This is one of the hardest questions to answer especially if your working on a inpatient unit with depressed patients. They are mostly severely ill for a long time and demoralised when they get admitted. To get a clear picture of what is wrong we usually get rid of all psychopharmacological drugs for diagnostic purposes. That's why i find this article of major importance, clearly written by experienced clinicians. The table offers clinical features that may help differentiate chronic depression from personality disorder.
Guidelines:
1. avoid unsupported conclusions based on nonresponse
2. bear in mind that depression is likely to make personality traits look more like full-fledged PDs by exaggerating a range of personality traits such as avoidance, dependence, and interpersonal sensitivity. Always consider what evidence exists that these were more than traits at any point when a patient was less markedly depressed
3. use multiple informants (family members, close friends, primary care doctors, psychotherapists) as well as other collateral information (eg, performance evaluations from work) to gauge the highest and usual levels of occupational and psychosocial functioning when less depressed. For example, even if the patient is in the middle of multiple struggles with his treatment team, a history from family and coworkers of the patient's typically satisfying stable work and personal relationships before a first episode of MDD in his mid-20s should lead a diagnostician to question the hypothesis of borderline PD.
4. systematically assess personality pathology with specific questions about onset, quality of relationships, mood fluctuations, and patterns of coping. In this respect, clinician-rated, semistructured interviews that inquire about specific symptoms and behaviors and associated impairment may be helpful as a supplement to global clinical impressions. This may be even more reliable than patient-rated questionnaires, which may be more sensitive but less specific.
Wednesday, May 30, 2007
Is it a chronic depression or personality disorder
Information Trapping, Real-Time research on the Web, book review
This excellent book by Tara Calishain is worth every penny. She is the autor of ResearchBuzz, a website with news about search engines, databases and other information collections.
When I walked in to this book I remembered her name from other excellent books so I had a look inside. Immediately I was seized by her examples of how you could use information trapping. In my case I just started a blog about depression and electroconvulsive therapy and related psychiatric subjects. I was wondering how to keep up with all the information on the web. For my job as a psychiatrist, teacher and researcher keeping up with all the new articles, websites, scientific papers is an every day struggle. Since I am very interested in getting as much information with the least effort for my work and now my blog this book seemed to me an excellent introduction in how to use the computer to gain these goals.
After the first introductory chapter about information trapping the book starts of with three other important chapters in which RSS feeds, page monitors and e-mail alerts are explained and how they can help you finding information in different ways.
These chapters are full of examples with their advantages and disadvantages. After explaining how you can find RSS feeds and which websites are of help she continues in explaining the two different types of feeds and more important which feed to use and when. This chapter ends with a description of the most important feed readers and their characteristics.
The next chapter about page monitors was new to me. The most important web based and client based page monitors are described including their costs. Chapter 4 is about e-mail alerts and useful e-mail alert services.
The next chapter is about building queries. This surprised me since I already tried all the services she explained before this chapter. Building a good query is usually the starting point after which you can decide to gather the result by RSS feed or e-mail alert. She explains this order of chapters by pointing out that you first need to know the tools of the information trapper's toolbox before you learn what to trap, where to trap it and when. To me that was a little confusing, already started working. Maybe in the next book a note in the first chapter about this order of chapters. The chapter about building queries is again very well written with important tips and tricks as can be expected from this authority on search engines and their use. Made me curious about her book about search engines.
Chapter 6 is an important chapter about "Who's linking to your site". Information about who's linking to your blog or website is internal information, external information is anything else. Knowing who is linking to your blog can enhance your content and services. Knowing what people think of your website can improve your writing and if know who is linking you can approach sites like these and ask them to link to your blog as well.This chapter discusses Google and Yahoo for finding out which inbound links are there to your blog. Technorati and the new kid Icerocket are discussed as well.
Chapter 7 is the core chapter of this book, it is also the largest chapter in comparison with the other chapters.It is all about trapping information from external sources, mainly search engines. This chapter desribes a lot of different kind of search engines.General search engines, news search engines, blog search engines, commercial search engines, trapping government information, monitoring international sites and some more. All engines are descrbed with how to build your query for that typical search engine , trapping information and possibilities. Kebberfegg is a special kind of power search tool, delivers a lot of information, is not yet very user friendly. It is developed by Researchbuzz. Chapter 8 is about trapping podcastst, video and images. Chapter 9 discloses the use of tags and conversations. A lot of information about flickr, del.icio.us and others. Chapter 10 addresses the issue of organizing all the information that is filling your inbox. This is an excellent howto for the use of Gmail. Chapter 11 has two examples in two case studies as well as how to get rid of information if it's not to your liking.Chapter 12 is a very useful chapter about organizing all the information. Organizing the information on a single computer with google or yahoo desktop. The organization tools in browsers and online organizing options. Some of the software is not vailable anymore but using the keywords bookmark managers or information organizers in Google or Yahoo will keep you up to date with the newest possibilities in this field. The last chapter is about publishing your information.
In conclusion it's a very good book, sometimes overwhelming with all the possibilities that are mentioned but on the other hand a lot of suggestions to try and see what fits your needs. So far the best book written about this subject. I tried to find the author on internet but she was hard to find. Finally after reading her book and using her advice a could finally trap a picture of her. I thought someone so famous as author who is hard to find on the internet besides her books, probably doesn't want to be found. So buy the book and go search for yourself!
Sunday, May 27, 2007
Give Your Mind A Workout, online cognitive therapy
Give Your Mind A Workout on Finding Optimism
This is an article on one of my favorite blogs. It is a review of a website. This site offers selfhelp with depression based on Cognitive Behavioral Therapy. This review descibes how this website works as well as the pros and cons.
Article in British Medical Journal about psychotherapy on the internet.
The reviewed website: http://www.moodgym.anu.edu.au/
Saturday, May 26, 2007
VNS for Depression “New”? No, But Don’t Tell Wired - World of Psychology
VNS for Depression “New”? No, But Don’t Tell Wired - World of Psychology
Nuanced comment in this blog about Vagus nerve stimulation (VNS). As it states the FDA has approved this treatment 2 years ago. It is mostly used with pharamcotherapy- and ECT resistant depressed patients.
Since recently the treatment is not covered as a treatment for Medicare recipients since may this year. The effectiveness of this treatment is not clear, we need some good research but the trouble is how can you design a trial with a control or even a placebo condition?
Thursday, May 24, 2007
Drugs in psychiatry, book review
This is a small book fits in your pocket nicely. It is written for medical students, junior doctors and general practitioners. It starts with a clear and concise introduction in psycho pharmacology. It explains pharmacokinetic and pharmacodynamic principles. Next drugs are discussed in the main categories of psychopharmacological drugs: antipsychotics, mood-stabilisers, tricyclic antidepressants, mono amine oxydase inhibitors, selective serotonin re uptake inhibitors, other antidepressants and a chapter for other drugs used in psychiatry such as benzodiazepines, drugs for Alzheimer disease, drugs used in substance dependence.
Every category starts with an introduction and a summary of the drugs. Next every drug is briefly descibed. Chemical structure, receptor binding, dose, laboratory testing, routine examinations and investigations and side effects are all mentioned for each drug if applicable. The descriptions are very up to date, nice book to have for introduction
Terrific introduction to blogging, book review
This is a wonderfull book about blogging. It is mainly an introduction. The book starts with some general information about blogging. Next it explains the different kind of blogs, were to host your blog or use a server side blog. It also guides you how to write a blog, how to earn money with your blog. The last part of the book consits of a list per category of the most important blogs. It is not a book to read from cover to cover. I used it for inspiration and examples as well as instruction book. What I did was read a chapter and followed the links it provided. The design of the book is very pretty, well done a pleasure to read and a excellent introduction.
It doesn't go into details how to maintain a blog or how to do research for your blog e.g. using e-mail alerts, website monitors etc.
Tuesday, May 22, 2007
Magnetic brain stimulator touted as treatment for depression - Engadget
Magnetic brain stimulator touted as treatment for depression - Engadget
As it said in the article this device is introduced during the American Psychiatric Association meeting in San Diego this year. It employs transcranial magnetic stimulation.The mistake in this article is the notion that previously you had to have anesthesia for it, they probably mean with ECT. There is no hard evidence that transcranial magnetic stimulation is actually working as a treatment for depression.
See also:about depression.com
Saturday, May 19, 2007
About To Have ECT? Fine, but Don't Watch It in the Movies: The Sorry Portrayal of ECT in Film
About To Have ECT? Fine, but Don't Watch It in the Movies: The Sorry Portrayal of ECT in Film
An excellent overview of ECT in movies. This article is a summary of an article by G. Walter an Australian psychiatriust. This summary is made by Prof. Max Fink from the U.S.A.
This summary discusses all movies since the beginning of the 20th century. Movies from Hollywood as well as European and Australian movies. It shortly describes the place of ECT in the movie. In this study by Walter et al. (2002) one third of medical students decreased their support for the treatment after being shown scenes from movies.
Friday, May 18, 2007
ScienceDaily: Mice On Prozac Help Scientists Find Better Depression Treatments
ScienceDaily: Mice On Prozac Help Scientists Find Better Depression Treatments
Scientist discovered in mice a probable new mechanism for developing new antidepressants. They suggest that chemicals that selectively activate the serotonin receptor 5-HT6 might represent a new class of antidepressants.
Thursday, May 17, 2007
ECT online, an english website about electroshock
ECT online, a very nice website. It's author has the view that ECT does have a place in modern medicine. Critical standpoints are also mentioned.
Sunday, May 13, 2007
Electroconvulsive therapy
This is a video on which a patients tells about her complaints during her depressive episode. It also shows some details on an ECT session.
One of the psyciatrists on this video is Prf. Dr. Max Fink, an authority on ECT.
He wrote many books. He visits european countries to help them establish good ECT services.
Thursday, May 10, 2007
Memory psychology for a general audience
This site from the University of Amsterdam has several memory tests. You can do as many as you like. The tests are in several different languages such as English, Italian, Japanese. Polish and Portuguese. The're different memory test e.g about your favorite movies, daily news test and a training course for your memory capabillities.
I tried the Daily News Memory Test, scored 78,6% of the man with same age and interest in news and education. What did you score on this test?
Visit: www.memory.uva.nl
Monday, May 7, 2007
ECT and beta blockers
In this recently published review we summarized the results of the placebo-controlled randomized clinical trials with beta-blocking adrenergic agents during electroconvulsive therapy (ECT), and review the effect on seizure duration and cardiovascular variables.
Esmolol can have a significant effect on seizure duration during ECT, it shortens seizure duration, and this effect is probably dose dependent.
Since the relation between seizure duration and efficacy of ECT is dependent on electrode placement it seems advisable to use bilateral electrode placement with patients with cardiovascular risk factors and use of esmolol during every session before seizure induction. One should take into account the possible negative effect of esmolol on seizure duration in these cases and adhere to the guidelines for ECT that advise at least 10 treatment sessions with bilateral ECT before one can conclude that ECT is not efficacious.
In the absence of cardiovascular risk factors but with prolonging hypertension or tachycardia during ECT sessions, esmolol also is again preferred. Labetalol is an alternative although, especially in high dose, the longer half-life can be considered as a disadvantage. Experiences with landiolol are limited but the short half-life, greater degree of cardioselectivity and more potency makes it a promising alternative.
Please read the article here: articles on ectweb wiki
Sunday, May 6, 2007
Antidepressants stimulate new nerve cells in adult monkeys, may have implications for humans
In rodents ECT stimulates nerve growth. The suggestion is that this growth of new nerve cells is necessary for recovery from depression. These brain changes were not a response to tissue damage due to the electroconvulsive therapy.
Antidepressants stimulate new nerve cells in adult monkeys, may have implications for humans
