Thursday, October 5, 2006
Scopolamine for depression? Ketamine; Are we palliatists? Cancer treatment goals; Palliative care of the terminally ill drug addict
Well I'm back from Montreal and have a seemingly insurmountable backlog of things to blog.
So, in brief...
Archives of General Psychiatry has published the results of a randomized controlled trial of scopolamine for depression. It seems the investigators were using scopolamine to look at its cognitive effects in depressed (many had bipolar disorder) patients and observed that IV scopolamine infusions rapidly improved depressive symptoms. So then they randomized 18 patients to scopolamine (4mcg/kg IV) verses placebo; gave them each a few infusions every 3-4 days; then switched groups. Essentially they found rapid (within a few days) and significant improvement in depressive symptoms in the treatment group. They also found an anxiolytic response with scopolamine as well. This is pretty exciting news & I hope they trial the patch for this. The makers of artificial saliva should be pretty happy too....
Pain Medicine has a comparison of the bioavailability of oral versus sublingual ketamine. If you include serum levels of norketamine (which from a clinical standpoint you should as norketamine is analgesic) both routes had similar bioavailability.
The latest PC-FACS are out. The website does seem to be restricting access to these to AAHPM members only (this has been in the works for a while). This month's PC-FACS has the word "palliatist" in it, to describe a palliative care/medicine practitioner. I am not sure how I feel about this word. That being said there was probably a lot of cringing when "intensivist" started being used. I'd be curious if anyone out there is using this word to describe themselves. It is certainly shorter than "palliative medicine physician" or some variation thereof. Personally I just call myself a "death doctor" which I'll point out has fewer syllables than "palliatist."**
Supportive Care in Cancer has an interesting article about patients' & their caregivers' understanding of cancer treatment goals (e.g. curative vs. non-curative). What is interesting about this study is that the subjects' understanding was followed longitudinally. It's a think study with a lot of details that I'm not going to summarize. The authors have contributed a lot in the last few years to this area and it's good to see more interesting research coming from them (see here & here).
Cancer Investigations has a review on the palliative care of the terminally ill drug addict. This is truly a data-free topic (as far as I can tell there is no research into this) and the authors give what seem like very reasonable recommendations. This is a topic that causes a lot of anxiety for some and I'd recommend this article for the old teaching file as there's very little, even in the way of expert opinion, writing about this (the NCI's PDQ has an OK overview about substance abuse and the cancer patient).
That's all for now....
**This sentence was a joke.