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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The influence of psychosocial factors on clinical outcomes after surgery has been investigated in several studies. This review is limited to surgical outcomes studies published between 1990 and 2004 that include (1) psychosocial variables (eg, depression, social support) as predictors of outcome and that focus on (2) clinical outcomes (eg, postoperative pain, functional recovery) using (3) specific multivariate analytic techniques with (4) relevant clinical variables (eg, presurgical health status) included as covariates. Twenty-nine studies met these criteria. Results indicate that psychosocial factors play a significant role in recovery and are predictive of surgical outcome, even after accounting for known clinical factors. Attitudinal and mood factors were strongly predictive; personality factors were least predictive. The results suggest that preoperative consideration of attitudinal and mood factors will assist the surgeon in estimating both the speed and extent of postoperative recovery.
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PMID:Psychosocial factors and surgical outcomes: an evidence-based literature review. 1682 87

Increasing interest has been directed to role of pharmaceuticals in the recovery of cerebrovascular events. However, only few scientific studies are available to date, and further research is needed. Amphetamine is the most extensively studied drug shown to promote recovery of function, although clinical data have lead to conflicting results. Other psychostimulants drugs have been proposed, as levodopa or methylphenidate, even if published data are still few. Recently, two studies have been published about the positive role of cholinesterase inhibitor donepezil on stroke recovery. However, such data must still be confirmed by randomized controlled trials. Antidepressant drugs have shown to be effective not only in improving depressive symptoms in stroke patients, but also in decreasing, although partially, the negative impact of poststroke depression on functional outcome. Serotoninergic agents may have a role in improving stroke recovery, in a fashion that is not dependent on their primary antidepressant activity. Last, it is important to be aware that certain drugs as clonidine, prazosin, dopamine receptor antagonists, benzodiazepines, phenytoin, and phenobarbital could have a detrimental effect on the poststroke recovery.
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PMID:New developments on drug treatment rehabilitation. 1683 44

Major depressive disorder (MDD) is a highly prevalent disease often associated with significant medical comorbidity. However, limited data are available examining the associated symptoms of MDD, especially the painful physical symptoms that frequently occur in patients. The presence of these physical symptoms greatly reduces a clinician's ability to recognize and diagnose MDD, ultimately leading to poor treatment outcome. While the treatment goal of MDD is complete remission of all symptoms and the patient's return to full-functioning capacity, if physical symptoms persist, the patient does not achieve functional recovery. Severe consequences have been associated with incomplete remission and residual symptoms, including greater disability and health care costs, plus the increased risk of relapse, morbidity, and mortality. In the treatment of MDD, the noradrenergic, serotonergic, and dopaminergic neural pathways have been found to be affected by depression. More specifically, these neural pathways may correlate with certain psychological and physical symptoms of depression. By studying the effects of antidepressant medications on specific neurotransmitters, antidepressant therapies could be matched to treat specific symptoms of depression. To achieve the goal of remission, clinicians must first determine the best rating method to identify and accurately evaluate the physical symptoms of depression in addition to the core mood symptoms. Therefore, further studies are needed to aid our assessment of physical symptoms and to meet the challenge of effectively matching treatments to a patient's specific symptoms.
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PMID:Major depressive disorder: remission of associated symptoms. 1684 74

Critical care physicians often find themselves prognosticating for their patients, attempting to predict patient survival as well as disability. In the case of neurologic injury, this can be especially difficult. A frequent cause of coma in the intensive care unit is resuscitation following cardiac arrest, for which mortality and severe neurologic disability remain high. Recent studies of the clinical examination, of serum markers such as neuron-specific enolase, and of somatosensory evoked potentials allow accurate and specific prediction of which comatose patients are likely to suffer a poor outcome. Using these tools, practitioners can confidently educate the family for the majority of patients who will die or remain comatose at 1 month. Delirium is a less dramatic form of neurologic injury but, when sought, is strikingly prevalent. In addition, delirium in the intensive care unit is associated with increased mortality and poorer functional recovery, prompting investigation into preventative and therapeutic strategies to counter delirium. Finally, neurologic damage may persist long after the patient's recovery from critical illness, as is the case for cognitive dysfunction detected months and years after critical illness. Psychiatric impairment including depression or post-traumatic stress disorder may also arise. Mechanisms contributing to each of these entities are reviewed.
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PMID:Brain dysfunction in critically ill patients--the intensive care unit and beyond. 1687 26

We compared subjective responses to simple questions after stroke with interviewer-assessed stroke outcome measures. Among those in the highest functional category, women were more likely to report incomplete recovery and greater need for help than men. Among these women, depressed mood was associated with a response of a need for help despite a good functional recovery. Self-reported responses in stroke outcome assessments require further validation by gender and may need to consider the confounding effects of depression.
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PMID:Gender differences in self-report of recovery after stroke: the Northern Manhattan Study. 1703 Jul 68

Disability in life functioning is an important and poorly understood consequence of major depressive disorder (MDD). Mood symptoms do not account for the magnitude of disability resulting from MDD. Impairments in several domains of neurocognitive (NC) functioning have been shown to interfere with functionality in other psychiatric populations. These deficits, also present in MDD, may play a significant role in disability experienced by many with this disorder. The aim of this study was to examine the degree to which NC deficits, independent of affective and psychotic symptoms, explain functional outcome 6 months following hospitalization for a major depressive episode. Participants with an MDD diagnosis (N=48) received NC testing and symptom ratings while in the hospital. These procedures were repeated, along with functionality ratings, 6 months later. Six-month NC performance was strongly associated with functionality ratings after covariation for residual depression. Selected NC domains tested at baseline were predictive of functionality at 6 months. These data indicate that NC deficits, at least for some MDD sufferers, play an important role in functional recovery. New treatments, whether pharmacologic or rehabilitative, may be required to help affected patients accommodate neurocognitively based performance deficits at work, at home and in the community.
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PMID:Neurocognitive deficits and disability in major depressive disorder. 1704 58

The long-term goals of treating both bipolar disorder and schizophrenia are to achieve remission, promote functional recovery, prevent relapse, and improve patients' subjective response. To meet these goals in patients with bipolar disorder, management of the acute episodes of mania, depression, and mixed symptomatology is necessary and may help to maintain favorable patient behavior and avoid hospitalization. In this review, the definitions of remission, recovery, and relapse are compared and contrasted between bipolar disorder and schizophrenia to highlight the similarities and, most notably, the differences in assessments between the two conditions. The implications for the treatment of bipolar disorder stem from the ideology that underlies many of the studies in schizophrenia.
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PMID:Outcomes to monitor when treating bipolar disorder or schizophrenia. 1710 69

This study aimed to assess whether subcortical vascular lesions (SVLs) predict functional recovery after rehabilitation in elderly patients with gait disorders (GD) due to multiple etiology (GD-ME). All patients consecutively admitted with GD-ME (n=103) in our Rehabilitation and Aged Care Unit (RACU) underwent a standardized rehabilitative program. The outcome measure was the Barthel Index (BI) Relative Functional Gain (RFG), a measure of improvement adjusting for baseline functional level. Potential predictors included cognition, depression, functional and nutritional status, physical health, occurrence of adverse clinical events during hospital stay, and SVLs, assessed with a validated visual rating scale based on brain CT scans. Predictors were divided into quartiles and the association with RFG was assessed. In a multivariate linear regression model, SVLs maintained its predictive power on RFG after adjustment for age, gender, and adverse clinical events, which was the only variable associated to RFG in the bivariate model (adjusted p=0.002 for trend). The study shows that SVLs is a predictor of functional recovery in elderly patients with GD-ME.
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PMID:Subcortical vascular lesions and functional recovery in older patients with gait disorders. 1712 55

Chronically elevated levels of cortisol have been associated with changes in cognitive functioning and brain morphology. Using Cushing's disease as a model to assess the effects of high levels of cortisol on cognitive functioning, 27 patients with Cushing's disease were examined at baseline and three successive follow-up periods up to 18 months after successful surgical treatment. At all follow-up periods, patients were administered cognitive tests as well as measures of plasma and urinary free cortisol. Structural MRIs and a depression measure were taken at baseline and one-year follow-up. Results showed that there is a specific pattern of significant cognitive and morphological improvement following successful treatment. Verbal fluency and recall showed recovery, although brief attention did not. Age of participants was a significant factor as to when recovery of function occurred; younger patients regained and sustained their improvement in cognitive functioning more quickly than older participants. Improvement in verbal recall also was associated with a decrease in cortisol levels as well as an increase in hippocampal formation volume one year after treatment. Overall, these findings suggest that at least some of the deleterious effects of prolonged hypercortisolemia on cognitive functioning are potentially reversible, up to at least 18 months post treatment.
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PMID:Patterns of cognitive change over time and relationship to age following successful treatment of Cushing's disease. 1716

Despite the fact that antidepressants represent the gold standard for the treatment of depression, not all patients treated with an antidepressant monotherapy achieve complete remission of depressive symptoms and functional recovery. Therefore, further examination of the components that may be involved in the action mechanism of antidepressants will benefit patients who show either no response or partial response by identifying their hidden functions and key roles in the therapeutic mechanism of antidepressants. The cocaine- and amphetamine-regulated transcript (CART), which is a brain-enriched mRNA with a protein product(s) is an interesting neuropeptide in relation to the treatment of depression. CART mRNA is strongly expressed in the major limbic structures that modulate affect and anxiety as well as being a possible key target for the action of antidepressants. A bidirectional relationship between CART and the hypothalamic-pituitary-adrenal (HPA) axis activity has been accepted to date, which suggests that CART might efficiently bridge the interaction between the stress-related events and the neurobehavioral response. The regulation of the signal transduction pathways by CART by modulating neurotrophic factors, such as brain-derived neurotrophic factor (BDNF), kinases (trkB), and neurotransmitters (5-HT), can also contribute to the treatment of depression. It might have an augmenting effect in the treatment of depression because it acts as a putative and potential neurotransmitter/cotransmitter that is involved in psychostimulant action as well. Finally, preliminary results suggest that CART directly controls the expression of major neurotransmitters such as serotonin, noradrenaline, and dopamine. Hence, further studies on therapeutic implications of CART for depression are warranted and will contribute to the development of newer selective antidepressants.
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PMID:Therapeutic implication of cocaine- and amphetamine-regulated transcript (CART) in the treatment of depression. 1719 60


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