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

Repetitive transcranial magnetic stimulation (rTMS) is a new technology which holds promise as a treatment of psychiatric disorders. Most work to date has been on depression. Superiority to placebo has been indicated in three small blind studies. We compared the antidepressant effects of rTMS and ECT in 32 patients suffering major depressive episode (MDE) who had failed to respond to at least one course of medication. There was no limit to the number of treatment sessions which could be given and treatment was continued until remission occurred or response plateaued. A significant main effect for treatment type was found [Pillai trace = 0.248, F(3,28) = 3.076, p = 0.044; power = 0.656], reflecting an advantage for ECT patients on measures of depression overall, however, rTMS produced comparable results on a number of measures. Blind raters using the 17-item Hamilton Depression Rating Scale (HDRS) found the rate of remission (HDRS = ? 8) was the same (68.8%), and the percentage improvement over the course of treatment of 55.6% (rTMS) and 66.4% (ECT), while favouring ECT, was not significantly different. Significant differences were shown (p & 0.03) in percentage improvement on Beck Depression Inventory ratings (rTMS, 45.5%; ECT, 69.1%), but not for improvement in Visual Analogue ratings of mood (rTMS 42.3%; ECT, 57%). rTMS has antidepressant effects of useful proportions and further studies are indicated.
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PMID:Comparison of unlimited numbers of rapid transcranial magnetic stimulation (rTMS) and ECT treatment sessions in major depressive episode. 1134 89

Diurnal, nocturnal or seasonal modes of behavior are not passive responses to changes in the environment; rather, they are generated by an endogenous circadian pacemaker, entrained by a few environmental cues like lightdark cycles. Circadian clock mechanisms involve periodic gene expression, synchronized by a hierarchically superior structure located in mammals in the hypothalamic suprachiasmatic nuclei. Cycles of sleep and wakefulness are the most conspicuous circadian rhythm. Since modern humans use artificial light to extend their period of wakefulness and activity into the evening hours, they adhere to a shortnight sleep schedule with a highly consolidated and efficient sleep. As shown by studies in artificial long nights, modern humans may be sleepdeprived. Humans have also increasingly insulated themselves from the natural cycles of light and darkness. Still, the human circadian pacemaker has conserved a capacity to detect seasonal changes in day length. A mood disorder involving a recurring autumn or winter depression (seasonal affective disorder, SAD) is related to latitude, with the number of cases increasing with distance from the equator. SAD is ameliorated by using brilliant light. In nonseasonal depression, mood typically fluctuates daily, with improvement over the course of the day, and various physiological functions exhibit an altered circadian pattern, suggesting a link with circadian disruption. Treatment of circadian rhythm disorders, whether precipitated by intrinsic factors (e.g., sleep disorders, blindness, mental disorders, aging) or by extrinsic factors (e.g., jet lag, shift work) has led to the development of a new type of agents called "chronobiotics," among which melatonin is the prototype.
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PMID:The human body circadian: How the biologic clock influences sleep and emotion. 1145 28

The association between regional measures of cortical atrophy and neuropsychological (NP) dysfunction was studied in 35 multiple sclerosis (MS) patients. Patients underwent neurological examination, MRI, and NP testing. Blind quantitative MRI analysis yielded total T(2) lesion area (TLA) and third ventricle width (3VW). Cortical atrophy, rated by blind visual inspection, was more extensive in superior frontal and parietal cortices than in other regions. No MRI measures were correlated with depression scores. TLA and 3VW were significantly correlated with each NP test. Cortical atrophy measures for bilateral superior frontal cortex were retained in regression models predicting impairments in verbal learning, spatial learning, attention, and conceptual reasoning. The authors conclude that cerebral atrophy predicts NP impairment while accounting for the influence of TLA or 3VW. Regions of cortex most susceptible to atrophic and cognitive changes in MS are the right and left superior frontal lobes.
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PMID:Frontal cortex atrophy predicts cognitive impairment in multiple sclerosis. 1188 54

Thirty-eight psychiatric inpatients who fulfilled DSM-III criteria for major depressive disorder with melancholia received weekly dexamethasone suppression tests (DSTs) while undergoing a clinical course of ECT. Blind ratings of clinical improvement were obtained weekly from patients on the Beck Depression Inventory and from physicians and nurses on the Hamilton Depression Scale. The 26 patients with abnormal DSTs and the 12 patients with normal DSTs demonstrated an equivalent rate of clinical remission (75 vs. 77%) as defined by a composite rating of the nurse, physician, and patient. Other individual rater analyses also confirmed the finding that initial DST status is not predictive of response to a course of ECT.
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PMID:Dexamethasone Suppression Test as a Predictor of Response to Electroconvulsive Therapy. I. Inpatient Treatment. 1194 Aug 61

Vision loss is ranked third behind arthritis and heart disease as the most common condition causing a need for assistance with activities of daily living (ADLs) for persons 70 years and older, but is often overlooked in the home care setting when treating patients for other conditions. Visual impairments lead to patient depression, anxiety, increased passivity, decreased confidence, and feelings of social isolation. Vision rehabilitation can play a dramatic part in keeping these patients healthy and functioning at their maximal level.
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PMID:A caregiver's eye on elders with low vision. 1255 58

Cyclic GMP (cGMP) has been implicated in the modulation of long-term potentiation (LTP) and depression (LTD) in the hippocampus. Transcripts for subunits of several types of cGMP specific phosphodiesterase are found in the mammalian brain but their relative role in hippocampal function is unclear. The retinal degeneration (rd) mutation in the gene encoding the PDE6B subunit causes a loss of function in PDE6 enzyme and in adult mice homozygous to the mutation it causes blindness. We have used this natural mutation, and the cGMP phosphodiesterase inhibitor zaprinast, in wild-type and rd/rd mouse littermates to investigate whether PDE5 and/or PDE6 regulates excitatory synaptic transmission in the hippocampus. Mice were genotyped using two independent PCR methods. Glutamate-mediated synaptic transmission in the CA1 region or dentate gyrus was unaffected in hippocampal brain slices from mice carrying the rd mutation. Similarly the facilitation of synaptic events by paired-pulse stimuli, and LTP induced by a theta-burst (10 bursts of four events at 100 Hz with a 200-ms inter-burst interval) were normal in rd/rd mice. Inhibition of cGMP-specific PDE activity by zaprinast (10 microM, an inhibitor of PDE5 and PDE6) induced a slowly developing and sustained depression of field synaptic potentials that was quantitatively similar in both wild-type and rd/rd mice. Thus in the CA1 region synaptic plasticity is likely to be regulated by the PDE5 rather than the PDE6 isoform.
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PMID:Hippocampal synaptic plasticity in mice carrying the rd mutation in the gene encoding cGMP phosphodiesterase type 6 (PDE6). 1265 Sep 75

Alcohol intoxication is the principal drug addiction in many countries of the world. It affects all age groups, both sexes and almost all social groups. Mortality associated with acute alcohol poisoning on its own is exceptional, but it can be an important factor if it coexists with recreational drugs. It is directly responsible for more than half of traffic accidents. Diagnosis is easy by means of anamnesis and clinical examination, and can be confirmed by determining the level of ethanol in the bloodstream. Supportive care is the best therapy in order to protect the patient from secondary complications. Methanol, or alcohol fuel, is used as a solvent, and can also be found as an adulterant of alcoholic drinks. Poisoning by oral means is the most frequent. Oxidized in the liver through dehydrogenase enzyme alcohol, toxicity is due to its metabolites, formaldehyde and formic acid. The clinical picture basically consists of cephalea, nausea, vomiting, hypotension and depression of the central nervous system. The optic nerve is especially sensitive, with total and irreversible blindness as a possible result. Ethylenglicol is used as a solvent and as an antifreeze; toxicity is due to an accumulation of its metabolites. The clinical picture includes symptoms that are held in common with methylalcohol intoxication. Kidney failure due to tubular necrosis and the deposit of oxalate crystals can occur.
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PMID:[Alcohol intoxication]. 1281 81

The advent of bupropion hydrochloride sustained release (Zyban) has heralded a major change in the options available for smoking cessation pharmacotherapy. Bupropion is a selective re-uptake inhibitor of dopamine and noradrenalin which prevents or reduces cravings and other features of nicotine withdrawal. Bupropion is a useful oral and non-nicotine form of pharmacotherapy for smoking cessation. For this review a total of 221 papers were reviewed plus poster presentations. This review examines in detail original clinical trials on efficacy, categorised according to whether they were acute treatment trials in healthy smokers; studies in specific populations such as people with depression, chronic obstructive pulmonary disease (COPD) or cardiovascular disease; or relapse prevention studies. Overall, these studies in varying populations comprising over four thousand subjects, showed bupropion consistently produces a positive effect on smoking cessation outcomes. The evidence highlights the major public health role that bupropion has in smoking cessation. The methodological issues of published clinical trials reporting one year outcomes were examined in detail including: completeness of follow-up; loss to follow-up; intention to treat analysis; blindness of assessment; and validation of smoking status. The review discusses contraindications, adverse effects, dose and overdose, addictive potential, and the role of bupropion in reducing cessation-related weight gain. Bupropion combined with or compared to other pharmacotherapies (nicotine patch; nortriptyline) is considered. Impressive evidence exists for the use of bupropion in smoking cessation among difficult patients who are hard-core smokers such as those with cardiovascular disease, chronic obstructive pulmonary disease (COPD) and depression. Bupropion reduces withdrawal symptoms as well as weight gain and is effective for smoking cessation for people with and without a history of depression or alcoholism. Serious side effects of bupropion use are rare. The major safety issue with bupropion is risk of seizures (estimated at approximately 0.1%) and it should not be prescribed to patients with a current seizure disorder or any history of seizures. In clinical trials of bupropion for smoking cessation no seizures were reported. Allergic reactions occur at a rate of approximately 3% and minor adverse effects are common including dry mouth and insomnia.
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PMID:Review of bupropion for smoking cessation. 1285 Sep 7

The traditional methods of pharmacotherapy of the degenerative diseases of the central nervous system do not frequently allow one to achieve the desired clinical effect. The fundamentally new approach for the treatment of severe neurological diseases is provided by the methods of biological medicine, in particular, transplantation of a complex of fetal tissues. Cell-based therapy was used to treat patients with multiple sclerosis; ante-, intra- and postnatal lesions; consequences of hemorrhagic and ischemic apoplexies; neuritis of facial nerve; sclerosis; Parkinson's disease; Alzheimer's disease; epilepsy and other types of pathologic process. The source material for obtaining a suspension of cells was the fetuses of allogenic origin. The suspension of brain cells in amounts of up to 1.5 x 10(8) cells and vitality not less than 40% was administered to the patients into liquor spaces using the method of endolumbar puncture. The total number of transplantations was 1900. Practically in all the cases FT was tolerated well. Positive clinical and immunologic changes were observed in the majority of the patients, thus, remission induction (in the patients with the progressive course of multiple sclerosis) for a period over 12 months was registered in 87.5% of the cases. Noteworthy that considerable changes were observed in immunograms: depression of antibody levels to brain-specific proteins, native and denatured DNA; quantitative and qualitative improvement of lymphocyte subpopulation indices, positive changes in the immunoregulatory index. Clinically, in 69% of the cases there was an improvement in more than one neurological defect and a change in the values of the Kurtzke scale towards a decrease by 2-3 points. The conduct of cell therapy with the MS patients under the acute process conditions after liquorosorption allowed the arresting of clinical manifestations and the creation of preconditions for further restoration. The retrobulbar transplantations provided a quick arrest of the retrobulbar neuritis clinical symptoms and in one case an almost complete restoration of vision in the patient with amaurosis (blindness). The remission duration has a marked direct dependence on the number of courses of endolumbar transplantations. Thus, the method of cell therapy with the use of human tissue transplantations is safe and can be used for different neurodegenerative lesions of the central nervous system. The high efficacy of the method suggests the possibility and necessity of using this method as an alternative of classical pharmacological therapy. An important element of cell therapy is the control after the state of the patient's immunity system.
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PMID:Cell-based therapy of chronic degenerative diseases of the central nervous system. 1290 13

Idiopathic intracranial hypertension (IIH) is an unusual disease, seen most often in women of childbearing age who are obese. If left untreated, IIH can cause chronic pain and blindness. Although IIH has been recognized by healthcare providers since the late 1880s, the cause is still not known and risk factors remain unclear. Treatment has not changed over the years. While professionals struggle to define, describe, and successfully treat IIH, persons with the disease are struggling to cope. Internet support group communications relate numerous personal stories of frustration, depression, pain, anxiety, and disability. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) model provides an appropriate framework through which to view what is known and what is yet to be discovered about IIH. The ICF model was designed to complement the International Statistical Classification of Diseases and Related Health Problems, looking beyond mortality and disease by describing how people live with their health conditions. Applying this framework to IIH reveals many opportunities for nursing research within the ICF domains of health condition, body function and structure, ability and participation, and environmental and personal factors.
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PMID:Idiopathic intracranial hypertension within the ICF model: a review of the literature. 1459 37


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