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Occupational therapy and affective disorders
Published in Stephen Curran, John P Wattis, Practical Management of Affective Disorders in Older People, 2018
Affective disorders can temporarily affect cognitive, sensorimotor and interpersonal skills. Impaired concentration frequently occurs with both depression and hypomania. The individual can find it difficult to make decisions or may be vulnerable to making ill-advised decisions. Both psychomotor retardation and over-activity may have an impact on an individual’s motor skills. Any of these will reduce a person’s ability to engage in purposeful activity to the level or standard that they would normally expect. In addition, common side-effects of many types of medication include blurred vision, dizziness and muscle tremors, which may temporarily exacerbate the impact of illness on an individual’s skills.
Signs and Symptoms in Psychiatry
Published in Mohamed Ahmed Abd El-Hay, Essentials of Psychiatric Assessment, 2018
Psychomotor retardation: a generalized reduction of physical and emotional reactions, in which there is lack of initiation and reduction of spontaneous movement. It shows all gradations up to stupor (see before). It is seen in patients with depression, catatonia, some frontal lobe syndromes, parkinsonian syndromes and delirium: In depressed patients with psychomotor retardation there is subjective feeling that all actions become more difficult to initiate and carry out. In more severe degrees, movements become more slow and dragging. In the mildest degrees, there is only lack of expression, with furrowed eyebrows, and the eyes are unfocused.Obstruction: the equivalent in the flow of action to thought blocking in the flow of speech. While carrying out a motor act, the patient stops still in his/her track. After a pause he/she continues with the act or may proceed to do something else. Usually he/she cannot account for his/her obstruction, but may do so in passive terms: “my actions were stopped.”Individual variations in the execution of goal-directed movements may become so pronounced that the movements are odd, although still obviously goal-directed. Unusual repeated performances of goal-directed motor action or the maintenance of an unusual modification of an adaptive posture are known as mannerisms. Examples of these are unusual hand movements while shaking hands, when greeting others, and when writing. The strange use of words, high-flown expressions (showy, grandiose, or fancy words or phrases that are intended to sound important and impressive), movements and postures, which are out of keeping with the total situation, can also be considered as mannerisms. Mannerisms can be found in relatively normal subjects, abnormal personalities, schizophrenia, and in neurological disorders. Mannerisms in non-psychotic persons are likely to be a means of attention-seeking. In the psychotic patient, they may result from delusional ideas or be regarded as expressions of catatonic motor disorder.
Vortioxetine in management of major depressive disorder – a favorable alternative for elderly patients?
Published in Expert Opinion on Pharmacotherapy, 2021
Another aspect important for the treatment of depression is managing psychomotor retardation. Some authors regard it as one of the central features of depression that impairs both motor function and cognition [51]. Additionally, movement disorders, including akathisia, dystonia, and parkinsonism, are prevalent in the elderly population and can arise from the prescribed treatment [52,53]. Therefore, assessment of drug effect on psychomotor function may be beneficial for the safety of depression therapy.
Melancholia: does this ancient concept have contemporary utility?
Published in International Review of Psychiatry, 2020
Gabriele Sani, Leonardo Tondo, Juan Undurraga, Gustavo H. Vázquez, Paola Salvatore, Ross J. Baldessarini
To evaluate several features that have traditionally been ascribed to melancholic depression, we recently compared those who did or did not meet DSM-5 criteria for melancholic features among over 3200 subjects in a major depressive episode and diagnosed with DSM-5 MDD or BD (Tondo, Vázquez, & Baldessarini, 2019). The prevalence of DSM-5 melancholic features determined by criteria derived from eight corresponding items in the 21-item Hamilton Depression Rating Scale (HDRS21) was 35.2% among adult subjects with moderate-severe depression (total HDRS21 score ≥18). The prevalence was very strongly associated with depression-severity assessed in several ways, and was 5.0% higher in BD than in MDD. A striking finding was that, among subjects with major depression matched for severity, with or without melancholic features, there were very few differences in a broad range of clinical features, including family history, sex, onset-age, recurrence rate, proportion of time ill, risk of hospitalization, or response to clinical treatment. There was considerable overlap of risk of individual melancholic features between depressed subjects meeting DSM-5 criteria for having melancholic features or not, ranging from greater than three-fold difference for psychomotor retardation to 62% greater prevalence of excessive guilt feelings (Tondo et al., 2019). The especially strongly differentiating effect of psychomotor retardation accords with previous reports (Parker, 2000; Parker & McCraw, 2017). In addition, there was a 27% higher lifetime risk of being suicidal (mainly suicidal ideation rather than attempts or fatalities) in association with melancholic features. In an additional study, we systematically reviewed reports of clinical responses to TCA versus SRI-type antidepressants among depressed patients diagnosed as melancholic or endogenous or not. In meta-analyses of data from such studies, there was no overall difference in responses to various types of antidepressants between the clinical subgroups, although TCAs were superior with melancholia (Undurraga, Vázquez, & Baldessarini, 2019).