Tag Archives: depression

Psychotherapeutical Intervention in Depressive State of Detainee Women

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.

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Augmentation Strategies for Patients with Major Depressive Disorder with an Inadequate Response to Antidepressant Monotherapy

DOI: 10.2478/amma-2014-0014

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.

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Clinical and Psychological Correlations between Job Loss and Depressive Experience

DOI: 10.1515/amma-2015-0062

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.

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Pain and Distress in Cancer Patients

DOI: 10.1515/amma-2015-0057

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.

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Association Between Increased Waist Circumference and Depression and Anxiety Trend

DOI: 10.1515/amma-2015-0028

Introduction: Abdominal adiposity assessed by increased waist circumference and depression have both a high incidence and prevalence and are associated with increased general mortality and cardiovascular risk. Several studies showed a significant association between abdominal obesity, metabolic syndrome and depression. Early detection of these associations is important for for prevention and treatment of this disease.
Material and method: Eighty patients were enrolled in a cross-sectional descriptive study. Waist circumference was measured in all patients and an increased waist circumference was considered for subjects with values higher than 80 cm in women and higher than 94 cm in men as. Patients completed standardized questionnaires HADS for assessment of depression and anxiety. A depression (D) score higher than 10 points showed a trend to depression while an anxiety (A) score higher than 10 indicated a tendency to anxiety. The association between increased waist circumference, depression and anxiety was studied.
Results: We interviewed 80 patients, 34 (43%) men (mean age 62+/-6.43) and 46 (57%) women (mean age 59+/-5.16). Increased waist circumference was recorded in 22 men, and in 30 women. We noticed a good association between increased waist circumference and both depression (p=0.0006, RR=2.007, 95%CI 1.24-3.24) and anxiety (p=0.017, RR=2.046, 95%CI 1.21-3.45). We found both anxiety and depression risks rather equal in men, while in women we observed a higher depression risk.
Conclusions: Increased waist circumference is associated to depression and anxiety tendency in both genders. Depression trend is more powerful in women, while in men both depression and anxiety seen to have an equal frequency. Psychotherapy should be added to lifestyle changes in patients with abdominal adiposity.

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Correlations Between Depression, Cognitive Status, Functional Scores, Disability and Lesion Load in Multiple Sclerosis Treated with Interferon Beta 1a

DOI: 10.1515/amma-2015-0016

Introduction: Depression and cognitive impairment are the most frequent mental disorders in multiple sclerosis (MS) and represent an important cause of morbidity and mortality. The aim of the study was to analyse the main determinants of depression in multiple sclerosis.
Materials and methods: Thirty-two patients with relapsing remitting multiple sclerosis (RRMS), treated with Interferon Beta 1a, without relapses and corticosteroid treatment in the last 30 days, were included in the study. The mean age of the patients was 35.4±9.2 years, M/F ratio 0.33. Depression level was evaluated by the Romanian version of Beck Depression Inventory (BDI) and the cognitive function with Paced Auditory Serial Addition Test 3 (PASAT 3), Symbol Digit Modalities Test (SDMT). The functional status and disability level of the patients were evaluated with Multiple Sclerosis Functional Composite and Expanded Disability Status Scale. In all patients a cerebral MRI with intravenous contrast administration was performed using a 1.5T MRI device.
Results: Twenty-three patients were free of depression (score 1-10), 4 patients presented mild mood disturbance (score 11-16), 3 borderline clinical depression (score 17-20) and 2 moderate depression (score 21-30). The mean BDI score was 8.71±7.16. BDI score correlated significantly with EDSS (R=0.38, p=0.03), PASAT 3 (R=-0.42, p=0.01), SDMT (R=-0.58, p=0.0007), Timed 25-Foot Walk (R=0.43, p=0.01) and 9-Hole Peg Test (R=0.45, p=0.008). From the EDSS functional scores, significant correlations were found with the urinary score (R=0.4, p=0.01) and sensitive score (R=0.49, p=0.004). BDI score correlated significantly with the total number of T2 lesions (R=0.31, p=0.05) while there was no correlation with the number of active lesions.
Conclusions: The main determinants of depression in RRMS patients are the cognitive impairment, the affection of fine hand movements (9-HP), gait impairment (T25FT) and bladder and sensitive dysfunction.

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