Depressive symptoms, medical illness, and functional status in depressed psychiatric inpatients.
ABSTRACT There is evidence that both psychiatric (especially affective) and medical illnesses contribute to physical disability. However, the differential contributions of specific psychiatric disorders and of medical pathology to functional status in psychiatric populations have not been studied. The authors therefore examined the contributions of depressive symptoms and medical illness to functional disability in depressed inpatients.
This prospective investigation included 109 psychiatric inpatients with DSM-III-R major depression. Regression techniques were used to examine the contribution of demographic variables (age, sex, education), depressive symptom severity (Hamilton Rating Scale for Depression score), psychiatric function (Global Assessment of Functioning Scale score), organ system pathology (Cumulative Illness Rating Scale score), and medical disability (Karnofsky Performance Status Scale score) to overall functional status (Instrumental Activities of Daily Living and Physical Self-Maintenance scores). These relationships were also examined in older and younger subgroups.
Greater age, female sex, and illness factors all contributed to poorer functional status. Of the illness factors, psychiatric pathology contributed more to low functional status than did medical illness. The predictive power came specifically from the functionally based measures of psychiatric and medical illness; a quantitative measure of symptoms (Hamilton depression scale) or organ pathology (Cumulative Illness Rating Scale) did not significantly predict overall functional status.
Clinicians and researchers should recognize that symptomatic and functional assessments tap related but different domains and that both psychiatric and medical illnesses contribute to overall disability.
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ABSTRACT: To explore the usefulness of "anhedonia", "fatigue" and "depressed mood" as screening symptoms for predicting a depressive episode in physically ill patients. 290 patients filled in a modified version of the Patient Questionnaire and were subsequently assessed by psychiatrists with the Composite International Diagnostic Interview (CIDI; ICD-10 version). 63 patients suffered from a current depressive episode according to the CIDI. If at least two of the three symptoms were used for screening positively (ICD-10 algorithm), the sensitivity was 93.2% and the specificity 72.7%, while the simpler algorithm of DSM-IV - requiring depressed mood or anhedonia to be present - yielded a slightly higher sensitivity (95.2%) and a slightly lower specificity (66.5%). One in five patients with a depressive episode did not report "depressed mood". It remains unclear how relevant the three core symptoms of depression are for the diagnosis of an ICD-10 depression in people who are not physically ill. The fact that both diagnostic algorithms yielded comparable results suggests that the more parsimonious DSM-IV algorithm is preferable and "fatigue" could be left out as a screening symptom. Since "depressed mood" was absent in a substantial proportion of patients, special attention has to be paid to "anhedonia". Medical students and non-psychiatric clinicians should be especially trained to ask for anhedonia, so that cases of depression will not be overlooked.Journal of Affective Disorders 10/2010; 126(1-2):245-51. DOI:10.1016/j.jad.2010.03.023 · 3.71 Impact Factor
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ABSTRACT: Functional impairment might amplify suicide risk in later life. A positive view of the future may reduce this risk. We tested the hypothesis that hopelessness and positive future orientation moderate the association between functional status and suicide ideation in a sample of 136 patients, 55 years of age or older, in treatment for depression. Future orientation moderated the association between functional status and suicide ideation; hopelessness did not. Although prospective research is needed to test more rigorously the hypothesized protective role of positive future orientation, our data suggest that treatments designed to enhance future orientation might decrease suicide risk.Depression and Anxiety 01/2007; 24(3):196-201. DOI:10.1002/da.20224 · 4.29 Impact Factor
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ABSTRACT: Tiivistelmä. Diss. -- Helsingin yliopisto. Internet-yhteys, WWW-selain ; Adobe Acrobat Reader.