July 29, 2008
Early response trumps all in predicting antidepressant success in elderly
How do you know when a particular antidepressant is working in an elderly patient, or whether the treatment strategy should change? Merging results from three NIMH studies of geriatric depression, researchers have devised a decision tree to help assess the question. The report appears in the American Journal of Psychiatry.
In general, early symptom improvement after 4 weeks of treatment predicts antidepressant response in this population. Other decision factors include the age of onset, sleep disturbance, and the co-occurrence of anxiety disorder.
Elsewhere in the same issue, an MRI study reveals why mild cognitive impairment often subsides after remission of depression, while executive function may remain impaired. These results may also inform treatment decisions involving geriatric patients.
Related searches
Hamilton Depression Rating Scale
executive function depression elderly
Practice Guidelines
Find recent guidelines about diagnosing and managing depression in the elderly here.
Practical Articles/News
A search here reveals that impaired executive function is associated with suicide risk in the elderly.
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July 22, 2008
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Depression, Family Medicine, Mood Disorder, Women | Tagged: smoking, Depression, pregnancy, psychosis, drug abuse, mental illness, alcohol abuse, postpartum depression, teratology, prenatal care | 
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July 22, 2008
Pediatricians use clues beyond guidelines to adjust asthma regimens
Pediatricians may rely heavily on factors other than asthma symptoms in making their treatment decisions, according to a survey newly published in Pediatrics. The report says the survey was spurred by inappropriate treatment of asthma in children.
The survey presented 500 members of the American Academy of Pediatrics (most of them in suburban private practice) with vignettes of asthma cases.
Guidelines advise doctors to reduce treatment to the lowest levels that control symptoms. Respondents were significantly less likely to say they would step down treatment for a child with well-controlled symptoms if:
* parents said they were bothered by the symptoms,
* the child had recently been hospitalized, or
* symptoms were still in control, but worse since the last visit
None of this may be inappropriate, the report said. Perhaps doctors might like an “easy to use tool” that incorporates these factors.
In general, the survey suggests, most pediatricians now prescribe inhaled corticosteroids appropriately. Their long-term effects on bone density are not severe enough to justify limiting their use for children with asthma, according to another new report in Pediatrics.
Research/Reviews
Find reviews in this section on achieving asthma control.
Practice Guidelines
Quickly find the latest guidelines on management of asthma in children.
Related Searches
parents asthma
assess asthma symptoms
asthma overtreatment
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July 22, 2008
Beyond biopsy: Experimental blood test monitors NSCLC treatment
The Harvard/Mass General researchers who came up with a blood test that can monitor lung-cancer treatment have published their report in the New England Journal of Medicine.
The test uses a microchip that filters tumor cells bearing the carcinoma-specific epithelial cell adhesion molecule (EpCAM), and then scans them for EGFR mutations. In a 23-patient study, the noninvasive method genotyped tumor cells with 96% sensitivity. Presence of the drug-resistance mutation T790M, detectable in about 40% of patients, correlated with reductions in progression-free survival.
Detecting the evolution of resistance to receptor-targeted drugs would obviously avoid wasting time and money, not to mention human suffering, says an editorial. But whether the method will evolve into a clinically useful test remains to be seen.
Start with SearchMedica, and you can move quickly and easily to find relevant information on topics related to your original query.
Related Searches
EpCAM
T790M
Research Reviews
What’s the latest progress to monitor treatment by assaying circulating tumor cells in breast cancer?
CME
Remind yourself about EGFR mutations in lung cancer with an online course.
No Comments » | Breast, Cancer, Lung | Tagged: Breast, blood tests, lung cancer, lung biopsy | Permalink
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July 15, 2008
Late treatment effects—not so much the virus—threaten new HIV patients
People diagnosed with sexually transmitted HIV in the industrialized world today have no greater risk of death within five years than the general population, according to the latest report from the multicenter European CASCADE study.
Those still at somewhat greater risk:
* Intravenous drug users
* People not treated immediately with the HAART regimen.
* In general, men compared with women.
Patients may yet face some excess mortality risk, starting a decade after they first show evidence of anti-HIV antibodies. This is probably due to the cardiac effects of the treatment regimen.
Related searches
CASCADE Collaboration HIV (Other results from the European study)
DAD study HIV (First evidence of heart risks from antiviral drugs)
SMART study HIV (Why restricting antivirals because of this risk is a bad idea)
CME
Find a free government-sponsored online CME course about HIV management.
Practice Guidelines
Find recent guidelines from the New York State Department of Health that address HIV management in primary care.
These guidelines give special attention to management of anxiety and depression, including increased risk of suicide, in this patient population.
Research/Reviews
Look to this category for more information about HAART toxicity.
No Comments » | Family Medicine, Internal Medicine, Respiratory_Infectious | Tagged: AIDS, drug abuse, HAART, HIV | Permalink
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July 15, 2008
Antipsychotics quell violence in schizophrenia–unless that’s not the cause
In general, antipsychotic medication leads to significant reductions in violent behavior among schizophrenia patients, according to new results from the multicenter CATIE study, sponsored by the National Institute of Mental Health.
However, look also for non-psychotic sources of violent behavior, suggests the report in the British Journal of Psychiatry, which medications will not help and which may require intensive therapy. For instance, among subjects with a childhood history of antisocial conduct problems, adherence to antipsychotic medication had no effect on the prevalence of violent behavior.
The 1445-patient study also revealed the following predictors of violent behavior among schizophrenia patients:
* Childhood conduct problems
* Substance misuse
* History of violent victimization
* Economic deprivation
* Living with others rather than alone
Schizophrenia patients with negative psychotic symptoms were less likely to be violent.
Related searches
victimization of mentally ill
MacArthur study
Practical Articles/News
A search here turns up an article from last month’s Psychiatric Times about how to protect yourself against a violent patient.
Research Reviews
Find studies on the effects of clozapine on violent patients with schizophrenia. (Clozapine was not included for patients in this arm of the CATIE study.)
No Comments » | Psychiatry, Schizophrenia | Tagged: clozapine, conduct disorder, psychosis, Schizophrenia, substance abuse, victimization, violent behavior | Permalink
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