Depression Treatment: Critical Role of Calcitonin Gene-Related Peptide Receptors in Cortical Spreading Depression.

Critical role of calcitonin gene-related peptide receptors in cortical spreading depression.

Filed under: Depression Treatment

Proc Natl Acad Sci U S A. 2012 Oct 29;
Tozzi A, de Iure A, Di Filippo M, Costa C, Caproni S, Pisani A, Bonsi P, Picconi B, Cupini LM, Materazzi S, Geppetti P, Sarchielli P, Calabresi P

Cortical spreading depression (CSD) is a key pathogenetic step in migraine with aura. Dysfunctions of voltage-dependent and receptor-operated channels have been implicated in the generation of CSD and in the pathophysiology of migraine. Although a known correlation exists between migraine and release of the calcitonin gene-related peptide (CGRP), the possibility that CGRP is involved in CSD has not been examined in detail. We analyzed the pharmacological mechanisms underlying CSD and investigated the possibility that endogenous CGRP contributes to this phenomenon. CSD was analyzed in rat neocortical slices by imaging of the intrinsic optical signal. CSD was measured as the percentage of the maximal surface of a cortical slice covered by the propagation of intrinsic optical signal changes during an induction episode. Reproducible CSD episodes were induced through repetitive elevations of extracellular potassium concentration. AMPA glutamate receptor antagonism did not inhibit CSD, whereas NMDA receptor antagonism did inhibit CSD. Blockade of voltage-dependent sodium channels by TTX also reduced CSD. CSD was also decreased by the antiepileptic drug topiramate, but not by carbamazepine. Interestingly, endogenous CGRP was released in the cortical tissue in a calcium-dependent manner during CSD, and three different CGRP receptor antagonists had a dose-dependent inhibitory effect on CSD, suggesting a critical role of CGRP in this phenomenon. Our findings show that both glutamate NMDA receptors and voltage-dependent sodium channels play roles in CSD. They also demonstrate that CGRP antagonism reduces CSD, supporting the possible use of drugs targeting central CGRP receptors as antimigraine agents.
HubMed – depression

The delirium experience: what is the effect on patients, relatives and staff and what can be done to modify this?

Filed under: Depression Treatment

Int J Geriatr Psychiatry. 2012 Oct 30;
Partridge JS, Martin FC, Harari D, Dhesi JK

BACKGROUND: Delirium is a common clinical syndrome with significant associated mortality, morbidity and financial cost. Less is understood about the experience of delirium for the patient, their family and staff involved in their care. OBJECTIVE: This synthesis draws on qualitative and quantitative literature examining different populations (patients, relatives and staff) in different clinical settings (intensive care units, surgery and hospice care) to provide a clinical summary of the delirium experience from the perspective of patients, relatives and staff. DESIGN: A literature search was conducted in Ovid, MEDLINE, Embase, PsychINFO, British Nursing Index and Archive and PubMed between 1980 and 2011 using the terms ‘delirium’ combined with ‘distress’, ‘recall’, ‘anxiety’, ‘depression’, ‘PTSD’, ‘experience’ and ‘patient education’. Articles were restricted to English language only. RESULTS: Evidence suggests that some patients recall delirium and that recollections are generally distressing. Distress may be greater in relatives witnessing delirium and is also reported in professional staff. This distress may result in longer-term psychological sequelae. Remedial action, such as explanatory information to patients and their families, may reduce distress and psychological morbidity. CONCLUSIONS: A better understanding of the experience and psychological consequences of delirium will inform the development of appropriate methods of providing support and information to those at risk of delirium and their families or carers. Copyright © 2012 John Wiley & Sons, Ltd.
HubMed – depression

Validation of the grip test and human activity profile for evaluation of physical performance during the intermediate phase after allogeneic hematopoietic stem cell transplantation.

Filed under: Depression Treatment

Support Care Cancer. 2012 Nov 1;
Kramer M, Heussner P, Herzberg PY, Andree H, Hilgendorf I, Leithaeuser M, Junghanss C, Freund M, Wolff D

OBJECTIVES: The aims of the presented study were to validate tools evaluating physical functioning (PF) after allogeneic hematopoietic stem cell transplantation (alloHSCT) and to analyze the impact of the clinical course on PF. METHODS: Forty patients undergoing alloHSCT were enrolled in a prospective trial which included evaluation of muscle strength (grip test, CITEC dynamometer), endurance (2-min walk test), anxiety and depression (Hospital Anxiety and Depression Scale), fatigue (Modified Fatigue Impact Scale and Brief Fatigue Inventory), and physical activity (Human Activity Profile-HAP) before (t1) and 1 (t2) and 3 (t3) months after alloHSCT. RESULTS: At t2, all patients showed a 6 % (p?=?0.02) loss of muscle strength which was higher in patients with acute graft-versus-host disease (aGVHD) (12 %). While patients without aGVHD recovered at t3, the loss of muscle strength was progressive in patients with aGVHD. The grip test results correlated with the results of detailed measurement of muscle strength by CITEC dynamometer (r?=?0.4-0.8, p?=?0.05-0.001). Moreover, the HAP scores correlated with physical performance. CONCLUSION: The results demonstrate that loss of PF occurs during the first month followed by a regain during the subsequent 2 months in the absence of aGVHD. The HAP and the grip test may serve as surrogate marker for the strength loss in the course of aGVHD.
HubMed – depression

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