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

Anaesthetic and analgesic techniques in the critically ill are determined largely by the nature of the presenting illness. The commonest conditions likely to present as life-threatening emergencies are pre-eclampsia, obstetric haemorrhage, cardiac disease and severe sepsis. Issues dictating choice of anaesthetic technique are the patient's ability to maintain her airway, coagulation status, intravascular volume and haemodynamic dependence upon sympathetic drive, and requirements for ventilatory support and intensive care. Fetal well-being is an issue in the antepartum period, uteroplacental blood flow should be maintained and hypotension avoided. Maternal survival takes priority, however, and occasionally general anaesthetic techniques must be used which lead to neonatal respiratory depression and requirement for ventilatory support. Anaesthesia itself is associated with known hazards. The risks of each technique must be balanced against possible benefits in the context of the presenting illness.
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PMID:Anaesthesia and analgesia for the critically ill parturient. 1147 12

Information about the psychological sequelae of pre-eclampsia (PE) is scarce. Post-traumatic stress disorder (PTSD) may develop after exposure to a stress condition. This study explored whether PE predisposes to PTSD in patients and their partners. Primiparas with a recent history of preterm PE (n=18), preterm birth (PT; n=29), term PE (n=23), or uneventful term birth (C; n=43), and most of their partners completed questionnaires measuring PTSD, depression and related psychological factors. About one-fourth of patients developed PTSD after preterm PE as well as after PT. It occurred in 17% after term PE and in none of the control subjects. A substantial minority of partners was also affected. PTSD symptoms were strongly related to individual psychological characteristics (peritraumatic dissociation, negative interpretations of symptoms, and thought suppression) rather than to objective indicators of condition-severity. The data suggest that PE predisposes to PTSD, primarily but not exclusively resulting from concomitant preterm birth.
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PMID:Posttraumatic stress disorder after pre-eclampsia: an exploratory study. 1210 Aug 37

Adolescent pregnancy increases the risk of pregnancy complications, low birth weight (LBW), and infant mortality. Complications include urinary tract infections, acute pyelonephritis, and preeclampsia. Full eclampsia is often fatal, thus preeclamptic women are delivered immediately. LBW (below 2500 g) is caused by prematurity and intrauterine growth retardation, both of which factors are associated with adolescence. In 1989, approximately 7% of all live births in the US were LBW (5.7% White and 13.5% Black). A large sample of births in 1975-78 found increased risk of neonatal mortality for the infants of adolescents, possibly owing to higher rates of LBW. In 1991, a random sample of 389 adolescent mothers who had given birth in 1983 indicated a 54% rate of depression, and even higher rates existed among those with 2 or more pregnancies. Additional risk factors include socioeconomic circumstances (poor housing, nutrition, and cultural deprivation). In a 1991 study of adolescent mothers, 80% of Blacks and 57% of Whites lived in female-headed households. Of the total, 1% of Blacks and 25% of Whites were married and living together. 45% of Whites and 58% of Blacks lived in poverty. Only 44% of these women used prenatal care in the 1st trimester, and 11% had no regular source of health care at 15-18 months after childbirth. A 1989 study of 253 pregnant women aged 19 or younger showed that 52.2% admitted drinking alcohol, 31.6% admitted using marijuana, and 13.8% admitted using cocaine during pregnancy. Nutritional problems included skipping meals and eating junk food, as well as not getting enough food, although they were entitled to government food stamps. Immaturity and lack of knowledge also contributed to poor health. Prenatal clinics, school-based clinics, and hospitals have to encourage prenatal care (e.g., the Johns Hopkins University comprehensive maternity-care program for adolescents), treat depression, assess their concrete needs regarding services and eligibility, and recognize that adolescents have cognitive and emotional limitations.
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PMID:Health effects of adolescent pregnancy: implications for social workers. 1231 42

Hyperhomocysteinemia (HHCY) is a consequence of disturbed methionine metabolism. It results from enzyme and/or vitamin deficiency. Epidemiological and clinical studies have proven HHCY to be an independent risk factor for atherosclerotic cardiovascular diseases, stroke, peripheral arterial occlusive disease and venous thrombosis. Trials in progress may clarify the "causality" of high homocysteine (HCY) concentrations and will assess the value of HCY lowering therapy. HHCY is also seen as a risk factor for neurodegenerative diseases such as cognitive impairment, dementia, Alzheimer's disease, and also for depression. There is a high prevalence of HHCY as a syndrome of vitamin shortage in elderly subjects, which strongly increases with advancing age. Elderly people have a high frequency of vitamin B12 deficiency which is more reliably diagnosed by measurement of serum methylmalonic acid and holotranscobalamin II, the metabolically active B12 fraction, than by total serum vitamin B12. Subjects who follow a strict vegetarian diet also have a high prevalence of HHCY caused by vitamin B12 deficiency. For prevention of neurological damages an early diagnosis of vitamin B12 deficiency is important. Furthermore, HHCY is a factor in the pathogenesis of neural tube defects and preeclampsia. HCY should be measured in patients with a history of atherothrombotic vessel diseases, in patients with diabetes or hyperlipidemia, in renal patients, in adipose subjects, in elderly people, in vegetarians, in postmenopausal women, and in early pregnancy.
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PMID:Hyperhomocysteinemia: a new risk factor for degenerative diseases. 1238 6

A late-gestation jill was presented for depression, anorexia, and weakness. The working diagnosis became pregnancy toxemia. Supportive care was initiated and an emergency cesarian section performed. Twelve live kits were delivered; however, all soon perished despite home care. Surgery and recovery are discussed, including information regarding pregnancy toxemia in general.
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PMID:Pregnancy toxemia in a ferret. 1502 52

Schizophrenia is a multifactorial disease with complex interactions between a genetic liability, possible perinatal complications and exposure to later environmental risk factors in childhood. Maternal influenza infection, wartime-famine-related denutrition and maternal depression or exposure to repeated stress in pregnancy may have a deleterious effect on brain development and neuronal migration. Obstetrical complications which are significantly associated with schizophrenia are bleeding, diabetes, prematurity, fetal growth retardation, Rhesus incompatibility, preeclampsia and congenital malformations. Subjects with onset of schizophrenia before age 22 had more often a history of acute fetal distress (abnormal presentation at birth and complicated cesarean delivery). Obstetrical complications may have a direct negative impact on fetal brain development or may be on the causal pathway between prepartum maternal depression or psychosis, exposure to stress and impaired relation between mother and child consecutive to postnatal depression.
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PMID:[Obstetrical complications and further schizophrenia of the infant: a new medicolegal threat to the obstetrician?]. 1506 96

In the US, the routine use of magnesium sulfate for seizure prophylaxis in women with preeclampsia is an ingrained obstetric practice. During the past decade, several observational studies and randomized trials have described the use of various regimens of magnesium sulfate to prevent or reduce the rate of seizures and complications in women with preeclampsia. There are only 2 double-blind, placebo-controlled trials evaluating the use of magnesium sulfate in mild preeclampsia. There were no instances of eclampsia among 181 women assigned to placebo, and there were no differences in the percentage of women who progressed to severe preeclampsia (12.5% in magnesium group vs 13.8% in the placebo group, relative risk [RR] 0.90; 95% CI 0.52-1.54). However, the number of women enrolled in these trials is too limited to draw any valid conclusions. There are 4 randomized controlled trials that compare the use of no magnesium sulfate, or a placebo vs magnesium sulfate, to prevent convulsions in patients with severe preeclampsia. The rate of eclampsia was 0.6% among 6343 patients assigned to magnesium sulfate vs 2.0 % among 6330 patients assigned to a placebo or control (RR 0.39; 95% CI 0.28-0.55). However, the reduction in the rate of eclampsia was not associated with a significant benefit in either maternal or perinatal outcome. In addition, there was a higher rate of maternal respiratory depression among those assigned magnesium sulfate (RR 2.06; 95% CI 1.33-3.18). The evidence to date confirms the efficacy of magnesium sulfate in reduction of seizures in women with eclampsia and severe preeclampsia; however, this benefit does not affect overall maternal and perinatal mortality and morbidities. The evidence regarding the benefit-to-risk ratio of magnesium sulfate prophylaxis in mild preeclampsia remains uncertain, and does not justify its routine use for that purpose.
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PMID:Magnesium sulfate prophylaxis in preeclampsia: Lessons learned from recent trials. 1528 24

Circulating platelets play a pivotal role in hemostasis. The platelet hemostatic function involves the direct interaction with damaged vessel walls, and circulating coagulation factors, primarily thrombin resulting in platelet activation, aggregation and formation of hemostatic plug. Flow cytometry is a useful technique for the study of platelet activation in circulating blood. Platelet activation markers for ex vivo analysis may include a) activation-dependent epitopes of the membrane glycoprotein (GP) IIb/IIIa (CD41a) receptor, as demonstrated by the binding of activation-specific monoclonal antibodies (MoAbs) PAC1, anti-LIBS1 and anti-RIBS); b) the expression of P-selectin (CD62p), the alpha-granule GP translocated to the platelet surface following release reaction; and c) platelet procoagulant activity, as demonstrated by the binding of i) annexin V protein to the prothrombinase-complex (prothrombin, activated factor X (Xa) and V (Va)) binding sites on the surface of activated platelets, and of ii) MoAbs against activated coagulation factors V and X bound to the surface of activated platelets. Using this method, platelet activation as a marker for in vivo prothrombotic activity can be demonstrated in various clinical conditions including coronary angioplasty, orthostatic challenge in primary depression, sickle cell disease in clinical remission and during pain episode, and in pregnancy-related hypertension with marked increase during preeclampsia. The finding of platelet procoagulant activity is corroborated by increased levels of plasma markers for thrombin generation and fibrinolytic activity.
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PMID:Platelet activation as a marker for in vivo prothrombotic activity: detection by flow cytometry. 1547 Dec 23

Preeclampsia causes substantial morbidity and mortality. A significant part of the etiology of preeclampsia involves endothelial damage and platelet activation and in this way can be conceived as an illness with a pathophysiology similar to coronary artery disease. Depression is an independent risk factor for the progression of cardiovascular disease [Am Heart J 140 (2000) S57] and there is evidence to suggest that it may be a risk factor for preeclampsia as well. SSRIs have been shown to reduce the progression of coronary artery disease, independent of improvement in mood. SSRIs may also reduce risk factors for preeclampsia in addition to treating depression in pregnancy. This is an important area for further research.
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PMID:Can SSRIs reduce the risk of preeclampsia in pregnant, depressed patients? 1553 6

Platelet activation is a hallmark of severe preeclampsia, and platelet PGH synthase 1-derived (PGHS1-derived) thromboxane A(2) (TxA(2)) has been implicated in its pathogenesis. However, genetic disruption of PGHS1 delays parturition. We created hypomorphic PGHS1 (PGHS1(Neo/Neo)) mice, in which the substantial but tissue-dependent variability in the inhibition of PGHS1-derived eicosanoids achieved by low-dose aspirin treatment is mimicked, to assess the relative impact of this strategy on hemostatic and reproductive function. Depression of platelet TxA(2) by 98% in PGHS1(Neo/Neo) mice decreased platelet aggregation and prevented thrombosis. Similarly, depression of macrophage PGE(2) by 75% was associated with selectively impaired inflammatory responses. PGF(2alpha) at 8% WT levels was sufficient to induce coordinated temporal oxytocin receptor (OTR) expression in uterus and normal ovarian luteolysis in PGHS1(Neo/Neo) mice at late gestation, while absence of PGHS1 expression in null mice delayed OTR induction and the programmed decrease of serum progesterone during parturition. Thus, extensive but tissue-dependent variability in PG suppression, as occurs with low-dose aspirin treatment, prevents thrombosis and impairs the inflammatory response but sustains parturition. PGHS1(Neo/Neo) mice provide a model of low-dose aspirin therapy that elucidates how prevention or delay of preeclampsia might be achieved without compromising reproductive function.
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PMID:Differential impact of prostaglandin H synthase 1 knockdown on platelets and parturition. 1577 9


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