Depression Treatment: Prescribing in Care Homes: The Role of the Geriatrician.

Prescribing in care homes: the role of the geriatrician.

Filed under: Depression Treatment

Ther Adv Chronic Dis. 2011 Nov; 2(6): 353-8
Burns E, McQuillan N

Large numbers of frail elderly people spend some time of their lives in care homes. Increasing age is associated with altered physiology, multiple diagnoses and complex comorbidity, and polypharmacy. Those living in care homes often take larger numbers of medications than those who live in the community and the risk of morbidity as a direct or indirect result of medications is high. Many methods have been suggested to revise the number and type of medications prescribed for individuals at risk of adverse drug reactions (ADRs), both in the community and in hospital with variable success and implementation. Assessment of prescribed and nonprescribed medications by pharmacists, nurses and general practitioners all have a role in optimizing therapeutics with evidence that improved prescribing can reduce the risk of ADRs. In conjunction with these professionals, community geriatricians undertaking a comprehensive geriatric assessment can reduce the number of medications prescribed or optimize therapy where there may be underprescribing (e.g. in depression), thereby reducing the overall risk of hospital admission ADRs.
HubMed – depression


Are Scores on English and French Versions of the PHQ-9 Comparable? An Assessment of Differential Item Functioning.

Filed under: Depression Treatment

PLoS One. 2012; 7(12): e52028
Arthurs E, Steele RJ, Hudson M, Baron M, Thombs BD,

Medical research increasingly utilizes patient-reported outcome measures administered and scored in different languages. In order to pool or compare outcomes from different language versions, instruments should be measurement equivalent across linguistic groups. The objective of this study was to examine the cross-language measurement equivalence of the Patient Health Questionnaire-9 (PHQ-9) between English- and French-speaking Canadian patients with systemic sclerosis (SSc).The sample consisted of 739 English- and 221 French-speaking SSc patients. Multiple-Indicator Multiple-Cause (MIMIC) modeling was used to identify items displaying possible differential item functioning (DIF).A one-factor model for the PHQ-9 fit the data well in both English- and French-speaking samples. Statistically significant DIF was found for 3 of 9 items on the PHQ-9. However, the overall estimate in depression latent scores between English- and French-speaking respondents was not influenced substantively by DIF.Although there were several PHQ-9 items with evidence of minor DIF, there was no evidence that these differences influenced overall scores meaningfully. The PHQ-9 can reasonably be used without adjustment in Canadian English- and French-speaking samples. Analyses assessing measurement equivalence should be routinely conducted prior to pooling data from English and French versions of patient-reported outcome measures.
HubMed – depression


Mismatch negativity/p3a complex in young people with psychiatric disorders: a cluster analysis.

Filed under: Depression Treatment

PLoS One. 2012; 7(12): e51871
Kaur M, Lagopoulos J, Ward PB, Watson TL, Naismith SL, Hickie IB, Hermens DF

We have recently shown that the event-related potential biomarkers, mismatch negativity (MMN) and P3a, are similarly impaired in young patients with schizophrenia- and affective-spectrum psychoses as well as those with bipolar disorder. A data driven approach may help to further elucidate novel patterns of MMN/P3a amplitudes that characterise distinct subgroups in patients with emerging psychiatric disorders.Eighty seven outpatients (16 to 30 years) were assessed: 19 diagnosed with a depressive disorder; 26 with a bipolar disorder; and 42 with a psychotic disorder. The MMN/P3a complex was elicited using a two-tone passive auditory oddball paradigm with duration deviant tones. Hierarchical cluster analysis utilising frontal, central and temporal neurophysiological variables was conducted.THREE CLUSTERS WERE DETERMINED: the ‘globally impaired’ cluster (n?=?53) displayed reduced frontal and temporal MMN as well as reduced central P3a amplitudes; the ‘largest frontal MMN’ cluster (n?=?17) were distinguished by increased frontal MMN amplitudes and the ‘largest temporal MMN’ cluster (n?=?17) was characterised by increases in temporal MMN only. Notably, 55% of those in the globally impaired cluster were diagnosed with schizophrenia-spectrum disorder, whereas the three patient subgroups were equally represented in the remaining two clusters. The three cluster-groups did not differ in their current symptomatology; however, the globally impaired cluster was the most neuropsychologically impaired, compared with controls.These findings suggest that in emerging psychiatric disorders there are distinct MMN/P3a profiles of patient subgroups independent of current symptomatology. Schizophrenia-spectrum patients tended to show the most global impairments in this neurophysiological complex. Two other subgroups of patients were found to have neurophysiological profiles suggestive of quite different neurobiological (and hence, treatment) implications.
HubMed – depression


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