e-space Collection:

Management of anxiety and depression in patients with COPD

Sun, 01 Jun 2008 00:00:00 GMT

Title: Management of anxiety and depression in patients with COPD Authors: Yohannes, Abebaw M. Abstract: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and disability in the elderly. The two common psychiatric conditions in COPD patients are anxiety and depression. This article reviews the level of evidence available on the management of anxiety and depression in patients with COPD. Depression and anxiety are associated with a greater level of physical disability, impaired quality of life, increased usage of healthcare services, noncompliance with medical treatment and elevated risk of mortality. The findings of the available literature suggest that antidepressant drug therapy, pulmonary rehabilitation, cognitive behavioral therapy, education and self-management are inconclusive in the treatment of anxiety and depression. This review also highlights our current understanding of the etiology of anxiety and depression, and assessment tools and implications for treatment. The collaborative care model (CCM) has been shown to be beneficial in the treatment of depression and acceptable for older patients in primary-care settings. It is worth investigating the benefits of CCM in patients with COPD. Healthcare providers should invest more time and resources into staff training to overcome barriers in the detection and treatment of depression and anxiety in order to improve the quality of life and survival in patients with COPD. Expected future considerations and developments in this field are also discussed. Description: Full-text of this article is not available in this e-prints service. This article was originally published in Expert reviews in respiratory medicine, published by and copyright Expert Reviews.

Health behaviour, depression and religiosity in older patients admitted to intermediate care

Tue, 01 Jul 2008 00:00:00 GMT

Title: Health behaviour, depression and religiosity in older patients admitted to intermediate care Authors: Yohannes, Abebaw M.; Koenig, Harold G.; Baldwin, Robert C.; Connolly, Martin J. Abstract: OBJECTIVE: To examine health behaviour, severity of depression, gender differences and religiosity in older patients admitted to intermediate care for further rehabilitation. DESIGN: Cross-sectional survey. PARTICIPANTS: A research physiotherapist interviewed 173 older patients (113 female), 60 and older consecutively admitted to intermediate care for rehabilitation, usually after acute care. MEASUREMENTS: Religiosity was measured using the Duke University Religion Index, depressive and anxiety symptoms using the Hospital Anxiety Depression Scale, and severity of depression measured by the Montgomery Asberg Depression Rating Scale. Physical disability was assessed by the Nottingham Extended Activities of Daily Living Scale and quality of life measured by the SF-36 questionnaire. RESULTS: After controlling for other factors using multiple regression, religious attendance was associated with positive general health perception (t = 1.9, p = 0.05), and inversely associated with number of pack years smoked (t = -2.05, p = 0.04) and severity of illness (Charlson Index), [t = -2.05, p = 0.04]. Intrinsic religious activity was associated with older age (t = 3.06, p < 0.003), female gender (t = 2.52, p = 0. 01), living situation (t = -2.17, p < 0.03) and with less severe depression (t = -2.43, p = 0.01). CONCLUSION: In older patients with chronic diseases in intermediate care, religious attendance was associated with positive perceptions of health, less severe illness, and fewer pack years. Intrinsic religious activities were associated with less severe depression and lower likelihood of living alone. Copyright (c) 2008 John Wiley & Sons, Ltd. Description: Yohannes, A.M. et al. Health behaviour, depression and religiosity in older patients admitted to intermediate care. International Journal of Geriatric Psychiatry, 2008, vol. 23, no. 7, 735-740. Published by and copyright John Wiley and Sons. The definitive version of this article is available from http://www3.interscience.wiley.com/journal/117884142/abstract

Mortality predictors in disabling chronic obstructive pulmonary disease in old age

Fri, 01 Mar 2002 00:00:00 GMT

Title: Mortality predictors in disabling chronic obstructive pulmonary disease in old age Authors: Yohannes, Abebaw M.; Baldwin, Robert C.; Connolly, Martin J. Abstract: OBJECTIVE: prospectively to evaluate predictors of mortality in elderly patients with disabling chronic obstructive pulmonary disease. METHODS: 137 (69 men) outpatients, aged 60-89 (mean 73) years with symptomatic disabling chronic obstructive pulmonary disease. We collected baseline demographic and physiological data. Subjects completed the Manchester Respiratory Activities of Daily Living Questionnaire, the Brief Assessment Schedule Depression Cards a screening questionnaire for depression, the Breathing Problems Questionnaire measuring quality of life, and the Montgomery Asberg Depression Rating Scale measuring severity of depression. All subjects were followed prospectively and survival and mortality data were confirmed by contacting general practitioners and scrutinising hospital notes at 30 months. RESULTS: the mean (standard deviation) of one second forced expiratory volume was 0.89 (0.3) litres. At 30 months, 44 patients (21 men, aged 61-89 [mean 75] years: 32% of the total) had died. Mean (standard deviation) baseline one second forced expiratory volume of those dying was 0.71 (0.2) litres. On logistic regression analysis, predictors of mortality were: Manchester Respiratory Activities Of Daily Living Questionnaire score (odds ratio=0.88, 95% confidence interval=0.80-0.97); pre-bronchodilator one second forced expiratory volume (odds ratio=0.04, confidence interval=0.005-0.32); body mass index (odds ratio=0.87, confidence interval=0.79-0.97); and long term oxygen therapy (odds ratio=3.17, confidence interval=1.04-8.36). Current smoking status, pack-years smoked, depression scores, quality of life scores, co-morbid diseases and social class did not predict mortality. CONCLUSION: disability, use of long-term oxygen therapy, pre-bronchodilator lung function and body-mass index were independent predictors of mortality in elderly patients with severe chronic obstructive pulmonary disease. Description: This metadata relates to an article accepted for publication in [journal title] following peer review. The definitive publisher-authenticated version, Yohannes, A.M et al. Mortality predictors in disabling chronic obstructive pulmonary disease in old age, Age and ageing, 2002, vol. 31, no. 2, pp. 137-140 is available online at: http://ageing.oxfordjournals.org/cgi/content/abstract/31/2/137

Prevalence of depression and anxiety symptoms in elderly patients admitted in post-acute intermediate care

Tue, 06 May 2008 00:00:00 GMT

Title: Prevalence of depression and anxiety symptoms in elderly patients admitted in post-acute intermediate care Authors: Yohannes, Abebaw M.; Baldwin, Robert C.; Connolly, Martin J. Abstract: OBJECTIVES: Depression and anxiety symptoms are common in medically ill older patients. We investigated the prevalence and predictors of depression and anxiety symptoms in older patients admitted for further rehabilitation in post acute intermediate care. DESIGN: Observational cohort study. SETTING: An intermediate care unit, North West of England. PARTICIPANTS: One hundred and seventy-three older patients (60 male), aged mean (SD) 80 (8.1) years, referred for further rehabilitation to intermediate care. MEASUREMENTS: Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale, and severity of depression examined by the Montgomery Asberg Depression Rating Scale. Physical disability was assessed by the Nottingham Extended ADL Scale and quality of life by the SF-36. RESULTS: Sixty-five patients (38%) were identified with depressive symptoms, 29 (17%) with clinical depression, 73 (43%) with anxiety symptoms, and 43 (25%) with clinical anxiety. 15 (35%) of the latter did not have elevated depression scores (9% of the sample). Of those with clinical depression, 14 (48%) were mildly depressed and 15 (52%) moderately depressed. Longer stay in the unit was predicted by severity of depression, physical disability, low cognition and living alone (total adjusted R(2) = 0.24). CONCLUSIONS: Clinical depression and anxiety are common in older patients admitted in intermediate care. Anxiety is often but not invariably secondary to depression and both should be screened for. Depression is an important modifiable factor affecting length of stay. The benefits of structured management programmes for anxiety and depression in patients admitted in intermediate care are worthy of evaluation. Copyright (c) 2008 John Wiley & Sons, Ltd. Description: Full-text of this article is not available in this e-prints service. This article was originally published following peer-review in the International journal of geriatric psychiatry, published by and copyright John Wiley and Sons Ltd.