Perception of Chronic Respiratory Impairment in Patients’ Drawings.

Perception of chronic respiratory impairment in patients’ drawings.

J Rehabil Med. 2013 Jun 24;
Luthy C, Cedraschi C, Pasquina P, Uldry C, Junod-Perron N, Janssens JP

Objective: To explore the perception of dyspnoea in patients with severe chronic obstructive pulmonary disease. Design: Cross-sectional study using mixed methods. Methods: Thirty-two patients with severe chronic obstructive pulmonary disease were included. Data collected included 3 health-related quality of life questionnaires (SF-36, St George and Maugeri respiratory questionnaires) and the Hospital Anxiety and Depression scale (HADS) to assess the impact of chronic obstructive pulmonary disease on quality of life and psychological functioning. Patients were then asked to draw their body and represent difficulties related to breathing. Drawings were coded and categorized. Patients’ comments were transcribed. Results: HADS showed scores of depression and anxiety as high as 12.3?±?2.6 and 9.3?±?2.2, respectively; SF-36 subscales were severely affected, and the St Georges and Maugeri questionnaires indicated a high impact of chronic obstructive pulmonary disease (79?±?13 and 60?±?18, respectively). Drawings illustrated the pervasiveness of dyspnoea; patients’ comments stressed breathlessness. Obstruction and tightening were salient, with a prominent representation of the head and internal structures, e.g. the lungs and the airways. Conclusion: Patients’ drawings capture a global expression of illness experience. They provide insight into the heterogeneity of patients’ perceptions, and allow acknowledgement of patients’ representations and experiences. This may, in turn, help in gaining patients’ participation in rehabilitation programmes or adherence to new medications. HubMed – depression


Biologically based treatment approaches to the patient with resistant perinatal depression.

Arch Womens Ment Health. 2013 Jul 5;
Robakis TK, Williams KE

This study aims to summarize the current state of knowledge regarding approaches to treatment-resistant depression in pregnancy and the postpartum period and to develop algorithms for ante- and postnatal management in cases of refractory major depression. PubMed, Scopus, Google Scholar, and the Cochrane Library databases were searched without temporal restriction. Search terms included pregnancy and depression, perinatal depression, postnatal depression, treatment resistance and depression, antipsychotics and pregnancy, antidepressants and pregnancy, and mood stabilizers and pregnancy. Abstracts were reviewed for relevance, and further articles were obtained from bibliographic citations. There is a significant subpopulation of patients in pregnancy and postpartum whose depressive symptoms do not respond to first-line treatments. No research studies have focused specifically on this population. Data extracted from studies on women with depressive symptoms in pregnancy suggest that in the absence of evidence on which to base clinical decisions, many are receiving combinations of psychotherapeutic medications that have not been specifically studied for use in pregnancy. Antidepressant use in pregnancy is well studied, but studies specifically addressing the case of the patient who does not respond to first-line treatments are absent. Research in this area is urgently needed. The authors review a number of possible therapeutic approaches to treatment-resistant depression in pregnancy and the postpartum period. HubMed – depression


[Should opioids be routinely used for the induction of general anaesthesia for caesarean section?].

Anasthesiol Intensivmed Notfallmed Schmerzther. 2013 Jun; 48(6): 374-7
Wasem S, Rifai M, Hönig A, Wirbelauer J, Roewer N, Kranke P

The spinal anaesthesia, epidural anaesthesia or combinations of these techniques (combined spinal epidural anaesthesia) so far remain the goldstandard to facilitate caesarean section. For some reasons such as refusal by the patients, medical reasons or emergency caesarean section, a general anaesthesia can be necessary. In patients with preeclampsia hypertension during endotracheal intubation has to be avoided. Here the application of an opioid is possible or even necessary to lessen increases of the heart rate and blood pressure. To lessen cardiovascular response, short acting Remifentanil has advantages, e.g. the fast clearance rate in newborns. However, the risk for the newborn from respiratory depression has to be considered and experienced staffto care for the newborn should be present after childbirth. Therefore, an interdisciplinary approach seems to be vital to cope with adverse effects that may arise due to the more frequent use of opioids in conjunction with general anaesthesia for caesarean section. HubMed – depression


Case Manager as Therapy Extender for Cognitive Behavior Therapy of Serious Mental Illness: A Case Report.

Community Ment Health J. 2013 Jul 5;
Pinninti NR, Schmidt LT, Snyder RP

Cognitive behavior therapy (CBT) is an evidence-based intervention for individuals with serious mental illness and potentiates standard medication management. Americans receiving publicly funded treatment for serious mental illnesses have limited access to CBT and hence we need to devise innovative ways of providing access to this important intervention. We present a case of a man who had severe disability, was medication resistant, and diagnosed with Obsessive Compulsive Disorder and Major Depressive Disorder. After being home bound for many years he was provided CBT utilizing his existing case manager as a therapy extender. The specific roles of the primary therapist and case manager as well as the improvement in quality of life of the individual are delineated. This case report opens up the possibility of further studying case managers as therapy extenders for treating serious mental illnesses. HubMed – depression