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Meşe Pekdemir E, Tanik N. Clinical significance of osmophobia and its effect on quality of life in people with migraine. Acta Neurol Belg 2023; 123:1747-1755. [PMID: 35864435 DOI: 10.1007/s13760-022-02030-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/10/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In this study, we aimed to evaluate the clinical significance of osmophobia and its effect on quality of life in people with migraine. METHODS A total of 145 people with migraine were included in this cross-sectional study. Patients were evaluated with the migraine data form, the Migraine 24-Hour Quality of Life Questionnaire (24-HrMQoLQ), the Migraine Disability Assessment Scale (MIDAS), the Patient Health Questionnaire-9 (PHQ-9), the Insomnia Severity Index (ISI), the Generalized Anxiety Disorder-7 (GAD-7), the Allodynia Symptom Checklist (ASC), and the Fatigue Severity Scale (FSS). To evaluate the presence of osmophobia retrospectively, a semi-structured interview was conducted with the patients by the neurologist. RESULTS The mean 24-Hr-MQoLQ of patients with osmophobia was significantly lower than those without osmophobia. The decrease in the 24-Hr-MQoLQ was statistically significant in the areas of feeling and concerns and social functionality. The mean of the MIDAS scale was higher significantly in patients with osmophobia than those without osmophobia. In addition, the mean ISI, PHQ-9, FSS and ASC scores of patients with osmophobia were statistically significantly higher than those without osmophobia. CONCLUSIONS Both 24-h and 3-month quality of life of people with migraine with osmophobia were more affected than those without osmophobia. At the same manner, insomnia, depression, fatigue and allodynia were observed at higher rates in people with migraine with osmophobia than in migraine without osmophobia. Osmophobia, which is one of the specific symptoms that distinguishes migraine from other headache disorders, deserves further and multifaceted investigation.
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Affiliation(s)
| | - Nermin Tanik
- Yozgat Bozok University Medical School, Yozgat, Turkey
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2
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Hung CI, Liu CY, Hsu SC, Yang CH. Comparing the associations of three psychometric scales at baseline with long-term prognosis of depression over a 10-year period. Int J Methods Psychiatr Res 2022; 31:e1896. [PMID: 34714578 PMCID: PMC8886283 DOI: 10.1002/mpr.1896] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/07/2021] [Accepted: 10/07/2021] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The Depression and Somatic Symptoms Scale (DSSS), a free scale, includes depression (DS) and somatic (SS) subscales. This study aimed to compare the associations of the baseline DSSS, Hamilton Depression Rating Scale (HAMD) and Hospital Anxiety and Depression Scale (HADS) scores with the outcome of depression over a 10-year follow-up period. METHODS Two hundred ninety outpatients with major depressive disorder (MDD) were enrolled and were followed-up at the 6-month, 2-year, and 10-year points. The three scales were administered at each follow-up. Multiple linear regressions were used to compare the associations. RESULTS In a comparison of the HAMD, DS, and HADS-depression, the HAMD and DS scores at baseline were most strongly associated with the HAMD score at two (6-month and 2-year) and one (10-year) follow-up points, respectively. In a comparison of the HAMD, DS, SS, HADS-depression, and HADS-anxiety, the SS and HAMD scores at baseline were most strongly associated with the HAMD score at two (6-month and 10-year) and one (2-year) follow-up points, respectively. CONCLUSIONS The DS, SS, and HAMD scores at baseline were significantly associated with the long-term outcome of depression. Scales or subscales assessing somatic symptoms might be more strongly associated with the outcome of depression.
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Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang-Gung Memorial Hospital at Linkou and Chang-Gung University College of Medicine, Tao-Yuan, Republic of China
| | - Chia-Yih Liu
- Department of Psychiatry, Chang-Gung Memorial Hospital at Linkou and Chang-Gung University College of Medicine, Tao-Yuan, Republic of China
| | - Shih-Chieh Hsu
- Department of Psychiatry, Chang-Gung Memorial Hospital at Linkou and Chang-Gung University College of Medicine, Tao-Yuan, Republic of China.,Department of Psychiatry, New Taipei Municipal Tucheng Hospital, New Taipei City, Republic of China
| | - Ching-Hui Yang
- Department of Nursing, Mackay Medical College, New Taipei City, Republic of China
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Saçmacı H, Cengiz GF, Aktürk T. Impact of dissociative experiences in migraine and its close relationship with osmophobia. Neurol Res 2020; 42:529-536. [PMID: 32295514 DOI: 10.1080/01616412.2020.1753417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Migraine is a complex episodic disease manifested by dysfunction of the sympathetic nervous system along with numerous neuropsychiatric symptoms. The aim of this study was to identify the dissociative symptoms with neurobiological similarities in episodic and chronic migraine patients and to evaluate their correlation with migraine frequency and severity of attacks. METHODS The study included 61 episodic, 45 chronic migraine patients diagnosed using the criteria of the International Headache Society and 54 healthy control subjects. Dissociative Experiences Scale, Beck Anxiety Scale and Beck Depression Inventory were filled with the interviews. Demographic, clinical and headache characteristics of the patients were recorded according to migraine types. Results were analyzed by Kruskal-Wallis method and Spearman's correlation tests. RESULTS Dissociative symptoms were more common in the patients with chronic migraine, and there was a statistically significant difference between the chronic migraine group and the episodic migraine and control groups (p = 0.001, p < 0.001). Dissociative experiences were correlated with depression and anxiety findings, and in both groups, there was a significant correlation between clinical characteristics of migraine and osmophobia in the controlled partial correlation analysis (p < 0.05). CONCLUSION This study revealed that dissociative symptoms are more common especially in patients with chronic migraine and there is a significant association with osmophobia in both migraine groups. According to these data, we think that dissociative symptoms in chronic migraine patients will be questioned and osmophobia may be a guide in this regard.
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Affiliation(s)
- Hikmet Saçmacı
- Department of Neurology, School of Medicine, Yozgat Bozok University , Yozgat, Turkey
| | - Gül Ferda Cengiz
- Department of Psychiatry, School of Medicine, Yozgat Bozok University , Yozgat, Turkey
| | - Tülin Aktürk
- Department of Neurology, School of Medicine, Yozgat Bozok University , Yozgat, Turkey
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Sarrouilhe D, Mesnil M, Dejean C. Targeting Gap Junctions: New Insights into the Treatment of Major Depressive Disorder. Curr Med Chem 2019; 26:3775-3791. [DOI: 10.2174/0929867325666180327103530] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 12/22/2017] [Accepted: 03/21/2018] [Indexed: 01/05/2023]
Abstract
Background:Major depressive disorder (MDD) is a multifactorial chronic and debilitating mood disease with high lifetime prevalence and associated with excess mortality. Treatments for this disease are not effective in all patients showing the need to find new therapeutic targets.Objective:This review aims to update our knowledge on the involvement of astroglial gap junctions and hemichannels in MDD and to show how they have become potential targets for the treatment of this pathology.Methods:The method applied in this review includes a systematic compilation of the relevant literature.Results and Conclusion:The use of rodent models of depression, gene analysis of hippocampal tissues of MDD patients and post-mortem studies on the brains from MDD patients suggest that astrocytic gap junction dysfunction may be a part of MDD etiologies. Chronic antidepressant treatments of rats, rat cultured cortical astrocytes and human astrocytoma cell lines support the hypothesis that the up-regulation of gap junctional coupling between astrocytes could be an underlying mechanism for the therapeutic effect of antidepressants. However, two recent functional studies suggest that connexin43 hemichannel activity is a part of several antidepressants’ mode of action and that astrocyte gap junctional intercellular communication and hemichannels exert different effects on antidepressant drug response. Even if they emerge as new therapeutic targets for new and more active treatments, further studies are needed to decipher the sophisticated and respective role of astrocytic gap junctions and hemichannels in MDD.
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Affiliation(s)
- Denis Sarrouilhe
- Laboratoire de Physiologie Humaine, Faculte de Medecine et Pharmacie, Universite de Poitiers, 6 rue de la Miletrie, Bat D1, TSA 51115, 86073 Poitiers, Cedex 9, France
| | - Marc Mesnil
- STIM, ERL 7003, CNRS-Universite de Poitiers, Pole Biologie Sante, Bat B36, TSA 51106, 1 rue Georges Bonnet, 86073 Poitiers, Cedex 9, France
| | - Catherine Dejean
- Service Pharmacie, Pavillon Janet, Centre Hospitalier Henri Laborit, 370 avenue Jacques Coeur, 86021 Poitiers Cedex, France
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Liu CH, Fu TS, Lee CP, Hung CI. Reliability and validity of the Depression and Somatic Symptoms Scale among patients with chronic low back pain. Neuropsychiatr Dis Treat 2019; 15:241-246. [PMID: 30679910 PMCID: PMC6338111 DOI: 10.2147/ndt.s188277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The Depression and Somatic Symptoms Scale (DSSS), which is a free scale that includes a depression subscale (DS) and a somatic subscale (SS), was developed to evaluate depression and somatic symptoms simultaneously. This study aimed to examine the reliability and validity of the DSSS among patients with chronic low back pain (CLBP). METHODS Two-hundred and twenty-five patients with CLBP were enrolled. Psychiatric diagnoses were made based on the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision. The DSSS, Oswestry Disability Index, Hospital Anxiety and Depression Scale (HADS), and Short Form 36 (SF-36) were administered. Cronbach's alpha was used to test internal consistency. Receiver operating characteristic (ROC) analysis was used to identify cutoff scores for a major depressive episode (MDE). RESULTS Subjects with an MDE (N=21) had greater severities of depression, anxiety, somatic symptoms, and disability as compared with those without an MDE. The Cronbach's alpha values of the DS and SS were 0.90 and 0.83, respectively. The DS and SS were significantly correlated with the Oswestry Disability Index, the HADS, and the SF-36 subscales. The DS had the greatest area under the receiver operating characteristic curve (0.96) as compared with the SS and the HADS subscales. The cutoff score for an MDE was a DS score ≥15 (sensitivity and specificity: 100% and 88.7%, respectively). CONCLUSION The DSSS subscales were of acceptable reliability and validity. The DS can be used as a tool for evaluating the severity of depression and detecting an MDE in patients with CLBP.
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Affiliation(s)
- Chun-Hao Liu
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan, .,Chang Gung University, Taoyuan, Taiwan,
| | - Tsai-Sheng Fu
- Chang Gung University, Taoyuan, Taiwan, .,Department of Orthopedics, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chin-Pang Lee
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan, .,Chang Gung University, Taoyuan, Taiwan,
| | - Ching-I Hung
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan, .,Chang Gung University, Taoyuan, Taiwan,
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6
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McKernan LC, Finn MTM, Carr ER. Personality and Affect When the Central Nervous System is Sensitized: An Analysis of Central Sensitization Syndromes in a Substance Use Disorder Population. Psychodyn Psychiatry 2018; 45:385-409. [PMID: 28846511 DOI: 10.1521/pdps.2017.45.3.385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Functional somatic syndromes, or more recently termed central sensitivity syndromes (CSS), comprise a significant portion of the chronic pain population. Although it is evident that personality is intricately related to the pain experience, it has not been widely studied. This article examines the impact of CSS on the clinical presentation of individuals presenting to treatment for a substance use disorder (SUD), with an emphasis on personality and emotional functioning. We examined personality profiles of individuals presenting to treatment with SUD between three groups: those with a CSS (n = 30), non-CSS chronic pain (n = 79), and no pain (n = 232). Based on previous research and a psychodynamic conceptualization of CSS, we hypothesized that predictors of the presence of a CSS in this sample would be higher rates of overall anxiety, traumatic stress, perfectionistic traits, and a need for interpersonal closeness. Logistic regression analyses did not support our hypothesis. Exploratory analyses indicated which personality traits most strongly predicted the presence of CSS. We discuss these findings using descriptive psychopathology literature, with recommendations for future research.
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Affiliation(s)
- Lindsey C McKernan
- Assistant Clinical Professor, Vanderbilt University School of Medicine, Osher Center of Integrative Medicine
| | - Michael T M Finn
- Doctoral Candidate in Clinical Psychology, The University of Tennessee, Knoxville
| | - Erika R Carr
- Assistant Professor, Director of Inpatient Psychology, Yale University School of Medicine
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7
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Weiss JJ, Prieto S, Bräu N, Dieterich DT, Marcus SM, Stivala A, Gorman JM. Multimethod assessment of baseline depression and relationship to hepatitis C treatment discontinuation. Int J Psychiatry Med 2018; 53:256-272. [PMID: 29298535 PMCID: PMC5975203 DOI: 10.1177/0091217417749796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The primary study objective is to determine which measures of depression are associated with early discontinuation of hepatitis C virus infection treatment and to determine which measure best characterizes the depression that develops during treatment. Methods Seventy-eight treatment-naïve subjects who initiated pegylated interferon/ribavirin treatment for hepatitis C virus infection were included. Baseline depression was assessed with the Structured Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), the Hamilton Depression Rating Scale, and the Beck Depression Inventory-II. The latter two measures were repeated at treatment weeks 12 and 24. Results Depression scores, as measured by the three instruments, lacked adequate consistency. Baseline depression as measured by the Beck Depression Inventory-II, but not by the other scales, was associated with early treatment discontinuation at weeks 12 and 24. Changes in depression during treatment were restricted to somatic symptoms. Of those who completed treatment, those who were not depressed at baseline tended to demonstrate significant depression increases during treatment. Conclusion The Beck Depression Inventory-II is recommended to assess depression prior to hepatitis C virus infection treatment. Somatic symptoms of depression should be monitored during treatment. Baseline depression as measured by the Beck Depression Inventory-II was associated with early treatment discontinuation. The Beck Depression Inventory-II, Structured Interview for DSM-IV, and Hamilton Depression Rating Scale yielded results that were not consistent with each other in this sample. Future research should focus on standardizing depression assessment in medically ill populations to identify measures that predict treatment discontinuation.
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Affiliation(s)
- Jeffrey J Weiss
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Sarah Prieto
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Norbert Bräu
- James J. Peters Veterans Affairs Medical Center, Infectious Diseases Section, Bronx, USA,Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Douglas T Dieterich
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Sue M Marcus
- Independent Statistical Consultant, Philadelphia, USA
| | - Alicia Stivala
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Jack M Gorman
- Franklin Behavioral Health Consultants and Critica LLC, Bronx, USA
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8
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Scanlon GC, Jain FA, Hunter AM, Cook IA, Leuchter AF. Neurophysiologic Correlates of Headache Pain in Subjects With Major Depressive Disorder. Clin EEG Neurosci 2017; 48:159-167. [PMID: 27000108 DOI: 10.1177/1550059416632411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Headache pain is often comorbid with major depressive disorder (MDD) and is associated with greater symptom burden, disability, and suicidality. The biological correlates of headache pain in MDD, however, remain obscure. The purpose of this study was to examine the association between brain oscillatory activity and headache pain in MDD subjects. METHODS A total of 64 subjects with MDD who were free of psychoactive medications were evaluated for severity of headache pain in the past week. Brain function was assessed using resting-state quantitative electroencephalography (qEEG). We derived cordance in the theta (4-8 Hz) and alpha (8-12 Hz) frequency bands at each electrode, and examined correlations with headache pain in regions of interest while controlling for depression severity. Frontal and posterior asymmetry in alpha power was calculated in regions of interest. RESULTS Headache pain severity was associated with depression severity ( r = 0.447, P < .001). In bilateral frontal and right posterior regions, alpha cordance was significantly associated with headache intensity, including when controlling for depression severity. The direction of the correlation was positive anteriorly and negative posteriorly. Frontal left dominant alpha asymmetry correlated with severity of headache but not depression symptoms. CONCLUSION Alterations in brain oscillations identified by alpha cordance and alpha asymmetry may be associated with the pathophysiology of headache pain in depression. These findings should be prospectively confirmed.
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Affiliation(s)
- Graham C Scanlon
- 1 UCLA Laboratory of Brain, Behavior, and Pharmacology and the Depression Research and Clinic Program, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Felipe A Jain
- 1 UCLA Laboratory of Brain, Behavior, and Pharmacology and the Depression Research and Clinic Program, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Aimee M Hunter
- 1 UCLA Laboratory of Brain, Behavior, and Pharmacology and the Depression Research and Clinic Program, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ian A Cook
- 1 UCLA Laboratory of Brain, Behavior, and Pharmacology and the Depression Research and Clinic Program, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Andrew F Leuchter
- 1 UCLA Laboratory of Brain, Behavior, and Pharmacology and the Depression Research and Clinic Program, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Discriminative Analysis of Migraine without Aura: Using Functional and Structural MRI with a Multi-Feature Classification Approach. PLoS One 2016; 11:e0163875. [PMID: 27690138 PMCID: PMC5045214 DOI: 10.1371/journal.pone.0163875] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 09/15/2016] [Indexed: 02/05/2023] Open
Abstract
Magnetic resonance imaging (MRI) is by nature a multi-modality technique that provides complementary information about different aspects of diseases. So far no attempts have been reported to assess the potential of multi-modal MRI in discriminating individuals with and without migraine, so in this study, we proposed a classification approach to examine whether or not the integration of multiple MRI features could improve the classification performance between migraine patients without aura (MWoA) and healthy controls. Twenty-one MWoA patients and 28 healthy controls participated in this study. Resting-state functional MRI data was acquired to derive three functional measures: the amplitude of low-frequency fluctuations, regional homogeneity and regional functional correlation strength; and structural MRI data was obtained to measure the regional gray matter volume. For each measure, the values of 116 pre-defined regions of interest were extracted as classification features. Features were first selected and combined by a multi-kernel strategy; then a support vector machine classifier was trained to distinguish the subjects at individual level. The performance of the classifier was evaluated using a leave-one-out cross-validation method, and the final classification accuracy obtained was 83.67% (with a sensitivity of 92.86% and a specificity of 71.43%). The anterior cingulate cortex, prefrontal cortex, orbitofrontal cortex and the insula contributed the most discriminative features. In general, our proposed framework shows a promising classification capability for MWoA by integrating information from multiple MRI features.
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Hung CI, Liu CY, Yang CH, Wang SJ. Headache: an important factor associated with muscle soreness/pain at the two-year follow-up point among patients with major depressive disorder. J Headache Pain 2016; 17:57. [PMID: 27233897 PMCID: PMC4883023 DOI: 10.1186/s10194-016-0648-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 05/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND No study has compared the associations of headache, anxiety, and depression at baseline with muscle soreness or pain (MS/P) at baseline and at the two-year follow-up point among outpatients with major depressive disorder (MDD). This study aimed to investigate the above issue. METHODS This study enrolled 155 outpatients with MDD at baseline, and 131 attended a two-year follow-up appointment. At baseline, migraine was diagnosed based on the International Classification of Headache Disorders, 2(nd) edition. MDD and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The visual analog scale was used to evaluate the intensities of headache and MS/P in the neck, shoulder, back, upper limbs, and lower limbs. Depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale. Multiple linear regressions were used to compare the associations of these factors with MS/P. RESULTS Compared with anxiety disorders, migraine was more strongly associated with MS/P in all areas at baseline and in the upper and lower limbs at follow-up. Headache intensity at baseline was the factor most strongly associated with MS/P in all areas at baseline and follow-up after controlling for depression and anxiety. Headache intensity at baseline predicted MS/P at baseline and follow-up. CONCLUSIONS Migraine and headache intensity are important factors related to MS/P at baseline and follow-up among patients with MDD. Integrating depression and headache treatment might be indicated to improve MS/P.
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Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan.,Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan.,Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Ching-Hui Yang
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
| | - Shuu-Jiun Wang
- Faculty of Medicine, National Yang-Ming University School of Medicine and Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Neurology, Taipei Veterans General Hospital, No. 201 Shi-Pai Road, Section 2, Taipei, 112, Taiwan.
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11
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Les jonctions gap : une nouvelle cible thérapeutique pour le traitement des troubles dépressifs majeurs ? Rev Neurol (Paris) 2015; 171:762-7. [DOI: 10.1016/j.neurol.2015.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 07/08/2015] [Accepted: 07/16/2015] [Indexed: 01/04/2023]
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12
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Lifestyle behaviors and illness-related factors as predictors of recurrent headache in U.S. adolescents. J Neurosci Nurs 2015; 46:337-50. [PMID: 25365048 DOI: 10.1097/jnn.0000000000000095] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE This study describes a multivariate model showing how lifestyle behaviors (skipping meals, water intake, tobacco use, alcohol use, and physical activity) and illness-related factors (depression, somatic complaints, insomnia, and obesity) work together to predict headache in an adolescent population. METHOD A descriptive, cross-sectional, secondary analysis using survey data from the National Longitudinal Study of Adolescent Health (1996) is reported. The National Longitudinal Study of Adolescent Health is a large database providing a nationally representative sample of adolescents (aged 11-17 years, n = 13,570). The database evaluated adolescent headache and is inclusive of all the predictors specific to this study. Frequency analysis and forward logistic regression were performed using each of the lifestyle behaviors and illness-related factors. RESULTS Approximately 26% of the adolescents experienced recurrent headache. Recurrent headache was reported by 19% of male adolescents and 26% of female adolescents. A multivariate model was developed that showed how lifestyle behaviors and illness-related factors predict recurrent headache in adolescents. The final model (Wald F = 86.88, p = .00) consisted of the following predictors: chest pain, muscle and joint pain, skip breakfast three or more times a week, skip lunch one or more times a week, and physical activity. The interactions of gender and age group, race and smoking regularly, and depression and insomnia were also included in the final model. CONCLUSION Providing evidence to clinicians that lifestyle behaviors and illness-related factors are associated with adolescent headache may improve overall headache assessment and may result in a more comprehensive plan of treatment.
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Hung CI, Liu CY, Yang CH, Wang SJ. The Impacts of Migraine among Outpatients with Major Depressive Disorder at a Two-Year Follow-Up. PLoS One 2015; 10:e0128087. [PMID: 26000962 PMCID: PMC4441375 DOI: 10.1371/journal.pone.0128087] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/29/2015] [Indexed: 11/28/2022] Open
Abstract
Background No study has investigated the impacts of migraine on depression, anxiety, and somatic symptoms and remission at the two-year follow-up point among patients with major depressive disorder (MDD). This study aimed to investigate the above issues. Methods Psychiatric outpatients with MDD recruited at baseline were investigated at a two-year follow-up (N = 106). The Hamilton Depression Rating Scale, Hospital Anxiety and Depression Scale, and Depression and Somatic Symptoms Scale were used. Migraine was diagnosed according to the International Classification of Headache Disorders, 2nd edition. The patients were divided into no migraine, inactive migraine, and active migraine subgroups. Multiple logistic regressions were used to investigate the significant factors related to full remission of depression. Results Among patients without pharmacotherapy at the follow-up, patients with active migraine had significantly greater severities of anxiety and somatic symptoms as compared with patients without migraine; moreover, patients with active migraine had the lowest improvement percentage and full remission rate. There were no significant differences in depression, anxiety, and somatic symptoms between patients with inactive migraine and those without migraine. Active headache at follow-up was a significant factor related to a lower full remission rate. Conclusions Active headache at follow-up was associated with a lower rate of full remission and more residual anxiety and somatic symptoms at follow-up among patients with migraine. Physicians should integrate a treatment plan for depression and migraine for the treatment of patients with MDD.
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Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou and Chang Gung University School of Medicine, Tao-Yuan, Taiwan
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou and Chang Gung University School of Medicine, Tao-Yuan, Taiwan
| | - Ching-Hui Yang
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
| | - Shuu-Jiun Wang
- Faculty of Medicine, National Yang-Ming University School of Medicine and Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail:
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Pharmacological treatment of depression with and without headache disorders: an appraisal of cost effectiveness and cost utility of antidepressants. J Affect Disord 2015; 170:255-65. [PMID: 25261631 DOI: 10.1016/j.jad.2014.08.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/28/2014] [Accepted: 08/25/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression and headache are highly prevalent in clinical settings. The co-occurrence of headache may impact choice of antidepressants, healthcare utilisation, and outcomes in patients with depression. The current study aims to examine the cost-effectiveness and cost-utility of different antidepressants for treating patients with depression and comorbid headache disorders. METHODS Adult patients prescribed with antidepressants for depression (n=96,501) were identified from the National Health Insurance Research Database in Taiwan. A cost-effectiveness and cost-utility analysis was conducted comparing selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs), and by the presence of comorbid headache disorders and other pain conditions. RESULTS In this study, SSRIs dominated SNRIs in both cost-effectiveness and cost-utility. As revealed in the cost-effectiveness acceptability curves, TCAs were likely to have a cost-utility advantage compared to SSRIs and SNRIs in improving quality-adjusted life years (QALYs) for patients with comorbid headache; SSRIs remained as the most cost-effective option for patients with other pain conditions. LIMITATIONS Limitations include the use of proxy definition of remission as effectiveness measure and the adoption of utility values from previous studies. CONCLUSIONS Given a pre-determined willingness-to-pay level, TCAs can be considered as a cost-effective option to improve QALYs for depressed patients with headache disorders. Future research is needed to further clarify factors influencing the cost-effectiveness and cost-utility of pharmacological treatments in depressed patients with specific pain conditions.
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Desai SD, Pandya RH. Study of psychiatric comorbidity in patients with headache using a short structured clinical interview in a rural neurology clinic in Western India. J Neurosci Rural Pract 2014; 5:S39-42. [PMID: 25540537 PMCID: PMC4271380 DOI: 10.4103/0976-3147.145199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Psychiatric disorders are common in patients attending neurology clinics with headache. Evaluation of psychiatric comorbidity in patients with headache is often missed in the busy neurology clinics. Aims: To assess the prevalence of Axis-I DSM-IV psychiatric disorders in patients with primary headache disorders in a rural-based tertiary neurology clinic in Western India. Settings and Design : A cross-sectional observation survey was conducting assessing all patients with migraine, tension-type headache and chronic daily headache attending the Neurology Clinic of Shree Krishna Hospital, a rural medical teaching hospital in Karamsad, in Gujarat in Western India. Materials and Methods: A total of 101 consecutive consenting adults with headache were interviewed using Mini International Neuropsychiatric Interview (M.I.N.I.), a structured diagnostic clinical interview to assess prevalence of Axis-I DSM-IV psychiatric disorders. Statistical Analysis: Descriptive statistics were calculated using SPSS software version 16 and a binomial regression model was used to study the relationship of psychiatric co-morbidity with patient-related factors. Results: 49 out of 101 (48.5%) patients with headache suffered from depressive disorders (dysthymia or depression or suicidality), 18 out of 101 patients with headache (17.90%) suffered from anxiety related disorders (generalized anxiety disorder or agoraphobia or social phobia or panic disorder). Conclusions: Axis-I psychiatric disorders are a significant comorbidity among patients with headache disorders. M.I.N.I. can be used as a short, less time consuming instrument to assess all patients with headache disorders.
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Affiliation(s)
- Soaham Dilip Desai
- Department of Neurology, Pramukhswami Medical College and Consultant Neurologist, Shree Krishna Hospital, Gujarat, India
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Hung CI, Liu CY, Chen CY, Yang CH, Wang SJ. The impacts of migraine and anxiety disorders on painful physical symptoms among patients with major depressive disorder. J Headache Pain 2014; 15:73. [PMID: 25382691 PMCID: PMC4236854 DOI: 10.1186/1129-2377-15-73] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/03/2014] [Indexed: 01/03/2023] Open
Abstract
Background No study has simultaneously investigated the impacts of migraine and anxiety disorders on painful physical symptoms (PPS) among patients with major depressive disorder (MDD). The study aimed to investigate this issue. Methods This open-label study enrolled 155 outpatients with MDD, who were then treated with venlafaxine 75 mg per day for four weeks. Eighty-five participants with good compliance completed the treatment. Migraine was diagnosed according to the International Classification of Headache Disorders. MDD and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The visual analog scale (VAS) was used to evaluate the severity of eight PPS. Multiple linear and logistic regressions were used to investigate the impacts of migraine and anxiety disorders on PPS. Results Compared with patients without migraine, patients with migraine had a greater severity of PPS at baseline and post-treatment. After controlling for demographic variables and depressive severity, migraine independently predicted the intensities of eight PPS at baseline and four PPS post-treatment. Moreover, migraine independently predicted poorer treatment responses of chest pain and full remission of pains in the head, chest, neck and/or shoulder. Anxiety disorders predicted less full remission of pains in the abdomen and limbs. Conclusion Migraine and anxiety disorders have negative impacts on PPS among patients with MDD. Integrating the treatment of migraine and anxiety disorders into the management of depression might help to improve PPS and the prognosis of MDD.
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Affiliation(s)
| | | | | | | | - Shuu-Jiun Wang
- Department of Neurology, National Yang-Ming University School of Medicine and Taipei Veterans General Hospital, No, 201 Shi-Pai Road, Section 2, Taipei 112, Taiwan.
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Alterations in regional homogeneity assessed by fMRI in patients with migraine without aura stratified by disease duration. J Headache Pain 2013; 14:85. [PMID: 24134520 PMCID: PMC3853130 DOI: 10.1186/1129-2377-14-85] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/04/2013] [Indexed: 12/23/2022] Open
Abstract
Background Advanced neuroimaging approaches have been employed to prove that migraine was a central nervous system disorder. This study aims to examine resting-state abnormalities in migraine without aura (MWoA) patients stratified by disease duration, and to explore the neuroimaging markers for reflecting the disease duration. Methods 40 eligible MWoA patients and 20 matched healthy volunteers were included in the study. Regional homogeneity (ReHo) analysis was used to identify the local features of spontaneous brain activity in MWoA patients stratified by disease duration, and analysis was performed to investigate the correlation of overlapped brain dysfunction in MWoA patients with different disease duration (long-term and short-term) and course of disease. Results Compared with healthy controls, MWoA patients with long-term disease duration showed comprehensive neuronal dysfunction than patients with short-term disease duration. In addition, increased average ReHo values in the thalamus, brain stem, and temporal pole showed significantly positive correlations with the disease duration. On the contrary, ReHo values were negatively correlated with the duration of disease in the anterior cingulate cortex, insula, posterior cingulate cortex and superior occipital gyrus. Conclusions Our findings of progressive brain damage in relation to increasing disease duration suggest that migraine without aura is a progressive central nervous disease, and the length of the disease duration was one of the key reasons to cause brain dysfunction in MwoA patients. The repeated migraine attacks over time result in resting-state abnormalities of selective brain regions belonging to the pain processing and cognition. We predict that these brain regions are sensitive neuroimaging markers for reflecting the disease duration of migraine patients without aura.
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Swanson SA, Zeng Y, Weeks M, Colman I. The contribution of stress to the comorbidity of migraine and major depression: results from a prospective cohort study. BMJ Open 2013; 3:bmjopen-2012-002057. [PMID: 23474788 PMCID: PMC3612807 DOI: 10.1136/bmjopen-2012-002057] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To assess how much the association between migraine and depression may be explained by various measures of stress. DESIGN National Population Health Survey is a prospective cohort study representative of the Canadian population. Eight years of follow-up time were used in the present analyses. SETTING Canadian adult population ages 18-64. PARTICIPANTS 9288 participants. OUTCOME Incident migraine and major depression. RESULTS Adjusting for sex and age, depression was predictive of incident migraine (HR: 1.62; 95% CI 1.03 to 2.53) and migraine was predictive of incident depression (HR: 1.55; 95% CI 1.15 to 2.08). However, adjusting for each assessed stressor (childhood trauma, recent marital problems, recent unemployment, recent household financial problems, work stress, chronic stress and change in social support) decreased this association, with chronic stress being a particularly strong predictor of outcomes. When adjusting for all stressors simultaneously, both associations were largely attenuated (depression-migraine HR: 1.30; 95% CI 0.80 to 2.10; migraine-depression HR: 1.19; 95% CI 0.86 to 1.66). CONCLUSIONS Much of the apparent association between migraine and depression may be explained by stress.
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Affiliation(s)
- Sonja A Swanson
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Yiye Zeng
- Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Murray Weeks
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian Colman
- Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Hung CI, Liu CY, Wang SJ. Migraine predicts physical and pain symptoms among psychiatric outpatients. J Headache Pain 2013; 14:19. [PMID: 23565902 PMCID: PMC3620433 DOI: 10.1186/1129-2377-14-19] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 02/19/2013] [Indexed: 11/12/2022] Open
Abstract
Background No study has been performed to compare the impacts of migraine and major depressive episode (MDE) on depression, anxiety and somatic symptoms, and health-related quality of life (HRQoL) among psychiatric outpatients. The aim of this study was to investigate the above issue. Methods This study enrolled consecutive psychiatric outpatients with mood and/or anxiety disorders who undertook a first visit to a medical center. Migraine was diagnosed according to the International Classification of Headache Disorders, 2nd edition. Three psychometric scales and the Short-Form 36 were administered. General linear models were used to estimate the difference in scores contributed by either migraine or MDE. Multiple linear regressions were employed to compare the variance of these scores explained by migraine or MDE. Results Among 214 enrolled participants, 35.0% had migraine. Bipolar II disorder patients (70.0%) had the highest percentage of migraine, followed by major depressive disorder (49.1%) and only anxiety disorder (24.5%). Patients with migraine had worse depression, anxiety, and somatic symptoms and lower SF-36 scores than those without. The estimated differences in the scores of physical functioning, bodily pain, and somatic symptoms contributed by migraine were not lower than those contributed by MDE. The regression model demonstrated the variance explained by migraine was significantly greater than that explained by MDE in physical and pain symptoms. Conclusions Migraine was common and the impact of migraine on physical and pain symptoms was greater than MDE among psychiatric outpatients. Integration of treatment strategies for migraine into psychiatric treatment plans should be considered.
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Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang-Gung Memorial Hospital at Linkou and Chang-Gung University School of Medicine, Taoyuan, Taiwan
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20
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Abstract
PURPOSE OF REVIEW Recent evidence supports the suggestion that migraine is a chronic disorder with episodic attacks that increase in frequency in a subgroup of patients, transforming migraine into a refractory chronic condition with poor outcome and severe impact. Among the risk factors for migraine chronification depression figures notably. Early diagnosis and management of risk factors in migraineurs prevent migraine chronification and its consequences. The scope of this article is to review depression as a potential cofactor for migraine chronification. RECENT FINDINGS Population-based studies revealed that migraineurs often have symptoms of depression, with strongest associations for migraine with aura. Patients with depression also have an increased risk for migraine, migraine with aura in particular. Twin studies showed similar findings. This bidirectional relationship suggests that migraine and depression may share common causative factors, possibly genetically determined, that might control migraine chronification. Migraine patients may develop depression as a result of the demoralizing experience of recurrent and disabling headaches and depressed patients may develop migraine because of increased pain sensitivity, in the basis of a common genetic background. SUMMARY We suggest that clinicians consider depression as part of migraine management in order to optimize treatment and avoid migraine progression.
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Hung CI, Liu CY, Wang SJ, Yao YC, Yang CH. The cut-off points of the Depression and Somatic Symptoms Scale and the Hospital Anxiety and Depression Scale in detecting non-full remission and a current major depressive episode. Int J Psychiatry Clin Pract 2012; 16:33-40. [PMID: 22122659 DOI: 10.3109/13651501.2011.617456] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to ascertain the cut-off scores of the Depression and Somatic Symptoms Scale (DSSS) for non-full remission (FR) and a current major depressive episode (MDE) and compare the discriminative abilities of the DSSS and the Hospital Anxiety and Depression Scale (HADS). METHODS One-hundred and nineteen depressive outpatients who completed a 6-month follow-up were used to ascertain the cut-off scores for non-FR, defined as a Hamilton Depression Rating Scale score ≥ 8; another 214 consecutive outpatients were assessed to identify the cut-off scores for a MDE, as defined by the Structured Clinical Interview for DSM-IV-TR. Receiver operating characteristic (ROC) analysis was used to ascertain the cut-off scores. RESULTS The area under the ROC curve was greatest for the DSSS depression subscale (DS), followed by the HADS depression subscale (HADS-D). The cut-off scores for non-FR were a DS score ≥ 9 (sensitivity and specificity: 88.7 and 71.9%, respectively) and a HADS-D score ≥ 8 (77.4 and 84.2%), and the cut-off scores for a MDE were a DS score ≥ 19 (86.3 and 75.6%) and a HADS-D score ≥ 11 (77.9 and 76.5%). CONCLUSIONS The DSSS and HADS can be used to distinguish different depressive states. The results demonstrated the discriminative validity of the DSSS and the HADS.
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Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou and Chang Gung University School of Medicine, Taiwan.
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22
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Hung CI, Liu CY, Yang CH, Wang SJ. Negative impact of migraine on quality of life after 4 weeks of treatment in patients with major depressive disorder. Psychiatry Clin Neurosci 2012; 66:8-16. [PMID: 22250605 DOI: 10.1111/j.1440-1819.2011.02286.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The impact of migraine on health-related quality of life (HRQoL) among patients with major depressive disorder (MDD) after acute antidepressant treatment has not been addressed. The aim of the present study was to investigate whether or not the negative impact of migraine on HRQoL among outpatients with MDD continued to have an effect after 4 weeks of venlafaxine treatment. METHODS A total of 135 outpatients with MDD were enrolled, who were then treated with venlafaxine 75 mg per day for 4 weeks in the present open-label study. Migraine was diagnosed based on the International Classification of Headache Disorders (2nd edn). Changes in Short-Form 36 (SF-36) and Hamilton Depression Rating Scale (HAMD) scores were the outcome measures. Multiple linear regression was used to assess whether migraine was an independent factor predicting SF-36 score after treatment. RESULTS Seventy-two participants (18M/54F) completed the 4-week treatment. Subjects with migraine had a poorer HRQoL in terms of bodily pain and mental health at baseline. Subjects with and without migraine showed significant improvement in all SF-36 subscales and depression after treatment, but subjects with migraine still had a poorer HRQoL regarding bodily pain and physical functioning after treatment as compared with those without migraine. Migraine could predict a negative outcome after treatment in the subscales of physical functioning, role limitations-physical, and role limitations-emotional. CONCLUSIONS Migraine may have a negative impact on the improvement of partial SF-36 subscales, especially on functional recovery, after acute treatment among outpatients with MDD. Whether additional intervention besides antidepressant treatment for migraine is indicated may need further study.
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Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taipei, Taiwan
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Passon AM, Gerber A, Schröer-Günther M. Wirksamkeit von schulbasierten Gruppeninterventionen zur Depressionsprävention. KINDHEIT UND ENTWICKLUNG 2011. [DOI: 10.1026/0942-5403/a000061] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Fünf bis zehn Prozent aller Kinder und Jugendlichen in Deutschland leiden an depressiven Symptomen. Chronische Depressionen gehen regelmäßig mit ersten Erkrankungssymptomen im Kindes- und Jugendalter einher. Der frühen Prävention depressiver Störungen kommt folglich eine hohe Bedeutung zu. Wir untersuchten die Wirksamkeit nichtpharmakologischer schulbasierter Gruppeninterventionen zur Depressionsprävention anhand eines systematischen Literaturreviews. Signifikante Verbesserungen depressiver Störungen konnten in 61 Prozent der eingeschlossenen Studien festgestellt werden. Aufgrund der Heterogenität von Studiendurchführung und –design können keine eindeutigen Aussagen abgeleitet werden, welche Faktoren zu einem Erfolg oder Misserfolg der Programme beitragen. Eine flächendeckende Umsetzung erscheint aufgrund der offenen Fragen zur optimalen Ausgestaltung verfrüht.
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Affiliation(s)
- Anna Marie Passon
- Institut für Gesundheitsökonomie und klinische Epidemiologie der Uniklinik Köln
| | - Andreas Gerber
- Institut für Gesundheitsökonomie und klinische Epidemiologie der Uniklinik Köln
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Hung CI, Wang SJ, Liu CY, Hsu SC, Yang CH. Comorbidities and factors related to discontinuation of pharmacotherapy among outpatients with major depressive disorder. Compr Psychiatry 2011; 52:370-7. [PMID: 21683174 DOI: 10.1016/j.comppsych.2010.08.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Revised: 08/21/2010] [Accepted: 08/30/2010] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Although many studies have researched adherence to pharmacotherapy among patients with major depressive disorder (MDD), the effects of chronic depression, anxiety comorbidities, migraine, and other factors on adherence have rarely been studied. This study investigated which comorbidities and factors independently predicted discontinuation of pharmacotherapy among psychiatric outpatients with MDD. METHODS One hundred thirty-five subjects (34 men, 101 women) with MDD were enrolled. MDD and anxiety comorbidities were diagnosed using the Structured Clinical Interview for DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision), migraine was diagnosed based on the International Classification of Headache Disorders, 2nd Edition, and depression severity was evaluated using the Hamilton Depression Rating Scale. Six months later, subjects' reasons for discontinuation were investigated, and Cox proportional hazards regression and logistic regression were used to investigate the independent factors predicting discontinuation. RESULTS Subjects with chronic depression, migraine, panic/agoraphobia, or posttraumatic stress disorder attended follow-up for longer before discontinuation than those without. Chronic depression and greater age independently predicted a longer follow-up before discontinuation. Concern about and intolerance of the side effects of antidepressants and lack of insight into MDD independently predicted discontinuation within 2 months. "Self-reported recovery" was the most common reason for discontinuation; however, 53.8% of the subjects who cited this reason did not reach full remission. CONCLUSIONS The impact of the duration of depression (chronic depression) on adherence may be more important than the severity of depression, anxiety comorbidities, and migraine. Education of MDD patients and society in general to improve understanding of MDD and antidepressants is needed to enhance adherence to pharmacotherapy.
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Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan.
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Antonaci F, Nappi G, Galli F, Manzoni GC, Calabresi P, Costa A. Migraine and psychiatric comorbidity: a review of clinical findings. J Headache Pain 2011; 12:115-25. [PMID: 21210177 PMCID: PMC3072482 DOI: 10.1007/s10194-010-0282-4] [Citation(s) in RCA: 256] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 12/16/2010] [Indexed: 01/23/2023] Open
Abstract
Migraine is an extremely common disorder. The underlying mechanisms of this chronic illness interspersed with acute symptoms appear to be increasingly complex. An important aspect of migraine heterogeneity is comorbidity with other neurological diseases, cardiovascular disorders, and psychiatric illnesses. Depressive disorders are among the leading causes of disability worldwide according to WHO estimation. In this review, we have mainly considered the findings from general population studies and studies on clinical samples, in adults and children, focusing on the association between migraine and psychiatric disorders (axis I of the DSM), carried over after the first classification of IHS (1988). Though not easily comparable due to differences in methodology to reach diagnosis, general population studies generally indicate an increased risk of affective and anxiety disorders in patients with migraine, compared to non-migrainous subjects. There would also be a trend towards an association of migraine with bipolar disorder, but not with substance abuse/dependence. With respect to migraine subtypes, comorbidity mainly involves migraine with aura. Patients suffering from migraine, however, show a decreased risk of developing affective and anxiety disorders compared to patients with daily chronic headache. It would also appear that psychiatric disorders prevail in patients with chronic headache and substance use than in patients with simple migraine. The mechanisms underlying migraine psychiatric comorbidity are presently poorly understood, but this topic remains a priority for future research. Psychiatric comorbidity indeed affects migraine evolution, may lead to chronic substance use, and may change treatment strategies, eventually modifying the outcome of this important disorder.
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Affiliation(s)
- Fabio Antonaci
- University Centre for Adaptive Disorders and Head pain (UCADH), Pavia, Italy.
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Casamassima F, Hay AC, Benedetti A, Lattanzi L, Cassano GB, Perlis RH. L-type calcium channels and psychiatric disorders: A brief review. Am J Med Genet B Neuropsychiatr Genet 2010; 153B:1373-90. [PMID: 20886543 DOI: 10.1002/ajmg.b.31122] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 07/28/2010] [Indexed: 01/11/2023]
Abstract
Emerging evidence from genome-wide association studies (GWAS) support the association of polymorphisms in the alpha 1C subunit of the L-type voltage-gated calcium channel gene (CACNA1C) with bipolar disorder. These studies extend a rich prior literature implicating dysfunction of L-type calcium channels (LTCCs) in the pathophysiology of neuropsychiatric disorders. Moreover, calcium channel blockers reduce Ca(2+) flux by binding to the α1 subunit of the LTCC and are used extensively for treating hypertension, preventing angina, cardiac arrhythmias and stroke. Calcium channel blockers have also been studied clinically in psychiatric conditions such as mood disorders and substance abuse/dependence, yielding conflicting results. In this review, we begin with a summary of LTCC pharmacology. For each category of disorder, this article then provides a review of animal and human data. In particular, we extensively focus on animal models of depression and clinical trials in mood disorders and substance abuse/dependence. Through examining rationale and study design of published clinical trials, we provide some of the possible reasons why we still do not have definitive evidence of efficacy of calcium-channel antagonists for mood disorders. Refinement of genetic results and target phenotypes, enrollment of adequate sample sizes in clinical trials and progress in physiologic and pharmacologic studies to synthesize tissue and isoform specific calcium channel antagonists, are all future challenges of research in this promising field. © 2010 Wiley-Liss, Inc.
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Hung CI, Liu CY, Wang SJ, Juang YY, Yang CH. Somatic symptoms: an important index in predicting the outcome of depression at six-month and two-year follow-up points among outpatients with major depressive disorder. J Affect Disord 2010; 125:134-40. [PMID: 20064663 DOI: 10.1016/j.jad.2009.12.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Revised: 12/14/2009] [Accepted: 12/14/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Few studies have simultaneously compared the ability of depression, anxiety, and somatic symptoms to predict the outcome of major depressive disorder (MDD). This study aimed to compare the MDD outcome predictive ability of depression, anxiety, and somatic severity at 6-month and 2-year follow-ups. METHODS One-hundred and thirty-five outpatients (men/women=34/101) with MDD were enrolled. Depression and anxiety were evaluated by the Hamilton Depression Rating Scale, Hospital Anxiety and Depression Scale, and depression subscale of the Depression and Somatic Symptoms Scale (DSSS). Somatic severity was evaluated by the somatic subscale of the DSSS. Subjects undergoing pharmacotherapy in the follow-up month were categorized into the treatment group; the others were categorized into the no-treatment group. Multiple linear regressions were used to identify the scales most powerful in predicting MDD outcome. RESULTS Among the 135 subjects, 119 and 106 completed the 6-month and 2-year follow-ups, respectively. Somatic severity at baseline was correlated with the outcomes of the three scales at the two follow-ups. After controlling for demographic variables, somatic severity independently predicted most outcomes of the three scales at the two follow-ups in the no-treatment group and the cost of pharmacotherapy and DSSS score at the 6-month follow-up in the treatment group. LIMITATIONS Division of the subjects into treatment and no-treatment groups was not based on randomization and bias might have been introduced. CONCLUSIONS Somatic severity was the most powerful index in predicting MDD outcome. Psychometric scales with appropriate somatic symptom items may be more accurate in predicting MDD outcome.
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Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang-Gung Memorial Hospital at Linkou and Chang-Gung University School of Medicine, Taiwan.
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Ligthart L, Penninx BWJH, Nyholt DR, Distel MA, de Geus EJC, Willemsen G, Smit JH, Boomsma DI. Migraine symptomatology and major depressive disorder. Cephalalgia 2010; 30:1073-81. [DOI: 10.1177/0333102410363492] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction and objective: Migraine and major depressive disorder (MDD) frequently co-occur, but it is unclear whether depression is associated with a specific subtype of migraine. The objective of this study was to investigate whether migraine is qualitatively different in MDD patients ( N = 1816) and non-depressed controls ( N = 3428). Methods: Migraine symptom data were analyzed using multi-group Latent Class Analysis, and a qualitative comparison was made between the symptom profiles of MDD patients and controls, while allowing for differences in migraine prevalence and severity between groups. Results: In both groups, three migrainous headache classes were identified, which differed primarily in terms of severity. Both mild and severe migrainous headaches were two to three times more prevalent in MDD patients. Migraine symptom profiles showed only minor qualitative differences in the MDD and non-MDD groups: in the severe migrainous headache class, significant differences were observed only in the prevalence of aggravation by physical activity (83% and 91% for the non-MDD and MDD groups, respectively) and aura (42% vs. 53%, respectively). Conclusion: The similar overall symptom profiles observed in the MDD and non-MDD subjects suggest that a similar disease process may underlie migraine in both groups.
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Affiliation(s)
| | - Brenda WJH Penninx
- VU University Medical Center, The Netherlands
- Leiden University Medical Center, The Netherlands
- University Medical Center Groningen, The Netherlands
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