Hamilton Scale Scores Research Articles

Psychological status of women with miscarriage

Introduction. During pregnancy, a woman becomes vulnerable to develop symptoms of depression and anxiety, which in turn are associated with increased risk of perinatal complications, postpartum depression as well as behavioral problems in children.Aim: to assess the prevalence of symptoms related to depression and anxiety in pregnant women with threatened abortion (ТА), non-developing pregnancy (NP) as well as those with physiological course of pregnancy (РР) in the first trimester of pregnancy; to reveal major predictors of psycho-emotional disorders in pregnant women.Materials and Methods. Three groups of pregnant women were stratified: 62 patients with TA, 60 patients with NP and 57 women with PP. Clinical history and physical examination were performed in all subjects. All pregnant women were assessed by Hamilton Anxiety Rating Scale and the Beck Depression Inventory.Results. It was found that the mean Beck’s score was significantly higher in NP vs. TA and PP groups (p < 0.05). Moreover, significant differences were also observed while comparing TA and PP groups (p = 0.037). Clinically important depression was found in 3.3 % NP women and in 1.6 % TA women. Preclinical depression was found in 13 % and 6.5 % women with NP and TA, respectively. The mean Hamilton scale score was significantly higher in NP vs. PP group (p < 0.05), but was comparable with that in TA group (p > 0.05). The mean score on the anxiety scale was significantly higher in TA vs. PP group (p = 0.001). Clinically significant mild to moderate anxiety was found in 4.9 % and 1.6 % TA and NP women, respectively. Mild anxiety symptoms were noted in 35.5 % of women with TA, 38.3 % of women with NP, and 15.7 % of women with PP. Multiple linear regression analysis revealed that a burdened obstetric history and the duration of the patient hospital stay had the strongest association with symptoms of depression and anxiety.Conclusion. Symptoms of prenatal anxiety and depression are widespread and should be identified in a timely manner. Psychological counseling and testing of pregnant women should be included into recommendations for pregnancy management.

Efficacy and safety of Aviandr in the treatment of anxiety in patients with adjustment disorders after COVID-19

To investigate the efficacy and safety of Aviandr in the treatment of anxiety in patients with adjustment disorders after COVID-19. A multicenter prospective open-label study included 109 patients of both sexes aged 18 to 65 years (70 women, 39 men, average age - 41.4±13.18 years) with a leading complaint of anxiety (Hamilton scale score, HAM-A ≥18 - ≤24), which arose after acute coronavirus infections. Clinical manifestations had to meet the diagnostic criteria F43.2 ICD-10. The drug Aviander was prescribed 20 mg 2 times a day for 4 weeks. At the end of taking the drug, patients were monitored for another 1 week (a delayed follow-up visit). Psychopathological, statistical and parametric research methods were used using standardized HAM-A, Montgomery-Asberg scales (MADRS), visual analog asthenia scale (VASH-A), Sheehan Disability Scale (SDS), digital character substitution test (DSST), general clinical impression scale (CGI). Data from 109\110 patients were analyzed to evaluate efficacy\safety. Aviandr was administered 20 mg 2 times daily for 4 weeks. Patients were followed for 1 week (delayed follow-up visit) at the end of treatment. Reducing the intensity of anxiety on the HAM-A scale was - 14.2±4.92 or 69.4±22.66% by the end of treatment. The response rate to therapy (responders are patients with a decrease in the total score on the HAM-A ≥50%) was 83.49%. Remission was achieved (sum of HAM-A scores ≤7) by the end of treatment 68.81% of patients, and 79.8% of patients at the follow-up visit. Significant changes were obtained on the MADRS, VAS-A, SDS and DSST scales. According CGI 45.9% of patients had «much improved» and 43.1% of patients had «very much improved» by the end of treatment; 58.7% of patients had «much improved» and of 33.9% patients had «very much improved» at the follow-up visit. 38 adverse events were reported in 27 (24.55%) patients during the study. A definite association with study drug was reported between 5 mild adverse events in 4 (3.64%) patients. No subjects withdrew from the study due to an adverse event. Positive dynamics (reduction of anxiety symptoms, decrease in asthenia) persisted after discontinuation of the study drug. No cases of withdrawal syndrome were observed. According to the results of the study, the anxiolytic, antidepressant, antiasthenic and pro-cognitive effects of Aviandr were observed. An increase in the social activity of patients was observed.

Efficacy and safety of Vespireit® (buspirone) prolonged-release tablets (PR) 15 mg in the therapy of patients with functional dizziness: results of the double-blind, placebo-controlled, multicenter, randomized, phase 3 clinical trial

Functional dizziness (FD) is one of the most common causes of chronic dizziness for which there is no effective drug therapy, highlighting the importance of searching for new treatment technologies.Objective: to evaluate the efficacy and safety of Vespireit® (INN buspirone) prolonged-release tablets 15 mg2 (JSC “Valenta Pharm”, Russia) compared with placebo in the treatment of patients with autonomic dysfunction syndrome accompanied by FD.Material and methods. The clinical trial (CT) included a total of 268 patients with autonomic dysfunction syndrome accompanied by FD and a DHI (The Dizziness Handicap Inventory) dizziness scale score of 36 to 52 inclusive, who were randomly divided into 2 groups and treated in a double-blind fashion. 135 patients (Group 1) received Vespireit® prolonged-release tablets 15 mg at a dose of 15 mg (1 tablet) once daily for 28 days. 133 patients (Group 2) received placebo at the same dosage regimen. Treatment was given against a background of vestibular gymnastic exercises. The primary outcome of the clinical trial was assessment of patient response rate (proportion of responders), i.e., a ≥50% reduction in total DHI for dizziness score at Visit 5 (day 28±1) compared with baseline (Visit 1, day 1). Secondary efficacy measures included assessment of: 1) treatment response rates (≥50% reduction in DHI total score compared to Visit 1) at Visits 2, 3, and 4; 2) DHI total score at Visits 2, 3, 4, and 5; 3) changes in DHI total score at Visits 2, 3, 4, and 5 compared to Visit 1; 4) proportion of patients with a 30% or greater reduction in DHI scale dizziness compared with baseline at Visit 2, 3, 4, and 5; 5) time elapsed until total DHI score decreased by ≥50% compared to baseline; 6) time elapsed until total DHI score decreased by ≥30% compared to baseline; 7) changes in Digital Rating Scale (DRS) score from Visit 1 to Visit 2, 3, 4, 5; 8) scores on the DRS at Visits 2, 3, 4, 5; 9) proportion of patients with different response to treatment on the Likert scale at Visits 2, 3, 4, and 5. Additional secondary criteria of efficacy were also assessed: total Hamilton Depression Rating Scale (HDRS) score at Visits 4 and 5; change in total Hamilton scale score at Visits 4 and 5 compared to Visit 1. The safety criterion assessed in the clinical trial was monitoring of adverse events (AEs), clinically significant deviations in vital signs, laboratory parameters, and ECG parameters.Results. The proportion of responders with a ≥50% reduction in DHI total score at Visit 5 (Day 28±1) compared to baseline (Visit 1, Day 1) was 68.7% (n=92) in Group 1, which was 52.9% more than in Group 2 – 15.8% (n=21) (p<0.0001). Evaluation of all secondary (including additional) efficacy criteria also showed a statistically significant benefit of therapy in Group 1 compared to Group 2 (p<0.0001). A total of 61 AEs were recorded in 46 (17.2%) patients: 30 AEs in 21 (15.6%) patients in Group 1 and 31 AEs in 25 (18.8%) patients in Group 2. There was no significant difference between treatment groups in the number of patients with AEs (p=0.5196). In both groups, there were no patients with AEs with severity ≥3, serious AEs (SAEs), SAEs with fatal outcome, or SAEs that led to discontinuation of study therapy. No clinically significant abnormalities were noted during assessment of vital signs, laboratory parameters, or ECG parametersConclusion. The superiority of Vespireit® prolonged-release tablets (PR) 15 mg therapy over placebo in reducing FD in patients with autonomic dysfunction syndrome was confirmed. The drug demonstrated a favorable safety profile comparable to placebo.

Manifestations and treatment strategies of anxiety disorders among English Chinese translators in cross-cultural translation

BackgroundAlthough English Chinese translators receive high salaries, their mental abilities are overwhelmed during long-term cross-cultural translation. In addition, the requirements for translation submission time and quality make them face long-term pressure, and over time, they develop anxiety disorders, mainly manifested as sleep disorders. To address this issue, research has added psychological intervention therapy to traditional drug therapy and used a combination of treatment strategies to treat anxiety disorders.Subjects and Methods100 English Chinese translators with anxiety disorders were randomly divided into two groups: Group C and Group D. Group C received drug therapy, while Group D received psychological intervention in addition to drug therapy. The experiment lasted for 3 months and their psyche was evaluated by Hamilton Anxiety Scale and data treatment was analyzed using SPSS 21.0. Metrics were indicated in the shape of average ± criterion variation and t-test was used.ResultsThe Hamilton scale score of Group D was 25.52 ± 1.15 before the intervention, and 7.06 ± 0.88 after the intervention; Before the intervention, the score of Group C was 25.47 ± 1.06, and after the intervention, it was 14.03 ± 1.55. Overall, the combination of drug therapy and psychological intervention has a better therapeutic effect.ConclusionsEnglish Chinese translators often exhibit anxiety disorders such as neurotic tension and sleep disorders in cross-cultural translation, and the combination of psychological intervention strategies in drug therapy is effective in treating their anxiety disorders.

Uso da acupuntura na depressão

This is a descriptive, quantitative and cross-sectional study carried out from January to March 2020, in Vitoria, ES, Brazil. It aims to describe the effects of acupuncture on adults with depression in a psychiatric institution. Data collection used a form containing sociodemographic information, acupuncture assessment form and the Hamilton Scale. Among the twenty subjects evaluated, a comparison was made among eight subjects, of which four from the intervention group (with the application of 10 sessions with a maximum of 10 points) and four from the control group (without the application of acupuncture). The results showed that there was improvement in the signs and symptoms associated with depression, with a reduction in the Hamilton scale score from 21.75 to 8.0 in the patients who received treatment with acupuncture; that is, from the condition of severe depression to mild depression. In addition, patients mentioned improvement in their sleep, mood, libido, control of emotions, relaxation and decreased pain. Acupuncture has shown beneficial effects in patients with depression.

Clinical Effect Observation of Jieyu Decoction in the Treatment of Generalized Anxiety Disorder

Objective: To observe the clinical effect of Jieyu decoction in treating generalized anxiety disorder with stagnation-heat in liver meridian type. Methods: There were 72 cases of generalized anxiety disorders outpatient and inpatient patients, and 36 in the control and treatment group. The control group was given oral Deanxit; the treatment group was given Jieyu decoction granules, and necessary psychological counseling was given to patients in both groups. Changes in traditional Chinese medicine syndrome scoring scale, Hamilton scale (HAMA), dynamic electrocardiogram heart rate variability and other indicators were recorded and compared between the two groups. Results: The total effective rate of the control group was 76.5%, and the total effective rate of the treatment group was 80.0%. The curative effect of the treatment group and the control group was significantly higher than that before treatment (P < 0.05), and there was no significant difference in the overall curative effect between the two groups (P > 0.05). The HAMA scale score of the two groups was significantly lower than that before treatment (P < 0.05), and there was no significant difference in the reduction rate of HAMA score between the two groups (P > 0.05). The traditional Chinese medicine syndrome scores of the two groups were significantly decreased compared with that before treatment (P < 0.05). The traditional Chinese medicine syndrome scores of the treatment group were significantly different from that of the control group after 8 weeks of treatment (P < 0.05). Two groups of heart rate variability in 24 h period of standard deviation between the average normal R - R (SDNN), 24 h per 5 min normal R - R period between the standard deviation (SDANN), root mean square of phase difference between adjacent R - R (RMSSD) and the number of cardiac 50 ms accounted for the percentage of the total number of cardiac (PNN50) than before treatment significantly increased (P < 0.05), 8 weeks after treatment the SDNN, SDANN than the control group no significant difference (P > 0.05), RMSSD,PNN50 significantly difference compared with control group (P < 0.05). Conclusion: Jieyu decoction has good efficacy and high safety in the treatment of generalized anxiety disorder of the type of liver meridian and heat stagnation, which is suitable for clinical promotion and application.

Neuropsychiatric Manifestations of Multiple Sclerosis in Egyptian Patients

Background: Multiple sclerosis (MS) is a chronic inflammatory central nervous system (CNS) disease, arising from a complex interaction of both environmental and genetic factors. MS affects individuals during the most productive time of their lives, and directly limits their work capacity, leading to major social and economic consequences. Objectives: The aim of the current work was to study neuropsychiatric manifestations in multiple sclerosis patients and to understand their correlation with the degree of clinical disability. Patients and Methods: A cross-sectional randomized study included a total of 40 consecutive M.S. patients (26 female and 14 males with mean age ± SD 32.60 ± 10.01) attended at MS Outpatient Clinics of Al-Azhar University Hospitals (Al Hussein and Bab Elshierya) and 20 controls during the period from January 2018 until February 2019. Results: The present study showed that there was a highly significant difference between patients and controls groups regarding Beck scale score for depression (p =0.005). There was 52.5% of MS patients had depression (while 25% of control subjects had depression). The study showed that there was significant positive correlation between beck scale score and EDSS scale score for disability a (p value =0.048 r=0.315). There was a highly significant difference between patients and control group regarding Hamilton scale score for anxiety as (P-value = 0.002). Conclusion: An understanding of neuropsychiatric disorders in MS is important for all professionals involved in the care of people with MS. These disorders affect about half of patients.

Is It Time for Going Beyond the P‐Value Paradigm With the Estimation of the Probability of Clinical Benefit as a Criterion for Assessing the Outcomes of a Clinical Trial? A Case Study in Patients With Major Depressive Disorder

The conventional statistical methodologies for evaluating treatment effect are based on hypothesis testing (P-value). Alternative measurements of treatment effect have been proposed for anti-infective treatments using the probability of target attainment. A general framework is proposed to extend this methodology to other therapeutic areas. A disease trial model is used for estimating the probability of reaching a treatment effect associated with relevant clinical benefits, in complement to the evaluation of the probability of rejecting the null hypothesis. A case study is presented in depression, where disease status is evaluated using bounded clinical scores (Hamilton Depression Rating Scale), and detectable treatment effect is inversely proportional to placebo response. The β-regression approach is used to model Hamilton scale scores, and a placebo-related criterion is proposed for determining the clinical benefit. The probability of reaching a clinical benefit represents a reliable criterion for replacing the P-value paradigm in the assessment of the outcomes of clinical trials.

Психовегетативные расстройства и боли у женщин с дисменореей

The aim: to identify the relationship between the severity of psychovegetative and pain in women with dysmenorrhea. Patients and methods: 46 women (mean age 22.3±6.2 years old) with dysmenorrhea. 3 groups: mild, moderate and severe dysmenorrhea were distinguished as symptoms severity. Results. The correlations between the pain severity according to numerical pain intensity scale (NPIS) and the values of other parameters: with the anxiety severity Sheehan scores (r=0.644, p <0.01), depression on the Hamilton scale (r=0.824, p <0.01), disorders the autonomic nervous system by questionnaire Wayne (r=0,442, p <0.05), reproductive system functioning satisfaction numerical scale (r=0.702, p <0.01), and the overall life quality on the SF-36 questionnaire (r=0.615, p <0.01) were identified. Patients with severe dysmenorrhea score on the Hamilton scale and severity of psycho-vegetative syndrome was significantly higher it was found when variance analysis depending on the Hamilton scale score and score on the questionnaire Wayne from a group at the prevailing sex hormones concentration changes, clustering parameter for the severe dysmenorrhea presence. Conclusion. Severe dysmenorrhea is probably a yellow flag patient psychosocial distress and requires the development of specific therapeutic strategies. The article also shows the relationship between the pathophysiological mechanisms of psycho-vegetative syndrome, pain and disorders of regulate the menstrual cycle hormones.

Long-Term Results after Modified Brostrom Procedure without Calcaneo-fibular Ligament Reconstruction

The short-term results of modified Brostrom procedures (MBP) have been satisfactory. However, the long-term results of anatomical reconstruction have been less frequently reported. We report on our long-term results in our patient group. Thirty patients with chronic ankle instability who were treated using the MBP without CFL reconstruction from March 1997 to June 1999 were evaluated retrospectively. This consecutive series of patients was comprised of 26 males and four females. The mean age of the patients at the time of operation was 23 years. The mean followup period was 10.6 years. Twenty-four of the 30 were high-level amateur or professional athletes. The operation procedure involved only ATFL imbrication with inferior extensor retinaculum (IER) reinforcement. Clinical outcomes were evaluated by reviewing clinical charts, retrospectively. Functional outcome scores were obtained using the Hamilton scale, a VAS, and AOFAS score at final followup visit, when each patient underwent a physical examination and stress radiography. Mean AOFAS score was 91 and the mean VAS at final followup was 87. According to the Hamilton classification, 12 achieved an excellent result, 16 a good result, and two a fair result. Mean anterior translation values at final followup were 6.9 and 6.1 mm on ipsilateral and contralateral sides. Furthermore, mean talar tilt angles were 3.0 and 2.5 degrees for ipsilateral and contralateral sides. Twenty-eight of the 30 patients were restored to pre-injury activity levels. The long-term surgical results of the MBP without CFL reconstruction for chronic lateral ankle instability were good to excellent in terms of functional, clinical, and radiographic assessments.

Depression in the Older Adult: The Challenge of Medical Comorbidity

Depression in the Older Adult: The Challenge of Medical Comorbidity

Women's preference on mode of delivery in Southern Italy

Rates of cesarean section are rising worldwide and maternal requests for this kind of delivery contribute to the increase in this trend. The purpose of this study was to analyze the factors influencing maternal demand in our region and the profile of women preferring this mode of delivery. Six obstetricians (3 male and 3 female) were asked to give out a questionnaire to their patients with an uncomplicated pregnancy. Demographic data, obstetrical history, lifestyle, and physician-patient relationship were analyzed. Patients who would have preferred abdominal delivery were asked to report the motivations for their choice. A psychiatric evaluation, using the Hamilton Anxiety Scale and the Montgomery-Asberg Depression Rating Scale, was conducted. 16.9% of 390 patients enrolled preferred cesarean section. This wish was correlated with patients' age > or = 35 years (OR 2.43; p=0.0065), high level of education (OR 4.28, p=0.019), previous infertility (OR 3.91, p=0.0045), smoking (OR 4.25, p=0.0008), quality of information (OR 29.08, p=0.0013), and desire for more comprehension (OR 8.25, p=0.00001). The most frequent motivation for this choice was a safer childbirth (90.9%). No difference was found for the Hamilton scale's score, while the Montgomery-Asberg Scale showed a lower mean score for the cesarean section group (7.2+/-3.3 versus 9.4+/-7.3, p=0.0002). A high rate of women wish to give birth by cesarean section. This is probably an expression of the changes in society's attitudes. However, more careful attention to the psychological aspects and more personalized information about pregnancy and delivery could reduce this maternal demand.

Perceived quality of life in obsessive-compulsive disorder: related factors

BackgroundObsessive-compulsive disorder (OCD) affects young adults and has great impact on the social, emotional and work spheres.MethodsWe measured perceived quality of life (QOL) in OCD patients, in order to analyse socio-demographic and clinical factors that may be associated with QOL perception. 64 OCD outpatients were assessed with the Mini International Neuropsychiatric Interview for DSM-IV, the Yale-Brown Obsessions and Compulsions scale (Y-BOCS), Hamilton's depression scale and the SF-36 self-administered global QOL perception scale.ResultsWe found a correlation among Hamilton's scale scores and all SF-36 subscales. The severity of the obsessive-compulsive disorder was correlated with all SF-36 subscales and with the highest scores in Hamilton's scale. The obsessions subscale was correlated to all SF-36 subscales, while the compulsions subscale was correlated only to social functioning, emotional role, mental health and vitality. Compulsions were not related to general health perception. There were significant differences between OCD patients and the Spanish general population in all SF-36 subscales except those related to physical health and pain. Gender, age, age of onset of the disorder, years of evolution and marital status of the patients did not significantly affect quality of life perception. Being employed was related to better scores in the subscale of physical role. Patients with medical comorbidity scored lower in the subscales of general health, social functioning and mental health. Patients with comorbid psychiatric disorders had worse scores in the subscales of pain, general health, social functioning and mental health.ConclusionQuality of life perception was different in OCD patients and the general population. Quality of life perception was related to severity of the disorder, physical and psychiatric comorbidity and employment status.

Estimulação Magnética Transcraniana na depressão: resultados obtidos com duas aplicações semanais

Transcranial Magnetic Stimulation (TMS) has been shown to be a useful therapy for depression. This paper evaluates the results of bi-weekly low-frequency TMS of 4 weeks duration, in 10 patients with depression who do not respond or are intolerant to antidepressive medication. This is a case series study. DMS-IV criteria were used to diagnose depression. In order to disclose possible improvements in depressive symptoms, the 17 items Hamilton scale was used at three different moments: at the beginning, middle and end of the treatment period. Results were analysed using Friedman's chi2 test. Hamilton's scale score improvement was > 50% in five patients and > 75% in 3 of these. TMS may be efficacious, safe and easily performed as an adjunct to medical treatment of depression. We cannot differentiate a potentiation of the effect of antidepressive medication from an intrinsic effect of TMS alone, since we did not treat any subjects without the concurrent use of medication.

Treatment of Bereavement-Related Major Depressive Episodes in Later Life: A Controlled Study of Acute and Continuation Treatment With Nortriptyline and Interpersonal Psychotherapy

Objective: The authors tested the hypothesis that nortriptyline and interpersonal psychotherapy, alone and in combination, are superior to placebo in achieving remission of bereavement-related major depressive episodes. Method: Eighty subjects, aged 50 years and older, with major depressive episodes that began within 6 months before or 12 months after the loss of a spouse or significant other were randomly assigned to a 16-week double-blind trial of one of four treatment conditions: nortriptyline plus interpersonal psychotherapy (N=16), nortriptyline alone in a medication clinic (N=25), placebo plus interpersonal psychotherapy (N=17), or placebo alone in a medication clinic (N=22). The protocol required that the acute-phase double-blind treatment be ended after 8 weeks if Hamilton depression scale ratings had not improved by 50%. Remission was defined as a 17-item Hamilton scale score of 7 or lower for 3 consecutive weeks. Results: The rate of remission for nortriptyline plus interpersonal psychotherapy w...

Double-blind, randomised, placebo-controlled study to evaluate the efficacy and safety of a fixed combination containing two plant extracts (Crataegus oxyacantha and Eschscholtzia californica) and magnesium in mild-to-moderate anxiety disorders

SUMMARYObjective: To assess the clinical efficacy of a neurotonic component containing fixed quantities of two plant extracts (Crataegus oxyacantha and Eschscholtzia californica) and magnesium versus placebo in mild-to-moderate anxiety disorders with associated functional disturbances, under usual general practice prescription conditions.Research design and methods: A total of 264 patients (81% female; mean age: 44.6 years) presenting with generalised anxiety (DSM-III-R) of mild-to-moderate intensity (total Hamilton anxiety scale score between 16 and 28) were included in a double-blind, randomised, placebo-controlled trial. Patients were randomly assigned to two groups: 130 received the study drug (Sympathyl), and 134 a placebo (two tablets twice daily for 3 months). Efficacy and safety data were recorded before first administration and 7, 14, 30, 60 and 90 days after start of treatment.Sympathyl is produced and marketed by Laboratoire Innotech International, Arcueil, France.Main outcome measures: Efficacy was assessed by (a) change in Hamilton anxiety scale total and somatic scores; (b) change in patient self-assessment; (c) number and percentage of responsive subjects (reduction of at least 50% in Hamilton or self-assessment score); and (d) the physician's clinical global impression. Tolerance was assessed by undesirable events spontaneously reported by the patients over the study period.Results: Total and somatic Hamilton scale scores and subjective patient-rated anxiety fell during treatment, indicating clinical improvement. The decrease was greater in the study drug than in the placebo group. End of treatment clinical improvement, as measured by the mean difference between final and pre-treatment scores, was, for the study drug and placebo groups respectively: −10.6 and −8.9 on the total anxiety score ( p = 0.005); −6.5 and −5.7 on the somatic score ( p = 0.054); and −38.5 and −29.2 for subjectively assessed anxiety ( p = 0.005). The risk/benefit ratio as judged by the investigating physicians was also significantly greater in the study drug than in the placebo group. In all, 15 patients (11.5%) in the study drug group and 13 patients (9.7%) in the placebo group experienced 22 and 15 adverse events, respectively. Undesirable events were mainly mild or moderate digestive or psychopathological disorders.Conclusions: The preparation containing fixed quantities of Crataegus oxyacantha, Eschscholtzia californica, and magnesium proved safe and more effective than placebo in treating mild-tomoderate anxiety disorders.

Estrogen therapy for depression in postmenopausal women

Objective: To look at the modification in depressive mood in postmenopausal depressed women after estrogen replacement therapy (ERT). Method: Twelve depressed patients divided into two groups of six women each were studied. One group received conjugated equine estrogens (CEE) 0.625 mg/day; the other did not receive any treatment (control group). Mood was assessed in all the subjects at baseline and at 6 months with Hamilton Rating Scale score and considered as depression when it was >15. Differences between groups were determined by Mann–Whitney U-test, and in each group between baseline and 6-month values with Wilcoxon test. Results: The ERT group had a statistically significant decrease in depressive mood (21 vs. 13 points, P<0.03), while in the control group no significant change was found. Final Hamilton scale scores were significantly lower ( P<0.05) in those under ERT, when compared with those in the control group. Conclusion: Depressive mood decreased after 6 months with CEE, so the prescription of ERT can be useful in postmenopausal women with depressive mood.

Stigma, depression, and somatization in South India.

The relationships of stigma to both depression and somatization were studied in psychiatric patients in South India to test the hypothesis that stigma is positively related to depressive symptoms and negatively related to somatoform symptoms. Illness experience, symptom prominence, and indicators of stigma for 80 psychiatric outpatients were addressed with the Explanatory Model Interview Catalogue. Stigma scores and ratings of symptom prominence were derived. The Structured Clinical Interview for DSM-III-R and the Hamilton Depression Rating Scale were administered to assess psychiatric diagnoses and symptoms of depression. Clinical narratives were analyzed to clarify the nature of relationships between stigma and symptom prominence. The mean stigma scores were 18.2 (SD = 13.0) for patients with somatoform disorders only, 36.0 (SD = 19.0) for patients with depressive disorders only, and 26.8 (SD = 16.0) for those with mixed depressive and somatoform disorders. The stigma scores were positively related to depressive symptoms, as indicated by Hamilton scale scores and prominence ratings for depressive symptoms, but stigma was inversely related to somatoform symptoms, as indicated by ratings of symptom prominence. Although both depressive and somatic symptoms were distressing, qualitative analysis clarified meanings of perceived stigma, showing that depressive symptoms, unlike somatic symptoms, were construed as socially disadvantageous. The tendency to perceive and report distress in psychological or somatic terms is influenced by various social and cultural factors, including the degree of stigma associated with particular symptoms. This study with the Explanatory Model Interview Catalogue demonstrates how quantitative and qualitative methods can be effectively combined to examine key issues in cultural psychiatry.

Severity of depression and response to cognitive behavior therapy

The authors studied the relationship between clinical severity of depression and response to cognitive behavior therapy. Fifty-nine outpatients with major depression with endogenous features, according to Research Diagnostic Criteria, were stratified into more severe (score of 20 or more on the Hamilton Rating Scale for Depression; N = 38) or less severe (Hamilton score of 19 or less; N = 21) subgroups. Patients were treated with a 16-week, 20-session cognitive behavior therapy protocol. Outcome was assessed with the Hamilton scale, the Global Adjustment Scale, and the Beck Depression Inventory. The more severe group was significantly more symptomatic across the 16-week protocol and had a significantly lower response rate on the Beck inventory (50% versus 81%). However, the groups did not significantly differ at end point on any of the three measures, and they showed comparable rates of symptomatic improvement (i.e., percent change in scores and interactions between severity classification and time). These results partially replicate the National Institute of Mental Health's Treatment of Depression Collaborative Research Program's findings of poorer response to cognitive behavior therapy in patients with Hamilton scale scores of 20 or more. However, both groups experienced robust and clinically significant reductions in depressive symptoms, and the response of the more severe patients in the current study could hardly be considered poor. While these findings do not support the view that a Hamilton scale score of 20 or more is a relative contraindication for cognitive behavior therapy, the symptoms of the more severely depressed patients did tend to remit less completely (particularly on the Beck inventory) and thus these patients may benefit from a more intensive or extended course of therapy.

Characterization of depression in war-related posttraumatic stress disorder

Many patients with posttraumatic stress disorder (PTSD) have symptoms of depression, but operationalized psychological constructs related to depression have not been used extensively in characterizing affective symptoms of PTSD. The authors' objective is to better characterize the affective component of PTSD. The subjects were 45 male psychiatric inpatients at a Veterans Administration medical center; 28 met DSM-III-R criteria for PTSD and 17 met Research Diagnostic Criteria (RDC) for major depressive disorder. All of the subjects with PTSD were Vietnam veterans. The 21-item Hamilton Rating Scale for Depression was used to assess state measures of symptom severity, and the Depressive Experiences Questionnaire was used to measure dimensions of dependency, self-criticism, and self-efficacy. The mean total Hamilton scale score of the patients with PTSD was nonsignificantly higher than that of the patients with major depressive disorder; patients with PTSD had higher scores on almost all individual Hamilton symptoms, particularly insomnia, somatic anxiety, and diurnal variation. Patients with PTSD had significantly higher scores on the self-criticism scale but not on the dependency and self-efficacy scales of the Depressive Experiences Questionnaire. The scores of patients with PTSD on the dependency and self-criticism scales were negatively correlated. No significant differences between patients with PTSD with and without concurrent major depressive disorder were observed. Characterization of such depressive dimensions of PTSD as dependency and self-criticism may have important clinical implications.