Biomedical subjects

Kay Parker

Publications and source records attributed to Kay Parker.

8 recordsLinked to original sources

PubMed2005

Self-harming in depressed patients: pattern analysis.

OBJECTIVE: As deliberate self-harm (DSH) is a common concomitant of depressive disorders, we undertook a study examining the relevance of possible determinants and correlates of DSH. METHOD: Three separate samples of depressed outpatients were studied to determine consistency of identified factors across samples, with principal analyses involving gender, age and diagnosis-matched DSH and non-DSH subjects. RESULTS: Across the samples, some 20% of subjects admitted to episodes of DSH. Women reported higher rates and there was a consistent trend for higher rates in bipolar patients. Univariate analyses examined the relevance of several sociodemographic variables, illicit drug and alcohol use, past deprivational and abusive experiences, past suicidal attempts and disordered personality functioning. Multivariate analyses consistently identified previous suicide attempts and high 'acting out' behaviours across the three samples, suggesting the relevance of an externalizing response to stress and poor impulse control. CONCLUSIONS: Results assist the identification and management of depressed patients who are at greater risk of DSH behaviours.

Adult↗

PubMed2005

Is combination olanzapine and antidepressant medication associated with a more rapid response trajectory than antidepressant alone?

OBJECTIVE: The authors' goal was to determine if prescription of antidepressant medication plus olanzapine initiates a more rapid response than prescription of antidepressant alone. METHOD: Twenty patients with major depression were studied. For 2 weeks the patients were blindly assigned to receive antidepressant plus olanzapine or antidepressant plus placebo. After 2 weeks, olanzapine augmentation was initiated for patients who did not improve with placebo augmentation. Response to medication was measured primarily by Hamilton Depression Rating Scale score. Other measures were the CORE, Clinical Global Impression, Beck Depression Inventory, and Daily Rating Schedule. RESULTS: Hamilton depression scores improved nonsignificantly in response to olanzapine combination therapy, but that trend was not evident on any secondary measure. Four patients who did not improve while receiving antidepressant and placebo showed rapid remission following late olanzapine augmentation. CONCLUSIONS: Failure to demonstrate any benefit from initial combination therapy may reflect an underpowered rather than a negative study. The distinct impact of late olanzapine augmentation suggests that pretreatment with an antidepressant may be required to facilitate a rapid antidepressant response to combined treatment.

Antidepressive Agents↗

PubMed2005

Atypical depression: Australian and US studies in accord.

PURPOSE OF REVIEW: A 2004 review of 'atypical depression' in Current Opinion in Psychiatry could be read as more reifying the Columbian and DSM-IV concept rather than considering an alternative model that has been supported by independent studies undertaken in Australia and North America. Additional analyses of the Australian data set are reported to examine inter-study agreement further and to consider the implications. RECENT FINDINGS: Both studies recruited patients meeting criteria for a major depressive episode, and then contrasted patients meeting or not meeting DSM-IV criteria for definite atypical depression. In both studies, those with atypical depression were comparable in terms of female preponderance, age, age at first episode and depression severity, but developed earlier and more persistent episodes, showed a slight female preponderance, and were more likely to meet criteria for panic disorder, social phobia and hypochondriasis, and of avoidant and dependent personality styles. In both, there was a lack of evidence suggesting that atypical depression differs in severity, in being clearly less likely to have certain 'endogeneity' symptoms, or in being more likely to be associated with bipolar disorder, while neither the centrality of mood reactivity nor interdependence of symptoms could be demonstrated. SUMMARY: Findings from both studies challenge the view that atypical depression is an entity and the current model of its constituent features. Both found support for primacy of personality style (rather than mood reactivity) and for certain expressions of anxiety. Both effectively argue for and assist shaping of a revisionist model for conceptualizing atypical depression as a syndrome or spectrum disorder.

Journal Article↗

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

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↗

PubMed2002

Shrinking away from psychiatry? A survey of Australian medical students' interest in psychiatry.

OBJECTIVE: We sought to examine the attitudes of newly recruited medical students towards psychiatry and other specialties to determine what factors influence their career choice options. METHOD: We surveyed the attitudes of 655 medical students using a 31-item self-report questionnaire. RESULTS: Australian medical students rated the ability to help patients as the most important aspect of a specialty in determining their choice. Attraction to psychiatry was based on the specialty being interesting and intellectually challenging,and providing a career that promised job satisfaction with good prospects and enjoyable work. Females expressed a greater interest in psychiatry and were more likely to consider pursuing it as a career, principally due to a greater interest in the subject matter and a stronger desire for interaction with patients. The least attractive aspects of psychiatry were its lack of prestige among the medical community and a perceived absence of a scientific foundation. CONCLUSION: The attitudes of medical students can perhaps be modified and recruitment into psychiatry enhanced by presenting the reality of psychiatry today - namely the wide range of available therapeutic processes, the predominantly positive outcomes, the interesting and intellectually challenging nature of the subject and its nurturing and accommodating work environment.

Adult↗

PubMed2002

A profile of regional psychiatry publishing: home and away.

OBJECTIVE: Previous reports have profiled Australian psychiatry publishing in high-ranking international journals over the last two decades. An audit of selected high ranking and regional psychiatric journals was therefore undertaken to obtain a current profile of Australasian publishing. METHODS: Journals were selected on the basis of impact factors for the year 2000, with the top five regional, generalist and specialist journals being selected, and with publication numbers over a two-year period (1999-2000) compared with numbers from other major geographical regions. RESULTS: Of the 4573 papers identified in the 15 journals, Australasian authors contributed 269 to the regional journals (with two-thirds in the Australian and New Zealand Journal of Psychiatry), 47 to the generalist journals (with two-thirds in Psychological Medicine) and very few (23) to the specialist journals. Representation in the so-called "dominant four" international journals has increased since the 1986-1989 audit. When analysis was made of the "top nine" international journals, the Australasian representation rate was a low 1.8% and lower than most regions examined. CONCLUSIONS: If Australasian psychiatry is to advance its international presence, a greater representation rate in top-ranking international journals should be set as an objective.

Australia↗