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Tobe RH, Tu L, Keefe JR, Breland MM, Ely BA, Sital M, Richard JT, Tural U, Iosifescu DV, Gabbay V. Personality characteristics, not clinical symptoms, are associated with anhedonia in a community sample: A preliminary investigation. J Psychiatr Res 2023; 168:221-229. [PMID: 37922596 DOI: 10.1016/j.jpsychires.2023.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/16/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
Anhedonia is a salient transdiagnostic psychiatric symptom associated with increased illness severity and chronicity. Anhedonia is also present to varying degrees in non-clinical cohorts. Here, we sought to examine factors influencing expression of anhedonia. Participants (N = 335) were recruited through the Nathan Kline Institute-Rockland Sample, an initiative to deeply phenotype a large community sample across the lifespan. Utilizing a data-driven approach, we evaluated associations between anhedonia severity, indexed by Snaith-Hamilton Pleasure Scale (SHAPS), and 20 physical, developmental, and clinical measures, including Structured Clinical Interview for DSM-IV, Beck Depression Inventory, State-Trait Anxiety Inventory, NEO Five-Factor Inventory-3 (NEO-FFI-3), BMI, Hemoglobin A1C, and demography. Using a bootstrapped AIC-based backward selection algorithm, seven variables were retained in the final model: NEO-FFI-3 agreeableness, extraversion, and openness to experience; BMI; sex; ethnicity; and race. Though median SHAPS scores were greater in participants with psychiatric diagnoses (18.5) than those without (17.0) (U = 12238.5, z = 2.473, p = 0.013), diagnosis and symptom measures were not retained as significant predictors in the final robust linear model. Participants scoring higher on agreeableness, extraversion, and openness to experience reported significantly lower anhedonia. These results demonstrate personality as a mild-to-moderate but significant driver of differences in experiencing pleasure in a community sample.
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Affiliation(s)
- Russell H Tobe
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, 10962, USA; Center for the Developing Brain, Child Mind Institute, New York, NY, 10022, USA.
| | - Lucia Tu
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, 10962, USA
| | - John R Keefe
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Melissa M Breland
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, 10962, USA
| | - Benjamin A Ely
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Melissa Sital
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, 10962, USA
| | - Jasmin T Richard
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, 10962, USA; Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Umit Tural
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, 10962, USA
| | - Dan V Iosifescu
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, 10962, USA; Department of Psychiatry, New York University School of Medicine, New York, NY, 10016, USA
| | - Vilma Gabbay
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, 10962, USA; Department of Psychiatry and Behavioral Sciences, University of Miami Leonard M. Miller School of Medicine, Coral Gables, FL, 33124, USA
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2
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Bergua V, Blanchard C, Amieva H. Depression in Older Adults: Do Current DSM Diagnostic Criteria Really Fit? Clin Gerontol 2023:1-38. [PMID: 37902598 DOI: 10.1080/07317115.2023.2274053] [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: 10/31/2023]
Abstract
OBJECTIVES The great heterogeneity in symptoms and clinical signs of depression in older adults makes the current diagnostic criteria difficult to apply. This scoping review aims to provide an update on the relevance of each of the diagnostic criteria as defined in the DSM-5. METHODS In order to limit the risk of bias inherent in the study selection process, a priori inclusion and exclusion criteria were defined. Articles meeting these criteria were identified using a combination of search terms entered into PubMed, PsycINFO, PsycARTICLES and SocINDEX. RESULTS Of the 894 articles identified, 33 articles were selected. This review highlights a different presentation of depression in older adults. Beyond the first two DSM core criteria, some symptoms are more common in older adults: appetite change, sleep disturbance, psychomotor slowing, difficulty concentrating, indecisiveness, and fatigue. CONCLUSIONS This review provides an updated description of the clinical expression of depressive symptoms in the older population while highlighting current pending issues. CLINICAL IMPLICATIONS Somatic symptoms should be systematically considered in order to improve the diagnosis of depression in older adults, even if, in some cases, they may reflect symptoms of age-related illnesses.
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Affiliation(s)
- Valérie Bergua
- Public health - Psychology, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Cécile Blanchard
- Public health - Psychology, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
- Psychiatry, Centre Hospitalier Cadillac, Bordeaux, France
| | - Hélène Amieva
- Public health - Psychology, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
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3
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Boyle CC, Bower JE, Eisenberger NI, Irwin MR. Stress to inflammation and anhedonia: Mechanistic insights from preclinical and clinical models. Neurosci Biobehav Rev 2023; 152:105307. [PMID: 37419230 DOI: 10.1016/j.neubiorev.2023.105307] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/09/2023]
Abstract
Anhedonia, as evidenced by impaired pleasurable response to reward, reduced reward motivation, and/or deficits in reward-related learning, is a common feature of depression. Such deficits in reward processing are also an important clinical target as a risk factor for depression onset. Unfortunately, reward-related deficits remain difficult to treat. To address this gap and inform the development of effective prevention and treatment strategies, it is critical to understand the mechanisms that drive impairments in reward function. Stress-induced inflammation is a plausible mechanism of reward deficits. The purpose of this paper is to review evidence for two components of this psychobiological pathway: 1) the effects of stress on reward function; and 2) the effects of inflammation on reward function. Within these two areas, we draw upon preclinical and clinical models, distinguish between acute and chronic effects of stress and inflammation, and address specific domains of reward dysregulation. By addressing these contextual factors, the review reveals a nuanced literature which might be targeted for additional scientific inquiry to inform the development of precise interventions.
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Affiliation(s)
- Chloe C Boyle
- Norman Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA, USA.
| | - Julienne E Bower
- Norman Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA, USA; Department of Psychology, UCLA, Los Angeles, CA, USA
| | | | - Michael R Irwin
- Norman Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA, USA
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Hochbaum DR, Dubinsky AC, Farnsworth HC, Hulshof L, Kleinberg G, Urke A, Wang W, Hakim R, Robertson K, Park C, Solberg A, Yang Y, Baynard C, Nadaf NM, Beron CC, Girasole AE, Chantranupong L, Cortopassi M, Prouty S, Geistlinger L, Banks A, Scanlan T, Greenberg ME, Boulting GL, Macosko EZ, Sabatini BL. Thyroid hormone rewires cortical circuits to coordinate body-wide metabolism and exploratory drive. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.10.552874. [PMID: 37609206 PMCID: PMC10441422 DOI: 10.1101/2023.08.10.552874] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Animals adapt to varying environmental conditions by modifying the function of their internal organs, including the brain. To be adaptive, alterations in behavior must be coordinated with the functional state of organs throughout the body. Here we find that thyroid hormone- a prominent regulator of metabolism in many peripheral organs- activates cell-type specific transcriptional programs in anterior regions of cortex of adult mice via direct activation of thyroid hormone receptors. These programs are enriched for axon-guidance genes in glutamatergic projection neurons, synaptic regulators across both astrocytes and neurons, and pro-myelination factors in oligodendrocytes, suggesting widespread remodeling of cortical circuits. Indeed, whole-cell electrophysiology recordings revealed that thyroid hormone induces local transcriptional programs that rewire cortical neural circuits via pre-synaptic mechanisms, resulting in increased excitatory drive with a concomitant sensitization of recruited inhibition. We find that thyroid hormone bidirectionally regulates innate exploratory behaviors and that the transcriptionally mediated circuit changes in anterior cortex causally promote exploratory decision-making. Thus, thyroid hormone acts directly on adult cerebral cortex to coordinate exploratory behaviors with whole-body metabolic state.
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5
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Ossola P, Garrett N, Biso L, Bishara A, Marchesi C. Anhedonia and sensitivity to punishment in schizophrenia, depression and opiate use disorder. J Affect Disord 2023; 330:319-328. [PMID: 36889442 DOI: 10.1016/j.jad.2023.02.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND From a behavioural perspective anhedonia is defined as diminished interest in the engagement of pleasurable activities. Despite its presence across a range of psychiatric disorders, the cognitive processes that give rise to anhedonia remain unclear. METHODS Here we examine whether anhedonia is associated with learning from positive and negative outcomes in patients diagnosed with major depression, schizophrenia and opiate use disorder alongside a healthy control group. Responses in the Wisconsin Card Sorting Test - a task associated with healthy prefrontal cortex function - were fitted to the Attentional Learning Model (ALM) which separates learning from positive and negative feedback. RESULTS Learning from punishment, but not from reward, was negatively associated with anhedonia beyond other socio-demographic, cognitive and clinical variables. This impairment in punishment sensitivity was also associated with faster responses following negative feedback, independently of the degree of surprise. LIMITATIONS Future studies should test the longitudinal association between punishment sensitivity and anhedonia also in other clinical populations controlling for the effect of specific medications. CONCLUSIONS Together the results reveal that anhedonic subjects, because of their negative expectations, are less sensitive to negative feedbacks; this might lead them to persist in actions leading to negative outcomes.
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Affiliation(s)
- Paolo Ossola
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Department of Mental Health, AUSL of Parma, Parma, Italy.
| | - Neil Garrett
- School of Psychology, University of East Anglia, Norfolk, UK
| | - Letizia Biso
- Department of Mental Health, AUSL of Parma, Parma, Italy
| | - Anthony Bishara
- Department of Psychology, College of Charleston, Charleston, SC, USA
| | - Carlo Marchesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Department of Mental Health, AUSL of Parma, Parma, Italy
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Boyle CC, Cole SW, Irwin MR, Eisenberger NI, Bower JE. The role of inflammation in acute psychosocial stress-induced modulation of reward processing in healthy female adults. Brain Behav Immun Health 2023; 28:100588. [PMID: 36683947 PMCID: PMC9853307 DOI: 10.1016/j.bbih.2023.100588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 01/10/2023] Open
Abstract
Background Anhedonia, or loss of interest and pleasure, is a pernicious symptom of depression that involves deficits in reward processing. Stress-induced inflammation is a plausible biopsychosocial mechanism of reward deficits, but little is known whether stress-induced inflammation alters reward behavior. The present study (a secondary analysis of a completed randomized controlled trial) tested whether acute stress activated a key pro-inflammatory transcription control pathway, NF-κB, and whether this activation was associated with acute stress-induced modulation of reward processing. Methods Healthy female adults (age 18-25) were randomized to undergo an acute psychosocial stressor (Trier Social Stress Test; n = 36) or a no-stress active control (n = 16). The Probabilistic Reward Task (PRT) (n = 30 stress; n = 12 control) was administered at baseline and at 90 min post-stress, coinciding with the peak of the stress-induced inflammatory response. Genome-wide expression profiling and bioinformatics analyses of NF-kB transcription factor activity were used to assess pro-inflammatory gene regulation. Results Relative to the control condition, stress increased bioinformatic measures of NF-κB transcription factor activity (p = .01) and increased reward response bias scores on the PRT (p = .03). Within the stress condition, greater NF-κB activity was associated with greater increases in PRT scores (p = .01), whereas in the control condition greater NF-κB activity was associated with decreases in PRT scores (p = .002). Conclusions Acute stress increases inflammatory signaling, and this effect is associated with increased reward processing. This demonstrates the reward system to be highly sensitive to inflammatory signaling, including the relatively mild alterations that occur following a single episode of acute psychosocial stress.
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Affiliation(s)
- Chloe C. Boyle
- Norman Cousins Center for Psychoneuroimmunology, UCLA, USA,Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, USA,Corresponding author. 300 UCLA Medical Plaza, Room 3200D, Los Angeles, CA, 90095, USA.
| | - Steve W. Cole
- Norman Cousins Center for Psychoneuroimmunology, UCLA, USA,Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, USA,Division of Hemotology-Oncology, Department of Medicine, UCLA School of Medicine, USA
| | - Michael R. Irwin
- Norman Cousins Center for Psychoneuroimmunology, UCLA, USA,Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, USA
| | | | - Julienne E. Bower
- Norman Cousins Center for Psychoneuroimmunology, UCLA, USA,Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, USA,Department of Psychology, University of California, Los Angeles, CA, USA
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7
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Li S, Yin Y, Cui G, Zhang C, Zhu H, Yao Y. The mediating and moderating effects of resilience between childhood trauma and geriatric depressive symptoms among Chinese community-dwelling older adults. Front Public Health 2023; 11:1137600. [PMID: 37124808 PMCID: PMC10140585 DOI: 10.3389/fpubh.2023.1137600] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/16/2023] [Indexed: 05/02/2023] Open
Abstract
Objective This study aims to examine the association between childhood traumatic events (CTEs), childhood trauma severity, and depressive symptoms, as well as to examine the mediating and moderating roles of resilience in these associations. Methods We conducted a cross-sectional study of 1,091 community-dwelling older adults in Jinan, China. The trauma history questionnaire (THQ) was used to measure CTEs and childhood trauma severity. CTEs were defined as the number of traumatic events before the age of 18. We calculated childhood trauma severity by multiplying the number of CTEs by the participants' self-perceived impact level of the events from the THQ. We then applied the 15-item Geriatric Depression Scale and 10-item Connor-Davidson Resilience Scale to assess participants' depressive symptoms and resilience, respectively. Linear regression models were used to examine the associations, and structural equation modeling was used to examine the mediating and moderating roles of resilience. Results Childhood traumatic events, childhood trauma severity, and resilience were all associated with depressive symptoms in older adults. Resilience mediated the relationship between childhood trauma severity and depressive symptoms (β = 0.082, 95% CI = 0.045-0.123), accounting for 26.6% of the overall effect (β = 0.308, 95% CI = 0.190-0.422). However, there was no evidence that resilience mediated the association between CTEs and depressive symptoms. In addition, we did not find that resilience played a moderating role in the associations of CTEs, childhood trauma severity with depressive symptoms. Conclusion Resilience plays a mediating role in the relationship between childhood trauma severity and depressive symptoms. Intervention measures on improving resilience may reduce childhood trauma severity associated with depression risk in older Chinese adults.
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Affiliation(s)
- Shaojie Li
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Yongtian Yin
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guanghui Cui
- Department of Integrated Traditional Chinese and Western Medicine, Peking University First Hospital, Beijing, China
| | - Chi Zhang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, Beijing, China
| | - He Zhu
- China Center for Health Development Studies, Peking University, Beijing, China
- *Correspondence: He Zhu,
| | - Yao Yao
- China Center for Health Development Studies, Peking University, Beijing, China
- Yao Yao,
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8
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Chene M, Sánchez-Rico M, Blanco C, De Raykeer RP, Hanon C, Vandel P, Limosin F, Hoertel N. Psychiatric symptoms and mortality in older adults with major psychiatric disorders: results from a multicenter study. Eur Arch Psychiatry Clin Neurosci 2022; 273:627-638. [PMID: 35723739 DOI: 10.1007/s00406-022-01426-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 05/02/2022] [Indexed: 12/01/2022]
Abstract
Prior research suggests that certain psychiatric symptoms could be associated with increased risk of death. However, it remains unclear whether this association could rely on all or specific symptoms. In this report, we used data from a multicenter 5-year prospective study (N = 641) of older adults with an ICD-10 diagnosis of schizophrenia, bipolar disorder or major depressive disorder, recruited from French community psychiatric departments. We used a latent variable approach to disentangle the effects shared by all psychiatric symptoms (i.e., general psychopathology factor) and those specific to individual psychiatric symptoms, while adjusting for sociodemographic and clinical factors. Psychiatric symptoms were assessed face-to-face by psychiatrists trained to semi-structured interviews using the Brief Psychiatric Rating Scale (BPRS). Among older adults with major psychiatric disorders, we found that all psychiatric symptoms were associated with increased mortality, and that their effect on the 5-year mortality were exerted mostly through a general psychopathology dimension (β = 0.13, SE = 0.05, p < 0.05). No BPRS item or lower order factor had a significant effect on mortality beyond and above the effect of the general psychopathology factor. Greater number of medical conditions, older age, male sex, and being hospitalized or institutionalized at baseline were significantly associated with this risk beyond the effect of the general psychopathology factor. Since psychiatric symptoms may affect mortality mainly through a general psychopathology dimension, biological and psychological mechanisms underlying this dimension should be considered as promising targets for interventions to decrease excess mortality of older individuals with psychiatric disorders.
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Affiliation(s)
- Margaux Chene
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France. .,Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France.
| | - Marina Sánchez-Rico
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, Madrid, Spain
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute On Drug Abuse, Bethesda, MD, USA
| | - Rachel Pascal De Raykeer
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France
| | - Cécile Hanon
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
| | - Pierre Vandel
- Department of Adult Psychiatry, Laboratory of Neurosciences, University Hospital of Besançon, UBFC, EA-481, Besançon, France
| | - Frédéric Limosin
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
| | - Nicolas Hoertel
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France
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9
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Greenfield L, Mathews S, Toukhsati SR. Anhedonia and anergia predict mortality in older Australians living in residential aged care. Aging Ment Health 2022; 26:614-622. [PMID: 33459050 DOI: 10.1080/13607863.2021.1872491] [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: 10/22/2022]
Abstract
OBJECTIVES Depression is common in older adults and is linked to morbidity and mortality. The aim of this study was to investigate whether specific symptoms of depression (dysphoria, anhedonia and anergia) predicted mortality in older Australian Aged Care residents. METHODS Eighty older adults (M = 83.16 ± 7.14) without cognitive impairment residing in 14 Residential Aged Care facilities located in Melbourne, Australia, completed the 15-item Geriatric Depression Scale-Short Form (GDS-15) and the Standardized Mini Mental State Examination. Residential Aged Care facilities provided the primary end-point of all-cause mortality at follow-up (M = 5.4 years ± 0.1). RESULTS Univariate Kaplan-Meier survival curves and Cox Proportional Hazards regression analyses were used to evaluate whether symptoms of depression predicted all-cause mortality, with known prognostic factors controlled. The results indicated that anhedonia (Hazard Ratio = 2.931 [95% CI 1.278-6.722], p = .011) and anergia (Hazard Ratio = 2.783 [95% CI 1.065-7.276], p = .037) were associated with almost a threefold increased risk of mortality in older adults living in RAC in adjusted analyses. Dysphoria did not predict mortality. CONCLUSIONS These findings advance understanding of the mortality risks of anhedonia and anergia in an understudied population. Symptoms of anhedonia and anergia should be targeted for screening in older adults living in Aged Care to increase the detection and potential for referral to treatment for depressive presentation.
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Affiliation(s)
- L Greenfield
- Department of Cardiology, Austin Health, Heidelberg, VIC, Australia.,The Cairnmillar Institute, VIC, Australia
| | - S Mathews
- Department of Cardiology, Austin Health, Heidelberg, VIC, Australia
| | - S R Toukhsati
- Department of Cardiology, Austin Health, Heidelberg, VIC, Australia.,School of Science, Psychology and Sport, Federation University Australia, Berwick, VIC, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
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10
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Chen X, Beltran DJ, Tsygankova VD, Woolwine BJ, Patel T, Baer W, Felger JC, Miller AH, Haroon E. Kynurenines increase MRS metabolites in basal ganglia and decrease resting-state connectivity in frontostriatal reward circuitry in depression. Transl Psychiatry 2021; 11:456. [PMID: 34482366 PMCID: PMC8418602 DOI: 10.1038/s41398-021-01587-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/04/2021] [Accepted: 08/19/2021] [Indexed: 12/25/2022] Open
Abstract
Inflammation is associated with the development of anhedonia in major depression (MD), but the pathway by which inflammatory molecules gain access to the brain and lead to anhedonia is not clear. Molecules of the kynurenine pathway (KP), which is activated by inflammation, readily influx into the brain and generate end products that alter brain chemistry, disrupt circuit functioning, and result in the expression of inflammatory behaviors such as anhedonia. We examined the impact of plasma and CSF KP metabolites on brain chemistry and neural function using multimodal neuroimaging in 49 depressed subjects. We measured markers of glial dysfunction and distress including glutamate (Glu) and myo-inositol in the left basal ganglia using magnetic resonance spectroscopy (MRS); metrics of local activity coherence (regional homogeneity, ReHo) and functional connectivity from resting-state functional MRI measures; and anhedonia from the Inventory for Depressive Symptoms-Self Report Version (IDS-SR). Plasma kynurenine/tryptophan (KYN/TRP) ratio and cerebrospinal fluid (CSF) 3-hydroxykynurenine (3HK) were associated with increases in left basal ganglia myo-inositol. Plasma kynurenic acid (KYNA) and KYNA/QA were associated with decreases and quinolinic acid (QA) with increases in left basal ganglia Glu. Plasma and CSF KP were associated with decreases in ReHo in the basal ganglia and dorsomedial prefrontal regions (DMPFC) and impaired functional connectivity between these two regions. DMPFC-basal ganglia mediated the effect of plasma and CSF KP on anhedonia. These findings highlight the pathological impact of KP system dysregulation in mediating inflammatory behaviors such as anhedonia.
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Affiliation(s)
- Xiangchuan Chen
- Emory Behavioral Immunology Program, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Diana J Beltran
- Emory Behavioral Immunology Program, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Valeriya D Tsygankova
- Emory Behavioral Immunology Program, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Bobbi J Woolwine
- Emory Behavioral Immunology Program, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Trusharth Patel
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Wendy Baer
- Emory Behavioral Immunology Program, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Jennifer C Felger
- Emory Behavioral Immunology Program, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Andrew H Miller
- Emory Behavioral Immunology Program, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Ebrahim Haroon
- Emory Behavioral Immunology Program, Atlanta, GA, USA.
- Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA.
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11
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Utz KS, Martini M, Mrochen A, Lambrecht V, Süß P, Renner B, Freiherr J, Schenk T, Winkler J, Marxreiter F. A Multisensory Deficit in the Perception of Pleasantness in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:2035-2045. [PMID: 34366379 DOI: 10.3233/jpd-212812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is growing interest in non-motor symptoms in Parkinson's disease (PD), due to the impact on quality of life. Anhedonia, the inability to experience joy and lust, has a prevalence of up to 46% in PD. The perception of pleasantness of an odor is reduced in anhedonia without PD. We previously showed a reduced hedonic olfactory perception in PD, i.e., patients evaluated odors as less pleasant or unpleasant compared to controls. This deficit correlated with anhedonia. OBJECTIVE We aimed to confirm these findings. Moreover, we hypothesized that the perception of pleasantness in PD is affected on a multisensory level and correlates with anhedonia. Therefore, we assessed olfactory, visual and acoustic evaluation of pleasantness in PD and healthy individuals. METHODS Participants had to rate the pleasantness of 22 odors, pictures, and sounds on a nine-point Likert scale. Depression, anhedonia, and apathy were assessed by means of questionnaires. Results of the pleasantness-rating were compared between groups and correlated to scores of the questionnaires. RESULTS In particular pleasant and unpleasant stimuli across all three modalities are perceived less intense in PD, suggesting that a reduced range of perception of pleasantness is a multisensory phenomenon. However, only a reduction of visual hedonic perception correlated with anhedonia in PD. A correlation of reduced perception of pleasantness with apathy or depression was not present. CONCLUSION We provide evidence for a multisensory deficit in the perception of pleasantness. Further studies should delineate the underlying neural circuity and the diagnostic value to detect neuropsychiatric symptoms in PD.
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Affiliation(s)
- Kathrin S Utz
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Max Martini
- Department of Molecular Neurology, University Hospital Erlangen, FAU, Erlangen, Germany
| | - Anne Mrochen
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Vera Lambrecht
- Department of Molecular Neurology, University Hospital Erlangen, FAU, Erlangen, Germany
| | - Patrick Süß
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Department of Molecular Neurology, University Hospital Erlangen, FAU, Erlangen, Germany
| | - Bertold Renner
- Institute of Experimental and Clinical Pharmacology and Toxicology, FAU, Erlangen, Germany.,Institute of Clinical Pharmacology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jessica Freiherr
- Department of Psychiatry and Psychotherapy, FAU, Erlangen, Germany.,Sensory Analytics, Fraunhofer Institute for Process Engineering and Packaging IVV, Freising, Germany
| | - Thomas Schenk
- Clinical Neuropsychology, Department Psychology, Ludwig-Maximilians University Munich, Munich, Germany
| | - Jürgen Winkler
- Department of Molecular Neurology, University Hospital Erlangen, FAU, Erlangen, Germany
| | - Franz Marxreiter
- Department of Molecular Neurology, University Hospital Erlangen, FAU, Erlangen, Germany
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12
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Liu R, Wang Y, Chen X, Zhang Z, Xiao L, Zhou Y. Anhedonia correlates with functional connectivity of the nucleus accumbens subregions in patients with major depressive disorder. Neuroimage Clin 2021; 30:102599. [PMID: 33662708 PMCID: PMC7930634 DOI: 10.1016/j.nicl.2021.102599] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND The nucleus accumbens (NAc) is an important region in reward circuit that has been linked with anhedonia, which is a characteristic symptom of major depressive disorder (MDD). However, the relationship between the functional connectivity of the NAc subregions and anhedonia in MDD patients remains unclear. METHODS We acquired resting-state functional magnetic resonance imaging (fMRI) scans from fifty-one subjects (23 MDD patients and 28 healthy controls). We assessed subjects' trait anhedonia with the Temporal Experience of Pleasure Scale (TEPS). Seed-based resting-state functional connectivity (rsFC) was conducted for each of the NAc subregions (bilateral core-like and shell-like subdivisions) separately to identify regions whose rsFCs with the NAc subregions were altered in the MDD patients and regions whose rsFCs with the NAc subregions showed different correlates with anhedonia between the MDD patients and the healthy controls. RESULTS Compared with the health controls, the MDD patients showed decreased rsFCs of the right NAc core-like subdivision with the left mid-anterior orbital prefrontal cortex and the right inferior parietal lobe as well as decreased rsFC of the left NAc core-like subdivision with the right middle frontal gyrus. Moreover, the severity of anhedonia by the group interaction was significant for the rsFC of the right NAc shell-like subdivision with the subgenual/pregenual anterior cingulate cortex and the rsFC of the right NAc core-like subdivision with the precuneus. CONCLUSIONS We found that the neural correlates of anhedonia indicated by the rsFCs of the NAc subregions were modulated by depression. The modulation effect was regionally-dependent. These findings enrich our understanding of the neural basis of anhedonia in MDD.
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Affiliation(s)
- Rui Liu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Yun Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Xiongying Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Zhifang Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Le Xiao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Yuan Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China; CAS Key Laboratory of Behavioral Science, Institute of Psychology & Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China.
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13
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Saracino RM, Cham H, Rosenfeld B, Nelson CJ. Confirmatory Factor Analysis of the Center for Epidemiologic Studies Depression Scale in Oncology With Examination of Invariance Between Younger and Older Patients. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2020; 36:229-236. [PMID: 32684745 DOI: 10.1027/1015-5759/a000510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Accurate measurement of depressive symptoms in the cancer setting is critical for ensuring optimal quality of life and patient outcomes. The present study compared the one-factor, correlated two-factor, correlated four-factor, and second-order factor models of the Center for Epidemiologic Studies Depression Scale (CES-D), a commonly used measure in oncology settings. Given the importance of adequate psychometric performance of the CES-D across age groups, a second aim was to examine measurement invariance between younger and older adults with cancer. Participants (N = 663) were recruited from outpatient clinics at a large cancer center. Over one-fourth of the sample endorsed clinically significant depressive symptoms (25.9%, n = 165). Confirmatory factor analysis of the CES-D supported the hypothesized correlated four-factor model as the best fit. The second-order factor also demonstrated good fit, but interpretations of the factors were more complex. Factors were highly correlated (range = .38-.91). There was also support for full scalar invariance between age groups, suggesting that regardless of age, respondents endorse the same response category for the same level of the latent trait (i.e., depression) on the CES-D. Taken together, the results suggest that the CES-D is a viable depression screening option for oncology settings and does not require scoring adjustments for respondent age.
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Affiliation(s)
- Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Psychology, Fordham University, Bronx, NY, USA
| | - Heining Cham
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Barry Rosenfeld
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Psychology, Fordham University, Bronx, NY, USA
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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14
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Goudarzi M, Nahavandi A, Mehrabi S, Eslami M, Shahbazi A, Barati M. Valproic acid administration exerts protective effects against stress-related anhedonia in rats. J Chem Neuroanat 2020; 105:101768. [DOI: 10.1016/j.jchemneu.2020.101768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/12/2020] [Accepted: 02/12/2020] [Indexed: 12/22/2022]
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15
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Mansur RB, Subramaniapillai M, Zuckerman H, Park C, Iacobucci M, Lee Y, Tuineag M, Hawco C, Frey BN, Rasgon N, Brietzke E, McIntyre RS. Effort-based decision-making is affected by overweight/obesity in major depressive disorder. J Affect Disord 2019; 256:221-227. [PMID: 31181378 DOI: 10.1016/j.jad.2019.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/09/2019] [Accepted: 06/02/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Anhedonia and abnormalities in reward behavior are core features of major depressive disorder (MDD). Convergent evidence indicates that overweight/obesity (OW), a highly prevalent condition in MDD, is independently associated with reward disturbances. We therefore aimed to investigate the moderating effect of OW on the willingness to expend efforts for reward in individuals with MDD and healthy controls (HC). METHODS Forty-one adults (HC n = 20, MDD n = 21) completed the Effort Expenditure for Rewards Task (EEfRT), clinical and cognitive measures. Anthropometric parameters were assessed in all participants, and an additional evaluation of laboratorial parameters were conducted solely on those with MDD. Individuals with MDD were all on vortioxetine monotherapy (10-20 mg/day). RESULTS Interactions between reward magnitude, group and OW were observed (χ2 = 9.192, p = 0.010); the OW-MDD group chose the hard task significantly less than normal weight (NW)-HC (p = 0.033) and OW-HC (p = 0.034), whereas there were no differences between NW-MDD and HCs. Within individuals with MDD, the proportion of hard task choices was more strongly correlated with body mass index (BMI) (r = -0.456, p = 0.043) and insulin resistance (HOMA2-IR) (r = -0.467, p = 0.038), than with depressive symptoms (r = 0.290, p = 0.214). CONCLUSIONS OW significantly moderated the association between MDD and willingness to make efforts for rewards. These findings offer novel evidence on the potential role of metabolic factors on the basis of anhedonia, and for the heuristic models proposing a pathophysiological connection between mood and metabolic disorders.
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Affiliation(s)
- Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, M5T 2S8, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, M5T 2S8, Canada.
| | - Mehala Subramaniapillai
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, M5T 2S8, Canada
| | - Hannah Zuckerman
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, M5T 2S8, Canada
| | - Caroline Park
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, M5T 2S8, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, M5T 2S8, Canada
| | - Michelle Iacobucci
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, M5T 2S8, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, M5T 2S8, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, M5T 2S8, Canada
| | - Maria Tuineag
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, M5T 2S8, Canada
| | - Colin Hawco
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 2S8, Canada; Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Ontario, Canada
| | - Natalie Rasgon
- Center for Neuroscience in Women's Health, Stanford University, Palo Alto, USA
| | - Elisa Brietzke
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, M5T 2S8, Canada; Department of Psychiatry, Queen's University, Kingston, ON, K7L 7X3, Canada; Research Group in Molecular and Behavioral Neurosciences of Mood Disorders, Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, 04038-000, Brazil
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, M5T 2S8, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, M5T 2S8, Canada; Research Group in Molecular and Behavioral Neurosciences of Mood Disorders, Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, 04038-000, Brazil; Brain and Cognition Discovery Foundation, Mississauga, ON L5C 4E, Canada
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16
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Melrose S. Late life depression: nursing actions that can help. Perspect Psychiatr Care 2019; 55:453-458. [PMID: 30499598 DOI: 10.1111/ppc.12341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/09/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This article explains the symptoms of late life depression (LLD) and discusses evidence-informed actions that nurses can implement to provide older adults with the help they need. CONCLUSIONS Recognizing and addressing depression in older adults can enhance quality of life. PRACTICE IMPLICATIONS People with LLD may not appear sad or express feelings of depression. Instead, they demonstrate loss of interest, frailty, cognitive impairment, suicidal ideation, unexplained somatic complaints, and loneliness. Documenting symptoms, screening, and assessing suicidal ideation are essential. Positive outcomes are associated with antidepressant medications, cognitive behavioral therapy, electroconvulsive therapy, neuromodulation therapies, and exercise.
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Affiliation(s)
- Sherri Melrose
- Faculty of Health Disciplines, Centre for Nursing and Health Studies, Athabasca University, Athabasca, Alberta
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17
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Biella MM, Borges MK, Strauss J, Mauer S, Martinelli JE, Aprahamian I. Subthreshold Depression Needs A Prime Time In Old Age Psychiatry? A Narrative Review Of Current Evidence. Neuropsychiatr Dis Treat 2019; 15:2763-2772. [PMID: 31576131 PMCID: PMC6765057 DOI: 10.2147/ndt.s223640] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/06/2019] [Indexed: 11/23/2022] Open
Abstract
This study aims to carry out a narrative review, aiming to update the literature on subsyndromic depression (SD), which is the most prevalent depressive disorder in older adults, and no formal guidelines or consensus are dedicated to this topic. We carried out an electronic search for articles on SD. Relevant articles were retrieved from Pubmed, EMBASE and Web of Science using the search terms "subthreshold depression," "prevalence," "treatment" and "older adults" in several combinations. Original articles in English were included from inception to 1st March 2019. No clear consensus exists in the literature on its nosologic classification, diagnostic tools, causes, course, outcomes or management. SD diagnosis should base in depressive symptoms scales and DSM criteria. Treatment relies mainly on collaborative care and psychotherapy. SD is relevant in clinical practice and research in geriatric psychiatry. Given the negative outcomes and potential benefits of treatment, we recommend brief psychotherapy as first-line treatment and use of psychotropic agents in cases with greater severity and/or functional impairment in association with psychotherapy. SD can precede major depressive disorder, but it also may consist of a primary depressive disorder in older adults. Furthermore, adequate treatment of SD can prevent or reduce negative outcomes associated with depressive symptoms such as worsening of clinical comorbidities, loss of functionality, increased demand for health services, and increased mortality.
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Affiliation(s)
- Marina Maria Biella
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marcus Kiiti Borges
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jason Strauss
- Geriatric Psychiatry, Cambridge Health Alliance, Harvard Medical School, Boston, MA, USA
| | - Sivan Mauer
- Department of Psychiatry, Tufts Medical Center, Tufts University Scholl of Medicine, Boston, MA, USA
| | - José Eduardo Martinelli
- Geriatrics & Psychiatry Division, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
| | - Ivan Aprahamian
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Geriatrics & Psychiatry Division, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
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18
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Saracino RM, Cham H, Rosenfeld B, J Nelson C. Latent Profile Analyses of Depressive Symptoms in Younger and Older Oncology Patients. Assessment 2018; 27:1383-1398. [PMID: 29947548 DOI: 10.1177/1073191118784653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The aging of America will include a significant increase in the number of older patients with cancer, many of whom will experience significant depressive symptoms. Although geriatric depression is a well-studied construct, its symptom presentation in the context of cancer is less clear. Latent profile analysis was conducted on depressive symptoms in younger (40-64 years) and older (≥65 years) patients with cancer (N = 636). The sample was clinically heterogeneous (i.e., included all stages, dominated by advanced stage disease). Participants completed questionnaires including the Center for Epidemiological Studies Depression Scale, which was used for the latent profile analysis. A four-class pattern was supported for each age group. However, the four-class pattern was significantly different between the younger and older groups in terms of the item means within each corresponding latent class; differences were primarily driven by severity such that across classes, older adults endorsed milder symptoms. An unexpected measurement issue was uncovered regarding reverse-coded items, suggesting that they may generate unreliable scores on the Center for Epidemiological Studies Depression Scale for a significant subset of patients. The results indicate that cancer clinicians can expect to see depressive symptoms along a continuum of severity for patients of any age, with less severe symptoms among older patients.
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Affiliation(s)
- Rebecca M Saracino
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Fordham University, Bronx, NY, USA
| | | | - Barry Rosenfeld
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Fordham University, Bronx, NY, USA
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19
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Bodner E, Palgi Y, Wyman MF. Ageism in Mental Health Assessment and Treatment of Older Adults. INTERNATIONAL PERSPECTIVES ON AGING 2018. [DOI: 10.1007/978-3-319-73820-8_15] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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20
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Sachs-Ericsson NJ, Hajcak G, Sheffler JL, Stanley IH, Selby EA, Potter GG, Steffens DC. Putamen Volume Differences Among Older Adults: Depression Status, Melancholia, and Age. J Geriatr Psychiatry Neurol 2018; 31:39-49. [PMID: 29251178 DOI: 10.1177/0891988717747049] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Individuals with major depressive disorder (MDD) may exhibit smaller striatal volumes reflecting deficits in the reward circuit. Deficits may change with age and be more pronounced among the melancholic subtype. Limited research has investigated striatal volume differences in older adults and by depression subtypes. METHOD We used baseline data from the Neurocognitive Outcomes of Depression in the Elderly study. We examined volumetric differences in the putamen and caudate nucleus among older adults (60 years and older), comparing healthy control participants (n = 134) to depressed participants (n = 226), and comparing nonmelancholic depressed participants (n = 93) to melancholic depressed participants (n = 133). Group-by-age interactions were examined. RESULTS There were no significant group differences for the caudate nucleus. For the left putamen, investigation of the significant group-by-age interaction revealed that volume size was greater for the healthy controls compared to the depressed participants but only at younger ages (60-65 years); group differences diminished with increasing age. Examining volume by depression subtype revealed that the melancholic depressed participants had a smaller left putamen compared to the nonmelancholic depressed participants. Anhedonia symptoms were related to both smaller left and right putamen. CONCLUSION Structural abnormalities in reward regions may underlie the anhedonic phenotype. Volume loss associated with MDD may attenuate in older age.
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Affiliation(s)
| | - Greg Hajcak
- 1 Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Julia L Sheffler
- 1 Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Ian H Stanley
- 1 Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Edward A Selby
- 2 Department of Psychology, Rutgers University, Piscataway, NJ, USA
| | - Guy G Potter
- 3 Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | - David C Steffens
- 4 Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
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21
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Chang WH, Lee IH, Chen WT, Chen PS, Yang YK, Chen KC. Coexisting geriatric anxiety and depressive disorders may increase the risk of ischemic heart disease mortality-a nationwide longitudinal cohort study. Int J Geriatr Psychiatry 2017; 32:e25-e33. [PMID: 27966781 DOI: 10.1002/gps.4646] [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] [Received: 05/26/2016] [Revised: 11/09/2016] [Accepted: 11/16/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES In the elderly, the risk of mortality because of physical illnesses related to anxiety disorders varies with potential confounding influences, including comorbidity with depressive disorders. Our study aimed to explore (i) whether anxiety disorders increase the risk of mortality in the elderly, and (ii) whether the risk of mortality mediated by anxiety and depressive disorders differs between physical illnesses. METHODS Our longitudinal cohort study included subjects aged over 60 years from the National Health Insurance Research Database. One thousand and eighty-six subjects with anxiety disorders and 50 554 control subjects without anxiety disorders were included. Propensity score-matched cohorts were analyzed. Rate ratios (RRs) were calculated for the risk of mortality associated with different physical illnesses with comorbidities of either anxiety disorders only or both anxiety and depressive disorders. RESULTS The risk of mortality in patients with anxiety disorders was significantly higher than controls, and was even higher when subjects had both anxiety and depressive disorder comorbidities. Furthermore, the co-occurrence of anxiety and depressive disorders increased the risk of mortality in elderly patients with ischemic heart diseases (RR = 1.60; 95% CI: 1.14-2.24). CONCLUSIONS Coexisting anxiety and depressive disorders could increase the risk of mortality in elderly patients with ischemic heart diseases. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Wei Hung Chang
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan.,Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I Hui Lee
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Wei Tseng Chen
- Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan.,Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan.,Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan.,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kao Chin Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
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22
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Saeed Mirza S, Ikram MA, Freak-Poli R, Hofman A, Rizopoulos D, Tiemeier H. 12 Year Trajectories of Depressive Symptoms in Community-Dwelling Older Adults and the Subsequent Risk of Death Over 13 Years. J Gerontol A Biol Sci Med Sci 2017; 73:820-827. [DOI: 10.1093/gerona/glx215] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/27/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Saira Saeed Mirza
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Canada
- Department of Neurology, Sunnybrook Health Sciences Center, Toronto, Canada
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rosanne Freak-Poli
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Henning Tiemeier
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, The Netherlands
- Department of Psychiatry, Erasmus Medical Center, The Netherlands
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23
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Wang J, Jia H, Shang J, Kearney JA. Critical Association Between Mental Health Disorders and Medical Status: Depression Intervention Use Indicates a Two-Fold Risk for Subsequent Medical Events in Older American Home Health Care Patients. J Gerontol Nurs 2016; 42:42-55. [PMID: 27379455 DOI: 10.3928/00989134-20160701-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/10/2016] [Indexed: 11/20/2022]
Abstract
The current study examined longitudinal associations between mental disorders and all-cause subsequent medical events in a 5% random sample of records in the 2010 national Outcome and Assessment Information Set. Records of older adults (N = 28,475) receiving home health care (HHC) services were examined with respect to mental disorders and medical events, including acute care hospitalization, emergency department admission, and 30-day rehospitalization. Predominant mental disorders were depression and anxiety identified by formal diagnoses, symptom clusters, and/or prescription of related mental health services. Depression intervention use was the strongest risk factor for all three types of medical events. However, 61.6% of patients receiving depression interventions did not screen positive at admission using the Patient Health Questionnaire-2. Moving forward, nurses must closely monitor high-risk older adults throughout the HHC stay using sensitive depression screening tools, as well as receive targeted training in geriatric psychiatry. [Journal of Gerontological Nursing, 42(10), 42-55.].
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Garey L, Bakhshaie J, Brandt CP, Langdon KJ, Kauffman BY, Schmidt NB, Leventhal AM, Zvolensky MJ. Interplay of dysphoria and anxiety sensitivity in relation to emotion regulatory cognitions of smoking among treatment-seeking smokers. Am J Addict 2016; 25:267-74. [PMID: 27122303 DOI: 10.1111/ajad.12379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/16/2016] [Accepted: 03/27/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is evidence that anxiety sensitivity (AS) plays a role in the maintenance of smoking, yet there is little understanding of how AS interplays with other affective symptomatology variables that are also related to smoking, such as dysphoria. Therefore, the current cross-sectional study evaluated the interactive effects of AS and dysphoria on emotion regulatory cognitions, including smoking negative affect reduction expectancies, perceived barriers for cessation, and smoking-specific experiential avoidance. METHOD A total of 448 adult treatment-seeking daily smokers, who responded to study advertisements, were recruited to participate in a smoking cessation treatment trial (47.8% female; Mage = 37.2, SD = 13.5). The current study utilized self-report baseline data from trial participants. RESULTS After accounting for covariates, simple slope analyses revealed that AS was positively related to negative affect reduction expectancies (β = .03, p = .01), perceived barriers to cessation (β = .22, p = .002), and smoking avoidance and inflexibility (β = .07, p = .04), among smokers with lower (vs. higher) levels of dysphoria. CONCLUSIONS The current findings suggest that higher levels of dysphoria may mitigate the relation between AS and emotion regulatory cognitions of smoking. SCIENTIFIC SIGNIFICANCE The current findings highlight the unique and additive clinical relevance of AS and dysphoria regarding emotion regulatory smoking cognitions that may impede quit success. (Am J Addict 2016;25:267-274).
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas
| | - Jafar Bakhshaie
- Department of Psychology, University of Houston, Houston, Texas
| | | | - Kirsten J Langdon
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare Center, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | | | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Adam M Leventhal
- Departments of Preventive Medicine and Psychology, University of Southern California, Los Angeles, California
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, Texas.,Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas
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Anton SD, Woods AJ, Ashizawa T, Barb D, Buford TW, Carter CS, Clark DJ, Cohen RA, Corbett DB, Cruz-Almeida Y, Dotson V, Ebner N, Efron PA, Fillingim RB, Foster TC, Gundermann DM, Joseph AM, Karabetian C, Leeuwenburgh C, Manini TM, Marsiske M, Mankowski RT, Mutchie HL, Perri MG, Ranka S, Rashidi P, Sandesara B, Scarpace PJ, Sibille KT, Solberg LM, Someya S, Uphold C, Wohlgemuth S, Wu SS, Pahor M. Successful aging: Advancing the science of physical independence in older adults. Ageing Res Rev 2015; 24:304-27. [PMID: 26462882 DOI: 10.1016/j.arr.2015.09.005] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 09/08/2015] [Accepted: 09/30/2015] [Indexed: 02/08/2023]
Abstract
The concept of 'successful aging' has long intrigued the scientific community. Despite this long-standing interest, a consensus definition has proven to be a difficult task, due to the inherent challenge involved in defining such a complex, multi-dimensional phenomenon. The lack of a clear set of defining characteristics for the construct of successful aging has made comparison of findings across studies difficult and has limited advances in aging research. A consensus on markers of successful aging is furthest developed is the domain of physical functioning. For example, walking speed appears to be an excellent surrogate marker of overall health and predicts the maintenance of physical independence, a cornerstone of successful aging. The purpose of the present article is to provide an overview and discussion of specific health conditions, behavioral factors, and biological mechanisms that mark declining mobility and physical function and promising interventions to counter these effects. With life expectancy continuing to increase in the United States and developed countries throughout the world, there is an increasing public health focus on the maintenance of physical independence among all older adults.
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Tapia-Muñoz T, Mascayano F, Toso-Salman J. Collaborative care models to address late-life depression: lessons for low-and-middle-income countries. Front Psychiatry 2015; 6:64. [PMID: 25999866 PMCID: PMC4419549 DOI: 10.3389/fpsyt.2015.00064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/12/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Thamara Tapia-Muñoz
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Franco Mascayano
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Terroni L, Amaro E, Iosifescu DV, Mattos P, Yamamoto FI, Tinone G, Conforto AB, Sobreiro MF, Guajardo VD, De Lucia MCS, Moreira AC, Scaff M, Leite CC, Fraguas R. The association of post-stroke anhedonia with salivary cortisol levels and stroke lesion in hippocampal/parahippocampal region. Neuropsychiatr Dis Treat 2015; 11:233-42. [PMID: 25678790 PMCID: PMC4322890 DOI: 10.2147/ndt.s73722] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Anhedonia constitutes a coherent construct, with neural correlates and negative clinical impact, independent of depression. However, little is known about the neural correlates of anhedonia in stroke patients. In this study, we investigated the association of post-stroke anhedonia with salivary cortisol levels and stroke location and volume. PATIENTS AND METHODS A psychiatrist administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition to identify anhedonia in 36 inpatients, without previous depression, consecutively admitted in a neurology clinic in the first month after a first-ever ischemic stroke. Salivary cortisol levels were assessed in the morning, evening, and after a dexamethasone suppression test. We used magnetic resonance imaging and a semi-automated brain morphometry method to assess stroke location, and the MRIcro program according to the Brodmann Map to calculate the lesion volume. RESULTS Patients with anhedonia had significantly larger diurnal variation (P-value =0.017) and higher morning levels of salivary cortisol (1,671.9±604.0 ng/dL versus 1,103.9±821.9 ng/dL; P-value =0.022), and greater stroke lesions in the parahippocampal gyrus (Brodmann area 36) compared to those without anhedonia (10.14 voxels; standard deviation ±17.72 versus 0.86 voxels; standard deviation ±4.64; P-value =0.027). The volume of lesion in the parahippocampal gyrus (Brodmann area 36) was associated with diurnal variation of salivary cortisol levels (rho=0.845; P-value =0.034) only in anhedonic patients. CONCLUSION Our findings suggest that anhedonia in stroke patients is associated with the volume of stroke lesion in the parahippocampal gyrus and with dysfunction of the hypothalamic-pituitary-adrenal axis.
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Affiliation(s)
- Luisa Terroni
- Consultation-Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Edson Amaro
- Department of Radiology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Dan V Iosifescu
- Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Patricia Mattos
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Fabio I Yamamoto
- Department of Neurology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Gisela Tinone
- Department of Neurology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Adriana B Conforto
- Department of Neurology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Matildes Fm Sobreiro
- Consultation-Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Valeri D Guajardo
- Consultation-Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Mara Cristina S De Lucia
- Division of Psychology, Central Institute, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Ayrton C Moreira
- Department of Medicine, University of São Paulo, School of Medicine, Ribeirão Preto, Brazil
| | - Milberto Scaff
- Department of Neurology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Claudia C Leite
- Department of Radiology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Renerio Fraguas
- Consultation-Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
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Donovan NJ, Hsu DC, Dagley AS, Schultz AP, Amariglio RE, Mormino EC, Okereke OI, Rentz DM, Johnson KA, Sperling RA, Marshall GA. Depressive Symptoms and Biomarkers of Alzheimer's Disease in Cognitively Normal Older Adults. J Alzheimers Dis 2015; 46:63-73. [PMID: 25697700 PMCID: PMC4544638 DOI: 10.3233/jad-142940] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Even low levels of depressive symptoms are associated with an increased risk of cognitive decline in older adults without overt cognitive impairment (CN). Our objective was to examine whether very low, "subthreshold symptoms of depression" are associated with Alzheimer's disease (AD) biomarkers of neurodegeneration in CN adults and whether these associations are specific to particular depressive symptoms. We analyzed data from 248 community-dwelling CN older adults, including measurements of cortical amyloid burden, neurodegeneration markers of hippocampal volume (HV) and cerebral 18F-fluorodeoxyglucose (FDG) metabolism in a composite of AD-related regions and the 30-item Geriatric Depression Scale (GDS). Participants with GDS >10 were excluded. General linear regression models evaluated the cross-sectional relations of GDS to HV or FDG in separate backward elimination models. Predictors included GDS total score, age, gender, premorbid intelligence, a binary amyloid variable and its interaction with GDS. Principal component analyses of GDS item scores revealed three factors (the Dysphoria, Apathy-Anhedonia, and Anxiety-Concentration Factors). In secondary analyses, GDS total score was replaced with the three factor scores in repeated models. Higher GDS score (p = 0.03) was significantly associated with lower HV and was marginally related (p = 0.06) to FDG hypometabolism. In secondary models, higher Dysphoria (p = 0.02) and Apathy-Anhedonia (p = 0.05) were related to lower HV while higher Apathy-Anhedonia (p = 0.003) was the sole factor related to FDG hypometabolism. Amyloid was not a significant predictor in any model. In conclusion, very low-level dysphoria, apathy and anhedonia may point to neurodegeneration in AD-related regions but this association appears to be independent of amyloid burden.
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Affiliation(s)
- Nancy J. Donovan
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - David C. Hsu
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Alexander S. Dagley
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Aaron P. Schultz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Rebecca E. Amariglio
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Elizabeth C. Mormino
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Olivia I. Okereke
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Dorene M. Rentz
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Keith A. Johnson
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Reisa A. Sperling
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Gad A. Marshall
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Ludvigsson M, Milberg A, Marcusson J, Wressle E. Normal Aging or Depression? A Qualitative Study on the Differences Between Subsyndromal Depression and Depression in Very Old People. THE GERONTOLOGIST 2014; 55:760-9. [PMID: 24398652 DOI: 10.1093/geront/gnt162] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 11/12/2013] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY The aim of this study was to make a qualitative comparison of experiences of being in very old people with subsyndromal depression (SSD), in relation to the experiences of very old people with syndromal depression or nondepression. Through investigation and deeper understanding of the interface between depressive disease and normal aging, clinicians might give more accurate prevention or treatment to those very old persons who need such help. DESIGN AND METHODS Semistructured qualitative interviews were conducted for 27 individuals of 87-88 years of age, who were categorized in the 3 strata of nondepressive, SSD, and syndromal depression. Transcripts were analyzed using qualitative content analysis within each stratum and later with a comparison between the strata. RESULTS The content analysis resulted in 4 themes in people with SSD, as defined by a self-report depression screening instrument, giving a comprehensive picture of SSD in very old people, and also showed qualitative differences between the SSD, syndromal depression, and nondepressive groups. A main finding was that SSD differs qualitatively from syndromal depression but not clearly from nondepression. IMPLICATIONS The results might indicate that SSD in very old people is not related to pathology but to normal aging, even though the condition correlates with negative health parameters. Overlooking certain psychosocial aspects of living in the very old may pose a risk of both underdiagnosis and overdiagnosis in the spectrum of depressive disorders.
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Affiliation(s)
- Mikael Ludvigsson
- Division of Geriatric Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Department of Geriatrics, County Council of Östergötland, Sweden.
| | - Anna Milberg
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, LAH/Unit of Palliative Care, County Council of Östergötland, and Palliative Education and Research Centre in the County of Östergötland, Sweden
| | - Jan Marcusson
- Division of Geriatric Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Department of Geriatrics, County Council of Östergötland, Sweden
| | - Ewa Wressle
- Division of Geriatric Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Department of Geriatrics, County Council of Östergötland, Sweden
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