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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Giant cell arteritis is a systemic disease of unknown origin. Vasculitis involves large and medium-sized vessels. Frequent clinical manifestations include characteristic headache in the temporal area, jaw or tongue claudication, apathy, fatigue, weight loss. The incidence of ocular involvement is reported in up to 70% patients. The most common and serious ophthalmic presentation is arteritic anterior ischemic optic neuropathy, which can lead to irreversible visual loss. Only early and aggressive steroid therapy may prevent this dangerous complication. The authors presented a case of a 68-years-old woman with giant cell arteritis. The main visual manifestation of this disease was anterior ischemic optic neuropathy.
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PMID:[Giant cell arteritis--case report]. 1866 91

Depressed patients draw small figures in the left upper corner of sheet in House-Tree-Person (H-T-P) Test. This type of drawing rarely was drawn by patients without melancholic complains. In the Crisis Intervention Department at the Budapest Social Center (Hungary), 5 homeless male patients between 42-67 years of ages were found with depressive type of drawing in the H-T-P Test, but without melancholy. One had alcoholic encephalopathy with mild cognitive disorder, four had alcoholic or vascular types of dementia. Three had severe apathy. One was euphoric, undiscriminating with logorhea, but reported depression without sadness in Beck Depression Inventory. One had retarded thinking. Psycho-organic signs were well demonstrated in demented patients' drawings. Four patients represented human figures without hands, which symbolized helplessness. Apathy frequently was reported to be the only syndrome in psycho-organic, chronic fatigue, burn out syndromes, or even in exhaustive depression and sickness-behaviour, but it could not be classified in ICD-10 or DSM-IV-TR. Apathy, like depression, responded to antidepressive treatments, therefore, this similarity of syndromes could be responsible for our lethargic patients' depressive type of drawings. Furthermore, clinically abortive depressions perhaps could be demonstrated only by nonverbal drawing test. Psycho-organic and depressive signs of drawings were reported to be independent of each other, therefore, dementia could not cause our patients' depressive type of drawings. So, H-T-P Drawing Test was a useful nonverbal method of psycho-organic patients' investigation, which demonstrated depression in patients without verbally manifest melancholic illness.
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PMID:[Depressive type of drawing test without melancholy]. 1895 20

Pellagra is associated with low levels of vitamin B3 (niacin) and/or tryptophan and often involves other other B vitamins. Since the time Gasper Casal first described the disease in 1972, it was observed that the patients with pellagra were all poor, subsisted mainly on maize, and rarely ate fresh meat. Subsequent occurrences have been in the form of epidemic outbreaks, consequent to either introduction to maize as a major food or increased consumption of other niacin-deficient diets like Jowar (Sorgum vulgare). The virtual disappearance of pellagra as an endemic health problem in recent years can be attributed to a rise in the standard of living of farmers and diversification of the diet globally. The clinical picture is a combination of multisystem alterations typically involving gastrointestinal, skin and central nervous system abnormalities. The cardinal manifestations have been popularly known as the three D's, which are dementia, dermatitis and diarrhea. Psychiatric manifestations are fairly common but are easily overlooked due to their non specific nature. These are commonly seen as irritability, poor concentration, anxiety, fatigue, restlessness, apathy and depression. The occurence of psychosis in pellagra is an uncommon finding, which is usually seen in advanced stages of pellagroid encephalopathy, commonly found in chronic alcoholics. Delusional parasitosis has been also reported in this condition, although the association is still controversial. We report a case of pellagra manifesting with delusional parasitosis in a man whose delusion resolved rapidly after he started niacin-augmentation therapy. This case may provide clues to the biological underpinnings of delusional parasitosis as well as niacin treatment as treatment option in similar cases.
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PMID:Rapid resolution of delusional parasitosis in pellagra with niacin augmentation therapy. 1906 87

Baseline predictors of cognitive change were explored in a sample of persons with multiple sclerosis (MS). Potential predictors included demographic features, baseline clinical characteristics, and psychological state. Participants were 38 individuals diagnosed with either relapsing remitting or secondary progressive MS who did not meet criteria for a current major depressive episode. Subjects were tested at baseline and approximately 1 year in an ongoing longitudinal study of cognition in MS. Participants completed neuropsychological tests sensitive to impairment in MS. They also completed self-report measures of depression, anxiety, fatigue, apathy, and positive and negative affect. Baseline measures of negative affect (e.g., depressed mood, state anxiety, and negative affective state) consistently predicted cognitive change over the course of the study. Higher baseline levels of negative affect were associated with greater relative declines in cognitive performance. This longitudinal relation occurred in the absence of a cross-sectional relation between negative affect and overall cognition. High baseline negative affect particularly predicted a relative decline in episodic memory for newly learned verbal and visuospatial information. The negative affect measures were unique in their predictive value among all the baseline measures assessed. (JINS, 2009, 15, 53-61.).
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PMID:Negative affect predicts subsequent cognitive change in multiple sclerosis. 1912 28

The safety and tolerability of antidepressants have improved considerably over the past two decades. Nevertheless, antidepressant side effects are still common and problematic. The majority of patients treated with contemporaty agents experience one or more bothersome side effects. These side effects often create barriers to achieving depressive remission, as well as to preventing relapse and recurrence. Clinicians tend to underestimate the prevalence of side effects, and as many as one quarter of patients discontinue their antidepressants because of difficult-to-tolerate side effects; others may continue on antidepressant therapy but experience diminished quality of life related to troublesome side effects. This article reviews the prevalence of side effects, the impact of side effects on treatment adherence, and methodological issues including the challenge of distinguishing side effects from residual depressive symptoms, discontinuation effects, and general medical problems. In addition, we address the most common side effects such as sexual dysfunction, gastrointestinal problems, sleep disturbance, apathy and fatigue, and offer strategies for management that may help patients achieve optimal response to pharmacotherapy
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PMID:Toward achieving optimal response: understanding and managing antidepressant side effects. 1917 Mar 98

Fatigue is one of the most common symptoms of multiple sclerosis (MS) and is associated with reduced quality of life. The fatigue syndrome is characterized by uncontrollable apathy, exhaustion, fatigability and lack of energy. The mechanisms underlying fatigue in MS are still poorly understood but studies suggest that immune and neuroendocrine factors may play a causative role in the development of fatigue. The first step in management of MS-related fatigue is identifying and eliminating any secondary causes (adverse effects of drugs, infections, sleep disorders, metabolic diseases). As the fatigue syndrome in patients with MS cannot be evaluated objectively in the routine clinical setting, a number of scales have been developed. The Fatigue Severity Scale is a general scale. Additional scales that have been tested in MS include the Fatigue Impact Scale. Therapy of fatigue syndrome consists of modafinil, amantadine, pemoline and non-pharmacological management.
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PMID:[Fatigue in multiple sclerosis]. 1935 46

We performed a multicenter survey using a semistructured interview in 1,072 consecutive patients with Parkinson's disease (PD) enrolled during 12 months in 55 Italian centers to assess the prevalence of nonmotor symptoms (NMSs), their association with cognitive impairment, and the impact on patients' quality of life (QoL). We found that 98.6% of patients with PD reported the presence of NMSs. The most common were as follows: fatigue (58%), anxiety (56%), leg pain (38%), insomnia (37%), urgency and nocturia (35%), drooling of saliva and difficulties in maintaining concentration (31%). The mean number of NMS per patient was 7.8 (range, 0-32). NMS in the psychiatric domain were the most frequent (67%). Frequency of NMS increased along with the disease duration and severity. Patients with cognitive impairment reported more frequently apathy, attention/memory deficit, and psychiatric symptoms. Apathy was the symptom associated with worse PDQ-39 score but also presence of fatigue, attention/memory, and psychiatric symptoms had a negative impact on QoL. These findings further support a key role for NMS in the clinical frame of PD and the need to address them specifically in clinical trials using dedicated scales.
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PMID:The PRIAMO study: A multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson's disease. 1951 14

Neuropsychiatric symptoms are common in Parkinson's disease, even at the earliest stages, and have important consequences for quality of life and daily functioning, are associated with increased carer burden and increased risk for nursing home admission. In addition to cognitive impairment, a wide range of neuropsychiatric symptoms have been reported. In this article, the epidemiology, clinical course, diagnosis, and management of some of the most common neuropsychiatric symptoms in PD are discussed: depression, anxiety, apathy, fatigue, and psychotic symptoms. Although much is known regarding the prevalence and course of these symptoms, the empirical evidence for how to manage these symptoms is limited at best. There is thus an urgent need for systematic studies for the pharmacological and non-pharmacological management of these symptoms.
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PMID:Neuropsychiatric symptoms in Parkinson's disease. 2132 29

Parkinson's disease (PD) is most frequently associated with characteristic motor symptoms that are known to arise with degeneration of dopaminergic neurons. However, patients with this disease also experience a multitude of non-motor symptoms, such as sleep disturbances, fatigue, apathy, anxiety, depression, cognitive impairment, dementia, olfactory dysfunction, pain, sweating and constipation, some of which can be at least as debilitating as the movement disorders and have a major impact on patients' quality of life. Many of these non-motor symptoms may be evident prior to the onset of motor dysfunction. The neuropathology of PD has shown that complex, interconnected neuronal systems, regulated by a number of different neurotransmitters in addition to dopamine, are involved in the aetiology of motor and non-motor symptoms. This review focuses on the non-dopaminergic neurotransmission systems associated with PD with particular reference to the effect that their modulation and interaction with dopamine has on the non-motor symptoms of the disease. PD treatments that focus on the dopaminergic system alone are unable to alleviate both motor and non-motor symptoms, particularly those that develop at early stages of the disease. The development of agents that interact with several of the affected neurotransmission systems could prove invaluable for the treatment of this disease.
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PMID:Neurotransmission in Parkinson's disease: beyond dopamine. 2005 Aug 85

The article investigates literary subjectivity in some texts by Samuel Beckett. The article proceeds by relating the ways of how narration and speech acts constitute literary subjectivity to the problems of subjectivity that scientific investigations deal with. While successful self-regulation of the organism nourishes the roots of subjectivity, i.e., the habits, subjectivity decomposes in states of exhaustion, when self-regulation breaks down. As soon as a certain threshold is transgressed, fatigue sets in, alters the personality and eventually leads to exhaustion--a state, which psychiatrists compare to mental illness. Notwithstanding the different explanations given, scientists agreed about the effects of exhaustion. According to their investigations, the decomposition of personality by exhaustion generally does not involve apathy, withdrawal from activity or termination of movements, but rather mere action. Similarly, in Beckett's novels and plays exhaustion is much more than tiredness, as French philosopher Gilles Deleuze observed. For Beckett, exhaustion is rather the model for both literary innovation and a new concept of subjectivity, which he explores on the basis of a detailed knowledge of physiology, psychology, and psychiatry, but using his own literary means. The exhausted subject is beyond any calculus of activity. It will perform an activity even if he or she makes mistakes or loses control, and will thus act in an unpredictable way. This unpredictable action is not an exception in the continuation of the habits, but rather points to the moment when a new subjectivity emerges. Such new subjectivity suraces in Beckett's novels and plays in forms of literary innovation.
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PMID:[Exhausted literature. The emergence of the new in Samuel Beckett's novels and plays]. 2048 Oct 58


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