Depression

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.

NEW ORLEANS -- Coronary artery disease patients younger than 55 reap a greater benefit from formal cardiac rehab and exercise training than those who are older, found a study here.

AUSTIN, Tex. -- The widely used acne drug Accutane (isotretinoin) appears to cause depression in mice -- another chapter in the checkered history of the agent.

OTTAWA, Ontario -- A large study of women with cosmetic breast implants found they had a suicide rate over two decades that was 73% higher than the general population -- but the rate was similar to that of women who had other cosmetic procedures.

PITTSBURGH -- Concerns about weight gain and body shape may sabotage pregnant women's motivation not to resume smoking after the baby is born, researchers reported.

PITTSBURGH -- Concerns about weight gain and body shape may sabotage pregnant women's motivation not to resume smoking after the baby is born, researchers reported.

EAST HANOVER, N.J. -- Investigators looking to see whether an Alzheimer's drug could help the memory of patients after a traumatic brain injury had to mine the data hard for a faint light at the end of the tunnel.

EAST HANOVER, N.J. -- Investigators looking to see whether an Alzheimer's drug could help the memory of patients after a traumatic brain injury had to mine the data hard for a faint light at the end of the tunnel.

BANGOR, Wales -- Selective serotonin reuptake inhibitors (SSRI) can have a rare paradoxical effect, sparking aggressive or violent behaviors in otherwise placid patients, said researchers here.