Depression: Baldwin RC

Anderson IM, Ferrier IN, Baldwin RC, Cowen PJ, Howard L, Lewis G, Matthews K, McAllister-Williams RH, Peveler RC, Scott J, Tylee A. · Senior Lecturer and Honorary Consultant Psychiatrist, Neuroscience and Psychiatry Unit, University of Manchester, UK. · J Psychopharmacol. · Pubmed #18413657 No free full text.

Abstract: A revision of the 2000 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in May 2006. Key areas in treating depression were reviewed, and the strength of evidence and clinical implications were considered. The guidelines were drawn up after extensive feedback from participants and interested parties. A literature review is provided, which identifies the quality of evidence to inform the recommendations, the strength of which are based on the level of evidence. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse, and stopping treatment.

Baldwin RC, Anderson D, Black S, Evans S, Jones R, Wilson K, Iliffe S, Anonymous00317. · Manchester Mental Health and Social Care Trust, Manchester Royal Infirmary, Manchester, UK. · Int J Geriatr Psychiatry. · Pubmed #12949851 No free full text.

Abstract: OBJECTIVE: To develop a guideline for the primary care management of depression in later life based on best practice. METHOD: Source material included relevant guidelines, literature reviews and consensus documents coupled with an updated literature review covering 1998-October, 2001. This material was summarised as a series of evidence-based statements and recommendations agreed by consensus. RESULTS: Good quality evidence exists for the pharmacological and psychological treatment of depressive episode (major depression), although not specifically in primary care. There is some evidence of efficacy of antidepressants in late-life dysthymia and minor depression associated with poor functional status. In depressive episode, current evidence suggests acute treatment for at least six weeks and a continuation period of at least 12 months. Both tricyclic antidepressants and Selective Serotonin Re-uptake Inhibitors are effective in longterm prevention. There is less data on how to manage patients who do not respond in the acute treatment phase. More data is needed on sub-groups of patients with specific co-morbid medical conditions and those who are frail. Collaborative care is effective in older depressed primary care patients. CONCLUSIONS: There are effective treatments for depression in primary care. More research is needed to address the optimum treatment of depression with medical co-morbidity and to elucidate the role of newer psychological interventions. Collaborative care between primary care and specialist services is a promising new avenue for management.

Yohannes AM, Baldwin RC, Connolly MJ. · No affiliation provided · Age Ageing. · Pubmed #16638758 links to  free full text

This publication has no abstract.

Baldwin RC. · Manchester Mental Health & Social Care Trust, Edale House, Manchester Royal Infirmary, Manchester, UK. · Curr Opin Psychiatry. · Pubmed #17921752 No free full text.

Abstract: PURPOSE OF REVIEW: This article focuses on recent research into depression, bipolar disorder and anxiety in older people. RECENT FINDINGS: Many physical illnesses are associated with a high prevalence of depression but overall medical burden may largely account for this. The relationship between depression and vascular disease is two way. Frontal brain dysfunction may underlie depression both in cerebrovascular disease and neurodegenerative disorders. Besides antidepressants, psychological treatments, psychosocial interventions and enhanced primary care services are effective. Longer-term outcomes are poor but preventive strategies show promise. Medical and psychiatric comorbidity are also important themes in later-life anxiety and bipolar disorders. SUMMARY: Improving prognosis is a key concern and more research into novel pharmacological approaches (including vasoprotection), psychological interventions and prevention is needed.

Paranthaman R, Baldwin RC. · Edale House, Manchester Mental Health & Social Care Trust, Manchester Royal Infirmary, Manchester, UK. · Int Rev Psychiatry. · Pubmed #17085364 No free full text.

Abstract: Neuropsychiatric syndromes are common in the setting of cerebrovascular disease. The most frequent psychiatric syndrome after stroke is depression. Emotionalism and apathy after stroke are also frequent and under-detected symptoms. Treatment principles are broadly similar to those currently used to treat non-organically ill patients. The evidence for pharmacological and psychological treatment for depression after stroke is scant, and of variable quality. Currently there is evidence of efficacy for both tricyclic antidepressants and SSRIs in the management of depression but the latter are better tolerated. Randomized controlled trials of antidepressants for post-stroke emotionalism are positive and this is encouraging. The current evidence base for psychological interventions either as first line or augmentative strategies is too limited and inconclusive to permit definite recommendations. Future studies might include multi-modal interventions using the principles of active case management and pharmacological studies which target both specific neuropsychiatric symptoms and underlying cerebrovascular disorder.

Baldwin RC. · Manchester Mental Health and Social Care Trust, Manchester Royal Infirmary, Manchester M13 9WL, UK. · Int J Geriatr Psychiatry. · Pubmed #15578670 No free full text.

Abstract: BACKGROUND: Vascular depression is an important conceptual and clinical concept. OBJECTIVE: To apply criteria which, in an ideal world, should be satisfied before an association between depression and vascular disease can be considered robust. METHOD: A literature review with discussion of findings in the light of recently suggested guidelines for the development of new psychiatric disorders. RESULTS: There is considerable evidence linking depression in later life with vascular brain disease but the interaction is bi-directional. Depression and vascular disease could be mediated by factors other than traditional vascular risk factors. There is increasing interest in mechanisms such as inflammatory processes which may mediate both depression and vascular disease. CONCLUSIONS: Vascular depression provides a useful framework with which to remind the clinician of important interactions between depression and vascular disease but conceptually it may be too restrictive.

Baldwin RC. · Manchester Mental Health & Social Care Trust, York House, Manchester Royal Infirmary, Manchester, UK. · Int Psychogeriatr. · Pubmed #12670056 No free full text.

Abstract: AIMS AND BACKGROUND: The International Psychogeriatric Association (IPA) aims to improve the mental health care of older people globally. With regard to depression, a number of key publications over the past decade have highlighted areas of progress and areas requiring further research. In order to help clarify what progress has been made, the author conducted a literature review of original research subsequent to three recent major reviews. METHOD: A literature search of four databases over the period 1998-October 2001. Publications with an abstract in English were studied to ascertain number of relevant publications; type of research methodology; topics; and where the research originated. RESULTS: A total of 1,002 publications meeting predefined criteria were located. Fifty-nine percent were cross-sectional studies; less than 10% were randomized controlled studies. The most common themes were depression with comorbidity and etiology, accounting for almost half the papers, with stroke and Parkinson's disease the most frequently researched comorbid medical disorders, although interest in Alzheimer's disease, heart disease, hip fracture, and chronic lung disease appears to be increasing. There were comparatively few studies of psychological and psychosocial interventions. A quarter of the publications concerned major depressive disorder. There were striking variations in the origin of publications with two regions, North America and Northern Europe, accounting for two thirds of all publications but only 13.7% of the world's population aged 65 and over. CONCLUSIONS: Progress is being made but it might occur more rapidly and with greater scope with more international and cross-center collaboration.

Baldwin RC, O'Brien J. · Manchester Royal Infirmary, Manchester, UK. · Br J Psychiatry. · Pubmed #11823328 links to  free full text

Abstract: BACKGROUND: Growing evidence suggests that there may be a subtype of depression arising in later life that is characterised by a distinct clinical presentation and an association with cerebrovascular disease. This has been termed 'vascular depression'. AIMS: To review the evidence for associations between cardiovascular disease and depression and between cerebrovascular disease and depression, and to examine implications for clinical practice and research. METHOD: The authors reviewed the medical literature covering the past 5 years. RESULTS: There is strong evidence for an association between cardiovascular disease and depression, but this is not confined to older people. The causal pathway may be bi-directional. There is also a convergence of evidence suggesting a causal link between cerebrovascular disease and depression, especially that occurring later in life. The major focus has been on neuroradiological findings thought to be due to vascular disease, although the pathology may be heterogeneous. CONCLUSIONS: Although there are gaps in the evidence there is strong support for the concept of vascular depression, characterised by reduced depression ideation, subcortical neurological dysfunction, apathy and psychomotor change. This has implications for both treatment and prevention.

Baldwin RC. · Central Manchester Healthcare Trust, Manchester Royal Infirmary, UK. · Ann Med. · Pubmed #10852141 No free full text.

Abstract: Depression is the most common mental health problem of older people. It is a serious disorder which can lead to persistent suffering, increased mortality, from both suicide and general medical causes, and poorer overall health. Although presenting symptoms are similar in all age groups there are different aetiological pathways. In older people the waning effect of genetic predisposition to affective disorder may be replaced by subcortical brain abnormalities of presumed vascular aetiology. These may influence prognosis. Depression in later life is often under-diagnosed and under-treated; these two factors are the main hurdles to an improved prognosis. Antidepressant treatment should be tailored to the patient and works best when combined with psychological therapy, but the latter treatment modality is woefully neglected in later life psychiatry. Improvements in prognosis are unlikely to come from new revolutionary treatments but from vigorous treatment in the acute phase, continuation after recovery for at least 12-18 months and long-term maintenance treatment for those at high risk of recurrence.

Naish JH, Baldwin RC, Patankar T, Jeffries S, Burns AS, Taylor CJ, Waterton JC, Jackson A. · Imaging Science and Biomedical Engineering, University of Manchester, and Education and Research Center, Wythenshawe Hospital, Manchester, UK. · Magn Reson Med. · Pubmed #16894588 No free full text.

Abstract: There is growing evidence that microvascular angiopathy (MVA) plays an important role in the development of dementia and affective disorders in older people. At currently available image resolutions it is not possible to image directly the vascular changes associated with MVA, but the effects on blood and cerebrospinal fluid (CSF) flow may be detectable. The aim of this study was to investigate a potential biomarker for MVA based on MRI of abnormalities in CSF flow. Since there is considerable indirect evidence that treatment resistance in late-onset depressive disorder is related to MVA, we assessed the method in a group of 22 normal volunteers and 29 patients with responsive (N=21) or treatment-resistant (N=8) late-onset depressive disorder. Single-slice quantified phase-contrast (PC) images of cerebral blood and CSF flow were collected at 15 points over a cardiac cycle, and the resulting flow curves were parameterized. Significant differences in the CSF flow (width of systolic flow peak and diastolic flow volume, both P<0.01) through the cerebral aqueduct were observed for the group of treatment-resistant patients when compared to age matched controls. No significant difference was observed for a group of 21 patients with treatment-responsive depression. The findings support the hypothesis that MR measurement of CSF flow abnormalities provides a biomarker of MVA, and thus could have application in a wide range of age-related diseases.

Yohannes AM, Connolly MJ, Baldwin RC. · Lecturer, Manchester School of Physiotherapy, Manchester Royal Infirmary, Manchester, UK. · Int J Geriatr Psychiatry. · Pubmed #11376459 No free full text.

Abstract: OBJECTIVES: To examine the acceptability of fluoxetine in elderly depressed patients with chronic obstructive pulmonary disease (COPD). SETTING: A university teaching hospital. METHOD: Single-blinded (open) study. One hundred and thirty-seven outpatients (69 male) with symptomatic irreversible, moderate to severe COPD were recruited. Major depression was diagnosed using the Geriatric Mental State Schedule. Quality of life was assessed by the Breathing Problems Questionnaire, physical disability by the Manchester Respiratory Activities of Daily Living Questionnaire and severity of depression using the Montgomery Asberg Depression Rating Scale. Exclusion criteria were: use of oral steroids within 6 weeks, acute or chronic confusion, known cancer and known psychosis. RESULTS: Fifty-seven patients (42%) (25 males) with a mean age of 72 years (range 60-89 years) were depressed. Fourteen (six male) agreed to undergo therapy with fluoxetine 20 mg/day for 6 months, while 36 (72%) refused antidepressant drug therapy. Only seven subjects completed the trial; of these, four (57%) responded to fluoxetine therapy. Five subjects withdrew because of side-effects. Twenty-two of those who refused treatment (61%) agreed to be interviewed, and of these 19 (86%) were still depressed. CONCLUSION: Patient acceptance of fluoxetine was poor. The reasons for refusing treatment varied but were largely due to misapprehension by the patient. Untreated depression became chronic. Offering antidepressants to COPD patients with depression is not an effective strategy. Why this might be so is discussed.

Yohannes AM, Baldwin RC, Connolly MJ. · Department of Physiotherapy, Manchester Metropolitan University, Elizabeth Gaskell Campus, Manchester, UK. · Int J Geriatr Psychiatry. · Pubmed #18457336 No free full text.

Abstract: OBJECTIVES: Depression and anxiety symptoms are common in medically ill older patients. We investigated the prevalence and predictors of depression and anxiety symptoms in older patients admitted for further rehabilitation in post acute intermediate care. DESIGN: Observational cohort study. SETTING: An intermediate care unit, North West of England. PARTICIPANTS: One hundred and seventy-three older patients (60 male), aged mean (SD) 80 (8.1) years, referred for further rehabilitation to intermediate care. MEASUREMENTS: Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale, and severity of depression examined by the Montgomery Asberg Depression Rating Scale. Physical disability was assessed by the Nottingham Extended ADL Scale and quality of life by the SF-36. RESULTS: Sixty-five patients (38%) were identified with depressive symptoms, 29 (17%) with clinical depression, 73 (43%) with anxiety symptoms, and 43 (25%) with clinical anxiety. 15 (35%) of the latter did not have elevated depression scores (9% of the sample). Of those with clinical depression, 14 (48%) were mildly depressed and 15 (52%) moderately depressed. Longer stay in the unit was predicted by severity of depression, physical disability, low cognition and living alone (total adjusted R2 = 0.24). CONCLUSIONS: Clinical depression and anxiety are common in older patients admitted in intermediate care. Anxiety is often but not invariably secondary to depression and both should be screened for. Depression is an important modifiable factor affecting length of stay. The benefits of structured management programmes for anxiety and depression in patients admitted in intermediate care are worthy of evaluation.

Yohannes AM, Koenig HG, Baldwin RC, Connolly MJ. · Department of Physiotherapy, Manchester Metropolitan University, Elizabeth Gaskell Campus, Manchester, UK. · Int J Geriatr Psychiatry. · Pubmed #18188870 No free full text.

Abstract: OBJECTIVE: To examine health behaviour, severity of depression, gender differences and religiosity in older patients admitted to intermediate care for further rehabilitation. DESIGN: Cross-sectional survey. PARTICIPANTS: A research physiotherapist interviewed 173 older patients (113 female), 60 and older consecutively admitted to intermediate care for rehabilitation, usually after acute care. MEASUREMENTS: Religiosity was measured using the Duke University Religion Index, depressive and anxiety symptoms using the Hospital Anxiety Depression Scale, and severity of depression measured by the Montgomery Asberg Depression Rating Scale. Physical disability was assessed by the Nottingham Extended Activities of Daily Living Scale and quality of life measured by the SF-36 questionnaire. RESULTS: After controlling for other factors using multiple regression, religious attendance was associated with positive general health perception (t = 1.9, p = 0.05), and inversely associated with number of pack years smoked (t = -2.05, p = 0.04) and severity of illness (Charlson Index), [t = -2.05, p = 0.04]. Intrinsic religious activity was associated with older age (t = 3.06, p < 0.003), female gender (t = 2.52, p = 0. 01), living situation (t = -2.17, p < 0.03) and with less severe depression (t = -2.43, p = 0.01). CONCLUSION: In older patients with chronic diseases in intermediate care, religious attendance was associated with positive perceptions of health, less severe illness, and fewer pack years. Intrinsic religious activities were associated with less severe depression and lower likelihood of living alone.

Dearman SP, Waheed W, Nathoo V, Baldwin RC. · Department of Psychiatry, Royal Preston Hospital, Preston, UK. · Aging Ment Health. · Pubmed #16938686 No free full text.

Abstract: Approximately 10% of elderly patients in primary care have depression yet it is often under-diagnosed and under-treated. It is unclear exactly how patients are being managed in primary care or what factors are associated with referral to psychiatric services. This study aimed to establish in a naturalistic setting how older depressed patients are managed in primary care; to determine which patients are referred to psychiatric services and the differences between patients referred and those not; in terms of primary care consultation rate and degree of co-morbid illness. Computerised records and referral letters were read for 1089 elderly patients in a large practice in central Manchester, UK. Of the 9% identified as depressed, 90% were managed in primary care alone, a third without antidepressants. More than half of those prescribed antidepressants received tricyclic antidepressants. Suicidal ideation and treatment failure were the principle reasons for referral. Patients referred had a greater psychiatric co-morbidity and had consulted their GP more frequently in the past year. Management of depression in the elderly may be conservative and older antidepressants may be over-prescribed. Increased primary care consultation rate and a greater psychiatric co-morbidity may be associated with referral to psychiatric services.

Baldwin RC, Gallagley A, Gourlay M, Jackson A, Burns A. · Old Age Psychiatry, Manchester Royal Infirmary, Manchester, UK. · Int J Geriatr Psychiatry. · Pubmed #16323252 No free full text.

Abstract: BACKGROUND: Late-onset depression (LOD) has a poor prognosis which may be worsened by the presence of cerebrovascular disease. Few studies have explored prospectively the influence of vascular risk factors on longer term prognosis. METHODS: The original study involved 50 patients with LOD and 35 healthy age matched controls. Follow-up was at three years. Baseline measures included clinical, neuroradiological and neuropsychological variables. Outcome was assessed by mortality, progression to dementia and clinical course of depressive disorder. RESULTS: Sixty-two (73%) of the original cohort agreed to be re-interviewed. Seven participants had died (all from the depressed group) and six developed dementia, all but one from the depressed group. Vascular dementia predominated (although not significantly so) among those with dementia at follow-up. For 28 depressed patients with complete follow-up data (56% of the original sample), poor outcome was predicted by lower High Density Lipoprotein (HDL), raised Erythrocyte Sedimentation Rate (ESR) and a higher score on the Hachinski Index scale and one test of immediate memory. Initial response to treatment was not associated with later outcome. CONCLUSION: Late-onset depressive disorder is associated with a high rate of mortality and possibly dementia. Biochemical and inflammatory markers may be important in prognosis and their role should be confirmed in future studies.

Yohannes AM, Baldwin RC, Connolly MJ. · Metropolitan University of Manchester, Manchester School of Physiotherapy, Manchester, UK. · Age Ageing. · Pubmed #16107452 links to  free full text

Abstract: INTRODUCTION: acute exacerbation of COPD (AECOPD) is a major cause of hospital admission, and predicts subsequent medium-term mortality. We aimed to examine mortality predictors in patients discharged from hospital after AECOPD. METHODS: we obtained baseline demographic and clinical data from 100 patients (mean age (range)=73 (60-98) years; 48 males) admitted with AECOPD. All completed the following validated questionnaires: a quality of life questionnaire (Breathing Problems Questionnaire; BPQ); a screening questionnaire for depression (Brief Assessment Schedule Depression Cards; BASDEC); a disability questionnaire (Manchester Respiratory Activities of Daily Living questionnaire; MRADL). Following discharge all were prospectively followed and survival/mortality at 12 months confirmed from hospital notes and by contacting general practitioners. RESULTS: the prevalence of depression at recruitment was 56%. One-year mortality in the whole group was 36%. Odds ratios (95% confidence intervals) for mortality predictors (univariate logistic regression analysis) were: use of long-term oxygen therapy=2.72 (1.06-6.97); subsequent readmission=2.57 (1.08-6.12); MRADL score=0.87 (0.80-0.94) (disability predicting death); BASDEC score=1.13 (1.02-1.26) (depression predicting death); BPQ score=1.08 (1.04-1.12) (low quality of life predicting death); length of original hospital stay=1.03 (1.00-1.07). On multivariate logistic regression analysis the only mortality predictor was BPQ with an odds ratio (95% confidence limits) of 1.13 (1.04-1.22). In terms of mortality prediction for individuals, a threshold MRADL score of <12 gave a sensitivity of 86%, specificity of 55%, positive predictive value of 88% and negative predictive value of 52%, with similar predictive values using BPQ as an independent variable. CONCLUSIONS: 1-year mortality after AECOPD admission is high. The presence of depressive illness (which is extremely common), and levels of both disability and impairment of quality of life are univariate predictors of 1-year mortality in this patient group. This model may be useful in predicting prognosis for individuals and thus in guiding treatment decisions.

Yohannes AM, Baldwin RC, Connolly MJ. · Manchester School of Physiotherapy, Manchester Royal Infirmary, Manchester, UK. · Int J Geriatr Psychiatry. · Pubmed #12766917 No free full text.

Abstract: OBJECTIVES: We hypothesized that COPD patients with sub-threshold depression would have levels of disability and impaired quality of life approaching that for major depression and significantly greater than for non-depressed COPD patients. SETTING: A university teaching hospital METHOD: 137 outpatients (69 men), with a mean age of 73 years (range 60-89 years) with symptomatic irreversible, moderate to severe COPD were recruited. Subjects were interviewed using the Geriatric Mental State Schedule (GMS), a structured psychiatric interview schedule, along with its diagnostic algorithm AGECAT. A GMS/AGECAT score of 3 or more is indicative of a case-level of depression, a GMS/AGECAT score of 1-2 indicates sub-threshold depression and GMS/AGECAT of 0, no depression. Physical disability was measured by the Manchester Respiratory Activities of Daily Living questionnaire (MRADL) and quality of life was assessed by the Breathing Problems Questionnaire (BPQ). RESULTS: Mean (SD) one second forced expiratory volume was 0.89 (0.33) litres. The prevalence of GMS/AGECAT case-level depression (>or= 3) was 57 cases (42%); of GMS/AGECAT sub-threshold depression (1-2) 34 (25%); and GMS/AGECAT non-depression (0) 46 (33%). Comparison of MRADL score in the three groups (mean, 95% confidence intervals) revealed [GMS >or= 3 = 9.9 (8.4 to 11.3) vs GMS = 1-2, 12.9 (11.2 to 14.4) vs GMS = 0, 15.6 (14 to 16.6) p < 0.0001]. BPQ scores (mean, 95% confidence intervals) showed [GMS >or= 3 = 54 (50 to 57) vs GMS = 1-2, 40 (36.3 to 44) GMS = 0, 33 (30.6 to 36.7) p < 0.0001]. There was no significant difference in FEV(1) between the three groups. CONCLUSION: Sub-threshold depression accounted for 25% of the sample. In this study disability associated with sub-threshold depression in patients with COPD was intermediate to that associated with case-level depression and no with depression and significantly worse than in the latter group. Sub-threshold depression is associated with substantial morbidity in COPD.

Yohannes AM, Baldwin RC, Connolly M. · The Manchester School of Physiotherapy, Manchester Royal Infirmary, Manchester, UK. · Age Ageing. · Pubmed #11937477 links to  free full text

Abstract: OBJECTIVE: prospectively to evaluate predictors of mortality in elderly patients with disabling chronic obstructive pulmonary disease. METHODS: 137 (69 men) outpatients, aged 60-89 (mean 73) years with symptomatic disabling chronic obstructive pulmonary disease. We collected baseline demographic and physiological data. Subjects completed the Manchester Respiratory Activities of Daily Living Questionnaire, the Brief Assessment Schedule Depression Cards a screening questionnaire for depression, the Breathing Problems Questionnaire measuring quality of life, and the Montgomery Asberg Depression Rating Scale measuring severity of depression. All subjects were followed prospectively and survival and mortality data were confirmed by contacting general practitioners and scrutinising hospital notes at 30 months. RESULTS: the mean (standard deviation) of one second forced expiratory volume was 0.89 (0.3) litres. At 30 months, 44 patients (21 men, aged 61-89 [mean 75] years: 32% of the total) had died. Mean (standard deviation) baseline one second forced expiratory volume of those dying was 0.71 (0.2) litres. On logistic regression analysis, predictors of mortality were: Manchester Respiratory Activities Of Daily Living Questionnaire score (odds ratio=0.88, 95% confidence interval=0.80-0.97); pre-bronchodilator one second forced expiratory volume (odds ratio=0.04, confidence interval=0.005-0.32); body mass index (odds ratio=0.87, confidence interval=0.79-0.97); and long term oxygen therapy (odds ratio=3.17, confidence interval=1.04-8.36). Current smoking status, pack-years smoked, depression scores, quality of life scores, co-morbid diseases and social class did not predict mortality. CONCLUSION: disability, use of long-term oxygen therapy, pre-bronchodilator lung function and body-mass index were independent predictors of mortality in elderly patients with severe chronic obstructive pulmonary disease.

Simpson SW, Baldwin RC, Burns A, Jackson A. · Consultant Psychiatrist, Forston Clinic, Dorchester, Dorset, UK. · Int J Geriatr Psychiatry. · Pubmed #11376462 No free full text.

Abstract: BACKGROUND: Elderly people who develop depression have demonstrable changes in cerebral structure but little is known of the relationship between regional cerebral volumes, treatment response and cognitive impairment. METHOD: Forty-four patients with major depression diagnosed according to DSM-IIIR criteria underwent magnetic resonance imaging and regional cerebral volumes were quantified using multispectral analysis. Response to antidepressant treatment was assessed prospectively and a neuropsychological test battery was administered. RESULTS: There was a trend for smaller fronto-temporal volumes in the treatment-resistant patients. Impaired immediate working memory was linked with reduced frontal and parietal lobe volume and impaired short-term memory functioning was associated with reduced temporal lobe volume. Ventricular enlargement was associated with prior administration of electro-convulsive therapy, poor physical health and later age at onset of first episode of depression. CONCLUSION: In late-life depression, brain changes should not preclude vigorous antidepressant treatment. Regional cerebral volume changes may be a complication of poor physical health and are associated with memory dysfunction even upon recovery from depression.

Simpson S, Baldwin RC, Jackson A, Burns A, Thomas P. · University Department of Old Age Psychiatry in South Manchester, Withington Hospital, West Didsbury, UK. · Int Psychogeriatr. · Pubmed #11263709 No free full text.

Abstract: BACKGROUND: "Vascular depression" has recently been proposed. It is characterized by magnetic resonance imaging (MRI) T2-weighted subcortical lesions, a late onset of first episode of depression, and reduced heritability; a cerebrovascular etiology is suggested. The validity of "vascular depression" might be strengthened if an association was found between the subcortical lesions used to define it and particular depressive symptoms. METHODS: A blinded cross-sectional examination of DSM-III-R depressive symptoms (American Psychiatric Association, 1987) and MRI T2-weighted subcortical lesions in 44 patients with late-life depression. RESULTS: Many associations were found; however, because of multiple comparisons, their significance is viewed with caution. The most robust finding was that psychomotor retardation was independently related to total white-matter score. The odds of showing psychomotor retardation was increased 1.9 times for every point increase in severity of white-matter change. CONCLUSION: In late-life depression the clinical expression of the depression is influenced by the pattern of MRI T2-weighted subcortical lesions. This gives some validity to the concept of an MRI-defined "vascular" subtype of late-life depression and strengthens the argument for including neuroimaging in the classification of late-life depression.

Baldwin RC, Walker S, Simpson SW, Jackson A, Burns A. · York House, Manchester Royal Infirmary, Oxford Road, Manchester M13 9 WL, UK. · Int J Geriatr Psychiatry. · Pubmed #11180465 No free full text.

Abstract: OBJECTIVE. To study the course of depressive symptoms over 3 years, rate of dementia and mortality in relation to baseline neuroradiological abnormalities. DESIGN. Retrospective casenote analysis of 38 patients (of 44) who had a Magnetic Resonance Imaging (MRI) scan 3 years earlier. Twenty-two patients also received a detailed interview. RESULTS. Overall outcome was good for around two-thirds of the sample. Poorer clinical course was associated with lesions in pons and more than five Virchow Robins spaces in the corona radiata. Pontine raphe lesions and confluent periventricular lesions were associated with later dementia and with reduced survival from cardiovascular death. Males had more recurrences and a reduced survival. CONCLUSIONS. MRI lesions influence outcome, mortality and the onset of dementia. However, because they are quite common in elderly depressed patients they have limited utility on their own as predictors of outcome. The association of periventricular lesions with dementia is a new finding, and suggests that the site and type of lesions may be as important than the quality of them.

Yohannes AM, Baldwin RC, Connolly MJ. · Department of Geriatric Medicine, The Manchester School of Physiotherapy and Department of Old Age Psychiatry, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK. · Int J Geriatr Psychiatry. · Pubmed #11180464 No free full text.

Abstract: OBJECTIVES. Depressive and anxiety symptoms are common in elderly patients with chronic obstructive pulmonary disease (COPD). However, true prevalence of clinical depression and anxiety is uncertain. We thus aimed to assess prevalence of clinical depression and/or anxiety in elderly COPD patients using the Geriatric Mental State Schedule (GMS) and determine severity of clinical depression by the Montgomery Asberg Depression Rating Scale (MADRS). We also aimed to validate the Brief Assessment Schedule Depression Cards (BASDEC) screening test for depressive symptoms against GMS. SETTING. A university teaching hospital. PARTICIPANTS. Subjects comprised 137 (69 men) outpatients with COPD, aged 60 - 89 (mean 73) years. Exclusion criteria were acute respiratory exacerbation or use of oral corticosteroid within 6 weeks, known psychosis, acute or chronic confusion. MEASUREMENTS. A GMS score > or =3 is diagnostic of clinical depression, and a BASDEC score > or =7 is classed as "case". GMS was taken as gold standard. Severity of depression was assessed by the MADRS. RESULTS. Mean (SD) one second forced expiratory volume was 0.89 (0.3) litres. Sixty-two subjects (46%) scored as a "case" on BASDEC and 57 subjects (42%) were identified as clinically depressed on GMS. In the depressed the prevalence of anxiety was 37% and in the non-depressed 5%. BASDEC performed well against GMS, having a sensitivity of 100%; a specificity of 93%; a positive predictive value of 91% and a negative predictive value of 100%. Assessment of severity of depression by MADRS showed that 17 subjects (30%) were mildly depressed, 39 (68%) were moderately depressed and one (2%) was severely depressed. CONCLUSION. Clinical depression and anxiety are common in elderly patients with COPD, though clinical anxiety seems mainly confined to those who also suffer clinical depression. Of those depressed, two-thirds scored in the moderately depressed range. BASDEC is a valid screening tool in this patient group.

Simpson S, Baldwin RC, Jackson A, Burns A. · York House, Manchester Royal Infirmary, United Kingdom. · Biol Psychiatry. · Pubmed #9951567 No free full text.

Abstract: BACKGROUND: Psychotic depression has been proposed as a distinct subtype of major depression. There is considerable evidence for this in younger patients, although the neuroimaging has been rudimentary. Volumetric imaging studies are required of consecutive cohorts of patients with depression. METHODS: Ninety-nine consecutive elderly patients were diagnosed with DSM-III-R major depression. Eighteen were psychotic, and 81 were not. Sixty-six patients were given a neuropsychological test battery, and 44 had a magnetic resonance imaging brain scan. A model integrating clinical, psychological, and neuroimaging findings for the explanation of delusion formation during depression is proposed. RESULTS: Psychotic depression was characterized by worse physical health, more family history of depression, a poorer response to antidepressant drugs, and more severe lowering of mood; however, the strongest predictors of the presence of delusions were diencephalic atrophy, reticular activating system lesions, brain stem atrophy, and left-sided frontotemporal atrophy. The psychotic patients had poorer performance on tests of frontal lobe function and mental processing speed. CONCLUSIONS: In the elderly, psychotic depression is etiologically, clinically, and neuroradiologically distinct, and has different treatment requirements, from nonpsychotic major depression.

Thornton A, Yohannes AM, Baldwin RC, Connolly MJ. · No affiliation provided · Age Ageing. · Pubmed #10855916 No free full text.

This publication has no abstract.

Baldwin RC, Walker S, Jackson A, Simpson SW, Burns A. · No affiliation provided · BMJ. · Pubmed #10215382 No free full text.

This publication has no abstract.