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Classic psychiatry patients are rare; real-world patients tend to have overlapping features of multiple disorders. Striving for diagnostic certainty, and treatments aimed at tentative diagnoses, often fail these patients. In such cases, tolerating diagnostic ambiguity and "treating the symptoms" can sometimes be transformative. An important symptom, often undertreated in a diagnosis-based approach, is rumination. We present a case study of a woman who, after 20 years of treatment failure, achieved significant symptom relief when her primary complaint-"labored thinking"-was targeted specifically. However, because no seriously ill person has only 1 symptom, 6 clinicians from different subdisciplines will discuss the patient's other issues, ones that an overfocus on rumination might leave out., (© Copyright 2022 Physicians Postgraduate Press, Inc.)

Objective: This study evaluates the effectiveness of a telepsychiatry-based culturally sensitive collaborative treatment (T-CSCT) intervention to improve treatment outcomes for depressed Chinese American immigrants., Methods: Participants were Chinese Americans recruited from primary care settings from February 1, 2009, to July 31, 2012, with DSM-IV major depressive disorder (MDD) identified by the Mini-International Neuropsychiatric Interview. Eligible patients were randomized to receive either T-CSCT or treatment as usual (TAU) for 6 months. T-CSCT involves (1) cultural consultation via videoconference and (2) care management. The primary outcome measure was the 17-item Hamilton Depression Rating Scale (HDRS₁₇); positive response was defined as a ≥ 50% decrease in HDRS₁₇ score, and remission was defined as HDRS₁₇ score ≤ 7. Secondary outcome measures were the Clinical Global Impressions-Severity of Illness (CGI-S) and Improvement (CGI-I) scales and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Outcomes were compared using multivariate logistic regression and mixed-model for repeated measures methods., Results: Among participants (N = 190), 63% were female, and the mean (SD) age was 50 (14.5) years. They were randomized to T-CSCT (n = 97; 51%) or TAU (n = 93; 49%). Using multivariate logistic regression analyses, the odds of achieving response and remission were significantly greater for the T-CSCT group compared to the control group (odds ratio [OR] = 3.9 [95% CI, 1.9 to 7.8] and 4.4 [95% CI, 1.9 to 9.9], respectively). Multivariate general linear model analyses showed that patients in the T-CSCT group had significantly greater improvement over time in HDRS₁₇ (F4,95 = 4.59, P = .002), CGI-S (F4,95 = 4.22, P = .003), and CGI-I (F4,95 = 2.95, P = .02) scores., Conclusions: T-CSCT is effective in improving treatment outcomes of Chinese immigrants with MDD., Trial Registration: ClincialTrials.gov identifier: NCT00854542., (© Copyright 2016 Physicians Postgraduate Press, Inc.)

Objective: Bereavement-related depression is excluded from a diagnosis of major depressive episode (MDE) in DSM-IV, unless the syndrome is prolonged or complicated. The objective of this study is to assess the validity of the bereavement exclusion by comparing characteristics of bereavement-related episodes that are excluded from a diagnosis and bereavement-related episodes that qualify for a diagnosis (complicated bereavement) to MDE., Method: We used data from 2 waves of the National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093) to compare bereavement-excluded depression and complicated bereavement to MDE with respect to indicators of preexisting risk for psychopathology (antecedent indicators) and indicators of disorder severity measured at baseline and at the study's 3-year follow-up interview (consequent indicators). The primary outcome measure was the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV., Results: Compared to individuals with MDE, individuals with bereavement-excluded depression had lower risks of preexisting psychiatric disorders (eg, 0.44 lower odds of social phobia, P = .006), fewer depressive episodes (recurrence rate 0.37 times lower, P < .001), less psychosocial impairment (P < .001), a 0.18 times lower odds of seeking treatment (P < .001), and a lower risk of psychiatric disorders during a 3-year follow-up period. Unexpectedly, this same pattern of differences was observed between individuals with complicated bereavement and MDE., Conclusions: Despite the presence of a clinically significant depressive episode, bereavement-excluded depression is in many ways less indicative of psychopathology than MDE. However, complicated bereavement was more similar to bereavement-excluded depression than to MDE. We therefore question whether the DSM-IV criteria validly distinguish between nondisordered loss reactions (bereavement-excluded depression), pathological loss reactions (complicated bereavement), and nonloss-related MDE., (© Copyright 2012 Physicians Postgraduate Press, Inc.)