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Henkel V, Mergl R, Allgaier AK, Hautzinger M, Kohnen R, Coyne J, Möller HJ, Hegerl U. Treatment of atypical depression: Post-hoc analysis of a randomized controlled study testing the efficacy of sertraline and cognitive behavioural therapy in mildly depressed outpatients. Eur Psychiatry 2020; 25:491-8. [DOI: 10.1016/j.eurpsy.2010.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 01/21/2010] [Accepted: 01/23/2010] [Indexed: 10/19/2022] Open
Abstract
AbstractObjectiveAtypical features are common among depressed primary care patients, but clinical trials testing the efficacy of psychopharmacological and/or psychotherapeutic treatment are lacking. This paper examines the efficacy of sertraline and cognitive behavioural therapy (CBT) among depressed patients with atypical features.Subjects and methodsAnalyses involve a double-blind comparison of sertraline versus placebo (N = 47) and a single-blind comparison between CBT versus a guided self-help group (GSG) (N = 48), with primary efficacy endpoints being the Inventory of Depressive Symptomatology (IDSC) and Hamilton Depression Scale (HAMD-17).ResultsIn intent-to-treat (ITT) analyses, the decrease on the IDSC scale (and HAMD-17) was greater after CBT compared to GSG: p = 0.01 (HAMD-17: p = 0.01). The difference between selective serotonin reuptake inhibitors (SSRI) versus placebo was not significant: p = 0.22 (HAMD-17: p = 0.36).LimitationsThe number of cases in each treatment group was small, thereby limiting statistical power. Patients medicated with sertraline were 10 to 15 years younger than those included in the other groups of treatment.ConclusionsCBT may be an effective alternative to GSG for mildly depressed patients with atypical features. Although SSRI were not superior to placebo, it would be premature to rule out SSRI as efficacious in atypical depression.
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Mergl R, Allgaier AK, Hautzinger M, Coyne JC, Hegerl U, Henkel V. One-year follow-up of a randomized controlled trial of sertraline and cognitive behavior group therapy in depressed primary care patients (MIND study). J Affect Disord 2018; 230:15-21. [PMID: 29355727 DOI: 10.1016/j.jad.2017.12.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 11/29/2017] [Accepted: 12/31/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The long-term course of symptoms in patients with mild-to-moderate depression is not well understood. A 12-month-follow-up analysis was performed on those participants from a randomized controlled 10-week trial (RCT, MIND-study), who had received either treatment with an antidepressant (sertraline) or a psychotherapeutic intervention (group cognitive-behavioral therapy (CBT)). METHODS The longitudinal interval follow-up evaluation (LIFE) was applied to 77 patients with mild-to moderate depression. The primary outcome was the number of weeks in the one-year follow-up period spent completely recovered from all depressive symptoms. Functional outcome was measured with the Global Assessment of Functioning (GAF) scale. Further outcomes were relapse and remission rates based on weekly psychiatric rating scales (PSR) and the number of weeks in the follow-up period during which patients had a depressive disorder or subthreshold symptoms of depression. RESULTS Patients with acute treatment (10 weeks) with SSRI and those with acute treatment with CBT (also 10 weeks) did not differ significantly concerning the number of weeks in the follow-up period in which they were completely recovered (primary outcome) (SSRI: 31.6 weeks (standard deviation (SD): 23.7), CBT: 27.8 weeks (SD: 24.3)). Sertraline was superior to CBT regarding GAF scores by trend (p = 0.06). LIMITATIONS The generalizability of the findings is limited by the moderate sample size and missing values (LIFE). CONCLUSIONS Sertraline and group CBT have similar anti-depressive effects in the long-term course of mild-to-moderate depression. Regarding long-term global functioning, sertraline seems to be slightly superior to CBT.
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Affiliation(s)
- Roland Mergl
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstr. 10, D-04103 Leipzig, Germany
| | - Antje-Kathrin Allgaier
- Department of Clinical Psychology, University of the Federal Armed Forces Munich, Werner-Heisenberg-Weg 39, D-85577 Neubiberg, Germany
| | - Martin Hautzinger
- Department of Psychology, Eberhard-Karls-University Tuebingen, Christophstr. 2, D-72072 Tuebingen, Germany
| | - James C Coyne
- Department of Health Psychology, UMCG, Groningen and University of Groningen, Groningen, The Netherlands
| | - Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstr. 10, D-04103 Leipzig, Germany.
| | - Verena Henkel
- Department of Psychiatry, Ludwig-Maximilians-University Munich, Nußbaumstr. 7, D-80336 Munich, Germany
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Henkel V, Casaulta F, Seemüller F, Krähenbühl S, Obermeier M, Hüsler J, Möller HJ. Study design features affecting outcome in antidepressant trials. J Affect Disord 2012; 141:160-7. [PMID: 22658811 DOI: 10.1016/j.jad.2012.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 02/17/2012] [Accepted: 03/12/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND A key issue in the approval process of antidepressants is the inconsistency of results between antidepressant clinical phase III trials. Identifying factors influencing efficacy data is needed to facilitate interpretation of the results. METHODS We reviewed data packages submitted as new drug applications to Swissmedic focusing on pivotal, short-term antidepressant trials. Included studies used HAMD-17 or HAMD-21 as primary measures and enrolled patients aged 18-65 years with a diagnosis of major depression. Due to the hierarchical structure of the data a mixed-effect regression model has been applied with responder rates as primary outcome criterion. Random intercepts were estimated for the different trials, while study design factors were assigned as explanatory fixed effects. RESULTS The final dataset was based upon 35 study reports with a total of N=10,835 patients. Significant results were found for study arm (placebo vs. active compound, p<0.001), sample size (p=0.002), duration of treatment (p=0.024), two or more active treatment arms (p=0.022) and the individual drug (p=0.029). Furthermore, a tendency to an association with the outcome was observed for baseline disease severity (p=0.077) and possibility of dosing adaptation (p=0.076). LIMITATIONS Due to strict confidentiality agreements, individual drugs are not reported here. Further research should consider additional variables that might have an impact on the results of antidepressant trials. CONCLUSIONS Efficacy data in antidepressant trials is significantly affected by various factors. These factors and their potentially confounding role have to be considered in the interpretation of the results.
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Affiliation(s)
- Verena Henkel
- Swissmedic, Swiss Agency for Therapeutic Products, Division Clinical Review, Hallerstr. 7, CH-3000 Berne 9, Switzerland.
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Helmreich I, Wagner S, Mergl R, Allgaier AK, Hautzinger M, Henkel V, Hegerl U, Tadić A. Sensitivity to changes during antidepressant treatment: a comparison of unidimensional subscales of the Inventory of Depressive Symptomatology (IDS-C) and the Hamilton Depression Rating Scale (HAMD) in patients with mild major, minor or subsyndromal depression. Eur Arch Psychiatry Clin Neurosci 2012; 262:291-304. [PMID: 21959915 DOI: 10.1007/s00406-011-0263-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 09/13/2011] [Indexed: 11/29/2022]
Abstract
In the efficacy evaluation of antidepressant treatments, the total score of the Hamilton Depression Rating Scale (HAMD) is still regarded as the 'gold standard'. We previously had shown that the Inventory of Depressive Symptomatology (IDS) was more sensitive to detect depressive symptom changes than the HAMD17 (Helmreich et al. 2011). Furthermore, studies suggest that the unidimensional subscales of the HAMD, which capture the core depressive symptoms, outperform the full HAMD regarding the detection of antidepressant treatment effects. The aim of the present study was to compare several unidimensional subscales of the HAMD and the IDS regarding their sensitivity to changes in depression symptoms in a sample of patients with mild major, minor or subsyndromal depression (MIND). Biweekly IDS-C28 and HAMD17 data from 287 patients of a 10-week randomised, placebo-controlled trial comparing the effectiveness of sertraline and cognitive-behavioural group therapy in patients with MIND were converted to subscale scores and analysed during the antidepressant treatment course. We investigated sensitivity to depressive change for all scales from assessment-to-assessment, in relation to depression severity level and placebo-verum differences. The subscales performed similarly during the treatment course, with slight advantages for some subscales in detecting treatment effects depending on the treatment modality and on the items included. Most changes in depressive symptomatology were detected by the IDS short scale, but regarding the effect sizes, it performed worse than most subscales. Unidimensional subscales are a time- and cost-saving option in judging drug therapy outcomes, especially in antidepressant treatment efficacy studies. However, subscales do not cover all facets of depression (e.g. atypical symptoms, sleep disturbances), which might be important for comprehensively understanding the nature of the disease depression. Therefore, the cost-to-benefit ratio must be carefully assessed in the decision for using unidimensional subscales.
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Affiliation(s)
- Isabella Helmreich
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany.
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Hegerl U, Allgaier AK, Henkel V, Mergl R. Can effects of antidepressants in patients with mild depression be considered as clinically significant? J Affect Disord 2012; 138:183-91. [PMID: 21641651 DOI: 10.1016/j.jad.2011.05.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 05/03/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND How to define clinical significance of antidepressants has become a matter of far-reaching clinical and regulatory consequences. A mean difference of at least 3 points on the Hamilton Depression Rating Scale (HAMD-17) between active treatment and placebo has been proposed as cut-off score for clinical significance in antidepressant trials. OBJECTIVE We aimed to present arguments that this, and other commonly used related approaches to establish clinical significance are likely to be misleading and risky depriving patients with mild depression of efficient treatments. METHODS These problems are exemplified with the data from a randomized placebo-controlled five-arm clinical trial with primary care patients with milder depressive syndromes (MIND-study). RESULTS AND CONCLUSIONS Designs for studying clinical significance have to be distinguished from those assessing efficacy. Moreover, evaluation of the clinical significance of psychotherapy as a possible alternative to antidepressants faces the problem of how to define a valid control group where blinding of neither therapists nor patients is possible.
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Affiliation(s)
- Ulrich Hegerl
- Department of Psychiatry, University of Leipzig, Semmelweisstr. 10, D-04103 Leipzig, Germany.
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Helmreich I, Wagner S, Mergl R, Allgaier AK, Hautzinger M, Henkel V, Hegerl U, Tadić A. P-491 - Sensitivity to changes during antidepressant treatment: a comparison of unidimensional depression rating scales in patients with minor depression. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)74658-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Riedel M, Möller HJ, Obermeier M, Adli M, Bauer M, Kronmüller K, Brieger P, Laux G, Bender W, Heuser I, Zeiler J, Gaebel W, Schennach-Wolff R, Henkel V, Seemüller F. Clinical predictors of response and remission in inpatients with depressive syndromes. J Affect Disord 2011; 133:137-49. [PMID: 21555156 DOI: 10.1016/j.jad.2011.04.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 04/11/2011] [Accepted: 04/11/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Most predictor analyses search for single predictors or rely on data from randomized controlled trials. We aimed at detecting a set of clinical baseline variables for prediction of response and remission in 1014 naturalistically treated inpatients with major depressive episode treated for 53.62 ± 47.5 days. METHODS A three-staged procedure was implemented. First, univariate tests were used for finding associations with baseline variables. Second, logistic regression and third-CART analyses were used to determine predictors of response to inpatient treatment. RESULTS Presence of suicidality, a higher initial HAMD-21 total score, an episode length <24 months, fewer previous hospitalizations, and absence of any ICD-10F4 comorbidity predicted response in 2 different statistical models. Remission was predicted by lower HAMD-21 baseline score, episode length <24 months and fewer previous hospitalizations in both models. LIMITATION Results were assessed by a post-hoc analysis, based on prospectively collected data. No controlled study design. CONCLUSION Contrary to current beliefs, baseline suicidality might be associated with higher chances for response. In addition, baseline severity might impact outcome depending on which criterion (remission or response) used.
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Affiliation(s)
- Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstrasse 7, 80336 Munich, Germany
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Helmreich I, Wagner S, Mergl R, Allgaier AK, Hautzinger M, Henkel V, Hegerl U, Tadić A. The Inventory Of Depressive Symptomatology (IDS-C(28)) is more sensitive to changes in depressive symptomatology than the Hamilton Depression Rating Scale (HAMD(17)) in patients with mild major, minor or subsyndromal depression. Eur Arch Psychiatry Clin Neurosci 2011; 261:357-67. [PMID: 21132437 DOI: 10.1007/s00406-010-0175-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 11/22/2010] [Indexed: 11/29/2022]
Abstract
Depression rating scales play a decisive role in the assessment of the severity of depression and the evaluation of the efficacy of antidepressant treatments. The Hamilton Depression Rating Scale (HAMD) is regarded as the 'gold standard'; nevertheless, studies suggest that the Inventory of Depressive Symptomatology (IDS) is more sensitive to detect symptom changes. The aim of the present study was to investigate whether the IDS is more sensitive in detecting changes in depression symptoms in patients with mild major, minor or subsyndromal depression (MIND). Biweekly IDS-C(28) and HAMD(17) data from 340 patients of a 10-week randomized, placebo-controlled trial comparing the effectiveness of sertraline and cognitive-behavioural therapy in patients with MIND were analysed. We investigated sensitivity to change for both scales (1) from assessment-to-assessment, (2) in relation to depression severity level, and (3) in relation to DSM-IV depression criterion symptoms. The IDS-C(28) was more sensitive in detecting changes in depression symptomatology over the treatment course as well as for different severity levels, especially in patients with a low depression severity. It assesses the DSM-IV criteria more thoroughly, is better able to track the change of cognitive symptoms and to identify residual symptoms. Both scales are well able to assess depressive symptomatology. However, the IDS-C(28) surpasses the HAMD(17) in detecting small changes especially in the core symptoms of depression. This is important for an optimal treatment by capturing early improvements, enabling prompt reactions and detecting residual symptoms.
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Affiliation(s)
- Isabella Helmreich
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Germany.
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Mergl R, Henkel V, Allgaier AK, Kramer D, Hautzinger M, Kohnen R, Coyne J, Hegerl U. Are treatment preferences relevant in response to serotonergic antidepressants and cognitive-behavioral therapy in depressed primary care patients? Results from a randomized controlled trial including a patients' choice arm. Psychother Psychosom 2011; 80:39-47. [PMID: 20975325 DOI: 10.1159/000318772] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 07/05/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Little is known about the influence of depressed patients' preferences and expectations about treatments upon treatment outcome. We investigated whether better clinical outcome in depressed primary care patients is associated with receiving their preferred treatment. METHODS Within a randomized placebo-controlled single-centre 10-week trial with 5 arms (sertraline; placebo; cognitive-behavioral group therapy, CBT-G; moderated self-help group control; treatment with sertraline or CBT-G according to patients' choice), outcomes for 145 primary care patients with mild-to-moderate depressive disorders according to DSM-IV criteria were investigated. Preference for medication versus psychotherapy was assessed at screening using a single item. Post-baseline difference scores for the Hamilton Depression Rating Scale (HAMD-17) were used to assess treatment outcome (mixed-model repeated-measures regression analysis). RESULTS Depressed patients receiving their preferred treatment (n = 63), whether sertraline or CBT-G, responded significantly better than those who did not receive their preferred therapy (n = 54; p = 0.001). The difference in outcome between both groups was 8.0 points on the HAMD-17 for psychotherapy and 2.9 points on the HAMD-17 for treatment with antidepressants. Results were not explained by differences in depression severity or dropout rates. CONCLUSIONS Patients' relative preference for medication versus psychotherapy should be considered when offering a treatment because receiving the preferred treatment conveys an additional and clinically relevant benefit (HAMD-17: +2.9 points for drugs; +8.0 points for CBT-G) in outcome.
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Affiliation(s)
- Roland Mergl
- Department of Psychiatry, University of Leipzig, Leipzig, Germany.
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Helmreich I, Wagner S, Mergl R, Allgaier AK, Hautzinger M, Henkel V, Hegerl U, Tadić A. The inventory of depressive symptomatology is more sensitive to changes in depressive symptomatology than the hamilton depression rating scale in patients with minor depression. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72340-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BackgroundDepression rating scales play a decisive role in the assessment of the severity of depression and the evaluation of the efficacy of antidepressant treatments. The Hamilton Depression Rating Scale (HAMD) is regarded as the ‘gold standard’; nevertheless, studies suggest that the Inventory of Depressive Symptomatology (IDS) is more sensitive to detect symptom changes. The aim of the present study was to investigate whether the IDS is more sensitive in detecting changes in depression symptoms in patients with mild major, minor or subsyndromal depression (MIND).MethodsBiweekly IDS-C28 and HAMD17 data from 340 patients of a 10-week randomized, placebo-controlled trial comparing the effectiveness of sertraline and cognitive-behavioural therapy in patients with MIND were analysed. We investigated sensitivity to change for both scales1)from assessment-to-assessment,2)in relation to depression severity level, and3)in relation to DSM-IV depression criterion symptoms.ResultsThe IDS-C28 was more sensitive in detecting changes in depression symptomatology over the treatment course as well as for different severity levels, especially in patients with a low depression severity. It assesses the DSM-IV criteria more thoroughly, is better able to track the change of cognitive symptoms and to identify residual symptoms.ConclusionsBoth scales are well able to assess depressive symptomatology. However, the IDS-C28 surpasses the HAMD17 in detecting small changes especially in the core symptoms of depression. This is important for an optimal treatment by capturing early improvements, enabling prompt reactions and detecting residual symptoms.
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Seemüller F, Möller HJ, Obermeier M, Adli M, Bauer M, Kronmüller K, Holsboer F, Brieger P, Laux G, Bender W, Heuser I, Zeiler J, Gaebel W, Schennach-Wolff R, Henkel V, Riedel M. Do efficacy and effectiveness samples differ in antidepressant treatment outcome? An analysis of eligibility criteria in randomized controlled trials. J Clin Psychiatry 2010; 71:1425-33. [PMID: 20816028 DOI: 10.4088/jcp.09m05166blu] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 06/15/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Because of strict inclusion and exclusion criteria, results drawn from placebo-controlled randomized antidepressant efficacy trials may not be transferable to real-world patients. METHOD This study was performed from March 2000 to September 2005 as a prospective, multicenter follow-up. Patients were recruited from February 2000 to June 2005. All patients were hospitalized (N = 1,014) and met DSM-IV criteria for major depressive episode. Assessments with the 21-item Hamilton Depression Rating Scale were conducted biweekly until discharge. According to the most commonly applied exclusion criteria in randomized controlled antidepressant efficacy trials, patients were retrospectively divided into 2 groups: (1) patients not fulfilling exclusion criteria and therefore eligible for a randomized placebo-controlled trial, referred to as "efficacy sample," and (2) patients fulfilling at least 1 exclusion criterion, not being eligible for inclusion in an efficacy trial ("nonefficacy sample"). The efficacy sample was compared with the nonefficacy sample in terms of sociodemographic and clinical baseline variables and outcome measures, such as remission and response rates, 17-item Hamilton Depression Rating Scale mean scores, time to remission, and time to response. RESULTS Significant differences were found, with the efficacy sample being older (P = .03) and being more often treated at a university hospital (P = .02). The efficacy sample demonstrated superior outcome only in significantly higher mean Global Assessment of Functioning scores at discharge (P = .03). There were no differences regarding remission (P = .68) and response (P = .06) rates, length of hospital stay (P = .49), 17-item Hamilton Depression Rating Scale total score at discharge (P = .13), or time to response (P = .39) or remission (P = .16). CONCLUSIONS Both groups differed significantly in several baseline measures and final Global Assessment of Functioning scores but not in any other outcome measure. Challenging current beliefs, our findings show that results from efficacy antidepressant trials might be more generalizable than previously thought.
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Affiliation(s)
- Florian Seemüller
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany.
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Henkel V, Seemüller F, Obermeier M, Adli M, Bauer M, Kronmüller K, Holsboer F, Brieger P, Laux G, Bender W, Heuser I, Zeiler J, Gaebel W, Mayr A, Riedel M, Möller HJ. Relationship between baseline severity of depression and antidepressant treatment outcome. Pharmacopsychiatry 2010; 44:27-32. [PMID: 20981642 DOI: 10.1055/s-0030-1267177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Assessment of depression severity is of key importance, since several clinical guidelines recommend choice of treatment dependent on the depression severity grade. Using different tools to assess baseline severity may result in different outcomes. METHODS This paper describes the results of a multicentre, naturalistic study investigating the relationship between depression symptom severity (using 4 different measures of symptom severity) and clinical outcome among patients hospitalised for depression (N=1 014). Moreover, the impact of differences between methods of measuring depression severity has been investigated. Statistical analyses (univariate measurements, logistic regression models) were conducted to detect coherences and differences between the various methods of severity categorisation. RESULTS Results revealed different associations between outcome and classification methods. Response or remission rates varied if baseline severity was assessed by different instruments. Moreover, the number of responders increased with higher baseline severity grades of depression, whereas the number of remitters decreased. Additional analyses dependent on outcome criteria using continuous instead of categorical data revealed similar results. DISCUSSION Baseline severity may be only one of many other important clinical variables that mediate clinical outcome, but it is surely an important one deserving further research and consideration.
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Affiliation(s)
- V Henkel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
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Seemüller F, Schennach-Wolff R, Obermeier M, Henkel V, Möller HJ, Riedel M. Does early improvement in major depression protect against treatment emergent suicidal ideation? J Affect Disord 2010; 124:183-6. [PMID: 19889462 DOI: 10.1016/j.jad.2009.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 10/12/2009] [Accepted: 10/12/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the association of early improvement and treatment emergent suicidal ideation in a large sample (N=705) of naturalistically treated inpatients with major depressive disorder. METHOD In line with previous reports early improvement was defined as a 20% HAMD improvement within the first two weeks of antidepressant treatment. Treatment emergent suicidal ideation was defined by a sudden increase from 0 or 1 to at least 3 on HAMD item 3 and from 0.1 to at least 4 on MADR item 10 for suicidal ideation. Early improvers were compared with non-early improvers with respect to the occurrence of treatment emergent suicidality during treatment. RESULTS Early improvers were 3 (MADRS) to 3.4 (HAMD) times less likely to experience new emergence of suicidal ideation during the treatment course than non-improvers. In addition, early improvement was associated with significantly less pessimistic thoughts. LIMITATIONS The analysis is based on secondary analysis of prospectively collected data. No controlled study design. CONCLUSION Early improvement is associated with significantly less treatment emergent suicidal ideation for it may provide rapid symptom relief and reduce hopelessness.
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Affiliation(s)
- Florian Seemüller
- Department of Psychiatry, Ludwig Maximilians University, Nussbaumstr. 7, Munich, Germany.
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Möhrenschlager M, Ring J, Henkel V. A 12-month-old boy with a localized verrucous tumor. Eur J Pediatr 2010; 169:513-5. [PMID: 19834737 DOI: 10.1007/s00431-009-1089-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 09/30/2009] [Indexed: 11/29/2022]
Abstract
A 12-month-old boy was admitted suffering from a localized pad-like thickening of tissue affecting the area of his right hand joint. First affection of skin was detected at age of 6 months, when a red macula was noted. The parents were now afraid of a viral or malignant disorder. The lesion completely resolved by the second birthday without medical intervention.
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Affiliation(s)
- Matthias Möhrenschlager
- Department of Dermatology and Allergology, Allergieklinik, Hochgebirgsklinik, Herman-Burchard-Street 1, 7265, Davos, Switzerland.
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Allgaier AK, Mergl R, Hautzinger M, Kohnen R, Coyne J, Möller HJ, Hegerl U, Henkel V. PW01-01 - Treatment of atypical depression: post-HOC analysis of a RCT testing the efficacy of sertraline and CBT in primary care patients. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71403-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Tadić A, Helmreich I, Mergl R, Hautzinger M, Kohnen R, Henkel V, Hegerl U. Early improvement is a predictor of treatment outcome in patients with mild major, minor or subsyndromal depression. J Affect Disord 2010; 120:86-93. [PMID: 19428118 DOI: 10.1016/j.jad.2009.04.014] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 04/15/2009] [Accepted: 04/15/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is substantial evidence that early improvement (EI) under antidepressant treatment is a clinically useful predictor of later treatment outcome in patients with major depressive disorders. The aim of this study was to test whether EI can also be used as a predictor for treatment outcome in patients with mild major, minor or subsyndromal depression, i.e. patients, who are typically treated by general practitioners. METHODS Analyses were carried out using data from 223 patients of a 10-weeks randomized, placebo-controlled trial comparing the effectiveness of sertraline and cognitive-behavioural therapy (CBT) in patients with mild major, minor or subsyndromal depression. EI was defined as a reduction of > or =20% on the 17-item Hamilton Rating Scale for Depression (HAMD-17) compared with baseline within the first 2 weeks of treatment. The predictive value of EI for stable response at week 8 and 10 (> or =50% HAMD-17 sum score reduction at weeks 8 and 10) and stable remission (HAMD-17 sum score < or =7 at weeks 8 and 10) was evaluated. RESULTS In both the sertraline- and CBT-treatment group, EI was a highly sensitive predictor for later stable response (76% and 82%, respectively) and stable remission (70% and 75%, respectively). In patients without EI, only a small proportion of sertraline or CBT-treated patients achieved stable response (20.9% and 5.9%, respectively) or stable remission (18.6% and 8.8%, respectively). Patients with EI were by far more likely to achieve stable response or stable remission than patients without as indicated by high odds ratios (95% confidence interval) of 8.1 (3.0-21.8) and 3.8 (1.4-10.1) for sertraline, and 11.1 (2.1-58.4) and 7.2 (1.7-30.8) for CBT-treated patients, respectively. LIMITATIONS Sample sizes were relatively low in different treatment groups. CONCLUSION The identification of early improvement might be useful in clinical decision making in the early course of treatment of patients with mild major, minor and subthreshold depression.
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Affiliation(s)
- André Tadić
- Department of Psychiatry and Psychotherapy, University of Mainz, Germany.
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Mergl R, Henkel V, Allgaier AK, Kramer D, Hautzinger M, Kohnen R, Coyne J, Hegerl U. P01-71 - Are treatment preferences relevant for response to serotonergic antidepressants and cognitive-behavioural therapy in depressed primary care patients? Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70290-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Mergl R, Henkel V, Allgaier AK, Hautzinger M, Kohnen R, Coyne JC, Hegerl U. Are treatment preferences relevant for response to serotonergic antidepressants and cognitive-behavioural therapy in depressed primary care patients? Results from a randomized controlled trial including a patient choice arm. Pharmacopsychiatry 2009. [DOI: 10.1055/s-0029-1240172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hegerl U, Bottner AC, Holtschmidt-Täschner B, Born C, Seemüller F, Scheunemann W, Schütze M, Grunze H, Henkel V, Mergl R, Angst J. Onset of depressive episodes is faster in patients with bipolar versus unipolar depressive disorder: evidence from a retrospective comparative study. J Clin Psychiatry 2008; 69:1075-80. [PMID: 18384245 DOI: 10.4088/jcp.v69n0705] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Depressive episodes can have a very fast onset (< 1 hour) or start very slowly (> 1 month). This interesting aspect, pointing to different neurophysiological pathomechanisms, has not been systematically evaluated so far. The aim of this study was to describe speed of onset of depressive episodes in a consecutive sample of patients with at least 1 depressive episode and to investigate potential differences between patients with major depression versus bipolar affective disorders concerning this variable. METHOD We examined 158 consecutive adult patients with major depression (N = 108) and bipolar disorder (N = 50) diagnosed according to criteria of the International Statistical Classification of Diseases, 10th revision, by applying the structured Onset-of-Depression Inventory. Patients with acute critical life events preceding the onset were excluded from final analyses. Data were collected between December 2001 and January 2007. RESULTS There was a significant positive association between speed of onset of the present depressive episode and that of the preceding depressive episode (rho = 0.66, p < .001). Patients with bipolar disorder developed full-blown depressive episodes significantly faster than patients with major depression (p < .001): Whereas depressive episodes began within 1 week in 58% of patients with bipolar disorder, this was the case in only 7.4% of patients with major depression. CONCLUSION Intraindividually, the speed of onset of depression is similar across different episodes. In the absence of acute critical life events, fast onset of depressive episodes (within 1 week) is common in bipolar disorder but rare in major depression. This aspect might be useful to identify depressive episodes occurring within a bipolar affective illness and might characterize a subgroup of patients with a distinct neurobiology.
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Affiliation(s)
- Ulrich Hegerl
- Department of Psychiatry, University of Leipzig, Johannisallee 20, D-04317 Leipzig, Germany.
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Seemüller F, Riedel M, Wickelmaier F, Adli M, Mundt C, Marneros A, Laux G, Bender W, Heuser I, Zeiler J, Gaebel W, Jäger M, Möller HJ, Henkel V. Atypical symptoms in hospitalised patients with major depressive episode: frequency, clinical characteristics, and internal validity. J Affect Disord 2008; 108:271-8. [PMID: 18164767 DOI: 10.1016/j.jad.2007.10.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 10/26/2007] [Accepted: 10/26/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective was (1) to assess the frequency of atypical depression (AD) in depressed inpatients; (2) to compare clinical features of patients with atypical and nonatypical depression (Non-AD) (3) to evaluate the meaning of single psychopathological symptoms with special respect to mood reactivity. METHOD Diagnoses of 1073 inpatients were assessed according to DSM-IV using SCID (Structured Clinical Interview for the DSM-IV) and AMDP (Association for Methodology and Documentation). Diagnosis of atypical depression was defined according to criteria of the DSM-IV specifier for AD. All patients were rated using HAMD-21 (Hamilton Depression Scale). RESULTS A high percentage of patients met criteria for AD (15.3%, 95% CI 13.0-17.9%). Women were more likely to suffer from AD (OR=1.54, p=0.037). There were no significant differences between AD and Non-AD patients regarding age, HAMD total baseline score, and diagnosis of any bipolar illness. In terms of psychopathology patients with AD were significantly more likely to suffer from somatic anxiety, somatic symptoms, guilt, genital symptoms, depersonalisation and suspiciousness as defined by HAMD-21 items. Interestingly, mood reactivity was not found to be significantly associated with the presence of two or more additional symptoms of AD. LIMITATIONS Results were assessed by a post-hoc analysis, based on prospectively collected data. Compared to other inpatient samples with MDE, prevalence of bipolar disorder was rather low. CONCLUSION (1) Frequency of AD may be underestimated, especially in inpatient samples. Further studies of inpatient samples are recommended. (2) Quality of distinct anxiety symptoms may be different in both groups, with AD patients being more likely to suffer from somatic symptoms and somatic anxiety. The presence of suspiciousness and even paranoid phenomena may not exclude a diagnosis of AD, but may be related to rejection sensitivity. (3) The mandatory presence of mood reactivity for the diagnosis of AD needs further consideration, regarding its validity for the concept.
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Affiliation(s)
- Florian Seemüller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Nussbaumstrasse 7, 80336 Munich, Germany.
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Hegerl U, Bottner AC, Mergl R, Holtschmidt-Täschner B, Seemüller F, Scheunemann W, Schütze M, Grunze H, Henkel V, Angst J, Born C. [Speed of onset of depressive episodes: a clinical criterion helpful for separating uni- from bipolar affective disorders]. Neuropsychiatr 2008; 22:92-99. [PMID: 18606111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Depressive episodes can begin abruptly or start very slowly (over weeks). This relevant clinical feature of affective disorders has not been systematically investigated so far. The aim of this study was to analyze speed of onset of depressive episodes in patients with unipolar depression (UD) and bipolar affective disorders (BD). METHODS 158 adult patients with UD (N = 108) and BD (N = 50) were examined using the structured "Onset-of-Depression Inventory". Only patients without acute critical life events preceding the onset were included in the study. RESULTS There was a significant positive correlation between speed of onset of the present and that of the preceding depressive episode (rho = 0.66; p < 0.001). The association between speed of onset and speed of decay of depressive episodes failed to be significant (rho = 0.20; p = 0.09). Patients with bipolar disorder were found to develop depressive episodes significantly faster than patients with major depression (p < 0.001): Whereas depressive episodes started in 58% of patients with bipolar disorder within one week, this was only the case in 7.4% of patients with major depression. CONCLUSIONS Within subjects, the speed of onset of depression is similar across different episodes. In the absence of acute critical life events, rapid onset of depressive episodes (within one week) is typical for bipolar depression, but not for unipolar depression. A rapid onset of depressive episodes might point to BD in patients with solely depressive episodes in the past and to subgroups with different neurobiological pathogenetic mechanisms.
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Affiliation(s)
- Ulrich Hegerl
- Klinik und Poliklinik für Psychiatrie, Universitätsklinikum Leipzig.
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Seemüller F, Riedel M, Mayr A, Mundt C, Holsboer F, Marneros A, Laux G, Bender W, Adli M, Heuser I, Zeiler J, Gaebel W, Jäger M, Möller HJ, Henkel V. Do data from a large prospective naturalistic study (N=1014, MDD) support the new FDA recommendation concerning antidepressants suicidality risk? Pharmacopsychiatry 2007. [DOI: 10.1055/s-2007-991685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Möhrenschlager M, Pontz BF, Lanzl I, Podskarbi T, Henkel V, Ring J. Fabry disease: case report with emphasis on enzyme replacement therapy and possible future therapeutic options. J Dtsch Dermatol Ges 2007; 5:594-7. [PMID: 17610610 DOI: 10.1111/j.1610-0387.2007.06334.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 38-year-old male Caucasian with Fabry disease presented with angiokeratomas and tortuous conjunctival and retinal vessels. Additionally, the patient showed characteristic skin lesions of psoriasis and seborrheic dermatitis. His past medical history revealed anhidrosis, acral paresthesias, myocardial infarction, phlebothrombosis, hypertension, antithrombin III deficiency, factor V Leiden disease, chronic obstructive lung disease, tinnitus, diarrhea, recurrent abdominal pain, headache, and depressive mood. He was treated with intravenous substitution of the deficient enzyme alpha-galactosidase A. Possible future options in treatment of Fabry disease are discussed.
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Mergl R, Seidscheck I, Allgaier AK, Möller HJ, Hegerl U, Henkel V. Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition. Depress Anxiety 2007; 24:185-95. [PMID: 16900465 DOI: 10.1002/da.20192] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Recent studies emphasize the negative impact of comorbidity on the course of depression. If undiagnosed, depression and comorbidity contribute to high medical utilization. We aimed to assess (1) prevalences of depression alone and with comorbidity (anxiety/somatoform disorders) in primary care, (2) coexistence of anxiety/somatoform disorders in depressive patients, and (3) diagnostic validity of two screeners regarding depression with versus without comorbidity. We examined 394 primary care outpatients using the Composite International Diagnostic Interview (CIDI), the General Health Questionnaire (GHQ-12), and the Well-Being Index (WHO-5). We conducted configurational frequency analyses to identify nonrandom configurations of the disorders and receiver operating characteristic (ROC)-analyses to assess diagnostic validity of the screeners. Point prevalence of any depressive disorder was 22.8%; with at least one comorbid disorder, 15%; and with two comorbid conditions, 6.1%, which significantly exceeded expected percentage (0.9%, P< or =.0001). Depression without comorbidity occurred significantly less often than expected by chance (P< or =.0007). Comorbidity of depressive and anxiety or somatoform disorders was associated with a high odds ratio (6.25). The screeners were comparable regarding their diagnostic validity for depression with [GHQ-12: area under the curve (AUC)=0.86; WHO-5: AUC=0.88] and without comorbidity (GHQ-12: AUC=0.84; WHO-5: AUC=0.86). It can be concluded that comorbidity between depression and anxiety/somatoform disorders in primary care may occur much more frequently than expected. These results confirm assumptions that the current division between depression and anxiety might be debatable. Validity of screeners tested in our study was not affected by comorbid conditions (e.g., anxiety or somatoform disorders).
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Affiliation(s)
- Roland Mergl
- Department of Psychiatry, Ludwig-Maximilians-University Munich, Munich, Germany
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Möhrenschlager M, Pontz BF, Lanzl I, Podskarbi T, Henkel V, Ring J. Morbus Fabry: Fallbericht unter besonderer Berücksichtigung der Enzymersatztherapie sowie möglicher zukünftiger Therapieoptionen. J Dtsch Dermatol Ges 2007. [DOI: 10.1111/j.1610-0387.2007.06334_supp.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mergl R, Pogarell O, Juckel G, Rihl J, Henkel V, Frodl T, Müller-Siecheneder F, Karner M, Tigges P, Schröter A, Hegerl U. Hand-motor dysfunction in depression: characteristics and pharmacological effects. Clin EEG Neurosci 2007; 38:82-8. [PMID: 17515173 DOI: 10.1177/155005940703800210] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Motor retardation is a relevant aspect of depression. Kinematic analysis of movements can be applied to explore which type of motor dysfunction is associated with depression and to examine motor side effects of antidepressants. Using this tool, we aimed to investigate fine motor performance in patients suffering from depression and to compare a selective noradrenaline re-uptake inhibitor (NARI) (reboxetine) and a selective serotonin reuptake inhibitor (SSRI) (citalopram) regarding motor side effects after 4 weeks of treatment. In the first study (I), we examined 37 depressed patients and 37 healthy subjects using a digitizing graphic tablet and kinematic analysis of handwriting and rapid drawing movements. Both groups were comparable regarding age, gender distribution, handedness (preponderance of right-handers) and educational level. In the second study (ll), we examined different types of hand movements in 16 depressed patients receiving citalopram (flexible dosage) and 12 depressed patients treated with reboxetine (varying dosage) using the afore-mentioned methods. Both groups were comparable regarding age, gender, handedness and the baseline Hamilton Depression Rating Scale total score. I: Depressed patients performed drawing with significantly less regular velocity than controls (p < 0.001), but normal velocity. Handwriting of depressed patients was abnormally slow (p = 0.04). II: Reboxetine led to a significant improvement of repetitive drawing movements in depression. In contrast, citalopram had no pronounced effects on hand movements in depressed patients. I: Irregular patterns of velocity peaks in depressed patients point to basal ganglia dysfunction and/or deficient activity of the sensorimotor cortex and the supplementary motor area as possible substrates of hand-motor disturbances in depression. II: Computer-aided analysis of hand movements is a sensitive tool for the registration of differential pharmaceutical effects on hand-motor function in depression.
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Affiliation(s)
- Roland Mergl
- Dept. of Psychiatry, University Leipzig, Germany.
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Henkel V, Moehrenschlager M, Hegerl U, Moeller HJ, Ring J, Worret WI. Screening for depression in adult acne vulgaris patients: tools for the dermatologist. J Cosmet Dermatol 2007; 1:202-7. [PMID: 17147540 DOI: 10.1111/j.1473-2165.2002.00057.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adult dermatological out patients have a 40% prevalence of psychiatric co-morbidity. If psychiatric co-morbidity is unrecognized, undetected and untreated, the consequences may be fatal. Acne is the most common skin disorder of the second and third decades of life. Acne and its treatments may cause depression. AIMS To identify a screening tool to identify depression in adult acne patients. METHODS The literature was reviewed to identify validated screening instruments for depressive disorders. Questionnaires studied included the Hospital Anxiety and Depression Scale (HAD), the Brief Patient Health Questionnaire (B-PHQ), the General Health Questionnaire-12 item version (GHQ-12), and the World Health Organization-5 Well Being Index (WHO-5). RESULTS WHO-5 performed best in terms of sensitivity (0.93 for a cut-off score of 13) as well as taking least time to complete (2-5 min) and evaluate (0.5-2 min). CONCLUSIONS WHO-5 can be recommended as part of a two-step screening process for depression in acne patients. Step 1 is the WHO-5. In the case of a positive score, step 2 is a detailed psychosocial assessment.
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Affiliation(s)
- Verena Henkel
- Department of Psychiatry, Ludwig-Maximilians-University Munich, Munich, Germany.
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Henkel V, Mergl R, Allgaier AK, Kohnen R, Möller HJ, Hegerl U. Treatment of depression with atypical features: a meta-analytic approach. Psychiatry Res 2006; 141:89-101. [PMID: 16321446 DOI: 10.1016/j.psychres.2005.07.012] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2004] [Revised: 02/23/2005] [Accepted: 07/26/2005] [Indexed: 01/11/2023]
Abstract
The present meta-analysis addressed the empirical evidence regarding the treatment of major depression with atypical features. The superiority of monoamine oxidase inhibitors (MAOIs) compared with other antidepressants in the treatment of major depression with atypical features has been frequently reported. According to the CONSORT Statement, studies included in our meta-analysis had to meet several criteria, especially a double-blind, controlled condition and an operational diagnosis according to Diagnostic and Statistical Manual of Mental Disorders (DSM)-III or DSM-IV criteria, respectively. Four databases for research-based evidence were used in a systematic review: Medline, Embase, Psyndex and PsycInfo. Only eight publications met inclusion/exclusion criteria, resulting in 11 comparisons. Our results contrast an effect size of 0.45 (95% confidence interval) for a comparison of MAOIs vs. placebo with an effect size of 0.02 (95% confidence interval: - 0.10-0.14) for a comparison of MAOIs vs. selective serotonin reuptake inhibitors. The effect size for MAOIs vs. tricyclic antidepressants was 0.27 (95% confidence interval: 0.16-0.42). MAOIs may be more effective for atypical major depressive disorder than tricyclic antidepressants. Most clinical research has been conducted on irreversible MAOIs. Additional studies testing more recently developed antidepressants (including reversible MAOIs) with an improved safety profile would be warranted. The available data are insufficient for a direct comparison between MAOIs and selective serotonin reuptake inhibitors.
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Affiliation(s)
- Verena Henkel
- Department of Psychiatry, Laboratory of Clinical Neurophysiology, Ludwig-Maximilians-University Munich, Nussbaumstr. 7, D-80336 Munich, Germany
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Pogarell O, Ehrentraut S, Rüther T, Mulert C, Hegerl U, Möller HJ, Henkel V. Prolonged Confusional State Following Electroconvulsive Therapy - Diagnostic Clues from Serial Electroencephalography. Pharmacopsychiatry 2005; 38:316-20. [PMID: 16342004 DOI: 10.1055/s-2005-916187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Cognitive impairment occasionally occurs after electroconvulsive therapy (ECT) and usually resolves within a few days. Any prolonged cognitive alterations or confusional states may have additional causes and require extensive diagnostic effort. Since cognitive dysfunction can also be caused by ictal states, electroencephalography (EEG) is an essential tool for these conditions. METHODS We report on a female patient with pharmacotherapy resistant major depression who had been treated by a series of ECT and subsequently developed severe confusion and fluctuating amnesia. RESULTS Laboratory and neuroimaging examinations were normal, however, EEG revealed a severe intermittent slowing with rhythmic high amplitude delta-/theta-activity and sporadic bitemporal sharp waves. Oral application of 1 mg lorazepam led to a sudden improvement of EEG abnormalities. Consequently, non-convulsive status epilepticus (NCSE) was suspected and the patient was regularly treated with lorazepam, accordingly. Clinically the confusional and amnesic symptoms declined, whereas serial EEG recordings showed a further improvement and normalization of brain electric activity. CONCLUSION Routine EEG is an indispensable tool in patients with sudden deterioration of cognitive functions and unclear neuropsychiatric symptomatology. A testing dose of lorazepam can help to classify EEG abnormalities in terms of ictal EEG patterns.
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Affiliation(s)
- O Pogarell
- Department of Psychiatry, Ludwig-Maximilians-University of Munich, Munich, Germany.
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Kronenberg G, Berger P, Tauber RF, Bandelow B, Henkel V, Heuser I. Randomized, double-blind study of SR142801 (Osanetant). A novel neurokinin-3 (NK3) receptor antagonist in panic disorder with pre- and posttreatment cholecystokinin tetrapeptide (CCK-4) challenges. Pharmacopsychiatry 2005; 38:24-9. [PMID: 15706463 DOI: 10.1055/s-2005-837768] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The present study was designed to examine the efficacy and tolerability of the non-peptide neurokinin-3 (NK3) receptor antagonist SR142801 in outpatients suffering from panic disorder. METHODS In a pilot study, 52 patients who were responders to a cholecystokinin tetrapeptide (CCK-4) challenge were randomized to four weeks of treatment with SR142801 (n = 36) or placebo (n = 16). Panic symptoms were assessed on weekly visits and a second CCK-4 challenge was performed at the end of the double-blind placebo controlled treatment period. Tolerability of SR142801 was generally good. RESULTS The proportion of patients who had at least one adverse event (AE) in the SR142801 group and the placebo group was similar (58.3 and 50 %, respectively). Independent of treatment group, patients' overall panic symptomatology was substantially improved at the end of the treatment. CONCLUSION With regard to efficacy of outcome, the compound was not significantly different from placebo. However, post-CCK-4 plasma prolactin concentrations showed a significant difference between placebo and SR142801.
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Affiliation(s)
- G Kronenberg
- Psychiatric Department, Charité-CBF, Free University of Berlin, Germany
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Benöhr P, Henkel V, Speer R, Vogel U, Sotlar K, Aydeniz B, Reiser A, Neubauer H, Tabiti K, Wallwiener D, Clare SE, Kurek R. Her-2/neu expression in breast cancer--A comparison of different diagnostic methods. Anticancer Res 2005; 25:1895-900. [PMID: 16158923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Determination of Her-2/neu overexpression in breast cancer has previously been shown to be of prognostic significance. In this study, Her-2/neu expression in breast cancer was characterised by real-time PCR (RLT-PCR) based LightCycler-HER-2/neu DNA Quantification with immunohistochemistry (IHC) and fluorescence in situ hybridisation (FISH). MATERIAL AND METHODS Fifteen specimens of invasive breast cancer - whole tissue sections as well as microdissected tumour cells - were subjected to RLT-PCR. Additionally, IHC and FISH were performed. RESULTS Her-2/neu overexpression was detected by FISH and by real-time PCR in the same tumours. In contrast, IHC revealed discordant results. CONCLUSION Determination of Her-2/neu amplification by real-time PCR is a sensitive and specific method with some advantages over FISH. This method is simple and reliable and has the potential of categorizing those tumours with borderline Her-2/neu overexpression as determined by IHC.
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Affiliation(s)
- P Benöhr
- Department of Nephrology and Rheumatology, University of Göttingen, Germany.
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Henkel V, Mergl R, Möller HJ. Major depression is common in people over the age of 50, particularly in those at socioeconomic disadvantage, or with poor physical health and previous depressive symptoms. Evid Based Ment Health 2005; 8:25. [PMID: 15671516 DOI: 10.1136/ebmh.8.1.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Verena Henkel
- Department of Psychiatry, Ludwig-Maximilians-Universität Munich, Munich, Bavaria, Germany
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Hegerl U, Mergl R, Henkel V, Pogarell O, Müller-Siecheneder F, Frodl T, Juckel G. Differential effects of reboxetine and citalopram on hand-motor function in patients suffering from major depression. Psychopharmacology (Berl) 2005; 178:58-66. [PMID: 15316714 DOI: 10.1007/s00213-004-1983-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2003] [Accepted: 02/19/2004] [Indexed: 10/26/2022]
Abstract
RATIONALE Motor dysfunctions might be a more common side effect of serotonergic than noradrenergic antidepressants. However, the effects of antidepressants on motor function in depression have rarely been analyzed systematically. Computerized methods allow the objective registration of drug-induced motor dysfunction and were applied in this study. OBJECTIVES To examine the effects of a selective noradrenaline re-uptake inhibitor (NARI) (reboxetine) and a selective serotonin re-uptake inhibitor (SSRI) (citalopram) on hand-motor function in patients with major depression. METHODS Different types of hand movements (drawing of circles and handwriting probes) were recorded and analyzed in 16 acutely depressed inpatients receiving citalopram (30-60 mg/day) and 12 acutely depressed inpatients treated with reboxetine (4-8 mg/day), using a digitizing tablet for the analysis of movement dynamics. Both groups were comparable regarding mean age (42-43 years), gender, handedness (preponderance of right-handers) and the mean baseline HAMD score (about 27). Five kinematical parameters reflecting velocity, regularity and degree of automation of hand movements have been computed. RESULTS Reboxetine had significantly more favorable effects on fine motor function (increased velocity of rapid hand movements) in depressed patients than citalopram. These differences became obvious when patients conducted more complex tasks and are not explained by differential antidepressant effects. CONCLUSIONS Our findings are in line with the hypothesis that SSRI tend to have small, but more pronounced negative effects on motor function than NARI.
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Affiliation(s)
- Ulrich Hegerl
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Ludwig-Maximilians-Universität München, Nussbaumstr. 7, 80336, Munich, Germany.
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Möhrenschlager M, Henkel V, Möller HJ, Worret WI, Ring J. Disturbance in the well-being of a patient with acne: suggestions for anticipation and detection. Acta Derm Venereol 2005; 85:182-3. [PMID: 15868645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
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Möhrenschlager M, Henkel V, Möller HJ, Worret WI, Ring J. Disturbance in the Well-being of a Patient with Acne: Suggestions for Anticipation and Detection. Acta Derm Venereol 2005. [DOI: 10.1080/00015550410024995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Henkel V, Mergl R, Coyne JC, Kohnen R, Allgaier AK, Rühl E, Möller HJ, Hegerl U. Depression with atypical features in a sample of primary care outpatients: prevalence, specific characteristics and consequences. J Affect Disord 2004; 83:237-42. [PMID: 15555720 DOI: 10.1016/j.jad.2004.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2004] [Revised: 07/09/2004] [Accepted: 07/14/2004] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the context of the current debate on the clinical relevance of atypical depression, the present study investigated the prevalence and specific characteristics of the disorder in depressed primary care outpatients and compared patients with atypical and with the prototypical form of depression ("non-atypical" depression). METHODS 403 patients were examined using the Composite International Diagnostic Interview, Inventory of Depressive Symptomatology, Hamilton Depression Scale and DSM-IV criteria. Configurational frequency analyses (CFA) were conducted to identify non-random configurations of symptoms. Moreover, tests for independent sample comparisons were applied. RESULTS The prevalence of atypical depression in our sample of depressed patients was 26.3%. CFA revealed one significant symptom pattern: mood reactivity without additional atypical features (p<0.000001). A significant difference emerged between patients suffering from atypical versus non-atypical depression in terms of severity (p< or =0.001). LIMITATIONS The sample size was modest. CONCLUSIONS A considerable proportion of depressed primary care outpatients may suffer from atypical depression which may contribute to under-recognition of depression in primary care. Results of CFA indicated the significance of mood reactivity which may also occur in depressed patients without additional atypical symptoms. Patients with atypical depression may suffer from less severe depression as compared to patients with non-atypical depression.
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Affiliation(s)
- Verena Henkel
- Department of Psychiatry, Ludwig-Maximilians-University Munich, Nussbaumstr. 7, D-80336 Munich, Germany.
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Henkel V, Mergl R, Coyne JC, Kohnen R, Möller HJ, Hegerl U. Screening for depression in primary care: will one or two items suffice? Eur Arch Psychiatry Clin Neurosci 2004; 254:215-23. [PMID: 15309389 DOI: 10.1007/s00406-004-0476-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2003] [Accepted: 11/18/2003] [Indexed: 10/26/2022]
Abstract
Small differences in implementation of screening and the associated burden on clinicians and patients could have substantial effects on the sustainability of screening in routine primary care. Therefore, we investigated the psychometric properties of single items and two-item combinations of the "WHO-5 Well Being Index" (WHO-5) and compared the obtained characteristics to those of the original version as well as to another proposed two-item screener (developed from PRIME-MD and BPHQ, respectively). Screening and diagnostic interview data from 431 primary care patients were analysed. Main outcome measures were sensitivity, specificity and AUC values. All test characteristics were assessed using the diagnoses derived from the Composite International Diagnostic Interview (CIDI) as the criterion standard.Single-item screening questions proved rather inadequate. However, only marginal differences in performance were found between two questions and the longer screening instrument with respect to major depression, dysthymia and "any depressive disorder". There were no statistically significant differences between these AUC values and most other test characteristics assessed. The results suggest that screening could be reduced to two questions with a potential advantage in terms of ease of administration and scoring and decreased staff and patient burden and perhaps a reduced stigma associated with a positive screening score.
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Affiliation(s)
- Verena Henkel
- Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336 Munich, Germany.
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Mergl R, Henkel V, Gallinat J, Kotter G, Müller-Siecheneder F, Pogarell O, Juckel G, Schröter A, Bürger K, Hampel H, Bahra R, Emir B, Laux G, Möller HJ, Hegerl U. Kinematical analysis of the effects of donepezil hydrochloride on hand motor function in patients with Alzheimer's dementia*. Pharmacopsychiatry 2004. [DOI: 10.1055/s-2003-825437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Henkel V, Mergl R, Schäfer M, Rujescu D, Möller HJ, Hegerl U. Kinematical Analysis of Motor Function in Schizophrenic Patients: a Possibility to Separate Negative Symptoms from Extrapyramidal Dysfunction Induced by Neuroleptics? Pharmacopsychiatry 2004; 37:110-8. [PMID: 15138894 DOI: 10.1055/s-2004-818988] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND In this prospective matched case-control study, hand movement analysis was conducted using a digitizing tablet (kinematical analysis). METHODS The study examined the association of different computer-assessed hand movement variables with clinical pathology (negative symptoms and extrapyramidal motor dysfunction). A sample of 16 schizophrenic patients and 16 healthy controls participated in the study. RESULTS At baseline, kinematical analysis indicated a significant higher prevalence of subtle hand motor dysfunction in unmedicated schizophrenic patients (who all exhibited clinically no extrapyramidal dysfunction) in comparison to healthy controls. No association between the observed motor signs and pre-enrollment total long-term butyrophenones exposure has been detected. After 14 days treatment with haloperidol, the hand movement variables, which correlated significantly with clinical rating scores reflecting drug-induced extrapyramidal dysfunction could definitely be separated from the hand movement variables with a close association to clinical rating measuring negative symptoms. CONCLUSIONS Results of the comparative analysis at baseline confirm previous findings concerning presence of neurological soft signs in unmedicated schizophrenic patients. Furthermore, results of this pilot study suggest that kinematical analysis by means of a digitizing tablet could be a useful approach towards a differentiation between drug-induced akinetic symptoms and disease-induced negative symptoms.
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Affiliation(s)
- Verena Henkel
- Department of Psychiatry, Ludwig-Maximilians-University Munich, Munich, Germany.
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Henkel V, Mergl R, Kohnen R, Allgaier AK, Möller HJ, Hegerl U. Use of brief depression screening tools in primary care: consideration of heterogeneity in performance in different patient groups. Gen Hosp Psychiatry 2004; 26:190-8. [PMID: 15121347 DOI: 10.1016/j.genhosppsych.2004.02.003] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2003] [Accepted: 02/11/2004] [Indexed: 11/18/2022]
Abstract
Heterogeneity of performance of screening tools in different patient groups has rarely been considered in the literature on depression screening in primary care. The objectives of the present study were to assess and to compare diagnostic accuracy of three screening questionnaires (Brief Patient Health Questionnaire, General Health Questionnaire-12, WHO-5) in identifying depression across various patient subpopulations and to assess the accuracy of the unaided clinical assessment of primary care physicians in the same subgroups. We conducted a cross-sectional validation study in 448 primary care patients. Two-by-two tables as well as receiver operating characteristics were applied. Results indicated that diagnostic accuracy (sensitivity, specificity) of the three screening instruments as well as of the clinical diagnoses differed in the various patient groups. Superiority of one screening tool over the other depends on the subgroup considered. Gender, age, form (subtype), and severity of depression influence the test characteristics of a screening tool. This should be considered if routine depression screening should be widely introduced. Of course, the benefit of routine screening also depends on efforts made for treatment and monitoring of patients in whom depression was diagnosed.
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Affiliation(s)
- Verena Henkel
- Department of Psychiatry, Ludwig-Maximilians-University Munich, Nussbaumstr. 7, D-80336 Munich, Germany.
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Abstract
OBJECTIVE Motor disturbances are a relevant aspect of depression. Kinematical analysis of movements can be applied to explore which type of motor dysfunction is associated with depression. We hypothesized that depressed patients draw and write significantly slower than controls and that motor disturbances become more pronounced under bi-manual demands. METHOD We examined 37 depressed patients and 37 healthy controls using a digitizing graphic tablet and subsequent kinematical analysis of handwriting and rapid drawing movements. RESULTS Depressed patients performed drawing with significantly less regular velocity than controls (P < 0.001), but normal velocity. Motor differences between patients and controls did not increase under bi-manual demands. Handwriting of patients was abnormally slow (P = 0.04). CONCLUSION Irregular patterns of velocity peaks in depressed patients point to basal ganglia dysfunction and/or deficient activity of the sensorimotor cortex and the supplementary motor area as a possible substrate of hand-motor disturbances in depression.
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Affiliation(s)
- R Mergl
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Ludwig-Maximilians-Universität München, München, Germany.
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Henkel V, Baghai TC, Eser D, Zill P, Mergl R, Zwanzger P, Schüle C, Bottlender R, Jäger M, Rupprecht R, Hegerl U, Möller HJ, Bondy B. The gamma amino butyric acid (GABA) receptor alpha-3 subunit gene polymorphism in unipolar depressive disorder: a genetic association study. Am J Med Genet B Neuropsychiatr Genet 2004; 126B:82-7. [PMID: 15048654 DOI: 10.1002/ajmg.b.20137] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is evidence that genes coding for the gamma aminobutyric acid (GABA) receptor may be involved in the etiology of affective disorders. Recently, an association between a CA-repeat in the GABRA 3 gene and bipolar disorder had been reported. The present study aimed at investigating the association between this polymorphism and unipolar major depressive disorder. The sample consisted of 201 unipolar depressive patients and 151 healthy subjects. All study participants were unrelated German individuals of the same ethnogeographical origin. No differences in genotype frequencies between unipolar patients and healthy subjects were found for GABRA 3 (P = 0.08). However, a significant difference of allelic frequencies was observed in female patients (n = 128) compared to female controls (n = 81) (P < or = 0.0001). This effect was not present in the group of male patients (n = 73) compared to male healthy subjects (n = 70) (P = 0.24). The results of our study indicate that GABRA 3 gene might also be involved in the genetic pathophysiology of unipolar major depressive disorder (at least in female patients), even if the findings do not support a predominant role of GABRA 3.
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Affiliation(s)
- Verena Henkel
- Department of Psychiatry, Ludwig-Maximilians-University Munich, Nussbaumstrasse 7, D-80336 Munich, Germany.
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Hegerl U, Mergl R, Henkel V, Gallinat J, Kotter G, Müller-Siecheneder F, Pogarell O, Juckel G, Schröter A, Bahra R, Emir B, Laux G, Möller HJ. Kinematic analysis of the effects of donepezil hydrochloride on hand motor function in patients with Alzheimer dementia. J Clin Psychopharmacol 2003; 23:214-6. [PMID: 12640228 DOI: 10.1097/00004714-200304000-00020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Affiliation(s)
- Verena Henkel
- Department of Psychiatry, Ludwig-Maximilians-University Munich, Nussbaumstr 7, D-80336 Munich, Germany.
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