RESUMO
Associations between affective disorders, anxiety disorders, and substance use disorders were examined in epidemiological studies conducted in Germany, Switzerland, Puerto Rico, and the mainland US. There was a remarkable degree of similarity across studies in the magnitude and type of specific disorders associated with the affective disorders. Comorbidity with affective disorders was greater for the anxiety disorders than for substance misuse. Panic disorder was the subtype of anxiety that was most highly comorbid with depression. Social phobia was the specific phobic type with the strongest association with the affective disorders. The magnitude of associations between substance misuse and affective disorders generally was quite low and less consistent across sites. No major differences were found in the patterns of comorbidity by gender or age group, affective subtype or prevalence period. The onset of anxiety disorders generally preceded that of depression, whereas alcohol misuse was equally likely to pre-or post-date the onset of affective disorders. Finally, comorbidity was associated with an elevation in treatment rates across all sites, confirming Berkson's paradox on an international level.
Assuntos
Transtornos de Ansiedade/epidemiologia , Transtornos do Humor/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Idade de Início , Idoso , Transtornos de Ansiedade/terapia , Estudos de Coortes , Comorbidade , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/terapia , Diagnóstico Duplo (Psiquiatria) , Alemanha/epidemiologia , Humanos , Pessoa de Meia-Idade , Transtornos do Humor/terapia , Razão de Chances , Transtorno de Pânico/epidemiologia , Transtornos Fóbicos/epidemiologia , Prevalência , Estudos Prospectivos , Porto Rico/epidemiologia , Estudos de Amostragem , Transtornos Relacionados ao Uso de Substâncias/terapia , Suíça/epidemiologia , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: This study sought to determine whether a set of symptoms interpreted as complicated grief could be identified and distinguished from bereavement-related depression and whether the presence of complicated grief would predict enduring functional impairments. METHOD: Data were derived from a study group of 82 recently widowed elderly individuals recruited for an investigation of physiological changes in bereaved persons. Baseline data were collected 3-6 months after the deaths of the subjects' spouses, and follow-up data were collected from 56 of the subjects 18 months after the baseline assessments. Candidate items for assessing complicated grief came from a variety of scales used to evaluate emotional functioning (e.g., the Hamilton Depression Rating Scale, the Brief Symptom Inventory). The outcome variables measured were global functioning, medical illness burden, sleep, mood, self-esteem, and anxiety. RESULTS: A principal-components analysis conducted on intake data (N = 82) revealed a complicated grief factor and a bereavement-depression factor. Seven symptoms constituted complicated grief: searching, yearning, preoccupation with thoughts of the deceased, crying, disbelief regarding the death, feeling stunned by the death, and lack of acceptance of the death. Baseline complicated grief scores were significantly associated with impairments in global functioning, mood, sleep, and self-esteem in the 56 subjects available for follow-up. CONCLUSIONS: The symptoms of complicated grief may be distinct from depressive symptoms and appear to be associated with enduring functional impairments. The symptoms of complicated grief, therefore, appear to define a unique disorder deserving of specialized treatment.
Assuntos
Luto , Transtorno Depressivo/diagnóstico , Pesar , Viuvez/psicologia , Fatores Etários , Idoso , Atitude Frente a Morte , Comorbidade , Choro , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/psicologia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Inventário de Personalidade , Probabilidade , Escalas de Graduação Psiquiátrica , Autoimagem , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/epidemiologia , Estresse Psicológico/diagnóstico , Estresse Psicológico/epidemiologiaAssuntos
Encéfalo/irrigação sanguínea , Ritmo Circadiano/fisiologia , Luz , Transmissão Sináptica/fisiologia , Tomografia Computadorizada de Emissão , Adulto , Velocidade do Fluxo Sanguíneo/fisiologia , Glicemia/metabolismo , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico , Feminino , Humanos , Masculino , Fluxo Sanguíneo Regional/fisiologiaRESUMO
BACKGROUND: Despite the advances in biological and psychosocial assessment methods, reliable distinction between depressed patients with endogenous presentations or melancholic symptom features and those with nonendogenous presentations has remained elusive. METHODS: Ninety patients with histories of frequent unipolar episodes classified as endogenous or nonendogenous by the Research Diagnostic Criteria were interviewed with the Bedford College Life Events and Difficulties Schedule regarding the 6 months before onset of their most recent episode of depression. RESULTS: Patients meeting the Research Diagnostic Criteria for definite endogenous subtype differed significantly from patients with nonendogenous features in terms of the proportion experiencing severe life stress in the 6 months before onset of their depressive episode (P < = .04). Furthermore, survival analysis revealed a closer temporal association between severe event and depression onset among patients with nonendogenous features (P < .02). CONCLUSION: Even among patients with a history of multiple recurrences of depression, psychological stress plays an important role in the timing of onset of episodes characterized by nonendogenous features.
Assuntos
Transtorno Depressivo/diagnóstico , Acontecimentos que Mudam a Vida , Adaptação Psicológica , Adulto , Idoso , Transtorno Depressivo/etiologia , Transtorno Depressivo/psicologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Recidiva , Apoio Social , Estresse Psicológico/psicologia , Análise de SobrevidaRESUMO
Our objective was to assess the effects of nortriptyline on electroencephalographic sleep and subjective sleep quality in spousally bereaved, depressed elders. Ten elderly volunteers with bereavement-related major depression had electroencephalographic sleep studies while depressed, after remission of depressive symptoms while still taking nortriptyline, and after nortriptyline discontinuation. Changes in sleep measures over time were compared both within bereaved subjects and with age- and sex-matched healthy controls. Remission of depressive symptoms while still on nortriptyline was associated with improvements in sleep quality (P < .002), rapid eye movement (REM) percent (P < .02), REM latency (P < .05), REM density (P < .05), and delta sleep ratio (P < .05). After discontinuation of nortriptyline, REM percent, REM latency, and delta ratio reverted to pretreatment levels, while sleep efficiency and sleep quality continued to show improvement coincident with sustained clinical remission. These data suggest that nortriptyline may be clinically useful in treating the sleep disturbance of elders with bereavement-related depression and that a double-blind, placebo-controlled, randomized clinical trial is warranted.
Assuntos
Luto , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/psicologia , Nortriptilina/uso terapêutico , Transtornos do Sono-Vigília/etiologia , Idoso , Transtorno Depressivo/diagnóstico , Eletroencefalografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nortriptilina/administração & dosagem , Sono REM , Resultado do TratamentoRESUMO
Forty-one recurrent unipolar depressed outpatients were studied at baseline (symptomatic period) and at recovery. Rectal temperatures were measured continuously between 1800h and 0600h on 2 successive nights at each time point. In those 24 patients who recovered after receiving interpersonal psychotherapy (IPT) alone ("psychotherapy responders") and who thus remained drug-free throughout, there was no difference in nocturnal body temperatures between baseline and recovery time points. Moreover, nocturnal temperature patterns appeared to be very similar to those of a healthy contrast group (n = 17). The contrast group was not matched for age and gender with the patient group, though, so the comparison was only suggestive. At baseline, those recovering after psychotherapy alone (n = 24) did not differ from those eventually failing to respond to IPT and requiring medications to achieve recovery ("medication responders") (n = 17). Medication responders did show some baseline versus recovery differences in nocturnal temperatures, but these may possibly have been a function of the medications used. At recovery, a subset of 19 psychotherapy responders and 13 medication responders underwent an "unmasking" experiment involving 36 hours of wakeful bedrest. In the resulting endogenous temperature rhythms, there was no evidence of any reliable differences between the psychotherapy responder and medication responder patient groups. Both groups showed rhythms that were very similar to those of a healthy contrast group (n = 17), although, again, the contrast group was not matched for age or gender with the patient group. In conclusion, in measures of body temperature, at least, there appeared to be little evidence of circadian dysfunction in this group of recurrent outpatient depressives.
Assuntos
Temperatura Corporal/fisiologia , Ritmo Circadiano/fisiologia , Transtorno Depressivo/fisiopatologia , Adulto , Análise de Variância , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Feminino , Fluoxetina/uso terapêutico , Humanos , Imipramina/uso terapêutico , Masculino , Escalas de Graduação Psiquiátrica , PsicoterapiaRESUMO
Increasingly, there is a need in both research and clinical practice to document and quantify sleep and waking behaviors in a comprehensive manner. The Pittsburgh Sleep Diary (PghSD) is an instrument with separate components to be completed at bedtime and waketime. Bedtime components relate to the events of the day preceding the sleep, waketime components to the sleep period just completed. Two-week PghSD data is presented from 234 different subjects, comprising 96 healthy young middle-aged controls, 37 older men, 44 older women, 29 young adult controls and 28 sleep disorders patients in order to demonstrate the usefulness, validity and reliability of various measures from the instrument. Comparisons are made with polysomnographic and actigraphic sleep measures, as well as personality and circadian type questionnaires. The instrument was shown to have sensitivity in detecting differences due to weekends, age, gender, personality and circadian type, and validity in agreeing with actigraphic estimates of sleep timing and quality. Over a 12-31 month delay, PghSD measures of both sleep timing and sleep quality showed correlations between 0.56 and 0.81 (n = 39, P < 0.001).
Assuntos
Projetos de Pesquisa , Transtornos do Sono-Vigília/psicologia , Sono/fisiologia , Vigília/fisiologia , Atividades Cotidianas , Ciclos de Atividade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Fenômenos Cronobiológicos , Ritmo Circadiano , Feminino , Humanos , Masculino , Personalidade , Polissonografia , Reprodutibilidade dos Testes , Fatores Sexuais , Inquéritos e QuestionáriosRESUMO
This study sought to determine possible causal linkages among stressful life events, social rhythms, and levels of depressive symptomatology for 81 elderly subjects (51 recently widowed, 30 healthy controls). We examined the associations among stressful life events (i.e., bereavement status at baseline or a severely threatening event occurring between baseline and followup), social rhythm stability, and the level of depressive symptoms. Results indicated that while stressful life events were not associated with significant changes in social rhythm stability, social rhythm stability was a significant negative correlate of both baseline and followup levels of depressive symptomatology; that is, lower levels of social rhythm stability at baseline were associated with high levels of depressive symptoms at baseline (rho = -0.33, n = 81, p < 0.001) and at followup (rho = -0.23, n = 81, p < 0.05). Bereavement was also a significant positive correlate of depressive symptomatology both at baseline (rho = 0.79, n = 81), p < 0.0001) and at followup (rho = 0.55, n = 81, p < 0.0001). It is likely that future research will benefit from social rhythm assessment obtained temporally closer to major life events and from the use of structured interviews to ascertain the presence of syndromal major depression at followup as well as the inclusion of subjects with a wider range of functional impairments. Nevertheless, these results represent a first step in disentangling possible causal connections among stressful life events, social rhythms, and depressive symptomatology.
Assuntos
Envelhecimento/psicologia , Transtorno Depressivo/psicologia , Acontecimentos que Mudam a Vida , Comportamento Social , Estresse Psicológico/psicologia , Idoso , Luto , Ritmo Circadiano , Feminino , Humanos , Masculino , Apoio SocialRESUMO
Although depressed patients have been shown to have diminished nocturnal penile tumescence (NPT), there remains considerable variability of NPT in depression. We hypothesized that affective experience during the day accounts for some of this variability. Forty-five depressed men had assessments of affect intensity and affect balance, NPT, and daytime sexual function, both before and after treatment with Beck's cognitive behavior therapy (CBT). Forty-three normal control subjects were studied for comparison. Daytime affect intensity in depressed men, but not in control subjects, correlated significantly and positively with measures of NPT duration and rigidity both before and after treatment, regardless of the adequacy of daytime sexual function. When the effect of daytime affect on REM activity was controlled, the observed correlations became nonsignificant at pretreatment, but remained significant at posttreatment. Neuropharmacologically mediated changes in arousal responsivity associated with depression may underlie the observed relation between daytime affect intensity, rapid eye movement activity, and NPT.
Assuntos
Afeto/fisiologia , Transtorno Depressivo/fisiopatologia , Ereção Peniana/fisiologia , Sono/fisiologia , Adulto , Eletroencefalografia , Humanos , Masculino , Sono REM/fisiologiaRESUMO
Research completed over the past decade has established the chronic and recurrent nature of major depression. To date, treatment for the prevention of recurrence has promoted the use of "maintenance" doses of antidepressant medications that are lower than the effective for the acute phase of treatment. Long-term randomized, double-blind studies of tricyclic antidepressant (TCA) maintenance therapy have shown, however, that full-dose treatment strategy has a highly significant prophylactic effect in preventing a new episode of depression for up to 5 years. Monthly interpersonal psychotherapy has also been shown to have a modest but significant effect on survival. Although prophylaxis with full-dose TCAs can be well tolerated by patients when proper education and support are provided, newer antidepressant agents with milder side effect profiles are being studied for their efficacy in long-term management of depression. The results of 1-year studies of maintenance therapy with serotonin selective reuptake inhibiting agents suggest that these medications will play a major role in prophylaxis for recurrent depression.
Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo/prevenção & controle , 1-Naftilamina/análogos & derivados , 1-Naftilamina/uso terapêutico , Antidepressivos/administração & dosagem , Doença Crônica , Terapia Combinada , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/psicologia , Esquema de Medicação , Fluoxetina/uso terapêutico , Humanos , Imipramina/administração & dosagem , Imipramina/uso terapêutico , Paroxetina/uso terapêutico , Psicoterapia , Recidiva , SertralinaRESUMO
Spousal bereavement in late life frequently leads to major depression. However, many people suffer from "minor" depressive symptoms that entail considerable suffering even in the absence of syndromal major depression. We describe longitudinal electroencephalographic (EEG) sleep and clinical evaluations in 14 elderly, recently spousally bereaved subjects who were experiencing subsyndromal depressive symptoms. While subjects did not meet diagnostic criteria for syndromal major depression, they did have mildly elevated scores on the Hamilton Rating Scale for Depression (mean = 10.6, range = 8-16) at the time of initial sleep studies (T1), which were carried out, on average, 5.5 months after loss of the spouse. Entry into the study was limited to volunteers who did not have a personal history of major depression or psychiatric disorder. Twelve subjects underwent followup clinical and EEG sleep evaluations (T2), 9.9 months after spousal loss. Fifty percent continued to show depressive symptoms at 6-month followup. Test-retest comparisons of sleep and clinical measures were made with a group of sex- and age-matched control subjects who were neither bereaved nor depressed. EEG sleep measures did not significantly correlate with time from loss of spouse, severity of depressive symptoms, or subjective sleep quality. Analysis of variance with repeated measures detected a significant group X time interaction effect for delta sleep ratio (decreasing in controls but increasing in the bereaved).
Assuntos
Idoso/psicologia , Luto , Depressão/fisiopatologia , Sono/fisiologia , Análise de Variância , Depressão/psicologia , Eletroencefalografia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Escalas de Graduação PsiquiátricaRESUMO
Electroencephalographic (EEG) sleep measures have been examined as predictors of therapeutic response in patients with major depression. Although some studies have reported that EEG sleep measures are predictive of a favorable outcome with medications, two recent studies found no differences in the baseline sleep characteristics of responders and nonresponders to psychotherapy. To clarify this issue, we compared baseline EEG sleep in a group of patients with recurrent depression who responded to interpersonal psychotherapy (n = 19) and a comparable group who did not respond (n = 18). Baseline ratings of depression severity did not differ in the groups, but some differences in baseline sleep were noted. Psychotherapy nonresponders had longer sleep latencies, lower sleep efficiency, and increased automated measures of phasic rapid eye movement (REM) activity. In addition, the two groups had different EEG sleep adaptation patterns for REM latency and phasic REM density measures across the two study nights. These preliminary results suggest that baseline EEG sleep patterns, as well as the pattern of laboratory adaptation, may differ for depressed patients who respond to psychotherapy and those who do not.
Assuntos
Nível de Alerta , Transtorno Depressivo/terapia , Eletroencefalografia , Psicoterapia Breve/métodos , Fases do Sono , Adolescente , Adulto , Assistência Ambulatorial , Transtorno Depressivo/psicologia , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Sono REMRESUMO
Electroencephalographic (EEG) sleep studies may help to identify persistent versus episodic biological characteristics of major depressive disorder. This report examines longitudinal EEG sleep studies in depressed patients treated with psychotherapy alone. Nineteen patients were studied during a symptomatic baseline period and again during early remission after treatment with interpersonal psychotherapy (IPT). EEG sleep findings at baseline were not markedly abnormal, but they were similar to those in other published studies of young adult outpatients. No changes were found in visually scored EEG sleep measures between depression and early remission. Automated measures of delta sleep and rapid eye movement (REM) activity showed small state-related changes, with delta activity increasing from baseline to remission, and automated REM measures decreasing. Strong baseline-remission correlations were noted for most sleep measures, including slow wave sleep, phasic REM activity, and automated delta EEG counts; measures of sleep continuity and tonic REM sleep were not strongly correlated. Consistent adaptation effects across nights were observed for sleep continuity and REM measures during each clinical phase. These findings support the hypothesis that most visually scored EEG sleep measures, as well as the sleep adaptation process, are stable through the acute episode of depression, at least into early symptomatic remission. They also suggest that finer-grained automated analyses of delta and REM activity may provide more sensitive tools for examining state-related changes.
Assuntos
Nível de Alerta , Transtorno Depressivo/terapia , Eletroencefalografia , Psicoterapia Breve/métodos , Fases do Sono , Adolescente , Adulto , Assistência Ambulatorial , Transtorno Depressivo/psicologia , Feminino , Humanos , Relações Interpessoais , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Tempo de Reação , Sono REMRESUMO
Although most studies on sleep in child and adolescent depression have indicated that sleep is relatively unaffected, abnormalities have been found. We hypothesized that discrepancies occur because family history of depression and sleep abnormalities in a parent have not been taken into account. In a group of parents and offspring with a family history of depression, 57% of parents had evidence of abnormal sleep. Sleep continuity and sleep architecture were correlated, and the magnitude of these correlations increased between parents with abnormal sleep and their offspring. Abnormal sleep may be expressed at a younger age when there is familial evidence for depression and abnormal sleep in a parent.
Assuntos
Filho de Pais com Deficiência , Transtorno Depressivo/genética , Eletroencefalografia , Fases do Sono/genética , Adulto , Córtex Cerebral/fisiopatologia , Criança , Filho de Pais com Deficiência/psicologia , Pré-Escolar , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/fisiopatologia , Transtorno Depressivo/psicologia , Potenciais Evocados/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Determinação da Personalidade , Tempo de Reação/fisiologia , Fases do Sono/fisiologia , Sono REM/genética , Sono REM/fisiologiaRESUMO
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.
Assuntos
Transtorno Depressivo/diagnóstico , Projetos de Pesquisa , Terminologia como Assunto , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Humanos , Inventário de Personalidade , Escalas de Graduação Psiquiátrica , Recidiva , Reprodutibilidade dos Testes , Projetos de Pesquisa/normas , Projetos de Pesquisa/estatística & dados numéricos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
OBJECTIVE: This study characterized objectively the hypersomnia frequently seen in the depressed phase of bipolar affective disorder. On the basis of previous work in sleep and affective disorders, it has been hypothesized that the hypersomnia is related to greater REM sleep. This hypothesis was tested by using a multiple sleep latency test to compare bipolar affective disorder with narcolepsy, a well-defined primary sleep disorder associated with known REM sleep dysfunction. METHOD: Twenty-five bipolar depressed patients were selected on the basis of complaints of hypersomnia. They underwent 2 nights of polysomnography followed by a multiple sleep latency test. Data on their nocturnal sleep and daytime naps were compared with similar data on 23 nondepressed narcoleptic patients referred for sleep evaluation. RESULTS: Despite their complaints of hypersomnia, no abnormalities were noted for the bipolar group in the results from the multiple sleep latency test. Contrary to the working hypothesis, REM sleep was notably absent during daytime naps in the depressed patients, in marked contrast to the findings for the narcoleptic group. CONCLUSIONS: The complaint of sleepiness in the hypersomnic bipolar depressed patient appears to be related to the lack of interest, withdrawal, decreased energy, or psychomotor retardation inherent in the anergic depressed condition, rather than an increase in true sleep propensity or REM sleep propensity.