Natural Solution for Depression Found

Destroy Depression

Destroy Depression is written by James Gordon, a former sufferer of depression from the United Kingdom who was unhappy with the treatment he was being given by medical personnell to fight his illness. Apparently, he stopped All of his medication one day and began to search for answers on how to cure himself of depression in a 100% natural way. He spent every waking hour researching all he could on the subject, making notes and changing things along the way until he had totally cured his depression. Three years later, he put all of his findings into an eBook and the Destroy Depression System was born. The Destroy Depression System is a comprehensive system that will guide you to overcome your depression and to prevent it from injuring you mentally and physically. Read more...

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Acute Treatment of Major Depression

The first acute study of IPT was a four-cell, 16-week randomized trial comparing IPT, amitriptyline (AMI), combined IPT and AMI, and a non-scheduled control treatment for 81 outpatients with major depression (DiMascio etal., 1979 Weissman etal., 1979). Amitripty-line more rapidly alleviated symptoms, but at treatment completion there was no significant difference between IPT and AMI in symptom reduction. Each reduced symptoms more efficaciously than the control condition, and combined AMI-IPT was more efficacious than either active monotherapy. One-year follow-up found that many patients remained improved after the brief IPT intervention. Moreover, IPT patients had developed significantly better psychosocial functioning at one year, whether or not they received medication. This effect on social function was not found for AMI alone, nor was it evident for IPT immediately after the 16-week trial (Weissman et al., 1981). The ambitious, multi-site National Institute of Mental Health...

Schizophrenia bipolar disorder and major depressive disorder

All three major psychiatric disorders, schizophrenia, bipolar disorder (BP) and major depressive disorder (MDD) affect brain cytoarchitecture. Along with numerous histopathological signals of neuronal malfunction (e.g. reduction in neuronal size, dendritic length and dendritic spines density), these diseases also affect glial cells. There are some indications for loss of astrocytes and GFAP expression in schizophrenia, BP and MDD. In BP and MDD, significant decreases in the numbers and volume of astroglial cells were detected in prefrontal and

Geriatric Depressed Patients

Interpersonal therapy was initially used as an addition to a pharmacotherapy trial of geriatric patients with major depression to enhance compliance and to provide some treatment for the placebo control group (Rothblum et al., 1982 Sholomskas et al., 1983). Investigators noted that grief and role transition specific to life changes were the prime interpersonal treatment foci. These researchers suggested modifying IPT to include more flexible duration of sessions, more use of practical advice and support (for example, arranging transportation, calling physicians) and recognizing that major role changes (such as divorce at age 75) may be impractical and detrimental. The six-week trial compared standard IPT to nortriptyline in 30 geriatric depressed patients. Results showed some advantages for IPT, largely due to higher attrition from side effects in the medication group (Sloane, Stapes & Schneider, 1985). Reynolds et al. (1999) conducted a three-year maintenance study for geriatric...

Conjoint IPT for Depressed Patients with Marital Disputes IPTCM

It is well established that marital conflict, separation and divorce can precipitate or complicate depressive episodes (Rounsaville et al., 1979). Some clinicians have feared that individual psychotherapy for depressed patients in marital disputes can lead to premature rupture of marriages (Gurman & Kniskern, 1978). To test and address these concerns, Klerman and Weissman developed an IPT manual for conjoint therapy of depressed patients with marital disputes (Klerman & Weissman, 1993). Both spouses participate in all sessions and treatment focuses on the current marital dispute. Eighteen patients with major depression linked to the onset or exacerbation of marital disputes were randomly assigned to 16 weeks of either individual IPT or IPT-CM. Patients in both treatments showed similar improvement in depressive symptoms but patients receiving IPT-CM reported significantly better marital adjustment, marital affection and sexual relations than did individual IPT patients (Foley et al.,...

Mood Disorders A Major Depressive Disorder

In some cultures, symptoms of depression are not generally recognized as a case for mental disorders. In addition, symptoms of depression might be presented in somatic terms rather than sadness or guilt (Castillo, 1997). For example, among Latin American and Mediterranean cultures depressive experiences might be manifested in terms of complaints of nerves and headaches Asians may show similar experiences in terms of weakness, tiredness, or imbalance, whereas among people from the Middle East and American Indian tribes these experiences might be shown in terms of difficulties with the heart or being Heartbroken, respectively (see DSM-IV, 1994, pp. 324-325). The severity of the depression might also be evaluated differently across cultures (e.g., sadness may lead to less concern than irritability in some cultures). Hallucinations and delusions, which are sometimes part of Major Depressive Disorder, should be differentiated from cultural hallucinations and delusions (e.g., fear of being...

Antidepressants SSRI group

Their prescription to child patients however, has become very controversial, because of lack of evidence of effectiveness in this patient group, and also concern over increased suicide risk. Recent NICE guidance is that 'antidepressant medication should not be used for the initial treatment of children and young people with mild depression' even in moderate to severe depression the place of medication is given as 'brief psychological therapy + - fluoxetine' (http www.nice. On the face of it, there seems to be some discrepancy between this and the NICE guidance for adults 'When an antidepressant is to be prescribed in routine care, it should be a selective serotonin reuptake inhibitor (SSRI)' (http www. However, NICE is really preaching to the choir on this. SSRIs have been vigorously promoted, and have been commercially successful. Many GPs use them as first-line treatment for depressive illness, on the basis of claimed therapeutic advantages that have not always stood up to critical...

Antidepressant medication

The initial choice of an antidepressant depends on the age and sex of the patient, prior response to medication, safety in overdosage and the sideeffect profile. All antidepressants are equally efficacious. The tricyclics and tetracyclics have been the first-line drugs but the newer drugs, the selective serotonin reuptake inhibitors and moclobemide (a reversible monoamine oxidase inhibitor (MAOI) antidepressant) are equally effective, are better tolerated, have a wider safety margin 6 and are now considered first-line drugs.

Depression and depressive disorders

Depression or depressive disorders (unipolar depression) are mental illnesses characterized by a profound and persistent feeling of sadness or despair and or a loss of interest in things that were once pleasurable. Disturbance in sleep, appetite, and mental processes are a common accompaniment. Everyone experiences feelings of unhappiness and sadness occasionally. But when these depressed feelings start to dominate everyday life and cause physical and mental deterioration, they become what are known as depressive disorders. Each year in the United States, depressive disorders affect an estimated 17 million people at an approximate annual direct and indirect cost of 53 billion. One in four women is likely to experience an episode of severe depression in her lifetime, with a 10-20 lifetime prevalence, compared to 5-10 for men. The average age a first depressive episode occurs is in the mid-20s, although the disorder strikes all age groups indiscriminately, from children to the elderly....

Diagnosis of depressive illness

Most episodes of depression are brief and mild, and are dealt with by the patient's own resources, or by talking with a relative or friend. Of those patients who do present for help, the vast majority are dealt with in primary care. The diagnosis of depressive illness in clinical settings will have some regard to the official classifications set out above. However, clinical training and experience also comes into play. Mild reactions to difficulties experienced in life may not in practice be diagnosed as clinical depression. The clinician should look for features such as biological symptoms of depression, anhedonia, and guilt before entertaining the diagnosis. Depressed mood which seems unduly severe or prolonged in relation to its apparent precipitant, the presence of somatic symptoms, and prominent guilt, pessimism, anhedonia, suicidal thinking, and low self-esteem, all suggest depressive illness.

Classification of depressive illness in the ICD

Two or three of the above symptoms are usually present. The patient is usually distressed by these but will probably be able to continue with most activities. F32.1 Moderate depressive episode. Four or more of the above symptoms are usually present and the patient is likely to have great difficulty in continuing with ordinary activities. F32.2 Severe depressive episode without psychotic symptoms. An episode of depression in which several of the above symptoms are marked and distressing, typically loss of self-esteem and ideas of worthlessness or guilt. Suicidal thoughts and acts are common and a number of 'somatic' symptoms are usually present. There are obvious problems with the practical use of ICD in daily clinical psychiatry, however. For example, there is no minimum time period. If one takes the description literally, a person who has a brief episode of, say, 'decrease in activity . . . and . . . marked tiredness after even minimum effort', and who...

Pharmacologic Treatments Antidepressants

Many of the treatment studies of depression in dementia are difficult to compare given varying diagnostic categories (symptoms vs. depressive syndromes) and types of studies performed (case reports, case series, chart reviews, open trials). Results of the four placebo-controlled outcome trials of antidepressants in patients with AD who met criteria for major depression are shown in Table 10.3. concern that the tricyclic antidepressants (TCAs) increase vulnerability to anticholinergic effects, including cognitive decrements, by blocking brain muscarinic cholinergic receptors. TCAs have been noted to cause cognitive changes with even low doses (such as imipramine 25 mg day) in depressed AD patients (Teri, 1991). Although the SSRIs are not free of side effects, anticholinergic effects are considerably less problematic. As shown in Table 10.3, only one placebo-controlled trial has addressed the use of an SSRI in major depression in dementia this trial found significantly greater...

Depressive illness and mania

Mood disorders (affective disorders) include depressive illness and mania. These are episodic conditions, occurring only once or twice in a lifetime for some patients but recurring at frequent intervals for others, usually with good recovery between episodes. Unipolar affective disorder single or recurrent depressive episode(s), without manic ones. This forms the vast majority of patients with affective disorders.


The reported frequency of depression in DLB varies between 30 and 50 . Rates may be slightly less frequent when Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV American Psychiatric Association, 1994) criteria for major depression are used and slightly higher if only depressive symptoms are assessed. The literature is also conflicting as to whether depression is more or less common in DLB when compared to AD or PD. Randomized, placebo-controlled trials comparing the various classes of antidepressants in DLB are limited. While depression is a well-recognized feature of DLB, appropriate treatment is not well studied. The severity of the cholinergic deficit in DLB should make the family of tricyclic antide-pressants (TCAs) a less than optimal choice because of their anticholinergic side effects. The selective serotonin reuptake inhibitors (SSRIs) and the multireceptor antidepressants venlafaxine, mirtazapine, and trazodone may be a better choice when efficacy...

Health Issues Affecting Lgbt Populations

Sexual orientation is not intrinsically linked to mental health problems however, stigma, homophobia, and prejudice may negatively impact the mental health of LGBT individuals (Meyer, 2003). Furthermore, estrangement from family members, adjusting to a LGBT identity, lack of support for relationships and families may be additional stressors. Unfortunately, population-based estimates of prevalence of mental disorders among LGBT people are lacking (Dean, et al., 2000). The few probability based studies that have been done found higher rates of depression, panic attacks syndrome, and psychological distress among MSM (Cochran and Mays, 2000 Cochran, et al., 2003 Mills, et al., 2004), especially among those who had experienced anti-gay harassment (Mills, et al., 2004). Lesbian and bisexual women appear to have higher prevalence of general anxiety disorder compared to heterosexual women (Cochran, et al., 2003). HIV (Bing, et al., 2001 Dickey, et al., 1999) as well as the stress of caring...

Selective Serotonin Reuptake Inhibitors

Results from uncontrolled studies suggest that SSRIs are effective for anxiety in PD (42-44). In an open-label study (n 10), Menza et al. (42) reported that citalopram (mean dose 19mg d) improved anxiety in depressed PD patients. In a study of 30 patients, paroxetine (20 mg twice daily) reduced psychic and somatic anxiety symptoms, as well as depressive symptoms after six weeks (43). Sertraline was also found to have anxiolytic effects in PD patients (44). Although these data are derived from uncontrolled studies, many specialists prefer to use SSRIs for managing anxiety and depression in PD (49).

Depression in children

Major depression in children and adolescents may be diagnosed using the same criteria as for adults, namely loss of interest in usual activities and the presence of a sad or irritable mood, persisting for 2 weeks or more. 6 The other constellation of depressive symptoms including somatic complaints may be present. Examples include difficulty in getting to sleep, not enjoying meals, poor concentration and low self-esteem. It can present as antisocial behaviour or as a separation anxiety, e.g. school refusal. Although suicidal thoughts are common, suicide is rare before adolescence. Depressed adolescents are a serious suicide risk. Referral of these patients to an experienced child psychiatrist is advisable.

The diagnostic approach

Depression can be associated with many illnesses but it is important to realise that the somatic symptoms may be the presentation of depressive illness and thus 'undifferentiated illness' is a feature. The patient tends to complain of aches and pains, gastrointestinal symptoms and other similar symptoms rather than emotional problems. There is a relationship between anxiety and depression so that many depressed patients are agitated and anxious a feature that may mask the underlying depression. 7

In Search Of Depressogenic Thought Processes

There has been a rather extensive search for a latent (as opposed to state-dependent) processing bias that might underlie depression (Segal, 1988 Segal & Ingram, 1994). What we can say from this research is that there may not be one. Rather, depres-sogenic thought is only revealed when the person is self-focused or in a sad mood at the time of testing (Segal & Ingram, 1994). From the perspective of an implicit science of personality, we believe that these results are important. They suggest that depression is nothing like a trait. Rather, it is a phenomenon that co-occurs with negative mood states and certain dispositional vulnerabilities. Thus, it may come as little surprise that self-reported traits play a relatively minimal role in understanding clinical depression (Segal & Ingram, 1994).

The Effect Of Comorbid Depression On Response To Bt Cbt And Sri Treatment

Abramowitz et al. (2000) found that patients with severe depression showed significantly less improvement with CBT, yet even highly depressed patients showed moderate treatment gains. Cox et al. (1993) found that exposure was not significantly effective for depressed mood. Hoehn-Saric (2000) found an SRI (sertraline) was better for co-morbid OCD and major depressive disorder than a non-SRI (desipramine). Hohagen et al. (1998) showed that BT plus fluvoxamine had a significantly better reduction in YBOCS than BT plus placebo in severely depressed patients with OCD.

Agerelated Changes in Hormones and Their Receptors in Animal Models of Female Reproductive Senescence

Traditionally, the onset and progression of menopause in humans has been attributed to ovarian follicular decline. Because the follicles are the primary source of circulating estrogens, these age-related changes lead to a number of symptoms such as hot flashes, mood swings, irritability, and depression, as well as increased risk of osteoporosis, cardiovascular disease, and age-associated diseases. Recent research indicates that along with the ovarian changes at menopause, the hypothalamic and pituitary levels of the reproductive axis also undergo significant changes during reproductive aging. Indeed, current research suggests a neural, as well as hormonal, mechanism involved in the menopausal process. A number of animal models are available to study these processes, most commonly the nonhuman primates and rodents, and to a lesser extent, avian systems. Here, we will discuss Old and New World monkey models, rats, mice (wild type, transgenic, and genetically modified), and birds as...

Depressed Adolescents IPTA

Mufson, Moreau & Weissman (1993) modified IPT to address developmental issues of adolescence. In adapting IPT to this population, they added a fifth problem area and potential focus the single parent family. This interpersonal situation appeared frequently in their adolescent treatment population and actually reflected multiple wider social problems in an economically deprived, high crime and drug-filled neighbourhood. Other adaptations included family and school contacts. The researchers completed a controlled 12-week clinical trial comparing IPT-A to clinical monitoring in 48 clinic-referred, 12- to 18-year-old patients who met DSM-III-R criteria for major depressive disorder. Thirty-two patients completed the protocol (21 IPT-A, 11 controls). Patients who received IPT-A reported significantly greater improvement in depressive symptoms and social functioning, including interpersonal functioning and problem-solving skills (Mufson, Weissman & Moreau, 1999). Mufson is completing a...

Subsyndromally Depressed Hospitalized Elderly Patients

Recognizing that subthreshold symptoms for major depression impeded recovery of hospitalized elderly patients, Mossey et al. (1996) conducted a trial using a modification of IPT called interpersonal counselling (IPC) (Klerman et al., 1987). Seventy-six hospitalized patients over age 60 with subsyndromal depression were randomly assigned to either 10 sessions of IPC or usual care (UC). A euthymic, untreated control group was also followed. Three-month assessment showed non-significantly greater improvement in depressive symptoms and on all outcome variables for IPC relative to UC, whereas controls showed mild symptomatic worsening. In the IPC and euthymic control groups, rates of rehospitalization were similar and significantly less than the subsyndromally depressed group receiving usual care. After 6 months the IPC group showed statistically significant improvement in depressive symptoms and self-rated health as compared to the UC group. The investigators felt 10 sessions were not...

Lost In Darknes Depression Diabetes And Heart Disease

Although depression causes severe dysfunction, many people can be successfully treated by a combination of medication and by tested forms of behavioral therapy such as cognitive behavioral therapy, which is a form of coaching. Regular physical exercise has been shown to reduce depressive symptoms exercise also improves blood glucose control and cardiovascular function.

Factors Unique To Older Minorities

Research has also identified certain factors unique to older minorities that influence the development of mental disorders among the elderly. Many groups of minority elderly are largely composed of immigrants almost 50 of older Hispanic Americans and 66 of older Asian Americans, for example, are immigrants (Hobbs & Damon, 1996). Studies on immigration have demonstrated both positive and negative effects regarding health and mental health. Overall, immigrants tend to be healthier than nonimmigrants, referred to as the healthy immigrant effect or migration selection (Moscicki, Locke, Rae, & Boyd, 1989). Immigration is also, however, a stressful event with lasting consequences such as reduced resources and social support. A recent study of older Mexican Americans (Black, Markides, & Miller, 1998) demonstrated that older male immigrants reflect the healthy immigrant effect in that they experience lower rates of depressive symptoms than males born in the United States. Among older females,...

Neuroendocrine Theories

Orcadian rhythm disturbance has been hypothesized to contribute to mental decline and depressive mood in AD (Moe, Vitello, Larsen, Larsen, & Prinz, 1995). Liu et al. (2000) investigated the expression of neuropep-tide vasopressin (AVP) mRNA in the human suprachiasmatic nucleus of AD patients with and without depression as well as age-matched controls. No significant differences were found in amount of AVP mRNA between AD patients with and without depression.

Neurobehavioral Changes

In addition to cognitive changes in diabetes, affective disorders, notably the incidence of depression, is increased in diabetes (Gavard et al., 1993 Lustman et al., 1986). Major depression has a higher recurrence rate, and depressive episodes may last longer in individuals with type 1 or type 2 diabetes (Lustman et al., 1986 Ryan, 1988). A significant relationship between poor glycemic control and major depression has been reported, although this relationship was not supported by other studies. Insulin resistance has been postulated as the missing link between the affective disorders and AD. However there is no conclusive empirical data to support this hypothesis at this time (Rasgon and Jarvik, 2004). It is not clear whether the high prevalence of depression in diabetes is the result of neurobiochemical changes associated with diabetes, or is secondary to psychological factors related to chronic disease state or its treatment.

Relationship to Behavioural and Neural Functioning

As for FA, MTR is a non-specific marker of neural damage, such as demyelina-tion. Many of the published MT studies have focused on patients with multiple sclerosis, who show decreased MT in both ROI and whole-brain histogram analyses. In other diseases, results are similar, indicating MTR is a viable marker for affected white and gray matter. MTR has been shown to increase with brain development during the first several years of life (Rademacher et al. 1999 van Buchem et al. 2001) and regional decreases with aging have been found (Armstrong et al. 2004). Differences in MTR were sufficiently large to distinguish patients with mild cognitive impairment from patients with Alzheimer's disease and controls (Kabani et al. 2002a Kabani et al. 2002b). A number of published studies have also used magnetization transfer methods to compare the brains in patients with schizophrenia against healthy control subjects (Foong et al. 2001 Bagary et al. 2003 Kiefer et al. 2004 Kubicki et al. 2005)....

Organization of services

Many of the problems identified in a comprehensive assessment are social rather than psychiatric, and require practical interventions accordingly. For example, a depressed patient living alone in poor accommodation will be unlikely to make a good recovery with antidepressant medication alone. Attending a day centre might combat loneliness and improve nutrition, and a social worker would advise about housing and social security benefits.

The Question of Symptom Persistence

Some have suggested that many depressive symptoms are largely transient, mild, shallower, or self-limited in patients with dementia (Devanand et al., 1997 Katz, 1998). O'Connor, Pollitt, and Roth (1990) and Forsell, Jorm, and Winblad (1994) found remissions of depression in all of their subjects with depression in dementia at baseline. However, other studies have found evidence for the persistence of depressive symptoms syndromes. Janzing, Teunisse, and Bouwens (2000) reported that both syndromal and subsyn-dromal depression were highly persistent in nursing home residents with dementia, few of whom were treated with antidepressants. Another study demonstrated a recurrence rate of 85 for depressive symptoms in dementia (Levy et al., 1996). In terms of major depression, there is evidence for a chronic course of depression in dementia, with one study reporting that 58 of subjects with major depression in dementia still had depression at 16-month follow-up (Starkstein et al., 1997).

Augmentation And Novel Treatment Strategies

Lithium has demonstrated some benefits when used as augmentation to antidepressants in older patients, with a 50 response acute rate (Zullino et al., 2001). Lithium augmentation significantly reduced relapse rates compared to antidepressants alone over two years (Wilkinson et al., 2002). However, it is recommended that special care be taken when treating elderly patients with lithium, because of a higher risk of adverse effects. No benefit was seen when total sleep deprivation was added to paroxetine in fact, the two interventions seem to counteract each other (Reynolds et al., 2005). Light therapy significantly improved depressive symptoms in a study in older depressed patients (Tsai et al., 2004). A small randomized trial comparing repetitive transcra-nial magnetic stimulation (rTMS) and sham treatment in older patients with treatment-resistant MDD reported antidepressant effects in both groups, with no significant benefits associated with rTMS (Mosimann et al., 2004). St John's...

Assessing physical symptoms in psychiatric practice

The assessment depends in part upon the setting. In some cases, for example, the patient on antipsychotic medication who complains of a shakiness of the hands, the most likely diagnosis (extrapyramidal side-effects of medication) will be obvious. Another common instance of side-effects of medication is the patient on tricyclic antidepressants, who complains of a dry mouth. However, it is always important to remember that the emergence of a physical symptom could represent the first sign of an underlying physical disorder. This is particularly pertinent in new referrals, for example, to the outpatient clinic. Usually, it is the responsibility of the referring GP or other doctor to exclude physical disease. However, the psychiatrist must check that appropriate investigations have been done, and continue to remain on the alert and review the matter during the course of treatment. Otherwise, sooner or later, he will find himself in the unenviable position of having tried unsuccessfully to...

The Washington Needs Assessment Household Survey

The Washington Needs Assessment Household Survey (WANAHS) was conducted in the State of Washington by Washington State University for The Washington State Department of Social and Health Services. Although primarily a substance abuse survey, it included assessments for major depression, mania, anxiety, panic attacks, and psychosis using a CIDI-based screener developed by Kessler from the NCS. The WANAHS differs from the ECA and NCS in several significant ways first, it was a telephone survey second, it covered only one state and third, it provided significant oversamples of five major ethnic groups, including White, Black, Asian, Native, and Hispanic.

Interpersonal Behavioral Approaches

As noted in Table 10.3, significant placebo response has been found in three of the four placebo-controlled trials. Katz (1998) noted that the pronounced improvement of depressive symptoms in placebo groups in those trials suggests that interpersonal or behavioral approaches might be effective in the treatment of depression in dementia. Teri, Logsdon, Uomoto, and McCurry (1997) studied two types of behavioral interventions the use of pleasant events for patients living in the community and teaching problem solving for their caregivers compared to a control wait-list condition in depressed patients with AD. Both approaches were associated with significant improvement in depressive symptoms in both patients and caregivers, and the improvement was maintained for six months. These results suggest that

Clinical manifestation

Symptoms are occasionally noted by relatives earlier than by the patient himself. This is why a history given by these persons is of utmost importance. Typical complaints are slowing of reasoning, forgetfulness, difficulties concentrating, lack of energy drive, mild depressive symptoms and emotional blunting. For symptoms and signs see Tables 1 and 2. Emotional Loss of drive and initiative, withdrawal from social activities, failure to manage the financial and administrative aspects of one's life, depressive mood, emotional blunting.

Ethnicity And Adolescent Depression A Prevalence

For example, Fleming and Offord (1990) identified nine epidemiologic studies of clinical depression and report that prevalence of current depression ranged from 0.4-5.7 in the five studies reporting such data. The mean prevalence of current major depression was 3.6 . Subsequent to that review, several other articles have appeared. Lewinsohn, Hops, Roberts, Seeley, and Andrews (1993) reported data from a large sample of high school students indicating a point prevalence for Diagnostic and Statistical Manual of Mental Disorders (3rd. rev. ed.) (DSM-III-R) (American Psychiatric Association, 1987) major depression of 2.6 . Garrison et al. (1992) reported 1 year prevalence rates of about 9 for DSM-III major depressive disorder in a large sample of middle-school students. Based on an epidemiologic survey of youths 6-17 years of age, Jensen et al. (1995) estimated prevalence of depression (Major Depressive Episode Dysthymia) to be 1.9 based on parent report and 2.8 based on child report....

Psychological and Nonpharmacological Aspects of Depression in Dementia

This chapter is divided into five sections. In the first section, we explore the evidence for and against the question of depression as risk factor or prodrome. In addition to providing the empirical evidence and interpreting whether it supports either or both concepts, we present information on the vascular depression hypothesis and how this framework may shed light on the mechanisms involved in the depression-dementia debate. In the second section, we explore the notion that depression causes excess disability in those with dementia. We interpret the empirical evidence in the context of the activity limitation framework of depression. In the third section, we review the evidence concerning the phenomenology of depression in dementia. Assessment of depression in dementia is discussed in the fourth section. In the final section, we explore nonpharmacological treatments that are available for practitioners in treating depression and its

Depression As Prodrome Or Risk Factor

Devanand and colleagues (1996) followed more than 1,000 individuals age 60 and older on a yearly basis. Baseline mood disorder in the absence of cognitive impairment was associated with a moderately increased risk for incident dementia at follow-up. Zubenko (2000) addressed the notion of depression as a prodrome to dementia in a slightly different fashion. He investigated the evidence for the neurobiology of major depression in AD. Forty-three percent of his sample of those who had depression along with a diagnosis of AD came from a family where major depression occurred. In contrast, only 9 of the nondepressed demented individuals came from a family with a history of major depression. Zubenko postulated that early The depression-as-a-risk-factor hypothesis suggests that the presence of depression somewhere along the life span puts individuals at higher risk for developing dementing disorders. The data from Speck et al. (1995) are intriguing in this regard. These authors took 294...

Vascular Depression Hypothesis

A conceptual framework for understanding the mechanisms at work with depression as a prodrome or risk factor for dementia may be the vascular depression hypothesis (Alexopoulos, Meyers, Young, Campbell, et al., 1997 Alexopoulos, Meyers, Young, Kakuma, et al., 1997). This hypothesis states that vascular risk factors and or disease can predispose, precipitate, or perpetuate depressive disorders in older age. The authors speculate that specific disruption of the frontal-subcortical brain circuitry is responsible for the mood disorder. O'Brien et al. (1996) investigated white matter changes in a group of normal adults age 55 years and older (n 40), depressives age 55 years and older (n 61), and a group of nondepressed Alzheimer's patients (n 68). The authors confirmed Coffey's finding that white matter changes were common in 59 of normal elders. White matter changes were extremely common in depressives, with 85 having these changes and 30 showing severe changes. Overall, deep white matter...

Acute Versus Chronic Pathology

For example, endogenous depression, in which a historically long-standing depressive mood exists without an obvious external precipitant, can suggest a poor prognosis. In contrast, the diagnosis of reactive depression incorporated in DSM-IV as dysthymic disorder indicates a depressive mood of relatively recent onset in which the symptom is directly tied to a specific traumatic event such as loss or injury. In such cases of recent onset, the depression is a reaction within the personality that is designed to allay panic and anxiety and allow the individual to gain time to cope with the problem. Under these circumstances of acute onset, prognosis is generally positive. When the traumatic event is not dealt with adap-tively, however, the acute reaction can potentially develop into a more protracted depressive state.

Behavioral Management Techniques

Literature that compares drug treatment to behavior management therapy (BMT) indicates that, in some instances, BMT can be as effective in managing symptoms as pharmaceutical interventions. Teri et al. (2000) compared pharmacological and nonpharmacological treatments in managing agitation and depressive symptoms for AD patients. Behavioral therapy has demonstrated efficacy in managing difficult behaviors, agitation, and aggression, and mood can be elevated through identification and involvement in pleasant activities, while matching activities to the individual's cognitive status (Holmberg, 1997 Teri, 1994). In a comparison of behavioral management strategies, Teri, Logsdon, Uomoto, and McCurry (1997) examined behavioral treatments for depressive symptoms of AD patients. Two behavioral treatments, one emphasizing maximizing pleasant events and the other emphasizing caregiver problem solving, were compared to two control conditions, standard care and wait-list. Two active treatment...

Suicide in children and adolescents

The suicide rate among children and adolescents in the U.S. has risen faster than that of the world population as a whole. The suicide rate for Caucasian males aged 15 to 24 years has tripled since 1950 and it has more than doubled for Caucasian females in the same age bracket. In 1999, a survey of high school students found that 20 had seriously considered suicide or attempted it in the previous year. Of adolescents who do commit suicide, 90 have at least one diagnosable psychiatric disorder at the time of their death. Most frequently it is major depression, substance abuse disorder, or conduct disorder. Adolescents are particularly susceptible to dramatic or glamorized portrayals of suicide in the mass media.

Deficiency Signs And Symptoms

Secondary deficiencies can develop in chronic diarrhoea, liver disease, chronic alcoholism, adrenal or thyroid hormone insufficiency and postoperative situations in which TPN solutions lack riboflavin. In most cases, riboflavin deficiency is accompanied by other vitamin deficiencies such as vitamin B6, niacin and folic acid. Drugs that impair riboflavin absorption or utilisation by inhibiting the conversion of the vitamin to the active coenzymes include tricyclic, antidepressants, chemotherapy drugs and psychotropic agents. There is also evidence suggesting an apparent increase in riboflavin requirements with increased physical exercise.

Self Report Measures Geriatric Depression Scale GDS

Chemerinski et al. (2001) investigated how well Alzheimer's patients themselves could report their own mood. Patients with dementia ( both with and without depression) had a mean MMSE score of 19, although the standard deviation was large (6). The depressed patients (as diagnosed by psychiatrists) themselves rated their own mood as significantly worse than those persons with dementia but without depression (t 6, p .00001). This finding is consistent with Mast's (2002) and Espiritu et al.'s (2001) finding that self-report depression information offers unique and valuable clinical information.

The Ejaculation Distribution Theory of Premature Ejaculation

Evidence for the role of the 5-HT2C receptor has been found in four stopwatch studies in men with premature ejaculation (31,42-44). It was demonstrated that the 5-HT2C receptor stimulating and the 5-HT2C blocking antidepressants exerted an ejaculation delay and absence of ejaculation delay, respectively. In a double-blind placebo-controlled study with the 5-HT2C 5-HT2A receptor antagonist and 5-HT noradrenaline reuptake inhibitor nefazo-done, 400 mg nefazodone daily did not exert any ejaculation delay in contrast

Efficacy and prediction of response

About 80 per cent of severe depressive episodes respond well to ECT in the short term. Features predicting a good response - which are essentially markers of a severe depressive illness in a previously healthy person - include retardation, guilt, delusions, early morning waking, symptoms worse in the mornings, short duration of illness, and stable premorbid personality.

Timing and number of treatments

ECT is usually given twice a week for depressive illness, and more frequent administration has no advantage. The number of treatments required in a course of ECT varies considerably, although typically it is 6-10. There is usually a transient improvement for a few hours after each application, which gradually becomes sustained. Most depressive illnesses are episodes of a recurrent condition, often requiring prophylactic treatment. This is usually with medication, but there are very occasional patients whom only 'maintenance' ECT administered every few weeks can keep from relapse.

Internalizing Disorders Anxiety Disorders

Unhappiness or wide swings in mood from sadness to elation. The two most common mood disorders in childhood are major depressive disorder (MDD) and dysthymic disorder (DD APA, 2000). MDD and DD are related many children with DD eventually develop MDD, and some children may experience both disorders (Lewinsohn, Rohde, Seeley, & Hops, 1991). A third mood disorder, bipolar disorder, is rare in children, although there is growing interest in this problem in young people (Carlson, Bromet, & Sievers, 2000 Geller & Luby, 1997). In the sections to follow, we limit our discussion to anxiety disorders, highlighting many of the same features that we covered for ADHD. Once again, issues that we raise in discussing anxiety disorders have relevance for other childhood disorders as well. SAD is the most common anxiety disorder in youths, occurring in about 10 of all children. It seems to be equally common in boys and girls, although when gender differences are found they tend to favor girls (Last,...

Genetic epidemiology Affective disorders

There is no doubt that affective disorders tend to run in families. Among the first to remark on this was Kraepelin (1921), the founder of modern psychiatric classification, who noted that ''hereditary taint'' was apparent in 80 of his patients suffering from manic-depressive illness. The first studies to distinguish between UPD and BPD were comparatively recent. They were carried out by Angst (1966), a Swiss psychiatrist, and independently, in the same year, by Perris (1966) in Sweden. Perris found that there was a striking degree of homotypia, that is, a tendency for relatives of UP and BP probands to ''breed true'' and exhibit the same type of disorder. However, the findings of Angst were more complex. Among the relatives of probands with UPD there was an increase only of UPD, but among the relatives of BPD probands there was an excess of both UPD and BPD. Most subsequent studies have conformed to the pattern found by Angst (McGuffin and Katz, 1986). Focusing initially on women,...

Causes and symptoms

The cause of kleptomania is unknown, although it may have a genetic component and may be transmitted among first-degree relatives. There also seems to be a strong propensity for kleptomania to coexist with obsessive-compulsive disorder, bulimia nervosa, and clinical depression.

Cardiac Disease Introduction

The important contribution of psychological factors to mortality and morbidity associated with ischaemic heart disease (IHD) is now well recognised. In a review of evidence-based cardiology, Hemingway & Marmot (1999) concluded that 'prospective cohort studies provide strong evidence that psychosocial factors, particularly depression and social support, are independent aetiological and prognostic factors for coronary heart disease.' The prevalence rates of major depressive illness in patients with IHD are three times that in the normal population. Cardiac mortality rates are increased by between three and four times for patients who are depressed post myocardial infarction (MI) compared with patients who have had a MI but are not depressed. Indeed the prognostic impact of depressive illness is comparable to that of degrees of ventricular dysfunction or coronary atherosclerosis in patients who have had a heart attack. Half of all cases of depression post-MI will remit spontaneously,...

Case Study I Neurological Perspectives

Regal is a 67-year-old woman who was initially treated by a geriatric psychiatrist three years ago for major depression complicated by generalized anxiety. Her depression improved with treatment, but she continued to have persistent anxiety symptoms. However, she did not return to see her psychiatrist. Mrs. Regal was functionally independent until she was hospitalized for a routine hysterectomy because of uterine bleeding caused by large fibroids. The second postoperative day, Mrs. Regal developed visual hallucinations (i.e., seeing a man in her room) and paranoid delusions (i.e., thought the nurses were plotting to kill her). The patient was given haloperidol orally for these symptoms in addition to the prochlorperazine that she was receiving for nausea. Within an hour of receiving haloperidol, she became very lethargic and immobile. She continued to have difficulty standing, dressing, and feeding herself for several days. After 10 days, she was discharged from the hospital...

Prevalence Of Latelife Depression And Anxiety

The Epidemiological Catchment Area Study (ECA) (Regier et al., 1988) was a major study investigating rates of depression and anxiety in the community carried out across five sites in the US. The ECA prevalence rates of major depressive disorder amongst older adults were lower than for younger adults (for review see Powers et al., 2002). In the UK, Lindesay, Brigs & Murphy (1989) reported prevalence rates of 4.3 for severe depression and 13.5 for mild moderate depression in a community dwelling urban sample. Beekman, Copeland & Prince (1999) carried out a systematic review of community-based studies examining prevalence of depression in older adults. Overall, Beekman, Copeland & Prince (1999) calculated prevalence rates of 13.5 for clinically relevant depression but concluded that major depression is relatively rare in later life (1.8 ) whereas minor depression is relatively more common (9.8 ). Similar figures reported by Copeland et al. (1987) and Livingston et al. (1990) have led to...

Kathryn L Bleiberg and John C Markowitz

Interpersonal psychotherapy (IPT) is a time-limited (12-16 sessions), diagnosis-targeted, empirically tested treatment. Relative to most psychotherapies, it has been carefully studied but, until recently, used primarily in research settings and not widely used in clinical practice. The success of IPT in the treatment of outpatients with major depression has led to its testing for an expanded range of diagnostic indications. Furthermore, it has grown from being a treatment used by research therapists into an increasingly popular treatment approach for clinicians in private practice.

Depression in Older Patients

Major depressive disorder is frequently undiagnosed and untreated in older patients, and can be associated with high morbidity and mortality in this patient group, who are particularly prone to completed suicide or self-neglect. Grief, pain, sleep issues, concurrent medications, altered physiology, and the presence of comorbid medical and psychiatric conditions can complicate the management of depression in older patients. Comorbid medical conditions, including cardiovascular events, stroke, vascular dementia, and Alzheimer's disease, which are common among older patients, can have a significant impact on depression, and vice versa. Depression is not a natural part of the aging process, and it should be diagnosed and actively treated in the elderly, just as it is in younger patients. Pharmacother-apy can be safe and effective in this population, as long as pharmacokinetic and pharmacodynamic properties, as well as the inherent biological differences in the elderly population are...

Theoretical Formulations

A meta-analytic review by Gould and colleagues (Gould et al., 1997) addressed treatment efficacy for 13 studies comparing psychological therapy with no treatment, wait-list or psychological placebo and 22 studies comparing pharmacotherapy with pill placebo. Both within- and between-group effect sizes were calculated for anxiety and depression measures at post-treatment and, where available, for follow-up. Length of treatment was fairly short (three to nine weeks for pharmacotherapy and six to 15 weeks for psychological therapy) and follow-up data limited to six months in six of the psychological treatment studies. The majority of studies allowed comorbid anxiety disorders as long as GAD was the primary disorder. The results indicated that, for severity of anxiety symptoms at post-treatment, both CBT and pharmacotherapy were superior to control conditions and of broadly similar efficacy with moderately large effect sizes (ES 0.70 for CBT, ES 0.61 for pharmacotherapy). For severity of...

Dean Filandrinos Thomas R Yentsch and Katie L Meyers

John's wort has demonstrated clinical efficacy for mild to moderate depression and compares favorably to other more potent or toxic antidepressants. Low side effects and potential benefits warrant its use as a first-line agent for select patients with mild to moderate depression or anxiety-related conditions. Benefits related to other reported uses such as an antimicrobial, agent to treat neuropathic pain, antiinflammatory, treatment alternative for atopic dermatitis, and antioxidant are either not well documented or evidence is encouraging but not conclusive and further study is needed. St. John's wort has an inherently wide margin of safety when taken by itself, with most reported adverse drug reactions (ADRs) being related to skin reactions. Isolated, but more significant ADRs have been reported in relation to neurological effects, impact on thyroid function, and increased prothrombin time. Of greatest concern is the potential for interactions between St. John's wort and...

Seven masquerades checklist

Depressive illness has to be considered in any patient with a chronic pain complaint. This common psychiatric disorder can continue to aggravate or maintain the pain even though the provoking problem has disappeared. This is more likely to occur in people who have become anxious about their problem or who are under excessive stress. Many doctors treat such patients with a therapeutic trial of antidepressant medication, for example, amitriptyline or doxepin.

Diffuse Lewy Body Dementia DLBD

Prevalence rates for depression in DLBD are less studied. Depression may be more common in DLBD than in AD (Ballard et al., 2002). Rates of depressive symptoms have been reported to be up to 50 of DLBD patients (Klatka, Louis, & Schiffer, 1996) with the proportion of major depression estimated at 14 to 33 (Ballard et al., 1995 McKeith, Perry, Fairbairn, Jabeen, & Perry, 1992). A study comparing clinical and neuropathological cohorts using Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R American Psychiatric Association, 1987) criteria for major depression found that depression was more common in DLBD than in AD (clinical cohort DLBD 19 vs. 8 AD neuropathological cohort 32 DLBD and 12.5 AD Ballard et al., 1999).

Lifelong Delayed Ejaculation

Unfortunately there is no drug treatment available for delayed ejaculation in men. In animals, the 5-HT1A receptor agonist, 8-OH-DPAT, fastens the ejaculation latency, but such selective 5-HT1A agonists are not yet available for safe human use. Another possibility is a selective blockade of the 5-HT2C receptor. However, in a stopwatch controlled study in men with premature ejaculation, the 5-HT2C receptor blocking antidepressants, nefazodone and mirtazapine, did not lead to either delayed ejaculation or a faster ejaculation time.

Legal Remedies as a Result of Being Involved in a Single Life Threatening Situation

That said there appears to be two important aspects to determine whether liability should be imposed. First, the injury alleged must be a recognised psychiatric disorder that is more than a claim purely for a temporary upset such as grief or distress or fright from which we all suffer at times (Hinz v. Berry, 1970 cf. Tredget v. Bexley Health Authority, 1994). Examples of psychiatric illness would include clinical depression, personality changes, PTSD. Second, the person claiming the psychiatric harm must fall within a category accepted by the courts as being entitled to claim. This latter restriction may present difficulties for the 'professional' rescuer, such as a police officer, as we shall see shortly.

Chronic fatigue syndrome ICD neurasthenia F480

Many patients have depressive symptoms, but it is not clear whether these are part of the syndrome itself, or a secondary reaction to it. Whatever the aetiology, psychosocial factors appear to be of prime importance in maintaining persistent symptoms and disability. Some patients, convinced that they are suffering from continuing viral illness, insist on continuing to rest, and this causes loss of fitness and eventually makes fatigue worse. Others are willing to engage in a programme of gradually increasing activity, although they are often reluctant to consider that their problems may have a psychological dimension.

Pharmacological Toxicological Effects

There have been many clinical trials studying the effectiveness of St. John's wort in the treatment of depression. By the spring of 2002, there were 34 controlled trials including more than 3000 patients. Most of these trials included patients with mild to moderate depression and used the Hamilton Rating Scale of Depression (HAMD) to measure efficacy (6). Schulz compared the results of all of the trials since 1990. Nine of the 11 placebo-controlled trials showed a significant difference in the HAMD scores favoring hypericum, and a trend favoring hypericum was demonstrated in the other two. Linde also compared clinical trials with hypericum, and came to the conclusion that hypericum was superior to placebo in mild to moderate depression (7). When compared with the synthetic antidepressants, there was one trial with amitriptyline, four with imiprimine, two with fluoxetine, two with sertraline, one with bromazepam, and one with maprotiline. Of these trials, hypericum was equal to or...

Physical somatic biological vegetative symptoms

Physical symptoms are just as common as psychological ones and often form the presenting complaint when depressed patients consult in general practice. Core symptoms of depression include pain and tiredness. These have been recognized since the early days of psychiatry. (Indeed, a more insightful way of looking at the problem would be to retreat from the somewhat arbitrary mind body split in which, at any rate in Western societies, we view the experience of distress.) Pain and fatigue and depressed mood can in fact be thought of as an army - or at any rate a platoon - that marches together often, the depressed mood is the most prominent feature and the correct clinical diagnosis of a depressive illness is easily made.

Cognitive Behavioural Therapy Rationale

Such findings do not argue against CBT as a treatment for depression. On the contrary they demonstrate its consistently robust performance in the face of many comparative evaluations. However they highlight the relative absence of studies with depressed patients in which CBT was found to be superior to an alternative psychological treatment, a superiority tacit in the predominance of this model of practice. Cognitive behavioural therapy has demonstrated equivalence in good quality pharmacology studies (De Rubeis et al., 1999 Hollon et al., 1992 McKnight, Nelson-Gray & Barnhill, 1992). Hollon et al. (1992) also found no difference in CBT outcome with more severely depressed patients, in contrast to the findings of the TDCRP (Elkin et al. 1995). De Rubeis et al. (1999) also conducted a meta-analysis of four studies comparing CBT and medication for patients with severe depression. Direct comparisons between the two lines of intervention showed no significant differences but overall...

Pharmacological Treatment of the Paraphilias

There is no data to suggest that pharmacological intervention cans specifically target or ameliorate underlying paraphilic mechanisms. Rather, pharmacological interventions are either symptom focused or directed toward ameliorating or managing comorbid conditions. For example, where hypersexuality is a factor, pharmacological treatments are commonly implemented to lower libidinal drive where concurrent mania fosters hypersexuality, mood stabilizing agents are indicated where comorbid depression or anxiety exacerbates paraphilic urges and behaviors, pharmacological intervention to lower affective distress may be a crucial early treatment where paraphilic behavior is driven by underlying psychotic or delusional processes, the obvious first line treatment is pharmacological management of the psychotic state. As exemplified in these scenarios, pharmacological interventions for the paraphilias fall into three primary categories antidepressants, antiandrogens, and neuroleptics and other...

Vulvar Vestibulitis Syndrome

Activity in a group of vestibulitis sufferers (92). Follow-up data and a randomized clinical trial are needed in order to fully assess the effects of this kind of treatment, as local and systemic medications, such as creams, antibiotics, and injectable medical treatments may cause more harm than benefit (5). In addition, there is no empirical evidence for the success of any medication, such as antidepressants, for the pain of vestibulitis.

Child Depression Inventory

In 2002 the National Institute of Mental Health (NIMH) estimated that as many as 2.5 of children and 8.3 of adolescents under the age of 18 in the United States suffer from depression. A study sponsored by the NIMH of 9- to 17-year-olds found that 6 developed depression in a six-month period, with 4.9 diagnosed as having major depression. Research also indicates that children and adolescents experience the onset of depression at earlier ages than previous generations, are more likely to experience recurrences, and are more likely to experience severe depression as adults.

Humanistic Therapies Theoretical Basis

Although an early meta-analysis suggested less favourable outcomes for humanistic therapies (Smith, Glass & Miller, 1980), more recent meta-analyses have indicated large effect sizes for pre- to post-treatment change in these therapies, particularly with relationship problems, anxiety and depressive disorders and trauma, with treatment gains generally being maintained at follow-up (Elliott, 1996, 2001, 2002 Elliott, Greenberg & Lietaer, 2004 Greenberg, Elliott & Lietaer, 1994). There is also evidence of such therapies being 'possibly efficacious' for people diagnosed with anger-related problems, schizophrenia, severe personality disorders and physical health problems. In comparative outcome studies, these effect sizes are generally equivalent to those in the other therapies studied, but considerably greater than those in untreated controls. There are also indications of greater effect sizes for Gestalt and process-experiential than for non-directive humanistic therapies.

Zyprexa see Olanzapine

Alzheimer's disease major depressive disorder substance use, abuse, or dependence Agoraphobia childhood Internet addiction major depressive disorder may occur with Wernicke-Korsakoff major depressive disorder postpartum depression seasonal affective disorder substance dependence undifferentiated somatoform disorder Arousal, sexual disorder major depressive disorder nightmare disorder post-traumatic stress disorder Attention-seeking behavior brief psychotic disorder major depressive disorder schizophrenia schizophreniform disorder Cold hands and feet anorexia nervosa Communication. See language Daily activities difficulties Alzheimer's disease childhood disintegrative disorder Decision-making difficulties dependent personality disorder major depressive disorder Defiance Alzheimer's disease bipolar disorder borderline personality disorder cyclothymic disorder dysthymic disorder major depressive disorder may occur with pyromania may occur with sexual dysfunctions pain disorder postpartum...

The Effects Of Drugs On Womens Orgasmic Ability

A number of psychotherapeutic drugs have been noted to affect the ability of women to attain orgasm. The selective serotonin reuptake inhibitors (SSRIs) frequently affect orgasmic functioning, leading to delayed orgasm or anorg-asmia. There is variability, however, in that some antidepressants have been associated with anorgasmia less frequently than others. For example, the anti-depressant, nefazodone, has been reported to produce fewer sexual side effects In summary, drugs that increase serotonergic activity (e.g., antidepressants), or decrease dopaminergic activity (e.g., antipsychotics) adversely impact female orgasm. The degree to which the former of these influences orgasm appears to be dependent upon which serotonin receptor subtype they activate inhibit.

Antiviral Therapy of Shingles in Dermatology

All virostatics have comparable but not sufficient influence on pain. Therefore, concomitant analgesic therapy is recommended and consists of a variety of modalities including analgesics, narcotics 36 , early use of tricyclic antidepressants (amitriptyline) in elderly patients 37-39 , opioids 40-42 , gabapentin 43-45 , capsaicin 5, 46 , local 5 -lidocaine-patch 46 , cutaneous stimulation, sympathectomy nerve blocks 47, 48 and corticosteroids therapy. Corticosteroids should be combined with an antiviral therapy in patients 50 years of age only with significant acute pain at presentation, if they have no contraindications for high dose corticosteroids administration, i.e. high blood pressure, diabetes, etc. Benefits of this adjunctive therapy are improvement in quality of life, total cessation of analgesic use and undisturbed sleep at night. The dosage of prednisone is recommended at least 1 mg kg body-weight and day respectively 60 mg daily for first week, 30 mg daily the second week...

Brief psychotic disorder

The cause of the symptoms helps to determine whether or not the sufferer is described as having brief psychotic disorder. If the psychotic symptoms appear as a result of a physical disease, a reaction to medication, or intoxication with drugs or alcohol, then the unusual behaviors are not classified as brief psychotic disorder. If hallucinations, delusions, or other psychotic symptoms occur at the same time that an individual is experiencing major clinical depression or bipolar (manic-depressive) disorder, then the brief psychotic disorder diagnosis is not given. The decision rules that allow the clinician to identify this cluster of symptoms as brief psychotic disorder are outlined in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision, produced by the American Psychiatric Association. This manual is referred to by most mental health professionals as DSM-IV-TR.

Interpersonal Psychotherapy Rationale

Interpersonal therapy provides a pragmatic, time-limited and interpersonally focused approach to the treatment of major depression. It is modest in its use of psychotherapy jargon and promotes attention to the relationship-based issues that are central to the experience of many depressed patients. The treatment does not become entangled in questions of causation, acknowledging the capacity for depression to both precipitate and reflect interpersonal change, difficulty and loss. Instead it attends to difficulties arising in the daily experience of maintaining relationships and resolving difficulties while depressed. The fundamental clinical task of IPT is to help patients to learn to understand their depressive symptoms in an interpersonal context, and to work towards resolution of interpersonal difficulties such that they will no longer precipitate or sustain the depressive state and so facilitate more effective symptom management. The National Institute of Mental Health (NIMH)...

Reward Deficiency Syndrome

L-tyrosine supplementation has been considered because chronic cocaine use is believed to cause catecholamine depletion and cocaine withdrawal has been associated with major depression. To date, results from trials using tyrosine as a stand-alone treatment during cocaine withdrawal have produced disappointing results (Chadwick et al 1990, Galloway et al 1996). Although untested as yet, the effects of tyrosine may be of most assistance where a deficiency of dopamine D2 receptors is suspected, such as in reward deficiency syndrome.

Studies Of Psychological Treatments In Bipolar Disorders

The IPSRT intervention was one of the first systematic psychological therapies developed specifically for individuals with BP. A randomized treatment trial with a two-year follow-up is under way. Interim reports are available on 82 participants initially allocated to IPSRT or intensive clinical management. The trial has two phases - an acute treatment phase and a maintenance phase - and 50 of participants in each group remain in the same treatment arm throughout the study while the remaining participants cross over to the other treatment arm (Frank et al., 1999). The key findings so far are that IPSRT does induce more stable social rhythms (Frank et al., 1994). There were no statistically significant between-treatment differences in time to remission but those entering the trial in a major depressive episode showed a significantly shorter time to recovery with IPSRT compared to intensive clinical management (21 weeks versus 40 weeks) (Hlastala et al., 1997). Interestingly, those...

Problemsolving Therapy Rationale

Research evaluations of problem-solving therapy have been exclusively conducted in primary care and community samples, with patients with mild depressive symptoms. Dowrick et al. (2000), Nezu et al. (1986), and Nezu, Nezu & Perri (1989) have shown problemsolving therapy to achieve greater symptom reduction than no-treatment control conditions for depressed patients at the end of treatment. Nezu's studies reported better outcome for full problem-solving therapy over components of the therapy and this was maintained over a six-month follow up. Dowrick's community sample did not maintain the initial gains over a naturalistic 12-month follow up.

Antidepressant Activity

The mode of antidepressant action is unknown, but is likely to involve several mechanisms. As a methyl donor, SAMe plays a role in the metabolism of various CNS neurotransmitters that play an integral part in synaptic transmission and behaviour, such as noradrenaline, dopamine and serotonin (Bottiglieri 1996). Supplementation with SAMe in depressed patients raises serotonin, dopamine and phosphatidylserine and improves neurotransmitter binding to receptor sites, resulting in increased activity (Pizzorno & Murray 2006). More recent evidence suggests that the dopaminergic activity is most prominent. One human study confirmed that 7 days of supplemental SAMe (400 mg day) decreased the exaggerated plasma noradrenaline levels found in depressed patients (Sherer et al 1986). It is also involved in the formation of phosphatidylcholine, a major component of cell membranes and neurotransmission (Carney et al 1987). Interestingly, significantly low levels of SAMe in cerebrospinal fluid have...

Assessing Behavioral And Psychiatric Symptoms

Initiative may be interpreted as withdrawal or depression even in the absence of depressed mood on the part of the patient. Several studies have suggested that depressive symptoms may be responsive to pharmacologic intervention but that they have no effect on cognition (Lyketsos et al., 2000). As the disease progresses, agitation or psychotic features such as hallucinations or delusions may occur. These symptoms can also arise from cognitive compromise and can be disturbing, challenging the coping strategies of the patient and family (Raskind, 1999).

Neurological Effects

Depression The balance between n-6 and n-3 fatty acids influences the metabolism of biogenic amines, an interaction that may be relevant to changes in mood and behaviour (Bruinsma &Taren 2000). In several observational studies, low concentrations of n 3 PUFAs predicted impulsive behaviours and greater severity of depression. Additionally early research by Horrobin et al (1999) revealed that almost all studies on depression have found increased PG2 series or related thromboxanes and there is evidence that the older antidepressants (i.e. MAOIs and TCAs) either inhibit PFG synthesis or are powerful antagonists of their actions. Going one step further are the findings of a number of studies showing a correlation between low erythrocyte n-3 EFAs and suicide attempts one of these demonstrated an eightfold difference in suicide attempt risk between the lowest and highest RBC EPA level quartiles (Huan et al 2004). Researchers from Belgium have also speculated about a seasonal variation in EFA...

Differential diagnosis of paranoid states

Paranoid symptoms are found in many of the common psychiatric conditions described elsewhere in this book, including schizophrenia, affective disorders (depressive illness and mania), drug and alcohol misuse, and the dementias. The following list describes some other syndromes in which paranoid symptoms are a main feature Morbid jealousy (pathological jealousy, Othello syndrome) patients, usually men, are deluded that their sexual partners are unfaithful. Morbid jealousy is often part of another syndrome paranoid schizophrenia, depressive illness, organic brain syndrome, or alcoholism. Many patients have sexual dysfunction and or poor personality adjustment. A small percentage may show homicidal behaviour, and lesser degrees of violence are even more common, so morbid jealousy is an important condition despite being rare. A formal risk assessment must be made in such cases, and an appropriate care plan put in place. Referral to forensic psychiatric services may have to be considered....

Introduction To Mood Disorders And Limitations Of Current Treatments

Bipolar disorder and unipolar depression are classified as mood disorders. They are common, severe, and chronic illnesses. Depression is typified by a depressed mood, anhedonia (inability to experience pleasure), feelings of worthlessness or excessive guilt, impaired sleep (either insomnia or hyper-somnia), cognitive and concentration deficits, psychomotor changes, recurrent thoughts of death or suicide, and a variety of neurovegetative symptoms. In bipolar disorder, patients typically alternate (albeit not in a one-to-one manner) between episodes of depression (mostly indistinguishable from unipolar depression) and episodes of mania, which is characterized by a heightened mood, hyperaroused state, racing thoughts, increased speed and volume of speech, quicker thought, brisker physical and mental activity levels, inflated self-esteem, grandiosity, increased energy (with a corresponding decreased need for sleep), irritability, impaired judgment, heightened sexuality, and sometimes...

Reading Case Studies

Some recent additions to the clinical literature on treating Asian Americans feature more detailed descriptions of the psychotherapy sessions than those that were previously available. These extended case examples provide more holistic pictures of various Asian American client cases in contrast to briefer case examples that can only illustrate a limited number of cultural-clinical phenomenology or cultural intervention. For example, Jung's (1998) text presents case studies of six different Chinese American individuals and families presenting with a variety of problems. The clinician may find particularly useful the extensive, session-by-session description of the Lee family case example. Shiang et al. (1998) also include a clinical case example of an eight-session psychotherapy with a Chinese American woman with somatic complaints. This case lists the relevant concerns for the STS variables for each session alongside the therapist's narrative. Cheung and Lin (1997) present a detailed...

Medical Letter In Reference To Erical Dysfunction

Feiger A, Kiev A, Shrivastava RK, Wisselink PG, Wilcox CS. Nefazodone versus sertraline in outpatients with major depression focus on efficacy, tolerability, and effects on sexual function and satisfaction. J Clin Psychiatry 1996 57(suppl 2) 53-62. 37. Bobes J, Gonzalez MP, Bascaran MT, Clayton A, Garcia M, Rico-Villade Moros F, Banus S. Evaluating changes in sexual functioning in depressed patients sensitivity to change of the CSFQ. J Sex Marital Ther 2002 28 93-103. 39. Labbate LA, Grimes J, Hines A, Oleshansky MA, Arana GW. Sexual dysfunction induced by serotonin reuptake antidepressants. J Sex Marital Ther 1998 24 3-12. 47. Nurnberg HG, Lauriello J, Hensley PL, Parker LM, Keith SJ. Sildenafil for iatrogenic serotonergic antidepressant medication-induced sexual dysfunction in 4 patients. J Clin Psychiatry 1999 60 33-35. 92. Landen M, Eriksson E, Agren H, Fahlen T. Effect of buspirone on sexual dysfunction in depressed patients treated with selective serotonin reuptake...

Evidence Based Medicine

In contrast to authority-based medicine, evidence-based medicine (26) has been accepted today as the hallmark for clinical research and medical practice. Particularly in last decade, randomized clinical trials with clomipramine (27,28) and some SSRIs (29-33) have repeatedly demonstrated the efficacy of serotonergic antidepressants to delay ejaculation. In spite of these studies, the belief persists among those involved in sexology that premature ejaculation is a psychological disorder. In order to unravel this dichotomy, it is important to apply principles of evidence-based medicine to both the psychological and neurobiological approaches to premature ejaculation and its treatments. In contrast with the easily accepted behavioral treatment by sexologists, drug treatment had to prove itself far more explicitly to avoid rejection by professionals in the field. Only a few physicians have tried to develop drug strategies to treat premature ejaculation. Currently, in spite of some residual...

Summary And Conclusions

Exposure therapies are the treatment of choice in adult specific phobia, social phobia, agoraphobia, and obsessive-compulsive disorder (Emmelkamp, 2004) and have also been found quite effective in phobic children (Nauta et al., 2003). Studies of the behavioural treatment of depression have come to a standstill due to the rise of cognitive therapy in this area but the lack of further research into the behavioural treatment of depression is not justified by the data. There are still a number of important issues that need to be addressed. For example, we have no idea why cognitive therapy, behavioural interventions, IPT and pharmacotherapy work equally well with depressed patients, although various researchers provide various theoretical explanations. Unfortunately, to date there is no evidence that

Difficulties In Assessing Outcome Research

In clinical practice it is rare to meet an individual who only meets ICD-10 DSM-IV criteria for a single personality disorder. As noted above, many individuals meet criteria for more than one personality disorder and others meet criteria for both Axis I and Axis II disorders (Oldham et al., 1995). This makes it difficult to decipher improvements observed clinically or reported in the literature. For example, a person with BPD and major depression may become more impulsive and destructive as the depression lifts (appearing to become more 'borderline') or this behaviour may diminish with the anergia of depression, creating the impression of improved impulse control. Despite the confounding effect of comorbidity when measuring outcome, published studies have generally failed to report this clearly.

Differential Therapeutics

As a clinician, when might you think of using IPT As a psychiatrist decides which antide-pressant medication to prescribe based on a patient's symptom constellation and research findings, so too should clinicians consider when to use IPT. The research to date supports that IPT works best for depressed patients who face distressing life events ranging from medical illness to job and relationship changes and conflicts. Patients with interpersonal deficits who report no recent life events or changes will probably fare better in CBT. Interpersonal therapy may also work well for patients with anxiety and personality disorders who report recent life events, but research is in these areas, although promising, is still in the early stages. Interpersonal therapy may be a good option for patients who want to augment their medication treatment with psychotherapy given that IPT and pharmacotherapy share the medical model of depressive illness, IPT seems like a good fit, although further research...


Depressive illness, which is probably the greatest masquerade of general practice, is one of the commonest illnesses in medicine and is often confused with other illnesses. It is a very real illness that affects the entire mind and body. Unfortunately, there is a social stigma associated with depression and many patients tend to deny that they are depressed. Many episodes of depression are transient and should be regarded as normal but 10 of the population have significant depressive illness. The lifetime risk of being treated for depression is approximately 12 for men and 25 for women. 1

Mental Illness and Substance Abuse

The prevalence of serious mental illness and substance abuse is high among homeless persons. In a nationwide U.S. survey of homeless people, 39 had mental health problems, 50 had an alcohol and or drug problem, and 23 had concurrent mental health and substance use problems (Burt, 2001). Common psychiatric diagnoses among homeless people include major depression, bipolar disorder, schizophrenia, and personality disorders. A systematic review of the prevalence of schizophrenia in homeless persons found rates ranging from 4 to 16 and a weighted average of 11 in the ten methodologically strongest studies (Folsom and Jeste, 2002). Characteristics associated with a higher prevalence of schizophrenia were younger age, female sex, and chronic homelessness. Marked cross-national variation is seen in the prevalence of schizophrenia, with prevalence rates of 23-46 reported among homeless people in Sydney, Australia (Teesson, et al., 2004).

Range Of Psychopathology And Personality Disorders Within Scope Of Treatment

Cognitive therapy was initially developed as a treatment for depression (A. T. Beck, Rush, Shaw, & Emery, 1979) and has subsequently been applied with a wide range of disorders such as anxiety disorders (A. T. Beck & Emery, 1985), substance abuse (A. T. Beck, Wright, Newman, & Liese, 1993), marital and family problems (Epstein & Baucom, 2002), and even schizophrenia (Perris & McGorry, 1998). However, although the principles of cognitive therapy apply across the full range of psychiatric problems, the treatment approach needs to be modified to take into account the characteristics of the individuals being treated. Some have argued that cognitive therapy of depression (A. T. Beck et al., 1979) is not an appropriate treatment for individuals with personality disorders (McGinn & Young, 1996 Rothstein & Vallis, 1991 Young, 1990) and this is indeed the case. Cognitive therapy of depression is a protocol for treating depression and somewhat different protocols are used in treating other...

From Philosophy To Theory

While the concept of prototype and subtype allows the natural heterogeneity of persons to be accommodated within a classification system, there are as many ways to fulfill a given diagnosis as there are subsets of the number of diagnostic criteria required at the diagnostic threshold. For example, there are many ways to score five of a total of nine diagnostic criteria, whatever the actual syndrome. In the context of an idealized medical disease model, which Axis I approximates, the fact that two different individuals, both of whom are depressed, might possess substantially different sets of depressive symptoms is not really problematic. The symptoms may be expressed somewhat differently, but the underlying pathology process is the same and can be treated in the same way. For example, while one person gains weight and wakes early in the morning, and the other loses weight and sleeps long into the day, both may be treated with an antidepressant and cognitive therapy. Personality,...

Cognitive and Psychiatric Disturbances

Earlier literature described euphoria as a feature of MS (120). However, depression is now recognized much more commonly, with 50 or more of patients experiencing this affective disturbance in some form during the course of the illness (121-123). Although this is usually relatively mild, major depression can occur (123). Suicide may be a major cause of mortality, accounting for 15 of adult deaths in one series (124). Recently, Feinstein (125) identified warning signs that include living alone, having a family history of mental illness, and reporting social isolation. Patients with a prior history of major depression, anxiety disorder, or alcohol abuse are also particularly vulnerable. The so-called euphoria is actually the inability to inhibit emotional expression, resulting in inappropriate laughing and crying. This occurs with subcortical forebrain lesions (126). Other instances of apparent euphoria seem to be associated with evidence of significant cognitive decline. Euphoria is...

Commonly Occurring Disorders

It is important to mention the high rates of traumatic stress experienced by Indian Natives as abuse victims and witnesses of the abuse of others, for they are related to the development of psychiatric symptomatology. As an example, Piasecki et al. (1989) found significantly higher rates of development disorders, conduct disorders, drug use disorders, depressive disorders, and anxiety disorders in abused Indian and Native youth than those without similar histories.

What about the new drugs

There has been a wave of new drugs, both antipsychotics (atypicals) and antidepressants (SSRIs, etc.), as well as others. The manufacturers have claimed that these new drugs are as effective as older drugs, but have fewer side-effects. They do seem to have a more favourable side-effect profile in some cases, although their adverse effects are now beginning to emerge for example, weight gain and diabetes with olanzepine. In medicine, as in life, one does not get anything for nothing, however, and clinical experience is that the newer drugs are less powerful. Although they may be satisfactory for milder cases, they may not be as effective in more severe cases in more disadvantaged areas.

Types of psychotherapy

Supportive psychotherapy involves discussion of problems at a simple, practical level, which may include offering advice. Any good doctor-patient relationship includes an element of supportive psychotherapy. Psychotherapy can be usefully combined with antidepressants or other psychotropic drugs for patients with formal psychiatric illness. Many psychotherapists prefer to speak of 'clients' rather than 'patients' however, the term 'patient' is retained here for the sake of consistency with the rest of the book.

The aftermath of suicide effects on those involved

Some suicides, such as those resulting from an acute severe depressive illness which could almost certainly have been cured, are major tragedies. In other cases, such as those associated with chronic intractable mental or physical illness, the argument that it might have been preventable may be less strong.

Socioeconomic factors

As well as long-term social difficulties, there is a well-established body of evidence indicating that patients with depression have experienced more adverse 'life events' than people without depression. These events, particularly so-called 'loss events', appear to be the precipitant of the majority of episodes of diagnosed depression. Such 'events, dear boy, events', seem to combine with the above-mentioned long-term difficulties, which include not only material poverty, but also absence of confiding relationships and family social support, to produce the depressive episode.

Psychiatry of adolescence

Psychiatric disorder is present in 15-20 per cent of adolescents. 'Adolescent turmoil' (identity crisis), when the process of maturation involves mood swings, rebellious behaviour, or experimentation with contrasting lifestyles, is a common phenomenon that may be confused with psychiatric illness.

Psychiatry in primary care

Some patients require psychotropic drug therapy, and antidepressants, although often prescribed in lower doses and for shorter courses than most psychiatrists would recommend, are effective. However, in many milder cases, they are probably acting as placebos. Benzodiazepines are recommended for short periods only, but many GPs now avoid prescribing them at all.

Mental features of depression

The cardinal symptom of a depressive illness is of course a pervasive depression of mood. This must go beyond the everyday experience of, for example, 'I'm really depressed about the gas bill.' The mood must be low, flat, and empty, and not able to be cheered up by things that the patient formerly enjoyed. There are those in psychiatry who feel that depression can be diagnosed without depression of mood being obvious to the patient or readily apparent to the psychiatrist. It is just conceivable that this may apply to prodromal or very mild cases of depression, or to patients with a mixture of anxiety and depression symptoms. However, generally speaking, it is necessary to do violence to the idea of clinical depression to consider that any significant case of depressive illness can exist without depression of mood. In a true depressive illness, the patient has a negative view of himself, so that he feels guilty, and that he is a failure or a bad person. This will tend to be coupled...

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