Biomedical subjects

D Hadzi-Pavlovic

Publications and source records attributed to D Hadzi-Pavlovic.

At least 19 recordsLinked to original sources

PubMed1992

Psychotic (delusional) depression: a meta-analysis of physical treatments.

Literature reviews have suggested that combination antidepressant/antipsychotic drug therapy and electroconvulsive therapy (ECT) are of comparable efficacy in treating psychotic depression, and distinctly superior to antidepressant alone or antipsychotic alone. We undertook a meta-analysis of 44 studies, and focussed on those three principal treatment options. There was a trend for ECT to be superior to combination drug therapy, with bilateral ECT being suggested as distinctly more effective than unilateral, and ECT was demonstrated to be significantly superior to tricyclic drug alone. Combination drug therapy ranked as more effective than antipsychotic alone and than antidepressant alone, but that greater efficacy was not significant.

Affective Disorders, Psychotic↗

PubMed1992

Comparison of clinician rated and family corroborative witness data for depressed patients.

There appear to be few published studies that have examined the levels of agreement between ratings of features of depression as assessed by clinicians and by corroborative witnesses. We therefore report a study of 141 depressed patients assessed by a clinical psychiatrist at a semi-structured interview, reviewing family and historical data as well as depressive symptoms, and rated on a series of designated mental state signs. A family member completed questionnaire data assessing the same features. Moderate agreement was obtained only for several historical items (e.g., previous depressive episode, response to ECT). Agreement was minimal or non-existent on numerous clinical symptoms and signs of depression. A number of sources of disagreement are considered, and it is suggested that discordance may have emerged principally from the contrasting domains and training experiences of the clinicians and the corroborative witnesses.

Adjustment Disorders↗

PubMed1992

Are there any differences between bipolar and unipolar melancholia?

Although it is now more than 30 years since Leohard originally proposed the distinction between bipolar and monopolar (unipolar) forms of affective disorder, there have been relatively few studies which have investigated clinical features which may differentiate the depressed phase of bipolar disorder from unipolar depression. In this study we examined the value of a new scale for rating depressive mental state signs (the 'core' score system), and a large series of symptoms and risk factors, in distinguishing between 27 age and sex-matched pairs of bipolar and unipolar patients diagnosed as melancholic on several diagnostic criteria. In general, we found a marked similarity between the groups on clinical features of the depressive episode when allowance was made for multiple tests. Bipolar patients, however, had shorter episodes of depression and were less likely to demonstrate 'slowed movements' than unipolar subjects. There were also consistent trends on other items for psychomotor retardation to be less common and agitation to be more likely in the bipolar patients. At the least, these findings suggest that the widely-held belief that bipolar depressed patients typically have psychomotor retardation is not as clear-cut as has been previously described.

Bipolar Disorder↗

PubMed1992

Parental representations of melancholic and non-melancholic depressives: examining for specificity to depressive type and for evidence of additive effects.

Several studies have suggested that 'anomalous parenting', as measured by the Parental Bonding Instrument (PBI), may be a differential risk factor to subsequent depression in adulthood--being irrelevant to melancholia but over-represented in non-melancholic depressive disorders. Such a 'specificity' effect is confirmed in our current sample of 65 melancholic and 84 non-melancholic depressed patients. Secondly, we examine the risk to depression effected by exposure to one parent with an anomalous parental style, and the extent to which that risk is modified by characteristics of the other parent. We find clear evidence of additive effects with the risk to non-melancholic depression being raised by exposure to 'anomalous parenting' from two parents. Of the varying parental styles measured by the PBI, low parental care from both parents provided the highest risk to non-melancholic depression (being 4-7 time higher in one sample and 13-27 times higher in the other).

Depressive Disorder↗

PubMed1992

Predicting the course of melancholic and nonmelancholic depression. A naturalistic comparison study.

We assessed improvement patterns and predictors of outcome over a 1-year period, in a sample of depressed patients receiving treatment from a specialized mood disorders unit. Patients with melancholia had a differential improvement pattern from the nonmelancholics in the first 20 weeks, but case rates and severity levels were comparable at 20 weeks and at 1 year. Only three variables (older age at first episode, less severe depression and extraversion) were predictors of improvement in both groups. Improvement was predicted by less psychomotor disturbance, absence of personality disorder, and higher social functioning in the melancholic patients. A reported absence of timidity and shyness in childhood, a briefer duration of depression, and receipt of individual psychotherapy predicted a better outcome in the nonmelancholic patients. Although significant predictors were few overall, the suggested differential relevance for most of the isolated predictors argues for outcome studies that examine melancholic and nonmelancholic depressive disorders separately.

Age Factors↗

PubMed1991

Distinguishing psychotic and non-psychotic melancholia.

To examine the necessary and sufficient status of delusions and hallucinations as clinical features of psychotic (delusional) depression, we studied a consecutive sample of 137 patients meeting DSM-III, RDC and our clinical criteria for endogenous depression/melancholia, of whom 35 had delusions and/or hallucinations, and represented our putative 'psychotic depressives' (PDs). The PDs were contrasted with the remaining 'endogenous depressives' (the EDs), and an age- and sex-matched subsample of the latter, the MEDs. Univariate and multivariate analyses of clinical features established that, in addition to the presence of delusions and/or hallucinations, the PDs could be distinguished in particular by severe psychomotor disturbance, as well as by sustained and unvarying depressive content, the absence of any diurnal mood variation and by constipation. Latent class analyses suggested that overt psychotic features (such as delusions and hallucinations) were sufficient but not necessary for a subject to be assigned to the 'psychotic' latent class, and a subsequent chart review suggested that, in some PDs actual psychotic features may not be able to be elicited because of severe psychomotor change, suggesting that clinical reliance on eliciting delusions or hallucinations may result in a number of 'masked psychotic depressives' escaping valid diagnosis.

Affective Disorders, Psychotic↗

PubMed1991

Psychosocial risk factors distinguishing melancholic and nonmelancholic depression: a comparison of six systems.

We examined six systems or scales designed to distinguish melancholia from residual nonmelancholic depressive disorders in a sample of 305 patients. A count of the number of significant psychosocial risk factors showed that a clinical diagnosis was the most differentiating (19 significant risk factors), followed by the Newcastle index (13), DSM-III (10), and the CORE system (10)--the last essentially assessing psychomotor change; Research Diagnostic Criteria (RDC) (7) and an endogeneity symptom scale (2) were the least differentiating. A subsample of "composite melancholics" was derived, comprising 138 who met "melancholia" criteria for DSM-III, RDC, and CORE, and they were contrasted with residual depressives. The composite melancholics were older, had had a briefer depressive episode, and differed significantly on 12 risk factors, essentially being less likely to report deprivational experiences such as deficient parenting and dysfunctional marital relationships. We suggest that such a risk factor strategy is of potential use in refining the clinical definition of melancholia.

Adaptation, Psychological↗

PubMed1991

Psychotic depression: a review and clinical experience.

We review research literature on psychotic (delusional) depression, including demographic, illness pattern, clinical, biological marker and treatment issues. Secondly, we report a study of a consecutive sample of 137 patients meeting criteria for DSM-III melancholia, RDC definite endogenous depression and our "clinical" criteria for endogenous depression, of whom there were 35 "psychotic depressives" (PDs). The PDs were contrasted with the remaining 76 depressives (EDs) and with an age and sex-matched subset (MEDs). The PDs were distinctly older than the EDs at assessment and at initial onset of any affective disorder. Compared to the MEDs, they tended to have longer illnesses, were more likely to be hospitalised (and to have longer stays), to receive (in the past and for the current episode) combination antipsychotic/antidepressant medication and/or ECT, and to have a poorer course over the following year. They were no more likely to have a bipolar pattern, a family history of depressive disorder, schizophrenia or alcoholism, or vegetative depressive features. Developmental psychosocial stressors and antecedent life event stressors were not over-represented. Most of the PDs had delusions, one-fifth reported hallucinations and psychomotor disturbance was marked. Other differential clinical findings were sustained mood disturbance, constipation, and the absence of a diurnal variation in mood and energy.

Adult↗

PubMed1991

Parental representations of patients with panic disorder and generalised anxiety disorder.

Previous studies using the Parental Bonding Instrument have shown a general trend for neurotic subjects to score their parents as less caring and more protective. Such a finding was broadly replicated in a study of 80 clinically anxious subjects and age- and sex-matched controls. Although direct comparisons of PBI scores failed to reveal clear-cut differences between generalised anxiety (GA) and panic disorder (PD) subgroups, logistic regression analyses revealed higher odds ratios for parental assignment to aberrant categories in the GA group, with PD patients reporting a more limited pattern of overprotective parenting only. Our findings suggest that adverse parental behaviour may be relevant to the pathogenesis of GA, while parental 'affectionate constraint' may be a parental response to early manifestations of PD.

Adult↗

PubMed1991

Depression sub-typing: unitary, binary or arbitrary?

The strongest statistical support for the binary view of depression has been provided by factor (principal components) analytic studies which delineate a bipolar factor with features interpreted as reflecting "endogenous depression" and "neurotic depression" at opposing poles. We review the seminal studies to suggest instead that the bipolar factor has generally polarised depression and anxiety, and that no such entity or symptom complex of "neurotic depression" has been isolated. Instead "neurotic depression" has been defined principally by features of anxiety and personality style. We argue that the suggested entity is, in fact, a pseudo-entity, being no more than a residual group of non-depressive features without any significant intrinsic depressive characteristics. We support our interpretation by showing comparable solutions in published studies of depressives alone, contrasted with separate analyses of anxious and depressed patients. We also report two studies in which the "neurotic depressive" pole is made to appear and disappear by the inclusion and exclusion of anxiety items. As factor analytic studies have defined the "residual" pole so variably, we argue that some features held to distinguish neurotic depression are of no utility and that such a diagnosis is meaningless. We suggest that the clinician should not proceed (after excluding endogenous depression) to conclude that the default option is necessarily an entity "neurotic depression" and that instead a heterogeneous group of options (e.g. anxiety, personality disorder) require review. If the "neurotic depressive" type of the multivariate analytic studies is a pseudo-entity, then a modified unitary view of depression may be valid.

Adult↗

PubMed1990

Perceived dysfunctional intimate relationships: a specific association with the non-melancholic depressive subtype.

Associations between perceptions of dysfunctional current intimate relationships and subtypes of depressive disorders were quantified in a sample of 136 patients, using the Intimate Bond Measure (IBM). Deficient care was two to three times more likely to be reported by patients with non-melancholic disorders than by matched subjects, but was no more likely to be reported by patients with melancholic disorders, suggesting a risk factor selective for depressive type. Patients who reported markedly deficient care in childhood were more likely to report very poor current intimate relationships. For the remaining patients, however, no evidence of continuity between a dysfunctional parental relationship and a current dysfunctional intimate relationship was found.

Adult↗

PubMed1990

Expressed emotion as a predictor of schizophrenic relapse: an analysis of aggregated data.

We examine published data from 12 studies assessing the capacity of Expressed Emotion (EE) status to predict schizophrenic relapse. Analysis of aggregated data, for 908 subjects, established a 3.7 times greater likelihood of relapse in those categorized as high EE, and a somewhat waning predictive strength EE over the publication interval, 1962-88.

Data Interpretation, Statistical↗

PubMed1990

Treatment of panic and agoraphobia. An integrative review.

There is now agreement about the clinical features of panic disorder and agoraphobia but less agreement about treatment because of controversy over whether the disorder is primarily biological or psychological. The authors were requested to produce an impartial review for continuing education and peer review. We chose to do this by using a quantitative review procedure, by providing a bibliography of studies, and by a literature review. We found that symptoms of panic and phobia did not change significantly while on wait-list control or while receiving placebo. The evidence for the efficacy of the low-potency benzodiazepines or of monoamine oxidase inhibitors was limited. It was also clear that only limited improvement can be expected from behavior therapies that do not involve exposure to the symptoms of panic or to the feared situation. Symptoms of panic, as well as the frequency of spontaneous panic, were shown to be substantially improved following imipramine, high-potency benzodiazepines such as alprazolam, exposure in vivo (especially if a cognitive anxiety management procedure was used), and the combination of imipramine and exposure in vivo. The effects on panic produced by the exposure therapies (with or without imipramine) were maintained over long follow-up periods. Imipramine, alprazolam, exposure therapy, and imipramine plus exposure each produced significant improvements in phobias. In the short term and in the long term, the larger improvements in phobias were associated with exposure therapy, particularly if used in combination with imipramine. We conclude that it would be unwise to theorize about the etiology of this disorder on the basis of response to a specific treatment because, both at the meta-analytic level and from the review of individual studies, it is clear that both drug and nondrug therapies can produce substantial and long-lasting changes in panic and in phobias.

Agoraphobia↗

PubMed1990

Depressive type and state effects on personality measures.

We examine the hypothesis that the effect of mood state on personality questionnaire scores is more a function of diagnosis than of depression severity. Sixteen endogenous and 83 neurotic depressives completed a battery of personality questionnaires at a baseline assessment and again 20 weeks later. Scores on the personality measures changed significantly. Endogenous depressives were found to have more pronounced changes on measures of dependence and timidity, but when change in mood state was partialed out only one of the dependence measures and timidity remained significant. Thus the hypothesis only received partial support--change in mood state appears to be the major factor in elevating personality questionnaire scores.

Adolescent↗

PubMed1990

Classifying depression by mental state signs.

The possibility that separation of a categorical depressive disease ('melancholia') from remaining depressive disorders can be improved by assessment of mental state signs was examined in patients treated by representative Sydney psychiatrists and patients referred to a specialised mood disorders unit. A set of signs, principally assessing retardation, was derived within the two samples by principal-components and latent-class analyses. Scores were significantly correlated with clinical, DSM-III, and RDC diagnoses, and appeared independent of severity, suggesting that melancholia can be defined phenomenologically. Scores were also associated with several 'validating' factors. Comparative analyses of a refined list of melancholia symptoms suggested that ratings of defined signs are likely to have greater capacity than symptom ratings to differentiate melancholia from residual depressive disorders.

Adjustment Disorders↗

PubMed1990

Psychosocial effects on carers of living with persons with dementia.

A survey of members of the Alzheimer's Disease and Related Disorders Society confirmed high rates of psychological morbidity, though not of depression, and social isolation in family carers of persons with dementia. Psychological morbidity in carers was associated with having an affected person at home, the carer being a spouse, demanding problem behaviours, poor physical health in the carer, social isolation, dissatisfaction with social supports, greater use of psychotropic medication, and a deteriorated marital relationship. Carers and patients had high rates of consultations with doctors and other health professionals. There was a vulnerable group of carers who were impaired psychologically, socially and physically. The identification of risk factors to carer morbidity may lead to useful interventions.

Adaptation, Psychological↗

PubMed1990

A survey of dementia carers: doctors' communications, problem behaviours and institutional care.

A survey of carers belonging to the Alzheimer's Disease and Related Disorders Society (ADARDS) had three aims: (i) to investigate the process of health professionals providing information to patients and carers: (ii) to determine the nature of problems burdening carers; and (iii) to examine factors associated with institutional placement. Carers reported on deficiencies in the provision of information and indicated their preferences as to how the information should be given. ADARDS, general practitioners and other health professionals were reportedly helpful, with each appearing to have a role in providing information about dementia. Multiple problem behaviours were reported by most carers, especially difficulties with communication, the need for constant supervision and disruption to personal life. Institutional care was most highly correlated with dependency problems, severity of dementia and a non-spouse carer. Implications include the need for training of doctors in communication and education about dementia with particular attention to management of dependency problems.

Adaptation, Psychological↗

PubMed1989

The life skills profile: a measure assessing function and disability in schizophrenia.

We review limitations of representative measures of function and disability associated with schizophrenia and specify requirements of a suitable measure for service evaluation: It should reliably and validly assess constructs relevant to survival, function, and adaptation in the community. Additionally, it should be brief, comprise specific and jargon-free items assessing distinct behaviors, and therefore be capable of completion by family members and community housing managers as well as by professional staff. The initial development of such a measure, the 39-item Life Skills Profile (LSP), with its five scales, is described. We report data to suggest that it is likely to be a measure of considerable utility both in research studies and in defining and assessing clinical services.

Activities of Daily Living↗