Search Results (53)

Psychological distress impacts a large portion of the general population. While effective treatments are available, few seek them out. This lack of treatment seeking may be due to several factors, particularly low mental health literacy (MHL). MHL is the knowledge an individual has regarding psychological disorders and their symptoms, treatments, and where to seek appropriate help when identified. The capacity to pay attention to present-moment experiences in MHL translates to the qualities of dispositional mindfulness (DM), the capacity to pay non-judgmental attention to present-moment experiences. The purpose of the present study was to evaluate the reliability and preliminary convergent validity of a newly developed, vignette-based assessment of psychological disorder recognition. A total of N = 299 participants were recruited via TurkPrime and completed measures of DM (FFMQ), MHL (MHLS), depression (PHQ-9), anxiety (GAD-7), and treatment-seeking attitudes (MHSAS). Participants were subsequently asked to read newly created vignettes based on ICD-11 criteria of major depressive, generalized anxiety, social anxiety, bipolar disorders, post-traumatic stress disorder, and schizophrenia. Participants then responded to questions assessing the recognition of disorder presence and identification. The vignettes with accompanying questions were titled the Psychological Disorder Recognition—Vignette (PDR-V) task. The PDR-V evidenced a Kuder–Richardson Formula 20 (KR-20) of 0.83, indicating excellent internal consistency. Independent sample t-tests indicated that participants with prior psychotherapy exposure, a history of mental health diagnosis, and, unexpectedly, those reporting lower education levels and no current mindfulness practice, scored significantly higher on the PDR-V. Spearman correlations revealed that higher scores on a validated MHL scale and specific facets of DM (describe, act with awareness) were positively correlated with PDR-V scores. Bipolar disorder evidenced the highest recognition as a psychological problem broadly, while social anxiety had the highest specific disorder identification accuracy rates. Generalized anxiety disorder had the lowest recognition and identification accuracy. While the PDR-V demonstrated promising preliminary psychometric properties, it also observed anomalies that warrant further investigation, as findings are limited by its cross-sectional nature. These findings suggest that the PDR-V is a versatile tool for differentiating the presence of a problem and accurately identifying the condition, supporting its potential as a reliable and sound measure. Full article

Introduction: The Diagnostic and Statistical Manual of Mental Disorders has been criticized for its reliability and validity, including for the major psychological injuries [Posttraumatic Stress Disorder (PTSD), chronic pain-related disorders, and neurocognitive disorders, pertinent for mild traumatic brain injury (MTBI)/persistent post-concussion syndrome (PPCS)]. Methods: This review article examines both the mental health/psychiatric and legal literature on the DSM-5 and its criticisms. The DSM-5 uses a polythetic approach, which leads to many complicating ways of expressing disorders (e.g., PTSD). Disorders related to chronic pain refer to somatic symptom disorders (e.g., with predominant pain), which leads to less focus on the chronic pain itself. The neurocognitive disorder diagnosis includes minor and major classifications, but excludes moderate ones. The international diagnostic system (International Classification of Diseases (ICD-11)) and alternate approaches to psychiatric nosology [the Research Domain Criteria (RDoC) and Hierarchal Taxonomy of Psychopathology (HiTOP)] do not help resolve these issues. Results: The comprehensive literature review undertaken indicates the limitations of the DSM-5 clinically and in court, especially for psychological injuries. The article includes tables and boxes that complement the text with specificities related to the issues raised. Conclusions: The article recommends supplementary diagnostic criteria for the three major psychological injuries (PTSD, chronic pain, and MTBI) for forensic use. This paper is an original contribution to improving the diagnostics/description and forensic use of the major psychological injuries: aside from the paper’s clinical contributions, these disorders/conditions are contentious in court, and their better specification in diagnosis, as attempted herein, is important to undertake forensically. Full article

Objectives: Real-world evidence that supports decision-making must meet numerous criteria, including validated identification of clinical outcomes. This study aimed to develop and validate a method for identifying new cases of myocardial infarction (MI) and ischemic stroke (IS) within real-world clinical data in China. Methods: Algorithms to identify MI and IS events were developed using ICD-10-CM codes and Chinese diagnosis keywords within the Tianjin Regional Healthcare Database. Validation followed predefined criteria: MI required cardiac troponin elevation and ischemic symptoms or cardiac troponin elevation and electrocardiogram changes; IS required clinical symptoms and neuroimaging confirmation of cerebral Magnetic Resonance Imaging (MRI) or Computerized Tomography (CT) reports. Positive predictive value (PPV) with 95% confidence intervals (CI) was calculated for each outcome. Results: Among 304 MI and 302 IS cases randomly selected, approximately half were identified using ICD-10-CM codes and half through Chinese diagnosis keywords. Overall PPV for MI was 69% (95% CI: 63–74%), with similar PPVs across identification methods. PPV increased to 88% for inpatient MI and 97% for primary inpatient MI. For IS, overall PPV was 65% (95% CI: 58–71%), with higher PPV for cases identified by ICD-10-CM codes (76%) compared to keyword-only cases (56%). PPV increased to 76% for inpatient IS and 91% for primary inpatient IS. Conclusions: The use of ICD-10-CM codes and Chinese diagnosis keywords in primary inpatient diagnoses provides a validated approach for the identification of clinical outcomes of MI and IS within real-world clinical data in China. Full article

Objective: To estimate how clinical signs shape whether catatonia is recorded during routine inpatient care and to identify training targets that reduce missed cases. Methods: We conducted a retrospective chart review at a tertiary psychiatric hospital (July 2019–July 2024). Of 14,907 admissions, 87 had a formal catatonia diagnosis. We screened discharge summaries with 24 terms; 697 encounters with ≥3 terms underwent independent ICD-11 review by two clinicians (third reviewer as needed), yielding 194 additional encounters meeting criteria. We compared patients with a recorded diagnosis with those meeting criteria without a diagnosis and fitted logistic models for diagnostic assignment. Results: At the patient level (first admission), 54 diagnosed and 183 underdiagnosed individuals were included. Hypokinetic signs—negativism, mutism, rigidity, and posturing—were more frequent in diagnosed cases, while grimacing and mannerisms were more frequent among underdiagnosed cases. In adjusted analyses, rigidity and negativism were linked to a higher likelihood of a recorded diagnosis, whereas grimacing signaled missed recognition. Medical complication rates did not differ. The longer unadjusted length of stay in diagnosed patients was not significant after adjustment for age and symptom burden. Conclusions: Clinicians tend to identify hypokinetic catatonia and overlook movement-rich presentations. A one-minute ICD-11 screen and documentation prompts for parakinetic/hyperkinetic signs are pragmatic steps for training programs. Full article

Background/Objectives: There is a growing need for autism spectrum disorder (ASD) assessment tools that are diagnostically aligned, clinically usable, and accessible across diverse service contexts. The Diagnostic Autism Spectrum Interview—Version 2 (DASI-2) is a freely available, semi-structured clinical interview mapped directly to DSM-5 and ICD-11 criteria. This pilot study aimed to adapt DASI-2 into Hungarian and explore the (1) acceptability of DASI-2 administration, (2) agreement with prior clinical ASD diagnoses, and (3) relationship between DASI-2 observational ratings and ADOS-2 classifications. Methods: Following a multistep translation procedure, DASI-2 was administered to seven children previously assessed for ASD in a multidisciplinary Hungarian clinical setting. The assessment included a parent interview, direct assessment with the child or young person, and completion of the DASI observational record (OR1–OR4). DASI diagnostic outcomes were compared with prior clinical decisions, and OR scores were analyzed in relation to ADOS-2 classifications. Results: All participants completed the DASI-2 interview in full. Agreement with prior clinical diagnosis was found in six of seven cases (κ = 0.70, indicating substantial agreement). When exploring the one non-aligned case, the divergence in diagnostic outcome was due to broader contextual information considered by the initial clinical team which influenced clinical opinion. The five participants diagnosed with ASD showed substantially higher DASI observational scores (mean = 15.26) than the two who were not diagnosed (mean = 1.57), mirroring ADOS-2 severity classifications. Conclusions: These findings support the acceptability and preliminary validity of DASI-2. Its inclusive structured observational record may provide a practical complement to resource-intensive tools such as the ADOS-2; however, further validation in larger and more diverse samples is needed. Full article

Background: Chronic primary orofacial pain (COFP) affects approximately 7% of the population and often leads to reduced quality of life. Patients frequently undergo multiple assessments and treatments across healthcare disciplines, often without a definitive diagnosis. The 2019 ICD-11 classification of chronic primary pain clusters together COFP subtypes based on chronicity and associated functional and emotional impairment. Objective: This study aimed to evaluate whether these subtypes of COFP share common underlying mechanisms by comparing neuroimaging findings. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Searches were performed using Medline (OVID) and Scopus up to April 2025. Inclusion criteria focused on MRI-based neuroimaging studies of participants diagnosed with COFP subtypes. Data extraction included participant demographics, imaging modality, brain regions affected, and pain assessment tools. Quality assessment used a modified Coleman methodological score. Results: Fourteen studies met the inclusion criteria, all utilising MRI and including two COFP subtypes (temporomandibular disorder and burning mouth syndrome). Resting- and task-state imaging revealed overlapping alterations in several brain regions, including the thalamus, somatosensory cortices (S1, S2), cingulate cortex, insula, prefrontal cortex, basal ganglia, medial temporal lobe, and primary motor area. These changes were consistent across both TMD and BMS populations. Conclusions: The findings suggest that chronic primary orofacial pain conditions (TMD and BMS) may share common central neuroplastic changes, supporting the hypothesis of a unified pathophysiological mechanism. This has implications for improving diagnosis and treatment strategies, potentially leading to more targeted and effective care for these patients. Full article

Background/Objectives: Surgical site infections (SSIs) in spine surgery pose significant risks, including neurological deficits, prolonged hospital stays, and increased healthcare costs. SSIs are classified by their location and include superficial, deep, and organ/space (OS) infections. In spine surgery, OS SSIs include osteomyelitis, discitis, and spinal epidural abscess. These infections are difficult to treat with conservative measures, impart significant morbidity, and incur increasing hospital costs. Despite advancements in surgical technique and infection control, the literature is conflicting on which factors are associated with a significant increase in risk of SSIs after spinal surgery. There is also a significant gap in the literature in defining the risk factors specific to OS SSIs. This study aims to identify risk factors associated with SSI after spine surgery at a single institution, as well as provide descriptive characteristics of patients with OS SSIs. Methods: This retrospective study analyzed spinal surgeries performed at a multi-center, single-institution between 1 January 2019 and 9 February 2025. Neurosurgical patients who underwent spine surgery were identified by ICD-10 procedure and diagnosis codes. Surgical infections were classified based on the National Healthcare Safety Network (NHSN) criteria. Univariate and multivariate analyses were performed to assess associations between patient demographics, comorbidities, and infection risk. Results: Of the 2363 unique spinal surgery patients, 39 developed infections, with 14 meeting the NHSN criteria for OS SSI. The overall rate of SSIs at this institution was 1.65%. Significant risk factors for developing an SSI included cardiovascular disease (p = 0.017) and COPD (p = 0.012). Multivariate analysis confirmed both risk factors identified in the univariate analysis as independent risk factors, with adjusted odds ratios of 1.97 (p = 0.033) and 2.072 (p = 0.041), respectively. The commonly cultured pathogens included Staphylococcus aureus, Staphylococcus epidermidis, and methicillin-resistant Staphylococcus aureus. Conclusions: Male sex, diabetes mellitus, gastroesophageal reflux disease, hyperlipidemia, hypertension, hardware placement, and a history of smoking were more common in patients with SSI. In the OS SSI subgroup, cardiovascular disease and COPD were associated with an increased risk of developing an OS SSI. Future research is needed to investigate more detailed risk factors and include mitigating factors of OS infection into the analysis. Full article

Discoid medial meniscus (DMM) is a rare congenital anomaly, with bilateral cases being even more uncommon. Due to its rarity, comprehensive data on its prevalence, clinical presentation, and optimal management strategies are limited. This study aimed to evaluate the prevalence, clinical characteristics, and treatment outcomes of symptomatic DMM in a pediatric population. A retrospective review was conducted on patients under 18 years of age diagnosed with symptomatic DMM. Data were extracted using ICD-10 codes Q68.6 and M23.16 and were supplemented by free-text searches. The inclusion criteria encompassed a confirmed DMM diagnosis, availability of MRI and radiographic imaging, complete clinical documentation, and a minimum of six months of postoperative follow-up. Demographic data, clinical presentations, imaging findings, surgical interventions, and outcomes were analyzed. Three patients (five knees) met the inclusion criteria. All presented with symptomatic DMM requiring surgical intervention. Arthroscopic saucerization combined with meniscal repair was performed in all cases. Postoperative follow-up revealed that two of the patients achieved excellent outcomes, while one required three reoperations due to retearing but remained symptom-free at one year post-revision. Radiographic assessments did not reveal characteristic changes typically associated with DMM. Symptomatic DMM, though rare, may be encountered more frequently than previously reported, especially when focusing on symptomatic cases. Arthroscopic saucerization with concurrent meniscal repair appears to be an effective treatment modality, yielding favorable mid-term outcomes. Given the limited number of cases and the variability in their presentations, further research with larger cohorts is essential to establish standardized management protocols and to better understand the long-term prognosis of patients with this rare condition. Full article

Background: Peripheral artery disease (PAD) is a progressive atherosclerotic condition associated with significant morbidity and mortality. While PAD prevalence is comparable between sexes, women tend to have worse clinical outcomes, higher rates of disability, and are underdiagnosed and undertreated compared to men. This study examines sex differences in PAD presentation, diagnosis, and treatment outcomes using the Medical Information Mart for Intensive Care (MIMIC)-IV v3.1 database. Methods: A retrospective cohort study was conducted using electronic health records from the MIMIC-IV v3.1 database, identifying patients diagnosed with PAD between 2008 and 2022. Patient selection was based on International Classification of Diseases (ICD)-9 and ICD-10 codes. The following two datasets were constructed: an admission-level dataset (6468 admissions, 3913 unique patients) and a patient-level dataset aggregating multiple admissions per individual. Key variables included demographics, hospitalization details, procedure rates, and clinical outcomes. Sex-based comparisons were performed to assess disparities in disease burden, intervention rates, and mortality. Results: The study cohort comprised 3913 PAD patients. Women were significantly older than men at time of admission (mean 70.78 vs. 68.97 years, p < 0.05) and had lower rates of procedural intervention across all categories, including angioplasty (12.85% vs. 15.39%) and bypass grafting (14.74% vs. 16.98%). Despite similar Intensive Care Unit (ICU) admission rates (30.56% in females vs. 31.73% in males), women experienced greater delays in PAD diagnosis and treatment initiation. The in-hospital mortality rate was comparable between sexes (6.62% vs. 6.92%). Women presented more frequently with atypical or asymptomatic PAD, leading to delays in diagnosis and specialist referrals. Conclusions: This study highlights significant sex disparities in PAD diagnosis and management. Women with PAD are older at diagnosis, receive fewer procedural interventions, and experience delayed clinical recognition, contributing to a higher cumulative disease burden. These findings underscore the need for sex-specific diagnostic criteria, improved clinical awareness, and equitable treatment strategies to optimize PAD outcomes in women. Full article

Background/Objectives: Cardiac amyloidosis (CA) is associated with amyloid infiltration of the extra-cardiac tissue, which may occur in the early stages of the disease. This study evaluates the diagnostic utility of thoracic fat pad biopsy obtained during a pacemaker or ICD implantation as an alternative to the standard diagnostic criteria for systemic amyloidosis. Methods: This exploratory, retrospective study included 27 patients with suspected or diagnosed CA who underwent pacemaker or defibrillator therapy. Results: Of these, 16 patients were confirmed to have CA (15 with technetium-labeled bisphosphonate bone scintigraphy and 1 with protein electrophoresis and echocardiographic findings) while 11 were confirmed to be CA-negative. The thoracic fat pad biopsy demonstrated a specificity of 100% but a sensitivity of only 31%. Among patients with transthyretin (ATTR)-CA, the sensitivity remained similarly low, at 27%. These results are consistent with prior findings on abdominal fat pad biopsy in ATTR-CA, highlighting the limited diagnostic yield of this method. Conclusions: Thoracic fat pad biopsy cannot be recommended as a standard diagnostic tool for CA, particularly in ATTR-CA, due to its poor sensitivity. However, in AL (amyloid light-chain) amyloidosis, this minimally invasive procedure may aid diagnosis without additional invasive interventions. Full article

Multifocal ectopic Purkinje-related premature contractions (MEPPC) syndrome is a recently recognized rare form of arrhythmia involving the entire His–Purkinje system and often coinciding with dilated cardiomyopathy (DCM). Certain variants in the SCN5A gene may be linked to MEPPC syndrome. We present a case of a 32-year-old Caucasian female who exhibited a high burden of premature ventricular contractions (PVCs) and non-sustained episodes of ventricular tachycardia (NSVT) with an alternating QRS pattern, and who was resistant to traditional medical therapy and radiofrequency catheter ablation (RFCA), necessitating implantation of a cardioverter-defibrillator (ICD). A positive family history (father’s death at the age of 40 years) and the rapid deterioration of left ventricular function parameters echocardiographically during recurrent arrhythmic episodes raised concern about a potentially complex disease scenario. Genetic testing revealed a heterozygous variant of the SCN5A gene, c.2440C>T, p.(Arg814Trp), confirming the diagnosis of MEPPC syndrome. Treatment with a combination of class I antiarrhythmic drugs, flecainide and mexiletine, concomitant with beta blockers, led to symptomatic improvement, a reduction of PVCs (from 66 491 (44%) to 858 (1%)), and the restoration of left ventricular function (LV EF from 44% to 53%). A lack of defined diagnostic criteria hampers timely diagnosis, leading to ineffective interventions and delayed initiation of treatment with antiarrhythmic drugs. MEPPC patients remain at significant risk for severe heart failure and sudden cardiac death. Our clinical case report underscores the importance of accurate and timely diagnosis, which allows effective treatment with a combination of antiarrhythmic drugs and mitigates the risk associated with MEPPC syndrome. Full article

Background/Objectives: Early studies have suggested that the SARS-CoV-2 virus has a deleterious effect on bone mineral density and may increase the risk of pathological fractures. This study characterized vertebral compression fractures in patients with and without a prior diagnosis of COVID-19. Methods: Using a nationwide claims database, this retrospective study used ICD-10 billing codes to identify patients with a diagnosis of vertebral compression fracture from January 2020 to April 2022. Two cohorts were created based on whether the patients had a concurrent diagnosis of COVID-19. Patient demographics, comorbidities, and outcome measures were characterized by descriptive analysis. Results: In total, 413,425 patients met the inclusion criteria. Among them, a total of 23,148 patients (5.60%) had a diagnosis of COVID-19 at the time of their compression fracture. Among the COVID-19 patients, the incidences of vertebral compression fracture were 0.42% in 2020 and 0.33% in 2021, in comparison to the historical average yearly incidence of 0.17% across all patients. The patients with COVID-19 at the time of compression fracture diagnosis had a higher rate of vitamin D deficiency (OR: 1.25) and a lower rate of routine healing (OR: 0.61). The patients without COVID-19 were more likely to be osteoporotic (OR: 0.88), experience additional compression fractures (OR: 0.38), and have kyphoplasty or vertebroplasty (OR: 0.73). Conclusions: Despite lower rates of osteoporosis, patients with a concomitant COVID-19 diagnosis exhibited a higher incidence of compression fractures. Although more research is needed, these results support increasing bone health surveillance in patients with a history of COVID-19 infection. Full article

Background: Although dietitians possess expert knowledge on the interplay between nutrition and health, their specific role in family therapy for anorexia nervosa (FT-AN) remains a topic of debate. Some of the literature indicates insufficient evidence to affirm the impact of dietetic interventions, emphasising variability in outcomes and a need for standardised research. This study aimed to identify the clinical characteristics of adolescents requiring dietetic intervention during FT-AN and to assess differences in clinical outcomes between those receiving dietetic support and those who did not. Methods: A retrospective cohort study was conducted at the Maudsley Centre for Child and Adolescent Eating Disorders in London. Patients were selected from electronic records. Inclusion criteria were ICD-10 diagnosis of AN and completion of FT-AN treatment between January 2020 and December 2022. Collected data included weight (kg and %mBMI), eating disorder symptom severity, pre-assessment anxiety (patient and parent), and details of FT-AN sessions (i.e., frequency and amount). The sample was divided into two groups: those who received dietetic input and those who did not. Statistical analyses included Mann–Whitney U tests, χ² tests, independent t-tests, and a logistic regression to examine differences at baseline, 4–6 weeks post-assessment, and discharge. Results: The study included 92 participants (dietetic group = 33 participants; non-dietetic group = 59 participants). Baseline characteristics were comparable between groups. The logistic regression showed no significant predictors for dietetic input. At 4–6 weeks, those requiring dietetic input exhibited lower %mBMI (83.3% vs. 87.3%, p = 0.027) and poorer weight gain (+2.3 kg vs. +3.1 kg, p = 0.04). By discharge, weight restoration was similar (92% vs. 93% mBMI, p = 0.64), although the dietetic group had more therapeutic treatment sessions (24 vs. 19, p = 0.04). Discussion: This study found no specific predictors for prioritising dietetic input in young people during FT-AN treatment. While those receiving dietetic support struggled with weight gain early and attended more sessions, both groups achieved similar weight outcomes by the end of treatment. Future research should focus on the timing and content of dietetic interventions, as well as perspectives from patients and caregivers, to better understand their role and impact on cognitive and emotional recovery aspects. Full article

Background: In the search for effective treatments for refractive obsessive–compulsive disorder (OCD), deep brain stimulation (DBS) serves as an alternative option for those with minimal response to pharmacotherapy. The rarity of reports regarding DBS use for OCD is attributed to the invasive nature of the procedure: placement of electrodes within targeted areas of the brain to provide neuromodulation. This treatment of last resort may decrease functional impairment and pharmacologic complications for a debilitating mental illness. This study compares the pharmacotherapy utilization and treatment outcomes of five treatment-refractory OCD patients after the placement of DBS with those of a matched cohort. Methods: This retrospective, single-center, case–cohort study reviewed the electronic medical records of five subjects treated with DBS for treatment-refractory OCD and compared them to a similar treatment-refractory cohort whose OCD was treated without the use of DBS. Control subjects were matched by age, sex, years since diagnosis, number of previous medication class trials, and additional clinical factors. Inclusion criteria were defined as those that are at least eighteen years of age, assigned a primary diagnosis of OCD per the ICD-10 classification, and received DBS treatment for refractory OCD. Exclusion criteria included comorbid psychotic disorders, unstable neurological or coagulation disorder(s), and/or an eating disorder diagnosis. The primary endpoint was the change in the number of psychotropic medications two years after implantation for the DBS cohort and two years after psychiatric decompensation for the comparator cohort. Secondary endpoints included: Y-BOCS (the Yale–Brown Obsessive–Compulsive Scale) changes over time, duration quantity of psychotropic medication classes prescribed, and additional symptomology scale changes. Results: Patients receiving DBS were more likely to be on fewer medications and trialed fewer medications after treatment. One out of the five patients was found to be a responder in Y-BOCS scoring after DBS treatment. A reduction in anxiety and depression symptoms was also seen in the HAM-A and HAM-D scales for those that received DBS. Conclusions: A reduction in psychiatric medications trialed during therapy was observed, as well as varying reductions in OCD, anxiety, and depression symptomology following DBS. Results from this study indicate that DBS implantation may contribute to a reduction in polypharmacy while displaying DBS’s potential impact on comorbid anxiety and depression symptoms. Given that the small sample size limits generalizability, additional prospective, randomized trials comparing the efficacy of DBS for OCD-specific symptomology and its overall impact on pharmacotherapy are needed in order to further establish the role of DBS as an accepted treatment option for OCD. Full article

The global aging population has experienced rapid growth in recent decades, leading to an increased prevalence of psychiatric disorders, particularly depression, among older adults. Depression in the geriatric population is often compounded by chronic physical conditions and various psychosocial factors, significantly impacting their quality of life. The main question raised in this review is as follows: how can personalized medicine and age-appropriate therapeutic approaches improve the management of geriatric depression? This paper explores the epidemiology of geriatric depression, highlighting the influence of gender, race, and socioeconomic status on its prevalence. The classification and diagnosis of geriatric depressive disorders, based on ICD-11 and DSM-5 criteria, reveal the complexity of managing these conditions in older adults. Personalized medicine (PM) emerges as a promising approach, focusing on tailoring treatments to the individual’s genetic, clinical, and environmental characteristics. However, the application of PM in this demographic faces challenges, particularly in the context of pharmaceutical forms. The need for age-appropriate drug delivery systems is critical, given the prevalence of polypharmacy and issues such as dysphagia among the older patients. This study emphasizes the importance of developing patient-centric formulations to enhance the effectiveness of personalized therapy in geriatric patients. Full article