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

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 was conducted in order to collect data regarding depressive disorder of elderly people at a community health center. METHODS: A total of 109 elderly people participated in this study. Trained examiners evaluated the general characteristics and symptoms of the subjects. Then the doctors conducted interviews with the elderly subjects in person and diagnosed depressive disorder according to the standard of Diagnostic and Statistical Manual of Mental Disorders-IV-TR. RESULTS: The prevalence of depressive disorder was 19.3%, major depressive disorder 10.1%, dysthymic disorder 1.8%, and others 7.3%. According to results of logistic regression analysis, in terms of demographic variables, the odds ratio of elementary school dropout compared with elementary school graduates was 3.60, after adjusting for age and sex. Thus, we found that elementary school dropout was associated with an increased risk of prevalence of depression. CONCLUSION: This is the first study of prevalence of depressive disorder in a primary health care center in Korea. Results of this study confirm that the prevalence of depressive disorder is two times higher among adults in the Chungju community. In addition, the level of education was also highly related. Examiners detected a possible relationship between sex and residence. The results will be helpful in conduct of future studies at the health care center.
Adult ; Aged* ; Community Health Centers* ; Delivery of Health Care ; Depression ; Depressive Disorder* ; Depressive Disorder, Major ; Dysthymic Disorder ; Education ; Humans ; Korea ; Logistic Models ; Odds Ratio ; Prevalence* ; Primary Health Care ; Student Dropouts

OBJECTIVE: Recently, the pharmacotherapy including antidepressants in treating depression is widely used. However, as a result of newer agents that are continuously introduced, pharmacological treatment strategy is also changing. To catch up this trend, Korean Medication Algorithm Project for Depressive Disorder was developed in 2002 and revised in 2006. Since the last revision, the third revision reflected the new research result and the latest trends in the areas of pharmacological treatment. METHODS: One hundred and twenty three psychiatrists who have vast clinical experiences in depressive disorder are primarily selected then survey was sent to them via mail, 67 surveys were retried. This survey is constructed with 44 questionnaires in which contained from overall treatment strategies to treatment strategies under the specific circumstances. Each treatment strategy or treatment option is evaluated with the overall score of nine and the following 95% confidence interval result treatment option were divided into three phases of recommendation; primary, secondary, tertiary. RESULTS: For dysthymic disorder, antidepressant monotherapy including selective serotonin reuptake inhibitor (SSRI) [(es)citalopram, fluoxetine, sertraline, paroxetine], serotonin-norepinephrine reuptake inhibitor (SNRI) (venlafaxine, duloxetine, milacipran), and mirtazapine, was recommended as the first line medications. For melancholic type, SSRI, SNRI, and mirtazapine were recommended as the first line medications. For atypical type and seasonal pattern, bupropion as well as SSRI, SNRI, and mirtazapine, were recommended as the first line medications. CONCLUSION: The preferences of antidepressants in experts were different according to the subtype of depression. These results suggest that clinicians have to consider the subtype of depression in the treatment of depressive disorders.
Antidepressive Agents ; Bupropion ; Depression ; Depressive Disorder ; Depressive Disorder, Major ; Dysthymic Disorder ; Fluoxetine ; Mianserin ; Postal Service ; Psychiatry ; Surveys and Questionnaires ; Seasons ; Serotonin ; Sertraline ; Thiophenes ; Duloxetine Hydrochloride

INTRODUCTIONChronic illnesses are common and have detrimental effects not only on the affected individuals but also on their families. These negative consequences on the physical and psychological health of caregivers constitute the burden of care. We investigate the predictors of perceived burden of care among relatives of people with any chronic physical or mental illness using secondary data from a nationwide survey in Singapore.

MATERIALS AND METHODSA cross-sectional household survey was conducted among adult residents of age 18 years and above and data were analysed to explore the predictors of high perceived burden of care. Two thousand four hundred and fifty-eight respondents having at least 1 close relative with any chronic physical and/or mental illness were included.

RESULTSMajority of the respondents had at least 1 close family member with physical illness (88.3%)--the most common illnesses reported were memory problems (86.9%), physical disability (74.8%), heart problems (70.1%) and cancer (62.2%). About 30.9% (n = 723) perceived high burden resulting from their relatives' health condition. Logistic analysis showed that women were more likely (OR 1.58, P = 0.0026) and Malays were less likely (OR 0.68, P = 0.0044) to perceive burden. Those who were able to open up to their family or friends (OR 1.65, P = 0.0162) and those who had dysthymia had higher odds (OR 4.91, respectively, P =0.0364) of perceiving burden.

CONCLUSIONOur results suggest that regardless of the nature of the chronic illnesses, gender or ethnicity, the capacity to open up to family or friends and the mental health status of caregivers can predict their perceived burden. The results provide valuable preliminary information for planning social policies and interventions for improving the well-being of caregivers.

Adult ; Aged ; Caregivers ; psychology ; Chronic Disease ; psychology ; therapy ; Cost of Illness ; Cross-Sectional Studies ; Dysthymic Disorder ; psychology ; Family ; psychology ; Female ; Humans ; Logistic Models ; Male ; Mental Disorders ; psychology ; therapy ; Middle Aged ; Singapore ; epidemiology

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: Stressful life events play the important role in depression. Somatic symptoms have also been closely linked to life stress. This study aimed to investigate the influence of life stress during four different life stages (childhood, adolescent, from 19 years to last year, the year prior to interview) on the severity of depression and somatic symptoms in depressive women. METHODS: Seventy women who had been diagnosed with major depressive disorder or dysthymic disorder according to the DSM-IV TR, and whose ages varied from 21 to 72 years (average age : 41 years), completed the Mooney Problem checklist, the Beck Depression Inventory (BDI), and Wittenborn`s somatic symptom scale. RESULTS: Life stressors which significantly influenced the severity of depression were difficulties with parents in the initial life stage, difficulties with other people in the third and fourth stages, and difficulties with social relationships in the fourth stage Further, somatic symptoms were influenced by health problem in the second period, difficulties with partners were prominent in the third stage, and difficulties with other people were noted in the fourth stage. The severity of depression showed a significantly positive correlation both with autonomic nervous system (p<0.001) and menopausal symptoms (p<0.001). After controlling for age, the severity of depression showed a significant positive correlation with stressors in the first stage (p<0.05), third stage (p<0.05), and fourth stage (p<0.01). Somatic symptom scores exhibited a significantly positive correlation with stressors in the second (p<0.05) and fourth stages (p<0.05). CONCLUSION: Current results suggested that the severity of depression and somatic symptoms were influenced by difficulties with other people in the fourth stage. The results of this study suggests that depression and somatic symptoms can be abbreviated by regulating excess stress.
Adolescent ; Autonomic Nervous System ; Checklist ; Depression ; Depressive Disorder, Major ; Diagnostic and Statistical Manual of Mental Disorders ; Dysthymic Disorder ; Female ; Humans ; Parents ; Stress, Psychological

PURPOSE: This study aimed to investigate the features and severity of depressive symptoms in peritoneal dialysis patients, and the relationship of depressive symptoms with levels of inflammation and oxidative stress (OS). METHODS: The diagnosis of depression was made using DSM-IV-TR and the depressive symptoms were evaluated using the Hamilton Rating Scale for Depression (HRSD) via a semi-structured interview. Levels of thiobarbituric acid-reactive substances (TBARs) were determined as markers of lipid peroxidation. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) activities were measured as antioxidants. RESULTS: 19 (28.8%) patients were diagnosed with depression (Major Depressive Disorder was 18.2%, Dysthymic disorder was 10.6%). OS markers were not different between patients with and without depression. Compared to non-depressed patients, depressed patients showed significantly higher depressed mood, feelings of guilt, suicidal ideation, sleep disturbances, psychomotor retardation, agitation, psychic and somatic anxiety, lower levels of work and activities, gastrointestinal and general somatic symptoms, and hypochondriasis. There was a significant positive correlation between HRSD scores and peritonitis (gamma=0.297, p=0.016), levels of high sensitivity C-reactive protein (hsCRP) (gamma=0.406, p=0.001) and ferritin (gamma=0.276, p=0.025), while there was a significant negative correlation between scores of HRSD and levels of albumin (gamma=-0.313, p=0.010). CONCLUSION: Major depressive disorder and dysthymic disorder were not related to inflammation and oxidative stress in peritoneal dialysis patients; however, depressive symptom severity was correlated with markers of inflammation and malnutrition. These results suggest that inflammation could have influence on depressive symptoms in peritoneal dialysis patients.
Anxiety ; C-Reactive Protein ; Catalase ; Depression ; Depressive Disorder ; Depressive Disorder, Major ; Dihydroergotamine ; Dysthymic Disorder ; Ferritins ; Glutathione Peroxidase ; Guilt ; Humans ; Hypochondriasis ; Inflammation ; Lipid Peroxidation ; Malnutrition ; Oxidative Stress ; Peritoneal Dialysis ; Peritonitis ; Suicidal Ideation ; Superoxide Dismutase

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

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