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Longitudinal syndromal and sub-syndromal symptoms after severe depression: 10-year follow-up study
- Authors:
- KENNEDY Noel, ABBOTT Rosemary, PAYKEL Eugene S.
- Journal article citation:
- British Journal of Psychiatry, 184(4), April 2004, pp.330-336.
- Publisher:
- Cambridge University Press
Few follow-up studies of depression have evaluated depressive symptomatology over time at both threshold and sub-threshold levels. The aim was to evaluate long-term longitudinal symptomatic course after an episode of severe depression. A total of 61 participants from a previous study cohort underwent a detailed interview covering the longitudinal course of depression and pharmacological treatment over 8–11 years of follow-up. Of the follow-up months, 52% were spent at an asymptomatic level, 15% at minor symptom level, 20% at residual symptom level and 13% at full depression level. Also, 30% of follow-up months were spent in an episode of depression, and 18% of patients never achieved asymptomatic status during follow-up. The percentage of patients at each symptom level remained relatively stable after the first 2 years, but levels in individuals fluctuated, with a mean of two changes in symptom levels per follow-up year.
Advances in the conceptualization of personality disorders: issues affecting social work practice and research
- Authors:
- LANIER Paul, BOLLINGER Sarah, KRUEGER Robert F.
- Journal article citation:
- Clinical Social Work Journal, 41(2), 2013, pp.155-162.
- Publisher:
- Springer
- Place of publication:
- New York
This article provides a review of the research that has informed the proposed changes to the DSM-5 conceptualisation of personality psychopathology with a focus on implications for social work practice and research. A paradigm shift to a dimensional model is likely to replace the current categorical model of personality disorders and will have profound implications for the profession. While establishing a diagnostic system that is grounded in empirical knowledge is the primary benefit, this tool will also be more consistent with social work’s orienting theories and values. Social workers should gain knowledge about the proposed changes and actively participate in the review process. (Publisher abstract)
Capacity-to-consent in psychiatric research: development and preliminary testing of a screening tool
- Authors:
- ZAYAS Luis H., CABASSA Leopoldo J., PEREZ M. Carmela.
- Journal article citation:
- Research on Social Work Practice, 15(6), November 2005, pp.545-556.
- Publisher:
- Sage
This article describes the development and preliminary testing of a capacity-to-consent tool constructed for a study of psychiatric diagnosing in a community clinic. A 10-item screening device based on four legal standards for demonstrating capacity (understanding, appreciation, reasoning, and voluntarism) was created and tested with 68 adult patients entering the study. The results found only five participants (7%) failed the screen, 61 (93%) passed. No participants who passed at entry were later found in psychiatric evaluations to lack capacity. The authors conclude that the tool was effective in identifying persons who could not demonstrate consent capacity, thereby protecting prospective participants.
Initial development of a measure of emotional dysregulation for individuals with Cluster B personality disorders
- Authors:
- NEWHILL Christina E., MULVEY Edward P., PILKONIS Paul A.
- Journal article citation:
- Research on Social Work Practice, 14(6), November 2004, pp.443-449.
- Publisher:
- Sage
Individuals with DSM-IV Cluster B personality disorders are at particular risk of violence toward self or others. Emotional dysregulation is likely to be a factor in such incidents and is a central issue addressed in therapies with personality-disordered individuals. This article reports findings from a study that developed an original 18-item measure of emotional dysregulation and administered the scale to 100 participants diagnosed with Cluster B personality disorders or traits. A 13-item scale (the General Emotional Dysregulation Measure or GEDM) reflecting general emotional arousal and dysregulation of negative affect was derived using principal components analysis. The GEDM demonstrates good reliability and validity and correlates significantly with other established measures of affect. This measure is seen as potentially useful in clinical social work practice and in future investigations of the relationships among emotional dysregulation, personality disorders, substance abuse, and violence.
Conversion pseudodementia in older people: a descriptive case series
- Author:
- HEPPLE J.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(10), October 2004, pp.961-967.
- Publisher:
- Wiley
This paper reports a case series of ten patients collected over a 12-year period of clinical work in old age psychiatry in the UK by the author. The core features of the syndrome are: apparent cognitive impairment, regression and increasing physical dependency beginning in late middle or early old age, without evidence for an organic dementia from investigations or from taking into account the course of the illness. The syndrome is more common in women from a higher socio-economic background with past psychiatric histories dominated by depressive symptoms. The syndrome usually progresses to the point where long term institutional care is needed although the mean survival from onset is 13 years. The author suggests that conversion pseudodementia in older people is caused by a catastrophic reaction to cumulative loss in later life in individuals who have predisposing borderline and narcissistic personality traits. Treatment using psychotherapeutic approaches may limit the progression of the syndrome if it is recognised at an early stage
Depression in dementia: a comparative and validation study of four brief scales in the elderly Chinese
- Authors:
- LAM Chee Kum, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(5), May 2004, pp.422-428.
- Publisher:
- Wiley
The study aimed to determine: (i) the diagnostic accuracy of four brief depression scales, the Geriatric Depression Scale (GDS), Even Briefer Assessment Scale for Depression (EBAS DEP), Single Question and Cornell Scale for Depression in Dementia (Cornell) in an elderly Chinese population with varying dementia severity; and (ii) which scale had the best diagnostic performance. All four scales were administered to 88 elderly outpatients with dementia: 66 without and 22 with depression. Receiver Operating Characteristic (ROC) analysis was used to establish the optimal cut-off scores of the GDS, EBAS DEP and Cornell scales. The patients' dementia-severity was dichotomously categorized into mild and moderate-severe dementia, and the above analysis was repeated in both these groups to look at changes in the scales' diagnostic performance as dementia advances. The best diagnostic scale for detecting depression in dementia was the Cornell scale. Its optimal cut-off score was 6/7 (sensitivity 91.7%, specificity 80.0%) in the mild dementia group and 12/13 (sensitivity 70.0%, specificity 87.0%) in the more advanced dementia group. The optimal cut-off scores of the GDS and EBAS DEP also shifted to higher values when moving from the mild to the more advanced dementia groups, indicating the increasing difficulty on all these scales to detect depression with worsening cognitive impairment. The Single Question, however, was more robust with much less changes in its diagnostic parameters in both dementia cohorts: sensitivity 58.3%, specificity 90.0% for mild dementia, and 60.0 and 84.8%, respectively, for more advanced dementia. An efficient strategy to diagnose depression in dementia amongst elderly Chinese patients is to administer the Single Question followed by, when necessary, the Cornell scale.
Delirium among patients with and without dementia: does the diagnosis according to the DSM-IV differ from the previous classifications?
- Authors:
- LAURILA Jouko V., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(3), March 2004, pp.271-277.
- Publisher:
- Wiley
Different diagnostic criteria differ in their capacity to identify subjects as delirious. It is not known how DSM-IV classification, compared with the DSM-III, DSM-III-R, and ICD-10, identifies delirium among individuals with and without dementia and whether the symptom profiles differ between these two subgroups. A cross-sectional study was performed on patients (age 70 years) in seven acute geriatric wards (n = 230) and in seven nursing-homes (n = 195) in Helsinki, Finland. Delirium was diagnosed according to the operationalized criteria according to the DSM-III, DSM-III-R, DSM-IV, and clinical criteria of ICD-10. Dementia was defined according to consensus judgment among three geriatricians with concise information including: prior dementia diagnoses, Clinical Dementia Rating Scale, operationalized criteria according to the DSM-IV, nurses and/or caregivers interviews, and the results of the brain CT/MRI and prior Mini-Mental State Examination scores, when available. According to the DSM-III, DSM-IIIR, DSM-IV and ICD-10 criteria of delirium 22.7, 23.5, 25.9 and 14.9% of the demented, and 12.9, 13.5, 23.5 and 2.9% of the non-demented, respectively, were diagnosed as delirious. In stepwise logistic regression analysis clouding of consciousness, perceptual disturbances, and disorganized thinking were the most significant contributors to delirium diagnosis according to the DSM-IV among individuals with dementia, whereas perceptual disturbances, motor disturbances, and disorientation were the most significant contributors among those without dementia. DSM-IV criteria of delirium identify new, often non-demented, subjects as being delirious, while ICD-10 is overly restrictive. The symptom profile of delirium was slightly different among individuals with and without dementia.
Child maltreatment prevalence and mental disorders outcomes among American Indian women in primary care
- Author:
- DURAN Bonnie
- Journal article citation:
- Child Abuse and Neglect, 28(2), February 2004, pp.131-145.
- Publisher:
- Elsevier
The aim was to examine (1) the prevalence, types, and severity of child abuse and neglect (CAN) and (2) the relationship between CAN and lifetime psychiatric disorders among American Indian women using primary care services. A cross-sectional study was conducted among 234 American Indian women, age 18–45 who presented for outpatient ambulatory services at a community-based Indian Health Service Hospital in Albuquerque, New Mexico. Dependent measures included mood, substance abuse, and anxiety disorders as well as posttraumatic stress disorder (PTSD) as measured by the Composite International Diagnostic Interview. CAN was assessed using the Childhood Trauma Questionnaire. Approximately three-quarters of respondents (76.5%; 95% CI=70.4, 81.7) reported some type of childhood abuse or neglect; over 40% reported exposure to severe maltreatment. Severity of child maltreatment was associated in a dose response manner with lifetime diagnosis of mental disorders. After adjusting for social and demographic correlates, severe child maltreatment was strongly associated with lifetime PTSD (prevalence ratio [PR]=3.9; 95% CI=1.9, 8.0); and was moderately associated with lifetime substance use disorders (PR=2.3; 95% CI=1.6, 3.3); mood disorders (PR=2.1; 95% CI=1.4, 3.2); and with two or more disorders (PR=2.3; 95% CI=1.6, 3.4). CAN was common in our sample of American Indian women in primary care and was positively associated with lifetime psychiatric disorders outcomes. Screening for CAN and psychiatric disorders would enhance the treatment of patients seeking primary care services. Primary prevention of child maltreatment might reduce the high prevalence of mental disorders among American Indian women.
Negative symptoms in Alzheimer's disease: a confirmatory factor analysis
- Authors:
- DE JONGHE Jos F. M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(8), August 2003, pp.748-753.
- Publisher:
- Wiley
Negative symptoms are a prominent clinical feature of Alzheimer's disease and they are related to memory impairment but not to mood disturbances. Methods employed in this research included Nurses' Behavioural observation scale for psychogeriatric inpatients (GIP). Global clinical ratings of severity of dementia and depression based on the Cambridge Examination for Mental Disorders of the Elderly-Dutch version (CAMDEX-N). A unidimensional model of dementia fitted the data poorly. Multidimensional models produced better results. In two- and three-factor models negative symptoms were separated from cognitive impairment and mood disturbances. The more severe the memory impairment, the more socially withdrawn patients were. In this sense negative symptoms may have been secondary to cognitive decline. However, no association was found between negative symptoms and mood disturbances.
'People don't understand': an investigation of stigma in schizophrenia using interpretative phenomenological analysis (IPA)
- Authors:
- KNIGHT Matthew T. D., WYKES Til, HAYWARD Peter
- Journal article citation:
- Journal of Mental Health, 12(3), June 2003, pp.209-222.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Recent investigations provide evidence of stigma against people with a diagnosis of mental illness. The purpose of this study was to provide an account of the life experiences of persons with schizophrenia. Focusing on the individuals' personal reports of events and situations, the issues of stigmatisation and discrimination were explored. Six participants were interviewed using a semi-structured schedule focusing on the areas of personal history, understanding of schizophrenia, social and medical contextualisation, and reflection on impact. The research was conducted using Interpretative Phenomenological Analysis (IPA). Super-ordinate themes of judgement, comparison, and personal understanding of the (mental health) issue emerged. Stigma was evident both as public-stigma and as self-stigma. The ramifications of stigma and discrimination are enduring and potentially disabling. IPA is a constructive tool in exploring these issues.