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

A total of 192 patients suffering from mild to moderate depression, with or without anxiety, accompanied by one or more specific somatic symptoms, was entered into a double-blind, multi-centre trial to compare flupenthixol and diazepam as treatments for psychosomatic syndromes in general practice. Each patient was treated for 4 weeks and assessed after 1, 2 and 4 weeks on the Hamilton Depression Scale, with visual analogue scales of depression and somatic symptoms, by global assessments (psychological and somatic symptoms) and on a side-effects scale. The principal somatic symptoms were tension headache (69 patients), epigastric discomfort (59 patients), chest pain (39 patients) and backache (25 patients). There were 9 drop-outs (2 on flupenthixol and 7 on diazepam), of whom 5 (2 on flupenthixol and 3 on diazepam) who were treated for at least 2 weeks were included in the analysis of results. All patients received 1 tablet a day (0.5 mg flupenthixol or 2.5 mg diazepam) for the first week. Thereafter, all except 5 patients (3 on flupenthixol and 2 on diazepam) had their dose doubled for the remaining 3 weeks of study. Both drugs were effective in producing consistent improvement in all four somatic symptom groups in terms of both depression and somatic symptoms over the 4 weeks of study. There was a trend throughout in favour of flupenthixol as the more therapeutically effective. Flupenthixol was significantly more effective in relieving depressive symptoms and somatic symptoms in all four somatic symptom groups considered together. It was also superior to diazepam as measured by its effect on the depression sub-scales, anxiety, agitated depression, retarded depression and melancholia. Both drugs were well tolerated, although diazepam-treated patients showed a moderate increase in side-effects scores initially, while the scores in patients treated with flupenthixol decreased consistently over all 4 weeks of the trial. It is concluded from this study that flupenthixol has an important place in the management of patients with psychosomatic illness.
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PMID:Neurotic depression accompanied by somatic symptoms: a double-blind comparison of flupenthixol and diazepam in general practice. 376 51

The chemistry of low-osmolality contrast agents is reviewed, the effects of these agents on vascular and organ physiology are compared with the effects of conventional ionic contrast media, and guidelines for intravascular use of the low-osmolality agents in selected high-risk patients are presented. Three low-osmolality contrast agents, the nonionic media iohexol (Omnipaque, Winthrop-Breon) and iopamidol (Isovue, Squibb) and the dimeric medium ioxaglate meglumine-sodium (Hexabrix, Mallinckrodt) have recently been introduced into the contrast-media market. Compared with conventional ionic contrast media, these new agents demonstrate approximately one third of the osmolality per given iodine concentration (degree of roentgenographic opacification). Therefore, the risks of hyperosmolarity-induced reactions to contrast media are lower with the new agents. The low-osmolality agents may be associated with a reduced incidence of contrast-media-induced hypersensitivity reactions. Because of their lower osmolality, these agents produce less vessel dilation, vascular endothelial damage, and associated pain and discomfort than equi-iodine concentrations of the conventional ionic media. They also demonstrate a reduction in the incidence and severity of contrast-media-induced renal vasoconstriction and proteinuria, hemodynamic alterations, negative chronotropic effects, depression of myocardial contractility, and neurotoxicity in the presence of an altered blood-brain barrier. These low-osmolality agents produce fewer undesirable physiological effects than conventional contrast agents, but the cost of the new products can be more than 10 times as great. Therefore, the new products should be used selectively in patients known to be at increased risk for reactions to intravascular contrast media. A scoring system was developed to permit rapid recognition of documented single or multiple risk factors and subsequent determination of whether to administer a low-osmolality agent.
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PMID:Evaluation of intravascular low-osmolality contrast agents. 378 Jan 59

Theoretical approaches to the understanding of psychological adjustment in spinal cord injury have recently experienced a re-examination which seriously questions the traditional "stage theory" of adjustment. Despite limited empirical validation at best, the stage theory has not only enjoyed an unchallenged popularity amongst rehabilitation professionals but often has been imposed upon new SCI patients as a necessary criterion for hospital discharge. Experienced professionals have also been shown to exaggerate the distress of their SCI patients and these misperceptions tend to progressively worsen with length of clinical experience. The present study replicated and extended this tendency amongst research personnel and their SCI subjects. Staff members tended to over-estimate depression, anxiety, and social discomfort while under-estimating the optimism of their SCI subjects. Recommendations are made for the use of a questionnaire to measure their distress. Also, suggestions are made regarding the potential clinical utility of assessing the contrasting perceptions of distress by SCI patients and significant people in their rehabilitation and social environments.
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PMID:Contrasting perceptions of distress by research personnel and their spinal cord injured subjects. 382 24

Previous research by the authors has pointed to depressive reactions among orthognathic surgery patients during the fixation-removal stage and up to 9 months later. However, less is known about emotional shifts among persons who choose to undergo conventional orthodontic treatment after considering surgical orthodontics. In the current study, a standard measure of mood states was applied to 90 surgical patients and 66 who had considered surgery but decided against it. Of these, 33 were undergoing orthodontic treatment and 33 were having no treatment. The mood scale and measures of personality were first applied before surgery and then during orthodontic treatment, just after surgery, at fixation removal, and 6 months after surgery. Nonsurgical respondents completed questionnaires at the same time as their matched surgical respondents. Scores on tension and fatigue increased significantly among surgical patients from before surgery to immediately after surgery and dropped to presurgical levels when fixation was removed. Anger-hostility increased at fixation removal but declined within 5 months. Postsurgical discomfort, pain, and paresthesia, and interpersonal and oral function problems were correlated with postsurgery emotional state. On the later questionnaires, which corresponded to the later periods of orthodontic treatment, patients who had opted for conventional orthodontic treatment reported that they experienced greater depression, anger, and tension. These patients may be particularly vulnerable to emotional problems because their orthodontic treatment may be more complex and of longer duration than that of the typical orthodontic patient. These results point to the importance of continued psychological support for both orthodontic and surgical patients throughout their course of treatment.
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PMID:The emotional impact of orthognathic surgery and conventional orthodontics. 386 45

Twenty-four patients with moderately severe (grade 2) to severe (grade 3) subjective tinnitus participated in an experimental group study. The patients were randomly assigned to a treatment group and a waiting-list control group. Treatment was given with a coping technique and comprised 10 one-hour sessions. Following a corresponding period without treatment, the control group was treated similarly. Daily self-recording of the subjective tinnitus loudness, the discomfort from the tinnitus, depression and irritation was performed before and after treatment. In addition, psychoacoustic measurement was undertaken on three occasions. The treatment group improved significantly more than the waiting-list control group. After treatment of the latter group, combined data of both groups showed statistically significant improvements in all variables. The results show that tinnitus annoyance can be treated by psychological methods.
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PMID:Psychological treatment of tinnitus. An experimental group study. 391 55

Artificial feeding can have an impact on the patient's quality of life. The psychosocial problems commonly reported in relation to parenteral nutrition are distress from loss of normal eating ability, depression, body image changes, fear of problems with apparatus, and decreased sexual activity. The psychosocial problems most commonly reported in relation to enteral nutrition include gustatory distress , some physical distress , and tube-related distress . Results of teaching approaches to reduce patient discomfort during tube feeding indicate that sensory rather than coping behavior information is more likely to be associated with higher levels of perceived control over enteral feeding, and that perceived control rather than perceived coping ability is more likely to be associated with willingness to repeat the experience. In general, the studies reviewed suggest that enteral feeding may be less stressful and produce fewer psychosocial problems than parenteral nutrition.
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PMID:Psychosocial aspects of artificial feeding. 391 63

A theoretical model of adolescent behavior is examined separately for males and females (N = 722). The model hypothesizes that depression and self-derogation may lead to a lack of purpose in life, which, in turn, may lead to suicide ideation and substance use. Confirmatory factor analyses and structural equation procedures were used to examine the model, using Bentler's (1984) EQS computer program, which is available from BMDP. For both the men and women, the model adequately accounted for the data although there were some important differences between the sexes. In response to psychic discomfort (i.e., Depression and Self-derogation), men are more apt to turn to drugs and alcohol, whereas women consider suicide. Conversely, the situation changes in response to feelings of meaninglessness or a lack of purpose in life. Here, the females appear to turn to substance use, whereas the males react with thoughts of suicide.
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PMID:Depression, self-derogation, substance use, and suicide ideation: lack of purpose in life as a mediational factor. 395 15

A therapeutic regimen is described for sedative, analgesic, and anti-emetic effect in patients receiving intra-arterial carmustine (BCNU) for malignant gliomas. This regimen consists of nalbuphine, 30 mg, i.v., and droperidol, 2.5 mg, i.v., given immediately prior to intra-carotid BCNU infusion. Droperidol, 2.5 mg, i.v., is then administered on four hour intervals for sixteen hours post-procedure. This combination provided excellent effect in nine patients treated for twelve intra-carotid infusions. None of the nine patients experienced vomiting, one experienced mild nausea several hours post-infusion, and non complained of severe pain or discomfort. Thirteen additional patients received diazepam, 10 mg, P.O., prior to the intra-carotid BCNU infusion, with fentanyl, 100 mcg, i.v., and prochlorperazine, 10 mg, i.m. at the onset of infusion. All thirteen patients suffered from severe nausea, vomiting, and orbital pain. The nalbuphine/droperidol combination is thought to provide a superior alternative to the traditional narcotic/pheonothiazine/benzodiazepine combination for carotid BCNU infusion. This combination has theoretical advantages for the patient with intracranial mass lesions by providing analgesia and sedation with minimal potential for respiratory depression and carbon dioxide retention.
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PMID:Nalbuphine and droperidol in combination for sedation and prevention of nausea and vomiting during intra-carotid BCNU infusion. 395 77

We have reviewed the histories of 320 patients in whom a diagnosis of coronary heart disease was ultimately established and traced the symptoms back to their first appearance. In 51% the first symptom was effort angina. Difficulties in recognition arose when the symptom was localized to an unusual site, when its occurrence was dependent on a combination of exercise with cold or a recent meal, or when it was induced by excitement rather than by effort. In a quarter of the cases the onset of angina was abrupt, and in these there was usually evidence of acute infarction.In 43% of cases the first symptom was an attack of pain or discomfort in the torso occurring without any discernable precipitating factor. Again, diagnosis was difficult when the pain was in an atypical site and also when it was of brief duration associated with skeletal or abdominal disease which could cause pain at the same site, or if the patient was able to undertake strenuous exertion. In four patients cardiac pain was first experienced during a paroxysm of tachycardia. In 6% of cases the onset was marked by a symptom other than pain-most frequently dyspnoea, tiredness, faintness, or syncope.Clinical examination was of no direct value in diagnosis. Its importance lay in disclosing factors which had to be taken into account in interpreting the electrocardiogram. The electrocardiogram was invaluable, though by no means infallible. In over half of the patients the first tracing showed major abnormalities of coronary type, and nearly a quarter more showed minor S-T/T depression consistent with coronary disease. Ten per cent. showed miscellaneous abnormalities, such as left ventricular hypertrophy or bundle-branch block, and 15% no definite abnormality.There is as yet no completely reliable objective method of diagnosing early coronary heart disease, so that the recognition of symptoms remains of paramount importance.
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PMID:Earliest symptoms of coronary heart disease and their recognition. 502 16

Depression is not only a common disorder, but also one that is readily treatable. Antidepressant drugs play a major role in treatment, although concurrent use of electroconvulsive therapy or psychotherapy may be indicated for some patients. Antidepressant drugs have been most specifically beneficial for patients with 'endogenous' depressions, but they should be used whenever this type of depression cannot be definitely ruled out. Besides the older tricyclic antidepressants and monoamine oxidase inhibitors, a new 'second generation' group of drugs is now available. Although these drugs offer no great therapeutic advantages over the older ones, they may prove to have a more acceptable profile of side effects, may act more quickly, and may show less cardiotoxicity with overdoses. Whether one can classify depression pathogenetically according to various biological markers, such as urinary excretion of the norepinephrine metabolite, 3-methoxy-4-hydroxy phenylglycol, is still uncertain. At present, the choice of antidepressant drug for an individual patient is largely empirical. Besides being useful for treating depression, antidepressants may be used for treating enuresis, chronically painful states, obsessive-compulsive-phobic states, acute panic attacks and cataplectic attacks in narcoleptics. Many studies have tried to define a therapeutic range of plasma concentrations of these drugs, so as to afford a better basis for dosing, but routine monitoring of drug plasma concentrations is seldom needed; the primary indication for doing so would be in the patient who has received what should be an adequate dose but who is still unresponsive. The value of maintenance treatment with antidepressants has been clearly established; the pattern it takes is best determined by the natural history of the disorder in individual patients. Most drug interactions with antidepressants are pharmacodynamic in nature and can be managed by adjusting doses. Pharmacokinetic interactions with various sympatholytic antihypertensive drugs, such as guanethidine, methyldopa and clonidine, are rare but may be serious. Patients with depression may be spared a considerable amount of discomfort, morbidity, and possibly mortality, by judicious use of antidepressant drugs and the other treatments currently available.
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PMID:Current antidepressant drugs: their clinical use. 611 51


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