Biomedical subjects

D Hadzi-Pavlovic

Publications and source records attributed to D Hadzi-Pavlovic.

At least 19 recordsLinked to original sources

PubMed2005

Sleeping in? The impact of age and depressive sub-type on hypersomnia.

BACKGROUND: While early morning wakening is held to be a classic feature of melancholia, we investigate the clinical observation that young patients with melancholia and bipolar depression tend to be more likely to report hypersomnia. METHODS: We examine age-related rates of those two sleep disturbance patterns in a consecutive set of out-patients with differing depressive sub-types assessed over a 20-year period. RESULTS: Hypersomnia was more likely to be reported than early morning wakening across all age bands by those with non-melancholic depression. Hypersomnia was also more likely than early morning wakening in younger patients with melancholia and bipolar disorder but, with age, early morning wakening became the dominant pattern. LIMITATIONS: The study was retrospective, undertaken in a sample attending a tertiary referral unit and artefactual determinants of the associations were not pursued. CONCLUSIONS: We speculate that hypersomnia may be a non-specific homeostatic coping response to stress and thus to the non-melancholic depressive disorders, but that this pattern is overruled by an early morning wakening pattern in the more biological depressive sub-types as the individual ages, perhaps reflecting a noradrenergic contribution.

Adult↗

PubMed2005

Progressing a spectrum model for defining non-melancholic depression.

OBJECTIVE: To further develop a 'spectrum model' for non-melancholic disorders that encompasses underlying personality styles and clinical patterning. METHOD: In a sample of patients with non-melancholic depression, we studied four personality constructs influencing risk to depression, assessing associational strength and specificity between personality scores and symptom and coping response patterns. RESULTS: Analyses refined four personality dimensions (anxious worrying, irritability, social inhibition, and self-centredness) for testing the model. For all dimensions, personality style was specifically linked with a mirroring 'coping' response. Quantification of specific links allowed development of a spectrum model for the non-melancholic depressive disorders in which underpinning personality style showed some specific links with the clinical 'pattern' of symptoms and coping repertoires. CONCLUSION: The model has the capacity to assist clinical assessment, identify aetiological personality influences and allow specific treatment effects for the heterogeneous non-melancholic depressive disorders to be determined.

Adaptation, Psychological↗

PubMed2005

Antenatal screening for the prediction of postnatal depression: validation of a psychosocial Pregnancy Risk Questionnaire.

OBJECTIVE: To assess the predictive value of an antenatal index of risk for postnatal depression (PND). METHOD: Participants returned the Pregnancy Risk Questionnaire (PRQ; 18 antenatal items) and the Edinburgh Depression Scale (EDS) at a mean of 32 weeks gestation; the EDS was then mailed out at 2 and 4 months postpartum to ascertain those women who were screened positive (score>2), i.e. probable cases of depression. Only those returning the EDS at 2 and/or 4 months were included in the study (n=1296). Women who screened positive (n=322; 24.8%) were contacted and of these, 245 completed the Auto-Composite International Diagnostic Interview (CIDI) and form the basis of our primary analyses. RESULTS: A CIDI diagnosis of major depression was found in 5.3% women at either 2 or 4 months. In this population, the optimal PRQ cut-off was >or=46 at which point sensitivity was 44% and specificity 92%. At this cut-off 9.9% tested positive (for risk of PND) on the PRQ with a positive predictive value (PPV) of 23.5%. Of 1079 women who scored below 46 on the PRQ, 3.2% were cases of CIDI depression while of those 119 scoring 46 or above, 23.5% were CIDI cases at 2 or 4 months postpartum, yielding an odds ratio of 9.18. CONCLUSION: Using a cut-off of >or=46, the PRQ is better than previously reported tools in the antenatal prediction of PND with respect to sensitivity and specificity, while like other studies PPV remains limited. The PRQ allows identification of high and low risk groups and thus has applicability in both the research and clinical settings.

Adult↗

PubMed2004

Is the female preponderance in major depression secondary to a gender difference in specific anxiety disorders?

BACKGROUND: While a female preponderance in unipolar depression is a consistent finding in community-based studies, determinants remain speculative. This study aimed to examine whether a female preponderance in certain anxiety disorders drives a gender difference in depression. METHOD: The relevant data from the National Comorbidity Study (NCS) are analysed. RESULTS: We observed a biphasic pattern in the emergence of a female preponderance in the depressive and anxiety disorders, with an initial pre-pubertal or early adolescent onset, and after attenuation in early to middle adulthood, re-emergence in mid- to late-adulthood. Analyses focused on determinants of the initial female preponderance. Female gender, presence of an anxiety disorder and variable ages of onset in the anxiety disorder all contributed to the increased chance of an initial depressive episode. Some specificity in linking the onset of depressive temporally in early adolescence with two anxiety disorders was demonstrated, specifically generalized anxiety disorder and panic disorder. CONCLUSIONS: The separate anxiety disorders and their age of onset had variable links with depression, but female gender remained a significant predictor of depression after accounting for the effects of prior anxiety.

Adolescent↗

PubMed2004

Measuring disordered personality functioning: to love and to work reprised.

OBJECTIVE: Current limitations to diagnosing and measuring the personality disorders encouraged a set of studies seeking to provide an alternate approach to modeling and measuring disordered personality function. METHOD: A large set of self-reported descriptors of disordered personality function were factor analyzed in a sample of patients with clinician-diagnosed personality dysfunction, generating 11 lower-order and two higher-order constructs. Subjects and non-clinical controls also completed a measure of personality styles underpinning formalized personality disorder groupings. Properties of the refined self-report (SR) measure were assessed in an independent sample of patients with a clinically diagnosed personality disorder. RESULTS: Limitations in 'cooperativeness' and 'coping' formed the higher-order constructs defining disordered personality function, with these constructs relevant to all personality styles. Analyses of SR, corroborative witness (CW) and clinician-rated data in an independent sample supported measuring disordered personality function by our derived 20-item SR measure, and exposed limitations to clinician-based assessment. CONCLUSION: Study findings build to a multi-axial strategy for measuring personality disorder, involving separate dimensional assessment of both disordered personality function and of personality style.

Adaptation, Psychological↗

PubMed2004

Scale matters: the need for a Bipolar Depression Rating Scale (BDRS).

OBJECTIVE: To briefly review the clinical and biological distinctions between unipolar and bipolar depression critiquing in particular currently available depression rating scales and discuss the need for a new observer-rated scale tailored to bipolar depression. METHOD: Relevant literature pertaining to the symptomatic differences between bipolar disorder and unipolar disorder as well as their measurement using existing assessment scales was identified by computerized searches and reviews of scientific journals known to the authors. RESULTS: Bipolar depression is distinct from unipolar depression in terms of phenomenology and clinical characteristics. These distinguishing features can be used to identify bipolarity in patients that present with recurrent depressive episodes. This is important because current self-report and observer-rated scales are optimized for unipolar depression, and hence limited in their ability to accurately assess bipolar depression. CONCLUSION: The development of a specific bipolar depression rating scale will improve the assessment of bipolar depression in both research and clinical settings and assist the development of better treatments and interventions.

Bipolar Disorder↗

PubMed2003

An Australian validation study of the temperament and character inventory.

OBJECTIVE: To assess the validity of the temperament and character inventory (TCI) measure in an Australian sample. METHOD: A sample of depressed subjects completed the TCI and a measure assessing personality disorder constructs (PDCs), while family members and psychiatrists also returned PDC ratings. RESULTS: Factor analyses generally supported the TCI constructs, when the temperament and character scales were analysed separately. Self-reported PDC scores were validated against corroborative witness ratings and used to assess the TCIs concurrent validity. Validation analyses supported all TCI temperament scales, but the Self-transcendence Character scale was unassociated with PDC scores. The remaining two character scales (i.e. cooperativeness and self-directedness) were non-specifically associated with all PDC scores. CONCLUSION: Study results support the validity of the TCI scales, but question the best model for conceptualizing the TCI. It is suggested that two character scales quantify disordered functioning, while temperament scales quantify style, constructs that may be inter-related or independent in individual subjects.

Adult↗

PubMed2002

Cognitive-based measures screening for depression in the medically ill: the DMI-10 and the DMI-18.

OBJECTIVE: We suggest that the identification of depression in the medically ill (DMI) might be improved by focussing on cognitive features. METHOD: We recruited 302 patients to complete our provisional cognitive-based measure. Subsets also completed one of two comparator screening measures, either the Hospital and Anxiety Depression Scale (HADS) or the Beck Depression Inventory for Primary Care (BDI-PC). One hundred and sixty patients were then assessed by a psychiatrist who estimated whether they were 'clinically depressed' and who also administered a standardized interview for depression (the CIDI). RESULTS: Analyses identified items discriminating clinically depressed and non-depressed individuals, allowing development of brief (10-item) and extended (18-item) measures. The two new measures were compared with the HADS and the BDI-PC in discriminating depressed and non-depressed medically ill patients. CONCLUSION: A cognitive construct-based approach to assessing depression in the medically ill appears strongly supported. We provide brief (DMI-10) and extended (DMI-18) measures that appear to have utility as screening instruments. Consideration of the discriminating items may also assist clinical decision making.

Chronic Disease↗

PubMed2001

Development of a simple screening tool for common mental disorders in general practice.

OBJECTIVE: To develop and validate a self-report screening tool for common mental disorders. DESIGN AND SETTING: Sequential development and validation studies in three cohorts of patients in general practice and one cohort of patients in a specialist psychiatry clinic. PARTICIPANTS: 1585 patients in general practice examined cross-sectionally and longitudinally; 46515 patients attending 386 general practitioners nationwide; 364 patients participating in a longitudinal study of psychiatric disorders in general practice; and 522 patients attending a specialist psychiatry clinic. MAIN OUTCOME MEASURES: Performance of the 12 items from the 34-item SPHERE questionnaire against DSM-III-R and DSM-IV diagnoses of psychiatric disorder, self-reported Brief Disability Questionnaire findings, GPs' ratings of patients' needs for psychological care and degree of risk resulting from mental disorder, and patients' and GPs' reports of reasons for presentation. RESULTS: Six somatic and six psychological questions identify two levels (and three types) of mental disorder: patients reporting both characteristic psychological and somatic symptoms (Level 1, Type 1), and patients reporting either psychological symptoms (Level 2, Type 2) or somatic symptoms (Level 2, Type 3). This classification system predicts disability ratings (Level 1, 8.2 "days out of role in the last month" and Level 2, 4.1 and 5.4 "days out of role in the last month" for Types 2 and 3, respectively), rates of lifetime psychiatric diagnoses (Level 1, 63% and Level 2, 59% and 48%, respectively), both patients' and GPs' report of reasons for presentation, and doctors' ratings of risk as a result of mental disorder. There are important and differing sociodemographic correlates for the three types of mental disorders. CONCLUSION: A classification system based on the 12 items from the 34-item SPHERE questionnaire can be used to identify common mental disorders. This system has acceptable validity and reliability, and is suited specifically for general practice settings.

Adult↗

PubMed2001

Unmet need for recognition of common mental disorders in Australian general practice.

OBJECTIVE: To determine the rate and predictors of unmet need for recognition of common mental disorders in Australian general practice. DESIGN AND SETTING: Cross-sectional national audit of general practices throughout Australia in 1998-1999. PARTICIPANTS: 46 515 ambulatory care patients attending 386 GPs. SCREENING TOOLS: Prevalence of common mental disorders--12 items from the 34-item SPHERE self-report questionnaire and associated classification system; prevalence of recognition of mental disorders by GPs--GPs reporting whether patients had depression, anxiety, mixed depression/anxiety, somatoform, or other psychological disorder; predictors of unmet need for recognition of mental disorders--self-report questions about demography for patients and GPs, and about practice organisation for GPs. MAIN OUTCOME MEASURES: Reported recognition of psychological disorders by GPs; actual prevalence of disorders; and patient, GP and practice characteristics predicting the failure to recognise disorders. RESULTS: GPs did not recognise mental disorder in 56% (11922/21210) of patients. These comprised 46% (5134/11060) of patients in the higher level of mental disorders, and (in the second level of disorders) 58% (2906/5036) of patients with predominantly psychological symptoms, and 76% (3882/5114) of those with predominantly somatic symptoms. Patients more likely to have their need for psychological assessment met had the following characteristics: middle-aged (odds ratio [OR], 1.76; 95% CI, 1.59-1.96), female (OR, 1.19; 95% CI, 1.12-1.27), Australian-born (OR, 1.16; 95% CI, 1.08-1.24), unemployed (OR, 1.75; 95% CI, 1.64-1.89), single (OR, 1.52; 95% CI, 1.41-1.61), presenting with mainly psychological symptoms (OR, 3.54; 95% CI, 3.28-3.81), and presenting for psychological reasons (OR, 4.20; 95% CI, 3.02-5.82). Characteristics of doctors associated with meeting patients' need for assessment were being aged over 35 years (OR, 1.51; 95% CI, 1.09-2.08), having an interest in mental health (OR, 1.27; 95% CI, 1.15-1.41), having had previous mental health training (OR, 1.29; 95% CI, 1.15-1.45), being in part-time practice (OR, 1.23; 95% CI, 1.09-1.39), seeing fewer than 100 patients per week (OR, 1.29; 95% CI, 1.13-1.47), working in practices with fewer than 2000 patients (OR, 1.28; 95% CI, 1.13-1.45) and working in regional centres (OR, 1.16; 95% CI, 1.05-1.28). CONCLUSION: Unmet need for recognition of common mental disorders remains high. Predictors of unmet need include a somatic symptom profile and practitioner and organisational characteristics which impede the provision of high quality mental health services.

Adolescent↗

PubMed2001

Treatment of common mental disorders in Australian general practice.

OBJECTIVE: To determine the rates and predictors of treatments for patients with common mental disorders in Australian general practice. DESIGN AND SETTING: Cross-sectional national audit of general practices throughout Australia in 1998-1999. PARTICIPANTS: 46 515 ambulatory care patients attending 386 GPs. SCREENING TOOLS: Prevalence of common mental disorders--12 items from the 34-item SPHERE self-report questionnaire and associated classification system; pharmacological and non-pharmacological treatment provided, as reported by the GPs--questions relating to treatments provided; predictors of treatments--self-report questions about demography for patients and GPs, and about practice organisation for GPs. MAIN OUTCOME MEASURES: GPs' reported provision of pharmacological and nonpharmacological treatments; and patient, GP and practice characteristics predicting treatment provision. RESULTS: There were complete data on treatment for 39 983 patients. 27% (10752) of all patients received some form of intervention; 21% (8304) received non-pharmacological and 12% (4765) received pharmacological treatments. Non-pharmacological treatments were mostly non-specific counselling and support (83%; 6892/8304). Among the 10303 patients with the most severe level of psychological disorders, only 50% (5152) received any intervention (38% [3872] received non-pharmacological and 27% [2766] pharmacological treatments). Evidence-based treatments were provided to only 12% (4961) of all patients (and only 27% [2802] of the 10303 with the most severe disorders). Although the newer antidepressant agents were commonly prescribed, older medications (mainly tricyclic antidepressants) were prescribed to older (OR, 1.29; 95% CI, 1.07-1.56), less educated (OR, 1.41; 95% CI, 1.12-1.79) and female (OR, 1.44; 95% CI, 1.23-1.70) patients. Among the 8304 patients receiving non-pharmacological treatments, specific (evidence-based) treatments were provided to only 17% (1412); these patients were typically middle-aged (OR, 2.94; 95% CI, 2.32-3.73) and the providing GPs were typically not in full-time practice (OR, 3.34; 95% CI, 2.56-4.17). CONCLUSION: Practitioners largely provide non-specific, non-pharmacological interventions for patients with common mental disorders. Even among those with the most severe disorders, only a minority receive pharmacological or specific evidence-based non-pharmacological treatments.

Adult↗

PubMed2001

The differential impact of age on the phenomenology of melancholia.

BACKGROUND: We pursue an observation that age may influence the clinical features of melancholia and, in particular, psychomotor disturbance. METHODS: Two large clinical databases were amalgamated allowing the clinical features of 124 depressed subjects meeting DSM-III-R and clinical criteria for melancholia to be contrasted with 218 subjects diagnosed as having a non-melancholic depression by both criteria sets. Psychomotor disturbance was assessed by the CORE measure and by seven classical endogeneity symptoms of melancholia which, when summed, created a ENDOG score. RESULTS: There was no impact of age on ENDOG scores in either the melancholics or non-melancholics. In the melancholics, increasing age was associated with increasing CORE scores and with agitation scale scores in particular. In a set of discriminant function analyses seeking to identify the comparative utility of a set of predictors of melancholic (versus non-melancholic) groups, age was significant, and while CORE and ENDOG scores were individual predictors, their combined entry established that the CORE score alone made the ENDOG score redundant, and that the addition of age then made little impact. CONCLUSIONS: Melancholia appears to have a later age of onset than non-melancholic depression, while its phenotypic expression appears to change with age, with psychomotor disturbance being more distinct in older subjects. Such an effect may have a number of clinical implications, including possible differential effects of varying antidepressant treatments.

Adult↗

PubMed2001

Is any female preponderance in depression secondary to a primary female preponderance in anxiety disorders?

OBJECTIVE: National community studies consistently identify higher rates of both depressive and anxiety disorders in women. The female preponderance in depression could be primary or, alternatively, a sex difference in anxiety could determine the differential depression rates. We therefore pursue whether the female preponderance in depression is secondary to a female preponderance in anxiety disorders in a community sample. METHOD: We analyse relevant data from the National Comorbidity Study (NCS) database, examining in particular whether sex differences in anxiety (here those meeting criteria for panic disorder, agoraphobia without panic disorder, generalized anxiety and social phobia) influenced sex differences in the prevalence of both major depression and dysthymia. RESULTS: Survival analyses indicated that, for both major depression and dysthymia, and within subsamples of those with early onset and late onset depression, both female sex and a preceding anxiety disorder made significant contributions, with preceding anxiety making the consistently stronger contribution of the two. CONCLUSION: A proportion of the female preponderance in major depression and dysthymia in the general community appears determined by a primary sex difference in anxiety.

Adolescent↗

PubMed2001

What is chronic fatigue syndrome? Heterogeneity within an international multicentre study.

OBJECTIVE: We sought to compare the characteristics of patients presenting with chronic fatigue (CF) and related syndromes in eight international centres and to subclassify these subjects based on symptom profiles. The validity of the subclasses was then tested against clinical data. METHOD: Subjects with a clinical diagnosis of CF completed a 119-item self-report questionnaire to provide clinical symptom data and other information such as illness course and functional impairment. Subclasses were generated using a principal components-like analysis followed by latent profile analysis (LPA). RESULTS: 744 subjects returned complete data sets (mean age 40.8 years, mean length of illness 7.9 years, female to male ratio 3:1). Overall, the subjects had a high rate of reporting typical CF symptoms (fatigue, neuropsychological dysfunction, sleep disturbance). Using LPA, two subclasses were generated. Class one (68% sample) was characterized by: younger age, lower female to male ratio; shorter episode duration; less premorbid, current and familial psychiatric morbidity; and, less functional disability. Class two subjects (32%) had features more consistent with a somatoform illness. There was substantial variation in subclass prevalences between the study centres (Class two range 6-48%). CONCLUSIONS: Criteria-based approaches to the diagnosis of CF and related syndromes do not select a homogeneous patient group. While substratification of patients is essential for further aetiological and treatment research, the basis for allocating such subcategories remains controversial.

Adult↗

PubMed2001

Screening for depression in the medically ill: the suggested utility of a cognitive-based approach.

OBJECTIVE: There is a need for a valid measure of depression in the medically ill, and one that is independent of medical illness characteristics. As yet, there is no such widely accepted measure. We thus report on the early development of such a measure using cognitive constructs that define depressive mood state nuances. METHOD: We studied 67 patients with a significant medical illness, verbally administering a set of 81 provisional items. Sample members also alternatively completed one of two comparison measures: the Hospital Anxiety and Depression Scale (HADS) or the Beck Depression Inventory for Primary Care (BDI-PC). A psychiatrist interviewed a subset to determine severity of any depression and whether subjects met formalized caseness criteria for depression. The Composite International Diagnostic Interview (CIDI) was also administered during interviews to assess agreement with psychiatrist judgements about caseness. RESULTS: A 16-item measure with high internal consistency was derived, with validation analyses suggesting it was distinctly superior to the HADS and somewhat superior to the BDI-PC measure. CONCLUSIONS: A cognitive-based approach (as used by both our measure and the BDI-PC) to screen for depression in medically ill groups appears to have distinct utility in identifying depressed patients, and in avoiding confounding influences of physical symptoms.

Adult↗

PubMed2001

Development of a brief form of the Life Skills Profile: the LSP-20.

OBJECTIVE: To develop a brief form of the Life Skills Profile (LSP) that incorporates all five subscales of the full form. METHOD: A new short form of the LSP (LSP-20) was developed to incorporate all five subscales of the full form. The LSP-20 development was based on a reanalysis of data from previously published studies. These data sets were also reanalysed to determine any differential effects of numbers and percentages of items in the LSP-39, LSP-16 and LSP-20, comparability of scores of the different forms, of test-retest and interrater reliability, and validity of the LSP-20 by comparison with the Positive and Negative Syndrome Scale (PANSS). RESULTS: A twenty-item short form of the LSP-39 (LSP-20) is described which retains 16 items of an earlier short form but which also reproduces the subscale concerned with disability associated with positive psychotic phenomena. The subscales correlated highly with their counterparts in the full form, interrater and test-retest reliabilities were comparable, and concurrent validity was good. CONCLUSIONS: The LSP-20 is a brief form of a widely used instrument that offers equivalent coverage to the full form with sound empirical properties, though unlike the LSP-39, it can be scored in the direction of impairments or strengths. Therefore the LSP-20 may be more suited to routine service disability and aggregated outcome assessments, but less suited than the LSP-39 to detailed research, or to interactive use as part of service user's individual care planning and review.

Adult↗

PubMed2001

Assessing depression in drug- and alcohol-dependent subjects: the utility of a cognitive-based approach.

Our objective was to report the development of a measure designed to assess depression severity in those with drug and or alcohol problems not confounded by somatic items that may more reflect the impact of drug and alcohol problems rather than depression itself. A questionnaire was derived with 49 items, each assessing cognitive aspects of depression. Subjects with drug and or alcohol problems completed the measure and a standard self-report depression inventory and were assessed for depression presence and severity by a psychiatrist, who used a structured case-finding measure to complement a semi-structured clinical assessment. A high percentage of the sample was found to be depressed. Total scores on the new measure correlated highly with scores on the two other depression reference measures, supporting its validity as a measure of depression severity. A refined set of 14 items was also identified as a valid measure of depression severity, whereas a determined cut-off established high assignment accuracy when examined against the clinical judgement of caseness. In conclusion, the refined 14-item set has been validated as a depression measure in those with drug and alcohol disorders, whereas the item content may assist clinicians to frame screening questions in assessing such patients.

Adult↗

PubMed2001

A question of style: refining the dimensions of personality disorder style.

The frequent finding that meeting criteria for one type of personality disorder (PD) is commonly associated with meeting criteria for several other PDs indicates significant problems in defining and measuring PDs independently of each other, whether measured categorically or dimensionally. This study was designed to enrich recent DSM descriptor sets and, with the enriched set of descriptors, develop refined PD dimensions. A large sample of patients with a PD or significant personality disturbance were studied, with most analyses based on self-report (SR) data, but with corroborative witness (CW) data also collected to validate refinement analyses. The original descriptor set comprised 139 DSM descriptors and 127 items obtained from other sources. Personality disorder dimensions of interest were refined by factor analyses. We specifically identify items that failed to "belong" to their original PD "base." A refined set of 92 items demonstrated greater independence of the underlying dimensions and suggested an underlying five-factor structure at some variance to the current DSM-IV cluster set. The study should assist measurement of individual PDs by identifying items and constructs that build to more homogeneous dimensions that define lower-order and higher-order PD traits.

Adult↗