K Ranga Rama Krishnan

..5. Sertraline was found to be a safe, well-tolerated, and effective as an antidepressant in elderly patients suffering from hypertension and other forms of vascular comorbidity...

..Future trials with SPAs will focus on the identification of appropriate patients and drug regimens and will also define the role of these agents in the treatment of depression...

..Medical comorbidity may be exacerbated or caused by pharmacotherapy of bipolar symptoms...

..Large-scale trials are needed to assess not only the safety and effectiveness of agents for the treatment of depression in comorbid illness, but also the effects of depression on the course of the medical illness itself...

..It is likely that a standardized approach that can develop and modify classification systems in a timely manner, based on science and free of societal and political influence, can enhance research, teaching and clinical practice...

..These processes are efficient and generally accurate, but can sometimes lead to errors or biases. In this review we discuss the nature of these processes and their potential effects on decision making...

..In turn, this strategy should improve our ability to discern particular features of a disease and refine our notion of its clinical presentation and lead toward novel and improved treatments for our patients...

..The authors examined the effect of the acetylcholinesterase inhibitor donepezil on magnetic resonance markers of neurodegeneration in Alzheimer's disease...

..The first is early life stress disorder, and the second vascular depression. These conditions have reached a point where the data supports them as distinct entities. In this paper, the rationale for this is discussed...

..We present evidence that this model explains many of the features of schizophrenia and we make a series of predictions about schizophrenia...

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..In addition there can be a differential impact based on the quality and comparability of studies. In this article we review the potential significance of these biases...

..Further research is needed to further characterize this disorder, particularly in regards to cognitive function and treatment implications...

..The purpose of this study was to determine whether microstructural abnormalities in the white matter of the dorsolateral prefrontal cortex are associated with late-life depression...

..To analyze the effects of antidepressants on cognitive functioning in elderly depression...

..These changes are thought to disrupt neural circuits involved in mood regulation, thus increasing the risk of developing depression...

..Because they are associated with age, they should increase in number and size over time. To our knowledge, this is the first longitudinal, volumetric MRI study of WMHs in depression...

..Additionally, differences between subgroups of depressed populations, including those with MRI-defined vascular depression and those with late-onset compared with early-onset depression are not well described...

..By extension, we suggest that orbitofrontal prefrontal cortex may play a role in sustaining perseverative processing in geriatric depression...

..There have been few placebo-controlled trials of selective serotonin reuptake inhibitors for depressed elderly patients. This placebo-controlled study of sertraline was designed to confirm the results of non-placebo-controlled trials...

..It is only beginning to be utilized in psychiatric research. This article reviews the theory behind diffusion tensor imaging, its potential to map fiber tracts in the brain, and its recent use in psychiatric research...

..Definitions of remission that are better associated with longer-term outcomes are needed...

..Mean change in lesion volume and mean percentage of change were determined between the two time points. Logistic regression models were used to examine the differential effects of age, sex, race, and self-reported medical morbidity...

..Deep white matter hyperintense lesions are associated with advanced age and late-life depression. The authors examined where age-related cerebral lesions occurred in elderly depressed and healthy control subjects...

..The authors correlated magnetic resonance imaging (MRI) lesion severity and mortality among depressed elderly patients...

..There have been mixed findings regarding the prognostic significance of age of onset, executive dysfunction, and hyperintensity burden on treatment outcome in late-life depression...

..We also suggest that subcortical lesions may decrease OFC volume. Further studies are needed to understand how subcortical lesions may be related to OFC volume changes...

..The authors report on prospectively observed mortality in elderly depressed patients, comparing differences in sex and vascular risk...

..These results add to the literature linking mood and cognitive disturbances to the PFC. Future studies with a larger sample employing functional measures are warranted...

..Future studies of depression outcomes in the elderly will need to include serial examination of cholesterol levels...

..Further studies are needed to determine how smaller OFC volumes are related to other MRI abnormalities associated with depression and functional impairment...

..Elderly depressed patients have more vascular hyperintensities in frontal white matter and basal ganglia than elderly control subjects. Cell pathology that might be related to increased vascular hyperintensities has not been examined...

..Data are lacking on the eventual outcomes of individuals who are partial responders or poor responders to initial treatment...

..6% of patients responded, and 65.35% of patients were able to achieve full remission of symptoms. The STAGED approach appears to be a clinically useful method of successfully treating elderly depressed patients...

..The DISH is efficient in yielding both a DSM-IV depression diagnosis and a 17-item Hamilton depression score...

..Thus in this exploratory analysis, the Met66 allele may be associated with increased odds of remission in older subjects, but also with increased time to remission as there was no 3-month effect...

..Patients with congestive heart failure (CHF) may have a high prevalence of depression, which may increase the risk of adverse outcomes...

..The authors present the case for psychiatry's adoption of the practical clinical trials model, which is widely used in research in other areas of medicine...

..The objective was to test the hypothesis that heart failure (HF) patients treated with sertraline will have lower depression scores and fewer cardiovascular events compared with placebo...

..Experimental opioid administration influences mechanisms and indices of oxidative stress, such as antioxidant compounds and purine metabolism. We examined perturbations of neurotransmitter-related pathways in opioid dependence (OD)...

..The current generation of clinical trials in pediatric psychiatry often fails to maximize clinical utility for practicing clinicians, thereby diluting its impact...

..The impact of sertraline on the prognosis and depression of patients with chronic heart failure (HF) and comorbid major depressive disorder (MDD) is unknown...

..5, Beck Depression Inventory scale 17.9 ± 6.5 vs 20.3 ± 7.2, p <0.001 for the 2 comparisons). In conclusion, this study indicates that remission from depression may improve the cardiovascular outcome of patients with heart failure...

..In conclusion, 4-week pregabalin treatment improved HRV in patients with painful diabetic peripheral neuropathy. Trial Registration: NCT00573261 (clinicaltrials.gov)...

..The Cardiovascular Health Study (CHS) provides an opportunity to examine the relationship between vascular brain pathology seen on neuroimaging and changes in depressive symptoms...

..Multipoint linkage analysis yielded negative results except for Model 1a, in which a maximal LOD score was -1.24. A mutation screen of Exons 3 and 4 was negative. Notch3 does not appear to be a candidate gene for BPD in this family...

..Bupropion SR demonstrated a significant reduction (p<.01, least square mean change) in symptoms over placebo on 4 domains (cognitive, retardation, fatigue/interest, and anxiety items)...

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..The best designed studies reported the least effects of these factors on treatment outcome. Clinically, this suggests that these factors should not be seen as impediments to treatment...

..The results support the value of early treatment of AD patients, particularly those with moderately severe AD...

..Implications for brain morphometry, the use of fat as a reference standard, and other issues in neuroimaging are discussed...

..Metabolomics emerges as another powerful tool in central nervous system research...

..The findings raise the possibility that this genetic locus may exert differential effects based on gender, increasing risk in men, and increasing risk of recurrence in women...

..Further comparisons of selective serotonin reuptake inhibitor and serotonin and norepinephrine reuptake inhibitor drugs on HRV are warranted...

..Depression after myocardial infarction (MI) is associated with higher morbidity and mortality. Although antidepressants are effective in reducing depression, their use in patients with cardiovascular disease remains controversial...

..However, no published evidence exists that antidepressant drugs are safe or efficacious in patients with unstable ischemic heart disease...

..This study determined the efficacy of antidepressant medication for the treatment of depression in the "old-old."..

..This study examined the severity of subcortical hyperintensities (SH) and the relationship between SH and depression characteristics in two samples of elderly depressed outpatients differing in age...

..Our results are consistent with prior magnetic resonance imaging, positron emission tomography, and postmortem reports of focal and lateralized abnormalities of the basal ganglia in MDD...

..The association between SH and antidepressant treatment response in depressed geriatric outpatients remains unclear and deserves further investigation...

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..Placebo response, drug response, and drug-placebo differences appear to vary among psychiatric conditions...

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..The authors examined which, if any, research design features and patient characteristics would significantly differ between successful and unsuccessful antidepressant trials...

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..This research is unique and is likely to enhance our understanding of the phenomenology, course, outcome and relationship of MRI changes to the pathophysiology of bipolar disorder in late life. ..

..Information collected in these follow-up contacts will include deaths, re-hospitalizations, cardiac events, functional status/quality of life measures, and level of depressive symptoms. ..

..This research is likely to be valuable in developing an understanding of the psychobiology of bipolar disorder and could lead to improving diagnosis and management of late life bipolar disorder. ..