In this study, we examined the influence of clinical depression and personality introversion on 15-month mortality following stroke. Ninety-four stroke inpatients were examined two months post-stroke for clinical depression and pre-stroke personality characteristics of neuroticism and introversion. Fifteen months later, the vital status of 84 of these patients was able to be determined. Seven (8%) of the 84 patients died. Mortality rate increased from non-depressed to minor depressed and to major depressed patients (1 /48 [2%], 2/21 [10%] and 3/13 [23%], respectively) (χ 2 [trend] = 6.6, df = 1, p = 0.01). Patients who died had higher depression symptom scores (mean ± SD) than survivors (17.7 ± 6.0 versus 9.9 ± 7.1) (p = 0.006). Non-survivors were more introverted (i.e. had lower extroversion scores) than survivors (1.7 ±1.4 versus 4.2 ± 2.1) (p = 0.004). In multivariate analyses, introversion and depression were independently associated with mortality. We conclude that personality introversion and depression are associated with increased mortality following stroke.
We examined the efficacy of naltrexone (an opioid antagonist) for alcohol dependence in a sample of alcohol-dependent men.A 12-week randomized placebo-controlled clinical trial.The outpatient clinic of a combined war veteran and general teaching hospital in Melbourne, Australia.Male alcohol-dependent subjects recruited from the community and from veteran groups.Alcohol-dependent subjects were treated with 50 mg of naltrexone or placebo daily for 12 weeks. Both treatment groups attended a weekly education support group. Subjects were assessed weekly.Primary study outcomes were the maintenance of abstinence and relapse to drinking.Fifty-five subjects were randomized to naltrexone and 56 to placebo. Forty subjects did not complete 12 weeks of therapy (17 naltrexone, 23 placebo). In the intention-to-treat sample (N = 111) fewer naltrexone treated subjects relapsed (p = 0.001). Among patients who completed the 12-week trial, naltrexone reduced the consumption of alcohol. Naltrexone was well tolerated and there were few adverse experiences.These findings demonstrate that naltrexone is effective in preventing relapse to drinking in the setting of limited psychosocial treatment. Further studies should examine the duration of treatment needed to maintain the effect long term.
After a report which challenged the generally-held view that renal-transplant recipients have a psychological advantage compared with patients who undergo dialysis, we surveyed the quality of life and psychological distress in all patients who were managed by renal transplantation or dialysis at The Royal Newcastle Hospital Renal Unit. A questionnaire was mailed to patients which covered demographic data; illness severity; the quality of life (satisfaction with life in general, general health, and sexual, family and social relationships); a 28-item general-health questionnaire; a life-event schedule; and a locus-of-control scale. The response rate was 88%. Data were obtained on 138 subjects of whom half (69 subjects) were renal-transplant recipients. The other 69 patients were divided between those who underwent haemodialysis at home (24 patients); those who underwent haemodialysis in a hospital centre (24 patients); and those who underwent continuous ambulatory peritoneal dialysis (21 patients). The study showed that while transplant recipients rated highest in the various aspects of quality of life, that of patients who underwent haemodialysis at home was nearly equivalent. Although patients with continuous ambulatory peritoneal dialysis were ranked third in terms of their quality of life, this clearly exceeded that of the group that underwent haemodialysis in a hospital centre, which generally shared very-similar demographic characteristics. Contrary to general expectations, no clear difference was found across the four treatment modalities in the proportion of patients who were disturbed psychologically or who had a history of treatment for "nervous" problems. The results confirm the superiority of renal transplantation in the treatment of end-stage renal disease but highlight the role of continuous ambulatory peritoneal dialysis as a well-tolerated alternative in the treatment of end-stage renal disease. (Med J Aust 1989; 150: 428-432)
Depression has been linked to higher than expected mortality from natural causes, particularly among elderly patients with physical illness. The authors examined the effect of depression on mortality among a group of stroke patients followed up for 10 years.A consecutive series of 103 patients was assessed for major or dysthymic (minor) depression approximately 2 weeks after stroke with the use of a structured mental status examination and DSM-III diagnostic criteria. Vital status was determined for 91 of these patients 10 years later.Forty-eight (53%) of the 91 patients had died. Patients with diagnoses of either major or minor depression were 3.4 times more likely to have died during the follow-up period than were nondepressed patients, and this relationship was independent of other measured risk factors such as age, sex, social class, type of stroke, lesion location, and level of social functioning. The mortality rate among depressed patients with few social contacts was especially high: over 90% had died.These results indicate that depressed mood following stroke is associated with an increased risk of subsequent mortality. Patients who are depressed and socially isolated seem to be particularly vulnerable.
Tardive dyskinesia is an involuntary movement disorder characterized by choreoathetoid movements, tics, grimaces, and dystonia secondary to the prolonged use of neuroleptic medication. The characteristic abnormal movements associated with tardive dyskinesia involve orofacial muscle dyskinesias as well as the limbs and trunk. Involvement of the respiratory musculature and esophagus has rarely been reported. The authors describe a case of tardive dyskinesia presenting with gastrointestinal symptoms. This case illustrates that neuroleptic side effects and the syndrome of tardive dyskinesia need to be considered in the assessment of gastrointestinal complaints in patients with long-term neuroleptic exposure.
Despite it being 50 years since the end of hostilities, a significant number of Second World War (WW2) veterans suffer post-traumatic stress disorder (PTSD) and its associated comorbidities. The prevalence, presentation, course and treatment of this disorder is examined. This examination reveals that PTSD is underdiagnosed in WW2 veterans. Although limited information is available concerning treatment, a broad biopsychosocial approach may be beneficial. The stressors of late life, leading to exacerbation of PTSD, are of particular relevance in this group.
The purpose of this article to describe a unique potential side effect of fluoxetine. A case report of a patient with post stroke depression treated with fluoxetine is presented. Fluoxetine was associated temporally with frequent short episodes of sexual excitement described by the patient as feeling like an orgasm. The relationship was dose dependent. Serotonergic medications, like fluoxetine, may induce sexual stimulation as a side effect. The mechanism for this effect is unclear but patients with organic brain disease may be at higher risk for this complication.
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