Validity of an operational definition for neurotic unipolar major depression

Bioprofiling of platelets in medicated patients with depression

BACKGROUND

Changes in platelet bioactivity and aggregation are of interest when studying patients with depression as this could help to explain the statistically observed association of depression and chronic somatic, especially cardiovascular disease. This link could potentially be mediated through serotonergic signaling or immunological changes.

METHODS

38 medicated patients with major depressive disorder (MDD) and 30 mentally healthy controls, both without a diagnosis of cardiovascular disease, were included in this naturalistic study. Demographic and psychometric data were obtained. Platelet aggregability was measured by PFA-100 and bioactive compounds and serotonin levels were quantified in platelet sonicate.

RESULTS

The comparison of patients with controls revealed no changes in platelet aggregability, but significant differences in platelet content of several bioactive compounds. In a second analysis, patients were grouped according to the receptors and transporters influenced by their medication and again compared to controls. A significant effect of MDD was found for platelet content of serotonin, CD40L, interleukin-1β, and platelet factor-4, independent of medication. These markers can thus be classified as sensitive to MDD. The effect of medication on platelet parameters was also evaluated. Platelet content of matrix metalloproteinase-2 and β-thromboglobulin was normalized in MDD patients by medication acting on the serotonin transporter.

LIMITATIONS

Owing to the naturalistic study design, patients were on a variety of different medications and combination therapies. This was accounted for by a novel analysis method.

CONCLUSION

Platelet serotonin levels and content of immunomodulatory compounds are significantly altered in patients with MDD, even if treatment effects are taken into account.

NEO-FFI factor scores as predictors of clinical response to fluoxetine in depressed outpatients

Research in unipolar depression suggests that neuroticism is associated with poor long-term outcome and greater chronicity. The objective of this study was to determine whether baseline neuroticism scores predict response to treatment with fluoxetine in depressed outpatients. Seventy-six depressed outpatients participating in a clinical trial of fluoxetine (fixed/flexible dosing) completed the NEO-FFI (five factor inventory short form) at baseline. Clinical response was defined as a 50% or greater decrease in the 17-item Hamilton Depression Rating Scale (HAM-D-17) total score (final visit--baseline). Logistic regression evaluated NEO-FFI factor scores as predictors of treatment outcome within an intent-to-treat model. Scores on the neuroticism scale were not found to significantly predict treatment response as measured by the HAM-D-17. Strengths of this study include a standardized treatment protocol and use of structured interview instruments, while limitations include a modest sample size, lack of continuation data, state/trait effects, and lack of generalizability to other antidepressant treatments.

A polydiagnostic study of depressive disorders according to DSM-IV and 23 classical diagnostic systems

The classification of mood disorders is one of the most highly debated topics in modern psychiatry. The introduction of DSM-III (and its followers) has set a new standard in this controversy but little empirical evidence is available as to how the various classical diagnostic categories of mood disorders by Kraepelin, Schneider, Leonhard, Hamilton, Kielholz, Winokur and others compare with this new standard. The Intensive Prospective Study arm of the Group for Longitudinal Affective Disorders Study has studied a broad spectrum of mood disorders in 23 participating centres from all over Japan with a polydiagnostic semistructured interview called Comprehensive Assessment List of Affective disorders. In this paper we examined how the various classical diagnostic systems of depressive disorders correspond to the DSM-IV diagnoses, and found the following: (1) The classical 'neurotic' or 'psychogenic' depressions are diagnosed as major depression and not as dysthymia in DSM-IV; although dysthymia was dubbed as 'depressive neurosis' in DSM-III, its criteria were not true to the traditional usage of the term. Viewed from the other side of the coin, DSM-IV can be said to stand in the unitary tradition. (2) Some of the classical diagnostic categories such as Schneider's depressive psychopathy and Klein's acute dysphoria as well as modern ones such as Akiskal's subaffective dysthymia and Angst's recurrent brief depression were rarely seen in traditional psychiatric treatment settings. (3) Comparisons of the unique diagnostic systems such as those by Leonhard, Winokur and Berner warrant further studies on their validity.

Depressive personality disorder: theoretical issues, clinical findings, and future research questions

This article reviews the theoretical construct of depressive personality disorder and its related research. The history of depressive personality disorder is reviewed. It is concluded that differing theories converge on similar descriptions and mechanisms of development for the depressive personality disorder. Substantial empirical work supports the diagnostic distinctiveness of depressive personality disorder in clinical populations. Past and current assessment devices for assessing depressive personality disorder are also described along with their psychometric properties and clinical value. Suggestions are made for future research on the etiology and validity of the depressive personality disorder construct in order to facilitate deciding whether or not to include depressive personality disorder in future editions of the Diagnostic and Statistical Manual of Mental Disorders.

Changes in CSF spaces differ in endogenous and neurotic depression. A planimetric CT scan study

Regional planimetric measurements of internal and external CSF spaces were performed in CT scans of 23 patients with endogenous depression (ICD 9, 296.1) and 28 patients with neurotic depression (ICD 9, 300.4) as compared to 56 control individuals without neuropsychiatric disorder. In female patients with endogenous depression, but not in men, the bilateral upper cortical sulci were widened, especially in the frontal regions, and the third ventricle was enlarged. In contrast, the female neurotic depressed group showed no enlargement of CSF spaces, but a narrowing of the Sylvian fissure and of the basal frontal lobe reaching level of significance in the right fronto-temporal region (P = 0.005). No narrowing of CSF spaces was observed in women with endogenous depression. A discriminant analysis of significantly changed CSF regions resulted in a correct classification in 82.4% of depressed women in either the endogenous or the neurotic group. Determination of divergent types of brain pathology might prove as a useful tool in validating the differential classification of these two main subtypes of affective disorders.

Clinical and personality correlates of outcome in depressive disorders in a Turkish sample

Effects of clinical and personality traits on the course of depression were investigated after a mean period of 30 months. 66 out of 119 depressive patients (according to DSM-III-R and ICD-10 diagnostic criteria) were re-assessed by the same clinicians of the index episode. Schedule for Standardized Assessment of Depressive Disorders (SADD) was the main instrument for the initial phase; the follow-up schedule of SADD was used for the second phase. In both phases personality was evaluated by Eysenck Personality Questionnaire (EPQ). Severity of the disorder was assessed by Beck Depression Inventory. We found a chronicity rate of 9.1%, recurrence rate of 31.8%. Common features of chronic depressives were female sex, being over 30 years of age, gradual and late onset, presence of anxiety and multiple life events. EPQ results of the subjects who were free of depression were compared at the follow-up assessment. The remitted recurrent depression group showed significantly lower neuroticism scores than remitted single depression group. Neurotic depression subgroup was significantly associated with higher neuroticism scores.

Adjustment reactions: a long-term prospective and retrospective follow-up of former patients in a crisis intervention ward

The results of a 5-year follow-up study of 76 patients in a crisis intervention ward who were suffering from an adjustment reaction (brief or prolonged depressive reaction) according to ICD-9 criteria indicate a rather favorable course and outcome using standardized instruments. Only 17% developed a chronic or severe course of primarily depressive symptoms and only 1 (2%) patient committed suicide after discharge, whereas 64% had a very favorable and 18% a favorable course and outcome. This result is reflected in a rather low use of psychiatric and psychotherapeutic outpatient services during the follow-up period.

The genetics of neurotic-reactive depression: a reanalysis of Shapiro's (1970) twin study using diagnostic criteria

The present study explored the role of genetic factors in the development of neurotic depression. Case studies of 16 monozygotic (MZ) and 14 same-sex dizygotic (DZ) twins from Robert Shapiro's 1970 study of non-endogenous depression were rediagnosed by two raters blind to the zygosity and identity of each twin. Diagnoses were made using Research Diagnostic Criteria (RDC) and George Winokur's 1985 criteria for neurotic-reactive depression. When neurotic depression was operationally defined using Winokur's criteria plus RDC major or definite minor depression, the concordance rate for MZ twins was significantly greater than that for DZ twins. Our results contrast with Shapiro's negative findings, probably due to our use of formal diagnostic criteria and Shapiro's requirement that cotwins be hospitalized to be considered concordant. The present results suggest that genetic factors play a role in the etiology of at least some forms of neurotic depression.

Prognostic validity of the familial subtypes of depression

We examined the prognostic validity of Winokur's familial subtypes of depression in 184 in-patients with primary unipolar major depression. Patients with familial pure depressive disease had a more favorable hospital course and reported less symptoms during a 6-month follow-up evaluation than patients with depressive spectrum disease or sporadic depressive disease. Consistent with previous studies of the validity of the familial subtypes, the use of stringent thresholds to diagnose the patient's relatives increased the validity of classification.

Family (genetic) studies in neurotic depression

Neurotic depression may be defined as a depression that occurs in the context of a long standing history of personality difficulties or neurotic symptoms. Two types of conditions fit this definition: (1) depressions secondary to personality disorder, neuroses or substance abuse; and (2) primary depressions with a family history of alcoholism. Depressions so defined show familial relationships with secondary depression, anxiety disorders, alcoholism, and depressions with personality disorders. The data suggest that these cluster in the same family and are related to the definition of neurotic depression given above. Whether these familial relationships are genetic awaits further research.