Depressive and anxiety symptoms in patients with schizophrenia and schizophreniform disorder

BACKGROUND: Symptoms of depression and anxiety are frequently encountered in the course of schizophrenia and are of considerable clinical importance. They may compromise social and vocational functioning, and they are associated with an increased risk of relapse and suicide. Various treatment approaches have been reported to be successful. METHOD: The sample comprised 177 patients with DSM-III-R or DSM-IV schizophrenia or schizophreniform disorder who were participants in multinational clinical drug trials at our academic psychiatric unit over a 7-year period and who were assessed by means of the Positive and Negative Syndrome Scale (PANSS). Analysis was performed on baseline PANSS scores. The depression/anxiety score was compared in the men and women, first-episode and multiple-episode patients, and those with predominantly positive and negative syndromes. Correlations were sought between depression/anxiety scores and age, total PANSS score, positive score, negative score, general psychopathology score, and treatment outcome. Multivariate analysis was applied to determine contributions of individual variables toward depression/anxiety and outcome scores. RESULTS: Depression and anxiety symptoms were more severe in women (p = .007), first-episode patients (p = .02), and those with predominantly positive symptoms (p < .0001). Depression/anxiety scores were significantly correlated to age (r = -0.31, p < .0001), PANSS positive scores (r = 0.39, p < .0001), and treatment outcome (r = 0.25, p = .006). Multivariate analysis bore out these results, with the exception that first episode was not a significant predictor of depression and anxiety scores. CONCLUSION: PANSS depressive/anxiety scores were generally low in our sample, perhaps because patients with schizoaffective disorder were excluded. The finding that these symptoms were more prominent in women and first-episode patients is in keeping with previous literature. The higher scores in first-episode patients are likely due to the higher positive symptom scores in these patients. The association between depressive/anxiety scores and positive symptoms but not with negative symptoms points to a specific relationship between affective symptoms and the positive symptom domain of schizophrenia. The presence of depressive and anxiety symptoms may predict a more favorable outcome to treatment, although this may only apply to the acute exacerbations of the illness.     

Depressive symptoms and anxiety in patients with chronic and episodic tension-type headache

BACKGROUND: Tension-type headache (TTH) is recognized as the most prevalent type of headache. Despite this, there is a limited understanding of the entity's physiology, epidemiology, and clinical presentation. Anxiety and depression are recognized comorbidities present among patients with TTH. OBJECTIVE: To quantify the prevalence of anxiety and depression among patients with episodic and chronic TTH. METHOD: fifty patients with episodic TTH and fifty patients with chronic TTH completed Beck's anxiety and depression surveys. Only patients presenting with moderate to severe scores were considered. RESULTS: among the patients with episodic TTH, anxiety and depression were observed in 30 (60%) and 16 (32%) patients respectively. Among the patients with chronic TTH, anxiety was observed in 22 (44%) patients, and depression was observed in 20 (40%). CONCLUSION: both comorbidities are important among patients with episodic and chronic TTH. Neglecting this association may result in failure of symptomatic and prophylactic treatment ultimately leading to lost quality of life.     

Depressive symptoms in HIV-infected patients treated with highly active antiretroviral therapy

IntroductionThe prevalence of depressive disorders in HIV-infected patients ranges from 12% to 66% and is undiagnosed in 50% to 60% of these patients. Depression in HIV-infected individuals may be associated with poor antiretroviral treatment (ART) outcomes, since it may direct influence compliance.ObjectiveTo assess the presence of symptoms and risk factors for depression in patients on ART.MethodsCross-sectional study. Certified interviewers administered questionnaires and the Beck Depression Inventory (BDI), and participants' self-reported compliance to ART. Clinical and laboratory variables were obtained from clinical records. Patients with BDI ≥ 12 were defined as depressed.ResultsOut of the 250 patients invited to participate, 246 (98%) consented. Mean age was 41 ± 9.9 years; most were male (63%). Income ranged from 0–14 Brazilian minimum wages. AIDS (CDC stage C) had been diagnosed in 97%, and 81% were in stable immune status. One hundred ninety-one (78%) reported compliance, and 161 (68%) had undetectable viral loads. The prevalence of depressive symptoms was 32% (95% CI 26–40). In multivariate analysis, depressive symptoms were significantly associated with income (prevalence ratio [PR] = 0.85; 95% CI 0.74–0.97; p = 0.02).ConclusionsDepressive symptoms are frequent in patients on ART, and are associated with low income.     

Depressive symptoms in older female carers of adults with intellectual disabilities

Background This survey study aims to examine the prevalence and factors associated with depressive symptoms among primary older female family carers of adults with intellectual disabilities (ID). Method In total, 350 female family carers aged 55 and older took part and completed the interview in their homes. The survey package contained standardised scales to assess carer self‐reported depressive symptoms, social support, caregiving burden and disease and health, as well as adult and carer sociodemographic information. Multiple linear regressions were used to identify the factors associated with high depressive symptoms in carers. Results Between 64% and 72% of these carers were classified as having high depressive symptoms. The factors associated with carer self‐reported depressive symptoms were carer physical health, social support and caregiving burden; overall, the carer self‐reported physical health was a stronger factor associated with depressive symptoms than their physical disease status. The level of the adult with ID's behavioural functioning and the carer age, marital status, employment status, education level and the family income level were not significantly associated with carer depressive symptoms. Conclusions The factors identified in this study as correlating with self‐reported depressive symptoms suggest that researchers and mental health professionals should collaborate to help improve the physical health and social support networks of the most vulnerable older female family carers. This should reduce depressive symptoms directly among this high‐risk group.     

Depressive symptoms and alcohol consumption among nonalcoholic depression patients treated with desipramine.

OBJECTIVE: There are few data addressing the effect of alcohol consumption on response to antidepressants among nonalcoholics with depression. Similarly, the effect of antidepressant treatment on alcohol consumption in this group is not yet understood. This study focuses on changes in depressive symptoms and alcohol consumption in response to treatment with desipramine. METHOD: Twenty-seven nonalcoholic outpatients with major depression (as determined by the Schedule for Affective Disorders and Schizophrenia-Lifetime Version) completed measures of depression (that is, the 17-item Hamilton Depression Rating Scale and the Beck Depression Inventory) and alcohol consumption at intake and after 5 weeks of open treatment with desipramine. Subjects were characterized as minimal or mild-to-moderate drinkers. RESULTS: There was no significant difference between the groups with respect to effectiveness of antidepressant treatment. Analysis for repeated measures demonstrated that alcohol consumption with desipramine was significantly lower after treatment than at intake (F = 4.8, df 23:2, P < 0.01). Further, carbohydrate consumption was also significantly lower after treatment than at intake (F = 4.4, df 23:2, P < 0.05). CONCLUSIONS: Desipramine treatment appeared to result in decreases in alcohol consumption in nonalcoholic patients with depression. Further research is needed to elucidate the effect of alcohol consumption on the course and outcome of major depressive illness among nonalcoholics as well as the effect of antidepressant medication on alcohol consumption in this population.     

Depressive symptoms in patients with Alzheimer's disease

OBJECTIVES: A comparison was made between the depressive symptom profiles of thirty patients with Alzheimer's disease (AD) who did not have co-existing depression and thirty patients with major depression who did not have co-existing dementia. The main objective was to identify symptoms common to both disorders and those which may be able to differentiate AD from major depression. METHOD: A sample of patients suffering from either AD (n = 30) or major depression (n = 30) were recruited from a specialist old age psychiatry service. Depressive symptoms were profiled using the Hamilton Depression Rating Scale (HDRS), the Cornell Scale for Depression in Dementia (CSDD) and the Geriatric Depression Scale (GDS). RESULTS: Depressive symptoms were present in AD in the absence of coexistent major depression. Certain depressive symptoms from all the three scales such as sadness, diurnal variation in mood and early or late insomnia were able to differentiate the two disorders with almost 90% accuracy while symptoms such as irritability, retardation and weight loss were common to both and were unable to differentiate the two. CONCLUSION: Depressive symptoms occur in AD when co-existing depression is ruled out. Their recognition has implications for the diagnosis of major depression in these patients.     

Depressive symptoms in relation to physical functioning in pulmonary hypertension

Objective

To investigate the association between depressive symptoms and physical functioning in pulmonary hypertension (PH) patients.

Methods

Fifty-two patients diagnosed with precapillary or postcapillary PH completed self-report questionnaires of depressive symptoms and physical functioning. Cardiac catheterization reports of patients were reviewed for hemodynamic variables.

Results

Physical functioning was significantly associated with depressive symptoms on bivariate analysis. On multivariate analysis, after controlling for demographic and hemodynamic variables, depressive symptoms accounted for 9% of variance in physical functioning.

Conclusion

The association of depressive symptoms with decreased physical functioning in PH patients indicates the need for longitudinal research regarding the possible effect of depression on disease outcomes in this population.     

Depressive symptoms in a treated multiple sclerosis cohort

BACKGROUND: Recent side effect data from clinical trials of interferon beta in multiple sclerosis (MS) have failed to confirm that these medications are associated with an increased risk of depression. However, these studies have used highly selected samples and the results may not be generalizable to real world settings. METHODS: Clinical data on subjects from southern Alberta who have applied for, or are receiving, public reimbursement for MS treatment are maintained in a database at the University of Calgary Multiple Sclerosis Clinic. Depression ratings obtained using the Center for Epidemiological Studies Depression Rating Scale (CES-D) are included in this database. In the current analysis, these longitudinal data were used to determine whether depressive symptoms were associated with disease-modifying treatments. RESULTS: At baseline, ratings were available for 163 subjects. Those choosing interferon beta resembled those choosing glatiramer acetate in most respects. During follow-up, no differences were observed in the prevalence or incidence of depression and CES-D scores were not found to differ between the treatment groups. CONCLUSIONS: The failure to identify higher rates of depression both in previous intervention studies and in the current observational study provides confirmation that these drugs are not substantially associated with the occurrence of depression.     

Depressive symptoms in aged Chinese patients with silicosis

Objectives: To investigate the prevalence of depressive symptoms in patients with silicosis and its determinants. Methods: A cross-sectional cohort study was performed. About 121 patients with silicosis randomly selected from a case registry of a non-ferrous metal company and 110 controls completed the questionnaires of sociodemographic variables, Beck depression inventory (BDI) and lung function test. chi(2) test was performed to compare the prevalence of depressive symptoms between two groups. The relationship between the variables and depressive symptoms in patients with silicosis was assessed by performing the logistic regression analysis. Results: Prevalence of depressive symptoms in patients with silicosis was 27.3%, which was higher than the figure 7.3% in controls (chi(2) = 15.8, p < 001). Severe respiratory symptoms, severe impaired physical function, FEV(1) < 50% predicted and (FVC)% predicted less than mean were significantly associated with the depressive symptoms (Odds ratio [OR] = 4.6, 5.9, 3.0 and 5.2, respectively). Conclusion: High prevalence of depressive symptoms was found in patients with silicosis. Respiratory symptoms, physical function and pulmonary functions were associated with depressive symptoms. Our findings provide evidence for physicians to screen for depressive symptoms in patients with silicosis.     

终末期肾病患者的抑郁症状

<正>随着透析技术的进步及医疗保险的贯彻实施,接受血液透析治疗的终末期肾病(End Stage Renal Disease,ESRD)患者越来越多,生存时间越来越长,ESRD患者的心血管系统、血液系统、骨骼疾病等躯体并发症与体征异常已引起人们的广泛关注,而ESRD患者可能出现的如神经衰弱、焦虑症、抑郁症、恐惧感等精神或神经症候群则容易被忽视。据统计,在普通人群中大约有1.1%～15%的男性和     

Depressive symptoms and white matter changes in patients with dementia

OBJECTIVE: The aim of the present study was to investigate if depressive symptoms in demented patients are associated with white matter changes (WMCs) in the brain. BACKGROUND: WMCs are frequently found in patients with dementia, as well as among elderly nondemented patients with depressive symptoms. However, it is less established whether or not WMCs are related to depressive symptoms in demented patients. METHODS: 67 (26 men, 41 women) patients with primary degenerative dementia (Alzheimer's disease, frontotemporal dementia), vascular dementia (VaD), or mixed Alzheimer/VaD dementia were included in the study. The patients were young-old (mean 68.1, SD 7.3). All patients underwent a standardized examination procedure and MRI of the brain. The degree of WMCs was visually rated, blindly. Depressive symptoms were rated according to the Gottfries-Br?ne-Steen scale (anxiety, fear-panic, depressed mood). RESULTS: No significant relationship was found between WMCs and depressive symptoms in the demented patients. CONCLUSION: The possible involvement of WMCs in the pathogenesis of depressive symptoms in dementia is unclear. A link between disruptions of frontal-subcortical pathways, due to WMCs, and depressive symptomatology in dementia has been hypothesised from earlier findings, which would imply common elements of pathogenesis for depressive symptomatology and cognitive impairment in dementia. However, the results of the present study do not add further support to this hypothesis.     

Depressive symptoms in intellectual disability: does gender play a role?

Background Gender issues remain largely unaddressed in the dual diagnosis arena, even in the area of depression where there is a 2 : 1 female to male ratio in the general population. This paper argues that women with intellectual disability (ID) report higher levels of depressive symptoms than men with ID and that risk factors for depression identified for women in the general population are relevant to this group. Method Findings are based on structured interviews with 99 men and women with ID, with corroborative information provided from caregivers and casebook reviews. Results Overall, women reported higher levels of depression than men. Individuals with higher depression scores were more lonely and had higher stress levels than individuals with lower scores. Women with higher depression scores were more likely to report coming from abusive situations, to have poor social support from family and to be unemployed when compared to women with lower scores, but similar differences were not found when comparing men with higher and lower depression scores. Conclusion Men and women who report experiencing these psychosocial correlates of depression should be a target group for future prevention efforts, taking gender specific concerns into consideration.     

Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study

Introduction

This is a prospective study, first to compare the frequency of depressive symptoms in stroke survivors treated, and non-treated, with intravenous thrombolysis and second, to explore relationships between post-stroke depression (PSD) and stroke treatment modalities, taking into account other possible determinants of PSD, including post-traumatic stress symptoms.

Methods

Groups of 73 thrombolysed and 73 non-thrombolysed patients matched for age and gender were examined at 3 and 12 months after discharge. PSD was assessed using the Beck Depression Inventory. Post-traumatic stress symptoms (PTSS), disability and social support were assessed with the Impact of Event Scale-Revised, the Barthel Index and the Berlin Social Support Scale.

Results

At 3 months, PSD was present in 23.3% of the thrombolysed and 31.5% in the non-thrombolysed groups (p?=?0.265). At 12 months, the frequencies were 29.2 and 20.6% (p?=?0.229). Logistic regression of the combined group of thrombolysed and non-thrombolysed patients indicated that at 3 months, the adjusted predictors of PSD were disability (OR 24.35), presence of PTSS (OR 9.32), low social support (OR 3.68) and non-thrombolytic treatment (OR 3.19). At 12 months, the predictors were disability (OR 15.78) and low education (OR 3.61).

Limitations

The use of a questionnaire for the detection of depression, the relatively small sample size and a significant drop-out rate could limit the interpretation of these results.

Conclusions

(1) Thrombolysed and non-thrombolysed stroke survivors had similar frequency of depressive symptoms although the thrombolysed patients had more severe neurological deficits in the acute phase. It can be assumed that if thrombolysis had not been used, depressive symptoms would have been more frequent. (2) Lack of the rt-PA treatment was associated with three-time greater odds of screening for PSD at 3 months post-stroke, after adjustment for other PSD correlates. (3) Therefore, thrombolytic therapy seems to have a positive, but indirect, effect on patients’ mood, especially in the first months after stroke. (4) All stroke patients, irrespective of the method of treatment, should be monitored for the presence of depression.