Depression

A 54-year-old woman presents for an initial consultation. She has multiple chronic disorders, including type 2 diabetes mellitus and hypertension, for which she takes various medications-none of which are new.

Primary care is demanding for a host of reasons, not the least of which is the daunting breadth of issues practitioners grapple with. One issue is evaluating the risk of suicide. Two recent studies provide some intriguing data that may change the way we practice.

Does an Achille’s tendon rupture, tendonitis, bursitis, or something else underlie sudden heel and lower leg pain?

Quality of life in children and adolescents with inflammatory bowel disease (IBD) is a key focus of research presented at the 2010 Advances in IBD conference in Hollywood, Florida. Two of the top abstracts address social isolation and patient adherence to medication regimens among teenagers with IBD.

Diabetes is a demanding and difficult chronic disease. Life changes dramatically for a patient and his or her family once the diagnosis is made. Nutritional food choices, increased physical activity, multiple medications, visits to a physician, and blood tests are no longer optional. They now are a means of changing the length and quality of life. The patient has to rapidly become knowledgeable about nutritional content of any food he eats, different ways to be active, blood glucose testing, medication doses and side effects, and new words and abbreviations, such as A1c, LDL, HDL, and triglycerides.

How to determine whether opioids are appropriate, what to do about breakthrough pain, and how frequently to monitor.

Dr Schneider addresses myths and misunderstandings about the long-term use of opioids to treat noncancer pain.

According to the Sgarbossa criteria, the patient had an acute MI: ECG revealed a greater than 1-mm ST-segment depression in lead V2 and about 5-mm discordant ST-segment elevation in leads II, III, and aVF.

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?

In this podcast, Dr Lieberman discusses the associated features of three specific mental disorders: anxiety, major depressive disorder, and bipolar disorder. He offers practical techniques that can be used in diagnosing each of these disorders and provides suggestions for treatment.

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

Primary care physicians are often the first to see patients with mental health problems and they provide 70% of metal health care to patients. They also write a majority of the prescriptions for antidepressant and antianxiety medications in the United States. This is understandable in light of the fact that physical and mental ailments are often comorbid. But, there may be more to treating a patient who presents with depression than prescribing a pill.

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,