Showing papers on "Depression (differential diagnoses) published in 1979"

Myocardial ischemia during non-cardiac surgical procedures in patients with coronary-artery disease.

Abstract: The purpose of this study was to determine the incidence of ST-segment depression during anesthesia and operation. Graded exercise testing has demonstrated a high correlation between ST-segment depression and myocardial ischemia. Therefore, 11 patients without and 29 patients with known coronary-artery disease were monitored during surgical procedures with a commercially available exercise electrocardiographic monitor (Viagraph). Comparisons were made between this device, which monitored lead V5, and the standard operating room monitor, which monitored lead 11. Eleven of 29 patients in the disease group demonstrated significant ST depression. Nine of the 11 ischemic episodes were not recognized on the standard operating room monitor. Retrospective review of anesthetic records of those 11 patients with ST-segment depression revealed rate--pressure product values greater than 11,000 for ten of them. Postoperatively, three of the 11 patients with significant ST-segment depression had changing electrocardiograms compatible with ischemia. None of the control group demonstrated significant ST-segment depression. The incidence of ischemia was 38 per cent during anesthesia and operation in the coronary-artery-disease group. Lead V5 analysis is superior to lead 11 analysis in detecting ST-segment depression. The period in which intubation is performed is one of the highest-risk intervals during anesthesia and operation, particularly when it is associated with an increased rate--pressure product.

Development of psychiatric illness in drug abusers. Possible role of drug preference.

Abstract: The origin of the psychiatric illnesses observed in drug abusers is often unclear. This study examines the causal relation between drug abuse and specific psychiatric disorders. Fifty-one male veterans first seen in 1972, who were admitted at least once per year for six consecutive years for inpatient drug-abuse treatment, underwent psychiatric assessments at each admission. Eleven men mainly used stimulants, 14 depressants, and 26 opiates. Initial psychiatric examinations showed low symptom levels in all groups but no statistically significant differences among them. By the end of six years, five of the stimulant users had psychoses, and eight of the depressant users had serious depression. The narcotics users showed no change in psychopathology. Differences between the groups were significant at the 0.01 level. These changes were not due to acute toxic reactions, but our data suggest that abuse of particular drugs has a major role in the development of specific psychiatric illnesses. The possibility that different preexisting personality disorders lead to different kinds of drug abuse cannot be excluded.

Depression treated with imipramine and ECT: the DeCarolis study reconsidered.

Abstract: The authors reevaluate a large prospective Italian study (437 patients) that compared high-dose imipramine with ECT treatment in the treatment of depression. The superiority of ECT was evident among patients with endogenous depression, and especially evident among those with delusional depression (83% improved with ECT versus 40% with imipramine) and depressions defined as severe (83% versus 35%).

The effectiveness of tricyclic antidepressants in the treatment of coexisting pain and depression

Abstract: A group of moderately to severely depressed individuals with moderate anxiety were studied to determine the frequency and nature of pain complaints and their response to doxepin. It was discovered that 100% of these subjects had chronic pain complaints, most of which paralleled the course of depression. Headache was most commonly noted. Doxepin's analgesic effects were intimately associated with its antidepressant effects. There was a highly significant relationship between improvement of depression and reduction of pain on doxepin (P

Psychiatric manifestations of Cushing's syndrome: response to lowering of plasma cortisol.

Abstract: The incidence of psychiatric abnormalities has been assessed in 38 patients with Cushing's syndrome and two with alcohol-induced pseudo-Cushing's syndrome. Twenty-six patients were examined by one of us using a standardized psychiatric interview, and this group included all those with severe to moderate psychiatric disorders. Depression was the commonest symptom: five patients (13%) were markedly or severely depressed, four (10%) were moderately depressed and 13 (32%) were mildly depressed. Four patients exhibited other, non-depressive psychiatric symptoms and only 14 (35%) were judged free from psychiatric abnormality. The first line of treatment was to reduce the circulating cortisol level either by adrenalectomy or by treatment with oral metyrapone; both patients with alcohol-induced pseudo-Cushing's syndrome were treated by alcohol withdrawal. Once the plasma cortisol level was successfully controlled, depressive symptoms were relieved in all five patients with marked or severe depression and in three of the four who were moderately depressed. Mild depressive symptoms were relieved in six of the 13 affected. It is concluded that metyrapone may be of considerable value in the management of the acute psychiatric states which may occur in Cushing's syndrome and these findings are discussed in the light of their possible pathogenesis.

Studies on the measurement of unpleasant events and relations with depression

Abstract: The goal was to construct a psychometrically sound instrument for the measurement of aversive events. Hypotheses about the occurrence of aversive events and depression were also tested. The Un plea...

Unipolar depression: is it divisible into autonomous subtypes?

Abstract: • Depression spectrum disease has been defined as an illness in which a first-degree family member has alcoholism and/or antisocial personality. Pure depressive disease may be considered as the remainder of the depressive illnesses or more rigorously as depression in a person who has a family history of depression but no alcoholism. Evidence is presented that the course of the illness is different in the two groups. Depression spectrum disease is more variable, with more personality problems and interpersonal conflict. Preliminary data indicate that depression spectrum disease may be linked to such genetic markers as C3 or α-haptoglobin.

Are all recently detoxified alcoholics depressed

Abstract: Reports of the prevalence of depression among alcoholics vary from 3% to 98%; the authors attribute this variation to the use of different diagnostic criteria. They used clinical diagnosis, the Hamilton Depression Rating Scale, the Zung Self-Rating Depression Scale, and the MMPI to diagnose 35 men recently withdrawn from alcohol. The percentages of depression diagnosed were 8.6%, 28%, 66%, and 43%, respectively. The authors point out that the Hamilton, Zung, and MMPI scales are not diagnostic of depression in themselves and that accurate diagnosis of depression in alcoholics will reduce inappropriate treatment of nondepressed alcoholics and ensure careful treatment of the truly depressed.

Central Serotonin Metabolism and Frequency of Depression

Abstract: Central serotonin (5-hydroxytryptamine; 5-HT) metabolism can be disturbed in a subgroup of patients with vital (endogenous, primary) depression. Presumably these disturbances do not result from the depression and have a predisposing rather than a causative relationship to it. This latter statement is based on two observations. First, in a majority of patients, the 5-HT disturbances persist after depression has abated. Secondly, 5-hydroxytryptophan seems to have prophylactic value, in particular in patients with persistent abnormalities in central 5-HT metabolism. In this study we approached the hypothesis that 5-HT disturbances are a predisposing factor to the occurence of depression from still another perspective. If this hypothesis is correct, then depressive patients with persistent 5-HT disturbances should have higher frequencies of depression than depressive patients without demonstrable 5-HT disturbances. This was indeed demonstrated. The same was true for family members of probands with low levels of 5-hydroxyindoleacetic acid. No cerebrospinal fluid data are available for family members. The reported findings strongly support the predisposition hypothesis.

Influence of Demographic Characteristics on Two Measures of Depressive Symptoms: The Relation of Prevalence and Persistence of Symptoms With Sex, Age, Education, and Marital Status

Abstract: • Respondents from community and inpatient populations were asked to recall for the preceding week the prevalence (presence of symptom at any time) and persistence (presence of symptom for five to seven days) of 16 symptoms associated with depression. The rates were adjusted for four-variable combinations of sex, age, education, marital status, and clinical status. For the majority of symptoms, statistically significant associations were found between prevalence and sex, age, and marital status and between persistence and education. These results suggest that white women, young adults, and those not currently married have a higher prevalence of transient depressed affect than those in the other categories of each variable, while the less well-educated are at greater risk than those in other education categories of having the depressive syndrome requiring therapeutic intervention.

Zimelidine: a therapeutic and pharmacokinetic study in depression.

Abstract: Zimelidine, a bicyclic compound with a strong effect on the neuronal reuptake of 5-hydroxytryptamine and with weak anticholinergic actions, was evaluated for its antidepressant efficacy in a double-blind comparative trial with amitriptyline. In doses of 200 mg a day it was found to be as effective as 150 mg amitriptyline, but with significantly less subjective side-effects. The plasma concentration of zimelidine and its metabolite, norzimelidine, showed no significant correlation with therapeutic outcome.

Mortality in Middle-Aged Smokers and Nonsmokers

Abstract: We assessed the relation of cigarette smoking to mortality in an 11-year follow-up study of 4004 men and women, 35 to 54 years of age, who responded to urging to have multiphasic health checkups. Accounting for 48 other characteristics, both individually and in combination, failed to eliminate the association of smoking with mortality from all causes or with mortality from coronary heart disease. The smoker-to-nonsmoker mortality ratios, crude and adjusted respectively, were 2.6 and 2.1 for all causes and 4.7 and 3.6 for coronary heart disease. This analysis did not support the counterhypothesis that the association of cigarette smoking with mortality is secondary to some underlying characteristic.

Psychiatric Adolescent Inpatients: Eight- to Ten-Year Follow-up

Abstract: • Seventy-seven adolescent psychiatric inpatients, whose index hospitalization was at a mean age of 16, were followed up for eight to ten years after discharge. The important findings at follow-up were as follows. Twelve patients had bipolar affective disorder and were severely disabled (of these, 11 had a longterm clinical course and three committed suicide). Sixteen patients had unipolar depression: five had one depressive episode and were well throughout the follow-up period, one patient had many episodes with complete remissions, and the remaining ten patients had only partial remissions and their impairment of functioning corresponded to the severity of their symptoms. One of the ten committed suicide. Eighteen (23%) patients were psychiatrically well and functioned adequately throughout the follow-up period. Five had primary depressions, five had undiagnosed psychiatric illness, and eight were diagnosed as not having a psychiatric disorder.

Electroencephalographic Findings in Children With Moyamoya Disease

Abstract: • The EEG findings in 25 children with moyamoya disease were studied. Characteristic findings such as posterior slow, centrotemporal slow (CT slow), "rebuildup" after the end of hyperventilation, and sleep spindle depression were observed. Posterior slow activity was mainly observed in the EEGs examined within a short period (mean, 10 months) after onset, CT slow activity after a longer period (mean, 28 months), and a diffuse low-voltage pattern after these periods (mean, 56 months). Buildup after the end of hyperventilation, which we refer to as "rebuildup," was discovered in more than half of the cases.

Sleep, depression and antidepressants.

Abstract: Normal Sleep Patterns (1) Two kinds ojsleep It is generally recognised that there are two qualitatively different kinds of sleep which alternate throughout the night in normal healthy individuals. These are the non-rapid eye-movement (NREM) sleep or orthodox sleep and the rapid-eye-movement (REM) sleep or paradoxical sleep. By means of electro encephalography (EEG), electrooculography (EOG) and electromyography (EMG), different stages of sleep have been defined according to a standardized scoring system (Rechtschaffen and Kales, 1968). NREM sleep is further classified into stages 1, 2, 3 and 4, which show a graded decrease in autonomic activities and an increase in depth of sleep. Stage 4 sleep is therefore the deepest stage and together with stage 3 is often referred to collectively as slow-wave sleep (SWS). Characteristically the first appearance of SWS after the onset of sleep nearly always coincides with a surge of growth hormone level in the blood. On the other hand, REM sleep is characterized by bursts of rapid eye movements (or REM activity), abolition of tone in many skeletal muscles, heightened but variable autonomic activities, and a low-voltage mixed frequency EEG pattern resembling that of stage 1 sleep. In animals, spike discharges can be recorded in the regions of pons, lateral geniculate nucleus and occipital cortex (PGO spikes) just pre ceding or during REM sleep. When a subject is awakened from REM sleep, he often reports dreams charged with emotions, in contrast to reports of mental activity obtained from most NREM awakenings which have the quality of thoughts. Under normal circumstances adult indivi duals sleep from 7 to 8 hours each night, 20—25 per cent of which will be spent in REM sleep. A normal night's sleep usually begins with NREM sleep, from light to deep stages, which is interrupted about every 90 minutes by a period of REM sleep. Thus NREM—REM sleep cycles alternate throughout the night, and there are 4—6such sleep cycles each night. In general, NREM sleep tends to predominate in the beginning of the night, whilst the REM sleep period becomes more prolonged as the night progresses.

Psychic and somatic symptoms of depression among young adults, institutionalized aged and noninstitutionalized aged

Abstract: Beck Depression Inventory scores were obtained from 48 elderly who had been residing in homes for the aged for more than one year, 31 elderly residing in the community and waiting to enter an old-age home, and 424 young adults enrolled in a fist-year psychology course. The residents of old-age homes reported no more symptoms of depression than the waiting-list controls, a finding that provides no support for the hypothesis that the institional nature of old-age homes increases depression in the elderly. Both the institutionalized and noninstitutionalized aged reported more somatic symptoms of depression than the young adults, but no greater cognitive or affective symptoms of depression. These results were interpreted as providing no support for the widely belief that the aged are more depressed than any other age group. Finally, it was argued that somatic complaints can be valid indicators of depression in the elderly if normative differences between young and old are taken into account.

The prevalence and clinical presentation of psychiatric illness in a rural setting in Kenya.

Abstract: One hundred and forty patients seen in a suburban walk-in walk-out clinic over a period of 30 days were studied. Twenty-eight (20 per cent) of them were found to be primarily psychiatrically disabled, 83 (59.3 per cent) primarily physically disabled and the diagnosis of the rest (20.7 per cent) was uncertain. The psychiatric patients were found to be suffering from anxiety and depressive states. Their sex, age, education, economic status, symptomatology and duration of the illness were analysed. The findings suggest among other things that the prevalence of psychiatric disorders in the rural setting in Kenya is high and therefore calls for a proportionate provision of mental health care facilities. They also suggest that anxiety and depression in African patients are masked by somatic symptoms, often leading to unnecessary delays in diagnosis and management.

Depression and cancer: a follow-up study.

Abstract: Thirty-nine male and 90 female patients aged 40 and over, who had been given a primary diagnosis of depression, were followed up for 2 1/3-4 years. During this period 9 male and 9 female patients died. Five male patients and 1 female died from cancer that had not been diagnosed at the time of their psychiatric admissions. The male cancer deaths are significantly higher than expected. The possible relationships of malignant neoplasm to affective disorder are discussed.

Depression of cerebral oxygen utilization by hypercapnia in the rhesus monkey

Abstract: PATTERSON et ul.. 1955; POSNEK & PLUM, 1960; C O H E ~ et nl., 1964; SHAPIKO et a/., 1966) and animals (METZGER et o/., 1971, EKLOF et al., 1973; GlEDDE et a/.> 1975; NILSSON et ul., 1976; GREGOIRE et uf., 1978) have failed to conclusively demonstrate an effect of hypercapnia on the cerebral metabolic rate for oxygen (CMRO,). In 1975, however, KOGURE rf ul. (1975), using Lowry’s closed system technique (LOWRY, 1964), rcportcd that moderate hypercapnia decreased overall cerebral energy use in adult rats by 17%, suggesting, despite carlier data to thc contrary, a rcduction in oxidative phosphorylation as well as glycolysis. This work has recently been extended by the study of DESROSIERS el ul. (1978), also in adult rats. which reported a reduction in both the CMRO, and the cerebral metabolic rate for glucose (CMRGlu) in adult rats with moderate hypercapnia. During recent studies in adult rhesus monkeys (Mucucu rnulurtrr). we observed a reversible reduction in CMROz produced by an acute increase in PaCO,. We now report Lhese data because they provide the first direct evidence of a depressant effect of CO, on brain oxidative metabolism in a primate species. Ten adult rhesus monkeys were used for these studies. For the measurement of CBF and CMRO, the monkeys received a single intramuscular dose (2 mg/kg) of Sernylan (1.1 -phenylcyclohexyl-piperidine hydrochloride, Bio-Centic Laboratories, St. Joseph, MO) approx 60 min before the experiment began, were paralyzed with Flaxedil (gallamine triethiodide, American Cyanamid Company, Pearl River, NY), and passively ventilated with an animal respirator. A catheter (1.4mm 0.d.) was then inserted into a femoral artery and its tip positioncd in thc right carotid artery under fluoroscopic control to permit injection of radionuclides into the internal carotid artery, measurement of arterial blood pressure, and the sampling of arterial blood. The end-tidal pCO,, arterial blood pressure, and rectal temperature were continuously monitored. Rectal temperature was maintained between 37°C and 39°C with a heating pad. Arterial pH, PO,, pCO,, and oxygen content were measured bcforc and after each injcction of radioisotope. lopathy (SIEKER & HICKAM, 1956; PLUM & POSNER, 1972).

Sex offenders: Three personality types

Abstract: Analyzed by a Q-type factor analysis MMPI profiles of 92 sex offenders institutionalized for psychiatric evaluation, which yielded three basic MMPI profile types. Altogether 88 of the 92 Ss coult be categorized into one of three types characterized by profile peaks on F,Sc; Pd,MA; or D,PD. Analysis of background information, social history items, nature of present crime, primary diagnosis, and ward observations revealed significant differences among the types. Of particular interest was the finding that the primary diagnosis for 85% of the "F,Sc" MMPI type was "no mental disorder" in spite of the fact that this group showed significantly more disturbed behavior on the ward (anxiety, depression, suspicion, and manic excitement) and had uniquely degraded their victims. The fact that two-thirds of these persons who had F scores greater than or equal to 80 and 50% denied the crime may have inadvertently affected diagnostic decisions.

Prognostic indexes for patients with ischemic heart disease enrolled in an exercise-centered rehabilitation program.

Abstract: Indexes of prognosis were calculated for 610 postinfarction patients who participated in a vigorous exercise-centered rehabilitation program for an average of 36.5 ± 6.5 months (mean ± standard deviation), commencing 8.2 ± 11.7 months after infarction. Over this period, 23 (group F) had a fatal and 21 (group R) a nonfatal recurrence of infarction; the remaining 566 patients (group C [“control” group]) had no recurrence, although 12 of these patients died of unrelated causes. Recurrences in group R occurred 22.8 ± 17.6 months, and deaths in group F 19.6 ± 17.8 months after the patients had joined the exercise program. The most significant individual index of prognosis was noncompliance with the exercise program, observed in 47.8 percent of those with a fatal (F) recurrence, 57.1 percent of those with a nonfatal (R) recurrence and 0.7 percent of those in the control group; the risk ratio for the combined group F plus R was 22.6. Risk ratios were at the expected level for certain other traditional indicators of prognosis (persistent angina 2.01; aneurysm 2.05; enlarged heart 2.34; and polyfocal exercise-induced ventricular premature complexes 1.52). For three factors (S-T segment depression on exercise 0.2 mv or greater, serum cholesterol 270 mg/100 ml [7 mmol/liter] or greater and persistence of cigarette smoking), risk ratios (3.20,1.98, and 1.93, respectively) were somewhat higher than usually reported for postinfarction patients who do not exercise. However, because of the overall low fatality rate among patients (1.2 percent/year, with 0.7 percent/year in those free of S-T depression on exercise), the prognosis for patients with such risk factors remained at least as good as in comparable patients not receiving exercise rehabilitation. Age, hypertension ( 150 100 mm Hg or greater , 20.0 13.3 kPa ), persistence of resting electrocardiographic abnormalities and the results of physiologic tests had little influence on the prognosis of patients who exercise. However, a combination of S-T segment depression during exercise and a high serum cholesterol level yielded a risk ratio of 4.26. The apparent absence of risk from resting hypertension and from a high systolic blood pressure on exercise probably reflects the inability of patients with myocardial impairment to sustain a high systemic pressure.

Secondary depression: familial, clinical, and research perspectives.

Abstract: The authors evaluate the clinical and research significance of the diagnosis of secondary depression by comparing 48 cases of primary and 26 cases of secondary depression The patients with secondary depression have a higher familial prevalence of alcoholism, affective disorder, and drug abuse The groups differ somewhat on a few sociodemographic, behavioral, and attitudinal variables but are similar in symptomatology, sex ratio, onset and duration of symptoms, treatment received, and response to treatment These results suggest that the distinction between primary and secondary depression should be retained in research that examines neurochemistry or genetics Primary and secondary depression appear to be identical from the persepctive of clinical care Management of these patients should emphasize the diagnosis of depression rather than antecedent diagnoses

Familial (genetic) subtypes of pure depressive disease.

Abstract: The author reviewed data from five studies and found that depressed patients with a history of depression in a parent or child have more sibships containing depression than depressed patients without this family history. Thus, there is a clustering of depressions in certain families. Sporadic pure depressive disease (PDD), where no depressive illness exists in a first-degree family member of a depressed proband, is associated with a later age of onset than familial PDD, where depressive illness does exist in a first-degree relationship. The possibility exists that familial PDD and sporadic PDD are autonomous illnesses. The presence of a family history of depression may be predictive to some extent of a good response to adequate tricyclic medication or ECT.

Pituitary‐gonadal dysfunction in low‐output cardiac failure

Abstract: SUMMARY Diminished cardiac output and digoxin therapy appear to have opposing effects on testosterone, oestradiol and luteinizing hormone concentrations. Depression of the levels of these hormones was significantly correlated with a decrease in cardiac index and elevation was noted by digoxin therapy of long duration. The effect of cardiac output is most marked on testosterone and that of digoxin on oestradiol.