Depression Treatment: Screening for Psychological Distress in Neurosurgical Brain Tumor Patients Using the Patient Health Questionnaire-2.
Screening for psychological distress in neurosurgical brain tumor patients using the Patient Health Questionnaire-2.
Filed under: Depression Treatment
Psychooncology. 2012 Dec 12;
Bunevicius A, Deltuva V, Tamasauskas S, Tamasauskas A, Bunevicius R
OBJECTIVE: Psychological distress is highly prevalent but often undiagnosed in brain tumor patients. We evaluated the psychometric properties of the Patient Health Questionnaire-2 (PHQ-2) for screening of distressed neurosurgical brain tumor patients. METHODS: A total of 226 (69% women; mean age 55.6?±?14.7?years) consecutive patients on admission for elective brain tumor surgery were evaluated for psychological distress using the PHQ-2, the Hospital Anxiety and Depression Scale (HADS; n?=?206), and the Beck Depression Inventory-II (BDI-II; n?=?196). At discharge, the patients were reevaluated using the PHQ-2 and HADS. RESULTS: On admission, 43% and 18% of patients had moderate-severe psychological distress according to the HADS (HADS depression or anxiety score ?11) and BDI-II (score ?20), respectively. At discharge, there was a significant decrease in psychological distress among patients according to the PHQ-2 (p?=?0.04) and HADS (p?0.001) screening results. The PHQ-2 had marginal internal consistency (Cronbach's coefficient alpha?=?0.68) and suboptimal test-retest reliability (intraclass correlation coefficient?=?0.51). The PHQ-2 had acceptable psychometric properties for identifying patients with moderate-severe psychological distress according to the HADS (sensitivity?=?74%, specificity?=?68%, and positive predictive value (PPV)?=?40%) and BDI-II (sensitivity?=?71%, specificity?=?65%, and PPV?=?30%). Psychometric properties of the PHQ-2 were inferior for mild-severe psychological distress. Greater number of PHQ-2 depressive symptoms was associated with greater scores on the HADS and BDI-II (all ps?0.001). CONCLUSIONS: Psychological distress is prevalent in brain tumor patients and can be successfully identified using the PHQ-2. The PHQ-2 has moderate internal consistency. The PHQ-2 should be considered for routine use in brain tumor patients for psychological distress screening purposes. Copyright © 2012 John Wiley & Sons, Ltd. HubMed – depression
[Multimorbidity and multi-target-therapy with herbal drugs].
Filed under: Depression Treatment
Praxis (Bern 1994). 2012 Dec 12; 101(25): 1637-42
Saller R, Rostock M
The active components of herbal drugs and substances are pleiotropic multi-ingredient compounds with multitarget properties including antiinflammatory effects. A pleiotropic inhibition of inflammation could play an important role in mutlimorbide patients as an attempt of prevention or retardation of metastasis. A large number of experimental data for European and non-European herbal drugs as well as various herbal drug combinations suggest such a possibility. Despite the so far small number of clinical studies, such an experimental herbal treatment could appear to be reasonable and acceptable, provided that there are data available on quality and safety of these herbal drugs by treatments of patients with various diseases. Besides, herbal drugs and substances play a growing role the treatment of patients with multimorbidity. Many of these herbal drugs have antiinflammatory effects beside their proved symptomatic efficacy in a lot of other diseases. The specific selection of herbal drugs that are efficacious in specific indications and additionally showed antiinflammatory effects offers the possibility of simultaneous antiinflammatory and specific efficacy. St. John’s Wort and milk thistle belong to the oldest and to the best experimentally and clinically examined herbal remedies. The spectrum of internal and external uses of Hypercum perforatum as a multicompound herbal drug includes functional gastro-intestinal complaint and illness, skin disease, mucosal lesion, superficial injury, depressive upset and depression, somatoform disorders, restlessness, nervosity, convalescence, exhaustion and sleep disturbances respectively. The plurivalent character of the multicompound even enables a broad spectrum of activity. This might justify to prefer St. John’s Wort to other drugs in a wide range of treatments: In multimorbide patients with depression or in depressive patients with coronary heart disease the anti-inflammatory effects could mean an additional advantage. However, at present there is still a great need and demand for therapy-oriented clinical research.
HubMed – depression
[Delirium and multimorbidity in the elderly].
Filed under: Depression Treatment
Praxis (Bern 1994). 2012 Dec 12; 101(25): 1633-6
Savaskan E
Delirium is an acute confusion state of multifactorial genesis, commonly seen in the elderly with multimorbidity. Age and dementia, followed by infections and polypharmacy, are known as the most important risk factors. Increased disease interactions and medication use in the multimorbid elderly might precipitate delirium. Serious consequences of multimorbidity often are psychiatric diseases such as depression. Also anxiety and schizoprenia show a high comorbidity with somatic diseases. The therapy of elderly multimorbid patients is risky and must be preceded by profound assessment of all pathogenic factors. Pharmacotherapy needs an ongoing screening for side effects and indication.
HubMed – depression
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