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Depression is a major affective disorder characterized by feelings of loss, worthlessness, fatigue, and a general decrease in interest in the usual activities of daily living. This complex disorder is the most common mental health problem in the United States, more common in women, adults over 60 years of age, and those of lower socioeconomic status. According to the DSM III, the major subclassifications related to depression are major depression and bipolar disorder. An integrated causation theory is useful in describing the etiology of this disorder. Generally, signs and symptoms involve changes in affect, cognition, behavior, and physical functioning. Depression may be treated with antidepressant psychotropic medications (tricyclics and MAO inhibitors), lithium carbonate (for bipolar disorder), electroconvulsive therapy, and a variety of psychotherapies. Careful monitoring of the drugs via blood level values must be ongoing. Nursing care of hospitalized depressed persons involves careful monitoring of clients' status and the effectiveness of treatments. Nursing care focuses on three areas of need. Immediate needs are those related to critical and safety issues. Short-term needs are concerned with identifying and reducing or eliminating obvious problem areas which hamper return to community living. Long-term needs are issues related to maintenance of persons in the least depressive state for as long as possible. To provide a sound basis for planning and implementing such care, nurses must understand the dynamics of depression, the issues which dictate selected treatment methods, and the issues which are likely to shape and change the treatment of depression in the future. Nursing must accept the responsibility of acting in a responsible, professional manner to ensure the best possible treatment for clients within the restraints imposed by policy decisions.
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PMID:Acute depression: treatment and nursing strategies for this affective disorder. 363 98

Depression has been reported to be common in patients with coronary artery disease (CAD), using a variety of criteria for the diagnosis of depression. However, many studies have relied solely on the presence of symptoms such as a dysphoric mood and fatigue in making a diagnosis of depression. Both fatigue and dysphoric mood are also associated with medical illnesses, and psychiatric diagnoses based on such nonspecific symptoms may lack the specificity necessary to predict the need for psychiatric treatment. To assess the incidence of depression likely to require and respond to psychiatric treatment, 50 patients documented to have CAD by coronary angiography underwent psychiatric diagnostic interviews. Current research-based criteria (DSM-III) were used to make diagnoses of major depressive disorder. In addition, the applicability of a brief screening inventory the (Beck depression inventory) for detecting the presence of depression in these patients was tested. Nine patients (18%) met criteria (DSM-III) for major depressive episode. Depression was not related to the extent of CAD, age or use of beta blockers. There was a relation between depression and smoking. Only 2 of the 9 depressed patients had been diagnosed previously and were being treated for depression. When a score of greater than or equal to 10 on the Beck depression inventory was used to distinguish patients with depression, it had moderate sensitivity (78%) and specificity (90%) for the identification of depression.
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PMID:Major depressive disorder in coronary artery disease. 368 79

Combat veterans (N = 25) with posttraumatic stress disorder had flashbacks related to their combat stressors, which included major losses and exposure to danger. Certain affects, loud noises, fatigue, and personal stress tended to precipitate flashback episodes. Flashbacks began a year or more after exposure to combat in 50% of patients; 56% of patients experienced daily flashbacks. Flashback phenomenology met DSM-III criteria for panic attacks. The similarity of flashbacks to panic attacks suggests treatment trials with monoamine oxidase inhibitors or imipramine for these selected symptoms.
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PMID:Combat-related flashbacks in posttraumatic stress disorder: phenomenology and similarity to panic attacks. 403 Jul 1

Increasing numbers of individuals with a diagnosis of cocaine abuse (DSM-III, 305.6) are seeking medical and psychiatric care. The majority of users inhale the drug in powdered form, as cocaine is rapidly absorbed by mucous membranes. The patterns of use resemble those for the use of alcohol and marijuana: recreational, intensified, circumstantial, and compulsive. When cocaine is taken intravenously or by freebasing, individuals are much more vulnerable to developing a compulsive pattern of use that could lead to an organic delusional syndrome. Cocaine causes systemic effects that are similar to those of amphetamine, but they have a much shorter duration of action. Blood pressure, heart rate, feelings of "pleasantness" and "stimulation" are increased, and hunger is decreased. Acute tolerance may develop over hours of continuous use, but it disappears after a short period of abstinence (overnight). In psychomotor testing, performance that is impaired by fatigue is restored to baseline levels. Users like cocaine because they feel more alert, energetic, sociable, and sensual. However, these positive feelings are commonly followed by anxiety, depression, irritability, fatigue, and craving more cocaine. Chronic intoxication is always associated with adverse psychosocial sequelae. Treatment initially must be directed toward the patient's stopping all use of cocaine, employing strategies such as contingency contracts, urinalysis, family intervention, the assignment of financial control to others, or hospitalization. Several psychopharmacologic agents are helpful as an adjunct to a comprehensive treatment plan. Overdoses of cocaine are treated by diazepam and propranolol. Antidepressant medications, both TCAs and MAOIs, often help relieve the symptoms of depression that emerge when chronic use of cocaine is discontinued. Classical and operant conditioning contribute to craving for the drug and opportunities to extinguish these factors are valuable in preventing relapse. Compulsive users often have an Axis II diagnosis of borderline or narcissistic personality disorder, which require long-term psychodynamic psychotherapy.
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PMID:Cocaine abuse and its treatment. 652 10

Organic brain syndromes constitute increasing public health, social and economic problems. In the diagnosis of organic brain syndrome no single symptom is pathognomonic. The core features of organic brain syndrome are disturbances in cognitive functions (memory, thinking, perception, and attention). The expression of emotions is altered, and alertness and vigilance are disturbed. The clinical picture is confused by compensatory, protective, and reactive symptoms. The most important psychopathogenetic mechanisms of organic brain syndrome are impaired cerebral function and the subjective meaning of the illness to the individual. According to American Psychiatric Association's classification (DSM-III), organic brain syndromes can be divided into seven purely descriptive clusters; subdivisions into psychotic and nonpsychotic syndromes and into acute and chronic brain syndromes have been omitted. The organic brain syndromes are delirium, dementia, amnestic syndrome, organic delusional syndrome, organic hallucinosis, organic affective syndrome and organic personality syndrome. The differential diagnostic aspects are discussed. Organic brain syndromes caused by industrial chemicals are nonspecific and multifactorial. When long term exposure to organic solvents occurs, the clinical picture is often characterized by tiredness and astheno-emotional or neurasthenic syndrome resembling neurotic states, depressive states, or presenile dementia.
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PMID:Organic brain syndromes from a psychiatric point of view: diagnostic and nosological aspects. 696 56

Questionnaires and clinician rating scales have been used to assess anxious and depressive symptoms among patients with panic disorder, but these methods do not usually evaluate symptoms in the same terms as the standardized criteria of diagnostic interviews. The present study provides data on the prevalence of symptoms of major depressive disorder and generalized anxiety disorder in 64 patients with panic disorder. Symptoms were assessed using DSM-III-R definitional criteria that consider not only the presence and severity of symptoms, but also their duration and pervasiveness. Depressive symptoms that most frequently met definitional criteria for diagnostic significance were fatigue, insomnia, and concentration difficulties. Over 50% of the sample endorsed feelings of tension, irritability, and restlessness. Disturbances in appetite, feelings of worthlessness, and suicidal ideation were found in less than 10% of the nondepressed panic patients. The implications of these findings for conceptualizing the comorbidity among anxiety and depressive disorders are discussed.
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PMID:Depression and generalized anxiety symptoms in panic disorder. Implications for comorbidity. 774 84

Medical patients' (75 with chronic fatigue complaints, 61 with dizziness, and 88 with disabling tinnitus; N = 224) current and past psychiatric diagnoses and personality characteristics were assessed to determine if they could independently explain the number of medically unexplained physical symptoms that the patients had experienced. Cloninger's Tridimensional Personality Questionnaire (TPQ) and the Diagnostic Interview Schedule based on DSM-III-R were used to assess the personality and psychiatric diagnoses, respectively. The results revealed that the number of lifetime medically unexplained symptoms were significantly, independently, and positively related to increasing numbers of current and past anxiety and depressive disorders and to the harm avoidance dimension of the TPQ. In a second analysis, the "worry/pessimism" and "impulsiveness" subscales were positively related to the number of medically unexplained symptoms. The results suggest that somatization is associated with current and past history of psychiatric illnesses and harm avoidance in this sample of medical patients.
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PMID:Severity of somatization and its relationship to psychiatric disorders and personality. 780 57

The psychopathological status of 25 inpatients suffering from clinically definite multiple sclerosis (MS) according to Poser criteria was assessed by using standardized methods (Structured Clinical Interview for DSM-III-R, Inpatient Multidimensional Psychiatric Scale, Hamilton and Montgomery-Asberg Depression Rating Scales and the Structured Interview for the Diagnosis of Alzheimer Dementia and Dementias of other Aetiology (SIDAM). Magnetic resonance (MRT) (0.5 T; T2-weighted sequence) of the brain was analysed by measuring the ventricular brain ration (VBR), the area of the corpus callosum (CC) and the extension of hyperintense lesions of the brainstem, the temporal lobes and the brain at all. Six of 25 (24%) of these moderately disabled patients (mean Extended Disability Score (EDSS) 3.3) were diagnosed to suffer from depressive mood disorder (major depression or dysthymia); 2 were demented. In correlation analysis, depression was unrelated to age, gender, duration of illness, status of disability (EDSS) or the results of cognitive assessment. No relationship between the depression scores and the different MRT measures could be identified. The presence or absence of gadolinium enhancement was also uncorrelated to depressive symptoms. Fatigue as measured by the Fatigue Severity Scale was unrelated to depression or subcortical brain atrophy (increased VBR) but significantly correlated to the area of hyperintense MRT changes in brainstem and midbrain. Cognitive impairment (decreased SIDAM scores) was correlated to the total area of hyperintense MRT changes of the brain parenchyma. The type of clinical course (relapsing-remitting vs chronic progredient) was not found to influence the affective or cognitive state in our MS patient's sample.
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PMID:Correlates of cognitive impairment and depressive mood disorder in multiple sclerosis. 817 61

506 patients with schizophrenia, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria, were included in a long term treatment programme with remoxipride, a selective dopamine (D2)-receptor antagonist. This overview includes pooled data from all patients who have been treated long term with remoxipride in clinical trials, focusing on patients treated for more than 6 months (n = 283). Remoxipride was administered in daily doses of 75 to 600mg. The assessment tools were Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI), Simpson and Angus scale, Abnormal Involuntary Movements Scale (AIMS) for abnormal involuntary movements, adverse events/symptoms using a 26-item checklist, clinical chemistry, and haematology and cardiovascular investigations. The majority of patients had a long duration of illness (median 11 years). 67% of patients (340/506) withdrew from treatment before 12 months and 44% (223/506) stopped treatment before 6 months. The median BPRS total score decreased during the first 3 months from 23 to 12, and this level of improvement was maintained throughout the 12-month period. Treatment-emergent adverse events reported by more than 5% of the patients were insomnia, tiredness, drowsiness and tremor in the group treated for 6 to 12 months. No symptoms, including checklist extrapyramidal symptoms (EPS), were reported by more than 5% of patients treated for 12 months. Low frequencies of EPS according to the Simpson and Angus scale were seen in patients treated for more than 6 months (n = 147). A small but statistically significant reduction of the mean total AIMS score from baseline to last rating was observed. There were infrequent changes in heart rate, resting diastolic blood pressure and electrocardiogram (ECG). Clinical chemistry and haematology data showed no evidence of clinically significant changes over time during the 12 months of treatment. Among 506 patients, 7 suicides and 7 suicide attempts occurred during the study period. Other serious adverse events were abnormal liver function test (2 cases), gastrointestinal, urinary retention, status epilepticus (psychotic polydipsia), granulocytopenia (1 each) and myocardial infarction (5 cases). Remoxipride is of potential value as a drug which is both effective and well tolerated in the long term management of patients with schizophrenia.
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PMID:Tolerability of remoxipride in the long term treatment of schizophrenia. An overview. 832 49

Performance on tests of memory in 39 patients who met Center for Disease Control (CDC) criteria for chronic fatigue immune dysfunction syndrome (CFIDS) was compared with 23 depressed patients (DSM-III-R) and 129 healthy controls. Although the CFIDS patients had normal neuropsychological profiles, they significantly overestimated their ability (metamemory), performed significantly worse on tests of recall as context increased (e.g., recognition), made more errors when rehearsal was prevented, and had delayed mental scanning as memory load increased. The overall pattern indicated that CFIDS patients had a significant memory deficit, far worse than implied by CDC criteria. The pattern for CFIDS patients was consistent with temporal-limbic dysfunction and significantly different than depressed patients and control subjects.
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PMID:Memory deficits associated with chronic fatigue immune dysfunction syndrome. 832 93


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