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Sample records for acutely depressed patients

  1. [Acute pharmacotherapy for anxiety symptoms in patients with depression].

    PubMed

    Quante, A

    2015-03-01

    Patients with depression often also present symptoms of anxiety. First-line pharmacotherapy of comorbid symptoms of depression and anxiety is often a combination therapy of an antidepressant agent, which is combined with benzodiazepines. However, benzodiazepines pose the drawbacks of being associated with cognitive and motor impairments and hold a significant risk for dependence. For some patients, benzodiazepines are contraindicated or patients refuse to take them. Therefore, alternative therapy strategies for the acute treatment of anxiety symptoms in depressed patients are urgently needed. A selective Medline/Pubmed search with focus on acute pharmacological treatment strategies for anxiety and agitation in depressed patients was undertaken. In the light of the paucity of studies in this field, positive effects could be assumed for quetiapine, olanzapine, olanzapine-fluoxetine combination, pregabaline and silexan.

  2. Depression impacts the course of recovery in patients with acute low-back pain.

    PubMed

    Melloh, Markus; Elfering, Achim; Käser, Anja; Salathé, Cornelia Rolli; Barz, Thomas; Aghayev, Emin; Röder, Christoph; Theis, Jean-Claude

    2013-01-01

    Little is known about the course of recovery of acute low back pain (LBP) patients as a function of depression. In a prospective study, 286 acute LBP patients were assessed at baseline and followed up over 6 months. Recovery was defined as improvement in the Oswestry Disability Index (ODI). Repeated-measures analysis of covariance was employed with ODI as repeated factor, age, sex, and body mass index as covariates, depression and all other potential prognostic factors as between-subject factors. Of study participants, 18% were classified as depressive (>33 points on the Zung Self-Rating Depression Scale). Of 286 participants, 135 were lost to follow-up. In the longitudinal sample of 151 patients the course of recovery was slower in depressive patients. Depression was associated with LBP especially after 6 weeks and should therefore be included in screening instruments for acute LBP patients to identify those at risk of delayed recovery at an early stage. PMID:23930900

  3. Increased activities of both superoxide dismutase and catalase were indicators of acute depressive episodes in patients with major depressive disorder.

    PubMed

    Tsai, Meng-Chang; Huang, Tiao-Lai

    2016-01-30

    Oxidative stress may play an important role in the pathophysiology of major depressive disorder (MDD). The aim of this study was to investigate the serum levels of oxidative stress biomarkers and S100B in patients with MDD in an acute phase, and evaluate the changes in superoxide dismutase (SOD), protein carbonyl content (PCC), glutathione peroxidase (GPX), 8-hydroxy 2'-deoxyguanosine after treatment (8-OHdG), catalase (CAT), thiobarbituric acid reactive substances (TBARS) and S100B. We consecutively enrolled 21 MDD inpatients in an acute phase and 40 healthy subjects. Serum oxidative stress markers were measured with assay kits. Serum SOD and CAT activities in MDD patients in an acute phase were significantly higher than those of healthy subjects, and serum PCC levels were significantly lower. The HAM-D scores had a significantly positive association with S100B levels. Eighteen depressed patients were followed up, and there was no significant difference among all of the markers after treatment. In conclusion, our results suggest that increased activities of both SOD and CAT might be indicators of acute depressive episodes in MDD patients.

  4. Confluence of Depression and Acute Psychological Stress Among Patients With Stable Coronary Heart Disease: Effects on Myocardial Perfusion

    PubMed Central

    Burg, Matthew M.; Meadows, Judith; Shimbo, Daichi; Davidson, Karina W.; Schwartz, Joseph E.; Soufer, Robert

    2014-01-01

    Background Depression is prevalent in coronary heart disease (CHD) patients and increases risk for acute coronary syndrome (ACS) recurrence and mortality despite optimal medical care. The pathways underlying this risk remain elusive. Psychological stress (PS) can provoke impairment in myocardial perfusion and trigger ACS. A confluence of acute PS with depression might reveal coronary vascular mechanisms of risk. We tested whether depression increased risk for impaired myocardial perfusion during acute PS among patients with stable CHD. Methods and Results Patients (N=146) completed the Beck Depression Inventory‐I (BDI‐I), a measure of depression linked to recurrent ACS and post‐ACS mortality, and underwent single‐photon emission computed tomography myocardial perfusion imaging at rest and during acute PS. The likelihood of new/worsening impairment in myocardial perfusion from baseline to PS as a function of depression severity was tested. On the BDI‐I, 41 patients scored in the normal range, 48 in the high normal range, and 57 in the depressed range previously linked to CHD prognosis. A BDI‐I score in the depressed range was associated with a significantly greater likelihood of new/worsening impairment in myocardial perfusion from baseline to PS (odds ratio =2.89, 95% CI: 1.26 to 6.63, P=0.012). This remained significant in models controlling ACS recurrence/mortality risk factors and medications. There was no effect for selective serotonin reuptake inhibitor medications. Conclusions Depressed patients with CHD are particularly susceptible to impairment in myocardial perfusion during PS. The confluence of PS with depression may contribute to a better understanding of the depression‐associated risk for ACS recurrence and mortality. PMID:25359402

  5. Electroconvulsive therapy exerts mainly acute molecular changes in serum of major depressive disorder patients.

    PubMed

    Stelzhammer, Viktoria; Guest, Paul C; Rothermundt, Matthias; Sondermann, Carina; Michael, Nikolaus; Schwarz, Emanuel; Rahmoune, Hassan; Bahn, Sabine

    2013-10-01

    Electroconvulsive therapy (ECT) is mainly used to treat medication resistant major depressive disorder (MDD) patients, with a remission rate of up to 90%. However, little is known about the serum molecular changes induced by this treatment. Understanding the mechanisms of action of ECT at the molecular level could lead to identification of response markers and potential new drug targets for more effective antidepressant treatments. We have carried out a pilot study which analysed serum samples of MDD patients who received a series of ECT treatments over 4 weeks. Patients received only ECT treatments over the first two weeks and a combination of ECT and antidepressant drugs (AD) over the subsequent two weeks. Blood serum analyses were carried out using a combination of multiplex Human MAP® immunoassay and liquid-chromatography mass spectrometry (LC-MS(E)) profiling. This showed that ECT had a predominant acute effect on the levels of serum proteins and small molecules, with changes at the beginning of ECT treatment and after administration of the ECT+AD combination treatment. This suggested a positive interaction between the two types of treatment. Changed molecules included BDNF, CD40L, IL-8, IL-13, EGF, IGF-1, pancreatic polypeptide, SCF, sortilin-1 and others which have already been implicated in MDD pathophysiology. We conclude that ECT appears to exert mainly acute effects on serum molecules.

  6. Lessons learned from study of depression in cardiovascular patients in an acute-care heart and vascular hospital.

    PubMed

    Davis, Michael; Brennan, J Michael; Vish, Nancy; Adams, Jenny; Muldoon, Mary; Renbarger, Tara; Garner, John

    2013-01-01

    Depression is highly prevalent in patients with cardiovascular disease, but questions about the effectiveness of screening and intervention remain unanswered. To evaluate the effects of proactive intervention at an acute-care heart and vascular hospital, patients who reported depressive symptoms on admission were randomized to an active, counseling-based depression intervention plus standard care (referral to a primary or psychiatric care physician) or to standard care alone. Despite early termination of patient enrollment because of lower-than-expected recruitment rates, the project had a positive impact. By involving and educating staff, the investigators raised awareness and improved the process of identifying and helping depressed patients. The lessons in study design and execution gained from this experience will help ensure success in future studies of this condition.

  7. Anxiety and depression propensities in patients with acute toxic liver injury

    PubMed Central

    Suh, Jeong Ill; Sakong, Jeong Kyu; Lee, Kwan; Lee, Yong Kook; Park, Jeong Bae; Kim, Dong Joon; Seo, Yeon Seok; Lee, Jae Dong; Ko, Soon Young; Lee, Byung Seok; Kim, Seok Hyun; Kim, Byung Seok; Kim, Young Seok; Lee, Heon Ju; Kim, In Hee; Sohn, Joo Hyun; Kim, Tae Yeob; Ahn, Byung Min

    2013-01-01

    AIM: To investigate anxiety and depression propensities in patients with toxic liver injury. METHODS: The subjects were divided into three groups: a healthy control group (Group 1, n = 125), an acute non-toxic liver injury group (Group 2, n = 124), and a group with acute toxic liver injury group caused by non-commercial herbal preparations (Group 3, n = 126). These three groups were compared and evaluated through questionnaire surveys and using the Hospital Anxiety-Depression Scale (HADS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and the hypochondriasis scale. RESULTS: The HADS anxiety subscale was 4.9 ± 2.7, 5.0 ± 3.0 and 5.6 ± 3.4, in Groups 1, 2, and 3, respectively. The HADS depression subscale in Group 3 showed the most significant score (5.2 ± 3.2, 6.4 ± 3.4 and 7.2 ± 3.4 in Groups 1, 2, and 3, respectively) (P < 0.01 vs Group 1, P < 0.05 vs Group 2). The BAI and BDI in Group 3 showed the most significant score (7.0 ± 6.3 and 6.9 ± 6.9, 9.5 ± 8.6 and 8.8 ± 7.3, 10.7 ± 7.2 and 11.6 ± 8.5 in Groups 1, 2, and 3, respectively) (BAI: P < 0.01 vs Group 1, P < 0.05 vs Group 2) (BDI: P < 0.01 vs Group 1 and 2). Group 3 showed a significantly higher hypochondriasis score (8.2 ± 6.0, 11.6 ± 7.5 and 13.1 ± 6.5 in Groups 1, 2, and 3, respectively) (P < 0.01 vs Group 1, P < 0.05 vs Group 2). CONCLUSION: Psychological factors that present vulnerability to the temptation to use alternative medicines, such as herbs and plant preparations, are important for understanding toxic liver injury. PMID:24379633

  8. Anxiety and depression in the acute porphyrias.

    PubMed

    Millward, L M; Kelly, P; King, A; Peters, T J

    2005-01-01

    A previous study of self-rated psychosocial aspects in patients with acute porphyria found that depression, and particularly anxiety, is more common in porphyria patients than in the general population or general medical outpatient attenders. Nearly half of the sample (46%) reported at least some problem with anxiety and/or depression: anxiety caseness was 26% and depression caseness was 13%. This paper extends our previous observations and investigates further the associations between porphyria and anxiety, depression and general mental health in 90 patients (58 acute intermittent porphyria, 32 variegate porphyria). The findings of this study confirm that anxiety is raised in patients with acute intermittent porphyria and with variegate porphyria, in both males and females, compared to the normative population and, using a series of questionnaires exploring the physical and psychosocial features of anxiety, that this anxiety is experienced as a 'relatively stable personality trait', rather than a 'transitory emotional state' (i.e. intrinsic rather than secondary to the porphyria).

  9. The Lunch Bunch: an innovative strategy to combat depression and delirium through socialization in elderly sub-acute medicine patients.

    PubMed

    Feyerer, Margot; Kruk, Dawn; Bartlett, Nicole; Rodney, Kathy; McKenzie, Cyndi; Green, Patrice; Keller, Lisa; Adcroft, Pat

    2013-01-01

    Hospitalized sub-acute medicine patients face challenges to their functional and cognitive abilities as they await transfer to long-term care facilities or return home. The Continuous Quality Improvement (CQI) Council, representing a multidisciplinary team of healthcare professionals working in the Sub-Acute Medicine Unit (SAMU), implemented a twice-weekly lunch program called the Lunch Bunch in order to combat depression and delirium in our elderly and cognitively impaired patients. The Lunch Bunch initiative includes chaplains, nurses and physiotherapists who have provided a framework through which essential socialization and exercise for this vulnerable population is facilitated. Providing a means for both mental and physical stimulation also allows patients to open up and discuss hidden feelings of loneliness and isolation, thereby beginning a journey of spiritual and emotional healing. PMID:24860951

  10. Sleep EEG and nocturnal secretion of testosterone and cortisol in patients with major endogenous depression during acute phase and after remission.

    PubMed

    Steiger, A; von Bardeleben, U; Wiedemann, K; Holsboer, F

    1991-01-01

    Sleep EEG and the nocturnal secretion of cortisol and testosterone in 12 male patients (mean age 46.4 +/- 11.26 years) with major endogenous depression were investigated concomitantly during acute depression, before treatment and after recovery and drug cessation. Testosterone concentration increased after remission, while cortisol secretion decreased. Sleep EEG disturbances remained unchanged in remitted patients. The data suggest that a blunted testosterone and an elevated cortisol secretion are state markers of acute depression, which normalize independently from sleep structure. An interaction between the hypothalamic-pituitary-gonadal axis and the limbic-hypothalamic-pituitary-adrenocortical axis appears likely.

  11. Depression and Suicide in Schizophrenic Patients.

    ERIC Educational Resources Information Center

    Salama, Aziz A.

    1988-01-01

    Identified schizophrenic patients as distinctive subgroup of patients who can suffer from major depressive illness and can commit suicide. Found 22.4 percent of 620 schizophrenics in psychiatric facility showed symptoms of major depressive episode. Seven patients committed suicide during acute phase of illness, 9 attempted suicide while…

  12. Anxiety and depression on an acute respiratory ward

    PubMed Central

    Thew, Graham R; MacCallam, Jackie; Salkovskis, Paul M; Suntharalingam, Jay

    2016-01-01

    Objectives: Psychological difficulties are a common complication among patients with respiratory disease, and are associated with poorer health outcomes and increased use of healthcare. As prevalence studies typically sample patients from community settings, this study aimed to explore the extent and nature of psychological difficulties during acute hospital admission. Methods: A case example of an acute respiratory ward is presented. In total, 41 acute respiratory inpatients completed standardised measures of depression, anxiety, and health anxiety. Results: Rates of clinically significant depression, anxiety, and health anxiety were 71%, 40%, and 21%, respectively, with 76% of participants showing clinically significant scores on at least one measure. Comparison to existing literature suggests depression rates may be elevated in the acute inpatient context. The difficulties experienced encompassed both contextual factors related to being in hospital and broader health concerns. Conclusion: We suggest that psychological distress may be particularly prevalent in inpatient settings and that larger-scale studies are warranted. PMID:27508081

  13. Treatment-Resistant Depression and Mortality after Acute Coronary Syndrome

    PubMed Central

    Carney, Robert M.; Freedland, Kenneth E.

    2012-01-01

    Depression is a risk factor for morbidity and mortality in patients with coronary heart disease (CHD), especially following acute coronary syndrome (ACS). Evidence from recent clinical trials suggests that treatment-resistant depression may be associated with a particularly high risk of mortality or cardiac morbidity in post-ACS patients. This manuscript reviews this evidence, and considers possible explanations for this relationship. Directions for future research are also considered, with particular emphasis on efforts to elucidate the underlying mechanisms and to develop more efficacious treatments for depression in patients with CHD. PMID:19289455

  14. Abnormal cerebellar volume in acute and remitted major depression.

    PubMed

    Depping, Malte S; Wolf, Nadine D; Vasic, Nenad; Sambataro, Fabio; Hirjak, Dusan; Thomann, Philipp A; Wolf, Robert C

    2016-11-01

    Abnormal cortical volume is well-documented in patients with major depressive disorder (MDD), but cerebellar findings have been heterogeneous. It is unclear whether abnormal cerebellar structure relates to disease state or medication. In this study, using structural MRI, we investigated cerebellar volume in clinically acute (with and without psychotropic treatment) and remitted MDD patients. High-resolution structural MRI data at 3T were obtained from acute medicated (n=29), acute unmedicated (n=14) and remitted patients (n=16). Data from 29 healthy controls were used for comparison purposes. Cerebellar volume was investigated using cerebellum-optimized voxel-based analysis methods. Patients with an acute MDD episode showed increased volume of left cerebellar area IX, and this was true for both medicated and unmedicated individuals (p<0.05 cluster-corrected). Remitted patients exhibited bilaterally increased area IX volume. In remitted, but not in acutely ill patients, area IX volume was significantly associated with measures of depression severity, as assessed by the Hamilton Depression Rating Scale (HAMD). In addition, area IX volume in remitted patients was significantly related to the duration of antidepressant treatment. In acutely ill patients, no significant relationships were established using clinical variables, such as HAMD, illness or treatment duration and number of depressive episodes. The data suggest that cerebellar area IX, a non-motor region that belongs to a large-scale brain functional network with known relevance to core depressive symptom expression, exhibits abnormal volume in patients independent of clinical severity or medication. Thus, the data imply a possible trait marker of the disorder. However, given bilaterality and an association with clinical scores at least in remitted patients, the current findings raise the possibility that cerebellar volume may be reflective of successful treatment as well.

  15. Intramuscular ketamine in acute depression: A report on two cases

    PubMed Central

    Harihar, Chilukuri; Dasari, Padmavathy; Srinivas, Jakka Sriramulu

    2013-01-01

    It takes about 2 weeks for the onset of antidepressant action of drugs while electroconvulsive therapy though faster, is a cumbersome procedure requiring an anaesthetist and at least a minor operation theatre. Recent studies have shown that Ketamine, when given to severely depressed patients in the dose of 0.5 mg/kg as a slow intravenous infusion over 40 minutes, brought about acute relief from depression and amelioration of suicidal risk within a few hours. The improvement, however, was transient and lasted for up to a week but could be sustained by further weekly or biweekly injections. As the dose of ketamine administered was found to be safe, it was now tried in the intramuscular route in two severely depressed patients with similar rapid improvement. The cases are reported here which pave way for an easier mode of treating acute depression. PMID:23825857

  16. Characterizing depression in borderline patients.

    PubMed

    Soloff, P H; George, A; Nathan, R S; Schulz, P M

    1987-04-01

    The comorbidity of depression and borderline disorder was studied in 39 symptomatic borderline inpatients defined by the Diagnostic Interview for Borderlines using three independent methods for assessing depression and three definitions of depression. Evaluations were conducted by the Schedule for Affective Disorders and Schizophrenia interviews for Research Diagnostic Criteria (RDC) depressive disorders, by clinical ratings for atypical depressive disorder, and by self-rated questionnaires for hysteroid dysphoria. Diagnoses of an RDC depression were made in 25 (64.1%), atypical depressive disorder in 16 (41%), and hysteroid dysphoria in 25 (64.1%) of the borderline patients. Two depressive diagnoses were present in 64.1% of patients, while 17.9% of patients met criteria for all three depressive disorders. No one method accurately characterized depression in borderline patients.

  17. Fractal correlation properties of R-R interval dynamics and mortality in patients with depressed left ventricular function after an acute myocardial infarction

    NASA Technical Reports Server (NTRS)

    Huikuri, H. V.; Makikallio, T. H.; Peng, C. K.; Goldberger, A. L.; Hintze, U.; Moller, M.

    2000-01-01

    BACKGROUND: Preliminary data suggest that the analysis of R-R interval variability by fractal analysis methods may provide clinically useful information on patients with heart failure. The purpose of this study was to compare the prognostic power of new fractal and traditional measures of R-R interval variability as predictors of death after acute myocardial infarction. METHODS AND RESULTS: Time and frequency domain heart rate (HR) variability measures, along with short- and long-term correlation (fractal) properties of R-R intervals (exponents alpha(1) and alpha(2)) and power-law scaling of the power spectra (exponent beta), were assessed from 24-hour Holter recordings in 446 survivors of acute myocardial infarction with a depressed left ventricular function (ejection fraction patients died (25.6%), with 75 deaths classified as arrhythmic (17.0%) and 28 as nonarrhythmic (6.3%) cardiac deaths. Several traditional and fractal measures of R-R interval variability were significant univariate predictors of all-cause mortality. Reduced short-term scaling exponent alpha(1) was the most powerful R-R interval variability measure as a predictor of all-cause mortality (alpha(1) <0.75, relative risk 3.0, 95% confidence interval 2.5 to 4.2, P<0.001). It remained an independent predictor of death (P<0.001) after adjustment for other postinfarction risk markers, such as age, ejection fraction, NYHA class, and medication. Reduced alpha(1) predicted both arrhythmic death (P<0.001) and nonarrhythmic cardiac death (P<0.001). CONCLUSIONS: Analysis of the fractal characteristics of short-term R-R interval dynamics yields more powerful prognostic information than the traditional measures of HR variability among patients with depressed left ventricular function after an acute myocardial infarction.

  18. Fractal analysis of heart rate dynamics as a predictor of mortality in patients with depressed left ventricular function after acute myocardial infarction. TRACE Investigators. TRAndolapril Cardiac Evaluation

    NASA Technical Reports Server (NTRS)

    Makikallio, T. H.; Hoiber, S.; Kober, L.; Torp-Pedersen, C.; Peng, C. K.; Goldberger, A. L.; Huikuri, H. V.

    1999-01-01

    A number of new methods have been recently developed to quantify complex heart rate (HR) dynamics based on nonlinear and fractal analysis, but their value in risk stratification has not been evaluated. This study was designed to determine whether selected new dynamic analysis methods of HR variability predict mortality in patients with depressed left ventricular (LV) function after acute myocardial infarction (AMI). Traditional time- and frequency-domain HR variability indexes along with short-term fractal-like correlation properties of RR intervals (exponent alpha) and power-law scaling (exponent beta) were studied in 159 patients with depressed LV function (ejection fraction <35%) after an AMI. By the end of 4-year follow-up, 72 patients (45%) had died and 87 (55%) were still alive. Short-term scaling exponent alpha (1.07 +/- 0.26 vs 0.90 +/- 0.26, p <0.001) and power-law slope beta (-1.35 +/- 0.23 vs -1.44 +/- 0.25, p <0.05) differed between survivors and those who died, but none of the traditional HR variability measures differed between these groups. Among all analyzed variables, reduced scaling exponent alpha (<0.85) was the best univariable predictor of mortality (relative risk 3.17, 95% confidence interval 1.96 to 5.15, p <0.0001), with positive and negative predictive accuracies of 65% and 86%, respectively. In the multivariable Cox proportional hazards analysis, mortality was independently predicted by the reduced exponent alpha (p <0.001) after adjustment for several clinical variables and LV function. A short-term fractal-like scaling exponent was the most powerful HR variability index in predicting mortality in patients with depressed LV function. Reduction in fractal correlation properties implies more random short-term HR dynamics in patients with increased risk of death after AMI.

  19. Depression and Anxiety in Migraine Patients

    MedlinePlus

    ... Depression and Anxiety in Migraine Patients Depression and Anxiety in Migraine Patients Todd A. Smitherman, PhD and ... if you experience these symptoms. Migraine, Depression, and Anxiety Many migraine patients suffer from symptoms of depression ...

  20. Depressive Symptoms and Impaired Physical Function after Acute Lung Injury

    PubMed Central

    Colantuoni, Elizabeth; Mendez-Tellez, Pedro A.; Dinglas, Victor D.; Shanholtz, Carl; Husain, Nadia; Dennison, Cheryl R.; Herridge, Margaret S.; Pronovost, Peter J.; Needham, Dale M.

    2012-01-01

    Rationale: Survivors of acute lung injury (ALI) frequently have substantial depressive symptoms and physical impairment, but the longitudinal epidemiology of these conditions remains unclear. Objectives: To evaluate the 2-year incidence and duration of depressive symptoms and physical impairment after ALI, as well as risk factors for these conditions. Methods: This prospective, longitudinal cohort study recruited patients from 13 intensive care units (ICUs) in four hospitals, with follow-up 3, 6, 12, and 24 months after ALI. The outcomes were Hospital Anxiety and Depression Scale depression score greater than or equal to 8 (“depressive symptoms”) in patients without a history of depression before ALI, and two or more dependencies in instrumental activities of daily living (“impaired physical function”) in patients without baseline impairment. Measurements and Main Results: During 2-year follow-up of 186 ALI survivors, the cumulative incidences of depressive symptoms and impaired physical function were 40 and 66%, respectively, with greatest incidence by 3-month follow-up; modal durations were greater than 21 months for each outcome. Risk factors for incident depressive symptoms were education 12 years or less, baseline disability or unemployment, higher baseline medical comorbidity, and lower blood glucose in the ICU. Risk factors for incident impaired physical function were longer ICU stay and prior depressive symptoms. Conclusions: Incident depressive symptoms and impaired physical function are common and long-lasting during the first 2 years after ALI. Interventions targeting potentially modifiable risk factors (e.g., substantial depressive symptoms in early recovery) should be evaluated to improve ALI survivors’ long-term outcomes. PMID:22161158

  1. Maternal Depressive Symptoms in Pediatric Major Depressive Disorder: Relationship to Acute Treatment Outcome

    ERIC Educational Resources Information Center

    Kennard, Betsy D.; Hughes, Jennifer L.; Stewart, Sunita M.; Mayes, Taryn; Nightingale-Teresi, Jeanne; Tao, Rongrong; Carmody, Thomas; Emslie, Graham J.

    2008-01-01

    A study examined maternal depressive symptoms at the beginning and end of acute pediatric treatment of children with major depressive disorder (MDD). Results suggested a direct and possible reciprocal association between maternal and child depression severity.

  2. Evaluating the impact of depression, anxiety & autonomic function on health related quality of life, vocational functioning and health care utilisation in acute coronary syndrome patients: the ADVENT study protocol

    PubMed Central

    2013-01-01

    Background Depression and anxiety are highly prevalent and co-morbid in acute coronary syndrome patients. Somatic and cognitive subtypes of depression and anxiety in acute coronary syndrome have been shown to be associated with mortality although their association with patient outcomes is unknown, as are the mechanisms that underpin these associations. We are conducting a prospective cohort study which aims to examine in acute coronary syndrome patients: (1) the role of somatic subtypes of depression and anxiety as predictors of health related quality of life outcomes; (2) how somatic subtypes of depression and anxiety relate to long term vocational functioning and healthcare utilisation; and (3) the role of the autonomic nervous system assessed by heart rate variability as a moderator of these associations. Methods Patients are being screened after index admission for acute coronary syndrome at a single, high volume centre, MonashHeart, Monash Health, Victoria, Australia. The inclusion criterion is all patients aged > 21 years old and fluent in English admitted to MonashHeart, Monash Health with a diagnosis of acute coronary syndrome. The primary outcome is mean health related quality of life (Short Form-36) Physical and Mental Health Summary scores at 12 and 24 months in subtypes with somatic symptoms of depression and anxiety. Depressive domains are assessed by the Beck Depression Inventory II and the Cardiac Depression Scale. Anxiety is measured using the Speilberger State-Trait Anxiety Inventory and the Crown Crisp Phobic Anxiety questionnaire. Secondary outcomes include clinical variables, healthcare service utilisation and vocational functioning. Discussion This manuscript presents the protocol for a prospective cohort study which will investigate the role of somatic subtypes of depression and anxiety as predictors of health related quality of life, long-term vocational functioning and health service use, and the role of the autonomic nervous system in

  3. Relationship Between Depressive State and Treatment Characteristics of Acute Cervical Spinal Cord Injury in Japan

    PubMed Central

    Matsuda, Yasufumi; Kubo, Tatsuhiko; Fujino, Yoshihisa; Matsuda, Shinya; Wada, Futoshi; Sugita, Atsuko

    2016-01-01

    Background Few studies have assessed whether treatment of acute cervical spinal cord injury (SCI) patients contributes to depression. Methods Using an administrative database, we assessed patients for whom the diagnosis was unspecified injuries of cervical spinal cord (International Classification of Diseases and Injuries-10th (ICD-10) code; S14.1). We categorized patients with codes for depressive episode (ICD-10 code; F32) or recurrent depressive disorder (F33), or those prescribed antidepressants (tricyclic, tetracyclic, Selective Serotonin Reuptake Inhibitors, Serotonin Noradrenaline Reuptake Inhibitors, Trazodone, Sulpiride, or Mirtazapine) as having a depressive state. We compared the rate of each acute treatment between the depressive state group and the non-depressive state group using chi-square tests, and a multiple logistic regression model was used to identify the association between the acute treatment and depressive state. Results There were 151 patients who were judged to be in a depressive state, and the other 2115 patients were categorized into the non-depressive state group. Intervention of intravenous anesthesia, tracheostomy, artificial respiration, and gastrostomy had a significant positive correlation with depressive state. Multiple logistic regression analysis showed that tracheostomy (odds ratio [OR] 2.18; 95% confidence interval [CI], 1.09–4.38) and artificial respiration (OR 2.28; 95% CI, 1.32–3.93) were significantly associated with depressive state, and men had a 36% reduction in the risk of depressive state compared with women (OR 0.64; 95% CI, 0.44–0.94), whereas age, wound-treatment, all of the orthopedic procedures, intravenous anesthesia, and gastrostomy were not associated with depressive state. Conclusions These findings suggest that tracheostomy, artificial respiration and female gender in the acute phase after cervical SCI might be associated with the development of depression. PMID:26567604

  4. Depression in breast cancer patients.

    PubMed

    Cvetković, Jovana; Nenadović, Milutin

    2016-06-30

    Breast cancer is the third most common illness in the world and the most frequent malignant disease with women. Cytotoxic therapy is connected to significant psychiatric adverse effects, and the appearance of depressive symptoms is the most common. The main goal is determining the degree of depression with breast cancer patients in the oncology ward of the University Clinical Hospital in Niš and its connection to their marital status, age, level of education, economic status and the number of therapy cycles. This research is a prospective study. The statistical data analysis included measures of descriptive and analytical statistics. The presence of depressive symptoms of different intensity was showed in 76.00% of the interviewees in group I, and the second included 77.4%. The frequency distributions show that 27.084% interviewees from the first group showed signs of depressive symptoms, while the second included 25%. The intensity of these symptoms categorizes them into the group of moderate to significantly expressed depressive states, so they require therapeutic treatment. Depression is significantly more often recorded with cancer patients receiving cytotoxic therapy; mild depression is the most common, followed by moderate and severe depression. PMID:27138829

  5. Depression and major depressive disorder in patients with Parkinson's disease.

    PubMed

    Inoue, Takeshi; Kitagawa, Mayumi; Tanaka, Teruaki; Nakagawa, Shin; Koyama, Tsukasa

    2010-01-15

    The prevalence of depression in Parkinson's disease (PD) varies greatly. In this study, we investigated major depressive disorder (MDD) and depressive symptoms without MDD in patients with PD. The psychopathological characteristics of depressive symptoms were assessed by a psychiatric interview. A total of 105 Japanese patients with PD without dementia were included. The Japanese version of the Beck Depression Inventory-II (BDI-II) with a cutoff score of 13/14 was used to screen for depression. Using a structured interview, a comprehensive psychiatric evaluation of patients with BDI-II scores >13 (high BDI patients) was completed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-TR. Forty patients (38%) had a BDI-II >13, but 29 did not show any depressed mood. Five cases met the criteria for MDD (three current, two past) and one patient was diagnosed with minor depressive disorder. A slight depressed mood that was associated with worrying about PD was seen in 6 of 34 patients without any depressive disorder and fluctuated with aggravation of PD symptoms in two of these patients. For the diagnosis of MDD, the number of positive items from the DSM-IV-TR definition of MDD is most important and useful for differentiating MDD and non-MDD. The low-prevalence rate of MDD in our patient population suggests that PD may be a psychological stressor for MDD, but does not necessarily induce MDD.

  6. Depression in medically ill patients.

    PubMed

    Rackley, Sandra; Bostwick, J Michael

    2012-03-01

    In medically ill patients, given the many entities the phenotype of depression may represent, clinicians must be prepared to cast their diagnostic nets widely, not settling for the obvious but frequently incorrect choice of major depressive episode and throwing antidepressants at it willy nilly. Having chosen the correct diagnosis from among a broad differential of depression “look-alikes,” clinicians can draw upon a broad swath of treatment modalities including medications, psychotherapy, social supports, and spiritual interventions. Working as a psychiatrist in the medical arena requires the curiosity and analytic skills of a detective and the breadth of knowledge of a polymath adapting therapeutic tools from across the biopsychosociospiritual spectrum to the specific needs of the patient. PMID:22370500

  7. Prevention of poststroke depression with milnacipran in patients with acute ischemic stroke: a double-blind randomized placebo-controlled trial.

    PubMed

    Tsai, Ching-Shu; Wu, Chen-Long; Chou, Shih-Yong; Tsang, Hin-Yeung; Hung, Tai-Hsin; Su, Jian-An

    2011-09-01

    Poststroke depression (PSD) is one of the most frequent neuropsychiatric consequences of stroke. It has been shown to be associated with both impaired recovery and increased mortality. The purpose of this study is to investigate the prophylactic effect of milnacipran in PSD. Ninety-two patients were enrolled in the 12 months of this double-blind randomized placebo-controlled trial. The assessment was performed at baseline, and at the first, third, sixth, ninth and 12th month after enrollment. The definition of PSD was in accordance with the diagnostic criteria of major depressive episode based on the Diagnostic and Statistical Manual, fourth edition. Forty-six patients were randomized to the treatment group with milnacipran and another 46 patients to the placebo group. No significant differences were found between the two groups in terms of sex (P=0.83), age (P=0.08), marital status (P=0.66), occupation (P=0.22), educational level (P=0.29), and drug side-effects (P=0.73). The incidence of depression in the two groups was 2.22% and 15.22%, respectively. Milnacipran was proved to have a statistically significant advantage in preventing PSD (P<0.05). In conclusion, milnacipran could prevent the development of depression in the first year following a stroke and is safe to use without significant adverse effects in stroke patients. PMID:21811172

  8. Spotlight on quetiapine in acute mania and depression associated with bipolar disorder.

    PubMed

    Dando, Toni M; Keating, Gillian M

    2006-01-01

    Quetiapine (Seroquel), an atypical antipsychotic with established efficacy in the treatment of schizophrenia, shows efficacy in the treatment of acute mania and depression associated with bipolar disorder.Quetiapine, either as monotherapy or in combination with lithium or divalproex sodium (valproate semisodium), is generally well tolerated and effective in reducing manic symptoms in adult and adolescent patients with acute bipolar mania, and is approved for use in adults for this indication. As monotherapy, the drug is also effective in reducing depressive symptoms in patients with bipolar depression. It is associated with a low incidence of extrapyramidal symptom (EPS)-related adverse events and low EPS ratings in bipolar disorder. Quetiapine thus shows potential in the treatment of bipolar depression, and represents a useful agent for the treatment of acute bipolar mania.

  9. Depression in adult patients with biotin responsive basal ganglia disease.

    PubMed

    Bubshait, Dalal K; Rashid, Asif; Al-Owain, Mohammed A; Sulaiman, Raashda A

    2016-01-01

    Biotin responsive basal ganglia disease (BBGD), is a potentially treatable inherited metabolic disorder which clinically presents as sub-acute encephalopathy in children. Early diagnosis and treatment of this disorder results in good clinical recovery in childhood. However, there is no report in the literature on the long term outcome of these treated patients in adult life. We report two patients with BBGD who were metabolically stable on treatment and developed depression later in life. These cases highlight the association of depression with basal ganglia disorders and demonstrate that depression is the potential long term complication of BBGD.

  10. Dreams in Patients Remitted from Reactive Depression

    ERIC Educational Resources Information Center

    Hauri, Peter

    1976-01-01

    The goal of the study described here was to learn more about dream content in patients who had recovered from serious depression. The question was asked whether these formerly depressed patients still showed depressive traits in their nocturnal dreams, even though their daytime behavior and mood now approached entirely normal levels. (Author)

  11. Serotonergic genes and depressive disorder in acute coronary syndrome: The Korean depression in ACS (K-DEPACS) study.

    PubMed

    Kim, Jae-Min; Stewart, Robert; Kang, Hee-Ju; Bae, Kyung-Yeol; Kim, Sung-Wan; Shin, Il-Seon; Hong, Young Joon; Ahn, Youngkeun; Jeong, Myung Ho; Park, Sung-Woo; Kim, Young-Hoon; Yoon, Jin-Sang

    2015-06-01

    Genes coding for the serotonergic pathway have been associated with depressive disorders. However, these associations have rarely been tested in acute coronary syndrome (ACS) patients vulnerable to depression. This study aimed to investigate whether polymorphisms of serotonin transporter (5-HTT) and serotonin 2a receptor (5-HTR2a) genes are associated with occurrence of depressive disorder in ACS. 969 patients with recently developed ACS were recruited at baseline, and 711 were followed 1 year thereafter. Depressive disorder was diagnosed according to DSM-IV criteria, and analysed as an outcome at baseline (prevalence), and follow up (incidence and persistence). Genotypes were ascertained for 5-HTTLPR, STin2 VNTR, 5-HTR2a 102T/C, and 5-HTR2a 1438A/G. Logistic regression models were used to investigate associations. The 5-HTTLPR s/s genotype was independently associated with depressive disorder prevalence and persistence following ACS, but no significant associations were found with the other polymorphisms. ACS patients with the 5-HTTLPR s allele are thus potentially susceptible to depressive disorder in the early phase after ACS, and with its persistence over the subsequent year.

  12. Depressive Symptoms Are Associated with Mental Stress-Induced Myocardial Ischemia after Acute Myocardial Infarction

    PubMed Central

    Wei, Jingkai; Pimple, Pratik; Shah, Amit J.; Rooks, Cherie; Bremner, J. Douglas; Nye, Jonathon A.; Ibeanu, Ijeoma; Murrah, Nancy; Shallenberger, Lucy; Raggi, Paolo; Vaccarino, Viola

    2014-01-01

    Objectives Depression is an adverse prognostic factor after an acute myocardial infarction (MI), and an increased propensity toward emotionally-driven myocardial ischemia may play a role. We aimed to examine the association between depressive symptoms and mental stress-induced myocardial ischemia in young survivors of an MI. Methods We studied 98 patients (49 women and 49 men) age 38–60 years who were hospitalized for acute MI in the previous 6 months. Patients underwent myocardial perfusion imaging at rest, after mental stress (speech task), and after exercise or pharmacological stress. A summed difference score (SDS), obtained with observer-independent software, was used to quantify myocardial ischemia under both stress conditions. The Beck Depression Inventory-II (BDI-II) was used to measure depressive symptoms, which were analyzed as overall score, and as separate somatic and cognitive depressive symptom scores. Results There was a significant positive association between depressive symptoms and SDS with mental stress, denoting more ischemia. After adjustment for demographic and lifestyle factors, disease severity and medications, each incremental depressive symptom was associated with 0.14 points higher SDS. When somatic and cognitive depressive symptoms were examined separately, both somatic [β = 0.17, 95% CI: (0.04, 0.30), p = 0.01] and cognitive symptoms [β = 0.31, 95% CI: (0.07, 0.56), p = 0.01] were significantly associated with mental stress-induced ischemia. Depressive symptoms were not associated with ischemia induced by exercise or pharmacological stress. Conclusion Among young post-MI patients, higher levels of both cognitive and somatic depressive symptoms are associated with a higher propensity to develop myocardial ischemia with mental stress, but not with physical (exercise or pharmacological) stress. PMID:25061993

  13. Understanding Heroin Overdose: A Study of the Acute Respiratory Depressant Effects of Injected Pharmaceutical Heroin.

    PubMed

    Jolley, Caroline J; Bell, James; Rafferty, Gerrard F; Moxham, John; Strang, John

    2015-01-01

    Opioids are respiratory depressants and heroin/opioid overdose is a major contributor to the excess mortality of heroin addicts. The individual and situational variability of respiratory depression caused by intravenous heroin is poorly understood. This study used advanced respiratory monitoring to follow the time course and severity of acute opioid-induced respiratory depression. 10 patients (9/10 with chronic airflow obstruction) undergoing supervised injectable opioid treatment for heroin addiction received their usual prescribed dose of injectable opioid (diamorphine or methadone) (IOT), and their usual prescribed dose of oral opioid (methadone or sustained release oral morphine) after 30 minutes. The main outcome measures were pulse oximetry (SpO2%), end-tidal CO2% (ETCO2%) and neural respiratory drive (NRD) (quantified using parasternal intercostal muscle electromyography). Significant respiratory depression was defined as absence of inspiratory airflow >10s, SpO2% < 90% for >10s and ETCO2% per breath >6.5%. Increases in ETCO2% indicated significant respiratory depression following IOT in 8/10 patients at 30 minutes. In contrast, SpO2% indicated significant respiratory depression in only 4/10 patients, with small absolute changes in SpO2% at 30 minutes. A decline in NRD from baseline to 30 minutes post IOT was also observed, but was not statistically significant. Baseline NRD and opioid-induced drop in SpO2% were inversely related. We conclude that significant acute respiratory depression is commonly induced by opioid drugs prescribed to treat opioid addiction. Hypoventilation is reliably detected by capnography, but not by SpO2% alone. Chronic suppression of NRD in the presence of underlying lung disease may be a risk factor for acute opioid-induced respiratory depression.

  14. Understanding Heroin Overdose: A Study of the Acute Respiratory Depressant Effects of Injected Pharmaceutical Heroin

    PubMed Central

    Jolley, Caroline J.; Bell, James; Rafferty, Gerrard F.; Moxham, John; Strang, John

    2015-01-01

    Opioids are respiratory depressants and heroin/opioid overdose is a major contributor to the excess mortality of heroin addicts. The individual and situational variability of respiratory depression caused by intravenous heroin is poorly understood. This study used advanced respiratory monitoring to follow the time course and severity of acute opioid-induced respiratory depression. 10 patients (9/10 with chronic airflow obstruction) undergoing supervised injectable opioid treatment for heroin addiction received their usual prescribed dose of injectable opioid (diamorphine or methadone) (IOT), and their usual prescribed dose of oral opioid (methadone or sustained release oral morphine) after 30 minutes. The main outcome measures were pulse oximetry (SpO2%), end-tidal CO2% (ETCO2%) and neural respiratory drive (NRD) (quantified using parasternal intercostal muscle electromyography). Significant respiratory depression was defined as absence of inspiratory airflow >10s, SpO2% < 90% for >10s and ETCO2% per breath >6.5%. Increases in ETCO2% indicated significant respiratory depression following IOT in 8/10 patients at 30 minutes. In contrast, SpO2% indicated significant respiratory depression in only 4/10 patients, with small absolute changes in SpO2% at 30 minutes. A decline in NRD from baseline to 30 minutes post IOT was also observed, but was not statistically significant. Baseline NRD and opioid-induced drop in SpO2% were inversely related. We conclude that significant acute respiratory depression is commonly induced by opioid drugs prescribed to treat opioid addiction. Hypoventilation is reliably detected by capnography, but not by SpO2% alone. Chronic suppression of NRD in the presence of underlying lung disease may be a risk factor for acute opioid-induced respiratory depression. PMID:26495843

  15. Understanding Heroin Overdose: A Study of the Acute Respiratory Depressant Effects of Injected Pharmaceutical Heroin.

    PubMed

    Jolley, Caroline J; Bell, James; Rafferty, Gerrard F; Moxham, John; Strang, John

    2015-01-01

    Opioids are respiratory depressants and heroin/opioid overdose is a major contributor to the excess mortality of heroin addicts. The individual and situational variability of respiratory depression caused by intravenous heroin is poorly understood. This study used advanced respiratory monitoring to follow the time course and severity of acute opioid-induced respiratory depression. 10 patients (9/10 with chronic airflow obstruction) undergoing supervised injectable opioid treatment for heroin addiction received their usual prescribed dose of injectable opioid (diamorphine or methadone) (IOT), and their usual prescribed dose of oral opioid (methadone or sustained release oral morphine) after 30 minutes. The main outcome measures were pulse oximetry (SpO2%), end-tidal CO2% (ETCO2%) and neural respiratory drive (NRD) (quantified using parasternal intercostal muscle electromyography). Significant respiratory depression was defined as absence of inspiratory airflow >10s, SpO2% < 90% for >10s and ETCO2% per breath >6.5%. Increases in ETCO2% indicated significant respiratory depression following IOT in 8/10 patients at 30 minutes. In contrast, SpO2% indicated significant respiratory depression in only 4/10 patients, with small absolute changes in SpO2% at 30 minutes. A decline in NRD from baseline to 30 minutes post IOT was also observed, but was not statistically significant. Baseline NRD and opioid-induced drop in SpO2% were inversely related. We conclude that significant acute respiratory depression is commonly induced by opioid drugs prescribed to treat opioid addiction. Hypoventilation is reliably detected by capnography, but not by SpO2% alone. Chronic suppression of NRD in the presence of underlying lung disease may be a risk factor for acute opioid-induced respiratory depression. PMID:26495843

  16. Prediction of fatal or near-fatal cardiac arrhythmia events in patients with depressed left ventricular function after an acute myocardial infarction†

    PubMed Central

    Huikuri, Heikki V.; Raatikainen, M.J. Pekka; Moerch-Joergensen, Rikke; Hartikainen, Juha; Virtanen, Vesa; Boland, Jean; Anttonen, Olli; Hoest, Nis; Boersma, Lucas V.A.; Platou, Eivind S.; Messier, Marc D.; Bloch-Thomsen, Poul-Erik

    2009-01-01

    Aims To determine whether risk stratification tests can predict serious arrhythmic events after acute myocardial infarction (AMI) in patients with reduced left ventricular ejection fraction (LVEF ≤ 0.40). Methods and results A total of 5869 consecutive patients were screened in 10 European centres, and 312 patients (age 65 ± 11 years) with a mean LVEF of 31 ± 6% were included in the study. Heart rate variability/turbulence, ambient arrhythmias, signal-averaged electrocardiogram (SAECG), T-wave alternans, and programmed electrical stimulation (PES) were performed 6 weeks after AMI. The primary endpoint was ECG-documented ventricular fibrillation or symptomatic sustained ventricular tachycardia (VT). To document these arrhythmic events, the patients received an implantable ECG loop-recorder. There were 25 primary endpoints (8.0%) during the follow-up of 2 years. The strongest predictors of primary endpoint were measures of heart rate variability, e.g. hazard ratio (HR) for reduced very-low frequency component (<5.7 ln ms2) adjusted for clinical variables was 7.0 (95% CI: 2.4–20.3, P < 0.001). Induction of sustained monomorphic VT during PES (adjusted HR = 4.8, 95% CI, 1.7–13.4, P = 0.003) also predicted the primary endpoint. Conclusion Fatal or near-fatal arrhythmias can be predicted by many risk stratification methods, especially by heart rate variability, in patients with reduced LVEF after AMI. PMID:19155249

  17. Outstanding Symptoms of Poststroke Depression during the Acute Phase of Stroke

    PubMed Central

    Nakase, Taizen; Tobisawa, Maiko; Sasaki, Masahiro; Suzuki, Akifumi

    2016-01-01

    Poststroke depression (PSD) is a critical complication which might lead to unfavorable outcomes. However, most cases of PSD in the acute phase, during the 2 or 3 weeks following a stroke, are neglected because of the variable comorbid conditions. In this study, aimed at revealing the outstanding symptoms of PSD during the acute phase, consecutive patients with intracranial hemorrhage (ICH) or brain infarction (BI) were asked to fill out a depression questionnaire (Quick Inventory of Depressive Symptomatology Self-Report: QIDS-SR) at 1 week and 1 month following stroke onset. Patients with disturbed consciousness or aphasia were excluded from this study. Forty-nine ICH patients and 222 BI patients completed the QIDS-SR at 1 week and 27 of ICH and 62 of BI at 1 month. The PSD rate was 67% and 46% at 1 week in ICH and BI, respectively. Although sleep disturbance was the most frequent symptom of PSD, psychomotor agitation and appetite disturbance were the most distinguishing symptoms in ICH at 1 week and fatigue at 1 month. On the other hand, most of the depressive symptoms addressed in QIDS-SR were observed in PSD of BI patients both at 1 week and 1 month. In conclusion, while sleep disturbance was a frequent but non-specific symptom, appetite disturbance and fatigue might be critical symptoms to suggest PSD during the acute phase of stroke. PMID:27706193

  18. Screening for Depression Patients in Family Medicine

    PubMed Central

    Alic, Alma; Pranjic, Nurka; Selmanovic, Senada; Alibasic, Esad; Alic, Fahrudin; Ramic, Enisa; Spahic-Sarajlic, Selvedina

    2014-01-01

    ABSTRACT Goal: The aims are to establish the prevalence of newfound, unidentified cases of depressive disorder by screening with the Becks Depression scale; To establish a comparative relationship with self-identified cases of depression in the patients in the family medicine; To assess the significance of the BDI in screening practice of family medicine. Patients and methods: A prospective study was conducted anonymously by Beck's Depression scale (Beck Depression Questionnaire org.-BDI) and specially created short questionnaire. The study included 250 randomly selected patients (20-60 years), users of services in family medicine in “Dom Zdravlja” Zenica, and the final number of respondents with included in the study was 126 (51 male, 75 female; response or response rate 50.4%). Exclusion factor was previously diagnosed and treated mental disorder. Participation was voluntary and respondents acknowledge the validity of completing the questionnaire. BDI consists of 21 items. Answers to questions about symptoms were ranked according to the Likert type scale responses from 0-4 (from irrelevant to very much). Respondents expressed themselves on personal perception of depression, whether are or not depressed. Results: Depression was observed in 48% of patients compared to 31% in self estimate depression analyzed the questionnaires. The negative trend in the misrecognition of depression is -17% (48:31). Depression was significantly more frequent in unemployed compared to employed respondents (p=0.001). The leading symptom in both sexes is the perception of lost hope (59% of cases). Conclusion: All respondents in family medicine care in Zenica showed a high percentage of newly detected (17%) patients with previously unrecognized depression. BDI is a really simple and effective screening tool for the detection and identification of persons with symptoms of depression. PMID:24783910

  19. The Day-to-Day Acute Effect of Wake Therapy in Patients with Major Depression Using the HAM-D6 as Primary Outcome Measure: Results from a Randomised Controlled Trial

    PubMed Central

    Martiny, Klaus; Refsgaard, Else; Lund, Vibeke; Lunde, Marianne; Sørensen, Lene; Thougaard, Britta; Lindberg, Lone; Bech, Per

    2013-01-01

    Background This paper reports day-to-day data for from a one-week intervention phase, part of a 9-weeks randomised parallel study with patient having major depression (data from weekly visits have been reported). Wake therapy (sleep deprivation) has an established antidepressant effect with onset of action within hours. Deterioration on the following night’s sleep is, however, common, and we used daily light therapy and sleep time stabilisation as a preventive measure. In particular, we evaluated the day-to-day acute effect of and tolerance to sleep deprivation and examined predictors of response. Methods Patients were assessed at psychiatric inpatient wards. In the wake group (n = 36), patients did three wake therapies in combination with light therapy each morning together with sleep time stabilisation. In the exercise group (n = 38), patients did daily exercise. Hamilton subscale scores were primary outcome (not blinded), secondary outcome was self-assessment data from the Preskorn scale and sleep. Results Patients in the wake therapy group had an immediate, large, stable, and statistically significant better antidepressant effect than patients in the exercise group with response rates at day5 of 75.0%/25.1% and remission rates of 58.6%/6.0%, respectively. The response and remission rates were diminished at day8 with response rates of 41.9%/10.1% and remission rates of 19.4%/4.7%, respectively. Patients and ward personnel found the method applicable with few side effects. Positive diurnal variation (mood better in the evening) predicted a larger response to wake therapy. In the wake group napping on days after intervention predicted greater deterioration on day8. Conclusions The intervention induced an acute antidepressant response without relapse between wake nights but with a diminishing effect after intervention. Development is still needed to secure maintenance of response. Avoiding napping in the days after wake therapy is important. Trial

  20. ED Patients with Prolonged Complaints and Repeat ED Visits Have an Increased Risk of Depression

    PubMed Central

    Brickman, Kristopher R.; Bahl, Rajiv; Marcinkowski, Nathan F.; Ammons, Katelyn R.; Akpunonu, Peter

    2016-01-01

    Introduction The objective of this study was to explore associations between presenting chief complaints of prolonged symptomatology, patient usage of the emergency department (ED), and underlying depression so that emergency physicians may better target patients for depression screening. Methods A convenience sample of ED patients were administered the Beck Depression Inventory-II (BDI-II) to assess for depression. We correlated completed BDI-II surveys to patient information including demographics, pertinent history of present illness information, and past medical history. Results Out of 425 participants screened, we identified complaints of two weeks or longer in 92 patients (22%). Of these patients, mild to severe depression was recognized in over half of the population (47), yet only nine patients reported a prior depression diagnosis. These 92 patients also visited the ED three times as frequently as those patients with more acute complaints (p<0.001). Finally, our study showed that patients with mild to severe depression had three times as many ED visits compared to patients with minimal or no depression (p<0.001). Conclusion Patients with complaints of symptomatology two weeks or longer are more likely to have underlying depression when presenting to the ED. Patients with three or more ED visits within the past year also have a greater incidence of underlying depression. We found a strong correlation between complaints with symptomatology of two weeks or longer and multiple ED visits, in which underlying depression may have contributed to these patients’ ED visits. PMID:27625727

  1. Effect of Tianeptine on Depressed Tinnitus Patients

    PubMed Central

    Hwang, Soo Min; Lim, Sae Hee; Oh, Dong Ju; Kim, Sung Kyun; Jung, Hak Hyun

    2016-01-01

    Background and Objectives Tianeptine is a tricyclic antidepressant that has a novel pharmacological property: it increases the reuptake of 5-hydroxytryptamine. Recent studies have reported that the prevalence of depression is greater in patients with tinnitus than in control subjects who do not have tinnitus. The purpose of this study was to assess the efficacy of tianeptine for the relief of tinnitus, especially in patients with depressive mood. Subjects and Methods Among a total of 52 tinnitus patients, 15 had depressive mood. The depressed tinnitus patients were prescribed Stablon® 12.5 mg once daily for 1 month without any other drug. We assessed the severity of tinnitus, level of depression, and the quality of sleep in these patients by using the Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), and Pittsburgh Sleep Quality Index (PSQI). Hearing impairment and severity of tinnitus were measured with pure tone audiometry, speech audiometry, and tinnitograms. These evaluations were conducted before and after medication treatment. Results For the 15 depressed tinnitus patients, THI scores significantly correlated with BDI and PSQI scores prior to medication treatment. These results showed that the discomfort of tinnitus was closely related to depression and sleep disorder. After medication treatment, THI and BDI scores significantly decreased, indicating that tinnitus and depression improved. However, no significant alteration in PSQI score was observed, indicating that there was no improvement in sleep quality. Conclusions In the treatment of depressed tinnitus patients, tianeptine might be an efficient drug to treat both tinnitus and depression. However, tianeptine is unlikely to improve the quality of sleep in these patients. PMID:27626082

  2. Effect of Tianeptine on Depressed Tinnitus Patients

    PubMed Central

    Hwang, Soo Min; Lim, Sae Hee; Oh, Dong Ju; Kim, Sung Kyun; Jung, Hak Hyun

    2016-01-01

    Background and Objectives Tianeptine is a tricyclic antidepressant that has a novel pharmacological property: it increases the reuptake of 5-hydroxytryptamine. Recent studies have reported that the prevalence of depression is greater in patients with tinnitus than in control subjects who do not have tinnitus. The purpose of this study was to assess the efficacy of tianeptine for the relief of tinnitus, especially in patients with depressive mood. Subjects and Methods Among a total of 52 tinnitus patients, 15 had depressive mood. The depressed tinnitus patients were prescribed Stablon® 12.5 mg once daily for 1 month without any other drug. We assessed the severity of tinnitus, level of depression, and the quality of sleep in these patients by using the Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), and Pittsburgh Sleep Quality Index (PSQI). Hearing impairment and severity of tinnitus were measured with pure tone audiometry, speech audiometry, and tinnitograms. These evaluations were conducted before and after medication treatment. Results For the 15 depressed tinnitus patients, THI scores significantly correlated with BDI and PSQI scores prior to medication treatment. These results showed that the discomfort of tinnitus was closely related to depression and sleep disorder. After medication treatment, THI and BDI scores significantly decreased, indicating that tinnitus and depression improved. However, no significant alteration in PSQI score was observed, indicating that there was no improvement in sleep quality. Conclusions In the treatment of depressed tinnitus patients, tianeptine might be an efficient drug to treat both tinnitus and depression. However, tianeptine is unlikely to improve the quality of sleep in these patients.

  3. Cortisol response to acute stress in asthma: Moderation by depressive mood.

    PubMed

    Trueba, Ana F; Simon, Erica; Auchus, Richard J; Ritz, Thomas

    2016-05-15

    Both individuals with asthma and depression show signs of a dysregulated hypothalamus-pituitary-adrenal axis. However, little is known about the cortisol response to stress in the context of co-occurring asthma and depressive mood. Thirty-nine individuals with asthma and 41 healthy controls underwent a combined speech and mental arithmetic stressor. During the course of the laboratory session, salivary cortisol was collected 5 times, with 1 sample at 0min before the stressor and 4 samples at 0, 15, 30 and 45min after the stressor. Depressive mood in the past week was assessed with the Hospital Anxiety and Depression Scale at the beginning of the session. Depressive symptoms moderated cortisol response to the acute stressor, but only among asthmatic patients. Higher depressive mood was associated with a significant increase in cortisol, whereas low depressive mood was associated with no cortisol response. In healthy participants, depressive mood had no substantial effect on cortisol response to the stressor. These findings suggest that depressive mood and chronic inflammatory diseases such as asthma can interact to augment cortisol response to stress.

  4. Are Intensive Care Factors Associated with Depressive Symptoms Six Months after Acute Lung Injury?

    PubMed Central

    Dowdy, David W.; Bienvenu, O. Joseph; Dinglas, Victor D.; Mendez-Tellez, Pedro A.; Sevransky, Jonathan; Shanholtz, Carl; Needham, Dale M.

    2009-01-01

    Objective To evaluate intensive care-related factors as predictors of depressive symptoms 6 months after acute lung injury (ALI) Design Prospective cohort study Setting Thirteen intensive care units (ICUs) in 4 hospitals in Baltimore, MD Patients Consecutive ALI survivors (n = 160; 71% from medical ICUs) screened for depressive symptoms at six months post-ALI Interventions None Measurements and Main Results We prospectively measured 12 features of critical illness and ICU care and used multivariable regression to evaluate associations with depressive symptoms as measured by the Hospital Anxiety and Depression (HAD) depression score. The prevalence of a positive screening for depression (score ≥8) at 6 months post-ALI was 26%. Depressive symptoms were significantly associated with surgical (versus medical or trauma) ICU admission (relative risk [RR] 2.2, 95% confidence interval [CI] 1.1 – 4.2), maximum daily Sequential Organ Failure Assessment score of >10 (RR 2.1, 95% CI 1.1 – 3.5), and mean daily ICU benzodiazepine dose of ≥75mg of midazolam-equivalent (RR 2.1, 95% CI 1.1 – 3.5). Conclusions Depressive symptoms at 6 months post-ALI are common and potentially associated with ICU-related factors. Mechanisms by which critical illness and intensive care management associate with depressive symptoms merit further investigation. PMID:19357507

  5. Lack of association of acute phase response proteins with hormone levels and antidepressant medication in perimenopausal depression

    PubMed Central

    2014-01-01

    Background Major depression is associated with higher plasma levels of positive acute-phase proteins, as well as with lower plasma levels of negative acute-phase proteins. The aim of this study is to examine the levels of acute-phase response proteins and whether these levels are influenced by reproductive hormones and antidepressant medication in the perimenopausal depression. Methods Sixty-five women (age range: 40–58 years old) participated in this study. All women were in the perimenopausal phase. The diagnosis of depression was made through a psychiatric interview and with the aid of Hamilton Depression Rating Scale 17 (HAM-D 17). The acute-phase response proteins, such as haptoglobin (HP), transferrine (TRf), α1-antitrypsin, complement protein 3 (C3), complement protein 4 (C4) and C-reactive protein (CRP) and the reproductive hormones, for example follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2), were analyzed using standard laboratory methods. Pearson’s correlations were applied to evaluate the relationship between acute-phase proteins and hormones. Results Perimenopausal women were divided into three groups. The first group consisted of normal controls, the second one involved depressed perimenopausal women, who were taking selective serotonin reuptake inhibitors (SSRIs), and the third one included depressed women that were not treated with SSRIs. Depressed women in perimenopause, when being compared to non-depressed women, did not differ as to serum levels of acute-phase proteins. There was a positive correlation between HP and E2 in depressed perimenopausal women, who were not taking SSRIs. Conclusions The lack of association between acute-phase proteins and depressive mood mentioned in this study does not support previous findings in patients with major depression. This negative finding in perimenopausal depression indicates either the absence or a more complex nature of the interactions between acute-phase proteins

  6. [Mirtazapine in inpatient treatment of depressed patients].

    PubMed

    Bailer, U; Praschak-Rieder, N; Pezawas, L; Kasper, S

    1998-10-01

    Mirtazapine is a new antidepressant with a specific pharmacological profile which is different from all other currently available antidepressants. It is a so-called noradrenergic and specific serotonergic antidepressant (NaSSA). 46 in-patients were treated with mirtazapine. The mean dose was 56 mg mirtazapine per day (SD: 23; range: 15 to 90). The duration of treatment was 3.6 weeks (SD +/- 3.4). Patients presented with following diagnosis: 29 (= 63%) were diagnosed as having a unipolar depression, 26% (n = 12) suffered from a depression in the course of a bipolar disorder. 37% (n = 17) were moderately depressed, 52% (n = 24) were severely depressed. 2 patients (= 4%) met ICD-10 (international Classification of Diseases) criteria for a schizoaffective disorder, 2 patients (= 4%) suffered from dysthymia. 1 patient suffered from an organic depressive disorder. The efficacy of the treatment was evaluated with CGI (Clinical Global Impression), when patients were discharged from hospital. 68% of the patients were in partial or full remission (CGI 2, 3 and 4), 17% were unimproved (CGI 5 and 6), in 15% of the patients the treatment was stopped before. Our observations are indicative that mirtazapine is effective in the treatment of moderately and severely depressed patients and therefore confirm the data obtained in phase III-trials. Furthermore we found mirtazapine in either mono- or combination-therapy with various other antidepressants to be tolerated well. Side effects did not cause in a single patient a discontinuation in treatment. PMID:9816638

  7. Electroconvulsive therapy for depression following acute coronary syndromes: a concern for the anesthesiologist.

    PubMed

    Pourafkari, Nosratollah; Pourafkari, Leili; Nader, Nader D

    2016-06-01

    The prevalence of depression in patients with cardiovascular disease is higher than general population and especially following an acute coronary syndrome (ACS), a significant number of patients report a wide spectrum of behavioral and mood changes attributable to clinical depression. Treatment of depression following ACS event is particularly challenging since most of the therapeutic modalities are associated with increasing the systemic sympathetic tone from neurogenic or pharmacologic sources. Increased activity of the adrenergic and catecholamine activity may further deter the myocardial oxygen supply and demand therefore treating depression should be carefully evaluated for its risk benefit ratio. Electroconvulsive therapy (ECT) is recommended for patients with severe depression, in whom behavioral and pharmacologic treatments have failed. Patients who refuse to take medications or present with any psychological emergency such as harming self or others, are also candidates for ECT. ECT is also associated with sudden surges of catecholamines and may cause recurrent myocardial ischemia and fatal dysrhythmias in patients convalescing from an ACS event. Herein, we provide an overview and practical guidelines for management of patients presented for ECT following ACS. PMID:27185716

  8. Anterior ST depression with acute transmural inferior infarction due to posterior infarction. A vectorcardiographic and scintigraphic study

    SciTech Connect

    Mukharji, J.; Murray, S.; Lewis, S.E.; Croft, C.H.; Corbett, J.R.; Willerson, J.T.; Rude, R.E.

    1984-07-01

    The hypothesis that anterior ST segment depression represents concomitant posterior infarction was tested in 49 patients admitted with a first transmural inferior myocardial infarction. Anterior ST depression was defined as 0.1 mV or more ST depression in leads V1, V2 or V3 on an electrocardiogram recorded within 18 hours of infarction. Serial vectorcardiograms and technetium pyrophosphate scans were obtained. Eighty percent of the patients (39 of 49) had anterior ST depression. Of these 39 patients, 34% fulfilled vectorcardiographic criteria for posterior infarction, and 60% had pyrophosphate scanning evidence of posterior infarction. Early anterior ST depression was neither highly sensitive (84%) nor specific (20%) for the detection of posterior infarction as defined by pyrophosphate imaging. Of patients with persistent anterior ST depression (greater than 72 hours), 87% had posterior infarction detected by pyrophosphate scan. In patients with inferior myocardial infarction, vectorcardiographic evidence of posterior infarction correlated poorly with pyrophosphate imaging data. Right ventricular infarction was present on pyrophosphate imaging in 40% of patients with pyrophosphate changes of posterior infarction but without vectorcardiographic evidence of posterior infarction. It is concluded that: 1) the majority of patients with acute inferior myocardial infarction have anterior ST segment depression; 2) early anterior ST segment depression in such patients is not a specific marker for posterior infarction; and 3) standard vectorcardiographic criteria for transmural posterior infarction may be inaccurate in patients with concomitant transmural inferior myocardial infarction or right ventricular infarction, or both.

  9. Depression and anxiety in patients with COPD.

    PubMed

    Yohannes, Abebaw M; Alexopoulos, George S

    2014-09-01

    Under-recognised and untreated depression and anxiety symptoms have deleterious effects on physical functioning and social interaction increasing fatigue and healthcare utilisation in patients with chronic obstructive pulmonary disease (COPD). Depression and anxiety are challenging to identify and treat because their symptoms often overlap with those of COPD. The cause(s) of depression and anxiety symptoms are multifactorial and include behavioural, social and biological factors. Less than one-third of COPD patients with comorbid depression or anxiety symptoms are receiving appropriate treatment. Factors that contribute to the lack of provision of treatment are varied, they include patient perceived barriers, for example lack of knowledge and reluctance to receive antidepressant drug therapy; poor treatment compliance and lack of a standardised diagnostic approach; and scarcity of adequate resources for mental health treatment. The evidence for the efficacy of antidepressant drug therapy in patients with COPD with comorbid depression and anxiety is inconclusive. There are some promising findings regarding pulmonary rehabilitation, psychological therapy and the collaborative care model in reducing depression and anxiety symptoms in patients with COPD, but these findings are limited by short-term follow-up periods. Further work is required to examine the efficacy of these interventions in randomised controlled trials with larger samples and long-term follow-up. PMID:25176970

  10. Comorbid personality disorders among patients with depression

    PubMed Central

    Wongpakaran, Nahathai; Wongpakaran, Tinakon; Boonyanaruthee, Vudhichai; Pinyopornpanish, Manee; Intaprasert, Suthi

    2015-01-01

    Purpose To investigate the personality disorders (PDs) diagnosed in patients with depressive disorders. Material and methods This study included a cross-sectional analysis, and was an extension of the Thai Study of Affective Disorder (THAISAD) project. Eighty-five outpatients with depressive disorders were interviewed using the Mini International Neuropsychiatric Inventory to assess for depression, in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and using the Thai version of the Structured Clinical Interview for PDs to assess for PD. Results Seventy-seven percent of the patients had at least one PD, 40% had one PD and 60% had two or more PDs (mixed cluster). The most common PDs found were borderline PD (20%) and obsessive–compulsive PD (10.6%), while the occurrence of avoidant PD was low when compared to the findings of previous, related studies. Among the mixed cluster, cluster A combined with cluster C was the common mix. Both dysthymic disorder and double depression were found to have a higher proportion of PDs than major depressive disorder (85.7% versus 76.1%). Dependent PD was found to be less common in this study than in previous studies, including those carried out in Asia. Conclusion The prevalence of PDs among those with depressive disorder varied, and only borderline PD seems to be consistently high within and across cultures. Mixed cluster plays a prominent role in depression, so more attention should be paid to patients in this category. PMID:25945052

  11. Mood disturbance and depression in Arab women following hospitalisation from acute cardiac conditions: a cross-sectional study from Qatar

    PubMed Central

    Donnelly, Tam Truong; Al Suwaidi, Jassim Mohd; Al-Qahtani, Awad; Asaad, Nidal; Fung, Tak; Singh, Rajvir; Qader, Najlaa Abdul

    2016-01-01

    Objectives Depression is associated with increased morbidity and mortality rates among cardiovascular patients. Depressed patients have three times higher risk of death than those who are not. We sought to determine the presence of depressive symptoms, and whether gender and age are associated with depression among Arab patients hospitalised with cardiac conditions in a Middle Eastern country. Setting Using a non-probability convenient sampling technique, a cross-sectional survey was conducted with 1000 Arab patients ≥20 years who were admitted to cardiology units between 2013 and 2014 at the Heart Hospital in Qatar. Patients were interviewed 3 days after admission following the cardiac event. Surveys included demographic and clinical characteristics, and the Arabic version of the Beck Depression Inventory Second Edition (BDI-II). Depression was assessed by BDI-II clinical classification scale. Results 15% of the patients had mild mood disturbance and 5% had symptoms of clinical depression. Twice as many females than males suffered from mild mood disturbance and clinical depression symptoms, the majority of females were in the age group 50 years and above, whereas males were in the age group 40–49 years. χ2 Tests and multivariate logistic regression analyses indicated that gender and age were statistically significantly related to depression (p<0.001 for all). Conclusions Older Arab women are more likely to develop mood disturbance and depression after being hospitalised with acute cardiac condition. Gender and age differences approach, and routine screening for depression should be conducted with all cardiovascular patients, especially for females in the older age groups. Mental health counselling should be available for all cardiovascular patients who exhibit depressive symptoms. PMID:27388362

  12. The acutely injured patient.

    PubMed

    Baker, M S

    1990-05-01

    This article reviews the examination techniques and priorities for an injured patient. The format can be tailored to both the field setting and the hospital. Learning a concise method of examination and treatment is basic to trauma care and helps ensure that life-threatening injuries are not overlooked.

  13. Psychomotor Retardation in Elderly Untreated Depressed Patients

    PubMed Central

    Beheydt, Lieve Lia; Schrijvers, Didier; Docx, Lise; Bouckaert, Filip; Hulstijn, Wouter; Sabbe, Bernard

    2015-01-01

    Background: Psychomotor retardation (PR) is one of the core features in depression according to DSM V (1), but also aging in itself causes cognitive and psychomotor slowing. This is the first study investigating PR in relation to cognitive functioning and to the concomitant effect of depression and aging in a geriatric population ruling out contending effects of psychotropic medication. Methods: A group of 28 non-demented depressed elderly is compared to a matched control group of 20 healthy elderly. All participants underwent a test battery containing clinical depression measures, cognitive measures of processing speed, executive function and memory, clinical ratings of PR, and objective computerized fine motor skill-tests. Statistical analysis consisted of a General Linear Method multivariate analysis of variance to compare the clinical, cognitive, and psychomotor outcomes of the two groups. Results: Patients performed worse on all clinical, cognitive, and PR measures. Both groups showed an effect of cognitive load on fine motor function but the influence was significantly larger for patients than for healthy elderly except for the initiation time. Limitations: Due to the restrictive inclusion criteria, only a relatively limited sample size could be obtained. Conclusion: With a medication free sample, an additive effect of depression and aging on cognition and PR in geriatric patients was found. As this effect was independent of demand of effort (by varying the cognitive load), it was apparently not a motivational slowing effect of depression. PMID:25674065

  14. Critical Analysis of the Efficacy of Meditation Therapies for Acute and Subacute Phase Treatment of Depressive Disorders: A Systematic Review

    PubMed Central

    Jain, Felipe A.; Walsh, Roger N.; Eisendrath, Stuart J.; Christensen, Scott; Cahn, B. Rael

    2014-01-01

    Background Recently, the application of meditative practices to the treatment of depressive disorders has met with increasing clinical and scientific interest, due to a lower side-effect burden, potential reduction of polypharmacy, as well as theoretical considerations that such interventions may target some of the cognitive roots of depression. We aimed to determine the state of the evidence supporting this application. Methods Randomized, controlled trials of techniques meeting the Agency for Healthcare Research and Quality (AHRQ) definition of meditation, for participants suffering from clinically diagnosed depressive disorders, not currently in remission, were selected. Meditation therapies were separated into praxis (i.e. how they were applied) components, and trial outcomes were reviewed. Results Eighteen studies meeting inclusionary criteria were identified, encompassing seven distinct techniques and 1173 patients, with Mindfulness-Based Cognitive Therapy comprising the largest proportion. Studies including patients suffering from acute major depressive episodes (N = 10 studies), and those with residual subacute clinical symptoms despite initial treatment (N = 8), demonstrated moderate to large reductions in depression symptoms within group, and relative to control groups. There was significant heterogeneity of techniques and trial designs. Conclusions A substantial body of evidence indicates that meditation therapies may have salutary effects on patients suffering from clinical depressive disorders during the acute and subacute phases of treatment. Due to methodological deficiences and trial heterogeneity, large-scale, randomized controlled trials with well-described comparator interventions and measures of expectation are needed to clarify the role of meditation in the depression treatment armamentarium. PMID:25591492

  15. Nomothetic and Idiographic Symptom Change Trajectories in Acute-Phase Cognitive Therapy for Recurrent Depression

    PubMed Central

    Vittengl, Jeffrey R.; Clark, Lee Anna; Thase, Michael E.; Jarrett, Robin B.

    2013-01-01

    Objective We tested nomothetic and idiographic convergence and change in three symptom measures during acute-phase cognitive therapy (CT) for depression and compared outcomes among patients showing different change patterns. Method Outpatients (N = 362; 69% women; 85% white; age mean = 43 years) with DSM-IV recurrent major depressive disorder completed the Hamilton Rating Scale for Depression (Hamilton, 1960), Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh 1961), and Inventory for Depressive Symptomatology—Self-Report (Rush, Gullion, Basco, Jarrett, & Trivedi, 1996) on 14 occasions, and pre-/post-CT measures of social-interpersonal functioning and negative cognitive content. Results The three symptom measures marked the same severity and change constructs, and we offer improved formulas for inter-measure score conversions via their common factor. Pre-post CT symptom reductions were large (ds 1.71-1.92), and nomothetic symptom curves were log-linear (larger improvements earlier and smaller improvements later in CT). Nonetheless, only 30% of individual patients showed clear log-linear changes, whereas other patients showed linear (e.g., steady decreases; 20%), one-step (e.g., a quick drop; 16%), and unclassified (34%) patterns. Log-linear, linear, and one-step patients were generally similar to one another and superior to unclassified patients post-CT in symptom levels, response and stable remission rates, social-interpersonal functioning, and cognitive content (median d = 0.69). Conclusions Reaching a low-symptom “destination” at the end of CT via any coherent “path” is more important in the short-term than which path patients take. We discuss implications for theories of change, clinical monitoring of individuals’ progress in CT, and the need to investigate long-term outcomes of patients with differing symptom change patterns. PMID:23627652

  16. Predictors of longitudinal outcomes after unstable response to acute-phase cognitive therapy for major depressive disorder.

    PubMed

    Vittengl, Jeffrey R; Clark, Lee Anna; Thase, Michael E; Jarrett, Robin B

    2015-06-01

    After patients with major depressive disorder (MDD) respond to acute-phase cognitive therapy (CT), continuation-phase treatments may be applied to improve long-term outcomes. We clarified which CT responders experience remission, recovery, relapse, and recurrence by testing baseline demographic, clinical, and personality variables. The sample of CT responders at higher risk of relapse (N = 241) was randomized to 8 months of continuation-phase CT, double-blinded fluoxetine, or pill placebo, and followed 24 months (Jarrett & Thase, 2010). Patients with lower positive emotionality and behavioral activation at the end of acute-phase CT showed increased risk for relapse/recurrence of MDD. In addition, patients with lower positive emotionality and behavioral activation, as well as higher residual depression (including emotional, cognitive, and social facets), showed decreased probability of remission (≥6 continuous weeks of minimal or absent symptoms) after acute-phase CT. Finally, patients with greater residual depression, as well as younger age and earlier MDD onset, showed decreased probability of recovery (≥35 continuous weeks of minimal or absent symptoms) after acute-phase CT. Moderator analyses did not reveal differential prediction across the continuation phase treatment arms. These results may help clinicians gauge the prognoses and need for continuation treatment among MDD patients who respond to acute-phase CT.

  17. Extreme Response Style in Recurrent and Chronically Depressed Patients: Change with Antidepressant Administration and Stability during Continuation Treatment

    ERIC Educational Resources Information Center

    Peterson, Timothy J.; Feldman, Greg; Harley, Rebecca; Fresco, David M.; Graves, Lesley; Holmes, Avram; Bogdan, Ryan; Papakostas, George I.; Bohn, Laurie; Lury, R. Alana; Fava, Maurizio; Segal, Zindel V.

    2007-01-01

    The authors examined extreme response style in recurrently and chronically depressed patients, assessing its role in therapeutic outcome. During the acute phase, outpatients with major depressive disorder (N = 384) were treated with fluoxetine for 8 weeks. Remitted patients (n = 132) entered a continuation phase during which their fluoxetine dose…

  18. [Blood concentrations of maprotiline in depressive patients].

    PubMed

    Rouillon, F; Sioufi, A; Serrurier, D; Mizon, J P; Plaquet, R; Richard, J B; Riche, C; Bourin, M; Kergueris, M F; Besançon, G

    1988-01-01

    Blood levels of Maprotiline were analysed and their relationship to the clinical response was examined in 89 depressed inpatients, according DSM III criteria for Major Depressive Episode, given the drug treatment for 3 weeks. Maprotiline produced marked decreases in mean MADRS and COVI scale scores by the end of treatment. On day 21, no correlation between blood levels of Maprotiline and MADRS or COVI scores were found when all patients were considered. Nevertheless, significant correlations were observed on day 14 (r = .22; p less than .05 for MADRS and r = .23; p less than .05 for COVI scale). In addition, a significant correlation between MADRS or COVI scale scores and Maprotiline blood levels were observed on days 14 and 21 in subgroups of young patients, severe depression (high scores to clinical global investigations), during of at least 3 months, treated without other drug than Maprotiline and good responders.

  19. Depressed patients' parental representations: stability across changes in depressed mood and specificity across diagnoses.

    PubMed

    Gerlsma, C; Das, J; Emmelkamp, P M

    1993-03-01

    Parental representations of a Dutch sample of psychiatric patients with diagnoses of dysthymia and unipolar depression were compared with those of a matched sample of non-depressed patients and a matched sample of healthy controls. No differences in recalled parental rearing styles were found between depressives with a diagnosis of dysthymia and those with a diagnosis of unipolar depression. Depressive did not differ from the mixed (but non-depressed) sample of psychiatric patients, whereas both the depressed and the mixed group of patients reported more adverse parenting than the healthy controls. Analysis of repeated measurements of parental representations showed that memories of parental behavior were highly stable across clinically significant changes in depressed mood, so that it seems unlikely that patients' relatively negative recollections of their parents' behavior were due to mood state dependent recall. Results are discussed within the framework of depression theories and with regard to the validity and utility of self-report instruments for parental rearing styles.

  20. Acute Stress Reduces Reward Responsiveness: Implications for Depression

    PubMed Central

    Bogdan, Ryan; Pizzagalli, Diego A.

    2008-01-01

    Background Stress, one of the strongest risk factors for depression, has been linked to “anhedonic” behavior and dysfunctional reward-related neural circuitry in preclinical models. Methods To test if acute stress reduces reward responsiveness (i.e., the ability to modulate behavior as a function of past reward), a signal-detection task coupled with a differential reinforcement schedule was utilized. Eighty female participants completed the task under both a stress condition, either threat-of-shock (n = 38) or negative performance feedback (n = 42), and a no-stress condition. Results Stress increased negative affect and anxiety. As hypothesized based on preclinical findings, stress, particularly the threat-of-shock condition, impaired reward responsiveness. Regression analyses indicate that self-report measures of anhedonia predicted stress-induced hedonic deficits even after controlling for anxiety symptoms. Conclusions These findings indicate that acute stress reduces reward responsiveness, particularly in individuals with anhedonic symptoms. Stress-induced hedonic deficit is a promising candidate mechanism linking stressful experiences to depression. PMID:16806107

  1. Scurvy in a patient with depression.

    PubMed

    Chang, Chen-Wang; Chen, Ming-Jen; Wang, Tsang-En; Chang, Wen-Hsiung; Lin, Ching-Chung; Liu, Chia-Yuan

    2007-05-01

    Scurvy is a nearly-forgotten disease in developed countries where adequate nutrition is easily available. It still may occur, however, when, for a variety of reasons, people fail to eat a diet containing adequate vitamin C. We report the case of a 52-year-old patient with depression who developed scurvy.

  2. Adjunctive agomelatine therapy in the treatment of acute bipolar II depression: a preliminary open label study

    PubMed Central

    Fornaro, Michele; McCarthy, Michael J; De Berardis, Domenico; De Pasquale, Concetta; Tabaton, Massimo; Martino, Matteo; Colicchio, Salvatore; Cattaneo, Carlo Ignazio; D’Angelo, Emanuela; Fornaro, Pantaleo

    2013-01-01

    Purpose The circadian rhythm hypothesis of bipolar disorder (BD) suggests a role for melatonin in regulating mood, thus extending the interest toward the melatonergic antidepressant agomelatine as well as type I (acute) or II cases of bipolar depression. Patients and methods Twenty-eight depressed BD-II patients received open label agomelatine (25 mg/bedtime) for 6 consecutive weeks as an adjunct to treatment with lithium or valproate, followed by an optional treatment extension of 30 weeks. Measures included the Hamilton depression scale, Pittsburgh Sleep Quality Index, the Clinical Global Impression Scale–Bipolar Version, Young Mania Rating Scale, and body mass index. Results Intent to treat analysis results demonstrated that 18 of the 28 subjects (64%) showed medication response after 6 weeks (primary study endpoint), while 24 of the 28 subjects (86%) responded by 36 weeks. When examining primary mood stabilizer treatment, 12 of the 17 (70.6%) valproate and six of the 11 (54.5%) lithium patients responded by the first endpoint. At 36 weeks, 14 valproate treated (82.4%) and 10 lithium treated (90.9%) subjects responded. At 36 weeks, there was a slight yet statistically significant (P = 0.001) reduction in body mass index and Pittsburgh Sleep Quality Index scores compared to respective baseline values, regardless of mood stabilizer/outcome. Treatment related drop-out cases included four patients (14.28%) at week 6 two valproate-treated subjects with pseudo-vertigo and drug-induced hypomania, respectively, and two lithium-treated subjects with insomnia and mania, respectively. Week 36 drop outs were two hypomanic cases, one per group. Conclusion Agomelatine 25 mg/day was an effective and well-tolerated adjunct to valproate/lithium for acute depression in BD-II, suggesting the need for confirmation by future double blind, controlled clinical trials. PMID:23430979

  3. Disentangling Multiple Sclerosis and depression: an adjusted depression screening score for patient-centered care.

    PubMed

    Gunzler, Douglas D; Perzynski, Adam; Morris, Nathan; Bermel, Robert; Lewis, Steven; Miller, Deborah

    2015-04-01

    Screening for depression can be challenging in Multiple Sclerosis (MS) patients due to the overlap of depressive symptoms with other symptoms, such as fatigue, cognitive impairment and functional impairment, for MS patients. The aim of this study was to understand these overlapping symptoms and subsequently develop an adjusted depression screening tool for better clinical assessment of depressive symptoms in MS patients. We evaluated 3,507 MS patients with a self-reported depression screening (PHQ-9) score using a multiple indicator multiple cause modeling approach. Our models showed significant differential item functioning effects denoting significant overlap of depressive symptoms with all MS symptoms under study and good model fit. The magnitude of the overlap was especially large for fatigue. Adjusted depression screening scales were formed based on factor scores and loadings that will allow clinicians to understand the depressive symptoms separate from other symptoms for MS patients for improved patient care.

  4. Are Improvements in Cognitive Content and Depressive Symptoms Correlates or Mediators during Acute-Phase Cognitive Therapy for Recurrent Major Depressive Disorder?

    PubMed Central

    Vittengl, Jeffrey R.; Clark, Lee Anna; Thase, Michael E.; Jarrett, Robin B.

    2015-01-01

    The cognitive model of depression posits that cognitive therapy’s (CT) effect on depressive symptoms is mediated by changes in cognitive content (e.g., automatic negative thoughts dysfunctional attitudes, failure attributions). We tested improvement and normalization of cognitive content among outpatients (N = 523) with recurrent major depressive disorder treated with acute-phase CT (Jarrett & Thase, 2010; Jarrett et al., 2013). We also tested whether improvement in cognitive content accounted for subsequent changes in depressive symptoms and vice versa. Five measures of content improved substantively from pre- to post-CT (median d = 0.96), and the proportions of patients scoring in “healthy” ranges increased (median 45% to 82%). Evidence for cognitive mediation of symptom reduction was limited (median r = .06), as was evidence for symptom mediation of cognitive content improvement (median r = .07). We discuss measurement and design issues relevant to detection of mediators and consider alternative theories of change. PMID:26401194

  5. Improving Depression Care in Patients with Diabetes and Multiple Complications

    PubMed Central

    Kinder, Leslie S; Katon, Wayne J; Ludman, Evette; Russo, Joan; Simon, Greg; Lin, Elizabeth HB; Ciechanowski, Paul; Von Korff, Michael; Young, Bessie

    2006-01-01

    BACKGROUND Depression is common in patients with diabetes, but it is often inadequately treated within primary care. Competing clinical demands and treatment resistance may make it especially difficult to improve depressive symptoms in patients with diabetes who have multiple complications. OBJECTIVE To determine whether a collaborative care intervention for depression would be as effective in patients with diabetes who had 2 or more complications as in patients with diabetes who had fewer complications. DESIGN The Pathways Study was a randomized control trial comparing collaborative care case management for depression and usual primary care. This secondary analysis compared outcomes in patients with 2 or more complications to patients with fewer complications. PATIENTS Three hundred and twenty-nine patients with diabetes and comorbid depression were recruited through primary care clinics of a large prepaid health plan. MEASUREMENTS Depression was assessed at baseline, 3, 6, and 12 months with the 20-item depression scale from the Hopkins Symptom Checklist. Diabetes complications were determined from automated patient records. RESULTS The Pathways collaborative care intervention was significantly more successful at reducing depressive symptoms than usual primary care in patients with diabetes who had 2 or more complications. Patients with fewer than 2 complications experienced similar reductions in depressive symptoms in both intervention and usual care. CONCLUSION Patients with depression and diabetes who have multiple complications may benefit most from collaborative care for depression. These findings suggest that with appropriate intervention depression can be successfully treated in patients with diabetes who have the highest severity of medical problems. PMID:16836628

  6. SHARED, NOT UNIQUE, COMPONENTS OF PERSONALITY AND PSYCHOSOCIAL FUNCTIONING PREDICT DEPRESSION SEVERITY AFTER ACUTE-PHASE COGNITIVE THERAPY

    PubMed Central

    Clark, Lee Anna; Vittengl, Jeffrey R.; Kraft, Dolores; Jarrett, Robin B.

    2005-01-01

    In a sample of 100 patients with recurrent major depression, we collected depression severity data early and late in acute-phase cognitive therapy, plus a wide range of psychosocial variables that have been studied extensively in depression research, including measures of interpersonal, cognitive, and social functioning, and personality traits using an inventory that is linked with the Big-Three tradition in personality assessment theory. By assessing this broad range of variables in a single study, we could examine the extent to which relations of these variables with depression were due to (a) a common factor shared across this diverse set of constructs, (b) factors shared among each type of construct (personality vs. psychosocial measures), or (c) specific aspects of the individual measures. Only the most general factor shared across the personality and psychosocial variables predicted later depression. PMID:14632375

  7. Depression Treatment Preferences in Older Primary Care Patients

    ERIC Educational Resources Information Center

    Gum, Amber M.; Arean, Patricia A.; Hunkeler, Enid; Tang, Lingqi; Katon, Wayne; Hitchcock, Polly; Steffens, David C.; Dickens, Jeanne; Unutzer, Jurgen

    2006-01-01

    Purpose: For depressed older primary care patients, this study aimed to examine (a) characteristics associated with depression treatment preferences; (b) predictors of receiving preferred treatment; and (c) whether receiving preferred treatment predicted satisfaction and depression outcomes. Design and Methods: Data are from 1,602 depressed older…

  8. Describing depression: Congruence between patient experiences and clinical assessments

    PubMed Central

    Kelly, Morgen A. R.; Morse, Jennifer Q.; Stover, Angela; Hofkens, Tara; Huisman, Emily; Shulman, Stuart; Eisen, Susan V.; Becker, Sara J.; Weinfurt, Kevin; Boland, Elaine; Pilkonis, Paul A.

    2011-01-01

    Objectives Efforts to describe depression have relied on top-down methods in which theory and clinical experience define depression but may not reflect the individuals’ experiences with depression. We assessed the degree of overlap between academic descriptions of depression and patient-reported symptoms as conceptualized in the Patient-Reported Outcomes Measurement Information System® (PROMIS®). By extension, this work assesses the degree of overlap between current clinical descriptions of depression and patient-reported symptoms. Design In this content analysis study, four focus groups were conducted across two sites to elicit symptoms and the experience of depression from depressed and medically ill patients. Methods Depressed and medically ill patients were asked to describe symptoms that characterize depression. Data were transcribed and then coded using an a priori list of 43 facets of depression derived from extant depression measures. Results Participants described 93% of the symptoms from the a priori list, supporting the validity of current depression measures. Interpersonal difficulties were underscored as was anger. In general, results from the focus groups did not require the generation of new items for depression and supported the content validity of the PROMIS hierarchical framework and item pool created originally. Conclusions This work supports the validity of current depression assessment, but suggests further investigation of interpersonal functioning and anger may add to the depth and breadth of depression assessment. PMID:21332520

  9. Neuroendocrinal study of depression in male epileptic patients.

    PubMed

    Afifi, Samah; Fadel, Wael; Morad, Heba; Eldod, Abdo; Gad, Elsayed; Arfken, Cynthia L; Samra, Abou; Boutros, Nash

    2011-01-01

    Endocrine changes are reported in both epilepsy and depression. The interrelationships between mood, epilepsy, and endocrine changes are not well characterized. The authors included 40 epileptic patients (20 depressed, 20 nondepressed) and 20 healthy subjects. All patients had an electroencephalogram, and were given the Hamilton Rating Scale for Depression. All subjects were tested for serum levels of cortisol, prolactin, testosterone, and thyroid hormones. Patients were medication-free. Patients had elevated prolactin and cortisol and reduced serum testosterone relative to control subjects. Depressed patients had higher cortisol levels than nondepressed. Data suggest that the effects of epilepsy and depression on cortisol, but not other hormones, may be additive.

  10. Prevalence of depression and depressive symptoms in patients with systemic lupus erythematosus: Iranian experience.

    PubMed

    Zakeri, Zahra; Shakiba, Mansoor; Narouie, Behzad; Mladkova, Nikol; Ghasemi-Rad, Mohammad; Khosravi, Alireza

    2012-05-01

    Psychiatric disorders including depression represent clinical manifestation of systemic lupus erythematosus (SLE). Recognition of depression in SLE patients is of utmost importance since it is treatable and can be of fatal consequences if unrecognized. This study was conducted to determine the prevalence of depression and depressive symptoms in SLE patients in terms of age, gender, disease duration and severity, and duration of steroid treatment in SLE patients. Eighty-five SLE patients (77 women, 8 men) with verified SLE diagnosis completed Beck's depression inventory, a self-reported measure of depression. Clinical data on disease and treatment were obtained from patient files. In total, 60% of patients achieved scores indicating depression. The most common depressive symptoms in participants were fatigue and weakness (88.2%), irritability (82.3%), sadness (77.6%), and somatic preoccupation (76.4%), while the least common symptoms were weight loss (34.1%), low level of energy (28.2%), and suicide ideation (10.5%). There was a significant difference between the disease activity and the severity of depression (P = 0.0001). Our findings show higher prevalence of depression in our sample in comparison with previous studies, suggesting that the prevalence of depression varies across different populations. Severity of depression increases with more severe disease course.

  11. Patients' perception of their depressive illness.

    PubMed

    Manber, Rachel; Chambers, Andrea S; Hitt, Sabrina K; McGahuey, Cynthia; Delgado, Pedro; Allen, John J B

    2003-01-01

    Perception of illness has been described as an important predictor in the medical health psychology literature, but has been given little attention in the domain of mental disorders. The patient's Perception of Depression Questionnaire (PDIQ) is a newly developed measure whose factor structure and psychometric properties were evaluated on a sample of 174 outpatients meeting criteria for major depressive disorder. The clinical utility of the questionnaire was assessed on a sub-sample of 121 participants in a study of acupuncture treatment for depression. The questionnaire has four subscales, each with high internal consistency and high test-retest reliability. These four subscales are: Self-Efficacy, which reflects perceived controllability of the illness, Externalizing, which reflects attributing the illness to external causes, Hopeless/Flawed, which reflect a belief that depression is a personal trait and therefore there is little hope for cure, and Holistic, which reflects a belief in alternative therapies. Although the PDIQ did not predict outcome, its subscales were related to adherence to treatment, treatment preference, expectations, and therapeutic alliance. The subscales have adequate convergent/discriminant validity and are clinically relevant to aspects of treatment provision.

  12. Depression in patients with Parkinson's disease and the associated features.

    PubMed

    Zheng, Jin; Sun, Shenggang; Qiao, Xian; Liu, Yudong

    2009-12-01

    The study was aimed to examine the prevalence of depression in patients with Parkinson's disease (PD) and identify its features. A total of 131 out-patients, diagnosed as having idiopathic PD in accordance with the United Kingdom Parkinson's Disease Society Brain Bank criteria, were interviewed with questionnaire and evaluated by Mini-Mental State Examination (MMSE), Unified Parkinson's Disease Rating Scale (UPDRS), Hohen &Yahr staging (H&Y staging) and Hamilton Rating Scale for Depression (HRSD). Patients were divided into three groups in terms of HRSD score: depression group, sub-threshold depression group and non-depression group. The clinical variables and symptom profiles were obtained and compared among the three groups. The results showed that 27 patients (20.6%) fell into the depression group, 71 (54.2%) into the sub-threshold depression group, and 33 (25.2%) into the non-depression group. There were no differences in age, gender or tremor score among the groups (P>0.05). Significant differences were found in duration of PD, UPDRS score, rigidity score and H&Y stage between the sub-threshold depression group (or the depression group) and the non-depression group (P<0.05). Moreover, the clinical variables in the subthreshold depression group had the trend of increasing with the severity of PD and their values were similar to those in the depression group. Anhedonia, feeling of incapability, sleep disturbance, gastrointestinal symptoms and depressive moods were most common in the depression group. And these symptoms also were more common in the other two groups. It is concluded that depression and sub-threshold depression are common in PD and share similar clinical features. Furthermore, subthreshold depression might be the prodrome of depression and may develop into depression as the condition progresses.

  13. Precordial ST segment depression during acute inferior myocardial infarction: early thallium-201 scintigraphic evidence of adjacent posterolateral or inferoseptal involvement

    SciTech Connect

    Lew, A.S.; Weiss, A.T.; Shah, P.K.; Maddahi, J.; Peter, T.; Ganz, W.; Swan, H.J.; Berman, D.S.

    1985-02-01

    To investigate the myocardial perfusion correlates of precordial ST segment depression during acute inferior myocardial infarction, a rest thallium-201 scintigram and a closely timed 12 lead electrocardiogram were obtained within 6 hours of the onset of infarction in 44 patients admitted with their first acute inferior myocardial infarction. Thirty-six patients demonstrated precordial ST segment depression (group 1) and eight did not (group 2). A perfusion defect involving the inferior wall was present in all 44 patients. Additional perfusion defects of the adjacent posterolateral wall (n . 20), the ventricular septum (n . 9) or both (n . 6) were present in 35 of 36 patients from group 1 compared with only 1 of 8 patients from group 2 (p less than 0.001). There was no significant difference in the frequency of multivessel coronary artery disease or disease of the left anterior descending artery between group 1 and group 2 or between patients with and those without a thallium-201 perfusion defect involving the ventricular septum. Thus, precordial ST segment depression during an acute inferior myocardial infarction is associated with thallium-201 scintigraphic evidence of more extensive involvement of the adjacent posterolateral or inferoseptal myocardial segments, which probably reflects the extent and pattern of distribution of the artery of infarction, rather than the presence of coexistent multivessel coronary artery disease or disease of the left anterior descending artery.

  14. The Relationship Between Borderline Personality Disorder and Major Depression in Later Life: Acute Versus Temperamental Symptoms

    PubMed Central

    Galione, Janine N.; Oltmanns, Thomas F.

    2012-01-01

    Objective A recent issue in the personality disorder field is the prevalence and course of Axis II symptoms in later life. Focusing on the presentation of personality disorder criteria over time may have some utility in exploring the relationship between borderline personality disorder (BPD) and major depression in older adults. Temperamental personality symptoms are relatively resistant to change but tend to be nonspecific to disorders, while acute symptoms remit relatively quickly. We predicted that temperamental BPD symptoms would be positively correlated with a history of depression and did not expect to find a relationship between major depression and acute BPD symptoms. Method One thousand six hundred and thirty participants between the ages of 55 and 64 were recruited to participate in a community-based longitudinal study representative of the St. Louis area. Participants completed a battery of assessments at baseline, including diagnostic interviews for all ten personality disorders and major depressive disorder. Results Temperamental and acute BPD symptoms were significantly correlated with a history of major depression. After adjustments were made for the effects of temperamental symptoms on depression, acute symptoms were no longer correlated with a history of depression. As predicted, temperamental symptoms remained significantly related to depression, even after controlling for the effects of acute symptoms. BPD acute symptoms showed a unique negative correlation with the amount of time following remission from a depressive episode. Conclusions Overall, this study supports associations between major depression and borderline personality in older adults. The findings indicate that a history of major depression is primarily related to stable BPD symptoms related to emotional distress, which are more prevalent in older adults compared to acute features. PMID:23567384

  15. Opioid Analgesics and Depressive Symptoms in Burn Patients: What Is the Real Relationship?

    PubMed Central

    Hong, Narei; Jung, Myung Hun; Kim, Jee Wook; Chun, Wook; Choi, Ihn-Geun; Kang, Tae-Cheon; Kee, Baik Seok; Lee, Boung-Chul

    2016-01-01

    Objective Major burn injuries are strongly associated with both psychological trauma and severe pain, and opioids are the mainstay analgesics for the treatment of severe burn pain. The objectives of this study are to find the complex relationship between opioid dose, depression, and post-traumatic stress disorder (PTSD) symptoms during the acute management of pain in burn patients. Methods The symptoms of depression and PTSD were assessed in 43 burn patients immediately following wound stabilization and 2 weeks after the initial evaluation. Results Total opioid doses and Hamilton Depression Scale (HAMD) scores obtained during the second evaluation were positively but weakly correlated after controlling for age and total burn surface area (R=0.33, p=0.03). Moreover, pain management with opioids was significantly more common in burn patients with low Clinician Administered PTSD Scale scores (evaluation 1) and high HAMD scores (evaluation 2) (F=6.66, p=0.001). Conclusion High opioid dose following acute burn trauma might have correlation with depressive symptoms. Monitoring of depressive symptoms may be important following acute burn trauma and consequent opioids pain management, particularly when PTSD symptoms appear minimal during the early stabilization of patients. PMID:27489384

  16. Factors affecting nurses' intent to assess for depression in heart failure patients.

    PubMed

    Lea, Patricia

    2014-01-01

    The association between depression and cardiovascular disease has been well established and has been shown to decrease patients' quality of life and increase the risk of mortality, frequency and duration of hospitalization, and health care costs. The inpatient setting provides a potentially valuable opportunity to assess and treat depression among patients with acute cardiac illness, allowing for daily monitoring of treatment side effects. Although systematic depression screening appears to be feasible, efficient, and well accepted on inpatient cardiac units, the current lack of consistent inpatient assessment for depression in heart failure patients suggests the presence of barriers influencing the effective diagnosis and treatment of depression among inpatients with heart failure. The theory of planned behavior describes the cognitive mechanism by which behavioral intent is formed, giving some insight into how nurses' attitudes and beliefs affect their performance of routine depression screening. In addition, application of this cognitive theory suggests that nurses may be influenced to adopt more positive attitudes and beliefs about depression through educational intervention, leading to greater likelihood of routine assessment for depression, ultimately leading to more timely diagnosis and treatment and improved patient outcomes.

  17. Factors affecting nurses' intent to assess for depression in heart failure patients.

    PubMed

    Lea, Patricia

    2014-01-01

    The association between depression and cardiovascular disease has been well established and has been shown to decrease patients' quality of life and increase the risk of mortality, frequency and duration of hospitalization, and health care costs. The inpatient setting provides a potentially valuable opportunity to assess and treat depression among patients with acute cardiac illness, allowing for daily monitoring of treatment side effects. Although systematic depression screening appears to be feasible, efficient, and well accepted on inpatient cardiac units, the current lack of consistent inpatient assessment for depression in heart failure patients suggests the presence of barriers influencing the effective diagnosis and treatment of depression among inpatients with heart failure. The theory of planned behavior describes the cognitive mechanism by which behavioral intent is formed, giving some insight into how nurses' attitudes and beliefs affect their performance of routine depression screening. In addition, application of this cognitive theory suggests that nurses may be influenced to adopt more positive attitudes and beliefs about depression through educational intervention, leading to greater likelihood of routine assessment for depression, ultimately leading to more timely diagnosis and treatment and improved patient outcomes. PMID:25280199

  18. Assessment of Depression in Dementia Patients: Association of Caregiver Mood with Depression Ratings.

    ERIC Educational Resources Information Center

    Teri, Linda; Truax, Paula

    1994-01-01

    Primary caregivers (n=41) of memory-impaired patients rated a standardized stimulus of depression and their actual patient. They were able to correctly identify depression in both. Further, their mood was unassociated with video ratings and only moderately associated with patient ratings. The findings support reliance on caregiver input.…

  19. Depression in patients on hemodialysis and their caregivers.

    PubMed

    Saeed, Zeb; Ahmad, Aizaz M; Shakoor, Abdul; Ghafoor, Farkhanda; Kanwal, Shumaela

    2012-09-01

    Depression is recognized as the most common psychiatric problem in patients with end-stage renal disease. Stress negatively affects the quality of life of not only the patients on hemodialysis but also their caregivers. The objective of this study was to measure and compare the frequency of depression in these patients and their attendants, and to assess the associated risk factors in both groups. A cross-sectional study was conducted at our hemodialysis unit from June to September 2009. A total of 180 patients and 180 caregivers were enrolled and the Beck's Depression Inventory (BDI-II) questionnaire was administered. Of the 360 respondents, 201 (55.8%) were males and 264 (73.3) were married. According to the BDI scoring, 135 (75%) of the patients and 60 (33.4%) of the attendants were found to be moderately to severely depressed. Marriage (OR 1.817), low income status (OR 1.757) and unemployment (OR 4.176) correlated with increased depression grade, while gender and education level did not. Anemia was the only co-morbidity showing positive association with depression scores in the patients' group (P = 0.023). We conclude that the majority of the patients undergoing dialysis were depressed and were twice more likely to be depressed than their caregivers. In both groups, marriage and unemployment were associated with increased depressive symptoms, while household income showed negative association with depression. Gender and education level were not related to the depression scores. PMID:22982905

  20. [Depression in Patients with Age-Related Macular Degeneration].

    PubMed

    Narváez, Yamile Reveiz; Gómez-Restrepo, Carlos

    2012-09-01

    Age-related macular degeneration is a cause for disability in the elderly since it greatly affects their quality of life and increases depression likelihood. This article discusses the negative effect depression has on patients with age-related macular degeneration and summarizes the interventions available for decreasing their depression index. PMID:26572116

  1. [Depression in Patients with Age-Related Macular Degeneration].

    PubMed

    Narváez, Yamile Reveiz; Gómez-Restrepo, Carlos

    2012-09-01

    Age-related macular degeneration is a cause for disability in the elderly since it greatly affects their quality of life and increases depression likelihood. This article discusses the negative effect depression has on patients with age-related macular degeneration and summarizes the interventions available for decreasing their depression index.

  2. Maintenance Deep Transcranial Magnetic Stimulation Sessions are Associated with Reduced Depressive Relapses in Patients with Unipolar or Bipolar Depression

    PubMed Central

    Rapinesi, Chiara; Bersani, Francesco Saverio; Kotzalidis, Georgios D.; Imperatori, Claudio; Del Casale, Antonio; Di Pietro, Simone; Ferri, Vittoria R.; Serata, Daniele; Raccah, Ruggero N.; Zangen, Abraham; Angeletti, Gloria; Girardi, Paolo

    2015-01-01

    Introduction: Deep transcranial magnetic stimulation (dTMS) is a new form of TMS allowing safe stimulation of deep brain regions. The objective of this preliminary study was to assess the role of dTMS maintenance sessions in protecting patients with bipolar disorder (BD) or recurrent major depressive disorder (MDD) from developing depressive or manic relapses in a 12-month follow-up period. Methods: Twenty-four drug-resistant patients with a current depressive episode and a diagnosis of MDD or BD have been enrolled in the study. All the participants underwent daily dTMS sessions for 4 weeks. One group (maintenance – M group) received additional maintenance dTMS sessions weekly or twice a week. Results: After the first dTMS cycle, a significant reduction of Hamilton Depression Rating Scale (HDRS) scores was observed in all participants. Subsequently, the HDRS mean scores did not significantly change over time in the M group, while it significantly increased in the non-M-group after 6 and 12 months. Discussion: This study confirms previous evidence of a positive therapeutic effect of dTMS on depressive symptoms and suggests that, after recovery from acute episodes, maintenance dTMS sessions may be helpful in maintaining euthymia in a 12-month follow-up period. PMID:25709596

  3. Predictors and Moderators of Acute Outcome in the Treatment for Adolescents with Depression Study (TADS)

    ERIC Educational Resources Information Center

    Curry, John; Rohde, Paul; Simons, Anne; Silva, Susan; Vitiello, Benedetto; Kratochvil, Christopher; Reinecke, Mark; Feeny, Norah; Wells, Karen; Pathak, Sanjeev; Weller, Elizabeth; Rosenberg, David; Kennard, Betsy; Robins, Michele; Ginsburg, Golda; March, John

    2006-01-01

    Objective: To identify predictors and moderators of response to acute treatments among depressed adolescents (N = 439) randomly assigned to fluoxetine, cognitive-behavioral therapy (CBT), both fluoxetine and CBT, or clinical management with pill placebo in the Treatment for Adolescents With Depression Study (TADS). Method: Potential baseline…

  4. The hemostatic disturbance in patients with acute aortic dissection

    PubMed Central

    Guan, Xinliang; Li, Jiachen; Gong, Ming; Lan, Feng; Zhang, Hongjia

    2016-01-01

    Abstract Coagulopathy is still a frequent complication in the surgical treatment of acute aortic dissection. However, the physiopathology of surgically induced coagulopathy has never been systematically and comprehensively studied in patients with acute aortic dissection. The aim of the present study was to describe the perioperative hemostatic system in patients with acute aortic dissection. The 87 patients who underwent aortic arch surgery for acute Stanford type A aortic dissection from January 2013 to September 2015 were enrolled in this study. The perioperative biomarkers of hemostatic system were evaluated using standard laboratory tests and enzyme-linked immunosorbent assays (ELISAs) at 5 time points: anesthesia induction (T1), lowest nasopharyngeal temperature (T2), protamine reversal (T3), 4 hours after surgery (T4), and 24 hours after surgery (T5). The ELISAs biomarkers revealed activation of coagulation (thrombin-antithrombin III complex [TAT] and prothrombin fragment 1 + 2 [F1 + 2] were elevated), suppression of anticoagulation (antithrombin III [AT III] levels were depressed), and activation of fibrinolysis (plasminogen was decreased and plasmin-antiplasmin complex [PAP] was elevated). The standard laboratory tests also demonstrated that surgery resulted in a significant reduction in platelet counts and fibrinogen concentration. Systemic activation of coagulation and fibrinolysis, and inhibition of anticoagulation were observed during the perioperative period in patients with acute aortic dissection. Indeed, these patients exhibited consumption coagulopathy and procoagulant state perioperatively. Therefore, we believe that this remarkable disseminated intravascular coagulation (DIC)-like coagulopathy has a high risk of bleeding and may influence postoperative outcome of patients with acute aortic dissection. PMID:27603366

  5. Long-term use of tianeptine in 380 depressed patients.

    PubMed

    Lôo, H; Ganry, H; Dufour, H; Guelfi, J D; Malka, R; Olié, J P; Scharbach, H; Tignol, J; Marey, C; Kamoun, A

    1992-02-01

    Tianeptine is a new tricyclic compound whose principal action is to increase the reuptake of serotonin. In a multicentre trial in which 380 depressed patients were treated for one year, tianeptine produced a significant reduction in the MADRS scores from day 14, with a sustained reduction maintained for up to 12 months; other measures of efficacy (HRSA, HSCL, and CGI) also reflected the improvement. Only 11% of patients withdrew because of recurrence of depression and 2% because of side-effects, which were mainly drowsiness, irritability, and gastrointestinal disturbance. Apart from a minor reduction in heart rate, unaccompanied by any conduction changes, no clinically relevant changes in vital signs or laboratory tests were seen. Seven subjects who attempted suicide by tianeptine overdose had favourable outcomes, in spite of also taking other psychotropic drugs or alcohol. No evidence of tolerance or withdrawal symptoms was seen after treatment was stopped. These results suggest that tianeptine has the potential to provide safe antidepressant activity in both the acute and chronic phases of treatment.

  6. Treatment response for acute depression is not associated with number of previous episodes: lack of evidence for a clinical staging model for major depressive disorder.

    PubMed

    Dodd, Seetal; Berk, Michael; Kelin, Katarina; Mancini, Michele; Schacht, Alexander

    2013-09-01

    Mental illness has been observed to follow a neuroprogressive course, commencing with prodrome, then onset, recurrence and finally chronic illness. In bipolar disorder and schizophrenia responsiveness to treatment mirrors these stages of illness progression, with greater response to treatment in the earlier stages of illness and greater treatment resistance in chronic late stage illness. Using data from 5627 participants in 15 controlled trials of duloxetine, comparator arm (paroxetine, venlafaxine, escitalopram) or placebo for the treatment of an acute depressive episode, the relationship between treatment response and number of previous depressive episodes was determined. Data was dichotomised for comparisons between participants who had >3 previous episodes (n=1697) or ≤3 previous episodes (n=3930), and additionally for no previous episodes (n=1381) or at least one previous episode (n=4246). Analyses were conducted by study arm for each clinical trial, and results were then pooled. There was no significant difference between treatment response and number of previous depressive episodes. This unexpected finding suggests that treatments to reduce symptoms of depression during acute illness do not lose efficacy for patients with a longer history of illness.

  7. Depression risk in patients with coronary heart disease in Germany

    PubMed Central

    Konrad, Marcel; Jacob, Louis; Rapp, Michael A; Kostev, Karel

    2016-01-01

    AIM To determine the prevalence of depression and its risk factors among patients with coronary heart disease (CHD) treated in German primary care practices. METHODS Longitudinal data from nationwide general practices in Germany (n = 1072) were analyzed. Individuals initially diagnosed with CHD (2009-2013) were identified, and 59992 patients were included and matched (1:1) to 59992 controls. The primary outcome measure was an initial diagnosis of depression within five years after the index date among patients with and without CHD. Cox proportional hazards models were used to adjust for confounders. RESULTS Mean age was equal to 68.0 years (SD = 11.3). A total of 55.9% of patients were men. After a five-year follow-up, 21.8% of the CHD group and 14.2% of the control group were diagnosed with depression (P < 0.001). In the multivariate regression model, CHD was a strong risk factor for developing depression (HR = 1.54, 95%CI: 1.49-1.59, P < 0.001). Prior depressive episodes, dementia, and eight other chronic conditions were associated with a higher risk of developing depression. Interestingly, older patients and women were also more likely to be diagnosed with depression compared with younger patients and men, respectively. CONCLUSION The risk of depression is significantly increased among patients with CHD compared with patients without CHD treated in primary care practices in Germany. CHD patients should be routinely screened for depression to ensure improved treatment and management. PMID:27721937

  8. The Natural History of Insomnia: Acute Insomnia and First-onset Depression

    PubMed Central

    Ellis, Jason G.; Perlis, Michael L.; Bastien, Célyne H.; Gardani, Maria; Espie, Colin A.

    2014-01-01

    Study Objectives: While many studies have examined the association between insomnia and depression, no studies have evaluated these associations (1) within a narrow time frame, (2) with specific reference to acute and chronic insomnia, and (3) using polysomnography. In the present study, the association between insomnia and first-onset depression was evaluated taking into account these considerations. Design: A mixed-model inception design. Setting: Academic research laboratory. Participants: Fifty-four individuals (acute insomnia [n = 33], normal sleepers [n = 21]) with no reported history of a sleep disorder, chronic medical condition, or psychiatric illness. Interventions: N/A. Measurements and Results: Participants were assessed at baseline (2 nights of polysomnography and psychometric measures of stress and mood) and insomnia and depression status were reassessed at 3 months. Individuals with acute insomnia exhibited more stress, poorer mood, worse subjective sleep continuity, increased N2 sleep, and decreased N3 sleep. Individuals who transitioned to chronic insomnia exhibited (at baseline) shorter REM latencies and reduced N3 sleep. Individuals who exhibited this pattern in the transition from acute to chronic insomnia were also more likely to develop first-onset depression (9.26%) as compared to those who remitted from insomnia (1.85%) or were normal sleepers (1.85%). Conclusion: The transition from acute to chronic insomnia is presaged by baseline differences in sleep architecture that have, in the past, been ascribed to Major Depression, either as heritable traits or as acquired traits from prior episodes of depression. The present findings suggest that the “sleep architecture stigmata” of depression may actually develop over the course transitioning from acute to chronic insomnia. Citation: Ellis JG; Perlis ML; Bastien CH; Gardani M; Espie CA. The natural history of insomnia: acute insomnia and first-onset depression. SLEEP 2014;37(1):97-106. PMID

  9. Efficacy and safety of vortioxetine (Lu AA21004), 15 and 20 mg/day: a randomized, double-blind, placebo-controlled, duloxetine-referenced study in the acute treatment of adult patients with major depressive disorder

    PubMed Central

    Loft, Henrik; Olsen, Christina Kurre

    2014-01-01

    This study assessed the efficacy, tolerability and safety of vortioxetine versus placebo in adults with recurrent major depressive disorder. This double-blind, randomized, placebo-controlled study included 608 patients [Montgomery–Åsberg Depression Rating Scale (MADRS) total score≥26 and Clinical Global Impression – Severity score≥4]. Patients were randomly assigned (1 : 1 : 1 : 1) to vortioxetine 15 mg/day, vortioxetine 20 mg/day, duloxetine 60 mg/day or placebo. The primary efficacy endpoint was change from baseline in MADRS total score at week 8 (mixed model for repeated measurements). Key secondary endpoints were: MADRS responders; Clinical Global Impression – Improvement scale score; MADRS total score in patients with baseline Hamilton Anxiety Rating Scale ≥20; remission (MADRS≤10); and Sheehan Disability Scale total score at week 8. On the primary efficacy endpoint, both vortioxetine doses were statistically significantly superior to placebo, with a mean difference to placebo (n=158) of −5.5 (vortioxetine 15 mg, P<0.0001, n=149) and −7.1 MADRS points (vortioxetine 20 mg, P<0.0001, n=151). Duloxetine (n=146) separated from placebo, thus validating the study. In all key secondary analyses, both vortioxetine doses were statistically significantly superior to placebo. Vortioxetine treatment was well tolerated; common adverse events (incidence≥5%) were nausea, headache, diarrhea, dry mouth and dizziness. No clinically relevant changes were seen in clinical safety laboratory values, weight, ECG or vital signs parameters. Vortioxetine was efficacious and well tolerated in the treatment of patients with major depressive disorder. PMID:24257717

  10. Effects of paroxetine-mediated inhibition of GRK2 expression on depression and cardiovascular function in patients with myocardial infarction

    PubMed Central

    Tian, Xiuqing; Wang, Qing; Guo, Rui; Xu, Lingling; Chen, Qin M; Hou, Yinglong

    2016-01-01

    Background Paroxetine is a selective serotonin reuptake inhibitor utilized in the treatment of depression and anxiety disorders. Recent studies have identified paroxetine as a G protein-coupled receptor kinase-2 (GRK2) inhibitor capable of reversing cardiac dysfunction and remodeling in experimental models of acute myocardial infarction (AMI). We determine the clinical importance of paroxetine on cardiac functions in patients having AMI with depression (AMID) in comparison with fluoxetine, an unrelated selective serotonin reuptake inhibitor that does not inhibit GRK2. Methods Diagnosis of depression was based on the 17-item Hamilton Depression Scale and Self-rating Depression Scale in AMI patients after hospital admission. AMID patients were randomly assigned to paroxetine or fluoxetine for treatment of depression. Heart rate variability and cardiac function were evaluated. GRK2 protein levels were measured using peripheral lymphocytes and Western blot. Results GRK2 expression in AMID patients was significantly higher than that in AMI patients without depression. In AMID patients, GRK2 levels were positively correlated with the 17-item Hamilton Depression Scale and the Self-rating Depression Scale scores, and negatively correlated with heart rate variability. Treatment of AMID patients with paroxetine significantly reduced the expression of GRK2, normalized the autonomic nervous system function, and improved cardiac performance. In contrast, fluoxetine normalized the autonomic nervous system but did not reduce the expression of GRK2 nor improved cardiac performance. Conclusion This study suggests that paroxetine is effective for improving cardiac function in patients with AMID and such effect correlates with GRK2 reduction.

  11. Management of Depression in Patients with Coronary Heart Disease: Association, Mechanisms, and Treatment Implications for Depressed Cardiac Patients

    PubMed Central

    Wang, Jenny T.; Hoffman, Benson; Blumenthal, James A.

    2010-01-01

    Importance of the field Coronary heart disease (CHD) and depression are two leading causes of death and disability in the United States and worldwide. Depression is especially common in cardiac patients, and there is growing evidence that depression is a risk factor for fatal and non-fatal events in CHD patients. Areas covered in this review This paper reviews current literature of depression as a risk factor for CHD along with pharmacologic and non-pharmacologic treatments for depression in cardiac patients. What the reader will gain Readers will gain knowledge about the importance of depression as a CHD risk factor and learn the results of efforts to treat depressed CHD patients. Take home message Although randomized clinical trials (RCTs) of medication and non-pharmacologic therapies have not demonstrated that treating depression improves survival, there is evidence that treating depressed patients can reduce depressive symptoms and improve quality of life. Additional RCTs are needed, including evaluation of non-pharmacologic therapies such as exercise, to examine the effects of treatment of depression on medical and psychosocial outcomes. PMID:20715885

  12. Respiratory depression in the intoxicated trauma patient: are opioids to blame?

    PubMed

    Shenk, Eleni; Barton, Cassie A; Mah, Nathan D; Ran, Ran; Hendrickson, Robert G; Watters, Jennifer

    2016-02-01

    Providing effective pain management to acutely intoxicated trauma patients represents a challenge of balancing appropriate pain management with the risk of potential respiratory depression from opioid administration. The objective of this study was to quantify the incidence of respiratory depression in trauma patients acutely intoxicated with ethanol who received opioids as compared with those who did not and identify potential risk factors for respiratory depression in this population. Retrospective medical record review was conducted for subjects identified via the trauma registry who were admitted as a trauma activation and had a detectable serum ethanol level upon admission. Risk factors and characteristics compared included demographics, Injury Severity Score, Glasgow Coma Score, serum ethanol level upon arrival, urine drug screen results, incidence of respiratory depression, and opioid and other sedative medication use. A total of 233 patients were included (78.5% male). Patients who received opioids were more likely to have a higher Injury Severity Score and initial pain score on admission as compared with those who did not receive opioids. Blood ethanol content was higher in patients who did not receive opioids (0.205 vs 0.237 mg/dL, P = .015). Patients who did not receive opioids were more likely to be intubated within 4 hours of admission (1.7% vs 12.1%, P = .02). Opioid administration was not associated with increased risk of respiratory depression (19.7% vs 22.4%, P = .606). Increased cumulative fentanyl dose was associated with increased risk of respiratory depression. Increased cumulative fentanyl dose, but not opioid administration alone, was found to be a risk factor for respiratory depression. PMID:26614581

  13. Divergent Relationship of Depression Severity to Social Reward Responses Among Patients with Bipolar Versus Unipolar Depression

    PubMed Central

    Sharma, Anup; Satterthwaite, Theodore D.; Vandekar, Lillie; Katchmar, Natalie; Daldal, Aylin; Ruparel, Kosha; A.Elliott, Mark; Baldassano, Claudia; Thase, Michael E.; Gur, Raquel E.; Kable, Joseph W.; Wolf, Daniel H.

    2016-01-01

    Neuroimaging studies of mood disorders demonstrate abnormalities in brain regions implicated in reward processing. However, there is a paucity of research investigating how social rewards affect reward circuit activity in these disorders. Here, we evaluated the relationship of both diagnostic category and dimensional depression severity to reward system function in bipolar and unipolar depression. In total, 86 adults were included, including 24 patients with bipolar depression, 24 patients with unipolar depression, and 38 healthy comparison subjects. Participants completed a social reward task during 3T BOLD fMRI. On average, diagnostic groups did not differ in activation to social reward. However, greater depression severity significantly correlated with reduced bilateral ventral striatum activation to social reward in the bipolar depressed group, but not the unipolar depressed group. In addition, decreased left orbitofrontal cortical activation correlated with more severe symptoms in bipolar depression, but not unipolar depression. These differential dimensional effects resulted in a significant voxelwise group by depression severity interaction. Taken together, these results provide initial evidence that deficits in social reward processing are differentially related to depression severity in the two disorders. PMID:27295401

  14. Similarities in acute phase protein response during hibernation in black bears and major depression in humans: A response to underlying metabolic depression?

    USGS Publications Warehouse

    Tsiouris, J.A.; Chauhan, V.P.S.; Sheikh, A.M.; Chauhan, A.; Malik, M.; Vaughan, M.R.

    2004-01-01

    This study investigated the effects of hibernation with mild hypothermia and the stress of captivity on levels of six acute-phase proteins (APPs) in serial samples of serum from 11 wild and 6 captive black bears (Ursus americanus Pallas, 1780) during active and hibernating states. We hypothesize that during hibernation with mild hypothermia, bears would show an APP response similar to that observed in major depression. Enzyme-linked immunoabsorbent assay was used to measure alpha2-macroglobulin and C-reactive protein, and a nephelometer to measure alpha1-antitrypsin, haptoglobin, ceruloplasmin, and transferrin. Levels of all other proteins except ceruloplasmin were significantly elevated during hibernation in both wild and captive bears at the p < 0.05 to p < 0.001 level. Alpha 2-macroglobulin and C-reactive-protein levels were increased in captive versus wild bears in both active and hibernating states at the p < 0.01 to p < 0.0001 level. During hibernation with mild hypothermia, black bears do not show immunosuppression, but show an increased APP response similar to that in patients with major depression. This APP response is explained as an adaptive response to the underlying metabolic depression in both conditions. Metabolic depression in hibernating bears is suggested as a natural model for research to explain the neurobiology of depression.

  15. Personality Factor as a Predictor of Depression Score Among Depressed and CHD Patients

    PubMed Central

    Kikhavani, Sattar

    2015-01-01

    Introduction Many risk factors can affect depression and coronary disease, these including physiological and psychological risk factors (such as personality traits) Objectives Our objectives were to examine whether personality factors (The Five-Factor Model) can predict depression score in the depressed and coronary heart disease (CHD) individuals compared to that of healthy subjects. Materials and Methods To achieve the above objectives, 100 depressed (Mean=35.90 years, SD=10.59 years), and 100 CHD (Mean=46.42 years, SD=12.52 years), patients and 100 healthy subjects (Mean = 37.97 years, SD =12.49 years) were selected by convenience sampling method. To compare the three groups of participants, ANOVA test was used. Stepwise Multiple Regression Analysis was used to identify the variables that most closely predict the perceived stress and depression scores. Pearson’s Correlation Co-efficient was used to examine the correlation between variables. Results In Neuroticism, the CHD patients had significant highest scores, followed by depressed patients. The healthy group had the least scores. In case of Extraversion, Openness and Agreeableness, healthy participants had significant higher scores followed by the depressed and CHD patients. Only in conscientiousness factor, Depressive and CHD groups had statistically less scores compared to the healthy group. Also, high Neuroticism and Age, and low Extraversion were significant protective factors for depression Scores of CHD patients, while high Neuroticism and low Extraversion function as predictors in the depressed and healthy groups. Conclusion The effects of Neuroticism and Extraversion on depression have been reported as inconsistent across previous studies. This study indicates that, older CHD individuals with high Neuroticism and low Extraversion scores are more vulnerable for depression. PMID:26557596

  16. Thyroid hormones association with depression severity and clinical outcome in patients with major depressive disorder.

    PubMed

    Berent, Dominika; Zboralski, Krzysztof; Orzechowska, Agata; Gałecki, Piotr

    2014-01-01

    The clinical implications of thyroid hormones in depression have been studied extensively and still remains disputable. Supplementation of thyroid hormones is considered to augment and accelerate antidepressant treatment. Studies on the role of thyroid hormones in depression deliver contradictory results. Here we assess theirs impact on depression severity and final clinical outcome in patients with major depression. Thyrotropin, free thyroxine (FT4), and free triiodothyronine (FT3) concentrations were measured with automated quantitative enzyme immunoassay. Depression severity and final clinical outcome were rated with 17-itemic Hamilton Rating Scale for Depression [HDRS(17)] and Clinical Global Impression Scales for severity and for improvement (CGIs, CGIi). FT3 and FT4 concentrations were significantly positively correlated with clinical improvement evaluated with CGIi (R = 0.38, P = 0.012; R = 0.33, P = 0.034, respectively). There was a significant correlation between FT4 concentrations and depression severity assessed in HDRS(17) (R = 0.31, P = 0.047). Male patients presented significantly higher FT3 serum levels (Z = 2.34, P = 0.018) and significantly greater clinical improvement (Z = 2.36, P = 0.018) when compared to female patients. We conclude that free thyroid hormones concentrations are associated with depression severity and have an impact on final clinical outcome. It can be more efficient to augment and accelerate the treatment of major depressive disorder with triiodothyronine instead of levothyroxine because of individual differences in thyroid hormones metabolism.

  17. Chronotypes in patients with nonseasonal depressive disorder: Distribution, stability and association with clinical variables.

    PubMed

    Müller, Matthias Johannes; Cabanel, Nicole; Olschinski, Christiane; Jochim, Dorothee; Kundermann, Bernd

    2015-01-01

    The individual's chronotype is regarded as rather stable trait with substantial heritability and normal distribution of the "morningness-eveningness" dimension in the general population. Eveningness has been related to the risk of developing affective, particularly depressive, disorders. However, age and other sociobiological factors may influence chronotypes. The present study investigated the distribution, stability, and clinical correlates of chronotype and morningness-eveningness in hospitalized patients with affective disorder. Chronotype was assessed with the morningness-eveningness questionnaire (MEQ) in 93 patients with nonseasonal depressive syndrome (85% major depression; 15% depressive adjustment disorder) after admission, and in 19 patients again before discharge. Distribution, stability and correlations of MEQ scores with clinical variables were calculated. Additionally, a literature analysis of chronotype distributions in samples of nondepressed persons and patients with nonseasonal depression was carried out. MEQ scores (mean 49 ± 11, range 23-75, higher scores indicate morningness) in 93 acutely depressed inpatients (age 41 ± 14 years, range 18-75 years; 63% women; hospitalization 48 ± 22 days; BDI-II 32 ± 11) were normally distributed (Shapiro-Wilk test; W = 0.993, p = 0.920) with 59.1% intermediate types, 19.4% evening types, and 21.5% morning types. MEQ change scores from admission to discharge were nonsignificant (-1.3 ± 5.0; paired t-test, t18 = -1.09; p = 0.29) despite significantly improved depression scores (-19.4 ± 7.6; paired t-test, t18 = 11.2, p < 0.001). Age (r = 0.24), and depression scores (r = -0.21) correlated significantly (p < 0.05) with MEQ scores; associations with sex and hospitalization duration were nonsignificant. The present study and literature findings revealed that the frequency of evening types is not clearly elevated in depression, but morning types are

  18. Borderline personality features in depressed or anxious patients.

    PubMed

    Distel, Marijn A; Smit, Johannes H; Spinhoven, Philip; Penninx, Brenda W J H

    2016-07-30

    Anxiety and depression frequently co-occur with borderline personality disorder. Relatively little research examined the presence of borderline personality features and its main domains (affective instability, identity problems, negative relationships and self-harm) in individuals with remitted and current anxiety and depression. Participants with current (n=597) or remitted (n=1115) anxiety and/or depression and healthy controls (n=431) were selected from the Netherlands Study of Depression and Anxiety. Assessments included the Personality Assessment Inventory - Borderline Features Scale and several clinical characteristics of anxiety and depression. Borderline personality features were more common in depression than in anxiety. Current comorbid anxiety and depression was associated with most borderline personality features. Anxiety and depression status explained 29.7% of the variance in borderline personality features and 3.8% (self-harm) to 31% (identity problems) of the variance in the four domains. A large part of the variance was shared between anxiety and depression but both disorders also explained a significant amount of unique variance. The severity of anxiety and depression and the level of daily dysfunctioning was positively associated with borderline personality features. Individuals with a longer duration of anxiety and depression showed more affective instability and identity problems. These findings suggest that patients with anxiety and depression may benefit from an assessment of personality pathology as it may have implications for psychological and pharmacological treatment. PMID:27183108

  19. 76 FR 63355 - Proposed Information Collection (Prevalence and Clinical course of Depression Among patients with...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-12

    ... AFFAIRS Proposed Information Collection (Prevalence and Clinical course of Depression Among patients with... depression in heart failure patients. DATES: Written comments and recommendations on the proposed collection... information technology. Title: Prevalence and Clinical Course of Depression Among Patients with Heart...

  20. Depression and Cognitive Function in Maintenance Hemodialysis Patients

    PubMed Central

    Agganis, Brian T.; Weiner, Daniel E.; Giang, Lena M.; Scott, Tammy; Tighiouart, Hocine; Griffith, John L.; Sarnak, Mark J.

    2010-01-01

    Background Both depression and cognitive impairment are common in hemodialysis patients, are associated with adverse clinical outcomes, and place an increased burden on health care resources. Study Design Cross-sectional cohort Setting & Participants 241 maintenance hemodialysis patients in the Boston area Predictor Depressive symptomatology, defined by a Center for Epidemiological Studies Depression Scale (CES-D) score of 16 or higher Outcome Performance on a detailed neurocognitive battery Results Mean age was 63.8 years, 49.0% were female, 21.6% were African American, and median dialysis duration was 13.8 months. There were 57 (23.7%) participants with significant depressive symptoms. In multivariable analysis adjusting for age, sex, education and other comorbid conditions, participants with and without depressive symptoms performed similarly on the Mini-Mental State Examination (p=0.4) and tests of memory. However, participants with greater depressive symptoms performed significantly worse on tests assessing processing speed, attention, and executive function, including Trails Making Test B (p=0.02) and Digit-Symbol Coding (p=0.01). Defining depression using a CES-D score ≥18 did not substantially change results. Limitations Cross-sectional design, absence of brain imaging Conclusions Hemodialysis patients with a greater burden of depressive symptoms perform worse on tests of cognition related to processing speed and executive function. Further research is needed to assess the effects of treating depressive symptoms on cognitive performance in dialysis patients. PMID:20673602

  1. Discharging patients from acute care hospitals.

    PubMed

    Goodman, Helen

    2016-02-10

    Planning for patient discharge is an essential element of any admission to an acute setting, but may often be left until the patient is almost ready to leave hospital. This article emphasises why discharge planning is important and lists the essential principles that should be addressed to ensure that patients leave at an optimum time, feeling confident and safe to do so. Early assessment, early planning and co-ordination of all the teams involved in the patient's care are essential. Effective communication between the various teams and with the patient and their family or carer(s) is necessary. Patients should leave hospital with all the information, medications and equipment they require. Appropriate plans should have been developed and communicated to the receiving community or non-acute team. When patient discharge is effective, complications as a result of extended lengths of hospital stay are prevented, hospital beds are used efficiently and readmissions are reduced.

  2. Effect of Regular Exercise Program on Depression in Hemodialysis Patients

    PubMed Central

    Rezaei, Jahangir; Abdi, Alireza; Rezaei, Mansour; Heydarnezhadian, Jafar; Jalali, Rostam

    2015-01-01

    Background and Aim. Depression is the most common psychological disorder in hemodialysis patients which decreases their quality of life and increases the mortality. This study was conducted to assess the effect of regular exercise on depression in hemodialysis patients. Methods. In a randomized clinical trial, 51 hemodialysis patients were allocated in two groups. Beck Depression Inventory (BDI) scale was used to assessing depression rate in participants. Designed program was educated using poster and face-to-face methods for case group. Intervention was carried out three times a week for ten weeks. At the beginning and the end of the study, depression rate of the subjects was assessed. Data was analyzed by SPSS16 software and descriptive and inferential statistics. Findings. According to the results of this study, there were no differences between case and control groups in depression rate at the beginning of the study, but there was significant difference after intervention (P = 0.016). In the beginning of the study, the mean and SD of depression in case group were 23.8 ± 9.29 and reduced to 11.07 ± 12.64 at the end (P < 0.001). Conclusion. The regular exercise program could reduce the depression in hemodialysis patients; therefore it is suggested for training this program for hemodialysis patients. This trial is registered with Iranian Registry of Clinical Trial (IRCT) number IRCT201205159763N1. PMID:27347502

  3. A patient-centered research agenda for the care of the acutely ill older patient

    PubMed Central

    Wald, Heidi L.; Leykum, Luci K.; Mattison, Melissa L. P.; Vasilevskis, Eduard E.; Meltzer, David O.

    2015-01-01

    Hospitalists and others acute care providers are limited by gaps in evidence addressing the needs of the acutely ill older adult population. The Society of Hospital Medicine (SHM) sponsored the Acute Care of Older Patients (ACOP) Priority Setting Partnership to develop a research agenda focused on bridging this gap. Informed by the Patient-Centered Outcomes Research Institute (PCORI) framework for identification and prioritization of research areas, we adapted a methodology developed by the James Lind Alliance to engage diverse stakeholders in the research agenda setting process. The work of the Partnership proceeded through four steps: convening, consulting, collating, and prioritizing. First, the steering committee convened a Partnership of 18 stakeholder organizations in May 2013. Next, stakeholder organizations surveyed members to identify important unanswered questions in the acute care of older persons, receiving 1299 responses from 580 individuals. Finally, an extensive and structured process of collation and prioritization resulted in a final list of ten research questions in the following areas: advanced care planning, care transitions, delirium, dementia, depression, medications, models of care, physical function, surgery, and training. With the changing demographics of the hospitalized population, a workforce with limited geriatrics training, and gaps in evidence to inform clinical decision-making for acutely ill older patients, the identified research questions deserve the highest priority in directing future research efforts to improve care for the older hospitalized patient and enrich training. PMID:25877486

  4. Uptake of Depression Treatment Recommendations among Latino Primary Care Patients

    PubMed Central

    Ishikawa, Rachel Zack; Cardemil, Esteban V.; Alegría, Margarita; Schuman, Catherine C.; Joseph, Robert C.; Bauer, Amy M.

    2014-01-01

    Background Primary care providers (PCP) are the entry point for public sector depression treatment for many Latino patients. However, many Latino patients do not initiate their PCPs’ recommended treatment, which likely contributes to ethnic disparities in depression treatment. This study examined factors related to Latino patients’ uptake of their PCPs’ recommendations for depression treatment. Method Ninety Latino primary care patients who received a depression treatment recommendation from their PCP participated in a telephone interview. Patients rated their working alliance with their PCPs and their PCPs’ cultural competence. They also reported their treatment preference, the type of recommendation, and their intended and actual uptake of the recommendation. Patients were contacted at two time points (Time 1: M = 14 days after PCP appointment; Time 2: M = 84 days after PCP appointment) to report their uptake status. Results At Time 1, 23% of patients had initiated uptake of the treatment recommendation, increasing to 53% at Time 2. Patients who received a medication recommendation were more likely to have followed though on the recommendation, compared to patients who received a psychotherapy recommendation. The working alliance was positively associated with intention to follow up on a treatment recommendation, and also mediated the relationship between cultural competence and intention of following up on the recommendation. Conclusion PCP’s treatment recommendation and the PCP – patient alliance play a role in Latino primary care patients intention to follow a treatment recommendation for depression. An improved understanding of this role could enhance efforts to improve depression treatment uptake. PMID:24512538

  5. The relationship between depressive symptoms, health service consumption, and prognosis after acute myocardial infarction: a prospective cohort study

    PubMed Central

    Kurdyak, Paul A; Gnam, William H; Goering, Paula; Chong, Alice; Alter, David A

    2008-01-01

    Background The use of cardiovascular health services is greater among patients with depressive symptoms than among patients without. However, the extent to which such associations between depressive symptoms and health service utilization are attributable to variations in comorbidity and prognostic disease severity is unknown. This paper explores the relationship between depressive symptoms, health service cardiovascular consumption, and prognosis following acute myocardial infarction (AMI). Methods The study design was a prospective cohort study with follow-up telephone interviews of 1,941 patients 30 days following AMI discharged from 53 hospitals across Ontario, Canada between December 1999 and February, 2003. Outcome measures were post discharge use of cardiac and non-cardiac health care services. The service utilization outcomes were adjusted for age, sex, income, comorbidity, two validated measures of prognosis (cardiac functional capacity and risk adjustment severity index), cardiac procedures (CABG or PTCA) and drugs prescribed at discharge. Results Depressive symptoms were associated with a 24% (Adjusted RR:1.24; 95% CI:1.19–1.30, P < 0.001), 9% (Adjusted RR:1.09; 95% CI:1.02–1.16, P = 0.007) and 43% (Adjusted RR: 1.43; 95% CI:1.34–1.52, P < 0.001) increase in total, cardiac, and non-cardiac hospitalization days post-AMI respectively, after adjusting for baseline patient and hospital characteristics. Depressive-associated increases in cardiac health service consumption were significantly more pronounced among patients of lower than higher cardiac risk severity. Depressive symptoms were not associated with increased mortality after adjusting for baseline patient characteristics. Conclusion Depressive symptoms are associated with significantly higher cardiac and non-cardiac health service consumption following AMI despite adjustments for comorbidity and prognostic severity. The disproportionately higher cardiac health service consumption among lower

  6. Use of the Beck Depression Inventory for assessing depression in patients hospitalized with severe burn. Disentangling symptoms of depression from injury and treatment factors.

    PubMed

    Thombs, Brett D

    2007-08-01

    The objective of this study was to assess whether scores on the Beck Depression Inventory (BDI) are biased by injury severity among hospitalized survivors of burn (N=262). A confirmatory factor analysis (CFA) model was developed with a general depression factor that loaded on all items and somatic and cognitive factors that were orthogonal to the general factor and to each other. The model fit the data well and substantially better than an alternative three-factor model with correlated factors. Percent total body surface area burned (TBSA) was significantly associated with the general depression factor (p=.04), but also with the orthogonal somatic factor (p<.001), suggesting biased measurement due to overlap between somatic symptoms of depression and the severity of the burn injury. Analysis of item communalities, however, suggested that only approximately 2% of total predicted item variance was associated with bias related to injury severity. It was concluded that, despite a small amount of bias, the BDI is a reasonably accurate clinical tool even in the context of severe burn. Appropriate adjustments for bias, however, should be made in research with the BDI among patients with acute burn.

  7. Correlates of Suicidality among Patients with Psychotic Depression

    ERIC Educational Resources Information Center

    Schaffer, Ayal; Flint, Alastair J.; Smith, Eric; Rothschild, Anthony J.; Mulsant, Benoit H.; Szanto, Katalin; Peasley-Miklus, Catherine; Heo, Moonseong; Papademetriou, Eros; Meyers, Barnett S.

    2008-01-01

    The independent association of age and other factors with suicidality in patients with major depression with psychotic features was examined. Of the 183 study participants, 21% had a suicide attempt during the current episode. Male gender, Hispanic background, past suicide attempt, higher depression scores, and higher cognitive scores were each…

  8. Assessing the Cognitive Regulation of Emotion in Depressed Stroke Patients

    ERIC Educational Resources Information Center

    Turner, Margaret A.; Andrewes, David G.

    2010-01-01

    This study evaluated the psychometric properties of a simple scale for measuring positive interpersonal attitudes of depressed stroke patients, with regard to their cognitive limitations. Two versions of the Attitudes Towards Relationships Scale were developed and administered to depressed stroke (n = 48) and control rheumatic/orthopaedic (n = 45)…

  9. [Increased risk of suicide in patients with agitated depression].

    PubMed

    Kenchadze, V G; Chkoniia, E D; Sikharulidze, G G

    2009-12-01

    In our study we aimed to verify the clinical features of agitated depression, which intensify suicidal trends leading to completed suicide. From 477 patients with agitated depression we selected 126, who presented high risk of suicide and studded them by using Mood Anxiety Inventory. On the bases of the structural-dynamic analyses we determine seven clinical variations of agitated-depression with prominent affective, cognitive, psychomotor, somato-algetic and behavioral symptoms. The most dangerous types with regards of suicidal behavior appeared to be senestopathic and algetic types and agitated depression with depersonalization and derealization. PMID:20090153

  10. Pharmacotherapy of Acute Bipolar Depression in Adults: An Evidence Based Approach.

    PubMed

    Muneer, Ather

    2016-05-01

    In the majority of cases of bipolar disorder, manic episodes are usually brief and typically responsive to currently available psychopharmacological agents. In contrast, depressive manifestations are more prevalent and persistent, and can present as major depressive/mixed episodes or residual interepisode symptoms. The depressive phase is often associated with other neuropsychiatric conditions, such as anxiety spectrum disorders, substance use disorders, stressor-related disorders, and eating disorders. It is viewed as a systemic disease with associated ailments such as metabolic syndrome, diabetes mellitus, and cardiovascular disease. There is an increased rate of mortality not only from suicide, but also from concomitant physical illness. This scenario is made worse by the fact that depressive symptoms, which represent the main disease burden, are often refractory to existing psychotropic drugs. As such, there is a pressing need for novel agents that are efficacious in acute depressive exacerbations, and also have applicable value in preventing recurrent episodes. The rationale of the present review is to delineate the pharmacotherapy of the depressive phase of bipolar disorder with medications for which there is evidence in the form of observational, open-label, or double-blind randomized controlled studies. In the treatment of acute bipolar depression in adults, a comprehensive appraisal of the extant literature reveals that among mood stabilizers, the most robust proof of efficacy exists for divalproex sodium; while atypical antipsychotics, which include olanzapine, quetiapine, lurasidone, and cariprazine, are also effective, as demonstrated in controlled trials. PMID:27274384

  11. Pharmacotherapy of Acute Bipolar Depression in Adults: An Evidence Based Approach

    PubMed Central

    2016-01-01

    In the majority of cases of bipolar disorder, manic episodes are usually brief and typically responsive to currently available psychopharmacological agents. In contrast, depressive manifestations are more prevalent and persistent, and can present as major depressive/mixed episodes or residual interepisode symptoms. The depressive phase is often associated with other neuropsychiatric conditions, such as anxiety spectrum disorders, substance use disorders, stressor-related disorders, and eating disorders. It is viewed as a systemic disease with associated ailments such as metabolic syndrome, diabetes mellitus, and cardiovascular disease. There is an increased rate of mortality not only from suicide, but also from concomitant physical illness. This scenario is made worse by the fact that depressive symptoms, which represent the main disease burden, are often refractory to existing psychotropic drugs. As such, there is a pressing need for novel agents that are efficacious in acute depressive exacerbations, and also have applicable value in preventing recurrent episodes. The rationale of the present review is to delineate the pharmacotherapy of the depressive phase of bipolar disorder with medications for which there is evidence in the form of observational, open-label, or double-blind randomized controlled studies. In the treatment of acute bipolar depression in adults, a comprehensive appraisal of the extant literature reveals that among mood stabilizers, the most robust proof of efficacy exists for divalproex sodium; while atypical antipsychotics, which include olanzapine, quetiapine, lurasidone, and cariprazine, are also effective, as demonstrated in controlled trials. PMID:27274384

  12. Outcomes of Subsyndromal Depression in Older Primary Care Patients

    PubMed Central

    Grabovich, Andrew; Lu, Naiji; Tang, Wan; Tu, Xin; Lyness, Jeffrey M.

    2010-01-01

    Objectives Most older persons in primary care suffering clinically significant depressive symptoms do not meet criteria for major or minor depression. We tested the hypothesis that patients with subsyndromal depression (SSD) would have poorer psychiatric, medical, and functional outcomes at follow-up than non-depressed patients, but not as poor as those with minor or major depression. We also explored the relative outcomes of three definitions of SSD to determine their relative prognostic value. Design Prospective observational cohort study. Setting Primary care practices in Monroe County, NY. Participants 481 primary care patients age ≥65 years who completed research assessments at intake and at least one year of follow-up evaluation. Measurements Depression diagnoses and three definitions of SSD were determined by the Structured Clinical Interview for DSM-IV and the 24-item Hamilton Depression Rating Scale. Other validated measures assessed anxiety, cognition, medical burden, and functional status. Results Patients with SSD had poorer 1-year lagged outcomes than non-depressed subjects in terms of psychiatric symptoms and functional status, often not significantly different than major or minor depression. Two of the SSD definitions identified subjects with poorer psychiatric and functional outcomes than the third SSD definition. Conclusions Clinicians should be vigilant in caring for patients with SSD, monitoring for persistent or worsening depressive symptoms including suicidality, anxiety, cognitive impairment, and functional decline. Researchers may use particular SSD definitions to identify individuals at higher risk of poor outcomes, to better understand the relationships of SSD to functional disability and to test innovative preventive and therapeutic interventions. PMID:20173424

  13. Acute respiratory failure in scrub typhus patients

    PubMed Central

    Sahoo, Jyoti Narayan; Gurjar, Mohan; Harde, Yogesh

    2016-01-01

    Respiratory failure is a serious complication of scrub typhus. In this prospective study, all patients with a diagnosis of scrub typhus were included from a single center Intensive Care Unit (ICU). Demographic, clinical characteristics, laboratory, and imaging parameters of these patients at the time of ICU admission were compared. Of the 55 scrub typhus patients, 27 (49%) had an acute respiratory failure. Seventeen patients had acute respiratory distress syndrome, and ten had cardiogenic pulmonary edema. Respiratory supported patients were older had significant chronic lungs disease and high severity illness scores (Acute Physiology and Chronic Health Evaluation-II and Sequential Organ Failure Assessment score). At ICU admission, these patients presented with more deranged laboratory markers, including high bilirubin, high creatine kinase, high lactate, metabolic acidosis, low serum albumin, and presence of ascites. The average ICU and hospital stay were 4.27 ± 2.74 and 6.53 ± 3.52 days, respectively, in the respiratory supported group. Three patients died in respiratory failure group, while only one patient died in nonrespiratory failure group.

  14. Acute respiratory failure in scrub typhus patients.

    PubMed

    Sahoo, Jyoti Narayan; Gurjar, Mohan; Harde, Yogesh

    2016-08-01

    Respiratory failure is a serious complication of scrub typhus. In this prospective study, all patients with a diagnosis of scrub typhus were included from a single center Intensive Care Unit (ICU). Demographic, clinical characteristics, laboratory, and imaging parameters of these patients at the time of ICU admission were compared. Of the 55 scrub typhus patients, 27 (49%) had an acute respiratory failure. Seventeen patients had acute respiratory distress syndrome, and ten had cardiogenic pulmonary edema. Respiratory supported patients were older had significant chronic lungs disease and high severity illness scores (Acute Physiology and Chronic Health Evaluation-II and Sequential Organ Failure Assessment score). At ICU admission, these patients presented with more deranged laboratory markers, including high bilirubin, high creatine kinase, high lactate, metabolic acidosis, low serum albumin, and presence of ascites. The average ICU and hospital stay were 4.27 ± 2.74 and 6.53 ± 3.52 days, respectively, in the respiratory supported group. Three patients died in respiratory failure group, while only one patient died in nonrespiratory failure group. PMID:27630462

  15. Acute respiratory failure in scrub typhus patients

    PubMed Central

    Sahoo, Jyoti Narayan; Gurjar, Mohan; Harde, Yogesh

    2016-01-01

    Respiratory failure is a serious complication of scrub typhus. In this prospective study, all patients with a diagnosis of scrub typhus were included from a single center Intensive Care Unit (ICU). Demographic, clinical characteristics, laboratory, and imaging parameters of these patients at the time of ICU admission were compared. Of the 55 scrub typhus patients, 27 (49%) had an acute respiratory failure. Seventeen patients had acute respiratory distress syndrome, and ten had cardiogenic pulmonary edema. Respiratory supported patients were older had significant chronic lungs disease and high severity illness scores (Acute Physiology and Chronic Health Evaluation-II and Sequential Organ Failure Assessment score). At ICU admission, these patients presented with more deranged laboratory markers, including high bilirubin, high creatine kinase, high lactate, metabolic acidosis, low serum albumin, and presence of ascites. The average ICU and hospital stay were 4.27 ± 2.74 and 6.53 ± 3.52 days, respectively, in the respiratory supported group. Three patients died in respiratory failure group, while only one patient died in nonrespiratory failure group. PMID:27630462

  16. Acute respiratory failure in scrub typhus patients.

    PubMed

    Sahoo, Jyoti Narayan; Gurjar, Mohan; Harde, Yogesh

    2016-08-01

    Respiratory failure is a serious complication of scrub typhus. In this prospective study, all patients with a diagnosis of scrub typhus were included from a single center Intensive Care Unit (ICU). Demographic, clinical characteristics, laboratory, and imaging parameters of these patients at the time of ICU admission were compared. Of the 55 scrub typhus patients, 27 (49%) had an acute respiratory failure. Seventeen patients had acute respiratory distress syndrome, and ten had cardiogenic pulmonary edema. Respiratory supported patients were older had significant chronic lungs disease and high severity illness scores (Acute Physiology and Chronic Health Evaluation-II and Sequential Organ Failure Assessment score). At ICU admission, these patients presented with more deranged laboratory markers, including high bilirubin, high creatine kinase, high lactate, metabolic acidosis, low serum albumin, and presence of ascites. The average ICU and hospital stay were 4.27 ± 2.74 and 6.53 ± 3.52 days, respectively, in the respiratory supported group. Three patients died in respiratory failure group, while only one patient died in nonrespiratory failure group.

  17. [Treatment response of depressive patients with comorbid problem drink].

    PubMed

    Ishikawa, Hiromi; Hashimoto, Eri; Tayama, Masaya; Saito, Toshikazu

    2013-10-01

    In this study, we investigated the impact of Problem Drink on depression. Forty participants with depression were divided into 2 groups: non-Problem Drinker (NPD) group (n = 22) and Problem Drinker (PD) group (n = 18) according to Alcohol Use Disorder Identification Test (AUDIT) score (NPD < 12, PD > or = 12). Depression was assessed by the Mini-International Neuropsychiatric Interview. The effect of medication on depressive symptoms was monitored over 12 weeks using the Hamilton Rating Scale for Depression (HAM-D). Significant improvement in HAM-D score was observed at 2 weeks in NPD patients but not until 4 weeks in PD patients. Total HAM-D scores were lower in NPD than in PD patients at the end of the treatment period. Therapeutic doses (dose of antidepressant used was equivalent to greater than 75 mg of imipramine) of antidepressants resulted in significant improvement in HAM-D scores at 2 weeks in NPD patients, but not until 8 weeks in PD patients and brought lower HAM-D scores in NPD than in PD patients at the end of the treatment period. The AUDIT score and total alcohol consumption during the study period were negatively correlated to the improvement in HAM-D score. In NPD patients, the level of education of patients in remission was higher than those by patients not in remission. In contrast, level of education of patients in remission were similar to those in PD patients not in remission. The above results suggest that co-occurrence of alcohol use disorders with depression is associated with a lower response to antidepressants which may reflect not only the result of biological alterations in the brain by chronic ethanol ingestion but also an inhibitory effect of ethanol on antidepressant action in the brain. Drinking-related cognitive dysfunction may also relate to the decreased response to treatment in the depressed patients with comorbid Problem Drinker. PMID:24427900

  18. Are your patients depressed? Implications for dental practice.

    PubMed

    D'Mello, Dale A

    2003-05-01

    Depressive disorders traditionally reside outside the realm of customary dental practice. Nonetheless, one in every five patients who visits a dentist experiences clinically significant symptoms of depression. The clinical implications of this are substantial. Depression is associated with diminished salivary flow and the complaint of dryness of mouth. It is associated with a diminished and distorted taste sensation, and a higher oral lactobacillus count. Depression is a risk factor for the development of dental caries, periodontal disease, and the erosive variant of oral lichen planus. Antidepressant medications can produce xerostomia, dysgeusia and bruxism. Depressive illness is a legitimate medical condition, with recognizable signs and symptoms, definable pathophysiology, and a significant response to treatment. Unfortunately, despite the availability of effective therapeutic measures, the majority of patients remain untreated. Routine dental checkup visits provide an opportunity for screening. PMID:12756671

  19. Patient Experiences of Depression and Anxiety with Chronic Disease

    PubMed Central

    DeJean, D; Giacomini, M; Vanstone, M; Brundisini, F

    2013-01-01

    Background Depression and anxiety are highly prevalent in patients with chronic disease, but remain undertreated despite significant negative consequences on patient health. A number of clinical groups have developed recommendations for depression screening practices in the chronic disease population. Objectives The objective of this analysis was to review empirical qualitative research on the experiences of patients with chronic disease (e.g., COPD, diabetes, heart disease, stroke) and comorbid depression or anxiety, and to highlight the implications of the screening and management of anxiety and/or depression on chronic disease outcomes. Review Methods We performed literature searches for studies published from January 2002 to May 2012. We applied a qualitative mega-filter to nine condition-specific search filters. Titles and abstracts were reviewed by two reviewers and, for the studies that met the eligibility criteria, full-text articles were obtained. Qualitative meta-synthesis was used to integrate findings across relevant published primary research studies. Qualitative meta-synthesis produced a synthesis of evidence that both retained the original meaning of the authors and offered a new, integrative interpretation of the phenomenon through a process of comparing and contrasting findings across studies. Results The findings of 20 primary qualitative studies were synthesized. Patients tended to experience their chronic conditions and anxiety or depression as either independent or inter-related (i.e., the chronic disease lead to depression/anxiety, the depression/anxiety lead to the chronic disease, or the two conditions exacerbated each other). Potential barriers to screening for depression or anxiety were also identified. Limitations A wider array of issues might have been captured if the analysis had focused on broader psychological responses to the chronic disease experience. However, given the objective to highlight implications for screening for anxiety

  20. The Misdiagnosis of Black Patients with Manic Depressive Illness

    PubMed Central

    Bell, Carl C.; Mehta, Harshad

    1980-01-01

    It has been shown repeatedly that, contrary to earlier beliefs, blacks may well demonstrate similar prevalence rates for manic depressive illness when compared with whites. Yet the authors believe that black manic depressive patients are frequently misdiagnosed as being chronic undifferentiated schizophrenics and treated with major tranquilizers when lithium is the drug of choice. This contention is supported by three case histories and some institutional dynamics that cause this form of iatrogenic morbidity to continue to prey upon black psychiatric patients. PMID:7365814

  1. Cognitive Behavioral Performance of Untreated Depressed Patients with Mild Depressive Symptoms.

    PubMed

    Li, Mi; Zhong, Ning; Lu, Shengfu; Wang, Gang; Feng, Lei; Hu, Bin

    2016-01-01

    This study evaluated the working memory performance of 18 patients experiencing their first onset of mild depression without treatment and 18 healthy matched controls. The results demonstrated that working memory impairment in patients with mild depression occurred when memorizing the position of a picture but not when memorizing the pictures themselves. There was no significant difference between the two groups in the emotional impact on the working memory, indicating that the attenuation of spatial working memory was not affected by negative emotion; however, cognitive control selectively affected spatial working memory. In addition, the accuracy of spatial working memory in the depressed patients was not significantly reduced, but the reaction time was significantly extended compared with the healthy controls. This finding indicated that there was no damage to memory encoding and function maintenance in the patients but rather only impaired memory retrieval, suggesting that the extent of damage to the working memory system and cognitive control abilities was associated with the corresponding depressive symptoms. The development of mild to severe depressive symptoms may be accompanied by spatial working memory damage from the impaired memory retrieval function extending to memory encoding and memory retention impairments. In addition, the impaired cognitive control began with an inadequate capacity to automatically process internal negative emotions and further extended to impairment of the ability to regulate and suppress external emotions. The results of the mood-congruent study showed that the memory of patients with mild symptoms of depression was associated with a mood-congruent memory effect, demonstrating that mood-congruent memory was a typical feature of depression, regardless of the severity of depression. This study provided important information for understanding the development of cognitive dysfunction.

  2. Depression in African-American patients with kidney disease.

    PubMed Central

    Kimmel, Paul L.; Patel, Somir S.; Peterson, Rolf A.

    2002-01-01

    There are few data on the epidemiology, consequences and treatment of depression in African-American patients with kidney disease in the US, even though such patients disproportionately bear the burden of this illness. This paper reviews data on the diagnosis and pathogenesis of depression and its consequences in patients with and without kidney disease, in addition to work on the epidemiology of depression in the African-American population and in the US End-stage Renal Disease (ESRD) program. African Americans are thought to have similar susceptibility to the development of depression as other populations in the US, but diminished access to care for this group of patients may be associated with differential outcomes. Data are presented from longitudinal studies of psychosocial outcomes in a population comprising primarily African-American patients with ESRD, and is reviewed the treatment of depression in patients with and without kidney disease. There are few studies of the management of depression that focus on minority populations. The authors agree with recommendations that treatment trials should include minority patients, patients with medical comorbidities, and the elderly, and assess function and quality of life as outcomes. The relationships between age, marital status and satisfaction, ethnicity, and perception of quality of life and depressive affect level and diagnosis of depression, and medical outcomes have not been determined in ESRD patients, or in African-American patients with ESRD. There are few studies of drugs for the treatment of depression in ESRD patients, and only one small randomized controlled trial. These have shown that therapy with selective serotonin reuptake inhibitors appears to be a safe treatment option for patients with ESRD. The long-term effectiveness of therapy, and its association with clinically important outcomes such as perception of quality of life, compliance, and survival have not been evaluated in ESRD patients. Also

  3. Prevalence of anxiety and depressive symptoms among patients with hypothyroidism

    PubMed Central

    Bathla, Manish; Singh, Manpreet; Relan, Pankaj

    2016-01-01

    Context: The association between depression and thyroid function is well known. Both conditions express many similar symptoms, thus making the diagnosis and treatment difficult. Aims: To find the prevalence of anxiety and depressive symptoms among patients with hypothyroid. Settings and Design: Cross-sectional study. Materials and Methodology: A total of 100 patients diagnosed as hypothyroidism were evaluated using Hamilton depression rating scale (HDRS) and Hamilton scale for anxiety (HAM-A). Statistical Analysis Used: The data were analyzed using the SPSS for Windows version 17.0 software. The quantitative data were expressed in number and percentage. The results obtained were compared using the Chi-square test. Results: Females constituted 70% of the sample. A total of 60% reported some degree of depression based on HDRS (males – 56.63% and females – 64.29%) whereas about 63% out of the total patients screened showed some degree of anxiety (males –56.66% and females – 65.72%) based on HAM-A. The most common depressive symptom among the males was depressed mood (73.33%) and among females was gastrointestinal somatic symptoms (68.54%). The most common anxiety symptom among the males was depressed mood (70.0%) and among females was anxious mood (92.85%). Conclusions: Psychiatric symptoms/disorders are common in patients with thyroid dysfunction. PMID:27366712

  4. Reduced Venous Blood Basophil Count and Anxious Depression in Patients with Major Depressive Disorder

    PubMed Central

    Baek, Ji Hyun; Kim, Hee-Jin; Fava, Maurizio; Mischoulon, David; Papakostas, George I; Nierenberg, Andrew; Heo, Jung-Yoon

    2016-01-01

    Objective Anxious depression has a distinct neurobiology, clinical course and treatment response from non-anxious depression. Role of inflammation in anxious depression has not been examined. As an exploratory study to characterize the role of inflammation on a development of anxious depression, we aimed to determine the relationship between white blood cell (WBC) subset counts and anxiety in individuals with major depressive disorder (MDD). Methods A total of 709 patients who were newly diagnosed with MDD were recruited. Anxiety levels of participants were evaluated using the Anxiety/ Somatization subitem of the Hamilton Depression Rating Scale. The association between WBC subset fraction and anxiety was evaluated. Results Basophil and eosinophil sub-fractions showed significant negative correlations with HAM-D anxiety/somatization factor scores (basophils: r=-0.092, p=0.014 and eosinophils: r=-0.075, p=0.046). When an anxiety score (a sum of somatic and psychic anxiety) was entered as a dependent variable, only basophils showed significant negative association with the anxiety scores after adjusting for all other WBC subset counts and demographic factors (t=-2.57, p=0.010). Conclusion This study showed that anxious depression had a decreased basophil subfraction, which might be associated with involvement of inflammation in development of anxious depression. PMID:27247599

  5. Sleep disorders and suicidal ideation in patients with depressive disorder.

    PubMed

    Chellappa, Sarah Laxhmi; Araújo, John Fontenele

    2007-10-31

    An intrinsic association between suicidal ideation and sleep disorders in patients with depressive disorder has been observed in recent studies. This study was conducted in order to examine the relationship between suicidal ideation and sleep disorders, such as insomnia and excessive sleepiness, in outpatients with major depressive disorder. Seventy patients with diagnoses of major depressive disorder were interviewed and assessed with the Sleep Habits Questionnaire and the Beck Scale for Suicidal Ideation (SSI). Data analyses were performed through descriptive analysis, Students t-test, Chi-square test and logistic regression model, with a statistical significance of 5%. In this study, depressed patients had high SSI scores (6.12+/-2.67), particularly for active suicidal ideation (1.61+/-0.39) and specific plans for suicide components (1.51+/-0.40). Depressed patients with insomnia had significantly higher SSI scores (7.39+/-2.84), in relation to patients with excessive sleepiness (3.68+/-1.73). Furthermore it was observed that insomniac patients had significantly higher scores on the following components: active suicide ideation, specific plans for suicide and previous suicide attempts. The results of multivariate analysis showed that only insomnia had a significant association with suicidal ideation. Thus, sleep disturbances, particularly insomnia, should be considered in the assessment of suicidal risk in outpatients with depressive disorder. PMID:17658614

  6. Depression, insomnia and sleep apnea in patients on maintenance hemodialysis

    PubMed Central

    Rai, M.; Rustagi, T.; Rustagi, S.; Kohli, R.

    2011-01-01

    Depression and sleep disorders are more frequent in patients on maintenance hemodialysis (HD) than the general population, and are associated with reduced quality of life and increased mortality risk. The purpose of this study was to assess the prevalence of depression, sleep apnea, insomnia in patients on HD as well as depression in their primary caregiver and to correlate these with the demographic profile. A cross-sectional study was conducted among 69 patients on maintenance HD for more than 3 months. There was high p revalence of depression (47.8%), insomnia (60.9%), increased risk of sleep apnea (24.6%) and depression in caregiver (31.9%). Depression was significantly more in patients with low monthly income (P=0.03), those on dialysis for more than 1 year (P=0.001) and the unemployed (P=0.009). High-risk patients for sleep apnea tended to be males with low monthly income (P=0.02). Insomnia was significantly higher in patients who were on dialysis for more than 1 year (P=0.003). PMID:22022080

  7. The Relationship of Depression to Work Status during the Acute Period of Low Back Pain.

    ERIC Educational Resources Information Center

    Beaudet, Joanne; Rasch, John

    1988-01-01

    Investigated relationship of Beck Depression Inventory (BDI) scores to employment status and time since injury among persons with acute low back pain. Work status was unrelated to BDI scores. Participants 5 to 6 months post-injury scored higher than participants l month post-injury; participants working 5 to 6 months post-injury scored higher than…

  8. Serum 25-Hydroxyvitamin D in Patients with Major Depressive Disorder

    PubMed Central

    DANA-ALAMDARI, Leila; KHEIROURI, Sorayya; NOORAZAR, Seyed Gholamreza

    2015-01-01

    Background: We investigated the association between serum 25(OH) D levels and depressive symptoms in patients with major depressive disorder (MDD). Methods: Eighty-five adults, 44 drug free patients with MDD and 41 apparently healthy controls, participated in the study. The Hamilton Depression Rating Scale was used to assess severity of major depression. Mental health of the controls was assessed according to DSM-IV criteria. Stress level of the participants was assessed by the Holmes and Rahe stress scale. Serum 25(OH) D levels was measured by immunochemiluminescence assay. Vitamin D deficiency was defined as a serum 25(OH) D concentration of lower than 20 ng/ml. Results: Depressed patients had the higher levels of stress. There was a positive correlation between stress level and disease severity (r= 0.32, P= 0.03). In total participants, mean percentage of vitamin D deficiency was 77.6% with 75% in patients and 80.5% in the healthy subjects. There were no differences between the two groups in serum 25(OH) D levels and percentage of subjects with the vitamin deficiency. A negative correlation was observed between disease severity and serum 25(OH) D level of patients with depression episodes < 2 y (r= −0.38, P = 0.08) and winter samples (samples collected and measured from December to march, r= −0.62, P = 0.004). Conclusion: Serum 25(OH) D levels were not associated with depression. However, the inverse relationship between levels of vitamin D and depressive symptoms in current depression episodes and in sun-deprived season warrants further investigation. PMID:26284211

  9. Depressive symptoms and spiritual wellbeing in asymptomatic heart failure patients.

    PubMed

    Mills, Paul J; Wilson, Kathleen; Iqbal, Navaid; Iqbal, Fatima; Alvarez, Milagros; Pung, Meredith A; Wachmann, Katherine; Rutledge, Thomas; Maglione, Jeanne; Zisook, Sid; Dimsdale, Joel E; Lunde, Ottar; Greenberg, Barry H; Maisel, Alan; Raisinghani, Ajit; Natarajan, Loki; Jain, Shamini; Hufford, David J; Redwine, Laura

    2015-06-01

    Depression adversely predicts prognosis in individuals with symptomatic heart failure. In some clinical populations, spiritual wellness is considered to be a protective factor against depressive symptoms. This study examined associations among depressive symptoms, spiritual wellbeing, sleep, fatigue, functional capacity, and inflammatory biomarkers in 132 men and women with asymptomatic stage B heart failure (age 66.5 years ± 10.5). Approximately 32 % of the patients scored ≥10 on the Beck Depression Inventory, indicating potentially clinically relevant depressive symptoms. Multiple regression analysis predicting fewer depressive symptoms included the following significant variables: a lower inflammatory score comprised of disease-relevant biomarkers (p < 0.02), less fatigue (p < 0.001), better sleep (p < 0.04), and more spiritual wellbeing (p < 0.01) (overall model F = 26.6, p < 0.001, adjusted R square = 0.629). Further analyses indicated that the meaning (p < 0.01) and peace (p < 0.01) subscales, but not the faith (p = 0.332) subscale, of spiritual wellbeing were independently associated with fewer depressive symptoms. Interventions aimed at increasing spiritual wellbeing in patients lives, and specifically meaning and peace, may be a potential treatment target for depressive symptoms asymptomatic heart failure. PMID:25533643

  10. Audiovisual emotional processing and neurocognitive functioning in patients with depression

    PubMed Central

    Doose-Grünefeld, Sophie; Eickhoff, Simon B.; Müller, Veronika I.

    2015-01-01

    Alterations in the processing of emotional stimuli (e.g., facial expressions, prosody, music) have repeatedly been reported in patients with major depression. Such impairments may result from the likewise prevalent executive deficits in these patients. However, studies investigating this relationship are rare. Moreover, most studies to date have only assessed impairments in unimodal emotional processing, whereas in real life, emotions are primarily conveyed through more than just one sensory channel. The current study therefore aimed at investigating multi-modal emotional processing in patients with depression and to assess the relationship between emotional and neurocognitive impairments. Fourty one patients suffering from major depression and 41 never-depressed healthy controls participated in an audiovisual (faces-sounds) emotional integration paradigm as well as a neurocognitive test battery. Our results showed that depressed patients were specifically impaired in the processing of positive auditory stimuli as they rated faces significantly more fearful when presented with happy than with neutral sounds. Such an effect was absent in controls. Findings in emotional processing in patients did not correlate with Beck’s depression inventory score. Furthermore, neurocognitive findings revealed significant group differences for two of the tests. The effects found in audiovisual emotional processing, however, did not correlate with performance in the neurocognitive tests. In summary, our results underline the diversity of impairments going along with depression and indicate that deficits found for unimodal emotional processing cannot trivially be generalized to deficits in a multi-modal setting. The mechanisms of impairments therefore might be far more complex than previously thought. Our findings furthermore contradict the assumption that emotional processing deficits in major depression are associated with impaired attention or inhibitory functioning. PMID

  11. Anosognosia and depression in patients with Alzheimer's dementia.

    PubMed

    Verhülsdonk, Sandra; Quack, Robin; Höft, Barbara; Lange-Asschenfeldt, Christian; Supprian, Tillmann

    2013-01-01

    Anosognosia refers to impaired awareness of patients to realize deficits related to a disorder and is a common symptom of dementia. Anosognosia has far-reaching consequences for diagnosis and treatment and is probably associated with unfavorable prognosis. This study examined the relationship between anosognosia and depression in patients with Alzheimer's dementia (AD). Assessment included interviews of patients and their caregivers. Depressive symptoms were evaluated with observer and self-rating instruments: the Geriatric Depression Scale (GDS), and the "mood" subscale of the Nurses Observation Scale for geriatric patients (NOSGER). Anosognosia was evaluated with the Anosognosia Questionnaire for Dementia (AQ-D). For the evaluation of behavioral and neuropsychological symptoms in dementia and the caregiver burden, the neuropsychiatric inventory (NPI) and the Cares of older People in Europe (COPE) Index were administered. A total of 47 patients were enrolled in the study at the department's geriatric psychiatry outpatient clinic. A considerable discrepancy was found between observer- and self-ratings of depressive symptoms. In 74.5% of the participants, caregiver ratings indicated secondary symptoms of depression as opposed to patient ratings. Thus, in AD, anosognosia may affect not only deficits in cognition and everyday functioning but also affective symptoms ("affective anosognosia"). Caregiver rating therefore is particularly important when assessing mood changes in AD patients.

  12. Associations between chronotype, sleep quality, suicidality, and depressive symptoms in patients with major depression and healthy controls.

    PubMed

    Selvi, Yavuz; Aydin, Adem; Boysan, Murat; Atli, Abdullah; Agargun, Mehmed Yucel; Besiroglu, Lutfullah

    2010-10-01

    Research interest concerning associations between sleep characteristics and suicidality in psychopathology has been growing. However, possible linkages of suicidality to sleep characteristics in terms of sleep quality and chronotypes among depressive patients have not been well documented. In the current study, the authors investigated the possible effects of sleep quality and chronotype on the severity of depressive symptoms and suicide risk in patients with depressive disorder and healthy controls. The study was conducted on 80 patients clinically diagnosed with major depression and 80 healthy subjects who were demographically matched with the patient group. All participants completed a questionnaire package containing self-report measures, including the Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), Morningness-Eveningness Questionnaire (MEQ), and Suicide Ideation Scale (SIS), and subjects were interviewed with the suicidality section of the Mini-International Neuropsychiatric Interview (MINI). Results are as follows: (a) logistic regression analyses revealed that poor sleep quality and depression symptom severity significantly predicted onset of major depression; (b) morningness-type circadian rhythm may play as a significant relief factor after onset of major depression; (c) sleep variables of chronotype and sleep quality did not significantly predict suicide ideation after controlling for depressive symptoms in the major depression group; and (d) suicide ideation and poor sleep quality were antecedents of depression symptom severity in patients with major depression, and in healthy controls. Findings are discussed under the theoretical assumptions concerning possible relations between chronotype, sleep quality, depression, and suicidality. PMID:20969525

  13. The effects of Nordic and general walking on depression disorder patients' depression, sleep, and body composition.

    PubMed

    Park, Seong Doo; Yu, Seong Hun

    2015-08-01

    [Purpose] This study examined Nordic walking as an exercise intervention for the elderly with depression. [Subjects] Twenty-four patients who were diagnosed with depression were randomly selected and divided into two groups, an experimental group which performed Nordic walking, and a control group, which performed normal walking. [Methods] Both groups practiced their respective walking exercise for 50 minutes per day, three times a week for eight weeks. To compare the effects of the intervention, psychological factors using the Beck depression inventory and sleep quality was assessed using the Korean version Pittsburgh sleep quality index. Skeletal muscle mass, fat free mass, body mass index, body fat percentage, and basal metabolism were estimated three times by a body composition analyzer, before the intervention, four weeks after the intervention, and eight weeks after the intervention. [Results] There was a significant difference in depression with a main effect of time in both groups. There was also a significant difference in sleep in over time and interaction. The differences over time between the two groups were significant for depression, sleep, and skeletal muscle mass. [Conclusion] The results suggests that Nordic walking has a positive effect on depression and sleeping disorders of the elderly, suggesting that Nordic walking based exercise programs should be developed for the elderly who suffer from depression or a sleeping disorder. PMID:26357429

  14. Bipolar depression: Managing patients with second generation antipsychotics.

    PubMed

    Avery, Lindsay M; Drayton, Shannon J

    2016-01-01

    Bipolar affective disorder is a debilitating illness that manifests as cyclical episodes of mood elevation and depression, but the treatment of the depressive episodes (i.e., bipolar depression) differs considerably from the treatment of major depressive disorder. In bipolar affective disorder, it is well known that patients spend a significantly greater amount of time in depressive episodes than manic or hypomanic episodes, yet there are currently just three Food and Drug Administration-approved agents for the treatment of bipolar depression: (1) olanzapine/fluoxetine combination (2) quetiapine, both immediate- and extended-release, and (3) lurasidone. The literature review presented here focuses on the clinical trials that led to the Food and Drug Administration-approval of these second generation antipsychotics in the treatment of bipolar depression. The discussion highlights key considerations regarding overall treatment strategies to aid clinicians in the selection of pharmacologic agents. Recommended monitoring parameters, potential adverse effects, and pertinent counseling points for second generation antipsychotics used in bipolar depression are included. PMID:27079776

  15. Acute stress, depression, and anxiety symptoms among English and Spanish speaking children with recent trauma exposure

    PubMed Central

    Barber, Beth A.; Kohl, Krista L.; Kassam-Adams, Nancy; Gold, Jeffrey I.

    2015-01-01

    A growing literature suggests the clinical importance of acute stress disorder (ASD) symptoms in youth following potentially traumatic events. A multisite sample of English and Spanish speaking children and adolescents (N=479) between the ages of 8 to 17, along with their caregivers completed interviews and self-report questionnaires between 2 days and one month following the event. The results indicate that children with greater total acute stress symptoms reported greater depressive (r = .41, p < .01), and anxiety symptoms (r = .53, p < .01). Examining specific acute stress subscales, re-experiencing was correlated with anxiety (r = .47, p < .01) and arousal was correlated with depression (r = .50, p < .01) and anxiety (r = .55, p < .01). Age was inversely associated with total acute stress symptoms (r = -.24, p < .01), re-experiencing (r = -.17, p < .01), avoidance (r = -.27, p < .01), and arousal (r = -.19, p < .01) and gender was related to total anxiety symptoms (Spearman's rho = .17, p < .01). The current study supports the importance of screening acute stress symptoms and other mental health outcomes following a potentially traumatic event in children and adolescents. Early screening may enable clinicians to identify and acutely intervene to support children's psychological and physical recovery. PMID:24337685

  16. Auditory hallucinations in tinnitus patients: Emotional relationships and depression

    PubMed Central

    Santos, Rosa Maria Rodrigues dos; Sanchez, Tanit Ganz; Bento, Ricardo Ferreira; Lucia, Mara Cristina Souza de

    2012-01-01

    Summary Introduction: Over the last few years, our Tinnitus Research Group has identified an increasing number of patients with tinnitus who also complained of repeated perception of complex sounds, such as music and voices. Such hallucinatory phenomena motivated us to study their possible relation to the patients' psyches. Aims: To assess whether hallucinatory phenomena were related to the patients' psychosis and/or depression, and clarify their content and function in the patients' psyches. Method: Ten subjects (8 women; mean age = 65.7 years) were selected by otolaryngologists and evaluated by the same psychologists through semi-structured interviews, the Hamilton Depression Rating Scale, and psychoanalysis interviews. Results: We found no association between auditory hallucinations and psychosis; instead, this phenomenon was associated with depressive aspects. The patients' discourse revealed that hallucinatory phenomena played unconscious roles in their emotional life. In all cases, there was a remarkable and strong tendency to recall/repeat unpleasant facts/situations, which tended to exacerbate the distress caused by the tinnitus and hallucinatory phenomena and worsen depressive aspects. Conclusions: There is an important relationship between tinnitus, hallucinatory phenomena, and depression based on persistent recall of facts/situations leading to psychic distress. The knowledge of such findings represents a further step towards the need to adapt the treatment of this particular subgroup of tinnitus patients through interdisciplinary teamwork. Prospective. PMID:25991952

  17. [Anxiety, depression and social support in patients with psoriasis].

    PubMed

    Hawro, Tomasz; Miniszewska, Joanna; Chodkiewicz, Jan; Sysa-Jedrzejowska, Anna; Zalewska, Anna

    2007-01-01

    Dermatological patients present significantly more psychological disturbances of various types than the general population. The aim of the present study was to analyze anxiety and depression in relation to social support in psoriasis patients. The study was performed on a group of 32 psoriasis vulgaris in-patients of the Department of Dermatology, Medical University of Lódź. The following questionnaires were employed: The Hospital Anxiety and Depression Scale (HADS) and Social Support Questionnaire (SOZU--Soziale Unterstützung). Psoriasis severity was evaluated by Psoriasis Area and Severity Index (PASI). Elderly psoriatic patients presented significantly higher levels of both anxiety and depression. Moreover, lower depression levels were observed in patients with positive psoriatic family history. Furthermore, there was a positive correlation between anxiety level and cutaneous lesions severity, pruritus severity and longer disease duration. Additionally, there was a negative correlation between both anxiety and depression levels and social support. In conclusion, support groups should primarily be organized for elderly psoriatic patients with negative psoriatic family history.

  18. Effects of paroxetine-mediated inhibition of GRK2 expression on depression and cardiovascular function in patients with myocardial infarction

    PubMed Central

    Tian, Xiuqing; Wang, Qing; Guo, Rui; Xu, Lingling; Chen, Qin M; Hou, Yinglong

    2016-01-01

    Background Paroxetine is a selective serotonin reuptake inhibitor utilized in the treatment of depression and anxiety disorders. Recent studies have identified paroxetine as a G protein-coupled receptor kinase-2 (GRK2) inhibitor capable of reversing cardiac dysfunction and remodeling in experimental models of acute myocardial infarction (AMI). We determine the clinical importance of paroxetine on cardiac functions in patients having AMI with depression (AMID) in comparison with fluoxetine, an unrelated selective serotonin reuptake inhibitor that does not inhibit GRK2. Methods Diagnosis of depression was based on the 17-item Hamilton Depression Scale and Self-rating Depression Scale in AMI patients after hospital admission. AMID patients were randomly assigned to paroxetine or fluoxetine for treatment of depression. Heart rate variability and cardiac function were evaluated. GRK2 protein levels were measured using peripheral lymphocytes and Western blot. Results GRK2 expression in AMID patients was significantly higher than that in AMI patients without depression. In AMID patients, GRK2 levels were positively correlated with the 17-item Hamilton Depression Scale and the Self-rating Depression Scale scores, and negatively correlated with heart rate variability. Treatment of AMID patients with paroxetine significantly reduced the expression of GRK2, normalized the autonomic nervous system function, and improved cardiac performance. In contrast, fluoxetine normalized the autonomic nervous system but did not reduce the expression of GRK2 nor improved cardiac performance. Conclusion This study suggests that paroxetine is effective for improving cardiac function in patients with AMID and such effect correlates with GRK2 reduction. PMID:27695334

  19. Cotard Syndrome without Depressive Symptoms in a Schizophrenic Patient

    PubMed Central

    Morgado, Pedro; Ribeiro, Ricardo; Cerqueira, João J.

    2015-01-01

    Introduction. Cotard syndrome is a rare condition characterized by nihilistic delusions concerning body or life that can be found in several neuropsychiatry conditions. It is typically associated with depressive symptoms. Method. We present a case of Cotard syndrome without depressive symptoms in the context of known paranoid schizophrenia. A literature review of Cotard syndrome in schizophrenia was performed. Results. Although there are few descriptions of this syndrome in schizophrenia, patients usually present depressive mood and psychomotor retardation, features not seen in our patient. Loss of the sense of the inner self, present in schizophrenia, could explain patient's symptomatology but neurobiological bases of this syndrome remain unclear. Conclusion. Despite not being considered in actual classifications, Cotard syndrome is still relevant and psychiatric evaluation is critical to diagnosing and treating this condition in psychiatric patients. PMID:26101683

  20. Attitudes and beliefs of patients with chronic depression toward antidepressants and depression

    PubMed Central

    Jacob, Sabrina Anne; Ab Rahman, Ab Fatah; Hassali, Mohamed Azmi Ahmad

    2015-01-01

    Background Many patients have erroneous views with regard to depression and its management, and it was noted that these attitudes and beliefs significantly affected their adherence rates. Objectives The primary aim of this study was to determine the attitudes and beliefs of patients with depression toward depression and antidepressants. A secondary aim was to assess the influence of ethnicity on patients’ attitudes and beliefs. Patients and methods The study involved patients with chronic depression being followed up at an outpatient clinic at a government-run hospital in Malaysia. Patients’ attitudes and beliefs were assessed using the Antidepressant Compliance Questionnaire. Results A total of 104 patients of Malay, Chinese, and Indian ethnic groups met the selection criteria. Chinese patients had significantly negative attitudes and beliefs toward depression and antidepressants compared to Malays and Indians (b=-8.96, t103=-3.22; P<0.05). Component analysis revealed that 59% of patients believed that antidepressants can cause a person to have less control over their thoughts and feelings, while 67% believed that antidepressants could alter one’s personality; 60% believed it was okay to take fewer tablets on days when they felt better, while 66% believed that antidepressants helped solve their emotional problems and helped them worry less. Conclusion Patients had an overall positive view as to the benefits of antidepressants, but the majority had incorrect views as to the acceptable dosing of antidepressants and had concerns about the safety of the medication. Assessing patients’ attitudes and beliefs, as well as the impact of their respective cultures, can be used in tailoring psychoeducation sessions accordingly. PMID:26064052

  1. Mental health professionals’ attitudes toward patients with PTSD and depression

    PubMed Central

    Maier, Thomas; Moergeli, Hanspeter; Kohler, Michaela; Carraro, Giovanni E.; Schnyder, Ulrich

    2015-01-01

    Background To date, mental health professionals’ attitudes toward posttraumatic stress disorder (PTSD), compared to other psychiatric disorders such as schizophrenia or depression, have rarely been studied. Objective We assessed mental health professionals’ attitudes toward patients with PTSD compared to patients suffering from depression. Method Case vignettes of a patient with either PTSD or depression were presented to two samples of mental health professionals: attendees of a conference on posttraumatic stress (N=226) or of a lecture for psychiatry residents (N=112). Participants subsequently completed a questionnaire that assessed their attitude reactions to the presented case. Results Participants showed similarly positive attitudes toward depression and PTSD. PTSD elicited a more favorable attitude with regard to prosocial reactions, estimated dependency, attributed responsibility, and interest in the case, particularly in mental health professionals specializing in psychotraumatology. Across diagnoses, higher age and longer professional experience were associated with more positive attitudes toward patients. Conclusions Mental health professionals’ positive attitudes toward patients with depression and PTSD correlate with their specific knowledge about the disorder, their level of professional training, and their years of professional experience. Limitations The instruments used, although based on established theoretical concepts in attitude research, were not validated in their present versions. PMID:26507340

  2. [MACROPHAGE PHAGOCYTIC SYSTEM AT THE PATIENTS WITH RECCURENT DEPRESSIVE DISORDER].

    PubMed

    Teryshina, I F

    2015-01-01

    The macrophage phagocytic system (MPS) indexes by the study of phagocytic activity of macrophages (PAM) at the patients with reccurent depressive disorder (RDD) was studied. It is set that before treatment of the patients with RDD was reduced the indexes of PAM, that testified to oppression of a functional condition MPS.

  3. Assessment of depression in medical patients: A systematic review of the utility of the Beck Depression Inventory-II

    PubMed Central

    Wang, Yuan-Pang; Gorenstein, Clarice

    2013-01-01

    To perform a systematic review of the utility of the Beck Depression Inventory for detecting depression in medical settings, this article focuses on the revised version of the scale (Beck Depression Inventory-II), which was reformulated according to the DSM-IV criteria for major depression. We examined relevant investigations with the Beck Depression Inventory-II for measuring depression in medical settings to provide guidelines for practicing clinicians. Considering the inclusion and exclusion criteria seventy articles were retained. Validation studies of the Beck Depression Inventory-II, in both primary care and hospital settings, were found for clinics of cardiology, neurology, obstetrics, brain injury, nephrology, chronic pain, chronic fatigue, oncology, and infectious disease. The Beck Depression Inventory-II showed high reliability and good correlation with measures of depression and anxiety. Its threshold for detecting depression varied according to the type of patients, suggesting the need for adjusted cut-off points. The somatic and cognitive-affective dimension described the latent structure of the instrument. The Beck Depression Inventory-II can be easily adapted in most clinical conditions for detecting major depression and recommending an appropriate intervention. Although this scale represents a sound path for detecting depression in patients with medical conditions, the clinician should seek evidence for how to interpret the score before using the Beck Depression Inventory-II to make clinical decisions. PMID:24141845

  4. Association Study of Genotype by Depressive Response during Acute Tryptophan Depletion in Subjects Recovered from Major Depression

    PubMed Central

    Moreno, Francisco A.; Erickson, Robert P.; Garriock, Holly A.; Gelernter, Joel; Mintz, Jim; Oas-Terpstra, Jennifer; Davies, Marilyn A.; Delgado, Pedro L.

    2015-01-01

    Purpose To study the brief and reversible mood response to acute tryptophan depletion (ATD) as a trait marker in subjects considered at risk for major depressive disorder (MDD). Procedures ATD was administered to 64 subjects (54 European-Americans and 10 from other races) with a personal and family history of MDD. They were in remission and had been medication-free for at least 3 months. Subjects were randomly assignment to an active or sham condition in a double-blind crossover design. They were genotyped for serotonin-related candidate genes, and mood response was quantified with the Hamilton Depression Rating Scale (HDRS). Data were analyzed using Poisson regression with repeated measures and latent trajectory models. Results Compared to the sham controls, active ATD caused modest depressive changes showing significant main effects of test condition (χ2 = 5.14, d.f. = 1, p = 0.023) and time (χ2 = 12.22, d.f. = 3, p = 0.007), but no significant interaction of time and test condition. Latent trajectory analysis revealed two groups, identified as depletion responders and non-responders. Those with the HTR2A rs6313 CC genotype had significantly higher HDRS scores during ATD (χ2 = 11.72, d.f. = 1, p = 0.0006). Conclusions ATD may help identifying the biological subtypes of MDD. These data are consistent with imaging reports implicating 5-HT2A receptor function in ATD phenotypes. PMID:26528486

  5. Pathological display of affect in patients with depression and right frontal brain damage. An alternative mechanism.

    PubMed

    Ross, E D; Stewart, R S

    1987-03-01

    Two patients are reported with the acute onset of pathological crying following right inferior frontal brain damage. Both had severe endogenous depression and neither had pseudobulbar palsy. These and other cases argue that two organic brain diseases--one structural and the other "physiopharmacological"--may interact to produce pathological display of affect that cannot be accounted for by traditional neurological explanations. A pharmacological mechanism for the rapid amelioration of pathological affect by tricyclic medications and its possible relationship to the newly discovered descending motor systems of the brain that use norepinephrine and serotonin as neurotransmitters is offered. These cases also suggest that pathological affect is a valuable clinical indicator of an underlying major depression in some brain-injured patients. PMID:3819712

  6. Depressed REM Sleep Behavior Disorder Patients Are Less Likely to Recall Enacted Dreams than Non-Depressed Ones

    PubMed Central

    Lee, Hyeong Gon; Choi, Jae Won; Lee, Yu Jin

    2016-01-01

    Objective REM sleep behavior disorder (RBD) is associated with psychiatric symptoms, such as anxiety and alexithymia. However, only a few studies on the relationship between depression and RBD have been published. In this study, we investigated the occurrence of depression and associated factors in patients with RBD. Methods In total 94 patients (mean age: 61.9±12.7 years, male: 70.2%) diagnosed as RBD were examined using detailed clinical histories, the Beck Depression Inventory (BDI), the Epworth Sleepiness Scale (ESS), and nocturnal polysomnography (PSG). Results The mean BDI score of all patients was 12.4±10.3 and 44.7% of RBD patients showed depressed mood (BDI >11 points). Depressed RBD patients were less able to recall enacted dreams than were non-depressed patients (61.9% vs. 86.5%, p=0.008). Logistic regression analysis showed that failure to recall enacted dreams was significantly associated with depression, after controlling for confounding variables including the respiratory disturbance index and a history of psychiatric disorders (odds ratio=0.323, p=0.041). Conclusion In this study, 44.7% of RBD patients were found to suffer from depressed mood. And, depression was found to be associated with reduced ability to recall enacted dreams. We suggest that routine evaluation of depression be performed in RBD patients, particularly when failure to recall enacted dreams is evident. We speculate that such failure may be associated with emotional dysregulation or neurodegeneration. PMID:27081385

  7. Patient experience of computerised therapy for depression in primary care

    PubMed Central

    Knowles, Sarah E; Lovell, Karina; Bower, Peter; Gilbody, Simon; Littlewood, Elizabeth; Lester, Helen

    2015-01-01

    Objective To explore patient experience of computerised cognitive behaviour therapy (cCBT) for depression in a pragmatic randomised controlled trial (Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy, REEACT). Design Qualitative semistructured interviews with 36 participants. Participants Depressed patients with a Patient Health Questionnaire 9 of 10 or above recruited into the REEACT randomised controlled trial. Setting Primary care settings in England. Results Participant experience was on a continuum, with some patients unable or unwilling to accept psychological therapy without interpersonal contact while others appreciated the enhanced anonymity and flexibility of cCBT. The majority of patients were ambivalent, recognising the potential benefits offered by cCBT but struggling with challenges posed by the severity of their illness, lack of support and limited personalisation of programme content. Low completion rates were commonly reported, although more positive patients reported greater engagement. Both positive and ambivalent patients perceived a need for monitoring or follow-up to support completion, while negative patients reported deliberate non-adherence due to dissatisfaction with the programme. Patients also reported that severity of depression impacted on engagement, and viewed cCBT as unsuitable for patients undergoing more severe depressive episodes. Conclusions The study demonstrates both the unique demands and benefits of computerised therapy. cCBT was preferred by some patients and rejected by others, but the majority of patients were ambivalent about the therapy. cCBT could be offered within a menu of options in stepped care if matched appropriately to individual patients or could be offered with enhanced support to appeal to a greater number of patients. Trial registration number ISRCTN91947481. PMID:26621513

  8. Depression among Chronic Pain Patients: Cognitive-Behavioral Analysis and Effect on Rehabilitation Outcome.

    ERIC Educational Resources Information Center

    Kerns, Robert D.; Haythornthwaite, Jennifer A.

    1988-01-01

    Examined relevance of depression to chronic pain. Found significant differences among 131 depressed, mildly depressed, and nondepressed chronic pain sufferers on instrumental activities and coping skills, with more depressed subjects reporting lower levels of functioning and less support. Depressed pain patients showed greater tendency to drop out…

  9. Buddhist group therapy for diabetes patients with depressive symptoms.

    PubMed

    Rungreangkulkij, Somporn; Wongtakee, Wiwat; Thongyot, Sawitta

    2011-06-01

    The objective of this study was to assess the effect of Buddhist group therapy on patients with type 2 diabetes who had depressive symptoms. A quasi-experimental design study using a control group with matching technique was conducted. After informed consent was obtained, the "Nine questions for assessing depressive disorder symptom" (Isan language) was used to determine the patient's condition. A total of 62 patients with type 2 diabetes who had depressive symptoms were assigned to either the experimental group (n = 32) or the control group (n = 32). Patients in the experimental group were divided further into four groups (8 patients per group) and attended the Buddhist group therapy. The intervention consisted of a weekly Buddhist group gathering lasting 2 hours for 6 weeks plus home meditation practices. Patients in the control group received treatment as usual. Both groups received standard physician treatment, including medication. Physicians did not know who was in either the control or experimental groups. Results show that 6 months after the intervention, 65.6% and 100% of patients in the control group and experimental group, respectively, returned to normal level. The intention-to-treat analysis, which included two participants in the experimental group lost follow-up, yielded a small reduction in the number of patients who returned to normal level (93.8%). With intention-to-treat analysis, the relative risk on depressive symptoms between the experimental and control groups was 6.5 (95% confidence interval, 1.4-30.6). Qualitative data from the experimental group supported that there were therapeutic group factors involved. However, patients realized the truth of being oneself and also accepted their current living condition. In conclusion, this program is effective in reducing depressive symptoms.

  10. Depressive symptoms and major depressive disorder in patients affected by subclinical hypothyroidism: a cross-sectional study.

    PubMed

    Demartini, Benedetta; Ranieri, Rebecca; Masu, Annamaria; Selle, Valerio; Scarone, Silvio; Gambini, Orsola

    2014-08-01

    The relationship between subclinical hypothyroidism and depression is still controversial. Our objective was to compare the prevalence of depressive symptoms and major depressive disorder in a population of patients affected by subclinical hypothyroidism and a control group without thyroid disease. The authors enrolled 123 consecutive outpatients affected by subclinical hypothyroidism undergoing follow-up at the endocrinology department of San Paolo Hospital in Milan and 123 controls without thyroid disease under the charge of general physicians.All patients and controls underwent an evaluation by means of a psychiatric interview; Hamilton Rating Scale for Depression (HAM-D); Montgomery-Asberg Depression Rating Scale (MADRS); and serum thyroid stimulating hormone, free T4, and free T3 levels. Patients were also screened for thyroid peroxidase antibodies and thyroglobulin antibodies. Patients affected by subclinical hypothyroidism had a prevalence of depressive symptoms of 63.4% at HAM-D and 64.2% at MADRS; 22 patients (17.9%) had a diagnosis of depressive episode (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria). The control group had a prevalence of depressive symptoms of 27.6% at HAM-D and 29.3% at MADRS, and only seven controls had a diagnosis of depressive episode. The prevalence of depressive symptoms between these two groups was statistically different. This study underlines a strong association between subclinical hypothyroidism and depressive symptoms, which could have some important diagnostic and therapeutic implications in the clinical practice.

  11. Efficacy of mirtazapine in clinically relevant subgroups of depressed patients.

    PubMed

    Nutt, D J

    1998-01-01

    Mirtazapine is a noradrenergic and specific serotonergic antidepressant (NaSSA) with a novel mode of action that differs from other antidepressants that are currently available. Clinical trials have demonstrated it to have good antidepressant efficacy and excellent tolerability. Analysis of the results of placebo-controlled trials in moderately or severely depressed patients have shown mirtazapine to be effective in clinically important subgroups of depressed patients, particularly anxious patients, patients with sleep disturbance, retarded patients, and agitated patients. The efficacy and tolerability of mirtazapine are attributable to its pharmacological profile. It is likely that the overall antidepressant activity arises from its dual action, enhancing both noradrenergic and 5-HT1 receptor-mediated serotonergic neurotransmission, while the anxiolytic and sleep-improving properties of mirtazapine are attributable to the specific blockade of 5-HT2 and 5-HT3 receptors. PMID:9597345

  12. Quality of Life of Patients After an Acute Coronary Event: Hospital Discharge

    PubMed Central

    Dias, Cristiane Maria Carvalho Costa; Macedo, Luciana Bilitario; Gomes, Lilian Tapioca Jones Cunha; de Oliveira, Paula Luzia Seixas Pereira; Albuquerque, Iana Verena Santana; Lemos, Amanda Queiroz; Brasil, Cristina Aires; Prado, Eloisa Pires Ferreira; Macedo, Pedro Santiago; de Oliveira, Francisco Tiago Oliveira; dos Reis, Helena Franca Correia; Darze, Eduardo Sahade; Guimaraes, Armenio Costa

    2014-01-01

    Background The acute coronary syndrome (ACS) has a high morbi-mortality rate, including physical deficiencies and functional limitations with impact on quality of life. Cardiovascular rehabilitation 1 (CVR1) should begin as early as possible, to enable improvement in functional capacity and quality of life. Previous studies have shown association of cardiovascular diseases with quality of life, in which depression and anxiety are the domains most altered. The aim of the study is to verify the impact of an acute coronary event on quality of life at the moment of hospital discharge. Methodology This was a cross-sectional study, with ACS patients hospitalized in ICU of a private hospital in the city of Salvador, Brazil, submitted to CVR1. The quality of life questionnaire Euroqol-5D was applied on discharge from hospital. Patients included in the study were those with ACV, who had medical permission to walk, had not been submitted to acute surgical treatment, were time and space oriented, and over the age of 18 years. Patients excluded from the study were those with cognitive, orthopedic and neurological problems, who used orthesis on a lower limb, and were in any condition of risk at the time of beginning with CVR1. Data were collected by a previously trained ICU team. Results Data were collected of 63 patients who revealed compromise in the domains of pain/feeling ill (20.63%) and anxiety/depression (38.09%). Statistical significance was observed in the association between sex and pain/feeling ill (P < 0.01), sex and anxiety/depression (P < 0.01), diabetes and mobility (P < 0.01), hereditary factors and anxiety/depression (p < 0.01), BMI and pain/feeling ill (P < 0.01). Conclusion In this sample of patients, on discharge from hospital after ACS, the pain/feeling ill and anxiety/depression domains were shown to be compromised. PMID:25110540

  13. Altered fecal microbiota composition in patients with major depressive disorder.

    PubMed

    Jiang, Haiyin; Ling, Zongxin; Zhang, Yonghua; Mao, Hongjin; Ma, Zhanping; Yin, Yan; Wang, Weihong; Tang, Wenxin; Tan, Zhonglin; Shi, Jianfei; Li, Lanjuan; Ruan, Bing

    2015-08-01

    Studies using animal models have shown that depression affects the stability of the microbiota, but the actual structure and composition in patients with major depressive disorder (MDD) are not well understood. Here, we analyzed fecal samples from 46 patients with depression (29 active-MDD and 17 responded-MDD) and 30 healthy controls (HCs). High-throughput pyrosequencing showed that, according to the Shannon index, increased fecal bacterial α-diversity was found in the active-MDD (A-MDD) vs. the HC group but not in the responded-MDD (R-MDD) vs. the HC group. Bacteroidetes, Proteobacteria, and Actinobacteria strongly increased in level, whereas that of Firmicutes was significantly reduced in the A-MDD and R-MDD groups compared with the HC group. Despite profound interindividual variability, levels of several predominant genera were significantly different between the MDD and HC groups. Most notably, the MDD groups had increased levels of Enterobacteriaceae and Alistipes but reduced levels of Faecalibacterium. A negative correlation was observed between Faecalibacterium and the severity of depressive symptoms. These findings enable a better understanding of changes in the fecal microbiota composition in such patients, showing either a predominance of some potentially harmful bacterial groups or a reduction in beneficial bacterial genera. Further studies are warranted to elucidate the temporal and causal relationships between gut microbiota and depression and to evaluate the suitability of the microbiome as a biomarker. PMID:25882912

  14. Altered fecal microbiota composition in patients with major depressive disorder.

    PubMed

    Jiang, Haiyin; Ling, Zongxin; Zhang, Yonghua; Mao, Hongjin; Ma, Zhanping; Yin, Yan; Wang, Weihong; Tang, Wenxin; Tan, Zhonglin; Shi, Jianfei; Li, Lanjuan; Ruan, Bing

    2015-08-01

    Studies using animal models have shown that depression affects the stability of the microbiota, but the actual structure and composition in patients with major depressive disorder (MDD) are not well understood. Here, we analyzed fecal samples from 46 patients with depression (29 active-MDD and 17 responded-MDD) and 30 healthy controls (HCs). High-throughput pyrosequencing showed that, according to the Shannon index, increased fecal bacterial α-diversity was found in the active-MDD (A-MDD) vs. the HC group but not in the responded-MDD (R-MDD) vs. the HC group. Bacteroidetes, Proteobacteria, and Actinobacteria strongly increased in level, whereas that of Firmicutes was significantly reduced in the A-MDD and R-MDD groups compared with the HC group. Despite profound interindividual variability, levels of several predominant genera were significantly different between the MDD and HC groups. Most notably, the MDD groups had increased levels of Enterobacteriaceae and Alistipes but reduced levels of Faecalibacterium. A negative correlation was observed between Faecalibacterium and the severity of depressive symptoms. These findings enable a better understanding of changes in the fecal microbiota composition in such patients, showing either a predominance of some potentially harmful bacterial groups or a reduction in beneficial bacterial genera. Further studies are warranted to elucidate the temporal and causal relationships between gut microbiota and depression and to evaluate the suitability of the microbiome as a biomarker.

  15. Efficacy of Hypericum extract WS® 5570 compared with paroxetine in patients with a moderate major depressive episode – a subgroup analysis

    PubMed Central

    Seifritz, Erich; Hatzinger, Martin; Holsboer-Trachsler, Edith

    2016-01-01

    Abstract Objectives: efficacy and tolerability of WS® 5570 for the treatment of acute mild-to-moderate depression, has been demonstrated in various studies. Here, we present a subgroup analysis of a double blind, randomised trial to compare the therapeutic efficacy of WS® 5570 with paroxetine in patients suffering from a major depressive episode with moderate symptom intensity. Methods: moderate depression was defined by a baseline Hamilton Depression Rating Scale (HAM-D) total score between 22 and 25. Patients received, after a single blind placebo run-in phase of 3–7 d, either 3 × 300 mg/d WS® 5570 or 20 mg/d paroxetine for six weeks. The change of the HAM-D total score was used to describe the efficacy of WS® 5570 compared with paroxetine in the subgroup of patients with moderate depression. Results: the reductions of the HAM-D total score were significantly more pronounced in patients treated with 3 × 300 mg/d WS® 5570 compared to 20 mg/d paroxetine. Conclusions: patients treated with WS® 5570 not only showed a reduction in depression severity score but also yielded greater response and remission rates compared with patients treated with paroxetine. KeypointsVarious studies showed the efficacy and tolerability of WS® 5570 for the treatment of acute mild-to-moderate depression.Beneficial effects of WS® 5570 have been also shown in patients with moderate-to-severe depression.In this study reductions of the HAM-D total score were significantly more pronounced in patients with moderate depression treated with WS® 5570 compared with paroxetine.Patients treated with WS® 5570 not only showed a reduction in depression severity score but also yielded greater response and remission rates compared with patients treated with paroxetine. PMID:27161105

  16. Dysfunctional Attitudes Scale Perfectionism: A Predictor and Partial Mediator of Acute Treatment Outcome among Clinically Depressed Adolescents

    ERIC Educational Resources Information Center

    Jacobs, Rachel H.; Silva, Susan G.; Reinecke, Mark A.; Curry, John F.; Ginsburg, Golda S.; Kratochvil, Christopher J.; March, John S.

    2009-01-01

    The effect of perfectionism on acute treatment outcomes was explored in a randomized controlled trial of 439 clinically depressed adolescents (12-17 years of age) enrolled in the Treatment for Adolescents with Depression Study (TADS) who received cognitive behavior therapy (CBT), fluoxetine, a combination of CBT and FLX, or pill placebo. Measures…

  17. Acute myocardial infarction in the obstetric patient.

    PubMed

    Firoz, Tabassum; Magee, Laura A

    2012-06-01

    Acute myocardial infraction (AMI) in the obstetric patient is a rare event, although the incidence is rising due to advancing maternal age and pre-existing cardiac risk factors and medical co-morbidities. While atherosclerotic disease is the leading cause of AMI, coronary artery dissection is an important consideration in pregnancy and in the postpartum period. The physiological changes of pregnancy as well as pregnancy-specific risk factors can predispose the obstetric patient to AMI. Diagnosis of AMI can be challenging as symptoms may be atypical. Furthermore, diagnostic tests must be interpreted in the context of pregnancy. While the overall management of the obstetric patient with AMI is similar to that outside of pregnancy, drug therapy requires modification as some medications may be contraindicated in pregnancy and breastfeeding. There is limited information about prognosis and risk stratification but it is anticipated that future studies will address this issue.

  18. Microbleeds on susceptibility-weighted MRI in depressive and non-depressive patients after mild traumatic brain injury.

    PubMed

    Wang, Xuan; Wei, Xiao-Er; Li, Ming-Hua; Li, Wen-Bin; Zhou, Ya-Jun; Zhang, Bin; Li, Yue-Hua

    2014-10-01

    The aim of this study was to explore the relationship between abnormality on susceptibility-weighted imaging (SWI) and newly-developed depression after mild traumatic brain injury. The study registered 200 patients with closed TBI and normal finding at CT and conventional MRI. All patients underwent MRI including conventional MR sequences and SWI. The number and volume of microbleed lesions were semi-automatically outlined and manually counted. All patients were followed up with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-IV) within 1 year after TBI. The difference in microbleed lesions on SWI was compared between the depressive and non-depressive groups. The depressive group had a higher rate of abnormality on SWI than did the non-depressive group (p < 0.001). Among patients that had exhibited microbleed lesions, the number and volume of lesions were greater in the depressive group than the non-depressive group (both p < 0.001). These differences in numbers and volume of lesions were found only at the frontal, parietal and temporal lobes (all p < 0.001). Among patients that had exhibited microbleed lesions, the number and volume of lesions in other areas were not significantly different between the depressive and non-depressive groups (all p > 0.05). In conclusion, SWI was useful to identify the microbleed lesions after mild TBI. The distribution range and location of microbleed lesions were correlated with depression after TBI.

  19. Diagnostic imaging of the acutely injured patient

    SciTech Connect

    Berquist, T.H.

    1985-01-01

    This book provides an analysis of pathophysiologic concepts of trauma and reviews the effectiveness of the available imaging modalities in acute trauma of various organ system. Topics covered are chest injuries; abdominal trauma; fractures of long bones; the foot and ankle; the knee; hand and wrist; the elbow; the shoulder; the pelvis hips; the spine; the skull and facial trauma and the clinical assessment of multiple injuries patients. Comparative evaluation of diagnostic techniques of radiography is discussed. Normal anatomy and bone fractures along with soft-tissue injuries are described.

  20. Depression, Anxiety and Stress among Saudi Arabian Dermatology Patients

    PubMed Central

    Ahmed, Anwar E.; Al-Dahmash, Abdulaziz M.; Al-Boqami, Qamra T.; Al-Tebainawi, Yazeed F.

    2016-01-01

    Objectives: This study aimed to determine the prevalence of depression, anxiety and stress among Saudi Arabian dermatology patients and to assess associations with sociodemographic and clinical characteristics. Methods: This cross-sectional study was conducted among 300 consecutive dermatology patients visiting King Abdulaziz Medical City in Riyadh, Saudi Arabia, in August 2015. The Arabic version of the Depression, Anxiety and Stress Scale was used to screen for symptoms of depression, anxiety and stress. Quality of life (QOL) was assessed using the Dermatology Life Quality Index. Results: A total of 254 dermatology patients participated in the study (response rate: 84.7%). The prevalence of depression, anxiety and stress was 12.6%, 22.1% and 7.5%, respectively. The presence of at least one of these negative emotional states was noted among 24.4% of the cohort (95% confidence interval: 19.3–30.2%). Depression was significantly higher among subjects who lacked family support (26.5% versus 10.7%; P = 0.006) while anxiety was less common among patients who engaged in physical exercise (14.5% versus 29.4%; P = 0.005). According to the multivariate logistic regression analysis, poor QOL and a lack of family support were significant predictors of a negative emotional state. Conclusion: Almost a quarter of the studied Saudi Arabian dermatology patients were found to suffer from at least one negative emotional state. A lack of family support and poor QOL were the primary factors associated with a negative emotional state. Interventional studies are needed to examine the effects of social and family support on psychological conditions among Saudi Arabian dermatology patients. PMID:27226914

  1. Anhedonia, suicide ideation and dexamethasone nonsuppression in depressed patients.

    PubMed

    Oei, T I; Verhoeven, W M; Westenberg, H G; Zwart, F M; van Ree, J M

    1990-01-01

    In the search for a valid analysis of a number of operationalised symptoms common to depressive behaviour, a study was performed comprising 46 patients showing depressive symptoms, according to operationalised criteria and as part of which all agreed to undergo the following tests: (a) psychiatric: Present State Examination; (b) psychological: Hamilton Rating Scale, Montgomery-Asberg Rating Scale, State-Trait Anxiety Inventory, Beck Suicide Ideation Scale, Chapman Anhedonia Scale, Mood Scale, Sleep Quality Scale, Activities Scale, Social Support Scale, Questionnaire on Recently Experienced Events and the Paykel Life Events Interview; and (c) biochemical: Dexamethasone Suppression (DEX) Test. After gathering different depressive subgroups, based on operationalised symptoms, a dichotomy was made in the distributions of the (an)hedonia, suicide ideation and DEX-(non) suppression scores. This study may indicate that anhedonia, suicide ideation and DEX-nonsuppression are the opening to the identification of a subgroup of depressed patients. This symptom complex could not definitely be identified on the basis of existing DSM-III diagnostic entities, because of the known fact that this method of classification is not appropriate for our purposes in revealing pathophysiological processes. It is suggested, therefore, that these symptoms might prove to be the anchor-point from which to reach a better insight into the aetiology and pathogenesis (i.e. the final common pathway) of depression.

  2. Investigation of Anxiety and Depression in Patients with Chronic Diseases

    PubMed Central

    Gerontoukou, Evangelia-Ioanna; Michaelidoy, Sofia; Rekleiti, Maria; Saridi, Maria; Souliotis, Kyriakos

    2015-01-01

    The health of an individual depends on both his/her physical and psychological condition. In recent years it has been observed that chronic patients have frequently an affected psycho-emotional state. The purpose of this study is to investigate anxiety and depression in patients with chronic diseases and the correlation of the results with daily physical activity levels and individual health levels, as well comorbidity. This study included patients with chronic diseases that were treated in a local general hospital or were visiting often outpatient clinics of the same hospital due to their condition. The sample in this particular study included 204 patients; 118 of them were women and 86 men. From the total sample that participated in our research, 118 (57.8%) were females and the majority of the participants were secondary/basic education graduates (67%), married (71%), living in urban areas (53%). Hypertension was the most frequent chronic disease in our sample, followed by hypercholesterolemia and diabetes mellitus. Comparing the occurrence of depression and anxiety symptoms in both questionnaires in relation to the expected frequency in the general population, significant levels of depression and anxiety symptoms were recorded. Taking into consideration the findings of this research, anxiety and depression symptoms can have profound effects regarding the control of chronic diseases, the patients’ quality of life and their general health. PMID:26973961

  3. [Investigation of the effects of cytoflavin on symptoms of depression and autonomic dysfunction in patients with organic depressive disorder].

    PubMed

    Gudkova, A N; Osinovskaia, N A; Polunina, A G; Gekht, A B

    2013-01-01

    The present observational study addressed effects of cytoflavin as an adjunctive nootropic therapy in patients with organic depressive disorder (F06.36). 54 female and 46 male in-patients were included into the study. All patients received standard antidepressant therapy (controls) and 48 patients additionally received 2 pills of cytoflavin twice per day. Age, gender distribution, education and severity of depression were equal in cytoflavin and control groups. The follow-up assessment at discharge showed a significantly more pronounced decline in the severity of depression symptoms in patients receiving cytoflavin in comparison with the controls. Importantly, the effect of cytoflavin on the depression symptoms was prominent only in females. Moreover, women receiving cytoflavin demonstrated the more pronounced normalization of autonomic regulation in comparison with control women. The present results allow to recommend cytoflavin in dose 4 pills daily as an adjunctive therapy in female patients with organic depressive disorder.

  4. Prospective Evaluation of Pretreatment Executive Cognitive Impairment and Depression in Patients Referred for Radiotherapy

    SciTech Connect

    Fuller, Clifton D. Schillerstrom, Jason E.; Jones, William E.; Boersma, Melissa; Royall, Donald R.; Fuss, Martin

    2008-10-01

    Purpose: Cancer patients are at risk of cognitive impairment and depression. We sought to ascertain the prevalence of executive, visuospatial, memory, and general cognitive performance deficits before radiotherapy in a radiation oncology clinic referral population and correlate the neurocognitive measures with the depression symptom burden. Methods and Materials: A total of 122 sequential patients referred for radiotherapy evaluation were administered a test battery composed of the Executive Interview (EXIT25), Executive Clock Drawing Task (CLOX1 and CLOX2), Mini Mental State Examination (MMSE), Memory Impairment Screen (MIS), and Geriatric Depression Scale (GDS). The mean age {+-} standard deviation was 58 {+-} 17 years. Of 122 patients, 24 (20%) had been referred for breast cancer, 21 (17%) for gastrointestinal cancer, 17 (14%) for genitourinary disease, and 8 (7%) for brain lesions; the rest were a variety of tumor sites. The cognitive performance among the tumor cohorts was compared using Bonferroni-corrected analysis of variance and Tukey-Kramer tests. Pearson correlation coefficients were determined between each cognitive instrument and the GDS. Results: Of the 122 patients, 52 (43%) exhibited a detectable executive cognition decrement on one or more test measures. Five percent had poor memory performance (MIS), 18% had poor visuospatial performance (CLOX2), and 13% had poor global cognition (MMSE). Patients with brain tumors performed substantially worse on the EXIT25. No between-group differences were found for CLOX1, CLOX2, MIS, or GDS performance. The EXIT25 scores correlated significantly with the GDS scores (r = 0.26, p = 0.005). Conclusions: The results of this study have shown that patients referred for radiotherapy exhibit cognitive impairment profiles comparable to those observed in acutely ill medical inpatients. Executive control impairment appears more prevalent than global cognitive deficits, visuospatial impairment, or depression.

  5. Symptoms of anxiety and depression and risk of acute myocardial infarction: the HUNT 2 study

    PubMed Central

    Gustad, Lise Tuset; Laugsand, Lars Erik; Janszky, Imre; Dalen, Håvard; Bjerkeset, Ottar

    2014-01-01

    Aims The nature of the association of depression and anxiety with risk for acute myocardial infarction (AMI) remains unclear. We aimed to study the prospective association of single and recurrent self-reported symptoms of anxiety and depression with a risk of AMI in a large Norwegian population based cohort. Methods and results In the second wave of the Nord-Trøndelag Health Study (HUNT2, 1995–97) baseline data on anxiety and depression symptoms, sociodemographic variables, health status including cardiovascular risk factors and common chronic disorders were registered for 57 953 adult men and women free of cardiovascular disease. The cohort was followed up during a mean (SD) 11.4 (2.9) years for a first AMI from baseline through 2008. A total of 2111 incident AMIs occurred, either identified at hospitals or by the National Cause of Death Registry. The multi-adjusted hazard ratios were 1.31 (95% CI 1.03–1.66) for symptoms of depression and 1.25 (CI 0.99–1.57) for anxiety. Two episodes of mixed symptoms of anxiety and depression (MSAD), reported 10 years apart, increased the risk for AMI by 52% (11–108%). After exclusion of the first 5 years of follow-up, the association of depression symptoms with AMI risk was attenuated. Relative risk for AMI with anxiety symptoms and MSAD weakened when participants with chronic disorders were excluded. Conclusion Self-reported symptoms of depression and anxiety, especially if recurrent, were moderately associated with the risk of incident AMI. We had some indications that these associations might partly reflect reverse causation or confounding from common chronic diseases. PMID:24057077

  6. Overgeneral autobiographical memory at baseline predicts depressive symptoms at follow-up in patients with first-episode depression.

    PubMed

    Liu, Yansong; Zhang, Fuquan; Wang, Zhiqiang; Cao, Leiming; Wang, Jun; Na, Aiguo; Sun, Yujun; Zhao, Xudong

    2016-09-30

    Previous studies have shown that overgeneral autobiographical memory (OGM) is a characteristic of depression. However, there are no studies to explore the association between baseline OGM and depressive symptoms at follow-up in patients with first-episode depression (FE). This study investigated whether baseline OGM predicts depressive symptoms at follow-up in patients with FE. We recruited 125 patients with FE. The participants were divided into remitted group and non-remitted group according to the severity of their depression at 12 months follow-up. The measures consisted of the 17-item Hamilton Depression Rating Scale, Ruminative Response Scale, and Autobiographical Memory Test. Hierarchical linear regression analyses and bootstrap mediation analyses were conducted. The results showed that non-remitted patients had more OGM at baseline. Baseline OGM predicted depressive symptoms at follow-up in patients with FE. Rumination mediated the relationship between baseline OGM and depressive symptoms at follow-up. Our findings highlight OGM as a vulnerability factor involved in the maintenance of depression in patients with FE. PMID:27392229

  7. Overgeneral autobiographical memory at baseline predicts depressive symptoms at follow-up in patients with first-episode depression.

    PubMed

    Liu, Yansong; Zhang, Fuquan; Wang, Zhiqiang; Cao, Leiming; Wang, Jun; Na, Aiguo; Sun, Yujun; Zhao, Xudong

    2016-09-30

    Previous studies have shown that overgeneral autobiographical memory (OGM) is a characteristic of depression. However, there are no studies to explore the association between baseline OGM and depressive symptoms at follow-up in patients with first-episode depression (FE). This study investigated whether baseline OGM predicts depressive symptoms at follow-up in patients with FE. We recruited 125 patients with FE. The participants were divided into remitted group and non-remitted group according to the severity of their depression at 12 months follow-up. The measures consisted of the 17-item Hamilton Depression Rating Scale, Ruminative Response Scale, and Autobiographical Memory Test. Hierarchical linear regression analyses and bootstrap mediation analyses were conducted. The results showed that non-remitted patients had more OGM at baseline. Baseline OGM predicted depressive symptoms at follow-up in patients with FE. Rumination mediated the relationship between baseline OGM and depressive symptoms at follow-up. Our findings highlight OGM as a vulnerability factor involved in the maintenance of depression in patients with FE.

  8. Depression

    MedlinePlus

    ... make negative thinking worse. previous continue Depression Can Go Unrecognized People with depression may not realize they ... themselves or who have eating disorders or who go through extreme mood changes may have unrecognized depression. ...

  9. Depression

    MedlinePlus

    ... The depression generally lifts during spring and summer. Bipolar disorder is different from depression but is included in this list is because someone with bipolar disorder experiences episodes of extreme low moods (depression). But ...

  10. Increased risk of venous thromboembolism in patients with acute leukaemia

    PubMed Central

    Mohren, M; Markmann, I; Jentsch-Ullrich, K; Koenigsmann, M; Lutze, G; Franke, A

    2006-01-01

    Patients with malignancies have an increased risk for venous thromboembolisms (VTE), but data on patients with acute leukaemia are very limited so far. We found VTE in 12% of 455 patients with acute leukaemia, half of which occurred in association with central venous catheters, with equal risk of ALL and AML. PMID:16421591

  11. [Quantitative morphology of periferal erythrocytes and bone marrow erythrokaryocytes in acute leukemia and hemopoietic depressions].

    PubMed

    Sokolinskiĭ, B Z; Piatnitskiĭ, A M; Betrozova, M V; Diagileva, O A; Pogorelov, V M; Kozinets, G I

    1999-02-01

    Morphology of peripheral blood erythrocytes was studied in patients with acute leukemia and aplastic anemia by a Russian cytoanalyzer Mekos-C. Twenty-eight patients with acute myeloblastic leukemia, 15 with acute lymphoblastic leukemia, and 11 with aplastic anemia were examined. Erythrocytes (n = 500) were examined in fixed non-stained blood smears. Hemoglobin content and morphometric parameters of each cell were studied and automatic classification of cells was carried out. The data of computer morphodensitometry are compatible with the data of cytochemical studies of the bone marrow erythroid cells (PAS reaction after McManus). The results indicate circulation of erythrocyte subpopulations differing by shape and other signs (hemoglobin content, section area, shape factor) in the blood of patients with acute leukemia and aplastic anemia. The share of pathological erythrocytes in the peripheral blood reflects failure of erythropoiesis. PMID:10876688

  12. Atypical Antipsychotics in the Treatment of Acute Bipolar Depression with Mixed Features: A Systematic Review and Exploratory Meta-Analysis of Placebo-Controlled Clinical Trials

    PubMed Central

    Fornaro, Michele; Stubbs, Brendon; De Berardis, Domenico; Perna, Giampaolo; Valchera, Alessandro; Veronese, Nicola; Solmi, Marco; Ganança, Licínia

    2016-01-01

    Evidence supporting the use of second generation antipsychotics (SGAs) in the treatment of acute depression with mixed features (MFs) associated with bipolar disorder (BD) is scarce and equivocal. Therefore, we conducted a systematic review and preliminary meta-analysis investigating SGAs in the treatment of acute BD depression with MFs. Two authors independently searched major electronic databases from 1990 until September 2015 for randomized (placebo-) controlled trials (RCTs) or open-label clinical trials investigating the efficacy of SGAs in the treatment of acute bipolar depression with MFs. A random-effect meta-analysis calculating the standardized mean difference (SMD) between SGA and placebo for the mean baseline to endpoint change in depression as well as manic symptoms score was computed based on 95% confidence intervals (CI). Six RCTs and one open-label placebo-controlled studies (including post-hoc reports) representing 1023 patients were included. Participants received either ziprasidone, olanzapine, lurasidone, quetiapine or asenapine for an average of 6.5 weeks across the included studies. Meta-analysis with Duval and Tweedie adjustment for publication bias demonstrated that SGA resulted in significant improvements of (hypo-)manic symptoms of bipolar mixed depression as assessed by the means of the total scores of the Young Mania Rating Scale (YMRS) (SMD −0.74, 95% CI −1.20 to −0.28, n SGA = 907, control = 652). Meta-analysis demonstrated that participants in receipt of SGA (n = 979) experienced a large improvement in the Montgomery–Åsberg Depression Rating Scale (MADRS) scores (SMD −1.08, 95% CI −1.35 to −0.81, p < 0.001) vs. placebo (n = 678). Publication and measurement biases and relative paucity of studies. Overall, SGAs appear to offer favorable improvements in MADRS and YMRS scores vs. placebo. Nevertheless, given the preliminary nature of the present report, additional original studies are required to allow more reliable and

  13. Identifying Patients with Depression Using Free-text Clinical Documents.

    PubMed

    Zhou, Li; Baughman, Amy W; Lei, Victor J; Lai, Kenneth H; Navathe, Amol S; Chang, Frank; Sordo, Margarita; Topaz, Maxim; Zhong, Feiran; Murrali, Madhavan; Navathe, Shamkant; Rocha, Roberto A

    2015-01-01

    About 1 in 10 adults are reported to exhibit clinical depression and the associated personal, societal, and economic costs are significant. In this study, we applied the MTERMS NLP system and machine learning classification algorithms to identify patients with depression using discharge summaries. Domain experts reviewed both the training and test cases, and classified these cases as depression with a high, intermediate, and low confidence. For depression cases with high confidence, all of the algorithms we tested performed similarly, with MTERMS' knowledge-based decision tree slightly better than the machine learning classifiers, achieving an F-measure of 89.6%. MTERMS also achieved the highest F-measure (70.6%) on intermediate confidence cases. The RIPPER rule learner was the best performing machine learning method, with an F-measure of 70.0%, and a higher precision but lower recall than MTERMS. The proposed NLP-based approach was able to identify a significant portion of the depression cases (about 20%) that were not on the coded diagnosis list.

  14. Identifying Patients with Depression Using Free-text Clinical Documents.

    PubMed

    Zhou, Li; Baughman, Amy W; Lei, Victor J; Lai, Kenneth H; Navathe, Amol S; Chang, Frank; Sordo, Margarita; Topaz, Maxim; Zhong, Feiran; Murrali, Madhavan; Navathe, Shamkant; Rocha, Roberto A

    2015-01-01

    About 1 in 10 adults are reported to exhibit clinical depression and the associated personal, societal, and economic costs are significant. In this study, we applied the MTERMS NLP system and machine learning classification algorithms to identify patients with depression using discharge summaries. Domain experts reviewed both the training and test cases, and classified these cases as depression with a high, intermediate, and low confidence. For depression cases with high confidence, all of the algorithms we tested performed similarly, with MTERMS' knowledge-based decision tree slightly better than the machine learning classifiers, achieving an F-measure of 89.6%. MTERMS also achieved the highest F-measure (70.6%) on intermediate confidence cases. The RIPPER rule learner was the best performing machine learning method, with an F-measure of 70.0%, and a higher precision but lower recall than MTERMS. The proposed NLP-based approach was able to identify a significant portion of the depression cases (about 20%) that were not on the coded diagnosis list. PMID:26262127

  15. Patient-Centered Technological Assessment and Monitoring of Depression for Low-Income Patients

    PubMed Central

    Wu, Shinyi; Vidyanti, Irene; Liu, Pai; Hawkins, Caitlin; Ramirez, Magaly; Guterman, Jeffrey; Gross-Schulman, Sandra; Sklaroff, Laura Myerchin; Ell, Kathleen

    2014-01-01

    Depression is a significant challenge for ambulatory care because it worsens health status and outcomes, increases health care utilizations and costs, and elevates suicide risk. An automatic telephonic assessment (ATA) system that links with tasks and alerts to providers may improve quality of depression care and increase provider productivity. We used ATA system in a trial to assess and monitor depressive symptoms of 444 safety-net primary care patients with diabetes. We assessed system properties, evaluated preliminary clinical outcomes, and estimated cost savings. The ATA system is feasible, reliable, valid, safe, and likely cost-effective for depression screening and monitoring for low-income primary care population. PMID:24525531

  16. Risk of anxiety and depressive disorders in patients with myocardial infarction: A nationwide population-based cohort study.

    PubMed

    Feng, Hsin-Pei; Chien, Wu-Chien; Cheng, Wei-Tung; Chung, Chi-Hsiang; Cheng, Shu-Meng; Tzeng, Wen-Chii

    2016-08-01

    Anxiety and depressive symptoms are associated with adverse cardiovascular events after an acute myocardial infarction (MI). However, most studies focusing on anxiety or depression have used rating scales or self-report methods rather than clinical diagnosis. This study aimed to investigate the association between psychiatrist-diagnosed psychiatric disorders and cardiovascular prognosis.We sampled data from the National Health Insurance Research Database; 1396 patients with MI were recruited as the study cohort and 13,960 patients without MI were recruited as the comparison cohort. Cox proportional hazard regression models were used to examine the effect of MI on the risk of anxiety and depressive disorders.During the first 2 years of follow-up, patients with MI exhibited a significantly higher risk of anxiety disorders (adjusted hazard ratio [HR] = 5.06, 95% confidence interval [CI]: 4.61-5.54) and depressive disorders (adjusted HR = 7.23, 95% CI: 4.88-10.88) than those without MI did. Greater risk for anxiety and depressive disorders was observed among women and patients aged 45 to 64 years following an acute MI. Patients with post-MI anxiety had a 9.37-fold (95% CI: 4.45-19.70) higher risk of recurrent MI than those without MI did after adjustment for age, sex, socioeconomic status, and comorbidities.This nationwide population-based cohort study provides evidence that MI increases the risk of anxiety and depressive disorders during the first 2 years post-MI, and post-MI anxiety disorders are associated with a higher risk of recurrent MI. PMID:27559951

  17. Physical Activity of Depressed Patients and Their Motivation to Exercise: Nordic Walking in Family Practice

    ERIC Educational Resources Information Center

    Suija, Kadri; Pechter, Ulle; Kalda, Ruth; Tahepold, Heli; Maaroos, Jaak; Maaroos, Heidi-Ingrid

    2009-01-01

    The objectives of this study were to find out how motivated depressed patients are to exercise regularly, to measure the physical activity of depressed patients and to find out how regular Nordic Walking affects the mood and physical fitness of depressed patients. A cross-sectional study was carried out. Three years after the Prediction of Primary…

  18. The effects of acute tryptophan depletion on speech and behavioural mimicry in individuals at familial risk for depression.

    PubMed

    Hogenelst, Koen; Sarampalis, Anastasios; Leander, N Pontus; Müller, Barbara C N; Schoevers, Robert A; aan het Rot, Marije

    2016-03-01

    Major depressive disorder (MDD) has been associated with abnormalities in speech and behavioural mimicry. These abnormalities may contribute to the impairments in interpersonal functioning that are often seen in MDD patients. MDD has also been associated with disturbances in the brain serotonin system, but the extent to which serotonin regulates speech and behavioural mimicry remains unclear. In a randomized, double-blind, crossover study, we induced acute tryptophan depletion (ATD) in individuals with or without a family history of MDD. Five hours afterwards, participants engaged in two behavioural-mimicry experiments in which speech and behaviour were recorded. ATD reduced the time participants waited before speaking, which might indicate increased impulsivity. However, ATD did not significantly alter speech otherwise, nor did it affect mimicry. This suggests that a brief lowering of brain serotonin has limited effects on verbal and non-verbal social behaviour. The null findings may be due to low test sensitivity, but they otherwise suggest that low serotonin has little effect on social interaction quality in never-depressed individuals. It remains possible that recovered MDD patients are more strongly affected.

  19. Cognitive estimation in aged patients with major depressive disorder.

    PubMed

    Barabassy, Agota; Beinhoff, Ulrike; Riepe, Matthias W

    2010-03-30

    In everyday life, we often estimate rather than know. It was the goal of this study to assess the effect of depressed mood on cognitive estimation in old age. Cognitive estimation was performed in 44 subjects with major depressive disorder (MDD; DSM-IV) and 48 age-matched healthy subjects (HS). Severity of depressive symptoms was rated with the Montgomery-Asberg Depression Rating Scale (MADRS, mean=18.6+/-S.D. 4.85). Estimation tasks comprised the dimensions length (coin diameter), weight (pile of paper), quantity (number of marbles in a glass jar), and time (estimation of time it takes for a marble to roll down a marble track both before and after having observed it). Other than the procedure followed in previous tests on cognitive estimation, the tasks were performed by observing objects rather than pictures thereof. MDD patients overestimated time (before and after observation) and underestimated quantity. Cognitive estimation was not correlated to measures of frontal functioning or semantic knowledge. We conclude that MDD patients in old age are impaired to some extent in cognitive estimation and in the ability to correct themselves, deficits that are likely to affect the performance of everyday activities. PMID:20064666

  20. Prefrontal cortical abnormalities in currently depressed versus currently remitted patients with major depressive disorder

    PubMed Central

    Salvadore, Giacomo; Nugent, Allison C.; Lemaitre, Herve; Luckenbaugh, David A.; Tinsley, Ruth; Cannon, Dara M.; Neumeister, Alexander; Zarate, Carlos A.; Drevets, Wayne C.

    2010-01-01

    Previous neuromorphometric investigations of major depressive disorder (MDD) have reported abnormalities in gray matter in several regions, although the results have been inconsistent across studies. Some discrepancies in the results across studies may reflect design limitations such as small sample sizes, whereas others may reflect biological variability that potentially manifests as differences in clinical course. For example, it remains unclear whether the abnormalities found in persistently depressed MDD subjects extend to or persist in patients who experience prolonged remission. The aim of the present study was to investigate gray matter (GM) differences in unmedicated, currently-depressed participants (dMDD) and unmedicated, currently-remitted (rMDD) participants with MDD compared to healthy controls (HC). The GM density and volume was compared across groups using voxel-based morphometry, a quantitative neuroanatomical technique, and high-resolution MRI images from 107 HC, 58 dMDD and 27 rMDD subjects. Relative to the HC group the dMDD group had reduced GM in the dorsal anterolateral (DALPFC), the dorsomedial (DMPFC) and the ventrolateral prefrontal cortex (VLPFC). Relative to the rMDD group the dMDD group showed reduced GM in the DALPFC, the VLPFC, the anterior cingulate cortex (ACC), the precuneus and the inferior parietal lobule. No regions were identified in which the rMDD group showed significantly lower GM compared to the HC group after p-values were corrected for the number of comparisons performed. In unmedicated patients in the depressed phase of MDD, we found evidence of morphometric abnormalities in DALPFC and in medial prefrontal cortical regions belonging to the visceromotor network. These findings, along with the absence of GM abnormalities in the remitted sample imply a possible link between greater GM tissue and better clinical outcome. Consistent with other neuroimaging and post-mortem neuropathological studies of MDD, we also found evidence

  1. Prefrontal cortical abnormalities in currently depressed versus currently remitted patients with major depressive disorder.

    PubMed

    Salvadore, Giacomo; Nugent, Allison C; Lemaitre, Herve; Luckenbaugh, David A; Tinsley, Ruth; Cannon, Dara M; Neumeister, Alexander; Zarate, Carlos A; Drevets, Wayne C

    2011-02-14

    Previous neuromorphometric investigations of major depressive disorder (MDD) have reported abnormalities in gray matter in several regions, although the results have been inconsistent across studies. Some discrepancies in the results across studies may reflect design limitations such as small sample sizes, whereas others may reflect biological variability that potentially manifests as differences in clinical course. For example, it remains unclear whether the abnormalities found in persistently depressed MDD subjects extend to or persist in patients who experience prolonged remission. The aim of the present study was to investigate gray matter (GM) differences in unmedicated, currently-depressed participants (dMDD) and unmedicated, currently-remitted (rMDD) participants with MDD compared to healthy controls (HC). The GM density and volume were compared across groups using voxel-based morphometry, a quantitative neuroanatomical technique, and high-resolution MRI images from 107 HC, 58 dMDD and 27 rMDD subjects. Relative to the HC group the dMDD group had reduced GM in the dorsal anterolateral (DALPFC), the dorsomedial (DMPFC) and the ventrolateral prefrontal cortex (VLPFC). Relative to the rMDD group the dMDD group showed reduced GM in the DALPFC, the VLPFC, the anterior cingulate cortex (ACC), the precuneus and the inferior parietal lobule. No regions were identified in which the rMDD group showed significantly lower GM compared to the HC group after p-values were corrected for the number of comparisons performed. In unmedicated patients in the depressed phase of MDD, we found evidence of morphometric abnormalities in DALPFC and in medial prefrontal cortical regions belonging to the visceromotor network. These findings, along with the absence of GM abnormalities in the remitted sample imply a possible link between greater GM tissue and better clinical outcome. Consistent with other neuroimaging and post-mortem neuropathological studies of MDD, we also found

  2. [Nurses interacting therapeutically with elderly patients in chronic depression].

    PubMed

    Osinaga, V L; Scatena, M C; Rodrigues, A R

    1998-01-01

    In a humanist care model we searched to analyse experiences lived by nurses interacting with chronic depression patients. There was a female patient who was being assisted by Psycho-social Support Nucleus (NAP), 60 years old, presenting depressive symptoms, proper for her age, probably stressed by her suffering experiences in life. It was a therapeutic interaction as matters of the patient's interest (not the nurses interest) have been presented; the pace of communication has been determined b the patient herself; the nurse (except in the very beginning when the patient was a little anxious) followed her communication, physically approaching her whenever it was necessary; intervened only at necessary moments; inspired confidence that was necessary for the patient to talk about her intimate feelings; helped her to recover when she was out of control; conducted her safely, but with comprehensive attitude until the patient felt easy to leave her; demonstrated that she could help her in other moments if she thought it was necessary. Interaction achieved its aims helping the patient and being technically adequate for therapeutic and diagnosis aspects. PMID:10776300

  3. Acute ischemic stroke in a pediatric patient.

    PubMed

    Gorchynski, Julie; Herrick, John; Cortes, Edgar

    2008-11-01

    Acute ischemic stroke in a pediatric patient is a complex disease with a variety of etiologies that differ from adults. Though rare, they are a real phenomenon with potentially devastating consequences. Some treating institutions are using anti-thrombotic drug therapy with unclear benefits. Available literature, which is limited to case reports and retrospective reviews of databases, clouds this topic with both positive and negative outcomes. Emergency department management should focus on stabilization and resuscitation with immediate involvement of a pediatric neurologist and intensivist. The decision to use anti-thrombotic drug therapy, including anti-platelet drugs and thrombolytics, should be in consult with the specialists involved until randomized controlled trials determine their safety and efficacy in the pediatric population.

  4. The predictive value of somatic and cognitive depressive symptoms for cytokine changes in patients with major depression

    PubMed Central

    Dannehl, Katharina; Rief, Winfried; Schwarz, Markus J; Hennings, Annika; Riemer, Sabine; Selberdinger, Verena; Stapf, Theresa; Euteneuer, Frank

    2014-01-01

    Context Elevated concentrations of proinflammatory cytokines have been hypothesized as an important factor in the pathophysiology of depression. Depression itself is considered to be a heterogeneous disorder. Current findings suggest that “cognitive” and “somatic” symptom dimensions are related to immune function in different ways. So far, little research has been done on the longitudinal aspects of inflammation in patients with major depression, especially with respect to different symptom dimensions of depression. Therefore, we investigated which aspects of depression may predict changes in tumor necrosis factor-alpha (TNF-alpha) and interleukin (IL)-6 over 4 weeks. Methods Forty-one patients with major depression diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and 45 healthy controls were enrolled. Serum measurements of TNF-alpha and IL-6 were conducted at baseline and 4 weeks later. Psychometric measures included the assessment of cognitive-affective depressive symptoms and somatic symptoms during the last 7 days as well as somatic symptoms during the last 2 years. Results Patients with depression showed increased levels of TNF-alpha (P<0.05) compared to healthy controls. Hierarchical regression analyses indicated that neither depressive nor somatic symptoms predict changes in proinflammatory cytokines in the whole sample of depressed patients. Moderation analyses and subsequent sex-stratified regression analyses indicated that higher somatoform symptoms during the last 2 years significantly predict an increase in TNF-alpha in women with major depression (P<0.05) but not in men. Exploratory analyses indicated that the stability of TNF-alpha and IL-6 (as indicated by intraclass correlation coefficients) over 4 weeks was high for TNF-alpha but lower for IL-6. Conclusion The present study demonstrated that a history of somatoform symptoms may be important for predicting future changes in TNF

  5. Management of Acute Hypertensive Response in Patients With Ischemic Stroke

    PubMed Central

    Qureshi, Adnan I.

    2016-01-01

    High blood pressure (BP) >140/90 mm Hg is seen in 75% of patients with acute ischemic stroke and in 80% of patients with acute intracerebral hemorrhages and is independently associated with poor functional outcome. While BP reduction in patients with chronic hypertension remains one of the most important factors in primary and secondary stroke prevention, the proper management strategy for acute hypertensive response within the first 72 hours of acute ischemic stroke has been a matter of debate. Recent guidelines recommend clinical trials to ascertain whether antihypertensive therapy in the acute phase of stroke is beneficial. This review summarizes the current data on acute hypertensive response or elevated BP management during the first 72 hours after an acute ischemic stroke. Based on the potential deleterious effect of lowering BP observed in some clinical trials in patients with acute ischemic stroke and because of the lack of convincing evidence to support acute BP lowering in those situations, aggressive BP reduction in patients presenting with acute ischemic stroke is currently not recommended. While the early use of angiotensin receptor antagonists may help reduce cardiovascular events, this benefit is not necessarily related to BP reduction. PMID:27366297

  6. The influence of light therapy in depressive patients.

    PubMed

    Fleischhauer, J; Glauser, G; Hofstetter, P

    1988-11-01

    Our study investigated the effects of light therapy on mainly endogenously depressive patients. We applied white fluorescent light of 1500-2000 lux for a length of 4-6 hours daily. For 10 days no antidepressants or sleeping pills were given. We observed a quick and substantial improvement of depressive symptoms within 3 to 5 days. 9 patients showed a very good and 5 patients a good remission of symptoms. This corresponds to an improvement of 65% and is comparable to the effects of antidepressants. The improvement however with light is more rapid and more intensive, the main improvement is to be seen until the 5th day of treatment. No influence was found on vital signs or laboratory values. The rare side-effect was an increase in general drive and activity, which was perceived as agreeable however, and did not take the character of restlessness. Two times an increase of sexual drive was reported. The patients' self-rating concerning vital energy and concentration improved along with the values of the HDRS and CGI as with the quality of sleep. In general patients found light therapy to be agreeable. 1 patient only minimally improved (295.7). No improvement was to be seen in 5 patients (4 x 296.1, 309.1). From our findings we can conclude that light therapy in our patients had the same therapeutic efficacy as tricyclics. In our study the antidepressive effect of light could be maintained with Amitriptylin. Unlike other authors we did not observe a relapse into depression in the responders after ending light therapy.

  7. Patient-reported functioning in major depressive disorder

    PubMed Central

    IsHak, Waguih William; James, David M.; Mirocha, James; Youssef, Haidy; Tobia, Gabriel; Pi, Sarah; Collison, Katherine L.; Cohen, Robert M.

    2016-01-01

    Objectives: Compared with the general population, patients with major depressive disorder (MDD) report substantial deficits in their functioning that often go beyond the clinical resolution of depressive symptoms. This study examines the impact of MDD and its treatment on functioning. Methods: From the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, we analyzed complete data of 2280 adult outpatients with MDD at entry and exit points of each level of antidepressant treatment and again 12 months post treatment. Functioning was measured using the Work and Social Adjustment Scale (WSAS). Results: The results show that only 7% of patients with MDD reported within-normal functioning before treatment. The proportion of patients achieving within-normal functioning (WSAS) scores significantly increased after treatment. However, the majority of patients (>60%) were still in the abnormal range on functioning at exit. Although remitted patients had greater improvements compared with nonremitters, a moderate proportion of remitted patients continued to experience ongoing deficits in functioning after treatment (20–40%). Follow-up data show that the proportions of patients experiencing normal scores for functioning after 12 months significantly decreased from the end of treatment to the follow-up phase, from 60.1% to 49% (p < 0.0001), a finding that was particularly significant in nonremitters. Limitations of this study include the reliance on self-report of functioning and the lack of information on patients who dropped out. Conclusion: This study points to the importance of functional outcomes of MDD treatment as well as the need to develop personalized interventions to improve functioning in MDD. PMID:27347363

  8. Assessment of Anxiety in Clinical Trials with Depressed Patients Using the Hamilton Depression Rating Scale

    PubMed Central

    Goldberger, C.; Guelfi, J.D.; Sheehan, D.V.

    2011-01-01

    Background The Hamilton Depression Rating Scale (HAMD17) is an outcome measure widely used in major depressive disorder (MDD) clinical trials. The objective of this analysis was to assess the validity of the anxiety/somatisation factor of the HAMD17 as a measure of anxiety in patients with MDD. Methods We pooled data from 1466 outpatients with MDD from four 8-week controlled studies of duloxetine. We performed a factor analysis of the HAMD17 to investigate the anxiety/somatisation factor. Results The HAMD17 factor analysis yielded 6 factors, but did not yield the pre-specified anxiety/somatisation factor. This latter factor showed weak correlation with the Hamilton Anxiety Scale total and subscale scores at baseline (0.46), but higher correlation coefficients over the trials up to 0.81. We identified another anxiety factor that included the hypochondriasis item in this sample. Conclusion Findings from this large sample suggest that the factor structure of the HAMD17 is unstable in MDD and that the anxiety/somatisation subscale should not be routinely used for anxiety assessment in depressed patients.

  9. Neighborhood matters: the impact of Hispanic ethnic density on future depressive symptoms 1-year following an ACS event among Hispanic patients.

    PubMed

    Denton, Ellen-Ge D; Shaffer, Jonathan A; Alcantara, Carmela; Cadermil, Esteban

    2016-02-01

    The Ethnic Density hypothesis posits that living around others from similar ethnic backgrounds reduces the risk of adverse mental health outcomes such as depression. Contrary to this hypothesis, previous work has shown that Hispanic ethnic density is cross-sectionally associated with increased depressive symptom severity among patients hospitalized with an acute coronary syndrome (ACS; myocardial infarction or unstable angina pectoris). To date, no study has examined the prospective association of Hispanic ethnic density on long-term depressive symptom severity following an acute medical event. We prospectively assessed the impact of Hispanic ethnic density on depressive symptoms, 1-year following an ACS event, among Hispanic adult patients. We tested the non-linear association between ethnic density and depressive symptoms to account for inconsistent findings on the ethnic density hypothesis. At the time of an index ACS event (i.e., baseline, N = 326) and 1-year later (N = 252), Hispanic patients from the Prescription Usage, Lifestyle, and Stress Evaluation prospective cohort study completed the Beck Depression Inventory as a measure of depressive symptom severity. Hispanic ethnic density was defined by the percentage of Hispanic residents within each patient's census tract using data extracted from the American Community Survey Census (2010-2013). Covariates included baseline demographic factors (age, gender, English fluency, education, nativity status), cardiovascular factors (Charlson comorbidity index, left ventricular ejection fraction, Global Registry of Acute Coronary Events 6-month prognostic risk score), and neighborhood factors (residential density, income, and percentage of households receiving public assistance). In an adjusted multivariable linear regression analysis there was a significant curvilinear association between Hispanic ethnic density and depressive symptom severity at 1 year. As Hispanic ethnic density increased from low to moderate

  10. Neighborhood matters: the impact of Hispanic ethnic density on future depressive symptoms 1-year following an ACS event among Hispanic patients.

    PubMed

    Denton, Ellen-Ge D; Shaffer, Jonathan A; Alcantara, Carmela; Cadermil, Esteban

    2016-02-01

    The Ethnic Density hypothesis posits that living around others from similar ethnic backgrounds reduces the risk of adverse mental health outcomes such as depression. Contrary to this hypothesis, previous work has shown that Hispanic ethnic density is cross-sectionally associated with increased depressive symptom severity among patients hospitalized with an acute coronary syndrome (ACS; myocardial infarction or unstable angina pectoris). To date, no study has examined the prospective association of Hispanic ethnic density on long-term depressive symptom severity following an acute medical event. We prospectively assessed the impact of Hispanic ethnic density on depressive symptoms, 1-year following an ACS event, among Hispanic adult patients. We tested the non-linear association between ethnic density and depressive symptoms to account for inconsistent findings on the ethnic density hypothesis. At the time of an index ACS event (i.e., baseline, N = 326) and 1-year later (N = 252), Hispanic patients from the Prescription Usage, Lifestyle, and Stress Evaluation prospective cohort study completed the Beck Depression Inventory as a measure of depressive symptom severity. Hispanic ethnic density was defined by the percentage of Hispanic residents within each patient's census tract using data extracted from the American Community Survey Census (2010-2013). Covariates included baseline demographic factors (age, gender, English fluency, education, nativity status), cardiovascular factors (Charlson comorbidity index, left ventricular ejection fraction, Global Registry of Acute Coronary Events 6-month prognostic risk score), and neighborhood factors (residential density, income, and percentage of households receiving public assistance). In an adjusted multivariable linear regression analysis there was a significant curvilinear association between Hispanic ethnic density and depressive symptom severity at 1 year. As Hispanic ethnic density increased from low to moderate

  11. Depression in Patients with Mastocytosis: Prevalence, Features and Effects of Masitinib Therapy

    PubMed Central

    Moura, Daniela Silva; Sultan, Serge; Georgin-Lavialle, Sophie; Pillet, Nathalie; Montestruc, François; Gineste, Paul; Barete, Stéphane; Damaj, Gandhi; Moussy, Alain; Lortholary, Olivier; Hermine, Olivier

    2011-01-01

    Depression in patients with mastocytosis is often reported but its prevalence and characteristics are not precisely described. In addition, the impact of therapies targeting mast cells proliferation, differentiation and degranulation on psychic symptoms of depression have never been investigated. Our objective was to determine the prevalence and to describe features of depression in a large cohort of mastocytosis patients (n = 288) and to investigate the therapeutic impact of the protein kinase inhibitor masitinib in depression symptoms. The description of depression was based on the analysis of a database with Hamilton scores using Principal Component Analysis (PCA). Efficacy of masitinib therapy was evaluated using non parametric Wilcoxon test for paired data within a three months period (n = 35). Our results show that patients with indolent mastocytosis present an elevated prevalence of depression (64%). Depression was moderate in 56% but severe in 8% of cases. Core symptoms (such as psychic anxiety, depressed mood, work and interests) characterized depression in mastocytosis patients. Masitinib therapy was associated with significant improvement (67% of the cases) of overall depression, with 75% of recovery cases. Global Quality of Life slightly improved after masitinib therapy and did not predicted depression improvement. In conclusion, depression is very frequent in mastocytosis patients and masitinib therapy is associated with the reduction its psychic experiences. We conclude that depression in mastocytosis may originate from processes related to mast cells activation. Masitinib could therefore be a useful treatment for mastocytosis patients with depression and anxiety symptoms. PMID:22031830

  12. Assessing and Treating the Patient with Acute Psychotic Disorders.

    PubMed

    Jensen, Lisa; Clough, Rebecca

    2016-06-01

    Patients with acute psychosis often present to emergency departments. Management of acute agitation and psychosis can be a challenge for the staff. Medical stabilization, appropriate assessment, and diagnosis are important. Verbal de-escalation and other psychosocial interventions are helpful in creating a safe and therapeutic environment. Psychiatric and emergency room nurses are poised to treat patients presenting with acute psychosis and must be knowledgeable of evidence-based approaches to treat these complex disorders. PMID:27229275

  13. The Red Blood Cell Acetylcholinesterase Levels of Depressive Patients with Suicidal Behavior in an Agricultural Area.

    PubMed

    Altinyazar, Vesile; Sirin, Fevziye Burcu; Sutcu, Recep; Eren, Ibrahim; Omurlu, Imran Kurt

    2016-10-01

    Long-term exposure to organophosphate pesticides (OPs) without acute poisoning can lead to various OPs. Environmental exposure to organophosphate pesticides may be associated with depression and suicide attempts in a population living in a rural agricultural area. Patients (n = 149) suffering from major depressive disorder (with and without attempted suicide) and a control group of healthy individuals (n = 64) who had been living in the same rural district for at least 1 year were selected. Red blood cell acetylcholine esterase (RBC-AChE) activity was examined as the basis of evaluating the degree of chronic environmental exposure to OPs residues. There were negative association between RBC-AChE activity levels and suicide attempts, the number of past suicide attempts and hopelessness levels in the depressive patients. The results of the study may support the idea that environmental exposure to OPs may be associated with mental health in individuals living in agricultural districts who are not farmers or working in occupations with access to OPs. PMID:27605747

  14. [Depression, social support and compliance in patients with chronic heart failure].

    PubMed

    Reutlinger, Julia; Müller-Tasch, Thomas; Schellberg, Dieter; Frankenstein, Lutz; Zugck, Christian; Herzog, Wolfgang; Lossnitzer, Nicole

    2010-01-01

    Depressive patients with chronic heart failure (CHF) show less social integration and greater physical impairment as well as poorer compliance than non depressive CHF patients. Using multiple regression analyses, this study (n=84) investigated a potential mediating effect of depression on the relationship between compliance and both social support and physical functioning. Results did not support the hypothesized mediating effect of depression. However, the variables age, depression, left ventricular ejection fraction (LVEF) and social support were associated with self-reported compliance. Therefore, a lack of social support and depression should be considered as possible reasons, if patients are noncompliant during the treatment process. PMID:20687012

  15. Treatment needs, diagnoses and use of services for acutely admitted psychiatric patients in northwest Russia and northern Norway

    PubMed Central

    2013-01-01

    Background We compared demography, diagnoses and clinical needs in acutely admitted psychiatric hospital patients in northwest Russia and northern Norway. Method All acutely admitted psychiatric patients in 1 psychiatric hospital in north-west Russia and 2 in northern Norway were in a three months period assessed with HoNOS and a Norwegian form developed to study acute psychiatric services (MAP). Data from a total of 841 patients were analysed (377 Norwegian, 464 Russian) with univariate and multivariate statistics. Results Russian patients were more often males who had paid work. 2/3 were diagnosed with alcohol and organic disorders, and 70% reported problems related to sleep. Depression was widespread, as were problems associated with occupation. Many more Norwegian patients were on various forms of social security and lived in community supported homes. They had a clinical profile of affective disorders, use of drugs, suicidality and problems with activities involved of daily life. Slightly more Norwegian patients were involuntary admitted. Conclusion Acutely admitted psychiatric patients in North West Russia and Northern Norwegian showed different clinical profiles: alcohol, depression and organic disorders characterised Russian patients, affective disorders, suicidality and use of drugs characterised the Norwegians. Whereas Norwegian patients are mainly referred from GPs the Russians come via 1.line psychiatric services (“dispensaries”). Average length of stay for Russian patients was 2.5 times longer than that of the Norwegian. PMID:23317010

  16. Humor, laughter, and the cerebellum: insights from patients with acute cerebellar stroke.

    PubMed

    Frank, B; Andrzejewski, K; Göricke, S; Wondzinski, E; Siebler, M; Wild, B; Timmann, D

    2013-12-01

    Extent of cerebellar involvement in cognition and emotion is still a topic of ongoing research. In particular, the cerebellar role in humor processing and control of laughter is not well known. A hypermetric dysregulation of affective behavior has been assumed in cerebellar damage. Thus, we aimed at investigating humor comprehension and appreciation as well as the expression of laughter in 21 patients in the acute or subacute state after stroke restricted to the cerebellum, and in the same number of matched healthy control subjects. Patients with acute and subacute cerebellar damage showed preserved comprehension and appreciation of humor using a validated humor test evaluating comprehension, funniness and aversiveness of cartoons ("3WD Humor Test"). Additionally, there was no difference when compared to healthy controls in the number and intensity of facial reactions and laughter while observing jokes, humorous cartoons, or video sketches measured by the Facial Action Coding System. However, as depression scores were significantly increased in patients with cerebellar stroke, a concealing effect of accompanying depression cannot be excluded. Current findings add to descriptions in the literature that cognitive or affective disorders in patients with lesions restricted to the cerebellum, even in the acute state after damage, are frequently mild and might only be present in more sensitive or specific tests.

  17. Protein Binding in Patients With Late-Life Depression

    PubMed Central

    Kumar, Anand; Kepe, Vladimir; Barrio, Jorge R.; Siddarth, Prabha; Manoukian, Vicki; Elderkin-Thompson, Virginia; Small, Gary W.

    2013-01-01

    Context Depression has been identified as a risk factor and a prodrome of dementia. Common neurobiological mechanisms may underlie this clinical and phenomenologic overlap. Objective To examine and compare protein (amyloid and tau) binding in critical brain regions in patients diagnosed as having late-life major depressive disorder (MDD) and healthy control individuals using 2-(1-{6-[(2-[18F]fluoroethyl) (methyl)-amino]-2-naphthyl}ethylidene) malononitrile ([18F]FDDNP) positron emission tomography. Design A cross-section neuroimaging study using positron emission tomography. Setting University of California, Los Angeles. Patients Our samples comprised 20 patients diagnosed as having MDD and 19 healthy control individuals of comparable age, sex, and educational level. Main Outcome Measure Relative distribution volume in regions of interest was used as the measure of [18F]FDDNP binding in all study participants. Results When compared with controls, [18F]FDDNP binding was significantly higher overall and in the posterior cingulate and lateral temporal regions in the MDD group. Conclusions These findings suggest that neuronal injury associated with higher protein load in critical brain regions might provide a mechanism in the pathophysiologic manifestation of MDD in late life and have implications for the therapeutics of depression in elderly individuals. PMID:22065530

  18. Study of depression among a sample of hypertensive patients.

    PubMed

    Al Madany, Adel Mohammed; Hassan, Fawzy Hamed; Al-Nabawy, Ali Abdel Fattah; Ramadan, Mohammed Elsayed Mohammed; Ismail, Abd-Allah Ahmed Abd-Allah

    2015-04-01

    Hypertension is one of the commonest diseases worldwide. Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition, which elevated blood pressure in the arteries. This forces the heart to work harder than normal to circulate blood via the blood vessels. Blood pressure is summarized by two measurements, systolic and diastolic, which depend on between beats (diastole). Normal blood pressure at rest is within the range of 100-140 mmHg systolic (top reading) high blood pressure is said to be present if it is persistently at or above 140/90 mmHg of cases are categorized as primary hypertension that means high blood pressure with no obvious underlying medical cause. Updated studies reported associations between depressive symptoms and hypertensive patients. Depression may be an independent diagnosis, it is also possible that depressive symptoms are secondary to chronic illnesses and their associated complex medication regimens, regardless of the diagnosis being primary or secondary, prior reports have demonstrated that depressive symptoms are associated with inadequate blood pressure control and complications of hypertension. PMID:26012236

  19. Orthognathic surgery improves quality of life and depression, but not anxiety, and patients with higher preoperative depression scores improve less.

    PubMed

    Brunault, P; Battini, J; Potard, C; Jonas, C; Zagala-Bouquillon, B; Chabut, A; Mercier, J-M; Bedhet, N; Réveillère, C; Goga, D; Courtois, R

    2016-01-01

    This study assessed quality of life (QoL), depression, and anxiety before and after orthognathic surgery and identified risk factors for poorer postoperative outcome. This multicentre prospective study included 140 patients from five French medical centres. We assessed patients before surgery (T1), 3 months after surgery (T2), and 12 months after surgery (T3). We assessed the severity of the orofacial deformity, physical, psychological, social, and environmental QoL (WHOQOL-BREF), and depression and anxiety (GHQ-28). Risk factors for poorer outcome were identified using linear mixed models. Between baseline and 12 months, there was significant improvement in psychological and social QoL and in depression (although below the norms reported in the general population), but not in anxiety. Physical QoL was poorer in patients who were younger, who had a mild orofacial deformity, and who were depressed. Psychological QoL was poorer in younger patients and in depressed patients. Social QoL was poorer in patients who were single, who had a mild orofacial deformity, and who were depressed. Although orthognathic surgery provides a moderate improvement in psychological and social QoL, the systematic screening and treatment of depression could further improve QoL after surgery because it is a major predictor of poor QoL in this population.

  20. Acute Hypoxic Test in Patients with Prediabetes.

    PubMed

    Shatylo, Valerii B; Serebrovska, Tatiana V; Gavalko, Anna V; Egorov, Egor; Korkushko, Oleg V

    2016-06-01

    Shatylo, Valerii B., Tetiana V. Serebrovska, Anna V. Gavalko, Egor Egorov, and Oleg V. Korkushko. Acute hypoxic test in patients with prediabetes. High Alt Med Biol. 17:101-107, 2016.-Prediabetes is a state of impaired carbohydrate metabolism when not all of the symptoms required to label a person as diabetic are present, but blood glucose is higher than in healthy subjects. Recent evidence suggests that intermittent hypoxia training (IHT) might provide a cost-effective strategy for improving metabolic functioning. One of the most important aspects of the successful IHT application is individualized approach to hypoxic dose and regimen prescription. To establish the relationships between indices of carbohydrate metabolism and individual resistance to hypoxia, the acute hypoxic test (AHT, breathing gas mixture with 12% O2 during 20 minutes) was performed in 33 healthy volunteers (mean age, 63.0, range, 44-76; fasting plasma glucose (FPG) less than 5.6 mmol/L and 2 hours postoral glucose tolerance test (OGTT) glycemia less than 7.8 mmol/L) and 30 patients with impaired glucose metabolism (mean age, 65.5, range, 44-75; FPG from 5.6 to 6.9 mmol/L and 2 hours post-OGTT glycemia from 7.8 to 11 mmol/L). Negative correlation was found between the SaO2 level at 20th minute AHT and FPG (r = -0.83; p < 0.01) and insulin (r = -0.27; p < 0.05), as well as 2 hours post-OGTT glucose and insulin levels (r = -0.75 and -0.40, respectively). Longer recovery time and less effective functioning of respiratory and cardiovascular systems were also registered in patients with prediabetes showing that their cardiovascular resilience is impaired compared to normoglycemic controls. These patterns of relationship must be considered when assigning the individual modes of IHT. PMID:27213550

  1. The role of acute pancreatitis in pediatric burn patients.

    PubMed

    Rivero, Haidy G; Lee, Jong O; Herndon, David N; Mecott, Gabriel A; Kulp, Gabriela A; Kraft, Robert; Brooks, Natasha C; Diblidox-Gonzales, Manuel; Hawkins, Hal K; Jeschke, Marc G

    2011-02-01

    Few publications recognize acute pancreatitis as a complication after large burns, consequently the incidence and outcome acute pancreatitis after burn in children is not well defined. The aim of this study was to determine the incidence, morbidity, and mortality relating to acute pancreatitis in a pediatric burn population and to correlate clinical diagnosis with autopsy findings to determine the incidence of unrecognized pancreatitis. Records of 2699 patients with acute burns were reviewed. Acute pancreatitis was defined as abdominal pain and/or feeding intolerance in addition to a three-fold elevation of amylase and/or lipase. One-hundred twenty-seven burned children served as the control cohort. To assess the presence of autopsy confirmed AP in pediatric burn patients, we evaluated autopsy reports of 78 children who died from burns, looking for reported evidence of pancreatic inflammation, and fat/parenchymal necrosis. Our data show that acute pancreatitis in children has a low incidence after burn. The study included 2699 patients of which 13 were suffering acute pancreatitis (13/2699 = 0.05%). Mortality is significantly higher for the acute pancreatitis group vs. the control group, p < 0.05. Autopsy reports established 11 of 78 patients with evidence of pancreatitis, resulting in an incidence of 0.17% for pancreatitis at autopsy. Although it has low incidence, acute pancreatitis is associated with increased mortality in severely burned pediatric patients, which underlines the importance of increased vigilance in the evaluation and treatment of pancreatitis in burned children.

  2. Neurologic Disorders in Immunocompetent Patients with Autochthonous Acute Hepatitis E

    PubMed Central

    Perrin, H. Blasco; Cintas, P.; Abravanel, F.; Gérolami, R.; d'Alteroche, L.; Raynal, J.-N.; Alric, L.; Dupuis, E.; Prudhomme, L.; Vaucher, E.; Couzigou, P.; Liversain, J.-M.; Bureau, C.; Vinel, J.-P.; Kamar, N.; Izopet, J.

    2015-01-01

    Neurologic disorders, mainly Guillain-Barré syndrome and Parsonage–Turner syndrome (PTS), have been described in patients with hepatitis E virus (HEV) infection in industrialized and developing countries. We report a wider range of neurologic disorders in nonimmunocompromised patients with acute HEV infection. Data from 15 French immunocompetent patients with acute HEV infection and neurologic disorders were retrospectively recorded from January 2006 through June 2013. The disorders could be divided into 4 main entities: mononeuritis multiplex, PTS, meningoradiculitis, and acute demyelinating neuropathy. HEV infection was treated with ribavirin in 3 patients (for PTS or mononeuritis multiplex). One patient was treated with corticosteroids (for mononeuropathy multiplex), and 5 others received intravenous immunoglobulin (for PTS, meningoradiculitis, Guillain-Barré syndrome, or Miller Fisher syndrome). We conclude that pleiotropic neurologic disorders are seen in HEV-infected immunocompetent patients. Patients with acute neurologic manifestations and aminotransferase abnormalities should be screened for HEV infection. PMID:26490255

  3. Prevalence and Characteristics of Anergia (Lack of Energy) in Patients with Acute Coronary Syndrome

    PubMed Central

    Shaffer, Jonathan A.; Davidson, Karina W.; Schwartz, Joseph E.; Shimbo, Daichi; Newman, Jonathan D.; Gurland, Barry J.; Maurer, Mathew S.

    2012-01-01

    Anergia, a commonly occurring syndrome in older adults and patients with cardiovascular diseases, is associated with functional and clinical limitations. To date, the prevalence and clinical-demographic characteristics of anergia in patients with acute coronary syndrome (ACS) have not been elucidated. We examined the prevalence and clinical-demographic characteristics of anergia in a multiethnic sample of patients with ACS. Hospitalized patients with ACS (n = 472), enrolled in the Prescription Usage Lifestyle and Stress (PULSE) prospective cohort study, completed assessments of demographic, behavioral, and clinical characteristics within 7 days of hospitalization for an ACS event. Current depressive disorder was ascertained using a structured psychiatric interview 3 to 7 days post-discharge. Anergia was assessed at baseline and defined using patients’ binary responses (yes/no) to seven items related to energy level. At least 1 complaint of anergia was reported by 79.9% (n = 377) of patients, and 32% (n = 153) of patients met criteria for anergia. In a multivariable logistic regression model, anergia was independently associated with being female, white (compared to black), having bodily pain, participating in exercise, having current depressive disorder, and having higher values on the Charlson comorbidity index. In conclusion, anergia is a highly prevalent syndrome among patients with ACS. It is distinct from depression and is associated with modifiable clinical factors such as participation in exercise and bodily pain that may be appropriate targets for intervention. PMID:22835409

  4. Depression.

    PubMed

    Stewart, Donna E; Gucciardi, Enza; Grace, Sherry L

    2004-08-25

    HEALTH ISSUE: Depression causes significant distress or impairment in physical, social, occupational and other key areas of functioning. Women are approximately twice as likely as men to experience depression. Psychosocial factors likely mediate the risks for depression incurred by biological influences. KEY FINDINGS: Data from the 1999 National Population Health Survey show that depression is more common among Canadian women, with an annual self-reported incidence of 5.7% compared with 2.9% in men. The highest rates of depression are seen among women of reproductive age. Predictive factors for depression include previous depression, feeling out of control or overwhelmed, chronic health problems, traumatic events in childhood or young adulthood, lack of emotional support, lone parenthood, and low sense of mastery. Although depression is treatable, only 43% of depressed women had consulted a health professional in 1998/99 and only 32.4% were taking antidepressant medication. People with lower education, inadequate income, and fewer contacts with a health professional were less likely to receive depression treatment. DATA GAPS AND RECOMMENDATIONS: A better understanding of factors that increase vulnerability and resilience to depression is needed. There is also a need for the collection and analysis of data pertaining to: prevalence of clinical anxiety; the prevalence of depression band 12 months after childbirth factors contributing to suicide contemplation and attempts among adolescent girls, current treatments for depression and their efficacy in depressed women at different life stages; interprovincial variation in depression rates and hospitalizations and the impact and costs of depression on work, family, individuals, and society.

  5. Effect of perceived social support and dispositional optimism on the depression of burn patients.

    PubMed

    He, Fei; Zhou, Qin; Zhao, Zhijing; Zhang, Yuan; Guan, Hao

    2016-06-01

    Burn wounds have a significant impact on the mental health of patients. This study aimed to investigate the impact of perceived social support and dispositional optimism on depression of burn patients. A total of 246 burn patients accomplished the Multidimensional Scale of Perceived Social Support, the Revised Life Orientation Test, and Depression Scale. The results revealed that both perceived social support and optimism were significantly correlated with depression. Structural equation modeling indicated that optimism partially mediated the relationship between perceived social support and depression. Implications for prevention of depression in burn patients were discussed.

  6. Magnetization Transfer Imaging of Suicidal Patients with Major Depressive Disorder

    PubMed Central

    Chen, Ziqi; Zhang, Huawei; Jia, Zhiyun; Zhong, Jingjie; Huang, Xiaoqi; Du, Mingying; Chen, Lizhou; Kuang, Weihong; Sweeney, John A.; Gong, Qiyong

    2015-01-01

    Magnetization transfer imaging (MTI) provides a quantitative measure of the macromolecular structural integrity of brain tissue, as represented by magnetization transfer ratio (MTR). In this study, we utilized MTI to identify biophysical alterations in MDD patients with a history of suicide attempts relative to MDD patients without such history. The participants were 36 medication-free MDD patients, with (N = 17) and without (N = 19) a history of a suicide attempt, and 28 healthy controls matched for age and gender. Whole brain voxel-based analysis was used to compare MTR across three groups and to analyze correlations with symptom severity and illness duration. We identified decreased MTR in left inferior parietal lobule and right superior parietal lobule in suicide attempters relative to both non-attempters and controls. Non-attempters also showed significantly reduced MTR in left inferior parietal lobule relative to controls, as well as an MTR reduction in left cerebellum. These abnormalities were not correlated with symptom severity or illness duration. Depressed patients with a history of suicide attempt showed bilateral abnormalities in parietal cortex compared to nonsuicidal depressed patients and healthy controls. Parietal lobe abnormalities might cause attentional dysfunction and impaired decision making to increase risk for suicidal behavior in MDD. PMID:25853872

  7. Emergency pulpotomy in relieving acute dental pain among Tanzanian patients

    PubMed Central

    Nyerere, Joachim W; Matee, Mecky I; Simon, Elison NM

    2006-01-01

    Background In Tanzania, oral health services are mostly in the form of dental extractions aimed at alleviating acute dental pain. Conservative methods of alleviating acute dental pain are virtually non-existent. Therefore, it was the aim of this study to determine treatment success of emergency pulpotomy in relieving acute dental pain. Methods Setting: School of Dentistry, Muhimbili National Hospital, Dar es Salaam, Tanzania. Study design: Longitudinal study. Participants: 180 patients who presented with dental pain due to acute irreversible pulpitis during the study period between July and August 2001. Treatment and evaluation: Patients were treated by emergency pulpotomy on permanent posterior teeth and were evaluated for pain after one, three and six week's post-treatment. Pain, if present, was categorised as either mild or acute. Results Of the patients with treated premolars, 25 (13.9%) patients did not experience pain at all while 19 (10.6%) experienced mild pain. None of the patients with treated premolars experienced acute pain. Among 136 patients with treated molars 56 (31%) did not experience any pain, 76 (42.2%) experienced mild pain and the other 4 (2.2%) suffered acute pain. Conclusion The short term treatment success of emergency pulpotomy was high being 100% for premolars and 97.1% for molars, suggesting that it can be recommended as a measure to alleviate acute dental pain while other conservative treatment options are being considered. PMID:16426455

  8. Agomelatine Increases BDNF Serum Levels in Depressed Patients in Correlation with the Improvement of Depressive Symptoms

    PubMed Central

    Pettorruso, Mauro; De Berardis, Domenico; Varasano, Paola Annunziata; Lucidi Pressanti, Gabriella; De Remigis, Valeria; Valchera, Alessandro; Ricci, Valerio; Di Nicola, Marco; Janiri, Luigi; Biggio, Giovanni; Di Giannantonio, Massimo

    2016-01-01

    Background: Agomelatine modulates brain-derived neurotrophic factor expression via its interaction with melatonergic and serotonergic receptors and has shown promising results in terms of brain-derived neurotrophic factor increase in animal models. Methods: Twenty-seven patients were started on agomelatine (25mg/d). Venous blood was collected and brain-derived neurotrophic factor serum levels were measured at baseline and after 2 and 8 weeks along with a clinical assessment, including Hamilton Depression Rating Scale and Snaith-Hamilton Pleasure Scale. Results: Brain-derived neurotrophic factor serum concentration increased after agomelatine treatment. Responders showed a significant increase in brain-derived neurotrophic factor levels after 2 weeks of agomelatine treatment; no difference was observed in nonresponders. Linear regression analysis showed that more prominent brain-derived neurotrophic factor level variation was associated with lower baseline BDNF levels and greater anhedonic features at baseline. Conclusions: Patients affected by depressive disorders showed an increase of brain-derived neurotrophic factor serum concentration after a 2-week treatment with agomelatine. The increase of brain-derived neurotrophic factor levels was found to be greater in patients with lower brain-derived neurotrophic factor levels and marked anhedonia at baseline. PMID:26775293

  9. Hepatic steatosis depresses alpha-1-antitrypsin levels in human and rat acute pancreatitis

    PubMed Central

    Wang, Qian; Du, Jianjun; Yu, Pengfei; Bai, Bin; Zhao, Zhanwei; Wang, Shiqi; Zhu, Junjie; Feng, Quanxin; Gao, Yun; Zhao, Qingchuan; Liu, Chaoxu

    2015-01-01

    Hepatic steatosis (HS) can exacerbate acute pancreatitis (AP). This study aimed to investigate the relation between α1-antitrypsin (AAT) and acute pancreatitis when patients have HS. Using proteomic profiling, we identified 18 differently expressed proteins pots in the serum of rats with or without HS after surgical establishment of AP. AAT was found to be one of the significantly down-regulated proteins. AAT levels were significantly lower in hepatic steatosis acute pancreatitis (HSAP) than in non-HSAP (NHSAP) (P < 0.001). To explore the clinical significance of these observations, we measured the levels of AAT in the serum of 240 patients with HSAP, NHSAP, fatty liver disease (FLD), or no disease. Compared with healthy controls, serum AAT levels in patients with NHSAP were significantly higher (P < 0.01), while in patients with HSAP serum AAT levels were significantly lower (P < 0.01). Further studies showed that acute physiology and chronic health evaluation (APACHE-II) scores were negatively correlated with serum AAT levels (r = −0.85, P < 0.01). In conclusion, low serum levels of AAT in patients with HSAP are correlated with disease severity and AAT may represent a potential target for therapies aiming to improve pancreatitis. PMID:26634430

  10. Patient Centered Communication During Primary Care Visits for Depressive Symptoms

    PubMed Central

    Chapman, Benjamin P.; Duberstein, Paul R.; Epstein, Ron; Fiscella, Kevin; Kravitz, Richard L.

    2009-01-01

    Background Patient Centered Communication (PCC) is associated with more appropriate treatment of depression in primary care. In part a function of patient presentation, little is known about other influences on PCC. We investigated whether PCC was also influenced by personality dispositions of primary care providers (PCPs), independent of patient presentation. Methods 46 PCPs completed personality scales from the NEO-Personality Inventory, Revised and provided care to 88 Standardized Patients (SPs) presenting with either major depression or adjustment disorder with comorbid musculoskeletal symptoms, either making or not making a medication request. Coders scored each visit using the Measure of Patient Centered Communication, assessing physicians’ ability to explore the patient’s illness experience (component 1), understand the patient’s psychosocial context (component 2), and involve the patient in collaborative discussions of treatment (component 3). Results Adjusting for physician demographics, training, and patient presentation, physicians who were more open to feelings explored the patient’s experience of illness more (p = .05). More dutiful, or rule-bound physicians engaged in greater exploration of the patient’s psychosocial and life circumstances (p = .04), but involved the patient less in treatment discussions (p = .03), as did physicians reporting more anxious vulnerability (p = .03). Physician demographics, training, and patient presentation explained 4-7% of variance in MPCC components, with personality explaining an additional 4-7% of the variance. Conclusion Understanding of personality dispositions which promote or detract from PCC may help medical educators better identify trainees of varying aptitude, addressing individual training needs in a tailored fashion. PMID:18665060

  11. [Autonomic nervous system unbalance in patients with ischemic heart disease and depression].

    PubMed

    Dolynna, O V

    2013-01-01

    It is set that in 26.9% patients with coronary desease there are the depressed disorders. The easy degree of depression was observed in 61.1% persons, maskable depression--in 27.8% persons, middle degree of depression--in 11.1% persons. For such patients the decline of heart rhythm variability, increase of sympathetic tone, violation of day's rhythm of vegetative nervous system, prevalence of humoral influence on a heart rhythm were revealed. PMID:24605628

  12. [Autonomic nervous system unbalance in patients with ischemic heart disease and depression].

    PubMed

    Dolynna, O V

    2013-01-01

    It is set that in 26.9% patients with coronary desease there are the depressed disorders. The easy degree of depression was observed in 61.1% persons, maskable depression--in 27.8% persons, middle degree of depression--in 11.1% persons. For such patients the decline of heart rhythm variability, increase of sympathetic tone, violation of day's rhythm of vegetative nervous system, prevalence of humoral influence on a heart rhythm were revealed.

  13. Acute myocarditis in dengue hemorrhagic fever: a case report and review of cardiac complications in dengue-affected patients.

    PubMed

    Lee, Ing-Kit; Lee, Wen-Huei; Liu, Jien-Wei; Yang, Kuender D

    2010-10-01

    We report a case of dengue hemorrhagic fever (DHF) complicated by acute myocarditis and review the literature. A 65-year-old woman experienced DHF due to dengue virus serotype 3, complicated with acute myocarditis and acute pulmonary edema. Clinically this masqueraded as acute myocardial infarction, with an electrocardiographically depressed ST segment in precordial leads and elevated serum cardiac-specific troponin I level. Under supportive management, the patient recovered 3 days later. A total of 18 pertinent articles involving 339 dengue-affected patients with cardiac complications were found by PubMed search. Clinical manifestations of cardiac complications varied considerably, from self-limiting tachy-brady arrhythmia to severe myocardial damage, leading to hypotension and pulmonary edema. Although rare, a fatal outcome was reported in some cases of dengue with cardiac complications. To avoid otherwise preventable morbidity and mortality, physicians should have a high index of suspicion for cardiac complications in patients with dengue illness and should manage this accordingly.

  14. The hemostatic disturbance in patients with acute aortic dissection: A prospective observational study.

    PubMed

    Guan, Xinliang; Li, Jiachen; Gong, Ming; Lan, Feng; Zhang, Hongjia

    2016-09-01

    Coagulopathy is still a frequent complication in the surgical treatment of acute aortic dissection. However, the physiopathology of surgically induced coagulopathy has never been systematically and comprehensively studied in patients with acute aortic dissection. The aim of the present study was to describe the perioperative hemostatic system in patients with acute aortic dissection.The 87 patients who underwent aortic arch surgery for acute Stanford type A aortic dissection from January 2013 to September 2015 were enrolled in this study. The perioperative biomarkers of hemostatic system were evaluated using standard laboratory tests and enzyme-linked immunosorbent assays (ELISAs) at 5 time points: anesthesia induction (T1), lowest nasopharyngeal temperature (T2), protamine reversal (T3), 4 hours after surgery (T4), and 24 hours after surgery (T5).The ELISAs biomarkers revealed activation of coagulation (thrombin-antithrombin III complex [TAT] and prothrombin fragment 1 + 2 [F1 + 2] were elevated), suppression of anticoagulation (antithrombin III [AT III] levels were depressed), and activation of fibrinolysis (plasminogen was decreased and plasmin-antiplasmin complex [PAP] was elevated). The standard laboratory tests also demonstrated that surgery resulted in a significant reduction in platelet counts and fibrinogen concentration.Systemic activation of coagulation and fibrinolysis, and inhibition of anticoagulation were observed during the perioperative period in patients with acute aortic dissection. Indeed, these patients exhibited consumption coagulopathy and procoagulant state perioperatively. Therefore, we believe that this remarkable disseminated intravascular coagulation (DIC)-like coagulopathy has a high risk of bleeding and may influence postoperative outcome of patients with acute aortic dissection. PMID:27603366

  15. Methadone, monoamine oxidase, and depression: opioid distribution and acute effects on enzyme activity

    SciTech Connect

    Kaufmann, C.A.; Kreek, M.J.; Raghunath, J.; Arns, P.

    1983-09-01

    Narcotic withdrawal is often accompanied by an atypical depression which responds to resumption of narcotics. It was hypothesized that methadone might exert its antidepressant effects through monoamine oxidase (MAO) inhibition. The current study examined /sub 3/H-methadone distribution in rat brain and effects on regional MAO activity with acute doses (2.5 mg/kg) which approximate those found during chronic methadone maintenance in man. Limbic areas (amygdala, basomedial hypothalamus, caudate-putamen, hippocampus, preoptic nucleus), as well as pituitary and liver were assayed for MAO activity and methadone concentration. MAO activities did not differ significantly in acute methadone or saline-treated cage-mates at 1 or 24 hr. The concentrations of methadone at 1 hr ranged between 17 and 223 ng/100 mg wet wt tissue in the preoptic nucleus and pituitary, respectively. No significant correlation was found between change in MAO activity (MAO methadone/MAO saline) and methadone concentration in any region at 1 or 24 hr. This study does not support the hypothesis that methadone acts as an antidepressant through MAO inhibition, at least not following acute administration of this exogenous opioid.

  16. Self-Report of Depressive Symptoms in Low Back Pain Patients.

    ERIC Educational Resources Information Center

    Crisson, James; And Others

    1986-01-01

    Presents two studies designed to examine the self-report of depressive symptoms in low back pain patients (N=134). Both studies found that patients were more likely to report somatic than cognitive symptoms of depression. Patients with multiple physical findings were not more likely to report somatic symptoms than patients with few physical…

  17. Co-occurrence of and remission from general anxiety, depression, and posttraumatic stress disorder symptoms after acute lung injury: a 2-year longitudinal study

    PubMed Central

    Bienvenu, O. Joseph; Colantuoni, Elizabeth; Mendez-Tellez, Pedro A.; Shanholtz, Carl; Dennison-Himmelfarb, Cheryl R.; Pronovost, Peter J.; Needham, Dale M.

    2014-01-01

    Objective To evaluate the co-occurrence, and predictors of remission, of general anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms during 2-year follow-up in survivors of acute lung injury (ALI) treated in an intensive care unit (ICU). Design, Setting, and Patients This prospective cohort study enrolled 520 patients from 13 medical and surgical ICUs in 4 hospitals, with follow-up at 3, 6, 12, and 24 months post-ALI. Measurements and Main Results The outcomes of interest were measured using the Hospital Anxiety and Depression Scale (HADS) anxiety and depression subscales (scores ≥8 indicating substantial symptoms) and the Impact of Event Scale-Revised (IESR, scores ≥1.6 indicating substantial PTSD symptoms). Of the 520 enrolled patients, 274 died before 3-month follow-up; 186/196 consenting survivors (95%) completed at least one HADS and IESR assessment during 2-year follow-up, and most completed multiple assessments. Across follow-up time points, the prevalence of supra-threshold general anxiety, depression, and PTSD symptoms ranged from 38–44%, 26–33%, and 22–24%, respectively; more than half of the patients had supra-threshold symptoms in at least one domain during 2-year follow-up. The majority (59%) of survivors with any supra-threshold symptoms were above threshold for 2 or more types of symptoms (i.e., of general anxiety, depression, and/or PTSD). In fact, the most common pattern involved simultaneous general anxiety, depression, and PTSD symptoms. Most patients with general anxiety, depression, or PTSD symptoms during 2-year follow-up had supra-threshold symptoms at 24-month (last) follow-up. Higher SF-36 physical functioning domain scores at the prior visit were associated with a greater likelihood of remission from general anxiety and PTSD symptoms during follow-up. Conclusions The majority of ALI survivors had clinically significant general anxiety, depressive, or PTSD symptoms, and these symptoms tended to co-occur across

  18. Thyroid axis activity and suicidal behavior in depressed patients.

    PubMed

    Duval, Fabrice; Mokrani, Marie-Claude; Lopera, Felix Gonzalez; Diep, Thanh Son; Rabia, Hassen; Fattah, Saïd

    2010-08-01

    The aim of this study was to investigate the relationship between suicidal behavior and hypothalamic-pituitary thyroid (HPT) axis activity in depressed patients. The serum levels of thyrotropin (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) were evaluated before and after 0800 and 2300 h thyrotropin-releasing hormone (TRH) challenges, on the same day, in 95 medication-free DSM-IV euthyroid major depressed inpatients and 44 healthy hospitalized controls. Compared to controls: (1) patients with a positive suicide history (PSH; n=53) showed lower basal FT4 (at 0800 h: p<0.005; at 2300 h: p<0.03), but normal FT3 levels, while patients with a negative suicide history (NSH; n=42) showed normal FT4 and FT3 levels; (2) TSH responses to TRH (DeltaTSH) were blunted in NSHs (at 0800 h: p<0.03; at 2300 h: p<0.00001), but not in PSHs; (3) both NSHs and PSHs showed lower DeltaDeltaTSH values (differences between 2300 h-DeltaTSH and 0800 h-DeltaTSH) (p<0.000001 and p<0.003, respectively). Compared to NSHs, basal FT4 levels were reduced in PSHs (at 0800 h: p<0.002; at 2300h: p<0.006). HPT parameters were not significantly different between recent suicide attempters (n=32) and past suicide attempters (n=21). However, compared to controls, recent suicide attempters showed lower 2300 h-DeltaTSH (p<0.04) and DeltaDeltaTSH (p<0.002) values, and lower basal FT4 values (at 0800 h: p<0.006; at 2300 h: p<0.02). Our results, obtained in a large sample of depressed inpatients, indicate that various degrees of HPT axis dysregulation are associated with the history of suicide. PMID:20129737

  19. Extracorporeal support for patients with acute and acute on chronic liver failure.

    PubMed

    Aron, Jonathan; Agarwal, Banwari; Davenport, Andrew

    2016-01-01

    The number of patients developing liver failure; acute on chronic liver failure and acute liver failure continues to increase, along with the demand for donor livers for transplantation. As such there is a clinical need to develop effective extracorporeal devices to support patients with acute liver failure or acute-on-chronic liver failure to allow time for hepatocyte regeneration, and so avoiding the need for liver transplantation, or to bridge the patient to liver transplantation, and also potentially to provide symptomatic relief for patients with cirrhosis not suitable for transplantation. Currently devices can be divided into those designed to remove toxins, including plasma exchange, high permeability dialyzers and adsorption columns or membranes, coupled with replacement of plasma proteins; albumin dialysis systems; and bioartificial devices which may provide some of the biological functions of the liver. In the future we expect combinations of these devices in clinical practice, due to the developments in bioartificial scaffolds.

  20. Chronobiology, cognitive function and depressive symptoms in surgical patients.

    PubMed

    Hansen, Melissa Voigt

    2014-09-01

    Biological rhythms are essential for the regulation of many life processes. Disturbances of the circadian rhythm are known to affect human health, performance and well-being and the negative consequences are numerous and widespread. Cognitive dysfunction, fatigue, pain, sleep disturbances and mood disorders, such as anxiety and depression, are common problems arising around the time of surgery or in the course of a cancer diagnosis and subsequent treatment period. The importance of investigating prevention or treatment possibilities in these populations is significant due to the extent of the problems and the derived consequences on morbidity and mortality. Genetic predisposition to these problems is also an issue in focus. In this thesis we initially investigated whether the specific clock gene genotype PER(5/5) was associated with the development of postoperative cognitive dysfunction one week after non-cardiac surgery. We did not find any association, although this could have been due to the size of the study. Yet, if PER3(5/5) is associated with a higher incidence of postoperative cognitive dysfunction, the risk seems to be only modestly increased and by less than 10%. Melatonin is a hormone with well-known chronobiotic and hypnotic effects. In addition, exogenous melatonin is also known to have anxiolytic, analgesic, antidepressant and positive cognitive effects. Based on the lack of studies investigating these effects of melatonin, we conducted the MELODY trial in which we investigated the effect of 6 mg oral melatonin on depressive symptoms, anxiety, sleep, cognitive function and fatigue in patients with breast cancer in a three month time period after surgery. Melatonin had an effect on reducing the risk of developing depressive symptoms and also increased sleep efficiency perioperatively and total sleep time postoperatively. No effect was found on anxiety, sleep quality, sleepiness, general well-being or pain, however melatonin seemed to positively

  1. Bacteriology of aspiration pneumonia in patients with acute coma.

    PubMed

    Lauterbach, Enise; Voss, Frederik; Gerigk, Roland; Lauterbach, Michael

    2014-12-01

    Loss of protective airway reflexes in patients with acute coma puts these patients at risk of aspiration pneumonia complicating the course of the primary disease. Available data vary considerably with regard to bacteriology, role of anaerobic bacteria, and antibiotic treatment. Our objective was to research the bacteriology of aspiration pneumonia in acute coma patients who were not pre-treated with antibiotics or hospitalized within 30 days prior to the event. We prospectively analyzed 127 patient records from adult patients admitted, intubated and ventilated to a tertiary medical intensive care unit with acute coma. Bacteriology and antibiotic resistance testing from tracheal aspirate sampled within 24 h after admission, blood cultures, ICU scores (APACHE II, SOFA), hematology, and clinical chemistry were assessed. Patients were followed up until death or hospital discharge. The majority of patients with acute coma suffered from acute cardiovascular disorders, predominantly myocardial infarction, followed by poisonings, and coma of unknown cause. In a majority of our patients, microaspiration resulted in overt infection. Most frequently S. aureus, H. influenzae, and S. pneumoniae were isolated. Anaerobic bacteria (Bacteroides spec., Fusobacteria, Prevotella spec.) were isolated from tracheal aspirate in a minority of patients, and predominantly as part of a mixed infection. Antibiotic monotherapy with a 2nd generation cephalosporin, or a 3rd generation gyrase inhibitor, was most effective in our patients regardless of the presence of anaerobic bacteria.

  2. A Patient-Held Medical Record Integrating Depression Care into Diabetes Care

    PubMed Central

    Satoh-Asahara, Noriko; Ito, Hiroto; Akashi, Tomoyuki; Yamakage, Hajime; Kotani, Kazuhiko; Nagata, Daisuke; Nakagome, Kazuyuki; Noda, Mitsuhiko

    2016-01-01

    PURPOSE Depression is frequently observed in people with diabetes. The purpose of this study is to develop a tool for individuals with diabetes and depression to communicate their comorbid conditions to health-care providers. METHOD We searched the Internet to review patient-held medical records (PHRs) of patients with diabetes and examine current levels of integration of diabetes and depression care in Japan. RESULTS Eight sets of PHRs were found for people with diabetes. All PHRs included clinical follow-up of diabetes and multidisciplinary clinical pathways for diabetes care. No PHRs included depression monitoring and/or treatment. In terms of an integrated PHR for a patient comorbid with diabetes and depression, necessary components include hopes/preferences, educational information on diabetes complications and treatment, medical history, stress and coping, resources, and monitoring diabetes and depression. CONCLUSION A new PHR may be suitable for comorbid patients with diabetes and depression. PMID:27478395

  3. [Urinalysis in patients at the early stage of acute pancreatitis].

    PubMed

    Rybak, Katarzyna; Sporek, Mateusz; Gala-Błądzińska, Agnieszka; Mazur-Laskowska, Małgorzata; Dumnicka, Paulina; Walocha, Jerzy; Drożdż, Ryszard; Kuźniewski, Marek; Ceranowicz, Piotr; Kuśnierz-Cabala, Beata

    2016-01-01

    Urinalysis is a routine and cheap laboratory test that provides clinically useful information in patients with acute abdominal conditions, including acute pancreatitis. The aim of the study was to assess the relationships between the results of urinalysis and the course of the disease among 65 patients with acute pancreatitis (34 men and 31 women, mean age 61 ± 19 years) at the early phase of the disease, i.e. during the first 72 hours from the onset of symptoms. Mild acute pancreatitis was diagnosed in 47 patients, moderately severe in 13 and severe in 5. The most prevalent abnormalities were proteinuria (43% of patients), high urinary bilirubin (20%), erythrocytes (18%), glucose (18%) and leukocytes (17%). High urinary protein and low specific gravity were associated with more severe acute disease and with acute kidney injury. The severity of bilirubinuria and proteinuria were positively correlated with urine concentrations of neutrophil gelatinase associated lipocalin (NGAL). Urinalysis should be routinely performed in patients with acute pancreatitis. PMID:27197429

  4. High Risk of Depressive Disorders in Patients With Gout: A Nationwide Population-Based Cohort Study.

    PubMed

    Changchien, Te-Chang; Yen, Yung-Chieh; Lin, Cheng-Li; Lin, Ming-Chia; Liang, Ji-An; Kao, Chia-Hung

    2015-12-01

    Metabolic abnormalities are common in patients with depressive disorders. However, the relationship between gout and depression is unclear. We explored the causal relationship among gout, antigout medication, and the associated risk of incidental depressive disorders.In this nationwide cohort study, we sampled data from the National Health Insurance Research Database to recruit 34,050 patients with gout as the gout cohort and 68,100 controls (without gout) as the nongout cohort. Our primary endpoint was the diagnosis of depressive disorders during follow-up. The overall study population was followed up until depression diagnosis, withdrawal from the NHI program, or the end of the study. The differences in demographic and clinical characteristics between both cohorts were determined using the Chi-square test for categorical variables and the t-test for continuous variables. Cox proportional hazard regression models were used to examine the effect of gout on the risk of depression, represented using the hazard ratio with the 95% confidence interval.Patients with gout exhibited a higher risk of depressive disorders than controls did. The risk of depressive disorders increased with age and was higher in female patients and those with hypertension, stroke, and coronary artery disease. Nonsteroidal antiinflammatory drug and prednisolone use was associated with a reduced risk of depression. Patients with gout who had received antigout medication exhibited a reduced risk of depressive disorders compared with nongout patients.Our findings support that gout increases the risk of depressive disorders, and that antigout medication use reduces the risk.

  5. Laparoscopic Cholecystectomy for Acute Cholecystitis in Elderly Patients

    PubMed Central

    Filho, Euler de Medeiros Ázaro; Galvão, Thales Delmondes; Ettinger, João Eduardo Marques de Menezes; Silva Reis, Jadson Murilo; Lima, Marcos; Fahel, Edvaldo

    2006-01-01

    Background: Acute cholecystitis is the major complication of biliary lithiasis, for which laparoscopic treatment has been established as the standard therapy. With longer life expectancy, acute cholecystitis has often been seen in elderly patients (>65 years old) and is often accompanied by comorbity and severe complications. We sought to compare the outcome of laparoscopic treatment for acute cholecystitis with special focus on comparison between elderly and nonelderly patients. Method: This study was a prospective analysis of 190 patients who underwent laparoscopic cholecystectomy due to acute cholecystitis or chronic acute cholecystitis, comparing elderly and nonelderly patients. Results: Of 190 patients, 39 (21%) were elderly (>65 years old) and 151 (79%) were not elderly (≤65 years), with conversion rates of 10.3% and 6.6% (P=0.49), respectively. The incidence of postoperative complications in elderly and nonelderly patients were the following, respectively: atelectasis 5.1% and 2.0% (P=0.27); respiratory infection 5.1% and 2.7% (P=0.6); bile leakage 5.1% and 2.0% (P=0.27), and intraabdominal abscess 1 case (0.7%) and no incidence (P=1). Conclusion: According to our data, laparoscopic cholecystectomy is a safe and efficient procedure for the treatment of acute cholecystitis in patients older than 65 years of age. PMID:17575761

  6. Chronic and Acute Stress, Gender, and Serotonin Transporter Gene-Environment Interactions Predicting Depression Symptoms in Youth

    ERIC Educational Resources Information Center

    Hammen, Constance; Brennan, Patricia A.; Keenan-Miller, Danielle; Hazel, Nicholas A.; Najman, Jake M.

    2010-01-01

    Background: Many recent studies of serotonin transporter gene by environment effects predicting depression have used stress assessments with undefined or poor psychometric methods, possibly contributing to wide variation in findings. The present study attempted to distinguish between effects of acute and chronic stress to predict depressive…

  7. [The nutrition of acute phase in patients with metabolic syndrome].

    PubMed

    Tsutsumi, Rie; Sebe, Mayu

    2016-03-01

    In this session, we describe the acute phase in patients with metabolic syndrome from two sides; acute disease that occurs higher in patients with metabolic syndrome such as colonary heart disease and stroke, and acute aggravation of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. The electrolyte imbalance is frequently detected in critical ill patients. It is reported that the extreme abnormalities of ionized calcium concentrations are independent predictors of mortality. In addition, from clinical database MIMIC-Ⅱ,calcium supplementation improves clinical outcome in intensive care unit patients. Although metabolic syndrome; lifestyle-related disease, is a chronic disease, the possibility of falling into acute disease by having it becomes very high and improvement of electrolyte imbalance, especially hypocalcaemia is expected to effective on clinical outcome. PMID:26923986

  8. [The nutrition of acute phase in patients with metabolic syndrome].

    PubMed

    Tsutsumi, Rie; Sebe, Mayu

    2016-03-01

    In this session, we describe the acute phase in patients with metabolic syndrome from two sides; acute disease that occurs higher in patients with metabolic syndrome such as colonary heart disease and stroke, and acute aggravation of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. The electrolyte imbalance is frequently detected in critical ill patients. It is reported that the extreme abnormalities of ionized calcium concentrations are independent predictors of mortality. In addition, from clinical database MIMIC-Ⅱ,calcium supplementation improves clinical outcome in intensive care unit patients. Although metabolic syndrome; lifestyle-related disease, is a chronic disease, the possibility of falling into acute disease by having it becomes very high and improvement of electrolyte imbalance, especially hypocalcaemia is expected to effective on clinical outcome.

  9. The correlation between impaired attention and emotional reactivity in depressed adolescent patients.

    PubMed

    Bloch, Yuval; Aviram, Shai; Faibel, Nurit; Govezensky, Jose; Braw, Yoram; Rabany, Liron; Walter, Garry

    2013-01-01

    A group of 20 drug-naïve depressed adolescents and 20 matched controls underwent cognitive evaluations and assessment of emotional reactivity. Emotional reactivity correlated only with attention and only in depressed patients. The cognitive-emotional construct may enhance the understanding of adolescent depression and aid diagnosis. PMID:24026716

  10. The association of major depressive episode and personality traits in patients with fibromyalgia

    PubMed Central

    de Melo Santos, Danyella; Lage, Laís Verderame; Jabur, Eleonora Kehl; Kaziyama, Helena Hideko Seguchi; Iosifescu, Dan V; de Lucia, Mara Cristina Souza; Fráguas, Renério

    2011-01-01

    INTRODUCTION: Personality traits have been associated with primary depression. However, it is not known whether this association takes place in the case of depression comorbid with fibromyalgia. OBJECTIVE: The authors investigated the association between a current major depressive episode and temperament traits (e.g., harm avoidance). METHOD: A sample of 69 adult female patients with fibromyalgia was assessed with the Temperament and Character Inventory. Psychiatric diagnoses were assessed with the Mini-International Neuropsychiatric Interview severity of depressive symptomatology with the Beck Depression Inventory, and anxiety symptomatology with the IDATE-state and pain intensity with a visual analog scale. RESULTS: A current major depressive episode was diagnosed in 28 (40.5%) of the patients. They presented higher levels of harm avoidance and lower levels of cooperativeness and self-directedness compared with non-depressed patients, which is consistent with the Temperament and Character Inventory profile of subjects with primary depression. However, in contrast to previous results in primary depression, no association between a major depressive episode and self-transcendence was found. CONCLUSIONS: The results highlight specific features of depression in fibromyalgia subjects and may prove important for enhancing the diagnosis and prognosis of depression in fibromyalgia patients. PMID:21808861

  11. 76 FR 78740 - Agency Information Collection (Prevalence and Clinical Course of Depression Among Patients With...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-19

    ... AFFAIRS Agency Information Collection (Prevalence and Clinical Course of Depression Among Patients With... Control No. 2900- 0719.'' SUPPLEMENTARY INFORMATION: Titles: Prevalence and Clinical Course of Depression.... Abstracts: The data collected will be used to evaluate the prevalence of clinical depression and...

  12. Electrophysiological Neuroimaging using sLORETA Comparing 100 Schizophrenia Patients to 48 Patients with Major Depression

    PubMed Central

    Eugene, Andy R.; Masiak, Jolanta

    2015-01-01

    In this retrospective analysis of electroencephalograms were to identify a surrogate biomarker for the Dopamine D2 receptors in the brain by comparing patients diagnosed with Schizophrenia taking Atypical Antipsychotics to Depressive patients medicated with Selective Serotonin Reuptake Inhibitors. To achieve this, thirty-seconds of resting EEG were spectrally transformed in sLORETA. Three-dimensional statistical non-paramentric maps (SnPM) for the sLORETA Global Field Power within each band were then computed. Our results illustrated that the Right Superior Frontal Gyrus (t=2.049, p=0.007), along the dopamine mesolimbic pathway, had higher neuronal oscillations in the delta frequency band in the 100 Schizophrenia patients as compared to the 32-depressive female patients. The comparisons with both the 48 depressive patient cohort or the sixteen male depressive patient cohort did not yield any statistically significant findings. We conclude that the Superior Frontal Gyrus should be investigated as a possible surrogate biomarker for preclinical and clinical drug discovery in neuropharmacology. PMID:26609423

  13. Use of the Hospital Anxiety and Depression Scale and the Taiwanese Depression Questionnaire for screening depression in head and neck cancer patients in Taiwan

    PubMed Central

    Lee, Yu; Wu, Yi-Shan; Chien, Chih-Yen; Fang, Fu-Min; Hung, Chi-Fa

    2016-01-01

    Objective The purposes of this study are 1) to estimate the prevalence of common mental disorders including depressive disorder in patients with head and neck cancer (HNC) at baseline and at the 6-month follow-up and 2) to test the validity of two self-reported questionnaires, the Hospital Anxiety and Depression Scale (HADS) and the Taiwanese Depression Questionnaire (TDQ), for screening depression in patients with HNC. Methods Participants were recruited from the outpatient collaborative care clinic for HNC of a tertiary hospital in Taiwan between January 2010 and January 2011. Ninety-three patients with HNC were enrolled and assessed using the HADS, TDQ, and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Patient edition, at baseline and at the 6-month follow-up. Conventional validity indices of the HADS and TDQ were examined. Results Our results showed that the validity of the TDQ was satisfactory and comparable to that of both the HADS depression subscale and the HADS total scale. The cutoff scores of the HADS and TDQ for screening possible depressive disorders were 8 and 15, respectively. The areas under the receiver operating characteristic curve of the HADS and TDQ were mean 0.975±0.015 and 0.966±0.019, respectively. Thirteen participants (14%) were diagnosed with depressive disorders at the 6-month follow-up, compared with 8.5% at baseline. Conclusion Our results indicate that both the HADS and TDQ are valid instruments for screening depression in patients with HNC. PMID:27789953

  14. Depression and anxiety among patients with somatoform disorders, panic disorder, and other depressive/anxiety disorders in Taiwan.

    PubMed

    Huang, Wei-Lieh; Chen, Tzu-Ting; Chen, I-Ming; Ma, Huei-Mei; Lee, Ming-Tzu; Liao, Shih-Cheng; Gau, Shur-Fen

    2016-07-30

    The aim of this study is to compare the severity of depression and anxiety in individuals with somatoform disorders, panic disorder, other depressive/anxiety disorders, and healthy controls in a Han Chinese population. According to the DSM-IV-TR-based diagnostic interviews, we recruited 152 subjects with somatoform disorders (SG), 56 with panic disorder (PG), 85 with other depressive/anxiety disorders (OG), and 179 without any psychiatric disorder (NG). The four groups reported on the Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) for depressive and anxiety symptoms, respectively. Correlation analysis and multivariate regression analysis were used to determine the effects of demographic factors and psychiatric diagnoses on depressive and anxiety symptoms separately. BDI-II scores were not significantly different in SG, PG, and OG but were higher than NG. SG and PG had the highest BAI scores, whereas NG had the lowest. Multiple linear regression analyses revealed that the associated factors for BDI-II were gender, residential location, somatoform disorders, panic disorder, major depressive disorder (MDD), and generalized anxiety disorder, whereas BAI was significantly associated with somatoform disorders, panic disorder, and MDD. Our results strongly suggest the inclusion of clinical assessment of depressive and anxious symptoms in patients with somatoform disorders.

  15. [Masked depression].

    PubMed

    Preradović, M; Griva, D; Eror, S

    1991-01-01

    The study comprised 25 patients with masked depression and 30 patients with endogenous depression. According to the general characteristics both groups were homogenous and accordingly, comparable. Together with clinical evaluation of depressive syndrome, psychological management was applied. Rorschach test, Thematic Apperception Test and Minnesota Multiphasic Personality Inventory were used in the study. In the clinical picture of masked depressions somatovegetative disorders dominated and depressive behavior in endogenous depression. The frequence of suicid does not differ between patients with masked and endogenous depression.

  16. Perceived parental characteristics of patients with obsessive compulsive disorder, depression, and panic disorder.

    PubMed

    Merkel, W T; Pollard, C A; Wiener, R L; Staebler, C R

    1993-01-01

    It has been hypothesized that parents of patients with obsessive compulsive disorder exhibit specific traits. 320 consecutive inpatient admissions who met criteria for OCD, depression, and panic disorder checked a list of adjectives to describe their parents. Patients with OCD were 1) less likely to perceive their mothers as disorganized than depressives, 2) more likely to perceive their mothers as overprotective than depressives and 3) less likely to perceive their fathers as demanding than patients with panic. PMID:8404245

  17. Depression.

    ERIC Educational Resources Information Center

    Strock, Margaret

    Approximately ten percent of the population suffers from a depressive illness each year. Although the economic cost is high, the cost in human suffering is immeasurable. To help educate the population about this disorder, this paper presents a definition of depression and its common manifestations. The symptoms that people often experience are…

  18. Depression and wish to die in a multicenter cohort of ALS patients.

    PubMed

    Rabkin, Judith G; Goetz, Raymond; Factor-Litvak, Pam; Hupf, Jonathan; McElhiney, Martin; Singleton, Jessica; Mitsumoto, Hiroshi

    2015-06-01

    Our objective was to determine prevalence of depressive disorders and wish to die at the baseline visit of a longitudinal multisite study of patients with ALS. Structured telephone interviews were conducted with patients diagnosed in past 18 months at 16 U.S. ALS centers. Demographic, medical, psychiatric and other psychological measures were administered. Of 329 patients assessed, mean ALSFRS-R score was 36.6; 88% (289/329) had no depressive disorder, 7% (24/329) had minor depression, and 5% (16/329) had current major depressive disorder (DSM-IV criteria). Demographic, financial and employment factors were unrelated to depression, as were duration of ALS symptoms and respiratory status, although depressed patients had lower scores on the total ALSFRS-R (p = 0.004) and gross motor function (p < 0.001). Depressed patients reported less pleasure, greater suffering, weariness and anxiety, more stress, were less hopeful, felt less control over illness management, reported lower quality of life, more often had thoughts about ending their lives and hastening death (all p < 0.001). Of the 62 patients (19% of the sample) who expressed a wish to die, only 37% (23/62) were clinically depressed. In conclusion, depressive disorders are not necessarily to be expected of ALS patients. Wish to die is not always expressed in the context of depression and does not necessarily represent psychopathology as such.

  19. Depression and Wish to Die in a Multi-Center Cohort of ALS Patients

    PubMed Central

    Rabkin, Judith G.; Goetz, Raymond; Factor-Litvak, Pam; Hupf, Jonathan; McElhiney, Martin; Singleton, Jessica; Mitsumoto, Hiroshi

    2015-01-01

    Objective To determine prevalence of depressive disorders and wish to die at the baseline visit of a longitudinal multi-site study of patients with ALS. Methods Structured telephone interviews were conducted with patients diagnosed in past 18 months at 16 U.S. ALS centers. Demographic, medical, psychiatric and other psychological measures were administered. Results Of 329 patients assessed, mean ALSFRS-R score was 36.6; 88% (289/329) had no depressive disorder, 7% (24/329)had minor depression, and 5% (16/329)had current major depressive disorder (DSM-IV criteria). Demographic, financial and employment factors were unrelated to depression, as were duration of ALS symptoms and respiratory status, although depressed patients had lower scores on the total ALSFRS-R ( p = .004) and gross motor function (p<.001). Depressed patients reported less pleasure, greater suffering, weariness and anxiety, more stress, were less hopeful, felt less control over illness management, reported lower quality of life, more often had thoughts about ending their lives and hastening death (all p<.001). Of the 62 patients (19% of the sample) who expressed a wish to die, only 37% (23/62) were clinically depressed. Conclusions Depressive disorders are not only to be expected of ALS patients. Wish to die is not always expressed in the context of depression and does not necessarily represent psychopathology as such. PMID:25482273

  20. Central autonomic network mediates cardiovascular responses to acute inflammation: Relevance to increased cardiovascular risk in depression?

    PubMed Central

    Harrison, Neil A.; Cooper, Ella; Voon, Valerie; Miles, Ken; Critchley, Hugo D.

    2013-01-01

    Inflammation is a risk factor for both depression and cardiovascular disease. Depressed mood is also a cardiovascular risk factor. To date, research into mechanisms through which inflammation impacts cardiovascular health rarely takes into account central effects on autonomic cardiovascular control, instead emphasizing direct effects of peripheral inflammatory responses on endothelial reactivity and myocardial function. However, brain responses to inflammation engage neural systems for motivational and homeostatic control and are expressed through depressed mood state and changes in autonomic cardiovascular regulation. Here we combined an inflammatory challenge, known to evoke an acute reduction in mood, with neuroimaging to identify the functional brain substrates underlying potentially detrimental changes in autonomic cardiovascular control. We first demonstrated that alterations in the balance of low to high frequency (LF/HF) changes in heart rate variability (a measure of baroreflex sensitivity) could account for some of the inflammation-evoked changes in diastolic blood pressure, indicating a central (rather than solely local endothelial) origin. Accompanying alterations in regional brain metabolism (measured using 18FDG-PET) were analysed to localise central mechanisms of inflammation-induced changes in cardiovascular state: three discrete regions previously implicated in stressor-evoked blood pressure reactivity, the dorsal anterior and posterior cingulate and pons, strongly mediated the relationship between inflammation and blood pressure. Moreover, activity changes within each region predicted the inflammation-induced shift in LF/HF balance. These data are consistent with a centrally-driven component originating within brain areas supporting stressor evoked blood pressure reactivity. Together our findings highlight mechanisms binding psychological and physiological well-being and their perturbation by peripheral inflammation. PMID:23416033

  1. Remission and Recovery in the Treatment for Adolescents with Depression Study (TADS): Acute and Long-Term Outcomes

    ERIC Educational Resources Information Center

    Kennard, Betsy D.; Silva, Susan G.; Tonev, Simon; Rohde, Paul; Hughes, Jennifer L.; Vitiello, Benedetto; Kratochvil, Christopher J.; Curry, John F.; Emslie, Graham J.; Reinecke, Mark; March, John

    2009-01-01

    The remission and recovery rates of adolescent patients with depression who were treated with fluoxetine, cognitive-behavioral therapy, their combination, and placebos were examined through a multisite clinical trial. It is concluded that most depressed adolescents who received such therapies achieved remission at the end of nine months.

  2. Randomized Trial of Behavioral Activation, Cognitive Therapy, and Antidepressant Medication in the Acute Treatment of Adults with Major Depression

    ERIC Educational Resources Information Center

    Dimidjian, Sona; Hollon, Steven D.; Dobson, Keith S.; Schmaling, Karen B.; Kohlenberg, Robert J.; Addis, Michael E.; Gallop, Robert; McGlinchey, Joseph B.; Markley, David K.; Gollan, Jackie K.; Atkins, David C.; Dunner, David L.; Jacobson, Neil S.

    2006-01-01

    Antidepressant medication is considered the current standard for severe depression, and cognitive therapy is the most widely investigated psychosocial treatment for depression. However, not all patients want to take medication, and cognitive therapy has not demonstrated consistent efficacy across trials. Moreover, dismantling designs have…

  3. Cognitive Function before and during Treatment with Selective Serotonin Reuptake Inhibitors in Patients with Depression or Obsessive-Compulsive Disorder

    PubMed Central

    2016-01-01

    Objectives. Identification of adverse effects of selective serotonin reuptake inhibitors (SSRIs) is of great importance due to their extensive use in medicine. Some studies have reported the effects of SSRIs on cognitive functions, but the results are conflicting. This study was designed to assess the effect of these drugs on cognition of patients with depression or obsessive-compulsive disorder (OCD). Methods. Patients with depression or OCD, naïve to therapy, and candidates of receiving one drug from SSRI class, voluntarily, entered this study. Mini-Mental State Examination (MMSE) test was the tool to assess their cognitive functions. MMSE scores of each patient were recorded prior to taking SSRIs and at weeks 3, 5, and 8 of drug therapy. Results. 50 patients met our inclusion criteria, with a baseline mean MMSE score of 23.94. At 3, 5, and 8 weeks of treatment, the mean scores were 22.1, 21.4, and 20.66, respectively. With a p value of <0.0001, the gradual decline was statistically significant. Conclusion. The MMSE scores of our patients showed a gradual decline over the consecutive weeks after taking SSRI drugs. It seems that the use of SSRIs in patients with depression or OCD, can cause cognitive dysfunction in the acute phase of treatment. PMID:27597949

  4. Cognitive Function before and during Treatment with Selective Serotonin Reuptake Inhibitors in Patients with Depression or Obsessive-Compulsive Disorder.

    PubMed

    Sayyah, Mehdi; Eslami, Kaveh; AlaiShehni, Shabnam; Kouti, Leila

    2016-01-01

    Objectives. Identification of adverse effects of selective serotonin reuptake inhibitors (SSRIs) is of great importance due to their extensive use in medicine. Some studies have reported the effects of SSRIs on cognitive functions, but the results are conflicting. This study was designed to assess the effect of these drugs on cognition of patients with depression or obsessive-compulsive disorder (OCD). Methods. Patients with depression or OCD, naïve to therapy, and candidates of receiving one drug from SSRI class, voluntarily, entered this study. Mini-Mental State Examination (MMSE) test was the tool to assess their cognitive functions. MMSE scores of each patient were recorded prior to taking SSRIs and at weeks 3, 5, and 8 of drug therapy. Results. 50 patients met our inclusion criteria, with a baseline mean MMSE score of 23.94. At 3, 5, and 8 weeks of treatment, the mean scores were 22.1, 21.4, and 20.66, respectively. With a p value of <0.0001, the gradual decline was statistically significant. Conclusion. The MMSE scores of our patients showed a gradual decline over the consecutive weeks after taking SSRI drugs. It seems that the use of SSRIs in patients with depression or OCD, can cause cognitive dysfunction in the acute phase of treatment. PMID:27597949

  5. Acute Porphyria in a Patient with Arnold Chiari Malformation

    PubMed Central

    Shen, Jianbin; O’Keefe, Kevin; Webb, Lisa B.; DeGirolamo, Angela

    2015-01-01

    Patient: Female, 33 Final Diagnosis: Acute porphyria Symptoms: Abdominal pain • alternating bowel habits Medication: Metronidazole • bactrim • oxybutynin Clinical Procedure: EMG • porhyria workup Specialty: Neurology Objective: Rare disease Background: Acute porphyria and Arnold Chiari malformation are both uncommon genetic disorders without known association. The insidious onset, non-specific clinical manifestations, and precipitating factors often cause diagnosis of acute porphyria to be missed, particularly in patients with comorbidities. Case Report: A women with Arnold Chiari malformation type II who was treated with oxybutynin and antibiotics, including Bactrim for neurogenic bladder and recurrent urinary tract infection, presented with non-specific abdominal pain, constipation, and diarrhea. After receiving Flagyl for C. difficile colitis, the patient developed psychosis, ascending paralysis, and metabolic derangements. She underwent extensive neurological workup due to her congenital neurological abnormalities, most of which were unremarkable. As a differential diagnosis of Guillain Barré syndrome, acute porphyria was then considered and ultimately proved to be the diagnosis. After hematin administration and intense rehabilitation, the patient slowly recovered from the full-blown acute porphyria attack. Conclusions: This case report, for the first time, documents acute porphyria attack as a result of a sequential combination of 3 common medications. This is the first case report of the concomitant presence of both acute porphyria and Arnold Chiari malformation, 2 genetic disorders with unclear association. PMID:25697467

  6. Are There Gender-Specific Risk Factors for Suicidal Activity among Patients with Schizophrenia and Depression?

    ERIC Educational Resources Information Center

    Kaplan, Kalman J.; Harrow, Martin; Faull, Robert N.

    2012-01-01

    Are there gender-specific risk factors for suicidal activity among patients with schizophrenia and depression? A total of 74 schizophrenia patients (51 men, 23 women) and 77 unipolar nonpsychotic depressed patients (26 men, 51 women) from the Chicago Follow-up Study were studied prospectively at 2 years posthospitalization and again at 7.5 years.…

  7. [Uncertain effect of psychological treatment on depression for patients with cancer].

    PubMed

    Johnsen, Anna Thit; Ross, Lone; Guldin, Mai-Britt

    2016-08-29

    Depression is a well-known co-morbidity of cancer. A possible intervention for depression is psychological treatment defined as psychotherapy provided by a psychologist. In this narrative review we investigated the effect of psychological treatment on depression for patients with cancer. Six Cochrane reviews of 38 studies investigating psychological or psychosocial interventions were reviewed. One of the 38 studies could not be assessed. None of the included studies investigated psychological treatment for patients who were diagnosed with depression or included because of depression symptoms. PMID:27592868

  8. Retaining Low-Income Minority Cancer Patients in a Depression Treatment Intervention Trial: Lessons Learned.

    PubMed

    Wells, Anjanette A; Palinkas, Lawrence A; Williams, Sha-Lai L; Ell, Kathleen

    2015-08-01

    Previously published work finds significant benefit from medical and behavioral health team care among safety-net patients with major depression. This qualitative study assessed clinical social worker, psychiatrist and patient navigator strategies to increase depression treatment among low-income minority cancer patients participating in the ADAPt-C clinical depression trial. Patient care retention strategies were elicited through in-depth, semi-structured interviews with nine behavioral health providers. Using grounded theory, concepts from the literature and dropout barriers identified by patients, guided interview prompts. Retention strategies clustered around five dropout barriers: (1) informational, (2) instrumental, (3) provider-patient therapeutic alliance, (4) clinic setting, and (5) depression treatment. All strategies emphasized the importance of communication between providers and patients. Findings suggest that strong therapeutic alliance and telephone facilitates collaborative team provider communication and depression treatment retention among patients in safety-net oncology care systems.

  9. Perceived Chronic Stress Exposure Modulates Reward-Related Medial Prefrontal Cortex Responses to Acute Stress in Depression

    PubMed Central

    Kumar, Poornima; Slavich, George M.; Berghorst, Lisa H.; Treadway, Michael T.; Brooks, Nancy H.; Dutra, Sunny J.; Greve, Douglas N.; O'Donovan, Aoife; Bleil, Maria E.; Maninger, Nicole; Pizzagalli, Diego A.

    2015-01-01

    Introduction Major depressive disorder (MDD) is often precipitated by life stress and growing evidence suggests that stress-induced alterations in reward processing may contribute to such risk. However, no human imaging studies have examined how recent life stress exposure modulates the neural systems that underlie reward processing in depressed and healthy individuals. Methods In this proof-of-concept study, 12 MDD and 10 psychiatrically healthy individuals were interviewed using the Life Events and Difficulties Schedule (LEDS) to assess their perceived levels of recent acute and chronic life stress exposure. Additionally, each participant performed a monetary incentive delay task under baseline (no-stress) and stress (social-evaluative) conditions during functional MRI. Results Across groups, medial prefrontal cortex (mPFC) activation to reward feedback was greater during acute stress versus no-stress conditions in individuals with greater perceived stressor severity. Under acute stress, depressed individuals showed a positive correlation between perceived stressor severity levels and reward-related mPFC activation (r = 0.79, p = 0.004), whereas no effect was found in healthy controls. Moreover, for depressed (but not healthy) individuals, the correlations between the stress (r = 0.79) and no-stress (r = −0.48) conditions were significantly different. Finally, relative to controls, depressed participants showed significantly reduced mPFC grey matter, but functional findings remained when accounting for structural differences. Limitation Small sample size, which warrants replication. Conclusion Depressed individuals experiencing greater recent life stress recruited the mPFC more under stress when processing rewards. Our results represent an initial step toward elucidating mechanisms underlying stress sensitization and recurrence in depression. PMID:25898329

  10. Loneliness, depression, and social support of patients with cancer and their caregivers.

    PubMed

    Şahin, Zümrüt Akgün; Tan, Mehtap

    2012-04-01

    Loneliness is a significant psychosocial concern for patients with cancer, and depression may be an antecedent to loneliness. To date, no studies have directly addressed the relationship of loneliness, depression, and social support among Turkish patients with cancer and their caregivers. The emotional responses that result from a cancer diagnosis vary and may include anxiety, anger, frustration, or depression. Because of the unexpected demands and emotions thrust on them, the caregivers of patients with cancer may be just as likely to experience loneliness or depression following a cancer diagnosis. As a result, this study sought to examine that relationship among a sample of 60 patients with cancer and 60 caregivers.

  11. ST-segment depression on the initial electrocardiogram in acute myocardial infarction-prognostic significance and its effect on short-term mortality: A report from the National Registry of Myocardial Infarction (NRMI-2, 3, 4).

    PubMed

    Pitta, Sridevi R; Grzybowski, Mary; Welch, Robert D; Frederick, Paul D; Wahl, Robert; Zalenski, Robert J

    2005-04-01

    This study analyzed 255,256 patients who had acute myocardial infarction and were enrolled in the National Registry of Myocardial Infarction 2, 3, and 4 (1994 to 2002). The objective was to determine in-hospital mortality rate among patients who had ST-segment depression on the initial electrocardiogram. Patients who had ST-segment depression had an in-hospital mortality rate (15.8%) similar to that of patients who had ST-segment elevation or left bundle branch block (15.5%). After adjusting for observed differences, ST-segment depression was associated with only a slightly lower odds ratio (0.91) of mortality compared with ST-segment elevation or left bundle branch block. PMID:15781012

  12. Predictors of cognitive/affective and somatic depression in heart failure patients.

    PubMed

    Seo, Yaewon; Yates, Bernice; Dizona, Paul; Laframboise, Louise; Norman, Joseph

    2014-06-01

    The effects of depression on patients with heart failure (HF) are substantial, yet the predictors remain unclear. The predictors of cognitive/affective and somatic depression in stable HF patients were studied. Using a cross-sectional design, 150 HF outpatients were recruited at two mid-Western HF clinics. Predictors included dyspnea with activities of daily living, family and friend social support, and loneliness; age and gender were control variables. All constructs were measured using standardized instruments. Structural equation modeling (SEM) showed that cognitive/affective depression was predicted by greater dyspnea and loneliness, whereas somatic depression was predicted by more dyspnea and friend support. Also, greater dyspnea was related to more loneliness and less friend support; less friend support was related to loneliness. Women reported more dyspnea and loneliness. Since cognitive/affective and somatic depression have different predictors, further study is warranted to identify HF patients at risk for depression and to establish interventions targeted at improving depression.

  13. Inflammation markers and Major Depressive Disorder in Patients with Chronic Heart Failure: Results from the Sertraline Against Depression and Heart Disease in Chronic Heart Failure (SADHART-CHF) study

    PubMed Central

    Xiong, Glen L.; Prybol, Kevin; Boyle, Stephen H.; Hall, Russell; Streilein, Robert D; Steffens, David C.; Krishnan, Ranga; Rogers, Joseph G.; O’Connor, Christopher M.; Jiang, Wei

    2015-01-01

    Background Major Depressive Disorder (MDD) and Chronic Heart Failure (CHF) have in common heightening states of inflammation, manifested by elevated inflammation markers such as C-reactive protein (CRP). This study compared inflammatory biomarker profiles in CHF patients with MDD to those without MDD. Methods The study recruited patients admitted to inpatient care for acute heart failure exacerbations, after psychiatric diagnostic interview. Patients with Beck Depression Inventory (BDI) scores < 10 and with no prior history of depression served as the non-depressed reference group (n = 25). MDD severity was defined as: Mild (BDI 10–15; n = 48); Moderate (BDI 16–23; n = 51); and Severe (BDI ≥ 24; n = 33). A Bio-Plex assay measured 18 inflammation markers. Ordinal logistic models were used to examine the association of MDD severity and biomarker levels. Results Adjusting for age, sex, statin use, BMI, LVEF, tobacco use, and NHYA class the MDD overall group variable was significantly associated with elevated interleukin (IL) −2 (p = .019), IL-4 (p = .020), IL-6 (p = .026),, interferon (INF)-γ (p = .010), monocyte chemoattractant protein (MCP-1) (p = .002), macrophage inflammatory protein (MIP-1β) (p = .003) and tumor necrosis factor (TNF)-α (p = .004). MDD severity subgroups had a greater probability of elevated IL-6, IL-8, IFN-γ, MCP-1, MIP-1β, and TNF-α compared to none-depressed group. The non-depressed group had greater probability of elevated IL-17 (p < 0.001) and IL-1β (p < 0.01). Conclusions MDD in CHF patients was associated with altered inflammation marker levels compared to CHF patients who had no depression. Whether effective depression treatment will normalize the altered inflammation marker levels requires further study. PMID:26186432

  14. Identifying and managing patients with delirium in acute care settings.

    PubMed

    Bond, Penny; Goudie, Karen

    2015-11-01

    Delirium is an acute medical emergency affecting about one in eight acute hospital inpatients. It is associated with poor outcomes, is more prevalent in older people and it is estimated that half of all patients receiving intensive care or surgery for a hip fracture will be affected. Despite its prevalence and impact, delirium is not reliably identified or well managed. Improving the identification and management of patients with delirium has been a focus for the national improving older people's acute care work programme in NHS Scotland. A delirium toolkit has been developed, which includes the 4AT rapid assessment test, information for patients and carers and a care bundle for managing delirium based on existing guidance. This toolkit has been tested and implemented by teams from a range of acute care settings to support improvements in the identification and immediate management of delirium.

  15. A Prospective Study of Depression and Anxiety in Female Fertility Preservation and Infertility Patients

    PubMed Central

    Lawson, Angela K.; Klock, Susan C.; Pavone, Mary Ellen; Hirshfeld-Cytron, Jennifer; Smith, Kristin N.; Kazer, Ralph R.

    2014-01-01

    Objective To prospectively assess anxiety, depression, coping, and appraisal in female fertility preservation patients compared to infertile patients. Design Prospective pre- and post-treatment survey. Setting Academic medical center. Patients 47 women with cancer (FP) and 91 age-matched infertile patients. Interventions None. Main Outcome Measures Depression, anxiety, coping, infertility–related stress, appraisal of treatment, and medical outcomes. Results FP patients reported more symptoms of anxiety and depression than infertile patients, but infertile patients’ symptoms worsened over time. 44% of FP and 14% of infertile patients’ scores exceeded the clinical cut-off for depression at pre-treatment. The interval between surveys and medical treatment data did not predict changes in mood symptoms. Coping strategies and infertility-related stress did not differ between groups and avoidant coping predicted higher depression and anxiety scores. Conclusion FP patients reported more anxiety and depression than infertile patients at enrollment in treatment, with more than one third of FP patients reporting clinically significant depressive symptoms. However, infertile patients’ anxiety and depressive symptoms increased across treatment. This increase was not related to time between registration for IVF and oocyte retrieval or the medical aspects of treatment. FP and infertile patients should be provided psychological consultation prior to treatment to identify mood and anxiety symptoms and to refer patients for counseling as needed to prevent worsening of symptoms. PMID:25154674

  16. The impact of depression in older patients with chronic obstructive pulmonary disease and asthma.

    PubMed

    Connolly, M J; Yohannes, A M

    2016-10-01

    Respiratory diseases are common in older people. However, the impact of comorbid depression in older patients with chronic obstructive pulmonary disease (COPD) and asthma has not been fully explored. This narrative review examines the impact of comorbid depression and its management in COPD and asthma in older adults. The causes of depression in patients with COPD and asthma are multifactorial and include physical, physiological and behavioural factors. Depression is associated with hospital readmission in older adults with asthma and COPD. We focus on the most current literature that has examined the efficacy of pulmonary rehabilitation (PR), cognitive behavioural therapy (CBT) and antidepressant drug therapy for patients with depression in the context of COPD and asthma. Our findings indicate that PR and CBT are beneficial in improving depressive symptoms and quality of life in short-term intervention studies. However, the long-term efficacy of CBT and PR is unknown. To date, the efficacy of antidepressant drug therapy for depression in patients with COPD and asthma is inconclusive. In addition, there has been no clear evidence that antidepressants can induce remission of depression or ameliorate dyspnoea or physiological indices of COPD. Factors that contribute to 'inadequate' assessment and treatment of depression in patients with COPD and asthma may include misconception of the disease by patients and their caregivers and stigma attached to depression. Thus, well-controlled randomized controlled trials are needed. PMID:27621232

  17. Particulate Air Pollution as a Risk Factor for ST-segment Depression in Patients with Coronary Artery Disease

    PubMed Central

    Chuang, Kai Jen; Coull, Brent A.; Zanobetti, Antonella; Suh, Helen; Schwartz, Joel; Stone, Peter H.; Litonjua, Augusto; Speizer, Frank E.; Gold, Diane R.

    2009-01-01

    Background The association of particulate matter (PM) with cardiovascular morbidity and mortality is well documented. PM-induced ischemia is considered a potential mechanism linking PM to adverse cardiovascular outcomes. Methods and Results In a repeated-measures study including 5,979 observations on 48 patients aged 43–75 years, we investigated associations of ambient pollution with ST-segment level changes averaged over half-hour periods, measured in the modified V5 position by 24-hr Holter electrocardiogram monitoring. Each patient was observed up to 4 times within one year after a percutaneous intervention for myocardial infarction, acute coronary syndrome without infarction, or stable coronary artery disease without acute coronary syndrome. Elevation in fine particles (PM2.5) and black carbon (BC) levels predicted depression of half-hour averaged ST-segment levels. An interquartile increase in the previous 24-h mean BC level was associated with a 1.50-fold increased in risk of ST-segment depression ≥0.1 mm (95% CI: 1.19, 1.89) and a −0.031 mm (95% CI: −0.042, −0.019) decrease in half-hour averaged ST-segment level (continuous outcome). Effects were greatest within the first month after hospitalization, and for patients with myocardial infarction during hospitalization or with diabetes. Conclusions ST-segment depression is associated with increased exposure to PM2.5 and BC in cardiac patients. The risk of pollution-associated ST-segment depression may be greatest in those with myocardial injury in the first month after the cardiac event. PMID:18779445

  18. Unrevealed Depression Involves Dysfunctional Coping Strategies in Crohn's Disease Patients in Clinical Remission

    PubMed Central

    Viganò, Caterina; Calzolari, Roberta; Marinaccio, Paola Marianna; Bezzio, Cristina; Furfaro, Federica; Ba, Gabriella; Maconi, Giovanni

    2016-01-01

    Background and Aims. This study investigated the proportion of CD patients in clinical remission with clinical depression, and coping strategies in those with severe depressive disorders. Materials and Methods. One hundred consecutive CD patients in clinical remission were screened for anxiety and depression by using Hospital Anxiety and Depression Scale and patients with depressive symptoms were further investigated by means of Cognitive Behavioural Assessment 2.0 and Beck Depression Inventory (BDI). Afterwards the coping strategies were assessed through the Brief-COPE questionnaire. Results. Twenty-one patients had anxious symptoms and 16 had depressive symptoms with or without anxiety. Seven of these patients (43.8%) showed significant depressive symptoms. Compared to patients without psychiatric disorders, these patients showed significant lower score in “positive reframing” (p: 0.017) and in “planning” (p: 0.046) and higher score in “use of instrumental social support” (p < 0.001), in “denial” scale (p: 0.001), and in “use of emotional social support” (p: 0.003). Conclusions. Depressed CD patients in clinical remission may have dysfunctional coping strategies, meaning that they may not be able to implement functional strategies to manage at best stress related with their disease. PMID:26823663

  19. Metformin may produce antidepressant effects through improvement of cognitive function among depressed patients with diabetes mellitus.

    PubMed

    Guo, Min; Mi, Jia; Jiang, Qiu-Ming; Xu, Jin-Mei; Tang, Ying-Ying; Tian, Geng; Wang, Bin

    2014-09-01

    Diabetes mellitus and depressive disorders are both common chronic diseases that increase functional disability and social burden. Cognitive impairment is a potentially debilitating feature of depression. Previous evidence indicates that the antidiabetic drug metformin could be suitable for diabetic patients with cognitive impairment. However, there is no direct evidence from clinical studies that metformin treatment improves cognitive function in diabetic patients suffering from depression. In the present study, 58 participants diagnosed with depression and type 2 diabetes mellitus (T2DM) were recruited and divided into two groups, one treated with metformin and the other treated with placebo for 24 weeks. Cognitive function, depressive behaviour and diabetes improvement were evaluated. Chronic treatment with metformin for 24 weeks improved cognitive performance, as assessed by the Wechsler Memory Scale-Revised, in depressed patients with T2DM. In addition, metformin significantly improved depressive performance and changed the glucose metabolism in depressed patients with diabetes. Depressive symptoms were negatively correlated with cognitive performance in metformin-treated participants. Furthermore, associations were observed between the parameters of blood glucose metabolism and the depression phenotype. These findings suggest that chronic treatment with metformin has antidepressant behavioural effects and that improved cognitive function is involved in the therapeutic outcome of metformin. The results of the present study also raise the possibility that supplementary administration of antidiabetic medications may enhance the recovery of depression, comorbid with T2DM, through improvements in cognitive performance.

  20. Low intracellular magnesium in patients with acute pancreatitis and hypocalcemia.

    PubMed Central

    Ryzen, E.; Rude, R. K.

    1990-01-01

    To determine the role of magnesium deficiency in the pathogenesis of hypocalcemia in acute pancreatitis, we measured magnesium levels in serum and in peripheral blood mononuclear cells in 29 patients with acute pancreatitis, 14 of whom had hypocalcemia and 15 of whom had normal calcium levels. Only six patients had overt hypomagnesemia (serum magnesium less than 0.70 mmol per liter [1.7 mg per dl]). The mean serum magnesium concentration in hypocalcemic patients was not significantly lower than in normocalcemic patients, but the mononuclear cell magnesium content in hypocalcemic patients with pancreatitis was significantly lower than in normocalcemic patients with pancreatitis (P less than .01). The serum magnesium level did not correlate with that of serum calcium or the mononuclear cell magnesium content, but the latter did significantly correlate with the serum calcium concentration (r = .81, P less than .001). Most patients with hypocalcemia had a low intracellular magnesium content. Three normomagnesemic, hypocalcemic patients with alcoholic pancreatitis also underwent low-dose parenteral magnesium tolerance testing and showed increased retention of the magnesium load. We conclude that patients with acute pancreatitis and hypocalcemia commonly have magnesium deficiency despite normal serum magnesium concentrations. Magnesium deficiency may play a significant role in the pathogenesis of hypocalcemia in patients with acute pancreatitis. PMID:2407029

  1. Depression.

    PubMed

    Weissman, Myrna

    2009-04-01

    This is an invited article on how my career as an epidemiologist studying depression unfolded. The role of the Civil Rights movement in opening the PhD doors to women at Yale began my career. The unfolding of depression studies are described. These studies included a clinical trial of medication and what later was known as interpersonal psychotherapy (IPT), the first community survey of psychiatric disorder, family genetic and brain imaging studies or depression and anxiety disorders. I hope the new generation will have the wonderful opportunities I have had.

  2. Depression.

    PubMed

    Weissman, Myrna

    2009-04-01

    This is an invited article on how my career as an epidemiologist studying depression unfolded. The role of the Civil Rights movement in opening the PhD doors to women at Yale began my career. The unfolding of depression studies are described. These studies included a clinical trial of medication and what later was known as interpersonal psychotherapy (IPT), the first community survey of psychiatric disorder, family genetic and brain imaging studies or depression and anxiety disorders. I hope the new generation will have the wonderful opportunities I have had. PMID:19344866

  3. Recollection deficiencies in patients with major depressive disorder.

    PubMed

    Drakeford, Justine L; Edelstyn, Nicola M J; Oyebode, Femi; Srivastava, Shrikant; Calthorpe, William R; Mukherjee, Tirthankar

    2010-02-28

    Neuropsychological research suggests that recognition memory (RM) and recall memory are impaired in patients with a major depressive disorder or a dysphoric mood state. This study examines the proposal that abnormalities in recollection (a form of recall) result from a breakdown in frontal strategic memory processes involved in encoding and retrieval, and executive functions linked to reality monitoring, planning, problem-solving, reasoning and decision-making. We investigated two predictions arising from this theory. Firstly, patients diagnosed with a major depressive disorder (MDD) will display a dissociation between (deficient) recollection and (preserved) familiarity. Secondly, if recollection impairments are indicative of a breakdown in prefrontal strategic memory processes which are dependent, at least in part, on executive processes, then an explicit correlational approach predicts that recollection will be positively associated with the severity of executive dysfunction in MDD patients. The remember/know paradigm was used to investigate RM for words and neutral faces in 16 MDD patients and 16 healthy volunteers, matched for age, gender and estimates of premorbid IQ. Measures of executive function included working memory, reasoning and decision-making. Applying the Dual Process Signal Detection interpretation of the remember/know data, the MDD group displayed significant impairments in RM and recollection rates for both verbal and neutral facial memoranda. In contrast, familiarity-aware rates were preserved. There was no evidence of executive dysfunction in the patient group, and little evidence that recollection rates correlated with executive function. Furthermore, a single process signal detection approach suggested that the MDD patients displayed a reduction in sensitivity for RM and remember rates but not know responses. The criteria for detecting studied from unstudied items, and remembering from knowing, were the same in both patient and healthy

  4. Epidemiology, Diagnosis, and Management of Depression in Patients With CKD

    PubMed Central

    Hedayati, S. Susan; Finkelstein, Fredric O.

    2011-01-01

    CASE PRESENTATION A 58-year-old Hispanic man who has been dialysis dependent for 2 years because of diabetic nephropathy reports depressive symptoms during dialysis rounds. For the past 6 weeks, he has had reduced energy and difficulty sleeping and concentrating. He reports a loss of interest in his usual hobbies and family activities and notes an increasing sense of feeling worthless and guilty. He denies suicidal ideation. Medical history includes diabetic retinopathy and neuropathy, coronary artery disease treated with 4-vessel coronary artery bypass grafting 3 years ago, ischemic cardiomyopathy with an ejection fraction of 30%, and cerebrovascular disease. His wife recently has been given a diagnosis of breast cancer. His medications are aspirin, metoprolol, lisinopril, simvastatin, sevelamer, and epoetin alfa. His blood pressure is 130/75 mm Hg, pulse is 65 beats/min, and cardiac and pulmonary examination results are unremarkable. He is interviewed by the social worker in the dialysis unit, who diagnoses clinical depression by using standard Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM IV) criteria. The patient refuses to discuss his problems with the social worker and declines further psychiatric evaluation. His nephrologist discusses a trial of antidepressant medication, but the patient refuses to use additional medication. During the next month, the patient presents with greater interdialytic weight gains and begins to come late for dialysis sessions. He then presents to a dialysis session reporting dyspnea and orthopnea and is found to have a 10-kg weight gain. On physical examination, blood pressure is 196/96 mm Hg and he has increased jugular venous pressure and bibasilar crackles. He is admitted to the hospital with a diagnosis of congestive heart failure. PMID:19592143

  5. Depression

    MedlinePlus

    ... newborns, as well as jitteriness, difficulty feeding, and low blood sugar after delivery. However, moms who stop medications can ... a kind of antidepressant for treating depression and anxiety disorders. However, a number of research studies show ...

  6. The Effects of Music Therapy on Anxiety and Depression of Cancer Patients

    PubMed Central

    Jasemi, Madineh; Aazami, Sanaz; Zabihi, Roghaieh Esmaili

    2016-01-01

    Background and Purpose: Cancer patients often suffer from anxiety and depression. Various methods are used to alleviate anxiety and depression, but most of them have side effects. Music therapy can be used as a noninvasive method to reduce anxiety and depression. This study aimed to examine the effect of music therapy on anxiety and depression in patients with cancer. Materials and Methods: This quasi-experimental study was conducted attaching hospitals in Urmia city. A total number of sixty patients with depression and anxiety were recruited using random sampling method and divided into two groups of control and intervention. Patients in intervention group listened to light music at least 20 min per day for 3 days. The degree of patients’ anxiety and depression was assessed by Hospital Anxiety and Depression Scale at baseline and 3 days after music therapy. Data were analyzed by SPSS version 13 using t-test, Pearson, and ANOVA tests. Results: The results showed no significant differences between demographic variable of intervention and control groups. Our findings indicated a significant decrease in the level of depression and anxiety among intervention group. There were significant relationships between anxiety, depression, and sex (P < 0.001, r = 0.42) as well as education (P = 0.003, r = 0.37). Conclusion: This study revealed positive effects of music therapy on decreasing level of depression and anxiety in patients with cancer. Therefore, it is recommended to include music therapy in the nursing care. PMID:27803568

  7. [Treatment of patients with coronary heart disease and depressive disorders in rehabilitation].

    PubMed

    Barth, Jürgen; Härter, Martin; Paul, Juliane; Bengel, Jürgen

    2005-01-01

    Depressive disorders in patients with coronary heart disease (CHD) are connected with negative effects on the course of the cardiac disease. Until today there has been no clear etiological model to explain the interaction of depressive disorders and cardiac risk parameters. Both, somatic and behavioural aspects seem to be important. Depressive symptoms are a serious risk factor for CHD-patients demanding for a broad bio-psychosocial treatment conception in cardiac rehabilitation. Most intervention studies have mainly focussed on the reduction of depressive and anxious symptoms in CHD-patients without co-morbid mental disorders. However, for CHD-patients with a co-morbid depressive disorder specific psychotherapeutic and psychopharmacological treatments have proved a reduction in depressive symptoms. This reduction in depression was -- unexpectedly -- not associated with an improved cardiac prognosis. Based on these previous studies the present paper introduces the concept of a combined psychotherapeutic and psychopharmacological intervention for depressed patients in cardiac rehabilitation. Specific characteristics of the patients and of the health care system are taken into consideration. Anticipated difficulties in the psychotherapeutic treatment of depressive CHD-patients are addressed and possible solutions are indicated.

  8. Depression in end-stage renal disease patients treated with hemodialysis: tools, correlates, outcomes, and needs.

    PubMed

    Kimmel, Paul L; Peterson, Rolf A

    2005-01-01

    Depression has been thought to be the most common psychiatric abnormality in hemodialysis (HD) patients. There are few data using psychiatric diagnostic criteria and a lack of large, well-designed epidemiologic research studies in patients with end-stage renal disease (ESRD) that can render definitive results on this topic. The prevalence of major depression or a defined psychiatric illness in ESRD patients is unknown, but is probably between 5% and 10%. The prevalence of increased levels of depressive affect is greater. Estimates of the prevalence will vary according to the screening techniques used. Depression could affect medical outcomes in ESRD patients through several mechanisms. Correlational analyses suggest stressors and protective factors play roles in mediating the level of depressive affect and associated outcomes. Although early studies suggested a deleterious effect of depression on survival in ESRD patients, more recent studies had failed to confirm such findings. The use of longitudinal analyses and larger samples has confirmed an association of depressive affect and morbidity and mortality in more contemporary ESRD populations. The importance of depressive affect compared with the presence of a defined psychiatric syndrome in mediating clinically important outcomes in patients with chronic kidney disease has not been determined. Studies of interventions designed to reduce levels of depressive affect in ESRD patients are urgently needed.

  9. Cortical thinning in drug-naive Parkinson's disease patients with depression.

    PubMed

    Luo, ChunYan; Song, Wei; Chen, Qin; Yang, Jing; Gong, QiYong; Shang, Hui-Fang

    2016-10-01

    To shed more light on the contribution of brain structural changes to PD-related depressive symptoms, this study conducted cortical thickness analysis in drug-naive PD patients with and without depression. We recruited 27 PD patients with depression (PD-Dep), 29 PD patients without depression (PD-NDep), and 56 normal controls. T1 weighted magnetic resonance imaging and surface-based morphometric analyses were performed to examine morphometric abnormalities in PD patients and their relationship to depression. We found decreased thickness in the left prefrontal cortex in PD-Dep group compared with PD-NDep group. No significant difference was found between PD patients and controls. In addition, we found there is a trend of inverse correlation between the structural changes and the score of depressive symptom in depressed PD patients. This study demonstrates that cortical thinning in prefrontal area in drug-naive PD patients with depression and highlights the critical role of prefrontal region in the depression associated with PD. PMID:27485171

  10. Depressive and Anxiety Disorders in Systemic Lupus Erythematosus Patients without Major Neuropsychiatric Manifestations

    PubMed Central

    Zhao, Yueyin; Cheng, Yuqi; Li, Shu; Lai, Aiyun; Xie, Zhongqi; Xu, Xinyu; Lu, Zhaoping

    2016-01-01

    Depressive and anxiety disorders are frequently observed in patients with Systemic Lupus Erythematosus (SLE). However, the underlying mechanisms are still unknown. We conducted this survey to understand the prevalence of depression and anxiety in SLE patients without major neuropsychiatric manifestations (non-NPSLE) and to explore the relationship between emotional disorders, symptoms, autoantibodies, disease activity, and treatments in SLE. 176 SLE patients were included, and SLE disease activity index (SLEDAI), Hamilton Depression Rating Scale (HAMD), and Hamilton Anxiety Rating Scale (HAMA) were recorded to evaluate their disease activity and emotional status. We found that depressive and anxiety disorders were common among SLE patients: 121 (68.8%) patients were in depression status while 14 (8.0%) patients could be diagnosed with depression. Accordingly, 101 (57.4%) were in anxiety status and 21 (11.9%) could be diagnosed with anxiety. Depression was associated with disease activity, and anxiety was associated with anti-P0 antibody, while both of them were associated with proteinuria. HAMA and HAMD scores were in strong positive correlation and they were independent risk factors of each other. We concluded that the high prevalence of depression and anxiety and the association between depression and SLE disease activity might reveal the covert damage of central nervous system in SLE. The role of anti-P0 antibody in SLE patients with emotional disorders warrants more researches. PMID:27747246

  11. The Inventory Of Depressive Symptomatology (IDS-C(28)) is more sensitive to changes in depressive symptomatology than the Hamilton Depression Rating Scale (HAMD(17)) in patients with mild major, minor or subsyndromal depression.

    PubMed

    Helmreich, Isabella; Wagner, Stefanie; Mergl, Roland; Allgaier, Antje-Kathrin; Hautzinger, Martin; Henkel, Verena; Hegerl, Ulrich; Tadić, André

    2011-08-01

    Depression rating scales play a decisive role in the assessment of the severity of depression and the evaluation of the efficacy of antidepressant treatments. The Hamilton Depression Rating Scale (HAMD) is regarded as the 'gold standard'; nevertheless, studies suggest that the Inventory of Depressive Symptomatology (IDS) is more sensitive to detect symptom changes. The aim of the present study was to investigate whether the IDS is more sensitive in detecting changes in depression symptoms in patients with mild major, minor or subsyndromal depression (MIND). Biweekly IDS-C(28) and HAMD(17) data from 340 patients of a 10-week randomized, placebo-controlled trial comparing the effectiveness of sertraline and cognitive-behavioural therapy in patients with MIND were analysed. We investigated sensitivity to change for both scales (1) from assessment-to-assessment, (2) in relation to depression severity level, and (3) in relation to DSM-IV depression criterion symptoms. The IDS-C(28) was more sensitive in detecting changes in depression symptomatology over the treatment course as well as for different severity levels, especially in patients with a low depression severity. It assesses the DSM-IV criteria more thoroughly, is better able to track the change of cognitive symptoms and to identify residual symptoms. Both scales are well able to assess depressive symptomatology. However, the IDS-C(28) surpasses the HAMD(17) in detecting small changes especially in the core symptoms of depression. This is important for an optimal treatment by capturing early improvements, enabling prompt reactions and detecting residual symptoms.

  12. Remission and Recovery in the Treatment for Adolescents with Depression Study (TADS): Acute and Long-term Outcomes

    PubMed Central

    Kennard, Betsy D.; Silva, Susan G.; Tonev, Simon; Rohde, Paul; Hughes, Jennifer L.; Vitiello, Benedetto; Kratochvil, Christopher J.; Curry, John F.; Emslie, Graham J.; Reinecke, Mark; March, John

    2010-01-01

    Objective We examine remission rate probabilities, recovery rates, and residual symptoms across 36 weeks in the Treatment for Adolescents with Depression Study (TADS). Method TADS, a multisite clinical trial, randomized 439 adolescents with major depressive disorder (MDD) to 12 weeks of treatment to fluoxetine (FLX), cognitive behavioral therapy (CBT), their combination (COMB), or pill placebo (PBO). The PBO group, treated openly after week 12, was not included in the subsequent analyses. Treatment differences in remission rates and probabilities of remission over time are compared. Recovery rates in remitters at week 12 (acute phase remitters) and week 18 (continuation phase remitters) are summarized. We also examined whether residual symptoms at the end of 12 weeks of acute treatment predicted later remission. Results At Week 36, the estimated remission rates for intention-to-treat cases were: COMB: 60%, FLX: 55%; CBT: 64%; overall: 60%. Paired comparisons reveal that at week 24 all active treatments converge on remission outcomes. The recovery rate at Week 36 was 65% for acute phase remitters and 71% for continuation phase remitters, with no significant between-treatment differences in recovery rates. Residual symptoms at the end of acute treatment predicted failure to achieve remission at weeks 18 and 36. Conclusions The majority of depressed adolescents in all three treatment modalities achieved remission at the end of nine months of treatment. PMID:19127172

  13. Flavopiridol, Cytarabine, and Mitoxantrone in Treating Patients With Acute Leukemia

    ClinicalTrials.gov

    2013-10-07

    Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Secondary Acute Myeloid Leukemia; Untreated Adult Acute Lymphoblastic Leukemia; Untreated Adult Acute Myeloid Leukemia

  14. Liver Function Test Abnormalities in Depressed Patients Treated with Antidepressants: A Real-World Systematic Observational Study in Psychiatric Settings

    PubMed Central

    Verstuyft, Céline; Corruble, Emmanuelle; Perlemuter, Gabriel; Colle, Romain

    2016-01-01

    Background Concerning the risk of antidepressant induced liver injury, it is not clear whether psychiatrists perform a liver function test (LFT) and whether an increase in aminotransferase levels should contraindicate antidepressant treatment. Aim To evaluate LFT availability, the prevalence of LFT abnormalities and the probable cause of an altered LFT in patients with a major depressive episode (MDE) requiring an antidepressant drug. Methods We studied LFT evaluation in a real world psychiatric setting, in a sample of 321 consecutive patients with a current major depressive episode (MDE) requiring an antidepressant drug treatment, but without current alcohol or drug dependence or unstable medical disease. Results An LFT is performed in 36.1% (116/321) of depressed patients. One fifth of antidepressant-treated patients who had an LFT evaluation had abnormal results. The most frequent causes of LFT abnormalities were: NAFLD (nonalcoholic fatty liver disease) (7/321; 2.1%), acute alcohol consumption (4/321; 1.2%), antidepressant-induced liver injury (3/321; 0.9%), hepatitis C virus infection (2/321; 0.6%) and heart failure (1/321; 0.3%). The cause of LFT abnormalities was unknown in 32% of patients (8/25) due to the absence of etiological investigations. Conclusion These results demonstrate that an LFT is infrequently performed by psychiatrists in depressed patients requiring an antidepressant drug. Baseline LFT assessment and observations during the first six months of antidepressant treatment may be useful for detection of patients with pre-existing liver disease such as NAFLD, and early identification of cases of antidepressant-induced liver injury. An increase in aminotransferase levels may be related to an underlying liver disease, but does not contraindicate antidepressant treatment. PMID:27171561

  15. Acute pain management in the opioid-tolerant patient.

    PubMed

    Bourne, Nicola

    The main goals in treating acute pain in opioid-tolerant patients are effective pain relief and prevention of withdrawal symptoms. This article provides an overview of the issues that practitioners need to consider when caring for potential and actual opioid-tolerant patients experiencing acute pain, for example following surgery or injury. It highlights the importance of a multimodal analgesic approach to pain control and the prevention of withdrawal. It defines the terminology used in managing opioid-tolerant patients in order to allay healthcare professionals' misconceptions.

  16. Treatment of hyperglycaemia in patients with acute stroke.

    PubMed

    Castilla-Guerra, L; Fernández-Moreno, M C; Hewitt, J

    2016-03-01

    The proportion of diabetic patients who are hospitalised for stroke has been increasing in recent years, currently reaching almost a third of all cases of stroke. In addition, about half of patients with acute stroke present hyperglycaemia in the first hours of the stroke. Although hyperglycaemia in the acute phase of stroke is associated with a poor prognosis, its treatment is currently a topic of debate. There is no evidence that the adminstration of intravenous insulin to these patients offers benefits in terms of the evolution of the stroke. New studies in development, such as the SHINE study (Stroke Hyperglycemia Insulin Network Effort), may contribute to clarifying the role of intensive control of glycaemia during the acute phase of the stroke. Ultimately, patients who have presented with stroke should be screened for diabetes. PMID:26189890

  17. Imaging Recommendations for Acute Stroke and Transient Ischemic Attack Patients

    PubMed Central

    Wintermark, Max; Sanelli, Pina C.; Albers, Gregory W.; Bello, Jacqueline A.; Derdeyn, Colin P.; Hetts, Steven W.; Johnson, Michele H.; Kidwell, Chelsea S.; Lev, Michael H.; Liebeskind, David S.; Rowley, Howard A.; Schaefer, Pamela W.; Sunshine, Jeffrey L.; Zaharchuk, Greg; Meltzer, Carolyn C.

    2014-01-01

    In the article entitled “Imaging Recommendations for Acute Stroke and Transient Ischemic Attack Patients: A Joint Statement by the American Society of Neuroradiology, the American College of Radiology and the Society of NeuroInterventional Surgery”, we are proposing a simple, pragmatic approach that will allow the reader to develop an optimal imaging algorithm for stroke patients at their institution. PMID:23948676

  18. Depression symptoms reduce physical activity in COPD patients: a prospective multicenter study

    PubMed Central

    Dueñas-Espín, Iván; Demeyer, Heleen; Gimeno-Santos, Elena; Polkey, Michael I; Hopkinson, Nicholas S; Rabinovich, Roberto A; Dobbels, Fabienne; Karlsson, Niklas; Troosters, Thierry; Garcia-Aymerich, Judith

    2016-01-01

    Background The role of anxiety and depression in the physical activity (PA) of patients with COPD is controversial. We prospectively assessed the effect of symptoms of anxiety and depression on PA in COPD patients. Methods We evaluated anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), PA (Dynaport® accelerometer), and other relevant characteristics in 220 COPD patients from five European countries at baseline and at 6 and 12 months of follow-up. HADS score was categorized as: no symptoms (score 0–7), suggested (8–10), and probable (>11) anxiety or depression. We estimated the association between anxiety and depression at t (baseline and 6 months) and PA at t+1 (6 and 12 months) using regression models with a repeated measures approach. Results Patients had a mean (standard deviation) age of 67 (8) years, forced expiratory volume in 1 second 57 (20)% predicted. At baseline, the prevalence of probable anxiety and depression was 10% and 5%, respectively. In multivariable models adjusted by confounders and previous PA, patients performed 81 fewer steps/day (95% confidence interval, −149 to −12, P=0.02) per extra point in HADS-depression score. HADS-anxiety symptoms were not associated with PA. Conclusion In COPD patients, symptoms of depression are prospectively associated with a measurable reduction in PA 6 months later. PMID:27354787

  19. Comparisons of the tolerability and sensitivity of quetiapine-XR in the acute treatment of schizophrenia, bipolar mania, bipolar depression, major depressive disorder, and generalized anxiety disorder.

    PubMed

    Wang, Zuowei; Kemp, David E; Chan, Philip K; Fang, Yiru; Ganocy, Stephen J; Calabrese, Joseph R; Gao, Keming

    2011-02-01

    Quetiapine extended-release (quetiapine-XR) has been studied in patients with schizophrenia, bipolar mania, bipolar depression, major depressive disorder (MDD), and generalized anxiety disorder (GAD). The purpose of this study was to compare the tolerability and sensitivity of quetiapine-XR among these psychiatric conditions. The discontinuation due to adverse events (DAEs) and reported somnolence in randomized, double-blind, placebo-controlled studies of quetiapine-XR in these psychiatric conditions were examined. The absolute risk reduction or increase and the number needed to treat to benefit (NNTB) or harm (NNTH) for DAEs and reported somnolence of quetiapine-XR ≥ 300 mg/d relative to placebo were estimated. Data from one study in schizophrenia (n=465), one in mania (n=316), one in bipolar depression (n=280), two in refractory MDD (n=624), two in MDD (n=669) and three in GAD (n=1109) were available. The risk for DAEs of quetiapine-XR relative to placebo was significantly increased in bipolar depression (NNTH=9), refractory MDD (NNTH=8), MDD (NNTH=9), and GAD (NNTH=5), but not in schizophrenia and mania. The risk for reported somnolence of quetiapine-XR relative to placebo was significantly increased in schizophrenia (600 mg/d NNTH=15 and 800 mg/d NNTH=11), mania (NNTH=8), bipolar depression (NNTH=4), refractory MDD (NNTH=5), MDD (NNTH=5) and GAD (NNTH=5). These results suggest that patients with GAD had the poorest tolerability during treatment with quetiapine-XR, but they had a similar sensitivity as those with bipolar depression and MDD. Patients with schizophrenia or mania had a higher tolerability and a lower sensitivity than those with bipolar depression, MDD, or GAD.

  20. Noninvasive ventilation for patients with acute lung injury or acute respiratory distress syndrome.

    PubMed

    Nava, Stefano; Schreiber, Ania; Domenighetti, Guido

    2011-10-01

    Few studies have been performed on noninvasive ventilation (NIV) to treat hypoxic acute respiratory failure in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The outcomes of these patients, for whom endotracheal intubation is not mandatory, depend on the degree of hypoxia, the presence of comorbidities and complications, and their illness severity. The use of NIV as an alternative to invasive ventilation in severely hypoxemic patients with ARDS (ie, P(aO(2))/F(IO(2)) < 200) is not generally advisable and should be limited to hemodynamically stable patients who can be closely monitored in an intensive care unit by highly skilled staff. Early NIV application may be extremely helpful in immunocompromised patients with pulmonary infiltrates, in whom intubation dramatically increases the risk of infection, pneumonia, and death. The use of NIV in patients with severe acute respiratory syndrome and other airborne diseases has generated debate, despite encouraging clinical results, mainly because of safety issues. Overall, the high rate of NIV failure suggests a cautious approach to NIV use in patients with ALI/ARDS, including early initiation, intensive monitoring, and prompt intubation if signs of NIV failure emerge. PMID:22008399

  1. A Study of Remitted and Treatment-Resistant Depression Using MMPI and Including Pessimism and Optimism Scales

    PubMed Central

    Suzuki, Masatoshi; Takahashi, Michio; Muneoka, Katsumasa; Sato, Koichi; Hashimoto, Kenji; Shirayama, Yukihiko

    2014-01-01

    Background The psychological aspects of treatment-resistant and remitted depression are not well documented. Methods We administered the Minnesota Multiphasic Personality Inventory (MMPI) to patients with treatment-resistant depression (n = 34), remitted depression (n = 25), acute depression (n = 21), and healthy controls (n = 64). Pessimism and optimism were also evaluated by MMPI. Results ANOVA and post-hoc tests demonstrated that patients with treatment-resistant and acute depression showed similarly high scores for frequent scale (F), hypochondriasis, depression, conversion hysteria, psychopathic device, paranoia, psychasthenia and schizophrenia on the MMPI compared with normal controls. Patients with treatment-resistant depression, but not acute depression registered high on the scale for cannot say answer. Using Student's t-test, patients with remitted depression registered higher on depression and social introversion scales, compared with normal controls. For pessimism and optimism, patients with treatment-resistant depression demonstrated similar changes to acutely depressed patients. Remitted depression patients showed lower optimism than normal controls by Student's t-test, even though these patients were deemed recovered from depression using HAM-D. Conclusions The patients with remitted depression and treatment-resistant depression showed subtle alterations on the MMPI, which may explain the hidden psychological features in these cohorts. PMID:25279466

  2. Is the presence of depression independent from signs of disease activity in patients with neurocysticercosis?

    PubMed

    de Almeida, Sergio Monteiro; Gurjão, Solange Aparecida

    2011-10-01

    Neurocysticercosis (NCC) is a common central nervous system (CNS) infection caused by Taenia solium metacestodes. Depression is present in 53-85% of the NCC patients. The present study was aimed to evaluate the correlation of signs of NCC activity (evolution phase of NCC cysts and CSF characteristics) with depression. The study group consisted of 65 patients subdivided into two groups: NCC with epilepsy (48) and NCC without epilepsy [17]. Depression was assessed and quantified by the Hamilton Rating Scale for Depression (HRSD-21) and compared with CSF inflammatory characteristics (increase of WBCs and total protein) and presence of calcifications or cysts. There was no difference between the scores of depression in the group with CNS calcifications or cysts. CSF signs of active disease, specifically increase of CSF TP, were significantly more frequent in patients with mild depression and in non-depressant patients. The depression scores were inversely proportional to the CSF TP levels in the groups with depression. Although immunological factors could be associated with the development of depression, the data above lead us to make assumptions about the association of other factors such as genetic predisposition, or social and cultural factors.

  3. Transient hyperkalemia and hypoaldosteronism in a patient with acute glomerulonephritis.

    PubMed

    Opastirakul, Sauwalak; Chartapisak, Wattana

    2002-04-01

    The authors describe a 7-year-old boy with acute glomerulonephritis, who developed acute renal failure in the early course of his disease. While the renal function and other clinical manifestations gradually improved, hyperkalemia occurred unexpectedly, and returned to normal level spontaneously after a short period of symptomatic treatment. With the result of a low transtubular potassium gradient (TTKG) level, it was concluded that hypoaldosteronism was the major cause of hyperkalemia in this patient.

  4. Incidence and Risk Factors for Acute Kidney Injury Following Mannitol Infusion in Patients With Acute Stroke

    PubMed Central

    Lin, Shin-Yi; Tang, Sung-Chun; Tsai, Li-Kai; Yeh, Shin-Joe; Shen, Li-Jiuan; Wu, Fe-Lin Lin; Jeng, Jiann-Shing

    2015-01-01

    Abstract Mannitol, an osmotic diuretic, is commonly used to treat patients with acute brain edema, but its use also increases the risk of developing acute kidney injury (AKI). In this study, we investigated the incidence and risk factors of mannitol-related AKI in acute stroke patients. A total of 432 patients (ischemic stroke 62.3%) >20 years of age who were admitted to the neurocritical care center in a tertiary hospital and received mannitol treatment were enrolled in this study. Clinical parameters including the scores of National Institutes of Health Stroke Scale (NIHSS) at admission, vascular risk factors, laboratory data, and concurrent nephrotoxic medications were registered. Acute kidney injury was defined as an absolute elevation in the serum creatinine (Scr) level of ≥0.3 mg/dL from the baseline or a ≥50% increase in Scr. The incidence of mannitol-related AKI was 6.5% (95% confidence interval, 4.5%–9.3%) in acute stroke patients, 6.3% in patients with ischemic stroke, and 6.7% in patients with intracerebral hemorrhage. Multivariate analysis revealed that diabetes, lower estimated glomerular filtration rate at baseline, higher initial NIHSS score, and concurrent use of diuretics increased the risk of mannitol-related AKI. When present, the combination of these elements displayed an area under the receiver operating characteristic curve of 0.839 (95% confidence interval, 0.770–0.909). In conclusion, mannitol-related AKI is not uncommon in the treatment of acute stroke patients, especially in those with vulnerable risk factors. PMID:26632702

  5. Diabetes Distress and Depressive Symptoms: A Dyadic Investigation of Older Patients and Their Spouses

    ERIC Educational Resources Information Center

    Franks, Melissa M.; Lucas, Todd; Stephens, Mary Ann Parris; Rook, Karen S.; Gonzalez, Richard

    2010-01-01

    In this dyadic study, we examined diabetes distress experienced by male and female patients and their spouses (N = 185 couples), and its association with depressive symptoms using the Actor-Partner Interdependence Model. Diabetes-related distress reported by both patients and spouses was associated with each partner's own depressive symptoms…

  6. Association of sleep disturbances with cognitive impairment and depression in maintenance memodialysis patients

    Technology Transfer Automated Retrieval System (TEKTRAN)

    There are few data on the relationship of sleep with measures of cognitive function and symptoms of depression in dialysis patients. We evaluated the relationship of sleep with cognitive function and symptoms of depression in 168 hemodialysis patients, using multivariable linear and logistic regress...

  7. Cognitive-Behavioral Therapy: Innovations for Cardiopulmonary Patients with Depression and Anxiety

    ERIC Educational Resources Information Center

    Cully, Jeffrey A.; Paukert, Amber; Falco, Jessica; Stanley, Melinda

    2009-01-01

    Medically ill patients face unique physical and emotional challenges that place them at increased risk for symptoms of depression and anxiety. Despite high prevalence and significant impact, depression and anxiety are infrequently treated in the medically ill because of a variety of patient, provider, and system factors. The current article…

  8. Distinguishing Symptoms of Grief and Depression in a Cohort of Advanced Cancer Patients

    ERIC Educational Resources Information Center

    Jacobsen, Juliet C.; Zhang, Baohui; Block, Susan D.; Maciejewski, Paul K.; Prigerson, Holly G.

    2010-01-01

    Several studies have shown that the symptoms of grief are different from symptoms of depression among bereaved family members. This study is an attempt to replicate this finding among advanced cancer patients and examine clinical correlates of patient grief and depression. Analyses were conducted on data from interviews with 123 advanced cancer…

  9. Recognition of depressive symptoms in the elderly: what can help the patient and the doctor.

    PubMed

    Parashos, Ioannis A; Stamouli, Sophia; Rogakou, Efi; Theodotou, Rita; Nikas, Ioannis; Mougias, Athanassios

    2002-01-01

    The general public heavily underrecognizes depression and depressive symptoms. This underrecognition is more pronounced among elderly people, and this study is an initial attempt to quantify the problem in a Greek elderly sample. Additionally the authors attempt to identify patient-related factors, which can assist a subject to recognize the depressive symptoms and the general practitioner to note their existence. Members of senior citizen centers (n = 682) participated in presentations about "depression in the elderly" and completed a questionnaire including the GDS-4 scale, four questions concerning depression risk factors and a question concerning a recent visit to a physician for depressive symptoms. Amongst those participating, 35.8% presented depressive symptoms (GDS-4 > or = 2). The calculated rate for recognition of depression in the studied population was very low (17.3%). Patients with depressive symptoms were more often females and had a higher proportion of past history of depression and a lack of social support. Patients with a past history of depression and more severe forms of illness consulted a doctor more frequently. Finally, subjects suffering from depressive symptoms and comorbid medical illness were characterized by a higher proportion of past history, lack of support, and existence of multiple risk factors. The authors propose that the inclusion in public campaigns of activities with an experiential dimension, e.g., patient videos and the use of a very simple screening tool, such as the GDS-4 scale by general practitioners (GP), could be helpful in improving the recognition of depressive symptoms by the patient and his/her relatives and its diagnosis by the doctor. This proposition awaits formal proof in future studies. PMID:12001179

  10. [Activation of caspases in lymphocytes of patients with depression and anxiety].

    PubMed

    Gerasimovich, E S; Yakovlev, A A; Druzhkova, T A; Grishkina, M N; Guekht, A B; Gulyaeva, N V

    2016-01-01

    The processes in the nervous and immune systems are closely interrelated. In particular, increased apoptosis was reported in lymphocytes of patients with depression. The aim of this study was to assess activities of proteases associated with cell death in lymphocytes of patient with personality disorders accompanied by depression and anxiety. In patients with personality disorders associated with organic brain dysfunction caspase activities were reduced in patients with depression and increased in patients with anxiety. The results may be useful for elucidation of pathogenetic mechanisms of personality disorders and in search of new biomarkers of these diseases.

  11. [Activation of caspases in lymphocytes of patients with depression and anxiety].

    PubMed

    Gerasimovich, E S; Yakovlev, A A; Druzhkova, T A; Grishkina, M N; Guekht, A B; Gulyaeva, N V

    2016-01-01

    The processes in the nervous and immune systems are closely interrelated. In particular, increased apoptosis was reported in lymphocytes of patients with depression. The aim of this study was to assess activities of proteases associated with cell death in lymphocytes of patient with personality disorders accompanied by depression and anxiety. In patients with personality disorders associated with organic brain dysfunction caspase activities were reduced in patients with depression and increased in patients with anxiety. The results may be useful for elucidation of pathogenetic mechanisms of personality disorders and in search of new biomarkers of these diseases. PMID:26973194

  12. Management of patients after recovering from acute severe biliary pancreatitis

    PubMed Central

    Dedemadi, Georgia; Nikolopoulos, Manolis; Kalaitzopoulos, Ioannis; Sgourakis, George

    2016-01-01

    Cholelithiasis is the most common cause of acute pancreatitis, accounting 35%-60% of cases. Around 15%-20% of patients suffer a severe attack with high morbidity and mortality rates. As far as treatment is concerned, the optimum method of late management of patients with severe acute biliary pancreatitis is still contentious and the main question is over the correct timing of every intervention. Patients after recovering from an acute episode of severe biliary pancreatitis can be offered alternative options in their management, including cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy, or no definitive treatment. Delaying cholecystectomy until after resolution of the inflammatory process, usually not earlier than 6 wk after onset of acute pancreatitis, seems to be a safe policy. ERCP and sphincterotomy on index admission prevent recurrent episodes of pancreatitis until cholecystectomy is performed, but if used for definitive treatment, they can be a valuable tool for patients unfit for surgery. Some patients who survive severe biliary pancreatitis may develop pseudocysts or walled-off necrosis. Management of pseudocysts with minimally invasive techniques, if not therapeutic, can be used as a bridge to definitive operative treatment, which includes delayed cholecystectomy and concurrent pseudocyst drainage in some patients. A management algorithm has been developed for patients surviving severe biliary pancreatitis according to the currently published data in the literature. PMID:27678352

  13. Management of patients after recovering from acute severe biliary pancreatitis

    PubMed Central

    Dedemadi, Georgia; Nikolopoulos, Manolis; Kalaitzopoulos, Ioannis; Sgourakis, George

    2016-01-01

    Cholelithiasis is the most common cause of acute pancreatitis, accounting 35%-60% of cases. Around 15%-20% of patients suffer a severe attack with high morbidity and mortality rates. As far as treatment is concerned, the optimum method of late management of patients with severe acute biliary pancreatitis is still contentious and the main question is over the correct timing of every intervention. Patients after recovering from an acute episode of severe biliary pancreatitis can be offered alternative options in their management, including cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy, or no definitive treatment. Delaying cholecystectomy until after resolution of the inflammatory process, usually not earlier than 6 wk after onset of acute pancreatitis, seems to be a safe policy. ERCP and sphincterotomy on index admission prevent recurrent episodes of pancreatitis until cholecystectomy is performed, but if used for definitive treatment, they can be a valuable tool for patients unfit for surgery. Some patients who survive severe biliary pancreatitis may develop pseudocysts or walled-off necrosis. Management of pseudocysts with minimally invasive techniques, if not therapeutic, can be used as a bridge to definitive operative treatment, which includes delayed cholecystectomy and concurrent pseudocyst drainage in some patients. A management algorithm has been developed for patients surviving severe biliary pancreatitis according to the currently published data in the literature.

  14. Management of patients after recovering from acute severe biliary pancreatitis.

    PubMed

    Dedemadi, Georgia; Nikolopoulos, Manolis; Kalaitzopoulos, Ioannis; Sgourakis, George

    2016-09-14

    Cholelithiasis is the most common cause of acute pancreatitis, accounting 35%-60% of cases. Around 15%-20% of patients suffer a severe attack with high morbidity and mortality rates. As far as treatment is concerned, the optimum method of late management of patients with severe acute biliary pancreatitis is still contentious and the main question is over the correct timing of every intervention. Patients after recovering from an acute episode of severe biliary pancreatitis can be offered alternative options in their management, including cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy, or no definitive treatment. Delaying cholecystectomy until after resolution of the inflammatory process, usually not earlier than 6 wk after onset of acute pancreatitis, seems to be a safe policy. ERCP and sphincterotomy on index admission prevent recurrent episodes of pancreatitis until cholecystectomy is performed, but if used for definitive treatment, they can be a valuable tool for patients unfit for surgery. Some patients who survive severe biliary pancreatitis may develop pseudocysts or walled-off necrosis. Management of pseudocysts with minimally invasive techniques, if not therapeutic, can be used as a bridge to definitive operative treatment, which includes delayed cholecystectomy and concurrent pseudocyst drainage in some patients. A management algorithm has been developed for patients surviving severe biliary pancreatitis according to the currently published data in the literature. PMID:27678352

  15. Endorsement and memory bias of self-referential pain stimuli in depressed pain patients.

    PubMed

    Pincus, T; Pearce, S; McClelland, A; Isenberg, D

    1995-05-01

    This study investigates information processing in chronic pain patients by comparing the responses of depressed pain patients, non-depressed pain patients and non-pain control subjects. Each subject contributed two scores: endorsement of adjectives as descriptors of themselves and their best-friends; and free recall of the presented words. The stimuli consisted of depression-related, pain-related and neutral control adjectives, and each content category was split into negative and positive valence. The four-way interaction between group, reference, content and valence was significant both in the recall data and the endorsement data. Further analysis revealed that depressed pain patients exhibited a bias towards self-referential negative pain words, but not towards self-referential negative depression information. These results are interpreted in line with content specificity theory of information processing and have implications for targeting cognitive interventions with pain patients.

  16. Multiple aberrations in shared inflammatory and oxidative & nitrosative stress (IO&NS) pathways explain the co-association of depression and cardiovascular disorder (CVD), and the increased risk for CVD and due mortality in depressed patients.

    PubMed

    Maes, Michael; Ruckoanich, Piyanuj; Chang, Young Seun; Mahanonda, Nithi; Berk, Michael

    2011-04-29

    There is evidence that there is a bidirectional relationship between major depression and cardiovascular disorder (CVD): depressed patients are a population at risk for increased cardiac morbidity and mortality, and depression is more frequent in patients who suffer from CVD. There is also evidence that inflammatory and oxidative and nitrosative stress (IO&NS) pathways underpin the common pathophysiology of both CVD and major depression. Activation of these pathways may increase risk for both disorders and contribute to shared risk. The shared IO&NS pathways that may contribute to CVD and depression comprise the following: increased levels of pro-inflammatory cytokines, like interleukin-1β (IL-1β), IL-2, IL-6, IL-8, IL-12, tumor necrosis factor-α, and interferon-γ; T cell activation; increased acute phase proteins, like C-reactive protein, haptoglobin, fibrinogen and α1-antitrypsin; complement factors; increased LPS load through bacterial translocation and subsequent gut-derived inflammation; induction of indoleamine 2,3-dioxygenase with increased levels of tryptophan catabolites; decreased levels of antioxidants, like coenzyme Q10, zinc, vitamin E, glutathione and glutathione peroxidase; increased O&NS characterized by oxidative damage to low density lipoprotein (LDL) and phospholipid inositol, increased malondialdehyde, and damage to DNA and mitochondria; increased nitrosative stress; and decreased ω3 polyunsaturated fatty acids (PUFAs). The complex interplay between the abovementioned IO&NS pathways in depression results in pro-atherogenic effects and should be regarded as a risk factor to future clinical CVD and due mortality. We suggest that major depression should be added as a risk factor to the Charlson "comorbidity" index. It is advised that patients with (sub)chronic or recurrent major depression should routinely be assessed by serology tests to predict if they have an increased risk to cardiovascular disorders.

  17. Correlation between bullying and clinical depression in adolescent patients

    PubMed Central

    Kaltiala-Heino, Riittakerttu; Fröjd, Sari

    2011-01-01

    A literature review of the associations between involvement in bullying and depression is presented. Many studies have demonstrated a concurrent association between involvement in bullying and depression in adolescent population samples. Not only victims but also bullies display increased risk of depression, although not all studies have confirmed this for the bullies. Retrospective studies among adults support the notion that victimization is followed by depression. Prospective follow-up studies have suggested both that victimization from bullying may be a risk factor for depression and that depression may predispose adolescents to bullying. Research among clinically referred adolescents is scarce but suggests that correlations between victimization from bullying and depression are likely to be similar in clinical and population samples. Adolescents who bully present with elevated numbers of psychiatric symptoms and psychiatric and social welfare treatment contacts. PMID:24600274

  18. Predictors of Depressive Mood in Patients With Isolated Cerebellar Stroke: A Retrospective Study

    PubMed Central

    2016-01-01

    Objective To identify predictive factors of depressive mood in patients with isolated cerebellar stroke. Methods A retrospective chart review was performed in patients who had experienced their first isolated cerebellar stroke during 2002–2014. The patients were classified into two groups by the Geriatric Depression Scale (GDS) (non-depressive group, 0≤GDS≤16; depressive group, 17≤GDS≤30). Data on demographic and socioeconomic factors, comorbidities, functional level, cognitive and linguistic function, and stroke characteristics were collected. Significant variables in univariate analysis were analyzed using logistic regression. Results Fifty-two patients were enrolled, of whom 55.8% had depressive mood, were older (p=0.021), and had higher hypertension rates (p=0.014). Cognitive and linguistic functions did not differ between the two groups. The depressive group had higher ischemic stroke rates (p=0.035) and showed a dominant right posterior cerebellar hemisphere lesion (p=0.028), which was independently associated with depressive mood in the multiple logistic regression analysis (odds ratio, 5.081; 95% confidence interval, 1.261–20.479). Conclusion The risk of depressive mood after cerebellar stroke was increased in patients at old age, with a history of hypertension, ischemic stroke, and lesion of the right posterior cerebellar hemisphere. The most significant determining factor was stroke lesion of the right posterior cerebellar hemisphere. Early detection of risk factors is important to prevent and manage depressive mood after cerebellar stroke. PMID:27446777

  19. The influence of the social support on symptoms of anxiety and depression among patients with silicosis.

    PubMed

    Han, Bing; Yan, Bo; Zhang, Jian; Zhao, Na; Sun, Jinkai; Li, Chao; Lei, Xibing; Liu, Hongbo; Chen, Jie

    2014-01-01

    The improvement of social support promotes the mental health and improves the health status. The study aimed to examine the influence of the social support on symptoms of anxiety and depression among patients with silicosis and provide the scientific basis to further alleviate anxiety and depression and to monitor their whole quality of life. We investigated 324 inpatients with silicosis between April 2011 and September 2011. The HADS (the Hospital Anxiety-Depression Scale) was the major methodology used to evaluate anxiety and depression, and the MSPSS (the Multidimensional Scale of Perceived Social Support) to evaluate the social support level. Among patients with silicosis, 99.1% had anxiety symptoms, and 86.1% had depression symptoms. Meanwhile, the social support significantly influenced symptoms of anxiety and depression. The study suggested that patients with silicosis presented more anxiety and depression symptoms, while the social support levels of the patients were relatively low. The influence of social support on symptoms of anxiety and depression among patients with silicosis implied that improving the level of social support and the effective symptomatic treatment might alleviate anxiety and depression symptoms and improve physical and mental status.

  20. Mindfulness-based cognitive therapy in patients with late-life depression: A case series

    PubMed Central

    Mathur, Sonal; Sharma, Mahendra Prakash; Bharath, Srikala

    2016-01-01

    Depression is the most common mental illness in the elderly, and cost-effective treatments are required. Therefore, this study is aimed at evaluating the effectiveness of a mindfulness-based cognitive therapy (MBCT) on depressive symptoms, mindfulness skills, acceptance, and quality of life across four domains in patients with late-onset depression. A single case design with pre- and post-assessment was adopted. Five patients meeting the specified inclusion and exclusion criteria were recruited for the study and assessed on the behavioral analysis pro forma, geriatric depression scale, Hamilton depression rating scale, Kentucky inventory of mindfulness skills, Acceptance and Action Questionnaire II, The World Health Organization quality of life Assessment Brief version (WHOQO-L-BREF). The therapeutic program consisted of education regarding the nature of depression, training in formal and informal mindfulness meditation, and cognitive restructuring. A total of 8 sessions over 8 weeks were conducted for each patient. The results of this study indicate clinically significant improvement in the severity of depression, mindfulness skills, acceptance, and overall quality of life in all 5 patients. Eight-week MBCT program has led to reduction in depression and increased mindfulness skills, acceptance, and overall quality of life in patients with late-life depression. PMID:27512325

  1. Mindfulness-based cognitive therapy in patients with late-life depression: A case series.

    PubMed

    Mathur, Sonal; Sharma, Mahendra Prakash; Bharath, Srikala

    2016-01-01

    Depression is the most common mental illness in the elderly, and cost-effective treatments are required. Therefore, this study is aimed at evaluating the effectiveness of a mindfulness-based cognitive therapy (MBCT) on depressive symptoms, mindfulness skills, acceptance, and quality of life across four domains in patients with late-onset depression. A single case design with pre- and post-assessment was adopted. Five patients meeting the specified inclusion and exclusion criteria were recruited for the study and assessed on the behavioral analysis pro forma, geriatric depression scale, Hamilton depression rating scale, Kentucky inventory of mindfulness skills, Acceptance and Action Questionnaire II, The World Health Organization quality of life Assessment Brief version (WHOQO-L-BREF). The therapeutic program consisted of education regarding the nature of depression, training in formal and informal mindfulness meditation, and cognitive restructuring. A total of 8 sessions over 8 weeks were conducted for each patient. The results of this study indicate clinically significant improvement in the severity of depression, mindfulness skills, acceptance, and overall quality of life in all 5 patients. Eight-week MBCT program has led to reduction in depression and increased mindfulness skills, acceptance, and overall quality of life in patients with late-life depression. PMID:27512325

  2. Depression in diabetic patients attending University of Gondar Hospital Diabetic Clinic, Northwest Ethiopia

    PubMed Central

    Birhanu, Anteneh Messele; Alemu, Fekadu Mazengia; Ashenafie, Tesfaye Demeke; Balcha, Shitaye Alemu; Dachew, Berihun Assefa

    2016-01-01

    Background Diabetes mellitus, frequently associated with comorbid depression, contributes to the double burden of individual patients and community. Depression remains undiagnosed in as many as 50%–75% of diabetes cases. This study aimed to determine the prevalence and associated factors of depression among diabetic patients attending the University of Gondar Hospital Diabetic Clinic, Northwest Ethiopia. Methods An institution-based cross-sectional study was conducted from March to May 2014 among 422 sampled diabetic patients attending the University of Gondar Hospital Diabetic Clinic. The participants were selected using systematic random sampling. Data were collected by face-to-face interview using a standardized and pretested questionnaire linked with patient record review. Depression was assessed using the Patient Health Questionnaire-9. Data were entered to EPI INFO version 7 and analyzed by SPSS version 20 software. Binary logistic regression analysis was performed to identify factors associated with depression. Results A total of 415 diabetic patients participated in the study with a response rate of 98.3%. The prevalence of depression among diabetic patients was found to be 15.4% (95% confidence interval (CI): 11.7–19.2). Only religion (adjusted odds ratio [AOR] =2.65 and 95% CI: 1.1–6.0) and duration of diabetes (AOR =0.27 and 95% CI: 0.07–0.92) were the factors associated with depression among diabetic patients. Conclusion The prevalence of depression was low as compared to other similar studies elsewhere. Disease (diabetes) duration of 10 years and above and being a Muslim religion follower (as compared to Christian) were the factors significantly associated with depression. Early screening of depression and treating depression as a routine component of diabetes care are recommended. Further research with a large sample size, wider geographical coverage, and segregation of type of diabetes mellitus is recommended. PMID:27274296

  3. Fatigue and Depression in Iranian Amyotrophic Lateral Sclerosis Patients in Tehran in 2012

    PubMed Central

    Nazemi, Maryam; Raad, Marjan Hassani; Arzoomanian, Christineh Serob; Ghasemzadeh, Azizreza

    2016-01-01

    Introduction Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease with a progressive and rapid course. Fatigue and depression are common among ALS patients. The aim of this study was to determine the relationship between depression and fatigue in Iranian ALS patients. Methods In this 2012 cross-sectional study, 40 ALS patients, including 22 females and 18 males, were selected through consecutive relapsing-remitting, and 40 age- and gender-matched health controls (HCs) were recruited from Loghman Hakim Hospital in Tehran, Iran. The Persian version of the Fatigue Severity Scale (FSS-Per) questionnaire and depression substance of Hospital Anxiety and Depression Scale (HADS) were used to assess fatigue and depression. Data were analyzed using the Kolmogorov-Sminov Test, Levene’s test, Independent Samples t-test, and Pearson product-moment correlation coefficient. Results We identified a significant and positive relationship between fatigue and depression in patients with ALS (p=0.000). Furthermore, the scores of fatigue and depression in ALS patients were higher than in non-ALS patients. Conclusion The results indicated that there was a relationship between fatigue and depression in ALS patients and that early intervention services can improve these symptoms. Further studies are suggested to investigate the direction of such relationship. PMID:27123230

  4. Is good insight associated with depression among patients with schizophrenia? Systematic review and meta-analysis.

    PubMed

    Belvederi Murri, Martino; Respino, Matteo; Innamorati, Marco; Cervetti, Alice; Calcagno, Pietro; Pompili, Maurizio; Lamis, Dorian A; Ghio, Lucio; Amore, Mario

    2015-03-01

    Among patients with schizophrenia, better insight may be associated with depression, but the findings on this issue are mixed. We examined the association between insight and depression in schizophrenia by conducting a systematic review and meta-analysis. The meta-analysis was based on 59 correlational studies and showed that global clinical insight was associated weakly, but significantly with depression (effect size r=0.14), as were the insight into the mental disorder (r=0.14), insight into symptoms (r=0.14), and symptoms' attributions (r=0.17). Conversely, neither insight into the social consequences of the disorder nor into the need for treatment was associated with symptoms of depression. Better cognitive insight was significantly associated with higher levels of depression. The exploratory meta-regression showed that methodological factors (e.g. the instrument used to assess depression and the phase of the illness) can significantly influence the magnitude of the association between insight and depression. Moreover, results from longitudinal studies suggest that the relation between insight and depression might be stronger than what is observed at the cross-sectional level. Finally, internalized stigma, illness perception, recovery attitudes, ruminative style, and premorbid adjustment seem to be relevant moderators and/or mediators of the association between insight and depression. In conclusion, literature indicates that among patients with schizophrenia, better insight is associated with higher levels of depressive symptoms. Thus, interventions aimed at promoting patients' insight should take into account the clinical implications of these findings.

  5. How patients understand depression associated with chronic physical disease – a systematic review

    PubMed Central

    2012-01-01

    Background Clinicians are encouraged to screen people with chronic physical illness for depression. Screening alone may not improve outcomes, especially if the process is incompatible with patient beliefs. The aim of this research is to understand people’s beliefs about depression, particularly in the presence of chronic physical disease. Methods A mixed method systematic review involving a thematic analysis of qualitative studies and quantitative studies of beliefs held by people with current depressive symptoms. MEDLINE, EMBASE, PSYCHINFO, CINAHL, BIOSIS, Web of Science, The Cochrane Library, UKCRN portfolio, National Research Register Archive, Clinicaltrials.gov and OpenSIGLE were searched from database inception to 31st December 2010. A narrative synthesis of qualitative and quantitative data, based initially upon illness representations and extended to include other themes not compatible with that framework. Results A range of clinically relevant beliefs was identified from 65 studies including the difficulty in labeling depression, complex causal factors instead of the biological model, the roles of different treatments and negative views about the consequences of depression. We found other important themes less related to ideas about illness: the existence of a self-sustaining ‘depression spiral’; depression as an existential state; the ambiguous status of suicidal thinking; and the role of stigma and blame in depression. Conclusions Approaches to detection of depression in physical illness need to be receptive to the range of beliefs held by patients. Patient beliefs have implications for engagement with depression screening. PMID:22640234

  6. The effects of anti-depressants on depression symptom scores at 12 months follow-up in patients with cardiometabolic disease: Results from a large primary care cohort

    PubMed Central

    Jani, Bhautesh Dinesh; Purves, David; Barry, Sarah J. E.; McCowan, Colin; Cavanagh, Jonathan; Mair, Frances S.

    2015-01-01

    Background: Evidence on the long-term usefulness of anti-depressants in managing depression in cardiometabolic disease is limited. Aim: We examined the effects of anti-depressant prescribing on depressive symptoms at 12 months follow-up in patients with cardiometabolic disease and a positive depression screening result at baseline. Design and Setting: We retrospectively reviewed routine UK primary care data for patients with coronary heart disease, diabetes and previous stroke for the year 2008–2009. 35,537 patients with one of the three above diseases underwent depression screening using the Hospital Anxiety and Depression Scale (HADS-D). Of 7080 patients with a positive screening result (HADS-D ≥ 8), 3933 (55.5%) patients had a repeat HADS-D recorded at 12 months follow-up. Methods: We compared the change in HADS-D at follow-up and remission rate in those who were prescribed anti-depressants (n = 223) against those who were not (n = 3710). Results: The mean change in HADS-D from baseline, for the nonprescribed group was similar to the reduction observed in patients who were continuously prescribed (n = 93) with anti-depressants during follow-up. Patients who were prescribed intermittently (n = 72) or only one (n = 58) prescription during follow-up had a lower reduction in HADS-D compared to the nonprescribed group. There was no difference in remission rates between continuously prescribed and the nonprescribed group, but remission was lower in patients prescribed intermittently and single prescription. Conclusion: Improvement in depressive symptoms in patients with cardiometabolic disease at 12 months was not any better in patients prescribed with anti-depressants compared to the nonprescribed group. The role of anti-depressants in the management of depression in cardiometabolic disease merits further investigation. PMID:26286616

  7. Cognitive behavioral therapy for depression in Japanese Parkinson’s disease patients: a pilot study

    PubMed Central

    Shinmei, Issei; Kobayashi, Kei; Oe, Yuki; Takagishi, Yuriko; Kanie, Ayako; Ito, Masaya; Takebayashi, Yoshitake; Murata, Miho; Horikoshi, Masaru; Dobkin, Roseanne D

    2016-01-01

    Objectives This study evaluated the feasibility of cognitive behavioral therapy (CBT) for Japanese Parkinson’s disease (PD) patients with depression. To increase cultural acceptability, we developed the CBT program using manga, a type of Japanese comic novel. Methods Participants included 19 non-demented PD patients who had depressive symptoms (GRID-Hamilton Rating Scale for Depression score ≥8). A CBT program comprising six sessions was individually administered. We evaluated the feasibility and safety of the CBT program in terms of the dropout rate and occurrence of adverse events. The primary outcome was depressive symptom reduction in the GRID-Hamilton Rating Scale for Depression upon completion of CBT. Secondary outcomes included changes in the self-report measures of depression (Beck Depression Inventory-II, Hospital Anxiety and Depression Scale-Depression), anxiety (Hospital Anxiety and Depression Scale-Anxiety, State and Trait Anxiety Inventory, Overall Anxiety Severity and Impairment Scale), functional impairment, and quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey). Results Of the 19 participants (mean age =63.8 years, standard deviation [SD] =9.9 years; mean Hohen–Yahr score =1.7, SD =0.8), one patient (5%) withdrew. No severe adverse event was observed. The patients reported significant improvements in depression (Hedges’ g =−1.02, 95% confidence interval =−1.62 to −0.39). The effects were maintained over a 3-month follow-up period. Most of the secondary outcome measurements showed a small-to-moderate but nonsignificant effect size from baseline to post-intervention. Conclusion This study provides preliminary evidence that CBT is feasible among Japanese PD patients with depression. Similar approaches may be effective for people with PD from other cultural backgrounds. The results warrant replication in a randomized controlled trial. PMID:27354802

  8. Acute anteroseptal myocardial infarction in a patient with dextrocardia.

    PubMed

    Alzand, Becker S N; Dennert, Robert; Kalkman, Robert; Gorgels, Anton P M

    2009-01-01

    Dextrocardia with situs inversus is an uncommon congenital condition in which the major visceral organs are reversed. The clinical diagnosis and electrocardiographic localization of myocardial infarctions in these patients remain a great challenge. We report a case of a 64-year-old man known with dextrocardia and situs inversus totalis presenting with acute chest pain irradiating to the right arm. The admission and reversed "normalized" electrocardiogram are presented, allowing for correct diagnosis of an acute anteroseptal myocardial infarction. The present case emphasizes the importance of performing a reversed electrocardiogram in patients with dextrocardia.

  9. Sleep Disturbances in Acutely Ill Patients with Cancer.

    PubMed

    Matthews, Ellyn E; Tanner, J Mark; Dumont, Natalie A

    2016-06-01

    Intensive care units may place acutely ill patients with cancer at additional risk for sleep loss and associated negative effects. Research suggests that communication about sleep in patients with cancer is suboptimal and sleep problems are not regularly assessed or adequately treated throughout the cancer trajectory. However, many sleep problems and fatigue can be managed effectively. This article synthesizes the current literature regarding the prevalence, cause, and risk factors that contribute to sleep disturbance in the context of acute cancer care. It describes the consequences of poor sleep and discusses appropriate assessment and treatment options. PMID:27215362

  10. Endovascular treatment for acute pulmonary embolism in neurological patient.

    PubMed

    Paul, Gunchan; Paul, Birinder S; Gautam, Parshotam L; Mohan, Bishav; Sharma, Shruti

    2015-07-01

    Among the spectrum of venous thrombo-embolic disease, acute pulmonary embolism accounts for the most life threatening manifestations with mortality exceeding 50%. It can affect many patient populations across various disciplines, hence immediate attention and aggressive treatment is crucial. With the advancement of technologies, various catheter-based devices are available to treat massive or submassive PE. In this paper we report two patients of acute pulmonary embolism with neurological issues where the life threatening emergency was successfully managed by utilizing endovascular directed thrombolytic reperfusion therapy. PMID:26609298

  11. An Acute Abdominal Catastrophe in a HIV Positive Patient

    PubMed Central

    Gaduputi, Vinaya; Patel, Harish; Vootla, Vamshidhar; Khan, Usman; Chilimuri, Sridhar

    2012-01-01

    We report this case of a 45-year-old man with HIV-AIDS on HAART therapy who presented with acute abdominal pain and renal failure. He was found to have pneumatosis intestinalis on computerized axial tomography scan of the abdomen. He underwent emergent explorative laparotomy, which revealed a necrotic large bowel segment for which a right-sided hemicolectomy and ileostomy were performed. The patient subsequently developed septic shock and hypoxic respiratory failure. He expired a week after the surgical procedure. Acute abdominal events due to vascular catastrophes secondary to hypercoagulability, endothelial dysfunction and accelerated atherosclerosis have been reported in HIV positive patients.

  12. Depression.

    PubMed

    Tallo, Donato

    2014-04-15

    Reading the CPD article was beneficial to my professional nursing practice and development. I gained a greater understanding of how depression is likely to exacerbate the effects of a physical illness or complicate the treatment of other health conditions. PMID:24712633

  13. Patients understanding of depression associated with chronic physical illness: a qualitative study

    PubMed Central

    2014-01-01

    Background Detection of depression can be difficult in primary care, particularly when associated with chronic illness. Patient beliefs may affect detection and subsequent engagement with management. We explored patient beliefs about the nature of depression associated with physical illness. Methods A qualitative interview study of patients registered with general practices in Leeds, UK. We invited patients with coronary heart disease or diabetes from primary care to participate in semi-structured interviews exploring their beliefs and experiences. We analysed transcripts using a thematic approach, extended to consider narratives as important contextual elements. Results We interviewed 26 patients, including 17 with personal experience of depression. We developed six themes: recognising a problem, complex causality, the role of the primary care, responsibility, resilience, and the role of their life story. Participants did not consistently talk about depression as an illness-like disorder. They described a change in their sense of self against the background of their life stories. Participants were unsure about seeking help from general practitioners (GPs) and felt a personal responsibility to overcome depression themselves. Chronic illness, as opposed to other life pressures, was seen as a justifiable cause of depression. Conclusions People with chronic illness do not necessarily regard depression as an easily defined illness, especially outside of the context of their life stories. Efforts to engage patients with chronic illness in the detection and management of depression may need further tailoring to accommodate beliefs about how people view themselves, responsibility and negative views of treatment. PMID:24555886

  14. Depressive Symptoms among Patients with Heart Failure in Korea: An Integrative Review

    PubMed Central

    Hwang, Boyoung; Choi, Heeseung

    2016-01-01

    This integrative review was conducted to examine studies reporting depressive symptoms among patients with heart failure (HF) in Korea. An extensive search with both English and Korean search terms was conducted using six electronic databases. Publications were screened by both authors independently, and 10 articles meeting the inclusion criteria were reviewed. All 10 studies were data-based, quantitative, and descriptive in nature. In all studies, depressive symptoms were measured at only one point in time. The prevalence of depression reported in these studies ranged from 24% to 68%. Heterogeneity in the study samples and measures of depression was noted. Depressive symptoms have received limited attention in research with HF patients in Korea. Additional studies, especially longitudinal studies and intervention studies, are needed to assess depressive symptoms and to test the effects of pharmacological and non-pharmacological interventions on depression among patients with HF in Korea. Clinicians need to screen patients with HF for depressive symptoms using validated measures and provide proper treatment for those who are depressed. PMID:27527234

  15. Hair thyroid hormones concentration in patients with depression changes with disease episodes in female Chinese.

    PubMed

    Wei, Jinxue; Sun, Guizhi; Zhao, Liansheng; Liu, Xiang; Lin, Dongtao; Li, Tao; Ma, Xiaohong

    2014-12-15

    Abnormal function of thyroid and deregulation of level of blood thyroid hormones, including triiodothyronine (T3) and thyroxine (T4), have been observed in patients with major depression. Nevertheless, no consistent conclusion can be drawn from previous reports. Hair hormones reflect average hormones levels in a certain period and have been involved in the studies of psychiatric diseases. However, no research has elucidated the relation between hair thyroid hormones level and depression. In the present study, we explored the correlation between thyroid hormones and major depression by analyzing and comparing the levels of hair thyroid hormones in patients with depression (n=30) and healthy controls (n=30). Our results showed that the levels of hair T3 and T4 were significantly lower in patients with depression in disease episode than that in pre-disease episode or in healthy controls. Moreover, patients with depression in pre-disease episode had a higher hair T4 level than healthy controls. No significant correlation was observed between hair T3 or T4 levels and the Hamilton depression rating scale and Hamilton anxiety rating scale scores. Our results indicate that hair thyroid hormones levels change with the episodes of depressions, which may be helpful for pathological studies of depression.

  16. Bupropion versus sertraline in the treatment of depressive patients with binge eating disorder: retrospective cohort study.

    PubMed

    Calandra, Carmela; Russo, Rina Giuseppa; Luca, Maria

    2012-06-01

    This study sought to compare Bupropion versus Sertraline in the treatment of depressed patients with Binge Eating Disorder (BED) prescribed off-label. Medical records of outpatients with diagnosis of BED and Depression (DSM-IV-TR criteria) were selected: 15 patients were treated with bupropion 150 mg/per day, and 15 with sertraline 200 mg/per day. During the screening and control visits (2°-6°-14°-24° week), the selected patients were first weighed and then evaluated using the following questionnaires: Binge Eating Disorder-Clinical Interview (BEDCI), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory X (STAI-X) and Arizona Sexual Experience Scale (ASEX). Both drugs reduced anxious-depressive symptoms and binge frequency: Bupropion showed a better effectiveness in reducing weight and improving sexual performances; weight loss related to it was proportional to the body mass index. Bupropion may be associated with more weight loss in BED, depressed patients than sertraline.

  17. Depression in romanian patients with type 2 diabetes: prevalence and risk factors

    PubMed Central

    MOCAN, ANDREIA S.; IANCU, SILVIA S.; DUMA, LIVIA; MURESEANU, CAMELIA; BABAN, ADRIANA S.

    2016-01-01

    Background and aims Co-existing major depression was found to have a negative impact on the diabetes outcome and the quality of life. The aim of the present study was to assess the prevalence of depressive symptoms in Romanian diabetes patients and to identify the risk factors associated with depression. Methods A total of 144 type 2 diabetes patients were included in the study. Five models of presumed predictors were used to assess the risk factors for depressive symptoms, using hierarchical regression analysis. Together with demographics, disease, lifestyle predictors, previous depressive symptoms and diabetes distress were taken into account. Results In our sample the prevalence of depression was 12.6%. Main risk factors for depressive symptoms were previous depressive symptoms which were associated with depression in both Model 4 (β=0.297, p=0.013) and Model 5 (β=0.239, p=0.017) and diabetes distress in Model 5 (β=0.540, p≤0.001). Employment (β =−0.276, p=0.029) and increased number of diabetes complications (β=0.236, p=0.017) became significant when diabetes distress was added to the analysis. Conclusions The overall prevalence of depressive symptoms was found to be in range with the prevalence identified in the literature. Previous depression and diabetes distress were both independently associated with depression, confirming the bidirectional relationship between depression and diabetes distress. Due to the consequences for daily living, screening for diabetes distress and depression should be done in primary care units both by physicians and trained nurses. PMID:27547056

  18. Spanish consensus on the physical health of patients with depressive disorders.

    PubMed

    Giner, José; Saiz Ruiz, Jerónimo; Bobes, Julio; Zamorano, Enric; López, Francisco; Hernando, Teresa; Rico-Villademoros, Fernando; Álamo, Cecilio; Cervilla, Jorge A; Ibáñez Cuadrado, Ángela; Ibáñez Guerra, Elena; López, Silvia; Morán, Pedro; Palao, Diego J; Romacho, Montserrat

    2014-01-01

    Comorbidity between depression and physical illnesses is very common and has a significant impact on the health and management of the patient. With the support of the Sociedades Españolas de Psiquiatría y Psiquiatría Biológica, and Sociedad Española de Médicos de Atención Primaria (SEMERGEN) a consensus was prepared on physical health in patients with depression and is summarized in the present work. The literature review highlighted the high frequency of cardiovascular and endocrine-metabolic disorders in patients with depression such as diabetes and obesity, thus making the primary and secondary prevention recommendations for patients with cardiovascular or metabolic risk applicable to patients with depression. Comorbidity between depression and chronic pain is also frequent, and requires an integrated therapeutic approach. The presence of physical illness in patients with depression may condition, but not preclude, the pharmacological treatment; drug selection should take into account potential side-effect and drug-drug interactions. On the other hand, psychotherapy may contribute to the patient's recovery. Overall, coordination between the primary care physician, the psychiatrist and other health professionals involved is essential for the management of patients with depression and concomitant physical illness. PMID:25087131

  19. Patient ethnicity and perceptions of families and friends regarding depression treatment

    PubMed Central

    Bogner, Hillary; Dobransky, Larissa N.; Wittink, Marsha N.

    2009-01-01

    Objective Black Americans are less likely than white Americans to seek professional treatment for depression. Whether treatment recommendations are sought and implemented by patients will be influenced by the role families and friends play in diagnostic acceptance and treatment decisions. We investigated the association of ethnicity with the perceived need for treatment of depression by family and friends of older primary care patients. Design Cross-sectional survey of 355 older adults with and without significant depressive symptoms was conducted. At the baseline visit, family and friends’ ratings of apathy and need for depression treatment were obtained on 314 of the 355 patients (88% response rate) and examined according to ethnicity. Participants were interviewed using standardized measures of chronic medical conditions, functional status, and psychological status. Results Older black patients compared to older white patients were less likely to be rated as needing depression treatment by their family and friends (odds ratio (OR) = 0.34; 95% confidence interval (CI) = [0.18, 0.64]) adjusting for depressive symptoms, cognition, functional status, and other potentially influential characteristics. Conclusions Our study suggests that patient ethnicity may play a role in a family member’s or friend’s perceived need for depression treatment of older adults who present in the primary care setting. Further study of attitudes, expectations, and values of patients and family members or friends in primary care settings may help elucidate the interplay of physician, patient, and family member or friend. PMID:18850370

  20. Spanish consensus on the physical health of patients with depressive disorders.

    PubMed

    Giner, José; Saiz Ruiz, Jerónimo; Bobes, Julio; Zamorano, Enric; López, Francisco; Hernando, Teresa; Rico-Villademoros, Fernando; Álamo, Cecilio; Cervilla, Jorge A; Ibáñez Cuadrado, Ángela; Ibáñez Guerra, Elena; López, Silvia; Morán, Pedro; Palao, Diego J; Romacho, Montserrat

    2014-01-01

    Comorbidity between depression and physical illnesses is very common and has a significant impact on the health and management of the patient. With the support of the Sociedades Españolas de Psiquiatría y Psiquiatría Biológica, and Sociedad Española de Médicos de Atención Primaria (SEMERGEN) a consensus was prepared on physical health in patients with depression and is summarized in the present work. The literature review highlighted the high frequency of cardiovascular and endocrine-metabolic disorders in patients with depression such as diabetes and obesity, thus making the primary and secondary prevention recommendations for patients with cardiovascular or metabolic risk applicable to patients with depression. Comorbidity between depression and chronic pain is also frequent, and requires an integrated therapeutic approach. The presence of physical illness in patients with depression may condition, but not preclude, the pharmacological treatment; drug selection should take into account potential side-effect and drug-drug interactions. On the other hand, psychotherapy may contribute to the patient's recovery. Overall, coordination between the primary care physician, the psychiatrist and other health professionals involved is essential for the management of patients with depression and concomitant physical illness.

  1. Low-income cancer patients in depression treatment: dropouts and completers.

    PubMed

    Wells, Anjanette A; Palinkas, Lawrence A; Shon, En-Jung; Ell, Kathleen

    2013-10-01

    This study aims to explore reasons for depression treatment dropout among low-income, minority women with depression and cancer. Semi-structured telephone interviews are conducted with 20, predominately Latina, patients who dropped out of depression treatment and 10 who completed. Transcripts analyzed using techniques rooted in grounded theory. Treatment completion barriers cluster according to Meichenbaum and Turk's (Facilitating treatment adherence: A practitioner's guidebook, Plenum Press, New York, 1987) five adherence dimensions: (a) Barriers to Treatment (informational, instrumental, cultural [language, discrimination]); (b) Disease Features (emotional burden of cancer/depression); (c) Cancer/Depression Treatment Regimens; (d) Provider-Patient Relationship (depression treatment dissatisfaction); and (e) Clinical Setting (hospital organizational issues). Although both groups describe multiple overlapping dimensions of barriers, completers seem more motivated and satisfied with treatment, possibly due to completers experiencing the positive treatment effects after the first several sessions. More research should be conducted to determine the most effective clinical treatment methods for this population. PMID:23868016

  2. The Role of Depression in Medication Adherence Among Heart Failure Patients

    PubMed Central

    Tang, Hsin-Yi (Jean); Sayers, Steven L.; Weissinger, Guy; Riegel, Barbara

    2014-01-01

    The purpose of the study was to explore the association between depression and medication adherence in heart failure (HF) patients. Studies have shown that people with depression are likely to be nonadherent to their prescribed medication treatment. But other studies suggest that nonadherence may be overestimated by people with depression. A total of 244 adults with Stage C HF completed the study. Self-reported medication adherence was obtained using the Basel Assessment of Adherence Scale (BAAS); objective data on medication adherence were collected using the electronic Medication Event Monitoring System (MEMS). Depression was measured via self-report with the Patient Health Questionnaire (PHQ-9). There was a significant difference between depressed and nondepressed participants in self-reported medication nonadherence (p = .008), but not in objectively measured medication nonadherence (p = .72). The depressed sample was 2.3 times more likely to self-report poor medication adherence than those who were nondepressed (p = .006). PMID:23548500

  3. Trajectories of depressive symptoms in patients undergoing interferon treatment are predicted by baseline sleep quality

    PubMed Central

    Marron, Megan M.; Anderson, Stewart J.; Garrity, Jessica; Reynolds, Charles F.; Lotrich, Francis E.

    2015-01-01

    Objective Some patients with hepatitis C (HCV) starting interferon-α (IFN-α) experience depression, although many patients do not develop depressive symptoms. We have found that poor sleep is associated with increased depressive symptoms on average. It is unknown whether this association holds generally or is driven by a specific, distinct subgroup. This investigation first determined whether patterns of change in depressive symptoms form clinically meaningful, distinct sub-groups; and then tested the extent to which sleep disturbances are associated with a less favorable depression trajectory. Method Group-based trajectory modeling was used on 124 HCV patients who started IFN-α therapy. The Pittsburgh Sleep Quality Index (PSQI) assessed pre-treatment sleep, the Beck Depression Inventory minus the sleep question (BDI-s) assessed depression over time, and the Structured Clinical Interview for DSM-IV provided categorical diagnoses. Results Three distinct subgroups were found, where each subgroup shared similar patterns of depressive symptoms over time. The groups were characterized as “non-depressed”, “slow increase”, and “rapid increase”. The non-depressed subgroup (44.4%) experienced low depressive symptoms with little change over time. In comparison, all rapid increasers (11.3%) were diagnosed with a mood disorder by 12 weeks of treatment. The PSQI was strongly associated with group membership,. where the odds of developing a rapid increase was elevated 39% for every unit score increase in the PSQI compared to individuals who remained non-depressed (OR=1.39, 95%CI=1.07–1.80, adjusted for depression at baseline). Conclusion Only a distinct sub-population of people is notably vulnerable to a developing a rapid increase in depression symptoms during IFN-α therapy. This group may be identifiable by their markedly poor sleep prior to IFN-α therapy. PMID:26407225

  4. Positive and Negative Relationship between Anxiety and Depression of Patients in Pain: A Bifactor Model Analysis

    PubMed Central

    li, Wen; Shang, Wen; Yan, Ming; Miao, Danmin; Zhang, Huiming

    2012-01-01

    Background The relationship between anxiety and depression in pain patients has not been clarified comprehensively. Previous research has identified a common factor in anxiety and depression, which may explain why depression and anxiety are strongly correlated. However, the specific clinical features of anxiety and depression seem to pull in opposite directions. Objective The purpose of this study is to develop a statistical model of depression and anxiety, based on data from pain patients using Hospital Anxiety and Depression Scale (HADS). This model should account for the positive correlation between depression and anxiety in terms of a general factor and also demonstrate a latent negative correlation between the specific factors underlying depression and anxiety. Methods The anxiety and depression symptoms of pain patients were evaluated using the HADS and the severity of their pain was assessed with the visual analogue scale (VAS). We developed a hierarchical model of the data using an IRT method called bifactor analysis. In addition, we tested this hierarchical model with model fit comparisons with unidimensional, bidimensional, and tridimensional models. The correlations among anxiety, depression, and pain severity were compared, based on both the bidimensional model and our hierarchical model. Results The bidimensional model analysis found that there was a large positive correlation between anxiety and depression (r = 0.638), and both scores were significantly positively correlated with pain severity. After extracting general factor of distress using bifactor analysis, the specific factors underlying anxiety and depression were weakly but significantly negatively correlated (r = −0.245) and only the general factor was significantly correlated with pain severity. Compared with the three first-order models, the bifactor hierarchical model had the best model fit. Conclusion Our results support the hypothesis that apart from distress, anxiety and

  5. Invasive coronary angiography in patients with acute exacerbated COPD and elevated plasma troponin

    PubMed Central

    Pizarro, Carmen; Herweg-Steffens, Neele; Buchenroth, Martin; Schulte, Wolfgang; Schaefer, Christian; Hammerstingl, Christoph; Werner, Nikos; Nickenig, Georg; Skowasch, Dirk

    2016-01-01

    Background In acute exacerbation of COPD, increased plasma levels of cardiac troponin are frequent and associated with increased mortality. Thus, we aimed at prospectively determining the diagnostic value of coronary angiography in patients with exacerbated COPD and concomitantly elevated cardiac troponin. Patients and methods A total of 88 patients (mean age 72.9±9.2 years, 56.8% male) hospitalized for acute exacerbation of COPD with elevated plasma troponin were included. All patients underwent coronary angiography within 72 hours after hospitalization. Complementary 12-lead electrocardiogram, transthoracic echocardiography, pulmonary function, and angiological testing were performed. Results Coronary angiography objectified the presence of ischemic heart disease (IHD) in 59 patients (67.0%), of whom 34 patients (38.6% of total study population) underwent percutaneous coronary intervention. Among these 34 intervened patients, the vast majority (n=26, 76.5%) had no previously known IHD, whereas only eight out of 34 patients (23.5%) presented an IHD history. Patients requiring coronary intervention showed significantly reduced left ventricular ejection fraction (45.8%±13.1% vs 55.1%±13.3%, P=0.01) and a significantly more frequent electrocardiographic ST-segment depression (20.6% vs 7.4%, P=0.01). Neither additional laboratory parameters for inflammation and myocardial injury nor lung functional measurements differed significantly between the groups. Conclusion Angiographically confirmed IHD that required revascularization occurred in 38.6% of exacerbated COPD patients with elevated cardiac troponin. In this considerable portion of patients, coronary angiography emerged to be of diagnostic and therapeutic value. PMID:27695304

  6. Invasive coronary angiography in patients with acute exacerbated COPD and elevated plasma troponin

    PubMed Central

    Pizarro, Carmen; Herweg-Steffens, Neele; Buchenroth, Martin; Schulte, Wolfgang; Schaefer, Christian; Hammerstingl, Christoph; Werner, Nikos; Nickenig, Georg; Skowasch, Dirk

    2016-01-01

    Background In acute exacerbation of COPD, increased plasma levels of cardiac troponin are frequent and associated with increased mortality. Thus, we aimed at prospectively determining the diagnostic value of coronary angiography in patients with exacerbated COPD and concomitantly elevated cardiac troponin. Patients and methods A total of 88 patients (mean age 72.9±9.2 years, 56.8% male) hospitalized for acute exacerbation of COPD with elevated plasma troponin were included. All patients underwent coronary angiography within 72 hours after hospitalization. Complementary 12-lead electrocardiogram, transthoracic echocardiography, pulmonary function, and angiological testing were performed. Results Coronary angiography objectified the presence of ischemic heart disease (IHD) in 59 patients (67.0%), of whom 34 patients (38.6% of total study population) underwent percutaneous coronary intervention. Among these 34 intervened patients, the vast majority (n=26, 76.5%) had no previously known IHD, whereas only eight out of 34 patients (23.5%) presented an IHD history. Patients requiring coronary intervention showed significantly reduced left ventricular ejection fraction (45.8%±13.1% vs 55.1%±13.3%, P=0.01) and a significantly more frequent electrocardiographic ST-segment depression (20.6% vs 7.4%, P=0.01). Neither additional laboratory parameters for inflammation and myocardial injury nor lung functional measurements differed significantly between the groups. Conclusion Angiographically confirmed IHD that required revascularization occurred in 38.6% of exacerbated COPD patients with elevated cardiac troponin. In this considerable portion of patients, coronary angiography emerged to be of diagnostic and therapeutic value.

  7. Cerebrospinal Fluid Proteome of Patients with Acute Lyme Disease

    SciTech Connect

    Angel, Thomas E.; Jacobs, Jon M.; Smith, Robert P.; Pasternack, Mark S.; Elias, Susan; Gritsenko, Marina A.; Shukla, Anil K.; Gilmore, Edward C.; McCarthy, Carol; Camp, David G.; Smith, Richard D.

    2012-10-05

    Acute Lyme disease results from transmission of and infection by the bacterium Borrelia burgdorferi following a tick bite. During acute infection, bacteria can disseminate to the central nervous system (CNS) leading to the development of Lyme meningitis. Here we have analyzed pooled cerebrospinal fluid (CSF) allowing for a deep view into the proteome for a cohort of patients with early-disseminated Lyme disease and CSF inflammation leading to the identification of proteins that reflect host responses, which are distinct for subjects with acute Lyme disease. Additionally, we analyzed individual patient samples and quantified changes in protein abundance employing label-free quantitative mass spectrometry based methods. The measured changes in protein abundances reflect the impact of acute Lyme disease on the CNS as presented in CSF. We have identified 89 proteins that differ significantly in abundance in patients with acute Lyme disease. A number of the differentially abundant proteins have been found to be localized to brain synapse and thus constitute important leads for better understanding of the neurological consequence of disseminated Lyme disease.

  8. Development of a Korean Version of the Perceived Deficits Questionnaire-Depression for Patients with Major Depressive Disorder

    PubMed Central

    Kim, Jae-Min; Hong, Jin-Pyo; Kim, Sang-Dae; Kang, Hee-Ju; Lee, Yong-Sung

    2016-01-01

    Objective Cognitive symptoms are an important component of depression and the Perceived Deficits Questionnaire-Depression is one of only a few instruments available for the subjective assessment of cognitive dysfunction in depression. Thus, the present study aimed to validate a Korean version of the PDQ-D (K-PDQ-D) using patients with major depressive disorder (MDD). Methods This study included 128 MDD patients who were assessed at study entry and 86 of these patients were then completed 12 weeks of antidepressant monotherapy. All subjects were assessed with the K-PDQ-D, the Montgomery-Asberg Depression Rating Scale (MADRS), the Sheehan Disability Scale (SDS), the EuroQol-5 dimensions questionnaire (EQ-5D), and the number of sick leave days taken in the previous week. The internal consistency, Guttman’s split-half and test-retest reliabilities, factorial analyses, and concurrent and predictive validities of the K-PDQ-D were investigated. Results The K-PDQ-D exhibited excellent internal consistency and reliabilities, and was composed of four factors with high coefficients of determination. The concurrent validity analyses revealed that the K-PDQ-D scores were significantly correlated with the MADRS, SDS, and EQ-5D scores and the number of sick leave days taken. The K-PDQ-D scores at study entry significantly predicted changes in sick leave days and EQ-5D score from study entry to the 12-week endpoint. Conclusion The newly developed K-PDQ-D is a reliable and valid instrument for the evaluation of subjective cognitive symptoms in MDD patients. The K-PDQ-D may assist in the gathering of unique information regarding subjective cognitive complaints, which is important for the comprehensive evaluation of patients with MDD. PMID:26792037

  9. Resilience as a correlate of acute stress disorder symptoms in patients with acute myocardial infarction

    PubMed Central

    Meister, Rebecca E; Weber, Tania; Princip, Mary; Schnyder, Ulrich; Barth, Jürgen; Znoj, Hansjörg; Schmid, Jean-Paul; von Känel, Roland

    2015-01-01

    Objectives Myocardial infarction (MI) may be experienced as a traumatic event causing acute stress disorder (ASD). This mental disorder has an impact on the daily life of patients and is associated with the development of post-traumatic stress disorder. Trait resilience has been shown to be a protective factor for post-traumatic stress disorder, but its association with ASD in patients with MI is elusive and was examined in this study. Methods We investigated 71 consecutive patients with acute MI within 48 h of having stable haemodynamic conditions established and for 3 months thereafter. All patients completed the Acute Stress Disorder Scale and the Resilience Scale to self-rate the severity of ASD symptoms and trait resilience, respectively. Results Hierarchical regression analysis showed that greater resilience was associated with lower symptoms of ASD independent of covariates (b=−0.22, p<0.05). Post hoc analysis revealed resilience level to be inversely associated with the ASD symptom clusters of re-experiencing (b=−0.05, p<0.05) and arousal (b=−0.09, p<0.05), but not with dissociation and avoidance. Conclusions The findings suggest that patients with acute MI with higher trait resilience experience relatively fewer symptoms of ASD during MI. Resilience was particularly associated with re-experiencing and arousal symptoms. Our findings contribute to a better understanding of resilience as a potentially important correlate of ASD in the context of traumatic situations such as acute MI. These results emphasise the importance of identifying patients with low resilience in medical settings and to offer them adequate support. PMID:26568834

  10. Aspiration-Related Acute Respiratory Distress Syndrome in Acute Stroke Patient

    PubMed Central

    Zhao, Jiang-nan; Liu, Yao; Li, Huai-chen

    2015-01-01

    Background Aspiration of oral or gastric contents into the larynx and lower respiratory tract is a common problem in acute stroke patients, which significantly increases the incidence of acute respiratory distress syndrome (ARDS). However, little is known about the clinical characteristics of aspiration-related ARDS in acute stroke patients. Methods Over 17-month period a retrospective cohort study was done on 1495 consecutive patients with acute stroke. The data including demographic characteristics, clinical manifestations, laboratory examinations, chest imaging, and hospital discharge status were collected to analysis. Results Aspiration-related ARDS was diagnosed in 54 patients (3.6%). The most common presenting symptom was tachypnea (respiratory rate ≥25 breaths/min) in 50 cases. Computed tomography (CT) images usually demonstrated diffuse ground-glass opacities (GGOs) and inhomogeneous patchy consolidations involving the low lobes. Age, NIHSS score, GCS score, dysphagia, dysarthria, hemoglobin concentration, serum aspertate aminotransferase (AST), serum albumin, serum sodium, and admission glucose level were independently associated with aspiration-related ARDS (odds ratio (OR) 1.05, 95% confidence interval (CI) (1.04–1.07); OR 2.87, (2.68–3.63); OR 4.21, (3.57–5.09); OR 2.18, (1.23–3.86); OR 1.67, (1.31–2.14); OR 2.31, (1.11–4.84); OR 1.68, (1.01–2.80); OR 2.15, (1.19–3.90); OR 1.92, (1.10–3.36) and OR 1.14, (1.06–1.21) respectively). Conclusions Aspiration-related ARDS frequently occurs in acute stroke patient with impairment consciousness. It is advisable that performing chest CT timely may identify disease early and prompt treatment to rescue patients. PMID:25790377

  11. Unexplained Painful Physical Symptoms in Patients with Major Depressive Disorder: Prevalence, Pathophysiology and Management.

    PubMed

    Jaracz, Jan; Gattner, Karolina; Jaracz, Krystyna; Górna, Krystyna

    2016-04-01

    Patients with major depression often report pain. In this article, we review the current literature regarding the prevalence and consequences, as well as the pathophysiology, of unexplained painful physical symptoms (UPPS) in patients with major depressive disorder (MDD). UPPS are experienced by approximately two-thirds of depressed patients. The presence of UPPS makes a correct diagnosis of depression more difficult. Moreover, UPPS are a predictor of a poor response to treatment and a more chronic course of depression. Pain, in the course of depression, also has a negative impact on functioning and quality of life. Frequent comorbidity of depression and UPPS has inspired the formulation of an hypothesis regarding a shared neurobiological mechanism of both conditions. Evidence from neuroimaging studies has shown that frontal-limbic dysfunction in depression may explain abnormal pain processing, leading to the presence of UPPS. Increased levels of proinflamatory cytokines and substance P in patients with MDD may also clarify the pathophysiology of UPPS. Finally, dysfunction of the descending serotonergic and noradrenergic pathways that normally suppress ascending sensations has been proposed as a core mechanism of UPPS. Psychological factors such as catastrophizing also play a role in both depression and chronic pain. Therefore, pharmacological treatment and/or cognitive therapy are recommended in the treatment of depression with UPPS. Some data suggest that serotonin and noradrenaline reuptake inhibitors (SNRIs) are more effective than selective serotonin reuptake inhibitors (SSRIs) in the alleviation of depression and UPPS. However, the pooled analysis of eight randomised clinical trials showed similar efficacy of duloxetine (an SNRI) and paroxetine (an SSRI) in reducing UPPS in depression. Further integrative studies examining genetic factors (e.g. polymorphisms of genes for interleukins, serotonin transporter and receptors), molecular factors (e.g. cytokines

  12. Unexplained Painful Physical Symptoms in Patients with Major Depressive Disorder: Prevalence, Pathophysiology and Management.

    PubMed

    Jaracz, Jan; Gattner, Karolina; Jaracz, Krystyna; Górna, Krystyna

    2016-04-01

    Patients with major depression often report pain. In this article, we review the current literature regarding the prevalence and consequences, as well as the pathophysiology, of unexplained painful physical symptoms (UPPS) in patients with major depressive disorder (MDD). UPPS are experienced by approximately two-thirds of depressed patients. The presence of UPPS makes a correct diagnosis of depression more difficult. Moreover, UPPS are a predictor of a poor response to treatment and a more chronic course of depression. Pain, in the course of depression, also has a negative impact on functioning and quality of life. Frequent comorbidity of depression and UPPS has inspired the formulation of an hypothesis regarding a shared neurobiological mechanism of both conditions. Evidence from neuroimaging studies has shown that frontal-limbic dysfunction in depression may explain abnormal pain processing, leading to the presence of UPPS. Increased levels of proinflamatory cytokines and substance P in patients with MDD may also clarify the pathophysiology of UPPS. Finally, dysfunction of the descending serotonergic and noradrenergic pathways that normally suppress ascending sensations has been proposed as a core mechanism of UPPS. Psychological factors such as catastrophizing also play a role in both depression and chronic pain. Therefore, pharmacological treatment and/or cognitive therapy are recommended in the treatment of depression with UPPS. Some data suggest that serotonin and noradrenaline reuptake inhibitors (SNRIs) are more effective than selective serotonin reuptake inhibitors (SSRIs) in the alleviation of depression and UPPS. However, the pooled analysis of eight randomised clinical trials showed similar efficacy of duloxetine (an SNRI) and paroxetine (an SSRI) in reducing UPPS in depression. Further integrative studies examining genetic factors (e.g. polymorphisms of genes for interleukins, serotonin transporter and receptors), molecular factors (e.g. cytokines

  13. Evaluating depressive symptoms in mania: a naturalistic study of patients with bipolar disorder

    PubMed Central

    Young, Allan H; Eberhard, Jonas

    2015-01-01

    Objective This study aimed to evaluate patients with bipolar I disorder (BD-I) who have mania with depressive symptoms and who meet the new “with mixed features” specifier of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Method This prospective, multinational, naturalistic study surveyed psychiatrists and their patients with BD-I from October 2013 to March 2014. Eligible patients had BD-I, had a (current) manic episode, and had experienced onset of a manic episode within the previous 3 months. Psychiatrists provided patient information on depressive symptoms (DSM-5 criteria); symptoms of anxiety, irritability, and agitation; suicide attempts; and physician satisfaction with treatment response. Data were stratified according to whether patients met the criteria for the BD-I “with mixed features” specifier of DSM-5 (≥3 depressive symptoms) or not, and characteristics were compared between the two subgroups. Patients also self-reported on depressive symptoms using the Mini-International Neuropsychiatric Interview module questionnaire. Results Overall, 34% of 1,035 patients met the criteria for BD-I “with mixed features,” exhibiting ≥3 depressive symptoms during their current manic episode. This correlated with the matched patient self-reports of depressive symptoms. During their current manic episode, BD-I patients “with mixed features” had more severe symptoms of anxiety, irritability, and agitation (average composite severity score of 4.1 vs 3.4), a higher incidence of suicide attempts (38% vs 9%), and more physician dissatisfaction with treatment response (22% vs 14%), compared to patients with 0–2 depressive symptoms (all P<0.05). Conclusion This study found that patients with BD-I “with mixed features” (ie, ≥3 depressive symptoms during a manic episode), suffered, on average, from a greater burden of disease than patients with pure mania. Improved identification of these patients may help to optimize

  14. Dimensional structure of the Hamilton Depression Rating Scale in patients with obsessive-compulsive disorder.

    PubMed

    Moritz, Steffen; Meier, Beat; Hand, Iver; Schick, Mildred; Jahn, Holger

    2004-02-15

    Comorbid depression is frequent in obsessive-compulsive disorder (OCD) and is acknowledged as a major confound in biological and neurocognitive investigations in OCD. The aim of the present study was to assess the distribution of depressive symptoms in a large OCD sample (n=162) and to analyze the dimensional structure of the Hamilton Depression Rating Scale (HDRS) in OCD. Major depressive disorder according to DSM-IV criteria was apparent in approximately one third of the patients. Frequent symptoms were depressed mood, reduced ability to work, anxiety symptoms and guilt feelings. HDRS scores were submitted to a varimax-rotated factor analysis. In accordance with studies conducted with depressed samples, multi-dimensional solutions suggesting three to six factors emerged. Subsequent confirmatory factor analysis revealed satisfactory fit indices for a four-factorial solution comprising core depressive symptoms, sleep disturbance, anxiety and gastrointestinal problems. Aggression-related obsessions as well as the overall severity of obsessions were related to core depressive symptoms. Anxiety symptoms were associated with excessive rituals. Greater recognition of depressive sub-components may help to raise the replicability of empirical findings in OCD research as there is evidence from both depression and OCD samples that distinct depressive syndromes have different biological correlates.

  15. Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease.

    PubMed

    Bonnet, Fabrice; Irving, Kate; Terra, Jean-Louis; Nony, Patrice; Berthezène, François; Moulin, Philippe

    2005-02-01

    Adherence to lifestyle recommendations for prevention of cardiovascular disease remains a critical issue. We examined the association of anxiety and depression with healthy behaviors in a large population of subjects at risk of cardiovascular disease. We studied 1612 consecutive subjects referred for evaluation of cardiovascular risk factors. Separated scores reflecting unhealthy behaviors (physical inactivity, smoking and poor diet) were combined to produce a global unhealthy lifestyle score. The Hospital Anxiety and Depression scale (HAD) was used to assess both anxiety and depression. Both anxiety and depression were significantly associated with physical inactivity in both sexes and with an unhealthy diet in men but not in women. Anxiety and depression were both significantly correlated to smoking habits in men whereas only depression was related to smoking in women. In both sexes, the global score reflecting unhealthy lifestyles was positively associated with the degree of anxiety and depression. In multivariate analysis, both anxiety and depression appeared as independent determinant of unhealthy lifestyle in both sexes, with a stronger influence for depression. Depression and to a lesser extent anxiety are associated with a cluster of unhealthy behaviors in subjects at risk of cardiovascular disease, suggesting the difficulty of modifying lifestyle in patients with anxious-depressive disorders.

  16. Depression and anxiety in patients with hematological malignancies, prevalence, and associated factors

    PubMed Central

    Abuelgasim, Khadega A.; Ahmed, Gasmelseed Y.; Alqahtani, Jamilah A.; Alayed, Aseel M.; Alaskar, Ahmed S.; Malik, Mansoor A.

    2016-01-01

    Objectives: To study the prevalence and associated factors of depression and anxiety in hematological cancers (HC) patients. Methods: We conducted a cross-sectional survey in all HC patients at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia between March 2014 and June 2015. We excluded patients with depression, or generalized anxiety disorder. We conducted a structured face to face interview using an internally developed and validated questionnaire (Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 patient’s questionnaire with all participants). Results: Among 211 participants, depression was detected in 98 (46.5%) and anxiety was detected in 47 (22.3%). Thirty-eight (18.1%) had concurrent anxiety and depression. Multiple co-morbidities and tense home atmosphere were predictive for anxiety and depression. We found no association between gender, smoking, income, or being on active therapy and depression or anxiety. Conclusions: Depression and anxiety are highly prevalent in HC patients in KAMC. Health care providers should screen HC cancers for depression and anxiety; as early intervention possibly improve their disease outcome and will likely enhance their psychological wellbeing. PMID:27464865

  17. Anxiety and depression in patients with advanced macular degeneration: current perspectives

    PubMed Central

    Cimarolli, Verena R; Casten, Robin J; Rovner, Barry W; Heyl, Vera; Sörensen, Silvia; Horowitz, Amy

    2016-01-01

    Age-related macular degeneration (AMD) – despite advances in prevention and medical treatment options – remains prevalent among older adults, often resulting in functional losses that negatively affect the mental health of older adults. In particular, the prevalence of both anxiety and depression in patients with AMD is high. Along with medical treatment options, low vision rehabilitation and AMD-specific behavioral and self-management programs have been developed and have demonstrated effectiveness in improving the mental health of AMD patients. This article reviews the prevalence of anxiety and depression in patients with advanced AMD, discusses potential mechanisms accounting for the development of depression and anxiety in AMD patients, presents the state-of the-art of available interventions for addressing anxiety and depression in AMD patients, and delineates recommendations for eye care professionals regarding how to screen for these two prevalent mental health problems and how to facilitate appropriate treatment for patients with AMD. PMID:26766899

  18. Imaging of acute invasive fungal rhinosinusitis in a patient with gorlin syndrome and acute lymphocytic leukemia.

    PubMed

    Donovan, S T; Thompson, J W; Sandlund, J T; Adderson, E E; Pivnick, E K; Harreld, J H

    2013-01-01

    Gorlin Syndrome (GS), also known as nevoid basal cell carcinoma syndrome, is a rare autosomal dominant condition characterized by developmental abnormalities and predisposition to certain neoplasms. Acute invasive fungal rhinosinusitis (AIFRS) is an uncommon clinical entity characterized by high morbidity and mortality. In immunocompromised patients, computed tomography plays a critical role in screening for suspected AIFRS. However, due to the association between exposure to ionizing radiation and subsequent development of malignancies in patients with GS, patients with GS and suspected AIFRS present a unique and challenging clinical scenario. We present a case of a pediatric patient with GS and acute lymphocytic leukemia (ALL) diagnosed with AIFRS; to the best of our knowledge, it is the only case described in the literature.

  19. Depression and Insomnia in Patients With Psoriasis and Psoriatic Arthritis Taking Tumor Necrosis Factor Antagonists

    PubMed Central

    Wu, Chun-Ying; Chang, Yun-Ting; Juan, Chao-Kuei; Shen, Jui-Lung; Lin, Yu-Pu; Shieh, Jeng-Jer; Liu, Han-Nan; Chen, Yi-Ju

    2016-01-01

    Abstract Psoriasis patients with moderate to severe disease often present with depression and insomnia. Treatment targeting both psoriasis and psychological comorbidities is needed to improve the quality of life of these patients. In this nationwide cohort study, a total of 980 patients with psoriatic arthritis or psoriasis who had received nonbiological disease-modifying antirheumatic drugs and biologics therapy between 2009 and 2012 were identified. The prevalence rates of patients taking medications for depression and insomnia were compared before and after biologics therapy. Logistic regression method was used to investigate the risk factors for depression and insomnia. Further stratified analyses were performed to examine the prevalence of use of medications for depression and insomnia among different patient subgroups. The prevalence of patients taking regular antidepressants before starting biologics therapy was about 20%. There was a more than 40% reduction in this prevalence after biologics therapy for 2 years. Age higher than 45 years, female sex, presence of comorbidities, and psoriatic arthritis were independently associated with depression and insomnia. Further stratified analyses revealed a more rapid and significant reduction in depression/insomnia in those undergoing continuous biologics therapy, younger than 45 years, without psoriatic arthritis and not taking concomitant methotrexate, when compared with their counterparts. The results suggest that biologics therapy may be associated with reduced rates of depression and insomnia, and a reduced rate of regular antidepressants use in psoriasis patients. PMID:27258525

  20. Depression and the older medical patient--when and how to intervene.

    PubMed

    Mitchell, Philip B; Harvey, Samuel B

    2014-10-01

    Depression in the elderly, particularly those with chronic physical health problems, is a common, but complex problem. In this paper we review the research literature on both the epidemiology and management of depression in the older medical patient. After a general overview of depression in the elderly, we discuss some of the particular issues relevant to depression and co-morbid physical illness amongst elderly patients. Depression can be difficult to diagnose in medically unwell older adults, particularly when there is substantial overlap in symptomatology. The epidemiology and evidence base for the treatment of depression in a number of chronic health problems common in an older adults population are then discussed, specifically cardiac disease, cerebrovascular disease, cancer, chronic kidney disease, chronic obstructive pulmonary disease, and Parkinson's disease. For many of these conditions there is emerging evidence that treatments can be effective in reducing depressive symptoms. However, these potential benefits need to be balanced against the often-increased risk of adverse events or interactions with medical treatments. Although co-morbid depression is consistently associated with poorer medical outcomes, there is limited evidence that standard anti-depressive therapy has additional benefits in terms of physical health outcomes. Collaborative care models appear particularly well suited to medically unwell older adult patients, and may provide more generalised benefits across both mental and physical health measures.

  1. Patients' views of physical activity as treatment for depression: a qualitative study

    PubMed Central

    Searle, Aidan; Calnan, Michael; Lewis, Glyn; Campbell, John; Taylor, Adrian; Turner, Katrina

    2011-01-01

    Background Clinical guidance recommends physical activity to manage patients with persistent subthreshold depressive symptoms or mild-to-moderate depression. However, little is known regarding the acceptability of physical activity as a treatment for depression from patients' perspective. Aim To explore patients' views of physical activity for the treatment of depression in the context of primary care. Design of study In-depth interviews were held with 33 participants taking part in a randomised controlled trial assessing the effectiveness of physical activity for the management of depression. Setting Primary care. Results Most participants perceived physical activity to be an acceptable treatment for depression. The mechanisms by which physical activity could enhance mood were attributed to a number of subjective benefits including biochemical pathways, providing a source of distraction from negative thoughts, and a sense of purpose. Participants who expressed a belief that their depression was caused by biochemical mechanisms reported activity that ‘raised the heartbeat’ as most beneficial, while those who believed depression was situational in origin tended to state the benefits of less-aerobic activities, such as walking. Many participants reported low motivation and a lack of confidence as barriers to undertaking physical activity. These patients suggested that medication could be helpful for initiating and maintaining activity. Conclusion Patients view physical activity as an effective treatment for depression. However, they vary in their views about how physical activity might impact on depression, what intensity and form of activity is necessary to enhance mood, and the barriers to undertaking activity. This variation suggests the need for GPs to elicit patients' views on physical activity as a treatment, and offer interventions that are tailored to the needs and expectations of individual patients. PMID:21439172

  2. Cortisol Supplement Combined with Psychotherapy and Citalopram Improves Depression Outcomes in Patients with Hypocortisolism after Traumatic Brain Injury

    PubMed Central

    Luo, Lanlan; Chai, Yan; Jiang, Rongcai; Chen, Xin; Yan, Tao

    2015-01-01

    Depression is one of the most prevalent psychiatric disorders in people with Traumatic brain injury (TBI). Depression after TBI is closely related with social and psychological factors and hypothalamic-pituitary -adrenal (HPA) axis dysfunction. However, there is a lack of evidence regarding effective treatment approaches for depression. A total of 68 patients with depression following closed TBI were recruited. Glasgow Coma Scale score (GCS) was employed to demonstrate the severity of neurological deficits and Glasgow Outcome Scale (GOS) was employed to measure functional outcome after TBI. The severity of depression was quantified using the Beck Depression Inventory-II (BDI-II) in line with DSM-IV. Citalopram and Prednisone were administered to subjects with normal cortisol levels or hypocortisolism separately, based on psychotherapeutic interventions. We investigated the relationship between degree of depression of TBI patients and the severity and progression of TBI with the therapeutic effects of Citalopram in combination with psychotherapeutic and Prednisone in depressed patients. There was no relationship between the severity of depression and the severity and progression of TBI. The basic treatment of psychotherapeutic interventions could partially relieve depressive symptoms. Combination of psychotherapeutic support and Citalopram significantly improved depressive symptoms in patients with normal cortisol levels, but not in hypocortisolic patients. Combination of Prednisone administration with psychotherapeutic treatment and Citalopram significantly improved depression outcome in hypocortisolic patients after TBI. Hypocortisolism after TBI may regulate depression. Combination of Prednisone with psychotherapeutic treatment and Citalopram may provide better therapeutic effects in depression patients with hypocortisolism after TBI. PMID:26618043

  3. Transcranial midbrain sonography and depressive symptoms in patients with Parkinson's disease.

    PubMed

    Stanković, Iva; Stefanova, Elka; Žiropadja, Ljubomir; Mijajlović, Milija; Pavlović, Aleksandra; Kostić, Vladimir S

    2015-03-01

    Transcranial sonography (TCS) appeared to be a promising marker associated with depression: hypo/anechogenicity of the brainstem raphe (BR) was found in 50-70 % of patients with unipolar depression, in 40-60 % of depressed patients with Parkinson's disease (PD), but also in 8-28 % of healthy controls. Our study included 120 consecutive PD outpatients. Abnormal BR echogenicity was found in 51 (43 %), while normal findings were present in 67 PD patients (57 %). Patients with abnormal BR echogenicity had higher scores on the Montgomery-Asberg Depression Rating Scale (MADRS) items of apparent sadness (p = 0.03), reported sadness (p = 0.01), and pessimistic thoughts (p = 0.049), when compared to those with normal BR. In the second part of the study, previously suggested cut-off value at 14/15 on the MADRS was used to dichotomize patients into depressed (dPD) (46 patients; 39 %) and non-depressed PD patients (ndPD) (72 patients; 61 %). Abnormal TCS BR findings were obtained in 27 dPD (58.7 %) and in only 24 ndPD patients (33.3 %) (p = 0.007): the risk that PD patients with the TCS BR abnormality would display depressive symptoms was about 3.5 times higher when compared to PD patients with intact BR, controlling for the effect of motor difficulties (cross-odds ratio; OR = 3.48). Therefore, at least in a subgroup of dPD patients, TCS of the midbrain midline structure may potentially be a useful tool for depressive symptoms prediction. PMID:25557281

  4. Differences in maladaptive schemas between patients suffering from chronic and acute posttraumatic stress disorder and healthy controls

    PubMed Central

    Ahmadian, Alireza; Mirzaee, Jafar; Omidbeygi, Maryam; Holsboer-Trachsler, Edith; Brand, Serge

    2015-01-01

    Background War, as a stressor event, has a variety of acute and chronic negative consequences, such as posttraumatic stress disorder (PTSD). In this context, early maladaptive schema-based problems in PTSD have recently become an important research area. The aim of this study was to assess early maladaptive schemas in patients with acute and chronic PTSD. Method Using available sampling methods and diagnostic criteria, 30 patients with chronic PTSD, 30 patients with acute PTSD, and 30 normal military personnel who were matched in terms of age and wartime experience were selected and assessed with the Young Schema Questionnaire-Long Form, Beck Depression Inventory second version (BDI-II), the Beck Anxiety Inventory (BAI), and the Impact of Events Scale (IES). Results Both acute and chronic PTSD patients, when compared with normal military personnel, had higher scores for all early maladaptive schemas. Additionally, veterans suffering from chronic PTSD, as compared with veterans suffering from acute PTSD and veterans without PTSD, reported more impaired schemas related, for instance, to Self-Control, Social Isolation, and Vulnerability to Harm and Illness. Discussion The results of the present study have significant preventative, diagnostic, clinical, research, and educational implications with respect to PTSD. PMID:26203249

  5. Anxiety and depression among patients with different types of vestibular peripheral vertigo.

    PubMed

    Yuan, Qing; Yu, Lisheng; Shi, Dongmei; Ke, Xingxing; Zhang, Hua

    2015-02-01

    Numerous studies have been published on comorbid anxiety and depression in patients with vertigo. However, very few studies have separately described and analyzed anxiety or depression in patients with different types of vestibular peripheral vertigo. The present study investigated anxiety and depression among patients with 4 different types of peripheral vertigo. A total of 129 patients with 4 types of peripheral vertigo, namely, benign paroxysmal positional vertigo (BPPV, n = 49), migrainous vertigo (MV, n = 37), Menière disease (MD, n = 28), and vestibular neuritis (VN, n = 15), were included in the present study. Otological and neurootological examinations were carefully performed, and self-rating anxiety scale and self-rating depression scale were used to evaluate anxiety and depression. Patients were divided into 2 groups, according to the vestibular function: normal and abnormal vestibular function. There was no significant difference in the risk of anxiety/depression between these 2 groups. However, for patients with the 4 different vertigo types, the prevalence of anxiety (MV = 45.9%, MD = 50%) and depression (MV = 27%, MD = 28.6%) was significantly higher in the patients with MV or MD than those with BPPV or VN (P < 0.05). Vestibular function is not significantly associated with the risk of anxiety/depression. Anxiety/depression is more common in patients with MV or MD than those with BPPV or VN. This may be due to the different mechanisms involved in these 4 types of vertigo, as well as differences in the prevention and self-control of the patients against the vertigo.

  6. MS patients with depressive symptoms exhibit affective memory biases when verbal encoding strategies are suppressed.

    PubMed

    Bruce, Jared M; Arnett, Peter A

    2005-09-01

    As many as 50% of multiple sclerosis (MS) patients experience clinical or subclinical depression. A voluminous literature has documented affective memory biases (AMB) among depressed individuals. Despite this, little is known regarding how depressive symptoms may affect MS patients' ability to recall positive and negative material. The present study employed an affective list-learning task that increased cognitive load and inhibited the use of higher order encoding strategies. The purpose of the study was twofold: to determine whether MS patients exhibit AMB and to examine whether subvocal repetition and other higher order encoding strategies are essential to the formation of AMB among people experiencing depression. Results indicated a strong relationship between depression and AMB in MS. The results are discussed in relation to existing biological research that indicates limbic and/or other subcortical systems may play a role in the formation of AMB.

  7. A Randomized, Placebo-Controlled Pilot Study of Quetiapine-XR Monotherapy or Adjunctive Therapy to Antidepressant in Acute Major Depressive Disorder with Current Generalized Anxiety Disorder

    PubMed Central

    Li, Ranran; Wu, Renrong; Chen, Jun; Kemp, David E.; Ren, Ming; Conroy, Carla; Chan, Philip; Serrano, Mary Beth; Ganocy, Stephen J.; Calabrese, Joseph R.; Gao, Keming

    2016-01-01

    Objectives To pilot efficacy and safety data of quetiapine-XR monotherapy or adjunctive therapy to antidepressant(s) in the acute treatment of MDD with current generalized anxiety disorder (GAD). Methods The Mini International Neuropsychiatric Interview was used to ascertain the diagnosis of DSM-IV Axis I disorders. Eligible patients were randomly assigned to quetiapine-XR or placebo for up to 8 weeks. Changes from baseline to endpoint in Hamilton Depression Rating Scale-17 items (HAMD-17), Hamilton Anxiety Rating Scale (HAM-A), Clinical Global Impression-Severity (CGI-S), Quick Inventory of Depression Symptomatology-16 items Self-Report (QIDS-16-SR) total scores, and other outcome measures were analyzed with the last observation carried forward strategy and/or mixed-effects modeling for repeated measures. Results Of the 34 patients screened, 23 patients were randomized to receive quetiapine-XR (n = 11) or placebo (n = 12), with 5 and 4 completing the study, respectively. The mean dose of quetiapine-XR was 154 ± 91 mg/d. The change from baseline to endpoint in the total scores of HAMD-17, HAM-A, QIDS-16-SR, and CGI-S were significant in the quetiapine-XR group, but only the change in HAM-A total score was significant in the placebo group. The differences in these changes between the two groups were only significant in CGI-S scores, with the rest of numerical larger in the quetiapine-XR group. The most common side effects from quetiapine-XR were dry mouth, somnolence/sedation, and fatigue. Conclusions In this pilot study, quetiapine-XR was numerically superior to placebo in reducing depressive and anxiety symptoms in patients with MDD and current GAD. Large sample studies are warranted to support or refute these preliminary findings.

  8. Cognitive Decline in Patients With Dementia as a Function of Depression

    PubMed Central

    Rapp, Michael A.; Schnaider-Beeri, Michal; Wysocki, Michael; Guerrero-Berroa, Elizabeth; Grossman, Hillel T.; Heinz, Andreas; Haroutunian, Vahram

    2011-01-01

    Objective There is evidence that major depression increases the risk for dementia, but there is conflicting evidence as to whether depression may accelerate cognitive decline in dementia. The authors tested the hypothesis that decline in cognitive function over time is more pronounced in patients with dementia with comorbid depression, when compared with patients with dementia without depression history. Design Prospective, longitudinal cohort study of aging. Setting Nursing home. Participants Three hundred thirteen elderly nursing home residents (mean age at baseline: 86.99 years, standard deviation = 6.7; 83.1% women). At baseline, 192 residents were diagnosed with dementia, and another 27 developed dementia during follow-up. Thirty residents suffered from major depression at any point during the study, and 48 residents had a history of depression. Measurements The authors measured cognitive decline using change in Mini-Mental State Examination (MMSE) scores over up to 36 months. The authors calculated multilevel regression models to estimate the effects of age, gender, education, dementia status, depression, depression history, and an interaction between dementia and depression, on change in MMSE scores over time. Results Beyond the effects of age, gender, and education, residents showed steeper cognitive decline in the presence of dementia (β = 13.69, standard error = 1.38) and depression (β = −4.16, SE = 1.2), which was further accelerated by the presence of both depression and dementia (β = −2.72, SE = 0.65). Conclusions In dementia, the presence of depression corresponds to accelerated cognitive decline beyond gender and level of education, suggesting a unique influence of depression on the rate of cognitive decline in dementia. PMID:20808140

  9. Depression and Anxiety Disorders among Patients with Psoriasis: A Hospital-Based Case-Control Study.

    PubMed

    Golpour, Masoud; Hosseini, Seyed Hamzeh; Khademloo, Mohammad; Ghasemi, Maryam; Ebadi, Aghdas; Koohkan, Fatemeh; Shahmohammadi, Soheila

    2012-01-01

    Background. Psoriasis is a common, genetically determined inflammatory and proliferative disease of the skin. Psychological stress can exacerbate the disease. This study sought to investigate the depression and anxiety disorders among patients with psoriasis and control group. Method. In this hospital-based case-control study, One hundred patients with psoriasis (case) referred to the dermatology department and 100 patients with otolaryngology problems and dermatological healthy volunteers (control) who referred to the Otolaryngology Department of Bouali Sina Hospital in Sari, Iran, in 2007 were studied. Demographic characteristics were recorded. Beck Depression Inventory and Spielberger State-Trait Anxiety Scale I-II were administered to the patients in both groups. Data were analyzed using SPSS statistical software and descriptive statistical tests. Results. From One-hundred patients in each group, 44 (45%) were men. Depression score was 67% and 12% in psoriatic patients and control, respectively. The Beck depression scores of patients with psoriasis were significantly higher than scores of the control group (P < 0.05). Based on Spielberger State-Trait Anxiety Scale, anxiety was found in 45% of patients in case group and 18% of controls. Conclusion. The results revealed that psoriatic patients reported significantly higher degrees of depression and anxiety than controls. In addition, psoriatic women were more depressed than psoriatic men.

  10. Acute renal failure in liver transplant patients: Indian study.

    PubMed

    Naik, Pradeep; Premsagar, B; Mallikarjuna, M

    2015-01-01

    The acute renal failure is the frequent medical complication observed in liver transplant patients. The objective of this study was to determine the cause of acute renal failure in post liver transplant patients. A total of 70 patients who underwent (cadaveric 52, live 18) liver transplantation were categorized based on clinical presentation into two groups, namely hepatorenal failure (HRF, n = 29), and Hepatic failure (HF, n = 41). All the patients after the liver transplant had received tacrolimus, mycophenolate and steroids. We analyzed the modification of diet in renal disease, (MDRD) serum urea, creatinine and albumin before and after 5th and 30th day of liver transplant and data was categorized into survivors and non-survivors group. In HRF survivor group, serum creatinine, and urea levels were high and, albumin, MDRD were low in pre- transplant and reached to normal levels on 30th day of post transplant, and 79.3 % of patients in this group showed resumption of normal kidney function. On the contrary in HRF nonsurvivor group, we did not observed any significant difference and 20.7 % of patients showed irreversible changes after the liver transplant. In HF survivor group, 82.9 % of liver failure patients did not show any deviation in serum creatinine, urea, albumin and MDRD, whereas in HF non survivor group, 17.1 % of liver failure patients who had HCV positive before the transplant developed acute renal failure. The levels of creatinine, urea, albumin and MDRD were normal before the transplant and on day 30th, the levels of albumin and MDRD were significantly low whereas serum urea, creatinine levels were high. In conclusion, based on these observations, an diagnosis and treatment of Acute renal failure is important among the liver transplantation cases in the early postoperative period.

  11. Acute Abdominal Pain in the Bariatric Surgery Patient.

    PubMed

    Lewis, Kyle D; Takenaka, Katrin Y; Luber, Samuel D

    2016-05-01

    Obesity is present in epidemic proportions in the United States, and bariatric surgery has become more common. Thus, emergency physicians will undoubtedly encounter many patients who have undergone one of these procedures. Knowledge of the anatomic changes specific to these procedures aids the clinician in understanding potential complications and devising an organized differential diagnosis. This article reviews common bariatric surgery procedures, their complications, and the approach to acute abdominal pain in these patients. PMID:27133251

  12. The Relation between Changes in Patients' Interpersonal Impact Messages and Outcome in Treatment for Chronic Depression

    ERIC Educational Resources Information Center

    Constantino, Michael J.; Laws, Holly B.; Arnow, Bruce A.; Klein, Daniel N.; Rothbaum, Barbara O.; Manber, Rachel

    2012-01-01

    Objective: Interpersonal theories posit that chronically depressed individuals have hostile and submissive styles in their social interactions, which may undermine their interpersonal effectiveness and maintain their depression. Recent findings support this theory and also show that patients' interpersonal impact messages, as perceived by their…

  13. Effect of neurofeedback training on depression and fatigue in patients with multiple sclerosis.

    PubMed

    Choobforoushzadeh, Azadeh; Neshat-Doost, Hamid Taher; Molavi, Hossien; Abedi, Mohammad Reza

    2015-03-01

    Depression and fatigue are common symptoms of multiple sclerosis (MS) and are the primary determinants of impaired quality of life in this demyelinating neurological disease. Untreated depression is associated with suicidal ideation, impaired cognitive function and poor adherence to immunomodulatory treatment. For these reasons, systematic screening and management of depressive symptoms and fatigue is recommended for all patients with MS. The objective of this study was to evaluate the effectiveness of neurofeedback in treating depression and fatigue in persons with MS. We conducted a randomized trial with 24 MS patients with primary fatigue and depression. Participants were randomized into two groups: neurofeedback training group (16 sessions of NFB) or treatment as usual. Participants were evaluated at 3 time points (baseline, end of the treatment, and 2-month follow-up) using the Fatigue Severity Scale and Depression subscale of the Hospital Anxiety and Depression Scale as outcome measures. A repeated measures analysis of variance was used to examine differences between the groups. NFB significantly reduced symptoms of depression and fatigue in patients with MS patients, compared to treatment as usual (p < .05), and these effects were maintained the 2-month follow-up (p < .05). PMID:25362584

  14. Effect of neurofeedback training on depression and fatigue in patients with multiple sclerosis.

    PubMed

    Choobforoushzadeh, Azadeh; Neshat-Doost, Hamid Taher; Molavi, Hossien; Abedi, Mohammad Reza

    2015-03-01

    Depression and fatigue are common symptoms of multiple sclerosis (MS) and are the primary determinants of impaired quality of life in this demyelinating neurological disease. Untreated depression is associated with suicidal ideation, impaired cognitive function and poor adherence to immunomodulatory treatment. For these reasons, systematic screening and management of depressive symptoms and fatigue is recommended for all patients with MS. The objective of this study was to evaluate the effectiveness of neurofeedback in treating depression and fatigue in persons with MS. We conducted a randomized trial with 24 MS patients with primary fatigue and depression. Participants were randomized into two groups: neurofeedback training group (16 sessions of NFB) or treatment as usual. Participants were evaluated at 3 time points (baseline, end of the treatment, and 2-month follow-up) using the Fatigue Severity Scale and Depression subscale of the Hospital Anxiety and Depression Scale as outcome measures. A repeated measures analysis of variance was used to examine differences between the groups. NFB significantly reduced symptoms of depression and fatigue in patients with MS patients, compared to treatment as usual (p < .05), and these effects were maintained the 2-month follow-up (p < .05).

  15. Predictors of Abdominal Pain in Depressed Pediatric Inflammatory Bowel Disease Patients

    PubMed Central

    Srinath, Arvind I.; Goyal, Alka; Zimmerman, Lori A.; Newara, Melissa C.; Kirshner, Margaret A.; McCarthy, F. Nicole; Keljo, David; Binion, David; Bousvaros, Athos; DeMaso, David R.; Youk, Ada; Szigethy, Eva M.

    2015-01-01

    Background Pediatric patients with inflammatory bowel disease (IBD) have high rates of abdominal pain. The study aims were to (1) Evaluate biological and psychological correlates of abdominal pain in depressed youth with IBD, (2) Determine predictors of abdominal pain in Crohn’s disease (CD) and ulcerative colitis (UC). Methods 765 patients ages 9–17 with IBD seen over 3 years at two sites were screened for depression. Depressed youth completed comprehensive assessments for abdominal pain, psychological (depression and anxiety), and biological (IBD-related, through disease activity indices and laboratory values) realms. Results 217 patients with IBD (161 CD, 56 UC) were depressed. 163 (120 CD, 43 UC) patients had complete API scores. In CD, abdominal pain was associated with depression (r=0.33; p<0.001), diarrhea (r=0.34; p=0.001), ESR (r=0.22; p=0.02), low albumin (r=0.24; p=.01), weight loss (r=0.33; p=0.001), and abdominal tenderness (r=0.38, p=0.002). A multivariate model with these significant correlates represented 32% of the variance in pain. Only depression (p=0.03), weight loss (p=0.04), and abdominal tenderness (p=0.01) predicted pain for CD patients. In UC, pain was associated with depression (r=0.46; p=0.002) and nocturnal stools (r=.32; p=.046). In the multivariate model with these significant correlates 23% of the variance was explained, and only depression (p=0.02) predicted pain. Conclusions The psychological state of pediatric patients with IBD may increase the sensitivity to abdominal pain. Thus, screening for and treating comorbid depression may prevent excessive medical testing and unnecessary escalation of IBD medications. PMID:24983975

  16. Elderly depression diagnostic of diabetic patients by brain tissue pulsatility imaging

    NASA Astrophysics Data System (ADS)

    Hachemi, Mélouka Elkateb; Remeniéras, Jean-pierre; Desmidt, Thomas; Camus, Vincent; Tranquart, François

    2010-01-01

    Pulsatile motion of brain parenchyma results from cardiac and breathing cycles and consists in a rapid displacement in systole, with slow diastolic recovery. Based on the vascular depression concept and recent studies where a correlation was found between cerebral haemodynamics and depression in the elderly, we emitted the hypothesis that tissue brain motion due to perfusion is correlated to elderly depression associated with cardiovascular risk factors. Tissue Pulsatlity Imaging (TPI) is a new ultrasound technique developed firstly at the University of Washington to assess the brain tissue motion. We used TPI technique to measure the brain displacement of two groups of elderly patients with diabetes as a vascular risk factor. The first group is composed of 11 depressed diabetic patients. The second group is composed of 12 diabetic patients without depressive symptoms. Transcranial acquisitions were performed with a 1.8 MHz ultrasound phased array probe through the right temporal bone window. The acquisition of six cardiac cycles was realized on each patient with a frame rate of 23 frames/s. Displacements estimation was performed by off-line analysis. A significant decrease in brain pulsatility was observed in the group of depressed patients compared to the group of non depressed patients. Mean displacement magnitude was about 44±7 μm in the first group and 68±13 μm in the second group.

  17. The effect of self-transcendence on depression in cognitively intact nursing home patients.

    PubMed

    Haugan, Gørill; Innstrand, Siw Tone

    2012-01-01

    Aims. This study's aim was to test the effects of self-transcendence on depression among cognitively intact nursing home patients. Background. Depression is considered the most frequent mental disorder among the elderly population. Specifically, the depression rate among nursing home patients is three to four times higher than that among community-dwelling elderly. Therefore, finding new and alternative ways to prevent and decrease depression is of great importance for nursing home patients' well-being. Self-transcendence is related to spiritual as well as nonspiritual factors, and it is described as a correlate and resource for well-being among vulnerable populations and at the end of life. Methods. A two-factor construct of the self-transcendence scale (interpersonal and intrapersonal) and the hospital anxiety and depression scale (HADS) was applied. A sample of 202 cognitively intact nursing home patients in central Norway was selected to respond to the questionnaires in 2008/2009. Results. A hypothesized SEM model demonstrated significant direct relationships and total effects of self-transcendence on depression. Conclusion and Implication for Practice. Facilitating patients' self-transcendence, both interpersonally and intrapersonally, might decrease depression among cognitively intact nursing home patients.

  18. The Effect of Self-Transcendence on Depression in Cognitively Intact Nursing Home Patients

    PubMed Central

    Haugan, Gørill; Innstrand, Siw Tone

    2012-01-01

    Aims. This study's aim was to test the effects of self-transcendence on depression among cognitively intact nursing home patients. Background. Depression is considered the most frequent mental disorder among the elderly population. Specifically, the depression rate among nursing home patients is three to four times higher than that among community-dwelling elderly. Therefore, finding new and alternative ways to prevent and decrease depression is of great importance for nursing home patients' well-being. Self-transcendence is related to spiritual as well as nonspiritual factors, and it is described as a correlate and resource for well-being among vulnerable populations and at the end of life. Methods. A two-factor construct of the self-transcendence scale (interpersonal and intrapersonal) and the hospital anxiety and depression scale (HADS) was applied. A sample of 202 cognitively intact nursing home patients in central Norway was selected to respond to the questionnaires in 2008/2009. Results. A hypothesized SEM model demonstrated significant direct relationships and total effects of self-transcendence on depression. Conclusion and Implication for Practice. Facilitating patients' self-transcendence, both interpersonally and intrapersonally, might decrease depression among cognitively intact nursing home patients. PMID:23738199

  19. Acute interstitial pneumonia: radiographic and CT findings in nine patients.

    PubMed

    Primack, S L; Hartman, T E; Ikezoe, J; Akira, M; Sakatani, M; Müller, N L

    1993-09-01

    The radiologic findings were reviewed in nine patients with biopsy- or autopsy-proved acute interstitial pneumonia (AIP). All patients had bilateral air-space opacification on radiographs and bilateral, symmetric areas of ground-glass attenuation on computed tomographic (CT) scans. The areas of ground-glass attenuation had a patchy distribution in six patients (67%) and were diffuse in three patients. Air-space consolidation was seen at CT in six patients (67%) and involved mainly the lower lung zones in three patients and upper lung zones in one patient and was diffuse in two patients. A predominantly subpleural distribution of the consolidation was present in two patients. Eight of the nine patients died within 3 months of presentation. The authors conclude that the radiographic and CT features of AIP are similar to those of adult respiratory distress syndrome and represent acute alveolar damage. AIP differs from the more chronic forms of interstitial pneumonia in clinical presentation and in pathologic and radiologic findings.

  20. Platelet parameters (PLT, MPV, P-LCR) in patients with schizophrenia, unipolar depression and bipolar disorder.

    PubMed

    Wysokiński, Adam; Szczepocka, Ewa

    2016-03-30

    There are no studies comparing platelet parameters platelet parameters (platelet count (PLT), mean platelet volume (MPV) and platelet large cell ratio (P-LCR)) between patients with schizophrenia, bipolar disorder and unipolar depression. Therefore, the aim of this study was to determine and compare differences in PLT, MPV and P-LCR in patients with schizophrenia, unipolar depression and bipolar disorder. This was a retrospective, cross-sectional, naturalistic study of 2377 patients (schizophrenia n=1243; unipolar depression n=791; bipolar disorder n=343, including bipolar depression n=259 and mania n=84). There were significant differences for PLT, MPV and P-LCR values between study groups. A significant percentage of patients with bipolar disorder had abnormal (too low or too high) number of platelets. Negative correlation between PLT and age was found in all study groups and positive correlation between age and MPV and P-LCR was found in patients with schizophrenia.

  1. [Therapeutic effects of tianeptine in patients with depression and anxiety disorders with or without associated alcoholism].

    PubMed

    Marey, C; Ganry, H; Delalleau, B; Kamoun, A

    1991-11-14

    Tianeptine is a new tricyclic antidepressant. Double blind studies comparing tianeptine with imipramine and amitriptyline have shown the effectiveness of tianeptine's antidepressor action, its properties of non-specific symptoms related to behaviour disorders (anxiety, inhibition ...) and its action on somatic complaints expressed by depressed patients. Tianeptine is an effective antidepressant in cases of depression with anxiety or alcoholism and also leads to good therapeutic response in cases of dysthemia. In depressions with melancholy and endogenous criteria, the expected percentage of responding patients has been observed with tianeptine. A reinforcement of the therapeutic effect has been demonstrated after 6 months of treatment. Its excellent clinical and parclinical acceptability, especially in long term treatment of patients at risk such as elderly depressed patients or alcoholic patients, makes tianeptine a first intention antidepressant.

  2. Postmortem diagnosis of acute myocardial infarction in patients with acute respiratory failure - demographics, etiologic and pulmonary histologic analysis

    PubMed Central

    de Matos Soeiro, Alexandre; Ruppert, Aline D; Canzian, Mauro; Capelozzi, Vera L; Serrano, Carlos V

    2012-01-01

    OBJECTIVES: Acute respiratory failure is present in 5% of patients with acute myocardial infarction and is responsible for 20% to 30% of the fatal post-acute myocardial infarction. The role of inflammation associated with pulmonary edema as a cause of acute respiratory failure post-acute myocardial infarction remains to be determined. We aimed to describe the demographics, etiologic data and histological pulmonary findings obtained through autopsies of patients who died during the period from 1990 to 2008 due to acute respiratory failure with no diagnosis of acute myocardial infarction during life. METHODS: This study considers 4,223 autopsies of patients who died of acute respiratory failure that was not preceded by any particular diagnosis while they were alive. The diagnosis of acute myocardial infarction was given in 218 (4.63%) patients. The age, sex and major associated diseases were recorded for each patient. Pulmonary histopathology was categorized as follows: diffuse alveolar damage, pulmonary edema, alveolar hemorrhage and lymphoplasmacytic interstitial pneumonia. The odds ratio of acute myocardial infarction associated with specific histopathology was determined by logistic regression. RESULTS: In total, 147 men were included in the study. The mean age at the time of death was 64 years. Pulmonary histopathology revealed pulmonary edema as well as the presence of diffuse alveolar damage in 72.9% of patients. Bacterial bronchopneumonia was present in 11.9% of patients, systemic arterial hypertension in 10.1% and dilated cardiomyopathy in 6.9%. A multivariate analysis demonstrated a significant positive association between acute myocardial infarction with diffuse alveolar damage and pulmonary edema. CONCLUSIONS: For the first time, we demonstrated that in autopsies of patients with acute respiratory failure as the cause of death, 5% were diagnosed with acute myocardial infarction. Pulmonary histology revealed a significant inflammatory response, which has

  3. Management of Patients Admitted with Acute Decompensated Heart Failure

    PubMed Central

    Krim, Selim R.; Campbell, Patrick T.; Desai, Sapna; Mandras, Stacy; Patel, Hamang; Eiswirth, Clement; Ventura, Hector O.

    2015-01-01

    Background Hospital admission for the treatment of acute decompensated heart failure is an unfortunate certainty in the vast majority of patients with heart failure. Regardless of the etiology, inpatient treatment for acute decompensated heart failure portends a worsening prognosis. Methods This review identifies patients with heart failure who need inpatient therapy and provides an overview of recommended therapies and management of these patients in the hospital setting. Results Inpatient therapy for patients with acute decompensated heart failure should be directed at decongestion and symptom improvement. Clinicians should also treat possible precipitating events, identify comorbid conditions that may exacerbate heart failure, evaluate and update current guideline-directed medical therapy, and perform risk stratification for all patients. Finally, efforts should be made to educate patients about the importance of restricting salt and fluid, monitoring daily weights, and adhering to a graded exercise program. Conclusion Early discharge follow-up and continued optimization of guideline-directed medical therapy are key to preventing future heart failure readmissions. PMID:26413005

  4. Outpatient costs in pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting

    PubMed Central

    2012-01-01

    Background To assess differences in outpatient costs among pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting. Methods A retrospective case control study over 3 years (2002-2004). Data on 7128 depressed patients and 23772 non-depressed matched controls were available from the electronic medical record system of 20 general practices organized in one large primary care organization in the Netherlands. A total of 393 depressed patients with diabetes and 494 non-depressed patients with diabetes were identified in these records. The data that were extracted from the medical record system concerned only outpatient costs, which included GP care, referrals, and medication. Results Mean total outpatient costs per year in depressed diabetes patients were €1039 (SD 743) in the period 2002-2004, which was more than two times as high as in non-depressed diabetes patients (€492, SD 434). After correction for age, sex, type of insurance, diabetes treatment, and comorbidity, the difference in total annual costs between depressed and non-depressed diabetes patients changed from €408 (uncorrected) to €463 (corrected) in multilevel analyses. Correction for comorbidity had the largest impact on the difference in costs between both groups. Conclusions Outpatient costs in depressed patients with diabetes are substantially higher than in non-depressed patients with diabetes even after adjusting for confounders. Future research should investigate whether effective treatment of depression among diabetes patients can reduce health care costs in the long term. PMID:22361361

  5. Delirium in acute promyelocytic leukemia patients: two case reports

    PubMed Central

    2013-01-01

    Background Delirium is a frequently misdiagnosed and inadequately treated neuropsychiatric complication most commonly observed in terminally ill cancer patients. To our knowledge this is the first report describing delirium in two patients aged less than 60 years and enrolled in an intensive chemotherapeutic protocol for acute promyelocytic leukemia. Case presentation Two female Caucasian acute promyelocytic leukemia patients aged 46 and 56 years developed delirium during their induction treatment with all-trans retinoic acid and idarubicin. In both cases symptoms were initially attributed to all-trans retinoic acid that was therefore immediately suspended. In these two patients several situations may have contribute to the delirium: in patient 1 a previous psychiatric disorder, concomitant treatments with steroids and benzodiazepines, a severe infection and central nervous system bleeding while in patient 2 steroid treatment and isolation. In patient 1 delirium was treated with short-term low-doses of haloperidol while in patient 2 non-pharmacologic interventions had a beneficial role. When the diagnosis of delirium was clear, induction treatment was resumed and both patients completed their therapeutic program without any relapse of the psychiatric symptoms. Both patients are alive and in complete remission as far as their leukemia is concerned. Conclusions We suggest that patients with acute promyelocytic leukemia eligible to intensive chemotherapy should be carefully evaluated by a multisciplinary team including psychiatrists in order to early recognize symptoms of delirium and avoid inadequate treatments. In case of delirium, both pharmacologic and non-pharmacologic interventions may be considered. PMID:24237998

  6. Comparative efficacy and acceptability of first-generation and second-generation antidepressants in the acute treatment of major depression: protocol for a network meta-analysis

    PubMed Central

    Salanti, Georgia; Atkinson, Lauren Z; Leucht, Stefan; Ruhe, Henricus G; Turner, Erick H; Chaimani, Anna; Ogawa, Yusuke; Takeshima, Nozomi; Hayasaka, Yu; Imai, Hissei; Shinohara, Kiyomi; Suganuma, Aya; Watanabe, Norio; Stockton, Sarah; Geddes, John R

    2016-01-01

    Introduction Many antidepressants are indicated for the treatment of major depression. Two network meta-analyses have provided the most comprehensive assessments to date, accounting for both direct and indirect comparisons; however, these reported conflicting interpretation of results. Here, we present a protocol for a systematic review and network meta-analysis aimed at updating the evidence base and comparing all second-generation as well as selected first-generation antidepressants in terms of efficacy and acceptability in the acute treatment of major depression. Methods and analysis We will include all randomised controlled trials reported as double-blind and comparing one active drug with another or with placebo in the acute phase treatment of major depression in adults. We are interested in comparing the following active agents: agomelatine, amitriptyline, bupropion, citalopram, clomipramine, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, levomilnacipran, milnacipran, mirtazapine, nefazodone, paroxetine, reboxetine, sertraline, trazodone, venlafaxine, vilazodone and vortioxetine. The main outcomes will be the proportion of patients who responded to or dropped out of the allocated treatment. Published and unpublished studies will be sought through relevant database searches, trial registries and websites; all reference selection and data extraction will be conducted by at least two independent reviewers. We will conduct a random effects network meta-analysis to synthesise all evidence for each outcome and obtain a comprehensive ranking of all treatments. To rank the various treatments for each outcome, we will use the surface under the cumulative ranking curve and the mean ranks. We will employ local as well as global methods to evaluate consistency. We will fit our model in a Bayesian framework using OpenBUGS, and produce results and various checks in Stata and R. We will also assess the quality of evidence contributing to network

  7. Incidence of Depression and Associated Factors in Patients With Type 2 Diabetes in Quebec, Canada

    PubMed Central

    Lunghi, Carlotta; Moisan, Jocelyne; Grégoire, Jean-Pierre; Guénette, Line

    2016-01-01

    Abstract It has been reported that the risk of depression is higher among people with type 2 diabetes compared with a nondiabetic population. Among diabetic patients, depression has been associated with worse self-care behaviors, poor glycemic control, and an increased risk of diabetes complications. Identifying factors associated with the occurrence of depression may help physicians identify earlier diabetic patients at a high risk of developing depression, improve prevention, and accelerate proper treatment. To our knowledge, very few population-based studies have reported on the incidence of clinically diagnosed depression as a consequence of type 2 diabetes over a long follow-up period. The objective of this study was to estimate the incidence of clinically diagnosed depression among type 2 diabetic patients newly treated with oral antidiabetic drugs (ADs) and to identify factors associated with the occurrence of depression. Administrative claims data from the public health insurance plan were used to identify a cohort of new oral AD users aged ≥18 years between 2000 and 2006. Patients were followed from oral AD treatment initiation until the diagnosis of depression, ineligibility for the public drug plan, death, or the end of the study, whichever came first. Incidence rates were determined using person-time analysis. Factors associated with depression were identified using multivariable Cox regression analysis. We identified 114,366 new oral AD users, of which 4808 had a diagnosis of depression. The overall incidence rate of depression was 9.47/1000 person-years (PYs) (10.72/1000 PYs for women and 8.27/1000 PYs for men). The incidence of depression was higher during the year after oral AD treatment initiation. Independent factors associated with depression included having had mental disorders other than depression, hospitalization, a higher number of different drugs taken and of physicians visited during the year before oral AD initiation. Moreover, we

  8. Could the depression of obese patients suffering from chronic hepatitis C be temporarily improved?

    PubMed

    Tarantino, G; Basile, V; Conca, P; Ariello, M; Di Minno, M N D; Romano, A; Gentile, A; Capone, D

    2008-09-01

    Depression is an usual finding in patients suffering from chronic hepatitis C. Development of moderate to severe depressive symptoms occurs frequently during pegylated interferon/ribavirin treatment and is generally predicted by baseline depression scores. Furthermore, the obese patients have been found to be twice as likely to suffer from anxiety, impaired social interaction, and depression when compared with the no obese population. In order to evaluate the efficacy of a pharmacological treatment of depression, 68 obese patients with chronic hepatitis C, under or not antiviral therapy, were selected and enrolled into this open, controlled pilot study. Our population was divided in two groups: 'on Selective Serotonin Reuptake Inhibitors plus support', with individual titration of medication to adequate side-effects, including thirty seven patients, and 'on only support', involving thirty one patients. Both groups were well balanced for gender, age and antiviral treatment. The selected patients had, at entry, a Beck Depression Inventory score of 24.5 +/- 8.1 (mean +/- SD). Therapeutic successful outcomes (a decreased score of >or= 10 units compared to the baseline) were statistically more frequent in antidepressant drug-treated group (P = 0.005); they were well predicted by dose of Selective Serotonin Reuptake Inhibitors. Thirty five percent of patients were non-responder to Selective Serotonin Reuptake Inhibitors. The drug tolerability was good. Nearly twenty percent of patients were responder to only support.

  9. Correlates of depression and burden for informal caregivers of patients in a geriatrics referral clinic.

    PubMed

    Drinka, T J; Smith, J C; Drinka, P J

    1987-06-01

    Caregiver burden has been associated with patient dementia. In this study we tested the hypothesis that caregiver burden and depression are related to patient cognitive impairment. We analyzed records of 127 elderly male patients from a Veterans hospital geriatrics referral clinic. The patients and their informal caregivers had been referred to the clinic because the complexity and multiplicity of their problems were beyond the treatment capability of other clinics. There was a high prevalence of dementia (73%) and depression (69%) in these patients according to Diagnostic and Statistical Manual (DSM-III) criteria. Quantitative measures of patient dementia and dependency in activities of daily living were not statistically associated with measures of caregiver depression or burden. In contrast, measures of patient depression were significantly correlated with measures of caregiver depression and burden. We hypothesize that caregivers of chronically ill, elderly men cope better with physical and cognitive incapacity than with affective symptoms. Because caregiver support is the most important factor in maintaining a disabled elder in the community, we suggest evaluating patients and caregivers for depression as part of standard practice in geriatric clinical settings. PMID:3553288

  10. Assessing depression and anxiety in the caregivers of pediatric patients with chronic skin disorders*

    PubMed Central

    Manzoni, Ana Paula Dornelles da Silva; Weber, Magda Blessmann; Nagatomi, Aline Rodrigues da Silva; Pereira, Rita Langie; Townsend, Roberta Zaffari; Cestari, Tania Ferreira

    2013-01-01

    BACKGROUND The literature has shown that the presence of emotional disturbances in caregivers of children with skin diseases affects the course and treatment of the disease. Anxiety and depression are among the most frequently reported psychiatric diagnoses related to this fact. OBJECTIVE To evaluate the presence of anxiety and depression in caregivers of pediatric patients with chronic skin disorders, exemplified by atopic dermatitis, psoriasis and vitiligo, and correlate them to the quality of life of the patients. METHODS The sample consisted of 118 patients with atopic dermatitis, vitiligo and psoriasis, monitored by their main caregiver. The levels of anxiety and depression in the caregivers were assessed using the Hamilton Anxiety Scale and the Beck Depression Inventory, respectively. The Children's Dermatology Life Quality Index was applied. RESULTS Anxiety was observed in 36% of the caregivers of the patients with atopic dermatitis, in 36% of those of children affected by psoriasis, and in 42% of those responsible for pediatric patients with vitiligo. Depression occurred in 36% of the caregivers of patients with atopic dermatitis, in 36% of those of children affected by psoriasis and in 26% of those responsible for pediatric patients with vitiligo. There was a significant correlation between poor quality of life scores in patients with vitiligo and the presence of depression and anxiety in their caregivers. CONCLUSION Emotional disorders tend to be present among close family members of children with the chronic skin diseases studied and their prevention can help in controlling and treating these diseases. PMID:24474096

  11. Treatment of nonpsychotic major depression during pregnancy: patient safety and challenges

    PubMed Central

    Epstein, Richard A; Moore, Katherine M; Bobo, William V

    2014-01-01

    In pregnant women with major depression, the overarching goal of treatment is to achieve or maintain maternal euthymia, thus limiting both maternal and fetal exposure to the harmful effects of untreated or incompletely treated depression. However, the absence of uniformly effective therapies with guaranteed obstetric and fetal safety makes the treatment of major depression during pregnancy among the most formidable of clinical challenges. Clinicians and patients are still faced with conflicting data and expert opinion regarding the reproductive safety of antidepressants in pregnancy, as well as large gaps in our understanding of the effectiveness of most antidepressants and nonpharmacological alternatives for treating antenatal depression. In this paper, we provide a clinically focused review of the available information on potential maternal and fetal risks of untreated maternal depression during pregnancy, the effectiveness of interventions for maternal depression during pregnancy, and potential obstetric, fetal, and neonatal risks associated with antenatal antidepressant use. PMID:25258558

  12. Problem based review: The patient with acute monoarthritis.

    PubMed

    Suresh, Ernest

    2013-01-01

    Acute monoarthritis is a common medical emergency with wide differential diagnosis. Common underlying causes include trauma, septic arthritis, crystal induced arthritis (gout and pseudogout), and reactive arthritis. Of these, septic arthritis is the diagnosis not to miss because of its association with significant morbidity and mortality. Precise diagnosis of the underlying cause of monoarthritis relies on a good history, physical examination findings, and results of focussed investigations. In this article, a practical approach to diagnosis and initial management of patients presenting with acute monoarthritis is described with the aid of a case vignette.

  13. Eruptive xanthomas and acute pancreatitis in a patient with hypertriglyceridemia

    PubMed Central

    Martínez, Desirée Pérez; Díaz, Juan Óscar Fernández; Bobes, Carmen Maciá

    2008-01-01

    Acute pancreatitis and eruptive xanthomas are the only recognised direct complications of severe hypertriglyceridaemia. We present the case of a 33-years old male patient in whom the onset of a type 2 diabetes, added to an unknown familial hyperlipidemia, precipitated a dramatic raise of serum triglyceride levels, that cause in turn an acute pancreatitis and the appearance of dermic eruptive xanthomas. Translation This article is translated from Spanish, originally published in Archivos de Medicina. The original work is at doi:10.3823/001 PMID:18474088

  14. Eruptive xanthomas and acute pancreatitis in a patient with hypertriglyceridemia.

    PubMed

    Martínez, Desirée Pérez; Díaz, Juan Oscar Fernández; Bobes, Carmen Maciá

    2008-05-12

    Acute pancreatitis and eruptive xanthomas are the only recognised direct complications of severe hypertriglyceridaemia. We present the case of a 33-years old male patient in whom the onset of a type 2 diabetes, added to an unknown familial hyperlipidemia, precipitated a dramatic raise of serum triglyceride levels, that cause in turn an acute pancreatitis and the appearance of dermic eruptive xanthomas. TRANSLATION: This article is translated from Spanish, originally published in Archivos de Medicina. The original work is at doi:10.3823/001.

  15. Eruptive xanthomas and acute pancreatitis in a patient with hypertriglyceridemia.

    PubMed

    Martínez, Desirée Pérez; Díaz, Juan Oscar Fernández; Bobes, Carmen Maciá

    2008-01-01

    Acute pancreatitis and eruptive xanthomas are the only recognised direct complications of severe hypertriglyceridaemia. We present the case of a 33-years old male patient in whom the onset of a type 2 diabetes, added to an unknown familial hyperlipidemia, precipitated a dramatic raise of serum triglyceride levels, that cause in turn an acute pancreatitis and the appearance of dermic eruptive xanthomas. TRANSLATION: This article is translated from Spanish, originally published in Archivos de Medicina. The original work is at doi:10.3823/001. PMID:18474088

  16. Aggressiveness across development and suicidal behavior in depressed patients.

    PubMed

    Carballo, Juan J; García-Nieto, Rebeca; Harkavy-Friedman, Jill; de Leon-Martinez, Victoria; Baca-García, Enrique

    2014-01-01

    The objective of this study was to determine differences in the pathway of aggressiveness across development between depressive subjects and normal controls, and to examine males and females separately with regard to level of aggression and suicidal behavior among depressed subjects. Participants were classified into 5 groups: depressed suicide attempters (DSA; n = 339), depressed non-suicide attempters (DNSA; n = 92), psychiatric controls who had attempted suicide (PSA; n = 188), psychiatric controls who had not attempted suicide (PNSA; n = 222), and normal controls (NC; n = 532). The level of aggressiveness across development in the different groups was examined using a 5 (DSA vs. DNSA vs. PSA vs. PNSA vs. NC)×3 (Childhood, Adolescence, and Adulthood) MANCOVA. Adjusted and separate models for males and females were conducted. Depressed subjects differed in severity of aggressiveness. The level of aggressiveness in individuals in the NC group remained stable across development, while subjects in the DSA and DNSA groups showed significantly higher levels of aggressiveness. This finding was also observed in subjects of the PSA and PNSA groups. The level of aggressiveness in males with depression significantly increased over time. In women, increasing levels of aggressiveness across development were only observed in depressed suicide attempters. Limitations of this study included use of semi-structured interview for the assessment of risk factors. We found significant differences in severity and in the pathway of aggressiveness across development between depressive subjects and normal controls. In addition, sex differences regarding level of aggression and suicidal behavior among depressed subjects were found.

  17. Risk stratification of patients with acute symptomatic pulmonary embolism.

    PubMed

    Jiménez, David; Lobo, Jose Luis; Barrios, Deisy; Prandoni, Paolo; Yusen, Roger D

    2016-02-01

    Patients with acute symptomatic pulmonary embolism (PE) who present with arterial hypotension or shock have a high risk of death (high-risk PE), and treatment guidelines recommend strong consideration of thrombolysis in this setting. For normotensive patients diagnosed with PE, risk stratification should aim to differentiate the group of patients deemed as having a low risk for early complications (all-cause mortality, recurrent venous thromboembolism, and major bleeding) (low-risk PE) from the group of patients at higher risk for PE-related complications (intermediate-high risk PE), so low-risk patients could undergo consideration of early outpatient treatment of PE and intermediate-high risk patients would undergo close observation and consideration of thrombolysis. Clinicians should also use risk stratification and eligibility criteria to identify a third group of patients that should not undergo escalated or home therapy (intermediate-low risk PE). Such patients should initiate standard therapy of PE while in the hospital. Clinical models [e.g., Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI)] may accurately identify those at low risk of dying shortly after the diagnosis of PE. For identification of intermediate-high risk patients with acute PE, studies have validated predictive models that use a combination of clinical, laboratory and imaging variables. PMID:26768476

  18. CLINICAL AND THERAPEUTIC CORRELATIONS IN PATIENTS WITH SLIGHT ACUTE PANCREATITIS

    PubMed Central

    MUNHOZ-FILHO, Clewis Henri; BATIGÁLIA, Fernando; FUNES, Hamilton Luiz Xavier

    2015-01-01

    Background Acute pancreatitis is an inflammatory disease of the pancreas due to enzymatic autodigestion which can cause necrosis or multiple organ failure; its pathophysiology is not fully known yet. Aim To evaluate the correlation between clinical and therapeutic data in patients with mild acute pancreatitis. Methods A retrospective study in 55 medical records of patients admitted with acute mild pancreatitis was realized to analyze the association between age, leukocytosis, serum glutamic-oxaloacetic transaminase and lactate dehydrogenase, glucose, antibiotics, time admission and Ranson´s scores. Results There was a positive association between less intensive care (strict hydration, analgesia and monitoring of vital signs), early antibiotic therapy (monotherapy), early return to diet after 48 hours and laboratory control of the serum amylase and lipase (high in the first week and decreasing after 10 days, without any prognostic value). Conclusions Changes in the management of patients with mild acute pancreatitis, such as enteral nutrition, rational use of lower spectrum antibiotics and intensive care, have contributed significantly to the reduction of hospitalization time and mortality. PMID:25861064

  19. QUALITY OF LIFE, PAIN, ANXIETY AND DEPRESSION IN PATIENTS SURGICALLY TREATED WITH CANCER OF RECTUM

    PubMed Central

    SANTOS, Letácio José Freire; GARCIA, João Batista dos Santos; PACHECO, Jairo Sousa; VIEIRA, Érica Brandão de Morais; dos SANTOS, Alcione Miranda

    2014-01-01

    Background The rectum cancer is associated with high rates of complications and morbidities with great impact on the lives of affected individuals. Aim To evaluate quality of life, pain, anxiety and depression in patients treated for medium and lower rectum cancer, submitted to surgical intervention. Methods A descriptive cross-sectional study. Eighty-eight records of patients with medium and lower rectum cancer, submitted to surgical intervention were selected, and enrolled. Forty-seven patients died within the study period, and the other 41 were studied. Question forms EORTC QLQ-C30 and EORTC QLQ-CR38 were used to assess quality of life. Pain evaluation was carried out using the Visual Analogical Scale, depression and anxiety were assessed through Depression Inventories and Beck's Anxiety, respectively. The correlation between pain intensity, depression and anxiety was carried out, and between these and the EORTC QLQ-C30 General Scale for Health Status and overall quality of life, as well as the EORTC QLQ-CR38 functional and symptom scales. Results Of the 41 patients of the study, 52% presented pain, depression in 47%, and anxiety in 39%. There was a marking positive correlation between pain intensity and depression. There was a moderate negative correlation between depression and general health status, and overall quality of life as well as pain intensity with the latter. There was a statistically significant negative correlation between future depression perspective and sexual function, and also a strong positive correlation between depression and sexual impairments. A positive correlation between anxiety and gastro-intestinal problems, both statistically significant, was observed. Conclusion Evaluation scales showed detriment on quality life evaluation, besides an elevated incidence of pain, depression, and anxiety; a correlation among these, and factors which influence on the quality of life of post-surgical medium and lower rectum cancer patients was

  20. Peripheral blood and neuropsychological markers for the onset of action of antidepressant drugs in patients with Major Depressive Disorder

    PubMed Central

    2011-01-01

    Background In Major Depressive Disorder (MDD), treatment outcomes with currently available strategies are often disappointing. Therefore, it is sensible to develop new strategies to increase remission rates in acutely depressed patients. Many studies reported that true drug response can be observed within 14 days (early improvement) of antidepressant treatment. The identical time course of symptom amelioration after early improvement in patients treated with antidepressants of all classes or with placebo strongly suggests a common biological mechanism, which is not specific for a particular antidepressant medication. However, the biology underlying early improvement and final treatment response is not understood and there is no established biological marker as yet, which can predict treatment response for the individual patient before initiation or during the course of antidepressant treatment. Peripheral blood markers and executive functions are particularly promising candidates as markers for the onset of action and thus the prediction of final treatment outcome in MDD. Methods/Design The present paper presents the rationales, objectives and methods of a multi-centre study applying close-meshed repetitive measurements of peripheral blood and neuropsychological parameters in patients with MDD and healthy controls during a study period of eight weeks for the identification of biomarkers for the onset of antidepressants' action in patients with MDD. Peripheral blood parameters and depression severity are assessed in weekly intervals from baseline to week 8, executive performance in bi-weekly intervals. Patients are participating in a randomized controlled multi-level clinical trial, healthy controls are matched according to mean age, sex and general intelligence. Discussion This investigation will help to identify a biomarker or a set of biomarkers with decision-making quality in the treatment of MDD in order to increase the currently disappointing remission rates

  1. Diagnosis and Treatment of Depression in Patients With Congestive Heart Failure: A Review of the Literature

    PubMed Central

    Stern, Theodore A.; Hebert, Kathy A.; Musselman, Dominique L.

    2013-01-01

    Context: Major depressive disorder (MDD) can be challenging to diagnose in patients with congestive heart failure, who often suffer from fatigue, insomnia, weight changes, and other neurovegetative symptoms that overlap with those of depression. Pathophysiologic mechanisms (eg, inflammation, autonomic nervous system dysfunction, cardiac arrhythmias, and altered platelet function) connect depression and congestive heart failure. Objective: We sought to review the prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure. Data Sources: A search of all English-language articles between January 2003 and January 2013 was conducted using the search terms congestive heart failure and depression. Study Selection: We found 1,498 article abstracts and 19 articles (meta-analyses, systematic reviews, and original research articles) that were selected for inclusion, as they contained information about our focus on diagnosis, treatment, and pathophysiology of depression associated with congestive heart failure. The search was augmented with manual review of reference lists of articles from the initial search. Articles selected for review were determined by author consensus. Data Extraction: The prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure were reviewed. Particular attention was paid to the safety, efficacy, and tolerability of antidepressant medications commonly used to treat depression and how their side-effect profiles impact the pathophysiology of congestive heart failure. Drug-drug interactions between antidepressant medications and medications used to treat congestive heart failure were examined. Results: MDD is highly prevalent in patients with congestive heart failure. Moreover, the prevalence and severity of depression correlate with the degree of cardiac dysfunction and development of congestive heart failure. Depression increases the risk of congestive heart

  2. Depressive symptoms among patients receiving varenicline and bupropion for smoking cessation.

    PubMed

    Hong, Arthur S; Elrashidi, Muhamad Y; Schroeder, Darrell R; Ebbert, Jon O

    2015-05-01

    While the combination therapy of varenicline and sustained release bupropion (bupropion SR) for cigarette smoking cessation can increase smoking abstinence rates, it has also been associated with increases in self-reported depressive symptoms. We conducted an analysis of the Beck Depression Inventory, second edition (BDI-II), data completed by 505 patients from a large randomized clinical trial, evaluating the efficacy of 12 weeks of combination therapy (varenicline+bupropion SR) compared to varenicline alone. At medication treatment week 2 (1 week after target quit date [TQD]), increased depressive symptoms were observed in patients receiving combination therapy (effect estimate=0.61, 95% CI [0.03, 1.19], P=.039) and those with a history of depression (effect estimate=0.82, 95% CI [0.07, 1.57], P=.033). For treatment weeks 2 to 4, smokers with a history of depression on combination therapy had a greater decline in depressive symptoms compared to those on varenicline alone (effect estimate=-1.99, 95% CI [-3.99, 0.00], P=.050). After treatment week 4, no significant effects of treatment or depression history on BDI-II scores were observed. A history of depression did not moderate the efficacy of combination therapy for smoking abstinence. Our study suggests that for combination therapy with varenicline and bupropion SR, an increase in depressive symptoms over the first 2 weeks may be observed; however, the effects on depressive symptoms do not last beyond 4 weeks. We conclude that among smokers without active moderate or severe depression, the decision to use this combination treatment approach should not be based upon a self-reported history of depression.

  3. Nutrition supplementation in patients with acute and chronic pancreatitis.

    PubMed

    Scolapio, J S; Malhi-Chowla, N; Ukleja, A

    1999-09-01

    Acute pancreatitis is a hypermetabolic state characterized by increased protein catabolism, lipolysis, and glucose intolerance. Most patients presenting with acute pancreatitis are better within 5 to 7 days and can be resume a regular diet. Patients with severe pancreatitis and who are unable to eat within 7 to 10 days should receive nutritional support. The decision to use parenteral or enteral nutrition is controversial. More recent data suggest that jejunal feedings are just as beneficial, if not better, than parenteral nutrition. Marked weight loss and abdominal pain are the features of chronic pancreatitis. Steatorrhea develops when greater than 90% of pancreatic exocrine dysfunction occurs. Treatment focuses on pain control and pancreatic enzyme replacement. Pancreatic enzymes should be given with meals. Patients with refractory steatorrhea may benefit from the addition of an H2 antagonist or proton-pump inhibitor with pancreatic enzyme replacement. Micronutrients, including antioxidants, should be replaced if serum levels suggest a deficiency.

  4. Patient-controlled modalities for acute postoperative pain management.

    PubMed

    Miaskowski, Christine

    2005-08-01

    Although numerous clinical practice guidelines for pain management have been published throughout the last 12 years, inadequate pain relief remains a significant health care issue. Several patient-controlled analgesia (PCA) modalities are currently available for the treatment of acute postoperative pain, including intravenous (IV) PCA, epidural (PCEA), and oral PCA. Although PCEA and IV PCA are both commonly used modalities, IV PCA is considered the standard of care for postoperative pain management. Limitations of this modality do exist, however. Consequently, noninvasive PCA systems are under development to circumvent many of these limitations, including the fentanyl hydrochloride patient-controlled transdermal system (PCTS); (IONSYS Ortho-McNeil Pharmaceutical, Raritan, NJ) and a number of patient-controlled intranasal analgesia (PCINA) delivery systems. The objective of this article is to review the PCA modalities currently in use and to discuss those in development for the treatment of acute postoperative pain.

  5. [Antibacterial therapy in surgery of patients with acute destructive appendicitis].

    PubMed

    Bezrodnyĭ, B H; Kolosovych, I V; Iovitsa, A V; Martynovych, L D; Sydorenko, R A; Sysak, O M

    2012-01-01

    Character of microflora of exsudate of abdominals and mucosis microflora of vermicular appendix is studied for patients with the destructive forms of appendicitis with the purpose of development of variants of antibacterial therapy at surgical treatment of patients with acute appendicitis. The patients with the destructive forms of appendicitis, which were on treatment in a municipal clinical hospital N 4 Kyiv for period 2004-2010. An Inflammatory-destructive process in an appendix is conditioned by both aerobic (Escherichia coli - 46,6 %, Enterobacter - 4,2 %, Citrobacter - 4,2 %, Klebsiella - 3,3 %, Pseudomonas aeruginosa - 5,8 %, Staphylococcus - 4,2 %) and anaerobic microorganisms (Bacteroides - 100 %) and increase Candida - 17,5 %. Antibacterial therapy is effective at 46,7 % patients with acute appendicitis. At 49,6 % patients acute appendicitis develops on a background dysbiotic intestinal disturbances. Clinically the effective charts of empiric antibacterial monotherapy 6 days it is been: Moxifloxacini intravenously 400 mgs one time in twenty-four hours during, Ertapenemi for a 1 g one time in twenty-four hours intravenously and combined - Aztreonami for a 1 g twice in twenty-four hours and of Clindamycini for 600 mgs twice in twenty-four hours, intramuscular during; Cefepimumi for a 1 g twice in twenty-four hours and of Clindamycini for 600 mgs twice in twenty-four hours, intramuscular.

  6. Efficacy of vilazodone on anxiety symptoms in patients with major depressive disorder.

    PubMed

    Thase, Michael E; Chen, Dalei; Edwards, John; Ruth, Adam

    2014-11-01

    Anxiety symptoms are prevalent in patients with major depressive disorder. A post-hoc analysis of two phase III trials was conducted to evaluate the efficacy of vilazodone on depression-related anxiety. Using the 17-item Hamilton Depression Rating Scale (HAMD17) Anxiety/Somatization subscale, patients were classified as anxious or nonanxious. Improvements in depressive symptoms were based on least squares mean changes in HAMD17 and Montgomery-Asberg Depression Rating Scale total scores. Anxiety symptoms in the anxious subgroup were evaluated using Hamilton Anxiety Rating Scale (HAMA) total and subscale (Psychic Anxiety, Somatic Anxiety) scores, HAMD17 Anxiety/Somatization subscale and item (Psychic Anxiety, Somatic Anxiety) scores, and the Montgomery-Asberg Depression Rating Scale Inner Tension item score. Most of the pooled study population [82.0% (708/863)] was classified with anxious depression. After 8 weeks of treatment, least squares mean differences between vilazodone and placebo for changes in HAMA total and HAMD17 Anxiety/Somatization subscale scores were -1.82 (95% confidence interval -2.81 to -0.83; P<0.001) and -0.75 (95% confidence interval -1.17 to -0.32; P<0.001), respectively. Statistically significant improvements with vilazodone were also found on all other anxiety-related measures, except the HAMA Somatic Anxiety subscale. Vilazodone may be effective in treating patients with major depressive disorder who exhibit somatic and/or psychic symptoms of anxiety.

  7. Prevalence of depression and anxiety in patients requesting physicians’ aid in dying: cross sectional survey

    PubMed Central

    Goy, Elizabeth R; Dobscha, Steven K

    2008-01-01

    Objective To determine the prevalence of depression and anxiety in terminally ill patients pursuing aid in dying from physicians. Design Cross sectional survey. Setting State of Oregon, USA. Participants 58 Oregonians, most terminally ill with cancer or amyotrophic lateral sclerosis, who had either requested aid in dying from a physician or contacted an aid in dying advocacy organisation. Main outcome measures Diagnosis of depression or anxiety according to the hospital anxiety and depression scale and the structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders. Results 15 study participants met “caseness” criteria for depression, and 13 met criteria for anxiety. 42 patients died by the end of the study; 18 received a prescription for a lethal drug under the Death with Dignity Act, and nine died by lethal ingestion. 15 participants who received a prescription for a lethal drug did not meet criteria for depression; three did. All three depressed participants died by legal ingestion within two months of the research interview. Conclusion Although most terminally ill Oregonians who receive aid in dying do not have depressive disorders, the current practice of the Death with Dignity Act may fail to protect some patients whose choices are influenced by depression from receiving a prescription for a lethal drug. PMID:18842645

  8. A comparison of depression scores between aesthetic and functional rhinoplasty patients.

    PubMed

    Naraghi, Mohsen; Atari, Mohammad

    2015-04-01

    Depression is a mood state of sadness, gloom, and pessimistic ideation with loss of interest or pleasure in normal activities. This mood disorder has been reported to occur more frequently among cosmetic surgery patients. The purpose of the current study was to compare the score of depression among aesthetic rhinoplasty candidates and functional rhinoplasty patients as control group. The Beck Depression Inventory (BDI) and Depression (DE) subscale of Symptom Check List-90-Revised (SCL-90-R) were administered on a sample of aesthetic rhinoplasty patients (n=21) as well as a sample of functional rhinoplasty patients (n=21). Those with both cosmetic and functional purposes were categorized regarding their primary objective. Questionnaires were given to patients preoperatively. Cohen's d was also calculated as a measure of Effect Size (ES). BDI and SCL-90-R-DE scores were analyzed using t-test for independent groups. Statistical analyses suggested that the mean BDI and SCL-90-R-DE scores of aesthetic surgery patients were significantly higher than those of functional surgery patients (P<0.05). The results showed that age, sex, and Socio-Economic Status (SES) were not significantly different between the two groups as they can be capable of influencing the depression score. Effect size was above the moderate level: d=0.51, d=0.72 for BDI and SCL-90-R-DE, respectively. Using two different depression instruments, the findings of this study showed that aesthetic rhinoplasty patients were more depressed in comparison with functional rhinoplasty patients. The measures of ES also supported the hypothesis that aesthetic rhinoplasty candidates had higher scores in depression. PMID:25701068

  9. A comparison of depression scores between aesthetic and functional rhinoplasty patients.

    PubMed

    Naraghi, Mohsen; Atari, Mohammad

    2015-04-01

    Depression is a mood state of sadness, gloom, and pessimistic ideation with loss of interest or pleasure in normal activities. This mood disorder has been reported to occur more frequently among cosmetic surgery patients. The purpose of the current study was to compare the score of depression among aesthetic rhinoplasty candidates and functional rhinoplasty patients as control group. The Beck Depression Inventory (BDI) and Depression (DE) subscale of Symptom Check List-90-Revised (SCL-90-R) were administered on a sample of aesthetic rhinoplasty patients (n=21) as well as a sample of functional rhinoplasty patients (n=21). Those with both cosmetic and functional purposes were categorized regarding their primary objective. Questionnaires were given to patients preoperatively. Cohen's d was also calculated as a measure of Effect Size (ES). BDI and SCL-90-R-DE scores were analyzed using t-test for independent groups. Statistical analyses suggested that the mean BDI and SCL-90-R-DE scores of aesthetic surgery patients were significantly higher than those of functional surgery patients (P<0.05). The results showed that age, sex, and Socio-Economic Status (SES) were not significantly different between the two groups as they can be capable of influencing the depression score. Effect size was above the moderate level: d=0.51, d=0.72 for BDI and SCL-90-R-DE, respectively. Using two different depression instruments, the findings of this study showed that aesthetic rhinoplasty patients were more depressed in comparison with functional rhinoplasty patients. The measures of ES also supported the hypothesis that aesthetic rhinoplasty candidates had higher scores in depression.

  10. The Risk of Depression in Patients With Cholelithiasis Before and After Cholecystectomy

    PubMed Central

    Shen, Te-Chun; Lai, Hsueh-Chou; Huang, Yu-Jhen; Lin, Cheng-Li; Sung, Fung-Chang; Kao, Chia-Hung

    2015-01-01

    Abstract The association between cholelithiasis and depression remains unclear. We examined the risk of depression in patients with cholelithiasis. From the National Health Insurance population claims data of Taiwan, we identified 14071 newly diagnosed cholelithiasis patients (4969 symptomatic and 9102 asymptomatic) from 2000 to 2010. For each cholelithiasis patient, 4 persons without cholelithiasis were randomly selected in the control cohort from the general population frequency matched by age, sex, and diagnosis year. Both cohorts were followed up until the end of 2011 to monitor the occurrence of depression. Adjusted hazard ratios (aHRs) of depression were estimated using the Cox proportional hazards model after controlling for age, sex and comorbidities. The overall incidence rates of depression were 1.87- and 1.83-fold greater in the symptomatic and asymptomatic cholelithiasis subcohorts than in the control cohort (incidence, 10.1 and 9.96 vs 5.43 per 1000 person-years, respectively). The multivariable Cox proportional hazards regression analysis revealed higher variable-specific aHRs in women than in men, in younger patients than in older patients, and in those without comorbidities than in those with any comorbidity. Cholecystectomy reduced the hazard of developing depression with aHRs of 0.79 (95% confidence interval [CI] 0.62–0.99) for symptomatic cholelithiasis patients and 0.76 (95% CI 0.60–0.96) for asymptomatic patients. Patients with cholelithiasis are at a higher risk of developing depression than the general population. Patients could be benefited from cholecystectomy and have the hazard of developing depression significantly reduced. PMID:25761193

  11. Illness perceptions mediate the relationship between depression and quality of life in patients with epilepsy.

    PubMed

    Shallcross, Amanda J; Becker, Danielle A; Singh, Anuradha; Friedman, Daniel; Montesdeoca, Jacqueline; French, Jacqueline; Devinsky, Orrin; Spruill, Tanya M

    2015-11-01

    The current study examined whether negative illness perceptions help explain the link between depression and quality of life. Seventy patients with epilepsy completed standardized self-report questionnaires measuring depression, illness perception, and quality of life (QOL). Illness perception statistically mediated the relationship between depression and QOL (Indirect effect (CI; confidence interval) = -.72, lower limit = -1.7, upper limit = -.22, p < .05). Results held with and without adjusting for potential confounding variables (age, sex, ethnicity, income, and seizure frequency) and when operationalizing depression as a continuous variable that indexed severity of symptoms or as a dichotomous variable that indexed criteria consistent with a diagnosis of major depressive disorder. This study is the first to suggest that illness perceptions may be a useful target in screening and intervention approaches in order to improve QOL among low-income, racially/ethnically diverse patients with epilepsy.

  12. The effects of complementary and alternative medicine on the speech of patients with depression

    NASA Astrophysics Data System (ADS)

    Fraas, Michael; Solloway, Michele

    2001-05-01

    It is well documented that patients suffering from depression exhibit articulatory timing deficits and speech that is monotonous and lacking pitch variation. Traditional remediation of depression has left many patients with adverse side effects and ineffective outcomes. Recent studies indicate that many Americans are seeking complementary and alternative forms of medicine to supplement traditional therapy approaches. The current investigation wishes to determine the efficacy of complementary and alternative medicine (CAM) on the remediation of speech deficits associated with depression. Subjects with depression and normal controls will participate in an 8-week treatment session using polarity therapy, a form of CAM. Subjects will be recorded producing a series of spontaneous and narrative speech samples. Acoustic analysis of mean fundamental frequency (F0), variation in F0 (standard deviation of F0), average rate of F0 change, and pause and utterance durations will be conducted. Differences pre- and post-CAM therapy between subjects with depression and normal controls will be discussed.

  13. The role of the ECG in diagnosis, risk estimation, and catheterization laboratory activation in patients with acute coronary syndromes: a consensus document.

    PubMed

    Birnbaum, Yochai; Nikus, Kjell; Kligfield, Paul; Fiol, Miguel; Barrabés, Jose Antonio; Sionis, Alessandro; Pahlm, Olle; Niebla, J Garcia; de Luna, Antonio Bayès

    2014-09-01

    The electrocardiogram (ECG) is the most widely used imaging tool helping in diagnosis and initial management of patients presenting with symptoms compatible with acute coronary syndrome. Acute ischemia affects the configuration of the QRS complexes, the ST segments and the T waves. The ECG should be read along with the clinical assessment of the patient. ST segment elevation (and ST depression in leads V1 -V3 ) in patients with active symptoms usually indicates acute occlusion of an epicardial artery with ongoing transmural ischemia. These patients should be triaged for emergent reperfusion therapy per current guidelines. However, many patients have ST segment elevation secondary to nonischemic causes. ST depression in leads other than V1 -V3 usually are indicative of subendocardial ischemia secondary to subocclusion of the epicardial artery, distal embolization to small arteries or spasm supply/demand mismatch. ST depression may also be secondary to nonischemic etiologies, such as left ventricular hypertrophy, cardiomyopathies, etc. Knowing the clinical scenario, comparison to previous ECG and subsequent ECGs (in cases that there are changes in the quality or severity of symptoms) may add in the diagnosis and interpretation in difficult cases. This review addresses the different ECG patterns, typically seen in patients with active symptoms, after resolution of symptoms and the significance of such changes when seen in asymptomatic patients.

  14. Sleep Quality and Depression and Their Association with Other Factors in Hemodialysis Patients

    PubMed Central

    Firoz, Masomeh Norozi; Shafipour, Vida; Jafari, Hedayat; Hosseini, Seyed Hamzeh; Charati, Jamshid Yazdani

    2016-01-01

    Background: Sleep disorders and depression, accompanied by reduced quality of life and increased mortality are the most common psychological problems in dialysis patients. This study was conducted with the aim to investigate depression and sleep quality and their association with some demographic and clinical factors in hemodialysis patients. Method: This descriptive-correlative study was conducted on 310 patients undergoing hemodialysis in 8 centers in educational hospitals in Mazandaran University of Medical Sciences. Data collection tools included a demographic questionnaire, Beck Depression Inventory, and Pittsburg Sleep Quality Index (PSQI). Statistical analysis was conducted using Chi-Square test and regression model. Results: Results obtained showed 44.8% depression in patients. Significant relationships were found between depression and increased blood phosphorus (P=0.002) and urea (P=0.001). Poor sleep quality was observed in 73.5% of hemodialysis patients, which was found significantly related to aging (P=0.048), female (P=0.04), and reduced frequency of weekly hemodialysis (P=0.035). Conclusion: Depression and poor sleep quality are two common factors in hemodialysis patients, but patients do not overtly show symptoms of these disorders.

  15. Neuropathic pain, depressive symptoms, and C-reactive protein in sciatica patients.

    PubMed

    Uher, Tomas; Bob, Petr

    2013-03-01

    There is evidence that neuropathic pain component in low back pain (LBP) patients is associated with higher ratings of comorbidities such as depression and anxiety disorders. In line with current findings, the purpose of this clinical study is to examine a hypothesis regarding a relationship of neuropathic pain component, depression, and other psychopathological symptoms in a specific group of LBP patients with sciatica pain. With respect to findings that depression is related to inflammatory changes, and inflammatory mediators may play a role in neuropathic pain generation, we have assessed also serum C-reactive protein (CRP). Results of the present study show that increased neuropathic pain component in sciatica patients is associated with elevated levels of depression, anxiety, alexithymia, and serum CRP levels. In conclusion, results of this study indicate that CRP levels in sciatica patients are closely associated with neuropathic pain.

  16. Acute complications and outcomes of acute head injury in adult patients with haemophilia.

    PubMed

    Rivera-Núñez, Maria A; Borobia, Alberto M; García-Erce, Jose A; Martí de Gracia, Milagros; Pérez-Perilla, Patricia; Quintana-Díaz, Manuel

    2014-10-01

    The aim of the present study is to describe the clinical and epidemiological characteristics, complications and outcome of patients with haemophilia and acute head injury (AHI) at the emergency department (ED), and develop a protocol to prevent early and late complications. This is a retrospective cohort study including all patients with haemophilia and AHI admitted to the ED. We identified 26 patients with AHI. A computed tomography scan was carried out on all patients at admission, and again on two patients (with neurosurgical complications) 48 h later. The discharge diagnosis was as follows: 3.8% subdural haematoma, 3.8% cerebellar epidural haematoma and 92.3% uncomplicated AHI. We propose the following protocol: a computed tomography scan upon arrival and another within 48 h post-AHI, unless there is an absence of clinical symptoms. In addition, all patients must self-administer a clotting factor as soon as possible and be observed in the ED for at least 48 h.

  17. Admission glycaemia and outcome in patients with acute coronary syndrome.

    PubMed

    Müdespacher, Damaris; Radovanovic, Dragana; Camenzind, Edoardo; Essig, Manfred; Bertel, Osmund; Erne, Paul; Eberli, Franz Robert; Gutzwiller, Felix

    2007-12-01

    Some studies of patients with acute myocardial infarction have reported that hyperglycaemia at admission may be associated with a worse outcome. This study sought to evaluate the association of blood glucose at admission with the outcome of unselected patients with acute coronary syndrome (ACS). Using the Acute Myocardial Infarction and unstable angina in Switzerland (AMIS Plus) registry, ACS patients were stratified according to their blood glucose on admission: group 1: 2.80-6.99 mmol/L, group 2: 7.00-11.09 mmol/L and group 3: > 11.10 mmol/L. Odds ratios for in-hospital mortality were calculated using logistic regression models. Of 2,786 patients, 73% were male and 21% were known to have diabetes. In-hospital mortality increased from 3% in group 1 to 7% in group 2 and to 15% in group 3. Higher glucose levels were associated with larger enzymatic infarct sizes (p<0.001) and had a weak negative correlation with angiographic or echographic left ventricular ejection fraction. High admission glycaemia in ACS patients remains a significant independent predictor of in-hospital mortality (adjusted OR 1.08; 95% confidence intervals [CI] 1.05-1.14, p<0.001) per mmol/L. The OR for in-hospital mortality was 1.04 (95% CI 0.99-1.1; p=0.140) per mmol/L for patients with diabetes but 1.21 (95% CI 112-1.30; p<0.001) per mmol/L for non-diabetic patients. In conclusion, elevated glucose level in ACS patients on admission is a significant independent predictor of in-hospital mortality and is even more important for patients who do not have known diabetes.

  18. Ecthyma gangrenosum in a patient with acute leukemia.

    PubMed

    Kryeziu, Emrush; Kryeziu, K; Bajraktari, Gjani; Abazi, M; Zylfiu, B; Rudhani, I; Sadiku, Sh; Ukimeri, A; Brovina, A; Dreshaj, Sh; Telaku, S

    2010-01-01

    Ecthymagangrenosum (EG)is a rare condition with characteristic clinical appearance of red maculae that progresses to a central area of necrosis surrounded by an erythematous halo. The most frequently it is caused by Pseudomonas bacteriaemia in neutropenic patient. The authors presents a patient with acute myloblastic leukemia M4 type in whom in relapse EG caused by Pseudomonas aeruginosa was found. The patient was treated with antibiotics and surgical debridement. The author wants to point out on clinical significance this condition with high mortality rate.

  19. General practitioners miss disability and anxiety as well as depression in their patients with osteoarthritis.

    PubMed Central

    Memel, D S; Kirwan, J R; Sharp, D J; Hehir, M

    2000-01-01

    BACKGROUND: General practitioners (GPs) integrate physical, psychological, and social factors when assessing patients, particularly those with chronic diseases. Recently, the emphasis has been on assessment of depression but not of other factors. AIM: To determine functional disability, psychological morbidity, social situation, and use of health and social services in patients with osteoarthritis and examine GP knowledge of these factors. METHOD: Two hundred patients completed a validated postal questionnaire about functional disability (Health Assessment Questionnaire [HAQ]), mood (Hospital Anxiety and Depression Scale [HAD]), employment status, who they lived with, welfare benefits received, and use of health and social services. A similar questionnaire was completed by the patient's GP, including a HAQ. However, a three-point scale was used to assess depression and anxiety. RESULTS: Forty-seven per cent of patients were moderately or severely disabled (HAQ > 1). GPs underestimated functional disability: mean patient HAQ = 1.04 (95% confidence interval [CI] = 0.92-1.16), mean GP HAQ = 0.74 (95% CI = 0.65-0.83), and there was low correlation between patient and GP scores (kappa = 0.24). There was moderate prevalence of depression and high prevalence of anxiety, which the GP often did not recognise: patient depression = 8.3% (95% CI = 4.1%-12.8%), GP depression = 6.0% (95% CI = 2.4%-9.6%), kappa = 0.11; patient anxiety = 24.4% (95% CI = 17.8%-31.0%), GP anxiety = 11.9% (95% CI = 6.9%-16.9%), kappa = 0.19. Only 46% of severely disabled patients (HAQ > 2) were receiving disability welfare benefits. GPs were often unaware of welfare benefits received or the involvement of other professionals. CONCLUSION: GPs frequently lack knowledge about functional disability, social factors, and anxiety as well as depression in their patients with osteoarthritis. PMID:11042917

  20. Disease-Related Variables and Depression Among Iranian Patients with Parkinson Disease

    PubMed Central

    Shakeri, Jalal; Chaghazardi, Maryam; Abdoli, Nasrin; Arman, Farid; Hoseini, Seyed Davood; Shakeri, Hania

    2015-01-01

    Background: The factors affecting the correlation between Parkinson disease (PD) and depression have remained unclear. Objectives: We assessed the prevalence of depression among patients with PD and the association between PD-related variables and depression severity. Patients and Methods: This is a cross-sectional study performed in Kermanshah Province of Iran. Sampling was based on recruitment of subjects according to inclusion and exclusion criteria. Patients with confirmed Parkinson disease who were referred to clinics of Kermanshah University of Medical Sciences participated in this study. Depression was evaluated with Beck Depression Inventory-II (BDI-II). Clinical characteristics of PD, including tremor, rigidity, impaired posture, loss of autonomic movement, changes in speech and handwriting, masked face, and hyposmia were indexed. Anhedonia was assessed with Farsi version of Snaith-Hamilton Pleasure Scale. Data were collected between April 2010 and March 2014. Results: A total of 350 patients (52.9% men and 47.1% women) participated in this investigation. Female gender (36.5% in women vs. 13.0% in men, P < 0.0001), impaired posture (27.2% in affected individuals vs. 18.8%, P = 0.002), masked face (39.0% vs. 5.2%, P < 0.0001), and hyposmia (48.7% vs. 21.0%, P = 0.001) were associated with higher susceptibility to profound depression. Lower scores of all domains of Farsi version of Snaith-Hamilton Pleasure Scale (including interest/pastimes, social interaction, sensory experience, and food/drink) were related to more severe depression (P < 0.0001 for all subscales). Severe and profound depression was found in 44% of the participants. Conclusions: This study estimated that the prevalence of major depression among Iranian individuals with PD living in Kermanshah as 44%. Major determinants of depression were female gender, rigidity, impaired posture, masked face, hyposmia, and anhedonia. PMID:26568863

  1. [The readiness to communication and self-presentation as chosen aspects of social activity in depressive patients].

    PubMed

    Nowicka-Sauer, K

    2000-01-01

    Willingness to communicate and self-presentation were examined in 68 patients with depression. The results of the patients were compared with a control group of healthy individuals. The results indicated changes in social life of patients, especially in interpersonal communication. Depressive patients showed significantly lower level of willingness to communicate than healthy persons. The self-presentation letters of patients mostly included information about the disease, negative feelings and thoughts connected with depression and negative self-description.

  2. Mortality in elderly patients with acute renal failure.

    PubMed

    Santacruz, F; Barreto, S; Mayor, M M; Cabrera, W; Breuer, N

    1996-07-01

    In a retrospective study, we identified 55 elderly patients with acute renal failure (ARF) admitted to our hospital during an 8-year period from 1985 to 1993. Information about the etiology, complications, laboratory data, and treatment course were obtained from the clinical history. Of the 200 patients with ARF admitted to the hospital during this period, 28% were patients more than 60 years old (41 male and 14 female) with an average age of 68.5 +/- 7 years. The main causes of ARF were sepsis, volume depletion, low cardiac output, arterial hypotension, nephrotoxicity by antibiotics, and obstructive uropathy. The global mortality of elderly patients with ARF was 53%. The mortality rate of the different types of the ARF were: prerenal 35%, intrinsic 64% (oliguric 76%, nonoliguric 50%), and postrenal 40%. Mortality as a result of sepsis occurred in 18 patients (62%), by cardiovascular disease in 4 patients (13%), by acute respiratory failure in 2 patients (7%), and by other causes in 5 patients (18%). In the cases of sepsis, Pseudomonas was detected in 7 cases (39%), Escherichia coli in 2 cases (11%), Gram-negative nonspecific in 3 cases (17%), Klebsiella in 1 case (5%), and in 5 cases (16%), the hemoculture was negative. The patient survival rate was 47% (26 of 55 patients). Of these patients, 19 recovered their normal renal function (73%), but 7 patients remained with renal failure (27%). In conclusion, the global mortality in the elderly patients without considering the types of ARF was 53%. The oliguric form had the highest mortality rate with 76%. The main causes for mortality were sepsis with 62%, cardiovascular disease with 13%, and other causes 18%.

  3. [Preliminary research on multi-neurotransmitters' change regulation in 120 depression patients' brains].

    PubMed

    Chi, Ming; Qing, Xue-Mei; Pan, Yan-Shu; Xu, Feng-Quan; Liu, Chao; Zhang, Cheng; Xu, Zhen-Hua

    2014-04-01

    In view of the effective traditional Chinese medicine (TCM) in the treatment of clinical depression, the mechanism is not clear, this study attempts to research the cause of depression in a complex situation to lay the foundation for the next step of TCM curative effect evaluation. Based on the brain wave of 120 depression patients and 40 ordinary person, the change regulation of acetylcholine, dopamine, norepinephrine, depression neurotransmitters and excited neurotransmitters in the whole and various encephalic regions' multi-neurotransmitters of depression patients-serotonin are analysed by search of encephalo-telex (SET) system, which lays the foundation for the diagnosis of depression. The result showed that: contrased with the normal person group, the mean value of the six neurotransmitters in depression patients group are: (1) in the whole encephalic region of depression patients group the dopamine fall (P < 0.05), and in the double centralregions, right temporal region and right parietal region distinct fall (P < 0.01); (2) in the right temporal region of depression patients group the serotonin rise (P < 0.05); (3) in the right central region, left parietal region of depression patients group the acetylcholine fall (P < 0.05), left rear temporal region fall obviously (P < 0.01). The correlation research between antagonizing pairs of neurotransmitters and neurotransmitters: (1) the three antagonizing pairs of neurotransmitters-serotonin and dopamine, acetylcholine and norepinephrine, depression neurotransmitters and excited neurotransmitters, in ordinary person group and depression patients group are characterizeed by middle or strong negative correlation. Serotonin and dopamine, which are characterized by weak negative correlation in the right rear temporal region of ordinary person group, are characterized by strong negative correlation in the other encephalic regions and the whole encephalic (ordinary person group except the right rear temporal region

  4. Depression and Quality of Life in Patients With Type 2 Diabetes

    PubMed Central

    Derakhshanpour, Firooze; Vakili, Mohammad Ali; Farsinia, Maryam; Mirkarimi, Kamal

    2015-01-01

    Background: Frequency of mood disorders in patients with chronic diseases, especially diabetes and its effects on life quality are dramatically increasing. Objectives: This study aimed to investigate the relation between depression and quality of life in patients with diabetes. Patients and Methods: This is a cross sectional survey. Subjects were selected from 330 eligible people referred to the only diabetes clinic in Gorgan City during 6 months, using systematic random sampling. Beak Depression questionnaire and the brief questioner with 26 questions recommended by the World Health Organization (WHOQOL-BREF) were used to measure depression and quality of life, respectively. Data were analyzed through descriptive methods, Chi-square, Independent t test and linear regression model using SPSS16; moreover, P value < 0.05 was considered as significant. Results: In total, 330 patients with diabetes (35.5 % male and 64.5% women) were studied. The mean and standard deviation of their age and years involved with diabetes were 50.6 ± 9.0 and 5.4 ± 4.5 years, respectively. Range of age was 25 - 75 years, as well. The prevalence of depression in all patients with diabetes was 58.2% (124 mild, 56 medium, and 12 with severe depression). Hypertension was 13.9% more in diabetic patients with depression (P value < 0.001) and physical activity in 24.7% of the cases was less with a meaningful difference (P value = 0.01). The mean and standard deviation of quality of life in diabetic patients with and without depression was 50.7 ± 14 and 60.5 ± 13.3, respectively that was significant in two groups (P < 0.0001). Conclusions: The prevalence of depression is high in patients with diabetes and has a considerable impact on the consequences of diabetes and quality of life too. PMID:26082854

  5. The effects of combined hyperbaric oxygen therapy on patients with post-stroke depression.

    PubMed

    Yan, Dong; Shan, Jin; Ze, Yu; Xiao-Yan, Zeng; Xiao-Hua, Hu

    2015-05-01

    [Purpose] To observe the effect of combined hyperbaric oxygen therapy on patients with post-stroke depression. [Subjects] Ninety patients with post-stroke depression were randomly divided into 3 groups: fluoxetine treatment group (n = 30), hyperbaric oxygen therapy group (n = 30), and hyperbaric oxygen combined treatment group (n = 30). [Methods] Fluoxetine treatment group received anti-depression drugs (fluoxetine, 20 mg/day), hyperbaric oxygen therapy group received hyperbaric oxygen (once a day, 5 days/week), hyperbaric oxygen combined treatment group received fluoxetine and hyperbaric oxygen treatments as described above. All patients received routine rehabilitation therapy. Hamilton Depression Scale (HAMD), and Scandinavian Stroke Scale (SSS) scores were evaluated before and at the end of 4th week. The total effective rate of depression release between the 3 groups was also compared at the end of study. [Results] The end scores of HAMD and SSS in the 3 groups were significantly lower than those before treatment. The total effective rate of combined hyperbaric oxygen therapy group after treatment was higher than the other two groups. [Conclusions] Combined hyperbaric oxygen therapy plays an important role in the treatment of patients with post-stroke depression. The total effective rate of combined hyperbaric oxygen therapy was higher than other routine anti post-stroke depression treatments.

  6. [Morita Therapy to Treat Depression: When and How to Encourage Patients to Join Activities].

    PubMed

    Nakamura, Kei

    2015-01-01

    The author discusses how Morita therapy is used to treat depression, illustrated with a clinical case, and makes comparisons between Morita therapy and behavioral activation (BA). The author further examines the issue of when and how to encourage patients to join activities in clinical practice in Japan. Both Morita therapy and BA share at least a common view that it is effective to activate patients' constructive behavior at a certain point in depression treatment. However, BA therapists, compared to Morita therapists, seem to pay less attention to the necessity of resting and the appropriate timing for introducing behavioral activation. There may be some contextual differences between depressive patients in Japan and those in North America. In the case of Japanese patients, exhaustion from overwork is often considered a factor triggering the development of depression. At the same time, the Morita-based pathogenic model of depression seems different from BA's model of the same disorder. BA's approach to understanding depression may be considered a psychological (behavioristic) model. In this model, the cause of depression lies in: (a) a lack of positive reinforcement, and (b) negative reinforcement resulting from avoidance of the experience of discomfort. Therefore, the basic strategy of BA is to release depressive patients from an avoidant lifestyle, which serves as a basis for negative reinforcement, and to redirect the patients toward activities which offer the experience of positive reinforcement BA is primarily practiced by clinical psychologists in the U. S. while psychiatrists prescribe medication as a medical service. On the other hand, the clinical practice of treating depression in Japan is based primarily on medical models of depression. This is also true of Morita therapy, but in a broad sense. While those who follow medical models in a narrow sense try to identify the cause of illness and then remove it, Morita therapists pay more attention to the

  7. [Morita Therapy to Treat Depression: When and How to Encourage Patients to Join Activities].

    PubMed

    Nakamura, Kei

    2015-01-01

    The author discusses how Morita therapy is used to treat depression, illustrated with a clinical case, and makes comparisons between Morita therapy and behavioral activation (BA). The author further examines the issue of when and how to encourage patients to join activities in clinical practice in Japan. Both Morita therapy and BA share at least a common view that it is effective to activate patients' constructive behavior at a certain point in depression treatment. However, BA therapists, compared to Morita therapists, seem to pay less attention to the necessity of resting and the appropriate timing for introducing behavioral activation. There may be some contextual differences between depressive patients in Japan and those in North America. In the case of Japanese patients, exhaustion from overwork is often considered a factor triggering the development of depression. At the same time, the Morita-based pathogenic model of depression seems different from BA's model of the same disorder. BA's approach to understanding depression may be considered a psychological (behavioristic) model. In this model, the cause of depression lies in: (a) a lack of positive reinforcement, and (b) negative reinforcement resulting from avoidance of the experience of discomfort. Therefore, the basic strategy of BA is to release depressive patients from an avoidant lifestyle, which serves as a basis for negative reinforcement, and to redirect the patients toward activities which offer the experience of positive reinforcement BA is primarily practiced by clinical psychologists in the U. S. while psychiatrists prescribe medication as a medical service. On the other hand, the clinical practice of treating depression in Japan is based primarily on medical models of depression. This is also true of Morita therapy, but in a broad sense. While those who follow medical models in a narrow sense try to identify the cause of illness and then remove it, Morita therapists pay more attention to the

  8. Intestinal permeability in patients with acute myeloid leukemia.

    PubMed

    Sundström, G M; Wahlin, A; Nordin-Andersson, I; Suhr, O B

    1998-10-01

    Intestinal permeability was studied in patients with acute myeloid leukemia (AML) before, during and after chemotherapy. Intestinal permeability was determined by the lactulose (La)/mannitol (Ma) absorption test in 16 adult patients with de novo AML. The hydrogen breath test was used to disclose bacterial fermentation of the test substances in the small intestine. The permeability was found significantly increased (p<0.02) in the patients before induction chemotherapy treatment. During induction treatment and throughout the cytopenic period the intestinal permeability was constantly and significantly increased, compared with controls. In patients with abnormally increased permeability, no increase in hydrogen breath test result was noted. From our results it can be concluded that increased intestinal permeability is present in AML patients before commencing chemotherapy. Factors other than chemotherapy would seem to be more important regarding the occurrence of intestinal disturbances in these patients.

  9. The role of 5-HT1A receptors in mediating acute negative effects of antidepressants: implications in pediatric depression

    PubMed Central

    Rahn, K A; Cao, Y-J; Hendrix, C W; Kaplin, A I

    2015-01-01

    Acute antidepressant exposure elevates the frequency of impulsive behavior and suicidal thoughts in children and adolescents with major depressive disorder (MDD). Long-term antidepressant treatment, however, is beneficial for pediatric MDD, so it is necessary to explore novel treatments that prevent the potentially dangerous consequences of acute antidepressant initiation. In the present study, a treatment strategy designed to reverse the acute negative behavioral effects of antidepressants was tested in rodents. Co-administration of the 5-HT1A receptor (5-HT1AR) antagonist WAY-100635 reversed the negative effects of acute fluoxetine, a serotonin reuptake inhibitor, but not reboxetine, a norepinephrine reuptake inhibitor, supporting the involvement of 5-HT1AR in mediating the negative consequences of acute selective serotonin reuptake inhibitor (SSRI) treatment. No 5-HT1AR antagonists are currently approved for use in pediatric populations, so alternative strategies should be explored. One such strategy was suggested based on the hypothesis that the rate of 5-HT1AR activation and the subsequent inhibition of serotonergic neuron activity caused by acute SSRI administration is proportional to the loading rate of an antidepressant. Existing pharmacological data were examined, and significant correlations were observed between the half-life of antidepressants and the rate of suicide-related events (SREs). Specifically, antidepressants with longer half-lives have lower rates of SREs. On the basis of these data, novel dosing strategies were developed for five antidepressants to mimic the pharmacological profile of the antidepressant with the longest half-life, fluoxetine. These dosing strategies could be used to decrease the rate of SREs associated with acute antidepressant treatment in pediatric MDD until an improved pharmacological treatment is developed. PMID:25942044

  10. Turkish hysterectomy and mastectomy patients - depression, body image, sexual problems and spouse relationships.

    PubMed

    Keskin, Gulseren; Gumus, Aysun Babacan

    2011-01-01

    The aim of this study was to compare hysterectomy and mastectomy patients in terms of depression, body image, sexual problems and spouse relations. The study group comprised 94 patients being treated in Ege University Radiation Oncology Clinic, Tulay Aktas Oncology Hospital, Izmir Aegean Obstetrics and Gynecology Training and Research Hospital for breast and gynecological cancer (42 patients underwent mastectomy, 52 patient underwent hysterectomy). Five scales were used in the study: Sociodemographic Data Form, Beck Depression Scale, Body Image Scale, Dyadic Adjustment Scale, Golombok Rust Sexual Functions Scale. Mastectomy patients were more depressive than hysterectomy patients (t = 2.78, p < 0.01). Body image levels of the patients were bad but there was no significant difference between the two patient groups (p > 0.05). Hysterectomy patients had more problems in terms of vaginismus (t = 2.32, p < 0.05), avoidance of sexual intercourse (t = 2.31, p < 0.05), communication (t = 2.06, p < 0.05), and frequency of sexual intercourse than mastectomy patients (t = 2.10, p < 0.05). As compared with compliance levels between patients and spouses; hysterectomy patients had more problems related to expression of emotions than mastectomy patients (t = 2.12, p < 0.05). In conclusion, body image was negative, mastectomy was associated with more depression and hysterectomy with greater sexual problems and difficulties with spouse relationships. PMID:21545207

  11. Upregulation of Leukocytic Syncytin-1 in Acute Myeloid Leukemia Patients

    PubMed Central

    Sun, Yi; Zhu, Hongyan; Song, Jianxin; Jiang, Yaxian; Ouyang, Hongmei; Huang, Rongzhong; Zhang, Guiqian; Fan, Xin; Tao, Rui; Jiang, Jie; Niu, Hua

    2016-01-01

    Background Syncytin-1, a cell membrane-localizing fusogen, is abnormally expressed in several cancers, including endometrial cancer, breast cancer, and leukemia. Although abnormal syncytin-1 expression has been detected in two-thirds of leukemia blood samples, its expression profile in acute leukemia patients has not yet been analyzed. Material/Methods Bone marrow samples from 50 acute myelogenous leukemia (AML) cases and 14 B-cell acute lymphocytic leukemia (B-cell ALL) patients were subjected to flow cytometry to assess leukocyte type distributions and leukocytic syncytin-1 surface expression. RT-PCR was applied to assess leukocytic syncytin-1 mRNA expression. Statistical analysis was applied to compare syncytin-1 expression between AML and B-cell ALL patients across blasts, granulocytes, lymphocytes, and monocytes as well as to determine clinical factors statistically associated with changes in syncytin-1 expression. Results The leukocyte type distributions of the AML and B-cell ALL cohorts highly overlapped, with an observable difference in blast distribution between the 2 cohorts. The AML cohort displayed significantly greater syncytin-1 surface and mRNA expression (p<0.05). Syncytin-1 surface and mRNA expression was significantly increased across all 4 leukocyte types (p<0.05). The percentage of syncytin-1-expressing blasts was significantly greater in AML patients (p<0.05), with blasts showing the largest fold-change in syncytin-1 expression (p<0.05). M5, M5a, and M5b AML patients displayed significantly higher syncytin-1 surface expression relative to all other AML French-American-British (FAB) classifications (p<0.05). Conclusions These findings suggest leukocytic syncytin-1 expression may play a role in the development and/or maintenance of the AML phenotype and the acute monocytic leukemia phenotype in particular. PMID:27393911

  12. Depression, anxiety, and stress comorbidities in sickle cell anemia patients with vaso-occlusive crisis.

    PubMed

    Mahdi, Najat; Al-Ola, Khadija; Khalek, Nahed Abdel; Almawi, Wassim Y

    2010-07-01

    We investigated the association of sickle cell anemia (SCA) vaso-occlusive crisis (VOC) with depression, anxiety, and stress disorders among Bahraini patients and controls. This was a cross-sectional study that involved administering Depression Anxiety Stress Scales (DASS-21) consisting of structured depression, anxiety, and stress scales to SCA patients with (n=138) and without (n=105) VOC. Multinomial regression and correlation analysis were used in assessing the association of VOC with depression and/or anxiety and/or stress, after adjusting for other covariates. Significantly higher proportion of VOC patients was found among the severe-extremely severe anxiety (P<0.002) and stress (P=0.001) groups; the frequency of depressed patients was comparable between the 2 groups. Adjusting for age, sex, income, number of affected individuals per family, and HbS levels, mild-moderate (P=0.042; odds ratio=2.00; 95% confidence interval=1.03-3.91) and severe-extremely severe (P=0.004; odds ratio=4.43; 95% confidence interval=1.59-12.34) anxiety were independently associated with VOC. Both depression and stress were not associated with VOC after adjusting for these covariates. These results suggest a positive contribution of VOC to the increased rates of anxiety disorders among SCA patients, thereby recommending counseling SCA patients with repeated VOC for these psychologic comorbidities, in particular anxiety.

  13. [Association of obesity and depression].

    PubMed

    Rihmer, Zoltán; Purebl, György; Faludi, Gábor; Halmy, László

    2008-10-01

    It has been long known that the frequency of overweight and obese people is higher among depressed and bipolar patients than in the general population. The marked alteration of body weight (and appetite) is one of the most frequent of the 9 symptoms of major depressive episode, and these symptoms occur during recurrent episodes of depression with a remarkably high consequence. According to studies with representative adult population samples, in case of obesity (BMI over 30) unipolar or bipolar depression is significantly more frequently (20-45%) observable. Since in case of depressed patients appetite and body weight reduction is observable during the acute phase, the more frequent obesity in case of depressed patients is related (primarily) not only to depressive episodes, but rather to lifestyle factors, to diabetes mellitus also more frequently occurring in depressed patients, to comorbid bulimia, and probably to genetic-biological factors (as well as to pharmacotherapy in case of medicated patients). At the same time, according to certain studies, circadian symptoms of depression give rise to such metabolic processes in the body which eventually lead to obesity and insulin resistance. According to studies in unipolar and bipolar patients, 57-68% of patients is overweight or obese, and the rate of metabolic syndrome was found to be between 25-49% in bipolar patients. The rate of metabolic syndrome is further increased by pharmacotherapy. Low total and HDL cholesterol level increases the risk for depression and suicide and recent studies suggest that omega-3-fatty acids possess antidepressive efficacy. Certain lifestyle factors relevant to healthy metabolism (calorie reduction in food intake, regular exercise) may be protective factors related to depression as well. The depression- and possibly suicide-provoking effect of sibutramine and rimonabant used in the pharmacotherapy of obesity is one of the greatest recent challenges for professionals and patients

  14. Association Between Anxiety and Depression With Dialysis Adequacy in Patients on Maintenance Hemodialysis

    PubMed Central

    Najafi, Afshan; Keihani, Sorena; Bagheri, Nazila; Ghanbari Jolfaei, Atefeh; Mazaheri Meybodi, Azadeh

    2016-01-01

    Background Depression and anxiety are common among hemodialysis patients and affect their treatment outcomes. Dialysis adequacy also affects the hemodialysis patients’ survival rates. Objectives This study aimed to evaluate the correlation between anxiety and depression with dialysis adequacy. Patients and Methods In this cross-sectional study, 127 hemodialysis patients (73 males, 57.5%) with the mean age of 55.7 ± 17.5 were enrolled. Demographic and recent laboratory data were collected using self-administered questionnaires and by reviewing medical records. Dialysis adequacy measures including the Kt/V and urea reduction rate (URR) were calculated using standard formulas. The Hospital Anxiety and Depression Scale (HADS) was used to diagnose depression and anxiety. Independent sample t-test and Chi-square test were used to compare the values in different groups. Pearson correlations and linear regression were used to analyze the data using SPSS version 21. Results The prevalence rates of depression and anxiety (HADS score ≥ 8) were 31.5% and 41.7%, respectively. The prevalence of both conditions was significantly higher in women than in men (P < 0.05). The mean values of Kt/V and URR were not different in patients with and without depression or anxiety. The anxiety scores were correlated with age (P = 0.007, r = -0.24) and parathyroid hormone (P = 0.04, r = -0.19). Younger age and lower parathyroid hormone were the only factors that predicted higher scores of anxiety in linear regression. The Kt/V or URR were not significantly correlated with depression and anxiety scores. Conclusions Depression and anxiety are common among hemodialysis patients. There are no statistically significant correlation between depression and anxiety and dialysis adequacy. PMID:27803725

  15. Universality of interpersonal psychotherapy (IPT) problem areas in Thai depressed patients

    PubMed Central

    2010-01-01

    Background Many studies have shown the efficacy of interpersonal psychotherapy (IPT) on depression; however, there are limited studies concerning the universality of the IPT problem areas in different countries. This study identifies whether the interpersonal problem areas defined in the IPT manual are endorsed by Thai depressed patients. Methods The Thai Hamilton Rating Scale for Depression (Thai HRSD) and Thai Interpersonal Questionnaire were used to assess 90 depressed and 90 non-depressed subjects in King Chulalongkorn Memorial Hospital, during July 2007 - January 2008. The association between interpersonal problem areas/sociodemographic variables and depressive disorder were analyzed by chi-square test. A multivariable analysis was performed by using logistic regression to identify the remaining factors associated with depressive disorder. Results Most of the subjects were young to middle-aged females living in Bangkok and the Central Provinces. All four interpersonal problem areas (grief, interpersonal role disputes, role transitions, and interpersonal deficits) were increased in the depressed subjects as compared to the non-depressed subjects, as were the sociodemographic variables (low education, unemployment, low income, and having a physical illness). Logistic regression showed that all interpersonal problem areas still remained problems associated with depression (grief: adjusted OR = 6.01, 95%CI = 1.93 - 18.69, p < 0.01; interpersonal role disputes: adjusted OR = 6.01, 95%CI = 2.18 - 16.52, p < 0.01; role transitions: adjusted OR = 26.30, 95%CI = 7.84 - 88.25, p < 0.01; and interpersonal deficits: adjusted OR = 2.92, 95%CI = 1.12 - 7.60, p < 0.05). Conclusion All four interpersonal problem areas were applicable to Thai depressed patients. PMID:20964850

  16. Investigating Factors Associated with Depression of Type 2 Diabetic Retinopathy Patients in China

    PubMed Central

    Qian, Duo; Dong, Qing; Gu, Zhifeng

    2015-01-01

    Aims and objectives To assess the depression status of type 2 diabetic retinopathy patients in Nantong China and to identify factors associated with depression. Methods Two hundred and ninety-four patients with type 2 diabetic retinopathy were recruited from the Affiliated Hospital of Nantong University. The severity of DR was measured in the worse eye. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale (CES-D); the quality of life was measured with the Medical Outcomes Study Short Form 36 (SF-36). The logistic regression analyses were used to identify the independent factors of depression. Results The mean age of the study subjects was 57.77 years (SD: 9.64). Approximately 35.7% of subjects reported depressive symptoms (n = 105).Multiple logistic regression analyses showed that female gender (p = 0.014), low monthly income (p = 0.01), poor vision in the better eye (P = 0.002), laser treatment history (p = 0.01) were significant risk factors for depression. The quality of life of individuals with CES-D score<16 was significantly better compared with individuals with CES-D score≥16. Conclusion The reported depressive symptoms among type 2 diabetic retinopathy population is higher in Nantong China. Gender, salary, vision acuity and treatment history were important risk factors linked to this disorder in the Chinese type 2 diabetic retinopathy population from Nantong. More attention by medical care personnel needs to be paid to the psychological health of this population. PMID:26151365

  17. Patient Activation through Counseling and Exercise – Acute Leukemia (PACE-AL) – a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Patients with acute leukemia experience a substantial symptom burden and are at risk of developing infections throughout the course of repeated cycles of intensive chemotherapy. Physical activity in recent years has been a strategy for rehabilitation in cancer patients to remedy disease and treatment related symptoms and side effects. To date, there are no clinical practice exercise guidelines for patients with acute leukemia undergoing induction and consolidation chemotherapy. A randomized controlled trial is needed to determine if patients with acute leukemia can benefit by a structured and supervised counseling and exercise program. Methods/design This paper presents the study protocol: Patient Activation through Counseling and Exercise – Acute Leukemia (PACE-AL) trial, a two center, randomized controlled trial of 70 patients with acute leukemia (35 patients/study arm) following induction chemotherapy in the outpatient setting. Eligible patients will be randomized to usual care or to the 12 week exercise and counseling program. The intervention includes 3 hours + 30 minutes per week of supervised and structured aerobic training (moderate to high intensity 70 - 80%) on an ergometer cycle, strength exercises using hand weights and relaxation exercise. Individual health counseling sessions include a self directed home walk program with a step counter. The primary endpoint is functional performance/exercise capacity (6 minute walk distance). The secondary endpoints are submaximal VO2 max test, sit to stand and bicep curl test, physical activity levels, patient reported outcomes (quality of life, anxiety and depression, symptom prevalence, intensity and interference). Evaluation of clinical outcomes will be explored including incidence of infection, hospitalization days, body mass index, time to recurrence and survival. Qualitative exploration of patients’ health behavior and experiences. Discussion PACE-AL will provide evidence of the effect of

  18. Brief Behavioral Activation and Problem-Solving Therapy for Depressed Breast Cancer Patients: Randomized Trial

    ERIC Educational Resources Information Center

    Hopko, Derek R.; Armento, Maria E. A.; Robertson, Sarah M. C.; Ryba, Marlena M.; Carvalho, John P.; Colman, Lindsey K.; Mullane, Christen; Gawrysiak, Michael; Bell, John L.; McNulty, James K.; Lejuez, Carl W.

    2011-01-01

    Objective: Major depression is the most common psychiatric disorder among breast cancer patients and is associated with substantial impairment. Although some research has explored the utility of psychotherapy with breast cancer patients, only 2 small trials have investigated the potential benefits of behavior therapy among patients with…

  19. Acute Time to Response in the Treatment for Adolescents with Depression Study (TADS)

    ERIC Educational Resources Information Center

    Kratochvil, Christopher; Emslie, Graham; Silva, Susan; McNulty, Steve; Walkup, John; Curry, John; Reinecke, Mark; Vitiello, Benedetto; Rohde, Paul; Feeny, Nora; Casat, Charles; Pathak, Sanjeev; Weller, Elizabeth; May, Diane; Mayes, Taryn; Robins, Michele; March, John

    2006-01-01

    Objective: To examine the time to response for both pharmacotherapy and psychotherapy in the Treatment for Adolescents with Depression Study (TADS). Method: Adolescents (N = 439, ages 12 to 17 years) with major depressive disorder were randomized to fluoxetine (FLX), cognitive-behavioral therapy (CBT), their combination (COMB), or pill placebo…

  20. Does early improvement in depressive symptoms predict subsequent remission in patients with depression who are treated with duloxetine?

    PubMed Central

    Sueki, Akitsugu; Suzuki, Eriko; Takahashi, Hitoshi; Ishigooka, Jun

    2016-01-01

    Purpose In this prospective study, we examined whether early reduction in depressive symptoms predicts later remission to duloxetine in the treatment of depression, as monitored using the Montgomery–Asberg Depression Rating Scale (MADRS). Patients and methods Among the 106 patients who were enrolled in this study, 67 were included in the statistical analysis. A clinical evaluation using the MADRS was performed at weeks 0, 4, 8, 12, and 16 after commencing treatment. For each time point, the MADRS total score was separated into three components: dysphoria, retardation, and vegetative scores. Results Remission was defined as an MADRS total score of ≤10 at end point. From our univariate logistic regression analysis, we found that improvements in both the MADRS total score and the dysphoria score at week 4 had a significant interaction with subsequent remission. Furthermore, age and sex were significant predictors of remission. There was an increase of approximately 4% in the odds of remission for each unit increase in age, and female sex had an odds of remission of 0.318 times that of male sex (remission rate for men was 73.1% [19/26] and for women 46.3% [19/41]). However, in the multivariate model using the change from baseline in the total MADRS, dysphoria, retardation, and vegetative scores at week 4, in which age and sex were included as covariates, only sex retained significance, except for an improvement in the dysphoria score. Conclusion No significant interaction was found between early response to duloxetine and eventual remission in this study. Sex difference was found to be a predictor of subsequent remission in patients with depression who were treated with duloxetine, with the male sex having greater odds of remission. PMID:27307739

  1. Depressed patients have decreased binding of tritiated imipramine to platelet serotonin ''transporter''

    SciTech Connect

    Paul, S.M.; Rehavi, M.; Skolnick, P.; Ballenger, J.C.; Goodwin, F.K.

    1981-12-01

    The high-affinity tritiated (3H) imipramine binding sites are functionally (and perhaps structurally) associated with the presynaptic neuronal and platelet uptake sites for serotonin. Since there is an excellent correlation between the relative potencies of a series of antidepressants in displacing 3H-imipramine from binding sites in human brain and platelet, we have examined the binding of 3H-imipramine to platelets from 14 depressed patients and 28 age- and sex-matched controls. A highly significant decrease in the number of 3H-imipramine binding sites, with no significant change in the apparent affinity constants, was observed in platelets from the depressed patients compared with the controls. These results, coupled with previous studies showing a significant decrease in the maximal uptake of serotonin in platelets from depressed patients, suggest that an inherited or acquired deficiency of the serotonin transport protein or proteins may be involved in the pathogenesis of depression.

  2. [The action of nitroglycerine on digitalis induced ST depression in patients with coronary disease (author's transl)].

    PubMed

    Lehmann, H U; Witt, E; Hochrein, H

    1979-04-01

    The influence of therapeutic digitalisation on ST depression due to myocardial ischemia was investigated in 11 patients, average age 53.6 years, with coronary heart disease, compared with the effectiveness of nitroglycerine. Therapeutic digitalis led to an average increase of ischaemic ST depression from -0.53 to -0.73 mV. The mean pulmonary arterial and pulmonary capillary pressure decreased slightly, the frequency of pectanginous attacks increased. Independent of the digitalis effect nitroglycerine had an opposing action on these parameters. In decompensated patients with coronary heart disease (n = 4) both digitalis and nitroglycerine produced a shift of the left ventricular function curve as an expression of improved cardiac action. This could not be observed in patients with compensated ventricular function (n = 7). In sufficient ventricular function digitalis led to a further increase of myocardial ischaemic ST depression. In ventricular insufficiency no uniform behaviour was apparent. ST depression induced by digitalis could be reversibly influenced by nitroglycerine. PMID:108065

  3. Clinical safety and efficacy of tianeptine in 1,858 depressed patients treated in general practice.

    PubMed

    Guelfi, J D; Dulcire, C; Le Moine, P; Tafani, A

    1992-01-01

    1,927 outpatients were included by 392 general practitioners in an open study in order to evaluate the safety of tianeptine in the ambulatory treatment of depression. The results of 1,858 depressed patients without melancholia and psychotic features, fulfilling DSM III criteria of Major Depressive Episode or Dysthymic Disorder, could be analysed. 1,458 patients completed the 3-month treatment period. The group treated with 37.5 mg/day of tianeptine showed improvement on the Montgomery-Asberg Depression Rating Scale. With regard to the clinical tolerance of tianeptine, somatic complaints were rarely reported and adverse events necessitating premature termination of treatment (4.8% of included patients) were without clinical severity. Cardiovascular, haematologic, hepatic and biochemical safety were verified. No signs of dependence and no specific withdrawal symptoms were found after discontinuation of treatment.

  4. Effects of nicotinic acetylcholine receptor agonists in assays of acute pain-stimulated and pain-depressed behaviors in rats.

    PubMed

    Freitas, Kelen C; Carroll, F Ivy; Negus, S Stevens

    2015-11-01

    Agonists at nicotinic acetylcholine receptors (nAChRs) constitute one drug class being evaluated as candidate analgesics. Previous preclinical studies have implicated α4β2 and α7 nAChRs as potential mediators of the antinociceptive effects of (–)-nicotine hydrogen tartrate (nicotine) and other nAChR agonists; however, these studies have relied exclusively on measures of pain-stimulated behavior, which can be defined as behaviors that increase in frequency, rate, or intensity after presentation of a noxious stimulus. Pain is also associated with depression of many behaviors, and drug effects can differ in assays of pain-stimulated versus pain-depressed behavior. Accordingly, this study compared the effects of nicotine, the selective α4/6β2 agonist 5-(123I)iodo-3-[2(S)-2-azetidinylmethoxy]pyridine (5-I-A-85380), and the selective α7 agonist N-(3R)-1-azabicyclo(2.2.2)oct-3-yl-4-chlorobenzamide in assays of pain-stimulated and pain-depressed behavior in male Sprague-Dawley rats. Intraperitoneal injection of dilute lactic acid served as an acute noxious stimulus to either stimulate a stretching response or depress the operant responding, which is maintained by electrical brain stimulation in an intracranial self-stimulation (ICSS) procedure. Nicotine produced a dose-dependent, time-dependent, and mecamylamine-reversible blockade of both acid-stimulated stretching and acid-induced depression of ICSS. 5-I-A-85380 also blocked both acid-stimulated stretching and acid-induced depression of ICSS, whereas N-(3R)-1-azabicyclo(2.2.2)oct-3-yl-4-chlorobenzamide produced no effect in either procedure. Both nicotine and 5-I-A-85380 were ≥10-fold more potent in blocking the acid-induced depression of ICSS than in blocking the acid-induced stimulation of stretching. These results suggest that stimulation of α4β2 and/or α6β2 nAChRs may be especially effective to alleviate the signs of pain-related behavioral depression in rats; however, nonselective behavioral effects

  5. Targeted Therapy in Treating Patients With Relapsed or Refractory Acute Lymphoblastic Leukemia or Acute Myelogenous Leukemia

    ClinicalTrials.gov

    2016-07-28

    Chronic Myelomonocytic Leukemia; Myelodysplastic Syndrome; Recurrent Acute Myeloid Leukemia With Myelodysplasia-Related Changes; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Refractory Adult Acute Lymphoblastic Leukemia

  6. Bupropion as an augmenting agent in patients of depression with partial response.

    PubMed

    Gulrez, Gaurav; Badyal, Dinesh Kumar; Deswal, Randhir Singh; Sharma, Arvind

    2012-03-01

    The objective of this study is to evaluate the effects of bupropion as an add-on therapy to selective serotonin reuptake inhibitor (SSRI) on patients of major depressive disorder with partial response. This prospective, randomized, controlled and single-blind study was conducted in sixty patients suffering from major depressive disorder as per Diagnostic and Statistical Manual (DSM)-IV TR criteria, who were having Hamilton depression rating scale (HDRS) score ≥16 after 4 weeks of treatment with SSRIs. Group A received SSRI plus placebo and group B received SSRI plus bupropion. Evaluation was performed based on changes in HDRS score, Montgomery and Asberg depression rating scale (MADRS), Amritsar depressive inventory (ADI) and spontaneously reported adverse effects. There was a significant decrease in the HDRS, MADRS and ADI scores as compared to baseline in both groups. However, the mean decrease in depression score was more in group B than in group A. The percentage decrease of remitters was also significantly more in group B (60% as per HDRS score and 63% as per MADRS score), as compared to group A (24% as per HDRS score and 27% as per MADRS score) (p < 0.05), at the end of treatment. In conclusion, bupropion add-on can act as augmenting agent in patients of depression with partial response to SSRIs.

  7. Acute management of poor condition subarachnoid hemorrhage patients

    PubMed Central

    Eleftherios, Archavlis; Carvi y Nievas, Mario Nazareno

    2007-01-01

    Poor condition subarachnoid hemorrhage (SAH) patients present a high mortality and morbidity. In this study, we reviewed the acute interventional (surgical and endovascular) management of 109 SAH-poor condition patients, who were treated as early as logistically possible after confirming stable circulation parameters. Patients over the age of 70 years, without clinical response to painful stimulation were excluded. We recognized at least 3 different postinterventional therapeutic approaches: (1) Norm- or hypovolemic, normotensive hemodilution in 30 patients with space-occupying intracranial hematomas as well as in 31 cases with acute cerebro-spinal-fluid obstruction. (2) Normovolemic, hypertensive hemodilution after unilateral decompressive craniotomy in 23 surgical- and 2 endovascular-treated patients with focalized space occupying lesions and reduced cerebral perfusion. (3) Hypovolemic, normo-, or hypertensive hemodilution after bilateral decompressive craniotomy in 23 cases with massive brain-swelling. We observed a reduced mortality (21%). The overall late outcome was favorable in 56% and unfavorable in 23%. Selective aggressive treatment adapted to increase the cerebral perfusion, seems to be an effective therapy to improve the survival and outcome of several poor condition SAH-patients. PMID:18200827

  8. Oral flora of elderly patients following acute medical admission.

    PubMed

    Preston, A J; Gosney, M A; Noon, S; Martin, M V

    1999-01-01

    The human oral microflora is diverse and is usually predominately composed of Gram-positive bacteria. It is uncommon to find Gram-negative bacilli (GNB) in healthy mouths. The incidence of infection with GNB rises in institutionalised, frail elderly subjects. There is also evidence of an association between intra-oral GNB presence and denture wearing. There have been few studies which have investigated intra-oral GNB carriage in acutely ill elderly patients. The aim of this study was to evaluate the oral flora of a group of elderly patients during an acute medical admission and to investigate any associations between the oral microflora and existing medical or oral factors. A total of 28 patients (17 females and 11 males; age: 74-93 years) on a care for the elderly ward were studied. Epidemiological data, detailed medical histories and oral examinations were undertaken. In addition, oral swabs of the palate area were taken to determine their oral flora. Twelve (43%) of the patients had GNB in their oral cavities. These patients were suffering from a variety of medical conditions and were on various drug regimes. There was a correlation between oral GNB presence and denture use. There was no association between GNB presence and denture hygiene. As oropharyngeal GNB colonisation can be associated with infections such as aspiration pneumonia, it is important in patients at risk that intra-oral organisms are identified and managed.

  9. Approach to the Patient with the Acute Respiratory Distress Syndrome

    PubMed Central

    Janz, David R; Ware, Lorraine B

    2014-01-01

    Given the high incidence and mortality of ARDS in critically ill patients, every practitioner needs a bedside approach both for early identification of patients at risk for ARDS and for the appropriate evaluation of patients who meet the diagnostic criteria of ARDS. Recent advances such as the Lung Injury Prediction Score, the Early Acute Lung Injury score, and validation of the SpO2/FiO2 ratio for assessing the degree of hypoxemia are all practical tools to aid the practitioner in caring for patients at risk of ARDS and will likely become more important in the future as more preventative therapies for ARDS are investigated. For patients who meet the diagnostic criteria for ARDS, the practitioner should focus on a thorough search for an underlying cause as well as the concurrent possibility of an underlying disease process that mimics the clinical syndrome of ARDS. PMID:25453418

  10. Nitric Oxide-Related Biological Pathways in Patients with Major Depression

    PubMed Central

    Baranyi, Andreas; Amouzadeh-Ghadikolai, Omid; Rothenhäusler, Hans-Bernd; Theokas, Simon; Robier, Christoph; Baranyi, Maria; Koppitz, Michael; Reicht, Gerhard; Hlade, Peter; Meinitzer, Andreas

    2015-01-01

    Background Major depression is a well-known risk factor for cardiovascular diseases and increased mortality following myocardial infarction. However, biomarkers of depression and increased cardiovascular risk are still missing. The aim of this prospective study was to evaluate, whether nitric-oxide (NO) related factors for endothelial dysfunction, such as global arginine bioavailability, arginase activity, L-arginine/ADMA ratio and the arginine metabolites asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) might be biomarkers for depression-induced cardiovascular risk. Methods In 71 in-patients with major depression and 48 healthy controls the Global Arginine Bioavailability Ratio (GABR), arginase activity (arginine/ornithine ratio), the L-arginine/ADMA ratio, ADMA, and SDMA were determined by high-pressure liquid chromatography. Psychiatric and laboratory assessments were obtained at baseline at the time of in-patient admittance and at the time of hospital discharge. Results The ADMA concentrations in patients with major depression were significantly elevated and the SDMA concentrations were significantly decreased in comparison with the healthy controls. Even after a first improvement of depression, ADMA and SDMA levels remained nearly unchanged. In addition, after a first improvement of depression at the time of hospital discharge, a significant decrease in arginase activity, an increased L-arginine/ADMA ratio and a trend for increased global arginine bioavailability were observed. Conclusions Our study results are evidence that in patients with major depression ADMA and SDMA might be biomarkers to indicate an increased cardiovascular threat due to depression-triggered NO reduction. GABR, the L-arginine/ADMA ratio and arginase activity might be indicators of therapy success and increased NO production after remission. PMID:26581044

  11. Cardiac computed tomography in patients with acute chest pain.

    PubMed

    Nieman, Koen; Hoffmann, Udo

    2015-04-14

    The efficient and reliable evaluation of patients with acute chest pain is one of the most challenging tasks in the emergency department. Coronary computed tomography (CT) angiography may play a major role, since it permits ruling out coronary artery disease with high accuracy if performed with expertise in properly selected and prepared patients. Several randomized trials have established early cardiac CT as a viable safe and potentially more efficient alternative to functional testing in the evaluation of acute chest pain. Ongoing investigations explore whether advanced anatomic and functional assessments such as high-risk coronary plaque, resting myocardial perfusion, and left ventricular function, or the simulation of the fractional coronary flow reserve will add information to the anatomic assessment for stenosis, which would allow expanding the benefits of cardiac CT from triage to treatment decisions. Especially, the combination of high-sensitive troponins and coronary computed tomography angiography may play a valuable role in future strategies for the management of patients presenting with acute chest pain.

  12. Use of Coaxil (tianeptine) in elderly patients with combined mild cognitive and depressive-anxiety disorders.

    PubMed

    Karpukhin, I B

    2009-01-01

    The studies reported here addressed 20 patients aged 60-69 years whose clinical picture combined the manifestations of mild dementia with those of mild depression and anxiety. Patients were treated with Coaxil (tianeptine) for 60 days at a dose of 37.5 mg/day. Patients were assessed by clinical-psychological investigations with addition of the Hamilton scales and neuropsychological testing by the Luriya method. Coaxil was found to be highly effective in relation to all psychopathological components. Recommendations for the use of Coaxil in elderly patients with cognitive and depressive-anxiety disorders are formulated.

  13. Hepatic encephalopathy in patients with acute decompensation of cirrhosis and acute-on-chronic liver failure.

    PubMed

    Romero-Gómez, Manuel; Montagnese, Sara; Jalan, Rajiv

    2015-02-01

    Hepatic encephalopathy in a hospitalized cirrhotic patient is associated with a high mortality rate and its presence adds further to the mortality of patients with acute-on-chronic liver failure (ACLF). The exact pathophysiological mechanisms of HE in this group of patients are unclear but hyperammonemia, systemic inflammation (including sepsis, bacterial translocation, and insulin resistance) and oxidative stress, modulated by glutaminase gene alteration, remain as key factors. Moreover, alcohol misuse, hyponatremia, renal insufficiency, and microbiota are actively explored. HE diagnosis requires exclusion of other causes of neurological, metabolic and psychiatric dysfunction. Hospitalization in the ICU should be considered in every patient with overt HE, but particularly if this is associated with ACLF. Precipitating factors should be identified and treated as required. Evidence-based specific management options are limited to bowel cleansing and non-absorbable antibiotics. Ammonia lowering drugs, such as glycerol phenylbutyrate and ornithine phenylacetate show promise but are still in clinical trials. Albumin dialysis may be useful in refractory cases. Antibiotics, prebiotics, and treatment of diabetes reduce systemic inflammation. Where possible and not contraindicated, large portal-systemic shunts may be embolized but liver transplantation is the most definitive step in the management of HE in this setting. HE in patients with ACLF appears to be clinically and pathophysiologically distinct from that of acute decompensation and requires further studies and characterization.

  14. Antidepressants in the treatment of depression/depressive symptoms in cancer patients: a systematic review and meta-analysis

    PubMed Central

    2013-01-01

    Background Over the past thirty years a number of studies have suggested that antidepressants can be effective in the treatment of depressive symptoms in patients with cancer. The aim of this paper was to review randomized controlled trials (RCTs) and to perform a meta-analysis in order to quantify their overall effect. Methods Pubmed and the Cochrane libraries were searched for the time period between 1980 and 2010. Results Nine RCTs were identified and reviewed. Six of them (with a total of 563 patients) fulfilled the criteria for meta-analysis, but exhibited an unclear risk for bias. The estimated effect size was 1.56 with 95% CI: 1.07- 2.28 (p= 0.021). There were no differences in discontinuation rates between antidepressants and placebo groups (RR= 0.86 with 95% CI 0.47- 1.56, p=0.62). Conclusions This meta-analysis suggests that antidepressants can be effective in treating depressive symptoms beside clinical depression. When considering the risk of side effects and interactions and the heterogeneity among the mostly small studies, a general recommendation cannot be made until well-controlled studies are conducted. PMID:23679841

  15. IDS-C and IDS-sr: psychometric properties in depressed in-patients.

    PubMed

    Corruble, E; Legrand, J M; Duret, C; Charles, G; Guelfi, J D

    1999-12-01

    Sixty-eight depressed in-patients were assessed at admission (DO), and after 5 days (D5), ten days (D10) and 28 days (D28) of antidepressant treatment, with the Inventory for Depressive Symptomatology-Clinician (IDS-C) and the Inventory for Depressive Symptomatology-Self-Rated (IDS-SR) (Rush et al., 1986), the Montgomery and Asberg Depression Rating Scale (MADRS) (Montgomery and Asberg, 1979) and the depression factor of the Symptom Check List (SCL-90R) (Derogatis, 1977), in order to assess IDS-C and IDS-SR psychometric properties in depressed in-patients and to compare IDS-C to MADRS and IDS-SR to the SCL-90R depression factor. Most of the IDS-C and IDS-SR items were significantly correlated to the final score and the Cronbach alpha coefficients were high (0.75 for the IDS-C and 0.79 for the IDS-SR). Principal Component Analyses (PCA) showed three factors for both IDS-C and IDS-SR: 'depression', 'anxiety/arousal' and 'sleep/appetite'. These results suggest satisfactory internal consistency of IDS-C and IDS-SR. Concurrent validity of the IDS-C with the MADRS was high (r = 0.81), as well as concurrent validity of the IDS-SR with the SCL-90R depression factor (r = 0.84). Concerning sensitivity to change, the four scales were able to discriminate between different levels of severity of depression. Moreover, considering paired t-tests on score changes, IDS-C sensitivity to change may be higher than MADRS sensitivity to change, this phenomenon being related to the number of items and degrees but not to the item contents. Contrary to IDS-C and MADRS, IDS-SR and SCL-90R depression factor were not different in terms of sensitivity to change. Finally, psychometric properties of IDS-C and IDS-SR in depressed in-patients are satisfactory and close to those obtained in depressed out-patients. The high sensitivity to change of the IDS-C may be an advantage for this scale as compared to the MADRS, especially in antidepressant drug trials.

  16. Health Related Quality of Life, Depression, Anxiety and Stress in Patients with Beta-Thalassemia Major

    PubMed Central

    Adib-Hajbaghery, M; Ahmadi, M; S, Poormansouri

    2015-01-01

    Background Awareness of factors associated with quality of life (QOL) in patients with beta-Thalassemia major (β-TM) is necessary to develop clinical programs in order to improve social support and QOL in β-TM patients. This study aimed to examine QoL, depression, anxiety, and stress in β-TM patients in Ahvaz, Iran. Materials and Methods A cross-sectional study was conducted on173 β-TM patients aged ≥12 years (12-18=55, ≥19=118). Subjects were selected using a census method. Data collection instrument consisted of three parts including: demographic questions, SF-36 questionnaire and depression, anxiety, and stress scale (DAS-21). Results The participants obtained a mean score of 64.38±18.20 for QOL, 6.4±5.1 for depression, 4.8±3.9 for anxiety, and 7.3±4.9 for stress. Significant relationship was found between QOL and employment (P=0.02) and education level (P<0.001). Patients in the age group of 12-18 years old had higher mean scores in the majority of QoL dimensions than those aged ≤19. The mean scores of depression, anxiety, and stress were higher in patients aged ≤19. No significant correlation was observed between QOL and depression, anxiety, stress scores, and other demographic variables. Moreover, a significant inverse correlation was found between QOL and depression (P<0.001,r= -0.62), anxiety (P<0.001,r= -0.55), and stress scores (P<0.001, r= -0.5) . Conclusion This study showed that β-TM patients experienced a considerable decrease both in their overall QoL and in its dimensions. A majority of the β-TM patients were also suffered from mild to severe depression, anxiety, and stress. PMID:26985352

  17. [Geriatric Depression Scale as auxiliary diagnostic tool used in patients 55 years and older].

    PubMed

    Bidzan, Leszek; Łapin, Joanna; Sołtys, Krzysztof; Turczyński, Jacek

    2002-01-01

    The purpose of this study was to examine the Geriatric Depression Scale translated into Polish for its sensitivity and specificity in relation to obligatory criterions ICD-10. 208 at random select patients from Psychiatry Department and Psychiatry Clinic were included into study. Diagnosis was based on ICD 10 criteria. Geriatric Depression Scale were used in full version containing 30 of questions directed to examined (self-rating). Each questions was read to examined persons. At last 185 persons were included to statistical analysis's. Sensitivity and specificity obtained for critical value equal or higher from 11 points, were 81% and 47% Geriatric Depression Scale is useful tool in initial diagnosis of depression in older people. However one should be clearly to underline, that investigation with Geriatric Depression Scale should start diagnostic process, never while to take place full psychiatric investigations. PMID:12647438

  18. Limitations of the Patient Health Questionnaire in Identifying Anxiety and Depression: Many Cases Are Undetected

    PubMed Central

    Eack, Shaun M.; Greeno, Catherine G.; Lee, Bong-Jae

    2013-01-01

    Objective To determine the concordance between the Structured Clinical Interview for DSM-IV (SCID) and the Patient Health Questionnaire (PHQ) in diagnosing anxiety and depressive disorders. Method Fifty women seeking psychiatric services for their children at two mental health centers in Western Pennsylvania were assessed for anxiety and depressive disorders using the SCID and the PHQ. Results Twenty-five women met SCID criteria for at least one anxiety disorder, 11 (44%) of whom the PHQ failed to identify. The PHQ was particularly limited in identifying individuals with anxiety disorders other than panic disorder. Seventeen women met SCID criteria for at least one major depressive disorder, 6 (35%) of whom the PHQ failed to identify. The PHQ was particularly limited in identifying depressed individuals with dysthymia. Conclusions Caution should be used when screening for anxiety and depression with the PHQ. Implications for improving diagnostic accuracy in social work practice are discussed. PMID:24465121

  19. Cognitive and Behavioral Treatments for Anxiety and Depression in a Patient with an Implantable Cardioverter Defibrillator (ICD): A Case Report and Clinical Discussion

    PubMed Central

    Sears, Samuel F.; Conti, Jamie B.

    2011-01-01

    Implantable cardioverter-defibrillators (ICDs) are the treatment of choice for patients at risk for potentially life threatening arrhythmias. The associated stress of living with an implanted device and receiving ICD shock therapy has been noted to exert a psychological toll on the individual patient and family. Anxious and depressive symptomatology is frequently reported by these patients, thus creating a demand for tailored psychological interventions for this population. The current case report describes the components, delivery, and effectiveness of a targeted treatment approach for anxiety and depression in an individual with an ICD. Test results and interview data revealed significant improvements in multiple domains of cognitive, emotional, and behavioral functioning. Improvements in marital relations were also achieved. These treatment effects were maintained at follow-up and in the context of acute, medical stressors. Future clinical and research directions are also discussed. PMID:19404725

  20. Salivary alpha-amylase and cortisol responsiveness following electrical stimulation stress in major depressive disorder patients.

    PubMed

    Tanaka, Yoshihiro; Ishitobi, Yoshinobu; Maruyama, Yoshihiro; Kawano, Aimi; Ando, Tomoko; Okamoto, Shizuko; Kanehisa, Masayuki; Higuma, Haruka; Ninomiya, Taiga; Tsuru, Jusen; Hanada, Hiroaki; Kodama, Kensuke; Isogawa, Koichi; Akiyoshi, Jotaro

    2012-03-30

    Major depressive disorder (MDD) is often associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis by chronic stress. In comparison, psychosocial stress-induced activation of salivary α-amylase (sAA) functions as a marker of sympathoadrenal medullary system (SAM) activity. However, in contrast to salivary cortisol, sAA has been less extensively studied in MDD patients. The present study measured sAA and salivary cortisol levels in patients with MDD. The authors determined Profile of Mood State (POMS) and State-Trait anxiety Inventory (STAI) scores, Heart Rate Variability (HRV), and sAA and salivary cortisol levels in 88 patients with MDD and 41 healthy volunteers following the application of electrical stimulation stress. Patients with major depressive disorder were 8 points or more on Hamilton Depression Scale (HAM-D) scores. Tension-Anxiety, Depression-Dejection, Anger-Hostility, Fatigue, and Confusion scores in patients with major depressive disorder were significantly increased compared to healthy controls. In contrast, Vigor scores in patients with MDD were significantly decreased compared with healthy controls. There was no difference in heart rate variability measures between MDD patients and healthy controls. The threshold of electrical stimulation applied in MDD patients was lower than that in healthy controls. SAA levels in female MDD patients were significantly elevated relative to controls both before and after electrical stimulation. Finally, there were no differences in salivary cortisol levels between major depressive patients and controls. In the present study only three time points were explored. Furthermore, the increased secretion of sAA before and after stimulation could allude to an increased responsiveness of novel and uncontrollable situations in patients with MDD. These preliminary results suggest that sAA might be a useful biological marker of MDD. PMID:22063648

  1. Acute single dose of ketamine relieves mechanical allodynia and consequent depression-like behaviors in a rat model.

    PubMed

    Zhang, Guang-Fen; Wang, Jing; Han, Jin-Feng; Guo, Jie; Xie, Ze-Min; Pan, Wei; Yang, Jian-Jun; Sun, Kang-Jian

    2016-09-19

    Both chronic pain and depression are debilitating diseases, which often coexist in clinic. However, current analgesics and antidepressants exhibit limited efficacy for this comorbidity. The present study aimed to investigate the effect of ketamine on the comorbidity of inflammatory pain and consequent depression-like behaviors in a rat model established by intraplantar administration of complete Freunds adjuvant (CFA). The mechanical withdrawal threshold, thermal withdrawal latency, open field test, forced swimming test, and sucrose preference test were evaluated after the CFA injection and ketamine treatment. The hippocampus was harvested to determine the levels of interleukin (IL)-6, IL-1β, indoleamine 2,3-dioxygenase (IDO), kynurenine (KYN), 5-hydroxytryptamine (5-HT), and tryptophan (TRP). The inflammatory pain-induced depression-like behaviors presented on 7days and lasted to at least 14days after the CFA injection. Single dose of ketamine at 20mg/kg relieved both the mechanical allodynia and the associated depression-like behaviors as demonstrated by the attenuated mechanical withdrawal threshold, reduced immobility time in the forced swim test, and increased sucrose preference after ketamine treatment. The total distance had no significant change after the CFA injection or ketamine treatment in the open field test. Simultaneously, ketamine reduced the levels of IL-6, IL-1β, IDO, and KYN/TRP ratio and increased the 5-HT/TRP ratio in the hippocampus. In conclusion, acute single dose of ketamine can rapidly attenuate mechanical allodynia and consequent depression-like behaviors and down-regulate hippocampal proinflammatory responses and IDO/KYN signal pathway in rats. PMID:27497920

  2. Outcome of patients admitted to an acute geriatric medical unit

    PubMed Central

    Devine, M J; McAleer, J J A; Gallagher, P M; Beirne, J A; McElroy, J G

    1986-01-01

    To find out what happens to patients admitted to an acute geriatric medical unit, all admissions during 1982 were reviewed. Demographic features were compared with those of the community served, and rehabilitation, inpatient mortality and mortality in the year following discharge were assessed. Inpatients accounted for 4% of the community aged over 65, and most patients were discharged back to the community. Inpatient mortality was 25% and mortality in the year following discharge was 23%, giving a two year mortality of 42%, which was similar in all age groups. The achievement of high rehabilitation rates was tempered by the considerable mortality rates following discharge. PMID:3739060

  3. [Disseminated papules in a patient with acute myeloid leukemia].

    PubMed

    Ceric-Dehdari, P; Houcinat, Y; Berger, T G

    2010-11-01

    Cryptococcosis most commonly occurs in immunosuppressed patients. The pathogen is the yeast Cryptococcus neoformans. This article reports on the case of a 20-year-old female patient with acute myeloid leukemia who suddenly developed disseminated livid red papules and papulovesicles. The clinical picture and in particular the histopathology findings led to the diagnosis of cutaneous cryptococcosis, which was successfully treated with amphotericin B. For the differential diagnosis generalized herpes zoster, erythema exudativum multiforme and disseminated molluscum contagiosum must be considered. To confirm the diagnosis attempts can also be made to culture the pathogen from skin biopsy preparations. Furthermore, fungal spores can be rapidly and simply detected with the Tzanck test. PMID:20927503

  4. [Nursing diagnosis in adult patients with acute myeloid leukemia].

    PubMed

    de Souza, Luccas Melo; Gorini, Maria Isabel Pinto Coelho

    2006-09-01

    This case study aimed at identifying Nursing Diagnosis (ND) in adult patients with Acute Myeloid Leukemia, with the purpose of contributing to the Systematization of Nurse Care. Interviews and observation were used for data collection, in addition to Nursing Process application. During the three months of data collection, other NDs were obtained by searching the files of the 6 patients. The 32 ND found in this study were grouped according to Maslow's hierarchy of needs. Out of these 32 ND, 15 corresponded to changes in Physiological Needs, and 10 to changes in Protection and Safety Needs.

  5. Decitabine and Bortezomib in Treating Patients With Acute Myeloid Leukemia

    ClinicalTrials.gov

    2014-11-06

    Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Recurrent Adult Acute Myeloid Leukemia; Secondary Acute Myeloid Leukemia; Untreated Adult Acute Myeloid Leukemia

  6. Decitabine in Treating Patients With Previously Untreated Acute Myeloid Leukemia

    ClinicalTrials.gov

    2016-05-18

    Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Secondary Acute Myeloid Leukemia; Untreated Adult Acute Myeloid Leukemia

  7. Gemtuzumab Ozogamicin in Treating Patients With Acute Myeloid Leukemia

    ClinicalTrials.gov

    2013-09-23

    Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Adult Acute Promyelocytic Leukemia (M3); Recurrent Adult Acute Myeloid Leukemia

  8. Comparison of the effectiveness of duloxetine in depressed patients with and without a family history of affective disorders in first-degree relatives

    PubMed Central

    WANG, Shiliang; QIAN, Mincai; ZHONG, Hua; SONG, Guohua; LU, Meijuan; FENG, Rui; ZHANG, Lei; NI, Jianliang; CHEN, Wei

    2015-01-01

    Background It remains unclear whether or not a positive family history of affective disorders predicts the effectiveness of antidepressant treatment of depression. Aims Assess the relationship of a family history of affective disorders to the efficacy of duloxetine in the treatment of depressive disorder. Methods Seventy-seven patients with depressive disorder (as defined by the 10th edition of the International Classification of Diseases, ICD-10) were enrolled in the study and treated with standard doses of duloxetine for 12 weeks. Among these patients<