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

We report a double-blind, randomized, placebo-controlled study utilizing a within-subjects design on 20 hospitalized, psychiatric patients who participated in sodium amobarbital interviews to determine if the drug has a specific effect in eliciting clinically useful information. The patients selected had difficulty communicating with their primary therapists during the postadmission, diagnostic interviews. Two raters completed a Hamilton Depression Scale, a New Haven Schizophrenia Index, and a Brief Psychiatric Rating Scale after each interview. Although both the amobarbital and saline interviews were moderately useful in obtaining new information, we found no significant difference in the primary therapists' assessments of clinical usefulness. In addition, the drug interview did not uncover material that would aid in the differential diagnosis between depression and schizophrenia. There was, however, a significant negative correlation between the assessment of general usefulness and the time interval between admission and interviewing. We report our only exception, a case of catatonic schizophrenia, in which the patient responded specifically to the drug.
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PMID:Clinical usefulness of sodium amobarbital interviewing. 3 65

Eight patients are reported who shared the combination of bilateral basal ganglia lesions and a frontal lobe-like syndrome. The main features were inertia and loss of drive, with preservation of intellectual function. Some patients showed stereotyped activities with compulsive and obsessive behaviour which were sometimes highly elaborate in pattern. Extrapyramidal clinical signs were absent or mild. Brain damage, related to anoxic or toxic encephalopathy, was demonstrated by CT scans and MRI. The lesions appeared to be confined to the lentiform nuclei, particularly affecting the pallidum, although there was generalized brain atrophy in 2 cases. Positron emission tomography (PET) in 7 patients revealed hypometabolism of the prefrontal cortex relative to other parts of the brain. The PET studies suggest dysfunction of the prefrontal cortex as a result of damage to the lentiform nuclei. These clinical, anatomical and functional observations emphasize the role of the circuits linking the prefrontal associative cortex and some specific areas of the neostriatum, including the pallidum. The existence of distinct nonoverlapping circuits in the motor field or in the associative field can explain the fact that basal ganglia lesions may give rise to a clinical picture that is either purely motor, purely behavioural (as in some of our patients), or both. Similarities existed between some symptoms found in our patients and certain features of major psychiatric illnesses such as severe depression, catatonic schizophrenia, and obsessive-compulsive disorder. This raises the hypothesis that some aspects of these psychiatric disorders could be related to structural and physiological disturbances in the systems linking the frontal associative cortex and the basal ganglia.
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PMID:Obsessive-compulsive and other behavioural changes with bilateral basal ganglia lesions. A neuropsychological, magnetic resonance imaging and positron tomography study. 278 40

A 72-year-old woman, who had previously been diagnosed as schizophrenic, experienced a year of deterioration in her ability to care for herself. She was variously diagnosed as having parkinsonism, catatonic schizophrenia, atypical psychosis, depression, and dementia before she was appropriately diagnosed as having progressive supranuclear palsy.
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PMID:Progressive supranuclear palsy misdiagnosed as schizophrenia. 286 Feb 4

During the 12-month period, 1 January 1978 to 31 December 1978, 690 people received 4,194 electroconvulsive treatments at the Psychiatric Hospital, Enugu. The diagnostic classifications of patients receiving this form of treatment included severe psychotic depression (and masked depression), catatonic schizophrenia (with marked withdrawal, mutism, or excitement); mania which has become unresponsive to major tranquilizers, some selected cases of acute delirium and the collective group "puerperal psychosis". Bilateral ECT was generally used and the frequency of treatment was two ECT's per week. The method of anaesthesia used is described and mention is made of the few and mild complications which were encountered. ECT was found to have reduced the total duration of stay in hospital (for in-patients). Considering the acute shortage of specialized manpower in the field of psychiatry in Nigeria, a suggestion is made for the establishment of community based psychiatric centres where, among other forms of therapy, ECT could be given in appropriate cases, on out-patient basis. The wider use of this form of treatment in deserving cases in psychiatric hospitals is also recommended.
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PMID:Present status and practice of electroconvulsive therapy at the Psychiatric Hospital, Enugu, Nigeria. 731 81

Between September 1st, 1994, and the end of August, 1995, 3% of all inpatients (21 of 731) were treated with electroconvulsive therapy (ECT) at the Department of General Psychiatry at the University Hospital for Psychiatry in Vienna. These patients suffered from psychotic and/or therapy-resistant depression (n = 15), therapy-resistant schizoaffective psychosis (n = 3), and catatonic schizophrenia (n = 3). ECT was administered in short-time anaesthetised and muscle relaxed patients. On average, each patient was treated with ECT on 9 non-consecutive days. As a rule, electrodes were placed unilaterally over the non-dominant hemisphere at the beginning. In four cases electrodes were placed bifronto-temporally. To be considered as effective the seizure had to last for at least 25 s. In shorter seizure duration ECT was repeated up to a maximum of three times in one session. With this procedure a reduction in clinical global impressions of -3.7 points was achieved in ECT-treated patients, who had been considered to be "severely" to "most severely" ill according to CGI before starting ECT. ECT proved to be effective for treating severe depression and catatonic schizophrenia, with only minor and reversible side effects. For establishing a favorable relation between good clinical outcome and remarkable few side effects, the following factors seem to be of importance, in accordance with the literature: (1) application of biphasic short-impulse stimuli in anaesthetised and muscle relaxed patients; (2) measurement of static impedance to avoid high skin impedance and short circuits. (3) at the beginning of each ECT series unilateral electrode placement over the non-dominant hemisphere; (4) ECT three times weekly on non-consecutive days.
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PMID:[Electroconvulsive therapy in clinical practice]. 928 Aug 51

Eliciting information about a patient's family history is a component of a standard diagnostic evaluation. Since depression runs in families, a question arises as to whether family history information should be considered when diagnosing depression. The text of DSM-IV indicates that a family history of a mood disorder should sometimes be considered when trying to distinguish between major depressive disorder and other conditions such as catatonic schizophrenia. The questions posed herein are how well family history of depression performs as a diagnostic criterion, and how its performance compares with the DSM-IV symptom criteria. One thousand eight hundred psychiatric outpatients were evaluated with a semistructured diagnostic interview as part of a research assessment infrastructure that has been embedded in the Rhode Island Hospital Department of Psychiatry outpatient practice. Family history diagnoses were based on information provided by the patient. The interview followed the guide provided in the Family History Research Diagnostic Criteria. We constructed a continuum of family history morbidity based on the number of first-degree family members with a history of depression and whether the family member was treated for their depression. Thus, we determined the presence or absence of the family history diagnostic criterion in different ways. Family history information was collected on 9763 first-degree relatives of 1776 patients. The sensitivity of the family history criterion was lower than each of the symptoms. Based on the broadest definition of the family history variable, the specificity was also lower than all other symptoms. Based on the narrowest definition (two or more family members who were treated for depression), the specificity was higher than all of the symptom criteria though sensitivity dropped to 15%. Overall, as a diagnostic criterion, a family history of depression did not perform as well as the DSM-IV symptom criteria. Consistent with the familial nature of depression, the family history variable performed better as a diagnostic criterion when considering diagnosis from a lifetime, rather than a current, perspective. This has implications for the future consideration of genetic markers as diagnostic criteria.
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PMID:Diagnosing major depressive disorder VII: family history as a diagnostic criterion. 1697 23

Depression is diagnosed in 14 million Americans every year, and pharmacotherapy is the standard treatment. However, in approximately 50% of patients, pharmacology intervention does not resolve depression. Electroconvulsive therapy (ECT) has been a mainstay as a treatment option for treatment-resistant major depression since its inception in the 1930s. It has also been shown to be effective in treatment-resistant mania and catatonic schizophrenia. The complication rate of ECT has improved from 50% in the 1960's to almost anecdotal adverse events, similar to the morbidity and mortality seen in minor surgery and childbirth. Although anesthetic agents are administered briefly, many patients experience significant fluctuations in physiologic parameters. The clinical anesthesiologist must be aware of these changes as well as have an understanding of perioperative pharmacological interventions. ECT is a proven therapy for select psychiatric patients, and appropriate anesthesia is a critical part of successful ECT. Careful review of the patient's medical history may reveal pertinent anesthetic considerations.
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PMID:Update on anesthesia considerations for electroconvulsive therapy. 2039 44

Although patients with atrial fibrillation (AF) have an increased risk of embolic stroke, some clinicians hesitate to provide anticoagulation therapy for these patients during electroconvulsive therapy (ECT), which is widely applied for the treatment of intractable depression, bipolar disorder, and catatonic schizophrenia, because of potential intracerebral hemorrhage. We report on a 77-year-old female depressive patient with AF treated with aspirin but not on anticoagulation therapy because of poor compliance who developed embolic stroke 1 day after the last ECT. The CHADS2 score of this patient was 2 and included the age and hypertension. The present case suggests that anticoagulation therapy should be considered for patients with obvious risks of embolic stroke when they are subjected to ECT.
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PMID:Acute embolic stroke in a patient with atrial fibrillation after electroconvulsive therapy. 3052 84