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

A naturalistic study with no predetermined duration of treatment was undertaken in order to examine the effectiveness of cognitive therapy in the treatment of panic disorder. Seventeen patients diagnosed as having panic disorder according to the Structured Clinical Interview for DSM-III Personality Disorders received a mean of 18 individual cognitive therapy sessions. Patients with personality disorder or depression required a longer duration of treatment to become symptom-free. As measured by a self-report weekly panic log, the mean number of panic attacks was reduced significantly to zero at the end of treatment. There was a concomitant reduction in self-report measures of depression and anxiety. Further, there was a significant reduction on a measure of cognitive dysfunction during panic attacks. Treatment results were maintained at 12-month follow-up.
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PMID:Cognitive therapy of panic disorder. A nonpharmacological alternative. 259 60

This brief report provides additional data indicating that the depressed state may lead to a significant increase in the frequency of diagnosis of personality disorder, and that the assessment of personality disorder should be delayed until successful treatment of an acute depression.
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PMID:Personality and depression: a further evaluation. 263 25

The question of which psychotropic medications are safe during pregnancy is likely to remain unanswered for many years to come. There are ethical limitations to performing the type of prospective controlled studies required to answer a scientific question of this type definitively. At the present time, in all patients with worsening psychiatric illness during pregnancy, be it in the schizophrenic, affective, anxiety disorder, or personality disorder spectrum, outpatient psychotherapy, hospitalization, and milieu therapy should be attempted prior to the routine use of psychotropic medication. Prior to pregnancy, withdrawal of psychotropic medications should be attempted under close supervision. Situations will arise in which hospitalization is not sufficient to avert psychotic decompensation. In both schizophrenic illnesses and acute mania, neuroleptics should be used, especially in the first trimester in preference to lithium. The use of high-potency neuroleptics appears preferable to low-potency agents as the first line of therapy, although subsequent management decisions will depend on ability to control side effects. In depression, TCAs should be used in cases of suicidality or incapacitating vegetative signs after the first trimester if supportive measures fail. There appears to be no rationale for withdrawal of TCAs prior to labor. In the third trimester, use of TCAs, low-potency neuroleptics, or lithium should be accompanied by obstetrical surveillance. In severe anxiety or insomnia following the first trimester, the occasional use of benzodiazepines may be warranted except during labor and the first week postpartum. The chronic use of benzodiazepines during any phase of pregnancy and in breastfeeding women is contraindicated. The importance of close rapport between the treating physician and the pregnant or breastfeeding patient cannot be overstated and will obviate or decrease reliance on psychotropic medication in many cases.
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PMID:The use of psychotropic agents in pregnancy and lactation. 265 14

In planning psychopharmacologic treatment of patients with borderline personality disorder (BPD), three partially validated subtypes should be considered. The validity of the schizotypal subtype is supported by their favorable response to neuroleptics as well as by familial and genetic studies. The validity of emotionally unstable character disorder (EUCD) is supported by the presence of neurological soft signs, their negative response to antidepressants, and their positive response to chlorpromazine and lithium. The data presented in this paper suggest that some patients who meet borderline criteria and have atypical depression (patients meeting DSM-III-R criteria for major depression or dysthymia who have reactive mood and any atypical symptoms) clearly benefit from treatment with antidepressant medication. Although some patients with atypical depression who meet borderline criteria will improve with tricyclic therapy, a significantly greater proportion will improve with the monoamine oxidase inhibitor (MAOI), phenelzine.
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PMID:Phenelzine, imipramine, and placebo in borderline patients meeting criteria for atypical depression. 269 83

Studies of suicide intent have found a link between seriousness of the attempt and personality. Following a parasuicide, 60 patients were assessed using measures of depression, suicide intent and personality. Personality disorder was found to be present in over 65% of these and was mainly of explosive type. It was significantly more common in men than women and the dimension measuring sociopathy was equivocally linked to male gender. There were no other associations between gender and the other dimensions measured. Using a categorical approach to personality, suicide intent was not significantly different between the categories of personality; there was no correlation between dimensional or categorical measures of personality and suicide intent, when the severity of depression was controlled. By itself personality did not contribute significantly in determining variance in intent but it did interact significantly with age.
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PMID:Personality disorder and suicide intent. 271 57

A consecutive sample of 298 nonpsychotic psychiatric outpatients was classified according to DSM-III and divided into 4 diagnostic groups: pure major depression, mixed major depression/panic disorder, pure panic disorder and a remaining group of other disorders. The patients' report of childhood relationship to parents and siblings, family atmosphere, their own personality characteristics as children and precipitating events were compared in the various groups. In addition, differences in personality and frequencies of personality disorders were investigated by means of various instruments. Our results show that the type of relationship to parents in childhood differed in the various groups. The mother seems to be the most crucial person for the development of depression, the father for the development of panic disorder. Patients with major depression are more obsessive and patients with panic disorder more infantile and avoidant with less control of their personality. Finally, patients with mixed conditions are more in accordance with the DSM-III anxious personality disorder cluster.
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PMID:Clinical differentiation between major depression only, major depression with panic disorder and panic disorder only. Childhood, personality and personality disorder. 273 8

Dysfunction of the central serotonergic system has been variously associated with depression and with suicidal and/or impulsive aggressive behavior. To evaluate central serotonergic function in relation to these variables, prolactin responses to a single-dose challenge with fenfluramine hydrochloride (60 mg orally), a serotonin releasing/uptake-inhibiting agent, were examined in 45 male patients with clearly defined major affective (n = 25) and/or personality disorder (n = 20) and in 18 normal male control patients. Prolactin responses to fenfluramine among all patients were reduced compared with responses of controls. Reduced prolactin responses to fenfluramine were correlated with history of suicide attempt in all patients but with clinician and self-reported ratings of impulsive aggression in patients with personality disorder only; there was no correlation with depression. These results suggest that reduced central serotonergic function is present in a subgroup of patients with major affective and/or personality disorder and is associated with history of suicide attempt in patients with either disorder, but with impulsive aggression in patients with personality disorder only.
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PMID:Serotonergic studies in patients with affective and personality disorders. Correlates with suicidal and impulsive aggressive behavior. 273 12

In a group of 111 students with depressive disorders, 70% presented a concurrent personality disorder and nearly 15% had prominent personality traits. The unstable, obsessive, hysteric and dysthymic types of personality disorders were relatively more frequent, the higher percent of cases (27.3%) being included in the mixed subgroup of these disorders. The patients with personality disorders had: an earlier age of affective illness onset, a more marked depression severity, a higher frequency of recurrent and nonreactive depression forms. Nonbipolar major depressive disorders were associated with the presence of unstable and dysthymic types of personality disorders, while minor depressive disorders were related with hysteric, asthenic and mixed ones.
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PMID:Personality disorders in students with depressive pathology. 274 Aug 1

This retrospective study examined the clinical characteristics and the course of 26 patients with major affective disorders who repeatedly relapsed during or shortly after antidepressant tapering off at the usual 6-12-month intervals. The patients apparently required long-term antidepressant continuation therapy not preventive therapy, as they were unable to be successfully tapered off antidepressants over a mean of 36.6 months. In contrast with a group of 15 randomly selected patients with a more typical recurrent course of illness and successful tapers after 6-12 months of treatment, the long-term continuation therapy patients were younger, had a longer duration of depression before entering treatment, and were more likely to meet the DSM-III criteria for concomitant dysthymic, panic, or personality disorder or major depression with psychotic features. The findings suggest that secondary Axis I and Axis II diagnoses in antidepressant-responsive depressed patients are associated with the need for long-term continuation treatment.
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PMID:Long-term continuation antidepressant treatment: a comparison study. 276

Neurasthenia is one of the commonest diagnostic terms in psychiatric practice in China, but it is employed less and less by psychiatrists in the Western world. In order to investigate what diagnoses would be given in terms of modern Western standard diagnostic systems, 40 patients who were diagnosed as suffering from neurasthenia by two Chinese psychiatrists were rediagnosed according to ICD-9 descriptive criteria, using the Catego computerized system based upon PSE findings and DSM-III criteria based on findings of the Diagnostic Interview Schedule (DIS). Furthermore a set of self-report or observer rating scales, including the SAS, SDS, HAMA, HAMD and BPRS, were administered to evaluate their psychopathological characteristics. The main findings are the following: (1) the distribution of the results of rediagnosis is widely dispersed from mild character disorder to severe affective disorder; (2) most of these patients are diagnosed as having an anxiety or depressive illness in different diagnostic systems; (3) the majority of diagnoses belong to the field of neurosis in all systems except DIS/DSM-III; (4) there is a group of patients who do not belong to any diagnostic entity in these systems; (5) the prominent psychopathological features are anxiety and depression and often a combination of both, which adds to the complexity of the clinical picture; and (6) these patients tend to over-report their suffering or symptoms, which results in a discrepancy of findings between objective assessment and self-reporting. The author suggests that the term neurasthenia represents a disease spectrum and should be refined in future study, but that it seems too early to discard it from psychiatric nosology.
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PMID:The diagnosis and phenomenology of neurasthenia. A Shanghai study. 276 91


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