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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report the case of a 17-year-old boy hospitalized after a violent and dramatic suicide attempt and the interpretative therapy that helped him overcome his depression. His course appeared to be typical of the difficulties encountered by clinicians when in charge of a severely depressed teenager, and of the liability of therapeutic treatment as the patient failed to improve with two consecutive antidepressant trials, and with a first attempted treatment by psychodynamic therapy. The present report stresses that: (i) in some cases, prolonged hospitalization might be helpful in managing treatment of acute phases; (ii) every effort should be made to help a depressed adolescent who attempts suicide to verbalize his experiences and give them meaning, whatever the psychotherapeutic technique. In the case of a suicide attempt with a staged component, the psychodynamic approach appears to be an interesting option as it may help the patient understand his pathological behavior as if it were a dream.
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PMID:Treatment of a suicide attempt through psychodynamic therapy in a 17-year-old boy with depression: a case study. 1661 63

Flatulence is a very common complaint related to functional gastrointestinal disorders. We know functional disorders is the main cause of consultation in gastroenterology offices. We don't know the exact reason of flatulence, but the intestinal fermentative microbiota could be an important etiologic factor. The objective of the study is to evaluate the effectiveness of the Nitazoxanida, on the clinical improvement of the flatulence in a group of patients of ambulatory consultation with respect to another group that receives placebo. The present article, is a controlled randomized clinical study designed to double blind, in whom 120 patients with flatulence criteria participate, of which 60 patients received Nitazoxanida 500mg, every 12 hours by 3 days, and the next 60 patients received placebo every 12 hours by 3 days, after one week were reevaluated, and they were put under a test of perception about clinical improvement (Jerome Frank). The Nitazoxanida group and the placebo group were very similar in age, sex, symptoms to the entrance, presence of anxiety, depression and upheavals of the dream. In the Nitazoxanida group was an average of improvement of 4.02 (75.31%) DS 0.94 and with placebo 2.35 (19.58%) D.S. 0.63. with percentage of 0.001 error. Being the perception of global improvement in the Nitazoxanida group 91.67% and in the placebo group 36.67%. Which is statistically significant. The study conclude that Nitozoxanide group produce a significative improvement in the perception of relief of flatulence in comparison to the placebo group. The study sets out a new therapeutic indication of the active principle Nitazoxanide, in flatulence. We found is a high prevalence of anxiety, depression and of upheavals of the dream in patients with flatulence.
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PMID:[Evaluation of the effect of nitazoxanide compared with placebo in patients with flatulence at the ambulatory consultation of the Central Clinic of Inppares-Lima]. 1841 54

Psychotic symptoms in Parkinson's disease (PD) are relatively common and, in addition to creating a disturbance in patients' daily lives, have consistently been shown to be associated with poor outcome. Our understanding of the pathophysiology of psychosis in PD has expanded dramatically over the past 15 years, from an initial interpretation of symptoms as dopaminergic drug adverse effects to the current view of a complex interplay of extrinsic and disease-related factors.PD psychosis has unique clinical features, namely that it arises within a context of a clear sensorium and retained insight, there is relative prominence of visual hallucinations and progression occurs over time. PD psychosis tends to emerge later in the disease course, and disease duration represents one risk factor for its development. The use of anti-PD medications (particularly dopamine receptor agonists) has been the most widely identified risk factor for PD psychosis. Other risk factors discussed in the literature include older age, disease severity, sleep disturbance, cognitive impairment, dementia and/or depression.Recent efforts have aimed to explore the complex pathophysiology of PD psychosis, which is now known to involve an interaction between extrinsic, drug-related and intrinsic, disease-related components. The most important extrinsic factor is use of dopaminergic medication, which plays a prominent role in PD psychosis. Intrinsic factors include visual processing deficits (e.g. lower visual acuity, colour and contrast recognition deficits, ocular pathology and functional brain abnormalities identified amongst hallucinating PD patients); sleep dysregulation (e.g. sleep fragmentation and altered dream phenomena); neurochemical (dopamine, serotonin, acetylcholine, etc.) and structural abnormalities involving site-specific Lewy body deposition; and genetics (e.g. apolipoprotein E epsilon4 allele and tau H1H1 genotype). Preliminary reports have also shown a potential relationship between deep brain stimulation surgery and PD psychosis.When reduction in anti-PD medications to the lowest tolerated dose does not improve psychosis, further intervention may be warranted. Several atypical antipsychotic agents (i.e. clozapine, olanzapine) have been shown to be efficacious in reducing psychotic symptoms in PD; however, use of clozapine requires cumbersome monitoring and olanzapine leads to motor worsening. Studies of ziprasidone and aripiprazole are limited to open-label trials and case reports and are highly variable; however, it appears that while each may be effective in some patients, both are associated with adverse effects. While quetiapine has not been determined efficacious in two randomized controlled trials, it is a common first-line treatment for PD psychosis because of its tolerability, ease of use and demonstrated utility in numerous open-label reports. Cholinesterase inhibitors currently represent the most promising pharmacological alternative to antipsychotics. Tacrine is rarely tried because of hepatic toxicity, and controlled trials with donepezil have not shown significant reductions in psychotic symptoms, due perhaps to methodological limitations. However, results from an open-label study and a double-blind, placebo-controlled trial involving 188 hallucinating PD patients support the efficacy of rivastigmine. With regard to non-pharmacological interventions, case reports suggest that electroconvulsive therapy has the potential to reduce psychotic symptoms and may be considered in cases involving concurrent depression and/or medication-refractory psychosis. Limited case reports also suggest that specific antidepressants (i.e. clomipramine and citalopram) may improve psychosis in depressed patients. Finally, studies in the schizophrenia literature indicate that psychological approaches are effective in psychosis management but, to date, this strategy has been supported only qualitatively in PD, and further studies are warranted.
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PMID:Pathophysiology and treatment of psychosis in Parkinson's disease: a review. 1866 59

The aim of this study was to investigate the frequency of recall and the content of dreams during pregnancy, as well as their correlation with socio-demographic, obstetric and physician-patients relationship variables, emotional state and duration of labour. A questionnaire, designed to analyse background characteristics, was given to 290 women in the third trimester of gestation. The psychiatric analysis of anxiety and depression was performed using the Hamilton Rating Scale for Anxiety and the Montgomery-Asberg Depression Rating Scale, while dreams were divided into masochistic and pleasant according to Beck's criteria. Oneiric activity was found to be associated with age >or= 35 years, higher family income, higher educational level, and a "satisfactory" physician-patient relationship. Masochistic content was associated with age<35 years, quality of information and frequent thoughts of delivery. Concerning the emotional state, depression levels were higher in women reporting masochistic dreams, while no difference in anxiety levels was found. Labour duration was shorter in the dreamer group and in patients with masochistic dream content. These findings may indicate that, also in pregnancy, the number and the content of dreams are influenced by women's mood and that the evaluation of the oneiric activity might represent a useful tool for clinicians either to investigate the women's emotional state or to predict its repercussions on the course of labour.
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PMID:Emotional state and dreams in pregnant women. 1870 67

The objective of this study is to evaluate psychiatric symptoms in Parkinson's disease (PD) patients and to assess their relation with other clinical aspects of PD. Psychotic symptoms (PS) and compulsive symptoms (CS) as well as other nonmotor and motor features were evaluated in 353 PD patients. Psychotic and compulsive symptom scores did not correlate significantly. PS occurred in 65% of patients, with item frequencies ranging from 10% (paranoid ideation) to 55% (altered dream phenomena). Regression analysis showed that autonomic impairment accounted for 20% of the 32% explained variance of PS, whereas cognitive problems, depression, daytime sleepiness, and dopamine agonist (DA) dose explained the rest. CS occurred in 19%, with item frequencies of 10% for both sexual preoccupation and compulsive shopping/gambling. Patients with more severe CS (score > or = 2 on one or both items) were significantly more often men, had a younger age at onset, a higher DA dose and experienced more motor fluctuations compared to the other patients. PS and CS are common but unrelated psychiatric symptoms in PD. The relations found between PS and cognitive problems, depression, daytime sleepiness, and autonomic impairment suggests a resemblance with Dementia with Lewy Bodies. The prominent association between PS and autonomic impairment may be explained by a shared underlying mechanism. Our results confirm previous reports on the profile of patients developing CS, and mechanisms underlying motor fluctuations may also play a role in the development of CS in PD.
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PMID:Psychotic and compulsive symptoms in Parkinson's disease. 1913 65

Trimipramine is a sedating tricyclic antidepressant which is not only effective in the treatment of depression but also in primary insomnia. In contrast to most other antidepressants, trimipramine does not affect rapid eye movement sleep. In a large sample of depressive outpatients (N = 3926), the effect of trimipramine on dream recall and dream emotions was studied. The effect of trimipramine on dream recall was small and might be explained by the reduction of negatively toned dreams. The 4-week treatment with trimipramine yielded a considerable shift in dream emotions towards the positive end of the scale, which is paralleled by the decrease of symptom severity. The present findings support the continuity hypothesis of dreaming by demonstrating a close link between waking-life symptomatolgy and negative dream emotions. Future studies should analyze dream content in order to support the hypothesis that improvement in day-time symptoms is reflected in patients' dreams.
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PMID:The effect of trimipramine on dream recall and dream emotions in depressive outpatients. 1940 77

Psychotic symptoms are frequent and disabling in patients with Parkinson's disease (PD). Methodological issues in the epidemiology of PD associated psychosis (PDP) include differences in the symptoms assessed, the methods of assessment, and the selection of patients. Most studies are prospective clinic-based cross-sectional studies providing point prevalence rates in samples on dopaminergic treatment. Visual hallucinations are present in about one quarter to one third of the patients, auditory in up to 20%. Tactile/somatic, and olfactory hallucinations are usually not systematically sought. Minor phenomena such as sense of presence and visual illusions affect 17 to 72% of the patients, and delusions about 5%. Lifetime prevalence of visual hallucinations reaches approximately 50%. Prospective longitudinal cohort studies suggest that hallucinations persist and worsen in individual patients, and that their prevalence increases with time. A facilitating role of treatment on PDP is demonstrated at least for dopaminergic agonists, but there is no simple dose-effect relationship between dopaminergic treatment and the presence or severity of hallucinations. The main endogenous non-modifiable risk factor is cognitive impairment. Other associated factors include older age/longer duration of PD, disease severity, altered dream phenomena, daytime somnolence, and possibly depression and dysautonomia. PDP reduces quality of life in patients and increases caregiver distress, and is an independent risk factor for nursing home placement and development of dementia.
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PMID:Epidemiology of psychosis in Parkinson's disease. 1974 Apr 86

Optimism about improved survival from cancer has increased. However, even with tremendous improvements in screening techniques and treatment, a cancer diagnosis may shatter the dream of a dignified old age for elderly patients. Cancer diagnosis and treatment often produce psychological stresses resulting from the actual symptoms of the disease, as well as the patient and family's perceptions of the disease and its stigma. Concerns related to cancer have particular meaning for aging individuals who undergo these situations in the context of retirement, widowhood, other medical disabilities, and other losses. Today, patients and families are more interested in treatment issues and quality of life, both during and after treatment. In this article we discuss late life depression, anxiety, and delirium and treatments related to elderly patients coping with cancer.
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PMID:Psychological issues in geriatric oncology. 1976 Oct 71

The aim of this study was to understand the meanings produced about smoking by women participating in a group for smokers in Florianopolis, SC, Brazil. Seven participants took part in structured interviews with five open questions. The theoretical framework was social constructionism with two themes: 1) Cigarettes in the women's life cycle 2) Expectations regarding treatment. The repertories used to describe the beginning of consumption in adolescence included glamour, charm, independence and peer acceptance and those used to describe the maintenance of consumption in adulthood included anxiety, depression and coping with daily stress. Regarding expectations for treatment they believed that contact with people who experience the same difficulties in relation to the cessation of consumption and the dream of a healthy life would be motivating. The treatment offered to smokers should explore strategies for women to achieve what they want regarding the consumption of cigarettes.
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PMID:[Meanings about smoking for women participant in a group for smokers]. 2069 36

Many studies have reported gender differences in nightmare frequency. In order to study this difference systematically, data from 111 independent studies have been included in the meta-analysis reported here. Overall, estimated effect sizes regarding the gender difference in nightmare frequency differed significantly from zero in three age groups of healthy persons (adolescents, young adults, and middle-aged adults), whereas for children and older persons no substantial gender difference in nightmare frequency could be demonstrated. There are several candidate variables like dream recall frequency, depression, childhood trauma, and insomnia which might explain this gender difference because these variables are related to nightmare frequency and show stable gender differences themselves. Systematic research studying the effect of these variables on the gender difference in nightmare frequency, though, is still lacking. In the present study it was found that women tend to report nightmares more often than men but this gender difference was not found in children and older persons. Starting with adolescence, the gender difference narrowed with increasing age. In addition, studies with binary coded items showed a markedly smaller effect size for the gender difference in nightmare frequency compared to the studies using multiple categories in a rating scale. How nightmares were defined did not affect the gender difference. In the analyses of all studies and also in the analysis for the children alone the data source (children vs. parents) turned out to be the most influential variable on the gender difference (reporting, age). Other results are also presented. Investigating factors explaining the gender difference in nightmare frequency might be helpful in deepening the understanding regarding nightmare etiology and possibly gender differences in other mental disorders like depression or posttraumatic stress disorder.
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PMID:Gender differences in nightmare frequency: a meta-analysis. 2081 9


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