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Yang Q, Wang Q, Peng P, Liu T, Zhang X. Association of clinical variables and thyroid-stimulating hormone with psychotic symptoms in patients with first-episode and drug-naïve major depressive disorder with elevated fasting blood glucose: preliminary exploratory study with a large sample. BJPsych Open 2024; 10:e99. [PMID: 38699891 PMCID: PMC11094438 DOI: 10.1192/bjo.2024.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 02/26/2024] [Accepted: 03/13/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Psychotic symptoms and elevated fasting blood glucose (FBG) are frequently observed in people with major depressive disorder (MDD), but there is a lack of research into this relationship within this cohort. AIMS This study aimed to preliminarily explore the prevalence of psychotic symptoms and their predictors among patients with MDD and elevated FBG. METHOD This study enrolled 1718 patients with first-episode and drug-naïve (FEDN) MDD. Sociodemographic data and physical and biochemical indicators were collected. Clinical symptoms were assessed with tools such as the Hamilton Rating Scale for Anxiety, Hamilton Rating Scale for Depression (HRSD) and Positive and Negative Syndrome Scale positive subscale. RESULTS The odds ratio for psychotic symptoms in those with MDD and elevated FBG (18.7%) was 2.33 times higher than those with MDD without elevated FBG. Presence of psychotic symptoms was significantly correlated with HRSD score, suicide attempts, and total cholesterol and thyroid-stimulating hormone levels. The combination of HRSD score, suicide attempts and thyroid-stimulating hormone levels among patients with MDD and elevated FBG effectively distinguished between individuals with and without psychotic symptoms, achieving an area under the curve of 0.87. CONCLUSIONS Psychotic symptoms are frequently observed among FEDN MDD patients with elevated FBG, and depressive symptoms, suicide attempts and thyroid-stimulating hormone levels are related to psychotic symptoms in this cohort.
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Affiliation(s)
- Qian Yang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China; and Department of Psychology, Zhongshan City People's Hospital, Zhongshan, China
| | - Qianjin Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Pu Peng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tieqiao Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Liu J, Wang Y, Mu W, Liu Y, Tong R, Lu Z, Yuan H, Jia F, Zhang X, Li Z, Yang W, Du X, Zhang X. Association between triglyceride glucose index (TyG) and psychotic symptoms in patients with first-episode drug-naïve major depressive disorder. Front Psychiatry 2024; 15:1342933. [PMID: 38463431 PMCID: PMC10920251 DOI: 10.3389/fpsyt.2024.1342933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
Objective Major depressive disorder (MDD) sufferers frequently have psychotic symptoms, yet the underlying triggers remain elusive. Prior research suggests a link between insulin resistance (IR) and increased occurrence of psychotic symptoms. Hence, this study sought to investigate the potential association between psychotic symptoms in Chinese patients experiencing their first-episode drug-naïve (FEDN) MDD and the triglyceride glucose (TyG) index, an alternative measure of insulin resistance (IR). Methods Between September 2016 and December 2018, 1,718 FEDN MDD patients with an average age of 34.9 ± 12.4 years were recruited for this cross-sectional study at the First Hospital of Shanxi Medical University in China. The study collected clinical and demographic data and included assessments of anxiety, depression, and psychotic symptoms using the 14-item Hamilton Anxiety Rating Scale (HAMA), the 17-item Hamilton Depression Rating Scale (HAMD-17), and the positive subscales of the Positive and Negative Syndrome Scale (PANSS), respectively. Measurements of metabolic parameters, fasting blood glucose (FBG), and thyroid hormones were also gathered. To assess the correlation between the TyG index and the likelihood of psychotic symptoms, the study used multivariable binary logistic regression analysis. Additionally, two-segmented linear regression models were employed to investigate possible threshold effects in case non-linearity relationships were identified. Results Among the patients, 9.95% (171 out of 1,718) exhibited psychotic symptoms. Multivariable logistic regression analysis showed a positive correlation between the TyG index and the likelihood of psychotic symptoms (OR = 2.12, 95% CI: 1.21-3.74, P = 0.01) after adjusting for confounding variables. Moreover, smoothed plots revealed a nonlinear relationship with the TyG index, revealing an inflection point at 8.42. Interestingly, no significant link was observed to the left of the inflection point (OR = 0.50, 95% CI: 0.04-6.64, P = 0.60), whereas beyond this point, a positive correlation emerged between the TyG index and psychotic symptoms (OR = 2.42, 95% CI: 1.31-4.48, P = 0.01). Particularly, a considerable 142% rise in the probability of experiencing psychotic symptoms was found with each incremental elevation in the TyG index. Conclusions Understanding the non-linear link between the TyG index and the risk of psychotic symptoms in Chinese patients with FEDN MDD highlights the potential for targeted therapeutic approaches. By acknowledging the threshold effect observed, there is an opportunity to mitigate risk factors associated with IR-related psychiatric comorbidities through tailored interventions. These preliminary results stress the need for further longitudinal research to solidify these insights and contribute to more effective therapeutic strategies.
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Affiliation(s)
- Junjun Liu
- Soochow University, Suzhou, China
- Nanjing Meishan Hospital, Nanjing, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | | | - Wei Mu
- School of Ethnology and Sociology, Yunnan University, Kunming, China
| | - Yang Liu
- Nanjing Meishan Hospital, Nanjing, China
| | | | - Zhaomin Lu
- Nanjing Meishan Hospital, Nanjing, China
| | | | - Fengnan Jia
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiaobin Zhang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Zhe Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Wanqiu Yang
- School of Ethnology and Sociology, Yunnan University, Kunming, China
| | - Xiangdong Du
- Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Valentine MJ, Kayastha A, Newsome-Cuby TR, Nguyen ATN, Fisher RG, Pham HM, Meimon SA, Phu A, Parry CA, Nelson JJ, Hayes EC, Muranjan S. A Clinical Suspicion of Quetiapine-Induced Psychosis: A Case Report and Literature Review. Cureus 2024; 16:e52167. [PMID: 38347998 PMCID: PMC10859674 DOI: 10.7759/cureus.52167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/15/2024] Open
Abstract
Quetiapine, a pharmacological agent within the class of atypical antipsychotics, is characterized by its efficacy in mood stabilization and its role in the modulation of serotonergic and dopaminergic pathways. Its therapeutic utility is broad, encompassing the management of acute psychotic episodes, schizophrenia, bipolar disorder, and treatment-resistant depressive states. Quetiapine's effectiveness extends to depressive disorders that do not exhibit classic psychotic features, with a side effect profile that is less burdensome than many alternative psychotropic medications. Its versatility in addressing a range of psychiatric conditions is useful in the psychopharmacological management of mood and thought disorders. However, like all drugs, quetiapine may have different effects relative to the individual. It is imperative to approach the administration of quetiapine carefully, ensuring any adverse effects are ameliorated for beneficial therapeutic outcomes. In this case report, we present a psychosis-naive 42-year-old male who developed psychotic symptoms after beginning a quetiapine regimen in order to manage major depressive disorder with suicidal ideation. Clinical suspicion of quetiapine-induced psychosis was a diagnosis considered due to symptom remission secondary to ziprasidone in the place of quetiapine. The determination of a suspected adverse drug reaction can utilize the Naranjo scale to demonstrate the likelihood of an adverse drug reaction. This patient scored a three on the Naranjo scale, indicating a possible adverse effect from quetiapine. Other potential etiologies of psychosis include medication-induced psychosis, major depressive disorder exacerbation, cocaine use/withdrawal, and brief psychotic disorder. Quetiapine-induced psychosis has not been described in the current literature, and therefore, this case report is solely based on clinical evaluation and is intended for educational purposes due to possible confounding factors and etiologies.
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Affiliation(s)
| | - Ankur Kayastha
- College of Osteopathic Medicine, Kansas City University, Kansas City, USA
| | | | - Anh Thu N Nguyen
- College of Osteopathic Medicine, Kansas City University, Kansas City, USA
| | - Riley G Fisher
- College of Life Sciences, Brigham Young University, Provo, USA
| | - Hanh M Pham
- College of Osteopathic Medicine, Kansas City University, Kansas City, USA
- Public Health, University of Nebraska Medical Center, Omaha, USA
| | - Saif A Meimon
- College of Osteopathic Medicine, Kansas City University, Kansas City, USA
| | - Alexander Phu
- College of Osteopathic Medicine, Kansas City University, Kansas City, USA
| | - Connor A Parry
- College of Osteopathic Medicine, Kansas City University, Kansas City, USA
| | - Joshua J Nelson
- College of Osteopathic Medicine, Kansas City University, Kansas City, USA
| | - Ethan C Hayes
- College of Osteopathic Medicine, Kansas City University, Joplin, USA
| | - Sunita Muranjan
- Psychiatry, Integrated Psychiatric Consultants, Kansas City, USA
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Liu S, Lin K, Zhang Y, Gao Y, Wang W, Du M, Jiang T, Zhou M, Zhang X. Prevalence and risk factors of psychotic symptoms in middle-aged patients with first-episode drug-naïve major depressive disorder: A large-scale cross-sectional study. J Affect Disord 2023; 325:102-109. [PMID: 36623569 DOI: 10.1016/j.jad.2023.01.002] [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] [Received: 11/23/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Psychotic symptoms are common in patients with major depressive disorder (MDD). However, few studies have assessed the incidence of comorbid psychotic symptoms in first-episode drug naïve (FEDN) MDD patients. The present study aimed to evaluate the prevalence and risk factors of psychotic symptoms in a large sample of middle-aged Chinese patients with FEDN MDD. METHODS 813 middle-aged (age range 35 to 65 years) outpatients with FEDN MDD were recruited. The 17-item Hamilton Rating Scale for Depression (HAMD), the 14-item Hamilton Anxiety Rating Scale (HAMA), and the positive subscales of the Positive and Negative Syndrome Scale (PANSS) were used to assess patient anxiety, depression and psychotic symptoms, respectively. RESULTS The prevalence of psychotic symptoms in middle-aged patients with FEND MDD was 10.95 %. Multivariate logistic regression analysis showed that HAMA score, HAMD score, TSH, TC and BMI levels were significant predictors of psychotic symptoms in MDD middle-aged patients. The HAMA score and HAMD score predicted psychotic symptoms for both male and female middle-aged patients with MDD, while higher TSH, TC and BMI levels were correlated with psychotic symptoms only in female MDD patients. Furthermore, combining the HAMA score, HAMD score, and TSH could differentiate between psychotic major depression (PMD) and nonpsychotic major depression (NPMD) in middle-aged patients. CONCLUSIONS Psychotic symptoms among middle-aged patients with MDD can be identified by integrating clinical and biological variables as early as possible during the first time see a doctor.
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Affiliation(s)
- Shilin Liu
- Department of Neurocritical Care Unit, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Keyi Lin
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China; Anhui Public Health Clinical Center, Hefei, Anhui, 230001, China
| | - Yang Zhang
- Department of Neurosurgery, The second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China
| | - Yaotian Gao
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China; Anhui Public Health Clinical Center, Hefei, Anhui, 230001, China
| | - Wei Wang
- Department of Neurosurgery, The second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China
| | - Mengcheng Du
- Department of Neurosurgery, The second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China
| | - Tao Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China; Anhui Public Health Clinical Center, Hefei, Anhui, 230001, China; Department of Neurosurgery, The second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China; Anhui Provincial Institute of Translational Medicine, Hefei, Anhui, 230001, China.
| | - Min Zhou
- Department of Neurocritical Care Unit, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China.
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Wagenmakers MJ, Oudega ML, Klaus F, Wing D, Orav G, Han LKM, Binnewies J, Beekman ATF, Veltman DJ, Rhebergen D, van Exel E, Eyler LT, Dols A. BrainAge of patients with severe late-life depression referred for electroconvulsive therapy. J Affect Disord 2023; 330:1-6. [PMID: 36858270 DOI: 10.1016/j.jad.2023.02.047] [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] [Received: 05/23/2022] [Revised: 01/28/2023] [Accepted: 02/12/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Severe depression is associated with accelerated brain aging. BrainAge gap, the difference between predicted and observed BrainAge, was investigated in patients with late-life depression (LLD). We aimed to examine BrainAge gap in LLD and its associations with clinical characteristics indexing LLD chronicity, current severity, prior to electroconvulsive therapy (ECT) and ECT outcome. METHODS Data was analyzed from the Mood Disorders in Elderly treated with Electroconvulsive Therapy (MODECT) study. A previously established BrainAge algorithm (BrainAge R by James Cole, (https://github.com/james-cole/brainageR)) was applied to pre-ECT T1-weighted structural MRI-scans of 42 patients who underwent ECT. RESULTS A BrainAge gap of 1.8 years (SD = 5.5) was observed, Cohen's d = 0.3. No significant associations between BrainAge gap, number of previous episodes, current episode duration, age of onset, depression severity, psychotic symptoms or ECT outcome were observed. LIMITATIONS Limited sample size. CONCLUSIONS Our initial findings suggest an older BrainAge than chronological age in patients with severe LLD referred for ECT, however with high degree of variability and direction of the gap. No associations were found with clinical measures. Larger samples are needed to better understand brain aging and to evaluate the usability of BrainAge gap as potential biomarker of prognosis an treatment-response in LLD. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02667353.
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Affiliation(s)
- Margot J Wagenmakers
- GGZ inGeest Specialized Mental Health Care, Psychiatry, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep and Stress, Amsterdam, the Netherlands.
| | - Mardien L Oudega
- GGZ inGeest Specialized Mental Health Care, Psychiatry, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep and Stress, Amsterdam, the Netherlands
| | - Federica Klaus
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland; Department of Psychiatry, University of California San Diego, San Diego, USA
| | - David Wing
- Exercise and Physical Activity Resource Center (EPARC), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego (UCSD), La Jolla, CA, USA
| | - Gwendolyn Orav
- Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Laura K M Han
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Julia Binnewies
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep and Stress, Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- GGZ inGeest Specialized Mental Health Care, Psychiatry, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Dick J Veltman
- GGZ inGeest Specialized Mental Health Care, Psychiatry, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep and Stress, Amsterdam, the Netherlands
| | - Didi Rhebergen
- Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands; GGZ Centraal Specialized Menthal Health Care, Amersfoort, the Netherlands
| | - Eric van Exel
- GGZ inGeest Specialized Mental Health Care, Psychiatry, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, USA; Desert-Pacific MIRECC, VA San Diego Healthcare, San Diego, CA, USA
| | - Annemieke Dols
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands and Amsterdam UMC
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Association between thyroid hormones and comorbid psychotic symptoms in patients with first-episode and drug-naïve major depressive disorder. Psychiatry Res 2023; 320:115052. [PMID: 36645990 DOI: 10.1016/j.psychres.2023.115052] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/26/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
Thyroid dysfunction is common in major depressive disorder (MDD) patients; however, its relationship with psychotic depression (PD) remains unclear. We aimed to assess thyroid hormones in 1718 first episode drug naïve (FEND) MDD patients and to determine their association with PD. The positive subscale of the Positive and Negative Symptom Scale (PANSS-P), Hamilton Anxiety Rating Scale (HAMA), and Hamilton Depression Rating Scale (HAMD) were used to detect clinical symptoms. The serum levels of free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), anti-thyroglobulin (TgAb), and thyroid peroxidases antibody (TPOAb) were assessed. The logistic regression model was conducted to determine risk factors for PD, and the Area Under the Curve (AUC) was used to test the performance of this model. 171 (10%) patients were identified as having PD. Serum levels of TSH, TgAb, and TPOAb displayed small-to-moderate associations with PANSS-P. HAMA score, HAMD score, and TSH levels were independently associated with PD. The regression model had excellent power to distinguish PD patients from non-PD patients with an AUC value of 0.93. Our study suggests TSH levels and severity of depression and anxiety symptoms were independent risk factors for PD. Regular thyroid function tests may help early detect PD.
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Garg P, Alambayan J, Garg V. Herbal Approaches in the Management of Mental Depression. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2023; 22:98-124. [PMID: 35088681 DOI: 10.2174/1871527321666220128091408] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Human's existence has become more stressful these days, most likely for the sake of improving one's lifestyle and fulfilling one's aspirations and needs. Depression is the most frequent neurological disorder, which affects millions of individuals worldwide. In clinical research, depression is the second most frequent chronic disease. A variety of herbal medications thought to have antidepressant-like effects have been reported in ancient pharmacopoeias from around the world. These provide several prospective chemicals that could be developed into modern mental medications while also causing no noticeable negative effects. OBJECTIVE The review is written to provide herbal treatment and comprehensive information about depression. METHODS Plants and plant formulations that were found effective in the treatment of depression are thoroughly reviewed. The antidepressant efficacies of medicinal plants, as well as their dosages, are investigated using experimental models. The review article contains 140 plants possessing antidepressant properties, 11 commercial formulations, and 25 active/isolated ingredients, as well as their chemical structure, which have been thoroughly reviewed with antidepressant activity after studying 283 references. RESULTS Literature revealed that a variety of medicinal plants are effective for the treatment of depression such as Hypericum perforatum, Catha edulis, Tinospora cordifolia, Curcuma longa, Ferula foetida, Rhodio larosea, Glycyrrhiza glabra, Crocus sativus, Ocimumba silicum and Embelica officinalis. CONCLUSION Potential compounds isolated from medicinal plants for the treatment of depressive disorders need to be established and herbal plant research could aid in this endeavour.
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Affiliation(s)
- Preeti Garg
- Department of Pharmacognosy and Phytochemistry, Hindu College of Pharmacy, Sonepat, Haryana, India
| | - Jyoti Alambayan
- Department of Pharmacognosy and Phytochemistry, Hindu College of Pharmacy, Sonepat, Haryana, India
| | - Vandana Garg
- Department of Pharmaceutical Sciences, M.D.U, Rohtak, Haryana, India
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Prevalence of suicidal ideation and planning in patients with major depressive disorder: A meta-analysis of observation studies. J Affect Disord 2021; 293:148-158. [PMID: 34192629 DOI: 10.1016/j.jad.2021.05.115] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Suicidal ideation (SI) and suicide planning (SP) are associated with an increased risk of future suicide. We performed a meta-analysis of observational studies to estimate the prevalence of SI and SP in patients with major depressive disorder (MDD) and its associated factors. METHODS A systematic literature search was conducted in PubMed, EMBASE, PsycINFO and Web of Science from their commencement date until 7 October 2020. Original studies containing data on the prevalence of SI and SP in individuals with MDD were analyzed. RESULTS Forty-six articles covering 53,598 patients were included in the meta-analysis. The overall prevalence of SI was 37.7% (95% confidence interval (CI): 32.3-43.4%) and the pooled prevalence of SP was 15.1% (95% CI: 8.0--26.8%). Subgroup analyses revealed that the timeframe over which SI was assessed, source of patients, study design, and diagnostic criteria were significantly associated with the pooled prevalence of SI. Meta-regression analyses revealed that the Hamilton Depression Rating Scale (HAMD) score and percentage of male participants were positively associated with the pooled prevalence of SI. Study quality and mean age were negatively associated with the pooled prevalence of SI. In contrast, survey year and study quality were negatively associated with pooled prevalence of SP LIMITATION: SI and SP were self-reported and subject to recall bias and impression management. CONCLUSIONS SI and SP are common in patients with MDD, especially among inpatients. Preventive measures and treatments focusing on factors associated with SI and SP may reduce the risk of suicide in patients with MDD.
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9
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Circadian depression: A mood disorder phenotype. Neurosci Biobehav Rev 2021; 126:79-101. [PMID: 33689801 DOI: 10.1016/j.neubiorev.2021.02.045] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 02/18/2021] [Accepted: 02/28/2021] [Indexed: 12/15/2022]
Abstract
Major mood syndromes are among the most common and disabling mental disorders. However, a lack of clear delineation of their underlying pathophysiological mechanisms is a major barrier to prevention and optimised treatments. Dysfunction of the 24-h circadian system is a candidate mechanism that has genetic, behavioural, and neurobiological links to mood syndromes. Here, we outline evidence for a new clinical phenotype, which we have called 'circadian depression'. We propose that key clinical characteristics of circadian depression include disrupted 24-h sleep-wake cycles, reduced motor activity, low subjective energy, and weight gain. The illness course includes early age-of-onset, phenomena suggestive of bipolarity (defined by bidirectional associations between objective motor and subjective energy/mood states), poor response to conventional antidepressant medications, and concurrent cardiometabolic and inflammatory disturbances. Identifying this phenotype could be clinically valuable, as circadian-targeted strategies show promise for reducing depressive symptoms and stabilising illness course. Further investigation of underlying circadian disturbances in mood syndromes is needed to evaluate the clinical utility of this phenotype and guide the optimal use of circadian-targeted interventions.
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10
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Kim J, Ha TH, Kim K, Lee EM, Kim H, Kim DK, Won HH, Lewis M, Lee H, Myung W. Atypical Antipsychotics Augmentation in Patients with Depressive Disorder and Risk of Subsequent Dementia: A Nationwide Population-Based Cohort Study. J Alzheimers Dis 2021; 80:197-207. [PMID: 33523000 DOI: 10.3233/jad-200994] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While atypical antipsychotic medications are widely used for treating depressive disorders, their long-term effects on the risk of subsequent dementia have not been studied adequately. OBJECTIVE To investigate whether the risk of dementia differs according to the use of atypical antipsychotic drugs, and compare the effects of antipsychotic agents on dementia risk in individuals with late-life depressive disorders. METHODS A nationwide population-based retrospective cohort study was conducted using data from the National Health Insurance Service-Senior Cohort of South Korea. Atypical antipsychotic dosages were standardized using a defined daily dose, and the cumulative dosage was calculated. Participants were observed from January 2008 to December 2015. Cox proportional hazard regression analysis was used to estimate the hazard ratios. RESULTS The cohort included 43,788 elderly adults with depressive disorders: 9,901 participants (22.6%) were diagnosed with dementia. Findings showed that atypical antipsychotics were prescribed to 1,967 participants (4.5%). Compared with non-users, users of atypical antipsychotics experienced a significantly higher risk for dementia with an adjusted hazard ratio (aHR) of 1.541 (95% confidence interval [CI], 1.415-1.678). A cumulative dose-response relationship was observed (test for trend, p < 0.0001). Among atypical antipsychotics, risperidone displayed the highest risk for dementia (aHR 1.767, [95% CI, 1.555-2.009]). CONCLUSION In this study of elderly individuals with depressive disorders, atypical antipsychotic use was associated with a significantly higher risk of subsequent dementia. Healthcare professionals should be aware of this potential long-term risk. A limitation that should be mentioned is that we could not exclude patients with bipolar depression.
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Affiliation(s)
- Jaehyun Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Tae Hyon Ha
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kiwon Kim
- Department of Psychiatry, Veteran Health Service Medical Center, Seoul, South Korea
| | - Eun-Mi Lee
- Department of Health Science, Dongduk Women's University, Seoul, South Korea
| | - Hyekyeong Kim
- Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Doh Kwan Kim
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hong-Hee Won
- Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Matthew Lewis
- The Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Hyewon Lee
- Department of Health Administration and Management, College of Medical Sciences, Soonchunhyang University, Asan, South Korea.,Department of Software Convergence, Soonchunhyang University Graduate School, Asan, South Korea
| | - Woojae Myung
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
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11
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Wagenmakers MJ, Oudega ML, Vansteelandt K, Spaans HP, Verwijk E, Obbels J, Rhebergen D, van Exel E, Bouckaert F, Stek ML, Sienaert P, Dols A. Psychotic late-life depression less likely to relapse after electroconvulsive therapy. J Affect Disord 2020; 276:984-990. [PMID: 32745834 DOI: 10.1016/j.jad.2020.07.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/29/2020] [Accepted: 07/05/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND A substantial number of patients with late-life depression (LLD) that remitted after ECT experience relapse. Identifying risk factors for relapse may guide clinical management to devote attention to those at increased risk. Therefore the current study aims to evaluate which baseline clinical characteristics are related to relapse within six months after successful ECT in patients with severe LLD. METHODS 110 patients with LLD from the prospective naturalistic follow-up Mood Disorders in Elderly treated with Electro-Convulsive Therapy (MODECT) study were included. A total of 73 patients (66.4%) remitted after ECT, six patients had missing information on relapse, rendering to a total sample size of 67 patients. Relapse within six months after ECT was defined as a Montgomery Åsberg Depression Scale (MADRS)-score > 15, readmission or restart of ECT. Logistic regression analyses were conducted to examine the association between baseline clinical characteristics and relapse. RESULTS A total of 22 patients (32.8%) experienced a relapse. Patients with psychotic depression were less likely to relapse (odds ratio = 0.32, p = .047), corrected for prior admissions; 76.9% of patients with psychotic depression remained remitted. LIMITATIONS Due to its naturalistic design, no firm conclusions can be drawn on the effect of post-ECT treatment. CONCLUSIONS Patients with psychotic depression had a lower risk to experience relapse after successful ECT. This result strengthens the hypothesis that psychotic depression might be a specific depression subtype with a favorable ECT outcome up to six months after ECT.
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Affiliation(s)
- Margot J Wagenmakers
- GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, the Netherlands.
| | - Mardien L Oudega
- GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, the Netherlands
| | - Kristof Vansteelandt
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium
| | - Harm-Pieter Spaans
- Parnassia Psychiatric Institute the Hague, Clinical Center for the Elderly-ECT Department, The Hague, the Netherlands
| | - Esmée Verwijk
- Parnassia Psychiatric Institute the Hague, Clinical Center for the Elderly-ECT Department, The Hague, the Netherlands; Department of Medical Psychology, Neuropsychology Department, Amsterdam UMC Academic Medical Center, the Netherlands; Department of Psychology, Brain & Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - Jasmien Obbels
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium; University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium
| | - Didi Rhebergen
- GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, the Netherlands
| | - Eric van Exel
- GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, the Netherlands
| | - Filip Bouckaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium
| | - Max L Stek
- GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, the Netherlands
| | - Pascal Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium
| | - Annemieke Dols
- GGZ inGeest Specialized Mental Health Care, Department of Old Age Psychiatry, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, the Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, the Netherlands
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12
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Pedraz-Petrozzi B, Neumann E, Sammer G. Pro-inflammatory markers and fatigue in patients with depression: A case-control study. Sci Rep 2020; 10:9494. [PMID: 32528052 PMCID: PMC7289841 DOI: 10.1038/s41598-020-66532-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/20/2020] [Indexed: 11/20/2022] Open
Abstract
The aim of this work was to investigate differences between depressed subjects (PG) and non-depressed healthy control participants (HCG) with regard to fatigue dimensions and inflammation. For this purpose, 43 participants in the PG and 51 participants in the HCG were included in the study. IL-6, IL-1β, TNF-α, IFN-γ, and CRP were assessed in venous blood samples. Fatigue and depression were assessed using the FIS-D and BDI-FS questionnaires. Main results showed higher BDI-FS values in PG. Moreover, PG showed mean differences for fatigue dimensions when compared to the HCG. For the pro-inflammatory markers, a moderate group effect was found between PG and HCG which was mainly caused by IL-6. Correlations between TNF-α and BDI-FS, TNF-α and cognitive fatigue, TNF-α and psychosocial fatigue were found within the PG. In the HCG, correlations were found between IL-6, TNF-α and somatic fatigue, as well as IL-6 and cognitive fatigue. Significant correlations were found between the psychological variables in both groups. All results were controlled for the confounding variables gender, age, BMI and multiple comparisons. These results suggest the presence of inflammation in both depression and fatigue. However, each correlates with different pro-inflammatory parameters, suggesting a biological heterogeneity.
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Affiliation(s)
- Bruno Pedraz-Petrozzi
- Cognitive Neurosciences at the Center for Psychiatry and Psychotherapy, Justus-Liebig University, Giessen, Hessen, Germany.
| | - Elena Neumann
- Internal Medicine and Rheumatology, Campus Kerckhoff, Justus-Liebig University, Bad Nauheim, Hessen, Germany
| | - Gebhard Sammer
- Cognitive Neurosciences at the Center for Psychiatry and Psychotherapy, Justus-Liebig University, Giessen, Hessen, Germany
- Faculty of Psychology and Sports Science, Justus-Liebig University, Giessen, Hessen, Germany
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13
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Oudega ML, van der Werf YD, Dols A, Wattjes MP, Barkhof F, Bouckaert F, Vandenbulcke M, De Winter FL, Sienaert P, Eikelenboom P, Stek ML, van den Heuvel OA, Emsell L, Rhebergen D, van Exel E. Exploring resting state connectivity in patients with psychotic depression. PLoS One 2019; 14:e0209908. [PMID: 30653516 PMCID: PMC6336266 DOI: 10.1371/journal.pone.0209908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/13/2018] [Indexed: 12/14/2022] Open
Abstract
Background Severe depression is associated with high morbidity and mortality. Neural network dysfunction may contribute to disease mechanisms underlying different clinical subtypes. Here, we apply resting-state functional magnetic resonance imaging based measures of brain connectivity to investigate network dysfunction in severely depressed in-patients with and without psychotic symptoms. Methods A cohort study was performed at two sites. Older patients with major depressive disorder with or without psychotic symptoms were included (n = 23 at site one, n = 26 at site two). Resting state 3-Tesla functional MRI scans, with eyes closed, were obtained and Montgomery-Åsberg Depression Rating Scales were completed. We denoised data and calculated resting state networks in the two groups separately. We selected five networks of interest (1. bilateral frontoparietal, 2.left lateralized frontoparietal, 3.right lateralized frontoparietal, 4.default mode network (DMN) and 5.bilateral basal ganglia and insula network) and performed regression analyses with severity of depression, as well as presence or absence of psychotic symptoms. Results The functional connectivity (FC) patterns did not correlate with severity of depression. Depressed patients with psychotic symptoms (n = 14, 61%) compared with patients without psychotic symptoms (n = 9, 39%) from site one showed significantly decreased FC in the right part of the bilateral frontoparietal network (p = 0.002). This result was not replicated when comparing patients with (n = 9, 35%) and without (n = 17, 65%) psychotic symptoms from site two. Conclusion Psychotic depression may be associated with decreased FC of the frontoparietal network, which is involved in cognitive control processes, such as attention and emotion regulation. These findings suggest that FC in the frontoparietal network may be related to the subtype of depression, i.e. presence of psychotic symptoms, rather than severity of depression. Since the findings could not be replicated in the 2nd sample, replication is needed before drawing definite conclusions.
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Affiliation(s)
- Mardien L. Oudega
- Department of Old age Psychiatry, GGZ inGeest Specialized Mental Health Care and Amsterdam University Medical center, location VU University medical center (VUmc), Amsterdam, the Netherlands
- Amsterdam Neuroscience, Vu/Vumc/UVA/AMC, Amsterdam, the Netherlands
- Department of Anatomy and Neurosciences, Amsterdam University Medical center, location VUmc, Amsterdam, the Netherlands
- * E-mail:
| | - Ysbrand D. van der Werf
- Amsterdam Neuroscience, Vu/Vumc/UVA/AMC, Amsterdam, the Netherlands
- Department of Anatomy and Neurosciences, Amsterdam University Medical center, location VUmc, Amsterdam, the Netherlands
| | - Annemieke Dols
- Department of Old age Psychiatry, GGZ inGeest Specialized Mental Health Care and Amsterdam University Medical center, location VU University medical center (VUmc), Amsterdam, the Netherlands
- Amsterdam Neuroscience, Vu/Vumc/UVA/AMC, Amsterdam, the Netherlands
- Department of Anatomy and Neurosciences, Amsterdam University Medical center, location VUmc, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health research institute, The Netherlands
| | - Mike P. Wattjes
- Department of Radiology, Amsterdam University Medical center, location VUmc, Amsterdam, the Netherlands
| | - Frederik Barkhof
- Amsterdam Neuroscience, Vu/Vumc/UVA/AMC, Amsterdam, the Netherlands
- Department of Radiology, Amsterdam University Medical center, location VUmc, Amsterdam, the Netherlands
- Institutes of Neurology and Healthcare Engineering, University College London, London, United Kingdom
| | - Filip Bouckaert
- Department of Old Age Psychiatry, University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium
| | - Mathieu Vandenbulcke
- Department of Old Age Psychiatry, University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium
| | - François-Laurent De Winter
- Department of Old Age Psychiatry, University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium
| | - Pascal Sienaert
- KU Leuven, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), Kortenberg, Belgium
| | - Piet Eikelenboom
- Department of Old age Psychiatry, GGZ inGeest Specialized Mental Health Care and Amsterdam University Medical center, location VU University medical center (VUmc), Amsterdam, the Netherlands
| | - Max L. Stek
- Department of Old age Psychiatry, GGZ inGeest Specialized Mental Health Care and Amsterdam University Medical center, location VU University medical center (VUmc), Amsterdam, the Netherlands
| | - Odile A. van den Heuvel
- Department of Old age Psychiatry, GGZ inGeest Specialized Mental Health Care and Amsterdam University Medical center, location VU University medical center (VUmc), Amsterdam, the Netherlands
- Amsterdam Neuroscience, Vu/Vumc/UVA/AMC, Amsterdam, the Netherlands
- Department of Anatomy and Neurosciences, Amsterdam University Medical center, location VUmc, Amsterdam, the Netherlands
| | - Louise Emsell
- Department of Old Age Psychiatry, University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium
| | - Didi Rhebergen
- Department of Old age Psychiatry, GGZ inGeest Specialized Mental Health Care and Amsterdam University Medical center, location VU University medical center (VUmc), Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health research institute, The Netherlands
| | - Eric van Exel
- Department of Old age Psychiatry, GGZ inGeest Specialized Mental Health Care and Amsterdam University Medical center, location VU University medical center (VUmc), Amsterdam, the Netherlands
- Amsterdam Neuroscience, Vu/Vumc/UVA/AMC, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health research institute, The Netherlands
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14
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Sacchetti E, Valsecchi P, Tamussi E, Paulli L, Morigi R, Vita A. Psychomotor agitation in subjects hospitalized for an acute exacerbation of Schizophrenia. Psychiatry Res 2018; 270:357-364. [PMID: 30293014 DOI: 10.1016/j.psychres.2018.09.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 09/25/2018] [Accepted: 09/25/2018] [Indexed: 11/19/2022]
Abstract
The aims of this study were to establish the prevalence of moderate and severe psychomotor agitation in patients hospitalized for an active phase of schizophrenia, the associations between psychomotor agitation and patients' demographic and clinical variables, the intra-individual stability of the agitated/non-agitated dichotomy in independent psychotic breakdowns. The study was performed on a database relative to 630 inpatients hospitalized with a diagnosis of schizophrenia. Psychomotor agitation was measured with the Positive and Negative Syndrome Scale - Excited Component (PANSS-EC). Prevalence of moderate and severe psychomotor agitation was 40.5% and 23.7%, respectively. Non-agitated patients were older, with longer illness history and duration of untreated psychosis, were more frequently on antipsychotic medication, had lower incidence of recent use of substances, and functioned better before the index hospitalization than moderately and/or severely agitated patients. Non-agitated patients had lower scores for total PANSS and Emsley's positive and anxiety dimensions. Compared with the severely agitated group, non-agitated and moderately agitated patients scored more in Emsley's depression dimension. Poor functioning before index hospital admission, higher scores for negative subscale and Emsley's positive dimension and use of substances exerted an effect on risk of psychomotor agitation.
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Affiliation(s)
| | - Paolo Valsecchi
- Department of Clinical and Experimental Sciences - University of Brescia, Brescia, Italy; Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
| | - Elena Tamussi
- Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
| | - Laura Paulli
- Department of Clinical and Experimental Sciences - University of Brescia, Brescia, Italy; Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
| | - Raffaele Morigi
- Department of Clinical and Experimental Sciences - University of Brescia, Brescia, Italy; Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences - University of Brescia, Brescia, Italy; Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
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15
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Van Gool AR, Meijer M, Birkenhäger TK. [Atypical presentation of depression leading to delay in treatment]. Tijdschr Gerontol Geriatr 2018; 49:206-209. [PMID: 30238287 DOI: 10.1007/s12439-018-0263-7] [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: 03/04/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
Major depression can present with atypical symptomatology and as a consequence, delay can occur in passing through the relevant algorithm for biological treatment. The case of a 62-year old female is presented who eventually was diagnosed with a major depressive episode, with psychotic features. The atypical presentation led to persistent diagnostic uncertainty both during outpatient treatment in several mental health care institutions and during inpatient observation. As a consequence, proceeding to the next step of the algorithm for biological treatment for major depression was delayed. Factors involved in this diagnostic uncertainty are discussed.
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Affiliation(s)
- Arthur R Van Gool
- Yulius Geestelijke Gezondheid, Postbus 1001, 3300 BA, Dordrecht, Nederland.
| | - Maarten Meijer
- Yulius Geestelijke Gezondheid, Postbus 1001, 3300 BA, Dordrecht, Nederland
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16
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van Diermen L, Schrijvers D, Cools O, Birkenhäger TK, Fransen E, Sabbe BGC. Distinguishing Subgroups Based on Psychomotor Functioning among Patients with Major Depressive Disorder. Neuropsychobiology 2018; 76:199-208. [PMID: 29975958 DOI: 10.1159/000490072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Retardation and agitation are symptoms of major depressive disorder (MDD), and their presence could play a role in determining clinically meaningful depressive subtypes such as nonmelancholic depression (NMD) and melancholic depression (MD). In this project, we explored whether three depression subgroups (NMD, MD with psychotic symptoms, and MD without psychotic symptoms) could be distinguished based on objective measures of psychomotor functioning. METHODS Sixty-nine patients with MDD underwent extensive clinical and psychomotor testing prior to treatment with electroconvulsive therapy. Psychomotor functioning was assessed subjectively using the Core Assessment of Psychomotor Change (CORE) and objectively by means of both 24-h actigraphy and performance on a fine motor drawing task. RESULTS The daytime activity levels measured by actigraphy were significantly lower (F = 7.1, p = 0.0004) in MD patients both with and without psychotic symptoms than in those with NMD. No objective psychomotor variable was able to distinguish between melancholic patients with and those without psychotic symptoms. CONCLUSIONS The depression subtypes NMD, MD with psychotic symptoms, and MD without psychotic symptoms are not marked by increasing psychomotor retardation, possibly because psychomotor disturbance in MD with psychotic symptoms often consists of agitation rather than retardation, or a mixture of the two. However, psychomotor functioning as measured by actigraphy can be used to distinguish between NMD patients and MD patients.
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Affiliation(s)
- Linda van Diermen
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,University Department, Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium
| | - Didier Schrijvers
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,University Department, Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium
| | - Olivia Cools
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,University Department, Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium
| | - Tom K Birkenhäger
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,Department of Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Erik Fransen
- StatUa Center for Statistics, University of Antwerp, Antwerp, Belgium
| | - Bernard G C Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,University Department, Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium
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17
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Gournellis R, Tournikioti K, Touloumi G, Thomadakis C, Michalopoulou PG, Christodoulou C, Papadopoulou A, Douzenis A. Psychotic (delusional) depression and suicidal attempts: a systematic review and meta-analysis. Acta Psychiatr Scand 2018; 137:18-29. [PMID: 29178463 DOI: 10.1111/acps.12826] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE It still remains unclear whether psychotic features increase the risk of suicidal attempts in major depressive disorder. Thus, we attempted, through a systematic review coupled with a meta-analysis, to elucidate further whether unipolar psychotic depression (PMD) compared to non-PMD presents higher levels of suicidal attempts. METHOD A systematic search was conducted in PubMed, EMBASE, PsycINFO as well as in various databases of the so-called gray literature for all studies providing data on suicidal attempts in PMD compared to non-PMD, and the results were then subjected to meta-analysis. RESULTS Twenty studies met our inclusion criteria, including in total 1,275 PMD patients and 5,761 non-PMD patients. An elevated risk for suicide attempt for PMD compared to non-PMD patients was found: The total (lifetime) fixed-effects pooled OR was 2.11 (95% CI: 1.81-2.47), and the fixed-effects pooled OR of the five studies of the acute phase of the disorder was 1.93 (95% CI: 1.33-2.80). This elevated risk of suicidal attempt for PMD patients remained stable across all age groups of adult patients. CONCLUSION Despite data inconsistency and clinical heterogeneity, this systematic review and meta-analysis showed that patients with PMD are at a two-fold higher risk, both during lifetime and in acute phase, of committing a suicidal attempt than patients with non-PMD.
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Affiliation(s)
- R Gournellis
- Second Department of Psychiatry, Medical School, University General Hospital 'ATTIKON', National and Kapodistrian University of Athens, Athens, Greece
| | - K Tournikioti
- Second Department of Psychiatry, Medical School, University General Hospital 'ATTIKON', National and Kapodistrian University of Athens, Athens, Greece
| | - G Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - C Thomadakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - P G Michalopoulou
- Cognition, Schizophrenia, Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - C Christodoulou
- Second Department of Psychiatry, Medical School, University General Hospital 'ATTIKON', National and Kapodistrian University of Athens, Athens, Greece
| | - A Papadopoulou
- Second Department of Psychiatry, Medical School, University General Hospital 'ATTIKON', National and Kapodistrian University of Athens, Athens, Greece
| | - A Douzenis
- Second Department of Psychiatry, Medical School, University General Hospital 'ATTIKON', National and Kapodistrian University of Athens, Athens, Greece
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18
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Kim-Romo DN, Rascati KL, Richards KM, Ford KC, Wilson JP, Beretvas SN. Medication Adherence and Persistence in Patients with Severe Major Depressive Disorder with Psychotic Features: Antidepressant and Second-Generation Antipsychotic Therapy Versus Antidepressant Monotherapy. J Manag Care Spec Pharm 2017; 22:588-96. [PMID: 27123919 PMCID: PMC10398011 DOI: 10.18553/jmcp.2016.22.5.588] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Major depressive disorder with psychotic features, or psychotic depression, is a severe mental health disorder often associated with a worse depression-related symptom profile when compared with major depressive disorder without psychotic features. While combination pharmacotherapy with an antidepressant and an antipsychotic is recommended as first-line therapy, antidepressant monotherapy has been found to be useful and efficacious in psychotic depression. OBJECTIVE To assess the rates of antidepressant adherence and antidepressant persistence in Texas Medicaid patients with psychotic depression who used antidepressant plus second-generation antipsychotic (AD/SGA) therapy or antidepressant (AD) monotherapy. METHODS Using Texas Medicaid prescription and medical claims data from September 2007 to December 2012, adult patients aged 18-63 years were included if they had no confounding psychiatric disorders, no antidepressant claims during a 6-month pre-index period, and at least 1 diagnosis for severe major depressive disorder with psychotic features (ICD-9-CM codes 296.24 and 296.34). The first claim date for an antidepressant served as the index date. All patients were required to have at least 2 antidepressant claims, and those in the AD/SGA cohort were required to have 2 or more claims for an SGA. Study covariates included age, gender, race/ethnicity, residence, Charlson Comorbidity Index (CCI) score, and tobacco use/dependence. Statistical analyses included descriptive statistics, univariate analyses, logistic regression, and Cox proportional hazards regression. RESULTS A total of 926 patients met study criteria (AD cohort = 510; AD/SGA cohort = 416). The overall sample had a mean [±SD] age of 40.5 [±13.2] years and was primarily female (66.8%) and non-Caucasian (74.8%). When compared with the AD cohort, patients in the AD/SGA cohort had a 52.3% higher likelihood of being adherent to antidepressant therapy based on proportion of days covered (PDC; OR = 1.523; 95% CI = 1.129-2.053; P = 0.006). Similarly, antidepressant adherence was 42.0% higher for the AD/SGA cohort based on medication possession ratio (MPR; OR = 1.420; 95% CI = 1.062-1.898; P = 0.018). Younger patients, African Americans, and tobacco users/dependents had significantly worse likelihoods of antidepressant medication adherence based on PDC and MPR. The risk of antidepressant nonpersistence was 23.2% lower for patients in the AD/SGA cohort (HR = 0.768; 95% CI = 0.659-0.896; P = 0.001), compared with those in the AD cohort. Antidepressant nonpersistence was significantly higher in younger patients, African Americans, Hispanics, and tobacco users/dependents. CONCLUSIONS Better antidepressant adherence and persistence outcomes were associated with combination pharmacotherapy with an AD and an SGA antipsychotic. This study provides real-world estimates that support the current first-line treatment recommendations for psychotic depression; however, it should be noted that the majority of study patients used AD therapy only. Future research in psychotic depression is needed. DISCLOSURES Kim-Romo received funding to conduct this study from the PhRMA Foundation Pre-Doctoral Fellowship in Health Outcomes. Rascati, Richards, Ford, Wilson, and Beretvas declare no conflict of interest in relation to this manuscript. Kim-Romo and Rascati collaborated on the study design, data analysis, study interpretation, and writing of this manuscript. Richards, Ford, Wilson, and Beretvas provided critical evaluation of the study design, analysis, and interpretation, as well as edited this manuscript.
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Affiliation(s)
- Dawn N Kim-Romo
- 1 Health Outcomes & Pharmacy Practice, College of Pharmacy, The University of Texas at Austin
| | - Karen L Rascati
- 1 Health Outcomes & Pharmacy Practice, College of Pharmacy, The University of Texas at Austin
| | | | - Kentya C Ford
- 1 Health Outcomes & Pharmacy Practice, College of Pharmacy, The University of Texas at Austin
| | - James P Wilson
- 1 Health Outcomes & Pharmacy Practice, College of Pharmacy, The University of Texas at Austin
| | - Susan N Beretvas
- 3 Research and Graduate Studies, College of Education, The University of Texas at Austin
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19
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Bürgy M. [Delusional depression : Diagnostics, phenomenology and therapy]. DER NERVENARZT 2016; 88:529-537. [PMID: 27357450 DOI: 10.1007/s00115-016-0149-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Depressive delusion is the key symptom of psychotic depression also known as major depressive disorder with psychotic features (ICD-10: F 32.3). Delusional topics are limited to guilt, impoverishment and hypochondria. Kurt Schneider described these as being the three primordial fears of human beings. Psychotic depression is distinguished by the particular severity and frequency of the episodes of illness as well as by increased suicidal tendencies. Although one in five patients with a major depression experiences psychotic symptoms, this condition is all too easily overlooked and the appropriate therapy is not initiated. Here we use case histories to illustrate some of the obstacles to diagnosis arising from the difficulty of identifying delusions hidden in a person's experience of depression, life history and personality. A targeted active exploration of these difficulties is significant taking into account the observable symptoms and not only the subjectively experienced symptoms. A phenomenological approach is chosen to explore the matter of depressive delusion and to investigate the interaction of delusion and affect and the special importance of anxiety for the genesis of delusion. In accordance with the current treatment recommendations and against this background, it is proposed that the pharmacological strategy should be supplemented by the use of benzodiazepines more often than has it has been in the past.
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Affiliation(s)
- M Bürgy
- Klinik für Spezielle Psychiatrie, Sozialpsychiatrie und Psychotherapie, Zentrum für Seelische Gesundheit, Klinikum Stuttgart, Prießnitzweg 24, 70374, Stuttgart, Deutschland.
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Zalpuri I, Rothschild AJ. Does psychosis increase the risk of suicide in patients with major depression? A systematic review. J Affect Disord 2016; 198:23-31. [PMID: 26998793 DOI: 10.1016/j.jad.2016.03.035] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 02/12/2016] [Accepted: 03/09/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Over the years studies have shown conflicting results about the risk of suicide in psychotic depression (MD-psych). To understand this association, we undertook a comprehensive review of the literature to ascertain whether individuals with MD-psych have higher rates of completed suicides, suicide attempts or suicidal ideation compared to those with non-psychotic depression (MD-nonpsych). METHODS We searched Pubmed, PsycINFO and Ovid in English language, from 1946-October 2015. Studies were included if suicidal ideation, attempts or completed suicides were assessed. RESULTS During the acute episode of depression, patients with MD-psych have higher rates of suicide, suicide attempts, and suicidal ideation than patients with MD-nonpsych, especially when the patient is hospitalized on an inpatient psychiatric unit. Studies done after the acute episode has resolved are less likely to show this difference, likely due to patients having received treatment. LIMITATIONS Diagnostic interviews were not conducted in all studies. Many studies did not report whether psychotic symptoms in MD-psych patients were mood-congruent or mood-incongruent; hence it is unclear whether the type of delusion increases suicide risk. Studies did not describe whether MD-psych patients experienced command hallucinations encouraging them to engage in suicidal behavior. Only 24 studies met inclusion criteria; several of them had small sample size and a quality score of zero, hence impacting validity. CONCLUSIONS This review indicates that the seemingly conflicting data in suicide risk between MD-psych and MD-nonpsych in previous studies appears to be related to whether one looks at differences during the acute episode or over the long-term.
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Affiliation(s)
- Isheeta Zalpuri
- Department of Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA 94305, United States.
| | - Anthony J Rothschild
- Center for Psychopharmacologic Research and Treatment, Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave North Worcester, MA 01655, United States.
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Chakrabarty T, Hadjipavlou G, Lam RW. Cognitive Dysfunction in Major Depressive Disorder: Assessment, Impact, and Management. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2016; 14:194-206. [PMID: 31975803 PMCID: PMC6519654 DOI: 10.1176/appi.focus.20150043] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cognitive dysfunction is increasingly being recognized as an important clinical dimension in major depressive disorder. This review summarizes the existing data on the epidemiology, assessment, and treatment of cognitive dysfunction among nonelderly adults with the disorder. Overall, cognitive dysfunction is prevalent, persists through periods of symptom remission, and may be independently associated with functional outcomes. However, although the evidence increasingly suggests that clinicians should be heedful of their patients' cognitive functioning, there is as yet no consensus on how best to monitor cognition clinically. In addition, although most studies have reported improved cognition with antidepressant medications, psychotherapy, and neuromodulation, the clinical significance of these improvements is unclear, and high-level evidence to guide decision making is limited. Nonetheless, given the important functional implications, clinicians should assess and monitor cognition and optimize both medication and psychological treatments to mitigate cognitive dysfunction among patients with major depressive disorder.
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Affiliation(s)
- Trisha Chakrabarty
- The authors are with the Department of Psychiatry, University of British Columbia, and the Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada. Send correspondence to Dr. Lam (e-mail: )
| | - George Hadjipavlou
- The authors are with the Department of Psychiatry, University of British Columbia, and the Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada. Send correspondence to Dr. Lam (e-mail: )
| | - Raymond W Lam
- The authors are with the Department of Psychiatry, University of British Columbia, and the Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada. Send correspondence to Dr. Lam (e-mail: )
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Joiner TE, Hom MA, Hagan CR, Silva C. Suicide as a derangement of the self-sacrificial aspect of eusociality. Psychol Rev 2015; 123:235-54. [PMID: 26524155 DOI: 10.1037/rev0000020] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Building upon the idea that humans may be a eusocial species (i.e., rely on multigenerational and cooperative care of young, utilize division of labor for successful survival), we conjecture that suicide among humans represents a derangement of the self-sacrificial aspect of eusociality. In this article, we outline the characteristics of eusociality, particularly the self-sacrificial behavior seen among other eusocial species (e.g., insects, shrimp, mole rats). We then discuss parallels between eusocial self-sacrificial behavior in nonhumans and suicide in humans, particularly with regard to overarousal states, withdrawal phenomena, and perceptions of burdensomeness. In so doing, we make the argument that death by suicide among humans is an exemplar of psychopathology and is due to a derangement of the self-sacrificial behavioral suite found among eusocial species. Implications and future directions for research are also presented.
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23
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Østergaard SD, Rothschild AJ, Flint AJ, Mulsant BH, Whyte EM, Leadholm AK, Bech P, Meyers BS. Rating scales measuring the severity of psychotic depression. Acta Psychiatr Scand 2015; 132:335-44. [PMID: 26016647 PMCID: PMC4604003 DOI: 10.1111/acps.12449] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Unipolar psychotic depression (PD) is a severe and debilitating syndrome, which requires intensive monitoring. The objective of this study was to provide an overview of the rating scales used to assess illness severity in PD. METHOD Selective review of publications reporting results on non-self-rated, symptom-based rating scales utilized to measure symptom severity in PD. The clinical and psychometric validity of the identified rating scales was reviewed. RESULTS A total of 14 rating scales meeting the predefined criteria were included in the review. These scales grouped into the following categories: (i) rating scales predominantly covering depressive symptoms, (ii) rating scales predominantly covering psychotic symptoms, (iii) rating scales covering delusions, and (iv) rating scales covering PD. For the vast majority of the scales, the clinical and psychometric validity had not been tested empirically. The only exception from this general tendency was the 11-item Psychotic Depression Assessment Scale (PDAS), which was developed specifically to assess the severity of PD. CONCLUSION In PD, the PDAS represents the only empirically derived rating scale for the measurement of overall severity of illness. The PDAS should be considered in future studies of PD and in clinical practice.
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Affiliation(s)
- Søren D. Østergaard
- Department of Clinical Medicine, Aarhus University Hospital,
Aarhus, Denmark,Department P - Research, Aarhus University Hospital - Risskov,
Risskov, Denmark
| | - Anthony J. Rothschild
- University of Massachusetts Medical School and University of
Massachusetts Memorial Health Care, Worcester, Massachusetts USA
| | - Alastair J. Flint
- Department of Psychiatry, University Health Network, Toronto,
Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto,
Ontario, Canada
| | - Benoit H. Mulsant
- Department of Psychiatry, University of Toronto, Toronto,
Ontario, Canada,Centre for Addiction and Mental Health, Toronto, Ontario,
Canada,Western Psychiatric Institute and Clinic, Department of
Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ellen M. Whyte
- Western Psychiatric Institute and Clinic, Department of
Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Per Bech
- Psychiatric Research Unit, Psychiatric Center North Zealand,
Copenhagen University Hospital, Hillerød, Denmark
| | - Barnett S. Meyers
- Weill Cornell Medical College and New York Presbyterian
Hospital - Westchester Division, White Plains, New York, USA
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Acceptance-based Behavior Therapy for Depression With Psychosis: Results From a Pilot Feasibility Randomized Controlled Trial. J Psychiatr Pract 2015; 21:320-33. [PMID: 26352221 PMCID: PMC4704101 DOI: 10.1097/pra.0000000000000092] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Acceptance-based depression and psychosis therapy (ADAPT), a mindfulness/acceptance-based behavioral activation treatment, showed clinically significant effects in the treatment of depression with psychosis in a previous open trial. The goal of the current study was to further test the feasibility of ADAPT to determine the utility of testing it in a future clinical trial, following a stage model of treatment development. Feasibility was determined by randomizing a small number of patients (N=13) with comorbid depression and psychosis to medication treatment as usual plus enhanced assessment and monitoring versus ADAPT for 4 months of outpatient treatment. Both conditions were deemed acceptable by patients. Differences in between-subjects effect sizes favored ADAPT posttreatment and were in the medium to large range for depression, psychosocial functioning, and experiential avoidance (ie, the target mechanism). Thus ADAPT shows promise for improving outcomes compared with medications alone and requires testing in a fully powered randomized trial.
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Formal psychological assessment in evaluating depression: a new methodology to build exhaustive and irredundant adaptive questionnaires. PLoS One 2015; 10:e0122131. [PMID: 25875359 PMCID: PMC4398546 DOI: 10.1371/journal.pone.0122131] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/10/2015] [Indexed: 12/11/2022] Open
Abstract
Psychological Assessment can be defined as a complex procedure of information collection, analysis and processing. Formal Psychological Assessment (FPA) tries to improve this procedure by providing a formal framework to build assessment tools. In this paper, FPA is applied to depression. Seven questionnaires widely used for the self-evaluation of depression were selected. Diagnostic criteria for major depressive disorder were derived from the DSM-5, literature and Seligman's and Beck's theories. A Boolean matrix was built, including 266 items from the questionnaires in the rows and 20 selected attributes, obtained through diagnostic criteria decomposition, in the columns. In the matrix, a 1 in a cell meant that the corresponding item investigated the specific attribute. It was thus possible to analyze the relationships between items and attributes and among items. While none of the considered questionnaires could alone cover all the criteria for the evaluation of depressive symptoms, we observed that a set of 30 items contained the same information that was obtained redundantly with 266 items. Another result highlighted by the matrix regards the relations among items. FPA allows in-depth analysis of currently used questionnaires based on the presence/absence of clinical elements. FPA allows for going beyond the mere score by differentiating the patients according to symptomatology. Furthermore, it allows for computerized-adaptive assessment.
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Xie H, Liu J, Yu M, Wang Y, Yao C, Yao S, Jin D, Hu D, Wang Y, Shen J, Pan S. Structure-activity relationship of 39 analogs of laetispicine with antidepressant properties. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2014; 41:1377-92. [PMID: 24228607 DOI: 10.1142/s0192415x13500924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The natural product Laetispicine ( N -isobutyl-(3,4-methylendioxyphenyl)-2E, 4E, 9E-undecatrienoamide), was isolated from the Piper laetispicum C. DC and screened, for its antidepressant activity and antinociceptive effects. Structure-functional activities of five natural products indicated that biological activity is dependent on double bonds present within the benzene ring and a conjugated double bond located at positions 2-3 and 4-5 in the molecular structure. To further understand the structural-activity relationship of Laetispicine as a new potent and safe antidepressant, the structural-activity relationship of 39 analogs of Laetispicine were synthetized and tested in forced swimming tests in mice whilst also in protective effects against glutamate or H 2 O 2 induced apoptosis in PC12 cells. The results show that the compound 30 - N -isobutyl-11-(4-chlorophenyl) undeca-2E,4E,9E-trienamide exhibited the same activity as the parental compound Laetispicine, and furthermore, the effective dose of this compound is lower than Laetispicine. Therefore, the compound 30 might be a potentially useful therapy in the treatment of depression. For structure, the conjugated double bonds located at 2-3, 4-5 and isolated double bonds from benzene ring are necessary for the antidepressant activities no matter the different length of carbon chain; the isobutyl connected with acylamino also are necessary; and the benzodioxole moiety is replaceable, the halogen atom in phenyl ring at the para-position could enhance this kind of activity.
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Affiliation(s)
- Hui Xie
- School of Pharmacy, Fudan University, Shanghai 201203, China
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Park SC, Lee HY, Sakong JK, Jun TY, Lee MS, Kim JM, Kim JB, Yim HW, Park YC. Distinctive Clinical Correlates of Psychotic Major Depression: The CRESCEND Study. Psychiatry Investig 2014; 11:281-9. [PMID: 25110501 PMCID: PMC4124187 DOI: 10.4306/pi.2014.11.3.281] [Citation(s) in RCA: 29] [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: 06/10/2013] [Revised: 09/14/2013] [Accepted: 09/20/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this investigation was to identify distinctive clinical correlates of psychotic major depression (PMD) as compared with non-psychotic major depression (NPMD) in a large cohort of Korean patients with major depressive disorder (MDD). METHODS We recruited 966 MDD patients of age over 18 years from the Clinical Research Center for Depression of South Korea (CRESCEND) study. Diagnoses of PMD (n=24) and NPMD (n=942) were made with the DSM-IV definitions and confirmed with SCID. Psychometric scales were used to assess overall psychiatric symptoms (BPRS), depression (HAMD), anxiety (HAMA), global severity (CGI-S), suicidal ideation (SSI-Beck), functioning (SOFAS), and quality of life (WHOQOL-BREF). Using independent t-tests and χ(2) tests, we compared clinical characteristics of patients with PMD and NPMD. A binary logistic regression model was constructed to identify factors independently associated with increased likelihood of PMD. RESULTS PMD subjects were characterized by a higher rate of inpatient enrollment, and higher scores on many items on BPRS (somatic concern, anxiety, emotional withdrawal, guilt feelings, tension, depression, suspiciousness, hallucination, motor retardation, blunted affect and excitement) global severity (CGI-s), and suicidal ideation (SSI-Beck). The explanatory factor model revealed that high levels of tension, excitement, and suicidal ideation were associated with increased likelihood of PMD. CONCLUSION Our findings partly support the view that PMD has its own distinctive clinical manifestation and course, and may be considered a diagnostic entity separate from NPMD.
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Affiliation(s)
- Seon-Cheol Park
- Department of Psychiatry, Yong-In Mental Hospital, Yongin, Republic of Korea
- Institute of Mental Health, Hanyang University, Seoul, Republic of Korea
| | - Hwa-Young Lee
- Department of Psychiatry, College of Medicine, Soonchunhyang University, Asan, Republic of Korea
| | - Jeong-Kyu Sakong
- Department of Psychiatry, College of Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Tae-Youn Jun
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min-Soo Lee
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, School of Medicine, Chonnam National University, Gwangju, Republic of Korea
| | - Jung-Bum Kim
- Department of Psychiatry, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Hyeon-Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Chon Park
- Institute of Mental Health, Hanyang University, Seoul, Republic of Korea
- Department of Psychiatry, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Gaudiano BA, Nowlan K, Brown LA, Epstein-Lubow G, Miller IW. An open trial of a new acceptance-based behavioral treatment for major depression with psychotic features. Behav Modif 2013; 37:324-55. [PMID: 23223385 PMCID: PMC4049629 DOI: 10.1177/0145445512465173] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Research suggests that cognitive and behavioral therapies produce significant benefits over medications alone in the treatment of severe, nonpsychotic major depression or primary psychotic disorders such as schizophrenia. However, previous research has not demonstrated the efficacy of psychotherapy for major depression with psychotic features. In this initial treatment development study, we conducted an open trial of a new behavioral intervention that combines elements of behavioral activation and acceptance and commitment therapy for depression and psychosis. Fourteen patients with major depressive disorder with psychotic features were provided with up to 6 months of Acceptance-Based Depression and Psychosis Therapy (ADAPT) in combination with pharmacotherapy. Patients reported a high degree of treatment credibility and acceptability. Results showed that patients achieved clinically significant and sustained improvements through posttreatment follow-up in depressive and psychotic symptoms, as well as psychosocial functioning. In addition, the processes targeted by the intervention (e.g., acceptance, mindfulness, values) improved significantly over the course of treatment, and changes in processes were correlated with changes in symptoms. Results suggest that ADAPT combined with pharmacotherapy is a promising treatment approach for psychotic depression that should be tested in a future randomized trial.
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Abstract
OBJECTIVE This study explored whether young adults with major depression who are physically active differ in their depression symptom profile from those physically inactive. METHODS Analyses included data from 950 (47.6%) men and 1045 women (mean [standard deviation] age = 31.5 [2.6] years) participating in a national study. Participants reported leisure physical activity (International Physical Activity Questionnaire) and ambulatory activity (pedometer steps per day). Diagnosis and symptoms of major depression were assessed using the Composite International Diagnostic Interview. RESULTS Prevalence of major depression was 5.5% (n = 52) for men and 11.6% (n = 121) for women. Interactions between physical activity and sex were observed for depressed mood, appetite changes, vacillating thoughts, and suicidality (all, p < .050). Among those with major depression, physically active men were significantly less likely to endorse the presence of insomnia (prevalence ratio [PR] = 0.78, 95% confidence interval [CI] = 0.63-0.96), fatigue (PR = 0.82, 95% CI = 0.69-0.99), and suicidality (PR = 0.69, 95% CI = 0.49-0.96) compared with inactive men. Physically active women were significantly less likely to endorse hypersomnia (PR = 0.50, 95% CI = 0.27-0.95), excessive/irrational guilt (PR = 0.76, 95% CI = 0.59-0.97), vacillating thoughts (PR = 0.74, 95% CI = 0.58-0.95), and suicidality (PR = 0.43, 95% CI = 0.20-0.89) compared with inactive women. Associations were adjusted for age, physical health, educational attainment, depression severity, and other depressive symptoms. CONCLUSIONS Among adults with major depression, those physically active seem to differ in their depression symptom profile from those physically inactive.
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30
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Symptom Profile and Severity in a Sample of Nigerians with Psychotic versus Nonpsychotic Major Depression. DEPRESSION RESEARCH AND TREATMENT 2013; 2013:815456. [PMID: 24027633 PMCID: PMC3763571 DOI: 10.1155/2013/815456] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/17/2013] [Accepted: 07/22/2013] [Indexed: 01/31/2023]
Abstract
The therapeutic strategies in managing patients with psychotic major depression (PMD) differ from those with non-psychotic major depression (NMD), because of differences in clinical profile and outcome. However, there is underrecognition of psychotic symptoms in depressed patients. Previous studies in Western population suggest that certain symptom patterns, apart from psychosis which may be concealed, can facilitate the discrimination of PMD from NMD. These studies may have limited applicability to sub-Saharan Africa due to cross-cultural differences in the phenomenology of depression. This study compared the rates and severity of depressive symptoms in outpatients with PMD (n = 129) and NMD (n = 117) using the Structured Clinical Interview for Depression (SCID) and Hamilton Depression Rating Scale (HAM-D). Patients with PMD had statistically significantly higher rates of suicidal ideation, suicidal attempt, psychomotor agitation, insomnia, and reduced appetite. Patients with NMD were more likely to manifest psychomotor retardation and somatic symptoms. PMD was associated with greater symptom severity. On logistic regression analysis, suicidal ideation, psychomotor disturbances, insomnia, and somatic symptoms were predictive of diagnostic status. The presence of these symptoms clusters may increase the suspicion of occult psychosis in patients with depression, thereby informing appropriate intervention strategies.
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Baitharu I, Jain V, Deep SN, Kumar G, Ilavazhagan G. Exposure to Hypobaric Hypoxia and Reoxygenation Induces Transient Anxiety-Like Behavior in Rat. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jbbs.2013.38063] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lee YJ, Cho SJ, Cho IH, Jang JH, Kim SJ. The relationship between psychotic-like experiences and sleep disturbances in adolescents. Sleep Med 2012; 13:1021-7. [DOI: 10.1016/j.sleep.2012.06.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 05/31/2012] [Accepted: 06/01/2012] [Indexed: 11/29/2022]
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33
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Ostergaard SD, Rothschild AJ, Uggerby P, Munk-Jørgensen P, Bech P, Mors O. Considerations on the ICD-11 classification of psychotic depression. PSYCHOTHERAPY AND PSYCHOSOMATICS 2012; 81:135-44. [PMID: 22398817 DOI: 10.1159/000334487] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 10/09/2011] [Indexed: 11/19/2022]
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34
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Freitas C, Pearlman C, Pascual-Leone A. Treatment of auditory verbal hallucinations with transcranial magnetic stimulation in a patient with psychotic major depression: one-year follow-up. Neurocase 2012; 18:57-65. [PMID: 21614723 PMCID: PMC3589800 DOI: 10.1080/13554794.2010.547864] [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] [Indexed: 10/18/2022]
Abstract
Auditory verbal hallucinations (AVH) in patients with schizophrenia can respond to repetitive transcranial magnetic stimulation (TMS). We report the therapeutic utility of rTMS in a 48-year-old patient with a 20-year history of severe depression (five suicidal gestures and previous failure of ECT) and internal AVH. First, 20 Hz rTMS to the left prefrontal cortex for 3 weeks significantly improved depression (BDI-II: 89% change, lasting 14 months along with weekly/bi-weekly maintenance treatments), but AVH remained unchanged. The patient also underwent a further course of the left temporo-parietal 1 Hz rTMS and amelioration of AVH severity was achieved (PSYRATS-AH: 53% change) and maintained at 1-year follow-up. AVH respond to rTMS in disorders other than schizophrenia. Furthermore, targeted rTMS to different brain regions can address diverse symptoms in neuropsychiatric conditions.
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Affiliation(s)
- Catarina Freitas
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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Jang SH, Park YN, Jae YM, Jun TY, Lee MS, Kim JM, Jeong SH, Kim JB. The Symptom Frequency Characteristics of the Hamilton Depression Rating Scale and Possible Symptom Clusters of Depressive Disorders in Korea: The CRESCEND Study. Psychiatry Investig 2011; 8:312-9. [PMID: 22216040 PMCID: PMC3246138 DOI: 10.4306/pi.2011.8.4.312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 04/25/2011] [Accepted: 06/30/2011] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study analyzed the symptom frequencies of 17-item Hamilton Depression Rating Scale (HDRS-17) to understand the characteristics of each item and to propose the possible symptoms clusters. METHODS From psychiatric clinics of 18 Hospitals in Korea, 1,183 patients, diagnosed with major depressive disorder (psychotic or non-psychotic), dysthymia or depressive disorder not otherwise specified. according to DSM-IV criteria, participated in this study from January 2006 to August 2008. The frequencies of each item of HDRS-17 were analyzed according to sex and severity. In addition, we compared this study with a previous study performed in England by Hamilton and with two studies performed in Korea by Kim et al. RESULTS The frequencies of HDRS-17 items varied widely in this study, ranging from 95.8% in work and activities to 37.4% in loss of weight. But, depressed mood, psychic anxiety and work and activities items exhibited constant and higher frequency or rank regardless of study, the severity of depression or sex. Insomnia early, somatic gastrointestinal, genital symptoms and insight showed relatively constant but lower frequency or rank in disregard of studies or the clinical variables. Other symptoms had variable frequencies or ranks according to the variable clinical situations (culture, time, sex, severity of depression). CONCLUSION WE PROPOSE THREE CLUSTERS OF SYMPTOMS IN DEPRESSIVE DISORDERS: core symptoms cluster, an associated symptoms, and a situation-specific symptoms. We can use these possible symptom clusters of depression in simplifying diagnosis of depression, increasing diagnostic specificity in special situation and indexing disease severity.
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Affiliation(s)
- Sae-Heon Jang
- Department of Neuropsychiatry, Bongseng Memorial Hospital, Busan, Korea
| | - Young-Nam Park
- Department of Psychiatry, SeoDaegu Daedong Hospital, Daegu, Korea
| | - Young-Myo Jae
- Department of Neuropsychiatry, Bongseng Memorial Hospital, Busan, Korea
| | - Tae-Youn Jun
- Department of Psychiatry, School of Medicine, the Catholic University, Seoul, Korea
| | - Min-Soo Lee
- Department of Psychiatry, School of Medicine, Korea University, Seoul, Korea
| | - Jae-Min Kim
- Department of Psychiatry, School of Medicine, Chonnam National University, Gwangju, Korea
| | - Seung-Hee Jeong
- Department of Preventive Medicine, School of Medicine, the Catholic University, Seoul, Korea
| | - Jung-Bum Kim
- Department of Psychiatry, Keimyung University School of Medicine, Daegu, Korea
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Souery D, Zaninotto L, Calati R, Linotte S, Sentissi O, Amital D, Moser U, Kasper S, Zohar J, Mendlewicz J, Serretti A. Phenomenology of psychotic mood disorders: lifetime and major depressive episode features. J Affect Disord 2011; 135:241-50. [PMID: 21889213 DOI: 10.1016/j.jad.2011.07.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 07/29/2011] [Accepted: 07/29/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND The nosological and clinical implications of psychotic features in the course of mood disorders have been widely debated. Currently, no specification exists for defining a subgroup of lifetime Psychotic Mood Disorder (PMD) patients. METHODS A total of 2178 patients were examined, including subjects with Bipolar Disorder (BP) type I (n=519) and II (n=207) and Major Depressive Disorder (n=1452). Patients were divided between PMD (n=645) and non-psychotic Mood Disorders (MD) (n=1533) by the lifetime presence of at least one mood episode with psychotic features. Subjects having a depressive episode at the time of assessment were also examined: HAM-D and YMRS scores were compared between MD and PMD subjects, both with and without current psychotic features. RESULTS A diagnosis of BP-I, a higher familial load for BP, a higher number of mood episodes lifetime, and a higher prevalence of OCD and somatic comorbidities were all associated to PMD. A diagnosis of BP (OR=4.48) was the only significant predictor for psychosis. PMD with non-psychotic depression were apparently less severe than MD patients and had a lower rate of "non-responders" to AD treatment. Sub-threshold manic symptoms and suicidal risk were also more pronounced among PMD. LIMITATIONS The lack of information about number and polarity of previous psychotic mood episodes may be the major limitations of our study. CONCLUSIONS BP diagnosis is the most significant predictor for psychosis in mood disorders. Non-psychotic mood episodes in PMD patients may be characterized by a distinctive symptom profile and, possibly, a different response to treatment.
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Affiliation(s)
- Daniel Souery
- Laboratoire de Psychologie Medicale, Université Libre de Bruxelles and Psy Pluriel, Centre Européen de Psychologie Medicale, Brussels, Belgium
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Excessive daytime sleepiness and fatigue in depressed patients and therapeutic response of a sedating antidepressant. J Affect Disord 2011; 134:421-6. [PMID: 21616541 DOI: 10.1016/j.jad.2011.04.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 04/27/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although sleepiness and fatigue are common symptoms in depressed patients, the relationships among sleepiness, fatigue and treatment of depression have not been fully elucidated. The main objective of this study was to investigate the therapeutic effects of a sedating antidepressant on sleepiness and fatigue in patients with depression. METHODS Forty-two depressed patients, who met DSM-IV diagnostic criteria, and 32 matched healthy controls participated in the baseline measurements. Sixteen of the depressed patients were treated with mirtazapine. At baseline, daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS) and Stanford Sleepiness Scale (SSS), and fatigue was assessed using the Fatigue Severity Scale (FSS) and Fatigue Impact Scale (FIS). During treatment, Multiple Sleep Latency Test (MSLT), ESS and SSS were used to measure daytime sleepiness, and the FIS, FACES Checklist-Fatigue subscale (FAF) and Fatigue Assessment Instrument (FAI) were used to measure fatigue. RESULTS At baseline, there were significant group differences between the depressed and healthy controls on the ESS (P = 0.001), SSS (P<0.001), FSS (P < 0.001) and FIS (P < 0.001). Significant improvement of sleepiness and fatigue measures was seen after treatment with mirtazapine on the MSLT (P = 0.011), ESS (P = 0.021), SSS (P = 0.001), FIS (P = 0.002) and FAF (P = 0.004). LIMITATIONS Open-label treatment and relatively small sample size. CONCLUSION Daytime sleepiness and fatigue are significant symptoms in depressed patients. Slightly paradoxically, a sedating antidepressant may alleviate these symptoms.
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Grillo L. Might the inability to feel pleasure (anhedonia) explain the symptoms of major depression and schizophrenia, including unmotivated anxiety, delusions and hallucinations? Med Hypotheses 2011; 78:98-101. [PMID: 22036091 DOI: 10.1016/j.mehy.2011.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 09/07/2011] [Accepted: 10/04/2011] [Indexed: 11/15/2022]
Abstract
Inability to enjoy normally pleasurable experiences (anhedonia) is a symptom common both to major depression and schizophrenia. It also regularly accompanies and follows stress, and its presence in the two mental illnesses could depend on the fact that both are facilitated and often preceded by stressful events. Anhedonia might possibly accompany stress because the loss of the pleasure of aiming for a goal and achieving it (including defending oneself and escaping from a danger) could lead to immobility, and immobility (playing dead) offers the extreme chance of safety when an animal is facing the worst possible stressful situation--being seized by a predator--as in this case any movement can further stimulate the predator's aggressiveness. Perceiving and connecting sensory information also gives pleasure, and this appears to enhance the clarity of sensations and is an important factor in learning. We propose that anhedonia, by reducing or eliminating the pleasure, might jeopardize the usual appearance of the environment, which must not only be clearly perceived but also continuously interpreted (for instance a foreshortening, or something far off seen as small, must not be seen as a real deformation; the same holds for words, where the meaning has to be grasped from the single letters, and so on). Consequently, anhedonia could in some cases make the environment's image strange, distorted and frightening, and this could cause anxiety, confusion, and give problems in contacts with people and things. As correct information about images and sounds can inhibit visual and auditory hallucinations (considering them, like delusions, as attempts to reconstruct and make sense again of a world that is becoming confused and alien), we propose that anhedonia, interfering with the correct perceiving and processing of sensations, may facilitate them.
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Xie H, Yan MC, Jin D, Liu JJ, Yu M, Dong D, Cai CC, Pan SL. Studies on antidepressant and antinociceptive effects of ethyl acetate extract from Piper laetispicum and structure–activity relationship of its amide alkaloids. Fitoterapia 2011; 82:1086-92. [DOI: 10.1016/j.fitote.2011.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 07/08/2011] [Accepted: 07/08/2011] [Indexed: 10/18/2022]
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Ruggero CJ, Kotov R, Carlson GA, Tanenberg-Karant M, González DA, Bromet EJ. Diagnostic consistency of major depression with psychosis across 10 years. J Clin Psychiatry 2011; 72:1207-13. [PMID: 21903033 PMCID: PMC3589602 DOI: 10.4088/jcp.10m06774] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 04/18/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The present study investigates how consistently DSM-IV major depressive disorder (MDD) with psychosis was diagnosed by research consensus across 10 years and the association of clinical characteristics with diagnostic consistency. METHOD The sample included 146 participants, part of a larger first-admission cohort (N = 628) presenting to a psychiatric inpatient facility with psychosis, who were diagnosed with psychotic depression at least once across 4 assessments spanning 10 years (after first admission and at 6-month, 24-month, and 10-year follow-ups). The primary outcome of this prospective epidemiologic study was retention of the best-estimate consensus diagnosis at each assessment. Diagnoses at each assessment were determined from semistructured interviews, medical records, and informant reports. The participants were recruited from 1989 to 1995. RESULTS Fifty-five of the 146 participants (37.7%) were diagnosed with psychotic depression at each available assessment; 13 (8.9%) switched from MDD to bipolar disorder, 24 (16.4%) switched from MDD to schizophrenia or schizoaffective disorder, and the remaining 54 (37.0%) had other patterns of diagnostic change. Only 47 of 80 participants (58.8%) diagnosed with MDD at baseline retained a mood disorder diagnosis 10 years later (36 [45.0%] had MDD and 11 [13.8%] had bipolar disorder), while 16 of 52 participants (30.8%) who ended the study with MDD were initially misdiagnosed. Compared to participants who were consistently diagnosed with MDD, those switching from MDD to bipolar disorder had better premorbid adjustment, more first-degree relatives with MDD, better functioning, and fewer negative symptoms at baseline, whereas those shifting to the schizophrenia spectrum had a more insidious onset, longer initial hospital stays, worse functioning, and more negative symptoms (all P values < .05). CONCLUSIONS The diagnosis of MDD with psychosis among inpatients showed poor long-term consistency. For clinicians, results indicate that the diagnosis of MDD with psychosis based on a single assessment should be considered provisional.
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Affiliation(s)
- Camilo J Ruggero
- Department of Psychology, University of North Texas, 1155 Union Cir #311280, Denton, TX 76203, USA.
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Conradi HJ, Ormel J, de Jonge P. Presence of individual (residual) symptoms during depressive episodes and periods of remission: a 3-year prospective study. Psychol Med 2011; 41:1165-1174. [PMID: 20932356 DOI: 10.1017/s0033291710001911] [Citation(s) in RCA: 298] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Residual depressive symptomatology constitutes a substantial risk for relapse in depression. Treatment until full remission is achieved is therefore implicated. However, there is a lack of knowledge about the prevalence of (1) residual symptoms in general and (2) the individual residual symptoms in particular. METHOD In a 3-year prospective study of 267 initially depressed primary care patients we established per week the presence/absence of the individual DSM-IV depressive symptoms during subsequent major depressive episodes (MDEs) and episodes of (partial) remission. This was accomplished by means of 12 assessments at 3-monthly intervals with the Composite International Diagnostic Interview (CIDI). RESULTS In general, residual depressive symptomatology was substantial, with on average two symptoms present during remissions. Three individual symptoms (cognitive problems, lack of energy and sleeping problems) dominated the course of depression and were present 85-94% of the time during depressive episodes and 39-44% of the time during remissions. CONCLUSIONS Residual symptoms are prevalent, with some symptoms being present for almost half of the time during periods of remission. Treatment until full remission is achieved is not common practice, yet there is a clear need to do so to prevent relapse. Several treatment suggestions are made.
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Affiliation(s)
- H J Conradi
- Department of Psychiatry, University of Groningen, The Netherlands.
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Domschke K, Lawford B, Young R, Voisey J, Morris CP, Roehrs T, Hohoff C, Birosova E, Arolt V, Baune BT. Dysbindin (DTNBP1)--a role in psychotic depression? J Psychiatr Res 2011; 45:588-95. [PMID: 20951386 DOI: 10.1016/j.jpsychires.2010.09.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 08/10/2010] [Accepted: 09/22/2010] [Indexed: 01/20/2023]
Abstract
Previous studies yielded evidence for dysbindin (DTNBP1) to impact the pathogenesis of schizophrenia on the one hand and affective disorders such as bipolar or major depressive disorder (MDD) on the other. Thus, in the present study we investigated whether DTNBP1 variation was associated with psychotic depression as a severe clinical manifestation of MDD possibly constituting an overlapping phenotype between affective disorders and schizophrenia. A sample of 243 Caucasian inpatients with MDD (SCID-I) was genotyped for 12 SNPs spanning 92% of the DTNBP1 gene region. Differences in DTNBP1 genotype distributions across diagnostic subgroups of psychotic (N = 131) vs. non-psychotic depression were estimated by Pearson Chi(2) test and logistic regression analyses adjusted for age, gender, Beck Depression Inventory (BDI) and the Global Assessment of Functioning Scale (GAF). Overall, patients with psychotic depression presented with higher BDI and lower GAF scores expressing a higher severity of the illness as compared to depressed patients without psychotic features. Four DTNBP1 SNPs, particularly rs1997679 and rs9370822, and the corresponding haplotypes, respectively, were found to be significantly associated with the risk of psychotic depression in an allele-dose fashion. In summary, the present results provide preliminary support for dysbindin (DTNBP1) gene variation, particularly SNPs rs1997679 and rs9370822, to be associated with the clinical phenotype of psychotic depression suggesting a possible neurobiological mechanism for an intermediate trait on the continuum between affective disorders and schizophrenia.
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Affiliation(s)
- Katharina Domschke
- Department of Psychiatry, University of Muenster, Albert-Schweitzer-Strasse 11, D-48143 Muenster, Germany.
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Pintér O, Domokos Á, Mergl Z, Mikics É, Zelena D. Do stress hormones connect environmental effects with behavior in the forced swim test? Endocr J 2011; 58:395-407. [PMID: 21505269 DOI: 10.1507/endocrj.k10e-375] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Forced swim test (FST) is a widely used test for antidepressant development. Depression is a stress related disease, as hormones of the stress-axis can modify mood. However it is not clear, how the appearance of depressive-like behavior (floating) in FST is connected with changes in the stress-hormone levels. We hypothesized, that different manipulations would alter the behavior through changes in stress-hormone levels. First the effect of environmental alterations was studied. Increasing water-temperature enhanced floating time together with a decrease in adrenocorticotropin levels. During the dark phase of the day rats spent more time with floating independently from the actual lighting. Neither the phase nor the actual lighting had significant effect on adrenocorticotropin concentrations with higher corticosterone levels during the dark phase. At greater water depth rats float less but the size of animals had no effect. Water depth did not influence adrenocorticotropin and corticosterone responses, but the size of the rats significantly affected both factors. Secondly, administration of imipramine reduced floating and adrenocorticotropin level without affecting corticosterone. Despite the known connection between depression and stress we did not find a correlation between floating behavior and hormone levels. As an alternative mechanism imipramine-induced heart rate and core body temperature decrease was found by telemetric approach. This study is the first summary in rats examining the effect of wide range of environmental alterations during FST. It seems likely that both brain monoamines and stress-axis take part in the development of depression, but these pathways are regulated independently.
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Affiliation(s)
- Ottó Pintér
- Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary
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Seol GH, Shim HS, Kim PJ, Moon HK, Lee KH, Shim I, Suh SH, Min SS. Antidepressant-like effect of Salvia sclarea is explained by modulation of dopamine activities in rats. JOURNAL OF ETHNOPHARMACOLOGY 2010; 130:187-190. [PMID: 20441789 DOI: 10.1016/j.jep.2010.04.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 04/15/2010] [Accepted: 04/20/2010] [Indexed: 05/29/2023]
Abstract
AIM OF THE STUDY The purpose of the present study was to screen aromatic essential oils that have antidepressant effects to identify the regulatory mechanisms of selected essential oils. MATERIALS AND METHODS The antidepressant effects of essential oils of Anthemis nobilis (chamomile), Salvia sclarea (clary sage; clary), Rosmarinus officinalis (rosemary), and Lavandula angustifolia (lavender) were assessed using a forced swim test (FST) in rats. Rats were treated with essential oils by intraperitoneal injection or inhalation. Serum levels of corticosterone were assessed by enzyme-linked immunosorbent assay (ELISA). RESULTS Among the essential oils tested, 5% (v/v) clary oil had the strongest anti-stressor effect in the FST. We further investigated the mechanism of clary oil antidepression by pretreatment with agonists or antagonists to serotonin (5-HT), dopamine (DA), adrenaline, and GABA receptors. The anti-stressor effect of clary oil was significantly blocked by pretreatment with buspirone (a 5-HT(1A) agonist), SCH-23390 (a D(1) receptor antagonist) and haloperidol (a D(2), D(3), and D(4) receptor antagonist). CONCLUSIONS Our findings indicate that clary oil could be developed as a therapeutic agent for patients with depression and that the antidepressant-like effect of clary oil is closely associated with modulation of the DAnergic pathway.
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Affiliation(s)
- Geun Hee Seol
- Department of Basic Nursing Science, Korea University School of Nursing, Seoul 136-713, South Korea
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Lieberman DZ, Massey SH. Desvenlafaxine in major depressive disorder: an evidence-based review of its place in therapy. CORE EVIDENCE 2010; 4:67-82. [PMID: 20694066 PMCID: PMC2899788 DOI: 10.2147/ce.s5998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Desvenlafaxine, the active metabolite of venlafaxine, is a serotonin norepinephrine reuptake inhibitor (SNRI) recently approved for the treatment of major depressive disorder. It is one of only three medications in this class available in the United States. AIMS The objective of this article is to review the published evidence for the safety and efficacy of desvenlafaxine, and to compare it to other antidepressants to delineate its role in the treatment of depression. EVIDENCE REVIEW At the recommended dose of 50 mg per day the rate of response and remission was similar to other SNRIs, as was the adverse effect profile. The rate of discontinuation was no greater than placebo, and a discontinuation syndrome was not observed at this dose. Higher doses were not associated with greater efficacy, but they did lead to more side effects, and the use of a taper prior to discontinuation. The most common side effects reported were insomnia, somnolence, dizziness, and nausea. Some subjects experienced clinically significant blood pressure elevation. PLACE IN THERAPY Like duloxetine, desvenlafaxine inhibits the reuptake of both norepinephrine and serotonin at the starting dose. Dual reuptake inhibitors have been shown to have small but statistically significantly greater rates of response and remission compared to selective serotonin reuptake inhibitors, and they have also shown early promise in the treatment of neuropathic pain. Desvenlafaxine may prove to be a valuable treatment option by expanding the limited number of available dual reuptake inhibitors.
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Affiliation(s)
- Daniel Z Lieberman
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Suena H Massey
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Gaudiano BA, Zimmerman M. Does comorbid posttraumatic stress disorder affect the severity and course of psychotic major depressive disorder? J Clin Psychiatry 2010; 71:442-50. [PMID: 20021993 PMCID: PMC3671375 DOI: 10.4088/jcp.08m04794gre] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 01/02/2009] [Indexed: 01/16/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) are commonly comorbid conditions that result in greater severity, chronicity, and impairment compared with either disorder alone. However, previous research has not systematically explored the potential effects of the psychotic subtyping of MDD and comorbid PTSD. METHOD The sample in this retrospective case-control study conducted from December 1995 to August 2006 consisted of psychiatric outpatients with DSM-IV-diagnosed psychotic MDD with PTSD, psychotic MDD without PTSD, or nonpsychotic MDD with PTSD presenting for clinic intake. Clinical indices of severity, impairment, and history of illness were assessed by trained diagnosticians using the Structured Clinical Interview for DSM-IV Axis I Disorders supplemented by items from the Schedule for Affective Disorders and Schizophrenia. RESULTS In terms of current severity and impairment, the psychotic MDD with PTSD (n = 34) and psychotic MDD only (n = 26) groups were similar to each other, and both tended to be more severe than the nonpsychotic MDD with PTSD group (n = 263). In terms of history of illness, the psychotic MDD with PTSD group tended to show greater severity and impairment relative to either the psychotic MDD only or nonpsychotic MDD with PTSD groups. Furthermore, the psychotic MDD with PTSD patients had an earlier time to depression onset than patients with either psychotic MDD alone or nonpsychotic MDD with PTSD, which appeared to contribute to the poorer history of illness demonstrated in the former group. CONCLUSIONS Future research should explore the possibility of a subtype of psychotic depression that is associated with PTSD, resulting in a poorer course of illness. The current findings highlight the need for pharmacologic and psychotherapeutic approaches that can be better tailored to psychotic MDD patients with PTSD comorbidity.
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Affiliation(s)
- Brandon A. Gaudiano
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University,Psychosocial Research Program, Butler Hospital
| | - Mark Zimmerman
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University,Department of Psychiatry, Rhode Island Hospital
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Does the dexamethasone suppression test reliably discriminate between psychotic and nonpsychotic major depression?: an exploratory analysis of potential confounds. J Nerv Ment Dis 2009; 197:395-400. [PMID: 19525738 PMCID: PMC3676665 DOI: 10.1097/nmd.0b013e3181a775cf] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Previous research has shown that psychotic major depression (PMD) is often associated with higher rates of nonsuppression on the dexamethasone suppression test (DST) compared with nonpsychotic major depression (NMD), suggesting the potential importance of cortisol hypersecretion in the psychotic subtype of the disorder. However, these patient groups also are known to differ from one another on a variety of other clinical variables, and there are numerous factors independent of diagnostic status known to affect the DST. Thus, we investigated possible confounds that could help account for the apparent DST abnormalities in PMD sometimes reported in past research. Hospitalized patients with PMD (n = 11) and NMD (n = 58) were compared on the DST and other clinical variables. As expected, PMD patients showed significantly higher rates of DST nonsuppression (55% vs. 24%; p = 0.04). However, PMD patients also had significantly higher levels of anxiety severity (p = 0.01). The higher rates of nonsuppression in the PMD group were attenuated when these patients were compared with a subsample of NMD patients matched on anxiety severity (55% vs. 55%). Implications for future research on biological markers of PMD are discussed.
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