Is it time for a Canadian Institute of Mental Illness and Mental Health Research?
Explore the source record for details and available documents.
Academic Medical Centers↗
Biomedical subjects
M Enns
Publications and source records attributed to M Enns.
"Are you depressed?" Screening for depression in the terminally ill.
OBJECTIVE: This study compared the performance of four brief screening measures for depression in a group of terminally ill patients. The methods included 1) a single-item interview assessing depressed mood, 2) a two-item interview assessing depressed mood and loss of interest in activities, 3) a visual analog scale for depressed mood, and 4) the Beck Depression Inventory-Short Form. METHOD: Semistructured diagnostic interviews for depression were administered to 197 patients receiving palliative care for advanced cancer. The interview diagnoses served as the standards against which the screening performance of the four brief screening methods was assessed. RESULTS: Single-item interview screening correctly identified the eventual diagnostic outcome of every patient, substantially outperforming the questionnaire and visual analog measures. CONCLUSIONS: Brief screening measures for depression are important clinical tools for terminally ill patients. For diagnostic purposes, however, they do not approach the validity of a single-item interview that asks, in effect, "Are you depressed?"
Aged↗
Hippocampal neurons are damaged by caffeine-augmented electroshock seizures.
Caffeine-augmented electroconvulsive therapy has been introduced into medical practice without experimental confirmation that such seizure modification does not result in neuronal injury. In this report rats pretreated with caffeine prior to a series of nine electrically induced convulsions showed neuronal injury confined to hippocampal sectors and striatum. Electrically induced convulsions without caffeine pretreatment did not result in injury. The potential deleterious effects of caffeine augmentation of human electroconvulsive therapy require rigorous clinical assessment.
Animals↗
Desire for death in the terminally ill.
OBJECTIVE: Euthanasia and physician-assisted suicide have become prominent medical and social issues. This study investigated the prevalence of the desire for death in terminally ill patients, the stability of this desire over time, and its association with psychiatric disorders. METHOD: Two hundred terminally ill inpatients were given semistructured interviews that assessed their desire for death and evaluated them for major and minor depressive episodes according to the Research Diagnostic Criteria. Each patient also completed a short form of the Beck Depression Inventory and provided ratings of pain and social support. When possible, patients who expressed a desire for death received a follow-up interview after a 2-week interval. RESULTS: Although occasional wishes that death would come soon were common (reported by 44.5% of the patients), only 17 (8.5%) of these individuals acknowledged a serious and pervasive desire to die. The desire for death was correlated with ratings of pain and low family support but most significantly with measures of depression. The prevalence of diagnosed depressive syndromes was 58.8% among patients with a desire to die and 7.7% among patients without such a desire. Follow-up interviews were conducted with six patients; in four cases, the desire to die had decreased during the 2-week interval. CONCLUSIONS: The desire for death in terminally ill patients is closely associated with clinical depression--a potentially treatable condition--and can also decrease over time. Informed debate about euthanasia should recognize the importance of psychiatric considerations, as well as the inherent transience of many patients' expressed desire to die.
Adult↗
Electrical dose titration for electroconvulsive therapy: a comparison with dose prediction methods.
Recent literature on electroconvulsive therapy (ECT) emphasizes the use of moderately suprathreshold electrical stimuli for clinical ECT. Since there is substantial interpatient variability in seizure thresholds, individualization of the ECT stimulus dose has been advocated. Three methods for selecting an electrical stimulus are compared in the present study. The methods compared include empirical titration and dose predictive methods described by two different ECT equipment instruction manuals. The use of ECT stimulus titration was found to be a more consistent means of selecting an electrical dose than either of the two predictive methods. The implications of these findings for the clinical practice of ECT are discussed.
Adolescent↗
Prevalence of depression in the terminally ill: effects of diagnostic criteria and symptom threshold judgments.
OBJECTIVE: Two issues that may influence the diagnosis of depression in the medically ill are 1) the severity with which symptoms must be expressed before they are considered clinically significant and 2) how to deal with somatic symptoms that may be caused by medical illness. This study used different approaches to case identification to examine prevalence rates for major and minor depression in a group of terminally ill cancer patients. METHODS: Semistructured diagnostic interviews were conducted with 130 patients receiving palliative care. Diagnoses according to the Research Diagnostic Criteria (RDC) were compared with diagnoses according to Endicott's revised criteria (which involve replacing somatic symptoms with non-somatic alternatives) when either a low-severity or a high-severity threshold for classifying RDC criterion A symptoms was used. RESULTS: A low-threshold (less stringent) diagnostic approach greatly increased the overall prevalence of major and minor depressive episodes with both the RDC and the Endicott criteria. With high thresholds, the RDC and the Endicott criteria were equivalent, whereas with low thresholds the Endicott substitutions identified fewer cases of major (but not minor) depression. CONCLUSIONS: Small differences between investigators in the applications of symptom-severity thresholds can result in large differences in prevalence rates for depression. However, the inclusions of somatic symptoms in the diagnostic criteria inflates the rates of diagnosis only when these symptoms are used in conjunction with a low-threshold approach.
Aged↗
Thyroid screening tests in psychiatric inpatients.
This study reports on a retrospective evaluation of the current practice of screening for thyroid dysfunction in an adult psychiatric inpatient program. Sixty-four percent of 342 admissions were tested during their hospital stay. Although 13.7% of tests yielded abnormal values on one or more of the thyroid indices, only 0.9% resulted in a diagnosis of hypothyroidism. None of the other abnormal test results led to any specific action being taken. The present pattern of use of thyroid function screening as observed in this study does not appear optimal. Issues in the selection of thyroid screening tests, and the value of the results obtained are discussed.
Adult↗
Electrical dosage and efficacy in electroconvulsive therapy.
The traditional view is that the elicitation of a series of generalized cerebral seizures is the essential requirement for efficacious electroconvulsive therapy (ECT). This theory is the basis of many recent recommendations that the minimum electrical dose required to elicit generalized seizures should be used. Evidence challenging this theory is reviewed, which suggests a role for supra-threshold electrical stimulation in ECT. Hypotheses to explain these findings are examined, and recommendations are made.
Cerebral Cortex↗
Effects of d-amphetamine and fenfluramine on feeding pattens and activity of obese and lean Zucker rats.
The effects of two doses of d-amphetamine and fenfluramine on male Zucker rats maintained ad lib on solid and liquid diets were investigated using the technique of meal pattern analysis. Amphetamine-induced anorexia was of short duration in both obese and lean rats. In the lean rats, anorexia was followed by rebound feeding resulting in little or no reduction in total daily intake. The drug reduced meal sizes of obese but not lean rats and caused a transient decrease in meal frequency. Increased spontaneous activity paralleled the decreased food intake. In contrast, anorexia following fenfluramine was greater, more prolonged and of equivalent magnitude in obese and in lean rats. No rebound feeding was observed. Reduction in intake was achieved primarily by changes in meal size rather than in meal frequency. These data demonstrate that food intakes of genetically obese Zucker rats are more susceptible to the action of d-amphetamine than those of lean rats, and are consistent with reports of differential neurotransmitter levels in the obese and lean rats.
Animals↗
Depression, Hopelessness, and suicidal ideation in the terminally ill.
This study investigated the mediational hypothesis of hopelessness in predicting suicidal ideation in a group of 196 patients with advanced terminal cancer. Each patient underwent a semistructured interview to assess hopelessness and suicidal ideation, and also completed the Beck Depression Inventory (short form). Hopelessness was correlated more highly with suicidal ideation than was the level of depression. In multiple linear-regression analyses, hopelessness contributed uniquely to the prediction of suicidal ideation when the level of depression was controlled. For health care providers attending to the needs of dying patients, hopelessness appears to be an important clinical marker of suicidal ideation in this vulnerable patient population.
Aged↗