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Bergdolt J, Hubert S, Schreiter J, Jenderny S, Beblo T, Driessen M, Steinhart I, Dehn LB. Predictors of return to work in people with major depression: Results from a supported employment program in Germany. J Affect Disord 2024; 364:1-8. [PMID: 39029690 DOI: 10.1016/j.jad.2024.07.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/26/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Depression is a common mental disorder and is associated with work disability. For the implementation of evidence-based interventions, such as Individual Placement and Support (IPS) for people with depression in Germany, the aim of this study was to investigate client variables that predict return to work. METHODS The sample consisted of 129 participants, initially treated in a psychiatric hospital due to major depression, who participated in IPS as part of a German clinical trial. Baseline demographic (age, sex, education, sickness absence days, employment status), psychiatric (symptom severity, comorbidity, general physical and mental health, disability), and neuropsychological (self-rated deficits, test performance) variables were included. Return to work within one year was predicted using separate and overall binary logistic regression analyses. RESULTS A total of 70 participants (56 %) returned to work within the one-year follow-up period. >100 days of sick leave in the year prior to study entry (vs. <100 days) and higher self-rated cognitive deficits were significantly associated with reduced odds of return to work within one year of IPS. LIMITATIONS The sample consisted of participants with a relatively good work history who were assigned to IPS by the treatment team, thus, the generalizability of the results is limited. CONCLUSIONS People with depression who participate in IPS interventions might benefit from specifically targeting perceived cognitive deficits. Factors associated with prolonged sick leave due to depression and their role in return to work with IPS need further investigation.
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Affiliation(s)
- Juliane Bergdolt
- Universitätsklinik für Psychiatrie und Psychotherapie, Evangelisches Klinikum Bethel gGmbH, Universitätsklinikum OWL, Universität Bielefeld, Remterweg 69-71, 33617 Bielefeld, Germany; Department of Psychology, University of Bielefeld, Universitätsstraße 25, 33615 Bielefeld, Germany.
| | - Stella Hubert
- Universitätsklinik für Psychiatrie und Psychotherapie, Evangelisches Klinikum Bethel gGmbH, Universitätsklinikum OWL, Universität Bielefeld, Remterweg 69-71, 33617 Bielefeld, Germany
| | - Julia Schreiter
- Institut für Sozialpsychiatrie Mecklenburg-Vorpommern e.V., Universität Greifswald, Greifswald, Germany
| | - Sarah Jenderny
- Institut für Sozialpsychiatrie Mecklenburg-Vorpommern e.V., Universität Greifswald, Greifswald, Germany
| | - Thomas Beblo
- Universitätsklinik für Psychiatrie und Psychotherapie, Evangelisches Klinikum Bethel gGmbH, Universitätsklinikum OWL, Universität Bielefeld, Remterweg 69-71, 33617 Bielefeld, Germany; Department of Psychology, University of Bielefeld, Universitätsstraße 25, 33615 Bielefeld, Germany
| | - Martin Driessen
- Universitätsklinik für Psychiatrie und Psychotherapie, Evangelisches Klinikum Bethel gGmbH, Universitätsklinikum OWL, Universität Bielefeld, Remterweg 69-71, 33617 Bielefeld, Germany; Department of Psychology, University of Bielefeld, Universitätsstraße 25, 33615 Bielefeld, Germany
| | - Ingmar Steinhart
- Institut für Sozialpsychiatrie Mecklenburg-Vorpommern e.V., Universität Greifswald, Greifswald, Germany
| | - Lorenz B Dehn
- Universitätsklinik für Psychiatrie und Psychotherapie, Evangelisches Klinikum Bethel gGmbH, Universitätsklinikum OWL, Universität Bielefeld, Remterweg 69-71, 33617 Bielefeld, Germany; Department of Psychology, University of Bielefeld, Universitätsstraße 25, 33615 Bielefeld, Germany
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Mahmood S, Tan X, Chen B, Tor PC. The influence of age on ECT efficacy in depression, mania, psychotic depression and schizophrenia: A transdiagnostic analysis. J Psychiatr Res 2024; 177:203-210. [PMID: 39032274 DOI: 10.1016/j.jpsychires.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/02/2024] [Accepted: 07/10/2024] [Indexed: 07/23/2024]
Abstract
AIM ECT use is variable across age groups. We aim to investigate the effect of age on ECT response among patients with depression, psychotic depression, mania and schizophrenia. METHODS Our retrospective observational study included patients from the Institute of Mental Health (Singapore) who were initiated on ECT (March 2017-February 2023). MADRS and BPRS scores were assessed 1-2 days before the first ECT and after the 6th session. The association between age group and ECT response was analyzed by ANOVA and generalized linear regression. A one-way sensitivity analysis was performed with age as a continuous variable. RESULTS 166 (15.7%) patients were "young-age (≤26 years)", 634 (60%) patients were in the "middle-age (27-59 years)" group and 256 (24.3%) were "old-age (≥60 years)". The association between older age and post-ECT improvement in patients with depression was significant in the categorical age analysis but it did not persist in the sensitivity analysis. No significant association between age and ECT response was noted in patients with bipolar disorder and schizophrenia as evidenced by both categorical and continuous age analyses. In a small subgroup with psychotic depression, younger patients improved significantly more than older patients post-ECT. CONCLUSION Patients with unipolar or bipolar depression, mania, or schizophrenia, regardless of age, respond favourably to ECT. Other associated factors such as psychomotor and psychotic symptoms, disease severity and number of failed pharmacotherapies should be considered in predicting ECT response. Younger patients with psychotic depression may respond better to ECT.
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Affiliation(s)
| | - Xiaowei Tan
- Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, 539747, Singapore
| | - Birong Chen
- Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, 539747, Singapore
| | - Phern Chern Tor
- Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, 539747, Singapore
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Hu Z, Li W, Ye Y, Zhang F, Liu H, Wang C, Lan X, Chen X, You Z, Lan Y, Ning Y, Zhou Y. Alterations of functional connectivity in young people with depression mediate the relationship between sleep quality and cognitive function. J Affect Disord 2023; 340:160-166. [PMID: 37557984 DOI: 10.1016/j.jad.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/07/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Sleep disturbances is common in young people with depression, and poor sleep quality affects the ability to learn. In this study, we examined possible resting-state functional connectivity abnormalities between regions of interest, and clarified the relationship with depressive symptoms, sleep quality, and cognitive function. METHODS Resting-state functional magnetic resonance imaging (fMRI) was collected on 42 healthy controls (HCs), 82 youth depressive patients (44 without sleep disturbances (NSD), and 38 with sleep disturbances (SD)). Regions of interest were defined by using Brainnetome Atlas. Functional connectivity was calculated, and its associations with depressive symptoms, sleep quality, and cognitive function were examined using correlation analysis and mediation analysis. RESULTS The left and right caudal of cingulate gyrus, tongue and larynx region of postcentral gyrus were significant brain regions in NSD versus SD. The average functional connectivity between these regions was associated with poor sleep quality (r = 0.368, p = 0.001) and worse working memory (r = -0.256, p = 0.023) and mediated the relationship between sleep quality and working memory (c = -0.738, c' = -0.500). LIMITATION Data consistency in this study was not good enough. This study did not monitor sleep rhythms to provide objective sleep-related data. CONCLUSION The functional connectivity between the left and right caudal of cingulate gyrus with tongue and larynx region of postcentral gyrus may be the neural mechanism by which sleep disturbances affect working memory. This provides an intervention target for clinically improving cognitive function in young people with depression.
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Affiliation(s)
- Zhibo Hu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Weicheng Li
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yanxiang Ye
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fan Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Haiyan Liu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Chengyu Wang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaofeng Lan
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaoyu Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zerui You
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yuting Lan
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
| | - Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
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Vicent-Gil M, Trujols J, Serra-Blasco M, Navarra-Ventura G, Puigdemont D, Alemany C, Crivillés S, de Diego-Adeliño J, Cardoner N, Portella MJ. If you feel you can't, you won't: the role of subjective and objective cognitive competence on psychosocial functioning in depression. Eur Psychiatry 2023; 66:e83. [PMID: 37855104 PMCID: PMC10755570 DOI: 10.1192/j.eurpsy.2023.2454] [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: 05/04/2023] [Revised: 07/27/2023] [Accepted: 08/21/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The purpose of this exploratory study is to examine the role of sociodemographic, clinical, and cognitive - both objective and subjective - factors in overall and in specific domains of psychosocial functioning, in patients with depression at different clinical states of the disease (remitted and non-remitted). METHODS A sample of 325 patients with major depressive disorder, 117 in remission and 208 in non-remission, were assessed with a semi-structured interview collecting sociodemographic, clinical, cognitive (with neuropsychological tests and the Perceived Deficit Questionnaire), and functional (Functioning Assessment Short Test) characteristics. Backward regression models were conducted to determine associations of global and specific areas of functioning with independent factors, for both clinical states. RESULTS Residual depressive symptomatology and self-appraisal of executive competence were significantly associated with psychosocial functioning in remitted patients, in overall and some subdomains of functioning, particularly cognitive and interpersonal areas. While depressive symptoms, executive deficits and self-appraisal of executive function were significantly related to functional outcomes in non-remitted patients, both in overall functioning and in most of subdomains. DISCUSSION This study evidences the strong association of one's appraisal of executive competence with psychosocial functioning, together with depressive symptoms, both in remitted and non-remitted patients with depression. Therefore, to achieve full recovery, clinical management of patients should tackle not only the relief of core depressive symptoms, but also the cognitive ones, both those that are objectified with neuropsychological tests and those that are reported by the patients themselves.
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Affiliation(s)
- Muriel Vicent-Gil
- Sant Pau Mental Health Research Group, Institut d’Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM-ISCIII), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Joan Trujols
- Sant Pau Mental Health Research Group, Institut d’Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM-ISCIII), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Maria Serra-Blasco
- eHealth ICOnnecta’t Program and Psycho-Oncology Service, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Spain
| | - Guillem Navarra-Ventura
- Institut d’Investigació Sanitària Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma, Spain
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS), Universitat de les Illes Balears, Palma, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III (CIBERES-ISCIII), Madrid, Spain
| | - Dolors Puigdemont
- Sant Pau Mental Health Research Group, Institut d’Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM-ISCIII), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Carlo Alemany
- Sant Pau Mental Health Research Group, Institut d’Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM-ISCIII), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Sara Crivillés
- Sant Pau Mental Health Research Group, Institut d’Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM-ISCIII), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Javier de Diego-Adeliño
- Sant Pau Mental Health Research Group, Institut d’Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM-ISCIII), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Narcís Cardoner
- Department of Psychiatry and Legal Medicine, Institute of Neuroscience, Universitat Autònoma de Barcelona (UAB)
| | - Maria J. Portella
- Sant Pau Mental Health Research Group, Institut d’Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM-ISCIII), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Guo W, Liu B, Wei X, Ju Y, Wang M, Dong Q, Lu X, Sun J, Zhang L, Guo H, Zhao F, Li W, Li Z, Liao M, Zhang L, Liu J, Zhang Y, Li L. The longitudinal change pattern of cognitive subtypes in medication-free patients with major depressive disorder: a cluster analysis. Psychiatry Res 2023; 327:115413. [PMID: 37579539 DOI: 10.1016/j.psychres.2023.115413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/24/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023]
Abstract
This study aimed to investigate whether there are different cognitive subtypes in patients with major depressive disorder (MDD) and the change pattern of cognitive clusters across the course of MDD. A battery of comprehensive cognitive tests was used to assess the executive function, processing speed, attention, and memory of 153 medication-free patients and 142 healthy controls (HCs). After 6 months of treatment with antidepressants, 87 patients completed cognitive tests again. K-means cluster analysis was performed to determine the cognitive subtypes. A preserved cognition cluster and an impaired cognition cluster were identified in the acute episode phase and the 6-month follow-up phase. 80.5% of the patients remained in their original subgroup after 6 months of treatment. The impaired cognition cluster during the 6-month follow-up period could be predicted by impaired cognition during the episode phase, disease state (remission or non-remission), current illness duration, and education level. This study supporting the heterogeneity of cognitive performance across the course of disease in patients with MDD using cluster analysis. It was found that cognitive impairment during depressive episodes was predictive of poorer cognitive performance even after treatment with antidepressants. Therefore, interventions targeting cognitive function from the early stages of MDD is essential.
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Affiliation(s)
- Weilong Guo
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Bangshan Liu
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Xiyu Wei
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Yumeng Ju
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Mi Wang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Qiangli Dong
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Xiaowen Lu
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jinrong Sun
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Liang Zhang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Hua Guo
- Zhumadian Psychiatric Hospital, Zhumadian, Henan, 463000, China
| | - Futao Zhao
- Zhumadian Psychiatric Hospital, Zhumadian, Henan, 463000, China
| | - Weihui Li
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Zexuan Li
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Mei Liao
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Li Zhang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jin Liu
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
| | - Yan Zhang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
| | - Lingjiang Li
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Yuan D, Wu J, Li S, Zhang R, Zhou X, Zhang Y. Network analysis of cold cognition and depression in middle-aged and elder population: the moderation of grandparenting. Front Public Health 2023; 11:1204977. [PMID: 37674685 PMCID: PMC10479032 DOI: 10.3389/fpubh.2023.1204977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/27/2023] [Indexed: 09/08/2023] Open
Abstract
Background Cognitive decline and negative emotions are common in aging, especially decline in cold cognition which often co-occurred with depression in middle-aged and older adults. This study analyzed the interactions between cold cognition and depression in the middle-aged and elder populations using network analysis and explored the effects of grandparenting on the cold cognition-depression network. Methods The data of 6,900 individuals (≥ 45 years) from the China Health and Retirement Longitudinal Study (CHARLS) were used. The Minimum Mental State Examination (MMSE) and the Epidemiology Research Center Depression Scale-10 (CESD-10) were used to assess cold cognition and depressive symptoms, respectively. Centrality indices and bridge centrality indices were used to identify central nodes and bridge nodes, respectively. Results Network analysis showed that nodes "language ability" and "depressed mood" were more central nodes in the network of cold cognition and depression in all participants. Meantime, nodes "attention," "language ability" and "hopeless" were three key bridge nodes connecting cold cognition and depressive symptoms. Additionally, the global connectivity of the cold cognition and depression network was stronger in the non-grandparenting than the grandparenting. Conclusion The findings shed a light on the complex interactions between cold cognition and depression in the middle-aged and elder populations. Decline in language ability and depressed mood can serve as predictors for the emergence of cold cognitive dysfunction and depression in individuals during aging. Attention, language ability and hopelessness are potential targets for psychosocial interventions. Furthermore, grandparenting is effective in alleviating cold cognitive dysfunction and depression that occur during individual aging.
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Affiliation(s)
- Dongling Yuan
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jialing Wu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shansi Li
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ruoyi Zhang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiao Zhou
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Zhang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
- Medical Psychological Institute of Central South University, Central South University, Changsha, China
- National Clinical Research Center on Mental Disorders (Xiangya), Changsha, China
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7
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Gerber M, Cody R, Beck J, Brand S, Donath L, Eckert A, Faude O, Hatzinger M, Imboden C, Kreppke JN, Lang UE, Mans S, Mikoteit T, Oswald A, Schweinfurth-Keck N, Zahner L, Ludyga S. Differences in Selective Attention and Inhibitory Control in Patients with Major Depressive Disorder and Healthy Controls Who Do Not Engage in Sufficient Physical Activity. J Clin Med 2023; 12:jcm12103370. [PMID: 37240475 DOI: 10.3390/jcm12103370] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Patients with major depressive disorder (MDD) are characterized by neurocognitive impairments and show deficits in various cognitive performance indicators, including executive function. We examined whether sustained attention and inhibitory control differ between patients with MDD and healthy controls, and whether differences exist between patients with mild, moderate, and severe depression. METHODS Clinical in-patients (N = 212) aged 18-65 years with a current diagnosis of MDD and 128 healthy controls were recruited. Depression severity was assessed using the Beck Depression Inventory, and sustained attention and inhibitory control were assessed using the oddball and flanker tasks. The use of these tasks promises insights into executive function in depressive patients that are not biased by verbal skills. Group differences were tested via analyses of covariance. RESULTS Patients with MDD showed slower reaction times in both the oddball and flanker task, independent of the executive demands of the trial types. Younger participants achieved shorter reaction times in both inhibitory control tasks. After correcting for age, education, smoking, BMI, and nationality, only differences in reaction times in the oddball task were statistically significant. In contrast, reaction times were not sensitive to the symptom severity of depression. CONCLUSION Our results corroborate deficits in basic information processing and specific impairments in higher-order cognitive processes in MDD patients. As difficulties in executive function underlie problems in planning, initiating, and completing goal-directed activities, they may jeopardize in-patient treatment and contribute to the recurrent nature of depression.
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Affiliation(s)
- Markus Gerber
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Robyn Cody
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Johannes Beck
- Psychiatric Clinic Sonnenhalde, 4125 Riehen, Switzerland
| | - Serge Brand
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
- Adult Psychiatric Clinics (UPKE), University of Basel, 4002 Basel, Switzerland
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran 1419733141, Iran
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, 50933 Cologne, Germany
| | - Anne Eckert
- Adult Psychiatric Clinics (UPKE), University of Basel, 4002 Basel, Switzerland
| | - Oliver Faude
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Martin Hatzinger
- Psychiatric Services Solothurn, University of Basel, 4503 Solothurn, Switzerland
| | | | - Jan-Niklas Kreppke
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Undine E Lang
- Adult Psychiatric Clinics (UPKE), University of Basel, 4002 Basel, Switzerland
| | - Sarah Mans
- Private Clinic Wyss, 3053 Münchenbuchsee, Switzerland
| | - Thorsten Mikoteit
- Psychiatric Services Solothurn, University of Basel, 4503 Solothurn, Switzerland
| | - Anja Oswald
- Psychiatric Clinic Sonnenhalde, 4125 Riehen, Switzerland
| | | | - Lukas Zahner
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Sebastian Ludyga
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
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8
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Zeng Y, Zhang F, Liu H, Li W, Ning Y, Zhou Y. Psychotic symptoms and neurocognition among patients with major depressive disorder: A chained mediation model of depressive symptoms and socio-occupational functioning. J Affect Disord 2023; 332:194-200. [PMID: 37044284 DOI: 10.1016/j.jad.2023.04.005] [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: 12/14/2022] [Revised: 03/12/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Depressive symptom and psychotic symptom have been identified as risk factors for impaired socio-occupational functioning in patients with major depressive disorder (MDD), while neurocognitive functioning is considered to be a potential protective factor against socio-occupational functioning. Nevertheless, little is known about the complex relationship among these factors in patients with MDD. The purpose of this research was to explore whether the relationship between depressive symptom severity and social-occupational functioning is mediated by neurocognitive functioning and psychotic symptom severity in MDD patients. METHODS A total of 659 eligible MDD patients included male and female, and their depressive symptoms and psychotic symptoms at baseline were assessed by the 17-item Hamilton Depression Scale (HAMD-17) and The Brief Psychiatric Rating Scale (BPRS) respectively. Cognitive domains were assessed by the MATRICS Consensus Cognitive Battery (MCCB), and subjective and objective functioning were measured by the Global Assessment of Functioning (GAF). LIMITATION The analysis is cross-sectional, which limits causal inference. RESULT (1) The correlation between depressive symptoms and thought disturbance was positive (r = 0.125, p = 0.001), whereas the correlations with visual learning and memory (r = -0.146, p < 0.001) and socio-occupational functioning (r = -0.175, p < 0.001) were negative. (2) Depressive symptoms mainly affect the socio-occupational functioning of MDD patients via three indirect effects: the single mediating effect of psychotic symptoms and neurocognitive functioning, and the chain mediating effect of psychotic symptoms and neurocognitive functioning. CONCLUSIONS The results suggest that the relationship between depressive symptom severity and socio-occupational functioning in MDD patients is partially mediated by psychotic symptom severity and neurocognitive functioning.
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Affiliation(s)
- Yexian Zeng
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Fan Zhang
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Haiyan Liu
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Weicheng Li
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yuping Ning
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Department of Psychology, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - Yanling Zhou
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
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9
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Hernandez Hernandez ME, Michalak E, Choudhury N, Hewko M, Torres I, Menon M, Lam RW, Chakrabarty T. Co-design of a Virtual Reality Cognitive Remediation Program for Depression (bWell-D) With Patient End Users and Clinicians: Qualitative Interview Study Among Patients and Clinicians. JMIR Serious Games 2023; 11:e43904. [PMID: 37027183 PMCID: PMC10131700 DOI: 10.2196/43904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/14/2023] [Accepted: 01/21/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is the leading cause of global disability; however, the existing treatments do not always address cognitive dysfunction-a core feature of MDD. Immersive virtual reality (VR) has emerged as a promising modality to enhance the real-world effectiveness of cognitive remediation. OBJECTIVE This study aimed to develop the first prototype VR cognitive remediation program for MDD ("bWell-D"). This study gathered qualitative data from end users early in the design process to enhance its efficacy and feasibility in clinical settings. METHODS Semistructured end-user interviews were conducted remotely (n=15 patients and n=12 clinicians), assessing the participants' perceptions and goals for a VR cognitive remediation program. Video samples of bWell-D were also shared to obtain feedback regarding the program. The interviews were transcribed, coded, and analyzed via thematic analysis. RESULTS End users showed an optimistic outlook toward VR as a treatment modality, and perceived it as a novel approach with the potential of having multiple applications. The participants expressed a need for an engaging VR treatment that included realistic and multisensorial settings and activities, as well as customizable features. Some skepticism regarding its effectiveness was also reported, especially when the real-world applications of the practiced skills were not made explicit, as well as some concerns regarding equipment accessibility. A home-based or hybrid (ie, home and clinic) treatment modality was preferred. CONCLUSIONS Patients and clinicians considered bWell-D interesting, acceptable, and potentially feasible, and provided suggestions to enhance its real-world applicability. The inclusion of end-user feedback is encouraged when developing future VR programs for clinical purposes.
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Affiliation(s)
| | - Erin Michalak
- University of British Columbia, Faculty of Medicine, Department of Psychiatry, Vancouver, BC, Canada
| | - Nusrat Choudhury
- National Research Council Canada, Medical Devices, Simulation and Digital Health, Montreal, QC, Canada
| | - Mark Hewko
- National Research Council Canada, Medical Devices, Simulation and Digital Health, Winnipeg, MB, Canada
| | - Ivan Torres
- University of British Columbia, Faculty of Medicine, Department of Psychiatry, Vancouver, BC, Canada
| | - Mahesh Menon
- University of British Columbia, Faculty of Medicine, Department of Psychiatry, Vancouver, BC, Canada
| | - Raymond W Lam
- University of British Columbia, Faculty of Medicine, Department of Psychiatry, Vancouver, BC, Canada
| | - Trisha Chakrabarty
- University of British Columbia, Faculty of Medicine, Department of Psychiatry, Vancouver, BC, Canada
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10
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de Oliveira C, Saka M, Bone L, Jacobs R. The Role of Mental Health on Workplace Productivity: A Critical Review of the Literature. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:167-193. [PMID: 36376610 PMCID: PMC9663290 DOI: 10.1007/s40258-022-00761-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Mental health disorders in the workplace have increasingly been recognised as a problem in most countries given their high economic burden. However, few reviews have examined the relationship between mental health and worker productivity. OBJECTIVE To review the relationship between mental health and lost productivity and undertake a critical review of the published literature. METHODS A critical review was undertaken to identify relevant studies published in MEDLINE and EconLit from 1 January 2008 to 31 May 2020, and to examine the type of data and methods employed, study findings and limitations, and existing gaps in the literature. Studies were critically appraised, namely whether they recognised and/or addressed endogeneity and unobserved heterogeneity, and a narrative synthesis of the existing evidence was undertaken. RESULTS Thirty-eight (38) relevant studies were found. There was clear evidence that poor mental health (mostly measured as depression and/or anxiety) was associated with lost productivity (i.e., absenteeism and presenteeism). However, only the most common mental disorders were typically examined. Studies employed questionnaires/surveys and administrative data and regression analysis. Few studies used longitudinal data, controlled for unobserved heterogeneity or addressed endogeneity; therefore, few studies were considered high quality. CONCLUSION Despite consistent findings, more high-quality, longitudinal and causal inference studies are needed to provide clear policy recommendations. Moreover, future research should seek to understand how working conditions and work arrangements as well as workplace policies impact presenteeism.
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Affiliation(s)
- Claire de Oliveira
- Centre for Health Economics, University of York, York, UK.
- Hull York Medical School, Hull and York, UK.
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | | | | | - Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
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11
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Gruber M, Mauritz M, Meinert S, Grotegerd D, de Lange SC, Grumbach P, Goltermann J, Winter NR, Waltemate L, Lemke H, Thiel K, Winter A, Breuer F, Borgers T, Enneking V, Klug M, Brosch K, Meller T, Pfarr JK, Ringwald KG, Stein F, Opel N, Redlich R, Hahn T, Leehr EJ, Bauer J, Nenadić I, Kircher T, van den Heuvel MP, Dannlowski U, Repple J. Cognitive performance and brain structural connectome alterations in major depressive disorder. Psychol Med 2023; 53:1-12. [PMID: 36752136 PMCID: PMC10600941 DOI: 10.1017/s0033291722004007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 12/02/2022] [Accepted: 12/23/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Cognitive dysfunction and brain structural connectivity alterations have been observed in major depressive disorder (MDD). However, little is known about their interrelation. The present study follows a network approach to evaluate alterations in cognition-related brain structural networks. METHODS Cognitive performance of n = 805 healthy and n = 679 acutely depressed or remitted individuals was assessed using 14 cognitive tests aggregated into cognitive factors. The structural connectome was reconstructed from structural and diffusion-weighted magnetic resonance imaging. Associations between global connectivity strength and cognitive factors were established using linear regressions. Network-based statistics were applied to identify subnetworks of connections underlying these global-level associations. In exploratory analyses, effects of depression were assessed by evaluating remission status-related group differences in subnetwork-specific connectivity. Partial correlations were employed to directly test the complete triad of cognitive factors, depressive symptom severity, and subnetwork-specific connectivity strength. RESULTS All cognitive factors were associated with global connectivity strength. For each cognitive factor, network-based statistics identified a subnetwork of connections, revealing, for example, a subnetwork positively associated with processing speed. Within that subnetwork, acutely depressed patients showed significantly reduced connectivity strength compared to healthy controls. Moreover, connectivity strength in that subnetwork was associated to current depressive symptom severity independent of the previous disease course. CONCLUSIONS Our study is the first to identify cognition-related structural brain networks in MDD patients, thereby revealing associations between cognitive deficits, depressive symptoms, and reduced structural connectivity. This supports the hypothesis that structural connectome alterations may mediate the association of cognitive deficits and depression severity.
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Affiliation(s)
- Marius Gruber
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany
| | - Marco Mauritz
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
| | - Susanne Meinert
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
- Institute of Translational Neuroscience, University of Münster, 48149 Münster, Germany
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
| | - Siemon C. de Lange
- Connectome Lab, Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, 1081 HV Amsterdam, The Netherlands
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, an institute of the Royal Netherlands Academy of Arts and Sciences, 1105 BA Amsterdam, The Netherlands
| | - Pascal Grumbach
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
| | - Janik Goltermann
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
| | - Nils Ralf Winter
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
| | - Lena Waltemate
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
| | - Hannah Lemke
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
| | - Katharina Thiel
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
| | - Alexandra Winter
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
| | - Fabian Breuer
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
| | - Tiana Borgers
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
| | - Verena Enneking
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
| | - Melissa Klug
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
| | - Katharina Brosch
- Department of Psychiatry and Psychotherapy, University of Marburg, 35039 Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, 35032 Marburg, Germany
| | - Tina Meller
- Department of Psychiatry and Psychotherapy, University of Marburg, 35039 Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, 35032 Marburg, Germany
| | - Julia-Katharina Pfarr
- Department of Psychiatry and Psychotherapy, University of Marburg, 35039 Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, 35032 Marburg, Germany
| | - Kai Gustav Ringwald
- Department of Psychiatry and Psychotherapy, University of Marburg, 35039 Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, 35032 Marburg, Germany
| | - Frederike Stein
- Department of Psychiatry and Psychotherapy, University of Marburg, 35039 Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, 35032 Marburg, Germany
| | - Nils Opel
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
- Department of Psychiatry, Jena University Hospital/Friedrich-Schiller-University Jena, 07743 Jena, Germany
| | - Ronny Redlich
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
- Institute of Psychology, University of Halle, 06108 Halle (Saale), Germany
| | - Tim Hahn
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
| | - Elisabeth J. Leehr
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
| | - Jochen Bauer
- Department of Radiology, University of Münster, 48149 Münster, Germany
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, University of Marburg, 35039 Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, 35032 Marburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, 35039 Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, 35032 Marburg, Germany
| | - Martijn P. van den Heuvel
- Connectome Lab, Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, 1081 HV Amsterdam, The Netherlands
- Department of Child Psychiatry, Amsterdam University Medical Center, Amsterdam Neuroscience, 1105 AZ Amsterdam, The Netherlands
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
| | - Jonathan Repple
- Institute for Translational Psychiatry, University of Münster, 48149 Münster, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany
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12
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Yıldız T, Oğuzhanoğlu NK, Topak OZ. Cognitive outcomes of transcranial magnetic stimulation in treatment-resistant depression: a randomized controlled study. Turk J Med Sci 2023; 53:253-263. [PMID: 36945926 PMCID: PMC10387879 DOI: 10.55730/1300-0144.5580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/03/2022] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a significant cause of workforce loss, and is associated with cognitive impairments which can continue even after the elimination of mood and behavioural symptoms. The aim of this study was to investigate the benefit of transcranial magnetic stimulation (TMS) on cognitive functions in treatment resistant depression. METHODS This randomised controlled clinical trial was conducted at a university hospital, department of psychiatry (tertiary centre) between October 2019 and July 2020. The study included 30 patients with depressive disorder, aged 18-50 years, who did not respond to at least two antidepressant medications for at least 8 weeks (one drug used was serotonin norepinephrine reuptake inhibitor [SNRI]; and 15 healthy control subjects. The patients were separated into two equal groups in a double-blind, random manner, and 20 sessions of repeated TMS was applied to one group, and 20 sessions of sham TMS to the other. The Montgomery Asberg Depression Scale (MADRS), Hamilton Depression Rating Scale (HAM-D), Stroop test, Wisconsin Card Sorting Test (WCST), Digit Span Test (DST), Trail Making Test A-B, and Verbal Memory Processes Test (VMPT) were applied to the patients before and after the TMS procedure. RESULTS The decrease in the HAM-D score was greater in the active magnetic stimulation (25 trains, 10 Hz, 110% motor threshold intensity) group, and with the exception of verbal memory processes, better performance was obtained by the active magnetic stimulation group than the sham group in the cognitive function tests. DISCUSSION TMS was seen toimprove the cognitive defects present in the active phase of treatment-resistant depression, and therefore TMS could provide early improvement in cognitive functions in clinical use. Key words: Depression, transcranial magnetic stimulation, neurocognitive functi.
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Affiliation(s)
- Tahir Yıldız
- Department of Psychiatry, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | | | - Osman Zülkif Topak
- Department of Psychiatry, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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13
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Shibaoka M, Masuda M, Iwasawa S, Ikezawa S, Eguchi H, Nakagome K. Relationship between objective cognitive functioning and work performance among Japanese workers. J Occup Health 2023; 65:e12385. [PMID: 36694368 PMCID: PMC9874020 DOI: 10.1002/1348-9585.12385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES We aimed to explore the relationship between objective cognitive functioning and work performance among Japanese workers. METHODS From February to November 2019, this cross-sectional study enrolled workers aged 18-65 years from 10 companies located in a metropolitan area of Japan. We emailed invitations to participate to employees of companies that had agreed to cooperate with the study. We measured work performance with the question, "How would you rate your performance (compared with your optimum performance) over the past 4 weeks?" Responses were made via a visual analog scale (range: 0-100). Cognitive functioning was assessed using the THINC-integrated tool (THINC-it®). THINC-it® is a brief, objective computerized cognitive assessment battery. Associations between work performance and cognitive functioning tests were examined using logistic regression analysis. RESULTS In total, 353 individuals provided e-consent to participate, of whom 276 were included in the analysis (after omitting those with missing values). The median work performance was used to divide participants into high- (scoring ≥ 80%) and low- (scoring < 80%) performing groups. The P-values for trends indicated that association between cognitive domains, such as attention, executive functioning and working memory was significant (P < .05). Work performance was significantly associated with cognitive function for the two tests that assess attention, executive functioning, and working memory in general workers. CONCLUSIONS Our results suggest that objective cognitive functioning may be related to work performance. Longitudinal investigations may allow for the establishment of causality.
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Affiliation(s)
- Michi Shibaoka
- Tokyo Rosai Hospital, Japan Organization of Occupational Health and SafetyTokyoJapan
| | | | - Satoko Iwasawa
- National Defense Medical College, Preventive Medicine and Public HealthSaitamaJapan
| | - Satoru Ikezawa
- Endowed Institute for Empowering Gifted MindsUniversity of Tokyo Graduate School of Arts and SciencesTokyoJapan
| | - Hisashi Eguchi
- Department of Mental Health, Institute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthFukuokaJapan
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14
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Myklebost SB, Amundsen OM, Geraghty AWA, Inal Y, Hammar Å, Nordgreen T. Developing an internet-delivered intervention targeting residual cognitive symptoms after major depressive disorder: a person-based approach. J Ment Health 2022; 31:842-850. [PMID: 34983282 DOI: 10.1080/09638237.2021.2022618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cognitive difficulties are rarely addressed after the treatment of major depressive disorder (MDD). New scalable treatments are needed. To ensure relevance and engagement of novel interventions, there is a need to understand the perspectives of the users. AIM Explore former depressed adults needs and perspectives during the planning and development of a novel internet-delivered intervention targeting residual cognitive symptoms after MDD. METHOD The planning phase included exploratory qualitative interviews with former depressed adults (n = 16). In the development phase, a prototype including psychoeducation, attention training and compensatory strategies was tested in think-aloud interviews with former depressed adults (n = 7) and psychologists (n = 4). Data were analysed thematically. RESULTS Analysis of exploratory interviews identified four themes. Experiences of residual cognitive symptoms consisted of two sub-themes (Everyday life is more demanding; Concerns about cognitive difficulties). Coping with residual cognitive symptoms had two sub-themes (Compensatory strategies; Acceptance). Needs from an intervention consisted of two-subthemes (Need for information; Therapist support). Barriers for engagement consisted of three sub-themes (Being overwhelmed; Not being motivated; Frequent registration). Analysis of think-aloud interviews was organized into three themes: Positive perceptions of content; Concerns regarding content; Perceptions of Layout, Visuals and Navigation. CONCLUSION The intervention may address concerns and consequences of cognitive difficulties by including psychoeducation, compensatory strategies and elements to increase acceptance and motivation, provided in manageable proportions.
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Affiliation(s)
- Sunniva Brurok Myklebost
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | | | - Adam W A Geraghty
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Yavuz Inal
- Department of Design, Faculty of Architecture and Design, Norwegian University of Science and Technology, Trondheim, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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15
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Yang KC, Hsieh WC, Chou YH. Cognitive factor structure and measurement invariance between healthy controls and patients with major depressive disorder. J Psychiatr Res 2022; 151:598-605. [PMID: 35636038 DOI: 10.1016/j.jpsychires.2022.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 05/03/2022] [Accepted: 05/20/2022] [Indexed: 02/01/2023]
Abstract
Cognitive impairments are crucial in functional outcomes of major depressive disorder (MDD). The effectiveness of currently available treatment methods for cognitive deficits is suboptimal. A cognitive test battery is often applied to evaluate cognition with multiple interrelated and difficult-to-interpret outcomes. Generating cognitive factor scores after the confirmation of a common cognitive structure and measurement invariance between healthy controls (HCs) and patients may aid in understanding cognition further. This methodology has been applied for several neuropsychiatric disorders, but not for MDD. Therefore, we conducted a series of exploratory factor analyses (EFA), confirmatory factor analyses (CFA), and multiple groups CFA (MGCFA) for a cognitive test battery in HCs and patients with MDD. The initial EFA of 106 HCs yielded a three-factor model-comprising attention, memory, and executive function. The CFA confirmed the initial model in other 94 HCs with revisions, which reasonably fit the cognitive data of 54 patients with MDD. MGCFA supported the measurement invariance of the determined model between HCs and patients with MDD. The associations of cognitive factor scores with age or education and the effect sizes of group differences in cognitive factor scores externally validated the determined model. In conclusion, this is the first study to demonstrate the measurement invariance of a cognitive model between HCs and patients with MDD using MGCFA. The measurement invariance substantiated valid group comparisons of factor scores and their relationships with other markers. The current results may be applicable for the development of improved treatment strategies for cognitive impairments in MDD.
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Affiliation(s)
- Kai-Chun Yang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Chih Hsieh
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuan-Hwa Chou
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Quality Management, Taipei Veterans General Hospital, Taipei, Taiwan.
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16
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Boyd JE, Sanger BD, Cameron DH, Protopopescu A, McCabe RE, O’Connor C, Lanius RA, McKinnon MC. A Pilot Study Assessing the Effects of Goal Management Training on Cognitive Functions among Individuals with Major Depressive Disorder and the Effect of Post-Traumatic Symptoms on Response to Intervention. Brain Sci 2022; 12:brainsci12070864. [PMID: 35884671 PMCID: PMC9312851 DOI: 10.3390/brainsci12070864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 01/27/2023] Open
Abstract
Recent meta-analyses highlight alterations in cognitive functioning among individuals with major depressive disorder (MDD), with performance deficits observed across multiple cognitive domains including executive functioning, memory, and attention. Moreover, impaired concentration is a formal diagnostic criterion for a major depressive episode. Notably, cognitive impairment is reported frequently in MDD and is associated with poor treatment response. Despite this knowledge, research examining the effectiveness of top-down, adjunctive treatments for cognitive dysfunction in MDD remains in its infancy. The primary aim of the present study was to perform a pilot investigation of the implementation of a standardized cognitive remediation program, Goal Management Training (GMT), among individuals with a primary diagnosis of MDD. A secondary aim was to explore how comorbid symptoms of post-traumatic stress disorder (PTSD) among those MDD patients exposed to trauma may affect treatment response. A final sample of thirty individuals were randomized to either participate in the nine-week GMT program (active group; n = 16) or to complete a nine-week waiting period (waitlist control; n = 14). One participant was excluded from the GMT group analysis following study completion due to meeting an exclusion criteria. In total, 60% of the individuals allocated to the GMT program were trauma exposed (n = 9). Groups were assessed at baseline, post-treatment, and at three-month follow-up. The assessment comprised neuropsychological tasks assessing a variety of cognitive domains, subjective measures of functioning and symptom severity, as well as a clinical interview to establish a primary diagnosis of MDD. Significant gains in processing speed, attention/concentration, and response inhibition were observed for the participants in the GMT condition relative to participants in the waitlist control condition. Individuals in the GMT condition also reported improvements in subjective cognitive functioning from baseline to post-treatment. Heightened PTSD symptom severity was associated with reduced response to treatment with respect to the domain of processing speed. The results of this pilot investigation highlight not only the potential utility of GMT as an augmentative treatment in MDD, but also highlight the contribution of comorbid symptoms of PTSD to diminished treatment response among trauma-exposed individuals with MDD. The study is limited primarily by its small pilot sample and the absence of a program evaluation component to gauge participant opinions and feedback of the treatment protocol.
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Affiliation(s)
- Jenna E. Boyd
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 3L8, Canada; (J.E.B.); (D.H.C.); (R.E.M.)
- Anxiety Treatment and Research Clinic, St. Joseph’s Healthcare Hamilton, Hamilton, ON L9C 0E3, Canada
| | - Brahm D. Sanger
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON L8S 3L8, Canada; (B.D.S.); (A.P.)
| | - Duncan H. Cameron
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 3L8, Canada; (J.E.B.); (D.H.C.); (R.E.M.)
- Anxiety Treatment and Research Clinic, St. Joseph’s Healthcare Hamilton, Hamilton, ON L9C 0E3, Canada
| | - Alina Protopopescu
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON L8S 3L8, Canada; (B.D.S.); (A.P.)
| | - Randi E. McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 3L8, Canada; (J.E.B.); (D.H.C.); (R.E.M.)
- Anxiety Treatment and Research Clinic, St. Joseph’s Healthcare Hamilton, Hamilton, ON L9C 0E3, Canada
| | | | - Ruth A. Lanius
- Department of Psychiatry, Western University, London, ON N6C 5J1, Canada;
- Lawson Health Research Institute, London, ON N6C 2R5, Canada
- Homewood Research Institute, Guelph, ON N1E 6K9, Canada
| | - Margaret C. McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 3L8, Canada; (J.E.B.); (D.H.C.); (R.E.M.)
- Homewood Research Institute, Guelph, ON N1E 6K9, Canada
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, ON L9C 0E3, Canada
- Correspondence:
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17
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Lee SH, Jeon SW, Shin C, Pae CU, Patkar AA, Masand PS, An H, Han C. Acute Efficacy and Safety of Escitalopram Versus Desvenlafaxine and Vortioxetine in the Treatment of Depression With Cognitive Complaint: A Rater-Blinded Randomized Comparative Study. Psychiatry Investig 2022; 19:268-280. [PMID: 35500900 PMCID: PMC9058271 DOI: 10.30773/pi.2021.0368] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/17/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to compare the efficacy and safety of escitalopram, vortioxetine, and desvenlafaxine for acute treatment of major depressive disorder (MDD) with cognitive complaint (CC). METHODS A total of 129 patients with MDD who also complained of CC were randomized evenly to either escitalopram, vortioxetine, or desvenlafaxine group and underwent a multi-center, six-week, rater-blinded, and head-to-head comparative trial. Differences in depressive symptoms following treatment were measured using the Hamilton Depression Rating Scale (HAMD) and the Montgomery-Åsberg Depression Rating Scale (MADRS). Subjective cognitive function and the presence of adverse events were assessed. RESULTS The three antidepressant treatment groups did not show significant differences in the improvement of depressive symptoms as measured by HAMD and MADRS. Desvenlafaxine treatment was associated with a superior treatment response rate in depressive symptoms compared to vortioxetine or escitalopram treatment. However, no significant differences were found in the remission rate of depressive symptoms. The three antidepressant treatment groups did not show significant differences in the improvement of CC. Adverse profiles of each treatment group were tolerable, with no significant differences. CONCLUSION In acute antidepressant treatment for MDD with CC, escitalopram, vortioxetine, and desvenlafaxine presented similar efficacy in relief of depressive symptoms; however, desvenlafaxine was associated with a superior treatment. Further studies are needed to confirm these results by investigating the therapeutic efficacy and safety profile of long-term antidepressant treatment of MDD with CC (Clinical Trial Registry, http://cris.nih.go.kr/cris/en/: KCT0002173).
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Affiliation(s)
- Seung-Hoon Lee
- Department of Psychiatry, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Sang Won Jeon
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheolmin Shin
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Chi-Un Pae
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ashwin A Patkar
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Hyonggin An
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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18
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Teh WL, Liu J, Satghare P, Samari E, Mok YM, Subramaniam M. Depressive symptoms and health-related quality of life in a heterogeneous psychiatric sample: conditional indirect effects of pain severity and interference. BMC Psychiatry 2021; 21:470. [PMID: 34579684 PMCID: PMC8474842 DOI: 10.1186/s12888-021-03470-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have examined clinically relevant mechanisms that underlie the association between two important indices of recovery- depression severity and health-related quality of life (HRQOL) in psychiatric outpatients. This study aimed to explicate the roles of pain interference and pain severity as mediating and moderating mechanisms in the relationship between depressive symptoms and HRQOL. METHODS Data from 290 outpatients diagnosed with schizophrenia (n = 102), depressive (n = 98), and anxiety (n = 90) disorders were examined. Participants completed a set of questionnaires that queried their sociodemographic statuses, current pain severity and interference levels, depression severity levels, and HRQOL. Subsequently, mediation and moderation analyses were conducted. RESULTS Analyses revealed that pain interference fully mediated the relationship between depressive symptoms and physical (34% of the total effect) but not mental HRQOL. At high pain levels (+ 1 SD from mean), depressive symptoms may interfere with physical quality of life through pain interference, but this was not present at low pain levels (- 1 SD from mean). CONCLUSIONS Prolonged pain symptoms could negatively influence psychiatric recovery beyond the physical aspect of HRQOL. These results thus imply a need to detect and manage severe physical pain complaints at the acute stage in psychiatric outpatients.
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Affiliation(s)
- Wen Lin Teh
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Jianlin Liu
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Pratika Satghare
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Ellaisha Samari
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Yee Ming Mok
- Department of Mood and Anxiety, Institute of Mental Health, Singapore, 539747, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
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19
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Keramat SA, Alam K, Ahinkorah BO, Islam MS, Islam MI, Hossain MZ, Ahmed S, Gow J, Biddle SJH. Obesity, Disability and Self-Perceived Health Outcomes in Australian Adults: A Longitudinal Analysis Using 14 Annual Waves of the HILDA Cohort. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:777-788. [PMID: 34522108 PMCID: PMC8434893 DOI: 10.2147/ceor.s318094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Both obesity and disability have been widely recognised as major public health challenges because they play significant roles in determining self-perceived general and mental health. Longitudinal studies of the relationship between obesity and disability with self-reported health outcomes are scarce. Therefore, the objective of the present study is to examine the relationship between obesity and disability with self-perceived general and mental health among Australian adults aged 15 years and above. METHODS Data were extracted from the most recent 14 waves (waves 6 through 19) of the annual individual person dataset of the Household, Income and Labour Dynamics in Australia (HILDA) survey. The longitudinal random-effects logistic regression model was adopted to investigate the relationships between obesity and disability with self-reported health outcomes. RESULTS The results revealed that obese individuals and adults with some form of disability are more likely to report poor or fair general and mental health. The odds of self-reporting poor or fair general health were 2.40 and 6.07 times higher among obese (aOR: 2.40, 95% CI: 2.22-2.58) and adults with some form of disability (aOR: 6.07, 95% CI: 5.77-6.39), respectively, relative to adults with healthy weight and those without disability . The results also showed that self-rated poor or fair mental health were 1.22 and 2.40 times higher among obese adults (aOR: 1.22, 95% CI: 1.15-1.30) and adults with disability (aOR: 2.40, 95% CI: 2.30-2.51), respectively, compared to their healthy weight peers and peers without disability. CONCLUSION As governmental and non-governmental organisations seek to improve the community's physical and mental well-being, these organisations need to pay particular attention to routine health care prevention, specific interventions, and treatment practices, especially for obese and/or people with disabilities.
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Affiliation(s)
- Syed Afroz Keramat
- School of Business, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
- Economics Discipline, Social Science School, Khulna University, Khulna, 9208, Bangladesh
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Khorshed Alam
- School of Business, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | | | - Md Sariful Islam
- Economics Discipline, Social Science School, Khulna University, Khulna, 9208, Bangladesh
| | - Md Irteja Islam
- School of Business, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Md Zobayer Hossain
- Development Studies Discipline, Social Science School, Khulna University, Khulna, 9208, Bangladesh
| | - Sazia Ahmed
- Economics Discipline, Social Science School, Khulna University, Khulna, 9208, Bangladesh
| | - Jeff Gow
- School of Business, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
- School of Accounting, Economics, and Finance, University of KwaZulu-Natal, Durban, 4000, South Africa
| | - Stuart J H Biddle
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
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20
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Schilling TM, Bossert M, Weisbrod M, Aschenbrenner S. [Cognitive impairments in patients with depression]. DER NERVENARZT 2021; 92:277-288. [PMID: 33646323 DOI: 10.1007/s00115-021-01074-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Cognitive impairments are frequent in patients suffering from major depressive disorders. They are among the first symptoms, often persist independently of improvement even after remission of the affective symptoms and are an important predictor of psychosocial functioning. In the clinical practice it is mandatory to ask about subjective complaints of the patient as well as to assess the cognitive abilities with the help of a standardized neuropsychological test battery. Cognitive remediation, selective serotonin reuptake inhibitors (SSRI) and vortioxetine as well as repetitive transcranial magnetic stimulation have proven their effectiveness as treatment options.
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Affiliation(s)
- Thomas M Schilling
- Sektion für Klinische Psychologie und Neuropsychologie, SRH Klinikum Karlsbad-Langensteinbach GmbH, Guttmanstraße 1, 76307, Karlsbad, Deutschland.
| | - Magdalena Bossert
- Sektion für Klinische Psychologie und Neuropsychologie, SRH Klinikum Karlsbad-Langensteinbach GmbH, Guttmanstraße 1, 76307, Karlsbad, Deutschland
| | - Matthias Weisbrod
- Abteilung für Psychiatrie und Psychotherapie, SRH Klinikum Karlsbad-Langensteinbach, Guttmanstraße 1, 76307, Karlsbad, Deutschland.,Klinik für Allgemeine Psychiatrie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg, Voßstraße 4, 69115, Heidelberg, Deutschland
| | - Steffen Aschenbrenner
- Sektion für Klinische Psychologie und Neuropsychologie, SRH Klinikum Karlsbad-Langensteinbach GmbH, Guttmanstraße 1, 76307, Karlsbad, Deutschland
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21
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Vieira IS, Ferrugem SCR, Reyes AN, Branco JC, Mondin TC, Cardoso TDA, Kapczinski F, Souza LDDM, Jansen K, da Silva RA, Pedrotti Moreira F. Effects of depression and excess body weight on cognition and functioning in young adults: A population-based study. J Affect Disord 2021; 282:401-406. [PMID: 33421869 DOI: 10.1016/j.jad.2020.12.083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/30/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study is to assess the independent effects of depression and excess body weight (EBW) on cognition and functioning in a community sample of young adults. METHODS This was a cross-sectional of 943 young adults. The diagnosis of a current depressive episode was performed using the Mini International Neuropsychiatric Interview (MINI). Cognition and functioning were assessed using the Montreal Cognitive Assessment (MoCA) and the Functional Assessment Short Test (FAST), respectively. The EBW was defined as BMI ≥ 25.0 kg/m2. The independent main effects of depression and EBW, as well as the analysis interaction were performed using two-way analysis of covariance (ANCOVA). RESULTS The total sample comprised 943 adults, with 75 (8.0%) individuals diagnosed with a current depressive episode and 493 (52,6%) with EBW. Of the 75 subjects with depression, 40 were identified with EBW comorbidity. Subjects with depression and EBW comorbidity reported greater cognitive and functional impairment, as compared to individuals with depression without EBW. There was a significant interaction between depression and EBW on MoCA total (p<0.001) as well as FAST total (p=0.010), work (p=0.002), cognition (p=0.023), finances (p=0.032) and relationships domains (p=0.008). CONCLUSIONS The adverse effects of depression and EBW are independent and cumulative with respect to cognition and functioning of individuals. The understanding of the complex interactions between cognition, functioning, EBW and depression are important for development of preventive and therapeutic strategies.
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Affiliation(s)
- Igor Soares Vieira
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | | | - Amanda Neumann Reyes
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil
| | - Jerônimo Costa Branco
- Mestrado em Ciências da Saúde e da Vida, Universidade Franciscana, Santa Maria, RS, Brazil
| | - Thaíse Campos Mondin
- Pró-Reitoria de Assuntos Estudantis (PRAE), Universidade Federal de Pelotas, RS, Brazil
| | - Taiane de Azevedo Cardoso
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil
| | - Flávio Kapczinski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil
| | - Luciano Dias de Mattos Souza
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil
| | - Karen Jansen
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil
| | - Ricardo Azevedo da Silva
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil
| | - Fernanda Pedrotti Moreira
- Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil.
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22
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Wood-Ross C, Best MW, Milanovic M, Bowie CR. Brain of Thrones: Cognitive Effort and Perceived Performance During a Cognitive Task in Major Depressive Disorder. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10145-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Allott K, Gao C, Hetrick SE, Filia KM, Menssink JM, Fisher C, Hickie IB, Herrman HE, Rickwood DJ, Parker AG, Mcgorry PD, Cotton SM. Subjective cognitive functioning in relation to changes in levels of depression and anxiety in youth over 3 months of treatment. BJPsych Open 2020; 6:e84. [PMID: 32753079 PMCID: PMC7453798 DOI: 10.1192/bjo.2020.68] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Subjective cognitive difficulties are common in mental illness and have a negative impact on role functioning. Little is understood about subjective cognition and the longitudinal relationship with depression and anxiety symptoms in young people. AIMS To examine the relationship between changes in levels of depression and anxiety and changes in subjective cognitive functioning over 3 months in help-seeking youth. METHOD This was a cohort study of 656 youth aged 12-25 years attending Australian headspace primary mental health services. Subjective changes in cognitive functioning (rated as better, same, worse) reported after 3 months of treatment was assessed using the Neuropsychological Symptom Self-Report. Multivariate multinomial logistic regression analysis was conducted to evaluate the impact of baseline levels of and changes in depression (nine-item Patient Health Questionnaire; PHQ9) and anxiety symptoms (seven-item Generalised Anxiety Disorder scale; GAD7) on changes in subjective cognitive function at follow-up while controlling for covariates. RESULTS With a one-point reduction in PHQ9 at follow-up, there was an estimated 11-18% increase in ratings of better subjective cognitive functioning at follow-up, relative to stable cognitive functioning. A one-point increase in PHQ9 from baseline to follow-up was associated with 7-14% increase in ratings of worse subjective cognitive functioning over 3 months, relative to stable cognitive functioning. A similar attenuated pattern of findings was observed for the GAD7. CONCLUSIONS A clear association exists between subjective cognitive functioning outcomes and changes in self-reported severity of affective symptoms in young people over the first 3 months of treatment. Understanding the timing and mechanisms of these associations is needed to tailor treatment.
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Affiliation(s)
- Kelly Allott
- Orygen, Australia; and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Caroline Gao
- Orygen; Centre for Youth Mental Health, The University of Melbourne; and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, University of Auckland, New Zealand
| | - Kate M Filia
- Orygen; and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Jana M Menssink
- Orygen; and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Caroline Fisher
- Department of Psychology, Royal Melbourne Hospital, Melbourne Health; and The Melbourne Clinic, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Australia
| | - Helen E Herrman
- Orygen; and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Debra J Rickwood
- headspace National Youth Mental Health Foundation; and Faculty of Health, University of Canberra, Australia
| | - Alexandra G Parker
- Orygen; Centre for Youth Mental Health, The University of Melbourne; and Institute for Health and Sport, Victoria University, Australia
| | - Patrick D Mcgorry
- Orygen; and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Sue M Cotton
- Orygen; and Centre for Youth Mental Health, The University of Melbourne, Australia
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24
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Nieman DH, Chavez-Baldini U, Vulink NC, Smit DJA, van Wingen G, de Koning P, Sutterland AL, Mocking RJT, Bockting C, Verweij KJH, Lok A, Denys D. Protocol Across study: longitudinal transdiagnostic cognitive functioning, psychiatric symptoms, and biological parameters in patients with a psychiatric disorder. BMC Psychiatry 2020; 20:212. [PMID: 32393362 PMCID: PMC7216345 DOI: 10.1186/s12888-020-02624-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Patients with psychiatric disorders, such as major depressive disorder, schizophrenia or obsessive-compulsive disorder, often suffer from cognitive dysfunction. The nature of these dysfunctions and their relation with clinical symptoms and biological parameters is not yet clear. Traditionally, cognitive dysfunction is studied in patients with specific psychiatric disorders, disregarding the fact that cognitive deficits are shared across disorders. The Across study aims to investigate cognitive functioning and its relation with psychiatric symptoms and biological parameters transdiagnostically and longitudinally. METHODS The study recruits patients diagnosed with a variety of psychiatric disorders and has a longitudinal cohort design with an assessment at baseline and at one-year follow-up. The primary outcome measure is cognitive functioning. The secondary outcome measures include clinical symptoms, electroencephalographic, genetic and blood markers (e.g., fatty acids), and hair cortisol concentration levels. DISCUSSION The Across study provides an opportunity for a transdiagnostic, bottom-up, data-driven approach of investigating cognition in relation to symptoms and biological parameters longitudinally in patients with psychiatric disorders. The study may help to find new clusters of symptoms, biological markers, and cognitive dysfunctions that have better prognostic value than the current diagnostic categories. Furthermore, increased insight into the relationship among cognitive deficits, biological parameters, and psychiatric symptoms can lead to new treatment possibilities. TRIAL REGISTRATION Netherlands Trial Register (NTR): NL8170.
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Affiliation(s)
- Dorien H. Nieman
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - UnYoung Chavez-Baldini
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Nienke C. Vulink
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Dirk J. A. Smit
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Guido van Wingen
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Pelle de Koning
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Arjen L. Sutterland
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Roel J. T. Mocking
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Claudi Bockting
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Karin J. H. Verweij
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Anja Lok
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Damiaan Denys
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
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25
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Hammar Å, Semkovska M, Borgen IMH, Myklebost S, Ronold EH, Sveen T, Ueland T, Porter R, Johnson SL. A pilot study of cognitive remediation in remitted major depressive disorder patients. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:172-182. [DOI: 10.1080/23279095.2020.1726919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Maria Semkovska
- Health Research Institute and Department of Psychology, University of Limerick, Limerick, Ireland
| | - Ida M. H. Borgen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Sunniva Myklebost
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Eivind H Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Thea Sveen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Torill Ueland
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- NORMENT, Oslo University Hospital, Oslo, Norway
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Sheri L. Johnson
- Department of Psychology, University of California, Berkeley, CA, USA
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26
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Jacobson W, Zhong W, Nomikos GG, Christensen MC, Kurre Olsen C, Harvey PD. Effects of vortioxetine on functional capacity across different levels of functional impairment in patients with major depressive disorder: a University of California, San Diego Performance-based Skills Assessment (UPSA) analysis. Curr Med Res Opin 2020; 36:117-124. [PMID: 31422713 DOI: 10.1080/03007995.2019.1657692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective: To evaluate the consistency of vortioxetine's effects on functional capacity in adults with major depressive disorder (MDD) and self-reported cognitive symptoms at different levels of functional impairment.Methods: An exploratory analysis of data from a randomized, placebo-controlled, duloxetine-referenced study (NCT01564862) involving 529 patients with moderate to severe MDD treated once-daily with vortioxetine 10/20 mg, duloxetine 60 mg, or placebo for 8 weeks. Analysis of the University of California, San Diego Performance-based Skills Assessment (UPSA) composite scores stratified patients into subgroups by baseline functional impairment and assessed clinically important differences using several cutoffs for change from baseline (CFB) (least-square means) in UPSA composite score. A path analysis was also conducted to determine the proportion of direct versus indirect effects of vortioxetine on functional capacity.Results: Vortioxetine significantly separated from placebo across different baseline levels of functional impairment, particularly at the ≤70 cutoff (mean difference = 5.9, 95% confidence interval, 1.5-10.4). A greater proportion of patients treated with vortioxetine than placebo exhibited UPSA composite score response at each threshold analyzed and were classified as responders based on UPSA CFB of ≥7 (p = 0.006) or ≥9 (p = 0.016). No significant effects were observed for duloxetine versus placebo for any baseline levels of functional impairment or response thresholds. Path analysis demonstrated that 96.9% of the effects on functional capacity can be directly attributed to the treatment effect of vortioxetine and are not mediated by improvements in depressive symptoms as measured by MADRS.Conclusion: The effects of vortioxetine on functional capacity is robust across different level of functional impairment in patients with MDD. The effect on functional capacity was largely independent of the effect on depressive symptoms. Trial Registration: ClinicalTrials.gov identifier: NCT01564862: https://clinicaltrials.gov/ct2/show/NCT01564862; European Clinical Trials Database [EudraCT] Number 2011-005298-22: https://www.clinicaltrialsregister.eu/ctr-search/trial/2011-005298-22/DE.
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Affiliation(s)
- William Jacobson
- Clinical Science, Takeda Development Center Americas, Inc, Deerfield, IL, USA
| | - Wei Zhong
- CNS Statistics, Takeda Development Center Americas, Inc, Deerfield, IL, USA
| | - George G Nomikos
- Clinical Science, Takeda Development Center Americas, Inc, Deerfield, IL, USA
| | | | - Christina Kurre Olsen
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, FL, USA
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, FL, USA
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Fuller JS, Young MA. Assessing impairment using a configural measure. METHODOLOGICAL INNOVATIONS 2019. [DOI: 10.1177/2059799119890794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Assessing impairment in daily functioning is an important part of a mental health evaluation and of monitoring progress in treatment. The Seasonality Assessment Form includes five yes/no impairment items written to reflect the ways that patients intuitively describe their levels of impairment. However, the items are not mutually exclusive and are not summative so that impairment severity is represented by the configural pattern of responses. This article used configural and graphical methods to examine the nature of response patterns and how to use them to generate an impairment severity score.
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Long-term functioning outcomes are predicted by cognitive symptoms in working patients with major depressive disorder treated with vortioxetine: results from the AtWoRC study. CNS Spectr 2019; 24:616-627. [PMID: 30802419 DOI: 10.1017/s1092852919000786] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE AtWoRC (Assessment in Work productivity and the Relationship with Cognitive symptoms) was an interventional, open-label, Canadian study (NCT02332954) designed to assess the association between cognitive symptoms and workplace productivity in working patients with major depressive disorder (MDD) receiving vortioxetine. METHODS Eligible patients with MDD received vortioxetine (10-20 mg/day) and were assessed over 52 weeks at visits emulating a real-life setting (n = 199). Partial correlation between changes in patient-reported cognitive symptoms (20-item Perceived Deficits Questionnaire-Depression; PDQ-D-20) and workplace productivity (Work Limitations Questionnaire; WLQ) was assessed at 12 and 52 weeks. Additional assessments included depression severity, cognitive performance, and patient-reported functioning. Structural equations model (SEM) analyses assessed causal relationships between changes in measures of cognition and functioning over time, adjusted for improvements in depressive symptoms. RESULTS Statistically significant improvements in all outcomes from baseline to week 52 were seen in the overall population and both subgroups (first treatment and switch). Response and remission rates were 77% and 56%, respectively. Improvements in PDQ-D-20 and WLQ productivity loss scores at weeks 12 and 52 were significantly correlated. SEM analyses found patient-rated cognitive symptoms (PDQ-D-20) at weeks 12 and 26 were significantly predictive (p < 0.05) of patient-reported functioning (Sheehan Disability Scale) at the subsequent visit. Depression severity and objectively measured cognitive performance did not significantly predict functional outcomes at any timepoint. CONCLUSION These results demonstrate the long-term benefits of vortioxetine treatment in working patients with MDD and emphasize the strong association between cognitive symptoms and functioning in a real-world setting.
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Cormack F, McCue M, Taptiklis N, Skirrow C, Glazer E, Panagopoulos E, van Schaik TA, Fehnert B, King J, Barnett JH. Wearable Technology for High-Frequency Cognitive and Mood Assessment in Major Depressive Disorder: Longitudinal Observational Study. JMIR Ment Health 2019; 6:e12814. [PMID: 31738172 PMCID: PMC6887827 DOI: 10.2196/12814] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 07/03/2019] [Accepted: 08/07/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Cognitive symptoms are common in major depressive disorder and may help to identify patients who need treatment or who are not experiencing adequate treatment response. Digital tools providing real-time data assessing cognitive function could help support patient treatment and remediation of cognitive and mood symptoms. OBJECTIVE The aim of this study was to examine feasibility and validity of a wearable high-frequency cognitive and mood assessment app over 6 weeks, corresponding to when antidepressant pharmacotherapy begins to show efficacy. METHODS A total of 30 patients (aged 19-63 years; 19 women) with mild-to-moderate depression participated in the study. The new Cognition Kit app was delivered via the Apple Watch, providing a high-resolution touch screen display for task presentation and logging responses. Cognition was assessed by the n-back task up to 3 times daily and depressed mood by 3 short questions once daily. Adherence was defined as participants completing at least 1 assessment daily. Selected tests sensitive to depression from the Cambridge Neuropsychological Test Automated Battery and validated questionnaires of depression symptom severity were administered on 3 occasions (weeks 1, 3, and 6). Exploratory analyses examined the relationship between mood and cognitive measures acquired in low- and high-frequency assessment. RESULTS Adherence was excellent for mood and cognitive assessments (95% and 96%, respectively), did not deteriorate over time, and was not influenced by depression symptom severity or cognitive function at study onset. Analyses examining the relationship between high-frequency cognitive and mood assessment and validated measures showed good correspondence. Daily mood assessments correlated moderately with validated depression questionnaires (r=0.45-0.69 for total daily mood score), and daily cognitive assessments correlated moderately with validated cognitive tests sensitive to depression (r=0.37-0.50 for mean n-back). CONCLUSIONS This study supports the feasibility and validity of high-frequency assessment of cognition and mood using wearable devices over an extended period in patients with major depressive disorder.
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Affiliation(s)
- Francesca Cormack
- Cambridge Cognition, Cambridge, United Kingdom
- Cognition Kit, Cambridge, United Kingdom
| | - Maggie McCue
- Takeda Pharmaceuticals USA, Deerfield, IL, United States
| | - Nick Taptiklis
- Cambridge Cognition, Cambridge, United Kingdom
- Cognition Kit, Cambridge, United Kingdom
| | - Caroline Skirrow
- Cambridge Cognition, Cambridge, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Emilie Glazer
- Cognition Kit, Cambridge, United Kingdom
- Ctrl Group, London, United Kingdom
| | - Elli Panagopoulos
- Cognition Kit, Cambridge, United Kingdom
- Ctrl Group, London, United Kingdom
| | | | - Ben Fehnert
- Cognition Kit, Cambridge, United Kingdom
- Ctrl Group, London, United Kingdom
| | - James King
- Cognition Kit, Cambridge, United Kingdom
- Ctrl Group, London, United Kingdom
| | - Jennifer H Barnett
- Cambridge Cognition, Cambridge, United Kingdom
- Cognition Kit, Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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Depressive Symptomatology, Presenteeism Productivity, and Quality of Life: A Moderated Mediation Model. J Occup Environ Med 2019; 60:301-308. [PMID: 29252917 DOI: 10.1097/jom.0000000000001253] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: In this study, we intend to test if presenteeism productivity influences the relationship between depressive symptoms and quality of life and also if this relation is conditional upon levels of information processing speed. Data were collected from 231 participants who completed a neuropsychological test and self-reported measures. Results revealed a significant indirect effect and a significant moderation effect. The association between depressive symptoms and presenteeism productivity was moderated by information processing speed only in their medium and high levels. Our findings suggest that individuals with higher levels of processing speed may have more difficulty in focusing on work without being distracted by health problems. The present investigation has made a significant contribution to the existing literature about cognitive function and productivity in workers with depressive symptomatology and its effects on their quality of life.
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Semkovska M, Quinlivan L, O'Grady T, Johnson R, Collins A, O'Connor J, Knittle H, Ahern E, Gload T. Cognitive function following a major depressive episode: a systematic review and meta-analysis. Lancet Psychiatry 2019; 6:851-861. [PMID: 31422920 DOI: 10.1016/s2215-0366(19)30291-3] [Citation(s) in RCA: 291] [Impact Index Per Article: 58.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Substantial evidence suggests that cognitive deficits might persist after remission of a major depressive episode. However, results are inconsistent relative to the importance, pattern, severity, and moderating factors of this impairment. We aimed to determine how cognitive function following a major depressive episode compares with normal function, to specify the pattern and severity of persistent cognitive dysfunctions, and to examine the potential moderator effect of ten prespecified clinical and demographic variables. METHODS We did a systematic review and meta-analysis of the published research. We searched systematically MEDLINE, Embase, PsycARTICLES, PsycINFO, the Cochrane Library, and relevant reviews identified by our database search, for research published from Jan 1, 1972, up to Jan 31, 2018, for studies of patients with past depression. We included all independent studies of patients who were assessed while in remission from a major depressive episode with at least one cognitive test, with inclusion of a healthy control group assessed with either the same test(s) as the major depressive episode group or with a standardised test with published age-stratified normative data. The main outcome was the difference in cognitive performance between major depressive episode remitters and healthy controls. Effect sizes were calculated using random-effects models for cognitive outcomes classified into 18 standard domains. Moderators of between-study variability were assessed using mixed-effects subgroup analyses and meta-regressions. FINDINGS Of 10 126 citations identified by our search, 75 cognitive variables from 252 eligible studies (11 882 major depressive episode remitters and 8533 healthy controls) were included in our meta-analysis. Significant deficits following major depressive episode remission were observed in 55 (73%) of the 75 cognitive variables. These deficits (in the domains of processing speed, visual selective attention, working memory, verbal learning, and executive functioning), were generally small (30 [40%] of the 75 variables) or medium (22 [29%]) in size, although three long-term memory variables showed large deficits: g=-0·81 [95% CI -1·01 to -0·61] for logical memory immediate recall, g=-0·88 [-1·19 to -0·57] for logical memory delayed recall, and g=-0·84 [-1·18 to -0·50] for Cambridge Neuropsychological Test Automated Battery pattern recognition latency. Auditory attention, general autobiographical memory, inhibition ability unconstrained by speed, and intellectual functioning unconstrained by speed were equivalent between major depressive episode remitters and matched controls. The number of previous depressive episodes explained heterogeneity in the majority of variables (z=-2·06 [p=0·039] to z=-4·26 [p<0·0001]). INTERPRETATION Deficits in selective attention, working memory, and long-term memory persist in remission from a major depressive episode and worsen with repeated episodes. Depression treatments, including relapse prevention, need to target these cognitive functions to optimise prognosis. FUNDING None.
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Affiliation(s)
- Maria Semkovska
- Department of Psychology, Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Lisa Quinlivan
- Department of Psychology, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Tara O'Grady
- Department of Psychology, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Rebecca Johnson
- Department of Psychology, University of Strathclyde, Glasgow, UK
| | - Aisling Collins
- Department of Psychology, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Jessica O'Connor
- Department of Psychology, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Hannah Knittle
- Department of Psychology, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Elayne Ahern
- Department of Psychology, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Taylor Gload
- Department of Psychology, Ursinus College, Collegeville, PA, USA
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A Hot-Cold Cognitive Model of Depression: Integrating the Neuropsychological Approach Into the Cognitive Theory Framework. CLINICAL PSYCHOLOGY IN EUROPE 2019. [DOI: 10.32872/cpe.v1i3.34396] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In the 50 years following Beck’s cognitive theory, empirical research has consistently supported the role of dysfunctional, ‘hot’ cognition in the onset and maintenance of major depressive disorder. Compromised ‘cold’ cognition in attention, memory, and executive control abilities, independent of the affective state, has attracted much clinical interest for its role throughout the course of illness and into remission. We propose integrating cold cognition into Beck’s cognitive theory framework to account for the complementary roles of both hot and cold cognition in depression onset and maintenance.
A critical review of cognitive research was conducted to inform an integrated hot-cold cognitive model of depression.
Cold cognitive deficits likely act as a gateway to facilitate the activation and expression of the hot cognitive biases through a weakened ability to attend, retrieve, and critically assess information. Cold deficits become exacerbated by the negative mood state, essentially ‘becoming hot’, lending to maladaptive emotion regulation through ruminative processes. Depleted cognitive resources contribute to the manifestation of further deficit in problem-solving ability in everyday life, which in itself, may act as a stressor for the onset of recurrent episodes, perpetuating the depressive cycle.
We discuss the interaction between hot and cold cognition within the cognitive theory framework and the potential of complementary hot-cold pathways to elucidate novel means of prevention and treatment for depression.
Dysfunction in hot (emotion-dependent) and cold (emotion-independent) cognition has been demonstrated in depression, but psychological treatment has largely focused on hot cognition only.
Hot and cold cognition are complementary processes throughout the activation and maintenance of depressive schemas and biases, necessitating the consideration of both hot and cold cognitive aspects to disrupt the depressive cycle.
The proposed hot-cold cognitive model shows promise to stimulate new research avenues for the prevention and treatment of depression.
Dysfunction in hot (emotion-dependent) and cold (emotion-independent) cognition has been demonstrated in depression, but psychological treatment has largely focused on hot cognition only.
Hot and cold cognition are complementary processes throughout the activation and maintenance of depressive schemas and biases, necessitating the consideration of both hot and cold cognitive aspects to disrupt the depressive cycle.
The proposed hot-cold cognitive model shows promise to stimulate new research avenues for the prevention and treatment of depression.
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Coleman MY, Cain SW. Eveningness is associated with greater subjective cognitive impairment in individuals with self-reported symptoms of unipolar depression. J Affect Disord 2019; 256:404-415. [PMID: 31228792 DOI: 10.1016/j.jad.2019.05.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 04/08/2019] [Accepted: 05/27/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Eveningness is associated with depression diagnosis and increased depressive symptom severity. Time-of-day preference has been linked with differences in cognitive function in the general population, with cognitive difficulties being a major factor in psychosocial impairment in depression. We therefore investigated the impact of time-of-day preference and self-reported depressed state on subjective cognitive function. METHODS Participants over the age of 18 with a self-reported history of depression completed an online questionnaire. They provided demographic and mental health information, and completed self-report scales assessing depression symptoms, time-of-day preference, and cognition. Participants were classified as "currently" or "previously depressed" based on self-reported symptoms, and as having a morning, neither, or evening time-of-day preference. RESULTS A total of 804 participants reporting a history of unipolar depression were included. Currently-depressed participants reported more cognitive difficulties in all areas measured. Evening types reported more complex attentional and retrospective memory difficulties than neither types, and reported more executive and prospective memory difficulties than both neither and morning types. There was an additive effect of mood state and time-of-day preference, with self-reported depressed evening types reporting the most cognitive problems. LIMITATIONS Depression history, time-of-day preference, and cognitive function were assessed using unsupervised self-report measures. Time-of-day preference does not necessarily reflect the physiological circadian system. CONCLUSIONS Both depressed state and evening preference were individually associated with subjective cognitive complaints in people with a self-reported history of unipolar depression. The additive effect of poor mood and eveningness is important given the high prevalence of eveningness in depression. Assessment of time-of-day preference could help to identify those susceptible to cognitive symptoms, and inform treatment.
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Affiliation(s)
- Michelle Y Coleman
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Clayton, VIC 3800, Australia
| | - Sean W Cain
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Clayton, VIC 3800, Australia.
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Abo Aoun M, Meek BP, Modirrousta M. Cognitive profiles in major depressive disorder: Comparing remitters and non-remitters to rTMS treatment. Psychiatry Res 2019; 279:55-61. [PMID: 31302352 DOI: 10.1016/j.psychres.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 01/04/2023]
Abstract
Major Depressive Disorder (MDD) is typically accompanied by cognitive impairment. Repetitive Transcranial Magnetic Stimulation (rTMS) treatment for MDD involves stimulation of the dorsolateral prefrontal cortex which plays an important role in cognition. This study aimed to identify differences in cognitive profiles between remitters and non-remitters to rTMS at baseline and across treatment. 25 patients with MDD performed cognitive tasks at baseline and after 6, 12 and 30 sessions of rTMS. At baseline, there was no difference in simple reaction time (RT) between groups, but remitters (n = 13) showed faster RTs than non-remitters (n = 12) in the Switch and No-Switch conditions of Task Switching. Across sessions, remitters showed a decrease in 3-Back omission errors and RTs to 3-Back, Stroop's Congruent and Incongruent, and Task Switching's Switch and No-Switch conditions, whereas non-remitters only showed improvements in Stroop Congruent and Incongruent RTs. Baseline and final scores on the Hamilton Depression Rating Scale were positively correlated with Switch and No-Switch RTs. This study demonstrates that eventual remitters to rTMS treatment for MDD perform better in cognitive tasks requiring shifting attention, and this difference is observable prior to the start of treatment. Remitters also show improvement in both their mood and cognitive performance.
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Affiliation(s)
| | | | - Mandana Modirrousta
- St Boniface General Hospital, Winnipeg, MB, R2H2A6, Canada; University of Manitoba, Department of Psychiatry, Winnipeg, MB, Canada.
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The glycine site of NMDA receptors: A target for cognitive enhancement in psychiatric disorders. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:387-404. [PMID: 30738126 DOI: 10.1016/j.pnpbp.2019.02.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/29/2019] [Accepted: 02/01/2019] [Indexed: 01/05/2023]
Abstract
Cognitive dysfunction is a principal determinant of functional impairment in major depressive disorder (MDD) and often persists during periods of euthymia. Abnormalities in the glutamate system, particularly in N-methyl-d-aspartate receptors (NMDARs) activity, have been shown to contribute to both mood and cognitive symptoms in MDD. The current narrative review aims to evaluate the potential pro-cognitive effects of targeting the glycine site of NMDARs in the treatment of psychiatric disorders, with a special focus on how these results may apply to MDD. Literature databases were searched from inception to May 2018 for relevant pre-clinical and clinical studies evaluating antidepressant and pro-cognitive effects of NMDAR glycine site modulators in both MDD and non-MDD samples. Six glycine site modulators with pro-cognitive and antidepressant properties were identified: d-serine (co-agonist), d-cycloserine (partial agonist), d-alanine (co-agonist), glycine (agonist), sarcosine (co-agonist) and rapastinel (partial agonist). Preclinical animal studies demonstrated improved neuroplasticity and pro-cognitive effects with these agents. Numerous proof-of-concept clinical trials demonstrated pro-cognitive and antidepressant effects trans-diagnostically (e.g., in healthy participants, MDD, schizophrenia, anxiety disorders, major neurocognitive disorders). The generalizability of these clinical studies was limited by the small sample sizes and the paucity of studies directly evaluating cognitive effects in MDD samples, as most clinical trials were in non-MDD samples. Taken together, preliminary results suggest that the glycine site of NMDARs is a promising target to ameliorate symptoms of depression and cognitive dysfunction. Additional rigorously designed clinical studies are required to determine the cognitive effects of these agents in MDD.
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Chokka P, Bougie J, Rampakakis E, Proulx J. Assessment in Work Productivity and the Relationship with Cognitive Symptoms (AtWoRC): primary analysis from a Canadian open-label study of vortioxetine in patients with major depressive disorder (MDD). CNS Spectr 2019; 24:338-347. [PMID: 29792585 PMCID: PMC6676443 DOI: 10.1017/s1092852918000913] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/21/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The Assessment in Work Productivity and the Relationship with Cognitive Symptoms (AtWoRC) study aimed to assess the association between cognitive symptoms and work productivity in gainfully employed patients receiving vortioxetine for a major depressive episode (MDE). METHODS Patients diagnosed with major depressive disorder (MDD) and treated with vortioxetine independently of study enrollment were assessed over 52 weeks at visits that emulated a real-life setting. Patients were classified as those receiving vortioxetine as the first treatment for their current MDE (first treatment) or having shown inadequate response to a previous antidepressant (switch). The primary endpoint was the correlation between changes in patient-reported cognitive symptoms (20-item Perceived Deficits Questionnaire [PDQ-D-20]) and changes in work productivity loss (Work Limitations Questionnaire [WLQ]) at week 12. Additional assessments included changes in symptom and disease severity, cognitive performance, functioning, work loss, and safety. RESULTS In the week 12 primary analysis, 196 eligible patients at 26 Canadian sites were enrolled, received at least one treatment dose, and attended at least one postbaseline study visit. This analysis demonstrated a significant, strong correlation between PDQ-D-20 and WLQ productivity loss scores (r=0.634; p<0.001), and this correlation was significant in both first treatment and switch patients (p<0.001). A weaker correlation between Digit Symbol Substitution Test and WLQ scores was found (r=-0.244; p=0.003). CONCLUSION At 12 weeks, improvements in cognitive dysfunction were significantly associated with improvements in workplace productivity in patients with MDD, suggesting a role for vortioxetine in functional recovery in MDD.
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Affiliation(s)
- Pratap Chokka
- Grey Nuns Community Hospital, Edmonton, Alberta, Canada
| | | | | | - Jean Proulx
- Lundbeck Canada Inc., Montreal, Quebec, Canada
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Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Characterize cognitive dysfunction in patients with major depressive disorder.• Evaluate approaches to treating cognitive dysfunction in patients with major depressive disorder. ABSTRACT Cognitive dysfunction is a core psychopathological domain in major depressive disorder (MDD) and is no longer considered to be a pseudo-specific phenomenon. Cognitive dysfunction in MDD is a principal determinant of patient-reported outcomes, which, hitherto, have been insufficiently targeted with existing multimodal treatments for MDD. The neural structures and substructures subserving cognitive function in MDD overlap with, yet are discrete from, those subserving emotion processing and affect regulation. Several modifiable factors influence the presence and extent of cognitive dysfunction in MDD, including clinical features (e.g., episode frequency and illness duration), comorbidity (e.g., obesity and diabetes), and iatrogenic artefact. Screening and measurement tools that comport with the clinical ecosystem are available to detect and measure cognitive function in MDD. Notwithstanding the availability of select antidepressants capable of exerting procognitive effects, most have not been sufficiently studied or rigorously evaluated. Promising pharmacological avenues, as well as psychosocial, behavioral, chronotherapeutic, and complementary alternative approaches, are currently being investigated.
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Vicent-Gil M, Raventós B, Marín-Martínez ED, González-Simarro S, Martínez-Arán A, Bonnin CDM, Trujols J, Pérez-Blanco J, de Diego-Adeliño J, Puigdemont D, Serra-Blasco M, Cardoner N, Portella MJ. Testing the efficacy of INtegral Cognitive REMediation (INCREM) in major depressive disorder: study protocol for a randomized clinical trial. BMC Psychiatry 2019; 19:135. [PMID: 31060604 PMCID: PMC6501398 DOI: 10.1186/s12888-019-2117-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/12/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Given the limitation of pharmacological treatments to treat cognitive symptoms in patients with Major Depressive Disorder (MDD), cognitive remediation programs has been proposed as a possible procognitive intervention but findings are not conclusive. This study investigates the efficacy of an INtegral Cognitive REMediation (INCREM) that includes a combination of a Functional Remediation (FR) strategy plus a Computerized Cognitive Training (CCT) in order to improve not only cognitive performance but also the psychosocial functioning and the quality of life. METHODS A single blind randomized controlled clinical trial in 81 patients with a diagnosis of MDD in clinical remission or in partial remission. Participants will be randomized to one of three conditions: INCREM (FR + CCT), Psychoeducation plus online games and Treatment As Usual (TAU). Intervention will consist in 12 group sessions, of approximately 110 min once a week. The primary outcome measure will be % of change in psychosocial functioning after treatment measured by the Functional Assessment Short Test (FAST); additionally, number of sick leaves and daily activities will also be recorded as pragmatic outcomes. DISCUSSION To our knowledge, this is the first randomized controlled clinical trial using a combination of two different approaches (FR + CCT) to treat the present cognitive deficits and to promote their improvements into a better psychosocial functioning. TRIAL REGISTRATION Clinical Trials NCT03624621 . Date registered 10th of August 2018 and last updated 24th August 2018.
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Affiliation(s)
- Muriel Vicent-Gil
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació Biomèdica Sant Pau (IBB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni Ma Claret 167, 08025 Barcelona, Catalonia Spain
- Mental Health Unit, Hospital Universitari Parc Taulí, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Catalonia Spain
| | - Beatriz Raventós
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació Biomèdica Sant Pau (IBB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni Ma Claret 167, 08025 Barcelona, Catalonia Spain
| | - Eduardo D. Marín-Martínez
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació Biomèdica Sant Pau (IBB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni Ma Claret 167, 08025 Barcelona, Catalonia Spain
| | - Sara González-Simarro
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació Biomèdica Sant Pau (IBB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni Ma Claret 167, 08025 Barcelona, Catalonia Spain
| | - Anabel Martínez-Arán
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), IDIBAPS, University of Barcelona (UB), Barcelona, Catalonia Spain
| | - Caterina del Mar Bonnin
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), IDIBAPS, University of Barcelona (UB), Barcelona, Catalonia Spain
| | - Joan Trujols
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació Biomèdica Sant Pau (IBB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni Ma Claret 167, 08025 Barcelona, Catalonia Spain
| | - Josefina Pérez-Blanco
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació Biomèdica Sant Pau (IBB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni Ma Claret 167, 08025 Barcelona, Catalonia Spain
| | - Javier de Diego-Adeliño
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació Biomèdica Sant Pau (IBB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni Ma Claret 167, 08025 Barcelona, Catalonia Spain
| | - Dolors Puigdemont
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació Biomèdica Sant Pau (IBB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni Ma Claret 167, 08025 Barcelona, Catalonia Spain
| | - Maria Serra-Blasco
- Mental Health Unit, Hospital Universitari Parc Taulí, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Catalonia Spain
| | - Narcís Cardoner
- Mental Health Unit, Hospital Universitari Parc Taulí, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Catalonia Spain
| | - Maria J. Portella
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació Biomèdica Sant Pau (IBB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni Ma Claret 167, 08025 Barcelona, Catalonia Spain
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Petersen JZ, Porter RJ, Miskowiak KW. Clinical characteristics associated with the discrepancy between subjective and objective cognitive impairment in depression. J Affect Disord 2019; 246:763-774. [PMID: 30623822 DOI: 10.1016/j.jad.2018.12.105] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/17/2018] [Accepted: 12/24/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with unipolar disorder (UD) commonly experience cognitive dysfunction during symptomatic and remitted phases. However, it is not necessarily the patients with the greatest subjective complaints, who display the largest objectively-measured deficits on neuropsychological tests. OBJECTIVE This report investigated the demographic and clinical factors associated with the discrepancy between subjective and objective measures of cognition in two separate depressed patient populations in Denmark and New Zealand, respectively, using a new methodology. METHODS Data from 137 depressed patients and 103 healthy controls including neuropsychological test scores, self-reported cognitive difficulties, and ratings of mood were pooled from two studies conducted in Copenhagen, Denmark, and Christchurch, New Zealand, respectively. Cognitive discrepancy scores were calculated using a novel methodology, with positive values indicating disproportionately more subjective than objective difficulties (i.e., "sensitivity") and negative values indicating more objective than subjective impairments (i.e., "stoicism"). RESULTS In the Danish partially remitted patient sample, greater 'sensitivity' was associated with more subsyndromal depression severity (standardized Beta (std. β )= 0.4, p < 0.01)), illness duration (std. β = 0.4, p < 0.01), and younger age (std. β = 0.6, p < 0.001). This association was replicated in the New Zealand sample of more symptomatic patients (p-values ≤ 0.05). LIMITATIONS The cross-sectional design hampered causal inferences. We had obtained different measures of objective and subjective cognition from the two studies. CONCLUSIONS Patients with more depressive symptoms and younger age overreported cognitive impairments across all illness states. The use of an objective cognition screener thus seems particularly relevant for these patients to assess whether subjective complaints are accompanied by measurable cognitive deficits.
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Affiliation(s)
- J Z Petersen
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet Dep. 6233, Blegdamsvej 9, DK-2100, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, DK-1353, Copenhagen, Denmark.
| | - R J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
| | - K W Miskowiak
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet Dep. 6233, Blegdamsvej 9, DK-2100, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, DK-1353, Copenhagen, Denmark.
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Liu W, Zhou Y, Zheng W, Wang C, Zhan Y, Li H, Chen L, Zhao C, Ning Y. Mediating effect of neurocognition between severity of symptoms and social-occupational function in anxious depression. J Affect Disord 2019; 246:667-673. [PMID: 30611065 DOI: 10.1016/j.jad.2018.12.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/26/2018] [Accepted: 12/25/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is associated with neurocognitive impairment and reduced social-occupational function. However, neurocognition and social-occupational function in patients with anxious depression have been under-investigated. An increasing number of studies have demonstrated that neurocognition plays an important role in social-occupational function. The objective of this study was to investigate the association of severity of symptoms, neurocognition and social-occupational function in patients with anxious depression. METHOD Using a cross-sectional design, 214 patients with MDD were recruited consecutively and evaluated using the 17-item Hamilton Depression Rating scale (HAMD-17), the MATRICS Consensus Cognitive Battery (MCCB) and the Global Assessment of Functioning (GAF). RESULT The prevalence of anxious depression in MDD patients was 64.5%. Compared to non-anxious subjects, the anxious group had more severe symptoms. Moreover, in the anxious group, social-occupational function was associated with several domains of symptoms and neurocognition, while social-occupational function was associated with only one aspect of depressive symptoms (cognitive disturbance) in the non-anxious group. In addition, there was a mediating effect of neurocognition on the association between the severity of symptoms and social-occupational function in the anxious group. LIMITATIONS The major limitation of the present study is the use of a cross-sectional design that is unable to illuminate causal relationships. CONCLUSION Our results suggest that the severity of symptoms is negatively associated with neurocognition and social-occupational function and that neurocognition is positively associated with social-occupational function in patients with anxious depression.
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Affiliation(s)
- Weijian Liu
- Southern Medical University, Guangzhou, China; The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China
| | - Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China
| | - Chengyu Wang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China
| | - Yanni Zhan
- Southern Medical University, Guangzhou, China; The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China
| | - Hanqiu Li
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China
| | - Lijian Chen
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China
| | - Cunyou Zhao
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Yuping Ning
- Southern Medical University, Guangzhou, China; The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Metal Disorders, Guangzhou, China.
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Abstract
Cognitive dysfunction is a symptomatic domain identified across many mental disorders. Cognitive deficits in individuals with major depressive disorder (MDD) contribute significantly to occupational and functional disability. Notably, cognitive subdomains such as learning and memory, executive functioning, processing speed, and attention and concentration are significantly impaired during, and between, episodes in individuals with MDD. Most antidepressants have not been developed and/or evaluated for their ability to directly and independently ameliorate cognitive deficits. Multiple interacting neurobiological mechanisms (eg, neuroinflammation) are implicated as subserving cognitive deficits in MDD. A testable hypothesis, with preliminary support, posits that improving performance across cognitive domains in individuals with MDD may improve psychosocial function, workplace function, quality of life, and other patient-reported outcomes, independent of effects on core mood symptoms. Herein we aim to (1) provide a rationale for prioritizing cognitive deficits as a therapeutic target, (2) briefly discuss the neurobiological substrates subserving cognitive dysfunction, and (3) provide an update on current and future treatment avenues.
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Averill IRE, Beaglehole B, Douglas KM, Jordan J, Crowe MT, Inder M, Lacey CJ, Frampton CM, Bowie CR, Porter RJ. Activation therapy for the treatment of inpatients with depression - protocol for a randomised control trial compared to treatment as usual. BMC Psychiatry 2019; 19:52. [PMID: 30709391 PMCID: PMC6359820 DOI: 10.1186/s12888-019-2038-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/25/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Inpatients with depression have a poor long term outcome with high rates of suicide, high levels of morbidity and frequent re-admission. Current treatment often relies on pharmacological intervention and focuses on observation to maintain safety. There is significant neurocognitive deficit which is linked to poor functional outcomes. As a consequence, there is a need for novel psychotherapeutic interventions that seek to address these concerns. METHODS We combined cognitive activation and behavioural activation to create activation therapy (AT) for the treatment of inpatient depression and conducted a small open label study which demonstrated acceptability and feasibility. We propose a randomised controlled trial which will compare treatment as usual (TAU) with TAU plus activation therapy for adult inpatients with a major depressive episode. The behavioural activation component involves therapist guided re-engagement with previously or potentially rewarding activities. The cognitive activation aspect utilises computer based exercises which have been shown to improve cognitive function. DISCUSSION The proposed randomised controlled trial will examine whether or not the addition of this therapy to TAU will result in a reduced re-hospitalisation rate at 12 weeks post discharge. Subjective change in activation and objectively measured change in activity levels will be rated, and the extent of change to neurocognition will be assessed. TRIAL REGISTRATION Unique trial number: U1111-1190-9517. Australian New Zealand Clinical Trials Registry (ANZCTR) number: ACTRN12617000024347p .
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Affiliation(s)
- Ian R. E. Averill
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand ,0000 0001 0040 0934grid.410864.fSpecialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Ben Beaglehole
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand ,0000 0001 0040 0934grid.410864.fSpecialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Katie M. Douglas
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Jennifer Jordan
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Marie T. Crowe
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Maree Inder
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Cameron J. Lacey
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Christopher M. Frampton
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Christopher R. Bowie
- 0000 0004 1936 8331grid.410356.5Department of Psychology, Queen’s University, Kingston, Canada
| | - Richard J. Porter
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand ,0000 0001 0040 0934grid.410864.fSpecialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
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Alonso-Prieto E, Rubino C, Lucey M, Evans VC, Tam EM, Woo C, Iverson GL, Chakrabarty T, Yatham LN, Lam RW. Relationship between work functioning and self-reported cognitive complaints in patients with major depressive disorder treated with desvenlafaxine. Psychiatry Res 2019; 272:144-148. [PMID: 30583256 DOI: 10.1016/j.psychres.2018.12.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/09/2018] [Accepted: 12/09/2018] [Indexed: 10/27/2022]
Abstract
Patients with major depressive disorder (MDD) often report that cognitive difficulties, such as memory problems or poor concentration, interfere with their work functioning. We examined the association between self-reported cognitive complaints and work functioning in employed patients with MDD treated with desvenlafaxine. A sample of 36 adult outpatients with MDD completed subjective cognition (British Columbia Cognitive Complaints Inventory [BC-CCI]) and functioning scales (Sheehan Disability Scale [SDS]; Lam Employment Absence and Productivity Scale [LEAPS]; and Health and Work Performance Questionnaire [HPQ]) before and after 8 weeks of open-label treatment with flexibly-dosed desvenlafaxine (50-100 mg/day). Multiple regression analyses were used to assess the relationship between subjective cognitive measures and work functioning scales. Patients showed significant improvements in clinical, cognitive, and work functioning measures following treatment with desvenlafaxine. A predictive association was found between the BC-CCI and both the SDS and LEAPS, but not with the HPQ, when adjusted for depression severity. Self-report cognitive questionnaires can provide useful information to monitor changes in cognitive functioning over time and to predict improvement in work functioning outcomes.
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Affiliation(s)
- Esther Alonso-Prieto
- Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Cristina Rubino
- Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Megan Lucey
- Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Vanessa C Evans
- Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Edwin M Tam
- Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Cindy Woo
- Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Grant L Iverson
- Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, United States
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.
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Lin CH, Chou LS, Tang SH, Huang CJ. Do baseline WAIS-III subtests predict treatment outcomes for depressed inpatients receiving fluoxetine? Psychiatry Res 2019; 271:279-285. [PMID: 30513459 DOI: 10.1016/j.psychres.2018.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 09/06/2018] [Accepted: 09/13/2018] [Indexed: 10/28/2022]
Abstract
This study aimed to determine whether baseline WAIS-III subtests could be associated with treatment outcomes for patients with major depressive disorder (MDD) receiving a 6-week fluoxetine treatment. A total of 131 acutely ill MDD inpatients were enrolled to receive 20 mg of fluoxetine daily for 6 weeks. Eight WAIS-III subtests were administered at baseline. Symptom severity and functional impairment were assessed at baseline, and again at weeks 1, 2, 3, 4, and 6 using the 17-item Hamilton Depression Rating Scale (HAMD-17) and the Modified Work and Social Adjustment Scale (MWSAS), respectively. The generalized estimating equations method was used to analyze the influence of potential predictors over time on the HAMD-17 and MWSAS, after adjusting for covariates. Of the 131 participants, 104 (79.4%) who completed 8 WAIS-III subtests at baseline and had at least one post-baseline assessment were included in the analysis. Patients with lower forward digit span scores were more likely to have poor treatment outcomes, both measured by HAMD-17, and by MWSAS. Forward digit span may be clinically useful in identifying MDD patients with greater treatment difficulty in symptoms and functioning. Other neurocognitive tests to predict treatment outcome require further exploration.
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Affiliation(s)
- Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Shiu Chou
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Shu-Hui Tang
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Chun-Jen Huang
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
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Baune BT, Christensen MC. Differences in Perceptions of Major Depressive Disorder Symptoms and Treatment Priorities Between Patients and Health Care Providers Across the Acute, Post-Acute, and Remission Phases of Depression. Front Psychiatry 2019; 10:335. [PMID: 31178765 PMCID: PMC6537882 DOI: 10.3389/fpsyt.2019.00335] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/29/2019] [Indexed: 11/15/2022] Open
Abstract
Limited data exist on concordance between patients' and health care providers' (HCPs) perceptions regarding symptoms of major depressive disorder (MDD) and treatment priorities, particularly across disease phases. This study examined concordance during the acute, post-acute, and remission phases of MDD. In an online survey, 2,008 patients responded based on their experience with MDD, and 1,046 HCPs responded based on their clinical experience treating patients with MDD. Questions included symptom frequency and severity, treatment priorities, and impact on psychosocial functioning. Patients reported more frequently mood, physical, and cognitive symptoms than HCPs in the post-acute and remission phases and greater impact on psychosocial functioning. Patients reported that all these symptoms require high treatment priority across the phases of MDD, generally to a greater extent than HCPs. Patients also gave high emphasis to addressing impairment in psychosocial functioning early in the treatment course. A substantial difference in the effectiveness of treating symptoms of MDD between patients and HCPs was observed. This is the first study to quantify, broadly, differences in perceptions of MDD symptom prevalence, severity, and treatment priorities across MDD phases, and the study findings highlight a need for improved communication between patients and HCPs about symptoms, their impact on psychosocial functioning, and treatment priorities across phases.
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Affiliation(s)
- Bernhard T Baune
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany.,Department of Psychiatry, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.,Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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Cambridge OR, Knight MJ, Mills N, Baune BT. The clinical relationship between cognitive impairment and psychosocial functioning in major depressive disorder: A systematic review. Psychiatry Res 2018; 269:157-171. [PMID: 30149273 DOI: 10.1016/j.psychres.2018.08.033] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/12/2018] [Accepted: 08/12/2018] [Indexed: 11/18/2022]
Abstract
Cognitive deficits are frequently observed in major depressive disorder (MDD), as well as impaired long-term psychosocial functioning. However, the relationship between cognitive deficits and psychosocial functioning in MDD is under-investigated. We aim to systematically review the literature on the relationship between specific cognitive impairments and psychosocial functioning in MDD. We systematically reviewed English-language literature in PubMed, PsychINFO, Scopus and Web of Science using search terms related to psychosocial functioning. Additional studies were identified by searching reference lists. Following our inclusion/exclusion criteria, 28 studies were reviewed. Inclusion criteria included age (> 18), MDD diagnosed by standard tools (e.g., DSM-IV), use of cognitive and psychosocial assessments. Cross-sectional studies indicated that cognitive deficits in domains of executive functioning, attention, memory, and global cognition are associated with psychosocial dysfunction in domains of as quality of life, and social, occupational, and global functioning. The cognition-functioning relationship was also observed in longitudinal studies, showing that only specific cognitive domains affected psychosocial outcomes over the long-term course of illness. Older age and greater MDD symptom severity appear to enhance cognition-psychosocial dysfunction relationship, however little is known regarding the role of a number of other clinical factors (e.g., psychosis, illness duration).
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Affiliation(s)
- Olivia R Cambridge
- Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC 3010, AUSTRALIA
| | - Matthew J Knight
- Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC 3010, AUSTRALIA
| | - Natalie Mills
- Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC 3010, AUSTRALIA
| | - Bernhard T Baune
- Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC 3010, AUSTRALIA.
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Knight MJ, Air T, Baune BT. The role of cognitive impairment in psychosocial functioning in remitted depression. J Affect Disord 2018; 235:129-134. [PMID: 29655074 DOI: 10.1016/j.jad.2018.04.051] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 03/20/2018] [Accepted: 04/04/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cognitive dysfunction is a prevalent and disabling symptom of Major Depressive Disorder (MDD), and is often retained in the remitted stage of illness. Emerging evidence suggests that cognitive impairment may be associated with dysfunction in a number of psychosocial domains (e.g., workplace productivity, social relationships). The current study explored the relationship between cognition and psychosocial functioning in remitted MDD and in healthy controls. METHODS Data were obtained from 182 participants of the Cognitive Function and Mood Study (CoFaM-S), a cross-sectional study of cognition, mood, and social cognition in mood disorders. Participants' (Remitted MDD n = 72, Healthy n = 110) cognition was assessed with a battery of cognitive tests including the Repeatable Battery for the Assessment of Neuropsychological Function (RBANS) and other standard measures of cognition (e.g., The Tower of London task). Psychosocial functioning was clinically evaluated with the Functioning Assessment Short Test (FAST). RESULTS The results indicated that executive functioning was the strongest independent predictor of functioning in remitted MDD patients, whereas various cognitive domains predicted psychosocial functioning in healthy individuals. LIMITATIONS Psychosocial functioning was measured with a clinical interview, and was therefore reliant on clinicians' judgement of impairment, as opposed to more objective measures of functioning. CONCLUSIONS These findings suggest that executive cognition plays an important role in functional recovery in remitted depression, and may be a crucial target in adjunctive treatment.
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Affiliation(s)
- Mattew J Knight
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, 57 North Terrace, Adelaide, SA 5000, Australia.
| | - Tracy Air
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, 57 North Terrace, Adelaide, SA 5000, Australia.
| | - Bernhard T Baune
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, 57 North Terrace, Adelaide, SA 5000, Australia.
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Abstract
We investigated the discrepancy between competence and real-world performance in major depressive disorder (MDD) for adaptive and interpersonal behaviors, determining whether self-efficacy significantly predicts this discrepancy, after considering depressive symptoms. Forty-two participants (Mage = 37.64, 66.67% female) with MDD were recruited from mental health clinics. Competence, self-efficacy, and real-world functioning were evaluated in adaptive and interpersonal domains; depressive symptoms were assessed with the Beck Depression Inventory II. Hierarchical regression analysis identified predictors of functional disability and the discrepancy between competence and real-world functioning. Self-efficacy significantly predicted functioning in the adaptive and interpersonal domains over and above depressive symptoms. Interpersonal self-efficacy accounted for significant variance in the discrepancy between interpersonal competence and functioning beyond symptoms. Using a multilevel, multidimensional approach, we provide the first data regarding relationships among competence, functioning, and self-efficacy in MDD. Self-efficacy plays an important role in deployment of functional skills in everyday life for individuals with MDD.
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Vortioxetine reduces BOLD signal during performance of the N-back working memory task: a randomised neuroimaging trial in remitted depressed patients and healthy controls. Mol Psychiatry 2018; 23:1127-1133. [PMID: 28533517 PMCID: PMC5984095 DOI: 10.1038/mp.2017.104] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/31/2017] [Accepted: 02/02/2017] [Indexed: 12/29/2022]
Abstract
Cognitive dysfunction is common in depression during both acute episodes and remission. Vortioxetine is a novel multimodal antidepressant that has improved cognitive function including executive function in depressed patients in randomised placebo-controlled clinical trials. However, it is unclear whether vortioxetine is able to target directly the neural circuitry implicated in the cognitive deficits in depression. Remitted depressed (n=48) and healthy volunteers (n=48) were randomised to receive 14 days treatment with 20 mg vortioxetine or placebo in a double-blind design. The effects of treatment on functional magnetic resonance imaging responses during an N-back working memory task were assessed at baseline and at the end of treatment. Neuropsychological measures of executive function, speed and information processing, attention and learning and memory were examined with the Trail Making Test (TMT), Rey Auditory Learning Test and Digit Symbol Substitution Test before and after treatment; subjective cognitive function was assessed using the Perceived Deficits Questionnaire (PDQ). Compared with placebo, vortioxetine reduced activation in the right dorsolateral prefrontal cortex and left hippocampus during the N-back task compared with placebo. Vortioxetine also increased TMT-A performance and self-reported cognitive function on the PDQ. These effects were seen across both subject groups. Vortioxetine modulates neural responses across a circuit subserving working memory in a direction opposite to the changes described in depression, when performance is maintained. This study provides evidence that vortioxetine has direct effects on the neural circuitry supporting cognitive function that can be dissociated from its effects on the mood symptoms of depression.
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Baune BT, Sluth LB, Olsen CK. The effects of vortioxetine on cognitive performance in working patients with major depressive disorder: A short-term, randomized, double-blind, exploratory study. J Affect Disord 2018; 229:421-428. [PMID: 29331703 DOI: 10.1016/j.jad.2017.12.056] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/13/2017] [Accepted: 12/27/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Major Depressive Disorder (MDD) is a complex disease characterized by emotional, physical and cognitive symptoms. We explored the efficacy of vortioxetine versus placebo on outcomes of cognition, functioning and mood symptoms in working patients with depression, using paroxetine as an active reference. METHODS Gainfully employed patients (18-65 years, N = 152) with MDD were randomized 1:1:1 to 8 weeks' double-blind, parallel treatment either with vortioxetine (10mg/day) or paroxetine (20mg/day), or with placebo. The primary efficacy measure was the Digit Symbol Substitution Test (DSST), analyzed using a mixed model for repeated measurements, and the key secondary efficacy measure was the University of San Diego Performance-based Skills Assessment - Brief (UPSA-B), analyzed using analysis of covariance (last observation carried forward). RESULTS At week 8, DSST and UPSA-B performance had improved relative to baseline in all treatment groups, with no statistically significant differences between treatment groups. While improvements in mood were comparable for vortioxetine and paroxetine, numerical improvements in cognitive performance (DSST) were larger with vortioxetine. Vortioxetine significantly improved overall cognitive performance and clinician-rated functioning relative to placebo. The majority of adverse events were mild or moderate, with nausea being the most common adverse event for vortioxetine. LIMITATIONS Small sample sizes implied limited statistical power. CONCLUSION This explorative study showed no significant differences versus placebo in DSST or UPSA-B performance at week 8. However, secondary results support vortioxetine as an effective and well-tolerated antidepressant, supporting an added benefit for cognition and functioning, which could have particular therapeutic relevance for the working patient population.
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Affiliation(s)
- Bernhard T Baune
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Australia.
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