Showing papers on "Depression (differential diagnoses) published in 1982"

Screening tests for geriatric depression

Abstract: Contends that the diagnosis of depression in aged patients is the responsibility of both psychologists, and non-psychologists, for it is the latter that is most likely to make initial contact with ...

Handbook of affective disorders

Abstract: Part 1 Descriptive aspects: symptoms and assessment of depression symptoms and assessment of mania concepts, diagnosis and classification history of the affective disorders the bipolar-unipolar distinction anxiety disorders and their relationship to depression course and outcome. Part 2 Causative aspects: epidemiology genetics life events and social stress early environment personaltiy psychodynamics animal models neurochemistry neuroendocrinology the hypothalamic-pituitary-adrenocortical ayarwm neuropsychology and imaging sleep and affective disorders. Part 3 Medication and physical treatments: tricyclic and newer antidepressants monoamine oxidase inhibitors electroconvulsive therapy lithium anticonsulsants and novel drugs maintenance treatment resistant depression prediction of treatment response. Part 4 Psychotherapeutic, cognitive and social treatments: psychoanalytically orientated psychotherapy group therapy family and marital therapy interpersonal psychotherapy cognitive therapy social and community approaches. Part 5 Special aspects: transcultural aspects seasonal affective disorders depression and childbirth depression in childhood and adolescence affective disorders in old age bereavement suicide and attempted suicide depression in general practice depression in medical settings.

Prospective study of the psychiatric disorders of childbirth.

Abstract: A representative sample of 105 women were assessed by Goldberg's Standardised Psychiatric Interview (SPI) on two occasions during pregnancy and twice more in the puerperium. Total SPI scores increased significantly after childbirth. Thirteen of the sample had a severe postnatal depression and a further 17 women had milder depression, which in 15 lasted at four weeks. Marked deterioration of their martial relationships was reported by the depressed women but no other social or obstetric characteristics of postnatal depression were found. Women with severe postnatal blues were particularly at risk of developing persistent depressive symptoms subsequently. The only two women referred to a psychiatrist had personality disorders rather than depressive illnesses.

Bipolar Illness in Adolescents With Major Depression: Clinical, Genetic, and Psychopharmacologic Predictors in a Three-to Four-Year Prospective Follow-up Investigation

Abstract: • Sixty adolescents, aged 13 to 16 years, hospitalized for major depression were studied prospectively for three to four years to determine the utility of clinical, genetic, and pharmacologic response variables in predicting a bipolar course of illness. Bipolar outcome was observed in 20% of the cohort. Statistical analyses showed that bipolarity was predicted by (1) a depressive symptom cluster comprising rapid symptom onset, psychomotor retardation, and mood-congruent psychotic features; (2) a "loading" of affective disorder in the family pedigree, a family history of bipolar illness, and the presence of illness in three successive generations of the pedigree; and (3) pharmacologically induced hypomania. All predictors were shown to have high specificity for bipolar outcome, whereas pharmacologic hypomania and symptom cluster permitted the highest confidence of prediction, 100% and 80%, respectively. Even in juvenile depression, careful attention to clinical and biologic variables may aid in the predictive differentiation of meaningful diagnostic subtypes.

Diagnosis and Symptoms of Depression in Opiate Addicts: Course and Relationship to Treatment Outcome

Abstract: • Evaluations of diagnosis and symptoms of depression were undertaken in 157 opiate addicts at entrance to a multimodality drug treatment program and six months later. While 17% were having an episode of major depression (defined by Research Diagnostic Criteria) and 60% had at least mildly elevated depressive symptoms at entrance to treatment, substantial improvement was noted at the six-month reevaluation, with the rates of major depression and elevated symptoms dropping to 12% and 31%, respectively. Symptomatic improvement, although related to retention in treatment, was not the result of specific antidepressant pharmacotherapy and did not differ across treatment modalities. Starting treatment during a major or minor depressive episode was predictive of poorer outcome in the areas of illicit drug use and psychological symptoms, but unrelated to the areas of occupational functioning, legal problems, and program retention.

Social origins of depression in old age.

Abstract: In a comparison between elderly depressed subjects and normal elderly people in the general population, an association was found between severe life events, major social difficulties, poor physical health and the onset of depression. Working class subjects within the general population had a higher incidence of depression and this appeared to be explained by their poorer health and greater social difficulties. Those elderly people who lacked a confiding relationship were more vulnerable to depression. Evidence is presented that the lack of a confidant was a reflection of life-long personality traits.

Coexistence of cognitive impairment and depression in geriatric outpatients.

Abstract: The authors diagnosed depression in 20 (23%) of 88 cognitively impaired geriatric outpatients. Three (20%) of these patients had depression only, and 17 (85%) had depression superimposed on an underlying dementia. The rate of coexisting depression decreased significantly with greater severity of the cognitive impairment: 9 (33%) of 27 mildly impaired patients were depressed, compared with 8 (23%) of 35 moderately impaired and 3 (12%) of 26 severely impaired patients. There was a nonsignificant trend for cognitively impaired women to be more likely to be depressed than for similarly impaired men. The authors conclude that although depression must be differentiated from dementia, it is equally important to consider the possibility that the diagnoses coexist.

"Double depression": superimposition of acute depressive episodes on chronic depressive disorders.

Abstract: Although ‘ ‘double depression ‘ ‘-major depressive disorder superimposed on an underlying chronic depression-is a f requent phenomenon, the concept has not been well formulated clinically and has rarely been described in the research literature. The authors found that 1) 26% of 101 patients who met the criteria for major depressive disorder had an underlying chronic depressive disorder of at least 2 years’ duration, 2) “recovery” ratesfor patients with superimposed depression differed greatly depending on whether recovery was defined as recovery from the major depressive disorder only or recovery from both disorders, and 3) patients with superimposed depression relapsed at a significantly higher rate immediately after recovery from the acute episode of depression than did patients without superimposed depression.

Excess Mortality in Panic Disorder: A Comparison With Primary Unipolar Depression

Abstract: • We located 113 former inpatients with panic disorder 35 years after index admission. According to age-and sex-specific Iowa population figures, patients with panic disorder had significant excess mortality due to death by unnatural causes. Other studies suggest that secondary depression and alcoholism may have had a role in these deaths. Men with panic disorder also exhibited excess mortality due to circulatory system disease. In an age-and sex-matched patient group with primary unipolar depression, both men and women showed excess mortality. Suicide accounted for 20.0% and 16.2% of deaths in the panic disorder and primary depression groups, respectively. We conclude that panic disorder accounted for much of the excess mortality formerly noted in the "neuroses."

Recovery in Major Depressive Disorder: Analysis With the Life Table and Regression Models

Abstract: • Regression models and life tables were used to describe the phenomenon of recovery from major depressive disorder for 101 patients in a naturalistic study in which treatment was not controlled by the investigators. Time to recovery from the onset of the episode was protracted, as only about 50% of patients recovered by one year. Annual rates of recovery then declined steadily to 28% in the second year, 22% in the third year, and 18% in the fourth year. In contrast, speed of recovery from entry into the study was more rapid, and 63% of patients recovered by four months. The recovery rates were about 20% each month for the first four months and then declined sharply for the remaining months of the one-year follow-up. Several clinical variables were statistically significant predictors of recovery when measured from entry into the study: superimposition of the acute episode on a chronic underlying depression, acuteness of onset of the depression, and severity of depression for the subgroup of patients without superimposed illness.

Suicide in chronic schizophrenia.

Abstract: A matched controlled study of 30 chronic schizophrenic suicides is presented. Eighty per cent were male and committed suicide at a mean age of 25.8 years after a mean duration of illness of 4.8 years. Significantly more of the suicides had a chronic relapsing schizophrenic illness; 23.3 per cent committed suicide while in-patients, and 50 per cent of the out-patients committed suicide within three months of discharge from in-patient care. Significantly more of the suicides had a past history of depression (56.6 per cent), were depressed in the last episode of contract (53.3 per cent), had their last admission for depression or suicidal ideation (55.2 per cent) and were unemployed (80 per cent).

Suicidal behavior and depression in children and adolescents

Abstract: The Children's Depression Inventory (CDI) and semistructured interview were used to study suicidal ideation, suicide attempt, depression as a syndrome, and diagnosis in 102 psychiatrically referred children and adolescents. We found that severe suicidal ideation increased around puberty and correlated with increasingly severe depression. Suicide attempts were more variable and did not reflect a continuum of suicidal ideation. While most youngsters who felt suicidal felt depressed, those that did not had nonaffective diagnoses. Similarly, youngsters whose suicide attempt did not lead to psychiatric hospitalization felt less depressed and met criteria for nondepressive diagnoses. Hopelessness, chronicity of psychiatric disorders, and family history of psychopathology are also explored.

Seasonal variation in depressive disorders and suicidal deaths in New South Wales.

Abstract: Month of admission data to psychiatric facilities in New South Wales, 1971-76, were examined for some 23,000 patients with a depressive disorder to determine if seasonal variations in admissions, described in the northern hemisphere, exist there. In addition, data were examined on month of occurrence of some 3,000 deaths due to suicide and self-inflicted injury, over the same period. Seasonality was demonstrated for three 'psychotic' depressive disorders, but not found for neurotic depression, further supporting the binary view of depression. A peak incidence in spring was found for MDP-mania and reactive depressive psychosis, while the peak incidence for MDP-depression was was in late winter. It is suggested that the increase in certain affective disorders around spring may follow a rapid increase in luminance, and in stimulation of the pineal gland. Suicidal deaths of males did not show significant seasonality, while those of females showed two incidence peaks, the significant one occurring in spring.

Sexual dysfunctions in depression

Abstract: The incidence of sexual dysfunctions in a group of 51 drug-free depressed patients and in age- and sex-matched controls was studied. Three groups of sexual dysfunction were assessed: alterations of libido, genital symptoms, and menstrual irregularities. The Beck Rating Scale for Depression, the Eysenck Personality Inventory (EPI), and the State-Trait Anxiety Inventory were completed on each participant. Depressed patients obtained significantly higher scores on anxiety, depression, and alterations of libido than controls. Rating scale scores for anxiety and depression were strongly inter-correlated, making the separation of depression-related symptoms from anxiety difficult. In males, the genital symptoms correlated inversely with the L (lie) score of the Eysenck Personality Inventory. There were no inter-relationships between the three groups of sexual dysfunction.

The treatment of depression in general practice: a comparison of L-tryptophan, amitriptyline, and a combination of L-tryptophan and amitriptyline with placebo

Abstract: One hundred and fifteen patients from 5 general practices participated in a 12-week, double-blind study comparing L-tryptophan, amitriptyline, L-tryptophan-amitriptyline combination and placebo in the treatment of depression. Analysis of total score on the Hamilton Depression Scale and a global rating of depression showed that all 3 active treatments were more effective than placebo. Significantly more patients were withdrawn as treatment failures in the placebo group compared with the active treatment groups. Side-effects necessitated withdrawal of more patients from the amitriptyline group than from the other active treatment groups, but this difference was not significant. Plasma amitriptyline and nortriptyline levels were similar in the amitriptyline and combined treatment groups. Standard haematological and biochemical profiles did not alter significantly in any group, but mean heart rate was significantly increased in patients receiving amitriptyline. There was no change in free or total plasma tryptophan concentration with treatment or on remission of symptoms.

Moods and memories: elation, depression, and the remembering of the events of one's life.

Abstract: Three experiments investigated the influence of current mood states on the remembering of past events of one's own life. In the first and the second experiment, participants were induced to experience either the mood state of elation or the mood state of depression. They then reported events and experiences that had occurred during the previous week. In the first and the second experiments, using converging methods for assessing memory for past events, participants differentially reported past events and experiences whose affective quality was congruent with their current mood states: participants in elated mood states preferentially reported pleasant events and happy experiences, and participants in depressed mood states preferentially reported unpleasant events and unhappy experiences. Additional evidence from the second experiment suggests that the differential remembering of affectively positive or affectively negative events requires that, at the time of the remembering of these events, participants actually experience the mood states of elation or depression and not simply attempt to remember past events that could account for elation or depression. In the third experiment, designed to assess the plausibility of "experimental demand" interpretations of these findings, participants who experienced ostensibly effective mood inductions that were actually ineffective failed to manifest differential remembering of affectively positive and affectively negative events. Implications of this series of experiments for understanding the mechanisms that may link moods and memories, as well as the intrapersonal and the interpersonal consequences of mood states, are discussed.

The bereaved child.

Abstract: This is a one-year prospective study of one hundred and five 2 to 17 year old children of a consecutive sample of young widows and widowers in the community and of the children of controls. The children's reactions to the parental death were recorded at one month and thirteen months after the event in a structured interview with the surviving parent. The interview included items of general adaption to the death, school performance, behaviour problems, symptoms relevant to psychopathological manifestations (depression, anxiety, etc.) and general health. The results indicate a significant increase of dysphoria which disappears over time (P less than 0.0001), the persistence of a minor form of depression (P less than 0.03), an increase in bedwetting (P less than 0.03), and a significant degree of impairment in school performance (P less than 0.0001). There were no significant increases in behaviour problems and severe forms of depression. The children's general health was not affected. Those results are compared to currently available data on childhood bereavement and discussed in the light of conflicting reports relating parental loss to adult psychopathology.

Pain and depression.

Abstract: This paper explores the relationship between depression and chronic intractable pain in which somatic pathology is playing a minor role. In this study, 114 patients with chronic pain were compared with 53 patients with depression. Patients with chronic pain were older, more likely to be married, more frequently attributed difficulties in activity and sleep to pain, and reported greater impairment of motor functions. They had less dysphoria and an illness behaviour profile (on the Illness Behaviour Questionnaire) suggestive of a conversion reaction. Depressed patients recalled more life events in the year prior to presentation, whilst pain patients recalled more events of nine and ten years earlier. It is concluded that the two patient groups cannot be considered identical. It is argued that the concept of abnormal illness behavior helps to distinguish the two groups.

Psychic disturbances in adult coeliac disease. I. Clinical observations.

Abstract: Adult coeliac patients living in a defined area of Sweden were examined for a history of major psychiatric illness occurring before the coeliac disease had been diagnosed. Eight of 42 patients without dermatitis herpetiformis (19%) and one medical control subject had attended a psychiatric clinic over a 10-year period for neurotic disorders (p < 0.05), mostly depression. Our study shows that psychiatric illness may be severe in undiagnosed adult coeliac patients. It was found to be the commonest reason for granting disability pension in our series, having occurred in altogether six patients.

Psychiatric symptom patterns of chronic epileptics attending a neurological clinic: a controlled investigation.

Abstract: The psychiatric morbidity of chronic epileptic out-patients unknown to psychiatric agencies was assessed using two questionnaire measures of psychopathology (GHQ and CCEI). Nearly half of the epileptics were classified as probable psychiatric cases. Psychiatric morbidity was both more prevalent and more severe in this group than in a comparison group of chronic neurological out-patients. Depression, anxiety and hysterical symptomatology were the commonest characteristics of psychiatrically impaired epileptics. The type and severity of epilepsy were found to influence both the degree and pattern of psychiatric morbidity. Contrary to previous findings, age of onset had no relation to psychopathology.

Biological markers for depression in chronic pain.

Abstract: Patients with chronic psychogenic pain appear to suffer from a specific depressive type of disease, with somatized pain as the prime expression of a concealed mental agony (pain-prone disorder). This view is supported by clinical, premorbid, and psychodynamic findings, as well as by the presence of

Factors associated with incomplete recovery in primary depressive illness.

Abstract: Factors associated with chronicity in primary depression were investigated. Chronic secondary and episodic primary depressives served as control groups. Shortened REM latency and relative absence of pronounced characterologic pathology in the chronic primary depressive group were similar to data for episodic primary depressive controls. Chronicity in primary depression was significantly correlated with a positive family history of affective disorder, multiple losses through death of family members, disabled spouses, concurrent incapacitating medical diseases (especially their treatment with depressant antihypertensive drugs), and secondary sedativism (including alcoholism). No correlation was found with childhood loss of a parent or severity of depressive episodes.

Screening for depression in geriatric medical patients

Abstract: Depression, a common and treatable psychiatric disorder in later life, is often overlooked in geriatric medical patients. The authors evaluated the validity of two self-rating depression scales, the Zung Self-Rating Depression Scale and the Popoff Index of Depression, for 55 elderly patients. They compared these ratings with the diagnosis assigned by a psychiatrist who was blind to scale results and who interviewed these patients using DSM-III criteria. The two scales correctly classified 80% and 69% of the subjects, respectively. The authors identify six items from the two scales that may serve as a simple screening instrument for the detection of depression in geriatric medical patients.

Development and Prediction of Postpsychotic Depression in Neuroleptic-Treated Schizophrenics

Abstract: • Data were collected during a year-long multicenter collaborative trial comparing short-acting fluphenazine hydrochloride with long-acting fluphenazine decanoate in a group of schizophrenic patients being maintained in the community. We examined the emergence and course of depressive symptomatology, operationally defined by the Hamilton Depression Scale total score. Of 211 patients, approximately 25% had depression develop within five months after discharge. Depressed patients had a more chronic psychiatric history and, contrary to the hypothesis that depression is a favorable prognostic indicator, they were more likely to relapse. There were no differences in incidence of emergent depression between the two drug treatment groups.

Screening for depression in hospitalized geriatric medical patients.

Abstract: As part of an effort to improve the detection of depression in geriatric hospitalized medical patients, the validity of two self-rating depression scales, the Zung Self-rating Depression Scale (SDS) and the Popoff Index of Depression (ID), was evaluated These two scales were completed by 42 medical inpatients whose mean age was 68 years A psychiatrist who was "blind" to scale results interviewed each patient and diagnosed the presence or absence of depression according to the Diagnostic and Statistical Manual-III (DSM-III) criteria for Major Depressive Episode On both the SDS and the ID, there was significant agreement between the scale results and the interview diagnosis Compared with the interview diagnosis, the SDS had a sensitivity of 58 per cent and a specificity of 87 per cent, and it correctly identified 74 per cent of the patients as being either depressed or nondepressed The ID had a sensitivity of 88 per cent and a specificity of 52 per cent, and it correctly identified 66 per cent of the patients Although performance on both scales is reduced compared with that of younger depressed patients, these self-rating scales appear to be useful aids for the detection of depression in geriatric medical patients

A controlled study of the association between ulcerative colitis and psychiatric diagnoses.

Abstract: Fifty consecutive patients with ulcerative colitis were personally examined to determine the lifetime prevalence of specific psychiatric diagnoses. A personality assessment and a tabulation of recently occurring stressful events were done. A matched control sample with chronic nongastrointestinal medical illnesses was evaluated in the same way. The two groups were compared so as to quantify the relative association and impact of psychiatric disorder in ulcerative colitis. We found no greater frequency of diagnosable psychiatric disorder in ulcerative colitis patients than in the control population. Those with ulcerative colitis and a psychiatric illness did not appear to have more serious gastrointestinal involvement, nor did severity of the ulcerative colitis predict more frequent or more serious psychiatric disorder. Personality profiles were similar in probands and controls, and there was no correlation between the frequency of potentially stressful life events within the six months prior to interview and severity of ulcerative colitis at the time of interview. We did find slightly higher levels of obsessional symptomatology in ulcerative colitis cases, but this association appeared to be weak and unrelated to the severity of the gastrointestinal disorder. Despite the fact that more than a quarter of the ulcerative colitis patients had some diagnosable psychiatric illness, the occurrence of psychiatric disorder was rarely documented in the medical charts.