Psychological treatment of late-life depression.

This article summarizes the following psychological interventions for late-life depression: cognitive and behavioral therapy, problem-solving therapy, reminiscence and life review therapy, brief psychodynamic therapy, and interpersonal therapy. Results indicate that all psychological interventions reviewed were effective in reducing depressive symptoms in older adults. Future research should include larger sample sizes and focus on moderators of treatment such as age, depression severity, medical illness, and cognitive impairment.

The impact of stressful life events on relapse of generalized anxiety disorder.

BACKGROUND: Stressful life events (SLEs) are associated with the onset of psychiatric disorders but little is known about the effects of SLEs on individuals already diagnosed with an anxiety disorder, particularly generalized anxiety disorder (GAD) in which worry about life events is a defining characteristic. This study examined the impact of SLEs on relapse in adults already diagnosed with GAD. METHODS: Data are obtained from the Harvard/Brown Anxiety Research Project (HARP), a naturalistic longitudinal study of adults with a current or past history of anxiety disorders. One hundred and twelve adults recovered from an episode of GAD and 27 subsequently relapsed during the study. Eight categories of SLEs were assessed via interview and were examined as predictors of GAD relapse. RESULTS: An increased total number of SLEs was associated with a higher cumulative probability of relapse into episode of GAD and there was a nonsignificant statistical trend indicating specific categories of SLEs including health, death, and family/friends/household were related to an increased probability of relapse into episodes of GAD. CONCLUSIONS: SLEs impact the course of GAD and certain types of stressors may be more relevant to symptomatology than others. The change and uncertainty associated with SLEs may exacerbate existing worry tendencies even among those who have recovered from GAD.

Efficacy of biofeedback for post-traumatic stress disorder.

OBJECTIVE: The authors investigated the potential effectiveness of biofeedback as a complementary treatment for PTSD. DESIGN: This exploratory study used heart variability biofeedback and determined its efficacy in treating PTSD through the use of two rating instruments, The Post-traumatic Stress Disorder Checklist (PCL)-Military version and the Zung Self-Rating Depression Scale. Active duty service members deployed to Iraq or Afghanistan were alternatively assigned to a treatment as usual control group and treatment as usual with the addition of biofeedback. The authors administered the two instruments before treatment and at the conclusion of three weeks of biofeedback therapy. RESULTS: Biofeedback did not produce a measurable improvement. A one way repeated measures analysis of variance (ANOVA) was used to examine change in PCL scores over time. There was a main effect for time, F(1, 36)=11.98, p<.001, indicating a decrease in PCL scores from baseline to three weeks for both the control and treatment group. Results demonstrated a nonsignificant main effect of group, F(1, 36)=.1.79, p=ns, and a nonsignificant group by time interaction, F(1, 36)=.2.59, p=ns. Similarly, for depression, results showed a significant main effect for time, F(1, 33)=10.26, p<.003, indicating a decrease in Zung scores from baseline to three weeks for both the control and treatment group. Results demonstrated a nonsignificant main effect of group, F(1, 33)=.385, p=ns, and a nonsignificant group by time interaction, F(1, 33)=3.52, p=ns. CONCLUSION: The addition of biofeedback did not produce a measurable improvement in PTSD or depression scores in this exploratory study.

Neurohormonal and inflammatory hyper-responsiveness to acute mental stress in depression.

Depression is associated with dysregulated hypothalamic-pituitary-adrenal (HPA) axis function, overactivity of the sympathoadrenal system, and increased levels of inflammation markers. It is not known whether these biological processes are disproportionately elevated in response to acute negative emotional arousal by mental stress (MS). The present study investigates responses of neurohormones and inflammatory markers to MS in 14 clinically depressed (age: 42+/-10 years; 50% female) and 14 non-depressed control (age: 39+/-6 years; 50% female) participants. Heightened acute MS reactivity was documented in depressed participants (adrenocorticotropic hormone, rho=0.001; norepinephrine, rho=0.042; epinephrine, rho=0.039), and a delayed increase in cortisol was observed (rho=0.002). Inflammation markers increased more strongly in depressed versus non-depressed participants (IL-6, rho=0.027; tumor necrosis factor-alpha, rho=0.050; and recovery C-reactive protein, rho=0.003). It is concluded that depressed individuals display hyper-reactivity of neuroimmunological markers in response to acute negative emotions. This hyper-reactivity may serve a pathologic role in the elevated morbidity and mortality risk associated with depression.

The role of depression in short-term mood and fatigue responses to acute exercise.

BACKGROUND: Depression is associated with reduced physical activity levels, but little is known about the mechanisms accounting for the sedentary lifestyle among depressed individuals. Acute exercise is associated with positive mood in healthy individuals but may evoke negative mood in depressed individuals, which would further reduce the initiation and maintenance of regular exercise. PURPOSE: The present study examined the effects of acute exercise on depressed mood and fatigue in individuals with depression and nondepressed participants. METHOD: Participants with diagnosed Major (n = 12) or Minor Depressive Disorder (n = 2; n = 14, mean age of 41.7 +/- 9.6 years, 50% women) and control participants (n = 16, mean age of 38.1 +/- 6.1 years, 50% women), engaged in treadmill exercise. Mood and fatigue were measured before and after the acute bout of exercise. RESULTS: Immediately following exercise, depressed individuals displayed improvements in depressed mood (Delta from baseline: p = 0.02), but subsequently exhibited increased depressed mood (Delta from baseline: p = 0.05) and fatigue (Delta from baseline: p = 0.005) at 30 min post-exercise. These delayed increases in depressed mood (p = 0.05) and fatigue (p = 0.007) were higher in depressed participants compared to controls. CONCLUSION: These findings indicate that depressed individuals have increased negative mood 30 min post-exercise which may partially explain reduced initiation and adherence to exercise programs in depression.

Association between symptoms of depression and anxiety with heart rate variability in patients with implantable cardioverter defibrillators.

OBJECTIVE: This study investigated whether depression and anxiety symptoms are associated with measures of autonomic nervous system dysfunction in patients with implantable cardioverter defibrillators who are at high risk of cardiac rhythm disturbances. Depression and anxiety are associated with autonomic nervous system dysfunction, which may promote the risk of malignant cardiac arrhythmias. METHODS: Patients with an implantable cardioverter defibrillator (ICD) underwent ambulatory electrocardiographic (ECG) monitoring (n = 44, mean age = 62.1 +/- 9.3 years). Depression was assessed using the Beck Depression Inventory and anxiety was evaluated using the Taylor Manifest Anxiety Scale. Heart rate variability was assessed using time (RMSSD, pNN50, and SDNN) and frequency domain measures derived from 24-hour R-R intervals. Multivariate models were adjusted for age, sex, hypertension, diabetes, and smoking status. RESULTS: Defibrillator patients with elevated depression symptoms (n = 12) had significantly lower RMSSD (15.25 +/- 1.66 ms versus 24.97 +/- 2.44 ms, p = .002) and pNN50 (1.83 +/- 0.77 versus 5.61 +/- 1.04, p = .006) than defibrillator patients with low depression symptoms (n = 32). These associations remained significant after multivariate adjustment for covariates. ICD patients with high anxiety levels (n = 10) displayed lower RMSSD (p = .013), which became marginally significant when adjusting for covariates (p = .069). CONCLUSIONS: Depression and anxiety in defibrillator patients are associated with autonomic nervous system dysfunction indices of reduced parasympathetic control. Autonomic nervous system dysfunction may partially explain the association between depression and anxiety with life-threatening cardiac outcomes in vulnerable patients.

Characteristics and course of panic disorder and panic disorder with agoraphobia in primary care patients.

OBJECTIVE: To examine the course of panic disorder (PD) and panic disorder with agoraphobia (PDA) in 235 primary care patients during a 3-year period. METHOD: Patients were recruited from primary care waiting rooms and diagnosed using the Structured Clinical Interview for DSM-IV. They were reassessed at 6 months, 1 year, and annually thereafter for diagnosis, treatment, and other clinical and demographic variables. Recruitment occurred between July 1997 and May 2001. RESULTS: At intake, 85 patients were diagnosed with PD and 150 were diagnosed with PDA. Patients with PD were significantly more likely to achieve recovery (probability estimate, 0.75) from their disorder than patients with PDA (0.22) at the end of 3-year follow-up (p < .0001). There was no difference in recurrence rates between the 2 disorders. Women were more likely to recover from PD (p = .001). At intake, comorbid generalized anxiety disorder (p = .004), higher Global Assessment of Functioning score (p = .0003), and older age at panic onset (p = .05) were related to recovery from PDA, and comorbid major depressive disorder (p = .05) and psychosocial treatment (p = .002) predicted remaining in an episode of PDA. The relationship between psychosocial treatment and poor recovery must be interpreted with caution and is most likely due to the treatment bias effect. CONCLUSION: Primary care patients with PDA have a chronic course of illness, whereas those with PD have a more relapsing course. Given the significant burden of PD and PDA in primary care, attention to factors relevant to the course of these disorders is important for recognition and for continued improvement of treatment interventions in this setting.

Anger, hostility, and cardiac symptoms in women with suspected coronary artery disease: the Women's Ischemia Syndrome Evaluation (WISE) Study.

OBJECTIVE: To determine the relationship of anger and hostility to angiographic coronary artery disease (CAD), symptoms, and functional status among women with suspected CAD. METHODS: Data were collected from 636 women with suspected CAD referred for diagnostic angiography in the Women's Ischemia Syndrome Evaluation (WISE) Study. CAD was assessed as angiographic presence/absence of disease (> or =50% stenosis in any epicardial coronary artery). Hostility/anger, angina, symptoms, and functional status were assessed by the Cook-Medley Hostility Inventory, Spielberger Anger Expression Scale, cardiovascular symptom history, and the Duke Activity Status Index. RESULTS: Logistic regression revealed that anger-out (i.e., aggressive behavior in response to angry feelings) was independently associated with the presence/absence of angiographic CAD (OR = 1.09, CI 1.01-1.17). Anger and hostility were higher among women reporting increased cardiovascular symptoms. In women without angiographic CAD, those with nonanginal cardiac symptoms had the highest anger-out, anger expression, hostile affect, and aggressive responding scores, and those with typical angina reported the lowest functional status. Among women with CAD, functional status was lowest in women with atypical angina. CONCLUSIONS: Among women with suspected CAD, anger-out scores were associated with the presence of angiographic CAD. Anger/hostility traits were associated with increased symptoms, particularly with nonanginal chest pain in women without angiographic CAD. Relationships among psychosocial factors, cardiac symptoms, and angiographic CAD are potentially important in the management of women with suspected CAD.

Changing multiple health behaviors: smoking and exercise.

BACKGROUND: Previous stage of change research examining health behaviors has tended to examine one behavior at a time. However, one recent study by King et al. (1996) examined the relationship between smoking and exercise across cognitive-behavioral mediators (i.e., decisional balance and self-efficacy) shown to be important in predicting readiness to change. In this study, we seek to replicate the study of King et al. (1996) in a low-income sample, the majority of whom are women, with at least one chronic illness who are attending primary care clinics. METHODS: Data were obtained from 270 adult outpatients attending four public primary care clinics in Louisiana. RESULTS: Smoking and exercise stage of change were not related. Significant relationships existed between the cognitive variables of smoking and exercise. No significant differences existed within exercise stage of change on the cognitive variables of smoking, and vice versa, no significant differences were noted within smoking stage of change on the cognitive variables of exercise. CONCLUSIONS: Smoking and exercise appear to be specific health behaviors that are independent constructs in this particular sample. However, caution should be taken when interpreting the findings since 75% of the sample had at least one chronic illness.

Historical development of the dopamine hypothesis of schizophrenia.

This review examines the history of discoveries that contributed to development of the dopamine hypothesis of schizophrenia. The origin of the hypothesis is traced to the recognition that neuroleptic drugs interfere with brain dopamine function. This insight was derived from two distinct lines of research. The first line originated from the discovery in 1956 that reserpine depletes brain serotonin. This finding resulted in a sequence of studies that led to the discovery that brain dopamine is involved in neuroleptic-induced extrapyramidal motor disturbances. The second line of research was aimed at determining the mechanism of action of psychomotor stimulants. This research produced evidence that stimulants directly or indirectly activate brain dopamine receptors. Because nonreserpine neuroleptics such as chlorpromazine block stimulant-induced movement, these findings suggested that neuroleptics were dopamine antagonists. Most previous accounts of the development of the dopamine hypothesis of schizophrenia emphasize the first line of research and ignore the second.

Family presence during invasive procedures and resuscitations in the emergency department: a critical review and suggestions for future research.

STUDY OBJECTIVE: We examine the literature relating to family presence in the emergency department, with a specific emphasis on parental experiences and presence during invasive procedures and family presence during cardiopulmonary resuscitation and resuscitation. METHODS: An electronic search and examination of resulting references was conducted using the words, "family centered care," "parent participation," "parent presence," "family presence," and "emergency department," "accident and emergency department," "procedure," "invasive procedure," and "resuscitation." Articles related to out-of-hospital emergency medical services were excluded. Also, articles were included only if the manuscript was based on an empirical study and if the manuscript was published in a peer-reviewed journal. RESULTS: Twenty articles, primarily composed of survey research, were included in this review. Research suggests that families want to be given the option and, when given the option, often choose to remain during invasive procedures and resuscitations. Those who remain generally report favorable experiences and feel it is beneficial to the patient and themselves. Providers, however, have mixed opinions regarding family presence. Nurses may have a more favorable view toward family presence during invasive procedures than physicians. Among physicians, it appears that greater age and experience may be associated with more favorable opinions of family presence. Randomized controlled trials are mixed regarding whether family presence actually helps the patient. CONCLUSION: Despite what appear to be promising data regarding the benefits of family presence, this area of research is in the initial phases of development with many limitations that are discussed. Recommendations for future research are presented.