Diagnosing depression in patients with medical illness.
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Depressive Disorder↗
Biomedical subjects
R Noyes
Publications and source records attributed to R Noyes.
Distress associated with cancer as measured by the illness distress scale.
Over 400 cancer patients were given the Illness Distress Scale (IDS), a brief measure of the physical and emotional distress related to serious illness. Physical manifestations of the disease proved to be the source of greatest discomfort among these patients. Greater distress was reported by younger patients and by those who were unmarried. Also, patients with more advanced disease scored higher on the scale. The IDS appeared to measure four dimensions of distress related to the experience of illness, including loss of meaning, physical disease, medical treatment and social isolation. Scores on the instrument correlated highly with a measure of depression, the Beck Depression Inventory. The IDS appears to be a reliable and valid measure of distress associated with serious illness.
Adaptation, Psychological↗
Frequency of constipation in major depression: relationship to other clinical variables.
A semistructured interview that evaluates 70 clinical variables, including constipation, was administered to 170 patients with major depression. Twenty-seven percent of the patients had depression-associated constipation. Constipation was not associated with any other clinical variable.
Constipation↗
Reduction of gastrointestinal symptoms following treatment for panic disorder.
Symptoms of gastrointestinal distress, including those of irritable bowel syndrome, were reported more frequently by patients with panic disorder than by nonanxious controls. Five of 30 subjects with panic disorder met criteria for irritable bowel syndrome, the onset of which coincided with the onset of panic disorder. Effective treatment for the anxiety disorder was accompanied by a reduction in gastrointestinal symptoms in all subjects.
Adult↗
Exclusion of the tyrosine hydroxylase gene in 14 panic disorder pedigrees.
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Adolescent↗
Diagnosis of major depression in cancer patients according to four sets of criteria.
Diagnoses of major depression in 152 cancer patients differed as much as 13% depending on the diagnostic system used. The Beck Depression Inventory and the Hamilton Rating Scale for Depression were useful tools for screening patients with depressive symptoms but frequently misclassified those who had no major depression according to one or more of the criteria-based diagnostic systems.
Adolescent↗
Long-term marijuana use and subsequent effects on learning and cognitive functions related to school achievement: preliminary study.
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Adult↗
The comorbidity and mortality of panic disorder.
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Alcoholism↗
Maintenance treatment with antidepressants in panic disorder.
Because panic disorder is a chronic illness, patients may require long-term pharmacologic treatment. Unfortunately, the benefits and risks of such therapy have received little study. At least two classes of antidepressants, the tricyclic antidepressants and the monoamine oxidase inhibitors, are effective for the treatment of panic disorder, but because relapse is common when these drugs are discontinued, many patients require maintenance treatment. However, such long-term use of tricyclic antidepressants and monoamine oxidase inhibitors exposes patients to risks that include potentially fatal overdoses and hypertensive crises. Patients should be aware of the risks involved and should weigh them against the benefits of long-term use. They should reduce the dose to the lowest effective level, from time to time gradually taper medications to assess continuing need, and avail themselves of other therapies rather than rely solely on drug treatment. Above all, more research should be done on the long-term risks and benefits of antidepressant drugs.
Agoraphobia↗
The significance of HPA axis disturbance in panic disorder.
Agoraphobic and panic disorder patients underwent 1-mg Dexamethasone Suppression Tests (DST) before, during, and after an 8-week trial of diazepam, alprazolam, or placebo. Previously described, never-ill controls underwent similar testing. At baseline, 21 of 82 (25.6%) panic disorder and 5 of 38 (13.2%) controls were nonsuppressors. This difference grew more marked with multiple testing over a 2-month period; 18 of 44 (40.9%) panic disorder patients were nonsuppressors on at least 1 of 3 tests compared with only 5 of 35 (14.3%) controls (p = 0.006). DST results were related to severity, but not to the presence or absence, of depressive syndromes. Control for plasma dexamethasone levels left highly significant differences in postdexamethasone cortisol across diagnostic groups. Neither DST results nor plasma dexamethasone levels changed in concert with clinical change, and type of treatment had little differential effect on these measures. Nor did DST results predict subsequent course when active treatment was extended by 6 months. However, DST results during the initial 8 weeks of treatment were strongly related to relapse when medications were tapered, even though this occurred 6 months after the last DST.
Adult↗
Direct comparison of urinary free cortisol excretion in patients with depression and panic disorder.
Urinary free cortisol (UFC) excretion in 31 patients with major depression is directly compared to UFC levels in 65 patients with panic disorder and 36 controls. Patients with depression demonstrated significantly higher UFC excretion [43 +/- 37 micrograms/g creatinine (cr)] than patients with panic disorder (29 +/- 13 micrograms/g-cr) or controls (22 +/- 10 micrograms/g-cr) (F = 8.5, df = 129, p less than 0.001). Panic patients with a secondary depression (35 +/- 17 micrograms/g-cr) or those with agoraphobia (34 +/- 14 micrograms/g-cr) had UFC levels that were in-between patients with primary major depression and panic patients without these complications (25 +/- 11 micrograms/g-cr). These findings support the hypothesis that patients with major depression, whether primary or secondary, and those with agoraphobia excrete more UFC than patients with uncomplicated panic disorder. This occurs despite the fact that panic disorder might also be expected to raise the stress-responsive hormone cortisol.
Adult↗
HPA axis disturbance in obsessive-compulsive disorder.
Twenty nondepressed outpatients with DSM-III obsessive-compulsive disorder entered a 10-week placebo-controlled study of clomipramine and underwent a 1-mg dexamethasone suppression test (DST) at baseline; 11 had a repeat DST at the end of treatment: Nonsuppression was rare. When compared to 82 previously described outpatients with panic disorder studied in a similar fashion, OCD patients had postdexamethasone cortisol values that were substantially lower and more stable over time. Results within the OCD group closely resembled those from a group of never-ill controls.
Clinical Trials as Topic↗
The relationship of panic disorder and its treatment outcome to 24-hour urinary MHPG levels.
Levels of 24-hour urinary 3-methoxy-4-hydroxyphenylglycol (MHPG) were not markedly elevated in a group of 35 panic disorder patients when compared to healthy controls (mean = 2,430 micrograms/day vs. 2,130 micrograms/day). There was a weak association between elevated pretreatment levels of MHPG and a positive treatment response to alprazolam or diazepam. Alprazolam and diazepam may differ in their effects on MHPG.
Adolescent↗
Language of publication of journal articles on suicide and mental disorders.
English as the language of publication for articles on suicide in the medical literature increased from 58% of articles in 1966 to 79% in 1986. This increase occurred at the expense of all languages. These changes parallel those for the language of publication of articles on mental disorders and all medical subjects.
Humans↗
Problems with tricyclic antidepressant use in patients with panic disorder or agoraphobia: results of a naturalistic follow-up study.
The authors followed up 107 patients with panic disorder or agoraphobia with panic attacks who had been placed on a regimen of tricyclic antidepressant treatment 1 to 4 years earlier. Sixty-three percent reported at least moderate improvement during treatment; however, side effects were often difficult to tolerate, and 35% discontinued tricyclic treatment on this account. Overstimulation, which occurred in 20%, was the most frequent reason for early termination, and weight gain, which occurred in 34%, was the most common reason for stopping the drug later on. Seizures occurred in 2 patients. Even though they were encouraged to discontinue drug use, most of the patients who had responded were still taking their drugs at follow-up. More than half of those who had responded before stopping drug treatment subsequently relapsed. The findings highlight problems with safety, side effects, and patient acceptance resulting from the use of tricyclic antidepressants in patients with anxiety disorders.
Adult↗
Alprazolam treatment of avoidant personality traits in social phobic patients.
The authors examined the effect of alprazolam treatment on avoidant personality traits in 14 DSM-III-R social phobics. Six of the nine avoidant traits examined improved with treatment. However, all but one trait (avoiding social or occupational activities requiring interpersonal contact) returned to baseline levels posttreatment. Treatment response and intercorrelation of items indicated two traits that may represent a separate segment of avoidant personality: "No close friends or confidants outside of relatives and family members" and "Exaggerates the potential dangers or risks of everyday situations."
Adult↗
Reliability of the telephone interview in diagnosing anxiety disorders.
The reliability of psychiatric diagnosis using the Schedule of Affective Disorders and Schizophrenia-Lifetime Version in personal and telephone interviews with 39 subjects was assessed using a 12- to 19-month test-retest design. Interrater reliability was high (kappa, .69 to .84) for the diagnosis of panic disorder, agoraphobia with panic attacks, probable panic disorder, major depression, and alcohol abuse. We conclude that it is possible to reliably make these lifetime diagnoses in a family study using the telephone interview.
Agoraphobia↗
Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. I. Efficacy in short-term treatment.
Following promising preliminary evidence, the benzodiazepine-derivative alprazolam was studied in a large, placebo-controlled, eight-week, flexible-dose trial in patients with agoraphobia with panic attacks and panic disorder. Of 526 patients, 481 completed three weeks of treatment; however, significantly more placebo (102/234) than alprazolam (21/247) recipients subsequently dropped out of the trial, primarily citing ineffectiveness (of placebo) as the reason. Alprazolam was found to be effective and well tolerated. There were significant alprazolam-placebo differences in improvement for (1) spontaneous and situational panic attacks, (2) phobic fears, (3) avoidance behavior, (4) anxiety, and (5) secondary disability, all significant by the end of week 1. At the primary comparison point (week 4), 82% of the patients receiving alprazolam were rated moderately improved or better vs 43% of the placebo group. At that point, 50% of the alprazolam recipients vs 28% of placebo recipients were free of panic attacks.
Adolescent↗