Psychiatric specialty clinics: do they weed out comorbid depression and anxiety?

The concept of comorbidity of anxiety and depression was examined as it relates to specialty clinics, a growing trend as mental health care providers attempt to compete for patients and provide efficient and specialized treatments. Twenty-nine patients from an anxiety clinic were compared with 23 patients from a mood disorders clinic in a university-based outpatient setting. Axis I diagnoses obtained by structured clinical interview for DSM-III-R were generally consistent with each specialty clinic. Incidence of diagnosable comorbid anxiety and mood disorders was not significantly different for the two clinics and within the range cited (11-78%) in several other studies drawing from various patient populations. Similarly, in comparing self-reported symptoms on three rating scales using Student's tests, authors found elevated symptoms of both depression and anxiety in both clinic populations. The importance of addressing the needs of patients with co-occurring diagnoses and symptoms within a specialty clinic is discussed as it pertains to treatment and research.

Course of depressive symptoms over follow-up. Findings from the National Institute of Mental Health Treatment of Depression Collaborative Research Program.

We studied the course of depressive symptoms during an 18-month naturalistic follow-up period for outpatients with Major Depressive Disorder treated in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. The treatment phase consisted of 16 weeks of randomly assigned treatment with the following: cognitive behavior therapy, interpersonal therapy, imipramine hydrochloride plus clinical management (CM), or placebo plus CM. Follow-up assessments were conducted at 6, 12, and 18 months after treatment. Of all patients entering treatment and having follow-up data, the percent who recovered (8 weeks of minimal or no symptoms following the end of treatment) and remained well during follow-up (no Major Depressive Disorder relapse) did not differ significantly among the four treatments: 30% (14/46) for those in the cognitive behavior therapy group, 26% (14/53) for those in the interpersonal therapy group, 19% (9/48) for those in the imipramine plus CM group, and 20% (10/51) for those in the placebo plus CM group. Among patients who had recovered, rates of Major Depressive Disorder relapse were 36% (8/22) for those in the cognitive behavior therapy group, 33% (7/21) for those in the interpersonal therapy group, 50% (9/18) for those in the imipramine plus CM group, and 33% (5/15) for those in the placebo plus CM group. The major finding of this study is that 16 weeks of these specific forms of treatment is insufficient for most patients to achieve full recovery and lasting remission. Future research should be directed at improving success rates of initial and maintenance treatments for depression.

Factors influencing choice of specialty and location of residency.

Students recently graduating from the University of Oklahoma College of Medicine are leaving the state for their postgraduate training and entering nonprimary care fields in increasing numbers. This study identifies the major determinants for training location as having to do with the anticipated quality of the program, and for specialty as having to do with positive experiences on clerkship and the perceived characteristics of the field, including potential controllability of practice. Other factors of significance include lifestyle, standard of living and opinions of others. A striking finding was the negative view of Oklahoma held by our graduates.

Personality disorders and treatment outcome in the NIMH Treatment of Depression Collaborative Research Program.

The authors investigated the relationship between personality disorders and treatment outcome in the National Institute of Mental Health Treatment of Depression Collaborative Research Program, which involved 239 outpatients with major depressive disorder randomly assigned to one of four 16-week treatment conditions. Patients with personality disorders (74% of the sample) had a significantly worse outcome in social functioning than patients without personality disorders and were significantly more likely to have residual symptoms of depression. There were no significant differences in work functioning or in mean depression scores at treatment termination. Outcome was similar for patients in the different clusters of personality disorders.

Improvement after evaluation in psychotherapy of depression: evidence of a placebo effect?

Thirty-two patients were seen by psychiatry residents, psychology interns, and social work fellows who were learning cognitive therapy of depression. Of these, 23 patients attended sufficient sessions for early response to be categorized as responding or not responding. Rapid response was not associated with positive perception of the therapist by the patient, self-control scores, or patient collaboration as viewed by the therapist. The BDI score at intake was moderately predictive of the BDI score at session 6, but it did not predict percent improvement. However, depressive severity at the beginning of session one was strongly predictive of the sixth session BDI, and it also predicted percent improvement. Another predictor of response was improvement in mood in the first therapy session, as measured by the VAS. However, outcome variance explained by the VAS did not significantly add to outcome variance explained by the first session BDI. Results are interpreted as indicating that improvement may be due to (1) a powerful beneficial effect that originates within the patient-therapist matrix and independent of therapist techniques; or (2) a continuing improvement process that began prior to entering treatment.

Sex education for children in a residential center.

Sex education programs for emotionally disturbed children present special problems. This article emphasizes training of child care workers and their role as teachers.