Evaluation of mood disorder patients in a primary care practice: measures of affective temperament, mental health risk factors, and functional health in a retrospective, descriptive study of 35 patients.

OBJECTIVE: THE PURPOSE OF THIS RETROSPECTIVE, DESCRIPTIVE STUDY WAS TO EVALUATE PRIMARY CARE PATIENTS DIAGNOSED WITH A MOOD DISORDER ON THE BASIS OF THE FOLLOWING: (1) comorbid medical illnesses, (2) risk factors for mood disorders and longitudinal presence of symptoms, (3) presence of affective temperament, and (4) functional status and quality of life. METHOD: Patients (N = 35) were a convenience sample diagnosed in the Mood Disorder Clinic (MDC), a family practice site-based mental health treatment consultation service. All study patients were assessed using a semistructured interview and diagnosed according to DSM-IV-TR criteria. Data were collected using both chart review and secondary analysis of a computerized touch-screen mood disorders database that included the 36-item Short-Form Medical Outcomes Study Health Survey (SF-36) and an affective temperament survey. The study was conducted from January 2000 through August 2000. RESULTS: A total of 62 comorbid medical illnesses were present in this group of patients; only 2 patients had no comorbid illnesses. Psychiatric diagnoses included 25 cases (78.1%) of bipolar depression, 5 cases (15.6%) of unipolar or dysthymic depression, and 2 cases (6.3%) of nonmood or anxiety disorders. All patients (100%) had a positive family history for mood disorders or substance abuse. Twenty-four patients (70.6%) had onset of their depressive symptoms prior to age 21, and 11 patients (35.5%) had a positive history of sexual abuse. Affective temperaments were positive in the 30 patients who completed this section. SF-36 scale scores were predominantly below national norms. CONCLUSION: The medical comorbidities in our study were expected; the positive family and individual histories for risk along with low SF-36 scores reflect the severity and chronicity of mood disorders in this population.

Pilot study of INSIGHT therapy in African American women.

The purpose of this pilot study was to determine if treatment with INSIGHT therapy, designed specifically for women, could reduce depressive and anxiety symptoms, hopelessness, and loneliness in African American women. Prevalence of mental illness differs in African Americans and Caucasians. The nonexperimental one-group pretest posttest design study examined the effectiveness of a 12-week INSIGHT group intervention. Due to the stigma of mental illness, groups met at an African American church. Reliability and validity of instruments were effectively demonstrated. Statistically significant difference was found in the level of depression but the study was underpowered to detect statistically significant differences in anxiety, hopelessness, and loneliness. Clinically significant improvement occurred for some participants in anxiety, hopelessness, and loneliness.

Assault history and follow-up contact of women survivors of recent sexual assault.

The purpose of this comparative descriptive study is to describe and examine differences in assault characteristics and the issues surrounding follow-up contact of women survivors of a recent sexual assault. This study identified assault characteristics: half of the assaults were by strangers; approximately one-third of the assaults occurred in the victim's home; 29% of the victims were abducted; weapons and physical force were used in over half of the cases; 63% were vaginal assaults; and 86% involved penile penetration. Three months after the assault and the initial examination, only 23% (n = 18) of the study participants could be contacted by telephone for follow-up. The study's findings provide not only data regarding the characteristics of sexual assault, but also the difficulties in contacting adult female survivors for follow-up services. Recommendations outline the importance of thorough, individualized examinations and the need for improved, timely, follow-up services for sexual assault victims.

INSIGHT potentially prevents and treats depressive and anxiety symptoms in black women caring for chronic hemodialysis recipients.

End stage renal disease (ESRD) unduly affects black families in the U.S., including black women who are the family caregivers of affected patients. Nephrology nurses who support chronic hemodialysis recipients may be the first to recognize depressive and anxiety symptoms in this understudied caregiver population. This article describes the risk factors for depression in black women who care for persons receiving chronic hemodialysis therapy and INSIGHT therapy as a potential intervention to reduce depressive symptoms.

Depression in the older adult: recognition and nursing intervention.

The importance of identifying and intervening in elders with depression cannot be underestimated. The baby boom population is reaching the chronological milestone of being considered older age, which means that the percentage of older adults with depression will result in increased numbers of depressed older adults in all settings needing nursing care. Nurses must be able to recognize symptoms of depression, whether subsyndromal depression or major depression, to be able to intervene effectively. Depressive symptoms interfere with the quality of life and respond to nursing interventions that address psychosocial functioning including loss, educational strategies to increase understanding of depression as a disease, its treatment and adherence strategies, interventions that monitor and improve chronic medical illness, and recognize medication management that has the least likelihood of side effects. The importance of psychotherapies was not stressed above due to limitations in space, but in addition to problem solving therapy, cognitive and interpersonal supportive therapies are also effective. Electroconvulsive therapy is also effective in treating depression in the elderly when the patient is suicidal.

Identify bipolar spectrum disorders.

Patients with bipolar spectrum disorders commonly present with depressive symptoms to primary care clinicians. This article details bipolar spectrum disorder assessment, treatment, and treatment response. By intervening early in the course of depressive and hypomanic episodes, you can help decrease the morbidity and suffering associated with bipolar spectrum disorders.