Depression Treatment: Low-Dose Propofol for the Abortive Treatment of Pediatric Migraine in the Emergency Department.

Low-Dose Propofol for the Abortive Treatment of Pediatric Migraine in the Emergency Department.

Filed under: Depression Treatment

Pediatr Emerg Care. 2012 Nov 26;
Sheridan DC, Spiro DM, Nguyen T, Koch TK, Meckler GD

OBJECTIVE: Limited progress has been made in the past decade for abortive treatment of migraine headache in the pediatric emergency department (PED). Propofol, a general anesthetic, has been reported to be effective in the treatment of refractory headaches in adults at subanesthetic doses but never in the pediatric population. The goal of this study was to review our institution’s experience with subanesthetic doses of propofol for the abortive treatment of pediatric migraine and compare propofol with standard abortive therapy in the PED. METHODS: Retrospective review of all patients discharged from the Oregon Health and Science University PED with a diagnosis of migraine headache from January 2010 to July 2011. Patients treated with subanesthetic doses of propofol were compared with matched controls who received standard abortive migraine therapy, defined as the combined use of a nonsteroidal anti-inflammatory medication, diphenhydramine, and prochlorperazine. Outcome variables of interest included reduction of pain as measured on a self-reported visual analog scale and length of stay after administration of initial abortive medication. RESULTS: Patients who received subanesthetic doses of propofol achieved significantly greater reduction in pain scores (80.1% vs 61.1%; P < 0.05) compared with matched controls as well as shorter stay (122 minutes vs 203 minutes; P = 0.2) after treatment. No adverse effects (hypotension, respiratory depression, or hypoxia) were recorded in either group. CONCLUSIONS: Propofol seems to be effective for the abortive treatment of pediatric migraine headache in the PED. Further prospective trials are warranted to either support or refute these initial findings. HubMed – depression


A Randomized Controlled Trial to Engage in Care of Adolescent Emergency Department Patients With Mental Health Problems That Increase Suicide Risk.

Filed under: Depression Treatment

Pediatr Emerg Care. 2012 Nov 26;
Grupp-Phelan J, McGuire L, Husky MM, Olfson M

BACKGROUND: In pediatric emergency departments (EDs), adolescents at risk for suicide often escape detection and successful referral for outpatient mental health care. OBJECTIVE: This study aimed to assess the effectiveness of a brief, ED-based mental health service engagement intervention to increase linkage to outpatient mental health services. DESIGN/METHODS: Adolescents presenting to a pediatric ED who were not currently receiving mental health services were screened for suicide-related risk factors (Columbia Suicide Scale). If positive, youths were then screened for impairment, alcohol use, and depression. Those screening positive on the Columbia Suicide Scale and the alcohol, impairment, or depression screen were randomly assigned to the intervention (short motivational interview, barrier reduction, outpatient appointment established, reminders before scheduled appointment) or standard referral (telephone number for a mental health provider). Study groups were compared with respect to screen acceptability and outpatient mental health care linkage and change in depression symptoms at 60 days after the index ED visit. RESULTS: A total of 204 families were enrolled. Overall, 24 adolescents (12%) screened positive for suicide risk factors and were randomized to the intervention (n = 11) or standard referral (n = 13) groups. The groups did not significantly differ on several measures of screen acceptability. As compared with the standard referral group (15.4%), the intervention group (63.6%) was significantly more likely to attend a mental health appointment during the follow-up period (Fisher exact test, P = 0.03). There was also a nonsignificant trend toward greater improvement of depressive symptoms in the intervention than standard referral group (t = 1.79, df = 18, P = 0.09). CONCLUSIONS: When adolescents are identified in the ED with previously unrecognized mental health problems that increase suicide risk, a brief motivational and barrier-reducing intervention improves linkage to outpatient mental health services.
HubMed – depression


Differential cognitive impairment in HCV coinfected men with controlled HIV compared to HCV monoinfection.

Filed under: Depression Treatment

J Acquir Immune Defic Syndr. 2012 Nov 26;
Sun B, Abadjian L, Rempel H, Monto A, Pulliam L

BACKGROUND:: Individuals infected with both HIV and HCV have shown impaired performance on different neuropsychological (NP) tests; however, whether coinfected individuals with controlled HIV and minimal liver damage in the era of antiretroviral therapy have impairment is understudied. METHODS:: Nineteen HCV monoinfected, 17 HIV/HCV coinfected and 17 control male participants were evaluated for depression, attention, executive function, information processing, fine motor speed, and verbal/visual learning/memory. Eleven controls and 14 HIV monoinfected participants with controlled viral load from a previous study were also included for comparison. At time of testing, participants were not using drugs or alcohol and did not have cirrhosis. A global deficit score (GDS) was calculated from 7 domains of NP tests and alterations in specific domains were determined. RESULTS:: HIV/HCV subjects had a higher depression score (11.1±7.5) than controls (5.4±4.1, p=0.010) and a higher GDS score (0.77±0.47) than HCV (0.46±0.34, p=0.036), HIV (0.45±0.36, p=0.008) and controls (0.30±0.29, p=0.001). Coinfection was associated with worse scores in attention working memory (p=0.007), executive function (p=0.01), fine motor function (p=0.011), verbal learning/memory (p<0.001) and visual learning/memory (p<0.001) compared to controls. Within the HCV group, viral load was associated with lower attention, executive function and information processing speed and positively with GDS. CONCLUSIONS:: Coinfection significantly increased the risk of cognitive impairment in subjects with controlled HIV viral loads. In HCV monoinfected but not coinfected subjects, HCV viral load correlated with worsening GDS, suggesting different pathways for neuropsychological impairment. HubMed – depression


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