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

Parkinsonism is an uncommon movement disorder in childhood. Six unusual cases of acquired parkinsonism in hospitalized children are described. Clinical manifestations included an akinetic-rigid syndrome with and without tremor, the combination of parkinsonism and dystonia, and a parkinsonism-plus syndrome. Altered mental status, mutism, dysphagia, and sialorrhea were frequent associations. Etiologies included hypoxic-ischemic encephalopathy; haloperidol treatment with and without neuroleptic malignant syndrome; toxicity of cytosine arabinoside, cyclophosphamide, amphotericin B, and methotrexate; St. Louis encephalitis and other encephalitides; and a pineal tumor with hydrocephalus. Cranial magnetic resonance imaging results ranged from normal to profound cerebral and cerebellar atrophy with chemotherapeutic toxicity. The illnesses usually were severe enough to require pharmacotherapy. Incorrect diagnoses of depression or catatonia delayed treatment or aggravated the problem. Acute treatment included amantadine, levodopa/carbidopa with or without selegiline, diphenhydramine, or benztropine. The concentration of CSF homovanillic acid was normal in a neuroleptic-associated patient, but the level was low in an encephalitic patient. All patients demonstrated dramatic improvement, including two who were not treated; some had complete resolution of symptoms and none required continued antiparkinsonian drugs despite poor scores on the Unified Parkinson's Disease Rating Scale and the Modified Hoehn and Yahr Rating Scales. The causes of parkinsonism described are more common in a general pediatric hospital than the parkinsonism associated with the popularized Segawa syndrome.
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PMID:Clinical spectrum of secondary parkinsonism in childhood: a reversible disorder. 802 61

Although catatonic features can be seen in various psychiatric and organic disorders, some patients with catatonia cannot be fitted into existing classification systems. In the current study various sociodemographic and clinical variables were compared between patients who presented with catatonia only (idiopathic catatonia), or with catatonia as a symptom of an identifiable underlying functional disorder. Patients seen over one year (1988) were classified into idiopathic catatonia (n = 30) and according to diagnosis (n = 35; schizophrenia n = 19, depression n = 16). There was an excess of females in the idiopathic group and the illness was of a shorter duration. There were no other differences between the groups. All subjects showed good response to ECTs and required almost the same mean number of ECTs. No clusters were observed using the average method. The current study suggests that catatonic symptoms can occur in the absence of any other identifiable psychiatric syndrome, although they cannot be otherwise differentiated from other psychiatric syndromes in which catatonia can present.
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PMID:Idiopathic catatonia: validity of the concept. 851 Dec 29

A 40-yr-old woman with a diagnosis of schizoaffective disorder developed catatonia in the context of a depressive episode. A dramatic decrease in perfusion of the inferior frontal, posterior temporal and parietal lobes bilaterally and in posterior frontal lobes corresponding to the motor cortices was noted on the 99mTc-HMPAO SPECT scan obtained in the acute phase. The most dramatic decreases compared to normal control subjects were observed in the left parietal and left motor cortices. The patient was treated with a five-treatment course of electroconvulsive therapy (ECT), which resulted in a complete resolution of catatonia and some resolution of her symptoms of depression. The repeat HMPAO-SPECT scan showed improved perfusion in all areas. The most dramatic increases occurred in the left parietal and left motor cortices. Decreased perfusion in motor and parietal cortices could be state-specific to catatonia. Thus, SPECT imaging may be a useful method for monitoring catatonia treatment response.
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PMID:ECT treatment and cerebral perfusion in Catatonia. 902 49

Depression is a common condition that often responds to a variety of treatment modalities. Concerns about antidepressant medications' safety and efficacy and individuals' lack of response or their problems complying with medication regimens have prompted a resurgence in electroconvulsive therapy (ECT) for specific mental health conditions. Outpatient maintenance ECT, performed under general anesthesia, is a safe, effective follow-up treatment for individuals with major depression who have undergone inpatient ECT. Individuals with bipolar disorders, catatonia, mania, and schizophrenia and those with Parkinson's disease also can benefit from outpatient ECT. Perioperative nursing care for individuals who undergo outpatient ECT is similar to the care provided to patients scheduled for ambulatory surgery. Successful performance of outpatient ECT requires collaboration by skilled perioperative nurses, psychiatrists, anesthesia care providers, affected individuals, and family members.
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PMID:Treatment of depression with outpatient electroconvulsive therapy. 906 Nov 52

It was discussed at the beginning of this century whether to categorize "late catatonia" in "manic-depressive disorder", in "schizophrenia", or to consider itself as another clinical entity. Sommer was the first to make a clinical report on "late catatonia"; however Kraepelin had reported on cases with very similar symptoms prior to Sommer, and called them "involutional melancholia" or "presenile psychosis". Followed by a couple of decades, Jacobi's clinical report gave "late catatonia" the impressions as having a very poor prognosis. It was then stated by M. Bleuler that approximately 30% of "late schizophrenia" was well-fitted into "late catatonia". According to Huber who carried out a survey utilizing the same criterion for "late schizophrenia" some 30 years later, no such concordance was found. Hence, it may be said that some kind of change in symptoms has occurred. Symptom-transitions of 16 "late catatonia" subjects were analysed in detail. "Late catatonia" is a symptomatic concept with characteristic progressive symptoms: Stage 1 (prodrome and primary depression), Stage 2 (anxiety, irritation), Stage 3 (hallucination, delusion), Stage 4 (catatonia), and the residual stage. "The complete type" which progresses to Stage 4 stepwise, may end up developing "malignant catatonia". In this case, it may be life threatening unless suitable treatment is carried out. This disease may be divided into 2 types of clinical courses; a multi-phasic course with intermittent remission, and a mono-phasic course which is chronic. Transition to the residual stage may occur at any point. In practice, there are 3 other subtypes; these three are called "the abortive types" (anxious/irritated type, depressive/delusional type, residual type). These cases are most typically considered as depression with severe anxiety and irritation, and in case flattening of affect becomes the major symptoms, it is often misdiagnosed as "organic dementia". Considering treatment, the majority was nonrespondent to neuroleptics, especially those at stage 4; however, ECT (electroconvulsive therapy) was observed to be effective in some cases.
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PMID:[A study on late catatonia--the psychopathological study of its symptoms, courses, subtypes, and treatments]. 955 42

Many behavioral manifestations of systemic disease exist, including delirium, psychosis, mania, catatonia, depression, and anxiety. The features and medical causes of each of those manifestations are described. The indications from history and physical examination that suggest underlying medical illness are reviewed. The psychiatric presentations of several specific conditions are discussed in detail.
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PMID:Psychiatric manifestations of systemic illness. 1076 78

Electroconvulsive therapy (ECT) is used increasingly in the older adult population for major depression, particularly when depression is not responsive to medications, when antidepressants are not tolerated due to side effects, or when depression is accompanied by life-threatening complications such as severe weight loss or catatonia where a rapid definitive response is required. ECT is considered a low-risk procedure that can be successfully done in medically ill older adults, but it is associated with a brief period of increased blood pressure and pulse leading to increased myocardial oxygen demand. ECT may cause delirium, particularly in the cognitively impaired older. As successful management of older patients undergoing a course of ECT often involves geriatricians and other medical practitioners, this review provides an update on the indications for ECT, how it is done, the common complications seen after the procedure, and its efficacy. Finally, specific recommendations for management are made.
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PMID:Update on electroconvulsive therapy (ECT) in older adults. 1081 52

Convulsive therapy was introduced to psychiatric practice in 1934. It was widely hailed as an effective treatment for schizophrenia and quickly recognized as equally effective for the affective disorders. Like other somatic treatments, it was replaced by psychotropic drugs introduced in the 1950s and 1960s. But two decades later, ECT was recalled to treat pharmacotherapy-resistant cases. Avid searches to optimize seizure induction and treatment courses, to reduce risks and fears, to broaden the indications for its use, and to understand its mechanism of action followed. Unlike other medical treatments, however, these searches were severely impeded by a vigorous antipsychiatry movement among the public and within the profession. ECT is effective in the treatment of patients with major depression, delusional depression, bipolar disorder, schizophrenia, catatonia, neuroleptic malignant syndrome, and parkinsonism, and this breadth of action is both remarkable and unique. ECT is a safe treatment. No age or systemic condition bars its use. Its major limitations are the high relapse rates and the occasional profound effects on memory and recall that mar its success. Experiments to sustain its benefits with medications and with continuation ECT are underway. Its mode of action remains a mystery and this puzzle is an unappreciated challenge. The full impact of this intervention is yet to be felt.
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PMID:Convulsive therapy: a review of the first 55 years. 1124 75

During the last two decades, much effort has been made to precisely characterize the symptom dimensions of schizophrenia. A number of dimensional models have been proposed, the most popular of which has been a three-dimensional model consisting of psychotic, negative and disorganizational symptoms. This model, however, has been criticized as too simplistic, and more complex models have been proposed, although to date there has been no consensus as to the number and nature of dimensions necessary to account for the whole range of schizophrenic symptoms. In the present paper, the authors review the main methodological issues which have led to the current confusion about the number of dimensions underlying schizophrenic psychopathology. Among the main issues influencing the delimitation of dimensions are: statistical procedures for determining the number of factors, phase of the illness, level of analysis of symptoms (i.e., symptoms or groups of symptoms), and measurement instrument used. Studies analyzing either a broad range of symptoms or particular symptoms at a finer level have produced a rather complex picture of schizophrenic dimensions. There is evidence supporting the existence of eight major dimensions of psychopathology: psychosis, disorganization, negative, mania, depression, excitement, catatonia and lack of insight. The dimensional structure of symptoms becomes even more complex if one considers that these big dimensions can be further divided into more elementary components. A hierarchical approach for organizing the complex dimensional structure of schizophrenic symptoms is proposed.
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PMID:How many and which are the psychopathological dimensions in schizophrenia? Issues influencing their ascertainment. 1135 88

Electroconvulsive therapy (ECT) has antidepressive and antipsychotic effects. Since being introduced in Italy in 1938, its mode of action has still not been clarified. Treatment modalities have changed in many ways. ECT, in which a generalized epileptic seizure is provoked by electrical stimulation of the brain, is performed under short intravenous anesthesia and muscle relaxation. Considering careful previous clinical examination and anesthesiological and internal counterindications, ECT is a very safe form of treatment. Single cases of persisting memory impairment were described after the formerly common bilateral sinus wave stimulation. However, recent developments such as brief pulse stimulation, unilateral electrode placement, and individual stimulus titration (on the basis of EEG monitoring) make memory impairment as a consequence of ECT a rare event which mostly remits completely in 4-8 weeks. Today, ECT is performed mainly in patients suffering from severe, therapy-resistant affective or schizophrenic disorders. Pernicious catatonia and the neuroleptic malignant syndrome are emergency indications. Adequate ECT treatment requires a series of 6-12 individual sessions (every second or third day). In therapy-resistant depression, for which the greatest number of data are available, the response rate lies between 50 and 60%. This has been confirmed by a descriptive analysis of all ECT treatments at the Department of Psychiatry, University of Vienna, between 1994 and 2000. There is a need for controlled studies on continuation therapy subsequent to successful ECT.
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PMID:[Use of electroconvulsive therapy in psychiatry]. 1157 99


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