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

Previous research has documented high rates of major depression and antisocial personality in opiate addicts. This study was designed to investigate the relationship of dual diagnosis in opiate-addicted probands to family history of psychiatric disorders and substance use disorders in biological relatives. Psychiatric disorders and substance use disorders were evaluated using direct interview and family history in a sample of 877 first-degree relatives of 201 opiate addicts and 360 relatives of 82 normal controls. Results indicate that (1) compared with relatives of normal subjects, opiate addicts' relatives had substantially higher rates of alcoholism, drug abuse, depression, and antisocial personality; (2) relatives of depressed opiate-addicted probands had elevated rates of major depression and anxiety disorders but not of other disorders, suggesting the validity of subtyping opiate addicts by the presence or absence of major depression; and (3) in contrast, relatives of antisocial opiate addicts had rates of disorders that were not significantly different from those of relatives of opiate addicts without antisocial personality. Implications of these findings for the classification and treatment of substance abuse are discussed.
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PMID:Psychiatric disorders in relatives of probands with opiate addiction. 198 60

The purpose of this study was to determine whether mentally ill chemical abusers (MICA patients) report greater distress than do psychiatric patients who do not abuse psychoactive substances. Thirty-two MICA patients and 31 non-substance-abusing patients completed the SCL-90-R. Group comparisons indicated that MICA patients reported greater levels of somatization, depression, anxiety, obsessive-compulsiveness, paranoia, and psychotic symptoms. MICA patients also reported greater overall distress than did psychiatric patients without substance abuse problems.
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PMID:Psychiatric symptoms in mentally ill chemical abusers. 199 60

Depression and alcohol abuse have been associated with alterations in cell-mediated immune function. This study directly compared the effects of depression, alcoholism, and their joint contribution to reduce natural killer cell cytotoxicity. Natural killer cell activity was significantly lower in both depressed (n = 18) and alcoholic (n = 19) patients compared with control subjects (n = 50). In addition, patients with a dual diagnosis of either alcohol abuse and secondary depression (n = 9) or depression with a history of alcohol abuse (n = 26) demonstrated a further decrease in natural killer cell activity compared with that found in patients with either depression or alcoholism alone. While both depression and alcoholism are separately associated with a reduction of natural killer cell activity, subgroups of patients in whom the diagnoses of alcoholism and depression coexist show a further decrement in natural killer cell function.
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PMID:Major depressive disorder, alcoholism, and reduced natural killer cell cytotoxicity. Role of severity of depressive symptoms and alcohol consumption. 237 42

When alcohol abuse occurs with depression, both the substance abuse and the mood disorder necessitate treatment. These conditions may have some similar manifestations, making differential diagnosis difficult. Depressed alcoholics report more previous treatment for substance abuse, withdrawal symptoms, and marital problems than those without depression. They also incur greater loneliness, unemployment, and social ineptness. Depressive symptoms found commonly in this group include work inhibition, guilt, self-disgust, dissatisfaction, and social disinterest. A history of depression among relatives favors a dual diagnosis of alcoholism and depression. Distinguishing those alcoholics with specific depressive illness enhances the therapeutic efficacy. Alcohol abusers need treatment, but those with concomitant depression persisting well beyond detoxification often require antidepressant medications. In long-term care, lithium may reduce alcohol-related rehospitalizations. A strong doctor-patient relationship with or without pharmacotherapy promotes continuation in a therapeutic regimen. Involvement in Alcoholics Anonymous and disulfiram maintenance therapy are other deterrents to drinking relapse.
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PMID:Depression and alcoholism: clinical considerations in management. 305 16

Presented here is a model for the diagnosis and treatment of cocaine dependence. Intrinsic in the understanding of this model is the use of the disease concept of chemical dependence. Within the construct of this model we regard cocaine dependence or "cocainism" as a disease process and part of the spectrum of the disease of chemical dependence. We note that "pure" cocainism is rare and cocaine is usually just another chemical used in the polyaddicted patient. We call cocaine the "Great Precipitator" as it often brings the polyaddicted chemically-dependent person into a crisis that requires a treatment intervention. Cocainism, with its overwhelming compulsion and destruction, often precipitates a crisis in a matter of months from first use. As psychiatrists practicing addictionology, we understand the need to deal with cocainism as a primary disease process rather than a symptom of an underlying psychiatric illness. We deal with cocainism as we deal with alcoholism. While the DSM-III requires withdrawal and tolerance changes to be an essential feature for dependence, we more easily identify the disease of cocainism by its production of intense psychological addiction. Thereby the diagnosis of the disease of cocainism, as with other drugs (including alcohol) in the spectrum of chemical dependence, is characterized by the persistent, uncontrolled, compulsive use of cocaine. This illogical, irrational compulsion with continued, repeated use of cocaine as it destroys the individual's life, is the primary symptom of this disease. In regards to specific considerations, the psychiatric complications of cocainism, which can include cocaine induced psychosis, can persist beyond the intoxication period. We also note the depression that can accompany abstinence from cocaine and often has a protracted course following initial abstinence as well. We advocate the very cautious use of any psychotropic medications after an alloted period of time since we find that many of these additional symptoms seem to dissipate during the treatment process when involved in our suggested setting. In the cases of where it is determined that additional psychiatric illness co-exist with cocaine and chemical dependence such as in "dual diagnosis" patients, we have had that success by treating both illnesses concomitantly and aggressively. The "contract" with the dual diagnosis patient has afforded excellent results in this instance. The treatment modalities most effective in this model include a treatment team with its multidisciplinary and recovering and non-recovering characteristics, and the use of the group process and peer group therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Cocainism--a workable model for recovery. 387 Jul 54

Exploration of the neurochemistry of psychiatric and substance use disorders in dual diagnosis patients may help explain the greater than chance comorbidity of these disorders and lead to advances in treatment. This paper will focus on the hypothesized neurochemical changes associated with primary substance use disorders which might lead to secondary psychiatric disorders by mimicking the hypothesized neurochemical changes of primary psychiatric disorders. For example, hypothesized serotonergic deficits in alcoholism, endorphin deficits in opioid dependence, and dopamine depletion in cocaine dependence all might predispose to depression. A vicious cycle of cocaine dependence and depression and a vicious cycle of alcohol and drug dependence and panic anxiety are reviewed as models for hypothesized alcohol or drug withdrawal related neurochemical changes predisposing to continued chemical dependency. Exploration of the neurochemistry of dual diagnosis patients reinforces the need for treatment approaches that take into account both aspects of illness.
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PMID:Hypothesized neurochemical models for psychiatric syndromes in alcohol and drug dependence. 750 27

Patients with substance dependence and psychiatric symptoms often present a diagnostic conundrum because each of these problems may mutually and reciprocally complicate the other. This may challenge the ability to identify dual-diagnosis patients who have both a substance abuse disorder and a definitive symptom-based psychiatric disorder. The main purpose of this explorative study was to identify variables suggestive of dual diagnosis in the population of substance-dependent patients with psychiatric symptoms. A secondary purpose was to examine the subgroups in this population for their distinctiveness from one another. Based upon clinical experience and the literature, seven independent variables were hypothesized as suggestive of dual diagnosis. Seventy-nine patients with substance dependence and psychiatric symptoms of depression, anxiety, and/or psychosis were assessed for symptom and disorder status generating three subgroups: I) 20 patients with psychiatric symptoms not meeting thresholds for clinical significance; II) 36 patients exhibiting a psychiatric disorder (dual diagnosis); and III) 23 patients with psychiatric symptoms meeting thresholds for clinical significance but not for a disorder. Odds ratios were calculated to examine the risk for dual diagnosis using the seven independent variables. A persistent increased risk for dual diagnosis was observed in patients who were positive for the seven variables. The seven variables were combined into an overall measure of patients' risk for dual diagnosis. Mean scores were significantly different for the three groups F(2, 76) = 8.4, p < .001. This study indicates variables that may be suggestive of dual diagnosis and finds subgroup distinctiveness in this sample. Both of these findings have treatment implications.
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PMID:Diagnostic conundrums in substance abusers with psychiatric symptoms: variables suggestive of dual diagnosis. 783 76

Our study sought to demonstrate the importance of attending to methodological issues in the study of personality characteristics of offspring of substance abusers (OSAs). A 4 x 2 factorial design, Parental Mental Health (no known psychological problems, substance abuse, other psychological problems, or dual diagnosis) x Exposure to Abuse/Neglect (present or absent), was used to examine depression proneness, neuroticism, alexithymia, self-esteem, self-concept, and locus of control in young adults. Results of this study demonstrated that in order to determine whether characteristics of OSAs are uniquely related to parental substance abuse, a psychiatric control group is needed. Also, the importance of separating the influences of other family environment variables (e.g., exposure to abuse/neglect) was demonstrated. None of the differences between groups in this study could be attributed to parental substance abuse per se; rather, the concomitants of substance abuse (i.e., exposure to abuse/neglect) were found to be more strongly related to poorer adjustment in OSAs. Finally, it was shown that the proportion of treatment-seeking subjects included in the sample affected the level of pathology observed. These results are discussed in relation to previous findings, and recommendations regarding methodology are made for future studies.
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PMID:Personality characteristics of young adult offspring of substance abusers: a study highlighting methodological issues. 793 26

1. Military personnel exposed to war-zone trauma are at risk for developing PTSD. Those at greatest risk are those exposed to the highest levels of war-zone stress, those wounded in action, those incarcerated as prisoners of war, and those who manifest acute war-zone reactions, such as CSR. 2. In addition to problems directly attributable to PTSD symptoms per se, individuals with this disorder frequently suffer from other comorbid psychiatric disorders, such as depression, other anxiety disorders, and alcohol or substance abuse/dependence. The resulting constellation of psychiatric symptoms frequently impairs marital, vocational, and social function. 3. The likelihood of developing chronic PTSD depends on premilitary and postmilitary factors in addition to features of the trauma itself. Premilitary factors include negative environmental factors in childhood, economic deprivation, family psychiatric history, age of entry into the military, premilitary educational attainment, and personality characteristics. Postmilitary factors include social support and the veteran's coping skills. 4. Among American military personnel, there are three populations at risk for unique problems that may amplify the psychological impact of war-zone stress. They are women whose war-zone experiences may be complicated by sexual assault and harassment; nonwhite ethnic minority individuals whose premilitary, postmilitary, and military experience is affected by the many manifestations of racism; and those with war-related physical disabilities, whose PTSD and medical problems often exacerbate each other. 5. The longitudinal course of PTSD is quite variable. Some trauma survivors may achieve complete recovery, whereas others may develop a persistent mental disorder in which they are severely and chronically incapacitated. Other patterns include delayed, chronic, and intermittent PTSD. 6. Theoretically primary preventive measures might include prevention of war or screening out vulnerable military recruits. In practice, primary preventive measures have included psychoeducational and inoculation approaches. Secondary prevention has been attempted through critical incident stress debriefing administered according to the principles of proximity, immediacy, expectancy, and simplicity. Tertiary prevention has included psychotherapy, pharmacotherapy, dual diagnosis approaches, peer counseling, and inpatient treatment. Few treatments have been rigorously evaluated. 7. There are both theoretical reasons and empirical findings to suggest that military veterans with PTSD are at greater risk for more physical health problems, poorer health status, and more medical service usage. Much more research is needed on this matter. 8. Despite the potential adverse impact of war-zone exposure on mental and physical health, there is also evidence that trauma can sometimes have salutary effects on personality and overall function.
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PMID:Post-traumatic stress disorder in the military veteran. 793 58

The relationship between aggression and depression was evaluated for 528 adults, adolescents and children, who were rated on either the adult or child versions of the Reiss instruments for dual diagnosis (Reiss 1988; Reiss & Valenti-Hein 1990). Criterion levels of depression were evident in about four times as many aggressive as nonaggressive subjects. Anger was significantly associated with both aggression and depression. Although anger may play a mediational role in the correlation between aggression and depression, in this study there was a significant correlation even after the effects of anger were held constant. The findings provide an initial step toward improving diagnostic specificity when evaluating aggressive behaviour in people with mental retardation.
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PMID:Joint occurrence of depression and aggression in children and adults with mental retardation. 833 20


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