Search Results for "depression"
- Online Learning Center (10)
- Policy Library (251)
- Performance Measures (13)
- Annals of Internal Medicine (1530)
- Annals of Internal Medicine: Clinical Cases (89)
- IM Matters (172)
- ACP Hospitalist (266)
- ACP Diabetes Monthly (53)
- ACP Gastroenterology Monthly (61)
Displaying 1 - 10 of 10 in Online Learning Center
Depression
A collection of educational materials in the Online Learning Center.
Mental Health and Burnout, Part 1
While there has been increased awareness of the concept of burnout in general, many Internal Medicine physicians may have gaps in their knowledge as to what burnout is and how they may be affected by it. Given that over 50% of physicians have experienced symptoms of burnout at some point during their careers (with rates significantly increasing during the COVID-19 pandemic), it is imperative that they understand the signs and the physical and mental consequences burnout can have. This includes increased rates of medical errors, depression, suicide, and leaving the medical field.
How Would You Manage This Patient With Iron Deficiency Anemia? Grand Rounds Discussion From Beth Israel Deaconess Medical Center
Iron deficiency anemia (IDA) is the most common cause of anemia worldwide and a major cause of disability, manifesting with symptoms including fatigue, weakness, exercise intolerance, worsening heart failure, impaired concentration, irritability, and depression. Women of reproductive age are disproportionately affected due to menstrual blood loss and gynecologic disorders. Iron deficiency anemia is diagnosed in patients who have both iron deficiency (ID), noted by low ferritin level and/or transferrin saturation, and anemia.
Geriatrics and Palliative Medicine for Internal Medicine Physicians: 2025 Video Recordings Package
Highly knowledgeable clinician educators will focus on practical, evidence-based strategies that the internal medicine physician can use across care settings to better identify and treat serious and chronic conditions common to older populations, such as cognitive impairment; function assessment, frailty, and falls; depression and anxiety; and hazards of hospitalization.
Geriatrics and Palliative Medicine for Internal Medicine Physicians: 2024 Video Recordings Package
Expert clinician-educations will focus on practical, evidence-based strategies that the internal medicine physician can use across care settings to better identify and treat serious and chronic conditions common to older populations, such as cognitive impairment; function assessment, frailty, and falls; depression and anxiety; and hazards of hospitalization.
Primary Care Psychiatry: Practical Skills for Internal Medicine Physicians: 2025 Video Recordings Package
Expert clinician educators will provide an evidence-informed update for internal medicine physicians on practical approaches to interviewing patients to recognize, diagnose, treat, and/or refer patients with commonly encountered mental health disorders. Faculty with training in both internal medicine and psychiatry will emphasize the importance of a patient-centered approach, motivational interviewing, and simple cognitive behavioral techniques that can be quickly used in medical settings.
Primary Care Psychiatry: Practical Skills for Internal Medicine Physicians: 2024 Video Recordings Package
Expert clinician-educators will provide a practical, evidence-based update for internal medicine physicians on approaches to interviewing patients with the goal of recognizing, diagnosing, treating, and/or referring patients with commonly encountered mental health disorders. Faculty with training in both internal medicine and psychiatry will emphasize the importance of a patient-centered approach, motivational interviewing, and quick cognitive behavioral techniques that can be quickly used in medical settings.
Primary Care Psychiatry: Everything Practicing Internal Medicine Physicians Need to Know: 2026 Focused Topic Recordings
This Online Learning Center activity features expert clinician-educators providing an evidence-informed update designed to teach internal medicine physicians practical approaches to recognizing, diagnosing, treating, and triaging patients with commonly encountered psychiatric disorders.
Geriatrics and Palliative Medicine for Internal Medicine Physicians: 2026 Focused Topic Recordings
This Online Learning Center activity focuses on practical, evidence-based strategies that the internal medicine physician can use across care settings to better identify and treat serious and chronic conditions common to older populations.
Digital Health Equity: Bridging the Divide
The digital divide is the gap between those who have access to technology or the Internet and those who do not, typically on the basis of higher versus lower socioeconomic status. Thirteen percent of U.S. adults do not use the Internet; of these, 19% do not use it because of cost barriers related to Internet service or computer ownership. In addition, demographic variables, such as age, education, community (rural, urban, or suburban), or income, may contribute to non-adoption of technology.
Displaying 1 - 10 of 251 in Policy Library
Displaying 1 - 10 of 13 in Performance Measures
Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan
Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the eligible encounter.
Depression Utilization of the PHQ-9 Tool
The percentage of adolescent patients (12 to 17 years of age) and adult patients (18 years of age or older) with a diagnosis of major depression or dysthymia who have a completed PHQ-9 tool during a four month measurement period.
Depression Response at Twelve Months, Progress Towards Remission
The percentage of adolescent patients (12 to 17 years of age) and adult patients (18 years of age or older) with major depression or dysthymia who are progressing towards remission by achieving a response (PHQ-9 or PHQ-9M score reduced by 50% or greater) twelve months (+/- 60 days) after an index visit.
Depression Response at Six Months- Progress Towards Remission
The percentage of adolescent patients (12 to 17 years of age) and adult patients (18 years of age or older) with major depression or dysthymia who are progressing towards remission by achieving a response (PHQ-9 or PHQ-9M score reduced by 50% or greater) six months (+/- 60 days) after an index visit.
Depression Remission at Twelve Months
The percentage of adolescent patients 12 to 17 years of age and adult patients 18 years of age or older with major depression or dysthymia who reached remission 12 months (+/- 60 days) after an index event date.
Depression Remission at Six Months
The percentage of adolescent patients 12 to 17 years of age and adult patients 18 years of age or older with major depression or dysthymia who reached remission six months (+/- 60 days) after an index event date.
Bipolar Disorder and Major Depression: Appraisal for Alcohol or Chemical Substance Use
INACTIVE REVIEW: This measure review is older than five years. Percentage of patients with depression or bipolar disorder with evidence of an initial assessment that includes an appraisal for alcohol or chemical substance use.
Adult Major Depressive Disorder (MDD): Comprehensive Depression Evaluation: Diagnosis and Severity
INACTIVE REVIEW: This measure review is older than five years. Percentage of patients aged 18 years and older with a diagnosis or recurrent episode of major depressive disorder (MDD) with evidence that they met the DSM-IV criteria for MDD AND for whom there is an assessment of depression severity during the visit in which a new diagnosis or recurrent episode was identified.
Anti-Depressant Medication Management
"Percentage of patients 18 years of age and older who were treated with antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication treatment. Two rates are reported. a. Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks). b. Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).
Displaying 1 - 10 of 1530 in Annals of Internal Medicine
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Depression
This issue provides a clinical overview of depression, focusing on screening, diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.
Quality Indicators for Major Depressive Disorder in Adults: A Review of Performance Measures by the American College of Physicians
Major depressive disorder (MDD) is a severe mood disorder that affects at least 8.4% of the adult population in the United States. Characteristics of MDD include persistent sadness, diminished interest in daily activities, and a state of hopelessness. The illness may progress quickly and have devastating consequences if left untreated. Eight performance measures are available to evaluate screening, diagnosis, and successful management of MDD. However, many performance measures do not meet the criteria for validity, reliability, evidence, and meaningfulness. The American College of Physicians (ACP) embraces performance measurement as a means to externally validate the quality of care of practices, medical groups, and health plans and to drive reimbursement processes. However, a plethora of performance measures that provide low or no value to patient care have inundated physicians, practices, and systems and burdened them with collecting and reporting of data. The ACP’s Performance Measurement Committee (PMC) reviews performance measures using a validated process to inform regulatory and accreditation bodies in an effort to recognize high-quality performance measures, address gaps and areas for improvement in performance measures, and help reduce reporting burden. Out of 8 performance measures, the PMC found only 1 measure (suicide risk assessment) that was valid at all levels of attribution. This paper presents a review of MDD performance measures and highlights opportunities to improve performance measures addressing MDD management.
Values and Preferences of Patients With Depressive Disorders Regarding Pharmacologic and Nonpharmacologic Treatments: A Rapid Review: Annals of Internal Medicine: Vol 176, No 2
Background: Developers of clinical practice guidelines need to take patient values and preferences into consideration when weighing benefits and harms of treatment options for depressive disorder. Purpose: To assess patient values and preferences regarding pharmacologic and nonpharmacologic treatments of depressive disorder. Data Sources: MEDLINE (Ovid) and PsycINFO (EBSCO) were searched for eligible studies published from 1 January 2014 to 30 November 2022. Study Selection: Pairs of reviewers independently screened 30% of search results. The remaining 70% of the abstracts were screened by single reviewers; excluded abstracts were checked by a second reviewer. Pairs of reviewers independently screened full texts. Data Extraction: One reviewer extracted data and assessed the certainty of evidence, and a second reviewer checked for completeness and accuracy. Two reviewers independently assessed risk of bias. Data Synthesis: The review included 11 studies: 4 randomized controlled trials, 5 cross-sectional studies, and 2 qualitative studies. In 1 randomized controlled trial, participants reported at the start of therapy that they expected supportive-expressive psychotherapy and antidepressants to yield similar improvements. A cross-sectional study reported that non-Hispanic White participants and men generally preferred antidepressants over talk therapy, whereas Hispanic and non-Hispanic Black participants and women generally did not have a preference. Another cross-sectional study reported that the most important nonserious adverse events for patients treated with antidepressants were insomnia, anxiety, fatigue, weight gain, agitation, and sexual dysfunction. For other comparisons and outcomes, no conclusions could be drawn because of the insufficient certainty of evidence. Limitations: The main limitation of this review is the low or insufficient certainty of evidence for most outcomes. No evidence was available on second-step depression treatment or differences in values and preferences based on gender, race/ethnicity, age, and depression severity. Conclusion: Low-certainty evidence suggests that there may be some differences in preferences for talk therapy or pharmacologic treatment of depressive disorders based on gender or race/ethnicity. In addition, low-certainty evidence suggests that insomnia, anxiety, fatigue, weight gain, agitation, and sexual dysfunction may be the most important nonserious adverse events for patients treated with antidepressants. Evidence is lacking or insufficient to draw any further conclusions about patients' weighing or valuation of the benefits and harms of depression treatments. Primary Funding Source: American College of Physicians. (PROSPERO: CRD42020212442)
Cost-Effectiveness of First- and Second-Step Treatment Strategies for Major Depressive Disorder: A Rapid Review: Annals of Internal Medicine: Vol 176, No 2
Background: Major depressive disorder (MDD) is the most prevalent, disabling form of depression, with a high economic effect. Purpose: To assess evidence on cost-effectiveness of pharmacologic and nonpharmacologic interventions as first- and second-step treatments in patients with MDD. Data Sources: Multiple electronic databases limited to English language were searched (1 January 2015 to 29 November 2022). Study Selection: Two investigators independently screened the literature. Seven economic modeling studies fulfilled the eligibility criteria. Data Extraction: Data abstraction by a single investigator was confirmed by a second; 2 investigators independently rated risk of bias. One investigator determined certainty of evidence, and another checked for plausibility. Data Synthesis: Seven modeling studies met the eligibility criteria. In a U.S. setting over a 5-year time horizon, cognitive behavioral therapy (CBT) was cost-effective compared with second-generation antidepressants (SGAs) as a first-step treatment from the societal and health care sector perspectives. However, the certainty of evidence is low, and the findings should be interpreted cautiously. For second-step treatment, only switch strategies between SGAs were assessed. The evidence is insufficient to draw any conclusions. Limitations: Methodologically heterogeneous studies, which compared only CBT and some SGAs, were included. No evidence on other psychotherapies or complementary and alternative treatments as first-step treatment or augmentation strategies as second-step treatment was available. Conclusion: Although CBT may be cost-effective compared with SGAs as a first-step treatment at a 5-year time horizon from the societal and health care sector perspectives, the certainty of evidence is low, and the findings need to be interpreted cautiously. For other comparisons, the evidence was entirely missing or insufficient to draw conclusions. Primary Funding Source: American College of Physicians.
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
An update is available for this article. Background: Primary care patients and clinicians may prefer alternative options to second-generation antidepressants for major depressive disorder (MDD). Purpose: To compare the benefits and harms of nonpharmacologic treatments with second-generation antidepressants as first-step interventions for acute MDD, and to compare second-step treatment strategies for patients who did not achieve remission after an initial attempt with antidepressants. Data Sources: English-language studies from several electronic databases from 1 January 1990 to 8 August 2022, trial registries, gray literature databases, and reference lists to identify unpublished research. Study Selection: 2 investigators independently selected randomized trials of at least 6 weeks' duration. Data Extraction: Reviewers abstracted data about study design and conduct, participants, interventions, and outcomes. They dually rated the risk of bias of studies and the certainty of evidence for outcomes of interest. Data Synthesis: 65 randomized trials met the inclusion criteria; eligible data from nonrandomized studies were not found. Meta-analyses and network meta-analyses indicated similar benefits of most nonpharmacologic treatments and antidepressants as first-step treatments. Antidepressants had higher risks for discontinuation because of adverse events than most other treatments. For second-step therapies, different switching and augmentation strategies provided similar symptomatic relief. The certainty of evidence for most comparisons is low; findings should be interpreted cautiously. Limitations: Many studies had methodological limitations or dosing inequalities; publication bias might have affected some comparisons. In some cases, conclusions could not be drawn because of insufficient evidence. Conclusion: Although benefits seem to be similar among first- and second-step MDD treatments, the certainty of evidence is low for most comparisons. Clinicians and patients should focus on options with the most reliable evidence and take adverse event profiles and patient preferences into consideration. Primary Funding Source: American College of Physicians. (PROSPERO: CRD42020204703)
The Management of Major Depressive Disorder: Synopsis of the 2022 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline
Description: In February 2022, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved a joint clinical practice guideline (CPG) for the management of major depressive disorder (MDD). This synopsis summarizes key recommendations. Methods: Senior leaders within the VA and the DoD assembled a team to update the 2016 CPG for the management of MDD that included clinical stakeholders and conformed to the National Academy of Medicine's tenets for trustworthy CPGs. The guideline panel developed key questions, systematically searched and evaluated the literature, created two 1-page algorithms, and distilled 36 recommendations for care using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Select recommendations that were identified by the authors to represent key changes from the prior CPG are presented in this synopsis. Recommendations: The scope of the CPG is diverse; however, this synopsis focuses on key recommendations that the authors identified as important new evidence and changes to prior recommendations on pharmacologic management, pharmacogenomics, psychotherapy, complementary and alternative therapies, and the use of telemedicine.
Displaying 1 - 10 of 89 in Annals of Internal Medicine: Clinical Cases
Chronic Eosinophilic Pneumonia With Multiple Drug-Related Risk Factors: Diagnosis and Management | Annals of Internal Medicine: Clinical Cases
Chronic eosinophilic pneumonia is a rare illness characterized by pneumonic infiltrates with peripheral eosinophilia. The underlying cause is unknown, but it is associated with multiple medications. The present article reports a woman in her 60s with a history of chronic sinusitis and asthma who presented with subacute cough and hemoptysis and significant peripheral and bronchioalveolar eosinophilia. This patient also had anxiety and depression treated chronically with trazodone and venlafaxine, which are associated with eosinophilic pneumonia. Symptoms promptly resolved within 24 hours following steroid treatment. This article highlights the diagnostic challenge eosinophilic pneumonia presents.
Apathetic Thyrotoxicosis Presenting With New-Onset Pulmonary Hypertension | Annals of Internal Medicine: Clinical Cases
Apathetic thyrotoxicosis is a distinct clinical entity of hyperthyroidism that occurs in elderly patients. Manifestations include depression, weight loss, mild tachycardia, and symptoms of heart failure. Noteworthy is the absence of typical hyperkinetic motor symptoms. Pulmonary hypertension is an often-overlooked manifestation of thyrotoxicosis. Here, we present a case of a 67-year-old woman who presented to the clinic with complaints of dyspnea on exertion, orthopnea, leg edema, and 20-lb weight loss. Further work-up revealed pulmonary hypertension with thyrotoxicosis, without the typical sympathetic symptoms. After achieving a euthyroid state with methimazole therapy, she experienced resolution of her symptoms, and her pulmonary artery pressures normalized.
Recurrent Pulseless Electrical Activity Arrests Due to Coronary Vasospasm Without Obstructive Coronary Artery Disease | Annals of Internal Medicine: Clinical Cases
This case describes recurrent pulseless electrical activity arrests in a postoperative patient caused by coronary vasospasm, an underrecognized but reversible trigger of cardiac arrest. Transient ischemic electrocardiogram changes, nonobstructive coronary angiography, rapid improvement with vasodilator therapy, and recovery of left ventricular function supported the diagnosis. The case emphasizes that vasospasm can mimic acute coronary syndromes and precipitate life-threatening instability, particularly in critically ill patients. It adds to current knowledge by highlighting the need for early suspicion, careful vasopressor selection, and prompt initiation of vasodilators to prevent irreversible myocardial injury and improve outcomes.
Acute Thigh Pain in a Patient With Diabetes Mellitus: A Rare Case of Diabetic Myonecrosis | Annals of Internal Medicine: Clinical Cases
Diabetic myonecrosis (also known as diabetic muscle infarction, or DMI) is a rare complication of poorly controlled diabetes, with fewer than 200 discrete cases reported in the English language medical literature over the past 60 years. In most published cases, diabetic myonecrosis occurs concurrently with other micro/macrovascular diabetic sequelae (e.g., nephropathy). Here, we describe a case of a patient with DMI without nephropathy, whose presentation was otherwise pathognomonic for DMI. We share this case to increase clinician awareness of this uncommon condition and to highlight the diagnostic and treatment considerations to keep in mind when managing suspected DMI, as choice of treatment can dramatically affect clinical course.
Dermatitis Neglecta: A Case Report of Hyperpigmentation Resulting From Impaired Mechanical Cleansing | Annals of Internal Medicine: Clinical Cases
Dermatitis neglecta (DN) results from inadequate frictional cleansing and is often associated with psychiatric or neurologic impairments. It is frequently misdiagnosed owing to its rarity and variable presentation. We report a 71-year-old woman with extensive hyperpigmented plaques from the mid-back to posterior thighs. Initially suspected to be tinea corporis, the primary lesion did not fluoresce on Wood's lamp examination. Mechanical cleansing with soap, water, and alcohol swabbing removed the pigmentation, confirming DN. This case emphasizes the importance of recognizing DN, particularly in patients with functional limitations, to avoid unnecessary testing and ensure effective management.
Symptomatic Methemoglobinemia at Low Levels in a Patient With Obstructive Sleep Apnea | Annals of Internal Medicine: Clinical Cases
Previously reported cases of hypoxemia secondary to methemoglobinemia usually had measured methemoglobin percentages of around 20% or greater. We report an unusual case of methemoglobinemia secondary to dapsone use in a 66-year-old man with obstructive sleep apnea who presented with dyspnea and hypoxia with a methemoglobin percentage of less than 10%.
Nocturnal Enuresis in an Adult With Obesity | Annals of Internal Medicine: Clinical Cases
We present a case of nocturnal enuresis (NE) in an adult with obesity that resolved with treatment of obstructive sleep apnea (OSA). The patient reported daytime somnolence and enuresis with no daytime urinary incontinence. A home sleep study diagnosed OSA. The patient received continuous positive airway pressure (CPAP) treatment with immediate resolution of enuresis. This case highlights the importance of recognizing enuresis as a potential symptom of sleep apnea.
Isolated Subcutaneous Sarcoidosis (Darier–Roussy Disease) Without Systemic Involvement: Diagnostic Challenge and Remission Following Intralesional Therapy | Annals of Internal Medicine: Clinical Cases
Subcutaneous sarcoidosis (Darier–Roussy disease) is a rare variant of cutaneous sarcoidosis characterized by painless subcutaneous nodules. We present the case of a 55-year-old woman with a firm, nontender mass overlying her right triceps region, initially misdiagnosed as cellulitis. Biopsy revealed a noncaseating granuloma consistent with subcutaneous sarcoidosis. Extensive systemic work-up was unremarkable, confirming isolated disease. The lesion resolved within 6 months following 2 intralesional corticosteroid injections administered 2 months apart, with no recurrence over 4 years. This case highlights the diagnostic challenges of subcutaneous sarcoidosis and the importance of histopathologic confirmation and multidisciplinary evaluation, even in the absence of systemic symptoms.
Isolated Cutaneous Perianal Crohn Disease With Rare Perineal Involvement | Annals of Internal Medicine: Clinical Cases
We present a rare case of isolated perianal Crohn disease (iPCD) with perineal involvement in a 28-year-old woman who remained free of luminal gastrointestinal symptoms for more than 10 years. The diagnosis was significantly delayed due to clinical overlap with hidradenitis suppurativa and pilonidal disease. The patient had multiple unsuccessful treatments, including antibiotics, immunosuppressants, and biological agents. Complete remission was ultimately achieved with combination therapy using infliximab and azathioprine. This case underscores the importance of early recognition, accurate differentiation from mimicking conditions, and a multidisciplinary approach to managing iPCD.
Stress Cardiomyopathy in Chronic Obstructive Pulmonary Disease and Asthma Exacerbations: A Narrative Literature Review | Annals of Internal Medicine: Clinical Cases
In patients with asthma or chronic obstructive pulmonary disease exacerbations, the association between use of β-adrenergic agonists and stress cardiomyopathy is becoming increasingly recognized. Considering the emergence of this association, we sought to consolidate information from the existing body of literature to derive observational trends. One case series and 8 case reports were reviewed. Sex, age, ethnicity, comorbid conditions, presenting symptoms, electrocardiogram findings, troponin values, amount and type of β-agonist used, and time to resolution of cardiomyopathy were examined.