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

Systematic treatment in children suffering from cancer pain is a field of pediatric oncology that was neglected for a long time. Investigations have shown that pain therapy oriented to the special situation of the child's body is urgently necessary. In Germany, an unpublished study by Fengler (Berlin), who reviewed all pediatric cancer centers, revealed serious deficiencies in the therapy of pain in children. In our study, we attempted to develop a new concept of cancer pain management, with the emphasis on cooperation between pediatric oncologist and anesthesiological pain therapists. PATIENTS AND METHODS. A total of 36 children and adolescents suffering from malignant tumors and in whom pain therapy according to WHO stage III was necessary were treated. After being seen by a pediatric oncologist and an anesthetist (pain therapist) each patient received either slow release oral morphine (MST, 0.5-1 mg/kg per dose) two to three times a day or a continuous infusion of morphine (0.05 mg/kg per h). The amount of morphine administered was quickly raised until the young patients were free of pain. Drug actions (pain score) and side effects were registered continuously with a documentation form. The morphine was combined with dipyrone 5-15 mg/kg per dose five times a day. The intravenous dosage of oral dipyrone was 2-5 mg/kg per h. RESULTS. The average age of the patients treated was 12 years (1.5-19 years); 10 were inpatients, and 26 were outpatients. All patients were treated successfully. The doses of morphine required for pain relief varied substantially (1-25 mg/kg per day p.o. and 0.05 mg-1 mg/kg per h i.v.). We did not observe extreme sedation or respiratory depression. In our patients we did not observe opioid-induced nausea such as is frequently seen in adults. All children needed laxatives. In 2 children, intolerable itching was experienced after oral administration of slow-release morphine. In 20 patients cortisone was given as adjuvant therapy, in 5 patients with neuropathic pain, anticonvulsants e.g., carbamazepine. In 6 patients we administered benzodiazepines successfully for sedation and anxiolysis. CONCLUSIONS. Therapy of pain in children with advanced cancer requires interdisciplinary cooperation. In most children therapy of pain can be successfully administered with slow-release morphine in combination with dipyrone, so that the children can remain in their usual social environment.
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PMID:[Cancer pain therapy in children and adolescents using morphine]. 204 10

In 60 patients undergoing a curettage in thiopentone induced inhalation anaesthesia with enflurane and N2O/O2 = 2:1, the effects of oral premedication (2 h before anaesthesia) with 30 mg morphine (MST 30) (n = 21), 1 mg lormetazepam (Noctamid) (n = 19) and placebo (n = 21) on psychological (anxiety, depression and asthenia), physiological (blood pressure, heart and respiratory rate) and pain parameters (visual analogue scale, analgesic consumption) were investigated. The study design was single blind, randomized. Before premedication the three groups did not differ in one parameter and so were comparable. MST 30 had a significantly better anxiolytic, Lormetazepam a significantly better antidepressive effect than the compared substance. There were no differences in blood pressure and heart rate. In contrast to lormetazepam and placebo after MST 30 there was no increase in the respiratory rate which can be explained by the anxiolytic stress reducing effect. There was no difference in peri- and intraoperative pain parameters, probably due to the type of surgery. Nausea and vomiting occurred more frequently after MST 30, but there was no significance. A higher rate was probably prevented by the application of transdermal scopolamine the day before surgery. The indication of analgesics (opiates) for premedication is discussed taking the controversy into account. The results of this study show that oral morphine (MST 30) has an anxiolytic effect, one of the most important effects a premedication should have. Further studies should investigate in which types of surgery the analgesic effect of MST 30 is peri- and intraoperatively relevant, so that advantages compared to e.g. Flunitrazepam, Midazolam or Lormetazepam in a higher dosage could be expected.
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PMID:[Effect and side effects of oral morphine, lormetazepam and placebos as premedication]. 288 17

New findings regarding the mechanisms of action of electro-convulsive therapy (ECT) have led to novel developments in treatment technique to further improve this highly effective treatment for major depression. These new approaches include novel placements, optimization of electrical stimulus parameters, and new methods for inducing more targeted seizures(eg, magnetic seizure therapy [MST]). MST is the use of transcranial magnetic stimulation to induce a seizure. Magnetic fields pass through tissue unimpeded, providing more control over the site and extent of stimulation than can be achieved with ECT. This enhanced control represents a means of focusing the treatment on target cortical structures thought to be essential to antidepressant response and reducing spread to medial temporal regions implicated in the cognitive side effects of ECT. MST is at an early stage of development. Preliminary results suggest that MST may have some advantages over ECT in terms of subjective side effects and acute cognitive functioning. Studies designed to address the antidepressant efficacy of MST are underway. As with all attempts to improve convulsive therapy technique, the clinical value of MST will need to be established through controlled clinical trials. This article reviews the experience to date with MST, and places this work in the broader context of other means of optimizing convulsive therapy in the treatment of depression.
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PMID:New developments in electroconvulsive therapy and magnetic seizure therapy. 1289 34

We have studied postoperative pain relief after different techniques of morphine administration given in addition to bupivacaine 15 mg during spinal anaesthesia for caesarean section. In group A, morphine was given both intravenously (10 mg) and orally (30 mg slow release MST) at the end of surgery and continued orally at 8-hourly intervals for 24 h. In group B morphine (80 microg) was given intrathecally only, with the bupivacaine. Both quality of analgesia and duration of action were better in group B, while most side-effects were more frequent in group A where a mild self limiting respiratory depression occurred in 38% of patients. Pruritus was, on the other hand, observed in 48% of patients of group B compared to 7% of the patients of group A. This study suggests that adding 80 microg of morphine to the local anaesthetic used in spinal anaesthesia for caesarean section is a simple procedure that gives excellent results in term of reliability, duration of analgesia and safety.
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PMID:Pain relief after caesarean section: comparison of different techniques of morphine administration. 1563 51

Vagal nerve stimulation (VNS) is used as a treatment for Epilepsy and is currently under investigation as a treatment for depression (see [M.S. George, Z. Nahas, X. Li, F.A. Kozel, B. Anderson, K. Yamanaka, J.H. Chae, M.J. Foust, Novel treatments of mood disorders based on brain circuitry (ECT, MST, TMS, VNS, DBS), Semin. Clin. Neuropsychiatry 7 (2002) 293-304; M.S. George, A.J. Rush, H.A. Sackeim, L.B. Marangell, Vagus nerve stimulation (VNS): utility in neuropsychiatric disorders, Int. J. Neuropsychopharmacol. 6 (2003) 73-83] for reviews). The mechanism of action of VNS is not fully understood [E. Ben-Menachem, Vagus-nerve stimulation for the treatment of epilepsy, Lancet Neurol. 1 (2002) 477-482] despite numerous imaging investigations (see [E. Ben-Menachem, Vagus-nerve stimulation for the treatment of epilepsy, Lancet Neurol. 1 (2002) 477-482; M.S. George, Z. Nahas, X. Li, F.A. Kozel, B. Anderson, K. Yamanaka, J.H. Chae, M.J. Foust, Novel treatments of mood disorders based on brain circuitry (ECT, MST, TMS, VNS, DBS), Semin. Clin. Neuropsychiatry 7 (2002) 293-304; M.S. George, A.J. Rush, H.A. Sackeim, L.B. Marangell, Vagus nerve stimulation (VNS): utility in neuropsychiatric disorders, Int J Neuropsychopharmacol 6 (2003) 73-83; M.S. George, H.A. Sackeim, L.B. Marangell, M.M. Husain, Z. Nahas, S.H. Lisanby, J.C. Ballenger, A.J. Rush, Vagus nerve stimulation. A potential therapy for resistant depression? Psychiatr. Clin. North Am. 23 (2000) 757-783] for reviews). However, there is some evidence to suggest that the locus coeruleus may play a role modulating the effects of VNS. This study investigated the effects of VNS (0.3mA), of sufficient intensity to recruit the A and B fibre components of the vagus [D.M. Woodbury, J.W. Woodbury, Effects of vagal stimulation on experimentally induced seizures in rats, Epilepsia 31 (Suppl. 2) (1990) S7-S19], on the discharge rate of single neurons from the locus coeruleus. This study is the first to demonstrate a direct neuronal response from the locus coeruleus following acute challenge of VNS in the anaesthetised rat. The results of this study indicate that neuronal activity of the locus coeruleus is modulated by VNS. This pathway through the locus coeruleus may be significant for mediating the clinical effects of VNS.
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PMID:Recordings from the rat locus coeruleus during acute vagal nerve stimulation in the anaesthetised rat. 1584 58

Sex differences and pretrauma functioning have been understudied in examinations of posttraumatic stress symptoms (PSS) and health. This study examined relationships between sexual harassment and assault in the military (MST), PSS, and perceived physical health when accounting for pre-MST PSS, pre-MST health, and current depression. Relationships were examined separately in 226 female and 91 male Marines endorsing recent MST (past 6 months). MST predicted increased PSS for women and especially men. For men, higher levels of MST were associated with worse perceived physical health, whereas for women, lower levels of MST were associated with worse perceived health. For men with MST, there was some evidence for the association being partially mediated by PSS, but no mediation was found in women.
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PMID:Sexual harassment in the Marines, posttraumatic stress symptoms, and perceived health: evidence for sex differences. 1917 91

Striate and extrastriate neurons present short-term synaptic depression and facilitation in response to brief stimulations. Recent psychophysical studies have shed light on some possible relationships between these short-term forms of neural plasticity and of psychophysical behavior. It has been shown that a brief adaptation to directional motion biases the perceived direction of a subsequently presented ambiguous test pattern towards the same direction to that of the adaptation (rapid visual motion priming--rVMP), but only after brief (40ms) adaptation-test blank intervals. Although when the adaptation duration is increased, the perceived motion direction of the ambiguous test pattern is biased towards the opposite direction to that of the adaptation pattern (rapid motion aftereffect--rMAE). In the present study we stimulated MT and MST neurons via the presentation of contracting and expanding circular gratings. Our aim was to assess whether rapid effects exist at these higher levels of processing where neurons respond to optic flow, and if such effects are present determine their timescale. Results revealed strong rMAEs and perceptual sensitization (PS), which is a long-lasting facilitation that increases gradually when using intermediate and long adaptation-test blank intervals. We did not observe any effect of rVMP. Our results are considered to reflect the competition between coexistent forms of short- and long-term synaptic depression and facilitation implemented at different visual cortical circuitries.
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PMID:The role of high-level visual areas in short- and longer-lasting forms of neural plasticity. 2060 Jan 91

Search for new therapeutic methods applied in psychiatric disorders, especially in depression--concern not only pharmacotherapy, but also physical techniques. Electroconvulsive treatment is a recognised and effective method for receiving of antidepressant effects by means of electric head stimulation with eliciting of seizures. During two past decades, a few new techniques using the electrical or magnetic stimulation were tested with respect to their therapeutic antidepressant activity. The trancranial magnetic stimulation TMS, vagus nerve stimulation VNS, magnetic seizure therapy/magnetoconvulsive therapy MST/MCT, deep brain stimulation DBS, and trancranial direct current stimulation tDCS are involved among these techniques. The paper discusses those above mentioned techniques and it makes a critical comparison--in relation to several criteria--with the electroconvulsive treatment and pharmacotherapy.
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PMID:[New techniques of electrical and magnetic stimulation in treatment of depression--comparison with electroconvulsive treatment and pharmacotherapy]. 2144 68

Nurses' awareness of MST as a specific type of sexual assault within the military culture and sensitivity to the physical and psychological symptoms are important aspects of care. Nurses must treat the physical and emotional components of sexual assault in all settings; however, referral to the veterans administration programs and resources is key for the woman veteran to receive the specialized care developed by the healthcare system. Women veterans who have PTSD from MST and combat exposure are prone to depression, suicide and substance use/abuse. Nurses must not fear asking the woman if she is having suicidal thoughts or has a plan and intent to follow through with the plan. MST and PTSD may result in internalized anger, shame, self-blame, helplessness, hopelessness and powerlessness. Patient safety is of utmost importance. Assessing Patients for Sexual Violence, A Guide for Health Care Providers (2009) is a useful resource for nurses. The National Center for PTSD (2009) newsletter on the topic of MST includes a list of research studies. The work of Benedict (2007) and Corbett (2007) provide additional personal accounts of women soldiers who were in the Middle East conflicts. The nurse's referral to specialized services to treat MST and PTSD with evidence-based therapies is a crucial first step in the resiliency and well-being of these brave women who have served in all branches of the U.S. military.
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PMID:Military sexual trauma. 2235 67

ECT is a well-established, effective, and safe treatment for many neuropsychiatric conditions, especially major depression. However, ECT is also associated with a high relapse rate, notable side-effects, and significant social stigma. Additionally, ECT is ineffective in a sizable minority of patients. Based on this, several other brain stimulation therapies are currently under active investigation. VNS is approved in many countries for the treatment of treatment-resistant epilepsy and TRD. The available data suggest long-term VNS may have clinically significant antidepressant effects, though more data are needed to clarify how VNS might optimally be used in the treatment of neuropsychiatric disease.TMS offers a noninvasive technique for modulating neural function, and preliminary studies support acute efficacy in the treatment of depression and several other neuropsychiatric illnesses; results from more definitive studies are pending. Although early in development,MST may develop as a form of convulsive therapy that minimizes characteristic side-effects of ECT while achieving similar efficacy; clearly, more data from larger, controlled trials are needed, tDCS is in the early stages of development, but may prove to be an effective, noninvasive alternative for treatment-resistant patients with psychiatric disorders. DBS is the most invasive of these brain stimulation therapies, but may become an effective intervention for patients who have failed other available treatments (including ECT). Very preliminary data support the efficacy of DBS for specific neuropsychiatric conditions, and more definitive data are eagerly awaited. Beyond their potential efficacy for neuropsychiatric conditions, these various brain stimulation therapies may help improve our understand-ing of the neurobiology of neuropsychiatric disease.
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PMID:Brain stimulation therapies for neuropsychiatric disease. 2260 52


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