Daniel S.P. Schubert

Increased Depression in Multiple Sclerosis Patients: A Meta-Analysis

Clinical reports and experimental studies have conflicted on depression in multiple sclerosis (MS) patients. Recent reviews show that few controlled studies have been done. A comprehensive search of the literature revealed six studies that compared depression in MS patients with depression in comparison groups. The meta-analytic combination of these studies indicates that MS patients are significantly more depressed than comparison groups.

Physical consequences of depression in the stroke patient

The past literature suggests the hypothesis that depression is associated with decreased physical functional ability in stroke patients. On a medical rehabilitation ward, 21 stroke patients were evaluated for depression by psychiatric interview and self-report, and were also rated on the Barthels Functional Index (BFI). The hypothesis was supported: Patients scoring 17 or higher on the Beck Depression Inventory (BDI) (N = 7) had lower initial scores on the BFI than patients with lower BDI scores. There was a trend for these seven depressed patients to improve more slowly as ascertained by the BFI. Depression was suggested to lower functional ability by increasing fatigue, hopelessness, and decreasing motivation.

Increase of medical hospital length of stay by depression in stroke and amputation patients: A pilot study.

Past studies have found that medical patients with the diagnosis of depression (comorbidity) have longer hospital lengths of stay (LOS) than those without the diagnosis of depression. This suggested that scores on a depression scale would be positively correlated with LOS. On a rehabilitation ward, 14 stroke and 17 amputee patients were given the Geriatric Depression Scale (GDS) and lengths of stay were recorded. Correlations between GDS scores and LOS were +0.575 for stroke and +0.266 for amputee patients, both in the hypothesized direction. Explanations considered included: (1) depression and medical illness each produce morbidity which summate to require increased LOS; (2) depression delays medical recovery as well as the appearance of medical recovery, and (3) discharge planning is complicated by depression. When depression is associated with inpatient medical illness, DRGs may need to be reevaluated.

Detection of depression in the stroke patient

The literature suggests the hypothesis that nonpsychiatrists will underrecognize depression in evaluations of stroke patients. On a medical rehabilitation ward, 15 stroke patients were evaluated for depression by psychiatric interview and self-report. Charts were examined for detection of depression by the rehabilitation team. The hypothesis was supported: in contrast to psychiatric interview (68% depressed) and self-report (Beck Depression Inventory, 50% depressed), none of the patients were described as depressed in chart notes by the rehabilitation team (excluding the psychiatrists). Psychiatrists should develop ongoing interactions with primary care physicians to improve detection of poststroke depression and other depressions on medical wards.

The effect of patient gender on the prevalence and recognition of alcoholism on a general medicine inpatient service

Objectives:1) to determine the rate of alcoholism among general internal medicine inpatients, 2) to assess the recognition and referral rates of these patients by their physicians, 3) to determine the effect of patient gender on physician recognition of alcoholism, and 4) to compare the observed alcoholism rates with rates reported in frequently cited studies, controlling for gender distribution.Design:Cross-sectional study, face-to-face interviews.Setting:A large, county-owned metropolitan teaching hospital.Patients/participants:Adult patients admitted to an inpatient general medical firm. From among 95 consecutive admissions, 78 patients (81%) entered the study.Intervention:The Michigan Alcoholism Screening Test (MAST) was administered to all study subjects. Chart reviews provided evidence of physician recognition and referral of patients with alcoholism. The observed rate of alcoholism was compared with rates reported in frequently cited studies after stratifying by type of service sampled and alcoholism assessment method used. Rates were then standardized for gender using the direct method.Measurements and main results:Twenty-two patients (28%) were found to be alcoholic by MAST criteria (scores of 5 or higher). Scores in the range indicative of alcoholism were observed more frequently among the 36 men than among the 42 women (p=0.002) and varied by age group. Only the interaction between gender and age group was significant (p=0.023). Sixteen of the 22 patients (73%) with alcoholism by MAST criteria were identified as alcoholic by physician evaluation. Physicians were significantly more likely to identify as alcoholic those patients with MAST scores higher than 29 and tended to more readily identify men who had alcoholism than women. Among physician-identified patients, only about one in five was referred for rehabilitation. The standardized alcoholism rate found (291/1,000) ranked about halfway between the highest and the lowest standardized rates from nine other studies of medicine inpatient services (465/1,000 and 112/1,000).Conclusions:Patient gender affected the prevalence of alcoholism and influenced its recognition by physicians. Alcoholism by MAST criteria was found in one in eight female and nearly one in two male inpatients. Physician recognition was higher for men and for more severely affected patients. An understanding of gender effects is essential to the appropriate interpretation of the results of screening tests for alcoholism and to understanding differences in reported crude rates of alcoholism among studies. Supplementing clinical impressions with the routine use of standardized methods for detecting alcoholism is recommended.

Associations among alcoholism, drug abuse, and antisocial personality: a review of literature.

Current practice through both diagnostic systems and clinical approaches tends to view alcoholism, drug abuse, and antisocial personality as completely distinct systems. In the course of research with other goals, the authors noted the apparent associations of each pair within this triad. As prior reviews of the literature on associations among these did not deal with implications of frequent association, this literature was re-evaluated with a more comprehensive assessment of the studies and reports bearing on these associations. After a broad search, studies were examined that reponed statistics indicating an association or none between one or more of the pairs of the triad. About 75% to 80% of the studies meeting the criteria showed positive associations between pairs. Also, a common etiological matrix may predispose one to behaviors diagnostic of each aspect of the triad: alcoholism, drug abuse, and antisocial personality. Although many studies contained methodological difficulties, the review suggests where diagnosis of one aspect is made, the other two should be suspected and the patient so evaluated.

Evaluation of studies on platelet alpha2 adrenoreceptors in depressive illness

Discrepant results have been reported from at least ten laboratories regarding the status of platelet alpha 2 adrenoreceptors in depressed patients. Using a statistical test to combine those studies which utilized radioligand binding techniques, we find the overall data support an elevation in density of platelet alpha 2 adrenoreceptors from drug-free depressed patients (p less than 0.05) and suggest a normalization to lower binding values following antidepressant drug treatment (0.05 less than p less than 0.10). However, these positive results are attributable to highly significant findings by only three laboratories. Much of the discrepancy may be attributable to numerous methodological variables which distinguish the studies. Foremost amongst these variables are the use of different platelet size populations, the use of different medium, and the choice of radioactive ligand and competitor (non-radioactive ligand) in the assay. We present a rationale for the proper choice of each methodological condition used in the clinical assessment of platelet alpha 2 adrenoreceptor status, hoping that improved experimental designs will resolve the current controversy.

Depression following a spinal cord injury

Object: Depression is a common problem following a spinal cord injury (SCI) and can greatly interfere with the rehabilitation process because of reduced energy, negative expectations, and social withdrawal. Understanding various factors which influence a vulnerability to depression may improve the diagnosis and treatment of depressive disorders and can improve rehabilitation outcome. Method: A thorough literature search was conducted using Medline, PsychLit, PyschInfo, and Social Science Citation Index to identify relevant articles published between 1967 and 1995. Results: A diathesis-stress model is proposed to explain the increased risk of depressive symptoms after a SCI. Biological changes associated with SCI and pre-existing cognitive biases may influence the individuals vulnerability to stressful life events following the injury. The nature and frequency of stressful life events following the injury can tax the individuals coping resources. Furthermore, the perceived quality of social support and the severity of conflict within the family can influence the individuals adaptation. Conclusions: Social support and recent stressors should be assessed to identify patients at high risk for depression. Patients are less likely to become depressed if their independence is fostered and they are encouraged to develop new sources of self-esteem. Relatives can be counseled to help maintain supportive relationships within the family.

Intelligence as Necessary But Not Sufficient for Creativity.

Summary G. T. scores on the Army General Classification Test (AGCT) as indicants of intelligence were correlated with scores on the Creative Imagination Test (CIT) for two groups of men differing on intelligence. Results supported the prediction of closer correspondence of intelligence and creativity scores in a low intelligence range (r = .437, p < .01) than in a high intelligence range. Intelligence was unrelated statistically to creativity (r = .10) when only the high intelligence range above 111 was considered. Guilfords triagular scatterplot conceptualization of intelligence-creativity relationship seemed most congruent with the present and earlier data. Intelligence was described as allowing the development of creativity, but not insuring such development. Personality and environmental factors may be important in creativity expression especially at upper intelligence ranges.

Decrease of depression during stroke and amputation rehabilitation

Clinical observation had suggested that mild depression occurs after admission for acute medical treatment and then decreases during further hospitalization for rehabilitation treatment. The Geriatric Depression Scale (GDS) was given on admission and discharge to 14 stroke and 17 amputee rehabilitation patients. Each of the two groups showed decreasing GDS scores from beginning to end of the rehabilitation admission. Suggested reasons included: (1) the gradually diminishing effects of stroke and amputation as life crises during the 1-2 month admission, (2) effects of physical improvement on mood and affect, (3) milieu effects of the medical ward, and (4) tendencies for all psychopathology scale scores to decrease on retest.