ABSTRACT
Some reports have described general anesthesias as a risk factor for dementia in the elderly. The authors investigated whether the number of general anesthesias during a lifetime was associated with cognitive functioning in the community-based age cohort of a geographical area of Vienna. Out of 606 seventy-five-year-old subjects, 43 reported not having undergone anesthesia and 113 reported five or more anesthesias. The number of general anesthesias was not associated with extensive psychometric data. Cognitive dysfunction at age 75 was significantly associated with level of education, a history of major head trauma, and having lived in a rural environment during childhood.
Subject(s)
Aging/physiology , Anesthesia, General/statistics & numerical data , Cognition Disorders/epidemiology , Aged , Austria/epidemiology , Cross-Sectional Studies , Education , Female , Humans , Magnetic Resonance Imaging , Male , Neuropsychological Tests , Regression Analysis , Risk Factors , Socioeconomic FactorsABSTRACT
Treatment-resistant depression (TRD) represents a significant challenge for physicians. About one third of patients with major depressive disorder fail to experience sufficient symptom improvement despite adequate treatment. Despite this high occurrence of TRD there was no general consensus on diagnosis criteria for TRD until 1997 when researchers proposed a model of defining and staging TRD. In 1999, others defined operational criteria for the definition of TRD. Treatment of TRD is commonly separated into pharmacologic and nonpharmacologic methods. This review gives a short overview of these two methods. The nonpharmacologic methods include psychotherapy, electroconvulsive therapy, and vagus nerve stimulation. Pharmacologic methods include switching to another antidepressant monotherapy, and augmentation or combination with two or more antidepressants or other agents. This review especially focuses on the augmentation of the antidepressant therapy with atypical antipsychotics.
