Obsessive Compulsive Personality Disorder and Parkinson’s Disease.

Obsessive compulsive personality disorder and Parkinson’s disease.

Filed under: Depression Treatment

PLoS One. 2013; 8(1): e54822
Nicoletti A, Luca A, Raciti L, Contrafatto D, Bruno E, Dibilio V, Sciacca G, Mostile G, Petralia A, Zappia M

To evaluate the frequency of personality disorders in Parkinson’s disease (PD) patients and in a group of healthy controls.Patients affected by PD diagnosed according to the United Kingdom Parkinson’s disease Society Brain Bank diagnostic criteria and a group of healthy controls were enrolled in the study. PD patients with cognitive impairment were excluded from the study. Structured Clinical Interview for Personality Disorders-II (SCID-II) has been performed to evaluate the presence of personality disorders. Presence of personality disorders, diagnosed according to the DSM-IV, was confirmed by a psychiatric interview. Clinical and pharmacological data were also recorded using a standardized questionnaire.100 PD patients (57 men; mean age 59.0±10.2 years) and 100 healthy subjects (52 men; mean age 58.1±11.4 years) were enrolled in the study. The most common personality disorder was the obsessive-compulsive personality disorder diagnosed in 40 PD patients and in 10 controls subjects (p-value<0.0001) followed by the depressive personality disorder recorded in 14 PD patients and 4 control subjects (p-value 0.02). Obsessive-compulsive personality disorder was also found in 8 out of 16 de novo PD patients with a short disease duration.PD patients presented a high frequency of obsessive-compulsive personality disorder that does not seem to be related with both disease duration and dopaminergic therapy. HubMed – depression


Does targeted education of emergency physicians improve their comfort level in treating psychiatric patients?

Filed under: Depression Treatment

West J Emerg Med. 2012 Dec; 13(6): 453-7
Marciano R, Mullis DM, Jauch EC, Carr CM, Raney L, Martin RH, Walker BJ, Saef SH

We determined if targeted education of emergency physicians (EPs) regarding the treatment of mental illness will improve their comfort level in treating psychiatric patients boarding in the emergency department (ED) awaiting admission.We performed a pilot study examining whether an educational intervention would change an EP’s comfort level in treating psychiatric boarder patients (PBPs). We identified a set of psychiatric emergencies that typically require admission or treatment beyond the scope of practice of emergency medicine. Diagnoses included major depression, schizophrenia, schizoaffective disorder, bipolar affective disorder, general anxiety disorder, suicidal ideation, and criminal behavior. We designed equivalent surveys to be used before and after an educational intervention. Each survey consisted of 10 scenarios of typical psychiatric patients. EPs were asked to rate their comfort levels in treating the described patients on a visual analogue scale. We calculated summary scores for the non intervention survey group (NINT) and intervention survey group (INT) and compared them using Student’s t-test.Seventy-nine percent (33/42) of eligible participants completed the pre-intervention survey (21 attendings, 12 residents) and comprised the NINT group. Fifty-five percent (23/42) completed the post-intervention survey (16 attendings, 7 residents) comprising the INT group. A comparison of summary scores between ‘NINT’ and ‘INT’ groups showed a highly significant improvement in comfort levels with treating the patients described in the scenarios (P = 0.003). Improvements were noted on separate analysis for faculty (P = 0.039) and for residents (P = 0.012). Results of a sensitivity analysis excluding one highly significant scenario showed decreased, but still important differences between the NINT and INT groups for all participants and for residents, but not for faculty (all: P = 0.05; faculty: P = 0.25; residents: P = 0.03).This pilot study suggests that the comfort level of EPs, when asked to treat PBPs, may be improved with education. We believe our data support further study of this idea and of whether an improved comfort level will translate to a willingness to treat.
HubMed – depression


Management of Type 2 Diabetes Mellitus in Children and Adolescents.

Filed under: Depression Treatment

Pediatrics. 2013 Jan 28;
Springer SC, Silverstein J, Copeland K, Moore KR, Prazar GE, Raymer T, Shiffman RN, Thaker VV, Anderson M, Spann SJ, Flinn SK

OBJECTIVE:Over the last 3 decades, the prevalence of childhood obesity has increased dramatically in North America, ushering in a variety of health problems, including type 2 diabetes mellitus (T2DM), which previously was not typically seen until much later in life. This technical report describes, in detail, the procedures undertaken to develop the recommendations given in the accompanying clinical practice guideline, “Management of Type 2 Diabetes Mellitus in Children and Adolescents,” and provides in-depth information about the rationale for the recommendations and the studies used to make the clinical practice guideline’s recommendations.METHODS:A primary literature search was conducted relating to the treatment of T2DM in children and adolescents, and a secondary literature search was conducted relating to the screening and treatment of T2DM’s comorbidities in children and adolescents. Inclusion criteria were prospectively and unanimously agreed on by members of the committee. An article was eligible for inclusion if it addressed treatment (primary search) or 1 of 4 comorbidities (secondary search) of T2DM, was published in 1990 or later, was written in English, and included an abstract. Only primary research inquiries were considered; review articles were considered if they included primary data or opinion. The research population had to constitute children and/or adolescents with an existing diagnosis of T2DM; studies of adult patients were considered if at least 10% of the study population was younger than 35 years. All retrieved titles, abstracts, and articles were reviewed by the consulting epidemiologist.RESULTS:Thousands of articles were retrieved and considered in both searches on the basis of the aforementioned criteria. From those, in the primary search, 199 abstracts were identified for possible inclusion, 58 of which were retained for systematic review. Five of these studies were classified as grade A studies, 1 as grade B, 20 as grade C, and 32 as grade D. Articles regarding treatment of T2DM selected for inclusion were divided into 4 major subcategories on the basis of type of treatment being discussed: (1) medical treatments (32 studies); (2) nonmedical treatments (9 studies); (3) provider behaviors (8 studies); and (4) social issues (9 studies). From the secondary search, an additional 336 abstracts relating to comorbidities were identified for possible inclusion, of which 26 were retained for systematic review. These articles included the following: 1 systematic review of literature regarding comorbidities of T2DM in adolescents; 5 expert opinions presenting global recommendations not based on evidence; 5 cohort studies reporting natural history of disease and comorbidities; 3 with specific attention to comorbidity patterns in specific ethnic groups (case-control, cohort, and clinical report using adult literature); 3 reporting an association between microalbuminuria and retinopathy (2 case-control, 1 cohort); 3 reporting the prevalence of nephropathy (cohort); 1 reporting peripheral vascular disease (case series); 2 discussing retinopathy (1 case-control, 1 position statement); and 3 addressing hyperlipidemia (American Heart Association position statement on cardiovascular risks; American Diabetes Association consensus statement; case series). A breakdown of grade of recommendation shows no grade A studies, 10 grade B studies, 6 grade C studies, and 10 grade D studies. With regard to screening and treatment recommendations for comorbidities, data in children are scarce, and the available literature is conflicting. Therapeutic recommendations for hypertension, dyslipidemia, retinopathy, microalbuminuria, and depression were summarized from expert guideline documents and are presented in detail in the guideline. The references are provided, but the committee did not independently assess the supporting evidence. Screening tools are provided in the Supplemental Information.
HubMed – depression


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