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The extent of social dysfunctioning and its relationship to psychological disorders among Dutch primary care patients was examined. Social dysfunctioning in these patients was rather limited, but was more pronounced in patients with a psychological disorder than in those without. Disabilities were largely restricted to the occupational and social roles, with family role functioning and self-care relatively intact. Social dysfunctioning was moderately related to psychopathology, with higher levels of dysfunctioning in more severe and depressed cases. The extent of social dysfunctioning among patients with both anxiety and depression was similar to that of patients with a single diagnosis of depression. Depressed patients had a similar level of dysfunctioning to non-psychotic psychiatric out-patients. Analyses regarding the effects of diagnosis and severity on social dysfunctioning revealed considerable overlap between these two aspects of psychopathology. This study supports the need for a simultaneous but separate assessment of psychopathology and social dysfunctioning. However, future research should incorporate additional predictors of social dysfunctioning (e.g. personality, life events, long-term difficulties, physical disorders), and prospective studies should be conducted to clarify the temporal sequences of symptom severity, diagnosis, and comorbidity on the one hand, and social dysfunctioning on the other.
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PMID:The relationship between social dysfunctioning and psychopathology among primary care attenders. 835 97

Depression in the elderly may have many presentations. Skill is required in differentiating clinical depressive conditions from mild reactive states and senile dysphoria. Screening tests are available that may assist the doctor in the diagnosis of depression. One of these, the Geriatric Depression Scale (short form), is easily completed by patients (Table 3). Exclusion of organic causes of depression and sub-typing of the depression are the first steps. Correct matching of type of treatment--medication, electroconvulsive therapy, cognitive-behavioural therapy or other forms of therapy--to the type of depression usually leads to a good outcome. Extra caution is required in prescribing medications to older people because of altered pharmacokinetics and the frequent co-occurrence of physical disorders. For example, the use of tricyclic antidepressants is precluded by the presence of cardiac conduction abnormalities, urinary outflow problems, narrow angle glaucoma or postural hypotension and the subsequent risk of falls and fractures. Depression in the elderly carries a much greater risk of endogenous and psychotic sub-types and of suicide. The proportion of the population who are elderly is increasing. Depression in older persons is very common, may be difficult to diagnose, is treatable and has a prognosis similar to that of middle aged or younger patients. Doctors should think depression in older patients and bear in mind possible atypical presentations. When the correct diagnosis, usually possible by taking a careful history, is followed by correct treatment, the outcome can be very rewarding for patient and doctor.
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PMID:Think of depression--atypical presentations in the elderly. 837 8

Maternal and paternal depression, anxiety, and marital discord were investigated as predictors of depression, anxiety, and self-esteem in 54 children with congenital or acquired limb deficiencies. Higher paternal depression predicted higher child depression and higher anxiety. Higher paternal anxiety predicted higher child depression and anxiety and lower self-esteem. Higher marital discord predicted higher child depression and anxiety and lower self-esteem. Maternal depression and anxiety did not predict child psychological adaptation. Family support had a positive effect on child adaptation, as did parent, classmate, teacher, and friend social support. The findings are discussed in terms of the risk and protective effects of parental distress, marital discord, and social support on the psychological adaptation of children with visible chronic physical disorders. J Dev Behav Pediatr 14:13-20, 1993. Index terms: limb deficiencies, children, adjustment, social support, parental distress, family functioning, marital discord.
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PMID:Effects of parental adjustment on the adaptation of children with congenital or acquired limb deficiencies. 843 74

To find out whether long-term physical disorders in childhood increase the risk for mental disorder, we interviewed 407 young adults and compared their findings to a control group of 123 age-matched controls. The overall prevalence of mental disorders according to ICD-8 classification exceeded 20% in both groups. Depression and phobic disorders were the most common diagnostic syndromes, being most prevalent in women with motor handicaps or short stature. Only 7 patients had received psychotherapy, 5 for psychotic symptoms. In conclusion, only a severe physical disease, visible and disabling for years in everyday life, seems to increase the risk for mental problems. The results demonstrate the need to improve the approach towards psychological problems in the somatic clinics treating patients with long-term physical diseases.
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PMID:Prevalence of mental disorders in young adults with chronic physical diseases since childhood as identified by the Present State Examination and the CATEGO program. 848 44

Chronic pain complaints often reflect or are influenced by psychiatric factors. Physicians commonly encounter "illness-affirming behaviors" in which patient complaints or symptoms go beyond what should be expected from a specific disease process. In this paper, I describe common psychiatric conditions that often feature pain as part of the illness: somatization disorder, hypochondriasis, factitious physical disorders, pain associated with psychological factors (new DSM-IV nomenclature), and malingering. These conditions can be distinguished based on the conscious awareness (or lack of awareness) of both motivation and symptom production. Other psychiatric disorders may strongly influence chronic pain without directly causing it--depression, anxiety, panic, and post-traumatic stress disorders. Except for malingering and factitious pain, chronic pain should be regarded as genuine. Effective management requires psychiatric as well as biological considerations.
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PMID:Psychiatric aspects of chronic pain. 853 83

Depression is an emotion experienced by each individual as some point in his or her lifetime. For some, the feelings are temporary, such as when one feels momentarily let down. For others, the feelings are deeper and may last for longer periods of time. Deeper and longer lasting depression may occur when individuals are confronted by certain unfavourable types of life situations such as a major physiological loss. For a once healthy individual, the depression associated with a physiological loss has penetrated through the individual's prior coping process and defences. Depression is a particularly common problem in individuals with a medical illness (Cavanaugh 1983). Heart disease is often experienced as a major loss for patients. Reports of depression in patients with coronary artery disease have ranged from 18% to 60% (Clark 1990). A broad range of physical disorders are commonly associated with depression. Among the most prominent disorders is congestive heart failure (Buckwater & Babich 1990). For depressed congestive heart failure (CHF) patients, a critical care nurse needs to assess the factors contributing to depression and recognise behaviours reflective of depression to be able to make appropriate nursing diagnoses and devise a plan to manage the patient's depression. To help critical care nurses accomplish this goal, this article contains an examination of depression as it applies to CHF patients according to Beck's cognitive triad (Ulerman et al 1984).
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PMID:A cognitive model for assessing depression and providing nursing interventions in cardiac intensive care. 871 14

Significant gains both for the individual patient and for the community can be made by preventing relapse and new depressive episodes. The depth of depression and the presence of other psychiatric problems are the most significant determinants of the duration of a depressive episode. The number of previous depressive episodes and age at first depression are the most significant determinants of the risk of future depression. However, the presence of interpersonal and social problems, other psychiatric or physical disorders, and the type of depression (e.g. depression as one "pole' in a bipolar disorder, dysthymia) are also factors of importance. The aim of maintenance treatment (i.e., continued treatment after the patient's recovery) is to prevent recurrence of the depressive episode, whereas the purpose of preventive treatment is to impede the occurrence of new depressive episodes.
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PMID:[Long-term treatment and prevention of depression]. 896 5

The risk of depressive symptoms and disorders increases 2-3-fold after the age of 65. Research on the treatment of depression in the elderly is a new field of which our knowledge is still scanty. Patients over 75 years of age, patients with intercurrent physical disorders, and elderly patients with depression and concomitant organic brain disorders are seldom included in controlled clinical studies. Only by an active approach to treatment can depression-related mortality be reduced. The risk of death is three times greater in elderly patients with depression than in age-matched healthy controls, and not solely due to suicide. Both the risk of cardiac death and that of death following apoplexy are considerably increased in patients with depression.
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PMID:[Treatment of depression an the elderly]. 896 6

The number of patients treated with interferon (IFN) has increased markedly in Japan since 1992, when the Health and Welfare Ministry approved the use of IFN for treating chronic active hepatitis C. It is important to identify and treat depression, which is one of the psychiatric complications of IFN therapy and often leads to discontinuation of the therapy, in patients with chronic hepatitis C. In this study we prospectively investigated the incidence of depression during IFN therapy in patients with chronic active hepatitis C. The psychiatric status of 85 patients (53 men, 32 women; mean age 49.1 years) with chronic active hepatitis C who began receiving IFN at Showa University Hospital was assessed before and 2, 4, 12 and 24 weeks after the start of IFN therapy, using the major depressive episode diagnostic criteria listed in the DSM-III-R and the Hamilton Depression Scale HDS). All of the patients provided informed consent prior to participation in this study. IFN therapy was discontinued in 5 cases (5.9%) because of physical side effects and in 4 cases (4.7%) because of depression. Two, 11, 14, 25 and 16 patients were diagnosed as having major depressive episodes before and 2, 4, 12 and 24 weeks after the start of IFN therapy, respectively. The number of patients who were asymptomatic before the start of IFN therapy but were diagnosed as having a major depressive episode at least once during IFN therapy was 31 (31/83 = 37.3%). The mean HDS scores at 2, 4, 12 and 24 weeks (5.4, 6.0, 8.8 and 6.6) were significantly higher than that before the start of IFN therapy (3.0). The patients whose first diagnosed major depressive episodes occurred more than 4 weeks after the start of IFN therapy tended to be more severely depressed than those in whom it occurred less than 4 weeks after the start of IFN therapy. Compared to the 47 patients who completed 24 weeks of IFN therapy without experiencing depression, the 31 patients who were diagnosed as experiencing major depressive episodes during IFN therapy had significantly higher neuroticism scores determined using the Eysenck Personality Questionnaire, showed a more severely depressed mood and experienced more severe sleep disturbances before the start of IFN therapy. The latter group of patients also tended to have comorbid chronic physical disorders such as hypertension or diabetes mellitus and the histories of mental disorders before the IFN therapy; however these differences were not statistically significant. There were no differences between the two groups in patient age or sex, the severity of hepatitis before the IFN therapy, the type of IFN used in the therapy or the efficacy of IFN in the treatment of the hepatitis C. Our results indicate that the decision as to whether to treat chronic active hepatitis C with IFN should be made carefully and that early intervention and careful monitoring of depression are required during IFN therapy in the treatment of chronic active hepatitis C.
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PMID:[Depression during interferon therapy in chronic hepatitis C patients--a prospective study]. 913 11

The progressive aging of the population as a whole, the frequent appearance of degenerative diseases, and the greater frequency of suicide among persons older than 65 years than in younger age groups, are worrisome issues that deserve investigation. The aim of this study was therefore to analyze different epidemiological and social factors that influence suicide behaviour in elderly subjects in Madrid (Spain) during a 5-year period from January 1990 to December 1994. Post-mortem reports on all deaths that were examined at the Institute of Forensic Medicine in Madrid were studied. All cases of suicide in subjects aged > or = 65 years during these years (N = 461) were studied through the autopsy records and information from the coroner's inquest. Variables corresponding to demographic, clinical and interpersonal factors, method of suicide, scene of death, season, month and time of suicide were registered. In both sexes, jumping from a height was the most frequent method (63.6%). Family members had noted symptoms of depression in almost half of the cases (49.5%). Coexisting physical disorders were present in 68.9% of the subjects. Health care professionals have an important role to play in-suicide prevention.
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PMID:Epidemiology of suicide in elderly people in Madrid, Spain (1990-1994). 921 61


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