A one-year prognosis of dysthymic disorder and major depression in old age

A prospective follow-up of 199 elderly (60 + yr) patients (65 men and 134 women) suffering from dysthymic disorder and 42 elderly (60 + yr) patients (13 men and 29 women) suffering from major depression is described. The mean duration of the follow-up was 15.3 ± 4.3 months for dysthymic men, 15.2 ± 4.4 months for dysthymic women, 15.3 ± 4.0 months for major depressive men and 14.0 ± 4.2 months for major depressive women. Forty-three per cent of the dysthymic men, 38% of the dysthymic women, 39% of the major depressive men and 48% of the major depressive women had a good outcome. In dysthymic men, few visiting contacts were associated with poor outcome. In dysthymic women, poor outcome was associated with many depressive symptoms, low social participation, not living alone, low self-perceived health, intensive diurnal variation of symptoms, low interest in work and activities, low sexual interest, and hypochondrial and compulsive symptoms. In major depressive men, no variable was associated with outcome. In major depressive women, poor outcome was associated with diabetes mellitus, suicidal ideas or attempted suicide, and psychomotor agitation or psychomotor retardation.     

Depressive symptoms and signs that differentiate major and atypical depression from dysthymic disorder in elderly finns

Symptoms and signs that in terms of severity differentiate major and atypical depression from dysthymic disorder were investigated in depressed Finns aged 60 years or over. The overall symptomatology of major depression was not significantly more severe than that of dysthymic disorder, although some symptoms, viz. sadness, paranoid symptoms, loss of interest in work and activities, loss of weight and depersonalization, were more severe in major depressive patients than in dysthymic patients. The overall symptomatology of atypical depression was less severe than that of dysthymic disorder. Sadness, psychic anxiety, loss of interest in work and activities, somatic anxiety, general somatic symptoms, strength of diurnal variation of symptoms, gastrointestinal symptoms and suicidal ideas were less severe in atypical depressive patients than in dysthymic patients but loss of insight was more severe in atypical depressive patients. Of objective signs, loss of weight was more common in major depressive patients than in dysthymic patients. Sad expression and crying were less common in atypical depressive patients than in dysthymic patients.     

Trait and state aspects of harm avoidance and its implication for treatment in major depressive disorder, dysthymic disorder, and depressive personality disorder

The authors evaluated the trait/state issues of harm avoidance in depressive-spectrum disorders and its predictive potential for antidepressant response. Subjects with Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) major depressive disorder (n = 39), dysthymic disorder (n = 37), depressive personality disorder (n = 39), and healthy control subjects (n = 40) were evaluated with the Temperament and Character Inventory and the 17-item Hamilton Depression Rating Scale (HDRS-17) at baseline and after a 12 week antidepressant treatment period. Higher harm avoidance scores predicted lesser improvement in subjects with dysthymic disorder and major depressive disorder, as determined by lesser decrease in HDRS-17 scores. Mean harm avoidance scores in depressed subjects were consistently greater than those in healthy controls, controlling for age, gender and diagnosis. Mean harm avoidance scores decreased significantly in all depressive-spectrum disorders after treatment, but still remained higher than harm avoidance scores in control subjects. The present study reports that harm avoidance is a reliable predictor of antidepressant treatment in subjects with major depressive disorder and dysthymic disorder and that harm avoidance is both trait- and state-dependent in depressive-spectrum disorders.     

Social and environmental factors and depression in old age

This community-based epidemiological study is concerned with relationships between social and environmental factors and depression in a Finnish population aged 60 years or over. A greater proportion of depressed than non-depressed men had retired and did not work at all. The occurrence of depression in both sexes was related to retirement because of sickness rather than age, a small number of rooms in their homes, low numbers of hobbies, lack of intimate friendships, and the occurrence of many long-standing and current social stress factors. Positive associations were also found in the men between the occurrence of depression and moving due to poor health, widowed or divorced marital status, being frequently alone and the fear of death, while a positive relationship was found between the occurrence of depression and low social participation in the women. In addition, the depressed women felt that elderly people were not appreciated. Also, the depressed women felt their relationships with their spouse, children, daughters-in-law and friends to be more distant than did their non-depressed counterparts. This finding suggests that family dynamics plays an important role in depression in elderly women.     

5-HT2 receptor antagonism in dysthymic disorder: a double-blind placebo-controlled study with ritanserin

Thirty patients suffering from dysthymic disorder participated in a 6-week double-blind trial comparing ritanserin 10 mg and placebo. After a single-blind placebo wash-out period of one week, the test medication was administered during 5 weeks on a double-blind basis. Twenty-three patients completed the study. At the end of the trial, ritanserin was significantly superior to placebo in its effect as manifested on the 19-item Hamilton Rating Scale for Depression, the Hamilton Rating Scale for Anxiety and the State Trait Anxiety Inventory X-1 and X-2. At the end of the study, the therapeutic effect was rated marked or moderate in 75% of the ritanserin-treated patients, but only in 18% of the controls. These data are consistent with the hypothesis of serotonin abnormalities in dysthymic disorder and suggest a therapeutic role of 5-HT2 antagonists. Ritanserin treatment was very well tolerated; no serious adverse experiences were reported.     

恶劣心境患者述情障碍与自主神经功能的相关研究

目的:探讨恶劣心境患者的人格特质、述情障碍与自主神经功能心理生理反应的相关机制。方法:采用多伦多述情障碍量表中文版(TAS-20-C)及心理健康测查表(PHI)对42例恶劣心境患者组(DD组)、33例重性抑郁症患者组(MD组)及30例健康对照组(NC组)进行述情障碍和心理健康水平和人格特质测定,并分析短时(5min)心率变异性(HRV),评定自主神经功能。结果:DD组TAS-20-C各因子得分及总分显著高于NC组(P<0.01),因子Ⅰ、因子Ⅱ及总分均明显高于MD组(P<0.01或P<0.05);DD组PHI量表躯体化、焦虑、病态人格及疑心因子分明显高于MD组(P<0.01或P<0.05);DD组HRV频谱指标中SDNN、PNN50及HF较MD及NC组均显著下降(P<0.01或P<0.05),LF∕HF较MD及NC组均明显升高(P<0.05);TAS-20-C总分及因子Ⅰ与躯体化、焦虑、病态人格、疑心均相关(︱r︱=0.25～0.38,0.40～0.44,0.47～0.59,0.43～0.42,P<0.01或P<0.05),因子Ⅱ与焦虑及变态人格相关(︱r︱=0.31,0.31,P<0.05);躯体化及焦虑与SDNN、VLF及LF均相关(︱r︱=0.26～0.27,0.39～0.27;︱r︱=0.36～0.28,P<0.05或P<0.01)。结论:恶劣心境患者存在明显的述情障碍,其人格特质可能导致患者焦虑程度更高,伴自主神经功能紊乱。     

Early loss of mother or father predicts depression in old age

The independent predictive roles of early losses, personality traits, acute losses and long-term stress situations for the occurrence of depression in elderly Finns were described using a longitudinal design. The persons non-depressed in an epidemiological study in 1984–85 were interviewed in 1989–90 (N=679) and the occurrence of depression was determined according to DSM III-criteria. Logistic regression models were used to assess the independent roles of the hypothesized factors as predictors. An early loss of the mother among men and an early loss of the father among women independently predicted the occurrence of depression in logistic regression models. Older age in men, and a higher number of symptoms, the occurrence of previous depression and not living alone in women were also independent predictors. In men, impaired functional abilities and poor self-perceived health tended to predict depression. In conclusion, the psychological trauma which develops upon the experience of an early parental loss contributes to the development of depression even in old age. The role of stressors in life as independent predictors of depression in old age was also ascertained. © 1998 John Wiley & Sons, Ltd.     

Cognition in older adults with bipolar disorder versus major depressive disorder

Gildengers AG, Butters MA, Chisholm D, Anderson SJ, Begley A, Holm M, Rogers JC, Reynolds CF III, Mulsant BH. Cognition in older adults with bipolar disorder versus major depressive disorder. Bipolar Disord 2012: 14: 198–205. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objectives: Bipolar disorder (BD) and major depressive disorder (MDD) are associated with cognitive dysfunction in older age during both acute mood episodes and remitted states. The purpose of this study was to investigate for the first time the similarities and differences in the cognitive function of older adults with BD and MDD that may shed light on mechanisms of cognitive decline. Methods: A total of 165 subjects with BD (n = 43) or MDD (n = 122), ages ≥ 65 years [mean (SD) 74.2 (6.2)], were assessed when euthymic, using comprehensive measures of cognitive function and cognitive–instrumental activities of daily living (C‐IADLs). Test results were standardized using a group of mentally healthy individuals (n = 92) of comparable age and education level. Results: Subjects with BD and MDD were impaired across all cognitive domains compared with controls, most prominently in Information Processing Speed/Executive Function. Despite the protective effects of having higher education and lower vascular burden, BD subjects were more impaired across all cognitive domains compared with MDD subjects. Subjects with BD and MDD did not differ significantly in C‐IADLs. Conclusion: In older age, patients with BD have worse overall cognitive function than patients with MDD. Our findings suggest that factors intrinsic to BD appear to be related to cognitive deterioration and support the understanding that BD is associated with cognitive decline.     

Dysthymic disorder: treatment with citalopram

We studied 15 patients with dysthymic disorder with open-label citalopram. The purpose of this study was to determine the dose range and safety of citalopram necessary for treatment of patients with dysthymic disorder and to attempt to increase doses in order to enhance remission of patients with dysthymic disorder when treated. Citalopram was well tolerated. The mean dose used in this 10-week study was 37.3 mg and the majority of patients responded to treatment. Various criteria for response and remission were employed. These findings are intended to give guidelines for a subsequent treatment study of dysthymic patients with citalopram using a double-blind placebo-controlled strategy.     

Depression in old age

The discrepancy between the constancy or increase of the prevalence of depressive symptoms and dysphoria in old age on one hand, and the decrease in the prevalence of the DSM-III diagnoses of major depression and dysthymia on the other, is discussed in light of the most frequent explanatory hypotheses such as memory defects, interpretation of depressive as somatic symptoms, higher risk of institutionalization as well as higher mortality of depressives and a mitigated course of depression in old age. We conclude that higher mortality, mitigation and the rarity of true late-onset depression are arguments for a real decline in prevalence, which occurs in accordance with the decline in all psychiatric disorders that are connected with emotional upheavals and substance ingestion. On the other hand, the connection of depressive states with somatic illness is strengthened, and according to preliminary validation studies, clinically relevant depressive states not reaching the threshold of DSM-III diagnoses may be typical for the depressive psychopathology of old age.     

Characterizing anger in the DSM-III borderline personality disorder

Anger has traditionally been described as the most intense and prevalent affect in the borderline patient. This study was designed to characterize anger in the borderline patient in an in-depth analysis by determining whether inpatients with DSM-III borderline personality disorder differed from controls with dysthymic disorder. Standardized rating instruments including subscales of the Profile of Mood States, Brief Psychiatric Rating Scale, and Minnosota Multiphasic Personality Inventory were utilized. Results generally indicated that borderline patients manifested more severe anger than dysthymic controls. The findings are discussed in light of previous psychodynamic, empirical, and research literature.     

老年抑郁症患者预后的影响因素

目的：探讨老年抑郁症患者预后的影响因素。方法：以标准化评定工具对老年抑郁症住院患者在出院后3年时进行随访评定。结果：逐步回归分析表明，影响老年抑郁症患者预后的主要因素依次为：伴精神病性症状、生活事件，治疗依从性，伴躯体疾病，艾森克个性问卷（EPQ）的N分及家庭社会支持。结论：老年抑郁症患者的预后受生物、心理、社会多种因素的影响。应对心理、社会因素进行干预，以改善患者的预后。     

Electroencephalography of DSM-III borderline personality disorder

The EEG's of hospitalized males with the sole diagnosis of borderline personality disorder (n = 37) were compared to those of a group with only dysthymic disorder (n = 31). Borderline patients were found to have significantly more marginal, definite, and combined (marginal and definite) abnormalities on the EEG. The most prevalent abnormality in the borderline was slow-wave activity. The mixture of wave frequencies occurring in the electroencephalogram, known as fusing, occurred significantly more often in the borderline group compared to the dysthymic group. Severity of illness of the borderline group and the depressed group was not significantly correlated with EEG abnormality. Neurophysiologic implications for the pathogenesis of the borderline personality disorder are discussed in light of these findings.     

Dysthymic disorder in adolescents with intellectual disability

The present report examines the clinical features of dysthymic disorder in a sample of adolescents with mild intellectual disability (ID). Frequency of symptoms, comorbidity, agreement between reports of subjects and parents, comparison between the frequency of depressive symptoms in subjects with ID and in two different groups of normal IQ dysthymic subjects (aged 7–11, 11 and 12–18 years) are described. The sample consisted of 12 subjects (age range = 12–25.6 years; mean age = 16.3 years) screened from unselected consecutively referred patients with mild ID. All the subjects were comprehensively diagnosed with a structured diagnostic interview, the Kiddie-Schedule for Affective Disorder and Schizophrenia (K-SADS), according to DSM-IV criteria. A symptomatic profile in the group with ID showed that intrapsychic and cognitive symptoms, such as depressed mood, irritability, pathological guilt and low self-image, were frequently reported in people with ID. Parents were less aware of depressed mood, but they reported high rates of low self-esteem; the agreement between the depressive reports of ID subjects and their parents was higher than in previous findings in normal IQ children. The symptomatic profile of subjects with ID was more comparable to that of prepubertal dysthymic children than that of dysthymic adolescents, but more significant are the analogies between dysthymic disorder in ID and normal IQ subjects. High rates of comorbidity with generalized anxiety disorder were evident in the group with ID. According to the present data, dysthymic disorder can be diagnosed in adolescents with mild ID. The K-SADS clinical interview seems to be a reliable instrument for the diagnosis and clinical definition of depressive symptomatology in this special population.     

Association between depressive symptoms and age,sex, loneliness and treatment among older people in Sweden

Objectives: The objective of this study was to examine the prevalence of and the association between depressive symptoms and loneliness in relation to age and sex among older people (65–80 years) and to investigate to what extent those who report depressive symptoms had visited a health care professional and/or used antidepressant medication.

Method: A cross-sectional study was conducted in a Swedish sample randomized from the total population in the age group 65–80 years (n = 6659). Chi square tests and logistic regression analyses were conducted.

Results: The data showed that 9.8% (n = 653) reported depressive symptoms and 27.5% reported feelings of loneliness. More men than women reported depressive symptoms, and the largest proportion was found among men in the age group 75–80 years. An association between the odds to have a depressive disorder and loneliness was found which, however, decreased with increasing age. Of those with depressive symptoms a low proportion had visited a psychologist (2.9%) or a welfare officer (4.2%), and one in four reported that they use antidepressant medication. Of those who reported depressive symptoms, 29% considered that they had needed medical care during the last three months but had refrained from seeking, and the most common reason for that was negative experience from previous visits.

Conclusion: Contrary to findings in most of the studies, depressive symptoms were not more prevalent among women. The result highlights the importance of detecting depressive symptoms and loneliness in older people and to offer adequate treatment in order to increase their well-being.     

Depression in Older People: What does the Future Hold?

Demographic, economic and social changes over the next few decades are likely to have a significant effect on the care of the elderly. This personal view, from a United Kingdom perspective, examines some of these changes and assesses the impact they may have on the prevalence and treatment of depression in older people. Strategies for minimizing the marginalization of this group are discussed.