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

Self-report depression scales include items concerning somatic symptoms, such as fatigue, pain, and inability to work, which may be symptoms of depression in individuals who do not have a chronic disease. However, in patients with somatic diseases such as rheumatoid arthritis, these symptoms may reflect disease rather than depression. Interpretation of responses to these items in patients with chronic disease as indicating depression is known as "criterion contamination". Criterion contamination has been described in responses of patients with rheumatoid arthritis on many widely-used depression scales, including the Minnesota Multiphasic Personality Inventory (MMPI), the Beck Depression Inventory, and the Center for Epidemiologic Studies Depression Index (CES-D). Evidence for criterion contamination in responses of patients with rheumatoid arthritis on these depression scales is summarized in this essay.
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PMID:Depression scales in rheumatoid arthritis: criterion contamination in interpretation of patient responses. 833 90

The priorities for future research from the NIH Consensus Development Conference on the Diagnosis and Treatment of Depression in Late Life, as republished in the previous article, included recommendations to "conduct clinical trials and observational studies of treatment in the very old, the elderly in institutional setting, and the elderly with medical illnesses," that is, in the frail elderly. The present article reviews recent research in this field and outlines the potential for future developments. The importance of these areas of investigation follows from epidemiological findings suggesting that the prevalence of major depression in community populations, in general, decreases as a function of age but that depressions of all types occur more frequently in the "oldest-old," in patients seen in medical care settings, and in those with chronic disease and disability. The psychopharmacological literature, as summarized for the Consensus Conference in the review by Salzman and the meta-analyses of Klawansky, Greenhouse, and Schneider, indicates that antidepressant medications remain effective in elderly patients with moderate to severe degrees of major depression. Questions remain, however, about the value of drug treatment for those depressions that are most common in late life, including those that occur in extremely old patients and in patients with significant medical illness.
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PMID:Drug treatment of depression in the frail elderly: discussion of the NIH Consensus Development Conference on the Diagnosis and Treatment of Depression in Late Life. 837 2

A New Zealand cohort of 58 patients with bipolar affective disorder was studied prospectively with three-monthly interviews in order to determine the relationship between life events and their relapses. Careful attention was paid to dating life events and the earliest signs of relapse and to assessing the independence of life events from the illness. No statistically significant association was found between life events and the likelihood of relapses, either mania or depression, for the 71% of patients who experienced at least one relapse during the two-year study. This finding is at variance with a companion study, with identical methodology, which found a small increase of life events before relapse. These data add further weight to the previous reports that life events are significant precipitants of bipolar illness only for earlier episodes in the course of this chronic disorder.
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PMID:Life events and relapse in established bipolar affective disorder. 819 98

Geriatric failure to thrive has three elements: deterioration in the biological, psychological, and social domains; weight loss or undernutrition; and lack of any obvious explanation for the condition. It results from the combined effects of normal aging, malnutrition, and specific physical, social, or psychological precipitants (eg, chronic disease, dementia, medication, dysphagia, depression, social isolation). Failure to thrive can be managed with a commonsense approach by primary care physicians and healthcare providers such as social workers and dietitians; extensive referral is not necessary. The key to effective care is to identify all of the precipitants and intervene early to prevent progression.
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PMID:'The dwindles'. Failure to thrive in older patients. 841 33

In order to implement the St Vincent Declaration programme, instruments for quality assurance of medical outcomes as well as measures of psychological outcomes of diabetes care had to be developed. This paper presents baseline values for three questionnaires measuring psychological Well-being, Treatment Satisfaction and General Health among a representative sample of adult people with diabetes in Sweden consisting of 423 individuals of which 153 were insulin treated and 270 were diet/tablet-treated. Cronbach's alpha indicated that each of the Well-being and Treatment Satisfaction subscales was internally reliable, alphas ranging from 0.66-0.88. Factor analysis resulted in identification of five subscales (depression, anxiety, positive well-being, treatment satisfaction and metabolic control). There was no relation between any of the quality of life subscales with HbA1c, BMI, duration of diabetes, frequency of blood glucose tests per day, insulin regimens or diabetic complications. Females reported a more negative impact of diabetes on daily life compared with males (p < 0.001). In conclusion, the Well-being and Treatment Satisfaction scales are reliable for quality assurance purposes in diabetes while the briefer general health instrument provides a useful assessment of the global impact of a chronic disease.
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PMID:Well-being and treatment satisfaction in adults with diabetes: a Swedish population-based study. 855 11

There is intriguing evidence suggesting pathophysiologic relationships among dyspnea, hyperventilation, and panic anxiety. The symptoms of panic attacks and pulmonary disease overlap, so that panic anxiety can reflect underlying cardiopulmonary disease and dyspnea can reflect an underlying anxiety disorder. The pathogenesis of panic may be related to respiratory physiology by several mechanisms: the anxiogenic effects of hyperventilation, the catastrophic misinterpretation of respiratory symptoms, and/or a neurobiologic sensitivity to CO2, lactate, or other signals of suffocation. In a subset of patients with PD, incipient pulmonary dysfunction may also contribute to their anxiety symptoms. Patients with pulmonary disease, particularly those with obstructive lung disease, have a high rate of panic symptoms and PD. There is reason to believe that pulmonary disease constitutes a risk factor for the development of panic related to repeated experiences with dyspnea and life-threatening exacerbations of pulmonary dysfunction, repeated episodes of hypercapnia or hyperventilation, the use of anxiogenic medications, and the stress of coping with chronic disease. Panic in pulmonary patients may carry significant morbidity, including phobic avoidance of activity, overly aggressive treatment with anxiogenic medications, and more prolonged and frequent hospitalization. Successful treatment of panic in these patients can improve functional status and quality of life by relieving anxiety and dyspnea. Nonpharmacologic treatment of panic, including cognitive-behavioral approaches, can be useful in patients with concomitant respiratory disease. Sedating medications such as benzodiazepines should be used with caution in patients with pulmonary disease to avoid respiratory depression. Serotonergic antidepressants (SSRIs) and anxiolytics (buspirone) may be effective treatments for panic or generalized anxiety in pulmonary patients and have relatively little potential for significant adverse effects.
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PMID:Panic anxiety, dyspnea, and respiratory disease. Theoretical and clinical considerations. 868 Jul

Anorexia is associated with disorders of all systems. Anorexia represents a consistent clinical manifestation during acute and chronic pathophysiological processes (infection, inflammation, injury, toxins, immunological reactions, malignancy and necrosis). Anorexia during disease can be beneficial or deleterious depending on the timing and duration. Temporary anorexia during acute disease may be beneficial to an organism since a restriction in the intake of micro- and macro-nutrients will inhibit bacterial growth. Long-term anorexia during chronic disease, however, is deleterious to an organism and may be associated with cachexia, which can ultimately result in death. Various mechanisms participate in the anorexia observed during disease, including cytokine action. Anorexia induced by cytokines is proposed to involve modulation of hypothalamic-feeding associated sites, prostaglandin-dependent mechanisms, modifications of neurotransmitter systems, gastrointestinal, metabolic, and endocrine factors. In addition, the anorexia-cachexia syndrome is multifactorial and may involve chronic pain, depression or anxiety, hypogeusia and hyposmia, chronic nausea, early satiety, malfunction of the gastrointestinal system, metabolic alterations, cytokine action, production of other anorexigenic substances and/or iatrogenic causes (chemotherapy, radiotherapy). Cachexia may result not only from anorexia and a decreased caloric intake, but also from malabsorption and losses from the body (ulcers, hemorrhage, effusions), or a change in body metabolism. Research has focused on potential interventions to modify anorexia during disease and the anorexia-cachexia syndrome. Nutritional modifications and the use of specific steroids (such as megestrol acetate) are being tested in the clinical setting. Understanding the specific mechanisms responsible for anorexia during disease as well as their interactions is essential to develop interventions for the control of anorexia (during a critical time in a specific disease), and to devise less toxic immunotherapeutic regimens using cytokines.
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PMID:Anorexia during acute and chronic disease. 905 54

The aim of this study was to compare the quality of life of patients under home mechanical ventilation (HMV) for restrictive lung disease, with the quality of life of patients with chronic obstructive pulmonary disease (COPD), having similar decrease in forced expiratory volume in one second (FEV1), but not receiving HMV. Sixteen patients who were receiving intermittent HMV (six post-tuberculosis, four post-poliomyelitis, two neuromuscular diseases, two kyphoscoliosis, two obesity-hypoventilation syndromes) were compared to 15 COPD patients who were receiving only usual conservative treatment, including long-term oxygen therapy. Dyspnoea scores, anxiety, depression, and psychosocial scores, as well as a panel of functional parameters were measured. The two groups did not differ in terms of functional impairment. However, patients under HMV had much better scores for anxiety, depression, and adjustment to illness than COPD patients. Scores for dyspnoea at rest were also better in the HMV group, but showed no relationship to quality of life. In spite of a cumbersome and intrusive type of treatment, patients under home mechanical ventilation for predominantly restrictive lung disease were found to have a better quality of life than chronic obstructive pulmonary disease patients under conservative therapy. In the first group, a longer history of coping with a chronic disease and the perception that medical intervention is effective may in part account for this difference.
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PMID:Quality of life of patients under home mechanical ventilation for restrictive lung diseases: a comparative evaluation with COPD patients. 876 89

Arthritis is a common chronic disease causing pain and progressive disability to millions of people. The purpose of the study was to examine the effectiveness of group patient education for people with one form of arthritis, ankylosing spondylitis (AS), in terms of change in: arthritis self-efficacy; psychological well-being; physical well-being; and home exercise activities. The Self-Management Course-Ankylosing Spondylitis (SMC-AS) demonstrated positive effects on arthritis self-efficacy and psychological well-being at 6-month follow-up. Analysis of change over time in the intervention group showed improvements in depression, self-efficacy and severity at 3 weeks, with trends towards continued improvement evident at 6 months. In contrast, the positive effects on range and frequency of home exercise activities at 3 weeks were not maintained at 6 months. In conclusion, the effectiveness of short, intensive patient education courses was demonstrated. However, the need for strategies to sustain improvements in exercise behaviour need to be explored.
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PMID:Group education for people with arthritis. 878 54

One commonly used instrument for evaluating general health and functional status is the medical outcomes survey short form 36 (MOS). Scores obtained from this instrument are known to vary with chronic diseases and depression. However, the degree to which these health dimensions may be influenced by sleep quality or sleepiness is not well understood. A cross-sectional study was performed on the association between general health status, as determined by the MOS, with sleepiness, assessed using a standardized questionnaire [the Epworth sleepiness scale (ESS)] and the multiple sleep latency test (MSLT). One hundred twenty-nine subjects (68 women), aged 25-65 years, without severe chronic medical or psychiatric illnesses, underwent an overnight sleep study, followed by an MSLT (consisting of a series of four attempts at napping at 2-hour intervals), and completed the MOS and the ESS. The mean MSLT score was 11 +/- 2 minutes, (range 2-20) and the mean ESS score was 10 +/- 5 (range 0-24). Scores for the MOS dimensions "general health perceptions", "energy/fatigue", and "role limitations due to emotional problems" were correlated significantly with ESS scores (r = -0.30, -0.41, and -0.30, respectively; p values were all < 0.001). The MSLT was also significantly correlated with "energy/fatigue" (r = -0.19; p < 0.05). After considering the effects of chronic illness and/or body mass index in a multiple hierarchical regression analysis, sleepiness, as assessed by the ESS score, explained 8% of the variance in general health perceptions, 17% of the variance in energy/fatigue, 6% of the variance in the summary measure of well-being, and 3% of the variance in the summary measure of functional status. The variation of MOS scores with sleepiness, unrelated to age or chronic disease, suggests that measures of general health status may be broadly influenced by sleepiness and sleep quality. These data suggest that 1) sleepiness has an important impact on general health and functional status, specifically influencing self-perceptions regarding energy/fatigue; 2) a more specific assessment of sleepiness in general health evaluations may help explain some of the observed variability in these measures across subjects; and 3) general health measures may be useful in the evaluations of patients with sleep disorders.
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PMID:Relationship between sleepiness and general health status. 889 38


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