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

Efficacy of a total smoking ban on an inpatient drug and alcohol rehab program was assessed by urine cotinine levels and indicated a continued smoking rate of 70%. In spite of these results, however, some staff were concerned that removal of the smoking ban would lead to a dramatic increase in patients' smoking. However, other staff were concerned over the apparent dishonesty undermining the objectives of the program. Therefore, a change in policy was initiated. Under this new approach, where smoking was no longer punished, cotinine levels were 60% positive. Although this was not a statistically significant reduction, it was clinically significant. Patients were openly encouraged to discuss their smoking, and therapies were designed to match patients' level of motivation. A significant reduction in number of cigarettes smoked (mean = 26 pretreatment, mean = 17 posttreatment; p < 0.01), increased interest to stop smoking (on a linear scale from 1 to 5, mean = 1.86 pretreatment and mean = 2.61 posttreatment; p < 0.01), and increased patient satisfaction was noted in a subsequent sample. Nonprohibitive counseling approaches were just as effective as prohibition of smoking. Change in smoking behavior and motivation were demonstrable with programming that emphasized behavior change and motivational counseling. Relationships between nicotine dependence, depression and other substance use disorders are discussed.
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PMID:Efficacy of smoking cessation strategies in a treatment program. 763 44

The recognition of depression was examined in 987 medical and surgical patients referred to a consultation-liaison psychiatry service. Overall concordance of recognition of depression by the referring doctor and diagnosis of depression by the consultant psychiatrist was 74%; 41% false-positive rate, 15% false-negative rate. Concordance was higher in the Renal Unit and lower in the General Medical Unit. Patients for whom there was discordance were significantly older than those for whom there was concordance. Patients referred for depression but not diagnosed as such by psychiatrists received DSM-III-R diagnoses of Organic Mental Disorder, Somatoform and Related Disorders, Psychoactive Substance Use Disorders and Personality Disorders. On the other hand, patients diagnosed as having depression but not referred as such were referred instead for ill-defined reasons (suspected psychological component to illness, coping problems), suicide risk evaluation and routine pre-operative or pre-dialysis assessment. The results highlight the continuing misdiagnosis of psychiatric disorders, especially Organic Mental Disorders, as well as the mislabelling of the syndrome described by psychiatrists as depression. This is part of the wider problem of defining the boundaries of a clinical depressive syndrome in the physically ill.
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PMID:The recognition of depression in patients referred to a consultation-liaison service. 763 76

This is a clinical study of failed suicides, in order to contribute to the explanation of completed suicides. 423 suicidal patients were admitted to the emergency critical care unit of a metropolitan municipal hospital during 6 years. The catchment area of the unit is the east four wards of Tokyo. Almost all patients who attempted suicide and four who later on completed suicide were interviewed by consultating psychiatrists. The total number of cases thus investigated was 265. Medical and psychiatric charts were retrospectively evaluated for the study. According to the lethality of respective suicidal methods, the 265 cases were divided to the ABSOLUTELY DANGEROUS GROUP (133 patients) and the RELATIVELY DANGEROUS GROUP (132 patients). The former, except for the few patients who later on died, could be considered as "failed suicides"; 75% of these patients were mentally disordered (psychoses, depressive disorders or psychoactive substance use disorders), whereas in the latter group the respective figure was 48%. The rates of each disorder were different in the age classes: younger (below 30), middle aged (30-49), and older (50 and over). In the younger group, psychoses (F2 cord of ICD-10 draft) were the main cause (52%). By contrast, endogenous major depression was the main cause in the older group (48%). The rate of psychoactive substance use disorders was highest (22%) in the middle aged among the three classes. There were 1562 officially recorded completed suicides in the catchment area during the same 6 years. From the distribution of diagnoses in each of the three age classes of the ABSOLUTELY DANGEROUS GROUP and the distribution of age classes in 1562 completed suicides, the rates of mental disorders amongst the completed suicides were estimated as roughly 26% psychoses, 46% depressive disorders and 18% substance use disorders. The total figure was 90% and quite similar to the results of previous studies by psychological autopsies in the western countries. For an attempt to decrease the rates of suicide, the most important point seems to be the prevention of suicides by the mentally disordered. Depression is most prevalent among elderly suicidal patients. In contrast to previous studies, the author found psychoses most often in younger patients. Psychotic symptoms of schizophrenic and of alcoholic suicidal patients were analysed in detail. None of them nor any other patient could be considered as a "rational suicide" case.
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PMID:[Mental disorder as a risk factor of suicide; a clinical study of failed suicides]. 793 8

The relationship between self-reported depression and a clinical diagnosis of depression was investigated. Within 2 weeks of completing the Center for Epidemiologic Studies Depression Scale (CES-D), a stratified sample of 425 primary medical care patients received the structured interview for the DSM-III-R. In the weighted data set, the CES-D was significantly related to a diagnosis of depression but also to other Axis I disorders. Most distressed subjects were not depressed, a fifth of the patients with major depressive disorder (MDD) had low distress, and the CES-D performed as well in detecting anxiety as in detecting depression. MDD, other depression diagnoses, and anxiety and substance use disorders were all significant predictors of CES-D score. Differences in demographic variables, treatment history, and impairment highlight the nonequivalence of the self-report scale and diagnosable depression. The use of a self-report in place of an interview-based diagnostic measure in the study of depression, as well as the use of such a report as a screening device, is discussed.
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PMID:The relationship of self-reported distress to depressive disorders and other psychopathology. 806 81

Demographic, clinical, and treatment episode characteristics of 3,087 American Indian veterans discharged from Department of Veterans Affairs hospitals in fiscal year 1991 were examined. Substance use disorders were diagnosed in 46.3 percent of discharged American Indians, compared with 23.4 percent of discharged veterans overall. More than 97 percent of American Indian substance use diagnoses were for alcohol dependence, while rates of other drug use disorders were low. Substance dependent American Indians were younger, and more likely to be male and unmarried, than nondependent American Indians. Psychiatric disorders, particularly personality disorders, depression, and posttraumatic stress disorders, were more prevalent among American Indians diagnosed with substance use disorders, than among nondependent American Indians. American Indians with substance use disorders were similar demographically to the general population of substance dependent veterans. Rates of diagnosed psychiatric disorders and drug dependencies other than alcohol were lower among American Indians receiving substance (alcohol or drug) use diagnoses than among the general population of substance dependent veterans. Rates of rehospitalization following discharge were higher in substance-abusing American Indian veterans than among their counterparts. Potential explanations for these findings are discussed.
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PMID:Substance dependent American Indian veterans: a national evaluation. 815 75

Recent studies of the effectiveness of specialized programs that treat substance use disorders in schizophrenia have obtained promising results but have not involved control groups. Interpretation of these apparently positive results is problematic because remission and relapse rates of substance use disorders have not been reported in this population. The present study reports 1-year rates of substance abuse and dependence remission and relapse in a sample of schizophrenics taken from the Epidemiologic Catchment Area study. Results indicated that the prevalence of substance use disorders in schizophrenia remained constant over the year primarily because rates of remission were balanced by rates of relapse. Individuals who developed abuse or dependence over the year were younger, male, and showed increases in depression and risk for hospitalization over the year. Individuals who remitted abuse or dependence were older, female, and showed decreases in depression over the year. Dual diagnosis treatment programs have recently reported higher rates of remission than were evidenced in this sample, thus providing preliminary support for the effectiveness of these treatments.
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PMID:Remission and relapse of substance use disorders in schizophrenia. Results from a one-year prospective study. 820 6

Depression and anxiety frequently coexist in patients with substance use disorders. This clinically-oriented article examines the relationship between these conditions and emphasizes data showing that substances of abuse can cause signs and symptoms of both depression and anxiety. These substance-related syndromes appear to have a different course and prognosis than uncomplicated, independent anxiety and major depressive disorders, and clinicians should consider the role of alcohol and other drugs in all patients presenting with these complaints. The authors also outline an approach for diagnosing and managing patients with the combination of a substance use and depressive or anxiety disorder.
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PMID:Affective and anxiety disorders and alcohol and drug dependence: diagnosis and treatment. 825 47

We contrasted the overall social functioning of pure dysthymics, double depressives, episodic major depressives and normal controls using both interview and self-report measures of social functioning and depression. In addition, we used hierarchical multiple regression to assess the differential impact of several variables (comorbid personality, anxiety and substance use disorders, life stress, duration of dysthymia and severity of depressive symptomatology) on social functioning in the dysthymics and double depressives. Participants included 41 outpatients with early-onset dysthymia alone, 56 outpatients with early-onset dysthymia and concurrent major depression, 45 outpatients with episodic major depression and 45 normal controls. All 3 patient groups were found to be significantly more impaired than normal controls in overall functioning, as well as in every specific role area. Double depression was found to be particularly impairing, both in overall functioning and in every specific role area. In dysthymic patients with and without concurrent major depression, current depressive symptomatology is the strongest predictor of impairment. Taken together, these data suggest that chronic, low-grade depressive symptoms and acute, moderate depressive symptoms have similar, significant and additive effects on social adjustment.
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PMID:Social adjustment in dysthymia, double depression and episodic major depression. 873 Oct 71

The distribution and correlates of hypomanic personality traits were examined in a representative sample of 1709 adolescents. Hypomanic traits were assessed with an abbreviated version of Eckblad and Chapman's (1986) Hypomanic Personality Scale. Hypomanic traits were normally distributed and were slightly but significantly higher among females. Test-retest stability over a mean 14-month interval was 0.54. High scores were associated with elevated lifetime rates of mood, disruptive behavior and substance use disorders. Among subjects with no history of mood disorder, hypomanic traits were associated with a broad range of indices of psychosocial dysfunction, both concurrently and at 1-year follow-up. In addition, hypomanic personality traits predicted increased levels of impairment in a number of areas, including depressive and internalizing symptomatology, over the course of the follow-up. Finally, among subjects with a past history of major depression, hypomanic traits were associated with a higher level of depression at the initial assessment, greater symptomatology and impairment during their worst episode, and higher rates of attempted suicide, comorbid disruptive behavior disorders and recurrent major depressive episodes.
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PMID:Hypomanic personality traits in a community sample of adolescents. 879 Nov 82

Associations between affective disorders, anxiety disorders, and substance use disorders were examined in epidemiological studies conducted in Germany, Switzerland, Puerto Rico, and the mainland US. There was a remarkable degree of similarity across studies in the magnitude and type of specific disorders associated with the affective disorders. Comorbidity with affective disorders was greater for the anxiety disorders than for substance misuse. Panic disorder was the subtype of anxiety that was most highly comorbid with depression. Social phobia was the specific phobic type with the strongest association with the affective disorders. The magnitude of associations between substance misuse and affective disorders generally was quite low and less consistent across sites. No major differences were found in the patterns of comorbidity by gender or age group, affective subtype or prevalence period. The onset of anxiety disorders generally preceded that of depression, whereas alcohol misuse was equally likely to pre-or post-date the onset of affective disorders. Finally, comorbidity was associated with an elevation in treatment rates across all sites, confirming Berkson's paradox on an international level.
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PMID:Comorbidity and boundaries of affective disorders with anxiety disorders and substance misuse: results of an international task force. 886 50


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