Article

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

Valeriusclinic, Free University, Amsterdam, The Netherlands.
Aging and Mental Health (Impact Factor: 1.78). 09/2002; 6(3):282-5. DOI: 10.1080/13607860220142413
Source: PubMed

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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    • "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). "
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    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. "
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    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 · 0.89 Impact Factor
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    • "erwachten dat het beloop verbetert op hogere leeftijd. Echter, het voorkomen van factoren waarvan bekend is dat ze een ongunstig effect hebben op het beloop van depressie neemt dramatisch toe met de leeftijd. Voorbeelden zijn lichamelijke ziekten en beperkingen, cognitieve achteruitgang en gebrek aan steun (Baldwin & Jolley 1986; Murphy e.a. 1983; Stek e.a. 2002). Hierdoor zou men verwachten dat het beloop juist verslechtert met de leeftijd. Het natuurlijk beloop laat zich het beste onderzoeken in de algemene bevolking of in de eerste lijn. Immers, patiënten verwezen naar gespecialiseerde gezondheidszorgvoorzieningen vertegenwoordigen een sterk geselecteerde groep ouderen: de groep met de ernst"
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    ABSTRACT: Background: Hardly any reliable data are available relating to the course of late-life depression. Aim: To trace the course of late-life depression in the community; to determine whether the outlook/or depressed persons deteriorates with age; and to find out whether failure to satisfy DSM criteria for affective disorders when the depression first manifests itself predicts the course of the depression. Method: The study was part of the Longitudinal Aging Study Amsterdam. Reliable data relating to 277 depressed elderly persons are available (on average9.8 observations per respondent]. Results: During a 6-year period the mean severity of symptoms in the study group was remained higher than the 85th percentile score for elderly persons in the general population. Fewer than 15% of the respondents were depressed/or less than 20% of the time. Of the respondents 23% went into remission, 12% went into remission but experienced recurrence, 32% fell into the chronic intermittent category and 32% fell into the chronic category. Both age at baseline and age-related risk/actors predicted that the depression would take a rather less favourable course. Respondents fulfilling the DSM-criteria/or depression or dysthymic disorder had the least favourable prognosis. In most cases the course of the depression in those diagnosed as having subthreshold depression at baseline was highly unfavourable and certainly far less favourable than in a control group of non-depressed elderly persons who were followed/or 3 years. Conclusion: The outlook/or most persons with late-life depression in the community as a whole is not promising and is probably less promising than for younger adults. The DSM-criteria for depression disorders are a helpful tool/or identifying the group whose depression will take the worst course. However, most of the elderly persons with symptoms of depression do not meet formal DSM-criteria. This 'grey area' in the classification of affective disorders is highly relevant, both clinically and from the point of view of public health, and therefore requires further research. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
    Tijdschrift voor psychiatrie
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