Are antipsychotics effective adjunctive Tx for patients with moderate-to-severe depression?

Q: Are antipsychotics effective adjunctive Tx for patients with moderate-to-severe depression? Evidence-based answer: YES. Augmentation with second-generation antipsychotics, especially aripiprazole and quetiapine, appears to be effective in patients with moderate-to-severe depression who have had a suboptimal response to a selective serotonin reuptake inhibitor or a serotonin-norepinephrine reuptake inhibitor (strength of recommendation [SOR]: A, based on a systematic review of randomized controlled trials [RCTs] and an individual RCT). Augmenting antidepressant therapy with cariprazine, ziprasidone, or olanzapine also appears to improve depressive symptoms over the short term. All antipsychotics studied carried an increased likelihood of adverse effects that could lead to discontinuation (SOR: A, based on a systematic review of RCTs).Heather Bleacher, MD, MPH; Lindsay Koerperich, MD; Naomi Malam, MD, MSPH (University of Colorado Family Medicine Residency, Denver) Kristen DeSanto, MSLS, MS, RD (University of Colorado Health Sciences Library, Denver)Includes bibliographical reference

“Mieux Vaut Prévenir que Guérir”: The Effect of Natural Disasters on Water- and Sanitation-Related Infectious Diseases and the Increasing Need for Disaster Preparedness

The world is suffering from an extreme global water crisis. 1.1 billion people in the world lack access to adequate clean water, and 2.6 billion people lack access to water and sanitation. Approximately 10 million deaths per year can be attributed to this water crisis; water-borne infectious diseases play a significant role in this death toll. Diarrhoeal disease accounts for 2.6 million deaths per year and is one of the leading causes of death in many developing countries. We are entering a period of undeniable climate change which is bringing about more natural disasters and extreme weather events than ever before, and unfortunately these catastrophes significantly exacerbate the already dire global water crisis. It is now more than ever important to understand the complexities of the relationship between water and health. Lack of access to water and sanitation, and infectious diseases severely detract from the quality of life and impede the progress of the developing world. Further, as Hurricane Katrina reminded us in 2005, natural disasters know no national borders or socioeconomic status. We cannot ignore the effect that natural disasters across the world have on water and sanitation systems, especially those across the world that are already sorely lacking, and the resulting burden of disease, and what comprises the response and rebuilding process. The results of this research highlight the dire need for improved methods of disaster prevention, preparedness, and response. There are many disaster-prone areas of the world that are very ill-prepared to handle these natural disasters when they occur. They lack the physical infrastructure to withstand the disasters, the human and financial resources to mitigate the effects after the disasters, or both. A comparison of the recent natural disasters in both New Orleans and Haiti demonstrates the successes and failures of disaster preparedness and response in both the developed and the developing world. It is absolutely vital to learn to adapt our world to understand to be better prepared for such disasters to mitigate the effects on water systems, and the health of the public overall