Early clinical predictors and correlates of long-term morbidity in bipolar disorder

OBJECTIVES: Identifying factors predictive of long-term morbidity should improve clinical planning limiting disability and mortality associated with bipolar disorder (BD). METHODS: We analyzed factors associated with total, depressive and mania-related long-term morbidity and their ratio D/M, as %-time ill between a first-lifetime major affective episode and last follow-up of 207 BD subjects. Bivariate comparisons were followed by multivariable linear regression modeling. RESULTS: Total % of months ill during follow-up was greater in 96 BD-II (40.2%) than 111 BD-I subjects (28.4%; P=0.001). Time in depression averaged 26.1% in BD-II and 14.3% in BD-I, whereas mania-related morbidity was similar in both, averaging 13.9%. Their ratio D/M was 3.7-fold greater in BD-II than BD-I (5.74 vs. 1.96; P<0.0001). Predictive factors independently associated with total %-time ill were: [a] BD-II diagnosis, [b] longer prodrome from antecedents to first affective episode, and [c] any psychiatric comorbidity. Associated with %-time depressed were: [a] BD-II diagnosis, [b] any antecedent psychiatric syndrome, [c] psychiatric comorbidity, and [d] agitated/psychotic depressive first affective episode. Associated with %-time in mania-like illness were: [a] fewer years ill and [b] (hypo)manic first affective episode. The long-term D/M morbidity ratio was associated with: [a] anxious temperament, [b] depressive first episode, and [c] BD-II diagnosis. CONCLUSIONS: Long-term depressive greatly exceeded mania-like morbidity in BD patients. BD-II subjects spent 42% more time ill overall, with a 3.7-times greater D/M morbidity ratio, than BD-I. More time depressed was predicted by agitated/psychotic initial depressive episodes, psychiatric comorbidity, and BD-II diagnosis. Longer prodrome and any antecedent psychiatric syndrome were respectively associated with total and depressive morbidity

Implementation of a Physical Activity Group at a Community Mental Health Center: A Pilot Quality Improvement Project to Reduce Depressive Symptoms in Adolescents with Major Depressive Disorder

Major Depressive Disorder is a debilitating illness that affects millions of Americans, including adolescents. The majority of adolescents with Major Depressive Disorder (MDD) do not receive treatment. There may be a variety of reasons for this including stigma, access to care, and potential adverse reactions. People suffering from MDD are known to be at high risk for suicide. Lack of treatments adds the risk of suicide for adolescents with MDD. Identifying and implementing treatment options that are more acceptable and accessible are of the utmost importance. Although there is limited research regarding exercise/physical activity, depressive symptoms, and adolescents with MDD, there are two promising studies by Hughes, Barnes, Barnes, DeFina, Nakonezny, & Graham (2013) and Finazzi, Mesquita, Lopes, Fu, & Oliveira (2009). Currently, there is a physical activity program at Lakes Region Mental Health for adult patients. Unfortunately, adolescents do not have access to a similar group. This Doctorate of Nursing Practice (DNP) Quality Improvement (QI) Project piloted an eight-week physical activity group for adolescents with MDD to determine the impact physical activity had on depressive symptoms. The PHQ-9 for Adolescents Depression Screening Tool was given to participants before joining the physical exercise group and upon completion of the physical activity group. Pre-intervention and post-intervention results of the PHQ-9 for Adolescents Depression Screening were compared and analyzed. In addition, a survey was administered at week four and upon completion of the physical activity group to gather qualitative data. The results of this Pilot DNP QI project indicate there was a decrease in the PHQ-9 for Adolescents for two out of the three participants. The qualitative data demonstrated improvement in depressive symptoms, self-esteem and social interaction for all three participants. These results are promising and support the need for a physical activity group for adolescents with MDD at Lakes Region Mental Health Center

Improving Depression Screening and Diagnosis in a Diverse Urban University Health Service

Background: Twenty percent of the United States (U.S.) adult population is affected by mental illness each year of which depression is the most common cause of disability and suicide. Each year, one in four young adults between the ages of 18 – 25 will experience at least one depressive episode. This demographic propensity for young adults to suffer depression has implications for college campuses where young adults congregate and high rates of depression have been noted. In addition to the impact of depression on health and quality of life, depression has been linked to a decrease in students’ academic performance. Thus from a health perspective as well as its potential impact on academic success, depression is a major health concern on college campuses. Objectives: The purpose of this quality improvement project is to evaluate whether integrating a brief depression screening tool into an electronic health record (EHR) and providing decision support increases the proportion of students screened and diagnosed for depression. Participants: Data were drawn from a convenience sample of 130 student patient scheduled visit notes in the Department of General Medicine at a diverse urban University over a 4 year period. Methods: Using the Plan-Do-Study-Act method of quality improvement, the brief depression screening tool was integrated into the EHR. Evaluation consisted of a pre/post implementation comparison of measures for screening for depressive symptoms and depression diagnosis. Results: Integration of the PHQ-2 and decision support into the EHR increased the proportion of students: screened for depressive symptoms (7.7%:86.2%); and diagnosed with Major Depressive Disorder (30%:45.5%). Conclusions: The integration of a valid and reliable tool to screen and diagnose depression can increase the number of students treated for depression. This has implications for academic success and quality of life

The mental health of children and adolescents: report on the second Australian child and adolescent survey of mental health and wellbeing

FOREWORD This report provides compelling reading for everyone interested in the health and wellbeing of Australian children and adolescents. Based on a survey conducted in the homes of over 6,300 families with children and/or adolescents aged 4 to 17 years, the report presents a comprehensive picture of the mental health of young Australians. It documents the prevalence and type of mental health problems, the impact of those problems on families and young people themselves and the role of health and education services in providing assistance. While the primary sources of information were parents and carers, the survey also engaged directly with young people 11 years and older who completed their own survey. This information provides unique insights about aspects of their emotional lives and behaviour that are generally not visible to parents and carers

Postpartum Depression Screening of Women Veterans in Alaska Quality Improvement Project

A Project Submitted in Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCE in Nursing SciencePostpartum depression screening guidelines were updated by the American College of Obstetricians and Gynecologists and the United States Preventive Services Task Force in 2015 and 2016, respectively. Universal postpartum depression screening is recommended where previously it was not. Postpartum depression screening is relevant to the rapidly growing population of women Veterans served by the Veterans Health Administration (VA) as part of their comprehensive health care benefits. Little information was available on the postpartum depression screening practices within the Alaska VA Healthcare System. Using a quality improvement methodology, the author identified postpartum depression screening as a topic of interest. Current practice was assessed through a retrospective chart audit of all maternity consults placed during the fiscal year 2014. The chart audit revealed an 81% postpartum depression screening rate. Incomplete data limited a full statistical analysis; however, all women who returned to an Alaska VA clinic, received screening and treatment. An informational brochure was developed for women and their health care providers highlighting postpartum depression screening and treatment resources.Title Page / Abstract / Table of Contents / List of Tables / List of Appendices / Introduction / Purpose / Literature Review / Implications for Nursing Practice / Methods / Results / Discussion / Conclusion / References / Appendice

Mental, behavioral and neurodevelopmental disorders in the ICD-11 : An international perspective on key changes and controversies

The Author(s). 2020Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.An update of the chapter on Mental, Behavioral and Neurodevelopmental Disorders in the International Classification of Diseases and Related Health Problems (ICD) is of great interest around the world. The recent approval of the 11th Revision of the ICD (ICD-11) by the World Health Organization (WHO) raises broad questions about the status of nosology of mental disorders as a whole as well as more focused questions regarding changes to the diagnostic guidelines for specific conditions and the implications of these changes for practice and research. This Forum brings together a broad range of experts to reflect on key changes and controversies in the ICD-11 classification of mental disorders. Taken together, there is consensus that the WHO's focus on global applicability and clinical utility in developing the diagnostic guidelines for this chapter will maximize the likelihood that it will be adopted by mental health professionals and administrators. This focus is also expected to enhance the application of the guidelines in non-specialist settings and their usefulness for scaling up evidence-based interventions. The new mental disorders classification in ICD-11 and its accompanying diagnostic guidelines therefore represent an important, albeit iterative, advance for the field.Peer reviewedFinal Published versio

Depression and Obstructive Sleep Apnea (OSA)

For over two decades clinical studies have been conducted which suggest the existence of a relationship between depression and Obstructive Sleep Apnea (OSA). Recently, Ohayon underscored the evidence for a link between these two disorders in the general population, showing that 800 out of 100,000 individuals had both, a breathing-related sleep disorder and a major depressive disorder, with up to 20% of the subjects presenting with one of these disorders also having the other. In some populations, depending on age, gender and other demographic and health characteristics, the prevalence of both disorders may be even higher: OSA may affect more than 50% of individuals over the age of 65, and significant depressive symptoms may be present in as many as 26% of a community-dwelling population of older adults. In clinical practice, the presence of depressive symptomatology is often considered in patients with OSA, and may be accounted for and followed-up when considering treatment approaches and response to treatment. On the other hand, sleep problems and specifically OSA are rarely assessed on a regular basis in patients with a depressive disorder. However, OSA might not only be associated with a depressive syndrome, but its presence may also be responsible for failure to respond to appropriate pharmacological treatment. Furthermore, an undiagnosed OSA might be exacerbated by adjunct treatments to antidepressant medications, such as benzodiazepines. Increased awareness of the relationship between depression and OSA might significantly improve diagnostic accuracy as well as treatment outcome for both disorders. In this review, we will summarize important findings in the current literature regarding the association between depression and OSA, and the possible mechanisms by which both disorders interact. Implications for clinical practice will be discussed