Showing papers on "Depression (differential diagnoses) published in 1986"

Responses to corticotropin-releasing hormone in the hypercortisolism of depression and Cushing's disease. Pathophysiologic and diagnostic implications.

Abstract: Primary depression can be associated with substantial hypercortisolism, thus prompting some researchers to suggest that depression shares pathophysiologic features with Cushing's disease. Clinically, depression can be difficult or impossible to distinguish from mild or early Cushing's disease that is associated with depressive features. The purpose of this study was to evaluate whether the pituitary-adrenal responses to ovine corticotropin-releasing hormone could help to clarify the mechanism of hypercortisolism in depression and in Cushing's disease and to assist in the differential diagnosis of these disorders. As compared with controls (n = 34), depressed patients (n = 30) had basal hypercortisolism (P less than 0.001) that was associated with attenuated plasma ACTH responses to ovine corticotropin-releasing hormone (P less than 0.001). This indicates that in patients with depression, the corticotroph cell in the pituitary responds appropriately to the negative feedback of high cortisol levels. In contrast, patients with Cushing's disease (n = 29) had plasma ACTH hyperresponsiveness to ovine corticotropin-releasing hormone (P less than 0.001), despite basal hypercortisolism (P less than 0.001), which indicates a gross impairment of the mechanism by which cortisol exerts negative feedback on the pituitary. Less than 25 percent of the patients with depression or Cushing's disease had peak ACTH responses that overlapped. We conclude that the pathophysiologic features of hypercortisolism in depression and Cushing's disease are distinct in each of the disorders and that the ovine corticotropin-releasing hormone stimulation test can be helpful in their differential diagnosis.

Impact of maternal postnatal depression on cognitive development of young children.

Abstract: Ninety four women and their first born children took part in a longitudinal study of maternal mental health during pregnancy and after delivery. The children's cognitive functioning was assessed at age 4 using the McCarthy scales, without knowledge of the mothers' psychiatric history or current health. As expected girls performed slightly better than boys and children from middle class and professional families did better than children from working class homes, as did children whose mothers had achieved at least one A level at school. Significant intellectual deficits were found in the children whose mothers had suffered with depression, but only when this depression occurred in the first year of the child's life. Marital conflict and a history of paternal psychiatric problems were independently linked with lower cognitive test scores; together with a working class home background these were the only factors that contributed to the deleterious effect of maternal postnatal depression.

Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria

Abstract: Two hundred and eighty-three chronic pain patients, consecutive admissions to the Comprehensive Pain Center of the University of Miami School of Medicine, received an extensive psychiatric evaluation based upon the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria and flowsheets. All patients received the following type of diagnoses: DSM-III axis I; DSM-III axis II, and personality type. The distribution of assigned diagnoses for the entire patient sample was reviewed and a statistical comparison between male and female patients was performed with regards to the prevalence of each diagnosis. Anxiety syndromes and depression of various diagnostic types were the most frequently assigned axis I diagnoses with over half the patient sample receiving each of these diagnoses. Males were significantly overrepresented in the axis I diagnoses of intermittent explosive disorders, adjustment disorders with work inhibitions, and alcohol abuse and other drug dependence, while females were significantly overrepresented in disorders of current depression of various diagnostic types and somatization disorders. 58.4% of the patients fulfilled criteria for axis II personality disorder diagnoses. The most frequently personality disorders found in the patient group were dependent (17.4%), passive aggressive (14.9%), and histrionic (11.7%). Males were significantly overrepresented in paranoid and narcissistic disorders while females were overrepresented in histrionic disorder. The most frequent personality types found in the patient group were compulsive (24.5%) and dependent (10.6%). All personality types were similarly distributed between the sexes. The results of the present study were compared to a previous study of DSM-III diagnoses in chronic pain patients and are discussed in terms of the prevalence of DSM-III diagnoses in the general population. Questions are raised as to the applicability of certain DSM-III diagnoses in the chronic pain population.

Cognitive therapy and pharmacotherapy for depression. Sustained improvement over one year.

Abstract: • Seventy patients with nonbipolar affective disorder who completed a 12-week course of either cognitive therapy (CT), pharmacotherapy, CT plus active placebo, or CT plus pharmacotherapy were assessed one month, six months, and one year after termination of active treatment. Of the 44 patients who had originally responded to treatment, 16 relapsed as defined by reentry into treatment or by self-reported depression scores in the moderately depressed range. Twenty-eight patients remained well during the one-year follow-up. Patients with relatively high levels of remaining depressive symptoms on completion of treatment relapsed more often than those who had little or no residual depression. Further, at treatment termination, patients who relapsed had significantly higher scores on a measure of dysfunctional attitudes. Patients who had received CT (with or without tricyclic antidepressants) were less likely to relapse in the one-year follow-up period than patients who received pharmacotherapy.

The prognosis of depression in old age.

Abstract: The initial features and progress of depressive symptomatology over 42 to 104 months are presented for 100 elderly patients admitted with severe, non-neurotic depressive states; none had experienced a previous hypomanic episode. Sixty per cent either remained well throughout or had further episodes followed by full recovery; only 7% suffered continuous depressive symptoms. Of potential prognostic factors, only male sex and poor physical health, both at presentation and developing subsequently, were associated with poorer outcomes. The view is supported that treatment with well established methods achieves worthwhile and sustained improvement for most patients.

Psychosocial problems among survivors of Hodgkin's disease.

Abstract: The psychosocial problems that develop in long-term survivors of Hodgkin's disease were examined in a cross-sectional survey of 403 patients. The average age at treatment was 27 years and at interview was 36 years. The median time since treatment was 9 years. Sixty percent of the patients were treated for stage I or II disease and 40% for stage III or IV. Eighty-two percent of the patients had never relapsed, and 98% were free of disease at the time of interview. The study investigated the type and frequency of problems by means of a self-administered questionnaire using standard survey items to assess disruption in three areas of life: sense of well-being, family relationships, and employment. Results indicate that energy had not returned to patients' satisfaction in 37% of the cases. This was influenced by age, time since therapy, stage of disease, and type of treatment. Patients with self-reported energy loss were more likely to be depressed. Moderately high divorce rates (32%), problems with infertility (18%), and less interest in sexual activity (20%) were reported. Employment patterns favored men returning to work, and number of hours worked was highly correlated with less depression, younger age, and return of energy. Difficulties at work were reported by 42% of the cases. The interaction of treatment, biologic, psychosocial, and functional variables is described.

Post-stroke depression: relationships to functional impairment, coping strategies, and rehabilitation outcome.

Abstract: This study examined the phenomenon of post-stroke depression and evaluated its impact on rehabilitation outcome. Sixty-four patients presenting to a rehabilitation program within weeks of first stroke were evaluated for depression through self-report measures and staff ratings. Patients also rated the particular coping strategies which they used in dealing with their illness and hospital stay. Physical and occupational therapists provided measures of functional impairment at admission and discharge. A high (47%) prevalence of depression was found in this population, with no overall differences observed between patients with right or left hemisphere lesions. Depressed patients, in comparison to non-depressed, evidenced greater functional impairment at both admission and discharge. However, both groups showed similar gains over the course of rehabilitation. Coping strategies employed by depressed patients appeared to reflect a lower level of participation in the rehabilitation process. A subgroup of patients evaluated 6 weeks after discharge revealed that depression was associated with a worsening on one measure of functional status. These findings indicate that depression is a frequent companion of stroke, that it is associated with degree of functional impairment, and that it may exert a negative impact on the rehabilitation process and outcome.

Culture and Depression

Abstract: The way in which depression is confronted, discussed, and managed varies among social worlds. Dr. Arthur Kleinman examines how cultural meanings and practices shape the course of depression.

Depression, hopelessness and suicide in chronic schizophrenia.

Abstract: Hospital records for 104 schizophrenic patients, 15 of whom subsequently committed suicide, were rated blindly for individual depressive symptoms comprising DSM III major depressive episode, and for hopelessness. Our results indicate that a large proportion of schizophrenic patients experienced major depressive episodes, and that these can be reliably identified. Presuicidal schizophrenics also experienced depressed mood, but only a minority developed the full syndrome; they typically exhibited the psychological, but not somatic symptoms. The relationship between depression and suicide disappears when hopelessness is taken into account.

Screening for depression in stroke patients: the reliability and validity of the Center for Epidemiologic Studies Depression Scale.

Abstract: This study examined the inter-observer reliability and validity of the Center for Epidemiologic Studies Depression Scale (CES-D) as a measure of depressive symptomatology in stroke patients, and its utility as a screening tool for depression in this population. The CES-D Scale is a brief questionnaire originally designed for use in community surveys. Twenty-seven non-aphasic patients enrolled in the Stroke Data Bank at the University of Maryland were interviewed by a research nurse using the CES-D. On the same day, each patient was independently evaluated by a research assistant using a psychiatric battery for depression and measures of cognitive, physical, and social functioning. Forty-one percent (11/27) of the patients were depressed according to clinical criteria for major or minor depression. With a cutpoint corresponding to the upper (most severe) 20% in community surveys, the CES-D Scale picked up 73% (8/11) of the depressed patients. In this sample no nondepressed patient scored over 16 on the CES-D (no false positives). The CES-D Scale scores correlated significantly with the other depression measures (r = .57 to r = .82, p less than .002) and did not correlate with the measures of cognitive, physical, or social functioning. Based on 24 patients who received a CES-D Scale score from both the nurse and the research assistant, inter-rater reliability was high (r = .76, p less than .001). Thus, the CES-D was found to be reliable and valid as a screening tool for assessing depression in stroke patients.

A 2.5-year follow-up of depression, life crises, and treatment effects on abstinence among opioid addicts.

Abstract: • Follow-up studies have suggested that treatment increases addicts' likelihood of remaining abstinent and that depression and life crises are associated with decreased abstinence. An important issue is to what extent receiving treatment can ameliorate psychosocial risk factors such as life crises and depression and decrease ex-addicts' vulnerability to continued drug abuse. In our 2.5-year follow-up of 268 opiate addicts, drug abuse treatment was generally associated with increased abstinence, and life crises and depression were significant risk factors for continued drug abuse. The impact of these risk factors, however, was ameliorated by drug abuse treatment. Although life crises had a greater impact than depression, these two risk factors had additive effects in increasing the risk for continued drug abuse. Among the types of life crises, arguments and losses ("exits") had very strong additive effects with depression as predictors of drug abuse.

Parkinson's disease with depression A possible subgroup of idiopathic parkinsonism

Abstract: We investigated the prevalence of mental depression (MD) in 34 patients with Parkinson's disease (PD) of recent onset, not receiving dopaminergic drugs, and in 23 healthy individuals of comparable age and sex. In the patients, dysthymic disorder and major depression were more common than in controls (p = 0.017). The severity of MD and PD were unrelated. In 15 patients, MD began before the symptoms of PD (mean, 5 years). These patients were younger, less impaired, and with a higher positive family history of PD. MD-associated PD may be a specific subgroup of PD.

Poststroke depression and lesion location. An attempted replication.

Abstract: Recent evidence suggests that poststroke depression is associated with the location of the brain infarct, proximity to the frontal pole being associated with greater depression following left hemisphere injury, and an opposite relationship being seen with injury to the right hemisphere. This study was designed to replicate and extend previous investigation of this issue. Depression was assessed following recent stroke in patients with localized right (n = 16) or left (n = 19) hemisphere lesions. No overall differences between these groups were found on several measures of depression. Although there appeared to be a negative linear relationship between severity of depression and distance of the lesion from the frontal pole in left hemisphere patients, this association failed to attain statistical significance. A curvilinear relationship was evident in right hemisphere patients, with anterior and posterior lesions associated with high depression scores. These data support the notion that lesion location is associated with the severity of poststroke depression, although the nature of this association may be more complex than has previously been suggested.

Pathological gambling and major affective disorder: preliminary findings.

Abstract: Twenty-five pathological gamblers were examined for additional DSM-III diagnoses and family history of psychiatric illness Eighteen subjects (72%) had experienced at least one episode of major depression, and 13 (52%) had recurrent major affective episodes A high prevalence (20%) of panic disorder and/or agoraphobia was also found

Depression influences intellectual impairment in stroke patients.

Abstract: Patients with ischaemic lesions of the left cerebral hemisphere were examined for depression and intellectual impairment: in non-depressed patients, the severity of impairment was related to both lesion volume and location, as assessed by CT scan analysis. Cognitive impairment in patients with major depression was greater than predicted by lesion volume alone, and when patients were matched for severity of impairment, depressed patients had smaller lesion volumes than the non-depressed. After six months, non-depressed patients had significantly less cognitive impairment than depressed patients who showed no improvement. Both depression and lesion volume were significantly and independently related to cognitive impairment. These findings suggest that post-stroke depression can produce a true dementia in its own right, and that treatment of post-stroke depression might benefit cognitive function.

Clinical and biochemical features of depression in Parkinson's disease.

Abstract: Among 49 consecutive patients with Parkinson’s disease, 40% were depressed according to DSM-III; they had major depression or dysthymic disorder accompanied by sleep disturbance, fatigue, psychomotor retardation, loss of self-esteem, and excessive guilt. During a 1 0-day dopamine-free period, lumbar puncture was performed to measure the metabolites of dopamine, serotonin, and norepinephrine. Patients were given an overnight dexamethasone suppression test, and the effects of thyrotropin-releasing hormone and L-dopa on plasma growth hormone and prolactin were examined. Level of CSF 5-hydroxyindoleacetic acid was lowest in parkinsonian patients with major depression and was related to psychomotor retardation and loss of self-esteem. (Am J Psychiatry 143:756-759, 1986)

Zung Self-Rating Depression Scale and Depression Status Inventory

Abstract: Every classification of depressive disorders uses the “Linnaean” binomial approach to its nomenclature that is familiar in taxonomies of both plant and animal kingdoms. Thus, the endogenous-reactive depressions, neurotic-psychotic depressions, or unipolar-bipolar depressions become depression endogenous, depression reactive, depression neurotic, depression psychotic, depression unipolar, or depression bipolar. The term depression is used as an equivalent to the “genus” and is modified by a term that is equivalent to the “species” of the binomial nomenclature. Conceptualized in this manner, the genus denotes depression as a disorder with common characteristics of types or subtypes of depression. To be operationally effective, symptomatology that can be demonstrated in patients diagnosed as having depression (genus), regardless of the type or subtype (species), must have a high degree of universal agreement.

Structural brain correlates of emotional disorder in multiple sclerosis.

Abstract: SUMMARY Eighty-seven patients with definite multiple sclerosis (MS) were examined neurologically and administered the Mini-mental State examination (MMS) to asses cognitive disability at the beginning and end of a one-year study. A CT scan was performed in 37. A group of 16 patients with stable spinal cord injuries (SCI) were studied in a similar manner. Of the MS patients, 47% had a mean General Health Questionnaire (GHQ) score in the abnormal range. This was a higher rate than in SCI patients (p = 0.004). Mean depression scores were similar in MS and SCI patients, but MS patients with brain involvement were more depressed than those with cord lesions only (p = 0.05). Depression score was unrelated to functional disability but was correlated with the degree of neurological impairment (p = 0.03). Euphoric patients were more likely to have brain involvement (P = 0.006), to have progressive MS (P < 0.0001), and to have enlarged ventricles (P = 0.04) and were more impaired cognitively (P = 0.04) than noneuphoric patients. These results suggest that depression in MS patients is partly determined by the presence of brain involvement, but that it is also an emotional reaction to the disorder Euphoria and cognitive disorder are reflections of brain involvement.

School Phobia: The Overlap of Affective and Anxiety Disorders

Abstract: In a group of 26 early adolescent, chronic school refusers, 69% met DSM-III criteria for affective disorder (depression), 62% met criteria for anxiety disorder, and 50% had both depressive and anxiety disorders. Patients with both disorders were more severely symptomatic as indicated by higher scores on rating scales for anxiety and depression. While children and adolescents with depressive disorders frequently reported anxiety symptoms, in general those with anxiety disorders did not commonly describe depression. However, those patients with severe anxiety symptoms reported specific depressive symptomatology, indicating that severe anxiety disorders in children and adolescents may be clinically indistinguishable from depression.

A survey of chronic pain in an elderly population.

Abstract: Elderly nursing home residents and those attending a day hospital program for six hours a week at the same home were surveyed to determine the prevalence of chronic pain. Of the 132 subjects, 83% reported having pain problems, mostly due to connective tissue disorders. Eighty-four percent of these patients were receiving analgesics for their pain, but the other 16% were receiving no treatment. Fifty percent of subjects report low levels of pain, 32% moderate levels, and 18% high to intolerable levels. For many patients, the pain has been present for several years. A relationship was also found between pain levels and depression. None of these patients was being actively treated for depression. There may be an inclination to underestimate the prevalence and intensity of pain in the elderly.

Effects of living with and looking after survivors of a stroke.

Abstract: Information from a two year, longitudinal study on a community sample of patients with acute stroke was analysed to determine the effects of the stroke on the mood of the chief carer (the person living with the patient). Increased anxiety was the most commonly reported change six months after stroke. Significant depression was seen in 11-13% of carers over the first two years after stroke. The patient9s functional disability was associated with depression in the carer over the first year but not at two years. A perceived poor recovery by the patient, a low level of general activities by the patient, and depression in the patient were also associated with depression in the carer within the first year. At two years after stroke none of the measured factors were related to a carer9s level of depression. Carers of patients who have suffered stroke showed anxiety and emotional distress unrelated to the patient9s physical disability after two years. More help from stroke support groups for carers is perhaps needed.

Symptomatic Depression in Elderly Medical Outpatients: I. Prevalence, Demography, and Health Service Utilization

Abstract: The authors assessed the prevalence and demography of depressive symptoms, their association with specific chronic diseases, and their influence on health service use in a large sample of elderly men seen in a primary care setting. Twenty-four percent of respondents reported clinically significant depressive symptoms; the prevalence of major depressive disorders was estimated at 10%, but only 1 % reported receiving mental health treatment by a specialist. Self-reported marital separation or divorce and physical disability affecting employment were strongly associated with high depression scores, whereas the normative stresses of aging (widowhood, retirement, social isolation) were not. Only chronic lung disease was differentially associated with high depression scores, and this effect was weak. The authors discuss the implications of these findings for the design of comprehensive health services for the elderly with chronic disease.

Dementia of the Alzheimer's type and depression.

Abstract: This retrospective review of medical records was designed to address three questions: 1) Can the depression seen in some patients with Dementia of the Alzheimer's Type (DAT) be successfully treated? 2) Does this treatment lead to any long-term improvement in the patient's cognitive status? and 3) Do patients with coexisting DAT and depression have a different long-term clinical course than nondepressed DAT patients? In the authors' sample of 131 DAT subjects, 41 (31%) also met DMS-III criteria for a major affective disorder. Of those DAT plus depression patients whose records reflected treatment (usually with a tricyclic antidepressant), 85% (17 of 20) showed clear evidence of improvement in mood, vegetative signs, or activities of daily living (ADLs) based on review of the medical record. An analysis of change in cognitive function (measured by the Folstein Mini-Mental State) and five global measures failed to reveal any differences between the depressed and nondepressed groups after a mean interval of 17 months. The depression that occurs in approximately one-quarter to one-third of DAT patients appears to respond to appropriate therapy. These patients often show improvement in their mood and ADLs but remain demented.