ACP Statement for the Record to the Senate Health, Education, Labor and Pensions Committee for the hearing “Examining Our COVID-19 Response: Using Lessons Learned to Address Mental Health and Substance Use Disorders

ACP Statement for the Record to the Senate Health, Education, Labor and Pensions (HELP) Committee hearing: Paid Leave for Working Families: Examining Access, Options, and Impacts

ACP Statement for the Record to the Senate Finance Committee Subcommittee on Improving Mental Health and Addiction Services in Our Communities

ACP Statement for the Record to the House Ways and Means Committee on America"s Mental Health Crisis

Joint Brochure Supporting Funding for VA Medical and Prosthetic Research Program for FY2020

Joint Statement of America’s Frontline Physicians Opposing Final Rule Rolling Back Protections in Flores Settlement Agreement

ACP Statement on the Comprehensive Addiction Resources Emergency (CARE) Act

Understanding and Addressing Disparities and Discrimination in Law Enforcement and Criminal Justice Affecting the Health of At-Risk Persons and Populations

Understanding and Addressing Disparities and Discrimination Affecting Health and Health Care of Persons and Populations at Highest Risk

The Role of the VA in an Evolving Health Care System

Reporting of Sex Effects by Systematic Reviews on Interventions for Depression, Diabetes, and Chronic Pain

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

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

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

In treatment-resistant major depression, ketamine was noninferior to ECT for treatment response

Source Citation Anand A, Mathew SJ, Sanacora G, et al. Ketamine versus ECT for nonpsychotic treatment-resistant major depression. N Engl J Med. 2023;388:2315-2325. 37224232

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

Unmasked by Fever: Diagnosing Brugada Syndrome After Ventricular Fibrillation Arrest | Annals of Internal Medicine: Clinical Cases

A 65-year-old man presented to the emergency department after he was resuscitated from cardiac arrest due to ventricular fibrillation. Coronary angiography demonstrated no evidence of coronary artery disease. Follow-up electrocardiograms (ECGs) were also unremarkable until the patient developed a fever, and a new ECG demonstrated a rapidly upsloping ST-segment followed by a downsloping, coved ST-segment in leads V1-V2. The diagnosis of Brugada syndrome was made after a procainamide challenge. The Brugada pattern on ECG can be transient and can manifest in the setting of fever or after taking medications with sodium channel blocking effects.

Lisinopril-Induced Burning Mouth Syndrome | Annals of Internal Medicine: Clinical Cases

Burning mouth syndrome (BMS) is defined as an uncomfortable burning sensation in the mouth and/or tongue in the absence of any oral mucosa lesions, sores, or other abnormalities. We describe a case in which a patient had a burning sensation in her mouth for several years with no identifiable cause. Two weeks after her primary care physician switched her lisinopril to another antihypertensive medication, she noted significant improvement in her symptoms and an improved quality of life. It is imperative for physicians to recognize angiotensin-converting enzyme inhibitors, specifically lisinopril, as a possible cause of burning mouth syndrome in symptomatic patients.

Mental Status Changes in Severe Babesiosis | Annals of Internal Medicine: Clinical Cases

Babesiosis is a tick-borne disease caused by an intraerythrocyte protozoon. We present a unique case of a patient who was infected with babesiosis and subsequently developed severely altered mental status, which dramatically improved after erythrocyte exchange transfusion. This case illustrates that mental status changes can be a diagnostic marker of severe babesiosis and may indicate the need for erythrocyte exchange transfusion.

Neurologic Manifestations of Germline GATA2 Deficiency: A Report of Two Cases | Annals of Internal Medicine: Clinical Cases

Germline pathogenic mutations in the GATA2 gene, a critical transcription factor in hematopoietic and neurologic development, are known to cause various syndromes characterized by both hematopoietic (for example, monocytopenia, myelodysplastic syndrome) and extra-hematopoietic (for example, lymphedema, atypical and mycobacterial infections) manifestations. Neurologic features of this disease need to be better understood. We describe 2 patients with germline GATA2 deficiency who developed a progressive neurologic illness characterized by upper motor neuron weakness, bulbar and cerebellar dysfunction, pronounced white matter magnetic resonance imaging abnormalities, and noninfectious leukoencephalopathy with cerebellar degeneration. These neurologic findings may be a novel extra-hematopoietic manifestation of germline GATA2 deficiency.

A Peculiar Manifestation of Chronic Myelogenous Leukemia in Lymphoid Blast Crisis | Annals of Internal Medicine: Clinical Cases

A 61-year-old man with a history of factor V Leiden mutation, hypothyroidism, and transient ischemic attacks presented to his physician's office but could not recall the reason for his visit. Initial laboratory test results showed a slight leukocytosis with slight basophilia; neuro-immunologic, infectious, and metabolic work-up was unrevealing. Flow cytometry results showed atypical B lymphoblasts. Bone marrow biopsy results revealed a hypercellular bone marrow with CD10 staining lymphoblasts and Philadelphia chromosomal translocation. Hematologic malignancy fusion panel results revealed BCR/ABL1 fusion with p210 oncoprotein, establishing the diagnosis of chronic myelogenous leukemia in lymphoid blast crisis—a peculiar manifestation of a disease that usually manifests with significant leukocytosis.

Cold Agglutinin Disease–Associated Transient Ischemic Attack, Non-ST Elevation Myocardial Infarction, and Skin Necrosis: A Case Report | Annals of Internal Medicine: Clinical Cases

Cold agglutinin disease is a rare autoimmune hemolytic anemia that preferentially affects female patients and is more common in those older than 60 years. The pathophysiology involves IgM autoantibodies against erythrocytes in areas of the body at cooler temperatures, causing thrombosis and hemolysis. We present the case of a 66-year-old man who was found to have cold agglutinin disease and initially presented with altered mental status, stroke-like symptoms, and non-ST elevation myocardial infarction. Overnight, he also developed striking soft-tissue necrosis of his bilateral feet due to microvascular occlusion. His altered mentation and cardiac ischemia completely resolved; however, he eventually required bilateral phalangeal amputation.

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.

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.

Study finds frequent use of medications for which depression is an adverse effect

Preventive cognitive therapy is an effective alternative and addition to antidepressants for preventing depression relapse, study finds

Adding aripiprazole to antidepressant therapy may help treat patients with resistant major depressive disorder

Depression may be an adverse effect of hormonal contraceptive use, study suggests

Communication of individual risk factors to patients shows small potential for preventing major depression

ACP issues clinical practice guideline on depression treatment in adults

MKSAP Quiz: Young woman with episodic chest discomfort

MKSAP Quiz: Preventive health care visit

ACP calls for streamlined, evidence-based performance measures to improve patient care

MKSAP Quiz: Six months of gait imbalance, tremor, cognitive impairment

First rapid-acting insulin biosimilar approved | ACP Hospitalist

Early stroke complications associated with poor outcomes after discharge | ACP Hospitalist

Improving palliative care in cirrhosis | ACP Hospitalist

Patients discharged to SNFs during early pandemic were older, more often from ICU | ACP Hospitalist

Cases from LSU Health New Orleans | ACP Hospitalist

AHA offers guidance on palliative pharmacotherapy for cardiovascular disease | ACP Hospitalist

Is your patient depressed or just demoralized? | ACP Hospitalist

Handling class and classes at once | ACP Hospitalist

Studies look at outcomes with drug use and heart failure, infective endocarditis | ACP Hospitalist

High stakes: Considerations about cannabis | ACP Hospitalist

Inpatient exercise improved outcomes in elderly type 2 diabetes patients

Spotlight on amputations

MKSAP quiz: Preconception medication management

Spotlight on temperature and light

MKSAP quiz: Treatment plan for obesity and diabetes

Spotlight on HIV and diabetes

Clinicians should integrate psychosocial components into diabetes care, ADA recommends

Spotlight on hypoglycemia

One-hour glucose tolerance test accurate, convenient for postpartum assessment

Risk for CVD events elevated years before type 2 diabetes diagnosis

Potency concerns lead to recall of anti-diarrhea drug

Telemedicine app reduced gastroenterology visits for inflammatory bowel disease

New drug approved for carcinoid syndrome diarrhea

Spotlight on irritable bowel syndrome

MASH treatments compared in network meta-analysis

Constipation associated with higher stroke risk

Risk for herpes zoster complications appears higher with IBD

A next-generation mt-sDNA test had 94% sensitivity for colorectal cancer and 91% specificity for advanced neoplasia

GLP-1 receptor agonists could modestly delay gastric emptying during periprocedural fasting, study suggests

Higher MAP linked with AKI reversal among hospitalized patients