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- Werneke, Ursula, et al.
(författare)
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A decision analysis of long-term lithium treatment and the risk of renal failure
- 2012
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley-Blackwell. - 0001-690X .- 1600-0447. ; 126:3, s. 186-197
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To establish whether lithium or anticonvulsant should be used for maintenance treatment for bipolar affective disorder (BPAD) if the risks of suicide and relapse were traded off against the risk of end-stage renal disease (ESRD).Method: Decision analysis based on a systematic literature review with two main decisions: (1) use of lithium or at treatment initiation and (2) the potential discontinuation of lithium in patients with chronic kidney disease (CKD) after 20 years of lithium treatment. The final endpoint was 30 years of treatment with five outcomes to consider: death from suicide, alive with stable or unstable BPAD, alive with or without ESRD.Results: At the start of treatment, the model identified lithium as the treatment of choice. The risks of developing CKD or ESRD were not relevant at the starting point. Twenty years into treatment, lithium still remained treatment of choice. If CKD had occurred at this point, stopping lithium would only be an option if the likelihood of progression to ESRD exceeded 41.3% or if anticonvulsants always outperformed lithium regarding relapse prevention.Conclusion: At the current state of knowledge, lithium initiation and continuation even in the presence of long-term adverse renal effects should be recommended in most cases.
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| 2. |
- Werneke, Ursula
(författare)
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A lively mind in a frozen body : the history of Rickety Kate—an australian poet who suffered from rheumatoid arthritis
- 2011
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Ingår i: Journal of Evidence-Based Complementary & Alternative Medicine. - : SAGE Publications. - 2156-5872 .- 2156-5899. ; 16:3, s. 233-238
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Tidskriftsartikel (refereegranskat)abstract
- "Rickety Kate” was the descriptive name of Minnie Agnes Filson, a popular Australian poet featured widely in the Australian media from the 1930s through to the 1960s. The assumed name was a reflection of her severe rheumatoid arthritis, which left her completely immobilized. During her lifetime, Kate received a variety of conventional medical treatments, which proved largely ineffective. She finally turned to an Indian healer, who managed to improve her quality of life although her physical disabilities persisted. This article explores the history of rheumatoid arthritis from a patient’s perspective in the light of the scientific knowledge at the time and critically reflects on the relationship between conventional and complementary/alternative medicine then and today.
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| 3. |
- Werneke, Ursula, et al.
(författare)
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Behavioral Interventions for Antipsychotic Induced Appetite Changes
- 2013
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Ingår i: Current Psychiatry Reports. - : Springer Science and Business Media LLC. - 1523-3812 .- 1535-1645. ; 15:3, s. 347-
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Tidskriftsartikel (refereegranskat)abstract
- Weight gain remains a well recognized yet difficult to treat adverse effect of many anti-psychotic drugs including agents of the first and second generation. The weight gain liabilities of antipsychotic drugs are partly associated with their ability to increase appetite. Most behavioral interventions for weight control remain of limited efficacy, possibly because they do not specifically target the neuroendocrine factors regulating appetite. Identifying new weight management interventions directly acting on the biochemical and neuroendocrine mechanisms of anti-psychotic induced weight gain may help to improve the efficacy of behavioral weight management programs. Such potentially specific strategies include (1) using diets which do not increase appetite despite calorie restriction; (2) countering thirst as an anticholinergic side-effect; (3) discouraging cannabis use and (4) adding metformin to a behavioral intervention. In view of our currently rather limited treatment repertoire it seems timely systematically to explore such novel options.
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| 6. |
- Werneke, Ursula
(författare)
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Psychiatry and reality : perception of matter or matter of perception?
- 2011
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Ingår i: NeuroQuantology. - 1303-5150. ; 9:1, s. 190-201
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Tidskriftsartikel (refereegranskat)abstract
- Current concepts of delusion rely on the assumption that one single objective external reality exists as a benchmark for our internal experiences. With the advent of quantum theory this assumption has become untenable. Accepting the Copenhagen interpretation that there is no reality beyond what is revealed by the act of measurement or observation implies that there is no objective reality. One alternative interpretation of quantum theory is the "many worlds" interpretation which finds its philosophical correlate in the "plurality of worlds" theory. However, the idea of all possible worlds being not just possible but real is even more counter-intuitive. Virtual reality is a way to systematically alter the usual relationship between external reality and the user's experience of it. Although virtual reality is not the same as parallel reality and both are separate strands in the "fabric of reality" they are related. With the advance of virtual reality there is already developing an increasing sense that the real and digital worlds seem to converge. But even if we believed in only one single objective external reality we could still never experience this reality directly. Our experience of reality is essentially one of virtual reality as generated by our brain. The "many worlds" interpretation implies that other copies of our brain rendering other experiences exist. Thus, in view of the uncertain nature of reality it is necessary to rethink our accepted concept of psychosis. Currently, meticulous history taking and accurate clinical observation remains our best option trying to understand psychotic symptoms.
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