Episode 142. Common problems in Psychiatry with Dr Usman Riaz (part 2)
From the RACGP Health of the Nation report; depression, anxiety, and sleep disturbances are amongst the most commonly seen presentations of mental disorders in general practice. About 1 in 8 people in the world live with a mental disorder which often involves significant disturbances in thinking, emotional regulation, or behaviour.
From the RACGP Health of the Nation report; depression, anxiety, and sleep disturbances are amongst the most commonly seen presentations of mental disorders in general practice. About 1 in 8 people in the world live with a mental disorder which often involves significant disturbances in thinking, emotional regulation, or behaviour.
Globally it is estimated that 5% of adults suffer from depression, affecting women a little more than men.
Anxiety disorders affect a similar number of people, characterised by excessive fear, and worry and related behavioural disturbances.
Bipolar disease is characterised by periods of depressive episodes alternating with periods where manic symptoms prevail. Affecting less than 1 % of the population, suicide risk is increased.
Addiction disorders embrace a long list of destructive habits. Post traumatic stress disorder (PTSD), schizophrenia, disruptive behaviour, and dissocial disorders as well as neurodevelopmental disorders are amongst the many conditions presenting clinically and often requiring psychiatric assessment.
I was also interested to discover more about the adverse effects of social media on teenage and young adults’ mental health and in this podcast, and was curious to explore some of the mental health conditions presenting commonly in primary practice and to understand the place of therapies available. It was a privilege to interview psychiatrist Dr Usman Riaz for this episode.
Dr Muhammad Usman Riaz is a fellow of The Royal Australian and New Zealand College of Psychiatrists and has sub-specialised in addiction psychiatry. He Holds a Master of Public Health with a major in Occupational Health and Safety from Monash University and Master of Psychiatry from the University of Melbourne. He is Director of Medical Service at The Langmore Centre in Berwick operated by St John of God Hospital. Please welcome Usman to the conversation.
REFERENCES:
Dr Usman Riaz-www.sjog.org.au
World Health Organization-Mental Disorders. Who.int
Selective Serotonin Reuptake Inhibitors-Stat Pearls www.ncbi.nlm.nih.gov
Episode 141. Common problems in Psychiatry with Dr Usman Riaz (part 1)
From the RACGP Health of the Nation report; depression, anxiety, and sleep disturbances are amongst the most commonly seen presentations of mental disorders in general practice. About 1 in 8 people in the world live with a mental disorder which often involves significant disturbances in thinking, emotional regulation, or behaviour.
From the RACGP Health of the Nation report; depression, anxiety, and sleep disturbances are amongst the most commonly seen presentations of mental disorders in general practice. About 1 in 8 people in the world live with a mental disorder which often involves significant disturbances in thinking, emotional regulation, or behaviour.
Globally it is estimated that 5% of adults suffer from depression, affecting women a little more than men.
Anxiety disorders affect a similar number of people, characterised by excessive fear, and worry and related behavioural disturbances.
Bipolar disease is characterised by periods of depressive episodes alternating with periods where manic symptoms prevail. Affecting less than 1 % of the population, suicide risk is increased.
Addiction disorders embrace a long list of destructive habits. Post traumatic stress disorder (PTSD), schizophrenia, disruptive behaviour, and dissocial disorders as well as neurodevelopmental disorders are amongst the many conditions presenting clinically and often requiring psychiatric assessment.
I was also interested to discover more about the adverse effects of social media on teenage and young adults’ mental health and in this podcast, and was curious to explore some of the mental health conditions presenting commonly in primary practice and to understand the place of therapies available. It was a privilege to interview psychiatrist Dr Usman Riaz for this episode.
Dr Muhammad Usman Riaz is a fellow of The Royal Australian and New Zealand College of Psychiatrists and has sub-specialised in addiction psychiatry. He Holds a Master of Public Health with a major in Occupational Health and Safety from Monash University and Master of Psychiatry from the University of Melbourne. He is Director of Medical Service at The Langmore Centre in Berwick operated by St John of God Hospital. Please welcome Usman to the conversation.
REFERENCES:
Dr Usman Riaz-www.sjog.org.au
World Health Organization-Mental Disorders. Who.int
Selective Serotonin Reuptake Inhibitors-Stat Pearls www.ncbi.nlm.nih.gov
Episode 128. Chronic Leukaemia with Jake Shortt
Leukemias are malignant progressive disease in which the bone marrow and other blood-forming organs produce increased numbers of immature or abnormal leucocytes. This is thought to occur after somatically acquired genetic mutations lead to dysregulation and clonal expansion of progenitor cells. Whilst most leukemias involve white blood cells, occasionally other cells are the primary leukemia cells such as red blood cells or platelets.
As disease progression occurs, suppression of normal blood cell production leads to anemia and cytopenia with a host of attendant symptoms and clinical consequences.
Leukemias are malignant progressive disease in which the bone marrow and other blood-forming organs produce increased numbers of immature or abnormal leucocytes. This is thought to occur after somatically acquired genetic mutations lead to dysregulation and clonal expansion of progenitor cells. Whilst most leukemias involve white blood cells, occasionally other cells are the primary leukemia cells such as red blood cells or platelets.
As disease progression occurs, suppression of normal blood cell production leads to anemia and cytopenia with a host of attendant symptoms and clinical consequences.
There are 14 new diagnoses of Leukaemia per day in Australia accounting for about 5200 diagnoses yearly and making up about 3.2 % of all new cancer diagnoses per year. Leukaemia is responsible for over 2100 deaths annually. Men are slightly more likely to be affected in a 60: 40 split with women. By the age of 85 years, one has a 1: 50 chance of this diagnosis. With current treatment approaches overall 5-year survival sits at about 64 % but this figure is influenced by the subtype of Leukaemia diagnosed with aggressive forms of Leukaemia such as AML carrying a much worse prognosis than a diagnosis such as CLL which may run an indolent course for many years.
Dividing adult Leukaemia into acute and chronic classification is most helpful and this podcast will approach the topic similarly over two episodes.
The acute Leukaemias encompass acute myeloid leukemia (30 % of adult Leukaemia), acute lymphoblastic Leukaemia and Leukaemia's of ambiguous origin.
The chronic Leukaemias include Chronic Myeloid Leukaemia (CML) and Chronic lymphocytic leukemia (CLL)
This is another vast subject, and it was a real honour to invite Professor Jake Shortt to the podcast. Jake is the Head of Haematology Research at the School of Clinical Sciences and clinical lead at Monash Haematology for Myeloid Leukaemia, myelodysplasia and T-cell lymphoma. He is the Principal Investigator on a range of clinical trials for T-cell lymphoma and myeloid malignancies, conducted through the Monash Haematology clinical trials unit and the recipient of a Medical Research Future Fund Career Development Fellowship. His work in the School of Clinical Sciences is focused on strategies incorporating epigenetic drugs with immunotherapy in haematological cancers, particularly Lymphoma and Multiple Myeloma. Jake heads the Blood Cancer Therapeutics laboratory within the Monash Health Translation Precinct and somehow also finds the time to be Chair of the Laboratory Sciences Working Party of the Australasian Leukaemia and Lymphoma Group (ALLG) and Deputy Chair of their Scientific Advisory Committee.
Please welcome Professor Jake Shortt to the podcast.
References :
Haematology and Oncology Subspecialty Consult, 4th Ed, Cashen and Van Tine, Wolters Kluwer, Ch 31
www.leukaemia.org.au
www.cancer.org.au
www.monashhealth.org/services/haematology/jake-shortt/
Episode 127. Acute Leukaemia with Jake Shortt
Leukemias are malignant progressive disease in which the bone marrow and other blood-forming organs produce increased numbers of immature or abnormal leucocytes. This is thought to occur after somatically acquired genetic mutations lead to dysregulation and clonal expansion of progenitor cells. Whilst most leukemias involve white blood cells, occasionally other cells are the primary leukemia cells such as red blood cells or platelets.
As disease progression occurs, suppression of normal blood cell production leads to anemia and cytopenia with a host of attendant symptoms and clinical consequences.
There are 14 new diagnoses of Leukaemia per day in Australia accounting for about 5200 diagnoses yearly and making up about 3.2 % of all new cancer diagnoses per year. Leukaemia is responsible for over 2100 deaths annually. Men are slightly more likely to be affected in a 60: 40 split with women. By the age of 85 years, one has a 1: 50 chance of this diagnosis. With current treatment approaches overall 5-year survival sits at about 64 % but this figure is influenced by the subtype of Leukaemia diagnosed with aggressive forms of Leukaemia such as AML carrying a much worse prognosis than a diagnosis such as CLL which may run an indolent course for many years.
Dividing adult Leukaemia into acute and chronic classification is most helpful and this podcast will approach the topic similarly over two episodes.
The acute Leukaemias encompass acute myeloid leukemia (30 % of adult Leukaemia), acute lymphoblastic Leukaemia and Leukaemia's of ambiguous origin.
The chronic Leukaemias include Chronic Myeloid Leukaemia (CML) and Chronic lymphocytic leukemia (CLL)
This is another vast subject, and it was a real honour to invite Professor Jake Shortt to the podcast. Jake is the Head of Haematology Research at the School of Clinical Sciences and clinical lead at Monash Haematology for Myeloid Leukaemia, myelodysplasia and T-cell lymphoma. He is the Principal Investigator on a range of clinical trials for T-cell lymphoma and myeloid malignancies, conducted through the Monash Haematology clinical trials unit and the recipient of a Medical Research Future Fund Career Development Fellowship. His work in the School of Clinical Sciences is focused on strategies incorporating epigenetic drugs with immunotherapy in haematological cancers, particularly Lymphoma and Multiple Myeloma. Jake heads the Blood Cancer Therapeutics laboratory within the Monash Health Translation Precinct and somehow also finds the time to be Chair of the Laboratory Sciences Working Party of the Australasian Leukaemia and Lymphoma Group (ALLG) and Deputy Chair of their Scientific Advisory Committee.
Please welcome Professor Jake Shortt to the podcast.
References :
Haematology and Oncology Subspecialty Consult, 4th Ed, Cashen and Van Tine, Wolters Kluwer, Ch 31
www.leukaemia.org.au
www.cancer.org.au
www.monashhealth.org/services/haematology/jake-shortt/
Leukemias are malignant progressive disease in which the bone marrow and other blood-forming organs produce increased numbers of immature or abnormal leucocytes. This is thought to occur after somatically acquired genetic mutations lead to dysregulation and clonal expansion of progenitor cells. Whilst most leukemias involve white blood cells, occasionally other cells are the primary leukemia cells such as red blood cells or platelets.
As disease progression occurs, suppression of normal blood cell production leads to anemia and cytopenia with a host of attendant symptoms and clinical consequences.
There are 14 new diagnoses of Leukaemia per day in Australia accounting for about 5200 diagnoses yearly and making up about 3.2 % of all new cancer diagnoses per year. Leukaemia is responsible for over 2100 deaths annually. Men are slightly more likely to be affected in a 60: 40 split with women. By the age of 85 years, one has a 1: 50 chance of this diagnosis. With current treatment approaches overall 5-year survival sits at about 64 % but this figure is influenced by the subtype of Leukaemia diagnosed with aggressive forms of Leukaemia such as AML carrying a much worse prognosis than a diagnosis such as CLL which may run an indolent course for many years.
Dividing adult Leukaemia into acute and chronic classification is most helpful and this podcast will approach the topic similarly over two episodes.
The acute Leukaemias encompass acute myeloid leukemia (30 % of adult Leukaemia), acute lymphoblastic Leukaemia and Leukaemia's of ambiguous origin.
The chronic Leukaemias include Chronic Myeloid Leukaemia (CML) and Chronic lymphocytic leukemia (CLL)
This is another vast subject, and it was a real honour to invite Professor Jake Shortt to the podcast. Jake is the Head of Haematology Research at the School of Clinical Sciences and clinical lead at Monash Haematology for Myeloid Leukaemia, myelodysplasia and T-cell lymphoma. He is the Principal Investigator on a range of clinical trials for T-cell lymphoma and myeloid malignancies, conducted through the Monash Haematology clinical trials unit and the recipient of a Medical Research Future Fund Career Development Fellowship. His work in the School of Clinical Sciences is focused on strategies incorporating epigenetic drugs with immunotherapy in haematological cancers, particularly Lymphoma and Multiple Myeloma. Jake heads the Blood Cancer Therapeutics laboratory within the Monash Health Translation Precinct and somehow also finds the time to be Chair of the Laboratory Sciences Working Party of the Australasian Leukaemia and Lymphoma Group (ALLG) and Deputy Chair of their Scientific Advisory Committee.
Please welcome Professor Jake Shortt to the podcast.
References :
Haematology and Oncology Subspecialty Consult, 4th Ed, Cashen and Van Tine, Wolters Kluwer, Ch 31
www.leukaemia.org.au
www.cancer.org.au
www.monashhealth.org/services/haematology/jake-shortt/
Episode 124. Lipids and Atherosclerotic Cardiovascular Disease with Dr Brett Forge (Part 3/3)
Lipids are essential for cell function and healthy metabolism however clinical analysis of a patient’s lipid profile also addresses one of the fundamental drivers of atherosclerotic cardiovascular disease responsible for 25 % of all deaths in Australia. Modification of abnormal serum lipid levels by lifestyle and pharmacologic intervention aims to achieve a healthy coronary circulation reducing new atheroma formation and stabilizing preexisting atheromatous plaques.
Lipids are essential for cell function and healthy metabolism however clinical analysis of a patient’s lipid profile also addresses one of the fundamental drivers of atherosclerotic cardiovascular disease responsible for 25 % of all deaths in Australia. Modification of abnormal serum lipid levels by lifestyle and pharmacologic intervention aims to achieve a healthy coronary circulation reducing new atheroma formation and stabilizing preexisting atheromatous plaques.
Atheroma develops when cholesterol esters and triglycerides enter the vascular intima inducing local inflammation. Macrophages recruited to the inflammation engulf the cholesterol esters by phagocytosis. Stuffed with cholesterol these cells are referred to as foam cells. The inflammatory cascade is accentuated and recruits more inflammatory cells some of whom perish over time and calcium deposition and fibrosis develops within a forming plaque. Plaque enlargement may distort vascular anatomy expanding into the vessel lumen impeding blood flow and inducing ischaemia however not all plaques impact in this way and even large developing plaques may form in a way that does not disrupt blood flow. Instability in a growing plaque however may lead to rupture and the initiation of an acute thrombotic event. Whilst hyperlipidemia underscores atheroma pathogenesis this complex and life-threatening process is also adversely influenced by cigarette smoking, hypertension, genetics, and poor glycaemic control.
Having a clear understanding of lipid physiology allows us to appreciate both atheroma formation and how cardiovascular risk may be modified. One of the key points is that as lipids are water insoluble and they must be transported in specialized vesicles. These are called lipoproteins when produced by the liver for entry into the circulation and micelles for entry into the biliary system and subsequently the gastrointestinal tract. Chylomicrons are the specialized vesicles produced by gut enterocytes to transport lipids from the digestive tract via lymphatics ultimately into the circulation.
Current Australian guidelines for lipid management recommend:
Total Cholesterol < 4 mmol/l if high risk, < 5 .5 mmol/l for general population
LDL < 1.8 mmol/l for high risk, < 2.0mmol/l general population
Triglycerides < 2 mmol/l
HDL > 1.0 mmol/l
Lowering LDL cholesterol by 1mmol/l reduces the incidence of major vascular events (non-fatal myocardial infarction, coronary death, coronary revascularization, or stroke) by about one fifth. With 11 fewer vascular events per 1000 treated over 5 years. Similarly, triglyceride reduction per 1 mmol/l is associated with about half this cardiovascular risk reduction.
Interventions that are utilized to modify the cardiac risk associated with lipids include:
Dietary manipulation
Pharmacologic modification of lipid synthesis or absorption
Multiple epidemiological studies have demonstrated a greater incidence of coronary artery disease linked to non-HDL cholesterol and elevated serum triglycerides as well as a protective benefit from high HDL levels which includes when triglycerides and LDL levels are high and a lowering of CVD risk even when optimal triglyceride and non HDL cholesterol levels are achieved.
Given the critical importance of cardiovascular risk modification it was a pleasure to invite cardiologist Dr Brett Forge to the following two episodes of this podcast to expand on this fascinating subject.
References:
Basic and Clinical Pharmacology 14th ed -Bertram G. Katzung, LANGE Books, Ch 35.
Principles of Medical Biochemistry, Eisenberg & Simmons,3Rd Ed, Elsevier Saunders, Ch 23
Ganong’s Review of Medical Physiology, Barrett et al,25 th Ed, LANGE Books, Ch 26
Dietary Fat and Risk of Cardiovascular Disease: Recent Controversies and Advances, Annual Review of Nutrition, Vol. 37:423-446, Wang & Hu
Dietary Cholesterol and the Lack of Evidence in Cardiovascular Disease, Nutrients 2018Jun;10(6):780 Ghada A. Soliman
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au. Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne, Australia, and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.