The primary care companion for CNS disorders
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Prim Care Companion CNS Disord · Jan 2013
ReviewDiagnosis and treatment of depression in patients with congestive heart failure: a review of the literature.
Major depressive disorder (MDD) can be challenging to diagnose in patients with congestive heart failure, who often suffer from fatigue, insomnia, weight changes, and other neurovegetative symptoms that overlap with those of depression. Pathophysiologic mechanisms (eg, inflammation, autonomic nervous system dysfunction, cardiac arrhythmias, and altered platelet function) connect depression and congestive heart failure. ⋯ At present, limited empirical data exist with regard to treatment of depression in the increasingly large population of patients with congestive heart failure. Evidence reveals that both psychotherapeutic treatment (eg, cognitive-behavioral therapy) and pharmacologic treatment (eg, use of the selective serotonin reuptake inhibitor sertraline) are safe and effective in reducing depression severity in patients with cardiovascular disease. Collaborative care programs featuring interventions that work to improve adherence to medical and psychiatric treatments improve both cardiovascular disease and depression outcomes. Depression rating scales such as the 9-item Patient Health Questionnaire should be used to monitor therapeutic efficacy.
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Prim Care Companion CNS Disord · Jan 2013
Effects of milnacipran on neurocognition, pain, and fatigue in fibromyalgia: a 13-week, randomized, placebo-controlled, crossover trial.
To investigate whether milnacipran is safe and effective in improving cognitive function in patients with fibromyalgia. ⋯ Milnacipran may have a potential role in the improvement of pain, disability, and mood. The effect of milnacipran on cognition in fibromyalgia needs further research.
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Prim Care Companion CNS Disord · Jan 2013
Efficacy of add-on deep transcranial magnetic stimulation in comorbid alcohol dependence and dysthymic disorder: three case reports.
Craving for alcohol is associated with abnormal activation in the dorsolateral prefrontal cortex. Deep transcranial magnetic stimulation (dTMS) has shown promise in the treatment of depression. There are few treatment options for treatment-resistant dysthymic disorder comorbid with alcohol use disorder. ⋯ High-frequency bilateral dorsolateral prefrontal cortex dTMS with left prevalence was found to produce significant anticraving effects in alcohol use disorder comorbid with dysthymic disorder. The potential of dTMS for reducing craving in patients with substance use disorder deserves to be further investigated.
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Prim Care Companion CNS Disord · Jan 2013
Childhood trauma and pain and pain catastrophizing in adulthood: a cross-sectional survey study.
Previous studies have indicated relationships between trauma in childhood and pain in adulthood, although some studies have reported no such relationships and challenge the methodologies of large-scale community samples. In this study involving a clinical sample, we examined relationships among (1) childhood trauma at ages 12 or younger, (2) rated pain for 3 time points in adulthood, and (3) pain catastrophizing (ie, catastrophic thoughts and feelings about pain). ⋯ In this clinical sample of adult outpatients, there were clear relationships between childhood trauma and all forms of pain assessment and pain catastrophizing. We discuss possible explanations and implications of these findings.