Depression

abstract: Common causes of poorly controlled asthma include nonadherence to long-term inhaler therapy; environmental exposures; and uncontrolled comorbidities, such as allergic rhinitis. Adherence can be limited by many factors, including inadequate patient education, medication cost, prior failed treatment, poor physician-patient relationship, unrealistic expectations for therapy, and depression. For patients who have a poor perception of their symptoms, emphasizing the "disconnect" between symptoms and pulmonary function can help motivate them to monitor themselves with a peak flow meter and to adjust their medication accordingly. For patients with allergic triggers, instituting allergen-specific environmental controls can decrease symptoms and urgent care visits for asthma. Chronic rhinosinusitis and gastroesophageal reflux disease can also contribute to difficult-to-control asthma, and treatment of these comorbidities can help reduce asthma symptoms. (J Respir Dis. 2007;28(9):365-369)

BETHESDA, Md. -- Emphasizing that asthma affects different patients in different ways, the National Asthma Education and Prevention Program has issued new evidence-based guidelines on the disease.

RICHMOND, Va. -- The Virginia Tech massacre might have been prevented if university authorities had heeded "clear warnings of mental instability" from the shooter, found a state review panel.

PROVIDENCE, R.I. -- Depression and living in a dank, moldy home are linked, but a lack of control and mold-related health problems also play a role, researchers said.

BOSTON -- Some men essentially outgrow and reverse delayed or partial puberty from idiopathic hypogonadotropic hypogonadism, investigators here suggested.

ROCHESTER, Minn. -- There is evidence of a neuroprotective effect of estrogen from two studies that found women were at an increased risk for dementia and parkinsonism after their ovaries were removed before natural menopause.

SAN FRANCISCO -- Children infected with HIV at birth appear to maintain normal behavior and academic performance after 10 years of follow-up, researchers reported here.

GALVESTON, Tex. -- Burn-associated morbidity and mortality in children are driven by an increased hypermetabolic and inflammatory reaction and impaired cardiac function related to burn size.

ST. LOUIS -- Poor housing conditions may contribute to African Americans' risk of developing diabetes, though how is unclear, researchers said.

BETHESDA, Md. -- The success of treatment with the antidepressant citalopram (Celexa) depends partly on a common genetic variation, researchers here said.

ANN ARBOR, Mich. -- Chronic obstructive pulmonary disease (COPD) with severe emphysema strikes women harder than men on clinical and physiological measures, researchers here affirmed.

ABSTRACT: Antidepressants and psychotherapy are effective treatments for major depression. In selecting an antidepressant, consider any previous response or family history of a response to a medication as well as anticipated side effects. Advise patients that antidepressants take at least 4 to 6 weeks to have a full therapeutic effect and that only about half of patients respond to the first drug prescribed. If the patient fails to respond or experiences intolerable side effects, it is usually advisable to substitute an antidepressant with a different mechanism of action. A combined approach using medication and psychotherapy often produces optimal results.

About 10% of all outpatients have major depression.1,2 Although you can prescribe pharmacotherapy, you probably do not have the time to provide extensive counseling.

CARDIFF, Wales -- Marijuana users face a risk of psychotic illness that increases with the frequency of exposure, results of a systematic review suggest.

MINNEAPOLIS -- For patients with obsessive-compulsive disorder, an anti-tuberculosis drug can jump start behavioral therapy, investigators here have found.

CAMBRIDGE, England -- Adding weekly cognitive behavioral therapy sessions to a daily fluoxetine (Prozac) regimen was no more beneficial for depressed adolescents than medication alone, researchers here found.

SAN FRANCISCO -- Poor-quality sleep and cognitive decline appear to go hand-in-hand among older women, but it's unclear which leads to the other, investigators here suggested.

CARDIFF, Wales -- Infants given 1% apraclonidine eye drops as a diagnostic test for Horner's syndrome may be at risk for extreme lethargy, bradycardia, and respiratory depression that can last for hours.

SAN ANTONIO -- High-dose therapy with the selective serotonin reuptake inhibitor (SSRI) sertraline resulted in statistically and clinically significant improvement in isolated impaired executive function in older patients.

BOSTON -- Electronic health records (EHRs) have yet to lead to quality improvements in health care promised by the technology's supporters, according to a review of national statistics.

PARIS, July 9 -- Episodic impaired memory, not dementia, is the crucial clinical symptom required for diagnosis of Alzheimer's disease, according to a proposal for revised diagnostic criteria.

TAIPEI, Taiwan -- Older patients prone to falling can have significantly better lives if they undergo a structured exercise programs, investigators here reported.

AARHUS, Denmark -- Epilepsy was associated with a three-fold increase in risk for suicide and the link was even greater in patients with psychiatric conditions who were newly diagnosed with the neurologic disorder.

SEATTLE -- Increases in suicide rates in the first month of treatment for depression appear to be unrelated to the use of antidepressants, reported investigators here.

NEW YORK -- Showing evidence of a link between environmental factors and migraine, investigators here found that a higher family income may protect adolescents against migraine -- if they have no genetic predisposition to it.

Your Observations About the Man With the Tripod Sign

A 67-year-old woman arrived via ambulance in ventricular tachycardia. She had been experiencing crushing substernal chest pain and shortness of breath that had worsened over the past several hours. She received oxygen (by mask) and lidocaine (100 mg intravenously) en route to the emergency department (ED), but there was no change in the rhythm.

The diagnostic criteria for major depression are anhedonia, depressed mood, feelings of worthlessness or inappropriate guilt, inability to concentrate, fatigue, insomnia or hypersomnia, psychomotor agitation or retardation, significant weight loss or gain, and recurrent thoughts of death or suicide. Five or more of these symptoms must be present for at least 2 weeks, and one of them must be anhedonia or depressed mood. Conditions that can present with depression include dysthymia, bipolar disorder, cyclothymia, and adjustment disorder. Depression may also result from substance abuse or from the physiological conditions associated with a medical disorder, such as spinal or head injury, AIDS, or cancer.

LONDON -- A program of breathing and relaxation exercises known as the Papworth method eases the symptoms of asthma significantly -- largely without change in underlying lung function, researchers here said.

MINNEAPOLIS -- Selective serotonin reuptake inhibitors (SSRIs) have been linked to decreased bone density in older women and men, according to two related studies.