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

The use of the psychostimulants in psychiatry is reviewed. A brief historical perspective on dextroamphetamine is presented, and a brief review of the psychopharmacology of dextroamphetamine, methylphenidate and magnesium pemoline is given. The literature on the use of stimulants in the treatment of resistant depression, apathetic geriatric patients and patients medically ill with a secondary depression is summarized and two case histories given to illustrate the clinical usefulness of the stimulants. The literature on the use of stimulants as an adjunct to antidepressant therapy and as a diagnostic test is also discussed. Finally the use of stimulants in obsessional illness and adult attention deficit disorder is summarized. The writer concludes by commenting that the stimulants have a very useful role in the treatment of certain categories of depression as well as other psychiatric syndromes and such patients should not be deprived of symptom relief by these drugs. The approach to therapy should be much the same as the use of analgesics for chronic pain sufferers.
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PMID:Psychostimulants in psychiatry. 218 May 48

Twenty-three consecutive admissions to a psychodynamically oriented day treatment program were assessed using a pre-/post-test design. Discharge scores revealed a significant improvement on all standardized scales for behaviour (p less than .0001), academics (p less than .05), personality measures (p less than .0001) and family measures (p less than .05). Parents reported a significantly greater behavioural improvement than both teachers and primary therapists (p less than .0001). Although all children showed improvement, parents reported significantly lower improvement rates (p less than 0.05) for children with conduct disorder compared with attention deficit disorder, oppositional defiant disorder and depression. Teachers found that younger boys (aged six to nine) showed a significantly greater improvement (p less than .05) than older boys (aged ten to 12) in total behaviour score and externalizing subscores of the Revised Child Behavior Profile. At discharge 87% of children were reintegrated into regular school; only 17% were attending regular school at admission.
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PMID:Evaluation of the effectiveness of a psychodynamically oriented day treatment program for children with behaviour problems: a pilot study. 220 86

The comorbidity between attention deficit disorder (ADD) and anxiety and/or depressive disorders was examined in the children of parents with panic disorder, major depressive disorder, or with no diagnosis. A child received a diagnosis by a self-report, parent report, and by consensus, using a best estimate procedure. The prevalence rates of ADD were significantly greater in offspring of parents with depressive and panic disorder by the parents' report and in children of depressed parents by consensus. A significant relationship between ADD and anxiety and/or depression was found for parent, child, and consensus diagnoses. Higher rates of ADD were reported by children (1% versus 13%), parents (8% versus 31%), and in the consensus diagnoses (13% versus 29%) when anxiety and/or depression was present. These results suggest that in children referred for evaluation of ADD, the possibility of a primary anxiety or depressive disorder should be considered.
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PMID:Attention deficit disorder in children at risk for anxiety and depression. 238 87

A yin-yang hypothesis is presented linking noradrenergic activity, thromboxane, melatonin, left hemisphere functioning, and cyclic AMP on the one hand, and dopamine, beta-endorphin, calcium, right hemisphere functioning, and cyclic GMP on the other. It is further suggested that there is a yoking of NA, TXA2, serotonin and melatonin in the left hemisphere, and a similar yoking of DA, BE, calcium and cGMP in the right. Evidence is presented to support the hypothesis that each element (NA, TXA2, etc.) on one side can modulate or balance a corresponding element (DA, BE, etc.) on the other. It is suggested that thromboxane is the key element in noradrenergic overactivity and that not taking this into consideration has confounded much prior research. This theory takes into account information processing models as well as pharmacological data and neurochemical theory on coupling of adenylate cyclase to its hormone receptors. Inhibiting noradrenergic overactivity can be obtained by inhibiting thromboxane and concomitantly activating opiate receptors. This protocol may have clinical utility in treating a wide range of disorders such as: anxiety, depression, schizophrenia, sleeplessness, withdrawal states, enuresis, Gilles de la Tourette syndrome, Parkinsonism, Alzheimers, dementia, anorexia, infant ruminations, essential tremor, spasticity of spinal cord injury, diarrhoea, ulcerative colitis, extrapyramidal symptoms, akathisia, neuroleptic malignant syndrome, attention deficit disorder, hyperhidrosis, and possibly AIDS.
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PMID:Inhibiting noradrenergic overactivity by inhibition of thromboxane and concomitant activation of opiate receptors via dietary means. 254 22

Effective antidepressants, including imipramine and monoamine oxidase (MAO) inhibitors, were discovered serendipitously in the 1950s. Many additional agents have been introduced since then, but most are chemically or pharmacologically similar to those known for nearly four decades. Some recently introduced antidepressants offer either lesser or dissimilar side effects, but none exceeds older treatments in efficacy. Selective serotoninpotentiating agents and short-acting MAO-A inhibitors promise efficacy with greater safety. Progress is made difficult because atypical or treatment-resistant patients are more often available for study than typical patients, and because most studies must rely heavily on potentially misleading "standard drug versus new drug" comparisons. Rational development of novel or better agents is slow, in part, due to limited understanding of the biological basis of major affective disorders and some circularity in relating actions of known drugs to pathophysiologic hypotheses. Action mechanisms of antidepressants are subtle and complex: adaptive changes occur in brain monoaminergic neurotransmission following repeated administration of agents of the tricyclic antidepressant (TCA) type that may lead to net facilitation of alpha 1-adrenergic transmission. Important advances have been made in using plasma TCA levels to guide individualization of dosing, in exploring higher doses of antidepressants when ordinary doses prove ineffective, and in recognizing a broadening spectrum of possible indications for antidepressants in adults and children. These indications include panic disorder, obsessive compulsive disorder, attention deficit disorder, and bulimia. Evidence for the prophylactic effects of antidepressants after the first months following recovery from an index episode of major depression is weak, and the treatment of common recurrent or chronic depression remains unsatisfactory. Gains have been made in increasing clinicians' and the general public's awareness of the common occurrence and appropriate treatment of major depression, even when the depression is associated with other medical or psychiatric disorders.
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PMID:Current status of antidepressants: clinical pharmacology and therapy. 250 33

Data are presented on risk factors for childhood psychopathology derived from a study of an island-wide probability sample of children in Puerto Rico aged 4 through 16 years. Analyses estimated the effects of 12 demographic, health, and family variables on the probability of being a "case," using two different operational definitions of caseness, as well as on the probability of receiving the diagnoses of oppositional disorder, attention deficit disorder, separation anxiety, depression, functional enuresis, and adjustment disorder. When compared to other findings, the results from these analyses indicate that the relationship between maladjustment and the risk factors evaluated does not appear to be culturally specific.
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PMID:Risk factors for maladjustment in Puerto Rican children. 280 53

Binding characteristics of tritiated imipramine on blood platelets were determined in daytime hospitalized prepubertal children who had mixed diagnoses of conduct disorder (CD) plus attention deficit disorder hyperactivity (ADDH) and in inpatient adolescents who had a history of aggressive behavior. The number of (3H)-imipramine maximal binding sites (Bmax) was significantly lower in the prepubertal patient group of CD plus ADDH; the dissociation constant (Kd) was not significantly different. There were significant negative correlations between Bmax and the Externalizing or Aggressive factors of the Child Behavior Checklist when the CD plus ADDH prepubertal patients were combined with their matched controls and within the adolescent inpatient group. We propose that a decreased platelet imipramine binding Bmax value, as an index of disturbed presynaptic serotonergic activity, is not specific to depression and may be used as a biologic marker for the lack of behavioral constraint in heterogeneous. populations of psychiatric patients.
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PMID:Reduction of (3H)-imipramine binding sites on platelets of conduct-disordered children. 285 2

Patients with both alcoholism and mental illness, or the one masquerading as the other, are very common and often puzzling and discouraging to clinicians. This article reviews several aspects of these problems: epidemiologic studies show that substantial proportions of mentally ill people suffer from alcoholism, and these disorders interlock in complex ways, each exacerbating the other. Many physicians feel uncomfortable working with alcoholic people, mostly because of poor training, and this impinges on difficulties of giving excellent care to these taxing patients. Complexities and resistances to interviewing obstruct evaluation. Interviewing and history taking techniques and the reason for them are discussed. The decision whether a patient needs medical or psychiatric hospitalization, alcoholism rehabilitation, or outpatient psychiatric or alcoholism treatment is reviewed along with the management and sequencing of treatment for primary and secondary alcoholism with concomitant psychosis, mania, depression, panic disorder, and adult attention deficit disorder. Clinical intervention and referral for the patient on a medical or surgical floor who may have alcoholism is discussed. Two special clinical problems, the differential diagnosis of postdetoxification depression and the risks of using alcohol cross-tolerant drugs, are also reviewed.
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PMID:Inpatient treatment of the psychiatric patient with alcoholism. 288 66

As part of a longitudinal nosologic study of major depressive disorder (MDD), dysthymic disorder, and adjustment disorder with depressed mood in 104 school-aged probands, the prevalence and consequences of comorbid conduct disorders (CD) were examined. During the index depressive episodes, 16% of the patients had comorbid CD; during the full study observation 23% had CD; and the estimated time-dependent risk of conduct disorder developing was 36% by age 19. For most cases, comorbid CD developed as a complication of the depression and persisted after the depression remitted. Comorbid CD was not differentially associated with the type of depression at study entry, did not affect depressive symptom presentation, was similarly distributed among boys and girls, and was unrelated to demographic factors. Additionally, comorbid CD did not affect recovery from the index depressive episodes and did not influence the symptom-free interval before a recurrent depression among cases with MDD. The risk of CD developing was not altered by chronologically earlier family variables or demographic factors. But girls who had attention deficit disorder, compared to those who did not, seemed to be at higher risk for CD during study observation. Finally, in this depressed cohort, having CD any time was associated with an increased rate of long-term functional problems.
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PMID:Depressive disorders in childhood. III. A longitudinal study of comorbidity with and risk for conduct disorders. 297 93

This study examines the prevalence of psychiatric dysfunction in the children of parents diagnosed with affective disorders. Sixty children from 37 proband families were compared to 43 children from 26 families obtained from matched controls as well as 20 children from 13 medically ill families. Group differences in diagnosable childhood disorders and familial characteristics are investigated. Significantly more disorders and symptoms were noted in the children with psychiatrically ill parents as compared to children from matched controls and medically ill parents. Using logistic and Cox survival analyses, correlates for the risk of affective disorder, attention deficit and conduct disorder in the children were examined. Maternal depression and paternal alcoholism were related to the risk for depression in the child. The child's sex and the presence of affective disorders in the father were significantly related to the risk for attention deficit disorder. Maternal alcoholism, parental divorce and the type of subject (proband or control family) were significantly related to the risk for conduct disorder. The findings are discussed relative to results from earlier studies on rates of disorder in the offspring of depressed parents.
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PMID:School-aged children of depressed parents: a blind and controlled study. 297 1


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