Depression after Subarachnoid Hemorrhage: A Systematic Review / 대한뇌졸중학회지

Background@#and Purpose Depression is common and debilitating illness accompanying many neurological disorders including non-traumatic subarachnoid hemorrhage (SAH). The aim of this systematic review was to identify and critically appraise all published studies that have reported the frequency, severity and time course of depression after SAH, the factors associated with its development and the impact of depression on patients’ quality of life after SAH. @*Methods@#The PubMed database was searched for studies published in English that recruited at least 40 patients (>18 years old) after SAH who were also diagnosed with depression. @*Results@#Altogether 55 studies covering 6,327 patients met study entry criteria. The frequency of depression ranged from 0% to 61.7%, with a weighted proportion of 28.1%. Depression remained common even several years after the index SAH. Depression after SAH was associated with female sex, premorbid depression, anxiety, substance use disorders or any psychiatric disorders, and coping styles. Comorbid cognitive impairment, fatigue, and physical disability also increased the risk of depression. Aneurysmal SAH and infarction may be related to depression as well. Depression reduces the quality of life and life satisfaction in patients after SAH. @*Conclusions@#Depression is common after SAH and seems to persist. Further research is needed to clarify its time course and identify the neuroendocrine and neurochemical factors and brain circuits associated with the development of post-SAH depression. Randomized controlled treatment trials targeting SAH-related depression are warranted.

Antipsychotic Medications in Major Depression and the Association with Treatment Satisfaction and Quality of Life: Findings of Three National Surveys on Use of Psychotropics in China Between 2002 and 2012 / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Optimizing treatment outcomes for depression requires understanding of how evidence-based treatments are utilized in clinical practice. Antipsychotic medications concurrent with antidepressant treatment are frequently used in major depression, but few studies have investigated trends and patterns of their use over time. This study aimed to examine the prescription patterns of antipsychotic medications for major depression in China from 2002 to 2012 and their association with treatment satisfaction and quality of life (QOL).</p><p><b>METHODS</b>A total of 3655 subjects with major depression treated in 45 Chinese psychiatric hospitals/centers nationwide were interviewed between 2002 and 2012. Patients' socio-demographic and clinical characteristics including psychopathology, medication side effects, satisfaction with treatment and QOL were recorded using a standardized protocol and data collection.</p><p><b>RESULTS</b>The frequency of antipsychotic use was 24.9% in the whole sample; the corresponding figures were 17.1%, 20.3%, and 32.8% in 2002, 2006, and 2012, respectively (χ2 = 90.3, df = 2, P < 0.001). Multiple logistic regression analyses revealed that patients on concurrent antipsychotics had significantly more delusions or hallucinations, longer illness duration, greater side effects, and more likely to be treated as inpatients and in major hospitals (i.e., Level-III hospital). Antipsychotic use was associated with lower treatment satisfaction while there was no significant difference with respect to physical and mental QOL between the antipsychotic and nonantipsychotic groups.</p><p><b>CONCLUSIONS</b>Concurrent antipsychotic use was found in about one in four treated depressed patients in China, which has increased over a 10-year period. Considering the association of drug-induced side effects and the lack of patients' and relatives' satisfaction with antipsychotic treatment, further examination of the rationale and appropriateness of the use of antipsychotics in depression is needed.</p>

Prevalence and prescription of antidepressants in depression with somatic comorbidity in Asia: the Research on East Asian Psychotropic Prescription Patterns study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Depression is often comorbid with chronic somatic diseases. Few previous studies have investigated the prevalence of somatic diseases in depression or the prescription pattern of antidepressants in comorbidly depressed patients in Asia. This study aimed to investigate the prevalence of somatic comorbidity (SC) in depression and compared the prescriptions of antidepressants in depressed patients with and without SC.</p><p><b>METHODS</b>A total of 2320 patients treated with antidepressants in 8 Asian countries were examined, and a diagnosis was based on the International Classification of Disease, 10 th revision. We listed 17 common chronic somatic diseases. Patients' socio-demographic and clinical characteristics and psychotropic drug prescriptions were recorded using a standardized protocol and data collection procedure.</p><p><b>RESULTS</b>Of the patients examined, 1240 were diagnosed with depression and 30% of them (n = 375) had SC. The most common comorbid condition was diabetes (23.7%). The patients with SC were more likely to seek help at a general hospital (74.7% vs. 47.2%), and had a higher incidence of symptoms involving sadness, disturbed sleep, and poor appetite. Noradrenergic and specific serotonergic antidepressant was prescribed more for patients with SC than for those without SC (30.4% vs. 22.9%).</p><p><b>CONCLUSIONS</b>SC is common in depressed Asian patients. It is important to strengthen the recognition of depression, especially in general hospitals and when patients report some somatic discomfort. It is also a matter of urgency to establish evidence-based guidelines for the use of new antidepressants in depressed patients with SC.</p>

Socio-demographic and Clinical Correlates of Suicide Attempts and Impact on Quality of Life in Schizophrenia Patients / 中国康复理论与实践

@#Objective To determine the socio-demographic and clinical correlates of suicide attempts in Chinese schizophrenia outpatients and their impact on patients' quality of life (QOL).Methods Two hundred and fifty eligible subjects were recruited and interviewed using standard instruments. Multiple logistic regression with stepwise method was used.Results The prevalence of suicide attempts was 33.6%. Patients with a history of suicide attempts were more likely to have multiple hospitalizations and poor physical QOL domain. Negative symptoms inversely predicted suicide attempts.Conclusion Suicide attempts could be controlled if more attention is paid on schizophrenia patients with multiple hospitalizations and poor physical QOL domain, which could facilitate the re-entry to community for schizophrenia outpatients in China.

Impact of Symptomology and Drug-induced Extrapyramidal Side Effects on Subjective Quality of Life for Schizophrenic Outpatients / 中国康复理论与实践

@#Objective To investigate the subjective quality of life(SQOL)in schizophrenia outpatients and explore the relationships among symptomology,drug-induced extrapyramidal side effects(EPS)and SQOL.Methods198 eligible subjects were recruited and interviewed using standard instruments.Multiple linear regression with stepwise method was used.ResultsEPS was found to significantly predict physical SQOL domain while anxiety and positive symptoms predicted psychological,social and environmental SQOL domains,respectively.ConclusionSQOL of schizophrenia outpatients could be improved if their anxiety and positive symptoms and EPS are effectively controlled.