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Disorders
Published in Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson, Pocket Prescriber Psychiatry, 2019
Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson
Depression may be categorised by severity based on number of symptoms, intensity and functional impairment. The following types of depression may also be considered: Melancholic depression: unreactive mood, diurnal variation (worse in morning), early morning wakening, psychomotor agitation/retardation, ↓wt/appetite.Atypical depression: mood reactivity, ↑wt/appetite, hypersomnia, leaden paralysis, fatigue. F > M.Psychotic depression: severe depression with hallucinations or delusions that are generally mood congruent.
Medical risks and management
Published in Alan Weiss, The Electroconvulsive Therapy Workbook, 2018
Kellner and Bernstein (1993) recommend a therapeutic trial of ECT for patients with this set of comorbidities who do not fulfil the classic symptoms of melancholic depression. To minimise the cognitive side effects of ECT it is recommended that ECT be administered: using an ultrabrief or brief-pulse stimulus, unilateral electrode placement; avoiding excessively high stimulus dosage; and administering the treatment twice a week or less frequently once there has been a clinical response (Price and McAllister, 1989).
Psychiatric Diagnosis: The State of the Art
Published in Mark S. Gold, R. Bruce Lydiard, John S. Carman, Advances in Psychopharmacology: Predicting and Improving Treatment Response, 2018
Robert Moreines, Irl Extein, Mark S. Gold
There is an additional requirement in DSM III that three of a group of other behavioral disturbances also be present. (See Table 7). The choice of those specific characteristics remains a controversial area. In a thorough review of a variety of methodological approaches, Nelson and Charny32 conclude there is consistent support for the following symptoms as associated with melancholic depression: distinct quality of depressed mood, diurnal variation with worsening in the morning, psychomotor change, and inappropriate or excessive guilt. A surprising finding was lack of discriminating significance for changes in sleep, appetite, and weight. These latter three features had long been held to be vegetative disturbances in autonomous depression, and are included in the DSM III melancholia criteria. Their more recent review34 suggests that severity of depression, loss of interest, and decreased concentration should be substituted as features in future categorizations, and sleep and eating disturbances be omitted.
Routinely accessible parameters of mineralocorticoid receptor function, depression subtypes and response prediction: a post-hoc analysis from the early medication change trial in major depressive disorder
Published in The World Journal of Biological Psychiatry, 2022
Jan Engelmann, Harald Murck, Stefanie Wagner, Lea Zillich, Fabian Streit, David P. Herzog, Dieter F. Braus, Andre Tadic, Klaus Lieb, Marianne B. Műller
The socio-demographic and clinical characteristics of patients were assessed relying on patients´ self-reports. Depression severity was assessed by the Hamilton Depression Rating Scale (HAMD17; Hamilton 1960) and the Inventory of Depressive Symptoms (interview [IDS-C30]; self-rating [IDS-SR30]) (Rush et al. 2000) in weekly intervals from baseline to week 8 by trained and blinded raters (Wagner et al. 2011). Melancholic depression was assessed by the German version of the M.I.N.I. International Neuropsychiatric Interview (MINI, Sheehan et al. 1998). Melancholic depression is characterised by loss of interest, bad mood, daily fluctuation of mood, waking up too early, feeling restless, and a negative view of the patient´s self. The atypical depression, assessed by the IDS clinician rating, exhibits symptoms like increased appetite, increased weight, extended sleep duration, loss of physical energy, increased interpersonal sensitivity and maintained mood responsiveness. Anxious depression was assessed by the HAMD17 single items: feeling anxious or tense, panic/phobic symptoms, bodily symptoms, constipation/diarrheal and hypochondriasis (Baumeister and Parker 2012).
Association of treatment facets, severity of manic symptoms, psychomotor disturbances and psychotic features with response to electroconvulsive therapy in bipolar depression
Published in The World Journal of Biological Psychiatry, 2021
Giulio E. Brancati, Beniamino Tripodi, Martina Novi, Margherita Barbuti, Pierpaolo Medda, Giulio Perugi
When looking at single features, as expected (Rasmussen 2011; Van Diermen et al. 2019; Veltman et al. 2019), severe psychomotor disturbances, namely motor retardation, motor tension or agitation, motor hyperactivity, and, at the multivariate level, mannerisms and posturing, were positively associated with response. While psychomotor features only appear among optional criteria in DSM-5 melancholic features specifier, whose utility in ECT response prediction was rejected (Fink et al. 2007), our study supports the clinical utility of considering psychomotor disturbances as mandatory criteria for melancholic depression, as previously proposed by different authors (Fink and Taylor 2007; Parker 2007). Intriguingly, a bidirectional relationship could be observed between melancholia and mixed states concepts, with severe agitated mixed depression being subsumed under the realm of melancholia on one hand (Koukopoulos et al. 2007), and a bipolar mixed core being attributed, on the other hand, to melancholia (Akiskal and Akiskal 2007). Regardless of theoretical speculations, both major mixed ‘affective and cognitive disturbance[s]’ (Himmelhoch 1992) and psychomotor disturbances related to melancholic depression predict a good outcome of ECT.
Melancholia: does this ancient concept have contemporary utility?
Published in International Review of Psychiatry, 2020
Gabriele Sani, Leonardo Tondo, Juan Undurraga, Gustavo H. Vázquez, Paola Salvatore, Ross J. Baldessarini
Renewed interest in the concept of melancholia emerged following introduction of the concept of major depression in 1980 as a very broad, clinically heterogeneous condition. Despite the intuitive appeal of the concept of melancholic depression, recent research tends to challenge its security as a clinically or biomedically distinct disorder or syndrome, as addressed above. In particular, the ability of DSM-5 “melancholic features” to provide clinically important predictions (e.g. future morbidity, risk of suicide attempts or fatalities, or particular treatment-responses) or associations (e.g. family history, sex, current age or age-at-onset, previous or future morbidity) seems to be surprisingly limited, especially among DSM-5 nonmelancholic and melancholic patient-subjects with similar depression-severity (Tondo et al., 2019; Undurraga et al., 2019).