Depression in Neurologic Disorders E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 584

Veröffentlichungsjahr: 2012

Beschreibung

The first part of the book begins with an overview of depression, its incidence and manifestations and neurobiological origins; how it's diagnosed; and its relevance to neurology, in particular to suicidality. The second part looks at depression in distinct conditions, in particular: migraine, stroke, epilepsy, Parkinson's Disease, Huntington's Disease, dementia, and traumatic brain injury. This useful guide takes a practical approach, with "tips and tricks" boxes, case studies, points of interest boxes, and take-home summaries.

Leseprobe

Table of Contents

Cover

Dedication

Title page

Copyright page

Contributors

Foreword

Preface

Acknowledgments

Part One: General Considerations

1 Depression in Neurologic Disorders: Why Should Neurologists Care?

Introduction

Concluding remarks

2 Neurobiological Aspects of Depression: How Do They Affect Neurologic Disorders?

Introduction

Anatomy of frontolimbic network

Neurotransmitters in neurobiology of depression

Models of neurobiology of depression

Neural networks of mood dysfunction

Conclusion

Acknowledgment

3 Idiopathic Depressive Disorders: Basic Principles

Clinical manifestations of idiopathic depressive disorders

Conclusion

4 Screening Instruments for Depression in Neurologic Disorders: Their Application in the Clinic and in Research

Introduction

Depression in epilepsy

Depression in MS

Depression in stroke

Depression in dementia

Depression in PD

Conclusion

5 Suicidality in Neurologic Diseases

Introduction

Physical illness and suicidality

Neurologic disease and suicidality

Screening for suicidality

Conclusions

6 Neuropsychological Aspects of Depression: Their Relevance in Depression in Neurologic Disorders

Introduction

Cognitive performance in depression

Cognitive performance in depression and neurologic illness

Cognitive performance following treatment of depression

The neuropsychological evaluation

Assessment

Case studies

Concluding remarks

7 Depressive Disorders in Children and Adolescents with Neurologic Disorders

Introduction

Clinical importance: why should neurologists care?

Neurobiological aspects

Clinical manifestations

Diagnostic instruments

Neuropsychological findings

Management

Case study: depression in a child with epilepsy

Conclusion: take home message

8 Basic Principles in the Management of Depression in Neurologic Disorders

Introduction

Classification of antidepressant drugs

Basic issues in the pharmacological treatment of depression

Antidepressant drugs in neurologic disorders

Conclusions

Part Two: Depression and Neurologic Disorders

9 Depression and Migraine

Case study

Relation between migraines and mood disorders: an epidemiologic perspective

Clinical manifestations

The negative impact of depression on the quality of life of patients with migraine

The negative impact of depression in the course of migraine

Common pathogenic mechanisms operant in depression and migraine

Treatment strategies

Acknowledgments

Permissions

10 Poststroke Depression

Introduction

Epidemiologic aspects

A bidirectional relation between depression and stroke

Intrinsic mechanisms

Extrinsic factors

Stroke-related pathogenic factors operant in PSD

Clinical manifestations

Impact of PSD on the course of the stroke

Treatment of PSD

Concluding remarks

Illustrative case

11 Depressive Disorders in Epilepsy

Introduction

Epidemiologic aspects

Negative impact of DDs in the life of PWE

A bidirectional relationship between DDs and epilepsy: Does it account for the high comorbidity?

Clinical manifestations

How to screen for DDs in the neurology clinic

DDs as an iatrogenic complication

Management of DDs in PWE

Nonpharmacological treatments

Should neurologists treat DDs in PWE?

Concluding remarks

Illustrative case

12 Depression and Movement Disorders

Introduction

Depression in PD and HD

Conclusions and future development

Case study

13 Depression and Multiple Sclerosis

Introduction

Multiple sclerosis: general overview

Symptoms and signs of depression in MS

Pseudobulbar affect

Prevalence of depression in MS

Relationship of MS severity to depression

Aspects of age and gender in MS-associated depression

Potential etiologies of depression in MS

Immunological aspects of depression in MS

Basic assessment of depression in MS

Asking patients about MS and depression

Screening inventories for depression in MS

Suicidality in MS

Fatigue, depression, and MS

Effects of MS-associated cognitive deficits on depression

Adverse effect of disease-modifying treatments on depression in MS

Effects of depression on MS treatment adherence

Clinical management of depression in MS

Psychopharmacologic approaches to MS-related depression

Psychotherapeutic treatment modalities for depression in MS

Quality of life in MS

Future directions in the study of MS-related depression

Case study

14 Depression and Alzheimer’s Disease

Introduction

Prevalence of depression in AD

Impact of depression in AD

Clinical manifestations and diagnosis of depression in AD

The complex relationship between depression and AD

Treatment of depression in AD

Avenues for future research

Summary

Clinical case

15 Depression and Traumatic Brain Injury

Introduction

Epidemiologic data and bidirectional relation between depression and TBI

Clinical manifestations

Negative impact on quality of life

Negative impact on the course and response to treatment of TBI

Common pathogenic mechanisms operant in depression and TBI

Treatment strategies

Conclusion and future directions

Index

I wish to dedicate this book to all the academicians of the Universities in Israel, who through their creativity and accomplishments have been a constant inspiration to me throughout my professional career.

I also wish to dedicate this book to my wife Hilary and my daughters Lesley Anne and Lauren Amanda who through their unconditional love and support have filled my life with joy.

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Library of Congress Cataloging-in-Publication Data

Depression in neurologic disorders : diagnosis and management / edited by

Andres M. Kanner. – 1st ed.

p. ; cm.

 Includes bibliographical references and index.

 ISBN 978-1-4443-3058-8 (hardback : alk. paper)

 I. Kanner, Andres M.

 [DNLM: 1. Depressive Disorder–complications. 2. Nervous System

Diseases–complications. 3. Brain Injuries–complications. 4. Depressive

Disorder–diagnosis. 5. Depressive Disorder–therapy. WM 171.5]

 616.85'27–dc23

2012014817

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: © iStockphoto/artfromthefringe

Cover design: Meaden Creative

Contributors

John J. Barry, MD, Department of Psychiatry, Stanford School of Medicine, Stanford, CA, USA

Julián Bustin, MD, MRCPsych, Head of Geriatric Psychiatry and Co-Head of The Memory Clinic, Institute of Cognitive Neurology (INECO); In­­stitute of Neuroscience, Favaloro University, Buenos Aires, Argentina

Rochelle Caplan, MD, Department of Psychiatry, David Geffen School of Medicine, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA

Alan B. Ettinger, MD, Neurological Surgery P.C., Lake Success, NY, USA

Christopher L. Grote, PhD, Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA

Hrvoje Hecimovic, MD, PhD, Zagreb Epilepsy Center, Department of Neurology, University Hospital, Zagreb, Croatia

Erica J. Kalkut, PhD, Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA

Andres M. Kanner, MD, Departments of Neurological Sciences and Psychiatry, Rush Medical College at Rush University; Laboratory of EEG and Video-EEG-Telemetry; Section of Epilepsy and Rush Epilepsy Center, Rush Univer­sity Medical Center, Chicago, IL, USA

Michael P. Kerr, MD, Welsh Centre for Learning Disabilities, Cardiff University, Cardiff, UK

Joan Roig Llesuy, MD, Neuropsychiatry and Addiction Institute, Hospital del Mar, Barcelona, Spain

Facundo Manes, MD, Director, Institute of Neuroscience, Professor of Neurology and Cogni­tive Neuroscience, Favaloro University; Director, Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina; Co-President, World Federation of Neurology, Research Group on Aphasia and Cognitive Disorders

Seth A. Mensah, MB, ChB, DPM, MSc, MRCPsych, Consultant Neuropsychiatrist, Welsh Neuropsy­chiatry Service, Whitchurch Hospital, Cardiff, UK

Marco Mula, MD, PhD, Department of Clinical and Experimental Medicine, Amedeo Avogadro University; Division of Neurology, University Hospital Maggiore della Carità, Novara, Italy

Pablo Richly, MD, Co-Head of The Memory Clinic, Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina

Dana J. Serafin, BS, Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY, USA

Angela Strobel Parsons, Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL, USA

Yukari Tadokoro, Department of Neuropsy­chiatry, School of Medicine, Aichi Medical University, Aichi-ken, Japan

Ludger Tebartz van Elst, MD, Section of Experimental Neuropsychiatry and Psycho­therapy, Department of Psychiatry and Psycho­therapy, University of Freiburg Medical Center, Freiburg, Germany

Oliver Tüscher, MD, Section of Experimental Neuropsychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy; Department of Neurology, University of Freiburg Medical Center, Freiburg, Germany; Department of Psychiatry and Psychotherapy, University of Mainz Medical Center, Mainz, Germany

Deborah M. Weisbrot, MD, Department of Psychiatry and Behavioral Sciences, Stony Brook University Medical Center, Stony Brook, NY, USA

Foreword

There is a new buzzword in neurologic circles, which is comorbidity. Sometimes mistaken for denoting any separate medical problem found to be increased in frequency with an index disorder, and defined as the co-occurrence of two disorders at above chance levels, the term usefully should relate to where there is a direct or a heuristic proposition of a biological or sociological link between the conditions. In other words, where the substrate of condition x presupposes condition y or vice versa. There needs to be some dependent endogenous link between two disorders, such that the causal link between them can be explored.

There is little to be pursued in trying to understand why people with tetraplegia develop sacral ulcers or have urinary infections, or why someone with epilepsy has head injuries. However, where a common organ is involved in two diagnostically separate disorders, then an increased comorbidity between the two will have both biological relevance and may lead to improved patient management. Since psychiatric and neurologic disorders both share the brain as the font of symptomatology, it is hardly surprising that overlapping syndromes are frequently noted in clinical practice.

The description of psychiatric symptoms in neurologic disorders has a long history, dating back to the times of Hippocrates, but such interest accelerated in the European literature of the 19th century, when the distinction between neurology and psychiatry as separate medical disciplines was not countenanced. With the growing rift between an organically based neurology and a psychologically based psychiatry in the first six decades of the 20th century, interest in such comorbidities waned, in spite of such obvious clinical presentations of, for example, postictal psychoses, or the dementias seen in conditions such as Parkinson’s disease or multiple sclerosis.

However, we are now in a different era, not only of shifting paradigms, with disciplines such as behavioral neurology and neuropsychiatry ready to embrace a more holistic view of brain–behavior associations, but with an understanding of neurobiology based on sophisticated technology, both for exploring the intricacies of brain structure and function, but also for bringing the live brain to life with differing imaging modalities. This timely book has been edited by Andres M. Kanner, who has not only made the psychiatric comorbidities of epilepsy a central area of research, but who has also the requisite clinical experience to envisage a wider perspective, embracing a spectrum of neurologic disorders and a frequently encountered but often ignored clinical problem, namely depression.

The observation that patients with various neurologic disorders develop depression is nothing new, except that few investigators have expressed much interest in the association until recently. The renewed importance of the comorbidity arises from several factors. Some decade or two ago, measuring quality of life (QOL) in various disorders became fashionable, and not surprisingly most neurologic conditions investigated compromised this important variable. However, closer inspection of QOL assessments revealed that much of the variance could be explained by the presence of depression. The growing understanding of the neuroanatomical and neurochemical substrates of depression, revealing interlinks between neural circuits and neurotransmitters common to both neurologic and psychiatric disorders, led the curious minded to reexplore the clinical situation, and the therapeutically minded to pursue treatments for the psychiatric comorbidity, thus going beyond that required for the index condition. Even more recently, the acknowledged link between certain neurologic disorders and their treatment and suicidal behaviors, including completed suicide, has placed all neurologists in the challenging position to explore the affective state of their patients, and if depression is suggested, to either manage it themselves or to refer to a competent associate.

Andres M. Kanner sets the scene by asking, “Why should neurologists care?” The rest of the book develops this theme, and helps with an even more important question: “How should neurologists care?”

Michael TrimbleProfessor of Behavioral NeurologyInstitute of Neurology, Queen SquareLondon, UKJanuary 2012

Preface

The lack of communication between psychiatrists and neurologists is one of the most incomprehensible phenomena in modern medicine, as most (if not all) neurologic disorders affecting the central nervous system are associated with a psychiatric comorbidity, of which depression is the most common. And yet, in a majority of patients, depression remains unrecognized and untreated, as most neurologists focus only on the identification of neurologic signs and symptoms and their treatment.

Nevertheless, the impact of a comorbid depressive disorder in the life of these patients can be as devastating as and often more disabling than the actual neurologic disorder. When inves­tigated, a lifetime history of depression can be identified in one out of every three to four patients suffering from any of the major neurologic conditions including epilepsy, stroke, migraine, multiple sclerosis, dementia, movement disorders and traumatic brain injury.

Contrary to old assumptions, depression is not simply a “reactive process” to the limitations and obstacles caused by the underlying neurologic disorder. In fact, there is a complex relation between depression and several neurologic disorders, as evidenced by the existence of a bidirectional relation between depression and conditions like epilepsy, stroke, migraine, Parkinson’s disease and possibly also dementia. In other words, not only are patients with these neurologic conditions at higher risk of developing depression, but patients with depression are at a higher risk of developing one of these neurologic disorders. This bidirectional relation does not establish causality but suggests the existence of common pathogenic mechanisms operant in the psychiatric and neurologic conditions.

The complex relation between depression and neurologic disorders has significant clinical implications that should be of great concern to neurologists, as the existence of a comorbid depressive disorder is associated with a worse course and poorer response to treatment of the neurologic disorder. Furthermore, comorbid depression has been found to be an independent risk factor for a poor quality of life and increased suicidal risk. It accounts for higher medical costs (not related to the psychiatric treatment) and lesser compliance with the neurologic treatment. Accordingly, one would expect to find a plethora of data on the impact of the treatment of depression on the course of the neurologic disorder. Alas, nothing is further from the truth! In fact, a review of the literature reveals a paucity of studies on the treatment of depression in most neurologic disorders. This problem is compounded by the limited access of patients to psychiatric treatment because of financial reasons, reluctance on the part of patients and their family to seek psychiatric evaluations, and a discomfort on the part of psychiatrists to treat patients with neurologic disorders.

The aim of this book is to start overcoming these serious shortcomings in the management of patients with neurologic disorders and facilitate the dialogue among neurologists, psychiatrists, neuropsychologists and other mental health providers. I was extremely fortunate to count with a group of international experts in the field to make this book a reality. The task given to each author was to review the available data in the literature and to provide practical strategies for the identification and treatment of comorbid depressive disorders in the major neurologic conditions.

The book is introduced by a chapter that makes the case of why neurologists should care about depression in neurologic patients by reviewing its impact on the course and treatment response of the neurologic disorder. In the other chapters of the book’s first section, we review the neurobiologic aspects of primary depression (Chapter 2), its clinical characteristics and treatment strategies (Chapter 3), and the use of screening instruments of depression in various neurologic disorders (Chapter 4). Suicide is more frequent in neurologic patients than in the general population. This important topic is reviewed with a focus on the prevalence and variables associated with its occurrence in the major neurologic conditions (Chapter 5). Cognitive disturbances are key clinical manifestations of depression, but they may result as well from the underlying neurologic condition. Distinguishing one from the other poses a significant diagnostic dilemma, which can be resolved with neuropsychological testing. The indications, diagnostic yield and limitations of this diagnostic modality are discussed in patients with primary depression as well as in neurologic patients with comorbid depression (Chapter 6). The diagnosis and management of depression in pediatric patients poses particular challenges which frequently limit its recognition and its management. Accordingly, a chapter is dedicated to review the principal aspects of this topic (Chapter 7). The last chapter of the first section (Chapter 8) provides a review of the basic principles in the management of depression in neurologic disorders.

The second section of the book focuses on the specific aspects of depression in the major neurologic disorders, including migraine (Chapter 9), stroke (Chapter 10), epilepsy (Chapter 11), movement disorders (Chapter 12), multiple sclerosis (Chapter 13), Alzheimer’s disease (Chapter 14) and traumatic brain injury (Chapter 15). Each one of these seven chapters reviews the epidemiologic aspects of depression in the respective neurologic condition, the potential pathogenic mechanisms that may explain the high comorbid prevalence and bidirectional relation, the clinical manifestations, with special emphasis on the clinical differences of depression in each par­ticular neurologic disorder (relative to primary depression) and, finally, the treatment strategies that can be considered.

My hope is that this book will provide clinicians the necessary data to understand the need to identify and treat comorbid depression in neurologic disorders, and make available the necessary tools to achieve those goals. While I do not expect or believe that neurologists should treat the depressive disorders in all their patients, they should ensure that their existence is investigated in every evaluation and, when possible and appropriate, treated by them or referred to a mental health professional.

Andres M. Kanner, MD

Acknowledgments

I wish to acknowledge the invaluable assistance of Mr. Jacob Wolff in the editing of this book.

Part One

General Considerations

1

Depression in Neurologic Disorders: Why Should Neurologists Care?

Andres M. Kanner

Departments of Neurological Sciences and Psychiatry, Rush Medical College at Rush University; Laboratory of EEG and Video-EEG-Telemetry; Section of Epilepsy and Rush Epilepsy Center, Rush University Medical Center, Chicago, IL, USA

Introduction

Depressive disorders are the fourth medical disorder with a significant burden on the individual, the family, and society worldwide. In the general population, their lifetime prevalence has been estimated to be 26% for women and 12% for men [1, 2]. In patients with neurologic disorders, the lifetime prevalence of depressive disorders ranges between 30% and 50%. For example, in patients with epilepsy, a lifetime prevalence of 34.2% (25.0–43.3%) was identified in a Canadian population-based study [3]. In a population-based study of 115,071 subjects aged 18 and older a 12-month prevalence rate of major depression of 25.7% was found among people with multiple sclerosis (compared with only 8.9% of those without) [4]. In a review of the literature, Robinson and Spalletta found an overall prevalence of major depression of 21.7% and minor depression of 19.5% based on pooled data [5]. Reijnders et al. conducted a systematic review of the literature of the prevalence of depressive disorders in Parkinson’s disease (PD) and found major depressive disorder in 17%, minor depression in 22%, dysthymia in 13%, and significant symptoms of depression not meeting any Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria in 35% of patients [6].

Yet, despite their high prevalence rates, depressive disorders remain underrecognized and undertreated in patients with neurologic disorders. For example, in a study of 100 consecutive patients with epilepsy, 69 patients were found to experience symptoms of depression severe enough to warrant referral for treatment; 63% of patients with spontaneous depression and 54% of patients with an iatrogenic depression had been symptomatic for more than 1 year before treatment was initiated [7].

Failure to recognize depression in patients with neurologic disorders is the result of various problems: (1) poor, if not lack of communica­tion between neurologists and psychiatrists; (2) limited training of psychiatric disorders in neurology residency programs and vice versa; and (3) limited access of patients to psychiatric care due to insurance-related obstacles and other economic factors. Thus, can neurologists continue ignoring the comorbid depressive disorders affecting their patients and can they just focus on the management of the neurologic disorder at hand? The aim of this chapter is to set up the case for why neurologists must care about the existence of comorbid depressive disorders and ensure of their timely treatment as part of a comprehensive management of their patients.