ABSTRACT
We report the case of a 70-year-old man with Segawa syndrome who achieved full remission in three episodes of psychotic depression following electroconvulsive therapy (ECT). As maintenance drug therapy was unable to prevent relapse, maintenance ECT seemed necessary. Segawa syndrome is a rare metabolic disorder characterized by dystonia and possibly psychiatric symptoms. We highlight the psychiatric vulnerability of patients with Segawa syndrome and point out some considerations in treating comorbid psychiatric disorders.
Subject(s)
Bipolar Disorder , Depressive Disorder, Major , Electroconvulsive Therapy , Psychotic Disorders , Male , Humans , Aged , Depression , Depressive Disorder, Major/therapy , Depressive Disorder, Major/psychology , Psychotic Disorders/therapy , SyndromeABSTRACT
BACKGROUND: Reducing the length of hospital stay (lohs) of elderly psychiatric patients is of great importance. The role of electroconvulsive therapy (ect) in this process is still unclear.
AIM: To explore the impact of ect on the lohs in elderly (>60 years) with major depressive disorder (mdd).
METHOD: All charts of patients with a diagnosis of mdd, discharged from geriatric psychiatry wards from April 2009 to December 2017 were gathered. Two groups were further explored: those who did not receive ect although available (no-ect; n = 170) and those who received ect within 3 weeks of admission (ect<3wks; n = 60). As primary outcome measure lohs was used.
RESULTS: No significant difference in lohs was observed between the no-ect group and the ect< 3wks group (mean 90.3 (sd: 109.2) and 86.4 (sd: 70.9) days; p=0.798). The distribution of diagnoses in the groups was significantly different (p<0.001) with psychotic features in 35.2% of patients in the no-ect group and 72% in the ect<3wks group. CONCLUSIONS Electroconvulsive therapy did not significantly change lohs in elderly with mdd. Time until starting ect and the presence of psychotic features appear to be important confounders that need to be taken into account in further research.
Subject(s)
Depressive Disorder, Major , Electroconvulsive Therapy , Aged , Depressive Disorder, Major/therapy , Hospitalization , Humans , Inpatients , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: There is a relative scarcity of studies on major depressive disorder that use objective assessment methods to explore the psychomotor effects of antidepressants. Striatal dopaminergic disturbances are known to be involved in the pathogenesis of major depressive disorder that is associated with psychomotor retardation. Because of its additional dopaminergic mechanism, the psychomotor effects of the selective serotonin reuptake inhibitor sertraline merit further exploration. METHODS: In 19 patients diagnosed with a current major depressive episode, clinical variables and graphic motor activity were assessed applying digitized figure copying tasks during a 6-week regimen of sertraline. Patients' baseline and weekly psychomotor performance was compared with the outcomes of 22 healthy, unmedicated controls. RESULTS: Patients' psychomotor slowing had improved after 6 weeks on sertraline as reflected by reductions in initiation and movement times on the simple line and figure copying tasks and decreased initiation times for the complex figure copying task relative to their baseline outcomes. CONCLUSIONS: The current study found evidence pointing to potential beneficial effects of sertraline after a 6-week treatment period in the lower-order cognitive and motor components involved in the graphic motor performance of depressed patients. The present findings are discussed in terms of the mechanism of action of sertraline.
Subject(s)
Antidepressive Agents/therapeutic use , Depressive Disorder, Major/drug therapy , Psychomotor Performance/drug effects , Selective Serotonin Reuptake Inhibitors/therapeutic use , Sertraline/therapeutic use , Adult , Depressive Disorder, Major/physiopathology , Female , Humans , Linear Models , Male , Multivariate Analysis , Neuropsychological TestsABSTRACT
INTRODUCTION: Psychomotor slowing is an intrinsic feature of schizophrenia that is poorly delineated from generally reduced processing speed. Although the Symbol Digit Substitution Test (SDST) is widely used to assess psychomotor speed, the task also taps several higher-order cognitive processes. Recording motor performance on copying tasks using a digitising tablet allows a more precise measurement of psychomotor speed. METHODS: A group of 75 schizophrenic inpatients were compared to 26 healthy controls in their performance on the SDST and two copying tasks. RESULTS: Factor analyses showed that the copying tasks were found to capture both a cognitively loaded factor and the motor component of psychomotor slowing better, which latter aspect is not properly assessed by the SDST. CONCLUSIONS: In schizophrenia psychomotor slowing seems to exist alongside reduced processing speed.
Subject(s)
Psychomotor Performance/physiology , Schizophrenic Psychology , Adult , Cognition/physiology , Data Interpretation, Statistical , Factor Analysis, Statistical , Female , Humans , Male , Neuropsychological Tests , Psychiatric Status Rating ScalesABSTRACT
After performing an exploratory factor analysis, Berrios & Luque (1995) identified three subcategories in the Cotard's syndrome: Cotard type I, Cotard type II and Cotard type psychotic depression. The article, which is based on two case studies and an examination of the relevant literature since 1995, explores whether there are different treatment strategies for Cotard type I and the Cotard type psychotic depression. For the Cotard type psychotic depression, electroconvulsive therapy proves to be an effective method of treatment. For Cotard type I, antipsychotic therapy seems to be sufficient.
