Marcy Wohl

Ethnic differences in clinical presentation of depression in adult women.

This study examined ethnic differences in self-report and interviewer-rated depressive symptoms and estimated the contributions of sociodemographic and psychosocial factors in predicting severity of depression. One hundred twenty-five clinically depressed African American (n = 46), Caucasian (n = 36), and Latina (n = 43) women were recruited. After controlling for differences in socioeconomic status, African American women reported more symptoms of distress and Latinas were rated as significantly more depressed than the other groups. However, these ethnic differences were not moderated by either education or employment. Finally, hierarchical regression analysis indicated that severity of depression was predicted by low education, being single, being Latina, high perceived stress, and feelings of hopelessness. Additional research is needed to validate these results and to investigate their clinical significance.

Clinical and Neuroradiologic Features Associated With Chronicity in Late-Life Depression

The authors conducted a 6-year follow-up of 16 patients with late-life depression to evaluate the relationships between clinical and neuroradiologic variables and disease outcome. Patients had a comprehensive neuropsychiatric evaluation and magnetic resonance imaging (MRI) at baseline and follow-up. Eight of the 16 developed a chronic course of unremitting major depression sufficient to cause significant psychosocial impairment. Six patients with a chronic course and four patients with a non-chronic course of depression had white matter hyperintensities (WMH) on MRI at baseline. Four patients whose WMH increased in size over time developed a chronic unremitting course of depression. No patients with non-chronic depression had large areas of WMH at baseline or exhibited increased WMH size over time. Chronic depression was associated with severity of cerebrovascular risk factors, apathy, and poor quality of life. Treatment and prevention of cerebrovascular disease may improve the outcome of late-life depression.

Neuropsychological deficits among older depressed patients with predominantly psychological or vegetative symptoms

Depressed outpatients having primarily psychological or vegetative symptoms, as defined by the factor analytically developed Hamilton Depression Scale superfactors described by Rhoades and Overall (1983), were compared with similarly aged normal controls on a comprehensive neuropsychological battery. The vegetative group evidenced poorer performance than controls on several measures associated with right hemisphere functioning and on a task associated with executive functioning. In contrast, the psychological group did not significantly differ from controls on any measure, and had significantly better performance than the vegetative group on several tasks. These findings suggest that neuropsychological deficits associated with depression may be limited to those patients with primarily vegetative symptoms.

Behavioral phenomenology in Alzheimer's disease, frontotemporal dementia, and late-life depression: a retrospective analysis.

Often patients in the early stages of Alzheimers disease (AD), frontotemporal dementia (FTD), and late-life depression can be difficult to differentiate clinically. Although subtle cognitive distinctions exist between these disorders, noncognitive behavioral phenomenology may provide additional discriminating power. In 19 subjects with AD, 19 with FTD, 16 with late-life psychotic depression (LLPD), and 19 with late-life nonpsychotic depression (LLNPD), noncognitive behavioral symptoms were quantified retrospectively using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and compared using both a one-way ANOVA and a multivariate stepwise discriminant analysis, which utilized a jackknife procedure. The FTD group showed the highest mean total SCAN score, while the AD group showed the lowest. ANOVA showed significant differences in the mean total SCAN scores between the four diagnostic groups (P < .0001). With the discriminant analysis, the four disorders demonstrated different clusters of behavioral abnormalities and were differentiated by these symptoms (P < .0001). A subset of 14 SCAN item group symptoms was identified that collectively classified correctly the following percentages of subjects in each diagnostic category: AD 94.7%, FTD 100%, LLPD 87.5%, and LLNPD 100%. These results indicate that AD, FTD, LLPD, and LLNPD were distinguished retrospectively by the SCAN without using cognitive data. Better definition of the longitudinal course of noncognitive behavioral symptoms in different dementias and psychiatric disorders will be valuable both for diagnosis and to help define behavioral syndromes that are associated with selective neuroanatomic and neurochemical brain pathology.

Relationship of age, age at onset, and sex to depression in older adults.

The authors investigated the relationships among factors of age, age at onset, and sex in depressed older adults. A group of 96 outpatients (mean age, 60) diagnosed with late-(LOD) and early-onset (EOD) major depression were assessed for severity of depression and underwent magnetic resonance imaging (MRI). The MRI scans were rated for severity of white-matter hyperintensities (WMH) and ventricle-to-brain ratio (VBR). LOD was associated with increased amounts of WMH, larger VBR, and history of hypertension. Men were more severely depressed than women, with higher rates of neurovegetative signs and history of smoking. Age correlated with increased VBR and WMH, history of hypertension, history of percipitants for the current episode, and lack of social support. Results suggest that a subgroup of men may be more at risk for LOD associated with WMH and that sex and age at onset need to be considered in future studies.

Performance of Older Depressed Patients on Two Cognitive Malingering Tests: False Positive Rates for the Rey 15-item Memorization and Dot Counting Tests

To our knowledge, no investigations have been undertaken to determine whether depression impacts performance on two commonly used tests to detect malingering of cognitive symptoms, the Rey 15-item Memorization Test and the Rey Dot Counting Test. This is a critical issue because of the high rate of depressive symptoms in patients with neurological conditions. It was hypothesized that depressed individuals, especially those with more severe depression, might be at risk for failing the tests, because these patients exhibit mild deficits in mental speed, visual perceptual/spatial skills, and visual memory, abilities required for successful completion of the malingering tests. However, examination of test performance in 64 older participants with major depression generally revealed very low false positive rates for most test scores, and severity of depression was unrelated to test scores. These results add to accumulating data supporting the validity of these cognitive malingering tests by documenting few false positive identifications.

Apolipoprotein-E and White-Matter Hyperintensities in Late-Life Depression

The authors conducted a follow-up study of 16 patients with late-life depression approximately 6 years after their initial assessment to evaluate the relationships between apolipoprotein-E (APO-E) status and white-matter hyperintensities (WMH). Ten patients had WMH at baseline, and four patients demonstrated an increase in WMH size over time. Three of four patients with the APO-E epsilon 4 allele demonstrated an increase in WMH over time, and only 1 of 12 patients without an epsilon 4 allele had an increase in WMH. Three of four patients with APO-E epsilon 4 allele developed a chronic course of major depression at follow-up. Patients with APO-E epsilon 4 had a higher number of depressive episodes and lower age at onset. APO-E may be a risk factor for cerebrovascular disease associated with late-life depression and may affect the clinical characteristics and disease course of depression.

Rapid Cycling Patients: Conceptual and Etiological Factors

The concept of rapid cycling is confusing in terms of its definition, clinical features, course of illness and the outcome. To complicate the matter further, rapid cycling has been reported to be drug resistant. Currently this condition has been reported to be secondary to lithium, tricyclic antidepressants and other agents such as cyproheptadine, a serotonin antagonist, piribedil, propranolol and levodopa. The increase in rapid cycling has coincided with the rapid increase in cocaine use in the society even though such an association cannot prove a causal relationship. Clinical or subclinical hypothyroidism as well as hyperthyroidism have been implicated in rapid cycling. In addition to the lack of specific knowledge on the etiology, a number of heterogeneous disorders has been grouped under this entity. It is useful to attempt a classification to ascertain whether clinically distinguishable subgroups have a common or different pathophysiology and to tailor the treatment that is most desirable for each subgroup.

Physical Illness in Hospitalized Psychiatric Patients

AbstractExtensive investigations including dianosis based on DSM-III criteria, physicaf examination, neurological examination, CT scans, EKG, toxicological screening, and biochemical tests were conducted on a randomly selected group of 75 psychiatric inpatients to assess the prevalence of previously undetected hysical illnesses. The illnesses that were Betected by the research team were divided into those that were (a) incidental, (b) a health burden, and (c) causative of or exacerbating psychiatric illness. Of the 30 hysical illnesses which were a healtx burden, 22 were undetected by the primary psychiatrists. Six of the 18 physical illnesses causing or exacerbating sychiatric illness were identified by tie primary psychiatrists. The most useful tool for detection of physical illnesses was physical examination following a standardized systems review and medical history at a time when the patients were able to provide a medical history and cooperate for a physical examination.