http://gruberpeplab.com/3131/Kreibig_2010.pdf

Autonomic nervous system activity in emotion: A review

The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease: A review

ContextBreast cancer screening in community practices may be different from
that in randomized controlled trials. New screening modalities are becoming
available.ObjectivesTo review breast cancer screening, especially in the community and to
examine evidence about new screening modalities.Data Sources and Study SelectionEnglish-language articles of randomized controlled trials assessing
effectiveness of breast cancer screening were reviewed, as well as meta-analyses,
systematic reviews, studies of breast cancer screening in the community, and
guidelines. Also, studies of newer screening modalities were assessed.Data SynthesisAll major US medical organizations recommend screening mammography for
women aged 40 years and older. Screening mammography reduces breast cancer
mortality by about 20% to 35% in women aged 50 to 69 years and slightly less
in women aged 40 to 49 years at 14 years of follow-up. Approximately 95% of
women with abnormalities on screening mammograms do not have breast cancer
with variability based on such factors as age of the woman and assessment
category assigned by the radiologist. Studies comparing full-field digital
mammography to screen film have not shown statistically significant differences
in cancer detection while the impact on recall rates (percentage of screening
mammograms considered to have positive results) was unclear. One study suggested
that computer-aided detection increases cancer detection rates and recall
rates while a second larger study did not find any significant differences.
Screening clinical breast examination detects some cancers missed by mammography,
but the sensitivity reported in the community is lower (28% to 36%) than in
randomized trials (about 54%). Breast self-examination has not been shown
to be effective in reducing breast cancer mortality, but it does increase
the number of breast biopsies performed because of false-positives. Magnetic
resonance imaging and ultrasound are being studied for screening women at
high risk for breast cancer but are not recommended for screening the general
population. Sensitivity of magnetic resonance imaging in high-risk women has
been found to be much higher than that of mammography but specificity is generally
lower. Effect of the magnetic resonance imaging on breast cancer mortality
is not known. A balanced discussion of possible benefits and harms of screening
should be undertaken with each woman.ConclusionsIn the community, mammography remains the main screening tool while
the effectiveness of clinical breast examination and self-examination are
less. New screening modalities are unlikely to replace mammography in the
near future for screening the general population.

https://jamanetwork.com/journals/jama/articlepdf/200479/JCR40026.pdf

Screening for Breast Cancer

Depressive symptoms and syndromes are common in the medically ill, although they are frequently unrecognized and untreated The authors review the epidemiology, differential diagnosis, clinical presentations, and response to treatment of this clinical problem They address such methodological issues in the current literature in this area as the advantages and limitations of standardized assessment measures and discuss treatment modalities for depression in the medically ill, including antidepressant medication and ECT This clinical problem warrants attention for a variety of reasons: its prevalence, associated morbidity, and treatability Elucidation of the mechanisms of depression in the medically ill may also contribute to a broader understanding of depression in other populations

Depression in the medically ill: An overview.

Background Cognitive behavioral treatment (CBT) of residual symptoms after successful pharmacotherapy yielded a substantially lower relapse rate than did clinical management in patients with primary major depressive disorders. The aim of this study was to test the effectiveness of this approach in patients with recurrent depression (≥3 episodes of depression). Methods Forty patients with recurrent major depression who had been successfully treated with antidepressant drugs were randomly assigned to either CBT of residual symptoms (supplemented by lifestyle modification and well-being therapy) or clinical management. In both groups, during the 20-week experiment, antidepressant drug administration was tapered and discontinued. Residual symptoms were measured with a modified version of the Paykel Clinical Interview for Depression. Two-year follow-up was undertaken, during which no antidepressant drugs were used unless a relapse ensued. Results The CBT group had a significantly lower level of residual symptoms after discontinuation of drug therapy compared with the clinical management group. At 2-year follow-up, CBT also resulted in a lower relapse rate (25%) than did clinical management (80%). This difference attained statistical significance by survival analysis. Conclusions These results challenge the assumption that long-term drug treatment is the only tool to prevent relapse in patients with recurrent depression. Although maintenance pharmacotherapy seems to be necessary in some patients, CBT offers a viable alternative for other patients. Amelioration of residual symptoms may reduce the risk of relapse in depressed patients by affecting the progression of residual symptoms to prodromes of relapse.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/204267/yoa7418.pdf

Prevention of Recurrent Depression With Cognitive Behavioral Therapy: Preliminary Findings

Depression and gastrointestinal illness: the joint use of biological and clinical criteria.

Paykel's Clinical Interview for Depression (CID), an observer-rated scale, and Kellner's Symptom Questionnaire (SQ), a self-rating inventory, were administered to twenty-six patients with breast cancer: 1) the day prior to discharge after mastectomy or lumpectomy, 2) after six months, during a follow-up outpatient visit. There were no significant changes in depression and anxiety (except for self-rated anxiety) and, indeed, there were very high test-retest correlations. Observer and self-rated assessments were significantly related, and these correlations improved on outpatient follow-up. DSM-III-R diagnoses of affective illness (mood and anxiety disorders) based on pre-established cut-offs of the CID, showed considerable stability, particularly as to major depressive illness.

Rating Depression and Anxiety after Mastectomy: Observer versus Self-Rating Scales:

40 women who underwent amniocentesis were administered the Symptom Questionnaire to evaluate changes in psychological distress. Anxiety, depression, somatic symptoms and hostility significantly decreased after the results of the procedure were communicated to the patient, replicating the findings in a previous study. Psychological distress, however, returned to the initial levels in the third trimester of pregnancy. Women whose only indication for amniocentesis was an age of 35 years or older displayed significantly higher hostility and somatic symptoms and less contentment before the procedure than the other women. Subsequently these differences lost their significance and the two groups showed similar patterns of psychological distress throughout the pregnancy.

Psychological Distress and Amniocentesis

Little interest has been taken in the characteristics of depression in medical and surgical patients and its correlations with syndromes which may be subsumed under the rubric of abnormal illness behaviour. Depressive symptoms and abnormal illness behaviour as measured by self-rating scales were studied among 325 inpatients of a general hospital. A principal component analysis was carried out. A first factor reflecting general severity was characterized by depressed affect, somatic symptoms, retardation, hypochondriasis, and disease conviction and showed considerable stability within the group. A second factor suggested that in contrast to the younger patients, older patients had a tendency to focus on somatic problems and not psychological determinants, were likely to attribute all difficulties to physical illness, and lacked readiness to report interpersonal friction.

Patterns of depression and illness behaviour in general hospital patients.

Psychiatric illness according to DSM-III-R criteria was investigated in 54 consecutive patients suffering from cardiac neurosis (neurocirculatory asthenia or Da Costa's syndrome). Thirty-seven of the 54 patients (68.5%) were found to suffer from a psychiatric disorder. Generalized anxiety disorder, social phobia and panic disorder accounted for most of the diagnoses. Panic disorder was frequently preceded by (and associated with) generalized anxiety, phobic avoidance and hypochondriasis. The results should alert the physician to inquire for symptoms of an anxiety disorder when a patient presents with cardiac neurosis.

Giancarlo Trombini

Papers

Depression and gastrointestinal illness: the joint use of biological and clinical criteria.

Rating Depression and Anxiety after Mastectomy: Observer versus Self-Rating Scales:

Psychological Distress and Amniocentesis

Patterns of depression and illness behaviour in general hospital patients.

Cardiac neurosis and psychopathology.