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

A 62-year-old woman developed neurologic deficits 7 months after pulmonary lobectomy for alveolar cell carcinoma of the lung. CT scan of the head demonstrated two metastases with marked peritumoral edema. Administration of Decadron, chemotherapy and 3,000 rad cranial radiation resulted in dramatic improvement of dysphasia and right hand paresis. Almost 2 months later, rhythmic, involuntary movements of the left hand developed. There was progression to multifocal seizures, grand mal seizures, postictal depression, status epilepticus, and coma, with death 9 days after onset of the movement disorder. Bronchoalveolar carcinoma was widely disseminated in lungs and bones, and as three metastases in brain. Bland "ischemic" necrosis in a pseudolaminar pattern was present in the neocortex. Innumerable Cowdry type A intranuclear inclusion bodies were seen in neurons, astrocytes, and oligodenodroglia. Immunofluorescence demonstrated Herpes simplex virus type 2 antigen and electron microscopy revealed virions with the morphology of the Herpes group. The case is significant for (1) the concurrence of intracranial metastases and Herpes simplex encephalitis, and (2) the causal agent, Herpes simplex virus type 2. The implication for the clinical neurocientist is the potential in a patient with systemic cancer, for the causation of neurologic complications by more than one factor or mechanism.
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PMID:Herpes simplex type 2 encephalitis concurrent with known cerebral metastases. 22 22

We describe an unusual case of a giant pericallosal artery aneurysm, producing psychomotor depression from mass effect, associated with a smaller aneurysm of the anterior communicating artery, a dural arteriovenous fistula, and a meningioma. Magnetic resonance imaging (MRI) and cerebral angiography demonstrated the giant aneurysm and the meningioma. Cerebral angiography provided a detailed appreciation of the cerebral circulation, including both aneurysms, the dural arteriovenous fistula, and the potential collateral supply to the involved anterior cerebral distribution. The anterior communicating artery aneurysm was successfully clipped as was the distal anterior cerebral branch supplying the giant aneurysm before its resection. The patient made a full recovery but with persisting, slight dysphasia. We conclude that computed tomography, cerebral angiography, and MRI are of specific value in the assessment of giant aneurysms, but only angiography can provide detailed characterization of the aneurysm and demonstrate other possible cerebrovascular pathology such as multiple aneurysms and arteriovenous fistulas.
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PMID:Giant aneurysm of the distal anterior cerebral artery: associated with an anterior communicating artery aneurysm and a dural arteriovenous fistula. 148 11

In view of the strong evidence supporting the hypothesis that high Expressed Emotion of a key relative contributes to relapse in psychiatric patients, methods used in Expressed Emotion research were applied in an investigation of psychiatric disorder in stroke patients receiving hospital based rehabilitation and support. Patient mood in 37 stroke patients was related to the critical attitude of a key relative. Patient depression may also have been associated with severity of dysphasia, but no link was found between patient mood and the other measures of cognitive or physical deficit used in this study. Psychiatric distress in the key relative had a rather different causal basis. Relatives' psychiatric disorders were associated with physical burden, cognitive deficit, and severity of dysphasia. This study suggests that, when the patient is dependent for self-care, rehabilitation-assisted recovery may alleviate relative distress more than patient distress.
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PMID:Social, functional, and neuropsychological determinants of the psychiatric symptoms of stroke patients receiving rehabilitation and living at home. 344 76

The criteria for clinical response to treatment in cerebral glioma remain poorly defined, but could be made more objective if simple measures of neurological impairments were included in the definitions. We assessed the utility of simple fast previously validated tests of limb impairment (Timed nine hole peg test and 10 meter walk), memory (Williams delayed recall test) and language (Boston Aphasia Severity Rating Scale) in fifty patients with primary brain tumours to see if they could act as a surrogate for neurological impairment. The tests were compared with established measures of physical disability (Barthel Disability Index [BDI]) and handicap. Timed tests of hand function and gait were sensitive to minor impairments and were abnormal in patients with physical disability on BDI. Timed tests correlated well with handicap (rank correlation 0.734). Short term memory was impaired more commonly with tumours involving the left hemisphere (p < 0.01). Dysphasia limited testing of memory in 8%. Depression was associated with problems in limb function (p < 0.01), memory (p < 0.001), language (p < 0.001), BDI (p < 0.001) and handicap (p < 0.001). The number of abnormal fast tests also correlated with the severity of handicap (rank correlation 0.786) indicating that memory impairment and aphasia contribute to handicap and should be assessed. Median time to complete all assessments was 7 minutes 20 seconds. Utilization of these simple tests will add sensitivity and objectivity to evaluation of neurological response in clinical trials and can be performed quickly by non medical staff.
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PMID:Recording neurological impairment in clinical trials of glioma. 781 3

The main objectives were to study relationships between the design of group living (GL) units and psychiatric symptoms in demented patients before, 6 months after, and 1 year after admission to GL units. The study population comprised 105 demented elderly (83 +/- 6 years), 37% with dementia of Alzheimer's type and 58% with vascular dementia. The patients were relocated by the municipal care planning team after clinical examination. An observational scale (the Organic Brain Syndrome scale) was used to assess confusional symptoms and disorientation. The physical environment was assessed by an architect using the Therapeutic Environment Screening Scale, which evaluates general design, space, lighting, noise, communication area, floor plan, and related factors. Less than 15% of the patients had no signs of dyspraxia, hallucinosis, dysphasia, or depression at admission, whereas 66% or more reported lack of vitality, aggressiveness, or restlessness. Fourteen out of 18 units had a corridor-like design (group A), one unit an L-shaped design (group B), and the others a square or H-shaped design (group C). Patients living in the B unit had less disorientation than the others at the 6-month follow-up. After 1 year, the patients in the A units had more dyspraxia, lack of vitality, and disorientation of identity. The communication areas in the units were negatively associated with "disorientation for recent memory" and "lack of vitality," adjusted for type of dementia (r = -0.13 to -0.16). The size of the activity area, indoor public rooms in square meters, was not correlated to confusional reactions and disorientation. In conclusion, a GL unit design that facilitates perception without reducing the communication area is to be preferred.
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PMID:How should a group living unit for demented elderly be designed to decrease psychiatric symptoms? 907 44

We report a man who presented in 1981 at the age of 30 with cutaneous lupus erythematosus (LE), which was resistant to a range of treatments over the subsequent 11 years. In 1991 he suffered fits, dysphasia and agitated depression, and in 1992 a severe septicaemic illness. Systemic LE was diagnosed, and investigation showed homozygous complement type 2 deficiency (C2d). Over a period of 30 months he has received 6 weekly fresh frozen plasma. Since starting this treatment his cutaneous disease has resolved and his depression, verbal fluency and psychomotor scores improved. We have not observed any adverse effects to this treatment and suggest it should be considered in similar patients.
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PMID:Systemic lupus erythematosus complicating complement type 2 deficiency: successful treatment with fresh frozen plasma. 911 23

The aims of this prospective study were to investigate levels of anxiety and depression in patients with a solitary intracranial neoplasm before and after surgery, and to determine if relationships exist between high levels of anxiety or depression and the hemispheric location of the tumour, the tumour type or patient gender. Patients aged between 17 and 79 years with a solitary intracranial neoplasm completed the Hospital Anxiety and Depression Scale (HAD) before and after biopsy or resective tumour surgery. A control group of non-brain-damaged subjects also completed the HAD before and after lumbar spinal surgery. Of the 109 patients with a brain tumour 30 and 16% demonstrated the likely presence of anxiety and depression, respectively, according to HAD scoring criteria. A greater proportion of females with a left hemisphere tumour reported higher levels of emotional disturbance than any other group of patients; relationships between dysphasia and levels of anxiety or depression were not significant. Patients with a meningioma had higher levels of anxiety and depression as measured by the HAD than those with any other tumour types. Levels of both anxiety and depression were significantly lower after tumour surgery according to the HAD. There were no significant differences in HAD scores between (a) left and right hemispheric tumour groups, and (b) the tumour and control (n = 20) groups. This study has found that anxiety and depression as measured by the HAD are relatively uncommon in patients with an intracranial neoplasm, and that levels of mood disturbance do not differ significantly from those in patients undergoing lumbar spinal surgery. Levels of anxiety and depression become lower after surgery in patients with a brain tumour. Patterns of anxiety and depression in patients with a brain tumour appear to differ from those reported in stroke.
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PMID:Anxiety and depression in patients with an intracranial neoplasm before and after tumour surgery. 1049 84

We report clinical, radiological and virological data from nine consecutive HIV-infected patients with herpes simplex virus (HSV) infection of the central nervous system (CNS). Three patients presented with confusion, two with fever and headache, two with anxiety and depression, one with slow mentation and memory loss and one with expressive dysphasia. Five patients had previous AIDS-defining diagnoses: four of these five patients had previous cutaneous HSV infection. HSV DNA was detected by the polymerase chain reaction (PCR) on cerebrospinal fluid (CSF) in seven patients. HSV infection was diagnosed by brain biopsy (after negative PCR on CSF) in one patient and at autopsy in one patient (after negative CSF PCR and brain biopsy). Seven patients received specific anti-viral therapy; two died of unrelated causes and the other five recovered. Two patients were not treated, in one the diagnosis was made at autopsy and the other recovered spontaneously. HIV-infected patients with CNS HSV infection have a varied presentation. Diagnosis by PCR on CSF identified the majority of cases. With specific treatment the outcome was good.
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PMID:Herpes simplex virus infection of the central nervous system in human immunodeficiency virus-type 1-infected patients. 1533 67

In the nineties, Marin proposed to define apathy as a clinical syndrome due to a lack of motivation. The syndrome is characterized by a diminished goal-directed overt behaviors, a lack of interest or concern for social and personal activities and a lack of responsiveness to positive and negative events. Apathy is clearly distinct from depression and can be observed in many conditions, in healthy people as well as in psychiatric disorders such as depression or schizophrenia. It is very common in patients with brain lesions involving the frontal lobes, the right hemisphere, but also in degenerative diseases such as Alzheimer's disease. Motivation, considered as the source of apathy by Marin, is not a simple construct. It refers to a complex set of multiple affective and cognitive processes. However, it is considered, either in an energetic acception, as a single quantitative variable, a force which impulses action but not direct behavior or, in a more specific acception, as the factor which direct behavior towards specific actions. The description of apathy by Marin and the scales designed to its assessment, are based on the first acception. The term apathy is only descriptive, such as those of dysphasia or anosognosia. They do not allow to study the mechanisms underlying the motivation disorders, essential process for the management of apathetic patients. A tentative qualitative approach to assess motivation disorders is proposed, using a semi-structured interview. However, it should be stressed that motivation can not be directly assessed: motivation is a concept to explain some behavior disorders and an inference from the study of behavior.
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PMID:[Apathy: a useful but limited concept]. 1568 65

In recent years, post-stroke depression (PSD) has attracted a worldwide interest. This review addresses the major research issues of PSD. PSD is the most frequent psychic complication among stroke survivors. Depression has a significant impact on post-stroke recovery and mortality. The diagnosis of PSD is based on the structured mental state examination and DSM-IV criteria as well as on the scores of the clinical symptoms scale (the Hamilton Depression Rating Scale) and self-rated inventories. PSD is multifactorial in origin and develops under the influence of biopsychosocial factors. The anatomical correlates of PSD change over time. In acute stage and 3-6 months after stroke, depression is associated with left-hemisphere lesion severity and proximity of the lesion to the frontal pole and related to the dysfunction of (cortico-) striato-pallido-thalamic-cortical projections. In post-stroke period (1-2 years) depression is significantly associated with right-hemisphere lesion severity and proximity of the lesion to the occipital pole. The most relevant psychosocial risk factors for PSD are described as follows: past history of depression and other mental disorders, dysphasia, functional impairment, living alone and post-stroke social isolation. Selective serotonin reuptake inhibitors (citalopram and fluoxetine) may be effective in the treatment of PSD.
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PMID:[Post-stroke depression]. 1819 38


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