary or secondary care services. Further research is needed to confirm our findings and identify the reasons for increased risk of clinical deterioration associated with cancer and mental health problems.

Abstract 14: The Influence of Provider Specialty on Anticoagulation Prescription Fills and Stroke Risk in Atrial Fibrillation Patients With History of Cancer

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Wesley T O’Neal ◽  
J’Neka Claxton ◽  
Richard MacLehose ◽  
Lin Chen ◽  
Lindsay G Bengtson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulant ◽  
Cox Regression ◽  
Prior History ◽  
Cancer Type ◽  
Patients With Cancer ◽  
Increased Risk ◽  
History Of ◽  
Reduced Risk ◽  
History Of Cancer

Background: Early cardiology involvement within 90 days of atrial fibrillation (AF) diagnosis is associated with greater likelihood of oral anticoagulant use and a reduced risk of stroke. Due to variation in cardiovascular care for patients with cancer, it is possible that a similar association does not exist for AF patients with cancer. Methods: We examined the association of early cardiology involvement with oral anticoagulation use among non-valvular AF patients with history of cancer (past or active), using data from 388,045 patients (mean age=68±15 years; 59% male) from the MarketScan database (2009-2014). ICD-9 codes in any position were used to identify cancer diagnosis prior to AF diagnosis. Provider specialty and filled anticoagulant prescriptions 3 months prior to and 6 months after AF diagnosis were obtained. Poisson regression models were used to compute the probability of an oral anticoagulant prescription fill and Cox regression was used to estimate the risk of stroke and major bleeding. Results: A total of 64,016 (17%) AF patients had a prior history of cancer. Cardiology involvement was less likely to occur among patients with history of cancer than those without (relative risk=0.92, 95% confidence interval (0.91, 0.93)). Similar differences were observed for cancers of the colon (0.90 (0.88, 0.92)), lung (0.76 (0.74, 0.78)), pancreas (0.74 (0.69, 0.80)), and hematologic system (0.88 (0.87, 0.90)), while no differences were observed for breast or prostate cancers. Patients with cancer were less likely to fill prescriptions for anticoagulants (0.89 (0.88, 0.90)) than those without cancer, and similar results were observed for cancers of the colon, lung, prostate, pancreas, and hematologic system. However, patients with cancer were more likely to fill prescriptions for anticoagulants (1.48 (1.45, 1.52)) if seen by a cardiology provider, regardless of cancer type. A reduced risk of stroke (hazard ratio=0.89 (0.81, 0.99)) was observed among all cancer patients who were seen by a cardiology provider than among those who were not, without an increased risk of bleeding (1.04 (0.95, 1.13)). Conclusion: AF patients with cancer were less likely to see a cardiologist, and less likely to fill an anticoagulant prescription than AF patients without cancer. However, cardiology involvement was associated with increased anticoagulant prescription fills and reduced risk of stroke, suggesting a beneficial role for cardiology providers to improve outcomes in AF patients with history of cancer.

Abstract 27: Statin use and risk of hemorrhagic stroke in a community-based cohort of aging women: The Women’s Health Initiative

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Elena Salmoirago-Blotcher ◽  
Kathleen M Hovey ◽  
Judith K Ockene ◽  
Chris A Andrews ◽  
Jennifer Robinson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Women's Health ◽  
Hemorrhagic Stroke ◽  
Extension Study ◽  
Prior History ◽  
Health Initiative ◽  
Increased Risk ◽  
History Of ◽  
Statin Use ◽  
The Women’S Health Initiative

Background: Statin therapy is recommended for treatment of hypercholesterolemia and prevention of cardiovascular events. Concerns have been raised about a potentially higher risk of hemorrhagic stroke in statin users; however, there is limited information in women and in older populations. We evaluated whether statin treatment was associated with increased risk of hemorrhagic stroke among women enrolled in the Women’s Health Initiative (WHI). Methods: This secondary data analysis was conducted among 68,132 women enrolled in the WHI Clinical Trials (CTs). Participants were 50 to 79 yrs old; postmenopausal; and were followed through 2005 (parent study) and for an additional 5 yrs (through September 30, 2010) in the WHI extension study. Statin use was assessed at baseline and at follow-up (FU) visits at 1, 3, 6, and 9 years. Women brought all medications in original containers for inventory. Strokes were self-reported annually and adjudicated by medical record review. Risk of hemorrhagic stroke by statin use (modeled as a time-varying covariate, with the “no use” category as the referent) was estimated from Cox proportional hazard regression models adjusted for age (model 1); risk factors for hemorrhagic stroke (model 2); and possible confounders by indication (model 3). All models adjusted for enrollment in the different CTs and in the extension study. Participants were censored at the date of last contact or loss to FU. Pre-specified subgroup analyses were conducted according to use or non-use of antiplatelet medications (including aspirin) or anticoagulants, and prior history of stroke. Results: Final models included 67,882 women (mean age at baseline 63 ± 7 yrs). Over a mean FU of 12 yrs, incidence rates of hemorrhagic stroke were 6.4/10,000 person-years among women on statins and 5.0/10,000 person-years among women not taking statins. The unadjusted risk of hemorrhagic stroke in statin users vs. non-users was 1.21 (CI: 0.96, 1.53). The HR was attenuated to 0.98 (CI: 0.76, 1.26) after adjusting for age, hypertension, and other risk factors for hemorrhagic stroke. Planned subgroups analyses showed that women taking both statins and antiplatelet agents had a higher risk of hemorrhagic stroke than women taking antiplatelet medications without statins (HR: 1.59; CI: 1.02, 2.46), whereas women not taking antiplatelet medications had no risk elevation with statins (HR=0.79; CI: 0.58-1.08); P for interaction = .01. No significant interactions were found for anticoagulant use or prior history of stroke, but the statistical power for these analyses was low. Conclusion: Statin use was not associated with an overall increased risk of hemorrhagic stroke among older community-dwelling women. However, women taking statins in conjunction with antiplatelet medications had elevated risk; a finding that warrants further study and potential incorporation into clinical decision making.

scholarly journals Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline

2006 ◽  
Vol 189 (2) ◽  
pp. 124-131 ◽  
Author(s):  
R. M. Post ◽  
L. L. Altshuler ◽  
G. S. Leverich ◽  
M. A. Frye ◽  
W A. Nolen ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Depression ◽  
Antidepressant Drugs ◽  
Patient Treatment ◽  
Adjunctive Treatment ◽  
Prior History ◽  
Rapid Cycling ◽  
Acute Response ◽  
Relative Risks ◽  
Increased Risk

BackgroundFew studies have examined the relative risks of switching into hypomania or mania associated with second-generation antidepressant drugs in bipolar depression.AimsTo examine the relative acute effects of bupropion, sertraline and venlafaxine as adjuncts to mood stabilisers.MethodIn a 10-week trial, participants receiving out-patient treatment for bipolar disorder (stratified for rapid cycling) were randomly treated with a flexible dose of one of the antidepressants, or their respective matching placebos, as adjuncts to mood stabilisers.ResultsA total of 174 adults with bipolar disorder I, II or not otherwise specified, currently in the depressed phase, were included. All three antidepressants were associated with a similar range of acute response (49–53%) and remission (34–41%). There was a significantly increased risk of switches into hypomania or mania in participants treated with venlafaxine compared with bupropion or sertraline.ConclusionsMore caution appears indicated in the use of venlafaxine rather than bupropion or sertraline in the adjunctive treatment of bipolar depression, especially if there is a prior history of rapid cycling.

Abstract 18516: Regional Dysfunction of Left Atrial Appendage and its Association with Stroke in Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Abdullah A Alissa ◽  
Yuko Inoue ◽  
Jochen Cammin ◽  
Qiulin Tang ◽  
Elliot Fishman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Control Group ◽  
Prior History ◽  
Area Change ◽  
Increased Risk ◽  
History Of ◽  
Regional Dysfunction

Background: Atrial Fibrillation (AF) is associated with an increased risk of cardioembolic stroke. Previous studies demonstrate that the Left atrial appendage (LAA) is the most common site of intracardiac thrombus, and the LAA morphology alone may determine the risk of stroke. We aimed to determine the association between LAA regional dysfunction using novel, noninvasive, image-based motion-estimation CT (iME) and prior history of stroke in patients with AF. Methods: Among the patients with history of AF referred for ablation who underwent pre-ablation CT with retrospective ECG gating, we identified 18 patients with a prior history of stroke or TIA, and 18 age- and gender-matched controls. The patients in AF at the time of CT were excluded. Four-dimensional motion vector field was estimated from reconstructed CT images using iME at every 5% RR interval. To assess myocardial deformation, area change ratio and area change rate were calculated over the endocardial surface of the LA and LAA. Univariate and multivariate comparisons were made by using binary logistic regression model. Results: A total of 36 patients (mean age 67.6 ± 8.1 years, 66.7% male, 16.7% persistent AF) were included in the study. Univariate analysis showed that the LA pre-atrial contraction area change ratio and LAA maximum area change ratio were significantly lower (P= 0.02 and 0.04, respectively) in the stroke/TIA group compared to the control group. These changes remained statistically significant in multivariate analysis (P=0.03 and 0.04, respectively) after adjusting for age, sex, body mass index, LV ejection fraction, type of AF, and CHADS score. Conclusions: LAA regional dysfunction is associated with stroke/TIA in patients with AF. LAA regional dysfunction detected by iME could represent a marker for stroke and a possible therapeutic target.

Abstract 26: Predictors of Atrial Cardiopathy Among Patients in the Arcadia Trial: An Analysis of the First 924 Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Mitchell Elkind ◽  
Will Longstreth ◽  
David Tirschwell ◽  
Richard Kronmal ◽  
Seemant Chaturvedi ◽  
...  
Keyword(s):  
Standard Dose ◽  
Stable Condition ◽  
Indirect Evidence ◽  
Arterial Disease ◽  
P Wave ◽  
Prior History ◽  
Blood Draw ◽  
Relative Risks ◽  
History Of ◽  
Peripheral Arterial

Background: Atrial cardiopathy (AC) in absence of atrial fibrillation is a suspected cause of embolic stroke of undetermined source (ESUS). Predictors of AC remain incompletely characterized. We hypothesized that demographics, vascular risk factors, and time from stroke presentation to assessment for AC predict AC among ESUS patients. Methods: ARCADIA is an ongoing, investigator-initiated, NINDS-funded, multicenter, randomized trial of standard dose apixaban versus aspirin 81 mg daily among consented patients with ESUS and biomarker evidence of AC, defined as any of: N-terminal pro-brain natriuretic peptide (NT-proBNP) > 250 pg/ml; P wave terminal force velocity on ECG lead V1>5,000 μV*ms; or echocardiographic left atrial diameter index ≥3 cm/m 2 . Patients may be enrolled up to 120 days after stroke. We used multivariable regression modelling to estimate relative risks and 95% confidence intervals (RR, 95%CI) for association of predictors with AC. Results: Among 924 ESUS patients who met inclusion/exclusion criteria as of July 16, 2019, 251 met > 1 AC criterion (164 NT-proBNP, 114 PTFV1, 4 echo). Compared to those without AC (n=673), those with AC were older (69.0 + 14.5 versus 64.0 + 15.0 years) and more often women (52.2% versus 40.9%). Multivariable predictors of AC were age (RR per decade 1.20, 95%CI 1.09-1.32), race (black versus other RR 1.20, 95%CI 0.95-1.52), sex (RR for women 1.22, 95%CI 0.98-1.52), hemoglobin (per unit RR 0.94, 95%CI 0.88-1.01), and cardiovascular/peripheral arterial disease, RR 1.48, 95%CI 1.16-1.88). Prior history of stroke or TIA, hypertension, diabetes, smoking, cancer, sleep apnea, and time from stroke to consent and blood draw for NT-proBNP were not associated with AC. Conclusions: Older age, female sex, black race, relative anemia, and history of vascular disease associate with AC among ESUS patients. Absence of association with time to assessment, particularly testing for NT-proBNP, provides indirect evidence that AC is not a reaction to stroke, but a stable condition, and supports patients being assessed for ARCADIA participation up to 4 months post stroke. The moderate strength of demographic associations with AC further underscores the importance of enrolling unselected ESUS patients into ARCADIA.

Abstract 16083: Risk of Preserved versus Reduced Ejection Fraction in Women With and Without History of Breast Cancer: The Pathways Heart Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jamal S Rana ◽  
Heather Greenlee ◽  
Richard Cheng ◽  
Cecile A Laurent ◽  
Hanjie Shen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Ejection Fraction ◽  
Endocrine Therapy ◽  
White Women ◽  
Cox Regression ◽  
Prior History ◽  
Reduced Ejection Fraction ◽  
Increased Risk ◽  
History Of

Introduction: Incidence of heart failure (HF), specifically with preserved ejection fraction (HFpEF), is rising in the general population, yet is understudied. To provide a population-based estimate of HF in breast cancer (BC) survivors, we compared risk of HF in women with and without BC history in the Kaiser Permanente Northern California (KPNC) integrated health system. Methods: Data were extracted from KPNC electronic health records. All invasive BC cases diagnosed from 2005-2013 were identified and matched 1:5 with non-BC controls on birth year, race/ethnicity, and KPNC membership at BC diagnosis. Cox regression models assessed the hazard of HF by EF status: HFpEF (EF ≥ 45%), HF with reduced EF (HFrEF; EF < 45%), and unknown EF. Women with prior history of HF were excluded. Models were adjusted for factors known to affect BC risk or CVD and for prevalent CVD at BC diagnosis. We also examined case subgroups who received cardiotoxic chemotherapy, left-sided radiation therapy, and/or endocrine therapy, versus their controls. Results: A total of 14,804 women diagnosed with invasive BC and with no history of HF were identified and matched to 74,034 women without BC history. Women were on average 61 years at BC diagnosis and 65% white. Women with HFpEF were older and more likely to have hypertension (p<0.05). Among all cases vs. controls, there was increased risk of HFrEF (HR: 1.5, 95% CI: 1.18, 1.98) but not HFpEF or unknown EF (figure). Compared to their controls, women treated with chemotherapy were more than 3-times likely to develop HFrEF (HR: 3.26, 95% CI: 2.2, 4.8) and more than 1.5-times likely to develop HFpEF (HR=1.61, 95% CI: 1.15, 2.24). Women who received left-sided radiation therapy had nearly double the risk of developing HFrEF (HR=1.85, 95% CI: 1.20, 2.84). No associations were found among women who received endocrine therapy. Conclusions: Increased surveillance is warranted for women with BC receiving cardiotoxic chemotherapy for development of both HFrEF and HFpEF.

Hormone replacement therapy in women with breast cancer. Do the risks outweigh the benefits?

1996 ◽  
Vol 14 (3) ◽  
pp. 997-1006 ◽  
Author(s):  
J A Roy ◽  
C A Sawka ◽  
K I Pritchard
Keyword(s):  
Breast Cancer ◽  
Replacement Therapy ◽  
Postmenopausal Women ◽  
Hormone Replacement ◽  
Risks And Benefits ◽  
Previous Diagnosis ◽  
Increased Risk ◽  
History Of ◽  
Expected Benefits ◽  
Meta Analyses

PURPOSE To review critically the literature regarding effects of estrogen replacement therapy (ERT)/combined estrogen and progesterone replacement therapy (HRT) on the risk of breast cancer and on other health risks and benefits in postmenopausal women, with a focus on risks and benefits in women with a previous diagnosis of breast cancer. METHOD A literature search was conducted using Medline, Cancerline, and the bibliographies of reports published as of March 1995. All five published meta-analyses that examined the risk of breast cancer in relation to ERT/HRT in otherwise healthy women were critically reviewed. All known reports of women with a history of breast cancer given ERT/HRT subsequent to diagnosis and additional reports regarding the benefits of ERT/HRT were also reviewed. RESULTS None of the five meta-analyses demonstrated a significantly increased risk of developing breast cancer in ever users compared with never users of ERT/HRT. Current use may be associated with a small increased risk. This increased risk should be balanced by the expected benefits of ERT/HRT on quality of life, bone metabolism, and cardiovascular function. Preliminary information does not suggest a major detrimental effect of ERT/HRT in women with a previous diagnosis of breast cancer, but these reports include few women with limited follow-up data. There are no randomized trials in women with a previous diagnosis of breast cancer. CONCLUSION In healthy postmenopausal women, the benefits associated with ERT/HRT outweigh the risks. In women with a previous diagnosis of breast cancer, the balance of risks and benefits should be explored in randomized controlled trials.

General medical disorders with psychiatric implications

2015 ◽  
Author(s):  
Erik J. Garcia ◽  
Warren J. Ferguson
Keyword(s):  
Mental Illness ◽  
Psychiatric Symptoms ◽  
The United States ◽  
Prior History ◽  
Medical Illness ◽  
Medical Conditions ◽  
Presenting Symptoms ◽  
Medical Disorders ◽  
Increased Risk ◽  
History Of

Traditionally the domain of consultation/ liaison psychiatry, the challenge of recognizing and then appropriately treating the psychiatric complications of general medical disorders requires thoughtful planning and attention in corrections. Medical conditions that have psychiatric symptoms represent a significant diagnostic dilemma, particularly in the correctional health setting. Over half of the inmates in the United States have symptoms of a major mental illness, but the pervasiveness of substance use disorders, the increasing prevalence of elderly inmates, and limited access to a patient’s past medical and psychiatric records all contribute to the challenge of discerning when a psychiatric presentation results from an underlying medical condition. One early study underscored this challenge, noting that 46% of the patients admitted to community psychiatric wards had an unrecognized medical illness that either caused or exacerbated their psychiatric illness. A more recent study observed that 2.8% of admissions to inpatient psychiatry were due to unrecognized medical conditions. Emergency room medical clearance of patients presenting for psychiatric admission has revealed an increased risk for such underlying medical conditions among patients with any of five characteristics: elderly, a history of substance abuse, no prior history of mental illness, lower socioeconomic status, or significant preexisting medical illnesses. This chapter examines several of these risk groups and focuses on the presenting symptoms of delirium, mood disorders, and psychosis and the underlying medical conditions that can mimic or exacerbate them.

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