Abstract:
:Nearly 1 in 5 Americans will struggle with major depression in their lives; some will have recurring bouts. Recent psychiatric research has given new attention to the prevalence of cognitive deficits in major depression and the impact such deficits have on remission and overall life functioning. When depression is partially treated i.e., leaving residual symptoms, patients have higher rates of relapse and lower functional outcomes. Impaired cognitive functioning is a frequent residual symptom, persisting in about 45% of patients even when emotional symptoms have improved, and results in a disproportionate share of the functional impairment, particularly in the workplace. Patients with depression have disrupted circuitry in brain regions responsible for cognition and it is therefore important to screen depressed patients for cognitive as well as emotional symptoms. Cognitive dysfunction should be evaluated in every mood disordered patient with validated self-report scales such as the Patient Health Questionnaire-9 or the Beck Depression Inventory and objective measures of cognitive function are also very very useful. Two easily administered tests are the Trails B Test and the Digit Symbol Substitution Test. Each take less than two minutes and measure working memory, executive function, and processing speed and can track cognitive improvement in depressed patients. Treatment of cognitive dysfunction in major depression is complicated by the 'serotonin conundrum': SSRI's frequently do not treat to full remission, and can cause cognitive blunting-actually adding to cognitive problems. Based on recent data including results from a recently completed meta-analysis by McIntyre and colleagues, an evidence-based algorithm for treating cognitive symptoms in depression is presented. A hierarchy of antidepressants and augmentation strategies based on the best available evidence is discussed. In conclusion, cognitive symptoms in major depressive disorder have been recognized as a target of therapeutic improvement by the FDA and have become a focus of clinical importance.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Mattingly G,Anderson RH,Mattingly SG,Anderson EQdoi
10.1080/00325481.2016.1221318subject
Has Abstractpub_date
2016-09-01 00:00:00pages
665-71issue
7eissn
0032-5481issn
1941-9260journal_volume
128pub_type
杂志文章,评审abstract::The clinical history and physical examination remain the most important factors in determining the presence, anatomic location, and physiologic extent of arterial occlusive disease and the need for operation. The physician should refrain from ordering arteriography to confirm the diagnosis of arterial disease unless o...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1976.11714271
更新日期:1976-02-01 00:00:00
abstract::Preview Management of otitis media in children is a controversial matter: The basic questions of why, in whom, and how it should be treated are undergoing continual reassessment. In this article, Drs Shapiro and Bluestone provide answers to these and other questions, such as Why is treatment of acute otitis media just...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1995.11945992
更新日期:1995-05-01 00:00:00
abstract::Hair loss is a common problem likely to be encountered by a clinical practitioner. The most frequent causes of hair loss in pediatric patients include tinea capitis, alopecia areata, traction alopecia, and trichotillomania. In the adult population, causes to be considered are alopecia areata and hair loss associated w...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1986.11699358
更新日期:1986-04-01 00:00:00
abstract:BACKGROUND:Adults with attention-deficit/hyperactivity disorder treated with atomoxetine were examined for time-to-onset and -resolution of common treatment-emergent adverse events (TEAEs) and male sexual dysfunction, and for changes in blood pressure (BP) and heart rate (HR) upon atomoxetine discontinuation. METHODS:...
journal_title:Postgraduate medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1080/00325481.2015.1083394
更新日期:2015-01-01 00:00:00
abstract::The majority of patients can be easily weaned from mechanical ventilation, but a substantial minority pose considerable difficulty. In such cases, the cause of ventilator dependency should be identified and correctable factors should be rectified. An organized plan of management, a team approach, optimal pulmonary and...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1991.11700795
更新日期:1991-01-01 00:00:00
abstract:OBJECTIVE:Among a random sample of emergency department (ED) patients, we sought to determine the extent to which reported risk for human immunodeficiency virus (HIV) is related to ever having been tested for HIV. METHODS:A random sample of patients (aged 18-64 years) from an adult, urban, northeastern United States, ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2010.01.2100
更新日期:2010-01-01 00:00:00
abstract::In this era of resource limitations, use of healthcare dollars should be directed to diagnostic and therapeutic programs that can be supported by scientifically valid information. Screening for colorectal cancer has to overcome two limitations before its routine use can be justified. First, the disease is largely a pr...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:
更新日期:1997-07-01 00:00:00
abstract::Pregnancy is an important risk factor for venous thrombosis, and venous thromboembolism is a leading cause of preventable death in pregnancy. Diagnosis of venous thromboembolism is complicated in that the symptoms of dyspnea and lower extremity edema are relatively common complaints of pregnant patients. Physicians sh...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2000.09.15.1238
更新日期:2000-09-15 00:00:00
abstract::Primary care physicians play an important role in the outpatient evaluation of proteinuria, a common finding in everyday medical practice. Therefore, it is important to recognize which symptoms and signs signal the need for further evaluation. A simple urine dipstick test usually is the first step, but factors leading...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1997.04.201
更新日期:1997-04-01 00:00:00
abstract::A varied and balanced diet is usually adequate to meet the energy, protein, vitamin, and mineral requirements of adults and the elderly. However, some high-risk groups may require supplementation or special dietary recommendations. Some examples are persons on a weight-loss diet, alcoholics, premenopausal women, women...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11699819
更新日期:1987-05-01 00:00:00
abstract::Evidence indicates that preventive healthcare in childhood reduces healthcare costs and enhances health. Physicians can assume a leadership role in promoting children's health by incorporating health promotion measures into their everyday practice, serving as resource persons or leaders in community and school efforts...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11699791
更新日期:1987-04-01 00:00:00
abstract::A carefully taken history and thorough physical examination are the first steps in establishing the cause of a neck mass. Location, size, consistency, and mobility of the mass provide clues and are useful for comparison during follow-up. Further studies are ordered on the basis of the impressions gathered from this ev...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11699816
更新日期:1987-05-01 00:00:00
abstract::With use of the International Normalized Ratio (INR), physicians can accurately assess the intensity of anticoagulation in treatment programs and trials. Bleeding is the major complication of oral anticoagulant therapy, and its incidence can be lessened, with no loss of efficacy, by using less intense therapy (INR, 2 ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1995-09-01 00:00:00
abstract::Many controversies, only a few of which have been discussed here, are now raging in the field of resuscitation. Much is expected to change in the next five to ten years. The American Heart Association is now considering changes for its new advanced cardiac life support course, which should be ready this year. The cour...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1986.11699404
更新日期:1986-05-15 00:00:00
abstract::The compatibility of a medication with other drugs and implanted materials is an important factor impacting drug safety and efficacy. The liposomal formulation of the local anesthetic bupivacaine is designed to provide prolonged postsurgical analgesia. Its compatibility with other drugs and materials depends on the co...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2014.01.2733
更新日期:2014-01-01 00:00:00
abstract::Severe gastroesophageal reflux disease is usually a chronic problem with periods of relapse, but effective medical and surgical therapies are available. Two recently introduced agents, omeprazole (Prilosec) and cisapride (Propulsid), represent advances in medical therapy; the safety of long-term, continuous omeprazole...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1995-05-01 00:00:00
abstract::Migraine is a common hereditary disorder manifested by episodic headache, irritability, and gastrointestinal upset. The condition may be triggered by dietary, environmental, psychological, or pharmacologic factors. With proper diagnosis and judicious use of abortive and prophylactic therapy, patients often obtain exce...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11699870
更新日期:1987-06-01 00:00:00
abstract:OBJECTIVES:Management of cardiovascular (CV) risk is an essential aspect of diabetes care, and acceptable CV risk is a requirement for antidiabetes medications. Dipeptidyl peptidase-4 (DPP-4) inhibitors effectively reduce glycated hemoglobin, with a low risk of hypoglycemia and weight gain. The purpose of this review i...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2015.1095616
更新日期:2015-01-01 00:00:00
abstract::Pain is among the most common reasons patients seek medical attention, and the care of patients with pain is a significant problem in the United States. Acute pain (mild-to-moderate intensity) represents one of the most frequent complaints encountered by primary care physicians (PCPs) and accounts for nearly half of p...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2011.03.2270
更新日期:2011-03-01 00:00:00
abstract::Preview Although heartburn is the most common symptom of gastroesophageal reflux, many patients with reflux have other, more obscure manifestations. Recognition of all potential signs and symptoms of reflux is important for expeditious management. This article focuses on these atypical presentations and discusses how ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1996.11946110
更新日期:1996-04-01 00:00:00
abstract::With the recent availability of human insulin, we have entered a new era in therapy for diabetes mellitus. Human insulin is not a cure for diabetes; however, no disadvantages are known to be associated with its use at present. Human insulin costs less than the other purified insulins, and because of its potential adva...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1986.11699459
更新日期:1986-07-01 00:00:00
abstract::Osteoblasts are mesenchymal cells that play a key role in maintaining bone homeostasis; they are responsible for the production of extracellular matrix proteins, regulation of matrix mineralization, control of bone remodeling and regulate osteoclast differentiation. Osteoblasts have an essential role in the pathogenes...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2017.1362312
更新日期:2017-11-01 00:00:00
abstract::Prompt and accurate diagnosis of patients presenting with symptoms suggestive of pulmonary arterial hypertension (PAH) is of outmost importance as delays in identifying this clinical entity have detrimental effects on both morbidity and mortality. Initial noninvasive assessment of these patients has traditionally incl...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2016.1115715
更新日期:2016-01-01 00:00:00
abstract::Patients with chronic pelvic pain are challenging, from both diagnostic and therapeutic viewpoints. At the pain clinic at the Medical College of Georgia School of Medicine, Augusta, we have discovered over the past 3 years that psychiatric disease is probably underrecognized in these patients and that physicians are o...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1993-12-01 00:00:00
abstract::In public whirlpools, low disinfectant levels and inadequate monitoring are clearly a public health concern. Implementing guidelines published by the Centers for Disease Control seems to be the most reasonable approach to preventing dermatitis in persons who use these facilities. Physicians should be on the alert for ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1991.11701042
更新日期:1991-09-01 00:00:00
abstract:INTRODUCTION:With rising health care costs in the United States, trainees will be increasingly challenged in discussing testing stewardship with patients. OBJECTIVE:We piloted a high-value care (HVC) communication skills curriculum utilizing the Four Habits Model for communication. We hoped residents would 1) learn to...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2020.1807728
更新日期:2020-08-22 00:00:00
abstract::A hepatitis B vaccine derived from the plasma of carriers of hepatitis B virus has recently become generally available in the United States. Its use is recommended in groups considered to be at high risk of hepatitis B because of their exposure to potentially infectious blood, saliva, or semen. Experience in more than...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1983.11697828
更新日期:1983-05-01 00:00:00
abstract::Proximal gastric vagotomy without drainage is widely accepted in Great Britain and Europe but in the United States has been done mainly in university centers. The operation denervates the acid-secreting parietal cell mass of the stomach, preserving vagal innervation to the gastric antrum and extragastric abdominal vis...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1978.11714810
更新日期:1978-04-01 00:00:00
abstract::Proper treatment of non-insulin-dependent (type II) diabetes presents the physician with a number of choices. Diet and exercise should be tried first in many patients; if this regimen is unsuccessful, treatment with either insulin or a first- or second-generation sulfonylurea must be considered. Theoretically, second-...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11699825
更新日期:1987-05-01 00:00:00
abstract:OBJECTIVES:The diagnosis of malignant pleural effusion (MPE) remains a clinical challenge. As a negative regulator of T-cell activation, cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) has been associated with many malignant diseases. However, there is limited data about the relationship between CTLA-4 and MPE. Th...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2017.1331112
更新日期:2017-08-01 00:00:00