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Akhtar A, Shafiq S, Parveen S, Nwofe E, Windle K. Exploring the Impact of Cognitive Dysfunction During Recurrent Depression in a Sample of Mid-to-Older Age British South Asians: A Qualitative Study. J Psychiatr Ment Health Nurs 2024. [PMID: 39314128 DOI: 10.1111/jpm.13113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/20/2024] [Accepted: 09/05/2024] [Indexed: 09/25/2024]
Abstract
INTRODUCTION Depression is a major public health issue, increasing the risk of comorbidities. Some people with depression experience cognitive dysfunction, which can persist even after symptomatic recovery. British South Asians are at greater risk of developing depression and are less likely to seek treatment. It is important to understand their experience of subjective cognitive dysfunction in depression and how best to support them. AIMS This study explored subjective experience of cognitive dysfunction during recurrent depression, in a sample of 12 British South Asians aged between 45 and 60 years. METHODS We conducted semi-structured interviews to explore cognitive dysfunction during recurrent depression. We analysed the data using thematic analysis. RESULTS Difficulties in attention and concentration resulted in lower quality of social relationships, including not feeling present and social isolation. Learning new information was difficult, thus impacting productivity. Participants found it difficult to engage in enjoyable activities that promoted brain health. The emotional, physical and spiritual impact negatively impacted on quality of life. DISCUSSION Cognitive strategies used in therapies could improve brain health and functional recovery in people living with depression. IMPLICATIONS Mental health nurses play a pivotal role in providing culturally appropriate information and strategies for managing cognitive dysfunction in recurrent depression.
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Affiliation(s)
- Amirah Akhtar
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Shabana Shafiq
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Sahdia Parveen
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Emmanuel Nwofe
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Karen Windle
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
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Myklebost SB, Amundsen OM, Geraghty AWA, Inal Y, Hammar Å, Nordgreen T. Developing an internet-delivered intervention targeting residual cognitive symptoms after major depressive disorder: a person-based approach. J Ment Health 2022; 31:842-850. [PMID: 34983282 DOI: 10.1080/09638237.2021.2022618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cognitive difficulties are rarely addressed after the treatment of major depressive disorder (MDD). New scalable treatments are needed. To ensure relevance and engagement of novel interventions, there is a need to understand the perspectives of the users. AIM Explore former depressed adults needs and perspectives during the planning and development of a novel internet-delivered intervention targeting residual cognitive symptoms after MDD. METHOD The planning phase included exploratory qualitative interviews with former depressed adults (n = 16). In the development phase, a prototype including psychoeducation, attention training and compensatory strategies was tested in think-aloud interviews with former depressed adults (n = 7) and psychologists (n = 4). Data were analysed thematically. RESULTS Analysis of exploratory interviews identified four themes. Experiences of residual cognitive symptoms consisted of two sub-themes (Everyday life is more demanding; Concerns about cognitive difficulties). Coping with residual cognitive symptoms had two sub-themes (Compensatory strategies; Acceptance). Needs from an intervention consisted of two-subthemes (Need for information; Therapist support). Barriers for engagement consisted of three sub-themes (Being overwhelmed; Not being motivated; Frequent registration). Analysis of think-aloud interviews was organized into three themes: Positive perceptions of content; Concerns regarding content; Perceptions of Layout, Visuals and Navigation. CONCLUSION The intervention may address concerns and consequences of cognitive difficulties by including psychoeducation, compensatory strategies and elements to increase acceptance and motivation, provided in manageable proportions.
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Affiliation(s)
- Sunniva Brurok Myklebost
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | | | - Adam W A Geraghty
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Yavuz Inal
- Department of Design, Faculty of Architecture and Design, Norwegian University of Science and Technology, Trondheim, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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3
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Tartt AN, Mariani MB, Hen R, Mann JJ, Boldrini M. Dysregulation of adult hippocampal neuroplasticity in major depression: pathogenesis and therapeutic implications. Mol Psychiatry 2022; 27:2689-2699. [PMID: 35354926 PMCID: PMC9167750 DOI: 10.1038/s41380-022-01520-y] [Citation(s) in RCA: 120] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 02/07/2023]
Abstract
Major depressive disorder (MDD) was previously hypothesized to be a disease of monoamine deficiency in which low levels of monoamines in the synaptic cleft were believed to underlie depressive symptoms. More recently, however, there has been a paradigm shift toward a neuroplasticity hypothesis of depression in which downstream effects of antidepressants, such as increased neurogenesis, contribute to improvements in cognition and mood. This review takes a top-down approach to assess how changes in behavior and hippocampal-dependent circuits may be attributed to abnormalities at the molecular, structural, and synaptic level. We conclude with a discussion of how antidepressant treatments share a common effect in modulating neuroplasticity and consider outstanding questions and future perspectives.
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Affiliation(s)
| | | | - Rene Hen
- Departments of Psychiatry, Columbia University, New York, NY, USA
- Neuroscience, Columbia University, New York, NY, USA
- Pharmacology, Columbia University, New York, NY, USA
- Integrative Neuroscience, NYS Psychiatric Institute, New York, NY, USA
| | - J John Mann
- Departments of Psychiatry, Columbia University, New York, NY, USA
- Molecular Imaging and Neuropathology, NYS Psychiatric Institute, New York, NY, USA
| | - Maura Boldrini
- Departments of Psychiatry, Columbia University, New York, NY, USA.
- Molecular Imaging and Neuropathology, NYS Psychiatric Institute, New York, NY, USA.
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Allott K, Gao CX, Fisher C, Hetrick SE, Filia KM, Menssink JM, Herrman HE, Rickwood DJ, Parker AG, McGorry PD, Cotton SM. The Neuropsychological Symptoms Self-Report: psychometric properties in an adolescent and young adult mental health cohort. Child Adolesc Ment Health 2022; 27:111-121. [PMID: 33913237 DOI: 10.1111/camh.12473] [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] [Accepted: 03/26/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Subjective cognitive symptoms are common in young people receiving mental health treatment and are associated with poorer outcomes. The aim of this study was to determine the psychometric properties of the Neuropsychological Symptoms Self-Report (NSSR), an eight-item measure recently developed to provide a snapshot of young people's perceived change in cognitive functioning in relation to mental health treatment. METHOD The sample included 633 youth aged 12-25 years (Mage = 18.2, 66.5% female, 88.6% Australian-born) who had sought mental health treatment in primary headspace services. At three-month follow-up, participants completed the NSSR and self-report measures of depression and anxiety. RESULTS Excellent internal consistency was found: Cronbach's alpha = 0.93. The NSSR had negative correlations with self-reported anxiety (r = -.33, p < .001) and depression (r = -.48, p < .001) symptoms, suggesting a link with affective symptoms, but still independence of constructs. Exploratory and confirmatory factor analyses supported a single-factor model. Item response theory (IRT) analysis suggested good model fit (homogeneity, data integrity, scalability, local independence and monotonicity) for all items. There was some evidence of measurement noninvariance (for item thresholds) by sex and age, but not diagnosis. IRT models also supported briefer six- and three-item versions of the NSSR. CONCLUSION In busy clinical practice, clinicians need a rapid and reliable method for determining whether cognitive symptoms are of concern and in need of further assessment and treatment. Study findings support the NSSR as a brief, psychometrically sound measure for assessing subjective cognitive functioning in adolescents and young adults receiving mental health treatment.
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Affiliation(s)
- Kelly Allott
- Orygen, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - Caroline X Gao
- Orygen, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Caroline Fisher
- Department of Psychology, Royal Melbourne Hospital, Melbourne Health, Parkville, Vic., Australia.,The Melbourne Clinic, Richmond, Vic., Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Kate M Filia
- Orygen, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - Jana M Menssink
- Orygen, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - Helen E Herrman
- Orygen, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - Debra J Rickwood
- headspace National Youth Mental Health Foundation, Melbourne, Vic., Australia.,Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Alexandra G Parker
- Orygen, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia.,Institute for Health and Sport, Victoria University, Melbourne, Vic., Australia
| | - Patrick D McGorry
- Orygen, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - Sue M Cotton
- Orygen, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
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Vicent-Gil M, Portella MJ, Serra-Blasco M, Navarra-Ventura G, Crivillés S, Aguilar E, Palao D, Cardoner N. Dealing with heterogeneity of cognitive dysfunction in acute depression: a clustering approach. Psychol Med 2021; 51:2886-2894. [PMID: 32476636 PMCID: PMC8640365 DOI: 10.1017/s0033291720001567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/18/2020] [Accepted: 05/08/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Heterogeneity in cognitive functioning among major depressive disorder (MDD) patients could have been the reason for the small-to-moderate differences reported so far when it is compared to other psychiatric conditions or to healthy controls. Additionally, most of these studies did not take into account clinical and sociodemographic characteristics that could have played a relevant role in cognitive variability. This study aims to identify empirical clusters based on cognitive, clinical and sociodemographic variables in a sample of acute MDD patients. METHODS In a sample of 174 patients with an acute depressive episode, a two-step clustering analysis was applied considering potentially relevant cognitive, clinical and sociodemographic variables as indicators for grouping. RESULTS Treatment resistance was the most important factor for clustering, closely followed by cognitive performance. Three empirical subgroups were obtained: cluster 1 was characterized by a sample of non-resistant patients with preserved cognitive functioning (n = 68, 39%); cluster 2 was formed by treatment-resistant patients with selective cognitive deficits (n = 66, 38%) and cluster 3 consisted of resistant (n = 23, 58%) and non-resistant (n = 17, 42%) acute patients with significant deficits in all neurocognitive domains (n = 40, 23%). CONCLUSIONS The findings provide evidence upon the existence of cognitive heterogeneity across patients in an acute depressive episode. Therefore, assessing cognition becomes an evident necessity for all patients diagnosed with MDD, and although treatment resistant is associated with greater cognitive dysfunction, non-resistant patients can also show significant cognitive deficits. By targeting not only mood but also cognition, patients are more likely to achieve full recovery and prevent new relapses.
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Affiliation(s)
- Muriel Vicent-Gil
- Mental Health Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona (UAB), Biomedical Research Networking Center Consortium on Mental Health (CIBERSAM), Parc Taulí 1, 08208 Sabadell, Catalonia, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Biomedical Research Networking Center Consortium on Mental Health (CIBERSAM), Sant Antoni Mª Claret 167, 08025 Barcelona, Catalonia, Spain
| | - Maria J. Portella
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Biomedical Research Networking Center Consortium on Mental Health (CIBERSAM), Sant Antoni Mª Claret 167, 08025 Barcelona, Catalonia, Spain
| | - Maria Serra-Blasco
- Mental Health Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona (UAB), Biomedical Research Networking Center Consortium on Mental Health (CIBERSAM), Parc Taulí 1, 08208 Sabadell, Catalonia, Spain
| | - Guillem Navarra-Ventura
- Mental Health Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona (UAB), Biomedical Research Networking Center Consortium on Mental Health (CIBERSAM), Parc Taulí 1, 08208 Sabadell, Catalonia, Spain
| | - Sara Crivillés
- Mental Health Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona (UAB), Biomedical Research Networking Center Consortium on Mental Health (CIBERSAM), Parc Taulí 1, 08208 Sabadell, Catalonia, Spain
| | - Eva Aguilar
- Mental Health Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona (UAB), Biomedical Research Networking Center Consortium on Mental Health (CIBERSAM), Parc Taulí 1, 08208 Sabadell, Catalonia, Spain
| | - Diego Palao
- Mental Health Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona (UAB), Biomedical Research Networking Center Consortium on Mental Health (CIBERSAM), Parc Taulí 1, 08208 Sabadell, Catalonia, Spain
| | - Narcís Cardoner
- Mental Health Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona (UAB), Biomedical Research Networking Center Consortium on Mental Health (CIBERSAM), Parc Taulí 1, 08208 Sabadell, Catalonia, Spain
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Ishigooka J, Hoshino T, Imai T, Yoshida H, Ono M, Ota M, Moriguchi Y, Fujikawa K, Shintani A, Fernandez JL. Patient and Physician Perspectives of Depressive Symptoms and Expectations for Treatment Outcome: Results from a Web-Based Survey. Neuropsychiatr Dis Treat 2021; 17:2915-2924. [PMID: 34531658 PMCID: PMC8440229 DOI: 10.2147/ndt.s324968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/18/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE A previous international study suggested that perceptions of depression symptoms, social function, and treatment expectations are different between patients/physicians. We aimed to examine whether such differences exist in Japan. METHODS A web-based survey was conducted with patients who reported that they had been diagnosed with depression, and physicians who reported that they had treated patients with depression, in Japan. Questionnaires were designed to quantify patients' perceptions of symptoms, social function, and treatment expectations. Patients were categorized into three stages of disorder based on their reported current symptoms: severe symptomatic, mild symptomatic, and remission. Physicians were assigned up to three patients, were provided with patient information from the questionnaire completed by those patients, and finally the completed questionnaire forms for each patient. Agreement between the perceptions of the patients and physicians was examined for each stage. RESULTS Of the 2618 eligible patients, 828 were assigned to 326 eligible physicians. Overall, we found small differences in the perceptions of depression treatment between patients/physicians. Slightly fewer physicians than patients reported physical symptoms (85% vs 91%; p=0.018) in the mild symptomatic stage. Fewer physicians than patients reported cognitive symptoms in the severe (82% vs 87%; p=0.029) and mild (54% vs 66%; p=0.003) symptomatic stages. Social function was deemed to be lower by physicians than by patients, across all stages of disorder (p<0.001). Regarding treatment expectations, more physicians than patients reported "return to a normal life" in the mild symptomatic (51% vs 35%, p<0.001) and remission stages (57% vs 36%, p<0.001), and more patients than physicians reported "reduction of side effects" in the severe (10% vs 4%, p=0.004) and mild (12% vs 5%, p<0.001) symptomatic disorder stages. CONCLUSION These results suggest small differences in patient/physician perceptions of depression treatment in Japan. Discrepancies between patients'/physicians' perceptions may vary depending on the medical environment.
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Affiliation(s)
| | - Tatsuya Hoshino
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Takumi Imai
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hisako Yoshida
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Midori Ono
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Mihoko Ota
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | | | - Keita Fujikawa
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
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Crowe M, Porter R, Douglas K, Inder M, Lacey C, Jordan J, Wells H. Patients' experiences of cognitive functioning in recurrent depression: A qualitative study. J Psychiatr Ment Health Nurs 2020; 27:321-329. [PMID: 31981272 DOI: 10.1111/jpm.12603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Recurrent depressive episodes involve significant morbidity, suicide risk and recurrent hospitalizations. In both major depressive disorder and bipolar disorder, there are significant impairments in functioning following resolution of acute symptoms. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides an in-depth qualitative understanding of the subjective experience of cognitive impairment following a depressive episode in a recurrent mood disorder. It identifies descriptions of two types of experience (being stuck and being preoccupied with one's thoughts) that led to impairments in concentration, memory, organization and decision-making. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses need to develop an awareness of the impact of cognitive difficulties in the process of recovery from recurrent mood disorders. Mental health nurses need to provide knowledgeable reassurance, information and interventions to people who experience cognitive difficulties to provide a framework of understanding that promotes recovery. ABSTRACT: Introduction People who experience recurrent depressive episodes often have ongoing cognitive problems that impact on their functional recovery. These cognitive difficulties have been identified as impacting on social, interpersonal and occupational functioning and can result in vulnerability to relapse. Aim The aim of this qualitative study was to explore participants' subjective experiences of cognitive impairment after discharge from mental health services following treatment for recurrent depression. Methods The study was designed as a qualitative study in order to best capture participants' subjective experiences. Data were collected by semi-structured interviews and were analysed using a process of thematic analysis. Results Twenty participants took part in this study. All participants described experiences of either 1) "being stuck"; or 2) "being preoccupied with own thoughts"; however, all participants described the experiences in the third theme: "it stops you living to your potential." Implications for practice In order to promote recovery in a meaningful way, mental health nurses need to provide information about and strategies for managing cognitive difficulties associated with recurrent mood disorders.
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Affiliation(s)
- Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Katie Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Maree Inder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Hayley Wells
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Wang Y, Zhang A, Yang C, Li G, Sun N, Liu P, Wang Y, Zhang K. Enhanced Functional Connectivity Within Executive Function Network in Remitted or Partially Remitted MDD Patients. Front Psychiatry 2020; 11:538333. [PMID: 33584355 PMCID: PMC7875881 DOI: 10.3389/fpsyt.2020.538333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 12/18/2020] [Indexed: 12/30/2022] Open
Abstract
Background: Impaired executive function (EF) is associated with a range of typical clinical characteristics and psychosocial dysfunction in major depressive disorder (MDD). However, because of the lack of objective cognitive tests, inconsistencies in research results, and improvement in patients' subjective experience, few clinicians are concerned with the persistent impairment of EF in euthymia. The study makes a further investigation for EF in remitted and partially remitted MDD patients via multiple EF tests and fMRI, so as to explore the executive function of patients in euthymia. Methods: We recruited 19 MDD patients and 17 age-, gender-, and education-matched healthy controls (HCs). All participants completed EF tests and fMRI scanning. Bilateral dorsolateral prefrontal cortex (dlPFC) regions were selected as the region of interests (ROIs) to conduct seed-based functional connectivity (FC). We conducted fractional amplitude of low-frequency fluctuations (fALFF) analysis for all ROIs and whole brain. Results: All MDD patients were in remission or partial remission, and they were comparable with HCs on all the EF tests. MDD group showed increased positive FC between left dlPFC and cerebellar Crus I, right dlPFC and supramarginal gyrus after 8-weeks treatment, even taking residual depressive symptoms into account. We did not find group difference of fALFF value. Conclusion: MDD patients persisted with EF impairment despite the remission or partially remission of depressive symptoms. Clinicians should focus on residual cognitive symptoms, which may contribute to maximize the efficacy of routine therapy.
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Affiliation(s)
- Yuchen Wang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Medical Psychology, College of Humanities and Social Science, Shanxi Medical University, Taiyuan, China
| | - Aixia Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Chunxia Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Gaizhi Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,College of Nursing, Shanxi Medical University, Taiyuan, China
| | - Penghong Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yanfang Wang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Kerang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
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Christensen MC, Wong CMJ, Baune BT. Symptoms of Major Depressive Disorder and Their Impact on Psychosocial Functioning in the Different Phases of the Disease: Do the Perspectives of Patients and Healthcare Providers Differ? Front Psychiatry 2020; 11:280. [PMID: 32390877 PMCID: PMC7193105 DOI: 10.3389/fpsyt.2020.00280] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022] Open
Abstract
This analysis was undertaken to examine the relationship between different symptoms of major depressive disorder (MDD) and psychosocial functioning from the perspectives of patients and healthcare providers (HCPs) across the different phases of the disease (acute, post-acute, and remission). Data regarding symptoms of MDD and psychosocial functioning, assessed by an adapted version of the Functioning Assessment Short Test (FAST) scale, were elicited via an online survey from 2,008 patients diagnosed with MDD (based on their personal experience of the disease) and 3,138 patients observed by 1,046 HCPs (based on individual patient records). Correlations between patient-reported and HCP-reported MDD symptoms and impairment of psychosocial functioning were assessed by multivariate regression analysis. The population comprised 1,946 patient respondents and 3,042 HCP-reported patients. Patients reported experiencing a wider range of symptoms and greater impairment of functioning than reported by HCPs across all phases of the disease. At the domain level, only cognitive symptoms were found to be significantly associated with functioning during the acute phase from the perspective of patients, while from the HCPs' perspective both mood and cognitive symptoms significantly impacted functioning in this phase. Significant associations were seen between mood, physical, and cognitive symptom domains and functioning in both cohorts during the post-acute and remission phases. Differences in associations between individual MDD symptoms and functioning were also observed between the two cohorts across all disease phases; in particular, HCPs found that more physical symptoms impacted functioning during remission than did patients. In summary, the results suggest that perceptions of MDD symptoms and the associations between these symptoms and functioning differ significantly between patients and HCPs across all phases of the disease. These findings further highlight the need for improved communication between patients and HCPs in order to set appropriate treatment goals and promote symptomatic and functional recovery in MDD.
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Affiliation(s)
| | | | - Bernhard T Baune
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany.,Department of Psychiatry, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
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10
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Abstract
A key message from the review of cognitive dysfunction in psychiatry published by Millan et al (2012) was not just that cognitive skills are often compromised in patients with psychiatric disorders, but that deficits in specific domains are common to a number of conditions. The review also highlighted that the magnitude of the observed deficits varied across disorders. A helpful element of the Millan et al study was the inclusion of a table in which the authors sought to convey the domains of cognition and a categorization of the magnitude of the observed deficits.In previous articles, we have considered best practice for the assessment of cognition. In these contributions, we have argued not for the use of specific tests, but instead for measures that meet acceptable standards of reliability, validity, and sensitivity. In the course of our discussions, we have included reference to test validity in the context of considering whether selected measures index appropriate domains of cognition. In this article, we begin with a brief discussion of the requirements for good test selection, especially with respect to issues of sensitivity, reliability, and validity. Thereafter the focus of this article is on the issue of domain validity. We will critically review the specification of the cognitive domains proposed by Millan et al, as well as those selected by authors of meta-analyses characterizing cognitive deficits in major depressive disorders. This focus is solely to make the discussion tractable, though we propose that the issues raised will be applicable across all psychiatric and neurological disorders.
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Baune BT, Christensen MC. Differences in Perceptions of Major Depressive Disorder Symptoms and Treatment Priorities Between Patients and Health Care Providers Across the Acute, Post-Acute, and Remission Phases of Depression. Front Psychiatry 2019; 10:335. [PMID: 31178765 PMCID: PMC6537882 DOI: 10.3389/fpsyt.2019.00335] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/29/2019] [Indexed: 11/15/2022] Open
Abstract
Limited data exist on concordance between patients' and health care providers' (HCPs) perceptions regarding symptoms of major depressive disorder (MDD) and treatment priorities, particularly across disease phases. This study examined concordance during the acute, post-acute, and remission phases of MDD. In an online survey, 2,008 patients responded based on their experience with MDD, and 1,046 HCPs responded based on their clinical experience treating patients with MDD. Questions included symptom frequency and severity, treatment priorities, and impact on psychosocial functioning. Patients reported more frequently mood, physical, and cognitive symptoms than HCPs in the post-acute and remission phases and greater impact on psychosocial functioning. Patients reported that all these symptoms require high treatment priority across the phases of MDD, generally to a greater extent than HCPs. Patients also gave high emphasis to addressing impairment in psychosocial functioning early in the treatment course. A substantial difference in the effectiveness of treating symptoms of MDD between patients and HCPs was observed. This is the first study to quantify, broadly, differences in perceptions of MDD symptom prevalence, severity, and treatment priorities across MDD phases, and the study findings highlight a need for improved communication between patients and HCPs about symptoms, their impact on psychosocial functioning, and treatment priorities across phases.
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Affiliation(s)
- Bernhard T Baune
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany.,Department of Psychiatry, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.,Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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Harrison JE, Barry H, Baune BT, Best MW, Bowie CR, Cha DS, Culpepper L, Fossati P, Greer TL, Harmer C, Klag E, Lam RW, Lee Y, Mansur RB, Wittchen H, McIntyre RS. Stability, reliability, and validity of the THINC-it screening tool for cognitive impairment in depression: A psychometric exploration in healthy volunteers. Int J Methods Psychiatr Res 2018; 27:e1736. [PMID: 30088298 PMCID: PMC6174931 DOI: 10.1002/mpr.1736] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 06/15/2018] [Accepted: 06/21/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES There is a need for a brief, reliable, valid, and sensitive assessment tool for screening cognitive deficits in patients with Major Depressive Disorders. This paper examines the psychometric characteristics of THINC-it, a cognitive assessment tool composed of four objective measures of cognition and a self-rated assessment, in subjects without mental disorders. METHODS N = 100 healthy controls with no current or past history of depression were tested on four sequential assessments to examine temporal stability, reliability, and convergent validity of the THINC-it tests. We examined temporal reliability across 1 week and stability via three consecutive assessments. Consistency of assessment by the study rater (intrarater reliability) was calculated using the data from the second and third of these consecutive assessments. RESULTS Test-retest reliability correlations varied between Pearson's r = 0.75 and 0.8. Intrarater reliability between 0.7 and 0.93. Stability for the primary measure for each test yielded within-subject standard deviation values between 5.9 and 11.23 for accuracy measures and 0.735 and 17.3 seconds for latency measures. Convergent validity for three tasks was in the acceptable range, but low for the Symbol Check task. CONCLUSIONS Analysis shows high levels of reliability and stability. Levels of convergent validity were modest but acceptable in the case of all but one test.
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Affiliation(s)
- John E. Harrison
- Alzheimer CenterVU Medical CenterAmsterdamThe Netherlands
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Kilmington CommonMetis Cognition LtdWiltshireUK
| | | | | | | | - Christopher R. Bowie
- Department of PsychologyQueen's UniversityKingstonONCanada
- Centre for Addiction and Mental HealthTorontoONCanada
| | - Danielle S. Cha
- Mood Disorders Psychopharmacology UnitUniversity Health NetworkTorontoONCanada
| | - Larry Culpepper
- Department of Family MedicineBoston UniversityBostonMassachusettsUSA
| | - Philippe Fossati
- Sorbonne Universités, UPMC Univ Paris 06, Inserm, CNRS, APHPInstitut du cerveau et de la moelle (ICM)‐Hôpital Pitié SalpétrièreParisFrance
| | - Tracy L. Greer
- Centre for Depression Research and Clinical Care, Department of PsychiatryUniversity of TexasDallasTexasUSA
| | - Catherine Harmer
- Cognitive Neuroscience, Department of PsychiatryOxford UniversityOxfordUK
| | - Esther Klag
- Clinical Psychologist, Rehabilitation Neuropsychologist, PsychotherapistLondonUK
| | - Raymond W. Lam
- BC Leadership Chair in Depression ResearchVancouverBCCanada
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
- Djavad Mowafaghian Centre for Brain HealthMood Disorders CentreVancouverBCCanada
- Canadian Network for Mood and Anxiety Treatments (CANMAT)VancouverBCCanada
| | - Yena Lee
- Mood Disorders Psychopharmacology UnitUniversity Health NetworkTorontoONCanada
- Institute of Medical ScienceUniversity of TorontoTorontoONCanada
| | - Rodrigo B. Mansur
- Mood Disorders Psychopharmacology UnitUniversity Health NetworkTorontoONCanada
- Canadian Network for Mood and Anxiety Treatments (CANMAT)VancouverBCCanada
| | - Hans‐Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy and Centre of Clinical Epidemiology and Longitudinal Studies, (CELOS)Technische Universität DresdenDresdenGermany
- Department of Psychiatry and PsychotherapyLudwig‐Maximilians‐University MunichMunichGermany
- Clinical Psychology and Psychotherapy MPCBDresdenGermany
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology UnitUniversity Health NetworkTorontoONCanada
- Institute of Medical ScienceUniversity of TorontoTorontoONCanada
- Department of PsychiatryUniversity of TorontoTorontoONCanada
- Brain and Cognition Discovery Foundation (BCDF)TorontoONCanada
- Department of PharmacologyUniversity of TorontoTorontoONCanada
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