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Biomedical subjects

M Fava

Publications and source records attributed to M Fava.

204 records · Page 12Linked to original sources
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Outcome definitions and predictors in depression.

BACKGROUND: The definition of outcome in antidepressant treatment studies may be a crucial factor influencing the relationship between possible treatment variables and treatment response. We therefore wanted to investigate possible relationships between baseline severity of depression and anxiety, and different definitions of outcome among outpatients with major depressive disorder undergoing antidepressant treatment. METHODS: Two hundred and forty-eight patients diagnosed with major depression with the Structured Clinical Interview for DSM-III-R Diagnosis - Patient Edition were treated with fluoxetine 20 mg/day for 8 weeks. Patients were evaluated both pretreatment and posttreatment with the 17-item Hamilton Rating Scale for Depression (Ham-D-17), the Clinical Global Impressions Scales for Severity (CGI-S) and Improvement (CGI-I). We chose four continuous definitions of response using a linear regression method to analyze the relationship to baseline anxiety and depression. We used a logistic regression analysis for the relationship between seven categorical definitions of response and baseline severity of depression and anxiety. RESULTS: Greater endpoint severity was significantly positively related to greater baseline severity of depression and anxiety. Lesser baseline severity of depression or anxiety predicted a greater degree of response on either the endpoint CGI-I score (with lower scores indicating greater improvement) or the percent change in HAM-D-17 score (with higher percent change indicating greater improvement). For all seven categorical definitions of response, lower baseline scores were significantly related to the probability of being a responder. CONCLUSIONS: These findings support the impression that how outcome is defined affects the strength and direction of observed relationships with predictive variables. Methodological implications are discussed.

Adult↗
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Management of major depression in the primary care setting.

BACKGROUND: Patients treated in community clinics, particularly those of minority status, may rely more heavily on primary care physicians (PCPs) for the diagnosis and management of depression. We wished to determine how PCPs in a community clinic setting initially manage patients newly diagnosed with major depression. METHODS: 698 patients were screened for major depression by the Structural Clinical Interview for DSM-III-R in a community-based primary care health center. Forty outpatients (29 Hispanic) were found to suffer from major depression. A letter explaining positive findings was sent to the patients' PCPs. Medical record charts were reviewed 3 months later to determine the PCP's management following the diagnosis. RESULTS: Of the 38 patients who remained in the study at 3 months, 20 (53%) received no intervention from the PCP by the end of 3 months after diagnosis, and of these, 14 were Hispanic. Five (13%) were prescribed an antidepressant by the PCP. Nine (24%) were referred to mental health services for medication, psychotherapy or combination treatment. Four (11%) were prescribed an antidepressant and then referred to mental health services. Differences between management of Hispanic and non-Hispanic patients were not statistically significant. CONCLUSIONS: Independent screening by psychiatrists in primary care settings may not be adequate enough to ensure appropriate management of depression by PCPs. Possible explanations may include time constraints during primary care visits, patient and/or physician reticence, and insufficient education of PCPs about depression.

Adult↗
PubMedDate not supplied

Postpartum hostility and prolactin.

In a previous study ten women with hyperprolactinemia and amenorrhea had significantly higher Symptom Questionnaire scores for depression, hostility and anxiety than patients with amenorrhea only and a matched nonpatient employees group. The hyperprolactinemic patients and employees were compared with ten women on their seventh day after childbirth who had been matched for sociodemographic variables and had similar prolactin levels. Hostility was significantly higher in postpartum patients than employees and did not differ significantly from that of women with hyperprolactinemic amenorrhea. Postpartum hyperprolactinemic women did not differ significantly from the employees for anxiety and depression, which was significantly lower than in the amenorrheic patients. In several mammals aggression occurs concurrently with lactation. The studies in humans suggest an association of high prolactin levels with hostility.

Adult↗