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Treatment of Affective Disorders

Treatment of Affective Disorders. Thomas G. Bowers, Ph.D. Penn State Harrisburg. Meta-analysis. A method to summarize and standardize the results of a large number of studies ES = (Mtx - Mcont)/SD Distributed as a Z score Mean = 0, SD = 1.0. Results . Steinbrueck, Maxwell & Howard (1983)

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Treatment of Affective Disorders

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  1. Treatment of Affective Disorders Thomas G. Bowers, Ph.D. Penn State Harrisburg

  2. Meta-analysis • A method to summarize and standardize the results of a large number of studies • ES = (Mtx - Mcont)/SD • Distributed as a Z score • Mean = 0, SD = 1.0

  3. Results • Steinbrueck, Maxwell & Howard (1983) • Reviewed 56 controlled studies, with dependent measures

  4. Results • Some obtained ES • Chemotherapy ES = .61 • Psychotherapy ES = 1.22 • Nature of Studies • Generally unipolar depression • Few “combined” studies

  5. Types of Control Conditions

  6. Type of Blinding Procedures

  7. Nature of Depression Treated

  8. Duration of Treatment

  9. Other Research Summaries • Smith et al. (1980) • Psychotherapy for depression ES = 1.09 • Chemotherapy for depression ES = .37

  10. Other Research Summaries • Some specific studies - Psychotherapy versus drug therapy • McLean and Hakistian (1979) • Shaw (1977) • Rush, Beck, Kovacs and Hollan (1977) • Hollan et al. (1977)

  11. Other Research Summaries • NIMH (1986) Still, some subjects benefit from chemotherapy

  12. Other Diagnostic Influences • Misdiagnosis common • Follow-up of 100 subjects “neurotic depression” • 18% found to be bipolar on 3-4 year follow-up

  13. Other Diagnostic Influences • Robins & Guze in 1972 • Ten year study • Less severe “neurotic” depression • Treated with antidepressants • Suffered a higher mortality than more severely depressed outpatients

  14. Other Diagnostic Influences • Misdiagnosis • Side Effects • Resperpine • antihypertensives • cardiac drugs (propranolol) • Birth control pills • Steroids

  15. Other Diagnostic Influences • Misdiagnosis • Medical problems undiagnosed in 50% of mental patients • Koranyi (1972)

  16. Other Diagnostic Influences • Misdiagnosis • Specific Problems • Thyroid, adrenal or parathyroid dysfunction • anemia • some viral infections • vitamin deficiencies • hysterectomy • epilepsy • arthritis

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