Depression and pain comorbidity: a literature review

Because depression and painful symptoms commonly occur together, we conducted a literature review to determine the prevalence of both conditions and the effects of comorbidity on diagnosis, clinical outcomes, and treatment. The prevalences of pain in depressed cohorts and depression in pain cohorts are higher than when these conditions are individually examined. The presence of pain negatively affects the recognition and treatment of depression. When pain is moderate to severe, impairs function, and/or is refractory to treatment, it is associated with more depressive symptoms and worse depression outcomes (eg, lower quality of life, decreased work function, and increased health care utilization). Similarly, depression in patients with pain is associated with more pain complaints and greater impairment. Depression and pain share biological pathways and neurotransmitters, which has implications for the treatment of both concurrently. A model that incorporates assessment and treatment of depression and pain simultaneously is necessary for improved outcomes.     

Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial

Context  Depression and arthritis are disabling and common health problems in late life. Depression is also a risk factor for poor health outcomes among arthritis patients. Objective  To determine whether enhancing care for depression improves pain and functional outcomes in older adults with depression and arthritis. Design, Setting, and Participants  Preplanned subgroup analyses of Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), a randomized controlled trial of 1801 depressed older adults (=" BORDER="0">60 years), which was performed at 18 primary care clinics from 8 health care organizations in 5 states across the United States from July 1999 to August 2001. A total of 1001 (56%) reported coexisting arthritis at baseline. Intervention  Antidepressant medications and/or 6 to 8 sessions of psychotherapy (Problem-Solving Treatment in Primary Care). Main Outcome Measures  Depression, pain intensity (scale of 0 to 10), interference with daily activities due to arthritis (scale of 0 to 10), general health status, and overall quality-of-life outcomes assessed at baseline, 3, 6, and 12 months. Results  In addition to reduction in depressive symptoms, the intervention group compared with the usual care group at 12 months had lower mean (SE) scores for pain intensity (5.62 [0.16] vs 6.15 [0.16]; between-group difference, -0.53; 95% confidence interval [CI], -0.92 to -0.14; P = .009), interference with daily activities due to arthritis (4.40 [0.18] vs 4.99 [0.17]; between-group difference, -0.59; 95% CI, -1.00 to -0.19; P = .004), and interference with daily activities due to pain (2.92 [0.07] vs 3.17 [0.07]; between-group difference, -0.26; 95% CI, -0.41 to -0.10; P = .002). Overall health and quality of life were also enhanced among intervention patients relative to control patients at 12 months. Conclusions  In a large and diverse population of older adults with arthritis (mostly osteoarthritis) and comorbid depression, benefits of improved depression care extended beyond reduced depressive symptoms and included decreased pain as well as improved functional status and quality of life.      

Changes in transport functions of isolated rabbit choroid plexus under the influence of oestrogen and progesterone

Isolated choroid plexuses from rabbits were used to determine uptake and accumulation of 10^-5 M radiolabelled choline (expressed as tissue/medium ratio) and the activities of various types of ATPases (based on ouabain inhibition and bicarbonate stimulation) following pre-treatment of the animals with 0.5 mg kg^-1 17-β-oestradiol, alone or in combination with 2 mg kg^-1 progesterone. The combined treatment reduced the choline uptake by 35% and also lowered the activity of Na⁺, K⁺-ATPase by 31%, without influencing tissue wet weight. The reduction in HCO₃-ATPase was smaller and not statistically significant. There was a tendency also for oestrogen alone to lower these activities, but only by less than 20%. The Ca²⁺, Mg²⁺-ATPase activity was not significantly affected by any of the hormones.     

HEMIMEGALENCEPHALY: A CLINICOPATHOLOGICAL STUDY OF FOUR CASES

Pathological findings in four cases of hemimegalencephaly are presented. These cases demonstrated diffuse enlargement of the cortex with disappearance of horizontal layering of the neurons restricted to one hemisphere. In all cases there was marked enlargement of a high percentage of neurons. The nosological situation is discussed and is considered to be heterogeneous; cases 1-3 had cerebral lesions without lesions of the skin or viscera. In these three cases, significant glial abnormalities were found in only one. These cases and others quoted in the literature were considered to be a separate entity completely different from Bourneville's tuberous sclerosis. The aetiology of this developmental malformation remains unknown; genetic factors were not found. Case 4 was associated with a cardiac lesion and with a linear sebaceous naevus characteristic of Solomon's syndrome. Periventricular tumours resembling candlewax drippings were noted. This case, close to Bourneville's disease, could be incorporated into the framework of neuroectodermoses together with tuberous sclerosis.     

A comparative study on the uptake and subsequent decarboxylation of monoamine precursors in cerebral microvessels

The endothelial cells and pericytes of brain microvessels (capillaries and small veins) are equipped with an enzymatic barrier, impeding the passage of circulating amino acids, such as amine precursors, into the brain. The properties of this mechanism was studied in brain slices and isolated microvessels from various species including man and also fetal material, following incubation in dihydroxyphenylalanine (DOPA), 5-hydroxytryptophan (5-HTP) and dihydroxyphenylserine (DOPS). A stereospecific, energy-dependent uptake leading to accumulation in the brain microvessel walls was found in all species studied; this process was found to exist already prenatally. The capacity of decarboxylation, the second step in the trapping mechanism at the blood-brain interphase, showed considerable species variation. The enzyme was present also in fetal brain microvessels. Inhibition experiments provided support for the presence of monoamine oxidase, but absence of catechol-O-methyl transferase, in the microvessel walls.     

Endothelial-related coagulation in cardiac surgery

The endothelium appears to play an important degrees in theregulation of intravascular coagulation. Thrombomodulin is oneof the anticoagulant substances that is expressed by endothelialcells. The influence of age and illness on the thrombomodulin-proteinC system was studied prospectively in 80 cardiac surgery patients.Patients > 70 yr old (n = 20) were compared with patients< 50 yr (n = 20) (group I), and patients undergoing a simplecardiac procedure (n = 20) were compared with patients scheduledfor complex surgery (n = 20) (group II). Thrombomodulin (normal<40 ng ml^–1 protein C and (free) protein S plasma concentrationswere measured by enzyme-linked immunosorbent assays (ELISA)after induction of anaesthesia (baseline values), during andafter cardiopulmonary bypass (CPB), at the end of surgery, 5h after CPB and on the first day after operation. Blood lossand use of homologous blood and blood products were significantlygreater in patients > 70 yr and in those undergoing complexsurgery. At baseline, thrombomodulin concentration was increasedin patients undergoing complex surgery (mean 52 (SD 9) ng ml^–1After bypass and after operation, thrombomodulin increased mostin patients > 70 yr (from 40 (8) to 78 (10) ng ml^–1and in those patients who underwent complex cardiac operations(from 52 (8) to 79 (10) ng ml^–1 (P < 0.05). Changesin protein C and protein S concentrations were similar in allgroups. On the first day after operation only, protein C concentrationswere reduced in patients > 70 yr and in patients who underwentcomplex cardiac surgery. Older patients and those who underwentcomplex cardiac surgery had greater changes in the thrombomodulin-proteinC system which may contribute to increased postoperative bloodloss.