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Biomedical subjects

D Blumer

Publications and source records attributed to D Blumer.

At least 19 recordsLinked to original sources
PubMed2001

Impact of depressed mood on neuropsychological status in temporal lobe epilepsy.

OBJECTIVES: Depression is a common psychiatric complication of temporal lobe epilepsy. This study examined the effect of depressed mood on neuropsychological performance among patients with chronic temporal lobe epilepsy. METHODS: Seventy consecutive surgery candidates for medication resistant complex partial seizures of unilateral temporal lobe origin were assessed for psychiatric symptoms and underwent comprehensive neuropsychological assessment. RESULTS: Standardised psychiatric interview disclosed that 34% of the patient sample exhibited significant depression. Controlling for seizure frequency, patients with comorbid depression at the time of neuropsychological assessment exhibited significantly poorer performance on measures of intelligence, language, visuoperceptual ability, memory, and executive function. Within lateralised temporal lobe epilepsy groups, the adverse effects of depression on cognitive function were greater in patients with left temporal lobe compared with those with right temporal lobe epilepsy. In addition, depression seemed to be underrecognised and undertreated as none of the patients with epilepsy and comorbid depression were treated for their psychiatric condition at the time of admission for monitoring. CONCLUSIONS: Depression, a common psychiatric comorbidity among patients with chronic temporal lobe epilepsy, seems to be undertreated and to have adverse effects on cognitive functioning.

Adult↗
PubMed2000

Treatment of the interictal psychoses.

BACKGROUND: The interictal "schizophrenia-like" psychoses of epilepsy conventionally are treated with antipsychotic medication with uncertain results. In patients with these psychoses, a preceding and concomitant dysphoric disorder usually can be documented. Effectiveness of the pharmacologic treatment by the combination of drugs that is effective for severe interictal dysphoric disorders is demonstrated in a series of patients with interictal psychosis. METHOD: Patients were treated with the combination of a tricyclic antidepressant and a selective serotonin reuptake inhibitor, enhanced if necessary by a small amount of the atypical neuroleptic risperidone. The series consisted of 8 consecutive patients with interictal psychosis seen over a 20-month period. Two additional patients seen over the past 10 years who required a different therapeutic intervention were also included. RESULTS: Five of the 8 consecutive patients achieved full remission of their psychosis; 3 patients could not be reached for the full treatment effort. One patient with a malignant psychosis had been treated successfully (prior to the series reported) by surgical removal of a left frontal epileptogenic zone; a second patient (treated after the series) recovered only upon elimination of the antiepileptic drug that had suppressed clinical seizures but had resulted in an alternating psychosis. CONCLUSION: Interictal psychoses can be viewed as severe interictal dysphoric disorders with psychotic features. The same combination of psychotropic medication that is effective for severe interictal dysphoric disorders serves as the primary therapy for interictal psychoses. The interictal psychiatric disorders presumably result from seizure-suppressing mechanisms that are the targets of the proconvulsant drugs. Upon suppression of seizures, some patients with interictal psychosis may require modification of the antiepileptic medication responsible for excessive inhibition. Complete surgical removal of the epileptogenic zone can eliminate a chronic interictal psychosis upon postoperative fading of inhibitory mechanisms.

Adult↗
PubMed1999

Evidence supporting the temporal lobe epilepsy personality syndrome.

A deepening of emotionality with a serious, highly ethical, and spiritual demeanor has been described by clinicians as a positive personality change among patients with chronic mesial temporal lobe epilepsy. Some of these patients tend to be particularly orderly and detailed in their speech and actions (viscosity) and often experience a relative decrease in sexual interest and arousal. These personality changes, distinct from personality changes noted in any other individuals, are subtle in the majority of patients with chronic epilepsy. Patients with the described personality changes may also develop intermittent symptoms of an interictal dysphoric disorder, with episodes of irritable moods that contrast with a predominantly good-natured attitude and for which the patients will be remorseful. The Bear-Fedio Inventory needs to be further modified before it can serve as an adequate instrument for assessing the prevailing personality changes and the intermittent dysphoric symptoms.

Epilepsy, Temporal Lobe↗
PubMed1998

To what extent do premenstrual and interictal dysphoric disorder overlap? Significance for therapy.

BACKGROUND: Premenstrual dysphoria has shown a significant relationship to epilepsy, and its symptoms correspond to those of the interictal dysphoric disorder. The established treatment for interictal dysphoric disorder is explored as an effective treatment for premenstrual dysphoria. METHODS: Women with premenstrual dysphoria (the majority with epilepsy) were evaluated and treated systematically. RESULTS: Premenstrual disorder responded well to the combination of antidepressant and antiepileptic medication. CONCLUSION: Concordance of symptomatology between interictal and premenstrual dysphoric disorder may extend to treatment. LIMITATIONS: The treatment needs to be evaluated in a large series of women without epilepsy. CLINICAL RELEVANCE: A novel understanding and treatment of premenstrual dysphoria is suggested.

Adult↗
PubMed1998

Psychiatric outcome of temporal lobectomy for epilepsy: incidence and treatment of psychiatric complications.

PURPOSE: To determine the incidence of psychiatric disorders before and after surgical treatment for partial epilepsy and to document the effectiveness of their treatment. METHODS: Fifty consecutive patients treated surgically for focal epilepsy (44 temporal and six frontal) were evaluated by established neuropsychiatric methods before surgery and over a mean period of 2 years after surgery. The patients with interictal dysphoric disorders, with or without psychotic episodes, were treated with tricyclic antidepressant medication alone or combined with serotonin selective reuptake inhibitors and, if necessary, with the addition of risperidone. RESULTS: Before surgery, 25 (57%) of the 44 patients with temporal lobe epilepsy had dysphoric disorders. After surgery, 17 (39%) of the 44 patients experienced either de novo psychiatric complications (six psychotic episodes, six dysphoric disorders, and two depressive episodes) or exacerbation of preoperative dysphoric disorder (three patients). Eight previously intact patients of the 19 (42%) developed dysphoric disorders after surgery that were significantly related to recurrence of seizures. All psychiatric complications occurred in the first 2 months after surgery, except for the six patients intact before surgery, who had a recurrence of seizures. A significant predictor of ultimate excellent psychiatric outcome was complete absence of seizures after surgery. All postoperative psychiatric complications remitted on treatment with psychotropic medication in the compliant patients. CONCLUSIONS: An exceptional psychiatric morbidity is associated with the months after temporal lobectomy. Possible pathogenetic mechanisms are discussed. Antidepressant drugs are very effective in treating the psychiatric disorders of chronic epilepsy; their use in conjunction with the surgical treatment of epilepsy appears to be crucial for the overall positive outcome of a significant number of patients.

Adolescent↗
PubMed1997

Antidepressant and double antidepressant treatment for the affective disorder of epilepsy.

BACKGROUND: About half of all patients with chronic epilepsy experience an intermittent and polysymptomatic affective disorder; fewer than 10% suffer from interictal psychotic episodes. The affective disorder responds well to treatment with tricyclic antidepressant medication. The interictal psychosis tends to develop among those with severe affective disorder, responds poorly to antipsychotic medication, and has been more difficult to treat. METHOD: At the Epi-Care Center, Memphis, Tennessee, we have recently begun to treat refractory cases, both nonresponders with affective disorder and those with interictal psychosis, with the combination of a tricyclic antidepressant (TCA) and a serotonin selective reuptake inhibitor (SSRI). The double antidepressant treatment of all previously intractable patients with interictal affective disorder seen over a 20-month period at the Epi-Care Center is reported here. RESULTS: The outcome of the novel treatment for the most severe psychiatric disorders of epilepsy has been highly satisfactory: 15 (68%) of 22 previously unresponsive patients with affective disorder were excellent or good responders. CONCLUSION: Antidepressants are the psychotropic drugs of choice for the affective disorder of epilepsy and can be effective in combined form (TCA and SSRI) for otherwise intractable patients. The paradoxical therapeutic effects of proconvulsant drugs in epilepsy conform with the hypothesis that the psychiatric complications of chronic epilepsy result from the development of seizure-suppressing mechanisms that can be mitigated by antidepressants.

Adult↗
PubMed1995

Psychiatric morbidity in seizure patients on a neurodiagnostic monitoring unit.

This study aimed to clarify prevalence and type of psychiatric disorders among 97 consecutive patients with seizures who were admitted for neurodiagnostic monitoring. Of the 97 patients, 33 (34%) had an atypical mood disorder, 21 (22%) had pseudoseizures, and 9 (9%) had other psychiatric disorders, for a total of 63 (65%) in need of psychiatric treatment. Patients with the atypical mood disorder had predominantly depressive symptoms, which occurred intermittently, were associated with episodes of irritability, and alternated with briefer euphoric moods. Anxiety and phobic symptoms occurred less often. The existence of an epilepsy-specific mood disorder is suggested.

Adolescent↗
PubMed1991

[Intravaginal PgE2 administration for inducing labor in premature rupture of fetal membranes].

In a prospective study, 121 patients with spontaneous rupture of the membranes of greater than 6 hours duration and unfavourable Bishop-Score (less than 6) were stimulated with 3 mg vaginal prostaglandin-E2-tablets. All patients started labour. Only one patient had a hyperstimulation which was corrected with betamimetics. There were no systemic side effects. Almost 90% of the women delivered on the first day. The rate of the Caesarean sections was low. There was no case of intraamniotic infection; the foetal outcome was good. In conclusion, vaginal prostaglandin-E2-tablets are safe to use in spontaneous rupture of the membranes.

Administration, Intravaginal↗
PubMed1989

The fate of World War II veterans with posttraumatic seizures.

Of 244 men who, as the result of a brain wound sustained in World War II, had had one or more convulsive seizures, 101 have died. Except for men who succumbed in the first decade of complications of the wounding--infection, systemic or mental disease, status epilepticus, etc--the cause of death was similar to that of men of similar age in the general population. Of the men whose status is known, 74% have had no unconscious attacks in the past ten years or in the ten years before their death. The absence of seizures is not related to the continued ingestion of anticonvulsant medication. Approximately 25% of the men have had varying degrees of mental deterioration. The death rate of men with posttraumatic epilepsy is higher than that of normal men. Wounds of the right cerebral hemisphere seem to shorten the life span more than similar injuries of the left hemisphere.

Adaptation, Psychological↗
PubMed1984

"Chronic pain as a variant of depressive disease". A rejoinder.

The pain-prone disorder as a discrete psychobiological entity was defined on the basis of clinical evaluation, including observation of characteristic premorbid traits, psychological testing, inferred psychodynamic characteristics, a particular family history, and biological markers such as response to antidepressant medication. It is discussed in relation to the complaints of pain found in patients diagnosed primarily as depressive. The points made in the article by Turk and Salovey (J. Nerv . Ment . Dis. 172: 398-404, 1984) are considered item by item.

Chronic Disease↗
PubMed1982

Chronic pain as a variant of depressive disease: the pain-prone disorder.

Review of the literature shows that the common syndrome of chronic pain of uncertain origin appears to be perpetuated by central mechanisms. No plausible neurological theory has been proposed. While the alternative concept of chronic pain as a psychogenic disorder has remained a vague entity, there is strong support to view chronic pain as the prime expression of a muted depressive state. This form of masked depression, however, tends to be associated with a number of characteristic traits. Our studies of patients with chronic pain have led to the identification of a well defined psychobiological disorder with characteristic clinical, psychodynamic, biographic, and genetic features. This syndrome is termed the pain-prone disorder and is viewed as a variant of depressive disease. It proves a distinct entity when compared with a group of patients whose pain can be related to a well defined somatic disease. The chronicity of the disorder appears partially related to the practice of protracted, costly, and futile physical procedures, focusing on a phantom peripheral source of the pain-- a practice commonly pursued by patients and physicians. Recognition of the disorder allows for early, rational, and more effective treatment approaches.

Adult↗
PubMed1982

Biological markers for depression in chronic pain.

Patients with chronic psychogenic pain appear to suffer from a specific depressive type of disease, with somatized pain as the prime expression of a concealed mental agony (pain-prone disorder). This view is supported by clinical, premorbid, and psychodynamic findings, as well as by the presence of biological markers including a family history of affective disorders and response to antidepressants. Additional biological markers of depression include shortened rapid eye movement (REM) latency in sleep and nonsuppression in the dexamethasone suppression test (DST). The study of both markers in 20 consecutive pain-prone patients with insomnia showed clearly abnormal REM latency and/or DST nonsuppression in one half of the otherwise homogeneous group. There was high correlation between DST cortisol level and REM latency. both biological markers tend to predict response to antidepressants. The findings confirm that the pain-prone disorder can be viewed as a variant of depressive disease.

Depressive Disorder↗
PubMed1982

Disturbed sleep in patients complaining of chronic pain.

Polygraphic recordings of the sleep of patients complaining of insomnia has led to recognition of specific patterns of disturbed sleep corresponding to different etiologies of insomnia. This study presents results of polygraphic recordings of the sleep of 26 patients with chronic pain for which no physical cause can be found. All 26 also complained of insomnia. Sleep parameters of this group were compared with those to two other groups also complaining of insomnia: 12 patients whose disturbed sleep was judged secondary to psychiatric disorder, and 16 patients with the subjective complaint of insomnia in whom no objective evidence of sleep disturbance could be demonstrated. The three groups differed significantly in terms of their sleep parameters. The pain patients slept less than the subjective insomnia patients. The sleep disturbance of the psychiatric patients was more severe than that of the chronic patients. Several chronic pain patients showed evidence of nocturnal myoclonus; several also showed alpha rhythm intrusions into their sleeping electroencephalograms. The study verifies that chronic pain patients do experience significant sleep disturbance and raises several questions concerning relationships among chronic pain, sleep disturbance, and psychiatric illness, particularly depression.

Adult↗