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

Menstruation is a biological phenomenon that has been subject of myths and taboos within and among various cultures. These myths distort the reality surrounding menstruation and create ambivalent feelings about the value and usefulness of this function outside of its necessity as mean of reproduction. Thus studies concerning menstruation need to take into account cultural and psychosocial factors that define the meaning, values and behavior associated with this biological phenomenon. According to several studies, 70% of women experience psychological faintness during this menstrual phase, 40% of them have these symptoms at each menstruation and between 3 to 8% of them suffer severely reacquiring medical support. This entity called premenstrual dysphoric disorder is defined by the presence of several symptoms (distress, tension, irritability, moodiness.) with a significant impairment in work or social functioning beginning during the week before and ending within a few days after the onset of menses. Several studies conducted over the past few years suggested that selective serotonin reuptake inhibitors (SSRIs) and serotoninergic tricyclic drugs may be more effective than other types of antidepressants in treating PMS symptoms. Two protocols are proposed; a continuous treatment or intermittent use during few days during pre-menstrual and menstrual phase for several cycles. The objective of the current study was to evaluate the prevalence of a potential premenstrual dysphoric disorder (PMDD) during one menstrual cycle, in a representative sample of general population of Casablanca, according the DSM IV criteria. On the other hand, a questionnaire, available from the authors, was used to explore socio-demographic data. Among 618 women interviewed, 310 met the criteria of a potential PMDD (50.2%). The mean age of the population with PMDD was 32.2 8 years ranging from 20 to 50 years; 54.8% of them were married, 33.9% of them were single and 66.5% of them had between 1 to 4 children. Two third of them were without a professional activity. During this premenstrual phase the following symptoms were found among the whole sample: marked depressive mood, feeling of hopelessness, or self-depreciation thoughts (77.7%, n=241%); difficulty of concentration (65%, n=201); marked change in appetite, overeating or specific food craving (82.8%, n=256); marked affective lability, with sadness tearful and increased sensitivity to rejection (65.8%, n=204); hypersomnia or insomnia (59.7%, n=185); subjective sense of being overwhelmed or out of control (55.7%, n=172); lethargy, excessive fatigability (91.6%, n=283); physical symptoms including breast tenderness, swelling, headache, joint or muscular pain, and a sensation of bloating and weight gain (81.9%, n=253). The most severe symptoms were fatigue and irritability. On the other hand, 73.9% of the sample had a disturbance in their socio-professional lives as a consequence to the psychological disturbances. Half of these women consulted a physician, mostly a general practitioner. These data are in accordance with the literature, confirming that this disorder is common and has a bad impact on mental health and on quality of life of the women suffering from PMDD.
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PMID:[Assessment of premenstrual dysphoric disorder symptoms: population of women in Casablanca]. 1250 65

The aim of our open clinical trial was to determine the efficacy and the tolerance of a blue coloured placebo in moderated anxious patients (Hamilton score below 15) and a red one for tired patients without DSM IV criteria of major depressive disorder. All the patients knew that treatment was a placebo and so, had no pharmacological effect. The trial run over seven days. All patients were considered as responders if their initial symptoms were reduced more than 50%. At the end of the week, the final clinical evaluation showed that 18 patients about 34 were in good condition (10 anxious patients, 7 women and 3 men, and 8 tired patients, 4 women and 4 men). The anxious score of Hamilton scale was reduced of 63%; 16 of the 18 responders were absolutely sure that the treatment was usefull. Four patients were obliged to stop their treatment because side effects: insomnia, tiredness and sleepiness, gastric pain and itching of fore arm.
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PMID:[Efficacy of a non blind placebo prescription]. 1264 Mar 29

Diagnosing depression in cancer patients has been challenging because the diagnostic criteria include somatic symptoms frequently attributed to the cancer itself or its treatment. However, few studies have explored how to appropriately deal with individual somatic symptoms. The authors used data from 220 cancer patients with major depression to examine the intercorrelations among the DSM-IV somatic and nonsomatic symptom criteria as well as whether the presence of an individual somatic symptom could discriminate the severity of major depression. Appetite changes and a diminished ability to think were positively associated with anhedonia. Sleep disturbance and fatigue were not significantly associated with nonsomatic symptoms. These associations were consistent after adjusting for physical functioning and pain. Only patients with appetite changes showed a higher severity of depression. These results suggest that individual somatic symptoms differ in nature and that appetite-related symptoms and a diminished ability to think may be useful for diagnosing depression in cancer patients, whereas sleep disturbances and fatigue may not be as useful.
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PMID:Somatic symptoms for diagnosing major depression in cancer patients. 1272 6

The efficacy and tolerability of 150 mg/d Kava special extract WS 1490 were investigated in a randomized, placebo-controlled, double-blind multicenter study in patients suffering from neurotic anxiety (DSM-III-R diagnoses 300.02, 300.22, 300.23, 300.29, or 309.24). 141 adult, male and female out-patients received 3 x 1 capsule of 50 mg/d WS 1490 or placebo for four weeks, followed by two weeks of observation without study-specific treatment. During randomized treatment the total score of the Anxiety Status Inventory (ASI) observer rating scale showed more pronounced decreases in the WS 1490 group than in the placebo group. Although a treatment group comparison of the post-treatment ASI scores was not significant (p > 0.05), an exploratory analysis of variance across the differences between treatment end and baseline, with center as a second factor, showed superiority of the herbal extract over placebo (p < 0.01, two-sided). 73% of the patients treated with WS 1490 exhibited ASI score decreases > 5 points versus baseline, compared to 56% for placebo. Significant advantages for WS 1490 were also evident in a structured well-being self-rating scale (Bf-S) and the Clinical Global Impressions (CGI), while the Erlangen Anxiety, Tension and Aggression Scale (EAAS) and the Brief Test of Personality Structure (KEPS) showed only minor treatment group differences. Although the results show consistent advantages for WS 1490 over placebo in several psychiatric scales and indicate significant improvements in the patients' general well-being, the differences versus placebo were not as large as in previous trials which employed 300 mg/d of the same extract. WS 1490 was well tolerated, with no influence on liver function tests and only one trivial adverse event (tiredness) attributable to the study drug.
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PMID:Treatment of anxiety, tension and restlessness states with Kava special extract WS 1490 in general practice: a randomized placebo-controlled double-blind multicenter trial. 1469 23

During Depression Screening Day in Uppsala, Sweden, 127 adolescents, 23 boys and 104 girls, in the ages 13-20 years were investigated. We found that 44 (34.6%) fulfilled the criteria for a major depression according to DSM-IV criteria and 42 (40.4%) of the girls and 2 (9.5%) of the boys had an ongoing depression. All depressive symptoms, except increased appetite, were significantly more common in the depressed as compared to the non-depressed adolescents. The most common symptoms were fatigue, decreased interest and concentration difficulties. When the adolescents with major depression were compared to adults with major depression, rated by means of self-rating with the Montgomery Asberg Depression Rating Scale, depressions among adolescents and adults were very similar. However, sleep disturbances and decreased initiative were less frequent among the adolescents while decreased appetite was more common. Many of the patients with major depression found had mild symptoms but 21 (44.7%) were regarded being in need for medical treatment.
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PMID:[Depression common among young people with somatic disorders. Fatigue, lack of emotional engagement, increased need of sleep are some of the warning signals]. 1498 44

Premenstrual syndrome consists of different somatic and/or psychological symptoms which occur in the second half of the menstrual cycle following ovulation. The symptoms usually occur around mid-circle and in majority of cases are most intense during the last seven days prior to menstruation. Given the fact that this topic has not been adequately addressed in our country the aims of this study have been defined as to determine the type and frequency of somatic and psychological symptoms related to menstruation. The study was done on the sample of 181 women in the age of 15-52 years, of different educational and marital status. Four groups were formed: married (78), single (103), and adult (138) and adolescent (43). In order to determine the type and frequency of symptoms we used a structural interview modified according to DSM-IV criteria. In accordance with DSM-IV criteria 52% of subjects have premenstrual dysphoric disorder, among which 23.4% adolescents, 76.6% adult women. The most frequent somatic symptoms related to menstruation are: swelling of the breasts, weight gain, myalgias, arm and leg swelling (81.8%), changes in appetite (63.5%), sleep problems (55%), headache (47%). The most frequent psychological problems were depressive mood (68%), fatigability and lack of energy (53.6%), anger and social withdrawal (49.7), anxiety (49%), difficulties of concentrating and difficulties with memory (40.7%). There is no statistically significant difference in frequency of symptoms between the groups except in the presence of pain which is significantly more frequent in adolescents. A defeating fact has been noted in that 64.9% of women inadequately define the duration of their menstrual cycle. It is concluded that premenstrual syndrome or premenstrual dysphoric disorder is a significant problem of women in Bosnia-Herzegovina (present in 52% of women) with a range of unpleasant psychological and somatic symptoms. Due to all this as well as the fact that a considerable number of women inadequately define the duration of their menstrual cycle, it is necessary to devote greater attention to this problem by public health professionals, family doctors, gynecologists and psychiatrists alike.
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PMID:[Psychological disorders in women in Bosnia and Herzegovina associated with menstruation]. 1502 63

Somatic symptoms are known to be the major manifestation in patients with depression. The aim of the present study was to investigate the major somatic and psychiatric symptoms associated with depression in each sex. Patients with a DSM-IV diagnosis of depressive disorders (n=335) and comparison patients without depression (n=425) among new outpatients in an urban hospital medical setting were eligible for study. The relationship between the three most distressing subjective symptoms at the first visit, confirmed by the patient's description on a health questionnaire and the admitting physician's interview, and depression was investigated in each sex. Most (77.4%) of the complaints in patients with depression were somatic. In a simple logistic regression analysis, diarrhea, excessive sweating and psychomotor retardation in men, and headache, depressed mood and grief in women were associated with depression. In multiple logistic regression analysis, diarrhea, excessive sweating and weight loss in men, and headache, dysesthesia and grief in women, as well as sleep disturbance, loss of appetite, general fatigue, loss of interest and agitation in both sexes, were statistically significantly associated with depression. Fever in men was also associated with depression by Fisher's exact test.
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PMID:Somatic symptoms most often associated with depression in an urban hospital medical setting in Japan. 1561 1

BACKGROUND: Depression is underdiagnosed in the primary care setting. Physical symptoms such as aches, pains, and gastrointestinal disturbance are frequently associated with major depressive disorder (MDD) and are often the presenting symptoms. Duloxetine, a dual-reuptake inhibitor of serotonin and norepinephrine, may have a positive effect on physical symptoms in addition to efficacy in treating emotional symptoms of depression. METHOD: Efficacy was evaluated in 6 double-blind, placebo- and/or active comparator-controlled trials of duloxetine for patients with MDD (DSM-IV criteria). Efficacy in depression was determined primarily using the 17-item Hamilton Rating Scale for Depression (HAM-D-17). Secondary efficacy measures included subscales of the HAM-D-17 and assessment of physical symptoms. Safety evaluations included adverse events, vital signs, laboratory analyses, and electrocardiograms. Safety was evaluated by pooling the data from the MDD trials and a study of duloxetine in nondepressed patients. RESULTS: Duloxetine demonstrated significant differences from placebo on core mood symptoms, physical symptoms (e.g., back pain), and global functioning as early as week 1 of treatment. The estimated probabilities of remission in the studies that demonstrated efficacy ranged from 43% to 57%. The most frequently observed adverse events for duloxetine-treated patients included nausea, dizziness, insomnia, fatigue, and somnolence. Duloxetine did not prolong corrected QT intervals, and the rate of sustained elevations of blood pressure did not differ significantly from placebo. CONCLUSION: In these studies, duloxetine was safe and effective in the treatment of both emotional and physical symptoms of MDD. Based on dose assessments, 60 mg q.d. appears to be the optimum starting and therapeutic dose.
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PMID:Duloxetine: A New Treatment for the Emotional and Physical Symptoms of Depression. 1515 43

This UK multicenter, noncomparative, open-trial study assessed risperidone in 74 first-psychotic-episode patients (DSM-IV schizophrenia) treated with flexible doses. Treatment commenced at 1 mg/day, increasing to 2 mg after 3 days; then adjusted to 8 mg/day maximum. Treatment duration was 12 weeks (Phase 1) with follow-up of 62 patients to 1 year on risperidone or another antipsychotic (Phase 2). Superiority over baseline was recorded on all Positive and Negative Syndrome Scale (PANSS) subscale scores at week 12 (P < 0.0001), occurring after 3 days of treatment. Clinical Global Impression of Severity of Illness and Improvement (CGI-Severity) significantly improved over Phase 1 (80% of patients improved, 1% deteriorated). Treatment was considered from being very to quite acceptable in 79% and a success in 77% (P = 0.0001). Only 5 patients switched to another antipsychotic. Significant improvements were maintained to 1 year. Treatment-related adverse events reported by > 10% of patients in Phase 1 were somnolence (23%) and fatigue (10.8%). Five patients stopped risperidone due to adverse events. Nine patients reported that adverse events started in Phase 2, and 3 patients stopped risperidone. Twenty-one patients (28%) in Phase 1 and 4 patients (6%) in Phase 2 (including a patient taking thioridazine) reported extrapyramidal symptoms (EPS); none stopped treatment. There was no significant change in Abnormal Involuntary Movement Scale (AIMS) or Targeting Abnormal Kinetic Effects (TAKE) scale at 12 weeks. No significant change in AIMS and a significant improvement in TAKE scale were found from week 12 to 1 year. There was no significant difference in efficacy and tolerability between 1- to 4-mg/day and 5- to 8-mg/day dose groups in Phase 1 or 2. Low-dose risperidone is concluded to be effective and well tolerated in first episode psychosis. Only 2 patients (3%) required doses of over 6 mg/day.
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PMID:A trial of low doses of risperidone in the treatment of patients with first-episode schizophrenia, schizophreniform disorder, or schizoaffective disorder. 1520 70

High doses of antidepressants are often used for treatment-resistant depression. Venlafaxine, a dual serotonin and noradrenaline reuptake inhibitor, has been shown to have a tolerable side-effect profile in previous studies using doses of up to 375 mg/day. We investigated the tolerability of higher than currently recommended doses of venlafaxine using the UKU side-effect rating scale. Seventy outpatients fulfilling DSM-IV criteria for major depressive disorder were recruited into two demographically matched groups according to their daily dosage of venlafaxine: high dose n = 35 (> or = 375 mg/day, range 375-600 mg, average 437 mg/day) or standard dose n = 35 (< 375 mg/day, range 75-300 mg, average 195 mg/day. Clinical characteristics were noted and the UKU side-effect rating scale was administered to a subsample of patients. The most frequently reported complaints in both groups were increased fatigue (48%), concentration difficulties (48%), sleepiness/sedation (37%), failing memory (44.4%) and weight gain (29.6%). Apart from weight gain, the complaints were found to be experienced significantly more severely by the high-dose group. Six patients discontinued venlafaxine due to intolerable side-effects but only two of these patients were on a high dose. There was a tendency for mildly raised blood pressure in 10% of patients on an average dose of 342 mg/day. However, no difference between the two groups was found. This preliminary open study demonstrates that venlafaxine is tolerated at higher than British National Formulary recommended doses (i.e. up to 600 mg daily). However, increased frequency and severity of reported side-effects in the high-dose group are not associated with increased rates of discontinuation.
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PMID:Tolerability of high-dose venlafaxine in depressed patients. 1526 Sep 8


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