Clinical aspects of depression in chronic pain patients.

It has been widely recognized that an appreciable proportion of chronic pain patients have depressive disorders. Although numerous studies and several literature reviews have examined the relationship between chronic pain and depression, disorders of mood come in many forms, and little attention has been paid to the different types of depressive disorders found among patients with chronic pain. In this article, the different ways in which a chronic pain patient may manifest depression are discussed. Diagnostic criteria for major depression, dysthymia, and atypical depression are described, and the relevance of these disorders and of masked depression to chronic pain is discussed. The medical illnesses and medications that can cause symptoms of depressive disorders are also briefly described. Depressive disorders and their concomitants are an integral part of the experience of chronic pain and are important in developing an optimal treatment plan. For these reasons, they should be carefully evaluated in all patients with chronic pain.     

Psychologic and physiologic aspects of depression

Depression is a serious condition that will be encountered by most nurses regardless of their specialty area or practice setting. There is good empirical support for biologic and psychologic models of depression. This article discusses how symptom management is enhanced through a combination of psychotherapeutic and somatic treatments.     

Clinical aspects of hemochromatosis

Hemochromatosis is one of the most frequent genetic diseases among the white populations, affecting one in three hundred persons. Its diagnosis has been radically transformed by the discovery of the HFE gene. In a given individual, the diagnosis can, from now on, be ascertained on the sole association of a plasma transferrin saturation (TS) over 45% and homozygosity for the C282Y mutation. Liver biopsy is only required to search for cirrhosis whenever there is hepatomegaly and/or serum ferritin >1000 ng/ml and/or elevated serum AST. Family screening is mandatory, primarily centered on the siblings. The treatment remains based on venesection therapy which improves many features of the disease (one of the most refractory, however, being the joint signs) and permits normal life expectancy provided the diagnosis is established prior to the development of cirrhosis or of insulin-dependent diabetes. In view of the prevalence, the non-invasive diagnosis, the spontaneous severity and the efficacy of a very simple therapy, hemochromatosis should benefit from population screening. This screening could be based, first, on the assessment of transferrin saturation, followed - when elevated - by the search for the C282Y mutation. The discovery of the HFE gene has also paved the road for the individualization of other types of iron overload syndromes which are not HFE-related.     

卒中后抑郁临床研究

目的探讨卒中后抑郁的发生率及其与神经功能缺损的关系,评价联合氟西汀治疗的疗效及安全性。方法对184例脑卒中患者采用汉密尔顿抑郁量表进行测试,确诊为抑郁症的78例患者随机分为两组各39例,两组均给予脑血管病常规治疗,研究组在此基础上联用氟西汀20mg·d-1治疗,疗程为60d。于治疗前及治疗2、4、8w末采用汉密顿抑郁量表进行评定分析。结果脑卒中抑郁发生率为42.4%。神经功能缺损重者,抑郁发生率高。治疗前两组间汉密顿抑郁量表评分无显著性差异(P>0.05),治疗2、4、8w末研究组评分均明显下降,与对照组比较均有极显著性差异(P0.01),且评分改善随时间的延长更明显。结论脑卒中后抑郁症应在积极治疗原发病的同时及时给予抗抑郁剂治疗。     

Clinical aspects of perimenstrual headaches

Menstrual migraine (MM) is either pure, if attacks are limited solely during the perimenstrual window (PMW), or menstrually related (MRM), if two of three PMWs are associated with attacks with additional migraine events outside the PMW. Acute migraine specific therapy is equally effective in MM and non-MM. Although the International Classification of Headache Disorders-Iiclassifies MM without aura, data suggest this needs revision. The studies on extended-cycle oral contraceptives suggest benefits for headache-prone individuals. Triptan mini-prophylaxis outcomes are positive, but a conclusion of “minimal net benefit compared to placebo” is not entirely unwarranted. In a 2008 evidence-based review, grade B recommendations exist for sumatriptan (50 and 100 mg), mefenamic acid (500 mg), and riza triptan (10 mg) for the acute treatment of MRM. For the preventive mini-prophylactic treatment of MRM, grade B recommendations are provided for transcutaneous estrogen (1.5 mg), frovatriptan (2.5 mg twice daily), and naratriptan (1 mg twice daily).