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Clinical presentation of depression in the elderly
Published in Simon Lovestone, Robert Howard, Depression in Elderly People, 2020
Simon Lovestone, Robert Howard
Increased activity, relentless pacing, incessant hand wringing can all point to a picture of agitated depression. This presentation is particularly difficult for relatives, and the elderly spouse of a person with agitated depression and insomnia should be drawn aside and assessed in their own right. The spouse will, not Infrequently, be found to be exhausted and to be suffering from some aspects of depression themselves. The management of the elderly agitated depressed patient (and indeed other syndromes of depression) will include consideration of measures designed to support the spouse such as day respite care.
Clinical Theory and Skills EMIs
Published in Michael Reilly, Bangaru Raju, Extended Matching Items for the MRCPsych Part 1, 2018
Each option may be used once, more than once or not at all.Choose the term above that best fits each of the following statements on endocrine disturbances that are commonly associated with neuropsychiatric manifestations.A young female is admitted for the treatment of agitated depression. She also has hot sweaty palms, tremor and tachycardia. This bedside examination is a useful sign in distinguishing between functional and organic disorder.In this endocrine disturbance, the psychiatric features are related to the serum calcium level.Insidious onset of weakness, fatigue, weight loss, gastrointestinal symptoms, depression, mild cognitive impairment and hyperpigmentation on the exposed areas and skin creases suggest this endocrine disease.
Psychiatric Diagnosis: The State of the Art
Published in Mark S. Gold, R. Bruce Lydiard, John S. Carman, Advances in Psychopharmacology: Predicting and Improving Treatment Response, 2018
Robert Moreines, Irl Extein, Mark S. Gold
Major depression with delusions is another disorder where past history information assumes crucial importance. It is generally accepted that these patients do not respond well to antidepressants alone and require either ECT or combination treatment with TCA and neuroleptics.32 Moreover, Roose has recently reported that this group of patients represents the most serious risk for suicide.46 It is often difficult to demonstrate the presence of delusions, and frequently they will be suppressed but present in a patient with severe agitated depression. In this respect, it is noteworthy that some clinicians recommend initiating treatment with neuroleptics for an agitated depression as it provides prompt relief of the most troublesome symptoms.26
Olfactory bulbectomy and raphe nucleus relationship: a new vision for well-known depression model
Published in Nordic Journal of Psychiatry, 2020
Halil Ozcan, Nazan Aydın, Mehmet Dumlu Aydın, Elif Oral, Cemal Gündoğdu, Sare Şipal, Zekai Halıcı
Removal of the olfactory bulbs (OBs) has been shown to cause depressive-like behaviors in animals (OBX) [10–12]. OBX, a well-known animal model of depression including hyposerotonergic-agitated depression [11–13], applied by the bilateral destruction of the OBs, may produce neurochemical and behavioral changes similar to those of depressed patients [12–16]. The lesion caused by OBX may induce a reorganization process in the rodent limbic and cortical areas that might be responsible for behavioral abnormalities, e.g. increased hyperactivity in a novel environment, deficits in passive-avoidance learning, and leading anhedonia [17,18]. Also in researches, olfactory deficits were detected in depressed patients and the severity of the olfactory deficits was found to be correlated with the severity of depressive symptoms [2,3,19–23]. Neuroimaging studies found reduced OB volume and olfactory sensitivity in depressive patients [20]. Although there is a well-known relationship between depressive behaviors, cognitive functions and olfactory system structures that also includes OBs. [21]. Mechanism of this relationship still remains unclear. In this point, all these findings indicate that olfactory system might have a crucial role on mood regulation especially depression and a new connectivity perspective may help to understand the relationship between olfaction and depression and the role of OBs on depression and emotional data information process [24]. Also, in recent studies, volume loss in OBs among depressed patients was found and the volume loss in OBs was suggested as a marker for depression [25,26].
Deutetrabenazine for tardive dyskinesia and chorea associated with Huntington’s disease: a review of clinical trial data
Published in Expert Opinion on Pharmacotherapy, 2019
Daniel O. Claassen, Michael Philbin, Benjamin Carroll
It is of importance to address the risk of treatment-emergent depression and suicidality, considering that the prescribing information for deutetrabenazine and tetrabenazine have black box warnings for these AEs in patients with HD [12,27]. Depression is a serious risk in patients with HD and it should be monitored carefully in patients taking VMAT2 inhibitors. In the well-controlled clinical trial of tetrabenazine, 19% of patients who received tetrabenazine self-reported depression (vs 0% in the placebo group) [27]. The 12-week and OLE studies in HD-associated chorea (First-HD and ARC-HD) showed similar rates of depression in deutetrabenazine-treated patients compared with those receiving placebo, despite one serious AE related to agitated depression (First-HD). Suicidal ideation was also rare across the deutetrabenazine studies. Similarly, patients with TD did not experience depression or suicidal ideation at higher rates than patients in the placebo group when given deutetrabenazine in either the 12-week trials (ARM-TD and AIM-TD) or in the OLE RIM-TD study.
Monitoring for antidepressant-associated adverse events in the treatment of patients with major depressive disorder: An international consensus statement
Published in The World Journal of Biological Psychiatry, 2018
Seetal Dodd, Philip B. Mitchell, Michael Bauer, Lakshmi Yatham, Allan H. Young, Sidney H. Kennedy, Lana Williams, Trisha Suppes, Carlos Lopez Jaramillo, Madhukar H. Trivedi, Maurizio Fava, A. John Rush, Roger S. McIntyre, Michael E. Thase, Raymond W. Lam, Emanuel Severus, Siegfried Kasper, Michael Berk
People with undiagnosed bipolar disorder often present for treatment for the first time during a depressive episode. These people may experience antidepressant-associated mood elevations, either as mania or hypomania. If mood elevation or features of mixed states are observed, bipolar disorder should be suspected (Berk et al. 2005). This is, however, a complex and controversial area, with issues in debate including the boundaries between mixed states and agitated depression, and readers are referred to recent reviews for a detailed exposition of the subject of mixed states and transition to bipolar disorder (Swann et al. 2013; Ratheesh et al. 2017).