摘要:

The recognition and treatment of depressive states, as well as their prevention, call for special knowledge and experience. Therefore it was considered desirable that practising physicians with no specialised knowledge of psychiatry should be given more extensive opportunity for post-graduate instruction in the diagnosis and management of depression and also that they should be in a position to collaborate more closely with psychiatrists. Hence the idea of establishing an international committee, the members of which would in their turn set up national committees with the aim of promoting and intensifying post-graduate instruction in their respective countries.

ISSN:0254-4962    

DOI:10.1159/000285134

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Several neuroendocrine studies with the clonidine-growth hormone stimulation test show endogenous depressive patients to have a reduced GH response as compared to neurotic depressives, schizophrenics and controls. The blunted GH response to clonidine seems to be a trait marker or vulnerability factor for mono- and bipolar endogenous depression. It could be explained by a reduced postsynaptic α2-adrenoceptor sensitivity or of structures related to them. The sensitivity of α2-adrenoceptors is influenced by both, the endorphinergic and cholinergic systems. First results supporting this concept are presented and discussed.

ISSN:0254-4962    

DOI:10.1159/000285135

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

This paper presents a brief review of markers and their potential uses in the study and treatment of affective illness. Some of these include the use of markers as aids in: 1) diagnosis, 2) selection of medication, 3) prediction of relapse, and 4) prediction of suicide. The use of combinations of markers to improve accuracy and the use of markers during the well-state will be discussed. A review of the literature suggests some promising candidates as markers of affective illness including the serotonin metabolite, 5 HIAA; 3H-imipramine platelet binding; REM induction using M-1 muscarinic agonists; and melatonin. Finally, a strategy using gene mapping techniques as a possible method of detecting additional markers is presented.

ISSN:0254-4962    

DOI:10.1159/000285136

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Recent research has been oriented towards the study of the clinical relevance of measuring free and total plasma levels of antidepressants and their hydroxylated metabolites, as animal experiments suggest that the latter may be clinically active. In central Europe, about 5–10% of the population has a genetic defect in metabolizing debrisoquine. This is of importance for pharmacopsychiatry, as some antidepressants like desipramine, nortriptyhne, amitriptyline, imipramine (and possibly maprotiline) are metabolized by the same enzyme as debrisoquine. This observation helps to understand not only the large interindividual differences in the steady-state levels of these drugs but also drug interferences.

ISSN:0254-4962    

DOI:10.1159/000285137

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

At present, PET is the only technology affording the quantitative, three-dimensional imaging of various aspects of brain function. In the few PET studies of mood disorders performed so far, usually cerebral glucose metabolism was investigated by the fluorodeoxyglucose method. Its largest individual diagnostic potential was demonstrated in certain forms of organic depression, while metabolic abnormalities in major unipolar and bipolar depression were more subtle – albeit significantly different. Other PET tracers for investigation of transmitter systems are available, but have not been systematically applied in depression research.

ISSN:0254-4962    

DOI:10.1159/000285138

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

The last decade of psychopharmacological research in depression is characterised by the development of structurally novel and biochemically selective-acting drugs and by the shift of interest from the acute to long-term treatment effects of antidepressants on catecholaminergic transmission. Of particular importance in this respect are the findings demonstrating adaptative changes occurring at receptor levels which have led to alternative theoretical formulations about the origin of depression and the mode of action of antidepressants. However in spite of the progress in this field of research the mechanism of therapeutic action of antidepressants remains unknown. Examples of drugs not affecting NA and 5-HT uptake or release and producing no adaptative changes of adrenergic receptors (trimipramine, levoxaprotiline) indicate that antidepressant-like activity can be achieved by mechanisms which still remain to be elucidated.

ISSN:0254-4962    

DOI:10.1159/000285139

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

The new pharmacological developments in antidepressants are reviewed with particular reference to MAOIs. Combining an MAOI with amitriptyline reduces the risk of a tyramine-induced rise of blood pressure but does not eliminate the risk which is comparable to that of one of the new reversible MAO-A inhibitors (CGP 11305A).

ISSN:0254-4962    

DOI:10.1159/000285140

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

A large number of depressed patients are undiagnosed and therefore untreated. A substantial proportion of those patients who are treated are allegedly ‘refractory’, ‘resistant’ or ‘non-responsive’ to anti-depressant drug therapy. Definitions and criteria for the use of these terms vary, or are totally lacking, and incidence figures in the literature vary between 10 to 50%. In addition, 3 to 15% of depressed patients otherwise satisfactorily treated suffer unwanted effects. Such observations clearly illustrate limits to successful antidepressive therapy. Some of these may require new approaches on the part of medical education or further research and development of psycho-active drugs on existing lines. However, the limitations imposed by the unwanted effects of antidepressives are more tangible and might be substantially influenced when manufacturers actively and succinctly inform the medical profession about changes in the ADR profiles of their products. As an example, the evolution of the ADR profile of the antidepressant maprotiline is demonstrated: the frequency of reports on convulsions in association with maprotiline treatment in the USA and the UK decreased about four-fold and seven-fold respectively after appropriate adjustments of daily-dose ranges were recommended.

ISSN:0254-4962    

DOI:10.1159/000285141

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

People in depressions are submitted to a suffering which always necessitates, in addition to pharmacotherapy, a psychotherapeutic approach. In all the psychotherapies known, a certain attitude of the therapist, which includes an unconditional openness for the patient, is necessary. Depressives cannot bear banal optimism, but need the therapist’s confidence in their future. This human participation helps to fill up, at least to a certain degree, their lack of narcissism. Special points of psychotherapy of depressives are described: 1. positive emotional attention, empathy, 2. unconditional listening, 3. asking questions (to give the patient’s word and attitudes a meaning and to activate cognitive processes), 4. more orientation than interpretation (during depressive phases), 5. giving advice: Whereas in most psychotherapies it is counterindicated to counsel the patient, in major depressions it can be necessary to formulate recommendations, 6. getting conscious about what happened during the therapeutic session in the patient and in the therapist, since otherwise the therapist may get too involved in the depressive’s unrealistic expectations or too defensive against him. – Psychotherapy with depressives does not only mean individual treatment, but can include – possibly in addition – their social environment: Partner therapy, family therapy, of the use of a social system as a milieu for psychotherapy (group psychotherapy). Whereas psychotherapy in the depressive phases consists mainly in the named procedure, in the intervals, the experiences of the depressive phases and the emotional and cognitive life and behavior patterns should be worked through focally, in an analytically oriented short-term psychotherapy. A long-term analytic treatment is only indicated in depressive neurotics. Depression, whatever its cause, always represents a suffering which leads, especially because of a more or less total lack in the realm of the self, to isolation, anxiety and pain. Even major depressions, parallel to typical biochemical findings, are characterized by specific psychodynamics like narcissistic emptiness respectively depletion and overwhelming dependance on a strict archaic conscience (superego) with corresponding behavior patterns, such as the need always to observe law and order (Battegay, 1985, 1, 2, Tellen-bach, 1961).

ISSN:0254-4962    

DOI:10.1159/000285142

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

In this paper findings from a nationwide study on adolescent student population focusing on the association of depressive disorders and drug use are presented. A progressive increase of depressive mood levels is found as we proceed from the non-users to the users of licit (tobacco, alcohol, psychotropics used without prescription) and illicit substances. The same pattern is also observed with rates of elevated depression scores and self-reported suicide attempts. These findings are discussed in connection with the issue of possible causal relationship between depressive mood and substance dependence.

ISSN:0254-4962    

DOI:10.1159/000285143

出版商:S. Karger AG    

年代:1986

数据来源: Karger