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Background: Systematic screening for depression has been recommended for patients who have medical conditions like cancer. The 9-item Patient Health Questionnaire (PHQ-9) is becoming widely used, but its diagnostic accuracy has not yet been tested in a cancer patient population. In this article, the authors report on the performance of the PHQ-9 as a screening instrument for major depressive disorder (MDD) in patients with cancer., Methods: Data obtained from a depression screening service for patients who were attending clinics of a Regional Cancer Centre in Edinburgh, United Kingdom were used. Patients had completed both the PHQ-9 and a 2-stage procedure to identify cases of MDD. Performance of the PHQ-9 in identifying cases of MDD was determined using receiver operating characteristic (ROC) analysis., Results: Data were available on 4264 patients. When scored as a continuous measure, the PHQ-9 performed well with an area under the ROC curve of 0.94 (95% confidence interval [CI], 0.93-0.95). A cutoff score of ≥ 8 provided a sensitivity of 93% (95% CI, 89%-95%), a specificity of 81% (95% CI, 80%-82%), a positive predictive value (PPV) of 25%, and a negative predictive value (NPV) of 99% and could be considered optimum in a screening context. The PHQ-9 did not perform as well when it was scored using an algorithm with a sensitivity of 56% (95% CI, 55%-57%), a specificity of 96% (95% CI, 95%-97%), a PPV of 52%, and an NPV of 97%., Conclusions: The PHQ-9 scored as a continuous measure with a cutoff score of ≥ 8 performed well in identifying MDD in cancer patients and should be considered as a screening instrument in this population., (© 2010 American Cancer Society.)

Objective: To describe the problems reported by people with cancer and major depressive disorder as elicited before starting problem-solving therapy (PST)., Methods: Ninety-eight outpatients, with a variety of cancers who met criteria for major depression, received PST as part of a system of treatment called 'Depression Care for People with Cancer' within a randomized trial. During the first session of PST, each patient was asked to provide an exhaustive list of problems defined as 'anything that was bothering them'. A coding system, based on thematic content, was developed to categorize the problems listed. Each problem was then coded by two raters independently (κ=0.81). The resulting categories were organized into larger conceptual domains using a card-sorting task., Results: Thirty-six problem categories were generated which were in turn organized into 11 larger conceptual domains. Patients reported problems in a mean of 9.2 different categories (range 3-21) and 5.7 domains (range 2-9). The most common problem categories were 'concerns about other people's well-being' (65%), 'problems in interpersonal relations' (61%), 'loss of interest' (56%), 'low mood' (55%), and 'cancer recurrence or relapse' (54%)., Conclusions: People with cancer and major depression report a wide variety of problems that include, but go beyond concerns about, both cancer and depression. The large number of problems related to concerns about other people's well-being and difficulties in interpersonal relationships, stresses the importance of these topics to patients and should be given more weight in the assessment and management of depressed cancer patients., (Copyright © 2010 John Wiley & Sons, Ltd.)

Background: Erectile dysfunction (ED) and cardiovascular disease (CVD) share similar risk factors, and ED may be a marker of CVD progression. The study assessed: (i) the temporal relationship between ED and CVD and (ii) the UK incidence of ED, in patients with CVD and an age-matched control group., Design: After ethics approval, 207 patients (CVD group) attending cardiovascular rehabilitation programmes and 165 age-matched subjects (control group), from GP practices across the UK, completed up to four questionnaires [ED details, The International Index of Erectile Function (IIEF) (before and after a cardiovascular event) and ED related Quality of Life]. A health professional also completed a medical details questionnaire., Results: Erectile dysfunction was reported by 66% of individuals with CVD, with a mean duration of 5 +/- 5.3 years. The control group was significantly different (p < 0.05) in both incidence (37%) and mean duration (6.6 +/- 6.8 years). Only 53% of the CVD group and 43% of the control group had discussed their symptoms of ED with a health professional. The IIEF demonstrated that ED became significantly worse (p < 0.05) after a cardiovascular event, changing from moderate to severe (13-10)., Conclusions: From these data, it is now evident that ED may precede a cardiovascular event by as much as 5 years. In almost half of the men with ED, there were missed opportunities to undertake a CVD risk assessment and provide an intervention, because the men did not acknowledge the problem. Men with ED should be specifically targeted for CVD preventative strategies in terms of lifestyle changes, and appropriate pharmacological treatments.

Virtual reality (VR) integrates real-time computer graphics, body tracking devices, visual displays, and other sensory input devices to immerse a participant in a computer-generated virtual environment that changes in a natural way with head and body motion. VR exposure (VRE) is proposed as an alternative to typical imaginal exposure treatment for Vietnam combat veterans with posttraumatic stress disorder (PTSD). This report presents the results of the first Vietnam combat veteran with PTSD to have been treated with VRE. The patient was exposed to two virtual environments, a virtual Huey helicopter flying over a virtual Vietnam and a clearing surrounded by jungle. The patient experienced a 34% decrease on clinician-rated PTSD and a 45% decrease on self-rated PTSD. Treatment gains were maintained at 6-month follow-up.