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Köhler-Forsberg O, Larsen ER, Buttenschøn HN, Rietschel M, Hauser J, Souery D, Maier W, Farmer A, McGuffin P, Aitchison KJ, Uher R, Mors O. Effect of antidepressant switching between nortriptyline and escitalopram after a failed first antidepressant treatment among patients with major depressive disorder. Br J Psychiatry 2019; 215:494-501. [PMID: 30698114 PMCID: PMC6624130 DOI: 10.1192/bjp.2018.302] [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] [Indexed: 11/23/2022]
Abstract
BACKGROUND For patients with major depressive disorder (MDD) experiencing side-effects or non-response to their first antidepressant, little is known regarding the effect of switching between a tricyclic antidepressant (TCA) and a selective serotonin reuptake inhibitor (SSRI).AimsTo compare the switch between the TCA nortriptyline and the SSRI escitalopram. METHOD Among 811 adults with MDD treated with nortriptyline or escitalopram for up to 12 weeks, 108 individuals switched from nortriptyline to escitalopram or vice versa because of side-effects or non-response (trial registration: EudraCT No.2004-001723-38 (https://eudract.ema.europa.eu/) and ISRCTN No.03693000 (http://www.controlled-trials.com)). Patients were followed for up to 26 weeks after switching and response was measured with the Montgomery-Åsberg Depression Rating scale (MADRS). We performed adjusted mixed-effects linear regression models with full information maximum likelihood estimation reporting β-coefficients with 95% CIs. RESULTS Switching antidepressants resulted in a significant decrease in MADRS scores. This was present for switchers from escitalopram to nortriptyline (n = 36, β = -0.38, 95% CI -0.51 to -0.25, P<0.001) and from nortriptyline to escitalopram (n = 72, β = -0.34, 95% CI -0.41 to -0.26, P<0.001). Both switching options resulted in significant improvement among individuals who switched because of non-response or side-effects. The results were supported by analyses on other rating scales and symptom dimensions. CONCLUSIONS These results suggest that switching from a TCA to an SSRI or vice versa after non-response or side-effects to the first antidepressant may be a viable approach to achieve response among patients with MDD.Declarations of interestK.J.A. holds an Alberta Centennial Addiction and Mental Health Research Chair, funded by the Government of Alberta. K.J.A. has been a member of various advisory boards, received consultancy fees and honoraria, and has received research grants from various companies including Johnson and Johnson Pharmaceuticals Research and Development and Bristol-Myers Squibb Pharmaceuticals Limited. D.S. has served on advisory boards for, and received unrestricted grants from, Lundbeck and AstraZeneca. A.F. and P.M. have received honoraria for participating in expert panels for Lundbeck and GlaxoSmithKline.
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Affiliation(s)
- Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Denmark,Department of Clinical Medicine, Aarhus University, Denmark,iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark,Corresponding author: Ole Köhler-Forsberg; Psychosis Research Unit; Aarhus University Hospital, Risskov; Skovagervej 2; DK-8240 Risskov; Phone: +45 2342 0661; ; Fax: +45 7847 1609
| | - Erik Roj Larsen
- Department of Psychiatry, Psychiatry in the Region of Southern Denmark; Institute of Clinical Research, Research Unit of Psychiatry, University of Southern Denmark
| | - Henriette N. Buttenschøn
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark,Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Denmark
| | - Marcella Rietschel
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim/Heidelberg University, Mannheim Germany
| | - Joanna Hauser
- Laboratory of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, Poland
| | - Daniel Souery
- Laboratoire de Psychologie Médicale, Université Libre de Bruxelles; Psy Pluriel - Centre Européen de Psychologie Médicale, Belgium
| | | | - Anne Farmer
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Peter McGuffin
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | | | - Rudolf Uher
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Ole Mors
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Denmark,Department of Clinical Medicine, Aarhus University, Denmark,iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
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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: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 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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Rutledge RB, Chekroud AM, Huys QJ. Machine learning and big data in psychiatry: toward clinical applications. Curr Opin Neurobiol 2019; 55:152-159. [PMID: 30999271 DOI: 10.1016/j.conb.2019.02.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 01/29/2019] [Accepted: 02/07/2019] [Indexed: 12/21/2022]
Abstract
Psychiatry is a medical field concerned with the treatment of mental illness. Psychiatric disorders broadly relate to higher functions of the brain, and as such are richly intertwined with social, cultural, and experiential factors. This makes them exquisitely complex phenomena that depend on and interact with a large number of variables. Computational psychiatry provides two ways of approaching this complexity. Theory-driven computational approaches employ mechanistic models to make explicit hypotheses at multiple levels of analysis. Data-driven machine-learning approaches can make predictions from high-dimensional data and are generally agnostic as to the underlying mechanisms. Here, we review recent advances in the use of big data and machine-learning approaches toward the aim of alleviating the suffering that arises from psychiatric disorders.
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Affiliation(s)
- Robb B Rutledge
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, England, United Kingdom; Wellcome Centre for Human Neuroimaging, University College London, London, England, United Kingdom
| | - Adam M Chekroud
- Department of Psychiatry, Yale University, New Haven, CT, United States; Spring Health, New York, NY, United States
| | - Quentin Jm Huys
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, England, United Kingdom; Division of Psychiatry, University College London, London, England, United Kingdom; Camden and Islington NHS Foundation Trust, London, England, United Kingdom.
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Association Study Between Serotonin Transporter Gene and Fluoxetine Response in Mexican Patients With Major Depressive Disorder. Clin Neuropharmacol 2019; 42:9-13. [PMID: 30520759 DOI: 10.1097/wnf.0000000000000315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Pharmacogenetic studies have identified genetic variants associated with fluoxetine response in patients with major depression disorder (MDD). The serotonin transporter gene is the principal site of action of selective serotonin reuptake inhibitors. Previous studies analyzing SLC6A4 gene variants are inconsistent and differ among populations. The aim of the present study was to analyze the association between 5-HTTLPR/rs24531 triallelic polymorphism and fluoxetine response in Mexican patients with MDD. METHODS We analyzed a sample of 150 patients with MDD. Fluoxetine response was assessed according to a reduction in the Hamilton Depression Rating Scale and Montgomery Depression Rating Scale scores of 50% or more at 8 weeks from baseline. In addition, we analyzed the genotype and allele distribution between responder and nonresponder patients in a subgroup of very severe depression patients. RESULTS We did not find association between fluoxetine responders and 5-HTTLPR/rs25531 variants (P = 0.0637). However, in the analysis of severe depression at baseline (Hamilton Depression Rating Scale ≥ 25), we observed a high frequency of low activity alleles (S/LG) in nonresponders patients (P = 0.0102). CONCLUSIONS Our findings showed an association between low activity alleles of SLC6A4 gene and fluoxetine nonresponse in patients with severe depression.
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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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Løge-Hagen JS, Sæle A, Juhl C, Bech P, Stenager E, Mellentin AI. Prevalence of depressive disorder among patients with fibromyalgia: Systematic review and meta-analysis. J Affect Disord 2019; 245:1098-1105. [PMID: 30699852 DOI: 10.1016/j.jad.2018.12.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/16/2018] [Accepted: 12/01/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND It is acknowledged that fibromyalgia (FM) as a medical (rheumatological) disorder and major depressive disorder (MDD) as a mental disorder often co-occurs, but the inconsistency is prevailing at study-level and no overall estimate of the co-occurrence exist. AIMS This systematic review and meta-analysis aimed to estimate the overall point- and life-time prevalence of MDD among FM patients based on structured clinical interviews (SCI); and to estimate the point-prevalence of MDD among FM patients based on screening symptom scales (SSS). METHOD The electronical databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and PsycINFO were searched for papers that reported on prevalence of MDD among FM patients. Eligible studies were included in a random effects meta-analysis pooling the prevalence of depression. RESULTS The literature search identified 11 eligible studies for the meta-analysis. For SCI, the overall pooled point-prevalence (PP) was 25% (95% CI 19 to 31%), and life-time prevalence (LP) was 65% (95% CI 59 to 71%). When estimating the PP with self-administered SSS the overall pooled PP was 45% (95% CI 32 to 59%), and a single clinician-administered SSS yielded a PP of 23% (95% CI 10 to 41%). There was low inconsistency for the SCI and high inconsistency for the SSS. CONCLUSION One fourth of all FM patients had MDD, and more than half experienced MDD during their life-time according to clinician-administered instruments. Prevalence of MDD was almost twice as high when using self-administered symptom scales and may be likely to overestimate the co-occurrence.
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Affiliation(s)
- J S Løge-Hagen
- Psychiatric Research Unit, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - A Sæle
- Psychiatric Research Unit, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - C Juhl
- Department of Sports Science and Clinical Biomechanics, Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark; Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - P Bech
- Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Copenhagen, Denmark
| | - E Stenager
- Psychiatric Research Unit, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark; Psychiatric Research Unit, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark
| | - A I Mellentin
- Psychiatric Research Unit, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
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Fang Y, Wu Z. Advance in Diagnosis of Depressive Disorder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1180:179-191. [DOI: 10.1007/978-981-32-9271-0_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Lee Y, Subramaniapillai M, Brietzke E, Mansur RB, Ho RC, Yim SJ, McIntyre RS. Anti-cytokine agents for anhedonia: targeting inflammation and the immune system to treat dimensional disturbances in depression. Ther Adv Psychopharmacol 2018; 8:337-348. [PMID: 30524702 PMCID: PMC6278744 DOI: 10.1177/2045125318791944] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 07/11/2018] [Indexed: 12/25/2022] Open
Abstract
The etiology of mood disorders is mechanistically heterogeneous, underscoring the need for a dimensional approach to identify and develop targeted treatments in psychiatry. Accumulating evidence implicates inflammation as an important contributor to the pathophysiology of depression and presents the immune system as a viable therapeutic target that may be more proximate to the pathogenic nexus of brain-based disorders in specific subpopulations. Anhedonia is a transdiagnostic (e.g. Parkinson's disease, diabetes mellitus, rheumatic diseases), yet specific, and clinically relevant symptom dimension subserved by well-characterized neurobiological and neurophysiological substrates of the positive valence systems (PVS). Brain circuits, nodes, and networks, as well as cellular and molecular pathways (e.g. dopaminergic transmission; excitotoxicity; synaptic plasticity), subserving anhedonia are preferentially affected by inflammatory processes. To our knowledge, no published randomized, controlled clinical trial in populations with mood disorders has, to date, primarily sought to determine the effects of an anti-inflammatory agent on PVS functions or pathophysiology. Three ongoing clinical trials aim to investigate the effects of anti-TNF-alpha biologic infliximab on measures of anhedonia [ClinicalTrials.gov identifier: NCT02363738], motivational behavior and circuitry [ClinicalTrials.gov identifier: NCT03006393], and glutamatergic changes in the basal ganglia [ClinicalTrials.gov identifier: NCT03004443] in clinical populations with unipolar or bipolar depression. Positive results would further instantiate the relevance of inflammatory processes and the immune system in the pathophysiology of mood disorders and provide the impetus to develop scalable treatments targeting inflammation and the immune system to mitigate transdiagnostic, dimensional disturbances in brain-based disorders.
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Affiliation(s)
- Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada Brain and Cognition Discovery Foundation, Toronto, ON, Canada Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Mehala Subramaniapillai
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Elisa Brietzke
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada Brain and Cognition Discovery Foundation, Toronto, ON, Canada Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roger C Ho
- Department of Psychological Medicine, National University of Singapore, Singapore
| | - Samantha J Yim
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada Brain and Cognition Discovery Foundation, Toronto, ON, Canada Institute of Medical Science, University of Toronto, Toronto, ON, Canada Department of Psychiatry, University of Toronto, Toronto, ON, Canada Department of Pharmacology, University of Toronto, Toronto, ON, Canada
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Zwicker A, Fabbri C, Rietschel M, Hauser J, Mors O, Maier W, Zobel A, Farmer A, Aitchison KJ, McGuffin P, Lewis CM, Uher R. Genetic disposition to inflammation and response to antidepressants in major depressive disorder. J Psychiatr Res 2018; 105:17-22. [PMID: 30130674 DOI: 10.1016/j.jpsychires.2018.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/11/2018] [Accepted: 08/02/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Inflammation may play an important role in depression and its treatment. A previous study found that increased C-reactive protein (CRP), a marker of systemic inflammation, is associated with worse response to the serotonergic antidepressant escitalopram and better response to the noradrenergic antidepressant nortriptyline. It is unclear whether this reflects genetic disposition to inflammation. METHODS We analyzed genotype data and weekly Montgomery-Åsberg Depression Rating Scale scores (MADRS) from 755 unrelated individuals obtained over a 12-week period in the Genome-Based Therapeutic Drugs for Depression (GENDEP) study. We calculated a polygenic risk score for CRP level based on genome-wide meta-analysis results from the CHARGE Consortium. RESULTS A higher polygenic risk score for CRP was associated with slightly better response to escitalopram and slightly worse response to nortriptyline, reflected in a statistically significant interaction between polygenic risk score and drug (beta = 1.07, 95% CI = 0.26-1.87, p = 0.0093). DISCUSSION A differential association between CRP-PRS and antidepressant drug that is in a direction opposite to that found with serum CRP measurement suggests that previously observed effect of inflammation on antidepressant efficacy may be driven by state factors distinct from genetic influences on systemic inflammation.
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Affiliation(s)
- Alyson Zwicker
- Department of Pathology, Dalhousie University, Halifax, NS, Canada; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada; Nova Scotia Health Authority, Halifax, NS, Canada
| | - Chiara Fabbri
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, UK; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Joanna Hauser
- Laboratory of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, Poland
| | - Ole Mors
- Aarhus University Hospital, Risskov, Psychosis Research Unit, Aarhus, Denmark
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - Astrid Zobel
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - Anne Farmer
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, UK
| | | | - Peter McGuffin
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Cathryn M Lewis
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Rudolf Uher
- Department of Pathology, Dalhousie University, Halifax, NS, Canada; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada; Nova Scotia Health Authority, Halifax, NS, Canada; King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, UK.
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Caldieraro MA, Walsh S, Deckersbach T, Bobo WV, Gao K, Ketter TA, Shelton RC, Reilly-Harrington NA, Tohen M, Calabrese JR, Thase ME, Kocsis JH, Sylvia LG, Nierenberg AA. Decreased activation and subsyndromal manic symptoms predict lower remission rates in bipolar depression. Aust N Z J Psychiatry 2018; 52:994-1002. [PMID: 29143534 DOI: 10.1177/0004867417741982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Activation encompasses energy and activity and is a central feature of bipolar disorder. However, the impact of activation on treatment response of bipolar depression requires further exploration. The aims of this study were to assess the association of decreased activation and sustained remission in bipolar depression and test for factors that could affect this association. METHODS We assessed participants with Diagnostic and Statistical Manual of Mental Disorders (4th ed) bipolar depression ( n = 303) included in a comparative effectiveness study of lithium- and quetiapine-based treatments (the Bipolar CHOICE study). Activation was evaluated using items from the Bipolar Inventory of Symptoms Scale. The selection of these items was based on a dimension of energy and interest symptoms associated with poorer treatment response in major depression. RESULTS Decreased activation was associated with lower remission rates in the raw analyses and in a logistic regression model adjusted for baseline severity and subsyndromal manic symptoms (odds ratio = 0.899; p = 0.015). The manic features also predicted lower remission (odds ratio = 0.934; p < 0.001). Remission rates were similar in the two treatment groups. CONCLUSION Decreased activation and subsyndromal manic symptoms predict lower remission rates in bipolar depression. Patients with these features may require specific treatment approaches, but new studies are necessary to identify treatments that could improve outcomes in this population.
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Affiliation(s)
- Marco Antonio Caldieraro
- 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,2 Serviço de Psiquiatria, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Samantha Walsh
- 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Thilo Deckersbach
- 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,3 Harvard Medical School, Boston, MA, USA
| | - William V Bobo
- 4 Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Keming Gao
- 5 Mood Disorders Program, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Terence A Ketter
- 6 Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Noreen A Reilly-Harrington
- 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,3 Harvard Medical School, Boston, MA, USA
| | - Mauricio Tohen
- 8 Department of Psychiatry and Behavioral Sciences, UNM Health Sciences Center, The University of New Mexico, Albuquerque, NM, USA
| | - Joseph R Calabrese
- 5 Mood Disorders Program, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Michael E Thase
- 9 Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - James H Kocsis
- 10 Department of Psychiatry, Weill Cornell Medical College, Ithaca, NY, USA
| | - Louisa G Sylvia
- 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,3 Harvard Medical School, Boston, MA, USA
| | - Andrew A Nierenberg
- 1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,3 Harvard Medical School, Boston, MA, USA
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Inkster B, Simmons A, Cole J, Schoof E, Linding R, Nichols T, Muglia P, Holsboer F, Saemann P, McGuffin P, Fu C, Miskowiak K, Matthews PM, Zai G, Nicodemus K. Unravelling the GSK3β-related genotypic interaction network influencing hippocampal volume in recurrent major depressive disorder. Psychiatr Genet 2018; 28:77-84. [PMID: 30080747 PMCID: PMC6531290 DOI: 10.1097/ypg.0000000000000203] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Glycogen synthase kinase 3β (GSK3β) has been implicated in mood disorders. We previously reported associations between a GSK3β polymorphism and hippocampal volume in major depressive disorder (MDD). We then reported similar associations for a subset of GSK3β-regulated genes. We now investigate an algorithm-derived comprehensive list of genes encoding proteins that directly interact with GSK3β to identify a genotypic network influencing hippocampal volume in MDD. PARTICIPANTS AND METHODS We used discovery (N=141) and replication (N=77) recurrent MDD samples. Our gene list was generated from the NetworKIN database. Hippocampal measures were derived using an optimized Freesurfer protocol. We identified interacting single nucleotide polymorphisms using the machine learning algorithm Random Forest and verified interactions using likelihood ratio tests between nested linear regression models. RESULTS The discovery sample showed multiple two-single nucleotide polymorphism interactions with hippocampal volume. The replication sample showed a replicable interaction (likelihood ratio test: P=0.0088, replication sample; P=0.017, discovery sample; Stouffer's combined P=0.0007) between genes associated previously with endoplasmic reticulum stress, calcium regulation and histone modifications. CONCLUSION Our results provide genetic evidence supporting associations between hippocampal volume and MDD, which may reflect underlying cellular stress responses. Our study provides evidence of biological mechanisms that should be further explored in the search for disease-modifying therapeutic targets for depression.
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Affiliation(s)
- Becky Inkster
- Department of Psychiatry, University of Cambridge, UK
- Wolfson College, University of Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Andy Simmons
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - James Cole
- The Computational, Cognitive & Clinical Neuroimaging Lab, Department of Medicine, Imperial College London, UK
| | - Erwin Schoof
- Biotech Research & Innovation Centre, University of Copenhagen
| | - Rune Linding
- Biotech Research & Innovation Centre, University of Copenhagen
| | - Tom Nichols
- Department of Statistics, Warwick University, UK
| | - Pierandrea Muglia
- Genetics Division, Drug Discovery, Medicine Development Centre, GlaxoSmithKline, R&D, Verona, Italy
| | | | | | - Peter McGuffin
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Cynthia Fu
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Kamilla Miskowiak
- Department of Psychiatry, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Paul M Matthews
- Department of Medicine, Imperial College London and UK Dementia Research Institute
| | - Gwyneth Zai
- Neurogenetics Section, Molecular Brain Science Department, Campbell Family Mental Health Research Institute, and Mood & Anxiety Division, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Kristin Nicodemus
- Centre for Genomics and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK
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Lee YY, Le LKD, Stockings EA, Hay P, Whiteford HA, Barendregt JJ, Mihalopoulos C. Estimation of a Relative Risk Effect Size when Using Continuous Outcomes Data: An Application of Methods in the Prevention of Major Depression and Eating Disorders. Med Decis Making 2018; 38:866-880. [PMID: 30156470 DOI: 10.1177/0272989x18793394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The raw mean difference (RMD) and standardized mean difference (SMD) are continuous effect size measures that are not readily usable in decision-analytic models of health care interventions. This study compared the predictive performance of 3 methods by which continuous outcomes data collected using psychiatric rating scales can be used to calculate a relative risk (RR) effect size. METHODS Three methods to calculate RR effect sizes from continuous outcomes data are described: the RMD, SMD, and Cochrane conversion methods. Each conversion method was validated using data from randomized controlled trials (RCTs) examining the efficacy of interventions for the prevention of depression in youth (aged ≤17 years) and adults (aged ≥18 years) and the prevention of eating disorders in young women (aged ≤21 years). Validation analyses compared predicted RR effect sizes to actual RR effect sizes using scatterplots, correlation coefficients ( r), and simple linear regression. An applied analysis was also conducted to examine the impact of using each conversion method in a cost-effectiveness model. RESULTS The predictive performances of the RMD and Cochrane conversion methods were strong relative to the SMD conversion method when analyzing RCTs involving depression in adults (RMD: r = 0.89-0.90; Cochrane: r = 0.73; SMD: r = 0.41-0.67) and eating disorders in young women (RMD: r = 0.89; Cochrane: r = 0.96). Moderate predictive performances were observed across the 3 methods when analyzing RCTs involving depression in youth (RMD: r = 0.50; Cochrane: r = 0.47; SMD: r = 0.46-0.46). Negligible differences were observed between the 3 methods when applied to a cost-effectiveness model. CONCLUSION The RMD and Cochrane conversion methods are both valid methods for predicting RR effect sizes from continuous outcomes data. However, further validation and refinement are required before being applied more broadly.
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Affiliation(s)
- Yong Yi Lee
- School of Public Health, University of Queensland, Herston, Queensland, Australia (YYL, HAW, JJB).,Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, Queensland, Australia (YYL, HAW).,Geelong, Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia (LK-DL, CM).,National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, New South Wales, Australia (EAS).,School of Medicine and Translational Health Research Institute, Western Sydney University, NSW, Australia (PH).,Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, WA (HAW).,Epigear International Pty Ltd, Sunrise Beach, Queensland Australia (JJB)
| | - Long Khanh-Dao Le
- School of Public Health, University of Queensland, Herston, Queensland, Australia (YYL, HAW, JJB).,Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, Queensland, Australia (YYL, HAW).,Geelong, Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia (LK-DL, CM).,National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, New South Wales, Australia (EAS).,School of Medicine and Translational Health Research Institute, Western Sydney University, NSW, Australia (PH).,Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, WA (HAW).,Epigear International Pty Ltd, Sunrise Beach, Queensland Australia (JJB)
| | - Emily A Stockings
- School of Public Health, University of Queensland, Herston, Queensland, Australia (YYL, HAW, JJB).,Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, Queensland, Australia (YYL, HAW).,Geelong, Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia (LK-DL, CM).,National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, New South Wales, Australia (EAS).,School of Medicine and Translational Health Research Institute, Western Sydney University, NSW, Australia (PH).,Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, WA (HAW).,Epigear International Pty Ltd, Sunrise Beach, Queensland Australia (JJB)
| | - Phillipa Hay
- School of Public Health, University of Queensland, Herston, Queensland, Australia (YYL, HAW, JJB).,Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, Queensland, Australia (YYL, HAW).,Geelong, Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia (LK-DL, CM).,National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, New South Wales, Australia (EAS).,School of Medicine and Translational Health Research Institute, Western Sydney University, NSW, Australia (PH).,Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, WA (HAW).,Epigear International Pty Ltd, Sunrise Beach, Queensland Australia (JJB)
| | - Harvey A Whiteford
- School of Public Health, University of Queensland, Herston, Queensland, Australia (YYL, HAW, JJB).,Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, Queensland, Australia (YYL, HAW).,Geelong, Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia (LK-DL, CM).,National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, New South Wales, Australia (EAS).,School of Medicine and Translational Health Research Institute, Western Sydney University, NSW, Australia (PH).,Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, WA (HAW).,Epigear International Pty Ltd, Sunrise Beach, Queensland Australia (JJB)
| | - Jan J Barendregt
- School of Public Health, University of Queensland, Herston, Queensland, Australia (YYL, HAW, JJB).,Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, Queensland, Australia (YYL, HAW).,Geelong, Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia (LK-DL, CM).,National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, New South Wales, Australia (EAS).,School of Medicine and Translational Health Research Institute, Western Sydney University, NSW, Australia (PH).,Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, WA (HAW).,Epigear International Pty Ltd, Sunrise Beach, Queensland Australia (JJB)
| | - Cathrine Mihalopoulos
- School of Public Health, University of Queensland, Herston, Queensland, Australia (YYL, HAW, JJB).,Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, Queensland, Australia (YYL, HAW).,Geelong, Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia (LK-DL, CM).,National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, New South Wales, Australia (EAS).,School of Medicine and Translational Health Research Institute, Western Sydney University, NSW, Australia (PH).,Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, WA (HAW).,Epigear International Pty Ltd, Sunrise Beach, Queensland Australia (JJB)
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Validation of the Arabic version of the MADRS scale among Lebanese patients with depression. Encephale 2018; 45:195-199. [PMID: 30122299 DOI: 10.1016/j.encep.2018.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 12/26/2022]
Abstract
AIM To use the Arabic version of the MADRS in Lebanese depressed patients, check its validity and reproducibility compared to other versions of the questionnaire and assess risk factors affecting the total MADRS score. METHODS This case-control study, performed between September 2016 and January 2017, included 200 patients (100 patients, 100 controls). The questionnaire included two parts, the first one concerning the socio-demographic characteristics another one that included the Montgomery-Asberg Depression Rating Scale (MADRS) questions, which was translated from English to Arabic through an initial translation and back translation process. RESULTS The MADRS scale items converged over a solution of one factor that had an Eigenvalue over 1, explaining a total of 83.90% of the variance. A Kaiser-Meyer-Olkin measure of sampling adequacy of 0.953 was found, with a significant Bartlett's test of sphericity (P<0.001). A stepwise linear regression, using the total MADRS score as continuous variable, showed that a university level of education would significantly decrease the total MADRS score by 20 points (beta=-20.02, CI: from -26.337 to -13.709, P<0.001). Unemployment was significantly more associated with an increase in the total MADRS score level by 10.23 points (beta=10.23, CI: 3.944-16.526, P=0.002). CONCLUSION This study shows that the Arabic version of the MADRS has promising psychometric properties, and thus it is a good tool to use for the diagnosis of patients with depression. Based on this study, health care professionals and researchers can readily use the MADRS questionnaire to estimate the overall severity of depression among psychiatric patients in Lebanon.
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Ren H, Fabbri C, Uher R, Rietschel M, Mors O, Henigsberg N, Hauser J, Zobel A, Maier W, Dernovsek MZ, Souery D, Cattaneo A, Breen G, Craig IW, Farmer AE, McGuffin P, Lewis CM, Aitchison KJ. Genes associated with anhedonia: a new analysis in a large clinical trial (GENDEP). Transl Psychiatry 2018; 8:150. [PMID: 30104601 PMCID: PMC6089928 DOI: 10.1038/s41398-018-0198-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 02/17/2018] [Accepted: 03/26/2018] [Indexed: 12/14/2022] Open
Abstract
A key feature of major depressive disorder (MDD) is anhedonia, which is a predictor of response to antidepressant treatment. In order to shed light on its genetic underpinnings, we conducted a genome-wide association study (GWAS) followed by investigation of biological pathway enrichment using an anhedonia dimension for 759 patients with MDD in the GENDEP study. The GWAS identified 18 SNPs associated at genome-wide significance with the top one being an intronic SNP (rs9392549) in PRPF4B (pre-mRNA processing factor 4B) located on chromosome 6 (P = 2.07 × 10-9) while gene-set enrichment analysis returned one gene ontology term, axon cargo transport (GO: 0008088) with a nominally significant P value (1.15 × 10-5). Furthermore, our exploratory analysis yielded some interesting, albeit not statistically significant genetic correlation with Parkinson's Disease and nucleus accumbens gray matter. In addition, polygenic risk scores (PRSs) generated from our association analysis were found to be able to predict treatment efficacy of the antidepressants in this study. In conclusion, we found some markers significantly associated with anhedonia, and some suggestive findings of related pathways and biological functions, which could be further investigated in other studies.
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Affiliation(s)
- Hongyan Ren
- Psychiatry and Medical Genetics, University of Alberta, Edmonton, AB, Canada
| | - Chiara Fabbri
- MRC Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Rudolf Uher
- Psychiatry Department, Dalhousie University, Halifax, NS, Canada
| | - Marcella Rietschel
- Division of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Mannheim, Germany
| | - Ole Mors
- Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Neven Henigsberg
- Croatian Institute for Brain Research, University of Zagreb, Zagreb, Croatia
| | - Joanna Hauser
- Psychiatry Department, University of Poznan, Poznan, Poland
| | - Astrid Zobel
- Psychiatry Department, University of Bonn, Bonn, Germany
| | - Wolfgang Maier
- Psychiatry Department, University of Bonn, Bonn, Germany
| | - Mojca Z Dernovsek
- University Psychiatric Clinic, University of Ljubliana, Ljubljana, Slovenia
| | - Daniel Souery
- Psychological Medicine, Free University of Brussels, Brussels, Belgium
| | | | - Gerome Breen
- MRC Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Ian W Craig
- MRC Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Anne E Farmer
- MRC Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Peter McGuffin
- MRC Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Cathryn M Lewis
- MRC Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Katherine J Aitchison
- Psychiatry and Medical Genetics, University of Alberta, Edmonton, AB, Canada.
- MRC Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK.
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Dunlop BW, Cole SP, Nemeroff CB, Mayberg HS, Craighead WE. Differential change on depressive symptom factors with antidepressant medication and cognitive behavior therapy for major depressive disorder. J Affect Disord 2018; 229:111-119. [PMID: 29306690 PMCID: PMC5807140 DOI: 10.1016/j.jad.2017.12.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/12/2017] [Accepted: 12/26/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a heterogeneous condition and individual patients are likely to be differentially responsive to specific treatments. In an exploratory factor analysis of three rating scales, the Genome-based Therapeutic Drugs for Depression (GENDEP) trial identified three factors that were differentially associated with outcome to nortriptyline and escitalopram. However, this factor analysis has neither been replicated or applied to a psychotherapy treatment. METHODS We replicated the GENDEP analytic method in the Emory Predictors of Remission to Individual and Combined Treatments (PReDICT) study. The 17-item Hamilton Depression Rating Scale, Montgomery Asberg Depression Rating Scale, and Beck Depression Inventory were administered to 306 MDD patients in the PReDICT study, which randomized previously untreated adults to 12 weeks of treatment with cognitive behavior therapy (CBT), escitalopram, or duloxetine. Utilizing Item Response Theory methodologies, factor scores were derived from the three scales and the efficacy of the three treatments was compared for the identified factor scores. RESULTS Four factors were identified: "Despair," "Mood and Interest," "Sleep," and "Appetite." These factors closely aligned with the factors identified in GENDEP. Compared to CBT, escitalopram and duloxetine produced more rapid but ultimately similar improvement on the Despair and Mood and Interest factors; no significant differences between treatments emerged on the other factors. LIMITATIONS The scales contained differing numbers of items pertaining to specific depressive symptoms. CONCLUSION The heterogeneity of MDD can be parsed into a consistent factor structure, with the factors showing differential rapidity, but ultimately similar, improvement across treatments.
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Affiliation(s)
- Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Steven P Cole
- Research Design Associates, Inc., Yorktown Heights, NY, USA
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Helen S Mayberg
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - W Edward Craighead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Department of Psychology, Emory University, Atlanta, GA, USA
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Jobst A, Sabaß L, Hall D, Brücklmeier B, Buchheim A, Hall J, Sarubin N, Zill P, Falkai P, Brakemeier EL, Padberg F. Oxytocin plasma levels predict the outcome of psychotherapy: A pilot study in chronic depression. J Affect Disord 2018; 227:206-213. [PMID: 29100154 DOI: 10.1016/j.jad.2017.10.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/18/2017] [Accepted: 10/21/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Oxytocin is associated with bonding and social deficits in psychiatric disorders and has also been discussed as a potential therapeutic intervention to augment psychotherapy. The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is a specific form of psychotherapy for chronic depression, an illness in which interpersonal deficits play a major role. In this pilot study, we investigated whether Oxytocin plasma levels predict the clinical outcome of chronic depressive patients after CBASP. METHODS Sixteen patients with chronic depression participated in a 10-week CBASP inpatient program. Oxytocin plasma levels were measured before and after participants played a virtual ball-tossing game (Cyberball) that mimics social exclusion. Clinical outcome after CBASP was evaluated with the Beck Depression Inventory-II (BDI-II) and the 24-item Hamilton Depression Rating Scale (HAMD-24). RESULTS After CBASP, depressive symptoms decreased significantly: the response rates were 44% (BDI-II) and 50% (HAMD-24); and the remission rates, 38% (BDI-II) and 44% (HAMD-24). Lower oxytocin plasma levels at baseline correlated with smaller changes in BDI-II scores, but not with the change in HAMD-24 scores. LIMITATIONS The limitations of our study were the small sample size, concomitant and non-standardized pharmacotherapy, and lack of a controlled design and a follow-up period. CONCLUSIONS Our study provides first evidence that oxytocin plasma levels may predict the outcome of psychotherapy in chronic depression. These findings need to be replicated in larger randomized, controlled trials.
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Affiliation(s)
- A Jobst
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany.
| | - L Sabaß
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany; Hochschule Fresenius, University of Applied Sciences, Munich, Germany
| | - D Hall
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - B Brücklmeier
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - A Buchheim
- Department of Psychology, Clinical Psychology, University of Innsbruck, Austria
| | - J Hall
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - N Sarubin
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany; Hochschule Fresenius, University of Applied Sciences, Munich, Germany
| | - P Zill
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - P Falkai
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - E-L Brakemeier
- Psychologische Hochschule Berlin (PHB), Berlin, Germany; Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Germany
| | - F Padberg
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
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Park SA, Jeon SW, Yoon HK, Yoon SY, Shin C, Ko YH. Characteristics of Residual Symptoms in Korean Patients with Major Depressive Disorder: A Validation Study for the Korean Version of Depression Residual Symptom Scale. Psychiatry Investig 2018; 15:178-185. [PMID: 29475225 PMCID: PMC5900396 DOI: 10.30773/pi.2017.07.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 06/23/2017] [Accepted: 07/13/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Residual symptoms of depression are related to more severe and chronic course of functional impairment with higher risk of relapse. The objective of this study was to validate, and determine psychometric properties of the Korean version of Depression Residual Symptom Scale (KDRSS). METHODS A total of 203 outpatients with recent episode of major depression based on DSM-IV criteria were enrolled in this study. They had been treated with antidepressants and assessed by KDRSS, Hamilton Depression Rating Scale-24 (HDRS-24), and Montgomery-Åsberg Depression Rating Scale (MARDS). The validity and reliability of KDRSS were assessed, including internal consistency reliability, concurrent validity, temporal stability, factorial validity, and discriminative validity. RESULTS Internal consistency (Cronbach's alpha=0.961), concurrent validity (MADRS: r=0.731, p<0.01, HDRS-24: r=0.663, p<0.01), and temporal stability (r=0.726, p<0.01) of KDRSS were all excellent. KDRSS showed good discriminative validity based on MARDS. KDRSS consisted of one-factor structure accounting for 63.8% of total variance. All subjects except two in full remission group had one or more residual symptoms. In 7 subscales of KDRSS consisting of similar items respectively, 'lack of energy' was the most commonly reported, followed by 'increased emotionalism' in this group. CONCLUSION KDRSS is a useful and sensitive instrument for measuring residual depressive symptoms. Since some depressive symptoms including 'lack of energy' and 'increased emotionalism' in patients with full remission might be persistent during psychiatric intervention, these symptoms need to be focused on in clinical practice.
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Affiliation(s)
- Sol A Park
- Department of Psychiatry, Korea University College of Medicine, Ansan Hospital, Ansan, Republic of Korea
| | - Sang Won Jeon
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Ho-Kyoung Yoon
- Department of Psychiatry, Korea University College of Medicine, Ansan Hospital, Ansan, Republic of Korea
| | - Seo Young Yoon
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Cheolmin Shin
- Department of Psychiatry, Korea University College of Medicine, Ansan Hospital, Ansan, Republic of Korea
| | - Young-Hoon Ko
- Department of Psychiatry, Korea University College of Medicine, Ansan Hospital, Ansan, Republic of Korea
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Leucht S, Fennema H, Engel RR, Kaspers-Janssen M, Szegedi A. Translating the HAM-D into the MADRS and vice versa with equipercentile linking. J Affect Disord 2018; 226:326-331. [PMID: 29031182 DOI: 10.1016/j.jad.2017.09.042] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 08/01/2017] [Accepted: 09/23/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The Hamilton Depression Rating Scale (HAM-D) and the Montgomery Asberg Depression Rating Scale (MADRS) are scales used frequently to rate the symptoms of depression. There are many situations in which it is important to know what a given total score or a percent reduction from baseline score of one scale means in relation to the other scale. METHOD We used the equipercentile linking method to identify corresponding scores of simultaneous HAM-D and MADRS ratings in 4388 patients from 31 mirtazapine trials in major depressive disorder. Data were collected at baseline and at weeks 1, 2 and 4. RESULTS HAM-D scores of 10, 20, 30 and 40 roughly corresponded to MADRS scores of 13, 26, 39 and 52-53, respectively. An absolute HAM-D improvement of 10, 20, 25 points corresponded to a MADRS improvement of 12, 26, and 34. A percentage improvement from baseline of the HAM-D was approximately the same as a percentage improvement on the MADRS. CONCLUSION These results are important for the comparison of trials that used the HAM-D and MADRS. We present conversion tables for future research.
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Affiliation(s)
- Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, Ismaningerstr. 22, 81675 München, Germany.
| | | | - Rolf R Engel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians Universität München, Germany
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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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Holzinger F, Fahrenkrog S, Roll S, Kleefeld F, Adli M, Heintze C. Discharge management strategies and post-discharge care interventions for depression - Systematic review and meta-analysis. J Affect Disord 2017; 223:82-94. [PMID: 28734149 DOI: 10.1016/j.jad.2017.07.026] [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: 01/26/2017] [Revised: 06/14/2017] [Accepted: 07/08/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with depression require treatment continuity when discharged from inpatient care. Interventions aimed at optimizing transition into outpatient care may be effective in preventing symptom deterioration and readmission. We aimed to evaluate the effectiveness of care transition interventions for patients with depression after psychiatric hospitalization. METHODS Systematic review and random-effects meta-analysis of controlled trials. Primary outcomes were readmissions and symptoms of depression. The control condition was treatment as usual. RESULTS We included 16 publications reporting the results of 13 different studies. Studies were heterogeneous concerning patient selection and interventional approach. Effects on readmissions and depression symptoms were non-significant in meta-analysis of 8 studies/710 patients and 7 studies/592 patients, respectively. Overall risk ratio for readmission during follow-up was 0.65 (95% CI [0.42;1.01], p=0.06), standardized mean difference for depression symptoms was -0.09 (95% CI [-0.37;0.19], p=0.53). Subgroup analyses indicated no preference for a specific interventional strategy. Data point to considerable risk for selection and publication bias. LIMITATIONS Included studies are heterogeneous; subgroups are often small and may not attain the power to detect effects. Reasonable classification of interventions into groups of comparable approaches was a challenge and may be arbitrary in some cases. CONCLUSIONS This systematic review and meta-analysis could not identify any convincingly effective interventional transition approach for patients with depression after psychiatric hospitalization. Current evidence regarding discharge management for depression is limited, heterogeneous and potentially prone to bias. Interventions might be more appropriate for patients with other diagnoses than depression. Further high-quality randomized studies are required.
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Affiliation(s)
- F Holzinger
- Institute of General Practice, Charité - Universitätsmedizin Berlin, Germany.
| | - S Fahrenkrog
- Institute of General Practice, Charité - Universitätsmedizin Berlin, Germany
| | - S Roll
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Germany
| | - F Kleefeld
- Institute of General Practice, Charité - Universitätsmedizin Berlin, Germany
| | - M Adli
- Department of Psychiatry and Psychotherapy, Research Group Mood Disorders, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Germany; Fliedner Klinik Berlin, Germany
| | - C Heintze
- Institute of General Practice, Charité - Universitätsmedizin Berlin, Germany
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Dornbach-Bender A, Ruggero CJ, Waszczuk MA, Gamez W, Watson D, Kotov R. Mapping emotional disorders at the finest level: Convergent validity and joint structure based on alternative measures. Compr Psychiatry 2017; 79:31-39. [PMID: 28754505 DOI: 10.1016/j.comppsych.2017.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 05/15/2017] [Accepted: 06/22/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Traditional categorization of emotional disorders suffers from within-disorder heterogeneity and excessive comorbidity. Quantitative nosology instead proposes grouping homogenous components of these disorders within a higher order internalizing dimension. However, the precise number, composition, and hierarchical structure of these components remains unclear and varies based on assessment tools. METHODS The present study jointly examined two assessment systems with the broadest coverage of homogeneous emotional disorder components-the revised Interview for Mood and Anxiety Symptoms (IMAS-R) and the self-report-based expanded version of the Inventory of Depression and Anxiety Symptoms (IDAS-II)-to map their convergent and discriminant validity and joint structure in outpatient (N=426) and treated student (N=306) samples. RESULTS Results identified 33 non-redundant components of emotional disorders. Most demonstrated strong convergent and discriminant validity between these two instruments. However, the IMAS-R provided more detailed and differentiated characterization of the content subsumed within three IDAS-II scales, and seven of the 33 components were unique to one measure or the other. Joint analysis of scales from both measures supported a four factor (i.e., distress, fear, OCD, mania) mid-level structure of emotional disorders. CONCLUSIONS Using multiple measures, methods, and samples, the present study provided evidence for the validity of core lower order components of the internalizing dimension and suggested they cluster into as many as four distinct factors reflecting distress, fear, OCD, and mania.
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Affiliation(s)
- Allison Dornbach-Bender
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, United States.
| | - Camilo J Ruggero
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, United States.
| | - Monika A Waszczuk
- Department of Psychiatry, Stony Brook University, HSC, Level T-10, Room 060F, Stony Brook, NY 11794-8101, United States.
| | - Wakiza Gamez
- Department of Psychology, University of Iowa, Iowa City, IA, USA.
| | - David Watson
- Department of Psychology, 118 Haggar Hall, University of Notre Dame, Notre Dame, IN 46556, United States.
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, HSC, Level T-10, Room 060H, Stony Brook, NY 11794-8101, United States.
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Dejonckheere E, Bastian B, Fried EI, Murphy SC, Kuppens P. Perceiving social pressure not to feel negative predicts depressive symptoms in daily life. Depress Anxiety 2017; 34:836-844. [PMID: 28499066 DOI: 10.1002/da.22653] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/21/2017] [Accepted: 04/22/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Western societies often overemphasize the pursuit of happiness, and regard negative feelings such as sadness or anxiety as maladaptive and unwanted. Despite this emphasis on happiness, the amount of people suffering from depressive complaints is remarkably high. To explain this apparent paradox, we examined whether experiencing social pressure not to feel sad or anxious could in fact contribute to depressive symptoms. METHODS A sample of individuals (n = 112) with elevated depression scores (Patient Health Questionnaire [PHQ-9] ≥ 10) took part in an online daily diary study in which they rated their depressive symptoms and perceived social pressure not to feel depressed or anxious for 30 consecutive days. Using multilevel VAR models, we investigated the temporal relation between this perceived social pressure and depressive symptoms to determine directionality. RESULTS Primary analyses consistently indicated that experiencing social pressure predicts increases in both overall severity scores and most individual symptoms of depression, but not vice versa. A set of secondary analyses, in which we adopted a network perspective on depression, confirmed these findings. Using this approach, centrality analysis revealed that perceived social pressure not to feel negative plays an instigating role in depression, reflected by the high out- and low instrength centrality of this pressure in the various depression networks. CONCLUSIONS Together, these findings indicate how perceived societal norms may contribute to depression, hinting at a possible malignant consequence of society's denouncement of negative emotions. Clinical implications are discussed.
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Affiliation(s)
- Egon Dejonckheere
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Brock Bastian
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Eiko I Fried
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Sean C Murphy
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Kuppens
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
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Köhler-Forsberg O, Buttenschøn HN, Tansey KE, Maier W, Hauser J, Dernovsek MZ, Henigsberg N, Souery D, Farmer A, Rietschel M, McGuffin P, Aitchison KJ, Uher R, Mors O. Association between C-reactive protein (CRP) with depression symptom severity and specific depressive symptoms in major depression. Brain Behav Immun 2017; 62:344-350. [PMID: 28257825 DOI: 10.1016/j.bbi.2017.02.020] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 02/03/2017] [Accepted: 02/27/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Population-based studies have associated inflammation, particularly higher C-reactive protein (CRP), with depressive severity, but clinical trials in major depressive disorder were rather non-specific without examining the role of gender. We aimed to investigate the association between CRP and overall depression severity including specific depressive symptoms and to examine potential gender differences. METHODS We included 231 individuals with major depressive disorder from the Genome-Based Therapeutics Drugs for Depression (GENDEP) study. At baseline, we assessed high-sensitivity CRP levels and psychopathology with the Montgomery Aasberg Depression Rating Scale (MADRS). We performed linear regression analyses to investigate the association between baseline CRP levels with overall MADRS severity and specific symptoms at baseline and adjusted for age, gender, anti-inflammatory and psychotropic drug treatment, body mass index, smoking, inflammatory diseases, and recruitment center. RESULTS Higher CRP levels were significantly associated with greater overall MADRS symptom severity (p=0.02), which was significant among women (p=0.02) but not among men (p=0.68). Among women, higher CRP was associated with increased severity on observed mood, cognitive symptoms, interest-activity, and suicidality, but we found no significant associations among men. Interaction analyses showed no significant gender differences on the overall MADRS score or specific symptoms. DISCUSSION Our results support the sickness syndrome theory suggesting that chronic low-grade inflammation may be associated with a subtype of depression. The potential gender differences in psychopathology may be explained by biological and/or psychosocial factors, e.g. differential modulation of immune responses by sex hormones. Clinical studies should investigate symptom-specific and/or gender-specific treatment guided by peripheral inflammatory markers.
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Affiliation(s)
- Ole Köhler-Forsberg
- Aarhus University Hospital, Risskov, Psychosis Research Unit, Aarhus, Denmark; iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark.
| | - Henriette N Buttenschøn
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Denmark
| | - Katherine E Tansey
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK
| | | | - Joanna Hauser
- Laboratory of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, Poland
| | | | - Neven Henigsberg
- Croatian Institute for Brain Research, Medical School, University of Zagreb, Croatia
| | - Daniel Souery
- Laboratoire de Psychologie Médicale, Université Libre de Bruxelles; Psy Pluriel - Centre Européen de Psychologie Médicale, Belgium
| | - Anne Farmer
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Peter McGuffin
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK
| | - Katherine J Aitchison
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK; Departments of Psychiatry and Medical Genetics, University of Alberta, Edmonton, AB, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, N.S., Canada
| | - Ole Mors
- Aarhus University Hospital, Risskov, Psychosis Research Unit, Aarhus, Denmark; iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
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Pharmacogenetics of antidepressant response: A polygenic approach. Prog Neuropsychopharmacol Biol Psychiatry 2017; 75:128-134. [PMID: 28159590 DOI: 10.1016/j.pnpbp.2017.01.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 12/30/2016] [Accepted: 01/26/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) has a high personal and socio-economic burden and >60% of patients fail to achieve remission with the first antidepressant. The biological mechanisms behind antidepressant response are only partially known but genetic factors play a relevant role. A combined predictor across genetic variants may be useful to investigate this complex trait. METHODS Polygenic risk scores (PRS) were used to estimate multi-allelic contribution to: 1) antidepressant efficacy; 2) its overlap with MDD and schizophrenia. We constructed PRS and tested whether these predicted symptom improvement or remission from the GENDEP study (n=736) to the STAR*D study (n=1409) and vice-versa, including the whole sample or only patients treated with escitalopram or citalopram. Using summary statistics from Psychiatric Genomics Consortium for MDD and schizophrenia, we tested whether PRS from these disorders predicted symptom improvement in GENDEP, STAR*D, and five further studies (n=3756). RESULTS No significant prediction of antidepressant efficacy was obtained from PRS in GENDEP/STAR*D but this analysis might have been underpowered. There was no evidence of overlap in the genetics of antidepressant response with either MDD or schizophrenia, either in individual studies or a meta-analysis. Stratifying by antidepressant did not alter the results. DISCUSSION We identified no significant predictive effect using PRS between pharmacogenetic studies. The genetic liability to MDD or schizophrenia did not predict response to antidepressants, suggesting differences between the genetic component of depression and treatment response. Larger or more homogeneous studies will be necessary to obtain a polygenic predictor of antidepressant response.
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Riepe MW, Gritzmann P, Brieden A. Preferences of psychiatric practitioners for core symptoms of major depressive disorder: a hidden conjoint analysis. Int J Methods Psychiatr Res 2017; 26:e1528. [PMID: 27859868 PMCID: PMC6877254 DOI: 10.1002/mpr.1528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 05/09/2016] [Accepted: 06/24/2016] [Indexed: 11/07/2022] Open
Abstract
According to ICD-10 and DSM-V, symptoms of depressive disorder are considered to be equally important for severity judgment. It was the goal to investigate the weight of selected symptom complexes for severity judgment. In workaday life severity judgment results from an overall impression rather than from calculating severity in different symptom complexes, separately. In fact, the drivers for overall judgment may not be known explicitly to the psychiatrist himself. A method of choice to resolve this is conjoint analysis. Based on the Montgomery-Asberg Depression Scale (MADRS) and the Sheehan Disability Scale (SDS) case vignettes were constructed. Different symptom severity in the domains mood, vegetative symptoms, cognition/inhibition, suicidality, and everyday functioning were worked into the vignettes. Different symptom complexes influence the severity judgment by clinical psychiatrists to a rather different extent. Mood has a greater impact on severity judgment than suicidality, cognition/inhibition, vegetative symptoms, and everyday functioning. We conclude that core complexes of major depressive disorder are valued with different clinical relevance by psychiatrists. Thus, diagnosis and appraisal of therapeutic efficacy are subject to individual preferences of clinical psychiatrists and prevalence and therapeutic efficacy may be over- or under-estimated unless these differences in preferences are taken into account.
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Affiliation(s)
- Matthias W Riepe
- Division of Mental Health & Old Age Psychiatry, Psychiatry II, Ulm University, Günzburg, Germany
| | - Peter Gritzmann
- Department of Mathematics, Technical University Munich, Munich, Germany
| | - Andreas Brieden
- Department of Wirtschafts- und Organisationswissenschaften, Universität der Bundeswehr München, Neubiberg, Germany
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CLOCK gene variants associated with the discrepancy between subjective and objective severity in bipolar depression. J Affect Disord 2017; 210:14-18. [PMID: 27992853 DOI: 10.1016/j.jad.2016.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/21/2016] [Accepted: 12/13/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The discrepancy between subjective and objective severity of depressive syndromes has been proposed as a predictor of treatment outcome and suicidal risk in depression, and is associated with depressive cognitive distortions. A recent study reported that evening-type depressed patients showed higher depressive cognitions than morning-type patients. Therefore, it can be hypothesized that genetic factors affecting evening preference, such as carrying of the CLOCK rs1801260*C allele, may influence the discrepancy. METHOD We tested this hypothesis in 132 patients affected by a major depressive episode in the course of bipolar disorder. The severity of depression was evaluated using self-rated (Beck Depression Inventory: BDI) and observer-rated (Hamilton Depression Rating Scale: HDRS) measures. The BDI-HDRS discrepancy score was calculated and the effects of the rs1801260 polymorphism on this score and on depressive cognitive distortions, as measured on the Cognitions Questionnaire, were examined. RESULTS The rs1801260*C carriers showed higher BDI-HDRS discrepancy scores than T/T homozygotes. Mediation analysis using bootstrapping procedures revealed that the dimension of depressive cognition "hopelessness" fully mediates the association between the rs1801260 polymorphism and the BDI-HDRS discrepancy. LIMITATIONS Many gene polymorphisms other than CLOCK rs1801260 may also influence the BDI-HDRS discrepancy and depressive cognitive distortions. CONCLUSION Our current results suggest that factors affecting the biological clock can influence the "non-clock" psychopathological features of mood disorders.
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Rosenström T, Jokela M. Reconsidering the definition of Major Depression based on Collaborative Psychiatric Epidemiology Surveys. J Affect Disord 2017; 207:38-46. [PMID: 27690352 DOI: 10.1016/j.jad.2016.09.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/12/2016] [Accepted: 09/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Diagnostic definitions for depressive disorders remain a debated topic, despite their central role in clinical practice and research. We use both recent evidence and nationally representative data to derive an empirically-based modification of DSM-IV/-5 Major Depressive Disorder (MDD). METHOD A modified MDD diagnosis was derived by analyzing data from Collaborative Psychiatric Epidemiology Surveys, a multistage probability sample of adults (n=20 013; age ≥ 18 years) in coterminous USA, Alaska and Hawaii. The old and the newly suggested MDD definitions were compared for their associated disability (WHO Disability Assessment Schedule and number of disability days in past month), suicide attempt, and other covariates. RESULTS Our data-driven definition for major depression was "lack of interest to all or most things" plus four other symptoms from the set {weight gain, weight loss, insomnia, psychomotor retardation, fatigue, feelings of worthlessness, diminished ability to think/concentrate, suicidal ideation/attempt}. The new definition captured all the disability implied by MDD and excluded cases that showed no greater disability than the general population nor increased risk of suicide attempts. The lifetime prevalence of the new diagnosis was 14.7% (95% CI=14-15.4%) of the population, slightly less than for the old definition (16.4%; CI=15.4-17.3%). LIMITATIONS Only conservative modifications of MDD could be studied, because of restrictions in the symptom data. CONCLUSIONS With only small adjusting, the new definition for major depression may be more clinically relevant than the old one, and could serve as a conservative replacement for the old definition.
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Affiliation(s)
- Tom Rosenström
- Institute of Behavioural Sciences, University of Helsinki, Finland.
| | - Markus Jokela
- Institute of Behavioural Sciences, University of Helsinki, Finland
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Suzuki M, Dallaspezia S, Locatelli C, Uchiyama M, Colombo C, Benedetti F. Discrepancy between subjective and objective severity as a predictor of response to chronotherapeutics in bipolar depression. J Affect Disord 2016; 204:48-53. [PMID: 27322769 DOI: 10.1016/j.jad.2016.06.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 06/07/2016] [Accepted: 06/11/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chronotherapeutic techniques (sleep deprivation and light therapy) are effective treatments for bipolar depression, but viable predictors of response for the daily clinical practice have not yet been established. The discrepancy between subjective and objective severity of the depressive syndrome has been proposed as a possible predictor of treatment outcome in depression. This study examined whether this discrepancy could predict response to chronotherapeutics in bipolar depression. METHOD We studied 149 consecutively admitted inpatients with a major depressive episode in course of bipolar disorder. Patients were treated with the combination of repeated sleep deprivation and bright light therapy. Severity of depression was evaluated using self-rated (Beck Depression Inventory: BDI) and observer-rated (Hamilton Depression Rating Scale: HDRS) measures. BDI-HDRS discrepancy score at baseline was calculated, and its associations with clinical response and with depressive cognitive distortions, as measured on the Cognitions Questionnaire, were examined. RESULTS Among the 147 completers, 66% responded to treatment (50% reduction of HDRS score). The response rate in patients with low discrepancy scores and in patients with high discrepancy scores were 80.2% and 48.5%, respectively. High BDI-HDRS discrepancy predicted negative response to treatment with odds ratio of 3.79 (95%CI: 1.61-8.93). BDI-HDRS discrepancy was positively associated with depressive cognitive distortions. LIMITATIONS Potential factors affecting the discrepancy and outcome other than cognitive distortion were not examined in this study. CONCLUSION Higher BDI-HDRS discrepancy can predict poorer response to chronotherapeutics in bipolar depression. The tendency to generalize hopelessness may be a factor influencing the link between the discrepancy and outcome.
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Affiliation(s)
- Masahiro Suzuki
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy; Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan.
| | - Sara Dallaspezia
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| | - Clara Locatelli
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| | - Makoto Uchiyama
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Cristina Colombo
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Benedetti
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
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Gerasch S, Kanaan AS, Jakubovski E, Müller-Vahl KR. Aripiprazole Improves Associated Comorbid Conditions in Addition to Tics in Adult Patients with Gilles de la Tourette Syndrome. Front Neurosci 2016; 10:416. [PMID: 27672358 PMCID: PMC5018494 DOI: 10.3389/fnins.2016.00416] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/26/2016] [Indexed: 12/13/2022] Open
Abstract
Gilles de la Tourette Syndrome (GTS) is characterized by motor and vocal tics, as well as associated comorbid conditions including obsessive-compulsive disorder (OCD), attention deficit/hyperactivity disorder (ADHD), depression, and anxiety which are present in a substantial number of patients. Although randomized controlled trials including a large number of patients are still missing, aripiprazole is currently considered as a first choice drug for the treatment of tics. The aim of this study was to further investigate efficacy and safety of aripiprazole in a group of drug-free, adult patients. Specifically, we investigated the influence of aripiprazole on tic severity, comorbidities, premonitory urge (PU), and quality of life (QoL). Moreover, we were interested in the factors that influence a patient's decision in electing for-or against- pharmacological treatment. In this prospective uncontrolled open-label study, we included 44 patients and used a number of rating scales to assess tic severity, PU, comorbidities, and QoL at baseline and during treatment with aripiprazole. Eighteen out of fortyfour patients decided for undergoing treatment for their tics with aripiprazole and completed follow-up assessments after 4–6 weeks. Our major findings were (1) aripiprazole resulted in significant reduction of tics, but did not affect PU; (2) aripiprazole significantly improved OCD and showed a trend toward improvement of other comorbidities including depression, anxiety, and ADHD; (3) neither severity of tics, nor PU or QoL influenced patients' decisions for or against treatment of tics with aripiprazole; instead patients with comorbid OCD tended to decide in favor of, while patients with comorbid ADHD tended to decide against tic treatment; (4) most frequently reported adverse effects were sleeping problems; (5) patients' QoL was mostly impaired by comorbid depression. Our results suggest that aripiprazole may improve associated comorbid conditions in addition to tics in patients with GTS. It can be hypothesized that these beneficial effects are related to aripiprazole's adaptive pharmacological profile, which exhibits an influence on the dopaminergic as well as a number of other neurotransmitter systems. For the first time, our data provide evidence that patients' decision making process for or against medical treatment is influenced by other factors than tic severity and QoL.
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Affiliation(s)
- Sarah Gerasch
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School Hannover, Germany
| | - Ahmad Seif Kanaan
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical SchoolHannover, Germany; Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School Hannover, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School Hannover, Germany
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Cano JF, Gomez Restrepo C, Rondón M. [Validation of the Montgomery-Åsberg Depression Rating Scale (MADRS) in Colombia]. ACTA ACUST UNITED AC 2016; 45:146-55. [PMID: 27569008 DOI: 10.1016/j.rcp.2015.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 08/14/2015] [Accepted: 08/24/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To adapt and to validate the Montgomery-Åsberg Depression Rating Scale (MADRS) in Colombia. METHODS Observational study for scale validation. Validity criteria were used to determine the severity cut-off points of the tool. Taking into account sensitivity and specificity values, those cut points were contrasted with ICD-10 criteria for depression severity. A a factor analysis was performed. The internal consistencY was determined with the same sample of patients used for the validity criteria. Inter-rater reliability was assessed by evaluating the 22 records of the patients that consented to a video interview. Sensitivity to change was established through a second application of the scale in 28 subjects after a lapse of 14 to 28 days. RESULTS The study was performed in Bogotá, the tool was applied in 150 patients suffering from major depressive disorder. The cut-off point for moderate depression was 20 (sensitivity, 98%; specificity, 96%), and the cut-off point for severe depression was 34 (sensitivity, 98%; specificity, 92%). The tool appears as a unidimensional scale, which possesses a good internal consistency with (α=.9168). The findings of inter-rater reliability evaluation showed the scale as highly reliable (intraclass correlation coefficient=.9833). The instrument has a good sensitivity to change. CONCLUSIONS The Colombian version of the Montgomery-Åsberg Depression Rating Scale has good psychometric properties and can be used in clinical practice and in clinical research in the field of depressive disorder.
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Affiliation(s)
- Juan Fernando Cano
- Centro de Investigaciones del Sistema Nervioso, Grupo CISNE, Bogotá, Colombia.
| | - Carlos Gomez Restrepo
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Martín Rondón
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
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Fieker M, Moritz S, Köther U, Jelinek L. Emotion recognition in depression: An investigation of performance and response confidence in adult female patients with depression. Psychiatry Res 2016; 242:226-232. [PMID: 27294796 DOI: 10.1016/j.psychres.2016.05.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 04/13/2016] [Accepted: 05/22/2016] [Indexed: 01/04/2023]
Abstract
Abnormalities in emotion recognition are frequently reported in depression. However, emotion recognition is not compromised in some studies, and confidence judgments, which are essential for social interaction, have not been considered to date. Due to the high prevalence rate of depression in women, and sex differences in emotion recognition, the aim of the present study was to investigate emotion recognition and confidence judgments in women with depression. A sample of female patients with depressive disorders (n=45) was compared with female healthy controls (n=30) in their ability to correctly identify facial emotion expressions along with confidence judgments. Groups performed similarly on emotional face recognition and showed no difference regarding confidence ratings. A negative correlation between self-assessed depression and response confidence was found. While some limitations of the study must be taken in consideration (e.g., small number of items per emotion category, low severity of depression), abnormalities in emotion recognition do not seem to be a major feature of depression. As self-assessed depression is accompanied by low response confidence for emotional faces, it is crucial to further examine the role of confidence judgments in emotion recognition, as underconfidence may foster interpersonal insecurity in depression.
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Affiliation(s)
- Martina Fieker
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany.
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany
| | - Ulf Köther
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany
| | - Lena Jelinek
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany
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83
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Iniesta R, Malki K, Maier W, Rietschel M, Mors O, Hauser J, Henigsberg N, Dernovsek MZ, Souery D, Stahl D, Dobson R, Aitchison KJ, Farmer A, Lewis CM, McGuffin P, Uher R. Combining clinical variables to optimize prediction of antidepressant treatment outcomes. J Psychiatr Res 2016; 78:94-102. [PMID: 27089522 DOI: 10.1016/j.jpsychires.2016.03.016] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 03/12/2016] [Accepted: 03/30/2016] [Indexed: 10/22/2022]
Abstract
The outcome of treatment with antidepressants varies markedly across people with the same diagnosis. A clinically significant prediction of outcomes could spare the frustration of trial and error approach and improve the outcomes of major depressive disorder through individualized treatment selection. It is likely that a combination of multiple predictors is needed to achieve such prediction. We used elastic net regularized regression to optimize prediction of symptom improvement and remission during treatment with escitalopram or nortriptyline and to identify contributing predictors from a range of demographic and clinical variables in 793 adults with major depressive disorder. A combination of demographic and clinical variables, with strong contributions from symptoms of depressed mood, reduced interest, decreased activity, indecisiveness, pessimism and anxiety significantly predicted treatment outcomes, explaining 5-10% of variance in symptom improvement with escitalopram. Similar combinations of variables predicted remission with area under the curve 0.72, explaining approximately 15% of variance (pseudo R(2)) in who achieves remission, with strong contributions from body mass index, appetite, interest-activity symptom dimension and anxious-somatizing depression subtype. Escitalopram-specific outcome prediction was more accurate than generic outcome prediction, and reached effect sizes that were near or above a previously established benchmark for clinical significance. Outcome prediction on the nortriptyline arm did not significantly differ from chance. These results suggest that easily obtained demographic and clinical variables can predict therapeutic response to escitalopram with clinically meaningful accuracy, suggesting a potential for individualized prescription of this antidepressant drug.
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Affiliation(s)
- Raquel Iniesta
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - Karim Malki
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn, Regina-Pacis-Weg 3, 53113 Bonn, Germany
| | - Marcella Rietschel
- Central Institute of Mental Health, Division of Genetic Epidemiology in Psychiatry, Square J5, 68159, Mannheim, Germany
| | - Ole Mors
- Research Department P, Aarhus University Hospital, Norrebrogade 44, Aarhus C, DK-8000, Risskov, Denmark
| | - Joanna Hauser
- Laboratory of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, Collegium Maius, Fredry 10, 61-701, Poznań, Poland
| | - Neven Henigsberg
- Croatian Institute for Brain Research, Medical School, University of Zagreb, Salata 3, 10 000, Zagreb, Croatia
| | - Mojca Zvezdana Dernovsek
- University Psychiatric Clinic and the Medical Faculty, University of Ljubljana, Kongresni trg 12, 1000, Ljubljana, Slovenia
| | - Daniel Souery
- Laboratoire de Psychologie Médicale, Université Libre de Bruxelles and Psy Pluriel - Centre Européen de Psychologie Médicale, Av Jack Pastur 47a, 1180, Uccle, Belgium
| | - Daniel Stahl
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Richard Dobson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Katherine J Aitchison
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK; Department of Psychiatry and Medical Genetics, University of Alberta, 116 St and 85 Ave, Edmonton, AB, T6G 2R3, Canada
| | - Anne Farmer
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Peter McGuffin
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Rudolf Uher
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK; Dalhousie University Department of Psychiatry, 5909 Veterans' Memorial Drive, Halifax, B3H 2E2, Nova Scotia, Canada
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84
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Hill NL, Mogle J, Wion R, Munoz E, DePasquale N, Yevchak AM, Parisi JM. Subjective Cognitive Impairment and Affective Symptoms: A Systematic Review. THE GERONTOLOGIST 2016; 56:e109-e127. [PMID: 27342440 DOI: 10.1093/geront/gnw091] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/15/2016] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF STUDY Subjective cognitive impairment (SCI) has been argued to reflect affective symptoms (i.e., depression and anxiety) rather than actual cognitive issues. Although a number of studies exist that look at the associations between SCI and affective symptoms, no review is available to aggregate this disparate literature. We addressed this gap by conducting a systematic review to better understand the relationships among SCI and affective symptoms among older adults in both community and clinical settings. DESIGN AND METHODS We reviewed available literature per the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Weight of evidence (WoE) ratings and narrative synthesis were completed for 58 articles. RESULTS A majority of studies focused on community-based samples (n = 40). Approximately half (53%) of the articles reviewed met high WoE criteria for the current review. Cross-sectional findings consistently identified a positive relationship among SCI and affective symptoms. Findings from available longitudinal studies (n = 9) were mixed but suggested a possible reciprocal relationship among SCI and depression. The relationship between SCI and anxiety appeared to be driven by fears over loss of function. Following consultation with health professionals, the association between SCI and anxiety was diminished or eliminated. IMPLICATIONS Although SCI is consistently related to affective symptoms in older adults cross-sectionally, more longitudinal work is needed to understand their temporal relationship. Improved measurement of SCI would support a deeper understanding of the impact of SCI on psychological well-being.
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Affiliation(s)
- Nikki L Hill
- College of Nursing, The Pennsylvania State University, University Park.
| | - Jacqueline Mogle
- College of Nursing, The Pennsylvania State University, University Park
| | - Rachel Wion
- College of Nursing, The Pennsylvania State University, University Park
| | - Elizabeth Munoz
- Department of Psychology, University of California, Riverside
| | - Nicole DePasquale
- Center for Healthy Aging and Department of Human Development & Family Studies, The Pennsylvania State University, University Park
| | - Andrea M Yevchak
- College of Nursing, The Pennsylvania State University, University Park
| | - Jeanine M Parisi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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85
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Ketharanathan T, Hanwella R, Weerasundera R, de Silva VA. Diagnostic Validity and Factor Analysis of Montgomery-Asberg Depression Rating Scale in Parkinson Disease Population. J Geriatr Psychiatry Neurol 2016; 29:115-9. [PMID: 26392481 DOI: 10.1177/0891988715606232] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 07/29/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Montgomery-Asberg Depression Rating Scale (MADRS) is commonly used to assess major depression in Parkinson disease (PD), but studies on its utility are few. This study examines the validity and factor structure of MADRS in population with PD. METHODS In 104 patients with idiopathic PD, major depression was diagnosed by Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision; DSM-IV-TR) criteria, and all patients were rated by MADRS. RESULTS The MADRS showed good concurrent validity with DSM-IV-TR criteria. The diagnostic cutoff was established as 16/17 (sensitivity 97.43, specificity 100%, positive predictive value 100%, and negative predictive value 98.48%). Factor analysis identified 3 factors, accounting for 76% of total variance: "sadness-anhedonia" comprising apparent sadness, reported sadness, concentration difficulties, lassitude, inability to feel, pessimistic thoughts, and suicidal ideas; "anxiety" with reduced sleep and inner tension; and "vegetative symptoms" with reduced appetite. CONCLUSION The MADRS has diagnostic utility in major depression in PD. The 3-factor structure of MADRS may help to understand the different dimensions of major depression and identify distinct symptom subgroups in this population.
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Affiliation(s)
| | - Raveen Hanwella
- Department of Psychological Medicine, University of Colombo, Colombo, Sri Lanka
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86
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Rizvi SJ, Pizzagalli DA, Sproule BA, Kennedy SH. Assessing anhedonia in depression: Potentials and pitfalls. Neurosci Biobehav Rev 2016; 65:21-35. [PMID: 26959336 DOI: 10.1016/j.neubiorev.2016.03.004] [Citation(s) in RCA: 282] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 09/23/2015] [Accepted: 03/03/2016] [Indexed: 01/06/2023]
Abstract
The resurgence of interest in anhedonia within major depression has been fuelled by clinical trials demonstrating its utility in predicting antidepressant response as well as recent conceptualizations focused on the role and manifestation of anhedonia in depression. Historically, anhedonia has been understood as a "loss of pleasure", yet neuropsychological and neurobiological studies reveal a multifaceted reconceptualization that emphasizes different facets of hedonic function, including desire, effort/motivation, anticipation and consummatory pleasure. To ensure generalizability across studies, evaluation of the available subjective and objective methods to assess anhedonia is necessary. The majority of research regarding anhedonia and its neurobiological underpinnings comes from preclinical research, which uses primary reward (e.g. food) to probe hedonic responding. In contrast, behavioural studies in humans primarily use secondary reward (e.g. money) to measure many aspects of reward responding, including delay discounting, response bias, prediction error, probabilistic reversal learning, effort, anticipation and consummatory pleasure. The development of subjective scales to measure anhedonia has also increased in the last decade. This review will assess the current methodology to measure anhedonia, with a focus on scales and behavioural tasks in humans. Limitations of current work and recommendations for future studies are discussed.
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Affiliation(s)
- Sakina J Rizvi
- ASR Chair in Suicide and Depression Studies Program, Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA
| | - Beth A Sproule
- Department of Clinical Pharmacy, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sidney H Kennedy
- ASR Chair in Suicide and Depression Studies Program, Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
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87
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Knowles EEM, Kent JW, McKay DR, Sprooten E, Mathias SR, Curran JE, Carless MA, de Almeida MAA, Harald HHG, Dyer TD, Olvera RL, Fox PT, Duggirala R, Almasy L, Blangero J, Glahn DC. Genome-wide linkage on chromosome 10q26 for a dimensional scale of major depression. J Affect Disord 2016; 191:123-31. [PMID: 26655122 PMCID: PMC4715913 DOI: 10.1016/j.jad.2015.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/27/2015] [Accepted: 11/09/2015] [Indexed: 12/28/2022]
Abstract
Major depressive disorder (MDD) is a common and potentially life-threatening mood disorder. Identifying genetic markers for depression might provide reliable indicators of depression risk, which would, in turn, substantially improve detection, enabling earlier and more effective treatment. The aim of this study was to identify rare variants for depression, modeled as a continuous trait, using linkage and post-hoc association analysis. The sample comprised 1221 Mexican-American individuals from extended pedigrees. A single dimensional scale of MDD was derived using confirmatory factor analysis applied to all items from the Past Major Depressive Episode section of the Mini-International Neuropsychiatric Interview. Scores on this scale of depression were subjected to linkage analysis followed by QTL region-specific association analysis. Linkage analysis revealed a single genome-wide significant QTL (LOD=3.43) on 10q26.13, QTL-specific association analysis conducted in the entire sample revealed a suggestive variant within an intron of the gene LHPP (rs11245316, p=7.8×10(-04); LD-adjusted Bonferroni-corrected p=8.6×10(-05)). This region of the genome has previously been implicated in the etiology of MDD; the present study extends our understanding of the involvement of this region by highlighting a putative gene of interest (LHPP).
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Affiliation(s)
- Emma E M Knowles
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital, Hartford, CT, USA.
| | - Jack W Kent
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - D Reese McKay
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital, Hartford, CT, USA
| | - Emma Sprooten
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital, Hartford, CT, USA
| | - Samuel R Mathias
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital, Hartford, CT, USA
| | - Joanne E Curran
- South Texas Diabetes and Obesity Institute, University of Texas Health Science Center at San Antonio & University of Texas of the Rio Grande Valley, Brownsville, TX, United States
| | - Melanie A Carless
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Marcio A A de Almeida
- South Texas Diabetes and Obesity Institute, University of Texas Health Science Center at San Antonio & University of Texas of the Rio Grande Valley, Brownsville, TX, United States
| | - H H Goring Harald
- South Texas Diabetes and Obesity Institute, University of Texas Health Science Center at San Antonio & University of Texas of the Rio Grande Valley, Brownsville, TX, United States
| | - Tom D Dyer
- South Texas Diabetes and Obesity Institute, University of Texas Health Science Center at San Antonio & University of Texas of the Rio Grande Valley, Brownsville, TX, United States
| | - Rene L Olvera
- Department of Psychiatry, University of Texas Health Science Center San Antonio, Texas Center San Antonio, San Antonio, TX, United States
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center San Antonio, San Antonio, TX, United States; South Texas Veterans' Healthcare System, 7400 Merton Minter, San Antonio, TX 78229, USA
| | - Ravi Duggirala
- South Texas Diabetes and Obesity Institute, University of Texas Health Science Center at San Antonio & University of Texas of the Rio Grande Valley, Brownsville, TX, United States
| | - Laura Almasy
- South Texas Diabetes and Obesity Institute, University of Texas Health Science Center at San Antonio & University of Texas of the Rio Grande Valley, Brownsville, TX, United States
| | - John Blangero
- South Texas Diabetes and Obesity Institute, University of Texas Health Science Center at San Antonio & University of Texas of the Rio Grande Valley, Brownsville, TX, United States
| | - David C Glahn
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital, Hartford, CT, USA
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88
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Bukumiric Z, Starcevic V, Stanisavljevic D, Marinkovic J, Milic N, Djukic-Dejanovic S, Janjic V, Corac A, Ilic A, Kostic M, Nikolic I, Trajkovic G. Meta-analysis of the changes in correlations between depression instruments used in longitudinal studies. J Affect Disord 2016; 190:733-743. [PMID: 26606717 DOI: 10.1016/j.jad.2015.10.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/01/2015] [Accepted: 10/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Correlations between instruments measuring the same construct reflect their concurrent validity. Little is known about changes in correlations between such instruments employed in studies with repeated assessment. The aim of this meta-analysis was to examine the changes in correlations between depression instruments in the course of longitudinal studies. METHODS A literature search was conducted using MEDLINE and PsycINFO for the period from 1960 to 2013. The total number of collected articles was 3723, of which 61 were included. Three meta-analyses were performed for the changes in correlations between each pair of the three depression scales: Hamilton Rating Scale for Depression (HAMD), Montgomery-Asberg Depression Rating Scale (MADRS) and Beck Depression Inventory (BDI). The effect size in these meta-analyses was obtained by the z-transformation of correlation coefficients. RESULTS Correlations between depression scales increased over time in 52 studies. Significant changes in correlation coefficients were found for correlations between HAMD and BDI (p<0.001) and for correlations between HAMD and MADRS (p<0.001). An increase in correlations between the scales was associated with a decrease in depression scores and increase in their variability. LIMITATIONS Univariable and multivariable meta-regression models were not obtained in all three meta-analyses because of the lack of data. CONCLUSIONS A finding that correlations between depression instruments tended to increase over time has significant implications for assessment of the concurrent validity of these instruments. In longitudinal designs it is important to estimate correlations between depression scales over time because different thresholds for scale correlations indicate acceptable concurrent validity at different times.
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Affiliation(s)
- Zoran Bukumiric
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia.
| | - Vladan Starcevic
- University of Sydney, Sydney Medical School - Nepean, Discipline of Psychiatry, Sydney, Australia
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia
| | - Jelena Marinkovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia
| | | | - Vladimir Janjic
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Aleksandar Corac
- Department of Public Health, Medical Faculty, University of Pristina, Kosovska Mitrovica, Serbia
| | - Aleksandra Ilic
- Department of Public Health, Medical Faculty, University of Pristina, Kosovska Mitrovica, Serbia
| | - Mirjana Kostic
- Department of Public Health, Medical Faculty, University of Pristina, Kosovska Mitrovica, Serbia
| | - Ivan Nikolic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia
| | - Goran Trajkovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia
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Rizvi SJ, Sproule BA, Gallaugher L, McIntyre RS, Kennedy SH. Correlates of benzodiazepine use in major depressive disorder: The effect of anhedonia. J Affect Disord 2015; 187:101-5. [PMID: 26331683 DOI: 10.1016/j.jad.2015.07.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/22/2015] [Accepted: 07/29/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Current treatment guidelines emphasize the limited role of benzodiazepines in Major Depressive Disorder (MDD), mainly due to the absence of long-term data, risk of abuse and potential adverse effects. However, benzodiazepines continue to be prescribed for long-term use in a significant number of patients. This study sought to evaluate benzodiazepine use in a large sample of MDD patients seen at a tertiary care clinic, and determine whether use is related to illness severity or complexity, as well as to identify the clinical predictors of benzodiazepine use. METHODS This was a naturalistic cross-sectional study conducted in MDD patients seen at the Mood Disorders Pyschopharmacology Unit at the University Health Network (N=326). Detailed information on current medication regimens was collected. A structured diagnostic interview, in addition to measures of symptom severity, quality of life, and personality were administered. Participants were grouped according to the presence or absence of prescribed benzodiazepines for daily use. RESULTS The prevalence of regular benzodiazepine use was 25%. Benzodiazepine users were more likely to be female, unemployed, have a history of child abuse, and have comorbid panic disorder. Depression and anxiety scores were not significantly different between groups, although anhedonia was greater in the benzodiazepine group. A logistic regression revealed anhedonia was the strongest predictor of regular benzodiazepine use. CONCLUSION The groups were similar in clinical profile suggesting benzodiazepine use is not necessarily linked to greater illness complexity or severity. Benzodiazepine use appears to be associated with specific diagnostic and symptom characteristics, possibly providing insight into the potential pharmacodynamic and neurobiological effects of frequent use.
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Affiliation(s)
- Sakina J Rizvi
- Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Psychiatry, University Health Network, Toronto, Ontario, Canada.
| | - Beth A Sproule
- Department of Pharmacy, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Laura Gallaugher
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - Roger S McIntyre
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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90
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Rizvi SJ, Quilty LC, Sproule BA, Cyriac A, Michael Bagby R, Kennedy SH. Development and validation of the Dimensional Anhedonia Rating Scale (DARS) in a community sample and individuals with major depression. Psychiatry Res 2015; 229:109-19. [PMID: 26250147 DOI: 10.1016/j.psychres.2015.07.062] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/16/2015] [Accepted: 07/22/2015] [Indexed: 11/25/2022]
Abstract
Anhedonia, a core symptom of Major Depressive Disorder (MDD), is predictive of antidepressant non-response. In contrast to the definition of anhedonia as a "loss of pleasure", neuropsychological studies provide evidence for multiple facets of hedonic function. The aim of the current study was to develop and validate the Dimensional Anhedonia Rating Scale (DARS), a dynamic scale that measures desire, motivation, effort and consummatory pleasure across hedonic domains. Following item selection procedures and reliability testing using data from community participants (N=229) (Study 1), the 17-item scale was validated in an online study with community participants (N=150) (Study 2). The DARS was also validated in unipolar or bipolar depressed patients (n=52) and controls (n=50) (Study 3). Principal components analysis of the 17-item DARS revealed a 4-component structure mapping onto the domains of anhedonia: hobbies, food/drink, social activities, and sensory experience. Reliability of the DARS subscales was high across studies (Cronbach's α=0.75-0.92). The DARS also demonstrated good convergent and divergent validity. Hierarchical regression analysis revealed the DARS showed additional utility over the Snaith-Hamilton Pleasure Scale (SHAPS) in predicting reward function and distinguishing MDD subgroups. These studies provide support for the reliability and validity of the DARS.
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Affiliation(s)
- Sakina J Rizvi
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada; Departments of Pharmaceutical Sciences and Neuroscience, University of Toronto, Toronto, Ontario, Canada.
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Beth A Sproule
- Department of Clinical Pharmacy, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Anna Cyriac
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - R Michael Bagby
- Department of Psychiatry, University of Toronto, Ontario, Canada; Department of Psychology, University of Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada; Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada
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91
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Buttenschøn HN, Foldager L, Elfving B, Poulsen PHP, Uher R, Mors O. Neurotrophic factors in depression in response to treatment. J Affect Disord 2015; 183:287-94. [PMID: 26047306 DOI: 10.1016/j.jad.2015.05.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 05/11/2015] [Accepted: 05/11/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor A (VEGF) have been suggested to play a role in the pathophysiology of depression. The neurotrophic model of depression hypothesises that the serum level of e.g. BDNF is decreased during depression and increased in response to treatment. The aim of the present study was to investigate BDNF and VEGF as potential predictors of response to antidepressant treatment. METHODS We investigated the longitudinal associations between depression scores and serum levels of these neurotrophic factors during antidepressant treatment in 90 individuals with depression of at least moderate severity. Serum levels were measured at baseline and after 8 and 12 weeks of treatment with nortriptyline or escitalopram. RESULTS No baseline or longitudinal correlations between depression scores and serum levels of BDNF and VEGF were found, and the baseline serum levels did not predict the MADRS depression score after 12 weeks of treatment or the improvement in depression scores. Interestingly, we observed a significant baseline and longitudinal correlation between serum levels of BDNF and VEGF. The two classes of antidepressant treatment did not affect the results differently. LIMITATIONS Information on potential factors influencing the serum levels is missing. CONCLUSION Our results do not support the neurotrophic model of depression, since a significant decrease in serum BDNF and VEGF levels after 12 weeks of antidepressant treatment was observed. Our study encourages future studies with large sample sizes, more observations and a longer follow-up period.
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Affiliation(s)
- Henriette N Buttenschøn
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Skovagervej 2, 8240 Risskov, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark.
| | - Leslie Foldager
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Skovagervej 2, 8240 Risskov, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark; Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark; Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
| | - Betina Elfving
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Skovagervej 2, 8240 Risskov, Denmark
| | - Pia H P Poulsen
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Skovagervej 2, 8240 Risskov, Denmark
| | - Rudolf Uher
- Kings College London, England; Department of Psychiatry, Halifax, Canada
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark; Research Department P, Aarhus University Hospital, Risskov, Denmark
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92
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Vares EA, Salum GA, Spanemberg L, Caldieraro MA, Fleck MP. Depression Dimensions: Integrating Clinical Signs and Symptoms from the Perspectives of Clinicians and Patients. PLoS One 2015; 10:e0136037. [PMID: 26313556 PMCID: PMC4552383 DOI: 10.1371/journal.pone.0136037] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 07/30/2015] [Indexed: 11/19/2022] Open
Abstract
Background Several studies have recognized that depression is a multidimensional construct, although the scales that are currently available have been shown to be limited in terms of the ability to investigate the multidimensionality of depression. The objective of this study is to integrate information from instruments that measure depression from different perspectives–a self-report symptomatic scale, a clinician-rated scale, and a clinician-rated scale of depressive signs–in order to investigate the multiple dimensions underlying the depressive construct. Methods A sample of 399 patients from a mood disorders outpatient unit was investigated with the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HDRS), and the Core Assessment of Psychomotor Change (CORE). Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to investigate underlying dimensions of depression, including item level analysis with factor loadings and item thresholds. Results A solution of six depression dimensions has shown good-fit to the data, with no cross-loading items, and good interpretability. Item-level analysis revealed that the multidimensional depressive construct might be organized into a continuum of severity in the following ascending order: sexual, cognitive, insomnia, appetite, non-interactiveness/motor retardation, and agitation. Conclusion An integration of both signs and symptoms, as well as the perspectives of clinicians and patients, might be a good clinical and research alternative for the investigation of multidimensional issues within the depressive syndrome. As predicted by theoretical models of depression, the melancholic aspects of depression (non-interactiveness/motor retardation and agitation) lie at the severe end of the depressive continuum.
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Affiliation(s)
- Edgar Arrua Vares
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- * E-mail:
| | - Giovanni Abrahão Salum
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Spanemberg
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Department of Psychiatry, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marco Antônio Caldieraro
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcelo P. Fleck
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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93
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A new measure of fear of falling: psychometric properties of the fear of falling questionnaire revised (FFQ-R). Int Psychogeriatr 2015; 27:1121-33. [PMID: 25079081 PMCID: PMC4312554 DOI: 10.1017/s1041610214001434] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although fear of falling is prevalent among older adults recovering from hip fracture, current instruments are inadequate due to focus on specific situations and measurement of self-efficacy rather than fear. METHODS The authors revised and tested a form of the Fear of Falling Questionnaire with three groups of older adults: 405 recovering from hip fracture, 89 healthy community dwelling, and 42 with severe fear of falling. Test-retest reliability was evaluated in a subsample of 16 hip fracture patients. Internal consistency was compared across all groups. Construct validity was established through factor analysis, convergent validity with a measure of fall-related self-efficacy, and discriminant validity with measures of depression and affect. RESULTS A revised two-factor, six-item scale appears to have adequate psychometric properties. Scores were lower in the healthy comparison group relative to the hip fracture and fear of falling groups. Cronbach's α ranged from 0.72-0.83, with test-retest reliability of 0.82. Correlations with a measure of fall-related self-efficacy were moderate for the hip fracture group (0.42) and high with the healthy comparison (0.68) and fear of falling (0.70) groups. Correlations with depression and negative and positive affect were low to moderate. CONCLUSIONS The Fear of Falling Questionnaire - Revised shows promise as a self-report measure of fear of falling, and is one of the first to be tested in older adults recovering from hip fracture. Advantages are that it is global rather than situation-specific and measures fear rather than self-efficacy. Future research on this scale is recommended in other older adult samples for whom fear of falling is relevant.
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94
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Revicki DA, Kleinman L, Cella D. A history of health-related quality of life outcomes in psychiatry. DIALOGUES IN CLINICAL NEUROSCIENCE 2015. [PMID: 25152652 PMCID: PMC4140507 DOI: 10.31887/dcns.2014.16.2/drevicki] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Health-related quality of life (HRQoL) is a multidimensional concept that includes subjective reports of symptoms, side effects, functioning in multiple life domains, and general perceptions of life satisfaction and quality. Rather than estimating it from external observations, interview, or clinical assessment, it is best measured by direct query. Due to a perception that respondents may not be reliable or credible, there has been some reluctance to use self-report outcomes in psychiatry. More recently, and increasingly, HRQoL assessment through direct patient query has become common when evaluating a range of psychiatric, psychological, and social therapies. With few exceptions, psychiatric patients are credible and reliable reporters of this information. This article summarizes studies that highlight the development, validation, and application of HRQoL measures in psychiatry. Thoughtful application of these tools in psychiatric research can provide a much-needed patient perspective in the future of comparative effectiveness research, patient-centered outcomes research, and clinical care.
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Affiliation(s)
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
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95
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Fried EI, Nesse RM. Depression sum-scores don't add up: why analyzing specific depression symptoms is essential. BMC Med 2015; 13:72. [PMID: 25879936 PMCID: PMC4386095 DOI: 10.1186/s12916-015-0325-4] [Citation(s) in RCA: 471] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/13/2015] [Indexed: 02/06/2023] Open
Abstract
Most measures of depression severity are based on the number of reported symptoms, and threshold scores are often used to classify individuals as healthy or depressed. This method--and research results based on it--are valid if depression is a single condition, and all symptoms are equally good severity indicators. Here, we review a host of studies documenting that specific depressive symptoms like sad mood, insomnia, concentration problems, and suicidal ideation are distinct phenomena that differ from each other in important dimensions such as underlying biology, impact on impairment, and risk factors. Furthermore, specific life events predict increases in particular depression symptoms, and there is evidence for direct causal links among symptoms. We suggest that the pervasive use of sum-scores to estimate depression severity has obfuscated crucial insights and contributed to the lack of progress in key research areas such as identifying biomarkers and more efficacious antidepressants. The analysis of individual symptoms and their causal associations offers a way forward. We offer specific suggestions with practical implications for future research.
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Affiliation(s)
- Eiko I Fried
- University of Leuven, Faculty of Psychology and Educational Sciences, Research Group of Quantitative Psychology and Individual Differences, Tiensestraat 102, 3000, Leuven, Belgium.
| | - Randolph M Nesse
- School of Life Sciences, Arizona State University, Room 351 Life Sciences Building A, Tempe, AZ, 85287-450, USA.
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Akashi H, Tsujii N, Mikawa W, Adachi T, Kirime E, Shirakawa O. Prefrontal cortex activation is associated with a discrepancy between self- and observer-rated depression severities of major depressive disorder: a multichannel near-infrared spectroscopy study. J Affect Disord 2015; 174:165-72. [PMID: 25497474 DOI: 10.1016/j.jad.2014.11.020] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 11/13/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Studies on major depressive disorder (MDD) show that the degree of correlation between the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HAMD) varies widely. We aimed to determine whether this discrepancy reflects specific functional abnormalities in the frontotemporal cortex. METHODS Mildly depressed or euthymic patients with MDD (n=52), including 21 patients with MDD with the discrepancy, i.e., those with low HAMD17 scores (≤13) but high BDI-II scores (>28), and 31 patients without the discrepancy, i.e., those with low HAMD17 scores and low BDI-II scores (≤28), participated in the study along with 48 control subjects. Regional changes of oxygenated hemoglobin (oxy-Hb) levels during a verbal fluency task (VFT) were monitored using a 52-channel near-infrared spectroscopy (NIRS) device. RESULTS In the frontotemporal regions, mean oxy-Hb changes induced by the VFT were significantly smaller in patients with MDD than in control subjects. In 5 channels within frontal regions, the increase in mean oxy-Hb levels was significantly greater in MDD patients with the BDI-HAMD discrepancy than in those without the discrepancy. In 6 channels within the frontal region of the patients with MDD, significant positive correlations were observed between mean oxy-Hb changes and BDI total scores (ρ=0.38-0.59; P<0.05, false discovery rate corrected). LIMITATIONS Our findings required replication in severely depressed patients, particularly those with melancholia. CONCLUSIONS The distinct pattern of activation of the prefrontal cortex suggests that MDD with the BDI-HAMD discrepancy is pathophysiologically different from MDD without the discrepancy.
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Affiliation(s)
- Hiroyuki Akashi
- Department of Neuropsychiatry, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan
| | - Noa Tsujii
- Department of Neuropsychiatry, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan.
| | - Wakako Mikawa
- Department of Neuropsychiatry, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan
| | - Toru Adachi
- Department of Neuropsychiatry, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan
| | - Eiji Kirime
- Department of Neuropsychiatry, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan
| | - Osamu Shirakawa
- Department of Neuropsychiatry, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan
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Möller HJ, Bandelow B, Bauer M, Hampel H, Herpertz SC, Soyka M, Barnikol UB, Lista S, Severus E, Maier W. DSM-5 reviewed from different angles: goal attainment, rationality, use of evidence, consequences--part 1: general aspects and paradigmatic discussion of depressive disorders. Eur Arch Psychiatry Clin Neurosci 2015; 265:5-18. [PMID: 25119146 DOI: 10.1007/s00406-014-0520-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/01/2014] [Indexed: 01/01/2023]
Abstract
DSM-5 was published in 2013 after about 10 years of preparation. Part 1 of this paper discusses several more general aspects of DSM-5 and offers a detailed, paradigmatic analysis of changes made to the chapter on depressive disorders. The background for the changes is analysed on the basis of a PubMed search and review papers on the classification of mental disorders in general and on empirical knowledge about individual disorders. Contrary to the original plans, DSM-5 has not introduced a primarily dimensional diagnostic system but has widely preserved the categorical system of disorders. Also, it has not adopted a more neurobiological approach to disorders by including biological markers to increase the objectivity of psychiatric diagnoses but has maintained the primarily symptom-based, descriptive approach. The criteria for some disorders have been changed, including affective, schizophrenic and addiction disorders, and a few new disorders have been added. A minimal version of the dimensional approach was realised through the introduction of several transnosological specifiers and the option to make symptom- or syndrome-related severity and dimensional assessments. These specifiers and assessments might allow a more individualised description of a patient's psychopathological state and more personalised treatment. However, most of the symptom- and syndrome-related assessments are not mandatory and therefore may not be used in clinical practice.
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Affiliation(s)
- Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany,
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98
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Helgadóttir B, Forsell Y, Ekblom Ö. Physical activity patterns of people affected by depressive and anxiety disorders as measured by accelerometers: a cross-sectional study. PLoS One 2015; 10:e0115894. [PMID: 25585123 PMCID: PMC4293141 DOI: 10.1371/journal.pone.0115894] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 11/09/2014] [Indexed: 12/21/2022] Open
Abstract
Background Exercise can relieve both depressive and anxiety disorders and it is therefore of importance to establish movement patterns of mildly to moderately affected sufferers to estimate the treatment potential. The aim is to describe the physical activity patterns of people affected by mild to moderate depressive and/or anxiety symptoms using objective measures of physical activity. Methods The design of the study was cross-sectional using data from 165 people aged 18–65 years, with mild to moderate depressive and/or anxiety disorder symptoms (scoring ≥10 on the PHQ-9). Diagnoses were made using Mini International Neuropsychiatric Interview (MINI) and symptom severity was measured with the Montgomery-Åsberg Depression Rating Scale (MADRS). The participants wore accelerometers for a week to evaluate physical activity patterns. Results No statistically significant differences were detected between different diagnoses, though depressed participants tended to be less active and more sedentary. Only one-fifth of the sample followed public health guidelines regarding physical activity. Each one point increase in MADRS was associated with a 2.4 minute reduction in light physical activity, independent of moderate-to-vigorous physical activity and sedentary time. MADRS was positively associated with number of sedentary bouts. Conclusions The physical activity pattern of people with depressive and/or anxiety disorders was characterized by large amounts of sedentary time and low fulfillment of physical activity guidelines. There is therefore a large treatment potential for this group by increasing exercise. The results suggest that instead of focusing exclusively on high intensity exercise for treating depressive and anxiety disorders, health care providers might encourage patients to reduce sedentary time by increasing light physical activity and decreasing the number of sedentary bouts, though further studies are needed that can determine directionality.
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Affiliation(s)
- Björg Helgadóttir
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Yvonne Forsell
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Örjan Ekblom
- The Åstrand Laboratory of Work Physiology, the Swedish School of Sport and Health Sciences, Stockholm, Sweden
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99
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Louise S, Gurvich C, Neill E, Tan EJ, Van Rheenen TE, Rossell S. Schizotypal Traits are Associated with Poorer Executive Functioning in Healthy Adults. Front Psychiatry 2015; 6:79. [PMID: 26082726 PMCID: PMC4450583 DOI: 10.3389/fpsyt.2015.00079] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/13/2015] [Indexed: 11/13/2022] Open
Abstract
Previous research has shown mild forms of the neurocognitive impairments seen in schizophrenia among healthy individuals exhibiting high schizotypal traits. This study aimed to explore associations between schizotypy and cognitive performance in an adult community sample. Ninety-five females and 79 males completed the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE), which measures four separable aspects of schizotypy: cognitive disorganization, unusual experiences, introvertive anhedonia, and impulsive non-conformity. Subsequently, participants were administered a neurocognitive battery incorporating measures of executive skills including inhibition, cognitive flexibility, reasoning, and problem solving along with measures of attention and processing speed and both verbal and spatial working memory. In line with predictions, the current study found that higher scores on the subscales of unusual experiences, cognitive disorganization, and impulsive non-conformity related to worse performance on a measure of inhibition. Additionally, as introvertive anhedonia increased, both attention and processing speed and reasoning and problem-solving performance became more impaired. In conclusion, this study extends schizotypy literature by examining the subscales of the O-LIFE, and enables inferences to be drawn in relation to cognitive impairment in schizophrenia.
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Affiliation(s)
- Stephanie Louise
- Monash Alfred Psychiatry Research Centre (MAPrc), Alfred Hospital, Central Clinical School, Monash University , Melbourne, VIC , Australia ; Faculty of Health, Arts and Design, Brain and Psychological Sciences Research Centre, Swinburne University of Technology , Melbourne, VIC , Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre (MAPrc), Alfred Hospital, Central Clinical School, Monash University , Melbourne, VIC , Australia
| | - Erica Neill
- Monash Alfred Psychiatry Research Centre (MAPrc), Alfred Hospital, Central Clinical School, Monash University , Melbourne, VIC , Australia ; Faculty of Health, Arts and Design, Brain and Psychological Sciences Research Centre, Swinburne University of Technology , Melbourne, VIC , Australia
| | - Eric J Tan
- Monash Alfred Psychiatry Research Centre (MAPrc), Alfred Hospital, Central Clinical School, Monash University , Melbourne, VIC , Australia ; Faculty of Health, Arts and Design, Brain and Psychological Sciences Research Centre, Swinburne University of Technology , Melbourne, VIC , Australia
| | - Tamsyn E Van Rheenen
- Monash Alfred Psychiatry Research Centre (MAPrc), Alfred Hospital, Central Clinical School, Monash University , Melbourne, VIC , Australia
| | - Susan Rossell
- Monash Alfred Psychiatry Research Centre (MAPrc), Alfred Hospital, Central Clinical School, Monash University , Melbourne, VIC , Australia ; Faculty of Health, Arts and Design, Brain and Psychological Sciences Research Centre, Swinburne University of Technology , Melbourne, VIC , Australia
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100
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Comparison of physician-rating and self-rating scales for patients with major depressive disorder. J Clin Psychopharmacol 2014; 34:716-21. [PMID: 25310200 DOI: 10.1097/jcp.0000000000000229] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Physician-rating scales remain the standard in antidepressant clinical trials. The current study aimed to examine the discrepancies between physician-rating scales and self-rating scales for symptoms and functioning, before and after treatment, in newly hospitalized patients. A total of 131 acutely ill inpatients with major depressive disorder were enrolled to receive 20 mg of fluoxetine daily for 6 weeks. Symptom severity and functioning were assessed at baseline and again at week 6. Symptom severity was rated using the 17-item Hamilton Depression Rating Scale (HDRS-17) and the Zung Self-rating Depression Scale (ZDS). Functioning was measured by the Global Assessment of Functioning (GAF) and the Work and Social Adjustment Scale (WSAS). Pearson correlation coefficients (r) between HDRS-17 and ZDS and between GAF and WSAS were calculated at week 0 and week 6. Sensitivity to change was measured using effect sizes. One-hundred twelve patients completed the 6-week trial. After 6 weeks of treatment, correlations between HDRS-17 and ZDS or correlations between GAF and WSAS became larger from baseline to end point. All correlations were statistically significant (P < 0.001). Effect sizes measured by physician-rating scales (ie, HDRS-17 and GAF) were larger than by self-rating scales (ie, ZDS and WSAS). Correlations between baseline physician-rating scale scores and self-rating scale scores improved after 6 weeks of treatment. Physician-rating scales had larger effect sizes than self-rating scales. Physician-rating scales were more sensitive in detecting symptom or functional changes than self-rating scales.
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