Patients with long-term diseases to be assessed for depression

GPs must assess people with chronic diseases to see whether they are suffering from depression, under new guidelines.

GPs must assess all patients with long-term diseases such as cancer to see whether they are suffering from depression, under new guidelines published today.

Too many doctors and patients assume that fatigue and weight loss are a result of the disease or the medicines they are taking, according to experts who formulated the guidelines for the National Institute for Healthcare and Clinical Excellence (NICE).

Depression affects one in six people at some point, but is three times more common in people with chronic diseases than in the rest of the population.

John Hindle, a consultant physician with the Betsi Cadwaladr University local health board, who was on the guideline development group, said that improving people's mood may even make them physically better.

"We should give everybody with physical disease the opportunity to be asked about the symptoms of depression," he said.

GPs should be asking two key questions, the guidelines say: during the last month, has the patient been bothered by feeling down, depressed or hopeless in the last month or by having little interest or pleasure in doing things?

READ MORE @ THE GUARDIAN

63 percent of RA patients suffer psychiatric disorders, with depressive spectrum conditions most likely

Over half (63%) of patients with rheumatoid arthritis (RA) also suffer from psychiatric disorders, with the majority of these (87%) occurring in the depressive spectrum, according to the results of a new study presented today at EULAR 2009, the Annual Congress of the European League Against Rheumatism in Copenhagen, Denmark. Interestingly, over half (52%) of the patients studied indicated that they had experienced stress events before the onset of their RA.

The study also revealed a number of other interesting findings about the emotional burden of RA:

* Cognitive dysfunction was diagnosed in 23% of patients, with 16% of this attributed to depression
* A third (33%) suffered from sleep disorders
* Those with depression also exhibited more severe RA (measured by X-ray), greater functional insufficiency and pain, as well as having received less aggressive treatment than patients without depression. (No significant differences in age, duration of illness, gender or DAS28* scores were noted between the two groups)
* Significantly, cognitive impairments were found more often (p=0.02) in patients older than 50 years (39% vs. 9%)
* The age of the first prednisone intake was significantly higher (p<0.05) in patients with depression compared to those without (48 vs. 30 years)

Dr Tatiana Lisitsyna from the State Institute of Rheumatology RAMS, Russian Federation, who conducted the study, said: "Psychiatric disorders are a very common comorbidity for people with RA, and they tend to be stress-related and associated with disease activity and chronic pain. Evaluating and addressing the mental health of those with RA should be a regular feature of rheumatology practice to improve quality of life and reduce the potentially distressing psychological burden of RA."

READ MORE @ EUREKALERT

Combo Treatment Relieves Comorbid Pain and Depression

A two-pronged intervention of optimized antidepressant and behavioral pain management therapy improves symptoms of comorbid pain and depression, a randomized trial showed.

The intervention yielded a clinically and statistically significant reduction of at least 50% in depression symptoms and at least 30% in pain for three times more patients than did usual care, which was significant at both six months (23.6% versus 7.9%) and 12 months (26.0% versus 7.9%).

The number needed to treat to improve pain to this threshold was 4.1, and it was 4.8 to achieve a response for depression, Kurt Kroenke, M.D., of Indiana University in Indianapolis, and colleagues reported in the May 27 issue of the Journal of the American Medical Association.

This was similar to the number needed to treat of 4 in a Cochrane review of antidepressants compared with placebo or no treatment in medically ill adults, they noted.

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Comorbidity: Psychiatric Comorbidity in Persons With Dementia

The assessment and treatment of psychiatric symptoms in persons with cognitive dysfunction are becoming increasingly important. Prevalence estimates of dementia in the United States range from 5% in those aged 71 to 79 years to 25% to 50% in those 90 or older. Up to 90% of patients with dementia have psychiatric comorbidities.1,2

Physicians who treat patients with dementia must remember that dementia is not merely a problem with memory. The presence of one or more additional cognitive disturbances, including aphasia, apraxia, or agnosia, is required to make the diagnosis according to DSM-IV-TR criteria. Furthermore, some patients may present with changes in personality or deficits in executive function rather than memory impairment, which complicates the initial diagnosis.3 Additional mental and behavioral disturbances often affect patients and caregivers as much as memory deficits and may influence quality of life, the need for institutionalization, mortality, and caregiver burden.2,4,5

This article emphasizes neuropsychiatric disturbances with the greatest prevalence and morbidity in persons with dementia. It also addresses comorbid depressive and anxiety disorders, as well as psychological and behavioral disturbances associated with dementia—psychosis and agitation/aggression.3,6

READ MORE @ PSYCHIATRIC TIMES

Comorbidity: Schizophrenia With Obsessive-Compulsive Disorder

The co-occurrence of obsessive-compulsive symptoms (OCS) and psychotic illness has been a challenge for clinicians and investigators for more than a century.1 Over the past decade, interest in this area has burgeoned because of recognition of higher-than-chance comorbidity rates of schizophrenia and obsessive-compulsive disorder (OCD), and observations of appearance or exacerbation of OCS during treatment of schizophrenia with atypical antipsychotics.2-6 Emerging neurobiological and genetic evidence suggests that persons with comorbid OCD and schizophrenia may represent a spe­cial category of the schizophrenic population.

The evidence for a putative schizo-obsessive disorder is examined and practical treatment suggestions for this subgroup of patients are outlined in this article.7-9

Comorbidity between OCD and schizophrenia
The lifetime prevalence for schizophrenia is 1% and for OCD it is 2% to 3%.10 Comorbidity rates for OCD in the schizophrenia population are substantially higher than what would be expected to occur randomly. In the schizophrenic population, the reported prevalence of clinically significant OCS and of OCD ranges from 10% to 52% and from 7.8% to 26%, respectively.11-23

The higher-than-expected comorbidity rate for OCD and schizophre­nia suggests a nonrandom association and possibly an integral relation between these 2 conditions.9 The question is whether this comorbid group with schizo-obsessive disorder represents a more severely ill group with greater brain dysfunction that could, in part, be caused by common neuro­developmental predisposing factors, or whether the 2 conditions are part of a more complex syndrome that rep­resents a distinct diagnostic entity. The answer could be clarified in part if neurobiological studies were to dem­­onstrate a distinct neuroanatomical substrate in this comorbid group rather than the summation or superimposition of neurobiological lesions observed in the separate disorders.9

READ MORE @ PSYCHIATRIC TIMES