ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThere has been a rapid expansion of interest into the role of childhood trauma in depression over the past 10-15 years. Most studies find associations between recalled trauma, particularly child sexual abuse, and depression. There is, however, a need to establish whether it has a causal role, and if so what are the processes linking the trauma to depression.Recent findingsSeveral recent studies have confirmed a high rate of recalled sexual abuse in the general population, of around 18% in women and 5% in men. Recalled sexual abuse has been associated consistently with the diagnosis of depression in both men and women. Much less attention has been paid to the role of physical abuse. These associations hold up in studies that account for genetic influences. However the specific role of child sexual abuse is not yet clear. It is associated with multiple adult psychiatric disorders, and recent studies indicate that it may contribute to some, but not all, pathways to depression. It is likely that psychological, social and neuro-endocrine processes are affected by childhood trauma, and contribute to the risk for depression.SummaryThe finding of associations of childhood trauma with depression, together with other adverse childhood experiences, underlines the need for clinicians treating children and adults to take a developmental perspective. The elucidation of different pathways to depression, including childhood adversities, can help to clarify heterogeneity within the broad-brush diagnosis of depression. This should lead to a better understanding of the role of different mechanisms, with implications for early intervention and treatment.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThe present review focuses on recent neuropsychological assessments in bipolar disorder, the methodological issues concerning such studies and areas for future investigation.Recent findingsA range of neuropsychological deficits has been demonstrated in manic and depressed patients. However, nonspecific factors may confound such studies. Neuropsychological assessments of euthymic bipolar patients suggest that deficits persist during remission. However, there is debate as to how best conceptualise such ‘trait’ deficits. Similar neuropsychological deficits have been reported in bipolar disorder and in schizophrenia, which has potential nosological implications. The temporal evolution of neuropsychological deficits is unclear. Deficits have been associated with illness progression. However a few recent studies provide evidence of selective neuropsychological deficits in high-risk groups in bipolar disorder. The neural correlates inferred from neuropsychological studies are consistent with reports from functional neuroimaging and neuropathological studies which have identified prefrontal cortex disturbance and disruption of frontostriatal circuits in bipolar disorder.SummaryPersistent cognitive impairment in bipolar disorder challenges long-held views on the nature of the disorder. Clarification of the cognitive profile is necessary but will require well-constructed, methodologically robust studies. Further investigations in high-risk groups may help to clarify the development and cause of cognitive dysfunction in bipolar disorder.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThis article reviews the most recent findings regarding the relationship between depression and dementia.Recent findingsA history of depression increases the risk of dementia, and in patients with dementia the incidence of depression seems to be elevated. Cross-sectional studies show that the overall levels of depressive symptoms are comparable for individuals with and without dementia. The depressive symptoms in dementia are predominated by symptoms suggesting motivation disturbance.SummaryAlthough the aetiology of depression in dementia is unknown, several lines of evidence stress the importance of neurobiological factors. Further studies are necessary to unravel this intriguing relationship.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewAlthough chronic fatigue is reported by up to one third of patients contacting primary health care physicians, it remains a controversial symptom/syndrome which does not fall comfortably into either psychiatry or other branches of medicine.Relevant findingsProspective studies suggest that the severity of fatigue reported at first consultation predicts severity at follow-up, including an increased risk of future major depressive disorder. There is a dual interaction between fatigue and depression, one increasing the risk of the other. However, there is not complete symmetry of the disorders; pre-morbid psychiatric history is a better predictor of depression than chronic fatigue syndrome, and conversely positive tests for infectious mononucleosis are a better predictor of chronic fatigue syndrome than depression. Chronic fatigue appears to show some genetic aetiology but links to immune dysfunction remain tentative and require further research. In terms of treatment, cognitive behavioural therapy and graded exercise therapy have proved effective and deliverable both in chronic fatigue syndrome and its related syndromes. The benefits are only for some; however, many remain disabled.SummaryFatigue extends its influences and interactions widely. It is seen both in its own bespoke syndrome of chronic fatigue syndrome and also within the family of somatoform disorders. Depression, fatigue and physical illness appear to be intimately linked, each worsening the experience of the other having profound implications for patients' quality of life.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThere is an emerging body of data and clinical experience on the use of atypical antipsychotics in disorders other than schizophrenia, and particularly in the field of mood disorders. The present review addresses the most recent data on the efficacy of these drugs in the treatment of mania, depression and other mood syndromes.Recent findingsRecent trials support the efficacy and the safety of most atypical antipsychotics in the treatment of acute mania. Several trials suggest that atypical antipsychotics are as effective as typical antipsychotics, but that they are safer and more efficacious than mood stabilizer monotherapy in the treatment of mania. Recent data also support the use of adjunctive olanzapine in both bipolar and unipolar depression, and there is a suggestion that some atypical antipsychotics may possess mood stabilizing effects.SummaryThe atypical antipsychotic agents are useful medications for the treatment of mood disorders. There is clear evidence for their efficacy in mania, and data are emerging that suggest that they may also be useful in augmentation treatment of several forms of depression, and even perhaps as prophylaxis.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewIn this article we will review the literature on the relationship of depression and marital discord and the available data on the efficacy of couple therapy in the treatment of depression.Recent findingsCross-sectional research consistently find correlation between measures of marital discord and depression. In short-term longitudinal studies, marital discord is occasionally a predictor of depression, and depression is occasionally identified as a predictor of marital discord. Comparisons of standard forms of couple therapy to individual therapy in couples with both depression and marital discord generally find each treatment equally effective in treating depression, while couple therapy is generally superior in improving relationship satisfaction. A single recent study found couple therapy superior to pharmacotherapy as assessed by changes in Beck Depression Inventory scores. Many of the published data examine patients with depressive symptoms rather than specific mood disorders.SummaryCouple therapy appears promising as a treatment of depression but couple interventions specifically designed for the treatment of depression are needed, along with controlled trials examining the combination of couple therapy and pharmacotherapy versus monotherapy. Future research should extend beyond populations with depressive symptoms and focus on patients with specific validated mood disorders.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewRandomized, double-blind, placebo-controlled clinical trials have become the standard for evaluating new mood disorder treatments. This model has been criticized as being unethical for including placebo, as well as being prone to high rates of failure for established treatments because of a large placebo response.Recent findingsIn the presence of so many marketed antidepressants, some medical ethicists contend that new antidepressants should be compared with old antidepressants, without using placebo. Others contend that placebo response is large, variable, and unpredictable. As part of this debate, the scope of research and new ideas are being infused into placebo research.SummaryCaution is warranted before excluding placebo from mood disorder research, and new research is underway to define and assess placebo response in mood disorders.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewNot only does the research on panic disorder and agoraphobia continue to be abundant but it also appears to be shifting its focus.Recent findingsRecent literature on panic disorder puts more emphasis on real-world management issues of panic disorder, such as ‘collaborative care’ in the primary care settings and cognitive-behavioral approach to those who wish to withdraw from successful pharmacotherapy.SummaryWe need to place even more attention to outcomes directly relevant to patients themselves, such as social functioning and much longer-term course in the future clinical studies.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID