Common Psychiatric Complication Research Articles

AGONIST OF V2 VASOPRESSIN RECEPTOR REDUCES DEPRESSIVE DISORDERS IN POST-STROKE PATIENTS

Poststroke depression is one of the common psychiatric complications after stroke. Thus, the research of new ways for treatment depressed mood after stroke is actual. The previous researches revealed vasopressin to be effective in patients with memory, speech and motor function disorders after stroke. The purpose of the study was to investigate influence of vasopressin on depression after stroke. Fourteen patients with affective disorders have been treated with subendocrine doses of 1-desamino-8-D-arginin-vasopressin (DDAVP) daily by intranasal application during 1,5-2 months. Vasopressin was effective in correcting both apatoadinamic and anxious depression. Treatment effect was durable, lasts for 0,5-1 year after the first course of therapy. The results of this pilot study demonstrate perspective of using selective agonist of vasopressin V2 receptors, DDAVP, in therapy of post-stroke depression.

Afasia y depresión post-ictus: una relación predictiva

Introduction/objectivesPost-stroke depression has been shown to be the most common psychiatric complication and that which is associated to a worse prognosis. There is still uncertainty as to its etiology and risk factors. Some factors have been established: stroke severity, degree of disability and cognitive impairment. Thus, it is urgent to define new factors that facilitate an early diagnosis, which may lessen the negative effects on the rehabilitation process. ObjectivesTo determine the incidence of post-stroke depression (PSD) and to study the variables described in the literature as possible predictors of PSD: gender, age, type of stroke, laterality, vascular territory and presence of aphasia. Materials and methodsA retrospective longitudinal study including all patients admitted to a Physical Medicine and Rehabilitation ward, with the diagnosis of stroke de novo, during a period of two years was performed. Initially 144 patients were included. Exclusion criteria were: “previous stroke”, “prior psychiatric illness with mood disturbance” and “antidepressant medication at the time of stroke”. The final number was 111 patients. ResultsThe incidence of PSD was 38.7%. Presence of aphasia showed a significant association with depression (P=0.05). There was no relation with the type of aphasia. The other predictors tested showed no statistically significant correlation. ConclusionsThis study establishes aphasia as a predictive factor of PSD. The high incidence of PSD in this population agrees with the existing studies. Further studies are needed, not only to increase the knowledge of the risk factors of PSD but also to improve the outcomes of rehabilitation programs.

Brain-Derived Neurotrophic Factor in Post-Partum Depressive Mothers

Postpartum depression (PPD) is the most common psychiatric complication observed in women after they give birth. Some women are particularly sensitive to hormonal changes, starting in early menarche, thus increasing their vulnerability to psychological stressing agents that are triggered by environmental and physiological factors throughout their lives. Decreased serum brain-derived neurotrophic factor (BDNF) levels have been associated to different neuropsychiatric conditions and BDNF has been considered as a candidate marker for such dysfunctions. The goal of this study was to compare the levels of BDNF between mothers who suffer from PPD and healthy control mothers as well as to searching for associations between BDNF levels and the severity of PPD. This is a case-control study including 36 mothers with PPD and 36 healthy control mothers. PPD was defined according to the Beck Depression Inventory (BDI). Serum BDNF was assayed with the sandwich ELISA method. Serum levels of BDNF were significantly lower in women with PPD than in control mothers (P≤0.03). A significant negative correlation between BDI score and serum BDNF levels was observed (P≤0.02 and r=-0.29). Our study demonstrated that low BDNF levels are associated with PPD. This result point out to the potential usage of BDNF in the screening of PPD, which could promote early treatment and, therefore, reduce the burden to the PPD women and to the health system.

Psychological risk factors of micro- and macrovascular outcomes in primary care patients with type 2 diabetes: rationale and design of the DiaDDZoB Study

BackgroundDepression is a common psychiatric complication of diabetes, but little is known about the natural course and the consequences of depressive symptoms in primary care patients with type 2 diabetes. While depression has been related to poor glycemic control and increased risk for macrovascular disease, its association with microvascular complications remains understudied. The predictive role of other psychological risk factors such as Type D (distressed) personality and the mechanisms that possibly link depression and Type D personality with poor vascular outcomes are also still unclear.Methods/DesignThis prospective cohort study will examine: (1) the course of depressive symptoms in primary care patients with type 2 diabetes; (2) whether depressive symptoms and Type D personality are associated with the development of microvascular and/or macrovascular complications and with the risk of all-cause or vascular mortality; and (3) the behavioral and physiological mechanisms that may mediate these associations. The DiaDDZoB Study is embedded within the larger DIAZOB Primary Care Diabetes study, which covers a comprehensive cohort of type 2 diabetes patients treated by over 200 primary care physicians in South-East Brabant, The Netherlands. These patients will be followed during their lifetime and are assessed annually for demographic, clinical, lifestyle and psychosocial factors. Measurements include an interviewer-administered and self-report questionnaire, regular care laboratory tests and physical examinations, and pharmacy medication records. The DiaDDZoB Study uses data that have been collected during the original baseline assessment in 2005 (M0; N = 2,460) and the 2007 (M1; N = 2,225) and 2008 (M2; N = 2,032) follow-up assessments.DiscussionThe DiaDDZoB Study is expected to contribute to the current understanding of the course of depression in primary care patients with type 2 diabetes and will also test whether depressed patients or those with Type D personality are at increased risk for (further) development of micro- and cardiovascular disease. More knowledge about the mechanisms behind this association is needed to guide new intervention studies.

Characteristics, interventions, and outcomes of misdiagnosed delirium in cancer patients

Although delirium is a common psychiatric complication in cancer patients, it is often not accurately recognized. To date, the characteristics and outcome of misrecognized patients are unclear in the cancer setting. This retrospective study was planned to determine the recognition by oncologists at the psychiatric consultation, characteristics, reversibility and outcome of misrecognized patients with delirium. We reviewed charts of 60 patients diagnosed with delirium by the psycho-oncologists who were referred to the psychiatric consultation by the oncologists. Information about demographics, initial assessment by the oncologists, delirium subtype, precipitating factors, intervention for delirium, reversibility, and final status was obtained. Twenty-two among 60 delirious patients were misrecognized by the oncologists at the time of consultation. They were often diagnosed as having anxiety or other psychiatric disorders. Misrecognized participants were significantly younger than accurately recognized cases of delirium. The psychiatrists made suggestions to the oncologists for all the referred patients, even when they were accurately diagnosed with delirium before consultation. For the correctly recognized patients, the main suggestion was pharmacological reevaluation. For the misdiagnosed cases, the psychiatrists suggested a reconsideration of the strategy for cancer treatment and the provision of information to the patient's family members about their condition. Despite its high prevalence, delirium is difficult to diagnose for non-psychiatric physicians. Its detection is important not only to give the best treatment option to cancer patients but also to provide the best opportunity to inform their family about their condition and end-of-life issues.

Does the Association Between Anxiety and Parkinsons Disease Really Exist? A Literature Review

Introduction: Although anxiety is a common psychiatric complication of Parkinsons disease (PD), it has received little attention compared to depression in PD, being still an under-recognized and under-diagnosed condition in clinical practice. Objective: To review general aspects of the association between anxiety and PD concerning prevalence, etiopathogenesis, clinical characteristics, comorbidities, and treatment. Method: The basic and clinical literature on anxiety and PD was reviewed via the Pubmed, Lilacs and Scielo indexing services, using the keywords anxiety, etiology, prevalence, treatment, Parkinson, and Parkinsons disease. Moreover, complementary information was extracted from the reference lists of the articles found in the search. Results: Up to 67% of PD patients present clinically significant anxiety levels. Oscillations in anxious symptoms may be related to the use of anti-Parkinson drugs and motor fluctuations. The association between anxiety in PD and depressive disorders sleep disturbances, and cognitive impairment has also been proposed as a possible explanation for this psychiatric complication. Thus far, few data on the treatment of anxiety disorders in PD are available. Conclusions: More studies investigating aspects such as prevalence, etiopathogenesis, comorbidities, impact on life quality, and treatment are necessary and opportune in order to facilitate the recognition and diagnosis of anxiety disorders in PD.

Postpartum Depression among Women in Uyo, Akwa-Ibom State.

Background Postpartum depression is a common psychiatric complication of childbearing among women. The increasing rate in addition to poor clinical diagnosis is attributable to poor health care services and inadequate medical attention. The implication is the high morbidity with adverse social and medical consequences. Aims The objectives of the study were to determine the prevalence of postpartum depression among women in Uyo and to determine the association between some sociodemographic variables such as parity, pattern of deliveries and postpartum depression. Method Three hundred and thirty five women who delivered at the University of Uyo Teaching Hospital between January and March 2007 were followed up at 6 weeks. They were screened for postpartum depression, using the Edinburgh Postnatal Depression Scale (EPDS). Results Of the 315 women assessed, 287 (91.1%) were aged between 20-39 years and the mean age of the women was 21.3 ± 4.7 years; 260 (82.5%) were married and 286 (90.8%) had secondary school education and above with 134 (42.5%) being employed. A total of 81 (25.7%) of them saussffoecrieadti ofrnosm b eptowstepeanr taugme (dXe2p=r8e.s1s7io9n, .d Tf=he4r;e P w

Lesions of dopaminergic neurons in the substantia nigra pars compacta and in the ventral tegmental area enhance depressive-like behavior in rats

Depression is the most common psychiatric complication in Parkinson's disease (PD). The pathophysiological events leading to PD-associated depression, however, remain largely unknown. The present study tested the differential implication of dopaminergic systems in depressive-like behavior in rats and its response to l-Dopa and the selective serotonin reuptake inhibitor citalopram. The learned helplessness model was used as a behavioral paradigm. Rats were lesioned in the substantia nigra pars compacta (SNc) and the ventral tegmental area (VTA) and assigned to subgroups with respect to the stereologically verified extent of the nigral and/or VTA degeneration. Both lesions increased depressive-like behavior in rats, which was reduced by both citalopram and l-Dopa treatment. We conclude that dopaminergic lesions of either the SNc or the VTA contribute to the manifestation of depressive-like behavior in rats. The effects of citalopram administration on depressive behavior induced by lesions of dopaminergic brain regions furthermore suggest an involvement of serotonergic pathways in dopaminergic cell loss-induced depression.

Recent advances in poststroke depression

Depression is the most common psychiatric complication after stroke. Its prevalence varies from 20% to 80%, and it is underdiagnosed and undertreated. It has significant impact on rehabilitation, motor recovery, activities of daily living, social and interpersonal life, and mortality. Several studies have shown that biological and psychosocial factors play significant roles in the development of this disabling disease. Recent research shows that neurochemical processes also may play some role in the pathophysiology of this condition. Several trials have shown evidence that the older, as well as newer antidepressants and psychostimulants may reduce/prevent depressive symptoms after stroke. At this point there are no clear guidelines available to choose safe and effective treatments. Drugs are selected based on their efficacy and side effect profile in these patients. More research is needed to understand the pathophysiology of depression after stroke. There also is a need for more randomized clinical trials to better treat patients with this condition.

Psychiatric Complications in Parkinson Disease

Although Parkinson disease (PD) is primarily considered a movement disorder, the high prevalence of psychiatric complications suggests that it is more accurately conceptualized as a neuropsychiatric disease. Affective disorders, cognitive impairment, and psychosis are particularly common in PD and are associated with excess disability, worse quality of life, poorer outcomes, and caregiver distress. Yet, in spite of this and their frequent occurrence, there is incomplete understanding of the epidemiology, phenomenology, risk factors, neuropathophysiology, and optimal treatment strategies for these disorders. Psychiatric complications are typically comorbid, and there is great intra- and inter-individual variability in presentation. The hallmark neuropathophysiological changes that occur in PD plus the association between exposure to dopaminergic medications and certain psychiatric disorders suggest a neurobiological basis for most psychiatric symptoms, although psychological factors are probably involved in the development of affective disorders. Although antidepressants, antipsychotics, and cognition-enhancing agents are commonly prescribed in PD, controlled studies demonstrating efficacy and tolerability of these drugs are virtually nonexistent. Because of the high prevalence and complexity of psychiatric complications in PD, geriatric psychiatrists are in a position to offer valuable consultation and clinical care to this population. This article provides an overview of the epidemiology, pathophysiology, clinical presentation, and management of the most common psychiatric complications in PD.

Poststroke Depression: Psychopharmacological Considerations

PSD is a common psychiatric complication of stroke. It is often underrecognized and untreated. Numerous studies show that untreated PSD impedes the rehabilitation and recovery process, jeopardizes quality of life, and increases mortality. Successful management of the PSD requires early recognition and initiation of appropriate treatment to facilitate an optimal level of functioning. As active members of the interdisciplinary treatment team, psychiatric consultative-liaison nurses play a pivotal role in facilitating positive treatment outcomes during both the acute and rehabilitation phases in the management of PSD.

Psychiatric complications in human immunodeficiency virus infection.

Human immunodeficiency virus (HIV) infection is associated with psychiatric complications, including cognitive impairment, affective disorders, and psychosis. These psychiatric complications impair quality of life, affect disease prognosis, and impede treatment by compromising medication adherence. They also increase the likelihood of HIV transmission, either directly or via their high prevalence rate among drug abusers. In this article, the authors provide a brief overview of the most common psychiatric complications associated with HIV infection and discuss the role of dopamine as a link between psychiatric manifestations and the progression of immunodeficiency infection.

Impact of depressed mood on neuropsychological status in temporal lobe epilepsy

OBJECTIVESDepression is a common psychiatric complication of temporal lobe epilepsy. This study examined the effect of depressed mood on neuropsychological performance among patients with chronic temporal lobe epilepsy.METHODSSeventy consecutive surgery...

Psychiatric Symptom Management in Terminal Care

During the terminal phase of illness, many geriatric patients develop psychiatric complications that subsequently have profound effects on their quality of life. Effective treatment requires the skills of a physician who is experienced in the recognition, assessment, and management of psychiatric complications of terminal care. Specialized knowledge is required, because even the most common psychiatric symptoms (anxiety, depression, and cognitive disorder) may be difficult to diagnose and treat. Recognition and management are complicated by the fact that these symptoms can arise as a consequence of other symptoms, for example, as a direct result of the disease and its treatment, or as a reflection of underlying psychosocial issues. In many instances, the use of pharmacologic agents, either alone or in combination with psychotherapeutic interventions, provides reasonable control of psychiatric symptoms. Here, too, specialized knowledge is required in order to know which regimens are likely to yield the most benefits with the least risk of toxicity. Fortunately, a considerable body of knowledge has accumulated over the last few years regarding the management of psychiatric symptoms in terminal care. The challenge for the future is to make sure that this information is applied in the routine clinical care of the terminally ill geriatric patient.

Southwestern Internal Medicine Conference: Depression and Medical Illness

Depression is the most common psychiatric complication of severe medical illness, and it occurs in about 20% of cases. Diagnosis of depression in patients with serious medical illness requires modified criteria. Treatment also must be adjusted for patients with such dual diagnoses.

Psychiatric aspects of organ transplantation

DURING the past 30 years, organ transplantation has moved from being an experimental procedure to an accepted treatment for several disorders. This review discusses the most common psychiatric complications as well as psychological benefits that children, adolescents, and adult transplantation patients and their families experience. Preoperative psychiatric evaluation; psychiatric aspects of living, related, and brain-dead donors; and the support provided by the transplantation unit staff are also discussed. During the early 1950s, Hume¹performed several cadaveric renal transplantations, but it was not until 1954, when Murray and colleagues^2,3successfully transplanted a kidney from one identical twin brother to the other that long-term success in transplantation began to be achieved. In the 30 years since that pioneering work, long-term survival has significantly increased. This has been largely due to the increased experience of surgeons, refinement of surgical technique, improvements in tissue typing and matching, more careful selection of candidates,

Psychiatric Aspects of Organ Transplantation

DURING the past 30 years, organ transplantation has moved from being an experimental procedure to an accepted treatment for several disorders. This review discusses the most common psychiatric complications as well as psychological benefits that children, adolescents, and adult transplantation patients and their families experience. Preoperative psychiatric evaluation; psychiatric aspects of living, related, and brain-dead donors; and the support provided by the transplantation unit staff are also discussed. During the early 1950s, Hume1performed several cadaveric renal transplantations, but it was not until 1954, when Murray and colleagues2,3successfully transplanted a kidney from one identical twin brother to the other that long-term success in transplantation began to be achieved. In the 30 years since that pioneering work, long-term survival has significantly increased. This has been largely due to the increased experience of surgeons, refinement of surgical technique, improvements in tissue typing and matching, more careful selection of candidates,

Psychiatric Complications Associated with Geriatric Surgery

Detection of pre-existing psychopathologic problems in the geriatric surgical patient can often preclude further psychiatric complications. When complications such as delirium arise, collaboration between the surgeon and the psychiatrist enhances a satisfactory outcome.

The Dependency Problem: The Most Common Surgical Risk

The most common psychiatric complication in any surgical procedure is the subtle and potentially devastating risk of dependency gratification which the operation permits in a socially sanctioned way. Some of the preoperative manifestations of potential psychologic problems are outlined to help the surgeon recognize high risk patients early.

Psychiatric complications of surgery ∗

Almost all psychiatric syndromes may occur in surgical patients at one time or another. The rate of occurrence varies considerably, but in one large municipal hospital study 22 per cent were found to have gross psychiatric complications. The most common psychiatric complications of surgery are (1) the anxiety reaction, (2) depression, (3) denial of illness and (4) acute brain syndrome. Therapy of all psychiatric complications is based on the institution of on-the-spot psychotherapy plus adjunctive drug therapy. When the acute brain syndrome develops, it is secondary to the disturbed physiology of the primary surgical condition and improves as the primary condition improves.