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Severity of depressive symptoms predicts outcome on the short and long term not personality
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
Aims: To describe the patterns of treatment of bipolar illness in north-eastern Nigeria and to determine if there is any relation between use of mood stabilizers and a positive treatment/prophylaxis outcome. Method: A 2 year case controlled retrospective study (2004–2006) of all bipolar disorder cases was conducted and comparison between patients treated with mood stabilizers plus antipsychotics and those on antipsychotics only was made. A total of 225 of all diagnosed cases of bipolar affective disorder that met the inclusion criteria were included in the study. Results: The average age of presentation of our patients is 19.5 years, with an equal male to female ratio. Majority (70%, n = 158) were diagnosed as bipolar affective disorder current episode manic. Most of the patients (79%, n = 166) were treated with typical antipsychotics only, while only 20%, (n = 41) had a combination of mood stabilizers and antipsychotic, less than 1%, (n = 4) received atypical. The differences between the compared groups in terms of core symptom relief and clinician's impression were statistically significant (X2 = 21.5, 2df, p b 0.005; X2 = 9.8, 2df, p b 0.005). While 43% of patients on mood stabilizers experienced no relapses in 2 years, all the patients on typical antipsychotic alone had at least 1 relapse. Discussions: Bipolar patients do well clinically when placed on mood stabilizers, yet only a minority who are able to afford do benefit from its inclusion into the treatment regimen, resulting in a generally poor outcome, increasing burden on family members, as well as stigmatization by the wider community. Clinicians practicing in underdeveloped countries should feel confident in prescribing mood stabilizers and governments should subsidize the cost of mental health care. Keywords: Treatment, Bipolar, North-east, Nigeria doi:10.1016/j.jad.2007.12.069
[P1.37] Severity of depressive symptoms predicts outcome on the short and long term not personality E. Hoencamp*,a,b, M Remijsena,b, I. Huijbrechtsa, J. Haffmansa,b a
Parnassia Bavo Groep, The Netherlands Leiden University, The Netherlands
b
Introduction: The purpose of the study was to compare the ability of several independent variables measuring
S85
depressive symptoms, psychopathology and personality pathology to predict outcome in the short ánd in the long term. Method: 167 patients participated (DSM-III R: major depression, dysthymia, depression NOS; HRSD-17 score ≥ 14). Baseline assessment included HRSD, SCL 90 and SCID II. Outcome at 6 weeks was HRSD score, at 3.5 years, a three-point categorization according to Nierenberg et al. (1990). Three multiple regression analyses were executed. Results: Severity of depressive symptoms, of psychopathology and the presence of Cluster C (NOS included) pathology predicted poor outcome at six weeks. Only severity of psychopathology (SCL-90 total score) at baseline predicted poor outcome at 3.5 years. Discussion: Our results indicate that severity of psychopathology might be more relevant than personality pathology – categorically assessed – in predicting outcome in both the long and the short-term. Only Cluster C (NOS included) personality pathology had a significant negative influence on the short-term which could merely reflect the large overlap between the criteria for depression and Cluster C (NOS included) personality pathology. Keywords: Predict, Personality, Depression, Outcome doi:10.1016/j.jad.2007.12.070
[P1.38] Relapse prevention of depression in the elderly S. Apila,b, E. Hoencamp*,a,b, J. Haffmansa,b, P. Spinhovenb a
Parnassia Bavo Groep, The Netherlands Leiden University, The Netherlands
b
Introduction: While substantial progress has been made in the treatment of acute depression, the prevention of relapse remains problematic. This study aimed to determine the effectiveness and feasibility of a stepped care approach for preventing relapse of depression in the elderly (55 and older) in daily clinical practice. Method: In a randomized controlled trial (RCT), persons aged 55 and older (N = 136) who had suffered at least one episode of Major Depression in the past received stepped care (SC) or care as usual (CAU). Measures consisted of demographic characteristics, past and present episodes of depression, current symptom levels of anxiety and depression dysfunctional attitudes, cognitive vulnerability for depression, major life events, social support, treatment costs and treatment satisfaction.
Aims: To describe the patterns of treatment of bipolar illness in north-eastern Nigeria and to determine if there is any relation between use of mood stabilizers and a positive treatment/prophylaxis outcome. Method: A 2 year case controlled retrospective study (2004–2006) of all bipolar disorder cases was conducted and comparison between patients treated with mood stabilizers plus antipsychotics and those on antipsychotics only was made. A total of 225 of all diagnosed cases of bipolar affective disorder that met the inclusion criteria were included in the study. Results: The average age of presentation of our patients is 19.5 years, with an equal male to female ratio. Majority (70%, n = 158) were diagnosed as bipolar affective disorder current episode manic. Most of the patients (79%, n = 166) were treated with typical antipsychotics only, while only 20%, (n = 41) had a combination of mood stabilizers and antipsychotic, less than 1%, (n = 4) received atypical. The differences between the compared groups in terms of core symptom relief and clinician's impression were statistically significant (X2 = 21.5, 2df, p b 0.005; X2 = 9.8, 2df, p b 0.005). While 43% of patients on mood stabilizers experienced no relapses in 2 years, all the patients on typical antipsychotic alone had at least 1 relapse. Discussions: Bipolar patients do well clinically when placed on mood stabilizers, yet only a minority who are able to afford do benefit from its inclusion into the treatment regimen, resulting in a generally poor outcome, increasing burden on family members, as well as stigmatization by the wider community. Clinicians practicing in underdeveloped countries should feel confident in prescribing mood stabilizers and governments should subsidize the cost of mental health care. Keywords: Treatment, Bipolar, North-east, Nigeria doi:10.1016/j.jad.2007.12.069
[P1.37] Severity of depressive symptoms predicts outcome on the short and long term not personality E. Hoencamp*,a,b, M Remijsena,b, I. Huijbrechtsa, J. Haffmansa,b a
Parnassia Bavo Groep, The Netherlands Leiden University, The Netherlands
b
Introduction: The purpose of the study was to compare the ability of several independent variables measuring
S85
depressive symptoms, psychopathology and personality pathology to predict outcome in the short ánd in the long term. Method: 167 patients participated (DSM-III R: major depression, dysthymia, depression NOS; HRSD-17 score ≥ 14). Baseline assessment included HRSD, SCL 90 and SCID II. Outcome at 6 weeks was HRSD score, at 3.5 years, a three-point categorization according to Nierenberg et al. (1990). Three multiple regression analyses were executed. Results: Severity of depressive symptoms, of psychopathology and the presence of Cluster C (NOS included) pathology predicted poor outcome at six weeks. Only severity of psychopathology (SCL-90 total score) at baseline predicted poor outcome at 3.5 years. Discussion: Our results indicate that severity of psychopathology might be more relevant than personality pathology – categorically assessed – in predicting outcome in both the long and the short-term. Only Cluster C (NOS included) personality pathology had a significant negative influence on the short-term which could merely reflect the large overlap between the criteria for depression and Cluster C (NOS included) personality pathology. Keywords: Predict, Personality, Depression, Outcome doi:10.1016/j.jad.2007.12.070
[P1.38] Relapse prevention of depression in the elderly S. Apila,b, E. Hoencamp*,a,b, J. Haffmansa,b, P. Spinhovenb a
Parnassia Bavo Groep, The Netherlands Leiden University, The Netherlands
b
Introduction: While substantial progress has been made in the treatment of acute depression, the prevention of relapse remains problematic. This study aimed to determine the effectiveness and feasibility of a stepped care approach for preventing relapse of depression in the elderly (55 and older) in daily clinical practice. Method: In a randomized controlled trial (RCT), persons aged 55 and older (N = 136) who had suffered at least one episode of Major Depression in the past received stepped care (SC) or care as usual (CAU). Measures consisted of demographic characteristics, past and present episodes of depression, current symptom levels of anxiety and depression dysfunctional attitudes, cognitive vulnerability for depression, major life events, social support, treatment costs and treatment satisfaction.