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The pattern and frequency of neurovegetative symptoms was studied in 57 patients with chronic pain. Seventy-nine percent of these patients had a diagnosable depressive illness, but endogenous depression was rare (5%). Patients with chronic pain were divided into major depressives, minor/intermittent depressives and patients with no depression. A control group of nonendogenous major depressives without pain was also utilized. Major depressives differed from the other two chronic pain groups in that there was more frequent or severe early waking, weight loss, anorexia, diminished libido and initial insomnia. Diurnal variation of mood was not a characteristic of major depression with chronic pain, and did not differ in frequency from the other two chronic pain groups. Major depressives exhibited a profile of neurovegetative symptoms very similar to that found in the control group of major depressives. Over one-third of minor/intermittent depressed patients with chronic pain exhibited atypical (reversed) vegetative symptoms of hyperphagia and weight gain. This finding, together with our review of the literature, suggests an important and previously unrecognized link between atypical depression and chronic pain.
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PMID:Neurovegetative symptoms in chronic pain and depression. 293 54

The complex of the symptoms of psychic disorders and of the disorders of sleep, appetite, and food intake often forms the basis of the clinical picture of a mental disease. However, it is only rarely conceived in a complex manner as a set of physiologically interdependent functions. A remarkable proof of the interdependence of these functions is their complex disorder, the Kleine-Levin syndrome. The first descriptions of the symptoms of the Kleine-Levin syndrome can be found in the studies of several authors published as early as at the turn of the century. In 1942, the syndrome was designated by Critchley and Hoffmann after Willi Kleine and Max Levin, who defined it precisely in 1925 and 1929. The syndrome of periodic hypersomnia, megaphagia, and psychic disorders, originally described only in young males, was later found in females as well; the original very strict criteria were gradually broadened and complemented to some extent. At present, the most commonly accepted criterion for the diagnosis of the Kleine-Levin syndrome is the existence of the combined sleep disorder (hypersomnia or insomnia lasting from days to weeks), food intake disorders (megaphagia or anorexia), and various psychic abnormalities accompanying or following the attacks of the affection. We term the syndrome typical if the sleep disorder appears in the form of hypersomnia, food disorder in the form of megaphagia, and if psychic abnormalities are clearly expressed. On the other hand, we term the syndrome atypical if one of the main symptoms is opposite. The incomplete syndrome consists of only two main symptoms. The attacks of the affection set on mostly suddenly, lasting from several days to several weeks, ending suddenly again. The interparoxysmal periods last from several days to several months, sometimes even to several years. The etiopathogenesis of the affection is still unknown. A number of reports indicate a disorder of the diencephalon, perhaps only of the hypothalamus. The pathological-anatomical findings following the death of persons suffering from the disorders of sleep and food intake and from psychic abnormalities mostly reveal lesions in the region of the third brain ventricle. The development of the typical syndrome is benign, however, and morphological studies are not available. The typical Kleine-Levin syndrome can hardly escape the attention of clinicians owing to the richness and clarity of symptoms. The atypical or discretely expressed forms, however, often remain unrecognized even after a detailed medical examination and may lead to diagnostic uncertainty.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Kleine-Levin syndrome ethiopathogenesis and treatment. 307 27

Masked depression refers to a concept of a phenomenological state, either endogenous or psychogenic where somatic symptoms replace sadness: Thirty patients were evaluated by RDC (22 endogenous and 8 masked depressions) wherein in the latter dysphoria was replaced by a nonreactive persistent somatic complaint. They were rated on Beck and Hamilton Depression Scales, on Hamilton and Trait-State Anxiety Scales and the NOSIE. All patients presented with insomnia, anorexia, loss of weight, diminished libido and anhedonia. Initial ratings were similar for both diagnostic groups except for a significantly higher agitation factor and lower retardation in masked depression. Although 59.9 percent of the subjects are positive on the dexamethasone test, only 1 masked depression did not suppress secretion of cortisol. After a randomized 30-day drug trial where patients were assigned to Clomipramine or Desipramine, patients in both groups show significant improvement on rating scales but diagnostic group drug treatment interaction exists on anxiety and agitation criteria.
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PMID:[Comparison of masked and endogenous depression using psychometric scales, endocrinological markers and pharmacological responses. Masked depression versus endogenous depression]. 309 93

American trypanosomiasis (Chagas' disease) is an endemic parasitic disease afflicting more than 20 million persons in Latin America. Two drugs are currently being used for treatment of the acute phase of Chagas' disease: 4-[(5-nitrofurfurylidene)amino-3-methylthiomorpholine-1,1-di oxide] (Nifurtimox; Nfx) and (N-benzl-2-nitro-1-imidazole acetamide) (Benznidazole; Bz). Nfx and Bz have serious undesirable effects, which have been reported during their clinical use, including anorexia and weight loss, nausea and vomiting, nervous excitation, insomnia, psyche depressions, convulsions, vertigo, headache, sleepiness, myalgias, arthralgias, loss of balance, disorientation, forgetfulness, paresthesias, adynamia, acoustic phenomena, peripheral neuropathies, gastralgia, mucosal edema, hepatic intolerance, skin manifestations, and intolerance to drinking alcohol. Effects in the central and peripheral nervous system of Nfx were also reproduced in animals. Signs of testicular and ovarian injury were reported for both Nfx and Bz, the effects of Bz being in general less intense than those of Nfx. Both drugs evidenced mutagenicity. In light of the present knowledge about the toxicity of Nfx and Bz, further studies on the mutagenic, teratogenic, carcinogenic, and reproductive effects of both drugs are recommended. Lack of information is particularly serious for Bz. Studies on Nfx and Bz biotransformation, activation to reactive metabolites, and potential mechanisms for their toxic effects were analyzed. Risk-benefit considerations of the use of Nfx and Bz were made and an analysis of the need for research on Chagas' disease chemotherapy was also performed.
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PMID:Toxic effects of nifurtimox and benznidazole, two drugs used against American trypanosomiasis (Chagas' disease). 315 55

The Zung Self-Rating Depression Scale (SDS) was presented to 99 depressed inpatients. The patients were categorized according to DSM-III as suffering from minor depression, major depression without melancholia and major depression with melancholia and/or with psychotic features. Differences in self-reported symptoms between these categories were studied with multivariate statistical techniques including linear discriminant analysis (LDA) and statistical isolinear multiple components analysis (SIMCA). Patients with minor depression rate themselves significantly less depressed than those with major depression. Patients with major depression without melancholia are less depressed than those with melancholia and/or psychotic features. The three DSM-III depressive categories can be regarded as belonging to a clinical continuum in which they form relevant levels with quantitative differences in self-reported symptoms. These differences are not only defined by gradual shiftings in the overall severity of illness, but also by quantitative differences in the severity of some target symptoms, i.e. agitation, retardation, diurnal variation, loss of libido, fatiguability, insomnia, anorexia, sadness and anhedonia.
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PMID:Self rated depression in relation to DSM-III classification: a statistical isolinear multiple components analysis. 334 93

Fluoxetine is a bicyclic antidepressant that is a specific and potent inhibitor of the presynaptic reuptake of serotonin. It has essentially no effect on the reuptake of norepinephrine or other neurotransmitters. Similarly, it has negligible binding affinity for neurotransmitter receptor sites. It is well absorbed after oral administration, with absolute bioavailability in dogs of approximately 72 +/- 27.6%. The mean Tmax is between 4 and 8 hours, and it is approximately 94% protein bound. After a single dose, the elimination half-life is 1-3 days. After long-term administration, the elimination half-life averages 4 days. Its pharmacokinetics appear nonlinear. It is metabolized to an active metabolite norfluoxetine, which is also specific for the inhibition of serotonin reuptake. Norfluoxetine's elimination half-life averaged 7 days after long-term administration. Little is known about potential drug interactions; however, fluoxetine appears to have minimal clinically relevant interactions. Fluoxetine is indicated in the treatment of major depression. Its efficacy is comparable to the tricyclics and it has a similar onset of action. Although doses as high as 80 mg/day have been used, the optimal dosage range appears to be 20-40 mg once daily. Fluoxetine has been used with success in obsessive-compulsive disorder and intention myoclonus, however, its use in these disorders remains investigational. The frequency of side effects is low and dose related; the most common effects are nausea, anxiety, insomnia, anorexia, diarrhea, nervousness, and headache. Eight reports of intentional overdose with fluoxetine alone resulted in no deaths and mild adverse effects. It will be marketed as 20-mg capsules under the brand name of Prozac. Although fluoxetine should be added to formularies, its use should be reserved for treatment of those who do not respond to or do not tolerate tricyclic agents.
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PMID:Fluoxetine: a serotonin-specific, second-generation antidepressant. 355 56

Controversy exists regarding the frequency of depression in renal dialysis patients. We have assessed an unselected sample of 99 dialysis patients using the Diagnostic Interview Schedule (DIS). A current Major Depressive Episode (MDE) was diagnosed in 8.1% of the sample, one-half of whom had a past history of MDE. An additional 12.1% had only a past history of depression. In contrast to patients with no affective disorder, characteristics of patients with a current MDE included the following: a history of previous MDE; female sex; duration of dialysis less than or equal to 24 months; a younger mean age; solitary living arrangements; and unemployment. The following DSM-III criteria distinguished patients with MDE from those with no affective disorder: depressed mood or loss of interest; feelings of worthlessness or excessive guilt; anorexia and weight loss; and slowed or mixed-up thoughts. DSM-III criteria that were common in the entire sample but not useful in distinguishing patients with MDE included loss of energy, insomnia, and decreased sexual interest. These results indicate that some DSM-III criteria are common in dialysis patients and therefore do not distinguish major depression, whereas other DSM-III criteria are more specific for MDE. Further, it is possible that the prevalence of MDE is greater in dialysis patients than in the general population.
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PMID:The diagnosis of major depression in renal dialysis patients. 367 37

Combined clonidine and naltrexone treatment allowed 38 of 40 patients addicted to methadone to withdraw completely in 4-5 days. For most patients naltrexone was gradually increased from 1 mg/day to 50 mg/day over 4 days. Clonidine reduced the intensity of naltrexone-induced withdrawal symptoms. Clonidine significantly decreased blood pressure without producing syncope and caused sedation but no other clinical problems. The withdrawal symptoms of anxiety, anorexia, insomnia, restlessness, and muscular aching were most resistant but were mild or nonexistent at discharge. Clonidine-naltrexone treatment should succeed with patients receiving methadone doses up to 50 mg/day, facilitate naltrexone maintenance, and apply to many clinical settings.
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PMID:The combined use of clonidine and naltrexone as a rapid, safe, and effective treatment of abrupt withdrawal from methadone. 371 21

The diagnostic importance of vegetative symptoms for melancholia was examined through DSM-III, the Newcastle Scale, and Extracted Criteria for melancholia. Statistically significant differences were diagnostically unimpressive in the case of DSM-III and the Newcastle criteria. With the Extracted Criteria, initial insomnia, early waking, anorexia, weight loss, loss of libido, and worsened mood in the morning were all significantly more common in melancholia than in non-melancholic depression, while increased appetite was more common in non-melancholia. Only diurnal variation of mood (worse in the morning) showed predictive value for melancholia; whereas the other traditional vegetative symptoms (disturbed sleep, weight, and libido) did not. Increased appetite and diurnal variation of mood (worse in the evening) were predictive for non-melancholia.
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PMID:Diagnostic significance of vegetative symptoms in depression. 373 Jul 11

While depressive reactions appear to be universal, until recently they have seldom been described outside Europe, probably because of their lack of exotic salience, but also because they are seldom identified locally as distinct entities. Where it occurs, such an identification reflects a local preference for the articulation of individual psychological notions, rather than universal moral imperatives. While the symptoms of reactive depression are recognized in rural Trinidad as a common experience, but not especially remarked, they are also identified by Afro-Caribbeans as a specific state, Tabanka, following the loss of a sexual partner to another. Tabanka is characterized by lassitude, anorexia, insomnia, feelings of worthlessness, anger, a loss of interest in work and other activities and, especially, by a preoccupation with the faithless one. It is said to be most common among married men and among the upwardly socially mobile, and to lead to heavy drinking and occasionally madness or suicide. The precipitation of Tabanka provokes hilarity rather than moral indignation, and its humour articulates an egalitarian and individualistic working-class attitude to marriage and social mobility. In contrast, Trinidadians of Asian or Venezuelan origin emphasize moral notions of honour and shame.
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PMID:An indigenous conceptualization of reactive depression in Trinidad. 402 32


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