The Psychiatric Patient's Right to Effective Treatment: Implications of .

Although never reached final court adjudication, the case generated widespread discussion in psychiatric, legal, and lay circles. The author served as a consultant to Dr. Osheroff and testified that Chestnut Lodge failed to follow through with appropriate biological treatment for its own diagnosis of depression, focusing instead on Dr.

Treatment of depressive symptoms in human immunodeficiency virus-positive patients.

Background: This randomized clinical trial compared 16-week interventions with interpersonal psychotherapy, cognitive behavioral therapy, supportive psychotherapy, and supportive psychotherapy with imipramine for human immunodeficiency virus (HIV)-positive patients with depressive symptoms.

Methods: Subjects (N = 101; 85 male, 16 female) with known HIV seropositivity for at least 6 months were randomized to 16 weeks of treatment. Inclusion criteria were 24-item Hamilton Depression Rating Scale score of 15 or higher, clinical judgment of depression, and physical health sufficient to attend outpatient sessions.

The role of drug and alcohol abuse in recent increases in depression in the US.

Previous studies have reported an increase in depression among recent birth cohorts. Concurrent with the increase in rates of depression, there have been increases in rates of drug and alcohol abuse and dependence. This study sought to determine if the recent increase in rates of depression could be attributed to co-morbid alcohol and drug abuse.

Long-term follow-up after a drug trial for panic disorder.

Background: This study investigates the naturalistic course of panic disorder over four years and attempts to identify predictors for outcome.

Method: 423 DSM-III-R panic disorder patients who had taken part in an international multicentre drug trial were selected for follow-up; we were able to re-interview 367 (87%). For panic attacks, phobic avoidance and disabilities the same rating scales were administered as had been used for the clinical trials.

Individual psychotherapies for depressed HIV-positive patients.

Objective: The authors present preliminary data from two treatment modalities of a randomized clinical trial in which they compared 16-week interventions of interpersonal psychotherapy to supportive psychotherapy.

Method: HIV-positive patients who were not acutely medically ill and had scores of 15 or higher on the Hamilton Depression Rating Scale were randomly assigned to one of four treatment modalities. They were assessed by the Hamilton scale and Beck Depression Inventory at 8 and 16 weeks.

Adverse effects associated with the short-term treatment of panic disorder with imipramine, alprazolam or placebo.

Side effects play a significant role in the selection of drugs to be used in panic disorder/agoraphobia whose polyphobic symptomatology often includes a suspiciousness about taking drugs and a fear of undesired side effects which may lead to the refusal of treatment. The safety, side effects and patients' acceptance of alprazolam and imipramine versus placebo were evaluated in 1168 subjects with panic disorder/agoraphobia who had been enrolled in the second phase of the Upjohn World Wide Panic Study. Side effects that worsened over baseline to a greater extent with alprazolam than with imipramine and placebo were sedation, fatigue/weakness, memory problems, ataxia and slurred speech.

What are the public health implications of subclinical depressive symptoms?

Longitudinal data from a community study of 9900 adults in the United States show that persons with depressive symptoms, as compared to those without such symptoms, were 4.4 times more likely to develop a first onset major depression over one year. The attributable risk, a measure which reflects both the relative risk associated with depressive symptoms (4.

A comparison of symptom determinants of patient and clinician global ratings in patients with panic disorder and depression.

The Clinical Global Impression (CGI) is a standard assessment tool that generally shows good sensitivity to change in psychopharmacology trials. However, systematic assessment has not been conducted to determine how rating decisions are made. In this article, we examine the relationship between syndromal symptomatology and the CGI severity and improvement ratings in a study of 116 patients who met DSM-III-R criteria for both Panic Disorder and Depression.

A psychodynamic model of panic disorder.

Current psychiatric research on panic disorder and its treatment are heavily influenced by neurobiological and cognitive-behavioral models rather than psychodynamic propositions, and psychodynamic treatment is generally considered to be of little benefit in amelioration of symptoms. However, because neither of the current models fully explains the clinical psychopathology, etiology, or pathogenesis of panic disorder, there is a need for further model building. The authors suggest that a psychodynamic approach may add to the understanding of patients with panic disorder.

Continuing female predominance in depressive illness.

This paper examines gender differences in temporal trends for major depressive disorder in childhood, adolescence, and young adulthood. The study sample, a high-risk group from the National Institute of Mental Health Collaborative Study on the Psychobiology of Depression, includes 2000 first-degree relatives of probands with affective disorder. The age-specific incidence rates were analyzed to determine the effect of gender, age, period, and cohort on depression by age 35.

The enduring psychosocial consequences of mania and depression.

Objective: The authors sought to determine the scope, severity, and persistence of psychosocial impairment arising from bipolar and unipolar affective disorder.

Method: Patients with bipolar (N = 148) or unipolar (N = 240) major affective disorder were assessed as they sought treatment and again after a 5-year follow-up. Concurrently, parents, siblings, and adult children underwent similar assessments and were followed for 6 years.

The roles of psychiatrists in organized outpatient mental health settings.

Objective: This paper describes the clinical roles of psychiatrists in U.S. organized outpatient mental health settings.

Trends in the prescription of antidepressants by office-based psychiatrists.

Objective: This study was done in an effort to determine whether there was a change over the past decade in the number and proportion of patients prescribed antidepressants by psychiatrists in private practice.

Method: The authors analyzed data from the National Ambulatory Medical Care Survey for the years 1980, 1985, and 1989, focusing on visits by adults over the age of 18 years to physicians specializing in psychiatry and psychiatric subspecialties.

Results: The number of visits that included prescribing an antidepressant medication grew from approximately 2.

The course of transient hypochondriasis.

Objective: This study examined the longitudinal course of patients known to have had a previous episode of transient hypochondriasis.

Method: Twenty-two transiently hypochondriacal patients and 24 nonhypochondriacal patients from the same general medical clinic were reexamined after an average of 22 months with the use of self-report questionnaires, structured diagnostic interviews, and medical record review.

Results: The hypochondriacal patients continued to manifest significantly more hypochondriacal symptoms, more somatization, and more psychopathological symptoms at follow-up.

Secular trends in lifetime onset of MDD stratified by selected sociodemographic risk factors.

We used multivariate proportional hazards (Cox) models to investigate the effects of cohort of birth on age of first onset of major depression measured independently at two occasions, about six years apart, in the first degree relatives of probands with major affective illnesses. We estimated the cohort trends in strata defined by sociodemographic and other measures, to see if the cohort trends are the same across strata. Graphical summaries of the trends reveal a generally consistent pattern of increasing rates and earlier age of onset with successive birth cohorts, across all strata examined.

Effect size as a measure of symptom-specific drug change in clinical trials.

A data-analytic strategy is proposed for identifying the symptom-specific effects of each medication in a clinical trial. The within-group effect size is a standardized ratio of the pre-post change relative to the stability of change for each treatment group. Advantages of using this descriptive approach are illustrated by examining antidepressant effects of alprazolam, imipramine, and placebo in a clinical trial for patients meeting criteria for both panic disorder and depression.

The treatment of depression: prescribing practices of primary care physicians and psychiatrists.

Background: Depression is one of the most common mental disorders treated by primary care physicians. Concern has been expressed that primary care physicians underutilize antidepressants and overutilize anxiolytics in their management of depressive disorders.

Methods: Data from the 1980, 1985, and 1989 National Ambulatory Medical Care Surveys were used to examine the pharmacologic treatment provided by primary care physicians and psychiatrists during office visits with patients diagnosed as depressed.

Depressive symptoms as relative and attributable risk factors for first-onset major depression.

Using longitudinal data from a community study of 9900 adults drawn from four sites in the United States and interviewed twice, 1 year apart, we investigated the predictors of first-onset major depression. Using odds ratios to estimate relative risk, we found that persons with depressive symptoms, compared with those without such symptoms, were 4.4 times more likely and persons with dysthymia were 5.

Interpersonal psychotherapy of depressed HIV-positive outpatients.

In an open pilot study, 23 depressed adults infected with human immunodeficiency virus were treated using interpersonal therapy. Twenty subjects recovered from depression after a mean of 16 sessions. The authors discuss six aspects of interpersonal therapy that make it useful with depressed HIV-infected persons: psychoeducation about the sick role; a here-and-now framework; formulation of problems from an interpersonal perspective; exploration of options for changing dysfunctional behavior patterns; identification of focused interpersonal problem areas (grief, role transition, interpersonal disputes, and interpersonal deficits); and the confidence therapists gain from a systematic approach to problem formulation and treatment.