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Anxiety disorders are characterized by excessive fear and worry. Generalized anxiety disorder (GAD) and panic disorder (PD) are two of the most common anxiety disorders in the United States. GAD is defined as excessive worry and anxiety that occur on most days for at least 6 months that affect daily functioning. PD is defined by recurrent unexpected panic attacks. Patients with symptoms of GAD or PD should be assessed for conditions such as hyperthyroidism, hyperparathyroidism, and cardiac arrhythmia before confirmation of an anxiety disorder diagnosis. A U.S. Preventive Services Task Force (USPSTF) draft statement recommends screening for anxiety in adults 64 years and younger, including pregnant and postpartum women. A final statement recommends screening for anxiety in children and adolescents ages 8 to 18 years. Multiple self-report tools have been validated for GAD and PD screening. The 7-item Generalized Anxiety Disorder (GAD-7) scale is an option for screening for GAD. The Panic Disorder Severity Scale (PDSS) is a 7-item tool with excellent sensitivity and specificity in screening for PD. Management with selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors in combination with psychotherapy has been shown to be effective for GAD and PD. Research on alternative treatments, such as psychedelic-assisted psychotherapy, is ongoing. [ABSTRACT FROM AUTHOR]

Major depressive disorder (MDD) is defined as five or more of the following symptoms in the past 2 weeks, during which at least one is depressed mood or loss of interest or pleasure: depressed mood; diminished interest or pleasure in activities; significant weight loss or gain, or decreased or increased appetite; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthlessness or excessive or inappropriate guilt; poor concentration or indecisiveness; or recurrent thoughts of death or suicidal ideation, plan, or attempt. Screening for MDD is recommended in the general adult population when resources are available for diagnosis, management, and follow-up. Several screening tools are available, including the Patient Health Questionnaire-9 (PHQ-9) and Beck Depression Inventory for Primary Care (BDI-PC). Laboratory tests may be considered to assess for significant comorbidities, differential diagnoses, or contraindications to treatment. Management of MDD depends on its severity and may include psychotherapy, pharmacotherapy, or both. The drugs most commonly used are selective serotonin reuptake inhibitors. Treatment should be continued for at least 16 to 24 weeks to prevent recurrence. Referral to a psychiatrist or other mental health clinician should be considered when the diagnosis is in question or when symptoms do not improve with standard treatment. [ABSTRACT FROM AUTHOR]

In the United States, suicide was the cause of more than 47,500 deaths in 2019. Females attempt suicide 1.5 times more frequently than males. However, rates of completed suicide are higher in males than in females. In the US population, the suicide rate is highest in adults older than 75 years. Factors associated with an increased risk of suicide include geographic and social isolation, low access to clinical resources, unemployment, and poverty. Patients with mental disorders, including schizophrenia, major depressive disorder (MDD), bipolar disorder, and substance use disorder, are at increased risk. Directly questioning a patient about suicide has not been shown to increase the patient's risk of completing suicide. Physicians should ask patients about any suicide plans and details of timing, location, means, and any preparation for the act. The goal of pharmacotherapy in patients with suicid-ality is management of comorbid mood disorders, most often MDD. Esketamine nasal spray is a pharmacotherapy option for MDD management in patients with acute suicidal ideation or behavior. It is approved for use in conjunction with an oral antidepressant. Use of "no harm contracts" or "safety contracts," in which patients attest that they will not commit suicide, should not be relied on to the exclusion of a formal suicide risk assessment and thorough clinical evaluation. [ABSTRACT FROM AUTHOR]

Bipolar I disorder affects approximately 0.4% to 1% of the global population. In the United States, bipolar-related disorders are associated with a significant economic burden because of the functional impairment they cause. Due to long wait times for access to specialist physicians and insurance issues, primary care physicians frequently manage this condition. Up to 4% of patients in primary care have bipolar disorder (BD). The diagnostic criteria for bipolar-related disorders are complex, and screening tools alone are insufficient for identification. Diagnosis involves a comprehensive clinical assessment that often requires multiple visits. Lithium continues to be the gold-standard mood-stabilizing drug for BD management and maintenance therapy in adults. Some anticonvulsants and atypical antipsychotics also have been shown to be effective for maintenance therapy. Ketamine is being studied as a possible future treatment option, but current research does not support its use. Psychotherapy, such as cognitive behavioral therapy and psychoeducation on management strategies, can be a useful adjunct therapy. Mental health clinicians can support primary care physicians in the evaluation and treatment of patients with BD. [ABSTRACT FROM AUTHOR]

Gonadotropin-releasing hormone agonists are uncommonly associated with hypersensitivity reactions. To date, there have been few reports of these cases by allergists and no clear published protocols on testing. Here, we report the case of a patient who had a potential reaction to leuprolide acetate depot and a framework for assessing for drug hypersensitivity with the available literature in mind.

RESUMEN El objetivo del estudio fue evaluar la bioacumulación de elementos potencialmente tóxicos (EPT) por el tallo de Sarcocornia neei del Área de Conservación Regional (ACR) Humedales de Ventanilla, Región Callao, Perú. Se extrajeron muestras del tallo de S. neei y del suelo superficial (0 -10 cm) provenientes de tres zonas geográficas del humedal: Zona turística (ZT), zona de uso silvestre (ZS) y zona de recuperación (ZR). Se analizaron concentraciones de 15 EPT de la planta y el suelo obtenidas por espectrometría de masas con plasma acoplado (ICP-MS), parámetros fisicoquímicos del suelo y factores de bioacumulación de cada EPT. Se realizó un dendrograma de similaridad euclidiana entre las zonificaciones según las concentraciones de EPT en suelo y una correlación de Spearman entre las variables evaluadas. Las concentraciones de plomo (Pb) en suelo de la ZT1 (99,1 mg kg-1) y en la ZS1 (120 mg kg-1) excedieron el estándar de calidad ambiental de Perú (70 mg kg-1). Según el Codex Alimentarius los EPT en el tallo de S. neei excedieron los valores para arsénico (As) (0,35 mg kg-1) la ZT2 y ZR1, para cadmio (Cd) (0,4 mg kg-1) la ZT3 y ZS2 y para Pb (0,4 mg kg-1) la ZT2, ZT3, ZR2 y ZR3, respectivamente. En general, Sarcocornia neei presentó las tres estrategias de acumulación de EPT (exclusor, tolerante y acumulador). La zonificación no presentó relación significativa con los EPT del suelo, EPT del tallo de S. neei, ni con los factores de biacumulación (FB) de S. neei. Solamente la conductividad eléctrica y la materia orgánica se asociaron con la bioacumulación de dos EPT (Co y Fe). Se concluye que la zonificación no determina la concentración de EPT en suelo superficial y presenta una baja contaminación por EPT. Finalmente, las estrategias de acumulación de EPT por S. neei son altamente variables.

The phase 4 ABOUND.70+ trial assessed the safety and efficacy of nab-paclitaxel/carboplatin continuously or with a 1-week break between cycles in elderly patients with advanced non-small cell lung cancer (NSCLC). Patients ≥70 years with locally advanced/metastatic NSCLC were randomized 1:1 to first-line nab-paclitaxel days 1, 8, 15 plus carboplatin day 1 of a 21-day cycle (21d) or the same nab-paclitaxel/carboplatin regimen with a 1-week break between cycles (21d + break; 28d). The primary endpoint was the percentage of patients with grade ≥ 2 peripheral neuropathy (PN) or grade ≥ 3 myelosuppression. Other key endpoints included progression-free survival (PFS), overall survival (OS), and overall response rate (ORR). A total of 143 patients were randomized (71 to 21d, 72 to 21d + break). The percentage of patients with grade ≥ 2 PN or grade ≥ 3 myelosuppression was similar between the 21d and 21d + break arms (76.5 and 77.1%; P = 0.9258). Treatment exposure was lower in the 21d arm compared with the 21d + break arm. Median OS was 15.2 and 16.2 months [hazard ratio (HR) 0.72, 95% CI 0.44–1.19; P = 0.1966], median PFS was 3.6 and 7.0 months (HR 0.48, 95% CI 0.30–0.76; P

In the United States, suicide was the cause of more than 47,500 deaths in 2019. Females attempt suicide 1.5 times more frequently than males. However, rates of completed suicide are higher in males than in females. In the US population, the suicide rate is highest in adults older than 75 years. Factors associated with an increased risk of suicide include geographic and social isolation, low access to clinical resources, unemployment, and poverty. Patients with mental disorders, including schizophrenia, major depressive disorder (MDD), bipolar disorder, and substance use disorder, are at increased risk. Directly questioning a patient about suicide has not been shown to increase the patient's risk of completing suicide. Physicians should ask patients about any suicide plans and details of timing, location, means, and any preparation for the act. The goal of pharmacotherapy in patients with suicidality is management of comorbid mood disorders, most often MDD. Esketamine nasal spray is a pharmacotherapy option for MDD management in patients with acute suicidal ideation or behavior. It is approved for use in conjunction with an oral antidepressant. Use of "no harm contracts" or "safety contracts," in which patients attest that they will not commit suicide, should not be relied on to the exclusion of a formal suicide risk assessment and thorough clinical evaluation., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Anxiety disorders are characterized by excessive fear and worry. Generalized anxiety disorder (GAD) and panic disorder (PD) are two of the most common anxiety disorders in the United States. GAD is defined as excessive worry and anxiety that occur on most days for at least 6 months that affect daily functioning. PD is defined by recurrent unexpected panic attacks. Patients with symptoms of GAD or PD should be assessed for conditions such as hyperthyroidism, hyperparathyroidism, and cardiac arrhythmia before confirmation of an anxiety disorder diagnosis. A U.S. Preventive Services Task Force (USPSTF) draft statement recommends screening for anxiety in adults 64 years and younger, including pregnant and postpartum women. A final statement recommends screening for anxiety in children and adolescents ages 8 to 18 years. Multiple self-report tools have been validated for GAD and PD screening. The 7-item Generalized Anxiety Disorder (GAD-7) scale is an option for screening for GAD. The Panic Disorder Severity Scale (PDSS) is a 7-item tool with excellent sensitivity and specificity in screening for PD. Management with selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors in combination with psychotherapy has been shown to be effective for GAD and PD. Research on alternative treatments, such as psychedelic-assisted psychotherapy, is ongoing.

Major depressive disorder (MDD) is defined as five or more of the following symptoms in the past 2 weeks, during which at least one is depressed mood or loss of interest or pleasure: depressed mood; diminished interest or pleasure in activities; significant weight loss or gain, or decreased or increased appetite; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthlessness or excessive or inappropriate guilt; poor concentration or indecisiveness; or recurrent thoughts of death or suicidal ideation, plan, or attempt. Screening for MDD is recommended in the general adult population when resources are available for diagnosis, management, and follow-up. Several screening tools are available, including the Patient Health Questionnaire-9 (PHQ-9) and Beck Depression Inventory for Primary Care (BDI-PC). Laboratory tests may be considered to assess for significant comorbidities, differential diagnoses, or contraindications to treatment. Management of MDD depends on its severity and may include psychotherapy, pharmacotherapy, or both. The drugs most commonly used are selective serotonin reuptake inhibitors. Treatment should be continued for at least 16 to 24 weeks to prevent recurrence. Referral to a psychiatrist or other mental health clinician should be considered when the diagnosis is in question or when symptoms do not improve with standard treatment., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Bipolar I disorder affects approximately 0.4% to 1% of the global population. In the United States, bipolar-related disorders are associated with a significant economic burden because of the functional impairment they cause. Due to long wait times for access to specialist physicians and insurance issues, primary care physicians frequently manage this condition. Up to 4% of patients in primary care have bipolar disorder (BD). The diagnostic criteria for bipolar-related disorders are complex, and screening tools alone are insufficient for identification. Diagnosis involves a comprehensive clinical assessment that often requires multiple visits. Lithium continues to be the gold-standard mood-stabilizing drug for BD management and maintenance therapy in adults. Some anticonvulsants and atypical antipsychotics also have been shown to be effective for maintenance therapy. Ketamine is being studied as a possible future treatment option, but current research does not support its use. Psychotherapy, such as cognitive behavioral therapy and psychoeducation on management strategies, can be a useful adjunct therapy. Mental health clinicians can support primary care physicians in the evaluation and treatment of patients with BD., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)