Depression

An 84-year-old woman presents with a 3-year history of slowly progressivememory impairment accompanied by functional decline. Thepatient lives alone but has been receiving an increasing amount of support from her 2 daughters,who accompany her to the appointment. The daughters first noticed that their mother was havingtrouble driving. About a year ago, she started forgetting family recipes. She also left food cookingon the stove unattended and burned several pans. Currently, the daughters are providing mealsand transportation, assisting with housework, and doing their mother’s laundry. They have becomeincreasingly alarmed because she takes her medications only sporadically, despite the factthat they fill her pillboxes and call her regularly with reminders. Their chief concern is whether itis safe for their mother to continue to live alone.

For 3 days, a 42-year-old man has had episodic dullchest pain. The anterior precordial and retrosternalpain intensifies with inspiration and movement. He has nohistory of recent viral infection, hypertension, coronaryartery disease, cardiac surgery, diabetes mellitus, or hyperlipidemia.There is no family history of cardiovasculardisease.

A 76-year-old woman presents with chest pain-which she describes as“muscle tightness”- that began when she awoke in the morning. Thepain is constant, exacerbated by deep inspiration, and accompanied by asubjective sense of slight dyspnea; she rates its severity as 3 on a scale of1 to 10. She denies pain radiation, nausea, diaphoresis, palpitations, andlight-headedness. Her only cardiac risk factors are hypertension and a distanthistory of smoking.

A variety of clinical syndromes can cause T-wave inversions; these range from life-threatening events, such as acute coronary ischemia, pulmonary embolism, and CNS injury, to entirely benign conditions. Here: a discussion of conditions that can cause T-wave inversions in leads V1 through V4.

ROCHESTER, N.Y. -- Childhood obesity remained a focus of pediatrics during the year, along with concerns about safety, particularly the safety of psychiatric medications.

SAN ANTONIO -- The advent of endocrine therapy for breast cancer has raised a host of unanswered questions about who should get the new drugs, when, and what should be done about treatment side effects, researchers said here.

SILVER SPRING, Md. -- FDA advisers have recommended that a suicidality-risk black box warning on antidepressant drugs be extended from children and adolescents to cover adults in their middle 20s.

SILVER SPRING, Md. -- FDA advisers have recommended that a suicidality-risk black box warning on antidepressant drugs be extended from children and adolescents to cover adults in their middle 20s.

NEW YORK -- Inner-city children exposed in utero to high levels of a now-banned pesticide had significantly greater delays in mental and psychomotor development than peers with low prenatal exposure, investigators reported.

KUOPIO, Finland -- Antidepressants do not significantly reduce suicide, and those taking the drugs increase attempts, according to a large Finnish study. Yet there was a reduced overall mortality among suicidal patients taking antidepressants.

AARHUS, Denmark -- A first-time major mental illness can strike mothers with dramatic suddenness within three weeks of delivering a first child, researchers here reported.

BRISTOL, England -- For newly diagnosed depression patients, there may be a tell-tale taste test for selecting the right antidepressant.

BETHESDA, Md. -- Employers including depression screening with care management as a benefit could help improve workers' lives and the company's bottom line, researchers have concluded.

TORONTO -- For sleep-deprived new mothers, some planning and training may translate into nearly an extra hour of welcome shuteye, according to a small study here.

Although the estimates of prevalence vary, there is convincing evidence that patients with chronic obstructive pulmonary disease (COPD) are at increased risk for depression. Moreover, depression has been associated with diminished functional status, increased symptoms, and increased mortality in patients with COPD. Encouraging news comes from Nguyen and Carrieri-Kohlman, who report that a dyspnea self-management program that includes exercise can reduce both dyspnea and depressed mood in these patients.

ABSTRACT: Age-related changes that affect drug distribution, such as increased total body fat, decreased muscle mass, and decreased total body water, necessitate reduction in the dosage of water- and lipid-soluble agents. Because creatinine clearance declines with age, the dosage of agents that are excreted primarily by the kidney must also be lowered to prevent toxicity. Examples include aminoglycosides, fluoroquinolones, penicillins, procainamide, lithium, angiotensin-converting enzyme inhibitors, and digoxin. A good rule of thumb to follow until creatinine clearance can be calculated is to reduce the total dose by half in frail elderly persons or in those with established renal disease. Anticholinergic agents should be used with caution because they are associated with urinary retention, heart block, constipation, dry mouth, blurred vision, sedation, and acute or chronic confusion in elderly patients.

Increasing evidence demonstrates that adolescents with asthma are at greater risk for anxiety and depression. However, few studies have investigated the association of psychological disorders with asthma symptoms, an important factor in evaluating asthma treatment. Now the results of a large population-based study of adolescents with asthma confirm that anxiety and depression are highly associated with increased asthma symptoms.

WASHINGTON -- The antidepressant Paxil (paroxetine) may cause fetal cardiac malformations, and the drug should be avoided if possible in pregnancy, recommended an advisory committee of the American College of Obstetricians and Gynecologists here.

NEW ORLEANS, Nov. 22 -- In the aftermath of Hurricane Katrina, patients here suffered from a generalized anxiety disorder dubbed "Katrina Brain," a psychiatrist reported here.

NEW ORLEANS -- Parents of children and adolescents with depression should be reassured that the benefits of antidepressants outweigh the risks, despite black box warnings about the potential of suicide in adolescents, a pediatric psychiatrist said here.

NEW ORLEANS -- Research has challenged the conventional wisdom that depressed patients need three to four weeks to respond to antidepressant medication and that any earlier response is due to the placebo effect, said an investigator here.

NEW ORLEANS -- The example of Andrea Yates, who drowned her five children in a bathtub five years ago, illustrates the difficulty of identifying postpartum psychosis, said a psychiatrist who testified in her defense.

NEW ORLEANS -- The pathology behind insomnia may be more than a consequence of mental disorders such as depression, anxiety, and alcohol abuse, investigators here said. It may be a harbinger of an underlying cause.

NIJMEGEN, The Netherlands -- Occupational therapy for patients with dementia and their caregivers improves the ability of both to cope with consequences of the condition, Dutch researchers found.

DURHAM, N.C. -- Patients with a constellation of negative personality traits, such as depression, anxiety, hostility, and anger, are at an increased risk for coronary heart disease, investigators here reported.