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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Our objective was to assemble expert clinical experience and judgment in the treatment of anxiety and related disorders in a systematic, quantitative manner. This article reports on some clinical features apart from diagnosis that may affect choice of strategy in the pharmacotherapy of anxiety disorders. A panel of internationally recognized experts in treating anxiety and depression was constituted by multistage peer nomination. Ninety percent (66 of 73) completed an extensive questionnaire. This report focuses on the expert panel's responses to questions on therapeutic options, based on multi-part case vignettes of several anxiety disorders presenting clinical variations within the same diagnosis. In the presence of higher levels of functional impairment, the experts more often recommended formal psychosocial procedures for adjustment disorder; medication for agoraphobia, social phobia, obsessive-compulsive disorder, and adjustment disorder; and polypharmacy for agoraphobia. Their therapeutic recommendations were not materially affected by chronicity in the case of panic disorder. Under the condition of heavy use of alcohol in the case of generalized anxiety disorder, the experts avoided benzodiazepines in favor of various other medications. In the presence of a serious cardiac conduction defect in the case of obsessive-compulsive disorder, they less often recommended medication. Those who did recommend medication changed their preference from tricyclic antidepressants (clomipramine) to selective serotonin reuptake inhibitors. Under the condition of a more severe precipitating event in the case of adjustment disorder, the experts were more likely to recommend both formal psychosocial intervention and medication.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: III. Clinical features affecting experts' therapeutic recommendations in anxiety disorders. 749 81

Patients undergoing physical rehabilitation have experienced a severe object loss and it is suggested that many patients in rehabilitation might have psychiatric disorders. We conducted a study to demonstrate the frequency and kinds of psychiatric and psychological symptoms. A Structured Interview according to the DSM-III-R was conducted, which demonstrated that 27 (43.5%) out of 62 rehabilitation inpatients met the criteria for some form of psychiatric disorders; 22 patients for major depression and five for adjustment disorder with anxious mood. The remaining 35 patients (56.5%) showed normal reactions to their diseases. They were also administered Zung's Self-rating Anxiety Scale (SAS), Zung's Self-rating Depression Scale (SDS) and Profile of Mood States (POMS). These three psychological tests were useful in detecting depression or adjustment disorder among rehabilitation patients; but they were not always specific to the type of psychiatric disorders. Patients with higher scores in these inventories should be referred to a psychiatric consultant for detailed examinations and proper treatment if necessary.
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PMID:Psychiatric evaluation of rehabilitation patients. 766 Mar 87

In a double-blind comparative study, 135 depressed patients were treated in 20 centers. Inclusion diagnoses were typical depressions with single episode (296.2), several episodes (296.3), depressive neurosis (300.4), and adjustment disorder with depressed mood (309.0) in accordance with DSM-III-R. The dosage was 3 x 300 mg hypericum extract LI 160 or 3 x 25 mg imipramine daily. The treatment lasted for 6 weeks. Main assessment criteria were the Hamilton Depression Scale (HAMD), the Depression Scale according to von Zerssen (D-S) and the Clinical Global Impressions (CGI). In both treatment groups, a parallel reduction of the Hamilton score from 20.2 to 8.8 (LI 160, n = 67) or from 19.4 to 10.7 (imipramine, n = 68), and the transformed D-S point values from 39.6 to 27.2 (LI 160) and 39.0 to 29.2 (imipramine) were found. The analysis of CGI revealed comparable results in both treatment groups. Clinically relevant changes of the safety parameters were not found. In the LI 160 group fewer and milder side effects were found as compared to imipramine.
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PMID:Effectiveness and tolerance of the hypericum extract LI 160 in comparison with imipramine: randomized double-blind study with 135 outpatients. 785 2

Early intervention and treatment of manic and depressive states at university mental health service are described. Frequency of depression among the population of university students is about 0.1-0.2% and has increased during the last 10 years. The diagnoses of depressive states according to DSM-III-R are as follows; adjustment disorder with depressed mood (50%), major depression (20-30%), dysthymia (20%), and bipolar disorder (5-8%). Some plans for early intervention are discussed, including screening and consultation from the teaching staff and parents. Concerning treatment, it is important to support their academic problems caused by their mental disorders in close cooperation with their parents and their teaching staff.
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PMID:[Early intervention and treatment of depressive and manic states among university students]. 800 19

Psychiatric morbidity was studied in 100 women attending gynecological outpatient and inpatient set-ups using two brief screening instruments: the General Health Questionnaire, 12 items, and the Present State Examination, ten short questions. Psychiatric morbidity was detected in 36% and was found to be higher in women with uterine prolapse and infections but not in those with menstrual irregularities (p < 0.001). The commonest psychiatric symptoms detected in this population were worrying (50%), aches and pains (51%), depression (50%) and disturbances of biological function (51%). The commonest diagnoses were neurotic depression (70%) and adjustment disorders (23%). The screening instruments used were found to be simple, sensitive, specific, with high identification indices and easy to administer.
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PMID:Detection of psychiatric morbidity in gynecology patients by two brief screening methods. 803 89

To assess relationships of total plasma cholesterol (TC) and triglyceride (TG) values to suicide, suicide ideation, and hospitalization for psychiatric disease, we studied 220 children, ages 5 to 18 y, hospitalized with affective, adjustment, disruptive, anxiety, schizophrenic, other, and organic psychiatric disorders. The 135 male and 85 female patients had higher TG values (p = 0.0001 and 0.0003, respectively) and higher Quetelet Indices (p = 0.0001 and 0.003, respectively) than the 732 male and 316 female schoolchild controls; male patients had higher TC values than male controls (p = 0.014). Substance abuse in patients was an independent inverse determinant of TC value (p = 0.05); TG value correlated positively with alcohol use (p < or = 0.1) and substance abuse (p < 0.05). After covariance adjustment for age, race, sex, and Quetelet, children having adjustment disorders with depression had much lower covariance-adjusted TC value than control schoolchildren (3.91 versus 4.29 mmol/L, p = 0.003), whereas those with disruptive behavior with oppositional defiant disorder had much higher adjusted TC value (5.09 mmol/L, p = 0.0001). After covariance adjusting for age, race, sex, Quetelet, cigarette smoking, alcohol use, and substance abuse, children having adjustment disorders with concomitant depression had the highest group suicide tendencies (attempts and ideation) and the lowest covariance-adjusted TC value (4.03 mmol/L). Conversely, children having disruptive behavior with attention deficit hyperactivity disorder or disruptive behavior with oppoistional defiant disorder had 50% lower suicide index than those with adjustment disorders with concomitant depression and higher adjusted TC levels (4.45 and 5.12 mmol/L, p = 0.0003).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hypocholesterolemia, hypertriglyceridemia, suicide, and suicide ideation in children hospitalized for psychiatric diseases. 806 45

We conducted a study to demonstrate the kinds and frequencies of psychiatric symptoms among 31 inpatients with malignant hematological diseases. The DSM-III-R (Diagnostic and Statistical Manual for Mental Disorders, third edition-revised, 1987) structured interview and three psychological tests, such as the Self-rating Anxiety Scale, Self-rating Depression Scale and Profile of Mood States, were administered. The structured interview demonstrated 29.0% of the patients to have met the criteria for some form of psychiatric disorder, i.e., two for major depression and seven for adjustment disorder (three with depressed mood, two with anxious mood and two with mixed emotional features). Of the remaining 22 patients (71.0%) none met the criteria for psychiatric disorders. Of the five patients who knew their true diagnoses, three were assessed as having adjustment disorder with depressed mood and one as having major depression. Also, among the five patients on chemotherapy, four met the criteria for psychiatric disorders. Adjustment disorders were fewer among Japanese patients with malignant hematological diseases than among patients from previous studies in western countries, which can be explained by the patients' defense mechanism such as 'denial' and/or the less frequent 'truth-telling' in Japan. In addition, since the diagnostic criteria or psychological scales contain physical symptoms, they should be arranged or revised if applied to patients with life-threatening diseases such as hematological malignancies.
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PMID:Emotional states of patients with hematological malignancies: preliminary study. 807 96

"Burn-out" is a kind of assistential laboral stress which affects the professions which involve an interpersonal relationship with beneficiaries of the job, such us health workers. It originates emotional alterations which lead to feelings of emptiness and personal failure or laboral inability. The revisions about studies of mental disorders in health workers fall upon such laboral stress and remark that in such professional people there is a bigger prevalence of disorders because of the use of substances and of depression. To analyse the mental disorders in health workers by means of the retrospective study of a sample in a general hospital which asked for a psychiatric consultation, sociodemographic variables, clinico-diagnostic and variables related to laboral activity were analysed. The sample is constituted by 112 patients of an average age of forty years old and preferentially females (79.5%). In the sample, some professions are represented above all expectations; they are nurses, physicians, the laboral category of "boss and managers" and the laboral regimen of "permanents". The more frequent psychiatric disorders were the adjustment disorders and code V, the affective disorders and the anxiety disorders (23-33%), the disorders caused by the use of substances and the psychotic disorders are limited (5%). The laboral activity was considered an important factor in 43% of the cases and the mental disorder caused laboral inability, transitory or permanent in half of the patients. It is detected a relationship between the diagnostic and variables such as sex, laboral category, laboral inability, psychosocial stress level and GAF and there hasn't been detected any association between mental disorders and age, profession, laboral regimen and laboral stress.
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PMID:[Psychosocial factors in duodenal ulcer]. 807 74

The influence of prolonged psychological stress on hormonal secretion was investigated in 84 East Germany refugees suffering from psychiatric disorders within 6 weeks of their arrival in West Berlin shortly before or after the fall of the Berlin Wall. Before leaving the German Democratic Republic, these patients had already experienced prolonged stress, which continued after migration. In most cases, the diagnosis was anxious-depressive syndrome with vegetative complaints and symptoms of increased arousal. Their formal DSM-III-R diagnoses (American Psychiatric Association, 1987) included adjustment disorders, depressive disorders, and anxiety disorders (the latter including posttraumatic stress disorder). Serum levels of thyroid stimulating hormone (TSH) and thyroid hormones (thyroxine, free thyroxine, triiodothyronine, and reverse triiodothyronine) were measured and compared with those of 20 healthy control subjects. TSH and all thyroid hormone concentrations were significantly reduced in the patient group. Fifty-two of the patients (62%) were in the hypothyroid range but did not show any clinical signs of hypothyroidism. These disturbances in hormonal secretion were not correlated to any psychiatric diagnosis or to the severity of acute or chronic stress. The marked abnormalities in the hypothalamic-pituitary-thyroid axis seen in these refugees differ from those reported in depression and would seem to reflect severe chronic stress rather than specific psychiatric disorders. The underlying neurochemical mechanisms remain to be investigated.
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PMID:Psychological and endocrine abnormalities in refugees from East Germany: Part I. Prolonged stress, psychopathology, and hypothalamic-pituitary-thyroid axis activity. 819 71

Anxiety in older patients is more often a symptom of an underlying mental or physical disorder than a primary diagnosis. Its various forms include situational anxiety, adjustment disorder, and phobias. A search for underlying organic causes is important, as age-related diseases, drug side effects, and substance abuse/withdrawal may have etiologic significance. Anxiety may also mask primary psychiatric disorders such as depression or delirium. Therapy requires treating any underlying psychiatric illness and seeking psychosocial intervention for functional causes. If medical therapy is indicated, short-acting benzodiazepines are the first choice, but patients should be followed closely for possible side effects.
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PMID:Anxiety in the older patient: differential diagnosis and treatment. 843 36


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