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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We describe the capnography tilt test (CTT) for the diagnosis of hyperventilation syncope. The CTT is a 10-min supine, 30-min head-up tilt test with simultaneous monitoring of end-tidal PCO2 (ETPCO2). Hyperventilation (HV) was defined as ETPCO2 < or = 25 mmHg. Hyperventilation syncope (HV syncope) was defined as loss of consciousness with ETPCO2 < or = 25 mmHg and no significant drop in blood pressure. Four groups of patients had the CTT: group I (n = 14), patients presenting with syncope who during a prior tilt test had lost consciousness without concomitant fall in blood pressure; group II (n = 50), syncope, primary evaluation, no prior tilt test done; group III (n = 20), generalized anxiety disorder, no syncope; group IV (n = 80), arterial hypertension, no syncope. Hyperventilation was found in 11/14 patients in group I, 5/50 in group II, 7/20 in group III, and none in group IV; HV syncope was diagnosed in seven patients, all in group I. None of the parameters measured in the evaluation, including ETPCO2, predicted HV syncope on tilting. The mechanisms of resting HV and HV during tilt are not well understood. We confirm the existence of HV syncope. The tilt test should probably be used to screen patients presenting with syncope, with the CTT reserved for patients who lose consciousness during the tilt test without an associated fall in blood pressure, as HV is not always clinically obvious.
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PMID:The capnography-tilt test for the diagnosis of hyperventilation syncope. 906 5

Children with asthma frequently have significant anxiety and depression that interfere with treatment outcome. Although the use of antidepressants may be helpful, in the one published study of antidepressant use in pediatric asthma, significant side effects necessitated discontinuance; these side effects were increased motor activity, impulsive behavior, insomnia, postural hypotension, premature auricular contractions, diastolic hypertension, and generalized seizure. The objective of this retrospective chart review was to examine whether antidepressants could be tolerated and administered safely to children on asthma medications. Forty pediatric inpatients (mean age 13.3 years, range 7-19) with varying levels of asthma severity (5 mild, 11 moderate, 24 severe) and an average duration of asthma treatment of 10.0 years were administered antidepressants while also taking an average of 5 medications for asthma (range 2-7). Ten of the patients had an additional comorbid medical diagnosis. There were 17 children diagnosed with a primary affective disorder; 7 with a primary anxiety disorder; and 16 with both an affective and anxiety disorder. Thirty-six children ultimately were continued on an antidepressant: 13 on desipramine, 9 on nortriptyline, 6 on imipramine, 4 on fluoxetine, 3 on bupropion, and 1 on sertraline. Significant cardiovascular side effects (tachycardia, hypertension, and postural hypotension) occurred in 4 subjects on tricyclic antidepressants (TCAs) and 1 subject on a non-TCA (fluoxetine); 3 of these subjects were able to continue treatment with an antidepressant. Two subjects were taken off antidepressants because of hypomanic symptoms (increased motor activity, mood lability, impulsive behavior, and insomnia). No medications were discontinued because of electrocardiogram changes, arrhythmias, or seizures. Doses of TCAs were comparable to those in previous studies, but the asthma medications differed. Discussion of current anti-asthmatic medications and potential for interactions with antidepressants is included.
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PMID:Cardiovascular effects of tricyclic antidepressants in childhood asthma: a case series and review. 919 41

Beta-adrenoceptors are members of a large family of hormone and neurotransmitter receptors that initiate their biological function by coupling to GTP-binding regulatory proteins. beta-Adrenoceptors can be subdivided into two main subgroups, designated beta1 and beta2. Atypical beta-adrenoceptors or beta3-adrenoceptors, which are present on adipocytes, have been demonstrated pharmacologically. Their function in adipose tissue is currently being investigated. Beta2-adrenoceptor agonists have played a key role in the treatment of asthma for some 30 years, being used for the relief and prophylaxis of symptoms. There is, however, no evidence that tolerance to the bronchodilator or anti-bronchoconstrictor effects of these drugs is responsible for the deleterious effects reported with the regular use of bronchodilators. In neuropsychiatry, beta-adrenoceptor antagonists have been used for the treatment of acute stress reactions and generalised anxiety, essential tremor and prophylaxis of migraine. In general, they are effective in anxiety disorders if the somatic symptoms are not extreme. For prophylactic treatment of migraine, beta-adrenoceptor antagonists such as propranolol, metoprolol, nadolol and atenolol are the drugs of first choice. In cardiology, beta-adrenoceptor antagonists are an important class for the treatment of high blood pressure, arrhythmias and angina pectoris, and for prevention of myocardial infarction. With chronic treatment, they reduce mortality in hypertension and prolong survival in patients with coronary heart disease.
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PMID:Current therapeutic uses and potential of beta-adrenoceptor agonists and antagonists. 955 98

Autogenic Training - Qualitative Meta-Analysis of Controlled Clinical Studies and Relation to NaturopathyAutogenic training is a relaxation technique based on autosuggestions and practice in the perception of 'natural' relaxating processes of the body with an increasing calm basic attitude. The psycho-physiological changes that occur after periodical exercises can be explained by a plausible model which has been empirically proved in many of its aspects. With regard to methodological aspects the present study deals with the qualitative meta-analysis of 64 controlled clinical studies from 1952 to 1997. The clinical effect of autogenic training on the main symptoms as exclusive or at least central psychotherapeutic intervention (partly in combination with a somatic basic therapy) was evaluated. It was proved that autogenic training has positive effects on psychosomatic disorders (hypertension, asthma, intestinal diseases, 'vegetative dystonia', glaucoma, atopic eczema), on preparation for childbirth, sleep disorders and anxiety disorders. A positive effect can also be expected in case of headaches and Raynaud's disease, however, other relaxation techniques seem to be superior in these cases. Moreover, positive effects on the mood (e. g. depressive symptoms) and the general subjective condition (e. g. 'quality of life') have been proved by many studies. Hence indications can be derived according to the basic rules of evidence-based medicine. Nevertheless there are contraindications, for instance regarding exogenous, acute schizophrenic or affective psychosis. Beyond that the preparedness to therapy of many patients can be improved if the therapeutic offers are enlarged by autogenic training as a 'low level' offer. Autogenic training is an effective and useful component of preventive, rehabilitative or therapeutic interventions and can last but not least be part of therapeutic interventions which include naturopathy.
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PMID:Autogenes Training - Qualitative Meta-Analyse kontrollierter klinischer Studien und Beziehungen zur Naturheilkunde. 989 18

Depression is more widespread than hypertension. Nevertheless, physicians specialized in family medicine did not have knowledge necessary to diagnose and treat depression and anxiety disorders. Only six persons out of fifty five who filled in the questionnaire could recognize depression correctly (ICD-10 criteria). Doctors knew antidepressant drugs, but they did not know therapeutic doses. We can try to explain this situation through doctor's pre and postgraduate education.
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PMID:[An estimate of family doctor's knowledge of diagnosis and treatment of depression and anxiety disorders]. 1085 57

Citalopram is a chiral antidepressant drug. Its eutomer, S-citalopram (escitalopram), has recently been introduced as an antidepressant. In an open pilot study, four outpatients and two inpatients with a major depressive episode (ICD-10), and who were nonresponders to a 4-week pretreatment with 40-60 mg/day citalopram, were comedicated for another 4-week period with carbamazepine (200-400 mg/day). Some of the patients suffered also from comorbidities: Phobic anxiety disorder with panic attacks (n=2), generalised anxiety disorder, alcohol abuse, dependent personality disorder, hypertension (n=1). After a 4-week augmentation therapy with carbamazepine, a significant (P<0.03) decrease of the plasma concentrations of S-citalopram and R-citalopram, by 27 and 31%, respectively, was observed. Apparently, the probable induction of CYP3A4 by carbamazepine results in a nonstereoselective increase in N-demethylation of citalopram. Moreover, there was a significant (P<0.03) decrease of the ratio S/R-citalopram propionic acid derivative, the formation of it being partly regulated by MAO-A and MAO-B. Already, within 1 week after addition of carbamazepine, there was a slight but significant (P<0.03) decrease of the MADRS depression scores, from 27.0+/-7.7 (mean+/-S.D.) to 23.3+/-6.6, and the final score on day 56 was 18.8+/-10.9. The treatment was generally well tolerated. There was no evidence of occurrence of a serotonin syndrome. After augmentation with carbamazepine, treatment related adverse events were: Nausea in one case, diarrhea in one case, and rash in two cases. In conclusion, the results of this pilot study suggest that carbamazepine augmentation of a citalopram treatment in previous nonresponders to citalopram may be clinically useful, but that in addition carbamazepine can lead to a decrease of the plasma concentrations of the active enantiomer escitalopram.
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PMID:Carbamazepine augmentation in depressive patients non-responding to citalopram: a pharmacokinetic and clinical pilot study. 1200 77

Psychological illness is responsible for considerable disability worldwide. The World Health Organization Global Burden of Disease Survey estimates that by the year 2020, major depression will be second only to ischemic heart disease in the amount of disability experienced by sufferers. Although different measures of disability have been used in different studies, they have consistently demonstrated that individuals with depression and anxiety disorders experience impaired physical and role functioning, more days in bed due to illness, more work days lost, increased impairment at work, and high use of health services. The disability caused by depression and anxiety is just as great as that caused by other common medical conditions, such as hypertension, diabetes, and arthritis. Comorbidity of depression with anxiety or medical illness further increases the disability experienced by sufferers. Recognition and treatment, however, relieve the burden imposed by untreated depression on the individual, society, and health services.
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PMID:The burden of depression and anxiety in general medicine. 1210 21

Obesity among adults has increased 60% since 1991, and 25% of children are overweight or obese. Direct and indirect costs of obesity represent almost 17% of total health care costs. People who are morbidly obese are far more likely to develop diabetes, hypertension, sleep apnea, osteoarthritis, and some forms of cancer, as well as depression and anxiety disorders than people who are not obese. Medical treatment of obesity only has long-term success rates of approximately 5%. Studies have validated that bariatric surgery, on the other hand, has greater success rates for weight loss maintenance. Of current surgical options, Roux-en-Y gastric bypass offers the best results:complications ratio and is seen as the "gold standard" in bariatric surgery.
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PMID:Roux-en-Y gastric bypass for morbid obesity. 1238 65

The purpose of this investigation was to explore the psychiatric complications of liver cirrhosis in a Nigerian general hospital setting. The mental state of 31 consecutive patients with liver cirrhosis seen in a gastroenterology unit, from July 1996 to August 1998, was assessed using the 30-item General Health Questionnaire (GHQ-30) and Present State Examination (PSE) and compared with those of 20 hypertensive patients and 20 apparently healthy controls. The socio-demographic characteristics of patients with liver cirrhosis who developed psychiatric complications were compared with those without such complications. The mental status of the cirrhosis patients in the present study was also compared with those of Chronic Obstructive Pulmonary Disease (COPD) and hemodialysis patients in earlier studies. About fifty-five percent of all the liver cirrhosis patients developed diagnosable psychiatric morbidity. This was significantly higher than that of the hypertensive patients (15%) or healthy controls (5%) (P=0.0001). The psychiatric conditions were depressive episode, generalized anxiety disorder, delirium and adjustment disorder. No socio-demographic parameter had a significant effect on the mental state of the patients with liver cirrhosis. The same proportion (55%) of hemodialysis and a lower proportion (30%) of COPD patients compared with cirrhosis patients had psychiatric morbidity. We found a high rate of psychiatric morbidity in the patients with liver cirrhosis compared with those of hypertension and normal subjects. None of the socio-demographic variables considered was found to be associated with psychiatric complications in the liver cirrhosis patients. Poor medical conditions seem to be associated with high levels of psychiatric morbidity.
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PMID:Specific psychiatric morbidity in liver cirrhosis in a Nigerian general hospital setting. 1249 Mar 47

Even though the number of alcohol-dependent women is only about 1/3 of the number of alcoholic men, the alcoholism in women, by its clinical features and its course, is the source of therapeutic and economic stakes, particularly in young women among whom an increase of alcohol consumption related problems is reported. Another specificity of the female alcoholism is the lack of care seeking, whereas women have tendency globally to solicit more often care structures than men. Women represent only 1/4 of the overall treated alcoholic patients. The main explanation for this phenomenon is the pejorative social and moral connotation of the female alcoholism, with frequent feelings of shame and deep guilt, that also account for the frequency of hidden and lonely alcohol intakes. The female alcoholism is essentially characterized by an increased vulnerability to the toxic effects of the alcohol, whereas the pathological consumption starts later and with smaller daily amounts. Most studies have revealed a higher vulnerability in women to somatic complications directly attributable to the alcohol organs toxicity, such as hepatic cirrhosis and cardiovascular complications (high blood pressure, non obstructive cardiomyopathy). The reported brain morphological abnormalities could also occur more precociously in alcoholic women than in men. A decreased corpus callosum size among alcoholic women, but not in alcoholic men, was thus found in a recent study, compared with healthy controls. Among the different hypothesis proposed to explain this increased alcohol toxicity, the most incriminated is higher alcohol blood rates for the same ingested amount, mainly of the fact of a lower size with a weaker proportion of the bodily total water, but also of weaker concentrations of gastro-intestinal tract ADH, or of a longer metabolism during some menstrual phases. Indeed, some experimental studies on animal showed that the alcohol toxic effects may occur only from a threshold of alcohol blood rate. More recent studies suggest that the explanation to keep is more related to the lower gastric metabolism in women (lower ADH activity), than the difference of gastric volume or alcohol hepatic oxidation. Regarding to comorbidity, in the Epidemiologic Catchment Area survey, 65% of women, versus 44% of men, with abuse and/or dependence to alcohol had at least one another life-time psychiatric disorder (mainly depression and anxiety disorders), compared to 36% of the overall women of the studied sample. On the other hand, the alcohol dependence is, more often than in men, secondary to other psychiatric disorders, essentially depressive episodes, but less associated to antisocial behaviours. Among the different etiopathogenic factors involved in the alcohol dependence occurrence, genetic factors seem to have a determinant impact. According to the previous family, separation/adoption and twins studies performed, genetic factors could explain 50 to 60% of the alcoholism vulnerability in both men and women. In this context, and whereas we assist to the development of etiopathogenic models with new therapeutic perspectives in alcohol dependence, it seems necessary not to neglect female alcoholism specificities.
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PMID:[Clinical and biological specificities of female alcoholism]. 1250 62


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