AFP Clinical Answers

Antidepressants for Older People, Point-of-Care Ultrasonography, BRCA Testing, Probiotics


Am Fam Physician. 2021 Mar 1;103(5):270.

What are the adverse events of antidepressants in adults 65 years and older with major depressive disorder?

Selective serotonin reuptake inhibitors cause adverse events at a similar rate to placebo and have lower discontinuation rates than tricyclic antidepressants for up to 12 weeks of treatment. Serotonin-norepinephrine reuptake inhibitors cause more adverse events and greater discontinuation of therapy for up to 12 weeks of treatment compared with placebo. Duloxetine increases the risk of falls over 12 to 24 weeks of treatment compared with placebo.

What urgent medical conditions can be diagnosed by point-of-care ultrasonography?

Lung ultrasonography can accurately determine the source of acute respiratory distress. Point-of-care ultrasonography can rule out ectopic pregnancy by intrauterine pregnancy visualization. Ultrasonography differentiates cellulitis from abscess more accurately than clinical evaluation and reduces inappropriate incision and drainage and failure to resolve postdrainage. Point-of-care ultrasonography lacks the sensitivity to rule out appendicitis but is diagnostic with positive findings.

Which women are recommended for breast cancer susceptibility 1 and 2 (BRCA 1/2) testing?

The U.S. Preventive Services Task Force recommends that women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or ancestry associated with BRCA 1/2 gene mutations be evaluated using a verified brief familial risk assessment tool, and women with positive screening results be evaluated by BRCA testing. The U.S. Preventive Services Task Force does not recommend a specific tool and recognizes the Ontario Family History Assessment Tool, Manchester Scoring System, Referral Screening Tool, Pedigree Assessment Tool, 7-Question Family History Screening Tool, International Breast Cancer Intervention Study instrument (Tyrer-Cuzick), and brief versions of BRCAPRO as



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