Kawasaki Disease Complicated by Salmonella oranienburg Coinfection

Kawasaki disease is a medium vessel vasculitis with a multisystem presentation affecting 9–20 per 100,000 children under 5 years of age in the United States. Salmonella coinfection has not been previously described. We present a 12-month-old vaccinated male with Kawasaki disease in the setting of Salmonella bacteremia. Initial intervention for the Kawasaki disease with IVIG was ineffective, prompting adjunctive therapy with anakinra, with eventual full recovery. Concurrent Kawasaki disease and bacteremia may confound diagnosis and necessitate nontraditional treatment approaches.

Depression

Major depressive disorder is a serious, debilitating, life-shortening illness that affects many persons of all ages and backgrounds. The point prevalence is high (2.3%–3.2% in men, 4.5%–9.3% in women) and the lifetime risk is 7% to 12% for men and 20% to 25% for women. Major depression is a disabling disorder that costs the United States over $200 billion per year in direct and indirect costs. Depression also has detrimental effects on all aspects of social functioning, such as self-care, social role, and family life, including household, marital, kinship, and parental roles. While there have been several treatments that are efficacious, many individuals suffering from depression experience life-long challenges due to the often chronic and episodic nature of the disease. Identifying strategies to find the right treatments for the right patients is critical. Ongoing research has explored the importance of examining physiologic biomarkers as well as clinical characteristics to gain a better understanding of subtypes of depression, which will lead to improved treatments and better outcomes. This book provides an introduction to the etiology and pathophysiology of depression, common comorbidities and differential diagnoses, pharmacotherapy strategies, psychotherapeutic and neuromodulation interventions, novel and nontraditional treatment strategies, and considerations in special populations.

Assessment and Treatment Considerations for Post Traumatic Stress Disorder at End of Life

Post traumatic stress disorder (PTSD) may first emerge, reemerge, or worsen as individuals approach end of life and may complicate the dying process. Unfortunately, lack of awareness of the occurrence and/or manifestation of PTSD at end of life can lead to PTSD going unaddressed. Even if PTSD is properly diagnosed, traditional evidence-based trauma-focused treatments may not be feasible or advisable with this group as many patients at end of life often lack the physical and mental stamina to participate in traditional psychotherapy. This article reviews the clinical and empirical literature on PTSD at end of life, as well as discusses assessment and psychotherapy treatment issues with this neglected population. In addition, it expands on the current reviews of this literature1–3 by extrapolating results from nontraditional treatment approaches with other patient populations. Elements of these approaches with patients sharing similar characteristics and/or comorbidities with patients with PTSD at end of life may provide additional benefits for the latter population. Clinical implications and suggestions for interdisciplinary care providers are provided.

HEALTH MAINTENANCE ORGANIZATIONS TURN TO SPIRITUAL HEALING

The psychological and spiritual sides of healing, long poor cousins of mainstream medicine, are finding new support from some institutions with growing power in medical care: health maintenance organizations (HMOs). At a recent conference here, Dr Herbert Benson, President of the Harvard Medical School's Mind/Body Medical Institute, said that his office at Harvard was now getting five or six calls a week from HMOs that were interested in the medical uses of relaxation and other nontraditional treatment methods. The reason, he said, is clear: if such methods succeed reliably in reducing workload, they are "just plain money in the bank for the HMOs." . . . The recent conference in Boston was a milestone in the growth of interest in what is sometimes called behavioral medicine. A few years ago this would have been the farthest fringe of medicine. And even now there was a hint of sideshow. There were snake handlers here, and some recommended the snakes as a way to induce relaxation.

Facilitated Communication

The optimistic side of FC, that nonspeaking children could miraculously become competent communicators, is unfortunately a myth. The dark side of the phenomenon of FC includes false hope, false communication, family disruption, losses of job and reputation, and inappropriate use of scarce resources.14 Unwitting pediatricians have accepted transcripts of FC that described sexual abuse by family members. The result was removal of the child from the family and prosecution of the alleged perpetrator even though the evidence suggested that the communication came from the facilitator and not from the child.16 As more families seek alternative health care for themselves29 and for their children,30 we pediatricians have the following responsibilities: 1) to become informed about our own community's offerings; 2) to develop a framework for our own evaluation (What is the theory or proposed mechanism? What is the research evidence? What is the cost in money and time? What is the potential harm?);)31 3) to support parents as they evaluate the risks and benefits of nontraditional interventions for their children;32 4) to advocate strongly for controlled evaluations of alternative therapies;33 and 5) to remember the unfortunate consequences of therapies such as facilitated communication when inclined to dismiss a nontraditional treatment as "not doing any harm."