Natural Depression Treatment Book

Destroy Depression

Destroy Depression is written by James Gordon, a former sufferer of depression from the United Kingdom who was unhappy with the treatment he was being given by medical personnell to fight his illness. Apparently, he stopped All of his medication one day and began to search for answers on how to cure himself of depression in a 100% natural way. He spent every waking hour researching all he could on the subject, making notes and changing things along the way until he had totally cured his depression. Three years later, he put all of his findings into an eBook and the Destroy Depression System was born. The Destroy Depression System is a comprehensive system that will guide you to overcome your depression and to prevent it from injuring you mentally and physically. Read more...

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Major Depression In The Context Of Evolution

Fundamental to the understanding of any biological process, including mental illnesses, involves understanding their evolutionary context. There are few readily apparent evolutionary advantages for the development of a high prevalence of major depressive illnesses among Homo sapiens. Major depression frequently destroys peoples lives and has a chronic recurring course. Major depression is defined by DSM-IV diagnostic criteria (American Psychiatric Association, 1994) by the loss of the ability to function in family or job life for at least 2 wk, as a a result of disturbances in mood, sleep, concentration, self-esteem, appetite, physical energy, and sexual energy or function. This disease not only directly reduces the likelihood of procreation but also causes significant disruption in social and family interactions. Prior to 1910, the prevalence of major depression may have been nearly 100-fold less than current rates (Klerman et al., 1985). The increased rates of prevalence of...

Crossnational Epidemiology And Major Depression

The analyses of cross-national epidemiological data, collected using high-quality modern diagnostic and epidemiological sampling methods, does provide one method of testing the hypothesis that a lower omega-3 fatty acid status is related to higher prevalence rates of affective disorders, psychotic disorders, or aggressive behaviors. Economic data describing seafood consumption has been useful in these cross-national studies. Although economic data on the production and consumption of seafood cannot accurately be used to quantify dietary intake for an individual, these data can be used to describe trends for the populations of entire countries and thus provide a basis for comparing consumption across countries (World Health Organization, 1996). The financial incentive to produce accurate data also adds some confidence to the accuracy of consumption estimates derived from economic data. When compared cross-nationally, greater amounts of seafood consumption were robustly correlated (r...

Major Depression And Tissue Composition Studies

Since the publication our of initial hypothesis (Hibbeln and Salem, 1995), a series of clinical studies have reported that depressed patients have low tissue concentrations of EPA and or DHA, and several supplementation trials have reported improvements in depressive or symptoms in the affective spectrum. Although initial reports described elevated plasma concentrations of DHA among subjects with some mixture of depressive symptoms (Ellis et al., 1977 Fehily et al., 1981), unfortunately these studies lacked diagnostic specificity, did not control for alcoholism or smoking, and did not specify the use of psychotrophic medications. Following those initial reports, eight studies have reported that lower concentrations of n-3 fatty acids in plasma or red blood cells (RBCs) predicted depressive symptoms (Adams et al., 1996 Maes et al., 1996 Peet et al., 1998 Edwards et al., 1998a Edwards et al., 1998b Peet et al., 1999 Maes et al., 1999 Hibbeln et al., 2000). Adams et al. (1996) were the...

Major Depression Treatment

Only one treatment study of omega-3 fatty acids in major depression has been completed and none have been published (Marengell et al., 2000). In contrast to the predictions of the tissue compositional and epidemiological studies, this 6-wk trial of 2 g d of DHA alone did not document any differences in depressive symptoms among subjects with mild to moderate major depression. This study of medication-free patients with a Hamilton depression rating scale of greater than 17 and no significant comorbid psychiatric diagnoses was well designed and carefully conducted. However, several questions remain before the efficacy of DHA in major depression can be ruled out. First, the trial length may not have been adequate. Second, although the dose of DHA (2 g d) appeared adequate to change most tissue compositions, this dose may have been excessive if there is a nonlinear or inverted U-shaped pattern of response. In other words, response may be seen at low doses, but secondary antagonistic...

Antidepressants Elavil and Relatives

These drugs date from 1958, when the parent compound, imip-ramine (Tofranil), was invented. It is still in wide use today, along with a close relative, amitriptyline (Elavil), and a number of other similar drugs. Some depressed patients respond very well to these medications but not until after at least two weeks of regular use. On the other hand, the toxic effects begin right away sedation, dry mouth, blurred vision, constipation, difficulty in urinating. Normal people are likely to notice only these side effects'' without any positive mood changes. A newer antidepressant drug is fluoxetine (Prozac), unrelated to the older members of this group. It is currently very popular in psychiatric medicine. Fluoxetine is an effective antidepressant, but some patients cannot tolerate it, because it makes them very anxious. Like the major tranquilizers, the antidepressants do not lend themselves to recreational use because no one likes their effects. Often, even depressed patients who are...

Summary of the pharmacological properties of antidepressants in general use in Europe

Sertraline Muscarinic

Tricyclic antidepressants (TCAs) The excellent clinical efficacy of the TCAs has been well documented and the pharmacokinetic profiles are favourable. The most serious disadvantage of the TCAs lies in their cardiotoxicity. Thus, with the exception of lofepramine, all the tricyclic antidepressants, including maprotiline, block the fast sodium channels in the heart which can lead to heart block and death. Approximately 15 of all patients with major depression die by suicide and a high proportion of these (up to 25 ) do so by taking an overdose of TCAs. Such a dose can be as low as 5-10 times the recommended daily dose. Lofepramine differs from the other TCAs in that its structure seems to preclude it from causing the anticholinergic, antihistaminergic and antiadrenergic effects evident with the other TCAs. In addition, it does not appear to be any more cardiotoxic than most of the second-generation antidepressants. The reason for this is an enigma, as the main metabolite of lofepramine...

Clinical Subtypes of Mood Disorders 1 Depressive Disorders

The DSM-IV classification includes three types of depressive disorders. a. Major Depressive Disorder This disorder is characterized by a clinical course of one or more major depressive episodes without a history of manic, mixed, or hypomanic episodes. In addition, the episodes are not due to direct physiological effects of a drug or a medical condition and are not present during the course of schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified. There are two types major depressive disorder, single episode, and major depressive disorder, recurrent. c. Depressive Disorders Not Otherwise Specified This category includes depressive disorders that do not meet the criteria for major depressive disorder, dysthymic disorder, adjustment disorder with depressed mood, or adjustment disorder with mixed anxiety and depressed mood such as minor depression (based on suggested research criteria).

Heterocyclic Antidepressants Hcas

Although tricyclic antidepressants (named for their three-ring structure) were first synthesized in the nineteenth century, their antidepressant properties were not recognized until the late 1950s. Since that time, other cyclic antidepressant agents have been formulated thus creating need for the more general term heterocyclic (Table., .282-3). The therapeutic effect of HCAs is believed to be related to secondary downregulation of norepinephrine and serotonin postsynaptic receptors after initial blockade of presynaptic reuptake of norepinephrine and serotonin. HCAs are primarily indicated for major depression but may also be effective for dysthymic disorder, panic disorder, agoraphobia, obsessive compulsive disorder, enuresis, and school phobia. As previously advised, initiation of HCA therapy in the emergency department is not routinely recommended. TABLE 282-3 Commonly Used Heterocyclic Antidepressants TABLE 282-3 Commonly Used Heterocyclic Antidepressants

Depressive Symptoms as Prodromal Signs of Schizophrenia

Several first-episode studies have consistently reported an extremely high frequency of depressive symptoms in the first psychotic episode depressive mood or at least two depressive symptoms were found in 70-75 of cases 56,57,113-115 . As shown above, depressive symptoms frequently appear long before the first positive symptom 16,114,116 . In the ABC study cohort, the lifetime prevalence of depressive mood of a duration of two or more weeks -assessed until first admission - was 81 . In 39 of cases the symptom was continuously present, in 34 recurrent, and in 8 it occurred only once. Only 19 of the first-episode cases of schizophrenia reported not to have suffered from an episode of depressed mood 114 . A comparison of 57 first-episode patients with schizophrenia with 57 population controls matched by age, sex and place of residence showed that three out of four depressive symptoms were significantly more frequent in patients than in controls 114 . For depressive mood, the lifetime...

Major Depression

In treating the child who is suffering from ADHD, it is important to remember that psychostimulants are liable to arouse a clinical depression which was previously covert. Depressive symptoms also play a prominent role in the clinic for children with CD ODD. On the other hand, a behaviour disorder may lead the child to recurrent social failures that in turn lead to damage of self-worth and subsequently to depression. Accordingly, depression is one of the main phenomena that must be examined and discounted in children exhibiting any kind of behaviour disorder. This demand is especially vital in light of the empathic failure that these children create, due to which internalizing disorders are not examined or diagnosed sufficiently 47 . PTSD is also characterized by a high prevalence of depressive symptoms. Many children who exhibit clinical depression conceal a history of acute or chronic trauma. In addition, these children are liable to be ''many-layered'' i.e. depression may be the...

Sex Differences in Psychopathology

One of the best sources for identifying broad sex differences in psychopathology is the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV) (American Psychiatric Association, 1994), the manual used by psychologists and psychiatrists to diagnose psychological problems. Under the heading of individual diagnoses, this manual includes a check-list of diagnostic criteria, a discussion of several related problems, and a section entitled Specific Culture, Age, and Gender Features which outlines, where appropriate, sex differences in various diagnostic categories. Major Depressive Episodes, for example, and Major Depressive Disorders (DSM-IV, pp. 325, 341) are reported as occurring twice as often in women as in men. This finding echoes those of higher Depression scores for women in personality tests and higher Depression or Sadness scores for women in tests focusing on emotion.

The ABC Schizophrenia Study

Using the IRAOS interview, the ABC Schizophrenia Study examined a population-based sample of 232 first illness episodes, representing 84 of 276 first treatment episodes, and a representative subsample of 130 subjects, who were compared with two age- and gender-matched control samples -one from the ''healthy'' population (n 130), the other first hospitalized with a diagnosis of depressive episode (n 130).

Water Soluble Vitamins

Folic acid is transported into brain as methylenete-trahydrofolic acid, the major form of folic acid in the circulation. It is then transported rapidly into neurons and glia from the CSF extracellular fluid. Once inside cells, folates are polyglutamated. Methylenetetrahydrofolate is used by neurons and glia in reactions involving single carbon groups, such as in the conversion of serine to glycine or homocysteine to methionine. Once methylenetetra-hydrofolate is consumed in these reactions, folic acid is transported out of the brain into the circulation. Folate has become an issue of neurologic concern because of a link between folate deficiency and abnormal CNS development. The incidence of spina bifida, a serious spinal cord abnormality, rises above the population mean in the children of women who are folate-deficient during pregnancy. Moreover, the incidence of spina bifida can be reduced by folic acid supplementation during pregnancy, beginning prior to conception. Initiating...

Assessment And Differential Diagnosis

BDD is regularly associated with comorbid or secondary disorders, including major depression (approximately 60-80 ), social phobia (lifetime rate of 38 ), substance use disorder (lifetime rate of 36 ), and obsessive-compulsive disorder (lifetime rate of 30 ) (Phillips & Diaz, 1997). Individuals with BDD may hold their preoccupations with a delusional intensity, which would warrant the added diagnosis of delusional disorder, somatic type (APA, 2000). However, recent theory suggests that adding the delusional diagnosis has little value and contradicts current etiopathol-ogy and treatment response indications (Castle & Phillips, 2002).

The importance of drug pharmacokinetics to drug interactions

In pharmacokinetics, genetic polymorphism refers to differences between individuals' ability to metabolize drugs. More than 25 years ago it was shown that the steady-state plasma concentration of the TCA nortriptyline was related to the genetic characteristics of the patient. Thus homozygous, but not heterozygous, twins had similar blood nortriptyline concentrations. Since that time it has become clear that many of the liver enzymes concerned with drug metabolism exhibit genetic polymorphism. This may be particularly important when depressed patients receiving antidepressant therapy are also given other drugs which compete for the same hepatic enzyme.

Developmental Origins Of Cognitive Vulnerability To Depression

In the CVD Project, we also studied HR and LR participants' parents as well as the participants' early developmental experiences (Alloy et al., 2003). Our findings suggest several potential antecedents of negative cognitive styles. Mothers of HR participants had greater histories of depression than mothers of LR participants. This could occur due to shared genetic risk for depression or to learning of negative cognitive styles from parents. Children's cognitive styles may develop in part through modeling of their parents' cognitive styles or through parental inferential feedback regarding the causes and consequences of negative events in the child's life. In the CVD Project, mothers of HR individuals had more dysfunctional attitudes, but not more negative inferential styles, than mothers of LR individuals, even after controlling for the mothers' levels of depressive symptoms. Fathers' cognitive styles did not differ for HR and LR participants (Alloy et al., 2003)....

Cognitive Vulnerability In Context

What has the work on cognitive vulnerability to depression taught us That negative cognitive styles confer increased risk for clinically significant depressive disorders not only provides the first demonstration of a psychological vulnerability to depression, but suggests that purely biological approaches to understanding depression are likely to fall short. Indeed, our recent research indicates that even bipolar spectrum mood disorders (manic-depression, cyclothymia), which have traditionally been viewed as almost entirely genetic in origin, may also be influenced by cognitive styles for interpreting life events. Both hypomanic manic and depressive symptoms among bipolar individuals were predicted prospectively by individuals' cognitive styles and information processing in interaction with the occurrence of

Future Directions

A limitation of the CVD Project and a key issue for the cognitive theories of depression in general is the need to demonstrate that negative cognitive styles not only predict depression prospectively, but also contribute causally to their onset. Such a demonstration would require, in addition, that manipulations of cognitive vulnerability lead to corresponding changes in the likelihood of depression onset. Consistent with a potential causal role for cognitive vulnerability to depression, DeRubeis and Hollon (1995) reported that decreases in depressed patients' negative cognitive styles following cognitive therapy for depression predicted corresponding reductions in relapse of depression. Specifically, depressed patients successfully treated with cognitive therapy were less likely to suffer relapses of depression, and the reduced relapse rate was mediated by the therapy's effect on decreasing patients' stable and global styles for inferring causes of negative events. Similarly,...

Prevalence And Correlates Of Depression And Personality Disorders In Late Life

Depressive symptoms in late life are associated with increased risk of death from suicide (older adults have the highest suicide rate of any age group) and medical illness in addition to higher levels of functional impairment and health services utilization (Lynch, Morse, Mendelson, & Robins, 2003 Reynolds & Kupfer, 1999). The vast majority of treatment outcome studies for mental health problems have focused on pharmacotherapy, but medication treatment in the elderly is complicated by sensitivity to side effects, potential for harmful interactions with other medications, and comorbid medical and neurological disorders (Hollon, Thase, & Markowitz, 2002 Thompson, 1996). Psychosocial interventions, such as CBT, may thus be particularly appropriate for older adults. The American Psychiatric Association (APA, 2000) guidelines for treating major depressive disorder suggest that CBT is warranted if patients prefer not to take medications or if they experience...

Daniel R Strunk and Robert J DeRubeis

Cognitive therapy (CT) involves an effort to correct patients' biased thinking patterns, which, in turn, is thought to help them to overcome their depressive symptoms. Although several cognitive-behavioral psychotherapies for depression exist, researchers have focused primarily on Beck's CT (Beck, Rush, Shaw, & Emery, 1979). Beck's CT is a short-term, structured, manualized therapy. As in other psychotherapies, CT therapists strive to form a good collaborative working relationship with their patients. However, in contrast to some psychotherapies, CT also involves specific techniques. These CT techniques fall into three classes. Behavioral techniques are used to facilitate patients' engaging in activities that give them a sense of pleasure or mastery, as well as to test beliefs (e.g., I can't even get out of bed in the morning). Cognitive techniques are used to encourage patients to treat their cognitions as hypotheses The Cognitive Behavioral Analysis System of Psychotherapy...

Beck Therapy Approach

Cognitive Conceptualization Diagram

Diagnosis Axis I Major depressive episode_Axis II_ None Key dysfunctional beliefs can be identified in several ways. Sometimes patients (especially depressed patients) express their beliefs directly, as automatic thoughts (I'm a complete failure.) Beliefs may be inferred by examining the consistent themes in automatic thoughts across situations. Cynthia, for example, had frequent thoughts such as, Mary won't want to spend time with me, No one will want to talk to me at the party, My friends don't really know me very well, If I try to get closer to Jane, she'll reject me, and People don't seem to like me much. One of Cynthia's central beliefs, expressed indirectly in the thoughts above, was that she was unlovable.

Contemporary Treatment Practices

Cognitive-behavioral treatments typically begin with a focus on behavioral components. If necessary, therapists first manage suicidal symptoms. They also seek to increase the child's experience of positive reinforcement through their relationship with the child, activity scheduling and pleasant-events monitoring. The therapist provides positive incentives for the child to engage in adaptive activities, social interaction, and mastery experiences. Therapists may seek to decrease the child's reinforcement for depressive symptoms (e.g., ignore non-life-threatening depressive behaviors such as whining). Therapists also increase the child's use of self-reinforcement (e.g., pleasurable activities or self-praise) for engaging in adaptive behavior. If skill deficits exist, the therapist teaches skills (e.g., social skills, problem solving) that will help the child receive more positive reinforcement from the environment. Social skills training approaches have frequently been implemented in a...

Depression in Children

Until the 1970s, many clinicians and scholars expressed doubt that children experience genuine depression. The common view held that children were incapable of experiencing full-blown depression. It is clear that children do experience depression, but do so and express it differently from adults (e.g., in offering less verbalization concerning mood and symptoms). With proper developmentally appropriate rewording, the same diagnostic criteria for major depression that are used in adults can apply to children. Depression becomes increasing common as the child grows and reaches a prevalence rate among adolescents that is comparable to that in adults. It is estimated that up to 9 percent of adolescents meet current criteria for major depressive disorder (MDD) and up to 25 percent had suffered from it by their late teens (Kessler et al.). While depression seems to equally affect boys and girls before puberty, female teenagers have a substantially higher rate of depression than their male...

Incidence And Impact Of Psychological Issues

The typical ICD recipient must overcome both the stress of experiencing a life threatening arrhythmia and the challenge of adjusting to the ICD. Anxiety is particularly common, with approximately 24-87 of ICD recipients experiencing increased symptoms of anxiety after implantation and diagnostic rates for clinically significant anxiety disorders ranging from 13-38 .3 The occurrence of ICD shocks is generally faulted for this psychological distress, but its causal influence is confounded by the presence of a life threatening medical condition. Depressive symptoms reported in 24-33 of ICD patients are consistent with other cardiac populations.3

Symptoms Of Depression

Depression tends to be classified into two major categories major depressive disorder and dysthymic disorder. The principal differences between major depressive disorder and dysthymic disorder are severity and chronicity. Major depressive disorder is more severe and characterized by discrete major depressive episodes, whereas dysthymic disorder is less severe and characterized by a more chronic course. These disorders are not mutually exclusive a major depressive episode superimposed on a chronic course of dysthymic disorder is conceptualized as double depression. The American Psychiatric Association, in its Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), defined the symptomatic criteria for a major depressive episode (Table I). Once the criteria for a major depressive episode have been met, and the appropriate diagnostic rule-outs have been made (e.g., other psychiatric disorder and general medical condition causing the depressive episode), a diagnosis of major...

Prevalence Of Psychosocial Distress

Although there is a great deal of variability in individuals' responses to the challenges of providing care, family caregiving is associated with higher rates of psychosocial distress and mental health problems. This is especially true for family caregivers of individuals with dementia. Studies of dementia family caregivers have found elevated rates of depressed, irritated, and anxious mood, clinical depression, and generalized anxiety disorder among this population. In addition, dementia family caregivers tend to report poorer perceived sleep and general health, and an increased use of psychotropic medications (Ory et al., 2000). These declines in psychosocial functioning not only affect the caregivers' general well-being and quality of life, they also can affect their ability to provide care. Thus, interventions that aim to reduce caregiver psychosocial distress are extremely important. Before we begin our review of such interventions, however, we want to highlight that levels of...

Epidemiology Of Depression

Up to 17 of the general population in the United States will meet criteria for a major depressive episode at some time. The lifetime prevalence for dysthymia is approximately 6 , and that of depression with a seasonal pattern is approximately 0.4 . Also, many more people will have some experience with lower, subclinical levels of depressive symptoms. Children and adolescents also experience depression and its associated symptoms Estimates of the number of children who will experience a depressive episode by the end of high school range as high as 20 . and emotional consequences of depression. Almost 75 of individuals who reported a lifetime history of depression also reported experience with one or more other psychiatric disorders, including anxiety disorders (58 ) and substance use disorders (39 ). Up to 15 of individuals with severe major depressive disorder will attempt to commit suicide.

Electroconvulsive Treatment

ECT is the second form of biological treatment for depression and is currently used predominately with individuals experiencing severe and or intractable depression that has not responded to antidepressant medications and psychotherapy. ECT involves the induction of a general seizure via the application of a brief electrical stimulus through electrodes that are placed on the scalp. Individuals are placed under general anesthesia and given a muscle relaxant in order to prevent discomfort and injury resulting from the seizure. It is the seizure that is believed to produce the antidepressant effect, although the mechanism of action remains unclear. Animal studies suggest that ECT exerts its effects via the enhancement of norepi-nephrine and serotonin systems, paralleling the effects of antidepressant medications. In addition, ECT appears to affect the dopaminergic, cholinergic, GABA, and opioid systems. Considerable research has supported the short-term efficacy of ECT in alleviating...

Summary And Future Directions

Depression is a serious disorder with significant economic and social consequences that appears to be increasing in prevalence. Attempts to understand the causes of depression must encompass both biological and psychological perspectives. Treatments of depression offer significant hope Up to 70 of individuals will respond to antidepressant medication specific forms of psychotherapy produce similar rates of symptom alleviation. ECT is even more effective Up to 90 of people will respond to treatment. However, depression appears to be a chronic, relapsing disorder. The risk for relapse remains high in both treated and untreated individuals. ALCOHOL DAMAGE TO THE BRAIN ALZHEIMER'S DISEASE, NEUROPSYCHOLOGY OF ANGER APHASIA BASAL GANGLIA BEHAVIORAL NEUROGENETICS COGNITIVE PSYCHOLOGY, OVERVIEW DEMENTIA HUMOR AND LAUGHTER MANIC-DEPRESSIVE ILLNESS NEUROPSYCHOLOGICAL ASSESSMENT PSYCHOACTIVE DRUGS PSYCHONEUROENDO-CRINOLOGY PSYCHOPHYSIOLOGY SUICIDE

Suggested Reading

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. American Psychiatric Association, Washington, DC. Blazer, D. G., Kessler, R. C., McGonagle, K. A., and Swartz, M. S. (1994). The prevalence and distribution of major depression in a national community sample The National Comorbidity Survey. Am. J. Psychiatr. 151, 979-986. Consensus Development Panel (1985). Mood disorders Pharama-cologic prevention of recurrences. Am. J. Psychiatr. 142, 469-476. Fava, G. A., Rafanelli, C., Grandi, S., Canestrari, R., and Morphy, M. A. (1998). Six-year outcome for cognitive behavioral treatment of residual symptoms in major depression. Am. J. Psychiatr. 155, 1443-1445. Horst, W. D., and Preskorn, S. H. (1998). Mechanism of action and clinical characteristics of three atypical antidepressants Venla-faxine, nefazodone, buproprion. J. Affective Disorders 51, 237-254. Keitner, G. I., and Miller, I. W. (1990). Family functioning and major depression An...

Neuropsychiatry Implications

Bind to GABA-A receptor subtypes in the amygdala and alter the neuronal excitability. Corticotropin-releasing factor is an anxiogenic peptide that appears to act in the amygdala and adjacent nuclei. Several functional imaging studies have demonstrated that phobic and depressive symptoms rely on abnormal activity within the amygdala, together with abnormalities in other brain structures.

Demoralization Hypothesis

In general, depression is a mood state characterized by a sense of inadequacy, feelings of despondency, sadness, pessimism, and decrease in activity or reactivity. Depressive disorders involve a spectrum of psychological dysfunctions that vary in frequency, duration, and severity. At one end of the continuum is the experience of normal depression (a transient period, usually lasting no longer than two weeks), consisting of fatigue and sadness, and precipitated by identifiable stressors. At the other end of the spectrum is the longer-lasting period of depressed mood approaching clinical depressive disorders, which is accompanied by difficulties in sleeping, onset of eating problems, and growing thoughts of despair and hopelessness. In psychotic depression, the individual suffers deep despair and sadness and may lose contact with reality and develop delusions, hallucinations, and severe motor and psychological retardation. In this sense, depression may be a...

Symptom Substitution

Research on exposure therapies for phobias has revealed no convincing evidence of symptom substitution. Once fears or phobias are eliminated by exposure therapy, the treatment-related gains tend to be maintained. Although new symptoms may sometimes later emerge (e.g., depressive symptoms), a more common pattern is that there is a generalization of treatment effects once a patient's phobia has been reduced by exposure, the patient's mood may improve and he or she may become happier in general. This effect is most often seen when debilitating phobias have been eliminated, thereby enabling the person to enjoy a higher quality of life. Interestingly, in the treatment of phobias, even Freud recommended in vivo exposure as an important component of therapy.

Inhibition of Amine Uptake

Inhibition of amine reuptake is believed to be the most important mechanism by which TCAs are efficacious in treating depression. TCAs are potent inhibitors of norepinephrine (NE) and serotonin (5-HT) reuptake but have little affinity for inhibition of dopamine (DA) reuptake. 3 Inhibition of neurotransmitter reuptake leads to increased synaptic levels and subsequent augmentation of the neurotransmitter response. Inhibition of NE reuptake is thought to produce the early sympathomimetic effects occasionally seen in some TCA overdoses and may contribute to the development of cardiac dysrhythmias. Serotonin syndrome results from increased 5-HT brainstem activity and has been produced by TCAs that are particularly potent 5-HT uptake inhibitors such as clomipramine and amitriptyline. In general, TCAs must be used in combination with other serotonergic agents to produce serotonin syndrome. Myoclonus and hyperreflexia often are attributed to increased serotonin activity.

Dimensions of Costs

Affective disorders are a common illness with 11 of the adult population in the United States suffering each year with an affective disorder. Of these patients, one half have major depression, one third dysthymia, and one sixth bipolar disorder. One fifth of Americans will have an affective illness during their lifetime. Green-berg and colleagues estimated the cost of depression in the United States in 1990, including both the direct costs of medical treatment and the indirect costs from mortality and reduced productivity, at 43 billion dollars. Several investigators have documented the greater disability and medical costs from depression than for other common medical conditions and other mental health disorders. In addition, depressed patients seek general medical care and have higher general medical costs than non-depressed patients. There are a handful of studies that document directly the cost impact and cost savings of psychotherapy for depressed patients. For patients with major...

Clinical Descriptions

Of racing thoughts were similar in all age groups) in normal children, manic children and manic adults in an attempt to describe ''paediatric age equivalents of adult symptoms of mania''. At all ages, manic subjects appear to be the happiest of people, because of their infectious, amusing, elated affect. The authors recommend it is important to evaluate children's affect in relationship to historical features in exactly the way one evaluates the incongruity between the infectious elation of manic adult patients in the context of histories that include loss of family, unemployment and jail sentences. A common presentation for bipolar children is to harass teachers about how to teach the class this harassment is often so intense that teachers telephone parents, begging them to ask their children to desist. These children may fail intentionally at school because they believe the courses are taught incorrectly. Another common grandiose manifestation in children as young as seven is to...

Efficacy and Side Effects

The effectiveness of ECT in reversing severe depression seems beyond dispute (Abrams Crowe APA Task Force) Many large studies show a significant recovery from depression in 80 to 90 percent of patients who receive ECT, as compared with 50 to 60 percent of depressed patients who respond to antidepressant medication. Patients who do not respond to drugs show a high response rate to ECT about 50 to 60 percent recover. No study comparing the differential effects of drugs and ECT has ever found that drugs have a greater therapeutic effect. ECT also works more quickly than drugs Patients who improve typically begin to do so after about one week drugs, if they work, typically take three to four weeks, sometimes longer, to have a significant effect. Many studies have shown that unilateral and bilateral ECT are equally effective treatments, although a minority have found unilateral ECT to be on average less effective. However unilateral ECT also causes, on average, less cognitive confusion...

Longitudinal Course Of The Disorder Outcome Studies

Lewinsohn et al. 22 interviewed 893 adolescents and then reassessed them at the age of 24. At baseline, 18 had bipolar disorder, 14 had sub-syndromal bipolar disorder, and 275 had major depression. Out of the bipolar group, 27 had a recurrence by the age of 24. Only < 1 of adolescents with major depression switched to bipolar disorder by the age of 24. Adolescents with bipolar disorder and sub-syndromal bipolar disorder had significant impairment in psychosocial functioning by the age of 24. However, none of the subjects with the sub-syndromal condition developed bipolar disorder during the 6-year follow-up period.

Psychological studies of anxiety and attention

Although the Stroop task has provided some important findings, the contribution of attentional as opposed to response processes (i.e., response inhibition) is not always clear. A more controlled paradigm, the dot probe task, has provided generally converging findings. This task involves the simultaneous presentation of two words, one of which is occasionally threatening in meaning, followed after 500 milliseconds by a detection target. In an initial study, MacLeod, Mathews & Tata (1986) found that patients suffering from generalized anxiety disorder were fast to detect the target when it appeared in the location of a threatening word, suggesting that their attention was preferentially allocated to the threatening location. In a subsequent study of trait anxiety, MacLeod & Mathews (1988) tested subjects under conditions involving low state anxiety (12 weeks before a major examination) and high state anxiety (1 week before the examination). Subjects high in trait anxiety showed an...

Culture Context and Individual Differences

Rates of depression and substance abuse disorders are low among Mexican Americans born in Mexico (Vega et al., 1998), and immigrant Mexican American women have a lifetime rate of depression of 8 , similar to the rates of nonimmigrant Mexicans (Vega et al., 1998). However, after 13 years in the United States, rates of depression for those women who immigrated to the U.S. rise precipitously. U.S.-born women of Mexican heritage experience lifetime rates of depression similar to those of the White population in the United States, nearly twice the rate of immigrants. These findings are mirrored in other indicators of health Despite high rates of poverty, Mexican American immigrant women have low rates of physical and mental health problems (Vega et al., 1998), Chinese American immigrant women have a lifetime rate of major depression near 7 , approximately half that of White women (Takeuchi et al., 1998). These results suggest that some aspects of culture may protect against culture pp....

Medical And Mental Problems In Primary Care

Helping patients to alter cognitive, emotional, and behavioral pathogenic risk factors. In addition, their knowledge in the assessment and treatment of mental health problems serves to contribute to the comprehensive, continuous care of patients across the life cycle. Over 25 of primary care patients have a diagnosable mental health disorder, most of which go undetected and untreated (Schulberg & Burns, 1998). Furthermore, undiagnosed psychological problems exert a tremendous impact on health care utilization, patient outcomes, and overall costs. There are considerable costs associated with untreated mental disorders such as depression and anxiety (Campbell et al., 2000). For example, depressed patients have higher rates of office visits, unexplained physical symptoms, and non-mental-health-related hospital-izations (Unutzer et al., 1997). In a meta-analysis of 91 studies conducted over a 30-year period on the impact of psychological interventions on health care costs, decreases in...

Problemsolving Formulation Of Depression

The most important concept in the relational problemsolving model is problem-solving coping, which integrates all cognitive appraisal and coping activities within a general social problem-solving framework. Specifically, when an individual is faced with a negative life event, various problems can occur, resulting in an increase in the likelihood of experiencing emotional stress. If the individual's ability to cope with such events is effective, then the stressful nature of this situation is reduced and little to no depressive symptoms are likely to emerge. However, if the person is not an effective problem-solver, he or she will have difficulty coping with the stress engendered by the negative life events and related set of problems. He or she will then have an increased likelihood

Problem Solving And Depression

A recent review of the available literature indicates that across several different samples of both clinical (e.g., adult outpatients reliably diagnosed with major depressive disorder, adult and adolescent inpatient groups, adult cancer patients) and nonclinical (e.g., high school students, college students, community residents) groups, strong associations exist between various problem-solving variables and depression (Nezu, Wilkins, & Nezu, in press). This appears to be true as well across various cultures (e.g., American, Chinese, and South African undergraduate students, French adolescents) and using various types of measures to assess problem solving (e.g., self-report and behavioral performance tests). For example, a negative problem orientation has been found to be an especially strong predictor of depression. Further, depressed adults, compared to matched nondepressed controls, evidence deficits in various problem-solving tasks related to real-life problems, such as...

Effective Versus Ineffective Problem Solvers

Important differences have been identified between individuals characterized as effective versus ineffective problem-solvers. In general, when compared to effective problem solvers, ineffective problem solvers report a greater number of life problems, more health and physical symptoms, more anxiety, more depression, and more psychological maladjustment. In addition, a negative problem orientation has been found to be associated with negative moods under routine and stressful conditions in general, as well as pessimism, negative emotional experiences, and clinical depression. Further, persons with a negative orientation tend to worry and complain more about their health (see Nezu, Wilkins, & Nezu, in press, for a review of this literature).

The Risk For Mood Disorders

Depressive disorders are frequently reported in the offspring of bipolar parents and, according to several studies 15,17,25 , they are the most frequently reported disorder. For Kashani et al. 11 , depression is more frequent in bipolar offspring (22 ) than in offspring of depressed parents, while Hammen et al. 17 and Radke-Yarrow et al. 18 found higher rates in children of depressed parents than in children of bipolar parents. Longitudinal studies may be needed to explore the eventual bipolar outcome in this population of depressed offspring, in view of the high rates of subsequent manic episodes in early-onset depression 46 . This risk is reported to be even higher in depressed children with a positive family history of bipolar disorder 47 . Chang et al. 21 described cross-sectional psychopathological features in 60 subjects (mean age 11.1 years) from 37 families with at least one bipolar parent. Of these 60 subjects, 33 (55 ) had a DSM-IV axis I disorder 17 subjects (28 ) met...

Epidemiology And Cause

Science has gained a large amount of information about manic-depressive illness but has been unable to identify specifically how the illness starts. There are most likely several causes for this syndrome of disorders. Studies of families, twins, and adoptions suggest that most cases of manic-depression are genetically inherited. There is general agreement among researchers that genetic components play a more significant role in transmitting bipolar I disorder than major depressive disorder, but this perspective continues to be debated. Family studies report that having a first-degree relative with bipolar I disorder increases the chances of developing manic-depressive illness by 8-18 times over families with no first-degree members having a bipolar disorder history. The likelihood of developing bipolar I disorder is 1.5-2.5 times greater if a first-degree family member has a major unipolar depressive disorder. Perhaps more illustrative of the genetic relationship to manic-depression...

Bipolar Affective Disorder

One of the most important contributions to the field of omega-3 fatty acids in psychiatric disorders has been the double-blind, placebo-controlled treatment study conducted by Stoll et al. (1999a) among subjects with bipolar affective disorder. Bipolar affective disorder is also commonly known as manic-depressive disorder, which more vividly describes the debilitating clinical course of this illness. Thirty subjects were treated with 14 capsules per day containing either 9.6 g d of ethyl ester EPA plus DHA or an olive oil placebo. Subjects were studied as outpatients for 4 mo and received the capsules in addition to their regular pharmacological therapies. After 4 mo, there was a significantly reduced relapse to a severe episode of mania or depression in the omega-3-treated group compared to the placebo treated group. Among subjects taking no other medications, four subjects in the EPA plus DHA group remained symptom-free for the length of the study, whereas the four subjects in the...

Postpartum Depression

Postpartum depression may provide an extremely useful model for testing the hypothesis that a deficiency of omega-3 fatty acids in adulthood, and in particular DHA, increases the predisposition to suffering depressive disorders (Hibbeln and Salem, 1995). Throughout pregnancy, the placenta actively transfers DHA from the mother to the developing fetus (Cambell et al., 1998). Without adequate dietary replenishment, DHA stores in mothers can become depleted (Holman et al., 1991 Al et al., 1995) and may not be replenished for 26 wk (Otto et al., 1997). Given these basic findings, we predicted that the prevalence rates of postpartum depression would be higher in countries with lower rates of seafood consumption. This study evaluated published data on the prevalence of

Neurotransmitter Alterations In Infancy

Other investigators have established that neurotransmission in the frontal cortex can also be affected by dietary essential fatty acids during infancy. De la Presa Owens and Innis (1999) fed piglets one of four infant formulas for 18 d. The formulas were either adequate or deficient in 18 2n6 and 18 3n3 or contained supplemental AA (0.2 ) and DHA (0.16 ). Frontal cortex concentrations of serotonin, tryptophan, dopamine, homovanillic acid, and norepinephrine were nearly doubled in the formulas supplemented with long-chain polyunsaturated fatty acids. It is remarkable that only 18 d of dietary intervention altered concentrations of these fundamental neurotransmitters. Austead et al. (2000) also reported changes in concentrations of both serotonin and CSF 5-HIAA in frontal cortex among piglets given control and DHA AA-supplemented formulas. They reported that frontal cortex concentrations of serotonin increased while the concentration of the metabolite, CSF 5-HIAA, decreased. One...

Serotinergic Metabolism And Impulsivity

Abnormalities in serotinergic neurotransmission caused by low-omega-3 status could potentially increase the risk for impulsive behaviors such as suicide and homicide and may be an important mechanism leading to an increased predisposition toward developing a depressive disorder (Hibbeln et al., 1998a). Abnormalities in serotinergic function are thought to be important in impulsive, suicidal, and depressive behaviors. Most of the commonly used antidepressant medications act to increase serotinergic neurotransmission (Meltzer and Lowey, 1987). One of the best-replicated findings in biological psychiatry is that low concentrations of CSF 5-HIAA are associated with suicide and depression (Roy et al., 1991). Low CSF 5-HIAA concentrations predict impulsive, hostile, and aggressive behaviors (Mann, 1995 Virkkunen et al., 1994 Linnoila et al., 1983) and reflect serotonin turnover in the frontal cortex (Stanley et al., 1985).

Considerations Of Central And Peripheral Mechanisms

One paradoxical observation that appears to be emerging from the clinical intervention trials is that EPA appears to be more clinically effective than DHA. In fact, no clinical study has yet demonstrated a clinical effect of DHA (Voigt et al., 1998 Peet et al., 2000 Marengell et al., 2000). Whereas DHA is selectively concentrated in neuronal membranes, EPA is virtually absent from neuronal tissues. Few peripheral mechanisms by which EPA could have central nervous systems effects have been described. For example, it is possible that EPA and or DHA might increase vascular blood flow through the brain. However, a more plausible and well-substantiated immune-neuro-endocrine mechanism has been proposed by Smith (1991) and examined by Maes et al. (1993). This model has been described extensively in other publications (Smith, 1991 Maes et al 1993 Hibbeln, 1999) and will only be briefly presented here. Hyperactivity of the hypothalamic pituitary axis has repeatedly been described among...

Comments For The Design Of Future Studies Tissue Concentration Studies

Comparisons of tissue concentrations between controls and patients groups may be useful for exploratory analyses, but the groups should be controlled for confounding influences on fatty acid metabolism and catabolism and care should be take in the interpretation of the results. Comparison studies are of little value without careful diagnostic assessment and patient characterization. Consideration should also be given to the observation that improvement of depressive symptoms among subjects with other diagnoses may confound other outcome measures such as improvements in psychosis or cognition. Typically, comparison studies of the tissue composition of the fatty acids only determine if there is a difference between the groups at single point in time. Thus, it may be difficult to make interpretations concerning differences in basal metabolism or causal relationships. A series of critical questions must be addressed. Does this measure reflect differences in dietary intake Does the measure...

Psychological distress associated with genetic counselling for breastovarian cancer

Some research has used standard measures, which give an indication of the proportion of women who can be classified as clinical cases in terms of their levels of anxiety, depression and general psychological distress, and has found fairly high proportions of individuals to be under stress. In a recent study it was found that 41 of the women had a possible anxiety disorder, as measured by the Hospital Anxiety and Depression Scale, and 11 had a possible depression disorder, prior to attending for genetic counselling (Bish et al., 2002). These proportions are comparable to those found in other studies of women undergoing genetic counselling for breast ovarian cancer risk (e.g. Dudokdewit et al., 1998 Lodder et al., 1999 Kent et al., 2000). Other studies (e.g. Cull et al., 1999 Watson et al., 1999) have found approximately 30 of their sample of women undergoing genetic counselling to be classifiable as 'cases' on a psychiatric measure (General Health Questionnaire).

Recovery Curves And Treatment

The most effective treatment approach to most mild head injuries focuses on enhancing the natural recovery curve. Unlike more severe brain injury, significant medical intervention, cognitive rehabilitation, and physical therapy are rarely indicated. Interventions that focus on the previously mentioned individual risk factors will allow the individual to take advantage of natural recovery. Specific suggestions include increasing rest and reducing stress levels, reducing or eliminating alcohol consumption, treating depression with supportive psychotherapy and medications where warranted, assessing and treating pain and sleep disturbance, and educating the patient, family, and significant others regarding the typical mild head injury symptoms and natural recovery course. Early in the intervention process, it is important for everyone involved to have appropriate reassurances and positive expectations but an appreciation for the possible development of symptoms and an understanding that...

Neurochemical Contributions 1 Norepinephrine

Monosynaptic projections to the amygdala, hippocampus, cingulate gyrus, thalamus, hypothalamus, midbrain, and cerebral cortex. As early as 1929, Cannon described the role of NE in responses to threatening stimuli. NE has been linked to visual, auditory, and somesthetic stimuli as well as pleasurable experiences. The catecholamine hypothesis articulated by Schildkraut posits that mood disorders are the result of a deficit in noradrenergic activity leading to depressive states, whereas increased noradrenergic activity leads to mania. Although the exact relationship between mood disorders and NE activity is not fully understood, a vast amount of research has examined this hypothesis, which suggests that depression is in some way related to inefficient functioning of the NE system and that greater output is required to sustain adequate functioning. Since direct measures of NE or its urinary metabolite 3-methoxy-4-hydroxy-phenolglycol are difficult to interpret, physiologic markers have...

Generalized Brain Abnormalities

One study of patients with secondary depression found that patients with poststroke major depression had significantly larger lateral and third ventricular to brain ratios compared to patients with stroke who were nondepressed. This study suggested that subcortical atrophy preceding brain injury might produce a vulnerability to depression in patients with secondary depression.

Lithium Lithane Lithonate

Lithium salts are a relatively new treatment for manic-depressive psychosis, a serious mental illness in which people swing back and forth between extremes of mood, from intense elation (mania) to intense depression. Lithium damps out these mood swings and is especially good at preventing manic episodes, although it is also used to treat depression. It has many side effects and can produce serious toxicity in the nervous system, heart, and kidneys. It has no effects on the mind that recommend it for nonmedical use. Contraindications C'a comj and predisposition to urinary retention Not recommended n pregnancy Precautions and Side Effect* Drowsiness ay occur within the I rst few days of therapy Patients should ne warned against driving a car or operating machinery or appliances requiring alert attention When depression is accompanied by annety or agitation too severe to be controMed t> y riAVIL HCl atone a phenoth a me tranquilizer may be given concomitantly. Suiode is always a...

Regional Brain Abnormalities

Cortical Changes Studies of frontal lobe abnormalities among patients with mood disorders have reported findings such as smaller mean frontal area or higher T1 values on MRI scan in the frontal lobe in patients with UP depressive disorder but not in patients with BP disorder. However, additional studies of prefrontal cortical gray matter volume with better definition of what constitutes medial, dorsal, lateral, and orbital frontal cortex are needed to determine whether structural frontal abnormalities are associated with primary mood disorder. Based on consistent findings using functional imaging techniques of abnormal function in prefrontal cortex, it seems likely that structural abnormalities of prefrontal cortex may be identified in the future. Figure 2 The percentage of patients with major or minor depression based on the localization of their subcortical lesions. Patients with left basal ganglia lesions had a significantly higher frequency of major depression than those with...

Positron Emission Tomography Studies

The most common findings of PET studies of patients with depression are caudate and prefrontal hypome-tabolism. One study examined brain metabolic activity in three types of depressive disorder UP depression, BP depression, and obsessive compulsive disorder with secondary major depression. This study demonstrated a decreased glucose metabolic activity in the anterior lateral prefrontal cortex in all three groups of patients compared to controls. There was also a significant correlation between left frontal cortical metabolic rate and Hamilton Depression Score. A study examining regional cerebral blood flow in patients with primary depression and controls found significantly reduced cerebral blood flow in the left anterior cingulate and left dorsal lateral prefrontal cortex. In addition to confirming the frontal and basal ganglia findings, another recent study reported hypo-metabolism in prefrontal cortex ventral to the genu of the corpus callosum in both familial BP and familial UP...

Psychosocial Aspects Of Mood Disorders

Although evidence suggests that depressed patients suffer an impairment of social adjustment, the impact of life events and social support on the course of depression is controversial. In their Cumberwell study, Brown and colleagues identified the following social factors that explained the more prevalent numbers of depression in working-class women compared to middle-class women The working-class women (i) lacked an intimate relationship with a husband or cohabitant, (ii) had three or more children at home, and (iii) lost their mothers before age 11. Weissman and Paykel, using the Social Adjustment Scale, showed that depressed women had marital, parental, ocupa-tional, social, and leisure adjustment deficits.

Alternative Mood Stabilizing Drugs

In a review of the literature comparing treatment for depression with real ECT or simulated ECT, placebo, TCAs, and MAOIs, Fink showed that real ECT was significantly more effective in each comparison. Studies have also shown that ECT is equally effective in depressed UP and BP patients. The mechanism of action of ECT is not completely elucidated, but animal studies have found enhancement of brain concentrations of several neurotrans-mitters, such as norepinephrine, serotonin, dopamine, and GABA. These studies suggest that ECT might produce similar changes in neurotransmitter receptors as those produced by antidepressant drugs. The side effects of ECT are generally less severe than those that accompany the use of antidepressants, although loss of memory is a common complaint. Rapid transcranial magnetic stimulation (rTMS) is a new noninvasive technique that transfers energy from current in a magnetic coil to cortical neurons. The strength of the induced current is a function...

Nimh Collaborative Depression Efficacy Study

Affective Disorders and Schizophrenia interview to eliminate participants with comorbid diagnoses. Inclusion criteria included the diagnoses of a current episode of major depressive disorder, and a score of 14 or higher on an amended version of the 17-item Hamilton Rating Scale for Depression. Remaining candidates for the trial were excluded if they had additional psychiatric disorders, two or more schizotypal features, history of schizophrenia, organic brain syndrome, mental retardation, concurrent treatment, presence of specific physical illness or other medical contraindications for the use of imipramine, and presence of a clinical state inconsistent with participating in the research protocol (e.g., high suicidality). The 250 patients who passed the clinical and medical screening gave consent to be entered into the study and were randomly assigned to a treatment condition based on a separate computer-generated random order for each of three sites Pittsburgh, Oklahoma City, and...

What are the signs of depression

Medical institutions love to put diseases under neat little codes so the insurance company can pay for them. On paper, then, clinical depression has certain characteristics, and, according to insurance regulations, depressive disorder has at least one of the following characteristics In addition, you have to have four of the following symptoms to be diagnosed with a depressive disorder

Treating Emotional Problems with Medication

Experts differ on treatment for depression and anxiety. Although some doctors feel a combination of therapy and medication is most helpful, others believe a trial of antidepressant medication may be adequate. If you want to try medication without counseling first, your doctor may suggest one of the many antidepressants available. Most of these medications change the balance of the nerve chemicals in your brain. These chemical messengers, called neurotransmitters, are released by nerves and then taken up again by the nerves for reuse.

Personality Differences by Gender

Assertive, and goal oriented, while girls are taught to be passive, obedient, and adaptable. Accordingly, men are inclined to be independent, whereas women tend to be dependent. The sparse research available indicates that women across all marital statuses score higher than their male counterparts on measures of depressive symptoms (H. M. J. Kung & Farrell, 1992). Among the reasons offered for this phenomenon are the burden of multiple roles and social expectations (Y. H. Hu, 1990), unbearable marriages households (Wolf, 1975), and social isolation (Selya, 1985).

Factors That Affect Treatment Outcome

The presence of concurrent psychopathology is also known to affect treatment outcome for individuals with SAD. In one study, patients whose SAD was accompanied by a mood disorder were compared to patients with either uncomplicated SAD or a comorbid anxiety disorder. Those with comorbid mood disorders had more severe SAD symptoms and were more impaired before and after receiving CBGT (Erwin, Heimberg, Juster, & Mindlin, 2002). As was the case with subtype, patients with comorbid depression benefited from CBT to the same degree as those without comorbid depression. However, they remained relatively worse off following treatment. In an earlier study, patients who presented with high levels of depression at pretreatment were less likely to improve on measures of social anxiety and social skill following treatment with CBT (Chambless, Tran, & Glass, 1997). These findings highlight the importance of conducting a careful assessment of depressive symptoms among individuals seeking...

Individual Psychological Traits and Personality Features

A reliable assessment of pre-illness personality traits is difficult to make without prospective studies. As it is, most personality research has been done retrospectively and some studies have relied on the patient's memory alone, with its subjective bias, instead of obtaining information from independent interviews of parents or other relatives. It is also difficult to judge personality features during the acute stage of the disorder, since the starvation state tends to reinforce rigidity and controlling tendencies 25 . Other manifest features may be a consequence of a comorbid psychiatric disorder for instance, depressive symptoms affect self-esteem 25 . On the other hand, the overall stability of personality traits into adulthood makes it possible to obtain valid information from patients after full recovery 26,27 .

Background And Research

In depressive patients the psychotherapeutic part of the treatment involving cognitive restructuring is central especially since low self-esteem is a painful part of the psy-chopathological problem area. Enhancement of self-esteem and social skills works as an antidote to the depressive symptoms.

Family Interaction Environment and Psychopathology

Controlled family studies of AN have described strong familial aggregation in AN families, with intergenerational transmission, but there was no clustering of affective disorders, unless AN coexisted with a depressive disorder 40 . These findings were confirmed in a study of males with AN, which observed a twenty-fold increase of AN in female relatives. Conversely, bulimia nervosa was relatively uncommon among relatives of males with AN 41 .

The Cognitive Revolution

The Cognitive Revolution

The principle task in cognitive therapy (CT) is to help clients systematically determine ways of challenging these thoughts, usually by evidence gathering and self-monitoring. Since the time that Beck and his colleagues described this method for treating depression, it has been extended to anxiety disorders, substance abuse, personality disorders, obsessive-compulsive disorder, eating disorders, and delusions. Beck's approach has shown a great deal of promise in alleviating emotional distress, as well as shedding light on the interaction between therapy and medication. Specifically, it has been shown in numerous trials that cognitive therapy alone is at least as effective as antidepressant medication for depression, while also showing greater maintenance of gains following medication discontinuation. This has since become an important experimental design for use in determining the relative contribution of CBT and medication for a number of other psychological conditions such as...

Suggestion Laws Of See Frequency Law Of

Anomic - is based entirely on social issues. In the psychological domain, the hopelessness theory of suicidality emphasizes the developmental, emotional, and cognitive aspects of personal hopelessness, stress, depression, and vulnerability, as well as the psychosocial processes culminating in the suicidal act cf., major events effect - refers to the finding that in the case of personal disasters and emergencies, such as suicides, the rate of the occurrence of such behaviors is reduced prior to major events (such as important elections or sporting contests), and that the rate of occurrences of such behaviors (as suicide) increases following major catastrophes (such as earthquakes and floods) . Statistically, in the context of psychopathology, it is estimated that about 15 percent of individuals with major depression or bipolar disorder commit suicide each year. See also ANOMIE THEORY DEPRESSION, THEORIES OF PSYCHOPATHOLOGY, THEORIES OF. REFERENCES

Behavioral Case Formulation

As noted, behavior therapists emphasize a detailed analysis and evaluation of behavior. They use the term functional analysis to describe the clinician's assessment of causal relationships among a patient's problematic behavior, goals, affect, and cognition. Although the emphasis is on readily observable behavior including how the environment affects behavior, many behavior therapists also attend to an individual's thoughts and affect, considering these to be important mediating variables leading to behavior problems or solutions. Behavior therapists distinguish between ultimate outcomes and instrumental outcomes. The former reflect global, multidimensional, end-point solutions, such as resolution of a depressive episode. The latter refers to sets of tools that can facilitate achieving the ultimate outcome. For example, a depressive episode may be resolved through increasing social contacts, improving social skills so as to increase social reinforcements, exercise, changing...

Prevention And Intervention Protocols Incorporating Information About Precursors

A methodologically different approach, testing whether body image and eating disturbances contribute to the increase in major depression that occurs among girls during adolescence, is directly relevant to intervention efforts. Stice et al. 65 analysed data from a 4-year school-based longitudinal study and found that elevated body dissatisfaction, dietary restraint and bulimic symptoms at study entry predicted onset of subsequent depression among initially non-depressed youth when controlling for initial depressive symptoms. This study highlights the importance of mood changes in BN which would need to be taken into consideration in prevention efforts. The study confirms that the body image and eating-related problems in puberty constitute proximate risk factors for depression and contribute to the elevated rates of depressive disorders in adolescent girls.

Mental Disorders Due to a General Medical Condition

DSM-IV has implemented a major change in the classification of psychiatric symptoms caused by medical conditions. The previous terminology of organic brain syndrome and the subtypes organic mood disorder, organic delusional disorder, for example, have been eliminated because of the implication that the functional mental disorders were unrelated to biologic changes in brain function. Using DSM-IV, where there is evidence that a psychiatric disturbance is a direct physiologic consequence of a general medical condition or substance, the mental disorder is specified as due to the medical problem for example, major depression due to hypothyroidism. Common medical causes of psychotic and mood disorders are covered in Chap 281,

Dissociative Disorders

The patient presenting with a personality disorder may often be recognized by the characteristic effect the interaction has on the physician and medical staff. Antisocial patients, for instance, are disliked immediately they seem to be in control of their behavior unlike psychotic or depressed patients, but nonetheless have repeatedly engaged in maladaptive behavior. The patient may be seen as using the emergency department for some vague, or obvious, goal. These disorders are the most common secondary diagnosis in the malingerer.

TABLE 2811 Mental Status in the Emergency Department An Outline

Investigation of higher cognitive functions includes assessment of a patient's general command of information mental calculation, especially subtraction, such as serial sevens and spelling of words forward and backward (such as world). Patients with organic disease often have difficulty spelling backward or performing serial calculation. The patient's affect or outward display of emotion should be evaluated for sadness, euphoria, and anxiety. This may help distinguish between cognitive disturbance induced by depressive disorders and dementia due to significant cerebral pathology. An examiner can draw some conclusions regarding a patient's thought processes during the patient's own telling of his or her history.

Monoamine Oxidase Inhibitors Maois

MAO catalyzes the oxidation of biogenic amines (tyramine, serotonin, dopamine, and norepinephrine) throughout the body. The therapeutic effect of MAOIs is probably related to their ability to increase norepinephrine and serotonin in the CNS. They are recommended for atypical major depressive episodes, characterized by hyperphagia, hypersomnolence, reversed diurnal variation (worse in the evening), emotional lability, so-called leaden paralysis (heavy leaden feelings in arms or legs), and rejection hypersensitivity. They are also occasionally useful in selected cases of HCA-refractory major depression and panic disorder. Only two agents in this class, phenelzine (Nardil) and tranylcypromine (Parnate), are commonly used in the United States. As with HCAs, initiation of therapy in the emergency department is not recommended. The physician who initiates MAOI therapy must have firmly established an appropriate indication for use and provided the patient with extensive counseling about...

Theoretical Bases

Also in 2000, Robert Kohlenberg, Mavis Tsai, Chauncey Parker, Jonathan Kanter, and Madelon Bolling completed a National Institute of Mental Health treatment development study using FECT for clients with major depression. The study demonstrated that experienced cognitive therapists could learn how to competently do FECT. The results also showed that FECT improved treatment outcomes and interpersonal Although the empirical findings are favorable, FAP is a new treatment, and the types of empirical studies conducted thus far reflect its early stage in the treatment development process. Threats to internal validity have not been dealt with unequivocally. To advance to the next stage of empirical support, Robert Kohlenberg and colleagues are conducting a randomized clinical trial in which patients are randomly assigned to receive either CT or FECT for major depression. The outcome of this study will add important evidence that will be useful in assessing the utility of FAP

The Relationship Of Fidelity To Outcome

Research has suggested that specific and structuring behavioral aspects of therapy are associated with more symptom change than more abstract or theoretical aspects of treatment (Feeley, DeRubeis, & Gelfand, 1999). Feeley et al. (1999), for example, measured treatment adherence using the CSPRS and alliance in predicting therapeutic change in depressed patients treated by one of four CBT therapists. They found that the CT concrete scale was a significant positive predictor of change in depressive symptoms, in that the more the therapists delivered concrete skills early on in the therapy sessions, the greater the symptom relief. The CT abstract subscale had no relation to symptom change. Shaw et al. (1999) investigated the relationship between treatment competence and outcome in 37 individuals with major depression. The competence of eight cognitive-behavioral therapists was evaluated using the CTS. Results indicated limited support for the relationship between therapist competence...

Social Anxiety Disorder

SAD has a relatively early onset, and can persist for many years. Comorbid disorders often begin later on 61 . These include major depression, other anxiety disorders and substance use disorders. Simple screening questions 62 or scales, such as the Liebowitz Social Anxiety Scale (LSAS) and the Mini-Social Phobia Inventory (SPIN), are useful for screening for the presence of the disorder 63,64 . However, given that many people with SAD are unaware that they have a treatable medical disorder, and do not present to physicians for care, it is also important to increase awareness of the condition in the community as a whole. Early robust treatment of SAD might conceivably be able to decrease the morbidity of this condition, and prevent secondary comorbidity.

Psychiatric Evaluation

Some homeless patients without documented history of chronic psychiatric illness or substance dependence may present to the ED with psychiatric complaints. The stresses of sustaining life without a home are associated with a variety of diagnoses, including adjustment disorders, substance use, and major depression. 18 Alternatively, some homeless patients have a chronic history of psychiatric illness, including schizophrenia or bipolar disorder, that may be partially responsible for precipitating homelessness.19 The psychiatric assessment of homeless patients is important to providing adequate disposition of medical problems whose management may be compromised by mental illness. In addition, primary pharmacologic therapy can be evaluated or instituted in patients with chronic psychiatric disorders.

Chronic Stress and Depression 1 Animal Research

Appear to be consistently associated with alterations in particular lymphocyte subsets, although overall a higher number of leukocytes have been reported in depressed patients compared to controls. Studies of lymphocyte proliferation to mitogens in depressed patients have been particularly mixed, resulting in findings of higher, lower, or no differences in activity between depressed and age- and gender-matched nondepressed patients. Decreased NK activity appears to be the most consistent immunological change linked with depression. In addition, depressed individuals taking selective serotonin reuptake inhibitors demonstrate significant increases in NK activity (NK activity had been significantly lower than that of controls at the start of the experiment) which coincide with alleviation of the depressive symptoms. Although depression appears to be linked with suppression of some immune indices, many variables have been shown to affect the relationship between immune and depression,...

TABLE 2846 Benodiazepines

ANTIDEPRESSANTS Treatment with antidepressants is considered by many clinicians to be the mainstay of treatment for panic disorder, since the potential complications of abuse, dependence, and withdrawal are not associated with their use. Additionally, antidepressants may be beneficial in treating comorbid depression disorders. Due to safety considerations and side-effect profiles, SSRIs are considered the drugs of choice. Although sexual side effects may be problematic with all three antidepressant classes, SSRIs lack the anticholinergic side effects, cardiovascular effects, and toxicity in overdose associated with TCAs or When initiating treatment with SSRIs and TCAs, the starting dose should be lower than that used to treat depression, because panic disorder patients often are extremely sensitive to side effects. It is helpful to advise patients that they may temporarily notice some increased anxiety or activation when initiating treatment or increasing the dose. Patients should...

Combined Biological And Psychological Treatments

Clinicians and researchers have assumed that combining different forms of treatments would provide individuals with the most benefit. Antidepressant medications could reduce many of the physiological symptoms of depression (e.g., sleep and appetite dysregulation) while psychotherapy could reduce the maladaptive cognitions and behaviors. However, the research evidence supporting the efficacy of combined treatment for depression has produced mixed results. Adding psychological treatments to biological treatments has been shown to reduce relapse rates however, various studies examining the combination of antidepressant and psychotherapy from the outset of treatment have not found significant advantages of using either antidepressant medication or psychotherapy alone. Thus, researchers have begun to more closely examine patient variables that might contribute to improved response from combined treatment. For example, a recent large-scale study conducted by Martin Keller and associates...

Esther Deblinger and Melissa K Runyon

A number of protective factors have been identified that may buffer children from the negative effects of child abuse and may explain the variability in symptom development in child victims. Numerous investigations, for example, have documented the powerful influence of the reactions and adjustment of parents on children's outcomes following abuse (Cohen & Mannarino, 1996a Deblinger, Steer, & Lippmann, 1999 Kelly, Faust, Runyon, & Kenny, 2002). With respect to child-specific traits, a number of studies have demonstrated that negative general and abuse-specific attributions are related to anxious and depressive symptoms in children who have suffered CPA or CSA (Brown & Kolko, 1999 Cohen & Mannarino, 1996a Runyon & Kenny, 2002). These studies support the notion that children's perceptions about the abuse, themselves, others, and the world mediate the development of postabuse symptomatology.

Assessment In Clinical Practice

Successful use of the thought record depends on a number of factors the clinician's willingness to use this tool the clinician's knowledge about how to use this tool to help the patient identify cognitive distortions the ability of the patient to consciously access and write down his her automatic thoughts the ability of the patient to see this as a valuable tool and the willingness of the patient to use the thought record outside of session. Persons and colleagues (2001) identified other drawbacks to this tool such as difficulty in eliciting automatic thoughts from patients reluctance by patients to use the thought record in session beliefs by patients that it is not helpful and noncompliance with homework assignments to complete thought records. Despite these limitations in clinical practice, results from randomized clinical trials have demonstrated support for the value of the thought record in the treatment of depressed patients as a tool for identifying and changing dysfunctional...

Nurturant Supportive Affectionate Loving and Warm Parenting

Mental Health, Psychological Adjustment, and Emotional Well-Being Outcomes. Evidence of mental health, psychological adjustment, behavioral, and substance abuse outcomes of maternal warmth or lack thereof have now been documented for over 50 years. For example, when Australian, Chinese, Egyptian, German, Hungarian, Italian, Swedish, and Turkish mothers exhibit little warmth, offspring tend to exhibit significant symptoms of both clinical and non-clinical depression. Moreover, lack of maternal warmth has been related to depression among every major ethnic group in the United States, including Asian Americans, African Americans, Mexican Americans, and European Americans (Rohner & Britner, 2002). When paternal warmth is concurrently investigated with maternal warmth, paternal warmth often merges as a more significant predictor of mental health and psychological adjustment problems than does maternal warmth (Rohner & Veneziano, 2001). Cole and McPherson (1993), for example,...

Cognitive Behavioral Case Formulation

Persons has reported data showing average to good levels of agreement among clinicians independently constructing CBT-based formulations. The utility of CBT formulations has been preliminarily assessed by exploring the contribution that individualized formulations have on treatment outcome. Early evidence is equivocal. A study by Persons found that a group of depressed patients treated by her with individualized CBT guided by a CBT case formulation had similar outcomes to patients treated in a much larger study in which similar patients were treated with a standardized CBT protocol. Persons noted, however, that many of her patients had comorbid diagnoses that would have ruled them out for the comparative study.

Historical Overview

Throughout history scholars have described the symptoms and effects of manic-depressive illness. Ancient Greek, Persian, and biblical writers recorded The first person to identify the link between mania and melancholia or depression was Theophile Bonet. In 1686 Bonet described patients who cycled between high and low moods as having ''manico-melancoli-cus.'' During the mid-1800s, French researchers Falret and Baillarger each independently observed that patients having manic and depressive episodes were not experiencing two different disorders, but rather two different presentations of the same illness. Falret described the disorder as ''circular insanity'' and listed the symptoms much as they appear in today's medical books and journals. He also (remarkably) hypothesized that the illness was hereditary and believed that through research a medication would be found for effectively treating the symptoms. The German psychiatrist Emil Kraepelin, building on Falret and Baillarger's work in...

History And Overview Of Cognitive Distortions

Cognitive distortions were originally defined by Beck (1967) as the result of processing information in ways that predictably resulted in identifiable errors in thinking. In his work with depressed patients, Beck defined six systematic errors in thinking arbitrary inference selective abstraction overgeneralization magnification and minimization personalization and absolutistic, dichotomous thinking. Years later, Burns (1980) renamed and extended Beck's cognitive distortions to ten types all-or-nothing thinking overgener-alization mental filter discounting the positive jumping to conclusions magnification emotional reasoning should statements labeling and personalization and blame. Additional cognitive distortions, defined by Freeman and

Arthur A Freeman and Bradley Rosenfield

Regardless of the task, homework assignments should be concrete teaching hypothesis-testing skills. The essence of homework is to have patients examine specific beliefs, conduct direct tests of these beliefs, and practice hypothesis-testing skills in specific in-session and between-session exercises (Beck et al., 1979 DeRubeis & Feeley, 1990. Belief testing also produced more improvement in depressive symptoms posttreatment than less cognitive tasks.

Neuroglycopenic Syndromes

The third syndrome is exceedingly rare. It occurs only when the blood glucose concentration remains low, either due to the presence of an insulin-secreting tumor of the pancreas or overzealous treatment of diabetes with insulin for weeks or months on end. It is characterized by mental dysfunction resembling clinical depression, schizophrenia, or dementia, the symptoms of which are not relieved by restoring the blood glucose level to normal. Partial recovery may, however, take place over the

Winnie Eng and Richard G Heimberg

As noted earlier, CBT was first developed as a treatment for depression. CBT for depression has been shown in numerous studies to be more effective than no treatment at all and more effective than nonspecific treatments (those not specifically targeted at depression). CBT has also been shown to be at least as effective as, or more effective than, other psychological and pharmacological treatments. Also of note, CBT seems to reduce the risk of experiencing subsequent depressive episodes following treatment. Despite a long and relatively successful tradition of using CBT to treat depression, this approach does not

Case Examples A Anorexia Nervosa

Patsy was a 17-year-old high school student who had been suffering from anorexia nervosa since the age of 13. She was characterized by her family as a tenacious and diligent student, and she had been an excellent athlete in middle school and earlier in high school. Starting at ages 9 and 10 she clearly excelled in track and appeared to be headed for the State championship team. However, at age 13, shortly after she first started to menstruate, she started to diet severely in response to a casual remark by a friend at practice concerning her weight. At first her parents thought little of it, but within a few months she had lost considerable weight and the family took her to her pediatrician, who diagnosed anorexia nervosa and referred her to a child psychologist. The pediatrician also thought she was depressed and obsessional and started to treat her with paroxetine (Paxil), a selective serotonin reuptake inhibitor used to treat depression and obsessive-compulsive disorder.

Enantiomers their importance in psychopharmacology Introduction

(4) Antidepressants It is widely agreed that there is little difference in the therapeutic efficacy between any of the first- and second-generation antidepressants. However, in terms of their tolerability and safety, the second-generation drugs are superior. Of these, the SSRI antidepressants are the most widely used but, despite their clear advantages over the tricyclic antidepressants which they have largely replaced in industrialized countries, they have such side effects as nausea and sexual dysfunction which can affect compliance. While there are clearly differences in the frequency of side effects between the SSRIs, no clear overall advantage emerges for any one of the drugs. Many currently used antidepressants are chiral drugs (for example, tricyclic antidepressants, mianserin, mirtazepine, venlafaxine, reboxetine, fluoxetine, paroxetine, sertraline, citalopram), some of which are administered as racemates (such as the tricyclics, mianserin, mirtazepine, fluoxetine, reboxetine,...

Aspects of the biochemical basis of depression

Metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG) in the brains of suicide victims. The problem with such post-mortem studies is that (a) the precise diagnosis may be uncertain, (b) there is usually a considerable postmortem delay before the brain is removed at autopsy and (c) suicide is often committed by taking an overdose of alcohol together with drugs which grossly affect central monoamine neurotransmitter function. Unless these variables are carefully controlled, the value of the results obtained from such analyses is uncertain. Nevertheless, there is evidence that the neurotransmitter receptors in post-mortem brain are less labile than the neurotransmitters that act upon them. The finding that the density of beta adrenoceptors is increased in cortical regions of the brains from suicide victims who had suffered from depression is evidence of disturbed noradrenergic function which is associated with some of the symptoms of the illness. Such observations are further supported by...

Pharmacological Management of Undernutrition

One third of depressed older adults manifest with weight loss. Effective antidepressant therapy should result in weight gain in this subset of patients. Notably, the choice of antidepressant therapy may influence body weight reuptake. Selective serotonin (5-hydroxytryptamine, 5-HT) inhibitors, such as fluoxetine, can cause significant weight loss at the onset of therapy. Evidence in younger adults suggests that this is a transient phenomenon with baseline body weight being restored as treatment progresses. However, age-related changes in energy regulation and adaptation to chronic disease may delay or prevent return to baseline body weight in older patients. Mirtazapine has proved useful in the management of depressed patients with weight loss. Mirtazapine is a well-tolerated and effective antidepressant that inhibits presynaptic alpha2 adrenergic receptors and postsynaptic 5-HT2 and 5-HT3 receptors. Mirtazapine has been shown to induce an earlier increase in appetite and subsequent...

Bdv And Human Disease

Recognition of BDV's broad experimental host range, and the observation that disturbances in behaviors in experimentally infected animals are reminiscent of some aspects of human neuropsychiatric diseases, including major depressive disorder, bipolar disorder, schizophrenia, and autism, led to the proposal that BDV might be implicated in their pathogenesis. Although there is consensus that humans are likely to be susceptible to BDV infection, the epidemiology and clinical consequences of human infection remain

Historical Background

Contemporary terms for mood disorders, however, are mostly influenced by the work of Emil Kraepelin (1856-1926). In his textbook issued between 1883 and 1914 he applied the method of systematic collection and description of facts for the clinical delineation of mental disease entities. Under the term depressive states,'' he included melancholia simplex, melancholia gravis, fantastic melancholia, delirious melancholia, and stupor. Perhaps the greatest contribution of Kraepelin to modern psychiatric classification, however, was the distinction of affective disorders (for him, all forms of recurrent affective psychoses) from the more severe dementia praecox. Whereas dementia praecox exhibited a chronic deteriorating course resulting in poor long-term prognosis, manic-depressive illness had a recurrent course with full remission between psychotic episodes.

Impact Of Catecholamines On Behavior

Much of the information that is available concerning the functions of catecholamines in regulating human behavior directly results from the use of a group of medications often called psychotropic drugs and antidepressant medications called thymoleptics. Other medications that impact on catecholamines include psychostimulants, such as dextroamphetamine and methylphenidate (commonly known by its trade name, Ritalin) and l-dopa (which has been used to treat Parkinsonism), as well as a medication that was initially used to treat hypertension. Most of these drugs affect more than one system (e.g., dopaminergic, noradrenergic, or serotonergic systems). Catechola-mines have been proposed as mediators of many psychiatric illnesses, including schizophrenia, Tour-ette's syndrome, depression, autism, attention deficit-hyperactivity disorder, stereotypic movements, tremors, and substance abuse. More generically, cate-cholamines also play a critical role in the stress response. Unfortunately,...

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