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Affective disorders in old age: detection and clinical features
Published in Stephen Curran, John P Wattis, Practical Management of Affective Disorders in Older People, 2018
Several studies have suggested that the pattern of symptoms may differ between older and younger patients. The classic paper by Brown et al.5 on ‘involutional melancholia’ compared depressed patients with a first onset of illness after the age of 50, with younger depressed patients and with a group of older patients who had had previous episodes of depression when aged less than 50. Regardless of age of initial onset, older patients had more somatic complaints, sleep disturbance (particularly initial insomnia) and agitation, but were less likely to express feelings of guilt. More recently a more specific association has been reported between depression and painful symptoms in older people, strongest for neck and back pain.6 Prince et al.7 identified two symptom clusters in older depressed patients. The first, ‘affective suffering’ (depression, tearfulness and the wish to die), was associated with female gender. A second ‘motivation’ factor (loss of interest, poor concentration and lack of enjoyment) was more often found in very old people.
Shocks and Surgeries
Published in Petteri Pietikainen, Madness, 2015
In 1934, Meduna introduced Cardiazol shock treatment to produce epileptic convulsions in his schizophrenic patients. Cardiazol (Metrazol in the United States) was a synthetic preparation that was used as a circulatory and respiratory stimulant and that in high doses caused convulsions. After treating a handful of patients with Cardiazol, Meduna did not waste time in declaring that he had discovered a new psychiatric therapy. Meduna’s superior at the Brain Research Institute in Budapest thought his treatment was nothing but humbug, but Meduna was obstinate. In 1935 he published a report in which he claimed that of his first 26 patients treated with convulsive therapy, ten had completely recovered. When his Hungarian colleagues published similar, very encouraging reports the following year, central European psychiatrists began to try the method. Like Sakel, Meduna was a tireless promoter of his therapeutic invention, and, also like Sakel, he moved to the United States, where his method became widely known in the late 1930s. Cardiazol appeared to be an effective short-term treatment for acute catatonic schizophrenia, and it was later claimed that Cardiazol convulsions were also effective in the treatment of involutional melancholia (McCrae 2006, 72–6). For a few years in the late 1930s and the early 1940s, Cardiazol treatment was widely used in western psychiatry, and more than 1,000 articles were published on this method.
A Conceptual History of Anxiety and Depression
Published in Siegfried Kasper, Johan A. den Boer, J. M. Ad Sitsen, Handbook of Depression and Anxiety, 2003
In this definition, the bipolar disorder of our time coincides with “periodic and circular insanity”. Here, manic derangement is characterized by the triad of rapid association of ideas, elated mood, and hyperactivity. Depression, on the other hand, is associated with the triad of dejection or anxious moods, inhibition of thought, and reduced spontaneity. In addition to the circular and simple disorders, amentia, and milder mood disorders, Kraepelin also refers to mixed pictures. These cases exhibit characteristics resembling the mixed episodes of contemporary bipolar disorder. He also refers to the so-called “ground states” (Grundzustände; predisposing personality traits), which form the basis for the development of mood disorders [79]. Kraepelin distinguished four ground states: depressive, manic, irritable (erregbare), and cyclothymic. Finally, a distinction was made between this group and the form of melancholia associated with a decline due to the effects of aging (Rückbildungsalter; involution). In the latter case, inhibition was often absent while anxiety and hypochondria were more prominent. Although Kraepelin was initially inclined to keep this (involutional) melancholia separate from the others, he abandoned this idea after the comprehensive study of this clinical picture by [80]. He subsequently included this form of melancholia within manic-depressive psychosis (das manisch-depressive Irresein). The debate about involutional melancholia was not finally settled until the 1970s when this condition became just another form of depression.
A comparison of the safety, feasibility, and tolerability of ECT and ketamine for treatment-resistant depression
Published in Expert Opinion on Drug Safety, 2022
Amanda Tamman, Amit Anand, Sanjay J. Mathew
Electroconvulsive therapy (ECT) represents the gold standard treatment for acute TRD [10], particularly when depression is life-threatening and rapid treatment response is required [11,12]. ECT was introduced in the 1930s, and achieved widespread use first in treating schizophrenia and subsequently depression or ‘involutional melancholia’ in inpatient facilities [13,14]. Compared to relatively low remission rates for TRD using antidepressants, ECT achieves remission rates of 50–70% in TRD [15]. Despite substantial evidence for ECT<apos;>s effectiveness and potential life-saving capabilities, it is substantially underutilized [16]. Challenges include stigmatized public perceptions promoted in part by sensationalized and antiquated representations of ECT; possibility of cognitive impairment; and requirement of general anesthesia. Treatment implementation has evolved to minimize side effects.
On the Other Side of Menopause
Published in Issues in Mental Health Nursing, 2020
All of this reminded me of what has gone on in psychiatry and psychiatric/mental health nursing with regard to menopause and mental disorders where menopause may be considered an illness. That history can be tracked partially by looking at succeeding editions of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (APA). With each edition of the DSM, there has been greater attention paid to gender issues. The DSM I, published in 1952, contained essentially no mention of sex differences in psychiatric illness but included “this disorder” under “Disorders due to disturbances of metabolism, growth, nutrition or endocrine function” (APA, DSM II, 1958, p. 36). The DSM-II (1958) only rarely noted sex differences in disorders but did include the sex-specific disorder “Psychosis with Childbirth” as well as “Involutional Melancholia,” which was commonly associated with menopause. The DSM II described Involutional Melancholia as “a disorder occurring in the involutional period and characterized by worry, anxiety, agitation, and severe insomnia. Feelings of guilt and somatic preoccupations are frequently present and may be of delusional proportions (APA, p. 36). DSM II goes on to distinguish this disorder from manic–depressive illness, schizophrenia, and psychotic depressive reaction. Back track a minute—“somatic preoccupations?” I can just hear the authors of the writings cited earlier grinding their teeth over this description!