Depression linked to preemies. Why?

November 4, 2008

Depression symptoms early in pregnancy foreshadow preterm delivery

Among nearly 800 pregnant women in a study from California’s Kaiser Permanente program, those who experienced depressive symptoms early in their pregnancies were more likely to deliver preterm babies. The report is published early online in the journal Human Reproduction.

The likelihood of preterm delivery was exacerbated by:

* obesity
* lower education levels and
* a history of fertility problems

This echoes a smaller prospective study published last year. UCLA researchers found the same phenomenon, but they linked it to the medication rather than to the symptoms.

Enter “pregnancy depression” in the search box, and scroll down the page. You’ll see another new study in the American Journal of Psychiatry suggesting that this is fundamentally a circadian rhythm problem, which might be solved by a benign strategy: light therapy.

Psychiatric Times

Which antidepressants are safest in pregnancy? Find the answer in a recent review in Psychiatric Times by clicking on the dedicated link in the left column that searches this publication only.

Complementary Medicine

How about starting with the alternative remedy St. John’s wort? A search on “St. John’s wort pregnancy” in this category reveals that the herbal treatment for depression may not be innocuous to the fetus

No Comments » | Alternative Medicine, Depression, Family Medicine, Psychiatry, Women | Tagged: , , , , | Permalink
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Next: Genetic profiles on Facebook?

November 4, 2008

Project seeks volunteers to make their DNA profiles public for researchers

People may be thinking about genetic testing again, after reading recent press reports about the Personal Genome Project.

Late last month, the first few volunteers saw some of their genetic information made public on the Internet.

This effort seeks 100,000 volunteers willing to have their DNA sequenced, databased, and stored online, along with identifying medical and personal information, in order to speed the development of medical genomics.

For a quick brush-up on the pros and cons of reading your own gene map, the search term
risks genetic testing
offers some balanced reflections.

In some cases, diagnosis by history and examination has already given way to genetic testing. For instance, it’s now time to think “genotype first” when you see a child with a developmental issue, said an editorial in the New England Journal of Medicine a few weeks ago.

See what you can find by searching through the article categories with the search term “genetic testing”.

Evidence-based Articles

Scroll down first page of results for genetic testing to find a recent systematic review in JAMA about genetic testing for chronic adult diseases.

Practical Articles/News

This category holds a news article showing that an inconclusive genetic result can be as distressing as a positive one.

Patient Education

Scroll down here to find a Mayo Clinic blog for patients who may want to learn more about the topic on their own time.

No Comments » | Cancer, Cardiovascular, Diabetes_Endocrine, Family Medicine, Gastrointestinal, Internal Medicine, Medical ethics, Nervous System, Psychiatry, Respiratory_Infectious | Tagged: , | Permalink
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Can MRI tingle the blues away?

October 28, 2008

Transcranial magnetic stimulation approved for major depression

The FDA has reversed itself and has approved transcranial magnetic stimulation (TMS) for major depressive disorder after a first medication trial has failed. The device delivers MRI-like pulses to the brain.

A new randomized trial of 164 patients showed significant symptom improvement compared with placebo. The device will be available only at a few centers for now. It is approved only as a second-line treatment for this one indication, although it has been tested for many.

Earlier studies showed TMS to be less effective than ECT for depression, but also less invasive.

Research/Reviews

What is TMS exactly, and what has it been used for? A timely set of reviews appeared in the Canadian Journal of Psychiatry only last month.

Patient Education

Look in this category for reliable take-home information for patients who may ask about the therapeutic option.

No Comments » | Depression, Psychiatry, Uncategorized | Tagged: , , | Permalink
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Surviving the credit crisis with no bailout

October 28, 2008

Economic downturn spells yet tougher times for primary care, experts say

The current financial crisis could resolve the physician shortage temporarily, because seasoned doctors will probably delay retirement as a result, predict the pundits interviewed in a news report from MedPage Today.

However, because new graduates may opt for more lucrative specialties as a result of the crisis, the shortage of primary care physicians may worsen.

Everything may change after the election. Meanwhile, how should you respond to the current crisis?

Practice Management

In light of current events, learn how to make sensible decisions for your retirement planning.

How can your practice survive in the current credit crunch?

No Comments » | Family Medicine, Internal Medicine | Tagged: , , , | Permalink
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1. Solve breast cancer problem 2. Have baby

October 21, 2008

Expert review calls LHRH agonists “acceptable” for early breast cancer

LHRH agonists probably reduce the risk of recurrence and increase survival in premenopausal women with early breast cancer, whether used alone or in combination with tamoxifen. They’re an “acceptable alternative” to ovarian ablation or radiotherapy, concludes a systematic review from the Cochrane Collaboration.

They appear to reduce recurrence and mortality when used in combination with adjuvant chemotherapy. But evidence to date is too weak to draw strong conclusions, say the authors.

Perhaps results will be stronger when studies are done with the aid of genotyping.

Premenopausal women taking goserelin lose bone mass, but this is preventable with zoledronic acid, according to new results from an Austrian trial.

Research/Reviews

Why did it take so monopolize on endocrine factors in treating breast cancer (compared to HER-2, for instance)? Authors from Johns Hopkins’ Kimmel Center ponder the question in a recent review found in this category.

Clinical Trials

Use this article category to find current clinical trials testing tamoxifen or goserelin for breast cancer in premenopausal women.

No Comments » | Breast, Cancer, Women | Tagged: , , , | Permalink
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Now you can breathe easier about COPD

October 21, 2008

Spiriva doesn’t slow COPD decline, but it really helps a lot anyway

Tiotropium (Spiriva) did not achieve the main study objective of lowering the rate of decline in forced expiratory volume (FEV1) among COPD patients in the large multicenter UPLIFT trial.

However, the drug was responsible for significant improvements in

* lung function,
* quality of life, and
* time to first exacerbation

Patients in the study were allowed to use any respiratory medications they wanted, except for other inhaled anticholinergic agents.

Data from the same study just prompted the FDA to lift its earlier warning about tiotropium and the risk of stroke.

Like the TORCH study reported earlier this year, the UPLIFT study came close to (but did not succeed in) finding a significant effect on mortality.

The best way to slow the rate of FEV1 decline, of course, is to quit smoking. This helps even patients with severe COPD, according to a new review in the European Respiratory Journal.

Research/Reviews

In this category, you’ll find the latest research into the predictive value of the BODE index in COPD.

Related searches

Find reports from earlier trials of interventions to slow the respiratory decline in COPD:

EUROSCOP

ISOLDE

BRONCUS

No Comments » | Cardiovascular, Family Medicine, Geriatrics, Internal Medicine, Respiratory_Infectious, Uncategorized | Tagged: , | Permalink
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Can kids be bipolar–and outgrow it?

October 21, 2008

Longitudinal study documents persistence of child bipolar to adulthood

Not only does bipolar I disorder in fact affect children (despite the skeptics), those who have it are at least 13 times as likely as others to experience the disorder as adults, according to the first major prospective study of the question. The report appears in the October Archives of General Psychiatry.

The study followed 115 children enrolled since 1995. At least half are now 18.

More than 44% continued to have manic episodes as adults, and 35% had substance use disorders. Long episode duration and daily cycling were characteristic features of the syndrome in childhood and often continued after age 18.

Young age at onset and having a mother who wasn’t very warm strongly predicted quicker relapse after recovery. Maternal warmth is a known factor from previous studies of bipolar.

Related searches

Treatment of Early Age Mania study

WASH-U-KSADS

No Comments » | Bipolar, Pediatrics, Uncategorized | Tagged: , | Permalink
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New cardiac test for primary care: Depression screening

October 14, 2008

AHA, APA advise depression screening for all with coronary heart disease

People who have coronary heart disease should all be screened for depression, the American Heart Association and the American Psychiatric Association advise in new recommendations published in Circulation.

The report offers substantial information about links between heart disease and depression. Using SearchMedica, you can quickly locate many of the supporting documents listed in the references.

Recent evidence suggests that young women may be at particularly high risk of depression after myocardial infarction.

Numerous studies link depression and depressive symptoms with poor outcomes in patients with coronary heart disease. Find them using the query “depression cardiac risk factor”.

Or you can retrieve a particular study in the reference list by using words from the title as your search term.

Depression and anxiety predict onset of cardiac events, according to a recent report in the Archives of General Psychiatry, located with the search term “depression anxiety predictors 2-year cardiac events”.

An earlier article in the same journal pinpointed a direct link between depression and the onset of coronary events.

There’s plenty of evidence that people with depression have poor adherence to treatment for cardiac conditions.

On the other hand, cardiac rehabilitation improves depression.

So, primary care physicians should be looking for, and probably treating, depression in heart patients.

Which screening instruments should they use?

Way back in 2000, the New England Journal published an article identifying ways to manage depression in outpatient practice.

In this case, even using its exact title (”Managing depression in medical outpatients”), that article appears far down the list, on page 3.

That’s not good! Why isn’t it at the top of the list?

(Because the article is so old, and SearchMedica’s default setting ranks newest articles highest.)

Try de-selecting the option “Prioritize results by publication date” just beneath the search box, making relevance to your search term rank higher than publication date. The eight-year-old article appears at the top of the list.

Practice Guidelines

Find a new guideline for treatment of depression in adults in primary care using this article category.

CME

Find a new CME course about treating depression in primary care, from an authoritative source.

No Comments » | Depression, Family Medicine, Internal Medicine | Tagged: , , , | Permalink
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Intensive psychotherapy validated (while vanishing)

October 14, 2008

Long-term psychodynamic therapy proves best for some disorders

It must be a challenge to do even one randomized controlled trial of long-term psychotherapy. But German researchers found 11 of them published since 1960, added 12 observational studies, and carried out a meta-analysis which appears in the October 1 edition of the Journal of the American Medical Association.

Psychodynamic psychotherapy continued for at least a year was better than other treatments for

* complex depression or anxiety
* personality disorders, and
* chronic and multiple psychiatric disorders

Only 8 of the trials had sufficient power to be authoritative. And a lack of randomization prevented firm conclusions about whether adding medication to long-term therapy improves the outcomee.

Despite its flaws, a companion editorial asked, does the meta-analysis satisfy the demand for evidence of long-term therapy’s efficacy? Its assessment was a “qualified yes”.

The editorial points out that psychotherapy actually produces changes in brain structure and function, according to the results of recent research.

Evidence that the most challenging of patients can respond to intensive therapy comes at a time when ever fewer psychiatrists offer psychotherapy.

Evidence-based Articles

Use this article category to find rigorous evidence about the effects of long-term psychodynamic psychotherapy.

Psychiatric Times

Last month’s edition of Psychiatric Times featured a review of the effects of psychotherapy on brain function.

No Comments » | Anxiety, Depression, Psychiatry | Tagged: , , , | Permalink
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Chelation and autism: End of the line?

October 7, 2008

NIMH pulls the plug on chelation therapy trial for autism

A clinical trial of chelation therapy in autistic children with detectable blood levels of mercury has been cancelled by the NIMH.

The agency explained that a suggested link between mercury-containing vaccines and autism has not been proven.

Also, rat studies suggested that chelation therapy might be dangerous in the absence of blood lead.

No children had been enrolled in the clinical trial before it was cancelled.

All of Medicine tab

This month’s edition of Archives of Disease in Childhood compiles a recent study finding no link between the MMR vaccine and autism with letters responding to that study.

Practical Articles/News

A recent article in Psychiatric Times reviews complementary therapies for autism.

Evidence-based Medicine

Placebo worked just as well as chelation therapy in reducing distress among people concerned about the mercury in their dental fillings, according to an old randomized study found in this article category.

(The chelating drug did elute mercury, but people on placebo scored equally on anxiety and somatization measures after treatment.)

No Comments » | Adolescent, Family Medicine, Internal Medicine, Pediatrics, Psychiatry, Uncategorized | Tagged: , , , , , | Permalink
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