Early treatment of depressive symptoms and long-term survival after liver transplantation.

While depression after liver transplantation (LTX) is associated with decreased survival, the effects of treating depression remain unknown. We assessed a previously described, prospective cohort of 167 patients transplanted for alcohol-related liver disease from 1998 to 2003. Depressive symptoms were measured with the Beck Depression Inventory serially throughout the first posttransplant year. Adequacy of antidepressant treatment was measured with the Antidepressant Treatment History Form. Using Cox-proportional Hazards modeling, survival times were assessed for recipients with no depression versus depression with adequate medications versus depression with inadequate medications. Seventy-two recipients had depressive symptoms in the first posttransplant year. Of these, 43% (n=31) received adequate pharmacotherapy and 57% (n=41) received inadequate (n=7) or no pharmacotherapy (n=34). After a median follow-up time of 9.5 years, 32% of the inadequately treated depressed group survived versus 52% of the adequately treated group and 56% of the nondepressed group (p=0.006). Compared to the nondepressed group, those with adequately treated depression had no significant difference in survival. However, recipients with depression and inadequate pharmacotherapy had decreased survival times compared to nondepressed recipients (HR for death=2.44, 95% CI=1.45, 4.11), controlling for other known confounders. The factor most strongly linked to long-term mortality after liver transplantation in this cohort was untreated depression.

Treatment practices for childhood posttraumatic stress disorder.

OBJECTIVE: This study surveyed practices in treating childhood PTSD among child psychiatrists and non-M.D. therapists with self-identified interest in treating traumatized children. METHOD: An anonymous survey was mailed to 207 child psychiatrists ("medical") and 460 nonphysician ("non-medical") therapists inquiring about current interventions used to treat children with PTSD. RESULTS: Two hundred and forty-seven responses were received: of 77 medical and 82 nonmedical respondents who currently treat children with PTSD, a wide variety of modalities are used. Most preferred modalities among medical responders were pharmacotherapy, psychodynamic, and cognitive-behavioral therapy. Most preferred modalities among nonmedical respondents were cognitive-behavioral, family, and nondirective play therapy. Ninety-five percent of medical respondents used pharmacotherapy for this disorder; most preferred medications to treat childhood PTSD were selective serotonin reuptake inhibitors and alpha-adrenergic agonists. Several significant differences between medical and nonmedical practices were identified. CONCLUSIONS: There is little clinical consensus regarding the effectiveness of the many modalities used to treat traumatized children who have PTSD symptoms; empirical research is particularly needed to evaluate the efficacy of pharmacotherapy and EMDR.

Pills for the poor: John Wesley's Primitive Physick.

While John Wesley's Primitive Physick (1747) cannot be termed a classic of British medical literature, it must certainly be identified as one of the most popular volumes published in England during the eighteenth century. Although the work came under attack from contemporary surgeons, physicians, and apothecaries, who maintained that its remedies were founded upon ignorance, Wesley probably knew as much as most members of the medical profession; in fact, on no less than twenty instances throughout the volume, he paraphrases or cites directly from prominent physicians and theorists-such figures as Sydenham, Boerhaave, Cheyne, Mead, and Huxham. However, despite its obvious emphasis upon practical remedies, the underlying focus of Primitive Physick is upon the soul of man. Wesley had consulted some sources, common sense, and his own experience, tempering those with the general principle of "doing good to all men," particularly "those who desire to live according to the gospel...." Thus, the Methodist patriarch's own formula for life had as much to do with the spread of Primitive Physick throughout eighteenth-century Britain and America as did all of the remedies and suggestions imprinted upon its pages.