Scalco AZ, Scalco MZ, Azul JBS, Lotufo Neto F. Hypertension and depression. Clinics. 2005;60(3):241-50.Despite the high prevalence of depression and hypertension, the relationship between the two diseases has received little attention. This paper reviews the epidemiological, pathophysiological, and prognostic aspects of this association, as well as its implications for treatment. A Medline search was conducted using the following key words: depression, blood pressure, blood pressure variability, physical morbidity, hypertension, mood, stress, hypertension, antidepressive agents, and genetics, from 1980 to 2004. We found descriptions of increased prevalence of hypertension in depressed patients, increased prevalence of depression in hypertensive patients, association between depressive symptomatology and hypotension, and alteration of the circadian variation of blood pressure in depressed patients. There is considerable evidence suggesting that hyperreactivity of the sympathetic nervous system and genetic influences are the underlying mechanisms in the relationship between depression and hypertension. Depression can negatively affect the course of hypertensive illness. Additionally, the use of antidepressive agents can interfere with blood pressure control of patients with hypertension by inducing changes in blood pressure and orthostatic hypotension.Several studies have focused on the association between depression and cardiovascular diseases; however, the relationship between depression and hypertension has received less attention. Nevertheless, interactions between blood pressure (BP) and psychic factors have been observed. O'Hare observed that by asking hypertensive patients to talk about health problems or other life stresses, he could induce substantial increases in their BP, and while after resting quietly for 20 to 40 minutes, they had large drops in BP. 1 Over the next several decades, these observations were replicated many times by other investigators who also found that BP measurements by a doctor are frequently accompanied by marked increased BP and heart rate (HR). This increase (named the "white-coat" effect) is quite common and is believed to be a consequence of an anxiety response to the doctor's visit. 2 Since both hypertension and depression are highly prevalent, it is extremely important to better understand the relationship between them. METHODThis paper reviews the epidemiological, pathophysiological, and prognostic aspects of the association between hypertension and depression, as well as its implications for treatment. The method was a Medline search, which was conducted using the following key words: depression, blood pressure (BP), blood pressure variability (BPV), physical morbidity, hypertension, mood, stress, hypertension, antidepressive agents, and genetics, from 1980 to 2004. RESULTS Epidemiologics aspectsBoth hypertension and hypotension have been observed in association with depression or depressive symptoms. CLINICS 2005;60(3):241-50 Hypertension and depression Scalco AZ et al.

Aims: To estimate dementia prevalence and describe the etiology of dementia in a community sample from the city of São Paulo, Brazil. Methods: A sample of subjects older than 60 years was screened for dementia in the first phase. During the second phase, the diagnostic workup included a structured interview, physical and neurological examination, laboratory exams, a brain scan, and DSM-IV criteria diagnosis. Results: Mean age was 71.5 years (n = 1,563) and 58.3% had up to 4 years of schooling (68.7% female). Dementia was diagnosed in 107 subjects with an observed prevalence of 6.8%. The estimate of dementia prevalence was 12.9%, considering design effect, nonresponse during the community phase, and positive and negative predictive values. Alzheimer’s disease was the most frequent cause of dementia (59.8%), followed by vascular dementia (15.9%). Older age and illiteracy were significantly associated with dementia. Conclusions: The estimate of dementia prevalence was higher than previously reported in Brazil, with Alzheimer’s disease and vascular dementia being the most frequent causes of dementia. Dementia prevalence in Brazil and in other Latin American countries should be addressed by additional studies to confirm these higher dementia rates which might have a sizable impact on countries’ health services.

Moderate-to-severe depression is associated with increased MSNA. Sertraline treatment reduces MSNA at rest and during mental challenge in depressed patients, which may have prognostic implications in this group.

ResumoContexto: A realização de diagnóstico neurológico e psiquiátrico em ambiente de emergência hospitalar com freqüência é uma tarefa complexa e exige colaboração interdisciplinar. Um dos diagnósticos diferenciais de doenças neurológicas é o transtorno conversivo, cuja característica principal é a presença de sintomas afetando funções motoras ou sensoriais, que sugerem desordem clínica ou neurológica, porém sem doença orgânica subjacente que explique o quadro. Relato de caso: Os autores relatam o caso de uma paciente de 23 anos com apresentação clínica atípica de acidente vascular cerebral, afasia global sem hemiparesia, que foi inicialmente diagnosticada como transtorno psiquiátrico pelo serviço de clínica médica de emergência. Conclusão: Certas apresentações neurológicas podem ser interpretadas como transtorno conversivo pelas similaridades clínicas entre as duas desordens, raridade do quadro clínico, pela presença de sintomatologia psiquiátrica e fatores psicossociais nos pacientes neurológicos. Mesmo com apresentações neurológicas atípicas e sintomas psiquiátricos, pacientes com quadro sugestivo de transtorno conversivo devem ser sempre investigados de forma interdisciplinar.Negreiros, D.P. et al. / Rev. Psiq. Clín. 34 (1); 23-27, 2007 Palavras-chave: Acidente cerebrovascular, transtorno conversivo, afasia, diagnóstico diferencial, serviços médicos de emergência. AbstractBackground: The neurologic and psychiatric diagnosis in emergency settings are difficult tasks and require interdisciplinary effort. Conversion disorder is one of the differential diagnosis for certain neurologic disorders. The main characteristic is motor or sensory deficits suggesting neurologic or medical condition, but without organic disease that explains the symptoms. Case report: We present a 23 year-old-woman with an atypical clinical presentation of stroke: global aphasia without hemiparesis. This patient was initially diagnosed with conversion disorder by the internal medicine service in the emergency room. Conclusion: Some rare neurologic diseases can be interpreted as conversive disorders due to some reasons: clinical similarities between the two disorders, unusual clinical presentations, comorbidity of neurologic and psychiatric disorders and psychological features of the neurological patients. Patients presenting with atypical neurological or psychiatric symptoms, in which a diagnosis of conversion disorder is suspected, should always be investigated in an interdisciplinary setting.

No abstract