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

Based on the experimental results of thyroplasty, thyroplasty type I which aims at medical shifting the vocal cord was performed on 8 patients with dysphonia, 6 with vocal cord paralysis and 2 with vocal cord atrophy. The surgery was conducted on either in- or out-patient basis and local anesthesia was used. Usually, a rectangular incision was made on the thyroid cartilage at the level of the vocal cord, and the fragmemt was depressed inward. A cartilage piece taken from the opposite side was used as a wedge, if necessary, to enhance the effect of lateral compression of the vocal cord. The voice after surgery was generally satisfactory, except in one case of traumatic vocal cord paralysis. Complications such as stridor or dyspnea were nil. As surgical intervention inside the thyroid cartilage is minimal, fine and reliable adjustment of depression is possible during the surgery.
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PMID:Thyroplasty type I (lateral compression) for dysphonia due to vocal cord paralysis or atrophy. 120 20

Whereas recent research has focused upon neuromotor aspects of spasmodic dysphonia, the disorder has historically been regarded as having a psychogenic basis. Relatively little empirical evidence, however, has been offered either to support or refute that claim. The present study examines emotional characteristics of 18 female spasmodic dysphonic subjects in comparison to matched normal controls across psychometric measures of depression, anxiety, and somatic complaints. Statistically significant differences were noted between groups for all measures and over half of the dysphonic subjects exhibited clinically significant levels of depression and anxiety relative to published test norms. Correlational analysis revealed the presence of an "affective factor" among the dysphonics that was not evident among the controls. These findings raise serious concerns for neuromotor interpretations given in various areas of recent spasmodic dysphonia research. Theoretical, clinical and methodological implications are discussed.
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PMID:Emotional considerations in spasmodic dysphonia: psychometric quantification. 180 74

The authors evaluated 11 surgically-treated patients with spastic dysphonia, a phonation disorder of unclear etiology. The results indicate that the illness does not appear to be a somatoform disorder, but that stress may play a role in its expression, and that there may be secondary depression and anxiety. The experience of spastic dysphonics suggests that psychiatric treatments may be inappropriately applied to an illness without clear organic etiology, whereas, conversely, a proper psychiatric role may be rejected when effective medical or surgical treatment is available. The authors recommend that psychiatrists evaluating patients with illnesses of unclear etiology should be cautious in making a primary psychiatric diagnosis unless DSM-III criteria are met.
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PMID:Defining the psychiatric role in spastic dysphonia. 336 Mar 12

Formaldehyde is but one of many chemicals capable of causing the tight building syndrome or environmentally induced illness (EI). The spectrum of symptoms it may induce includes attacks of headache, flushing, laryngitis, dizziness, nausea, extreme weakness, arthralgia, unwarranted depression, dysphonia, exhaustion, inability to think clearly, arrhythmia or muscle spasms. The nonspecificity of such symptoms can baffle physicians from many specialties. Presented herein is a simple office method for demonstrating that formaldehyde is among the etiologic agents triggering these symptoms. The very symptoms that patients complain of can be provoked within minutes, and subsequently abolished, with an intradermal injection of the appropriate strength of formaldehyde. This injection aids in convincing the patient of the cause of the symptoms so he can initiate measures to bring his disease under control.
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PMID:Diagnosing the tight building syndrome. 344 98

A review of the literature clearly shows that connective tissue degeneration in the larynx, particularly of elastic and collagen fibers, is more prevalent in males than in females. Reinke's edema or polypoidal degeneration of vocal cords may or may not be more common in females. Whether or not the above statements are true, tissue atrophy causes a problem in males because the voice becomes higher pitched, weak or reedy, less masculine, whereas polypoidal change in the older female larynx results in a lower pitch, husky voice that would be acceptable in a male but makes the female voice more male-like and undesirable. Functional misuses of laryngeal muscles come into play when patients try to compensate for these changes. The etiology of dysphonia in the elderly gets even more confusing when psychological factors such as loneliness and depression add their effects to laryngeal muscle misuse. Laryngeal cancer is still probably the most common cause of hoarseness in older persons. Unfortunately the biopsy to rule out cancer in a person who is hoarse from degenerative or functional causes will often greatly worsen the dysphonia and render voice therapy less effective.
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PMID:Voice disorders in the elderly. 374 18

A group of pulmonologists from different sites of Argentina convened to establish consensus guidelines for treatment of acute and chronic bronchial asthma. General acceptance that in fatal asthma diagnosis and hospital admission are usually too late and treatment insufficient prompted the need for this meeting. The purpose of treatment was devised to keep the patient symptomless, decrease frequency of exacerbations and the risk of severe attacks. Peak expiratory flow rate (PEFR) measurement in all patients was decided. inhalation of anti-inflammatory drugs (corticosteroids, CE, and/or disodium cromoglycate, DSG, in those younger than 20 years) was established as first line of treatment. Inhaled CE (even in high doses such as 2 mg/day) do not provoke significant adverse systemic effects (immune depression, Cushing syndrome, hyperglycemia in diabetics or osteopenia). Secondary local adverse effects are however frequent: oral and pharyngeal candidiasis and dysphonia. It is advisable considering present evidence, that bronchodilators (Bd) be used preferentially on demand. On account of small bronchodilator effect and frequent secondary adverse effects, use of theophylline should be limited to patients not adequately responsive to anti-inflammatory drugs in high dosage. Immunotherapy is not useful in asthma. Four clinical levels were defined in chronic asthma considering severity of dyspnea, frequency of nocturnal bronchial obstruction, levels of PEFR and amount of required Bd. Guidelines of treatment were established for each clinical level considering increasing dosage of CGS, inhaled CE (up to 2 mg/day) and regular administration of Bd. Indications for systemic CE administration were also established. Three levels of acute asthma (sudden worsening of symptoms) were accepted based on clinical evidence and PEFR values. Treatment was quantitatively adjusted to severity. Criteria for hospital admission either in emergency or intensive care areas and treatment procedures were established.
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PMID:[Standards established by consensus for the treatment of bronchial asthma and its exacerbations]. 811 34

The objectives of this study were to determine the effects of botulinum toxin injection on measures of depression, anxiety, and somatic complaints in patients diagnosed as having spasmodic dysphonia. Patients were asked to complete preinjection questionnaires with self-ratings of depression, state and trait anxiety, and somatic complaints. Approximately 1 week and 2 months following injection, patients were again asked to complete the questionnaires. The spasmodic dysphonic subjects exhibited significantly elevated mean levels of depression and anxiety. These levels were significantly reduced approximately 1 week after injection. Two months later, depression and anxiety measures did not change significantly from their 1-week postinjection values. The results suggest that patients with spasmodic dysphonia who demonstrate significantly elevated measures of depression and anxiety show a reduction in those measures following treatment with botulinum toxin.
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PMID:Spasmodic dysphonia. Emotional status and botulinum toxin treatment. 812 41

The side-effects and complications of posteroventral pallidotomy are analysed in 138 consecutive patients who underwent 152 pallidotomies. Transient side-effects, lasting less than three months, appeared in 18% of the patients, that is, 16.5% of the surgical procedures. Long term complications, lasting more than 6 months, were noted in 10% of the patients, that is, 9.2% of the surgical procedures. Sixteen complications occurred alone or in various combinations in 14 patients and included fatigue and sleepiness (2), worsening of memory (4), depression (1), aphonia (1), dysarthria (3), scotoma (1), slight facial and leg paresis (2) and delayed stroke (2). Complications such as dysarthria and paresis could be attributed to MR- or CT-verified pallidal lesions lying too medially and encroaching on the internal capsule. Two of the patients with deterioration in memory had some memory impairment before surgery, and the aphonic patient had dysphonia preoperatively. The study suggests that stereotactic MRI and careful impedance monitoring and macro-stimulation of the posteroventral pallidum area should be sufficient for minimizing the risk of complications; the stereotactic lesion should be centered within the posterior ventral pallidum without involvement of internal capsule. It is concluded that pallidotomy is a safe procedure if performed on cognitively alert patients, and it seems that both the incidence and especially the severity of complications are lower for posteroventral pallidotomy than for thalamotomy.
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PMID:The side-effects and complications of posteroventral pallidotomy. 923 12

The aims of this study were to evaluate the emotional status and life quality of the patients with spasmodic dysphonia (SD) before and after botulinum toxin treatment, and to ascertain whether SD is a somatoform disorder. Ten patients with spasmodic dysphonia were injected unilaterally into the vocal cord with botulinum toxin. Before botulinum toxin treatment, two clinician's rating scales--Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS), and three self-rating psychometrics--Zung's Self-Rating Depression Scale (SDS), Life Quality Scale (GHQ/QL-12), and Symptom Distress Checklist (SCL-90) were applied. Self-rating scales were also administered in 20 matched normal controls. The patients were reevaluated 1 month after botulinum toxin treatment. The Clinical Global Impression Scale (CGI) was also rated by the patients themselves and a speech pathologist. The mean scores of SD patients were significantly higher than that of controls in SDS, and subscales of somatization, obsessive-compulsive symptoms, depression, anxiety, and psychoticism in SCL-90. The mean score of GHQ/QL-12 was significantly higher in the control group. The scores of HDRS, SDS, GHQ/QL-12 and subscales of somatization, depression, and anxiety in SCL-90 showed significant improvement after botulinum treatment. In CGI, seven patients were rated as improved by patients themselves and the speech pathologist. The patients with SD had more anxiety, depression and somatization symptoms, and poor life quality than normal controls. Their emotional status and life quality improved after botulinum toxin treatment. The results suggest that the emotional symptoms of patients with SD are mainly secondary to voice disorder.
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PMID:Emotional symptoms are secondary to the voice disorder in patients with spasmodic dysphonia. 971 6

Psychogenic dysphonia refers to loss of voice where there is insufficient structural or neurological pathology to account for the nature and severity of the dysphonia, and where loss of volitional control over phonation seems to be related to psychological processes such as anxiety, depression, conversion reaction, or personality disorder. Such dysphonias may often develop post-viral infection with laryngitis, and generally in close proximity to emotionally or psychologically taxing experiences, where "conflict over speaking out" is an issue. In more rare instances, severe and persistent psychogenic dysphonia may develop under innocuous or unrelated circumstances, but over time, it may be traced back to traumatic stress experiences that occurred many months or years prior to the onset of the voice disorder. In such cases, the qualitative nature of the traumatic experience may be reflected in the way the psychogenic voice disorder presents. The possible relationship between psychogenic dysphonia and earlier traumatic stress experience is discussed, and the reportedly low prevalence of conversion reaction (4% to 5%) as the basis for psychogenic dysphonia is challenged. Two cases are presented to illustrate the issues raised: the first, a young woman who was sexually assaulted and chose to "keep her secret," and the second, a 52-year-old woman who developed a psychogenic dysphonia following a second, modified thyroplasty for a unilateral vocal fold paresis.
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PMID:Psychogenic voice disorders and traumatic stress experience: a discussion paper with two case reports. 1451 54


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