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

A 6-week randomized, double-blind, placebo controlled trial of desipramine (DMI) in daily doses averaging 4 to 5 mg/kg for the treatment of children and adolescents with attention deficit disorder with hyperactivity (ADDH) was further analyzed. Investigators examined whether comorbidity of ADDH with conduct disorder, major depression, an anxiety disorder, or a family history of ADDH predicted response to DMI treatment. There was a highly significant effect of treatment with DMI in outcome assessments, but responses to DMI were indistinguishable in ADDH patients with and without a comorbid disorder or familial ADDH. Cases of "pure" ADDH (lacking comorbidity with depression, anxiety, or conduct disorder and having a positive family history of ADDH) showed a trend toward lesser placebo responses and a corresponding greater DMI-placebo difference. These findings suggest that (1) DMI is effective in simple, noncomorbid cases, (2) DMI is not selective for comorbid cases, but (3) a response to DMI can be obtained even in complex cases of ADDH with associated comorbidity.
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PMID:A double-blind placebo controlled study of desipramine in the treatment of ADD: III. Lack of impact of comorbidity and family history factors on clinical response. 842 72

Vigilance has been defined as steady-state alertness-wakefulness. The right cerebral hemisphere, predominantly the right inferior parietal lobule and posterior parietal cortices, seems specialized for vigilance. Studies of the primary disorder of vigilance, a genetically determined condition, should provide a better understanding of the neurobiology of vigilance. Common causes of secondary hypovigilance (depression, learning disability, narcolepsy, and acquired focal right cerebral hemisphere brain lesions) explain the symptom complex of ADHD. If these specific entities producing hypovigilance are correctly identified, treatment is successful and with favorable outcome. The neuroanatomic substrate of lowered vigilance seems to be loss of modulating influence of the right cerebral hemisphere on the diencephalon and select brain stem nuclei. We propose that the right (more than the left) cerebral hemisphere is responsible for alertness and wakefulness (vigilance) with the reticular formation being accountable for sleep.
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PMID:Vigilance and its disorders. 844 74

Empirical studies of prepubertal mania are scarce and are limited by a lack of assessment instruments. This study extended previous research on the Mania Rating Scale (MRS) in children. Psychometric properties of the MRS were examined in three new groups of prepubertal subjects: (1) 10 inpatients with bipolar disorder, (2) 10 inpatients with attention deficit hyperactivity disorder (ADHD), and (3) 10 outpatients with ADHD. Subjects were administered the MRS and other standard depression and hyperactivity measures. The MRS had adequate internal consistency (alpha = .80), convergent validity (r = .83, p < .0001), and divergent validity (no significant correlations with depression and hyperactivity ratings). Items assessing "classic" manic symptoms (e.g., elevated mood, increased sexual interest, pressured speech, racing thoughts) effectively discriminated the bipolar group from both comparison groups, while items assessing increased activity level and irritability did not. Results suggest that the MRS can be used with children.
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PMID:The Mania Rating Scale (MRS): further reliability and validity studies with children. 864 72

The prevalence of attention deficit hyperactivity disorder (ADHD) with childhood onset and its relationship to course and treatment outcome of major depressive disorder (MDD) in adults was studied in 116 patients (ages 18-65) consecutively enrolled for treatment of MDD. Sixteen percent of the patient were found to meet full or subthreshold criteria for the DSM-III-R diagnosis of childhood ADHD. Twelve percent endorsed persistence of ADHD symptoms into adulthood. Depressed adults meeting criteria for childhood ADHD did not differ significantly from other depressed adults on any measures related to the chronicity or severity of the mood disorder, Axis I comorbidity, or response to acute antidepressant treatment. Our results are clinically important as they suggest that clinicians need to be aware of the possibility that a substantial proportion of patients with MDD may suffer from comorbid ADHD and that treatments need to include the targeting of possible residual ADHD symptoms in addition to those of depression.
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PMID:Attention deficit hyperactivity disorder in childhood among adults with major depression. 880 31

We examined adolescents with conduct disorder (CD) and substance problems to determine if those with attention deficit hyperactivity disorder (ADHD) symptomatology had more severe delinquency and substance involvement. ADHD symptomatology was assessed in two ways: (1) by self-reports using the Diagnostic Interview Schedule for Children (DISC) and (2) by use of DISC plus reports of others (parents, program staff, and program teacher). We divided boys into three ADHD groups based on DISC: those who met criteria, those who reported at least eight current symptoms, and those who reported fewer than eight symptoms. We also divided the same boys into two groups: those with reports of ADHD by two or more sources and those without this multisource ADHD. Examining these definitions of ADHD revealed that boys with either self- or multisource ADHD had more CD symptoms, earlier age of CD onset, more substance dependence diagnoses, and more comorbid depression and anxiety.
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PMID:Contribution of ADHD symptoms to substance problems and delinquency in conduct-disordered adolescents. 883 4

This article is a practical review of the current psychopharmacological agents used in the treatment of child and adolescent psychiatric disorders. Psychostimulants such as methylphenidate, dexamphetamine and pemoline are effective in the control of symptoms associated with attention deficit hyperactivity disorder. The controlled release preparations and the adjunctive use of clonidine are helpful to extend stimulant effects and control adverse effects. Tricyclic antidepressants are helpful in individual cases of child and adolescent depression, but adverse effects may limit their use. Clomipramine has been found to be effective for childhood obsessive-compulsive disorder. Selective serotonin (5-HT) reuptake inhibitors (SSRIs) appear to be safer for depression and are also useful in obsessive-compulsive disorder. Buspirone is effective for the treatment of anxiety disorders in children. Newer atypical antipsychotics such as risperidone may have less limiting adverse effects than older antipsychotics in the treatment of psychosis and severe behaviour disorders, but the physician must be vigilant for the emergence of tardive dyskinesia. Drug treatment in children and adolescents must take into account the child's environmental influences and be part of an overall treatment plan where individual, familial and cultural issues are addressed.
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PMID:Pharmacological treatment of psychiatric disorders in children and adolescents: focus on guidelines for the primary care practitioner. 886 45

Three women with several diagnoses, including depression and psychosis, personality disorder, attention deficit hyperactivity disorder, alcohol abuse, and physical disease, were treated with selective serotonin reuptake inhibitors (fluoxetine, paroxetine, fluvoxamine). One patient was prescribed paroxetine in addition to methylphenidate. While receiving these agents, two women experienced undesirable sexual arousal and the third had increased sexual desire, arousal, and hypersexuality.
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PMID:Female sexual stimulation during antidepressant treatment. 916 67

Inositol is a simple polyol precursor in a second messenger system important in the brain. Cerebrospinal fluid inositol has been reported as decreased in depression. A double-blind controlled trial of 12 g daily of inositol in 28 depressed patients for four weeks was performed. Significant overall benefit for inositol compared to placebo was found at week 4 on the Hamilton Depression Scale. No changes were noted in hematology, kidney or liver function. Since many antidepressants are effective in panic disorder, twenty-one patients with panic disorder with or without agoraphobia completed a double-blind, placebo-controlled, four week, random-assignment crossover treatment trial of inositol 12 g per day. Frequency and severity of panic attacks and severity of agoraphobia declined significantly with inositol compared to placebo. Side-effects were minimal. Since serotonin re-uptake inhibitors benefit obsessive compulsive disorder (OCD) and inositol is reported to reverse desensitization of serotonin receptors, thirteen patients with OCD completed a double-blind controlled crossover trial of 18 g inositol or placebo for six weeks each. Inositol significantly reduced scores of OCD symptoms compared with placebo. A controlled double-blind crossover trial of 12 g daily of inositol for a month in twelve anergic schizophrenic patients, did not show any beneficial effects. A double-blind controlled crossover trial of 6 g of inositol daily vs. glucose for one month each was carried out in eleven Alzheimer patients, with on clearly significant therapeutic effects. Antidepressant drugs have been reported to improve attention deficit disorder (ADDH) with hyperactivity symptomatology. We studied oral inositol in children with ADDH in a double-blind, crossover, placebo-controlled manner. Eleven children, mean age 8.9 +/- 3.6 years were enrolled in an eight week trial of inositol or placebo at a dose of 200 mg/kg body weight. Results show a trend for aggravation of the syndrome with myo-inositol as compared to placebo. Recent studies suggest that serotonin re-uptake inhibitors are helpful in at least some symptoms of autism. However a controlled double-blind crossover trial of inositol 200 mg/kg per day showed no benefit in nine children with autism. Cholinergic agonists have been reported to ameliorate electroconvulsive therapy (ECT)-induced memory impairment. Inositol metabolism is involved in the second messenger system for several muscarinic cholinergic receptors. Inositol 6 g daily was given in a crossover-double-blind manner for five days before the fifth or sixth ECT to a series of twelve patients, without effect. These results suggest that inositol has therapeutic effects in the spectrum of illness responsive to serotonin selective re-uptake inhibitors, including depression, panic and OCD, and is not beneficial in schizophrenia, Alzheimer's ADDH, autism or ECT-induced cognitive impairment.
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PMID:Controlled trials of inositol in psychiatry. 916 2

Attention-deficit hyperactivity disorder (ADHD) has been considered a mental and behavioral disorder of childhood and adolescence. It is being increasingly recognized in adults, who may have psychiatric co-morbidity with secondary depression, or a tendency to drug and alcohol abuse. We describe a 32-year-old woman known for years as suffering from borderline personality disorder and drug dependence (including hashish, marijuana, LSD and "ecstasy") and alcohol abuse that did not respond to treatment. Only when correctly diagnosed as ADHD and appropriately treated with the psychotropic stimulant, methylphenidate (Ritalin), was there significant improvement. She succeeded academically, which had not been possible previously, the craving for drugs diminished and a drug-free state was reached. Although administration of psychostimulants to drug abusers is controversial, as they are addictive, in cases of ADHD they have promoted drug abstinence.
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PMID:[Attention deficit hyperactivity disorder, facilitating alcohol and drug abuse in an adult]. 922 72

This study explores mental health care treatment among primary care nurse practitioners. Forty-two nurse practitioners from a variety of specialty practice areas responded to a questionnaire focusing on mental health care management in their practice setting. Results showed that 95% of the nurse practitioners encountered clients with mental illness in their practices. The most common psychiatric disorders seen among the nurse practitioners were depression and anxiety disorders. Attention deficit/hyperactivity disorder was the most frequently encountered mental illness among the pediatric nurse practitioners. Bipolar disorder and schizophrenia were also encountered by nurse practitioners in a variety of settings, though with less frequency. Seventy-six percent of the nurse practitioners reported prescribing psychotropic medications. Details of the nurse practitioners' prescriptive patterns are described. Recommendations for further research are discussed, and the need for continuing education in psychopharmacology among primary care nurse practitioners is highlighted.
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PMID:Psychotropic prescriptive patterns among nurse practitioners in nonpsychiatric settings. 928 51


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