Depression

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.

PHILADELPHIA -- Teens with asthma are more likely to be depressed and to smoke than their non-asthmatic peers, according to a preliminary analysis of CDC survey data.

DALLAS -- A dioxin in the Vietnam War-era herbicide Agent Orange affects the normal growth of the male reproductive system, according to researchers here. It decreases the risk of benign prostatic hyperplasia and lowers testosterone levels.

LOS ANGELES -- Six months of testosterone replacement therapy in aging men restored serum values to normal without apparent harmful effects to the prostate, according to preliminary data from a small study.

CHICAGO -- Some relatively simple steps by the pharmacy may sharply escalate compliance by older patients, researchers reported here.

STANFORD, Calif. -- Allowed a 40-minute nap midway through 12-hour night shifts, emergency room residents and nurses responded with more vigilance and vigor, found researchers here.

The NIH’s National Institute of Mental Health is fundinga $60 million effort to find treatments to counteract HIV’seffects on the human brain.

Although it has been evident since the early days of the HIV epidemic that a dementing illness often accompanies HIV infection and that the virus invades the nervous system soon after systemic infection, the clinical syndrome has evolved with the introduction of antiretroviral therapy.

A 61-year-old woman presented with progressive dyspnea of 5 months' duration. She first noticed dyspnea while engaged in her usual daily activities, and it gradually progressed in severity. A primary care physician prescribed bronchodilators without relief. She was subsequently referred for a pulmonary evaluation.

When your patient presents with chest pain and other symptoms of an acute coronary syndrome (ACS), yet a standard 12-lead ECG shows no evidence of ST-segment elevation myocardial infarction (STEMI), you may face a diagnostic dilemma. The patient could have a non-STEMI ACS for which conservative treatment will suffice--or he could have a STEMI in an electrocardiographically "silent" area and need acute reperfusion therapy.

A 78-year-old woman requests evaluation of worsening dyspnea. A long-time smoker, she quit when chronic obstructive pulmonary disease (COPD) developed. At each of the last several visits, her hair had been uniformly white.

When your patient presents with chest pain and other symptoms of an acute coronary syndrome (ACS), yet a standard 12-lead ECG shows no evidence of ST-segment elevation myocardial infarction (STEMI), you may face a diagnostic dilemma.

ABSTRACT: Only a small number of patients with celiac disease exhibit the textbook symptoms of malabsorptive diarrhea with steatorrhea, weight loss, and nutritional deficiencies. Others may present with a subclinical enteropathy, GI complaints without constitutional symptoms, persistent travelers' diarrhea, or extraintestinal manifestations alone. Be alert for suggestive signs, such as weight loss, skin lesions, oral aphthae, muscle atrophy, de-enamelization of the teeth, and vague GI symptoms, such as bloating. Helpful serologic tests include IgG and IgA antigliadin antibodies, enzyme tissue transglutaminase antibodies, antiendomysial antibodies, and total IgA. Typical endoscopic findings are mucosal atrophy, fissuring, and scalloping. In addition to a gluten-free diet, management encompasses repletion of vitamins and minerals, including iron, folate, calcium, and vitamin D; screening for thyroid disease and diabetes mellitus; bone densitometry and age-appropriate cancer screening; and pneumococcal vaccination.

SAN DIEGO -- For a variety of factors, HIV-infected children appear to have more psychiatric problems than uninfected children, researchers reported here.

SAN DIEGO -- Antidepressant medication should be continued for at least six months past the acute stage of major depressive disorder in children and teens, as is done for adults, researchers reported here.

SAN DIEGO -- Although antidepressants may have an effect on fetuses in utero, so may the lack of the drug during pregnancy.

OTTAWA, Ontario -- American cancer patients are more than twice as likely to commit suicide as the general population, with the rate for men nearly five times that for women, a radiation oncologist reported.

FLINT, Mich. -- Moderate aerobic exercise three to five times a week may make adjuvant radiation for breast cancer more tolerable, found researchers here.

SEOUL, South Korea -- The key to selecting the right antidepressant for initial treatment of late-life depression may lie in the patient's genetic makeup, researchers here have found.

ABSTRACT: Signs that strongly suggest Parkinson disease (PD) include unilateral hand tremor, slowed or decreased movement, and gait changes. Postural alterations include leaning forward or asymmetric shoulder height; the arm may not swing when the patient walks, or it may be held flexed at the elbow. Patients may report increasing difficulties in occupational and social functioning. Mimics of PD include essential tremor, normal pressure hydrocephalus, other neurodegenerative diseases, and drug-induced parkinsonism. Most patients report such nonmotor symptoms as sleep disturbances, visual difficulties, bowel and bladder problems, fatigue, depression, and anxiety. Cognitive impairment in many patients takes the form of slowing of memory and difficulty with visual spatial tasks and executive function. A more realistic treatment goal than tremor eradication is improved overall mobility.

ABSTRACT: Although levodopa and the dopamine agonists remain the mainstays of treatment, the number of therapeutic options has increased, and trials of new medications are ongoing. Some trials are evaluating ways to alter disease progression. Medical management of the symptoms of Parkinson disease is generally successful but requires familiarity with the agents to avoid troublesome side effects. Deep brain stimulation surgery is an option for some patients whose symptoms are not adequately managed with medication.

Because the manifestations of Parkinson disease are protean and complex, the diagnosis can be difficult and treatment challenging. However, an awareness of the key clinical features and familiarity with 2 or 3 of the dopaminergic medications can facilitate management.

BOSTON -- When a diagnosis of irritable bowel syndrome comes to mind, consider migraine, fibromyalgia, and depression as well.