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Palliative & Supportive Care Dec 2012Depression is a frequent problem in cancer patients, which is known to reduce quality of life; however, many cancer patients with depression are not treated because of...
OBJECTIVE
Depression is a frequent problem in cancer patients, which is known to reduce quality of life; however, many cancer patients with depression are not treated because of the difficulties in assessing depression in this population. Our aim was to evaluate and improve the depression assessment strategies of palliative care (PC) physicians and oncologists.
METHOD
We invited all medical oncologists and PC physicians from three cancer centers to participate in this multicenter prospective study. They were asked to classify 22 symptoms (related and specific to depression in cancer patients, related but not specific, and unrelated) as "very important," "important," "less important," or "not important" for the diagnosis of depression in cancer patients, at three different time points (at baseline, after a video education program, and after 4 weeks). They were also asked to complete a questionnaire exploring physicians' perceptions of depression and of their role in its systematic screening.
RESULTS
All 34 eligible physicians participated. Baseline performance was good, with >70% of participants correctly classifying at least seven of nine related and specific symptoms. We found no significant improvement in scores in the immediate and 4-week follow-up tests. Additionally, 24 (83%) and 23 (79%) participants expressed support for systematic depression screening and a role for oncologists in screening, respectively.
SIGNIFICANCE OF RESULTS
Oncologists had good baseline knowledge about depression's main symptoms in cancer patients and a positive attitude toward being involved in screening. Underdiagnosis of depression is probably related to problems associated with the oncology working environment rather than the physicians' knowledge.
Topics: Adult; Attitude of Health Personnel; Depression; Depressive Disorder; Female; France; Humans; Male; Mass Screening; Medical Oncology; Neoplasms; Outpatients; Palliative Medicine; Pilot Projects; Practice Patterns, Physicians'; Prospective Studies; Surveys and Questionnaires
PubMed: 22583756
DOI: 10.1017/S1478951511000988 -
International Psychogeriatrics Nov 2010Although studies have shown the prevalence of depression in nursing homes to be high, under-recognition of depression in these facilities is widespread. Use of screening...
BACKGROUND
Although studies have shown the prevalence of depression in nursing homes to be high, under-recognition of depression in these facilities is widespread. Use of screening tests to enhance detection of depressive symptoms has been recommended.
METHODS
This paper aims to provoke discussion about optimal management of depression in nursing homes. The utility of the Cornell Scale for Depression in Dementia (CSDD) is considered. CSDD data relating to residents assessed in 2008-2009 were collected from three Sydney nursing homes.
RESULTS
CSDD scores were available from 162 residents, though raters stated they were unable to score participants on at least one item in 47 cases. Scores of 13 or more were recorded for 23% of residents in these facilities, but in most of these cases little was documented in case files to show that the results had been discussed by staff, or that they led to interventions, or that follow-up testing was arranged.
CONCLUSIONS
Results of CSDD testing should prompt care staff (including doctors) to consider causation of depression in cases where residents are identified as possibly depressed. In particular, there needs to be discussion of how to help residents to cope with disability, losses, and feelings of powerlessness. Research is needed, examining factors that might predict response to antidepressants, and what else helps. Accreditation of nursing homes could be made to depend partly on evidence that staff regularly search for, and (if found) ensure appropriate responses to, depression.
Topics: Aged; Aged, 80 and over; Antidepressive Agents; Australia; Depression; Depressive Disorder; Geriatric Assessment; Homes for the Aged; Humans; Nursing Homes; Prevalence; Psychiatric Status Rating Scales; Psychometrics; Socioeconomic Factors
PubMed: 20678303
DOI: 10.1017/S1041610210001602 -
Journal of Affective Disorders Sep 2013Ultrabrief pulse electroconvulsive therapy (ECT) is increasingly used in daily practice when treating depression despite doubts about its efficacy compared to standard... (Review)
Review
BACKGROUND
Ultrabrief pulse electroconvulsive therapy (ECT) is increasingly used in daily practice when treating depression despite doubts about its efficacy compared to standard techniques.
METHOD
Using electronic search techniques, we collected all studies on the comparison between ultrabrief pulse (UBP) versus brief pulse (BP) ECT in depressed patients which reported validated rating scales as outcome measures. The Jadad scale was used to evaluate the quality of the studies.
RESULTS
Two randomized and one non-randomized prospective study using unilateral (UL) ECT, and two randomized and one retrospective study using bilateral (BL) ECT were identified comparing UBP with BP ECT. One UL randomized high quality study and one non-randomized study suggest an equal response and remission for both conditions. The number of treatment sessions to achieve remission using UBP is equal in one study and is higher in the second. Both BL studies, one of high quality, point to a lower efficacy for UBP ECT with a lower speed of remission.
LIMITATIONS
We restricted our review to the efficacy of UBP vs. BP ECT in depressed patients and did not address other clinically important issues such as the cognitive adverse effects. A statistical meta-analysis was not possible, because of the heterogeneity of outcome measures and the small amount of studies.
CONCLUSION
The literature shows no clear advantage for the efficacy of ultrabrief pulse over brief pulse ECT using unilateral as well as bilateral electrode placement. The increasing use of unilateral brief pulse ECT as first line method for depression is not supported by the current evidence.
Topics: Adult; Depression; Depressive Disorder; Depressive Disorder, Major; Electroconvulsive Therapy; Humans; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 23790557
DOI: 10.1016/j.jad.2013.05.072 -
The Canadian Journal of Cardiology May 2000Epidemiological research over the past decade indicates that major depression and depressive symptomatology are common among patients with coronary artery disease (CAD)... (Review)
Review
Epidemiological research over the past decade indicates that major depression and depressive symptomatology are common among patients with coronary artery disease (CAD) and postmyocardial infarction. Major depression is a serious, debilitating comorbid disorder that can significantly increase risk for and complicate recovery from cardiac events (eg, myocardial infarction). Unfortunately, major depression is rarely detected or treated in the cardiology setting. However, it is a disorder that can be successfully and safely treated in the majority of cases. Although the mechanisms that may be mediating the depression-CAD link are less well understood, there are several plausible mechanisms by which depression may influence the course and outcome of CAD. This review examines the literature linking major depression and depressive symptomatology to CAD course and outcome, and makes recommendations for improving assessment and treatment of depression in the cardiology setting.
Topics: Anger; Antidepressive Agents; Anxiety; Coronary Disease; Depression; Depressive Disorder; Hostility; Humans; Personality; Prognosis; Risk Factors; Treatment Outcome
PubMed: 10833544
DOI: No ID Found -
Journal of Affective Disorders Sep 2016Depression is a mental disorder characterized by high and dysregulated negative affect in addition to diminished positive affect. To our knowledge, there has been no... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Depression is a mental disorder characterized by high and dysregulated negative affect in addition to diminished positive affect. To our knowledge, there has been no systematic review of the impact of psychotherapeutic interventions on these affective dimensions.
METHODS
Two comprehensive literature searches for all randomized controlled trials of psychotherapy in adults with depression were performed. The first from 1996 to December 31, 2014 and the second from January 1, 2015 to December 31, 2015. The primary outcome was the mean score of positive and negative affect. Depressive symptoms were measured to be included as a predictor in the meta-regression analyses.
RESULTS
Ten studies with 793 adults with depression were included. All studies assessed positive and negative affect. Psychotherapeutic interventions resulted in significantly increased positive affect (g=0.41; 95% CI: 0.16-0.66 p=0.001), and significantly decreased negative affect (g=0.32; 95% CI: 0.15-0.78, p=0.001) in depressed adults. Because of the small number and substantial heterogeneity of the existing studies the meta-regression analyses produced conflicting results. As a consequence, we were unable to sufficiently demonstrate whether NA and depressive symptoms are in fact correlated or not.
LIMITATIONS
Given the small number and heterogeneity of the included studies, the findings should be considered with caution.
CONCLUSIONS
Psychotherapeutic interventions demonstrate low to moderate effects in enhancing positive and reducing negative affect in depressed adults.
Topics: Adult; Depression; Depressive Disorder; Humans; Psychotherapy; Psychotropic Drugs
PubMed: 27262637
DOI: 10.1016/j.jad.2016.05.019 -
Postgraduate Medicine Jul 1996Depression is a common but highly treatable mood disorder. Unfortunately, two thirds of depressed patients may never receive appropriate intervention. Because of... (Review)
Review
Depression is a common but highly treatable mood disorder. Unfortunately, two thirds of depressed patients may never receive appropriate intervention. Because of individual and societal barriers to the diagnosis, depressive symptoms often go unrecognized. However, primary care physicians are in a unique position to surmount these obstacles by being alert to manifestations of the disorder. Treatment with antidepressant drugs, psychotherapy, electroconvulsive therapy, or a combination of these is very efficacious. The choice of method is based on such factors as history of previous response, severity of disease, concomitant medical illness, and patient preference.
Topics: Antidepressive Agents; Depression; Depressive Disorder; Family Practice; Humans; Psychotherapy; Risk Factors; Suicide; Suicide Prevention
PubMed: 8668624
DOI: 10.3810/pgm.1996.07.9 -
Integrative Physiological and... 1999
Topics: Depression; Depressive Disorder; Humans
PubMed: 10485610
DOI: 10.1007/BF02688716 -
Current Opinion in Supportive and... Dec 2010To provide an overview of factors related to quality of life and symptoms of depression in heart failure patients and their partners. Furthermore, to give an overview of... (Review)
Review
PURPOSE OF REVIEW
To provide an overview of factors related to quality of life and symptoms of depression in heart failure patients and their partners. Furthermore, to give an overview of interventions that can be effective in improving their quality of life and decrease depressive symptoms.
RECENT FINDINGS
Quality of life of patients with heart failure and their partners is poor compared with their age-matched peers from the general population and also compared with patients suffering from other chronic diseases. Furthermore, many heart failure patients are depressed. Depressive symptoms of patients and of their partners seem to be interrelated, making interventions complicated but needed. Although the number of studies that specifically target improvement of quality of life and depression in heart failure patients and their partners is still small, several interventions are known to improve quality of life, and these could be implemented in daily care.
SUMMARY
This review considers demographic and clinical factors that are related to quality of life and depressive symptoms and addresses interventions that can contribute to improvement of quality of life of heart failure patients and their partners and decrease depressive symptoms. Education on self-care management and physical exercise are important elements of disease management programs. A multidisciplinary care approach including optimizing medical therapy and optimal symptom management is advised, focusing both on the patient and the caregiver. Treatment and care should not only focus on heart failure, but also address the consequences of co-morbidities and the side-effects of therapies.
Topics: Caregivers; Depression; Depressive Disorder; Heart Failure; Humans; Quality of Life
PubMed: 20966757
DOI: 10.1097/SPC.0b013e328340744d -
The Journal of Nervous and Mental... Nov 2022The aim of the current study was to compare the longitudinal clinical course of patients with a history of melancholic and nonmelancholic bipolar depression....
The aim of the current study was to compare the longitudinal clinical course of patients with a history of melancholic and nonmelancholic bipolar depression. Seventy-seven euthymic outpatients with bipolar disorder were categorized as melancholic or nonmelancholic through the clinician-rated Sydney Melancholia Prototype Index. Clinical course was assessed for a period longer than 48 months by time spent ill, density of affective episodes, severity and duration of depressive episodes, and time to depressive recurrence. The mean follow-up time was 69.05 months. Patients with melancholic depressions had more severe and longer depressive episodes during follow-up, whereas patients with nonmelancholic depressions had a shorter time to depressive recurrence and more subsyndromal depressive symptoms and affective instability. These findings highlight the heterogeneity inherent to the current construct of bipolar depression and position melancholia as an interesting target for comparison with nonmelancholic depressions in other external validators in the field of bipolar disorder.
Topics: Humans; Bipolar Disorder; Depression; Depressive Disorder; Outpatients
PubMed: 35687741
DOI: 10.1097/NMD.0000000000001553 -
Medycyna Wieku Rozwojowego 2004Until the 1960-ties, there was considerable debate on whether or not depression exists before adulthood. Next, there were popular concepts, which emphasized that... (Review)
Review
Until the 1960-ties, there was considerable debate on whether or not depression exists before adulthood. Next, there were popular concepts, which emphasized that depression during adolescence is "normal" for that particular stage of development. From 1980-ties, adolescent depression is seen as the same problem as with adults. The diagnosis of depression in adolescents is based on adult diagnostic criteria. Today, there is a more generally accepted standard that adolescence depression is essentially the same phenomenon as adult depression but with some development specific modifications. As compared with adults, adolescents with depression demonstrate a more variable course. The adolescent with depression may exhibit somatic complaints, school difficulties and deconcentration rather than depressed mood. Three conceptualizations of depressive phenomena during adolescence have been presented in the literature: (1) depressed mood alone, (2) depressive syndrome, and (3) depressive disorders. Compas, Ey and Grant have compared and integrated different approaches to a synthesis that reflected a comprehensive model of depressive phenomena during adolescence. Depressed mood, syndromes, and disorders are integrated as 3 levels of depressive phenomena in a hierarchical and sequential model.
Topics: Adolescent; Affect; Depression; Depressive Disorder; Female; Humans; Male; Psychology, Adolescent
PubMed: 15951611
DOI: No ID Found