Current Depression-medicine News Results

Comparisons of two different doses of fentanyl for procedural analgesia during epidural catheter placement: a double-blind prospective, randomized, placebo-controlled study.

J Anesth. 2010 Sep 2;
Yano T, Okubo S, Naruo H, Iwasaki T, Tsuneyoshi I

The purpose of this study was to investigate the effect of fentanyl on analgesic properties and respiratory responses during an epidural procedure. Sixty patients premedicated with oral brotizolam 0.25 mg were allocated to receive procedural analgesia with saline or 25 or 50 mug of fentanyl. Five minutes after administration, an epidural procedure was started. Pain assessments were made immediately after the epidural catheter placement using a visual analog scale. The lowest SpO(2) levels during the procedure were recorded to evaluate respiratory depression, and cardiovascular complications were also recorded. The pain scores were significantly lower in the 25 and 50 mug fentanyl groups than in the placebo group (P < 0.01). There was no difference in pain assessment between the 25 and 50 mug fentanyl groups. The lowest SpO(2) value of the 50 mug fentanyl group was significantly lower than those of the other groups (P < 0.001). Seven of 20 cases in the 50 mug fentanyl group needed oxygen administration because of a decreased SpO(2) value (<94%). No cardiovascular complications were observed in any group during the entire study period. Thus, intravenous fentanyl at a dose of 25 mug provides effective procedural analgesia without the risk of hypoxemia during an epidural procedure in a patient with preanesthetic medication.

Effect of rapamycin, an mTOR inhibitor, on radiation sensitivity of lung cancer cells having different p53 gene status.

Int J Oncol. 2010 Oct; 37(4): 1001-10
Nagata Y, Takahashi A, Ohnishi K, Ota I, Ohnishi T, Tojo T, Taniguchi S

Activation to a large extent of the phosphatidylinositol 3-kinase (PI3K)/Akt pathway and mutations in the p53 gene are involved in lung cancer therapeutic resistance. The mammalian target of rapamycin (mTOR) acts as a downstream effector for Akt. Activation of the Akt/mTOR signal is a contributing factor to decreased radiation sensitivity. The purpose of this study was to examine whether the effect of rapamycin on radiation sensitivity is affected by cellular p53 gene status. Cellular radiation sensitivity was evaluated by using two human non-small cell lung cancer (NSCLC) cell lines with the same genetic background except for their p53 gene status (H1299/wtp53 and H1299/mp53). The cells were treated with rapamycin and/or radiation. Cell viability, cell proliferation, apoptosis, cell cycle and Akt/mTOR signaling activity were explored. Rapamycin synergistically enhanced the cytotoxicity of radiation, promoting the induction of apoptosis. Moreover, the combined treatment augmented the cytostatic effects of radiation regardless of cellular p53 gene status. Rapamycin in combination with radiation increased G1 arrest and suppressed progression to S phase in both cell lines. Furthermore, the combined treatment conduced to a prominent p53-independent down-regulation of the mTOR signal and pro-survival molecule, cyclin D1. Rapamycin can enhance the effect of radiation through the repression of pro-survival signals and the reduction in the apoptotic threshold. Taken together, inhibition of the mTOR signal may be a promising strategy for radiosensitization with no relevance to p53 gene status from the aspects of cell lethality and cell growth depression.

Oxidative Stress Increased in Healthcare Workers Working 24-Hour On-Call Shifts.

Am J Med Sci. 2010 Aug 31;
Buyukhatipoglu H, Kirhan I, Vural M, Taskin A, Sezen Y, Dag OF, Turan MN, Aksoy N

INTRODUCTION:: Long work hours, night shifts, stressful situations and insufficient social support increase levels of anxiety and depression and decrease motivation to perform among healthcare professionals. In this study, we evaluated oxidative stress levels in medical residents working 24-hour on-call shifts, and in nurses, relative to non-healthcare hospital staff in sedentary positions. We also measured serum prolidase activity, a measure of collagen turnover, as an objective proxy for level of physical activity. METHODS:: Fifty-five male and 15 female medical residents on 24-hour, in-house, on-call duty, and 45 nurses and 30 (15 male/15 female) non-healthcare staff working 8-hour shifts were recruited. All were healthy nonsmokers. Parameters of oxidative stress and serum prolidase activity were measured twice for each subject, upon arising at 8 am after an overnight fast; and then again near the end of the work shift, or after 16 hours of consecutive work (at 12 pm) for residents. RESULTS:: After hours of continuous work, serum total oxidative status and the oxidative stress index increased significantly, whereas total antioxidant status decreased (all P < 0.0001) in healthcare staff (nurses, male and female residents). All these variables remained virtually unchanged in non-healthcare staff. Similarly, serum prolidase activity increased in healthcare staff (P < 0.0001), but failed to increase statistically in non-healthcare staff. CONCLUSIONS:: Healthcare workers suffer increased oxidative stress after prolonged work hours, especially while still on duty. Possible mechanisms for this include increased workload and, perhaps, psychological stress as well. However, long-term studies are needed to clarify the effects of sustained exposure to oxidative stress.

A case of a maintenance hemodialysis patient in whom a change of sensitivity to acetate was suspected.

ASAIO J. 2010 Sep-Oct; 56(5): 488-90
Kuragano T, Furuta M, Kida A, Kitamura R, Nanami M, Otaki Y, Nonoguchi H, Nakanishi T

Sodium acetate, which is a buffering agent in dialysates, has a vasodilatation effect as well as effects for depression of myocardial contractility even in low dosages. Also, it is presumed to be one of the causes of hypotension during hemodialysis (HD). In recent years, acetate-free dialysates [A(-)D] have been developed. In this case, although it was possible to maintain a relatively stable hemodynamic condition during HD using 10 mEq/L of acetate-containing dialysate [A(+)D], after HD using A(-)D for 4 months and then switched back to A(+)D, the patient complained of several symptoms such as nausea, vomiting, and headache, and severe hypotension episodes increased during HD. Furthermore, stabilization of the hemodynamic condition was obtained after switching back to A(-)D. Moreover, the nutritional state and anemia were improved. Conventionally, it has been considered that cases referred to as acetate intolerance have various symptoms with increasing blood acetate levels; however, this case suggests the possibility that tolerance to acetate was acquired by using the A(+)D over time, and the tolerance dissipated after using the A(-)D for 4 months. The number of cases involving broadly defined acetate intolerance as in this case was higher than expected. These findings suggest that using A(-)D for such cases, it may therefore be possible to maintain stable hemodynamic conditions during HD and improve the nutritional state and anemia.

Reliability and validity of a Nepalese version of the Kiddo-KINDL in adolescents.

Biosci Trends. 2010 Aug; 4(4): 178-85
Yamaguchi N, Poudel KC, Poudel-Tandukar K, Shakya D, Ravens-Sieberer U, Jimba M

The objective of this study was to assess the reliability and validity of a Nepalese version of the Kiddo-KINDL to measure Health-Related Quality of Life (HRQOL) in adolescents. We collected data from 204 students between 13 to 16 years old from four secondary schools in Lalitpur district, Nepal. The students answered a Nepalese version of the Kiddo-KINDL and the Center for Epidemiological Studies-Depression Scale (CES-D) with a self-administrated questionnaire. We conducted a test-retest study on the instrument at an interval of 10 days and then compared the Kiddo-KINDL scores between the low CES-D score group and the high CES-D score group students. The instrument showed good reliability and a small response variation. The internal consistency (Cronbach's alpha) of the total score was 0.93. Corrected item-total correlations showed that all items ranged from 0.47 to 0.79. The reproducibility was satisfactory with an Intraclass Correlation Coefficient (ICC) of 0.88-0.95. The Kiddo-KINDL scores in the low CES-D score group were significantly lower than those in the high CES-D score group students. The optimal cut-off score of the Kiddo-KINDL was estimated at 54.7, with an Area Under the Curve (AUC) score of 0.83 and both sensitivity (73.5%) and specificity (71.8%) were acceptably high. We recommended a mean change in Kiddo-KINDL total scores of 4.0 to be used to define a minimal important difference according to two-point CES-D score changes. Our results showed that a Nepalese version of the Kiddo-KINDL has internal consistency, reproducibility, responsiveness, interpretability, and discriminant validity.

The Spinal Substrate of the Suppression of Action during Action Observation.

J Neurosci. 2010 Sep 1; 30(35): 11605-11
Stamos AV, Savaki HE, Raos V

We have previously demonstrated that the forelimb representations of the primary motor and somatosensory cortices, as well as several premotor and parietal areas, are activated by both action-execution and action-observation, indicating that the spectator mentally simulates the observed action. Moreover, several studies demonstrated repeatedly that corticospinal excitability is modulated during action observation, providing evidence of an activation of the observer's motor system. However, evidence for the involvement of the spinal cord in action observation is controversial. The aim of the present study was to explore whether and how action-observation affects the spinal cord. To this end, we analyzed the spinal cord of eight monkeys (Macaca mulatta) trained to either execute reaching-to-grasp movements or observe the experimenter performing the same movements. Observation of grasping induced a bilateral decrease of glucose consumption in the spinal forelimb representation, whereas execution of grasping induced an increase of glucose utilization in the same area, ipsilaterally to the grasping hand. The depression of overall activity in the cervical enlargement of the spinal cord for action-observation may explain the suppression of overt movements, despite the activation of the observer's motor system.

The Effect of Medication Samples on Self-Reported Prescribing Practices: A Statewide, Cross-Sectional Survey.

J Gen Intern Med. 2010 Aug 31;
Pinckney RG, Helminski AS, Kennedy AG, Maclean CD, Hurowitz L, Cote E

BACKGROUND: The pharmaceutical industry spends billions of dollars annually to encourage clinicians to prescribe their medications. Small studies have demonstrated that one of the marketing strategies, the distribution of free sample medications, is associated with increased use of brand name medication over generic medication. OBJECTIVES: To determine the relationship between the presence of drug samples in primary care clinics and prescription of preferred drug treatments. DESIGN: Cross-sectional survey. PARTICIPANTS: Primary care prescribers in the state of Vermont. MAIN MEASUREMENT: Prescribers were presented with two clinical vignettes and asked to provide the name of the medication they would prescribe in each case. We compared the responses of prescribers with and without samples in their clinics. KEY RESULTS: Two hundred six prescribers out of the total population of 631 returned the survey and met the eligibility criteria. Seventy-two percent of prescribers had sample closets in their clinics. Seventy percent of clinicians with samples would prescribe a thiazide diuretic for hypertension compared to 91% in those without samples (P < 0.01). For managing depression 91% of prescribers with samples would have provided a generic medication in a patient with no health insurance, compared to 100% of those without samples in their clinic (P = 0.02). CONCLUSIONS: Clinicians with samples in their clinics were less likely to prescribe preferred medications for hypertension and depression.

Remifentanil Versus Fentanyl for Esophagogastroduodenoscopy in Children.

J Pediatr Gastroenterol Nutr. 2010 Aug 25;
Hirsh I, Lerner A, Shnaider I, Reuveni A, Pacht A, Segol O, Pizov R

OBJECTIVES:: We compared sedation by propofol combined with either fentanyl or remifentanil in pediatric outpatients undergoing diagnostic esophagogastroduodenoscopy. PATIENTS AND METHODS:: Forty-two children scheduled for esophagogastroduodenoscopy in our institution were randomly assigned to receive 2 mg/kg propofol plus either 1 mug/kg bolus of fentanyl (group F; n = 20) or 0.5 mug/kg bolus of remifentanil (group R; n = 22). Cardiorespiratory parameters, sedation level, adverse effects related to the drugs and/or to the procedure, ease of performance for the endoscopist, and time to awakening were analyzed. RESULTS:: There were no clinically significant changes in hemodynamics. Apnea periods >20 seconds and decreases in SaO2 <90% occurred more frequently in group R (31.8% vs 0%, P < 0.01, and 27.3% vs 5.0%, P > 0.05, respectively). Children in group R had significantly shorter average time to awakening: 9.5 +/- 5.6 vs 16.5 +/- 10.5 minutes (P = 0.01), and received a significantly lower total dose of propofol (P = 0.034). Adverse effects within the first 24 hours postprocedure occurred less frequently in group R (P = 0.03). CONCLUSIONS:: Remifentanil in combination with propofol provides good analgesic and sedative effects, which were shorter lasting compared with fentanyl-based sedation, and caused fewer delayed adverse effects. The use of remifentanil was associated with respiratory depression, emphasizing the need for experienced anesthesiologists.

Cognitive Decline in Patients With Dementia as a Function of Depression.

Am J Geriatr Psychiatry. 2010 Jul 8;
Rapp MA, Schnaider-Beeri M, Wysocki M, Guerrero-Berroa E, Grossman HT, Heinz A, Haroutunian V

OBJECTIVE:: There is evidence that major depression increases the risk for dementia, but there is conflicting evidence as to whether depression may accelerate cognitive decline in dementia. The authors tested the hypothesis that decline in cognitive function over time is more pronounced in patients with dementia with comorbid depression, when compared with patients with dementia without depression history. DESIGN:: Prospective, longitudinal cohort study of aging. SETTING:: Nursing home. PARTICIPANTS:: Three hundred thirteen elderly nursing home residents (mean age at baseline: 86.99 years, standard deviation = 6.7; 83.1% women). At baseline, 192 residents were diagnosed with dementia, and another 27 developed dementia during follow-up. Thirty residents suffered from major depression at any point during the study, and 48 residents had a history of depression. MEASUREMENTS:: The authors measured cognitive decline using change in Mini-Mental State Examination (MMSE) scores over up to 36 months. The authors calculated multilevel regression models to estimate the effects of age, gender, education, dementia status, depression, depression history, and an interaction between dementia and depression, on change in MMSE scores over time. RESULTS:: Beyond the effects of age, gender, and education, residents showed steeper cognitive decline in the presence of dementia (beta = -13.69, standard error = 1.38) and depression (beta = -4.16, SE = 1.2), which was further accelerated by the presence of both depression and dementia (beta = -2.72, SE = 0.65). CONCLUSIONS:: In dementia, the presence of depression corresponds to accelerated cognitive decline beyond gender and level of education, suggesting a unique influence of depression on the rate of cognitive decline in dementia.

Depression in Parkinson's Disease: Symptom Improvement and Residual Symptoms After Acute Pharmacologic Management.

Am J Geriatr Psychiatry. 2010 Jun 26;
Dobkin RD, Menza M, Bienfait KL, Gara M, Marin H, Mark MH, Dicke A, Friedman J

OBJECTIVE:: Parkinson's disease (PD) is frequently complicated by depression and there is a paucity of controlled research that can inform the management of this disabling nonmotor complaint. A randomized controlled trial of nortriptyline, paroxetine, and placebo for the treatment of depression in PD (dPD) was recently completed. The purpose of this article is to describe the baseline pattern of depressive symptom presentation in PD, the specific symptoms of dPD that improve with pharmacotherapy, and the residual symptoms that remain in patients who meet a priori criteria for response or remission after acute treatment (8 weeks). SETTING:: The Departments of Psychiatry and Neurology at Robert Wood Johnson Medical School, New Jersey. PARTICIPANTS:: Fifty-two depressed patients (major depression or dysthymia based on Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria) with Parkinson's disease (by research criteria). DESIGN/INTERVENTION:: A randomized controlled trial of nortriptyline, paroxetine, and placebo. MEASUREMENT:: The four subscales (core mood, anxiety, insomnia, and somatic) and individual items from the Hamilton Rating Scale for Depression-17 were the focus of this study. These measures were assessed at baseline and Week 8. RESULTS:: Baseline depressive symptoms were unrelated to motor functioning. Treatment response was associated with significant improvements in the core mood, anxiety, insomnia, and somatic symptoms seen in dPD. Residual symptoms, such as sadness and loss of interest, persisted in treatment responders in a milder form than was initially present. CONCLUSIONS:: Antidepressants may influence all symptoms of dPD, including those that share great overlap with the physical disease process. Additional research regarding adjunctive interventions is needed to help optimize the management of dPD.

Depressive Symptoms in Men Aged 50 Years and Older and Their Relationship to Genetic Androgen Receptor Polymorphism and Sex Hormone Levels in Three Different Samples.

Am J Geriatr Psychiatry. 2010 Jun 25;
Schneider G, Nienhaus K, Gromoll J, Heuft G, Nieschlag E, Zitzmann M

OBJECTIVE:: Depression in aging men has been related to low sex hormone concentrations; the putatively modulating effects of the genetically determined androgen receptor (AR) cytosine-adenosine-guanine (CAG) repeat polymorphism are often not taken into account. The aim of this study was to determine how sex hormone levels and the AR polymorphism relate to depressive symptoms in aging men. METHODS:: This cross-sectional study of men aged 50 years and older included 120 consecutive patients of the Department of Psychosomatics and Psychotherapy, 76 consecutive patients of the Andrologic Clinic, and 100 participants from the community sample (CS); all participants completed the Patient Health Questionnaire. Morning blood samples were analyzed for total and free testosterone, estradiol, and the AR CAG polymorphism. Patients on hormone substitution or other medication known to influence testosterone levels were excluded. RESULTS:: The two clinical samples had significantly longer AR CAG repeats and higher depression levels compared with the CS. When controlling for possible confounders, depression scores were positively correlated with CAGn (r = 0.20, df: 107, p

Depressive Symptoms Impair Everyday Problem-Solving Ability Through Cognitive Abilities in Late Life.

Am J Geriatr Psychiatry. 2010 Jun 25;
Yen YC, Rebok GW, Gallo JJ, Jones RN, Tennstedt SL

BACKGROUND:: The association between depression and functional disability in late life remains unclear. This study aimed to explore the relationship between depressive symptoms and daily functioning through the mediation of cognitive abilities, measured by memory, reasoning, and speed of processing. METHODS:: The authors recruited 2,832 older adults (mean age = 73.6 years, standard deviation = 5.9) participating in the Advanced Cognitive Training for Independent and Vital Elderly Study. Structural equation modeling was applied to illustrate the relationship between depressive symptoms and everyday problem-solving ability through the mediation of cognitive abilities. RESULTS:: Depressive symptoms were associated with impaired everyday problem-solving ability directly and indirectly mediated through learning and memory, and reasoning. Although depressive symptoms were associated with speed of processing, speed of processing was not significantly related to everyday problem-solving ability. CONCLUSIONS:: This study conceptualizes the possible relationships between depressive symptoms and daily functioning with mediation of cognitive abilities and provides a feasible model for the prevention of functional impairment related to geriatric depressive symptoms.

Antipsychotic and Benzodiazepine Use Among Nursing Home Residents: Findings From the 2004 National Nursing Home Survey.

Am J Geriatr Psychiatry. 2010 Jun 22;
Stevenson DG, Decker SL, Dwyer LL, Huskamp HA, Grabowski DC, Metzger ED, Mitchell SL

OBJECTIVES:: To document the extent and appropriateness of use of antipsychotics and benzodiazepines among nursing home residents using a nationally representative survey. METHODS:: Cross-sectional analysis of the 2004 National Nursing Home Survey. Bivariate and multivariate analyses examined relationships between resident and facility characteristics and antipsychotic and benzodiazepine use by appropriateness classification among residents aged 60 years and older (N = 12,090). Resident diagnoses and information about behavioral problems were used to categorize antipsychotic and benzodiazepine use as appropriate, potentially appropriate, or having no appropriate indication. RESULTS:: More than one quarter (26%) of nursing home residents used an antipsychotic medication, 40% of whom had no appropriate indication for such use. Among the 13% of residents who took benzodiazepines, 42% had no appropriate indication. In adjusted analyses, the odds of residents taking an antipsychotic without an appropriate indication were highest for residents with diagnoses of depression (odds ratio [OR] = 1.31; 95% confidence interval [CI]: 1.12-1.53), dementia (OR = 1.82; 95% CI: 1.52-2.18), and with behavioral symptoms (OR = 1.97, 95% CI: 1.56-2.50). The odds of potentially inappropriate antipsychotic use increased as the percentage of Medicaid residents in a facility increased (OR = 1.08, 95% CI: 1.02-1.15) and decreased as the percentage of Medicare residents increased (OR = 0.46, 95% CI: 0.25-0.83). The odds of taking a benzodiazepine without an appropriate indication were highest among residents who were female (OR = 1.44; 95% CI: 1.18-1.75), white (OR = 1.95; 95% CI: 1.47-2.60), and had behavioral symptoms (OR = 1.69; 95% CI: 1.41-2.01). CONCLUSION:: Antipsychotics and benzodiazepines seem to be commonly prescribed to residents lacking an appropriate indication for their use.

Caregiver Burden in Alzheimer Disease: Cross-Sectional and Longitudinal Patient Correlates.

Am J Geriatr Psychiatry. 2010 Jun 7;
Mohamed S, Rosenheck R, Lyketsos K, Schneider LS

OBJECTIVES:: Alzheimer disease (AD) imposes a severe burden on patients and their caregivers. Although there is substantial evidence of the adverse impact of burden, considerably less is known about its specific correlates and potential causes. DESIGN:: The authors use data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE)-AD study to examine the relationship of burden and depression among AD caregivers to patient and caregiver sociodemographic characteristics, patients' cognitive status, psychiatric and behavioral symptoms, functional abilities, quality of life, and intensity of care provided by caregivers. SETTING:: CATIE-AD included outpatients in usual care settings and assessed treatment outcomes during 9 months. PARTICIPANTS:: Data were examined from 421 ambulatory outpatients with a diagnosis of dementia of the Alzheimer type or probable AD with agitation or psychosis. Measures: The Burden Interview, the Beck Depression Inventory, and the Caregiver Distress Scale were used to evaluate caregiver burden. RESULTS:: More severe psychiatric and behavioral problems and decreased patient quality of life, as well as lower functional capability were significantly associated with higher levels of burden and depression among caregivers at baseline. Six-month changes showed that decreased symptoms and improved quality of life were associated with decreased burden and accounted for most of the explained variance in change in burden measures. CONCLUSION:: Severity of psychiatric symptoms, behavioral disturbances, and patients' quality of life are the main correlates of caregivers' experience burden. Psychosocial and pharmacologic interventions targeting these two aspects of the disorder are likely to not only alleviate patient suffering but also promote caregiver well-being.

Cerebrovascular Risk Factors and Cerebral Hyperintensities among Middle-Aged and Older Adults with Major Depression.

Am J Geriatr Psychiatry. 2010 Apr 27;
Smith PJ, Blumenthal JA, Babyak MA, Watkins LL, Hinderliter A, Hoffman BM, Steffens DC, Sherwood A, Doraiswamy PM

OBJECTIVES:: To examine the association between cerebral hyperintensities and cerebrovascular risk factors (CVRF) among middle-aged and older adults with major depressive disorder (MDD). METHODS:: Thirty patients (aged 55-77 years) with MDD and no history of stroke participated in a magnetic resonance imaging assessment to assess for the presence of cerebral hyperintensities and underwent a physical examination to assess stroke risk as indexed by the Framingham Stroke Risk Profile (FSRP). In addition, intima medial thickness (IMT) was measured in the left and right carotid arteries. RESULTS:: Higher FSRP levels were associated with total greater cerebral hyperintensities (r = 0.64), as well as greater subependymal hyperintensities (r = 0.47), confluent periventricular changes (r = 0.46), and tended to be associated with subcortical gray matter hyperintensities (r = 0.34). A quadratic relationship was observed between IMT and total cerebral hyperintensities (b = 4.84), and higher IMT levels were associated with greater subependymal hyperintensities (r = 0.40). CONCLUSIONS:: Higher levels of CVRF are associated with graded increases in cerebral hyperintensities among middle-aged and older adults with MDD.

Screening Depression Aging Services Clients.

Am J Geriatr Psychiatry. 2010 Apr 27;
Richardson TM, He H, Podgorski C, Tu X, Conwell Y

OBJECTIVES:: To establish the psychometric characteristics of the Patient Heath Questionnaire (PHQ) (PHQ-2, -9, and their sequential administration) in older adults who use community-based, social service care management. DESIGN:: Comparison of screening tools with criterion standard diagnostic interview. SETTING:: A community-based aging services agency. PARTICIPANTS:: Three hundred seventy-eight adults aged 60 years or older undergoing in-home aging services care management assessments. MEASUREMENTS:: Subjects were administered the PHQ-9 and Structured Clinical Interview for DSM-IV-TR-fourth edition. The authors examined the sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and receiver operating characteristic (ROC) curve for the PHQ-2 and PHQ-9 separately, and for a two-stage screening process that used each in sequence (the PHQ-2/9). RESULTS:: Using a cut score of 3, the sensitivity of the PHQ-2 was 0.80 and the specificity was 0.78. The area under the ROC curve (AUC) for the PHQ-2 was 0.87. Using a cut score of 10, the sensitivity and specificity of the PHQ-9 were 0.82 and 0.87. The AUC was 0.91. The sensitivity and specificity of the two-stage PHQ-2/9 were 0.81 and 0.89, respectively, and the AUC was 0.91. CONCLUSIONS:: The greater specificity of the PHQ-9 is an advantage over the PHQ-2 in aging service settings in which false-positive tests have potentially high cost. The PHQ-2/9 performed equally well as the PHQ-9, but would be more efficient for the agency to administer. Combined with an appropriate referral system to healthcare providers, use of the PHQ-2/9 sequence by aging services personnel can efficiently assist in reducing the burden of late-life depression.

A New Home-Based Mental Health Program for Older Adults: Description of the First 100 Cases.

Am J Geriatr Psychiatry. 2010 Apr 27;
Johnston D, Smith M, Beard-Byrd K, Albert A, Legault C, McCall WV, Singleton A, Brenes G, Hogan P, Reifler B

BACKGROUND:: The Geriatric Psychiatry Outreach (GO) Program began in 2005 and provides in-home psychiatric evaluation and treatment for older adults who have difficulty getting to an office-based setting. METHOD:: An initial assessment was conducted on the first 100 patients seen by the program and follow-up treatment was provided as clinically indicated. RESULTS:: The mean age of patients seen was 79.7 (SD: 8.2), 74% were women, and the most common psychiatric diagnoses were depression (50%) and dementia (45%), with a mean of 1.4 (SD: 0.6) psychiatric diagnoses per patient. The patients had a mean of 4.8 (SD: 2.9) medical diagnoses and were on a mean of 6.8 (SD: 4.0) prescription and 2.2 (SD: 1.2) nonprescription medications. Patients received a mean of 4.2 (SD: 4.2) in-person visits and a mean of 30.2 (SD: 36.5) additional contacts related to their care, such as phone calls, e-mails, and faxes. CONCLUSIONS:: Providing psychiatric services at home for older adults with mental illness is a much needed but rarely available service. Such patients typically have a complex combination of medical and psychiatric diagnoses and benefit from contacts in addition to the face-to-face visits.

Depression Among Older Adults in the United States and England.

Am J Geriatr Psychiatry. 2010 Apr 9;
Zivin K, Llewellyn DJ, Lang IA, Vijan S, Kabeto MU, Miller EM, Langa KM

CONTEXT:: Depression negatively affects health and well being among older adults, but there have been no nationally representative comparisons of depression prevalence among older adults in England and the United States. OBJECTIVE:: The authors sought to compare depressive symptoms among older adults in these countries and identify sociodemographic and clinical correlates of depression in these countries. DESIGN AND SETTING:: The authors assessed depressive symptoms in non-Hispanic whites aged 65 years and older in 2002 in two nationally representative, population-based studies: the U.S. Health and Retirement Study and English Longitudinal Study of Ageing. PARTICIPANTS:: A total of 8,295 Health and Retirement Study respondents and 5,208 English Longitudinal Study of Ageing respondents. MAIN OUTCOME MEASURES:: The authors measured depressive symptoms using the eight-item Center for Epidemiologic Studies Depression Scale. The authors determined whether depressive symptom differences between the United States and England were associated with sociodemographic characteristics, chronic health conditions, and health behaviors. RESULTS:: Significant depressive symptoms (Center for Epidemiologic Studies Depression Scale score >/=4) were more prevalent in English than U.S. adults (17.6% versus 14.6%, adjusted Wald test F[1, 1593] = 11.4, p < 0.001). Adjusted rates of depressive symptoms in England were 19% higher compared with the United States (odds ratio: 1.19, 95% confidence interval: 1.01-1.40). U.S. adults had higher levels of education, and net worth, but lower levels of activities of daily living/instrumental activities of daily living impairments, tobacco use, and cognitive impairment, which may have contributed to relatively lower levels of depressive symptoms in the United States. CONCLUSIONS:: Older adults in the United States had lower rates of depressive symptoms than their English counterparts despite having more chronic health conditions. Future cross-national studies should identify how depression treatment influences outcomes in these populations.

Depression-Executive Dysfunction Syndrome Relates to Poor Poststroke Survival.

Am J Geriatr Psychiatry. 2010 Mar 22;
Melkas S, Vataja R, Oksala NK, Jokinen H, Pohjasvaara T, Oksala A, Leppävuori A, Kaste M, Karhunen PJ, Erkinjuntti T

BACKGROUND:: The aim of this study was to investigate the influence of poststroke depression and executive dysfunction on long-term survival after acute stroke. METHODS:: A total of 257 consecutive acute ischemic stroke patients were included in the study and followed up to 12 years. Depression was diagnosed 3 months after stroke in 99 patients (38.5%). FINDINGS:: In Kaplan-Meier analysis, there was no difference in survival of patients with and without poststroke depression (8.7 versus 8.3 years). Instead, patients with both depression and executive dysfunction had shorter median survival than patients with neither depression nor executive dysfunction (6.6 versus 10.3 years). Comparison between all patients with executive dysfunction and patients without it, not regarding depressive status, showed that executive dysfunction in itself was strongly associated with poor poststroke survival (6.4 versus 10.6 years). In stepwise Cox regression proportional hazards analysis adjusted with covariates, poststroke depression with executive dysfunction (hazard ratio [HR] 1.63) and advanced age (HR 1.11) remained as independent predictors of poor long-term survival. INTERPRETATION:: The authors' well-defined poststroke cohort with long-term follow-up indicates that in poststroke depression, the depression-executive dysfunction syndrome is the predictor of poor long-term survival rather than depression in itself.

Depressive Symptoms Are Associated With Subclinical Cerebrovascular Disease Among Healthy Older Women, Not Men.

Am J Geriatr Psychiatry. 2010 Mar 11;
Wendell CR, Hosey MM, Lefkowitz DM, Katzel LI, Siegel EL, Rosenberger WF, Waldstein SR

BACKGROUND:: Associations among diagnosed unipolar depression, depressive symptoms, and cerebrovascular disease are well known. However, minimal research has investigated whether sex may modify such associations, despite known sex differences in depression and depressive symptoms. This study examined whether depressive symptoms were disproportionately related to subclinical cerebrovascular disease (SCD) in women versus men. METHODS:: One hundred one older adults (58% men; mean age = 67 years), free of major comorbidities, completed the Beck Depression Inventory and underwent magnetic resonance imaging (MRI). MRI scans were neuroradiologist rated for markers of SCD (periventricular and deep white matter hyperintensities, and number of silent infarcts) and brain atrophy (ventricular enlargement and sulcal widening). Two rank-sum outcome variables (SCD and brain atrophy) were then created. RESULTS:: On average, depressive symptoms were relatively low in magnitude (mean = 3.8, standard deviation = 3.6, range = 0-17). Multiple regression analyses, adjusted for age, sex, education, systolic blood pressure, fasting glucose, maximal oxygen consumption, body mass index, average weekly alcohol consumption, and Mini-Mental State Examination performance revealed sex to be a significant effect modifier of depressive symptoms in the prediction of SCD. Sex-stratified regression analyses indicated depressive symptoms, and SCD was strongly related among women but not men. Depressive symptoms were not related to brain atrophy, regardless of inclusion of sex as an effect modifier. CONCLUSIONS:: Depressive symptoms, even in a subclinical range, are significantly associated with an MRI-derived index of SCD among women, but not men, in the present sample of relatively healthy older adults.