Depression

BRISTOL, England -- For newly diagnosed depression patients, there may be a tell-tale taste test for selecting the right antidepressant.

BETHESDA, Md. -- Employers including depression screening with care management as a benefit could help improve workers' lives and the company's bottom line, researchers have concluded.

TORONTO -- For sleep-deprived new mothers, some planning and training may translate into nearly an extra hour of welcome shuteye, according to a small study here.

Although the estimates of prevalence vary, there is convincing evidence that patients with chronic obstructive pulmonary disease (COPD) are at increased risk for depression. Moreover, depression has been associated with diminished functional status, increased symptoms, and increased mortality in patients with COPD. Encouraging news comes from Nguyen and Carrieri-Kohlman, who report that a dyspnea self-management program that includes exercise can reduce both dyspnea and depressed mood in these patients.

ABSTRACT: Age-related changes that affect drug distribution, such as increased total body fat, decreased muscle mass, and decreased total body water, necessitate reduction in the dosage of water- and lipid-soluble agents. Because creatinine clearance declines with age, the dosage of agents that are excreted primarily by the kidney must also be lowered to prevent toxicity. Examples include aminoglycosides, fluoroquinolones, penicillins, procainamide, lithium, angiotensin-converting enzyme inhibitors, and digoxin. A good rule of thumb to follow until creatinine clearance can be calculated is to reduce the total dose by half in frail elderly persons or in those with established renal disease. Anticholinergic agents should be used with caution because they are associated with urinary retention, heart block, constipation, dry mouth, blurred vision, sedation, and acute or chronic confusion in elderly patients.

Increasing evidence demonstrates that adolescents with asthma are at greater risk for anxiety and depression. However, few studies have investigated the association of psychological disorders with asthma symptoms, an important factor in evaluating asthma treatment. Now the results of a large population-based study of adolescents with asthma confirm that anxiety and depression are highly associated with increased asthma symptoms.

WASHINGTON -- The antidepressant Paxil (paroxetine) may cause fetal cardiac malformations, and the drug should be avoided if possible in pregnancy, recommended an advisory committee of the American College of Obstetricians and Gynecologists here.

NEW ORLEANS, Nov. 22 -- In the aftermath of Hurricane Katrina, patients here suffered from a generalized anxiety disorder dubbed "Katrina Brain," a psychiatrist reported here.

NEW ORLEANS -- Parents of children and adolescents with depression should be reassured that the benefits of antidepressants outweigh the risks, despite black box warnings about the potential of suicide in adolescents, a pediatric psychiatrist said here.

NEW ORLEANS -- Research has challenged the conventional wisdom that depressed patients need three to four weeks to respond to antidepressant medication and that any earlier response is due to the placebo effect, said an investigator here.

NEW ORLEANS -- The example of Andrea Yates, who drowned her five children in a bathtub five years ago, illustrates the difficulty of identifying postpartum psychosis, said a psychiatrist who testified in her defense.

NEW ORLEANS -- The pathology behind insomnia may be more than a consequence of mental disorders such as depression, anxiety, and alcohol abuse, investigators here said. It may be a harbinger of an underlying cause.

NIJMEGEN, The Netherlands -- Occupational therapy for patients with dementia and their caregivers improves the ability of both to cope with consequences of the condition, Dutch researchers found.

DURHAM, N.C. -- Patients with a constellation of negative personality traits, such as depression, anxiety, hostility, and anger, are at an increased risk for coronary heart disease, investigators here reported.

PHILADELPHIA -- Teens with asthma are more likely to be depressed and to smoke than their non-asthmatic peers, according to a preliminary analysis of CDC survey data.

DALLAS -- A dioxin in the Vietnam War-era herbicide Agent Orange affects the normal growth of the male reproductive system, according to researchers here. It decreases the risk of benign prostatic hyperplasia and lowers testosterone levels.

LOS ANGELES -- Six months of testosterone replacement therapy in aging men restored serum values to normal without apparent harmful effects to the prostate, according to preliminary data from a small study.

CHICAGO -- Some relatively simple steps by the pharmacy may sharply escalate compliance by older patients, researchers reported here.

STANFORD, Calif. -- Allowed a 40-minute nap midway through 12-hour night shifts, emergency room residents and nurses responded with more vigilance and vigor, found researchers here.

The NIH’s National Institute of Mental Health is fundinga $60 million effort to find treatments to counteract HIV’seffects on the human brain.

Although it has been evident since the early days of the HIV epidemic that a dementing illness often accompanies HIV infection and that the virus invades the nervous system soon after systemic infection, the clinical syndrome has evolved with the introduction of antiretroviral therapy.

A 61-year-old woman presented with progressive dyspnea of 5 months' duration. She first noticed dyspnea while engaged in her usual daily activities, and it gradually progressed in severity. A primary care physician prescribed bronchodilators without relief. She was subsequently referred for a pulmonary evaluation.

When your patient presents with chest pain and other symptoms of an acute coronary syndrome (ACS), yet a standard 12-lead ECG shows no evidence of ST-segment elevation myocardial infarction (STEMI), you may face a diagnostic dilemma. The patient could have a non-STEMI ACS for which conservative treatment will suffice--or he could have a STEMI in an electrocardiographically "silent" area and need acute reperfusion therapy.

A 78-year-old woman requests evaluation of worsening dyspnea. A long-time smoker, she quit when chronic obstructive pulmonary disease (COPD) developed. At each of the last several visits, her hair had been uniformly white.

When your patient presents with chest pain and other symptoms of an acute coronary syndrome (ACS), yet a standard 12-lead ECG shows no evidence of ST-segment elevation myocardial infarction (STEMI), you may face a diagnostic dilemma.

ABSTRACT: Only a small number of patients with celiac disease exhibit the textbook symptoms of malabsorptive diarrhea with steatorrhea, weight loss, and nutritional deficiencies. Others may present with a subclinical enteropathy, GI complaints without constitutional symptoms, persistent travelers' diarrhea, or extraintestinal manifestations alone. Be alert for suggestive signs, such as weight loss, skin lesions, oral aphthae, muscle atrophy, de-enamelization of the teeth, and vague GI symptoms, such as bloating. Helpful serologic tests include IgG and IgA antigliadin antibodies, enzyme tissue transglutaminase antibodies, antiendomysial antibodies, and total IgA. Typical endoscopic findings are mucosal atrophy, fissuring, and scalloping. In addition to a gluten-free diet, management encompasses repletion of vitamins and minerals, including iron, folate, calcium, and vitamin D; screening for thyroid disease and diabetes mellitus; bone densitometry and age-appropriate cancer screening; and pneumococcal vaccination.

SAN DIEGO -- For a variety of factors, HIV-infected children appear to have more psychiatric problems than uninfected children, researchers reported here.

SAN DIEGO -- Antidepressant medication should be continued for at least six months past the acute stage of major depressive disorder in children and teens, as is done for adults, researchers reported here.

SAN DIEGO -- Although antidepressants may have an effect on fetuses in utero, so may the lack of the drug during pregnancy.

OTTAWA, Ontario -- American cancer patients are more than twice as likely to commit suicide as the general population, with the rate for men nearly five times that for women, a radiation oncologist reported.