Diagnosis Of Severe Depression Research Articles

Evaluation of Patients Diagnosed with Essential Hypertension in Terms of Mental and Personality Disorders.

Recent studies have suggested a link between hypertension and psychiatric disorders. However, the relationship between hypertension and mental health conditions remains unclear. So in this study, it was aimed to compare the prevalence of psychiatric diseases seen in hypertension patients with the healthy group. Psychiatric interviews were conducted with 104 patients in the hypertension group and 102 participants in the control group. The Sociodemographic and Clinical Data Form, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Disorders, Structured Clinical Interview for DSM-5-Clinician Version, and DSM-5 Structured Clinical Interview for Personality Disorders were implemented for participants. Patients with hypertension were found to have a significantly higher number of psychiatric disorders compared to the control group (χ 2 = 29.389; P = .001). Statistically significant difference in the diagnosis of severe depression, chronic depression disorder, and specific phobia was discovered between the 2 groups (P < .05). The HAM-A and HAM-D scores were also significantly higher in the hypertension group (P < .001). No statistically significant difference was found between the patient and control groups in terms of the frequency of personality disorders. (χ 2 = 0.045; P = .833). The fact that depression and anxiety symptoms are more common in hypertension patients stands out as a subject that needs further investigation in terms of both the pathophysiology of hypertension. In this regard, since essential hypertension is a serious risky disease for mortality and morbidity on its own, it is critical to conduct psychiatric screening and develop new additional treatments to provide patients with supportive care.

New Caregiver Diagnoses of Severe Depression and Child Asthma Controller Medication Adherence.

Children with asthma who have depressed caregivers are known to be less adherent to medication regimes. However, it is less clear how adherence responds to a caregiver's new diagnosis of severe depression or whether there is a similar relationship with other serious caregiver diagnoses. The hypothesis is that adherence worsens both with new diagnoses of depression and possibly with new diagnoses of other serious conditions. This study follows a cohort of 341,444 continuously insured children with asthma before and after a caregiver's new diagnosis of severe depression or another serious health condition. The effect of a new depression diagnosis on a child's medication adherence is compared to the effect of new diagnoses of other common caregiver chronic conditions including diabetes, cancer, congestive heart failure, coronary artery disease, and chronic obstructive pulmonary disease. Results show that children's medication adherence declines following a caregiver's new diagnosis of severe depression, but that it also declines following a caregiver's new diagnosis of diabetes. There is no association with new diagnoses of the other caregiver chronic conditions examined. Children whose caregivers have a new diagnosis of depression or diabetes may be at increased risk of deterioration in their medication adherence. These caregivers may benefit from additional support and follow-up. The relationship between caregivers' health and children's medication adherence is complex and deserves further study.

Journal Digest: Treatment-Emergent Mania, Fingerprint Scans, and More

Journal Digest: Treatment-Emergent Mania, Fingerprint Scans, and More

CYP2C19 polymorphisms are associated with severity of depression at initial evaluation and after the treatment independently of the prescribed medications: 4 weeks prospective study.

The cytochrome P-450 2C19 (CYP2C19) enzyme is involved in the metabolism of numerous antidepressants. It also metabolises some endogenous substrates, which could also confer to vulnerability. We aimed to establish whether the severity of depression and treatment response are associated with the genetically predicted CYP2C19 phenotype. We assessed the CYP2C19 genotype-predicted metabolic phenotypes (normal, intermediate or ultrarapid, there were no poor metabolisers) in patients with moderate or severe depression. We used the self-rated Beck Depression Inventory-II (BDI-II) scale and the clinician-rated Montgomery-Åsberg Depression Rating Scale (MADRS) at baseline, after 2 and 4 weeks of an empirical treatment trial. Patients and clinicians were blind to the genetic testing results. Seventy-six patients participated in the present study. At baseline, impaired CYP2C19 metabolisers, compared to normal metabolisers, had higher BDI-II (P = 0.046; ηp2 = 0.08) but not MADRS score. Intermediate metabolisers more often had a diagnosis of severe depression than normal metabolisers (P = 0.003). After 4 weeks of empirical treatment, intermediate metabolisers had significantly higher MADRS and BDI-II scores than normal metabolisers (P = 0.006; ηp2 = 0.131 and P = 0.030; ηp2 = 0.091). These differences were independent of the use of CYP2C19-metabolised medications in the treatment trial, as well as the treatment discrepancy status. Intermediate CYP2C19 polymorphism-predicted activity was associated with more severe depression after an empirical treatment trial. The lack of association between the prescription of CYP2C19-metabolised drugs and treatment response calls for a further look into the role of endogenous substrates of CYP2C19.

Compliance with nice guidelines for management of depression in a community mental health team

AimsTo evaluate compliance within a Community Mental Health Team (CMHT) to the NICE guidelines for the management of depression.BackgroundReducing the prevalence of depression continues to be a major public health challenge.Given the complexity and recurrent nature of the condition, the NICE guideline CG90 is an invaluable resource to aid the effective management of depression. Here we present an audit of adherence to this guideline within a CMHT.MethodA retrospective electronic casenote review of all patients diagnosed with depression between January 2016 and October 2019 under the care of a Birmingham CMHT (n = 35), assessing key performance areas including: quality of assessment and coordinated care, risk assessment, choice of pharmacological and psychological treatment using the stepped care model and appropriate crisis resolution planning.ResultKey results include: The majority of patients were Caucasian (63%). Ages ranged from 27 to 69 (mean age 48 years old).Severity of disorder was typically moderate (46%) or severe (48%). Of those with a diagnosis of severe depression, 41% had associated psychotic symptoms.Psychiatric comorbidity was high (49%), of which generalised anxiety disorder was the most common (59%).Referrals were typically from primary care (77%). Approximately half (51%) had reported suicidal thoughts according to the referral.A quarter of patients (26%) were seen by CMHT within 8 weeks of referral; 20% of referrals however waited over 12 months before being assessed.Risk assessments were out of date for 71% of patients.100% of patients had a crisis plan noted within their most recent clinic letter; however, none of these met the required standards.Polypharmacy was common (60%), with 34% prescribed two antidepressants. Use of lithium augmentation was uncommon, with only one patient prescribed this. 43% were prescribed an antipsychotic; of which, 29% had appropriate physical health monitoring completed.Over half of patients (60%) had been referred to psychology services; of these, 38% had either completed or were in ongoing treatment at the time of review.ConclusionCMHTs manage the care of individuals with depression who have high levels of active symptoms and disability, psychiatric comorbidity, care requirements, and complex treatment plans. Pharmacological management was broadly in line with guidelines, and rates of referral to psychology were satisfactory. Risk assessment and crisis planning are clear areas in need of urgent attention in order to comply with guidelines and ensure patient safety.

Diabetes associated with decreased severe depression at time of depression diagnosis

Background: The combined impact of diabetes mellitus and major depressive disorder (MDD) is well defined with significant evidence for a bi-directional relationship. Prior studies at our institution have demonstrated that the diagnoses of diabetes or the baseline control of diabetes did not independently predict clinical outcomes of depression at 6 months. Our hypothesis for this study was that the diagnosis of diabetes in depressed primary care patients would have no effect on incidence of severe depression at the time of diagnosis of depression. Methods: This study was a retrospective chart review analysis of patients who were diagnosed with either MDD or Dysthymia and had a score of ≥ 10 on PHQ-9 at the time of clinical diagnosis. From 1 January 2008 through 30 September 2012, a cohort of 4,311 patients who authorized research of their medical records and had complete data sets available was then developed. Results: With logistic regression modeling, the diagnosis of diabetes was inversely related with the odds of diagnosis of severe depression (PHQ-9 ≥ 20) at index with an odds ratio of 0.649 (95% CI 0.486-0.868, p=0.004). Obesity was not associated independently with the initial diagnosis of severe depression (p=0.471). Conclusions: The diagnosis of diabetes was associated with decreased risk for severe depression at the time of diagnosis in our patient population. Further studies would be beneficial to explore potential reasons for this, with implications for the development of person-centered approaches to care.

Validity indices of the Rorschach test and Personality Assessment Inventory: a comparison in pathological and healthy subjects.

The debate about the validity of the Rorschach test, compared with psychometric inventories, is particularly relevant in the forensic evaluation. The aim of the study is to present an overview on the control indices proposed in Rorschach (e.g. R, F%, Lambda Index) and in a personality inventory ( Personality Assessment Inventory : e.g., openness, desirability, inconsistency, infrequency, negative and positive impression, malingering and defensiveness, treatment rejection) and to cross-correlate these indices. The sample consisted of 50 adult inpatients with diagnosis of severe depression or psychosis, and a control group of healthy subjects, matched by gender, age and educational level. The results show that the analytic style, as opposed to the global one, is related to greater openness to psychological assessment, less social desirability and defensive tendency. The Rorschach Lambda index demonstrates good validity in detecting tendency to defensiveness, social desirability and dissimulation, both in normal and pathological protocols.

Treatment With Phytoestrogens for Depressive Symptoms in Late-Onset Schizophrenia

To the Editor: Sex differences in the course and outcome of schizophrenia are a well-known entity, with females having a relatively favorable course. This difference could be due to the protective role of estrogen in premenopausal women and could explain the second peak of schizophrenia in postmenopausal women.1 Hence, estrogen is a potential treatment for schizophrenia in elderly postmenopausal women; however, its use is limited by potential side effects.2 Phytoestrogens are a safer alternative to estrogen, but to date, there have been few reports of the use of phytoestrogens in schizophrenia,3 and to the best of our knowledge, there is no report of their use for treatment of depressive symptoms in schizophrenia. Here, we report the case of a perimenopausal patient with paranoid schizophrenia whose depressive symptoms were successfully treated with adjuvant phytoestrogens. Case report. Ms A, a 47-year-old married woman, presented in 2010 with illness of 7 months’ duration characterized by delusions of reference and persecution, thought broadcast, and third-person auditory hallucinations. She had sought a gynecologic consultation 2 months earlier for dysfunctional uterine bleeding; she underwent a hysterectomy, following which she developed pervasive sadness, anhedonia, and depressive cognitions. A detailed history was obtained from her husband—the primary caregiver—and her mental status examination results were corroborative. She was diagnosed as having paranoid schizophrenia (DSM-IV) and was started on tablet paliperidone 6 mg/d. She showed substantial improvement in her psychosis at the end of 3 months. However, she continued to complain of depressed mood and inability to perform her household chores; thus, tablet escitalopram 5 mg/d was started. She reported no improvement in depressive symptoms after 2 months but developed akathisia, following which escitalopram was stopped. Her akathisia resolved after stoppage of escitalopram. Because the depressive symptoms had worsened following the hysterectomy, phytoestrogen supplement was started on cessation of escitalopram.3 Ms A reported improvement in her symptoms during 8 weeks of treatment. She was continued on the combination of paliperidone and phytoestrogens, and improvement was maintained during the last follow-up at the end of 6 months. The patient had onset of psychotic symptoms during menopause and depressive symptoms after a hysterectomy. Because she developed depressive symptoms only after the hysterectomy, diagnosis of severe depression with psychotic symptoms was unlikely, though such a diagnosis is common in this age group. Estrogen has significant effect on modulation of dopamine and serotonin receptors.4 However, estrogen replacement is associated with potential complications such as thromboembolism, coronary artery disease, and endometrial cancer.2 Phytoestrogens are a group of biologically active plant substances with a chemical structure that is similar to estradiol and are a safer alternative to estrogen. Earlier reports indicate use of phytoestrogens as adjuvant treatment for positive symptoms of schizophrenia.3 Their reported therapeutic effect on depression is yet to be examined.5 Because our patient did not show improvement on 5 mg/d of escitalopram but instead developed akathisia, we did not give an adequate trial of conventional antidepressant medication. In conclusion, our report suggests phytoestrogens as a potential treatment for depressive symptoms in schizophrenia, especially in elderly women who are not responding to or are intolerant to conventional antidepressants. Further evaluation in controlled trials is warranted.

First-time Diagnosis of Severe Depression

First-time Diagnosis of Severe Depression

Case Study: The Treatment of Auditory Hallucinations in Children with Emotional Disorders

The nosological status and treatment of auditory hallucinations in children who have either emotional or behavioural disorders is an area that is poorly researched. Auditory hallucinations are associated with a wide range of emotional and behavioural disorders, and are likely to be present in between 1% to 5.7% of children seen in out‐patient clinics by child and adolescent psychiatrists. A case study of a 12‐year‐old boy with a 14‐month history of second‐person auditory hallucinations associated with a diagnosis of severe depression is presented. In terms of age, gender, family history and symptomatology, this case is typical of children with non‐organic, non‐schizophreniform hallucinations. In this case, successful treatment comprised both cognitive‐behavioural techniques, aimed at alleviating the mood disorder, and neuroleptic medication.

Personality pattern of depression and its relation to acquiescence.

The Personality Research Form (PRF) was administered to 35 hospitalized patients with the diagnosis of severe depression. In comparison with a control group, the patients were significantly higher in Abasement, Harmavoidance, and Succorance but significantly lower in Achievement, Dominance, Endurance, Exhibition, Sentience, Understanding, and Desirability. When the groups were compared by using scores on the true-keyed subscales, 5 dimensions showed significant differences which did not occur on the false-keyed subscales of the same dimensions. There were significant differences for 8 other personality dimensions on the false-keyed subscales which were not found on the true-keyed subscales. It was hypothesized that depressed patients exhibit an acquiescence response set which is specifically related to and dependent upon the content of the personality dimension tested.