Depression

Since his twenties, a 71-year-old man had had multiple tiny, pinhead, whitish yellow papules on his palms. They were asymptomatic but made his skin feel like sandpaper. Other members of his family had similar lesions.

Sleep complaints are common in patients with chronic obstructive pulmonary disease (COPD). Many patients complain of morning tiredness, early awakenings, difficulty in falling asleep, restlessness, and daytime sleepiness. Functional status may eventually be impaired by the resulting chronic fatigue that is compounded by dyspnea.

Binge eating disorder is more common than anorexia and bulimia combined, according to a national survey, but many physicians are unaware of the problem. The guidance and evidence discussed here highlight the key issues in recognizing and managing the disorder.

BOSTON -- If a depressed patient with bipolar disorder is taking a mood stabilizer such as lithium, adding an antidepressant has no more effect than a placebo, according to researchers here.

CHAPEL HILL, N.C. -- Major depression severity is much the same in a psychiatric clinic as it is in the practice of a generalist, reported investigators in a multicenter study.

NEW ORLEANS -- Heart failure patients who develop clinical depression have a significantly worse survival than those who are not depressed, found a large record review.

SEATTLE -- For depressed patients on medication but too sad to seek psychotherapy, lasting help may be available by the telephone, researchers found in a follow-up study.

CLEVELAND -- Concerns that morphine or other opioids will cause respiratory depression when given to cancer patients for pain appear to be unfounded, investigators here found.

STANFORD, Calif. -- Despite hopes that selective serotonin reuptake inhibitors can help control kleptomania, a small randomized trial of one agent yielded no more than a placebo response.

INDIANAPOLIS -- Anxiety disorders are as prevalent as depression among patients in primary-care practices, but anxiety often goes untreated, investigators here have found.

SYDNEY, Australia -- The swollen and twisted joints in the hands and feet from rheumatoid arthritis are associated with depression in patients who become unhappy with their physical appearance, researchers here said.

BOSTON -- Depression tends to be more severe and persistent in blacks than in whites, according to a national epidemiologic study.

ROCHESTER, N.Y. -- Chronic family stress was associated with an increase in febrile illness in children, researchers here reported.

STANFORD, Calif. -- Children with post-traumatic stress disorder, similar to adults, show physical changes in the brain, according to researchers here.

UTRECHT, The Netherlands -- IVF rates for term live births after "mild" ovarian stimulation with single-embryo transfer equaled the rates for standard stimulation with two-embryo transfer, Dutch researchers reported.

Managing Managed Care: Health Literacy, HIV, and Outcomes

abstract: Depression and anxiety are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), and like COPD, they are often underrecognized. Both of these comorbidities can adversely affect the course of COPD. Anxiety, for example, is associated with more severe dyspnea, greater disability, and impaired functional status; it also is a significant predictor of hospitalizations for acute exacerbations of COPD. When evaluating depressive symptoms, it is important to rule out cognitive impairment, particularly in patients with severe COPD and hypoxemia. Treatment options include antidepressants and cognitive behavioral therapy. Participation in a pulmonary rehabilitation program also can help reduce anxiety and depressive symptoms in patients with COPD. (J Respir Dis. 2007;28(3):94-103)

ABSTRACT: Antiplatelet agents used to treat non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina include aspirin, clopidogrel, and glycoprotein (GP) IIb/IIIa inhibitors. Aspirin is recommended for all patients with acute coronary syndromes (ACS). Clopidogrel can also be used in all patients with ACS, although this agent increases the risk of major bleeding complications if coronary artery bypass grafting is performed less than 5 days after the last dose. Early use of a GP IIb/IIIa inhibitor provides additional benefit in patients with NSTEMI, particularly those who undergo percutaneous coronary intervention. Agents used for anticoagulation in patients with NSTEMI or unstable angina include unfractionated heparin, low molecular weight heparins (LMWHs), and the direct thrombin inhibitor bivalirudin. Enoxaparin-the only LMWH currently indicated for treatment of patients with NSTEMI-can be considered as an alternative to unfractionated heparin, particularly in those who do not require urgent cardiac catheterization.

NEW HAVEN -- The negative emotions of grief -- yearning, depression, and anger -- following the death of a family member from natural causes usually peak within six months, according to a Yale bereavement study of 233 mourners

GLASGOW, Scotland, Feb. 19 -- There's more evidence women can benefit from moderate exercise during early treatment for breast cancer, researchers here said.

SAN FRANCISCO -- A robot dubbed Howard may help stroke patients regain hand function and strength even when the therapy is begun after a delay of three months, researchers said here.

PITTSBURGH -- Common symptoms of depression such as fatigue, sleep disturbances, and anhedonia may trigger initima-media thickness changes associated with subclinical atherosclerosis, researchers here reported.

NEW YORK -- Low birth weight and child abuse combine synergistically to increase the later risks of depression by 10-fold and social dysfunction by nearly ninefold, researchers here said.

GLASGOW, Scotland -- About half of patients with newly diagnosed epilepsy will have good control of their seizures with the first medication tried, and a majority of responders will be seizure-free at the lowest dose, reported European investigators.

DALLAS, Feb. 5 -- For the acute phase of temporomandibular disorder (TMD), cognitive behavioral training and biofeedback reduces overall and jaw-related care costs, researchers found.

The investigators employed the HIV Epidemiological Research Study, a longitudinal prospective cohort study, along with semiannual interview, physical examination, and laboratory assays. They recruited 773 HIV-positive women aged 16 to 55 years from 4 academic medical facilities in Baltimore; Bronx, New York; Providence, RI; and Detroit.

PARIS -- Treating the families of dying patients with compassion, keeping them informed, and establishing good communications with ICU staffers in a formal process can ease the pain of bereavement, according to investigators here.

MONTREAL -- The selective serotonin reuptake inhibitor (SSRI) Celexa (citalopram) appears effective in treating depression among patients with coronary artery disease, researchers here found.

ANN ARBOR, Mich. -- People who are cynically distrustful tend to have higher levels of inflammatory markers associated with atherosclerosis than those who believe the best of others' motives, investigators here suggested.

MONTREAL -- Commonly used selective serotonin reuptake inhibitors (SSRIs) may increase the risk of osteoporotic fractures among patients 50 and older, researchers here found.