Statistical Manual Of Mental Disorders-IV Research Articles

Recognition and management of delirium among doctors, nurses, physiotherapists, and psychologists: an Italian survey

There are no studies that have identified the ability to recognize and manage delirium among Italian health providers caring for patients at risk. Therefore, the Italian Association of Psychogeriatrics (AIP) conducted a multicenter survey among doctors, nurses, psychologists and physiotherapists to assess their competence regarding the theme of delirium and its management in the everyday clinical practice. The survey period was 1st June 2013 to 30th November 2013. The invitation to participate was sent via email, with publication on the AIP website. The survey included 14 questions and two case vignettes. A total of 648/1,500 responses were collected. Most responders were doctors (n = 322/800), followed by nurses (n = 225/500), psychologists (n = 51/100), and physiotherapists (n = 30/100). Generally, doctors and psychologists correctly defined delirium, while nurses and physiotherapists did not. The most frequently used diagnostic tools were the Confusion Assessment Method (CAM) and the Diagnostic and Statistical Manual of Mental Disorders-IV. Delirium intensity was rarely assessed. Hypoactive delirium was generally managed with non-pharmacological approaches, while hyperactive delirium with a combination of non-pharmacological and pharmacological approaches. However, possible causes of delirium were under-assessed by half of doctors and by the majority of other professionals. Nurses, psychologists and physiotherapists did not answer the case vignettes, while doctors identified the correct answer in most cases. This is the first Italian survey among health providers caring for patients at risk of delirium. This is also the first survey including doctors, nurses, psychologists and physiotherapists. The results emphasize the importance of training to improve knowledge of this relevant unmet medical need.

Comparison of personality beliefs between depressed patients and healthy controls

IntroductionAccording to the cognitive model, the common mechanism underlying all psychological disorders is distorted or dysfunctional thoughts that affect mood and behaviors. Dysfunctional thoughts predispose an individual to depression and are among the processes that form the basis of personality traits. Elucidating the personality beliefs associated with depression and dysfunctional thoughts is important to understanding and treating depression. The aim of the present study is to determine whether depressed patients exhibited pathological personality beliefs compared with healthy controls. Furthermore, we investigated which personality beliefs were more common among such depressed patients. MethodsA total of 70 patients who were admitted to the Department of Psychiatry at Ankara Diskapi Yildirim Beyazit Training and Research Hospital (Ankara, Turkey) and diagnosed with major depressive disorder according to The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnostic criteria were included in the study. Additionally, 70 healthy controls matched for age, marital status, and education were included in the study. The Sociodemographic Data Form and Personality Belief Questionnaire-Short form (PBQ-SF) were administered to the participants. ResultsA comparison of the depression group with the healthy controls revealed higher scores in dependent, passive–aggressive, obsessive–compulsive, antisocial, histrionic, paranoid, borderline, and avoidant personality subscales in the depressive group. ConclusionsThese results suggest that personality beliefs at the pathological level are more common in depressive patients and that the detection of these beliefs would be useful for predicting the prognosis of the disease and determining appropriate treatment methods.

(11)C-PIB-PET for the early diagnosis of Alzheimer's disease dementia and other dementias in people with mild cognitive impairment (MCI).

According to the latest revised National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (now known as the Alzheimer's Association) (NINCDS-ADRDA) diagnostic criteria for Alzheimer's disease dementia, the confidence in diagnosing mild cognitive impairment (MCI) due to Alzheimer's disease dementia is raised with the application of imaging biomarkers. These tests, added to core clinical criteria, might increase the sensitivity or specificity of a testing strategy. However, the accuracy of biomarkers in the diagnosis of Alzheimer's disease dementia and other dementias has not yet been systematically evaluated. A formal systematic evaluation of the sensitivity, specificity, and other properties of positron emission tomography (PET) imaging with the (11)C-labelled Pittsburgh Compound-B ((11)C-PIB) ligand was performed. To determine the diagnostic accuracy of the (11)C- PIB-PET scan for detecting participants with MCI at baseline who will clinically convert to Alzheimer's disease dementia or other forms of dementia over a period of time. The most recent search for this review was performed on 12 January 2013. We searched MEDLINE (OvidSP), EMBASE (OvidSP), BIOSIS Previews (ISI Web of Knowledge), Web of Science and Conference Proceedings (ISI Web of Knowledge), PsycINFO (OvidSP), and LILACS (BIREME). We also requested a search of the Cochrane Register of Diagnostic Test Accuracy Studies (managed by the Cochrane Renal Group).No language or date restrictions were applied to the electronic searches and methodological filters were not used so as to maximise sensitivity. We selected studies that had prospectively defined cohorts with any accepted definition of MCI with baseline (11)C-PIB-PET scan. In addition, we only selected studies that applied a reference standard for Alzheimer's dementia diagnosis for example NINCDS-ADRDA or Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria. We screened all titles generated by electronic database searches. Two review authors independently assessed the abstracts of all potentially relevant studies. The identified full papers were assessed for eligibility and data were extracted to create two by two tables. Two independent assessors performed quality assessment using the QUADAS 2 tool. We used the hierarchical summary receiver operating characteristic (ROC) model to produce a summary ROC curve. Conversion from MCI to Alzheimer's disease dementia was evaluated in nine studies. The quality of the evidence was limited. Of the 274 participants included in the meta-analysis, 112 developed Alzheimer's dementia. Based on the nine included studies, the median proportion converting was 34%. The studies varied markedly in how the PIB scans were done and interpreted.The sensitivities were between 83% and 100% while the specificities were between 46% and 88%. Because of the variation in thresholds and measures of (11)C-PIB amyloid retention, we did not calculate summary sensitivity and specificity. Although subject to considerable uncertainty, to illustrate the potential strengths and weaknesses of (11)C-PIB-PET scans we estimated from the fitted summary ROC curve that the sensitivity was 96% (95% confidence interval (CI) 87 to 99) at the included study median specificity of 58%. This equated to a positive likelihood ratio of 2.3 and a negative likelihood ratio of 0.07. Assuming a typical conversion rate of MCI to Alzheimer's dementia of 34%, for every 100 PIB scans one person with a negative scan would progress and 28 with a positive scan would not actually progress to Alzheimer's dementia.There were limited data for formal investigation of heterogeneity. We performed two sensitivity analyses to assess the influence of type of reference standard and the use of a pre-specified threshold. There was no effect on our findings. Although the good sensitivity achieved in some included studies is promising for the value of (11)C-PIB-PET, given the heterogeneity in the conduct and interpretation of the test and the lack of defined thresholds for determination of test positivity, we cannot recommend its routine use in clinical practice.(11)C-PIB-PET biomarker is a high cost investigation, therefore it is important to clearly demonstrate its accuracy and standardise the process of the (11)C-PIB diagnostic modality prior to it being widely used.

Characteristics of schizophrenia suicides compared with suicides by other diagnosed psychiatric disorders and those without a psychiatric disorder

There has been much literature on schizophrenia, but very little is known about the characteristics of suicides with schizophrenia in comparison with the suicides with other diagnosed psychiatric disorders and without psychiatric disorders. Thirty-eight suicides with schizophrenia, 150 suicides with other psychiatric disorder, and 204 suicides without a psychiatric disorder were entered in current study. Psychological autopsy (PA) was applied to collect information of the suicides. Social demographic factors and clinical characteristics of the suicides were measured. The well validated standard scales were applied: Beck Hopelessness Scale (BHS), Landerman's Social Support Scale (DSSI), Dickman's Impulsivity Inventory (DII), Spielberger State-Trait Anxiety Inventory (STAI) and Hamilton Depression Scale (HAMD). Suicide intents were appraised by the Beck Suicide Intent Scale (SIS). The SCID based on the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) was applied to assess the psychiatric status of individuals. Demographic characteristics, clinical characteristics, method of suicide and suicide intents of suicides were compared among the three groups (schizophrenia group, other psychiatric disorders group, and none psychiatric disorders group). There were 9.7% of suicides who suffered schizophrenia. The current study found that being female was the risk factor for suicides with schizophrenia in rural China, which was opposite to the previous studies. The suicides with psychiatric disorder scored higher on hopelessness, anxiety, and depression, but lower on social support and impulsivity than suicides without psychiatric disorder. The suicides with psychiatric disorder were less impulsive than none psychiatric disorders group, too. The schizophrenia group did not show more violence than other psychiatric disorders group. This research compared the demographic characteristics, clinical characteristics, method of suicide and suicide intents among the suicides with schizophrenia, with other diagnosed psychiatric disorder and without psychiatric disorders. The result indicated that each groups showed their unique characteristics, which gave us new viewpoints to control and prevent the prevalence of suicides according to their different characteristics.

Psychometric properties of the Generalized Anxiety Disorder Inventory in a Canadian sample

The Generalized Anxiety Disorder Inventory is a recently developed self-report measure that assesses symptoms of generalized anxiety disorder. Its psychometric properties have not been investigated further since its original development. The current study investigated its psychometric properties in a Canadian student/community sample. Exploratory principal component analysis replicated the original three-component structure. The total scale and subscales demonstrated excellent internal consistency reliability (α = 0.84-0.94) and correlated strongly with the Penn State Worry Questionnaire (r = 0.41-0.74, all ps <0.001) and Generalized Anxiety Disorder-7 (r = 0.55-0.84, all ps <0.001). However, only the total scale and cognitive subscale (r = 0.48-0.49, all ps <0.05) significantly predicted generalized anxiety disorder diagnosis established by diagnostic interview. The somatic subscale in particular may require revision to improve predictive validity. Revision may also be necessary given changes in required somatic symptoms for generalized anxiety disorder diagnostic criteria in more recent versions of the Diagnostic and Statistical Manual of Mental Disorders (i.e. although major changes occurred from Diagnostic and Statistical Manual of Mental Disorders-III-R to Diagnostic and Statistical Manual of Mental Disorders-IV, changes in Diagnostic and Statistical Manual of Mental Disorders-5 were minimal) and the possibility of changes in the upcoming 11th revision of the International Classification of Diseases.

The Relationship Between Serum Lipids and Depression

Objective: Low cholesterol is associated with depression among western countries. The objective of this study was to examine the relationship between cholesterol and depression in Korean population with low levels of serum cholesterol. Methods: The data of about 740,000 individuals, aged 30-64 years at entry in the Korean Cancer Prevention Study, were used. Total cholesterol levels were measured in 1992. Depression was measured using the modified DSM-IV (Diagnostic Criteria of Major Depressive Episode in Diagnostic and Statistical Manual of Mental Disorders-IV) scale. Total cholesterol was classified into four groups (quartile). Odds Ratios of low level of cholesterol were evaluated using multi-variable logistic models. Results: The prevalence of major depression was 7.7% in men and 10.4% in women. After adjustment for various confounding variables, an inverse association was detected between cholesterol levels and depression intensity among men and women. The odds ratio (95% confidence interval) of the lowest quartile of cholesterol was 1.16 (1.13-1.20) on major depression compared with the highest quartile of cholesterol in men. The corresponding odds ratio among women was 1.09 (1.04-1.15). The strongest association among 9 items of depression was found at decreased appetite and lost weight in both men (OR=1.68) and women (OR=1.43). Conclusion: Low cholesterol is associated with major depression in men and women. Further studies are necessary to evaluate the cross-validation, to explore the biological mechanism, and to identify the clinical implication.

The Underlying Reasons of Suicide Attempts among Arab Population in the Holy-Land—Nazareth: View and Overview

Suicide is one of the leading causes of death in many western countries, but in eastern countries this phenomenon was until recently extremely rare. Our study, performed during 2005-2012 comes to shed lights on the prevalence and the underlying reasons of the notable increase of suicide attempts in the conservative and religious Arab community of Nazareth, Israel. Extensive interviews, sociodemographic information, suicide risk factors in addition to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnoses were used in current retrospective study of 772 suicide attempters in the emergency room at the Nazareth Hospital. Statistical analysis using SPSS version 17, Pearson χ2 analysis and percentage distribution were used for the statistical analysis. We considered the differences to be significant at the level of p < 0.05. Three fold frequency of suicide attempts were observed among females (77%) compared to males (23%), (P = 0.0001). During the year 2009 the suicide attempts prevalence was the highest 118 (15.3%) and during 2005 it was the lowest 77 (10%). 76.5% of the attempters arrived to the emergency room within 1 - 6 hours. A single suicide attempt was observed among 60% of males compared to 70.5% among females [OR = 0.846 (CI: 0.742 - 0.966)] additionally, more than one suicide attempt was notified among 40% of males whereas 29.5% among females [OR = 1.367 (CI: 1.099 - 1.701), (P = 0.007)]. Psychiatric patients (59.3%) performed more than one suicide attempt compared to normal subjects (21.5%), [OR = 2.76; CI: 2.276 - 3.354, P-value = 0.0001]. Drugs was preferred for suicide attempts in both genders (87.7%), especially among females compared to males (90.6% vs. 78.8% respectively), [OR = 0.869; CI: 0.801 - 0.942, P = 0.001]. 38 of males (21.3%) committed suicide attempts by causing accidents and self harm compared to 56 females (9.4%); [OR = 2.261; CI: 1.552 - 3.294, (P = 0.0001)]. 40 psychiatric patients (18.7%) chose this method compared to 54 non-psychiatric patients (9.7%), [OR = 1.925; CI: 1.32 - 2.806, P-value = 0.001]. The underlying causes of suicide were as follows: 50% social causes, 26% adjustment reactions and 24% psychiatric diseases. Conclusion: Being the first unique study to shed lights on the increasing phenomenon of suicide in the Arab community, our findings unveiled a tragic transition in the rate of suicide attempts in a supposedly conservative and religious community. Even though the rate of suicide attempts is lower than other communities it should not divert focus away from efforts to develop effective strategies to prevent suicide attempts, especially among females.

Family accommodation of obsessional symptoms and naturalistic outcome of obsessive–compulsive disorder

Accommodation of symptoms by families and expressed emotion (EE) may have a negative impact on the outcome of obsessive–compulsive disorder (OCD). The study examines the effect of family accommodation (FA) and EE on the 1-year naturalistic outcome of OCD. Patients with OCD who met the criteria for the Diagnostic and Statistical Manual of Mental Disorders-IV, text revision (DSM-IV TR; N=94) were followed up for 1 year and assessed every 3 months. Assessments included measurement of symptom severity, FA, EE and family burden. By the 12th month, the cumulative probability of remission was 58%. Non-remitters compared with remitters had a significantly higher FA, EE and family burden at the baseline and did not report significant reductions on any of the family variables over the year. In a Cox proportional hazard regression analysis, a higher FA at the baseline significantly predicted time to remission. FA of symptoms has a significant negative impact on the naturalistic outcome of OCD. This emphasises the need to design specific interventions to reduce FA for a better outcome.

A meta-analysis of Chinese herbal medicines for vascular dementia.

OBJECTIVE:To investigate the efficacy and safety of Chinese herbal medicines in the treatment of patients with vascular dementia.DATA RETRIEVAL:We retrieved publications from Cochrane Library (2004 to July 2011), PubMed (1966 to July 2011), the Chinese Science and Technique Journals Database (1977 to July 2011), the China National Knowledge Infrastructure (1979 to July 2011), Google Scholar (July 2011), and the Chinese Biomedical Database (1977 to July 2011) using the key words “Chinese medicine OR Chinese herbal medicine” and “vascular dementia OR mild cognition impair OR multi-infarct dementia OR small-vessel dementia OR strategic infarct dementia OR hypoperfusion dementia OR hemorrhagic dementia OR hereditary vascular dementia“.SELECTION CRITERIA:Randomized controlled trials comparing Chinese herbal medicines with placebo/western medicine in the treatment of patients with vascular dementia were included. Diagnostic standards included Diagnostic and Statistical Manual of Mental Disorders-IV, and National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherché et l’Enseignement en Neurosciences. Two participants independently conducted literature screening, quality evaluation and data extraction. The quality of each trial was assessed according to the Cochrane Reviewers’ Handbook 5.0.MAIN OUTCOME MEASURES:Effective rate, Mini-Mental State Examination scores, Hasegawa Dementia Scale scores, and incidence of adverse reactions.RESULTS:We identified 1 143 articles discussing the effects of Chinese medicine on vascular dementia. Thirty-one of these were included in the analysis. These studies involved a total of 2 868 participants (1 605 patients took Chinese medicine decoctions (treatment group); 1 263 patients took western medicine or placebo). The results of our meta-analysis revealed that Chinese herbal remedies in the treatment group were more efficacious than the control intervention (relative risk (RR) = 1.27; 95% confidence interval (CI): 1.18–1.38, P < 0.01). Mini-Mental State Examination scores were higher in patients taking Chinese herbal medicines than in those in the control group (weighted mean difference (WMD) = 2.83; 95%CI: 2.55–3.12, P < 0.01). Patients in the treatment group showed better disease amelioration than those in the control group (Hasegawa Dementia Scale scores; WMD = 2.41, 95%CI: 1.48–3.34, P < 0.01). There were also considerably fewer adverse reactions among those in the treatment group compared with those in the control group (RR = 0.20, 95%CI: 0.08–0.47, P < 0.01).CONCLUSION:Chinese herbal medicine appears to be safer and more effective than control measures in the treatment of vascular dementia. However, the included trials were generally low in quality. More well-designed, high-quality trials are needed to provide better evidence for the assessment of the efficacy and safety of Chinese medicines for vascular dementia.

Attention Deficit Hyperactivity Disorder, differential diagnosis with blood oxygenation, beta/theta ratio, and attention measures

Attention Deficit Hyperactivity Disorder (ADHD) is one of the disorders causing the greatest impact, conditioning academic learning, quality of concentration, and capacity for self-regulation and control. The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV-TR) establishes the most commonly accepted criteria for diagnosis (Inattentive: ADHD-I, Hyperactive/impulsive: ADHD-HI, and Combined: ADHD-C), but currently, diverse studies disagree about whether to address it as a continuum with different degrees of intensity (subtype structure) or as specific disorders (counterposed profiles). Prior research has tested the hypothesis of differential categories with performance measures and cortical activation. The goal proposed herein is to confirm these results, incorporating a new measure, near-infrared hemoencefalography (nir-HEG), in order to control cortical activation through levels of blood oxygenation. For this purpose, we used a sample of 205 children between 8 and 13 years (105 control group, 28 with ADHD-I, 35 with ADHD-HI, and 37 with ADHD-C), administering a continuous performance test (TOVA), quantified electroencephalogram (Q-EEG), and nir-HEG. Results reflect the counterposed profiles hypothesis instead of the degrees of intensity, although the latter is more habitual and generalized.

Kiss my Asperger's: turning the tables of knowledge

Since the early 1990s Asperger's syndrome (AS) has steadily gained media attention and public recognition to the point of being described as a cultural obsession. Using multi-method inquiry this paper: (1) challenges prevailing medicalised discourses of AS by including a satire of the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) [1994. Washington, DC: American Psychiatric Publishing] and a critique of advertisements created about AS and other related disabilities; (2) offers alternative interpretations within social, cultural, historical, and personal contexts; (3) foregrounds the experience and understanding of AS from individuals with AS; (4) contemplates the need for schools and colleges to become more receptive to neurodiversity, and to support students with AS. The author calls attention to the ongoing problematics of defining AS and illustrates how disability studies in education helps reframe AS in diverse ways, valuing the ontological and epistemological differences between ‘official’ representations and individuals with the AS label.† †Both professional and popular literature use Asperger and Asperger's interchangeably. The latter is used in this paper.

Affective information processing in pregnancy and postpartum with and without major depression

Adults with clinical depression exhibit systematic errors in their recognition and interpretation of affective stimuli. This study investigated the extent to which depression and phases of pregnancy and postpartum influence affective processing of positive and negative information, and the extent to which affective information processing in pregnancy predicts depressive symptoms in postpartum. Data were collected from 80 unmedicated women, diagnosed with major depressive disorder (MDD) or with no psychiatric disorder and between ages 18 and 44 years, during 32–36 weeks of pregnancy and during 6–8 weeks postpartum. All completed a Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) Axis I review, symptom reports, and a computer task measuring affective information processing. Significant group differences were found in which postpartum women with major depression were less responsive to negative stimuli, with lower ratings of intensity and reactions to negative pictorial stimuli, compared with postpartum healthy women. Also, lower ratings of the intensity and reactions to negative stimuli during pregnancy among depressed women predicted postpartum depression severity, even after controlling for depressive severity and affect ratings in pregnancy. Blunted affective reactivity to negative stimuli is a characteristic of depression that was observed among depressed women during pregnancy and postpartum in our study.

A Validation Study of the Brief Alcohol Use Disorder Identification Test (AUDIT): A Brief Screening Tool Derived from the AUDIT

BackgroundThe prevalence of alcohol use disorder (AUD) is very high in Korea. To identify AUD in the busy practice setting, brevity of screening tools is very important. We derived the brief Alcohol Use Disorders Identification Test (AUDIT) and evaluated its performance as a brief screening test.MethodsOne hundred male drinkers from Kangbuk Samsung Hospital primary care outpatient clinic and psychiatric ward for alcoholism treatment completed questionnaires including the AUDIT, cut down, annoyed, guilty, eye-opener (CAGE), and National Alcoholism Screening Test (NAST) from April to July, 2007. AUD (alcohol abuse and dependence), defined by a physician in accordance with Diagnostic and Statistical Manual of Mental Disorders-IV, was used as a diagnostic criteria. To derive the brief AUDIT, factor analysis was performed using the principal component extraction method with a varimax rotated solution. Receiver operating characteristic (ROC) curve analysis was performed to investigate the discrimination ability of the brief AUDIT. Areas under the ROC curve were compared performance of screening questionnaires with 95% confidence intervals.ResultsThe derived brief AUDIT consists of 4 items: frequency of heavy drinking (item 3), impaired control over drinking (item 4), increased salience of drinking (item 5), and alcohol-related injury (item 9). Brief AUDIT exhibited an AUD screening accuracy better than CAGE, and equally to that of NAST. Areas under the ROC curves were 0.87 (0.80-0.94), 0.76 (0.66-0.85), and 0.81 (0.73-0.90) for the brief AUDIT, CAGE, and NAST for AUD, and 0.97 (0.95-0.99), 0.93 (0.88-0.98) and 0.93 (0.88-0.98) for alcohol dependence.ConclusionThe new brief AUDIT seems to be effective in detecting male AUD in the primary care setting in Korea. Further evaluation for women and different age groups is needed.

Role of severity and gender in the association between late-life depression and all-cause mortality

Mortality associated with depression may be influenced by severity of depression and gender. We investigated the differential impacts on all-cause mortality of late-life depression by the type of depression (major depressive disorder, MDD; minor depressive disorder, MnDD; subsyndromal depression, SSD) and gender after adjusting comorbid conditions in the randomly sampled elderly. One thousand community-dwelling elderly individuals were enrolled. Standardized face-to-face clinical interviews, neurological examination, and physical examination were conducted to diagnose depressive disorders and comorbid cognitive disorders. Depressive disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria and SSD to study-specific operational criteria. Five-year survivals were compared between groups using Cox proportional hazards models. By the end of 2010, 174 subjects (17.4%) died. Depressive disorder (p = 0.001) and its interaction term with gender (p < 0.001) were significant in predicting five-year survival. MDD was an independent risk factor for mortality in men (hazard ratio = 3.65, 95% confidence interval = 1.67-7.96) whereas MnDD and SSD were not when other risk factors were adjusted. MDD may directly confer the risk of mortality in elderly men whereas non-major depression may be just an indicator of increased mortality in both genders.

The effect of Gami Guibitang (GGBT), a medicinal herbal formulation, on moderate depression

Aim of the studyThis study was conducted to assess the efficacy of Gami Guibitang (GGBT), a mixture of Korean traditional medicinal herb extracts, in the treatment of patients suffering from moderate depression. MethodologyA randomized, double-blind, placebo-controlled clinical trial was conducted. A total of 164 male and female patients, between 19 and 80 years of age, who suffered from moderate depression and fulfilled the condition of >13 of the Hamilton depression (HAM-D17) rating scales and the diagnostic criteria for major depressive disorder or dysthymic disorder according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), were selected for the present study. Patients were randomized into either GGBT (n=82) or placebo (n=82) groups. Subjects in the GGBT group were given 3 capsules of GGBT daily (4000mg extracts/day), whereas the placebo group received 3 placebo capsules daily. The effects of GGBT were evaluated on day 1 and at week 8 of treatment by assessing depression (HAM-D17 scale), quality of life (SF-36 questionnaires) and morning salivary cortisol levels. ResultsNo serious side effects that could be attributed to the herb extract were reported. Considerable reductions in HAM-D17 scales were observed in both groups but without any significant difference between them (placebo effect). However, increases in the score of subscale Bodily Pain in SF-36 questionnaire was significantly higher in placebo group compared to GGBT group, indicating more intense Bodily Pain in the placebo group after 8-weeks. Change in mean morning salivary cortisol level was significantly higher in GGBT group than that in the placebo group. ConclusionsThere was no significant difference in the reduction of HAM-D17 scales between the placebo and GGBT groups. However, compared to placebo, GGBT treatment increased morning cortisol level which could be associated with the improvement in Bodily Pain in these patients suffering from moderate depression.

Prevalence of DSM-IV Major Depression Among U.S. Military Personnel: Meta-Analysis and Simulation

A meta-analysis of 25 epidemiological studies estimated the prevalence of recent Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) major depression (MD) among U.S. military personnel. Best estimates of recent prevalence (standard error) were 12.0% (1.2) among currently deployed, 13.1% (1.8) among previously deployed, and 5.7% (1.2) among never deployed. Consistent correlates of prevalence were being female, enlisted, young (ages 17-25), unmarried, and having less than a college education. Simulation of data from a national general population survey was used to estimate expected lifetime prevalence of MD among respondents with the sociodemographic profile and none of the enlistment exclusions of Army personnel. In this Simulated sample, 16.2% (3.1) of respondents had lifetime MD and 69.7% (8.5) of first onsets occurred before expected age of enlistment. Numerous methodological problems limit the results of the meta-analysis and simulation. The article closes with a discussion of recommendations for correcting these problems in future surveillance and operational stress studies.

ADHD 치료에서 가족치료캠프의 적용

Objectives : Demands for comprehensive and intensive treatment programs for treatment of children with attention-deficit hyperactivity disorder (ADHD) who suffer from serious impairment in various psychosocial areas are increasing. The aim of this study was to evaluate the possibility of developing new types of camp programs focused on improving social adjustment of children and helping parents effectively manage their children's problem behaviors. Methods : Fifteen children diagnosed as ADHD according to Diagnostic and Statistical Manual of Mental Disorders-IV (mean age 9.5 years) and their parents participated in this program. Eight consecutive camps were held at two-week intervals, from Jun 2007 to Oct 2007 in an adolescent training center located at Chungtaesan, in Korea. Each camp program included social skills training in the classroom and outdoor activities in the forest for children, as well as parent training for mothers. In addition, after the sixth camp, we conducted one parental session for fathers and a three-day booster family camp three months later. Finally, eleven families adhered to the program. Results : All children, parents, and therapists rated questionnaires or checklists at baseline, intra-, and post-treatment. Parenting burden rated using the Parenting Stress Index showed a significant decrease, from 57.89 to 46.22 (p=.019). And, overprotection rated using the Parenting Bonding Instrument showed a significant decrease, from 16.56 to 12.44 (p=.046). However, no significant improvement in children's behavioral and emotional problems was observed. Conclusion : In this study, the consecutive ADHD family camp program was effective for empowerment of parental competency, but not for general improvement of children's behavioral and emotional symptoms.

Relationship between Opium Abuse and Severity of Depression in Type 2 Diabetic Patients

BackgroundOpium use in diabetic populations is associated with major depressive disorder (MDD). This study was designed to investigate the relationship between opium use and severity of depression in Iranian diabetic patients.MethodsIn this case-control study, 642 type 2 diabetic patients were recruited from those presenting at two outpatient clinics at the Akhavan Hospital in Kashan, Iran; of them, 600 diabetic patients were included in the study and divided into two groups: opium-abusers (150 patients) and non-opium-abusers (450 patients). Clinical and demographic information was obtained through a detailed questionnaire. Depression symptomalogy and severity were assessed with the Beck Depression Inventory (BDI), and a corresponding diagnosis was made based on the Diagnostic and Statistical Manual of Mental Disorders-IV, Text Revision, 2000 (DSM-IV TR) criteria.ResultsThe mean depression score was higher in the opium abuse group than in the non-abuser group (29.27±1.44 vs. 18.29±1.31, P<0.001). In general, a significant association was found between opium abuse and depression among patients (odds ratio [OR], 4.54; 95% confidence interval [CI], 2.87 to 7.44; P=0.001). No significant relationship was found between dysthymia and opium abuse (OR, 0.68; 95% CI, 0.18 to 1.192; P=0.155), while MDD was significantly higher in the opium abuser group (OR, 7.32; 95% CI, 5.20 to 12.01; P<0.001).ConclusionDepression is more frequent in opium-dependent diabetic patients, and its severity is also greater. Given these findings, opium-dependent diabetic patients should be advised about the increased risks of depression and related comorbidities.

Attention Deficit Hyperactivity Disorder in Epileptic Children

It is well-known that the prevalence of attention deficit hyperactivity disorder (ADHD) is higher in epileptic children than in the general pediatric population. The aim of this study was to compare the accompaniment of ADHD in epileptic children with well-controlled seizures and no significant intellectual disability with that in healthy controls. We included epileptic children between the ages of 6 and 12 yr visiting our clinic for six consecutive months and controls without significant medical or psychiatric illnesses. We excluded patients with intellectual disability or persistent seizures during the recent three months. The diagnosis of ADHD was based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). After exclusion of 84 patients, we enrolled 102 (54.8%) children (mean age, 9.4 ± 2.0 yr). Seven (7 of 102, 6.9%) were diagnosed with ADHD. As compared to control group (4 of 110, 3.6%), there was no difference in ADHD accompaniment (P = 0.29). No difference was observed in ADHD accompaniment according to seizure type and epilepsy syndrome. In conclusion, the accompaniment of ADHD in epileptic children with well-controlled seizures and no intellectual disability may not differ from that of the general pediatric population.

Efficacy of Cognitive-Behavior Therapy (CBT) On Depressed Spouses of Cancer Patients in an Adjuvant Care Setting

Purpose: To assess the efficacy of cognitive behavior therapy for spouses of cancer patients with refractory depression according to the Diagnostic and Statistical Manual of Mental Disorders-IV. Patients and Methods: All English-speaking spouses of cancer patients were eligible to participate. All spouses completed the following self-report questionnaires: Demographic variables sheet and Beck Depression Inventory (BDI). The research sample was consisted of 10 married spouses of cancer patients in the Adyar Cancer Institute, Chennai, in southern India. All spouses with moderate degrees of depression were selected. The cognitive behavior therapy sessions extended for 60 minutes and were held once weekly. The present study is a pre-post test design before and after intervention program. Continuous data were analyzed by using paired t tests to assess change over time. The analyses were conducted by using the SPSS version 11.0. Results: The mean of the Beck scores at the beginning and end of the study was respectively: Intervention group 24.6, SD= 3.84 versus 11.4, SD= 4.27 and control group 26.4, SD= 4.21 versus 27, SD= 3.93, the decrease in the Intervention group was significantly more than control group. Intervention group showed a significant decrease in BDI scores, t (17.96) = 4, p .607. Conclusion: Depression is common and persistent in spouses of cancer patients. Psychological screening and appropriate intervention such as CBT is an essential part of palliative care. This preliminary study suggested that cognitive behavior therapy might be an effective psychological treatment for major depression among spouses of cancer patients. However, further large scale randomized controlled trials are needed before definitive conclusions can be drawn.