Depression and Suicidal Behavior in Adolescents
Depression commonly onsets in adolescence, affecting approximately 1 in 4 female adolescents and 1 in 10 males in the United States. Adolescent depression is a significant risk factor for suicide, the cause of over a third of all American adolescent deaths. Adolescent depression is introduced alongside its developmental and gendered considerations with a focus on important risk factors of adolescent depression, including nonsuicidal self-injury, adverse childhood experiences, and substance abuse. Protective factors and contemporary special topics of the COVID-19 pandemic and social media use are reviewed. Therapeutic optio...
Source: Medical Clinics of North America - October 27, 2022 Category: Primary Care Authors: Aliza Grossberg, Timothy Rice Source Type: research
Frailty
This article aims to provide an updated overview of this conceptual change by examining the emerging definitions of physical, cognitive, social, and psychological frailty; the tools used for diagnosis and assessment of these domains; the epidemiology of the domains; their pathogenesis, risk factors, and course; frameworks for prevention and treatment; and unresolved issues affecting the field. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - October 27, 2022 Category: Primary Care Authors: Carl I. Cohen, Rivka Benyaminov, Md Manumar Rahman, Dilys Ngu, Michael Reinhardt Source Type: research
Management of Psychiatric Disorders and Suicidal Behavior in the Twenty-First Century
Over the past decades, diagnosis and treatment of psychiatric disorders have advanced enormously. Scientific achievements, including advances in biochemistry and neuroimaging, led to the development of new methods of diagnosis and treatment of mental illnesses. Effective medications offer opportunities for individuals with psychiatric disorders to lead full and fruitful lives. Today is definitely the best time in human history for patients and families who face mental disorders. The recognition of the global importance of psychiatric disorders has put mental health firmly on the international public health agenda. (Source:...
Source: Medical Clinics of North America - October 27, 2022 Category: Primary Care Authors: Leo Sher Tags: Preface Source Type: research
From Mouse to Man: N-Methyl-d-Aspartic Acid Receptor Activation as a Promising Pharmacotherapeutic Strategy for Autism Spectrum Disorders
The BALB/c mouse displays hypersensitivity to behavioral effects of MK-801 (dizocilpine), a noncompetitive N-methyl-d-aspartic acid (NMDA) receptor “open-channel” blocker, and shows both no preference for an enclosed stimulus mouse over an inanimate object and reduced social interaction with a freely behaving stimulus mouse. NMDA receptor agonist interventions improved measures of social preference and social interaction of the BALB/c mouse model of autism spectrum disorder (ASD). A “proof of principle/proof of concept” translational 10-week clinical trial with 8-week of active medication administration was conduct...
Source: Medical Clinics of North America - October 27, 2022 Category: Primary Care Authors: Stephen I. Deutsch, Jessica A. Burket Source Type: research
Schizophrenia: One Name, Many Different Manifestations
Schizophrenia is a disabling condition impacting approximately 1% of the worldwide population. Symptoms include positive symptoms (eg, hallucinations, delusions), negative symptoms (eg, avolition, anhedonia), and cognitive impairment. There are likely many different environmental and pathophysiologic etiologies involving distinct neurotransmitters and neurocircuits. Pharmacologic treatment at present consists of dopamine receptor antagonists, which are reasonably effective at treating positive symptoms, but less effective at treating cognitive and negative symptoms. Nondopaminergic medications targeting alternative recepto...
Source: Medical Clinics of North America - October 27, 2022 Category: Primary Care Authors: Justin Faden, Leslie Citrome Source Type: research
Overall goal of Cognitive-Behavioral Therapy in Major Psychiatric Disorders and Suicidality
Cognitive-behavioral therapy (CBT) is a form of psychological treatment that is based on the underlying assumption that mental disorders and psychological distress are maintained by cognitive factors, that is, that general beliefs about the world, the self, and the future contribute to the maintenance of emotional distress and behavioral problems. The overall goal of CBT is to replace dysfunctional constructs with more flexible and adaptive cognitions. The most relevant cognitive-behavioral techniques in clinical practice are: i. Cognitive Restructuring (also known as the ABCDE method) is indicated to support patients deal...
Source: Medical Clinics of North America - October 27, 2022 Category: Primary Care Authors: Gianluca Serafini, Alessandra Costanza, Andrea Aguglia, Andrea Amerio, Valeria Placenti, Luca Magnani, Andrea Escelsior, Leo Sher, Mario Amore Source Type: research
Microbiome in Anxiety and Other Psychiatric Disorders
Initial studies suggested that the fluctuations in the quantity, variety, and composition of the gut microbiota can significantly affect disease processes. This change in the gut microbiota causing negative health benefits was coined dysbiosis. Initial research focused on gastrointestinal illnesses. However, the gut microbiome was found to affect more than just gastrointestinal diseases. Numerous studies have proven that the gut microbiome can influence neuropsychiatric diseases such as Parkinson ’s disease, Alzheimer’s disease, and multiple sclerosis. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - October 27, 2022 Category: Primary Care Authors: Norman M. Spivak, Jonathan Haroon, Andrew Swenson, Scott A. Turnbull, Nolan Dang, Matthew Ganeles, Collin Price, Margaret Distler, Erika Nurmi, Helen Lavretsky, Alexander Bystritsky Source Type: research
Exciting Times
Primary care physicians and other practitioners hardly need to be convinced of the importance of psychiatry in their practices. Psychiatric disorders are common in primary care. These disorders may underlie or contribute to the problems patients bring to their internists and family physicians. Many patients are reluctant to be referred to a mental health professional, or as our Guest Editor, Leo Sher, points out in his Preface, mental health professionals may not be available. Not surprisingly, therefore, knowledge of psychiatric disorders and treatment of the same have come to be considered core knowledge for internists a...
Source: Medical Clinics of North America - October 27, 2022 Category: Primary Care Authors: Jack Ende Tags: Foreword Source Type: research
Testing and Treating Mycobacterium tuberculosis Infection
After infection with Mycobacterium tuberculosis, a minority of individuals will progress to tuberculosis disease (TB). The risk is higher among persons with well-established risk factors and within the first year after infection. Testing and treating individuals at high risk of progression maximizes the benefits of TB preventive therapy; avoiding testing of low-risk persons will limit potential harms. Several treatment options are available; rifamycin-based regimens offer the best efficacy-safety balance. In this review, we present an overview of the diagnosis and treatment of TB infection, and summarize common clinical sc...
Source: Medical Clinics of North America - October 22, 2022 Category: Primary Care Authors: Edgar Ortiz-Brizuela, Dick Menzies, Marcel A. Behr Source Type: research
Advances in Evaluation and Treatment of Severe Asthma (Part One)
This article outlines a systematic approach to their evaluation, attempting to identify remediable factors that are making their asthma more severe than most other persons with asthma. This approach includes an emphasis on ensuring the correct diagnosis, minimizing exposures to stimuli that worsen airway inflammation, alleviating modifiable comorbidities such as chronic rhinosinusitis and gastroesophageal reflux, and supporting regular medication adherence and effective technique for administering inhaled medications. A basic diagnostic laboratory work-up is recommended, to be modified and amplified according to individual...
Source: Medical Clinics of North America - October 22, 2022 Category: Primary Care Authors: Christopher H. Fanta Source Type: research
Advances in Evaluation and Treatment of Severe Asthma (Part Two)
Providers caring for patients with severe, therapy-resistant asthma have novel options for their treatment. Administration of additional inhaled corticosteroids at the time of increased symptoms, a strategy referred to as anti-inflammatory rescue or AIR, has been proved to be effective in reducing the frequency of exacerbations and improving asthma-related quality of life. Long-acting muscarinic antagonists can be used in combination with long-acting beta-agonist bronchodilators for additional bronchodilation. The care of the patient with severe asthma must also include a strategy to help avoid severe, life-threatening ast...
Source: Medical Clinics of North America - October 22, 2022 Category: Primary Care Authors: Christopher H. Fanta Source Type: research
The Survival of the Surviving Sepsis Campaign
Even well-intentioned policies have great potential to cause harm. This statement is vividly illustrated by the influential, yet controversial, Surviving Sepsis Campaign guidelines and subsequent CMS benchmarks. Despite low-quality evidence, tendentious industry ties, and rebuke from the Infectious Disease Society of America (IDSA), these benchmarks continue to eschew therapy driven by clinician expertise and individual patient needs in favor of mandating an arbitrary, one-size-fits-all approach that suspends clinical judgment and promotes indiscriminate use of treatments that have the potential to cause great harm. (Sourc...
Source: Medical Clinics of North America - October 22, 2022 Category: Primary Care Authors: Rory Spiegel, Max Hockstein, Jessica Waters, Munish Goyal Source Type: research
Specialists Without Borders
It was 30 years ago that the iconic medical sociologist, Barbara Starfield, in her ground-breaking book, Primary Care: Concept Evaluation and Policy,1 laid out the tenets of primary care. These have come to be known as the 4 C ’s: First Contact, Comprehensiveness, Coordination, and Continuity, and serve as aspirational goals of general internal medicine, family medicine, and primary care overall. This is what we stand for. This is what we hope to provide. As a general internist myself, I have strived to represent and pr ovide the 4 C’s. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - October 22, 2022 Category: Primary Care Authors: Jack Ende Tags: Foreword Source Type: research
CME Accreditation Page
(Source: Medical Clinics of North America)
Source: Medical Clinics of North America - October 22, 2022 Category: Primary Care Source Type: research
Pulmonary Diseases
MEDICAL CLINICS OF NORTH AMERICA (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - October 22, 2022 Category: Primary Care Authors: Daniel M. Goodenberger Source Type: research
