Steve Simpson

The differentiation of DSM-III-R psychotic depression in later life from nonpsychotic depression: comparisons of brain changes measured by multispectral analysis of magnetic resonance brain images, neuropsychological findings, and clinical features

BACKGROUND Psychotic depression has been proposed as a distinct subtype of major depression. There is considerable evidence for this in younger patients, although the neuroimaging has been rudimentary. Volumetric imaging studies are required of consecutive cohorts of patients with depression. METHODS Ninety-nine consecutive elderly patients were diagnosed with DSM-III-R major depression. Eighteen were psychotic, and 81 were not. Sixty-six patients were given a neuropsychological test battery, and 44 had a magnetic resonance imaging brain scan. A model integrating clinical, psychological, and neuroimaging findings for the explanation of delusion formation during depression is proposed. RESULTS Psychotic depression was characterized by worse physical health, more family history of depression, a poorer response to antidepressant drugs, and more severe lowering of mood; however, the strongest predictors of the presence of delusions were diencephalic atrophy, reticular activating system lesions, brain stem atrophy, and left-sided frontotemporal atrophy. The psychotic patients had poorer performance on tests of frontal lobe function and mental processing speed. CONCLUSIONS In the elderly, psychotic depression is etiologically, clinically, and neuroradiologically distinct, and has different treatment requirements, from nonpsychotic major depression.

Neurological correlates of depressive symptoms in Alzheimer's disease and vascular dementia.

BACKGROUND Organic brain disease such as dementia or stroke is associated with depression. In dementia, depressive symptoms are common where there is evidence of vascular disease and in Alzheimers disease they often coexist with extrapyramidal signs. METHOD In a study of 60 patients with Alzheimers disease and 39 patients with vascular dementia, depressive symptoms were rated using the Cornell Scale for Depression in Dementia. Neurological signs were assessed and severity of cognitive impairment was measured with the Mini-Mental State Examination. RESULTS Depressive symptoms were more severe in vascular dementia. Pyramidal tract signs had no relationship to depression in either type of dementia. In vascular dementia, extrapyramidal and grasp reflexes were strongly related to the severity of depression, and were associated with neurovegetative features. In Alzheimers disease, extrapyramidal signs were the strongest independent predictor of the severity of depression. CONCLUSION Depressive symptoms are more severe in vascular dementia compared to Alzheimers disease and were related to neurological abnormalities.

CRIME-RELATED POST-TRAUMATIC STRESS DISORDER IN ELDERLY PSYCHIATRIC PATIENTS: A CASE SERIES

Previous research has shown that fear of crime among the elderly is very common, and being a victim is not uncommon. There have been no descriptions of the impact of crimes on the mental health of the victims. In this study, 350 psychiatric patients were screened for post‐traumatic stress disorders (PTSD). One hundred of the patients had been victims, and five of the victims (5%) had PTSD. Their clinical characteristics are described. In this series, most crimes were not complicated by PTSD.