[Side-effects of psychiatric somatic therapy during pregnancy].
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Although there have been previously published algorithms for the treatment of depression, few have been rigorously studied in terms of outcome. We present the Duke Somatic Treatment Algorithm for Geriatric Depression (STAGED) approach, developed by clinicians in the Duke Mood Disorders Program. The algorithm consists of five stages based on treatment history. In developing the approach, we enrolled 228 depressed elderly patients in a National Institute of Mental Health-funded longitudinal study of depression. Patients were treated by geriatric psychiatrists using the algorithm as a guideline for treatment. Initially, 174 patients were treated with antidepressant medications, and 54 patients were treated with electroconvulsive therapy. Over the course of 18 months of treatment, 88.6% of patients responded, and 65.35% of patients were able to achieve full remission of symptoms. The STAGED approach appears to be a clinically useful method of successfully treating elderly depressed patients.
The concept of a subtype of depression with a biological rather than a psychological set of causes has been more prominent in the psychiatric literature than in the psychological literature on depression. There has been dispute as to whether research on melancholia supports the distinction of a separate subtype with a distinct symptomatic profile characterized by marked anhedonia, psychomotor difficulties, excessive guilt or hopelessness, suicidal features, and appetite and weight disturbances. Research suggests that individuals with melancholic depression are qualitatively different from those with non-melancholic depression in their symptomatology. Examination of biological functioning, personality traits, responsiveness to treatment, and suicidality also tend to support the melancholic-non-melancholic distinction. This paper reviews the status of the melancholia concept and explores its implications for psychological research and practice.
Generally, there are few absolute contraindications to the use of somatic psychiatric therapies in the medically or surgically ill. A knowledge of psychotropic drugs, of their predictable effects on organs, of their interactions with other medications, and of the idiosyncratic reactions that they often produce allows the consultation psychiatrist to treat the seriously ill patient safely. Close collaboration with other consultants is essential to maximize therapeutic benefits.
The currently available data from randomized, controlled trials and a considerable amount of open clinical data suggest that adolescent-onset bipolar disorder probably responds to the same agents as adult-onset bipolar disorder. Research examining psychopharmacologic treatment approaches in the early-onset bipolar disorder is limited, however. Methodologic problems include small sample sizes, lack of comparison groups, retrospective designs, and lack of standardized measures. In addition, sometimes no clear differentiation is made between mania and bipolar disorder, the latter term being used broadly in the literature. Often the studies show that symptoms improve because of treatment, but the functioning of the patients does not improve significantly. More research is clearly needed in all aspects of this disorder but especially in examining the efficacy of various types of treatment, its longitudinal course, and diagnostic issues. The indications for, and the overall duration of, long-term maintenance therapy need further study. Many adolescents and children with bipolar disorder do not respond to any of the first-line pharmacologic treatments; therefore, studies with novel agents should be extended to patients in this age range. Furthermore, physicians will probably continue to use combination therapies when confronted by either lack of efficacy or delayed onset of efficacy with a single agent. Thus, such resultant drug-drug interactions also should also be systematically studied [97].
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Numerous somatic interventions have been studied as potential treatments of depressive disorders in children and adolescents. These include antidepressant medications, light therapy, electro-convulsive therapy, and alternative therapies. The available evidence suggests that several somatic interventions hold promise as potentially safe and effective treatments for depressed youth; however, there is still much to be learned about these interventions. This article reviews what is known and what needs to be learned about the somatic treatment of pediatric depression.
Clinical depression is a common disorder with serious implications that is often misdiagnosed or underestimated. More than 50% of suicides are associated with a major depressive disorder, and depression can adversely impact a variety of other medical conditions. Although > or = 70% of depressions can respond to appropriate medications, few patients actually receive adequate medical therapy. This article reviews the definition of adequate therapy for depression, discusses common comorbid conditions, and examines the issue of true treatment resistance. Practical strategies for treatment-resistant depression, including switching classes of antidepressant drugs, combination therapy, augmentation strategies, and somatic therapies, are incorporated into a treatment algorithm.
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The article is an attempt of review of recent achievements in dance therapy. It presents possibilities of introducing dance into the treatment of psychiatric disturbances (psychoses, dementias, neurotic disorders) and somatic disorders (rheumatoid arthritis, osteoporosis, terminal stages). The authors basing on the contemporary literature describe positive results of dance therapy in various clinical situations.
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