CME Article: Use of Psychotropic Drugs in Cerebrovascular Disease
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ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.
CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.0 category 1 credit toward the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. Valid October 1 - December 31, 2005. Estimated time: 1 hour
FULL DISCLOSURE POLICY AFFECTING CME ACTIVITIES
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or provider has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following: Dr. Hill has indicated that he has received honoraria from and is a member of the Speaker’s Bureau for Eli Lilly and Company. Dr. Watson has indicated that she has not received financial support for consultation, research or evaluation or has a financial interest relevant to this article. Dr. Hill has indicated that the presentation will include information on unlabeled uses of psychotropic drugs.
DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.
Educational Objectives
1. To recognize common psychiatric sequelae of cerebrovascular disease
2. To describe the benefits and challenges of treating depression in patients with cerebrovascular disease
3. To understand the appropriate use and potential risks of using antipsychotics in patients with cerebrovascular disease
4. To describe treatment strategies for the various psychiatric manifestations of vascular dementia
Cerebrovascular disease and its many manifestations, including stroke, transient ischemic attack, dementia, depression, and executive dysfunction syndrome, are extremely common worldwide. Currently, stroke is the third leading cause of death in the United States and the leading cause of serious long-term disability in adults, according to the National Stroke Association.1 In the United States, it is estimated that there are over 4 million stroke survivors, with almost one-third of these individuals suffering from some ongoing disability.1 Add to these the millions of people suffering from vascular dementia, post-stroke and vascular depressions, and executive dysfunction syndrome, and this is an overwhelming source of ongoing disability and despair. Fortunately, the discomfort and disability related to depression and psychosis, and the behavioral manifestations of these syndromes, can often be improved significantly by the judicious use of existing psychotropic medications.
DEPRESSION AND VASCULAR DISEASE
Depression and cerebrovascular disease are closely interrelated. There is evidence suggesting that depression itself is a risk factor for stroke.2 Conversely, depressive symptoms are extremely common not only in stroke survivors but also in those with evidence of cerebrovascular disease in the absence of obvious strokes.
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