Depression in the medical setting: biopsychological interactions and treatment considerations.

This article examines depression in 6 medical conditions: coronary artery disease (CAD), cancer, human immunodeficiency virus (HIV) infection, Parkinson's disease, pain, and the sex hormone changes of aging. Research is beginning to define specific biological and psychological mechanisms underlying the adverse interactions between depression and these medical conditions. Antidepressant medications, psychosocial therapies, and hormonal manipulations are effective in reducing depressive symptoms. Specific psychosocial interventions may increase longevity in CAD and cancer and may enhance quality of life in HIV infection. Newer antidepressants appear to be safer and better tolerated than older agents for medically ill patients, but do not appear to be as effective for neuropathic pain. Dopamine agonists may benefit depression associated with Parkinson's disease. Hormone replacement therapy may improve subsyndromal depressive symptoms in postmenopausal women and may enhance antidepressant response for older women with major depression.

A comparison of two approaches to the assessment of binge eating in obesity.

OBJECTIVE: To compare two different methods of assessing binge eating in a sample of 128 obese women enrolled in a weight loss protocol. METHOD: Prior to treatment, participants completed the Binge Eating Scale (BES) and the Questionnaire on Eating and Weight Patterns (QEWP), as well as measures of other relevant constructs. They were then classified as bingers and nonbingers by each method and chance-corrected agreement was calculated. RESULTS: The BES and QEWP identified a small and nearly equal number of subjects as having significant binge eating, but there was only modest overlap between the two groups (kappa of .45). Subgroup comparisons revealed fundamental differences between the BES and QEWP in the assessment of the critical and associated features of binge eating. DISCUSSION: The relative merits of these two approaches to classifying binge eaters and implications for the design of new methods are discussed.

Anxiety and depression in advanced lung disease.

Anxiety, panic, and depression commonly complicate chronic airflow obstruction, and probably other forms of advanced lung disease as well. Despite the recent development of many new therapeutic options, these conditions remain under-recognized and under-treated in this patient population. Under-diagnosis may result in part from the challenge of distinguishing between the somatic manifestations of psychiatric disease and the physical symptoms of severe respiratory dysfunction. Treatment relies on judicious pharmacotherapy and appropriate psychologic support. Serotonin selective reuptake inhibitors are particularly useful in the treatment of depression and panic, and may be helpful in controlling other forms of anxiety, as well. Cognitive behavioral therapy is an important adjunct in the management of anxiety. Electroconvulsive therapy should be considered for selected lung disease patients with refractory depression.

Psychosocial consequences of weight reduction: how much weight loss is enough?

We reviewed the psychosocial consequences of weight reduction and concluded that weight loss is usually associated with improvements in mood in significantly obese individuals (> or = 20% overweight) who are treated by diet and lifestyle modification. Less is known about the psychologic effects of weight loss in mildly overweight individuals who reduce their weight on their own but the limited data suggest similarly positive effects. We recommend that significantly obese individuals seek a 10% reduction in body weight, a loss that is likely to be associated with improvements in psychologic as well as physical health. A loss of this magnitude is typically produced by 16-20 wk of treatment by diet and behavior modification. Persons who ae mildly overweight (particularly those with health complications) are encouraged to reduce their weight by increasing their physical activity. Exercise is associated with modest but long-term weight losses and with improvements in mood and physical health. The recommendation that overweight Americans seek a healthier weight should be combined with efforts to promote healthier attitudes toward weight and shape in normal-weight women and girls.

Sertraline and relapse prevention training following treatment by very-low-calorie diet: a controlled clinical trial.

This study examined the combination of sertraline, a selective serotonin reuptake inhibitor, and relapse prevention training in the maintenance of weight loss following treatment by a very-low-calorie diet. A total of 53 women who had lost a mean (+/- SD) of 22.9 +/- 7.1 kg from a pretreatment weight of 103.1 +/- 17.8 kg were randomly assigned to a 54-week weight maintenance program that was combined with either: 1) 200 mg/d of sertraline; or 2) placebo. During the first 6 weeks, sertraline subjects lost significantly more weight and reported significantly greater reductions in hunger and preoccupation with food than did subjects on placebo. After this time, however, women in both conditions regained weight steadily. The 13 sertraline subjects who completed the 54-week study regained 17.7 +/- 10.6 kg of their original 26.3 +/- 7.6 kg loss, equal to a regain of 70.9 +/- 41.7%. The 17 placebo completers regained 11.8 +/- 9.0 kg of their 23.4 +/- 7.8 kg loss, equal to a 46.5 +/- 34.6% regain. End-of-treatment differences between groups in weight change were not statistically significant. Nor were there significant differences between the two conditions at any time in changes in fat-free mass, resting metabolic rate or dysphoria, all of which tended to increase with weight regain. The results are discussed in relation to findings from other long-term studies that combined diet and medication.

A comparison of currently used serum lipase and amylase procedures in the serial detection of enzyme elevations in acute pancreatitis.

Twenty-eight patients having acute pancreatitis were followed during convalescence with serum amylase and lipase determinations. Starch and p-nitrophenyl-oligosaccharide substrates were used for amylase. Dimercaptotributyrate and triolein were employed for lipase. The extreme sensitivity of the lipase procedure using the tributyrate detected a persistent elevation of lipase when other parameters of measurement had returned to normal.