Treatment of major depression in HIV-seropositive men. HIV Neurobehavioral Research Center Group.

BACKGROUND: The purpose of this randomized double-blind, placebo-controlled study was to compare the efficacy and safety of fluoxetine plus group psychotherapy versus group psychotherapy alone in HIV-seropositive men (based on 1986 CDC classes II, III, and IV.C.2) who had been diagnosed with major depressive disorder (DSM-III-R). METHOD: During a 7-week trial, patients were treated with fluoxetine 20-60 mg or placebo 1-3 capsules per day and were seen in weekly supportive group psychotherapy. In addition, subjects were rated on the 17-item Hamilton Rating Scale for Depression (HAM-D-17), Clinical Global Impressions scales for Improvement (CGI-I) and Severity of Illness (CGI-S), and the short version of the Beck Depression Inventory (BDI-13). Of the 47 patients enrolled in the study, 25 were administered fluoxetine and 22 were given placebo. RESULTS: Subjects who received fluoxetine began to show significantly more improvement than patients who received placebo on both self- and observer-rated scales by the end of the first week of treatment. By endpoint, patients treated with fluoxetine experienced greater mean changes from baseline compared with placebo-treated patients on the HAM-D-17 (12.1 vs. 6.6; F = 6.53, df = 1,45; p < .05) and BDI-13 (5.9 vs. 1.2; F = 5.73, df = 1,45; p < .05), and a greater percentage of fluoxetine-treated patients experienced a > or = 50% in HAM-D-17 scores (64% vs. 23%; chi2= 8.60, df = 1, p < .01). Differences were particularly apparent in subjects whose initial depressive episodes were rated as severe (i.e., HAM-D-17 score > or = 24). Severely depressed patients treated with fluoxetine had an endpoint CGI-I of 1.4 compared with an endpoint CGI-I of 2.7 for patients treated with placebo (F = 6.02, df = 1,11; p < .05). Further, side effects were generally mild and transient. The most frequently noted effects reported by subjects treated with fluoxetine were nausea, dry mouth, headache, and diarrhea, in decreasing order of frequency. CONCLUSION: This study supports the efficacy and safety of fluoxetine over and above group psychotherapy for the treatment of HIV-associated major depression.

Cupid's bow contour of the vertebral body: evaluation of pathogenesis with bone densitometry and imaging-histopathologic correlation.

PURPOSE: To investigate the Cupid's bow contour by means of bone densitometry and imaging-histopathologic correlation. MATERIALS AND METHODS: Radiographs and histologic slices were obtained in 64 cadaveric thoracolumbar spines to assess the morphology, distribution, and histopathologic features of the Cupid's bow contour. Dual-energy x-ray absorptiometry and radiography were performed in the lumbar spine in 406 healthy subjects. Bone density and body height and weight were then related to the presence of the Cupid's bow contour. The Cupid's bow contour was compared with the fish vertebra of osteoporosis and Schmorl node. RESULTS: No clinically important relationship was found between lumbar bone density, body height and weight, and prevalence of the Cupid's bow contour. Histologic examination showed thickened bone in the Cupid's bow end plate with annular fibers inserting into this region. In cadavers, the Cupid's bow contour occurred at multiple lumbar and thoracic levels, with the highest frequency in the lower lumbar spine. Lateral radiographs enabled better detection of the contour change. CONCLUSION: The Cupid's bow deformity is a developmental phenomenon that is unrelated to osteopenia or mechanical stress on the spine.

Dating and remarriage over the first two years of widowhood.

In this study we examined the following: (1) frequencies of remarrying or becoming romantically involved for widows and widowers during the first 2 years of widowhood; (2) attitudes toward dating and remarriage among the recently widowed, and their evolution; (3) identifiable factors which predict the development of new romances, such as sex, age, income, and level of education; and (4) the psychological well-being of those widows and widowers involved in romances compared to those who were not. The San Diego Widowhood Project was a prospective study in which 249 widows and 101 widowers who were identified through San Diego County death certificates completed detailed questionnaires 2, 7, 13, 19, and 25 months after their spouses' deaths. The main outcome measures for this study were marital and romance status, attitudes toward romance at several time points, demographic predictors of romance status, and self-reported measures of psychological well-being. By 25 months after the spouse's death 61% of men and 19% of women were either remarried or involved in a new romance. Women expressed more negative feelings about forming new romantic relationships. Younger age was a predictor of becoming involved in a new romance for women, and higher monthly income and level of education were predictors for men. Greater psychological well-being was highly correlated with being remarried or in a new romance 25 months after the spouse's death. It may be helpful for family, friends, and therapists to know that dating and remarriage are common and appear to be highly adaptive behaviors among the recently bereaved.

The effect of noninsulin dependent diabetes mellitus on the prevalence of clinical osteoarthritis. A population based study.

OBJECTIVE: To explore the relation between noninsulin dependent diabetes mellitus (NIDDM) and osteoarthritis (OA) in a population. METHODS: The study population included 632 men and 882 women aged 52-95 years from the Rancho Bernardo community. In 1984-87, participants answered questions about history of diabetes and had a standard oral glucose tolerance (OGTT). In 1988-92, subjects completed a questionnaire about history of arthritis, type of arthritis diagnosed, and presence of joint pain. Nurses examined subjects for presence of Heberden's nodes. Subjects with no history of arthritis were compared to those with a history of OA and other types of arthritis with regard to age, body size, and plasma glucose levels. In addition, subjects were classified by diabetes status to determine differences in the prevalence of arthritis and related characteristics. RESULTS: Neither impaired glucose tolerance nor NIDDM was associated with history of OA, regardless of how inclusive the definition of OA, before or after adjustment for age and maximum lifetime obesity. In age and obesity adjusted analyses, men with a history of OA had lower fasting plasma glucose levels than men with no arthritis (100.2 vs. 103.6 mg/dl, p < 0.05), and men with NIDDM had less hand and hip pain than normoglycemic men (p < 0.05). Heberden's nodes were unrelated to glucose tolerance status. CONCLUSION: This population based study found no positive association between clinical OA and NIDDM defined by OGTT. These results are compatible with community based data examining radiographic OA and history of diabetes.

Bereavement, depression, and immune function.

This study evaluates whether recently widowed women who fulfill criteria for a depressive syndrome differ in their immune responses from widows who do not. Twenty-one middle-aged widows who had lost their spouses 2 months before the initial evaluation and 21 demographically matched married women were evaluated at approximately 6-month intervals for 13 months. Evaluations consisted of diagnostic interviews using the Schedule for Affective Disorders and Schizophrenia, Hamilton Rating Scale for Depression, and Beck Depression Inventory. Immune function was measured by total lymphocyte counts, natural killer (NK) cell activity, mitogen responsiveness to concanavalin A, and T-cell subsets. There were no statistically significant differences on any of the immune measures between the entire cohort of widows and control subjects. However, the subset of widows who met DSM-III-R criteria for major depressive syndromes demonstrated impaired immune function (lower NK cell activity and lower mitogen stimulation) compared with those who did not meet criteria for major depression. This study suggests a relationship between impaired immune function and depression in women experiencing the stress of bereavement.

The spectrum of depressive phenomena after spousal bereavement.

BACKGROUND: Major depressive syndromes have been found to be prevalent, disabling, and often persistent during the stress of bereavement. To add to the burden of mood changes associated with bereavement, a substantial number of bereaved individuals may suffer from depressive symptoms that do not quite equal the requisite number to meet criteria for a major depressive episode, but which also may be quite disabling, if not be actual forerunners of major depression. This study evaluates the frequency, morbidity, and stability of subsyndromal symptomatic depressions. METHOD: 350 widows and widowers were evaluated for depressive symptoms and syndromes at 2, 13, and 25 months after the death of their spouse. An additional 126 demographically similar men and women also were evaluated. In addition to the presence of a number of depressive symptoms, a number of outcome measures were obtained: use of antidepressant medication, self-perceived physical health, satisfaction with work performance, number of days of social activity per month, self-rated adjustment to widow-hood, satisfaction with ongoing interpersonal relationships, and development of a new relationship. RESULTS: Both symptomatic major depression (SMD) syndromes and subsyndromal symptomatic depression (SSD) were prevalent throughout the first 2 years of widowhood. More than one third of subjects with SSD 2 months after their spouse's death either continue to have SSD after the first full year of bereavement (28%) or worsen (9%) during that time. On most outcome measures, subjects with SSD stand between subjects with no depression and those with SMD and are significantly more likely than euthymic subjects to complain of poor physical health, be dissatisfied with their work performance, and refrain from social activity; they show a statistical trend for more disturbed ongoing relationships with friends and to be less likely to be involved in a new romantic relationship. CONCLUSION: Although heretofore relatively unrecognized, SSDs are prevalent, often persist, and are associated with substantial morbidity in widows and widowers during the first 2 years of bereavement.

Reported suicidal behavior and current suicidal ideation in a psychiatric outpatient clinic.

One thousand consecutive intakes at an outpatient psychiatric clinic were screened for past suicide attempts and present suicidal ideation and diagnosed using DSM-III-R criteria. A full range of thoughts about death and suicide were prevalent in all diagnostic groups. Over one-third of patients with major depression and borderline personality disorder had actual plans to kill themselves, and over two-thirds of patients with borderline personality disorder had made one or more suicide attempts.

Aging and bereavement.

This paper compares the grief responses of widows and widowers of different age groups over the 1st year of bereavement. The results strongly suggest that older widows and widowers perceive themselves as adjusting better to their loss and suffering from less depression and fewer anxiety symptoms than their younger counterparts. Furthermore, the oldest widows/widowers demonstrate the most consistent improvement in their levels of distress over time. Thus, when it comes to coping, older persons are not at the disadvantage that certain stereotypes and "clinical wisdoms" have previously suggested. Seniors are every bit as adaptive and able to cope with the severest forms of stress as anyone else, and they are, if anything, less prone to depression than are younger individuals.