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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2010.01.020 Byline: W. Victor R. Vieweg (a)(b), Mehrul Hasnain (g), Edward J. Lesnefsky (b)(f), Elizabeth E. Turf (c)(d)(e), Ananda K. Pandurangi (a) Keywords: Coronary heart disease; Depression; Major depressive disorder; Psychiatric measures Abstract: Our understanding of how depression alters the origin and course of coronary heart disease is derived from subjective methodologies. Many psychiatric instruments were not tested for reliability and validity in subjects with comorbid medical illness, particularly coronary heart disease. They largely use scales of categoric or ordinal variables. Instruments used to assess coronary heart disease are considerably more objective and often use interval variables. By searching the websites of Circulation and the Journal of the American College of Cardiology, we entered the word 'depression' on August 28, 2009. We ignored articles using 'depression' in the context of cardiovascular concepts such as 'ST-segment depression.' By searching articles dating back to 1995, we selected publications that studied the prognostic association of depression and coronary heart disease. There were 5 relevant publications: 3 from Circulation and 2 from the Journal of the American College of Cardiology. The methods used to assess coronary heart disease (specifically, myocardial infarction) are largely homogenous across the studies, but the methods used to assess depression are heterogeneous. Parameters used to diagnose myocardial infarction and determine its severity are precise, objective, and reliable, whereas those used to assess depression and its severity exhibit less precision and lack comparable objectivity and reliability. This mismatch may compromise our understanding of the link between coronary heart disease and depression in depressed patients with comorbid coronary heart disease. We propose using precise instruments to identify and quantitate coronary heart disease as outcome variables to assess psychiatric interventions and to better define depression in depressed patients with comorbid coronary heart disease. This should lead to a better understanding of the link between depression and comorbid coronary heart disease. Author Affiliation: (a) Department of Psychiatry, Virginia Commonwealth University, Richmond (b) Department of Internal Medicine, Virginia Commonwealth University, Richmond (c) Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond (d) Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond (e) Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond (f) Medical Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (g) Sir Thomas Roddick Hospital, Stephenville and Memorial University of Newfoundland, St John's, Newfoundland, Canada Article Note: (footnote) Funding: None., Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript., Authorship: All authors had access to the data and played a role in writing this manuscript.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2007.08.043 Byline: W. Victor R. Vieweg (a)(b)(d)(e), James R. Levy (b)(e), Sonja K. Fredrickson (b)(e), Stuart R. Chipkin (f), Mary Beatty-Brooks (c), Antony Fernandez (a)(d), Mehrul Hasnain (g), Anand K. Pandurangi (d) Keywords: Depression; Diabetes mellitus; Metabolic syndrome; Obesity; Psychotropic drugs Abstract: Depression, obesity, diabetes mellitus, and the metabolic syndrome are conditions commonly treated in primary care. The prevalence of each condition separately does not explain the frequency of their co-occurrence. Depression may lead to or exacerbate these endocrine and metabolic conditions. Conversely, these medical conditions may lead to or exacerbate depression. Psychotropic drugs that treat depression may increase appetite with resultant weight gain. Rarely, such agents may be associated with weight loss. We review the potential for psychotropic drugs to alter body weight and provide a table as a guide to drug selection. Unless circumstances dictate otherwise, clinicians should select psychotropic drugs least likely to induce weight gain when treating depressed patients with obesity, diabetes mellitus, or the metabolic syndrome. Even drugs generally thought to be 'weight neutral' may occasionally be associated with weight gain. Thus, alerting patients to this potential and due diligence form the cornerstone of weight management in the depressed patient. Author Affiliation: (a) Psychiatry Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va (b) Medicine Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va (c) Medical Media, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va (d) Department of Psychiatry, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond (e) Department of Internal Medicine, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond (f) School of Public Health and Health Sciences, University of Massachusetts, Amherst (g) Department of Psychiatry, Western Regional Integrated Health Authority, Sir Thomas Roddick Hospital, Stephenville, Newfoundland, Canada.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2005.09.027 Byline: W. Victor R. Vieweg (a)(b)(d)(e), Demetrios A. Julius (a)(d), Antony Fernandez (a)(d), Mary Beatty-Brooks (c), John M. Hettema (d), Anand K. Pandurangi (d) Keywords: Anxiety disorder; Depression; Military veterans; Posttraumatic stress disorder (PTSD); Primary care; Rape victims Abstract: Posttraumatic stress disorder (PSTD), classified as an anxiety disorder, has become increasingly important because of wars overseas, natural disasters, and domestic violence. After trauma exposes the victim to actual or threatened death or serious injury, 3 dimensions of PTSD unfold: (1) reexperiencing the event with distressing recollections, dreams, flashbacks, and/or psychologic and physical distress; (2) persistent avoidance of stimuli that might invite memories or experiences of the trauma; and (3) increased arousal. Traumatic events sufficient to produce PTSD in susceptible subjects may reach a lifetime prevalence of 50% to 90%. The actual lifetime prevalence of PTSD among US citizens is approximately 8%, with the clinical course driven by pathophysiologic changes in the amygdala and hippocampus. Comorbid depression and other anxiety disorders are common. General principles of treatment include the immediate management of PTSD symptoms and signs; management of any trauma-related comorbid conditions; nonpharmacologic interventions including cognitive behavioral treatment; and psychopharmacologic agents including antidepressants (selective serotonin reuptake inhibitors most commonly), antianxiety medications, mood stabilizing drugs, and antipsychotics. This review of PTSD will provide the reader with a clearer understanding of this condition, an increased capacity to recognize and treat this syndrome, and a greater appreciation for the role of the internist in PTSD. Author Affiliation: (a) Psychiatry, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va (b) Medicine Services, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va (c) Medical Media, Hunter Holmes McGuire Veterans Affairs Medical Center,Richmond, Va (d) Department of Psychiatry, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, Va (e) Department of Internal Medicine, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, Va Article History: Received 5 April 2005