摘要:

Thanks to progress in the diagnosis and treatment of depression it is now possible for most cases to be treated on an out-patient basis. Only 15–20% of patients require hospitalisation, most of them because their depression has proved resistant to therapy. To overcome therapy-resistance the following methods of treatment are available: (1) In therapy-resistant endogenous and psychogenic depressions, mono-infusion therapy is the treatment of choice; it can also be administered on an out-patient basis. (2) In extremely intractable cases, it is advisable to resort to combined infusion therapy, preceded by five days of relaxation therapy with oral doses of a neuroleptic, and possibly reinforced by medication with 5-hydroxytryptophan (the precursor of serotonin) or by sleep deprival. (3) In therapy-resistant cases of so-called masked depression, marked by overtones of anxiety and hypochondriasis, infusions of maprotiline are indicated, because this anti-depressant exerts a relaxing and mildly anxiolytic action, has a stabilising influence on the autonomic nervous system, and produces a mood-brightening effect. (4) In patients who are apathetic and devoid of drive and suffering from involutional depression or depression of old age, infusion therapy plus administration of an MAO inhibitor can be recommended. (5) Combination of an antidepressant with a neuroleptic agent also displaying certain antidepressive properties is really indicated only in the rare cases of schizo-affective psychosis. (6) Electroconvulsive therapy should be employed only as a last resort in extremely retarded and apathetic patients with strong suicidal tendencies, and the indication for ECT should be established with the utmost reserve.

ISSN:0254-4962    

DOI:10.1159/000285154

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Lowering of standard serum lithium levels to 0.5–0.8 mmol/l has led to a marked reduction of side effects. Safety is increased through temporary discontinuation or dosage reduction of lithium in special risk situations. In unipolar but not in bipolar patients maintenance treatment with antidepressants is a valid alternative to lithium, and treatment choice may be determined by individual tolerance. Carbamazepine and valproate are worth trying in bipolar patients not responding to or not tolerating lithium. General principles for long-term preventive therapy are discussed.

ISSN:0254-4962    

DOI:10.1159/000285155

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Every depression is accompanied or preceded by a series of internal or external losses. They determine a situation of loneliness, sometimes material and always psychological and relational. It is therefore important to consider beyond pharmaco-therapy and psychotherapy the application of a sociotherapy including: a) a material and emotional help in the social sphere b) practical life and hygiene advices c) the creation of feed-backs by using interactions caused by the patient’s participation to therapeutical groups.

ISSN:0254-4962    

DOI:10.1159/000285156

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

It is widely known that during the depressive psychotic stages of depression, the risk of suicide is extremely high. In 17 of the follow-up studies reviewed, death and suicide data were presented. The data indicate that these affective disorders were associated with very high suicide rates. Suicide accounted for at least 12% of all deaths in every study. In nine studies suicide accounted for 12–19% of deaths, while in the other eight studies it accounted for 35–60%. The ratio of suicides to all deaths levelled off at about 15% as the deaths approached 100%.

ISSN:0254-4962    

DOI:10.1159/000285157

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

The delinquency of the depressed numerically only plays an unimportant role. The ‘extended suicide’ is regarded as the most typical and simultaneously most tragical delict. Almost exclusively this concerns severely depressed young mothers of 30 to 40 years of age, who in a delusional frame of mind include their children in their suicide, in order to prevent them from a presumably unavoidable disaster. Suicidality and aggressivity are intimately related phenomena, which should be treated in a forensic-psychiatric manner. Criminal acts, such as sexual and property delicts arising from an acting out of inner tension, may occur in anxiety or manic-depressive states of a mixed character. Although as a whole infrequent, the criminogenous importance of especially milder forms of depression is obviously often overlooked.

ISSN:0254-4962    

DOI:10.1159/000285158

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

The paper, based on the theoretical analysis of the problem and a review of the pertinent literature, focusses on the following questions: (1) Which behaviour patterns can be understood as self-healing attempts in depressive disorders? (2) Are there any scientific findings with regard to the efficacy of such self-healing attempts? (3) In which phase of a depression are such attempts being applied? (4) Are self-healing techniques teachable and learnable? The label ‘depressive disorders’ covers not only brief and mild affective disturbances but also persistent severe depressions. In recent years, psychiatry has been taking renewed interest in concepts of autonomy [3] and autoprotective efforts of the mentally ill. Our own relevant studies (Boeker, Brenner et al.) about schizophrenia [4, 5] and psychotherapeutic experience gained during the recovery of a depressive patient [6] have induced me to look for such self-help phenomena in depressives, too. Up to now, this subject still lacks sufficient data that has been systematically verified. The following text compiles some personal considerations and findings from specific literature, classified by a small number of aspects.

ISSN:0254-4962    

DOI:10.1159/000285159

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

A short description of the clinical picture of the major depression is given. Different forms of missed diagnosis in depression are discussed. Beside somatic symptomatology there are behavioural disturbances and disorders of a psychopathological type. Attention is paid to sexuality, anxiety and compulsion. The depression as a mistaken diagnosis is considered in relationship with endocrinopathy and with pharmacotherapy. In this respect reference is made to Cushing’s disease, psychotropic drugs and oral contraceptives

ISSN:0254-4962    

DOI:10.1159/000285160

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

In the context of the questions under discussion here, three findings from this study should be briefly emphasised: (1) Neurophysiological parameters investigated in healthy subjects receiving single doses of the two enantiomers of oxaprotiline in an acute experiment, performed in the sleep laboratory under defined conditions, revealed marked qualitative and quantitative differences between the effects of these enantiomers. (2) Since the two enantiomers are practically devoid of any anticholinergic or anti-serotonergic effect and display similar antihistaminic and sedative-antiaggressive activity, it is reasonable to assume that the differences in their effects on the sleep parameters measured are attributable to the difference in their pharmacodynamic profiles with respect to inhibition of noradrenaline uptake. (3) REM sleep parameters correlate significantly with the effect of the d-(+)-enantiomer, i.e. with its selective effect on inhibition of noradrenaline uptake.

ISSN:0254-4962    

DOI:10.1159/000285161

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

The treatment of sleep disorders in depressives depends basically on the nature of the underlying affective disorder (endogenous, organic, psychogenic or constitutional depression). Therapeutic approaches may be categorized in: 1) psychological, 2) somatic and 3) pharmacological ones. The former include psychotherapies and behavioral treatments which are useful in psychogenic and constitutional depressions with sleep-onset insomnia but may also be supportive in endogenous depressions. The basic therapeutic factor common to all is anxiety reduction. Somatic therapies, such as ECT, total, partial and REM-sleep deprivation, sleep schedule shifts and bright light (BL) are utilized mostly in endogenous depressions. Sleep laboratory findings and different hypotheses concerning the mode of action of these alternative treatment methods are reviewed. Somnopolygraphic, psychometric, and neuroendocrinological data of our comparative trial with BL and partial sleep deprivation in normals and patients are discussed. The similarity of changes after BL, antidepressants and lithium points to a chronobiological factor in the pathogenesis and treatment of affective disorders. Electrosleep is still controversial, hydro-, ergo- and physical therapy are supportive therapies and as such indicated in all depressions. Exercise, fatigue and nutritional factors may influence sleep. Psychopharmacological treatment has to be regarded as the most important therapeutic approach for sleep disorders in depressives. Antidepressants are the drugs of choice for most patients. Based on their effects on sleep-induction, -maintenance, and -architecture and REM measures, one may differentiate at least two subtypes: sedative antidepressants of the amitriptyline type and nonsedative antidepressants of the desipra-mine type. Bedtime infusions of antidepressants may have sleep promoting properties, which was objectivated by an EEG spectral analysis during infusion and subsequently by all night sleep studies. Measures indicative of therapeutic outcome are still controversial. Tranquilizers, hypnotics, neuroleptics and serotonin precursors are utilized if the antidepressants alone do not ameliorate insomnia. However, as evidence of a shared diathesis of origin of depressive and anxiety disorders is building up, benzodiazepines are increasingly prescribed as monotherapy too. Finally, sleep laboratory data concerning the hypnotic properties of a pharmacological 80 mg dosis of melatonin are demonstrated.

ISSN:0254-4962    

DOI:10.1159/000285162

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

The relationships between depression and art are many and varied. Examples of poets, novelists, and musicians spring to mind who have vividly portrayed depression, usually from personal experience of it. These portrayals often had a psychohygienic significance for the artists concerned – as in the case of Goethe, who, in writing ‘The sorrows of young Werther’, exorcised his own suicidal impulses and thoughts, thus probably saving his own life. Artists have also depicted the physiognomy of depressives, e.g. Hans Baldung Grien in his picture ‘Saturn’ showing the pronounced nasolabial folds described by Veraguth as indicative of melancholia. Relationships between depression and art also play a role in certain theories of creativity, such as that of Silverman, who postulates that in the depressive phase new impressions arise which then find their expression in a manic phase. Finally, there are the various creative therapies designed in cases of depression (e.g. by encouraging the patient to paint or draw) to reactivate the non-dominant hemisphere of the brain. Particularly in chronic or recurrent depressions this reactivation also serves to open up to the patient new perspectives for the solution of the problems that drive him into depression.

ISSN:0254-4962    

DOI:10.1159/000285163

出版商:S. Karger AG    

年代:1986

数据来源: Karger