Assessing depression and anxiety in chronic dialysis patients

One hundred and twenty-eight patients on chronic dialysis were studied by the Zung Self-Rating Depression Scale and Self-Rating Anxiety Scale, the Differential Emotion Scale (DES), the Test of Emotional Styles (TES), and the Social Dysfunction Rating Scale (SDRS). As measured by the Zung scales, approximately half of the sample manifested depression and anxiety symptoms at clinically relevant levels. The data suggested an inverse correlation between depression and anxiety levels and patients' total length of time on dialysis, which may explain some of the variation in depression and anxiety results obtained with different samples. Depression and anxiety scores were correlated with related DES and SDRS factors, but patients' scores on the DES, TES, and SDRS generally indicated positive mood and functioning. Scales containing disease-related somatic items may yield exaggerated depression and anxiety scores for dialysis patients. It may be useful to assess patients' psychological functioning with several different instruments.     

Prevalence of clinically significant anxiety in a family practice setting

The Zung Self-Rating Anxiety Scale was administered to 739 consecutive patients seen in a family medicine center during a 9-month period. When a morbidity cutoff score of 50 was used, 20% of the patients were found to have clinically significant anxiety symptoms.     

后循环短暂性脑缺血发作患者的负性情绪研究

目的 探讨后循环短暂性脑缺血发作（transient ischemic attack，TIA）患者的负性情绪及影响因素，以指导心理干预，提高患者生活质量。方法 选用Zung焦虑自评量表（SAS）和抑郁自评量表（SDS）、艾森克人格问卷（EPQ），对257例后循环TIA患者进行调查。结果 后循环TIA组 SAS和SDS评分与国内常模比较，差异有统计学意义（P <0.01）。结论 后循环TIA患者多伴有焦虑和抑郁情绪，并与患者的人格特征有一定的相关性。     

Trazodone, a new antidepressant: efficacy and safety in endogenous depression.

The effectiveness of trazodone was assessed over a 4-week period under double-blind conditions. Twenty-eight inpatients with a diagnosis of endogenous depression received either trazodone, imipramine, or placebo. Trazodone was significantly better than placebo and frequently better than imipramine according to analyses of the results of the Hamilton Psychiatric Scale for Depression, severity of illness and clinical global improvement ratings, and the Global Ward Behavior Scale. Significant improvement was evident in the trazodone group by the end of the first week of therapy, particularly in those symptoms associated with depression and accompanying anxiety. There were fewer side effects with trazodone than with imipramine.     

Trazodone. A comparative clinical and predictive study

The clinical efficacy and tolerability of trazodone and amitriptyline were compared in 74 hospital patients suffering from depressive illness. The daily doses of trazodone and amitriptyline were 150-300 mg and 75-225 mg, respectively, with half-strength capsules for patients over the age of 65 years. Twenty-five and 29 patients receiving trazodone and amitriptyline, respectively, completed the 6 week treatment period. Antidepressant activity was measured using the Hamilton Depression Rating Scale (HDRS), the Zung Scale of Depression, visual analogue scales and a Global Assessment Scale. Trazodone and amitriptyline were both effective but not statistically different from each other in terms of antidepressant action. Moreover, patients with neurotic or endogenous depression responded equally well on either treatment. Trazodone was less troublesome in respect of the persistent dry mouth and severe adverse psychiatric reactions which occurred with amitriptyline. Patients should be advised to take trazodone after meals.     

Effect of clorazepate on depressed mood in anxious patients

A double-blind, placebo-controlled study of clorazepate in the treatment of 189 patients diagnosed with generalized anxiety disorder was conducted to evaluate the efficacy of an anxiolytic on the depressed-mood component of anxiety. Clorazepate-treated patients with concomitant high levels of depressed mood, defined as a score of 60 or above on the Zung Self-Rating Depression Scale (SDS), showed significant improvement of anxiety symptomatology, as measured by the Hamilton Rating Scale for Anxiety and the Zung Self-Rating Anxiety Scale, and of depressed mood, as measured by the SDS, compared with placebo-treated patients (all p values less than .01).     

Double-blind comparison of citalopram and placebo in depressed outpatients with melancholia

This multicenter study compared the efficacy and safety of citalopram and placebo in a population of moderately to severely depressed patients with melancholia. This randomized, double-blind, parallel-group study compared citalopram (flexible dose; 20-80 mg/day) with placebo in 180 psychiatric outpatients with a DSM-III diagnosis of major depression or bipolar disorder, depressed, who also met DSM-III criteria for melancholia. Following a 1-week placebo washout period, patients meeting study entry criteria were randomized to 4 weeks of double-blind treatment with either citalopram or placebo. Efficacy measures included the Hamilton Rating Scale for Depression (HAM-D), the Clinical Global Impressions (CGI) Scale, and the Zung Self-Rating Depression Scale. Patients treated with citalopram showed significantly greater improvement at endpoint than placebo patients on the HAM-D, CGI, and Zung scales. On the HAM-D, citalopram patients exhibited significantly greater improvement than placebo patients after 1 week of double-blind treatment and at all subsequent study visits. Endpoint analyses of the HAM-D subscales demonstrated that citalopram produced significant improvement of the psychomotor retardation, cognitive disturbance, sleep disturbance, and melancholia symptom clusters. Nausea, dry mouth, somnolence, dizziness, and increased sweating were reported at higher rates by citalopram-treated patients than by placebo-treated patients, but there were no significant citalopram-placebo differences in the incidence of activation (e.g., anxiety, nervousness, insomnia) or sexual dysfunction. Analysis of electrocardiograms, vital signs, and laboratory tests did not reveal any clinically significant effects of citalopram treatment. The results of this study indicate that citalopram is safe and effective in the treatment of depressed patients with melancholia, and is associated with a favorable side effect profile and a potentially rapid onset of action.     

Gynaecological symptoms and psychological distress in potential hysterectomy patients

The association between psychological and gynaecological problems has long been recognised and has recently received empirical support. The association of gynaecological symptoms with anxiety and depression was investigated. One hundred and two women referred to a gynaecology clinic, for non-malignant problems likely to result in hysterectomy, were assessed. A scale of gynaecological symptoms was constructed using principal component analysis. The Kellner-Sheffield Self-Rating Scale of Distress and the Zung Self-Rating Scale of Depression were also used. The depression measure correlated with complaints of heavy bleeding, flooding and clotting. The anxiety measure correlated with the complaint of long-standing painful menstruation. Anxiety and depression levels were significantly greater in this group than in an age-related population sample of women taken from the same city. It is argued that the use of such a scale of gynaecological symptoms might aid prediction of psychological difficulty in those presenting with certain gynaecological complaints.     

Self rated depression in relation to DSM-III classification: a statistical isolinear multiple components analysis

The Zung Self-Rating Depression Scale (SDS) was presented to 99 depressed inpatients. The patients were categorized according to DSM-III as suffering from minor depression, major depression without melancholia and major depression with melancholia and/or with psychotic features. Differences in self-reported symptoms between these categories were studied with multivariate statistical techniques including linear discriminant analysis (LDA) and statistical isolinear multiple components analysis (SIMCA). Patients with minor depression rate themselves significantly less depressed than those with major depression. Patients with major depression without melancholia are less depressed than those with melancholia and/or psychotic features. The three DSM-III depressive categories can be regarded as belonging to a clinical continuum in which they form relevant levels with quantitative differences in self-reported symptoms. These differences are not only defined by gradual shiftings in the overall severity of illness, but also by quantitative differences in the severity of some target symptoms, i.e. agitation, retardation, diurnal variation, loss of libido, fatiguability, insomnia, anorexia, sadness and anhedonia.     

Effect of levetiracetam on depression and anxiety in adult epileptic patients

BACKGROUND: Interictal depression is common in patients with epilepsy and it significantly impacts quality of life. Some studies indicate that levetiracetam (LEV) may have mood stabilizing properties. METHODS: Twenty-five adults with uncontrolled partial seizures and concomitant depressive symptoms were treated with LEV. Patients were evaluated for depression and anxiety with several psychometric measures, including: Montgomery and Asberg Depression Rating Scale (MADRS), Hamilton Depression Rating Scale (HDRS), Zung Self-rating Scale for Depression (Z-SDS), Hamilton Anxiety Rating Scale (HARS), Zung Self-rating Scale for Anxiety (Z-SAS). RESULTS: Evaluations after 5 weeks and after 3 months of LEV treatment demonstrated significant improvement in depression and anxiety. CONCLUSIONS: This uncontrolled study suggests that treatment with LEV may also improve depression and anxiety in patients with partial seizures. However, the sample of patients is limited and the possibility of a placebo effect cannot be excluded. These findings must be considered preliminary and should be replicated under placebo-controlled conditions.     

氟西汀和曲唑酮的抗焦虑作用

目的　观察氟西汀 (fluoxetine)和曲唑酮 (trazodone)对焦虑症状的改善作用。方法　选择符合CCMD II R抑郁症诊断标准、伴有焦虑或单纯广泛性焦虑的病例共 148例 ,按就诊顺序随机分为 4组。一组单用氟西汀2 0mg/d ,一组用氟西汀 2 0mg/d加曲唑酮 50～ 10 0mg/d ,一组用氟西汀 2 0mg/d加罗拉 1 5mg/d ,一组用安慰剂加少量安定或 10g/dL水化氯醛。观察 8周。结果　氟西汀能有效的改善焦虑症状 ,但疗效出现较晚 ,第 6周才显示抗焦虑效果。加用曲唑酮或罗拉能加强氟西汀的抗焦虑作用 ,同时能缓解氟西汀在用药早期加重焦虑和影响睡眠的副作用。结论　氟西汀有抗焦虑疗效。用氟西汀抗焦虑的早期加用曲唑酮或罗拉有利于病情的缓解和提高患者的治疗依从性。     

Assessment of Anxiety and Depression in Adolescents with Mental Retardation

This report examines the concurrent validity of different informant and self-report assessment instruments of psychopathology, both general and specific for anxiety and/or depression, in referred mentally retarded adolescents with a depressive and anxiety disorders, according to DSM IV criteria. A consecutive, unselected sample of 50 mildly and moderate mentally retarded adolescents (29 males and 21 females, aged 11.8 to 18 years, mean age 15.1) were assessed using standardized assessment techniques: Psychopathology Instrument for Mentally Retarded Adults (PIMRA) (informant version) (total score, affective and anxiety subscales), Child Behavior Checklist (CBCL) (informant version) (total score, internalizing and externalizing scores, anxiety-depression scale), Zung Self-Rating Depression Scale and Zung Self-Rating Anxiety Scale. Patterns of correlation among measures were calculated. PIMRA and CBCL total scores were closely intercorrelated. Internalizing and externalizing scores of CBCL were not intercorrelated, but they both correlated with CBCL and PIMRA total scores. Anxiety measures were positively correlated; they correlated with PIMRA and CBCL total scores, as well as with the internalizing score of CBCL. Depression measures were not correlated; their correlation with more general measures of psychopathology was weak. Clinical implications of these findings are discussed.     

Comorbidity of obsessive-compulsive disorder and depression: prevalence,symptom severity,and treatment effect

BACKGROUND: The goal of this study was to investigate the co-occurrence of depressive disorders in obsessive-compulsive disorder (OCD) and the effect of these disorders on combined pharmacologic and behavioral treatment for OCD. METHOD: A retrospective chart analysis was performed on baseline ratings of 120 OCD patients and posttreatment ratings of 72 of these patients. For depressive symptoms, the Montgomery-Asberg Depression Rating Scale and the Self-Rating Depression Scale were applied; for obsessive-compulsive symptoms, the Yale-Brown Obsessive Compulsive Scale and the Maudsley Obsessive Compulsive Inventory were used; and for general anxiety symptoms, the Self-Rating Anxiety Scale, the Clinical Anxiety Scale, and the State-Trait Anxiety Inventory were given. RESULTS: One third of the OCD patients in our sample were found to be depressed. Symptom severity on OCD symptoms at baseline did not differ between depressed and nondepressed OCD patients; on general anxiety symptoms, the comorbid group was more severely affected. Both depressed and nondepressed OCD patients responded well to treatment, as reflected in assessments for depressive, obsessive-compulsive, and general anxiety symptoms. However, comorbid depression had a negative effect on treatment: depressed OCD patients showed less improvement than nondepressed OCD patients on most scales. CONCLUSION: Depression frequently accompanies OCD and appears to affect treatment outcome negatively. While both groups of patients improved with combination treatment, the OCD-alone group had more improvement than the group that had comorbid depression.     

The bidirectional longitudinal relationship between insomnia,depression and anxiety in patients with early-stage,medication-naïve Parkinson's disease

IntroductionWhile anxiety, depression and insomnia frequently (co-)occur in Parkinson's disease (PD) patients, little is known about their temporal relationship. In this study, we tested two hypotheses: i) insomnia predicts an increase in symptoms of depression or anxiety and ii) anxiety or depression at baseline predicts insomnia in PD patients six months later.MethodsWe used longitudinal data from a prospective cohort study of early-stage, medication-naïve PD patients. Primary outcome measures were: anxiety symptoms, measured with the State-Trait Anxiety Inventory (STAI); depressive symptoms, measured with the 15-item Geriatric Depression Scale (GDS-15); and insomnia, defined as a score ≥ 2 on item 1.7 of the Movement Disorder Society – Unified Parkinson's Disease Rating Scale. We performed linear and logistic regression analyses, correcting for baseline value of the respective outcome variable.ResultsBaseline insomnia was not associated with GDS-15 or STAI total score at follow-up. In a post hoc analysis, we found that insomnia predicted a higher STAI State score (B(SE) = 2.50 (1.07), p < 0.05), while the association with the STAI Trait score was not significant. Baseline STAI scores (B(SE) = 0.02 (0.01), p = 0.001) and GDS-15 score (B(SE) = 0.15 (0.05), p < 0.001) were significantly associated with insomnia at follow-up.ConclusionSymptoms of anxiety and depression may constitute a risk factor for insomnia in PD. The relationship between insomnia and anxiety is bidirectional, which suggests that both anxiety and sleep disorders can start a negative spiral in PD patients, where one enhances the other. Independent clinical attention for these symptoms in PD patients is therefore warranted.     

Antidepressant therapy after stroke. A double-blind trial

Twenty-seven inpatients participating in a stroke rehabilitation program were randomized to receive either placebo or trazodone hydrochloride (Desyrel) beginning a mean (+/- SEM) of 44 +/- 4 days after stroke. The target dosage was 200 mg/d. Patients with either a clinical diagnosis of depression or abnormal Zung depression scores showed a consistent trend toward greater improvement in Barthel activities of daily living (ADL) scores with trazodone than with placebo. An abnormal dexamethasone suppression test result was associated with significant improvement in the Barthel ADL scores of patients receiving trazodone (38 +/- 6 vs 20 +/- 6 for placebo). Patients with stroke and evidence of depression are therefore likely to benefit from treatment with trazodone.     

Short-term course of depression following attempted suicide: a preliminary report

The course of depression over 1 week in patients admitted to hospital following an attempted suicide was examined utilizing a clinical interview, the Zung Self-Rating Depression Scale, the Levine-Pilowsky Depression (LPD) Questionnaire and the Hamilton Rating Scale for Depression. On all measures the group had depression of moderate to marked severity at the time of attempted suicide. In males there was a statistically and clinically significant reduction in severity of depression over 1 week. This trend was also observed in the younger patients. There was no significant change in the frequency of the LPD category endogenous depression, but examination of changes in DSM-III diagnostic frequencies revealed a significant reduction in major affective disorder over 1 week. Symptom changes were also examined. Factors that may have contributed to the observed changes in depression are discussed. Therapeutic implications and further research directions are outlined.     

Chronic pelvic pain and depression

The psychological and clinical characteristics of 29 women who underwent laparoscopy for chronic pelvic pain (CPP) have been studied. Patients (n = 11) with CPP without obvious organic pathology showed a significantly higher mean score at the Zung Self-Rating Depression Scale and more somatic symptoms which usually accompany depression than patients (n = 18) with CPP in whom pathology was found; they also showed higher frequencies for depressive disorders in personal anamnesis and for 'depression spectrum disorders' in family history. No differences between the two groups emerged for anxiety, somatization and inadequacy as measured by the Kellner-Sheffield Symptom Rating Test. Through a comparison with a group of women affected with another type of idiopathic chronic pain, and on the basis of the above reported results, the authors suggest that CPP without obvious organic pathology might be an expression of a depressive disorder.     

Reliability of psychiatric scales in patients with dementia of the Alzheimer type

For 43 patients with probable Alzheimer's disease who were screened for psychiatric disorders, the interrater reliability of the Global Deterioration Scale, BPRS, and Hamilton Rating Scale for Depression was high (intraclass correlation, 0.82-0.998). As expected, the prevalence of psychiatric symptoms in this sample was low. The score on the Zung Self-Rating Depression Scale correlated with the score on the rater-administered Hamilton depression scale in patients whose Alzheimer's disease was of low severity (N = 24) but not high severity (N = 19).     

Efficacy and tolerability of aripiprazole augmentation in sertraline-resistant patients with borderline personality disorder

Information is available on aripiprazole as a treatment for borderline personality disorder (BPD), but no data have yet been presented concerning the use of this drug as an adjunctive treatment for drug-resistant BPD patients. This study investigates aripiprazole augmentation of ongoing sertraline therapy in drug-resistant BPD patients. Twenty-one outpatients with a DSM-IV-TR diagnosis of BPD who did not respond to sertraline, 100-200 mg/day for 12 weeks, were treated for 12 weeks with the addition of aripiprazole, 10-15 mg/day. Patients were assessed at baseline, week 4, and week 12 with the Clinical Global Impression Scale - Severity item (CGI-S), the Brief Psychiatric Rating Scale (BPRS), the Hamilton scales for depression and anxiety (HAM-D, HAM-A), the Social Occupational Functioning Assessment Scale (SOFAS) for social functioning, the Borderline Personality Disorder Severity Index (BPDSI), and the Barratt Impulsiveness Scale (BIS-11). Adverse effects were evaluated using the Dosage Record and Treatment Emergent Symptom Scale (DOTES). Sixteen patients completed the study. Five patients (23.8%) dropped out due to anxiety/insomnia or non-compliance. Nine patients (56.3%) were responders. Analysis of variance revealed significant changes in the following measures: CGI-S, BPRS, BPDSI total score, BPDSI "impulsivity" and "dissociation/paranoid ideation" items, and BIS-11. Adverse effects were mild headache, insomnia, and anxiety. Aripiprazole is an efficacious and well-tolerated add-on treatment for sertraline-resistant BPD patients. It acts on impulsive and psychotic-like symptoms.     

Identification and treatment of masked depression in a general medical practice

The usefulness of the Zung Self-Rating Depression Scale as a screening instrument to uncover masked depression, and the benefits of early identification and treatment with alprazolam, were evaluated in a general medical practice population. There was a 95% scale acceptance by patients and a 12% overall prevalence of depression based on SDS results. Patients who scored in the depressed range on the SDS were, on a randomized basis, either identified immediately to their physicians and treated with alprazolam (N = 21) or identified after 4 weeks (natural history controls, N = 20). Treatment resulted in improvement in 66% of the identified group versus a 35% spontaneous improvement in the control group (p less than .05).