Search PubMed⌕ Search

Biomedical subjects

Gordon Parker

Publications and source records attributed to Gordon Parker.

At least 19 recordsLinked to original sources
PubMed2003

The development of a six-item daily self-report measure assessing identified depressive domains.

BACKGROUND: There is debate as to whether any anti-depressant strategy acts more rapidly than any other, while 'improvement' in overall depression severity reflects a summation of individual domains that may individually show differing trajectories. We developed a brief self-report measure of depression's constituent constructs to allow such issues to be examined. METHODS: A 25-item measure was prepared and completed daily by depressed patients until they had evidenced distinct improvement. RESULTS: Factor analyses favoured a six-factor structure, with constructs labelled depression, irritability, brooding, poor concentration, insomnia and anxiety. Scores on those constructs were differentially associated with overall depression severity as measured on the clinician-rated Hamilton measure, arguing for their potential utility. LIMITATIONS: The original data set was small while the measure's utility will only emerge in application studies. CONCLUSIONS: The six-item measure is appended and several possible application studies noted. In particular, we favour its evaluation in studies examining the impact and time to onset of differing antidepressant strategies on differing depressive sub-types.

Affect↗
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

Valid assessment of the clinical features of depression by relatives appears to slip under the RADAR.

OBJECTIVE: We report on the development of an observational measure designed for completion by relatives, the Recent Appearance of Depression Assessed by Relatives (RADAR), and consider its validity. METHOD: One hundred and one patients with a current major depressive episode had a relative or close friend complete the RADAR, while psychiatrists and research assistants collected extensive data. RESULTS: Correlated against both patient self-report and psychiatrist-rated depression severity measures, RADAR scores evidenced poor validity overall. Recent Appearance of Depression Assessed by Relatives scores also failed to differentiate depressive subtypes, in that scores for patients with melancholic depression were not significantly higher than for those with non-melancholic depression. CONCLUSIONS: Results are consistent with previous findings of poor agreement between clinicians and corroborative witnesses in assessing clinical depressive features, and argue against reliance on corroborative witness reports.

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↗
PubMed2003

What's the use of worrying? Its function and its dysfunction.

OBJECTIVE: To provide an overview of theory and research regarding the phenomenology and function of worry. METHOD: A systematic literature search focusing on conceptualizations of worry as a cognitive activity and worry research over the last 20 years was conducted. RESULTS: Worry can be both functional and dysfunctional. Disruption to daily functioning, perceived uncontrollability, pervasiveness and extensive coverage of worry themes (including "remote" events and the presence of meta-worry), all have specificity to more severe and dysfunctional worry. CONCLUSIONS: Research investigating both the relationship between worry and anxiety and the attributes of severe worriers, has brought attention to its role in fostering emotional disturbance and has clarified factors relevant to treatment.

Anxiety↗
PubMed2003

Cognitive behavior therapy for depression? Choose horses for courses.

OBJECTIVE: Although cognitive behavior therapy is a widely accepted treatment for depression, the problematic nature of efficacy studies is insufficiently recognized. METHOD: The authors reviewed original studies and quantitative analyses on the use of cognitive behavior therapy for depression. RESULTS: The authors suggested that claims for cognitive behavior therapy's efficacy on depression have been overstated, questioned whether its efficacy fits within its theoretical underpinning, and argued against viewing cognitive behavior therapy as a universal rather than a targeted strategy. CONCLUSIONS: Although cognitive behavior therapy may act more by its nonspecific therapeutic ingredients, the authors argued that by testing cognitive behavior therapy's efficacy in heterogeneous study groups, rather than in specific subgroups, failure to differentiate it from control therapies may have been ensured.

Antidepressive Agents↗
PubMed2003

Mental health literacy beliefs. A comparison of psychiatric trained nurses and enrolled nurses in Singapore.

The views of mental health professionals may influence diagnosis and management options. This study reports nurses' views about the management of three common psychiatric disorders--schizophrenia, depression, and mania. Results demonstrate the effect of greater psychiatric education and training, received by psychiatric trained nurses, on mental health literacy.

Attitude of Health Personnel↗
PubMed2002

A randomised, controlled trial of fluoxetine in methadone maintenance patients with depressive symptoms.

BACKGROUND: Depression and antidepressant use are prevalent in methadone maintenance patients (MMPs). However, antidepressant efficacy is not well established in this population. This study examined the efficacy of fluoxetine in improving depressive symptoms and reducing substance use in MMPs. METHODS: Stabilised MMPs scoring over 21 on the Beck Depression Inventory were randomised to receive fluoxetine or placebo over 12 weeks. RESULTS: Forty-nine subjects were randomised. In both groups, significant improvements were observed in depression, life functioning, and social impairment over 12 weeks. Poly-drug use improved in completers only. No fluoxetine effects were observed. CONCLUSIONS: Little evidence supports use of fluoxetine as a treatment for depressive symptoms in MMPs.

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

Treatment-resistant depression: when antidepressant drug intolerance may indicate food intolerance.

OBJECTIVE: To describe a patient with food intolerance probably contributing to depressive symptoms, intolerance to psychotropic medication and treatment resistance. METHOD: The case vignette and investigatory procedures are detailed. RESULTS: The patient's course improved considerably with an elimination diet. CONCLUSIONS: The prevalence of food intolerance as a contributing factor to depressive disorders requires clarification. Clinicians should be aware of the possible syndrome and that it may be worsened by psychotropic medication.

Adult↗
PubMed2002

A profile of regional psychiatry publishing: home and away.

OBJECTIVE: Previous reports have profiled Australian psychiatry publishing in high-ranking international journals over the last two decades. An audit of selected high ranking and regional psychiatric journals was therefore undertaken to obtain a current profile of Australasian publishing. METHODS: Journals were selected on the basis of impact factors for the year 2000, with the top five regional, generalist and specialist journals being selected, and with publication numbers over a two-year period (1999-2000) compared with numbers from other major geographical regions. RESULTS: Of the 4573 papers identified in the 15 journals, Australasian authors contributed 269 to the regional journals (with two-thirds in the Australian and New Zealand Journal of Psychiatry), 47 to the generalist journals (with two-thirds in Psychological Medicine) and very few (23) to the specialist journals. Representation in the so-called "dominant four" international journals has increased since the 1986-1989 audit. When analysis was made of the "top nine" international journals, the Australasian representation rate was a low 1.8% and lower than most regions examined. CONCLUSIONS: If Australasian psychiatry is to advance its international presence, a greater representation rate in top-ranking international journals should be set as an objective.

Australia↗
PubMed2002

Tardive dyskinesia among Chinese and Malay patients with schizophrenia.

The prevalence of tardive dyskinesia (TD) was studied with the Abnormal Involuntary Movements Scale in Chinese and Malay patients with schizophrenia who were hospitalized in a Singapore state psychiatric institute. We also studied the relationship of neuroleptic-induced extrapyramidal side effects to TD. By using established criteria, the rates of TD were 40.6% for Chinese and 29.0% for Malays, higher than previously reported for Chinese subjects. Older age and lower current neuroleptic dose were significantly associated with TD. Multivariate analysis, after controlling for other salient risk variables, did not show a significant difference in TD prevalence rates between the two races. We conclude that suggested differences in interethnic rates of TD among Chinese, Malays, and Westerners are unlikely to exist and that any variation in prevalence is more likely to be determined by differences in duration of exposure and dose levels of neuroleptic drugs.

Adult↗
PubMed2002

Caudate nucleus volumes and genetic determinants of homocysteine metabolism in the prediction of psychomotor speed in older persons with depression.

OBJECTIVE: The authors sought to determine whether caudate nucleus volumes or specific genotypes predict psychomotor slowing in older persons with depression. METHOD: Forty-seven persons with depression (mean age=51.8 years, SD=12.4) and 20 healthy volunteers (mean age=56.1 years, SD=9.8) underwent clinical assessments, a neuropsychological test of psychomotor speed (part A of the Trail Making Test), high-resolution magnetic resonance imaging scans, and genotyping for the apolipoprotein E epsilon4 allele and a mutation of the methylenetetrahydrofolate reductase enzyme. RESULTS: Multivariate analyses revealed that psychomotor speed was uniquely predicted by age, a diagnosis of depression, right caudate nucleus volume, and mutation of the methylenetetrahydrofolate reductase enzyme. CONCLUSIONS: Psychomotor slowing, a key clinical and cognitive phenomenon in older persons with depression, is predicted by reduced caudate nucleus volumes and genetic determinants of homocysteine metabolism.

Adult↗
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↗