Archives of general psychiatry
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Arch. Gen. Psychiatry · Jan 2011
Comparative StudyIncreased mortality risk in women with depression and diabetes mellitus.
Depression and diabetes mellitus have been associated with an increased risk of all-cause and cardiovascular disease (CVD) mortality. However, data evaluating the joint effects of these 2 conditions on mortality are sparse. ⋯ Depression and diabetes are associated with a significantly increased risk of all-cause and CVD mortality rate. The coexistence of these conditions identifies women at particularly high risk.
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Arch. Gen. Psychiatry · Jan 2011
Longitudinal effects of mild traumatic brain injury and posttraumatic stress disorder comorbidity on postdeployment outcomes in national guard soldiers deployed to Iraq.
Troops deployed to Iraq and Afghanistan are at high risk for exposure to combat events resulting in mild traumatic brain injury (MTBI) or concussion and posttraumatic stress disorder (PTSD). The longer-term impact of combat-related concussion/MTBI and comorbid PTSD on troops' health and well-being is unknown. ⋯ Although combat-related PTSD was strongly associated with postconcussive symptoms and psychosocial outcomes 1 year after soldiers returned from Iraq, there was little evidence of a long-term negative impact of concussion/MTBI history on these outcomes after accounting for PTSD. These findings and the 2-fold increase in reports of deployment-related concussion/MTBI history have important implications for screening and treatment.
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Arch. Gen. Psychiatry · Dec 2010
Randomized Controlled Trial Multicenter Study Comparative StudyAntidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression.
Mindfulness-based cognitive therapy (MBCT) is a group-based psychosocial intervention designed to enhance self-management of prodromal symptoms associated with depressive relapse. ⋯ For depressed patients achieving stable or unstable clinical remission, MBCT offers protection against relapse/recurrence on a par with that of maintenance antidepressant pharmacotherapy. Our data also highlight the importance of maintaining at least 1 long-term active treatment in unstable remitters.
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Arch. Gen. Psychiatry · Dec 2010
Multicenter StudyMultisite investigation of traumatic brain injuries, posttraumatic stress disorder, and self-reported health and cognitive impairments.
Few large-scale, multisite investigations have assessed the development of posttraumatic stress disorder (PTSD) symptoms and health outcomes across the spectrum of patients with mild, moderate, and severe traumatic brain injury (TBI). ⋯ More severe TBI was associated with a diminished risk of PTSD. Regardless of TBI severity, injured patients with PTSD demonstrated the greatest impairments in self-reported health and cognitive function. Treatment programs for patients with the full spectrum of TBI severity should integrate intervention approaches targeting PTSD.
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Arch. Gen. Psychiatry · Dec 2010
A marginal structural model to estimate the causal effect of antidepressant medication treatment on viral suppression among homeless and marginally housed persons with HIV.
Depression strongly predicts nonadherence to human immunodeficiency virus (HIV) antiretroviral therapy, and adherence is essential to maintaining viral suppression. This suggests that pharmacologic treatment of depression may improve virologic outcomes. However, previous longitudinal observational analyses have inadequately adjusted for time-varying confounding by depression severity, which could yield biased estimates of treatment effect. Application of marginal structural modeling to longitudinal observation data can, under certain assumptions, approximate the findings of a randomized controlled trial. ⋯ Antidepressant medication treatment increases viral suppression among persons with HIV. This effect is likely attributable to improved adherence to a continuum of HIV care, including increased uptake and adherence to antiretroviral therapy.