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Plas X, Bruinsma B, van Lissa CJ, Vermetten E, van Lutterveld R, Geuze E. Long-term trajectories of depressive symptoms in deployed military personnel: A 10-year prospective study. J Affect Disord 2024; 354:702-711. [PMID: 38537760 DOI: 10.1016/j.jad.2024.03.139] [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: 12/21/2023] [Revised: 03/07/2024] [Accepted: 03/24/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Military missions, especially those involving combat exposure, are associated with an increased risk of depression. Understanding the long-term course of depressive symptoms post-deployment is important to improve decision-making regarding deployment and mental health policies in the military. This study investigates trajectories of depressive symptoms in the Dutch army, exploring the influence of factors such as demographics, early-life trauma, posttraumatic stress disorder (PTSD) symptoms, and deployment stressors. METHODS A cohort of 1032 military men and women deployed to Afghanistan (2005-2008) was studied from pre- to 10 years post-deployment. Depressive and PTSD symptoms were assessed using the Symptom CheckList-90 and the Self-Rating Inventory for PTSD. Demographics, early trauma, and deployment experiences were collected at baseline and after deployment, respectively. Latent Class Growth Analysis was used to explore heterogeneity in trajectories of depressive symptoms over time. RESULTS Four trajectories were found: resilient (65%), intermediate-stable (20%), symptomatic-chronic (9%), and late-onset-increasing (6%). The resilient group experienced fewer deployment stressors, while the symptomatic-chronic group reported more early life traumas. Trajectories with elevated depressive symptoms consistently demonstrated higher PTSD symptoms. LIMITATIONS Potential nonresponse bias and missing information due to the longitudinal design and extensive follow-up times. CONCLUSIONS This study identified multiple trajectories of depressive symptoms in military personnel up to 10 years post-deployment, associated with early trauma, deployment stressors, adverse life events and PTSD symptoms. The prevalence of the resilient trajectory suggests a substantial level of resilience among deployed military personnel. These findings provide valuable insights and a foundation for further research.
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Affiliation(s)
- Xandra Plas
- Department of Psychiatry, University Medical Centre Utrecht Brain Centre, Utrecht, the Netherlands; Brain Research and Innovation Centre, Ministry of Defence, Utrecht, the Netherlands.
| | - Bastiaan Bruinsma
- Department of Psychiatry, University Medical Centre Utrecht Brain Centre, Utrecht, the Netherlands; Brain Research and Innovation Centre, Ministry of Defence, Utrecht, the Netherlands
| | - Caspar J van Lissa
- Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | - Remko van Lutterveld
- Department of Psychiatry, University Medical Centre Utrecht Brain Centre, Utrecht, the Netherlands; Brain Research and Innovation Centre, Ministry of Defence, Utrecht, the Netherlands
| | - Elbert Geuze
- Department of Psychiatry, University Medical Centre Utrecht Brain Centre, Utrecht, the Netherlands; Brain Research and Innovation Centre, Ministry of Defence, Utrecht, the Netherlands
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Capodilupo G, Blattner R, Must A, Navarro SG, Opler M. A qualitative investigation of the Montgomery-Åsberg depression rating scale: discrepancies in rater perceptions and data trends in remote assessments of rapid-acting antidepressants in treatment resistant depression. Front Psychiatry 2024; 15:1289630. [PMID: 38751415 PMCID: PMC11094466 DOI: 10.3389/fpsyt.2024.1289630] [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: 09/06/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Despite the development of many successful pharmaceutical interventions, a significant subset of patients experience treatment-resistant depression (TRD). Ketamine and its derivatives constitute a novel therapeutic approach to treat TRD; however, standard tools, such as the Montgomery-Åsberg Depression Rating Scale (MADRS) are still being used to measure symptoms and track changes. Methods The aim of this study was to review item-level differences between rate of data change (MADRS score) and rater-weighted perception of the most useful items for assessing change in symptoms while remotely conducting the 10-item version of the MADRS in TRD in a clinical trial of rapid-acting antidepressants. Two studies of rapid-acting antidepressants in the treatment of TRD were used to identify item-scoring trends when MADRS is administered remotely and repeatedly (733 subjects across 10 visits). Scoring trends were evaluated in tandem to a rater survey completed by 75 raters. This was completed to gain insight on MADRS items' perceived level of helpfulness when assessing change of symptoms in rapid-acting antidepressant trials. Results MADRS items 'Reduced sleep', 'Apparent sadness', and 'Pessimistic thoughts' were found to have the greatest average data change by visit, while raters ranked 'Reported sadness', 'Lassitude' and 'Apparent sadness' as the most helpful items when assessing symptom change. Discussion The diversion between rate of data-change ranking and rater perception of helpfulness could be related to difficulty in assessing specific items, to the novel treatment itself, and/or to the sensitivity to symptom change to which raters are accustomed in traditional antidepressant treatments.
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Affiliation(s)
| | - Raymond Blattner
- WCG Clinical Endpoint Solutions, Princeton, NJ, United States
- Seton Hall University, South Orange, NJ, United States
| | - Anita Must
- WCG Clinical Endpoint Solutions, Princeton, NJ, United States
- Department of Psychiatry, Whanganui District Health Board, Whanganui, New Zealand
| | - Silvia Gamazo Navarro
- WCG Clinical Endpoint Solutions, Princeton, NJ, United States
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Mark Opler
- WCG Clinical Endpoint Solutions, Princeton, NJ, United States
- The PANSS Institute, New York, NY, United States
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Dimitropoulos G, Bassi EM, Bright KS, Gondziola J, Bradley J, Fersovitch M, Stamp L, LaMonica HM, Iorfino F, Gaskell T, Tomlinson S, Johnson DW. Implementation of an Electronic Mental Health Platform for Youth and Young Adults in a School Context Across Alberta, Canada: Thematic Analysis of the Perspectives of Stakeholders. JMIR Ment Health 2024; 11:e49099. [PMID: 38231558 PMCID: PMC10831665 DOI: 10.2196/49099] [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: 05/31/2023] [Revised: 11/06/2023] [Accepted: 12/01/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Youth, aged 15 to 24 years, are more likely to experience mental health (MH) or substance use issues than other age groups. This is a critical period for intervention because MH disorders, if left unattended, may become chronic and serious and negatively affect many aspects of a young person's life. Even among those who are treated, poor outcomes will still occur for a percentage of youth. Electronic MH (eMH) tools have been implemented in traditional MH settings to reach youth requiring assistance with MH and substance use issues. However, the utility of eMH tools in school settings has yet to be investigated. OBJECTIVE The objective of this study was to gain an understanding of the perspectives of key school staff stakeholders regarding barriers and facilitators to the implementation of the Innowell eMH platform in secondary schools across the province of Alberta, Canada. METHODS Guided by a qualitative descriptive approach, focus groups were conducted to elicit stakeholder perspectives on the perceived implementation challenges and opportunities of embedding the Innowell eMH platform in secondary school MH services. In total, 8 focus groups were conducted with 52 key school staff stakeholders. RESULTS Themes related to barriers and facilitators to youth and school MH care professional (MHCP) capacity in implementing and using eMH tools were identified. With respect to youth capacity barriers, the following themes were inductively generated: (1) concerns about some students not being suitable for eMH services, (2) minors requiring consent from parents or caregivers to use eMH services as well as confidentiality and privacy concerns, and (3) limited access to technology and internet service among youth. A second theme related to school MHCP barriers to implementation, which included (1) feeling stretched with high caseloads and change fatigue, (2) concerns with risk and liability, and (3) unmasking MH issues in the face of limited resources. In contrast to the barriers to youth and MHCP capacity, many facilitators to implementation were discussed. Youth capacity facilitators included (1) the potential for youth to be empowered using eMH tools, (2) the platform fostering therapeutic relationships with school personnel, and (3) enhancing access to needed services and resources. MHCP capacity facilitators to implementation were (1) system transformation through flexibility and problem-solving, (2) opportunities for collaboration with youth and MHCPs and across different systems, and (3) an opportunity for the continuity of services. CONCLUSIONS Our findings highlight nuanced school MHCP perspectives that demonstrate critical youth and MHCP capacity concerns, with consideration for organizational factors that may impede or enhance the implementation processes for embedding eMH in a school context. The barriers and facilitators to implementation provide future researchers and decision makers with challenges and opportunities that could be addressed in the preimplementation phase.
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Affiliation(s)
- Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
- Calgary Eating Disorders Program, Alberta Health Services, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Emilie M Bassi
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Katherine S Bright
- School of Nursing and Midwifery, Faculty of Health, Community, and Education, Mount Royal University, Calgary, AB, Canada
- Heroes in Mind, Advocacy, and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jason Gondziola
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - Jessica Bradley
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - Melanie Fersovitch
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - Leanne Stamp
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | | | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Tanya Gaskell
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - Sara Tomlinson
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - David Wyatt Johnson
- Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada
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Sellers KK, Cohen JL, Khambhati AN, Fan JM, Lee AM, Chang EF, Krystal AD. Closed-loop neurostimulation for the treatment of psychiatric disorders. Neuropsychopharmacology 2024; 49:163-178. [PMID: 37369777 PMCID: PMC10700557 DOI: 10.1038/s41386-023-01631-2] [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: 03/07/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
Despite increasing prevalence and huge personal and societal burden, psychiatric diseases still lack treatments which can control symptoms for a large fraction of patients. Increasing insight into the neurobiology underlying these diseases has demonstrated wide-ranging aberrant activity and functioning in multiple brain circuits and networks. Together with varied presentation and symptoms, this makes one-size-fits-all treatment a challenge. There has been a resurgence of interest in the use of neurostimulation as a treatment for psychiatric diseases. Initial studies using continuous open-loop stimulation, in which clinicians adjusted stimulation parameters during patient visits, showed promise but also mixed results. Given the periodic nature and fluctuations of symptoms often observed in psychiatric illnesses, the use of device-driven closed-loop stimulation may provide more effective therapy. The use of a biomarker, which is correlated with specific symptoms, to deliver stimulation only during symptomatic periods allows for the personalized therapy needed for such heterogeneous disorders. Here, we provide the reader with background motivating the use of closed-loop neurostimulation for the treatment of psychiatric disorders. We review foundational studies of open- and closed-loop neurostimulation for neuropsychiatric indications, focusing on deep brain stimulation, and discuss key considerations when designing and implementing closed-loop neurostimulation.
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Affiliation(s)
- Kristin K Sellers
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Joshua L Cohen
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Ankit N Khambhati
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Joline M Fan
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, CA, USA
| | - A Moses Lee
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Andrew D Krystal
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.
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McDaniel BT, Cornet V, Carroll J, Chrones L, Chudzik J, Cochran J, Guha S, Lawrence DF, McCue M, Sarkey S, Lorenz B, Fawver J. Real-world clinical outcomes and treatment patterns in patients with MDD treated with vortioxetine: a retrospective study. BMC Psychiatry 2023; 23:938. [PMID: 38093196 PMCID: PMC10720213 DOI: 10.1186/s12888-023-05439-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND This study included evaluation of the effectiveness of vortioxetine, a treatment for adults with major depressive disorder (MDD), using patient-reported outcome measures (PROMs) in a real-world setting. METHODS This retrospective chart review analyzed the care experiences of adult patients with a diagnosis of MDD from Parkview Physicians Group - Mind-Body Medicine, Midwestern United States. Patients with a prescription for vortioxetine, an initial baseline visit, and ≥ 2 follow-up visits within 16 weeks from September 2014 to December 2018 were included. The primary outcome measure was effectiveness of vortioxetine on depression severity as assessed by change in Patient Health Questionnaire-9 (PHQ-9) scores ~ 12 weeks after initiation of vortioxetine. Secondary outcomes included changes in depression-related symptoms (i.e., sexual dysfunction, sleep disturbance, cognitive function, work/social function), clinical characteristics, response, remission, and medication persistence. Clinical narrative notes were also analyzed to examine sleep disturbance, sexual dysfunction, appetite, absenteeism, and presenteeism. All outcomes were examined at index (start of vortioxetine) and at ~ 12 weeks, and mean differences were analyzed using pairwise t tests. RESULTS A total of 1242 patients with MDD met inclusion criteria, and 63.9% of these patients had ≥ 3 psychiatric diagnoses and 65.9% were taking ≥ 3 medications. PHQ-9 mean scores decreased significantly from baseline to week 12 (14.15 ± 5.8 to 9.62 ± 6.03, respectively; p < 0.001). At week 12, the response and remission rates in all patients were 31.0% and 23.1%, respectively, and 67% continued vortioxetine treatment. Overall, results also showed significant improvements by week 12 in anxiety (p < 0.001), sexual dysfunction (p < 0.01), sleep disturbance (p < 0.01), cognitive function (p < 0.001), work/social functioning (p = 0.021), and appetite (p < 0.001). A significant decrease in presenteeism was observed at week 12 (p < 0.001); however, no significant change was observed in absenteeism (p = 0.466). CONCLUSIONS Using PROMs, our study results suggest that adults with MDD prescribed vortioxetine showed improvement in depressive symptoms in the context of a real-world clinical practice setting. These patients had multiple comorbid psychiatric and physical diagnoses and multiple previous antidepressant treatments had failed.
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Affiliation(s)
- Brandon T McDaniel
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
| | - Victor Cornet
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
| | - Jeanne Carroll
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
| | | | - Joseph Chudzik
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
| | - Jeanette Cochran
- Parkview Physicians Group - Mind-Body Medicine, Fort Wayne, IN, US
| | - Shion Guha
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
- Faculty of Information, Department of Computer Science, University of Toronto, Toronto, ON, Canada
| | | | - Maggie McCue
- Takeda Pharmaceuticals U.S.A., Inc, Lexington, MA, US
| | - Sara Sarkey
- Takeda Pharmaceuticals U.S.A., Inc, Lexington, MA, US
| | - Betty Lorenz
- Takeda Pharmaceuticals U.S.A., Inc, Lexington, MA, US
| | - Jay Fawver
- Parkview Physicians Group - Mind-Body Medicine, Fort Wayne, IN, US.
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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.
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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
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Strege MV, Siegle GJ, Richey JA, Krawczak RA, Young K. Cingulate prediction of response to antidepressant and cognitive behavioral therapies for depression: Meta-analysis and empirical application. Brain Imaging Behav 2023; 17:450-460. [PMID: 36622532 PMCID: PMC10329727 DOI: 10.1007/s11682-022-00756-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/26/2022] [Accepted: 12/16/2022] [Indexed: 01/10/2023]
Abstract
We sought to identify baseline (pre-treatment) neural markers associated with treatment response in major depressive disorder (MDD), specific to treatment type, Cognitive Behavioral Therapy (CBT) or pharmacotherapy (selective serotonin reuptake inhibitors; SSRI). We conducted a meta-analysis of functional magnetic resonance imaging (fMRI) studies to identify neural prognostic indicators of response to CBT or SSRI. To verify the regions derived from literature, the meta-analytic regions were used to predict clinical change in a verification sample of participants with MDD who received either CBT (n = 60) or an SSRI (n = 19) as part of prior clinical trials. The meta-analysis consisted of 21 fMRI studies that used emotion-related tasks. It yielded prognostic regions of the perigenual (meta pgACC) and subgenual anterior cingulate cortex (meta sgACC), associated with SSRI and CBT response, respectively. When applying the meta-analytic regions to predict treatment response in the verification sample, reactivity of the meta pgACC was prognostic for SSRI response, yet the effect direction was opposite of most prior studies. Meta sgACC reactivity failed to be prognostic for CBT response. Results confirm the prognostic potential of neural reactivity of ACC subregions in MDD but further research is necessary for clinical translation.
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Affiliation(s)
- Marlene V Strege
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, United States.
| | - Greg J Siegle
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, United States
| | - John A Richey
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, United States
| | | | - Kymberly Young
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, United States
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Mayes TL, Deane AE, Aramburu H, Yagnik K, Trivedi MH. Improving Identification and Treatment Outcomes of Treatment-Resistant Depression Through Measurement-Based Care. Psychiatr Clin North Am 2023; 46:227-245. [PMID: 37149342 DOI: 10.1016/j.psc.2023.02.002] [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: 05/08/2023]
Abstract
Measurement-based care (MBC) is the systematic screening and ongoing assessment of symptoms, side effects, and adherence to adjust treatments as needed based on these factors. Studies show MBC leads to improved outcomes for depression and treatment-resistant depression (TRD). In fact, MBC may reduce the chances of developing TRD, as it leads to optimized treatment strategies based on symptom changes and compliance. There are many rating scales available for monitoring depressive symptoms, side effects, and adherence. These rating scales can be used in a variety of clinical settings to help guide treatment decisions, including depression treatment decisions.
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Affiliation(s)
- Taryn L Mayes
- Center for Depression Research and Clinical, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas, 75390-9119, USA
| | - Amber E Deane
- Center for Depression Research and Clinical, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas, 75390-9119, USA
| | - Hayley Aramburu
- Center for Depression Research and Clinical, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas, 75390-9119, USA
| | - Kush Yagnik
- Center for Depression Research and Clinical, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas, 75390-9119, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas, 75390-9119, USA.
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Atashipour HS, Momeni F, Dolatshahi B, Mirnaseri MS. Effectiveness of memory bias modification in reducing depression and rumination symptoms and autobiographical memory bias: a pilot study. Front Psychol 2023; 14:1145259. [PMID: 37292497 PMCID: PMC10244539 DOI: 10.3389/fpsyg.2023.1145259] [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: 01/15/2023] [Accepted: 04/27/2023] [Indexed: 06/10/2023] Open
Abstract
There is a strong interest in cognitive bias modification as a new intervention that targets key underlying vulnerability factors of depression. Memory bias is believed to be a risk factor for the onset and maintenance of depression. In this study, we aimed to examine the effectiveness of memory bias modification on depression symptoms, ruminative thoughts, and autobiographical memory bias. We recruited 40 participants with mild depression who were randomly assigned to two groups of positive (n = 20) and neutral (n = 20) training. The participants were instructed to read and learn French-paired words with their Farsi translations. Next, they were encouraged to recall positive or neutral Farsi translations of French words according to their groups in the first session. After training, and in the second session (follow-up), they were asked to recall all the Farsi translations of the French words. Data were collected using Beck Depression Inventory II (BDI-II), Rumination Response Scale (RRS), Self-Referent Encoding Task (SRET). Analysis of covariance (ANCOVA) and logistic regression were used to analyze the data. Repeated retrieval practices resulted in better recall of the target words of the training in both conditions. Still, none of the groups had significant changes in depression scores, ruminative thoughts, and emotional aspects of memory bias. Our results suggest that two sessions of modifying memory biases were not sufficient for reducing the symptoms of depression and rumination. Implications of the finding from this study for future works are further discussed.
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Affiliation(s)
- Haniyeh Sadat Atashipour
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fereshte Momeni
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Behrooz Dolatshahi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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10
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Hart KL, McCoy TH, Henry ME, Seiner SJ, Luccarelli J. Factors associated with early and late response to electroconvulsive therapy. Acta Psychiatr Scand 2023; 147:322-332. [PMID: 36744383 PMCID: PMC10038910 DOI: 10.1111/acps.13537] [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: 10/18/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is an effective treatment for severe depressive symptoms, yet more research is needed to examine predictors of treatment response, and factors associated with response in patients not initially improving with treatment. This study reports factors associated with time to response (early vs. late) to ECT in a real-world setting. METHODS This was a retrospective, single-center cohort study of patients endorsing moderate to severe depressive symptoms using the Quick Inventory of Depressive Symptomatology (QIDS; QIDS>10). Response was defined as 50% or greater decrease in QIDS score from baseline. We used logistic regression to predict response at treatment #5 (early response) as well as after treatment #5 (late response) and followed patients through ECT discontinuation or through treatment #20. RESULTS Of the 1699 patients included in this study, 555 patients (32.7%) responded to ECT treatment at treatment #5 and 397 (23.4%) responded after treatment #5. Among patients who did not respond by treatment #5, those who switched to brief pulse width ECT from ultrabrief pulse ECT had increased odds of response after treatment #5 compared with patients only receiving ultrabrief pulse (aOR = 1.55, 95% CI: 1.16-2.07). Additionally, patients with less improvement in QIDS from baseline to treatment #5 had decreased odds of response after treatment #5 (aOR = 0.97, 95% CI = 0.97-0.98). CONCLUSION Among depressed patients treated with ECT, response occurred in 56.0% of patients by treatment #20. Patient receiving ultrabrief pulse ECT at baseline and who did not respond by treatment #5 had greater odds of subsequent response if switched to brief pulse ECT than if continued with ultrabrief pulse.
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Affiliation(s)
| | - Thomas H. McCoy
- Harvard Medical School, 25 Shattuck Street, Boston MA
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston MA
| | - Michael E. Henry
- Harvard Medical School, 25 Shattuck Street, Boston MA
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston MA
| | - Stephen J. Seiner
- Harvard Medical School, 25 Shattuck Street, Boston MA
- Department of Psychiatry, McLean Hospital, 115 Mill Street, Belmont MA
| | - James Luccarelli
- Harvard Medical School, 25 Shattuck Street, Boston MA
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston MA
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11
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Ham J, Kim HE, Kim JJ, Seok JH, Kim E, Park JY, Lee B, Oh J. Differential relationship of observer-rated and self-rated depression and anxiety scales with heart rate variability features. Front Psychiatry 2023; 14:1124550. [PMID: 37077280 PMCID: PMC10109339 DOI: 10.3389/fpsyt.2023.1124550] [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: 12/15/2022] [Accepted: 03/13/2023] [Indexed: 04/21/2023] Open
Abstract
Heart rate variability (HRV) is a known psychophysiological marker for diverse psychiatric symptoms. In this study, we aimed to explore the potential for clinical use of HRV by investigating the interrelationship between HRV indices and clinical measures mainly used to assess depressive and anxious symptoms. Participants who reported depressive and anxious symptoms were designated into the following groups: group 1, clinician-rated and self-rated depression; group 2, only self-rated depression; group 3, clinician-rated and self-rated anxiety; group 4, only self-rated anxiety. Statistical comparisons were performed between these groups to investigate the association between HRV and clinical measures. As a result, HRV variables showed significant correlations only with the clinician-rated assessments. Moreover, both time and frequency domain HRV indices were significantly different between groups 1 and 2, but groups 3 and 4 showed significant differences only in frequency domain HRV indices. Our study showed that HRV is an objective indicator for depressive or anxious symptoms. Additionally, it is considered a potential indicator for predicting the severity or state of depressive symptoms rather than of anxious symptoms. This study will contribute to increasing the diagnostic utility of discriminating those symptoms based on HRV in the future.
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Affiliation(s)
- Jinsil Ham
- Department of Biomedical Science and Engineering (BMSE), Gwangju Institute of Science and Technology (GIST), Gwangju, Republic of Korea
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hesun Erin Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, 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
| | - Boreom Lee
- Department of Biomedical Science and Engineering (BMSE), Gwangju Institute of Science and Technology (GIST), Gwangju, Republic of Korea
- *Correspondence: Boreom Lee,
| | - 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
- Jooyoung Oh,
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12
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Wittekind DA, Kratzsch J, Biemann R, Mergl R, Riedel-Heller S, Witte V, Villringer A, Kluge M. Association Between Self-rating Depression Scores and Total Ghrelin and Adipokine Serum Levels in a Large Population-Based Sample. Front Psychiatry 2022; 13:891325. [PMID: 35633817 PMCID: PMC9130496 DOI: 10.3389/fpsyt.2022.891325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Ghrelin and the adipokines leptin and adiponectin have been suggested to be involved in mood and anxiety regulation and to be altered in affective disorders. However, studies investigating the association between ghrelin, leptin and adiponectin and depressive symptomatology are scarce but might contribute to a better understanding of their involvement in mood regulation. We thus aimed investigating the association between depressive symptomatology and total ghrelin as well as leptin and adiponectin serum levels in a large population-based sample. Methods Total serum ghrelin, adiponectin and leptin levels were determined in 1666 subjects of a population-based cross-sectional study ("LIFE"). The Center for Epidemiological Studies Depression Scale (CES-D) and the Inventory of Depressive Symptoms - Self Rating (IDS-SR) were administered. Multiple linear regression analyses were conducted to examine the association between total serum ghrelin, leptin and adiponectin and the intensity of depressive symptoms. Results In the total sample (n = 1,092), neither ghrelin nor leptin or adiponectin serum levels showed a significant association with CES-D or IDS-SR sum scores (N = 1,092) or in depressed/non-depressed subjects. Leptin serum levels showed a significantly positive association with IDS-SR sum scores in elderly men (≥60 years; β = 0.122, 95% CI: 0.009; 0.236; p = 0.035). Conclusion Our study suggests that peripheral levels of ghrelin and adipokines in a cross-sectional study design might not be sufficient to measure their involvement in depression, suggesting that associations are more complex and multi-layered.
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Affiliation(s)
| | - Jürgen Kratzsch
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Ronald Biemann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Roland Mergl
- Institute of Psychology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Steffi Riedel-Heller
- Faculty of Medicine, Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Veronika Witte
- Department of Neurology, Max Planck Institute for Cognitive and Brain Sciences, Leipzig, Germany
| | - Arno Villringer
- Department of Neurology, Max Planck Institute for Cognitive and Brain Sciences, Leipzig, Germany
| | - Michael Kluge
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
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13
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Individual response to electroconvulsive therapy is not correlated between multiple treatment courses. J Affect Disord 2022; 298:256-261. [PMID: 34742999 PMCID: PMC8709707 DOI: 10.1016/j.jad.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/24/2021] [Accepted: 11/02/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) effectively treats depressive disorders, but many patients will have subsequent relapses. While some guidelines suggest prior response to ECT is an indication for ECT in a subsequent mood episode, it is unknown whether response to ECT is correlated between treatment courses. This study explores whether response to ECT at a first treatment correlates with response to treatment in a second independent ECT course. METHODS Single-center retrospective cohort of patients receiving two different ECT treatment courses between 2011 and 2020 and who self-reported depression symptoms using the Quick Inventory of Depressive Symptomatology (QIDS) at baseline and following treatment #5. RESULTS 286 patients received two independent ECT series during the study period, of whom 153 received at least 5 treatments in both series. Patients had similar QIDS scores at the start of each treatment series (Pearson's correlation, r = 0.58, p <0.001), but the change in QIDS following 5 ECT treatments was not correlated between series for individual patients (Pearson's correlation, r = 0.083, p = 0.31). In multivariate analyses, change in QIDS was similar for both treatment series, but patients were less likely to receive 5 treatments in the second treatment series. LIMITATIONS retrospective cohort cannot control for factors influencing access to repeat ECT treatment CONCLUSIONS: While on average final QIDS score was the same following two independent treatment courses, for individual patients the change in depression symptoms was not correlated between treatment series. Further research is needed to identify factors that may predict longitudinal ECT response.
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14
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Aas M, Ueland T, Mørch RH, Laskemoen JF, Lunding SH, Reponen EJ, Cattaneo A, Agartz I, Melle I, Steen NE, Andreassen OA. Physical activity and childhood trauma experiences in patients with schizophrenia or bipolar disorders. World J Biol Psychiatry 2021; 22:637-645. [PMID: 33779484 DOI: 10.1080/15622975.2021.1907707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Physical activity promotes resilience and reduces stress. Here we aimed to clarify the impact of physical activity and childhood trauma experiences on current mood and cognitive function in patients with schizophrenia (SZ) or bipolar disorders (BD). METHODS Three-hundred-and-six patients with DSM-IV schizophrenia (SZ) or bipolar disorder (BD) were included in the study. Diagnoses were assessed using the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Physical activity was measured as hours spent on any regular physical activity per week. All patients underwent a neuropsychological test battery. History of Childhood trauma was assessed using the Childhood Trauma Questionnaire and mood symptoms were assessed with the Inventory of Depressive Symptoms. RESULTS Patients with childhood trauma who were physically inactive (˂90 min per week) had the most severe clinical profile, characterised by the highest depressive symptoms (p ˂ 0.001) and lowest performance on working memory tasks (p ˂ 0.001). Among patients with childhood trauma, those who were physically active (≥90 min per week) had better working memory performance than physically inactive patients (p = 0.02). DISCUSSION A history of childhood trauma was associated with poorer working memory and more depressive symptoms only in patients who were physically inactive, suggesting a possible protective factor of physical activity in severe mental disorder.
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Affiliation(s)
- Monica Aas
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torill Ueland
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Ragni H Mørch
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | - Elina J Reponen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Annamaria Cattaneo
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Ingrid Agartz
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.,Department of Clinical Neuroscience, Centre of Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nils E Steen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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15
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von Glischinski M, von Brachel R, Thiele C, Hirschfeld G. Not sad enough for a depression trial? A systematic review of depression measures and cut points in clinical trial registrations. J Affect Disord 2021; 292:36-44. [PMID: 34091381 DOI: 10.1016/j.jad.2021.05.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Patient reported outcomes are central to the evaluation of behavioral, drug, or somatic interventions focusing depression. Continuous measures are mostly interpreted with cut points that serve as inclusion criteria and define remission. The present review provides an overview of measures (BDI; BDI-II; CESD; HADS; HAMD-17; MADRS; PHQ-9; QIDS) and cut points in clinical trials on depression and tests for systematic differences concerning varying types of interventions. METHODS We analyzed 2632 trials registered via clinicaltrials.gov registered between 2000/01/01 - 2019/12/31 that used one or more pre-specified measures of depression of which 1600 reported cut points for either inclusion of participants or the definition of clinical remission. RESULTS The included studies more often used clinician-administered scales than self-report questionnaires as criterion for the inclusion of study participants and for the definition of clinical remission. Clinician administered scales are dominating in drug trials, while self-report questionnaires are primarily used in behavioral trials. This trend accelerated during the last 20 years. Compared to studies on behavioral therapies, studies with drug or other interventions used higher cut points to include patients. Comparisons between the interventions revealed highly significant differences in the used cut points of MADRS, HAMD-17 and PHQ-9. CONCLUSIONS Choice of measure and cut points is an important aspect of trial design and should be homogenized in order to make trials of different types of interventions more readily comparable. Similarly, systematic differences between treatment types in how patients are included and how remission is defined also hamper the comparisons between different treatment modalities.
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Affiliation(s)
| | - Ruth von Brachel
- Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany
| | - Christian Thiele
- University of Applied Sciences Bielefeld, Interaktion 1, 33619 Bielefeld, Germany
| | - Gerrit Hirschfeld
- University of Applied Sciences Bielefeld, Interaktion 1, 33619 Bielefeld, Germany
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16
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White EJ, Kuplicki R, Stewart JL, Kirlic N, Yeh HW, Paulus MP, Aupperle RL. Latent variables for region of interest activation during the monetary incentive delay task. Neuroimage 2021; 230:117796. [PMID: 33503481 DOI: 10.1016/j.neuroimage.2021.117796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/27/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The Monetary Incentive Delay task (MID) has been used extensively to probe anticipatory reward processes. However, individual differences evident during this task may relate to other constructs such as general arousal or valence processing (i.e., anticipation of negative versus positive outcomes). This investigation used a latent variable approach to parse activation patterns during the MID within a transdiagnostic clinical sample. METHODS Participants were drawn from the first 500 individuals recruited for the Tulsa-1000 (T1000), a naturalistic longitudinal study of 1000 participants aged 18-55 (n = 476 with MID data). We employed a multiview latent analysis method, group factor analysis, to characterize factors within and across variable sets consisting of: (1) region of interest (ROI)-based blood oxygenation level-dependent (BOLD) contrasts during reward and loss anticipation; and (2) self-report measures of positive and negative valence and related constructs. RESULTS Three factors comprised of ROI indicators emerged to accounted for >43% of variance and loaded on variables representing: (1) general arousal or general activation; (2) valence, with dissociable responses to anticipation of win versus loss; and (3) region-specific activation, with dissociable activation in salience versus perceptual brain networks. Two additional factors were comprised of self-report variables, which appeared to represent arousal and valence. CONCLUSIONS Results indicate that multiview techniques to identify latent variables offer a novel approach for differentiating brain activation patterns during task engagement. Such approaches may offer insight into neural processing patterns through dimension reduction, be useful for probing individual differences, and aid in the development of optimal explanatory or predictive frameworks.
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Affiliation(s)
- Evan J White
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA.
| | - Rayus Kuplicki
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA; Department of Community Medicine, Oxley Health Sciences, University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Namik Kirlic
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
| | - Hung-Wen Yeh
- Pediatrics Department, Children's Mercy Kansas City, 2401 Gilham Road, Kansas City, MO 64108, USA
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- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
| | - Martin P Paulus
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA; Department of Community Medicine, Oxley Health Sciences, University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Robin L Aupperle
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA; Department of Community Medicine, Oxley Health Sciences, University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
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17
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Lin K, Li Y, Toit ED, Wendt L, Sun J. Effects of Polyphenol Supplementations on Improving Depression, Anxiety, and Quality of Life in Patients With Depression. Front Psychiatry 2021; 12:765485. [PMID: 34819888 PMCID: PMC8606635 DOI: 10.3389/fpsyt.2021.765485] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Increased prevalence of mental disorders has become a significant public health concern. Recent studies have linked nutrition to depression and anxiety, suggesting that dietary changes or nutritional supplementation may be beneficial in improving mental disorders. Polyphenols have anti-inflammatory and antioxidant properties that may counteract physiological changes in depression and anxiety. This study examined the effectiveness of polyphenol supplementation in improving depression, anxiety and quality of life (QoL). Methods: Randomized controlled trials in English and with polyphenol supplementation as the intervention were searched. The primary outcome was depression, and secondary outcomes were anxiety and QoL. Only studies of at least moderate quality based on the Physiotherapy Evidence Database tool were included. Comprehensive systematic review and meta-analysis were then used to determine the effect of polyphenol supplementations on improving depression, anxiety and quality of life (QoL) in patients with depression. Results: Nineteen studies with 1,523 participants were included; 18 studies (n = 1,523) were included in the depression meta-analysis, and 5 (n = 188) and 6 (n = 391) in the QoL and anxiety meta-analyses, respectively. Twelve of the 18 studies found significant improvements in depression with polyphenol use, while the meta-analyses results also indicated that polyphenol supplementation significantly improved depression score as compared to control conditions (MD: -2.280, 95% CI: -1.759, -0.133, I 2 = 99.465). Although subgroup analyses were conducted a significantly high heterogeneity was still found amongst subgroups. Only 2 of the 5 studies found significant improvements in QoL following polyphenol supplementation and meta-analyses found that polyphenol use did not benefit QoL (MD: -1.344, p < 0.05, I 2 = 55.763). For anxiety, 5 of the 6 studies found significant reductions in depression score following polyphenol use but meta-analyses found no significant differences in anxiety score (MD: -0.705, CI: -1.897, 0.487, I 2 = 84.06) between polyphenol supplementation and control. Conclusion: The results suggest that polyphenol supplementation is effective in improving depression. Physical illness may act as a risk factor that worsens depression, suggesting the need for preventative supplementation to improve depression. Polyphenol types may have varying effects, which suggests that different populations with depression may benefit from different polyphenols.
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Affiliation(s)
- Kelly Lin
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Yanni Li
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Eugene Du Toit
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Lauren Wendt
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Jing Sun
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia.,Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD, Australia
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18
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Towards Automatic Depression Detection: A BiLSTM/1D CNN-Based Model. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10238701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Depression is a global mental health problem, the worst cases of which can lead to self-injury or suicide. An automatic depression detection system is of great help in facilitating clinical diagnosis and early intervention of depression. In this work, we propose a new automatic depression detection method utilizing speech signals and linguistic content from patient interviews. Specifically, the proposed method consists of three components, which include a Bidirectional Long Short-Term Memory (BiLSTM) network with an attention layer to deal with linguistic content, a One-Dimensional Convolutional Neural Network (1D CNN) to deal with speech signals, and a fully connected network integrating the outputs of the previous two models to assess the depressive state. Evaluated on two publicly available datasets, our method achieves state-of-the-art performance compared with the existing methods. In addition, our method utilizes audio and text features simultaneously. Therefore, it can get rid of the misleading information provided by the patients. As a conclusion, our method can automatically evaluate the depression state and does not require an expert to conduct the psychological evaluation on site. Our method greatly improves the detection accuracy, as well as the efficiency.
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19
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Zeifman RJ, Wagner AC, Watts R, Kettner H, Mertens LJ, Carhart-Harris RL. Post-Psychedelic Reductions in Experiential Avoidance Are Associated With Decreases in Depression Severity and Suicidal Ideation. Front Psychiatry 2020; 11:782. [PMID: 32903724 PMCID: PMC7438781 DOI: 10.3389/fpsyt.2020.00782] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 07/22/2020] [Indexed: 12/23/2022] Open
Abstract
Psychedelic therapy shows promise as a novel intervention for a wide range of mental health concerns but its therapeutic action is incompletely understood. In line with acceptance and commitment therapy's (ACT's) transdiagnostic model, qualitative research has suggested that reductions in experiential avoidance are an important component of therapeutic outcomes associated with psychedelics. However, limited research has quantitatively explored the association between decreases in experiential avoidance and therapeutic outcomes associated with psychedelics. Therefore, in two prospective studies, using convenience samples of individuals with plans to use a psychedelic, we explored the impact of psychedelic use on experiential avoidance, depression severity, and suicidal ideation, as well as relationships between changes in these outcomes. Participants (Study 1, N=104; Study 2, N=254) completed self-report questionnaires of depression severity, suicidal ideation, and experiential avoidance: 1) before using a psychedelic (in ceremonial and non-ceremonial contexts), as well as 2) 2-weeks and 3) 4-weeks after psychedelic use. Across both studies, repeated measures ANOVAs indicated significant decreases in experiential avoidance, depression severity, and suicidal ideation after psychedelic use. Furthermore, decreases in experiential avoidance were significantly associated with decreases in depression severity and suicidal ideation. These results suggest that psychedelics may lead to significant decreases in experiential avoidance, depression severity, and suicidal ideation. Additionally, these findings imply that reduced experiential avoidance may be a transdiagnostic mechanism mediating treatment success within psychedelic therapy. We conclude that integrating psychedelics with psychotherapeutic interventions that target experiential avoidance (e.g. ACT) may enhance therapeutic outcomes.
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Affiliation(s)
- Richard J. Zeifman
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Ros Watts
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Hannes Kettner
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Lea J. Mertens
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Molecular Neuroimaging, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Robin L. Carhart-Harris
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
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20
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Phua DY, Chen H, Chong YS, Gluckman PD, Broekman BFP, Meaney MJ. Network Analyses of Maternal Pre- and Post-Partum Symptoms of Depression and Anxiety. Front Psychiatry 2020; 11:785. [PMID: 32848949 PMCID: PMC7424069 DOI: 10.3389/fpsyt.2020.00785] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/22/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Maternal mental health problems often develop prenatally and predict post-partum mental health. However, the circumstances before and following childbirth differ considerably. We currently lack an understanding of dynamic variation in the profiles of depressive and anxiety symptoms over the perinatal period. METHODS Depressive and anxiety symptoms were self-reported by 980 women at 26-week pregnancy and 3 months post-partum. We used network analysis of depressive and anxiety symptoms to investigate if the symptoms network changed during and after pregnancy. The pre- and post-partum depressive-anxiety symptom networks were assessed for changes in structure, unique symptom-symptom interactions, central and bridging symptoms. We also assessed if central symptoms had stronger predictive effect on offspring's developmental outcomes outcomes at birth and 24, 54, and 72 months old than non-central symptoms. Bridging symptoms between negative and positive mental health were also assessed. RESULTS Though the depressive-anxiety network structures were stable during and after pregnancy, the post-partum network was more strongly connected. The central depressive-anxiety symptoms were also different between prenatal and post-partum networks. During pregnancy, central symptoms were mostly related to feeling worthless or useless; after pregnancy, central symptoms were mostly related to feeling overwhelmed or being punished. Central symptoms during pregnancy were associated with poorer developmental outcomes for the child. Anxiety symptoms were strongest bridging symptoms during and after pregnancy. The interactions between negative and positive mental health symptoms were also different during and after pregnancy. CONCLUSIONS The differences between pre- and post-partum networks suggest that the presentation of maternal mental health problems varies over the peripartum period. This variation is not captured by traditional symptom scale scores. The bridging symptoms also suggest that anxiety symptoms may precede the development of maternal depression. Interventions and public health policies should thus be tailored to specific pre- and post-partum symptom profiles.
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Affiliation(s)
- Desiree Y. Phua
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Helen Chen
- Department of Psychological Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peter D. Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Centre for Human Evolution, Adaptation and Disease, Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Birit F. P. Broekman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Amsterdam UMC and OLVG, VU University, Amsterdam, Netherlands
| | - Michael J. Meaney
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Sackler Program for Epigenetics & Psychobiology, McGill University, Montreal, QC, Canada
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
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21
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Luccarelli J, McCoy TH, Seiner SJ, Henry ME. Maintenance ECT is associated with sustained improvement in depression symptoms without adverse cognitive effects in a retrospective cohort of 100 patients each receiving 50 or more ECT treatments. J Affect Disord 2020; 271:109-114. [PMID: 32479305 PMCID: PMC7289157 DOI: 10.1016/j.jad.2020.03.152] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/19/2020] [Accepted: 03/29/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is the most effective acute treatment for depression, but relapse is common following discontinuation. One strategy for prolonging remission is the use of maintenance ECT, but the clinical evidence supporting its efficacy and safety are limited. We examined the effects of maintenance ECT on depression and cognition. METHODS Participants were from a retrospective cohort of 100 patients receiving ECT at a freestanding psychiatric hospital and who received at least 50 treatments during a single treatment series. QIDS, BASIS-24, and MoCA were assessed at baseline and every 10 treatments thereafter during the clinical course. RESULTS ECT was associated with a rapid decrease in depression symptoms and overall self-reported mental health status within the first 10 treatments, which was sustained throughout a median of 22.1 months of follow-up. There was no change in cognitive functioning as measured by the MoCA. Bilateral and brief pulse treatment parameters were more common by treatment 50 than at the first treatment. Most participants either continued in ECT at the end of the study period or discontinued due to sustained remission. LIMITATIONS retrospective observational study without control group who did not receive ECT. CONCLUSIONS In this ECT cohort with at least 50 treatments, improvement in depression was sustained on QIDS and BASIS-24 and adverse cognitive effects were not detected by serial MoCAs, supporting the utility of maintenance ECT in this cohort.
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Affiliation(s)
- James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital, Boston (Luccarelli, Henry, McCoy); Department of Psychiatry, McLean Hospital, Belmont (Seiner).
| | | | | | - Michael E. Henry
- Department of Psychiatry, Massachusetts General Hospital, Boston (Luccarelli, Henry, McCoy); Department of Psychiatry, McLean Hospital, Belmont (Seiner)
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22
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Glazer K, Rootes-Murdy K, Van Wert M, Mondimore F, Zandi P. The utility of PHQ-9 and CGI-S in measurement-based care for predicting suicidal ideation and behaviors. J Affect Disord 2020; 266:766-771. [PMID: 29954612 DOI: 10.1016/j.jad.2018.05.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/21/2018] [Accepted: 05/28/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Measurement-based care (MBC) has emerged as an effective strategy for improving outcomes in patients with mood disorders. Suicide is a particularly devastating outcome of mood disorders. Using data from a new MBC program from the National Network of Depression Centers (NNDC), we examined whether capturing a patient-rated symptom measure, the patient health questionnaire (PHQ-9), along with a provider-rated global functioning measure, the clinical global impression scale (CGI-S), improves identification of patients at risk of suicide over using either measure alone. METHODS A total of 126 adults with mood disorders from nine sites in the NNDC completed the PHQ-9 and CGI-S and had at least one subsequent visit where they completed the Columbia-suicide severity rating scale (C-SSRS). The PHQ-9 (≥10) and CGI-S (≥4) were dichotomized at commonly accepted severity thresholds. Associations of the PHQ-9 and CGI-S with suicidal ideation or behavior were examined using Firth's logistic regression to accommodate small samples while controlling for age, sex, race, and diagnosis. RESULTS Patients who scored higher on only the PHQ-9 or CGI-S were not significantly more likely to experience subsequent suicidal ideation or behaviors. However, patients who scored higher on both the PHQ-9 and CGI-S were significantly more likely to experience suicidal ideation (OR = 4.70, p = 0.0005) and suicidal behaviors (OR = 25.38, p = 0.0003). DISCUSSION Information from both patient and clinician-rated measures was better able to identify patients with mood disorders at risk for suicidal ideation and behaviors. Using both together may help reduce the risk of suicide by identifying those patients at greatest risk and allowing for more targeted interventions.
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Affiliation(s)
- Kara Glazer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Kelly Rootes-Murdy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Michael Van Wert
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Francis Mondimore
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Peter Zandi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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23
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Ninomiya A, Sado M, Park S, Fujisawa D, Kosugi T, Nakagawa A, Shirahase J, Mimura M. Effectiveness of mindfulness-based cognitive therapy in patients with anxiety disorders in secondary-care settings: A randomized controlled trial. Psychiatry Clin Neurosci 2020; 74:132-139. [PMID: 31774604 DOI: 10.1111/pcn.12960] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/01/2019] [Accepted: 10/30/2019] [Indexed: 01/12/2023]
Abstract
AIM The primary objective of this study was to examine the effectiveness of mindfulness-based cognitive therapy (MBCT) in secondary-care settings where the vast majority of the patients have already undergone pharmacotherapy but have not remitted. METHODS Eligible participants were aged between 20 and 75 years and met the criteria for panic disorder/agoraphobia or social anxiety disorder specified in the DSM-IV. They were randomly assigned to either the MBCT group (n = 20) or the wait-list control group (n = 20). The primary outcome was the difference in mean change scores between pre- and post-intervention assessments on the State-Trait Anxiety Inventory (STAI). The outcome was analyzed using an intent-to-treat approach and a mixed-effect model repeated measurement. RESULTS We observed significant differences in mean change scores for the STAI State Anxiety subscale (difference, -10.1; 95% confidence interval, -16.9 to -3.2; P < 0.005) and STAI Trait Anxiety subscale (difference, -11.7; 95% confidence interval, -17.0 to -6.4; P < 0.001) between the MBCT and control groups. CONCLUSION MBCT is effective in patients with anxiety disorders in secondary-care settings where the vast majority of patients are treatment-resistant to pharmacotherapy.
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Affiliation(s)
- Akira Ninomiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Center for Stress Research, Keio University, Tokyo, Japan
| | - Mitsuhiro Sado
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Center for Stress Research, Keio University, Tokyo, Japan
| | - Sunre Park
- Faculty of Nursing and Medicine Care, Keio University, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Division of Patient Safety, Keio University Hospital, Tokyo, Japan
| | - Teppei Kosugi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Atsuo Nakagawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Joichiro Shirahase
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Center for Stress Research, Keio University, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Center for Stress Research, Keio University, Tokyo, Japan
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24
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Yuan S, Tirrell E, Gobin AP, Carpenter LL. Effect of Previous Electroconvulsive Therapy on Subsequent Response to Transcranial Magnetic Stimulation for Major Depressive Disorder. Neuromodulation 2019; 23:393-398. [PMID: 31588659 DOI: 10.1111/ner.13046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/12/2019] [Accepted: 08/20/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Patients with major depressive disorder (MDD) who received electroconvulsive therapy (ECT) often seek transcranial magnetic stimulation (TMS) therapy as a less invasive treatment option. How prior history of ECT and its responsiveness may affect TMS treatment outcomes for MDD is unclear. We aim to contribute evidence to this important clinical question. MATERIALS AND METHODS Retrospective naturalistic TMS treatment data from n = 257 MDD patients. Three sets of analyses were conducted: History of past exposure to ECT (n = 71, "+ECT" vs. n = 186 ECT-naïve, "-ECT") was examined as a potential predictor of TMS outcomes (measured by two self-report scales); A subset of n = 38 +ECT patients with adequate ECT trials in current depression episode were compared with -ECT patients blindly matched on clinical variables associated with TMS outcomes; for a subset with available data, TMS outcomes were explored in relation to positive/negative response to prior ECT. RESULTS Compared to -ECT, +ECT patients more likely had past psychiatric hospitalizations (p < 0.01) and were more severely depressed at baseline (p = 0.07). Response (p = 0.07) and remission (p = 0.02) rates were higher in -ECT than +ECT groups on one scale. However, comparison between the subsets (n = 38 each) matched on confounding factors did not find history of ECT to be a significant independent predictor of TMS outcomes. Differential responsiveness to ECT and ECT treatment characteristics did not significantly impact TMS outcomes. CONCLUSIONS Although limited by the retrospective nature of this analysis, the results suggest that history of the past ECT, regardless of responsiveness to ECT, may not independently portend differential TMS treatment outcomes.
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Affiliation(s)
- Shiwen Yuan
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Butler Hospital, 345 Blackstone Boulevard, Providence, RI, USA
| | - Eric Tirrell
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Butler Hospital, 345 Blackstone Boulevard, Providence, RI, USA
| | - Asi P Gobin
- Butler Hospital, 345 Blackstone Boulevard, Providence, RI, USA
| | - Linda L Carpenter
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Butler Hospital, 345 Blackstone Boulevard, Providence, RI, USA
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25
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Lyu D, Wu Z, Wang Y, Huang Q, Wu Z, Cao T, Zhao J, Cao Y, Hu Y, Chen J, Wang Y, Su Y, Zhang C, Peng D, Li Z, Cao L, Hong W, Fang Y. Disagreement and factors between symptom on self-report and clinician rating of major depressive disorder: A report of a national survey in China. J Affect Disord 2019; 253:141-146. [PMID: 31035214 DOI: 10.1016/j.jad.2019.04.073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/21/2019] [Accepted: 04/17/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Measurement-based care (MBC) is a popular strategy of clinical management for patients with major depressive disorder (MDD). The consistency of self-report and clinical measurements is of importance, but whether individual symptom severity is in agreement for both self-report and clinician rating in MDD has not been comprehensively tested. This study aimed to test whether individual symptom severity of MDD was in agreement between self-report and clinician rating, and to explore factors affecting the agreement. METHODS In the National Survey on Symptomatology of Depression (NSSD) of China, 3275 patients with a major depressive episode were evaluated by both self-report and a clinician-rated version of 62 questions. RESULTS On average, 59% of all patients reached absolute agreement with their research clinicians. Among all questions, 73% returned with moderate positive strength of correlation, followed by 27% with low positive correlation. In 77% of the total questions, there was a tendency to rate higher in the self-report version compared with the clinician-rated version. After classifying the symptoms by six major domains, it was found that patients and clinicians showed more consistent answers in history and somatic questions (81% and 65% reached agreement), and that there were more differences in mood, energy, and anxiety questions (up to 56% in full agreement). "Outpatient", "high financial status", "poor working condition", and "high education level" were found to be significant positive predictors for patients rating higher than clinicians or patients and clinicians reaching agreement as opposed to clinicians rating higher than patients. LIMITATIONS The cross-sectional nature of our study undermines the interpretation of the results across the MDD treatment course. CONCLUSIONS It is sufficient to use the self-report version of a questionnaire to screen, monitor, and detect remission for MDD symptoms. Complete assessment of depression severity should take both clinician-rated scales and self-reported measures into consideration. Factors other than source of admission, financial status, working condition, and education level should be further investigated for the discrepancy between self-report and clinician rating.
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Affiliation(s)
- Dongbin Lyu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zhiguo Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yun Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Qinte Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zhenling Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Tongdan Cao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Huangpu District Mental Health Center, Shanghai, PR China
| | - Jie Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Huangpu District Mental Health Center, Shanghai, PR China
| | - Yonghua Cao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yingyan Hu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Jun Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yong Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yousong Su
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Chen Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Daihui Peng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zezhi Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Lan Cao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
| | - Wu Hong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai, PR China.
| | - Yiru Fang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai, PR China; Chinese Academy of Sciences (CAS) Center for Excellence in Brain Science and Intelligence Technology, Shanghai, PR China.
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26
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„Cognitive bias modification“ als mögliche Add-on-Therapie bei Depression. PSYCHOTHERAPEUT 2019. [DOI: 10.1007/s00278-019-0354-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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27
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Impact of subjective vs. objective remission status on subjective cognitive impairments in depression. J Affect Disord 2019; 246:99-104. [PMID: 30578953 DOI: 10.1016/j.jad.2018.12.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/12/2018] [Accepted: 12/16/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The impact of subjective vs. objective illness severity on subjective cognitive impairment in patients with depression has not been addressed. METHODS This study is a post-hoc analysis of our cross-sectional study in Japanese outpatients with depressive disorder (ICD-10) (Ozawa et al., 2017). The participants received assessments with the Japanese version of the Perceived Deficits Questionnaire (J-PDQ), Quick Inventory of Depressive Symptomatology (QIDS), and Montgomery-Asberg Depression Rating Scale (MADRS). First, multiple regression analysis was conducted to examine the effects of demographic and clinical characteristics, including illness severity and medications (e.g., antidepressants and benzodiazepines), on the PDQ total score. Next, we categorized the participants into 4 groups based on the presence/absence of subjective and objective symptom remission (i.e., QIDS total score of ≤5 and MADRS total score of ≤9, respectively), and compared the differences in PDQ total scores between the QIDS- and MADRS-remitted group and the QIDS-non-remitted but MADRS-remitted group. RESULTS 102 participants were included (45 men; mean ± SD age, 50.5 ± 14.7 years). Higher QIDS and MADRS total scores were significantly associated with a greater PDQ total score (both p's < 0.001), while other factors did not exhibit any associations. The QIDS-non-remitted but MADRS-remitted group showed a significantly higher PDQ total score than that of the QIDS- and MADRS-remitted group (median 10.0 [8.0-12.0] vs. 3.0 [range: 2.0-4.0], p < 0.001). CONCLUSIONS These findings suggest that objective remission in the absence of subjective remission may not be adequate to improve subjective cognitive functioning.
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28
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Effects of Mindfulness-Based Cognitive Therapy on a Behavioural Measure of Rumination in Patients with Chronic, Treatment-Resistant Depression. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-09997-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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29
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Lopez FV, Split M, Filoteo JV, Litvan I, Moore RC, Pirogovsky-Turk E, Liu L, Lessig S, Schiehser DM. Does the Geriatric Depression Scale measure depression in Parkinson's disease? Int J Geriatr Psychiatry 2018; 33:1662-1670. [PMID: 30251374 DOI: 10.1002/gps.4970] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 08/06/2018] [Indexed: 11/11/2022]
Abstract
UNLABELLED The Geriatric Depression Scale (GDS) is recommended for screening depression in individuals with Parkinson's disease (PD). Empirical evidence, however, is limited regarding its validity and factor structure in PD. Thus, the current study sought to evaluate the convergent and divergent validity of the GDS, as well as the structure and validity of the derived factors. METHOD Nondemented individuals with PD (n = 158) completed the GDS-30, and items were subjected to a principle component analysis. Geriatric Depression Scale total and factor scores were correlated with depression items from the Movement Disorder Society Unified Parkinson's disease Rating Scale (MDS-UPDRSd) and Hamilton Rating Scale for Depression (HAMDd), as well as with the Apathy Scale (AS), State-Trait Anxiety Inventory (STAI), Modified Fatigue Impact Scale (MFIS), Parkinson's disease Sleep Scale, and a Subjective Cognitive Function composite score. RESULTS The GDS total score was strongly correlated with divergent neuropsychiatric measures (AS, r = 0.57; STAI, r = 0.66; MFIS, r = 0.60), while only moderately correlated with convergent measures (MDS-UPDRSd, r = 0.36; HAMDd, r = 0.32; Ps < 0.05). Linear regression analyses revealed standardized measures of anxiety, apathy, and fatigue independently predicted the GDS total score, while depression items (MDS-UPDRSd and HAMDd) failed to reach significance. Three independent factors were identified: Anxiety, Apathy, and Fatigue. These factors were significantly predicted by their respective convergent measures. CONCLUSIONS Taken together, our findings suggest that the GDS and its subscales appear to primarily measure anxiety, apathy, and fatigue in PD, or alternatively, these symptom dimensions may be predominant in PD-depression. Future research with clinically diagnosed samples is needed to confirm these initial findings.
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Affiliation(s)
- Francesca V Lopez
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Molly Split
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - J Vincent Filoteo
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California.,Department of Psychiatry, University of California San Diego, La Jolla, California.,Department of Neurosciences, University of California San Diego, La Jolla, California
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, La Jolla, California
| | - Raeanne C Moore
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California.,Department of Psychiatry, University of California San Diego, La Jolla, California
| | - Eva Pirogovsky-Turk
- Department of Psychiatry, University of California San Diego, La Jolla, California
| | - Lin Liu
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | - Stephanie Lessig
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California.,Department of Neurosciences, University of California San Diego, La Jolla, California
| | - Dawn M Schiehser
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California.,Department of Psychiatry, University of California San Diego, La Jolla, California
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30
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Vrijsen JN, Fischer VS, Müller BW, Scherbaum N, Becker ES, Rinck M, Tendolkar I. Cognitive bias modification as an add-on treatment in clinical depression: Results from a placebo-controlled, single-blinded randomized control trial. J Affect Disord 2018; 238:342-350. [PMID: 29908472 DOI: 10.1016/j.jad.2018.06.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Only 60% of depressed patients respond sufficiently to treatment, so there is a dire need for novel approaches to improve treatment effects. Cognitive Bias Modification (CBM) may be an effective and easily implemented computerized add-on to treatment-as-usual. Therefore, we investigated the effects of a positivity-attention training and a positivity-approach training compared to control trainings. METHODS In a blinded randomized-controlled design, 139 depressed inpatients received either the CBM Attention Dot-Probe Training (DPT) or the CBM Approach-Avoidance Training (AAT), next to treatment as usual. N = 121 finished all four training sessions. Both trainings had an active and a control condition. In both active conditions, patients were trained to preferentially process generally positive pictures over neutral pictures. Depressive symptom severity was assessed before and after CBM, and positivity bias was measured at the start and end of each session. RESULTS Clinician-rated depressive symptom severity decreased more in patients who received the active condition of the DPT or the AAT compared to patients in the control conditions. Significant change in positivity bias was found for the DPT (not the AAT), but did not mediate the effect of the training on depressive symptoms. CONCLUSIONS The results suggest that both types of CBM (i.e., DPT and AAT) may provide a fitting add-on treatment option for clinical depression. The working mechanisms and optimal dose of CBM trainings, plus their possible combination, should be examined in more detail.
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Affiliation(s)
- Janna N Vrijsen
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands; Pro Persona Mental Health Care, Depression Expertise Center, Nijmegen, The Netherlands.
| | - Verena S Fischer
- LVR-Hospital Essen, Department for Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Germany
| | - Bernhard W Müller
- LVR-Hospital Essen, Department for Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Germany; Department of Psychology, University of Wuppertal, Germany
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department for Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Germany
| | - Eni S Becker
- Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
| | - Mike Rinck
- Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands; LVR-Hospital Essen, Department for Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Germany
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31
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Navrady LB, Adams MJ, Chan SWY, Ritchie SJ, McIntosh AM. Genetic risk of major depressive disorder: the moderating and mediating effects of neuroticism and psychological resilience on clinical and self-reported depression. Psychol Med 2018; 48:1890-1899. [PMID: 29183409 PMCID: PMC6088772 DOI: 10.1017/s0033291717003415] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/25/2017] [Accepted: 10/27/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Polygenic risk scores (PRS) for depression correlate with depression status and chronicity, and provide causal anchors to identify depressive mechanisms. Neuroticism is phenotypically and genetically positively associated with depression, whereas psychological resilience demonstrates negative phenotypic associations. Whether increased neuroticism and reduced resilience are downstream mediators of genetic risk for depression, and whether they contribute independently to risk remains unknown. METHODS Moderating and mediating relationships between depression PRS, neuroticism, resilience and both clinical and self-reported depression were examined in a large, population-based cohort, Generation Scotland: Scottish Family Health Study (N = 4166), using linear regression and structural equation modelling. Neuroticism and resilience were measured by the Eysenck Personality Scale Short Form Revised and the Brief Resilience Scale, respectively. RESULTS PRS for depression was associated with increased likelihood of self-reported and clinical depression. No interaction was found between PRS and neuroticism, or between PRS and resilience. Neuroticism was associated with increased likelihood of self-reported and clinical depression, whereas resilience was associated with reduced risk. Structural equation modelling suggested the association between PRS and self-reported and clinical depression was mediated by neuroticism (43-57%), while resilience mediated the association in the opposite direction (37-40%). For both self-reported and clinical diagnoses, the genetic risk for depression was independently mediated by neuroticism and resilience. CONCLUSIONS Findings suggest polygenic risk for depression increases vulnerability for self-reported and clinical depression through independent effects on increased neuroticism and reduced psychological resilience. In addition, two partially independent mechanisms - neuroticism and resilience - may form part of the pathway of vulnerability to depression.
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Affiliation(s)
- L. B. Navrady
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK
| | - M. J. Adams
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK
| | - S. W. Y. Chan
- Section of Clinical Psychology, University of Edinburgh, Medical Quad, Teviot Place, Edinburgh EH8 9AG, UK
| | | | - S. J. Ritchie
- Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, UK
| | - A. M. McIntosh
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, UK
- Generation Scotland, Centre for Genetics and Experimental Medicine, Institute for Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh EH42XU, UK
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32
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Silverstein MJ, Faraone SV, Alperin S, Biederman J, Spencer TJ, Adler LA. How Informative Are Self-Reported Adult Attention-Deficit/Hyperactivity Disorder Symptoms? An Examination of the Agreement Between the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Scale V1.1 and Adult Attention-Deficit/Hyperactivity Disorder Investigator Symptom Rating Scale. J Child Adolesc Psychopharmacol 2018; 28:339-349. [PMID: 29172673 DOI: 10.1089/cap.2017.0082] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Assess agreement between self-ratings via the adult attention-deficit/hyperactivity disorder (ADHD) Self-Report Scale (ASRS)-v1.1 Symptom Checklist and clinician ratings via the adult ADHD Investigator Symptom Rating Scale (AISRS) expanded version using DSM-5 adult ADHD patients (referred sample) and ADHD controls (recruited from a primary care physician practice). METHODS The ASRS v1.1 Symptom Checklist was administered to measure self-reported ADHD symptoms and impairment, the Adult ADHD Clinical Diagnostic Scale v1.2 was used to establish an adult ADHD diagnosis and the childhood and adult/current sections of the scale were used to provide scores to measure symptoms of childhood ADHD and recent symptoms of adult ADHD, the AISRS to measure ADHD current symptom severity. RESULTS Participants (n = 299; range 18-58), of which 171 were ADHD+ and 128 ADHD-. ASRS and AISRS total scores and individual subsections examining inattention, hyperactivity, emotional dysfunction (EF), and emotional dyscontrol (EC) were all significantly correlated (Spearman's ρ's = 0.78-0.89, ps < 0.01). Correlations remained significant when controlling for demographic factors and psychiatric conditions. CONCLUSIONS The ASRS (self) and AISRS (clinician rated) scales have high agreement. This agreement extended not only the to the core 18 DSM symptoms, but also to the additional 13 symptoms that examine EC and EF.
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Affiliation(s)
- Michael J Silverstein
- 1 Department of Psychology, Drexel University , Philadelphia, Pennsylvania.,2 Department of Psychiatry, New York University School of Medicine , New York, New York
| | - Stephen V Faraone
- 3 Department of Psychiatry, and Department of Neuroscience and Physiology, SUNY Upstate Medical University , Syracuse, New York
| | - Samuel Alperin
- 2 Department of Psychiatry, New York University School of Medicine , New York, New York.,4 Department of Pediatrics, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.,5 Zucker School of Medicine at Hofstra/Northwell , Hempstead, New York
| | | | | | - Lenard A Adler
- 2 Department of Psychiatry, New York University School of Medicine , New York, New York.,7 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
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Nietola M, Heiskala A, Nordström T, Miettunen J, Korkeila J, Jääskeläinen E. Clinical characteristics and outcomes of psychotic depression in the Northern Finland Birth Cohort 1966. Eur Psychiatry 2018; 53:23-30. [PMID: 29859378 DOI: 10.1016/j.eurpsy.2018.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022] Open
Abstract
BACKGROUND Psychotic depression (PD) is heavily understudied despite high mortality and the severe course of illness. A majority of the studies conducted so far are also largely based on selected clinical samples. The aim of this study was to examine the clinical characteristics of PD in a representative prospective birth cohort sample. METHODS The Northern Finland Birth Cohort 1966 is a well-known prospective population-based cohort including 12 058 people followed since mid-pregnancy. We identified 55 individuals with PD, analysed their characteristics and compared them with schizophrenia (SZ), non-psychotic depression (NPD), psychotic bipolar disorder (PBD) and other psychoses (PNOS). RESULTS The life-time prevalence of stable (no conversion to schizophrenia, bipolar disorder or schizoaffective disorder) PD was 0.5%. PD subjects were older than SZ and PNOS subjects during the first psychotic episode and compared to SZ, more often female. PD required hospitalization and transition to disability pension more often than NPD, but less often than SZ. Comorbid alcohol abuse disorder (44%) and personality disorder (40%) were highly common in PD. PNOS had a similar occupational outcome than PD but hospitalization rate was lower in the PNOS group. PBD and PD had mostly comparable outcomes. CONCLUSIONS Our findings in a naturalistic cohort support the notion that the course of illness in PD is mostly similar to that of PBD, it is less severe than in schizophrenia, but worse than in non-psychotic depression. PD seems to have high psychiatric comorbidity.
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Affiliation(s)
- Miika Nietola
- Psychiatric Department, University of Turku and the Hospital District of Southwest Finland, Finland.
| | - Anni Heiskala
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Tanja Nordström
- Center for Life Course Health Research, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jyrki Korkeila
- Psychiatric Department, University of Turku and Satakunta Hospital District, Finland
| | - Erika Jääskeläinen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Psychiatry, Oulu University Hospital, Oulu, Finland
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Jääskeläinen E, Juola T, Korpela H, Lehtiniemi H, Nietola M, Korkeila J, Miettunen J. Epidemiology of psychotic depression - systematic review and meta-analysis. Psychol Med 2018; 48:905-918. [PMID: 28893329 DOI: 10.1017/s0033291717002501] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Large amount of data have been published on non-psychotic depression (NPD), schizophrenia (SZ), and bipolar disorder, while psychotic depression (PD) as an own entity has received much smaller attention. We performed a systematic review and meta-analyses on epidemiology, especially incidence and prevalence, risk factors, and outcomes of PD. A systematic search to identify potentially relevant studies was conducted using four electronic databases and a manual search. The search identified 1764 unique potentially relevant articles, the final study included 99 articles. We found that the lifetime prevalence of PD varies between 0.35% and 1%, with higher rates in older age. Onset age of PD was earlier than that of NPD in younger samples, but later in older samples. There were no differences in gender distribution in PD v. NPD, but higher proportion of females was found in PD than in SZ or in psychotic bipolar disorder (PBD). Risk factors have rarely been studied, the main finding being that family history of psychosis and bipolar disorder increases the risk of PD. Outcomes of PD were mostly worse when compared with NPD, but better compared with SZ and schizoaffective disorder. The outcome compared with PBD was relatively similar, and somewhat varied depending on the measure of the outcome. Based on this review, the amount of research on PD is far from that of NPD, SZ, and bipolar disorder. Based on our findings, PD seems distinguishable from related disorders and needs more scientific attention.
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Affiliation(s)
- E Jääskeläinen
- Center for Life Course Health Research,University of Oulu,Finland
| | - T Juola
- Center for Life Course Health Research,University of Oulu,Finland
| | - H Korpela
- Center for Life Course Health Research,University of Oulu,Finland
| | - H Lehtiniemi
- Center for Life Course Health Research,University of Oulu,Finland
| | - M Nietola
- Psychiatric Department,University of Turku and Turku University Hospital,Finland
| | - J Korkeila
- Psychiatric Department,University of Turku and Satakunta Hospital District,Finland
| | - J Miettunen
- Center for Life Course Health Research,University of Oulu,Finland
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Rogers ES, Millner UC, Brandt D, Chan L, Jette A, Marfeo E, Ni P, Rasch E. Concordance of assessments of clients' mental and behavioral health with in vivo assessment of work performance. Work 2018; 61:11-20. [PMID: 30223409 PMCID: PMC10009694 DOI: 10.3233/wor-182776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Assessing functioning and disability among individuals with mental and behavioral health disorders has historically relied on deriving accurate psychiatric diagnoses and assessing symptoms. However, growing empirical evidence suggests that this approach is inadequate to determine real world performance, particularly with respect to work. OBJECTIVE We examined a performance-based approach to the assessment of work functioning and its relationship to mental and behavioral health status. METHODS A cross-sectional study was conducted at two mental health programs. Trained employment providers conducted performance-based assessments of work function and ratings of mental and behavioral health while study participants self-reported their mental/behavioral health functioning. We hypothesized that participant and provider ratings of mental/behavioral health would be moderately correlated with performance-based assessments of work function. RESULTS We found no significant correlation between participants' self-report of their mental and behavioral health and performance-based assessments of work. Employment providers' ratings of participants' mental/behavioral health were moderately correlated with performance-based measures of work. Finally, we found low concordance between employment providers and study participants' with respect to ratings of their mental/behavioral health. CONCLUSIONS Contrary to our hypotheses, ratings of mental/behavioral health were only moderately correlated with performance-based measures of work. Results confirm earlier research suggesting that it is difficult to predict work performance from participants' self-reports of their mental/behavioral health alone. Performance-based assessments of work capacity as well as ratings of mental and behavioral health may both be needed for a more complete and complimentary picture of the ability of individuals with mental and behavioral health disorders to function in the work place.
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Affiliation(s)
- E Sally Rogers
- Center for Psychiatric Rehabilitation, Sargent College, Boston University, Boston, MA, USA
| | - Uma Chandrika Millner
- Center for Psychiatric Rehabilitation, Sargent College, Boston University, Boston, MA, USA
| | - Diane Brandt
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Leighton Chan
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Alan Jette
- Health and Disability Research Institute, School of Public Health, Boston University, Boston, MA, USA
| | - Elizabeth Marfeo
- Department of Occupational Therapy, Tufts University, Medford, MA, USA
| | - Pengsheng Ni
- Health and Disability Research Institute, School of Public Health, Boston University, Boston, MA, USA
| | - Elizabeth Rasch
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, MD, USA
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Tsujimoto E, Tsujii N, Mikawa W, Ono H, Shirakawa O. Discrepancies between self- and observer-rated depression severities in patients with major depressive disorder associated with frequent emotion-oriented coping responses and hopelessness. Neuropsychiatr Dis Treat 2018; 14:2331-2336. [PMID: 30254445 PMCID: PMC6140753 DOI: 10.2147/ndt.s175973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The rating discrepancy for patients with major depressive disorder (MDD) is believed to be associated with hopelessness, risk of suicidal behavior, and personality characteristics, such as high neuroticism. However, it remains to be elucidated whether the discrepancy is also mediated by coping styles, which are conceptualized as personality characteristics. PATIENTS AND METHODS We enrolled 154 participants and divided them into three groups: patients with MDD with a rating discrepancy (MDD-WD; n=46), patients with MDD without a rating discrepancy (MDD-WoD; n=50), and healthy controls (HCs; n=58). A rating discrepancy was defined as a high Beck Depression Inventory score and low Hamilton Depression Rating Scale score. Coping styles and hopelessness were compared among the groups. RESULTS The MDD-WD group exhibited a higher level of hopelessness than those in the MDD-WoD and HC groups. They also demonstrated a significantly increased number of suicide attempts compared with the MDD-WoD group. Both the MDD-WD and MDD-WoD groups exhibited lesser task-oriented and greater emotion-oriented coping styles than those in the HC group, with the MDD-WD group demonstrating even greater emotion-oribented coping than that in the MDD-WoD group. Overall, high levels of hopelessness, a history of suicide attempts, and frequent use of emotion-oriented coping mechanisms were associated with rating discrepancy. CONCLUSION Patients with MDD who showed rating discrepancy tended to use emotion-oriented coping. Planning for minimal use of emotion-oriented coping may be a psychotherapeutic intervention for such patients. Reduced emotion-oriented coping may also reduce the feeling of hopelessness and risk of developing suicidal behavior.
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Affiliation(s)
- Emi Tsujimoto
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan, .,Department of Psychological Sciences, Graduate School of Humanities, Kwansei Gakuin University, Nishinomiya, Hyogo, Japan
| | - Noa Tsujii
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan,
| | - Wakako Mikawa
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan,
| | - Hisae Ono
- Department of Psychological Sciences, Graduate School of Humanities, Kwansei Gakuin University, Nishinomiya, Hyogo, Japan
| | - Osamu Shirakawa
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan,
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Spitz A, Studerus E, Koranyi S, Rapp C, Ramyead A, Ittig S, Heitz U, Uttinger M, Riecher-Rössler A. Correlations between self-rating and observer-rating of psychopathology in at-risk mental state and first-episode psychosis patients: influence of disease stage and gender. Early Interv Psychiatry 2017; 11:461-470. [PMID: 26376725 DOI: 10.1111/eip.12270] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/17/2015] [Indexed: 01/25/2023]
Abstract
AIM Research findings on the correlations between self-rating and observer-rating of schizophrenic psychopathology are inconsistent and have rarely considered first-episode psychosis (FEP) and at-risk mental state (ARMS) for psychosis patients. This study investigates these correlations in ARMS and FEP patients and how they are moderated by disease stage and gender. METHODS In the Basel Früherkennung von Psychosen (FePsy) study, positive and negative psychotic and affective symptoms were rated in 126 ARMS and 94 FEP patients using two observer- and three self-rating scales. The agreement between self-rating and observer-rating and the moderating influence of disease stage and gender was quantified using Pearson correlation and multiple regression models. RESULTS Correlations between self- and observer-rated subscales covering the same symptom dimension were low and mostly non-significant except for one correlation of positive and one of negative symptoms. There was no moderating influence of disease stage and gender on the correlations between self-rating and observer-rating except for one higher association in positive symptoms in FEP compared to ARMS and in women compared to men. However, these significant interaction effects did not withstand correction for multiple testing. CONCLUSIONS This study suggests that the agreement between self-rating and observer-rating in FEP and ARMS patients is rather low, similar across symptom dimensions, and only partially dependent on disease stage and gender. However, low correlations between self-rating and observer-rating do not necessarily indicate that these patients have difficulties reporting their symptoms. They could also have occurred because the scales did not exactly cover the same symptom dimensions.
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Affiliation(s)
- Andrea Spitz
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Erich Studerus
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Susan Koranyi
- University of Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Charlotte Rapp
- Psychiatric Services, Treatment Center for Psychosis, Solothurn, Switzerland
| | - Avinash Ramyead
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Sarah Ittig
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Ulrike Heitz
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Martina Uttinger
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Anita Riecher-Rössler
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
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Ramleth RK, Groholt B, Diep LM, Walby FA, Mehlum L. The impact of borderline personality disorder and sub-threshold borderline personality disorder on the course of self-reported and clinician-rated depression in self-harming adolescents. Borderline Personal Disord Emot Dysregul 2017; 4:22. [PMID: 29093819 PMCID: PMC5663078 DOI: 10.1186/s40479-017-0073-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/17/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies on adults suggest that the presence of comorbid depression and Borderline Personality Disorder (BPD) is associated with an elevated risk of self-harming behaviours and that self-harming behaviours, when present, will have higher severity. This comorbidity, furthermore, complicates clinical assessments, which may be an obstacle to early identification and proper intervention. Adolescents who self-harm frequently report high levels of depressive symptoms, but this is often not reflected in the clinicians' assessment. BPD is still a controversial diagnosis in young people, and less is known about the clinical significance of comorbid BPD in adolescent populations.The purpose of the present study was to examine the impact of BPD on the assessment and course of self-reported and clinician-rated depression in self-harming adolescents before and after a treatment period of 19 weeks. We hypothesized that, compared to adolescents without BPD, adolescents with BPD would self-report higher levels of depression at baseline, and that they would have less reduction in depressive symptoms. METHODS A total of 39 adolescents with depressive disorders and BPD-traits participating in a randomised controlled trial on treatment of self-harm with Dialectical Behaviour Therapy adapted for Adolescents or enhanced usual care were included. Adolescents with full-syndrome BPD (n = 10) were compared with adolescents with sub-threshold BPD (n = 29) with respect to their self-reported and clinician-rated depressive symptoms, suicidal ideation and global level of functioning at baseline, and after 19 weeks of treatment (end of trial period). RESULTS At baseline, adolescents with full-syndrome BPD self-reported significantly higher levels of depressive symptoms and suicidal ideation compared to adolescents with sub-threshold BPD, whereas the two groups were rated as equally depressed by the clinicians. At trial completion, all participants had a significant reduction in suicidal ideation, however, adolescents with BPD had a poorer treatment outcome in terms of significantly higher levels of clinician-rated and self-reported depressive symptoms and significantly lower levels of global functioning. At baseline as well as at trial completion, self-reported and clinician-rated levels of depressive symptoms were not significantly correlated in adolescents with BPD. In a multiple linear regression analysis, a diagnosis of BPD and a high baseline level of clinician-rated depressive symptoms predicted higher levels of depressive symptoms at trial completion, whereas receiving Dialectical Behaviour Therapy predicted lower levels of depressive symptoms. CONCLUSION Our findings suggest that a diagnosis of BPD may have a strong impact on the assessment and course of depressive symptoms in self-harming adolescents. Although rated as equally depressed, adolescents with BPD self-reported significantly higher levels of depressive symptoms and suicidal ideation at baseline, and showed a poorer outcome in terms of higher levels of depressive symptoms and lower levels of global functioning at trial completion compared to adolescents with sub-threshold BPD. Our findings suggest that receiving Dialectical Behaviour Therapy could lead to a greater reduction in depressive symptoms, although firm conclusions cannot be drawn given the limited sample size.Clinicians should be aware of the possibility of underestimating the severity of depression in the context of emotional and behavioral dysregulation. Providing BPD specific treatments seems to be important to achieve sufficient treatment response with regard to depressive symptoms in adolescents with BPD-traits. TRIAL REGISTRATION Treatment for Adolescents With Deliberate Self Harm; NCT00675129, registered May 2008.
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Affiliation(s)
- Ruth-Kari Ramleth
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, Bygg 12, 0372 Oslo, Norway
| | - Berit Groholt
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, Bygg 12, 0372 Oslo, Norway
| | - Lien M Diep
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, Bygg 12, 0372 Oslo, Norway
| | - Fredrik A Walby
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, Bygg 12, 0372 Oslo, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, Bygg 12, 0372 Oslo, Norway
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Nakase T, Tobisawa M, Sasaki M, Suzuki A. Outstanding Symptoms of Poststroke Depression during the Acute Phase of Stroke. PLoS One 2016; 11:e0163038. [PMID: 27706193 PMCID: PMC5051825 DOI: 10.1371/journal.pone.0163038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/01/2016] [Indexed: 11/21/2022] Open
Abstract
Poststroke depression (PSD) is a critical complication which might lead to unfavorable outcomes. However, most cases of PSD in the acute phase, during the 2 or 3 weeks following a stroke, are neglected because of the variable comorbid conditions. In this study, aimed at revealing the outstanding symptoms of PSD during the acute phase, consecutive patients with intracranial hemorrhage (ICH) or brain infarction (BI) were asked to fill out a depression questionnaire (Quick Inventory of Depressive Symptomatology Self-Report: QIDS-SR) at 1 week and 1 month following stroke onset. Patients with disturbed consciousness or aphasia were excluded from this study. Forty-nine ICH patients and 222 BI patients completed the QIDS-SR at 1 week and 27 of ICH and 62 of BI at 1 month. The PSD rate was 67% and 46% at 1 week in ICH and BI, respectively. Although sleep disturbance was the most frequent symptom of PSD, psychomotor agitation and appetite disturbance were the most distinguishing symptoms in ICH at 1 week and fatigue at 1 month. On the other hand, most of the depressive symptoms addressed in QIDS-SR were observed in PSD of BI patients both at 1 week and 1 month. In conclusion, while sleep disturbance was a frequent but non-specific symptom, appetite disturbance and fatigue might be critical symptoms to suggest PSD during the acute phase of stroke.
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Affiliation(s)
- Taizen Nakase
- Department of Stroke Science, Research Institute for Brain and Blood Vessels–Akita, Akita, Japan
- * E-mail:
| | - Maiko Tobisawa
- Department of Stroke Science, Research Institute for Brain and Blood Vessels–Akita, Akita, Japan
| | - Masahiro Sasaki
- Department of Stroke Science, Research Institute for Brain and Blood Vessels–Akita, Akita, Japan
| | - Akifumi Suzuki
- Department of Stroke Science, Research Institute for Brain and Blood Vessels–Akita, Akita, Japan
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Conijn JM, Emons WHM, Page BF, Sijtsma K, Van der Does W, Carlier IVE, Giltay EJ. Response Inconsistency of Patient-Reported Symptoms as a Predictor of Discrepancy Between Patient and Clinician-Reported Depression Severity. Assessment 2016; 25:917-928. [PMID: 27630204 DOI: 10.1177/1073191116666949] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to assess the extent to which discrepancy between self-reported and clinician-rated severity of depression are due to inconsistent self-reports. Response inconsistency threatens the validity of the test score. We used data from a large sample of outpatients ( N = 5,959) who completed the self-report Beck Depression Inventory-II (BDI-II) and the clinician-rated Montgomery-Åsberg Depression Rating Scale (MADRS). We used item response theory based person-fit analysis to quantify the inconsistency of the self-report item scores. Inconsistency was weakly positively related to patient-clinician discrepancy (i.e., higher BDI-II scores relative to MADRS scores). The mediating effect of response inconsistency in the relationship between discrepancy and demographic (e.g., ethnic origin) and clinical variables (e.g., cognitive problems) was negligible. The small direct and mediating effects of response inconsistency suggest that inaccurate patient self-reports are not a major cause of patient-clinician discrepancy in outpatient samples. Future research should investigate the role of clinician biases in explaining clinician-patient discrepancy.
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Affiliation(s)
- Judith M Conijn
- 1 University of Amsterdam, Amsterdam, The Netherlands.,2 Leiden University, Leiden, The Netherlands
| | | | | | | | | | | | - Erik J Giltay
- 4 Leiden University Medical Centre, Leiden, The Netherlands
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Zeng Q, Wang WC, Fang Y, Mellor D, Mccabe M, Byrne L, Zuo S, Xu Y. Evaluations of treatment efficacy of depression from perspective of both patients' symptoms and general sense of mental health and wellbeing: A large scale, multi-centered, longitudinal study in China. Psychiatry Res 2016; 241:55-60. [PMID: 27156024 DOI: 10.1016/j.psychres.2016.04.111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 03/02/2016] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
Abstract
Relying on the absence, presence of level of symptomatology may not provide an adequate indication of the effects of treatment for depression, nor sufficient information for the development of treatment plans that meet patients' needs. Using a prospective, multi-centered, and observational design, the present study surveyed a large sample of outpatients with depression in China (n=9855). The 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Remission Evaluation and Mood Inventory Tool (REMIT) were administered at baseline, two weeks later and 4 weeks, to assess patients' self-reported symptoms and general sense of mental health and wellbeing. Of 9855 outpatients, 91.3% were diagnosed as experiencing moderate to severe depression. The patients reported significant improvement over time on both depressive symptoms and general sense after 4-week treatment. The effect sizes of change in general sense were lower than those in symptoms at both two week and four week follow-up. Treatment effects on both general sense and depressive symptomatology were associated with demographic and clinical factors. The findings indicate that a focus on both general sense of mental health and wellbeing in addition to depressive symptomatology will provide clinicians, researchers and patients themselves with a broader perspective of the status of patients.
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Affiliation(s)
- Qingzhi Zeng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China
| | - Wei Chun Wang
- School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne 3004, Australia
| | - Yiru Fang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China
| | - David Mellor
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Marita Mccabe
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Linda Byrne
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Sai Zuo
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China
| | - Yifeng Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China; Shanghai Key Laboratory of Psychotic Disorders, 600 Wan Ping Nan Road, Shanghai 200030, China.
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Huntley CD, Fisher PL. Examining the role of positive and negative metacognitive beliefs in depression. Scand J Psychol 2016; 57:446-52. [DOI: 10.1111/sjop.12306] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022]
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Philip NS, Carpenter SL, Ridout SJ, Sanchez G, Albright SE, Tyrka AR, Price LH, Carpenter LL. 5Hz Repetitive transcranial magnetic stimulation to left prefrontal cortex for major depression. J Affect Disord 2015; 186:13-7. [PMID: 26210705 PMCID: PMC4565741 DOI: 10.1016/j.jad.2014.12.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 12/04/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) to left prefrontal cortex at 10Hz is the most commonly utilized protocol for major depressive disorder (MDD). Published data suggests that left sided 5Hz rTMS may be efficacious and well tolerated. OBJECTIVE We analyzed outcomes in a naturalistic cohort of MDD patients who could not tolerate 10Hz rTMS and were routinely switched to 5Hz. We hypothesized that the efficacy of 5Hz rTMS would be equivalent to 10Hz. METHODS Records were reviewed for patients (n=98) who received 15 or more acute rTMS treatments. The sample was split based upon the frequency (10 or 5Hz) at which the majority of treatments were delivered. The Inventory of Depressive Symptoms (IDS-SR) and 9-Item Patient Health Questionnaire (PHQ-9) were used to evaluate outcomes. RESULTS Baseline IDS-SR was higher in the 5Hz (n=27) than in the 10Hz (n=71) group (p<.05), as was frequency of comorbid anxiety (p=.002). Depression outcomes did not differ between groups, and there were no differences in response or remission rates (all p>.1). Statistical power was sufficient to detect small group differences (d=.26). LIMITATIONS Open-label data in a naturalistic setting. CONCLUSION Outcomes associated with 5Hz rTMS did not differ from 10Hz, despite higher baseline depressive symptom severity and anxiety in 5Hz patients. 5Hz stimulation may be an alternative treatment option for patients unable to tolerate 10Hz rTMS.
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Affiliation(s)
- Noah S Philip
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, United States; Butler Hospital Mood Disorders Research Program, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States.
| | - S Louisa Carpenter
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, United States
| | - Samuel J Ridout
- Butler Hospital Mood Disorders Research Program, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States
| | - George Sanchez
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, United States
| | - Sarah E Albright
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, United States
| | - Audrey R Tyrka
- Butler Hospital Mood Disorders Research Program, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States
| | - Lawrence H Price
- Butler Hospital Mood Disorders Research Program, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States
| | - Linda L Carpenter
- Butler Hospital Mood Disorders Research Program, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States
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Acceptance-based Behavior Therapy for Depression With Psychosis: Results From a Pilot Feasibility Randomized Controlled Trial. J Psychiatr Pract 2015; 21:320-33. [PMID: 26352221 PMCID: PMC4704101 DOI: 10.1097/pra.0000000000000092] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Acceptance-based depression and psychosis therapy (ADAPT), a mindfulness/acceptance-based behavioral activation treatment, showed clinically significant effects in the treatment of depression with psychosis in a previous open trial. The goal of the current study was to further test the feasibility of ADAPT to determine the utility of testing it in a future clinical trial, following a stage model of treatment development. Feasibility was determined by randomizing a small number of patients (N=13) with comorbid depression and psychosis to medication treatment as usual plus enhanced assessment and monitoring versus ADAPT for 4 months of outpatient treatment. Both conditions were deemed acceptable by patients. Differences in between-subjects effect sizes favored ADAPT posttreatment and were in the medium to large range for depression, psychosocial functioning, and experiential avoidance (ie, the target mechanism). Thus ADAPT shows promise for improving outcomes compared with medications alone and requires testing in a fully powered randomized trial.
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Trujols J, de Diego-Adeliño J, Feliu-Soler A, Iraurgi I, Puigdemont D, Alvarez E, Pérez V, Portella MJ. The Spanish version of the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16): a psychometric analysis in a clinical sample. J Affect Disord 2014; 169:189-96. [PMID: 25212994 DOI: 10.1016/j.jad.2014.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/25/2014] [Accepted: 08/06/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Psychometrically robust and easy-to-administer scales for depressive symptoms are necessary for research and clinical assessment. This is a psychometric study of the Spanish version of the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16) in a clinical sample. METHOD One-hundred and seventy-three patients (65% women) with a psychiatric disorder including depressive symptoms were recruited. Such symptoms were assessed by means of the QIDS-SR16 and two interviewer-rated instruments: the 17-item Hamilton Depression Rating Scale (HDRS17) and the Clinical Global Impression-Severity (CGI-S) scale. Self-rated measures of health-related quality of life, subjective happiness and perceived social support were also obtained. Dimensionality, internal consistency, construct validity, criterion validity, and responsiveness to change of the QIDS-SR16 were examined. RESULTS Exploratory and confirmatory factor analyses replicated the original one-factor structure. The Spanish version of the QIDS-SR16 showed good to excellent internal consistency (α=0.88), convergent validity [HDRS17 (r=0.77), CGI-S (r=0.78)], and divergent validity [EuroQol-5D Visual Analogue Scale (r=-0.78), Subjective Happiness Scale (r=-0.72)]. The QIDS-SR16 was excellent in discriminating clinically significant from non-significant depressive symptomatology (area under ROC curve=0.93). It also showed a high sensitivity to treatment-related changes: patients with greater clinical improvement showed a greater decrease in QIDS-SR16 scores (p<0.001). LIMITATIONS The study was conducted in a single center, which may limit the generalizability of the findings. CONCLUSIONS The Spanish version of the QIDS-SR16 retains the soundness of metric characteristics of the original version which makes the scale an invaluable instrument to assess depressive symptoms.
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Affiliation(s)
- Joan Trujols
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d׳Investigació Biomèdica Sant Pau (IIB Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sant Antoni Maria Claret 167, 08025 Barcelona, Spain.
| | - Javier de Diego-Adeliño
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d׳Investigació Biomèdica Sant Pau (IIB Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Albert Feliu-Soler
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d׳Investigació Biomèdica Sant Pau (IIB Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Ioseba Iraurgi
- DeustoPsych - Unidad de Investigación, Desarrollo e Innovación en Psicología y Salud, Universidad de Deusto, Bilbao, Spain
| | - Dolors Puigdemont
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d׳Investigació Biomèdica Sant Pau (IIB Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Enric Alvarez
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d׳Investigació Biomèdica Sant Pau (IIB Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sant Antoni Maria Claret 167, 08025 Barcelona, Spain; Departament de Psiquiatria i Medicina Legal, Facultat de Medicina, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Víctor Pérez
- Departament de Psiquiatria i Medicina Legal, Facultat de Medicina, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Maria J Portella
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d׳Investigació Biomèdica Sant Pau (IIB Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
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Weiss RB, Aderka IM, Lee J, Beard C, Björgvinsson T. A Comparison of Three Brief Depression Measures in an Acute Psychiatric Population: CES-D-10, QIDS-SR, and DASS-21-DEP. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2014. [DOI: 10.1007/s10862-014-9461-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lako IM, Wigman JTW, Klaassen RMC, Slooff CJ, Taxis K, Bartels-Velthuis AA. Psychometric properties of the self-report version of the Quick Inventory of Depressive Symptoms (QIDS-SR₁₆) questionnaire in patients with schizophrenia. BMC Psychiatry 2014; 14:247. [PMID: 25178310 PMCID: PMC4159524 DOI: 10.1186/s12888-014-0247-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/19/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Self-report instruments for the assessment of depressive symptoms in patients with psychotic disorders are scarce. The Quick Inventory of Depressive Symptoms (QIDS-SR16) may be a useful self-report instrument, but has received little attention in this field. This paper aimed to test the psychometric properties of the QIDS-SR16 questionnaire in patients with a psychotic disorder. METHODS Patients diagnosed with a psychotic disorder from health care institutions in The Netherlands were included in the study. Depressive symptoms were assessed with the QIDS-SR16 and the Calgary Depression Scale for Schizophrenia (CDSS). Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS) and extrapyramidal symptoms (EPS) with three EPS rating scales. Spearman's correlation coefficients were used to compare the total score of the QIDS-SR16 with the total scores of the CDSS, PANSS-subscales and EPS rating scales. RESULTS In a sample of 621 patients with psychotic disorders, the QIDS-SR16 showed good internal consistency (α = 0.87). The QIDS-SR16 correlated moderately with the CDSS (r = 0.44) and the PANSS subscale for emotional distress (r = 0.47). The QIDS-SR16 showed weak correlation with the PANSS subscale for negative symptoms (r = 0.28) and minimal correlation with EPS rating scales (r = 0.09-0.16). CONCLUSIONS The QIDS-SR16 may reliably assess depressive symptoms in patients with psychotic disorders, but its concurrent validity with the CDSS was rather poor in this population. We would recommend developing a new self-report questionnaire for the assessment of depressive symptoms in patients with psychotic disorders.
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Affiliation(s)
- Irene M Lako
- Division of Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Johanna TW Wigman
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, The Netherlands ,Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Cees J Slooff
- Department of Psychotic Disorders, Mental Health Center Assen (GGZ Drenthe), Assen, Netherlands
| | - Katja Taxis
- Division of Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Agna A Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, The Netherlands.
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Brakoulias V, Starcevic V, Berle D, Milicevic D, Hannan A, Viswasam K, Mann K. The clinical characteristics of obsessive compulsive disorder associated with high levels of schizotypy. Aust N Z J Psychiatry 2014; 48:852-60. [PMID: 24740253 DOI: 10.1177/0004867414531831] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aims to examine the characteristics of obsessive compulsive disorder (OCD) associated with high levels of schizotypy. METHODS Using the Schizotypal Personality Questionnaire (SPQ) with 177 individuals with OCD, patients with OCD and high levels of schizotypy (OCD-HS) were compared to patients with OCD and low levels of schizotypy (OCD-LS) on a range of clinical characteristics. Self-report and clinician-administered instruments were used. Results were adjusted for the severity of OCD symptoms, age, marital status and comorbidity using logistic regression. RESULTS Patients with OCD-HS were younger and less likely to have been married. OCD-HS was associated with higher rates of symmetry/order obsessions, ordering/arranging compulsions, checking compulsions, co-occurring major depression, post-traumatic stress disorder, substance use disorders and greater general psychopathology. Previously reported associations, such as higher total scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) were not significant when adjusted for differences in demographic variables and comorbidity. CONCLUSIONS Patients with OCD-HS were associated with specific OCD symptoms and comorbid conditions and may warrant a specific treatment approach.
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Affiliation(s)
| | | | - David Berle
- Nepean Blue Mountains Local Health District, Mental Health Services, Penrith, Australia
| | | | - Anthony Hannan
- Nepean Blue Mountains Local Health District, Mental Health Services, Penrith, Australia
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Brief, unidimensional melancholia rating scales are highly sensitive to the effect of citalopram and may have biological validity: implications for the research domain criteria (RDoC). J Affect Disord 2014; 163:18-24. [PMID: 24836083 DOI: 10.1016/j.jad.2014.03.049] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 03/25/2014] [Accepted: 03/26/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Most depression rating scales are multidimensional and the resulting heterogeneity may impede identification of coherent biomarkers. The aim of this study was to compare the psychometric performance of the multidimensional 17-item Hamilton Depression Rating Scale (HAM-D17) and the 30-item Inventory of Depressive Symptomatology (IDS-C30) to that of their unidimensional six-item melancholia subscales (HAM-D6 and IDS-C6). METHODS A total of 2242 subjects from level 1 (citalopram) of the Sequenced Treatment Alternatives to Relieve Depression (STAR* study were included in the analysis. Symptom change, response and remission rates were compared for HAM-D6 versus HAM-D17 and for IDS-C6 versus IDS-C30. The changes in total scores on these scales were compared to the change in Quality of Life Enjoyment and Satisfaction Questionnaire (QLES-Q) score using correlation analysis. RESULTS The response to treatment was significantly greater according to the HAM-D6 and IDS-C6. Furthermore, the correlation of changes in depression-ratings with changes in QLES-Q scores were comparable for the subscales and full scales. LIMITATIONS STAR*D was not designed to answer the research questions addressed in this analysis. CONCLUSIONS Our findings indicate that the HAM-D6 and IDS-C6 melancholia scales capture a coherent construct in depression. The syndrome reflected in these scales is unidimensional, sensitive to specific pharmacological intervention, and therefore likely to have biological validity. We therefore believe that "melancholia" thus defined could be a valuable construct under the Research Domain Criteria (RDoC), which specifically aims at identifying the neurobiology underlying mental disorders and providing drugable targets.
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Baseline difference between patients' and clinicians' rated illness severity scores and subsequent outcomes in major depressive disorder: analysis of the sequenced treatment alternatives to relieve depression data. J Clin Psychopharmacol 2014; 34:297-302. [PMID: 24743720 PMCID: PMC3992483 DOI: 10.1097/jcp.0000000000000112] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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