Biomedical subjects

Dusan Hadzi-Pavlovic

Publications and source records attributed to Dusan Hadzi-Pavlovic.

6 recordsLinked to original sources

PubMed2003

Distinguishing early and late onset non-melancholic unipolar depression.

AIM: We seek to determine whether unipolar non-melancholic major depression commencing early in life has a differing clinical picture, and whether it may have differing determinants. METHODS: We study a sample of such patients, comparing those with depression onset in their first 25 years against residual subjects, matching exactly by sex and controlling for age. RESULTS: There were no differences in current depression severity. Despite early onset subjects having a distinctly younger current mean age, they had a lifetime pattern of both greater depression chronicity and disability, and judged themselves as less likely to have benefited from any antidepressant medication or psychotherapy. 'Phenotypically' early onset subjects did not differ in terms of 'depressive' symptoms, but were distinguished by a greater irritability, which we interpret as reflecting a temperament dimension influencing symptom expression. Multivariate analyses indicated that the clinical pattern in those with an early onset was distinguished by more evident irritability and anxiety, that there was a distinct familial contribution to early onset depression, that its forerunners were an early personality style of behavioural inhibition or shyness, and that they were more likely to use alcohol and illicit drugs. CONCLUSIONS: While early onset unipolar depression is unlikely to be a pure depressive 'type', it may well be that certain familial temperament characteristics lead to an early onset of depression marked by irritability, a process that invokes a spectrum disorder concept linking temperament style and the depressive manifestations. Early onset depression is indicative of a poor prognosis, both in terms of response to interventions and in regard to chronicity and disability.

Adult↗

PubMed2003

Clinical and personality correlates of a new measure of depression: a general practice study.

OBJECTIVE: There is a need for a brief, efficient depression screening measure for general practice settings, particularly for identifying those who are at high risk of depression. We therefore test the usefulness of a measure developed in a sample of medically ill hospitalized patients. METHOD: More than 600 patients attending six Sydney general practices completed the Depression in the Medically Ill (DMI-10) measure, in conjunction with sociodemographic, depression history and personality profile measures. The impacts of sociodemographic, personality and lifetime depression variables on DMI-10 scores (and identified 'cases') were examined as a measure of its usefulness. RESULTS: Gender did not influence depression scores, while there were slight associations between DMI-10 scores and age, marital and occupational status. Higher scores were returned by those with more severe, lengthier and perceived stressful medical illnesses. Using a predetermined cut-off score, 36% rated as putative 'cases', a prevalence almost identical to our general hospital study. 'Cases' were distinctly more likely to have had previous depressive episodes, to have sought help for such episodes and to have received antidepressant medication. They also scored higher on measures of anxious (anxious worrying and irritability) and self-critical ('depressive personality') personality styles. CONCLUSIONS: The DMI-10 appears useful as a brief and acceptable screen for depression in a general practice setting, both identifying those who are likely to be currently depressed and those with a background of previous depression.

Adult↗

PubMed2002

Measuring psychomotor agitation by use of an actimeter: a pilot study.

BACKGROUND: Psychomotor agitation is variably defined, with differing emphases on subjective and motor components. We assess the utility of an actimeter to inform us about aspects of the motor component. METHODS: A wrist actimeter measured motor activity of three inpatients with agitated depression. RESULTS: For each patient, diurnal activity patterns were observed, with activity generally elevated in mornings and late afternoons. Each patient also evidenced a clear decline in motor activity in the mid-evening, with little or no activity recorded during 'sleep' hours. Thus, psychomotor agitation (like motor activity) appears to require a conscious state. LIMITATIONS: Actimeters measure any baseline activity together with any superimposed movement component (which may range from movement changes to medication effects), making it difficult to disentangle components. We studied few patients and for brief intervals.

Aged↗

PubMed2002

Atypical depression: a reappraisal.

OBJECTIVE: The study evaluated the DSM-IV definition of the atypical features specifier for a major depressive episode in major depressive disorder. METHOD: Nonpsychotic patients with major depressive disorder were assessed to determine if the DSM-IV model and decision rules for the atypical features specifier for a major depressive episode could be supported. RESULTS: The five clinical features of the DSM-IV atypical features specifier for a major depressive episode showed weak internal consistency, and the mandatory criterion A feature of mood reactivity did not show specificity in relation to any of the four criterion B accessory symptoms. The more severe the depression, the less likely the patient was to report criterion A and hence to meet criteria for the atypical features specifier. Remodeling the five features favored the personality style descriptor of interpersonal rejection sensitivity as an alternate primary feature. A reformulated model also suggested lifetime panic disorder and social phobia as higher-order determinants of atypical features in major depressive disorder. Additional analyses of criteria suggested that interpersonal rejection sensitivity and leaden paralysis had a phenomenological base in anxiety, that mood reactivity was linked with irritability, and that neither weight gain nor hypersomnia were clearly aligned with anxiety or depression, raising questions about their status as symptoms. CONCLUSIONS: The current definition and modeling of the DSM-IV atypical features specifier for a major depressive episode in major depressive disorder appears problematic. As suggested by earlier descriptions of atypical depression, certain expressions of anxiety may have primacy, and some clinical features associated with the DSM-IV model may be adaptive homeostatic responses rather than pathological symptoms.

Antidepressive Agents, Tricyclic↗

PubMed2002

Assessing outcome in community mental health patients: a comparative analysis of measures.

BACKGROUND: We undertook a twelve-month intervention study for community mental health patients using a number of measures administered at baseline and at twelve months. Overall improvement in that sample allowed for comparative analyses of the key measures in terms of their ability to measure and to predict outcome. AIMS: To assess and compare the usefulness of each of the measures in predicting outcome status. METHODS: A patient-rated quality of life (QOL) questionnaire, the DSM-III-R Global Assessment of Functioning (GAF), the Life Skills Profile (LSP) and the Health of the Nation Outcome Scales (HoNOS) were compared and evaluated in a sample of seventy-nine patients. RESULTS: The LSP appeared to measure disability only, while the HoNOS and the GAF assessed composite symptoms and general functioning. The HoNOS was identified as the most distinctive predictor of outcome. CONCLUSIONS: The utility of the HoNOS as an overall service measure is supported, while properties and likely utility of other measures in outcome studies are detailed.

Activities of Daily Living↗

PubMed2002

Defining disordered personality functioning.

Current definitions of the PDs commonly combine descriptors of personality style and disordered personality functioning. This leads to artefactual comorbidity of formally separate disorders and compromising of diagnostic precision. We suggest that measurement of disordered functioning alone might provide a more efficient and precise first-level measure of PD. We review candidate constructs for the definition of disordered functioning and consider how constructs might be refined in subsequent research and lead to applied measures.

Behavioral Symptoms↗