The Journal of clinical psychiatry
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Psychiatric disorders are common in children with chronic pain, but their course and impact when children grow up are unknown. This study examines the 6-year clinical outcome of children referred for chronic pain with and without comorbid psychiatric disorders. ⋯ Children referred for chronic pain frequently continue to suffer from chronic pain and psychiatric disorders in adolescence and young adulthood. In this population, comorbid psychiatric disorder at study entry was a predictor of psychiatric disorder, but not of persistent chronic pain, in adolescence and young adulthood.
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Interactive Tutorial
Using adjunctive treatments when first-line antidepressants fail.
Treatment-resistant depression is a common challenge for clinicians, as the majority of patients with depression do not achieve remission after an initial antidepressant trial. Major strategies for managing treatment-resistant depression include switching to another antidepressant or augmenting the initial antidepressant with another medication. ⋯ Several effective antidepressant augmentation agents are available, including lithium, thyroid hormone, anti-anxiety medications, and atypical antipsychotics. The evidence for the efficacy and risks of these strategies is discussed.
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Late-life depression is an important public health issue, given the growing proportion of the elderly relative to the general population in the developed world. The purpose of this study was to examine the efficacy of antidepressants for the treatment of major depressive disorder (MDD) in elderly patients. ⋯ The present meta-analysis suggests that antidepressants are efficacious in late-life MDD, but significant study heterogeneity suggests that other factors may contribute to these findings. A secondary analysis raises the possibility that efficacy of these agents may be reduced in trials involving patients aged 65 years or older. Why antidepressants may be less efficacious in elderly versus younger subjects remains unclear.
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The relationship between comorbid panic and suicide in depressed persons remains unclear. ⋯ Panic attacks appear to be an independent risk factor for suicide attempt among depressed individuals with and without suicidal ideation. Further, panic attacks, particularly those characterized by prominent catastrophic cognitions, may mediate the transition from suicidal ideations to suicide attempts in subjects with depressive episodes. Assessment of these symptoms may improve prediction of suicide attempts in clinical settings.
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Interactive Tutorial
Clinical impact of updated diagnostic and research criteria for Alzheimer's disease.
Almost 30 years ago, the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (more commonly known as the Alzheimer's Association) developed the original clinical diagnostic criteria for Alzheimer's disease (AD). Recently, the National Institute on Aging and the Alzheimer's Association released updated research and diagnostic criteria for AD. ⋯ The new criteria also describe advancements in biomarker evidence, which is still being researched and is not yet ready for clinical settings. Additionally, the American Psychiatric Association is currently revising the Diagnostic and Statistical Manual of Mental Disorders, which will include updated diagnostic criteria for AD and other neurocognitive disorders.