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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sixty-one winter depressive patients were evaluated for evidence of bipolar illness. Using the Schedule for Affective Disorders and Schizophrenia-Lifetime Version and the General Behavior Inventory, only nine (15%) could be considered bipolar. On prospective evaluation of patients during the summer following winter depression, few showed signs of manic or hypomanic symptoms. Also, few patients had a family history of bipolar illness. When patients were asked to evaluate symptoms of winter depression, lack of energy was found to be the most prominent feature of the syndrome.
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PMID:Is winter depression a bipolar disorder? 234 Jul 14

The MAOIs have been an underutilized and overly feared class of medical compounds potentially useful for a wide spectrum of disorders. At one end of the spectrum they have been found effective for several anxiety disorders, especially when phobic or panic reactions are part of the symptoms. At the other end of the spectrum, they are effective in patients with melancholic depressions, especially outpatients who have lack of energy, a history of bipolar disorder, or a nonresponse to conventional treatment with TCAs. However, their major role for psychiatric patients appears to be in the large heterogeneous group of ambulatory depressives who have symptoms of both anxiety and depression. The danger of side effects or toxicity associated with MAOIs has been exaggerated. Most side effects are relatively mild and are controllable by dose reduction or other supportive measures. The adverse reaction of most concern, hypertensive crisis, is great extent preventable with appropriate dietary restrictions. Selective and reversible MAOI's may have a better safety profile compared to classical MAOI's.
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PMID:[Indications for therapy using MAO inhibitors]. 268 53

Depression is a major affective disorder characterized by feelings of loss, worthlessness, fatigue, and a general decrease in interest in the usual activities of daily living. This complex disorder is the most common mental health problem in the United States, more common in women, adults over 60 years of age, and those of lower socioeconomic status. According to the DSM III, the major subclassifications related to depression are major depression and bipolar disorder. An integrated causation theory is useful in describing the etiology of this disorder. Generally, signs and symptoms involve changes in affect, cognition, behavior, and physical functioning. Depression may be treated with antidepressant psychotropic medications (tricyclics and MAO inhibitors), lithium carbonate (for bipolar disorder), electroconvulsive therapy, and a variety of psychotherapies. Careful monitoring of the drugs via blood level values must be ongoing. Nursing care of hospitalized depressed persons involves careful monitoring of clients' status and the effectiveness of treatments. Nursing care focuses on three areas of need. Immediate needs are those related to critical and safety issues. Short-term needs are concerned with identifying and reducing or eliminating obvious problem areas which hamper return to community living. Long-term needs are issues related to maintenance of persons in the least depressive state for as long as possible. To provide a sound basis for planning and implementing such care, nurses must understand the dynamics of depression, the issues which dictate selected treatment methods, and the issues which are likely to shape and change the treatment of depression in the future. Nursing must accept the responsibility of acting in a responsible, professional manner to ensure the best possible treatment for clients within the restraints imposed by policy decisions.
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PMID:Acute depression: treatment and nursing strategies for this affective disorder. 363 98

A 41-year-old man died in 1995 during ketoacidotic coma. He suffered from chronic manic depression, used lithium carbonate, and consulted the psychiatrist and the general practitioner (GP) frequently. Diabetes had not been diagnosed. Late in 1994 the situation worsened, the patient complaining of general illness, fatigue, nausea, vomiting, diarrhoea, thirst and excessive drinking of soft drinks. The GP referred the patient to a neurologist who found no neurological disorder but who asked for determination of blood glucose and lithium levels, and of thyroid function. The day afterwards the neurologist went on holiday. The blood glucose level proved to be elevated (16.9 mmol/1) but nobody took any action and the GP was not informed. Six days after returning from his holiday, the neurologist who had an administration backlog, found the laboratory findings only after he had been informed that the patient had just died. The court gave the neurologist a warning. Lessons are that somatic problems should be treated as such, even in a psychiatric patient, and that a good administrative signalling system is a prerequisite for quality in medical practice.
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PMID:[Medical and administrative neglect of high blood glucose levels; comments on a decision by a medical disciplinary tribunal]. 954 47

A 15 year-old adolescent boy with a severe treatment refractory bipolar disorder type I, most recent episode manic, severe with psychotic features had previously required hospitalizations and treatment with lithium and/or carbamazepine and high doses of standard neuroleptics without any response. A treatment with a combined clozapine-lithium therapy was progressively started in a hospital setting (clozapine 300 mg/day; lithium 1350 mg/day). After 15 days a dramatic improvement in mood and psychotic symptoms was evident. After four weeks there was 50% improvement on the BPRS (from 74 to 37). The mean CGAS score changed from 25 to 72. At the CGI-Severity of Illness subscale, a 57% decrease was evident; at the CGI-Global Improvement subscale there was a 75% increase. The only significant side effects were sedation and fatigue, but they were not so severe as to induce a reduction of dosage. The boy was discharged from the hospital after three weeks and successfully returned to school with no modifications in treatment. After a nine-month treatment there was no reoccurrence of psychotic or manic symptoms. The implications of pharmacological therapy in treatment refractory manic episodes with psychotic features are discussed.
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PMID:Clozapine treatment in an adolescent with bipolar disorder. 978 28

Topiramate is a newly developed anticonvulsant agent with possible mood-stabilizing properties. Little is known about the short- and long-term effects of topiramate monotherapy in bipolar disorder. We here present the case of a 60-year-old female bipolar patient who received topiramate alone as maintenance treatment after recovering from euphoric mania. During 7 months, she was free from new manic symptomatology and she was able to reduce her overweight by 16.5 kg. The patient who is known to have a strongly hyperthymic temperament described symptoms of fatigue and sedation and eventually discontinued topiramate monotherapy. When she presented again in our bipolar clinic, severe euphoric mania had developed. After hospitalization, she slowly responded to oral sodium valproate loading plus zotepine. Her weight increased again and so did her triglyceride serum levels. Topiramate treatment and discontinuation did not seem to affect cholesterol serum levels.
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PMID:Topiramate monotherapy in the maintenance treatment of bipolar I disorder: effects on mood, weight and serum lipids. 1109 73

Atypical neuroleptics are increasingly used in the treatment of bipolar and schizoaffective disorders. Currently, numerous controlled short-term studies are available for clozapine, olanzapine, risperidone or quetiapine, but long-term data are still missing. Three patients (2 with bipolar disorder, 1 with schizoaffective disorder) are described who showed a marked reduction of affective symptomatology after clozapine had been added to mood stabilizer pretreatment. The patients were seen once a month before and after the introduction of clozapine for at least 6 months. Treatment response was evaluated using different rating scales (IDS, YMRS; GAF; CGI-BP) and the NIMH Life Chart Methodology. All patients showed a marked improvement after the add-on treatment with clozapine had been initiated. Clozapine was tolerated well with only transient and moderate weight gain and fatigue as only side effects. This case series underlines the safety and efficacy of clozapine as add-on medication in the treatment of bipolar and schizoaffective disorders.
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PMID:Clozapine as add-on medication in the maintenance treatment of bipolar and schizoaffective disorders. A case series. 1189 76

The author discusses 4 referrals that were the direct result of a case description from his own practice that he presented during a lecture on the treatment of mixed anxious and depressive illness in primary care. The cases depict energetic, productive women who suffer fatigue and episodic depressions. These cases suggest that hyperthymic temperaments complicated by depressive episodes represent a form of mood disorder presentation that is highly recognizable and responsive to pharmacologic intervention. Such premorbid temperamental hypomanic tendencies may represent a soft form of bipolar illness that requires somatic strategies in line with those of classic manic depressive illness. The cases underscore the challenge of treating mood disorders and the need for treatment research to reach primary care practitioners, who see the majority of depressed and anxious patients.
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PMID:Refractory Depressed and Anxious States in Hyperthymic Women: A Case Series Generated by a Speaking Engagement. 1501 63

The aim of this study was to investigate depressive symptomatology across distinct major psychiatric disorders. A total of 1351 subjects affected by major depressive disorder (MDD = 389), bipolar disorder (BP = 511), delusional disorder (DD = 93) and schizophrenia (SKZ = 358) were included in our study. Subjects were assessed using the Operational Criteria for Psychotic Illness checklist (OPCRIT). The most frequently represented depressive symptoms in MDD were Loss of energy/tiredness, Loss of pleasure, Poor concentration, and Sleep disorders. Compared with MDD, BP had higher occurrences of Agitated activity, Excessive sleep, and Increased appetite and/or Weight gain, as well as lower Loss of pleasure. In our sample, 32.3% and 26.8% of DD and SKZ, respectively, had quite consistent depressive symptomatology, with at least four or more depressive symptoms. The most common depressive symptoms were Sleep disorders, Poor concentration and Loss of energy/Tiredness, followed by Psychomotor symptoms in SKZ only. Excessive self-reproach, Suicidal ideation, and Appetite and/or Weight changes were more specific to mood disorders. Finally, compared with SKZ, DD suffered from more depressive symptoms and had more severe depressive symptomatology. A quite consistent level of depressive symptomatology is therefore present in subpopulations of delusional and schizophrenic subjects other than in affective subjects. We identified some symptoms that are common across all major psychoses and symptoms that are more specific to each group.
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PMID:Depressive syndrome in major psychoses: a study on 1351 subjects. 1526 8

Mitochondria are intracellular organelles crucial to the production cellular energy. Mitochondrial disease results from a malfunction in this biochemical cascade. These disorders can affect any organ system, producing diverse signs and symptoms, including psychiatric ones. Several authors argue that mitochondrial dysfunction is related to the pathophysiology of bipolar disorder and schizophrenia. Also, the authors retrieved 19 case reports that describe patients with mitochondrial diseases and psychiatric disorders. Most of these patients have psychiatric presentations that preceded the diagnosis of mitochondrial disease. The most common physical findings are fatigue, muscle weakness with or without atrophy, and hearing loss.
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PMID:Review of the literature on major mental disorders in adult patients with mitochondrial diseases. 1638 2


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