1
|
Johnco CJ, Zagic D, Rapee RM, Kangas M, Wuthrich VM. Long-term remission and relapse of anxiety and depression in older adults after Cognitive Behavioural Therapy (CBT): A 10-year follow-up of a randomised controlled trial. J Affect Disord 2024; 358:440-448. [PMID: 38723682 DOI: 10.1016/j.jad.2024.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 05/03/2024] [Accepted: 05/04/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND This study examined the long-term durability of cognitive behaviour therapy (CBT) for older adults with comorbid anxiety and depression 10 years after treatment, in comparison to an active control group. METHOD Participants from a randomised controlled trial for older adults with comorbid anxiety and depression (Wuthrich et al., 2016) were re-contacted. Participants had received either group CBT or an active control treatment (Discussion Group). The final sample (N = 54; Aged 70-84, Mage = 76.07, SD = 3.83; 59 % of the eligible original sample) completed a diagnostic interview, cognitive assessment and self-report measures of symptoms and quality of life. RESULTS CBT was associated with significantly improved long-term (10-year) efficacy for reducing anxiety and depression in older adults compared to the Discussion group. Effects included higher rates of remission (58 % remission of all diagnoses vs 27 %, 88 % of all depressive diagnoses vs 54 %, 63 % of all anxiety diagnoses vs 35 %, 67 % of primary diagnosis vs 42 %), lower rates of relapse (25-31 % vs 50-78 %) and lower rates of chronic treatment-resistance (8 % primary disorder vs 39 %, 21 % any disorder vs 58 %). Participants who showed an acute treatment response at post-treatment were 7-9 times more likely to be in remission after 10 years than those with residual symptoms. LIMITATIONS Results may not generalise to those who do not complete CBT, and the time trajectory of symptom change is unclear. CONCLUSIONS Long-term improvements in symptoms are specific to CBT. Results provide compelling evidence for CBT as an effective and durable treatment for late-life anxiety and depression.
Collapse
Affiliation(s)
- Carly J Johnco
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney, Australia; School of Psychological Sciences, Macquarie University, Sydney, Australia.
| | - Dino Zagic
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney, Australia; School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Ronald M Rapee
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney, Australia; School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Maria Kangas
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney, Australia; School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Viviana M Wuthrich
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney, Australia; School of Psychological Sciences, Macquarie University, Sydney, Australia
| |
Collapse
|
2
|
Kryza-Lacombe M, Kassel MT, Insel PS, Rhodes E, Bickford D, Burns E, Butters MA, Tosun D, Aisen P, Raman R, Landau S, Saykin AJ, Toga AW, Jack CR, Koeppe R, Weiner MW, Nelson C, Mackin RS. Anxiety in late-life depression: Associations with brain volume, amyloid beta, white matter lesions, cognition, and functional ability. Int Psychogeriatr 2024:1-12. [PMID: 38268483 DOI: 10.1017/s1041610224000012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVES Late-life depression (LLD) is common and frequently co-occurs with neurodegenerative diseases of aging. Little is known about how heterogeneity within LLD relates to factors typically associated with neurodegeneration. Varying levels of anxiety are one source of heterogeneity in LLD. We examined associations between anxiety symptom severity and factors associated with neurodegeneration, including regional brain volumes, amyloid beta (Aβ) deposition, white matter disease, cognitive dysfunction, and functional ability in LLD. PARTICIPANTS AND MEASUREMENTS Older adults with major depression (N = 121, Ages 65-91) were evaluated for anxiety severity and the following: brain volume (orbitofrontal cortex [OFC], insula), cortical Aβ standardized uptake value ratio (SUVR), white matter hyperintensity (WMH) volume, global cognition, and functional ability. Separate linear regression analyses adjusting for age, sex, and concurrent depression severity were conducted to examine associations between anxiety and each of these factors. A global regression analysis was then conducted to examine the relative associations of these variables with anxiety severity. RESULTS Greater anxiety severity was associated with lower OFC volume (β = -68.25, t = -2.18, p = .031) and greater cognitive dysfunction (β = 0.23, t = 2.46, p = .016). Anxiety severity was not associated with insula volume, Aβ SUVR, WMH, or functional ability. When examining the relative associations of cognitive functioning and OFC volume with anxiety in a global model, cognitive dysfunction (β = 0.24, t = 2.62, p = .010), but not OFC volume, remained significantly associated with anxiety. CONCLUSIONS Among multiple factors typically associated with neurodegeneration, cognitive dysfunction stands out as a key factor associated with anxiety severity in LLD which has implications for cognitive and psychiatric interventions.
Collapse
Affiliation(s)
- Maria Kryza-Lacombe
- Mental Illness Research Education and Clinical Centers, Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Michelle T Kassel
- Mental Illness Research Education and Clinical Centers, Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Philip S Insel
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Emma Rhodes
- Mental Illness Research Education and Clinical Centers, Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - David Bickford
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Emily Burns
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Meryl A Butters
- Department of Psychiatry Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Duygu Tosun
- Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Paul Aisen
- University of Southern California, Los Angeles, CA, USA
- Keck School of Medicine, Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | - Rema Raman
- University of Southern California, Los Angeles, CA, USA
- Keck School of Medicine, Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | - Susan Landau
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences and the Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Arthur W Toga
- Laboratory of Neuro Imaging, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Robert Koeppe
- Department of Radiology, University of Michigan, Ann Arbor, USA
| | - Michael W Weiner
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Craig Nelson
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - R Scott Mackin
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- Veterans Affairs Medical Center, San Francisco, CA, USA
| |
Collapse
|
3
|
Wu J, Qiu L, Xiong W, Shen Y, Li J, Wu J, Zhou Q. COVID-19 anxiety and related factors amid adjusted epidemic prevention policies: a cross-sectional study on patients with late-life depression in China. BMJ Open 2023; 13:e072725. [PMID: 38000824 PMCID: PMC10680000 DOI: 10.1136/bmjopen-2023-072725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES To explore the prevalence and associated factors of COVID-19 anxiety in patients with late-life depression (LLD) during the adjustment of epidemic prevention policies in China. DESIGN Cross-sectional study. SETTING The data analysed in this study were collected from seven regions in China between November 2022 and January 2023. PARTICIPANTS A total of 1205 patients with LLD (aged 60-78 years) participated in the survey. They completed a social demographic assessment and the Chinese version of the five-point Coronavirus Anxiety Scale (CAS). PRIMARY OUTCOME MEASURES The primary outcome was the anxiety level of the participants. Patients were categorised into two groups based on their anxiety levels, one with anxiety and one without, according to CAS scores. RESULTS The prevalence of COVID-19 anxiety in depressed older adults was 47.3%. Regression analysis revealed that the average COVID-19 anxiety score was significantly higher among females (AOR: 2.177, 95% CI 1.201 to 3.947), widowed individuals (AOR: 3.015, 95% CI 1.379 to 6.591), patients residing at a distance from healthcare facilities (AOR: 3.765, 95% CI 1.906 to 7.438), and those who frequently experienced worry (AOR: 1.984, 95% CI 1.111 to 3.543). Conversely, the anxiety score was significantly lower among divorced individuals (AOR: 0.491, 95% CI 0.245 to 0.988), those aged 70 years and above (AOR: 0.117, 95% CI 0.064 to 0.213), patients without difficulty obtaining medication (AOR: 0.027, 95% CI 0.007 to 0.097), those living with family members (AOR: 0.080, 95% CI 0.022 to 0.282) or in nursing homes compared with those living alone (AOR: 0.019, 95% CI 0.004 to 0.087). CONCLUSION Women with LLD who are widowed, live far from healthcare facilities, and are prone to excessive worry are more likely to experience anxiety. It is advisable to implement appropriate preventive measures and provide psychosocial support programmes for this vulnerable group during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Jianhong Wu
- Department of Pharmacy, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, China
| | - Linghe Qiu
- Department of General Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, China
| | - Wendian Xiong
- School of Life Sciences and Health Engineering, Jiangnan University, Wuxi, Jiangsu, China
| | - Yuan Shen
- Department of Pharmacy, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, China
| | - Jun Li
- Department of Pharmacy, Nanjing First Hospital, Nangjing, Jiangsu, China
| | - Ju Wu
- Department of Pharmacy, Jiangsu Provincial Rongjun Hospital, Wuxi, Jiangsu, China
| | - Qin Zhou
- Department of Pharmacy, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, China
| |
Collapse
|
4
|
Stahl ST, Kincman J, Karp JF, Anne Gebara M. Psychosocial interventions to improve adherence in depressed and anxious older adults prescribed antidepressant pharmacotherapy: a scoping review. Ther Adv Psychopharmacol 2023; 13:20451253231212322. [PMID: 38022838 PMCID: PMC10664420 DOI: 10.1177/20451253231212322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Medication nonadherence in depressed and anxious older adults is prevalent and associated with non-response to antidepressant pharmacotherapy. Evidence-based options to improve medication adherence are limited in this population. To review the state of the literature on the types and efficacy of psychosocial interventions for improving antidepressant pharmacotherapy adherence in depressed and anxious older adults. We conducted a scoping review according to PRISMA-ScR guidelines. PubMed/Medline and article references starting in 1980 up to 28 February 2023 were reviewed. Of the 710 records screened, 4 psychosocial interventions were included in the review. All studies included depressed older adults, and none included anxious older adults. Samples included racial and ethnic minorities and were primarily women. The psychosocial interventions consisted mainly of psychoeducation with usual care as the control comparison. Measures of antidepressant adherence included self-reported adherence or pill counting. Three of the four randomized controlled trials improved medication adherence rates and reduced depression symptom burden. Effective interventions exist for improving antidepressant medication adherence in depressed older adults. Improved adherence can reduce depression symptom burden. The lack of interventions for anxious older adults highlights the need to develop and deliver interventions for anxious older adults prescribed antidepressant pharmacotherapy.
Collapse
Affiliation(s)
- Sarah T. Stahl
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA, 15213, USA
| | - Joelle Kincman
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jordan F. Karp
- Department of Psychiatry, University of Arizona, Tucson AZ, USA
| | - Marie Anne Gebara
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
5
|
Kim J, Kim JJ, Seok JH, Kim E, Park JY, Kim HE, Oh J. Association and interaction between clinician-rated measures of depression and anxiety with heart rate variability in elderly patients with psychiatric disorders. Heliyon 2023; 9:e20740. [PMID: 37860509 PMCID: PMC10582342 DOI: 10.1016/j.heliyon.2023.e20740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023] Open
Abstract
Background Older adults are vulnerable to comorbid depression and anxiety symptoms; however, these conditions are widely underrecognized and often untreated. Understanding their combined manifestation using objective measurements, such as clinician-rated scales and heart rate variability (HRV), can help refine the diagnosis and select a treatment strategy for geriatric patients. Methods This study included patients over 65 years who were mainly diagnosed with either category of depressive or anxiety disorders from the psychiatric outpatient clinic in a university hospital. A total of 114 patients met eligibility with a completed collection of electrocardiograms, the Hamilton Depression Rating Scale (HDRS; clinician-rated depression), and the Hamilton Anxiety Scale (HAS; clinician-rated anxiety) to assess the severity of symptoms. Both main and interaction effects between HDRS and HAS on HRV parameters were examined. Results Significant interaction effects between clinician-rated depression and anxiety (HDRS × HAS) on HRV reduction in frequency parameters (i.e., nuLF, nuHF, LF/HF ratio) were found, which consistently indicated autonomic nervous system dysregulation. Findings imply that HRV could reflect synergistic effects of comorbid depressive and anxiety symptoms, perhaps due to the amplification of individual symptoms in geriatric patients. Conclusions The results imply that using objective measurements can improve diagnostic accuracy, particularly in geriatric patients with comorbid status, and the normalization of the autonomic nervous system might be a candidate target for prevention and treatment.
Collapse
Affiliation(s)
- Joonbeom Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Interdisciplinary Graduate Program in Social Welfare Policy, Yonsei University, Seoul, Republic of Korea
| | - Jae-Jin Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Ho Seok
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eunjoo Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Park
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Hesun Erin Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jooyoung Oh
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
6
|
Pedroso-Chaparro MDS, Cabrera I, Márquez-González M, Ribeiro Ó, Losada-Baltar A. Comorbid Depressive and Anxiety Symptomatology in Older Adults: The Role of Aging Self-Stereotypes, Loneliness, and Feelings of Guilt Associated with Self-Perception as a Burden. THE SPANISH JOURNAL OF PSYCHOLOGY 2023; 26:e26. [PMID: 37772769 DOI: 10.1017/sjp.2023.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
The main objective of this study was to analyze the differences between older adults' symptom profiles (subclinical, anxiety, depressive, and comorbid) in negative aging self-stereotypes, loneliness, and feelings of guilt associated with self-perception as a burden. Participants were 310 community-dwelling people aged 60 years and over. The sample was grouped into four symptom profiles of older adults: anxiety, depressive, comorbid anxiety-depression, and subclinical symptoms. We carried out multinomial logistic regression analyses to analyze the role of assessed variables in the explanation of the four symptom profiles. Older adults who reported a comorbid symptomatology presented higher negative aging self-stereotypes and feelings of loneliness than the other three profiles. Compared with the subclinical profile, older adults who reported clinical symptomatology (anxiety, depressive, and comorbid profile) presented higher feelings of guilt associated with self-perception as a burden. The findings of this study suggest potential associations that may contribute to understanding and treating comorbid anxiety and depressive symptoms in older adults.
Collapse
|
7
|
Sikström S, Kelmendi B, Persson N. Assessment of depression and anxiety in young and old with a question-based computational language approach. NPJ MENTAL HEALTH RESEARCH 2023; 2:11. [PMID: 38609578 PMCID: PMC10955843 DOI: 10.1038/s44184-023-00032-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/11/2023] [Indexed: 04/14/2024]
Abstract
Middle aged adults experience depression and anxiety differently than younger adults. Age may affect life circumstances, depending on accessibility of social connections, jobs, physical health, etc, as these factors influence the prevalence and symptomatology. Depression and anxiety are typically measured using rating scales; however, recent research suggests that such symptoms can be assessed by open-ended questions that are analysed by question-based computational language assessments (QCLA). Here, we study middle aged and younger adults' responses about their mental health using open-ended questions and rating scales about their mental health. We then analyse their responses with computational methods based on natural language processing (NLP). The results demonstrate that: (1) middle aged adults describe their mental health differently compared to younger adults; (2) where, for example, middle aged adults emphasise depression and loneliness whereas young adults list anxiety and financial concerns; (3) different semantic models are warranted for younger and middle aged adults; (4) compared to young participants, the middle aged participants described their mental health more accurately with words; (5) middle-aged adults have better mental health than younger adults as measured by semantic measures. In conclusion, NLP combined with machine learning methods may provide new opportunities to identify, model, and describe mental health in middle aged and younger adults and could possibly be applied to the older adults in future research. These semantic measures may provide ecological validity and aid the assessment of mental health.
Collapse
Affiliation(s)
| | - Bleona Kelmendi
- Department of Psychology, Potsdam University, Potsdam, Germany
| | - Ninni Persson
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Institute for Globally Distributed Open Research and Education (IGDORE), Gothenburg, Sweden
| |
Collapse
|
8
|
Cao B, Yang E, Wang L, Mo Z, Steffens DC, Zhang H, Liu M, Potter GG. Brain morphometric features predict depression symptom phenotypes in late-life depression using a deep learning model. Front Neurosci 2023; 17:1209906. [PMID: 37539384 PMCID: PMC10394384 DOI: 10.3389/fnins.2023.1209906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/04/2023] [Indexed: 08/05/2023] Open
Abstract
Objectives Our objective was to use deep learning models to identify underlying brain regions associated with depression symptom phenotypes in late-life depression (LLD). Participants Diagnosed with LLD (N = 116) and enrolled in a prospective treatment study. Design Cross-sectional. Measurements Structural magnetic resonance imaging (sMRI) was used to predict five depression symptom phenotypes from the Hamilton and MADRS depression scales previously derived from factor analysis: (1) Anhedonia, (2) Suicidality, (3) Appetite, (4) Sleep Disturbance, and (5) Anxiety. Our deep learning model was deployed to predict each factor score via learning deep feature representations from 3D sMRI patches in 34 a priori regions-of-interests (ROIs). ROI-level prediction accuracy was used to identify the most discriminative brain regions associated with prediction of factor scores representing each of the five symptom phenotypes. Results Factor-level results found significant predictive models for Anxiety and Suicidality factors. ROI-level results suggest the most LLD-associated discriminative regions in predicting all five symptom factors were located in the anterior cingulate and orbital frontal cortex. Conclusions We validated the effectiveness of using deep learning approaches on sMRI for predicting depression symptom phenotypes in LLD. We were able to identify deep embedded local morphological differences in symptom phenotypes in the brains of those with LLD, which is promising for symptom-targeted treatment of LLD. Future research with machine learning models integrating multimodal imaging and clinical data can provide additional discriminative information.
Collapse
Affiliation(s)
- Bing Cao
- College of Intelligence and Computing, Tianjin University, Tianjin, China
| | - Erkun Yang
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lihong Wang
- Department of Psychiatry, University of Connecticut School of Medicine, University of Connecticut, Farmington, CT, United States
| | - Zhanhao Mo
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - David C. Steffens
- Department of Psychiatry, University of Connecticut School of Medicine, University of Connecticut, Farmington, CT, United States
| | - Han Zhang
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mingxia Liu
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Guy G. Potter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| |
Collapse
|
9
|
Oh H, Lee J, Patriquin MA, Oldham J, Salas R. Reward Processing in Psychiatric Inpatients With Depression. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:731-740. [PMID: 34174484 DOI: 10.1016/j.bpsc.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Previous neuroimaging studies have investigated reward-processing dysfunction in major depressive disorder and have led to the common finding that major depressive disorder is associated with reduced reward responses within the reward circuit. Yet it is unclear whether such reward-processing dysfunction is specifically associated with the severity of depressive symptoms in major depressive disorder or is associated with common comorbidities. METHODS We investigated reward-processing differences using a classic juice-delivery functional magnetic resonance imaging experiment to compare psychiatric patients with severe depressive symptoms (DEPs) to both psychiatric control subjects (PCs) and healthy control subjects. In this study, the DEPs (n = 108) were matched to healthy control subjects (n = 62) for demographic characteristics and to the PCs (n = 108) for demographics and comorbid psychiatric diagnoses. An a priori region of interest, the left putamen, was selected using previous studies. An exploratory whole-brain analysis was performed to explore for nonhypothesized regions. RESULTS Relative to the PCs and healthy control subjects, the DEP group showed smaller responses to reward stimulus in the left putamen. Whole-brain exploratory analysis revealed that DEPs had significantly lower responses to reward stimulus in the bilateral dorsal striatum (putamen and caudate), middle frontal gyrus, left precentral gyrus, and middle cingulate cortex than PCs. CONCLUSIONS Our findings suggest that DEPs may have a lesser ability to modulate behavior as a function of reward, especially in those individuals who experience the most severe depressive symptoms. In both DEPs and PCs, the severity of depressive symptoms was related to reduced reward responses in the left putamen.
Collapse
Affiliation(s)
- Hyuntaek Oh
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas; The Menninger Clinic, Houston, Texas
| | - Jaehoon Lee
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas; Department of Educational Psychology and Leadership, College of Education, Texas Tech University, Lubbock, Texas
| | - Michelle A Patriquin
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas; The Menninger Clinic, Houston, Texas
| | - John Oldham
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas; The Menninger Clinic, Houston, Texas
| | - Ramiro Salas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas; The Menninger Clinic, Houston, Texas; Department of Neuroscience, Baylor College of Medicine, Houston, Texas; Center for Translational Research on Inflammatory Diseases, Michael E DeBakey VA Medical Center, Houston, Texas.
| |
Collapse
|
10
|
Pedroso-Chaparro MDS, Antón-López JC, Cabrera I, Márquez-González M, Martínez-Huertas JÁ, Losada-Baltar A. 'I feel old and have aging stereotypes'. Internalized aging stereotypes and older adults' mental health: the mediational role of loneliness. Aging Ment Health 2023; 27:1619-1626. [PMID: 36604315 DOI: 10.1080/13607863.2022.2163376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The main objective of this study was to analyze the role of aging stereotype activation (when older adults with aging stereotypes begin to consider themselves as older persons) in the relationship between ageist stereotypes, depressive, anxiety, loneliness, and comorbid anxiety-depressive symptoms. METHODS Participants were 182 autonomous community-dwelling people between 60 and 88 (mean age = 72.30; SD = 5.53). Three path models were tested exploring the role of considering oneself as an older person as a moderator variable. Ageist stereotypes were included as the independent variable, loneliness as the mediating variable, and anxiety symptoms, depressive symptoms, and comorbid anxiety-depressive symptoms as dependent variables for each model. RESULTS The results suggest an influence of ageist stereotypes on anxiety, depressive, and comorbid anxiety-depressive symptoms only in older adults who consider themselves as older persons, and mediated by loneliness. CONCLUSION This study suggests that, when someone considers him or herself as an older person, ageist stereotypes activate loneliness feelings, and this activation is associated with psychological distress, including anxiety, depressive, and comorbid anxiety-depressive symptoms.
Collapse
Affiliation(s)
| | | | - Isabel Cabrera
- Biological and Health Psychology Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Márquez-González
- Biological and Health Psychology Department, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | |
Collapse
|
11
|
Kavelaars R, Ward H, Mackie DS, Modi KM, Mohandas A. The burden of anxiety among a nationally representative US adult population. J Affect Disord 2023; 336:81-91. [PMID: 37164067 DOI: 10.1016/j.jad.2023.04.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/07/2023] [Accepted: 04/16/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Anxiety disorders are highly prevalent and are associated with a significant humanistic and economic burden. This study evaluates the impact of anxiety symptoms on direct and indirect costs and quality of life in individuals with self-reported and unrecognized anxiety symptoms. METHODS The 2019 US National Health and Wellness Survey database was analyzed to compare individuals with anxiety symptoms to individuals without symptoms, stratified by responses to a yes/no question about experiencing anxiety symptoms, and further stratified by severity of symptoms based on GAD-7 scores. Individuals who responded 'yes' were characterized as having self-reported anxiety symptoms, and those who responded 'no' were screened for unrecognized anxiety symptoms. RESULTS Overall, 44.0 % of the population experienced anxiety symptoms, of which 32.5 % self-reported experiencing anxiety, while an additional 11.5 % had mild to severe symptoms but did not self-identify as having anxiety. Both groups experienced significantly worse quality of life, and higher direct and indirect costs than a control group who had no anxiety symptoms (GAD-7 ≤ 4). Individuals with more severe anxiety symptoms experienced worse outcomes. LIMITATIONS The data were cross-sectional, so causality could not be determined. Outcomes were based on self-report, and are therefore subject to reporting and recall bias. Prevalence and severity were assessed using the GAD-7, and not clinically validated. CONCLUSION A substantial proportion of the population experiences anxiety symptoms without recognizing it. Anxiety symptoms had a significant impact on quality of life, direct costs, and indirect costs, representing a considerable burden that increased with severity of illness.
Collapse
Affiliation(s)
| | - Haley Ward
- NYU Langone Health, 550 1st Ave., New York, NY 10016, USA.
| | - deMauri S Mackie
- Cerner Enviza, 2800 Rock Creek Pkwy, North Kansas City, MO 64117, USA.
| | - Kushal M Modi
- Cerner Enviza, 2800 Rock Creek Pkwy, North Kansas City, MO 64117, USA.
| | - Anita Mohandas
- Twill Inc., 114 5th Ave., 10th Fl., New York, NY 10011, USA.
| |
Collapse
|
12
|
The Influence of Probiotic Supplementation on the Severity of Anxiety and Depressive Symptoms; Function and Composition of Gut Microbiota; and Metabolic, Inflammation, and Oxidative Stress Markers in Patients with Depression-A Study Protocol. Metabolites 2023; 13:metabo13020182. [PMID: 36837799 PMCID: PMC9966580 DOI: 10.3390/metabo13020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/11/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
This article aims to present the theoretical basis, methodology, and design of a clinical trial we will conduct. The study will be prospective, randomized, placebo-controlled, and double-blind. Each intervention period will last 8 weeks and the trial will be conducted on 100 patients in total, who will be randomly divided into two groups consisting of 50 patients each. We plan to investigate the impact of Lactobacillus helveticus Rosell and Bifidobacterium longum Rosell on the depressive, anxiety, and stress levels in patients with depressive disorders with possible comorbid anxiety. In addition to assessing the influence of probiotics on the clinical condition, we also plan to study the clinical and biochemical parameters of metabolic syndrome, which often coexists with depression. Both depressive and metabolic issues may have part of their etiopathology in common, e.g., inflammation, oxidative stress, and dysbiosis. This is why we will additionally investigate the parameters related to gut microbiota, inflammatory, and oxidative statuses. Thus, the primary endpoint of the study will be the change in depression score measured with the Montgomery-Åsberg Depression Rating Scale. The secondary endpoints will include changes in anxiety and stress levels, as well as metabolic, inflammation, and oxidative stress parameters.
Collapse
|
13
|
Liu Y, Zhao W, Lu Y, Zhao Y, Zhang Y, Dai M, Hai S, Ge N, Zhang S, Huang M, Liu X, Li S, Yue J, Lei P, Dong B, Dai L, Dong B. Systematic metabolic characterization of mental disorders reveals age‐related metabolic disturbances as potential risk factors for depression in older adults. MedComm (Beijing) 2022; 3:e165. [PMID: 36204590 PMCID: PMC9523679 DOI: 10.1002/mco2.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/01/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Mental disorders are associated with dysregulated metabolism, but comprehensive investigations of their metabolic similarities and differences and their clinical relevance are few. Here, based on the plasma metabolome and lipidome of subcohort1, comprising 100 healthy participants, 55 cases with anxiety, 52 persons with depression, and 41 individuals with comorbidity, which are from WCHAT, a perspective cohort study of community‐dwelling older adults aged over 50, multiple metabolites as potential risk factors of mental disorders were identified. Furthermore, participants with mental illnesses were classified into three subtypes (S1, S2, and S3) by unsupervised classification with lipidomic data. Among them, S1 showed higher triacylglycerol and lower sphingomyelin, while S2 displayed opposite features. The metabolic profile of S3 was like that of the normal group. Compared with S3, individuals in S1 and S2 had worse quality of life, and suffered more from sleep and cognitive disorders. Notably, an assessment of 6,467 individuals from the WCHAT showed an age‐related increase in the incidence of depression. Seventeen depression‐related metabolites were significantly correlated with age, which were validated in an independent subcohort2. Collectively, this work highlights the clinical relevance of metabolic perturbation in mental disorders, and age‐related metabolic disturbances may be a bridge‐linking aging and depressive.
Collapse
Affiliation(s)
- Yu Liu
- National Clinical Research Center for Geriatrics and Department of General Practice State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Wanyu Zhao
- National Clinical Research Center for Geriatrics and Department of General Practice State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Ying Lu
- National Clinical Research Center for Geriatrics and Department of General Practice State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Yunli Zhao
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada
| | - Yan Zhang
- National Clinical Research Center for Geriatrics and Department of General Practice State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Miao Dai
- National Clinical Research Center for Geriatrics and Department of General Practice State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Shan Hai
- National Clinical Research Center for Geriatrics and Department of General Practice State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Ning Ge
- National Clinical Research Center for Geriatrics and Department of General Practice State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Shuting Zhang
- Department of Neurology, West China Hospital Sichuan University Chengdu China
| | - Mingjin Huang
- The Third Hospital of Mianyang Sichuan Mental Health Center Mianyang China
| | - Xiaohui Liu
- School of Life Sciences Tsinghua University Beijing China
| | - Shuangqing Li
- National Clinical Research Center for Geriatrics and Department of General Practice State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Jirong Yue
- National Clinical Research Center for Geriatrics and Department of General Practice State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Peng Lei
- National Clinical Research Center for Geriatrics and Department of General Practice State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Biao Dong
- National Clinical Research Center for Geriatrics and Department of General Practice State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Lunzhi Dai
- National Clinical Research Center for Geriatrics and Department of General Practice State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| | - Birong Dong
- National Clinical Research Center for Geriatrics and Department of General Practice State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu China
| |
Collapse
|
14
|
Wang X, Rao W, Chen X, Zhang X, Wang Z, Ma X, Zhang Q. The sociodemographic characteristics and clinical features of the late-life depression patients: results from the Beijing Anding Hospital mental health big data platform. BMC Psychiatry 2022; 22:677. [PMID: 36324116 PMCID: PMC9628045 DOI: 10.1186/s12888-022-04339-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/26/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The sociodemographic characteristics and clinical features of the Late-life depression (LLD) patients in psychiatric hospitals have not been thoroughly studied in China. This study aimed to explore the psychiatric outpatient attendance of LLD patients at a psychiatric hospital in China, with a subgroup analysis, such as with or without anxiety, gender differences. METHODS This retrospective study examined outpatients with LLD from January 2013 to August 2019 using data in the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM) in Beijing Anding Hospital. Age, sex, number of visits, use of drugs and comorbid conditions were extracted from medical records. RESULTS In a sample of 47,334 unipolar depression patients, 31,854 (67.30%) were women, and 15,480 (32.70%) were men. The main comorbidities of LDD are generalized anxiety disorder (GAD) (83.62%) and insomnia (74.52%).Among patients with unipolar depression, of which benzodiazepines accounted for the largest proportion (77.77%), Selective serotonin reuptake inhibitors (SSRIs) accounted for 59.00%, a noradrenergic and specific serotonergic antidepressant (NaSSAs) accounted for 36.20%. The average cost of each visit was approximately 646.27 yuan, and the cost of each visit was primarily attributed to Western medicine (22.97%) and Chinese herbal medicine (19.38%). For the cost of outpatient visits, depression comorbid anxiety group had a higher average cost than the non-anxiety group (p < 0.05). There are gender differences in outpatient costs, men spend more than women, for western medicine, men spend more than women, for Chinese herbal medicine, women spend more than men (all p < 0.05). The utilization rate of SSRIs and benzodiazepines in female patients is significantly higher than that in male patients (p < 0.05). CONCLUSION LLD patients are more commonly women than men and more commonly used SSRIs and NaSSAs. Elderly patients with depression often have comorbid generalized anxiety. LLD patients spend most of their visits on medicines, and while the examination costs are lower.
Collapse
Affiliation(s)
- Xiao Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Department of Psychiatry, Capital Medical University& Beijing Anding Hospital, Capital Medical University, 5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, China
| | - Wenwang Rao
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Xueyan Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Department of Psychiatry, Capital Medical University& Beijing Anding Hospital, Capital Medical University, 5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, China
| | - Xinqiao Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Department of Psychiatry, Capital Medical University& Beijing Anding Hospital, Capital Medical University, 5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, China
| | - Zeng Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Department of Psychiatry, Capital Medical University& Beijing Anding Hospital, Capital Medical University, 5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, China
| | - Xianglin Ma
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Department of Psychiatry, Capital Medical University& Beijing Anding Hospital, Capital Medical University, 5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Department of Psychiatry, Capital Medical University& Beijing Anding Hospital, Capital Medical University, 5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, China.
| |
Collapse
|
15
|
Kennair LEO, Hagen R, Hjemdal O, Havnen A, Ryum T, Solem S. Depression, Anxiety, Insomnia, and Quality of Life in a Representative Community Sample of Older Adults Living at Home. Front Psychol 2022; 13:811082. [PMID: 35432108 PMCID: PMC9010942 DOI: 10.3389/fpsyg.2022.811082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/11/2022] [Indexed: 12/02/2022] Open
Abstract
Background The aim of the study was to explore symptoms of anxiety and depression, insomnia, and quality of life in a Norwegian community sample of older adults. Methods A representative sample (N = 1069) was drawn from home-dwelling people of 60 years and above, living in a large municipality in Norway (Trondheim). Results Based on established cut-off scores, 83.7% of the participants showed no symptoms of anxiety/depression, 12% had mild symptoms, 2.7% moderate symptoms, 1.5% showed severe symptoms of anxiety/depression. A total of 18.4% reported insomnia symptoms. Regarding health-related quality of life, few participants reported problems with self-care, but pain and discomfort were common (59%). Depression/anxiety, insomnia, and health-related quality of life showed moderate to strong associations. Discussion The results suggest a close interplay between anxiety/depression, insomnia, and health-related quality of life in older adults.
Collapse
Affiliation(s)
| | - Roger Hagen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- Modum Bad, Research Institute, Vikersund, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Audun Havnen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- St. Olavs Hospital, Trondheim, Norway
| | - Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- *Correspondence: Stian Solem,
| |
Collapse
|
16
|
Kuo TB, Yang CC, Hung CT, Chen CH, Lan TH, Li JY. Behavioural consistency and hippocampal theta rhythm can reflect age-related anxiety during the behaviour test. Exp Gerontol 2022; 163:111808. [DOI: 10.1016/j.exger.2022.111808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/02/2022] [Accepted: 04/10/2022] [Indexed: 11/28/2022]
|
17
|
Yan Z, Meng F, He M, Li Z. The efficacy of a transdiagnostic group cognitive behavioral intervention for Chinese elderly with emotional disorders: A one-year follow-up randomized clinical trial. Front Psychiatry 2022; 13:1027994. [PMID: 36506431 PMCID: PMC9732091 DOI: 10.3389/fpsyt.2022.1027994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND With the global aging, geriatric emotional disorders have received more and more attention. Psychotherapy is an effective approach for alleviating the symptoms associated with emotional disorder, but the number of experienced therapists is low. Studies should be conducted to explore a low-cost and efficient treatment method. Previous findings indicate that transdiagnostic cognitive behavior therapy is an effective approach for treatment of emotional disorders. Group therapy is appropriate for the elderly as they are characterized by high levels of loneliness. In this study, we compared and explored the effects of a transdiagnostic group cognitive behavioral intervention (TD-GCBT), a transdiagnostic individual cognitive behavioral intervention (TD-CBT), and treatment as usual (TAU) on treatment of emotional disorders among the elderly. METHOD A total of 120 elderly patients diagnosed with emotional disorders were randomly assigned to the TD-GCBT group (40), TD-CBT group (40), and TAU group (40). Changes in symptoms were assessed using HAMD, PHQ-9, HAMA, and GAD-7 scales at baseline, post-treatment (three months), six-month and twelve-months follow-up. The efficacies of the three intervention strategies were compared using linear mixed-effects models. Post-hoc and simple effect analyses were conducted to determine the differences among the three groups. RESULTS The HAMD, PHQ-9, HAMA, and GAD-7 scores revealed a significant effect from baseline to 12 months for time (p < 0.001), group (p < 0.001) and time × group interaction (p < 0.001) in TD-GCBT group compared with the TD-CBT group and TAU group. The effect of TD-GCBT (HAMD: Cohen's d (3th month, 6th month, 12th month) = 2.69, 3.98, 4.51; HAMA: Cohen's d = 2.84, 4.13, 5.20) and TD-CBT (HAMD: Cohen's d = 2.55, 2.87, 2.63; HAMA: Cohen's d = 2.43, 2.83, 2.78) group was better relative to that of the TAU group (HAMD: Cohen's d = 0.41, 1.13, 1.46; HAMA: Cohen's d = 0.64, 1.22, 1.57) (p < 0.001). The scores of the TD-GCBT group showed the most significant decrease compared with the other two groups. CONCLUSION The findings indicate that TD-GCBT method is effective for treatment of emotional disorders among the elderly. TD-GCBT is effective for alleviating depression and anxiety symptoms up to at least nine months after treatment. The results indicate that TD-GCBT is a cost-effective and resource-effective strategy and can be used an alternative therapy for treatment of mental disorders. CLINICAL TRIAL REGISTRATION [https://www.chictr.org.cn], identifier [ChiCTR1900021806].
Collapse
Affiliation(s)
- Zijun Yan
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Fanqiang Meng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Meiling He
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zhanjiang Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| |
Collapse
|
18
|
Chen X, Zhang T, Shan X, Yang Q, Zhang P, Zhu H, Jiang F, Liu C, Li Y, Li W, Xu J, Shen H. High-frequency repetitive transcranial magnetic stimulation alleviates the cognitive side effects of electroconvulsive therapy in major depression. Front Psychiatry 2022; 13:1002809. [PMID: 36262627 PMCID: PMC9575950 DOI: 10.3389/fpsyt.2022.1002809] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/12/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The retrospective study aimed to explore the difference in mood outcomes and cognitive function between high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) over dorsolateral prefrontal cortex (DLPFC) and electroconvulsive therapy in major depression disorder (MDD) patients and to examine the improvement of HF-rTMS on cognitive impairment evoked by electroconvulsive therapy (ECT). MATERIALS AND METHODS A total of 116 participants with MDD, who completed a 4-week follow-up assessment, were enrolled. The cohort consisted of 26 cases classed as control, 46 participants administrated with HF-rTMS (HF-rTMS group), 22 patients treated with ECT (ECT group), and 23 cases treated with HF-rTMS and ECT at the course of hospitalization (HF-rTMS + ECT group). Medication was kept constant as well in all participants. The 17-item Hamilton Depression Rating Scale for Depression (HAMD-17) and 14-item Hamilton Anxiety Rating Scale (HAMA-14) were used to assess depression and anxiety, respectively. Montreal Cognitive Assessment (MoCA) was to elevate cognitive function. RESULTS No statistical significance was found for baseline in sociodemographic, characteristics of depression, anxiety and cognition, and psychopharmaceutic dosages among control, HF-rTMS, ECT, and HF-rTMS + ECT groups (p > 0.05). Compared with baseline level, total scores of HAMD-17 and HAMA-14 significantly decreased at the end of 4 weeks after treatment (p < 0.001). Furthermore, the decline in scores of HAMD-17 and its sleep disorder and retardation factors from baseline to post-treatment was greater in HF-rTMS, ECT, and HF-rTMS + ECT group than in control (p < 0.05), and there was a significant difference between control and HF-rTMS group in the decline of psychological factor of HAMA-14 (p < 0.01). ECT treatment evoked total score of MoCA to decrease significantly at the end of 4-week after intervention (p < 0.001), and the decline in scores of MoCA and its delayed recall and language performances from baseline to post-treatment was greater in ECT than control, HF-rTMS, and HF-rTMS + ECT (p < 0.05). CONCLUSION High-frequency repetitive transcranial magnetic stimulation improved psychological anxiety and ameliorated the cognition impairment evoked by ECT though it had the same anti-depressant efficacy as ECT.
Collapse
Affiliation(s)
- Xing Chen
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Tongtong Zhang
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Xiaoyan Shan
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Qun Yang
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Peiyun Zhang
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Haijiao Zhu
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Fei Jiang
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Chao Liu
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Yanzhong Li
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Weijun Li
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Jian Xu
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Hongmei Shen
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China.,Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
| |
Collapse
|
19
|
Cheng Y, Thorpe L, Kabir R, Lim HJ. Latent class growth modeling of depression and anxiety in older adults: an 8-year follow-up of a population-based study. BMC Geriatr 2021; 21:550. [PMID: 34645416 PMCID: PMC8515663 DOI: 10.1186/s12877-021-02501-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression and anxiety are common mental health conditions in the older adult population. Understanding the trajectories of these will help implement treatments and interventions. AIMS This study aims to identify depression and anxiety trajectories in older adults, evaluate the interrelationship of these conditions, and recognize trajectory-predicting characteristics. METHODS Group-based dual trajectory modeling (GBDTM) was applied to the data of 3983 individuals, aged 65 years or older who participated in the Korean Health Panel Study between 2008 and 2015. Logistic regression was used to identify the association between characteristics and trajectory groups. RESULTS Four trajectory groups from GBDTM were identified within both depression and anxiety outcomes. Depression outcome fell into "low-flat (87.0%)", "low-to-middle (8.8%)", "low-to-high (1.3%)" and "high-stable (2.8%)" trajectory groups. Anxiety outcome fell into "low-flat (92.5%)", "low-to-middle (4.7%)", "high-to-low (2.2%)" and "high-curve (0.6%)" trajectory groups. Interrelationships between depression and anxiety were identified. Members of the high-stable depression group were more likely to have "high-to-low" or "high-curved" anxiety trajectories. Female sex, the presence of more than three chronic diseases, and being engaged in income-generating activity were significant predictors for depression and anxiety. CONCLUSIONS Dual trajectory analysis of depression and anxiety in older adults shows that when one condition is present, the probability of the other is increased. Sex, having more than three chronic diseases, and not being involved in income-generating activity might increase risks for both depression and anxiety. Health policy decision-makers may use our findings to develop strategies for preventing both depression and anxiety in older adults.
Collapse
Affiliation(s)
- Yanzhao Cheng
- Collaborative Biostatistics Program, School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Lilian Thorpe
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N2Z4, Canada
| | - Rasel Kabir
- Collaborative Biostatistics Program, School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Hyun Ja Lim
- Collaborative Biostatistics Program, School of Public Health, University of Saskatchewan, Saskatoon, Canada. .,Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N2Z4, Canada.
| |
Collapse
|
20
|
Romero-Moreno R, Márquez-González M, Barrera-Caballero S, Vara-García C, Olazarán J, Pedroso-Chaparro MDS, Jiménez-Gonzalo L, Losada-Baltar A. Depressive and Anxious Comorbidity and Treatment Response in Family Caregivers of People with Dementia. J Alzheimers Dis 2021; 83:395-405. [PMID: 34308903 DOI: 10.3233/jad-210348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While most intervention studies conducted with dementia family caregivers have focused on depressive symptoms as the main outcome, no study has analyzed the effects of an intervention on comorbid clinical presentations of depressive and anxious symptomatology. OBJECTIVE The aim of this study was to examine the association between clinical depressive and anxious symptomatology at baseline and treatment responses of dementia family caregivers using samples from two randomized intervention trials with the same pre-post design. METHODS Specifically, the effects on depressive and anxious comorbidity of three intervention conditions (Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and a control group (CG)) were analyzed. Participants were 130 dementia family caregivers. In addition to sociodemographic variables, depressive and anxious symptomatology were measured. RESULTS Caregivers with clinical depressive and anxiety comorbid symptoms at baseline recovered less well from depressive symptoms after CBT (45.45%) and ACT (47.72%) interventions than caregivers with non-comorbidity (100% recovery in both treatments). No significant association between comorbidity and treatment responses on depression was found for the control group. Regarding anxiety, among participants with comorbidity at baseline, 36.36% of caregivers in CBT and 30.9 % in the ACT group recovered from anxiety symptoms after treatment, compared to 6.45% in the control group. Similar results were obtained regarding those caregivers who recovered both from clinical depressive and anxiety symptoms and showed comorbidity at baseline. CONCLUSION Caregivers that show comorbid depressive and anxiety symptoms at baseline may benefit less from interventions than caregivers who do not show comorbidity.
Collapse
Affiliation(s)
| | - María Márquez-González
- Autonomous University of Madrid, Department of Biological and Health Psychology, Madrid, Spain
| | | | | | - Javier Olazarán
- Service of Neurology, HGU Gregorio Marañón, Madrid, Spain.,Maria Wolff Foundation, Madrid, Spain
| | | | | | | |
Collapse
|
21
|
An Overview of Anxiety, Trauma-Related and Obsessive-Compulsive Disorders. CURRENT GERIATRICS REPORTS 2021. [DOI: 10.1007/s13670-021-00361-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
22
|
Wuthrich VM, Meuldijk D, Jagiello T, Robles AG, Jones MP, Cuijpers P. Efficacy and effectiveness of psychological interventions on co-occurring mood and anxiety disorders in older adults: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2021; 36:858-872. [PMID: 33368598 DOI: 10.1002/gps.5486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/19/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Co-occurring mood and anxiety disorders are common in older adult populations and are associated with worse long-term outcomes and poorer treatment response than either disorder alone. This systematic review and meta-analysis aimed to examine the efficacy and effectiveness of psychological interventions for treating co-occurring mood and anxiety disorders in older adults. METHOD The study was registered (PROSPERO CRD4201603834), databases systematically searched (MEDLINE, PSYCINFO, PubMed and Cochrane Reviews) and articles screened according to PRISMA guidelines. INCLUSION Participants aged ≥60 years with clinically significant anxiety and depression, psychological intervention evaluated against control in randomised controlled trial, changes in both anxiety and depression reported at post-treatment. ResultsFour studies were included (total n = 255, mean age range 67-71 years). Overall, psychological interventions (cognitive behavioural therapy, mindfulness) resulted in significant benefits over control conditions (active, waitlist) for treating depression in the presence of co-occurring anxiety (Hedges' g = -0.44), and treating anxiety in the presence of depression (Hedges' g = -0.55). However, conclusions are limited; the meta-analysis was non-significant, few studies were included, several were low quality and there was high heterogeneity between studies. Benefits at follow-up were not established. CONCLUSION Co-occurring anxiety and mood disorders can probably be treated simultaneously with psychological interventions in older adults with moderate effect sizes, however, more research is needed. Given comorbidity is common and associated with worse clinical outcomes, more high-quality clinical trials are needed that target the treatment of co-occurring anxiety and mood disorders, and report changes in diagnostic remission for both anxiety and mood disorders independently.
Collapse
Affiliation(s)
- Viviana M Wuthrich
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia.,Department of Psychology, Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia
| | - Denise Meuldijk
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia.,Department of Psychology, Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia
| | - Tess Jagiello
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Alberto González Robles
- Department of Basic, Clinical Psychology, and Neuropsychology, Universitat Jaume I, Castellón, Spain
| | - Michael P Jones
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
23
|
Fusi G, Colombo B, Zanetti M, Crepaldi M, Rozzini L, Rusconi ML. The Effect of Psychological Symptoms on Divergent Thinking in Healthy Older Adults. CREATIVITY RESEARCH JOURNAL 2021. [DOI: 10.1080/10400419.2021.1892413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Giulia Fusi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | | | - Maura Crepaldi
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Luca Rozzini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Luisa Rusconi
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| |
Collapse
|
24
|
Suradom C, Wongpakaran N, Wongpakaran T, Lerttrakarnnon P, Jiraniramai S, Taemeeyapradit U, Lertkachatarn S, Arunpongpaisal S, Kuntawong P. Mediation model of comorbid anxiety disorders in late-life depression. Ann Gen Psychiatry 2020; 19:63. [PMID: 33292322 PMCID: PMC7670777 DOI: 10.1186/s12991-020-00313-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 10/25/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A number of studies have been conducted on risk factors of comorbid anxiety disorders regarding late-life depression (LLD). This study investigated the associated factors and their relationship to comorbid anxiety disorders in LLD. METHODS Participants included 190 elderly Thais (73.2% female, with a mean age of 68.39 ± 6.74 years) with depressive disorders, diagnosed according to DSM-IV Diagnosis Axis I disorders assessed by Mini-International Neuropsychiatric Interview. Demographic data, medical and psychiatric history, family psychiatric history, past depression, family history of depression, Neuroticism Inventory and 7-Item Hamilton Depression Rating Scale (HAMD-7) were analyzed for path analysis using Structural Equation Model framework. The bootstrapping method was used for testing indirect effects. RESULTS Being female was associated with comorbid anxiety disorders with an indirect effect (β = - 0.032, P = 0.018) through neuroticism, depression severity, history and family history of depression. Family history of depression had no effect on comorbidity (P = 0.090). Neuroticism had an indirect effect on comorbid anxiety disorders (β = 0.075, P = 0.019) via depression severity as reflected by HAMD-7 score (β = 0.412, P = < 0.001). Total variance explained from this model was 11%. This model had good-fit index with Chi-square > 0.05, CFI and TLI > 0.95 and RMSEA < 0.06. CONCLUSION Neuroticism mediates the effect of relationship between sex, family history and history of depressive disorders and comorbid anxiety disorders in LLD. Moreover, depression severity is a mediator for neuroticism and comorbid anxiety disorders. Longitudinal studies are warranted to indicate the importance of effective treatment of depression to lower the risk of developing comorbid anxiety disorders among depressed elderly.
Collapse
Affiliation(s)
- Chawisa Suradom
- Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., Chiang Mai, 50200, Thailand
| | - Nahathai Wongpakaran
- Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., Chiang Mai, 50200, Thailand.
| | - Tinakon Wongpakaran
- Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., Chiang Mai, 50200, Thailand
| | - Peerasak Lerttrakarnnon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Surin Jiraniramai
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Suwanna Arunpongpaisal
- Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pimolpun Kuntawong
- Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., Chiang Mai, 50200, Thailand
| |
Collapse
|
25
|
Zhang L, Zhu J, Zhang T, Jia Q, Hui L, Zhu H, Tang Y, Wang J. Comparative efficacy of add-on rTMS in treating the somatic and psychic anxiety symptoms of depression comorbid with anxiety in adolescents, adults, and elderly patients-A real-world clinical application. J Affect Disord 2020; 276:305-311. [PMID: 32871660 DOI: 10.1016/j.jad.2020.05.151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is an effective adjuvant treatment for depression. Many patients with depression have comorbid anxiety symptoms. However, previous rTMS studies have focused on patients with depression, and often excluded comorbid anxiety. This real-world study aimed to investigate the comparative efficacy of add-on rTMS in treating the somatic and psychic anxiety symptoms of depression comorbid with anxiety in adolescents, adults and elderly patients. METHODS This study included 147 depression patients with anxiety symptoms who were treated with at least 10 sessions of rTMS. The symptoms of anxiety and depression were assessed with the Hamilton Rating Scale for Anxiety (HAMA) and the Hamilton Rating Scale for Depression (HAMD) at baseline and after 2 and 4 weeks of treatment. This was done to compare the improvement degree of add-on rTMS on somatic and psychic anxiety symptoms in adolescents, adults and elderly patients respectively. RESULTS Both somatic and psychic anxiety symptoms were significantly improved after the add-on rTMS in adolescents, adults and elderly patients. The improvement of somatic anxiety was better than that of psychic anxiety after rTMS treatment in elderly patients (t2w=3.895, P<0.001; t4w=2.823, P = 0.008). LIMITATION The overall sample was mostly composed of elderly patients, while adolescents and adult patients were fewer. CONCLUSIONS The add-on rTMS treatment can improve somatic anxiety better than psychic anxiety in depression with anxiety symptoms, especially in elderly patients.
Collapse
Affiliation(s)
- Ling Zhang
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, China
| | - Junjuan Zhu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Tianhong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.
| | - Qiufang Jia
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, China
| | - Li Hui
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, China
| | - Hongliang Zhu
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, China
| | - Yingying Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.
| |
Collapse
|
26
|
Rainer C, Nasrouei S, Tschofen S, Bliem HR, Wilhelm FH, Marksteiner J. Fear acquisition and extinction in elderly patients with depression. J Affect Disord 2020; 276:197-204. [PMID: 32697699 DOI: 10.1016/j.jad.2020.06.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/29/2020] [Accepted: 06/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Depression in elderly patients is common and characterized by anxiety symptoms and cognitive impairment. To our knowledge, no studies have yet investigated the process of fear extinction in these patients. We investigated fear extinction with a paradigm consisting of habituation, acquisition and extinction. METHODS We included three age matched (mean age: 75.7 years) groups: Late Life Depression (LLD, n = 33), Mild Cognitive Impairment (MCI, n = 39), healthy controls (HC, n = 39). All participants were diagnosed with a standardized procedure including clinical examination, CERAD cognitive test battery, as well as magnetic resonance imaging. Participants underwent a fear conditioning paradigm consisting of habituation, acquisition, and extinction. During acquisition, a neutral face (conditioned stimulus, CS+) was paired with an electrical unconditioned stimulus, whereas another face (safety stimulus, CS-) was unpaired. Conditioned responses were measured by US-expectancy and valence ratings. RESULTS Compared to HC, both patient groups showed a significantly lower, differential (CS+ vs. CS-) fear acquisition across all measurements. Patients with cognitive impairment showed a significantly slower extinction, which is characterized by higher US-expectancy and reduced positive valence for CS+. Fear extinction was significantly less differential (CS+ vs. CS-) in patients with LLD. LIMITATIONS Due to the cross-sectional design we cannot distinguish whether the observed differences in fear extinction are state or trait markers in the LLD patients. CONCLUSIONS In this study, we demonstrate that fear extinction is impaired in elderly patients with depression. These results can have influence on treatment strategies.
Collapse
Affiliation(s)
- Christina Rainer
- Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall, Austria; Department of Psychology, University of Innsbruck, Innsbruck, Austria.
| | - Sarah Nasrouei
- Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall, Austria; Division of Clinical Psychology, Psychotherapy, and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Simon Tschofen
- Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall, Austria
| | - Harald R Bliem
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Frank H Wilhelm
- Division of Clinical Psychology, Psychotherapy, and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall, Austria
| |
Collapse
|
27
|
Jackson M, McGill K, Lewin TJ, Bryant J, Whyte I, Carter G. Hospital-treated deliberate self-poisoning in the older adult: Identifying specific clinical assessment needs. Aust N Z J Psychiatry 2020; 54:591-601. [PMID: 31957465 DOI: 10.1177/0004867419897818] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hospital-treated deliberate self-poisoning is common, with a median patient age of around 33 years. Clinicians are less familiar with assessing older adults with self-poisoning and little is known about their specific clinical requirements. OBJECTIVE To identify clinically important factors in the older-age population by comparing older adults (65+ years) with middle-aged adults (45-64 years) during an index episode of hospital-treated deliberate self-poisoning. METHODS A prospective, longitudinal, cohort study of people presenting to a regional referral centre for deliberate self-poisoning (Calvary Mater Newcastle, Australia) over a 10-year period (2003-2013). We compared older-aged adults with middle-aged adults on demographic, toxicological and psychiatric variables and modelled independent predictors of referral for psychiatric hospitalisation on discharge with logistic regression. RESULTS There were (n = 157) older-aged and (n = 925) middle-aged adults. The older-aged group was similar to the middle-aged group in several ways: proportion living alone, reporting suicidal ideation/planning, prescribed antidepressant and antipsychotic drugs, and with a psychiatric diagnosis. However, the older-aged group were also different in several ways: greater proportion with cognitive impairment, higher medical morbidity, longer length of stay, and greater prescription and ingestion of benzodiazepines in the deliberate self-poisoning event. Older age was not a predictor of referral for psychiatric hospitalisation in the multivariate model. CONCLUSION Older-aged patients treated for deliberate self-poisoning have a range of clinical needs including ones that are both similar to and different from middle-aged patients. Individual clinical assessment to identify these needs should be followed by targeted interventions, including reduced exposure to benzodiazepines.
Collapse
Affiliation(s)
- Mariann Jackson
- MH-READ, Hunter New England Mental Health Services, Newcastle, NSW, Australia
| | - Katie McGill
- MH-READ, Hunter New England Mental Health Services, Newcastle, NSW, Australia.,Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Terry J Lewin
- MH-READ, Hunter New England Mental Health Services, Newcastle, NSW, Australia.,Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | | | - Ian Whyte
- Calvary Mater Newcastle, Waratah, NSW, Australia.,Discipline of Clinical Pharmacology, The University of Newcastle, Newcastle, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Gregory Carter
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Calvary Mater Newcastle, Waratah, NSW, Australia
| |
Collapse
|
28
|
Anxiety Disorders in the Elderly. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:561-576. [DOI: 10.1007/978-981-32-9705-0_28] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
29
|
Saade YM, Nicol G, Lenze EJ, Miller JP, Yingling M, Wetherell JL, Reynolds CF, Mulsant BH. Comorbid anxiety in late-life depression: Relationship with remission and suicidal ideation on venlafaxine treatment. Depress Anxiety 2019; 36:1125-1134. [PMID: 31682328 PMCID: PMC6891146 DOI: 10.1002/da.22964] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/14/2019] [Accepted: 09/13/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The purpose of this study was to examine the influence of comorbid anxiety symptoms on antidepressant treatment remission in older adults with major depressive disorder (MDD). METHOD In this multisite clinical trial, 468 older adults aged 60 years or older with MDD received open-label protocolized treatment with venlafaxine extended release (ER) titrated to a maximum of 300 mg daily. At baseline, anxiety was assessed with the Anxiety Sensitivity Index, the Brief Symptom Inventory (BSI) anxiety subscale, and the Penn State Worry Questionnaire. To measure treatment response, depressive symptoms and suicidality were assessed every 1-2 weeks with the Montgomery-Asberg Depression Rating Scale and the 19-item Scale for Suicide Ideation; anxiety was assessed with the BSI. Logistic regression and survival analysis were used to evaluate whether anxiety symptoms predicted depression remission. We also examined the relationships between anxiety scores and suicidality at baseline. RESULTS Baseline anxiety symptoms did not predict remission or time to remission of depressive symptoms. Depressive, worry, and panic symptoms decreased in parallel in patients with high anxiety. Anxiety symptoms were associated with the severity of depression and with suicidality. CONCLUSION In older adults with MDD, comorbid anxiety symptoms are associated with symptom severity but do not affect antidepressant remission or time to remission.
Collapse
Affiliation(s)
- Yasmina M Saade
- Washington University, St Louis, Missouri (Department of Psychiatry, 660 S. Euclid Box 8134, St Louis, MO 63110
| | - Ginger Nicol
- Washington University, St Louis, Missouri (Department of Psychiatry, 660 S. Euclid Box 8134, St Louis, MO 63110
| | - Eric J Lenze
- Washington University, St Louis, Missouri (Department of Psychiatry, 660 S. Euclid Box 8134, St Louis, MO 63110
| | - J Philip Miller
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO
| | - Michael Yingling
- Washington University, St Louis, Missouri (Department of Psychiatry, 660 S. Euclid Box 8134, St Louis, MO 63110
| | - Julie Loebach Wetherell
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
30
|
Ng CZ, Tang SC, Chan M, Tran BX, Ho CS, Tam WW, Ho RC. A systematic review and meta-analysis of randomized controlled trials of cognitive behavioral therapy for hemodialysis patients with depression. J Psychosom Res 2019; 126:109834. [PMID: 31525637 DOI: 10.1016/j.jpsychores.2019.109834] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this meta-analysis was to examine the efficacy of cognitive behavioral therapy (CBT) for hemodialysis patients with comorbid depression and to identify which other aspects, including anxiety and quality of life, can be improved through intervention. METHODS A systematic literature review was performed using multiple databases (PubMed, EMBase, PsycINFO, CENTRAL). The inclusion criteria included randomized controlled trials (RCTs) of CBT conducted in hemodialysis patients with depression. Study reporting quality was assessed with the Cochrane tool and Review Manager version 5.3 was used to obtain pooled results. RESULTS Eight RCTs, with a total sample size of 540 participants, met the inclusion criteria. Compared with control groups, the CBT groups had statistically significant improvements in depression (standardized mean differences [SMD] = -0.68, 95% confidence interval [CI] (-0.94 to -0.42), P < .001), anxiety (SMD = -0.99, 95%CI (-1.99 to 0.00), P = .05) and quality of life (SMD = 0.34, 95%CI (0.13 to 0.54), P < .001). CONCLUSIONS The results of this meta-analysis showed that CBT could have an effective role in reducing symptoms of depression and anxiety as well as improving quality of life in hemodialysis patients with comorbid depression.
Collapse
Affiliation(s)
- Chong Zheng Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sydney C Tang
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Meanne Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Bach X Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Viet Nam; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Cyrus S Ho
- Department of Psychological Medicine, National University Health System, Singapore
| | - Wilson W Tam
- Alice Lee School of Nursing, National University of Singapore, Singapore
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 119077, Singapore; Biomedical Global Institute of Healthcare Research & Technology (BIGHEART), National University of Singapore, 119228, Singapore; Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Viet Nam; Faculty of Education, Huaibei Normal University, 100 Dongshan Road, Huaibei, Anhui 235000, China.
| |
Collapse
|
31
|
Okamura T, Sugiyama M, Inagaki H, Murayama H, Ura C, Miyamae F, Edahiro A, Motokawa K, Awata S. Anticipatory anxiety about future dementia-related care needs: towards a dementia-friendly community. Psychogeriatrics 2019; 19:539-546. [PMID: 30884068 DOI: 10.1111/psyg.12433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 01/01/2019] [Accepted: 01/22/2019] [Indexed: 11/30/2022]
Abstract
AIM Although a dementia-friendly community is a global goal, community-dwelling persons with dementia continue to have unmet care needs. The aim of this study was to explore the characteristics of persons who experience anxiety about the possibility of not receiving proper dementia care should they need it in the future. METHODS A questionnaire was mailed to all residents aged 65 years or older (n = 132 005) living in one Tokyo district. The questionnaire included an item that measured anxiety about the possibility of not receiving proper dementia care as well as items about sociodemographic variables, depressive symptoms, frailty, housebound status, socioeconomic status, social support, access to a general practitioner (GP), and experience of dementia care. RESULTS Of the 74 171 participants who responded to the anxiety item, 58 481 (78.8%) reported anxiety about the possibility of not receiving proper dementia care should they need it in the future. Simultaneous multiple logistic regression analysis indicated that factors associated with this anticipatory anxiety were depressive symptoms, frailty or prefrailty, being female, not being currently socioeconomically disadvantaged, not having someone who can take you to the hospital when you do not feel well, being younger (65-74 years), being married, not trusting in neighbours, higher educational level (>9 years), not having someone to consult when you are in trouble, not working, having been socioeconomically disadvantaged in childhood, only greeting or less with neighbours, and not having the experience of dementia care. Having access to a GP, living alone, and going out less than once a week did not show a significant association. CONCLUSIONS This large-scale study explored factors associated with anticipatory anxiety about the possibility of not receiving proper dementia care should it be needed in the future. Further studies concerning interventions to decrease such anxiety are needed.
Collapse
Affiliation(s)
| | - Mika Sugiyama
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hiroki Inagaki
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | | | - Chiaki Ura
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Fumiko Miyamae
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Ayako Edahiro
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Keiko Motokawa
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Shuich Awata
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| |
Collapse
|
32
|
Laird KT, Siddarth P, Krause B, Kilpatrick L, Milillo M, Aguilar Y, Narr KL, Lavretsky H. Anxiety symptoms are associated with smaller insular and orbitofrontal cortex volumes in late-life depression. J Affect Disord 2019; 256:282-287. [PMID: 31200165 PMCID: PMC6750975 DOI: 10.1016/j.jad.2019.05.066] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 04/19/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Increasing understanding of the neural correlates of anxiety symptoms in late-life depression (LLD) could inform the development of more targeted and effective treatments. METHODS Grey matter volume (GMV) was assessed with volumetric magnetic resonance imaging in a sample of 113 adults ≥60 years with MDD using the following regions of interest: amygdala, anterior cingulate cortex (ACC), insula, orbitofrontal cortex (OFC), and temporal cortex. RESULTS After controlling for demographic (age, sex, education) and clinical variables (antidepressant use, anxiolytic use, duration of illness, medical comorbidity, cognitive functioning), greater severity of anxiety symptoms was associated with lower GMV bilaterally in the insula, F(1,102) = 6.63, p = 0.01, and OFC, F(1,102) = 8.35, p = 0.005. By contrast, depressive symptom severity was significantly associated with lower bilateral insula volumes, F(1,102) = 6.43, p = 0.01, but not OFC volumes, F(1,102) = 5.37, p = 0.02. LIMITATIONS Limitations include (1) the relatively mild nature of anxiety symptoms in our sample; (2) the cross-sectional research design, which prohibits inferences of directionality; (3) the relatively homogenous demographic of the sample, and (4) the exclusion of participants with significant psychiatric comorbidity, suicidality, or cognitive impairment. CONCLUSIONS Decreased OFC volumes may serve as a unique biomarker of anxiety symptoms in LLD. Future longitudinal and clinical studies with long-term follow up and more diverse samples will help further elucidate the biological, psychological, and social factors affecting associations between anxiety and brain morphology in LLD.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Helen Lavretsky
- Department of Psychology and Human Development, University of California, Los Angeles (UCLA), 760 Westwood Plaza, Los Angeles, CA 90095, United States.
| |
Collapse
|
33
|
The effect of anxiety on cognition in older adult inpatients with depression: results from a multicenter observational study. Heliyon 2019; 5:e02235. [PMID: 31497664 PMCID: PMC6722253 DOI: 10.1016/j.heliyon.2019.e02235] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/06/2019] [Accepted: 08/01/2019] [Indexed: 11/23/2022] Open
Abstract
Late-life depression is associated with reduced cognitive function beyond normal age-related cognitive deficits. As comorbid anxiety frequently occur in late-life depression, this study aimed to examine the association between anxiety symptoms and cognitive function among older inpatients treated for depression. We hypothesized that there would be an overall additive effect of comorbid anxiety symptoms on dysfunction across cognitive domains. The study included 142 patients treated for late-life depression in hospital, enrolled in the Prognosis of Depression in the Elderly study. Anxiety symptoms were measured at admission using the anxiety subscale of the Hospital Anxiety and Depression Scale. Patients completed cognitive tasks at admission and discharge. Linear mixed and generalized linear mixed models were estimated to investigate the effect of anxiety, on continuous and categorical cognitive scores, respectively, while controlling for depression. Anxiety severity at admission was not associated with performance in any of the cognitive domains. Patients with more symptoms of anxiety at admission demonstrated a significant improvement in immediate recall during the hospital stay. Patients with a score above cutoff indicating clinically significant symptoms on the anxiety subscale performed better on general cognitive function, as measured by the Mini Mental Status Examination at admission, than those below cutoff for anxiety. In conclusion, comorbid anxiety symptoms had no additive effect on cognitive dysfunction in late-life depression in our sample of inpatients.
Collapse
|
34
|
Affiliation(s)
- Raymond Pary
- a Veterans Administration Medical Center , Louisville , KY , USA
| | - Simrat Kaur Sarai
- b University of Louisville School of Medicine , Louisville , KY , USA
| | - Riley Sumner
- c University of Louisville , Louisville , KY , USA
| | - Steven Lippmann
- b University of Louisville School of Medicine , Louisville , KY , USA
| |
Collapse
|
35
|
Grover S, Sahoo S, Chakrabarti S, Avasthi A. Anxiety and somatic symptoms among elderly patients with depression. Asian J Psychiatr 2019; 41:66-72. [PMID: 30054249 DOI: 10.1016/j.ajp.2018.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 06/30/2018] [Accepted: 07/17/2018] [Indexed: 02/08/2023]
Abstract
AIM OF THE STUDY This study aimed to evaluate the symptom profile, including anxiety and somatic symptoms among elderly patients with depression using the Geriatric depression scale (GDS-30), Beck Depression Inventory (BDI), Generalized anxiety Disorder -7 Scale (GAD-7) and Patient Health Questionnaire-15 (PHQ-15) scale. Additional aim was to carry out the factor analysis of symptoms reported on various scales. METHODOLOGY 83 elderly patients (age ≥60 years) with depression were evaluated on GDS-30, BDI, GAD-7 and PHQ-15. RESULTS 60 subjects (72.28%) had GAD-7 score of ≥10, which is indicative of significant anxiety. On PHQ-15, 98.8% of patients had moderate to severe somatization. There was no correlation between severity of depressive symptoms (as assessed by GDS-30 and BDI) with anxiety and depressive symptoms except for significant correlation between BDI total score and GAD-7 total score (Pearson correlation coefficient-0.319;p = 0.003).Factor analysis of GDS-30 yielded a five factor solution and when the items of other 3 scales were added, the number of factors/symptoms clusters increased to 7. CONCLUSION The present study suggests that there is a higher prevalence of anxiety and somatic symptoms in elderly patients with depression and GDS-30 is unable to capture all the symptoms of depression among elderly in the Indian context. Hence, complete assessment of depression in elderly should include assessment of anxiety and somatic symptoms by using other scales like GAD-7,BDI-II and PHQ-15. There is a need to develop a new scale which will be helpful in capturing the entire symptom profile of depression among elderly.
Collapse
Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| |
Collapse
|
36
|
Liu W, Zhou Y, Zheng W, Wang C, Zhan Y, Li H, Chen L, Zhao C, Ning Y. Mediating effect of neurocognition between severity of symptoms and social-occupational function in anxious depression. J Affect Disord 2019; 246:667-673. [PMID: 30611065 DOI: 10.1016/j.jad.2018.12.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/26/2018] [Accepted: 12/25/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is associated with neurocognitive impairment and reduced social-occupational function. However, neurocognition and social-occupational function in patients with anxious depression have been under-investigated. An increasing number of studies have demonstrated that neurocognition plays an important role in social-occupational function. The objective of this study was to investigate the association of severity of symptoms, neurocognition and social-occupational function in patients with anxious depression. METHOD Using a cross-sectional design, 214 patients with MDD were recruited consecutively and evaluated using the 17-item Hamilton Depression Rating scale (HAMD-17), the MATRICS Consensus Cognitive Battery (MCCB) and the Global Assessment of Functioning (GAF). RESULT The prevalence of anxious depression in MDD patients was 64.5%. Compared to non-anxious subjects, the anxious group had more severe symptoms. Moreover, in the anxious group, social-occupational function was associated with several domains of symptoms and neurocognition, while social-occupational function was associated with only one aspect of depressive symptoms (cognitive disturbance) in the non-anxious group. In addition, there was a mediating effect of neurocognition on the association between the severity of symptoms and social-occupational function in the anxious group. LIMITATIONS The major limitation of the present study is the use of a cross-sectional design that is unable to illuminate causal relationships. CONCLUSION Our results suggest that the severity of symptoms is negatively associated with neurocognition and social-occupational function and that neurocognition is positively associated with social-occupational function in patients with anxious depression.
Collapse
Affiliation(s)
- Weijian Liu
- Southern Medical University, Guangzhou, China; The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China
| | - Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China
| | - Chengyu Wang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China
| | - Yanni Zhan
- Southern Medical University, Guangzhou, China; The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China
| | - Hanqiu Li
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China
| | - Lijian Chen
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China
| | - Cunyou Zhao
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Yuping Ning
- Southern Medical University, Guangzhou, China; The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China.
| |
Collapse
|
37
|
Grenier S, Desjardins F, Raymond B, Payette MC, Rioux MÈ, Landreville P, Gosselin P, Richer MJ, Gunther B, Fournel M, Vasiliadis HM. Six-month prevalence and correlates of generalized anxiety disorder among primary care patients aged 70 years and above: Results from the ESA-services study. Int J Geriatr Psychiatry 2019; 34:315-323. [PMID: 30418683 DOI: 10.1002/gps.5023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 11/03/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To estimate the 6-month prevalence of generalized anxiety disorder (GAD) in primary care patients aged 70 years and above and to describe their clinical profile, including types of worries. METHODS/DESIGN Participants (N = 1193) came from the Étude sur la Santé des Aînés (ESA) services study conducted in Quebec, Canada. An in-person structured interview was used to identify GAD and other anxiety/depressive disorders as well as to identify types of worries. Three groups were created (ie, patients with GAD, patients with another anxiety disorder, and patients without anxiety disorders) and compared on several sociodemographic and clinical characteristics using multinomial logistic regression analyses. RESULTS The 6-month prevalence of GAD was 2.7%. Findings also indicated that the most common types of worries were about health, being a burden for loved ones, and losing autonomy. Compared with respondents without anxiety disorders, older patients with GAD were more likely to be women, be more educated, suffer from depression, use antidepressants, be unsatisfied with their lives, and use health services. In comparison with respondents with another anxiety disorder, those with GAD were 4.5 times more likely to suffer from minor depression. CONCLUSIONS GAD has a high prevalence in primary care patients aged 70 years and above. Clinicians working in primary care settings should screen for GAD, since it remains underdiagnosed. In addition, it may be associated with depression and life dissatisfaction. Screening tools for late-life GAD should include worry themes that are specific to aging.
Collapse
Affiliation(s)
- Sébastien Grenier
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada.,Département de psychologie, Université de Montréal, Montreal, Canada
| | - Frédérique Desjardins
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada.,Département de psychologie, Université de Montréal, Montreal, Canada
| | - Béatrice Raymond
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada.,Département de psychologie, Université de Montréal, Montreal, Canada
| | - Marie-Christine Payette
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada.,Département de psychologie, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Marie-Ève Rioux
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada.,Département de psychologie, Université du Québec à Montréal, Montreal, Quebec, Canada
| | | | - Patrick Gosselin
- Département de psychologie, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-Josée Richer
- Département de psychoéducation, Université de Montréal, Montreal, Quebec, Canada
| | - Bruno Gunther
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada.,Département de psychologie, Université de Montréal, Montreal, Canada
| | - Mélanie Fournel
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada
| | - Helen-Maria Vasiliadis
- Département des sciences de la santé communautaire, Faculté de Médecine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| |
Collapse
|
38
|
Suradom C, Wongpakaran N, Wongpakaran T, Lerttrakarnnon P, Jiraniramai S, Taemeeyapradit U, Lertkachatarn S, Arunpongpaisal S. Prevalence and associated factors of comorbid anxiety disorders in late-life depression: findings from geriatric tertiary outpatient settings. Neuropsychiatr Dis Treat 2019; 15:199-204. [PMID: 30662265 PMCID: PMC6328289 DOI: 10.2147/ndt.s184585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The study evaluated the prevalence of comorbid anxiety disorders in late-life depression (LLD) and identified their associated factors. PATIENTS AND METHODS This study involved 190 elderly Thais with depressive disorders diagnosed according to the Mini-International Neuropsychiatric Interview (MINI). Anxiety disorders were also diagnosed by the MINI. The 7-item Hamilton Depression Rating Scale (HAMD-7), Montreal Cognitive Assessment, Geriatric Depression Scale (GDS), Core Symptoms Index, Neuroticism Inventory, Perceived Stress Scale and Multidimensional Scale for Perceived Social Support were completed. Descriptive statistics and ORs were used for analysis. RESULTS Participants included 139 females (73.2%) with a mean age of 68.39±6.74 years. The prevalence of anxiety disorders was 7.4% for generalized anxiety disorder (GAD), 4.7% for panic disorder, 5.3% for agoraphobia, 1.1% for social phobia, 2.1% for obsessive-compulsive disorder and 3.7% for post-traumatic stress disorder, with an overall prevalence of 16.84%. The comorbidity of anxiety disorders was associated with gender (P=0.045), history of depressive disorder (P=0.040), family history of depressive disorder (P=0.004), GDS (P=0.037), HAMD-7 (P=0.001), suicidality (P=0.002) and neuroticism (P=0.003). History of alcohol use was not associated. CONCLUSION The prevalence of anxiety in LLD was comparable to other studies, with GAD and agoraphobia being the most prevalent. This study confirmed the role of depression severity and neuroticism in developing comorbid anxiety disorders.
Collapse
Affiliation(s)
- Chawisa Suradom
- Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,
| | - Nahathai Wongpakaran
- Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,
| | - Tinakon Wongpakaran
- Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,
| | - Peerasak Lerttrakarnnon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Surin Jiraniramai
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Suwanna Arunpongpaisal
- Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| |
Collapse
|
39
|
King G, Baker KD, Bisby MA, Chan D, Cowan CSM, Stylianakis AA, Zimmermann KS, Richardson R. A precision medicine approach to pharmacological adjuncts to extinction: a call to broaden research. Psychopharmacology (Berl) 2019; 236:143-161. [PMID: 30116858 DOI: 10.1007/s00213-018-4999-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/07/2018] [Indexed: 12/21/2022]
Abstract
There is a pressing need to improve treatments for anxiety. Although exposure-based therapy is currently the gold-standard treatment, many people either do not respond to this therapy or experience a relapse of symptoms after treatment has ceased. In recent years, there have been many novel pharmacological agents identified in preclinical research that have potential as adjuncts for exposure therapy, yet very few of these are regularly integrated into clinical practice. Unfortunately, the robust effects observed in the laboratory animal often do not translate to a clinical population. In this review, we discuss how age, sex, genetics, stress, medications, diet, alcohol, and the microbiome can vary across a clinical population and yet are rarely considered in drug development. While not an exhaustive list, we have focused on these factors because they have been shown to influence an individual's vulnerability to anxiety and alter the neurotransmitter systems often targeted by pharmacological adjuncts to therapy. We argue that for potential adjuncts to be successfully translated from the lab to the clinic empirical research must be broadened to consider how individual difference factors will influence drug efficacy.
Collapse
Affiliation(s)
- Gabrielle King
- School of Psychology, The University of New South Wales, Sydney, Australia.
| | - Kathryn D Baker
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - Madelyne A Bisby
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - Diana Chan
- School of Psychology, The University of New South Wales, Sydney, Australia
| | | | | | | | - Rick Richardson
- School of Psychology, The University of New South Wales, Sydney, Australia
| |
Collapse
|
40
|
Grover S, Sahoo S, Avasthi A, Lakdawala B, Dan A, Nebhinani N, Dutt A, Tiwari S, Gania A, Subramanyam A, Kedare J, Suthar N. Prevalence of suicidality and its correlates in geriatric depression: A multicentric study under the aegis of the Indian Association for Geriatric Mental Health. JOURNAL OF GERIATRIC MENTAL HEALTH 2019. [DOI: 10.4103/jgmh.jgmh_35_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
41
|
An MH, Park SS, You SC, Park RW, Park B, Woo HK, Kim HK, Son SJ. Depressive Symptom Network Associated With Comorbid Anxiety in Late-Life Depression. Front Psychiatry 2019; 10:856. [PMID: 31824354 PMCID: PMC6880658 DOI: 10.3389/fpsyt.2019.00856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/31/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Depression and anxiety are the most common comorbid psychiatric disorders in the elderly. Psychiatrists have been reporting worsened depression symptoms and prognosis by comorbid anxiety symptoms. However, it is still unclear how anxiety affects the course of depression in the elderly. The aims of this study are (1) to identify the symptom network in late-life depression (LLD), and (2) to examine the role of anxiety in LLD with a network perspective. Methods: The study analyzed 776 community-based participants who were clinically diagnosed with depression and enrolled in Suwon Geriatric Mental Health Center. Network analysis was used to investigate the relationships between the symptoms of the Montgomery-Åsberg Depression Rating Scale (MADRS). The depression sample was divided into groups of low and high anxiety according to the Beck Anxiety Index. Propensity score matching (PSM) was used to minimize the effects of depression severity on the network. Network comparison test (NCT) were carried out to compare the global connectivity, global strength, and specific edge strength between the two subgroups. Results: Reported sadness, pessimistic thinking, and suicidal ideation are the core symptoms of LLD in terms of node strength. The MADRS sum score [mean (SD) 28.10 (9.19) vs 20.08 (7.11); P < .01] was much higher in the high anxiety group. The NCT before PSM showed the high anxiety group had significantly higher global strength (P < .01). However, the NCT after PSM did not reveal any statistical significance both in global structure (P = .46) and global strength (P = .26). A comparison between centrality indices showed a higher node strength of vegetative symptoms in the high anxiety group and this also remained after PSM. Conclusion: Based on the statistical analysis, anxiety worsens the severity of depression in the elderly. However, NCT after PSM revealed comorbid anxiety does not change the global structure and strength of the depression symptom network. Therefore, anxiety may affect LLD in a way of worsening the severity, rather than changing psychopathology. Additionally, the study revealed the centrality of vegetative symptoms was low in LLD but increased substantially in patients with comorbid anxiety.
Collapse
Affiliation(s)
- Min Ho An
- Ajou University School of Medicine, Suwon, South Korea
| | | | - Seng Chan You
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | | | - Han Ki Kim
- Ajou University School of Medicine, Suwon, South Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
| |
Collapse
|
42
|
Balsamo M, Cataldi F, Carlucci L, Padulo C, Fairfield B. Assessment of late-life depression via self-report measures: a review. Clin Interv Aging 2018; 13:2021-2044. [PMID: 30410319 PMCID: PMC6199213 DOI: 10.2147/cia.s178943] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Depression in later life is a significant and growing problem. Age-related differences in the type and severity of depressive disorders continue to be questioned and necessarily question differential methods of assessment and treatment strategies. A host of geropsychiatric measures have been developed for diagnostic purposes, for rating severity of depression, and monitoring treatment progress. This literature review includes the self-report depression measures commonly and currently used in geropsychological practice. Each of the included measures is considered according to its psychometric properties. In particular, information about reliability; convergent, divergent, and factorial validity evidence based on data from clinical and nonclinical samples of older adults; and availability of age-appropriate norms was provided along with the strengths and weaknesses of each measure. Results highlighted that in cognitively intact or mildly impaired patients over 65 years, the Geriatric Depression Scale and the Geriatric Depression Scale-15 currently seem to be the preferred instruments. The psychometric functioning of the Beck Depression Inventory-II and the Center for Epidemiological Studies Depression Scale, instead, is mixed in this population. Most importantly, this review may be a valuable resource for practicing clinicians and researchers who wish to develop state-of-the-science assessment strategies for clinical problems and make informed choices about which instruments best suit their purposes in older populations.
Collapse
Affiliation(s)
- Michela Balsamo
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health, University "G. d'Annunzio" of Chieti-Pescara, Italy,
| | - Fedele Cataldi
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health, University "G. d'Annunzio" of Chieti-Pescara, Italy,
| | - Leonardo Carlucci
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health, University "G. d'Annunzio" of Chieti-Pescara, Italy,
| | - Caterina Padulo
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health, University "G. d'Annunzio" of Chieti-Pescara, Italy,
| | - Beth Fairfield
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health, University "G. d'Annunzio" of Chieti-Pescara, Italy,
| |
Collapse
|
43
|
Faye C, McGowan JC, Denny CA, David DJ. Neurobiological Mechanisms of Stress Resilience and Implications for the Aged Population. Curr Neuropharmacol 2018; 16:234-270. [PMID: 28820053 PMCID: PMC5843978 DOI: 10.2174/1570159x15666170818095105] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/25/2017] [Accepted: 07/27/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Stress is a common reaction to an environmental adversity, but a dysregulation of the stress response can lead to psychiatric illnesses such as major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and anxiety disorders. Yet, not all individuals exposed to stress will develop psychiatric disorders; those with enhanced stress resilience mechanisms have the ability to adapt successfully to stress without developing persistent psychopathology. Notably, the potential to enhance stress resilience in at-risk populations may prevent the onset of stress-induced psychiatric disorders. This novel idea has prompted a number of studies probing the mechanisms of stress resilience and how it can be manipulated. METHODS Here, we review the neurobiological factors underlying stress resilience, with particular focus on the serotoninergic (5-HT), glutamatergic, and γ-Aminobutyric acid (GABA) systems, as well as the hypothalamic-pituitary axis (HPA) in rodents and in humans. Finally, we discuss stress resiliency in the context of aging, as the likelihood of mood disorders increases in older adults. RESULTS Interestingly, increased resiliency has been shown to slow aging and improved overall health and quality of life. Research in the neurobiology of stress resilience, particularly throughout the aging process, is a nascent, yet, burgeoning field. CONCLUSION Overall, we consider the possible methods that may be used to induce resilient phenotypes, prophylactically in at-risk populations, such as in military personnel or in older MDD patients. Research in the mechanisms of stress resilience may not only elucidate novel targets for antidepressant treatments, but also provide novel insight about how to prevent these debilitating disorders from developing.
Collapse
Affiliation(s)
- Charlène Faye
- CESP/UMR-S 1178, Univ. Paris-Sud, Fac Pharmacie, Inserm, Université Paris-Saclay, 92296 Chatenay-Malabry, France
| | - Josephine C. McGowan
- Doctoral Program in Neurobiology and Behavior, Columbia University, New York, NY, USA
| | - Christine A. Denny
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Integrative Neuroscience, New York State Psychiatric Institute/Research Foundation for Mental Hygiene, Inc., New York, NY, USA
| | - Denis J. David
- CESP/UMR-S 1178, Univ. Paris-Sud, Fac Pharmacie, Inserm, Université Paris-Saclay, 92296 Chatenay-Malabry, France
| |
Collapse
|
44
|
Ly M, Andreescu C. Advances and Barriers for Clinical Neuroimaging in Late-Life Mood and Anxiety Disorders. Curr Psychiatry Rep 2018; 20:7. [PMID: 29492705 DOI: 10.1007/s11920-018-0870-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Mood and anxiety disorders are very commonly experienced by older adults and are becoming a growing concern due to the rapidly aging global population. Recent advances in neuroimaging may help in improving outcomes in late-life mood and anxiety disorders. The elucidation of mechanisms contributing to late-life mental health disorders may ultimately lead to the identification of novel therapeutic interventions. Alternatively, clinically validated imaging biomarkers may allow for the prediction of treatment response and identification of better therapeutic approaches in late-life mood and anxiety disorders. RECENT FINDINGS In community samples, late-life depression and late-life generalized anxiety disorder occur up to 38 and 15%, respectively, while late-life bipolar disorder is less common and occur in approximately 0.5% of the population. There are significant challenges in treating and improving outcome in late-life mood and anxiety disorders. Time to treatment response and treatment resistance are increased in older adults. Novel neuroimaging techniques have the potential to improve diagnostic and therapeutic outcome in late-life mood and anxiety disorders either through "personalized pharmacotherapy" or through identifying dysfunction regions/networks to be subsequently used for direct interventions such as transcranial magnetic stimulation. This review will provide an overview of recent literature that substantiates the potential role of neuroimaging in clinical practice, as well as the barriers that must be overcome prior to clinical translation.
Collapse
Affiliation(s)
- Maria Ly
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, USA
| | - Carmen Andreescu
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, USA.
| |
Collapse
|
45
|
Camacho A, Tarraf W, Jimenez DE, Gallo LC, Gonzalez P, Kaplan RC, Lamar M, Khambaty T, Thyagarajan B, Perreira KM, Hernandez R, Cai J, Daviglus ML, Wassertheil-Smoller S, González HM. Anxious Depression and Neurocognition among Middle-Aged and Older Hispanic/Latino Adults: Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Results. Am J Geriatr Psychiatry 2018; 26:238-249. [PMID: 28684241 PMCID: PMC5752627 DOI: 10.1016/j.jagp.2017.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The purpose of this study is to examine the association between verbal learning, fluency, and processing speed with anxious depression symptomatology (ADS) among diverse Hispanics. We hypothesized an inverse association of anxious depression with neurocognition among Hispanics of different heritage. DESIGN Data are from the Hispanic Community Health Study/Study of Latinos. The sample included 9,311participants aged 45-74 years (mean: 56.5 years). A latent class analysis of items from the Center for Epidemiological Studies for Depression scale and the Spielberger Trait Anxiety Inventory was used to derive an anxious depression construct. Neurocognitive measures included scores on the Brief Spanish English Verbal Learning Test (B-SEVLT, learning and recall trials), Word Fluency (WF), Digit Symbol Substitution (DSS) test, and a Global Cognitive Score (GCS). We fit survey linear regression models to test the associations between anxious depression symptomatology and cognitive function. We tested for effect modification by sex, Hispanic heritage, and age groups. RESULTS Among men, 71.6% reported low, 23.3% moderate, and 5.1% high ADS. Among women, 55.1% reported low, 33.2% moderate, and 11.8% high ADS. After controlling for age, sex, sociodemographic characteristics, cardiovascular risk factors and disease, and antidepressant use, we found significant inverse associations between moderate and high anxious depression (ref:low) with B-SEVLT learning and recall, DSS and GCS. Moderate, but not high, anxious depression was inversely associated with WF. Associations were not modified by sex, Hispanic heritage, or age. CONCLUSIONS Increased anxious depression symptomatology is associated with decreased neurocognitive function among Hispanics. Longitudinal studies are needed to establish temporality and infer if negative emotional symptoms precede cognitive deficits.
Collapse
Affiliation(s)
- Alvaro Camacho
- Departments of Psychiatry, Family Medicine, and Public Health, University of California San Diego, San Diego, CA.
| | - Wassim Tarraf
- Institute of Gerontology and Department of Healthcare Sciences, Wayne State University, Detroit, MI
| | - Daniel E Jimenez
- Department of Psychiatry and Behavioral Sciences, Center of Aging, University of Miami, Miami, FL
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA
| | - Patricia Gonzalez
- Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Melissa Lamar
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL
| | | | | | - Krista M Perreira
- Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, NC
| | - Rosalba Hernandez
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Jianwen Cai
- Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, NC
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL
| | | | - Hector M González
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI
| |
Collapse
|
46
|
Bingham KS, Kumar S, Dawson DR, Mulsant BH, Flint AJ. A Systematic Review of the Measurement of Function in Late-Life Depression. Am J Geriatr Psychiatry 2018; 26:54-72. [PMID: 29050912 DOI: 10.1016/j.jagp.2017.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/17/2017] [Accepted: 08/11/2017] [Indexed: 12/11/2022]
Abstract
Recovery of everyday premorbid function is a primary goal in the treatment of depression. Measurement of function is an important part of achieving this goal. A multitude of scales have been used to measure function in depression, reflecting the complex, multifaceted nature of functioning. Currently, however, there are no evidence-based guidelines to assist the researcher or clinician in deciding which instruments are best suited to measure function in late-life depression (LLD). Thus, the aims of this study are to 1) systematically review and identify the instrumental activities of daily living and social functioning assessment instruments used in the LLD literature; 2) identify and appraise the measurement properties of these instruments; and 3) suggest factors for LLD researchers and clinicians to consider when selecting functional assessment instruments and make pertinent recommendations. We performed a systematic review of MEDLINE and CINAHL to identify studies that i) incorporated subjects aged 60 years and older with a depressive disorder, and ii) measured instrumental activities of daily living and/or social functioning. Our search yielded 21 functional assessment instruments. Only two of these instruments, the 36-Item Short Form Survey and the Performance Assessment of Self-Care Skills, have formal validation data in LLD. Four additional instruments, although not formally validated, have relevant data regarding their measurement properties. The primary finding of this study is that very few functional assessment instruments have been validated in LLD, and the available measurement property data are mixed; there is a need for further instrument validation in late-life depression. With this caveat in mind, we provide evidence-based suggestions for researchers and clinicians assessing functioning in LLD patients.
Collapse
Affiliation(s)
- Kathleen S Bingham
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| | - Sanjeev Kumar
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Deirdre R Dawson
- Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada; Rotman Research Institute, Baycrest, Ontario, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alastair J Flint
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
47
|
Langan C, Sarode DP, Russ TC, Shenkin SD, Carson A, Maclullich AMJ. Psychiatric symptomatology after delirium: a systematic review. Psychogeriatrics 2017; 17:327-335. [PMID: 28127828 DOI: 10.1111/psyg.12240] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/25/2016] [Accepted: 11/21/2016] [Indexed: 01/21/2023]
Abstract
Delirium is an acute and usually transient severe neuropsychiatric syndrome associated with significant long-term physical morbidity. However, its chronic psychiatric sequelae remain poorly characterized. To investigate the prevalence of psychiatric symptoms, namely anxiety, depressive, and post-traumatic stress disorder (PTSD) symptoms after delirium, a systematic literature search of MEDLINE, EMBASE and PsycINFO databases was performed independently by two authors in March 2016. Bibliographies were hand-searched, and a forward- and backward-citation search using Web of Science was performed for all included studies. Of 6411 titles, we included eight prospective cohort studies, including 370 patients with delirium and 1073 without delirium. Studies were heterogeneous and mostly included older people from a range of clinical groups. Consideration of confounders was variable. The prevalence of depressive symptoms was almost three times higher in patients with delirium than in patients without delirium (22.2% vs 8.0%, risk ratio = 2.79; 95% confidence interval = 1.36-5.73). There was no statistically significant difference between the prevalence of anxiety symptoms between patients with and without delirium. The prevalence of PTSD symptoms after delirium was inconclusive: only one study investigated this and no association between PTSD symptoms after delirium was reported. There is limited published evidence of the prevalence of psychiatric symptoms after non-ICU delirium and the strongest evidence is for depressive symptoms. Further longitudinal studies are warranted to investigate the prevalence of anxiety and PTSD symptoms.
Collapse
Affiliation(s)
- Clare Langan
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Deep P Sarode
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Tom C Russ
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Susan D Shenkin
- Edinburgh Delirium Research Group, Geriatric Medicine, University of Edinburgh, Edinburgh, UK.,Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alasdair M J Maclullich
- Edinburgh Delirium Research Group, Geriatric Medicine, University of Edinburgh, Edinburgh, UK.,Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
48
|
Kong XM, Xu SX, Sun Y, Wang KY, Wang C, Zhang J, Xia JX, Zhang L, Tan BJ, Xie XH. Electroconvulsive therapy changes the regional resting state function measured by regional homogeneity (ReHo) and amplitude of low frequency fluctuations (ALFF) in elderly major depressive disorder patients: An exploratory study. Psychiatry Res Neuroimaging 2017; 264:13-21. [PMID: 28412557 DOI: 10.1016/j.pscychresns.2017.04.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 04/06/2017] [Accepted: 04/06/2017] [Indexed: 02/07/2023]
Abstract
Electroconvulsive therapy (ECT) is the most effective and rapid treatment for severe major depressive disorder (MDD) in elderly patients. The mechanism of ECT is unclear, and studies on ECT in elderly MDD patients by resting-state functional magnetic resonance imaging are rare. Thirteen elderly MDD patients were scanned before and after ECT using a 3.0T MRI scanner. Regional homogeneity (ReHo) and amplitude of low-frequency fluctuations (ALFF) were processed to compare resting-state function before and after treatment. Depression and anxiety symptoms of all patients abated after ECT. Decreased ReHo values in the bilateral superior frontal gyrus (SFG) were observed after ECT, and the values of right SFG significantly correlated with an altered Hamilton depression rating scale score. Increased ALFF values in the left middle frontal gyrus, right middle frontal gyrus, orbital part, and decreased ALFF values in the left midcingulate area, left precentral gyrus, right SFG/middle frontal gyrus after ECT were also observed. These results support the hypothesis that ECT may affect the regional resting state brain function in geriatric MDD patients.
Collapse
Affiliation(s)
- Xiao-Ming Kong
- Department of psychiatry, Anhui Mental Health Center, Hefei, China
| | - Shu-Xian Xu
- Department of psychiatry, Huizhou 2nd Municipal Hospital, Huizhou, China; Department of psychiatry, Anhui Medical University, Hefei, China
| | - Yan Sun
- Department of endocrinology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ke-Yong Wang
- Department of psychiatry, Anhui Mental Health Center, Hefei, China.
| | - Chen Wang
- Department of psychiatry, Anhui Mental Health Center, Hefei, China; Department of psychiatry, Anhui Medical University, Hefei, China
| | - Ji Zhang
- Department of magnetic resonance imaging, Hefei 2nd Municipal Hospital, Hefei, China
| | - Jin-Xiang Xia
- Department of magnetic resonance imaging, Hefei 2nd Municipal Hospital, Hefei, China
| | - Li Zhang
- Department of psychiatry, Anhui Mental Health Center, Hefei, China
| | - Bo-Jian Tan
- Department of psychiatry, Huizhou 2nd Municipal Hospital, Huizhou, China
| | - Xin-Hui Xie
- Department of psychiatry, Anhui Mental Health Center, Hefei, China; Department of psychiatry, Huizhou 2nd Municipal Hospital, Huizhou, China; Department of psychiatry, Anhui Medical University, Hefei, China.
| |
Collapse
|
49
|
Cristancho P, O’Connor B, Lenze EJ, Blumberger DM, Reynolds CF, Dixon D, Mulsant BH. Treatment Emergent Suicidal Ideation in depressed older adults. Int J Geriatr Psychiatry 2017; 32:596-604. [PMID: 27162147 PMCID: PMC5102819 DOI: 10.1002/gps.4498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/08/2016] [Accepted: 04/12/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Treatment-Emergent Suicidal Ideation (TESI) in older adults is poorly understood. We characterized TESI in older depressed adults during treatment with venlafaxine and explored whether TESI is related to antidepressant exposure versus dimensions of the psychiatric illness. We examined the relationship among medication exposure, onset of TESI, and clinical characteristics. METHODS We analyzed data on 233 clinical trial participants with major depression and no baseline suicidal ideation who were treated for up to 12 weeks with venlafaxine XR (target dose: 150-300 mg/day). Suicidal ideation was assessed weekly with the Scale for Suicide Ideation. A Kaplan-Meier curve displayed the time course of TESI. Differences in baseline demographic and clinical variables between the TESI and Non-TESI groups were assessed with analyses of covariance or logistic regression. A final multivariate logistic regression model indicated baseline predictors of TESI. Depression treatment outcomes in subjects developing TESI versus those who did not were examined with a mixed effects model. RESULTS TESI occurred in 10% of participants, typically with onset within 4 weeks of the start of treatment. Anxiety, and depression severity at baseline were predictors of TESI. Most TESI was mild and transient, with 6/233 participants having TESI considered clinically meaningful. TESI was not associated with venlafaxine blood levels or side effects. CONCLUSIONS In older depressed adults, TESI is relatively uncommon and it is likely related to the underlying illness rather than to a medication adverse effect. This suggests that TESI requires continuing rather than discontinuing antidepressant treatment. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Pilar Cristancho
- Department of Psychiatry, Healthy Mind Lab, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Brendan O’Connor
- Department of Psychiatry, Healthy Mind Lab, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Eric J Lenze
- Department of Psychiatry, Healthy Mind Lab, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | | | | | - David Dixon
- Department of Psychiatry, Healthy Mind Lab, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health, University of Toronto, Toronto, CA
| |
Collapse
|
50
|
Abstract
BACKGROUND Impairments in psychosocial status and cognition relate to poor clinical outcomes in patients with atrial fibrillation (AF). However, how often these conditions co-occur and associations between burden of psychosocial and cognitive impairment and quality of life (QoL) have not been systematically examined in patients with AF. METHODS A total of 218 patients with symptomatic AF were enrolled in a prospective study of AF and psychosocial factors between May 2013 and October 2014 at the University of Massachusetts Medical Center. Cognitive function, depression, and anxiety were assessed at baseline and AF-specific QoL was assessed 6 months after enrollment using validated instruments. Demographic and clinical information were obtained from a structured interview and medical record review. RESULTS The mean age of the study participants was 63.5 ± 10.2 years, 35% were male, and 81% had paroxysmal AF. Prevalences of impairment in 1, 2, and 3 psychosocial/cognitive domains (eg, depression, anxiety, or cognition) were 75 (34.4%), 51 (23.4%), and 16 (7.3%), respectively. Patients with co-occurring psychosocial/cognitive impairments (eg, >1 domain) were older, more likely to smoke, had less education, and were more likely to have heart failure (all P < 0.05). Compared with participants with no psychosocial/cognitive impairments, AF-specific QoL at 6 months was significantly poorer among participants with baseline impairment in 2 (B = -13.6, 95% CI: -21.7 to -5.4) or 3 (B = -15.1, 95% CI: -28.0 to -2.2) psychosocial/cognitive domains. CONCLUSION Depression, anxiety, and impaired cognition were common in our cohort of patients with symptomatic AF and often co-occurred. Higher burden of psychosocial/cognitive impairment was associated with poorer AF-specific QoL.
Collapse
|