Cerebral metabolism and mood in remitted opiate dependence.
(25/94)
BACKGROUND: Opiate-dependent individuals are prone to dysphoria that may contribute to treatment failure. Methadone-maintenance therapy (MMT) may mitigate this vulnerability, but controversy surrounds its long-term use. Little is known about the neurobiology of mood dysregulation in individuals receiving or removed from MMT. METHODS: Fifteen opiate-abstinent and 12 methadone-maintained, opiate-dependent subjects, who lacked other Axis I pathology, and 13 control subjects were compared on the Cornell Dysthymia Rating Scale (CDRS) and regional cerebral glucose metabolism (rCMRglc) using [(18)F]fluorodeoxyglucose positron emission tomography. RESULTS: CDRS scores showed no group differences. Opiate-abstinent subjects had lower rCMRglc than control subjects in the bilateral perigenual anterior cingulate cortex (ACC), left mid-cingulate cortex, left insula and right superior frontal cortex. Methadone-maintained subjects exhibited lower rCMRglc than control subjects in the left insula and thalamus. In opiate-abstinent subjects, rCMRglc in the left perigenual ACC and mid-cingulate cortex correlated positively with CDRS scores. CONCLUSIONS: In remitted heroin dependence, opiate-abstinence is associated with more widespread patterns of abnormal cortical activity than MMT. Aberrant mood processing in the left perigenual ACC and mid-cingulate cortex, seen in opiate-abstinent individuals, is absent in those receiving MMT, suggesting that methadone may improve mood regulation in this population. (+info)
Depression and anxiety in urban hemodialysis patients.
(26/94)
Depression is well established as a prevalent mental health problem for people with ESRD and is associated with morbidity and mortality. However, depression in this population remains difficult to assess and is undertreated. Current estimates suggest a 20 to 30% prevalence of depression that meets diagnostic criteria in this population. The extent of other psychopathology in patients with ESRD is largely unknown. The aim of this study was to expand the research on psychiatric complications of ESRD and examine the prevalence of a broad range of psychopathology in an urban hemodialysis center and their impact on quality of life. With the use of a clinician-administered semistructured interview in this randomly selected sample of 70 predominately black patients, >70% were found to have a psychiatric diagnosis. Twenty-nine percent had a current depressive disorder: 20% had major depression, and 9% had a diagnosis of dysthymia or depression not otherwise specified. Twenty-seven percent had a current major anxiety disorder. A current substance abuse diagnosis was found in 19%, and 10% had a psychotic disorder. The mean Beck Depression Inventory score was 12.1 +/- 9.8. Only 13% reported being in current treatment by a mental health provider, and only 5% reported being prescribed psychiatric medication by their physician. A total of 7.1% had compound depression or depression coexistent with another psychiatric disorder. The construct of depression was also disentangled from the somatic effects of poor medical health by demonstrating a unique relationship between depressive affect and depression diagnosis, independent of health status. This study also suggests the utility of cognitive variables as a meaningful way of understanding the differences between patients who have ESRD with clinical depression or other diagnoses and those who have no psychiatric comorbidity. The findings of both concurrent and isolated anxiety suggest that the prevalence of psychopathology in patients with ESRD might be higher than previously expected, and the disorders may need to be treated independently. In addition, the data suggest that cognitive behavioral therapeutic techniques may be especially advantageous in this population of patients who are treated with many medications. (+info)
Longitudinal associations between depressive and anxiety disorders: a comparison of two trait models.
(27/94)
BACKGROUND: Depression and anxiety are highly co-morbid disorders. Two latent trait models have been proposed to explain the nature of the relationship between these disorders. The first posits that depressive and anxiety disorders are both manifestations of a single internalizing factor. The second model, based on a tripartite model proposed by Clark & Watson [Journal of Abnormal Psychology (1991) 100, 316-336], proposes that depressive and anxiety disorders reflect a combination of shared and disorder-specific factors. METHOD: We directly compared the two models in a sample of 891 individuals from the Oregon Adolescent Depression Project who participated in up to four diagnostic assessments over approximately 15 years. Structural equation models were used to examine the relationship between depressive and anxiety disorders across different developmental periods (<14, 14-18, 19-23, 24-30 years of age). RESULTS: The one- and three-factor models were hierarchically related. Thus, a direct comparison between the one- and three-factor models was possible using a chi2 difference test. The result found that the three-factor model fit the data better than the one-factor model. CONCLUSIONS: The three-factor model, positing that depressive and anxiety disorders were caused by a combination of shared and disorder-specific factors, provided a significantly better fit to the data than the one-factor model postulating that a single factor influences the development of both depressive and anxiety disorders. (+info)
Mental health and substance use disorders among Latino and Asian American lesbian, gay, and bisexual adults.
(28/94)
Growing evidence suggests that lesbian, gay, and bisexual adults may be at elevated risk for mental health and substance use disorders, possibly due to anti-gay stigma. Little of this work has examined putative excess morbidity among ethnic/racial minorities resulting from the experience of multiple sources of discrimination. The authors report findings from the National Latino and Asian American Survey (NLAAS), a national household probability psychiatric survey of 4,488 Latino and Asian American adults. Approximately 4.8% of persons interviewed identified as lesbian, gay, bisexual, and/or reported recent same-gender sexual experiences. Although few sexual orientation-related differences were observed, among men, gay/bisexual men were more likely than heterosexual men to report a recent suicide attempt. Among women, lesbian/bisexual women were more likely than heterosexual women to evidence positive 1-year and lifetime histories of depressive disorders. These findings suggest a small elevation in psychiatric morbidity risk among Latino and Asian American individuals with a minority sexual orientation. However, the level of morbidity among sexual orientation minorities in the NLAAS appears similar to or lower than that observed in population-based studies of lesbian, gay, and bisexual adults. (+info)
Predictors of a new depression diagnosis among older adults admitted to complex continuing care: implications for the depression rating scale (DRS).
(29/94)
BACKGROUND: depression is a major disabling condition among older adults, where it may be under-diagnosed for a number of reasons, including a different presentation for younger people with depression. The Minimum Data Set 2.0 (MDS 2.0) assessment system provides a measurement scale for depression, the Depression Rating Scale (DRS), in addition to other items that may represent depressive phenomenology. OBJECTIVE: the ability of the DRS to predict the presence of new depression diagnoses at follow-up, among hospitalised older adults admitted without depression, is examined. METHODS: the study sample consists of all persons aged 65 years or more admitted between 1996 and 2003 to a complex continuing care (CCC) bed in Ontario without a recorded depression diagnosis. The sample was restricted to those who remained in hospital for about 3 months (n = 7,818) in order to obtain follow-up assessment information. Logistic regression was used to explore the relationship between admission characteristics (i.e. DRS scale items, other MDS 2.0 items related to DSM-IV criteria for depression) and receipt of a depression diagnosis on the follow-up assessment. RESULTS: a new depression diagnosis at follow-up was present in 7.5% of the individuals. The multivariate model predicting depression diagnosis included only the DRS scale, sadness over past roles, and withdrawal from activities. CONCLUSIONS: the DRS score at admission was predictive of receiving a depression diagnosis on a follow-up assessment among older adults admitted to the CCC. Further, the predictive ability of the DRS is only modestly improved by the addition of other items related to DSM-IV criteria. (+info)
Prenatal dysthymia versus major depression effects on the neonate.
(30/94)
Depressed pregnant women were classified as dysthymic or major depression disorder based on the Structured Clinical Interview for Depression and followed to the newborn period. The newborns of dysthymic versus major depression disorder mothers had a significantly shorter gestational age, a lower birthweight, shorter birth length and less optimal obstetric complications scores. The neonates of dysthymic mothers also had lower orientation and motor scores and more depressive symptoms on the Brazelton Neonatal Behavioral Assessment Scale. These findings were not surprising given the elevated cortisol levels and the inferior fetal measures including lower fetal weight, fetal length, femur length and abdominal circumference noted in our earlier study on fetuses of dysthymic pregnant women. (+info)
Anticipation of affect in dysthymia: behavioral and neurophysiological indicators.
(31/94)
Anticipation for future affective events and prediction uncertainty were examined in healthy controls and individuals with dysthymia (DYS) using behavioral responses and the contingent negative variation (CNV) and post-imperative negative variation (PINV) event-related potential (ERP) components. Warning stimuli forecasted the valence of subsequently presented adjectives ("+", positive; "=", neutral; "-", negative), and participants indicated whether each adjective would describe them over the next two weeks. Controls expected fewer negative, and individuals with DYS expected fewer positive, adjectives to apply to them. CNV amplitudes were enhanced in controls prior to positive versus other adjectives. Response times and PINV amplitudes were greater following neutral compared to other adjectives, and PINV was larger overall in dysthymics compared to controls. In sum, healthy controls and individuals with DYS exhibit different behavioral and neurophysiological biases in anticipation for future affective events. These results are discussed in the context of cognitive theories of depression. (+info)
New episodes and new onsets of major depression in borderline and other personality disorders.
(32/94)