Showing papers on "Depression (differential diagnoses) published in 1983"

The Prevalence of Psychiatric Disorders Among Cancer Patients

Abstract: Two hundred fifteen randomly accessed cancer patients who were new admissions to three collaborating cancer centers were examined for the presence of formal psychiatric disorder. Each patient was assessed in a common protocol via a psychiatric interview and standardized psychological tests. The American Psychiatric Association'sDSM-IIIdiagnostic system was used in making the diagnoses. Results indicated that 47% of the patients received aDSM-IIIdiagnosis, with 44% being diagnosed as manifesting a clinical syndrome and 3% with personality disorders. Approximately 68% of the psychiatric diagnoses consisted of adjustment disorders, with 13% representing major affective disorders (depression). The remaining diagnoses were split among organic mental disorders (8%), personality disorders (7%), and anxiety disorders (4%). Approximately 85% of those patients with a positive psychiatric condition were experiencing a disorder with depression or anxiety as the central symptom. The large majority of conditions were judged to represent highly treatable disorders. (JAMA1983;249:751-757)

The prognosis of depression in old age.

Abstract: The paper describes a one year prospective study of 124 elderly depressed patients. Only one third of the group had a good outcome. Poor outcome was associated with severity of initial illness, those with depressive delusions having a particularly poor outcome. Outcome was also influenced by physical health problems and severe life events in the follow-up year. Social class differences in outcome were thought to be due to class differences in the experience of severe life events. There was no evidence that an intimate relationship protected against relapse in the face of continuing life stress.

Hopelessness, Depression, and Suicidal Intent Among Psychiatrically Disturbed Inpatient Children

Abstract: The present investigation evaluated hopelessness, depression, and suicidal intent among children (8 to 13 years old) hospitalized on a psychiatric intensive care service. A hopelessness scale, modeled after the adult version, was developed and administered to 66 children along with measures of depression (Children's Depression Inventory, Bellevue Index of Depression, Depression Symptom Checklist) and self-esteem (Self-Esteem Inventory). As predicted, children who scored high on the hopelessness scale showed significantly more severe depression and lower self-esteem than children who scored low on the scale. Children who evinced suicidal attempt or ideation, independently assessed at intake diagnosis, showed greater hopelessness than children who did not evince intent. Suicidal intent was more consistently correlated with hopelessness than with depression, a finding parallel to results obtained with adults. Overall, the present findings suggest that negative expectations toward oneself and the future can be assessed in children and are related both to depression and suicidal intent.

Prevalence of depression and its correlates in older adults

Abstract: Depression was studied in a community sample of 962 males and 1555 females aged 55 years and over living in Kentucky in 1981. The sample was representative of the population in Kentucky in that age group and quite similar to that US population. The Center for Epidemiologic Studies Depression Scale was used as a measure of depression, and 13.7% of the males and 18.2% of the females were at or above a previously established cutpoint of 20 for adults over age 55 years. Significant relationships to depression were found in both sexes for age, education, income, housing quality, marital status, and health. For females, the age-depression relationship was not linear. By far the strongest relationship was with self-reported physical health. Significant proportions of those with self-reported kidney or bladder disease, heart trouble, lung trouble, hardening of the arteries, and stroke were above the depression cutpoint. For those conditions, physicians could expect high levels of concomitant depression in about one fourth of males and at least one third of females. These levels of depression were not found for those with high blood pressure, stomach ulcers, cancer, or diabetes. Over half of the sample reported taking prescribed medication and over half had needed a physician's care in the previous six months. Only 3.9% of the males and 3.2% of the females admitted to needing help for mental health problems. Thus, older adults with depression would probably be more likely to seek help from physicians than from services or professionals with explicit mental health labels.

A two-year longitudinal study of post-stroke mood disorders: findings during the initial evaluation.

Abstract: A consecutive series of 103 stroke patients capable of undergoing a psychiatric interview were evaluated for mood disorders. Nearly 50% of patients studied in the acute stroke period had clinically significant depressions and one fourth had symptom clusters found in major depressive disorders. We confirmed our previous findings that lesion location is most important in determining frequency and severity of depression. In addition, we have identified other variables including functional physical impairment, intellectual impairment, quality of social support, and age which contribute to or modify depression. Post-stroke depressive disorders are multifactorial in their determination and expression and include both neurophysiological-neurochemical mechanisms and psychological factors in their etiology.

Arnold-Chiari malformation. Review of 71 cases.

Abstract: The natural history of symptomatic adult Type I Arnold-Chiari malformation (ACM) is variable, and the value of surgery in the management of this disease is difficult to assess. A series of 71 patients in whom a diagnosis of Type I ACM was confirmed at operation is presented, and the progress of the patients following posterior fossa decompression is analyzed. The length of history varied greatly. Pain was the commonest symptom (69% of patients); other symptoms included weakness (56%), numbness (52%), and unsteadiness (40%). The presenting physical signs consisted of a foramen magnum compression syndrome (22%), central cord syndrome (65%), or a cerebellar syndrome (11%). Myelography was performed in 69 patients, and was the most useful investigation. Only 23% of plain radiographs were abnormal. In addition to tonsillar descent, the operative findings included arachnoid adhesions (41%) and syringomyelia (32%). All patients underwent suboccipital craniectomy and C1-3 laminectomy. Respiratory depression was the most frequent postoperative complication (14%), and one patient died from sleep apnea. Early postoperative improvement of both symptoms (82%) and signs (70%) was followed by later relapse in 21% of patients, showing an initial benefit following surgery. None of the patients with a cerebellar syndrome deteriorated, whereas 56% of patients with evidence of foramen magnum compression and 66% of those with a central cord syndrome maintained their initial improvement. The authors conclude that posterior fossa decompression appears to benefit some patients, although a significant proportion might be expected to relapse within 2 to 3 years after operation, depending upon the presenting syndrome.

Panic Disorder and Major Depression: Increased Risk of Depression, Alcoholism, Panic, and Phobic Disorders in Families of Depressed Probands With Panic Disorder

Abstract: • In a large, case-control family study of depression, 77 (58%) of 133 depressed probands displayed anxiety symptoms that met DSM-III criteria for agoraphobia, panic disorder, or generalized anxiety disorder. In two thirds of these 77 cases, these symptoms were associated with depressive episodes. In a previous study, the lifetime rate of major depression and anxiety disorders among first-degree family members of probands with major depression plus an anxiety disorder was found to be significantly increased regardless of when the anxiety symptoms occurred. In this study we analyzed our data according to the specific anxiety disorders observed. Major depression plus panic disorder in probands was associated with a marked increase in risk in relatives for a number of psychiatric disorders; relatives were more than twice as likely to have major depression, panic disorder, phobia, and/or alcoholism than the relatives of probands with major depression without any anxiety disorder. These results indicate that the relationship between major depression and anxiety disorders requires further study.

"Double depression": two-year follow-up.

Abstract: Of 316 patients with a major depressive disorder who were followed for between 6 months and 2 years, 80 (25%) had a preexisting chronic minor depression of at least 2 years' duration. The chronic minor depression reduced the apparent effect of the known predictors of recovery and relapse from the major depressive disorder and predicted a very pernicious course for the chronic depression. Furthermore, the longer the patient continued to suffer from a chronic minor depression after recovering from the major depression, the greater the probability that relapse into another major depression would preempt recovery from the chronic depression.

Assessment of childhood depression: correspondence of child and parent ratings.

Abstract: The present investigation evaluated the correspondence of child and parental reports of the children's depression. One-hundred-four children (ages 5–13) hospitalized on a psychiatric intensive care service, 101 mothers, and 47 fathers independently completed several measures to assess severity and duration of the children's depression. To validate the depression instruments, measures of hopelessness and self-esteem (completed by the children) and somatic complaints and internalizing (completed by the parents) were also included. The results indicated that different measures of depression completed by the same rater (child, mother, or father) were highly intercorrelated. However, there was little or no relationship between mother-child and father-child reports of the children's depression for the same or different measures of depression. Children's ratings of depression were positively correlated with hopelessness and parent ratings of somatic complaints and negatively correlated with self-esteem. Children independently diagnosed as depressed (DSM-III) were higher in severity of depression than nondepressed children on child and parent completed measures. The implications of the present results for further evaluation of child self-report and factors that may contribute to correspondence with parental report are highlighted.

Recognition and treatment of depression in a family medicine practice

Abstract: To test the hypothesis that depression is significantly underdiagnosed in general medical settings, the Zung Self-Rating Depression Scale was administered to 1,086 family medicine outpatients seen during a 12-month period before their initial medical examination. The effects of such screening on clinical recognition and treatment of depression were examined. Of the 1,086 patients, 143 (13.2%) were symptomatically depressed. These patients were randomized into two groups: 102 were identified as clinically depressed to their physician, and the remaining 41 were not (control group). Physicians diagnosed depression in 15% of the control group and in 68% of the identified group. At 4-week follow-up, 64% of the identified patients who were treated with maprotiline (16 of 25) showed improvement; only 28% of the identified patients who were electively not treated improved. Improvement occurred in only 18% of the control group. It appears that the diagnosis of depression is not ordinarily made in family medicine outpatient settings and that self-rating depression scales are useful diagnostic aids, whose regular use is indicated by the high prevalence of depression in general medical populations.

Depression in a Sample of 9-Year-Old Children: Prevalence and Associated Characteristics

Abstract: • We investigated the prevalence of depression in a sample of 9-year-old children from the general population being studied longitudinally. Current point prevalences of major and minor depressive disorder were estimated at 1.8% and 2.5%, respectively. A comparison of children with depression and a nondepressed group disclosed no significant differences by sex, nor any significant association between depression and socioeconomic status, teacher reports of behavior problems, and cognitive or motor development. The children with current depression were reported by a parent to have had a history of more behavioral problems, had been referred more often for assessment or treatment of behavioral or emotional problems, and had more negative self-perceptions of their academic ability. The results suggested that parents may be more sensitive than teachers to the behavior problems exhibited by depressed children.

Child, mother, and father evaluations of depression in psychiatric inpatient children.

Abstract: The agreement among children and their parents in evaluating the children's depression was examined in 48 families. Newly admitted inpatient children (ages 6-13) and their mothers and fathers independently completed self-report and interview measures to assess severity and duration of the children's depression. The results indicated that different measures of depression completed by the same rater (child, mother, or father) were highly intercorrelated. Yet there was little or no relationship between child-mother and child-father ratings of the children's depression for the same or related measures of depression. Children independently diagnosed (DSM III) as depressed rated themselves and were rated by their parents as more depressed than nondepressed children. Even so, children consistently rated themselves as less depressed across the measures than did their parents. Parent ratings of the children's depression and the correspondence of child-parent ratings varied as a function of several child and family variables, including child IQ, gender, race, and family welfare status.

Disease activity and emotional state in multiple sclerosis

Abstract: The prevalence and nature of emotional disturbance in patients with multiple sclerosis (MS) was studied prospectively in 64 MS patients and 23 spinal cord-injured (SCI) control patients by administration of the 28-item subscale General Health Questionnaire (GHQ). MS patients in remission had a mean GHQ score of 4.4, and patients with acute exacerbation or progressive nonremitting MS had a mean score of 15.7, a significant difference (p less than 0.001). The prevalence of emotional disturbance was 90% in exacerbating or progressing patients, 39% in stable patients, and 12% in SCI control patients. The presence of emotional disturbance was not related to age, sex, or other demographic variables, to duration or severity of disease, or to the degree of disability. In the group of MS patients in remission, somatic complaints, anxiety, and social dysfunction were more prevalent than symptoms of depression.

Anxiety syndromes and their relationship to depressive illness.

Abstract: The DSM-III categories of anxiety disorder are reviewed, and a study of anxiety symptoms in subjects with RDC-defined major depression is described. Anxiety appears to be common in major depression; 29% of the sample studied had a history of panic attacks, and moderate psychic anxiety was reported in 62%. Analysis by depressive subtypes showed no differences for the bipolar/unipolar distinction. However, significant differences in anxiety symptoms were seen in the primary vs. secondary and, more strikingly, endogenous vs. nonendogenous categories. The presence/severity of anxiety symptoms thus appears to be an important factor in the clinical management of major depression and may eventually serve as a guide to choosing among the increasing number of available antidepressant medications.

At Risk for Depression: A Study of Young Mothers

Abstract: Summary A sample of 75 mothers between 15 and 19 years of age was used to investigate the relationship between depression and the maternal behavior of young mothers. Depression, as measured by the Center for Epidemiologic Studies of Depression (CES-D) Scale, varied with marital status, education, and maternal age and was related to hostile, indifferent and rejecting patterns of mother-child interaction. Levels of depression increased in relation to the amount of stress faced by the young mother and decreased when the mother was involved in a supportive social network.

Depression, delusions, and suicide.

Abstract: A retrospective analysis of all the suicides at the New York State Psychiatric Institute over a 25-year period was carried out. The authors retrospectively assigned diagnoses according to Research Diagnostic Criteria and DSM-III and found that among the patients who committed suicide there were 14 with unipolar endogenous depression. Of those 14 patients, 10 were considered delusional or probably delusional. In comparison, a control group of similarly diagnosed depressed patients taken from the same institution over the same time period included far fewer delusional depressions. Thus, there was a significant association between delusions and suicide: A delusionally depressed patient was five times more likely to commit suicide than a nondelusional one.

Assessment of depression in mentally retarded adults.

Abstract: Depression and psychopathology were assessed in 110 adult patients (ages 18-71 years) classified as borderline, mildly, moderately, or severely mentally retarded. Patients completed modified versions of the Beck Depression Inventory, the Zung Self-Rating Depression Scale, the MMPI depression scale, the Thematic Apperception Test, and the Psychopathology Instrument for Mentally Retarded Adults. Clinicians and ward personnel rated the patients on the Hamilton Rating Scale for Depression and an informant version of the Psychopathology Instrument for Mentally Retarded Adults. The measures correlated significantly with each other and were consistently related to the diagnosis of depression.

Alcoholic patients with secondary depression.

Abstract: This study of alcoholic patients with and without secondary depression showed that the two groups were almost identical in demographic characteristics, early-life antisocial problems, quantity and frequency of drinking, and family history of affective disorder. The depressed patients reported slightly more alcoholism in their first-degree male relatives and tended to have more alcohol-related life problems. The only significant difference between the two groups was that the depressed patients were heavier users of drugs other than alcohol. Thus severe depression in alcoholics may be related to a greater intake of drugs in addition to alcohol.

The dexamethasone suppression test: identification of subtypes of depression.

Abstract: In this study mean 4 p.m. cortisol levels were significantly higher in patients with major depression than in control subjects or in patients with bipolar depression or dysthymic-related disorders. Moreover, the distribution of values differed significantly among groups. Eighteen of 45 patients with major depression had cortisol levels of 10 micrograms/dl or more, compared with 2 of 20 bipolar depressed patients and 0 of 31 controls. Patients with very high cortisol levels (15 micrograms/dl or more) tended to fulfill criteria for major depression with mood-congruent psychosis. The distribution of values in the major depression group also suggested the existence of three major subgroups. The authors discuss the implications of these data.

Hypertension and DSM-III depression in psychiatric outpatients.

Abstract: Among 452 psychiatric outpatients, DSM-III diagnoses of major depression were three times as common among those with hypertensive disease as those without hypertension. Age, sex, chronic medical illness, and current antihypertensive medication did not account for these diagnostic differences.

Depression among amputees.

Abstract: A 35% prevalence of major depressive disorder was found in a prospective study of 65 amputees evaluated in a Physical Medicine and Rehabilitation Department. The findings indicate significantly more alcohol abuse among the depressed group. Higher percentages of female than male amputees were found to be depressed and unmarried. The prevalence of smoking was significantly higher among those whose amputations were due to vascular disease rather than other causes (e.g., trauma). In addition to the physical care of amputees, their emotional needs and well-being merit serious consideration.

Anxiety disorders and depression: contradictions between family study data and DSM-III conventions.

Abstract: The authors report data from a case-control family study of lifetime psychiatric diagnoses among the relatives of individuals with major depression. Specifically, they address the relationship between anxiety disorders and major depression. The findings indicate that relatives of individuals with major depression plus an anxiety disorder are at greater risk for major depression, as well as anxiety disorders; than are the relatives of individuals with major depression without an anxiety disorder. This increased risk appears to be present whether or not the anxiety disorder occurs solely in association with episodes of major depression or is temporally separate. The nosological implications of these findings are discussed.

Depression in chronic schizophrenia.

Abstract: Eighteen depressed chronic schizophrenic out-patients were matched with non-depressed schizophrenic out-patients. The depressed schizophrenics had had significantly more psychiatric admissions, past depression, past treatment for depression, significantly more had attempted suicide, lived alone, had low self-esteem, had early parental loss and had had more life events in the six months before the onset of depression. Depressive disorder in schizophrenic out-patients well controlled by neuroleptics may occur in those who are at risk for depression and experience an excess of life events.

Preliminary report on affective symptoms in the early stages of senile dementia of the Alzheimer type.

Abstract: The authors rated 30 probands with senile dementia of the Alzheimer type and 30 healthy controls for depression at the beginning of a longitudinal study and 1 year later. Significant degrees of depression were not found in either group at either time.