Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The pharmacological properties of centrally acting alpha2-receptor agonists such as clonidine suggest a potentially important role as ideal adjuvants for anesthesia since they produce sedation, analgesia anxiolysis, xerostomia and cardiovascular stability without respiratory depression, development of tolerance or addiction liability. Further clinical experience with this exciting development will undoubtedly establish the ultimate role and optimal use of alpha2 -receptor agonists in anesthetic practice. Beta-blockage can result in significant bradycardia, atrial ventricular conduction problems, bronchospasm and left ventricular contractile dysfunction. Thus, the use of long-acting beta-blockers is of limited value in the perioperative period. Esmolol, because of its ultrashort action, cardioselective properties and titratability, has been shown to be safe and effective for the treatment of tachycardia and hypertension. Doses from 50 to 300 micrograms/kg/min for up to 7 hours in the perioperative period have been shown to cause no apparent cumulative effect. It has been used in the treatment of asthmatic patients with tachycardia and hypertension without significant increases in airway resistance. Studies using esmolol during general anesthesia have demonstrated no significant interaction with several anesthetic regimens.
 ...
PMID:Clinical pharmacology of alpha2-agonist and beta-adrenergic blocker. 257 80

Thirty seven consecutive applicants to methadone maintenance were assessed for depression and for level of opiate dependence using a 0.8-mg naloxone challenge. Nineteen of the applicants met DSM-III-R criteria for current major depression. At 3-month follow-up, high naloxone challenge test (NCT) scores at intake (high levels of opiate addiction) were found to predict poor program retention and elevated symptoms of depression at follow-up. Reports of heavy current drug use at intake were also associated with poor program retention and with high frequencies of positive urine screens for illicit substances during treatment. Level of addiction and reported amount of drug use at intake independently predicted program retention with a multiple correlation of 0.46 (P less than .01). Although NCT predicted depression at follow-up, depression at intake did not significantly predict treatment outcome, and NCT score predicted outcome independently of psychopathology.
 ...
PMID:Naloxone challenge as a biological predictor of treatment outcome in opiate addicts. 259 40

Chronically suicidal persons with chronic psychiatric disorders (dysthymia, recurrent depression, alcoholism/addiction, schizophrenia, personality disorders) challenge the experience and resourcefulness of psychiatrists. The author reviews his 30 years of experience with these patients and makes six recommendations for long-term treatment: (1) a team approach using consultants and ancillary therapists, (2) flexible therapeutic plans combining medication with psychotherapy, (3) care in monitoring transference and countertransference, (4) brief hospitalization at turning points in the patient's life or in the treatment, (5) decisions based on risk-benefit evaluation, and (6) appropriate record keeping. He also summarizes effective treatment approaches with patients who have chronic psychiatric disorders.
 ...
PMID:Long-term treatment of chronically suicidal patients. 265 88

Identification of 5-HT receptor subtypes--5-HT1A, 5-HT1B, 5-HT1C, 5-HT1D, 5-HT2 (possibly A and B), 5-HT3 subtypes, and possibly 5-HT4--has encouraged the manufacture of 5-HT receptor inhibitors with greater subtype specificity. However, it appears that the receptors interact, and drugs initially thought to be specific may have multiple actions. For some conditions such as anxiety/depression, almost all receptors are implicated. Clinical studies provide clear evidence that manipulation of the 5-HT system has a role in treating depression, anxiety, obsessional illness, migraine, and eating disorders. Interactions between the various receptor subtypes make it difficult to identify specific clinical functions. The 5-HT1A receptors may be involved in aggression, anorexia, and hypotension. The 5-HT1B receptors may be involved in aggression, while the 5-HT1C receptors may play a role in central aversion systems and anxiety/depression. The role of the 5-HT1D receptors remains speculative; 5-HT2 receptors appear to be involved in depression, anxiety, appetite, sleep, vasoconstriction, and hypertension. Many drugs that are effective in treating migraine are potent 5-HT2 antagonists. 5-HT3 antagonists at high doses are effective in treating nausea and at low doses in treating anxiety. Treatment of aggression, suicidal behaviour, addiction behaviour, memory impairment, dementia, and schizophrenia with 5-HT inhibitors requires further testing.
 ...
PMID:Is there a relationship between serotonin receptor subtypes and selectivity of response in specific psychiatric illnesses? 269 41

One hundred cocaine abusers were evaluated with a full battery of psychological tests (Shipley Institute of Living Scale, MMPI, Millon Clinical Multiaxial Inventory, Rorschach, Beck Depression Inventory) by Norman J. Lesswing, Ph.D. These patients were treated in a 6-week program on a chemical dependency unit at the Benjamin Rush Center in Syracuse, New York, from 1984 to 1986. Information was gathered across a wide range of demographic and clinical variables (age, sex, marital status, race, education, family history, and cross addiction), and psychological features (MMPI profile types, intellectual functioning, personality disorders, depression ratings, and Rorschach variables). Results are presented through comprehensive description of the sample across these patient and psychometric characteristics with use of summary statistics. Support was not found for the notion that cocaine abusers are self-medicating affective disorders, but evidence for high frequency of personality disorders was revealed. Cross addiction and abuse of alcohol and other substances were very frequent.
 ...
PMID:Inpatient cocaine abusers: an analysis of psychological and demographic variables. 270 73

A series of 252 patients with terminal cancer (mostly with bony metastases) were treated with epidural morphine. Results were good to excellent pain relief in 85% of patients, but those with malignant growths above the neck showed relatively poor response. For those who survived more than 3 months, the daily morphine requirement increased progressively from 3.5 +/- 0.6 mg to 19.5 +/- 5.3 mg. Drug tolerance developed but no signs of addiction were noted. Respiratory depression was detected in 2 cases due to negligence but resolved uneventfully. No infection of the central nervous system was seen. Systemic reactions were mild and transient. The major drawbacks were catheter failure which required reinsertion, and sharp pain during injection in the later stages of therapy. Despite the side-effects, percutaneous epidural morphine is a useful treatment modality of pain control in cancer patients because it is readily available, safe and not too expensive.
 ...
PMID:A preliminary study of long-term epidural morphine for cancer pain via a subcutaneously implanted reservoir. 272 85

Early studies examining the relationship of personality disorders to opiate addiction attempted to define an "addictive personality." Later research found that personality disorders in opiate addicts were common but heterogeneous. We examined whether different comorbid personality disorders have prognostic specificity. Rates of depression and alcoholism as well as assessments of specific problems were measured in a 2.5-year follow-up of 150 treated opioid addicts. Using DSM-III criteria, we found that borderline personality disorder predicted more depressive disorders and alcoholism at follow-up; yet greater recovery from these disorders was seen. Borderline patients had more severe psychiatric problems as measured by the Addiction Severity Index. Other ASI outcomes differed by personality disorder; antisocial addicts had more legal problems, and narcissistic addicts had more medical problems. These results suggest that treatment for opiate addicts be tailored to the specific needs of the patients, which can be predicted, in part, by their comorbid personality disorder diagnosis.
 ...
PMID:Personality disorders in opiate addicts show prognostic specificity. 279 5

This paper has examined the possibilities of applying significant pharmacologic help to a variety of psychiatric problems that may accompany narcotic addiction. It has been shown that many of the patients do have such difficulties, with affective disorders being most common. As far as the various psychotropic drugs are concerned, neuroleptics for schizophrenia and lithium for manic disorders are generally agreed upon. A more extensive trial of lithium in a variety of situations seems indicated. Minor tranquilizers for anxiety and MAO-inhibitors for depression are both seen as problematic in this population--the former because of the possibility of abuse, the latter because of the danger of drug interaction associated with the addict's careless lifestyle. Tricyclic antidepressants may clearly have a role in treating major depression in opiate addicts on or off methadone, but the lability of the syndrome over time with frequent spontaneous remission argues against their routine use until it is clear that depression has persisted 3-6 months into methadone. Disulfiram appears to be a useful adjunct for drug abusers with serious alcohol problems. Psychotropic agents are most helpful to opiate addicts when used to treat coexisting psychopathology. While there is no clear evidence that such agents will reduce or affect the addiction itself, they may help keep patients available for rehabilitation efforts. Failure to intervene may make treatment dropout and recidivism more likely. Given the relative frequency of potentially treatable psychiatric disorders in these patients and the consequences of undiagnosed and untreated conditions, it is important for clinicians to maintain a high index of suspicion for concomitant psychiatric illness and for programs to have a mechanism for routinely diagnosing either all patients or, at a minimum, all patients not doing well. If programs used a standard instrument such as the SADS, it would be possible to compare various programs on this factor; in addition, it would provide a rich source of data for outcome studies.
 ...
PMID:Brief effective treatment strategies: pharmacological therapy for opiate addicts. 286 55

Psychotropic agents are most helpful to opiate addicts when used to treat co-existing psychopathology. While such agents may not impact directly on the addiction itself, they might help keep patients available for rehabilitation efforts since concomitant severe psychopathology has been associated with poorer outcome. Neuroleptics for schizophrenia and lithium for manic disorders are generally agreed upon. Minor tranquilizers for anxiety and MAO inhibitors for depression may be too risky for this population. Tricyclic antidepressants clearly have a role in treating major depression in addicts but the lability of the syndrome over time argues against their routine use until the depression has persisted at least 3 months.
 ...
PMID:The use of psychotropic drugs in the treatment of compulsive opiate abusers: the rationale for their use. 287 Jun 23

Pain is a complex somato-psychic experience, and all pains do not respond equally to opioid analgesics. Muscle and deafferentation pains are best eased by alternative treatments. Bone pain responds best to the combined use of morphine and an NSAID. Nerve compression often necessitates the concurrent use of a corticosteroid. Few patients need neurolytic or neuro-ablative procedures. Opioid use is governed by three key principles: "By the mouth," "by the clock," and "by the ladder." Morphine remains the strong opioid of choice for most patients. Respiratory depression is not a problem, nor is tolerance. Addiction (psychological dependence) does not occur in patients with opioid responsive pains.
 ...
PMID:The management of pain in cancer: a guide to drugs and dosages. 290 83


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>