Alcoholism and affective disorder: Clinical course of depressive Symptoms
This study compared the severity of and the change in depressive symptoms among men with alcohol dependence, affective disorder, or both disorders during 4 weeks of inpatient treatment.
After their primary and secondary psychiatric disorders were defined with the use of criteria based on chronology of symptoms, 54 unmedicated men entering treatment for alcohol dependence or affective disorder were assessed for 4 consecutive weeks with the Hamilton Depression Rating Scale.
The findings indicate that the rate of remission of depressive symptoms was consistent with the primary diagnosis. Depressive symptoms remitted more rapidly among the men with primary alcoholism than among those with primary affective disorder. However, a minimum of 3 weeks of abstinence from alcohol appeared to be necessary to consistently differentiate the groups with dual diagnoses on the basis of their current depressive symptoms. Alcohol dependence occurring in conjunction with primary affective disorder did not intensify presenting depressive symptoms or retard the resolution of such symptoms.
Diagnoses of alcohol dependence and affective disorder based on symptom chronology appear to have prognostic significance with respect to remission of depressive symptoms in men with both diagnoses. Depressive symptoms of dysphoric mood, dysfunctional cognitions, vegetative symptoms, and anxiety/agitation showed different rates and levels of remission across the primary diagnostic groups.
Available from: Cassiano Coelho
- "Causal theories suggest that heavy drinking or alcohol use/abuse may cause depression, in the short-term, due to the pharmacological effects of alcohol . In the long term, neurobiological studies have demonstrated that depression could result from hippocampal atrophy . "
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The associations between depressive symptoms and alcohol-related disorders, drinking patterns and other characteristics of alcohol use are important public health issues worldwide. This study aims to study these associations in an upper middle-income country, Brazil, and search for related socio-demographic correlations in men and women.
A cross-sectional study was conducted between November 2005 and April 2006. The sample of 3,007 participants, selected using a multistage probabilistic sampling method, represents the Brazilian population aged 14 and older. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale and alcohol dependence was assessed using the Composite International Diagnostic Interview. Associations assessed using bi-variate analysis were tested using Rao-Scott measures. Gender specific multinomial logistic regression models were developed.
Among the participants with alcohol dependence, 46% had depressive symptoms (17.2% mild/moderate and 28.8% major/severe; p < 0.01); 35.8% (p = 0.08) of those with alcohol abuse and 23.9% (p < 0.01) of those with a binge-drinking pattern also had depressive symptoms. Alcohol abstainers and infrequent drinkers had the highest prevalence of major/severe depressive symptoms, whereas frequent heavy drinkers had the lowest prevalence of major/severe depressive symptoms. In women, alcohol dependence and the presence of one or more problems related to alcohol consumption were associated with higher risks of major/severe depressive symptoms. Among men, alcohol dependence and being ≥45 years old were associated with higher risks of major/severe depressive symptoms.
In Brazil, the prevalence of depressive symptoms is strongly related to alcohol dependence; the strongest association was between major/severe depressive symptoms and alcohol dependence in women. This survey supports the possible association of biopsychosocial distress, alcohol consumption and the prevalence of depressive symptoms in Brazil. Investing in education, social programs, and care for those with alcohol dependence and major/severe depressive symptoms, especially for such women, and the development of alcohol prevention policies may be components of a strategic plan to reduce the prevalence of depression and alcohol problems in Brazil. Such a plan may also promote the socio-economic development of Brazil and other middle-income countries.
- "associated with substance use disorders (Brown et al., 1995; Husband et al., 1996) and may confound screening for mental disorders. Moreover, establishing the required criteria for a mental disorder that is not substance related can be difficult, because patients may have a hard time remembering whether it was the substance abuse that preceded the mental disorder or vice versa (Rounsaville et al., 2002). "
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ABSTRACT: Objective: This study intended to test the effectiveness of the Kessler-6 to identify severe symptoms of mental disorders among outpatients undergoing treatment for substance use disorders. Methods: Patients (N = 135) were administered the Mini International Neuropsychiatric Interview 5.0, the Addiction Severity Index drug and alcohol items, and the Kessler-6. Six months later, patients were reinterviewed and administered the Kessler-6 and the Addiction Severity Index drug and alcohol items again (follow-up rate: 74%). Results: The Kessler-6 was associated with the presence of anxiety, major depression, and dysthymia. In multivariate analysis controlling for gender, age, drug use, alcohol use, and attention deficit/hyperactivity disorder, patients with any anxiety or mood disorder scored 6.93 points higher on the Kessler-6 compared to patients without such disorders, corresponding to 1.06 standard deviations. Screening properties were not satisfactory, primarily because of the high prevalence of mental disorders in this sample. The Kessler-6 was moderately correlated over 6 months (r = .52, p < .0001) and predicted continuous drug use after controlling for age, gender, and wave 1 drug use (partial r = .20, p = .048). Conclusions: For research purposes, the Kessler-6 may be used as a valid indicator of mental disorder in clinical samples of patients with substance use disorders. For clinical use, it is likely to identify patients with severe symptoms who are at high risk for poor response to treatment.
Available from: Jennifer Johnson
- "Furthermore , substance use disorder is the rule rather than the exception among incarcerated women (with a 6-month prevalence of 45e60% and a lifetime prevalence of 70%; Jordan et al., 1996; Teplin et al., 1996). The study targeted women who met criteria for MDD after at least 4 weeks of substance use treatment because some studies (e.g., Brooner et al., 1997; Brown et al., 1995; Nunes et al., 1998) have documented a decrease in depressive symptoms following the first few weeks of substance use treatment. The study recruited women who would be released from prison in the near future in order to evaluate the effects of MDD treatment on both inprison and post-release outcomes. "
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ABSTRACT: This study, the largest randomized controlled trial of treatment for major depressive disorder (MDD) in an incarcerated population to date, wave-randomized 38 incarcerated women (6 waves) with MDD who were attending prison substance use treatment to adjunctive group interpersonal psychotherapy (IPT) for MDD or to an attention-matched control condition. Intent-to-treat analyses found that IPT participants had significantly lower depressive symptoms at the end of 8 weeks of in-prison treatment than did control participants. Control participants improved later, after prison release. IPT's rapid effect on MDD within prison may reduce serious in-prison consequences of MDD.
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