Affective Disorders and Cerebral Vascular Disease

1989 ◽  
Vol 154 (2) ◽  
pp. 170-182 ◽  
Author(s):  
Sergio E. Starkstein ◽  
Robert G. Robinson
Keyword(s):  
Affective Disorder ◽  
Mood Disorders ◽  
Depressive Disorders ◽  
Right Hemisphere ◽  
Rare Complication ◽  
Empirical Studies ◽  
Response To Treatment ◽  
Predisposing Factor ◽  
Connected Area ◽  
One Year

Empirical studies have recently demonstrated that major and minor depressive disorders occur in 30–50% of stroke patients, and last more than one year without treatment, although they do respond to tricyclic antidepressants. These mood disorders are not strongly associated with severity of impairment, demographic characteristics, social supports or prior personal history, but major depression is often strongly associated with left frontal or left basal ganglia lesions and pre-existing subcortical atrophy. While the aetiology of these mood disorders remains unknown, serotonergic or noradrenergic dysfunction may play a role. Mania is a rare complication of stroke: the clinical presentation and response to treatment are usually the same as mania without brain injury. Post-stroke mania is strongly associated with both a right hemisphere lesion in a limbic-connected area and a second predisposing factor, such as genetic loading for affective disorder, pre-existing subcortical atrophy or seizure disorder. This disorder may be mediated through frontal lobe dysfunction. The lesion method represents a potentially fruitful technique for investigating the mechanisms of affective disorder.

scholarly journals The role of glucocorticoids and corticotropin-releasing hormone regulation on anxiety symptoms and response to treatment

2017 ◽  
Vol 6 (2) ◽  
pp. R1-R7 ◽  
Author(s):  
Greta B Raglan ◽  
Louis A Schmidt ◽  
Jay Schulkin
Keyword(s):  
Stress Response ◽  
Mood Disorders ◽  
Depressive Disorders ◽  
Anxiety Symptoms ◽  
Response To Treatment ◽  
Anxiety And Depression ◽  
Hormone Regulation ◽  
Clinical Presentations ◽  
Clinical Disorders

The stress response has been linked to the expression of anxiety and depression, but the mechanisms for these connections are under continued consideration. The activation and expression of glucocorticoids and CRH are variable and may hold important clues to individual experiences of mood disorders. This paper explores the interactions of glucocorticoids and CRH in the presentation of anxiety and depressive disorders in an effort to better describe their differing roles in each of these clinical presentations. In addition, it focuses on ways in which extra-hypothalamic glucocorticoids and CRH, often overlooked, may play important roles in the presentation of clinical disorders.

Recurrent facial nerve baroparesis in a military diver: a case report

2019 ◽  
pp. 87-90
Author(s):  
Zoe Marinides ◽  
◽  
Gina R. Virgilio ◽  
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Facial Nerve ◽  
Rare Complication ◽  
Gas Embolism ◽  
Predisposing Factor ◽  
Cardiac Procedure ◽  
Complete Work ◽  
One Year ◽  
Work Up

Middle ear barotrauma is common in diving. However, facial nerve baroparesis is a relatively rare complication. A dehiscent facial nerve canal may be a predisposing factor to developing this complication. Although there is an increasing number of facial baroparesis cases in the literature, they are likely still under-reported. In order to avoid unnecessary recompression treatments or detrimental effects to a professional diver’s career, it is important to consider this in the differential diagnosis while evaluating dive injuries. This case report describes recurrent facial baroparesis in a military diver, which manifested on contralateral sides of his face. His initial presentation was misdiagnosed as an arterial gas embolism, which led to recompression treatment and a cardiac procedure. Upon recurrence about one year later, a complete work-up was done, which included an ENT evaluation and a CT scan. Imaging demonstrated a predisposing anatomic variant bilaterally. His symptoms resolved quickly and spontaneously both times, and he has been able to return to diving.

scholarly journals A206 EVOLUTION OF PEDIATRIC AUTOIMMUNE CHOLANGITIS AND PRIMARY SCLEROSING CHOLANGITIS INTO ADULTHOOD

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 234-236
Author(s):  
P Willems ◽  
J Hercun ◽  
C Vincent ◽  
F Alvarez
Keyword(s):  
Primary Sclerosing Cholangitis ◽  
Sclerosing Cholangitis ◽  
Response To Treatment ◽  
Similar Proportion ◽  
Autoimmune Cholangitis ◽  
Significant Difference ◽  
One Year ◽  
Liver Tests

Abstract Background The natural history of primary sclerosing cholangitis (PSC) in children seems to differ from PSC in adults. However, studies on this matter have been limited by short follow-up periods and inconsistent classification of patients with autoimmune cholangitis (AIC) (or overlap syndrome). Consequently, it remains unclear if long-term outcomes are affected by the clinical phenotype. Aims The aims of this is study are to describe the long-term evolution of PSC and AIC in a pediatric cohort with extension of follow-up into adulthood and to evaluate the influence of phenotype on clinical outcomes. Methods This is a retrospective study of patients with AIC or PSC followed at CHU-Sainte-Justine, a pediatric referral center in Montreal. All charts between January 1998 and December 2019 were reviewed. Patients were classified as either AIC (duct disease on cholangiography with histological features of autoimmune hepatitis) or PSC (large or small duct disease on cholangiography and/or histology). Extension of follow-up after the age of 18 was done for patients followed at the Centre hospitalier de l’Université de Montréal. Clinical features at diagnosis, response to treatment at one year and liver-related outcomes were compared. Results 40 patients (27 PSC and 13 AIC) were followed for a median time of 71 months (range 2 to 347), with 52.5% followed into adulthood. 70% (28/40) had associated inflammatory bowel disease (IBD) (78% PSC vs 54% AIC; p=0.15). A similar proportion of patients had biopsy-proven significant fibrosis at diagnosis (45% PSC vs 67% AIC; p=0.23). Baseline liver tests were similar in both groups. At diagnosis, all patients were treated with ursodeoxycholic acid. Significantly more patients with AIC (77% AIC vs 30 % PSC; p=0.005) were initially treated with immunosuppressive drugs, without a significant difference in the use of Anti-TNF agents (0% AIC vs 15% PSC; p= 0.12). At one year, 55% (15/27) of patients in the PSC group had normal liver tests versus only 15% (2/13) in the AIC group (p=0.02). During follow-up, more liver-related events (cholangitis, liver transplant and cirrhosis) were reported in the AIC group (HR=3.7 (95% CI: 1.4–10), p=0.01). Abnormal liver tests at one year were a strong predictor of liver-related events during follow-up (HR=8.9(95% CI: 1.2–67.4), p=0.03), while having IBD was not (HR=0.48 (95% CI: 0.15–1.5), p=0.22). 5 patients required liver transplantation with no difference between both groups (8% CAI vs 15% CSP; p=0.53). Conclusions Pediatric patients with AIC and PSC show, at onset, similar stage of liver disease with comparable clinical and biochemical characteristics. However, patients with AIC receive more often immunosuppressive therapy and treatment response is less frequent. AIC is associated with more liver-related events and abnormal liver tests at one year are predictor of bad outcomes. Funding Agencies None

scholarly journals Astroglial Connexin43 as a Potential Target for a Mood Stabiliser

2020 ◽  
Vol 22 (1) ◽  
pp. 339
Author(s):  
Motohiro Okada ◽  
Tomoka Oka ◽  
Misaki Nakamoto ◽  
Kouji Fukuyama ◽  
Takashi Shiroyama
Keyword(s):  
Gap Junction ◽  
Mood Disorders ◽  
Depressive Disorders ◽  
Bipolar Disorders ◽  
Depressive Mood ◽  
The Other ◽  
Health Concern ◽  
Monoamine Transporter ◽  
Other Hand ◽  
Novel Strategy

Mood disorders remain a major public health concern worldwide. Monoaminergic hypotheses of pathophysiology of bipolar and major depressive disorders have led to the development of monoamine transporter-inhibiting antidepressants for the treatment of major depression and have contributed to the expanded indications of atypical antipsychotics for the treatment of bipolar disorders. In spite of psychopharmacological progress, current pharmacotherapy according to the monoaminergic hypothesis alone is insufficient to improve or prevent mood disorders. Recent approval of esketamine for treatment of treatment-resistant depression has attracted attention in psychopharmacology as a glutamatergic hypothesis of the pathophysiology of mood disorders. On the other hand, in the last decade, accumulated findings regarding the pathomechanisms of mood disorders emphasised that functional abnormalities of tripartite synaptic transmission play important roles in the pathophysiology of mood disorders. At first glance, the enhancement of astroglial connexin seems to contribute to antidepressant and mood-stabilising effects, but in reality, antidepressive and mood-stabilising actions are mediated by more complicated interactions associated with the astroglial gap junction and hemichannel. Indeed, several depressive mood-inducing stress stimulations suppress connexin43 expression and astroglial gap junction function, but enhance astroglial hemichannel activity. On the other hand, monoamine transporter-inhibiting antidepressants suppress astroglial hemichannel activity and enhance astroglial gap junction function, whereas several non-antidepressant mood stabilisers activate astroglial hemichannel activity. Based on preclinical findings, in this review, we summarise the effects of antidepressants, mood-stabilising antipsychotics, and anticonvulsants on astroglial connexin, and then, to establish a novel strategy for treatment of mood disorders, we reveal the current progress in psychopharmacology, changing the question from “what has been revealed?” to “what should be clarified?”.

scholarly journals Caspase-Cleaved Keratin 18 Measurements Identified Ongoing Liver Injury after Bariatric Surgery

2021 ◽  
Vol 10 (6) ◽  
pp. 1233
Author(s):  
Felix Hempel ◽  
Martin Roderfeld ◽  
Lucas John Müntnich ◽  
Jens Albrecht ◽  
Ziya Oruc ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Liver Disease ◽  
Liver Injury ◽  
Response To Treatment ◽  
Morbidly Obese ◽  
Alcoholic Fatty Liver ◽  
Laboratory Parameters ◽  
Nafld Fibrosis Score ◽  
Keratin 18 ◽  
One Year

Bariatric surgery has emerged as an effective treatment option in morbidly obese patients with non-alcoholic fatty liver disease (NAFLD). However, worsening or new onset of non-alcoholic steatohepatitis (NASH) and fibrosis have been observed. Caspase-cleaved keratin 18 (ccK18) has been established as a marker of hepatocyte apoptosis, a key event in NASH development. Thus, ccK18 measurements might be feasible to monitor bariatric surgery patients. Clinical data and laboratory parameters were collected from 39 patients undergoing laparoscopic Roux-en-Y gastric bypass at six timepoints, prior to surgery until one year after the procedure. ccK18 levels were measured and a high-throughput analysis of serum adipokines and cytokines was carried out. Half of the cohort’s patients (20/39) presented with ccK18 levels indicative of progressed liver disease. 21% had a NAFLD-fibrosis score greater than 0.676, suggesting significant fibrosis. One year after surgery, a mean weight loss of 36.87% was achieved. Six and twelve months after surgery, ccK18 fragments were significantly reduced compared to preoperative levels (p < 0.001). Yet nine patients did not show a decline in ccK18 levels ≥ 10% within one year postoperatively, which was considered a response to treatment. While no significant differences in laboratory parameters or ccK18 could be observed, they presented with a greater expression of leptin and fibrinogen before surgery. Consecutive ccK18 measurements monitored the resolution of NAFLD and identified non-responders to bariatric surgery with ongoing liver injury. Further studies are needed to elicit the pathological mechanisms in non-responders and study the potential of adipokines as prognostic markers.

scholarly journals Cognitive errors assessed by observer ratings in bipolar affective disorder: relationship with symptoms and therapeutic alliance

2009 ◽  
Vol 2 (2) ◽  
pp. 92-105 ◽  
Author(s):  
Ueli Kramer ◽  
Guy Bodenmann ◽  
Martin Drapeau
Keyword(s):  
Cognitive Therapy ◽  
Affective Disorder ◽  
Mood Disorders ◽  
Bipolar Affective Disorder ◽  
Cognitive Model ◽  
Control Group ◽  
Cognitive Errors ◽  
Manic Symptoms ◽  
Observer Ratings ◽  
Depressive Patients

AbstractThe construct of cognitive errors is clinically relevant for cognitive therapy of mood disorders. Beck's universality hypothesis postulates the relevance of negative cognitions in all subtypes of mood disorders, as well as positive cognitions for manic states. This hypothesis has rarely been empirically addressed for patients presenting bipolar affective disorder (BD). In-patients (n= 30) presenting with BD were interviewed, as were 30 participants of a matched control group. Valid and reliable observer-rater methodology for cognitive errors was applied to the session transcripts. Overall, patients make more cognitive errors than controls. When manic and depressive patients were compared, parts of the universality hypothesis were confirmed. Manic symptoms are related to positive and negative cognitive errors. These results are discussed with regard to the main assumptions of the cognitive model for depression; thus adding an argument for extending it to the BD diagnostic group, taking into consideration specificities in terms of cognitive errors. Clinical implications for cognitive therapy of BD are suggested.

Bulimia nervosa: treatment and short-term outcome

1986 ◽  
Vol 16 (1) ◽  
pp. 65-70 ◽  
Author(s):  
L. K. George Hsu ◽  
Diane Holder
Keyword(s):  
Treatment Outcome ◽  
Bulimia Nervosa ◽  
Response To Treatment ◽  
Dropping Out ◽  
Methodological Issues ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome ◽  
Duration Of Illness ◽  
One Year

SynopsisFifty-six bulimia nervosa patients were treated by means of a behavioural approach and followed for at least one year after completion or dropping out of treatment. Outcome was encouraging in about half of the patients and several psychiatric indicators, such as duration of illness and response to treatment, were identified. The significance of the findings and unresolved methodological issues are discussed.

Cognitive-Behavioral Group Therapy for Heterogeneous Anxiety and Mood Disorders in a Psychiatric Hospital Outpatient Clinic

2013 ◽  
Vol 27 (2) ◽  
pp. 138-154 ◽  
Author(s):  
Lynndall Dwyer ◽  
Sara Olsen ◽  
Tian Po S. Oei
Keyword(s):  
Quality Of Life ◽  
Anxiety Disorders ◽  
Mood Disorders ◽  
Outcome Measures ◽  
Depressive Disorders ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Cognitive Behavioral Group Therapy ◽  
Group Cbt

Recent literature has shown that group cognitive-behavioral therapy (CBT) is effective for individuals with heterogeneous anxiety disorders. However, these studies have used a narrow range of outcome measures, and have not included global measures such as quality of life. In addition, heterogeneous mood disorders have not been well researched. The aim of this study was to replicate and extend on previous studies by assessing the effectiveness of group CBT treatment programs designed for use with heterogeneous anxiety or depressive disorders. Global outcome measures of quality of life and social functioning were assessed in addition to outcome measures of anxiety and mood symptoms. There were 173 patients who completed either group CBT for anxiety disorders or for depressive disorders. Symptom measures and quality of life measures were used to determine treatment effectiveness. Results demonstrated that the treatments were effective in reducing overall symptom severity and improving quality of life. Treatment gains were maintained to 12 month follow-up. However, the degree of change was considerably lower than that found in comparable trials with diagnostically homogenous samples. Overall, group CBT for heterogeneous diagnostic populations was effective but requires further investigation and refinement.

Treatment Resistant Mood Disorders Among LGBTQ People: Clinical Features and Response to Treatment

2021 ◽  
Vol 89 (9) ◽  
pp. S160-S161
Author(s):  
Fumie Oka ◽  
Kamile Weischedel ◽  
Amanda Bakian ◽  
Brian Mickey
Keyword(s):  
Mood Disorders ◽  
Clinical Features ◽  
Response To Treatment ◽  
Treatment Resistant
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