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PubMed2000

Mixed anxiety-depressive disorder and major depressive disorder: comparison of the severity of illness and biological variables.

Mixed anxiety-depressive disorder (MADD) is a new diagnostic category defining patients who suffer from both anxiety and depressive symptoms of limited and equal intensity accompanied by at least some autonomic features. Patients do not meet the criteria for specific anxiety or depressive disorders. The emergence of the symptoms is independent of stressful life events. There are many issues presently under investigation about the validity of this clinical entity. In this study, a group of 29 patients with MADD was compared with a group of 31 patients with major depressive disorder (MDD) to assess the differences and similarities between these two disease categories in terms of severity measures and biological variables. The dexamethasone suppression test (DST) was employed, and thyroid hormones and thyrotropin (TSH) levels were measured for the evaluation of hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-thyroid (HPT) axes, respectively. The patients with MADD were found to be less depressive and more anxious compared to those with MDD. DST responses and thyroid functions were found to be similar in the two groups. When severity of depression was controlled, k(max) and 2300-h cortisol values were found to be significantly higher in the MADD group. Although the patients with MDD and MADD presented with relatively different clinical features, there is not enough biological evidence indicating that MADD represents a discrete diagnostic category. However, there may be relatively higher HPA activity in MADD patients.

Adult↗
PubMedDate not supplied

Advocating for mental health services for children with depressive disorders.

Depressive disorders can have far-reaching effects on functioning and future adjustment of children. Early identification and referral for treatment are crucial for the emotional well-being of the child and family (NIMH, 2000). Pediatric nurses/NPs are key players in assuring that children receive these services. Although the pediatric nurses and NPs have not always advocated for mental health services for children, it is important we take up this cause.

Child↗
PubMed1994

Common psychiatric disorders in cancer patients. I. Adjustment disorders and depressive disorders.

A high prevalence of adjustment and depressive disorders has been reported in oncology. These conditions are highly treatable, therefore the assumption that emotional distress is just a foreseeable and ordinary reaction to cancer had to be reviewed. Clinical presentation, etiology, assessment, and therapy of adjustment and depressive disorders are summarized in order to optimize supportive care.

Adjustment Disorders↗
PubMed2002

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders, Part 2: Maintenance treatment of major depressive disorder and treatment of chronic depressive disorders and subthreshold depressions.

These practice guidelines for the biological treatment of unipolar depressive disorders were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal for developing these guidelines was to systematically review all available evidence pertaining to the treatment of the complete spectrum of unipolar depressive disorders, and to produce a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians seeing and treating patients with these conditions. The data used for developing these guidelines have been extracted primarily from various national treatment guidelines and panels for depressive disorders, as well as from meta-analyses and reviews on the efficacy of antidepressant medications and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and was then categorized into four levels of evidence (A-D). The first part of these WFSBP guidelines on unipolar depressive disorders covered the acute and continuation treatment of major depressive disorder (Bauer et al 2002). This second part of the guidelines covers the management of the maintenance-phase treatment of major depressive disorder, as well as the treatment of chronic and subthreshold depressive disorders (dysthymic disorder, double depression, minor depressive disorder and recurrent brief depression). These guidelines are primarily concerned with the biological treatment (including antidepressants, lithium, other psychopharmacological and hormonal medications, and electroconvulsive therapy) of young adults and also, albeit to a lesser extent, children, adolescents and older adults.

Adolescent↗
PubMed2003

[Agreement in physicians' and patients' assessment of depressive disorders].

Depression is one of the most frequently encountered mental health disorders in primary care. The health and financial burden caused by this disorder emphasise the clinical importance of depressive disorders. Research shows that these conditions often remain unrecognised and untreated. The aim of this study is to analyse if and how primary care physicians identify this condition in comparison to the patients' self-evaluation. A total of 1,233 cases in 32 primary care physicians' offices were examined to see if symptoms of depression were recognised. The assessment procedures were evaluated, too. In this study, the prevalence of depressive disorders was 10%, and the recognition rate of primary care physicians 45%. These results underscore the importance of improving physicians' recognition of depression and use of ICD-10 criteria for differential diagnosis. Conclusions must be drawn for a specific training of primary care physicians that focuses on the improvement of diagnosis and treatment of depressed patients.

Depressive Disorder↗
PubMed2002

[Allele polymorphism of the serotonin transporter gene and clinical heterogeneity of depressive disorders].

Depression disorders are a clinically heterogeneous disease group. Their development is to a substantial extent underlain by dysfunction of the serotonin system, in particular, disturbed serotonin transport. The heterogeneity of depressions is associated, among other factors, with the age at disease onset. Allele polymorphism of the serotonin transporter (5-HTT) gene was tested for association with age at disease onset, clinical signs, and anxiety-related traits of depression patients. A sample included 77 patients (mean age 61.2 +/- 8.8 years) with late-onset depression (LOD, mean age at onset 56.58 +/- 9.7 years) and 74 patients (mean age 31.0 +/- 11.8 years) with early-onset depression (EOD, mean age at onset 23.9 +/- 7.4 years). In genotype frequency distribution of two 5-HTT gene polymorphism, the LOD and EOD groups did not differ from each other (chi 2 = 0.33, P = 0.85 for VNTR-17; chi 2 = 3.33, P = 0.19 for HTTLPR) and from a control group (chi 2 = 0.34, P = 0.84 for VNTR-17; chi 2 = 2.1, P = 0.35 for HTTLPR). In either group, patients differing in VNTR-17 and HTTLPR genotypes did not differ in psychological traits and, in particular, in anxiety-related traits. In the case of the HTTLPR polymorphism, LOD patients with genotype ss tended to display less severe neuroticism (t = 2.03, P = 0.0507) and scored significantly less on the Hamilton depression scale (t = 2.19, P = 0.039). Thus, the 5-HTT gene polymorphisms do not affect the risk of depression but is possibly associated with specific clinical signs of the disease, at least in elderly patients.

Age of Onset↗
PubMed2003

Alexithymia in somatoform and depressive disorders.

OBJECTIVE: Alexithymia and its association with attribution styles, amplification and illness attitudes was studied among subjects with somatoform disorders, depressive disorders and normal subjects. METHODS: Two groups of 30 subjects each, bearing diagnoses of somatoform disorder and depressive disorder respectively (ICD-10 DCR), and one group of 30 normal controls were recruited. The study subjects were assessed using the Toronto Alexithymia Scale and scales for assessing attribution styles, amplification and illness attitudes. RESULTS: Mean alexithymia scores in the somatoform (60.4) and depressive disorder groups (62.5) were higher than in normal subjects (54.2). In the somatoform disorder group, total alexithymia and 'difficulty describing feelings' scores positively correlated with psychological attribution (the latter correlation was also noted in the depressive disorder group), but not with the illness attitudes, amplification, somatic attribution scores or any of the sociodemographic variables. Compared with normal subjects, those with somatoform and depressive disorder had greater difficulty in identifying bodily sensations and feelings. Subjects with depressive disorder had more difficulty in expressing feelings compared to somatoform disorder subjects. CONCLUSIONS: While total alexithymia scores do not differentiate somatoform from depressive disorders, the two diagnostic groups do differ in that depressed subjects have greater difficulty in expressing feelings. However, all three groups had mean scores within the non-alexithymic range. Alexithymia and difficulty in expressing feelings were associated with psychological attribution of innocuous bodily sensations in the somatoform disorder group suggesting that alexithymic subjects are more able to psychologize bodily symptoms than non-alexithymic subjects. Somatoform and depressive disorder subjects and normals differ from each other in certain alexithymic characteristics, which could have potential therapeutic implications.

Adult↗
PubMed2002

Association between panic disorder, major depressive disorder and celiac disease: a possible role of thyroid autoimmunity.

OBJECTIVE: To evaluate the association between celiac disease and specific anxiety and depressive disorders and to identify potential common pathogenetic links, with particular regard to thyroid function and autoimmunity. METHODS: Cases included 36 adult celiac patients, 25 females and 11 males, aged 18-64 years. Controls comprised 144 healthy subjects matched by sex and age with no clinical evidence or family history of celiac disease. Diagnosis of celiac disease was made on the basis of clinical history and serological criteria. Psychiatric diagnoses were formulated using the International Composite Diagnostic Interview, according to DSM-IV criteria. Thyroid was evaluated by palpation, echography and measurement of serum-free thyroid hormones (FT4, FT3), thyroid-stimulating hormone (TSH) and antithyroid autoantibodies (anti-TPO). RESULTS: Compared to controls, a significantly higher number of celiac patients met criteria for lifetime [15 (41.7%) versus 30 (29.8%), P < .01] and 6-month [7 (19.4%) versus 9 (6.2%), OR = 3.2, chi(2) = 5.2, P < .05] major depressive disorder (MDD) and lifetime [5 (13.9%) versus 3 (2.1%), P < .001] and 6-month [3 (8.1%) versus 2 (1.4%), P < .05] panic disorder (PD). Anti-TPO prevalence was significantly higher in celiac patients than in the control group (11/36 = 30.5% versus 14/144 = 9.7%, P < .001). A higher frequency of PD and MDD was found in celiac patients with positive anti-TPO when compared to negative anti-TPO patients (4/11 = 36.4% PD in TPO+ versus 1/25 = 4% PD in TPO-, P < .01; 9/11 = 81.8% MD in TPO+ versus 6/25 = 9.5% MD in TPO-, P < .01). CONCLUSION: Patients affected by celiac disease tend to show a high prevalence of PD and MDD and association with subclinical thyroid disease appears to represent a significant risk factor for these psychiatric disorders.

Adolescent↗
PubMed1990

Relationship between anxiety disorders and depressive disorders in patients with cerebrovascular injury.

The interaction between anxiety disorder and major depressive disorder in patients with cerebrovascular lesions was examined in a controlled, 2 x 2 study design. A consecutive series of 24 patients who met criteria for major depression only were compared with 6 patients who met criteria for both major depression and generalized anxiety disorder, and 45 patients who did not meet criteria for either major depression of generalized anxiety. Among patients with positive computed tomographic scans, the anxious-depressed group (n = 19) showed a significantly higher frequency of cortical lesions, while patients with major depression only (n = 15) had a significantly higher frequency of subcortical (basal ganglia) strokes. No significant between-group differences were found in other variables, such as demographic variables, familial and personal history of psychiatric disorders, and neurologic deficits. These findings suggest that, in this mostly black, low-socioeconomic-status population, cortical vs subcortical lesion location may play an important role in determining whether severe anxiety occurs in patients with post-stroke major depression.

Anxiety Disorders↗
PubMed1994

The prevalence of respiratory disorders in panic disorder, major depressive disorder and V-code patients.

Point prevalence and lifetime prevalence of respiratory disorders were assessed in 100 panic disorder (PD), 100 major depressive disorder (DD) and 100 V-code (VC) patients. Both current and past frequency of respiratory diseases were significantly higher in PD patients in comparison to VC patients, while no significant differences in point and lifetime prevalence between PD and DD or DD and VC patients were observed. It is hypothesized that a disturbed respiratory physiology may have differential effects depending upon the nature of the disorder and the appraisal by the patient.

Adult↗
PubMed2006

Neurodevelopmental origins of depressive disorders.

Depression is a common and devastating neuropsychiatric disorder, and a better understanding of its pathophysiology is needed to improve diagnosis, treatment and prevention. By considering the developmental dimensions of genetic and environmental factors, new insights have been found into the etiology and pathophysiology of depression. Specifically, we begin to understand how certain vulnerability factors affect the maturation of brain circuits involved in emotional function to increase the risk for depressive disorders later in life. These new findings might help us to better categorize and manage this complex disease.

Animals↗
PubMed2004

Serum lipid concentrations in Croatian veterans with post-traumatic stress disorder,post-traumatic stress disorder comorbid with major depressive disorder,or major depressive disorder.

The aim of this study was to assess eventual differences in serum cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, LDL-C/HDL-C ratio between veterans with combat-related post-traumatic stress disorder (PTSD) only or comorbid with major depressive disorder (MDD), veterans with combat experiences with MDD, and healthy control group. PTSD and/ or MDD were diagnose according to structured clinical interview based on DSM-IV criteria. Additional criteria to diagnose PTSD were Clinician Administered PTSD Scale (CAPS), and to diagnose MDD Montgomery-Asberg Depression Rating Scale (MADRAS). Serum lipid concentrations were determined by using the enzyme-assay method. Veterans with combat-related PTSD as well as veterans with combat-related PTSD comorbid with MDD showed significantly higher concentrations of cholesterol (F=9.858, p<0.01), triglycerides (F=10.112, p<0.01), LDL-C (F=11.145, p<0.01), and LDL-C/HDL-C ratio (F=8.346, p<0.01) vs. veterans with MDD or healthy control group. Contrary healthy control group and veterans with MDD showed significantly higher concentrations of HDL-C (F=8.421, p<0.01), vs. veterans with PTSD or PTSD comorbid with MDD. In conclusion, there are no differences in serum lipid concentrations between veterans with combat-related PTSD and PTSD comorbid with MDD, but they have higher lipid concentrations than veterans with MDD or healthy control subjects.

Adult↗
PubMed1989

Noradrenergic function in generalized anxiety disorder, major depressive disorder, and healthy subjects.

Plasma norepinephrine (NE), free 3-methoxy-4-hydroxyphenethylene glycol (MHPG), and binding of tritiated yohimbine to platelet membranes were measured in 14 patients with generalized anxiety disorder (GAD), who were matched for age and sex with 14 patients with unipolar major depressive disorder (MDD) and 14 normal subjects. Plasma NE and MHPG levels were increased and the number of alpha2-adrenoreceptors (Bmax) was decreased in GAD patients compared with MDD and normal subjects. No differences were found between MDD patients and normal subjects for plasma NE, MHPG, and alpha2-adrenoreceptor binding. Plasma NE and MHPG were significantly correlated in MDD patients and tended toward a significant positive correlation in GAD patients. Plasma MHPG and affinity of binding platelet alpha2-adrenoreceptors (Kd) were significantly correlated in normal subjects. Thus, noradrenergic activity seems to be increased in patients with GAD, but not in patients with MDD. In GAD patients, higher levels of catecholamines may lead to a down-regulation of presynaptic alpha2-adrenoreceptors.

Adult↗
PubMed1983

Schizophrenia, conduct disorder and depressive disorder: neuropsychological, speech sample and EEG results.

The relationship between degree of schizophrenia and neuropsychological impairment was investigated in 24 adolescent and adult hospitalized and non-hospitalized psychiatric patients with diagnoses of depressive disorder, conduct disorder, and schizophrenia. Schizophrenic adults and conduct disordered adolescents showed greater cognitive impairment than depressed patients on a neuropsychological test of rhythm perception and attention and showed greater frequency of EEG abnormality. Schizophrenics were differentiated from other groups by their impaired abstraction ability on the Halstead-Reitan Category Test. Use of these tests for prediction of adolescents at high risk for schizophrenia was discussed.

Adolescent↗
PubMed1998

Major depressive disorder and depressive symptomatology as predictors of husband to wife physical aggression.

This study investigated the association between a husband's depressive symptomatology and the frequency of physical aggression toward his wife, as well as a husband's Major Depressive Disorder (MDD) and the frequency of physical aggression toward his wife. We assessed physically aggressive men who volunteered for treatment with their wives (N = 89). Almost one third had moderate levels of depressive symptomatology (Beck Depression Inventory [BDI > or = 14]), but only 11% met criteria for MDD (based on a structured interview [SCID]). Although the rate of MDD was not absolutely high, it was higher than that reported in a community sample (i.e., 3%). A significant relationship between increased depressive symptomatology and frequency of physical aggression was found, but the association was most likely accounted for by self-reported anger. Related contextual factors including marital discord and psychological aggression are addressed. Theoretical and treatment implications are discussed, including the severity of the treatment population (volunteer vs. court mandated), and severity of the depression (symptomatology vs. clinical diagnosis).

Adult↗
PubMed2006

Diurnal mood variation in major depressive disorder.

Depression disturbs mood, but a clear picture of diurnal mood rhythms in depression has yet to emerge. This study examined variations in positive affect (PA) and negative affect (NA), two dimensions of mood that generate diurnal patterns among healthy individuals. Repeated measurements of NA and PA in daily life were obtained over 6 days from 47 depressed outpatients and 39 healthy individuals using the Experience Sampling Method. Relative to healthy individuals, depressed individuals exhibited increasing PA levels during the day with a later acrophase. In contrast, depressed persons' NA exhibited a more pronounced diurnal rhythm and was more variable from moment to moment than healthy individuals'. Ambulatory mood measurements in depression suggest distinct diurnal disturbances of positive and negative affect.

Activities of Daily Living↗
PubMed2002

Sadness and amusement reactivity differentially predict concurrent and prospective functioning in major depressive disorder.

Depressed individuals often fail to react to emotionally significant stimuli. The significance of this pattern of emotional dysregulation in depression is poorly understood. In the present study, depressed and nondepressed participants viewed standardized neutral, sad, fear, and amusing films; and experiential, behavioral, and physiological responses to each film were assessed. Compared with nondepressed controls, depressed participants reported sadness and amusement in a flattened, context-insensitive manner. Those depressed participants who reported the least reactivity to the sad film exhibited the greatest concurrent impairment. Prospectively, the depressed participant who exhibited the least behavioral and heart rate reactivity to the amusing film were the least likely to recover from depression. Loss of the context-appropriate modulation of emotion in depression may reflect a core feature of emotion dysregulation in this disorder.

Adaptation, Psychological↗