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Estimation of desvenlafaxine transfer into milk and infant exposure during its use in lactating women with postnatal depression

Estimation of desvenlafaxine transfer into milk and infant exposure during its use in lactating women with postnatal depression

Abstract  

This study characterises the extent of desvenlafaxine transfer into milk and provides data on infant exposure to desvenlafaxine
via breast milk in ten women with postnatal depression and their breastfed infants. Desvenlafaxine concentration in milk and
plasma was measured chromatographically in milk and in maternal and infant plasma collected at steady state. Theoretic and
relative infant doses via milk were estimated and the per cent drug in infant versus mother’s plasma was calculated. Theoretic
infant dose via milk was 85 (53–117) μg kg−1 day−1 (mean and 95% confidence interval) and relative infant dose was 6.8% (5.5–8.1%). The ratio of drug in infant/maternal plasma
also gave an infant exposure estimate of 4.8% (3.5–6.2%) for all ten infants and 5.3% (4.2–5.7%) in the eight infants who
were exclusively breastfed. No adverse effects were seen in the infants. The relative infant dose was similar to that for
previous studies using venlafaxine and was supported by a separate exposure measure using the ratio of drug in the infant’s
plasma relative to that in the mother’s plasma. The theoretic infant dose of desvenlafaxine was 41–45% of that for venlafaxine
and its metabolite desvenlafaxine in previous studies, reflecting the lower recommended maternal dose for desvenlafaxine.
Although our data for desvenlafaxine use in lactation are encouraging and there are supporting data from venlafaxine studies,
more patients and their infants need to be studied before the safety of desvenlafaxine as a single therapeutic agent can be
fully assessed.

  • Content Type Journal Article
  • DOI 10.1007/s00737-010-0188-9
  • Authors
    • Jonathan Rampono, Department of Psychological Medicine, King Edward Memorial Hospital, Women and Newborn Health Services, Subiaco, Australia
    • Stephanie Teoh, Department of Pharmacy, King Edward Memorial Hospital, Women and Newborn Health Services, Subiaco, Australia
    • L. Peter Hackett, Clinical Pharmacology and Toxicology Laboratory, Path West Laboratory Medicine, Nedlands, Australia
    • Rolland Kohan, Department of Neonatal Paediatrics, King Edward Memorial Hospital, Women and Newborn Health Services, Subiaco, Australia
    • Kenneth F. Ilett, Clinical Pharmacology and Toxicology Laboratory, Path West Laboratory Medicine, Nedlands, Australia

Hospital Privileges for Psychologists in the Era of Competencies and Increased Accountability

Abstract  

After campaigning to be granted hospital privileges decades ago, new issues are emerging that are affecting psychologists’
hospital privileges. Some of the forces shaping hospital privileges emanate from within the field of psychology, where there
has been a movement to more closely examine psychologists’ competences. Other forces impinging on hospital privileges are
external to psychology, most notably the Joint Commission, which has promulgated new standards for hospital-based practitioners
across disciplines. This article discusses the effects of these new standards on the practice of psychology and describes
the findings of a survey examining how privileges are currently obtained and maintained within hospitals.

  • Content Type Journal Article
  • DOI 10.1007/s10880-010-9203-6
  • Authors
    • William N. Robiner, University of Minnesota Medical School Health Psychology, Department of Medicine Mayo Mail Code 741, 420 Delaware Street, S.E Minneapolis MN 55455 USA
    • Kim E. Dixon, Brody School of Medicine at East Carolina University Department of Psychiatric Medicine 600 Moye Boulevard, Mail Stop 694 Greenville NC 27834 USA
    • Jacob L. Miner, Columbia University College of Physicians and Surgeons New York NY USA
    • Barry A. Hong, Washington University School of Medicine Department of Psychiatry St. Louis MO USA

2020 Foresight: Practicing Ethically While Doing Things That Don’t Yet Exist

Abstract  

The APA Ethical Code struggles to offer guidance in the rapidly changing field of clinical health psychology. Professional
challenges anticipated in the next decade are described, and their implications for ethical practice examined. This paper
is based in part on a presentation at the 2009 Conference at the Association of Psychologists in Academic Health Centers held
in St. Louis, Missouri.

  • Content Type Journal Article
  • DOI 10.1007/s10880-010-9204-5
  • Authors
    • John C. Linton, West Virginia University School of Medicine, Charleston, WV USA

Early Intervention of Eating- and Weight-Related Problems

Abstract  

Obesity and other eating-related problems are widespread and are associated with harmful physical, psychological, and social
problems. The dramatic increases in rates of pediatric obesity has created a mounting need for psychologists and other mental
health care providers to play a significant role in the assessment and treatment of youth with eating- and weight-related
problems. Therefore, it is imperative for providers to be aware of the causes and consequences of eating- and weight-related
problems and to be familiar with evidence-based assessment and intervention approaches. Currently, the most well-established
intervention approaches are family-based behavioral treatments, and weight loss maintenance treatments with a socio-ecological
focus are promising. This paper provides a comprehensive review of these topics and highlights the important roles that mental
health care providers can have. Medical settings are often the patient’s first point of contact within the healthcare system,
making mental health care providers in such settings uniquely suited to assess for a broad range of eating- and weight-related
problems and associated comorbidities, to deliver relevant evidence-based interventions, and to make appropriate referrals.
Moving forward, providers and researchers must work together to address key questions related to the nature of eating- and
weight-related problems in youth and to achieve breakthroughs in the prevention and treatment of such problems in this vulnerable
population.

  • Content Type Journal Article
  • DOI 10.1007/s10880-010-9209-0
  • Authors
    • Denise E. Wilfley, Department of Psychiatry, Washington University School of Medicine, 660 South Euclid, Box 8134, St. Louis, MO 63110, USA
    • Anna Vannucci, Department of Psychiatry, Washington University School of Medicine, 660 South Euclid, Box 8134, St. Louis, MO 63110, USA
    • Emily K. White, Department of Psychiatry, Washington University School of Medicine, 660 South Euclid, Box 8134, St. Louis, MO 63110, USA

To accept a pilot? Addressing men’s ambivalence and altering their expectancies about therapy.

When considering the challenges therapists encounter with their male clients, perhaps the most daunting tasks occur at the very beginning. Getting boys and men to avail themselves of psychological services is the first challenge. But when men do present, the second challenge is to get them to trust therapists sufficiently enough to share their issues and to form an effective working alliance. This article describes these gender-related challenges from male clients’ point of view, and then elaborates upon effective techniques to help them engage in and benefit from psychotherapy. We suggest that good therapists for men, like good ship pilots, are informed and prepared. They learn the major cognitive and emotional issues they are likely to encounter with their male clients, and develop a variety of ways to help their male clients navigate the tricky psychological issues of their lives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Not supposed to feel this: Traditional masculinity in psychotherapy with male veterans returning from Afghanistan and Iraq.

Traditional masculine socialization presents challenges in psychotherapy, for example, by decreasing the likelihood of help-seeking and by making emotion-laden content more difficult to address. While this has been established in civilian populations, more intense forms of masculine socialization found in military settings may amplify such issues in male veteran populations. Male veterans returning from and Afghanistan (OEF) and Iraq (OIF) exhibit strong traditional masculine socialization and generally present in a unique manner. It is posited that OEF/OIF male veterans’ unique presentation is in large part because of an interaction between high degrees of endorsement of traditional masculine gender role norms, relative youth, recency of distressing events, and recent experience in the social context of the military where traditional masculinity is reinforced. The impact of these variables on the psychotherapeutic process for male OEF/OIF veterans is significant and likely adds to ambivalence about change and increases dropout from psychotherapy. Modifications of traditional psychotherapeutic approaches designed to address traditional masculine gender role norms and their many interactions with other variables are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)