Mood disorders, following

Angst F, Stassen HH, Clayton PJ, et al Mortality of patients with mood disorders follow-up over 34—38 years. J Affect Disord 68 167—181, 2002... 

Compared to antipsychotics, there are even fewer studies on the prescribing patterns of antidepressants done in Asian countries. Pi etal. (1985) conducted a survey of psychotropic prescribing practices reported by psychiatrists in 29 medical schools in 9 Asian countries. Daily dose range of tricyclic antidepressants (TCAs) such as amitriptyline, imipramine, and nortriptyline in Asian countries was comparable to the practice in USA. This is despite differences found between Asian and non-Asian populations in the pharmacokinetics of TCAs (Pi et al, 1993). A questionnaire on the practical prescribing approaches in mood disorders administered to 298 Japanese psychiatrists was reported by Oshima et al. (1999). As first-line treatment, the majority of respondents chose newer TCAs or non-TCAs for moderate depression and older TCAs for severe depression. Combination of antidepressants and anxiolytics was preferred in moderate depression, while an antidepressant and antipsychotic combination was common in severe psychotic depression. Surprisingly, sulpiride was the most favored drug for dysthymia. In a naturalistic, prospective follow-up of 95 patients with major depression in Japan, the proportion of patients receiving 125 mg/day or less of imipramine was 69% at one month and 67% at six months (Furukawa et al., 2000). 

Other abnormalities are more trait-like, and persist following symptom remission. They are found in orbital and medial prefrontal cortex areas where postmortem studies have also documented reductions in cortex volume and histopathologic changes in primary mood disorders [68], Evidence from brain mapping, lesion analysis and electrophysiologic studies of humans and experimental... 

Perino C, Rago R, Cicolin A, et al. Mood and behavioural disorders following traumatic brain injury clinical evaluation and pharmacological management. Brain Injury 2001 15(2) 139-148. 

In 1992, an open study of 22 psychiatric inpatients, ages 5 to 12 years, with disruptive behavioral and mood disorders were treated with trazodone. The results revealed a significant decrease in aggressive and impulsive behaviors in 13 of the patients following therapy with trazodone (Zubieta and Alessi, 1992). 

P., Jeammet, P., Allilaire, J.E, and Basquin, M. (2000) Absence of cognitive impairment at long-term follow-up in adolescents treated with ECT for severe mood disorders. Am J Psychiatry 157 460-162. 

Aggression is an important component of mood disorders. Thus, a measure that captures the frequency and severity of the child s outbursts, such as the Overt Aggression Scale (OAS Yudofsky et ah, 1986), may be useful. This rating was evaluated in one inpatient study, and appears to be reliable and valid (Kafantaris et ah, 1996). Behavior disorder rating scales that measure ADHD and ODD are also likely to be useful. As noted above, our clinic uses a combined Child and Adolescent Symptom Inventory both at baseline and to follow treatment response, as it provides a comprehensive rating of symptoms (Grayson and Carlson, 1991 Gadow et al., 1999). 

What then, is the current evidence to support a role of norepinephrine in depression, such that manipulation of noradrenergic activity bears particular relevance to the successful treatment of mood disorders Interpretation of studies depends on the continually evolving conceptualizations of the roles of brain noradrenergic systems. A potentially useful way of thinking about the function of the norepinephrine in the brain can be derived from examining the neuroanatomy of the noradrenergic system. A summary of findings [primarily from rodents and primates) is as follows. 

Chronic dysthymia followed by major depressive disorder ( double depression ) Prompt relapse following prior treatment discontinuation Strong positive family history of recurrent mood disorders Coexisting medical problems or complication of aging that would make a future episode hazardous... 

Cohen LS, Eriedman JM, Jefferson JW, et al A reevaluation of risk of in utero exposure to lithium. JAMA 271 146-150, 1994 Coppen A, Abou-Saleh MX, Milln P, et al Lithium continuation therapy following electroconvulsive therapy. Br J Psychiatry 139 284-287, 1981 Coyle JT, Duman RS Finding the intracellular signaling pathways affected by mood disorder treatments. Neuron 38 157-160, 2003 Dean JC, Penry JK Valproate, in The Medical Treatment of Epilepsy. Edited by Resor SR Jr, Kutt H. New York, Marcel Dekker, 1992, pp 265-278... 

Mood disorders are frequently associated with cognitive impairment. In younger depressives attention and concentration are primarily affected, and responses in speed-related tasks may be abnormally slowed. Complaints about serious cognitive dysfunction, which are particularly frequent in older patients with depression, cannot always be fully substantiated by means of objective tests (O Hara et al., 1986). Nevertheless, significant deficits in the following areas have been found ... 

In the search for specific neurophysiological markers of idiopathic psychiatric syndromes (e.g., schizophrenia, major mood disorders), studies have reported various nonspecific EEG abnormalities. In addition, psychiatric patients appear more sensitive to activation procedures such as the following ... 

Longitudinal follow-up of carefully defined schizophrenia shows that approximately 95% have a lifetime illness and are rarely rediagnosed later as having a mood disorder (32, 33). They also often had the following characteristics ... 

Black and colleagues (37) studied suicide in subtypes of major mood disorders and compared them with the general population in Iowa. They found an increased risk in all psychiatric groups except for female patients with bipolar mood disorder, which was associated with a lower risk in comparison with unipolar disorders. Seventy-three percent of all suicides occurred during the first few years of follow-up. This trend was particularly pronounced in primary unipolar female patients and bipolar male patients. 

It is important to consider explanatory precipitants in a patient with no prior history of a mood disorder. Clearly, the diagnosis of bipolar mania should not be made if the syndrome can be explained by known organic factors, which vary widely and include the following ... 

Schizophrenia-related disorders, such as schizophreniform disorder, can closely mimic an acute exacerbation of mania. Attention to premorbid personal and family history may help differentiate them from mood disorders. A definitive diagnosis may not be possible, however, until the course of the illness is followed for a period of time. Clinical clues include the propensity of bipolar manics (in contrast to schizophrenics) to demonstrate pressured speech, flight of ideas, grandiosity, and overinclusive thinking. Hallucinations are less common than delusions in both mania and depression, with delusions normally taking on the qualities of expansivity, hyperreligiosity, or grandiosity. Delusions are also relatively less fixed than in schizophrenia. 

It is becoming increasingly evident that prevention of relapse, as well as adequate prophylactic strategies for patients with major mood disorders, are much more complicated than was originally assumed. Factors that contribute to this situation include the following ... 

Although lithium has been a major advance in the pharmacotherapy of severe mood disorders, a number of problems limit its usefulness, including the following ... 

Clozapine Longitudinal Trials. In a naturalistic study design, Banov et al. (300) found clozapine was an effective long-term treatment in mood disorders, particularly nondepressed affective patients. After a chart review, the authors identified 193 treatment-resistant patients, including the following ... 

As with the insomnia disorders, hypersomnias may be categorized as primary, as secondary to another mental disorder (e.g., mood disorders, schizophrenia, somatoform disorder, borderline personality disorder), or as secondary to a known organic factor such as the following ... 

The NE system mediates various autonomic, neuroendocrine, emotional and cognitive functions. One of the central roles of NE is response to stress and aversion. This role can be summarized as an activation of response to the acute stress and aversion, followed by decreased reaction to repeated or chronic aversion. Since the response to stress and aversion is a basic part in pathology of mood disorder, NE should play an important role in anxiety, depression and mania. Indeed, this role has been demonstrated in numerous animal and human studies. Majority of antidepressant drugs and mood stabilizers affect NE system as their direct or indirect target. Various medications have different effects on NE neuronal activity. The majority of antidepressants, Li and benzodiazepines suppress NE transmission. Other medications, such as AADs, activate NE neuronal firing activity and NE release. Appropriate combination of different medications, based on the consideration of their effect on NE system, might be critical to obtain good treatment outcome. The combination of SSRIs... 

Mood Disorders. The brain is reported to receive a priority supply of selenium during dietary depletion and/or repletion studies in animals and the turnover of neurotransmitters is altered. This has led to extensive studies of the role of selenium and other antioxidants in senility of the elderly, in epilepsy in children, and in Alzheimer s disease. Marginal selenium depletion has been associated with anxiety, confusion, and hostility, and improvements have been claimed following supplementation." ... 

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