Do stressful life events predict medical treatment outcome in first episode of depression?

Background  

It is unclear whether medical treatment outcome in first episode depression differ for patients with and without stressful life events prior to onset of depression.     

The influence of 4–week treatment with sertraline on the combined T3/TRH test in depressed patients

In the present study, the influence of a 4–week treatment with sertraline on the regulation of hypothalamic–pituitary–thyroid (HPT) axis activity in depression was investigated, in particular the impact of sertraline on the thyroid receptor (TR)–mediated negative feedback control as measured by the combined T3/TRH test. In 20 drug–free patients (8 men,12 women) suffering from a major depressive episode according to DSM-IV criteria the single TRH–stimulation test (administration of 200 μg TRH at 09:00h) was carried out followed by a combined T3/TRH test (pre–treatment with 40 μg 3,5,3’–triiodothyronine [T3] the night before; administration of 200 μg TRH at 09:00h the next day). After 4 weeks of treatment with sertraline at a standard dosage of 50 mg/day, both the single TRH test and the combined T3/TRH test were repeated in the depressed patients. Using repeated–measures ANOVA for statistical analysis, antidepressant therapy with sertraline did not have any significant impact on the TRH–induced TSH and prolactin stimulation (ΔTSH, ΔPRL) during the single TRH test nor during the combined T3/TRH test, neither in responders (n = 10) nor in non–responders (n = 10). Moreover, the percentage suppression of TRH–induced TSH stimulation (ΔTSH) after pre–treatment with 40 μg T3 was comparable before (–61.07 %) and after the 4–week treatment with sertraline (–58.92 %). Apparently, the therapeutic efficacy of antidepressants such as sertraline is not related to the regulation of HPT axis activity in depressed patients.     

Endovascular treatment of intracranial aneurysms as the first thérapeutic option

BACKGROUND AND PURPOSE: To prospectively evaluate the results of endovascular treatment (EVT) of intracranial aneurysms when it is considered as first-intention treatment. METHODS: From April 2004-October 2006, 167 consecutive patients with 202 aneurysms were treated in our institution. Five patients with a ruptured aneurysm with an associated haematoma were excluded. In 162 patients with 197 aneurysms, EVT was considered as first-intention treatment. RESULTS: Surgical clipping was performed in 25 aneurysms (25/197=12.7%) including 22 aneurysms excluded from EVT and three EVT failures. EVT was thus attempted in 144 patients with 175 aneurysms and successfully performed in 141 patients with 172 aneurysms (172/197=87.3%). EVT failure rate was 1.7%. Clinical outcome according to the modified Glasgow Outcome Scale was: Excellent, 81.5%; Good, 7%; Poor or Fair, 3.5%; Death, 8%. Procedural complications occurred in 17 cases (10%). Balloon- or stent-assisted techniques were used in 60 cases (34.9%) and were not associated with higher complication rate. Overall procedural morbidity and mortality rates were 4.2 and 2.1%. Initially, complete occlusion was obtained in 68%, neck remnant in 23%, and incomplete occlusion in 9% of aneurysms. Follow-up (mean 11 months) was obtained in 119 aneurysms and showed major recanalisation--that required re-treatment--in 13 cases (11%) and minor recanalisation in 17 cases (14.3%). CONCLUSION: Our findings suggest that new endovascular techniques allow proposing EVT as first-intention treatment in 87.3% of patients with intracranial aneurysms. This therapeutic strategy is associated with good clinical results. However, anatomical results are not improved and remain the EVT limiting factor.     

Challenges in the diagnosis and treatment of transsexualism in contemporary China

##正##According to the International Classification of Diseases10th Edition(ICD-10),[1]transsexualism refers to thecondition where an individual desires to live and to beaccepted as someone of the gender which is oppositetheir biological sex.It is usually accompanied withdiscomfort or distress about their anatomic sex.In somecases,individuals with this condition modify their bodyfeatures using laser or plastic surgeries to resemble     

Adaptation of skull clamp for use in image-guided surgery of children in the first 2 years of life

Introduction We describe a simple but effective modification of the skull clamp, aimed at stabilising the head of very young children, while avoiding the risk of creating a depressed skull fracture, in order to enable the utilisation of image-guidance in such young patients.Methods We machined three small perspex discs 3 cm in diameter. On the outer surface of these pads we drilled reception holes for the pins to prevent slippage. To avoid direct contact with the skin, we interfaced a thick pad of soft felt. During intraoperative positioning, the weight of the head was supported by a suction bean-bag placed on the operating table. Hence, the clamp apparatus was employed only to secure the head position, and not to support the weight of the head, thus requiring less clamp force. We employed this modification in three children (aged 9, 13 and 15 months) who required image-guided surgery for brain tumours.Outcome In all cases the head remained immobile throughout the operation, making possible the accurate use of image guidance. At the end of the operation, some transient skin redness was noticed in the contact areas, which settled in a few days.The material in this paper was presented as a poster at the 31st Annual Meeting of the International Society for Pediatric Neurosurgery, Monaco, 14–18 September 2003     

The value of therapeutic communities in the treatment of personality disorder: a suitable place for treatment?

In the United Kingdom, a government program investigating the links between offending and personality disorder has stimulated renewed interest in the treatment of personality disorders. One psychosocial treatment option for patients with personality disorders is the therapeutic community (TC). In 2000, the authors conducted a small qualitative study with a sample of psychiatrists which suggested that TCs were not well understood and that the status of evidence on efficacy might be partly responsible for low referral numbers. This article reviews the evidence for the efficacy and cost-effectiveness of TCs as a treatment for personality disorders and considers which types of disorders are amenable to TC treatment. We conclude that there is a strong case for more rigorous evaluation and that some of the difficulties anticipated in applying randomized clinical trial (RCT) methodology to the study of TCs could be overcome.     

Self‐correction in apraxia of speech: The effect of treatment

Background: Overt attempts at self‐correction of speech errors reflect conscious monitoring of speech output. The ability to monitor speech reveals something about the dynamics of motor control. Speakers with apraxia of speech (AOS) attempt to self‐correct speech, but systematic analyses of self‐correction in AOS have rarely been done.

Aims: The aims of the study were to determine the effect of treatment on the number of overt attempted self‐corrections during the course of treatment, on the number of overt attempted self‐corrections as a percentage of the total number of incorrect productions, and on successful self‐corrections as a percentage of the total number of self‐corrections.

Methods & Procedures: One speaker with AOS was treated for a period of 18 months. Self‐corrections were noted during three repetitions of 110 words and 110 nonwords. Three pre‐treatment baseline probes and four subsequent probes, spanning the treatment period, were performed.

Outcomes & Results: The number of attempted self‐corrections decreased and the percentage of successful self‐corrections increased during treatment. However, attempted self‐corrections as a percentage of the total number of incorrect productions remained fairly stable during treatment.

Conclusions: The results indicate that success of overt self‐corrections improved during treatment. However, the almost unchanged number of self‐corrections as a percentage of the total number of incorrect productions suggests that the process of internal predictive control remained dysfunctional. The inadvertent occurrence of speech errors points towards a loss or dysfunction of volitional control of speech production. Mental practice as a complementary treatment technique may need to be considered. A continuum of volitional control of speech is presented to explain AOS.     

Economic factors in of patients’ nonadherence to antidepressant treatment

Purpose

Patients’ nonadherence to antidepressant treatment hampers cost and efficacy of depression-specific treatment. However, previous studies have failed to find consistent findings in economic effect on nonadherence and also failed to reach consensus in how to measure nonadherence to treatment. The study attempts to investigate income effect on nonadherence to selective serotonin reuptake inhibitors (SSRIs) treatment with clear definitions of nonadherence: self discontinuation of SSRIs (nonpersistence) and under-dose of SSRIs (noncompliance).

Methods

The study extracted data from the National Comorbidity Survey-Replication (NCS-R). The study sample (n?=?280) includes adults between the ages of 18 and 64 who were diagnosed with Diagnostic Statistics Manual IV Major Depressive Episode (MDE) at some point during their lifetime and medicated with SSRIs in the past 12?months.

Results

Just above poverty level of family income and no health insurance increased the risk of medication nonpersistence in SSRIs treatment. The study findings confirmed that African Americans were at higher risk of medication noncompliance than Whites (odds ratio, 4.53) and MDE comorbidity was positively associated with medication noncompliance (odds ratio, 4.25).

Conclusions

Low income level, combined with health insurance status, and race/ethnicity, predict nonadherence to antidepressant treatment. The study findings would help physicians and hospitals developing interventional strategies and programs to increase patients’ adherence rates in antidepressant treatment.     

Steroids or vigabatrin in the treatment of infantile spasms?

In many countries, vigabatrin is now recommended as the first choice of treatment for infantile spasms instead of steroids. The aim of this study was to review the efficacy and side effects of the two drugs, steroids and vigabatrin, by using data from published series. Results suggest that vigabatrin certainly is efficacious in the treatment of the disorder but, on the whole, it does not seem to be any more effective than steroids, especially corticotrophin, even in children with tuberous sclerosis. The possible benefits of vigabatrin do not justify the risks of the possible irreversible visual changes associated with vigabatrin.     

Are subjects in pharmacological treatment trials of depression representative of patients in routine clinical practice?

OBJECTIVE: The methods used to evaluate the efficacy of antidepressants differ from treatment for depression in routine clinical practice. The rigorous inclusion/exclusion criteria used to select subjects for participation in efficacy studies potentially limit the generalizability of these trials' results. It is unknown how much impact these criteria have on the representativeness of subjects in efficacy trials. This study estimated the proportion of depressed patients treated in routine clinical practice who would meet standard inclusion/exclusion criteria for an efficacy trial. METHOD: A total of 803 individuals, aged 16--65 years, who were seen at intake at an outpatient practice underwent a thorough diagnostic evaluation, including the administration of semistructured diagnostic interviews; 346 patients had current major depression. Common inclusion/exclusion criteria used in efficacy studies of antidepressants were applied to the depressed patients to determine how many would have qualified for an efficacy trial. RESULTS: Approximately one-sixth of the 346 depressed patients would have been excluded from an efficacy trial because they had a bipolar or psychotic subtype of depression. The presence of a comorbid anxiety or substance use disorder, insufficient severity of depressive symptoms, or current suicidal ideation would have excluded 86.0% (N=252) of the remaining 293 outpatients with nonpsychotic unipolar major depressive disorder from an antidepressant efficacy trial. CONCLUSIONS: Subjects treated in antidepressant trials represent a minority of patients treated for major depression in routine clinical practice. These results show that antidepressant efficacy trials tend to evaluate a subset of depressed individuals with a specific clinical profile.     

Evaluation of modified hemodilution combined therapy in the treatment of acute ischemic stroke in the elderly

IN T R O D U C T IO N Atpresent, throm bolysis therapy applied atthe early stage is devel- oped in patients w ith acute stroke, and itw orks w elland decreases disability rate.Butthrom bolysis therapy is notsuitable forsom e elder- ly patients w ho delaye…     

Pramipexole versus sertraline in the treatment of depression in Parkinson’s disease

In addition to treating the motor symptoms of Parkinson's disease, the dopamine agonist pramipexole has shown an antidepressant effect. The trials, however, included patients with motor complications, raising the question of whether the antidepressant benefit represented only a treatment-related motor improvement. To address this issue, we have conducted a 14-week randomized trial comparing pramipexole with an established antidepressant in patients without motor complications. At seven Italian centers, 67 Parkinsonian outpatients with major depression but no history of motor fluctuations and/or dyskinesia received open-label pramipexole (at 1.5 to 4.5 mg/day) or sertraline (at 50 mg/day). In both groups, the Hamilton Depression Rating Scale (HAM-D) score decreased throughout 12 weeks of treatment, but in the pramipexole group the proportion of patients who recovered, as defined by a final HAM-D score 相似文献   

The benefits of pramipexole selection in the treatment of Parkinson’s disease

Levodopa administration as a gold standard in Parkinson’s disease (PD) treatment is very valuable, however, long-term administration may cause some motor complications such as abnormal unintended movements and shortening response to each dose (wearing off phenomenon). Dopamine agonists were developed to reduce duration of immobile off periods and dependence to levodopa for improving motor impairments (Clarke et al., Cochrane Libr 1:1–23, 2000). Pramipexole is one of these nonergot dopamine agonists with high relative in vitro specificity and full intrinsic activity at D2 subfamily of dopamine receptors, with a higher binding affinity to D3 than to D4 or D2 receptor subtypes (Piercey, Clin Neuropharmacol 21:141–151, 1998). It can be advantageously administered as monotherapy or adjunctive therapy to levodopa to decrease side effects and increase effectiveness in both early and advanced PD treatment.     

Problems in the treatment of mentally ill offenders--a problem of general psychiatry?

The special position of psychiatry among the various medical disciplines is determined not least by the phenomenon of violent behaviour of some of its patients and the possibility of coercive measures against patients. The worldwide process of deinstitutionalization since the last decades is characterized by a substantial reduction of inpatient treatment and the expansion and improvement of increasingly specialized community care offers. Yet, at the same time paradoxically we are confronted with an increasing neglect of the special care requirements of a certain group of difficult-to-place patients (mostly severely chronically ill with high rates of comorbidity). Despite different social and legal conditions this has uniformly led to an increasing shift of these patients into the forensic system which is illustrated by a comparison of international and Austrian data. Forensic psychiatry is hardly able to cope with this development because of structural and personal deficits existing and is in danger of being misused primarily as an instrument of social control. From the position of forensic psychiatry the limits of deinstitutionalization are set by the feeling of responsibility of general psychiatry for a subgroup of troublesome and difficult to treat patients.