DEPRESSION PLUS HEART DISEASE A PARTICULARLY LETHAL COMBINATION

This is an item I am re-posting from its source.

September 21, 2010 — Patients who have both coronary heart disease (CHD) and depression have a significantly higher risk of dying than patients who have just one of these conditions, according to new research published online September 16 in the journal, Heart.

Compared with patients without depression and CHD, the risk for all-cause mortality was 3 times higher, and the risk for cardiovascular disease mortality 4 times higher, in patients who had both, after adjusting for age and sex, report Hermann Nabi, MD, from Hôpital Paul-Brousse, Villejuif, Paris, France, and colleagues.

This study provides further evidence that the relationship between depression and morbidity–mortality is real,” Dr. Nabi told Medscape Medical News.

Depression and mortality have been studied separately in patients with CHD and in healthy patients, but this does not allow comparisons across risk-factor groups according to depression and CHD status.

In the study, Dr. Nabi and his team examined the effects of both on mortality in nearly 6,000 middle-aged men and women whose mental and physical health were followed-up for about 5.6 years.

Need for a More Integrated Approach: The study findings have implications for research and clinical practice, Dr. Nabi said.

For clinical practice, it implies the need for a more integrated approach in the healthcare system and a shift toward a more “mind–body medicine” approach.

An important step would be to identify cardiac patients who also have depression, he said.

“In this study, depression worsened heart disease, because we observed that participants with both depression and heart disease were at increased risk for death when compared with those with heart disease only. So we should identify those cardiac patients who have clinically significant depressive symptoms.”

Dr. Nabi expressed the wish that his study findings will prompt clinicians to be aware of and look for depression in their patients with heart disease.

He also discussed some limitations of the study. “This study is based on a cohort (population) of civil servants and did not include blue-collar workers, unemployed, or individuals with precarious jobs. This may have underestimated the magnitude of associations observed in our study because the prevalence of depression and the mortality rate are higher in these latter individuals. Thus, it is reasonable to assume that the effect of depression would be greater in studies including various populations.”

Reference: MedscapeCME Clinical Briefs: “Depression Plus Heart Disease a Particularly Lethal Combination”

EFFECTIVE HOSTAGE-NEGOTIATION

Earlier this week, the Philippine National Police embarrassed itself and the nation by bungling the outcome of a hostage situation. (Click here, here, and here for three accounts of the incident: by a local TV station, by Reuters, and by CNN.)

A good friend of mine sent me an email describing how Chinese authorities, in a situation with many similarities, handled their hostage situation. Here it is:

FIRST, I have three demands. Meet them or I shall kill this hostage.

SECOND, The authorities confer in the next room.

THIRD, The head negotiator speaks with the hostage-taker.

FOURTH, Negotiations continue.

FIFTH, Negotiations conclude.

SIXTH, The mess is cleaned up and life move on.

As you can see, the situation was resolved quickly, inexpensively, and effectively. To illustrate one similarity between this situation and the recent Philippine incident, the photo below shows the hostage-taker in the recent Philippine incident. It was was taken during his negotiation with the Philippine authorities.

Why wasn’t he just shot at this point?

Another example of the police’s mistake occurred when they attempted to shatter the bus windows with a sledgehammer. The windows simply bounced back. They should have used a spring-loaded pointed tool or even this $15 pointed hammer: