Severity and risk factors of depression in Alzheimer's disease.

OBJECTIVE: To determine the frequency, severity and risk factors of depression in Alzheimer's disease. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The Department of Psychiatry, Sir Ganga Ram Hospital, Lahore, from August 2007 to December 2008. METHODOLOGY: Consecutive patients of Alzheimer's disease reporting to the department during the study period were included and those with extreme cognitive impairment were excluded. The cognitive status was judged by using the Mini- Mental State Examination (MMSE). The Hamilton rating scale for depression (Ham-D) was used as a symptom checklist to diagnose major depression according to the DSM-IV criteria. Chi-square test was used to check the significance of association. RESULTS: There were 76 patients comprising of 34 males and 42 females. The mean age was 67.74 + or - 6.71 years; 66% were married, 14% were single and 20% were widowed; 47% had family history of depression and medical co-morbidity was observed in 48%. Based on MMSE, 31.5% had mild Alzheimer, 55.3% had moderate and 13.1% had severe Alzheimer. Judging from Hamilton rating scale, 25% patients were free from depression, 19.7% had mild depression, 27.6% had moderate depression and 27.6% were suffering from severe depression. The frequency of depression was significantly higher (p=0.0013) among females (90%) as compared to males (55.9%). CONCLUSION: There is a high frequency of depression among patients of Alzheimer's disease particularly among female patients. This finding is consistent with the reports from other countries.

Eliciting explanatory models of common mental disorders using the Short Explanatory Model Interview (SEMI) Urdu adaptation--a pilot study.

The purpose of this pilot study was to describe the presenting symptoms and its explanation from the patients' perspective of GHQ (General Health Questionnaire) positive cases attending primary care facility/a general practice in semiurban Lahore. Fifteen consecutive attenders were screened with GHQ and 11 GHQ positive cases went on to complete an adapted questionnaire derived from SEMI (Short Explanatory Model Interview). Though there was no consistency in the presenting symptoms of GHQ positive cases on presentation to a general practitioner, all described their problems as intense, less than 2 years on onset and on reflection located its origins in their social worlds. These findings have implications in terms of providing preliminary data for a larger study, perhaps looking at development of psychosocial interventions for treatment of mental distress in our local context as it seems to have its origins in their social worlds.