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Young onset dementia − challenges in nomenclature and clinical definitions
Published in Marjolein de Vugt, Janet Carter, Understanding Young Onset Dementia, 2021
Dennis van de Veen, Christian Bakker, Tor Rosness, Raymond Koopmans
For instance, Davies et al. (2011), in their review, discuss depression as a possible cause or mediating factor in young onset dementia. In their opinion, a wide variety of neurological and general medical conditions may eventually cause dementia, including depression. Depression is known to be related to a depressed mood, diminished interest in surroundings or pleasure in activities and negative thoughts such as guilt. A decrease in cognitive functioning can often be present as well, as there is a loss of energy and (thinking) speed and attention deficits occur, which causes memory problems (American Psychiatric Association, 2013). A severe or chronic depression, especially when treatment is not effective, might cause lasting and perhaps progressive cognitive disorders (Bennett & Thomas, 2014). On the other hand, dementia can cause neuropsychiatric symptoms such as depression. Especially when a proper diagnosis is lacking, it is difficult to separate depressive symptoms from dementia symptoms and to distinguish cause from effect (Liebson et al., 2005).
Treatment for Perinatal Depression: Navigating the Transition to Motherhood
Published in Laura H. Choate, Depression in Girls and Women Across the Lifespan, 2019
Fortunately, the options for treatment are not limited to medication alone. In many cases, psychotherapy and enhanced self-care are the best routes to recovery. It is helpful that there are general guidelines available to help a client make these decisions based on her symptom profile and severity. For the subset of women who have severe depressive symptoms, are suicidal, or who have a history of chronic depression (over five years or more than three episodes), then the benefits of medication tend to outweigh its potential risks. For women whose depression is mild to moderate and who do not have a significant history of depression, guidelines suggest that they will benefit from psychotherapy such as CBT or IPT (APA, 2010; ACOG Committee Opinion, 2018); therefore medication is not warranted unless symptoms do not improve with treatment. Practice guidelines also suggest that women at all levels of severity will benefit from psychotherapy, even when taking medication. And for the subset of women whose initial symptoms are mild, starting with self-care (e.g., sleep hygiene, exercise, social support, nutrition), might be all the extra support that is needed to help her symptoms resolve.
Introduction
Published in Mohamed Ahmed Abd El-Hay, Essentials of Psychiatric Assessment, 2018
These roles include: Carrier of an illness: patients see themselves only temporarily impaired. They put a distance between themselves and the disorder, e.g., they will say it is their sleep not themself that is disturbed. They put the problem into quarantine so that it cannot infect the rest of them. Other than the disturbance, the patient tries to live a normal life and does not demand special privileges, or crave sympathy, but expects only expert medical management.The sufferer: such patients are the opposite from the carrier of an illness. They are consumed by their disturbance and suffering. They exaggerate the disability and crave comfort, sympathy, and understanding rather than expert advice. They force the clinician to set firm limits. Chronic depression and some personality disorders favor the development of this role.The VIP: some patients see themselves as very important, privileged, and entitled to attention at any time of day or night. They expect preferential treatment. They search for the very best in the field, the star psychiatrist or psychologist. Establishing rapport with such patients may become complex and limit setting is unavoidable. The VIP attitude can be adopted by anyone, from the very successful to the least privileged.
Persistent depressive disorder among persons receiving an HIV test: an understudied phenomenon
Published in AIDS Care, 2022
According to the DSM5, PDD is a consolidation of chronic major depressive disorder and dysthymic disorder. It is possible that major depression may occur prior to PDD, and depressive episodes can also occur in the context of PDD. The DSM-5 specifies that persons who meet the criteria for major depressive disorder for 2 years should be given a diagnosis of both PDD and major depressive disorder. PDD is often undetected in health care settings, including HIV care. There appear to be no data on PDD among non-clinical community samples in the absence of major depression (Parker & Malhi, 2019). However, among 140 Turkish patients who were receiving treatment for depression, 54.2% met the criteria for PDD (Ildirli et al., 2015). In an Australian community household survey of over 8000 participants, chronic depression of at least two years’ duration had a lifetime prevalence of 4.6% (95% CI: 3.9–5.3%).
Tailoring the therapeutic interventions for behavioral and psychological symptoms of dementia
Published in Expert Review of Neurotherapeutics, 2022
Barbara Vuic, Marcela Konjevod, Lucija Tudor, Tina Milos, Matea Nikolac Perkovic, Gordana Nedic Erjavec, Nela Pivac, Suzana Uzun, Ninoslav Mimica, Dubravka Svob Strac
The primary finding of neuroimaging and biomarker investigations has been decreased function of monoaminergic neurotransmitters, such as those for serotonin, norepinephrine and dopamine, as well as lower frontoparietal metabolism in depressed AD patients [117]. Some postmortem studies observed a higher burden of neuropathology in AD subjects with depression [118,119]. It has been demonstrated that the neurotoxic effects of elevated cortisol levels in the hippocampus, present in chronic depression, can accelerate the neurodegenerative changes of AD [120]. Moreover, several areas of the AD brain revealed decreased concentrations of serotonin, with reduction of the 5-HT1 and 5HT-2 receptors seen especially in the cerebral cortex, suggesting a disturbed serotoninergic system [121]. In addition, subjects with dementia and depressive symptoms demonstrated a loss of noradrenergic cells, due to degeneration of the locus coeruleus [121].
What impact does bipolar disorder staging have on the use of pharmacotherapy?
Published in Expert Opinion on Pharmacotherapy, 2021
Jairo Vinícius Pinto, Márcia Kauer-Sant’Anna, Lakshmi N Yatham
Late-stage bipolar disorder is commonly defined as a group of patients with longer length of illness, multiple episode, and some degree of impairment in functioning [5]. As in the early-stage case, there is almost no clinical trial that included only late-stage patients or guidelines with recommendations explicitly made for this group of patients. Nonetheless, there are recommendations for a specific group of patients at later stages of the illness that include those who do not fully respond to pharmacological treatment and follow a course characterized by frequent recurrence and residual symptoms, known as treatment-resistant bipolar disorder [17]. The clinical characteristics of this group of individuals include rapid cycling, chronic depression, mixed symptoms, neurocognitive difficulties, and comorbid anxiety disorders, among others [17]. For this group of late-stage patients, definitions and treatment recommendation were recently organized in a guideline [17]. This consensus suggests to always initially assess whether these patients are genuinely treatment resistant, by reassessing the diagnosis, if the symptoms are not secondary to any other etiology, as well as if the failure of therapy is not due to poor tolerability or lack of adherence, among other factors [17]. When the diagnosis of treatment-resistant bipolar disorder is confirmed, algorithms provide evidence-based recommendations on how to manage the resistant mania and bipolar depression, as well as the maintenance phase [17].