Search results for ‘Author:"baldwin robert c."’ Sort:
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Prognosis of late life depression: a three-year cohort study of outcome and potential predictors
- Author:
- BALDWIN Robert C.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(1), January 2006, pp.57-63.
- Publisher:
- Wiley
Late-onset depression (LOD) has a poor prognosis which may be worsened by the presence of cerebrovascular disease. The original study involved 50 patients with LOD and 35 healthy age matched controls. Follow-up was at three years. Baseline measures included clinical, neuroradiological and neuropsychological variables. Outcome was assessed by mortality, progression to dementia and clinical course of depressive disorder. Sixty-two (73%) of the original cohort agreed to be re-interviewed. Seven participants had died (all from the depressed group) and six developed dementia, all but one from the depressed group. Vascular dementia predominated (although not significantly so) among those with dementia at follow-up. For 28 depressed patients with complete follow-up data (56% of the original sample), poor outcome was predicted by lower High Density Lipoprotein (HDL), raised Erythrocyte Sedimentation Rate (ESR) and a higher score on the Hachinski Index scale and one test of immediate memory. Initial response to treatment was not associated with later outcome. It is concluded that late-onset depressive disorder is associated with a high rate of mortality and possibly dementia.
Is vascular depression a distinct sub-type of depressive disorder?: a review of causal evidence
- Author:
- BALDWIN Robert C.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(1), January 2005, pp.1-11.
- Publisher:
- Wiley
A literature review with discussion of findings in the light of recently suggested guidelines for the development of new psychiatric disorders. There is considerable evidence linking depression in later life with vascular brain disease but the interaction is bi-directional. Depression and vascular disease could be mediated by factors other than traditional vascular risk factors. There is increasing interest in mechanisms such as inflammatory processes which may mediate both depression and vascular disease. Vascular depression provides a useful framework with which to remind the clinician of important interactions between depression and vascular disease but conceptually it may be too restrictive.
Delusional depression in elderly patients: characteristics and relationship to age onset
- Author:
- BALDWIN Robert C.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 10(11), November 1995, pp.981-985.
- Publisher:
- Wiley
In a prospective study, 34 patients with delusional depression were compared with 100 non-psychotically depressed patients and a subgroup of 30 age- and sex-matched control patients. Depressed patients with delusions were more likely to be single, especially single men. The most common delusions were those of persecution and hypochondriasis. There were no striking differences in other depression symptoms and no evidence for the hypothesis that delusional depression is associated with a later age of depression onset.
Comparison of older people with psychosis living in the community and in care homes
- Authors:
- CLANCY Emily, BALDWIN Robert C.
- Journal article citation:
- Psychiatric Bulletin, 32(4), May 2008, pp.177-179.
- Publisher:
- Royal College of Psychiatrists
The aim was to compare two groups of older people with chronic schizophrenia or delusional disorder living in the community and in care homes, along the domains of morbidity suggested by prior research. From the case-load of one old age psychiatrist, 22 individuals with chronic psychosis residing in care homes were compared to 23 living in their own homes. The measures used were: the Positive and Negative Symptom Score (PANSS); the Mini Mental State Examination (MMSE); the Burvill Physical Illness Scale (Burvill); and an Activities of Daily Living Scale (IADL) Those in care homes had significantly higher PANSS scores, largely accounted for by significantly more deficit symptoms. They also had poorer cognition and significantly greater impairment in daily-life activities but their medical condition was not significantly worse. Most were seen only by a psychiatrist. The greater morbidity and disablement of older people with chronic schizophrenia or delusional disorder living in care homes is likely to be intrinsic to the disorder but does not appear to be taken into account in current service planning or delivery.
Guideline for the management of late-life depression in primary care
- Authors:
- BALDWIN Robert C., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(9), September 2003, pp.829-838.
- Publisher:
- Wiley
The aim was to develop a guideline for the primary care management of depression in later life based on best practice. Source material included relevant guidelines, literature reviews and consensus documents coupled with an updated literature review covering 1998-October, 2001. This material was summarised as a series of evidence-based statements and recommendations agreed by consensus. Good quality evidence exists for the pharmacological and psychological treatment of depressive episode (major depression), although not specifically in primary care. There is some evidence of efficacy of antidepressants in late-life dysthymia and minor depression associated with poor functional status. In depressive episode, current evidence suggests acute treatment for at least six weeks and a continuation period of at least 12 months. Both tricyclic antidepressants and Selective Serotonin Re-uptake Inhibitors are effective in longterm prevention. There is less data on how to manage patients who do not respond in the acute treatment phase. More data is needed on sub-groups of patients with specific co-morbid medical conditions and those who are frail. Collaborative care is effective in older depressed primary care patients. There are effective treatments for depression in primary care. More research is needed to address the optimum treatment of depression with medical co-morbidity and to elucidate the role of newer psychological interventions. Collaborative care between primary care and specialist services is a promising new avenue for management.