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Depression and heart diseases
S106
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
high and 43.75% reported Moderate Depersonalization on the MBI. Of the sample, 43.75% reported low Personal Accomplishment on the MBI, while 12.5% reported high Emotional Exhaustion (MBI). Positive correlations were found between the BDI and Emotional Exhaustion on the MBI ( p b 0.05). Positive correlations were also reported between the Avoidance and Intrusion subscales of the MBI and the Personal Accomplishment scale on the MBI ( p b 0.05). There were significant levels of depression and burnout for this group and implications for service delivery are discussed. Keywords: Depression, Burnout, Impact of events, Lay counsellors doi:10.1016/j.jad.2007.12.109
[P2.18] An ICT supported stepped collaborative care treatment algorithm for depressive disorder in primary care in The Netherlands. RCT C.M. van der Feltz-Cornelis*, K. Huijbregts Trimbos Instituut, The Netherlands In the The Netherlands, currently a stepped collaborative care project is underway evaluating stepped care for depressive disorder provided by the primary care practitioner, a nurse–care-manager, and a consultant psychiatrist, in the primary care setting in a Randomised Controlled Trial. 240 Patients with depressive disorder are offered a treatment plan and can choose from two options: Problem Solving Treatment with or without antidepressant treatment. The medication is prescribed by the PCP, PST and monitoring is provided by the care-manager and the psychiatrist is consulted every 6 weeks in order to see if the intervention is sufficient to improve the symptoms of the patient. The PHQ is used for monitoring and a two step approach is aimed at; if the patient did not achieve remission after 18 weeks, the patient is referred to mental health care. This stepwise approach is supported by a training and supervision program and by a web-based tracking system in which the care-manager and the patient can monitor progress and consult the psychiatrist. This approach is compared with Care As Usual in the primary care setting. In the presentation, preliminary results will be presented. doi:10.1016/j.jad.2007.12.110
[P2.19] Depression and heart diseases D.M. Podea* West Vasile Goldis University Arad, Romania Recognizing and treating symptoms of depression in patients with heart diseases can enhance quality of life and improve treatment compliance. Objective: The study aimed to evaluate the outcome of depression comorbid with heart diseases. Methods: The study comprises 120 patients diagnosed with major depressive disorder (MDD) that were hospitalized in the Psychiatric and Cardiology Clinic of Arad, during January 2007–August 2007. The research was conducted comparatively by dividing the patients into two groups: – Group A — 60 patients diagnosed with MDD – Group B — 60 patients diagnosed with MDD and cardiovascular diseases (arterial hypertension, heart failure, angina pectoris, post myocardial infarction). The diagnosis of MDD was done according to ICD10 and DSM-IV-TR operational criteria and the diagnosis and also the treatment of cardiovascular diseases were done by the cardiologist. The antidepressant that we used was escitalopra (SSRI). The depression's severity was evaluated with Hamilton Rating Scale for Depression (HAMD), Montgomery Asberg Depression Rating Scale (MADRS) and Global Assessment of Functioning Scale (GAFscore) at admission and at discharge. Results: In group B sex ratio F:B was 3:1, probably because the increased risk of cardiovascular diseases to woman in menopausal period. Almost all the patients from group B were professionally inactive (n = 52) despite the group A where 2/3 of the patients were professionally inactive (n = 40) and 1/3 were professionally active (n = 20). The average of the statistical HAMD and MADRS scores reveals a real improvement in group A in comparison to group B; it increases with 6 vs. 4 points after HAMD and with 8 vs. 5 points after MADRS. GAFscore of 90–81, 80–71, 70–61 points which was calculated after 3 weeks of clinical evolution and treatment was recorded in a higher percentage in the patients of group A in comparison to those in group B. Conclusions: The cardiovascular risk is higher to woman in menopausal period. The cardiovascular disease is a negative prognostic factor for the outcome of depression and it influences the professional activity of the patients.
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
Keywords: Major depressive disorder, Heart diseases, Professionally active, Prognostic
[P2.21] Bipolar diathesis of unipolar treatment resistant depression
doi:10.1016/j.jad.2007.12.111
W.M. Bahk*, Y.S. Woo, J.H. Chae, T.Y. Jun, K.S. Kim
[P2.20] Relationship between predominant episode and clinical features in bipolar I disorder
Catholic University of Korea, Republic of Korea
W.M. Bahk*, H.J. Seo, Y.S. Woo, T.Y. Jun, J.H. Chae, K.S. Kim Catholic University of Korea, Republic of Korea In this study, we present a comparison of bipolar patients with predominance of depressive episodes and with predominance of manic episodes in clinical implication. The recruitment was conducted within inpatients who had received psychiatric treatment for bipolar I disorder. The number and polarity of past episodes were assessed, and subjects were divided to depressive or manic episode predominant groups. These groups were defined as the number of one episode was greater than the other episode at least by two. The patients who did not meet the criteria for predominant group and who have shown any mixed and ambiguous episodes were excluded. The data were analysed using Student's t-tests and chi-square test. Forty nine subjects were classified as depressive episode predominant group (depressive episode group) and twenty eight subjects as manic episode predominant group (manic episode group). Psychotic symptoms were more prominent in depressive episode group significantly (X2 = 5.84, df = 1, p = 0.016). 89.4% (n = 44) subjects of depressive episode group showed depressive episode as first episode, and 92.9% (n = 26) of manic episode group experienced manic episode as first episode (X2 = 50.61, df = 1, p b 0.001). In the comparison of past year highest GAF score and total number of episodes, significant differences were found between two groups (t = 2.48, df = 75, p = 0.015; t = − 2.63, df = 32.08, p = 0.040). The type of onset episode appears related to predominant episode in our study. The patients with predominant depressive episode related to psychotic symptoms and patients with predominant manic episode related to more recurrent episodes and lower functioning. Keywords: Bipolar disorder, Predominant episode, Clinical features
S107
In this study, we investigate the demographic and clinical characteristics, diagnostic subtypes, and illness outcome of patients with resistant depression. A medical record review of patients who were admitted at a university hospital with the diagnosis of major depressive disorder was conducted. We selected patients with “treatment resistant depression”, which was defined as failure to respond to two adequate trials of antidepressants. Detailed clinical information including demographic data, age of illness onset, nature of symptoms, medical and psychiatric comorbidity, and psychiatric family history in first degree relatives was obtained. Patients were reevaluated using the recently proposed criteria for bipolar spectrum disorder by Ghaemi et al. At discharge, 281 patients were diagnosed as major depressive disorder. Patients with treatment resistant depression (TRD) (n = 68) were compared on demographic data and clinical characteristics with patients who were diagnosed with a major depressive disorder except treatment resistant depression (MDD) (n = 213). Of the TRD group, 32 patients (47.1%) were bipolar spectrum disorder and 8 (3.8%) of the MDD group were bipolar spectrum disorder. ( p b 0.001) At two year follow up, diagnosis of 38 patients was changed. There was an 8.9% prevalence of bipolar disorder in our sample. Of the TRD group, 18 (26.5%) were subsequently classified as having bipolar disorder, and 7 (3.3%) of the MDD group ( p b 0.001). There was no difference between these two groups in other clinical and demographic variables. The findings suggest that a large part of cases of unipolar treatment resistant depression have a bipolar diathesis. Keywords: Treatment resistant, Major depressive disorder, Bipolar disorder doi:10.1016/j.jad.2007.12.113
[P2.22] Clinical features of early onset bipolar disorder W.M. Bahk*, Y.S. Woo, J.H. Chae, T.Y. Jun, K.S. Kim
doi:10.1016/j.jad.2007.12.112
Catholic University of Korea, Republic of Korea
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
high and 43.75% reported Moderate Depersonalization on the MBI. Of the sample, 43.75% reported low Personal Accomplishment on the MBI, while 12.5% reported high Emotional Exhaustion (MBI). Positive correlations were found between the BDI and Emotional Exhaustion on the MBI ( p b 0.05). Positive correlations were also reported between the Avoidance and Intrusion subscales of the MBI and the Personal Accomplishment scale on the MBI ( p b 0.05). There were significant levels of depression and burnout for this group and implications for service delivery are discussed. Keywords: Depression, Burnout, Impact of events, Lay counsellors doi:10.1016/j.jad.2007.12.109
[P2.18] An ICT supported stepped collaborative care treatment algorithm for depressive disorder in primary care in The Netherlands. RCT C.M. van der Feltz-Cornelis*, K. Huijbregts Trimbos Instituut, The Netherlands In the The Netherlands, currently a stepped collaborative care project is underway evaluating stepped care for depressive disorder provided by the primary care practitioner, a nurse–care-manager, and a consultant psychiatrist, in the primary care setting in a Randomised Controlled Trial. 240 Patients with depressive disorder are offered a treatment plan and can choose from two options: Problem Solving Treatment with or without antidepressant treatment. The medication is prescribed by the PCP, PST and monitoring is provided by the care-manager and the psychiatrist is consulted every 6 weeks in order to see if the intervention is sufficient to improve the symptoms of the patient. The PHQ is used for monitoring and a two step approach is aimed at; if the patient did not achieve remission after 18 weeks, the patient is referred to mental health care. This stepwise approach is supported by a training and supervision program and by a web-based tracking system in which the care-manager and the patient can monitor progress and consult the psychiatrist. This approach is compared with Care As Usual in the primary care setting. In the presentation, preliminary results will be presented. doi:10.1016/j.jad.2007.12.110
[P2.19] Depression and heart diseases D.M. Podea* West Vasile Goldis University Arad, Romania Recognizing and treating symptoms of depression in patients with heart diseases can enhance quality of life and improve treatment compliance. Objective: The study aimed to evaluate the outcome of depression comorbid with heart diseases. Methods: The study comprises 120 patients diagnosed with major depressive disorder (MDD) that were hospitalized in the Psychiatric and Cardiology Clinic of Arad, during January 2007–August 2007. The research was conducted comparatively by dividing the patients into two groups: – Group A — 60 patients diagnosed with MDD – Group B — 60 patients diagnosed with MDD and cardiovascular diseases (arterial hypertension, heart failure, angina pectoris, post myocardial infarction). The diagnosis of MDD was done according to ICD10 and DSM-IV-TR operational criteria and the diagnosis and also the treatment of cardiovascular diseases were done by the cardiologist. The antidepressant that we used was escitalopra (SSRI). The depression's severity was evaluated with Hamilton Rating Scale for Depression (HAMD), Montgomery Asberg Depression Rating Scale (MADRS) and Global Assessment of Functioning Scale (GAFscore) at admission and at discharge. Results: In group B sex ratio F:B was 3:1, probably because the increased risk of cardiovascular diseases to woman in menopausal period. Almost all the patients from group B were professionally inactive (n = 52) despite the group A where 2/3 of the patients were professionally inactive (n = 40) and 1/3 were professionally active (n = 20). The average of the statistical HAMD and MADRS scores reveals a real improvement in group A in comparison to group B; it increases with 6 vs. 4 points after HAMD and with 8 vs. 5 points after MADRS. GAFscore of 90–81, 80–71, 70–61 points which was calculated after 3 weeks of clinical evolution and treatment was recorded in a higher percentage in the patients of group A in comparison to those in group B. Conclusions: The cardiovascular risk is higher to woman in menopausal period. The cardiovascular disease is a negative prognostic factor for the outcome of depression and it influences the professional activity of the patients.
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
Keywords: Major depressive disorder, Heart diseases, Professionally active, Prognostic
[P2.21] Bipolar diathesis of unipolar treatment resistant depression
doi:10.1016/j.jad.2007.12.111
W.M. Bahk*, Y.S. Woo, J.H. Chae, T.Y. Jun, K.S. Kim
[P2.20] Relationship between predominant episode and clinical features in bipolar I disorder
Catholic University of Korea, Republic of Korea
W.M. Bahk*, H.J. Seo, Y.S. Woo, T.Y. Jun, J.H. Chae, K.S. Kim Catholic University of Korea, Republic of Korea In this study, we present a comparison of bipolar patients with predominance of depressive episodes and with predominance of manic episodes in clinical implication. The recruitment was conducted within inpatients who had received psychiatric treatment for bipolar I disorder. The number and polarity of past episodes were assessed, and subjects were divided to depressive or manic episode predominant groups. These groups were defined as the number of one episode was greater than the other episode at least by two. The patients who did not meet the criteria for predominant group and who have shown any mixed and ambiguous episodes were excluded. The data were analysed using Student's t-tests and chi-square test. Forty nine subjects were classified as depressive episode predominant group (depressive episode group) and twenty eight subjects as manic episode predominant group (manic episode group). Psychotic symptoms were more prominent in depressive episode group significantly (X2 = 5.84, df = 1, p = 0.016). 89.4% (n = 44) subjects of depressive episode group showed depressive episode as first episode, and 92.9% (n = 26) of manic episode group experienced manic episode as first episode (X2 = 50.61, df = 1, p b 0.001). In the comparison of past year highest GAF score and total number of episodes, significant differences were found between two groups (t = 2.48, df = 75, p = 0.015; t = − 2.63, df = 32.08, p = 0.040). The type of onset episode appears related to predominant episode in our study. The patients with predominant depressive episode related to psychotic symptoms and patients with predominant manic episode related to more recurrent episodes and lower functioning. Keywords: Bipolar disorder, Predominant episode, Clinical features
S107
In this study, we investigate the demographic and clinical characteristics, diagnostic subtypes, and illness outcome of patients with resistant depression. A medical record review of patients who were admitted at a university hospital with the diagnosis of major depressive disorder was conducted. We selected patients with “treatment resistant depression”, which was defined as failure to respond to two adequate trials of antidepressants. Detailed clinical information including demographic data, age of illness onset, nature of symptoms, medical and psychiatric comorbidity, and psychiatric family history in first degree relatives was obtained. Patients were reevaluated using the recently proposed criteria for bipolar spectrum disorder by Ghaemi et al. At discharge, 281 patients were diagnosed as major depressive disorder. Patients with treatment resistant depression (TRD) (n = 68) were compared on demographic data and clinical characteristics with patients who were diagnosed with a major depressive disorder except treatment resistant depression (MDD) (n = 213). Of the TRD group, 32 patients (47.1%) were bipolar spectrum disorder and 8 (3.8%) of the MDD group were bipolar spectrum disorder. ( p b 0.001) At two year follow up, diagnosis of 38 patients was changed. There was an 8.9% prevalence of bipolar disorder in our sample. Of the TRD group, 18 (26.5%) were subsequently classified as having bipolar disorder, and 7 (3.3%) of the MDD group ( p b 0.001). There was no difference between these two groups in other clinical and demographic variables. The findings suggest that a large part of cases of unipolar treatment resistant depression have a bipolar diathesis. Keywords: Treatment resistant, Major depressive disorder, Bipolar disorder doi:10.1016/j.jad.2007.12.113
[P2.22] Clinical features of early onset bipolar disorder W.M. Bahk*, Y.S. Woo, J.H. Chae, T.Y. Jun, K.S. Kim
doi:10.1016/j.jad.2007.12.112
Catholic University of Korea, Republic of Korea