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Effect of palliative care-led meetings for families of patients with chronic critical illness

Patients are considered to have developed chronic critical illness when they experience acute illness requiring prolonged mechanical ventilation or other life-sustaining therapies but neither recover nor die within days to weeks. It is estimated that chronic critical illness affected 380,000 patients in the United States in 2009. Family members of patients in the intensive care unit ( ICU ) experience emotional distress including anxiety, depression, and posttraumatic stress disorder (PTSD). Palliative care specialists are trained to provide emotional support, share information, and engage patients and surrogate decision makers in discussions of patient values and goals of care. Shannon S. Carson, M.D., of the University of North Carolina School of Medicine, Chapel Hill, N.C., Judith E. Nelson, M.D., J.D., of the Memorial Sloan Kettering Cancer Center, New York, and colleagues randomly assigned adult patients requiring 7 days of mechanical ventilation and their family surrogate dec...
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Brain inflammation linked to depression in multiple sclerosis

A new study in Biological Psychiatry supports this hypothesis, providing evidence that inflammation of the hippocampus, a region of the brain implicated in the genesis and maintenance of depression and in the pathology of multiple sclerosis, alters its function and contributes to symptoms of depression. "This study elegantly links hippocampal inflammation to depression," said Dr. John Krystal, Editor of Biological Psychiatry. The research was a collaboration between King's College London, Imperial College London, and Imanova Center for Imaging Sciences. Led by senior authors Paul Matthews and Eugenii Rabiner, the research team combined two complementary brain imaging techniques to study the relationship between hippocampal immune response, functional connections, and depressive symptoms in 13 patients with multiple sclerosis and 22 healthy control subjects. Positron emission tomography (PET) allowed for quantification of activated microglia , a measure of immune res...
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Vision-threatening stages of diabetic retinopathy associated with higher risk of depression

Diabetic retinopathy (DR) is a common microvascular complication of diabetes. It is a progressive eye disease that is characterized by an asymptomatic non-proliferative stage (NPDR) and symptomatic proliferative stage (PDR). The PDR stage, together with diabetic macular edema (DME), which can develop at any stage, are the primary causes of vision loss in people with diabetes. Research is needed to clarify inconsistent findings regarding the association between diabetes-related eye complications and psychological well-being. This study included 519 participants with a median duration of diabetes of 13 years. Patients underwent a comprehensive eye examination in which images were obtained and graded for the presence and severity of DR and DME . Visual acuity was also assessed. Patients were screened for symptoms of depression and anxiety. Eighty individuals (15 percent) screened positive for depressive symptoms and 118 persons (23 percent) screened positive for symptoms of anxiety...
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Antidepressants: Treatment for bad marriages?

The assumption that people struggling with their marriages or other domestic issues are suffering from depression is not supported by the way depression is defined medically, said Jonathan M. Metzl, Frederick B. Rentschler II Professor of Sociology and Medicine, Health and Society at Vanderbilt and the study's lead author. The study, conducted using a Midwestern medical center's records from 1980 to 2000, appears in the current issue of the  Yale Journal of Biology and Medicine Notably, Metzl said, the time period of analysis followed a 1974 decision that removed the term "homosexuality" from the Diagnostic and  Statistical Manual of Mental Disorders  ( DSM ), the standard reference book of psychiatric illnesses. "As it became less acceptable to overtly diagnose homosexuality, it became increasingly acceptable to diagnose threats to female-male relationships as conditions that required psychiatric intervention," Metzl said. "Doctors increasingly ...
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Scientists link bipolar disorder to unexpected brain region

Scientists from the Florida campus of The Scripps Research Institute (TSRI) have shown for the first time that ensembles of genes within the striatum--a part of the brain that coordinates many primary aspects of our behavior, such as motor and action planning, motivation and reward perception--could be deeply involved in the disorder. Most modern studies of bipolar disorder have concentrated on the brain's cortex, the largest part of the brain in humans, associated with higher-level thought and action. "This is the first real study of gene expression in the striatum for bipolar disorder," said Ron Davis, chair of the Department of Neuroscience at TSRI, who directed the study. "We now have a snapshot of the genes and proteins expressed in that region." The study, published recently online ahead of print in the journal  Molecular Psychiatry , also points to several pathways as potential targets for treatment. Bipolar disorder is a mental illness that affec...
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Resilience affects whether childhood trauma results in harmful gene response

Previous research has shown that chronic exposure to trauma is associated with an increase in pro-inflammatory gene expression and a decrease in antibodies and antiviral responses in immune cells. Those molecular responses have been linked to cardiovascular and neurodegenerative diseases, cancer, infections and mental illnesses such as anxiety and depression. Brandon Kohrt, M.D., Ph.D., professor of psychiatry and global health at Duke, and colleagues conducted a five-year longitudinal study of former child soldiers exposed to the trauma of a decade-long civil war in Nepal. The findings were published during the week of July 11 in the  Proceedings of the National Academy of Sciences . "This study has important implications for responding to young people exposed to war, terrorism and natural disasters," Kohrt said. The researchers focused on 154 former child soldiers and 136 youths who experienced the war as civilians. They were evaluated using the Child PTSD (post-tra...
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New antidepressant target discovered

The investigators showed decreasing a set of proteins called HCN channels reduced depression-like behavior in mice. If replicated in humans, the findings could inform fresh therapies for millions of patients who do not respond to existing treatments for depression. "Drugs currently available for treating depression help most patients, but they stop working for some patients and don't work from the get-go for others," said senior author Dr. Dane Chetkovich, ?a professor of neurology and of physiology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine neurologist. "There is a real need for new therapies to help patients desperate for alternatives to the available therapeutic options." The study will be published July 12 in the journal  Molecular Psychiatry . Most existing antidepressants affect mood and emotions by increasing levels of neurotransmitters called monoamines, namely serotonin, dopamine and norepinephrine . But t...
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