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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

H-Reflex recruitment curves were obtained at 0.1 and 1 Hz in the right soleus of an incomplete SCI man before and after training and on 12 neurologically normal individuals. Low frequency depression (LFD) was calculated by the formula: 1 - (H-wave amplitude at 1 Hz/0.1 Hz) x 100. Training consisted of treadmill walking at the speed matching his overground fast walking. The subject trained for 30 min every other day for 10 days under supervision and then continued three times a week for 4 months at a health club. Maximum H/M ratio of the right soleus (78%) was greater than that of the normals (67%) and did not change following training (79%). The mean LFD of the SCI subject was 24% prior to training compared to 42% for the normal subjects. Following training, LFD increased to 35%. In addition, the reflex threshold appears to have increased following training. This was accompanied by 47 and 45% increases in the subject's self selected and fast gait velocities, respectively. We conclude that training adaptations enabled the SCI subject to increase his gait velocity due to an improved ability to gate peripheral afferent feedback during gait.
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PMID:The effect of treadmill gait training on low-frequency depression of the soleus H-reflex: comparison of a spinal cord injured man to normal subjects. 979 23

Failure to recognize subthreshold expressions of mania contributes to the frequent under-diagnosis of bipolar disorder. There are several reasons for the lower rate of recognition of subthreshold manic symptoms, when compared to the analogous pure depressive ones. These include the lack of subjective suffering, enhanced productivity, ego-syntonicity, and diurnal and seasonal rhythmicity associated with many of the manic and hypomanic symptoms, and the psychiatrists' tendency to subsume persistent or even alternating symptoms among personality disorders. Furthermore, the central diagnostic importance placed on alterations in mood distracts clinicians from paying attention to other more subtle but clinically meaningful symptoms, such as changes in energy, neurovegetative symptoms and distorted cognitions. Although officially accepted in both ICD-10 and DSM-IV, we believe bipolar II disorder is underdiagnosed because of inattention to symptoms of hypomania. Moreover, by requiring the presence of both full-blown hypomanic and major depressive episodes, current nosology fails to include symptoms or signs which are mild and do not meet threshold criteria. There is already agreement in the field that such symptoms are important for depression. We now propose that attention should also be devoted to mild symptomatic manifestations of a manic diathesis, even if such manifestations may sometimes enhance quality of life. The term 'spectrum' is used to refer to the broad range of such manifestations of a disorder from core symptoms to temperamental traits. Spectrum manifestations may be present during, between, or even in the absence of, an episode of full-blown disorder. We have developed a structured clinical interview to assess the mood spectrum (SCI-MOODS) to evaluate the whole range of depressive and manic symptoms. This instrument is currently undergoing psychometric testing procedures. Similar to the SCID interview, the SCI-MOODS interview provides a separate rating for each of the major DSM-IV symptoms, but the latter also identifies and rates subthreshold and atypical manifestations. This paper presents the concept of a subthreshold bipolar disorder and discusses the potential epidemiological, diagnostic and therapeutic relevance of such a spectrum conditions. We also describe the SCI-MOODS interview used reliably to identify the occurrence of a bipolar spectrum condition. Obviously a great deal of systematic research needs to be conducted to ascertain the reliability and validity of subthreshold bipolarity as summarized in this paper and embodied in our instrument.
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PMID:The bipolar spectrum: a clinical reality in search of diagnostic criteria and an assessment methodology. 1046 78

In this study, self-reported symptoms (cognitive, physical, behavioural/affective) from the TIRR Symptom Checklist are compared across six panels: 135 individuals with mild TBI, 275 with moderate/severe TBI, 287 with no disability, 104 with spinal cord injury, 197 who are HIV positive and 107 who had undergone liver transplantation. Participants with TBI and SCI were at least 1 year post-injury. Individuals with TBI reported significantly more symptoms than other panels. Symptom reports in the TBI panels were independent of demographic variables (gender, education, income, ethnicity, age), as well as time since injury and depression. Five of the 67 symptoms were found to be sensitive/specific to TBI in general; 25 symptoms were sensitive/specific to mild TBI (23 were cognitive, one physical and one behavioural/affective). Implications of these results in terms of current debates about the 'reality' of symptom reports in individuals with mild TBI are discussed, as well as implications for using symptom checklists for TBI screening.
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PMID:The sensitivity and specificity of self-reported symptoms in individuals with traumatic brain injury. 1067 Jun 59

Persons with chronic SCI have several metabolic disturbances. As a consequence of inactivity and the body compositional changes of decreased skeletal muscle with a relative increase in adiposity, a state of insulin resistance and hyperinsulinemia has been demonstrated to exist, associated with abnormalities in oral carbohydrate handling. Elevated plasma insulin levels in persons with SCI probably contribute to the cause of frequent dyslipidemia and hypertension. This constellation of metabolic changes represents an atherogenic pattern of CHD risk factors with many of the distinctive features of a cardiovascular dysmetabolic syndrome that is called syndrome X. Reduction in modifiable risk factors for CHD should decrease the occurrence of catastrophic cardiovascular events. There is evidence to suggest that endogenous anabolic hormone levels are depressed in a proportion of individuals with SCI. Depression of serum testosterone and growth hormone/IGF-I levels may exacerbate the adverse lipid and body compositional changes, reduce exercise tolerance, and have deleterious effects on quality of life. Because of immobilization, individuals with paraplegia have osteoporosis of the pelvis and lower extremities, and those with tetraplegia also have osteoporosis of the upper extremities. In addition, there is evidence to suggest that bone loss progresses with time in persons with chronic SCI. This may be caused by chronic immobilization per se or may be a consequence of adverse hormonal changes, including deficiency of anabolic hormones or deficiency of vitamin D and calcium with secondary hyperparathyroidism. Serum thyroid function abnormalities resembling the euthyroid sick "low T3 syndrome" have been reported in those with acute and chronic spinal cord injury. Depressed serum T3 and elevated rT3 in chronic SCI may be caused by associated illness. Current practice has been hesitant to treat abnormal serum thyroid chemistries associated with nonthyroidal illness. Recognition of metabolic abnormalities in individuals with SCI is vital as a first step in improving clinical care. The application of appropriate interventions to correct or ameliorate these abnormalities promises to improve longevity and quality of life in persons with SCI.
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PMID:Metabolic changes in persons after spinal cord injury. 1068 Jan 61

Although dissociative phenomena are often transient features of mental states, existing measures of dissociation are designed to measure enduring traits. A new present-state self-report measure, sensitive to changes in dissociative states, was therefore developed and psychometrically validated. Fifty-six items were formulated to measure state features, and sorted according to seven subscales: derealization, depersonalization, identity confusion, identity alteration, conversion, amnesia and hypermnesia. The State Scale of Dissociation (SSD) was administered with other psychiatric scales (DES, BDI, BAI, SCI-PANSS) to 130 participants with DSM-IV major depressive disorder schizophrenia, alcohol withdrawal, dissociative disorders and controls. In these sample populations, the SSD was demonstrated as a valid and reliable measure of changes in and the severity of dissociative states. Discriminant validity, content, concurrent, predictive, internal criterion-related, internal construct and convergent validities, and internal consistency and split-half reliability were confirmed statistically. Clinical observations of dissociative states, and their comorbidity with symptoms of depression and psychotic illness, were confirmed empirically. The SSD, an acceptable, valid and reliable scale measuring state features of dissociation at the time of completion, was obtained. This is a prerequisite for further investigation of correlations between changes in dissociative states and concurrent physiological parameters.
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PMID:Psychometric validation of the State Scale of Dissociation (SSD). 1200 98

Determining treatment and extent of care has been returned to the patient with the advent of the durable power of attorney and reinforcement of patients' rights. To a great extent, patient autonomy replaced the medical team's role of beneficence in the decision-making process. Professionals acknowledge the patient's right in the decisional process of his/her care, though there is skepticism of such decisions being made by the patient who has suffered high-level tetraplegia within the acute care arena. This article explores (a) basing decisions upon life experiences and knowledge, (b) differentiating between informed consent for withdrawing care and consent resulting from stress or depression, (c) assessing the patient's psychological balance, and (d) advocating for the patient when he/she chooses to end all treatment options. Guidelines provide assistance to the health professional and the patient through a potentially volatile ethical dilemma. These provide insight into potential problems for all involved and clearly define steps that individuals should take to assure that the decision is made with informed consent rather than emotions.
SCI Nurs 2001
PMID:Patient requested removal of ventilatory support in high-level tetraplegia: guidelines for the health care provider. 1203 64

The psychometric properties of a clinician-administered, DSM-IV-based, structured clinical interview for pathological gambling (SCI-PG) were examined. Seventy-two consecutive subjects requesting treatment for gambling problems were administered the SCI-PG. Reliability and validity were determined. Classification accuracy was examined using longitudinal course of illness. The SCI-PG demonstrated excellent inter-rater and test-retest reliability. Concurrent validity was observed with the South Oaks Gambling Screen (SOGS). Discriminant validity was observed with measures of anxiety and depression. The SCI-PG demonstrated both high sensitivity and specificity based on longitudinal assessment. The SCI-PG demonstrated excellent reliability and validity in diagnosing PG in subjects presenting with gambling problems. These findings require replication in other groups to examine their generalizability.
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PMID:Preliminary validity and reliability testing of a structured clinical interview for pathological gambling. 1545 Sep 17

The ability of 23 previously identified Minnesota Multiphasic Personality Inventory (MMPI) "neurologic content" items to distinguish between individuals with traumatic brain injury (TBI; n = 32) or spinal cord injury (SCI; n = 17) was examined. Principal-components analysis of the 23 items revealed three conceptually coherent, nonoverlapping, and uncorrelated factors (Cognitive, Somatic, Inactivity) that together accounted for 44% of the total variance. Coefficients of internal consistency for the factors were in the moderate to high range. Together, the factors were named the Revised Neurobehavioral Scales of the MMPI. The group with TBI scored significantly higher on the Cognitive scale and significantly lower on the Inactivity scale than the group with SCI (with or without depression as a covariate). The Glasgow Coma Scale correlated significantly and negatively with the Cognitive scale in the group with TBI. Discriminant function analysis revealed that together the scales correctly classified individuals with sensitivity and a positive predictive value (with respect to TBI) of 87% and 81%, respectively. Specificity and a negative predictive value (with respect to SCI) were 68% and 76%, respectively. The overall rate of correct classification of individual cases was 80% (with or without depression in the analysis). The Cognitive scale alone correctly classified individuals in the group with TBI with a positive predictive value of 84%. Findings are discussed in terms of the discriminative validity and potential utility of TBI-related MMPI items, as well as the issue of "neurocorrection" of the MMPI (or MMPI-2) in verified cases of TBI.
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PMID:Revised neurobehavioral scales of the MMPI: sensitivity and specificity in traumatic brain injury. 1613 41

This study aimed to investigate the extent to which spinal cord injury posttraumatic stress (SCI PTSD) responses and the use of the external or internal health locus of control might vary according to age. Sixty-two patients with SCI were recruited for the study and divided into young (n = 23), middle-aged (n = 25) and elderly (n = 14) groups. They were assessed using the Posttraumatic Stress Disorder Checklist (PCL), the General Health Questionnaire-28 (GHQ-28), and the Multidimensional Health Locus of Control (MHLC). The results showed no significant differences between the three age groups in terms of PTSD symptoms. The elderly patients were significantly more socially dysfunctional than the other patients. The young patients believed in chance locus of control (CHLC) significantly more than the middle-aged and elderly patients. Correlation results revealed no significant relationship between PTSD symptoms and type of locus of control for the middle-aged patients. Otherwise, for both the young and elderly patients, internal health locus of control (IHLC) was negatively correlated with the avoidance symptom. For the elderly patients, powerful other locus of control (POLC) was positively correlated with the avoidance symptom. Both young and middle-aged patients revealed significant positive correlations between POLC, CHLC, and general health problems. For the elderly patients, POLC was positively correlated with social dysfunction and depression. SCI-PTSD responses did not differ according to age; however, the use of health locus of control differed depending on whether patients were younger or older.
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PMID:Spinal cord injury, posttraumatic stress, and locus of control among the elderly: a comparison with young and middle-aged patients. 1670 33

Although psychological aspects of SCI-related pain have been investigated in those with chronic pain, little data is available regarding these factors in those early in the course of the injury. Using a sample admitted for SCI rehabilitation, this paper describes the relationships between usual pain intensity, mood, disability and both pain and SCI-related psychological factors. The sample were largely similar to other samples of individuals with SCI-related chronic pain in terms of mood, but were noted to be less catastrophic in their thinking about pain than a comparative pain clinic sample. They also reported SCI self-efficacy and acceptance scores consistent with other SCI samples. Compared with other SCI populations there were mixed findings in relation to physical disability. Consistent with previous findings in chronic pain SCI samples, usual pain intensity was found to have a strong relationship with symptoms of anxiety and depression, and pain-related life interference. SCI acceptance was significantly negatively associated with depression scores, pain catastrophizing was significantly positively associated with both anxiety and depression scores, and SCI self-efficacy was significantly negatively associated with both anxiety and depression scores. SCI self-efficacy was also significantly positively associated with physical function scores. These findings suggest that pain-related psychological factors may have importance even early in the clinical course following SCI, but that it is important, however, to consider more general SCI-related psychological factors alongside them. In addition, these findings suggest the possibility that early interventions based upon the cognitive behavioural treatment of pain may be integrated into SCI rehabilitation programmes.
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PMID:Spinal cord injury-related pain in rehabilitation: a cross-sectional study of relationships with cognitions, mood and physical function. 1865 64


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