Stek ML, Van Exel E, Van Tilburg W, et al. The prognosis of depression in old age: outcome six to eight years after clinical treatment
ABSTRACT Previous studies suggest that the short-term outcome in severely depressed elderly in The Netherlands is worse compared to other studies in the Western world. The present study examines the long-term prognosis of hospitalized elderly patients with major depressive disorder and possible predictors of outcome. One hundred and five elderly inpatients with unipolar major depression, admitted by regional mental health services in a geographically delimited area, were evaluated six to eight years after index episode by trained residents using a structured diagnostic interview (C.I.D.I.) The GP was interviewed using a standard questionnaire. At follow-up 40% of the original sample had died. Of the survivors 33% had fared well, 24% had a relapsing course, 22% had residual symptoms, 11% were continuously ill, and 9% had probable dementia. With respect to prognostic factors, personality disorder predicted a worse outcome. All patients with a major depressive disorder at follow-up received specialised care and used antidepressants. None of the patients received ECT. The mortality rate in clinically treated elderly with major depressive disorder is high. Among survivors the long-term prognosis in The Netherlands is comparable with other studies to date. The presence of a personality disorder predicts worse outcome. Though the accessibility of services seems to be good, more vigorous treatment was not applied.
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- " The prognosis of late-life depression is often poor.  It appears to have a chronic course and higher relapse rates compared to early-life depression [3-6] and co morbidity with cognitive decline and somatic diseases is higher than in depression in younger adults. [7-9] In addition, in late-life depression co morbidity with other psychiatric disorders, especially anxiety disorders is high, [10-13] and leads to longer time to remission as well as higher recurrence rates . "
ABSTRACT: To study late-life depression and its unfavourable course and co morbidities in The Netherlands. We designed the Netherlands Study of Depression in Older Persons (NESDO), a multi-site naturalistic prospective cohort study which makes it possible to examine the determinants, the course and the consequences of depressive disorders in older persons over a period of six years, and to compare these with those of depression earlier in adulthood. From 2007 until 2010, the NESDO consortium has recruited 510 depressed and non depressed older persons (≥ 60 years) at 5 locations throughout the Netherlands. Depressed persons were recruited from both mental health care institutes and general practices in order to include persons with late-life depression in various developmental and severity stages. Non-depressed persons were recruited from general practices. The baseline assessment included written questionnaires, interviews, a medical examination, cognitive tests and collection of blood and saliva samples. Information was gathered about mental health outcomes and demographic, psychosocial, biological, cognitive and genetic determinants. The baseline NESDO sample consists of 378 depressed (according to DSM-IV criteria) and 132 non-depressed persons aged 60 through 93 years. 95% had a major depression and 26.5% had dysthymia. Mean age of onset of the depressive disorder was around 49 year. For 33.1% of the depressed persons it was their first episode. 41.0% of the depressed persons had a co morbid anxiety disorder. Follow up assessments are currently going on with 6 monthly written questionnaires and face-to-face interviews after 2 and 6 years. The NESDO sample offers the opportunity to study the neurobiological, psychosocial and physical determinants of depression and its long-term course in older persons. Since largely similar measures were used as in the Netherlands Study of Depression and Anxiety (NESDA; age range 18-65 years), data can be pooled thus creating a large longitudinal database of clinically depressed persons with adequate power and a large set of neurobiological, psychosocial and physical variables from both younger and older depressed persons.BMC Research Notes 12/2011; 4(1):524. DOI:10.1186/1756-0500-4-524
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- "There also is preliminary evidence for negative effects of PD features on treatment outcomes for depressed older adults. Personality psychopathology has generally been associated with poorer response to treatment (Fiorot, Boswell, & Murray, 1990; but not Kunik et al., 1994; Thompson et al., 1988) and ''chronicity''—meaning relapse or staying continuously ill (Stek et al., 2002; Vine & Steingart, 1994). Findings on the association of co-morbid PD diagnoses with simple relapse have been inconsistent, with some findings indicating higher relapse rates (Brodaty et al., 1993), and others finding no association of PD diagnoses with simple relapse (Molinari & Marmion, 1995). "
ABSTRACT: Despite considerable research on depression in older adults, few studies have included individuals with personality disorders or have used laboratory tasks to examine behavioral correlates of depression among older adults. This study used the Bechara Gambling Task to examine the hypothesis that depressed older adults with co-morbid personality disorders (n=59) would demonstrate greater aversion to risk, when compared with older adult controls without depression or personality disorders (n=34). Results indicated weak support for the notion that depressed individuals are more risk averse than non-depressed controls, and stronger support for the role of obsessive-compulsive personality disorder (OCPD) in risk aversion. Individuals with OCPD became considerably more risk averse as the task progressed, compared with controls. In addition, the severity of OCPD features, rather than depression, accounted for increased risk aversion in depressed older adults with OCPD.Cognitive Therapy and Research 04/2007; 31(2):161-174. DOI:10.1007/s10608-006-9114-x · 1.70 Impact Factor
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- "Em amostras adultas, pacientes com transtorno de personalidade têm respostas menos favoráveis do que os sem transtorno a uma variedade de tratamentos já testados para depressão, incluindo medicações antidepressivas, psicoterapia interpessoal, placebo e medicação combinada mais terapia. Os transtornos de personalidade têm sido geralmente associados com limitada resposta aos tratamentos e também à cronicidade , que se refere aos pacientes que se mantêm sempre doentes (Stek et al., 2002). Situação essa que acontece com este caso relatado, em que a paciente não respondeu a nenhuma das terapêuticas medicamentosas propostas e manteve um quadro crônico de difícil manejo. "
ABSTRACT: Context: Interpersonal difficulties, affective instability, distortions of the clinician-patient relationship, and unpredic- table responses to clinical interventions, are characteristics found in older adults as well as in younger patients with personality disorders. Case report: We report the case of a 68 years old patient with histrionic personality disorder and other psychiatric comorbidities. Conclusion: Personality disorders are frequently overlooked in the diagnostic workout of complex psychogeriatric syndromes, and require a comprehensive assessment of personality traits. The correct identification of personality disorders and their subtypes is critical for planning the therapeutic approach, including pharmacotherapy and psychological management.Revista de Psiquiatria Clínica 01/2007; 34(1). DOI:10.1590/S0101-60832007000100003 · 0.52 Impact Factor