What's New | Decker

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

The two leading classification systems for diagnosing mental illness are the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association and the ICD-10, the most recent edition of the International Classification of Diseases published by the World Health Organization.
There is no standard medical workup for a patient presenting with depression. Health care providers use their clinical judgment in conjunction with a good history, review of medical systems, and physical examination. Indiscriminate ordering of laboratory tests in depressed patients rarely yields useful results. A pooled analysis of psychiatric inpatients showed the rates of clinically significant laboratory findings to be remarkably low.
Single-photon emission CT (SPECT) has been promoted by some as a reliable tool in diagnosing and treating a number of psychiatric disorders, including depression. SPECT measures regional cerebral blood flow using a gamma-emitting tracer in the blood.

Although borderline personality disorder has traditionally been perceived as difficult or impossible to treat, significant progress has been made in developing and validating treatments.
Specialized psychotherapy remains the treatment of choice.
Short-term or stepped care interventions may represent a more efficient treatment model.
Common factors, such as structured therapies, may be nearly as effective as specialized treatments.
Pharmacotherapy plays a limited role in treatment.

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