Dialogues in clinical neuroscience
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Dementia is an important public health problem of increasing magnitude. At present, available therapies provide only minor and temporary relief, and attempts to find a cure have so far failed. ⋯ In principle, these findings provide an opportunity to intervene and prevent the dementia epidemic. Attention to nongenetic risk factors such as hypertension, hyperlipidemia, smoking, and obesity may thus not only prevent cardiovascular disease but also dementia, although it is difficult to prove the efficacy of these measures for dementia prevention.
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Dialogues Clin Neurosci · Jan 2008
ReviewEpilepsy surgery: eligibility criteria and presurgical evaluation.
Epilepsy surgery has benefited from major advances during the last 20 years, thanks to the development of neuroimaging and long-term video-electroencephalographic (EEG) monitoring. However, it remains the case that only a small minority of potential epilepsy surgery candidates will have access to a comprehensive presurgical evaluation. Furthermore, this subset of patients are operated on after an average of 20 to 25 years of epilepsy duration. ⋯ However, the decision as to whether or not to perform a presurgical evaluation must be individualized, and take into account the likelihood of meeting the patient's expectations in terms of outcome. These expectations need to be balanced with the apparent severity of the epileptic condition, the chance of achieving a successful surgical treatment, and the risk of a postoperative neurological, cognitive, or psychiatric deterioration. The roles and specific features of the main types of presurgical investigations are reviewed.
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In spite of recent developments in the pharmacotherapy of depressive disorders, the delay until clinical improvement can be achieved, and the considerable rate of nonresponse and nonremission, are major problems which remain unresolved. Electroconvulsive therapy (ECT) is a nonpharmacologic biological treatment which has been proven to be a highly effective treatment option, predominantly for depression, but also for schizophrenia and other indications. Though there is a lack of controlled investigations on long-term treatments, ECT can also be used for relapse prevention during maintenance therapies. ⋯ Thus, today a safe treatment can also be offered to patients with higher somatic risks. ECT still represents an important option, especially in the therapy of treatment-resistant psychiatric disorders after medication treatment failures. Earlier consideration of ECT may reduce the rate of chronic and difficult-to-treat psychiatric disorders.
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Dialogues Clin Neurosci · Jan 2007
ReviewNeuropsychiatric consequences of cardiovascular medications.
The use of cardiovascular medications can have a variety of neuropsychiatric consequences. Many cardiovascular agents cause higher rates of fatigue and sedation than placebo, and case reports of medication-induced mood syndromes, psychosis, and cognitive disturbances exist for many cardiovascular drugs. ⋯ Though low cholesterol levels have been associated with depression and suicide, lipid-lowering agents have not been associated with these adverse effects. Finally, cardiovascular medications may have beneficial neuropsychiatric consequences; for example, the use of clonidine in patients with attention deficit-hyperactivity disorder, the use of prazosin for patients with post-traumatic stress disorder; and the use of propranolol for performance anxiety and akathisia.