OBJECTIVE: To assess effects of stepped collaborative care depression intervention on disability. DESIGN: Randomized controlled trial. SETTING: Four primary care clinics of a large health maintenance organization. PATIENTS: Two hundred twenty-eight patients with either 4 or more persistent major depressive symptoms or a score of 1.5 or greater on the Hopkins Symptom Checklist. Depression items were randomized to stepped care intervention or usual care 6 to 8 weeks after initiating antidepressant medication. INTERVENTION: Augmented treatment of persistently depressed patients by an on-site psychiatrist collaborating with primary care physicians. Treatment included patient education, adjustment of pharmacotherapy, and proactive monitoring of outcomes. MAIN OUTCOME MEASURES: Baseline, 1-, 3-, and 6-month assessments of the Sheehan Disability Scale and the social function and role limitation subscales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). RESULTS: Patients who received the depression intervention experienced less interference in their family, work, and social activities than patients receiving usual primary care (Sheehan Disability Scale, z = 2.23; P =.025). Patients receiving intervention also reported a trend toward more improvement in SF-36-defined social functioning than patients receiving usual care (z = 1.63, P =.10), but there was no significant difference in role performance (z = 0.07, P =.94). CONCLUSIONS: Significant disability accompanied depression in this persistently depressed group. The stepped care intervention resulted in small to moderate functional improvements for these primary care patients. Arch Fam Med. 2000;9:1052-1058

Data Collection↗

PubMedDate not supplied

Fatty acid composition of adipose tissue in aged rats: effects of dietary restriction and exercise.

Little is known about the long-term effects of diet restriction, exercise, and aging on the fatty acid composition of adipose tissue. To investigate these effects, male Wistar rats were placed in one of four experimental groups: 1) ad libitum fed, nonexercised; 2) ad libitum fed, exercised; 3) diet restriction, nonexercised; and 4) diet restriction, exercised. Exercise consisted of swimming on alternate days, and diet-restricted animals were fed every other day. Animals were assigned to one of the four treatment groups at weaning, and the fatty acid composition in the epididymal, perirenal, and inguinal fat depots were determined every 4 months from 12 to 28 months of age. All animals were fed the same diet so the relative percentage of fatty acids in the diet did not contribute to the changes observed in adipose tissue fatty acid composition. Regardless of treatment groups and fat depot, the concentration of saturated fatty acids in adipose tissue tended to decrease as body weight increased. Saturated fatty acid composition was greater in the diet-restricted than the ad libitum-fed groups. The saturated fatty acid concentration was different between the three fat depots (perirenal 27.8%, inguinal 24.7%, and epididymal 21.6%; P < 0.001). The linoleic acid content did not change with age in the epididymal or perirenal fat depot; however, the change was significant for the inguinal fat depot. Following a large decrease in inguinal linoleic concentration through 20 months, linoleic acid concentration increased in all treatments between 20 and 28 months. The results indicate that diet restriction, exercise, and aging have significant effects on adipose tissue fatty acid composition and these effects are different depending on the anatomical location of the adipose tissue depot.

Adipose Tissue↗

PubMedDate not supplied

The positive/negative symptom distinction in schizophrenia. Validity and etiological relevance.

This paper presents an overview of the literature on the positive/negative symptom distinction in schizophrenia, and explores the implications of the findings for etiological models. Despite the diversity in methodology and focus, certain consistencies emerge from the research. Most important are findings that negative symptoms show a stronger relation with premorbid dysfunction than positive symptoms, and are more predictive of concordance for schizophrenia in monozygotic twins. Thus it appears that negative symptom ratings partially tap some long-standing characteristics of the individual. Moreover, these characteristics appear to be influenced by genetic factors. The implications of the findings for models of the etiology of positive and negative symptoms are discussed.

Humans↗

PubMedDate not supplied

Neuroticism and extraversion as predictors of health outcomes in depressed primary care patients.

Depressed primary care patients (N = 217) were assessed to determine if certain personality characteristics predict health domains independent of chronic disease, demographics, depression, and psychiatric diagnoses. Eleven health variables were used to create three outcome factor scores: disability (e.g., days missed work); somatization (e.g., medically unexplained symptoms); and subjective pain (severity, interference). Neuroticism explained significant variance in all health outcomes independent of the other predictors. Depression and neuroticism interacted in the disability and pain models. Depression was related to health in neurotic patients, while in the absence of neuroticism, little relation between depression and health was observed. Neuroticism may explain why persons with similar health problems have differing levels of disability, pain, and somatization.

Depressive Disorder↗