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

The psychopathology of stroke encompasses several psychiatric and behavioral disorders that have high prevalence in the geriatric population, reduce the patient autonomy and increase the caregiver's burden. These disorders are usually associated with other cognitive and neurological deficits, and are labelled as neuropsychiatric when the whole clinical picture is consistent with the specific dysfunction of a neural system or brain region. Thus the neuropsychiatry of stroke comprises disorders of the perception/identification of the self and the environment (anosognosia of hemiplegia, misidentification syndromes, confabulations, visual hallucinations, delirium and acute confusional state), amotivational syndromes (apathy and athymhormia), disorders of emotional reactivity (blunted affect, emotional incontinence, irritability, catastrophic reactions), poor impulse or ideation control (mania) and personality changes. The clinical profile of the subcortical vascular dementia also points to specific brain dysfunction (frontal-subcortical pathways) that manifests with behavioral (depression, emotionalism, irritability) and cognitive symptoms (psychomotor retardation, attention, executive and memory deficits). However, post-stroke depression and anxiety, which have a more variable clinical presentation and might be assimilated, for several aspects, to post-traumatic or adaptive disorders, are disorders less characterized in their neural correlates.
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PMID:[Psychopathology of stroke]. 1631 15

Suicide risk is thought to increase with a greater potential for activation of suicide-related schemas. Suicide schemas are less likely to be activated with reductions of emotional range associated with certain negative symptoms of schizophrenia. The study tested whether suicide risk would increase in patients with recent onset schizophrenia with increased potential for suicide schema activation as indicated by lower levels of specific negative symptoms that reflected emotional reactivity, namely emotional withdrawal and blunted affect. A logistic regression analysis of baseline data of 278 recent onset schizophrenic patients with a measure of suicide behaviour as the dependent variable and negative symptoms, delusions, hallucinations, depression, gender, episode, ethnicity, education, age, duration of untreated psychosis and substance use as independent variables was carried out. Emotional withdrawal, but not blunted affect was significant and negatively associated, and depression positively associated with suicide behaviour. There was evidence to indicate that restricted emotions are associated with reduced suicide risk as predicted.
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PMID:Suicide schema in schizophrenia: the effect of emotional reactivity, negative symptoms and schema elaboration. 1746 40

Research indicates that women with serious mental illness (SMI) are vulnerable to sexual abuse, resulting in adverse health outcomes such as posttraumatic stress disorder (PTSD). The purpose of this pilot study was to examine the prevalence of undiagnosed PTSD among a cohort of 20 women with SMI and reporting past sexual abuse. Furthermore, the researcher sought to identify specific symptom manifestations of PTSD among women with SMI and sexual abuse histories. Finally, the feasibility of using specific data collection tools was examined. Results indicated that PTSD was not previously diagnosed or recognized in the study sample, in spite of the presence of a sexual trauma history. The screening tools were effective in identifying depression, guilt, emotional withdrawal, blunted affect, decreased psychomotor activity, suicidal ideations, sexual dysfunction, and substance abuse. Additionally, the data collection tools provided a framework for discussing sensitive issues related to sexual abuse. Implications of this pilot study suggest the need to evaluate all women with SMI and history of sexual abuse for PTSD.
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PMID:Sexual abuse and posttraumatic stress disorder in adult women with severe mental illness: a pilot study. 2052 15

Negative symptoms that do not improve following antipsychotic treatment represent a challenge for development of effective treatments. Few studies have been carried out so far, especially in first-episode schizophrenia patients, to clarify prevalence, correlates and impact of persistent negative symptoms (PNS) on short- and long-term outcome of the disease. All patients from EUFEST study for whom both baseline and 12-month assessments were available were included (N=345). PNS were defined as the presence of at least one negative symptom of moderate or higher severity, not confounded by depression or parkinsonism, at baseline and after 1 year of treatment. Patients with PNS were compared to those with at least one negative symptom of moderate or higher severity at the baseline, not persisting after 1 year, on demographic, clinical, neurocognitive, global functioning and quality of life measures. PNS not confounded by depression or parkinsonism were present in 6.7% of the sample. The symptom that more often persisted was blunted affect. Patients with PNS differed from those without PNS for a longer duration of untreated psychosis (DUP) and a more frequent discontinuation of study treatment; they also had a poorer psychopathological outcome and a worse global functioning after 1 year of treatment. The presence of PNS was associated to poorer improvement of all psychopathological dimensions and worse global functioning after 1 year of treatment. The longer DUP in subjects with PNS suggests that programs aimed at shortening DUP might reduce the prevalence of PNS and improve prognosis of schizophrenia.
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PMID:Persistent negative symptoms in first episode patients with schizophrenia: results from the European First Episode Schizophrenia Trial. 2264 33

Our goal was to analyze the consistency of the symptomatic dimensions of schizophrenia over the course of our 20-year prospective study. We investigated a sample of patients diagnosed with Diagnostic and Statistical Manual of Mental Disorders Third version (DSM III) schizophrenia and later re-diagnosed with Diagnostic and Statistical Manual of Mental Disorders Fourth version (DSM IV) at four intervals: three, seven, twelve and twenty years from their first hospitalization. The severity of symptoms was assessed using expanded version of Brief Psychiatric Rating Scale (BPRS - E). Exploratory factor analyses and then confirmatory factor analyses were conducted. A four-factor structure was found, with positive, negative, depressive and excitement factors. In the confirmatory factor analysis, the only symptomatic dimension confirmed at all follow-ups was the negative factor (emotional withdrawal, motor retardation, blunted affect and conceptual disorganization) as derived from the 20-year follow up in exploratory factor analysis. The positive syndrome derived from the three-year follow-up (hostility, suspiciousness, unusual thought content and hallucinations) was confirmed at the seven- and 20-year follow-ups. In the depressive syndrome the model from the 12-year follow-up (guilt, depression, suicidality, anxiety and somatic concern) was confirmed for the follow-ups after seven and 20 years. As regards the excitement syndrome, we confirmed the model from the three-year follow-up (motor hyperactivity, elated mood, conceptual disorganization, excitement) at the follow-ups at seven and 12 years.
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PMID:Consistency of symptomatic dimensions of schizophrenia over 20 years. 2288 15

It is assumed that patients with psychosis have difficulties indicating clinical symptoms accurately in self-reported measures. The present study investigated the ability of self-rating scales to detect symptoms of depression in patients with psychosis and aimed at identifying demographic, clinical and neurocognitive factors that predict the discordance between self-ratings and observer ratings. Inpatients and outpatients with psychosis (n=118) were assessed for depression by applying two observer rating and two self-rating scales. We found reasonable correlation scores between the ratings by patients and observers (range: r=0.50-0.57). In half of the patients (49.2%) the self-ratings corresponded well with the ratings of clinicians. Patients who rated their depressive symptoms as less severe than the clinicians demonstrated more negative symptoms such as blunted affect and poor affective rapport. Patients who rated their depression symptoms as being more severe were characterized by more self-reported general psychopathology. The concordance rates indicate that self-ratings of depression can be a valid additional tool in clinical assessment of patients with psychosis. However, clinicians should be attentive to the fact that some patients might have a general tendency to over-report symptoms and that patients with negative symptoms tend to be rated as more depressed in observer ratings compared with self-assessments.
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PMID:The extent and origin of discordance between self- and observer-rated depression in patients with psychosis. 2306 95

This paper integrates personal narratives with the methods of phenomenology in order to draw some general conclusions about 'what it means' and 'what it feels like' to be depressed. The analysis has three parts. First, it explores the ways in which depression disrupts everyday experiences of spatial orientation and motility. This disruption makes it difficult for the person to move and perform basic functional tasks, resulting in a collapse or contraction of the life-world. Second, it illustrates how depression creates a situational atmosphere of emotional indifference that reduces the person's ability to qualitatively distinguish what matters in his or her life because nothing stands out as significant or important anymore. In this regard, depression is distinct from other feelings because it is not directed towards particular objects or situations but to the world as a whole. Finally, the paper examines how depression diminishes the possibility for 'self-creation' or 'self-making'. Restricted by the illness, depression becomes something of a destiny, preventing the person from being open and free to access a range of alternative self-interpretations, identities, and possible ways of being-in-the-world.
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PMID:Depression and embodiment: phenomenological reflections on motility, affectivity, and transcendence. 2337 90

Diminished expressivity is a poorly understood, but important construct for a range of mental diseases. In the present study, we employed computerized acoustic analysis of natural speech to understand diminished expressivity in patients with schizophrenia and mood disorders. We were interested in the degree to which speech characteristics tapping alogia (i.e., average pause duration) and blunted affect (i.e., prosody computed from fundamental frequency and intensity) reflected psychiatric symptoms (i.e., depression, anxiety, paranoia and bizarre behavior) versus neurocognitive deficits. Twenty-six subjects with schizophrenia and 22 subjects with mood disorders provided speech samples in response to a variety of laboratory stimuli and completed neuropsychological batteries assessing a range of abilities. For both the schizophrenia and mood disorder groups, attentional coding deficits were significantly correlated with increased pause time (at large effect size levels) and, for the schizophrenia group only, reduced prosody (also at a large effect size level). For the mood disorder but not the schizophrenia group, increased average pause time was also significantly associated with neurocognitive deficits on a range of other tests (medium to large effect size levels). Psychiatric symptoms were not significantly associated with speech characteristics for either group (generally, negligible effect sizes). These results suggest that there is a link between expressivity and neurocognitive dysfunctions for both patients with schizophrenia and mood disorders. Implications and future research directions are discussed.
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PMID:Psychiatric symptom versus neurocognitive correlates of diminished expressivity in schizophrenia and mood disorders. 2348 82

In the present randomized, controlled, double-blind trial (12 wk treatment plus double-blind extension for 12 wk), 25-50 mg/d agomelatine (n = 164) and 10-20 mg/d escitalopram (n = 160) were compared for short- and long-term efficacy, subjective sleep and tolerability. The effects of these drugs on emotional experiences were also compared in patients having completed the Oxford Questionnaire on the Emotional Side-Effects of Antidepressants (agomelatine: n = 25; escitalopram: n = 20). Agomelatine and escitalopram similarly improved depressive symptoms, with clinically relevant score changes over 12 and 24 wk and notable percentage of remitters (week 12: 60.9 and 54.4%; week 24: 69.6 and 63.1% respectively). Over the 12 and 24-wk treatment periods, the 'global satisfaction on sleep' scores increased in both treatment groups and did not differ between groups. Satisfaction with sleep-wake quality was high in both groups; the 'wellness feeling on waking' was more improved with agomelatine than with escitalopram (p = 0.02). In patients with pronounced sleep complaints, quality of sleep and feeling on waking were significantly more improved with agomelatine than with escitalopram (p = 0.016 and p = 0.009, respectively). Emotional blunting was less frequent on agomelatine than on escitalopram. Indeed, 28% of patients on agomelatine vs. 60% on escitalopram felt that their emotions lacked intensity and 16% of patients on agomelatine vs. 53% on escitalopram felt that things that they cared about before illness did not seem important any more (p = 0.024). The tolerability profile of agomelatine was found to be superior to that of escitalopram and the incidence of patients with at least one emergent adverse event leading to treatment discontinuation was lower in the agomelatine group than in the escitalopram group (5.5 vs. 10.6%). The findings suggest that agomelatine displays additional long-term clinical benefits on sleep-wake quality and emotional experiences over escitalopram in the management of depression.
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PMID:Efficacy of agomelatine and escitalopram on depression, subjective sleep and emotional experiences in patients with major depressive disorder: a 24-wk randomized, controlled, double-blind trial. 2382 99

Negative symptoms of schizophrenia include blunted affect, alogia, asociality, anhedonia, and avolition. Rating scales are helpful for recognizing and monitoring these symptoms, but clinicians must determine whether the symptoms are primary or secondary. Secondary negative symptoms can be caused by depression, psychotic symptoms, medication side effects, and substance abuse, and they usually improve with treatment of the underlying cause. On most rating scales, negative symptoms have been found to load onto 1 of 2 domains-apathy or diminished expression. This distinction may facilitate the development of new treatments.
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PMID:Recognizing primary vs secondary negative symptoms and apathy vs expression domains. 2481 10


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