Depression prognosis

One-third of patients with PTSD have a poor prognosis, and about 80% have a concurrent depression or anxiety disorder. Over half of men with... 

There are several prerequisites to the initiation of treatment for depression. The diagnosis of depression must be firmly established, and any comorbid psychiatric or medical illnesses that may affect the treatment should be identified. Medical causes for the depression must also be ruled out. Finally, the diagnosis, its long-term prognosis, and treatment options should be discussed with the patient. Only then can well-informed treatment begin. 

Arana GW, Baldessarini RJ, Ornsteen M The dexamethasone suppression test for diagnosis and prognosis in psychiatry. Arch Gen Psychiatry 42 1193-1204, 1985 Arana GW, Santos AB, Laraia EA Dexamethasone for the treatment of depression a randomized, placebo-controlled, double-blind trial. Am J Psychiatry 152 265-267, 1995... 

Interventions that may improve prognosis include referrals for vocational testing and training, substance- and alcohol-abuse counseling, and aggressive management of depressive symptoms as they occur. 

Coryell W, Keller M, Lavori P, et al. Affective syndromes, psychotic features, and prognosis. I. Depression. Arch Gen Psychiatry 1990 47 651-657. 

Rennie TAC. Manic-depressive disease prognosis following shock treatment. Psychiatr Q 1943 17 642-654. 

The diagnosis of depression still rests primarily on the clinical interview. Major depressive disorder (MDD) is characterized by depressed mood most of the time for at least 2 weeks and/or loss of interest or pleasure in most activities. In addition, depression is characterized by disturbances in sleep and appetite as well as deficits in cognition and energy. Thoughts of guilt, worthlessness, and suicide are common. Coronary artery disease, diabetes, and stroke appear to be more common in depressed patients, and depression may considerably worsen the prognosis for patients with a variety of comorbid medical conditions. 

The primary indication for antidepressant agents is the treatment of MDD. Major depression, with a lifetime prevalence of around 17% in the USA and a point prevalence of 5%, is associated with substantial morbidity and mortality. MDD represents one of the most common causes of disability in the developed world. In addition, major depression is commonly associated with a variety of medical conditions—from chronic pain to coronary artery disease. When depression coexists with other medical conditions, the patient s disease burden increases, and the quality of life—and often the prognosis for effective treatment—decreases significantly. 

The patient should be told of the diagnosis, prognosis, and treatment options, including costs, duration, and potential side effects. In educating patient and family about the clinical management of depression, it is useful to emphasize the following information ... 

Lundquist, G. 1945, Prognosis and course in manic depressive psychosis, Acta Psychiatr.Neurol.Scand. Suppl., vol. 35, pp. 1-96. 

Panic disorder typically starts in the third decade of life, although it may start in childhood or late in life as well. It is a recurrent, chronic, and disabling condition, in which relapses after remission are common. Panic disorder affects females twice as often as males, and after remission, women are more likely to relapse than men. The long duration of illness and the presence of agoraphobia portend a less favorable prognosis. Suicide risk is comparable to that seen among patients with major depression. 

A second, more serious, type of bone marrow depression consists of aplastic anemia. Considered an idiosyncratic reaction rather than a toxic reaction, aplastic anemia occurs most commonly weeks to months after completion of therapy and is not dose related. In the most severe form of aplastic anemia, pancytopenia with an aplastic marrow is present. Prognosis is very poor because the anemia is usually irreversible. 

Barbara M., 35, was admitted to an inpatient psychiatric unit after she developed suicidal ideas and incidents in which she repeatedly sliced the inside of her calf. Her admitting diagnosis was major depression and borderline personality disorder. The borderline diagnosis was based on the rather bizarre self-mutilation. The treating psychiatrist informed the patient s family that her acute depression could indeed be treated, but that the apparent personality disorder would likely be a serious, ongoing problem and the prognosis was more guarded. 

May be 2-3 vessel disease but usually with 1 culprit artery. More frequently in leads with dominant R wave. Cases of worst prognosis present ST depression in V4-V6 and in FP leads, with negative T wave in V4-V6. 

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