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

A comprehensive evaluation of incontinence using office-based techniques may discover reversible problems such as delirium, urinary infections, vaginitis, depression, drug effects, endocrinologic causes, immobility, or impaction. Treatment of these causes may alleviate incontinence. Bedside urodynamics are a sensitive, specific, and useful office-based technique that can identify detrusor instability, overflow incontinence, or stress incontinence. Low urinary flow rate, difficulty with catheterization, slow bladder filling or severe urgency, bladder capacity over 600 ml, and post-void residual over 150 ml need referral. Patients with hematuria, recurrent infections, recent surgery or pelvic irradiation, and pelvic or prostatic masses also need further evaluation. A number of medical and behavioral therapies are available for stress incontinence and detrusor instability that can substantially reduce incontinence, but most patients with overflow have more complicated problems requiring further evaluation, surgery, or long-term bladder drainage.
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PMID:Practical management of urinary incontinence. 268 69

In this review we discuss the symptoms, etiology and therapy of reversible organic mental disorders following surgery. Acute confusional states and delirium still pose difficult and unsolved problems in our operative wards and intensive care units. They are a major cause of morbidity and mortality following geriatric surgery. It is necessary to keep a watchful eye for signs of mild cerebral impairment. Slight disorientation, minor fear, depression or delusions can be the first step towards an aggressive or delirious restlessness. Changes in cognitive skills and a reduction in the operative level are useful guidelines. In most cases more than one etiological factor contributes to the psychopathology. The list of possible causes is long and the frequency and importance varies greatly. Preexisting dementia, unrecognized hypoxia, massive surgical procedures, extracorporeal circulation during cardiac surgery, drug and alcohol withdrawal, infections and the use of multiple medications with cerebral side effects can all interfere. A total, but reversible cerebral alteration or sometimes local damage with neurological dysfunction is thought to be part of the pathomechanism. Disorders of the blood-brain barrier, changes in transmitter turnover, disturbances in the circadian rhythm and REM sleep phases are also being considered. When attempting to make a diagnosis, one should look for signs of neurological damage, withdrawal reactions and exclude or verify major or menacing etiological factors. The therapeutic strategy consists of treatment of the underlying organic diseases, consistent and attentive care that provides orientation and support, and carefully selected medication. The change in pharmacokinetics during old age, and the anticholinergic or other confusion-inducing properties in drugs should be remembered. The administration of either minor or major tranquilizers should be in accordance with a clear treatment strategy.
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PMID:[Postoperative transitory syndrome and delirium]. 268 86

The differential diagnosis of Alzheimer's disease is a problem that arises in different circumstances. At an advanced stage of the disease the symptoms are so typical that the clinical diagnosis can be made immediately. Complementary examinations (i.e. essentially computerized tomography) are performed to exclude other causes of amnesia and dementia, notably curable dementias. The diagnosis may be more difficult at the early stage of the disease in patients with only slight disorders of memory or certain types of depression. The same applies to cases with unusual presentation, focal symptoms, episodes of confusion, or delirium and hallucinations.
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PMID:[Differential diagnosis of Alzheimer's disease]. 270 60

Narcotic analgesics are the mainstay of pharmacological interventions for cancer pain. There is however growing awareness that psychotropic drugs, in particular the antidepressants, are useful adjuvant analgesic agents in the management of cancer pain. In addition many of these drugs are important in the treatment of psychiatric complications of cancer. Unfortunately cancer patients with pain are most vulnerable to such problems as depression, anxiety and delirium. For the clinician who wants to provide comprehensive management of cancer pain, familiarity with the indications and usefulness of psychotropic drugs will be most rewarding.
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PMID:Psychotropic adjuvant analgesic drugs for cancer pain. 277 53

Forty-six orthopedic patients were studied to determine the incidence, natural history, and risk factors associated with post-operative delirium. Pre-operatively, patients were given a neuropsychological screening evaluation, the Mood Adjective Checklist (MACL), the Zung Depression Scale, the Anxiety Inventory Scale, and the Health Assessment Questionnaire (HAQ). A psychiatrist interviewed each patient on post-op day four for evidence of delirium as defined by DSM III criteria. Of the patients studied, thirteen (26%) were possibly or definitely delirious following surgery. Treatment with propranolol, scopolamine, or flurazepam (Dalmane) conferred a relative risk for delirium of 11.7 (p = 0.0028). Delirium was associated with increased post-operative complications (p = 0.01), poorer post-operative mood (p = 0.06), and an increase of about 1.5 days in length of stay (not significant). Delirious patients were significantly less likely than matched controls to improve in function at six months compared with a pre-operative baseline HAQ (t = 6.43, p less than 0.001).
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PMID:Delirium after elective orthopedic surgery: risk factors and natural history. 280 36

The author reviews the literature reporting the untoward effects of withdrawing monoamine oxidase inhibitors (MAOIs). The withdrawal of these agents can result in severe anxiety, agitation, pressured speech, sleeplessness or drowsiness, hallucinations, delirium and paranoid psychosis. MAOI withdrawal phenomena resemble the symptoms produced by the discontinuation of chronically administered psychostimulants. The capacity of MAOI to exert amphetamine-like effects presynaptically, and the propensity of somatic treatments for depression to subsensitize presynaptic receptors regulating the release of catecholamines, can provide a basis for the development of psychotic syndromes upon the withdrawal of MAOIs. Evidence for this hypothesis is reviewed.
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PMID:Monoamine oxidase inhibitor withdrawal phenomena: symptoms and pathophysiology. 284 11

Severe alcohol withdrawal has a mortality rate of 5% to 10%. Uncontrolled bouts may sensitize the patient, making future episodes more frequent and severe. Thus, aggressive treatment that produces rapid control of alcohol withdrawal is essential. The author briefly discusses some of the neuropharmacological aspects of alcohol's actions and alcohol withdrawal. Drug treatment options are also considered. Benzodiazepines offer the highest margin of safety. Lorazepam is an excellent first choice because of its intermediate half-life, absence of active metabolites, and high bioavailability that can be achieved with a number of routes of administration. Combination therapy with clonidine, beta-adrenergic blocking agents, and haloperidol is becoming increasingly attractive because it results in decreased sedation, better control of delirium, less respiratory depression, and improved outcome. The availability of shorter half-life, rapid-acting drugs like esmolol and midazolam, administered by continuous infusion, makes dose titration more precise in the critically ill patient.
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PMID:Emerging treatment options in the alcohol withdrawal syndrome. 290 29

Infusion-therapy with antidepressants has been of value in severe as well as therapy resistant depressive states. In addition to doses lower than those used for oral treatment, a more rapid onset of therapeutic effect and a better tolerance, the beneficial effect seems also to depend on the setting in which the treatment takes place. Infusion-therapy is a combined pharmacopsychotherapeutic procedure. Next to infusion-treatment a pretreatment with neuroleptics is advised either via the oral or parenteral route. In extremely refractory depression the infusion-therapy can be applied twice a day; in some cases we resort to continuous infusion for a few days. Infusion-therapy is not applicable in patients prone to epileptic seizures or with serious cerebral dysfunction with a risk of delirium. In case of doubt an EEG is mandatory. Tricyclic antidepressants may not be used in cardiac diseases especially those with troubles of the conduction propagation or repolarization.
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PMID:[The treatment of severe, therapy-resistant depression using infusions of antidepressants]. 292 14

In the United States electroconvulsive therapy (ECT) is not commonly used with patients who have conditions affecting the structure or function of the brain. Many clinicians may be unaware, therefore, that ECT has been used safely to treat patients with combined major depression and central nervous system disorders; patients with organic mental syndromes, particularly delirium; and patients who have psychiatric disorders that mimic or are distorted by brain disease. The author discusses the successful use of ECT with such patients as well as potential dangers of the treatment through a review of worldwide experience with ECT and presentation of case examples. He concludes by suggesting possible mechanisms through which ECT may benefit both depression and organic mental syndromes.
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PMID:Using electroconvulsive therapy for patients with neurological disease. 301 63

The contribution of a liaison psychiatrist to a cardiac transplant programme is described. Ninety one patients were referred to the transplant unit for assessment over four years, and of these, 86 were assessed by the psychiatrist. A high prevalence of preoperative anxiety and depression was found. Thirty four transplants were performed on 33 patients during the study and 22 patients survived. Six patients developed transient delirious episodes during the first 10 postoperative days, three showed symptoms of considerable anxiety, and three developed social and behavioural problems during the convalescent period. Subjects with higher scores on the somatic scale of the general health questionnaire showed increased postoperative mortality. In conclusion, the liaison psychiatrist is useful in evaluating and managing heart transplant patients before and after operation.
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PMID:Psychiatric aspects of heart transplantation: preoperative evaluation and postoperative sequelae. 308 Jan 51


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