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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A clinical study was made on depressive state following stroke using stroke patients in the chronic stage. There were 118 stroke patients in the present study and 25 patients (21.2%) satisfied the diagnostic criteria for major depressive syndrome of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised (DSM-III-R). As for dispositional, social, and somatic factors, a tendency was observed for depressive state to develop at a high frequency among patients with a past history of mental disorder prior to development of stroke, patients residing in suburban area, patients engaged in domestic and agricultural work, and patients with a frequent history of physical disorders. A tendency was observed for depressive state to develop at a high frequency among patients showing B type in YG test and patients presenting laterality in electroencephalography. Among the 49 right stroke patients, depressive state was observed in 10 cases (20.4%), while among the 43 left stroke patients, depressive state was seen in 10 cases (23.2%) with the incidence of depressive state showing no difference by hemisphere stroke. Study of the clinical characteristics of depressive state by hemisphere stroke with the use of symptom items of Zung scale and Hamilton scale showed that patients in depressive state with right hemisphere stroke had high values in symptom items considered close to the essence of endogenous depression such as depressed mood, suicide, diurnal variation, loss of weight, and paranoid symptoms, while patients in depressive state with left hemisphere stroke had high values in symptom items having a nuance of so-called neurotic depression such as psychic anxiety, hypochondriasis, and fatigue. Comparison with endogenous depression patients indicated that right stroke patients rather than left stroke patients showed a clinical picture suggestive of endogenous depression. Antidepressant was effective in 71.4% of the cases, but no difference in effectiveness could be observed by hemisphere stroke. In stroke patients in the chronic stage the incidence of clinical depressive state was higher than 20%, and involved in its onset were not only brain organ lesions but also dispositional, social, and somatic factors and integration dysfunction in the emotional activity of the left and right hemisphere functions. As for the clinical picture, a picture considered close to endogenous depression was observed in right stroke patients, while that considered close to so-called neurotic depression was seen in left stroke patients. The therapeutic effect of antidepressant was almost equivalent to that for endogenous depression.
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PMID:[Clinical study on depressive state following stroke]. 223 45

Eighty-one patients undergoing carotid endarterectomy were divided into two groups based on the degree of stenosis of the carotid artery. Group I, 37 patients, was defined as having severe carotid stenosis (greater than 70%). Group II, 44 patients, was defined as having mild (less than 40%) or moderate (40% to 70%) carotid artery stenosis. Both groups were evaluated for neurologic and psychologic changes in the postoperative period. Prospective analysis demonstrated no significant differences between groups I and II in the areas of cardiac disease, history of preoperative stroke, preoperative and postoperative hypertension, diabetes, or postoperative computed tomography changes. Group II had a significantly higher percentage of carotid artery ulceration (p less than 0.01). Postoperative analysis revealed 34 group I patients had 6 to 8 weeks of lethargy versus two group II patients (p less than 0.01). Eleven group I patients had headaches for the first week postoperatively versus three patients in group II (p less than 0.05). Four group I patients had paranoid ideation, and another four patients had clinical depression, but not one patient in group II (p less than 0.01) had these psychiatric disturbances. These data suggest that significant, reversible neurologic and psychologic changes can occur because of reperfusion after relief of severe stenosis of the carotid artery.
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PMID:Postoperative somnolence in patients after carotid endarterectomy. 235 8

Controversy continues to surround the value of drug treatment of hypertension in the elderly. Epidemiologic evidence implicates hypertension as a major risk factor in the precocious development of stroke and coronary heart disease in the elderly subject as clearly as it is implicated in the younger person. The hemodynamic and neuroendocrine profiles of the older patient with essential hypertension are similar to those of younger patients in the stable phase of the disease. However, the arterial ravages induced by many years of sustained hypertension render the circulation of the elderly subject more sensitive to pharmacologic intervention. The benefit-risk ratio of most antihypertensive drugs appears to be inversely related to age. Diuretics reduce the blood pressure at rest but have no influence on the increases in systolic pressure during normal activity; in addition, they carry potentially serious metabolic hazards in the elderly hypertensive patient. Centrally acting drugs likewise lower the blood pressure at rest without influencing the high systolic pressures induced by exercise. They also enhance the tendency to endogenous depression. Adrenergic-neurone blocking drugs and alpha-adrenoceptor antagonists are contraindicated because of the frequency of impaired cardiovascular reflexes in the elderly. The beta-blocking drugs can reduce the risk of coronary and cerebrovascular disease in the older patient with hypertension. They appear to be well tolerated, but because of their impaired metabolic handling in many elderly patients they should probably be used in smaller doses than those prescribed in younger patients. The influence of antihypertensive treatment on cardiovascular morbidity and mortality in the elderly hypertensive patient is not known.
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PMID:Oxprenolol in the treatment of hypertension in the elderly. 613 12

A diagnosis of depression is frequently considered in the evaluation of patients after cerebrovascular accident (CVA); however, the usual clinical signs of depression may be either masked in depressed patients or mimicked in nondepressed patients. The dexamethasone suppression test (DST), first used to screen patients with a suspected diagnosis of Cushing's disease, has been shown in the psychiatric population to be abnormal in about 50% of patients with primary or endogenous depression. This study employed the DST to assess its diagnostic value in a population of 20 CVA patients admitted to a rehabilitation hospital. The test was found to have an 83% specificity. Results suggest that the low incidence of primary depression in this setting greatly limits the utility of the DST in such usage.
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PMID:Dexamethasone suppression test and depression in a rehabilitation setting. 661 80

General practice physicians and clinical specialists use various methods for assessing dementia, including the Mental State Questionnaire (MSQ), Face-Hand Test (FHT), Dementia Rating Scale (DRS), tests for developmental reflexes and focal neurologic signs, and examination for evidence of clinical depression, stroke, or other physical health problems. In order to determine how these various methods concur, a sample of elderly persons living in the community were evaluated on eight indices. When MSQ scores were used as criteria, the DRS and FHT concurred with classification of impairment in 76 per cent and 45 per cent of cases, respectively. Positive focal signs and developmental reflexes were significantly related to cognitive impairment but were not common features in this sample. Physical health, drug use, and demographic variables did not appear to be related to cognitive function. Although dysphoric mood was related to cognitive impairment, pseudodementia was not identified. After one year the subjects were retested with the MSQ and the DRS; 14 per cent and 20 per cent, respectively, had improved, indicating a lack of predictive validity of these measures. Results are discussed in the context of the utility of clinical methods for screening and staging cognitive impairment, and recommendations are made regarding a standardized battery.
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PMID:A comparison of clinical methods for assessing dementia. 685 44

In this study, we examined the influence of clinical depression and personality introversion on 15-month mortality following stroke. Ninety-four stroke inpatients were examined two months post-stroke for clinical depression and pre-stroke personality characteristics of neuroticism and introversion. Fifteen months later, the vital status of 84 of these patients was able to be determined. Seven (8%) of the 84 patients died. Mortality rate increased from non-depressed to minor depressed and to major depressed patients (1/48 [2%], 2/21 [10%] and 3/13 [23%], respectively) (chi 2[trend] = 6.6, df = 1, p = 0.01). Patients who died had higher depression symptom scores (mean +/- SD) than survivors (17.7 +/- 6.0 versus 9.9 +/- 7.1) (p = 0.006). Non-survivors were more introverted (i.e. had lower extroversion scores) than survivors (1.7 +/- 1.4 versus 4.2 +2- 2.1) (p = 0.004). In multivariate analyses, introversion and depression were independently associated with mortality. We conclude that personality introversion and depression are associated with increased mortality following stroke.
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PMID:Depression, introversion and mortality following stroke. 825 Jul 88

The authors discuss the most modern non-invasive methods for the examination of the circulatory system and consider the opportunity of their application in psychiatry. They refer to the results of their earlier studies on the some selected parameters of the circulatory system by means of radiocardiography i.e. Total Peripheral Resistance Index (TPRI), Heart Rate (HR), Arterial Blood Pressure (AP) and the Stroke Index (SI). It follows from the results that such examinations are appropriate mainly in patients with endogenous depression and may contribute to an increased safety factor in the treatment with tricyclic antidepressants. Among the methods which could contribute to the better evaluation of the state of the circulatory system (especially on contraction in the left ventricle of the heart and peripheral resistance) in depressive patients, phonocardiography, mechanocardiography and Doppler echo sounding cardiography are enumerated. Haemodynamic examinations turned out to be useful in predictions of the somatic tolerance of tricyclic antidepressants and to be helpful in understanding the reason for several complains involving the circulatory system in patients with endogenous depression. Two groups of patients: psychomotorically retarded and excited (with high intensity of anxiety) who differ from each other in the haemodynamic parameters are discriminated. This paper points out the necessity for the control of the circulatory system in these patients by means of modern non-invasive methods and is in agreement with the holistic attitude towards a patient.
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PMID:[The application of hemodynamic examination in psychiatry]. 837 65

Fifteen healthy, colostrum-fed, male dairy calves, aged 2 to 7 d were used in a study to develop a diarrhea protocol for neonatal calves that is reliable, practical, and economical. After instrumentation and recording baseline data, diarrhea and dehydration were induced by administering milk replacer [16.5 mL/kg of body weight (BW), PO], sucrose (2 g/kg in a 20% aqueous solution, p.o.), spironolactone and hydrochlorothiazide (1 mg/kg, PO) every 8 h, and furosemide (2 mg/kg, i.m., q6h). Calves were administered sucrose and diuretic agents for 48 h to induce diarrhea and severe dehydration. Clinical changes after 48 h were severe watery diarrhea, severe depression, and marked dehydration (mean, 14% BW loss). Cardiac output, stroke volume, mean central venous pressure, plasma volume, thiocyanate space, blood pH and bicarbonate concentration, base excess, serum chloride concentration, and fetlock temperature were decreased. Plasma lactate concentration, hematocrit, and serum potassium, creatinine, phosphorus, total protein and albumin concentrations were increased. This non-infectious calf diarrhea protocol has a 100% response rate, while providing a consistent and predictable hypovolemic state with diarrhea that reflects most of the clinicopathologic changes observed in osmotic/maldigestive diarrhea caused by infection with rotavirus, coronavirus or cryptosporidia. Limitations of the protocol, when compared to infectious diarrhea models, include failure to induce a severe metabolic acidosis, absence of hyponatremia, renal instead of enteric loss of chloride, renal as well as enteric loss of free water, absence of profound clinical depression and suspected differences in the morphologic and functional effect on intestinal epithelium. Despite these differences, the sucrose/diuretic protocol should be useful in the initial screening of new treatment modalities for calf diarrhea. To confirm their efficacy, the most effective treatment methods should then be examined in calves with naturally-acquired diarrhea.
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PMID:A reliable, practical, and economical protocol for inducing diarrhea and severe dehydration in the neonatal calf. 968 50

Recently, clinical depression has been identified as an independent risk factor for increased mortality in patients following acute coronary events. Although the underlying mechanisms of this link remain uncertain, increased platelet activity has been suggested but never proven as the mechanism responsible for this association. Sertraline hydrochloride is a selective serotonin reuptake inhibitor (SSRI), and is an effective antidepressant agent. Its major liver metabolite, N-desmethylsertraline (NDMS), is known to be neurologically inactive. We assessed the in vitro effects of escalating concentrations of sertraline and NDMS on human platelets by aggregometry in plasma and whole blood, by expression of major surface receptors with flow cytometry in washed cells and in the whole blood, and quantitatively by various platelet function analysers in healthy volunteers and patients with coronary artery disease. Pretreatment of blood samples with sertraline and NDMS resulted in a dose-dependent inhibition of platelet-rich plasma aggregation induced by 5 microM ADP (P =, 0.002), by 10 microM ADP (P = 0.0017), by collagen (P = 0.008), and by thrombin (P = 0.026). Whole blood platelet aggregability was also significantly reduced when induced by 20 microM ADP (P = 0.006), and by collagen (P = 0.01). Surface expression of CD9 (P = 0.004), GP Ib (P = 0.0001), GP IIb/IIIa (P = 0.007), VLA-2 (P = 0.01), P-selectin (P = 0.02), and PECAM-1 (P = 0.01), but not the vitronectin receptor, was also reduced in sertraline and NDMS pretreated washed platelets. Whole blood flow cytometry revealed significant inhibition of GP IIb/IIIa (P = 0.008), and P-selectin expression (P = 0.0001) in NDMS treated samples. Closure time was delayed for the collagen-ADP cartridge (P = 0.009), and for the collagen-epinephrin cartridge (P = 0.01), indicating platelet inhibition in whole blood under high shear conditions. Rapid platelet-function assay revealed a decreased (P = 0.002) ability of platelets to agglutinate fibrinogen-coated beads, suggesting GP IIb/IIIa inhibition. Both sertraline, and its neurologically inactive metabolite NDMS, exhibited significant dose-dependent inhibition of human platelets. The documented anti-platelet effects of sertraline and NDMS may be directly related to the mortality benefits of SSRIs after ischemic events including myocardial infarction and stroke.
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PMID:Platelet inhibition by sertraline and N-desmethylsertraline: a possible missing link between depression, coronary events, and mortality benefits of selective serotonin reuptake inhibitors. 1139 37

The purpose of this study was to compare family caregivers of person with dementia and caregivers of stroke survivors with similar levels of caregiving responsibilities. The design was descriptive and included characteristics of care recipients, caregivers, and care situations. Caregivers of individuals with dementia reported care recipients were more impaired with independent activities of daily living and memory and behavior problems. There were no differences in caregiver depression and fatigue. Even with the benefit of respite care, a substantial number of caregivers had depression scores above the level indicating possible clinical depression. Consultation by advanced practice psychiatric nurses for caregivers and care recipients may be beneficial in detecting depression and making recommendations for appropriate treatment.
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PMID:Comparison of family caregivers. Stroke survivors vs. person with Alzheimer's disease. 1264 Aug 64


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