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depression

Depression

see Major depression.

Depression has been associated with poor outcomes in neurosurgical patients, including increased pain, poorer functional recovery, delayed return to work, and decreased patient satisfaction.

The Beck Depression Inventory (BDI, BDI-1A, BDI-II), created by Aaron T. Beck, is a 21-question multiple-choice self-report inventory, one of the most widely used psychometric tests for measuring the severity of depression.

Etiology

Depression is found to be associated with up-regulation of inflammatory cytokines. However, the relationship in high grade glioma (HGG) patients is still unclear. In a prospective study, a total 132 HGG patients participated in blood sample collection for inflammatory cytokines detection by ELISA, mental status, quality of life (QOL) and physical functional status testing. The association between inflammatory cytokines and depression risk was assessed using conditional logistic regression. The incidences of depressive symptoms and depression in high grade glioama patients were 45.5 and 25 % respectively during 12 months follow-up. We found the risk of depression was elevated with increased C-reactive protein (CRP) and interleukin-6 (IL-6) in high grade glioma patients after adjustment of confounders. The serum levels of CRP and IL-6 in patients with transient depression and depression were higher than those without depressive symptoms. In addition, depression had significant effects on the survival, QOL and physical functional status of patients. Depression is prevalent among patients with HGG. The present study suggests that serum CRP and IL-6 may serve as a depression marker for HGG patients. The survival and quality of life of HGG patients may be improved by an effective management for depression 1).

This article was retracted 2).

Depression and cervical spine surgery

Quality of life (QoL) has been identified as one of the most important outcome measurements following cervical spine surgery. The contributing factors to post-operative QoL remain limited.

A study of Yang et al. aimed to prospectively examine the QoL and related pre-operative emotional factors in patients who underwent anterior cervical spine surgery.

A total of 124 patients who underwent anterior cervical spine surgery were recruited. All participants were prospectively evaluated for their QoL and 2 aspects of emotion, depression and anxiety, before and after surgery, respectively.

Pre-operatively, 13% of patients showed signs of depression and 31% of patients reported symptoms of anxiety. Post-operatively 14% of patients reported depression, but 41% reported symptoms of anxiety. A significant association between depression, anxiety and different domains of QoL were identified, and specific cut-off points of pre-operatively depressive and/or anxiety levels to predict unfavorable postoperative QoL was further established.

This prospective study demonstrated specific emotional factors, specifically depression and anxiety, influence patients' QoL following surgery. These results suggest clinicians should also monitor patients' emotional adjustments with their physical conditions 3).

Depression after brachial plexus injury

Data were collected retrospectively on all patients who underwent brachial plexus reconstruction to restore elbow flexion between 2005 and 2013. Elbow flexion, graded via the Medical Research Council scale, was assessed at latest follow-up. Multiple variables, including the presence of Axis I psychiatric diagnoses, were assessed for their association with the dichotomous outcome of Medical Research Council scale score ≥3 (antigravity) vs <3 elbow flexion. Standard statistical methods were used.

Thirty-seven patients met inclusion criteria. The median postsurgical follow-up time was 21 months. Operations included neurolysis (n = 3), nerve graft repair (n = 6), and nerve transfer (n = 28). Depression was present in 10 of 37 patients (27%). Of variables tested, only depression was associated with poor elbow flexion outcome (odds ratio: 6.038; P = .04).

Preoperative depression is common after brachial plexus injury. The presence of depression is associated with reduced elbow flexion recovery after reconstruction. Our data suggest assessment and treatment of preoperative mental health is important in designing a comprehensive postoperative management plan to optimize outcomes and patient satisfaction 4).

Brain tumor

Depression as well as anxious and OCD psychopathology were shown to be prevalent signs among patients with intracranial tumor. Diagnosis of symptoms were totally based on DSM-IV criteria and these disorders and the percentiles don't seem to be related to each other. Due to high variability of tumor stages, statistical analysis of whether the mentioned psychiatric symptoms get worsen at the later stages of the tumor genesis was not feasible. Although not measured directly, psychiatric symptoms seem to get worsen at the later stages of the brain tumor. The associated factors are tumor location, patient's premorbid psychiatric status, cognitive symptoms and adaptive or maladaptive response to stress 5).

Treatment

Typically, people are treated with antidepressant medication and, in many cases, also receive counseling, particularly cognitive behavioral therapy (CBT).

Medication appears to be effective, but the effect may only be significant in the most severely depressed.

Hospitalization may be necessary in cases with associated self-neglect or a significant risk of harm to self or others. A minority are treated with electroconvulsive therapy (ECT). The course of the disorder varies widely, from one episode lasting weeks to a lifelong disorder with recurrent major depressive episodes. Depressed individuals have shorter life expectancies than those without depression, in part because of greater susceptibility to medical illnesses and suicide. It is unclear whether or not medications affect the risk of suicide. Current and former patients may be stigmatized.

The understanding of the nature and causes of depression has evolved over the centuries, though this understanding is incomplete and has left many aspects of depression as the subject of discussion and research. Proposed causes include psychological, psycho-social, hereditary, evolutionary and biological factors. Long-term substance abuse may cause or worsen depressive symptoms. Psychological treatments are based on theories of personality, interpersonal communication, and learning. Most biological theories focus on the monoamine chemicals serotonin, norepinephrine and dopamine, which are naturally present in the brain and assist communication between nerve cells. This cluster of symptoms (syndrome) was named, described and classified as one of the mood disorders in the 1980 edition of the American Psychiatric Association's diagnostic manual.

see Treatment resistant depression.

References

1)
Jiao JT, Sun J, Ma JF, Dai MC, Huang J, Jiang C, Wang C, Cheng C, Shao JF. Relationship between inflammatory cytokines and risk of depression, and effect of depression on the prognosis of high grade glioma patients. J Neurooncol. 2015 Sep;124(3):475-84. doi: 10.1007/s11060-015-1861-7. Epub 2015 Jul 28. Retraction in: J Neurooncol. 2017 Aug 18;:. PubMed PMID: 26215876.
2)
Jiao JT, Sun J, Ma JF, Dai MC, Huang J, Jiang C, Wang C, Cheng C, Shao JF. Retraction Note to: Relationship between inflammatory cytokines and risk of depression, and effect of depression on the prognosis of high grade glioma patients. J Neurooncol. 2017 Aug 18. doi: 10.1007/s11060-017-2592-8. [Epub ahead of print] PubMed PMID: 28822096.
3)
Yang CC, Lin WC, Chien A, Wang JL, Lai DM. Heterogeneous influences of emotional disturbances on multi-domain quality of life after anterior cervical spine surgery: A prospective study. Clin Neurol Neurosurg. 2019 Jul 15;184:105447. doi: 10.1016/j.clineuro.2019.105447. [Epub ahead of print] PubMed PMID: 31325902.
4)
Wilson TJ, Chang KW, Yang LJ. Depression and Anxiety in Traumatic Brachial Plexus Injury Patients Are Associated With Reduced Motor Outcome After Surgical Intervention for Restoration of Elbow Flexion. Neurosurgery. 2016 Jun;78(6):844-50. doi: 10.1227/NEU.0000000000001086. PubMed PMID: 26516821.
5)
Seddighi A, Seddighi AS, Nikouei A, Ashrafi F, Nohesara S. Psychological aspects in brain tumor patients: A prospective study. Hell J Nucl Med. 2015 Sep-Dec;18 Suppl 1:63-67. PubMed PMID: 26665213.
depression.txt · Last modified: 2019/07/21 20:30 by administrador