Journal Article Annotations
2016, 3rd Quarter
Annotations by Paula Zimbrean, MD, FAPM and Marta Novak, MD, PhD
Also of interest:
This is a systematic review of the molecular mechanisms through which lithium induced kidney damage. Since lithium continues to be one of the most efficient treatments for bipolar disorder and an effective antidepressant, this article is a quick reference for any psychiatrist who wants to understand the mechanisms of lithium nephrotoxicity.
The finding: Presence of depression was associated with 20% increase of risk of developing chronic kidney disease in patients with diabetes (and with 32% increase in the hazard of developing stroke).
Strength and weaknesses: This is a very large cohort study assessing the association between depression and development of kidney disease in patients with diabetes. The analysis controlled for factors associated with depression and incident kidney disease. The main limitations of the study consists in the variability of depression assessment among clinical sites and reliance on administrative records for diagnosis of depression.
Relevance: This study replicates at a larger scale previous findings that depression increased the risks of medical complications in patients with diabetes. These findings support consideration to screening for depression and early intervention for depression in patients with DM.
The finding: Cognitive behaviour therapy is effective for depression and anxiety symptoms in hemodialysis patients.
Strength and weaknesses: This was a randomized prospective study on a relative high number of patients. It is remarkable that the control group also underwent a psychological intervention. The main limitations of this study consists on use of self reported measures and measures who are not very specific for anxiety in this population (Hospital Anxiety and Depression Scale) and the relative homogenous sample which questions the generalizablility of the findings.
Relevance: Despite the high number of patients on hemodialysis and despite extensive evidence of a high prevalence of depression and anxiety in this population, there are remarkably few studies looking at treatment intervention in this group of patients. This highlights the importance of this study which shows that CBT is a feasible and effective intervention.