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depression

The Impact of Depressive Symptoms: Considerations for Clinicians Treating Patients with Low Back Pain

Teaser: 

Jessica Wong, DC, MPH,1
Linda Carroll, PhD, 2
Pierre Côté, DC, PhD, 3

1 Research Associate, UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC).
2Professor Emeritus, School of Public Health, University of Alberta.
3 Professor and Canada Research Chair in Disability Prevention and Rehabilitation, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT); Director, UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC).

CLINICAL TOOLS

Abstract: A considerable proportion of patients with low back pain (LBP) experience depressive symptoms. A clinical case is used to highlight potential steps that clinicians can take to help manage depressive symptoms in these patients: 1) Assess for depressive symptoms using a valid and reliable questionnaire; 2) Provide education, reassurance, and self-management strategies to initiate the program of care; 3) Adjust care plans if patients also present with depressive symptoms (e.g., ongoing support and education); and 4) Provide ongoing assessment of depressive symptoms, and consider referrals to a specialist or other health care providers (e.g., counselors, clinical psychologists, or psychiatrists) for further evaluation if symptoms are worsening.
Key Words: Low back pain, depressive symptoms, depression, depressive disorder.

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A considerable proportion of patients with low back pain present with depressive symptoms
Depressive symptomatology includes depression that has not been formally diagnosed and symptoms that do not meet the criteria for depression
The presence of depression may indicate poorer recovery from low back pain
Patients experiencing low back pain and concomitant depressive symptoms may benefit from ongoing assessments, education, reassurance, and self-management strategies
Assess for depressive symptoms in patients with LBP using a valid and reliable questionnaire (e.g., Patient Health Questionnaire-9)
Provide education, reassurance, and self-management strategies to all patients with LBP to initiate the program of care
Adjust the care plan accordingly if patients also present with depressive symptoms, including additional support and education (e.g., addressing misconceptions, encouraging activity) on an ongoing basis
Provide ongoing assessment of depressive symptoms, and consider referrals for further evaluation if symptoms are worsening
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Personality Traits: Stability and Change with Age

Personality Traits: Stability and Change with Age

Teaser: 

Antonio Terracciano, PhD, Laboratory of Personality and Cognition, National Institute on Aging (NIA), National Institutes of Health (NIH), U.S. Department of Health and Human Services (DHHS), Baltimore, MD, USA.
Robert R. McCrae, PhD, Laboratory of Personality and Cognition, NIA, NIH, DHHS, Baltimore, MD, USA.
Paul T. Costa Jr., PhD, Laboratory of Personality and Cognition, NIA, NIH, DHHS, Baltimore, MD, USA.

Individual differences in personality traits are generally stable during adulthood; where there are changes, they are generally in the direction of greater maturity. The trends are similar for men and women and across cultures. With advancing age, people generally become more emotionally stable, agreeable, and conscientious, with better impulse control, but less active and less open to new actions and values than younger individuals. Those trajectories provide several insights into adult development, challenging some negative stereotypes about older adults and serving as a reminder that enduring individual differences are more important than age in understanding personality.
Key words: personality traits, aging, cross-cultural, depression, Alzheimer’s disease.

Depression among Older Adults with Dementia: Double Trouble

Depression among Older Adults with Dementia: Double Trouble

Teaser: 


Eran Metzger, MD, Associate Director of Geropsychiatry, Hebrew SeniorLife, Boston; Assistant Professor of Psychiatry, Harvard Medical School, Boston, MA, USA.

The management of depression among individuals with dementia can be one of the more challenging problems in geriatric practice. Depression in dementia is common regardless of the type of dementia and compounds the impairment of the underlying dementing illness. Some symptoms of dementia, including apathy, impaired concentration, and decreased food intake, may be difficult to distinguish from similar symptoms of depression. This article presents background information on the epidemiology and pathophysiology of depression in dementia followed by recommendations for a systematic approach to diagnosis. Treatment modalities including psychotherapy, pharmacotherapy, and electroconvulsive therapy are reviewed.
Key words: dementia, depression, Alzheimer’s disease, psychotherapy, psychopharmacology.

Post-Stroke Depression: Focus on Diagnosis and Management during Stroke Rehabilitation

Post-Stroke Depression: Focus on Diagnosis and Management during Stroke Rehabilitation

Teaser: 

Elizabeth A. Johnson, RN, PhD(c), Board Certified Geriatric Clinical Nurse Specialist, Doctoral Candidate, Indiana University School of Nursing; Department of Adult Health, Indiana University School of Nursing, Indianapolis, IN, USA.
Tamilyn Bakas, RN, DNS, FAHA, Associate Professor, Department of Adult Health, Indiana University School of Nursing, Indianapolis, IN, USA.
Linda S. Williams, MD, Chief of Neurology, Roudebush Veterans Administration Medical Center; Research Coordinator, VA Stroke QUERI; Associate Professor of Neurology, Indiana University School of Medicine; Research Scientist, Regenstrief Institute, Indianapolis, IN, USA.

Depression, the most frequent neuropsychological problem after stroke, is greatly influenced by the complex relationships between the neurobiological and psychological changes that occur after stroke. Post-stroke depression leads to negative rehabilitation outcomes including less participation in therapy, extended recovery time, significantly decreased quality of life, and increased utilization of health care resources. Because of the high prevalence of post-stroke depression, all stroke survivors should be screened early in the rehabilitation process. Use of a biopsychosocial framework acknowledges the multifactorial etiology of post-stroke depression and contributes to effective, evidence-based treatment. Attention to the needs of the family caregivers further promotes successful post-stroke rehabilitation.
Key words: stroke, depression, risk factors, recovery, treatment.

Post-Stroke Depression -- July/August 2007

Post-Stroke Depression -- July/August 2007

Teaser: 

Lana S. Rothenburg, BSc(Hons), Neuropsychopharmacology Research Program, Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON.
Nathan Herrmann, MD FRCP(C), Neuropsychopharmacology Research Program; Department of Psychiatry, Sunnybrook Health Sciences Centre; Department of Psychiatry, University of Toronto, Toronto, ON.
Krista L. Lanctôt, PhD, Neuropsychopharmacology Research Program; Department of Psychiatry, Sunnybrook Health Sciences Centre; Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON.

Depression is a common sequela of stroke, occurring in approximately 33% of all patients. Post-stroke depression (PSD) is associated with greater cognitive and functional impairments, excess mortality, and increased health care costs, although symptoms are often mild. Diagnosis of PSD can be made using standard clinical criteria, despite the potential overlap with the somatic and vegetative symptoms of stroke. Post-stroke depression responds to standard antidepressant pharmacotherapies, but use of tricyclic antidepressants may result in increased cardiac adverse events. Given the high prevalence and major negative impact of PSD, active screening of all stroke patients for depression and aggressive treatment is recommended.
Key words: stroke, depression, diagnosis, risk factors, treatment.

Identifying and Treating Depression among Older Adults with Cancer

Identifying and Treating Depression among Older Adults with Cancer

Teaser: 


Scott M. Sellick, PhD, CPsych, Associate Research Scientist & Director of Supportive Care, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON.

Approximately 25% of persons with cancer report symptoms that meet the diagnostic criteria for the most prevalent mood disorders, including major depression, dysthymic minor depression, and adjustment disorder with depressed mood. This is two to four times the incidence found among the general population. To simply consider depression as “normal” precludes the possibility that some very good things can happen when patients are properly diagnosed and referred to a psychosocial program to be seen by a psychiatrist, psychologist, or social worker. Asking about a patient’s general mood or spirits needs to become as routine as asking about pain. While screening instruments can be very helpful, single questions are equally useful for identifying patients with this unmet need. Otherwise, patients remain feeling helpless or that their condition is hopeless, and this can easily spiral into despair and significantly worsened depression.
Key words: cancer, depression, psychosocial, supportive care, coping.

Recognition of Psychotic Symptoms among Older Adults

Recognition of Psychotic Symptoms among Older Adults

Teaser: 


Abi V. Rayner MD MPH, Buller Medical Service, Westport, New Zealand.

Psychotic symptoms, hallucinations, and delusions, arising de novo in older adults, represent a major risk factor for the development of dementia, illness, delirium, functional impairment and death. These symptoms and associated behavioural manifestations overlap with depressive disorders and may be signs of cognitive impairment or dementia. Symptoms may be vague or legitimized so that the psychosis is unrecognized by family and physicians. Specific queries regarding the nature of the symptoms and the impact on function will provide diagnostic clues. Several brief assessment tools can be used in primary care, specifically the NPI-Q and Blessed Dementia Scale.
Key words: psychosis, hallucinations, delusions, dementia, depression.

Cardiovascular Disease and Depression in Older Men and Women

Cardiovascular Disease and Depression in Older Men and Women

Teaser: 


Adrienne H. Kovacs, PhD, CPsych, Behaviour Cardiology, Division of Cardiology, University Health Network, Toronto, ON.

Approximately 20% of older adults with cardiovascular disease (CVD) experience significant depression. Further, in a pattern consistent with the general adult population, women with CVD have double the rates of depression compared to men. Among older men and women with CVD, depression is associated with poorer cardiac outcomes, although patterns of depressive symptoms appear to differ between men and women. Treatment approaches include traditional modalities, namely psychotherapy and pharmacotherapy. Additional recommendations involve emphasizing adherence to prescribed medical and behavioural health regimens, fostering social support, and increasing referrals to cardiac rehabilitation programs as medically appropriate.
Key words: depression, gender differences, cardiovascular disease, myocardial infarction, mortality.

Pain and Depression in Aging Individuals

Pain and Depression in Aging Individuals

Teaser: 


Lucia Gagliese, PhD, CIHR New Investigator, School of Kinesiology and Health Science, York University; Department of Anesthesia, Behavioural Sciences & Health Research Division, University Health Network; Departments of Anesthesia and Psychiatry, University of Toronto, Toronto, ON.

Depression is highly prevalent among older adults with chronic pain living both in community and institutional settings. It is associated with decreased quality of life, including impairments in physical and social well-being. This article reviews the relationship between pain and depression. The potential mediating role of disability, life interference, and perceived control are described. Routine assessment of both pain and mood, using scales validated for this age group, is advocated. Finally, the importance of integrating pharmacological and psychological interventions for the management of pain and depression in the older adult is highlighted.
Key words: chronic pain, depression, mood disturbance, assessment, management.

Ethnic Differences in the Caregiving Experience: Implications for Interventions

Ethnic Differences in the Caregiving Experience: Implications for Interventions

Teaser: 

Martin Pinquart, PhD, Associate Professor, Department of Developmental Psychology and Center for Applied Developmental Science, Friedrich Schiller University, Jena, Germany.
Silvia Sörensen, PhD, Assistant Professor, Department of Psychiatry, University of Rochester, Rochester, NY, USA.

Due to the aging of society and the increase in ethnic diversity, there is a growing interest in the needs of ethnically diverse caregivers for older adults. Based on a recent meta-analysis, this article outlines ethnic differences in caregiving stressors, available social resources, and caregiver health. We offer suggestions on how to consider ethnic differences in the planning and implementation of caregiver interventions.
Key words: family caregivers, ethnicity, stress, burden, depression.