Search PubMed⌕ Search

Biomedical subjects

R Ramana

Publications and source records attributed to R Ramana.

13 recordsLinked to original sources
PubMed1999

Medication received by patients with depression following the acute episode: adequacy and relation to outcome.

BACKGROUND: The adequacy of pharmacotherapy received in practice by patients after an acute episode of depression has been little studied. AIMS: To describe and assess adequacy of drug continuation and maintenance in patients with depression. METHOD: Patients with depression were interviewed 18 months after discharge from hospital. Quantitative assessments of drug treatment doses and compliance were made monthly over this period, and qualitative ratings in continuation and maintenance phases. RESULTS: About 20% of patients were prescribed low drug doses after discharge and 10% were prescribed no drugs at all. Reported compliance was around 70%. About 30% failed to receive adequate longer-term treatment, mostly due to the continuation phase being too short. Deficiencies of dosage and compliance were greater in patients who never achieved full recovery. Patient refusal was the most common reason for not using antidepressants. Further episodes of depression were not particularly associated with inadequate treatment. CONCLUSIONS: There were deficiencies in drug treatment that did not appear to be the principal cause of further episodes but may be important in non-recovery. Patient fears require discussion.

Acute Disease↗
PubMed1997

Expressed emotion and depression. A longitudinal study.

BACKGROUND: Previous studies show that criticism by relatives during acute depressive illness predicts relapse over nine months, but the course of criticism over time and its relation to the course of illness, have not been examined in depressed patients. METHOD: Thirty-nine depressed patients and their partners, were interviewed separately at three-monthly intervals over about one year. Illness was assessed by Research Diagnostic Criteria and Hamilton Depression Rating Scale. Criticism was measured by the Camberwell Family Interview. RESULTS: Criticism when patients were most depressed predicted neither remission nor subsequent relapse. Patients who fully recovered, with or without later relapse, had partners who were consistently uncritical, or critical only at presentation. Patients with residual symptoms during remission had more persistently critical partners. CONCLUSIONS: The nature of the association between criticism and depression could not be unequivocally established, although it appeared likely that continuing criticism was a result of continuing depression. Relatives' understanding of the illness may mediate between levels of criticism and the course of depression.

Adult↗
PubMed1996

Life events, social support and marital relationships in the outcome of severe depression.

The effects of life events, social support and marital relationships on outcome were examined in a predominantly recurrent in-patient sample of depressives studied longitudinally every 3 months to remission and up to 15 months thereafter. Outcomes examined were length of time to remission, presence of residual symptoms at remission, and subsequent relapse. There were few associations between these outcomes and the social variables. These findings add to other recent evidence that psychosocial factors are relatively unimportant in the subsequent course of severe and recurrent depressions, in contrast to their contribution to onset of such depressions and subsequent outcome of milder depressions.

Adolescent↗
PubMed1995

Social influences on bipolar affective disorders.

The impact of psychosocial adversity on the onset and course of bipolar disorder has been assessed in studies that have relied on methods of eliciting life event histories and evaluating family atmosphere. The results of life event studies have been inconsistent, perhaps because the relationship between bipolar disorder and major stress is only pronounced in first or early episodes. If this is so, this phenomenon itself invites explanation, whether in social or biological terms. The two studies to data of family atmosphere suggest an association between high expressed emotion and relapse. The relationship between psychosocial stress and bipolar disorder requires further and more detailed research.

Bipolar Disorder↗
PubMed1995

The epidemiology of bipolar affective disorder.

This paper reviews the current position of studies on the epidemiology of bipolar affective disorder. A disorder that cannot be recognized until sometime after its onset poses special difficulties for epidemiological study. These are discussed and attempts made to solve them. Community psychiatric surveys suggest a morbid risk of bipolar disorder of around 2-2.5%, but probably include many false-positives. Studies of treated cases indicate a morbid risk of 0.5%, but will miss untreated cases. It is probably reasonable to suggest a compromise value of 1-1.5%; bipolar disorder is thus still a rare condition. It is possible to quantify the unipolar-bipolar conversion rate, which is of the order of 5%, and is of particular interest that female sufferers have proportionately fewer manic episodes. Age at onset, possible cohort phenomena, comorbidity, and sociodemographic correlates are discussed.

Adolescent↗
PubMed1995

Remission and relapse in major depression: a two-year prospective follow-up study.

This paper reports the course with respect to remission and relapse of a cohort of predominantly in-patient RDC major depressive subjects, who were followed at 3-monthly intervals to remission and for up to 15 months thereafter. Remission was comparatively rapid with 70% of subjects remitting within 6 months. Only 6% failed to do so by 15 months. However, 40% relapsed over the subsequent 15 months, with all the relapses occurring in the first 10 months. Greater severity of the depression and longer duration of the illness predicted a longer time to remission. Greater initial severity of depression also predicted relapse. Subjects with a worse outcome had not received less adequate treatment than the remainder. Our results confirm the comparatively poor outcome subsequent to remission that has been reported in recent literature, in spite of the availability of modern methods of treatment. The clustering of relapses in the first 10 months gives some support to the distinction between relapse and later recurrence.

Adolescent↗
PubMed1995

Residual symptoms after partial remission: an important outcome in depression.

This paper draws attention to an important adverse outcome in depression, the occurrence of residual symptoms after partial remission. Among patients with definite major depression followed every 3 months to remission and thereafter, residual symptoms reaching 8 or more on the Hamilton Depression Scale 17-item total were present in 32% (19) of the 60 who remitted below major depression by 15 months. The pattern was of mild but typical depressive symptoms. Residual symptoms were more common in subjects with more severe initial illness, but were not related to any other predictors, including longer prior illness, dysthymia, or lower dose of drug treatment during the illness episode. There were weak associations with personality that might have been consequences of symptom presence. Residual symptoms were very strong predictors of subsequent early relapse, which occurred in 76% (13/17) of those with residual symptoms and 25% (10/40) of those without.

Adolescent↗
PubMed1989

. . . or not?

Explore the source record for details and available documents.

Australia↗
PubMedDate not supplied

Classification of affective disorders.

The classification of affective disorders has provoked much controversy in the past. Current classification systems, ICD-10 and DSM-IIIR, define operational criteria for diagnosis and recognize the presence of more chronic and milder forms. They reflect a growing consensus on the subject.

Bipolar Disorder↗