1/11. Successful antidepressant treatment for five terminally ill cancer patients with major depression, suicidal ideation and a desire for death.In the debate on euthanasia and physician-assisted suicide, we have to exclude terminally ill patients in whom the desire for death is caused by major depression. However, it is still not clear to what degree major depression can be treated by psychiatric intervention in this setting. We evaluated the effect of antidepressant treatment in terminally ill cancer patients. Six cancer patients with suicidal ideas thought to be due to major depression were treated with tricyclic antidepressants. Three had requested terminal sedation to relieve them from their suffering. The median survival of five of these patients was 4 weeks after diagnosis; one was lost to follow-up. The efficacy of the antidepressant treatment was assessed using the Hamilton Rating Scale for depression (HRSD). One week after the start of treatment with antidepressants, five of the six patients showed a marked improvement in their mood and showed no further suicidal thoughts or requests for terminal sedation. The average reduction in the HRSD score was 23.4 points (14-38; SD = 9. 9). Antidepressant treatment can be effective in alleviating the desire for death due to major depression, even in terminally ill cancer patients.- - - - - - - - - - ranking = 1keywords = mood (Clic here for more details about this article) |
2/11. Delirious mania in the elderly.Delirious mania is a clinical syndrome in which the signs and symptoms of delirium manifest themselves in the context of a manic episode. Though there have been numerous descriptions and case reports of this syndrome, all have described mania as the presenting feature, with signs of delirium developing subsequently, and none of the vignettes have involved elderly patients. We report two cases of elderly individuals with mania who initially presented as in a delirium. Both of them experienced clear manic episodes, which were confirmed by their psychiatric histories and clinical responses to mood stabilizers. Mania needs to be in the differential diagnosis of elderly people presenting with confusion, disorientation, and perceptual changes, particularly in those with a history of bipolar disorder.- - - - - - - - - - ranking = 1keywords = mood (Clic here for more details about this article) |
3/11. Treatment of mania in dementia with electroconvulsive therapy.Symptoms of mania have been given inadequate attention as a source of agitated behavior in the dementia patient. Characterized by elevation in mood or grandiosity, pressured speech, and impulsivity, mania is common among the elderly population, with a prevalence approaching 20% in some studies. Because it is so highly associated with behavioral agitation, mania has a significant impact on patient management, and can often lead to the institutionalization of difficult patients. Here we present a case series of three elderly individuals who had signs of mania in conjunction with dementia. Refractory to psychotropic medications, all were given an acute plus maintenance courses of right-unilateral electroconvulsive therapy (ECT). The patients achieved significant improvement in signs of mania and agitation, as well as in mental status scores. We conclude that a short course of ECT, followed by maintenance treatments every 2 weeks, can contribute significantly to the management of dementia patients whose behavioral agitation is associated with signs of mania.- - - - - - - - - - ranking = 1keywords = mood (Clic here for more details about this article) |
4/11. Clinical approach to agitation after electroconvulsive therapy: a case report and literature review.Agitation is a neurologic complication that may occur after electroconvulsive therapy (ECT). Severe agitation after ECT has been associated with multiple factors, both anesthetic and psychiatric. This case report describes severe postictal agitation after ECT in a patient with bipolar affective disorder. The clinical management of this challenging presentation is discussed, including both the anesthetic and psychiatric approaches.- - - - - - - - - - ranking = 144.71043915217keywords = affective disorder, affective (Clic here for more details about this article) |
5/11. kluver-bucy syndrome and psychiatric illness.A 52-year-old woman, whose initial psychiatric presentation at the age of 15 was with a disorder resembling schizophrenia, developed symptoms of kluver-bucy syndrome, and is now thought to suffer from an organic psychotic disorder. kluver-bucy syndrome must be distinguished from symptoms of schizophrenia or affective disorder; its presence suggests an organic process.- - - - - - - - - - ranking = 144.71043915217keywords = affective disorder, affective (Clic here for more details about this article) |
6/11. Akinesia and postpsychotic depression: a difficult differential diagnosis.Detailed clinical case descriptions highlight the potential symptomatic overlap between the syndromes of akinesia and postpsychotic depression in neuroleptic-treated patients. The cases demonstrate that both syndromes may resemble major depression phenomenologically. However, the syndromes are not identical in medication response. Thus, differential medication response may potentially be a useful tool in teasing apart the various postpsychotic depressionlike states in the course of schizophrenia or schizoaffective disorder.- - - - - - - - - - ranking = 144.71043915217keywords = affective disorder, affective (Clic here for more details about this article) |
7/11. The psychiatry of vertebro-basilar insufficiency with the report of a case.Vertebro-basilar insufficiency produces a rich spectrum of psychological and neurological symptoms. Where psychological symptoms dominate the picture, the patient may be presented first to a psychiatrist. The phenomenology of vertebro-basilar insufficiency is discussed with special reference to hallucinatory syndromes, memory disturbance, affective disorders, akinetic mutism, 'unusual reports', cortical blindness, agitated delirium, the capgras syndrome and normal pressure hydrocephalus. Finally, the case of a 61-year-old man illustrating a variety of the neurological and psychological features described in this paper is presented.- - - - - - - - - - ranking = 144.71043915217keywords = affective disorder, affective (Clic here for more details about this article) |
8/11. ECT as a therapeutic option in severe brain injury.electroconvulsive therapy (ECT) is a safe, highly effective, and rapidly acting treatment for certain major psychiatric illnesses, most notably severe mood disorders. Disturbances in mood and behavior as symptoms of delirium may complicate recovery from traumatic brain injury, but virtually no data exist on the role of ECT as a treatment modality in such clinical situations. We describe a patient with severe, unremitting, agitated behavior following a severe closed head injury from a motor vehicle accident. The initial glasgow coma scale score was 3, with computed tomographic evidence of bilateral frontal and left thalamic contusions. After awakening from a 21-day coma, the patient failed to improve beyond a Ranchos Los Amigos level 4 recovery stage. He exhibited persistent severe agitation with vocal outbursts and failed to assist in performing activities of daily living. His difficulties proved unresponsive to combined behavioral therapy and multiple trials of various psychopharmacologic agents. As an intervention of "last resort," he then received six brief-pulse, bilateral ECT treatments that resulted in marked lessening of his agitation and improvement in his ability to express his needs and participate in his self-care. Also, following the ECT, he showed a markedly enhanced response to psychopharmacologic agents. These findings may have important clinical implications for treatment of prolonged delirium after traumatic brain injury.- - - - - - - - - - ranking = 2keywords = mood (Clic here for more details about this article) |
9/11. Benign partial epilepsy with affective symptoms: hyperkinetic behavior during interictal periods.We report a 4-year-old boy with benign partial epilepsy (BPE) with affective symptoms associated with hyperkinetic behavior during interictal periods. He had had hypermobility and restlessness since about age 3. At 4 years, 6 months, he developed episodes consisting of an expression of terror without complete loss of consciousness. Although we first suspected an acute psychic problem, the ictal EEG was abnormal. After carbamazepine (CBZ) therapy, the frequency of the attacks decreased dramatically and the hyperkinetic behavior gradually diminished.- - - - - - - - - - ranking = 108.70361284436keywords = affective (Clic here for more details about this article) |
10/11. Rapid cycling in severely multidisabled children: a form of bipolar affective disorder?A debilitating, regularly recurring, biphasic disorder is described in 6 severely multidisabled children. It was characterized by several days of lethargy, withdrawal, loss of abilities, irritability, and hypersomnolence followed or preceded by a high-energy state for several days during which the children slept very little, at times were euphoric, had improved mental ability, and were hyperactive. These cyclic episodes had been present for years but unexpectedly disappeared in one child. The etiology is unknown, in spite of detailed neurologic, metabolic, and endocrine investigations. All patients had family histories positive for affective disorder. melatonin treatment helped to regulate the coexisting chronic sleep disorders of 3 children but failed to eliminate the cycles. Antiepileptic drug treatment, lithium, sedatives, stimulants, tranquilizers, and light therapy were largely ineffective. The children's symptoms and signs fit the diagnostic criteria of a bipolar affective illness, as it was modified for patients with associated neurologic disability; therefore, the patients appeared to have a unique disorder that closely resembles or is a variant of rapid cycling affective disorder.- - - - - - - - - - ranking = 890.00335748192keywords = affective disorder, affective (Clic here for more details about this article) |
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