Chronic disease can severely impact an individual’s quality of life, influencing both physical and mental health. Major depressive disorder is one of the most common diagnoses among patients with physical conditions. Cognitive-behavioral therapy is a prominent evidence-based psychological treatment for depression. The objective of the present review is to summarize current research on the efficacy of this intervention in medically ill patients with comorbid depression. First, the relation between chronic disease and depression will be briefly described. Following this introduction, studies examining the efficacy of cognitive and behavioral techniques for reducing depressive symptoms in patients with frequent chronic diseases will be outlined. Subsequently, the effects of the psychological treatment for different patient populations will be analyzed. Finally, a few recommendations for adapting the intervention protocols to various target groups of people with specific characteristics will be provided in order to improve the mental health of patients with chronic medical conditions.
Objective: The aim of this study was to assess the prevalence of depression, anxiety and cognitive impairment in patients with type 2 diabetes (T2D).
Material and methods: We conducted a cross-sectional study in patients with T2D. Depression and anxiety were assessed by questionnaires (PHQ-9, CES-D and GAD-7 respectively), cognitive function by the MoCA test. Additionally, 503 patients’ clinic charts were separately analyzed in order to compare the data recorded in the charts with that resulted from the active assessment.
Results: In the screening study 216 subjects with T2D were included (62.2 ± 7.8 years old). 34.3% of them had depression and 7.4% presented major depression. 44.9% of patients with T2D had anxiety (9.2% major anxiety) and this was highly correlated with depression (OR: 21.139, 95%CI: 9.767-45.751; p<0.0001). Women had significantly higher prevalence of depression and anxiety compared to men (42.1% vs. 21.7%; p: 0.0021 and 51.1% vs. 34.9%; p: 0.02), but severe depression was similar between genders (9.0% vs. 4.8%; p: 0.29). Significantly more patients had depression and anxiety than recorded in their charts (34.3% vs. 13.9% and 44.9% vs. 9.3%,respectively; p<0.0001 for both). 69.0% of T2D patients had mild, 6.0% had moderate and none had severe cognitive dysfunction, respectively. Significantly more patients with depression and anxiety had mild and moderate cognitive impairment (p: 0.03 and p: 0.04, respectively).
Conclusions: Patients with T2D had a high prevalence of comorbid depression, anxiety and cognitive impairment. Depression and anxiety were significantly more frequent in women. These conditions were under-evaluated and/or under-reported.
Objective: The aim of this paper was to evaluate if depressed patients have an increased level of morning serum cortisol compared to healthy persons and to assess the relation between high levels of cortisol and prosocial coping mechanisms, in the context of Recurrent Major Depressive Disorder.
Methods: Morning serum cortisol level was measured in 15 depressed patients hospitalized in First Clinic of Psychiatry Tirgu Mures and in 15 healthy controls. We have analyzed 3 behavioral coping strategies with The Strategic Approach of Coping Scale (SACS): social joining (SJ), seeking social support (SSS) and cautious action (CA).
Results: 30 participants were included, the mean value of the cortisol for females was Mcort_female= 16.38 µg/dl and for males Mcort_male= 16.31 µg/dl. Independent sample t test showed that the cortisol level in depressed group was higher than the cortisol level in the control group: t = 2.394, p < 0.05 (0.024). In the MDD group the Spearman correlation between the level of serum cortisol and prosocial coping strategies was: rcortisol-SJ= -0.519; rcortisol-SSS= -0.107; rcortisol-CA= -0.382.
Conclusions: Although the studied sample patient was small, we can conclude that the patients with Recurrent Major Depressive Disorder have an increased level of morning serum cortisol compared to healthy persons. In these patients there is an inverse correlation between the increased levels of morning cortisol and the frequency of use of the effective prosocial coping strategies, particularly the social joining type.
Introduction: Health-related quality of life (HRQoL) is an accepted outcome measure in patients with depression.
Aim: Our study aimed at assessing QoL in depressed elderly patients with cluster C PDs, admitted to Psychiatric Clinic No II Targu Mures. Cluster C PDs is the most frequent diagnosis on axis II for depression.
Material and method: A sample of thirty elderly in-patients with cluster C PDs and depression was studied. Mental disorders were assessed based on DSM IV criteria, Hamilton scale of depression and SCID II (structured clinical interview for DSM). QoL was assessed with the aid of the World Health Organization Quality of Life instrument (WHOQoL-Bref), and the Global Assessment of Functioning scale (GAF).
Results: We formed high co-morbidity among depression and cluster C PD, especially dependent PD, which was associated with poor QoL. The WHOQoL physical health and social functioning were significantly associated with GAF. Conclusion and Discussion: PD symptoms in elderly patients appear to operate as co-factor that amplify or exacerbate the impact of depression on long-term functioning and QoL. We conclude that if co-morbid personality disorder is not treated, patients will respond less well to treatment for depression than do those without PD.
Background: Increasing evidence indicates that chronic obstructive pulmonary disease (COPD) is a complex disease involving more than airflow obstruction. Systemic inflammation can initiate or worsen comorbid diseases, such as ischemic heart disease, heart failure, arrhythmia, diabetes, osteoporosis, lung cancer and depression.
Material and method: We explored the Medprax database, from an ambulatory care in order to obtain rates of comorbidities in COPD patients. Medprax electronic database is a locally developed system designed to fulfil the requirements of an integrated healthcare system. We identified a population of 9,659 patients (4472 men and 5187 women) aged ≥ 30 years registered between 01.01.2000 and 01.02.2010.
Results: The overall prevalence of COPD was 5.17% (384 men and 116 women). Compared to the non-COPD patients, COPD was found to be a significant risk factor in both sexes for cardiovascular events: ischemic heart disease (OR = 3.06, 95%CI 2.54–3.68), atrial fibrillation (OR = 2.70, 95%CI 2.12–3.43) and heart failure (OR = 4.49, 95%CI 3.74–5.40) regardless of age. Association with diabetes mellitus type 2 was extremely significant in COPD men (OR = 1.69, 95%CI 1.26–2.27), but not in COPD women. Significant correlation with osteoporosis (OR = 3.26, 95%CI 1.94–5.48) was found only in women over 60 years and men under 60. Pulmonary malignancy was found only in male COPD patient compared to non-COPD patients (OR = 5.04, 95%CI 2.02–12.44). The impact on
depressive disorders was noted only in younger COPD men (OR = 5.71, 95%CI 1.94–16.82).
Conclusions: Our results indicate that COPD is a risk factor for all these comorbid conditions and that in the management of COPD all these conditions need to be carefully evaluated.
Background: The risk of woman to present a depressive clinical picture increases in parallel with the approaching age of perimenopause.
Aim: The main purpose of the paper is to study correlations between symptoms of perimenoapuse and depressive episode occurance, taking into consideration the severity and the frequency of symptoms of perimenopause.
Material and methods: We have selected the cases by performing a screening to pacients with major depressive disorder, hospitalized in No. 1 Psychiatric Clinic, between 01.01.2007–31.12.2009.
Results: From the total patients admitted (1342) only 160 patients aged 34–55 years, voluntarily wanted to participate, representing 11.92% of all patients. Analyzing the severity of psychological symptoms we have obtained statistical significance in the age group 46–50 years: p = 0.0303. Analyzing the frequency of vasomotor symptoms by age group, we have obtained statistical significance in the age group 34–40 years: p = 0.006. Analyzing the frequency and severity of somatic symptoms by age groups, we have obtained statistical significance in the age group 34–40 years.
Conclusions: The rural environment proved to be a protective factor in the emergence of depressive disorders (P = 0.0189). Estimating the role of hormonal decline at patients aged over 40 years, helped us to understand that the emergence and evolution of clinical manifestations during perimenopause and menopause may be caused by fluctuations of central secretion of pituitary hormones and sex steroids.
Introduction: Concerning the thematic of our intervention it can be said that there is a bigger susceptibility for woman to develop a major depressive episode after a life event that generates stress and which is related to her own life, or to what happens around her, determining a back stroke state. Plus, childhood experiences lived by women, like: “neurotic” features, defective relationship with the mother, maltreatment, may constitute factors that lead to depression. In the same time we can say that women are trice more affected than men by combined depression (major, plus the one of short duration) asking again ourselves: “is the woman very different by man?” In our configuration, the woman being in the detention state develops a certain behavioral state, different by the one that develops the man being in the same state. Even if the statistics show a lower feminine delinquency rate, we can remark though the positive fact that the woman is lees amenable to commit a delinquency act than man.
Materials and methods: In our intervention we used among intervention, conversation, observation, biographical dialogue also scales like: Beck’s scale of auto evaluating the depression – Woodworth test and tree test, all identifying the existence of depressive state.
Results: It was shown that the woman in detention it is more amenable to develop an increased adherence to the elements that release the apparition of depressive state and in consequence to depression itself. Identifying in/at the depressive state does not determine vindicatory the existence of correlation between: deed and detention; detention and depression; detention and therapy, even if there may be established some resemblances of concept and attitudinal-behavioral expression, all reporting to the initial context, but foreshadowing a new personality profile.
Conclusions: It is imposed: to recognize the existence of the phenomenon itself, practicing the psychotherapeutic centered programs, in our case depression, and also implementing some reintegration programs, re-socialization, reeducation and professional re-conversion, having as main character the detainee woman.
Introduction: Major depressive disorder is a chronic and debilitating disease characterized by a wide range of emotional and physical symptoms that coexist during a depressive episode and may reoccur at some point during the progression of the disease for the majority of patients. The purpose of the study was to investigate psychiatrists’ experience regarding the response to antidepressive treatment and their options regarding augmentation strategies in depression with incomplete response to antidepressant monotherapy.
Method: We applied an 18-item questionnaire containing multiple choice questions to adult psychiatrists working in ambulatories, hospitals or mental health centers.
Results: Fourty-two psychiatrists have agreed to answer the questionnaire. The majority of them were psychiatry specialists, between 35 and 49 years of age, working in an outpatient unit. For the majority of doctors, SSRIs (Serotonin Reuptake Inhibitors) proved to be the first line treatment both for the first depressive episode and for recurrent depression, followed by SNRI (Serotonin and Noradrenalin Reuptake Inhibitors). Regarding the duration of maintenance treatment for the patients who achieved complete remission after the first episode of depression, the results showed a wide spectrum from 4 to 9 months.
Conclusions: Incomplete response to antidepressive monotherapy is very frequent both for the first depressive episode and for recurrent depression. Given the pharmacological profile that some atypical antipsychotic have, augmentation with atypical antipsychotics in patients with inadequate response to antidepressant monotherapy is a useful therapeutic strategy that should be considered.
Introduction: Stressful life events have a negative effect on mental health. Job loss is an event with a psychotraumatic character. Identification of the main sources of stress faced by the individual is essential in the management of depression.
Objective: The aim of this study was to identify the main risk factors that play a role in the onset and maintenance of depression.
Material and methods: we made a prosepctive study including 68 outpatients aged over 18, recently diagnosed with Major Depressive Disorder (MDD), without psychotic features, with initiated antidepressant treatment, being in evidence of First Clinic of Psychiatry Tirgu-Mures, between 01.01.2013-31.12.2013. To assess the severity of depression and to measure the antidepressant treatment efficacy we used Hamilton Depression Scale (HAM-D17) at study onset, respectively at endpoint. The parameters followed were: HAM-D17 score, response to treatment, the mean number of hospitalizations in a year.
Results: The group included 82.35% women and 17.65% men, mostly from urban areas, aged between 35 and 68, with a HAM-D17 score between 24 and 27. The major stressful life events inventory shows that 20.58 % of the patients were unemployed. The observed effects were more extensive in men.
Conclusions: How stressful life events exert their influence on mood is complex. The onset of depression often seems to coincide with a stressful event, although sometimes the event is only the revelator of an episode ready to trigger. The findings indicate the need of prevention politics for relapse of the disease, which is a disadvantage regarding the re-employment.
Background: A significant number of patients with cancer suffer from anxiety and depressive disorder. Perceived emotional distress, anxiety and depressive symptoms are significantly more frequent in cancer patients with pain than in patients without pain. Despite their high prevalence cancer pain and distress are frequently undertreated.
Material and method: Thirty two oncology patients were included in the study who were receiving concurrent oncologic and pain treatment in the Oncology Clinic TgMures. Patient demographic and clinical information was obtained from medical records and patient report. Patients were screened for pain scores using the Visual Analog Scale and distress scores, using the Distress Thermometer.
Results: The gender proportion of the sample is: 38% female, 62% male. More than 75% of the sample was over 50 years of age , and more than half of the patients (59.3%) had metastatic disease. Significant decreasing trend were seen for pain score difference before and after the pain treatment was reassessed (dosage increase or conversion) (p<0.0001), and decreasing trend seen for distress score (p<0.0001) also.
Conclusions: Pain and distress occurred concomitant in this population. An adequate pain management and pain reassessment contributes to improve the cancer patient emotional distress score, anxiety and depressive symptoms. An accurate screening instrument can facilitate the recognition of patients who needs further assessment and psychiatric treatment.