Symptom Patterns of Depressive Disorder in the Elderly Medical Inpatients: Focused on Major Depressive Disorder

ABSTRACT

OBJECTS Depressive symptoms are common in the elderly medical inpatients. But depressive disorders are considerably underdiagnosed and undertreated. Especially in major depressive disorder, patients show cognitive impairments and do not respond adequately to medical treatment. The goals of this study were to examine what are the patterns of depressive symptoms of major depressive disorders which differentiate from minor depressive disorders in the elderly medical inpatients. METHODS: A 4-month prospective study of 312 patients (65 years and older) was conducted in a general hospital. Depression was screened with Hamilton Depression Rating Scale and cognitive function was screened with Mini-Mental State Examination-K. The subjects were diagnosed according to DSM-IV for depression. And according to DSM-IV diagnosis, HDRS and MMSE-K subscales were analysed. RESULTS: In the 228 patients who were investigated, 16 (7%) patients were major depressive disorder, 53 (23%) were minor depressive disorder. Females were more depressed than males but there was no statistical significance. While the patients of major depressive disorder complained of depression and anxiety, the control subjects complained of loss of body weight, somatic symptoms and somatic anxiety, and the minor depressive disorders shows mixed symptoms of the two. The complaining frequency of the somatic symptoms and somatic anxiety were similar among the three groups. Significant differences were found among the three groups in terms of HDRS total scores. Among the three groups in terms of HDRS subscale scores all subscale scores except for the genital symptoms and body weight were significantly high in depressive disorders. Initial insomnia (p<0.01), middle insomnia (p<0.05), GI symptoms (p<0.01) and somatic symptomgeneral (p<0.05) were significantly different between the control subjects and the depressive disorder group. The subscales of terminal insomnia, agitation and loss of insight were significantly different between the minor depressives and major depressives (p<0.01), but no difference between the control subjects and the minor depressives. MMSE total scores were significantly correlated in major depressive disorders among the 3 groups. Comparing subscales of the three groups, significant correlation were found in time orientation, attention and calculation (p<0.05) and language (p<0.01). CONCLUSION: Major depressive disorder patients in elderly medical inpatients chiefly complained of depression and anxiety, but they also complained somatic symptoms. If elderly medical inpatients complain of agitation, terminal insomnia, cognitive impairment associated with depressive symptoms, consultants will pay attention for the major depressive disorders. This study suggests that further systematic study is necessary for the recognition of major depressive disorder in the elderly medical inpatients.