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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Most older adults in the United States live at home and are well nourished. Approximately 5% to 6% reside in nursing homes, and this segment of the older population typically suffers from multiple diseases that contribute to a high incidence of malnutrition. Forty percent of hospital beds are occupied by older persons. This article addresses the causes of malnutrition in older persons institutionalized in long-term and acute-care facilities. The causes include changes in nutrient requirements secondary to disease processes and drug modalities in combination with low or marginal dietary intake. Infections are common and result in anorexia, poor dietary intake, and malnutrition, which predispose the patient to another infection. Occurrence of decubitus ulcers is related to nutritional status and presents a serious risk for older persons with limited mobility. Depression and dementia are commonly seen in older persons and are major contributors to poor appetite and malnutrition. Cancer cachexia accounts for about half of the cases of malnutrition in older institutionalized persons. Physiologic changes that occur with age and multiple drug use place older persons at a high risk for adverse drug reactions. Less body water in the older individual influences and complicates many aspects of treatment. Standards, methods, and interpretation of nutritional assessment measurements in older persons differ from those in younger adults. The nutrition care provider must carefully consider many complex physical, medical, and psychosocial factors to deliver individualized nutrition care.
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PMID:Malnutrition in the institutionalized older adult. 151 70

The long-term efficacy of digoxin maintenance therapy must be determined individually for patients with normal sinus rhythm who have a history of congestive heart failure but no remaining signs or symptoms. Predictive factors for successful discontinuation of the agent in the elderly include normal mental status (including absence of depression), ability to adequately perform activities of daily living, general feelings of well-being, absence of multiple organic disease, absence of multiple drug use, and no evidence of existing congestive heart failure or atrial fibrillation. Our findings indicate that physicians and patients need to reexamine the concept that congestive heart failure is necessarily a chronic disease. Certainly, evidence exists that continuing digitalis therapy indefinitely is inappropriate and may be harmful. Further investigation may prove that congestive heart failure in the elderly, like pneumonia, is a common acute occurrence and in many cases not a chronic state for which patients are destined to receive medication indefinitely. We hope that the findings from our small sample will stimulate other investigators to question the indiscriminate long-term use of digitalis in the elderly.
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PMID:Digitalis for congestive heart disease in the elderly. A family practice view of the efficacy of long-term therapy. 310 Oct 52

The pharmacologic treatment of depression in the aged is complicated by an increased frequency of concurrent medical disease and multiple drug use. In addition, age-related physiologic changes may alter the pharmacokinetics and pharmacodynamics of the antidepressant medications. As a consequence, the variability of response and the incidence of adverse effects are increased in the elderly. The clinical implications of these factors and guidelines for the use of antidepressants in the elderly are discussed.
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PMID:Depression in the elderly: pharmacologic considerations in treatment. 612 36

This article reports on the HIV risk behaviors of a sample of 158 women heroin addicts admitted into the Los Angeles Enhanced Methadone Maintenance Project. Risk behaviors for HIV were associated with age, lack of education, ethnicity, relationship with a drug user, HIV status, and higher scores on measures of illegal activity, suicidality, depression, polydrug use, and alcohol use. Significant reductions in number of male sex partners and needle-sharing partners were reported at follow-up, although frequency of condom use was unchanged. Methadone maintenance programs need to screen women for risk factors and assist them in developing new behavioral skills in order to implement a harm reduction approach to treatment.
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PMID:HIV risk behaviors among women in methadone maintenance treatment. 883 63

This study describes partner violence in a representative sample of young adults. Physical violence perpetration was reported by 37.2% of women and 21.8% of men. Correlates of involvement in severe physical violence differed by gender. Severe physical violence was more strongly associated with unemployment, low educational attainment, few social support resources, polydrug use, antisocial personality disorder symptoms, depression symptoms, and violence toward strangers for men than for women. Women who were victims of severe physical violence were more likely than men who were victims to experience symptoms of anxiety. The findings converge with community studies showing that more women than men are physically violent toward a partner and with clinical studies highlighting violence perpetrated against women by men with deviant characteristics.
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PMID:Gender differences in partner violence in a birth cohort of 21-year-olds: bridging the gap between clinical and epidemiological approaches. 910 36

Despite the fact that needle exchange was introduced in Vancouver as early as 1988, needle sharing remains common. An analysis was conducted to identify determinants of borrowing used needles among subjects participating in a case-control study. IDUs had a documented HIV seroconversion after 1 January, 1994 (n = 89), or repeatedly tested HIV-seronegative after this date (n = 192). Interviewer-administered questionnaires focused on drug use, sexual behaviours, source of needles and depression. Subjects were asked if they had "ever been forced to have sex" as a child, youth or adult. Logistic regression identified determinants of borrowing needles. After controlling for HIV serostatus, factors independently associated with borrowing were injecting > 4 times/day, polydrug use, and ever experiencing non-consensual sex (AOR = 3.4, 95% CI: 1.8, 6.5). Depression was associated with borrowing, although not independently so. Homosexual activity was independently associated with borrowing among males, whereas living with a sexual partner was an independent predictor for females. Access or barriers to clean needle use were not associated with borrowing. Social determinants, particularly a history of sexual abuse, are among the most significant predictors of needle borrowing among Vancouver's IDUs. Early identification of these factors should be a component of HIV prevention programmes.
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PMID:Social determinants predict needle-sharing behaviour among injection drug users in Vancouver, Canada. 948 50

There are great variations in the way psychotropic drugs are prescribed. Most experts are in favour of psychopharmacological monotherapy, but little is known about the extent to which it is actually practised. A survey of the psychopharmacological medication of all patients under treatment was carried out in three Austrian psychiatric clinics of various types on two separate days. A psychiatric university clinic, the psychiatric department of a general hospital and a regional mental hospital were selected for the survey. It was established that only 8% to 22% of the patients underwent psycho-pharmacological monotherapy and that the patients received 2.2 to 3.3 psychotropics on average. Five to 22% of the patients received five or more psychotropic agents. The results are presented in more detail in relation to the diagnoses of schizophrenia and depression. The rare occurence of monotherapy might be due to unsound treatment regimens in some instances, but much more to a general trend in psychiatry fostering polydrug use.
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PMID:Polypharmacy in psychiatric treatment. Patterns of psychotropic drug use in Austrian psychiatric clinics. 2004 22

This paper investigates injecting, shared use of needles/syringes and sexual risk behaviours at intake to treatment and at one-year follow-up among 753 drug users recruited to the National Treatment Outcome Research Study (NTORS). Injecting, sharing and having unprotected sex were substantially reduced among clients admitted to methadone programmes and among those admitted to residential treatments. The overall levels of risk fell after treatment, and the majority of those who were engaged in high risk behaviours at intake had stopped at follow-up. The results also show the variability of individual outcomes. A minority persisted with their risk behaviour, and others who were not at risk at intake who had started to engage in risky behaviours at follow-up. The behaviour of these clients creates a focal point for risk as well as being a threat to public health. Several social and psychological factors were predictive of health risk behaviours. These included frequency and duration of heroin use, polydrug use, alcohol use, gender, ethnicity, having a drug-using partner, anxiety and depression. The results indicate the important role that can be played by treatment services in helping to reduce the risk of blood-borne infections. We suggest that risk reduction interventions are an important and effective component of treatment programmes.
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PMID:Reduced injection risk and sexual risk behaviours after drug misuse treatment: results from the National Treatment Outcome Research Study. 1179 7

Seeking care for prolonged musculoskeletal pain is very common in primary care. We aimed to analyse the pain-related drug use patterns among primary care patients with musculoskeletal pain. The study population consisted of 358 adults visiting a primary care physician due to nonacute musculoskeletal pain. Pain-related medication use, sociodemographic data and pain-related factors were recorded. Depression and mental distress were assessed using the 13-item Beck's Depression Inventory and the 12-item General Health Questionnaire. A chi2 test and logistic regression analysis were used to study the associations between drug use and background factors. The physicians diagnosed musculoskeletal pain in 572 patients. Patients' response rate was 63%. Of these patients, 63% had used prescription drugs and 46% over-the-counter (OTC) drugs during the week preceding the visit. Three out of ten patients (28%) had used drugs daily and 29% had used more than one drug simultaneously due to pain. One out of six patients had used sedatives or hypnotics. The use of prescription drug was closely related to the severity of pain and to the previous visits due to present pain. OTC drug use was associated with living alone. Depression or mental distress associated closely with daily use, multiple drug use and especially hypnotic or sedative use. Among primary care patients with musculoskeletal pain, daily drug use and multiple drug use as well as the use of sedatives or hypnotics are common. These drug use patterns are associated as closely with sociodemographic factors or mental distress or depression as with pain severity.
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PMID:Drug use by patients visiting primary care physicians due to nonacute musculoskeletal pain. 1245 9

This study examined whether higher rates of depressive symptoms among amphetamine compared with cocaine users result from amphetamine use itself, polydrug use, or experiencing a major lifetime depressive episode and whether depressive symptoms among amphetamine users are more likely to persist 12 months after treatment. The association between amphetamine use and depressive symptoms disappears when controlling for polydrug use and lifetime major depressive episode. Polydrug use and lifetime depressive episode are significantly related to depressive symptoms in the year preceding treatment. Amphetamine use at intake does not predict depressive symptoms among individuals who are abstinent at follow-up, and amphetamine users are no more likely than cocaine users to report depression at a 12-month follow-up.
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PMID:Depressive symptoms among amphetamine and cocaine users before and after substance abuse treatment. 1250 6


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