Depression

Selective serotonin reuptake inhibitors and other second-generation antidepressants have become common therapeutic options for the management of depression. Although these agents are effective and generally well tolerated, they frequently cause sexual adverse effects that can impact patients’ quality of life, thus ultimately leading to nonadherence to therapy in many cases.

Primary care physicians treat the majority of patients in this country who have mental health disorders. But how well prepared are we for these patients when they present to our offices?

Some women 75 and older who are in good health and have excellent functional status may benefit from mammography screening, while others who are in poor health and have short life expectancies probably do not.

Two of the numerous geriatrics offerings at this year’s ACP convention were part of a series entitled “Modifying Your Office Practice for the Tsunami of Older Adults.” This eminently apropos title was actually something of a theme for the convention as a whole. This year, only 3 clinical categories boasted more offerings than geriatrics. Clearly, primary care physicians are beginning to feel the impact of the baby boomers’ coming of age.

Probiotics and prebiotics are now widely used by patients – and even present in many common foods.

Phillip arrived at the appointment for his first psychiatric outpatient session, filled out the paperwork, told me he was depressed, shed a tear, and became completely silent. No amount of coaxing from me could get him to talk. He looked down or into space, avoiding my eyes, and just sat there for the entire 50-minute session.

In the United States, it has been estimated that 7.8% of the total population has diabetes. In 2007, the direct medical expenditures for diabetes were about $116 billion and the total direct and indirect costs were $174 billion, according to the CDC.1

What associated disorders should primary care clinicians be alert for in patients with Parkinson disease?

A national survey done by the American Psychiatric Association (APA) showed that workers are hesitant to seek treatment for mental health issues. Reasons cited included concerns about confidentiality or fears of loss of status in the workplace.

Until recently, I never paid much attention to the possibility that abnormalities of the parathyroid glands could be relevant to patients in my practice. But I decided to learn more about this issue when one of my patients with bipolar disorder who had been treated with lithium told me that she had been given a diagnosis of a parathyroid adenoma after her primary care physician noted hypercalcemia on routine testing.

Parkinson disease (PD) is associated with a number of nonmotor symptoms, including depression, drug-induced psychosis and impulse control disorders, cognitive impairment, anxiety, and sleep disturbances.

A 75-year-old woman presented with worsening dyspnea of about 6 to 8 months' duration. Her symptoms were initially associated with exercise, after about 30 minutes on the treadmill, and now were present at rest. Her breathing pattern had changed to "panting" to improve airflow during minimal activity.

Results of a large study showed that electroconvulsive therapy (ECT) might be equally effective in both patients with unipolar depression and those with bipolar depression.1

Current guidelines for the management of bipolar depression are outdated because they are based on the definition and treatment of unipolar depression, accor

Repetitive transcranial magnetic stimulation (rTMS) may be an effective therapy for treatment-resistant bipolar depression, according to the results of a recent pilot study led by Guohua Xia,

Although rapid-cycling bipolar disorder has been linked to the use of antidepressants, these treatments may still have a role in the management of patients with bipolar depression, said Stephen V. Sobel, MD, clinical instructor at the University of California, San Diego School of Medicine, in a presentation at the US Psychiatric and Mental Health Congress in Las Vegas.1 Patients with bipolar disorder spend most of their time in depression, and antidepressants can alleviate the symptoms, he said.

Almost 90% of employers consider employee medication compliance to be a prime health management objective, according to a study by the National Pharmaceutical Council (NPC).1 The majority of study respondents reported that they are analyzing or have plans to analyze prescription data to determine medication compliance for select health conditions.

What is the role of the primary care practitioner in the care of patients with HIV infection?Although the treatment of human immunodeficiency virus type 1 (HIV-1) infection is usually directed by subspecialists, many patients who are taking highly active antiretroviral therapy (HAART) continue to see their primary care physician. What is the most effective regimen-and what complications should we be on the lookout for?

Dozens of guidelines and algorithms are available from a range of authoritative sources to guide selection of psychopharmacology.

SSRIs and related antidepressants are great drugs for the treatment of depression, anxiety, premenstrual disorders, and other conditions. However, sexual dysfunction is very common and affects 30% to 70% of patients,1 or 36% to 43% of patients depending on the particular medications and the study protocol.2 Men are somewhat more likely than women to have difficulty, especially with the desire phase of sexual function. However, it is clear that patients of both sexes may have either phase-specific or global sexual dysfunction while taking antidepressants.

Huskamp and associates recently reported that in the year following the implementation of Part D, many patients dually eligible for Medicaid and Medicare benefits had difficulty gaining access to psychiatric medications.

The medications currently approved for the treatment of insomnia include 9 benzodiazepine receptor agonist (BZRA) hypnotics and the selective melatonin receptor agonist ramelteon.

Estimates for the costs of treating breast cancer vary considerably, depending on patient population, time horizon, methodology, and other variables. According to a recent review by Campbell and Ramsey1 from the Fred Hutchinson Cancer Research Center in Seattle, estimates of lifetime per patient costs associated with breast cancer ranged from $20,000 to $100,000. As a result of the relatively long survival of patients with breast cancer, the costs of continuing care account for the largest proportion of lifetime costs.

Major depressive disorder (MDD) does not always respond to antidepressants. Whether we are using SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclics, monoamine oxidase inhibitors, or heterocyclics (trazodone, nefazodone, bupropion), the result often falls short of full remission of symptoms.

Patients with migraine accompanied by depression or anxiety disorders had greater improvements in headache-related disability than those without a psychiatric disorder, according to results of the Treatment of Severe Migraine trial.

Tonabersat is effective in the prophylaxis of aura in patients with migraine, according to a recent study led by Jes Olesen, MD, a professor of neurology at the Danish Headache Center at Glostrup Hospital, University of Copenhagen, Glostrup, Denmark.

Patients with migraine are more likely than nonmigraineurs to have temporomandibular disorder (TMD). According to the results of a new study presented at the 14th annual International Headache Conference in Philadelphia, TMD may also be associated with increased headache frequency.

Physicians rate 15% of patient visits as “difficult,” according to the results of a classic study.

Diabetes is the most demanding chronic illness. It challenges every fiber of a patient’s body and spirit and demands a system of care that ministers to the biological, social, and psychological aspects of the illness. It takes a “village” to accomplish this task.

Since the 2006 launch of the Medicare Part D prescription drug benefit, the Centers for Medicare & Medicaid Services (CMS) has required all Part D sponsors, including Health Net, to offer free medication therapy management program (MTMP) services to members at high risk for drug-related problems.