In children, SSRIs can be considered as a second-line therapy in those with moderate to severe impairment, with close monitoring for psychiatric adverse effects. Patients treated with SSRIs are about twice as likely to respond to treatment as are those treated with placebo, so this treatment is qualified as efficacious. Efficacy has been demonstrated both in short-term (6–24 weeks) treatment trials, and in discontinuation trials with durations of 28–52 weeks.In 2006, the National Institute for Health and Care Excellence (NICE) guidelines recommended augmentative second-generation (atypical) antipsychotics for treatment-resistant OCD. Atypical antipsychotics are not useful when used alone, and no evidence supports the use of first-generation antipsychotics. For OCD treatment specifically, there is tentative evidence for risperidone, and insufficient evidence for olanzapine. Quetiapine is no better than placebo with regard to primary outcomes, but small effects were found in terms of Y-BOCS score. The efficacy of quetiapine and olanzapine are limited by an insufficient number of studies. A 2014 review article found two studies that indicated that aripiprazole was "effective in the short-term", and found that "[t]here was a small effect-size for risperidone or anti-psychotics in general in the short-term"; however, the study authors found "no evidence for the effectiveness of quetiapine or olanzapine in comparison to placebo." While quetiapine may be useful when used in addition to an SSRI/SNRI in treatment-resistant OCD, these drugs are often poorly tolerated, and have metabolic side effects that limit their use.
Distal clavicular osteolysis
Distal clavicular osteolysis (DCO) is often associated with problems weightlifters have with their acromioclavicular joints due to high mechanical stresses put on the clavicle as it meets with the acromion. This condition is often referred to as "weight lifters shoulder". Medical ultrasonography readily depicts resorption of the distal clavicle as irregular cortical erosions, whereas the acromion remains intact. Associated findings may include distended joint capsule, soft tissue swelling, and joint instability. A common surgery to treat recalcitrant DCO is resection of distal clavicle by removing a few millimetres of bone from the very end of the bone. See also
Osteolytic lesion
Biomineralization

References


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