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

This paper reports on the results of a pilot study comparing the efficacy of an experimental case review program between psychiatrists and primary care physicians (PCPs) with PCPs' usual care on the outcome of depressive disorders at 1-year. The secondary aim of the paper is to identify correlates of remission of depressive disorders at the 1-year follow-up. The experimental case review program consisted of 12 biweekly meetings of primary care physicians with a psychiatrist. Meetings lasted two hours and were based on review of cases identified at the interview as suffering from full-blown or subthreshold conditions. Subjects were assessed at baseline, 3 months and 1 year. The baseline assessment included the Composite International Diagnostic Interview, the Hamilton Depression (HDRS) and Anxiety (HARS) Rating Scales, the Medical Outcomes Study SF-36 and some forms to collect life events, major difficulties, social support, and ongoing treatments. At 3 months patients received by mail the General Health Questionnaire (GHQ-12) and at one year the baseline clinical assessment was replicated. Assessments were conducted on eighty cases with major, minor or subsyndromal depression (SSD). The experimental case review program was similar in efficacy to usual care, with an average reduction of 5.5 points on the HAMD. Significant reduction in the severity of depression was associated with a limited number of baseline characteristics, such as being married and having minor depression as compared to major depression and SSD. On the contrary, chronic physical illness at baseline predicted a lower reduction of HAMD scores at one year. While major difficulties and life events during the one-year interval between the two assessments significantly predicted a poorer outcome, social support at home was related to a better outcome. This pilot study indicates that a case review intervention program is not efficacious in a mixed sample of patients with subsyndromal to major depression representative of the current practice of primary case physicians. Still, it might be worthwhile for "difficult" patients selected by the PCPs. In our sample, psychosocial factors seem to be important predictors of outcome. Future trials and large naturalistic studies are needed to address this key point.
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PMID:Case review vs. usual care in primary care patients with depression: a pilot study. 1186 40

Traditional theories about grief and bereavement have been fundamentally and thoroughly challenged, primarily by Stroebe and Stroebe (1987), Wortman and Silver (1989), and Bonanno and Kaltman, (1999). In contrast to the old grief work perspective with its working through, depression, social disclosure of distress, and termination of the relationship to the dead, a completely different new perspective focusing on repression of depressive emotions and thoughts, display of positive emotions, moderate social disclosure, and continuation of the relationship to the dead has been proposed and scientifically supported. Still, the grief work perspective is very popular. In this article, both the old and the new views are challenged, and a more moderate perspective is suggested. Rational and irrational reasons for the old perspective's popularity are suggested. Consequences for therapeutic work (psychotherapy, counseling, nursing) are outlined. Finally, it is underlined that grief may be a meaningful, enrichening experience.
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PMID:"It ain't necessarily so"... Challenging mainstream thinking about bereavement. 1196 13

Mothers' representations of their infants may influence early development of emotional self-regulation. This study examined the associations between characteristics of mothers' (N = 100) narratives about their 7-month-old infants, maternal depression, and their infants' affect regulation during the Still Face procedure. Findings showed that (1) mothers' representations were linked with individual differences in their infants' behavior across the Still Face procedure, (2) the association between mothers' representations and their infants' behavior was mediated by parenting behavior, and (3) mothers' representations explained unique variance in their infants' affect regulation beyond the contribution of maternal depression. Although infants' displays of positive affect diminished while mothers held a still face, only infants of mothers in the balanced representation category returned to high levels of positive affect upon resuming interaction. These findings highlight the role of maternal representations in the process by which dyads repair temporary disruptions in interaction, as well as individual differences in infants' and mothers' responses to the Still Face.
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PMID:Maternal representations of the infant: associations with infant response to the still face. 1214 51

Racial variations in the use of effective medical care and subsequent clinical outcomes have been identified for many medical conditions. Still, it is unclear whether racial variations in care and clinical outcomes exist for depressed primary care patients. Primary care patients presenting for routine treatment were screened for major depression as part of a study to disseminate a depression treatment guideline. Primary care physicians (PCPs) were informed of their patients' depression via an electronic medical record system and asked whether they agreed with the diagnosis. Treatment patterns and depressive symptoms over the following six-months were assessed by chart review and the Hamilton Rating Scale for Depression, respectively. Over a 20-month period, 8,944 African-American and Caucasian patients aged 18-64 were approached for screening. African-Americans were less likely to agree to undergo screening than Caucasians (83% vs. 88%; P<.0001), but those doing so were more likely to report mood symptoms (26% vs. 15%; P<.001). 204 patients, including 52 African-Americans (25%), met protocol-eligibility criteria and completed a baseline interview. Baseline sociodemographic and clinical characteristics, and PCPs' agreement rate with the depression diagnosis were similar. Although PCPs were less likely to counsel their African-American than Caucasian patients for depression (P=.03), this difference resolved after adjusting for education level, employment, and insurance status and we found no other variations in the depression care provided or in clinical outcomes by race. We found little racial variation in either process measures or clinical outcomes for depression in our sample of African-American and Caucasian primary care patients.
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PMID:Race, quality of depression care, and recovery from major depression in a primary care setting. 1249 Mar 39

Despite the fact that most researchers acknowledge the high prevalence of comorbid substance abuse among schizophrenic patients, there is no common agreement regarding the etiology of this serious public health problem. At the center of this debate though, Khantzian's self-medication hypothesis has captured most of the attention. In the present literature review, the authors evaluate this hypothesis in the light of our current knowledge. Formulated in a clinical context, in reaction to the psychoanalytic interpretation of addiction as a pleasure seeking pathology, Khantzian's hypothesis holds that schizophrenic patients use psychoactive substances to relieve their symptoms. Properly understood, this conjecture presupposes that, with the relief of certain target symptoms, substance use would no more be a necessity. But in reality, the use of psychoactive substances usually leads to a general deterioration of the patients' condition. Pharmacodependent schizophrenic patients relapse more often, they are more frequently hospitalized, they show more violent behaviors, and they are more frequently homeless. In particular, the positive symptoms of these patients are generally exacerbated by the psychoactive drugs--with the possible exception of opiates. This observation is in lign with the fact that psychostimulants (cocaine, amphetamines), anesthesic dissociatives (PCP, ketamine) as well as hallucinogens (cannabis, LSD) are all known to exert psychotomimetic effects. As for negative symptoms, the reality is more complex. Preliminary results certainly suggest that stimulants (minor or major) relieve these symptoms, but in the case of the other psychoactive substances, empirical evidence remains fragmentary. Still, the properties of psychoactive substances invite to pay close attention, among the negative symptoms, to the cognitive deficits, the social inaptitudes and the hedonic deficits of these patients. Unsatisfied with the self-medication hypothesis, an increasing number of researchers hypothesize that schizophrenic patients abuse drugs in hope to relieve the negative affects (stress, depression) that commonly accompany their symptomatology. Interestingly, increasing data link these negative manifestations and substance abuse among schizophrenic patients. But these same data do not elucidate whether these manifestations are primary or secondary to drug abuse. For the moment, these findings must be replicated. Furthermore, it remains to be clarified what negative affect is involved here. Is it stress, anxiety or, as commonly thought, depression? Other paths aim in the direction of personality traits and dissociation. The first path is suggested by recent studies demonstrating that pharmacodependent schizophrenic patients differ from non-abusing schizophrenics in that their personality is characterized by traits such as sensation seeking and impulsivity. As for the second path, it is suggested by a recurrent observation in addictive medicine practice, that is: alcohol, cannabis, ketamine, LSD, opiates, PCP, all these substances can induce dissociative states (depersonalization, derealization, etc.). Surprisingly, most of the hypotheses advanced so far have been formulated without reference to neuroscience. However, from a biological perspective, substance abuse among schizophrenic patients appears paradoxical: while the positive symptoms of schizophrenia might involve an hyperactivity of the reward system, the drugs of abuse all seem to increase dopamine release in that same system. That very paradox further casts some doubt on the self-medication hypothesis. And it opens an alternative: schizophrenic patients might be biologically vulnerable to the rewarding effects of drugs abuse. On the therapeutic level finally, the authors argue that polypharmacy medications such as clozapine and quetiapine, known to act on the reward system preferentially to the extrapyramidal system and known to dissociate fastly from the dopamine-D2 receptor, could simplify clinical intervention.
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PMID:[Schizophrenia and addiction: An evaluation of the self-medication hypothesis]. 1287 43

Anticholinergic syndrome may present with a wide variety of signs and symptoms. Central manifestations range from excitatory symptoms including delirium and agitation to central nervous system depression, stupor and coma. Anticholinergic syndrome was once a common phenomenon after general anesthesia because of the frequent administration of the anticholinergic agents atropine and scopolamine. Now that these agents are rarely administered, anesthesia-related anticholinergic syndrome is currently infrequently reported. Still, many prescription and over the counter medications as well as many anesthetic agents possess anticholinergic activity, and this diagnosis should be considered in patients with altered mental status following general anesthesia. We report a case of prolonged somnolence following general anesthesia for an MRI. A rapid improvement of mental status with physostigmine confirmed the diagnosis of anticholinergic syndrome. This case is unique in that anticholinergic syndrome-related respiratory depression was promptly reversed with physostigmine.
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PMID:Anticholinergic syndrome after anesthesia: a case report and review. 1499 67

Electroconvulsive therapy (ECT) has been used to treat patients for 60 years. It is a humane and effective treatment. It is now firmly established as an important and effective method of treating certain severe forms of depression. Still, very little is known about its mode of action. Research in the refinement of administration has reduced undesirable side effects. There are almost no absolute contraindications to its administration. Nurses are involved directly with patients before, during, and after treatment.
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PMID:Electroconvulsive therapy: present and future. 1520 91

Existing etiological and pathogenetical theories of schizophrenia have only been able to find support in some epidemiological, clinical, and pathophysiological facts. A selective literature review and synthesis is used to present a hypothesis that finds support in all facts and is contradicted by none. Heeled footwear began to be used more than a 1000 years ago, and led to the occurrence of the first cases of schizophrenia. Industrialization of shoe production increased schizophrenia prevalence. Mechanization of the production started in Massachusetts, spread from there to England and Germany, and then to the rest of Western Europe. A remarkable increase in schizophrenia prevalence followed the same pattern. In Baden in Germany the increasing stream of young patients more or less hastily progrediating to a severe state of cognitive impairment made it possible for Kraepelin to delineate dementia praecox as a nosological entity. The patients continued to use heeled shoes after they were admitted to the hospitals and the disease progrediated. High rates of schizophrenia are found among first-generation immigrants from regions with a warmer climate to regions with a colder climate, where the use of shoes is more common. Still higher rates among second-generation immigrants are caused by the use of shoes during the onset of walking at an age of about 11-12 months. Other findings point to the importance of this in the later development of schizophrenia. A child born in January-March begins to walk in December-March, when it's cold outside and the chances of going barefoot are smaller. They are also smaller in urban settings. During walking synchronised stimuli from mechanoreceptors in the lower extremities increase activity in cerebello-thalamo-cortico-cerebellar loops through their action on NMDA-receptors. Using heeled shoes leads to weaker stimulation of the loops. Reduced cortical activity changes dopaminergic function which involves the basal ganglia-thalamo-cortical-nigro-basal ganglia loops. Bicycle riding reduces depression in schizophrenia due to stronger stimulation by improved lengthening contractions of the triceps surae muscles. Electrode stimulation of cerebellar loops normally stimulated by mechanoreceptors in the lower extremities could improve functioning in schizophrenia. Cross-sectional prevalence studies of the association between the use of heeled footwear and schizophrenia should be made in immigrants from regions with a warmer climate or in groups of people who began to wear shoes at different ages.
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PMID:Is there an association between the use of heeled footwear and schizophrenia? 1532 26

It is unclear whether potential living kidney donors and the general public differ in attitudes and psychological characteristics. We performed a case-control study to explore differences in these groups using a standardized questionnaire (analyzed using conditional logistic regression). Strangers (N = 42) were more willing than controls (N = 126) to incur risks: 64% strangers versus 35% controls accepting >50% medical complications (MC) risk; 90% strangers versus 61% controls accepting >8 days hospitalization; 71% strangers versus 43% controls accepting >3 months unpaid; 55% strangers versus 16% controls accepting 100% kidney failure (KF) risk; 70% strangers versus 34% controls accepting < or =10% likelihood of successful transplant (all p < 0.01). Relatives (N = 251) were also more willing than controls (N = 251) to incur risks. Strangers were most willing to incur MC, KF and transplant failure. Groups did not differ in attitudes, depression or anxiety. Potential stranger and related donors are willing to undergo greater risks with donation than the general public, but do not differ in other attitudes, depression or anxiety. This should help reassure transplant centers and the public that both forms of live donation do not necessarily involve increased ethical risks of donor coercion or irrational thought processes. Still, careful attention to communication of all risks of donation is warranted.
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PMID:Attitudes, psychology, and risk taking of potential live kidney donors: strangers, relatives, and the general public. 1594 25

Depression is highly prevalent in children and adolescents. Psychodynamic therapies are only insufficiently evaluated in this field although many children and adolescents suffering from depression are treated using this approach. Therefore, the aim of our study was to evaluate the efficacy of psychodynamic short-term psychotherapy (PSTP) for the treatment of depression in children and adolescents. In a waiting-list controlled study, 20 children and adolescents fulfilling diagnosis of major depression or dysthymia were included. The treatment group received 25 sessions of psychodynamic psychotherapy. Main outcome criterion was the Impairment-Score for Children and Adolescents (IS-CA) as well as the Psychic and Social-Communicative Findings Sheet for Children and Adolescents (PSCFS-CA) and the Child Behavior Checklist (CBCL), which were assessed at the beginning and the end of treatment. The statistical and clinical significance of changes in these measures were evaluated. There was a significant advantage of the treatment group compared to the waiting group for the IS-CA. The effect size of the IS-CA total score was 1,3. In contrast to the treatment group, where 20% of the children showed clinically significant and reliable improvement, no subject in the waiting-list control group met this criterion. Comparable results were found for the PSCFS-CA and for the internalising score assessed with the CBCL. The results show that psychodynamic short-term psychotherapy (PSTP) is an effective treatment for depressed children and adolescents. Still, some of the children surely require more intensive treatment.
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PMID:[Efficacy of psychodynamic short-term psychotherapy for children and adolescents with depression]. 1618 May 27


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