Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The identification of a genetic marker linked to Huntington's chorea may soon lead to a generally available presymptomatic test that has a high degree of accuracy. Bird outlines the likely consequences of such genetic screening for potentially affected persons and their families. The desire to know whether one has inherited a fatal defect, versus the psychological stress if such a defect is found, are factors to consider. Foreknowledge of disease may lead to better decision making about life-style or reproduction, but depression or suicide may also result. Counseling should be available to those at risk and to their families; whether to be tested should be an individual decision. Confidentiality of all test results must be maintained.
JAMA 1985 Jun 14
PMID:Presymptomatic testing for Huntington's disease. 315 56

We describe the vicissitudes of depressed mood for one medical school class that was assessed repeatedly overtime, from the first day of medical school until several months short of graduation, using the Beck Depression Inventory (BDI). Using an arbitrarily defined BDI cutoff point of 14 or greater, at least 12% of the class showed considerable depressive symptoms at any assessment during the first three years; the largest fraction (25%) was symptomatic near the end of the second year. The median class BDI score increased almost threefold during the first two years. Students were likely to be in a similar class ranking at all assessments, indicating that for many students dysphoric mood was enduring. Those with BDI scores of 21 or greater were more likely to quit medical school. Students with high scores for dysphoria were not more likely to evidence a family history of major depression or concomitant substance abuse. Women medical students were not more vulnerable to depressed mood than men.
JAMA 1988 Nov 04
PMID:Vicissitudes of depressed mood during four years of medical school. 292 42

To understand why the dexamethasone suppression test (DST) for the diagnosis of depression became widely accepted and later rejected, we reviewed the sequence of publications in the DST literature. To evaluate the events, we developed and applied concepts of a five-phase process that can be used to assess the clinical utility of diagnostic marker tests. The review showed that when the DST was introduced into the clinical arena, the initial and final two phases of testing (I, IV, and V) had not been adequately conducted. When these phases of testing were suitably checked many years later, the Phase I studies (exploring basic mechanics of test procedures) showed that dexamethasone had variable bioavailability and that the cortisol assay procedure was unreliable. The Phase IV and V studies (examining test results in groups with suitably broad spectrums of cases and controls) showed that the test did not differentiate depression from most pertinent comorbid conditions. Beyond application to the specific problems of the DST, the proposed five phases of development and evaluation for diagnostic marker tests can be used to plan suitable research and avoid similar problems in the future.
JAMA 1988 Mar 18
PMID:How to evaluate a diagnostic marker test. Lessons from the rise and fall of dexamethasone suppression test. 327 49

Seventy-one heavy smokers who had failed in previous attempts to stop smoking participated in a randomized clinical trial to test the efficacy of clonidine as an aid in smoking cessation. The success rate in clonidine-treated subjects (verified by serum cotinine concentration) was more than twice that in the placebo-treated subjects. When the data were stratified by gender, a strong effect present in women was not apparent in men. After six months, cessation rates remained significantly higher among smokers treated with clonidine than those receiving placebo. The data also revealed an unexpectedly high prevalence (61%) of a history of major depression in this sample and a significant negative effect of such a history on cessation regardless of treatment. These findings, highly suggestive of an important role of clonidine in smoking cessation, warrant further studies to establish the long-term (greater than or equal to 12 months) efficacy of this drug and to replicate the association between nicotine dependence and depression.
JAMA 1988 May 20
PMID:Heavy smokers, smoking cessation, and clonidine. Results of a double-blind, randomized trial. 336 52

The medical encounter, like all human interaction, is unavoidably emotion laden. Rather than viewing them as something to be overcome, the emotional responses of the physician can be analyzed for information about the patient or about the physician. The emotional states of patients arouse complementary reactions in the clinician that are diagnostic clues to important clinical syndromes such as depression or character disorders. Conversely, the physician can have idiosyncratic responses to patients that can lead to inappropriate diagnostic and therapeutic choices or to avoidance of particular problems or patients. Self-awareness is the key to utilizing these reactions to improve the patient-physician relationship.
JAMA 1988 Jun 10
PMID:Doctors have feelings too. 337 61

Although fatigue is one of the most common complaints in ambulatory care, research has been minimal. Of the 1159 consecutive patients surveyed in two adult primary-care clinics, 276 (24%) indicated that fatigue was a major problem. Fatigue was more prevalent in women than in men (28% vs 19%). Extensive clinical, laboratory, psychometric, and functional data were gathered for 102 fatigued patients and 26 controls. Laboratory testing was not useful in detecting unsuspected medical conditions or in determining the cause of fatigue. Depression or somatic anxiety or both were suggested by screening psychometric instruments in 82 fatigued patients (80%) compared with three controls (12%). Global dysfunction was marked, as reported by patients on the Sickness Impact Profile. The mean score on the Sickness Impact Profile of 11.3 for fatigued patients is similar to that reported for patients with major medical illnesses. After one year of follow-up, only 29 fatigued patients (28%) had improved. The high prevalence, persistence, and functional consequences of fatigue mandate a search for effective therapy.
JAMA 1988 Aug 19
PMID:Chronic fatigue in primary care. Prevalence, patient characteristics, and outcome. 339 97

We conducted a double-blind, placebo-controlled, crossover study of the effectiveness of amitriptyline and fluphenazine in alleviating the pain of diabetic peripheral neuropathy in six diabetic patients. Pain was evaluated by the patients with a graphic rating scale. A placebo response was found, but no additional effect of amitriptyline and fluphenazine was seen. Although the statistical power of this study was low, these data, when combined with a reevaluation of previous trials of amitriptyline and fluphenazine in the treatment of painful diabetic neuropathy, indicate that there is no justification for the use of these agents in the treatment of painful neuropathy outside of large, controlled clinical trials. Depression as a possible cause of this condition should not go unnoted or untreated.
JAMA 1986 Feb 07
PMID:A trial of amitriptyline and fluphenazine in the treatment of painful diabetic neuropathy. 351 12

As part of a prospective, randomized, controlled study of the effectiveness of a geriatric consultation team, we examined compliance by the house staff with recommendations made by the team. Recommendations were formulated for 185 patients, aged 75 years or older, who were randomized into intervention (n = 92) and control (n = 93) groups. In the control group, only 27.1% of the actions that would have been recommended by the team were implemented independently by the house staff. Problems commonly neglected included polypharmacy, sensory impairment, confusion, and depression. In the intervention group, overall compliance was 71.7%. Highest compliance occurred for recommendations addressing instability and falls (95.0%) and discharge planning (94.3%). We conclude that a geriatric consultation team contributes substantial additional input into the care of older patients. Furthermore, relatively high compliance can be achieved with recommendations made by a geriatric consultation team, thereby overcoming the first barrier to the establishment of such a service.
JAMA 1986 May 16
PMID:A randomized, controlled clinical trial of a geriatric consultation team. Compliance with recommendations. 351 96

To select topics for quality assurance activities focusing on older patients, we convened a 14-member panel of physicians and experts in quality assurance. In two rounds of ratings, panelists rated 42 medical conditions (eg, pneumonia) in terms of their effects on patient outcomes, the availability of beneficial interventions, and the health benefits from improving current quality. They rated 27 health services (eg, adult day-care) on similar dimensions. The feasibility of doing quality assurance work on each condition and service also was rated. Using the ratings, the conditions selected for quality assurance work were congestive heart failure, hypertension, pneumonia, breast cancer, adverse effects of drugs, incontinence, and depression. Health care services selected were hospital discharge planning, acute inpatient care for the frail elderly, long-term-care facilities (intermediate-care facilities and skilled nursing facilities), home health care services, and case management.
JAMA 1987 Oct 09
PMID:Assuring the quality of health care for older persons. An expert panel's priorities. 365

We found significant differences in time to recovery and rates of chronicity in 155 patients with bipolar illness when the episodes were subtyped into those with manic symptoms alone (pure manic), depressive symptoms alone (pure depressed), or symptoms of depression and mania (mixed or cycling) up to the time of entry into a clinical research study. Most of the patients in all three groups who did not recover received levels of somatotherapy that were generally consistent with current recommendations for intensity of treatment appropriate to each condition. Based on a median follow-up of 18 months, the life-table estimate of the probability of remaining ill for at least one year was 7% for the pure manic patients compared with 32% in patients who entered the study with episodes that were mixed or cycling. Purely depressed patients had a 22% probability of remaining ill, approximating rates found in patients without bipolar illness who have episodes of depression. Different clinical variables were found to predict time to recovery in each of these groups. We propose that this subtyping of episodes may be a clinically useful part of the classification of bipolar disorders.
JAMA 1986 Jun 13
PMID:Differential outcome of pure manic, mixed/cycling, and pure depressive episodes in patients with bipolar illness. 370 24


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>