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Gordon Parker

Publications and source records attributed to Gordon Parker.

At least 19 recordsLinked to original sources
PubMed2004

Capacity of the 10-item Depression in the Medically Ill screening measure to detect depression 'caseness' in psychiatric out-patients.

The 10-item Depression in the Medically Ill (DMI-10) screening measures has been demonstrated to be useful in medically ill and general practice patients. Its usefulness as a screening or monitoring measure in depressed psychiatric out-patients is now reported. One hundred subjects-currently depressed or recovered from a recent episode-completed the measure, with scores for those 69 currently meeting DSM-IV depression caseness criteria compared with 31 non-depressed subjects. A cut-off score of 10 or more had high sensitivity and specificity for discriminating between 'cases' and 'non-cases'. The discriminating capacity of each item was also quantified. We conclude that the DMI-10 is brief, gender non-specific and less intrusive than many depression screening measures in clinical practice with depressed patients, with the currently established cut-off score similar to that established in medically ill samples. Analyses suggest useful items for clinicians to determine depression caseness status.

Adult↗
PubMed2004

Some recommendations to assess depression in Chinese people in Australasia.

OBJECTIVE: To provide some general recommendations for psychiatric assessment of depression among Chinese patients within a predominately Western society. METHOD: A literature review is provided with interpretive comments. RESULTS: The prevalence of depression reported in community studies undertaken in Chinese communities is very low. To what extent Chinese people experience and seek help for depression, and how they report depressive symptoms have long been topics of some importance. The impact of acculturation as well as concepts and interpretations of illness in traditional Chinese medicine are discussed. Awareness of sensitive issues and practices within the Chinese culture will facilitate communication between medical professionals and patients, resulting in more accurate identification and diagnosis of depressive disorders. CONCLUSION: Direct but culturally sensitive and empathic questioning of psychological symptoms is needed to unveil patients' explanatory models, as most Chinese initially nominate only somatic symptoms to health practitioners. Successfully treated patients can promote earlier and wider utilization of mental health services to other Chinese people.

Adaptation, Psychological↗
PubMed2004

Evaluating treatments for the mood disorders: time for the evidence to get real.

OBJECTIVE: To detail limitations to level I evidence derived from randomised controlled trials of antidepressant treatments and which is held to be fundamental to the development and validity of treatment guidelines. METHOD: Recent efficacy studies and meta-analyses of treatments of major depression are considered. RESULTS: The largest database in psychiatry--demonstrating that all principal treatments are of similar efficacy, and that antidepressant drugs are not distinctly superior to placebo treatment--is unlikely to be valid. CONCLUSION: Excessive belief in and weighting of the evidence emerging from randomised controlled trials deserves to be criticized. An argument is put for adopting alternative approaches to evaluating the likely effectiveness of any antidepressant treatment.

Antidepressive Agents↗
PubMed2003

Modelling late-life depression.

OBJECTIVE: To determine if we could find support for a three-class depression sub-typing model (and identify differentiating constituent clinical features) in a sample of elderly depressed patients. BACKGROUND: Depression is currently modelled dimensionally, with little concession to descriptive psychopathology and distinction of meaningful clinical depressive sub-types. We have proposed a three-class hierarchical specificity model for sub-typing the depressive disorders (comprising psychotic, melancholic and non-melancholic depression), with specificity referring to two clinical features (psychotic symptoms and psychomotor disturbance or PMD) separating the first two classes from a residual non-melancholic class. METHOD: Subjects were aged 65 years or more, non-demented and being treated for depression. Extensive clinical assessment was undertaken, while several standardised measures were administered. 'Bottom up' analyses were data driven, while 'top down' analyses respected DSM-III-R decision rules. Dimensional and categorical multivariate analyses sought to identify features differentiating psychotic depression (PD), melancholic depression (MEL) and a residual non-melancholic (NON-MEL) class. RESULTS: Of the 123 referred patients (having a mean age of 75.6 years), 46 had DSM-defined PD, 46 had MEL and 31 were assigned as NON-MEL. Mean total CORE scores (measuring PMD) more clearly distinguished the groups than scores on two depression severity measures. Psychotic depression was best distinguished from melancholic depression by psychotic features, as well as more severe PMD and anhedonia. Melancholic depression was best distinguished from non-melancholic depression by PMD, terminal insomnia and pathological guilt. CONCLUSION: The specificity of PMD to the definition of the psychotic and melancholic depression was confirmed in our elderly depressed sample. Clinical features identified as distinguishing psychotic, melancholic and non-melancholic depression were broadly consistent with findings from our previous studies involving younger subjects and with our three-class hierarchical model.

Aged↗
PubMed2003

The development of a six-item daily self-report measure assessing identified depressive domains.

BACKGROUND: There is debate as to whether any anti-depressant strategy acts more rapidly than any other, while 'improvement' in overall depression severity reflects a summation of individual domains that may individually show differing trajectories. We developed a brief self-report measure of depression's constituent constructs to allow such issues to be examined. METHODS: A 25-item measure was prepared and completed daily by depressed patients until they had evidenced distinct improvement. RESULTS: Factor analyses favoured a six-factor structure, with constructs labelled depression, irritability, brooding, poor concentration, insomnia and anxiety. Scores on those constructs were differentially associated with overall depression severity as measured on the clinician-rated Hamilton measure, arguing for their potential utility. LIMITATIONS: The original data set was small while the measure's utility will only emerge in application studies. CONCLUSIONS: The six-item measure is appended and several possible application studies noted. In particular, we favour its evaluation in studies examining the impact and time to onset of differing antidepressant strategies on differing depressive sub-types.

Affect↗
PubMed2003

Distinguishing early and late onset non-melancholic unipolar depression.

AIM: We seek to determine whether unipolar non-melancholic major depression commencing early in life has a differing clinical picture, and whether it may have differing determinants. METHODS: We study a sample of such patients, comparing those with depression onset in their first 25 years against residual subjects, matching exactly by sex and controlling for age. RESULTS: There were no differences in current depression severity. Despite early onset subjects having a distinctly younger current mean age, they had a lifetime pattern of both greater depression chronicity and disability, and judged themselves as less likely to have benefited from any antidepressant medication or psychotherapy. 'Phenotypically' early onset subjects did not differ in terms of 'depressive' symptoms, but were distinguished by a greater irritability, which we interpret as reflecting a temperament dimension influencing symptom expression. Multivariate analyses indicated that the clinical pattern in those with an early onset was distinguished by more evident irritability and anxiety, that there was a distinct familial contribution to early onset depression, that its forerunners were an early personality style of behavioural inhibition or shyness, and that they were more likely to use alcohol and illicit drugs. CONCLUSIONS: While early onset unipolar depression is unlikely to be a pure depressive 'type', it may well be that certain familial temperament characteristics lead to an early onset of depression marked by irritability, a process that invokes a spectrum disorder concept linking temperament style and the depressive manifestations. Early onset depression is indicative of a poor prognosis, both in terms of response to interventions and in regard to chronicity and disability.

Adult↗
PubMed2003

Valid assessment of the clinical features of depression by relatives appears to slip under the RADAR.

OBJECTIVE: We report on the development of an observational measure designed for completion by relatives, the Recent Appearance of Depression Assessed by Relatives (RADAR), and consider its validity. METHOD: One hundred and one patients with a current major depressive episode had a relative or close friend complete the RADAR, while psychiatrists and research assistants collected extensive data. RESULTS: Correlated against both patient self-report and psychiatrist-rated depression severity measures, RADAR scores evidenced poor validity overall. Recent Appearance of Depression Assessed by Relatives scores also failed to differentiate depressive subtypes, in that scores for patients with melancholic depression were not significantly higher than for those with non-melancholic depression. CONCLUSIONS: Results are consistent with previous findings of poor agreement between clinicians and corroborative witnesses in assessing clinical depressive features, and argue against reliance on corroborative witness reports.

Adult↗
PubMed2003

Clinical and personality correlates of a new measure of depression: a general practice study.

OBJECTIVE: There is a need for a brief, efficient depression screening measure for general practice settings, particularly for identifying those who are at high risk of depression. We therefore test the usefulness of a measure developed in a sample of medically ill hospitalized patients. METHOD: More than 600 patients attending six Sydney general practices completed the Depression in the Medically Ill (DMI-10) measure, in conjunction with sociodemographic, depression history and personality profile measures. The impacts of sociodemographic, personality and lifetime depression variables on DMI-10 scores (and identified 'cases') were examined as a measure of its usefulness. RESULTS: Gender did not influence depression scores, while there were slight associations between DMI-10 scores and age, marital and occupational status. Higher scores were returned by those with more severe, lengthier and perceived stressful medical illnesses. Using a predetermined cut-off score, 36% rated as putative 'cases', a prevalence almost identical to our general hospital study. 'Cases' were distinctly more likely to have had previous depressive episodes, to have sought help for such episodes and to have received antidepressant medication. They also scored higher on measures of anxious (anxious worrying and irritability) and self-critical ('depressive personality') personality styles. CONCLUSIONS: The DMI-10 appears useful as a brief and acceptable screen for depression in a general practice setting, both identifying those who are likely to be currently depressed and those with a background of previous depression.

Adult↗
PubMed2003

What's the use of worrying? Its function and its dysfunction.

OBJECTIVE: To provide an overview of theory and research regarding the phenomenology and function of worry. METHOD: A systematic literature search focusing on conceptualizations of worry as a cognitive activity and worry research over the last 20 years was conducted. RESULTS: Worry can be both functional and dysfunctional. Disruption to daily functioning, perceived uncontrollability, pervasiveness and extensive coverage of worry themes (including "remote" events and the presence of meta-worry), all have specificity to more severe and dysfunctional worry. CONCLUSIONS: Research investigating both the relationship between worry and anxiety and the attributes of severe worriers, has brought attention to its role in fostering emotional disturbance and has clarified factors relevant to treatment.

Anxiety↗
PubMed2003

Influence of symptom attribution on reporting depression and recourse to treatment.

OBJECTIVE: A Bristol general practice study demonstrated the extent to which patients' attribution style influences psychological diagnostic case rates. We pursue this issue and several implications in this Australian study. METHOD: A survey was undertaken of six general practices in Sydney, and involving more than 900 routine general practice patients. Subjects completed questionnaires assessing personality styles observed in those with clinical depression, attributional response (i.e. 'psychological', 'somatic' and 'normalizing') to three somatic cues, state depression, lifetime depression, use of antidepressant medication, and recourse to professional help. RESULTS: Responders attributing psychological explanations to the somatic cues had the highest state and lifetime depression rates, viewed their depression as more likely to be a 'disorder' and were more likely to have received treatment for depression. Those with a personality style of 'anxious worrying' reported increased morbidity across all depression variables, but personality did not make attributional style redundant in multivariate analyses. CONCLUSIONS: Interpreting somatic cues in a psychological way is associated with higher rates of reported depression and increased recourse to depression treatment. Thus, a normalizing response style may make depression recognition and detection difficult. Study findings challenge the capacity of self-report measures to detect depression, especially in general practice settings.

Adult↗
PubMed2003

Which antidepressants flick the switch?

OBJECTIVE: The Black Dog Institute seeks to address issues of relevance to the clinical management of those with a mood disorder. This overview considers the capacity of antidepressant drugs, and particularly the new classes, to induce manic switching in depressed patients. METHOD: Relevant literature is reviewed. RESULTS: It is unclear whether antidepressant drugs from any of the classes induce switching in unipolar depressed patients. In bipolar depressed patients, the broad-spectrum tricyclic and monoamine oxidase inhibitor drugs present a clear risk of switching, the selective serotonin re-uptake inhibitors do not appear (at standard doses) to increase the risk, while the capacity of the dual action (serotonergic and noradrenergic) drugs to induce switching remains unestablished but may be slight. CONCLUSIONS: As switching induced by narrow action antidepressants does not appear to present a substantive causal risk, clinicians can have confidence in prescribing certain anti-depressants for managing bipolar depression, and without any necessity to first prescribe a mood stabilizer to pre-empt switching.

Antidepressive Agents↗
PubMed2003

Neuropsychological performance in patients with depression is associated with clinical, etiological and genetic risk factors.

The present study explores neuropsychological functioning in patients with depression with reference to key clinical, etiological and genetic features. In comparison to healthy volunteers, patients with severe depression demonstrated poorer performance on all neuropsychological tests except for WAIS-R Vocabulary and a 64-item computerized version of the Wisconsin Card Sorting Test. On average, patients exhibited significant impairments (greater than -2 standard deviation units) on tests of simple reaction time, Part B of the Trail Making Test and Raven's Colored Progressive Matrices. When performance decrements were analyzed with reference to key clinical features, patients with melancholia performed more poorly on WAIS-R Vocabulary, semantic fluency and choice reaction time than those with nonmelancholic depression. After controlling for age, those patients with late-onset depression (i.e., age of onset > or =50 years) exhibited poorer performance on a computerized version of the Tower of London test in comparison to those with an early onset. While there was no relationship between neuropsychological test scores and summed vascular risk factors or apolipoprotein E genotypes, presence of the methylenetetrahydrofolate reductase gene mutation was associated with slowed reaction time. The differential relationships between clinical, etiological and genetic risks and neuropsychological performance supports the presence of unique pathophysiological mechanisms in distinct subgroups of patients. These findings underscore the need to consider subtypes when investigating neuropsychological deficits in patients with depression.

Adult↗
PubMed2003

Cognitive behavior therapy for depression? Choose horses for courses.

OBJECTIVE: Although cognitive behavior therapy is a widely accepted treatment for depression, the problematic nature of efficacy studies is insufficiently recognized. METHOD: The authors reviewed original studies and quantitative analyses on the use of cognitive behavior therapy for depression. RESULTS: The authors suggested that claims for cognitive behavior therapy's efficacy on depression have been overstated, questioned whether its efficacy fits within its theoretical underpinning, and argued against viewing cognitive behavior therapy as a universal rather than a targeted strategy. CONCLUSIONS: Although cognitive behavior therapy may act more by its nonspecific therapeutic ingredients, the authors argued that by testing cognitive behavior therapy's efficacy in heterogeneous study groups, rather than in specific subgroups, failure to differentiate it from control therapies may have been ensured.

Antidepressive Agents↗
PubMed2003

Mental health literacy beliefs. A comparison of psychiatric trained nurses and enrolled nurses in Singapore.

The views of mental health professionals may influence diagnosis and management options. This study reports nurses' views about the management of three common psychiatric disorders--schizophrenia, depression, and mania. Results demonstrate the effect of greater psychiatric education and training, received by psychiatric trained nurses, on mental health literacy.

Attitude of Health Personnel↗
PubMed2002

A randomised, controlled trial of fluoxetine in methadone maintenance patients with depressive symptoms.

BACKGROUND: Depression and antidepressant use are prevalent in methadone maintenance patients (MMPs). However, antidepressant efficacy is not well established in this population. This study examined the efficacy of fluoxetine in improving depressive symptoms and reducing substance use in MMPs. METHODS: Stabilised MMPs scoring over 21 on the Beck Depression Inventory were randomised to receive fluoxetine or placebo over 12 weeks. RESULTS: Forty-nine subjects were randomised. In both groups, significant improvements were observed in depression, life functioning, and social impairment over 12 weeks. Poly-drug use improved in completers only. No fluoxetine effects were observed. CONCLUSIONS: Little evidence supports use of fluoxetine as a treatment for depressive symptoms in MMPs.

Adult↗