Network analysis of frontal lobe alpha asymmetry confirms the neurophysiological basis of four subtypes of depressive behavior

Introduction

Although depression is widespread carries a major disease burden, current treatments remain non-universally effective, arguably due to the heterogeneity of depression, and leading to the consideration of depressive "subtypes" or "depressive behavior subtypes." One such model of depressive behavior (DB) subtypes was investigated for its associations with frontal lobe asymmetry (FLA), using a different data analytic procedure than in previous research in this field.

Methods

100 community volunteers (54 males, 46 females) aged between 18 yr. and 75 years (M = 32.53 yr., SD = 14.13 yr) completed the Zung Self-rating Depression Scale (SDS) and underwent 15 min of eyes closed EEG resting data collection across 10 frontal lobe sites. DB subtypes were defined on the basis of previous research using the SDS, and alpha-wave (8-13 Hz) data produced an index of FLA. Data were examined via network analysis.

Results

Several network analyses were conducted, producing two models of the association between DB subtypes and FLA, confirming unique neurophysiological profiles for each of the four DB subtypes.

Discussion

As well as providing a firm basis for using these DB subtypes in clinical settings, these findings provide a reasonable explanation for the inconsistency in previous FLA-depression research.

Electronic Systems for Patients to Report and Manage Side Effects of Cancer Treatment: Systematic Review

BACKGROUND

There has been a dramatic increase in the development of electronic systems to support cancer patients to report and manage side effects of treatment from home. Systems vary in the features they offer to patients, which may affect how patients engage with them and how they improve patient-centered outcomes.

OBJECTIVE

This review aimed to (1) describe the features and functions of existing electronic symptom reporting systems (eg, symptom monitoring, tailored self-management advice), and (2) explore which features may be associated with patient engagement and patient-centered outcomes.

METHODS

The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) and followed guidelines from the Centre for Reviews and Dissemination (University of York, United Kingdom). Primary searches were undertaken of MEDLINE, Embase, PsycInfo, Web of Science, Cochrane Central Register of Controlled Trials, and the Health Technology Assessment databases. Secondary searches were undertaken by screening reference lists and citations. Two researchers applied broad inclusion criteria to identify and select relevant records. Data were extracted and summarized using Microsoft Excel. In order to meet the aims, the study selection, data extraction, and data synthesis comprised two stages: (1) identifying and characterizing available systems and (2) summarizing data on patient engagement and patient-centered outcomes.

RESULTS

We identified 77 publications relating to 41 distinct systems. In Stage 1, all publications were included (N=77). The features identified that supported clinicians and care were facility for health professionals to remotely access and monitor patient-reported data (24/41, 58%) and function to send alerts to health professionals for severe symptoms (17/41, 41%). Features that supported patients were facility for patients to monitor/review their symptom reports over time (eg, graphs) (19/41, 46%), general patient information about cancer treatment and side effects (17/41, 41%), tailored automated patient advice on symptom management (12/41, 29%), feature for patients to communicate with the health care team (6/41, 15%), and a forum for patients to communicate with one another (4/41, 10%). In Stage 2, only publications that included some data on patient engagement or patient-centered outcomes were included (N=29). A lack of consistency between studies in how engagement was defined, measured, or reported, and a wide range of methods chosen to evaluate systems meant that it was not possible to compare across studies or make conclusions on relationships with system features.

CONCLUSIONS

Electronic systems have the potential to help patients manage side effects of cancer treatment, with some evidence to suggest a positive effect on patient-centered outcomes. However, comparison across studies is difficult due to the wide range of assessment tools used. There is a need to develop guidelines for assessing and reporting engagement with systems, and a set of core outcomes for evaluation. We hope that this review will contribute to the field by introducing a taxonomy for characterizing system features.

TRIAL REGISTRATION

PROSPERO CRD42016035915; www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016035915.

A Web-Based Intervention to Reduce Distress After Prostate Cancer Treatment: Development and Feasibility of the Getting Down to Coping Program in Two Different Clinical Settings

Background

Distress after prostate cancer treatment is a substantial burden for up to one-third of men diagnosed. Physical and emotional symptoms and health service use can intensify, yet men are reticent to accept support. To provide accessible support that can be cost effectively integrated into care pathways, we developed a unique, Web-based, self-guided, cognitive-behavior program incorporating filmed and interactive peer support.

Objective

To assess feasibility of the intervention among men experiencing distress after prostate cancer treatment. Demand, acceptability, change in distress and self-efficacy, and challenges for implementation in clinical practice were measured.

Methods

A pre-post, within-participant comparison, mixed-methods research design was followed. Phase I and II were conducted in primary care psychological service and secondary care cancer service, respectively. Men received clinician-generated postal invitations: phase I, 432 men diagnosed <5 years; phase II, 606 men diagnosed <3.5 years. Consent was Web-based. Men with mild and moderate distress were enrolled. Web-based assessment included demographic, disease, treatment characteristics; distress (General Health Questionnaire-28); depression (Patient Health Questionnaire-9); anxiety (General Anxiety Disorder Scale-7); self-efficacy (Self-Efficacy for Symptom Control Inventory); satisfaction (author-generated, Likert-type questionnaire). Uptake and adherence were assessed with reference to the persuasive systems design model. Telephone interviews explored participant experience (phase II, n=10); interviews with health care professionals (n=3) explored implementation issues.

Results

A total of 135 men consented (phase I, 61/432, 14.1%; phase II, 74/606, 12.2%); from 96 eligible men screened for distress, 32% (30/96) entered the intervention (phase I, n=10; phase II, n=20). Twenty-four completed the Web-based program and assessments (phase I, n=8; phase II, n=16). Adherence for phase I and II was module completion rate 63% (mean 2.5, SD 1.9) versus 92% (mean 3.7, SD 1.0); rate of completing cognitive behavior therapy exercises 77% (mean 16.1, SD 6.2) versus 88% (mean 18.6, SD 3.9). Chat room activity occurred among 63% (5/8) and 75% (12/16) of men, respectively. In phase I, 75% (6/8) of men viewed all the films; in phase II, the total number of unique views weekly was 16, 11, 11, and 10, respectively. The phase II mood diary was completed by 100% (16/16) of men. Satisfaction was high for the program and films. Limited efficacy testing indicated improvement in distress baseline to post intervention: phase I, P=.03, r=−.55; phase II, P=.001, r=−.59. Self-efficacy improved for coping P=.02, r=−.41. Service assessment confirmed ease of assimilation into clinical practice and clarified health care practitioner roles.

Conclusions

The Web-based program is acceptable and innovative in clinical practice. It was endorsed by patients and has potential to positively impact the experience of men with distress after prostate cancer treatment. It can potentially be delivered in a stepped model of psychological support in primary or secondary care. Feasibility evidence is compelling, supporting further evaluative research to determine clinical and cost effectiveness.

Towards a new conceptualization of depression in older adult cancer patients: a review of the literature

OBJECTIVES

Identifying depression in older adults with cancer presents a set of unique challenges, as it combines the confounding influences of cancer and its treatment with the developmental changes associated with aging. This paper reviews the phenomenology of depression in older adults, and individuals diagnosed with cancer.

METHOD

PsychInfo, PubMed, Web of Science, and Google Scholar databases were searched for English-language studies addressing the phenomenology, symptoms, or assessment of depression in older adults and those with cancer.

RESULTS

The Diagnostic and Statistical Manual for Mental Disorders (DSM) criteria that appear to be relevant to both older adults and cancer patients are anhedonia, concentration difficulties, sleep disturbances, psychomotor retardation/agitation, and loss of energy. Possible alternative criteria that may be important considerations included constructs such as loss of purpose, loneliness, and irritability in older adults. Among cancer patients, tearfulness, social withdrawal, and not participating in treatment despite ability to do so were identified as potentially important symptoms.

CONCLUSIONS

Current DSM criteria may not adequately assess depression in older cancer patients and alternative criteria may be important to inform the understanding and identification of depression in this population. Enhancing diagnostic accuracy of depression is important as both the over-diagnosis and under-diagnosis is accompanied with significant costs. Thus, continued research exploring the phenomenology and identifying effective indicators of depression in older cancer patients is needed.

Screening tools for psychiatry disorders in cancer setting: Caution when using

This study evaluated sensitivity/specificity of self-report instruments for the screening of psychiatric disorders/symptoms in cancer outpatients like: current/past major depression, dysthymia, alcohol abuse and dependence, tobacco abuse and dependence, panic disorder, social anxiety disorder, generalized anxiety disorder, obsessive compulsive disorder, posttraumatic stress disorder, phobias, current mania, delusion and hallucination. First, 1384 patients responded to several self-assessment instruments. Then, 400 patients, were then interviewed by telephone to confirm the presence/absence of psychiatric diagnosis. The ROC analyses showed moderate/excellent specificity (Patient Health Questionnaire-4 (PHQ-4)=0.75-0.88, Generalized Anxiety Disorder (GAD-7)=0.77, Fast Alcohol Screening Test (FAST)=0.83-0.86, Fagerström Test for Nicotine Dependence (FTND)=0.72, Brief version of the Patient Health Questionnaire-Panic Disorder Module (Brief-PD)=0.75, and Self Reporting Questionnaire - psychosis items=(0.68-0.91) but low sensitivity (PHQ-4=0.53-0.54, GAD-7=0.52, FAST=0.48-0.58, FTND=0.97, and Brief-PD=0.66)). These results suggest that sensitivity indicators should be used with caution in the cancer clinical setting.

Psychosocial concerns of cancer patients in Singapore

AIMS

Psychosocial needs are high among cancer patients, and screening for these is recognized as integral to quality cancer care. This study identified the psychosocial needs of cancer patients at their first visit at a hematology-oncology clinic.

METHODS

Fifty-four new consecutive patients completed the Distress Thermometer and the Problem List, the Hospital Anxiety and Depression Scale, and the EuroQol Quality of Life Scale at their first visit to plan for chemotherapy. Data were analyzed with SPSS.

RESULTS

Analyses revealed that participants had an average of 2.8 ± 2.3 problems, with 82% having psychosocial needs. Emotional concerns formed the top four psychosocial needs of the cohort (worry 46%, fears 26%, nervousness 26%, sadness 24%), with the fifth being a practical concern (insurance/finance 22%). The former were more frequent among 41- to 50-year-olds and significantly correlated with distress scores. Practical concerns were significantly correlated with depressive symptoms. Family concerns were more significant in women. The overall score on the Problem List correlated with distress, anxious symptomatology and poorer quality of life scores.

CONCLUSIONS

Distress and psychosocial needs are high in cancer patients even at an early stage prior to chemotherapy. Attention to these needs is crucial as they cause significant distress and affect the patient's quality of life.

Differences in neurobiological pathways of four "clinical content" subtypes of depression

Although often considered as a mental disorder, depression is best described as a behavioral-neurobiological phenomenon. In addition, although usually reported as a unitary diagnosis, major depressive episode is composed of a range of different symptoms that can occur in nearly 1500 possible combinations to fulfill the required diagnostic criterion. To investigate and describe the underlying behavioral and neurobiological substrates of these symptoms, they were clustered into "clinical content" subtypes of depression according to their predominant common behavioral characteristics. These subtypes were then found to possess different neurobiological pathways that argue for different treatment approaches.