Depression

abstract: Proper assessment of the child's readiness for extubation and preparation for extubation are essential to minimize the need for reintubation and to maximize the child's safety in the periextubation period. Readiness for extubation requires that the child have adequate respiratory drive, the ability to maintain a patent airway, adequate oxygenation, and ability to ventilate spontaneously. Respiratory drive can be assessed by decreasing the ventilator settings to a minimal level and observing the child's respiratory effort and respiration rate. Evidence of increased work of breathing, such as tachypnea, retractions, and nasal flaring, suggests that the child may not be ready for extubation. If stridor and respiratory distress develop after the endotracheal tube is removed, nebulized racemic epinephrine is often quite effective; in addition, intravenous corticosteroids should be administered for 24 hours to help decrease the edema more quickly. (J Respir Dis. 2007;28(5):203-207)

The headaches vary in severity, but she usually has severeheadaches (8 on a 10-point visual analog scale[VAS]) once or twice a week; she describes the latter assevere throbbing or pounding pain on the top of thehead but also involving the occipital and frontalareas and occasionally one or the other temple.

ABSTRACT: Many patients with diabetes are anxious or fearful about the disease. These negative emotions stem in part from the fact that the patient is responsible for many facets of diabetes management, such as exercise, dietary modification, and blood glucose measurement. For example, failure to adhere to a regimen may engender guilt. Up to 30% of patients with diabetes are depressed, and hemoglobin A1c levels are higher in such patients. Even patients with good metabolic control may not be doing well psychologically. It is thus essential to ask about patients' concerns and fears, identify their psychosocial needs, and provide emotional support.

ABSTRACT: In addition to appropriate pharmacotherapy and assistance with smoking cessation, a secondary prevention plan should include counseling about a heart-healthy diet, a structured exercise program and/or increased physical activity, and assessment of psychosocial risk factors, such as depression. Advise patients to reduce their intake of salt, sugars, refined carbohydrates, and saturated and trans fats; incorporate more fruits, vegetables, and fish into their diet; and balance caloric intake and physical activity to achieve and maintain a body mass index between 18.5 and 24.9 kg/m2. Cardiorespiratory fitness is the key to cardioprotection; the threshold for improving it in persons with coronary heart disease is about 70% of the mea-sured maximal heart rate. Encourage patients to engage in multiple short bouts of physical activity daily, such as taking the stairs instead of the elevator or walking the dog. Among previously sedentary persons, this approach has effects on cardiorespiratory fitness, body composition, and coronary risk factors similar to those of a structured exercise program.

ABSTRACT: Patients who experience an acute myocardial infarction (MI) are at very high risk for recurrent cardiovascular events. Both site-supervised and home-based cardiac rehabilitation programs can effectively reduce all-cause and cardiovascular mortality. Start risk factor reduction as soon as possible; pharmacotherapy is best initiated while patients are still in the hospital. All patients who have had an MI should receive aspirin, an angiotensin-converting enzyme inhibitor, and a ß-blocker, unless these agents are contraindicated or are not tolerated. Prescribe aggressive lipid-lowering therapy to bring patients' low-density lipoprotein cholesterol levels to below 70 mg/dL. For smokers, quitting is the single most important change they can make to reduce future risk of MI.

SAN FRANCISCO -- Dysphoric mania and other mixed mania states of bipolar disorder will become easier to diagnose with better definitions, a researcher said here.

SAN FRANCISCO -- A significant number of patients with major depression also suffer from chronic insomnia that hampers recovery, and treating the insomnia may improve both conditions.

SAN FRANCISCO -- Remission rates remain low for major depression even with multiple antidepressant drug classes available, but the recently approved selegiline patch (Emsam) aims to bring the rates up.

BOSTON -- The anti-angina drug ranolazine (Ranexa) is safe in patients with non-ST elevation acute coronary syndromes (ACS), but it doesn't reduce the occurrence of cardiovascular events.

GRONINGEN, The Netherlands -- Cognitive behavior counseling for families and spouses bereaved by suicide helped relieve feelings of blame but failed to reduce complicated grief or depression, researchers here reported.

COLUMBUS, OH -- Antidepressants for children and teenagers with depression or anxiety disorders have benefits that may outweigh their risks, according to a large meta-analysis.

A 24-year-old woman presents to the emergency department (ED) withgeneralized weakness, headache, and muscle cramping that have progressivelyworsened over the past week. Recently, she has also had nauseaand vomiting. She denies chest pain, palpitations, dyspnea, cough, fever,chills, diarrhea, and urinary symptoms. She has a history of type 1 renaltubular acidosis.

SAN DIEGO, April 2 -- For better or worse, pediatric antidepressant prescriptions dropped 18.6% following an FDA hearing in 2004 that led to a black box warning a month later on an increased suicidality risk, according to researchers here.

BOULDER, Colo. -- Intensive psychotherapy, coupled with medication, speeds recovery from depression for patients with bipolar disorder, according to researchers here.

KANSAS CITY, Kan. -- For patients with Parkinson's disease poorly controlled by levodopa alone, the addition of ropinirole (Requip) both reduced "off" time and allowed for lower doses of levodopa.

Oral Contraceptives: Five Vignettes Illustrate Dx and Rx Problems-- and Solutions

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.