Medical illnesses, depression associated with

Because clove cigarettes also contain tobacco, they carry all of the hazards of regular tobacco smoking (Council on Scientific Affairs 1988). Several cases of serious medical illness have been associated with clove cigarettes in the United States (Guidotti et al. 1989). These include cases of hemorrhagic pulmonary edema, pneumonia, bronchitis, and hemoptysis. Because eugenol anesthetizes the respiratory tract, it inhibits the normal gag reflex and has led to aspiration pneumonia in at least one case. Accidental overdoses in children have led to CNS depression, urinary abnormalities, and anion-gap acidosis. These cases were treated successfully with supportive measures (Lane et al. 1991). 

Mood Disorder Due to a General Medical Condition. Commonly called secondary manias, certain medical and neurological illnesses produce symptoms that mimic mania. Often, secondary manias occur when injury or disease interferes with right-sided brain function. As one might anticipate, this is in contrast to the predilection for left-sided brain injury to be associated with depressive symptoms. 

In this case, a more careful psychiatric and physical examination can be of help. Although there are admitted similarities to depression and the negative symptoms of schizophrenia, Parkinson s disease is also associated with a resting tremor, called cogwheel rigidity, and at times drooling. These other symptoms are not typically due to psychiatric illness. If these symptoms are present, one should investigate the possibility of a medication side effect or the presence of Parkinson s disease. 

TABLE 18-3. Medical illnesses associated with treatment-resistant depression... 

Brown ES, Varghese FP, McEwen BS. Association of depression with medical illness does cortisol play a role Biol Psychiatry. 2004 55 1-9. 

The question of insomnia effects on morbidity is more difficult. Since insomnia complaints are associated with depression, anxiety, neuroticism, and a wide variety of medical illnesses (44,49,54,55), it may be difficult to distinguish effects of insomnia from effects of the comorbid processes. In some cases, medications taken by insomniacs may be responsible for impairment. One attempt to assess disability related to insomnia found no association meeting Bonferroni criteria, after adjustment for age, gender, chronic disease, and major depression (56). It is possible that the trend for association would have been entirely eliminated had control been done for subthreshold depression, which was prevalent in the sample. Although sleep symptoms do predict future depression, they are less... 

Depression and Diabetes Mellitus. Patients with chronic medical illness have a high prevalence of major depressive disorder [59], Depression may be three times more prevalent in the diabetic population when compared with its occurrence in nondiabetic individuals [60], In addition, microalbuminuria, hypertension, and hyperinsulinemia are another three independent risk factors for cardiac disease in non-insulin-dependent diabetes mellitus (NIDDM) [61], Nosadini et al. showed that peripheral insulin resistance, hypertension, microalbuminuria, and lipid abnormalities are associated with NIDDM [61], Further, Helkala et al. determined that cognitive and memory dysfunction are associated with NIDDM and explored the disease s relationship with depression, metabolic control, and serum lipids. The results showed that the NIDDM patients had impaired control of their learning processes [62], Obviously, future research examining the causal relationship of depression to the onset on diabetes and the effect of depression on the natural course of diabetes is needed [60]. 

Sleep in the elderly may also be affected by psychiatric morbidity. Psychiatric disorders, particularly major depressions, are not only associated with disturbed sleep but can also greatly impact both self-report and objective ratings of sleep quantity and quality [5], Depressive symptoms are common in older adults, especially among persons who are medically ill, bereaved, or cognitively impaired, but by no means always associated with disrupted sleep. In AD patients seen in clinical psychiatric settings, rates of major depression as high as 86 % have been reported, but the majority of studies report more modest rates of 17-29 %. 

Depressive illness constitutes one of the most frequently seen mental disorders. The morbidity and mortality associated with alteration of mood is one of the major problems facing behavioral health professionals, with the U.S. National Comorbidity Study of 1994 showing a lifetime prevalence of major depression of 12.7 percent in males and 21.3 percent in females. Most mood disorders are chronic and require long-term management. Pharmacotherapy continues to be a mainstay treatment of depression. Because depressant mood disorders are so prevalent in our society, antidepressant drugs are among the most frequently prescribed medications. 

Major depression is a common psychiatric illness associated with significant morbidity [25]. The illness is usually episodic and manifests with a depressed mood reduced energy changes in appetite, sleep, and concentration and psychological symptoms, such as reduced self-esteem and suicidal ideation. As many as 10% of people may experience a depressive episode at some point in their lives, with women more commonly affected than men. Despite its frequency, more than half of the patients with this illness remain untreated [26]. Unfortunately, the longer the duration of the illness, the poorer the outcome, with an increased rate of recurrence [27]. Effective treatment for depression has been available for nearly two generations. Older medications, the tricyclic antidepressants and... 

Anxiety is a symptom of many psychiatric disorders and an almost inevitable component of many medical and surgical conditions. Symptoms of anxiety commonly are associated with depression and especially with dysthymic disorder (chronic depression of moderate severity), panic disorder, agoraphobia and other specific phobias, obsessive-compulsive disorder, eating disorders, and many personality disorders. Sometimes, no treatable primary illness is found, or if one is found and treated, it may be desirable to deal directly with the anxiety at the same time. In such situations, antianxiety medications are frequently and appropriately used. 

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