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Query: UMLS:C0085632 (apathy)
 4,089 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A psychological investigation carried out by a psychologist was performed on 58 patients with myocardial infarction, initially hospitalized in an intensive care unit. The results were compared with those obtained in 37 patients hospitalized in the same conditions, but for different diseases. The manifestations previously described have been for a large part recognized: anxiety, indifference, regression, displacement of anxiety or its projection, depression, sleep disturbances, hostility, "surviver" or "Minotaurus" syndrome. A few practical conclusions are put forward concerning the attitude of the nursing team on arrival at hospital, on the style of physician-patient relationship, the duration of the stay in intensive care unit, the interest of interviews performed by a psychologist.
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PMID:[Psychological problems in a coronary intensive care unit]. 81 20

The study was carried out in 89 men aged 21 to 57 years with a history of exposure to mercury vapour from 2 to 26 years during occupational work involving chlorine production by the method of mercury electrolysis. The workers were divided into three groups depending on the duration of occupational exposure: 1) 32 workers with a short history of exposure 2-10 years, 2) 37 workers with medium-long exposure - 11-20 years, and 3) 20 workers with a history of long exposure - 21-26 years. The urinary concentrations of mercury in these individuals was 73 +/- 60 microliters x 1(-1), and in blood this concentration was not exceeding 50 microliters x 1(-1). The control group comprised 40 men aged 17 to 52 years. They had not had any occupational exposure to chemicals, or harmful physical factors. On the basis of clinical, haematological and biochemical studies 89 workers with occupational exposure to mercury vapour were regarded as clinically healthy. None of them had any symptoms and signs of the complete neurasthenic syndrome or organic brain injury. Increased nervous excitability was the complaint of 24 workers, 9 had headaches, sleep disturbances were reported by 5, and a feeling of tiredness and apathy was mentioned by 5 men. EEG recording demonstrated 81 normal tracings, and moderately pathological records in 8 men. The parameters of immunity and proteins acute phase reaction were determined, measuring the concentration of immunoglobulins, lysozyme, C3c, C4, alpha 1-acid glycoprotein, haptoglobin and ceruloplasmin in serum. A lower level of IgA, IgG and lysozyme was only noted in individuals with occupational exposure exceeding 20 years.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Parameters of immunity acute phase reaction in men in relation to exposure duration to mercury vapours. 172 75

Depressive mood is frequently associated with Parkinson's syndrome, but it may also occur as a precursor of this disease. As regards the subtypes of Parkinson's disease, the frequency of depressive states is significantly higher in the type dominated by akinesia and rigidity than in the type dominated by tremor. On the basis of biochemical changes, certain aspects of the depression can be successfully treated by substitution therapy: L-dopa medication may increase the reduced dopamine values in the striatum, thereby improving drive. Substitution with L-tryptophan raises the lowered serotonin values in the reticular formation, which may influence sleep disturbances. The changes of basic mood, however, which are characteristic of depression, such as cheerlessness and apathy, are the dopamine of antidepressive medication; only these drugs can re-establish the biochemical balance to a large extent.
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PMID:[Depression and Parkinson syndrome]. 287 39

The serotonin hypothesis postulates a decreased function of this neurotransmitter in the central nervous system of depressed patients. L-tryptophan and--more specific--5-hydroxytryptophan are natural precursors of this biogenic amine. Results of numerous therapeutic trials with L-tryptophan are not convincing of this compound's antidepressant efficacy in marked to severe endogenous depressions. On the other hand, it cannot be excluded that it is effective in moderate dysphoric states with apathy and sleep disturbances. However, possible toxic effects of high and long term use render its clinical use doubtful. The antidepressant efficacy of 5-hydroxytryptophan has not been proven. However, the possibility exists that a serotonin deficient subgroup of depressed patients responds to this substance and further, that it has depression prophylactic properties. As both tryptophan and 5-hydroxytryptophan are less effective than tricyclic antidepressants and not without side effects they do not appear to be useful antidepressants.
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PMID:[Serotonin precursors as antidepressive agents: a review]. 660 3

Adverse effects associated with antidepressant drug therapy rarely cause significant morbidity or mortality. Nevertheless, the successful management of patients with depression requires recognition of potential adverse effects that have serious consequences, which include the discontinuation of otherwise effective therapy. The aim of this overview is to highlight the more common and potentially deleterious adverse effects of both older and newer classes of antidepressant drugs. Major adverse effects attributed to the tricyclic antidepressant drugs (TCAs) include conduction defects and lethal overdose. Most worrisome with the selective serotonin reuptake inhibitor drugs (SSRIs) is the serotonin syndrome. Although rare, this syndrome can be insidious and lethal. Recent trends toward the use of medication combinations and augmentation therapies significantly enhance the risk of serotonin syndrome. Cognitive impairment also may occur, especially with the TCAs. Apathy is occasionally a problem with SSRI therapy. The syndrome of inappropriate antidiuretic hormone (SIADH) has been reported with most antidepressant drugs but appears to be more common with serotonergic agents and in elderly patients. Although seizures are uncommon in patients receiving antidepressant therapy, the risk must be understood by both the patient and the clinician. Adverse effects related to sexual function are common, especially with TCAs, SSRIs, and venlafaxine. Sexual dysfunction often leads to noncompliance and self-discontinuation of therapy. Sleep disturbances are common in patients with depression, and recent data illustrate how crucial sleep regulation is to mood. Antidepressant drugs vary in their sleep effects. Although antidepressant drugs can cause a variety of adverse effects, these drugs save lives and their benefits far exceed their risks.
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PMID:Antidepressant drugs: disturbing and potentially dangerous adverse effects. 979 63

Four patients treated in one ward of a psychiatric clinic were admitted to our burn unit within 2 months due to severe burn injuries. The patients showed signs of a self-mutilation epidemic. All four patients were female and the mean age was 28 years. The psychiatric diagnosis was schizophrenia in all patients (ICD 10: F20.9). The ignition of flammable liquid was the most common method and the mean burned TBSA was 33%. The mean severity score (ABSI) was 8 and the median hospital stay was 50 days. All patients were characterised by a prolonged hospital stay in comparison to patients without additional psychiatric pathology (median 31 days). This prolonged stay was based on a delayed wound healing, more operations, extended time for mobilisation and difficulties in co-operation. It is possible that in patients with schizophrenia, changes in nutrition, activity, sleep and drug use could influence their immune system profoundly. Anxiety and depression is also associated with the impairment of cellular and humoural immunity. Poor sleep reduces the production of an anabolic endocrine environment and sleep disturbances can interfere with macrophage and lymphocyte functions. Poor appetite leads to malnutrition, which is also capable of producing delayed wound healing. On the other hand, apathy and a general lack of motivation interfere with therapeutic strategies, because poor appetite and weight loss often occurs after neuroleptic withdrawal, which is correlated with clinical decompensation. Moreover, this "self-destructive" behaviour, which is acting on the immune system, might make a patient more susceptible to infection. All these aspects and side effects of schizophrenia combine to make the treatment of burned patients with schizophrenia a very special and difficult task.
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PMID:Treatment of patients with severe burn injuries: the impact of schizophrenia. 1254 45

Depressive disorders are highly prevalent in the general population. Long-term treatment with antidepressants consolidates the improvement obtained during the acute phase of the treatment and prevents relapses and recurrences of the disorder. On the other hand, there is growing evidence that antidepressant side effects may limit patients' quality of life and social functioning, as well as affect patients' health and treatment adherence. Most studies concerning antidepressant treatment have focused on short-term tolerability, ignoring both early-onset persistent side effects and late-onset side effects that are reported during long-term treatment. Nevertheless, these long-term treatment side effects are likely to have a dramatic impact on patient outcome and treatment adherence. Common long-term side effects of antidepressants are weight gain, sexual dysfunction, sleep disturbances, fatigue, apathy, and cognitive impairment (e.g., working memory dysfunction). Usual strategies for the management of these long-term side effects are: changing drug daily schedule, various augmentation therapies, antidepressant switches, drug-holidays, and dose tapering, with the latter two strategies being strongly discouraged on the basis of concerns that patients' depressive episodes may return. Selective serotonin reuptake inhibitors (SSRIs) and atypical antidepressants (e.g., venlafaxine, bupropion, and nefazodone) show a relatively favorable short-term as well as long-term tolerability compared with older drugs (e.g., tricyclics and monoamine oxidase inhibitors). Therefore, clinicians are likely to prefer them in usual practice, especially among patients requiring maintenance treatment. The present review focuses on management of long-term side effects.
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PMID:Tolerability issues during long-term treatment with antidepressants. 1514 9

Apathy and fatigue, sexual disturbances, mania, sleep disturbances, personality changes, pathologic gambling, and addiction to antiparkinson agents occur in patients with PD and may pose considerable stress on the patients themselves and their caregivers. With the exception of apathy and fatigue, little is known regarding the prevalence of these symptoms in patients with PD. The pathophysiologic mechanisms are unknown, although disturbances of the mesolimbic and mesocortical dopaminergic pathways are probably involved. Antiparkinsonian drugs or surgery seem to be the main etiologic factors for sexual disturbance, hypomania, addiction, and pathologic gambling, whereas hypodopaminergic states may contribute to symptoms such as apathy, fatigue, RBD, and possibly personality changes. Although some placebo-controlled trials have been published recently, no established treatments are currently available for these symptoms (85) (see Table 5-2), and thus future clinical trials are needed.
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PMID:Disorders of motivation, sexual conduct, and sleep in Parkinson's disease. 1638 12

Parkinson's disease (PD), Dementia with Lewy Bodies (DLB), Progressive Supranuclear Palsy (PSP) and Corticobasal Degeneration Syndrome (CBDS) are the most common neurodegenerative extrapyramidal syndromes. Beyond motor symptoms, cognitive dysfunctions and behavioral disturbances are reported. Neuropsychological and neuropsychiatry features in the early stages, however, are under-investigated, and few comparison studies are available yet. The aim of the present study was to evaluate the cognitive and behavioral profile in the early stages of neurodegenerative extrapyramidal syndromes. Thirty-nine PD, 27 DLB, 16 CBDS, and 24 PSP were recruited. Groups were matched for global cognitive and motor impairment. The overall sample showed a common neuropsychological core characterized by visuospatial deficits. Although in the early stage of the disease, a high presence of behavioral disturbances was detected, depression and anxiety were the most common disorders, followed by apathy and sleep disturbances. The observation of overlapping clinical entities points the attention on the need of adjunctive diagnostic markers for early differential diagnosis.
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PMID:Cognitive and behavioral assessment in the early stages of neurodegenerative extrapyramidal syndromes. 1776 37

In first term, we define the current concepts in regard to psychosis (delirium and hallucinations) and abnormal behaviours (aggression, depression and mood changes such as mania, apathy, anxiety, agitation and desinhibition) in dementia. We also review the most used drugs in order to control these symptoms (typical and atypical antipsychotics, anti-epileptic drugs, benzodiazepines, SSRI, memantine and AcheI). As well, we take in consideration pharmacokinetic and pharmacodynamic characteristics, relationship to aging and interactions of these medications. Finally, we briefly describe the management of non-pharmacological of the most common behavioural symptoms: disruptive conducts such as exaggerated responses to minimal stimuli, catastrophic reaction, violence, anger and hostility, wandering and sundowning. As well, we discuss how to manage sleep disturbances, sexual aggression, incontinence and dressing apraxia. Management of these conditions involves, in first term, a comprehensive understanding of the whole situation and identification of underlying possible causes will make possible to evaluate results. This approach will lead to a more rationale proposal of psychotherapeutic and behavioural techniques, and milieu modifications. Finaly, we consider safety patient's in the community as well as the risk of abuse originated in a non-healthy patient-caregiver relationship.
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PMID:[Behavioural and psychological signs in dementia. Clinical features. Pharmacological and non-pharmacological treatment strategies]. 1839 11


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