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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Almost 3 years ago, the Institute of Medicine (IOM) released its pivotal report, Crossing the Quality Chasm, which challenged the healthcare community to reevaluate and reinvent the way it provides care. In January, the IOM hosted an invitational summit in Washington, DC to look at whether that vision is becoming a reality across the country and in local communities. The summit focused on five priority areas: asthma, chronic heart failure, major depression, diabetes, and pain control in advanced cancer.
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PMID:Transforming healthcare: IOM panel discusses vision and reality after Crossing the Quality Chasm. 1508 55

A major factor in evaluating and treating depression is the presence of comorbid medical problems. In this paper, the authors will first evaluate studies showing that medical illness is a risk factor for depression. The authors will review a series of randomized, controlled studies of antidepressant treatment in subjects with major depressive disorder (MDD) and comorbid medical illnesses (myocardial infarction, stroke, diabetes, cancer, and rheumatoid arthritis). Most of these studies report an advantage for an active antidepressant over placebo in improvement of depressive symptoms. The authors also will review a series of studies in which the outcome of antidepressant treatment is compared between subjects with MDD with and without comorbid medical illness. In these studies, subjects with medical illness tend to have lower improvement of depressive symptoms and higher rates of depressive relapse with antidepressant treatment compared with MDD subjects with no medical comorbidity. In addition, the authors will review hypotheses on the mechanism of the interaction between medical illness and clinical response in MDD. The paper will conclude that medical comorbidity is a predictor of treatment resistance in MDD.
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PMID:Impact of medical comorbid disease on antidepressant treatment of major depressive disorder. 1514 72

Major depressive disorder is frequently undiagnosed and untreated in older patients. Grief, pain, sleep issues, concurrent medications, altered physiology, and the presence of comorbid medical and psychiatric conditions can complicate the management of depression in older patients. Remission should be the goal of therapy in treating depression in the elderly, just as it is in younger patients, to maximize the impact of treatment on quality of life. Managing depression in older patients can be done effectively with the antidepressant therapies currently available, including selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and mirtazapine. Comorbid medical conditions, which are common among older patients, can have a significant impact on depression and vice versa. Antidepressant therapy with SSRIs has demonstrated efficacy and tolerability in patients at high risk for cardiovascular events and stroke and in those with vascular dementia or Alzheimer's disease. Care should be taken to choose antidepressants with no or minimal effects on glucose levels in patients with diabetes. In addition, venlafaxine has demonstrated beneficial effects on the relief of the pain of diabetic neuropathy. Venlafaxine, mirtrazapine, and the SSRIs have demonstrated efficacy and tolerability in older patients, while tricyclic antidepressants have also demonstrated efficacy; however, tolerability can be a problem. Depression is not a natural part of the aging process, as some still believe. The review of current data indicates that the goal of management can and should be full remission. Further, the use of newer agents is safe and effective in this population, as long as one considers the pharmacokinetics and pharmacodynamic properties and inherent biological differences in the elderly population when selecting appropriate therapy.
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PMID:Special issues in the management of depression in older patients. 1514 35

Selective serotonin reuptake inhibitors (SSRIs) are well-established medications for the treatment of mood disorders including major depression. These agents are also known to exhibit potent antiplatelet and endothelium protective effects effects. Additionally, SSRIs can exacerbate the development of inflammation, and modulate the interleukin and interferon production. All of the above suggest that SSRIs therapy could be considered as a potential strategy for the wound healing treatment. We summarized some body of the available data on the history of serotonin metabolism, mechanism of action of ketanserin, and hypothesize why SSRIs may be beneficial in the wound repair natural history. Different pathophysiological considerations are also reflected in this review. Finally, we suggest that the topical use of SSRIs may represent a promising avenue for future strategies affecting wound repair in high-risk patients, especially those with diabetes mellitus, venous insufficiency, obesity, and other vascular disorders.
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PMID:Treatment with selective serotonin reuptake inhibitors for enhancing wound healing. 1519 59

This study was designed to compare the effects of fluoxetine and imipramine on fasting blood glucose (FBG) in patients with major depressive disorder. Sixty nondiabetic patients with major depressive disorder (based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) entered this randomized, double-blind study. Patients did not receive any medication affecting serum FBG levels for at least 2 weeks before the initiation of the study. Patients were assigned to receive 20 to 40 mg/d of fluoxetine or 75 to 200 mg/d of imipramine for 8 weeks. Pregnant women and patients with diabetes mellitus and a history of any major heart disease were excluded from this study. Additionally, none of the patients should have received electroconvulsive therapy within 6 months before the initiation of the antidepressants. FBG levels were measured at the initiation, as well as 4 and 8 weeks after starting antidepressants. Nineteen patients in the fluoxetine and 24 patients in the imipramine groups completed the study. In the fluoxetine group, FBG level was decreased from 88.5 mg/dL (baseline) to 85.0 mg/dL at week 4 (P = 0.73), and to 79.8 mg/dL at week 8 (P < 0.001). On the other hand, in the imipramine group, FBG level was increased from 86.96 mg/dL (baseline) to 89.71 mg/dL at week 4 (P = 0.079), and to 96.90 mg/dL at week 8 (P < 0.001). This 8-week study showed that FBG levels may decrease in depressive patients receiving fluoxetine and may increase in those patients treated with imipramine. Therefore, it is suggested to measure and monitor FBG before initiation and during treatment with fluoxetine and imipramine.
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PMID:Comparing the effects of 8-week treatment with fluoxetine and imipramine on fasting blood glucose of patients with major depressive disorder. 1523 29

Essential polyunsaturated fatty acids (PUFA) cannot be synthesised in the body and must be ingested by food. A balanced intake of both n-6 and n-3 PUFA is essential for good health. PUFA are the basic constituents of phospholipid membranes and determine cellular membrane fluidity and modulate enzyme activities, carriers and membrane receptors. They are also precursors of active metabolites known collectively as eicosanoids (prostaglandins, prostacyclins, thromboxanes and leukotrienes) which regulate our cellular functions. Studies indicate that n-3 PUFA have anti-inflammatory, antithrombotic, antiarrhythmic actions and immuno-modulating properties. Erythrocyte fatty acid status is a reflection of dietary fat intake. It also explores PUFA metabolism and gives information about the integration of these fatty acids into cellular membranes. Thus, erythrocyte fatty acid analysis can detect PUFA insufficiencies and imbalances from the diet, but also metabolic abnormalities and lipid peroxidation. It can be helpful in the prevention and the control of chronic diseases in which PUFA alterations have been observed as coronary heart diseases, hypertension, cancer, diabetes, inflammatory and auto-immune disorders, atopic eczema, Alzheimer dementia, major depression, schizophrenia, multiple sclerosis, etc.
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PMID:Alteration of polyunsaturated fatty acid status and metabolism in health and disease. 1546 Jan 66

Human neurodevelopment is the result of genetic and environmental interactions. This paper examines the role of prenatal nutrition relative to psychiatric disorders and explores the relationship among nutrients, mood changes, and mood disorders. Epidemiologic studies have found that adults who were born with a normal, yet low birth weight have an increased susceptibility to diseases such as coronary heart disease, diabetes, and stroke in adulthood. Prenatal caloric malnutrition, low birth weight, and prematurity also increase the risk for neurodevelopmental disorders, schizophrenia, affective disorders, and schizoid and antisocial personality disorders. Placebo-controlled studies in medicated patients suggest that add-on treatment with omega-3 fatty acids, particularly eicosapentaenoic acid, may ameliorate symptoms of major depressive disorder. Additional studies are necessary to confirm any benefits for bipolar disorders.
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PMID:Nutrients, neurodevelopment, and mood. 1553 90

A MAJOR RISK RECURRENCE: The sparcity of data in the absence of treatment renders assessment of the natural course of depressive disorders difficult. Naturalist studies have identified various elements that characterise the evolution. After an episode of depression, usually lasting 6 to 8 months, the disorder is marked by a high risk of recurrence. Fifty to 85% of the patients having exhibited an episode of major depression will relapse at least once in their life. A CHRONIC DISEASE: The propensity in the repetition of depression and the socio-professional and family impact that results has led to an increasing number of authors to consider the problem as a chronic disease, like asthma or diabetes. IN TERMS OF MANAGEMENT: It is important to replace depression in the progressive perspective of a chronic disease and to avoid, after the first episode, the risk of relapses and recurrences. During treatment of the acute phase, we recommend treatment to be continued up to 12 months after complete remission, so as to reduce the risk of relapse. Regarding prevention of recurrences, treatment should be continued for more than 12 months in patients who have had 3 episodes of depression or, in certain cases, only two. THE CONSEQUENCES OF A LACK OF INFORMATION: Research work has shown that depressive disorders have been insufficiently treated: either the doses are too low or the prescription is withdrawn too quickly, or the patient does not fully comply. In the majority of cases, insufficient management stems from a lack of knowledge on the course of depressive disorders and on treatment modalities, as far as not only the practitioner but also the patient are concerned.
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PMID:[Evolution of depressive disorders]. 1561 83

Hospitals use numerous guideline implementation approaches with varying success. Approaches have been classified as consistently, variably, or minimally effective, with multiple approaches being most effective. This project assesses the Department of Veterans Affairs (VA) use of effective guideline implementation approaches. A survey of 123 VA quality managers assessed the approaches used to implement the chronic obstructive pulmonary disease, diabetes mellitus, congestive heart failure, and major depressive disorder guidelines. Approaches were categorized based on their effectiveness, and the total number of approaches used was calculated. Commonly used approaches were clinical meetings, summaries, and revised forms. Consistently and minimally effective approaches were used most frequently. Most hospitals used 4-7 approaches. Odds ratios demonstrated that consistently effective approaches were paired with minimally and variably effective approaches. The frequent use of consistently effective approaches and multiple approaches benefits VA adherence. However, VA hospitals should consider selective combinations of approaches to ensure the use of the most effective implementation methods.
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PMID:Classifying the effectiveness of Veterans Affairs guideline implementation approaches. 1562 76

Reports of intentional massive overdoses of insulin are infrequent. A review of the literature revealed no reports of overdose attempts with either insulin glargine or insulin aspart. We report the case of a 33-year-old woman without diabetes mellitus who intentionally injected herself with an overdose of both products, which belonged to her husband. She arrived at the emergency department 15 hours after her suicide attempt, which took place the night before. Her husband had checked her blood glucose level throughout the night and had given her high-carbohydrate drinks and foods. The patient had a history of obsessive-compulsive disorder, major depression, and numerous suicide attempts. She recovered from the resulting hypoglycemia after 40 hours of dextrose infusion and was transferred to a mental health facility. The main danger associated with insulin overdose is the resultant hypoglycemia and its effects on the central nervous system; hypokalemia, hypophosphatemia, and hypomagnesemia also can develop with excess insulin administration. Dextrose infusion, with liberal oral intake when possible, and monitoring for electrolyte changes, making adjustments as needed, are recommended for the treatment of intentional insulin overdose.
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PMID:Intentional overdose with insulin glargine and insulin aspart. 1562 38


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