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Depression is a common psychiatric disorder in children, adolescents, adults, and the elderly. Primary care physicians, not mental health professionals, treat the majority of patients with symptoms of depression. Persons who are depressed have feelings of sadness, loneliness, irritability, worthlessness, hopelessness, agitation, and guilt that may be accompanied by an array of physical symptoms. A diagnosis of major depression requires that symptoms be present for two weeks or longer. Identifying patients with depression can be difficult in busy primary care settings where time is limited, but certain depression screening measures may help physicians diagnose the disorder. Patients who score above the predetermined cut-off levels on the screening measures should be interviewed more specifically for a diagnosis of a depressive disorder and treated within the primary care physician's scope of practice or referred to a mental health subspecialist as clinically indicated. Targeted screening in high-risk patients such as those with chronic diseases, pain, unexplained symptoms, stressful home environments, or social isolation, and those who are postnatal or elderly may provide an alternative approach to identifying patients with depression.
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PMID:Screening for depression across the lifespan: a review of measures for use in primary care settings. 1235 21

To understand the factors associated with interest in assisted suicide among terminally ill patients, we surveyed 50 caregivers of decedent amyotrophic lateral sclerosis (ALS) patients from Oregon and Washington regarding perceptions of patients' interest in assisted suicide and their physical and emotional state in the last month of life. For 38 caregivers, we had baseline information from the patients themselves, gathered a median of 11 months before death, regarding depression, hopelessness, sense of burden, social support, quality of life, pain, and suffering. According to our respondents, one-third of ALS patients discussed wanting assisted suicide in the last month of life. Hopelessness and interest in assisted suicide at baseline predicted desire for assisted suicide later on. ALS patients who were interested in assisted suicide, compared to those who were not, had greater distress at being a burden to others and more insomnia, pain, and discomfort other than pain.
J Pain Symptom Manage 2002 Sep
PMID:Predictors and correlates of interest in assisted suicide in the final month of life among ALS patients in Oregon and Washington. 1245 12

Menstruation is a biological phenomenon that has been subject of myths and taboos within and among various cultures. These myths distort the reality surrounding menstruation and create ambivalent feelings about the value and usefulness of this function outside of its necessity as mean of reproduction. Thus studies concerning menstruation need to take into account cultural and psychosocial factors that define the meaning, values and behavior associated with this biological phenomenon. According to several studies, 70% of women experience psychological faintness during this menstrual phase, 40% of them have these symptoms at each menstruation and between 3 to 8% of them suffer severely reacquiring medical support. This entity called premenstrual dysphoric disorder is defined by the presence of several symptoms (distress, tension, irritability, moodiness.) with a significant impairment in work or social functioning beginning during the week before and ending within a few days after the onset of menses. Several studies conducted over the past few years suggested that selective serotonin reuptake inhibitors (SSRIs) and serotoninergic tricyclic drugs may be more effective than other types of antidepressants in treating PMS symptoms. Two protocols are proposed; a continuous treatment or intermittent use during few days during pre-menstrual and menstrual phase for several cycles. The objective of the current study was to evaluate the prevalence of a potential premenstrual dysphoric disorder (PMDD) during one menstrual cycle, in a representative sample of general population of Casablanca, according the DSM IV criteria. On the other hand, a questionnaire, available from the authors, was used to explore socio-demographic data. Among 618 women interviewed, 310 met the criteria of a potential PMDD (50.2%). The mean age of the population with PMDD was 32.2 8 years ranging from 20 to 50 years; 54.8% of them were married, 33.9% of them were single and 66.5% of them had between 1 to 4 children. Two third of them were without a professional activity. During this premenstrual phase the following symptoms were found among the whole sample: marked depressive mood, feeling of hopelessness, or self-depreciation thoughts (77.7%, n=241%); difficulty of concentration (65%, n=201); marked change in appetite, overeating or specific food craving (82.8%, n=256); marked affective lability, with sadness tearful and increased sensitivity to rejection (65.8%, n=204); hypersomnia or insomnia (59.7%, n=185); subjective sense of being overwhelmed or out of control (55.7%, n=172); lethargy, excessive fatigability (91.6%, n=283); physical symptoms including breast tenderness, swelling, headache, joint or muscular pain, and a sensation of bloating and weight gain (81.9%, n=253). The most severe symptoms were fatigue and irritability. On the other hand, 73.9% of the sample had a disturbance in their socio-professional lives as a consequence to the psychological disturbances. Half of these women consulted a physician, mostly a general practitioner. These data are in accordance with the literature, confirming that this disorder is common and has a bad impact on mental health and on quality of life of the women suffering from PMDD.
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PMID:[Assessment of premenstrual dysphoric disorder symptoms: population of women in Casablanca]. 1250 65

Epidemiological studies of suicide in the elderly indicate that, in the last few decades, there has been a relevant increase in suicide rates in old age in a number of Asian and Latin nations, with an almost parallel decrease in Anglo-Saxon counties. Mental disorders, particularly depression, physical illness, personality traits such as hostility, hopelessness, the inability to verbally express psychological pain and dependency on others, recent life events and losses are all factors that may contribute to suicide in later life. Compared with suicide in other age groups, mors voluntaris in late life is associated with the use of highly lethal methods, less ambivalence and impulsivity, and more determination and intent to die. Accordingly, elderly suicidal individuals are more likely than younger subjects to complete rather than attempt suicide. Some evidence suggests also that the characteristics of elderly individuals who attempt suicide may not overlap with those who complete suicide. Death thoughts and suicidal ideations are relatively rare among mentally healthy elderly adults, and are less predominant in this age bracket. However, whether elderly suicidal behaviour exists along a continuum, progressing in severity from death thoughts and suicidal ideation to suicide attempts and completed suicide, remains unclear. Assisted suicide and euthanasia in the elderly have been associated with the desire to escape chronic physical pain and suffering caused by terminal illness, and to relieve mental anguish and feelings of hopelessness, depression and extreme "tiredness of life." The role of the family and those treating chronically ill members is crucial in the final stages of life, particularly when autonomy and the ability of the elderly individual to make end-of-life decisions are compromised. The main aspects associated with these controversial phenomena, particularly from a transcultural perspective, are reviewed in this article.
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PMID:Suicide and euthanasia in late life. 1288 40

DEPRESSION IN THE ELDERLY SUBJECT: Depression is diagnosed to a varying extent in the elderly. In subjects with Alzheimer's disease, the most specific signs involve mood disorders, loss of energy, a feeling of hopelessness, and sometimes body discomfort or pain. DEFINITION OF APATHY: Apathy is defined as a loss of motivation, expressed by a loss of interest in activities, lack of productivity, loss of will and initiative, as well as limited affective response to positive or negative elements. TWO DIFFERENT SYNDROMES: The differential diagnosis is difficult, but studies have demonstrated that depression and apathy are two relatively different syndromes, which may be intertwined. Lack of volition and initiative are suggestive of apathy. Neuropsychology, particularly the capacity to divide attention, may be useful. FUNCTIONAL CONSEQUENCES: Apathy and depression both have functional effects which may accelerate institutionalization (altered capacity for initiative, adaptation to the environment). FUNCTIONAL ANATOMY AND NEUROCHEMICAL CONSEQUENCES: Apathy and to a lesser degree depression, involve prefrontal cortical areas. Involvement of the prefrontal pathways is a common feature of apathy and depression, but the other pathways are affected specifically. Cholinesterase inhibitors and selective serotonine reuptake inhibitors as well as serotoninergic antidepressants have been found to be effective for certain components of apathy.
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PMID:[Depression and apathy in Alzheimer's disease]. 1294 3

In this paper, an extraordinary mother-son relationship involving 46 year-old, married, male patient with three children is discussed. He had never had any psychiatric complaint until his mother's death. However, he developed severe depressive and somatic symptoms following his 80 year-old mother's death. He showed no significant improvement after previous outpatient treatments and was admitted to the Psychiatric Department of Ege University School of Medicine with complaints of tension, insomnia, fatigue, anhedonia, hopelessness and pain all over his body. It was discovered that this man, who was loved and respected by both his family and his peers, used to suck his mother's breast twice daily. This act was no secret and was not considered a reason for seeking psychiatric help, a symptom of a disorder, or a source of distress for the son, mother, or any other family member. A phenomenon like this has never been reported in the literature before. We discuss this phenomenon through the dynamic formulation of the case using data from his psychiatric and developmental history as well as direct observation and psychological tests.
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PMID:[Forty-six year old baby]. 1456 74

Desire for death when expressed by patients is extremely demanding to the geriatric team. In an acute geriatric setting with its high proportion of multi morbid patients, decisions about diagnostic and therapeutic measures as well as decisions about restrictions of therapy have vital consequences. In this context, what is the significance of expressions of desire for death? A growing amount of literature has reported about studies on such questions with terminally ill patients. Studies in the field of acute geriatrics are still missing. In the present explorative pilot study, data of ten patients in an acute geriatric setting were collected within a two-month period. Data comprise various dimensions of the expressions of desire for death, and variables of their medical psychiatric, psychological, and psycho-social context. The dimensions of duration, intensity, and concreteness could be differentiated within the expressions of desire for death. In addition, they were each correlated to different context variables. Intensity was associated with experiences of pain. Subjective well-being and social support were relevant to concreteness. Duration was correlated with depression, hopelessness, experienced stress, and functional health. Physical health did not play a significant role. This means that expressions of desire for death do not only occur in the context of extreme health problems. The study has identified differentiated starting points for better understanding the expressions of desire for death and for better intervention. Further study is necessary to confirm these findings within a longitudinal design.
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PMID:[Desire for death-results of a pilot study with acute geriatric patients]. 1457 66

Shneidman (1996) proposed that intense mental pain is related to suicide. Relatedly, Frankl (1963) argued that the loss of life's meaning is related to intense mental pain. The first goal of this research was to test Shneidman's proposition by comparing the mental pain of suicidal and nonsuicidal individuals. Meaning in life and optimism are the polar opposites of suicidality and hopelessness, and the examination of these variables in relation to mental pain was undertaken to provide a test of Frankl's proposition. In two studies, a relationship between a newly developed measure of mental pain--the Orbach & Mikulincer Mental Pain Scale, 2002 (OMMP; see also Orbach, Mikulincer, Sirota & Gilboa-Schechtman, 2002)--and suicidal behavior and life meaning were examined. Results confirmed both propositions. Implications for the study of mental pain and suicide are discussed.
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PMID:Mental pain and its relationship to suicidality and life meaning. 1458 34

Shneidman (e.g., 1998) has theorized that psychache--general psychological and emotional pain that reaches intolerable intensity--is an important suicide-related variable, and indeed, represents a source of suicidal behavior. This conceptualization, while prominent and clinically and intuitively appealing, has received relatively little empirical scrutiny. In this study, we determined whether an index closely related to psychache, psychological quality of life, would display a special and resilient association to suicidality among 60 adult psychiatric outpatients in Brazil. All patients underwent structured clinical interviews and completed various clinical and quality-of-life measures. We found that the association between psychological quality of life and suicidality remained, even when depression, hopelessness, and other domains of quality of life were controlled. Psychache appears to deserve its place among key suicide-related variables, and deserves the attention of clinicians working with suicidal people.
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PMID:Psychache and suicidality in adult mood disordered outpatients in Brazil. 1458 35

The findings presented in this discussion seek to make a contribution to quality of life (QOL) research, by highlighting the import of factors affecting the communication of primary stage head and neck cancer patient's experiences of suffering after treatments by their clinicians. Qualitative research methodology based on open-ended interviews with 18 survivors of American Joint Committee on Cancer (AJCC) Stage I and Stage II, squamous cell carcinoma of the head and neck (SCCHN) were used. The interviews were transcribed verbatim and thematically analysed. In this preliminary analysis, three important themes emerged: (1) a self diminished by cancer; (2) the fear of addiction to pain medications; and (3) hopelessness and the loss of meaning in life after SCCHN. Our present findings indicate that SCCHN patients understand their experiences of cancer and under-report their experiences of suffering mainly because of fear. These include fears of: being further diminished by SCCHN, fears of addiction, and an inability to cope with the additional losses associated with SCCHN. As a consequence, and perhaps, because of a failure the part of clinicians and patients to adequately address these fears, SCCHN patients may also experience greater psychological morbidity, becoming fatalistic about biomedicine's ability to restore them to health after cancer, or related symptoms, including pain, despite being 'cured.' This study provides a perspective on why this under-reporting occurs, thereby potentially enhancing clinician-patient communication and the QOL of SCCHN patients who present with curable disease.
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PMID:Communicating suffering in primary stage head and neck cancer. 1496 76


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