Search Results for: "depression"

Systematic reviews (SRs) have the potential to contribute uniquely to the evaluation of sex and gender differences (termed “sex effects”). This article describes the reporting of sex effects by SRs on interventions for depression, type 2 diabetes mellitus, and chronic pain conditions (chronic low back pain, knee osteoarthritis, and fibromyalgia). It includes SRs published since 1 October 2009 that evaluate medications, behavioral interventions, exercise, quality improvement, and some condition-specific treatments. The reporting of sex effects by primary randomized, controlled trials is also examined. Of 313 eligible SRs (86 for depression, 159 for type 2 diabetes mellitus, and 68 for chronic pain), few (n = 29) reported sex effects. Most SRs reporting sex effects used metaregression, whereas 9 SRs used subgroup analysis or individual-patient data meta-analysis. The proportion of SRs reporting the sex distribution of primary studies varied from a low of 31% (n = 8) for low back pain to a high of 68% (n = 23) for fibromyalgia. Primary randomized, controlled trials also infrequently reported sex effects, and most lacked an adequate sample size to examine them. Therefore, all SRs should report the proportion of women enrolled in primary studies and evaluate sex effects using appropriate methods whenever power is adequate.

Screening for Major Depressive Disorder in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force

Background: Major depressive disorder (MDD) is common among children and adolescents and is associated with functional impairment and suicide. Purpose: To update the 2009 U.S. Preventive Services Task Force (USPSTF) systematic review on screening for and treatment of MDD in children and adolescents in primary care settings. Data Sources: Several electronic searches (May 2007 to February 2015) and searches of reference lists of published literature. Study Selection: Trials and recent systematic reviews of treatment, test–retest studies of screening, and trials and large cohort studies for harms. Data Extraction: Data were abstracted by 1 investigator and checked by another; 2 investigators independently assessed study quality. Data Synthesis: Limited evidence from 5 studies showed that such tools as the Beck Depression Inventory and Patient Health Questionnaire for Adolescents had reasonable accuracy for identifying MDD among adolescents in primary care settings. Six trials evaluated treatment. Several individual fair- and good-quality studies of fluoxetine, combined fluoxetine and cognitive behavioral therapy, escitalopram, and collaborative care demonstrated benefits of treatment among adolescents, with no associated harms. Limitation: The review included only English-language studies, narrow inclusion criteria focused only on MDD, high thresholds for quality, potential publication bias, limited data on harms, and sparse evidence on long-term outcomes of screening and treatment among children younger than 12 years. Conclusion: No evidence was found of a direct link between screening children and adolescents for MDD in primary care or similar settings and depression or other health-related outcomes. Evidence showed that some screening tools are accurate and some treatments are beneficial among adolescents (but not younger children), with no evidence of associated harms. Primary Funding Source: Agency for Healthcare Research and Quality.

Update Alert: Nonpharmacologic and Pharmacologic Treatments of Adult Patients With Major Depressive Disorder: A Systematic Review and Network Meta-analysis for a Clinical Guideline by the American College of Physicians

Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder: A Living Clinical Guideline From the American College of Physicians (Version 1, Update Alert)

Correction: Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder

Comparative Benefits and Harms of Antidepressant, Psychological, Complementary, and Exercise Treatments for Major Depression

Annals Graphic Medicine - One Artist's Look at Anxiety and Depression

Annals Graphic Medicine - Is This What Depression Looks Like?

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Displaying 21 - 30 of 82 in Annals of Internal Medicine: Clinical Cases

A Puzzling Case of Rapidly Progressive Global CNS Deterioration From Intravascular Large-Cell Lymphoma | Annals of Internal Medicine: Clinical Cases

Intravascular large-cell lymphoma is a rare, aggressive subtype of B-cell lymphoma leading to microvascular organ dysfunction. It often presents nonspecifically and is difficult to diagnose, with a rapidly progressive course. It classically presents with “B” symptoms, although any organ system can be affected. Neurologic symptoms vary but can involve rapid neurologic deterioration. It lacks association with a primary tumor or malignant cells in the blood or bone marrow, so diagnosis is difficult, made only by biopsy of affected tissues. Because of its rarity and often aggressive course, increased clinician familiarity is key to facilitating early diagnosis and proper management.

Eosinophilic Fasciitis: Clinical Signs Leading to Diagnosis | Annals of Internal Medicine: Clinical Cases

Eosinophilic fasciitis is a rare disease characterized by peripheral eosinophilia and inflammatory infiltrate on muscular fascia and subcutaneous tissue. Patients present with edema and stiffening of limbs, progressing rapidly to fibrosis. The Groove sign is a classical physical examination finding. A skin–fascia–muscle biopsy is the gold standard for diagnosis, but nuclear magnetic resonance imaging is also useful. Glucocorticoids in high doses are the initial treatment of choice. We report the patient case of a 22-year-old man with expressive eosinophilia and whose clinical findings (Groove sign and others) led to the diagnosis.

Hospital Stay Considerations in Hypermobile Ehlers-Danlos Syndrome: An Exemplary Case With Insights for Coexisting Symptoms | Annals of Internal Medicine: Clinical Cases

Ehlers-Danlos syndrome, hypermobility type, is a complex medical condition understood to be a genetic disorder resulting in abnormal collagen synthesis. It is characterized by joint hypermobility as well as skin laxity, poor wound healing, and other manifestations. It may present in conjunction with autonomic, neurologic, and immune abnormalities. Hypermobility spectrum disorder is similarly characterized by joint hypermobility but holds less extensive diagnostic criteria. When in the hospital setting, systemic differences resulting from hypermobility syndromes must be recognized to avoid harm. Here, we present the first case, to our knowledge, of a full hospital course with hypermobility syndrome–comorbidity-related complications described.

Peri-infarction Pericarditis: A Fading Complication of Myocardial Infarction | Annals of Internal Medicine: Clinical Cases

A 52-year-old man presenting with an anterior ST-segment elevation myocardial infarction (MI) had stent placement in the mid-left anterior descending coronary artery. A diagnosis of peri-infarction pericarditis (PIP) was made. The patient received acetaminophen and colchicine with complete symptom resolution and no complications. One of the diagnostic challenges with PIP is that the electrocardiographic changes are typically masked by the electrocardiographic changes seen in MI. Nonsteroidal anti-inflammatory drugs (except aspirin) and glucocorticoids should be avoided for 7 to 10 days after an acute MI because of the theory that impairment of collagen deposition and scarring can increase the risk for serious post-MI complications.

Postpartum Recurrent Mastitis Despite Resolution of Prior Prolactinoma | Annals of Internal Medicine: Clinical Cases

We present a 35-year-old woman with history of a prolactinoma who presented 11 weeks postpartum with recurrent mastitis. Per the patient, in the past she took cabergoline but stopped about 5 years previously. Despite attempts to wean, postpartum, she continued to express an excessive amount of breast milk. Magnetic resolution imaging revealed a slightly heterogeneous appearance of the pituitary gland, and she was started on dopaminergic agents. This case demonstrates that significant lactotroph hyperplasia can occur after breastfeeding ends despite the resolution of a prior prolactin-secreting microadenoma.

Cardiogenic Shock Secondary to Giant Cell Arteritis | Annals of Internal Medicine: Clinical Cases

This paper reports a case of type 1 nonatherothrombotic myocardial infarction caused by giant cell arteritis vasculitis.

Hypoglossal Nerve Paralysis Caused by Diffuse Idiopathic Skeletal Hyperostosis | Annals of Internal Medicine: Clinical Cases

Diffuse idiopathic skeletal hyperostosis (DISH) is a rare disease characterized by bony overgrowth of the spine. If severe enough, it can lead to dysphagia from many different mechanisms. These most commonly include mechanical obstruction, inflammation, or vocal cord paralysis. In our patient case, DISH caused paralysis of the hypoglossal nerve, which contributed to his dysphagia. Paralysis of the hypoglossal nerve as a result of DISH has not yet been reported in the literature.

Plasma Cell Myeloma With Lymphoplasmacytic Morphology and Negative CD138 Expression: Case Report and Differential Diagnosis | Annals of Internal Medicine: Clinical Cases

Plasma cell neoplasms may have variable morphologic and immunophenotypic features. This patient case demonstrates a rare presentation of plasma cell myeloma with negative CD138 expression and lymphoplasmacytic morphology. In this report, we discuss the possible differential diagnosis and highlight the importance of a comprehensive diagnostic approach including flow cytometry, immunohistochemistry, and molecular studies to arrive at the correct diagnosis.

Clopidogrel Nonresponsiveness Mimicking Endocarditis After PFO-Occlusion: Combining Aspiration, Retrieval, and Laboratory Assessment for Diagnostic-Therapeutic Work-Up | Annals of Internal Medicine: Clinical Cases

Percutaneous patent foramen ovale (PFO) closure lowers recurrent stroke risk but can rarely cause device thrombosis or infection. A 57-year-old woman had elective PFO closure with a GORE CARDIOFORM Septal Occluder device after cerebellar infarction. Despite aspirin and clopidogrel, she developed fever. Transesophageal echocardiography revealed large thrombi on the device. Multidisciplinary management achieved percutaneous retrieval 1-week postimplantation. Cultures were negative. Platelet testing confirmed aspirin effect but showed clopidogrel nonresponsiveness, leading to anticoagulation. Follow-up imaging demonstrated thrombus regression. This case highlights early device thrombosis mimicking infection, successful percutaneous retrieval, and the value of platelet function testing in guiding therapy.