Review of Psychotropic Agents Associated with Sialorrhoea, Except Clozapine

Introduction: Sialorrhoea, or excessive salivation, is common in psychiatric patients. This can be distressing because of its physical and psychosocial complications. Sialorrhoea due to psychotropic drugs has been reported repeatedly in the literature. Clozapine is the antipsychotic most commonly associated with sialorrhoea. Objective: The objective of this review was to examine and discuss the existing literature on all psychotropic drugs associated with sialorrhoea, except clozapine. Methods: Google Scholar and PubMed were searched for the literature on psychotropic-induced sialorrhoea. The search terms used were sialorrhoea, antidepressants, antipsychotics, mood stabilizer, and benzodiazepines. Case reports on patients suffering from psychotropic-induced sialorrhoea except clozapine are reviewed in this study. Results: The pathophysiology behind psychotropic-induced sialorrhoea, the population susceptible to sialorrhoea, and the exact duration from the start of sialorrhoea the drug course to the onset of sialorrhoea are unknown. Also, sialorrhoea is not associated with drug toxicity and is observed even in patients receiving normal doses of psychotropic medications. Treatment involves dose reduction, discontinuation of drugs responsible for the adverse effect, or adding anticholinergic drugs. Conclusion: Sialorrhoea due to clozapine has been reported in the literature. Many other antipsychotics, antidepressants such as sertraline, and other psychotropic drugs such as lithium have also been reported to cause sialorrhoea. No increase in the risk of sialorrhoea was seen in any of the age groups, and no association was found with treatment duration. In cases of lithium-induced sialorrhoea, no relationship was observed between serum levels of lithium and sialorrhoea.

Principles and guidelines in the management of ankle fractures in adults

Ankle fractures are common injuries that have many physical and psychosocial complications. As a result, it is important to be aware of how these patients present and are managed perioperatively. Detailed guidelines from NICE and the British Orthopaedic Association have been produced on this topic, including recent developments such as the decision to weight-bear early after surgery and the use of virtual fracture clinics. This article provides an overview of the key perioperative factors that need to be considered in cases of ankle fracture and the relevant clinical guidelines.

Parents' knowledge about complementary feeding: an integrative review

Currently, authorities and specialists in child development and public health have been concerned with the growth and nutritional status of children, especially due to the uncontrollable increase in overweight / obesity that has occurred in recent years. Obesity causes organic-functional complications, such as chronic-degenerative diseases (diabetes, high blood pressure, coronary heart disease), and psychosocial complications, such as withdrawal from social relationships, shame, exclusion and disturbances in body awareness. The objective was to identify in the literature the parents' knowledge about complementary feeding for infants. Integrative literature review based on the guidelines recommended by PRISMA. The search was carried out between the months of May and June 2017 by two researchers independently in the Scopus, PubMed, Scielo, LILACS and CINAHL databases. The following descriptors were used: “infant”, “complementary feeding”, “parents” and “knowledge” and “infant”, “complementary feeding”, “relatives” and “knowledge” in the DECs and MESH respectively. 1,012 studies were identified and a sample of 06 articles was obtained after applying the eligibility criteria. The knowledge evidenced was: use of appropriate utensils for feeding the child, not using cow's milk, caution with processed foods, issues related to breastfeeding and age of introduction of food and other liquids. Even so, there were still mistakes by parents regarding the recommendations of the main bodies dealing with food, such as the use of processed foods from the fourth month of life of the child and the relationship of the “fat” baby being the health model. It was concluded that the knowledge of parents / caregivers about complementary feeding is still permeated by mistakes. Thus, the nursing consultation should focus on health education and search for strategies that facilitate the process of introducing complementary feeding and help parents in this period. Key messages Targeting health strategies on complementary feeding in a timely manner. Guidance for the prevention of obesity in early childhood and the development of non-infectious diseases.

Impact of Pain on the Individual and Others

Chapter 3 describes how pain is a powerful stressor that aids in surviving an injury and how the resultant physiologic stressors put vulnerable patients at risk for pulmonary, renal, gastrointestinal, metabolic, and psychosocial complications. The timeliness and efficacy of pain control contribute to health outcomes. Of the estimated 30% of adults who develop chronic pain, these individuals face increased risk for an impoverished, premature death. Pain is a biopsychosocial experience that undermines health, activities, and enjoyment of life. Unless assessed and treated properly, pain devalues important things in the life of the sufferer, often leading down a path to disability and despair. Pain is always a combined physical, mental, and social experience that often partially responds to properly targeted therapy. Disparities are common in the way pain is managed and may relate to factors at the patient, provider, organizational, or payer levels. Thus, healthcare professionals who interact with people experiencing pain have a duty to dampen the biopsychosocial impact of pain to help them think, feel, and do better. Given potential harm related to analgesics or invasive treatments, ethical practices involve advocating for delivering personalized treatments, with vigilant monitoring to avoid potential harm.

The problem of medical care management for patients with epilepsy during the transition from childhood/adolescence to adulthood

The paper highlights the problems and diffi culties faced by patients with epilepsy and their parents when changing the medical institution and the attending physician due to the transition to adult health services. Considerable clinical and psychosocial complications of unfavourable epilepsy course in adults with childhoodonset epilepsy are discussed. The models of the evolution of childhood/adolescent epilepsy, which depend on the cause of the disease, are presented. Examples of the organization of a smooth and safe transition of people with childhood-onset epilepsy under the supervision of adult neurologists/ epileptologists in diff erent countries of the world are given. It is emphasized that the key to create an individualized program for a successful transition is the epilepsy etiology account, especially if young patients need special care because of mental disorders. The possibilities of such a transition in Ukraine are considered on the example of activities of the Lviv Regional Antiepileptic Centre. Keywords: epilepsy, childhood epilepsy, models of transition to adulthood

Alterações estéticas no contexto da doença renal crônica e complicações associadas à autoimagem

Objetivo: Identificar na literatura as alterações estéticas decorrentes da doença renal crônica (DRC) e seutratamento e as complicações associadas a mudanças na autoimagem. Método: Revisão integrativa realizada emjaneiro de 2016, na Lilacs, Medline, Biblioteca Digital de Teses e Dissertações e Google Acadêmico, utilizandoa estratégia PVO - P (problema/população): Insuficiência Renal Crônica; Diálise Renal; Fístula Arteriovenosa;V (variáveis do problema): Estética; O (outcomes/resultados): Autoimagem; Imagem Corporal. Incluíram-se aspublicações disponíveis em português, inglês e espanhol, publicados no período de 2010 a 2015 e que tratavamda temática. As publicações foram lidas, analisadas, sumarizadas e discutidas. Resultados: A amostra final de 28publicações apontou que o aspecto estético decorrente das fístulas e da presença de cateteres são as principaiscausas da autoimagem negativae implicam em complicações psicossociais, como sofrimento e sentimento deinferioridade. Outras alterações estéticas identificadas foram a baixa estatura, ganho e perda de peso e palidez.Conclusão: São necessários conhecimentos que desvelem a percepção do sujeito sobre seu corpo e que guardevaloração subjetiva de vivência diante da doença e sua estética.Palavras-chave: Insuficiência renal crônica; Estética; Autoimagem. ABSTRACTObjective: To identify in literature aesthetics changes resulting from chronic kidney disease (CKD) and itstreatment and complications associated with changes in self-image. Method: Review study conducted in January2016 in Lilacs, Medline, Digital Library of Theses and Dissertations and Google Scholar, using PVO strategy:PVO - P (problem/population): Renal Insufficiency, Chronic; Renal Dialysis; Arteriovenous Fistula; V (problemvariables): Esthetics; O (outcomes): Self Concept; Body Image. Were included the publications about the theme,available in Portuguese, English and Spanish, published between 2010-2015. The publications were read,analyzed, summarized and discussed. Results: The final sample of 28 publications pointed out that the aestheticappearance resulting from fistulas and the presence of catheters are the main causes of the negative self-imageand involve psychosocial complications such as pain and feeling of inferiority. Conclusion: Knowledge that revealthe perception of the subject on his body and saving subjective experience of valuation on the disease and itsaesthetics are required. Other aesthetics changes identified were short stature, gain and weight loss and pallor.Keywords: Renal Insufficiency Chronic; Esthetics; Self Concept

Improvement in excoriation (skin-picking) with use of risperidone in a patient with developmental disability

Patients with Autism Spectrum Disorder present with a heterogeneous mix of features beyond the core symptoms of the disorder. These features can be emotional, cognitive or behavioral. Behavioral symptoms often include self-injury, and this may take the form of repetitive skin-picking. The prevalence of skin-picking disorder in Autism is unknown. Skin-picking may lead to significant medical and psychosocial complications. Recent data suggest that behavioral interventions may be more effective than medications at reducing skin-picking in neurotypical patients. In this case, an 11-year-old male with intellectual disability and autistic spectrum disorder, with self-injurious skin-picking, was treated with risperidone with complete resolution of skin-picking symptoms. risperidone has been approved for irritability and aggression in Autistic spectrum disorder, and may be a valuable treatment option for skinpicking in pediatric patients with developmental disabilities.