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Application Effect of Laparoscopic Myomectomy and Comprehensive Rehabilitation Nursing on Patients with Uterine Fibroids. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4018803. [PMID: 36238468 PMCID: PMC9553328 DOI: 10.1155/2022/4018803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/30/2022] [Indexed: 11/18/2022]
Abstract
Background. Uterine fibroids are most common in women aged 30-50 and are the most common benign gynecological tumors. Relevant data suggest that about 25% of patients with uterine fibroids are at childbearing age. Uterine fibroids not only cause the discomfort symptoms, and affect the pregnancy, but also have certain malignant transformation risk, thus needed to be treated positively and promptly. Aim. This study is aimed at exploring the effect of laparoscopic myomectomy and comprehensive rehabilitation nursing on patients with uterine fibroids. Methods. The clinical data of 110 cases of uterine fibroids admitted to our hospital from August 2019 to December 2021 were analyzed retrospectively, and they were divided into two groups according to postoperative rehabilitation strategies. Both groups were treated with laparoscopic myomectomy. The A group was treated with routine rehabilitation strategy, while the B group was treated with comprehensive rehabilitation nursing strategy. The differences in operation-related indicators, stress factors, inflammatory factors, nutritional indicators, knowledge mastery, occurrence of adverse symptoms and pain scores, negative emotion scores, nursing satisfaction, and simplified comfort status scale (GCQ) scores between the two groups under nursing strategies were compared. Results. The postoperative exhaust time (
) h, bed time (
) h, postoperative hospital stay (
) d, and total hospital stay (
) d in the B group were shorter than those in the A group, and the hospitalization expenses (
) million were less than those in the A group (
). Before operation, stress factors, inflammatory factors, and nutritional indexes were compared between the two groups (
). On the 3rd day after operation, tumor necrosis factor-α (TNF-α), cortisol (Cor), norepinephrine (NE), and interleukin-1β (IL-1β) in the two groups showed a significantly upward trend compared with those before operation, and albumin and transferrin were significantly fell compared with those before operation. However, the values of stress factor and inflammatory factor in the B group were significantly lower than those in the A group, and the values after the decrease of nutritional index were significantly higher than those in the A group (
). The pain scores at 24 h, 48 h, and 72 h after operation in the B group were significantly lower than those in the A group (
). Negative emotions, nursing satisfaction, and GCQ scores were compared between the two groups before intervention (
). After the intervention, the scores of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) in the two groups were significantly lower than those before the intervention, and the scores of nursing satisfaction and GCQ were higher than those before the intervention. The values of negative emotions in the B group after the decline were significantly lower than those in the A group, while the values of nursing satisfaction and GCQ after the increase were higher than those in the A group (
). The excellent and good rate of knowledge acquisition in the B group was 94.55% (52/55), which was significantly higher than 78.18% (43/55) in the A group (
). The incidence of adverse symptoms in the B group was 9.09% (5/55), which was lower than 21.82% (12/55) in the A group, while the difference was not statistically significant (
). Conclusion. Laparoscopic myomectomy combined with comprehensive rehabilitation nursing can reduce the postoperative stress state of patients with uterine fibroids, improve patient satisfaction, reduce adverse emotions, and promote rehabilitation.
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Heuschen CBBCM, Mocking RJT, Zantvoord JB, Figueroa CA, Schene AH, Denys DAJP, Ruhé HG, Bockting CLH, Lok A. Suicidal ideation in remitted major depressive disorder predicts recurrence. J Psychiatr Res 2022; 151:65-72. [PMID: 35461004 DOI: 10.1016/j.jpsychires.2022.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/21/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Each year almost 800.000 people die from suicide, of which up to 87% are affected by major depressive disorder (MDD). Despite the strong association between suicidality and MDD, it remains unknown if suicidal symptoms during remission put remitted recurrent MDD patients (rrMDD) at risk for recurrence. METHODS At baseline we compared sociodemographic characteristics and suicidal symptoms in un-medicated rrMDD participants to matched never-depressed controls. We used the HDRS17 and IDS-SR30 to assess suicidal symptoms and depressive symptomatology. Next, we studied the longitudinal association between baseline suicidal symptoms and time to recurrence(s) in rrMDD during a 2.5-year follow-up period using cox regression analyses. Further, we studied with longitudinal data whether suicidal symptoms and depressive symptomatology were cross-sectionally associated using mixed model analysis. RESULTS At baseline, rrMDD participants (N = 73) had higher self-reported suicidal symptoms than matched never-depressed controls (N = 45) (χ2 = 12.09 p < .002). Self-reported suicidal symptoms were almost four times higher (27.9% versus 6.9%) compared to clinician-rated suicidal symptoms in rrMDD at baseline. Self-reported baseline suicidal symptoms, but not clinician-rated symptoms, predicted earlier MDD-recurrence during follow-up, independent of other residual depressive symptoms (χ2 = 7.26, p < .026). Higher suicidal symptoms were longitudinally related to higher depressive symptoms (HDRS17; F = 49.87, p < .001), IDS-SR30; (F = 22.36, p < .001). CONCLUSION This study showed that self-reported - but not clinician-rated - suicidal symptoms persist during remission in rrMDD and predict recurrence, independent from residual symptoms. We recommend to monitor both suicidal and depressive symptomatology during remission in rrMDD, preferably also including self-reported questionnaires apart from clinician-rated. It would be beneficial for future research to assess suicidality using questionnaires primarily designed for measuring suicidal ideation.
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Affiliation(s)
- Caroline B B C M Heuschen
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands.
| | - Roel J T Mocking
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands
| | - Jasper B Zantvoord
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands
| | - Caroline A Figueroa
- School of Social Welfare, University of California, Berkeley, United States; University Medical Centre Utrecht, Heidelberglaan, 100 3584 CX, Utrecht
| | - Aart H Schene
- Dept. of Psychiatry, Radboudumc, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Damiaan A J P Denys
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands
| | - Henricus G Ruhé
- Dept. of Psychiatry, Radboudumc, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Claudi L H Bockting
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Public Health Institute, Amsterdam UMC, Amsterdam, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Anja Lok
- Amsterdam UMC, University of Amsterdam, Department of psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Public Health Institute, Amsterdam UMC, Amsterdam, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
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Giam A, Chen L, Lisa Hahn, Gill S, Clarke P, Ng F, Galletly C, Fitzgerald P. Comparing theta burst stimulation with standard left high frequency transcranial magnetic stimulation in the treatment of depression in a randomized controlled study: A preliminary comparison study. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Carrozzino D, Patierno C, Fava GA, Guidi J. The Hamilton Rating Scales for Depression: A Critical Review of Clinimetric Properties of Different Versions. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:133-150. [PMID: 32289809 DOI: 10.1159/000506879] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/27/2020] [Indexed: 11/19/2022]
Abstract
The format of the original Hamilton Rating Scale for Depression (HAM-D) was unstructured: only general instructions were provided for rating individual items. Over the years, a number of modified versions of the HAM-D have been proposed. They differ not only in the number of items, but also in modalities of administration. Structured versions, including item definitions, anchor points and semi-structured or structured interview questions, were developed. This comprehensive review was conducted to examine the clinimetric properties of the different versions of the HAM-D. The aim was to identify the HAM-D versions that best display the clinimetric properties of reliability, validity, and sensitivity to change. The search was conducted on MEDLINE, Scopus, Web of Science, and PubMed, and yielded a total of 35,473 citations, but only the most representative studies were included. The structured versions of the HAM-D were found to display the highest inter-rater and test-retest reliability. The Clinical Interview for Depression and the 6-item HAM-D showed the highest sensitivity in differentiating active treatment from placebo. The findings indicate that the HAM-D is a valid and sensitive clinimetric index, which should not be discarded in view of obsolete and not clinically relevant psychometric criteria. The HAM-D, however, requires an informed use: unstructured forms should be avoided and the type of HAM-D version that is selected should be specified in the registration of the study protocol and in the methods of the trial.
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Affiliation(s)
| | - Chiara Patierno
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy
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Costa FBPD, Trachtenberg E, Boni A, Primo de Carvalho Alves L, Magalhães PVDS, Rocha NS. Psychotic depression in hospitalized patients: Longitudinal outcomes of psychotic vs. nonpsychotic depression among inpatients. J Psychiatr Res 2020; 129:73-79. [PMID: 32615470 DOI: 10.1016/j.jpsychires.2020.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/25/2020] [Accepted: 06/01/2020] [Indexed: 12/23/2022]
Abstract
Even though psychotic depression is related to worse outcomes than nonpsychotic depression, there is increasing evidence that this greater severity is not solely explained by the depressive symptoms. We evaluated the socio-demographic and clinical characteristics, as well as the differences in clinical outcomes of psychiatric hospitalization between psychotic and non-psychotic depression. Two-hundred-eighty-eight depressive inpatients were assessed within 72 h after hospitalization and 24 h before discharge. We compared scores of Hamilton Depression Rating Scale 17-items (HDRS-17), Clinical Global Impression (CGI), Brief Psychiatric Rating Scale (BPRS), and Global Assessment of Functioning (GAF) between psychotic and nonpsychotic patients. Instruments were compared both cross-sectionally - on admission and discharge - and longitudinally. Longitudinal outcomes were corrected for potential confounders (sex, age, age at disease onset, years of study, previous history of mania/hypomania, electroconvulsive therapy in current hospitalization, history of attempted suicide, number of suicide attempts, and previous hospitalizations). One-hundred-thirty-one depressive inpatients (45.4%) presented psychotic features. Both groups showed similar HDRS-17 scores at admission and discharge. However, psychotic patients had worse scores on BPRS, CGI, and GAF at both timepoints. Both groups had similar improvement on HDRS-17 (P = 0.75), CGI (P = 0.5), and GAF (P = 0.84), but psychotic patients had greater improvement on BPRS (P < 0.001). Psychotic inpatients showed worse clinical and functional parameters. Nonetheless, the groups did not differ in depressive symptom severity. These findings reinforce the hypothesis that depressive episode with psychotic features is a more severe form of the disease irrespective of intensity of affective symptomatology.
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Affiliation(s)
- Felipe Bauer Pinto da Costa
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Innovations and Interventions for Quality of Life Research Group, Brazil.
| | - Eduardo Trachtenberg
- São Pedro Psychiatric Hospital, Porto Alegre, RS, Brazil; Mario Martins University Foundation, Department of Psychopharmacology, Porto Alegre, RS, Brazil
| | - Aline Boni
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Lucas Primo de Carvalho Alves
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Innovations and Interventions for Quality of Life Research Group, Brazil; Clinical Research Center of Hospital de Clínicas de Porto Alegre, Brazil; Experimental Research Center of Hospital de Clínicas de Porto Alegre, Brazil
| | - Pedro Vieira da Silva Magalhães
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; National Institute for Translational Medicine, Porto Alegre, RS, Brazil; Clinical Research Center of Hospital de Clínicas de Porto Alegre, Brazil; Experimental Research Center of Hospital de Clínicas de Porto Alegre, Brazil
| | - Neusa Sica Rocha
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Innovations and Interventions for Quality of Life Research Group, Brazil; Clinical Research Center of Hospital de Clínicas de Porto Alegre, Brazil; Experimental Research Center of Hospital de Clínicas de Porto Alegre, Brazil
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Agorastos A, Sommer A, Heinig A, Wiedemann K, Demiralay C. Vasopressin Surrogate Marker Copeptin as a Potential Novel Endocrine Biomarker for Antidepressant Treatment Response in Major Depression: A Pilot Study. Front Psychiatry 2020; 11:453. [PMID: 32508691 PMCID: PMC7251160 DOI: 10.3389/fpsyt.2020.00453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/05/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) constitutes the leading cause of disability worldwide. Although efficacious antidepressant pharmacotherapies exist for MDD, only about 40-60% of the patients respond to initial treatment. However, there is still a lack of robustly established and applicable biomarkers for antidepressant response in everyday clinical practice. OBJECTIVE This study targets the assessment of the vasopressin (AVP) surrogate marker Copeptin (CoP), as a potential peripheral hypothalamic-level biomarker of antidepressant treatment response in MDD. METHODS We measured baseline and dynamic levels of plasma CoP along with plasma ACTH and cortisol (CORT) in drug-naive outpatients with MDD before and after overnight manipulation of the hypothalamic-pituitary-adrenal (HPA) axis [i.e., stimulation (metyrapone) and suppression (dexamethasone)] on three consecutive days and their association with treatment response to 4 weeks of escitalopram treatment. RESULTS Our findings suggest significantly higher baseline and post-metyrapone plasma CoP levels in future non-responders, a statistically significant invert association between baseline CoP levels and probability of treatment response and a potential baseline plasma CoP cut-off level of above 2.9 pmol/L for future non-response screening. Baseline and dynamic plasma ACTH and CORT levels showed no association with treatment response. CONCLUSIONS This pilot study provide first evidence in humans that CoP may represent a novel, clinically easily applicable, endocrine biomarker of antidepressant response, based on a single-measurement, cut-off level. These findings, underline the role of the vasopressinergic system in the pathophysiology of MDD and may represent a significant new tool in the clinical and biological phenotyping of MDD enhancing individual-tailored therapies.
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Affiliation(s)
- Agorastos Agorastos
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry, Division of Neurosciences, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,VA Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA, United States
| | - Anne Sommer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Heinig
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Wiedemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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7
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Jiao K, Xu H, Teng C, Song X, Xiao C, Fox PT, Zhang N, Wang C, Zhong Y. Connectivity patterns of cognitive control network in first episode medication-naive depression and remitted depression. Behav Brain Res 2019; 379:112381. [PMID: 31770543 DOI: 10.1016/j.bbr.2019.112381] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/19/2019] [Accepted: 11/22/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cognitive dysfunctions, such as impaired cognitive control, are frequently observed in patients with major depressive disorder (MDD). Although the cognitive control network (CCN) is widely considered a core feature of major depressive disorder (MDD), the relationship between cognitive dysfunction and symptom dimensions remains unclear. This study investigated differences in resting-state functional connectivity of the cognitive control network (CCN) between first-episode medication-naive MDD patients and remitted MDD. METHODS We collected resting-state functional MRI (rs-fMRI) data from 22 first-episode medication-naive major depressive disorder (fMDD) patients, 20 patients previously diagnosed with MDD in the remitted phase of depression (rMDD), and 20 healthy controls (HC). The CCN was derived from fMRI images using independent component analysis (ICA), a data-driven image analysis method. RESULTS Changes in functional connectivity (FC) within the CCN was mainly attenuated in the right dorsolateral prefrontal cortex and the left inferior parietal lobule, while strengthened in the right dorsal anterior cingulate cortex and the right insula in both fMDD and rMDD groups. Compared with the fMDD group, the rMDD group had decreased FC in the bilateral insula and the right dorsolateral prefrontal cortex. Further analysis explored that the FC in the bilateral insula, the right dorsal anterior cingulate cortex and the right inferior parietal lobule were correlated positively cognitive disturbance factor scores in both patients groups. CONCLUSIONS These findings are in agreement with the previous findings that the cognitive control network are impaired in MDD. Furthermore, our results suggest that the alteration of CCN might underpin the cognitive disturbance and the distinct patterns of the CCN between fMDD and rMDD patients may be an important target for effective cognitive remediation in MDD.
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Affiliation(s)
- Kaili Jiao
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China; Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Huazhen Xu
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China; Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Changjun Teng
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China; Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiu Song
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China; Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chaoyong Xiao
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Peter T Fox
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China; South Texas Veterans Healthcare System, University of Texas Health Science Center at San Antonio, United States; Research Imaging Institute, University of Texas Health San Antonio, United States
| | - Ning Zhang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China; Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chun Wang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China; Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China; School of Psychology, Nanjing Normal University, Nanjing, China.
| | - Yuan Zhong
- School of Psychology, Nanjing Normal University, Nanjing, China; Jiangsu Key Laboratory of Mental Health and Cognitive Science, Nanjing Normal University, Nanjing, China.
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Qu L, Ge S, Li N, Wang W, Yang K, Wu P, Wang X, Shi J. Clinical evaluation of deep brain stimulation of nucleus accumbens/anterior limb of internal capsule for opioid relapse prevention: protocol of a multicentre, prospective and double-blinded study. BMJ Open 2019; 9:e023516. [PMID: 30765398 PMCID: PMC6398661 DOI: 10.1136/bmjopen-2018-023516] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Deep brain stimulation (DBS) is a new potential surgical treatment for opioid dependence. However, the implement of DBS treatment in addicted patients is currently controversial due to the significant associated risks. The aim of this study was mainly to investigate the therapeutic efficacy and safety of bilateral DBS of nucleus accumbens and the anterior limb of the internal capsule (NAc/ALIC-DBS) in patients with refractory opioid dependence (ROD). METHODS AND ANALYSIS 60 patients with ROD will be enrolled in this multicentre, prospective, double-blinded study, and will be followed up for 25 weeks (6 months) after surgery. Patients with ROD (semisynthetic opioids) who meet the criteria for NAc/ALIC-DBS surgery will be allocated to either the early stimulation group or the late stimulation group (control group) based on the randomised ID number. The primary outcome was defined as the abstinence rate at 25 weeks after DBS stimulation on, which will be confirmed by an opiate urine tests. The secondary outcomes include changes in the Visual Analogue Scale (VAS) score for craving for opioid drugs, body weight, as well as psychological evaluation measured using the 17-item Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Pittsburgh Sleep Quality Index, Fagerstrom test for nicotine dependence assessment, social disability screening schedule, the Activity of Daily Living Scale, the 36-item Short Form-Health Survey and safety profiles of both groups. ETHICS AND DISSEMINATION The study received ethical approval from the medical ethical committee of Tangdu Hospital, The Fourth Military Medical University, Xi'an, China. The results of this study will be published in a peer-reviewed journal and presented at international conferences. TRIAL REGISTRATION NUMBER NCT03424616; Pre-results.
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Affiliation(s)
- Liang Qu
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Shunnan Ge
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Nan Li
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Wei Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Kaijun Yang
- Department of Neurosurgery, Southern Hospital, Southern Medical University, Guangzhou, China
| | - Ping Wu
- National Institute on Drug Dependence, Peking University, Beijing, China
| | - Xuelian Wang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Jie Shi
- National Institute on Drug Dependence, Peking University, Beijing, China
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9
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de Beurs E, Vissers E, Schoevers R, Carlier IVE, van Hemert AM, Meesters Y. Comparative responsiveness of generic versus disorder-specific instruments for depression: An assessment in three longitudinal datasets. Depress Anxiety 2019; 36:93-102. [PMID: 30188602 PMCID: PMC6586043 DOI: 10.1002/da.22809] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/03/2018] [Accepted: 05/29/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Routine outcome monitoring (ROM) may enhance individual treatment and is also advocated as a means to compare the outcome of different treatment programs or providers. There is debate on the optimal instruments to be used for these separate tasks. METHODS Three sets with longitudinal data from ROM were analyzed with correlational analysis and repeated measures ANOVAs, allowing for a head-to-head comparison of measures regarding their sensitivity to detect change. The responsiveness of three disorder-specific instruments, the Beck Depression Inventory, the Inventory of Depressive Symptoms, and the Mood and Anxiety Symptoms Questionnaire, was compared to three generic instruments, the Symptom Checklist (SCL-90), the Outcome Questionnaire (OQ-45), and the Brief Symptom Inventory, respectively. RESULTS In two of the three datasets, disorder-specific measures were more responsive compared to the total score on generic instruments. Subscale scores for depression embedded within generic instruments are second best and almost match disorder-specific scales in responsiveness. No evidence of a desynchronous response on outcome measures was found. LIMITATIONS The present study compares measures head-to-had, and responsiveness is not assessed against an external criterion, such as clinical recovery. DISCUSSION Disorder-specific measures yield the most precise assessment for individual treatment and are recommended for clinical use. Generic measures may allow for comparisons across diagnostic groups and their embedded subscales approach the responsiveness of disorder-specific measures.
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Affiliation(s)
- Edwin de Beurs
- Faculty of Clinical PsychologyLeiden UniversityLeidenThe Netherlands
| | - Ellen Vissers
- Department of PsychiatryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Robert Schoevers
- Department of PsychiatryUniversity Medical Center GroningenGroningenThe Netherlands
| | | | | | - Ybe Meesters
- Department of PsychiatryUniversity Medical Center GroningenGroningenThe Netherlands
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10
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Vartolomei L, Shariat SF, Vartolomei MD. Psychotherapeutic Interventions Targeting Prostate Cancer Patients: A Systematic Review of the Literature. Eur Urol Oncol 2018; 1:283-291. [PMID: 31100249 DOI: 10.1016/j.euo.2018.04.011] [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: 01/11/2018] [Revised: 02/28/2018] [Accepted: 04/17/2018] [Indexed: 11/15/2022]
Abstract
CONTEXT Psychological counseling is a rarely discussed need for patients diagnosed with prostate cancer (PCa). OBJECTIVE To systematically review studies that investigated the effectiveness and feasibility of professional psychotherapeutic support for PCa patients. EVIDENCE ACQUISITION A systematic search was carried out using electronic databases, including PubMed, Web of Science, PsycInfo, and the Cochrane library. The search was performed up to September 1, 2017; only articles published in English were considered. The combination of the search words "prostate cancer" with "psychotherapy" was used. Inclusion criteria were: (1) studies with psychotherapy interventions that included PCa patients; (2) patients with localized or advance disease; and (3) professional psychotherapeutic support. EVIDENCE SYNTHESIS We identified a total of ten studies (1067 participants). Six studies investigated cognitive behavioral therapy (CBT; 713 participants). Two studies used supportive psychotherapy (88 participants) and two used cognitive essential couple therapy (133 couples). Most studies came from the USA (5 studies). CBT seemed to be beneficial in African Americans, Hispanics, men with higher interpersonal sensitivity, and those with relatively high levels of stress in single studies. Couples therapies seemed beneficial for patients and their partners. Supportive psychotherapy was usually integrated into multimodal supportive treatments. CONCLUSIONS Despite the limitations of the available studies, there is promising early evidence that specialized psychotherapeutic support for PCa patients is feasible and beneficial. Psychological intervention can significantly improve PCa patients' wellbeing after therapy. Further multicenter randomized controlled trials should focus on assessing which patients need psychotherapeutic help and which are most likely to benefit from such support, and which type of interventions are the most appropriate for each patient. PATIENT SUMMARY We report on studies comparing psychological outcomes in prostate cancer patients treated with psychotherapeutic interventions. Psychotherapeutic support is feasible and improves overall wellbeing and cancer-related distress in some prostate cancer patients.
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Affiliation(s)
- Liliana Vartolomei
- Department of Urology, Medical University of Vienna, Austria; Department of Clinical Psychology, University Dimitrie Cantemir, Tirgu Mures, Romania
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York, NY, USA.
| | - Mihai Dorin Vartolomei
- Department of Urology, Medical University of Vienna, Austria; Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania
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Mayer JS, Hees K, Medda J, Grimm O, Asherson P, Bellina M, Colla M, Ibáñez P, Koch E, Martinez-Nicolas A, Muntaner-Mas A, Rommel A, Rommelse N, de Ruiter S, Ebner-Priemer UW, Kieser M, Ortega FB, Thome J, Buitelaar JK, Kuntsi J, Ramos-Quiroga JA, Reif A, Freitag CM. Bright light therapy versus physical exercise to prevent co-morbid depression and obesity in adolescents and young adults with attention-deficit / hyperactivity disorder: study protocol for a randomized controlled trial. Trials 2018; 19:140. [PMID: 29482662 PMCID: PMC5828138 DOI: 10.1186/s13063-017-2426-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/18/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The risk for major depression and obesity is increased in adolescents and adults with attention-deficit / hyperactivity disorder (ADHD) and adolescent ADHD predicts adult depression and obesity. Non-pharmacological interventions to treat and prevent these co-morbidities are urgently needed. Bright light therapy (BLT) improves day-night rhythm and is an emerging therapy for major depression. Exercise intervention (EI) reduces obesity and improves depressive symptoms. To date, no randomized controlled trial (RCT) has been performed to establish feasibility and efficacy of these interventions targeting the prevention of co-morbid depression and obesity in ADHD. We hypothesize that the two manualized interventions in combination with mobile health-based monitoring and reinforcement will result in less depressive symptoms and obesity compared to treatment as usual in adolescents and young adults with ADHD. METHODS This trial is a prospective, pilot phase-IIa, parallel-group RCT with three arms (two add-on treatment groups [BLT, EI] and one treatment as usual [TAU] control group). The primary outcome variable is change in the Inventory of Depressive Symptomatology total score (observer-blinded assessment) between baseline and ten weeks of intervention. This variable is analyzed with a mixed model for repeated measures approach investigating the treatment effect with respect to all three groups. A total of 330 participants with ADHD, aged 14 - < 30 years, will be screened at the four study centers. To establish effect sizes, the sample size was planned at the liberal significance level of α = 0.10 (two-sided) and the power of 1-β = 80% in order to find medium effects. Secondary outcomes measures including change in obesity, ADHD symptoms, general psychopathology, health-related quality of life, neurocognitive function, chronotype, and physical fitness are explored after the end of the intervention and at the 12-week follow-up. DISCUSSION This is the first pilot RCT on the use of BLT and EI in combination with mobile health-based monitoring and reinforcement targeting the prevention of co-morbid depression and obesity in adolescents and young adults with ADHD. If at least medium effects can be established with regard to the prevention of depressive symptoms and obesity, a larger scale confirmatory phase-III trial may be warranted. TRIAL REGISTRATION German Clinical Trials Register, DRKS00011666. Registered on 9 February 2017. ClinicalTrials.gov, NCT03371810. Registered on 13 December 2017.
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Affiliation(s)
- Jutta S Mayer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstr. 50, 60528, Frankfurt am Main, Germany.
| | - Katharina Hees
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Juliane Medda
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstr. 50, 60528, Frankfurt am Main, Germany
| | - Oliver Grimm
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Philip Asherson
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Mariano Bellina
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.,Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Michael Colla
- Department of Psychiatry, School of Medicine, University of Rostock, Rostock, Germany
| | - Pol Ibáñez
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Elena Koch
- Mental mHealth Lab, Department of Sport and Sport Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Antonio Martinez-Nicolas
- PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Chronobiology Research Group, Department of Physiology, Faculty of Biology, University of Murcia. Campus Mare Nostrum. IUIE. IMIB-Arrixaca. Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Adrià Muntaner-Mas
- PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Physical Activity and Exercise Sciences Research Group, University of Balearic Islands, Palma, Spain
| | - Anna Rommel
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Nanda Rommelse
- Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Saskia de Ruiter
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Ulrich W Ebner-Priemer
- Mental mHealth Lab, Department of Sport and Sport Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Johannes Thome
- Department of Psychiatry, School of Medicine, University of Rostock, Rostock, Germany
| | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Jonna Kuntsi
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - J Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.,Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstr. 50, 60528, Frankfurt am Main, Germany
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12
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Anterior cingulate volume predicts response to psychotherapy and functional connectivity with the inferior parietal cortex in major depressive disorder. Eur Neuropsychopharmacol 2018; 28:138-148. [PMID: 29239789 DOI: 10.1016/j.euroneuro.2017.11.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/26/2017] [Accepted: 11/03/2017] [Indexed: 12/21/2022]
Abstract
In major depressive disorder (MDD), the anterior cingulate cortex (ACC) has been associated with clinical outcome as well as with antidepressant treatment response. Nonetheless, the association between individual differences in ACC structure and function and the response to cognitive behavioral therapy (CBT) is still unexplored. For this aim, twenty-five unmedicated patients with MDD were scanned with structural and resting state functional magnetic resonance imaging before the beginning of CBT treatment. ACC morphometry was correlated with clinical changes following psychotherapy. Furthermore, whole-brain resting state functional connectivity with the ACC was correlated with clinical measures. Greater volume in the left subgenual (subACC), the right pregenual (preACC), and the bilateral supragenual (supACC) predicted depressive symptoms improvement after CBT. Greater subACC volume was related to stronger functional connectivity with the inferior parietal cortex and dorsolateral prefrontal cortex. Stronger subACC-inferior parietal cortex connectivity correlated with greater adaptive rumination. Greater preACC volume was associated with stronger functional connectivity with the inferior parietal cortex and ventrolateral prefrontal cortex. In contrast, greater right supACC volume was related to lower functional connectivity with the inferior parietal cortex. These results suggest that ACC volume and its functional connectivity with the fronto-parietal cortex are associated with CBT response in MDD, and this may be mediated by adaptive forms of rumination. Our findings support the role of the subACC as a potential predictor for CBT response.
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13
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Laws HB, Constantino MJ, Sayer AG, Klein DN, Kocsis JH, Manber R, Markowitz JC, Rothbaum BO, Steidtmann D, Thase ME, Arnow BA. Convergence in patient-therapist therapeutic alliance ratings and its relation to outcome in chronic depression treatment. Psychother Res 2017; 27:410-424. [PMID: 26829714 PMCID: PMC4969229 DOI: 10.1080/10503307.2015.1114687] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE This study tested whether discrepancy between patients' and therapists' ratings of the therapeutic alliance, as well as convergence in their alliance ratings over time, predicted outcome in chronic depression treatment. METHOD Data derived from a controlled trial of partial or non-responders to open-label pharmacotherapy subsequently randomized to 12 weeks of algorithm-driven pharmacotherapy alone or pharmacotherapy plus psychotherapy. The current study focused on the psychotherapy conditions (N = 357). Dyadic multilevel modeling was used to assess alliance discrepancy and alliance convergence over time as predictors of two depression measures: one pharmacotherapist-rated (Quick Inventory of Depressive Symptoms-Clinician; QIDS-C), the other blind interviewer-rated (Hamilton Rating Scale for Depression; HAMD). RESULTS Patients' and therapists' alliance ratings became more similar, or convergent, over the course of psychotherapy. Higher alliance convergence was associated with greater reductions in QIDS-C depression across psychotherapy. Alliance convergence was not significantly associated with declines in HAMD depression; however, greater alliance convergence was related to lower HAMD scores at 3-month follow-up. CONCLUSIONS The results partially support the hypothesis that increasing patient-therapist consensus on alliance quality during psychotherapy may improve treatment and longer term outcomes.
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Affiliation(s)
- Holly B Laws
- a Department of Psychiatry , Yale University School of Medicine , New Haven , CT , USA
| | - Michael J Constantino
- b Department of Psychological and Brain Sciences , University of Massachusetts Amherst , Amherst , MA , USA
| | - Aline G Sayer
- b Department of Psychological and Brain Sciences , University of Massachusetts Amherst , Amherst , MA , USA
| | - Daniel N Klein
- c Department of Psychology , Stony Brook University, Stony Brook , NY , USA
| | - James H Kocsis
- d Department of Psychiatry , Weill Medical College of Cornell University , New York , NY , USA
| | - Rachel Manber
- e Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , CA , USA
| | - John C Markowitz
- f New York State Psychiatric Institute , Columbia University College of Physicians and Surgeon , New York , NY , USA
| | - Barbara O Rothbaum
- g Department of Psychiatry , Emory University School of Medicine , Atlanta , GA , USA
| | - Dana Steidtmann
- e Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , CA , USA
- h Department of Family Medicine , University of Colorado School of Medicine , Aurora , CO , USA
| | - Michael E Thase
- i Perlman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA
| | - Bruce A Arnow
- e Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , CA , USA
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14
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Späti J, Chumbley J, Doerig N, Brakowski J, Holtforth MG, Seifritz E, Spinelli S. Valence and agency influence striatal response to feedback in patients with major depressive disorder. J Psychiatry Neurosci 2015; 40:394-400. [PMID: 26107160 PMCID: PMC4622637 DOI: 10.1503/jpn.140225] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Reduced sensitivity to positive feedback is common in patients with major depressive disorder (MDD). However, findings regarding negative feedback are ambiguous, with both exaggerated and blunted responses being reported. The ventral striatum (VS) plays a major role in processing valenced feedback, and previous imaging studies have shown that the locus of controls (self agency v. external agency) over the outcome influences VS response to feedback. We investigated whether attributing the outcome to one's own action or to an external agent influences feedback processing in patients with MDD. We hypothesized that depressed participants would be less sensitive to the feedback attribution reflected by an altered VS response to self-attributed gains and losses. METHODS Using functional MRI and a motion prediction task, we investigated the neural responses to self-attributed (SA) and externally attributed (EA) monetary gains and losses in unmedicated patients with MDD and healthy controls. RESULTS We included 21 patients and 25 controls in our study. Consistent with our prediction, healthy controls showed a VS response influenced by feedback valence and attribution, whereas in depressed patients striatal activity was modulated by valence but was insensitive to attribution. This attribution insensitivity led to an altered ventral putamen response for SA - EA losses in patients with MDD compared with healthy controls. LIMITATIONS Depressed patients with comorbid anxiety disorder were included. CONCLUSION These results suggest an altered assignment of motivational salience to SA losses in patients with MDD. Altered striatal response to SA negative events may reinforce the belief of not being in control of negative outcomes contributing to a cycle of learned helplessness.
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Affiliation(s)
| | | | | | | | | | | | - Simona Spinelli
- Correspondence to: S. Spinelli, Preclinical Laboratory for Translational Research into Affective Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, August Forel-Strasse 7, CH-8008 Zurich, Switzerland;
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15
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Prefrontal thinning affects functional connectivity and regional homogeneity of the anterior cingulate cortex in depression. Neuropsychopharmacology 2015; 40:1640-8. [PMID: 25598428 PMCID: PMC4915268 DOI: 10.1038/npp.2015.8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 12/20/2022]
Abstract
Major depressive disorder (MDD) is associated with structural and functional alterations in the prefrontal cortex (PFC) and anterior cingulate cortex (ACC). Enhanced ACC activity at rest (measured using various imaging methodologies) is found in treatment-responsive patients and is hypothesized to bolster treatment response by fostering adaptive rumination. However, whether structural changes influence functional coupling between fronto-cingulate regions and ACC regional homogeneity (ReHo) and whether these functional changes are related to levels of adaptive rumination and treatment response is still unclear. Cortical thickness and ReHo maps were calculated in 21 unmedicated depressed patients and 35 healthy controls. Regions with reduced cortical thickness defined the seeds for the subsequent functional connectivity (FC) analyses. Patients completed the Response Style Questionnaire, which provided a measure of adaptive rumination associated with better response to psychotherapy. Compared with controls, depressed patients showed thinning of the right anterior PFC, increased prefrontal connectivity with the supragenual ACC (suACC), and higher ReHo in the suACC. The suACC clusters of increased ReHo and FC spatially overlapped. In depressed patients, suACC ReHo scores positively correlated with PFC thickness and with FC strength. Moreover, stronger fronto-cingulate connectivity was related to higher levels of adaptive rumination. Greater suACC ReHo and connectivity with the right anterior PFC seem to foster adaptive forms of self-referential processing associated with better response to psychotherapy, whereas prefrontal thinning impairs the ability of depressed patients to engage the suACC during a major depressive episode. Bolstering the function of the suACC may represent a potential target for treatment.
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16
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Kasckow J, Klaus J, Morse J, Oslin D, Luther J, Fox L, Reynolds C, Haas GL. Using problem solving therapy to treat veterans with subsyndromal depression: a pilot study. Int J Geriatr Psychiatry 2014; 29:1255-61. [PMID: 24789736 PMCID: PMC4216632 DOI: 10.1002/gps.4105] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 02/25/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We conducted a pilot study comparing problem solving therapy for primary care (PST-PC) to a dietary education control condition in middle-aged and older veterans with symptoms of emotional distress and subsyndromal depression. METHODS This was a two-site study at the VA Pittsburgh Healthcare System and Philadelphia VA Medical Center. Participants included veterans >50 years of age referred from primary care clinics who were eligible if they obtained a pre-screen score >11 on the Centers for Epidemiologic Studies Depression (CES-D) scale. Exclusions were a DSM-IV Major Depressive Episode within the past year, active substance abuse/dependence within 1 month, current antidepressant therapy, and a Mini mental status exam score <24. Participants were randomized to receive one of two interventions--either PST-PC or an attention control condition consisting of dietary education (DIET)--each consisting of six to eight sessions within a 4-month period. RESULTS Of 45 individuals randomized, 23 (11 PST-PC and 12 DIET) completed treatment. Using regression models in completers that examined outcomes at end of treatment while controlling for baseline scores, there were significant differences between treatment groups in SF-36 mental health component scores but not in depressive symptoms (as assessed with either the 17-item Hamilton Rating Scale for Depression or the Beck Depression Inventory), social problem solving skills, or physical health status (SF-36 physical health component score). CONCLUSIONS These pilot study findings suggest that a six-to-eight session version of PST-PC may lead to improvements in mental health functioning in primary care veterans with subsyndromal depressive symptoms.
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Affiliation(s)
- J. Kasckow
- VA Pittsburgh Behavioral Health, VISN 4 CHERP and VISN 4
MIRECC, University Dr, Pittsburgh, PA, USA,UPMC Western Psychiatric Institute and Clinics, Pittsburgh,
PA, USA
| | - J. Klaus
- Philadelphia Veterans Affairs Medical Center VISN 4 MIRECC,
Philadelphia, PA, USA
| | - J. Morse
- UPMC Western Psychiatric Institute and Clinics, Pittsburgh,
PA, USA
| | - D. Oslin
- Philadelphia Veterans Affairs Medical Center VISN 4 MIRECC,
Philadelphia, PA, USA,Section of Geriatric Psychiatry, Department of Psychiatry,
University of Pennsylvania, Philadelphia, PA, USA
| | - J. Luther
- VA Pittsburgh Behavioral Health, VISN 4 CHERP and VISN 4
MIRECC, University Dr, Pittsburgh, PA, USA
| | - L. Fox
- VA Pittsburgh Behavioral Health, VISN 4 CHERP and VISN 4
MIRECC, University Dr, Pittsburgh, PA, USA
| | - C. Reynolds
- UPMC Western Psychiatric Institute and Clinics, Pittsburgh,
PA, USA
| | - G. L. Haas
- VA Pittsburgh Behavioral Health, VISN 4 CHERP and VISN 4
MIRECC, University Dr, Pittsburgh, PA, USA,UPMC Western Psychiatric Institute and Clinics, Pittsburgh,
PA, USA
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Björgvinsson T, Kertz SJ, Bigda-Peyton JS, McCoy KL, Aderka IM. Psychometric properties of the CES-D-10 in a psychiatric sample. Assessment 2013; 20:429-36. [PMID: 23513010 DOI: 10.1177/1073191113481998] [Citation(s) in RCA: 381] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The 10-item Center for the Epidemiological Studies of Depression Short Form (CES-D-10) is a widely used measure to screen for depression in primary care settings. The 10-item measure has demonstrated strong psychometric properties, including predictive accuracy and high correlations with the original 20-item version, in community populations. However, clinical utility and psychometric properties have yet to be assessed in an acutely symptomatic psychiatric population. This study examined the psychometric properties of the CES-D-10 in a sample of 755 patients enrolled in a psychiatric partial hospital program. Participants completed a diagnostic interview and a battery of self-report measures on admission and discharge. Exploratory factor analysis and confirmatory factor analysis suggested that a one-factor structure provided a good fit to the data. High item-total correlations indicated high internal consistency, and the CES-D-10 demonstrated both convergent validity and divergent validity. Previously suggested cutoff scores of 8 and 10 resulted in good sensitivity (.91 and .89, respectively) but poor specificity (.35 and .47). These data suggest that although the CES-D-10 has generally strong psychometric properties in this psychiatric sample, the measure should be primarily used to assess depression symptom severity rather than as a diagnostic screening tool.
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18
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Helmreich I, Wagner S, Mergl R, Allgaier AK, Hautzinger M, Henkel V, Hegerl U, Tadić A. Sensitivity to changes during antidepressant treatment: a comparison of unidimensional subscales of the Inventory of Depressive Symptomatology (IDS-C) and the Hamilton Depression Rating Scale (HAMD) in patients with mild major, minor or subsyndromal depression. Eur Arch Psychiatry Clin Neurosci 2012; 262:291-304. [PMID: 21959915 DOI: 10.1007/s00406-011-0263-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 09/13/2011] [Indexed: 11/29/2022]
Abstract
In the efficacy evaluation of antidepressant treatments, the total score of the Hamilton Depression Rating Scale (HAMD) is still regarded as the 'gold standard'. We previously had shown that the Inventory of Depressive Symptomatology (IDS) was more sensitive to detect depressive symptom changes than the HAMD17 (Helmreich et al. 2011). Furthermore, studies suggest that the unidimensional subscales of the HAMD, which capture the core depressive symptoms, outperform the full HAMD regarding the detection of antidepressant treatment effects. The aim of the present study was to compare several unidimensional subscales of the HAMD and the IDS regarding their sensitivity to changes in depression symptoms in a sample of patients with mild major, minor or subsyndromal depression (MIND). Biweekly IDS-C28 and HAMD17 data from 287 patients of a 10-week randomised, placebo-controlled trial comparing the effectiveness of sertraline and cognitive-behavioural group therapy in patients with MIND were converted to subscale scores and analysed during the antidepressant treatment course. We investigated sensitivity to depressive change for all scales from assessment-to-assessment, in relation to depression severity level and placebo-verum differences. The subscales performed similarly during the treatment course, with slight advantages for some subscales in detecting treatment effects depending on the treatment modality and on the items included. Most changes in depressive symptomatology were detected by the IDS short scale, but regarding the effect sizes, it performed worse than most subscales. Unidimensional subscales are a time- and cost-saving option in judging drug therapy outcomes, especially in antidepressant treatment efficacy studies. However, subscales do not cover all facets of depression (e.g. atypical symptoms, sleep disturbances), which might be important for comprehensively understanding the nature of the disease depression. Therefore, the cost-to-benefit ratio must be carefully assessed in the decision for using unidimensional subscales.
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Affiliation(s)
- Isabella Helmreich
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany.
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