Treatment of depression in the elderly.
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Aged↗
Biomedical subjects
M M Weissman
Publications and source records attributed to M M Weissman.
Incidence of psychiatric disorder in offspring at high and low risk for depression.
First onsets (incidence) of suicide attempts and DSM-III psychiatric disorders, including major depression, any anxiety disorder, conduct disorder, or substance abuse were determined in a 2-year longitudinal study of 174 offspring at high and low risk for major depression. All of the suicide attempts, the first onsets of major depression, and anxiety disorders were in offspring of depressed parents. Compared with asymptomatic offspring, offspring with subclinical manifestations of major depression, conduct disorder, and substance abuse at the initial interview were significantly more likely to become incident cases of the same disorder over the next 2 years. Either conduct disorder or substance abuse at initial interview were highly predictive of first onset of each other, but not of any other disorders 2 years later. Family risk factors (such as poor marital adjustment, parent-child discord, low cohesion, and affectionless control) at initial interview were associated with increased incidence of substance abuse, or conduct disorder, but not major depression or anxiety disorder. Combining both retrospective and prospective data, the overall suicide attempt rate was 7.8% in the offspring of depressed parents as compared with 1.4% in the offspring of nondepressed parents. By age 20, over 50% of the offspring of depressed patients reported a major depression.
Adolescent↗
Depression: current understanding and changing trends.
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Affective Disorders, Psychotic↗
Panic disorder in children and adolescents: a review.
OBJECTIVE: Panic disorder has been considered an adulthood disorder that does not occur in children or adolescents. The authors' goals were to critically review the available evidence for panic attacks and/or panic disorder in children and adolescents, to review the limited data on the biological basis of panic disorder as it has been studied in children and adolescents, to discuss the possible treatment approaches for panic disorder in children, and to suggest potential opportunities for further research on panic disorder in children. DATA COLLECTION: Sixty-three articles pertaining to panic disorder in children and adolescents were critically reviewed. These articles included retrospective histories of adults with panic disorder, clinical case reports of children and adolescents with panic disorder, studies of psychiatrically referred children and adolescents, reports from epidemiologic community and school samples of children and adolescents, studies of children and adolescents at risk for psychiatric disorder, reports of panic-like symptoms in pediatric patients, family studies of panic, studies of the biological basis of panic in adults, and studies of treatment for panic. FINDINGS: There is strong evidence that panic disorder occurs in children and adolescents and that its clinical presentation in this population is similar to that found in adults. CONCLUSIONS: Extending the many adult studies of panic disorder to children and adolescents would be extremely fruitful. Like adults with panic disorder, many children and adolescents are brought to emergency and medical clinics for the physical symptoms of unrecognized panic disorder.
Adolescent↗
Panic disorder and suicidal ideation.
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Comorbidity↗
Measuring the need for mental health care.
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Health Care Costs↗
A double-blind clinical trial of alprazolam, imipramine, or placebo in the depressed elderly.
The efficacy and safety of alprazolam as compared to imipramine or a placebo added to weekly interpersonal psychotherapy was compared in a 6-week double-blind randomized clinical trial of 35 ambulatory elderly patients with major depression. The average maximum dosage of alprazolam was 2.2 mg and the average maximum dosage of imipramine was 97.5 mg. The findings showed a rapid onset of action of alprazolam within 1 week on symptoms of depression and anxiety. The effects for imipramine were seen later in the study. There were no serious side effects that interfered with treatment. The anticholinergic effects of imipramine were the ones that most commonly interfered with treatment. Alprazolam produced the greatest number of symptoms with discontinuation, most of which were alleviated within a week. We conclude that alprazolam may be useful as an antidepressant for the elderly. More clinical trials are needed to test its efficacy in the depressed elderly with concomitant medical problems, using plasma levels. A double-blind discontinuation study of alprazolam is needed to determine the degree of symptom return.
Aged↗
Panic attacks in the community. Social morbidity and health care utilization.
This article focuses on social morbidity and health care utilization in persons with panic attacks not meeting full diagnostic criteria for panic disorder. The findings are based on data from a random sample of over 18,000 adults drawn from five US communities. Panic attacks not meeting full criteria for panic disorder have a relatively high lifetime prevalence (3.6% of the adult population). Persons with panic attacks had impairment in perceived physical and emotional health, and in occupational and financial functioning, increased use of health care facilities, emergency departments, and psychoactive drugs. Persons with panic attacks were intermediate in severity between those with panic disorder and those with other psychiatric disorders. The findings could not be explained by comorbidity with other psychiatric disorders. We conclude that panic attacks have clinical significance and are associated with substantial morbidity.
Adolescent↗
Psychiatric disorders in relatives of probands with opiate addiction.
Previous research has documented high rates of major depression and antisocial personality in opiate addicts. This study was designed to investigate the relationship of dual diagnosis in opiate-addicted probands to family history of psychiatric disorders and substance use disorders in biological relatives. Psychiatric disorders and substance use disorders were evaluated using direct interview and family history in a sample of 877 first-degree relatives of 201 opiate addicts and 360 relatives of 82 normal controls. Results indicate that (1) compared with relatives of normal subjects, opiate addicts' relatives had substantially higher rates of alcoholism, drug abuse, depression, and antisocial personality; (2) relatives of depressed opiate-addicted probands had elevated rates of major depression and anxiety disorders but not of other disorders, suggesting the validity of subtyping opiate addicts by the presence or absence of major depression; and (3) in contrast, relatives of antisocial opiate addicts had rates of disorders that were not significantly different from those of relatives of opiate addicts without antisocial personality. Implications of these findings for the classification and treatment of substance abuse are discussed.
Adult↗
Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence.
In 1988, the MacArthur Foundation Research Network on the Psychobiology of Depression convened a task force to examine the ways in which change points in the course of depressive illness had been described and the extent to which inconsistency in these descriptions might be impeding research on this disorder. We found considerable inconsistency across and even within research reports and concluded that research on depressive illness would be well served by greater consistency in the definition change points in the course of illness. We propose an internally consistent, empirically defined conceptual scheme for the terms remission, recovery, relapse, and recurrence. In addition, we propose tentative operational criteria for each term. Finally, we discuss ways to assess the usefulness of such operational criteria through reanalysis of existing data and the design and conduct of new experiments.
Depressive Disorder↗
The validity of major depression with psychotic features based on a community study.
This article reports on the evidence for the validity of psychotic major depression as a distinct subtype based on cross-sectional and 1-year prospective data from the Epidemiologic Catchment Area study. Consistent with findings from previous clinical studies, only about 14% of major depressions were accompanied by psychotic features. Psychotic as compared with nonpsychotic depression had a more severe course, as reflected in increased risk of relapse, persistence over 1 year, suicide attempts, hospitalization, comorbidity, and financial dependency. These differences could not be explained by differences in demographic characteristics or by symptom severity, as assessed by symptom profile or number of symptoms. The boundary problem with schizophrenia and bipolar affective disorder that is seen in clinical studies was also found in this sample. To our knowledge, this is the first study to examine the validity of psychotic depression in a community sample; the findings are consistent with those from clinical samples. They support the clinical significance of psychotic depression and the continuation of its inclusion as a distinct subtype in DSM-IV.
Adult↗
Longitudinal assessment of major depression and anxiety disorders in children.
Two-year recall and mother-child agreement with respect to a child's DSM-III lifetime diagnoses of major depression and anxiety disorder, based on K-SADS-E interviews with children, were assessed for a sample of 59 children, 6 to 16 years of age, at high and low risk for depression. The mothers had excellent recall and the children had good recall of a child's major depression. Both mothers and children had poor recall of a child's anxiety disorder. Mother-child agreement on major depression in children improved at the 2-year follow-up. A comparison of diagnoses based on mother and child reports with the psychiatrists' best estimate diagnoses of major depression suggested that children were more informative than mothers at the initial interview. The children were slightly less informative than the mothers at follow-up. These findings underscore the importance of multiple informants and longitudinal assessment in research on childhood psychiatric disorder.
Adolescent↗
The effects of age and sex on depression ratings in children and adolescents.
The self-reports of depressive symptomatology of the 89 children and the parental reports of 62 parents whose children had such symptoms from a sample of 220 children, aged 6 to 23 years, in a family-genetic study of children at high and low risk of depression were examined for the effects of the age and sex of the child. The age of the child at interview proved to have a significant effect upon the dating of the onset of dysphoric episodes and the dating of the worst ever episode of dysphoria. The older girls reported about two more depressive symptoms on average than the younger girls. This finding was obscured unless account was taken of the age at which the subjects were interviewed. However, these effects did not apply to a group of melancholia-related symptoms. There were no consistent effects of age at interview or age at episode on the symptom reports of the boys or in the reports from the parents about both their male and female children.
Adolescent↗
Interpersonal psychotherapy for adolescent depression: description of modification and preliminary application.
Interpersonal psychotherapy (IPT) is a brief treatment developed and tested specifically for depressed adults. This paper describes a modification for use with depressed adolescents (IPT-A) that will be tested in a controlled clinical trial. A description of IPT, its efficacy in adults, a rationale for developing IPT-A, and preliminary experience with depressed adolescents treated with IPT-A are presented. Data available on the treatment of depressed adolescents using drugs and/or psychotherapy is more than a decade behind that of adults. The specification and testing of psychotherapy will accelerate a rational, scientific basis for their treatment.
Adolescent↗
Epidemiology of borderline personality disorder.
The limited epidemiological data available on borderline personality disorder suggest that the prevalence of the disorder is between .2 and 1.8 percent in the general community, 15 percent among psychiatric inpatients, and 50 percent among psychiatric inpatients with a diagnosis of personality disorder. No data on the incidence--the rate of new cases--of the disorder have been reported, and inferences about incidence based on prevalence rates are complicated by differences in the formal designation of personality disorders before and after DSM-III was issued. Current findings suggest that about 76 percent of borderline patients are female. Epidemiological study of borderline personality disorder has been hindered by the lack of a brief semistructured interview that can be used with large population samples and that does not require substantial clinical expertise. The authors discuss alternative research methods, including use of lay interviewers, recoding of existing data, telephone interviews, and self-report inventories.
Borderline Personality Disorder↗
Drug use and abuse in five US communities.
Data from the five-site Epidemiologic Catchment Area study (ECA), a probability sample of 18,571 adults, were used to describe the prevalence of drug abuse in the United States and to evaluate the hypothesis that multiple prescription regulations are effective in reducing drug abuse and drug diversion. The five sites surveyed were New Haven, Connecticut; Baltimore, Maryland; St. Louis, Missouri; Durham, North Carolina; and Los Angeles, California. The California triplicate prescription law was established in 1939 and is the longest continuously running triplicate prescription program in the country (Schedule II drugs). None of the other ECA sites had multiple prescription regulations in effect at the time the study was conducted. In general, the rates of drug use, abuse, and dependence were significantly higher in Los Angeles as compared with the other sites, both before and after controlling for sociodemographic differences. The proportion of users who go on to become abusers was consistent across sites (about 20%). The vast majority of those with a DSM-III diagnosis of abuse of prescription drugs reported that they obtained the drugs from a source other than their physician, suggesting that "diversion" of prescriptions from legal channels occurred at all sites. Limitations of the study design with respect to conclusions are discussed.
Drug Prescriptions↗
Panic disorder: impact on quality of life.
The author reviews selected data from the Epidemiologic Catchment Area study of a probability sample of over 18,000 adults living in five U.S. communities. The data indicate that panic disorder, like major depression, is associated with impairments in quality of life. These impairments need to be considered in planning treatment and evaluating the efficacy of its outcome.
Adolescent↗
Factors associated with 1-year outcome of major depression in the community.
Evidence from outcome studies of major depression indicates a high rate of relapse and chronicity, and that prior chronicity, recurrent episodes, and the presence of psychosocial stressors are associated with a poor outcome. However, the generalizability of these findings is limited because most studies have focused on treated samples; thus, these studies may have been biased toward more chronic or severe illnesses. In prospectively surveying a large probability sample of the general population, the Epidemiologic Catchment Area program offers the opportunity to investigate prognosis without selection bias. In this study, the Epidemiologic Catchment Area subjects with a diagnosis of Major Depressive Disorder at first interview (n = 423) were categorized according to their diagnostic status 1 year later. The results confirmed a high rate of nonrecovery, with clinical features associated with a poor outcome that resembled those identified in previous clinical studies. Overall, clinical factors were more important prognostically than were sociodemographic characteristics. However, there was some evidence that a poorer outcome in older women may partially explain the greater female prevalence of depression in the community.
Adolescent↗