Effectiveness in psychiatric care: I. A cross-national study of the process of treatment and outcomes of major depressive disorder

Article Abstract:

About 8.3 percent of the general population suffers from at least one episode of major depression. While treatment is available, it is not always delivered in the most effective way. Four areas are thought to be important when treating someone for mental illness: medication, psychotherapy, supportive therapy for the family, and patient and family education programs. Some studies suggest that there is an underuse of care, and some fault the physician for not integrating the four areas. A study was designed to look at the relationships between treatment delivery, achievement of treatment goals, and outcome of patients with major depressive disorder. Three cultures were represented, American (seven patients), Italian (seven patients), and Japanese (10 patients). The majority suffered from a major depression that was best treated by the combination of the treatment measures outlined above. Subjects, doctors, and family members were interviewed separately and then together to gather information about treatment methods, goals, outcome, and demographics. Overall, all subjects improved over the course of the study but resolution reached only an average of three on a five-point scale. This score was similar for patients, regardless of country. The more aggressive the treatment approach with patient and family, the better the outcome. Also, more complete achievement of goals resulted in better outcome. When the group with the worst outcome was compared with the group with the best outcome, it was found that the group with worst outcome received significantly less combined treatment. Clearly, there is value in an aggressive approach to treating depression that integrates the patient and family through a variety of modalities, and works toward defined goals. Difficulties in achieving various aspects of this total care approach, such as patient and family compliance, are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychiatry

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Characteristics and long-term follow-up of patients hospitalized for mood disorders in the Phipps clinic, 1913-1940

Article Abstract:

The natural course of mood disorders, such as depression and manic-depression (bipolar illness), has been studied longitudinally, but there are still many contradictions and unanswered questions. One difficulty is the fact that the current widespread use of drugs to treat these disorders makes it impossible to observe and evaluate their natural course over time. However, this information is important to the development of maintenance treatment. One approach is the retrospective evaluation of treatment records from a time period when drugs were not widely administered as a maintenance treatment. The records of 1,017 patients who has at least a five-year follow-up (average follow-up was 13.5 years) were evaluated. The patients were hospitalized for mood disorders between 1913 and 1940. Two hundred ninety-seven were diagnosed with bipolar illness and 945 suffered from depression only. One hundred three of the patients committed suicide within five years after discharge. Bipolar patients had an earlier onset than depressives (by about 10 years) and were more likely to exhibit psychotic symptoms such as delusions and hallucinations. Depressives were more likely to be female and married. They were also more likely to have attempted suicide than bipolars and were more likely to have been hospitalized after to a specific, identifiable event. Bipolars often had problems with alcohol and had a longer hospitalization history than depressives. Those who committed suicide usually did so within a year of discharge. Overall, bipolar patients had the worst premorbid history and eventual outcome, with 43 percent unimproved after treatment. If left untreated after discharge, the natural course of affective disorder is characterized by repeat episodes of symptoms and chronicity, and was more pronounced for bipolars than for depressives in this sample. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Bipolar disorder, Psychiatric hospital care, Psychiatric hospitals

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Effect of personality disorders on outcome of treatment

Article Abstract:

The systematic investigation of the treatment of mental disorders such as depression and anxiety has failed to include an analysis of ways in which personality traits may affect the treatment and outcome of clinical syndromes. Refinement of techniques for the diagnosis of personality and psychiatric disorders has sparked new interest in undertaking this investigation. Two areas were examined: the effect of personality traits in predicting outcome of treatment of clinical syndromes such as depression and anxiety; and the association of specific personality traits with specific outcomes. There have been about 21 studies over the past 20 years which addressed these questions. All studies that examined the effect of personality traits on treatment outcome showed, to varying degrees, that personality pathology, or the presence of negative personality traits correlated with poorer outcome. Studies have focussed on short- and long-term treatment responses. Regarding the second inquiry, trends emerging from research results suggest that personality traits do differentially affect response to treatment of clinical syndromes. Personality traits that cluster around the anxious or dramatic categories may predict poor outcome for anxiety and depression. The treatment of obsessive-compulsive disorder may be inhibited by the presence of traits consistent with schizotypal personality disorder, characterized by interpersonal deficits and peculiar thoughts, beliefs, appearance, and behavior. However, there is not enough data yet to draw definitive conclusions. Once further evidence is found for the relationships suggested thus far, the mechanism of the effect needs to be investigated to determine exactly how personality traits affect treatment outcomes of psychiatric clinical syndromes such as depressive and anxiety disorders. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Personality disorders, Panic disorders, Panic disorder, Obsessive-compulsive disorder, Obsessive compulsive disorder

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