5 research outputs found
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Case report: delayed response after electroconvulsive therapy in a patient with major depressive disorder.
BACKGROUND: Major depressive disorder and associated mood syndromes are amongst the most common psychiatric disorders. To date, electroconvulsive therapy (ECT) is considered the most effective short-term treatment for patients with severe or treatment-resistant depression. In clinical practice, there is considerable variation in the ECT dosing schedule, with the number of sessions typically ranging from 6 to 12, with early antidepressant effects being predictive of increased positive outcomes. We describe here an unusual case of a female patient with severe depression who did not respond to ECT until the 11th session, after which she had shown a drastic improvement in her mental state. CASE PRESENTATION: A 75-year-old female presented to the old age psychiatry inpatient unit with new onset dysphoric mood, anhedonia, and severe negativity. She scored 23 on the 17-item Hamilton Rating Scale for Depression (HAM-D), and was rated 6 on Clinical Global Impression severity (CGIS) by the responsible clinician. She suffered from post-natal depression fifty years ago and was successfully treated with ECT. She was therefore initiated on a course of ECT treatment. Her condition initially deteriorated, displaying features of catatonia and psychosis, unresponsive to ECT treatment or concurrent psychotropic medications. After 11th ECT session, she started to show signs of clinical improvement and returned close to her baseline mental state after a total of 17 ECT sessions. She remained well 3Â months post-treatment, scoring 4 on HAM-D, Clinical Global Improvement or change (CGI-C) rated as 1 (very much improved). The diagnosis was ICD-10âF32.3 severe depressive episode with psychotic symptoms. CONCLUSIONS: we describe here an unusual case of delayed response to electroconvulsive therapy in the treatment of severe depressive disorder. Studies have shown the number of acute ECT treatments to be highly variable, affected by a number of factors including treatment frequency, condition treated and its severity, the ECT technical parameters, as well as concurrent use of pharmacological treatment. This may call for re-consideration of the current ECT treatment guidelines, requiring more research to help stratify and standardize the treatment regime
Voice handicap ap in Huelvaâs teachers
ArtĂculos Originales[ES] IntroducciĂłn: La prevalencia de trastornos de la voz en docentes en nuestro entorno se sitĂșa entre el
34% y 57%. Desde el año 2006 la patologĂa por nĂłdulos de las cuerdas vocales se considera enfermedad
profesional. El Ăndice de Incapacidad Vocal es una herramienta validada para valorar el menoscabo asociado
a la disfonĂa que percibe la persona.
Objetivos: Valorar el impacto de la disfonĂa y las posibles diferencias en la incapacidad vocal entre
factores relacionados con la disfonĂa.
Material y MĂ©todos: Durante el examen de salud voluntario los docentes son interrogados sobre
sĂntomas de disfonĂa y cumplimentan el Ăndice de Incapacidad Vocal.
Resultados: Los docentes con incapacidad moderada y severa representan el 16,6% y 1,2% respectivamente. Un 50,9% han presentado sĂntomas de disfonĂa en algĂșn momento de su vida laboral. Se encuentran diferencias significativas en la incapacidad vocal segĂșn el diagnostico de nĂłdulos de cuerdas vocales, la presencia de sĂntomas y el nĂșmero de sĂntomas.[EN] Introduction: The prevalence of voice disorders in teachers in our environment is between 34% and
57%. Since 2006, the pathology of vocal cord nodules is considered an occupational disease. Vocal Handicap Index is a validated tool to assess the impairment associated with the perceived dysphonia.
Objectives: To assess the impact of dysphonia and the possible differences in the vocal disability in function of dysphonia-related factors in teachers.
Methods: During the exam of health, volunteer teachers are interviewed about symptoms of dysphonia and complete the Vocal Handicap Index.
Results: Teachers with moderate and severe disability represent 16.6% and 1.2% respectively. 50.9% have shown symptoms of dysphonia at any moment in their working lives. There are significant differences in vocal disability in function of diagnosis of vocal cord nodules, the presence of symptoms and the number
of symptoms. Conclusions: Dysphonia produces a significant impact on the population studied. The diagnosis of vocal cord nodules, the presence of symptoms and the number of symptoms of dysphonia involves differences in
impairment assessing. It is unable to perform the extrapolation of results due to the limitations of the study.N
Improving Conversations about Parkinson's Dementia
Background: People with Parkinson's disease (PD) have an increased risk of dementia, yet patients and clinicians frequently avoid talking about it due to associated stigma, and the perception that ânothing can be done about itâ. However, open conversations about PD dementia may allow people with the condition to access treatment and support, and may increase participation in research aimed at understanding PD dementia. Objectives: To coâproduce information resources for patients and healthcare professionals to improve conversations about PD dementia. Methods: We worked with people with PD, engagement experts, artists, and a PD charity to open up these conversations. 34 participants (16 PD; 6 PD dementia; 1 Parkinsonism, 11 caregivers) attended creative workshops to examine fears about PD dementia and develop information resources. 25 PD experts contributed to the resources. Results: While most people with PD (70%) and caregivers (81%) shared worries about cognitive changes prior to the workshops, only 38% and 30%, respectively, had raised these concerns with a healthcare professional. 91% of people with PD and 73% of caregivers agreed that PD clinicians should ask about cognitive changes routinely through direct questions and perform cognitive tests at clinic appointments. We used insights from the creative workshops, and input from a network of PD experts to coâdevelop two openâaccess resources: one for people with PD and their families, and one for healthcare professionals. Conclusion: Using artistic and creative workshops, coâlearning and striving for diverse voices, we coâproduced relevant resources for a wider audience to improve conversations about PD dementia
Recommended from our members
Case report: delayed response after electroconvulsive therapy in a patient with major depressive disorder.
BACKGROUND: Major depressive disorder and associated mood syndromes are amongst the most common psychiatric disorders. To date, electroconvulsive therapy (ECT) is considered the most effective short-term treatment for patients with severe or treatment-resistant depression. In clinical practice, there is considerable variation in the ECT dosing schedule, with the number of sessions typically ranging from 6 to 12, with early antidepressant effects being predictive of increased positive outcomes. We describe here an unusual case of a female patient with severe depression who did not respond to ECT until the 11th session, after which she had shown a drastic improvement in her mental state. CASE PRESENTATION: A 75-year-old female presented to the old age psychiatry inpatient unit with new onset dysphoric mood, anhedonia, and severe negativity. She scored 23 on the 17-item Hamilton Rating Scale for Depression (HAM-D), and was rated 6 on Clinical Global Impression severity (CGIS) by the responsible clinician. She suffered from post-natal depression fifty years ago and was successfully treated with ECT. She was therefore initiated on a course of ECT treatment. Her condition initially deteriorated, displaying features of catatonia and psychosis, unresponsive to ECT treatment or concurrent psychotropic medications. After 11th ECT session, she started to show signs of clinical improvement and returned close to her baseline mental state after a total of 17 ECT sessions. She remained well 3Â months post-treatment, scoring 4 on HAM-D, Clinical Global Improvement or change (CGI-C) rated as 1 (very much improved). The diagnosis was ICD-10âF32.3 severe depressive episode with psychotic symptoms. CONCLUSIONS: we describe here an unusual case of delayed response to electroconvulsive therapy in the treatment of severe depressive disorder. Studies have shown the number of acute ECT treatments to be highly variable, affected by a number of factors including treatment frequency, condition treated and its severity, the ECT technical parameters, as well as concurrent use of pharmacological treatment. This may call for re-consideration of the current ECT treatment guidelines, requiring more research to help stratify and standardize the treatment regime
Recommended from our members
Improving Conversations about Parkinson's Dementia.
Publication status: PublishedBACKGROUND: People with Parkinson's disease (PD) have an increased risk of dementia, yet patients and clinicians frequently avoid talking about it due to associated stigma, and the perception that "nothing can be done about it". However, open conversations about PD dementia may allow people with the condition to access treatment and support, and may increase participation in research aimed at understanding PD dementia. OBJECTIVES: To co-produce information resources for patients and healthcare professionals to improve conversations about PD dementia. METHODS: We worked with people with PD, engagement experts, artists, and a PD charity to open up these conversations. 34 participants (16 PD; 6 PD dementia; 1 Parkinsonism, 11 caregivers) attended creative workshops to examine fears about PD dementia and develop information resources. 25 PD experts contributed to the resources. RESULTS: While most people with PD (70%) and caregivers (81%) shared worries about cognitive changes prior to the workshops, only 38% and 30%, respectively, had raised these concerns with a healthcare professional. 91% of people with PD and 73% of caregivers agreed that PD clinicians should ask about cognitive changes routinely through direct questions and perform cognitive tests at clinic appointments. We used insights from the creative workshops, and input from a network of PD experts to co-develop two open-access resources: one for people with PD and their families, and one for healthcare professionals. CONCLUSION: Using artistic and creative workshops, co-learning and striving for diverse voices, we co-produced relevant resources for a wider audience to improve conversations about PD dementia