Journals watch: Obesity, PSA, schizophrenia treatment and dementia

A review of medical research papers selected by GPs. By Dr Tillmann Jacobi

Obesity did not seem to affect resolution of symptoms of reflux disease (SPL)
Obesity did not seem to affect resolution of symptoms of reflux disease (SPL)

Obesity and effectiveness of PPI treatment for reflux

J Clin Gastroenterol 2013 doi: 10.1097/MCG.0b013e31827e46be

This large study evaluated the effect of obesity on symptom resolution in patients with reflux disease.

The study distinguished patients at baseline between non-erosive reflux disease and erosive disease. Two post-hoc analyses were performed with data from PPI treatment outcomes of 704 patients with non-erosive reflux and 11,027 with erosive reflux.

Although the severity of erosion was significantly higher in overweight or obese patients than in those with a BMI of 25 or less, the proportion of symptom resolution with PPI treatment was similar overall in all BMI groups.

Other factors, apart from PPI treatment, appeared to be beneficial for symptom resolution and physiological healing, namely increased age and male sex, although this could not be clearly explained.

Obesity and its influence on PSA

BJU Int 2013 doi: 10.1111/j.1464-410X. 2012.11766.x

It is well established that a BMI of more than 30 can significantly reduce serum PSA levels, but it is unclear if there is a linear connection, so that greater obesity may result in a greater impact.

This study from Korea examined the records of 3,471 patients with an initial PSA level of less than 30ng/ml, who had undergone ultrasound-guided prostate biopsies. It found that prostate cancer was detected from biopsy in 1,102 (31.7%) patients. The mean age and median PSA level were inversely associated with BMI. PSA accuracy in each BMI category showed no significant differences.

This study reminds us that we should follow our clinical suspicion regarding prostate cancer, particularly in obese patients, even if their PSA seems normal or borderline.

Could schizophrenia treatment increase the risk of osteoporosis?

Clin Schizophr Relat Psychoses 2013 doi:10.3371/CSRP.KISE.020113

Elevated prolactin levels can lead to a decrease in bone mineral density (BMD). Treatment of schizophrenia with conventional antipsychotics or risperidone causes a degree of hyperprolactinaemia.

This large-scale cross-sectional secondary analysis of 402 schizophrenic patients examined BMD in patients who were well established on antipsychotics or risperidone for at least three months.

The study found a low BMD in 25% of the women and more than 30% of the men. It suggests a generally greater prevalence of low BMD in such patients (both sexes).

This was thought to be due to increased bone turnover related to the medication. However, for men, the medication-induced decline of testosterone appeared to lead additionally to accelerated bone resorption, and therefore further increased their risk for low BMD.

Neuropsychological predictors of dementia in depression

Am J Geriatr Psychiatry 2013; 21(3): 297-306

There is widespread interest in discovering a better way to predict dementia before it starts.

In this longitudinal cohort study, 179 significantly depressed elderly patients without dementia were monitored with yearly neuropsychological testing for a mean time of more than five years.

Thirty (17%) of these patients developed dementia during the study period and were found to have displayed broadly lower cognitive performance at baseline compared with those without dementia.

The study concludes that depression in older adults with cognitive deficits, specifically in the domains of memory and executive functions, indicates a higher risk for developing dementia. If depression occurs for the first time late in life or appears to be significant, it may already indicate the early onset of dementia.

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

  • Dr Jacobi is a GP in York and a member of our team who regularly review the journals

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Consider some coaching on effective ways to raise the matter of weight or obesity opportunistically during a consultation.
  • If not routinely done by your local psychiatric team, discuss the importance of maintaining bone health with your schizophrenic patients at their annual mental health review.
  • Reconsider the situation and diagnosis of elderly patients with 'low mood' or depression to estimate the risk of dementia.

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