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Depressive Disorders (depressive + disorders)
Selected AbstractsRelationship of DSM-IV-Based Depressive Disorders to Smoking Cessation and Smoking Reduction in Pregnant SmokersTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 4 2006Janice A. Blalock PhD This study investigated DSM-IV depressive disorders as predictors of smoking cessation and reduction in 81 pregnant smokers participating in a smoking cessation trial. Thirty-two percent of the sample met criteria for current dysthymia, major depressive disorder in partial remission, or minor depression. There was no significant reduction in smoking among women with or without current depressive disorders. Unexpectedly, as compared to women without depressive disorders, women with dysthymia significantly increased the mean number of cigarettes smoked (from 8 to 23 cigarettes per day during the 2 to 30 days post-targeted quit date period) and were smoking significantly more cigarettes at 30 days. A main effect approaching significance suggested that women with current depressive disorders were less likely to be abstinent than women without current depressive disorders (OR = 6.3; 3.9% vs. 12.7% at 30 days post-targeted quit date; 0% vs. 6.2% at 30 days post-partum). Results add to previous findings indicating a correlation between depressive symptoms and continued smoking in pregnant women. Further investigation of mood-focused smoking cessation interventions may be warranted. [source] Residual cognitive impairments in remitted depressed patients,DEPRESSION AND ANXIETY, Issue 6 2008Wendelien Merens M.A. Abstract Depressive disorders are associated with various cognitive impairments. Studies on whether or not these impairments persist into the euthymic phase have shown conflicting results, due to differences in test versions and in study samples. In this paper, we aimed to compare the cognitive performance of remitted depressed patients with that of age- and gender-matched healthy volunteers across a wide range of cognitive domains. In two studies, we found few differences on neutral as well as emotional information processing tests. The findings indicate that remitted depressed patients who use antidepressant medication still show an increased recognition of facial expression of fear compared to healthy controls. Patients also performed worse on a test of recognition of abstract visual information from long-term memory. No other residual cognitive impairments were found. These results indicate that most of the cognitive impairments associated with depression resolve with recovery through medication, even when recovery is incomplete. Considering the finding that remitted depressed patients have higher levels of cognitive reactivity, future studies may investigate the possibility that these cognitive impairments have not resolved but have become latent, and may therefore easily be triggered by small changes in mood state. Depression and Anxiety 0:1,10, 2007. © 2007 Wiley-Liss, Inc. [source] Classification of Anxiety and Depressive disorders: problems and solutionsDEPRESSION AND ANXIETY, Issue 4 2008G. Andrews MD Abstract The American Psychiatric Association and the World Health Organization have begun to revise their classifications of mental disorders. Four issues related to these revisions are discussed in this study: the structure of the classifications, the relationship between categories and dimensions, the sensitivity of categorical thresholds to definitions, and maximizing the utility and validity of the diagnostic process. There is now sufficient evidence to consider replacing the present groupings of disorders with an empirically based structure that reflects the actual similarities among disorders. For example, perhaps the present depression and anxiety disorders would be best grouped as internalizing disorders. Most mental disorders exist on a severity dimension. The reliability and validity of the classification might be improved if we accepted the dimensional nature of disorders while retaining the use of categorical diagnoses to enhance clinical utility. Definitions of the thresholds that define categories are very susceptible to detail. In International Classification of Diseases-11(ICD-11) and Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V), disorders about which there is agreement should be identically defined, and disorders in which there is disagreement should be defined differently, so that research can identify which definition is more valid. The present diagnostic criteria are too complex to have acceptable clinical utility. We propose a reduced criterion set that can be remembered by clinicians and an enhanced criterion set for use with decision support tools. Depression and Anxiety 25:274,281, 2008. © 2008 Wiley-Liss, Inc. [source] Depression Treatment in Rural California:Preliminary Survey of Nonpsychiatric PhysiciansTHE JOURNAL OF RURAL HEALTH, Issue 4 2002Bernardo Ng M.D. Depressive disorders have been recognized as disabling conditions of public health proportions. However, in areas underserved by mental health professionals, the treatment of depressed patients becomes challenging. Furthermore, patients living in rural areas and communities underserwd by health professionals are at risk for high levels of depressive symptoms and low access to care. Physicians (N = 58)of multiple nonpsychiatric specialties in Imperial County, a rural underserved area in California, were surveyed to ascertain their preferred strategies in the management of depressed patients. More than half (57%) of the respondents preferred to either refer patients to a mental health specialist(p > .01) as the only strategy, or in combination with counseling, prescribing medication, or both. The most commonly reported form of counseling was of a supportive nature. The most commonly prescribed drugs were selective serotonin reuptake inhibitors (in order of frequency: fluoxetine, sertraline, and paroxetine). Tricyclic antidepressants and benzodiazepines were identified as first-line drugs by some pediatricians and surgeons. The results of this study support the need for enhanced postgraduate training in the treatment of depression for nonpsychiatric physicians, and greater exposure of psychiatric residents to rural psychiatry. [source] Prevention of depressive disorders: a brave new worldDEPRESSION AND ANXIETY, Issue 12 2009Charles F. Reynolds III M.D. First page of article [source] Innovative child and adolescent treatment research for anxiety and depressive disordersDEPRESSION AND ANXIETY, Issue 4 2009Hilary B. Vidair Ph.D. No abstract is available for this article. [source] Interrelationship of childhood trauma, neuroticism, and depressive phenotypeDEPRESSION AND ANXIETY, Issue 3 2007Valentina Moskvina Ph.D. Abstract Both childhood trauma (CT) and genetic factors contribute to the pathophysiology of depression. We studied the relationship of CT to age of onset (AO) of depression, personality traits, and expression of symptom dimensions in 324 adults with recurrent unipolar depression. Subjects received structured psychiatric interviews and completed CT, depressive symptom, and personality rating questionnaires. Experience of at least one type of trauma was reported by 79.9% of subjects, and the most common forms of trauma were physical neglect, emotional abuse, and emotional neglect. There was an earlier AO of depression in the groups that reported CT compared to those that reported none, with earliest AO occurring in those who had experienced the highest levels of CT. There were no significant correlations between overall CT scores and neuroticism or extraversion. Total CT was a significant (P=.008) predictor of the Mood symptom dimension, mostly accounted for by emotional abuse (P=.019), and physical neglect predicted the Anxiety symptom dimension (P=.002). All types of CT are commonly reported in individuals with depression, and emotional abuse and physical neglect, though previously less well identified, appear to have an important role in the pathogenesis of depressive disorders. The effect of CT on individuals with an underlying genetic vulnerability to depression may result in differences in depressive phenotype characterized by earlier AO of depression and the expression of specific depressive symptom dimensions. Depression and Anxiety 24:163,168, 2007. © 2006 Wiley-Liss, Inc. [source] Childhood life events and childhood trauma in adult patients with depressive, anxiety and comorbid disorders vs. controlsACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2010J. G. F. M. Hovens Hovens JGFM, Wiersma JE, Giltay EJ, van Oppen P, Spinhoven P, Penninx BWJH, Zitman FG. Childhood life events and childhood trauma in adult patients with depressive, anxiety and comorbid disorders vs. controls. Objective:, To investigate the association between childhood life events, childhood trauma and the presence of anxiety, depressive or comorbid anxiety and depressive disorders in adulthood. Method:, Data are from 1931 adult participants in the Netherlands Study of Depression and Anxiety (NESDA). Childhood life events included divorce of parents, early parental loss and ,placed in care', whereas childhood trauma was assessed as experienced emotional neglect, psychological, physical and sexual abuse prior to age 16. Results:, Childhood life events were not associated with psychopathology, except for ,placed in care' in the comorbid group. All types of childhood trauma were increasingly prevalent in the following order: controls, anxiety, depression, and comorbid group (P < 0.001). The higher the score was on the childhood trauma index, the stronger the association with psychopathology (P < 0.001). Conclusion:, Childhood trauma rather than childhood life events are related to anxiety and depressive disorders. The strong associations with the comorbid group suggest that childhood trauma contributes to the severity of psychopathology. Our study underscores the importance of heightened awareness of the possible presence of childhood trauma, especially in adult patients with comorbid anxiety and depressive disorders. [source] Little evidence for different phenomenology in poststroke depressionACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2010T. B. Cumming Cumming TB, Churilov L, Skoog I, Blomstrand C, Linden T. Little evidence for different phenomenology in poststroke depression. Objective:, It remains unclear whether mood depressive disorders after stroke have a distinct phenomenology. We evaluated the symptom profile of poststroke depression (PSD) and assessed whether somatic symptoms were reported disproportionately by stroke patients. Method:, The sample was 149 stroke patients at 18 months poststroke and 745 age- and sex-matched general population controls. A comprehensive psychiatric interview was undertaken and depression was diagnosed according to DSM-III-R criteria. Results:, Depressed controls reported more ,inability to feel' (P = 0.002) and ,disturbed sleep' (P = 0.008) than depressed stroke patients. Factor analysis of the 10 depressive symptoms identified two main factors, which appeared to represent somatic and psychological symptoms. There was no difference in scores on these two factors between stroke patients and controls. Conclusion:, Phenomenology of depression at 18 months poststroke is broadly similar but not the same as that described by controls. Somatic symptoms of depression were not over-reported by stroke patients. [source] Progressing a spectrum model for defining non-melancholic depressionACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2005G. Parker Objective:, To further develop a ,spectrum model' for non-melancholic disorders that encompasses underlying personality styles and clinical patterning. Method:, In a sample of patients with non-melancholic depression, we studied four personality constructs influencing risk to depression, assessing associational strength and specificity between personality scores and symptom and coping response patterns. Results:, Analyses refined four personality dimensions (anxious worrying, irritability, social inhibition, and self-centredness) for testing the model. For all dimensions, personality style was specifically linked with a mirroring ,coping' response. Quantification of specific links allowed development of a spectrum model for the non-melancholic depressive disorders in which underpinning personality style showed some specific links with the clinical ,pattern' of symptoms and coping repertoires. Conclusion:, The model has the capacity to assist clinical assessment, identify aetiological personality influences and allow specific treatment effects for the heterogeneous non-melancholic depressive disorders to be determined. [source] The Bech,Rafaelsen Melancholia Scale (MES) in clinical trials of therapies in depressive disorders: a 20-year review of its use as outcome measureACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2002P. Bech Bech P. The Bech,Rafaelsen Melancholia Scale (MES) in clinical trials of therapies in depressive disorders A 20-year review of its use as outcome measure. Acta Psychiatr Scand 2002: 106: 252,264. © Blackwell Munksgaard 2002. Objective:,To evaluate the psychometric properties of the Bech,Rafaelsen Melancholia Scale (MES) by reviewing clinical trials in which it has been used as outcome measure. Method:,The psychometric analysis included internal validity (total scores being a sufficient statistic), interobserver reliability, and external validity (responsiveness in short-term trials and relapse prevention in long-term trials). Results:,The results showed that the MES is a unidimensional scale, indicating that the total score is a sufficient statistic. The interobserver reliability of the MES has been found adequate both in unipolar and bipolar depression. External validity including both relapse, response and recurrence indicated that the MES has a high responsiveness and sensitivity. Conclusion:,The MES has been found a valid and reliable scale for the measurement of changes in depressive states during short-term as well as long-term treatment. [source] Dose,response relationship of selective serotonin reuptake inhibitors treatment-emergent hypomania in depressive disordersACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2001R. Ramasubbu Objective:,The notion that antidepressant treatment-associated hypomania or mania being pharmacologically induced has been challenged. To determine whether selective serotonin reuptake inhibitors (SSRI) induced hypomania is secondary to medication effects, we examined the dose,response relationship of SSRI-induced hypomania in two patients with depressive disorder. Method:,Case study. Result:,Hypomanic symptoms emerged during treatment with sertraline at the dose of 300 mg per day in a 45-year-old male with major depression. Paroxetine treatment at the dose of 80 mg per day induced hypomania in a 37-year-old female with dysthymia and trichitillomania. These patients have no family or personal history of bipolar disorder. Hypomania resolved when sertraline was decreased to 200 mg per day and paroxetine to 40 mg per day. No hypomanic switch was observed during 18,24 months follow-up. Conclusion:,In the absence of risk factors for manic switch, SSRI-induced hypomania may be dose-dependent medication effects. [source] Psychopathology in treated Wilson's disease determined by means of CPRS expert and self-ratingsACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2000K. Portala Objective: To examine the occurrence and severity of psychopathological symptoms in patients with treated Wilson's disease (WD) and to evaluate the clinical utility of a self-assessment. Method: Twenty-six consecutive patients with confirmed WD were investigated using the Comprehensive Psychopathological Rating Scale (CPRS) and the CPRS Self-rating Scale. Results: The total CPRS scores ranged from 2.5 to 59.0 (mean 29.4±15.5). Most common symptoms were: autonomic disturbances, observed muscular tension, fatiguability, reduced sexual interest, lack of appropriate emotion, concentration difficulties, reduced sleep, aches and pains, hostile feelings, apparent sadness and failing memory. Agreement between interview-based ratings and self-ratings was low. Conclusion: The patients with treated WD have prominent psychopathology in the same range as in patients with moderate to severe depressive disorders. A specific symptom profile has been identified. If confirmed, the identification of the typical symptom profile might be of great importance. The patients with WD tend to underestimate the presence of psychopathological symptoms. [source] The relation between different dimensions of alcohol consumption and burden of disease: an overviewADDICTION, Issue 5 2010Jürgen Rehm ABSTRACT Aims As part of a larger study to estimate the global burden of disease and injury attributable to alcohol: to evaluate the evidence for a causal impact of average volume of alcohol consumption and pattern of drinking on diseases and injuries; to quantify relationships identified as causal based on published meta-analyses; to separate the impact on mortality versus morbidity where possible; and to assess the impact of the quality of alcohol on burden of disease. Methods Systematic literature reviews were used to identify alcohol-related diseases, birth complications and injuries using standard epidemiological criteria to determine causality. The extent of the risk relations was taken from meta-analyses. Results Evidence of a causal impact of average volume of alcohol consumption was found for the following major diseases: tuberculosis, mouth, nasopharynx, other pharynx and oropharynx cancer, oesophageal cancer, colon and rectum cancer, liver cancer, female breast cancer, diabetes mellitus, alcohol use disorders, unipolar depressive disorders, epilepsy, hypertensive heart disease, ischaemic heart disease (IHD), ischaemic and haemorrhagic stroke, conduction disorders and other dysrhythmias, lower respiratory infections (pneumonia), cirrhosis of the liver, preterm birth complications and fetal alcohol syndrome. Dose,response relationships could be quantified for all disease categories except for depressive disorders, with the relative risk increasing with increased level of alcohol consumption for most diseases. Both average volume and drinking pattern were linked causally to IHD, fetal alcohol syndrome and unintentional and intentional injuries. For IHD, ischaemic stroke and diabetes mellitus beneficial effects were observed for patterns of light to moderate drinking without heavy drinking occasions (as defined by 60+ g pure alcohol per day). For several disease and injury categories, the effects were stronger on mortality compared to morbidity. There was insufficient evidence to establish whether quality of alcohol had a major impact on disease burden. Conclusions Overall, these findings indicate that alcohol impacts many disease outcomes causally, both chronic and acute, and injuries. In addition, a pattern of heavy episodic drinking increases risk for some disease and all injury outcomes. Future studies need to address a number of methodological issues, especially the differential role of average volume versus drinking pattern, in order to obtain more accurate risk estimates and to understand more clearly the nature of alcohol,disease relationships. [source] Health psychology and distress after haematopoietic stem cell transplantationEUROPEAN JOURNAL OF CANCER CARE, Issue 1 2009V. DeMARINIS phd The purpose of this study of 23 adult haematopoietic stem cell transplantation (HSCT) recipients is to compare the presence of post-transplantation depression disorders by gender and to compare the outcomes among those with and without depressive disorders using a health psychology focus. This cross-sectional pilot study of mid-term survivors took place in hospital outpatient clinic. Main outcome measures are depression disorders, health status (Short Form-12) and health anxiety. Female survivors had a higher rate of depression disorders, but those with treated depressive disorders were similar to those without depression on health-related quality of life and health anxiety. Neither patient age nor time since HSCT was associated with depressive disorders. A health psychology approach may enhance management of HSCT survivorship. [source] Post-stroke depression, executive dysfunction and functional outcomeEUROPEAN JOURNAL OF NEUROLOGY, Issue 3 2002T. Pohjasvaara The early diagnosis of vascular cognitive impairment has been challenged and executive control function has been suggested to be a rational basis for the diagnosis of vascular dementia. We sought to examine the correlates of executive dysfunction in a well-defined stroke cohort. A group of 256 patients from a consecutive cohort of 486 patients with ischaemic stroke, aged 55,85 years, was subjected to a comprehensive neuropsychological examination 3,4 months after ischaemic stroke and 188 of them in addition to detailed psychiatric examination. Basic and complex activities of daily living (ADLs) (bADLs and cADLs) post-stroke were assessed. The DSM-III-R criteria were used for the diagnosis of the depressive disorders. Altogether 40.6% (n=104) of the patients had executive dysfunction. The patients with executive dysfunction were older, had lower level of education, were more often dependent, did worse in bADLs and cADLs, had more often DSM-III dementia, had worse cognition as measured by Mini Mental State Examination (MMSE) and were more depressed as measured by the BECK depression scale, but not with the more detailed psychiatric evaluation. They had more often stroke in the anterior circulation and less often in the posterior circulation. The independent correlates of executive dysfunction were cADLs (OR 1.1, 95% CI 1.03,1.16), each point of worsening in cognition by MMSE (OR 1.7, 95% CI 1.42,1.97) and stroke in the posterior circulation area (OR 0.4, 95% CI 0.18,0.84). Clinically significant executive dysfunction is frequent after ischaemic stroke and is closely connected with cADLs and to overall cognitive status but could be distinguished from depression by detailed neuropsychological examination. Executive measures may detect patients at risk of dementia and disability post-stroke. [source] ,2A and ,2C -adrenoceptor regulation in the brain: ,2A changes persist after chronic stressEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 5 2003G. Flügge Abstract Stress-induced activation of the central nervous noradrenergic system has been suspected to induce depressive disorders. As episodes of depression often occur some time after a stress experience we investigated whether stress-induced changes in the ,2 -adrenoceptor (,2 -AR) system persist throughout a post-stress recovery period. Brains of male tree shrews were analysed after 44 days of chronic psychosocial stress and after a subsequent 10-day recovery period. Expression of RNA for ,2A and ,2C -adrenoceptors was quantified by in situ hybridization, and receptor binding was determined by in vitro receptor autoradiography. Activities of the sympathetic nervous system and of the hypothalamo,pituitary,adrenal axis were increased during chronic stress but normalized during recovery. ,2A -AR RNA in the glutamatergic neurons of the lateral reticular nucleus was elevated significantly after stress and after recovery (by 29% and 17%). In the dorsal motor nucleus of the vagus, subtype A expression was enhanced after recovery (by 33%). In the locus coeruleus, subtype A autoreceptor expression was not changed significantly. Subtype C expression in the caudate nucleus and putamen was elevated by stress (by 5 and 4%, respectively) but normalized during recovery. Quantification of 3H-RX821002 binding revealed receptor upregulation during stress and/or recovery. Our data therefore show: (i) that chronic psychosocial stress differentially regulates expression of ,2 -adrenoceptor subtypes A and C; (ii) that subtype A heteroreceptor expression is persistently upregulated whereas (iii), subtype C upregulation is only transient. The present findings coincide with post mortem studies in depressed patients revealing upregulation of ,2A -ARs. [source] Efficacy of a triple herbal preparation in mild depressive disorders: results of a randomised placebo-controlled trialFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 4 2003I Urlea-Schön [source] Quality of private personal care for elderly people with a disability living at home: correlates and potential outcomesHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2008Claudio Bilotta MD Abstract To investigate correlates of the quality of private personal care for community-dwelling elderly people, this cross-sectional study enrolled 100 elderly outpatients living at home, along with their private aides and 88 informal caregivers, from May 2005 to January 2007. Cases were stratified according to the quality of private care as was described by both elderly participants and informal caregivers. In cases where the elderly person was suffering from overt cognitive impairment, only the opinions of the informal caregivers were taken into account. A comparison was made between the ,poor or fair care' group (n = 16), the ,intermediate care' group (n = 39) and the ,optimal care' group (n = 45). Considering the characteristics of private aides, there was a significant trend across the three groups in terms of language skills (P = 0.002) and level of distress with life conditions (P = 0.020). A statistical analysis performed on elderly participants without an overt cognitive impairment (n = 59) and informal caregivers showed an increase in the European Quality of Life Visual Analogue Scale score in the elderly group [mean ± standard deviation (SD) were, respectively, 45 ± 23.2, 63.7 ± 19.7 and 68.8 ± 21.6; P = 0.007], and a decrease in the Caregiver Burden Inventory score (mean ± SD were, respectively, 34.9 ± 25.3, 26 ± 17.7 and 17.6 ± 14.6; P = 0.020) across the three groups. We found no significant difference between elderly people in the three groups in terms of social variables, functional and cognitive status, prevalence of depressive disorders and morbidity. Therefore, good language skills and non-distressing life conditions of private aides appeared to be correlates of an optimal quality of care for community-dwelling elderly people with a disability, and also a better quality of life for them and less distress for their informal caregivers appeared to be potential outcomes of the quality of personal care. [source] Changes in rat hippocampal CA1 synapses following imipramine treatmentHIPPOCAMPUS, Issue 7 2008Fenghua Chen Abstract Neuronal plasticity in hippocampus is hypothesized to play an important role in both the pathophysiology of depressive disorders and the treatment. In this study, we investigated the consequences of imipramine treatment on neuroplasticity (including neurogenesis, synaptogenesis, and remodelling of synapses) in subregions of the hippocampus by quantifying number of neurons and synapses. Adult male Sprague-Dawley rats were injected with imipramine or saline (i.p.) daily for 14 days. Unbiased stereological methods were used to quantify the number of neurons and synapses. No differences in the volume and number of neurons of hippocampal subregions following imipramine treatment were found. However, the number and percentage of CA1 asymmetric spine synapses increased significantly and, conversely, the percentage of asymmetric shaft synapses significantly decreased in the imipramine treated group. Our results indicate that administration of imipramine for 14 days in normal rats could significantly increase the excitatory spine synapses, and change the relative distribution of spine and shaft synapses. We speculate that the present findings may be explained by the establishment of new synaptic connections and by remodelling or transformation of existing synapses. © 2008 Wiley-Liss, Inc. [source] Comorbidity and mixed anxiety-depressive disorder: clinical curiosity or pathophysiological need?HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue S1 2001Hans-Ulrich Wittchen Abstract The paper reviews available epidemiological evidence for the existence of and the implications of comorbidity of anxiety and depressive disorders and mixed anxiety,depressive (MAD) disorders. Using epidemiolological evidence of prevalence and incidence and data relating to time-course of illness, risk factor and outcome, it is concluded: (1) that anxiety,depression comorbidity is quite frequent in epidemiological and clinical settings throughout the world; (2) this comorbidity is diagnosis-specific and is associated with increased vulnerabilities and risks as well as poorer outcome and marked disabilities; and (3) no such evidence was found for MAD disorders. Contrary to what was predicted, the prevalence of MAD disorders was quite low even when using the more recent criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. (4) Furthermore, there was quite a heterogeneous pattern in terms of risk, severity and outcome making it questionable whether this disorder, as currently defined, is a clinical entity. These findings are discussed in terms of two perspectives, the ,lumpers' with their dimensional view and the ,splitters' with their categorical view. It is concluded that although comorbidity of threshold anxiety and depressive disorders seems to be an important phenomenon, no such evidence is provided for MAD disorders. Copyright © 2001 John Wiley & Sons, Ltd. [source] Screening for mental disorders in cancer patients , discriminant validity of HADS and GHQ-12 assessed by standardized clinical interviewINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 2 2001Katrin Reuter Abstract The detection and classification of comorbid mental disorders has major implications in cancer care. Valid screening instruments for different diagnostic specifications are therefore needed. This study investigated the discriminant validity of the German versions of the Hospital Anxiety and Depression Scale (HADS) and the General Health Questionnaire (GHQ-12). A total of 188 cancer patients participated in the examination, consisting first of the assessment of psychological distress and, second, of the diagnosis of mental disorders according to DSM-IV by clinical standardized interview (CIDI). Discriminant validity of the two instruments regarding the diagnosis of any mental disorder, anxiety, depression and multiple mental disorders was compared using ROC analysis. Overall, the total HADS scale shows a better screening performance than the GHQ-12, especially for the detection of depressive and anxiety disorders. Best results are achieved for depressive disorders with an area under the curve (AUC) of 0.80, a sensitivity of 79% and a specificity of 76% (cut-off point = 17). For the ability of the instruments to detect patients with mental disorders in general, the GHQ-12 (AUC: 0.68) shows a similar overall accuracy to the HADS (AUC: 0.70). The screening performance of both scales for comorbid mental disorders is comparable. The HADS is a valid screening instrument for depressive and anxiety disorders in cancer care. The GHQ-12 can be considered as an alternative to the HADS when diagnostic specifications are less detailed and the goal of screening procedures is to detect patients with single or multiple mental disorders in general. Limitations of conventional screening instruments are given through the differing methodological approaches of screening tests (dimensional approach) and diagnosis according to DSM-IV (categorical approach). Copyright © 2001 Whurr Publishers Ltd. [source] Late-Life Depression is Associated with Arterial Stiffness: A Population-Based StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2003Henning Tiemeier MD Objectives: To determine whether arterial stiffness is associated with depression in the elderly. Design: Population-based cross-sectional study. Setting: In Ommoord, a suburb of Rotterdam, the Netherlands. Participants: Three thousand seven hundred four subjects of the Rotterdam Study aged 60 and older. Measurements: Arterial stiffness was assessed using the distensibility of the carotid artery and the carotid-femoral pulse wave velocity. All participants were screened for depressive symptoms with the Center for Epidemiologic Studies,Depression scale. Those with depressive symptoms had a psychiatric evaluation to establish a diagnosis of depressive disorders according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Results: Participants with increased arterial stiffness were more likely to have depressive symptoms. Odds ratios (ORs) for depressive symptoms were 1.24 (95% confidence interval (CI) = 1.01,1.52) per standard deviation decrease in carotid distensibility and 1.17 (95% CI = 1.00,1.38) per standard deviation increase in aortic pulse wave velocity. The association was stronger for depressive disorders meeting DSM-IV criteria (OR = 1.44, 95% CI = 1.03,2.03; OR = 1.48, 95% CI = 1.16,1.90, respectively). Control for atherosclerosis, as measured by the ankle-to-brachial index or presence of plaques in the carotid artery, did not change the associations. Conclusion: This study shows an association between arterial stiffness and depression in the elderly. The findings are compatible with the vascular depression hypothesis. These data suggest that arterial stiffness may partly cause the proposed relationship between vascular factors and depression. [source] CYP2D6 polymorphism and clinical effect of the antidepressant venlafaxineJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 5 2006M. E. E. Shams PhD Summary Background:, Venlafaxine (V) is a mixed serotonin and noradrenaline reuptake inhibitor used as a first-line treatment of depressive disorders. It is metabolized primarily by the highly polymorphic cytochrome P450 (CYP) enzyme CYP2D6 to yield a pharmacologically active metabolite, O -desmethylvenlafaxine (ODV), and to a lesser extent by CYP3A4, to yield N -desmethylvenlafaxine (NDV). Objectives:, The aim of this study was to assess whether the O-demethylation phenotype of V has an impact on the pharmacokinetics and clinical outcome. Method:, In 100 patients treated with V, serum concentrations of V, ODV and NDV and the ratios of concentrations ODV/V as a measure of O-demethylation were determined. Individuals exhibiting abnormally high or low metabolic ratios of ODV/V were selected for genotyping. Clinical effects were monitored by the Clinical Global Impressions Scale and side effects by the UKU (Udvalg for Kliniske Undersogelser Side Effect Rating Scale) rating scale. Results:, There was wide inter-individual variability in ODV/V ratios. The median ratio ODV/V was 1·8 and the 10th and 90th percentiles 0·3 and 5·2, respectively. Individuals with ODV/V ratios below 0·3 were all identified as poor metabolizers (PM), with the genotypes *6/*4 (n = 1), *5/*4 (n = 2) or *6/*6 (n = 1). Individuals with ratios above 5·2 were all ultra rapid metabolizers (UM, n = 6) due to gene duplications. Five individuals with intermediate metabolic activity (ODV/V, 1·1 ± 0·8) were heterozygotes with the CYP2D6*4 genotype, and one patient with an intermediate metabolic ratio of 4·8 had the genotype *4/2x*1. Clinical outcome measurements revealed that patients with ODV/V ratios below 0·3 had more side effects (P < 0·005) and reduced serum concentrations of sodium (P < 0·05) in comparison with other patients. Gastrointestinal side effects, notably nausea, vomiting and diarrhoea were the most common. Differences in therapeutic efficacy were not significant between the different phenotypes. Conclusion:, The O-demethylation phenotype of V depends strongly on the CYP2D6 genotype. A PM phenotype of CYP2D6 increases the risk of side effects. [source] Distinguishing anxiety and depression in self-report: purification of the beck anxiety inventory and beck depression inventory-II,JOURNAL OF CLINICAL PSYCHOLOGY, Issue 9 2010Niklaus Stulz Abstract The overlap of symptoms associated with anxiety and depressive disorders hinders their differentiation using self-report scales. The aim of this study was to develop purified versions of the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory-II (BDI-II) that encompass only items highly specific to anxiety and depression, respectively. However, using these purified scales only increased the ability to differentiate anxiety and depressive disorders slightly. Anxiety and depression seem to be inherently linked and, thus, the high comorbidity of anxiety and depressive disorders seems to be not a function of the same types of symptoms being reported for each disorder. Nevertheless, purified BAI and BDI-II scales might be useful for separating the effects of interventions on anxiety and depressive symptoms. © 2010 Wiley Periodicals, Inc. J Clin Psychol: 66:1,14, 2010. [source] Treating the aged in rural communities: the application of cognitive-behavioral therapy for depressionJOURNAL OF CLINICAL PSYCHOLOGY, Issue 5 2010Martha R. Crowther Abstract Many rural communities are experiencing an increase in their older adult population. Older adults who live in rural areas typically have fewer resources and poorer mental and physical health status than do their urban counterparts. Depression is the most prevalent mental health problem among older adults, and 80% of the cases are treatable. Unfortunately, for many rural elders, depressive disorders are widely under-recognized and often untreated or undertreated. Psychotherapy is illustrated with the case of a 65-year-old rural married man whose presenting complaint was depressive symptoms after a myocardial infarction and loss of ability to work. The case illustrates that respect for rural elderly clients' deeply held beliefs about gender and therapy, coupled with an understanding of their limited resources, can be combined with psychoeducational and therapeutic interventions to offer new options. © 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 66:1,11, 2010. [source] Meditation with yoga, group therapy with hypnosis, and psychoeducation for long-term depressed mood: a randomized pilot trialJOURNAL OF CLINICAL PSYCHOLOGY, Issue 7 2008Lisa D. Butler Abstract This randomized pilot study investigated the effects of meditation with yoga (and psychoeducation) versus group therapy with hypnosis (and psychoeducation) versus psychoeducation alone on diagnostic status and symptom levels among 46 individuals with long-term depressive disorders. Results indicate that significantly more meditation group participants experienced a remission than did controls at 9-month follow-up. Eight hypnosis group participants also experienced a remission, but the difference from controls was not statistically significant. Three control participants, but no meditation or hypnosis participants, developed a new depressive episode during the study, though this difference did not reach statistical significance in any case. Although all groups reported some reduction in symptom levels, they did not differ significantly in that outcome. Overall, these results suggest that these two interventions show promise for treating low- to moderate-level depression. © 2008 Wiley Periodicals, Inc. J Clin Psychol 64(7): 1,15, 2008. [source] The use of psychiatric medications to treat depressive disorders in African American womenJOURNAL OF CLINICAL PSYCHOLOGY, Issue 7 2006Allesa P. Jackson Review of the current literature confirms that African American women as a group are underdiagnosed and undertreated for psychiatric disorders. Hence, much effort is targeted towards awareness, screening, and improving access to health care for this population. However, once an African American woman is diagnosed with a major mental health disorder, determining the optimal course of treatment is a process that must be approached carefully because of gender and racial/ethnic differences in response and metabolism of psychiatric medications. African American women fall into both of these understudied categories. Given the small numbers of African American women represented in the clinical trials on which clinical practice is based, one must consider the limitations of current knowledge regarding psychoactive medications in this population. Culturally based attitudes or resistance to pharmacotherapy can complicate the use of psychoactive medicines, often a first-line approach in primary care clinics. Communication with patients is key, as well as openness to patient concerns and tolerance of these medications. © 2006 Wiley Periodicals, Inc. J Clin Psychol 62: 793,800, 2006. [source] Computer-aided CBT self-help for anxiety and depressive disorders: Experience of a London clinic and future directionsJOURNAL OF CLINICAL PSYCHOLOGY, Issue 2 2004Lina Gega This article describes a broad-spectrum, computer-aided self-help clinic that raised the throughput of anxious/depressed patients per clinician and lowered per-patient time with a clinician without impairing effectiveness. Many sufferers improved by using one of four computer-aided systems of cognitive behavior therapy (CBT) self-help for phobia/panic, depression, obsessive-compulsive disorder, and general anxiety. The systems are accessible at home, two by phone and two by the Web. Initial brief screening by a clinician can be done by phone, and if patients get stuck they can obtain brief live advice from a therapist on a phone helpline. Such clinician-extender systems offer hope for enhancing the convenience and confidentiality of guided self-help, reducing the per-patient cost of CBT, and lessening stigma. The case examples illustrate the clinical process and outcomes of the computer-aided system. © 2003 Wiley Periodicals, Inc. J Clin Psychol/In Session. [source] Melatonin and sleep disorders associated with intellectual disability: a clinical reviewJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 1 2007S. G. Sajith Abstract Background Melatonin is used to treat sleep disorders in both children and adults with intellectual disability (ID), although it has no product license for such use. The evidence for its efficacy, potential adverse effects and drug interactions are reviewed in the context of prescribing to people with ID. Methods A literature search was performed using multiple electronic databases. More literature was obtained from the reference lists of papers gathered through the searches. Results Most of the studies were uncontrolled and the few controlled trials available were of small size. Melatonin appears effective in reducing sleep onset latency and is probably effective in improving total sleep time in children and adolescents with ID. It appears to be ineffective in improving night-time awakenings. Melatonin is relatively safe for short-term use. Its safety for long-term use is not established. Potential drug interactions, possible effects on puberty and concerns regarding the use of melatonin in epilepsy, asthma and depressive disorders are discussed. Conclusions Melatonin appears to be an effective sleep-initiator for children and adolescents with ID and probably has a similar effect for adults. There may be heterogeneity of response depending on the nature of the sleep problem and cause of the ID or associated disabilities. Further studies are necessary before firm conclusions can be drawn and guidelines for the use of melatonin for people with ID formulated. [source] | ||||||||||||||||||||||||||||||||||