Signs and symptoms An lithograph of a woman diagnosed with depression Major depression significantly affects a person's family and personal relationships, work or school life, sleeping and eating habits, and general health. Depressed people may be preoccupied with, or ruminate over, thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness, hopelessness, and self-hatred.
Wijkstra and colleagues 43 reported on a double-blind, randomized controlled study of hospitalized patients aged 18—65 years with psychotic depression at 8 sites in the Netherlands. Dosages used were the following: For the primary outcome measure of response, the venlafaxine-quetiapine combination was statistically significantly more effective than venlafaxine; there were no statistically significant differences in the response rates between venlafaxine-quetiapine and imipramine or between imipramine and venlafaxine.
The authors concluded that the combination of venlafaxine and quetiapine was more effective than venlafaxine alone on the primary outcome measure response and was well tolerated. The largest study to date, the NIMH Study of the Pharmacotherapy of Psychotic Depression STOP-PD reported results that indicated that the combination of an antidepressant and an atypical antipsychotic medication was more efficacious than monotherapy with the atypical antipsychotic.
Combination therapy was comparably superior in both younger OR, 1. Overall, tolerability was comparable across age groups. Both age groups had significant increases in cholesterol and triglyceride concentrations, but statistically significant increases in glucose occurred only in younger adults.
Younger adults gained significantly more weight than older subjects mean [SD], 6. Although the STOP-PD study did not include a sertraline monotherapy arm, a previous open-label study 50 reported that patients with major depression with psychotic features had a markedly lower response rate to mg of sertraline per day for 8 weeks than patients with nonpsychotic depression.
In 2 randomized, placebo-controlled trials, 45 a combination of the selective serotonin reuptake inhibitor fluoxetine plus the second-generation antipsychotic olanzapine was compared with olanzapine monotherapy or placebo in hospitalized patients with psychotic depression.
These 2 studies are the largest randomized controlled trials for the treatment of psychotic depression that included a placebo arm.
In both studies, patients were randomized to placebo, olanzapine mean doses: The first trial showed a reduction in HAM-D score that was statistically greater in the combination group than in the olanzapine monotherapy group or the placebo group throughout the 8 weeks.
The second trial failed to reveal any statistically significant differences between the 3 treatment groups except for the HAM-D score in the combination group that was statistically lower than the placebo group at the end of week 1.
However, there were several aspects of the study design that were biased against the combination of fluoxetine and olanzapine. First, the study was powered to show a difference between olanzapine monotherapy and placebo and not the combination therapy, resulting in a small sample size in the combination group, which limited statistical power.
Unipolar major depression with psychotic features is a severe subtype of unipolar major depression (major depressive disorder). The psychotic symptoms are delusions and/or hallucinations that are frequently consistent with depressive themes of guilt and worthlessness [ 2 ]. Major Depressive Disorder without Psychotic Features- A Case Report. referred case study for major depressive disorder will be the scenario of a 30 year old woman who attempted suicide by Keywords Major depressive disorder, Psychotic features, Suicidal ideation 1. Introduction An episode of major depression includes five or more. Postpartum mood disorder (major depressive or manic) episodes with psychotic features appear to occur in from 1 in to 1 in deliveries. The risk is particularly increased for women with prior postpartum mood episodes but is also elevated for those with a prior history of a depressive or bipolar disorder or a family history of bipolar.
It is plausible that if higher doses of fluoxetine had been used, it could have produced greater reductions in depressive symptoms or higher response or remission rates. Older Medications Amitriptyline Plus Haloperidol. No significant differences were found in rates of response and remission between the 2 groups.
A possible explanation for the fact that no differences were found between the 2 groups is, as the authors themselves point out, that a high dosage of trimipramine was compared with a lower dosage of amitriptyline combined with haloperidol.
Mulsant and colleagues 47 compared in a double-blind trial the efficacy of nortriptyline plus perphenazine vs nortriptyline plus placebo in a group of older inpatients who presented with a major depressive episode with psychotic features. Fifty-two patients mean age: After patients had received nortriptyline for at least 4 weeks combined with either perphenazine or placebo for at least 2 weeks median: Anton and Burch 48 conducted a randomized, double-blind investigation that explored whether the efficacy of combination amitriptyline plus perphenazine could be matched by monotherapy with amoxapine, an antidepressant derivative of the antipsychotic medication loxapine, with dopamine antagonist activity.
Extrapyramidal symptoms were significantly more frequent in the amitriptyline plus perphenazine group than in the amoxapine treated patients. Spiker and colleagues 49 compared the combination of amitriptyline and perphenazine with amitriptyline alone and perphenazine alone in the treatment of patients with psychotic depression over a 5-week period.The purpose of this study was to determine the best practice for a client diagnosed with major depressive disorder whom was referred for treatment at a community mental health facility.
Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working.
Case Study: Major Depressive Disorder Case Study: Psychotic Features Iris: My wife, Iris, changed very suddenly after our daughter was born. She began to withdraw Case Studies 2 Case Study: Bipolar Disorder Justine: I have to say, I sort of loved my manic episode at the time, but I have come to realize that the results can be.
Start studying Major Depressive Disorder Case Study. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Leanne: A Case Study in Major Depressive Disorder, Recurrent Leanne came to the office because she stated that her depression had worsened in recent months and that she was feeling nervous and panicky almost daily.
Major depressive disorder (MDD) with psychotic features is a distinct type of depressive illness in which mood disturbance is accompanied by either delusions, hallucinations, or both. Psychotic features occur in nearly % of patients who are diagnosed with MDD.
1 The prevalence of MDD with psychotic features increases with age.