Diagnosis and neuroanatomical correlates of depression in brain-damaged patients. Implications for a neurology of depression.

Recognizing depression in brain-damaged patients poses considerable problems. The standard diagnostic criteria often are not applicable since the neurological lesion may distort or even obliterate salient features of depression. Patients actually may deny being depressed or dysphoric, not have a depressive affect, or be totally unaware of abnormal vegetative behaviors. Furthermore, brain lesions themselves may produce striking behavioral alterations that can be mistakenly attributed to depression, or striking behavioral changes due to depression may be mistakenly attributed to the brain lesion. Based on five case studies, several clinical guidelines for recognizing and diagnosing depression in brain-damaged patients are offered. These cases also provide a data base to generate initial hypotheses about the neuroanatomical basis of the depressive syndrome. By observing how focal brain lesions modify the signs and symptoms of depression, inferences are made about brain areas crucial for modulating the various features of the depressive syndrome.

[1]  J. Stevens,et al.  Telemetered EEG-EOG during psychotic behaviors of schizophrenia. , 1979, Archives of general psychiatry.

[2]  P. Gloor.  Temporal Lobe Epilepsy: Its Possible Contribution to the Understanding of the Functional Significance of the Amygdala and of Its Interaction with Neocortical-Temporal Mechanisms , 1972 .

[3]  Ruben C. Gur,et al.  Lateral asymmetry in intensity of emotional expression , 1978, Neuropsychologia.

[4]  Hommes Or,et al.  Depression and cerebral dominance. A study of bilateral intracarotid amytal in eleven depressed patients. , 1970 .

[5]  M. Hamilton.  A RATING SCALE FOR DEPRESSION , 1960, Journal of neurology, neurosurgery, and psychiatry.

[6]  Wilson Sa.  Pathological Laughing and Crying. , 1923 .

[7]  P. Flor-Henry.  The Endogenous Psychoses: A Reflection of Lateralized Dysfunction of the Anterior Limbic System , 1978 .

[8]  E. Ross,et al.  The aprosodias. Functional-anatomic organization of the affective components of language in the right hemisphere. , 1981, Archives of neurology.

[9]  P. Venables,et al.  Bimodality and lateral asymmetry of skin conductance orienting activity in schizophrenics: replication and evidence of lateral asymmetry in patients with depression and disorders of personality. , 1974, Biological psychiatry.

[10]  Wexler Be.  Cerebral laterality and psychiatry: a review of the literature. , 1980 .

[11]  P. Fedio,et al.  Quantitative analysis of interictal behavior in temporal lobe epilepsy. , 1977, Archives of neurology.

[12]  A. Zolovick.  Effects of Lesions and Electrical Stimulation of the Amygdala on Hypothalamic-Hypophyseal-Regulation , 1972 .

[13]  J. Mendels,et al.  Neuroendocrine regulation in depression. II. Discrimination of depressed from nondepressed patients. , 1976, Archives of general psychiatry.

[14]  S. Hollon,et al.  Depressed outpatients treated with cognitive therapy or pharmacotherapy. A one-year follow-up. , 1981, Archives of general psychiatry.

[15]  E. Becker,et al.  Abnormalities of cerebral lateralization in schizophrenia patients. , 1978, Archives of general psychiatry.

[16]  J. Feighner,et al.  Diagnostic criteria for use in psychiatric research. , 1972, Archives of general psychiatry.

[17]  P. Flor-Henry.  On certain aspects of the localization of the cerebral systems regulating and determining emotion. , 1979, Biological psychiatry.

[18]  R. Mathew,et al.  Cerebral blood flow in depression. , 1980, The American journal of psychiatry.

[19]  M. Kesselman,et al.  ASYMMETRY OF INFORMATION PROCESSING IN HALLUCINATORS AND NONHALLUCINATORS , 1976, The Journal of nervous and mental disease.

[20]  A. Benton.  Aphasia, Alexia and Agraphia , 1980 .

[21]  Hippocrates,et al.  The Genuine Works Of Hippocrates , 1849 .

[22]  D. Charney,et al.  The symptoms of major depressive illness. , 1981, The American journal of psychiatry.

[23]  J. Mendels,et al.  Neuroendocrine regulation in depression. I. Limbic system-adrenocortical dysfunction. , 1976, Archives of general psychiatry.

[24]  Benson Df.  Psychiatric Aspects of Aphasia , 1973 .

[25]  G. Winokur,et al.  Hypothalamic-pituitary-adrenal axis activity in depressive illness. Its relationship to classification. , 1980, Archives of general psychiatry.

[26]  B. Kaada.  Stimulation and Regional Ablation of the Amygdaloid Complex with Reference to Functional Representations , 1972 .

[27]  M. Weissman.  The psychological treatment of depression. Evidence for the efficacy of psychotherapy alone, in comparison with, and in combination with pharmacotherapy. , 1979, Archives of general psychiatry.

[28]  S. Dimond.  Brain circuits for consciousness. , 1976, Brain, behavior and evolution.

[29]  S. Dimond,et al.  Differing emotional response from right and left hemispheres , 1976, Nature.

[30]  B. Carroll,et al.  A specific laboratory test for the diagnosis of melancholia. Standardization, validation, and clinical utility. , 1981, Archives of general psychiatry.

[31]  A. Hirano,et al.  AN ATLAS OF THE HUMAN BRAIN FOR COMPUTERIZED TOMOGRAPHY. , 1978 .

[32]  E. Ross,et al.  How the brain integrates affective and propositional language into a unified behavioral function. Hypothesis based on clinicoanatomic evidence. , 1981, Archives of neurology.

[33]  K. Heilman,et al.  Discrimination and evocation of affectively intoned speech in patients with right parietal disease , 1977, Neurology.

[34]  R. Robinson,et al.  Mood change following left hemispheric brain injury , 1981, Annals of neurology.

[35]  W. Brown,et al.  The 24-hour dexamethasone suppression test in a clinical setting: relationship to diagnosis, symptoms, and response to treatment. , 1979, The American journal of psychiatry.

[36]  Joseph E LeDoux,et al.  The Integrated Mind , 1978, Springer US.

[37]  D. Klein.  Endogenomorphic depression. A conceptual and terminological revision. , 1974, Archives of general psychiatry.

[38]  R. Gur.  Motoric laterality imbalance in schizophrenia. A possible concomitant of left hemisphere dysfunction. , 1977, Archives of general psychiatry.

[39]  Z. Koles,et al.  EEG Studies in Depression, Mania and Normals: Evidence for Partial Shifts of Laterality in the Affective Psychoses , 1980 .

[40]  J. H. Jacksons.  On affections of speech from disease of the brain , 1878 .

[41]  M. Myslobodsky,et al.  Bilateral electrodermal activity depressive patients , 1978, Biological Psychology.

[42]  R. Gur,et al.  Left hemisphere dysfunction and left hemisphere overactivation in schizophrenia. , 1978, Journal of abnormal psychology.

[43]  D. Bell.  PSYCHIATRIC ASPECTS OF CEREBRAL VASCULAR DISEASE , 1966, The Medical journal of Australia.

[44]  L. Hurwitz,et al.  MENTAL BARRIERS TO RECOVERY FROM STROKES. , 1963, Lancet.

[45]  M. Mesulam,et al.  Dominant language functions of the right hemisphere? Prosody and emotional gesturing. , 1979, Archives of neurology.

[46]  K M Heilman,et al.  Auditory affective agnosia. Disturbed comprehension of affective speech. , 1975, Journal of neurology, neurosurgery, and psychiatry.

[47]  E. Robins,et al.  Research diagnostic criteria: rationale and reliability. , 1978, Archives of general psychiatry.

[48]  M. Folstein,et al.  Mood disorder as a specific complication of stroke. , 1977, Journal of neurology, neurosurgery, and psychiatry.

[49]  R. Mathew,et al.  CEREBRAL BLOOD FLOW IN DEPRESSION , 1980, The Lancet.

[50]  R. Davidson,et al.  Right hemisphere lateralization for emotion in the human brain: interactions with cognition , 1975, Science.