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About gungho49

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  1. absolutely agree with sands to each his own. Ones happiness may be other's misery and vice versa.
  2. Kamran all the best you have all our prayers with you
  3. Objective To investigate any association between selective serotonin reuptake inhibitors (SSRIs) taken during pregnancy and congenital major malformations. Design Population based cohort study. Participants 493 113 children born in Denmark, 1996-2003. Main outcome measure Major malformations categorised according to Eurocat (European Surveillance of Congenital Anomalies) with additional diagnostic grouping of heart defects. Nationwide registers on medical redemptions (filled prescriptions), delivery, and hospital diagnosis provided information on mothers and newborns. Follow-up data available to December 2005. Results Redemptions for SSRIs were not associated with major malformations overall but were associated with septal heart defects (odds ratio 1.99, 95% confidence interval 1.13 to 3.53). For individual SSRIs, the odds ratio for septal heart defects was 3.25 (1.21 to 8.75) for sertraline, 2.52 (1.04 to 6.10) for citalopram, and 1.34 (0.33 to 5.41) for fluoxetine. Redemptions for more than one type of SSRI were associated with septal heart defects (4.70, 1.74 to 12.7)). The absolute increase in the prevalence of malformations was low—for example, the prevalence of septal heart defects was 0.5% (2315/493 113) among unexposed children, 0.9% (12/1370) among children whose mothers were prescribed any SSRI, and 2.1% (4/193) among children whose mothers were prescribed more than one type of SSRI. Conclusion There is an increased prevalence of septal heart defects among children whose mothers were prescribed an SSRI in early pregnancy, particularly sertraline and citalopram. The largest association was found for children of women who redeemed prescriptions for more than one type of SSRI.
  4. Joint APA-ACOG Algorithms for Treatment of Depression During Pregnancy A groundbreaking collaboration provides useful advice on a clinically challenging problem. Depression is common in women during the childbearing years, and psychiatrists and obstetricians alike can find it challenging to treat depression during pregnancy. A workgroup convened by the American Psychiatric Association and the American College of Obstetricians and Gynecologists, with input from a developmental pediatrician, has reviewed the literature and developed algorithms for treating women with depression who either are contemplating pregnancy or are already pregnant. Many studies were confounded by elevated rates of substance use and poor prenatal care in depressed women. In some studies, depression itself was associated with higher rates of miscarriage, preterm birth, fetal growth problems, and developmental delay; however, the workgroup could not draw definitive conclusions about these possible links. Despite problems with confounding, the evidence suggested that antidepressants raised risks for miscarriage, low birth weight, transient neonatal symptoms, and persistent pulmonary hypertension of the newborn. Highlights of the treatment algorithms are: Adequate treatment of depression is essential, ideally beginning before conception. Women with severe recurrent major depression who stop pharmacotherapy are at high risk for relapse. Psychotherapy (preferably cognitive-behavioral therapy or interpersonal psychotherapy) is recommended for treatment of mild-to-moderate depression during pregnancy. Clinicians and patients should make decisions about pharmacotherapy collaboratively. Electroconvulsive therapy is an option in severe depression. Patients with severe depression, acute suicidality, psychosis, or bipolar disorder should receive psychiatric referrals. Comment: The collaboration by these two specialty groups is groundbreaking. Despite the limitations of a mixed literature and lack of randomized controlled trials, the treatment algorithms for various clinical scenarios are helpful. The workgroup does not recommend specific antidepressants as being safer in pregnancy but discusses the possibly higher risk of cardiac malformations with paroxetine. However, a recent study suggests that this increased risk may be a class effect of SSRIs in general (BMJ 2009 Sep 26; 339:b3569). Also, 'psychotherapy,' which comprises a multitude of treatments, has been little studied; moreover, empirically validated therapies (CBT and interpersonal psychotherapy) are not always available. Clinicians should certainly recommend psychotherapy, preferably of a validated type, for mild-to-moderate depression. However, they must also continue to monitor depressive symptoms and reevaluate the need for medication throughout pregnancy, especially as depression during pregnancy raises the risk for postpartum depression. This article was simultaneously published in Obstetrics and Gynecology (2009 Sep; 114:703). Deborah Cowley, MD Published in Journal Watch Psychiatry September 28, 2009
  5. a daft question.will the hongkong venue have english actors.
  6. yes very interesting answer that will be indeed.adios.
  7. if not mirror what about life.
  8. u come in another name but the real nastiness is palpable.talking about wolves sheeps etc.
  9. dude get a mirror first.
  10. call first thing tomorrow 9 and i dont think they wud mind a cheque of 760 quid.
  11. flak eventhough schizophrenia has a genetic etiology i dont think it will come under the term 'genetic disease'.even then it bcomes a controversial issue.
  12. interesting read. i fully agree with the happiness bit.i hav very similar thoughts.
  13. sorry to hear that noc.only way out is to call them explain the situation and hopefully they shud consider.
  14. reallybored wrote: sore loser
  15. good post saphire cheers