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  • March 3, 2008
  • 02:00 PM

6 Different Definitions of Treatment Resistant Depression

by Dr Shock in Dr Shock MD PhD

Failure to respond to 1 adequate trial of an antidepressantFailure to respond to one or more adequate trials of antidepressantsFailure to respond to 2 adequate trials of antidepressantsFailure to respond to 2 adequate trials of antidepressants form different classes (e.g. SSRI and TCA)Failure to respond to 2 or more adequate antidepressant trialsFailure to respond to 2 or more adequate antidepressants from different classesSome authors and researchers object to the phrase failure to respond. The........ Read more »

  • March 3, 2008
  • 12:14 PM

Emotional Vitality May Protect Against Heart Disease

by Shaheen Lakhan in Brain Blogger

While a number of studies have shown that negative social behaviors and emotional states tend to correlate with a lower overall level of physical health, few have sought to illuminate a link between emotional vitality and physical well-being. A recent study provides evidence that there may, indeed, be a connection. Six thousand twenty-five men and ... Read more »

  • March 3, 2008
  • 09:06 AM

Once more into the muck: Creationists and the evolution of antibiotic resistance

by Orac in Respectful Insolence

I'm not sure why, but it's been a while since I've delved into the cesspit of pseudoscience that is the Discovery Institute's propaganda organ, Evolution News & Views. Perhaps it was because I simply got tired of diving into the depths of stupid. Of course, that then begs the question of why I've been spending so much time diving into the Age of Autism website or the sophisticated-sounding yet ultimately vacuously pseudoscientific blather that is David Kirby. Trying to d........ Read more »

Frédérique Maurice, Isabelle Broutin, Isabelle Podglajen, Philippe Benas, Ekkehard Collatz, & Frédéric Dardel. (2008) Enzyme structural plasticity and the emergence of broad-spectrum antibiotic resistance. EMBO reports. DOI: 10.1038/embor.2008.9  

  • March 1, 2008
  • 10:13 AM

Why Some Men, Like Women, Cannot Read Maps Too

by Shaheen Lakhan in Brain Blogger

I never quite got around to write the sequel to Barbara and Allan Pease’s evocative work (1), although I had figured out a nice name for it, “Why men don’t use makeup, and women can’t Sumo wrestle.” Not to make fun of the genetic determinists who study gender differences, but to drive home the whole ... Read more »

  • February 28, 2008
  • 12:00 AM

Antibiotics and Treating Infections in the Elderly

by Pallimed Bloggers in Pallimed: a Hospice & Palliative Medicine Blog

1)The Archives of Internal Medicine published a significant study regarding antibiotic use in the elderly authored by Dr. D'Agata and Dr. Mitchell from Beth Israel Deaconess. In their article, they review the antibiotic usage in 214 (mostly white, female and over 80yo) nursing home residents with advanced dementia, defined as very severe cognitive impairment, minimal communication, dependent eating/toileting, bowel/bladder incontinence, and inability to walk. This study was part of a larg........ Read more »

  • February 27, 2008
  • 09:10 AM

Do cell phones make men sterile?

by Orac in Respectful Insolence

A few days ago, I came across an article on Engadget that mentioned almost in passing some studies that seemed to indicate health problems or no health problems, depending on the specific study, due to the ubiquitous and maligned cellular telephone. Not having dealt with this issue much on my blog, I decided to take a look, mostly out of curiosity. The claims that cell phones somehow cause cancer have been circulating for many years, and the studies marshaled to show such a link have in general ........ Read more »

  • February 27, 2008
  • 09:00 AM

Adolescents with Treatment Resistant Depression

by Dr Shock in Dr Shock MD PhD

About 40% of depressed adolescents do not respond to a Selective Serotonin Reuptake Inhibitor (SSRI). The combination of switching to a different antidepressant agent and receiving CBT resulted in a higher rate of clinical response than switching only to a different medication. There was no difference in response to the medication switches, and patients who were switched to a different SSRI experienced fewer adverse effects than patients taking venlafaxine.This trial doesn't permit any conc........ Read more »

David Brent. (2008) Switching to Another SSRI or to Venlafaxine With or Without Cognitive Behavioral Therapy for Adolescents With SSRI-Resistant Depression. The Journal of the American Medical Association, 299(8), 901-913.

  • February 26, 2008
  • 04:00 PM

New Antidepressants only better than Placebo in Severe Depression

by Dr Shock in Dr Shock MD PhD

Drug–placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients.This is the conclusion of a meta-analysis of all clinical trials submitted to the US Food and Drug Administration (FDA) for the licensing of the four new-generation antidepressants for which full datasets were available. These antidepressants are: include fluoxetine, venlafaxine, nefazodone, paroxetine. The article is published in Pl........ Read more »

  • February 26, 2008
  • 11:14 AM

The Chattering Brain - How Chronic Pain Throws our Cortex out of Sync

by Shaheen Lakhan in Brain Blogger

A new study from the Northwestern University’s Feinberg School of Medicine has provided important clues to how chronic pain might throw our lives out of gear by affecting many areas of the cerebral cortex. Worse, if left unchecked, it could lead to irreversible damage to the interconnection between the neurons, leading to permanent changes in ... Read more »

Lynn Webster, Youngmi Choi, Himanshu Desai, Linda Webster, & Brydon J Grant. (2007) Sleep-Disordered Breathing and Chronic Opioid Therapy. Pain Medicine, 2147483647. DOI: 10.1111/j.1526-4637.2007.00343.x  

  • February 25, 2008
  • 11:00 PM

Reasons for PAS; Prognosis in TBI; More

by Pallimed Bloggers in Pallimed: a Hospice & Palliative Medicine Blog

I'm traveling the rest of the week & this will be my only post until March, which I'm hoping will host fewer record-breaking snowfalls in the upper Midwest than January and February have.1)The Journal of General Internal Medicine has an article about family perceptions of why their loved ones pursued physician assisted suicide. It involved interviews of ~80 patients who had pursused PAS in Oregon (about 50 actually received prescriptions and 30 went through with ingestion of the l........ Read more »

Linda Ganzini, Elizabeth Goy, & Steven Dobscha. (2008) Why Oregon Patients Request Assisted Death: Family Members’ Views. Journal of General Internal Medicine, 23(2), 154-157. DOI: 10.1007/s11606-007-0476-x  

  • February 25, 2008
  • 05:00 PM

Management of depression

by Dr Shock in Dr Shock MD PhD

This is the title of a recent article in British Medical Journal. It is accurate, precise, and important information not only for professionals but it could also benefit patients. It is not yet free online, you will have to wait another 12 months.Nevertheless the two most important conclusions to my opinion are about the components of a comprehensive management plan and factors associated with increased risk for recurrence of depression. These are important because this knowledge make patients b........ Read more »

M Timonen, & T Liukkonen. (2008) Management of depression in adults. BMJ, 336(7641), 435-439. DOI: 10.1136/bmj.39478.609097.BE  

  • February 21, 2008
  • 09:00 AM

Vagus Nerve Stimulation, an Update

by Dr Shock in Dr Shock MD PhD

The short history of Vagus Nerve Stimulation (VNS) in treatment resistant depression is hampered by some drawbacks. Scientifically the results of a double-blind randomized sham controlled trial with no definitive evidence of short-term efficacy for adjunctive VNS in treatment resistant depression were of major importance. Of human interest was the undisclosed background of Dr Nemeroff, then editor in chief of the journal in which he published a review about VNS for treatment resistant depression........ Read more »

  • February 20, 2008
  • 12:00 AM

Genetics and morphine toxicity; Prognosis articles

by Pallimed Bloggers in Pallimed: a Hospice & Palliative Medicine Blog

A rather academic post: genetics and some prognostically relevant papers.1)Cancer has a study on genetic variations and response to morphine in cancer patients. The data comes from a prospective study of ~220 advanced cancer patients who were receiving morphine for pain. They were treated per a palliative care team's protocol and about 60 of them were rotated off morphine due to inadequate analgesia /- intolerable side effects. This analysis compares rates of certain genetic polymorphis........ Read more »

Joy Ross, Julia Riley, Annie B Taegetmeyer, Hiroe Sato, Sophy Gretton, Roland M du Bois, & Kenneth I Welsh. (2008) Genetic variation and response to morphine in cancer patients. Cancer. DOI: 10.1002/cncr.23292  

  • February 19, 2008
  • 02:00 PM

Lack of Proper Evaluation of Curricula about resident-phamaceutical industry interaction

by Dr Shock in Dr Shock MD PhD

9 Curricula were identified in a literature search for curricula addressing resident-pharmaceutical industry relationship. Lack of experience may make young doctors particular vulnerable to pharmaceutical industry influence. These interactions between doctor and pharmaceutical companies have an impact on doctor knowledge and prescribing practice. The pharmaceutical companies have different and efficient marketing techniques to influence doctors. Residents may be even more influenced when not edu........ Read more »

  • February 14, 2008
  • 02:04 PM

Breast cancer information on the Internet

by Orac in Respectful Insolence

It figures again.

I go a few days without Internet access again, and not only does Generation Rescue take out a full page antivaccination ad full of stupidity in USA Today, which I couldn't resist opening both barrels on earlier, but a study's lead senior author is someone I know (albeit not well) about three topics I'm very interested in: breast cancer, health information on the Internet, and so-called "complementary and alternative" medicine. Not surprisingly, in my a........ Read more »

  • February 14, 2008
  • 08:00 AM

rTMS update part 2

by Dr Shock in Dr Shock MD PhD

Even a Dutch research group published a placebo controlled trial with rTMS. Not that they found rTMS to be significantly better than sham TMS after two weeks of treatment. Both groups had a reduction of 2.5 points on the Hamilton Depression Rating Scale (17-item version) and 1 point in the second week, the decrease never passed 20% in either group. Their point being a continuing improvement in the rTMS and the sham rTMS group during the follow-up of 3 months. This resulted in a significant mean ........ Read more »

Frank Koerselman. (2004) a 3-month, follow-up, randomized, placebo-controlled study of repetitive transcranial magnetic stimulation in depression. Journal of Clinical Psychiatry, 65(10), 1323-1328.

Paul Fitzgerald. (2003) Transcranial Magnetic Stimulation in the Treatment of Depression. Archives of General Psychiatry, 60(Octobre), 1002-1008.

  • February 11, 2008
  • 02:00 PM

The Influence on Reporting a Celebrity Suicide on Suicidal Behavior

by Dr Shock in Dr Shock MD PhD

Patients who are younger and depressed and have made a suicide attempt within a month prior to a media report of a celebrity suicide are at increased risk of a subsequent suicide attempt. The increase was almost 12 times higher than subjects with no previous attempt, 8 times higher to those with a suicide attempt within a half year, and further to 2 to 3-fold among those with a suicide attempt of longer than a half year.Factors influencing the risk of media influences Age under 55 yearsPrevious........ Read more »

  • February 10, 2008
  • 12:00 PM

Update on rTMS part 1

by Dr Shock in Dr Shock MD PhD

The information in this review suggests that there is no strong evidence for benefit from using transcranial magnetic stimulation to treat depression, although the small sample sizes do not exclude the possibility of benefit.This was the conclusion of the authors of the Cochrane library about Transcranial magnetic stimulation for treating depression.Since then (2002) 8 randomized controlled trials were published about rTMS and depressionSearch strategy in PubMed:"Transcranial Magnetic Stimu........ Read more »

John O'Reardon. (2005) Long-Term Maintenance Therapy for Major Depressive Disorder With rTMS. Journal of Clinical Psychiatry, 66(12), 1524-1528.

  • February 9, 2008
  • 12:00 PM

3 Guidelines for ECT with Adolescents

by Dr Shock in Dr Shock MD PhD

So far I have found three guidelines about ECT with adolescents for depression. Summarized these guidelines suggest the following recommendations:ECT is not recommended for children (5–11 years).ECT should only be considered for young people with very severe depression and either life-threatening symptoms (such as suicidalbehaviour) or intractable and severe symptoms that have not responded to other treatments. ECT should be used extremely rarely in young people and only after careful asse........ Read more »

Neera Ghaziuddin, Stanley Kutcher, Penelope Knapp, William Bernet, Valerie Arnold, Joseph Beitchman, R Benson, Oscar Bukstein, Joan Kinlan, Jon McClellan.... (2004) Practice Parameter for Use of Electroconvulsive Therapy With Adolescents. Journal of the American Academy of Child , 43(12), 1521-1539. DOI: 10.1097/01.chi.0000142280.87429.68  

  • February 7, 2008
  • 10:06 PM

Image Gently

by The Samurai Radiologist in Not Totally Rad

If Google led you here thinking this was a post about a lost sequel to Douglas Adams' holistic detective, turn back! Instead, it concerns a widespread movement to reduce radiation dosage in children.A recent article by Brenner and Hall raised important concerns about safety in patients undergoing computed tomography (CT).Brenner, D.J., Hall, E.J. (2007). Computed Tomography -- An Increasing Source of Radiation Exposure. New England Journal of Medicine, 357(22), 2277-2284. DOI: 10.1056/NEJM........ Read more »

M Goske, K E Applegate, J Boylan, P F Butler, M J Callahan, B D Coley, S Farley, D P Frush, M Hernanz-Schulman, D Jaramillo.... (2008) The Image Gently Campaign: Working Together to Change Practice. American Journal of Roentgenology, 190(2), 273-274. DOI: 10.2214/AJR.07.3526  

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