Rating scales in general practice depression: psychometric analyses of the clinical interview for depression and the Hamilton rating scale

Circuit-based neuromodulation enhances delayed recall in amnestic mild cognitive impairment

BACKGROUND

This study aimed to investigate the efficacy of circuits-based paired associative stimulation (PAS) in adults with amnestic mild cognitive impairment (aMCI).

METHODS

We conducted a parallel-group, randomised, controlled clinical trial. Initially, a cohort of healthy subjects was recruited to establish the cortical-hippocampal circuits by tracking white matter fibre connections using diffusion tensor imaging. Subsequently, patients diagnosed with aMCI, matched for age and education, were randomly allocated in a 1:1 ratio to undergo a 2-week intervention, either circuit-based PAS or sham PAS. Additionally, we explored the relationship between changes in cognitive performance and the functional connectivity (FC) of cortical-hippocampal circuits.

RESULTS

FCs between hippocampus and precuneus and between hippocampus and superior frontal gyrus (orbital part) were most closely associated with the Auditory Verbal Learning Test (AVLT)_N5 score in 42 aMCI patients, thus designated as target circuits. The AVLT_N5 score improved from 2.43 (1.43) to 5.29 (1.98) in the circuit-based PAS group, compared with 2.52 (1.44) to 3.86 (2.39) in the sham PAS group (p=0.003; Cohen's d=0.97). A significant decrease was noted in FC between the left hippocampus and left precuneus in the circuit-based PAS group from baseline to postintervention (p=0.013). Using a generalised linear model, significant group×FC interaction effects for the improvements in AVLT_N5 scores were found within the circuit-based PAS group (B=3.4, p=0.017).

CONCLUSIONS

Circuit-based PAS effectively enhances long-term delayed recall in adults diagnosed with aMCI, which includes individuals aged 50-80 years. This enhancement is potentially linked to the decreased functional connectivity between the left hippocampus and left precuneus.

TRIAL REGISTRATION NUMBER

ChiCTR2100053315; Chinese Clinical Trial Registry.

Mental health and quality of life in patients with craniofacial movement disorders: A cross-sectional study

Background

Facial appearance and expressions influence social interaction. Hemifacial spasm (HFS), blepharospasm (BPS), and blepharospasm-oromandibular dystonia (BOD) are common forms of craniofacial movement disorders. Few studies have focused on the mental burden and quality of life (QoL) in patients with craniofacial movement disorders. Therefore, this study investigated mental health and QoL in these patients.

Methods

This cross-sectional study included 90 patients with craniofacial movement disorders (HFS, BPS, and BOD; 30 patients per group) and 30 healthy individuals without craniofacial movement disorders (control group) recruited from October 2019 to November 2020. All participants underwent QoL and mental health evaluations for depression, anxiety, and stigma using the 36-item Short Form Health Survey (SF-36), Hamilton Anxiety Rating Scale (HAMA), Hamilton Rating Scale for Depression-24 (HAMD-24) and a questionnaire related to stigma.

Results

Depression was diagnosed in 37 (41.11%) patients, whereas 30 patients (33.33%) had anxiety. HAMA scores were significantly higher in the BPS and BOD groups than in the control group. Nineteen patients (21.11%) experienced stigma and SF-36 scores were lower in various dimensions in the movement disorders groups compared to healthy controls. The role-physical and social function scores were significantly lower in the movement disorders groups than in the control group all p < 0.05. The vitality scores of the BPS group and mental health scores of the BPS and BOD groups were significantly lower than those of the control group. Correlation analysis showed that the eight dimensions of SF-36 correlated with education level, disease duration, HAMD score, and HAMA score (all p < 0.05). Regression analysis demonstrated that the HAMD score correlated with general health, vitality, social function, role-emotional, and mental health (all p < 0.05). The HAMA score correlated with body pain after adjusting for education level and disease duration.

Conclusion

This study highlights the significant frequency of mental symptoms, including depression, anxiety, and stigma, which lower QoL in patients with craniofacial movement disorders.

Research on the Method of Depression Detection by Single-Channel Electroencephalography Sensor

Depression is a common mental health illness worldwide that affects our quality of life and ability to work. Although prior research has used EEG signals to increase the accuracy to identify depression, the rates of underdiagnosis remain high, and novel methods are required to identify depression. In this study, we built a model based on single-channel, dry-electrode EEG sensor technology to detect state depression, which measures the intensity of depressive feelings and cognitions at a particular time. To test the accuracy of our model, we compared the results of our model with other commonly used methods for depression diagnosis, including the PHQ-9, Hamilton Depression Rating Scale (HAM-D), and House-Tree-Person (HTP) drawing test, in three different studies. In study 1, we compared the results of our model with PHQ-9 in a sample of 158 senior high students. The results showed that the consistency rate of the two methods was 61.4%. In study 2, the results of our model were compared with HAM-D among 71 adults. We found that the consistency rate of state-depression identification by the two methods was 63.38% when a HAM-D score above 7 was considered depression, while the consistency rate increased to 83.10% when subjects showed at least one depressive symptom (including depressed mood, guilt, suicide, lack of interest, retardation). In study 3, 68 adults participated in the study, and the results revealed that the consistency rate of our model and HTP drawing test was 91.2%. The results showed that our model is an effective means to identify state depression. Our study demonstrates that using our model, people with state depression could be identified in a timely manner and receive interventions or treatments, which may be helpful for the early detection of depression.

The Hamilton Rating Scales for Depression: A Critical Review of Clinimetric Properties of Different Versions

The format of the original Hamilton Rating Scale for Depression (HAM-D) was unstructured: only general instructions were provided for rating individual items. Over the years, a number of modified versions of the HAM-D have been proposed. They differ not only in the number of items, but also in modalities of administration. Structured versions, including item definitions, anchor points and semi-structured or structured interview questions, were developed. This comprehensive review was conducted to examine the clinimetric properties of the different versions of the HAM-D. The aim was to identify the HAM-D versions that best display the clinimetric properties of reliability, validity, and sensitivity to change. The search was conducted on MEDLINE, Scopus, Web of Science, and PubMed, and yielded a total of 35,473 citations, but only the most representative studies were included. The structured versions of the HAM-D were found to display the highest inter-rater and test-retest reliability. The Clinical Interview for Depression and the 6-item HAM-D showed the highest sensitivity in differentiating active treatment from placebo. The findings indicate that the HAM-D is a valid and sensitive clinimetric index, which should not be discarded in view of obsolete and not clinically relevant psychometric criteria. The HAM-D, however, requires an informed use: unstructured forms should be avoided and the type of HAM-D version that is selected should be specified in the registration of the study protocol and in the methods of the trial.

Narrative Identity in Psychopathology: A Negative Past and a Bright but Foreshortened Future

We examined narrative identity as a possible transdiagnostic marker of psychopathology by interviewing individuals with schizophrenia, individuals with depression and a nonclinical control group about past and future chapters in their life stories. Participants were 20 patients with schizophrenia, 20 patients with depression, and 20 nonclinical control participants matched on age, gender, and education. Participants described up to 10 chapters in their past and future life stories and self-rated chapters on emotional tone and self-event connections. In addition, cognitive function and current levels of symptoms was assessed. Both patient groups self-rated their past chapters as more negative and less positive compared to the control group, but did not differ from each other. There were no group differences in positivity of future chapters, but both patient groups identified fewer future chapters with shorter temporal projections. The results are consistent with the notion that negative past aspects of narrative identity are a transdiagnostic marker of psychopathology, while also suggesting that individuals with mental illness construct a positive future, which may support hope.

Development of a validated Chinese version of the inflammatory bowel disease disability index

OBJECTIVE

The inflammatory bowel disease disability index (IBD-DI) has been used to evaluate functional status for patients with inflammatory bowel diseases (IBD). The study aimed to develop a reliable Chinese version of IBD-DI (C-IBD-DI).

METHODS

Consecutive patients with IBD and healthy controls were recruited from June 2016 to July 2017 in the First Affiliated Hospital, College of Medicine, Zhejiang University (Hangzhou, Zhejiang Province, China) to complete an inflammatory bowel disease questionnaire-32 (IBDQ-32), Hamilton's anxiety rating scale (HAMA) and Hamilton's depression rating scale-24 items (HAMD-24). The validation process included item reduction, reliability and validity tests.

RESULTS

Altogether 122 patients with IBD completed the validation process. Factor analysis reduced the C-IBD-DI to 13 items. Cronbach's α coefficient was 0.90. The C-IBD-DI scores were correlated with IBDQ-32 score (r = -0.79, P < 0.001), HAMA (r = 0.78, P < 0.001) and HAMD-24 (r = 0.81, P < 0.001). The total score of C-IBD-DI was significantly higher in patients with active IBD than in those in remission. The intraclass correlation coefficient was 0.83 in the stable IBD group, representing a good test-retest reliability. Those with improved disease activity had a significantly lower C-IBD-DI score at the follow-up visit than at baseline. Patients with IBD had worse disability levels and quality of life than the controls, and were more likely to be anxious and depressed, especially those with active IBD.

CONCLUSIONS

The validated C-IBD-DI comprising 13 questions has highly acceptable reliability and validity. Multicenter studies including large sample sizes are needed to further confirm our results.

Efficacy and safety of Chinese herbal medicine for depression: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

To conduct a systematic review to assess the current evidence available for the effectiveness and safety of Chinese herbal medicine (CHM) for depression.

METHODS

An electronic search was conducted in eight databases from inception until April 2018. Randomized controlled trials with risk of bias (RoB) score ≥ 4 according to the Cochrane RoB tool were included for analyses. The primary outcome was the severity of depression. The secondary outcomes were total effective rate (TER) and adverse events. The minimally important difference (MID) of the severity of depression was a reduction in the Hamilton Rating Scale for Depression 17 items (HAMD-17) scores by 4. RevMan 5.3 Software was used for data analyses. GRADE system was used to assess the certainty of evidence.

RESULTS

A total of 40 eligible studies with 3549 subjects were identified. Meta-analyses showed that CHM monotherapy had better clinically effects than placebo according to HAMD-17 score (Mean Difference (MD) = -4.53, 95% CI (-5.69, -3.37), P < 0.00001; Certainty of evidence: Moderate) and TER (Risk Ratio (RR) = 2.15, 95% CI (1.61, 2.88), P < 0.00001, Certainty of evidence: Low). Meta-analyses showed that CHM was as effective as western conventional medications (WCM) in TER (RR = 0.99, 95% CI (0.95, 1.02), P = 0.41, Certainty of evidence: High) and in reducing HAMD-17 score (MD = 0.44, 95% CI (-0.11, 0.99), P = 0.12, Certainty of evidence: Moderate). Meta-analyses showed that CHM in combination with WCM was better than WCM in TER (RR = 1.16, 95% CI (1.07, 1.27), P = 0.0004, Certainty of evidence: High), while had comparable clinically effects with WCM according to HAMD-17 score (MD = -2.51, 95% CI (-3.24, -1.77), P < 0.00001, Certainty of evidence: Moderate). In additional, CHM were associated with less adverse events than WCM, and adding CHM to WCM reduced adverse events.

CONCLUSION

The findings of present systematic review, at least to a certain extent, provided supporting evidence for the routine use of CHM for depression.

Accounting for the uncounted: Physical and affective distress in individuals dropping out of oral naltrexone treatment for opioid use disorder

BACKGROUND

The theoretical benefits of naltrexone as a treatment for opioid use disorder (e.g., safety, non-addictive, low risk of diversion) stand in sharp contrast to its disappointing record on retention in most samples. The relationship of uncomfortable physical and dysphoric symptoms to retention on naltrexone is a controversial and under-studied issue.

METHODS

Using data from a randomized controlled trial of voucher-based contingency management and support from a significant other to enhance retention on oral naltrexone, we compared self-reported somatic and dysphoric symptoms, measured weekly, for individuals who were retained on naltrexone through the 12-week trial (n = 50) versus those who dropped out (n = 70).

RESULTS

There were no differences between participants who completed treatment and those who dropped out on multiple baseline characteristics, including somatic or affective symptoms prior to treatment. However, whether analyzed cross-sectionally or over time, participants who dropped out consistently reported higher rates of somatic symptoms, particularly difficulty sleeping, as well as affective symptoms, including multiple indicators of depression, anxiety, and anhedonia.

CONCLUSIONS

Although the smaller group of participants who were retained on oral naltrexone for 12 weeks reported decreasing physical and affective discomfort over time, there was substantial evidence that those who dropped out experienced continued and significant levels of distress. Individuals who report physical or affective distress while taking naltrexone may be at higher risk of dropout.

Association of Fatigue Intensification with Cognitive Impairment during Radiation Therapy for Prostate Cancer

PURPOSE

Cancer-related fatigue is a common complaint during cancer treatment and is often associated with cognitive impairment. This study examined cognitive deficits that were associated with fatigue symptoms during external-beam radiation therapy (EBRT) in men with localized prostate cancer.

METHODS

A total of 36 participants were enrolled and followed up at baseline, 24 h, 7 days, 14 days after EBRT initiation, at midpoint, and at completion of EBRT. Fatigue was measured by self-report using the Functional Assessment of Cancer Therapy - Fatigue (FACT-F), and cognitive impairment by the Computer Assessment of Mild Cognitive Impairment (CAMCI®).

RESULTS

Subjects with increased fatigue during EBRT reported a significant decline in cognitive function and had difficulties with CAMCI®'s route finding and item recall tasks during EBRT. Increased fatigue during EBRT was associated with perceived cognitive difficulties in executive function and recognition memory, but not with attention or verbal memory.

CONCLUSIONS

Our results suggest that there might be specific cognitive domains that are associated with increased fatigue during EBRT. These findings will provide important information for targeting specific cognitive domains using pharmacotherapy or behavioral interventions. CAMCI® is a valuable tool for psycho social providers to detect subtle cognitive impairment in fatigued cancer patients in a clinical setting.

Hamilton rating scale for depression-24 (HAM-D24) as a novel predictor for diabetic microvascular complications in type 2 diabetes mellitus patients

The study was designed to investigate whether the hamilton rating scale for depression (24-items) (HAM-D₂₄) can be used to predict the diabetic microvascular complications in type 2 diabetes mellitus (T2DM) patients. 288 hospitalized patients with T2DM were enrolled. Their diabetic microvascular complications including diabetic nephropathy, diabetic retinopathy, diabetic peripheral neuropathy and diabetic foot as well as demographic, clinical data, blood samples and echocardiography were documented. All the enrolled patients received HAM-D₂₄ evaluation. The HAM-D₂₄ score and incidence of depression in T2DM patients with each diabetic microvascular complication were significantly higher than those in T2DM patients without each diabetic microvascular complication. After the adjustment of use of insulin and hypoglycemic drug, duration of T2DM, mean platelet volume, creatinine, albumin, fasting glucose, glycosylated hemoglobin type A1C, left ventricular ejection fraction, respectively, HAM-D₂₄ score was still significantly associated with diabetic microvascular complications (OR = 1.188-1.281, all P < 0.001). The AUC of HAM-D₂₄ score for the prediction of diabetic microvascular complication was 0.832 (0.761-0.902). 15 points of HAM-D₂₄ score was considered as the optimal cutoff with the sensitivity of 0.778 and specificity of 0.785. In summary, HAM-D₂₄ score may be used as a novel predictor of diabetic microvascular complications in T2DM patients.

Psychometric evaluation of a 6-item Chinese version of the Hamilton Depression Rating Scale: Mokken scaling and item analysis

BACKGROUND

It is unclear whether the 6-item Melancholia subscale of the Hamilton Depression Rating Scale (HAM-D₆ ) has better psychometric properties than the parental 17-item version (HAM-D₁₇ ) in the Chinese populations.

METHODS

The study was to check the Chinese HAM-D₁₇ and HAM-D₆ for reliability and validity with Mokken scale analysis and item analysis. We reanalyzed a clinical sample of adult psychiatric outpatients (N = 214; age, mean (SD) = 38.3 (10.5) years; 63.1% female) in Taiwan.

RESULTS

Our Mokken scale analysis showed that the HAM-D₆ was a moderate unidimensional scale (H_s  = 0.44) while the HAM-D₁₇ was not (H_s  = 0.26). The 5 items of the HAM-D₆ had strong invariant item ordering (H^T  = 0.58). The HAM-D₁₇ and HAM-D₆ had comparable reliability (α = 0.79) and validity (r = 0.91), and the HAM-D₆ was more homogenous than the HAM-D₁₇ . To predict depression in remission (HAM-D₁₇  ≤ 7), the best cutoff of the HAM-D₆ was 4 (specificity, 87.5%; sensitivity, 100%; positive predictive value, 56.0%; negative predictive value, 100%).

DISCUSSION

The Chinese HAM-D₆ was a reliable, valid, and unidimensional scale of depression.

Illness severity and biomarkers in depression: Using a unidimensional rating scale to examine BDNF

BACKGROUND

Numerous studies have reported reduced peripheral brain-derived neurotrophic factor (BDNF) in major depression (MD). However, most of these studies used multidimensional depression rating scales, and failed to identify a relationship between BDNF levels and depression severity. Unidimensional scales are a more valid measure of syndrome severity. In these scales, items are ordered in increasing severity, so that as scores increase, syndrome severity increases; thus, each item adds unique information, and items can be totaled to a meaningful sum. The current study used the HAM-D6, a unidimensional measure of depression, to examine if it could identify a correlation between serum BDNF and depression severity.

METHODS

Serum BDNF levels and symptom severity were assessed in 163 depressed patients, including those with both unipolar (84.0%) and bipolar (16.0%) depression. The evaluation of depression severity included the total HAM-D17 and 3 subscales, including the HAM-D6.

RESULTS

On average, patients presented moderate to severe depression (HAM-D17=21.2±5.5). Overall BDNF levels were 60.4±22.6ng/mL. The correlation between serum BDNF and depression severity was modest and not different when assessed by the HAM-D6 subscale or the HAM-D17 as a whole (z=0.951; p=0.341), despite being statistically significant for the HAM-D6 (r=-0.185; p=0.019; 95% CI: -0.335 to -0.033), but not for the entire HAM-D17 (r=-0.127; p=0.108; 95% CI: -0.272 to 0.027).

CONCLUSION

We could not identify a strong relationship between serum BDNF levels and depression severity using the HAM-D6. This is in concordance with results of previous studies that reported no correlation between these variables, and indicates that the properties of the clinical measures used cannot explain the results these studies.

The Major Depressive Disorder Hierarchy: Rasch Analysis of 6 items of the Hamilton Depression Scale Covering the Continuum of Depressive Syndrome

OBJECTIVES

Melancholic features of depression (MFD) seem to be a unidimensional group of signs and symptoms. However, little importance has been given to the evaluation of what features are related to a more severe disorder. That is, what are the MFD that appear only in the most depressed patients. We aim to demonstrate how each MFD is related to the severity of the major depressive disorder.

METHODS

We evaluated both the Hamilton depression rating scale (HDRS-17) and its 6-item melancholic subscale (HAM-D6) in 291 depressed inpatients using Rasch analysis, which computes the severity of each MFD. Overall measures of model fit were mean (±SD) of items and persons residual = 0 (±1); low χ2 value; p>0.01.

RESULTS

For the HDRS-17 model fit, mean (±SD) of item residuals = 0.35 (±1.4); mean (±SD) of person residuals = -0.15 (±1.09); χ2 = 309.74; p<0.00001. For the HAM-D6 model fit, mean (±SD) of item residuals = 0.5 (±0.86); mean (±SD) of person residuals = 0.15 (±0.91); χ2 = 56.13; p = 0.196. MFD ordered by crescent severity were depressed mood, work and activities, somatic symptoms, psychic anxiety, guilt feelings, and psychomotor retardation.

CONCLUSIONS

Depressed mood is less severe, while guilt feelings and psychomotor retardation are more severe MFD in a psychiatric hospitalization. Understanding depression as a continuum of symptoms can improve the understanding of the disorder and may improve its perspective of treatment.

PANSS-6: a brief rating scale for the measurement of severity in schizophrenia

OBJECTIVE

The 30-item Positive and Negative Syndrome Scale (PANSS-30) is the most widely used rating scale in schizophrenia, but too long for clinical use. Shorter PANSS versions have been proposed, including the PANSS-14 and PANSS-8. However, none of these PANSS versions has been validated using the parametric Rasch rating scale model, which evaluates 'scalability'. Scalability means that each item in a rating scale provides unique information regarding syndrome severity and is a statistical prerequisite for using the total score as a measure of overall severity.

METHOD

Based on data from two randomized placebo-controlled trials in schizophrenia, we tested the scalability of PANSS-30, PANSS-14 and PANSS-8 by means of the parametric Rasch rating scale model. Furthermore, we tested whether a scalable PANSS version could separate efficacy of haloperidol and sertindole from placebo.

RESULTS

Neither PANSS-30, PANSS-14 nor PANSS-8 was scalable. However, PANSS-6, consisting of the items: P1-Delusions, P2-Conceptual disorganization, P3-Hallucinations, N1-Blunted Affect, N4-Social withdrawal, N6-Lack of spontaneity and flow of conversation, was scalable. Furthermore, PANSS-6 captured superior symptom reduction and higher remission rates during treatment with haloperidol and sertindole vs. placebo.

CONCLUSION

PANSS-6 is a short schizophrenia severity rating scale that adequately separates antipsychotic efficacy from that of placebo.

Psychodynamic and biodynamic analysis of treatment of outlet obstructive constipation (OOC) using Procedure for Prolapse and Hemorrhoids (PPH)

To discuss the possible pathogenesis of outlet obstructive constipation (OOC) and identify the theoretical basis of the Procedure for Prolapse and Hemorrhoids (PPH) used to treat outlet obstructive constipation (OOC). 19 patients diagnosed with outlet obstructive constipation (OOC) form the case group, and 9 healthy volunteers form the control group. Patients, before and after operation, and the control group, were equally given such tests as Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Scale (HAMA) and anorectal dynamics. No significant difference in the functional lengths of anal canals was found between all groups (F = 0.98, p = 0.41). The minimum perception threshold, maximum tolerance threshold, and rectal defecation threshold of Group A, of 15 days after operation, were equally lower than those before operation, and than the control group (P < 0.05). These thresholds rebounded significantly in Group B 90 days after operation. Mentally, HAMA (F = 23.75, p = 0.00) and HAMD (F = 20.99, p = 0.00) total scores, after operation, were equally decreased first and then rebounded. Patients with outlet obstructive constipation (OOC) are subject to anorectal dynamic disorders as well as mental and psychological disorders, which can be remarkably improved using the Procedure for Prolapse and Hemorrhoids (PPH).