Update on depression in neurologic illness: stroke, epilepsy, and multiple sclerosis

Psychomotor retardation in depression: biological underpinnings, measurement, and treatment

Psychomotor retardation is a long established component of depression that can have significant clinical and therapeutic implications for treatment. Due to its negative impact on overall function in depressed patients, we review its biological correlates, optimal methods of measurement, and relevance in the context of therapeutic interventions. The aim of the paper is to provide a synthesis of the literature on psychomotor retardation in depression with the goal of enhanced awareness for clinicians and researchers. Increased knowledge and understanding of psychomotor retardation in major depressive disorder may lead to further research and better informed diagnosis in regards to psychomotor retardation. Manifestations of psychomotor retardation include slowed speech, decreased movement, and impaired cognitive function. It is common in patients with melancholic depression and those with psychotic features. Biological correlates may include abnormalities in the basal ganglia and dopaminergic pathways. Neurophysiologic tools such as neuroimaging and transcranial magnetic stimulation may play a role in the study of this symptom in the future. At present, there are three objective scales to evaluate psychomotor retardation severity. Studies examining the impact of psychomotor retardation on clinical outcome have found differential results. However, available evidence suggests that depressed patients with psychomotor retardation may respond well to electroconvulsive therapy (ECT). Current literature regarding antidepressants is inconclusive, though tricyclic antidepressants may be considered for treatment of patients with psychomotor retardation. Future work examining this objective aspect of major depressive disorder (MDD) is essential. This could further elucidate the biological underpinnings of depression and optimize its treatment.

Introduction: chronic medical conditions and depression--the view from primary care

Martin Hickman maneuvered his way into the office and pulled up his sleeve as the medical assistant put the brake on his wheelchair and attached the blood pressure cuff around his oversized upper arm. A bulky 56-year-old man with a heavy shock of gray hair teetering on the edge of his forehead, his problem list included type 2 diabetes, chronic obstructive pulmonary disease, hypertension, obesity, and hyperlipidemia. For the past 15 years he has used a wheelchair due to T4 paraplegia from a gunshot wound. He has also suffers from bouts of major depression that respond to sertraline but never fully remit. As the medical assistant inflated the cuff, Mr. Hickman smiled weakly and maintained a cheerful façade even after she informed him that his blood pressure was 164/88 mm Hg and his glucose was 267 mg/dl (both well above goal). Later, on more careful questioning by his primary care physician, Hickman admitted that he was feeling “more down than usual” and that he sometimes neglected to take his diabetes medicine and blood pressure pills. Thinking back over the years he had cared for this patient, the physician recalled that December tended to be a particularly bad month. Social isolation, tolerable for most of the year, became painful around the holidays. December also happened to mark the anniversary of Hickman's spinal cord injury. The clock was running, the waiting room was full, and the physician realized he was already falling behind.

Multiple sclerosis and behavior

Multiple sclerosis (MS) is one of the most frequently seen neurological causes of progressive disability in early to middle adulthood. The disease is variable in its presentation and course, affects roughly 100-300 per 100,000 persons within the United States alone, and is slightly more common among females than males. MS places substantial burdens on patients, families, and caregivers. It negatively affects cognitive abilities and psychiatric functioning, and can add a notably deleterious effect on a patient's quality of life. This chapter reviews the recent literature on the behavioral manifestations of MS. Cognitive domains discussed include executive functioning, processing speed, attention, learning and memory, language functioning, and visual spatial processing. Some attention will also be paid to differential diagnosis and the cognitive effects of treatment. Psychiatric manifestations are also discussed, including symptoms of depression, bipolar disorder, euphoria, pathological laughter and crying, and psychosis, as well as maladaptive personality traits. Finally, the chapter concludes with a discussion of the effects of MS on quality of life including such areas as fatigue, sexual dysfunction, pain, employment, and cognitive functioning.