Psychotic Late-Life Depression: A 376-Case Study

1999 ◽  
Vol 11 (3) ◽  
pp. 325-332 ◽  
Author(s):  
Franco Benazzi
Keyword(s):  
Rating Scale ◽  
Bipolar Depression ◽  
Late Life ◽  
Psychotic Depression ◽  
Global Assessment Of Functioning ◽  
Late Life Depression ◽  
Younger Patients ◽  
Unipolar Disorder ◽  
Age Related ◽  
Psychotic Features

The aim of the report was to study clinical differences between psychotic late-life depression and psychotic depression in younger patients, to determine if differences were age-related or specific for psychotic late-life depression. Three hundred seventy-six consecutive outpatients, presenting for treatment of unipolar or bipolar depression (with or without psychotic features), were assessed by means of the Structured Clinical Interview for DSM-IV, the Montgomery and Asberg Depression Rating Scale, and the Global Assessment of Functioning Scale. Results showed that psychotic late-life (50 years or more) depression, versus psychotic depression in younger patients, was associated with significantly higher age at study entry/onset, longer duration, and lower comorbidity. Psychotic depression versus nonpsychotic late-life depression, in late-life and in younger patients, was associated with significantly greater severity, lower comorbidity, more patients with bipolar I disorder, and fewer patients with unipolar disorder. Findings were related to psychosis or to age, and not to specific features of psychotic late-life depression. These results support a unitary view of psychotic depression.

scholarly journals Vortioxetine for depression treatment in hospital setting: experience from a single psychiatric hospital

2020 ◽  
pp. 83-88
Author(s):  
O. V. Limankin ◽  
A. V. Bugorskij ◽  
E. M. Gricevskaja ◽  
T. V. Ivanova ◽  
Ju. S. Kulikova ◽  
...  
Keyword(s):  
Depressive Disorders ◽  
Rating Scale ◽  
Hospital Setting ◽  
Depression Treatment ◽  
Psychotic Depression ◽  
First Line ◽  
Clinical Global Impression Scale ◽  
Previous Therapy ◽  
Psychotic Features ◽  
First Line Treatment

The study was conducted to assess the possibility of using vortioxetine for the treatment of depressive disorders in a hospital setting. Material and methods: 32 patients with depressive disorders of various etiologies were included. Patients were assessed using Clinical Global Impression scale and Hamilton Depression Rating Scale HDRS-17 at the beginning of the study and in dynamics. Mean HDRS-17 value at the beginning was 20.1±6.6. According to the etiology of depressive disorders patients were divided into three groups: endogenous disorders—17, organic depressions—11, reactive states—4. Patients were followed-up for 60 days. Results. Vortioxetine was used both as first line treatment and after previous therapy, 10 to 20 mg a day. In 7 patients (21,9%) therapy was discontinued due to adverse events or worsening of condition. The remaining 25 patients (78,1%) showed positive dynamics. Patients with depression with psychotic features (n = 18) were assessed separately: in 5 patients therapy was discontinued, in the remaining 13 people positive dynamics were noted. Conclusion. The study has demonstrated high efficacy of vortioxetine when prescribed for the treatment of depressive disorders, including psychotic depression, in a hospital setting. The drug was well tolerated in the majority of patients.

scholarly journals Subtypes of Late-Life Depression: A Data-Driven Approach on Cognitive Domains and Physical Frailty

2020 ◽  
Vol 76 (1) ◽  
pp. 141-150 ◽  
Author(s):  
Astrid Lugtenburg ◽  
Marij Zuidersma ◽  
Klaas J Wardenaar ◽  
Ivan Aprahamian ◽  
Didi Rhebergen ◽  
...  
Keyword(s):  
Depressive Symptom ◽  
Cognitive Performance ◽  
Latent Profile Analysis ◽  
Profile Analysis ◽  
Late Life ◽  
Late Life Depression ◽  
Physical Frailty ◽  
Cognitive Domains ◽  
Age Related ◽  
Latent Profile

Abstract Background With increasing age, symptoms of depression may increasingly overlap with age-related physical frailty and cognitive decline. We aim to identify late-life-related subtypes of depression based on measures of depressive symptom dimensions, cognitive performance, and physical frailty. Methods A clinical cohort study of 375 depressed older patients with a DSM-IV depressive disorder (acronym NESDO). A latent profile analysis was applied on the three subscales of the Inventory of Depressive Symptomatology, as well as performance in five cognitive domains and two proxies for physical frailty. For each class, we investigated remission, dropout, and mortality at 2-year follow-up as well as change over time of depressive symptom severity, cognitive performance, and physical frailty. Results A latent profile analysis model with five classes best described the data, yielding two subgroups suffering from pure depression (“mild” and “severe” depression, 55% of all patients) and three subgroups characterized by a specific profile of cognitive and physical frailty features, labeled as “amnestic depression,” “frail-depressed, physically dominated,” and “frail-depressed, cognitively dominated.” The prospective analyses showed that patients in the subgroup of “mild depression” and “amnestic depression” had the highest remission rates, whereas patients in both frail-depressed subgroups had the highest mortality rates. Conclusions Late-life depression can be subtyped by specific combinations of age-related clinical features, which seems to have prospective relevance. Subtyping according to the cognitive profile and physical frailty may be relevant for studies examining underlying disease processes as well as to stratify treatment studies on the effectiveness of antidepressants, psychotherapy, and augmentation with geriatric rehabilitation.

scholarly journals Functional connectivity predictors of acute depression treatment outcome

2019 ◽  
Vol 31 (12) ◽  
pp. 1831-1835 ◽  
Author(s):  
David C. Steffens ◽  
Lihong Wang ◽  
Godfrey D. Pearlson
Keyword(s):  
Functional Connectivity ◽  
Rating Scale ◽  
Inferior Frontal Gyrus ◽  
Late Life ◽  
Multivariate Regression Analysis ◽  
Brain Regions ◽  
Frontal Eye Field ◽  
Late Life Depression ◽  
Madrs Score ◽  
Sensorimotor Network

ABSTRACTFew studies have examined functional connectivity (FC) patterns using functional magnetic resonance imaging (fMRI) to predict outcomes in late-life depression. We hypothesized that FC within and between frontal and limbic regions would be associated with 12-week depression outcome in older depressed adults. Seventy-one subjects with major depression were enrolled in the study. A study geriatric psychiatrist performed a clinical interview and completed a Montgomery-Åsberg Depression Rating Scale (MADRS). All study participants were free of medication at baseline and had a brain fMRI scan. Using a regions of interest (ROI) atlas (including 164 ROIs), we conducted ROI-to-ROI resting-state FC analyses for each participant. In terms of treatment participants were offered sertraline initially, although in this naturalistic study, other medications were also prescribed. Subjects were evaluated every 2 weeks up to 12 weeks by the study psychiatrist, who followed a flexible, clinically based medication dosing schedule. Multivariate regression analysis was used to examine correlation between change of MADRS score over 12 weeks and baseline FC between brain regions, controlling for age, gender, mean head motion, and baseline MADRS. We found greater FC between the left inferior frontal gyrus pars triangularis and the left frontal eye field and FC of these two regions with a number of brain regions related to reward, salience, and sensorimortor function were correlated with change in MADRS score over 12 weeks. Our results highlight the important role of between inner speech-reward, attention-salience, and attention-sensorimotor network synchronization in predicting acute treatment response in late-life depression.

scholarly journals Presence of neuroticism and antidepressant remission rates in late-life depression: results from the Neurobiology of Late-Life Depression (NBOLD) study

2017 ◽  
Vol 30 (7) ◽  
pp. 1069-1074 ◽  
Author(s):  
David C. Steffens ◽  
Rong Wu ◽  
James J. Grady ◽  
Kevin J. Manning
Keyword(s):  
Older Adults ◽  
Emotional Regulation ◽  
Rating Scale ◽  
Late Life ◽  
Late Life Depression ◽  
Open Label ◽  
Madrs Score ◽  
Neo Personality Inventory ◽  
Intention To Treat ◽  
Remission Rates

ABSTRACTNeuroticism in older adults is common yet understudied, particularly its effects on depression treatment outcomes. We hypothesized that presence of high neuroticism would be associated with lower 12-week remission rates in older depressed sertraline-treated patients. In this longitudinal cohort study, 43 depressed older adults completed the Revised NEO Personality Inventory (NEO PI-R). A study psychiatrist administered the Montgomery Ǻsberg Depression Rating Scale (MADRS), and the Cumulative Illness Rating Scale (CIRS, a measure of medical burden) at baseline, and the MADRS at each clinical visit. All subjects began open-label sertraline treatment and were followed over 12 weeks with clinically indicated flexible dosing and an option to switch antidepressants. We used regression analyses to examine factors related to 12-week remission of depression (MADRS score < 8) and final MADRS score. We found that higher total neuroticism (odds ratio (OR) = 0.963, 95% confidence interval (CI) = 0.928–1.000) and a neuroticism subscale, stress vulnerability (OR = 0.846, 95% CI = 0.728–0.983), were associated with lower likelihood of remission among both the intention-to-treat group and sertraline completers. Findings remained significant after controlling for baseline MADRS and CIRS score. In conclusion, assessment of personality, particularly features of neuroticism, may be important in management of late-life depression. Future studies should determine if depressed patients high in neuroticism may benefit from psychotherapy focusing on emotional regulation and stress management.

Impaired Financial Capacity in Late-Life Depression: Revisiting Associations with Cognitive Functioning

2019 ◽  
Vol 25 (10) ◽  
pp. 1088-1093 ◽  
Author(s):  
Ruth T. Morin ◽  
Mitzi M. Gonzales ◽  
David Bickford ◽  
Daniel Catalinotto ◽  
Craig Nelson ◽  
...  
Keyword(s):  
Cognitive Functioning ◽  
Independent Living ◽  
Rating Scale ◽  
Late Life ◽  
Executive Dysfunction ◽  
Depression Severity ◽  
Late Life Depression ◽  
Cognitive Domains ◽  
Financial Capacity ◽  
Clinically Depressed

AbstractObjectives:Impairment in financial capacity is an early sign of cognitive decline and functional impairment in late life. Cognitive impairments such as executive dysfunction are well documented in late-life major depression; however, little progress has been made in assessing associations of these impairments with financial incapacity.Methods:Participants included 95 clinically depressed and 41 nondepressed older adults without dementia. Financial capacity (assessed with the Managing Money scale of the Independent Living Scale), cognitive functioning (comprehensive neuropsychological evaluation), and depression severity (Hamilton Depression Rating Scale – 24) were assessed. T tests were used to assess group differences. Linear regression was used to analyze data.Results:Depressed participants performed significantly lower on financial capacity (t = 2.98, p < .01). Among depressed participants, executive functioning (B = .24, p < .05) was associated with reduced financial capacity, controlling for age, gender, education, depression severity, and other cognitive domains.Conclusions:Our results underscore the importance of assessing financial capacity in older depressed adults as they are likely vulnerable to financial abuse even in the absence of dementia. It will be valuable to assess whether treatment for depression is an effective intervention to improve outcomes.

scholarly journals Late-onset depressive disorders: a preventable variant of cerebrovascular disease?

1998 ◽  
Vol 28 (5) ◽  
pp. 1007-1013 ◽  
Author(s):  
IAN HICKIE ◽  
ELIZABETH SCOTT
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Depressive Disorders ◽  
Late Onset ◽  
Late Life ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Late Life Depression ◽  
Age Related ◽  
Medical Morbidity

The severe depressive disorders of late life are associated with high rates of medical morbidity and mortality, cognitive impairment, suicide, disability, complex treatment regimens, institutionalization and high costs to the community (Murphy, 1983; Murphy et al. 1988; Bruce & Leaf, 1989; NIH Consensus Development Panel, 1992; Alexopoulos et al. 1993a, b; Brodaty et al. 1993; Bruce et al. 1994; Forsell et al. 1994; Hickie et al. 1995; Blazer, 1996). Those disorders that are accompanied by cognitive impairment and/or concurrent medical morbidity have a particularly poor outcome (Bruce & Leaf, 1989; Alexopoulos et al. 1993b; Hickie et al. 1995, 1997a). Although psychosocial models of late-life depression place considerable importance on age-related psychological and social risk factors, those who survive into later life may actually be characterized by psychological resilience (Henderson, 1994; Blazer, 1997).Current aetiological research in late-life depression, therefore, places particular emphasis on the potential role of biological risk factors. The potential importance of vascular risk factors is receiving renewed attention and may provide opportunities for specific prevention and intervention strategies in high-risk populations. This emphasis on possible vascular risk factors, and the wider importance of vascular pathologies in late-life neuropsychiatric disorders, mirrors the emphasis of much earlier clinico-pathological studies (Binswanger, 1894; Alzheimer, 1895). The specific focus on the importance of small progressive changes within the subcortical white matter, as distinct from more discrete cortical infarcts (Olszewski, 1962), is now supported by the emerging neuroimaging literature and theoretical constructs in late-life depression (Krishnan, 1991, 1993; Hickie et al. 1996, 1997b; Krishnan et al. 1997).

scholarly journals Age-Related Hearing Loss and the Development of Cognitive Impairment and Late-Life Depression: A Scoping Overview

2021 ◽  
Vol 42 (01) ◽  
pp. 010-025
Author(s):  
Rahul K. Sharma ◽  
Alexander Chern ◽  
Justin S. Golub
Keyword(s):  
Hearing Loss ◽  
Social Isolation ◽  
Late Life ◽  
Later Life ◽  
Late Life Depression ◽  
Age Related ◽  
Impaired Cognition ◽  
Behavioral Mechanisms ◽  
Age Related Hearing Loss ◽  
The Relationship

AbstractAge-related hearing loss (ARHL) has been connected to both cognitive decline and late-life depression. Several mechanisms have been offered to explain both individual links. Causal and common mechanisms have been theorized for the relationship between ARHL and impaired cognition, including dementia. The causal mechanisms include increased cognitive load, social isolation, and structural brain changes. Common mechanisms include neurovascular disease as well as other known or as-yet undiscovered neuropathologic processes. Behavioral mechanisms have been used to explain the potentially causal association of ARHL with depression. Behavioral mechanisms include social isolation, loneliness, as well as decreased mobility and impairments of activities of daily living, all of which can increase the risk of depression. The mechanisms underlying the associations between hearing loss and impaired cognition, as well as hearing loss and depression, are likely not mutually exclusive. ARHL may contribute to both impaired cognition and depression through overlapping mechanisms. Furthermore, ARHL may contribute to impaired cognition which may, in turn, contribute to depression. Because ARHL is highly prevalent and greatly undertreated, targeting this condition is an appealing and potentially influential strategy to reduce the risk of developing two potentially devastating diseases of later life. However, further studies are necessary to elucidate the mechanistic relationship between ARHL, depression, and impaired cognition.

scholarly journals Regional cerebral blood flow in late-life depression: arterial spin labelling magnetic resonance study

2012 ◽  
Vol 200 (2) ◽  
pp. 150-155 ◽  
Author(s):  
Sean J. Colloby ◽  
Michael J. Firbank ◽  
Jiabao He ◽  
Alan J. Thomas ◽  
Akshya Vasudev ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
White Matter ◽  
Magnetic Resonance ◽  
Rating Scale ◽  
Late Life ◽  
Arterial Spin Labelling ◽  
Control Group ◽  
Late Life Depression ◽  
Spin Labelling

BackgroundA limited number of studies have demonstrated changes in cerebral blood flow (CBF) in older individuals with depression, but there are considerable inconsistencies between studies.AimsTo investigate changes in CBF using arterial spin labelling (ASL) magnetic resonance imaging (MRI) in people with late-life depression and in a similarly aged healthy control group.MethodSixty-eight participants (30 healthy individuals, 38 with depression) underwent ASL and T1-weighted MRI scanning. For each individual, regional estimates of separate grey and white matter CBF were obtained. Group differences in CBF and their associations with clinical features were examined.ResultsSignificant increases were observed in white matter CBF in patients with depression relative to the control group (F1,65 = 9.7, P = 0.003). Grey matter CBF in lateral frontal, medial frontal, cingulate, central and parietal regions did not significantly differ between groups (F1,65≤2.1, P≥0.2). A significant correlation was found between white matter CBF and Montgomery–Åsberg Depression Rating Scale (MADRS) scores in depression (r’ =–0.42, P = 0.03). Further analyses revealed that compared with controls, significant elevation of white matter CBF was apparent in participants whose depression was in remission (n = 21, MADRS≤10, P = 0.001) but not in those with current depression (n = 17, MADRS≥11, P = 0.80).ConclusionsFindings suggest a compensatory response to white matter pathological change or a response to (or a predictor of) successful antidepressant treatment, perhaps by facilitating neurotransmission in specific circuits and so reducing depressive symptoms.

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