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Biomedical subjects

A Tylee

Publications and source records attributed to A Tylee.

At least 19 recordsLinked to original sources
PubMed2006

Duloxetine 60 mg once daily in the treatment of milder major depressive disorder.

There is ongoing debate regarding the effectiveness of antidepressants in patients with milder major depressive disorder (MDD). This post-hoc analysis evaluated the efficacy and tolerability of duloxetine in the subset of 159 (75 duloxetine and 84 placebo) patients with milder MDD (baseline HAMD17 total score > or = 15 and < or = 18) who were treated once daily with duloxetine 60 mg or placebo in two identical, 9-week, randomised, double-blind trials. At endpoint, change from baseline on HAMD17 was greater in the duloxetine group (-7.0) than in the placebo group (-4.1) (p = 0.005). Response and remission rates, and improvement on the Clinical Global Impressions-Severity (CGI-S) scale, the Patient Global Impressions-Improvement (PGI-I) scale, and measures of painful symptoms were also significantly better in the duloxetine group (p < 0.05). Tolerability was consistent with that seen in previous studies of duloxetine in patients with more severe depression. In conclusion, duloxetine 60 mg/day is effective and well tolerated in milder MDD.

Adolescent↗
PubMed2005

'They're all depressed, aren't they?' A qualitative study of social care workers and depression in older adults.

Statutory and voluntary social services provide care and support for vast numbers of vulnerable older adults, yet little is known about how social care practitioners respond to depression in this high risk population. This study elicited the perceptions and conceptualizations of this condition among social care staff, and views on how the response of social care and other agencies might be improved. Qualitative interviews were conducted with 20 social care practitioners working in generic services for older adults in south London. Depression was perceived to be remarkably common among clients, a phenomenon largely attributed to the adverse circumstances of old age, particularly social isolation. A key message from participants was that social causes indicate a need for social interventions. While primary care was criticised for not taking depression seriously in older people, mental health services were generally praised. Expansion of social, recreational and psychological interventions was advocated.

Aged↗
PubMed2002

Gender differences in depression. Epidemiological findings from the European DEPRES I and II studies.

BACKGROUND: While there is ample evidence that the prevalence rates for major depressive disorder (MDD) in the general population are higher in women than in men, there is little data on gender differences as regard to symptoms, causal attribution, help-seeking, coping, or the consequences of depression. METHOD: The large DEPRES Study dataset covering representative population samples of six European countries (wave I: 38,434 men and 40,024 women; wave II: 563 men and 1321 women treated for depression) was analyzed for gender differences. RESULTS: In wave I marked gender differences were found in the six-month prevalence rate for major depression but less so for minor depression; the gender differences for major depression persisted across all age groups. Even after stratification by clinically significant impairment and paid employment status, men reported fewer symptoms than women; as a consequence, men reached the diagnostic threshold less often. In wave II there were clear gender differences in causal attribution and in coping. Men coped by increasing their sports activity and consumption of alcohol and women through emotional release and religion. Women felt the effects of depression in their quality of sleep and general health, whereas men felt it more in their ability to work. LIMITATIONS: The second wave of the study comprises treated depressives only and may be less representative than the first wave.

Adaptation, Psychological↗
PubMed2001

The impact of personality disorder in UK primary care: a 1-year follow-up of attenders.

BACKGROUND: The usefulness of the concept of personality disorder has not been properly tested outside psychiatric services. We set out to examine this in primary care, by examining the ability of the diagnosis to predict health status and patterns of service use. METHOD: A cohort of consecutive attenders, who had previously been rated for the presence of personality disorder using a standardized assessment, was followed-up at 1 year. The participating general practitioners also rated the personalities of, and their attitudes towards, a proportion of this sample of attenders. RESULTS: After adjusting for the effects of all covariates, a rating of personality disorder (generated by the standardized assessment) was associated with frequent attendance to general practice and fewer referrals to secondary care. A GP rating of personality disorder was associated with the prescription of psychotropic medication. The level of agreement between a GP rating of personality disorder and the standardized assessment was poor. GPs rated personality disorder more frequently in participants who were perceived to be less compliant, less likeable and more stressful to deal with. Participants with a psychiatric rating of personality disorder did not attract these negative perceptions. CONCLUSIONS: Personality disorder, as rated by a research interview, is a predictor of health service usage. There is a significant disparity between a research rating of personality disorder and the diagnostic ratings made by GPs. The GP ratings of personality disorder were strongly associated with adverse perceptions of the patient's consulting behaviour.

Adult↗
PubMed2000

Symptom attribution and the recognition of psychiatric morbidity.

OBJECTIVE: Patients' interpretation of ambiguous physical symptoms may influence illness presentation in primary care. The present study sought to investigate the influence of symptom attribution style on the recognition of psychiatric morbidity by general practitioners (GPs). METHODS: Patients consulting GPs completed assessments of attribution style and General Health Questionnaires (GHQs), while GPs provided independent ratings of psychiatric distress. Analysis examined the relationship between patient demographic variables, attribution style (using the Symptom Interpretation Questionnaire [SIQ]), and GP and GHQ assessments of patients' mental health. RESULTS: The results indicate that severity of disorder and patient age were reliable predictors of recognition: normalizing and psychological attributions were additional predictors in some analyses, but their effects were inconsistent. CONCLUSIONS: The results provide some support for the role of symptom attribution in the recognition of psychiatric morbidity, but suggest that the predictive value of such attributions may be relatively modest. The SIQ may not be the optimum instrument for the measurement of attributions.

Adolescent↗
PubMed2000

Foreword

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Journal Article↗
PubMed2000

Depression in Europe: experience from the DEPRES II survey. Depression Research in European Society.

Despite being one of the most prevalent psychiatric conditions in the community, depression is commonly unrecognised in clinical practice. The Depression Research in European Society (DEPRES) survey examined depression in a pan-European population (N=78463) and identified a 6-month prevalence of depression of 17%. In DEPRES II (N=1884), more than 50% of the individuals were categorised as being currently depressed, with one-third receiving antidepressant treatment. Cluster analysis grouped patients within six clearly differentiated types. Individuals with patient type 'severe depression and anxiety' (Group III), had the greatest number of symptoms and were more likely to be taking antidepressants than the other patient groups. In Group III, depression prevented individuals from undertaking normal activities for 6 weeks and prevented them from working for 1 month. The patient type making the most demands on healthcare resources are those with depression and anxiety. Prompt and effective treatment would be of benefit to all patient types, and the use of a selective serotonin reuptake inhibitor (SSRI) with activity against anxiety symptoms is an appropriate management strategy.

Antidepressive Agents, Tricyclic↗
PubMed2000

The prevalence of personality disorder among UK primary care attenders.

OBJECTIVE: To determine the prevalence rate of personality disorder among a consecutive sample of UK primary care attenders. Associations between a diagnosis of personality disorder, sociodemographic background and common mental disorder were examined. METHOD: Three hundred and three consecutive primary care attenders were examined for the presence of ICD-10 and DSM-4 personality disorders using an informant-based interview. RESULTS: Personality disorder was diagnosed in 24% (95% CI: 19-29) of the sample. Personality-disordered subjects were more likely to have psychiatric morbidity as indicated by GHQ-12, to report previous psychological morbidity, to be single and to attend the surgery on an emergency basis. 'Cluster B' personality disorders were particularly associated with psychiatric morbidity. CONCLUSION: There is a high prevalence rate of personality disorders among primary care attenders. These disorders are associated with the presence of common mental disorder and unplanned surgery attendance. Personality disorders may represent a significant source of burden in primary care.

Adult↗
PubMed1999

DEPRES II (Depression Research in European Society II): a patient survey of the symptoms, disability and current management of depression in the community. DEPRES Steering Committee.

The first pan-European survey of depression in the community (DEPRES I) demonstrated that 17% of the general population suffer from depression (major depression, minor depression, or depressive symptoms). This article describes findings from a second phase of DEPRES (DEPRES II), in which detailed interviews based on a semi-structured questionnaire (78 questions) were conducted with 1884 DEPRES I participants who had suffered from depression and who consulted a healthcare professional about their symptoms during the previous 6 months. The mean time from onset of depression was 45 months, and the most commonly experienced symptoms during the latest period were low mood (76%), tiredness (73%) and sleep problems (63%). During the previous 6 months, respondents had been unable to undertake normal activities because of their depression for a mean of 30 days, and a mean of 20 days of work had been lost to depression by those in paid employment. Approximately one-third of respondents (30%) had received an antidepressant during the latest period of depression. Significantly more respondents given a selective serotonin reputake inhibitor found that their treatment made them feel more like their normal self than those given a tricyclic antidepressant, and fewer reported treatment-related concentration lapses, weight problems, and heavy-headedness (all P < 0.05). Approximately two-thirds of respondents (70%) had received no antidepressant therapy during the latest period of depression, and prescription of benzodiazepines alone, which are not effective against depression, was widespread (17%). There is a need for education of healthcare professionals to encourage appropriate treatment of depression.

Antidepressive Agents↗
PubMed1999

Impact of a national campaign on GP education: an evaluation of the Defeat Depression Campaign.

BACKGROUND: The Defeat Depression Campaign, which was run by the Royal College of Psychiatrists and the Royal College of General Practitioners (RCGP) from 1992 to 1996, aimed to educate general practitioners (GPs) to recognize and manage depression. AIM: To measure the educational impact on GPs of the Defeat Depression Campaign. METHOD: A postal survey using a structured questionnaire was distributed to 2046 GPs obtained by systematically sampling 1 in 14 GPs from alphabetical lists from family health services authorities (FHSAs) in England and Wales. The questionnaire covered awareness of the campaign, awareness and use of campaign materials, and ratings of the usefulness of the campaign in relation to other educational activities. RESULTS: Two-thirds of GPs were aware of the campaign and 40% had definitely or possibly made changes in practice as a result of it. Impact of materials was highest for a consensus statement on the recognition and management of depression in general practice and for guidelines derived from it, each of which had been read in detail by about one quarter of responders and was known of by an additional one third. Impact was low for the other materials. The campaign had the highest impact among younger GPs, members of the RCGP, and (less strongly) among those who had undertaken a six-month post in psychiatry, those who were working in larger practices and fundholding practices, and women; 56% of GPs had attended a teaching session on depression in the past three years. CONCLUSION: A national campaign of this kind can have a useful impact, but it needs to be supplemented by local and practice-based teaching activities.

Adult↗
PubMed1999

Depression in the community: physician and patient perspective.

Depression and anxiety are the most common mental disorders seen by primary care physicians. The conditions often coexist. It has been reported that about half the psychiatric comorbidity in patients visiting their primary care physician goes unrecognized. Consequently, there is widespread agreement that an improvement in recognition of mental illnesses is required. This review examines how patient characteristics and patient presentation affect the acknowledgment of depression. Furthermore, the role of the physician will be discussed, with relation to the importance of acquiring specific consulting and prescribing skills for dealing with patients with depression. It is hoped that, with increasing awareness of depression and the development of training schemes for primary care physicians that focus specifically on the recognition and management of the condition in this setting, underrecognition and undertreatment of the disorder will improve.

Adolescent↗
PubMed1999

Identification of depressed patient types in the community and their treatment needs: findings from the DEPRES II (Depression Research in European Society II) survey. DEPRES Steering Committee.

DEPRES II (Depression Research in European Society II), the first in-depth, pan-European survey of depression in the community, provided an opportunity to identify depressed patient types and their treatment needs. Cluster analysis applied to data generated from DEPRES II interviews revealed six depressed patient types with clearly differentiated profiles. The patient type with moderately impaired depression has episodic depression and minimal disability. By contrast, severe depression associated with anxiety presents with chronic symptoms, including anxiety and panic, and causes considerable disruption to normal life and employment. Depression associated with chronic physical problems and depression associated with social problems are characterized by chronic physical illness and relationship or financial difficulties, respectively, and sufferers are pessimistic about recovery. Depression associated with sleep problems is associated with symptoms of tiredness and broken or inadequate sleep, and is commonly caused by stress. Tiredness is also a principal symptom of depression associated with tiredness or fatigue, but sufferers' ability to sleep is unaffected. All patient types would benefit from antidepressant therapy. The depressed patient types identified from the DEPRES II data make intuitive sense, but now need to be tested for face validity in the primary care setting.

Cluster Analysis↗