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

A patient (PC) with severe and chronic retrograde amnesia for world knowledge (tested with famous events and famous faces), but unimpaired autobiographical memory is described. The 64-year-old man had traumatic brain injury four years prior to the present evaluation. Current brain imaging showed principally damage involving the infero-lateral prefrontal and the lateral temporal regions of the left-hemisphere. PC was of average intelligence, had no depression and only minor language problems, but manifested some additional anterograde memory deficits and performed subaverage in various frontal lobe-sensitive tests. Patient PC represents one of the very few cases with a preserved retrograde episodic and an impaired retrograde knowledge system, showing a dissociation between preserved retrieval of autobiographical events and amnesia for nonpersonal famous events. It is hypothesized that the sparing of autobiographical memories can be linked to the integrity of the right frontal and temporo-polar cortices.
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PMID:Retrograde amnesia for world knowledge and preserved memory for autobiographic events. A case report. 1036 96

If patients who need electroconvulsive therapy are unable to consent, it is necessary to gain the guardian's permission to carry out the treatment. It remains unclear if, due to possible side effects, it is necessary to gain an additional approval from the Guardianship Court according to Section 1904 of German Civil Code (BGB). The high court of Hamburg (Landgericht Hamburg) decided that legal permission is necessary as a result of the risk of persisting retrograde amnesia and the ensuing danger of permanent damage to the patient's health. This paper points out however, that electroconvulsive therapy, even considering the contraindications, is a safe and effective treatment for depression and schizophrenic psychoses. Application of unilateral short-pulse stimulation reduces the frequency and intensity of cognitive side effects. In particular, retrograde amnesia is very rare with regard to frequency and intensity and is negligible when compared with the dangers of the illness itself. Therefore, it is not necessary to apply for approval from the Guardianship Court.
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PMID:[Need for approval of electroconvulsive therapy from the Guardian- ship Court within the context of guardianship (Section 1904 BGB)]. 1075 32

A quantitative analysis of two rat syndromes of myoclonus are presented, modeling myoclonic epilepsy and postanoxic myoclonus. Like the human conditions, both of the models benefit therapeutically from drugs that act on the serotonin system. The rat model of myoclonic epilepsy is associated with a profound loss of serotonin throughout the brain (except in the striatum) and is generated by an oscillator that is synchronized around the midline. The rat model of posthypoxic myoclonus does not demonstrate a significant reduction in serotonin in any location of its brain and is generated by a non-oscillating circuit in the medulla. Although some forms of myoclonic epilepsy may benefit from serotonin drugs because they are caused by a decrease in brain serotonin, our data indicate that posthypoxic myoclonus is not caused by a decrease in the serotonergic innervation of any region of the brain. That the raphe nuclei do not degenerate after global brain ischemia was noted by C. David Marsden in a discussion of the histologic findings of three of his human cases of posthypoxic myoclonus (page 117 of reference 10) and led him to question the hypothesis that posthypoxic myoclonus was due to a loss of serotonin neurons. Our data confirm his observation in the rat, but also indicate that density of serotonin fibers and terminals throughout the brain is not reduced by the brain ischemia that produces posthypoxic myoclonus. It remains to be determined whether the physiologic responsiveness of serotonin neurons is altered by global brain ischemia and whether changes in serotonin release or serotonin receptor properties are associated with posthypoxic myoclonus. The stability of the serotonin system in posthypoxic myoclonic rats is remarkable when one considers the wide range of disorders that is produced by the prolonged brain ischemia. The inability of the most severely posthypoxic myoclonic rats to perform 7-Hz tongue protrusions indicates substantial physiologic disruption of brainstem motor function. Moreover, the posthypoxic myoclonic rat suffers from ataxia, seizures, retrograde amnesia, and impaired ability to learn. The wide spectrum of these deficits is sharply constrasted by its apparently intact serotonin system. We have identified the inferior olive as a locus that may generate the rhythmic components of tremor and myoclonus in syndromes that are truly associated with a dramatic loss of brainstem serotonin. Serotonin acts within the inferior olive to constrain its rhythmic firing. Without intraolivary serotonin, olivary neurons are predisposed to oscillate continuously, providing a substrate upon which sustained rhythmic spiking may be superimposed. It is clear that such unconstrained rhythmicity produces synchronized whole-body tremor at 10 Hz (33, 41-43). The effects of serotonin to suppress olivocerebellar rhythmicity are mediated by postsynaptic 5-HT2 receptors that reduce the magnitude of the low-threshold calcium conductance, IT. It is notable that dysregulation of this conductance has been associated with hyper-rhythmic states in the thalamus underlying cognitive disorders ranging from depression to tinnitus (49), indicating a common mechanism underlying a variety of neurologic conditions. The identification of a specific brainstem locus (inferior olive), serotonin receptor 5-HT2, and ionic current IT involved in a form of rhythmic myoclonus may provide multiple clues toward which future pharmacotherapies can be directed.
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PMID:The serotonin hypothesis of myoclonus from the perspective of neuronal rhythmicity. 1196 57

Magnetic seizure therapy (MST) is a novel means of performing convulsive therapy using rapidly alternating strong magnetic fields. MST offers greater control of intracerebral current intensity than is possible with electroconvulsive therapy (ECT). These features may result in a superior cognitive side effect profile for MST, while possibly retaining the efficacy of ECT. The objective of this study was to determine whether MST and ECT differ in seizure characteristics, and acute objective and subjective cognitive side effects. A total of 10 inpatients in a major depressive episode referred for ECT were enrolled in this randomized, within-subject, double-masked trial. Seizure threshold was determined with MST and ECT in the first two sessions of a course of convulsive therapy, with order randomized. The remaining two sessions consisted of suprathreshold stimulation with MST and ECT. A neuropsychological battery and side effect rating scale were administered by a masked rater before and after each session. Tonic-clonic seizures were elicited with MST in all patients. Compared to ECT, MST seizures had shorter duration, lower ictal EEG amplitude, and less postictal suppression. Patients had fewer subjective side effects and recovered orientation more quickly with MST than ECT. MST was also superior to ECT on measures of attention, retrograde amnesia, and category fluency. Magnetic seizure induction in patients with depression is feasible, and appears to have a superior acute side effect profile than ECT. Future research will be needed to establish whether MST has antidepressant efficacy.
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PMID:Safety and feasibility of magnetic seizure therapy (MST) in major depression: randomized within-subject comparison with electroconvulsive therapy. 1286 3

This report describes the successful treatment of a patient suffering from an episode of drug-resistant major depression using magnetic seizure therapy (MST). The patient suffered from recurrent major depression since adolescence. MST is a novel brain stimulation method using transcranial magnetic stimulation at convulsive parameters in order to induce therapeutic seizures under general anesthesia in the same setting used for electroconvulsive therapy (ECT). The first use of therapeutic magnetic seizure induction in a psychiatric patient took place at the University Hospital in Bern, Switzerland, in May 2000. Results of a recent randomized, within-subject, double-masked trial comparing ECT and MST in 10 patients indicate that MST appears to have less subjective and objective side effects, is associated with faster recovery of orientation, and is superior to ECT on measures of attention, retrograde amnesia, and category fluency. ECT has an unparalleled and well-documented efficacy in severe depression but is associated with cognitive side effects. MST is currently under study in several centers with respect to its antidepressant efficacy. We report here on the treatment of a patient with refractory major depression (DSM IV-R), who underwent a series of 12 sessions of MST in an inpatient setting. Baseline Hamilton Depression Rating Scale (HRSD-21) of 33 and Beck Depression Inventory (BDI) of 40 decreased to 6 and 11 respectively, 1 week after completion of the MST trial. Measures of cognitive functions support the hypothesis that MST is associated with a less severe profile of cognitive side effects. [(99m)Tc]-HMPAO SPECT studies (baseline and 4 days after the completion of the MST trial) point to a raise of blood flow at baseline in the left fronto-parietal region and the brainstem. Our preliminary data support the prospect of antidepressant efficacy of MST and point to a benign cognitive side-effect profile in a patient suffering from severe treatment-resistant major depression.
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PMID:Magnetic seizure therapy improves mood in refractory major depression. 1294 46

Little attention has been given to the effects of delirium on the course of depression. In clinical practice, we sometimes observe delirium brought on incidentally by severe physical illness or therapeutic drugs such as tricyclic antidepressants. Recently, investigators have discussed whether delirium can in fact have a beneficial effect on the course of depression. We present three cases of delusional depression in which depressive symptoms resolved after patients recovered from incidental delirium caused in two cases by medication, and by respiratory distress leading to asphyxiation in the third. We surmise that delirium may create a biological effect similar to that of electroconvulsive therapy (ECT), which is widely hailed as an effective treatment for delusional depression. Retrograde amnesia caused by delirium and the supportive milieu during treatment of the delirium may have a beneficial psychological effect on recovery from delusional depression.
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PMID:Resolution of delusional depression after recovery from delirium. 1512 55

We describe three patients exhibiting an acute reversible amnesia characterised by an impaired recollection of past events with preserved anterograde memory, thus consistent with a focal retrograde amnesia (FRA). This occurred after variable events: state of fugue, road accident, post-traumatic headache. Retrograde amnesia affected autobiographical memory so severely as to cover all of the patients' lives and to erase knowledge of their own identity. The retrieval of public events was variably affected, ranging from normality to severe impairment. No lesions were found on neuroimaging, and neurophysiological findings were unimpressive. FRA subsided in a few days, leaving a gap for the onset. The hypothesis of a psychogenic amnesia is considered, but overcoming the organic/psychogenic dichotomy the episodes appear as examples of "functional" memory inhibition, potentially triggered by different conditions, including events classifiable as psychic trauma. The clinical and neuropsychological traits of functional FRA are discussed. According to a current theory of autobiographical memory, the memory profile may be explained by a lost access to abstract autobiographical knowledge. Given some analogies with the more common transient global amnesia, a mechanism of spreading depression may also be hypothesised for functional FRA.
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PMID:Functional focal retrograde amnesia: lost access to abstract autobiographical knowledge? 1619 19

Few studies have been conducted comparing complaints of memory problems using objective and subjective memory scales in depressed patients who received electroconvulsive therapy (ECT) + pharmacotherapy or treatment with pharmacotherapy only. Patients who suffer from depression according to the Diagnostic and Statistical Manual of Mental Disorder (Fourth Edition) criteria and who were admitted within the past 5 years before this study in a general psychiatric hospital were screened for inclusion. Objective retrograde amnesia was assessed using the Autobiographical Memory Interview and the Amsterdam Media Questionnaire (AMQ). Subjective retrograde amnesia was assessed using the Squire Subjective Memory Questionnaire and the ECT Retrograde Amnesia and Perception Scale (ERAPS), a newly developed scale. Twenty of the 84 patients who received ECT + pharmacotherapy and 30 of the 196 patients who received pharmacotherapy only participated in the study. Patients' ERAPS memory scores were compared with proxies' ERAPS memory scores of the patients to assess the reliability of memory complaints. The ECT + pharmacotherapy group was found to suffer more from memory problems using the AMQ 1990 test. There was also a difference for the proxy's ERAPS memory score, reflecting the conviction of proxies from the ECT + pharmacotherapy patients that these patients suffer more memory problems due to the illness, treatment with pharmacotherapy, or ECT. The differences could not be explained by the influence of determinants for retrograde amnesia. ECT + pharmacotherapy patients did not attribute their memory problems mainly to ECT but put equal "blame" on the depressive illness, treatment with pharmacotherapy, and ECT. The analyses suggest that the AMQ 1990s test is (more) sensitive in registering retrograde amnesia than the other scales used in the study.
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PMID:A retrospective controlled study into memory complaints reported by depressed patients after treatment with electroconvulsive therapy and pharmacotherapy or pharmacotherapy only. 1695 37

A polymorphism in the human serotonin transporter (5-HTT) gene is implicated in susceptibility to anxiety and depression and in enhanced emotion-induced activation in the amygdala. A role for 5-HTT polymorphism in the emotional modulation of human episodic memory has yet to be demonstrated. Here, we demonstrate that whereas emotional memory for aversive events per se is not influenced by 5-HTT polymorphism, an emotion-induced retrograde amnesia is expressed solely in the presence of the short allele. The findings indicate a critical role for the serotonin system in emotion-mediated memory disruption.
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PMID:Emotion-induced retrograde amnesia is determined by a 5-HTT genetic polymorphism. 1861 71

Electroconvulsion therapy (ECT) is the generation of an epileptic seizure by means of a brief pulse of electrical current under general anaesthesia and is used to treat psychiatric disorders. The principal indication for ECT is severe depression, with or without psychotic characteristics. ECT works quicker and is more effective than antidepressants and has a lower risk of side effects. The principle side effect is retrograde amnesia. ECT can be administered with unilateral or bilateral electrodes. In the Netherlands the unilateral electrode is used, as this probably gives rise to fewer cognitive side effects.
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PMID:[Electroconvulsion therapy]. 1990 Mar 18


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