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Maggi G, D'Iorio A, Aiello EN, Poletti B, Ticozzi N, Silani V, Amboni M, Vitale C, Santangelo G. Psychometrics and diagnostics of the Italian version of the Beck Depression Inventory-II (BDI-II) in Parkinson's disease. Neurol Sci 2023; 44:1607-1612. [PMID: 36653542 PMCID: PMC10102079 DOI: 10.1007/s10072-023-06619-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Depression is one of the most disabling neuropsychiatric manifestations of Parkinson's disease (PD) and requires proper screening and diagnosis because it affects the overall prognosis and quality of life of patients. This study aimed to assess the psychometric and diagnostic properties of the Beck Depression Inventory-II (BDI-II) in an Italian PD cohort. MATERIALS AND METHODS Fifty consecutive outpatients with PD underwent the Italian version of the BDI-II and other questionnaires to evaluate anxiety and apathetic symptoms. Patients' caregivers completed the depression/dysphoria domain of the Neuropsychiatric Inventory (NPI-D). We evaluated the internal consistency, convergent and divergent validity, and factorial structure of BDI-II. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios were computed using ROC analyses, and an optimal cutoff was defined using the Youden index. RESULTS The BDI-II proved to be internally consistent (Cronbach's α = 0.840) and substantially met the bi-factorial structure. Regarding construct validity, the BDI-II was substantially related to anxiety measures, but not to apathy. With the combination of the NPI-D and anxiety score used as the gold standard, the BDI-II overall showed good accuracy (AUC = 0.859) with adequate sensitivity (75%) and specificity (87%). The optimal cutoff point was defined at 14.50. CONCLUSIONS We provide evidence of the psychometric and diagnostic properties of the Italian version of the BDI-II as a screening tool for depression in patients with PD. The BDI-II was found to be reliable and valid for the measurement of depression in patients with PD; therefore, it is available for use in clinical research and practice.
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Affiliation(s)
- Gianpaolo Maggi
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Alfonsina D'Iorio
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Edoardo Nicolò Aiello
- Department of Neurology and Laboratory of Neuroscience, IRCCS, Istituto Auxologico Italiano, Milano, Italy.,PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS, Istituto Auxologico Italiano, Milano, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS, Istituto Auxologico Italiano, Milano, Italy.,Department of Pathophysiology and Transplantation, "Dino Ferrari Center", Università degli Studi di Milano, Milano, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS, Istituto Auxologico Italiano, Milano, Italy.,Department of Pathophysiology and Transplantation, "Dino Ferrari Center", Università degli Studi di Milano, Milano, Italy
| | - Marianna Amboni
- Institute of Diagnosis and Health, IDC-Hermitage Capodimonte, Naples, Italy.,Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Carmine Vitale
- Institute of Diagnosis and Health, IDC-Hermitage Capodimonte, Naples, Italy.,Department of Motor Sciences and Wellness, University "Parthenope", Naples, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
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Guo Y, Zhang L, Zhang J, Lv SX, Du CX, Wang T, Wang HS, Xie W, Liu J. Activation and Blockade of Serotonin-4 Receptors in the Lateral Habenula Produce Antidepressant Effects in the Hemiparkinsonian Rat. Neuropsychobiology 2021; 80:52-63. [PMID: 32663830 DOI: 10.1159/000508680] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/05/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The 5-hydroxytryptamine (5-HT) neurotransmitter system and lateral habenula (LHb) are involved in the regulation of depression, while the mechanisms remain to be clarified. OBJECTIVES The effects and possible mecha-nism underlying activation or blockade of 5-HT4 receptors (5-HT4Rs) in the LHb in depression were investigated by behavioral and neurochemical methods based on a Parkinson's disease (PD) rat model. METHOD 6-Hydroxydopamine (6-OHDA) was injected unilaterally into the substantia nigra pars compacta to establish the PD rat model. The depressive-like behaviors were measured by the forced swimming test (FST) and sucrose preference test (SPT). The concentrations of dopamine (DA), noradrenaline (NA) and 5-HT in the related brain regions were measured by a neurochemical method. RESULTS The 6-OHDA lesions increased the immobility time in the FST and decreased the sucrose consumption in the SPT, suggesting the induction of depressive-like behaviors. Intra-LHb injection of BIMU-8 (5-HT4R agonist) or GR113808 (5-HT4R antagonist) produced antidepressant effects in the lesioned rats. Intra-LHb injection of BIMU-8 significantly increased the DA levels in the medial prefrontal cortex (mPFC) and ventral hippocampus (vHip), increased the 5-HT level in the mPFC and decreased the NA level in the vHip only in the lesioned rats, while intra-LHb injection of GR113808 changed DA, NA and 5-HT levels in the mPFC, LHb and vHip in both sham and the lesioned rats. CONCLUSIONS All these results suggest that activation or blockade of the LHb 5-HT4Rs produce antidepressant effects in the 6-OHDA-lesioned rats, which are related to the changes of monoamines in the limbic and limbic-related regions.
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Affiliation(s)
- Yuan Guo
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Li Zhang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jin Zhang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Shu-Xuan Lv
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Cheng-Xue Du
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Tao Wang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Hui-Sheng Wang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Wen Xie
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jian Liu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China,
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Screening for depression in cancer patients using the PHQ-9: The accuracy of somatic compared to non-somatic items. J Affect Disord 2019; 254:74-81. [PMID: 31108283 DOI: 10.1016/j.jad.2019.05.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/25/2019] [Accepted: 05/12/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The PHQ-9 is a standard screening tool for depressive disorders in cancer patients. As for the frequently reported symptom overlap with somatic disease, it has been debated whether somatic items are suitable for identifying depressive disorders in cancer patients. Thus, this study examines the diagnostic accuracy of somatic versus cognitive-emotional PHQ-9 items. METHODS The routine data of 4,705 patients, screened at the National Center for Tumor Diseases in Heidelberg between 2011 and 2016, was analyzed. For the single PHQ-9 items, receiver operating characteristics (ROC), sensitivity, specificity, positive, and negative predictive values (PPV and NPV), the Youden Index (YI), and the Clinical Utility Index (UI+/UI-) were applied for the diagnoses of major depressive disorder (MDD) and any depressive disorder (ADD). RESULTS The non-somatic items played a pivotal role in the diagnosis of MDD, whereas the diagnostic accuracy of the somatic items increased in the diagnosis of ADD. For both MDD and ADD, the best performance was achieved by the non-somatic items "little interest" and "feeling down." LIMITATIONS In this study, only one self-reported instrument was used (i.e., the PHQ-9). In other words, the diagnoses were not validated by clinical interviews or other self-reported instruments. CONCLUSION The somatic PHQ-9 items showed less discriminatory value than the non-somatic items. However, they may be useful as screening mechanisms for identifying at-risk cancer patients with mild/moderate depression. Disregarding the somatic items would lead to an underestimation of depressive syndromes and inadequate treatment of somatic symptoms.
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Akhmadeeva GN, Magzhanov RV, Tayupova GN, Bajtimerov AR, Hidijatova IM. [Anxiety and depressive disorders in Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:54-58. [PMID: 28514334 DOI: 10.17116/jnevro20171171254-58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This review presents the most recent data of worldwide research on anxiety and depressive disorders in patients with Parkinson's disease. Their characteristics and epidemiology, pathogenetic and clinical features, methods of diagnosis and treatment are presented. Depression occurs in 40-50% of patients with PD, anxiety in 17-43% of patients. Pramipexole, a dopamine agonist, is only one drug recommended for depression treatment. Nortriptyline and desipramine, belonging to the group of tricyclic antidepressants (TCAs), are considered to be possibly effective. There are no clear recommendations for treatment of anxiety. In general, methods of therapy of anxiety and depressive disorders in PD are not well understood which determines the conduct of large-scale studies in the future.
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Affiliation(s)
- G N Akhmadeeva
- Kuvatova Rebublic Clinical Hospital, Ufa, Russia; Rebublic Consultative Diagnostic Centre of the Extrapyramidal Pathology and the botulinotherapy, Ufa, Russia; Institute of Biochemistry and Genetics of Ufa Science Centre, Ufa, Russia
| | - R V Magzhanov
- Bashkir State Medical University, Minzdrav, Ufa, Russia
| | - G N Tayupova
- Kuvatova Rebublic Clinical Hospital, Ufa, Russia; Rebublic Consultative Diagnostic Centre of the Extrapyramidal Pathology and the botulinotherapy, Ufa, Russia
| | - A R Bajtimerov
- Rebublic Consultative Diagnostic Centre of the Extrapyramidal Pathology and the botulinotherapy, Ufa, Russia
| | - I M Hidijatova
- Institute of Biochemistry and Genetics of Ufa Science Centre, Ufa, Russia
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Hanganu A, Bruneau MA, Degroot C, Bedetti C, Mejia-Constain B, Lafontaine AL, Chouinard S, Monchi O. Depressive symptoms in Parkinson's disease correlate with cortical atrophy over time. Brain Cogn 2016; 111:127-133. [PMID: 27918935 DOI: 10.1016/j.bandc.2016.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/25/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Depressive symptoms are very common in patients with Parkinson's disease (PD) and have a significant impact on the quality of life. METHODS The present study analyzed the correlations between over-time changes in depressive symptoms and gray matter parameters of cortical thickness and subcortical volumes in non-demented PD patients. RESULTS A significant correlation was observed, between increased scores for depression over time and lower cortical thickness over time in the right temporo-parietal junction, right occipital medial region, right dorsolateral prefrontal cortex, right posterior cingulate region, left middle temporal as well as left supplementary motor area. Furthermore, the presence of depressive symptoms at baseline predicted increased cortical thinning over time in the left middle temporal, left anterior cingulate, right posterior cingulate and right parahippocampal cortices. Finally, a statistically significant negative correlation has been revealed between the thalamus' volume changes over time and the change in depressive symptoms scores. All other analyzed subcortical structures didn't reveal any significant correlations. CONCLUSION These results suggest that depressive symptoms in PD patients are associated with gray matter cortical thinning and thalamus volume shrinkage over time and higher scores of depressive symptoms at baseline correlate with a higher rate of cortical thinning longitudinally. The present study highlights the importance of addressing depressive symptoms in PD patients early in the disease.
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Affiliation(s)
- Alexandru Hanganu
- Department of Clinical Neurosciences and Department of Radiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, AB, Canada; Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada.
| | - Marie-Andrée Bruneau
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada.
| | - Clotilde Degroot
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada; Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada.
| | - Christophe Bedetti
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré Cœur de Montréal, Montréal, QC, Canada.
| | - Béatriz Mejia-Constain
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada.
| | - Anne-Louise Lafontaine
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada; Movement Disorders Unit, McGill University Health Centre, Montréal, QC, Canada.
| | - Sylvain Chouinard
- Unité des troubles du mouvement André Barbeau, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
| | - Oury Monchi
- Department of Clinical Neurosciences and Department of Radiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, AB, Canada; Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada; Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada.
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Borgonovo J, Allende-Castro C, Laliena A, Guerrero N, Silva H, Concha ML. Changes in neural circuitry associated with depression at pre-clinical, pre-motor and early motor phases of Parkinson's disease. Parkinsonism Relat Disord 2016; 35:17-24. [PMID: 27889469 DOI: 10.1016/j.parkreldis.2016.11.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/08/2016] [Accepted: 11/18/2016] [Indexed: 12/17/2022]
Abstract
Although Parkinson's Disease (PD) is mostly considered a motor disorder, it can present at early stages as a non-motor pathology. Among the non-motor clinical manifestations, depression shows a high prevalence and can be one of the first clinical signs to appear, even a decade before the onset of motor symptoms. Here, we review the evidence of early dysfunction in neural circuitry associated with depression in the context of PD, focusing on pre-clinical, pre-motor and early motor phases of the disease. In the pre-clinical phase, structural and functional changes in the substantia nigra, basal ganglia and limbic structures are already observed. Some of these changes are linked to motor compensation mechanisms while others correspond to pathological processes common to PD and depression and thus could underlie the appearance of depressive symptoms during the pre-motor phase. Studies of the early motor phase (less than five years post diagnosis) reveal an association between the extent of damage in different monoaminergic systems and the appearance of emotional disorders. We propose that the limbic loop of the basal ganglia and the lateral habenula play key roles in the early genesis of depression in PD. Alterations in the neural circuitry linked with emotional control might be sensitive markers of the ongoing neurodegenerative process and thus may serve to facilitate an early diagnosis of this disease. To take advantage of this, we need to improve the clinical criteria and develop biomarkers to identify depression, which could be used to determine individuals at risk to develop PD.
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Affiliation(s)
- Janina Borgonovo
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile; Center for Geroscience, Brain Health and Metabolism, Santiago, Chile
| | - Camilo Allende-Castro
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile; Center for Geroscience, Brain Health and Metabolism, Santiago, Chile
| | - Almudena Laliena
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile
| | - Néstor Guerrero
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile
| | - Hernán Silva
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile
| | - Miguel L Concha
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile; Center for Geroscience, Brain Health and Metabolism, Santiago, Chile.
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Hanganu A, Degroot C, Monchi O, Bedetti C, Mejia-Constain B, Lafontaine AL, Chouinard S, Bruneau MA. Influence of depressive symptoms on dopaminergic treatment of Parkinson's disease. Front Neurol 2014; 5:188. [PMID: 25309508 PMCID: PMC4174860 DOI: 10.3389/fneur.2014.00188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/10/2014] [Indexed: 01/04/2023] Open
Abstract
Introduction: Depressive symptoms are very common in patients with Parkinson’s disease (PD) and have a significant impact on the quality of life. Dopaminergic medication has been shown to have an influence on the development of depressive symptoms. Materials and methods: The present study analyzed two groups of non-demented patients with PD, with and without depressive symptoms, and reported the correlations between antiparkinsonian medication [specifically levodopa (l-DOPA) and dopaminergic agonists] with depressive symptoms. Results: A strong statistically significant positive correlation between l-DOPA dosages and the level of depressive symptoms has been revealed, suggesting that higher l-DOPA dosages correlate with a worsening of depressive status. No significant correlation was found with dopamine agonists. Discussion: The results of this study show that in patients with PD, higher l-DOPA dosages correlate with worse depressive symptoms. From this point of view, PD patients need to be better diagnosed with respect to depressive symptoms and need additional treatment adjustment when clinical manifestations of depression are present. Clinicians must be aware that dopaminergic drugs are not sufficient to alleviate depressive symptoms.
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Affiliation(s)
- Alexandru Hanganu
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal , Montreal, QC , Canada
| | - Clotilde Degroot
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal , Montreal, QC , Canada
| | - Oury Monchi
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal , Montreal, QC , Canada ; Department of Radiology, Faculty of Medicine, University of Montreal , Montreal, QC , Canada
| | - Christophe Bedetti
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré Coeur de Montréal , Montreal, QC , Canada
| | - Béatriz Mejia-Constain
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal , Montreal, QC , Canada
| | - Anne-Louise Lafontaine
- Movement Disorders Unit, McGill University Health Center , Montreal, QC , Canada ; Department of Neurology, Montreal Neurological Hospital , Montreal, QC , Canada
| | - Sylvain Chouinard
- Unité des troubles du mouvement André Barbeau, Centre Hospitalier de l'Université de Montréal , Montreal, QC , Canada
| | - Marie-Andrée Bruneau
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal , Montreal, QC , Canada
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Assogna F, Fagioli S, Cravello L, Meco G, Pierantozzi M, Stefani A, Imperiale F, Caltagirone C, Pontieri FE, Spalletta G. Depressive symptoms in Parkinson's disease and in non-neurological medical illnesses. Neuropsychiatr Dis Treat 2013; 9:389-96. [PMID: 23569379 PMCID: PMC3615851 DOI: 10.2147/ndt.s40013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with neurological and non-neurological medical illnesses very often complain of depressive symptoms that are associated with cognitive and functional impairments. We compared the profile of depressive symptoms in Parkinson's disease (PD) patients with that of control subjects (CS) suffering from non-neurological medical illnesses. METHODS One-hundred PD patients and 100 CS were submitted to a structured clinical interview for identification of major depressive disorder (MDD) and minor depressive disorder (MIND), according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR), criteria. The Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI) were also administered to measure depression severity. RESULTS When considering the whole groups, there were no differences in depressive symptom frequency between PD and CS apart from worthlessness/guilt, and changes in appetite reduced rates in PD. Further, total scores and psychic and somatic subscores of HDRS and BDI did not differ between PD and CS. After we separated PD and CS in those with MDD, MIND, and no depression (NODEP), comparing total scores and psychic/somatic subscores of HDRS and BDI, we found increased total depression severity in NODEP PD and reduced severity of the psychic symptoms of depression in MDD PD, with no differences in MIND. However, the severity of individual symptom frequency of depression was not different between PD and CS in MDD, MIND, and NODEP groups. CONCLUSION Although MDD and MIND phenomenology in PD may be very similar to that of CS with non-neurological medical illnesses, neurological symptoms of PD may worsen (or confound) depression severity in patients with no formal/structured DSM-IV-TR, diagnosis of depressive mood disorders. Thus, a thorough assessment of depression in PD should take into consideration the different impacts of neurological manifestations on MDD, MIND, and NODEP.
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Abstract
Depression is a clinically heterogeneous disorder common in Parkinson disease (PD). The goal of this study was to characterize PD depression in terms of components, including negative affect, apathy, and anhedonia. Ninety-five, nondemented individuals with idiopathic PD underwent a diagnostic interview and psychological battery. Twenty-seven patients (28%) met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition [DSM-IV]) criteria for a current depressive episode. The best-fitting confirmatory factor analysis model had 3 factors (negative affect, apathy, and anhedonia). Apathy loaded most strongly onto a second-order factor representing global psychological disturbance. All factors are uniquely associated with depression status. Negative affect exhibited the strongest relationship. Psychological disturbance in PD is heterogeneous and can produce symptoms of apathy, anhedonia, and negative affect. Apathy appears to be the core neuropsychiatric feature of PD, whereas negative affect (eg, dysphoria) seems to be most pathognomonic of depression. Future studies should examine the specific neural correlates and treatment response patterns unique to these 3 components.
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Affiliation(s)
- Laura B. Zahodne
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Michael S. Okun
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
,Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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Dissanayaka NNW, Sellbach A, Silburn PA, O'Sullivan JD, Marsh R, Mellick GD. Factors associated with depression in Parkinson's disease. J Affect Disord 2011; 132:82-8. [PMID: 21356559 DOI: 10.1016/j.jad.2011.01.021] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 01/31/2011] [Accepted: 01/31/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Depression is common in Parkinson's disease (PD) and contributes significantly to a reduced quality of life in PD patients. The determinants of depression in PD are complex and poorly understood. We investigated the factors associated with depression in PD. METHODS PD patients were recruited from Neurology clinics. A validated method was used to screen for a lifetime history of depression. 'Depressed' patients were identified by a score of >6 in the Geriatric Depression Scale (GDS-15) or by having had prescribed treatment for depression. 'Never depressed' patients were recognised by a score of <5 in the GDS-15 with no signs of a history of depression. A newly developed and validated questionnaire was used to collect other information. RESULTS Depression was identified in 66% of the 639 PD patients who met the inclusion criteria. Depression was associated with an increased severity of illness as evidenced by higher Unified PD Rating Scale scores and a higher Hoehn and Yahr stage. Other clinical factors associated with disease severity were also more frequently observed in depressed patients. Similar to findings in non-PD samples, depressed PD patients were more likely to have a lower education level, a history of smoking and to regularly use non-aspirin based NSAIDs or analgesics. Comorbidities such as anxiety, memory problems, hallucinations, sleep disturbances and postural hypotension were more common in depressed PD patients. LIMITATIONS To avoid patient exhaustion of over-surveying, some factors within the psychological domain were not examined. CONCLUSION Our results provide a focus for future intervention strategies.
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Collins DM, Fitzgerald SG, Sachs-Ericsson N, Scherer M, Cooper RA, Boninger ML. Psychosocial well-being and community participation of service dog partners. Disabil Rehabil Assist Technol 2009; 1:41-8. [DOI: 10.1080/09638280500167183] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sertraline in the treatment of depressive disorders in patients with Parkinson's disease. Neurol Sci 2008; 29:391-5. [PMID: 19002650 DOI: 10.1007/s10072-008-1021-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 09/16/2008] [Indexed: 01/23/2023]
Abstract
We studied 54 idiopathic Parkinson's disease (PD) patients with depressive disorders (DD) to compare the efficacy and the effect of treatment with sertraline in the usual formulation and in the liquid oral concentrate (LOC) formulation. After 6 months of sertraline treatment, the Hamilton Depression Rating Scale and the Montgomery and Asberg Depression Rating Scale showed a decrement (p<0.001, for both formulations). Parkinson's Disease Questionnaire scores improved (p<0.005 for usual formulation and p<0.001 for LOC formulation), as did Clinical Global Impression-Severity of Illness scale and Clinical Global Impression-Global Improvement scale scores (p=0.1, for both formulations). Mini Mental State Examination and Unified Parkinson's Disease Rating Scale motor subscores did not change. These results suggest that sertraline LOC may also be a useful treatment for DD in PD patients, especially for those with swallowing problems, and have significant benefit for quality of life, without worsening of parkinsonian features.
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Abstract
The incidence of depressive mood among people with Parkinson's disease (PD) is well documented, yet less is known about the biopsychosocial correlates of this low mood state. In this study, 82 people with PD (M age = 68 years, SD = 9.4) completed questionnaires related to the duration of their illness, social support, coping, relationship satisfaction, and depression. The authors entered variables that correlated significantly with depressive mood into a multiple regression analysis, and the variables in the final model explained 64% of the variance in depressive mood. Gross motor impairment (beta = .45), blaming self (beta = .41), avoidance (beta = .33), symptom severity (beta = .21), and recreational intimacy (beta = -.14) were strong predictors of depressive mood. The authors discuss the findings in terms of interventions aimed at reducing the use of emotion-focused strategies, encouraging recreational intimacy among people with PD and their partners, and educational programs that provide information on PD symptoms, to promote positive mood and adjustment among people with PD.
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Paelecke-Habermann Y, Ebersbach G, Leplow B. Depressivität und Depression bei der Parkinson-Erkrankung. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2007. [DOI: 10.1024/1016-264x.18.3.207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Ein erheblicher Anteil an Patienten mit einer idiopathischen Parkinson-Erkrankung (PD) entwickelt im Verlauf eine sekundäre Depression. Die Prävalenzraten schwanken erheblich, da die Diagnosestellung aufgrund von Symptomüberschneidungen zwischen neurologischer Grunderkrankung und Major Depression (MD) erschwert ist. Dies führt zu Problemen bei der therapeutischen Indikationsstellung sowie zu einer eingeschränkten Interpretierbarkeit neuropsychologischer und neurophysiologischer Studien. Ein weiterer Aspekt bezieht sich auf Gemeinsamkeiten und Unterschiede zwischen sekundärer und primärer Depression. Entgegen dem klinischen Eindruck einer PD-spezifischen Depression erbrachten psychometrische Verfahren zur Depressionsdiagnostik diesbezüglich bisher nur unbefriedigende Ergebnisse. Ziele dieses Überblicksartikels: 1. Charakterisierung depressiver Syndrome bei der PD, 2. Überblick über den Forschungsstand zur Neuropathologie und Neuropsychologie, 3. Gegenüberstellung klinisch- und/oder neuropsychologischer Gemeinsamkeiten/Unterschiede zwischen sekundärer und primärer MD und 4. Konsequenzen für Forschung und Differenzialdiagnostik.
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Affiliation(s)
| | - Georg Ebersbach
- Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson Beelitz-Heilstätten
| | - Bernd Leplow
- Institut für Psychologie, Martin-Luther-Universität zu Halle-Wittenberg
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Ehrt U, Brønnick K, Leentjens AFG, Larsen JP, Aarsland D. Depressive symptom profile in Parkinson's disease: a comparison with depression in elderly patients without Parkinson's disease. Int J Geriatr Psychiatry 2006; 21:252-8. [PMID: 16477585 DOI: 10.1002/gps.1456] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Depression is a common neuropsychiatric syndrome in Parkinson's disease (PD), and may be etiologically related to the neurochemical changes accompanying this disease. It is still unclear whether the disturbances of neurotransmitter activities lead to a specific profile of depressive symptoms, that is characteristic for PD and differs from that in depressed patients without PD. METHOD We compared the individual depressive symptoms of 145 non-demented depressed patients with PD and 100 depressed patients without PD by comparing item scores on the Montgomery-Asberg Depression Rating Scale by way of MANCOVA. RESULTS The severity of depression and the level of cognitive functioning in depressed PD patients were comparable with that of depressed control subjects. However, patients with PD showed significant less reported sadness, less anhedonia, less feelings of guilt and, slightly less loss of energy, but more concentration problems than depressed control subjects. CONCLUSION The profile of depressive symptoms in PD differs from that in depressed subjects without PD. This finding is important for the conceptualisation and clinical diagnosis of depression in PD.
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Affiliation(s)
- Uwe Ehrt
- Section of Geriatric Psychiatry, Stavanger University Hospital, Norway
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Ondo WG, Fayle R, Atassi F, Jankovic J. Modafinil for daytime somnolence in Parkinson's disease: double blind, placebo controlled parallel trial. J Neurol Neurosurg Psychiatry 2005; 76:1636-9. [PMID: 16291885 PMCID: PMC1739456 DOI: 10.1136/jnnp.2005.065870] [Citation(s) in RCA: 202] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Excessive daytime somnolence (EDS) commonly complicates Parkinson's disease (PD). The aetiology of EDS is probably multifactorial but is probably exacerbated by dopaminergic medications. Modafinil is a wake-promoting agent approved for use in narcolepsy, but it is often used to treat a variety of somnolent conditions. METHOD A double blind, placebo controlled parallel design trial was conducted to assess the efficacy of modafinil (200-400 mg/day) for the treatment of EDS in PD. The primary efficacy measure was the Epworth Sleepiness (ES) scale score. Secondary efficacy points included the Unified Parkinson's Disease Rating Scale (UPDRS), the Fatigue Severity Scale, the Hamilton Depression Scale, and the multiple sleep latency test (MSLT). RESULTS Of a total of 40 subjects (29 men, mean (SD) age 64.8 (11.3) years), randomised to modafinil or placebo, 37 completed the study. Modafinil failed to significantly improve ES scores compared with placebo (2.7 v 1.5 points improvement, respectively, p = 0.28). MSLT failed to improve with modafinil relative to placebo (-0.16 v -0.70, respectively, p = 0.14). UPDRS, global impressions, Fatigue Severity Scale, and Hamilton Depression Scale scores were unchanged. Adverse events were minimal. CONCLUSION Modafinil failed to significantly improve EDS in PD compared with placebo. The drug did not alter motor symptoms in PD and was well tolerated.
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Affiliation(s)
- W G Ondo
- Baylor College of Medicine, Houston, TX 77030, USA.
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Cole K, Vaughan FL. The feasibility of using cognitive behaviour therapy for depression associated with Parkinson's disease: a literature review. Parkinsonism Relat Disord 2005; 11:269-76. [PMID: 15970452 DOI: 10.1016/j.parkreldis.2005.03.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Revised: 09/23/2004] [Accepted: 03/07/2005] [Indexed: 01/07/2023]
Abstract
Clinicians and researchers have called for more information on how to treat depression in Parkinson's disease. Cognitive Behaviour Therapy (CBT) has been identified as the treatment of choice for a range of psychological disorders and is increasingly applied to depression associated with chronic medical conditions. The present paper will review the relevant literature on CBT treatment effectiveness and the nature of depression in Parkinson's disease before suggesting how CBT might be adapted to assist this client group. The authors conclude that CBT is a promising option for depressed patients coping with Parkinson's disease, but further research is recommended.
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Affiliation(s)
- Kristina Cole
- Conwy and Denbighshire NHS Trust and University of Wales Bangor, Bangor, UK.
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Abstract
AIMS To discuss the current methodological and conceptual difficulties inherent in characterizing the emotional manifestations of neurodegenerative disease through critically reviewing depression as a manifestation of idiopathic Parkinson's disease (PD). METHODS Selective literature review of the neurobiological, psychological, and physical basis of depressive symptoms in PD from 1993-2003, with reference to key earlier articles. CONCLUSIONS There are difficulties in defining the syndromes of PD itself as well as depression in PD. The use of more conceptually reductionistic definitions of emotion and behavior in comprehensive longitudinal studies of the natural history of PD is recommended.
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Affiliation(s)
- Jeffrey C Looi
- Faculty of Medicine and Centre for Mental Health Research, Australian National University (ANU), Canberra, ACT, Australia.
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Brown RG, Dittner A, Findley L, Wessely SC. The Parkinson fatigue scale. Parkinsonism Relat Disord 2005; 11:49-55. [PMID: 15619463 DOI: 10.1016/j.parkreldis.2004.07.007] [Citation(s) in RCA: 217] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2004] [Revised: 07/08/2004] [Accepted: 07/27/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND In recent years several studies have highlighted the clinical significance of fatigue in Parkinson's disease. While we are becoming aware of its prevalence and impact on the lives of patient, little progress has been made in understanding its nature or aetiology, nor on finding ways to manage the problem clinically. One possible reason for the slow pace of progress is the lack of an appropriate instrument to measure fatigue in Parkinson's disease and related disorders. While assessment tools have been developed for assessing fatigue associated with other diseases, their use in patients with Parkinsonism can pose problems and their validity cannot be assumed. OBJECTIVES In an attempt to progress research and improve clinical management a new instrument is presented, the Parkinson Fatigue Scale. METHODS This 16-item self-report instrument (the PFS-16) arose from statements by individuals with Parkinsonism experiencing fatigue. Initially tested on a sample of almost 500 patients, and subsequently on an independent sample of over 100. RESULTS The PFS-16 scale was designed to tap a single construct encompassing the physical aspects fatigue and their impact on the patient's daily function. The scale deliberately excludes emotional and cognitive features that may occur as part of the fatigue experience but which may also occur independently in Parkinsonism. The scale has good intrinsic properties and satisfactory test-retest reliability. It shows reasonable associations with other measures of fatigue and is able to identify patients who self-report the presence of fatigue, and particularly those in whom fatigue is a problem. Cut-off scores are provided in both cases with good specificity and sensitivity. CONCLUSION While further evaluation is required, the scale is offered to facilitate clinical practice and future research. It is hoped that its use will enable the improved understanding and clinical management of this important problem.
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Affiliation(s)
- R G Brown
- Department of Psychology, PO77, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.
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Reuter K, Raugust S, Bengel J, Härter M. Depressive symptom patterns and their consequences for diagnosis of affective disorders in cancer patients. Support Care Cancer 2004; 12:864-70. [PMID: 15480816 DOI: 10.1007/s00520-004-0694-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2004] [Accepted: 08/17/2004] [Indexed: 11/30/2022]
Abstract
GOALS OF WORK In order to obtain references for adequate diagnostic procedures of depressive syndromes in cancer patients, the present study analyzes first the prevalence of somatic, emotional, and cognitive symptoms of depression. In a second part, the ability of diagnostic procedures to discriminate between patients with and without comorbid affective disorder is investigated. PATIENTS AND METHODS From a cross-sectional survey investigating comorbid mental disorders in cancer patients with standardized clinical assessment, a subsample of 71 patients with current affective disorders and depressive symptoms according to the Diagnostic and Statistic Manual of Mental Disorders, 4th edition (DSM-IV) were analyzed. In addition to patients' symptom patterns, a discriminant analysis including all depressive symptoms was conducted. MAIN RESULTS Cognitive symptoms are less prevalent in cancer patients than somatic and emotional symptoms. Loss of interest discriminated best between patients with and without diagnosis of comorbid affective disorder. Additionally, decreased energy and fatigue proved to have discriminatory value. CONCLUSIONS Cognitive symptoms should receive special attention in diagnostic procedures for affective disorders in cancer patients. In spite of possible symptom overlap with the cancer disease and its treatment, fatigue proves to be a useful criteria for diagnosis of depression.
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Affiliation(s)
- Katrin Reuter
- Department of Psychiatry and Psychotherapy, Freiburg University Medical Center, Hauptstrasse 5, 79104, Freiburg, Germany.
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Welsh M. Parkinson's disease and quality of life: issues and challenges beyond motor symptoms. Neurol Clin 2004; 22:S141-8. [PMID: 15501362 DOI: 10.1016/j.ncl.2004.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mickie Welsh
- Department of Neurology, University of Southern California, 1520 San Pablo, Suite 3000, Los Angeles, CA 90033, USA.
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