The Hamilton Rating Scale for depression: a factor analysis

Attenuated post-movement beta rebound reflects psychomotor alterations in major depressive disorder during a simple visuomotor task: a MEG study

BACKGROUND

Psychomotor alterations are a common symptom in patients with major depressive disorder (MDD). The primary motor cortex (M1) plays a vital role in the mechanism of psychomotor alterations. Post-movement beta rebound (PMBR) in the sensorimotor cortex is abnormal in patients with motor abnormalities. However, the changes in M1 beta rebound in patients with MDD remain unclear. This study aimed to primarily explore the relationship between psychomotor alterations and PMBR in MDD.

METHODS

One hundred thirty-two subjects were enrolled in the study, comprising 65 healthy controls (HCs) and 67 MDD patients. All participants performed a simple right-hand visuomotor task during MEG scanning. PMBR was measured in the left M1 at the source reconstruction level with the time-frequency analysis method. Retardation factor scores and neurocognitive test performance, including the Digit Symbol Substitution Test (DSST), the Making Test Part A (TMT-A), and the Verbal Fluency Test (VFT), were used to measure psychomotor functions. Pearson correlation analyses were used to assess relationships between PMBR and psychomotor alterations in MDD.

RESULTS

The MDD group showed worse neurocognitive performance than the HC group in all three neurocognitive tests. The PMBR was diminished in patients with MDD compared to HCs. In a group of MDD patients, the reduced PMBR was negatively correlated with retardation factor scores. Further, there was a positive correlation between the PMBR and DSST scores. PMBR is negatively associated with the TMT-A scores.

CONCLUSION

Our findings suggested that the attenuated PMBR in M1 could illustrate the psychomotor disturbance in MDD, possibly contributing to clinical psychomotor symptoms and deficits of cognitive functions.

Ensemble Approach for Detection of Depression Using EEG Features

Depression is a public health issue that severely affects one’s well being and can cause negative social and economic effects to society. To raise awareness of these problems, this research aims at determining whether the long-lasting effects of depression can be determined from electroencephalographic (EEG) signals. The article contains an accuracy comparison for SVM, LDA, NB, kNN, and D3 binary classifiers, which were trained using linear (relative band power, alpha power variability, spectral asymmetry index) and nonlinear (Higuchi fractal dimension, Lempel–Ziv complexity, detrended fluctuation analysis) EEG features. The age- and gender-matched dataset consisted of 10 healthy subjects and 10 subjects diagnosed with depression at some point in their lifetime. Most of the proposed feature selection and classifier combinations achieved accuracy in the range of 80% to 95%, and all the models were evaluated using a 10-fold cross-validation. The results showed that the motioned EEG features used in classifying ongoing depression also work for classifying the long-lasting effects of depression.

Validation of the Hamilton Depression Rating Scale (HDRS) and sociodemographic factors associated with Lebanese depressed patients

OBJECTIVES

The Hamilton Depression Rating Scale (HDRS) is the most commonly used scale for the evaluation of patients' treatments for depression. Since the HDRS has never been validated in Lebanon to our knowledge, our primary objective, therefore, is to investigate the correlation, sensitivity, specificity, as well as the reliability and the validity of the Hamilton Depression Rating Scale (HDRS) among Lebanese depressed patients. The secondary objective is to identify sociodemographic factors that would be correlated to depression among our sample.

METHODS

This case-control study, performed between January till May 2017, included 400 patients (200 patients, 200 controls).

RESULTS

The HDRS scale items converged over a solution of four factors, explaining a total of 58.88% of the variance. A high Cronbach's alpha was found for the full scale (0.862). A stepwise linear regression, using the total HDRS score as continuous variable, showed that a low socioeconomic level, divorced participants and a family history of mental disorders would significantly increase the HDRS total score (Beta=4.278; Beta=5.405; and Beta=3.922) respectively. However, having a university level of education would significantly decrease the HDRS total score (Beta=-4.248, P<0.001).

CONCLUSION

This study shows that the Arabic version of the HDRS has promising psychometric properties, making it a good tool to use for the diagnosis of patients with depression. Depression recognition and treatment in general practice with the aim of improving patient outcome and reducing health care expenditure, is definitely warranted.

Psychiatric disturbances in radiologically isolated syndrome

BACKGROUND

Radiologically isolated syndrome (RIS) is characterized by incidental lesions suggestive of multiple sclerosis (MS) on MRI without typical symptoms of MS. Clinically isolated syndrome (CIS) is characterized by a first episode of neurologic symptoms caused by demyelination in the central nervous system. To date, psychiatric disorders have not been systematically addressed in RIS subjects. We assessed emotional disturbances, personality features and health-related quality of life (HRQoL) in a cohort of RIS patients as compared with clinically isolated syndrome (CIS).

METHODS

Twenty-eight RIS patients, 25 clinically isolated syndrome (CIS) patients, and 22 healthy subjects were enrolled in the study. Participants were administered a mood scale (Hamilton Depression Rating Scale), behavioural measures (Personality Assessment Inventory), and fatigue measures (Fatigue Impact Scale for Daily Use). HRQoL was quantified using the EuroQol-5.

RESULTS

14 (50%) of RIS patients had clinically significant depression, with over one-third of these having moderate depression, scores virtually identical to those observed in CIS patients. 11 of 28 (39.3%) subjects with RIS had anxious depression, a figure three times higher than that found in CIS patients. RIS patients' HAMD-17 total score showed a very strong correlation with severity of fatigue. In addition, RIS patients reported lower HRQoL (p = 0.036) and a significantly higher symptoms load for somatisation compared to both CIS and control groups (p < 0.002).

CONCLUSION

RIS patients had high rates of depression, particularly anxious depression and somatization. Future studies are warranted to clarify whether these psychiatric disturbances are causally associated with a distinct white matter psychopathologic process.

Chronic physical health problems moderate changes in depression and substance use among dual diagnosed individuals during and after treatment

BACKGROUND

Physical illnesses frequently co-occur with depression and substance use disorders and may impact their improvement. Physical illness symptoms may overlap with or exacerbate somatic symptoms of depression. Individuals may use substances to cope with symptoms of physical illness.

OBJECTIVES

We examined whether chronic physical health problems moderated changes in depression and substance use among dual diagnosed individuals during and in the year following treatment.

METHODS

Participants were recruited from a Veterans Affairs dual diagnosis outpatient program between March 2000 and November 2007 and were randomized to either Integrated Cognitive-Behavioral Therapy or Twelve-Step Facilitation Therapy. A total of 214 veterans with assessment data for the variables of interest were included in analyses. Participants completed quarterly depression, substance use, and health assessments over an 18 month period. We used linear-mixed effects models to analyze patterns of change for depression and substance use.

RESULTS

Individuals with severe chronic health problems and higher intake depression showed slower improvements in both nonsomatic and somatic depression symptoms. Individuals with severe chronic health problems and higher midtreatment substance use showed less improvement in substance use.

CONCLUSIONS

Assessing and addressing physical health issues during depression and substance use disorder treatment may improve outcomes.

Sexual dysfunction in women with diabetes mellitus

Diabetes mellitus (DM) is an increasing health concern throughout the world. DM is categorized as either type 1 (DM-1) or type 2 (DM-2), where DM-1 represents a lack of insulin production, and DM-2 is characterized by a relative lack of insulin (i.e., decreased sensitivity to the effect of insulin). DM has long been considered a risk factor for sexual dysfunction in men and women, although the evidence in women is less clear. This review attempts to give an overview of female sexual dysfunction in women with DM. Although women with DM are at higher risk of developing sexual dysfunction than women without DM, there is great variability in results across studies, with the incidence of sexual dysfunction in women with DM generally linked less to organic factors and more to psychological factors, especially coexisting depression. This review hypothesizes several presumed causes for such variation in findings across studies and uses these explanations as the basis for a discussion of differences between men's and women's sexuality.

The factor structure of lifetime depressive spectrum in patients with unipolar depression

BACKGROUND

While previous attempts to elucidate the factor structure of depression tended to agree on a central focus on depressed mood, other factors were not replicated across studies. By examining data from a large number of items covering the range of depressive symptoms, the aim of the present study is to contribute to the identification of the structure of depression on a lifetime perspective.

METHODS

The study sample consisted of 598 patients with unipolar depression who were administered the Mood Spectrum Self-Report (lifetime version) in Italian (N=415) or English (N=183). In addition to classical exploratory factor analysis using tetrachoric correlation coefficients, an IRT-based factor analysis approach was adopted to analyze the data on 74 items of the instrument that explore cognitive, mood and energy/activity features associated with depression.

RESULTS

Six factors were identified, including 'Depressive Mood', 'Psychomotor Retardation', 'Suicidality', 'Drug/Illness related depression', 'Psychotic Features' and 'Neurovegetative Symptoms', accounting overall for 48.3% of the variance of items.

LIMITATIONS

Clinical information on onset of depression and duration of illness is available only for 350 subjects. Therefore, differences between sites can only be partially accounted using available data.

CONCLUSIONS

Our study confirms the central role of depressed mood, psychomotor retardation and suicidality and identifies the factors 'Drug/Illness related depression', 'Psychotic features' and the neurovegetative dysregulation not captured by the instruments most frequently used in previous studies. The identification of patients with specific profiles on multiple factors may be useful in achieving greater precision in neuroimaging studies and in informing treatment selection.

Headache after moderate and severe traumatic brain injury: a longitudinal analysis

OBJECTIVES

To measure longitudinally headache (HA) after moderate and severe traumatic brain injury (TBI) and to examine potential association with demographic, injury, and psychologic factors.

DESIGN

Cohort study.

SETTING

Four Veterans Administration rehabilitation facilities (Minneapolis, Palo Alto, Richmond, Tampa) within the Defense and Veterans Brain Injury Center.

PARTICIPANTS

Consecutive patients (military or veteran beneficiaries) with moderate or severe TBI (N=109) who during acute rehabilitation consented to data collection and who completed 6- and 12-month follow-up evaluations.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

HA frequency, location, type, and incapacitation levels measured during prospective neurologic assessments.

RESULTS

Nearly 38% (41/109) of patients had acute posttraumatic headache (PTHA) symptoms; most often in a frontal location (20/41), most often of daily frequency (31/41), and showing no relation to injury severity, emotional, or demographic variables. Postacutely, PTHA symptom severity declined within the group. Better individual improvement was associated with less anxiety and depression at 6-month follow-up. Almost all subjects (21/22) with PTHA symptoms that persisted into the 6-month follow-up period reported symptoms again at 12-month follow-up.

CONCLUSIONS

PTHA severity in this sample of persons with moderate and severe TBI showed a pattern of improvement that leveled off by 6 months posthospitalization.

Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton, and Zung

Four separate metaanalyses of factor analyses were conducted for the Beck Depression Inventory (BDI), the Center for Epidemiological Studies Depression Scale (CES-D), the Hamilton Rating Scale for Depression (HRSD), and the Zung Self-Rating Depression Scale (SDS). The total number of participants (N) and studies (k) included in each of the metaanalyses were the following: BDI (N = 13,643, k = 33), CES-D (N = 22,340, k = 28), HRSD (N = 2,606, k = 17), and SDS (N = 12,621, k = 13). Metaanalysis results suggest that the specific depression symptom factors within each test appear to be relatively robust and well established and match fairly closely previously hypothesized factor structures. A general Depression Severity factor and a small Somatic Symptoms factor are found in all four tests and two tests had a small Positive Affect factor. There were fewer common specific depression symptom factors across tests than expected.

The DOSE study: a clinical trial to examine efficacy and dose response of exercise as treatment for depression

The Depression Outcomes Study of Exercise (DOSE) was a randomized clinical trial to determine whether exercise is an efficacious treatment for mild to moderate major depressive disorder (MDD) in adults ages 20 to 45 years. The specific hypotheses under investigation were (1) active exercise is an efficacious monotherapy for mild to moderate levels of MDD, and (2) there is a dose-response relation between the exercise amount and reduction in depressive symptoms. The primary outcome measure was the Hamilton Rating Scale for Depression (HRSD) collected weekly over 12 weeks. Secondary outcome measures were the Inventory of Depressive Symptoms (clinician and self-report), HRSD scores at 24 weeks, cardiorespiratory fitness, self-efficacy, and quality of life. Eighty men and women who were diagnosed with a Structured Clinical Interview for Depression and who had mild (HRSD 12-16) to moderate (HRSD 17-25) MDD were randomized to one of five doses of exercise: 7.0 kcal/kg/week in 3 days/week; 7.0 kcal/kg/week in 5 days/week; 17.5 kcal/kg/week in 3 days/week; 17.5 kcal/kg/week in 5 days/week; or 3 days/week of stretching and flexibility exercises for 15 to 20 min/session. Participants exercised under supervision in our laboratory over the course of 12 weeks. Symptoms of depression were measured weekly by trained clinical raters blinded to the participant's treatment assignment. The design of the study restricted participant characteristics to mild to moderate MDD and controlled exercise features to permit the evaluation of exercise as a sole treatment for depression. This study is the first to examine dose-response effects of exercise in participants diagnosed with MDD.

A comparison of characteristics of depressed patients and efficacy of sertraline and amitriptyline between Japan and the West

BACKGROUND

This study was conducted to investigate the differences and similarities of the profile of depressed patients and the efficacy of the antidepressants, sertraline and amitriptyline, between Japan and the West (United States, Europe), using the Hamilton Depression Rating Scale (HAM-D) score of the individual patients.

METHODS

Using common selection criteria, 680 patients from three regional clinical studies were chosen for this investigation. Factor analysis of the HAM-D scores for each regional group was carried out to compare the profile of depressed patients. Analysis of covariance was used to compare the efficacy of sertraline and amitriptyline between the regions.

RESULTS

Factor analyses clearly showed three main factors (major depressive symptoms, anxiety and sleep disturbance) to be common across all three geographic regions. Higher HAM-D component scores of "Work and interests" and "Retardation" and lower ones of "Depressed mood" and "Feeling of guilt" were observed for the Japanese patients compared to the Western patients. Improvement of anxiety symptoms was marked for the Japanese amitriptyline treated patients.

LIMITATIONS

Although the patient data used in these analyses were restricted by using identical selection criteria, there still remains some methodological shortcomings due to the original study design differences.

CONCLUSIONS

Overall, the three main factors of depression and their magnitudes were similar between Japan and the West. The presentation of major depressive symptoms in Japanese patients differed from Western patients; this could be related to social, cultural and religious differences. Marked sedative effect for Japanese patients appeared to be due to the factor of anxiety being the strongest of the three main factors in Japanese depressed patients.

Psychopathological dimensions of depression: a factor study of the 17-item Hamilton depression rating scale in unipolar depressed outpatients

BACKGROUND

Agreement on the factor structure of the Hamilton Depression Rating Scale (HDRS) has not been consistent among studies, and some investigators argued that the scale's factor structure is not reliable. This study aimed at shedding more light on this debated issue.

METHODS

We studied 186 adults with unipolar depression (Major Depressive Disorder, n=80; Dysthymic Disorder, n=71; Depressive Disorder Not Otherwise Specified, n=25; Adjustment Disorder, n=10). They had no comorbid DSM-IV axis I or axis II disorders, and had received no treatment with antidepressant drugs in the previous 2 months. The factor structure of the scale was studied using the principal factor method, followed by oblique rotation. Factor scores were computed for each subject using the regression method.

RESULTS

Using the scree-test criterion for factor extraction, we obtained a four-factor solution, explaining 43.8% of total variance. The four factors extracted were identified as (1) somatic anxiety/somatization factor; (2) a psychic anxiety dimension; (3) a pure depressive dimension; and (4) anorexia factor. Patients with Major Depressive Disorder scored significantly higher than patients with other diagnoses on the pure depressive dimension.

LIMITATIONS

These results need to be replicated in different cultures, using analogous factoring techniques.

CONCLUSIONS

Though not exhibiting factorial invariance in the stricter sense of the term, the 17-item HDRS did exhibit a relatively reliable factor structure. Our analysis provides further evidence that the scale is multidimensional. However, as long as the multidimensional character of the scale is taken into account the scale should be able to play a useful role in clinical research.

Potential treatment for subthreshold and mild depression: a comparison of St. John's wort extracts and fluoxetine

Subthreshold depressive disturbances and depressive episodes of mild severity are frequently associated with disability and socioeconomic burden, and often show an increase in symptomatology over time if untreated. Thus, there is an urgent need for antidepressant active compounds that are more readily available than those that must be obtained by prescription. To get an impression of the efficacy of the widely used phytopharmaceutical St. John's wort, the antidepressant efficacy in mild depressive disorders was compared with that of the standard antidepressant fluoxetine. The present overview includes controlled trials of fluoxetine in depression with a mean initial score on the Hamilton Rating Scale for Depression (HAM-D) < or =24, which were compared to the respective studies on St. John's wort. The mean HAM-D reduction of all St. John's wort studies was 10.2 (52.9%), and the respective figures for fluoxetine were 12.5 points and 55.5%. Thus, no relevant efficacy difference between the groups of investigations was found based on the studies included. The most important restrictions of this overview are no meta-analysis was performed, the studies were performed with heterogeneous methodological standards, and the St. John's wort extracts used were very different. However, St. John's wort might be a treatment option to reduce symptoms in patients not suffering from full-blown depressive disorder.

Comparative efficacy of sertraline vs. fluoxetine in patients age 70 or over with major depression

Using data from a larger 12-week clinical trial, the authors evaluated the comparative efficacy and safety of sertraline (n=42) and fluoxetine (n=33) in patients over age 70 with a diagnosis of major depressive disorder. Similar improvement on measures of depression, including remission of depressive symptoms, was evident, although significantly more sertraline-treated patients achieved a criterion clinical response. Significantly greater improvement for the sertraline group was apparent on the Digit Symbol Substitution Test, but not on two other measures of cognitive functioning. Although there was no difference in the rate of adverse events experienced, fluoxetine-treated patients lost significantly more body weight over the 12-week trial than did sertraline-treated patients, whereas the latter group exhibited significantly more "shaking. "

Workplace performance effects from chronic depression and its treatment

Utilizing data from a clinical trial and an econometric model incorporating the impact of a medical intervention and regression to the mean, we present evidence supporting the hypotheses that for chronically depressed individuals: (i) the level of perceived at-work performance is negatively related to the severity of depressive status; and (ii) a reduction in depressive severity improves the patient's perceived work performance. Improvement in work performance is rapid, with about two-thirds of the change occurring already by week 4. Those patients having the greatest work improvement are those with both relatively low baseline work performance and the least severity of baseline depression.

The Major Depression Rating Scale (MDS). Inter-rater reliability and validity across different settings in randomized moclobemide trials. Danish University Antidepressant Group

The Major Depression Rating Scale (MDS) has been derived from the Hamilton Depression Scale and the Melancholia Scale. The MDS contains the nine DSM-IV items for major depression which all have anchoring scores from 0 to 4; hence, the theoretical score range is up to 36. The Major Depression Rating Scale has in this study been psychometrically analysed in randomized moclobemide trials. The results showed that the MDS had higher internal validity than the Hamilton Depression Scale. Thus, the homogeneity of the items was higher; factor analysis identified only one general depression factor (after 4 weeks of treatment explaining more than 50% of the variance). The inter-rater reliability of the two scales was of the same high level. The ability to measure changes (external validity) was tested in randomized clinical trials with moclobemide versus tricyclics (clomipramine and notriptyline) performed in Denmark in the psychiatric setting as well as in the general practice. The results showed that in the psychiatric setting tricyclics were superior to moclobemide with effect sizes ranging between 0.43 and 0.53. The highest effect size was obtained with the Melancholia Scale and the Major Depression Rating Scale, while the Hamilton Depression Scale was below 0.50. In the general practice setting no difference was found between moclobemide and clomipramine. In conclusion, the Major Depression Rating Scale has been found to have a more homogeneous factor structure than the Hamilton Depression Scale, but still with the same level of reliability and external validity. However, studies are needed to standardize the scale, especially in the general practice setting.

Statistics and the nature of depression

A critical examination is made of the role that statistical methods have played in the understanding of depression. The development of instruments for measuring depression is illustrated by reference to the Beck Depression Inventory and the Hamilton Rating Scale. The controversy over the existence of one or two types of depression is examined from the perspective of the statistical tools used. Some of the problems in studies of the heritability of depression are outlined. The development of clinical trials of depression is examined, with particular reference to ECT and maintenance therapy, and the role of meta-analysis is discussed.

The efficacy and tolerability of combined antidepressant treatment in different depressive subgroups

Eighty patients admitted to hospital with major depression were randomly allocated to six weeks of treatment with tranylcypromine, amitriptyline, or tranylcypromine and amitriptyline in combination, in a double-blind study. Scores on the HRSD improved significantly in all three groups, but there were no differences between the three groups. Patients on tranylcypromine and amitriptyline combined improved more according to their self-ratings after six weeks, and response was earlier as measured by a clinical global improvement scale. Those with endogenous depression improved more than those with neurotic depression, irrespective of treatment group. Combined treatment was less well tolerated than single treatments and gave rise to more side-effects, although there was no serious toxicity. Orthostatic hypotension was observed more frequently in patients on combined treatment. This group also experienced a significant increase in weight and prolongation of the P-R interval on ECG.

Sex differences in mental illness: a community study of the influence of physical health and sociodemographic factors

This paper examines sex differences in psychiatric morbidity, using data from a community sample. The PSE-CATEGO-ID system was used to evaluate psychopathology. Six sociodemographic factors and physical illness were taken as independent variables. Females exhibit both a significantly higher psychiatric morbidity than males and a predominance of syndromes closely related to depression (SD; OD syndromes) and anxiety (GA; SA; TE; IT syndromes). Logistic modelling analysis, carried out separately for each sex, yielded different models. Psychiatric illness in men was best predicted by physical illness, unemployment and the interaction between the two. In contrast, physical illness emerged, in women, as the only factor exerting significant effects on psychiatric morbidity.

A structured interview version of the Hamilton Depression Rating Scale: evidence of reliability and versatility of administration

A structured interview version of the Hamilton Depression Rating Scale (SI-HDRS) is described. Data are presented in support of its inter-rater and internal consistency reliability. SI-HDRS scores were reproducible by trained interviewers who lacked psychiatric backgrounds. Test-retest scores of a subset of patients who were interviewed twice (once in person and once by telephone) were highly correlated. Scores on the SI-HDRS did not differ between face-to-face and telephone administration groups, controlling for demographic factors, depression-specific indicators, and social and physical functioning. Since the SI-HDRS does not require a face-to-face interview by an experienced clinician, this instrument can be used economically in large-scale, community-based research projects.

Factorial structure and factor reliability of the Hamilton Rating Scale for Depression

Identical principal components factor analyses of total Hamilton Rating Scale for Depression scores were conducted for two separate sub-samples (N = 183 and N = 182) drawn from the same clinic population of moderately depressed outpatients. A comparison of the two factor analyses revealed substantial agreement for four factors across the two sub-samples (i.e., four factors from the first sub-sample correlated at least 0.80 with a homologous dimension in the second sub-sample). The four factors were labelled Somatic Complaints, Anorexia, Sleep Disturbance, and Agitation/Retardation. Some additional factors emerged in the analysis of one sub-sample but failed to appear in the other. Overall, these results suggest that the HRS exhibited a relatively stable factorial structure based on a large sample of outpatients with unipolar depressive disorders. Methodological problems with earlier research are discussed in light of the current findings.

A new validation of the Hamilton Rating Scale for Depression

This paper investigates the reliability and validity of a Spanish version of the Hamilton Rating Scale for Depression (17-item version) which has good concurrent (r = 0.82) and content (average frequency = 62%) validity. Inter-rater reliability (r = 0.99), split-half reliability (r = 0.89) and alpha reliability (r = 0.72) are acceptable. A Factor Analysis identified five factors accounting for 56% of total variance.

The inventory to diagnose depression, lifetime version

The lifetime version of the Inventory to Diagnose Depression (IDDL) is a 22-item self-report scale designed to diagnose a lifetime history of DSM-III major depressive disorder (MDD). One hundred and sixty-four first-degree relatives of healthy control probands completed the IDDL and were interviewed with the Diagnostic Interview Schedule (DIS). The IDDL had good internal consistency (Cronbach's alpha = 0.92), split-half reliability (Spearman-Brown coefficient = 0.90), and all of the item total correlations were significant. The lifetime prevalence of MDD was nonsignificantly higher in the IDDL than the DIS (14.8% vs. 11.7%). Using the DIS as the criterion measure, the sensitivity of the IDDL was 74% and its specificity was 93% and the chance corrected agreement between the two measures was kappa = 0.60.

The structure of depressive symptoms in the elderly

In a structured sample of 100 male and 100 female minimally impaired patients, aged 60 years and over, females were more depressed. Varimax factor analysis demonstrated four factor groupings which have clinical relevance - Depression, Anxiety, Cognitive impairment, and Psychosomatic disorder; their relative importance is different in males and females. Analysis of variance of the scores of clusters generated by cluster analysis demonstrated four groups of subjects - normal, mildly depressed, moderately depressed with borderline dementia and disability, and severely depressed with moderate dementia and frank disability. In the mildly and moderately depressed, symptoms of anxiety predominated.

[Dimensions of the Hamilton Depression Scale. Factor analysis studies]

The results of factor analysis of HAMD are not unitary. Studying the stability in course and the independence of selection criteria for the population we rated two groups (n = 107, n = 98) of inpatients with HAMD; these groups differ in nosological selection criteria. We furthermore rated one group at different timepoints (before treatment and 3 weeks after). The one-factor-solution is the only stable one and the only one which is independent from selection criteria. In all groups the one-factor-solutions show a high similarity with other published solutions of the German version of HAMD. But there is no way to extract a general factor. Thus the ability of HAMD in judging the severity of depression is doubtful. Ways are discussed to circumvent this problem.

Sex differences in minor psychiatric morbidity: a survey of a homogeneous population

Epidemiological methods of psychiatric assessment were used to examine whether there is a sex difference in the constitutional vulnerability of the male and female phenotype to minor psychiatric morbidity. In order to minimise the effect of environment and of sex roles and stereotypes as far as possible, a sample of relatively homogeneous employed men and women are studied. No sex difference in prevalence of minor psychiatric morbidity or its outcome was found in this population of men and women of similar age, education, occupation and social environment. However, women did report significantly more somatic symptoms of psychogenic origin.

Sex differences in minor psychiatric morbidity

This monograph is concerned with some epidemiological observations of minor psychiatric morbidity. Differences in rates of specific disorders have historically formed a crucial part of epidemiological enquiry. Sex differences in the prevalence of minor affective disorders have been demonstrated in studies of populations in treatment and in community populations, and have been variously ascribed to constitutional or environmental factors. A review of the literature exposes the methodological problems of measurement and study design, and the conflicting nature of the findings. Efforts have recently concentrated on establishing the social factors important in the aetiology of minor affective disorder without adequate exclusion of constitutional factors. The importance of life events, chronic social stress and inadequate social supports in the aetiology of minor affective disorder has been demonstrated, but the variance explained by such factors is small, reinforcing the view that constitutional factors of some kind are likely to be of importance. The evidence for a genetic contribution to minor affective disorder is tenuous, but there is circumstantial evidence that changes in gonadal hormones are linked to mood changes in women. Until further evidence is available this must remain a powerful possibility in the genesis of sex differences in minor affective disorder. This investigation used epidemiological methods to assess whether there is a sex difference in the constitutional vulnerability of the male and female phenotype to minor psychiatric morbidity. In order to minimize the effects of environment and of sex roles and stereotypes as far as possible, a sample of relatively homogeneous employed men and women (drawn from a population of executive officers in the Home Office) was studied. The data obtained from this population of men and women of similar age, education, occupation and social environment were compatible with the null hypothesis that there is no sex difference in the prevalence of minor psychiatric morbidity, or its outcome in such a homogeneous group. However, women did report significantly more somatic symptoms than men. The second hypothesis, that there is a substantial sex difference in the self-perception of illness, illness behaviour and sickness absence in individuals with minor psychiatric morbidity among a homogeneous group of men and women of similar age, education and occupation, and subject to similar levels of social stress and support, received only partial support from the findings of the study.(ABSTRACT TRUNCATED AT 400 WORDS)

Item characteristics of the Hamilton Rating Scale for Depression

The Hamilton Rating Scale for Depression has become a popular instrument for quantifying clinical assessments of the severity of depression in psychiatric research, and data on its psychometric properties continue to accumulate. Data are presented on item interrater reliability, internal consistency, concurrent validity, and ability to differentiate depressed from non-depressed groups. Recommendation for a reduced scale and for anchoring point guidelines are made.

Studies in the relationship between depressive disorders and anxiety states. Part 1. Rating scales

Systematic clinical examination, 7 rating scales for severity and the Newcastle Anxiety Depression Scale were applied in 117 patients with depressive, anxiety or phobic neurosis. "Endogenous" (autonomous) depressions were excluded. Principal component and discriminant function analysis were used to determine whether the depressive and anxiety syndromes could be differentiated from each other. With the aid of discriminant function analysis, separation of the 2 groups was achieved in the full sample and in 2 randomly derived sub-samples. The most powerful discriminators in all analyses were the Hamilton Depression Scale and the Newcastle Anxiety Depression Scale. Discriminant function analysis of the items from the Hamilton Depression Scale showed that it was possible to allocate 90% of the patients to the groups to which they had originally been classified by clinical diagnosis.

The Hamilton depression scale. Evaluation of objectivity using logistic models

The consistency of the Hamilton Depression Scale (HDS) as a measure of the severity of depressive states has been examined when the scale was used weekly during a trial when imipramine. By use of logistic models (Rasch) the consistency of the HDS has been considered across patient-variables as age, sex, plasma levels of imipramine, and diagnosis. The results showed that the original 17-item HDS was without adequate consistency, i.e. the total score of the sample of items was no one-dimensional measure of depressive states. However, a melancholia subscale of the HDS contained items the total of which can be used to compare patients quantitatively, although in some part of the analysis one of these items showed ceiling effect. It was concluded that the melancholia subscale (containing the items depressed mood, guilt, work and interests, retardation, psychic anxiety, and general somatic symptoms) can form the basis for further improvements in the field of quantitative rating scales for depressive states.

Hypochondriacal states

A brief historical introduction traces the evolution of the concept of hypochondriasis. It is suggested that the term should now be used only as a descriptive adjective when there is a morbid preoccupation with health or body. Social and cultural factors are outlined, as well as problems of measurement. The psychopathology, as formulated by Freud and others, is also described. Clinical aspects are discussed under the headings of general symptoms, pain, smell, bodily appearance, sexual, gastro-intestinal, cardio-respiratory, eyes, and ears, nose and throat. Psychiatric syndromes mentioned are: hypochondria as a possible primary state, personality disorders, phobic-anxiety state, neurashthenia, obsessional neurosis, hysteria, depression, paranoid psychosis and organic. In general, hypochondriacal symptoms seem to make the prognosis rather worse. Treatment is to be aimed at the primary condition, which is most commonly depression, anxiety state or conversion reaction.

An evaluation of evidence on depressive classification and some alternative suggestions from physiology

The wealth of material on depressive classification provides both researcher and clinician with a sorting task of monumental proportions. Moreover the criticisms which have been fired at studies of depressive classification using symptoms as a data base, also require systematic sorting and elucidation. An attempt has been made to review the major studies of depressive classification in a systematic way, together with the principal criticisms which have been made of them. The survey is not exhaustive but aims at providing a relatively ordered overview of the area. The most critical issue, that of subjectivity of data collection is taken up, and it is suggested that biological measures may form a more objective data base for studies of depressive classification than ratings of symptoms and behaviour.

Apomorphine and psychopathology

Forty men, mainly alcoholics, were administered either the dopamine receptor agonist, apomorphine HCl (1 mg), or distilled water subcutaneously three times a day for 14 days in a double blind study. None of the subjects developed an endogenous depression or schizophrenic symptoms. Scores on the Hamilton Rating Scale, Zung Self Rating Scale, and Brief Psychiatric Rating Scale showed improvement with both apomorphine and placebo. There were no significant differences between the two treatments on these rating scales. A significant incidence of spontaneous penile erections occurred after apomorphine treatment compared with placebo. Both treatments eliminated subjective craving for alcohol. Acute administration of apomorphine had no effect on psychomotor retardation or depressed mood in two patients with endogenous depression.

A comparative study of four depression rating scales

Comparisons were made between the overall scores on the Beck, Hamilton, Zung and a visual analogue rating scale in a group of depressed patients. The comparisons were made initially and at one, two and three weeks. Significant correlations between the global scores were found on these depression scales. The value of these scales in clinical research studies in depression is discussed wirh special mention of the value of the visual analogue scale.