International Journal of Geriatric Psychiatry, 22(11), November 2007, pp.1063-1086.
Publisher:
Wiley
A systematic literature review based on the Cochrane methodology was performed. PubMed, PsychINFO and EMBASE databases were searched for existing studies that fulfilled predefined inclusion criteria. The studies were divided into: (1) those that analysed the association between severity of AD and prevalence of depressive symptoms (continuous approach) and (2) those that investigated the association between severity of AD and diagnosed depression (categorical approach). The quality of existing studies was rated and the results were synthesized with a best evidence synthesis. Twenty-four studies fulfilled the inclusion criteria. Nineteen reported results for a continuous approach and seven for a categorical approach. Three of the four high quality studies within the continuous approach did not find a significant association between severity of AD and prevalence of depressive symptoms. None of the three high quality studies using the categorical approach found a significant association between the severity of AD and the prevalence of diagnosed depression. There is evidence for a lack of association between the severity of AD and the prevalence of comorbid depressive symptoms or diagnosed depression. Until new studies contradict this conclusion, prevention and intervention strategies for comorbid depression in AD should be aimed at all patients irrespective their disease severity.
A systematic literature review based on the Cochrane methodology was performed. PubMed, PsychINFO and EMBASE databases were searched for existing studies that fulfilled predefined inclusion criteria. The studies were divided into: (1) those that analysed the association between severity of AD and prevalence of depressive symptoms (continuous approach) and (2) those that investigated the association between severity of AD and diagnosed depression (categorical approach). The quality of existing studies was rated and the results were synthesized with a best evidence synthesis. Twenty-four studies fulfilled the inclusion criteria. Nineteen reported results for a continuous approach and seven for a categorical approach. Three of the four high quality studies within the continuous approach did not find a significant association between severity of AD and prevalence of depressive symptoms. None of the three high quality studies using the categorical approach found a significant association between the severity of AD and the prevalence of diagnosed depression. There is evidence for a lack of association between the severity of AD and the prevalence of comorbid depressive symptoms or diagnosed depression. Until new studies contradict this conclusion, prevention and intervention strategies for comorbid depression in AD should be aimed at all patients irrespective their disease severity.
Subject terms:
research methods, Alzheimers disease, depression, diagnosis, comorbidity;
International Journal of Geriatric Psychiatry, 22(6), June 2007, pp.543-548.
Publisher:
Wiley
This American study aimed to determine the frequency of depression in Parkinson's disease (PD) in routine clinical care, and to examine its association with co-morbid psychiatric and medical conditions and healthcare utilization. Depression diagnoses and healthcare utilization data for all male veterans with PD age 55 or older seen in fiscal year 2002 (n = 41,162) were analyzed using Department of Veterans Affairs (VA) national databases. Frequencies of co-morbid disorders and healthcare utilization were determined for depressed and non-depressed patients; associations with depression were examined using multivariate logistic regression models. A depression diagnosis was recorded for 18.5% of PD patients, including major depression in 3.9%. Depression decreased in frequency and severity with increasing age. In multivariate logistic regression models, depressed patients had significantly greater psychiatric and medical co-morbidity, including dementia, psychosis, stroke, congestive heart failure, diabetes, and chronic obstructive pulmonary disease than non-depressed patients. Depressed PD patients were also significantly more likely to have medical and psychiatric hospitalizations, and had more outpatient visits, than non-depressed PD patients in adjusted models. Depression in PD in non-tertiary care settings may not be as common or as severe as that seen in specialty care, though these findings also may reflect under-recognition or diagnostic imprecision. The occurrence of depression in PD is associated with greater psychiatric and medical co-morbidity, and greater healthcare utilization. These findings suggest that screening for depression in PD is important and should be embedded in a comprehensive psychiatric, neuropsychological, and medical evaluation.
This American study aimed to determine the frequency of depression in Parkinson's disease (PD) in routine clinical care, and to examine its association with co-morbid psychiatric and medical conditions and healthcare utilization. Depression diagnoses and healthcare utilization data for all male veterans with PD age 55 or older seen in fiscal year 2002 (n = 41,162) were analyzed using Department of Veterans Affairs (VA) national databases. Frequencies of co-morbid disorders and healthcare utilization were determined for depressed and non-depressed patients; associations with depression were examined using multivariate logistic regression models. A depression diagnosis was recorded for 18.5% of PD patients, including major depression in 3.9%. Depression decreased in frequency and severity with increasing age. In multivariate logistic regression models, depressed patients had significantly greater psychiatric and medical co-morbidity, including dementia, psychosis, stroke, congestive heart failure, diabetes, and chronic obstructive pulmonary disease than non-depressed patients. Depressed PD patients were also significantly more likely to have medical and psychiatric hospitalizations, and had more outpatient visits, than non-depressed PD patients in adjusted models. Depression in PD in non-tertiary care settings may not be as common or as severe as that seen in specialty care, though these findings also may reflect under-recognition or diagnostic imprecision. The occurrence of depression in PD is associated with greater psychiatric and medical co-morbidity, and greater healthcare utilization. These findings suggest that screening for depression in PD is important and should be embedded in a comprehensive psychiatric, neuropsychological, and medical evaluation.
Subject terms:
Parkinsons disease, service uptake, depression, health care, comorbidity;
HUSSEY David L., DRINKARD Allyson M., FLANNERY Daniel L.
Journal article citation:
Journal of Social Work Practice in the Addictions, 7(1/2), 2007, pp.117-138.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
This study examines the offence, substance use, and mental illness characteristics for a subset of adolescent juvenile detainees receiving services through a federally funded system of care initiative in the United States. Findings indicate that 65% of these youth were comorbid for both mental and substance use disorders. Female detainees were at greater risk on almost every measure of mental health impairment and dual substance use and mental disorders. Study results highlight the need for effective, integrated treatment models that can serve youth involved in multiple child-serving systems, and address the challenging constellation of comorbid conditions faced by many juvenile offenders. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
This study examines the offence, substance use, and mental illness characteristics for a subset of adolescent juvenile detainees receiving services through a federally funded system of care initiative in the United States. Findings indicate that 65% of these youth were comorbid for both mental and substance use disorders. Female detainees were at greater risk on almost every measure of mental health impairment and dual substance use and mental disorders. Study results highlight the need for effective, integrated treatment models that can serve youth involved in multiple child-serving systems, and address the challenging constellation of comorbid conditions faced by many juvenile offenders. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Subject terms:
mental health problems, risk, substance misuse, young offenders, dual diagnosis, gender, comorbidity;
British Journal of Psychiatry, 191(11), November 2007, pp.408-414.
Publisher:
Cambridge University Press
... offending. In a community adult sample, self-reported crime and skin conductance orienting were collected on four diagnostic groups: schizophrenia-spectrum personality disorder only; antisocial personality disorder only; comorbidity of the two disorders; and a control group. The comorbid group showed significantly higher levels of criminal behaviour than the other three groups. They also showed reduced
Studies have examined people with comorbid schizophrenia-spectrum personality disorder and antisocial personality disorder, a subgroup who may differ psychophysiologically and behaviourally from those with either condition alone. The aim was to test whether individuals with both types of personality disorder are particularly characterised by reduced orienting and arousal and by increased criminal offending. In a community adult sample, self-reported crime and skin conductance orienting were collected on four diagnostic groups: schizophrenia-spectrum personality disorder only; antisocial personality disorder only; comorbidity of the two disorders; and a control group. The comorbid group showed significantly higher levels of criminal behaviour than the other three groups. They also showed reduced skin conductance orienting to neutral tones compared with the other groups, and significantly reduced arousal and orienting to significant stimuli compared with the control group. Reduced orienting may reflect a neurocognitive attentional risk factor for both antisocial and schizotypal personality disorders that indirectly reflects a common neural substrate to these disorders.
DIDDEN Robert, KORZILIUS Hubert, CURFS Leopold M G
Journal article citation:
Journal of Applied Research in Intellectual Disabilities, 20(5), September 2007, pp.409-419.
Publisher:
Wiley
Individuals with Prader-Willi syndrome (PWS) are at increased risk for mental health and behaviour problems, such as skin-picking and compulsive behaviours. Prevalence and functional assessment of skin-picking, and its association with compulsive behaviour and self-injury, were investigated in a large group of individuals with PWS (n = 119) from the Netherlands. Data on demographic characteristics, skin-picking and compulsive and self-injurious behaviours were collected by questionnaires. Behavioural function of skin-picking was assessed by administering the Questions About Behavioral Function scale. Skin-picking was found in 86% of the sample, and correlated positively with compulsive behaviours. No associations were found between skin-picking and other variables. Functional assessment suggest that in most cases (i.e. 70%) skin-picking primarily had non-social functions. Skin-picking and compulsive behaviours are common in PWS. In most cases, skin-picking may be maintained by contingent arousal reduction. Controlled studies on behavioural treatment are lacking. Implications for treatment selection are discussed.
Individuals with Prader-Willi syndrome (PWS) are at increased risk for mental health and behaviour problems, such as skin-picking and compulsive behaviours. Prevalence and functional assessment of skin-picking, and its association with compulsive behaviour and self-injury, were investigated in a large group of individuals with PWS (n = 119) from the Netherlands. Data on demographic characteristics, skin-picking and compulsive and self-injurious behaviours were collected by questionnaires. Behavioural function of skin-picking was assessed by administering the Questions About Behavioral Function scale. Skin-picking was found in 86% of the sample, and correlated positively with compulsive behaviours. No associations were found between skin-picking and other variables. Functional assessment suggest that in most cases (i.e. 70%) skin-picking primarily had non-social functions. Skin-picking and compulsive behaviours are common in PWS. In most cases, skin-picking may be maintained by contingent arousal reduction. Controlled studies on behavioural treatment are lacking. Implications for treatment selection are discussed.
Child Abuse and Neglect, 31(5), May 2007, pp.531-547.
Publisher:
Elsevier
The current study examined the effects of childhood sexual and physical abuse on reports of pain in 1,727 men and women from the United States. Data from the National Comorbidity Survey, a nationally representative sample, were utilized. Childhood experiences of physical and sexual abuse were assessed, and pain reports in relation to current health problems were obtained. Regression and mediation
The current study examined the effects of childhood sexual and physical abuse on reports of pain in 1,727 men and women from the United States. Data from the National Comorbidity Survey, a nationally representative sample, were utilized. Childhood experiences of physical and sexual abuse were assessed, and pain reports in relation to current health problems were obtained. Regression and mediation analyses were used to examine the relationship between childhood abuse and current pain reports and to determine whether depression mediated this relationship. Individuals who experienced abuse reported more health problems compared to those participants without abuse histories. Among participants with a current health problem, those who experienced abuse reported more pain compared to those participants without abuse histories. Because childhood abuse is associated with depression and depression is associated with more reported pain, the influence of depression on the relationship between childhood abuse and adult pain reports was examined. After controlling for differences between the abused and non-abused participants on specific health problems, depression was not found to have mediated the relationship. Childhood abuse was associated with more reported pain. The higher rate of depression found among adults who experienced childhood abuse was not the primary factor for these increased pain reports. Rather, childhood abuse and depression independently contributed to pain reports. Treatment of both underlying problems (i.e., pain and depression) is recommended in addressing the needs of abused individuals with these comorbid disorders.
Subject terms:
pain, survivors, adults, child abuse, child sexual abuse, depression, comorbidity;
Community Mental Health Journal, 43(3), June 2007, pp.229-249.
Publisher:
Springer
Few studies estimate rural psychiatric disorder rates. No study has reported either DSM-III-R or DSM IV disorder prevalence and mental health service use among US rural young adults. This paper reports psychiatric disorder prevalence, comorbidity, service utilization, and disorder correlates in a community sample of 536 young adults, aged 19 to 23 years, living in the rural Midwestern US. More
Few studies estimate rural psychiatric disorder rates. No study has reported either DSM-III-R or DSM IV disorder prevalence and mental health service use among US rural young adults. This paper reports psychiatric disorder prevalence, comorbidity, service utilization, and disorder correlates in a community sample of 536 young adults, aged 19 to 23 years, living in the rural Midwestern US. More than 60% of the sample met criteria for a lifetime disorder. Substance use disorders were most prevalent. Results indicate that young adults living in the rural Midwest demonstrate substantial rates of psychiatric disorder that are comparable to other population groups.
Subject terms:
mental health problems, mental health services, rural areas, service uptake, young adults, comorbidity;
British Journal of Psychiatry, 190(4), April 2007, pp.344-349.
Publisher:
Cambridge University Press
Comorbid anxiety is common in depressive disorders in both middle and late life, and it affects response to antidepressant treatment. The aim was to examine whether anxiety symptoms predict acute and maintenance (2 years) treatment response in late-life depression. Data were drawn from a randomised double-blind study of pharmacotherapy and interpersonal psychotherapy for patients age 70 years and over with major depression. Anxiety symptoms were measured using the Brief Symptom Inventory. Survival analysis tested the effect of pre-treatment anxiety on response and recurrence. Patients with greater pretreatment anxiety took longer to respond to treatment and had higher rates of recurrence. Actuarial recurrence rates were 29% (pharmacotherapy, lower anxiety), 58% (pharmacotherapy, higher anxiety), 54% (placebo, lower anxiety) and 81% (placebo, higher anxiety). Improved identification and management of anxiety in late-life depression are needed to achieve response and stabilise recovery.
Comorbid anxiety is common in depressive disorders in both middle and late life, and it affects response to antidepressant treatment. The aim was to examine whether anxiety symptoms predict acute and maintenance (2 years) treatment response in late-life depression. Data were drawn from a randomised double-blind study of pharmacotherapy and interpersonal psychotherapy for patients age 70 years and over with major depression. Anxiety symptoms were measured using the Brief Symptom Inventory. Survival analysis tested the effect of pre-treatment anxiety on response and recurrence. Patients with greater pretreatment anxiety took longer to respond to treatment and had higher rates of recurrence. Actuarial recurrence rates were 29% (pharmacotherapy, lower anxiety), 58% (pharmacotherapy, higher anxiety), 54% (placebo, lower anxiety) and 81% (placebo, higher anxiety). Improved identification and management of anxiety in late-life depression are needed to achieve response and stabilise recovery.
International Journal of Geriatric Psychiatry, 22(2), February 2007, pp.101-105.
Publisher:
Wiley
The utility of Interpersonal Psychotherapy (IPT) has been documented as a maintenance treatment for late life depression as mono-therapy or in combination with antidepressant medication. Late life depression, however, is frequently co-morbid with declining memory or other cognitive abilities such that the usefulness of one-to-one psychotherapies is called into question for this subgroup. Additionally, concerned caregivers often accompany these patients to request help and their role in the presenting symptoms and in their potential resolution must also be addressed by any successful psychotherapy in this population. The aim was to explore ways in which IPT could be modified to better serve the particular presentation and needs of depressed elders with cognitive decline along with their caregivers. Various modifications of traditional IPT techniques were experimented with and refined in our collaborative late life research center using regular group supervision and feedback from patients and their caregivers. A key component of these modifications involves the integration of the caregiver into the treatment process in flexible ways that recognize their own role transition that is taking place simultaneously with that of the patient's role transition from a greater to a lesser functional state. Other techniques for resolving role conflicts, particularly those directly involving care issues for the patient, are also delineated. These modifications are collectively referred to as IPT-CI for cognitive impairment. A brief case vignette is presented. The modifications outlined in this communication reflect an evolving work-in-progress and serve as a framework for the future development of a manual of guidelines to assist healthcare personnel to optimally treat this population and their caregivers.
The utility of Interpersonal Psychotherapy (IPT) has been documented as a maintenance treatment for late life depression as mono-therapy or in combination with antidepressant medication. Late life depression, however, is frequently co-morbid with declining memory or other cognitive abilities such that the usefulness of one-to-one psychotherapies is called into question for this subgroup. Additionally, concerned caregivers often accompany these patients to request help and their role in the presenting symptoms and in their potential resolution must also be addressed by any successful psychotherapy in this population. The aim was to explore ways in which IPT could be modified to better serve the particular presentation and needs of depressed elders with cognitive decline along with their caregivers. Various modifications of traditional IPT techniques were experimented with and refined in our collaborative late life research center using regular group supervision and feedback from patients and their caregivers. A key component of these modifications involves the integration of the caregiver into the treatment process in flexible ways that recognize their own role transition that is taking place simultaneously with that of the patient's role transition from a greater to a lesser functional state. Other techniques for resolving role conflicts, particularly those directly involving care issues for the patient, are also delineated. These modifications are collectively referred to as IPT-CI for cognitive impairment. A brief case vignette is presented. The modifications outlined in this communication reflect an evolving work-in-progress and serve as a framework for the future development of a manual of guidelines to assist healthcare personnel to optimally treat this population and their caregivers.
Aggression and Violent Behavior, 12(1), January 2007, pp.16-35.
Publisher:
Elsevier
This paper critically appraises the criteria for DSM diagnoses of the paraphilias relevant to sexual offenders. It is concluded that these criteria leave a lot to be desired and that a more helpful approach would be to rate the features of each type of sexual offender along dimensions ranging from normal to seriously problematic. Next consideration is given to the evidence on the incidence of multiple paraphilias and comorbid disorders. It is not yet completely clear from this evidence that sexual offenders typically have multiple sexual outlets although some obviously do. What is clear is that incidence of comorbid disorders is sufficiently high to warrant concerns about how to effectively address these additional disordered aspects of sexual offenders in treatment. Finally, suggestions are offered about how to address in treatment both multiple paraphilic offenders and those with associated comorbid disorders.
This paper critically appraises the criteria for DSM diagnoses of the paraphilias relevant to sexual offenders. It is concluded that these criteria leave a lot to be desired and that a more helpful approach would be to rate the features of each type of sexual offender along dimensions ranging from normal to seriously problematic. Next consideration is given to the evidence on the incidence of multiple paraphilias and comorbid disorders. It is not yet completely clear from this evidence that sexual offenders typically have multiple sexual outlets although some obviously do. What is clear is that incidence of comorbid disorders is sufficiently high to warrant concerns about how to effectively address these additional disordered aspects of sexual offenders in treatment. Finally, suggestions are offered about how to address in treatment both multiple paraphilic offenders and those with associated comorbid disorders.
Subject terms:
rape, sex offenders, treatment, therapy and treatment, child sexual abuse, diagnosis, comorbidity;