Systematic evidence review of newborn screening and treatment of severe combined immunodeficiency.

CONTEXT: Severe combined immunodeficiency (SCID) is a group of disorders that leads to early childhood death as a result of severe infections. Recent research has addressed potential newborn screening for SCID. OBJECTIVE: To conduct a systematic review of the evidence for newborn screening for SCID, including test characteristics, treatment efficacy, and cost-effectiveness. METHODS: We searched Medline and the OVID In-Process & Other Non-Indexed Citations databases. We excluded articles if they were reviews, editorials or other opinion pieces, or case series of fewer than 4 patients or if they contained only adult subjects or nonhuman data. The remaining articles were systematically evaluated, and data were abstracted by 2 independent reviewers using standardized tools. For topics that lacked published evidence, we interviewed experts in the field. RESULTS: The initial search resulted in 719 articles. Twenty-six met inclusion criteria. The results of several small studies suggested that screening for SCID is possible. Interviews revealed that 2 states have begun pilot screening programs. Evidence from large case series indicates that children receiving early stem-cell transplant for SCID have improved outcomes compared with children who were treated later. There is some inconclusive evidence regarding the need for donor-recipient matching and use of pretransplant chemotherapy. Few data on the cost-effectiveness of a SCID-screening program. CONCLUSIONS: Evidence indicates the benefits of early treatment of SCID and the possibility of population-based newborn screening. Better information on optimal treatment and the costs of treatment and screening would benefit policy makers deciding among competing health care priorities.

Dysfunctional attitudes and perceived stress predict depressive symptoms severity following antidepressant treatment in patients with chronic depression.

Many patients continue to experience depressive symptoms after optimal pharmacological treatment. The aim of this study was to investigate whether Beck's cognitive diathesis stress model of depression would help predict the degree of improvement in the depressive symptoms of patients with chronic depression receiving antidepressant treatment. The study investigated the dysfunctional attitudes, perceived stress, and depressive symptoms of 117 patients with chronic depression before and after they were treated with an 8-week course of fluoxetine. A hierarchical multiple regression analysis showed a significant effect for the interaction between dysfunctional attitudes and perceived stress explaining severity of depressive symptom following antidepressant treatment. Patients with both high perceived stress and high dysfunctional attitudes prior to treatment reported more depressive symptoms at the end of treatment than patients with high perceived stress and lower dysfunctional attitudes. Surprisingly, in the presence of low perceived stress, patients with higher dysfunctional attitudes experienced less depressive symptoms at the end of treatment than patients with lower dysfunctional attitudes. Results suggest the value of taking into consideration both patients' perceived stress and dysfunctional attitudes when assessing treatment for depressive symptoms.

Validation of the Patient Health Questionnaire-9 for depression screening among Chinese Americans.

OBJECTIVE: The objective of this study was to validate the Chinese Bilingual version of the Patient Health Questionnaire (CB-PHQ-9) for screening for depression among Chinese Americans in primary care. METHOD: Chinese-American patients attending a primary care clinic were screened for major depressive disorder (MDD) using the CB-PHQ-9. All patients who scored 15 or higher on the CB-PHQ-9 were interviewed using the Chinese-bilingual Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, patient version. Eight percent of patients who scored less than 15 on the CB-PHQ-9 were randomly selected and interviewed with the depression module of the Chinese-bilingual Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, patient version. RESULTS: During the study, 1940 unduplicated patients completed the CB-PHQ-9. The CB-PHQ-9 had high internal consistency (alpha = 0.91), and the scores of each of its 9 items had moderate to moderately high correlations (0.52-0.85) with the total scores. The sensitivity and specificity of the CB-PHQ-9 for recognizing MDD were found to be 81% and 98%, respectively, and the area under the receiver operating characteristic curve was estimated to be 0.97 (SE, 0.01). CONCLUSION: The CB-PHQ-9 is a valid and useful instrument for screening for MDD among Chinese Americans in primary care.

Does psychiatry residency training reflect the "real world" of psychiatry practice? A survey of residency graduates.

OBJECTIVE: The authors determine whether Massachusetts General Hospital's residency graduates believed their training reflected their current practice activities. METHOD: The authors surveyed 134 graduates from MGH and MGH-McLean residency classes from 1983 to 2003. Subjects ranked their satisfaction with different components of training on a scale of 1 to 6 and listed areas they wanted emphasized during residency. RESULTS: Sixty-six subjects (49%) returned surveys. Twenty respondents graduated in the 1980s (Cohort 1), 27 in the 1990s (Cohort 2), and 16 in the 2000s (Cohort 3). The most common activities included psychopharmacology, teaching, supervision, research, administration, psychodynamic therapy, and supportive therapy. Least common activities included geriatrics, addiction, and psychoanalysis. Satisfaction with training was high, as was relevance of training. CONCLUSIONS: Our graduates from 1983 to 2003 considered residency good preparation for the world of practice and reported that psychopharmacology should be emphasized during training. Respondents expressed a strong desire for continued training in psychodynamic therapy, despite growing emphasis on short-term therapies and biological treatments.

Recognizing and engaging depressed Chinese Americans in treatment in a primary care setting.

OBJECTIVES: To examine the effectiveness of depression screening and the Engagement Interview Protocol (EIP) in identifying and engaging in treatment depressed Chinese Americans in a primary care setting. METHODS: Chinese American patients who attended a primary care clinic between 15 September, 2004 and 14 September, 2005 were screened for depression using the Chinese Bilingual version of the Patient Health Questionnaire (CB-PHQ-9). Patients who screened positive (CB-PHQ-9>or=15) were evaluated using the EIP to establish psychiatric diagnosis and to engage patients in treatment. RESULTS: Three thousand eight hundred and twelve patients completed the CB-PHQ-9, of which 113 (3.2%) screened positive for MDD. Among those screening positive, six (5.3%) had been receiving psychiatric treatment for depression, 57 (50%) declined to receive a psychiatric interview or were unable to be contacted, and 50 (44%) agreed to be interviewed with the EIP. Out of the 50 patients interviewed, 44 (88%) had their MDD diagnosis confirmed; among them, 41 (93%) agreed to receive treatment for depression and three (7%) declined intervention. CONCLUSIONS: Under-recognition and under-treatment of depressed Chinese Americans in primary care settings continue to be prevalent. Recognition of depression can be enhanced by using the brief CB-PHQ-9 to screen for depression. Half of the Chinese Americans who screened positive for MDD declined evaluation by a mental health professional. Most of the depressed Chinese Americans who were evaluated agreed to receive treatment. Enhanced cultural sensitivity with the use of the EIP in psychiatric assessment may have contributed to the success in engaging depressed Chinese Americans in treatment.