1,721,134 research outputs found
Depression in epilepsy: symptom or syndrome?
No full textAn occurrence of depression or depressive symptomatology has been reported in 30% of patients with epilepsy. Depression has been reported peri- and interictally. To make a differentiation may be difficult in patients with frequent seizures. However, complex partial seizures, particularly if are located on temporal lobe, appear to be etiologic factors, especially in men with left-sided epileptic foci. Depression is also more frequent in patients treated with polytherapy, particularly with phenobarbital and vigabatrin. The depression appears to be endogenous and has also been described in patients with temporal lobectomy. Underlying risk factors (genetic, metabolic, etc) and some psychosocial condition also play a part and may explain the increased rates of depression in patients with epilepsy. Treatment approaches include psychotherapy, rationalization of antiepileptic drug medication and antidepressant treatment. The use of antidepressant treatment, in these patients, still raises uncertainties because of the widespread persuasion that this drugs exacerbated seizures. This adverse event is relatively uncommon at therapeutic dosages, and its incidence with some of most frequently used antidepressant drugs is close to that of spontaneous seizures calculated for the general population, but the incidence may rise up to 30-40% after overdosage. On the basis of the data reported in literature, it appears fair to say that maprotiline and amoxapine show the greatest seizure risk, whereas trazodone, fluoxetine and fluvoxamine show the least. The data also showed that antidepressant drugs may display both convulsant and anticonvulsant effect and it is likely that the most important factor to assess the effect of a given antidepressant drug in terms of inhibition-excitation is drug dosage. Nevertheless, further studies are needed in this field, both to clarify the complex modulating effects of antidepressants on seizure threshold and to identify clearer and safer guidelines to manage the treatment of patients with epilepsy and concomitant depression
Alzheimer disease: primary ischemia concept and promising therapy
No full textThe important role of cerebral blood flow (CBF) in Alzheimer disease (AD) has been increasingly recognized in recent years. An abundance of data (The Rotterdam Study, see text) has shown the decline of CBF velocity with transcranial Doppler, confirming earlier data obtained with the xenon133 method. In spite of these data, AD is still considered a neurodegenerative disorder with secondary CBF changes.
This work is a critical evaluation of earlier literature because of cogent reasons for the adoption of a new concept of AD as a primary ischemic disorder.
Reports of lacking correlation between severity of CBF deficit and degree of tissue damage or clinical findings serve as evidence for primary ischemia because of the incompatibility with the concept of secondary ischemia.
The CBF deficit in is thought to be due to the human upright gait in heretopredisposed individuals. As to therapy and prevention, a very simple, cheap and promising treatment is suggested (head-down-therapy)
Omega-3 fatty acids and schizophrenia: evidences and recommendations
No full textSchizophrenia is a brain disease that represents a not rare condition, in fact the lifetime risk of developing schizophrenia is widely accepted to be around 1 in 100. Schizophrenia clinically manifests with acute episodes which are associated with hallucinations, delirium, behavioral disorders and a variable range of chronic persistent symptoms, which can be debilitating. The causes of schizophrenia are not clearly understood. It seems that genetic factors may produce a vulnerability to schizophrenia, along with environmental factors that contribute in a different way from individual to individual. In this context schizophrenia represents the outcome of a complex interaction between multiple genes and environmental risk factors, none of which on its own causes the disorder itself.
Antipsychotic medications represent the first line of psychiatric treatment for schizophrenia. But there is a growing body of evidence that omega-3 fatty acids can prevent the disease or at least mitigate the course and symptoms. Probably, an appropriate dietary supplementation can play a partially therapeutic effect, even in more severe patients, improving some behavioral aspects and, mainly, reducing the cognitive deterioration. In this context the role of omega-3 fatty acids as a treatment for schizophrenia will strengthen the thrust of researchers and clinicians to the integrated approach to the prevention and cure of a disease that for more than a century challenging researchers
An update on pharmacotherapy for personality disorders
No full textPersonality disorders are common and present in many medical settings. Prevalence ranges between 4% and 15%, both in men and in women [1 Tyrer P, Reed GM, Crawford MJ. Classification, assessment, prevalence, and effect of personality disorder. Lancet. 2015;385:717–726.
[CrossRef], [PubMed], [Web of Science ®]
]. The highest prevalence has been reported in people followed by with health-care services and in people in contact with the criminal justice system. Patients with personality disorders have higher morbidity and mortality than others, partly because they present an increased incidence of suicide and homicide, partly for poor research for care and lifestyle factors that amplify the risk for cardiovascular and respiratory diseases. Many patients suffer from multiple personality disorders or traits that span several types of disturbances; besides significant comorbidity exists with alcohol and chemical abuse, and with anger traits [2 Angstman KB, Rasmussen NH. Personality disorders: review and clinical application in daily practice. Am Fam Physician. 2011;84(11):1253–1260.
[PubMed], [Web of Science ®]
]. Problems in coping with interpersonal relationships that are at the heart of the majority of personality disorders can also affect therapeutic relationships.
Experts generally agree that personality disorders have roots in childhood and adolescence, but many clinicians avoid the diagnosis at early ages for the fear of stigmatizing patients. The 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes the dimensional nature of personality disorders across the lifespan and has removed age-related caveats for this diagnosis in young people.
There is evidence that patients with personality disorders are prescribed psychotropic medications with greater frequency than any other diagnostic group. Nevertheless, since in the USA there are no FDA-approved medication for the treatment of these disorders, pharmacotherapy usually results off-label and pharmacological strategies remain lacking [3 Ripoll LH, Triebwasser J, Siever LJ. Evidence-based pharmacotherapy for personality disorders. Int J Neuropsychopharmacol. 2011;14:1257–1288.
[CrossRef], [PubMed], [Web of Science ®]
]. Evidence-based practice recommends a combined approach including both psychotherapy and pharmacotherapy. It seems very difficult to translate present research into precise clinical recommendations for the treatment of personality disorders. This is due to different study limitations: considered populations of patients are heterogeneous, because of many assessment criteria used; there are small sample sizes and short follow-up; there is generally poor control of coexisting comorbidity with other mental illnesses [4 Bateman AW, Gunderson J, Mulder R. Treatment of personality disorder. Lancet. 2015;385:735–743.
[CrossRef], [PubMed], [Web of Science ®]
].
The use of psychotropic agents in the treatment of personality disorders derives from the observation that behavioral traits associated with personality disorders may be related to neurochemical alterations of the central nervous system. Notwithstanding it is reasonably supposed that these behavioral traits could respond to drugs, this psychobiological model remains largely underestimated. At present, drug choices only address specific aspects of personality disorder’s pathological effects, such as affective instability and cognitive disturbances.
Another important goal is the process of collaboration with patients. Many patients show demanding, aggressive, dependent, or manipulative behaviors, and for such a reason, physicians often feel frustrated, irritated, or helpless [2 Angstman KB, Rasmussen NH. Personality disorders: review and clinical application in daily practice. Am Fam Physician. 2011;84(11):1253–1260.
[PubMed], [Web of Science ®]
]. A core strategy for experts is an intervention based on active listening and construction of a collaboratively developed crisis and safety plan. It is important, for example, to not confuse the chronic loneliness and emptiness of some personality disorders with depressive symptoms, and to accurately take into account that most often the crises could pass very quickly. To establish an open collaborative relationship with the patient may be more important than the actual medication chosen
Depression and suicide in epilepsy: Fact or artefact?
No full textThere is evidence that depression is the most frequent
comorbid psychiatric disorder in epilepsy and a history of
depression is associated with a 4- to 6-fold greater risk of
developing epilepsy. Epilepsy, on the other hand, as a chronic
and stressful disease, represents a risk factor for developing
depression. These data suggest either a possible “bi-directional”
relationship between these two disorders or the presence of
common pathogenic mechanisms that facilitate the occurrence
of one in the presence of the other [10]. So the question is: Is
the association between depression and suicide in epilepsy a
fact or an artefact?We do not yet knowwhether a bi-directional
relationship exists between depression and epilepsy, and we
need to identify common mechanisms that facilitate depression
associated with epilepsy and epilepsy associated with
depression. We found no difference across the depression
and temporal lobe epilepsy groups in the depression
inventories and risk for suicide. Further research is needed to
clarify the impact of depressive symptoms in people with
epilepsy, such as the presence of suicidal risk factors, suicidal
ideation and suicide attempts in these patients as correlates of
depression or as psychopathological features directly associated
to epileptic disease
Better Understanding of Bipolar Disorder from Clinical Expression to Therapeutic Strategies
No full textBipolar disorder is a psychiatric disease that involves profound changes in mood accompanied by severe changes in feelings, thoughts and behaviors: emotions can move quickly from a deep depression to excessive excitement, without some apparent reason. BD is usually a chronic condition and may last for life with recurring episodes that often occur during adolescence or early adulthood, sometimes during childhood and usually requires treatment for life.
In the manic phase the disorder typically occurs in forms of exasperated disinhibition and manic symptoms may include: an euphoric mood or irritable, angry and reactive state of mind; increased activity and feelings of strength and energy; ambitious and grandiose aspirations; poor self-criticism; greater interest in sexual activity and reduction in hours of sleep and need for sleep.
On the other hand, depressive phases may be so serious that can also lead to episodes of self-harm. Depressive symptomatology may include: depressed or apathetic mood; reduced strength in activities, thinking and talking; feeling of being hopeless and helpless; pessimistic approach to reality, sometimes, with suicidal thoughts; alteration in the rhythm of appetite and in sleep patterns.
Although it is not known a definitive cure, BD is a very treatable disease that can be kept under control. Drugs play a key role in the care of persons affected by BD, in particular medications commonly used to treat the manic episodes of bipolar disorder are mood stabilizers. During depressive episodes, people with bipolar disorder can be treated with antidepressants by evaluating administration and dosage with extreme caution because of the risk to switch to a manic phase. In addition to medications psychotherapy and psychoeducational approaches are essential for individuals suffering from bipolar disorder.
At present BD is considered a multifactorial etiology condition in which many physiopathogenetic factors are involved, thus researchers have identified several causes such as biological differences, imbalance of neurotransmitters and hormones, genetic predisposition, traumatic life events, stress and environmental factors
Gut microbiota in women: The secret of psychological and physical well-being
No full textThe gut microbiota works in unison with the host, promoting its health. In particular, it has been shown to exert protective, metabolic and structural functions. Recent evidence has revealed the influence of the gut microbiota on other organs such as the central nervous system, cardiovascular and the endocrine-metabolic systems and the digestive system. The study of the gut microbiota is outlining new and broader frontiers every day and holds enormous innovation potential for the medical and pharmaceutical fields. Prevention and treatment of specific women's diseases involves the need to deepen the function of the gut as a junction organ where certain positive bacteria can be very beneficial to health. The gut microbiota is unique and dynamic at the same time, subject to external factors that can change it, and is capable of modulating itself at different stages of a woman's life, playing an important role that arises from the intertwining of biological mechanisms between the microbiota and the female genital system. The gut microbiota could play a key role in personalized medicine
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