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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Following a brief presentation of the clinical picture of major depression, attention is directed to different forms of missed diagnosis. The clinical picture of major depression is characterized by marked uniformity and includes 2 highly typical disturbances: pronounced diurnal fluctuations and early or very early awakening. Other central features include a feeling of hopelessness, the disappearance of all prospects for the future, and feelings of guilt sometimes assuming absurd proportions. In addition, there are many other accompanying manifestations. Yet, despite this, it is not easy to recognize depression, particularly since the patient's gloomy and dejected mood often occupies the background of the picture. Cross-cultural psychiatric studies reveal that in non-Western cultures expression often mainfests itself in the form of a wide variety of somatic complaints, including pain. The term "masked depression" has come into common use to describe what are cases where, in the presence of predominantly physical signs and symptoms, an underlying depressive state goes unrecognized. This applies particularly to syndromes of which headache and pains in the chest, abdomen, and limbs are prominent features. It is unclear as to what extent somatic manifestations of depression are on the increase in the Western world. Yet, clearly, many patients deny that they suffer from depression and cling firmly to their physical complaints. Although depression may lurk behind a series of poorly defined physical complaints, essential characteristics of genuine depression emerge upon further diagnostic exploration. Secondary accompaiments to depression include periodic abuse of alcohol or medicines and disturbances affecting sexual behavior. In the elderly, the differential diagnosis of dementia and depression may give rise to confusion. Anxiety emerges as a frequent accompanying manifestation in depressive patients, yet all anxious patients do not suffer with depression. Additionally, many manifestations of anxiety and depression closely resemble one another, adding to the confusion. There is limited awareness of phobic and compulsive phenomena as manifestations of depression. These phenomena may disappear in response to treatment for the depression and are by no means always related to a premorbid compulsive personality structure. The issue of the application of the term "depression" to conditions that most likely are not depressive are considered from the standpoints of endocrinopathy and of pharmacology. The problem posed by depressive syndromes occurring in oral contraceptive (OC) users is more complex. When the progesterone content is high in relation to the estrogen component, the patient may sometimes suffer from loss of libido and loss of pleasure in sex or life in general. These changes respond favorably to a change in the type of OC.
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PMID:Depression--a diagnosis sometimes missed and sometimes mistaken. 357 25

Tritiated imipramine binding to whole platelets was measured in 16 chronic pain patients who were free from major depression, and in a control group. The maximum binding was significantly lower in chronic pain patients than in the control group, whereas the binding affinity was not significantly different. Twelve patients were treated with mianserin for 21 days; this produced a significant improvement in the mean scores for pain (evaluated with the McGill Questionnaire) and depressive symptoms (assessed with the Zung Self-Rating Scale). The improvement in both types of symptom was accompanied by a significant mean increase in the density of the [3H]imipramine binding sites without modifications in the values of the constant of affinity. All the patients who responded well to treatment (N = 8) had a family history of depressive spectrum disorders (DSD), while none of those who failed to respond had a first degree relative with DSD.
Pain 1987 Sep
PMID:Modifications of [3H]imipramine binding sites in platelets of chronic pain patients treated with mianserin. 367 Aug 78

The assessment of patients with chronic pain is receiving increasing attention by psychiatrists. Recent publications have put forward the concept of the "pain-prone disorder" as a variant of depressive illness. This study describes a series of 50 consecutive patients with chronic pain in terms of the five axes of the DSM-III nosology. Diagnoses were made after a 90- to 120-minute psychiatric interview, and a check on diagnostic reliability was made on a small subsample. Psychological factors affecting physical condition were diagnosed in 34% and dysthymic disorder was diagnosed in 28%, while major depression, psychogenic pain disorder, somatization disorder, and anxiety disorders were each respectively diagnosed in 8%. Only 6% had no diagnosis on axis I and 4% had no diagnosis on axis III. Personality disorder was diagnosed in 40%, and traits of dependence, compulsiveness, and anxiety were common. Overall, the patients had experienced a high degree of psychosocial stress with fair to poor adaptive functioning. The notion of chronic pain as a variant of depressive disease is questioned on the basis of these findings. The author suggests that although pain-proneness is a useful psychodynamic concept, the case for its establishment as a new psychobiological disorder is not proven. Furthermore, the concepts of pain-proneness, depression, and psychogenic pain have become confused. The author argues that the current classification is adequate to deal with the varieties of depression associated with chronic pain and that psychogenic pain disorder should be remerged with conversion disorder for the sake of clarity.
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PMID:DSM-III diagnoses in chronic pain. Confusion or clarity? 370 17

Basal and postdexamethasone concentrations of cortisol and prolactin were studied in three groups of male patients: chronic pain patients with no psychiatric diagnosis (n = 12), chronic pain patients with coexisting major depression by Research Diagnostic Criteria (RDC) (n = 24), and pain-free psychiatric patients meeting RDC criteria for major depression (n = 28). Basal cortisol concentrations were significantly higher in pain-major depression and psychiatric-major depression patients compared to pain patients without psychiatric illness. The frequency of cortisol nonsuppression after dexamethasone was significantly greater in pain patients with major depression (41.7%) compared to pain patients without psychiatric disorder (8.3%), and was comparable to that of psychiatric patients (21.4%). Prolactin concentrations, but not cortisol levels, were significantly correlated with observer-rated severity of depression in pain patients. These findings suggest that cortisol and prolactin abnormalities in chronic pain may be related to psychiatric disorder rather than to pain per se, at least in male patients, and may indicate a role for cholinergic mechanisms in the interface of pain and depression.
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PMID:Neuroendocrine responses in psychiatric and pain patients with major depression. 370 35

To assess the behavior of two putative neuroendocrine markers of depression in chronic pain, the authors determined plasma cortisol and prolactin concentrations before and after dexamethasone in 52 hospitalized male chronic pain patients. Their psychiatric diagnoses by Research Diagnostic Criteria (RDC) were: major depression (N = 24; 44.2%), minor depression (N = 10; 19.2%), another RDC diagnosis (N = 7; 13.5%) and not mentally ill (N = 12; 21.6%). Failure to suppress cortisol after dexamethasone (a positive DST) occurred in 43.5% of those with major depression, 20% of those with minor depression, 42.8% of those with other psychiatric diagnoses and in 8.3% of patients without a psychiatric disorder. The frequency of non-suppression was significantly different only for patients with major depression compared to those without diagnosable psychiatric disorder. Mean basal cortisol concentrations at 08.00, 16.00 and 23.00 h did not differ among psychiatric diagnostic groups of pain patients, or between these groups and healthy volunteers. Levels of prolactin, but not cortisol, were significantly correlated with the severity of mood disturbances. These findings suggest strategies using multiple endocrine markers to distinguish pain from depression should be explored.
Pain 1986 Apr
PMID:Basal and post-dexamethasone cortisol and prolactin concentrations in depressed and non-depressed patients with chronic pain syndromes. 371 87

Prevalence rate of chronic pain in a psychiatric outpatient clinic has been evaluated in this study and characteristics of chronic pain patients have been compared with non-pain psychiatric patients. Chronic pain was reported by 14.37% of psychiatric patients. Of these, 43% had dysthymic disorder, 20% had anxiety states and 20% somatoform disorders. As compared to the control group, chronic pain patients belonged more often to the middle age group (p less than 0.05), were more frequently females (p less than 0.001), married (p less than 0.02) and from an urban habitat. There is a marked difference in the diagnostic breakdown between the two groups with a predominance of dysthymic and anxiety disorders in pain patients. Very few chronic pain patients had psychosis. Major depression was found in equal proportions in pain and non-pain patients. The study identifies variables which differentiate chronic pain patients from other psychiatric patients.
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PMID:Chronic pain in a psychiatric clinic. 373 78

Thirty-seven patients with chronic pain admitted to a 3-week inpatient pain program were interviewed using the NIMH Diagnostic Interview Schedule and the family history method. The most frequent psychiatric diagnoses were major depressive disorder (current episode = 32.4%, past episode = 43.2%) and alcohol abuse (40.5%). More than half of the patients had a history of one or more episodes of major depression and/or alcohol abuse before the onset of their chronic pain. Family history revealed that 59.5% of the patients had at least one first-degree family member with chronic pain, 29.7% had a family member with affective illness, and 37.8% had a family member with alcohol abuse.
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PMID:Chronic pain: lifetime psychiatric diagnoses and family history. 403 26

This investigation evaluated the prevalence of depression in female patients who had cancer in any of five predesignated sites. Five hundred five women aged 17 to 80 (190 with breast cancer, 143 with gynecologic malignancies, 111 with melanoma, 37 with bowel cancer, and 24 with lymphoma) were randomly screened. Assessment included the Hamilton rating scale for depression, the Zung self-rating depression scale, the Karnofsky performance scale, and a 10-cm visual pain analogue line. The results revealed a mean Hamilton of 10.2 (range, 0 to 41; SD, 7.5), a mean Zung score of 35.3 (range, 11 to 68; SD, 9.6), a Karnofsky median score of 80, and a median pain score of 0. Scores on the Zung scale were highly correlated with those of the Hamilton scale (r = .75). Based on cutoff scores accepted as indicating depression (Hamilton greater than or equal to 20 and Zung greater than or equal to 50), patients were depressed. The depressed subgroup was in significantly more pain, experienced greater physical disability, and was more likely to have had prior episodes of depression as compared to the non-depressed women. The two best predictors of current depression were performance status (Karnofsky) and history of depression. No relationship was found between depression and other demographic variables or disease parameters (diagnosis, time since diagnosis, stage or phase of illness, and current treatment). Our findings indicate that the prevalence of major depression in cancer patients is lower than many previous studies have indicated and falls within the range seen in the general population.
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PMID:Absence of major depressive disorder in female cancer patients. 405 46

The presence of pain as a symptom has been studied in a series of 51 depressed elderly inpatients and in a control group of 71 subjects. The frequency of patients with moderate to severe pain was significantly higher in the experimental group (72%) than in the controls (33.8%). Of the various categories diagnosed according to the DSM III degree criteria, the highest scores for pain were gained by the subjects suffering from dysthymic disorder and atypical depression, while those obtained by the patients with major depression and adjustment disorder with depressive mood were lower. The difference does not seem to depend on the quantity of anxiety present.
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PMID:Pain as a symptom in elderly depressed patients. Relationship to diagnostic subgroups. 409 11

The effects of low frequency (2 Hz) high intensity (10-12 mA) (electroacupuncture, EA) and of high frequency (100 Hz) low intensity (2 mA) (transcutaneous nerve stimulation, TNS) conditioning stimuli were studied on the nociceptive component (R2) of the blink reflex in normal volunteers. EA induced a progressive and moderate partially naloxone-reversible depression in the R2 response. In contrast, TNS induced a rapid and major depression in this reflex. In this latter case, naloxone failed to produce any reversal effect. These two patterns of data are discussed and further electrophysiological studies provide some evidence for two different mechanisms in the depressive effects of EA and TNS upon the nociceptive component of the blink reflex in man.
Pain 1982 Nov
PMID:Comparative effects of electroacupuncture and transcutaneous nerve stimulation on the human blink reflex. 698 65


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