Some patients with obsessive-compulsive disorder (OCD) exhibit an unsatisfactory reduction in symptom severity despite being treated with all the available therapeutic alternatives. The clinical variables associated with treatment-refractoriness in OCD are inconsistently described in the literature. METHODS: To investigate factors associated with treatment-refractoriness of patients with OCD, we conducted a case-control study, comparing 23 patients with treatment-refractory OCD to 26 patients with treatment-responding OCD.
Electroconvulsive therapy (ECT) is one of the most effective methods for managing treatment-resistant depression. Although the proposed mechanisms of action have thus far mainly been investigated at the cellular level, recent observations and developments in the field of molecular biology and genomics have provided novel insights in the actual molecular underpinnings of dynamic alterations in gene expression, particularly in response to environmental exposures, and experience-dependent plasticity, both of which are highly relevant to ECT.
Depression is a severe and heterogeneous disorder resulting from interacting genetic, environmental, and epigenetic factors. Nutrient deficiency resulting from bariatric bypass surgery has been involved in the pathophysiological mechanisms of depression and treatment response.We report the case of a patient who developed, after a bariatric bypass surgery, a severe depressive episode, refractory to both pharmacological treatment and electroconvulsivotherapy (ECT). Folate deficiency was evidenced. A dramatic response to ECT was observed after folate supplementation.
A case of the Capras phenomenon in a man of 58, arising during the course of a depressive illness, is described. Physical, electroencephalographic and psychometric investigations gave no sign of organic disease, and recovery was complete. Factors leading to the development of a depressive psychosis and its particular manifestation in the Capgras delusion are traced in detail. The psychopathology of the condition and the implications for treatment are discussed.
BACKGROUND: Erotomania, as a primary disorder, is categorized in DSM-III-R under delusional (paranoid) disorder. However, erotomanic delusions also are seen frequently in the context of other psychiatric disorders. There is increasing evidence that patients with such delusions often have an underlying affective disorder and effective treatment of the underlying disorder can lead to resolution of the erotomanic delusions. METHOD: The case histories of three patients with prominent affective features and erotomanic delusions are presented.