摘要:

Two types of biological markers are considered in this review. State markers of depression reflect the psychopathology and return to normal after remission irrespective of the cause of the remission. By contrast, trait markers are largely unchanged irrespective of the psychiatric state of the patient. Trait markers are therefore potentially useful markers of the vulnerability of the patient whereas state markers reflect the changes which may be directly or indirectly associated with the symptoms of depression.Changes in monoamine metabolites in post mortem brain and cerebrospinal fluid have received considerable attention in the past but the variability of the data obtained, and the problems arising obtaining reproducible data limit the value of such markers. The use of imaging methods (such as SPECT) however implicate a major abnormality in the serotonin transporter as a marker of depression. This has been validated by genetic studies which indicate polymorphisms for the promoter of the serotonin transporter gene which may confer a genetic basis for susceptibility to depression.An abnormal functioning of the serotonin transporter on the platelet membrane may provide a useful marker of depression but it seems unlikely that the allosteric modulatory sites on the platelet transporter (3H-imipramine and3H-paroxetine binding sites) are useful markers.Catecholamine markers of depression have also received considerable attention but the variable results reported for changes in lymphocyte beta adrenoceptor density limit the usefulness of this marker. Agonist ligand binding to the platelet alpha-2 adrenoceptor has proved more consistent but it is not clear whether the increased density of these receptors are primarily due to changes in the alpha-2 adrenoceptors or to the I1imidazoline receptors which are also labelled by the ligands.Neuroendocrine changes following neurotransmitter receptor challenges still represent the most consistent markers of depression but it is uncertain whether the changes in the growth hormone or prolactin responses are state or trait markers of the condition. While the dexamethasone suppression test of pituitary-adrenal function lacks specificity, it is possible that vasopressin challenge tests could be of value.Lastly, a number of immune changes have been reported to occur in depression, many of which (e.g. reduced natural killer cell activity, proinflammatory cytokine increases) are normalised by effective treatment. Such potential markers require further study.It is concluded that the heterogeneity of depression, the effect of comorbidity, gender and racial factors on the biological changes that may influence the symptoms of depression make it unlikely that any marker, even if identified, will be of heuristic value. However, a number of markers representing changes in the endocrine, immune and neurotransmitter system could eventually be identified and be of practical value in the diagnosis of depression.

ISSN:0951-7367    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The limitations of management by medication alone in the treatment of bipolar disorder have become more apparent, and therefore the use of adjunctive psychotherapy has been explored. Several such forms of psychotherapy have been developed, including cognitive behavioral, interpersonal, psychoeducational, and family therapies. This review focuses on recent empirical studies of psychosocial approaches to the management of bipolar disorder.

ISSN:0951-7367    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

An increasing awareness of the importance of comorbidity in psychiatric disorders has emerged. Over the past decade numerous reports on the overlap of attention deficit hyperactivity disorder and depression have been published. A growing number of reports have now addressed the overlap of childhood mania and attention deficit hyperactivity disorder. Clinical, epidemiological and family genetic studies have provided evidence supporting the coexistence of these conditions.

ISSN:0951-7367    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Recent longitudinal studies of affective disorder highlight a poor prognosis for both unipolar depression and bipolar disorder. Although new treatments might help, inadequate treatment with the currently available antidepressant agents plays a significant role. To optimize outcome in depression each episode should be treated as early as possible and with vigour, with complete resolution of symptoms as the goal. Treatment should be maintained for a minimum of 6 months but often longer. Many patients who would benefit from maintenance therapy do not receive it. More imaginative treatment, such as the use of psychological approaches, education, close follow-up and support, are under-utilized and poorly evaluated in prognosis.

ISSN:0951-7367    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Research evidence shows that depression is very common among individuals with alcohol dependence, and that the comorbidity between these disorders is considered to be a critical risk factor for suicidal ideation and behavior. Although the etiological mechanisms involved in this comorbidity remain to be deciphered, recent advances have been made in pharmacologic treatment options and in investigations that target the elderly.

ISSN:0951-7367    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Serotonin specific reuptake inhibitor antidepressants (SSRIs) have become the de facto first line treatment in pharmacotherapy of major depression. Albeit SSRIs have the advantage in tolerance and safety over older treatments, their ease of use does not circumvent the major enduring clinical problem of treatment resistant depression (TRD). For TRD in the setting of an SSRI failure recent data supports a range of strategies including switching, either to a second SSRI or out of the class to a non-SSRI antidepressant, or augmentation with the addition of lithium carbonate. Data concerning use of buspirone and pindolol, serotonin 1A receptor partial agonists, as augmentation agents in SSRI failure remains mixed. In contrast venlafaxine continues to look quite promising in TRD.

ISSN:0951-7367    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0951-7367    

出版商:OVID    

年代:2000

数据来源: OVID