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McIntosh GE, Liu ES, Allan M, Grech LB. Clinical Practice Guidelines for the Detection and Treatment of Depression in Multiple Sclerosis: A Systematic Review. Neurol Clin Pract 2023; 13:e200154. [PMID: 37124459 PMCID: PMC10132261 DOI: 10.1212/cpj.0000000000200154] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/16/2023] [Indexed: 05/02/2023]
Abstract
Purpose of Review The association of multiple sclerosis (MS) with depression has been well documented; however, it frequently remains undiagnosed, untreated, or undertreated, with consequences to the person, family, and economy. The aim of this study was to determine the quality, scope, and consistency of available guidelines and consensus statements to guide clinicians managing people with comorbid MS and depression. Recent Findings Based on our systematic search of the literature, 6 guidelines and consensus statements met the inclusion criteria. Of these, 4 presented recommendations on depression screening in MS and 5 offered recommendations for treatment. Despite most guidelines presenting evidence-based recommendations, they were generally of low-quality evidence overall. Inconsistencies identified across guidelines and consensus statements included variations in recommendation for routine screening and which screening tool to use. Most guidelines lacked detail, often referring to general population guidelines without describing to what extent they can be applied to people with MS. Summary The findings of this review highlight the need to develop high-quality, comprehensive clinical practice guidelines with clear recommendations that can be globally implemented by healthcare clinicians working with people with MS.
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Affiliation(s)
- Georgia E McIntosh
- Department of Medicine (GEM, ESL, MA, LBG), School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University; Department of Neurology (MA), Monash Medical Centre, Monash Health, Clayton; and Department of Neurology (MA), Frankston Hospital, Peninsula Health, Frankston, Australia
| | - Edward S Liu
- Department of Medicine (GEM, ESL, MA, LBG), School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University; Department of Neurology (MA), Monash Medical Centre, Monash Health, Clayton; and Department of Neurology (MA), Frankston Hospital, Peninsula Health, Frankston, Australia
| | - Michelle Allan
- Department of Medicine (GEM, ESL, MA, LBG), School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University; Department of Neurology (MA), Monash Medical Centre, Monash Health, Clayton; and Department of Neurology (MA), Frankston Hospital, Peninsula Health, Frankston, Australia
| | - Lisa B Grech
- Department of Medicine (GEM, ESL, MA, LBG), School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University; Department of Neurology (MA), Monash Medical Centre, Monash Health, Clayton; and Department of Neurology (MA), Frankston Hospital, Peninsula Health, Frankston, Australia
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2
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Jackson DA, Nicholson R, Bergmann C, Wilken J, Kaczmarek O, Bumstead B, Buhse M, Zarif M, Penner IK, Hancock LM, Golan D, Doniger GM, Bogaardt H, Barrera M, Covey TJ, Gudesblatt M. Cognitive impairment in people with multiple sclerosis: Perception vs. performance - factors that drive perception of impairment differ for patients and clinicians. Mult Scler Relat Disord 2023; 69:104410. [PMID: 36399966 DOI: 10.1016/j.msard.2022.104410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/10/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurologists' perceptions of the presence of cognitive impairment (CI) in people with multiple sclerosis (PwMS) may not always align with findings of objective cognitive assessment. The accuracy of self-reported CI in PwMS can also be highly variable across individuals, and may not align with objective measurement of cognitive disturbances. Research suggests that additional factors impact perceived cognitive ability, such as depression and fatigue. Objective cognitive screening regardless of patient or neurologist perception has been recommended but still is often limited in routine care. Moreover, comprehensive neuropsychological assessment is even less routinely done. OBJECTIVE To explore how neurologists' perceptions of PwMS' CI compare to the perception of the patient by determining whether PwMS and their clinicians are accurate in detecting the presence and degree of CI as defined by a multi-domain validated computerized test battery in PwMS, as well as investigate what factors influence perception of CI in each group. METHODS PwMS completed a computerized multi-domain cognitive testing battery, and self-reported measures of disease impact (MSIS-29), fatigue (MFIS), and depression (BDI-II). Disability was assessed by the clinician using the Expanded Disability Status Scale (EDSS). Clinicians and patients also provided an estimation of cognitive deficits along a Likert scale. RESULTS In this cohort of PwMS (N=202, age range: 20 to 88, gender: 71% female), their level of accuracy in detecting attention deficits (k = -.028, p = .010) was low but statistically significant. In contrast, clinicians' accuracy in detecting global CI (k = -.037, p < .001) and a number of specific domain deficits was moderate. Fatigue (p < .001) and cognitive performance (p = .012) significantly predicted patient perceived cognitive deficits. Clinician perceived cognitive performance was significantly predicted by multiple factors: cognitive scores (p < .001), physical disability (p = .011), age (p = .021), and depression (p = .038). CONCLUSION The need to objectively screen for CI in PwMS, regardless of perception, can be aided by a better understanding of the agreement and discrepancies between the patient and clinician regarding perceived cognitive disturbances and the presence of CI defined by a multi-dimensional objective screening battery.
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Affiliation(s)
- Daija A Jackson
- The Chicago School of Professional Psychology, Washington, D.C., USA.
| | | | | | - Jeffrey Wilken
- Washington Neuropsychology Research Group, Fairfax, VA, USA
| | | | | | | | - Myassar Zarif
- South Shore Neurologic Associates, Patchogue, NY, USA
| | - Iris-Katharina Penner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Laura M Hancock
- University of Wisconsin School of Medicine, Madison, WI, USA; William S. Middleton VA Medical Center, Madison, WI, USA
| | - Daniel Golan
- Multiple Sclerosis and Neuroimmunology Center, Clalit Health Services, Nazareth, Israel; Department of Neurology, Lady Davis Carmel Medical Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Hans Bogaardt
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, Australia
| | - Marissa Barrera
- Katz School of Science & Health, Yeshiva University, New York, NY, USA
| | - Thomas J Covey
- Department of Neurology, Division of Cognitive and Behavioral Neurosciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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3
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Impact of Multiple Sclerosis and Its Association with Depression: An Analytical Case-Control Investigation. Healthcare (Basel) 2022; 10:healthcare10112218. [PMID: 36360559 PMCID: PMC9690715 DOI: 10.3390/healthcare10112218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Multiple sclerosis (MS) is a neurological, chronic, inflammatory, and progressive disease with musculoskeletal problems and neurodegenerative disorders that causes worsening of the health status of patients. The aim of this study was to determine the level of depression in MS patients compared to a population of healthy subjects. The established sample size was 116 subjects matched with the same age, sex, and body mass index. The subjects were recruited from different multiple sclerosis associations and neurology clinics in different public health areas (case group n = 58) and healthy subjects from the same locality (control group n = 58). The scores and categories of the Beck Depression Inventory (BDI) in its Spanish version were collected. There was a clear statistically significant difference (p < 0.05) in the BDI scores between both groups. As a result, we found that the subjects with MS presented worse results with BDI = 9.52 ± 7.70 points compared to the healthy subjects with a BDI score = 5.03 ± 5.14. Within the BDI categories, there were statistically significant differences (p < 0.001), which were greater for the MS group. Depression is a dangerous factor for MS patients, being a trigger for a poorer quality of life.
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4
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Harnas SJ, Knoop H, Bennebroek Evertsz F, Booij SH, Dekker J, van Laarhoven HWM, van der Lee M, Meijer E, Sharpe L, Sprangers MAG, van Straten A, Zweegman S, Braamse AMJ. Personalized versus standard cognitive behavioral therapy for fear of cancer recurrence, depressive symptoms or cancer-related fatigue in cancer survivors: study protocol of a randomized controlled trial (MATCH-study). Trials 2021; 22:696. [PMID: 34641961 PMCID: PMC8507219 DOI: 10.1186/s13063-021-05657-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/27/2021] [Indexed: 11/12/2022] Open
Abstract
Background Fear of cancer recurrence, depressive symptoms, and cancer-related fatigue are prevalent symptoms among cancer survivors, adversely affecting patients’ quality of life and daily functioning. Effect sizes of interventions targeting these symptoms are mostly small to medium. Personalizing treatment is assumed to improve efficacy. However, thus far the empirical support for this approach is lacking. The aim of this study is to investigate if systematically personalized cognitive behavioral therapy is more efficacious than standard cognitive behavioral therapy in cancer survivors with moderate to severe fear of cancer recurrence, depressive symptoms, and/or cancer-related fatigue. Methods The study is designed as a non-blinded, multicenter randomized controlled trial with two treatment arms (ratio 1:1): (a) systematically personalized cognitive behavioral therapy and (b) standard cognitive behavioral therapy. In the standard treatment arm, patients receive an evidence-based diagnosis-specific treatment protocol for fear of cancer recurrence, depressive symptoms, or cancer-related fatigue. In the second arm, treatment is personalized on four dimensions: (a) the allocation of treatment modules based on ecological momentary assessments, (b) treatment delivery, (c) patients’ needs regarding the symptom for which they want to receive treatment, and (d) treatment duration. In total, 190 cancer survivors who experience one or more of the targeted symptoms and ended their medical treatment with curative intent at least 6 months to a maximum of 5 years ago will be included. Primary outcome is limitations in daily functioning. Secondary outcomes are level of fear of cancer recurrence, depressive symptoms, fatigue severity, quality of life, goal attainment, therapist time, and drop-out rates. Participants are assessed at baseline (T0), and after 6 months (T1) and 12 months (T2). Discussion To our knowledge, this is the first randomized controlled trial comparing the efficacy of personalized cognitive behavioral therapy to standard cognitive behavioral therapy in cancer survivors. The study has several innovative characteristics, among which is the personalization of interventions on several dimensions. If proven effective, the results of this study provide a first step in developing an evidence-based framework for personalizing therapies in a systematic and replicable way. Trial registration The Dutch Trial Register (NTR) NL7481 (NTR7723). Registered on 24 January 2019.
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Affiliation(s)
- Susan J Harnas
- Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Hans Knoop
- Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Floor Bennebroek Evertsz
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sanne H Booij
- Department of Developmental Psychology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands.,Center for Integrative Psychiatry, Lentis, Groningen, the Netherlands
| | - Joost Dekker
- Department of Psychiatry, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marije van der Lee
- Research Department, Center for Psycho-Oncology, Helen Dowling Institute, Bilthoven, the Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University Tilburg School of Social and Behavioral Sciences, Tilburg, the Netherlands
| | - Ellen Meijer
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Louise Sharpe
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology & Amsterdam Public Health Research Institute, VU University, Amsterdam, the Netherlands
| | - Sonja Zweegman
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Annemarie M J Braamse
- Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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5
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Ayoobi F, Khalili P, Azin H, Shahrokhabadi S, Azin M. Effects of tactile stimulation on the sensory, motor and cognitive function in people with multiple sclerosis. Clin Neurol Neurosurg 2021; 205:106643. [PMID: 33906001 DOI: 10.1016/j.clineuro.2021.106643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/01/2021] [Accepted: 04/05/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS) is a chronic inflammatory neurodegenerative disease that causes demyelination in the brain and spinal cord. Repetitive sensory stimulation (RSS) can enhance sensory perception and motor function, improve inappropriate synaptic connections and adaptable malformations, and increase cognitive function. The purpose of this study was to specify the effect of RSS on the sensory, motor, and cognitive function in people with MS. METHODS RSS was applied to 50 people with MS. In this study, the following tests were used: two-point discrimination, 9-Hole Peg Test (9-HPT), Box and Block Test (BBT), hand mental rotation (HMR), Paced Auditory Serial Addition Test (PASAT), and Symbol Digit Modalities Test (SDMT). The tests were performed before and after the intervention. RESULTS The results of this study showed significant difference before and after the stimulation in intervention and control groups two-point discrimination threshold (both groups= 0.001), BBT score (both groups: P < 0.001) and 9-HPT score (both groups: P < 0.001), HMR ability (reaction time: both groups: P = 0.003; accuracy rate: intervention: P = 0.004, control: P < 0.001), PASAT score (intervention: P < 0.001, control: P = 0.012) and SDMT score (intervention: P = 0.008, control: P < 0.001), but there was no statistical difference observed between the two groups before and after the intervention in terms of the mentioned variables (P > 0.05). CONCLUSION The application of 30 min of RSS in the right index finger of people with MS could not improve the two-point discrimination threshold and the manual dexterity. In addition, this intervention did not improve cognitive function.
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Affiliation(s)
- Fatemeh Ayoobi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Parvin Khalili
- Social Determinants of Health Research Centre, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Hossein Azin
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran; Neurology Department, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Shohreh Shahrokhabadi
- Physiology-pharmacology Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mahdieh Azin
- Physiology-pharmacology Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran; Department of Physiology and Pharmacology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
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6
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El-Salem K, Khalil H, Al-Sharman A, Al-Mistarehi AH, Yassin A, Alhayk KA, Qawasmeh MA, Bashayreh SY, Kofahi RM, Obeidat AZ. Serum vitamin d inversely correlates with depression scores in people with multiple sclerosis. Mult Scler Relat Disord 2021; 48:102732. [PMID: 33422916 DOI: 10.1016/j.msard.2020.102732] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Vitamin D (Vit.D) deficiency is a risk factor for multiple sclerosis (MS) and correlates with its severity. Depression is also common in people with MS (PWMS). We aim to investigate Vit.D correlation with depression risk scores in PWMS. METHODS A cross-sectional cohort of PWMS were studied. Clinical and demographic data were collected. The Hospital Anxiety Depression Scale (HADS) and the Beck Depression Inventory-II (BDI-II) were used to evaluate the risk of depression. Expanded Disability Status Scale (EDSS) and Patient Determined Disease Steps (PDDS) were used to evaluate the disability. Serum concentrations of 25-hydroxyvitamin D were measured. Bivariate and partial correlations of Vit.D status and scores of depressive and disability scales were statistically analyzed. The IBM Statistical Package for Social Sciences software, version 25.0, was used for data processing. RESULTS A total of 88 PWMS were enrolled. More than half of them had potential depression, and 68% had below-normal serum Vit.D levels (normal ≥ 30 ng/ml, insufficient = 21-29 ng/ml, and deficient ≤ 20 ng/ml). Serum Vit.D levels significantly correlated with scores of depression scales in both males and females, which was more robust in males. This association was maintained with a partial correlation analysis controlling for age, sex, body mass index, disease duration, type of MS, and EDDS HADS: r=-0.513, p<0.001; BDI-II: r=-0.401, p<0.001). Serum Vit.D had significant inverse correlations with EDSS score (r=-0.353, p = 0.001) and PDDS score (r=-0.341, p = 0.001), with more robust correlations in females compared to the whole group. CONCLUSION Vit.D levels correlate with depression risk scores in PWMS with differential sex effects.
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Affiliation(s)
- Khalid El-Salem
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Hanan Khalil
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
| | - Alham Al-Sharman
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
| | - Abdel-Hameed Al-Mistarehi
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Ahmed Yassin
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Kefah A Alhayk
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Majdi Al Qawasmeh
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Salma Y Bashayreh
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Raid M Kofahi
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Ahmed Z Obeidat
- Department of Neurology, Medical College of Wisconsin, Milwaukee, United States.
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Psychological Mindedness and Alexithymia Predict Symptom Reduction in Cognitive Behavior Therapy for Major Depressive Disorder. Int J Cogn Ther 2019. [DOI: 10.1007/s41811-019-00062-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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8
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Loy BD, Fling BW, Sage KM, Spain RI, Horak FB. Serum Histidine is Lower in Fatigued Women with Multiple Sclerosis. FATIGUE : BIOMEDICINE, HEALTH & BEHAVIOR 2019; 7:69-80. [PMID: 32440368 PMCID: PMC7241417 DOI: 10.1080/21641846.2019.1611786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/23/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Disabling persistent perceived fatigue occurs in 50% of people with multiple sclerosis (MS), but mechanisms are poorly understood. Low histidine could contribute to fatigue since it is the neurotransmitter histamine precursor and low serum levels are reported in other diseases where fatigue is common (e.g., breast cancer, kidney disease, diabetes). Serum histidine is also inversely correlated with proinflammatory cytokines (e.g., TNF, IFN-y), which have been linked to MS fatigue. PURPOSE To determine if serum histidine is low in fatigued women with MS, and if histidine is related to differences in proinflammatory cytokines. METHODS Participants were classified as having elevated (n = 19) or normal (n = 18) perceived fatigue based on a median sample split using Profile of Mood States fatigue scale scores, with the elevated fatigue group having scores >7. Histidine and gene-expression of TNF, IFN-y, and leptin were assayed from a serum sample. RESULTS After adjustment for depression, serum histidine was significantly lower in women with MS with elevated fatigue, compared to normal fatigue (64.57 vs. 70.48 nmol/ml, p = .048, g = 0.75). There were no differences between groups in cytokine expression (all p > .24). Gene expression of TNF correlated with histidine only in people with normal fatigue (r = .51, p = .034), while no other cytokines related to histidine levels. CONCLUSIONS These results provide evidence that serum histidine is lower in fatigued women with MS, but the study did not find a relationship between histidine and TNF, IFN-y, or leptin gene expression.
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Affiliation(s)
- Bryan D. Loy
- Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Brett W. Fling
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO
| | - Kylie M. Sage
- Biostatistics & Design Program, Oregon Health & Science University, Portland, OR
| | - Rebecca I. Spain
- Department of Neurology, Oregon Health & Science University, Portland, OR
- Neurology Services, VA Portland Health Care System, Portland, OR
| | - Fay B. Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR
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Adalat M, Khalili M, Ayromlou H, Haririan S, Fazljou SMB, Rezaeizadeh H, Safari AA, Zargaran A. Antidepressant Effects of a Persian Medicine Remedy on Multiple Sclerosis Patients: A Double-Blinded Randomized Clinical Trial. Galen Med J 2019; 8:e1212. [PMID: 34466472 PMCID: PMC8343653 DOI: 10.31661/gmj.v8i0.1212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/11/2018] [Accepted: 09/03/2018] [Indexed: 10/26/2022] Open
Abstract
Background Multiple sclerosis (MS), an inflammatory neurodegenerative disease of the central nervous system, is accompanied by some psychiatric disorders, one prominent example of which is depression. The aim of this study was to investigate the effects of a Persian herbal medicine treatment that contains Crocus sativus, Hypericum perforatum, Cinnamon verum, and Vitis vinifera on fatigue and sleep disorders in MS patients. Materials and Methods A Persian medicine remedy containing C.sativus, H.perforatum, C.verum, and V.vinifera was tested for its ability to improve the symptoms of depression in MS patients. This randomized double-blind clinical study was performed among 52 patients with MS who were allocated to their respective research groups through blocked randomization. The patients were treated for 4 weeks with either the drug or the placebo. To quantify the symptoms of depression, Beck depression inventory (BDI) was used. Results Forty-six patients completed the study. In the course of the study, as the primary outcome, BDI decreased in the drug group (p =0.000) and the placebo group (p =0.001) significantly, but the rate of change in the drug group was significantly higher than in the placebo group (-13.9 ± 8.6 vs. -3.9 ± 4.3, p =0.000). While analyzing time and treatment effect for BDI, significant decreases in BDI were observed for the drug group, but not in the placebo group (p = 0.001). Conclusion The present study suggests that Persian medicine remedy treatment in combination with chemical drugs may improve depression symptoms in MS patients. More investigations are needed to discover the exact mechanisms and processes involved.
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Affiliation(s)
- Maryam Adalat
- Department of Traditional Medicine, School of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Khalili
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Neurosciences Research Center; Tabriz University of Medical Sciences, Tabriz, Iran
- Correspondence to: Mohammad Khalili, PhD, Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran Telephone Number: +98216312374 Email Address:
| | - Hormoz Ayromlou
- Neurosciences Research Center; Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Neurology, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Hossein Rezaeizadeh
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Safari
- Department of Traditional Pharmacy, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Arman Zargaran
- Department of Traditional Pharmacy, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Mähler A, Balogh A, Csizmadia I, Klug L, Kleinewietfeld M, Steiniger J, Šušnjar U, Müller DN, Boschmann M, Paul F. Metabolic, Mental and Immunological Effects of Normoxic and Hypoxic Training in Multiple Sclerosis Patients: A Pilot Study. Front Immunol 2018; 9:2819. [PMID: 30555484 PMCID: PMC6281996 DOI: 10.3389/fimmu.2018.02819] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 11/14/2018] [Indexed: 01/24/2023] Open
Abstract
Background: Physical activity might attenuate inflammation and neurodegeneration in multiple sclerosis (MS). Erythropoietin, which is produced upon exposure to hypoxia, is thought to act as a neuroprotective agent in MS. Therefore, we studied the effects of intermittent hypoxic training on activity energy expenditure, maximal workload, serum erythropoietin, and immunophenotype focusing on regulatory and IL-17A-producing T cells. Methods: We assigned 34 relapsing-remitting MS patients within a randomized, single blind, parallel-group study to either normoxic (NO) or hypoxic (HO) treadmill training, both 3 times/week for 1 h over 4 weeks (Clinicaltrials.gov identifier: NCT02509897). Before and after training, activity energy expenditure (metabolic chamber), maximal workload (incremental treadmill test), walking ability, depressive symptoms (Beck Depression Inventory I), serum erythropoietin concentrations, and immunophenotype of peripheral blood mononuclear cells (PBMCs) were assessed. Results: Energy expenditure did not change due to training in both groups, but was rather fueled by fat than by carbohydrate oxidation after HO training (P = 0.002). Maximal workload increased by 40 Watt and 42 Watt in the NO and HO group, respectively (both P < 0.0001). Distance patients walked in 6 min increased by 25 m and 27 m in the NO and HO group, respectively (NO P = 0.02; HO P = 0.01). Beck Depression Inventory score markedly decreased in both groups (NO P = 0.03; HO P = 0.0003). NO training shifted Treg subpopulations by increasing and decreasing the frequency of CD39+ and CD31+ Tregs, respectively, and decreased IL-17A-producing CD4+ cells. HO training provoked none of these immunological changes. Erythropoietin concentrations were within normal range and did not significantly change in either group. Conclusion: 4 weeks of moderate treadmill training had considerable effects on fitness level and mood in MS patients, both under normoxic and hypoxic conditions. Additionally, NO training improved Th17/Treg profile and HO training improved fatty acid oxidation during exercise. These effects could not be attributed to an increase of erythropoietin. Clinical Trial Registration: ClinicalTrials.gov; NCT02509897; http://www.clinicaltrials.gov
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Affiliation(s)
- Anja Mähler
- Experimental and Clinical Research Center Cooperation Between Charité Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,German Centre for Cardiovascular Research Partner Site Berlin, Berlin, Germany
| | - Andras Balogh
- Experimental and Clinical Research Center Cooperation Between Charité Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,German Centre for Cardiovascular Research Partner Site Berlin, Berlin, Germany.,Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Ilona Csizmadia
- Experimental and Clinical Research Center Cooperation Between Charité Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Berlin, Germany
| | - Lars Klug
- Experimental and Clinical Research Center Cooperation Between Charité Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Markus Kleinewietfeld
- VIB Laboratory of Translational Immunomodulation, VIB Center for Inflammation Research Hasselt University, Diepenbeek, Belgium
| | - Jochen Steiniger
- Experimental and Clinical Research Center Cooperation Between Charité Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Berlin, Germany
| | - Urša Šušnjar
- Experimental and Clinical Research Center Cooperation Between Charité Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Berlin, Germany.,International Centre for Genetic Engineering and Biotechnology, Triste, Italy
| | - Dominik N Müller
- Experimental and Clinical Research Center Cooperation Between Charité Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,German Centre for Cardiovascular Research Partner Site Berlin, Berlin, Germany.,Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Michael Boschmann
- Experimental and Clinical Research Center Cooperation Between Charité Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center Cooperation Between Charité Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center and Department of Neurology, Charité Universitätsmedizin Berlin Humboldt Universität Berlin, Berlin, Germany
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11
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Association between social support and quality of life in patients with affective disorders. EUROPEAN JOURNAL OF PSYCHIATRY 2018. [DOI: 10.1016/j.ejpsy.2018.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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12
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Weiss JJ, Prieto S, Bräu N, Dieterich DT, Marcus SM, Stivala A, Gorman JM. Multimethod assessment of baseline depression and relationship to hepatitis C treatment discontinuation. Int J Psychiatry Med 2018; 53:256-272. [PMID: 29298535 PMCID: PMC5975203 DOI: 10.1177/0091217417749796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The primary study objective is to determine which measures of depression are associated with early discontinuation of hepatitis C virus infection treatment and to determine which measure best characterizes the depression that develops during treatment. Methods Seventy-eight treatment-naïve subjects who initiated pegylated interferon/ribavirin treatment for hepatitis C virus infection were included. Baseline depression was assessed with the Structured Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), the Hamilton Depression Rating Scale, and the Beck Depression Inventory-II. The latter two measures were repeated at treatment weeks 12 and 24. Results Depression scores, as measured by the three instruments, lacked adequate consistency. Baseline depression as measured by the Beck Depression Inventory-II, but not by the other scales, was associated with early treatment discontinuation at weeks 12 and 24. Changes in depression during treatment were restricted to somatic symptoms. Of those who completed treatment, those who were not depressed at baseline tended to demonstrate significant depression increases during treatment. Conclusion The Beck Depression Inventory-II is recommended to assess depression prior to hepatitis C virus infection treatment. Somatic symptoms of depression should be monitored during treatment. Baseline depression as measured by the Beck Depression Inventory-II was associated with early treatment discontinuation. The Beck Depression Inventory-II, Structured Interview for DSM-IV, and Hamilton Depression Rating Scale yielded results that were not consistent with each other in this sample. Future research should focus on standardizing depression assessment in medically ill populations to identify measures that predict treatment discontinuation.
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Affiliation(s)
- Jeffrey J Weiss
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Sarah Prieto
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Norbert Bräu
- James J. Peters Veterans Affairs Medical Center, Infectious Diseases Section, Bronx, USA,Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Douglas T Dieterich
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Sue M Marcus
- Independent Statistical Consultant, Philadelphia, USA
| | - Alicia Stivala
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Jack M Gorman
- Franklin Behavioral Health Consultants and Critica LLC, Bronx, USA
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13
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Abstract
STUDY DESIGN Review of spine surgery literature between 2005 and 2014 to assess the reporting of patient outcomes by determining the variability of use of patient outcomes metrics in the following categories: pain and disability, patient satisfaction, readmission, and depression. OBJECTIVE Expose the heterogeneity of outcomes reporting and discuss current initiatives to create more homogenous outcomes databases. SUMMARY OF BACKGROUND DATA There has been a recent focus on the reporting of quality metrics associated with spine surgery outcomes. However, little consensus exists on the optimal metrics that should be used to measure spine surgery outcomes. MATERIALS AND METHODS A PubMed search of all spine surgery manuscripts from January 2005 through December 2014 was performed. Linear regression analyses were performed on individual metrics as well as outcomes categories as a fraction of total papers reviewing surgical outcomes. RESULTS Outcomes reporting has increased significantly between January 1, 2005 and December 31, 2014 [175/2871 (6.1%) vs. 764/5603 (13.6%), respectively; P<0.001; R=98.1%]. For the category of pain and disability reporting, Visual Analog Score demonstrated a statistically significant decrease in use from 2005 through 2014 [56/76 (73.7%) vs. 300/520 (57.7%), respectively; P<0.001], whereas Oswestry Disability Index increased significantly in use [19/76 (25.0%) vs. 182/520 (35.0%), respectively; P<0.001]. For quality of life, EuroQOL-5 Dimensions increased significantly in use between 2005 and 2014 [4/23 (17.4%) vs. 30/87 (34.5%), respectively; P<0.01]. In contrast, use of 36 Item Short Form Survey significantly decreased [19/23 (82.6%) vs. 57/87 (65.5%), respectively; P<0.01]. For depression, only the Zung Depression Scale underwent a significant increase in usage between 2005 and 2014 [0/0 (0%) vs. 7/13 (53.8%), respectively; P<0.01]. CONCLUSIONS Although spine surgery outcome reporting has increased significantly over the past 10 years, there remains considerable heterogeneity in regards to individual outcomes metrics utilized. This heterogeneity makes it difficult to compare outcomes across studies and to accurately extrapolate outcomes to clinical practice.
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14
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Kara B, Küçük F, Poyraz EC, Tomruk MS, İdıman E. Different types of exercise in Multiple Sclerosis: Aerobic exercise or Pilates, a single-blind clinical study. J Back Musculoskelet Rehabil 2018; 30:565-573. [PMID: 27911284 DOI: 10.3233/bmr-150515] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKROUND The aim of our study is to examine effects of aerobic and Pilates exercises on disability, cognition, physical performance, balance, depression and fatigue in relapsing-remitting Multiple Sclerosis (MS) patients as compared to healthy controls. METHODS The subjects were divided as aerobic exercise (n = 26), Pilates (n = 9), and the healthy control group (n = 21). We used MSFC, physical performance, Berg balance scale, Beck depression scale, fatigue impact scale. All evaluations were performed before and after exercise training. RESULTS There are statistically meaningful differences between Nine hole testing, PASAT 3, physical performance and fatique impact scale before and after aerobic exercise. Also we found significant difference for physical performance in the Pilates group. There are no significant differences in measures of fatique impact scale and depression between aerobic exercise group and the healthy controls after exercise. We found significant differences between Pilates and control group's after measurements except depression. There were significant differences between the Pilates and aerobic group for cognitive tests in favor of the Pilates group. CONCLUSION Aerobic exercise and clinical Pilates exercises revealed moderate changes in levels of cognitive, physical performance, balance, depression, fatigue in MS patients.
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Affiliation(s)
- Bilge Kara
- Department of Physical Therapy and Rehabilitation, School of Health Sciences, Dokuz Eylül University, İnciraltı, İzmir, Turkey
| | - Fadime Küçük
- Department of Physical Therapy and Rehabilitation, Institute of Health Sciences, Hacettepe University, Ankara, Turkey
| | | | - Melda Soysal Tomruk
- Department of Physical Therapy and Rehabilitation, School of Health Sciences, Dokuz Eylül University, İnciraltı, İzmir, Turkey
| | - Egemen İdıman
- Department of Neurology, School of Medicine, Dokuz Eylül University, İzmir, Turkey
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15
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Abstract
Multiple sclerosis is the most common disabling neurological illness affecting young and middle-aged adults. Although attention has tended to focus mainly on its neurological manifestations, reports of the presence of neuropsychiatric symptoms date back to the writings of Charcot in 1877. This article details the neuropsychiatric sequelae of multiple sclerosis and the evidence base for available treatments.
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16
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de Jong M, Peeters F, Gard T, Ashih H, Doorley J, Walker R, Rhoades L, Kulich RJ, Kueppenbender KD, Alpert JE, Hoge EA, Britton WB, Lazar SW, Fava M, Mischoulon D. A Randomized Controlled Pilot Study on Mindfulness-Based Cognitive Therapy for Unipolar Depression in Patients With Chronic Pain. J Clin Psychiatry 2018; 79:15m10160. [PMID: 28252881 PMCID: PMC6020018 DOI: 10.4088/jcp.15m10160] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/01/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Chronic pain is a disabling illness, often comorbid with depression. We performed a randomized controlled pilot study on mindfulness-based cognitive therapy (MBCT) targeting depression in a chronic pain population. METHOD Participants with chronic pain lasting ≥ 3 months; DSM-IV major depressive disorder (MDD), dysthymic disorder, or depressive disorder not otherwise specified; and a 16-item Quick Inventory of Depressive Symptomatology-Clinician Rated (QIDS-C₁₆) score ≥ 6 were randomly assigned to MBCT (n = 26) or waitlist (n = 14). We adapted the original MBCT intervention for depression relapse prevention by modifying the psychoeducation and cognitive-behavioral therapy elements to an actively depressed chronic pain population. We analyzed an intent-to-treat (ITT) and a per-protocol sample; the per-protocol sample included participants in the MBCT group who completed at least 4 of 8 sessions. Changes in scores on the QIDS-C₁₆ and 17-item Hamilton Depression Rating Sale (HDRS₁₇) were the primary outcome measures. Pain, quality of life, and anxiety were secondary outcome measures. Data collection took place between January 2012 and July 2013. RESULTS Nineteen participants (73%) completed the MBCT program. No significant adverse events were reported in either treatment group. ITT analysis (n = 40) revealed no significant differences. Repeated-measures analyses of variance for the per-protocol sample (n = 33) revealed a significant treatment × time interaction (F₁,₃₁ = 4.67, P = .039, η²p = 0.13) for QIDS-C₁₆ score, driven by a significant decrease in the MBCT group (t₁₈ = 5.15, P < .001, d = >1.6), but not in the control group (t₁₃ = 2.01, P = .066). The HDRS₁₇ scores did not differ significantly between groups. The study ended before the projected sample size was obtained, which might have prevented effect detection in some outcome measures. CONCLUSIONS MBCT shows potential as a treatment for depression in individuals with chronic pain, but larger controlled trials are needed. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01473615.
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Affiliation(s)
- Marasha de Jong
- Mondriaan, Institute of Mental Health, PsyQ Department of Mood Disorders, Oranjeplein 10, 6224 KD Maastricht, the Netherlands. .,Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands.,PsyQ Department of Mood Disorders, Mondriaan, Institute of Mental Health, Maastricht, the Netherlands
| | - Frenk Peeters
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Tim Gard
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA,Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Heidi Ashih
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jim Doorley
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rosemary Walker
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Ronald J. Kulich
- Center for Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Karsten D. Kueppenbender
- Center for Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan E. Alpert
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth A. Hoge
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Sara W. Lazar
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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17
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Comparison of Two Versions of the Hospital Anxiety and Depression Scale in Assessing Depression in a Neurologic Setting. Cogn Behav Neurol 2017; 30:145-149. [PMID: 29256909 DOI: 10.1097/wnn.0000000000000138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Hospital Anxiety and Depression Scale-Depression Subscale (HADS-D) is widely used to assess depression in people with multiple sclerosis (MS). Developed specifically for use in a medical setting, the scale has one item, "I feel as if I am slowed down," that might represent a significant somatic confounder, possibly biasing the assessment. OBJECTIVE We sought to determine whether inclusion or exclusion of the "slowed down" item in the HADS-D affects the detection of depression and the scale's associations with impaired cognition, fatigue, and employment status. METHODS A sample of 193 people with confirmed MS completed the HADS. To identify depressed participants, we used previously established cutoff scores for the HADS-D with (≥8) and without (≥6) the "slowed down" item. Linear and logistic regression models were used to determine predictors of cognition and employment status. RESULTS The HADS-D with and without the "slowed down" item detected similar rates of depression: 30.6% and 31.6%, respectively. Both versions of the HADS-D predicted processing speed and executive functioning, but not memory. Neither version predicted employment status. CONCLUSIONS The HADS-D is an easy-to-use and clinically relevant self-report psychometric scale for detecting depression in MS. Removing the "slowed down" item from the HADS-D does not influence its internal consistency, and both versions have similar associations with clinical outcomes.
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18
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McKeever JD, Schultheis MT, Sim T, Goykhman J, Patrick K, Ehde DM, Woods SP. Selective reminding of prospective memory in Multiple Sclerosis. Neuropsychol Rehabil 2017; 29:675-690. [PMID: 28424025 DOI: 10.1080/09602011.2017.1313747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS) is associated with prospective memory (PM) deficits, which may increase the risk of poor functional/health outcomes such as medication non-adherence. This study examined the potential benefits of selective reminding to enhance PM functioning in persons with MS. METHOD Twenty-one participants with MS and 22 healthy adults (HA) underwent a neuropsychological battery including a Selective Reminding PM (SRPM) experimental procedure. Participants were randomly assigned to either: (1) a selective reminding condition in which participants learn (to criterion) eight prospective memory tasks in a Selective Reminding format; or (2) a single trial encoding condition (1T). RESULTS A significant interaction was demonstrated, with MS participants receiving greater benefit than HAs from the SR procedure in terms of PM performance. Across diagnostic groups, participants in the SR conditions (vs. 1T conditions) demonstrated significantly better PM performance. Individuals with MS were impaired relative to HAs in the 1T condition, but performance was statistically comparable in the SR condition. CONCLUSIONS This preliminary study suggests that selective reminding can be used to enhance PM cue detection and retrieval in MS. The extent to which selective reminding of PM is effective in naturalistic settings and for health-related behaviours in MS remains to be determined.
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Affiliation(s)
- Joshua D McKeever
- a Department of Psychology , Drexel University , Philadelphia , USA.,b Psychology Service, VA Palo Alto Healthcare System , Palo Alto , USA
| | | | - Tiffanie Sim
- b Psychology Service, VA Palo Alto Healthcare System , Palo Alto , USA
| | - Jessica Goykhman
- a Department of Psychology , Drexel University , Philadelphia , USA
| | - Kristina Patrick
- a Department of Psychology , Drexel University , Philadelphia , USA
| | - Dawn M Ehde
- c Department of Rehabilitation Medicine , University of Washington , Seattle , USA
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19
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Korsen M, Kunz R, Schminke U, Runge U, Kohlmann T, Dressel A. Dalfampridine effects on cognition, fatigue, and dexterity. Brain Behav 2017; 7:e00559. [PMID: 28127507 PMCID: PMC5256171 DOI: 10.1002/brb3.559] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Dalfampridine exerts beneficial effects on walking ability in a subgroup of patients with multiple sclerosis (MS). These patients are termed "responders". Here, we investigated whether the responder status with respect to mobility measures would determine whether dalfampridine treatment exerts a beneficial effect on other MS symptoms. We therefore assessed walking ability, upper limb function, cognition, fatigue, visual evoked potentials (VEPs), depression, and quality of life in patients before and after dalfampridine treatment. METHODS Patients with MS and impaired mobility were recruited. Maximal walking distance, timed 25 Foot Walk, nine hole peg test, paced auditory serial addition test (PASAT), fatigue severity scale (FSS), VEPs, Beck Depression Inventory (BDI), EuroQol five dimensional questionnaire, and quality of life visual analogue scale were determined before and after 12-14 days of dalfampridine treatment. Repeated measures analysis of variance was applied to determine the effect of dalfampridine treatment. RESULTS Of the 34 patients who completed the study, 22 patients were responders and 12 patients nonresponders, according to their performance in mobility measures. Treatment effects for the entire patient cohort were observed for PASAT (p = .029) and BDI (p = .032). Belonging to the responder cohort did not predict the response to treatment in these tests. For the FSS, response to dalfampridine treatment was dependent on the responder status (p = .001) while no effects in the total patient cohort were observed (p = .680). Other neurological functions remained unaltered. For VEP latencies, no significant improvements were detected. CONCLUSION In this study, we observed beneficial effects of dalfampridine on cognition, depression, and fatigue. These effects were not limited to patients who responded to dalfampridine with improved mobility measures. These findings underscore the need to assess the beneficial effects of dalfampridine on neurological deficits in MS patients in additional randomized clinical trials.
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Affiliation(s)
- Melanie Korsen
- Department of Neurology University Medicine Greifswald Greifswald Germany
| | - Rhina Kunz
- Department of Neurology University Medicine Greifswald Greifswald Germany
| | - Ulf Schminke
- Department of Neurology University Medicine Greifswald Greifswald Germany
| | - Uwe Runge
- Department of Neurology University Medicine Greifswald Greifswald Germany
| | - Thomas Kohlmann
- Institute of Community Medicine University Medicine Greifswald Greifswald Germany
| | - Alexander Dressel
- Department of Neurology University Medicine Greifswald Greifswald Germany; Department of Neurology Carl-Thiem-Klinikum Cottbus Cottbus Germany
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20
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Hind D, Kaklamanou D, Beever D, Webster R, Lee E, Barkham M, Cooper C. The assessment of depression in people with multiple sclerosis: a systematic review of psychometric validation studies. BMC Psychiatry 2016; 16:278. [PMID: 27491674 PMCID: PMC4973535 DOI: 10.1186/s12888-016-0931-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 06/15/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The prevalence of depression in people with multiple sclerosis (PwMS) is high; however, symptoms common to both conditions makes measurement difficult. There is no high quality overview of validation studies to guide the choice of depression inventory for this population. METHODS A systematic review of studies validating the use of generic depression inventories in people with MS was conducted using MEDLINE and PsycINFO. Studies validating the use of depression inventories in PwMS and published in English were included; validation studies of tests for cognitive function and general mental health were excluded. Eligible studies were then quality assessed using the COSMIN checklist and findings synthesised narratively by instrument and validity domain. RESULTS Twenty-one studies (N = 5,991 PwMS) evaluating 12 instruments were included in the review. Risk of bias varied greatly between instrument and validity domain. CONCLUSIONS The review of validation studies was constrained by poor quality reporting and outcome reporting bias. Well-conducted evaluations of some instruments are unavailable for some validity domains. This systematic review provides an evidence base for trade-offs in the selection of an instrument for assessing self-reported symptoms of depression in research or clinical practice involving people with MS. We make detailed and specific recommendations for where further research is needed. TRIAL REGISTRATION PROSPERO CRD42014010597.
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Affiliation(s)
- Daniel Hind
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Daphne Kaklamanou
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Heart of the Campus, 42 Collegiate Crescent, Sheffield, S10 2BQ, UK.
| | - Dan Beever
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Ellen Lee
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Michael Barkham
- Centre for Psychological Services Research, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Cindy Cooper
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
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21
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Chruzander C, Gottberg K, Ytterberg C, Backenroth G, Fredrikson S, Widén Holmqvist L, Johansson S. A single-group pilot feasibility study of cognitive behavioural therapy in people with multiple sclerosis with depressive symptoms. Disabil Rehabil 2016; 38:2383-91. [PMID: 26750510 DOI: 10.3109/09638288.2015.1130179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aims were to evaluate (a) the feasibility of face-to-face cognitive behavioural therapy (CBT) in people with MS (PwMS) with depressive symptoms; (b) the feasibility of methods and measurements used; and (c) the outcome of the intervention before the conducting of an equivalence study of comparative methods of face-to-face CBT. DESIGN A single-group pilot feasibility study. PATIENTS PwMS (n = 15) with sub-threshold to moderate depressive symptoms, recruited at the Karolinska University Hospital, Stockholm, Sweden. METHODS The intervention consisted of 15-20 sessions of face-to-face CBT. Feasibility outcomes included recruitment rate, recruitment procedure and adverse events. Primary clinical outcome was the Beck Depression Inventory-II (BDI-II). Follow-ups were conducted after 3 weeks and 3 months. An estimated sample size calculation was conducted. RESULTS The face-to-face CBT intervention, methods and measurements used were feasible. The outcome on BDI-II indicated that face-to-face CBT is an effective method for alleviating sub-threshold to moderate depressive symptoms in PwMS. CONCLUSION Face-to-face CBT is feasible for use in PwMS aiming at decrease depressive symptoms. For an equivalence study, a screening process for depressive symptoms and two comparative intervention arms including traditional face-to-face CBT and low-intensity face-to-face CBT is recommended. Primary outcomes should include the BDI-II and also assessment of anxiety symptoms. Implications for Rehabilitation Depression is common among people with MS (PwMS), however, depressed PwMS do not always receive adequate treatment for depression which may lead to increased disability and worse health-related quality of life (HRQL). Cognitive behavioural therapy (CBT) is a psychological treatment method that might be beneficial for PwMS with depressive symptoms, but the evidence is still weak and further research is needed. The results from our pilot feasibility study demonstrate that for an effectiveness study of face-to-face CBT for PwMS with sub-threshold to moderate depressive symptoms the following points should be acknowledged. The design of an effectiveness study should be a randomized controlled trial including two treatment arms: traditional face-to-face CBT and a low-intensity face-to-face CBT. To increase the inclusion rate a screening process for depressive symptoms is recommended. Primary outcomes besides the Beck Depression Inventory-II should include the Hospital Anxiety and Depression Scale in order to capture anxiety symptoms and the Multiple Sclerosis Impact Scale-29 to capture HRQL.
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Affiliation(s)
- Charlotte Chruzander
- a Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Huddinge , Sweden ;,b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden ;,c Department of Physiotherapy , Karolinska University Hospital , Stockholm , Sweden
| | - Kristina Gottberg
- a Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Huddinge , Sweden ;,b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Charlotte Ytterberg
- a Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Huddinge , Sweden ;,b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden ;,c Department of Physiotherapy , Karolinska University Hospital , Stockholm , Sweden
| | - Gunnel Backenroth
- b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Sten Fredrikson
- b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Lotta Widén Holmqvist
- a Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Huddinge , Sweden ;,b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden ;,c Department of Physiotherapy , Karolinska University Hospital , Stockholm , Sweden
| | - Sverker Johansson
- a Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Huddinge , Sweden ;,b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden ;,c Department of Physiotherapy , Karolinska University Hospital , Stockholm , Sweden
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22
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Fischer A, Fischer M, Nicholls RA, Lau S, Poettgen J, Patas K, Heesen C, Gold SM. Diagnostic accuracy for major depression in multiple sclerosis using self-report questionnaires. Brain Behav 2015; 5:e00365. [PMID: 26445703 PMCID: PMC4589811 DOI: 10.1002/brb3.365] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/31/2015] [Accepted: 06/07/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Multiple sclerosis and major depressive disorder frequently co-occur but depression often remains undiagnosed in this population. Self-rated depression questionnaires are a good option where clinician-based standardized diagnostics are not feasible. However, there is a paucity of data on diagnostic accuracy of self-report measures for depression in multiple sclerosis (MS). Moreover, head-to-head comparisons of common questionnaires are largely lacking. This could be particularly relevant for high-risk patients with depressive symptoms. Here, we compare the diagnostic accuracy of the Beck Depression Inventory (BDI) and 30-item version of the Inventory of Depressive Symptomatology Self-Rated (IDS-SR30) for major depressive disorder (MSS) against diagnosis by a structured clinical interview. METHODS Patients reporting depressive symptoms completed the BDI, the IDS-SR30 and underwent diagnostic assessment (Mini International Neuropsychiatric Interview, M.I.N.I.). Receiver-Operating Characteristic analyses were performed, providing error estimates and false-positive/negative rates of suggested thresholds. RESULTS Data from n = 31 MS patients were available. BDI and IDS-SR30 total score were significantly correlated (r = 0.82). The IDS-SR30total score, cognitive subscore, and BDI showed excellent to good accuracy (area under the curve (AUC) 0.86, 0.91, and 0.85, respectively). CONCLUSION Both the IDS-SR30 and the BDI are useful to quantify depressive symptoms showing good sensitivity and specificity. The IDS-SR30 cognitive subscale may be useful as a screening tool and to quantify affective/cognitive depressive symptomatology.
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Affiliation(s)
- Anja Fischer
- Department of Health Psychology, King's College London SE1 9RT, London, UK ; Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Marcus Fischer
- Department of Pharmaceutical Chemistry, University of California San Francisco San Francisco, California, 94158
| | - Robert A Nicholls
- Structural Studies Division, MRC Laboratory of Molecular Biology Cambridge, CB2 0QH, UK
| | - Stephanie Lau
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Jana Poettgen
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Kostas Patas
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Christoph Heesen
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany ; Department of Neurology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Stefan M Gold
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany ; Department of Medical Psychology, University Medical Center Hamburg-Eppendorf Hamburg, Germany ; Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (CBF), Charité Universitätsmedizin Berlin, Germany
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Strober LB, Arnett PA. Depression in multiple sclerosis: The utility of common self-report instruments and development of a disease-specific measure. J Clin Exp Neuropsychol 2015. [PMID: 26223270 DOI: 10.1080/13803395.2015.1063591] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The ultimate objective of the present investigation was to improve the detection of depression in multiple sclerosis (MS) by comparing common self-report depression measures to a new, modified measure, which takes into account the contribution that symptoms of MS may have on individuals' reports. There has been a longstanding concern regarding the accurate assessment of depression in MS, particularly with regard to the overlap of MS symptomatology and neurovegetative depression symptoms on self-report questionnaires, which may lead to an overdiagnosis of depression in MS. To address these difficulties, we previously proposed a "trunk and branch" of depression in MS. This model allows for the delineation of what symptoms are most reflective of depression in MS. By identifying these symptoms, it was possible to develop a modified Beck Depression Inventory (BDI) in which only the items found to be most related to depression in MS are included in the new measure, the MS Specific BDI (MS-BDI). We compared this measure to common self-report instruments (Beck Depression Inventory-Second Edition, BDI-II; Beck Depression Inventory-Fast Screen, BDI-FS; Chicago Multiscale Depression Inventory, CMDI). Results suggest that cutoffs of 4 on the BDI-FS and 23 on the CMDI Mood subscale are most useful when screening for depression in MS, with a sensitivity for both of 100%, while a cutoff of 19 on the BDI-II, a cutoff of 22 on the CMDI Evaluative scale, and a cutoff of 8 on the MS-BDI had high specificities, suggesting they can be used as to assist in diagnosing depression in MS.
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Affiliation(s)
- Lauren B Strober
- a Neuropsychology and Neuroscience Laboratory , Kessler Foundation , West Orange , NJ , USA
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Wardenaar KJ, Wanders RBK, Roest AM, Meijer RR, De Jonge P. What does the beck depression inventory measure in myocardial infarction patients? a psychometric approach using item response theory and person-fit. Int J Methods Psychiatr Res 2015; 24:130-42. [PMID: 25994207 PMCID: PMC6878327 DOI: 10.1002/mpr.1467] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/04/2015] [Accepted: 03/17/2015] [Indexed: 11/05/2022] Open
Abstract
Observed associations between depression following myocardial infarction (MI) and adverse cardiac outcomes could be overestimated due to patients' tendency to over report somatic depressive symptoms. This study was aimed to investigate this issue with modern psychometrics, using item response theory (IRT) and person-fit statistics to investigate if the Beck Depression Inventory (BDI) measures depression or something else among MI-patients. An IRT-model was fit to BDI-data of 1135 MI patients. Patients' adherence to this IRT-model was investigated with person-fit statistics. Subgroups of "atypical" (low person-fit) and "prototypical" (high person-fit) responders were identified and compared in terms of item-response patterns, psychiatric diagnoses, socio-demographics and somatic factors. In the IRT model, somatic items had lower thresholds compared to depressive mood/cognition items. Empirically identified "atypical" responders (n = 113) had more depressive mood/cognitions, scored lower on somatic items and more often had a Comprehensive International Diagnostic Interview (CIDI) depressive diagnosis than "prototypical" responders (n = 147). Additionally, "atypical" responders were younger and more likely to smoke. In conclusion, the BDI measures somatic symptoms in most MI patients, but measures depression in a subgroup of patients with atypical response patterns. The presented approach to account for interpersonal differences in item responding could help improve the validity of depression assessments in somatic patients.
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Affiliation(s)
- Klaas J Wardenaar
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
| | - Rob B K Wanders
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
| | - Annelieke M Roest
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
| | - Rob R Meijer
- Department of Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands
| | - Peter De Jonge
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
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Grech LB, Kiropoulos LA, Kirby KM, Butler E, Paine M, Hester R. The effect of executive function on stress, depression, anxiety, and quality of life in multiple sclerosis. J Clin Exp Neuropsychol 2015; 37:549-62. [DOI: 10.1080/13803395.2015.1037723] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Does Self-Efficacy Affect Cognitive Performance in Persons with Clinically Isolated Syndrome and Early Relapsing Remitting Multiple Sclerosis? Mult Scler Int 2015; 2015:960282. [PMID: 26064686 PMCID: PMC4429205 DOI: 10.1155/2015/960282] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/15/2015] [Indexed: 11/28/2022] Open
Abstract
In persons with multiple sclerosis (MS) a lowered self-efficacy negatively affects physical activities. Against this background we studied the relationship between self-efficacy and cognitive performance in the early stages of MS. Thirty-three patients with Clinically Isolated Syndrome (CIS) and early Relapsing Remitting MS (eRRMS) were assessed for self-efficacy (MSSES-18), cognition (CDR System), fatigue (MFIS-5), depressive symptoms (BDI), disease impact (MSIS-29), and disability (EDSS). Correlative analyses were performed between self-efficacy and cognitive scores, and stepwise regression analyses identified predictors of cognition and self-efficacy. Good correlations existed between total self-efficacy and Power of Attention (r= 0.65; P< 0.001), Reaction Time Variability (r= 0.57; P< 0.001), and Speed of Memory (r= 0.53; P< 0.01), and between control self-efficacy and Reaction Time Variability (r= 0.55; P< 0.01). Total self-efficacy predicted 40% of Power of Attention, 34% of Reaction Time Variability, and 40% of Speed of Memory variabilities. Disease impact predicted 65% of total self-efficacy and 58% of control self-efficacy variabilities. The findings may suggest that in persons with CIS and eRRMS self-efficacy may positively affect cognitive performance and that prevention of disease activity may preserve self-efficacy.
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Safi SZ. A Fresh Look at the Potential Mechanisms of Progressive Muscle Relaxation Therapy on Depression in Female Patients With Multiple Sclerosis. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2015; 9:e340. [PMID: 26251663 PMCID: PMC4525452 DOI: 10.17795/ijpbs340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/28/2014] [Accepted: 01/21/2015] [Indexed: 11/25/2022]
Abstract
Background: According to the World Health Organization (WHO) report released in 2000, about 121 million people worldwide suffer from depression. The major depressive disorder (MDD) among multiple sclerosis (MS) patients is one of the most common mood disorders experienced during life. MS patients who simultaneously suffer from depression have reported more severe symptoms of disease and slower adaptation to new conditions, which ultimately increase the cost of treatment. Objectives: The aim of this study was to assess the effectiveness of progressive muscle relaxation therapy (PMRT) as an adjunctive therapy for reducing level of depression for MS patients. Materials and Methods: This research had the randomized controlled trial design with pre and posttest. Thirty female patients based on criteria of MS and MDD disease, were selected from the MS Society of Shiraz, Iran. Beck Depression Inventory (BDI-II) was administered at pre and posttest. The participants were randomly allocated to two groups (experimental and control). Twelve sessions of PMRT using Bernstein and Borkovec’s method were held for the experimental group. Levin’s test, covariance and ANOVA with repeated measures were used for data analysis. Results: Experimental and control groups were compared before and after treatment. Analysis of covariance showed that seven levels of depression decreased in the experimental group and analysis of repeated measure showed that 49% of the changes were related to PMRT. Conclusion: According to the results, PMRT is effective in reducing depression. This therapy enables patients to reach relaxation quickly, and thus can cope with depression reactions effectively.
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A Fresh Look at the Potential Mechanisms of Progressive Muscle Relaxation Therapy on Depression in Female Patients With Multiple Sclerosis. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2015. [DOI: 10.5812/ijpbs.340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Raimo S, Trojano L, Spitaleri D, Petretta V, Grossi D, Santangelo G. Psychometric properties of the Hamilton Depression Rating Scale in multiple sclerosis. Qual Life Res 2015; 24:1973-80. [PMID: 25669154 DOI: 10.1007/s11136-015-0940-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is frequently associated with depressive symptoms and major depression. OBJECTIVE We assessed psychometric properties of the Hamilton Depression Rating Scale (HDRS, 17-item version) for assessing depressive symptomatology in a sample of MS patients. METHODS Seventy patients (aged 43.3 ± 10.3 years) completed the HDRS and a thorough clinical and neuropsychological assessment, including diagnosis of major depression according to the established clinical criteria. RESULTS HDRS was easy to administer and acceptable, and showed fair internal consistency (Cronbach's alpha = 0.8). The HDRS showed good convergent validity with respect to neuropsychiatric inventory (NPI) subdomain of depression (r rho = .85) and good divergent validity with respect to remaining NPI subdomains (r rho < .30). Moreover, HDRS's total score correlated moderately with functional disability and apathetic symptomatology, and poorly with general cognitive status. Receiver operating characteristics curve analysis demonstrated that a cutoff >14.5 can identify clinically relevant depressive symptoms with good sensitivity (93 %) and specificity (97 %) with respect to the diagnosis of major depression. Such a cutoff identified clinically relevant depressive symptoms in 42 % of our MS sample, whereas 44.2 % patients met established clinical criteria for major depression. CONCLUSION The HDRS can be considered as an easy, reliable, and valid tool to assess depressive symptomatology for clinical and research purposes in non-demented MS patients.
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Affiliation(s)
- Simona Raimo
- Department of Psychology, Second University of Naples, Viale Ellittico, 31, Caserta, Italy
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Moodley J. Women's mental health: coping mechanisms in the context of poverty. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2014.906078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Jacqueline Moodley
- Centre for Social Development in Africa, University of Johannesburg, Johannesburg, South Africa
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Jongen PJ, Lehnick D, Koeman J, Frequin S, Heersema D, Kornips B, Schyns-Soeterboek A, Visser LH, Schiphof P, Valkenburg A, Hiel J. Fatigue and health-related quality of life in relapsing-remitting multiple sclerosis after 2 years glatiramer acetate treatment are predicted by changes at 6 months: an observational multi-center study. J Neurol 2014; 261:1469-76. [PMID: 24792727 PMCID: PMC4119257 DOI: 10.1007/s00415-014-7363-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/18/2014] [Accepted: 04/18/2014] [Indexed: 11/28/2022]
Abstract
Observational studies of up to 12 months duration showed that glatiramer acetate (GA) treatment of relapsing-remitting multiple sclerosis may result in decreased fatigue and improves health-related quality of life (HRQoL), with no changes in disability or mood. We investigated whether in the second year of treatment these improvements are sustained, disability or mood yet improved, and 2-year changes may be predicted by changes in the first 6 or 12 months. The multi-center FOCUS-Extension study was a prospective extension of the 12-month, international, observational FOCUS study and included 67 patients (38 treatment-naïve, 29 pre-treated) of the Dutch FOCUS cohort. Fatigue, HRQoL, depression and disability were measured by the Fatigue Impact Scale (FIS), Leeds Multiple Sclerosis Quality of Life (LMSQoL) questionnaire, Beck Depression Inventory-Short Form and the Guy's Neurological Disability Scale. A 2-year period of GA treatment was associated with -0.52 and +0.66 standard deviation changes in mean FIS and LMSQoL scores compared to baseline, whereas disability and mood remained unchanged. For FIS and LMSQoL, the Pearson correlation coefficients between 6-month changes and 2-year scores were 0.47 and 0.50, and between 12-month changes and 2-year scores 0.65 and 0.62. After 2 years GA treatment, the improvements in fatigue and HRQoL observed at 1 year are sustained, whereas disability and mood remain unchanged compared to baseline. Moreover, the levels of fatigue and HRQoL at 2 years GA treatment are predicted by the improvements at 6 months.
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Jongen PJ, Wesnes K, van Geel B, Pop P, Sanders E, Schrijver H, Visser LH, Gilhuis HJ, Sinnige LG, Brands AM. Relationship between working hours and power of attention, memory, fatigue, depression and self-efficacy one year after diagnosis of clinically isolated syndrome and relapsing remitting multiple sclerosis. PLoS One 2014; 9:e96444. [PMID: 24787714 PMCID: PMC4006840 DOI: 10.1371/journal.pone.0096444] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 04/09/2014] [Indexed: 11/18/2022] Open
Abstract
The role of cognitive domain dysfunction with respect to vocational changes in persons with Clinically Isolated Syndrome (CIS) and early Relapsing Remitting Multiple Sclerosis (eRRMS) is insufficiently known. We investigated thirty-three patients - 14 CIS, 19 eRRMS -, mean (standard deviation [SD]) time since diagnosis 13.5 (4.8) months and mean (SD) Expanded Disability Status Scale (EDSS) score 1.3 (1.1). Patients were assessed on the CDR System, a set of automated tests of cognitive function, which yielded scores for Power of Attention (ms), Continuity of Attention (#), Working Memory (SI), Episodic Memory (#) and Speed of Memory (ms). Work-related items and the confounding variables fatigue, depression, disease impact and self-efficacy, were assessed by self-report questionnaires. Patients had poorer Power of Attention compared to normative data (1187 [161.5] vs. 1070 [98.6]; P<0.0001) and slower Speed of Memory (4043 [830.6]) vs. 2937 [586.1]; P<0.0001). Power of Attention (Pearson r = −0.42; P<0.04), Working Memory (r = 0.42; P<0.04) and depression r = −0.41; P<0.05) correlated with number of days worked per week. Fatigue (r = −0.56; P<0.005), self-efficacy (r = 0.56; P<0.005) and disease impact (r = −0.46; P<0.05) correlated with number of hours worked per week. Persons who wished to work less had poorer Power of Attention (1247 vs. 1116 ms; P<0.02), those who wished to change job had poorer Episodic Memory (1.35 vs. 1.57; p<0.03). People who reduced working hours within 12 months after diagnosis had higher fatigue and disease impact, and lower self-efficacy. The findings of this pilot study indicate that one year after the diagnosis of CIS and RRMS Power of Attention and Speed of Memory are reduced, that Power of Attention and Memory are associated with a capability of working less hours, and that fatigue, depression and disease impact may negatively, and self-efficacy positively affect working hours.
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Affiliation(s)
| | - Keith Wesnes
- Bracket, Goring-on-Thames, United Kingdom; Swinburne University, Melbourne, Australia
| | | | - Paul Pop
- Viecuri Medisch Centrum, Venlo-Venray, The Netherlands
| | | | | | - Leo H Visser
- St. Elisabeth Ziekenhuis, Tilburg, The Netherlands
| | | | | | - Augustina M Brands
- Department of Experimental Psychology, Utrecht University, The Netherlands; Zuwe Hofpoort Ziekenhuis/Regionaal Psychiatrisch Centrum Woerden, The Netherlands
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Osborne LA, Gareth Noble J, Maramba IDC, Jones KH, Middleton RM, Lyons RA, Ford DV, Reed P. Outcome measures for multiple sclerosis. PHYSICAL THERAPY REVIEWS 2014. [DOI: 10.1179/1743288x13y.0000000094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Carlozzi NE, Miciura A, Migliore N, Dayalu P. Understanding the Outcomes Measures used in Huntington Disease Pharmacological Trials: A Systematic Review. J Huntingtons Dis 2014; 3:233-52. [PMID: 25300328 PMCID: PMC4217648 DOI: 10.3233/jhd-140115] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The identification of the gene mutation causing Huntington disease has raised hopes for new treatments to ease symptoms and slow functional decline. As such, there has been a push towards designing efficient pharmacological trials (i.e., drug trials), especially with regard to selecting outcomes measures that are both brief and sensitive to changes across the course of the disease, from subtle prodromal changes, to more severe end-stage changes. OBJECTIVES Recently, to aid in efficient development of new HD research studies, the National Institute of Neurological Disorders and Stroke (NINDS) published recommendations for measurement selection in HD. While these recommendations are helpful, many of the recommended measures have little published data in HD. As such, we conducted a systematic review of the literature to identify the most common outcomes measures used in HD clinical trials. METHODS Major medical databases, including PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials, were used to identify peer-reviewed journal articles in English from 2001 through April 2013; 151 pharmacological trials were identified. RESULTS The majority of HD clinical trials employed clinician-reported outcomes measures (93%); patient reported outcome measures (11%) and observer reported outcome measures (3%) were used with much less frequency. CONCLUSIONS We provide a review of the most commonly used measures across these trials, compare these measures to the clinical recommendations made by the NINDS working groups, and provide recommendations for selecting measures for future clinical trials that meet the Food and Drug Administration standards.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Angela Miciura
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Migliore
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Praveen Dayalu
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
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Assessing depression in obese women: an examination of two commonly-used measures. J Psychosom Res 2013; 75:425-30. [PMID: 24182630 PMCID: PMC3886826 DOI: 10.1016/j.jpsychores.2013.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 08/22/2013] [Accepted: 08/23/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Obesity and depression are associated with somatic complaints that may complicate the measurement of depression in obese individuals. The Beck Depression Inventory-II (BDI-II) and the Hamilton Rating Scale for Depression (HRSD) are frequently used to measure depression severity. The BDI-II and HRSD's ability to measure depression severity may be compromised in those with obesity, to the extent that scores on their somatic items stem more from obesity than from depression. This study examined the: 1) internal consistency of the BDI-II and HRSD among obese women who varied in depressive symptomatology and 2) total and item-level change in the measures among participants who met the criteria for depression remission at 6-months. METHODS Data were from a randomized controlled trial of obese women with depression who received either behavioral activation for depression followed by a lifestyle intervention or a lifestyle intervention with attention control. RESULTS At screening (n=355), internal consistency was strong for the BDI-II (α=0.89), but moderate for the HRSD (α=0.67). Among the participants who met the criteria for depression remission following treatment (n=115), every BDI-II item showed significant change at 6-months. In contrast, three HRSD items did not significantly change: the anxiety-somatic (p=0.063), somatic symptoms-gastrointestinal (p=1.000) and loss of weight (p=0.319) items. CONCLUSION The BDI-II may be more reliable and sensitive to change than the HRSD in obese women with comorbid depression. Intervention studies involving obese, depressed women should consider these findings in selecting depression outcome measures.
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Pagoto S, Schneider KL, Whited MC, Oleski JL, Merriam P, Appelhans B, Ma Y, Olendzki B, Waring ME, Busch AM, Lemon S, Ockene I, Crawford S. Randomized controlled trial of behavioral treatment for comorbid obesity and depression in women: the Be Active Trial. Int J Obes (Lond) 2013; 37:1427-34. [PMID: 23459323 PMCID: PMC3675166 DOI: 10.1038/ijo.2013.25] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 01/04/2013] [Accepted: 01/13/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Depression is associated with increased risk for obesity and worse weight loss treatment outcomes. The purpose of the present study was to test the hypothesis that delivering evidence-based behavior therapy for depression before a lifestyle weight loss intervention improves both weight loss and depression. DESIGN In a randomized controlled trial, obese women with major depressive disorder (N=161, mean age=45.9 (s.d.: 10.8) years) were randomized to brief behavior therapy for depression treatment followed by a lifestyle intervention (BA) or a lifestyle intervention only (LI). Follow-up occurred at 6 and 12 months. Main outcome measures included weight loss and depression symptoms. RESULTS Intention-to-treat analyses revealed both conditions lost significant weight, but no differences between conditions in weight change at 6 months (BA=-3.0%, s.e.=-0.65%; LI=-3.7%, s.e.=0.63%; P=0.48) or 12 months (BA=-2.6%, s.e.=0.77%; LI=-3.1%, s.e.=0.74%; P=0.72). However, the BA condition evidenced significantly greater improvement in Beck Depression Inventory-II scores relative to the LI condition at both 6 months (BA mean change=-12.5, s.d.=0.85; LI mean change=-9.2, s.d.=0.80, P=0.005) and 12 months (BA mean change=-12.6, s.d.=0.97; LI mean change=-9.9, s.d.=0.93; P=0.045). Participants who experienced depression remission by 6 months (61.2%) lost greater weight (mean=-4.31%; s.e.=0.052) than those who did not (39.7%; mean=-2.47%, s.e.=0.53; P=.001). CONCLUSION Adding behavior therapy to a lifestyle intervention results in greater depression remission but does not improve weight loss within 1 year. Improvement in depression is associated with greater weight loss.
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Affiliation(s)
- S Pagoto
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Schwedt TJ, Larson-Prior L, Coalson RS, Nolan T, Mar S, Ances BM, Benzinger T, Schlaggar BL. Allodynia and descending pain modulation in migraine: a resting state functional connectivity analysis. PAIN MEDICINE 2013; 15:154-65. [PMID: 24165094 DOI: 10.1111/pme.12267] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Most migraineurs develop cutaneous allodynia during migraines, and many have cutaneous sensitization between attacks. Atypical pain modulation via the descending pain system may contribute to this sensitization and allodynia. The objective of this study was to test the hypothesis that compared with non-allodynic migraineurs, allodynic migraineurs have atypical periaqueductal gray (PAG) and nucleus cuneiformis (NCF) resting-state functional connectivity (rs-fc) with other pain processing regions. DESIGN Ten minutes resting-state blood-oxygen-level-dependent data were collected from 38 adult migraineurs and 20 controls. Seed-based analyses compared whole-brain rs-fc with PAG and with NCF in migraineurs with severe ictal allodynia (N = 8) to migraineurs with no ictal allodynia (N = 8). Correlations between the strength of functional connections that differed between severely allodynic and non-allodynic migraineurs with allodynia severity were determined for all migraineurs (N = 38). PAG and NCF rs-fc in all migraineurs was compared with rs-fc in controls. RESULTS Migraineurs with severe allodynia had stronger PAG and NCF rs-fc to other brainstem, thalamic, insula and cerebellar regions that participate in discriminative pain processing, as well as to frontal and temporal regions implicated in higher order pain modulation. Evidence that these rs-fc differences were specific for allodynia included: 1) strong correlations between some rs-fc strengths and allodynia severity among all migraineurs; and 2) absence of overlap when comparing rs-fc differences in severely allodynic vs non-allodynic migraineurs with those in all migraineurs vs controls. CONCLUSION Atypical rs-fc of brainstem descending modulatory pain regions with other brainstem and higher order pain-modulating regions is associated with migraine-related allodynia.
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Matcham F, Rayner L, Steer S, Hotopf M. The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology (Oxford) 2013; 52:2136-48. [PMID: 24003249 PMCID: PMC3828510 DOI: 10.1093/rheumatology/ket169] [Citation(s) in RCA: 511] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective. There is substantial uncertainty regarding the prevalence of depression in RA. We conducted a systematic review aiming to describe the prevalence of depression in RA. Methods. Web of Science, PsycINFO, CINAHL, Embase, Medline and PubMed were searched for cross-sectional studies reporting a prevalence estimate for depression in adult RA patients. Studies were reviewed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and a meta-analysis was performed. Results. A total of 72 studies, including 13 189 patients, were eligible for inclusion in the review. Forty-three methods of defining depression were reported. Meta-analyses revealed the prevalence of major depressive disorder to be 16.8% (95% CI 10%, 24%). According to the PHQ-9, the prevalence of depression was 38.8% (95% CI 34%, 43%), and prevalence levels according to the HADS with thresholds of 8 and 11 were 34.2% (95% CI 25%, 44%) and 14.8% (95% CI 12%, 18%), respectively. The main influence on depression prevalence was the mean age of the sample. Conclusion. Depression is highly prevalent in RA and associated with poorer RA outcomes. This suggests that optimal care of RA patients may include the detection and management of depression.
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Affiliation(s)
- Faith Matcham
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK.
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Cascione M, Wynn D, Barbato LM, Pestreich L, Schofield L, McCague K. Randomized, open-label study to evaluate patient-reported outcomes with fingolimod after changing from prior disease-modifying therapy for relapsing multiple sclerosis: EPOC study rationale and design. J Med Econ 2013; 16:859-65. [PMID: 23647445 DOI: 10.3111/13696998.2013.802239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The study to Evaluate Patient OutComes, Safety, and Tolerability of Fingolimod (EPOC; NCT01216072) aimed to test the hypothesis that therapy change to oral Gilenya (Novartis AG, Stein, Switzerland) (fingolimod) improves patient-reported outcomes compared with standard-of-care disease-modifying therapy (DMT) in patients with relapsing multiple sclerosis; safety and tolerability were also assessed. This communication describes the study rationale and design. METHODS EPOC is a phase 4, open-label, multi-center study conducted in the US and Canada of patients with relapsing forms of multiple sclerosis who are candidates for therapy change. Therapy change eligibility was determined by the treating physician (US patients) or required an inadequate response to or poor tolerance for at least 1 MS therapy (Canadian patients). Patients were randomly assigned in a 3:1 ratio to 6 months of treatment with once-daily oral fingolimod 0.5 mg or standard-of-care DMTs. The primary study end-point was the change from baseline in treatment satisfaction as determined by the global satisfaction sub-scale of the Treatment Satisfaction Questionnaire for Medication. Secondary end-points included changes from baseline in perceived effectiveness and side-effects, and measures of activities of daily living, fatigue, depression, and quality-of-life. A 3-month open-label fingolimod extension was available for patients randomly assigned to the DMT group who successfully completed all study visits. RESULTS Enrollment has been completed with 1053 patients; the patient population is generally older and has a longer duration of disease compared with populations from phase 3 studies of fingolimod. LIMITATIONS Inclusion criteria selected for patients with a sub-optimal experience with a previous DMT, limiting the collection of data on therapy change in patients who were satisfied with their previous DMT. CONCLUSIONS Results of the EPOC study are anticipated in early 2013 and will inform treatment selection by providing patient-centered data on therapy switch to fingolimod or standard-of-care DMTs. TRIAL REGISTRATION ClinicalTrials.gov NCT01216072.
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Affiliation(s)
- Mark Cascione
- Tampa Neurology Associates, South Tampa Multiple Sclerosis Center, Tampa, FL 33609, USA.
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Tedeschini E, Pingani L, Simoni E, Ferrari D, Giubbarelli C, Giuggioli D, Lumetti F, Rigatelli M, Ferri C, Ferrari S. Correlation of articular involvement, skin disfigurement and unemployment with depressive symptoms in patients with systemic sclerosis: a hospital sample. Int J Rheum Dis 2013; 17:186-94. [DOI: 10.1111/1756-185x.12100] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Luca Pingani
- Department of Human Resources; Azienda USL Reggio Emilia; Reggio Emilia Italy
- International PhD School in Clinical and Experimental Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Elena Simoni
- Psychiatry Unit; Department of Clinical-Diagnostic Medicine and Public Health; University of Modena and Reggio Emilia; Modena Italy
| | - Daniela Ferrari
- Rheumatology Unit; Department of Internal Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Cinzia Giubbarelli
- Psychiatry Unit; Department of Clinical-Diagnostic Medicine and Public Health; University of Modena and Reggio Emilia; Modena Italy
| | - Dilia Giuggioli
- Rheumatology Unit; Department of Internal Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Federica Lumetti
- Rheumatology Unit; Department of Internal Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Marco Rigatelli
- Psychiatry Unit; Department of Clinical-Diagnostic Medicine and Public Health; University of Modena and Reggio Emilia; Modena Italy
| | - Clodoveo Ferri
- Rheumatology Unit; Department of Internal Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Silvia Ferrari
- Psychiatry Unit; Department of Clinical-Diagnostic Medicine and Public Health; University of Modena and Reggio Emilia; Modena Italy
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Schwedt TJ, Schlaggar BL, Mar S, Nolan T, Coalson RS, Nardos B, Benzinger T, Larson-Prior LJ. Atypical resting-state functional connectivity of affective pain regions in chronic migraine. Headache 2013; 53:737-51. [PMID: 23551164 DOI: 10.1111/head.12081] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Chronic migraineurs (CM) have painful intolerances to somatosensory, visual, olfactory, and auditory stimuli during and between migraine attacks. These intolerances are suggestive of atypical affective responses to potentially noxious stimuli. We hypothesized that atypical resting-state functional connectivity (rs-fc) of affective pain-processing brain regions may associate with these intolerances. This study compared rs-fc of affective pain-processing regions in CM with controls. METHODS Twelve minutes of resting-state blood oxygenation level-dependent data were collected from 20 interictal adult CM and 20 controls. Rs-fc between 5 affective regions (anterior cingulate cortex, right/left anterior insula, and right/left amygdala) with the rest of the brain was determined. Functional connections consistently differing between CM and controls were identified using summary analyses. Correlations between number of migraine years and the strengths of functional connections that consistently differed between CM and controls were calculated. RESULTS Functional connections with affective pain regions that differed in CM and controls included regions in anterior insula, amygdala, pulvinar, mediodorsal thalamus, middle temporal cortex, and periaqueductal gray. There were significant correlations between the number of years with CM and functional connectivity strength between the anterior insula with mediodorsal thalamus and anterior insula with periaqueductal gray. CONCLUSION CM is associated with interictal atypical rs-fc of affective pain regions with pain-facilitating and pain-inhibiting regions that participate in sensory-discriminative, cognitive, and integrative domains of the pain experience. Atypical rs-fc with affective pain regions may relate to aberrant affective pain processing and atypical affective responses to painful stimuli characteristic of CM.
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Affiliation(s)
- Todd J Schwedt
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
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Abstract
This paper considers the issue of the measurement of depression with those who have a primary diagnosis of schizophrenia. Originally the concept of depression as a core aspect of schizophrenia was raised by Bleuler and that affective disorders are associated with psychosis raised by Kraepelin. The construct of depression within the context of schizophrenia as a distinct condition that constitutes an apparent shift from the individual's usual cognitive style, affect and functioning, is an observation that has been relatively recently highlighted. In individuals with a primary diagnosis of schizophrenia comorbid depression can be a factor in risk of suicide, impaired level of functioning, and higher rates of relapse or rehospitalization. The assessment of depression in this population creates many challenges in relation to the differentiation of this condition within the complex presentation of schizophrenia. The depression literature may refer to: (i) depressed affect; (ii) depression as a symptom isolated from the wider signs of depressive illness; and (iii) depression as a syndrome with all the facets required for a formal diagnosis. This review considers the literature in relation to the measurement of depression in people with a primary diagnosis of schizophrenia and assesses the psychometric properties of those measures with this population.
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Affiliation(s)
- B Scholes
- Lecturer in Mental Health Chair in Mental Health, School of Health, Nursing and Midwifery, University of the West of Scotland, Ayr, UK
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Sundgren M, Maurex L, Wahlin Å, Piehl F, Brismar T. Cognitive impairment has a strong relation to nonsomatic symptoms of depression in relapsing-remitting multiple sclerosis. Arch Clin Neuropsychol 2013; 28:144-55. [PMID: 23291310 DOI: 10.1093/arclin/acs113] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
It is unclear how cognitive impairment in multiple sclerosis (MS) is influenced by physical disability, fatigue, and depression. Our aim was to identify the strongest clinical predictors for cognitive impairment in relapsing-remitting MS (RRMS) patients. The clinical risk factors included in the analysis were physical disability (EDSS), fatigue (FSS), the somatic and nonsomatic components of depression (BDI), disease progression rate [Multiple Sclerosis Severity Score (MSSS)], and psychotropic medication. Cognitive impairment had a prevalence of 30.5% in patients affecting preferentially attention, executive functions, processing speed and visual perception/organization. MSSS was not associated with cognitive impairment, depression, or fatigue. In regression models, cognitive performance was best predicted by the nonsomatic symptoms of depression alone or in combination with physical disability. Exclusion of patients with any psychotropic medication did not influence the results. Our results underscore the importance of evaluating depressive symptoms when suspecting cognitive impairment in patients with RRMS.
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Affiliation(s)
- Mathias Sundgren
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Mori F, Nicoletti CG, Kusayanagi H, Foti C, Restivo DA, Marciani MG, Centonze D. Transcranial direct current stimulation ameliorates tactile sensory deficit in multiple sclerosis. Brain Stimul 2012; 6:654-9. [PMID: 23122918 DOI: 10.1016/j.brs.2012.10.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 10/01/2012] [Accepted: 10/07/2012] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Deficit of tactile sensation in patients with MS is frequent and can be associated with interference with daily life activities. Transcranial direct current stimulation (tDCS) showed to increase tactile discrimination in healthy subjects. OBJECTIVE In the present study, we investigated whether tDCS may be effective in ameliorating tactile sensory deficit in MS patients. METHODS Patients received sham or real anodal tDCS of the somatosensory cortex for 5 consecutive days in a randomized, double blind, sham-controlled study. Discrimination thresholds of spatial tactile sensation were measured using the grating orientation task (GOT). As secondary outcomes we also measured subjective perception of tactile sensory deficit through a visual analog scale (VAS), quality of life and overall disability to evaluate the impact of the treatment on patients daily life. Evaluations were performed at baseline and during a 4-week follow-up period. RESULTS Following anodal but not sham tDCS over the somatosensory cortex, there was a significant improvement of discriminatory thresholds at the GOT and increased VAS for sensation scores. Quality of life, and disability changes were not observed. CONCLUSION Our results indicate that a five day course of anodal tDCS is able to ameliorate tactile sensory loss with long-lasting beneficial effects and could thus represent a therapeutic tool for the treatment of tactile sensory deficit in MS patients.
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Affiliation(s)
- Francesco Mori
- Clinica Neurologica, Dipartimento di Neuroscienze, Università Tor Vergata, Rome, Italy.
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Skokou M, Soubasi E, Gourzis P. Depression in multiple sclerosis: a review of assessment and treatment approaches in adult and pediatric populations. ISRN NEUROLOGY 2012; 2012:427102. [PMID: 23097716 PMCID: PMC3477767 DOI: 10.5402/2012/427102] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 09/17/2012] [Indexed: 12/18/2022]
Abstract
Multiple sclerosis is a chronic demyelinating disease affecting one million people worldwide, with a significant burden of psychiatric comorbidity. Depression is the commonest psychiatric manifestation but still remains largely underdiagnosed and undertreated. The present work reviews current knowledge on diagnosis, assessment, and somatic and psychotherapeutic treatment interventions for depression in adult and pediatric populations of patients with multiple sclerosis.
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Affiliation(s)
- Maria Skokou
- Department of Psychiatry, School of Medicine and University Hospital of Patras, University of Patras, Rio, 26504 Patras, Greece
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Abstract
Abstract
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Boeschoten RE, Dekker J, Uitdehaag BMJ, Polman CH, Collette EH, Cuijpers P, Beekman ATF, van Oppen P. Internet-based self-help treatment for depression in multiple sclerosis: study protocol of a randomized controlled trial. BMC Psychiatry 2012; 12:137. [PMID: 22967202 PMCID: PMC3493307 DOI: 10.1186/1471-244x-12-137] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 08/31/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Depression in MS patients is frequent but often not treated adequately. An important underlying factor may be physical limitations that preclude face-to-face contact. Internet-based treatment showed to be effective for depressive symptoms in general and could thus be a promising tool for treatment in MS. METHODS/DESIGN Here, we present a study protocol to investigate the effectiveness of a 5 week Internet-based self-help problem solving treatment (PST) for depressive symptoms in MS patients in a randomized controlled trial. We aim to include 166 MS patients with moderate to severe depressive symptoms who will be randomly assigned to an Internet-based intervention (with or without supportive text-messages) or waiting list control group. The primary outcome is the change in depressive symptoms defined by a change in the sum score on the Beck Depression Inventory (BDI-II). Secondary outcomes will include measures of anxiety, fatigue, cognitive functioning, physical and psychological impact of MS, quality of life, problem solving skills, social support, mastery, satisfaction and compliance rate. Assessments will take place at baseline (T0), within a week after the intervention (T1), at four months (T2) and at ten months follow-up (T3: only the intervention group). The control group will be measured at the same moments in time. Analysis will be based on the intention-to-treat principle. DISCUSSION If shown to be effective, Internet-based PST will offer new possibilities to reach and treat MS patients with depressive symptoms and to improve the quality of care. TRIAL REGISTRATION The Dutch Cochrane Center, NTR2772.
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Affiliation(s)
- Rosa E Boeschoten
- Department of Psychiatry, VU University Medical Center Academic Anxiety Outpatient Clinic and GGZinGeest, A. J. Ernststraat 1187, Amsterdam, HL 1081, The Netherlands.
| | - Joost Dekker
- Department of Psychiatry, VU University Medical Center Academic Anxiety Outpatient Clinic and GGZinGeest, A. J. Ernststraat 1187, Amsterdam, HL, 1081, The Netherlands,EMGO Institute for Mental Health and Care Research, VU University, Amsterdam, The Netherlands
| | - Bernard MJ Uitdehaag
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Chris H Polman
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Emma H Collette
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Pim Cuijpers
- EMGO Institute for Mental Health and Care Research, VU University, Amsterdam, The Netherlands,Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Aartjan TF Beekman
- Department of Psychiatry, VU University Medical Center Academic Anxiety Outpatient Clinic and GGZinGeest, A. J. Ernststraat 1187, Amsterdam, HL, 1081, The Netherlands,EMGO Institute for Mental Health and Care Research, VU University, Amsterdam, The Netherlands
| | - Patricia van Oppen
- Department of Psychiatry, VU University Medical Center Academic Anxiety Outpatient Clinic and GGZinGeest, A. J. Ernststraat 1187, Amsterdam, HL, 1081, The Netherlands,EMGO Institute for Mental Health and Care Research, VU University, Amsterdam, The Netherlands
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Quaranta D, Marra C, Zinno M, Patanella AK, Messina MJ, Piccininni C, Batocchi AP, Gainotti G. Presentation and Validation of the Multiple Sclerosis Depression Rating Scale: A Test Specifically Devised to Investigate Affective Disorders in Multiple Sclerosis Patients. Clin Neuropsychol 2012; 26:571-87. [DOI: 10.1080/13854046.2012.668220] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Muller BE, Erford BT. Choosing Assessment Instruments for Depression Outcome Research With School-Age Youth. JOURNAL OF COUNSELING AND DEVELOPMENT 2012. [DOI: 10.1111/j.1556-6676.2012.00026.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cooper CL, Hind D, Parry GD, Isaac CL, Dimairo M, O'Cathain A, Rose A, Freeman JV, Martin L, Kaltenthaler EC, Thake A, Sharrack B. Computerised cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis: external pilot trial. Trials 2011; 12:259. [PMID: 22168507 PMCID: PMC3272061 DOI: 10.1186/1745-6215-12-259] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 12/14/2011] [Indexed: 11/10/2022] Open
Abstract
Background People with multiple sclerosis (MS) are at high risk of depression. We undertook a pilot trial of computerised cognitive behavioural therapy (CCBT) for the treatment of depression in people with MS to test the feasibility of undertaking a full trial. Methods Participants with a diagnosis of MS and clinical levels of depression were recruited through out-patient clinics and postal screening questionnaires at two UK centres and randomised to CCBT or usual care. Clinical outcomes included the Beck Depression Inventory (BDI-II) and Multiple Sclerosis Impact Scale (MSIS-29) at baseline, 8 and 21 weeks. Feasibility outcomes included: recruitment rate; reasons for refusal, withdrawal and dropout; feasibility and acceptability of the proposed outcome measures; sample size estimation and variation in and preferences for service delivery. Results Twenty-four participants were recruited. The recruitment rate, calculated as the proportion of those invited to fill in a screening questionnaire who were consented into the trial, was 4.1%. Recruitment through out-patient clinics was somewhat slower than through screening questionnaire mail-out but the overall recruitment yield was similar. Of the 12 patients in the CCBT arm, 9 (75%) completed at least four, and 6 completed all 8 CCBT sessions. For completers, the median time (IQR) to complete all eight CCBT sessions was 15 (13 to 20) weeks. Participants expressed concern about the face validity of the Beck Depression Inventory II for the measurement of self-reported depression in people with MS. The MSIS-29 was the patient-reported outcome measure which participants felt best reflected their concerns. The estimated sample size for a full trial is between 180 and 390 participants. NHS partners were not delivering CCBT in community facilities and participants preferred to access CCBT at home, with no one expressing a preference for use of CCBT in an alternative location. Conclusions A definitive trial, with a recruitment window of one year, would require the participation of around 13 MS centres. This number of centres could be reduced by expanding the eligibility criteria to include either other neurological conditions or people with more severe depression. The MSIS-29 should be used as a patient-important outcome measurement. Trial registration ISRCTN: ISRCTN81846800
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Affiliation(s)
- Cindy L Cooper
- Clinical Trials Research Unit, ScHARR, University of Sheffield, Regent Court, Sheffield, UK.
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