A Treatment Outline for Depressive Disorders

1983 ◽  
Vol 17 (2) ◽  
pp. 129-146 ◽  
Keyword(s):  
Quality Assurance ◽  
Treatment Outcome ◽  
Electroconvulsive Therapy ◽  
Depressive Disorders ◽  
Meta Analysis ◽  
Antidepressant Drugs ◽  
Endogenous Depression ◽  
Government Support ◽  
Sources Of Information ◽  
Quality Assurance Project

With College and Government support the Quality Assurance Project is developing a series of explicit and detailed treatment outlines of major psychiatric disorders for use in peer review. Three sources of information are used: a meta-analysis of the treatment outcome literature, the opinions of a sample of practising psychiatrists and the views of a panel of nominated experts. The present outline concerns the treatment of depressive disorders. The three sources of information were in agreement that tricyclic and allied antidepressants were the treatments of choice for endogenous depression and were also to be considered in persistent neurotic depressions. Electroconvulsive therapy was recommended in patients with endogenous depression who were severely ill, troubled by hallucinations and delusions or for whom the antidepressant drugs had not proven effective. The psychotherapies, both dynamic and behavioural, were regarded as the treatments of choice in neurotic depression.

A Methodology for Preparing ‘Ideal’ Treatment Outlines in Psychiatry: The Quality Assurance Project

1982 ◽  
Vol 16 (3) ◽  
pp. 153-158 ◽  
Keyword(s):  
Quality Assurance ◽  
Treatment Outcome ◽  
Depressive Disorders ◽  
Treatment Process ◽  
Meta Analysis ◽  
Postgraduate Education ◽  
Expert Committee ◽  
Sources Of Information ◽  
Quality Assurance Project ◽  
Review Criteria

The methodology of preparing treatment process criteria for agoraphobia and the depressive disorders is described. To avoid bias three sources of information were used: the results of a meta-analysis of the treatment outcome literature, the views of a sample of practising psychiatrists, and the views of a small representative expert committee. When criteria for schizophrenia and the neuroses have been completed the quality assurance project should serve two main purposes: first as an aid to continuing and postgraduate education and second as a basis for clinical review criteria required by peer review and other quality assurance activities.

A Survey of Practising Psychiatrists' Views on Treatment of the Depressions

1986 ◽  
Vol 149 (6) ◽  
pp. 742-750 ◽  
Author(s):  
M. S. Armstrong ◽  
G. Andrews
Keyword(s):  
Quality Assurance ◽  
Drug Therapy ◽  
Random Sample ◽  
Electroconvulsive Therapy ◽  
Tricyclic Antidepressants ◽  
Endogenous Depression ◽  
Treatment Recommendations ◽  
Quality Assurance Project ◽  
Treatment Plans ◽  
Psychotic Features

The views of practising psychiatrists on treatment of the depressions were investigated as part of a Quality Assurance Project. A one in six random sample of all Australian psychiatrists was mailed a questionnaire. This asked for treatment recommendations for each of five case descriptions of patients with depression. Respondents were asked to code their treatment plans from a glossary listing possible treatments for depression: 85% of the sample responded. Tricyclic antidepressants were the treatment of choice for two cases of endogenous depression, electroconvulsive therapy (ECT) being recommended when psychotic features were present or when drug therapy had failed. Psychotherapies were the treatment of choice for cases with neurotic features, drugs being recommended when Improvement with psychotherapy did not occur.

Treatment Outlines for the Management of Schizophrenia

1984 ◽  
Vol 18 (1) ◽  
pp. 19-38 ◽  
Author(s):  
G. Andrews
Keyword(s):  
Quality Assurance ◽  
Antipsychotic Drugs ◽  
Meta Analysis ◽  
Active Phase ◽  
Management Program ◽  
Family Management ◽  
Anti Psychotic ◽  
Sources Of Information ◽  
Social Interventions ◽  
Quality Assurance Project

The Quality Assurance Project is developing explicit and detailed treatment outlines for each of the major psychiatric disorders. Three sources of information are used: a meta-analysis of the treatment outcome literature, the opinions of a sample of practising psychiatrists, and the views of a panel of nominated experts. The present outlines report the resulting recommendations for the treatment of schizophrenia. The three sources of information agree that anti-psychotic drugs are the principal treatment during the active phase of the disorder. As schizophrenia is so often a serious and disabling chronic illness, the treatment recommendations stress the need for continuity of care during the post-acute and residual phases in order to prevent relapse and minimise residual deficits. The outlines particularly emphasise the consistent but conservative use of antipsychotic drugs, and the implementation of a specific type of family management program in addition to the customary social interventions.

scholarly journals Risks of Antidepressant induced psychotic events in patients with depression and psychosis

2022 ◽  
Author(s):  
Sourav Dakua
Keyword(s):  
Literature Review ◽  
Depressive Disorders ◽  
Meta Analysis ◽  
Antidepressant Drug ◽  
Age Groups ◽  
Antidepressant Drugs ◽  
Individual Risk ◽  
Major Depressive ◽  
Compulsive Disorder ◽  
Drug Classes

The aim of this ‘literature review’-based argumentative paper has been to find out the risks of developing psychotic and depressive disorders in patients having been treated with antidepressants. In order to reach a resounding supposition, this literature review-based argumentative study had taken an incisive look into previous research works and meta-analysis, which in effect had underscored the risks of antidepressant-induced psychotic and depressive disorders in patients with depression as well as psychosis even as the protagonists of antidepressant drug classes could not be undermined given their upscaled magnitude of benefits. While following a probing interpretation of past studies, this might be demystified that antidepressants could lead to psychotic events and depressive disorders in patients of all age groups with children and young adults being more susceptible to develop psychosis. The psychotic episodes could even be developed during initial phase of treatments in patients suffering from depressive and psychotic disorders such as bipolar mood disorder, unipolar depression, major depressive disorders, mania, OCD (Obsessive Compulsive Disorder), delusional depression (psychotic depression), schizophrenia, schizoaffective disorders alongside multiple somatic symptoms among others as well. Concomitantly, with efficaciousness of antidepressants in major depressive disorder still remaining a subject to utter dubitability, different antidepressant drug classes were found to be associated with a considerable scale of adverse effects after carrying out protracted arguments on findings of evidence-based past studies, meta-analysis of previous researches and relevant clinical cases. Therefore, following a systematized approach towards past studies, this argumentative research has reached a coherent conclusion that antidepressants are likely to cause psychotic events and exaggeration of depressive disorders up to some extent in several cases. Hence, there is a stipulation of individual risk-benefit assessment and intricate history taking in patients being contemplated for antidepressant drugs alongside a close observation and follow-up in patients of all age groups after introducing antidepressant medications.

Anhedonia: a neglected symptom of psychopathology

1993 ◽  
Vol 23 (4) ◽  
pp. 957-966 ◽  
Author(s):  
Philip Snaith
Keyword(s):  
Depressive Disorders ◽  
Rating Scales ◽  
Antidepressant Drugs ◽  
Endogenous Depression ◽  
Depressive Illness ◽  
Point Of View ◽  
Psychiatric Research ◽  
Biological Research ◽  
The 1960S ◽  
Definition Of

SynopsisIn the last century psychopathologists attached importance to the concept of anhedonia, the loss of ability to experience pleasure. Its role in the diagnosis of melancholia was considered to be crucial. In the present century attention to anhedonia has faded, possibly because of the focus upon depressed mood as the pathognomonic feature of depressive disorders. Research on the symptomatology of endogenous depression did not include the concept; anhedonia was also lacking from the major instruments of psychiatric research, the depression rating scales,Attention was drawn to anhedonia by two authors: by Meehl in the 1960s and by Klein in the 1970s. Meehl considered anhedonia from the point of view of a personality defect predisposing to mental illness; and Klein regarded anhedonia to be a symptom of depressive illness and probably the best clinical marker predicting response to antidepressant drugs.In 1980 the revised DSM presented the concept of ‘loss of interest or pleasure’ as one of the two cardinal symptoms of major depression. Since then there has been a gradual recovery of emphasis although many systems confuse the two concepts of‘loss of interest’ and anhedonia. It is possible that anhedonia may provide the key to a more exact delineation of depressive disorders in biological research and in clinical practice. Further research will depend upon a more precise, cross-nationally agreed definition of the concept and the means of its assessment.

Treatment Outlines for the Management of Obsessive-Compulsive Disorders

1985 ◽  
Vol 19 (3) ◽  
pp. 240-253 ◽  
Author(s):  
Gavin Andrews
Keyword(s):  
Personality Disorder ◽  
Cognitive Behaviour Therapy ◽  
Meta Analysis ◽  
Sources Of Information ◽  
Behaviour Therapy ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Cognitive Behaviour ◽  
Quality Assurance Project ◽  
Obsessive Compulsive Disorders

The Quality Assurance Project is developing explicit and detailed treatment outlines for each of the major psychiatric disorders. Three sources of information are used: a meta-analysis of the treatment outcome literature, the opinions of a sample of practising psychiatrists, and the views of a panel of nominated experts. The recommendations for the treatment of obsessive-compulsive disorder were as follows: for those patients who have no significant personality disorder, either short-term dynamic psychotherapy or cognitive behaviour therapy is indicated if the illness has lasted less than a year or if obsessions are the predominant symptoms. When compulsions predominate, particularly when they have been present for more than a year, response prevention is the treatment of choice. Tricyclic antidepressants and cingulo-tractomy are also worthy of consideration in patients with persisting symptoms. Psychotherapy or cognitive behaviour therapy are the approaches recommended for compulsive personality disorder.

scholarly journals Personality disorder and the outcome of depression: Meta-analysis of published studies

2006 ◽  
Vol 188 (1) ◽  
pp. 13-20 ◽  
Author(s):  
Giles Newton-Howes ◽  
Peter Tyrer ◽  
Tony Johnson
Keyword(s):  
Personality Disorder ◽  
Electroconvulsive Therapy ◽  
Affective Disorders ◽  
Depressive Disorders ◽  
Meta Analysis ◽  
Random Effects Model ◽  
Poor Outcome ◽  
Electronic Search ◽  
Conflicting Evidence ◽  
Made In

BackgroundThere is conflicting evidence about the influence of personality disorder on outcome in depressive disorders.AimsMeta-analysis of studies in which a categorical assessment of personality disorder or no personality disorder was made in people with depressive disorders, and categorical outcome (recovered/not recovered) also determined.MethodSystematic electronic search of the literature for relevant publications. Hand searches of Journal of Affective Disorders and recent reviews, with subsequent meta-analysis of selected studies.ResultsComorbid personality disorder with depression was associated with a doubling of the risk of a poor outcome for depression compared with no personality disorder (random effects model OR=2.18, 95% C11.70–2.80), a robust finding maintained with only Hamilton-type depression criteria at outcome (OR=2.20, 95% C11.61–3.01). All treatments apart from electroconvulsive therapy (ECT) showed this poor outcome, and the ECT group was small.ConclusionsCombined depression and personality disorder is associated with a poorer outcome than depression alone.

Efficacy and Safety of Electroconvulsive Therapy in Depressive Disorders

2018 ◽  
Author(s):  
Joseph J. Taylor ◽  
Robert Ostroff
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Electroconvulsive Therapy ◽  
Clinical Case ◽  
Depressive Disorders ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Safety And Efficacy ◽  
Life Saving ◽  
Basic Concepts

This chapter will summarize an important systematic review and meta-analysis. The authors of this study analyzed decades of evidence from thousands of patients in order to address fundamental questions about the safety and efficacy of electroconvulsive therapy for depressive symptoms. The data from this manuscript continue to inform clinical practice in regards to this stigmatized yet potentially life-saving treatment. The chapter will discuss the setup and implementation of the systematic review and meta-analysis before focusing on the results and their implications. The last section of the chapter will identify relevant studies and present a hypothetical clinical case that requires the reader to apply basic concepts learned from the systematic review and meta-analysis.

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