Masters Degrees (Pharmacology)
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Browsing Masters Degrees (Pharmacology) by Subject "Antidepressants"
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Item Open Access Co-morbidity of and treatment for irritable bowel syndrome, depression and anxiety in residents of retirement villages(University of the Free State, 2014-12) Tromp, Adelheit; Van Zyl, P. M.Introduction: Irritable bowel syndrome (IBS), depression and anxiety are very common and often co-occur. Data for depression prevalence in the elderly in South Africa is available, but there is no data on the prevalence of anxiety and IBS in this population. Further, the existing literature does not report on the influence of medication use on these conditions. Aim and objectives: The aim of this study was to determine the prevalence and co-morbidity of IBS, depression and anxiety in retirement village residents against the background of the pattern of medication use. Specific objectives of the study were the assessment of current symptoms of IBS, depression and anxiety and the assessment of the use of antidepressants, anxiolytics and gastrointestinal (GI) medications that might influence the symptoms of IBS. Methods: Two hundred ambulant residents older than 50 years were recruited from 2 retirement villages in an urban setting in South Africa by means of convenience sampling. A cross-sectional observational study was performed with a questionnaire. The questionnaire consisted of the Manning criteria and the Hospital Anxiety and Depression Scale (HADS), supplemented by custom designed questions to evaluate medication use. Results: The prevalence of IBS, depression and anxiety were found to be 4.5%, 3.0% and 4.5%, respectively. Sixty-nine participants (34.5%) reported antidepressant use. Selective serotonin re-uptake inhibitors (SSRis) were used by 63.8% and tricyclic antidepressants (TCAs) by 33.3% of participants reporting antidepressant medication use, fluoxetine and amitriptyline being used in the majority of such cases. Forty-one participants (20.5%) reported the current use of benzodiazepines (BZDs). Proton pump inhibitors (PPis) were used by 17.5%. The majority of participants using antidepressants, anxiolytics and PPis were taking these for one year or longer. Participants taking PPis or antidepressants were more likely to experience symptoms of IBS than those who were not taking PPis or antidepressants and these differences were statistically significant. BZDs did not have an influence on the presence of IBS symptoms. There was no association between constipation and use of the target medication groups. Conclusion: The lower than expected prevalence of IBS, depression and anxiety occurred against the background of a high level of prolonged antidepressant, anxiolytic and proton pump inhibitor use.Item Open Access Hypothalamic-pituitary-adrenal axis function and hypothalamic-pituitary-thyroid axis function in mentally retarded oatients with and without self-injurious and/or aggressive behaviour(University of the Free State, 2003-12) Van Zyl, Paulina Maria; Gagiano, C. A.; Walubo, A.; Bester, C. J.English: The etiology of aggression and self-injuring behaviour in low functioning mentally retarded patients is multi-factorial and may reflect the presence of undiagnosed psychiatric conditions, unapparent due to the degree of the patient's impairment. It may also reflect hyperactivity of the stress response. The intricacies of diagnosis in this group of patients call for the development of biological markers to aid in diagnosis, therapy selection and drug response monitoring. Measuring and determining the relative contribution of individual neurotransmitters in the problem behaviour is complex and impractical. An alternative route may be to evaluate the functions of the hypothalamic-pituitary axis, which has extensive connections with the limbic area and is relatively easy to assess. The hypothalamic-pituitary system controls the behavioural, endocrine, autonomic and immunological responses to stress. The dexamethasone suppression test (OST) as adapted by Carroll and the thyroid-releasing hormone stimulation test (TRHST) has been extensively used in research on biological markers in major depression. Stress is known to activate the hypothalamic-pituitary-adrenal (HPA) axis, reflected by elevated cortisol levels. The study is a matched control study comparing hypothalamic-pituitary-adrenal axis function and hypothalamic-pituitary-thyroid axis function in 44 institutionalised mentally retarded patients with and without self-injuring and aggressive behaviour through the measurement of baseline cortisol levels and the application of the dexamethasone suppression test and the thyroid-releasing hormone stimulation test. The groups were matched according to gender, age and level of functioning. The mean age of the aggressive group 106 was 44,1 years (±SO 9,8) and the mean age of the non-aggressive group was 44,2 years (±SO 10,5). Baseline hypercortisolaemia occurred in five of the 22 aggressive subjects (22,7 %) and in two of the 22 non-aggressive subjects (9,1 %). Cortisol nonsuppression with the OST occurred in two subjects in the aggressive group (9,1 %) and one subject in the non-aggressive group (4,5 %). The OST did not demonstrate a difference in the two groups, yet there were more individuals in the aggressive group with abnormal high baseline cortisol, as well as a tendency towards a higher baseline cortisol in the aggressive group, suggesting an abnormal or more reactive stress response. Higher baseline cortisol levels were not related to age or the type of aggression, yet subjects with more recent aggressive activity showed higher baseline cortisol levels. The TRHST was generally well tolerated by the subjects. Side effects were few and transient. There were two male subjects in the aggressive group showing a blunted TRHST. Primary hypothyroidism was demonstrated in one of the female subjects in the non-aggressive group and subclinical hypothyroidism in two subjects in the non-aggressive group, as well as in one subject in the aggressive group. Longitudinal studies are needed to determine cortisol levels in unmedicated patients, in addition to comparing cortisol levels during different kinds of treatment.