Depressive disorders and chronic comorbid disease states: a pharmacoepidemiological evaluation
- Authors: Kritiotis, Lia Costas
- Date: 2007
- Subjects: Depression, Mental , Child psychopathology , Adolescent psychopathology
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:10151 , http://hdl.handle.net/10948/653 , Depression, Mental , Child psychopathology , Adolescent psychopathology
- Description: The treatment of Depressive Disorders in patients with chronic comorbid disease states warrants careful consideration of the risk-benefit ratio pertaining to the pharmacokinetic and pharmacodynamic characteristics of the antidepressant being considered, against the physiological susceptibilities of the patient; potential drug-drug interactions and depressive symptoms. The primary aim of this study was to investigate the relationship between Depressive Disorders and the most frequently diagnosed chronic comorbid disease states in a depressed South African study population; and to comment on the appropriateness of antidepressants prescribed to these patients. This retrospective drug utilisation study consisted of two parts: the first part focused on the prevalence of the most frequently diagnosed chronic comorbidities in a depressed South African population (N = 21 171). The three most prevalent chronic comorbid disease states were Hypertension (52.87 percent), Lipid Disorders (20.40 percent) and Arthritis (16.70 percent). The second part of the study included an assessment of the antidepressants prescribed to depressed patients in 2004 (N = 6 150). Emphasis was placed on the suitability of antidepressants selected for depressed adult patients (18 years of age and older) with comorbid Hypertension, Lipid Disorders or Arthritis. SSRIs were prescribed most frequently to the depressed patients during 2004 (59.67 percent). SSRIs are the suggested first-line treatments for depressed patients with multiple chronic comorbid disease states. However, of the SSRIs, fluoxetine has the least favourable pharmacokinetic profile and was found to be the antidepressant prescribed most often. Amitriptyline, which was the TCA prescribed most frequently, produces the greatest degree of anticholinergic, sedative and hypotensive effects, relative to other agents in the same antidepressant class. Thus, it is not recommended as a first-line antidepressant, especially in depressed patients with comorbidities. This study identifies potential areas of intervention regarding antidepressant prescribing in depressed individuals with chronic comorbid disease states and offers recommendations to promote the selection of optimal, individualised drug treatment strategies for these patients.
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- Date Issued: 2007
Profile of paediatric psychosocial disorders in Frere Hospital and analysis of associated patterns of referrals
- Authors: Chukwuemeka, Gregory Adjuba
- Date: 2000
- Subjects: Child psychopathology , Frere Hospital
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:2949 , http://hdl.handle.net/10962/d1002458 , Child psychopathology , Frere Hospital
- Description: The profile of psychosocial disorders in children and the attendant patterns of referrals and health communication, were investigated within the context of a tertiary referral centre in the Eastern Cape Province. Literature on childhood disorders points to a high level of functional and substance related disorders in technologically developed countries of Europe and North America, in contrast to the developing countries of Asia and Africa, where the burden of infectious diseases and disorders of deprivation and lack still predominate in the profile of psychosocial disorders in children. In South Africa however, there is almost non-existent research on clinical psychosocial disorders profile and the research sets out to be an exploratory study in this area. A combination design was employed in which interviews and observations complemented a primarily quantitative descriptive cross sectional analysis of hospitalcase records. A pilot study was performed using an information gathering questionnaire and interviews, with findings subsequently explored in the main study. The International Classification of Diseases (ICD-10) (WHO, 1992) diagnostic categories were used to create a profile of all ailments in the paediatric unit. Psychosocial disorders both in terms of aetiology and illness course, can be viewed from the perspective of socialadjustment and functioning (in which there is a potential role of social factors as provoking, causal or modifying factors) (Williams &Clare, 1979); and the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) (American Psychiatric Association,1994) criteria was used to create the profile of these disorders in the paediatric unit at Frere Hospital which accounted for 45% of the ailments managed in one year. The derived profile is a picture in between the profile found in technologically advanced countries, and developing countries. While the infection burden and malnutrition appear to be readily contained or curtailed, there appears to be a serious problem with access to health care services which manifest especially at the level of perinatal events, with resultant high level of hypoxic brain damage and consequently mental retardation and varying levels of impairment or disability. These medical consequences in turn are fundamentally psychosocial, requiring psychosocial care with heavy reliance on strategic communication and referrals. The referrals in respect of psychosocial disorders are mainly at primary care level revolving around local health care clinics, private clinics, special schools and rehabilitation centres.
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- Date Issued: 2000