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Recent studies suggest that depression is associated with somatic pain. Despite growing research interest in the topic, the effects of depression-related somatic pain remain unclear. The present study sought to investigate the relationships between depression-related somatic pain, treatment satisfaction, and functions of daily living, and to compare them with the relationships between these factors and mental health measures.
We administered an Internet-based survey to 663 patients with depression in Japan, including questions about pain symptoms, mental health, functions of daily living, and dissatisfaction with depression treatment. The SF-8 questionnaire was used to assess functions of daily living. We conducted a multiple linear regression analysis to examine the associations between depression-related somatic pain, functions of daily living and treatment satisfaction, and between mental health measures, somatic pain and functions of daily living.
An increase per unit in the number of pain symptoms was associated with a 1.04-unit decrease in physical functioning score (P < 0.001), a 0.67-unit decrease in the role functioning-physical score (P < 0.001), and a 0.53-unit decrease in role functioning-emotional score (P = 0.0010). Meanwhile, we found no significant association between the number of pain symptoms and patients’ satisfaction with treatment, and no significant association between the number of pain symptoms and social functioning.
These results suggest that even when patients report satisfaction with their treatment, they may be suffering from reduced physical functioning and role functioning. These impairments may escape clinical recognition when clinicians or patients fail to discuss pain symptoms.
There is increasing recognition that pain often coexists with depression. the current survey was undertaken to ascertain patients’ and clinicians’ perceptions of pain as a physical symptom associated with depression.
Web-based surveys were undertaken for patients with depression, and for physicians treating patients with depression (psychiatrists, psychosomatic physicians, general internists).
848 patients aged 20–59 years entered the main survey, of whom 663 returned the completed survey (78.2%). of the respondents, 424 (64.0%) experienced at least one painful symptom, with almost three-quarters (72.1%) reporting that the pain affected mental symptoms and 68.6% indicating that it prevented recovery from depression itself. Among 337 patients who discussed their painful symptoms with their physician, 52.5% initiated the discussion.
456 physicians completed the physician survey. When asked about the influence of pain associated with depression, 61.7% of physicians indicated that they ask their patients about pain during a consultation, and 79.9% considered that painful symptoms might disturb the patients’ daily life and 52.8% felt that they would delay recovery from depression.
The survey provides further evidence of the association between depression and pain, highlighting the fact that pain is prevalent in this patient population. Increased patient and physician awareness of pain in association with depression and improved doctor-patient communication, enabling patients to discuss painful symptoms with their physicians, and vice-versa, should lead to better overall management and treatment strategies.
Risperidone is a common psychopharmacological treatment for irritability in autism spectrum disorder (ASD). It is not well-established how effective risperidone is across the initial symptom severity range. This study aims to examine the influence of baseline severity on the efficacy of risperidone in the treatment of ASD.
Participants were from the NIMH funded RUPP multisite, randomized, double-blind trial that compared risperidone to placebo to treat autistic disorder with severe tantrums, aggression, or self-injury. Participants were aged 5 to 17, and randomly assigned to risperidone (n = 49) or placebo (n = 52). Baseline and change scores were computed with the Aberrant Behavior Checklist (ABC) parent assessed scales with irritability as the primary outcome, as well as the clinician assessed ABC Irritability subscale, and Clinical Global Impression Scale.
The relationship between baseline severity and change scores for the risperdone and placebo groups was examined with eight competing three-level mixed-effects models for repeated measure models. Significant (P < 0.01) interactions between treatment and baseline severity were observed for parent ABC ratings of irritability and lethargy only. Greater magnitudes of the differences between risperidone and placebo were observed from moderate to very severe baseline severity on irritability and lethargy. Initial severity values over approximately 30 had a strong effect on symptom change [irritability: effect size (ES) = 1.9, number needed to treat (NNT) = 2, lethargy ES = 0.9, NNT = 5].
Parents may expect benefits of risperidone on irritability and lethargy with moderate to severe symptoms of ASD.