From: "Dr. D. Kossove" <doctordee@telkomsa.net>
To: "LMS List" <L-M-SARCOMA@LISTSERV.ACOR.ORG>; "mesothelioma list" <MESOTHELIOMA@listserv.acor.org>; "Rare Cancer List" <RARE-CANCER@LISTSERV.ACOR.ORG>; "ACC List" <adrenocorticalcarcinoma@yahoogroups.com>; "LiF List" <LI-FRAUMENI@LISTSERV.ACOR.ORG>
Subject: diagnosing depression in the face of serious illness
Date: Wednesday, November 12, 2003 2:25 PM


The info below was from Medscape's CME, Psychiatry section,
"Psychiatry and Medicine  Common Patients Different Perspective"

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How do you diagnose depression in patients with diabetes? More
precisely, going back to the medical literature, how do you diagnose
depression in any patient with a serious medical disorder? Do you
utilize all the criteria of depression, whether or not the disorder or
the treatment of the depression induces conditions such as insomnia or
nausea? Do you use the inclusive criteria, taking all of the symptoms
into account, or do you utilize exclusive criteria, discarding
physical symptoms that are induced by the disorder or the treatment of
it?

Lustman single-handedly has been pushing the field forward by
gathering information about diabetes and depression. He looked at
patients with diabetes -- those who had depression and those who did
not. He also studied patients who were depressed but not diabetic. In
addition, he studied a set of patients who were not depressed but who
had cardiac disorders. The groups start to overlap when you start to
look at symptoms of unstable diabetes: weight loss, feeling tired,
sleeping too much, for example. So Lustman took a Beck Depression
Inventory (BDI) and he also did a structured clinical interview, the
National Institute of Mental Health-Diagnostic Interview Schedule
(NIMH-DIS). He found that if you use the exclusive criteria -- that
is, whether or not the patient is experiencing the physical symptoms
associated with their diabetes -- and just focus on the cognitive
systems, such as feeling down or feeling helpless, hopeless, or
worthless, you can use the cognitive criteria, or the exclusive
criteria, to diagnose depression in a sensitive and specific way. So,
using exclusive criteria in patients with diabetes does work.


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not prepared by Medscape's editors, but are made available on our site
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Psychiatry and Medicine: Common Patients, Different Perspectives
Chairperson: Charles B. Nemeroff, MD, PhD; Faculty: Dominique L.
Musselman, MD; Steven E. Bruce, PhD; Philip T. Ninan, MD; Larry
Culpepper, MD, MPH


Copyright  2003 M2 Communnications.
This program is based on an Industry-Supported Symposium presented at
the American Psychiatric Association 156th Annual Meeting. The APA was
not involved in, and received no commercial support for, the
development of this product and does not award CME credit for this
program. This CME activity is based on transcripts and slides of
presentations as delivered by the faculty at the "Psychiatry and
Medicine: Common Patients, Different Perspectives" symposium held at
the Hilton San Francisco in San Francisco, California on May 18, 2003.

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