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Wang W, Wang Y, Wang F, Chen H, Qin X, Yang L, Yang X, Yang L. Notable dysthymia: evolving trends of major depressive disorders and dysthymia in China from 1990 to 2019, and projections until 2030. BMC Public Health 2024; 24:1585. [PMID: 38872130 PMCID: PMC11170895 DOI: 10.1186/s12889-024-18943-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 05/23/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Depressive disorders have been identified as a significant contributor to non-fatal health loss in China. Among the various subtypes of depressive disorders, dysthymia is gaining attention due to its similarity in clinical severity and disability to major depressive disorders (MDD). However, national epidemiological data on the burden of disease and risk factors of MDD and dysthymia in China are scarce. METHODS This study aimed to evaluate and compare the incidence, prevalence, and disability-adjusted life-years (DALYs) caused by MDD and dysthymia in China between 1990 and 2019. The temporal trends of the depressive disorder burden were evaluated using the average annual percentage change. The comparative risk assessment framework was used to estimate the proportion of DALYs attributed to risk factors, and a Bayesian age-period-cohort model was applied to project the burden of depressive disorders. RESULTS From 1990 to 2019, the overall age-standardized estimates of dysthymia in China remained stable, while MDD showed a decreasing trend. Since 2006, the raw prevalence of dysthymia exceeded that of MDD for the first time, and increased alternately with MDD in recent years. Moreover, while the prevalence and burden of MDD decreased in younger age groups, it increased in the aged population. In contrast, the prevalence and burden of dysthymia remained stable across different ages. In females, 11.34% of the DALYs attributable to depressive disorders in 2019 in China were caused by intimate partner violence, which has increasingly become prominent among older women. From 2020 to 2030, the age-standardized incidence, prevalence, and DALYs of dysthymia in China are projected to remain stable, while MDD is expected to continue declining. CONCLUSIONS To reduce the burden of depressive disorders in China, more attention and targeted strategies are needed for dysthymia. It's also urgent to control potential risk factors like intimate partner violence and develop intervention strategies for older women. These efforts are crucial for improving mental health outcomes in China.
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Affiliation(s)
- Wei Wang
- Department of Psychology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong, 250012, China
| | - Yihe Wang
- Department of Neurology, The Second Hospital of Shandong University, Jinan, China
| | - Feng Wang
- Department of Education, Guangxi Normal University, Guilin, China
| | - Hui Chen
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaqing Qin
- Department of Psychology, Shandong Normal University, Jinan, China
| | - Lexia Yang
- Nursing Department, The Third Hospital of Jinan, Jinan, Shandong, 250000, China
| | - Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China.
- Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Lejin Yang
- Department of Psychology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong, 250012, China.
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Xie Z, Liu X, Hu Z, Dong C. Longitudinal association between the dynamic nature of depression with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). BMC Public Health 2024; 24:1121. [PMID: 38654263 DOI: 10.1186/s12889-024-18618-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Depression is associated with an increased risk of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). Whether the dynamic nature of depression affects the incidence of LUTS/BPH remains unknown. A four-year cohort study based on the China Health and Retirement Longitudinal Study (CHARLS) was conducted to assess their association. METHODS This study included 3433 Chinese men from the CHARLS 2011, representative of > 95 million individuals. All eligible individuals underwent three assessments of LUTS/BPH and depression in 2011, 2013 and 2015. The dynamic nature of depression was classified as acute depression with remission, acute depression with recurrence, or chronic major depression. Weighted, generalized additive analyses with three binomial models were used to investigate the relationship between LUTS/BPH and the dynamic nature of depression. RESULTS During the four-year follow-up, 11.5% (95% confidence interval [95% CI] = 9.5-13.3%) of Chinese men were diagnosed with newly incident LUTS/BPH. Meanwhile, there were 60.6% (95% CI = 58.5-62.7%) of the individuals without depression and 8.9% (95% CI = 7.9-10%) of the individuals with chronic major depression. A total of 25.1% (95% CI = 23.4-26.9%) and 5.4% (95% CI = 4.6-6.3%) of the individuals were categorized as acute depression with remission and recurrence. After weighted, adjusted all included confounding risk factors, chronic major depression (RR = 1.63, 95% CI = 1.14-2.33, P < 0.01) but not acute depression with remission (RR = 1.2, 95% CI = 0.92-1.56, P = 0.18) and recurrence (RR = 1.32, 95% CI = 0.82-2.10, P = 0.26) significantly increased the incidence of LUTS/BPH compared with no depression. The subgroup analysis showed that the above relationships appeared to be evident among Chinese men < 60 years. CONCLUSIONS Our results suggest that the dynamic nature of depression has a different effect on the incidence of LUTS/BPH. The monitoring and treatment of depression are important in preventing LUTS/BPH.
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Affiliation(s)
- Zonglan Xie
- Department of Urology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Jiaoping Road No. 42, 523710, Dongguan, People's Republic of China
| | - Xuebin Liu
- Department of Urology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Jiaoping Road No. 42, 523710, Dongguan, People's Republic of China
| | - Zhigang Hu
- Department of Evidence Based Medicine Center, The First College of Clinical Medicine Science, China Three Gorges University, 443003, Yichang, China
| | - Chuanjiang Dong
- Department of Urology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Jiaoping Road No. 42, 523710, Dongguan, People's Republic of China.
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von Mücke-Heim IA, Pape JC, Grandi NC, Erhardt A, Deussing JM, Binder EB. Multiomics and blood-based biomarkers of electroconvulsive therapy in severe and treatment-resistant depression: study protocol of the DetECT study. Eur Arch Psychiatry Clin Neurosci 2024; 274:673-684. [PMID: 37644215 PMCID: PMC10995021 DOI: 10.1007/s00406-023-01647-1] [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: 02/24/2023] [Accepted: 07/07/2023] [Indexed: 08/31/2023]
Abstract
Electroconvulsive therapy (ECT) is commonly used to treat treatment-resistant depression (TRD). However, our knowledge of the ECT-induced molecular mechanisms causing clinical improvement is limited. To address this issue, we developed the single-center, prospective observational DetECT study ("Multimodal Biomarkers of ECT in TRD"; registered 18/07/2022, www.clinicalTrials.gov , NCT05463562). Its objective is to identify molecular, psychological, socioeconomic, and clinical biomarkers of ECT response in TRD. We aim to recruit n = 134 patients in 3 years. Over the course of 12 biweekly ECT sessions (± 7 weeks), participant blood is collected before and 1 h after the first and seventh ECT and within 1 week after the twelfth session. In pilot subjects (first n = 10), additional blood draws are performed 3 and 6 h after the first ECT session to determine the optimal post-ECT blood draw interval. In blood samples, multiomic analyses are performed focusing on genotyping, epigenetics, RNA sequencing, neuron-derived exosomes, purines, and immunometabolics. To determine clinical response and side effects, participants are asked weekly to complete four standardized self-rating questionnaires on depressive and somatic symptoms. Additionally, clinician ratings are obtained three times (weeks 1, 4, and 7) within structured clinical interviews. Medical and sociodemographic data are extracted from patient records. The multimodal data collected are used to perform the conventional statistics as well as mixed linear modeling to identify clusters that link biobehavioural measures to ECT response. The DetECT study can provide important insight into the complex mechanisms of ECT in TRD and a step toward biologically informed and data-driven-based ECT biomarkers.
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Affiliation(s)
- Iven-Alex von Mücke-Heim
- Department Genes and Environment, Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- Research Group Molecular Neurogenetics, Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- Department of Psychiatry, Clinical Anxiety Research, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Julius C Pape
- Department Genes and Environment, Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany.
- Department of Psychiatry, Clinical Anxiety Research, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany.
| | - Norma C Grandi
- Department Genes and Environment, Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- Department of Psychiatry, Clinical Anxiety Research, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Angelika Erhardt
- Department Genes and Environment, Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- Department of Psychiatry, Clinical Anxiety Research, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Jan M Deussing
- Research Group Molecular Neurogenetics, Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- Department of Psychiatry, Clinical Anxiety Research, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Elisabeth B Binder
- Department Genes and Environment, Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- Department of Psychiatry, Clinical Anxiety Research, University of Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
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Del Pino-Sedeño T, Infante-Ventura D, Hernández-González D, González-Hernández Y, González de León B, Rivero-Santana A, Hurtado I, Acosta Artiles FJ. Sociodemographic and clinical predictors of adherence to antidepressants in depressive disorders: a systematic review with a meta-analysis. Front Pharmacol 2024; 15:1327155. [PMID: 38318137 PMCID: PMC10839896 DOI: 10.3389/fphar.2024.1327155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction: Current evidence reveals concerning rates of non-adherence to antidepressant treatment, possibly influenced by various relevant determinants such as sociodemographic factors or those related to the health system and their professionals. The aim of this paper is to review the scientific evidence on sociodemographic and clinical predictors of adherence to pharmacological treatment in patients diagnosed with a depressive disorder. Methods: a systematic review (SR) was conducted. The search for a previous SR was updated and de novo searches were performed in Medline, EMBASE, Web of Science (WoS) and PsycInfo (last 10 years). The risk of bias was assessed using the Cochrane tool for non-randomized studies-of Exposure (ROBINS-E). Meta-analyses were conducted. Results: Thirty-nine studies (n = 2,778,313) were included, 24 of them in the meta-analyses. In the initiation phase, no association of adherence was found with any of the predictors studied. In the implementation and discontinuation phases, middle-aged and older patients had better adherence rates and lower discontinuation rates than younger ones. White patients adhered to treatment better than African-American patients. Discussion: Age and ethnicity are presented as the predictive factors of pharmacological adherence. However, more research is needed in this field to obtain more conclusive results on other possible factors. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023414059], identifier [CRD42023414059].
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Affiliation(s)
- Tasmania Del Pino-Sedeño
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPPS), Tenerife, Spain
- Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, Spain
- Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna, Tenerife, Spain
| | - Diego Infante-Ventura
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
- Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna, Tenerife, Spain
| | | | - Yadira González-Hernández
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
| | - Beatriz González de León
- Multiprofessional Teaching Unit of Family and Community Care La Laguna-Tenerife Norte, Management of Primary Care of Tenerife, Santa Cruz de Tenerife, Spain
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPPS), Tenerife, Spain
| | - Isabel Hurtado
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPPS), Tenerife, Spain
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Valencia, Spain
| | - Francisco Javier Acosta Artiles
- Department of Mental Health, General Management of Health care Programs, Canary Islands Health Service, Las Palmas de Gran Canaria, Spain
- Department of Psychiatry, Insular University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
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Koshikawa Y, Onohara A, Wakeno M, Takekita Y, Kinoshita T, Kato M. Characteristics of persistent depression in the long-term: Randomized controlled trial and two-year observational study. Heliyon 2023; 9:e20917. [PMID: 37886758 PMCID: PMC10597827 DOI: 10.1016/j.heliyon.2023.e20917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
Major depressive disorder is a chronic condition that can recur and relapse. It would be clinically useful to know the patient background to predict the chronicity of depressive symptoms, and the change in diagnosis of bipolar disorder. This study included 197 patients enrolled in a six-week randomized controlled trial with a two-year follow-up. We conducted multiple logistic regression analyses to identify the clinical and sociodemographic characteristics associated with persistent depressive disorder (PDD), relapse, and changes in bipolar disorder diagnosis. The significantly correlated factors were residual symptoms, including insight, work and activity, and general somatic symptoms at week six. We could not identify any factors that contributed to relapse or change in the diagnosis of bipolar disorder. We found that the specific residual symptoms of acute treatment affected long-term treatment outcomes for depression. Attention should be paid to the residual symptoms of depression in the early stages of treatment, and measures should be considered to improve them. There are several limitations to this study, including the fact that PDD may exist among patients who discontinued treatment, treatment was not standardized during the study period, and adherence was confirmed verbally.
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Affiliation(s)
- Yosuke Koshikawa
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Ai Onohara
- Social Welfare Corporation Uminoko Gakuen Ikejimaryo, Osaka, Japan
| | - Masataka Wakeno
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | | | | | - Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
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Wolf J, Padberg F, Nenov-Matt T, Amann BL, Barton BB, Tang J, Glessner G, Brakemeier EL, Jobst A, Musil R, Reinhard MA. Suicidal behaviors are associated with loneliness and decrease during inpatient CBASP treatment for persistent depressive disorder. J Psychiatr Res 2022; 154:139-144. [PMID: 35939998 DOI: 10.1016/j.jpsychires.2022.07.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/18/2022] [Accepted: 07/26/2022] [Indexed: 10/16/2022]
Abstract
Suicidal ideation and behavior (SIB) are common in persistent depressive disorder (PDD) and may be related to interpersonal dysfunction. While SIB has been extensively analyzed in other high-risk disorders (e.g., borderline personality disorder, BPD), data on interpersonal risk factors and effects of specific psychotherapy on SIB in PDD are limited. This study aimed at investigating loneliness versus social network size as interpersonal risk factors for SIB in PDD and assess effects of cognitive behavioral analysis system of psychotherapy (CBASP) on this domain. In a prospective naturalistic study, 64 PDD patients were assessed, who underwent a 10-weeks inpatient CBASP program. Our clinical comparison group consisted of 34 BPD patients, who underwent a 10-weeks inpatient dialectical behavioral therapy (DBT) program. SIB was measured with the Columbia-Suicide Severity Rating Scale (C-SSRS), loneliness and social network size with the UCLA Loneliness Scale (UCLA) and the Social Network Index (SNI). Twenty-six PDD patients (40.6% of the PDD sample) showed current SIB at baseline in comparison with 26 BPD patients (76.5% of the BPD sample). While in suicidal PDD patients, SIB was associated with perceived social isolation (UCLA), but not with reduced social network size (SNI), this association was not observed in suicidal BPD patients. In PDD, SIB significantly decreased during CBASP. In conclusion, SIB appears to be associated with interpersonal factors related to loneliness in PDD, but not in BPD. CBASP showed first positive evidence in reducing SIB in PDD, but our pilot data need replication studies.
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Affiliation(s)
- Johannes Wolf
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany.
| | - Frank Padberg
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Tabea Nenov-Matt
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Benedikt L Amann
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany; Parc de Salut Mar, Research Unit Centre Forum, IMIM, Univ. Pompeu Fabra, CIBERSAM, Barcelona, Spain
| | - Barbara B Barton
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Jeni Tang
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Gloria Glessner
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Eva-Lotta Brakemeier
- Department for Clinical Psychology and Psychotherapy, University Greifswald, Greifswald, Germany
| | - Andrea Jobst
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Richard Musil
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Matthias A Reinhard
- Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University, Munich, Germany
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Tang M, Xi J, Fan X. QT interval is correlated with and can predict the comorbidity of depression and anxiety: A cross-sectional study on outpatients with first-episode depression. Front Cardiovasc Med 2022; 9:915539. [PMID: 36247470 PMCID: PMC9559700 DOI: 10.3389/fcvm.2022.915539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectPatients with depression are at an increased risk for developing cardiovascular diseases. The associations between electrocardiogram (ECG) abnormalities and the severity of psychiatric disorders, such as depression and anxiety, have not been clearly elucidated. The present study aims to investigate the associations between depression and anxiety symptoms with ECG indices, and to predict the severity of depression and anxiety using ECG indicators.Methods61 outpatients with first-episode depression from the Shanghai Pudong New Area Mental Health Center were selected and met the diagnostic criteria of DSM-IV. All participants provided self-reported scores on the Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS) and underwent the standard 12-lead ECG assessment.ResultsAmong the 61 included outpatients (mean [standard deviation, SD] age: 37.84 [13.82] years; 41[67.2%] were female), there were 2 (3.3%) outpatients without depression symptoms, 16 (26.2%) with mild depression, 19 (31.1%) with moderate depression, and 24 (39.3%) with severe depression. Ten (16.4%) outpatients did not have anxiety symptoms, 19 (31.1%) exhibited mild anxiety, 20 (32.8%) exhibited moderate anxiety, and 12 (19.7%) exhibited severe anxiety. Only 1 (1.6%) outpatient exhibited neither depression nor anxiety, 9 (14.8%) and 1 (1.6%) outpatients only exhibited depression and anxiety, respectively, and most outpatients (50 [82.0%]) had comorbid depression and anxiety symptoms. In the correlation analysis, depression and anxiety severity levels were significantly positively correlated (r = 0.717, p < 0.01). Moreover, categorical anxiety significantly differs in QT interval (p = 0.022), and continuous SAS scores were significantly correlated with QT interval (r = 0.263, p = 0.04). In addition, the correlations between ECG measurements and both categorical depression and continuous SDS scores were not statistically significant. The comorbidity of anxiety and depression was significantly correlated with heart rate (p = 0.039) and QT interval (p = 0.002). Disorder status significantly differed with different QT intervals (p = 0.021). In the prediction analysis, QT interval was the only significant predictor (p = 0.01, b = 0.058, Odds Ratio = 1.059) for comorbid anxiety and depression symptoms.ConclusionThis study found that comorbid symptoms of depression and anxiety were significantly associated with QT interval and heart rate. Additionally, QT interval could predict the comorbidity of these two psychiatric disorders. Further prospective research in a larger and high-risk population is needed.
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Affiliation(s)
- Mingcong Tang
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
- Department of Psychology, Southwest University, Chongqing, China
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Juzhe Xi
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
- *Correspondence: Juzhe Xi
| | - Xiwang Fan
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
- Xiwang Fan
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Guhn A, Merkel L, Heim C, Klawitter H, Teich P, Betzler F, Sterzer P, Köhler S. Impaired empathic functioning in chronic depression: Behavioral evidence for the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) model. J Psychiatr Res 2022; 152:79-85. [PMID: 35716512 DOI: 10.1016/j.jpsychires.2022.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/19/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022]
Abstract
The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) model proposes preoperational functioning as a core feature of persistent depressive disorders (PDD). Empathy deficits comprise one aspect. Resulting from childhood maltreatment, empathy deficits may aggravate social isolation, a key factor in the maintenance of depression. CBASP targets empathy by teaching patients to disengage from past experiences and to engage successfully in present social interactions. However, behavioral evidence for empathy deficits in PDD has remained elusive. We reasoned that deficits become apparent only under stress and that these deficits improve after CBASP-treatment. Twenty-two patients and 21 controls performed two parallel versions of the Multifaceted Empathy Test. For stress induction, a negative autobiographical event was presented before performing the task. A neutral event served as control. Fifteen patients performed the experiment twice, before and after a 12-week inpatient CBASP-treatment. Supporting our hypotheses, patients showed reduced empathy under stress, while no group difference was found in the absence of stress. Reduced empathy correlated with the level of re-experiencing negative memories. Pre-post-treatment comparison revealed that the stress-induced empathy deficit improved in patients over time. Post-treatment empathic capacity correlated positively with clinical improvement. Our findings provide empirical support for the CBASP model, but highlight an important new aspect: Empathy is not generally deficient in PDD but becomes impaired under stress. In real-life situations, stress-induced empathy impairments may exacerbate interpersonal conflicts. CBASP's interpersonal focus improved empathy, accompanied by clinical improvement as the model predicts.
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Affiliation(s)
- Anne Guhn
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Charitéplatz 1, 10117, Berlin, Germany.
| | - Lydia Merkel
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Charitéplatz 1, 10117, Berlin, Germany
| | - Christine Heim
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Charitéplatz 1, 10117, Berlin, Germany
| | - Heiko Klawitter
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Charitéplatz 1, 10117, Berlin, Germany
| | - Paula Teich
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Charitéplatz 1, 10117, Berlin, Germany
| | - Felix Betzler
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Charitéplatz 1, 10117, Berlin, Germany
| | - Philipp Sterzer
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Charitéplatz 1, 10117, Berlin, Germany
| | - Stephan Köhler
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Charitéplatz 1, 10117, Berlin, Germany
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Modified Xiaochaihu Decoction Combined with Mirtazapine in the Treatment of Persistent Depression: A Pilot Randomized Controlled Trial. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8682612. [PMID: 35833082 PMCID: PMC9252686 DOI: 10.1155/2022/8682612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/19/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022]
Abstract
Background Western drugs effectively manage persistent depressive disorder (PDD) but are associated with side effects. Objective To observe the efficacy and safety of modified Xiaochaihu Decoction combined with mirtazapine in treating PDD. Methods Patients with PDD were enrolled at the Naval General Hospital (06/2018-02/2019) and randomized to modified Xiaochaihu Decoction and modified Xiaochaihu Decoction with mirtazapine. The self-rating depression scale (SDS) and traditional Chinese medicine (TCM) scale were assessed at baseline and after 12 weeks. The overall clinical efficacy (primary outcome) and adverse reactions were observed. Results Sixty-four participants completed the trial in the combined and control groups (30 and 28), respectively. In controls, the total effective rate was 78.6%, compared with 96.7% in the combined group (P=0.035). The scores of the SDS and TCM syndrome scale in the two groups were lower after treatment (P < 0.001) but without difference between groups (P=0.077). The combined group showed higher improvement rates regarding insomnia (96.4% vs. 44.0%, P < 0.001), bitter taste (90.5% vs. 52.6%, P=0.007), languid (72.0% vs. 31.8%, P=0.006), and belching/anorexia (100% vs. 52.6%, P < 0.001). The combined group showed a higher frequency of adverse events (73.3% vs. 3.6%) (P < 0.001). Conclusion Modified Xiaochaihu Decoction combined with mirtazapine effectively treats PDD, and its curative effect is better than that of TCM alone. Trial Registration. This trial was registered with https://www.chictr.org.cn/index.aspx/ChiCTR2100048188.
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Seemüller F, Kolter M, Musil R, Schennach R, Adli M, Bauer M, Brieger P, Laux G, Riedel M, Falkai P, Möller HJ, Padberg F. Chronic vs non-chronic depression in psychiatric inpatient care - Data from a large naturalistic multicenter trial. J Affect Disord 2022; 299:73-84. [PMID: 34800575 DOI: 10.1016/j.jad.2021.11.042] [Citation(s) in RCA: 2] [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] [Received: 06/28/2021] [Revised: 10/16/2021] [Accepted: 11/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Around 20% - 30% of depressed individuals experience a chronic form of depression lasting two or more years. This naturalistic study investigates the characteristics and the course of chronic depressed patients (CD) during standard antidepressant treatment in comparison to not chronically depressed (NCD) patients. METHODS Data of 954 patients were drawn from the prospective naturalistic, multicenter study of the German research network on depression, CD was met as classifier by 113 patients (11.8%), whereas 841 patients (88.2%) had non-chronic courses (NCD). RESULTS CD was significantly associated with a low age at onset, use of benzodiazepines, psychotherapy at baseline, substance abuse, a depressive personality disorder and a low degree of extraversion. CD patients showed a longer hospital stay, lower remission rates, increased rates of suicidal ideation as well as higher depression scores at discharge. In addition, individuals with chronic depression continued to obtain higher neuroticism scores and lower extraversion scores at discharge. LIMITATION Results were assessed by a post-hoc analysis, based on prospectively collected data. CONCLUSION CD patients have an inferior outcome in clinical measures as well as personality dimensions (i.e. low extraversion) compared to non-CD patients. These findings support the notion that CD patients entering a setting of standard psychiatric inpatient care will show less benefit compared to non-CD patients, and that this difference as such may be used as a stratifying marker for providing specialized psychiatric treatment with optimized pharmacological and psychotherapeutic protocols.
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Affiliation(s)
- Florian Seemüller
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, kbo-Lech-Mangfall-Klinik, Garmisch-Partenkirchen, Auenstrasse 6, 82467 Garmisch-Partenkirchen, Germany.
| | - Miriam Kolter
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Rebecca Schennach
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany; Schoen Clinic Roseneck, Am Roseneck 6, 83209 Prien am Chiemsee, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus, Charité Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany; Fliedner Klinik Berlin, Center for Psychiatry, Psychotherapy and Psychosomatic Medicine, Markgrafenstrasse 34, 10117 Berlin, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Peter Brieger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany; Department of Psychiatry and Psychotherapy, kbo-Isar-Amper-Klinikum Region Munich, Vockestr. 72, 85540 Haar, Germany
| | - Gerd Laux
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany; Department of Psychiatry and Psychotherapy and Psychosomatic Medicine, kbo-Inn-Salzach-Klinikum. Gabersee 7, 83512 Wasserburg, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany; Centre for Disturbance of Memory and Demetia, Marion von Tessin Memory-Centre, Nymphenburgerstrasse 45, 80636 Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
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11
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Kurkinen K, Kärkkäinen O, Lehto SM, Luoma I, Kraav SL, Nieminen AI, Kivimäki P, Therman S, Tolmunen T. One-carbon and energy metabolism in major depression compared to chronic depression in adolescent outpatients: A metabolomic pilot study. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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12
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von Muecke-Heim IA, Ries C, Urbina L, Deussing JM. P2X7R antagonists in chronic stress-based depression models: a review. Eur Arch Psychiatry Clin Neurosci 2021; 271:1343-1358. [PMID: 34279714 PMCID: PMC8429152 DOI: 10.1007/s00406-021-01306-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/12/2021] [Indexed: 12/17/2022]
Abstract
Depression affects around 320 million people worldwide. Growing evidence proposes the immune system to be the core interface between psychosocial stress and the neurobiological and behavioural features of depression. Many studies have identified purinergic signalling via the P2X7 receptor (P2X7R) to be of great importance in depression genesis yet only a few have evaluated P2X7R antagonists in chronic stress-based depression models. This review summarizes their findings and analyses their methodology. The four available studies used three to nine weeks of unpredictable, chronic mild stress or unpredictable, chronic stress in male mice or rats. Stress paradigm composition varied moderately, with stimuli being primarily psychophysical rather than psychosocial. Behavioural testing was performed during or after the last week of stress application and resulted in depressive-like behaviours, immune changes (NLRP3 assembly, interleukin-1β level increase, microglia activation) and neuroplasticity impairment. During the second half of each stress paradigm, a P2X7R antagonist (Brilliant Blue G, A-438079, A-804598) was applied. Studies differed with regard to antagonist dosage and application timing. Nonetheless, all treatments attenuated the stress-induced neurobiological changes and depressive-like behaviours. The evidence at hand underpins the importance of P2X7R signalling in chronic stress and depression. However, improvements in study planning and reporting are necessary to minimize experimental bias and increase data purview. To achieve this, we propose adherence to the Research Domain Criteria and the STRANGE framework.
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Affiliation(s)
- Iven-Alex von Muecke-Heim
- Max Planck Institute of Psychiatry, Molecular Neurogenetics, Munich, Germany.
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany.
| | - Clemens Ries
- Max Planck Institute of Psychiatry, Molecular Neurogenetics, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
- Graduate School of Systemic Neurosciences, University of Munich (LMU), Munich, Germany
| | - Lidia Urbina
- Max Planck Institute of Psychiatry, Molecular Neurogenetics, Munich, Germany
- Graduate School of Systemic Neurosciences, University of Munich (LMU), Munich, Germany
| | - Jan M Deussing
- Max Planck Institute of Psychiatry, Molecular Neurogenetics, Munich, Germany.
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Boede M, Gensichen JS, Jackson JC, Eißler F, Lehmann T, Schulz S, Petersen JJ, Wolf FP, Dreischulte T, Schmidt KFR. Trajectories of depression in sepsis survivors: an observational cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:161. [PMID: 33926493 PMCID: PMC8082919 DOI: 10.1186/s13054-021-03577-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Advances in critical care medicine have led to a growing number of critical illness survivors. A considerable part of them suffers from long-term sequelae, also known as post-intensive care syndrome. Among these, depressive symptoms are frequently observed. Depressive symptom trajectories and associated factors of critical illness survivors have rarely been investigated. Study objective was to explore and compare different trajectories of depressive symptoms in sepsis survivors over 1 year after discharge from ICU. METHODS Data of a randomized controlled trial on long-term post-sepsis care were analyzed post hoc. Depressive symptoms were collected at 1, 6 and 12 months post-ICU discharge using the Major Depression Inventory (MDI), among others. Statistical analyses comprised descriptive analysis, univariate and multivariate, linear and logistic regression models and Growth Mixture Modeling. RESULTS A total of 224 patients were included into this analysis. We identified three latent classes of depressive symptom trajectories: Over the course of 1 year, 152 patients recovered from mild symptoms, 27 patients showed severe persistent symptoms, and 45 patients recovered from severe symptoms. MDI sum scores significantly differed between the three classes of depressive symptom trajectories at 1 and 6 months after ICU discharge (p < 0.024 and p < 0.001, respectively). Compared with other classes, patients with the mild recovered trajectory showed lower levels of chronic pain (median sum score of 43.3 vs. 60.0/53.3 on the Graded Chronic Pain Scale, p < 0.010) and posttraumatic stress (4.6% with a sum score of ≥ 35 on the Posttraumatic Stress Scale 10 vs. 48.1%/33.3%, p < 0.003); and higher levels of health-related quality of life (HRQOL) using the Short Form-36 scale within 1 month after ICU discharge (p < 0.035). CONCLUSIONS In the first year after discharge from ICU, sepsis survivors showed three different trajectories of depressive symptoms. Course and severity of depressive symptoms were associated with chronic pain, posttraumatic stress and reduced HRQOL at discharge from ICU. Regular screening of sepsis survivors on symptoms of depression, chronic pain and posttraumatic stress within 1 year after ICU may be considered. Trial registration ISRCTN, ISRCTN 61744782. Registered April 19, 2011-Retrospectively registered, http://www.isrctn.com/ISRCTN61744782 .
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Affiliation(s)
- Monique Boede
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany.
| | - Jochen S Gensichen
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany.,Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Pettenkoferstr. 10, 80336, Munich, Germany.,Center for Sepsis Control and Care, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - James C Jackson
- Department of Medicine, Pulmonary and Critical Care, Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University, Suite 450, 4th Floor 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Fiene Eißler
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany.,Paediatrics and Adolescent Medicine, Sanaklinikum Lichtenberg, Fanningerstraße 32, 10365, Berlin, Germany
| | - Thomas Lehmann
- Center for Clinical Studies, Jena University Hospital, Salvador-Allende-Platz 27, 07747, Jena, Germany
| | - Sven Schulz
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Juliana J Petersen
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt a. Main, Germany
| | - Florian P Wolf
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Tobias Dreischulte
- Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Pettenkoferstr. 10, 80336, Munich, Germany
| | - Konrad F R Schmidt
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany.,Center for Sepsis Control and Care, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.,Institute of General Practice, Charité University Medicine, Charitéplatz 1, 10117, Berlin, Germany
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14
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Konvalin F, Grosse-Wentrup F, Nenov-Matt T, Fischer K, Barton BB, Goerigk S, Brakemeier EL, Musil R, Jobst A, Padberg F, Reinhard MA. Borderline Personality Features in Patients With Persistent Depressive Disorder and Their Effect on CBASP Outcome. Front Psychiatry 2021; 12:608271. [PMID: 33790813 PMCID: PMC8006327 DOI: 10.3389/fpsyt.2021.608271] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 02/15/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction: The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) was developed for the treatment of persistent depressive disorder (PDD), where comorbid personality disorders (PD) are common. In contrast to other PD, comorbid borderline personality disorder (BPD) is often regarded as an exclusion criterion for CBASP. In clinical settings, however, subthreshold BPD symptoms are prevalent in PDD and may not be obvious at an initial assessment prior to therapy. As data on their impact on CBASP outcome are very limited, this naturalistic study investigates BPD features in PDD and their relevance for the therapeutic outcome of a multimodal CBASP inpatient program. Method: Sixty patients (37 female, mean age 38.3, SD 11.9 years) meeting DSM-5 criteria for PDD underwent a 10 weeks CBASP inpatient program. BPD features (i.e., number of fulfilled DSM-5 criteria) together with childhood maltreatment and rejection sensitivity were assessed on admission. Before and after treatment, severity of depressive symptoms was measured using the Montgomery-Asberg Depression Rating Scale (MADRS) and the Beck Depression Inventory (BDI-II). BPD symptoms were assessed using the Borderline Personality Disorder Severity Index (BPDSI-IV) and the Borderline Symptom List (BSL-23). Intercorrelations of baseline characteristics and symptom change during treatment were analyzed. Results: Patients with PDD met a mean of 1.5 (SD 1.6) BPD criteria with 4 patients fulfilling ≥5 criteria. BPD symptoms and depressive symptoms showed a strong correlation, and BPD symptoms were additionally correlated with emotional abuse and rejection sensitivity. There was no association between BPD features at baseline and improvement on the MADRS, however, BPD features tended to be associated with a lower response according to the BDI-II score after 10 weeks of treatment. Furthermore, BPD symptoms (i.e., abandonment, impulsivity and affective instability) were reduced after 10 weeks of CBASP treatment. Discussion: BPD symptoms are prevalent in patients with PDD and highly intertwined with the experience of depressive symptoms. In this naturalistic study in PDD, BPD features at baseline did not limit the clinical response to CBASP. Future studies may extend the spectrum of PDD to comorbid subsyndromal or even syndromal BPD in order to develop tailored psychotherapeutic treatment for these complex affective disorders.
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Affiliation(s)
- Franziska Konvalin
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | | | - Tabea Nenov-Matt
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Kai Fischer
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Barbara B. Barton
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Stephan Goerigk
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Andrea Jobst
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Matthias A. Reinhard
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
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15
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Guhn A, Schön D, Zische Y, Sterzer P, Köhler S. Interpersonal Change During Inpatient CBASP Treatment: Focus on Group Therapy. Front Psychiatry 2021; 12:620037. [PMID: 33716820 PMCID: PMC7952983 DOI: 10.3389/fpsyt.2021.620037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/05/2021] [Indexed: 12/20/2022] Open
Abstract
Background: The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been tailored specifically to the demands of patients with persistent depressive disorder (PDD). According to the CBASP model, PDD patients are supposed to live perceptually disconnected from their social environment, which consequently maintains depression. While initially developed as an individual treatment modality, the adaptation for group therapy yields an important interpersonal space. However, little is known about the specific factors that contribute to patients' benefit from the CBASP group modality. Methods: The analyzed sample comprised N = 87 PDD patients who completed a 12 week multimodal inpatient treatment including 2 weekly CBASP-specific individual and group sessions, respectively, as well as CBASP-unspecific medical contacts, pharmacotherapy and complementary therapies. Group sessions included trainings in situational analysis and interpersonal skills. Interpersonal change over therapy was examined based on the patients' self-perceived interpersonal problems (IIP) and the impact messages as perceived by their individual therapists (IMI). Pre and post-treatment data were compared using within-sample t-tests. Additionally, patients evaluated CBASP group therapy on a feedback form. They were invited to reflect on individual benefits and its helpful and unhelpful aspects. Qualitative content analysis with inductive category development was used to analyze feedback. Inter-rater reliability was computed to confirm categories before summarizing the frequencies of reported factors. Results: Self-perceived interpersonal distress significantly decreased over therapy. Patients reported reduced interpersonal problems and therapists reported more friendly and dominant impact messages. Interestingly, patients who showed a significant depressive symptom reduction described higher change scores. Regarding qualitative data, patients reported five main benefits from group therapy: Gain in social competence, self-confidence, self-reflection, interpersonal dynamics, and optimism/universality. Patients responding to CBASP identified significantly more factors than non-responders. Conclusions: Compared to studies with individual CBASP only, the present findings suggest that CBASP group therapy may contribute to the improvement of interpersonal behavior. Group therapy is discussed as a potential boosting effect for individual CBASP. However, as the present data were collected in a multimodal inpatient setting without competitor, randomized controlled trials are warranted that investigate the specific benefits of the group modality or the combined individual and group therapy over individual CBASP only.
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Affiliation(s)
- Anne Guhn
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - David Schön
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Yvonne Zische
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Philipp Sterzer
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Stephan Köhler
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
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Frick A, Thinnes I, Hofmann SG, Windmann S, Stangier U. Reduced Social Connectedness and Compassion Toward Close Others in Patients With Chronic Depression Compared to a Non-clinical Sample. Front Psychiatry 2021; 12:608607. [PMID: 33815163 PMCID: PMC8012512 DOI: 10.3389/fpsyt.2021.608607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/19/2021] [Indexed: 11/19/2022] Open
Abstract
Reduced social functioning in depression has been explained by different factors. Reduced social connectedness and prosocial motivation may contribute to interpersonal difficulties, particularly in chronic depression. In the present study, we tested whether social connectedness and prosocial motivation are reduced in chronic depression. Forty-seven patients with persistent depression and 49 healthy controls matched for age and gender completed the Inclusion of the Other in the Self Scale (IOS), the Compassionate Love Scale (CLS), the Beck Depression Inventory-II, and the Childhood Trauma Questionnaire. A Multivariate analysis of variance (MANOVA) with IOS and CLS as dependent variables revealed a highly significant difference between both groups. The IOS and the CLS-subscale Close Others were lower in persistent depression, whereas there was no difference in the CLS-subscale Strangers/Humanity. IOS and CLS-Close Others showed significant negative correlations with depressive symptoms. Connectedness to family members as measured by the IOS was negatively correlated with childhood trauma in patients with chronic depression. The results indicate that compassion and perceived social connection are reduced in depressed patients toward close others, but not to others in general. Implications for the treatment of depression are discussed.
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Affiliation(s)
- Artjom Frick
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Isabel Thinnes
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, United States
| | - Sabine Windmann
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrich Stangier
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
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[Psychosomatic medicine in the Gutenberg Health Study (GHS) - research questions, measurement instruments, selected results]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2020; 66:355-375. [PMID: 33284063 DOI: 10.13109/zptm.2020.66.4.355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Psychosomatic medicine in the Gutenberg Health Study (GHS) - research questions, measurement instruments, selected results Goal: Main questions from the Gutenberg Health Study (GHS) related to psychosomatic medicine are presented: (1) Prevalence and incidence of mental illnesses, (2) Sex-specific risk- and protective factors for mental health, (3) Interplay between psychological and somatic diseases and (4) methodical-psychometric developments. Methods: The GHS is an ongoing, prospective and interdisciplinary cohort study in Mainz. The comprehensive examinations include psychological characteristics and clinical and laboratory tests. 15010 respondents were selected in the baseline study from 2007 until 2012 and re-examined after 2.5 years and 5 years. Results: Of the first 5000 respondents in the baseline study 413 women (8.7 %) and 276 men (5.8 %) indicated depressive symptoms (PHQ-9 > = 10). After five years, half of the participants with depressive symptoms at baseline also indicated depressive symptoms five years later. Risk factors for men were a lack of social support, for women smoking and Type D personality. The proportion of new cases of depression at follow-up was 4.4 %. Risk factors were symptoms of anxiety, Type D, smoking and comorbid cancer. Protective were age and social support. Findings on the association of physical and mental disorders and their behavioral and biological links (atherosclerosis, inflammation) are presented. Conclusions: Prospective assessment of biological, psychological and social parameters offers the possibility to study their interplay in the development of mental and somatic illnesses.
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Brakemeier EL, Wirkner J, Knaevelsrud C, Wurm S, Christiansen H, Lueken U, Schneider S. Die COVID-19-Pandemie als Herausforderung für die psychische Gesundheit. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2020. [DOI: 10.1026/1616-3443/a000574] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Zusammenfassung. Die COVID-19-Pandemie als multidimensionaler und potenziell toxischer Stressfaktor führt auch in Deutschland zu psychischen Problemen in der Allgemeinbevölkerung und wird voraussichtlich einen Anstieg der Inzidenz- und Prävalenzraten psychischer Störungen bedingen. In diesem Positionspapier erfolgt daher eine wissenschaftlich differenzierte Betrachtung der psychologischen Auswirkungen der COVID-19-Pandemie auf verschiedene Altersstufen sowie psychische Vulnerabilitäten und Störungsbilder, wobei auch Chancen für die psychische Gesundheit und psychotherapeutische Versorgung diskutiert werden. Basierend auf den Befunden werden abschließend u. a. folgende gesundheitspolitische Ziele und Maßnahmen abgeleitet: Implementierung von universellen und indizierten modularen Präventionsangeboten sowie Anpassung der evidenzbasierten Richtlinienpsychotherapien hinsichtlich Bedarf, Inhalt und Modalität. Die Klinische Psychologie und Psychotherapie stellt aufgrund ihrer ausgewiesenen Expertise im Bereich der psychischen Gesundheit zentrales Wissen für die erfolgreiche Bewältigung der COVID-19-Pandemie zur Verfügung und kann in interdisziplinären und interprofessionellen Kooperationen dazu beitragen, die Herausforderungen für die psychische Gesundheit anzugehen.
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Affiliation(s)
- Eva-Lotta Brakemeier
- Abteilung für Klinische Psychologie und Psychotherapie, Universität Greifswald
- Abteilung für Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg
| | - Janine Wirkner
- Abteilung für Klinische Psychologie und Psychotherapie, Universität Greifswald
| | | | - Susanne Wurm
- Abteilung für Präventionsforschung und Sozialmedizin, Universitätsmedizin Greifswald
| | - Hanna Christiansen
- Abteilung für Klinische Kinder- und Jugendpsychologie, Philipps-Universität Marburg
| | - Ulrike Lueken
- Abteilung für Psychotherapie, Humboldt-Universität zu Berlin
| | - Silvia Schneider
- Forschungs- und Behandlungszentrum für psychische Gesundheit, Ruhr-Universität Bochum
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