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Update in Psychiatry
- Robert K. Schneider, MD; and
- James L. Levenson, MD
- From Medical College of Virginia Campus of Virginia Commonwealth University, Richmond, Virginia.
2001–2002 Series: Update Sessions from ACP–ASIM's 2001 Annual Session
Margaret Ring Gillock, Editor/David A. Cramer, MD, Co-Editor/Paul T. Kefalides, MD, Co-Editor
Annals published its first Update in Psychiatry on 5 October 1999 (1) and the first Update in Addiction Medicine on 6 March 2001 (2). This Update is the first Update in Psychiatry presented at an Annual Session of the American College of Physicians–American Society of Internal Medicine. We see these Updates as steps toward creating a knowledge base of current evidence in psychiatry for internists that is on par with the knowledge bases of other medical specialties. This Update is broadly divided into the following categories: mood disorders, anxiety disorders, geropsychiatry, and new therapeutics.
Mood Disorders
Mood (affective) disorders often present in relapsing, remitting, and chronic forms or in combination with each other (for example, dysthymia and major depression are called “double depression”). Depressive disorders can also present with somatic symptoms as well as psychological symptoms. The reports summarized in this section address treatment of chronic depression, the risk for a recurrence of major depression, and physical symptoms and depression.
Treatment of Chronic Depression with a Combination of Medication and Psychotherapy Is Superior to Either Treatment Alone
Chronic depression is a significant source of impairment. At least 3% of the U.S. population has a chronic form of depression. Treatments for chronic depression have been varied, and few controlled clinical trials have examined treatment effects of psychotherapy or medications.
In a multicenter clinical trial, Keller and colleagues randomly assigned adults 18 to 75 years of age to receive nefazodone alone (not to exceed 600 mg/d), cognitive–behavioral psychotherapy alone, or a combination of the two therapies. The authors defined chronic depressive disorder as the presence of severe depressive symptoms for at least 2 years. The score on the Hamilton Rating Scale for Depression (HRSD) was the primary outcome measured.
The overall response rate (both remission and satisfactory response) was …
