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Biomedical subjects

R M Hirschfeld

Publications and source records attributed to R M Hirschfeld.

At least 55 records · Page 3Linked to original sources
PubMed1996

Symptomatology in dysthymic and major depressive disorder.

The lists of associated symptoms included in the DSM-III, DSM-III-R, and DSM-IV criteria for dysthymic disorder have been criticized for lacking content and discriminant validity. The literature on the content and discriminant validity of dysthymic symptoms was reviewed and relevant data from the DSM-IV Mood Disorders Field Trial were presented. These data indicate that cognitive and social-motivational symptoms are much more characteristic of dysthymic disorder than are vegetative and psychomotor symptoms. In addition, subjects with major depressive disorder exhibit higher rates of most depressive symptoms than do subjects with dysthymic disorder, but there is little evidence of qualitative distinctions in symptomatology between these conditions. Finally, after taking course and exclusion criteria into account, variations in the symptom criteria do not have a major effect on case definition.

Chronic Disease↗
PubMed1996

Reliability of diagnosis in mood disorders.

The reliability of diagnosing mood disorders is reviewed for previous and current versions of the American Psychiatric Association's DMS. Reliability is shown to improve with the increasing specificity of diagnostic criteria. The new specifiers for the course of major depression in relation to dysthymia also are shown to be reliable.

Adult↗
PubMed1996

Chronic mood disorder and depressive personality.

This article considers the relationship between chronic mood disorders and depressive personality from several perspectives. A historical overview of various theoretical, descriptive, and empirically based typologies is provided as well as a review of the relevant classifications from the psychiatric nomenclatures. The defining features of the different conceptions of chronic depression and depressive personality then are considered within the framework of dimensional models of personality, including the dimensions of positive and negative affectivity, and the five-factor model. It is proposed that these dimensional models may provide a useful integrating framework for future work in this area.

Chronic Disease↗
PubMed1996

Long-term drug treatment of unipolar depression.

Depression is characterized by a recurrent course in many patients, and as a potentially chronic illness. It therefore often requires a long-term treatment strategy. This article proposes answers to the questions involved in devising such a strategy, using the available literature. Cessation of treatment immediately after the observation of a response is associated with a high relapse rate, especially within the following 4 months, and all patients should therefore be treated for at least 3-6 months after the acute response to secure a stable remission. Patients at risk of recurrence should be considered for maintenance therapy thereafter. Such patients include those with prior episodes of depression within the last 5 years, those with a particularly severe or chronic depressive episode, those with residual symptoms scoring HAMD > 8 and also those whose age at onset was < 25 or < 60 years. Those who need maintenance therapy are likely to need it for a number of years, or indefinitely. SSRIs are better tolerated than TCAs or MAOIs and display similar efficacy in acute, continuation and maintenance treatment. They are less likely to be fatally toxic if taken in overdosage. There is growing evidence to support the use of a full therapeutic dose of antidepressant in maintenance treatment.

Antidepressive Agents↗
PubMed1996

Placebo response in the treatment of panic disorder.

A review of key placebo-controlled studies of benzodiazepines and selective serotonin reuptake inhibitors (SSRIs) over the past decade challenges the widespread view that placebo response rates resulting from clinical trials of pharmacotherapy for panic disorder are excessively high. Statistically and clinically significant drug-placebo differences have been demonstrated in large-scale trials. Further research is needed on the impact of pharmacological treatments on the medium- and long-term course of the disorder.

Benzodiazepines↗
PubMed1996

Panic disorder: diagnosis, epidemiology, and clinical course.

Panic disorder occurs frequently and present in a wide variety of medical settings. It is often comorbid with mood disorders, substance abuse disorders, and other anxiety disorders. Individuals with panic disorder have lower recovery rates than those with depression, as well as high rates of relapse, and many have a chronic course. Panic disorder is associated with numerous adverse psychological consequences, including poor general medical and emotional health, increased risk of alcohol abuse, marital and occupational dysfunction, greater use of medication, and increased emergency room use. In addition, rates of suicide attempts among individuals with panic disorder may be as high as 20% and exceed the 15% rate of suicide attempts among individuals with depression. This paper will examine the development of panic disorder and its psychological and clinical consequences.

Adolescent↗
PubMed1995

Results of the DSM-IV mood disorders field trial.

OBJECTIVE: The DSM-IV mood disorders field trial, a multisite collaborative study, was designed to explore the reliability of a course-based diagnostic classification system for major depression, evaluate the symptom criteria for dysthymia, and explore the need for additional diagnostic categories for milder forms of mood disorder (e.g., minor and recurrent brief depression). METHOD: Five hundred twenty-four depressed subjects were recruited from inpatient, outpatient, and community settings at five sites and evaluated with structured interviews according to DSM-III and DSM-III-R criteria, with careful attention to longitudinal course. Within- and across-site interrater reliability studies and 6-month test-retest reliability studies were also conducted on subsets of the sample. RESULTS: For evaluations of major depression and dysthymia, intrasite reliability was good to excellent and intersite reliability was fair to good; 6-month test-retest reliability was fair for dysthymia and poor to fair for major depression. Interrater reliability for six course of illness specifiers was fair to good, and almost all subjects could be assigned to a specific type of course. CONCLUSIONS: The results supported the use of a course-based classification system for major depression. They also suggested that the content validity of the DSM-III-R symptom criteria for dysthymia could be improved by emphasizing cognitive and social/motivational symptoms, although such changes are unlikely to sharpen the distinction between dysthymia and major depression. Finally, 91% of the subjects met the criteria for current or lifetime major depression or dysthymia, suggesting that additional categories for milder forms of depression are not needed.

Adult↗
PubMed1995

Treatment of chronic depression with sertraline or imipramine: preliminary blinded response rates and high rates of undertreatment in the community.

Despite the prevalence of chronic depression and its associated morbidity, there has been little systematic study of pharmacotherapy for this disorder. In this article, we report a preliminary analysis of the first 12-week phase of a multicenter clinical trial that will eventually include approximately 635 patients in acute, continuation, crossover, and maintenance studies of sertraline, a selective serotonin reuptake inhibitor (SSRI), and imipramine, a tricyclic antidepressant, for the treatment of chronic depression. Of the first 212 patients to enter the study, 168 completed all 12 weeks; of these, 61.3 percent were responders, including 58.9 percent of the 73 patients with chronic major depression and 63.2 percent of the 95 patients with double depression. Only 26.8 percent of the 198 patients for whom such data were available had ever had an adequate trial of an antidepressant medication, defined as 150 mg/day of imipramine or its equivalent taken for at least 4 consecutive weeks. In general, demographic and diagnostic characteristics were more similar than different for patients with chronic major and double depression. However, comorbid generalized anxiety disorder was significantly more common in patients with chronic major depression (11.2% threshold for chronic versus 4.9% threshold for double depression, p = .02). The results of this study provide preliminary evidence of the responsiveness of patients with chronic major or double depression to an SSRI or a tricyclic antidepressant.

1-Naphthylamine↗
PubMed1995

The impact of health care reform on social phobia.

According to the National Comorbidity Survey, social phobia is the third most frequent psychiatric disorder in the United States. Its lifetime prevalence rate of 13.3% ranks behind only major depressive episode (17.1%) and alcohol dependence (14.1%). As was the case with depression 15 years ago, social phobia has often been trivialized and stigmatized. For example, some with social phobia may be dismissed as having mere "stage fright" or excessive shyness, while, in fact, social phobia is a serious mental illness associated with substantial psychosocial distress, comorbidity, and morbidity. Typical onset of social phobia is in the midteens and often continues throughout an individual's lifetime, leading to severe social and occupational impairment. Several excellent, efficacious treatments are available. Access to these treatments for social phobia may be more difficult in the future due to managed care initiatives and health care reform. Various proposals are now being considered as a part of health care reform that may have significant impact on the diagnosis and treatment of social phobia.

Adolescent↗
PubMed1994

Long-term management of depression.

Major depression is often a chronic and recurrent disorder. Findings from a landmark study, the Pittsburgh Study of Maintenance Therapies in Recurrent Depression, demonstrate that full doses of antidepressants prevent recurrent depression and that maintenance therapy lasting at least 5 years may be required for patients with severely recurrent disease. In addition, psychotherapy is a useful adjunct to antidepressant maintenance therapy in prolonging the duration between recurrent episodes. The currently accepted approach to preventing recurrent depression is to treat the acute episode to full remission and follow up by maintaining the patient on the full, acute dose used to achieve the initial response. The selective serotonin reuptake inhibitors (SSRIs) have been studied in recurrent depression and are rational choices for initial maintenance therapy because of demonstrated efficacy, safety, and tolerance during long-term therapy.

Antidepressive Agents↗
PubMed1994

The National Depressive and Manic-depressive Association (DMDA) survey of bipolar members.

Members of the National Depressive and Manic-Depressive Association who have bipolar disorder were surveyed. 59% of respondents had their first symptoms during childhood or adolescence. Long delays between symptom onset, treatment-seeking, and receipt of a bipolar diagnosis were common. 45% of respondents currently experience frequent recurrences. Child/adolescent onset was associated with a positive family history, depressive or mixed initial symptoms, and frequent recurrence, with predominantly depressive symptoms. Frequent recurrences were associated with depressive or mixed initial symptoms and depressive episodes, but not with medication non-compliance. Both child/adolescent onset and frequent recurrence were associated with increased social morbidity, which was diminished by effective treatment. Respondents with frequent recurrences were less likely to be treated with mood-stabilizers, more likely to be treated with anti-depressants, or anxiolytics, and more likely to report past anxiety symptoms and diagnoses. 13% of respondents had no medical insurance, and 15% had failed to take medicine for financial reasons. The treatment of bipolar illness could be enhanced by (a) public health efforts to promote early diagnosis and treatment; (b) ensuring adequate trials of mood-stabilizers for patients with frequent recurrences; (c) further research on bipolar disorder with prominent anxiety symptoms; and (c) improved access to mental health care.

Adolescent↗
PubMed1994

The Diagnostic Interview for Depressive Personality.

OBJECTIVE: The development of a new structured interview for depressive personality disorder is described. METHOD: A literature search yielded 32 traits associated with depressive personality; these traits were then used to develop the interview. Interrater reliability for the interview was tested in an initial group of 16 patients with longstanding depressive personality traits. Data from a second group of 67 subjects--54 with a possible clinical diagnosis of depressive personality and 13 normal volunteers--were used to examine the interview's psychometric properties and to modify its content. Factor analysis of the traits in the interview and modification of the instrument's structure was carried out on the basis of data from a third group of 526 subjects who were participating in a large epidemiologic study of mood disorders. RESULTS: The Diagnostic Interview for Depressive Personality, which emerged from this process, assess 30 personality traits that were shown to have satisfactory interrater reliability (kappa = 0.67), test-retest reliability (kappa = 0.41), and diagnostic reliability (kappa = 0.62). A cutoff score of 42 (from a total possible score of 60) on the interview offers a useful threshold for diagnosis. CONCLUSIONS: This interview provides a reliable method for assessing depressive personality traits and establishing the diagnosis of depressive personality disorder.

Adult↗
PubMed1994

Depressive personality disorder: clinical implications.

Although the concept of a depressive personality has a long and rich tradition in psychiatry, it has only recently been included in any official nomenclature. Those afflicted with depressive personality have been subsumed under a variety of mood disorders and other personality disorders. This article presents criteria for depressive personality disorder that were developed for the DSM-IV Task Force. A framework for validating a personality disorder, including that of depressive personality disorder, is presented. Results of the DSM-IV Mood Disorders Field Trial relevant to this issue are reported in the article. Results show that DSM-IV depressive personality disorder identifies a group of patients whose diagnosis does not overlap substantially with major depression, dysthymia, or early-onset dysthymia; the patients have significant social and occupational morbidity. These results provide significant evidence to justify the validity of depressive personality disorder.

Adult↗
PubMed1994

Guidelines for the long-term treatment of depression.

Depression is frequently a recurrent and sometimes a chronic illness. Unfortunately, most research on treatment has focused almost exclusively on the short-term. For example, the majority of clinical trials of medications and psychotherapeutic approaches last only 6 to 16 weeks. Relatively little research has been conducted on continuation treatment (usually 3-6 months) to prevent relapses and on maintenance treatment (6-24 months) to prevent recurrences. This paper will review continuation and maintenance phase pharmacotherapeutic trials and will make recommendations for clinical treatment of patients during these periods.

Adult↗
PubMed1994

Major depression, dysthymia and depressive personality disorder.

The separation of persistent depression into meaningful and useful subcategories, including major depression, dysthymia, recurrent brief depression, and depressive personality disorder, is the subject of much debate. Depressions can be grouped on the basis of their type and severity of symptoms, aetiology, clinical course, or their association with other psychiatric illnesses. Several investigators have conducted epidemiologic and family studies to evaluate the prevalence of depressive disorders, their diagnostic stability over time, and the amount of overlap among the disorders. Although progress has been made toward a better understanding of the different disorders, insufficient evidence exists to support the hypothesis that these disorders are separate and distinct from one another. However, preliminary data suggest that depressive personality disorder is separate from the other disorders. Additionally, several questions have been raised, particularly the extent to which differentiation between the depressive disorders, specifically major depression and dysthymia, has an impact on treatment decisions.

Adolescent↗
PubMed1992

Time to recovery, chronicity, and levels of psychopathology in major depression. A 5-year prospective follow-up of 431 subjects.

The course of illness of 431 subjects with major depression participating in the National Institute of Mental Health Collaborative Depression Study was prospectively observed for 5 years. Twelve percent of the subjects still had not recovered by 5 years. There were decreasing rates of recovery over time. For example, 50% of the subjects recovered within the first 6 months, and then the rate of recovery declined markedly. Instantaneous probabilities of recovery reflect that the longer a patient was ill, the lower his or her chances were of recovering. For patients still depressed, the likelihood of recovery within the next month declined from 15% during the first 3 months of follow-up to 1% to 2% per month during years 3, 4, and 5 of this follow-up. The severity of current psychopathology predicted the probability of subsequent recovery. Subjects with moderately severe depressive symptoms, minor depression, or dysthymia had an 18-fold greater likelihood of beginning recovery within the next week than did subjects who were at full criteria for major depressive disorder. Many subjects who did not recover continued in an episode that looked more like dysthymia than major depressive disorder.

Adolescent↗
PubMed1991

Depressive illness: diagnostic issues.

Mental health professionals have made significant advances in the understanding of depression, yet controversies continue about the classification of subtypes. After reviewing the history of approaches to the diagnosis of depression, the author summarizes current knowledge of the clinical course of the illness and the relevance of this knowledge to diagnosis. He concludes with a discussion of the renewed interest in depressive personality disorder and its relationship to the official nomenclature, as well as to related disorders.

Depressive Disorder↗