Five thousand, seven hundred and twenty-nine consecutive admissions to the three general hospitals and the mental hospital in St. John's, Newfoundland, Canada, were examined retrospectively for the use of electroconvulsive therapy (ECT). The proportion of patients admitted who received ECT (rate), and the number of treatments per admission were recorded. Rate of ECT, expressed as percentage of patients admitted, was assessed for all hospitals separately and compared on legal status and diagnosis. One thousand, two hundred and thirty-six (21.5%) patients admitted, received ECT with little variation over a three year period. The rate was higher for the general hospitals and for voluntary patients. ECT was used in a very high proportion of patients with diagnoses of depression (50%), mania (20%), schizophrenia (36%), and neurotic disorders (20%). These findings are discussed in the context of the overall trend of a low utilization of ECT elsewhere, and the previous research evidence of limited indications for ECT.
Objective: Explore general practitioners' (GPs') views on and experiences of working with care managers for patients treated for depression in primary care settings. Care managers are specially trained health care professionals, often specialist nurses, who coordinate care for patients with chronic diseases. Design: Qualitative content analysis of five focus-group discussions. Setting: Primary health care centers in the Region of Västra Götaland and Dalarna County, Sweden. Subjects: 29 GPs. Main outcome measures: GPs' views and experiences of care managers for patients with depression. Results: GPs expressed a broad variety of views and experiences. Care managers could ensure care quality while freeing GPs from case management by providing support for patients and security and relief for GPs and by coordinating patient care. GPs could also express concern about role overlap; specifically, that GPs are already care managers, that too many caregivers disrupt patient contact, and that the roles of care managers and psychotherapists seem to compete. GPs thought care managers should be assigned to patients who need them the most (e.g. patients with life difficulties or severe mental health problems). They also found that transition to a chronic care model required change, including alterations in the way GPs worked and changes that made depression treatment more like treatment for other chronic diseases. Conclusion: GPs have varied experiences of care managers. As a complementary part of the primary health care team, care managers can be useful for patients with depression, but team members' roles must be clear. KEY POINTS A growing number of primary health care centers are introducing care managers for patients with depression, but knowledge about GPs' experiences of this kind of collaborative care is limited. GPs find that care managers provide support for patients and security and relief for GPs. GPs are concerned about potential role overlap and desire greater latitude in deciding which patients can be assigned a care manager. GPs think depression can be treated using a chronic care model that includes care managers but that adjusting to the new way of working will take time.
Preponderance in depression of the melancholy affect was characterized by a drop in the level of norepinephrine (NE) and rise in epinephrine (E). Exposure to light was associated with fall in E, with no change recordable in NE. In anxious depression, following light therapy, high levels of excretion of both catecholamines tended to return to normal. Ligh was found to cause opposite changes in the quantitative measures depending upon the initial value for the E:NE ratio (above or below control).
Mental health problems and hazardous alcohol consumption often co-exist. Hazardous drinking could have a negative impact on different aspects of health and also negatively influence the effect of mental health treatment. The aims of this study were to examine if alcohol consumption patterns changed after treatment for depression and if the changes differed by treatment arm and patient sex.
This study of 540 participants was conducted in a large randomised controlled trial (RCT) that aimed to compare the effect of internet-based cognitive behavioural therapy, physical exercise and treatment as usual on 945 participants with mild-to-moderate depression. Treatment lasted for 12 weeks; alcohol consumption (Alcohol Use Disorder Identification Test (AUDIT)) and depression (Montgomery Åsberg Depression Rating Scale (MADRS)) were assessed at baseline and 12-month follow-up. Changes in alcohol consumption were examined in relation to depression severity, treatment arm and patient sex.
The AUDIT distribution for the entire group remained unchanged after treatment for depression. Hazardous drinkers exhibit decreases in AUDIT scores, although they remained hazardous drinkers according to the cut-off scores. Hazardous drinkers experienced similar improvements in symptoms of depression compared with non-hazardous drinkers, and there was no significant relation between changes in AUDIT score and changes in depression. No differences between treatment arm and patient sex were found.
The alcohol consumption did not change, despite treatment effects on depression. Patients with depression should be screened for hazardous drinking habits and offered evidence-based treatment for hazardous alcohol use where this is indicated.
Contemporary standards of practice of electroconvulsive therapy with respect to the treatment procedure, clinical indications, and dosage (number of treatments per course) are summarized. The actual clinical practice at one psychiatric hospital over a 16-year period, comprising 22,647 treatments, was compared to those standards. The most significant findings in this series were the over-representation of patients with a diagnosis of schizophrenia and the absence of any clinically significant difference in the treatment dosage for schizophrenia and affective disorders. The significance of these findings is discussed with respect to their identification of patient subgroups that warrant case auditing. In addition, the results are used as a basis for a critical examination of the rationale for the presently recommended maximum treatment dosages.
Depression is one of the leading causes of disability and affects 10-15% of the population. The majority of people with depressive symptoms seek care and are treated in primary care. Evidence internationally for high quality care supports collaborative care with a care manager. Our aim was to study clinical effectiveness of a care manager intervention in management of primary care patients with depression in Sweden.
In a pragmatic cluster randomized controlled trial 23 primary care centers (PCCs), urban and rural, included patients aged =?18 years with a new (
Nowadays the low-intensive laserotherapy is shown to be an effective and non-hazardous method of asteno-depressive syndrome treatment. The differences of EEG-reactions to laser influences have been revealed in patients of different age groups. And the close negative correlation between the therapy effect, on the one hand, and the patient's age and the disease duration, on the other hand, has been shown. No significant changes of the patient's state or integrative EEG-indices have been evoked by a placebo application. The results showed the advantages of the low-intensive laserotherapy in asteno-depressive syndrome treatment and confirmed the significance of computer EEG-monitoring for prediction, control and correction of the state of the patient.
The purpose for this study was to evaluate the association between depression-focused interpersonal counseling (IPC) and the use of healthcare services in Finland after myocardial infarction (MI).
The measures were done at 6 and 18 months after MI in the randomized intervention (n= 51) and the control group (n= 52).
There was less use of somatic specialized healthcare services in the intervention group from 6 to 18 months after hospital discharge, and with intervention patients who had no other long-term disease during 6 months.
Confirmation of possible benefits of IPC for practice calls for more specific studies.
It is logical that tailoring implementation strategies to address identified determinants of adherence to clinical practice guidelines should improve adherence. This study aimed to identify and prioritize determinants of adherence to six recommendations for elderly patients with depression.
Group and individual interviews and a survey were conducted in Norway.
Individual and group interviews with healthcare professionals and patients, and a mailed survey of healthcare professionals. A generic checklist of determinants of practice was used to categorize suggested determinants.
Physicians and nurses from primary and specialist care, psychologists, researchers, and patients.
Determinants of adherence to recommendations for depressed elderly patients in primary care.
A total of 352 determinants were identified, of which 99 were prioritized. The most frequently identified factors had to do with dissemination of guidelines, general practitioners' time constraints, the low prioritization of elderly patients with depression, and the patients' or relatives' wish for medication. Approximately three-quarters of the determinants were from three of the seven domains in the generic checklist: individual healthcare professional factors, patient factors, and incentives and resources. The survey did not provide useful information due to a low response rate and a lack of responses to open-ended questions.
The list of prioritized determinants can inform the design of interventions to implement recommendations for elderly patients with depression. The importance of the determinants that were identified may vary across communities, practices. and patients. Interventions that address important determinants are necessary to improve practice.