RESUMO
El concepto de depresión vascular hace referencia a casos de depresión de inicio tardío, con infartos cerebrales en técnicas de imagen y factores de riesgo cardiovascular, con déficit cognitivos y pobre respuesta a fármacos antidepresivos. Se presenta el caso de una mujer de 71 años, sin antecedentes psiquiátricos y con factores de riesgo vascular, que reingresa en una unidad de hospitalización psiquiátrica por depresión melancólica con síntomas psicóticos. La resonancia magnética de la paciente mostró un infarto lacunar subcortical y una ligera leucoaraiosis y presentó déficit cognitivos en las pruebas neuropsicológicas. En los ingresos previos fue refractaria a psicofármacos, respondiendo únicamente a terapia electroconvulsiva (TEC). En este ingreso se aplicó TEC, con remisión de la sintomatología, incluyéndose en programa de TEC de mantenimiento. El concepto de depresión vascular podría explicar las especiales características y evolución del caso
The concept of vascular depression includes cases of late-onset depression, with cerebral infarction observed in imaging modalities and cardiovascular risk factors, with cognitive disabilities and poor response to antidepressant drugs. A case of a 71 year-old woman with no psychiatric background and with vascular risk factors who was re-admitted to a psychiatric hospitalization unit for melancholic depression with psychotic symptoms is presented. The magnetic resonance imaging showed a subcortical lacunar lesion and mild leukoaraiosis lesions and the neuropsychological examinations showed mild cognitive impairments. In the previous admissions the symptoms were refractory to several psychopharmacology strategies, responding only to electroconvulsive therapy (ECT). In this admission she received ECT, with remission of the symptoms, and was included in an ECT maintenance program. The vascular depression concept would explain the special features and outcome of this case
Assuntos
Feminino , Pessoa de Meia-Idade , Humanos , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Eletroconvulsoterapia/métodos , Doenças Vasculares/complicações , Doenças Vasculares/psicologia , Fatores de Risco , Antidepressivos/uso terapêutico , Neuropsicologia/métodos , Transtorno Depressivo Maior/psicologia , Cardiomiopatias/psicologia , Eletroconvulsoterapia/psicologia , Eletroconvulsoterapia/tendências , Infarto Cerebral/complicações , Infarto Cerebral/psicologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/complicações , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/psicologia , Cardiomiopatias/complicaçõesRESUMO
The concept of vascular depression includes cases of late- onset depression, with cerebral infarction observed in imaging modalities and cardiovascular risk factors, with cognitive disabilities and poor response to antidepressant drugs. A case of a 71 year-old woman with no psychiatric background and with vascular risk factors who was re-admitted to a psychiatric hospitalization unit for melancholic depression with psychotic symptoms is presented. The magnetic resonance imaging showed a subcortical lacunar lesion and mild leukoaraiosis lesions and the neuropsychological examinations showed mild cognitive impairments. In the previous admissions the symptoms were refractory to several psychopharmacology strategies, responding only to electroconvulsive therapy (ECT). In this admission she received ECT, with remission of the symptoms, and was included in an ECT maintenance program. The vascular depression concept would explain the special features and outcome of this case.
