Diagnosis Of Endogenous Depression Research Articles

The status of leukocyte-inhibitory system of inflammation in different age groups of patients with endogenous depression

The comparison of inflammatory markers in different age groups of patients with endogenous depression and correlation of immunological parameters with the clinical features of depression. The study included 140 patients with endogenous depression (ED) (F21, F31-F34, ICD-10) aged 15 to 82 years (39.8±23 years), including 55 patients of adolescent age (18.9±2.8 years), 30 middle-aged patients (38.7±10.3 years) and 55 elderly patients (69.1±7.1 years). The total duration of the disease differed from 5 months to 45 years. Psychometric assessment of patients was carried out using HDRS. The control groups consisted of 143 healthy people aged 16 to 75 years. The activity of inflammatory markers leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI), their ratio (leukocyte-inhibitory index, LII), the levels of antibodies to S100B and myelin basic protein (MBP) were determined in blood. Three immunological clusters were identified that correspond to different clinical variants of ED. A pro-inflammatory status with an activation of the leukocyte-inhibitory system is characteristic of 52.9% of patients (cluster 1). The clinical feature of this status is predominantly «classic» ED in the form of anxious, anxious-melancholic or anxious-apathetic depression without pronounced negative symptoms. Two other clusters are characterized by the imbalance of leukocyte-inhibitory system associated with insufficient a1-PI activity (cluster 2) and with insufficient LE activity (cluster 3). A common clinical feature of such ED is an atypical course with the predominance of apathetic-adynamic and dysphoric depression, the presence of negative disorders and a poor prognosis. The imbalance of leukocyte-inhibitory system associated with insufficient LE activity is typical mainly for elderly patients and is characterized by a longer duration of disease. The status of leukocyte-inhibitory system of inflammation is correlated with the clinical features of ED in different age groups of patients. LII can be considered as an additional paraclinical criterion for differential diagnosis and prognosis of ED.

Rate of Stroke Death after Depression: A 40-year Longitudinal Study Extension of Chichester/Salisbury Catchment Area Study

This study examined clinically diagnosed depression as a risk factor for incidence of death by stroke in a prospective clinically based design study. Risk for stroke was examined separately by sex in a long-term follow-up study spanning 40years. Patients who were diagnosed with depression in the Chichester (population 100,000)/Salisbury (population 85,000) Catchment Area Study were followed up for 40years. Death certificates were used to determine the cause of death in the cohort. Death rates in the general population, adjusted for age, gender, and year, were used as a control. Clinical depression was found to be a risk factor for subsequent death from stroke in men but not in women. Death by stroke was a statistically significant cause of death in the men with diagnoses of endogenous depression but not in those men diagnosed with reactive depression. The strength of the relationship of depression with stroke increased over time. These findings suggest that the identification of depressive symptoms at younger ages may have an impact on the primary prevention of stroke in later life. The notion that depression has stronger effects over a long period is consistent with a view that severe clinical depression and physical illness occur concurrently, one exacerbating the other, and health is degraded through slow-acting, cumulative processes. Data were unavailable for the type of stroke or the health-risk behaviors (smoking, diet, and so forth) in the cohort which constituted a limitation of the study. Neither is it known what proportion of the cohort suffered a nonlethal stroke nor to what extent thetreatment of clinical depression militates against suffering a lethal stroke.

Type of depression and results of mortality

The object of this study was to discover if a mortality study could distinguish between reactive/neurotic and endogenous depression; a reoccurring concern. Research has so far been inconclusive and psychiatrists still use the two diagnoses; reactive and endogenous depression. A method was designed using a cohort selected 24 years previously and that followed the strict criteria of a Medical Research Unit in the U.K. Each patient was given the diagnosis of either reactive or neurotic at that time. The cohorts were followed prospectively for 24 years. The results were computed to test the statistical significance of premature mortality for both diagnosis and to compare the results with a control group. The results showed endogenous depression was associated with premature mortality, from both natural and unnatural death, particulary in the years immediately after discharge. The results give some support to the distinction between endogenous and reactive depression, and demonstrate that a diagnosis of endogenous depression is related to a higher risk of premature mortality in some patients.

TSH responsiveness to TRH (‘the TRH test’)—of no diagnostic value in depression

AbstractSerum free T4, free T3 and TSH (IRMA), along with TSH responsiveness to TRH (500 μg i.v.), were investigated in 12 patients, initially when severely depressed and again upon recovery, and in a group of age‐matched controls. The TSH response to TRH did not differ significantly between patients and controls, nor did it alter with treatment of depression. There were no significant differences in basal TSH levels. Free T3 levels were very significantly lower in untreated patients than in controls (p = 0·004), as were free T4 levels (p = 0·02), and had not improved significantly at recovery. Basal TSH levels showed a strong association with the integrated TSH response to TRH (p < 0·001) in both patients and controls. Thus in depression, as in thyoid dysfunction, the TRH test can be abandoned in favour of sensitive basal TSH measurement but, more importantly, the TRH test has no value in the diagnosis of endogenous depression or in monitoring treatment response. However, there is a reduction in free thyroid hormone levels in depression which has not been rectified by the time of clinical recovery.

Abnormal zymosan-induced neutrophil chemiluminescence as a marker of depression

Preliminary studies have shown that polymorphonuclear neutrophil (PMN) activity is decreased in a state-dependent manner in patients with endogenous depression. The present study investigates this finding in a larger group of psychiatric patients and attempts to determine the identification of the factor responsible for the abnormal neutrophil function. Chemiluminescence responses of PMNs from patients with diagnoses of endogenous depression, panic disorder, anxiety, schizophrenia and alcoholism were assessed concurrently with age- and sex-matched control subjects. The reduction in PMN activity was observed in panic disorder patients as well as during depression but remained normal in schizophrenia, alcoholism and generalised anxiety. The defect in PMN function appears to be related to an abnormal factor in the serum of the patient which is corrected on clinical recovery. Aspirin-inhibited prostaglandin synthesis resulted in an enhancement of PMN activity in healthy subjects, suggesting a possible role for prostaglandins in the abnormal PMN response.

The use of psychiatric facilities by depressives: results of the Upper Bavarian Study.

Utilization of psychiatric facilities by noninstitutionalized persons aged 20 years and older, identified as "depressive cases", was examined. Data were based on the representative community sample of the Upper Bavarian follow-up field study with an original sample size of 1668 people. In the 5-year follow-up 1384 (83%) subjects were interviewed, while 80 subjects (4.8%) had died. The 5-year prevalence of depressive disorders, according to the definition used, was 10.3%. We analyzed which people with depressive disorders sought help from mental health professionals according to type of depressive disorder, sociodemographic data, psychosocial factors and course of disorder. The psychiatric treatment rate (in- or outpatient) was 23.9% of the depressive cases. The majority of treated persons were outpatients. Patients with the diagnosis of endogenous depression were most likely to have received psychiatric treatment. Limitation in the ability to work due to depression was the most important psychosocial factor influencing help-seeking behavior. The highest consultation rate in psychiatric facilities was obtained from the depressives who had grown up without their parents.

TSH Responsiveness to TRH (“The TRH Test”) - of No Diagnostic Value in Depression

Serum free T4, free T3 and TSH (IRMA), along with TSH responsiveness to TRH (500 μg i.v.), were investigated in 12 patients, initially when severely depressed and again upon recovery, and in a group of age-matched controls. The TSH response to TRH did not differ significantly between patients and controls, nor did it alter with treatment of depression. There were no significant differences in basal TSH levels. Free T3 levels were very significantly lower in untreated patients than in controls (p = 0·004), as were free T4 levels (p = 0·02), and had not improved significantly at recovery. Basal TSH levels showed a strong association with the integrated TSH response to TRH (p < 0·001) in both patients and controls. Thus in depression, as in thyoid dysfunction, the TRH test can be abandoned in favour of sensitive basal TSH measurement but, more importantly, the TRH test has no value in the diagnosis of endogenous depression or in monitoring treatment response. However, there is a reduction in free thyroid hormone levels in depression which has not been rectified by the time of clinical recovery.

Diurnal variations of mood in psychiatric patients of different nosological groups.

In order to investigate whether diurnal variations of mood (DV) are pathognomonic for the diagnosis of endogenous depression, 130 patients and 21 healthy control subjects were examined. The patients differed in the type of primary disease (neurotic, endogenous depression, depression in schizophrenia). All subjects recorded their subjective mood on the Visual Analogue Scale every morning and evening over a period of 3 weeks. In addition, they were classified by expert rating according to clinical criteria as belonging to one of the three different groups of rhythmic type: morning type, evening type, indifference type. The results reveal that DV occur frequently but that they are nonspecific. No correlation between nosological diagnosis and rhythmic type was found. It follows that DV, therefore, cannot improve sample homogeneity in studies on psychoactive drugs.

Frequency and Implications of Personality Disorders in a Sample of Depressed Outpatients

The frequency of DSM-III, Axis II personality disorders and their relationship to selected demographic and clinical characteristics were investigated in a sample of 249 outpatients with major depressive disorder. Thirty-five percent of the sample had at least one personality disorder using stringent criteria; an additional 40% had a probable personality disorder. The most frequent disorders were in the “anxious' cluster of Axis II, including avoidant, dependent, and obsessive-compulsive. Paranoid, histrionic, and borderline were the next most common disorders. Personality disorder patients had more prior episodes of depression and were more likely to be diagnosed as recurrent MDD. They also had a longer duration of current episode, were more likely to have a diagnosis of endogenous depression, and had higher ratings of distress on multiple dimensions of general symptomatology. In addition, patients in the Axis II “odd” and “dramatic” clusters were less likely to be married, and dramatic patients were youn...

Sources of disagreement between clinical (ICD-9) and operational (RDC, DSM-III) diagnosis of endogenous depression (Melancholia)

In a sample of 173 depressed in-patients, the sources of disagreement between the clinical ICD-9 diagnosis of endogenous depression (ED) and the corresponding operational definitions of RDC and DSM-III were analyzed. The RDC definition of ED gave a significantly higher degree of concordance with the ICD-9 diagnosis of ED, than that of DSM-III. This difference was mainly due to the algorithm used in DSM-III. When empirically derived algorithms were applied to the diagnostic criteria of DSM-III and RDC, both criteria lists reached a higher degree of concordance with the ICD-9 diagnosis of ED. When the criteria lists of RDC and DSM-III were supplemented with cross-sectional criteria (psychotic features, incapacitation) and by course-related criteria (recurrence, bipolarity, primary episode, adequate personality, no precipitating stress), this did not result in significant enhancement of the degree of concordance.

A polydiagnostic scale for dimensional classification of endogenous depression Derivation and validation

Several operational diagnoses (OPD) for endogenous depression have been proposed. However--though aiming at similar clinical concepts--the amount of association and agreement between different OPD is rather low. In this study the relationship between eight OPD (Research Diagnostic Criteria, DSM-III, Michigan Discrimination Index, Newcastle Scale I, Newcastle Scale II, Taylor-Abrams Criteria, Vienna Research Criteria, Hamilton Endogenomorphy Index) was assessed by applying latent trait analyses to the classificatory data of these eight OPD which were rated simultaneously in a sample of 173 depressive inpatients. According to these analyses six OPD (RDC, DSM-III, NCS-I, NCS-II, TAC and VRC) are tapping the same phenomenon. This latent trait represents compatible concepts of endogenous depression; it is strongly associated with the independently assessed clinical ICD-9 diagnosis of endogenous depression. The six OPD can be considered as items of a scale (so-called OPD-scale). The total scores of the OPD-scale represent a dimensional assessment of the decisiveness of the diagnosis endogenous depression. Coefficients and parameters of this new scale are presented.

Depression and adrenocortical function in spinal cord injury patients: a review.

Depressive disorders are a significant problem among patients with spinal cord injury (SCI), but their diagnosis is difficult. The Dexamethasone Suppression Test (DST) has recently been shown useful for diagnosis of endogenous depression in physically healthy individuals. This article reviews the literature pertinent to depression and adrenocortical regulation after SCI, with special emphasis on DST. While depression is fairly common in SCI patients, endogenous depression occurs infrequently. The validity of the DST for diagnosis of depression in these patients is questionable because of the changes in adrenocortical regulation caused by SCI. Directions for future research are suggested.

Neuropeptides in the cerebrospinal fluid (CSF) in psychiatric disorders

Concentrations of vasoactive intestinal polypeptide (VIP), cholecystokinin (CCK) and gastrin in the cerebrospinal fluid (CSF) was studied in patients with endogenous depression, non-endogenous depression, mania, schizophrenia and a control group. All patients were classified according to various diagnostic systems. In the group of non-endogenously depressed patients CSF-VIP levels (median 16 pmol/1) were found significantly lowered compared to controls (median = 32 pmol/1) and endogenous depression (26 pmol/1). Going through the non-endogenous group it appeared that the low CSF-VIP was due to a group of patients with a former diagnosis of endogenous depression or a present diagnosis of possible endogenous depression. Moreover, this group was clinically characterized by ‘dysphoric/hysterical features’, ‘reversed diurnal variation’ (i.e. worst in the evening), and ‘lack of clearly circumscribed episode’. In many aspects this group seems similar to the atypical depressions described as monoamineoxidase responders. Concerning CSF-CCK and CSF-gastrin no significant differences between the examined groups were demonstrated.

Diurnal variation of total plasma tryptophan in depressive patients.

Total plasma tryptophan was analysed during a 24-h period in 27 control persons and 42 patients with a diagnosis of endogenous depression. Total plasma tryptophan was unchanged in endogenously depressed patients compared with controls. The effect of one night's sleep reversal was investigated in control persons. During the following day, when the persons were asleep, plasma tryptophan concentration fell below control values. The normal diurnal variation with low values in the night and high values in the daytime disappeared when the persons were kept fasting.

Biases in the Laboratory Diagnosis of Depression in Medical Practice

Several studies, conducted in psychiatric settings, have reported that the dexamethasone suppression test (ST) is useful in the diagnosis of endogenous depression. To determine whether the test has clinical utility in internal medicine practice, data were reviewed and reanalyzed from all studies that evaluated the dexamethasone ST in the diagnosis of depression. In these 11 studies, the mean positive predictive value reported for the test was 84%, reflecting high prevalence of disease (50%), sensitivity (43%), and specificity (92%) in those specialized populations studied. When estimates of the prevalence and severity of conditions associated with depressed mood seen in internal medicine were used, the sensitivity dropped to 30%, and the specificity to 85%. Assuming a prevalence of 20%, a figure based on available epidemiologic data, the predictive value for a positive test would be 33%, too low to have value in most clinical settings. Data from studies currently available do not support the use of dexamethasone ST in internal medicine practice. More generally, before any test is adopted in a general medical setting, it should be studied in that setting, or available data should be reanalyzed to correct for biases affecting prevalence, sensitivity, and specificity that may inflate the test's value.

Viloxazine and amitriptyline in endogenous depression

AbstractIn a double‐blind clinical trial carried out on 20 outpatients with the diagnosis of endogenous depression, amitriptyline (75–225 mg) was found to be somewhat faster in its therapeutic effects on depression than viloxazine (150–450 mg), whereas viloxazine was somewhat faster in its therapeutic effect on anxiety. Cardiovascular adverse effects were only encountered with amitriptyline, whereas gastrointestinal side effects were present with viloxazine.

Diagnosis of endogenous depression: Comparison of clinical, research and neuroendocrine criteria

Eighty-nine depressed outpatients were studied by clinical criteria, Research Diagnostic Criteria (RDC), and the dexamethasone suppression test (DST) of neuroendocrine regulation. A simple outpatient version of the DST, requiring only one blood sample, correctly identified 40% of patients diagnosed clinically as endogenous depression (ED), with a specificity of 98% and a diagnostic confidence of 95%. Differences in age, sex, or severity of symptoms between endogenous and non-endogenous depressives did not account for these results. By comparison, the diagnostic performance of the DST was weaker for the RDC categories Major Depressive Disorder (MDD) and primary MDD. These were less selective and more heterogenous than the clinical category ED. The clinical diagnoses of ED were supported in 98% of cases by the RDC, but 22% of RDC endogenous MDD diagnoses were not supported by the clinical diagnoses. Abnormal DST results were found only in patients with both the clinical diagnosis of ED and the RDC diagnosis of endogenous MDD. Patients with definite endogenous MDD had a significantly higher frequency of abnormal DST results (42%) than those with probable endogenous MDD (14%), or those with other RDC diagnoses (3%). A significant association was found between positive DST results and a positive family history of depression. These results support other evidence for use of a positive DST result as an external validating criterion for ED. The category MDD contained all cases diagnosed clinically as ED, but was diluted by cases diagnosed clinically as non-endogenous depression who had no neuroendocrine disturbance. The results also confirmed that the endogenous/nonendogenous and primary/secondary classifications of depression are not identical. We conclude: (1) that the DST can be used in the differential diagnosis of depressed outpatients as well as inpatients; (2) that the RDC category primary MDD and the Washington University category primary depression are more heterogenous and probably less valid than the clinical category ED; (3) that the RDC for endogenous MDD have only moderate validity; (4) that RDC diagnoses cannot substitute for careful clinical diagnoses in research studies, (5) that the best use of the RDC is to support clinical diagnoses, but not to generate diagnoses independently as a free-standing system; (6) that the concept of endogenous or endogenomorphic depression has validity and should be retained in research studies of depression.

Multiple monitored electroconvulsive therapy in the elderly.

Twenty patients aged 45 or older with the diagnosis of endogenous depression were evaluated in terms of safety and efficacy in their response to multiple monitored electroconvulsive therapy (MMECT) versus single electroconvulsive therapy (SECT). The MMECT group (10 patients) when compared retrospectively with the control SECT group (10 patients) showed a similar record for safety and efficacy. However, the MMECT group required shorter overall duration of treatment, fewer sessions of general anesthesia, and lower dosages of anesthetic agents. The chief benefit of MMECT probably is in the reduction of the time the patient is at risk for suicide.

Fertility and Offspring of Alcoholic Women: An Unsuccessful Search for the Fetal Alcohol Syndrome

SummaryForty married women in a psychiatric hospital with a diagnosis of alcoholism were interviewed to obtain details of their pregnancies and outcome of pregnancies with particular reference to spontaneous abortions, stillbirths, deaths, mental handicap and congenital abnormalities. Forty controls matched by age and with a diagnosis of endogenous depression were also interviewed. No significant differences were found in the fertility, outcome of pregnancy or state of the children. The probable reasons for this are discussed briefly and the introduction contains a review of some of the literature on the Fetal Alcohol Syndrome.

Some Preliminary Observations on a Questionnaire Technique for Classifying Depressive Illness: Its Relationship with Clinical Diagnosis and a Biological Technique for Depressive Classification

A questionnaire designed to assist in the classification of depressive illness, was administered to 20 acute depressive patients and 10 normal controls. Patient classification according to the decision rules employed by the questionnaire, were compared with patient classification arrived at by symptomatic (diagnostic) and physiological (G.S.R. inhibition threshold) means. It was found that a preponderance of patients classified as "endogenous depressives" by the questionnaire technique, also had clinical diagnoses of endogenous depression, and had low G.S.R. inhibition thresholds relative to normals. Furthermore a preponderance of patients classified as "non-endogenous depressives" by the questionnaire technique, had clinical diagnoses of neurotic depressive illness, and had high G.S.R. inhibition thresholds relative to normals. This supports the assertion that the questionnaire technique has some validity in the classification of depressive illness.