Showing papers on "Depression (differential diagnoses) published in 1989"

The functioning and well-being of depressed patients. Results from the Medical Outcomes Study

Abstract: We describe the functioning and well-being of patients with depression, relative to patients with chronic medical conditions or no chronic conditions. Data are from 11 242 outpatients in three health care provision systems in three US sites. Patients with either current depressive disorder or depressive symptoms in the absence of disorder tended to have worse physical, social, and role functioning, worse perceived current health, and greater bodily pain than did patients with no chronic conditions. The poor functioning uniquely associated with depressive symptoms, with or without depressive disorder, was comparable with or worse than that uniquely associated with eight major chronic medical conditions. For example, the unique association of days in bed with depressive symptoms was significantly greater than the comparable association with hypertension, diabetes, and arthritis. Depression and chronic medical conditions had unique and additive effects on patient functioning. ( JAMA . 1989;262:914-919)

Epidemiologic study of sleep disturbances and psychiatric disorders : an opportunity for prevention

Abstract: As part of the National Institute of Mental Health Epidemiologic Catchment Area study, 7954 respondents were questioned at baseline and 1 year later about sleep complaints and psychiatric symptoms using the Diagnostic Interview Schedule. Of this community sample, 10.2% and 3.2% noted insomnia and hypersomnia, respectively, at the first interview. Forty percent of those with insomnia and 46.5% of those with hypersomnia had a psychiatric disorder compared with 16.4% of those with no sleep complaints. The risk of developing new major depression was much higher in those who had insomnia at both interviews compared with those without insomnia (odds ratio, 39.8; 95% confidence interval, 19.8 to 80.0). The risk of developing new major depression was much less for those who had insomnia that had resolved by the second visit (odds ratio, 1.6; 95% confidence interval, 0.5 to 5.3). Further research is needed to determine if early recognition and treatment of sleep disturbances can prevent future psychiatric disorders.

Reduction of prefrontal cortex glucose metabolism common to three types of depression.

Abstract: • Using positron emission tomography, we studied cerebral glucose metabolism in drug-free, age- and sex-matched, righthanded patients with unipolar depression (n =10), bipolar depression (n =10), obsessive-compulsive disorder (OCD) with secondary depression (n =10), OCD without major depression (n =14), and normal controls (n =12). Depressed patients were matched for depression on the Hamilton Depression Rating Scale, and subjects with OCD without depression and OCD with depression had similar levels of OCD pathology. We also studied six non—sex-matched patients with mania. Mean ( ± SD) glucose metabolic rates for the left dorsal anterolateral prefrontal cortex, divided by the rate for the ipsilateral hemisphere as a whole (ALPFC/hem), were similar in the primary depressions (unipolar depression = 1.05 ±0.05; bipolar depression =1.04 ± 0.05), and were significantly lower than those in normal controls (1.12 ± 0.06) or OCD without depression (1.15 ± 0.05). Results for the right hemisphere were similar. Values in subjects with OCD with depression (1.10 0.05) were also significantly lower than in subjects with OCD without depression, and values in subjects with bipolar depression were lower than those in manic subjects (1.12 ± on this measure in the left hemisphere, although results were not significant in the right hemisphere. There was a significant correlation between the HAM-D score and the left ALPFC/hem. With medication for depression (n =12), the left ALPFC/hem increased significantly and the percentage change in the Hamilton scale score correlated with the percentage change in the left ALPFC/hem. These data support other findings that major depression is associated with a left ALPFC abnormality.

Increasing rates of depression.

Abstract: Several recent, large epidemiologic and family studies suggest important temporal changes in the rates of major depression: an increase in the rates in the cohorts born after World War II; a decrease in the age of onset with an increase in the late teenaged and early adult years; an increase between 1960 and 1975 in the rates of depression for all ages; a persistent gender effect, with the risk of depression consistently two to three times higher among women than men across all adult ages; a persistent family effect, with the risk about two to three times higher in first-degree relatives as compared with controls; and the suggestion of a narrowing of the differential risk to men and women due to a greater increase in risk of depression among young men These trends, drawn from studies using comparable methods and modern diagnostic criteria, are evident in the United States, Sweden, Germany, Canada, and New Zealand, but not in comparable studies conducted in Korea and Puerto Rico and of MexicanAmericans living in the United States These cohort changes cannot be fully attributed to artifacts of reporting, recall, mortality, or labeling and have implications for understanding the etiology of depression and for clinical practice (JAMA 1989;261:2229-2235)

The nature and course of depression following myocardial infarction.

Abstract: • Two hundred eighty-three patients admitted to cardiac care units for myocardial infarction at two urban teaching hospitals were interviewed 8 to 10 days after infarction and 171 were reinterviewed 3 to 4 months later Initially, 45% met diagnostic criteria for minor or major depression, including 18% with major depressive syndromes Depression was not associated with the severity of cardiac illness but was associated with the presence of noncardiac medical illnesses Three to 4 months after infarction, 33% of patients met criteria for minor or major depression The large majority of patients who initially met criteria for major but not minor depression showed evidence of depression at 3 months and most patients with major depression had not returned to work by 3 months Treatment of major depressive syndromes after myocardial infarction may reduce chronicity and disability, while minor depressive syndromes may be similar to normal grief and tend to be self-limited ( Arch Intern Med 1989;149:1785-1789)

Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum.

Abstract: Examined the prevalence of depression in a heterogeneous sample of 360 pregnant women. Subjects were assessed with respect to both depressive symptomatology and diagnostic status during pregnancy and after delivery. At both assessments, approximately 25% of the sample reported elevated levels of depressive symptomatology. In contrast, 10% of the women met diagnostic criteria for depression during pregnancy, and 6.8% were depressed postpartum. However, only half of the cases of postpartum depression were new onset (3.4%); the remaining women receiving a diagnosis in the postpartum had also been depressed during pregnancy. Finally, depression during pregnancy was related to different sociodemographic variables than was postpartum depression, suggesting that depression at these two times may be associated with different psychological or etiological factors.

Counselling in a general practice setting: controlled study of health visitor intervention in treatment of postnatal depression.

Abstract: OBJECTIVE--To determine whether counselling by health visitors is helpful in managing postnatal depression. DESIGN--Controlled, random order trial. SETTING--Health centres in Edinburgh and Livingston. PATIENTS--Sixty women identified as depressed by screening at six weeks post partum and by psychiatric interview at about 13 weeks post partum. Five women did not wish to participate, and a further five did not complete the trial. Age, social and obstetric factors, and diagnosis were similar in women who completed the trial and those who withdrew. INTERVENTION--Eight weekly counselling visits by health visitors who had been given a short training in counselling for postnatal depression. END POINT--Reduction of depression. MEASUREMENTS and main results--Standardised psychiatric interviews and a 10 point self report scale were used to identify depression before and after intervention. The psychiatrist was not told to which group women were allocated. After three months 18 (69%) of the 26 women in the treatment group had fully recovered compared with nine (38%) of the 24 in the control group. The difference between the groups was thus 32% (95% confidence interval 5 to 58). CONCLUSIONS--Counselling by health visitors is valuable in managing non-psychotic postnatal depression.

The use of rating scales to identify post-natal depression.

Abstract: One hundred and forty-seven mothers were screened for major depression at six to eight weeks post-partum. Using predetermined cut-off points, the Edinburgh Postnatal Depression Scale and the Beck scale were compared in their abilities to identify the 15% of subjects who had major depression according to DSM-III criteria. The sensitivity of Edinburgh scale was 95% and its specificity 93%. The performance of the Beck scale was markedly inferior, with a sensitivity of 68% and specificity of 88%.

Detection of depressive disorder for patients receiving prepaid or fee-for-service care. Results from the Medical Outcomes Study

Abstract: We estimated clinicians' awareness of depression for patients with current depressive disorder (N = 650) who received care in either a single-specialty solo or small group practice, a large multispecialty group practice, or a health maintenance organization in three US sites. Depressive disorder was determined by independent diagnostic assessment shortly after an office visit. Detection and treatment of depression were determined from visit-report forms completed by the treating clinician. Depending on the setting, from 78.2% to 86.9% of depressed patients who visited mental health specialists had their depression detected at the time of the visit, compared with 45.9% to 51.2% of depressed patients who visited medical clinicians, after adjusting for case-mix differences. Among patients of mental health specialists, there were no significant differences by type of payment in the likelihood of depressive disorder being detected or treated. Among patients of medical clinicians, however, those receiving care financed by prepayment were significantly less likely to have their depression detected or treated during the visit than were similar patients receiving fee-for-service care. (JAMA. 1989;262:3298-3302)

Affective disorders and cerebral vascular disease.

Abstract: Empirical studies have recently demonstrated that major and minor depressive disorders occur in 30-50% of stroke patients, and last more than one year without treatment, although they do respond to tricyclic antidepressants. These mood disorders are not strongly associated with severity of impairment, demographic characteristics, social supports or prior personal history, but major depression is often strongly associated with left frontal or left basal ganglia lesions and pre-existing subcortical atrophy. While the aetiology of these mood disorders remains unknown, serotonergic or noradrenergic dysfunction may play a role. Mania is a rare complication of stroke: the clinical presentation and response to treatment are usually the same as mania without brain injury. Post-stroke mania is strongly associated with both a right hemisphere lesion in a limbic-connected area and a second predisposing factor, such as genetic loading for affective disorder, pre-existing subcortical atrophy or seizure disorder. This disorder may be mediated through frontal lobe dysfunction. The lesion method represents a potentially fruitful technique for investigating the mechanisms of affective disorder.

The Guy's/Age Concern Survey: Prevalence Rates of Cognitive Impairment, Depression and Anxiety in an Urban Elderly Community

Abstract: A sample of 890 people aged 65 years and over living at home in the Lewisham and North Southwark Health District was interviewed using a structured schedule containing CARE organic brain syndrome and depression scales, and items dealing with anxiety symptoms. Total prevalence rates were 4.6% for cognitive impairment, 13.5% for depression, 3.7% for generalised anxiety, and 10.0% for phobic disorders. Cognitive impairment increased exponentially with age, and was associated with lower occupational class. There was no significant association between occupational class and depression, generalised anxiety, or phobic disorder in this sample. Cognitive impairment, depression and agoraphobia were associated with significantly higher levels of dependency in the tasks of daily living.

Double-blind trial of imipramine in Alzheimer's disease patients with and without depression.

Abstract: The authors divided 61 subjects with primary degenerative dementia of the Alzheimer's type into a group who also met DSM-III criteria for depression (N = 28) and a group who did not (N = 33). Both groups were randomly assigned to an 8-week double-blind trial of imipramine or placebo. Scores on the Hamilton Rating Scale for Depression, administered at baseline and weeks 2, 4, 6, and 8, indicated significant improvement in both groups. Two measures of cognitive function yielded differing results. The results suggest that moderate depression is a treatable condition in patients with Alzheimer's disease.

Validity of the Center for Epidemiological Studies Depression Scale in arthritis populations.

Abstract: Using data from 3 studies of patients with rheumatoid arthritis, we examined the extent to which responses to items in the Center for Epidemiological Studies Depression Scale (CES-D) are influenced by aspects of the disease process other than depression. Our findings suggested that 4 CES-D items (i.e., "I felt that everything I did was an effort," "I felt hopeful about the future," "My sleep was restless," and "I could not get going") may be influenced by aspects of the disease process and, thus, are not necessarily indicative of depression among persons with arthritis. The impact that these items have on the interpretation of CES-D scores was assessed in relation to 2 research issues: estimation of the prevalence and severity of depression in arthritis populations and identification of the determinants of depression among individuals with arthritis. Our results suggest that the original CES-D may overestimate the prevalence and severity of depression among patients with arthritis. The magnitude of this bias is modest, however. The results also suggest that in studies designed to identify the determinants of depression among individuals with arthritis, inclusion of the 4 items identified is unlikely to have any effect on study findings.

Psychiatric diagnoses in patients who have chronic fatigue syndrome.

Abstract: Patients with persistent fatigue are often suspected of having psychiatric illnesses, particularly depression. The authors used the Diagnostic Interview Schedule to assess the lifetime prevalence of psychiatric disorders in 28 patients who met Centers for Disease Control case definition criteria for chronic fatigue syndrome. Compared with studies of the general population and studies of chronically medically ill patients who received the same structured interview, the rates of psychiatric illness in patients with the chronic fatigue syndrome appeared high. An examination of the medical histories of the 28 patients indicated that psychiatric disorders more often preceded the chronic fatigue than followed it.

Depression and Alzheimer's disease.

Abstract: In his classic case, Alzheimer described cognitive symptoms such as amnesia, aphasia, and apraxia and noncognitive symptoms such as delusions and agitation. Recent studies have suggested that depression also occurs in Alzheimer's disease. In this study, 144 patients who met criteria for Alzheimer's disease were examined for depression on a modified version of the Present State Examination. The prevalence rate of major depression was 17%. The depressed Alzheimer's disease patients were more cognitively impaired and more disabled than the nondepressed patients. Studies are needed to clarify the etiology and treatment of depression in Alzheimer's disease.

Depression in late life

Abstract: Aims to be a comprehensive guide to the understanding, recognition and management of late-life depression, containing practical information for anyone involved in the care of the older patient.

Mood disorder following cerebrovascular accident.

Abstract: Depression appears to be common after stroke, and therefore may have a bearing upon rehabilitation. To examine whether the depression is due to a specific brain lesion, or is reactive to the consequent disability, this study looked at the frequency and associations of depressed mood in a stroke rehabilitation unit in-patient population, unselected for site of lesion. Depression affected 50% of the patients; history of previous psychiatric disorder and cerebrovascular accident appeared to be important risk factors. There were hemispheric differences in the relationships between measures, with both the site-of-lesion and reactive viewpoints being upheld.

A three-year follow-up of Cambodian young people traumatized as children

Abstract: Twenty-seven Cambodian young people, who were severely traumatized at ages 8 to 12, were followed up 3 years after an original study. A structured interview and self-rating scales showed that post-traumatic stress disorders (PTSD) were still highly prevalent (48%). Depression existed in 41%. Those with PTSD differed significantly from those without PTSD on the Global Adjustment Scale, the Social Adjustment Scale, the Beck Depression Inventory, and the Impact of Event Scale. Eight subjects had PTSD at both interviews, while 11 had none at either time. Eight showed a variable course. Avoidance behavior was highly prevalent, even among those without PTSD diagnosis. Although functioning relatively well, these youths continued to show symptoms related to their trauma of 8 to 12 years before.

Depression in the elderly.

Abstract: Presentation differs from that in the young, as does choice of therapy, which tends to be empiric. The tricyclics are considered the best treatment, although electroconvulsive therapy may be preferable in severe delusional depression.

Mental disorder in youth suicide. DSM-III-R Axes I and II.

Abstract: A 3-year urban material of suicides in adolescents and young adults (age 15-29 years) was studied retrospectively by means of interviews with survivors (n = 58). Classification of mental disorders according to DSM-III-R showed that major depression was important as background to suicides in 41%, primary (22%) or secondary (19%) to other disorders. Adding major depression, depressive disorder, not otherwise specified, dysthymia and adjustment disorder with depressed mood gave a total of 64% depressive syndromes. Schizophrenia (14%) and borderline personality disorder (28%) constituted other relevant groups. Coexisting substance use disorder occurred in 47%. A majority of the subjects (72%) were known by psychiatric caregivers and 16% committed suicide during inpatient care. Language: en

Childhood and adolescent depression.

Abstract: used by Dr Davies is 0.5%. This is the currently esti mated risk of seroconversion after a needlestick injury of HIV positive blood —¿ this point requires em phasis as it leads directly on to the need to have an estimate of population prevalence of HIV. Secondly, the best available population estimate of HIV prevalence in the UK is derived from voluntary blood donation screens. The UK prevalence derived from this source is 0.0016% (British Medical Journal, 1988). Using a simple probability calculation, the risk of seroconversion after needlestick injury with blood of unknown HIV status is 1 in 12.5 million. We can build assumptions into this calculation, e.g. that the prevalence of HIV in a psychiatric hospital popu lation is, say, 100 times that in the general population; the risk from a single random needlestick injury then becomes 1 in 125 000. I do not †̃¿ dismiss' this risk, but attempt to view it in relation to, for example, the I in 1000 risk of a child dying before its first birthday (Office of Population Censuses and Surveys, 1986a) the 2 in 1000 risk of a man aged 45—54dying of a coronary heart disease(Office of Population Censuses and Surveys, 1986b) and the 6—30%risk of hepatitis B seroconversion after needlestick injury with infected blood (Population Reports, 1986). Furthermore, using a simple binomial model it would require in excess of85 000 events to produce a greater than 50% probability of at least one seroconversion. I shall not follow Dr Davies' practice of confusing terms whose meanings are widely held to be different. Screening is not the same as assessment, and cer tainly not the same as “¿ assessment― under the 1983 Mental Health Act. It is a pity that Dr Davies has not assimilated the cogent arguments by Dickens (1988) on the legal rights and duties of health professionals; this is surprising, as Dr Davies himself cited Dickens' article. Of equal importance are the ethical argu ments for and against involuntary screening. Walters (1988), in a reasoned and eloquent article, concluded: “¿ Mandatory screening programmes other than those involving persons who voluntarily donate blood, semen, or organs are not morally justifiable at this time―.Taken together, these papers present the case for a voluntary screening programme and emphasise the essentially voluntary relationship which ought to exist between doctor and patient. Finally, it is precisely because Dr Davies and I hold genuinely different opinions about the best approach to the problems presented by HIV infection that I cannot join with him in a trivialising of the debate —¿ summed up in his recycled phrase “¿ where will all this nonsense end?―In particular, there is a pressing need for anonymous screening for HIV so that better population prevalence figures are available for monitoring trends and planning services —¿ informed debate on this and other relevant issues are not non sense. Such debate is, in fact, an essential part of developing valid and acceptable practice and policy responses to the greatest health risk of our time. J. B. CONNELLY Department of Community Medicine St Mary's Hospital Medical School London W2

Wilson's disease. Psychiatric symptoms in 195 cases.

Abstract: A series of 195 cases of Wilson's disease were assessed retrospectively on a range of variables, including psychiatric, neurologic, and hepatic symptoms, and biochemical data as recorded at first admission to a specialist clinic. Ninety-nine patients (51%) were rated as displaying some evidence of psychopathologic features, and 39 (20%) had seen a psychiatrist before the diagnosis of Wilson's disease. The most common psychiatric features were abnormal behavior and personality change, although depression and cognitive impairment were also rated frequently. Schizophrenialike psychoses were rare, apparently occurring at no more than chance frequency. Psychiatric symptoms were related to neurologic rather than hepatic symptoms, and certain symptoms (incongruous behavior, irritability, and personality change) had a particularly significant relationship with bulbar and dystonic disorders but not with tremor. Psychiatric manifestations are important in Wilson's disease, and many of the psychopathologic features seem to have an organic basis.

White matter hyperintensity on magnetic resonance imaging: clinical and neuroanatomic correlates in the depressed elderly.

Abstract: In a prospective study of depressed elderly patients referred for electroconvulsive therapy (ECT), subcortical white matter hyperintensity (WMH) was seen in all 51 patients 60 years or older who received magnetic resonance imaging (MRI) prior to treatment. In over half of the patients the WMH was formally rated as at least moderately severe, and it was commonly associated with other structural brain changes. The majority (80%) of patients had late-age-onset depression, suggesting that structural brain changes may interact with aging to facilitate the emergency of depression in late life.

Depression and posttraumatic stress disorder in Southeast Asian refugees.

Abstract: The authors report on 404 Southeast Asian refugees seen at a community clinic. Approximately three-quarters of these patients met DSM-III criteria for major depressive episode, and 14% had posttraumatic stress disorder. Complaints of pain and sleep disturbances were the predominant presenting symptoms. Most of the men were married, but more than 40% of the women were widowed. Between 15% and 30% of the patients reported specific traumatic experiences either in their homeland or during their escape. Widowhood and such traumatic experiences were positively correlated with more symptoms of depression and anxiety.

Survival and health care utilization in elderly medical inpatients with major depression.

Abstract: Forty-one elderly medical inpatients with active major depression were matched with nondepressed controls from the same population. Survival and health care utilization were examined during a mean follow-up period of five months. Cases and controls were matched by age, functional status, severity and type of medical illness, and extent of disease. In-hospital mortality was significantly higher among depressed compared with nondepressed controls (6 vs 0 deaths, P = .03). For patients discharged from the hospital alive, however, depression did not have a substantial impact on mortality (31.4% cases, 31.7% controls). Health care utilization--in terms of days of inpatient care--was significantly higher both during the index admission (25 vs 14 days, P less than .005) and during the follow-up period (16 vs 7 days, P less than .05) for depressed patients compared with controls. Hence, older medically ill patients with major depression consume more healthcare resources and experience greater mortality during their initial hospital stay. After discharge, while survival is little affected, excess resource utilization persists among those with depression.

Dizziness in a community elderly population.

Abstract: Dizziness was studied in 1,622 community-dwelling adults aged 60 and older who were interviewed as part of the Duke Epidemiologic Catchment Area study. The lifetime prevalence of dizziness (defined as severe enough to see a physician, to take a medication, or to interfere with daily activities) was 29.3%; the 1-year prevalence was 18.2%. When the subgroup with dizziness was compared with those who never suffered dizziness, using logistic regression, four variables displayed the strongest associations: a constructed variable of risk for multiple neurosensory deficits, a cardiovascular risk score, a depression symptom inventory, and perception of self as a nervous person. In this population, dizziness was not associated with increased risk of death or institutionalization at the 1-year follow up.

Mood changes after right-hemisphere lesions.

Abstract: Ninety-three patients with acute stroke lesions restricted to the right hemisphere were examined for the presence of mood changes. While 46 patients showed no mood changes, 19 were unduly cheerful, 17 had developed major depression, and 11 had developed minor depression. Although there were no significant between-groups differences in other demographic variables, neurological deficits, activities of daily living, cognitive impairment, or quality of social support, patients with major depression had a significantly higher frequency of familial history of psychiatric disorder and lesions of the parietal cortex than patients with either no mood change or major depression following left-hemisphere lesions. On the other hand, undue cheerfulness was significantly associated with lesions of the right frontal operculum. These findings suggest that major depression following right-hemisphere lesions may have a different aetiology and mechanism than major depression following left frontal or basal ganglia lesions.