OBJECTIVE: To evaluate the presence of Major Depressive Disorder (MDD) and Dysthymic Disorder (DD) in a sample of Italian children with Attention Deficit Hyperactivity Disorder (ADHD) and to explore specific features of comorbid depressive disorders in ADHD. METHODS: Three hundred and sixty-six consecutive, drug-naive Caucasian Italian outpatients with ADHD were recruited and comorbid disorders were evaluated using DSM-IV-TR criteria. To evaluate ADHD severity, parents of all children filled out the ADHD Rating Scale. Thirty-seven children with comorbid MDD or DD were compared with 118 children with comorbid conduct disorder and 122 without comorbidity for age, sex, IQ level, family psychiatric history, and ADHD subtypes and severity. RESULTS: 42 of the ADHD children displayed comorbid depressive disorders: 16 exhibited MDD, 21 DD, and 5 both MDD and DD. The frequency of hyperactive-impulsive subtypes was significantly lower in ADHD children with depressive disorders, than in those without any comorbidity. ADHD children with depressive disorders showed a higher number of familial psychiatric disorders and higher score in the Inattentive scale of the ADHD Rating Scale, than children without any comorbidity. No differences were found for age, sex and IQ level between the three groups. CONCLUSION: Consistent with previous studies in other countries, depressive disorders affect a significant proportion of ADHD children in Italy. Patient assessment and subsequent treatment should take into consideration the possible presence of this comorbidity, which could specifically increase the severity of ADHD attention problems.
Attention Deficit Disorder with Hyperactivity ; Child ; Comorbidity ; Conduct Disorder ; Depressive Disorder* ; Depressive Disorder, Major ; Dysthymic Disorder ; Humans ; Italy ; Outpatients ; Parents

OBJECTIVES: This study aimed to evaluate the effects of severity of functional disability, caused by physical illness, on the depressive symptoms and depressive disorders of the elderly patients (above 65 year-old) with physical illness. METHOD: Complete medical and psychiatric evaluations were achieved on 138 patients, except the 12 patients, who were severely cognitively impaired (MMSE-K score;below 19), of the 150 elderly patients (above 65 year-old) with physical illness. Sociodemographic data and health characteristic data were systematically collected, and the severity of functional disability caused by physical illness was evaluated. Depression scales (KGDS, GDS, MADRS) on 138 elderly patients were executed. In addition, based on the 61 patients of the 65 elderly patients (above 65 years old) with physical illness, except 4 patients who were severely cognitively impaired (MMSE-K score;below 19), sociodemographic data and health characteristic data were collected. The clinical diagnosis by DSM-IV diagnostic criteria and KGDS on 61 elderly patients were performed, and their functional disability caused by physical illness was evaluated. RESULTS: The frequency of depressive symptoms showed 50.0%, 36.2%, and 35.5%, respectively in KGDS, GDS, and MADRS. The patients with severe functional disability caused by physical illness-compared with those with mild functional disability-had significantly higher score on the depression scales (KGDS, GDS, MADRS). The correlation between severity of functional disability caused by physical illness and depression scales was highly positive. Severity of functional disability caused by physical illness was the strongest contributor to the depression scales. In the additional study, 19.7% of patients were diagnosed as major depressive disorder, 18% of them as dysthymic disorder, and depressive disorder (major depressive disorder & dysthymic disorder) group-compared with nondepressive disorder group-showed significantly higher score on the FDRPT and KGDS. CONCLUSION: The frequency of depressive symptoms and depressive disorder in elderly patients with physical illness was higher, compared with those in general elderly people. Functional disability caused by physical illness most highly influenced on depressive symptoms. Thus, it is important to discriminate whether the elderly patients with physical illness have depressive symptoms or not. In addition, we assumed that KGDS was not only highly correlated with other depression scales (GDS, MADRS), but also had the high diagnostic power of dis-crimination for depressive symptoms and depressive disorder. This study suggested that KGDS was available in screening depression in the elderly patients with physical illness. It was necessary to study systematically the availability of KGDS in the future.
Aged* ; Depression* ; Depressive Disorder ; Depressive Disorder, Major ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Dysthymic Disorder ; Humans ; Mass Screening ; Weights and Measures

OBJECTIVES: This preliminary study was carried out to develop the Family Burden Scale(FBS) of the schizophrenics. METHODS: Ninety-four items were collected by interviewing in a free unstructured format with one relative of each 200 schizophrenic patients and reviewing foreign FBS's. Several professionals and relatives were asked to group and integrate them into several categories. Finally 36 burden items were chosen to constitute a FBS. The FBS was administered to the relatives of 135 schizophrenic, 22 anxiety disorder, 26 dysthymic disorder and somatization disorder, and 49 dementia patients for examining the reliability and validity. RESULTS: The FBS showed high test-retest reliability, internal consistency, and discriminant validity. The results of the factor analysis revealed five-factor solution. CONCLUSION: The FBS can be used to evaluate the effectiveness of various programs intended not only to reduce decompensation among schizophrenics, but also to alleviate family burden.
Anxiety Disorders ; Dementia ; Dysthymic Disorder ; Humans ; Reproducibility of Results ; Schizophrenia ; Somatoform Disorders

BACKGROUND: Since dysthymia begins in late childhood or adolescence and has a chronic course, long-term pharmacotherapy may be required. New generation antidepressant, moclobemide, with more acceptable side effect profiles, is effective in the treatment of dysthymia. The main objective of this study was to determine whether they exhibit comparable efficacy and tolerability in dysthymia to amitriptyline. METHOD AND MATERIALS: The efficacy and tolerability of the moclobemide and amitriptyline, were compared in a eight-week single-centre double-blind study in patients(n=37) with dysthymia using he HAMD-17, the Clinical Global Impression Scale(CGI), the Montgomery-Asberg Depression Rating Scale(MADRS), Efficacy Index-Therapeutic Index(EITE), 4-point Index Side Effect Scale(4-PISES), and Efficacy Index-Side Effect Scale(EISE). RESULTS: A total of 37 patients entered the study, 19 were randomly assigned to the moclobemide group and 18 to be amitriptyline group. Demographic and illness characteristics were similar in both groups. There were no significant difference between two groups at the total 17-HDRS score, the HAMD-17% improvement, the total MADRS score, CGI response, and the EITE. In the comparison of EISE between two groups, the scores of the moclobemide group were relatively lower than the amitriptylinen group in full treatment. And the differences were significant(moclobemide group 1.39+/-0.61 ; amitriptyline group 2.00+/-0.85, p<.001). At the 4-PISE. There was no serious or treatment threatening side effects. And there was no specific difference in side effects between two groups. The moclobemide group reported higher EIR scores than the amitriptyline group at every follow up day, but the differences were not significant. And there was no significant differences in the scores of five HRQOL subcategories which is compared between two groups at every follow up days. CONCLUSIONS: In terms of 17-HDRS and MADRS, moclobemide and amitriptyline are equally effective at least in allevating dysthymic symptoms. But moclobemide tended to be less troubling and better tolerated than amitriptyline. Therefore, moclobemide treatment can be used as a safe, and higher satisfactory treatment strategy for the dysthymia.
Adolescent ; Amitriptyline* ; Depression ; Double-Blind Method ; Drug Therapy ; Dysthymic Disorder* ; Follow-Up Studies ; Humans ; Moclobemide*

Neurocognitive research focusing on cognitive deficits in Depression has resulted in several important but yet potentially contradictory findings. Much literature documents the presence of significant neurocognitive impairments in depressive patients. Studies have shown that dysthymic disorder patients demonstrate a diffuse pattern of cognitive impairment which is frequently indistinguishable from that of focal braindamaged patients. Some reports have suggested that there is a focal pattern of deficit, such as anterior cingulate dysfunction, frontal lobe impairment, or dysfunction of the temporal-limbic cortex. The aim of this study is to evaluate the neurocognitive functions in dysthymic disorder patients, and to compare the functions with those of major depressive disorder patients. The subjects are 17 dysthymic disorder patients. And their neurocognitive functions are compared with those of 23 major depressive episode patients. Patients with a history of neurologic disease, alcohol dependence, substance abuse and mental retardation are excluded. They are assessed with a part of Vienna Test System which is computerized neurocognitive function tests and can evaluate attention, eductive ability, reproductive ability, visuoperceptual analysis, vigilance, visual immediate memory, the speed of information-processing, judgement, and fine motor coordinations. There are no other specific difference between two groups, except the result of cognitrone test. This study provides information about the neurocognitive functions and some difference between major depressive disorder patients and carefully diagnosed dysthymic disorder patients.
Alcoholism ; Depression ; Depressive Disorder, Major* ; Dysthymic Disorder* ; Frontal Lobe ; Humans ; Intellectual Disability ; Memory, Short-Term ; Substance-Related Disorders

OBJECTIVES: The purpose of this study is to investigate the relationship between the triallelic serotonin transporter gene and stressful life events to determine their effect on depression with alcohol dependence. METHODS: Ninety-five hospitalized patients with alcohol dependence (73 male, 22 female) were enrolled in this study. Thirty-two (33.7%) of the total patients were diagnosed with major depressive disorder and dysthymic disorder by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV. The characteristics of stress were evaluated using the stressful life events scale, and depressive symptoms were assessed using the depression scale (Beck Depression Inventory, BDI). Alcoholism with depression (n = 32) and alcoholism without depression (n = 63) were genotyped for the triallelic serotonin transporter gene (LA : higher expressing allele, LG/S : lower expressing allele). RESULTS: There was no significant difference in the allele frequency between the depression group and the non-depression group (chi2 = 0.345, p = 0.619). LG/S alleles had more comorbid depression in the higher score of stressful life events scale [Mental-Haenszel (MH)-chi2 = 4.477, p = 0.034]. But there was no significant difference in the comorbidity according to the scores from the stressful life event scale in the LA alleles (MH-chi2 = 0.741, p = 0.399). In the results, alcohol-dependent individuals with LG/S alleles had more comorbid depression than those with LA alleles when they had experienced severe stressful life events (MH-odds ratio = 2.699, p = 0.028). CONCLUSIONS: These results suggest that there is no direct relationship between triallelic serotonin transporter gene and depression in the alcohol dependent patients. But alcohol dependent individuals with the lower expressing alleles of the serotonin transporter gene were more susceptible to depression than those with the higher expressing alleles in response to stressful life events.
Alcoholism ; Alleles ; Comorbidity ; Depression ; Depressive Disorder, Major ; Dysthymic Disorder ; Gene Frequency ; Humans ; Male ; Serotonin ; Serotonin Plasma Membrane Transport Proteins

OBJECTIVES: There have been noticeable progresses in the pharmacological management of depressive disorders along with vigorous preclinical and clinical trials of newer antidepressant drugs during the last decade. Since the first development of Korean Medication Algorithm for Major Depressive Disorder (KMAP-MDD) in 2002, there has been a substantial need for the revision of this algorithm. We amended the KMAP-MDD to Korean Medication Algorithm for Depressive Disorders (KMAP-DD) in 2006 and included treatment strategies for other types of depressive disorders. This article is about the treatment of MDD without psychotic features in the KMAP-DD 2006. METHODS: Questionnaires were developed by the executive committee for KMAP-DD. The first part of this questionnaire is about the treatment strategies of MDD without psychotic features, minor depressive disorder and dysthymic disorder. Seven questions and 10 sub-items were prepared to investigate the experts' opinions about treatment of major depressive disorders without psychotic features. The expert review committee composed of 101 experienced Korean psychiatrists was asked to evaluate the medication strategies for various clinical situations of depressive disorders using a 9-point scale. The scale was slightly modified from the format developed by the RAND corporation. We classified the expert opinions into 3 categories (first-line, high second-line and low second-line) by the 95% confidence interval of response score and evaluated the consensus of opinions of Korean experts using Chi2-test. RESULTS: For patients with MDD without psychotic features, antidepressant monotherapy was the optimal first-line treat-ment strategy regardless of the severity of an episode. In case of no or partial response to antidepressant monotherapy for severe episode of MDD, combination treatment with another antidepressant drug or augmentation treatment with triiodothyronine or lithium was considered as the second-line treatment. Meanwhile, for mild-to-moderate episode of MDD without psychotic features, switching to another antidepressant as well as augmentation or combination treatment was also considered as the second-line treatment. Selective serotonin reuptake inhibitors, venlafaxine, and mirtazapine were chosen as the 1st-line antidepressant drugs for MDD without psychotic features in Korea. CONCLUSION: The initial treatment strategy for patients with major depressive disorder without psychotic features is similar to that of the previous medication algorithm (KMAP-MDD). However, combination treatment with two antidepressant drugs and augmentation treatment strategies were considered at a relatively earlier step in this algorithm than in the previous version of Korean medication algorithm (KMAP-MDD) for the severe episode of major depressive disorder. The recent trials of newer antidepressant drugs and the preference of more active treatment strategy in up-to-date clinical psychiatry fields may have affected these changes in Korea.
Advisory Committees ; Antidepressive Agents ; Consensus ; Depressive Disorder* ; Depressive Disorder, Major* ; Dysthymic Disorder ; Expert Testimony ; Humans ; Korea ; Lithium ; Psychiatry ; Surveys and Questionnaires ; Serotonin Uptake Inhibitors ; Triiodothyronine ; Venlafaxine Hydrochloride

BACKGROUND: Depression and suicide are common in neurological disorders. However, their reported frequencies have varied widely due to heterogeneities in methodology and assessment timing. We evaluated the frequencies of current depression and suicidality in patients with epilepsy, Parkinson's disease (PD), and ischemic stroke (IS). METHODS: We enrolled patients who visited a tertiary care hospital in Seoul between January and December 2013. All of the patients completed the Beck Depression Inventory (BDI) and the Hospital Anxiety and Depression Scale-Depression subscale (HADS-D). Any patient with depressive symptoms (defined as a total HADS-D or BDI score of ≥9 or ≥17, respectively) was reassessed with a structured psychiatric interview based on the Mini International Neuropsychiatric Interview Plus 5.0.0 (MINI). RESULTS: In total, 305 patients were recruited, comprising epilepsy (n=92, 30.2%), PD (n=99, 32.4%), and IS (n=114, 37.4%). Depressive symptoms were exhibited by 52 epilepsy patients (56.5%), 56 PD patients (56.6%), and 54 IS patients (47.4%), and these were further evaluated with the aid of the MINI. Seven epilepsy patients were diagnosed as major depressive disorder (MDD), five as dysthymic disorder (DD), and nine as depressive disorder not otherwise specified (DDNOS). Twelve PD patients were diagnosed as MDD, 7 as DD, and 10 as DDNOS. Ten stroke patients were diagnosed as MDD, 7 as DD, and 11 as DDNOS. Most patients with depressive symptoms (91.4%) exhibited suicidality. CONCLUSIONS: Patients with epilepsy, PD, and IS frequently exhibit depression and suicidality. Neurologists should always be concerned about comorbid psychiatric problems when they see patients with neurological disorders.
Anxiety ; Depression* ; Depressive Disorder ; Depressive Disorder, Major ; Dysthymic Disorder ; Epilepsy* ; Humans ; Nervous System Diseases* ; Parkinson Disease* ; Seoul ; Stroke* ; Suicide ; Tertiary Healthcare

OBJECTIVES: In 2002, the Korean Medication Algorithm Project for Major depressive Disorder (KMAP-MD) was published, but there has been a need for a guideline about detailed issues of depressive disorder. We revised KMAP-MDD and reestablished Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) in 2006. METHODS: A questionnaire had been developed by the executive committee for KMAP-DD. The review committee consisted of 101 experienced psychiatrists. From the total of 22 questions in the questionnaire, 7 questions were evaluated for these subjects . We classified the expert opinions to 3 categories according to its confidence interval; first, second and third line. RESULTS: SSRI and venlafaxine were the first line antidepressants (AD) for atypical and melancholic depression. For dysthymic disorder and minor depressive disorder, SSRI was recommended as the first line medications. Only AD medications was a preferred initial strategy for treating premenstrual dysphoric disorder, mild to moderate and severe non-psychotic postpartum depression. In severe psychotic postpartum depression, combination therapy of AD and atypical antipsychotics was the treatment of choice. SSRI was preferred when considering sedation, anticholinergic and cardiovascular adverse effects. Also, experts recommended mirtazapine against gastrointestinal adverse effects and bupropion in avoiding sexual dysfunction. CONCLUSION: These results suggest that clinicians have to consider both clinical situations and drug adverse effects in the choice of antidepressant medications.
Advisory Committees ; Antidepressive Agents ; Antipsychotic Agents ; Bupropion ; Depression* ; Depression, Postpartum ; Depressive Disorder* ; Depressive Disorder, Major ; Dysthymic Disorder ; Expert Testimony ; Female ; Humans ; Psychiatry ; Surveys and Questionnaires

OBJECTIVE: The aim of this study was to identify the characteristic symptoms which can be used for the diagnosis of hwa-byung, a culture-related anger syndrome in Korea. METHODS: The symptoms of the Hwa-byung Scale were correlated with the Korean versions of the Hamilton Depression Rating Scale (K-HDRS) and the State and Trait Anger Inventory (K-STAXI) in 89 patients, who were diagnosed as having major depressive disorder, dysthymic disorder, anxiety disorders, somatoform disorders, or adjustment disorder according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria and who had self-labeled hwa-byung. Also, the symptoms of the Hwa-byung Scale were correlated with each other. RESULTS: The symptoms of the Hwa-byung Scale which were significantly correlated with the state anger of the K-STAXI but not with the depressive mood (item 1 of K-HDRS) included feelings of unfairness, subjective anger, external anger, heat sensation, pushing-up in the chest, dry mouth, and sighing. The symptoms which were significantly correlated with state anger and depressed mood included respiratory stuffiness, "haan" and hate. The symptoms which were not significantly correlated with depressed mood and state anger included going-out, epigastric mass, palpitation, headache/pain, frightening easily, many thoughts, and much pleading. These symptoms also showed higher correlation with each other in the correlation matrix. CONCLUSION: Our findings suggest that hwa-byung is different from depressive syndrome in terms of its symptom profile, and suggest what symptoms should be included in the diagnostic criteria of hwa-byung, an anger disorder.
Adjustment Disorders ; Anger ; Anxiety Disorders ; Depression ; Depressive Disorder ; Depressive Disorder, Major ; Diagnostic and Statistical Manual of Mental Disorders ; Dysthymic Disorder ; Hate ; Hot Temperature ; Humans ; Korea ; Mouth ; Sensation ; Somatoform Disorders ; Thorax