What's New | Decker

Identification of major anxiety disorders observed in adults according to the DSM-5
Description of physiologic, cognitive, and behavioral components of anxiety and their relevance to diagnosis and treatment
Review of cognitive-behavioral treatments and their efficacy for anxiety disorders in adults
Review of pharmacologic treatments and their efficacy for anxiety disorders in adults

Bactericidal antibiotics are used parenterally in high doses. With the exception of PVE caused by staphylococci, antimicrobial therapy for PVE caused by a specific organism uses the same drugs recommended for native valve endocarditis.
Endocarditis caused by relatively penicillin-resistant (MIC = 0.2 to 0.5 µg/mL) viridans or other nonenterococcal streptococci is treated with a higher dose of penicillin G combined with gentamicin. If the strain is even more resistant to penicillin (MIC > 0.5 µg/mL), the infection is treated with one of the standard regimens for enterococcal endocarditis.
Operative intervention to débride infected perivalvular tissue or to replace or reconstruct a dysfunctioning valve is important in the management of complicated infective endocarditis that involves either a native or a prosthetic valve. Overall, surgery is indicated in 25 to 40% of patients with infective endocarditis, and up to 45% of patients undergo surgery during the active phase of their disease.

The cholinesterase inhibitors donepezil, galantamine, and rivastigmine have been approved by the Food and Drug Administration (FDA) for the treatment of AD dementia.
Patients with mild to moderate AD dementia are the appropriate candidates for cholinesterase inhibitor therapy. These patients need a designated caregiver to supervise the use of the medication.
Support for and empowerment of the caregivers of dementia patients must be an integral part of management. The emotional and physical health of caregivers is critical to long-term outcomes.

The main function of corticosteroids in CNS tumors is to control brain and spinal cord vasogenic edema and decrease intracranial pressure. Corticosteroids should be used with caution because of its significant side effects, such as insomnia, hyperglycemia, myopathy, psychiatric effects, and opportunistic infections.
Maximal safe resection is recommended for all glioma grades and subtypes if the tumor is surgically accessible and there are no absolute medical contraindications to surgery. Nevertheless, even a macroscopic complete resection is almost never curative because grade II to IV gliomas infiltrate the normal brain.
The addition of WBRT to either surgical resection or radiosurgery decreases the risk of brain metastasis recurrence but does not improve survival in patients with one to three brain metastases.

Amyloid positron emission tomography (PET) has greatly expanded our knowledge of Alzheimer disease (AD), from its preclinical to its clinical manifestations.
Tau PET has become available as a research tool and is providing new insights into the evolution of AD.
A conceptual scheme that classifies the imaging and cerebrospinal fluid biomarkers of AD into amyloid, tau, and neurodegeneration has been adopted.

Cognitive-behavioral therapy (CBT) is typically more structured and shorter duration and centers on identifying thoughts and beliefs and how they impact feelings and behaviors. The therapist helps individuals label and challenge these thoughts and beliefs, and often homework is assigned to identify and counter these as they occur in their daily life.
All guidelines agree that an antidepressant trial should be a minimum of 4 weeks and up to 8 to 12 weeks at an adequate duration and dose. Even with dozens of antidepressant therapies on the market, overall response rates are still suboptimal, and remission rates remain low.
There are few data on long-term use of antidepressants. Studying relapse and prevention therapies is challenging because of the heterogeneity of the disease and difficulty retaining subjects in long-term antidepressant studies.

Follow-up studies have shown the continuity of antisocial behaviors from childhood through the adult years.
Research has implicated brain regions that control judgment and impulse control.
Cognitive-behavioral therapy may be helpful in mild cases.

2016 EAST practice management guideline on prevention of fall-related injuries in the elderly
2016 CTF on Preventive Health Care recommendations on screening for cognitive impairment in older adults
2016 USPSTF recommendation statement on screening for depression in adults
2015 AGS Beers criteria for potentially inappropriate medication use in older adults
2016 AAO preferred practice guideline on comprehensive adult medical eye evaluation

SAM Psychiatry