Showing papers on "Depression (differential diagnoses) published in 1984"

Six-Month Prevalence of Psychiatric Disorders in Three Communities: 1980 to 1982

Abstract: • Six-month prevalence rates for selected DSM-III psychiatric disorders are reported based on community surveys in New Haven, Conn, Baltimore, and St Louis. As part of the Epidemiologic Catchment Area program, data were gathered on more than 9,000 adults, employing the Diagnostic Interview Schedule to collect information to make a diagnosis. The most common disorders found were phobias, alcohol abuse and/or dependence, dysthymia, and major depression. The most common diagnoses for women were phobias and major depression, whereas for men, the most predominant disorder was alcohol abuse and/or dependence. Rates of psychiatric disorders dropped sharply after age 45 years.

The children's depression inventory: a systematic evaluation of psychometric properties.

Abstract: Community Mental Health Center, Yorkville, New YorkThis article presents data from a series of studies designed to determine thepsychometric properties of the Children's Depression Inventory (GDI). A total of294 school children and 269 children who were psychiatric inpatients served assubjects. Reliability studies were conducted with both normal and clinicalpopulations. Good internal consistency was documented, but test-retest data werevariable across populations and test-retest intervals. Validity studies indicate thatthe GDI can distinguish children with general emotional distress from normalschool children. However, differences between GDI scores of depressed (bysymptom checklists from the Diagnostic and Statistical Manual of MentalDisorders, DSM-1II; American Psychiatric Association, 1980) and nondepressedchildren were not significantly different. There was a good correspondencebetween the GDI and self-report measures of self-concept. Our data suggestedthat the GDI measures a multidimensional construct that overlaps with otherchildhood disorders, particularly anxiety. Findings are reviewed and discussedrelative to data presented by Kovacs, Kazdin, and others. Although the GDI maystill be the best researched instrument available to measure depression from thechild's viewpoint, more work is needed before it can be interpreted withconfidence in clinical and research settings.

Mood disorders in stroke patients: importance of location of lesion

Abstract: In a selected group of right-handed patients with single stroke lesions of either the right (n=14) or left (n=22) hemisphere and no predisposing factors for psychiatric disorder, we found that the severity of depression was significantly increased in patients with left anterior lesions as opposed to any other lesion location. In addition, the severity of depression correlated significantly with proximity of the lesion on CT scan to the frontal pole in the left anterior group. The right hemisphere lesion group showed the reverse trend: patients with right posterior lesions were more depressed than patients with right anterior lesions, who were unduly cheerful and apathetic. These findings suggest that intrahemispheric lesion location is in some way related to mood disorder in stroke patients and that there is a graded effect of lesion location on severity of mood change. The neuroanatomy of the biogenic amine-containing pathways in the cerebral cortex might explain this graded effect and provide a neurochemical basis for the mood change.

Depression in hospitalized cancer patients.

Abstract: The study of depression in cancer patients has been hampered by difficulty in establishing diagnostic criteria, since neurovegetative signs and symptoms may be attributable either to depression or physical illness. Confusion has also arisen in defining the boundary between "normal" grieving with illness, and "abnormal" clinical depression. We studied 62 oncology inpatients applying DSM-III diagnostic criteria, patient self-report, and interview report rating scales. Forty-two percent met criteria for nonbipolar major depression: 24% with severe and 18% with moderately severe symptoms. Fourteen percent of the sample had depressive symptoms that did not meet criteria for a major depression. Forty-four percent had no depressed affect. Medical and demographic variables were evaluated for relationship to depression; only greater degree of physical disability was clearly associated. Other negative life events and poor quality of social supports were additionally associated with depression in the less disabled patients. The use of clearly defined criteria for diagnosis of depression in cancer patients provides a basis for the study and implementation of specific therapeutic interventions.

Depressive Disorders in Childhood: II. A Longitudinal Study of the Risk for a Subsequent Major Depression

Abstract: • As part of a longitudinal nosologic study of major depressive disorder, dysthymic disorder (DD), and adjustment disorder with depressed mood (ADDM) in a school-aged cohort, the predictive validity of each diagnosis was examined. Using all available data on the course of the disorders, the criterion was the first subsequent major depressive episode. Major depressive disorder and DD signaled a similarly high risk of a new bout of depressive illness. For the children who recovered from their first episode of major depression and then had their second one (40%), the free interval did not exceed two years; an underlying dysthymia increased the risk of recurrence. Major depression and dysthymia were distinct from ADDM and a set of control disorders; the latter two diagnostic groups were associated with a minimal risk for major depression.

Measurement of depression in patients with cancer.

Abstract: The recognition or detection of depressive symptoms and syndromes in patients with cancer is of value to the patient because his mental distress may respond to treatment, and to the clinician because some of the clinical complications or difficulties in diagnosis and treatment of the patient may be reduced. Many factors militate against the diagnosis of depressive syndromes in patients with cancer. These include problems with the application of standard sets of criteria for depression, the assumption on the part of medical staff, family, and patients that depression is a "natural" response and therefore not treatable, and the pressure on all involved to "think positive." Some ways of modifying the usual screening and diagnostic procedures for depressive disorders are suggested.

Psychosocial status in chronic illness. A comparative analysis of six diagnostic groups.

Abstract: Assumptions that psychological attributes are specific to particular diagnoses characterize many investigations of chronically ill patients. We studied 758 patients, each of whom had one of six different chronic illnesses, to determine and compare their scores on the Mental Health Index. Five groups of physically ill patients (with arthritis, diabetes, cancer, renal disease, or dermatologic disorders) did not differ significantly from one another or from the general public, but all had significantly higher scores for psychological status when compared with the sixth group, patients under treatment for depression. There was a significant direct relation between higher mental-health scores and advancing age across all patient populations. Patients with recently diagnosed illness in all groups had poorer mental-health scores than did patients whose illness had been diagnosed more than four months previously. A direct relation between declining physical status and mental-health scores was observed. These results suggest that psychological adaptation among patients with chronic illnesses is remarkably effective and fundamentally independent of specific diagnosis.

Depression and Anxiety Disorders in Parents and Children: Results From the Yale Family Study

Abstract: The children (aged 6 to 17 years) of probands with primary major depression, with and without various anxiety disorders, were compared with the children of a matched normal control group. The results from the study of these young children parallel our previous findings among the adult first-degree relatives of these probands. Depression in the proband increased the risk of depression in the children. Depression plus panic disorder or agoraphobia in the proband conferred an additional risk of depression and of an anxiety disorder in the children. Panic disorder in the parents conferred more than a threefold increased risk of separation anxiety in the children. Other factors that increased the risk to children were degree of familial loading for psychiatric illness, parental assortative mating, and parental recurrent depression. The findings suggest a relationship between depression and some of the anxiety disorders, and between adult panic disorder and agoraphobia and transmission of anxiety disorders to children.

Transient ST-segment depression as a marker of myocardial ischemia during daily life.

Abstract: Patients with angina and coronary artery disease (CAD) have many episodes of transient ST-segment depression during ordinary daily life, and these are often asymptomatic. To investigate this signal as a marker of myocardial ischemia, 30 patients with chronic stable angina and CAD underwent positron tomography, recording the regional myocardial uptake of rubidium-82, pain and ST-segment changes before, during and after 59 technically satisfactory exercise tests, 35 cold pressor tests and 22 episodes of unprovoked ST depression. Exercise resulted in 53 episodes of ST depression with angina and in 5 episodes without pain. After cold pressor tests, there were 3 episodes of ST depression and pain and 12 of painless ST depression. Only 9 episodes of unprovoked ST depression were accompanied by pain. Tomography showed independent evidence of ischemia in 63 (97%) of the total 65 episodes of ST depression with angina and in all 30 episodes of painless ST depression. In each patient perfusion defects occurred in the same myocardial segment during painful and painless ST depression and responses were significantly different from those in 16 normal subjects studied in the same way. These findings support the use of transient ST depression in continuous monitoring to assess the activity of CAD, but only in patients with typical angina pectoris, ST depression during exercise and proved CAD. They strengthen the evidence derived from ambulatory monitoring for a wider picture of the disease than is generally appreciated, with more frequent episodes of silent myocardial ischemia than of angina pectoris.

Symptoms of Emotional Distress in a Family Planning Service: Stability over a Four-Week Period

Abstract: The 25-item Hopkins Symptom Checklist ( HSCL -25) was used on two occasions four weeks apart to identify self-reported symptoms of anxiety and depression in patients attending a family planning service. Only 28 per cent of patients classified as anxious to start with remained so four weeks later, but 62 per cent of those with high depression scores and 74 per cent of those with high depression and high anxiety scores maintained significant levels of depression. The implications of these findings for routine screening are discussed.

Onset of Major Depression in Early Adulthood: Increased Familial Loading and Specificity

Abstract: • In a family study of 133 probands with major depression and 82 normal control subjects, and 1,518 of their first-degree relatives, we found a substantial inverse relationship between the age of onset of major depression in the probands and the risk of major depression in their relatives. The relatives of probands whose onset of major depression occurred when they were younger than 20 years of age had the highest risk of major depression, compared with the relatives of probands who had later ages of onset or with the relatives of normal subjects. Probands with an age of onset of 40 years or more had familial loading that was only slightly higher than the families of normal control subjects. Our statistical methods enabled us to examine the relationship of the ages of onset in the probands and their relatives while accounting for possible confounding factors. More studies will be needed to sort out secular changes in the rates of the occurrence of major depression among young persons (cohort effect) from the high familial loading of major depression that has its onset in childhood and adolescence, and to determine whether the specificity of transmission of early-onset depression is the result of a single homogeneous disorder.

Long-term Outcome of Episodes of Major Depression: Clinical and Public Health Significance

Abstract: Twenty-one percent (20/97) of patients with an episode of major depressive disorder and no history of chronic minor depression who sought treatment at five university medical centers had not recovered after two years of prospective follow-up The rate of recovery was highest in the three months after entry into the study, with a notable decrease in rate after one year Most patients who did not recover had severe depressive symptoms throughout the two years of follow-up Long duration of episode before entry into the study, inpatient hospitalization status at entry, intact marriage, low family income, admitting research center, and a history of nonaffective psychiatric disorders (including alcoholism) predicted a chronic course The implications of these findings for clinicians, researchers, and public health planners are discussed ( JAMA 1984;252:788-792)

Major Depression in Patients With Agoraphobia and Panic Disorder

Abstract: • A review of the life-time occurrence of major depression, the temporal relationship of major depression to episodes of panic and agoraphobic disorders, and the severity of anxiety and depressive symptoms were determined In 60 patients with agoraphobia or panic disorder. Forty-one (68%) of the patients had a past or current episode of major depression, and 35 (85%) of these patients had endogenous-type major depression. Twenty patients (33%) had an episode of primary major depression, and an average of three years separated the end of primary major depression and the first panic attack. Secondary major depression occurred in 28 patients. Patients with a history of major depression had a more severe anxiety disorder. These data support the view that In a subgroup of patients, episodes of depression and panic anxiety disorder may be manifestations of a common underlying pathogenic process.

Psychopathology in the Children (Ages 6–18) of Depressed and Normal Parents

Abstract: Data from a pilot family-history study of 194 children (ages 6–18) of probands with major depression compared with the children of normal controls showed children of depressives were at increased risk for psychological symptoms, treatment for emotional problems, school problems, suicidal behavior, and DSM-III diagnoses. The magnitude of the risk was increased 3-fold for any DSM-III diagnosis in the children of depressed probands. Major depression was the most common psychiatric disorder, followed by attention deficit and separation anxiety. The risk to children of major depression and of any DSM-III diagnosis increased linearly if both parents were psychiatrically ill than if only one or neither parent had psychiatric illness. Other significant predictors of risk to children were early onset of the proband's depression, an increased number of the proband's first-degree relatives who were ill with any psychiatric disorder and/or major depression, and if the proband was divorced, separated or widowed. While diagnoses were based on multiple informants and were made by a psychiatrist who was blind to the clinical status of the probands, the absence of direct interviews with the children make these findings preliminary. A direct interview study is under way.

Cognitive therapy for major depressive disorder in primary care.

Abstract: Cognitive therapy for depression is a psychological treatment designed to train patients to identify and correct the negative depressive thinking which, it has been hypothesised, contributes to the maintenance of depression. General practice patients meeting Research Diagnostic Criteria for primary major depressive disorder were randomly allocated either to continue with the treatment they would normally receive (which in the majority of cases included antidepressant medication) or to receive, in addition, sessions of cognitive therapy. At completion of treatment, patients receiving cognitive therapy were significantly less depressed than the comparison group, both on blind ratings of symptom severity made by psychiatric assessors and on a self-report measure of severity of depression. At three-month follow-up cognitive therapy patients no longer differed from patients receiving treatment-as-usual, but this was mainly as a result of continuing improvement in the comparison group.

Cortisol hypersecretion and cognitive impairment in depression.

Abstract: We attempted to investigate the relationship between hypothalamic-pituitary-adrenal axis activity and cognitive function by measuring mean urinary free cortisol (MUFC) excretion and performance on the Halstead Category Test in depressed patients and normal controls. We observed a significant relationship between category test errors and MUFC in the depressed patients, but not in the controls. While an even more robust correlation was observed between age and category test errors in the patients, it appeared that age and depression interacted to produce severe cognitive impairment. Depression-related cortisol hypersecretion or its underlying determinants may contribute to depression-related cognitive dysfunction.

Self‐report screening measures for depression in chronic pain patients

Abstract: Depression is prevalent among chronic pain patients, yet little is known about the ability of various self-report measures to detect this disorder in this population. This study investigated the relationship of several self-report depression scales (Beck Depression Inventory-standard and short forms, MMPI Depression, Depression subtle, and Depression obvious scales, and the Zung Self-Rating Depression Scale) to clinician DSM-III diagnoses of major depressive disorder in 40 chronic pain patients. Thirty percent of the Ss met criteria for major depression. Sensitivity and specificity values obtained for each scale are presented. The standard and short forms of the Beck Depression Inventory and the Zung Self-Rating Depression Scale showed good sensitivity and specificity and were comparable in detecting major depression in this sample.

A two year longitudinal study of mood disorders following stroke. Prevalence and duration at six months follow-up.

Abstract: We are conducting a two year longitudinal study of mood disorders in a group of 103 stroke patients. During the first six month period following the stroke the prevalence of symptoms of major depression increased from 23 per cent to 34 per cent while the frequency of symptoms of dysthymic depression increased from 20 per cent to 26 per cent. In addition, 10 of 13 patients who had major depressive symptoms during the initial evaluation continued to have these symptoms at six months follow-up and 4 of 9 patients who had minor depression in hospital developed major depression, while 5 of 9 continued to have minor depressive symptoms. Thus, the duration of depression following stroke is more than six months and the prevalence of major depressive symptoms increases steadily for the first half year after a cerebral hemorrhage or ischemic lesion.

A two-year longitudinal study of post-stroke mood disorders: dynamic changes in associated variables over the first six months of follow-up.

Abstract: We are prospectively studying a group of 103 stroke patients over the first 2 years after infarction to determine the variables which are associated with the development of depression. At both 3 and 6 months post-stroke, patients with left hemisphere infarcts showed a strong relationship between severity of depression and distance of the lesion on CT scan from the frontal pole. The strength of this association was unchanged from the immediate post-infarction period. In contrast, the correlation between degree of functional physical impairment and severity of depression steadily increased over the 6 month follow-up. The correlation between severity of depression and Mini-Mental score or between depression and social functioning score dropped between in-hospital and 3 months but then increased significantly between 3 and 6 months post-stroke. Age did not correlate with depression beyond the acute post-stroke period. Whether the increasing strength of the relationships between impairment and depression over the first 6 months post-stroke indicates that continued depression led to delayed recovery or whether continued severe impairments led to depression is not known, however, this issue will be addressed in further data evaluation from this prospective study.

A longitudinal study of maternal depression and child behaviour problems

Abstract: Using a random sample of first-time mothers from an inner London borough, the relationship was examined between maternal depression and child behaviour problems at various stages after the birth of the child. Child problems at 14 months were unrelated to present or past maternal depression. Child problems at 27 and 42 months were related in an interactive way with present and past depression. There was little indication of behaviour problems preceding maternal depression. An examination of possible confounding factors in these relationships was also attempted.

Behavioral disorders in multiple sclerosis, temporal lobe epilepsy, and amyotrophic lateral sclerosis. An epidemiologic study.

Abstract: • Certain CNS diseases can produce specific behavioral abnormalities. We used a computer search technique to identify all inpatients at Strong Memorial Hospital, Rochester, NY, who had received diagnoses of multiple sclerosis (MS), temporal lobe epilepsy (TLE), and amyotrophic lateral sclerosis (ALS) between 1965 and 1978. We found 368 patients with MS, 402 patients with TLE, and 124 patients with ALS. These groups were matched against the Monroe County (New York) Psychiatric Register to determine patterns of behavioral pathology. Prevalence rates for psychiatric contact were not significantly different between MS and TLE (19.3% v 22.9%), but both were higher than the prevalence rate for ALS (4.8%). When behavioral patterns were assessed, patients with MS demonstrated a significantly higher rate of depressed affective disorders (61.97% of register matches) than patients with the other two diseases. Multiple sclerosis may present a neurologic model for mood disturbance.

Depression in multiple sclerosis as a function of length and severity of illness, age, remissions, and perceived social support

Abstract: Degree of depression found in 120 spinal multiple sclerosis (MS) outpatients was related significantly to selected illness, demographic, and social variables. The more depressed individuals tended to be more disabled, older, and, in particular, perceived their families and friends as providing less social support than those who were less depressed. Those who had experienced at least one remission were less depressed than those who never had had a remission. Contrary to hypothesized expectations, the results also suggested that the longer a patient has MS, the more depressed he will be. Such results raise implications for psychotherapeutic intervention in this population, as well as suggest the need for future investigations of the MS patients's body image, self-concept, and perception of disability.

Cognitive-behavioral and psychodynamic group psychotherapy in treatment of geriatric depression.

Abstract: The purpose of the study was to assess whether depressed geriatric patients would respond to group psychotherapy and, if so, would they respond differently to cognitive-behavioral and psychodynamic group psychotherapy. Thirty-three persons entered the study and 20 completed the 9-month course of treatment. Patients in both types of groups showed statistically and clinically significant reductions on observer-rated measures of depression and anxiety, as well as on self-report measures of depression. There were no clinically significant differences, but a statistically significant difference between the types of groups was found for the Beck Depression Inventory and this favored the cognitive-behavioral treatment. Limitations on interpretation of these results because of the lack of a control condition are discussed. Approximately 7% to 11% of the American population age 65 and older suffer from depression (Gurland, 1976), making the treatment of depression in the elderly an important concern of both research and practice. Yet, few psychologists (Dorken & Webb, 1979) or psychiatrists (Marmor, 1975) in private practice see elderly patients, and the preferred mode of treatment for this age group appears to be pharmacological (Ford & Sbordone, 1980). However, the use of antidepressants may be contraindicat ed for a large number of el

A Comparative Outcome Study of Group Psychotherapy vs. Exercise Treatments for Depression

Abstract: (1984). A Comparative Outcome Study of Group Psychotherapy vs. Exercise Treatments for Depression. International Journal of Mental Health: Vol. 13, Group Psychotherapies for Depression, pp. 148-176.