Wait-there's evidence for that? Integrative medicine treatments for major depressive disorder.

Depression is one of the most common mental health disorders and currently affects over 17 million Americans. Up to two-thirds of patients with depression in the United States will seek complementary and alternative or integrative medical treatments and thus medical providers who treat depression should understand that many integrative medical treatments have evidence of efficacy either as monotherapies or as add-on adjuncts to other treatments. This review references guidelines from the Canadian Network for Mood and Anxiety Treatments and Michigan Medicine, along with an updated literature review, to provide a framework for reviewing medications or herbal formulation, as well as other therapies, which have evidence in the treatment of depression. In general, St. John's Wort, Omega-3 Fatty Acids, S-adenosyl-L-methionine, and crocus sativus (saffron) have the highest levels of evidence in the treatment of mild-to-moderate depression. Acetyl-l-carnitine, l-methylfolate, DHEA, and lavender have a moderate level of evidence in treating depression, whereas Vitamin D, one of the most common supplements in the United States, does not have evidence in treating depression. Of the non-medication-based therapies, exercise, light therapy, yoga, acupuncture, and probiotics have evidence in the treatment of depression, whereas a full review of dietary modifications for depression was out of scope for this article.

Revisiting the canons of psychiatry: Teaching the fundamentals of CATIE, STAR*D, and STEP-BD to family medicine residents.

Family medicine physicians are often the first providers to encounter and identify mental illness in their patients. Having a solid understanding of three landmark studies-Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), Sequenced Treatment Alternatives to Relieve Depression (STAR*D), and Systemic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)-can significantly improve a family medicine physician's approach to mental illness and treatment choices, ultimately improving patient outcomes. Each of these studies has generated dozens of publications and consolidating the fundamentals of each one is essential for a resident to retain and implement findings in a real-world setting when treating patients with schizophrenia, depression, and bipolar disorder. When presented at the 38th Forum for Behavioral Science in Family Medicine in Chicago, IL, in September 2017, learners answered pre- and post-presentation questions about the treatment and guidelines pertaining to the three studies. Discussion leaders-physicians double-boarded in family medicine and psychiatry-presented key findings, clinical guidelines generated from each study, and updates since their respective publications. At the conclusion of the talk, participants received access to a slide deck and one-page summary for use in teaching at their home residency programs. Here, we present a framework for teaching family medicine residents three important canons of psychiatry with the goal of better management of three commonly encountered mental illnesses in the primary care setting.

Mobile App Tools for Identifying and Managing Mental Health Disorders in Primary Care.

PURPOSE OF REVIEW: Mental health apps are intriguing yet challenging tools for addressing barriers to treatment in primary care. In the current review, we seek to assist primary care professionals with evaluating and integrating mental health apps into practice. We briefly summarize two leading frameworks for evaluating mental health apps and conduct a systematic review of mental health apps across a variety of areas commonly encountered in primary care. RECENT FINDINGS: Existing frameworks can guide professionals and patients through the process of identifying apps and evaluating dimensions such as privacy and security, credibility, and user experience. For specific apps, several problem areas appear to have relatively more scientific evaluation in the current app landscape, including PTSD, smoking, and alcohol use. Other areas such as eating disorders not only lack evaluation, but contain a significant subset of apps providing potentially harmful advice. SUMMARY: Overall, individuals seeking mental health apps will likely encounter strengths such as symptom tracking and psychoeducational components, while encountering common weaknesses such as insufficient privacy settings and little integration of empirically-supported techniques. While mental health apps may have more promise than ever, significant barriers to finding functional, usable, effective apps remain for health professionals and patients alike.

Correlation of patient-derived utility values and quality of life after pancreaticoduodenectomy for pancreatic cancer.

BACKGROUND: Utility value (UV) represents the "value" that a patient places on a given health state and can be closely associated with quality of life. The purpose of this study was to determine if UV and quality of life are correlated after pancreaticoduodenectomy for pancreatic adenocarcinoma and to assess quality of life after pancreaticoduodenectomy. STUDY DESIGN: Patients who underwent pancreaticoduodenectomy for pancreatic cancer were interviewed using the 36-item Short Form Health Survey, which measures 8 domains of quality of life. Patients assessed their current health state by rating their present health from 0 (which was equivalent to death) to 100 (which was equivalent to prefect health), and by a time-exchange (TE) method that asked how many years of their present life they would be willing to exchange for perfect health. Statistical analysis consisted of linear regression analysis and Mann-Whitney U test. RESULTS: Twenty patients were interviewed. The UVs correlated with the TE (p = 0.003, r = -0.63), and 6 of 8 36-item Short Form Health Survey domains: physical functioning (p < 0.00001, r = 0.82), role-physical (p = 0.005, r = 0.61), bodily pain (p = 0.003, r = 0.63), general health (p = 0.00001, r = 0.81), vitality (p = 0.01, r = 0.54), and mental health (p = 0.03, r = 0.5). The TE score correlated with the physical functioning (p = 0.06, r = -0.59) and bodily pain (p = 0.05, r = -0.44) domains. There were significant differences in the UV, TE, physical functioning, role-physical, and role-emotional between patients less than 1 year and more than 1 year postoperative. CONCLUSIONS: These data imply that patient-perceived health status and quality of life are linked and that quality-of-life scores after pancreaticoduodenectomy are better in patients more than 1 year postoperative.

Recurrent pleural effusions and a normal cardiac CT.

Our patient had the classic square root sign typical of constrictive pericarditis, but contrary to what we would have expected, his end-diastolic pressures did not equalize.

Isradipine treatment of hypertension in children: a single-center experience.

Many children with hypertension, particularly those with new-onset hypertension related to glomerulonephritis, organ transplantation, or other forms of secondary hypertension, require treatment with a short-acting antihypertensive in order to quickly achieve blood pressure (BP) control. We administered isradipine, a short-acting, second-generation calcium antagonist, to 72 such children. Retrospective data collection was undertaken to determine the effects of isradipine treatment. The mean age of children treated with isradipine was 74+/-55 months (mean+/-SD). Nearly all of these children had secondary hypertension and were initially treated as hospital inpatients for newly diagnosed hypertension. Mean isradipine dose was 0.36+/-0.17 mg/kg per day, with no significant variation in dose according to patient age. Isradipine was administered three times per day in most instances, but 21% of the time it was administered four times per day. An extemporaneous isradipine suspension was used in 62% of treatment courses. BP control was achieved with isradipine alone in 38 children; the remainder received isradipine in combination with additional antihypertensives. Comparison of pre-treatment BP with BP obtained 8+/-9 days later demonstrated a significant BP reduction with isradipine treatment, with a mean reduction of 14+/-13 mmHg for systolic BP and 13+/-15 mmHg for diastolic BP. There was no effect of isradipine treatment on heart rate. Adverse effects occurred in 9.5% of treatment courses, and included headache, flushing, dizziness, and tachycardia. We conclude that isradipine successfully lowers BP in hypertensive children with secondary forms of hypertension. Use of isradipine suspension allows infants and young children to be treated as readily as older children.