Depressive disorders evaluation

Einarson TR, Arikian S, Sweeney S, Doyle J (1995). A model to evaluate the cost effectiveness of oral therapies in the management of patients with major depressive disorders. Clin Ther 17, 136-53. 

Evaluation of the economics of mental illness in primary care is an ongoing initiative of the UK Department of Health (Lloyd and Jenkins, 1995). A similar American study in Washington State included sub-threshold anxiety or depression, but these imposed relatively little economic load compared with disorder-level anxiety or depression (Simon et al, 1995). Mental health treatment accounted for only a small part of overall utilization, approximately 5%. Nevertheless, most patients with anxiety or depressive disorders showed considerable improvement. This was accompanied by only modest reductions in cost. 

Agor, agoraphobia Dep, depression Dx, diagnosis MDD, major depressive disorder OCD, obsessive-compulsive disorder Not eval, not evaluated. 

With drugs that produce a depression after chronic exposure (e.g., alcohol), detoxification is instituted, in addition to supportive care and therapy for substance dependency. Even though most alcoholics will experience depression immediately after the cessation of heavy and prolonged consumption, the majority will remit within several weeks following detoxification and supportive care (see Chapter 14, The Alcoholic Patient ). For those who do not, it is likely there had been a preexisting depressive disorder, which itself can lead to substance dependency, because patients frequently self-medicate before seeking professional intervention. This possibility should be evaluated through a review of the patient s personal medical and psychiatric history, as well as family history. 

Although there are papers that discuss the relationships between cholesterol, lipid profiles, and major depression [34-39], there are few data that discuss the association between lipid profiles and depressive disorders with different phenotypes. Huang and Chen investigated the correlation between serum lipid, lipoprotein concentration, and major depressive disorder in patients evaluated for general health screening [41]. They found that analysis of covariance after age adjustment revealed significant differences in patients with melancholic feature and patients with atypical feature in serum concentrations of TG and VLDL in men and HDL in women [41]. However, there are still no reports that discuss the relationships between lipid profiles and major depression with postpartum onset or catatonic feature. In the future, large sample numbers will be needed to clarify the clinical differences in this field. 

Czekalla and colleagues [271] looked for potential effects of Hypericum extract on cardiac conduction, since it is well-known that tricyclic antidepressants can delay atrioventricular conduction. Of 84 patients treated with the Hypericum extract LI 160 and 76 patients receiving imipramine in a therapeutic drug trial [253] evaluable ECG recordings were available at baseline and after 6 weeks of treatment. All patients suffered from a severe episode of recurrent depressive disorder [ICD-10 F 33.2] the daily doses were 3 x 600 mg LI 160 and 3 x 50 mg imipramine, respectively. 

The use ofLt in early pregnancy may be associated with an increase in the incidence of cardiovascular anomalies of the newborn, especially Ebstein s malformation. The antimanic anticonvulsants valproic acid and probably carbamazepine have an associated risk of irreversible spina bifida that may exceed 1/100, and so do not represent a rational alternative for pregnant women. In balancing the risk versus benefit of using LG in pregnancy, it is important to evaluate the risk of untreated manic-depressive disorder and to consider conservative measures, such as deferring intervention until symptoms arise or using a safer treatment, such as a neuroleptic or ECT... 

Clinical - Several reviews and articles on the nature and therapy of depressive disorders were published in 1968 °- as well as a useful introductory text on clinical psychiatry . Irwin 5 has proposed a rational framework for the clinical evaluation and use of psychoactive drugs. He noted that patients with depression exhibit a wide variety of behaviour and that the different forms of the disease require different classes of drugs. Mendels likewise remarked that "few terms in psychiatry are used with as many different meanings as depression". The importance of using a suitably large sample size in clinical studies of drug evaluation was stressed . The foregoing are a caveat for the interpretation of the clinical reports discussed below. 

Feiger AD, Tourian KA, Rosas GR, Padmanabhan SK. A placebo-controlled study evaluating the efficacy and safety of flexible-dose desvenlafaxine treatment in outpatients with major depressive disorder. CNS Spectr 2009 14(1) 41-50. 

The efficacy of vitamin C supplementation as an adjunct to fluoxetine therapy for treating major depressive disorders in children has been evaluated in a six-month randomised, double-blind, placebo-controlled pilot study including 24 participants. No major adverse events were observed [313. 

The molten carbonate fuel ceU uses eutectic blends of Hthium and potassium carbonates as the electrolyte. A special grade of Hthium carbonate is used in treatment of affective mental (mood) disorders, including clinical depression and bipolar disorders. Lithium has also been evaluated in treatment of schizophrenia, schizoaffective disorders, alcoholism, and periodic aggressive behavior (56). 

How the different neurotransmitters may be involved in the initiation and maintenance of some brain disorders, such as Parkinson s disease, epilepsy, schizophrenia, depression, anxiety and dementia, as well as in the sensation of pain, is then evaluated and an attempt made to see how the drugs which are used in these conditions produce their effect by modifying appropriate neurotransmitter function (section C). The final section (D) deals with how neurotransmitters are involved in sleep and consciousness and in the social problems of drug use and abuse. 

Salomon, RM, Miller, HL, Delgado, PL and Charney, D (1993) The use of tryptophan depletion to evaluate central serotonin function in depression and other neuropsychiatric disorders. Int. J. Clin. Psychopharmacol. 8 41-46. 

Evaluate the clinical outcomes of treatment by using the UPDRS. In addition, periodically ask patients to record the amount of on and off time they have with and without dyskinesias in a diary. There are a variety of scales that can be used to assess QOL, depression, anxiety, and sleep disorders. Patients with PD cannot be cured but treatment can delay the progression of symptoms and improve QOL. Delaying the patient s admission into a nursing home is a good outcome. 

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