Clinical trials of antidepressant medications are producing meaningless results.
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Antidepressive Agents↗
Biomedical subjects
Gordon Parker
Publications and source records attributed to Gordon Parker.
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↗
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↗
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↗
Do the newer antidepressant have mood stabilizing properties?
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Adult↗
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↗
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↗
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↗
Are the atypical antipsychotic drugs antidepressants?
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Affect↗
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↗
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↗
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↗
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↗
Critique of the guidelines for the treatment of depression: flaws in the construction.
OBJECTIVE: To examine the likely utility of the recently published Australian and New Zealand clinical practice guidelines for the treatment of depression. METHOD: The guidelines are critiqued for their intrinsic logic and their success in extracting potentially valid and useful management templates. RESULTS: This paper provides examples of key limitations to many specific interpretations and conclusions. CONCLUSIONS: It is argued that these guidelines are far less precise and informative for clinical practice than they appear and with a disturbing lack of rigour for a document promulgated by a professional college.
Australia↗
Screening for Depression in the Medically Ill: a comparison of self-report measures, clinician judgment, and DSM-IV diagnoses.
The performance of the self-report 10-item Depression in the Medically Ill scale was observed in 210 patients as part of clinical assessment by consultation-liaison psychiatry clinicians. Both the Depression in the Medically Ill scale and the Beck Depression Inventory for Primary Care were completed by the patient, and the clinicians made their judgment of the presence and severity of "clinical depression" and DSM-IV affective disorder diagnoses. Both the Depression in the Medically Ill scale and the Beck Depression Inventory for Primary Care detected 85% of patients with DSM-IV major depressive episode. The Depression in the Medically Ill scale was slightly superior to the Beck Depression Inventory for Primary Care in its relationship to clinicians' judgments of clinical depression caseness.
Adolescent↗
A validation study of two brief measures of depression in the cardiac population: the DMI-10 and DMI-18.
The authors report on the psychometric characteristics and clinical efficacy of two versions of a recently developed screening measure of depression (the DMI-18 and DMI-10) in the cardiac population. Patients with acute coronary syndrome or heart failure (N = 322) completed the DMI measures, psychosocial questionnaires, and a semistructured clinical interview during the hospital stay. The DMI-18 and DMI-10 measures have adequate psychometric properties, demonstrating high sensitivity and specificity when evaluated against clinical judgment based on a semistructured interview. The DMI-18 and DMI-10 are appropriate for use as screening instruments in cardiac patients.
Acute Disease↗