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Narasimhappa K, Mamtani H, Jain K, Holla VV, Ganjekar S, Manjunath N, Kulanthaivelu K, Desai G. Unmasking bipolarity in recurrent depressive disorder following herpes simplex virus triggered n-methyl-D-aspartate encephalitis. Bipolar Disord 2024; 26:192-195. [PMID: 37973382 DOI: 10.1111/bdi.13393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Herpes simplex virus (HSV) infection triggered n-methyl-D-aspartate (NMDA) encephalitis can lead to varied neuropsychiatric manifestations, including movement disorders and manic symptoms. HSV is known to affect the same brain regions as in secondary mania. METHOD We present a 35-year-old female diagnosed with recurrent depressive disorder (RDD) who developed NMDA encephalitis triggered by HSV infection. RESULT HSV-triggered NMDA encephalitis led to a manic switch in a woman with RDD on antidepressants, along with the new onset of dyskinetic movements. CONCLUSION A neurological insult predisposed our patient to the variable effects of antidepressant drugs.
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Affiliation(s)
- Karthik Narasimhappa
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Harkishan Mamtani
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Kshiteeja Jain
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Vikram V Holla
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Netravathi Manjunath
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Karthik Kulanthaivelu
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
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Evanger LN, Flo-Groeneboom E, Sørensen L, Schanche E. Mindfulness-based cognitive therapy improves insomnia symptoms in individuals with recurrent depression: secondary analyses from a randomized controlled trial. Front Psychiatry 2024; 14:1231040. [PMID: 38312915 PMCID: PMC10834689 DOI: 10.3389/fpsyt.2023.1231040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/27/2023] [Indexed: 02/06/2024] Open
Abstract
Background Embedded within a randomized efficacy trial, the present study aimed to investigate whether mindfulness-based cognitive therapy (MBCT) for recurrent depression improved symptoms of insomnia. Methods Sixty-eight remitted participants with at least three prior episodes of depression were randomized to 8 weeks of MBCT (n = 33) or a waitlist control condition (n = 35). The Bergen Insomnia Scale was used to screen for insomnia symptoms before and after the intervention. The analyses were conducted using one-way between-groups analyses of covariance. Results Twenty-five MBCT participants and 30 waitlist controls completed the study (74.5% females; mean age 40.7 ± 12.9 years). At baseline, 83.6% screened positive for the insomnia diagnosis. Following the intervention and after controlling for corresponding insomnia parameters at baseline, MBCT completers reported significantly less severe insomnia symptoms (p = 0.017), as well as less problems with prolonged sleep onset (p = 0.047) and nocturnal awakenings (p = 0.023), relative to controls. No group differences were found on early morning awakening, daytime impairment, or dissatisfaction with sleep. Conclusion The results suggest that MBCT improves certain insomnia symptoms. However, additional sleep-specific interventions may be needed to further improve this population's sleep.Clinical Trial Registration: ISRCTN, ISRCTN18001392, registered 22/11/2018. URL: 10.1186/ISRCTN18001392.
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Affiliation(s)
- Linn Nyjordet Evanger
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | | | - Lin Sørensen
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Elisabeth Schanche
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
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Bokhan NA, Galkin SA, Vasilyeva SN. EEG alpha band characteristics in patients with a depressive episode within recurrent and bipolar depression. Consort Psychiatr 2023; 4:5-12. [PMID: 38249536 PMCID: PMC10795944 DOI: 10.17816/cp6140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/03/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The search for biological markers for the differential diagnosis of recurrent depression and bipolar depression is an important undertaking in modern psychiatry. Electroencephalography (EEG) is one of the promising tools in addressing this challenge. AIM To identify differences in the quantitative characteristics of the electroencephalographic alpha band activity in patients with a depressive episode within the framework of recurrent depression and bipolar depression. METHODS Two groups of patients (all women) were formed: one consisting of subjects with recurrent depressive disorder and one with subjects experiencing a current mild/moderate episode (30 patients), and subjects with bipolar affective disorder or a current episode of mild or moderate depression (30 patients). The groups did not receive pharmacotherapy and did not differ in their socio-demographic parameters or total score on the Hamilton depression scale. A baseline electroencephalogram was recorded, and the quantitative characteristics of the alpha band activity were analyzed, including the absolute spectral power, interhemispheric coherence, and EEG activation. RESULTS The patients with recurrent depressive disorder demonstrated statistically significantly lower values of the average absolute spectral power of the alpha band (z=2.481; p=0.042), as well as less alpha attenuation from eyes closed to eyes open (z=2.573; p=0.035), as compared with the patients with bipolar affective disorder. CONCLUSION The presented quantitative characteristics of alpha activity are confirmation that patients with affective disorders of different origins also display distinctive electrophysiological features which can become promising biomarkers and could help separate bipolar depression from the recurrent type.
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Affiliation(s)
- Nikolay A. Bokhan
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences
- Siberian State Medical University
| | - Stanislav A. Galkin
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences
| | - Svetlana N. Vasilyeva
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences
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4
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Kuehner C, Schricker IF, Nayman S, Reinhard I, Zamoscik V, Kirsch P, Huffziger S. Effects of Rumination and Mindful Self-Focus Inductions During Daily Life in Patients With Remitted Depression: An Experimental Ambulatory Assessment Study. Behav Ther 2023; 54:902-915. [PMID: 37597966 DOI: 10.1016/j.beth.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 08/21/2023]
Abstract
Rumination has been proposed as an important risk factor for depression, whereas mindful attention is considered a protective form of self-focusing. Experimental studies have demonstrated differential effects of these modes when induced in the lab. However, their impact on daily life processes is poorly understood, particularly in individuals vulnerable to depressive relapses. The aim of our study was to examine short- and longer-term effects of repeated brief rumination and mindful self-focus inductions during daily life on momentary mood, cognitions, and cortisol in patients with remitted depression (rMDD) as well as in healthy individuals, and to identify their potential differential effects in these groups. The study involved repeated short ambulatory inductions of a ruminative or a mindful self-focus during daily life with additional assessments of momentary mood, rumination, self-acceptance, and cortisol over 4 consecutive days in a sample of patients with rMDD (n = 32, ≥2 lifetime episodes, age 19-55 years) and matched healthy controls (n = 32, age 21-54 years). Multilevel models revealed differential immediate effects of the two induction modes on all momentary mood and cognitive outcomes (all p's < .001), but not on cortisol. Detrimental effects of rumination over mindful self-focus inductions were particularly strong for cognitions in the patient group. Longer-term effects of the inductions over the day were lacking. This study underlines immediate deteriorating effects of an induced ruminative compared to a mindful self-focus on momentary mood and cognitions during daily life in patients with rMDD and in healthy individuals. The observed stronger rumination-related reactivity in patients suggests heightened cognitive vulnerability. Understanding rumination- and mindfulness-based mechanisms of action in real-life settings can help to establish mechanism-based treatment options for relapse prevention in depression.
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Affiliation(s)
| | | | - Sibel Nayman
- Central Institute of Mental Health Mannheim, Heidelberg University
| | - Iris Reinhard
- Central Institute of Mental Health Mannheim, Heidelberg University
| | - Vera Zamoscik
- Central Institute of Mental Health Mannheim, Heidelberg University
| | - Peter Kirsch
- Central Institute of Mental Health Mannheim, Heidelberg University
| | - Silke Huffziger
- Central Institute of Mental Health Mannheim, Heidelberg University
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5
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Belge JB, Sabbe ACF, Sabbe BGCC. An update on pharmacotherapy for recurrent depression in 2022. Expert Opin Pharmacother 2023; 24:1387-1394. [PMID: 37300545 DOI: 10.1080/14656566.2023.2223962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Major depressive disorder remains a major challenge due to its biopsychosocial burden with increased morbidity and mortality. Despite successful treatment options for the acute episode, recurrence rates are high, on average four times in a life span. AREAS COVERED Both pharmacological as non-pharmacological evidence-based therapeutic options to prevent and treat recurrent depression are discussed. EXPERT OPINION Although some risk factors for recurrence are well known, better evidence is needed. Antidepressant medication should be continued after acute treatment at its full therapeutic dose for longer periods, at least 1 year. There are no clear differences between classes of antidepressant medication when treatment is focused on preventing relapse. Bupropion is the only antidepressant with a proven efficacy to prevent recurrence in seasonal affective disorder. Recent findings conclude maintenance subanesthetic ketamine and esketamine treatment can be effective in sustaining antidepressant effect following remission. Furthermore, the pharmacological approach must be integrated with lifestyle interventions, especially aerobic exercise. Finally, combining pharma- and psychotherapy seems to improve outcome. Network and complexity sciences will help to decrease the high recurrence rates of MDD by developing more integrative and personalized approaches.
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Affiliation(s)
- Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Amber C F Sabbe
- Department of Internal Medicine, University Hospital of Antwerp, Edegem, Belgium
- Campus Drie Eiken, Universiteitsplein 1, University of Antwerp, Wilrijk, Belgium
| | - Bernard G C C Sabbe
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Rybakowski JK, Ferensztajn-Rochowiak E. Updated perspectives on how and when lithium should be used in the treatment of mood disorders. Expert Rev Neurother 2023; 23:157-167. [PMID: 36809989 DOI: 10.1080/14737175.2023.2181076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Lithium is one of the most important drugs for the treatment of mood disorders. The appropriate guidelines can ensure that more patients benefit from its use in a personalized way. AREAS COVERED This manuscript provides an update on the application of lithium in mood disorders, including prophylaxis of bipolar and unipolar mood disorder, treatment of acute manic and depressive episodes, augmentation of antidepressants in treatment-resistant depression, and use of lithium in pregnancy and the postpartum period. EXPERT OPINION Lithium remains the gold standard for the prevention of recurrences in bipolar mood disorder. For long-term treatment/management of bipolar mood disorder, clinicians should also consider lithium's anti-suicidal effect. Furthermore, after prophylactic treatment, lithium may also be augmented with antidepressants in treatment-resistant depression. There have also been some demonstration of lithium having some efficacy in acute episodes of mania and bipolar depression as well as in the prophylaxis of unipolar depression.
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Affiliation(s)
- Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
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Uzbekov MG, Shikhov SN, Kryukov VV, Krasnov VN. [Steadfastly increased level of the ciliary neurotrophic factor in the blood serum within the positive therapeutic dynamics of depression as possible prognostic marker of depressive relapse]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:120-123. [PMID: 37655420 DOI: 10.17116/jnevro2023123081120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To study a role of the ciliary neurotrophic factor (CNTF) in the pathogenesis of depression and its prognostic significance in dynamics of the antidepressant therapy. MATERIAL AND METHODS CNTF level was investigated in the blood serum of patients with melancholic depression (n=32) before the start of therapy and after 30 days, when improvement was achieved by at least 75% of baseline scores on the Hamilton Depression Rating Scale. RESULTS Steadfastly increased level of CNTF in the blood serum of patients with melancholic depression compared with the control, remaining practically unchanged with an obvious improvement in the condition - 732.2±126.5 and 679.1±63.1 pg/ml of serum, respectively (p>0.05). CONCLUSION The initially elevated level of CNTP indicates its probable significance in the pathogenesis of depression; persistently high serum CNTP level, despite clinical improvement during therapy, can serve as a predictor of the stability of the biological mechanisms of recurrent depressive disorder with a continuing risk of another relapse of a depressive episode.
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Affiliation(s)
- M G Uzbekov
- Serbsky National Medical Research Center of Psychiatry and Narcology - Moscow Research Institute of Psychiatry, Moscow, Russia
| | - S N Shikhov
- Serbsky National Medical Research Center of Psychiatry and Narcology - Moscow Research Institute of Psychiatry, Moscow, Russia
| | - V V Kryukov
- Serbsky National Medical Research Center of Psychiatry and Narcology - Moscow Research Institute of Psychiatry, Moscow, Russia
| | - V N Krasnov
- Serbsky National Medical Research Center of Psychiatry and Narcology - Moscow Research Institute of Psychiatry, Moscow, Russia
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8
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Christensen TN, Wallstrøm IG, Eplov LF, Laursen TM, Nordentoft M. Incidence rates and employment trends in schizophrenia spectrum disorders, bipolar affective disorders and recurrent depression in the years 2000-2013: a Danish nationwide register-based study. Nord J Psychiatry 2022; 76:225-232. [PMID: 34339349 DOI: 10.1080/08039488.2021.1952304] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS The study aimed to investigate time trends in incidence rates in schizophrenic spectrum disorders (ICD-10: F20-F29), bipolar affective disorder (ICD-10: F30, F31), and recurrent depression (ICD-10: F33) and to investigate the rates of employment for all incident cases. METHOD We used nationwide longitudinal data from 2000 to 2013 on all psychiatric inpatients and outpatients contacts in Denmark. Age-adjusted incidence rate ratios were calculated for the three diagnostic groups, and rates of employment, education, and disability pension were measured 1 year before and 2 years after the diagnosis for all the incident cases. RESULTS The incidence rates increased significantly in all diagnostic groups and both sexes. Comparing the incidence rates in 2013 with 2000 yielded an incidence rate ratio of 1.67 (95% CI 1.51-1.84) for schizophrenic spectrum disorders, 3.82 (95% CI 3.23-4.52) for bipolar affective disorder, and 2.80 (95% CI 2.58-3.04) for recurrent depression. During the same observation period, the employment rates decreased, both 1 year before and 2 years after diagnosis in all three subgroups. In the year 2002, employment rates, 2 years after diagnosis, were 24.6% for schizophrenia spectrum disorder, 35.0% for bipolar affective disorder and 47.1% for recurrent depression. These rates had declined to 15.8%, 26.8%, and 34.7%, respectively, in 2013. CONCLUSION This study of three severe mental illness subgroups shows significant increasing incidence rates and decreasing employment rates both before and after the diagnosis between 2000 and 2013, highlighting the importance of timely and correct volume of the psychiatric treatment and vocational rehabilitation programs.
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Affiliation(s)
| | - Iben Gammelgård Wallstrøm
- Research Unit of Psychiatry, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lene Falgaard Eplov
- Mental Health Centre Copenhagen, Copenhagen Research Center for Mental Health - CORE, Hellerup, Denmark
| | - Thomas Munk Laursen
- National Centre for Register-Based Research, University of Aarhus, Aarhus, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Copenhagen Research Center for Mental Health - CORE, Hellerup, Denmark
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Svendsen JL, Schanche E, Vøllestad J, Visted E, Jentschke S, Karl A, Binder PE, Osnes B, Sørensen L. Self-Compassion and Its Association With Ruminative Tendencies and Vagally Mediated Heart Rate Variability in Recurrent Major Depression. Front Psychol 2022; 13:798914. [PMID: 35330721 PMCID: PMC8940525 DOI: 10.3389/fpsyg.2022.798914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background Recurrent Major Depressive Disorder (MDD) is one of the most disabling mental disorders in modern society. Prior research has shown that self-compassion protects against ruminative tendencies, a key feature of recurrent MDD. In addition, self-compassion has been found to be positively related to higher psychophysiological flexibility (indexed by a higher vagally mediated heart rate variability; vmHRV) in young, healthy adults. To our knowledge, there is a lack of studies on how self-compassion relates to vmHRV in patients with recurrent MDD. The aim of the current study was to investigate whether higher self-compassion would associate with (1) lower ruminative tendencies and (2) higher vmHRV in a sample of adults with recurrent MDD. Methods We included a sample of 63 patients (46 females) between 20 and 71 years old (M = 40.24, SD = 12.8) with a history of three or more depressive episodes. They filled out the Self-Compassion Scale (SCS), Beck Depression Inventory (BDI), and Rumination Rating Scale (RRS). ECG (used to derive vmHRV) was acquired while resting and the square root of the mean squared differences of successive RR interval values (RMSSD) was calculated as measure of vmHRV. Results As hypothesized, self-compassion was associated with lower ruminative tendencies. However, self-compassion was not associated with level of vmHRV. Several confounding variables were controlled for in the statistical analyses, and higher age predicted lower vmHRV across all statistical analyses. Conclusion The results confirmed our hypothesis that higher self-compassion would be associated with lower ruminative tendencies in recurrent MDD. Contrary to our expectation, we did not find that the tendency to be more self-compassionate was associated with higher vmHRV. As such, higher self-compassion seems to relate with a lower tendency to ruminate about past mistakes and events but does not seem to relate to a flexible autonomic stress response (as indexed by higher vmHRV). Other potential explanatory factors for lower vmHRV in recurrent MDD is suggested as focus for exploration in future studies.
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Affiliation(s)
| | | | - Jon Vøllestad
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Endre Visted
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | | | - Anke Karl
- Mood Disorder Centre, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Per-Einar Binder
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Berge Osnes
- Bjørgvin District Psychiatric Centre, Haukeland University Hospital, Bergen, Norway.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Lin Sørensen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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Varghese S, Frey BN, Schneider MA, Kapczinski F, de Azevedo Cardoso T. Functional and cognitive impairment in the first episode of depression: A systematic review. Acta Psychiatr Scand 2022; 145:156-185. [PMID: 34758106 DOI: 10.1111/acps.13385] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/27/2021] [Accepted: 11/07/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To describe the cognitive and functional impairment in individuals with the first episode of major depressive disorder (MDD) as compared to controls and individuals with recurrent MDD. Also to describe the functional and cognitive trajectory after the first episode of MDD. METHODS A total of 52 studies were included in our systematic review. 32 studies compared the cognitive performance between first episode of depression (FED) and controls, 11 studies compared the cognitive performance between recurrent depression (RD) and FED, 10 compared global functioning between RD and FED, four studies assessed cognition in FED over time, and two studies assessed global functioning in FED over time. RESULTS The majority of studies (n = 22/32, 68.8%) found that FED subjects performed significantly worse than controls on cognitive tests, with processing speed (n = 12) and executive/working memory (n = 11) being the most commonly impaired domains. Seven out of 11 studies (63.6%) found that RD performed significantly worse than FED, with verbal learning and memory being the most commonly impaired domain (n = 4). Most studies (n = 7/10, 70%) did not find a significant difference in global functioning between RD and FED. In three of four longitudinal studies assessing cognition, subgroup analyses were used instead of directly assessing cognition in FED over time while the remaining study found significant cognitive declines over time in FED when compared to controls. The two longitudinal studies assessing functional trajectory found that functioning significantly improved over time, possibly due to the improvement of depressive symptoms. CONCLUSION There is strong evidence that cognitive impairment is present during the first episode of depression, and individuals with multiple episodes display greater cognitive impairment than individuals with a single episode. Future studies aimed at identifying predictors of cognitive and functional impairment after the first episode of depression are needed to describe the functional and cognitive trajectory of individuals with the first episode of MDD over time.
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Affiliation(s)
- Shawn Varghese
- Undergraduate Medical Education (UGME), McMaster University, Hamilton, Ontario, Canada
| | - Benicio N Frey
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Maiko A Schneider
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Youth Wellness Centre, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Flavio Kapczinski
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Rio Grande do Sul, Brazil.,Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Taiane de Azevedo Cardoso
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Breedvelt JJF, Brouwer ME, Harrer M, Semkovska M, Ebert DD, Cuijpers P, Bockting CLH. Psychological interventions as an alternative and add-on to antidepressant medication to prevent depressive relapse: systematic review and meta-analysis. Br J Psychiatry 2021; 219:538-545. [PMID: 33205715 DOI: 10.1192/bjp.2020.198] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND After remission, antidepressants are often taken long term to prevent depressive relapse or recurrence. Whether psychological interventions can be a viable alternative or addition to antidepressants remains unclear. AIMS To compare the effectiveness of psychological interventions as an alternative (including delivered when tapering antidepressants) or addition to antidepressants alone for preventing depressive relapse. METHOD Embase, PubMed, the Cochrane Library and PsycINFO were searched from inception until 13 October 2019. Randomised controlled trials (RCTs) with previously depressed patients in (partial) remission where preventive psychological interventions with or without antidepressants (including tapering) were compared with antidepressant control were included. Data were extracted independently from published trials. A random-effects meta-analysis on time to relapse (hazard ratio, HR) and risk of relapse (risk ratio, RR) at the last point of follow-up was conducted. PROSPERO ID: CRD42017055301. RESULTS Among 11 included trials (n = 1559), we did not observe an increased risk of relapse for participants receiving a psychological intervention while tapering antidepressants versus antidepressants alone (RR = 1.02, 95% CI 0.84-1.25; P = 0.85). Psychological interventions added to antidepressants significantly reduced the risk of relapse (RR = 0.85, 95% CI 0.74-0.97; P = 0.01) compared with antidepressants alone. CONCLUSIONS This study found no evidence to suggest that adding a psychological intervention to tapering increases the risk of relapse when compared with antidepressants alone. Adding a psychological intervention to antidepressant use reduces relapse risk significantly versus antidepressants alone. As neither strategy is routinely implemented these findings are relevant for patients, clinicians and guideline developers.
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Affiliation(s)
- Josefien Johanna Froukje Breedvelt
- Amsterdam University Medical Centers, Department of Psychiatry, University of Amsterdam, The Netherlands; and the Mental Health Foundation, London, UK
| | - Maria Elisabeth Brouwer
- Amsterdam University Medical Centers, Department of Psychiatry, University of Amsterdam, The Netherlands
| | - Mathias Harrer
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Maria Semkovska
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - David Daniel Ebert
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands
| | - Claudi Louisa Hermina Bockting
- Amsterdam University Medical Centers, Department of Psychiatry, University of Amsterdam; and Institute for Advanced Study, Amsterdam, The Netherlands
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Abstract
Cognitive effects of tobacco use among women with schizophrenia, bipolar disorder or depression have not been studied extensively as most studies focussed on men smokers. As part of a study on prevalence and cognitive effects of tobacco use, women with schizophrenia, bipolar disorder and depression were assessed for cognitive functioning using an information questionnaire derived from the Indian Post Graduate Institute Battery of Brain Dysfunction (PGIBBD) and the Trail Making Tests (TMT) A and B. The community dwelling women were clinically diagnosed and recruited from the outpatient department of a free tertiary care teaching hospital in India. The sample consisted of 321 women, 141 with schizophrenia (SZ), 80 with Bipolar Disorder (BD) and 100 with Recurrent Depressive Disorder (RDD). Tobacco users answered statistically significantly fewer questions on the PGIBBD Information Questionnaire. Users also took significantly more time to complete both TMT-A and TMT-B. Age, years of schooling and tobacco use were all significant co-variates for performance on cognitive tests. Tobacco users had lower motor speed and lesser visual scanning, poorer flexibility of thinking and working memory. Women with schizophrenia performed the worst. Tobacco use may exacerbate the cognitive dysfunction associated with major mental illnesses among women.
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Affiliation(s)
- Bhupendra Khobragade
- Dept. of Psychiatry, De-addiction Services & Resource Center for Tobacco Control, Centre of Excellence in Mental Health, ABVIMS - Dr Ram Manohar Lohia Hospital, Bangabandhu Sheikh Mujib Road, New Delhi, India 110001.
| | - Vikas Sharma
- Dept. of Psychiatry, De-addiction Services & Resource Center for Tobacco Control, Centre of Excellence in Mental Health, ABVIMS - Dr Ram Manohar Lohia Hospital, Bangabandhu Sheikh Mujib Road, New Delhi, India 110001.
| | - Smita N Deshpande
- Dept. of Psychiatry, De-addiction Services & Resource Center for Tobacco Control, Centre of Excellence in Mental Health, ABVIMS - Dr Ram Manohar Lohia Hospital, Bangabandhu Sheikh Mujib Road, New Delhi, India 110001.
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13
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Liu J, Liu B, Wang M, Ju Y, Dong Q, Lu X, Sun J, Zhang L, Guo H, Zhao F, Li W, Zhang L, Li Z, Zhang Y, Liao M, Li L. Evidence for Progressive Cognitive Deficits in Patients With Major Depressive Disorder. Front Psychiatry 2021; 12:627695. [PMID: 33664684 PMCID: PMC7921310 DOI: 10.3389/fpsyt.2021.627695] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/25/2021] [Indexed: 01/24/2023] Open
Abstract
Background: Cognitive deficits have shown progressive feature in major depressive disorder (MDD). However, it remains unknown which component of cognitive function is progressively impaired across episodes of MDD. Here we aim to identify the progressively impaired cognitive components in patients with MDD. Methods: A comprehensive neurocognitive test battery was used to assess the cognitive components (executive function, attention, processing speed, memory, working memory, inhibition, shifting, and verbal fluency) in 35 patients with first-episode MDD (FED), 60 patients with recurrent MDD (RD) and 111 matched healthy controls (HCs). After 6 months of treatment with antidepressant, 20 FED and 36 RD patients achieved clinical remission and completed their second-time neurocognitive tests. Statistical analyses were conducted to identify the impaired cognitive components in the FED and RD groups before and after treatment, and to assess the relationship between the cognitive components and the number of episodes and total illness duration in the MDD patient group. Results: At baseline, both the FED and RD groups showed impairments in all of the cognitive components; the FED and RD groups showed no significant difference in all of the components except for shifting. After remission, only shifting in the RD group showed no significant improvement and remained in an impaired status. Furthermore, shifting was the only component negatively correlated with the number of episodes as well as the total illness duration. Conclusions: Shifting may serve as the progressive cognitive deficit across episodes of MDD. Clinical Trials Registration: Registry name: HPA function and MRI study of trauma-related depression; Registration number: ChiCTR1800014591; URL: http://www.chictr.org.cn/edit.aspx?pid=24669&htm=4.
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Affiliation(s)
- Jin Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Bangshan Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Mi Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Yumeng Ju
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Qiangli Dong
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Xiaowen Lu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Jinrong Sun
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Liang Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Hua Guo
- Zhumadian Psychiatric Hospital, Zhumadian, China
| | - Futao Zhao
- Zhumadian Psychiatric Hospital, Zhumadian, China
| | - Weihui Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Li Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Zexuan Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Yan Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Mei Liao
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Lingjiang Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
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14
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Ivanets NN, Kinkulkina MA, Tikhonova YG, Izumina TA, Lazareva AV. [Clinical and sociodemographic characteristics of patients with the first depressive episode and recurrent depression]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:33-39. [PMID: 33340295 DOI: 10.17116/jnevro202012011133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To comparare socio-demographic and clinical characteristics of patients with the first depressive episode and recurrent depression. MATERIAL AND METHODS Three hundred and twenty one patients with unipolar depression, including 96 patients with first depressive episode and 225 patients with recurrent depression, were examined using clinical and psychometric methods. RESULTS AND CONCLUSION There were differences in clinical characteristics between groups but such factors as gender, marital status, level of education, family history of mental disorders and personality were similar. With each new episode of recurrent depression, the next episode tends to be more severe with more intense pessimistic and suicidal thoughts but fewer anxiety and complaints of depressive mood that affects the differences and requires further research, especially considering the effect of therapy.
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Affiliation(s)
- N N Ivanets
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M A Kinkulkina
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Y G Tikhonova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - T A Izumina
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A V Lazareva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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15
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Huijbers MJ, Wentink C, Simons E, Spijker J, Speckens A. Discontinuing antidepressant medication after mindfulness-based cognitive therapy: a mixed-methods study exploring predictors and outcomes of different discontinuation trajectories, and its facilitators and barriers. BMJ Open 2020; 10:e039053. [PMID: 33177138 PMCID: PMC7661362 DOI: 10.1136/bmjopen-2020-039053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/15/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study aimed to explore predictors and outcomes associated with different trajectories of discontinuing antidepressant medication (ADM), in recurrently depressed individuals after participation in mindfulness-based cognitive therapy (MBCT). Facilitators and barriers of discontinuation were explored qualitatively. DESIGN Mixed-methods study combining quantitative and qualitative data, drawn from a randomised controlled trial. SETTING Twelve secondary and tertiary psychiatric outpatient clinics in the Netherlands. PARTICIPANTS Recurrently depressed individuals (N=226) who had been using ADM for at least 6 months and in partial or full remission. Regardless of trial condition, we made post-hoc classifications of patients' actual discontinuation trajectories: full discontinuation (n=82), partial discontinuation (n=34) and no discontinuation (n=110) of ADM within 6 months after baseline. A subset of patients (n=15) and physicians (n=7) were interviewed to examine facilitators and barriers of discontinuation. INTERVENTIONS All participants were offered MBCT, which consisted of eight weekly sessions in a group. PRIMARY AND SECONDARY OUTCOME MEASURES Demographic and clinical predictors of successful discontinuation within 6 months, relapse risk within 15 months associated with different discontinuation trajectories, and barriers and facilitators of discontinuation. RESULTS Of the 128 patients assigned to MBCT with discontinuation, only 68 (53%) fully discontinued ADM within 6 months, and 17 (13%) discontinued partially. Predictors of full discontinuation were female sex, being employed and lower levels of depression. Relapse risk was lower after no discontinuation (45%) or partial discontinuation (38%), compared with full discontinuation (66%) (p=0.02). Facilitators and barriers of discontinuation were clustered within five themes: (1) pre-existing beliefs about depression, medication and tapering; (2) current experience with ADM; (3) life circumstances; (4) clinical support and (5) mindfulness. CONCLUSIONS Discontinuing antidepressants appears to be difficult, stressing the need to support patients and physicians in this process. MBCT may offer one of these forms of support. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT00928980); post-results.
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Affiliation(s)
| | | | - Esther Simons
- Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
| | - Jan Spijker
- Expertise Centre for Depression, Pro Persona Locatie Tarweweg, Nijmegen, Gelderland, The Netherlands
| | - Anne Speckens
- Psychiatry, Radboudumc, Nijmegen, Gelderland, The Netherlands
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16
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Foster CE, Owens M, Kudinova AY, Gibb BE. Attentional biases to emotional faces among women with a history of single episode versus recurrent major depression. Cogn Emot 2020; 35:193-198. [PMID: 32752929 DOI: 10.1080/02699931.2020.1802228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Major depressive disorder (MDD) is a highly prevalent psychiatric disorder, and recurrent depression is associated with severe and chronic impairment. Identifying markers of risk is imperative to improve our ability to predict which individuals are likely to experience a recurrence. According to cognitive theories, biases in attention for affectively-salient information may serve as one mechanism of risk. Existing research has combined participants with a single episode (sMDD) and those with recurrent MDD (rMDD); therefore, little is known about whether these biases track the severity of disease course. The current study examined attentional biases to facial displays of emotion among 115 women with a history of rMDD, sMDD, or no history of psychopathology using a passive viewing eye-tracking task. Women with rMDD exhibited significantly lower sustained attention to happy faces compared to both healthy controls and sMDD women. These results extend previous research on the presence of attentional avoidance of positive stimuli in individuals with a history of MDD and provide preliminary evidence that this bias is strongest among individuals with a history of rMDD.
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Affiliation(s)
- Claire E Foster
- Department of Psychology, Binghamton University (SUNY), Binghamton, NY, USA
| | - Max Owens
- Department of Psychology, University of South Florida, St. Petersburg, FL, USA
| | | | - Brandon E Gibb
- Department of Psychology, Binghamton University (SUNY), Binghamton, NY, USA
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17
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Abramkin AA, Lisitsyna TA, Veltishchev DY, Seravina OF, Kovalevskaya OB, Glukhova SI, Nasonov EL. [Depression and severity of articular destruction in patients with rheumatoid arthritis]. TERAPEVT ARKH 2020; 92:22-32. [PMID: 32598772 DOI: 10.26442/00403660.2020.05.000624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Indexed: 11/22/2022]
Abstract
AIM To assess the influence of anxiety and depressive disorders on joint destruction in patients with rheumatoid arthritis (RA). MATERIALS AND METHODS 128 RA-patients were included, 87% were women with a mean age of 47.411.3 years and a median of RA duration 96 [48; 228] months. At the inclusion most patients had moderate (n=56, 43.7%) and severe (n=48, 37.5%) disease activity according to DAS28. Joint destruction was classified as maximal in patients with radiographic stage III, IV and/or osteonecrosis) and minimal in patients with stage I, II and no osteonecrosis. Pain intensity was measured with the BPI (Brief Pain Inventory) scale, severity of fatigue with fatigue severity scale (FSS), clinically important fatigue was diagnosed in patients with FSS4. Anxiety and depressive disorders (ADD) were diagnosed by a licensed psychiatrist in 123 (96.1%) of RA-patients in accordance with ICD-10 in semi-structured interview. Severity of depression and anxiety was evaluated with Montgomery-Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A). RA-patients with ADD were divided into the following treatment groups: 1 сDMARDs (n=39), 2 сDMARDs+PPT (sertraline or mianserine), n=43, 3 сDMARDs+bDMARDs (n=32), 4 сDMARDs+bDMARDs+PPT (sertraline or mianserine), n=9. Biologics treatment duration varied from 1 to 6 years, antidepressants from 6 to 96 weeks. 83 (67.5%) RA patients were assessed at five-years follow-up. Linear regression analysis was conducted to determine factors associated with maximal join destruction. RESULTS According to linear regression analysis, maximal joint destruction at 5 years follow-up was associated with higher baseline BPImax, longer RA and ADD duration, clinically important fatigue at baseline, baseline extraarticular RA manifestations, recurrent depressive disorder at 5-years follow-up and treatment with cDMARDs only. CONCLUSION Recurrent depressive disorder without antidepressant treatment is an important predictor of progression of joint destruction in patients with rheumatoid arthritis.
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Affiliation(s)
| | | | - D Y Veltishchev
- Moscow Research Institute of Psychiatry - branch of the Serbskiy National Medical Research Center of Psychiatry and Narcology.,Pirogov Russian National Research Medical University
| | - O F Seravina
- Moscow Research Institute of Psychiatry - branch of the Serbskiy National Medical Research Center of Psychiatry and Narcology
| | - O B Kovalevskaya
- Moscow Research Institute of Psychiatry - branch of the Serbskiy National Medical Research Center of Psychiatry and Narcology
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18
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Čukić M, Stokić M, Radenković S, Ljubisavljević M, Simić S, Savić D. Nonlinear analysis of EEG complexity in episode and remission phase of recurrent depression. Int J Methods Psychiatr Res 2020; 29:e1816. [PMID: 31820528 PMCID: PMC7301286 DOI: 10.1002/mpr.1816] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Biomarkers of major depressive disorder (MDD), its phases and forms have long been sought. Objectives were to examine whether the complexity of EEG activity, measured by Higuchi's fractal dimension (HFD) and sample entropy (SampEn), differs between healthy subjects, patients in remission, and in episode phase of the recurrent depression and whether the changes are differentially distributed between hemispheres and cortical regions. METHODS Resting state EEG with eyes closed was recorded from 22 patients suffering from recurrent depression (11 in remission, 11 in the episode), and 20 age and sex-matched healthy control subjects. Artifact-free EEG epochs were analyzed by in-house developed programs running HFD and SampEn algorithms. RESULTS Depressed patients had higher HFD and SampEn complexity compared to healthy subjects. The complexity was higher in patients who were in remission than in those in the acute episode. Altered complexity was present in the frontal and centro-parietal regions when compared to control group. The complexity in frontal and parietal regions differed between the two phases of depressive disorder. CONCLUSIONS Complexity measures of EEG distinguish between the healthy controls, patients in remission and episode. Further studies are needed to establish whether these measures carry a potential to aid clinically relevant decisions about depression.
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Affiliation(s)
- Milena Čukić
- Department of General Physiology and Biophysics, School of Biology, University of Belgrade, Belgrade, Serbia
| | - Miodrag Stokić
- Cognitive Neuroscience Department, Life Activities Advancement Center, Belgrade, Serbia
| | | | - Miloš Ljubisavljević
- Department of Physiology, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | - Slobodan Simić
- Department for Forensic Psychiatry, Institute for Mental Health, Belgrade, Serbia
| | - Danka Savić
- Laboratory of Theoretical and Condensed Matter Physics 020/2, Vinča Institute, University of Belgrade, Belgrade, Serbia
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19
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Visted E, Sørensen L, Vøllestad J, Osnes B, Svendsen JL, Jentschke S, Binder PE, Schanche E. The Association Between Juvenile Onset of Depression and Emotion Regulation Difficulties. Front Psychol 2019; 10:2262. [PMID: 31695636 PMCID: PMC6816416 DOI: 10.3389/fpsyg.2019.02262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/23/2019] [Indexed: 01/04/2023] Open
Abstract
Juvenile onset of Major Depressive Disorder (MDD) is associated with increased likelihood of recurrent episodes of depression and more detrimental clinical trajectories. The aim of the current study was to investigate the effect of juvenile onset of MDD on emotion regulation as measured by self-report and Heart Rate Variability (HRV). Furthermore, we wanted to assess whether juvenile onset impacted the association between rumination and depressive symptoms. Sixty-four individuals with at least three prior episodes of MDD were recruited and filled out self-report questionnaires measuring rumination and emotion regulation abilities. In addition, electrocardiographic assessments were used to calculate HRV. Based on self-reported age of MDD onset, individuals were divided in two groups: Juvenile onset of MDD (first MDD episode before the age of 18, n = 30) and adult onset of MDD (first MDD episode after the age of 18, n = 34). Results showed that individuals whose first depressive episode occurred in childhood and adolescence reported more rumination and less emotional clarity compared to individuals who had their first episode of MDD in adulthood. Moreover, the tendency to ruminate was strongly associated with depressive symptoms in the juvenile onset of MDD group, whereas no such association was found in the adult onset group. There was no significant group difference for HRV. The findings are discussed in light of existing literature, in addition to suggesting how our findings may inform clinical practice and future research. We conclude that juvenile onset of MDD may lead to difficulties in emotion regulation and that these difficulties may increase depressive symptoms and vulnerability for relapse in this particular subgroup.
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Affiliation(s)
- Endre Visted
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Lin Sørensen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Jon Vøllestad
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
- Solli District Psychiatric Center (DPS), Nesttun, Norway
| | - Berge Osnes
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Bjørgvin District Psychiatric Centre, Haukeland University Hospital, Bergen, Norway
| | - Julie Lillebostad Svendsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | | | - Per-Einar Binder
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
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20
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Geugies H, Mocking RJT, Figueroa CA, Groot PFC, Marsman JBC, Servaas MN, Steele JD, Schene AH, Ruhé HG. Impaired reward-related learning signals in remitted unmedicated patients with recurrent depression. Brain 2019; 142:2510-2522. [PMID: 31280309 PMCID: PMC6734943 DOI: 10.1093/brain/awz167] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 04/11/2019] [Accepted: 04/21/2019] [Indexed: 01/17/2023] Open
Abstract
One of the core symptoms of major depressive disorder is anhedonia, an inability to experience pleasure. In patients with major depressive disorder, a dysfunctional reward-system may exist, with blunted temporal difference reward-related learning signals in the ventral striatum and increased temporal difference-related (dopaminergic) activation in the ventral tegmental area. Anhedonia often remains as residual symptom during remission; however, it remains largely unknown whether the abovementioned reward systems are still dysfunctional when patients are in remission. We used a Pavlovian classical conditioning functional MRI task to explore the relationship between anhedonia and the temporal difference-related response of the ventral tegmental area and ventral striatum in medication-free remitted recurrent depression patients (n = 36) versus healthy control subjects (n = 27). Computational modelling was used to obtain the expected temporal difference errors during this task. Patients, compared to healthy controls, showed significantly increased temporal difference reward learning activation in the ventral tegmental area (PFWE,SVC = 0.028). No differences were observed between groups for ventral striatum activity. A group × anhedonia interaction [t(57) = -2.29, P = 0.026] indicated that in patients, higher anhedonia was associated with lower temporal difference activation in the ventral tegmental area, while in healthy controls higher anhedonia was associated with higher ventral tegmental area activation. These findings suggest impaired reward-related learning signals in the ventral tegmental area during remission in patients with depression. This merits further investigation to identify impaired reward-related learning as an endophenotype for recurrent depression. Moreover, the inverse association between reinforcement learning and anhedonia in patients implies an additional disturbing influence of anhedonia on reward-related learning or vice versa, suggesting that the level of anhedonia should be considered in behavioural treatments.
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Affiliation(s)
- Hanneke Geugies
- University Medical Center Groningen, University Center for Psychiatry, Mood and Anxiety Disorders, University of Groningen, The Netherlands
- University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, University of Groningen, The Netherlands
| | - Roel J T Mocking
- Department of Psychiatry, Amsterdam University Medical Center, location AMC, University of Amsterdam, The Netherlands
| | - Caroline A Figueroa
- Department of Psychiatry, Amsterdam University Medical Center, location AMC, University of Amsterdam, The Netherlands
- Warneford Hospital, Department of Psychiatry, University of Oxford, UK
| | - Paul F C Groot
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, University of Amsterdam, The Netherlands
| | - Jan-Bernard C Marsman
- University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, University of Groningen, The Netherlands
| | - Michelle N Servaas
- University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, University of Groningen, The Netherlands
| | - J Douglas Steele
- Medical School (Neuroscience), University of Dundee, Scotland, UK
| | - Aart H Schene
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henricus G Ruhé
- University Medical Center Groningen, University Center for Psychiatry, Mood and Anxiety Disorders, University of Groningen, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, location AMC, University of Amsterdam, The Netherlands
- Warneford Hospital, Department of Psychiatry, University of Oxford, UK
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
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21
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Aleksovski B, Novotni A, Vujović V, Rendevski V, Manusheva N, Neceva V, Filipce A, Risteski A, Aleksovski V, Gjorgoski I. Evaluation of peripheral serotonin content and α 2-adrenergic receptor function as potential markers for life-long recurrent depressive disorder by using methodological improvements. Int J Psychiatry Clin Pract 2018; 22:215-224. [PMID: 29216784 DOI: 10.1080/13651501.2017.1411516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We aimed to evaluate the role and the relations between peripheral platelet serotonin content, blood plasma serotonin concentration and the function of platelet α2-adrenergic receptors (α2-AR) as potential state or trait biomarkers for recurrent depressive disorder (RDD). METHODS 26 drug-free patients with life-long RDD and 31 healthy controls were included in the study. Several methodological improvements in blood collection and platelet isolation were implemented following the present standards in Haematology and Light transmission aggregometry. RESULTS Our results have shown lower platelet serotonin content, higher plasma serotonin concentration and desensitization of platelet α2-AR in patients with RDD. The variables were found heterogeneous and mainly influenced by the clinical characteristics of the current episode. High amplitude of the α2-AR correlated with severe anxious symptoms and high platelet serotonin content (as well as low plasma serotonin levels) were associated with psychotic symptoms. CONCLUSIONS The evaluated peripheral markers reflect only state (but not trait) abnormalities in patients with current severe episode of RDD. The observed peripheral α2-AR and serotonin abnormalities are mutually not related and they are probably triggered by different mechanisms.
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Affiliation(s)
- Boris Aleksovski
- a Faculty of Natural Sciences and Mathematics , "Ss. Cyril and Methodius" University , Skopje , Republic of Macedonia
| | - Antoni Novotni
- b Medical Faculty , University Clinic of Psychiatry, "Ss. Cyril and Methodius" University , Skopje , Republic of Macedonia
| | - Viktorija Vujović
- b Medical Faculty , University Clinic of Psychiatry, "Ss. Cyril and Methodius" University , Skopje , Republic of Macedonia
| | - Vladimir Rendevski
- c Medical Faculty , University Clinic of Neurosurgery, "Ss. Cyril and Methodius" University , Skopje , Republic of Macedonia
| | - Nensi Manusheva
- b Medical Faculty , University Clinic of Psychiatry, "Ss. Cyril and Methodius" University , Skopje , Republic of Macedonia
| | - Violeta Neceva
- d Department for Haemostasis and Thrombosis , Institute for Transfusion Medicine , Skopje , Republic of Macedonia
| | - Ana Filipce
- b Medical Faculty , University Clinic of Psychiatry, "Ss. Cyril and Methodius" University , Skopje , Republic of Macedonia
| | - Aleksandar Risteski
- b Medical Faculty , University Clinic of Psychiatry, "Ss. Cyril and Methodius" University , Skopje , Republic of Macedonia
| | - Vasko Aleksovski
- e Medical Faculty , University Clinic of Neurology, "Ss. Cyril and Methodius" University , Skopje , Republic of Macedonia
| | - Icko Gjorgoski
- a Faculty of Natural Sciences and Mathematics , "Ss. Cyril and Methodius" University , Skopje , Republic of Macedonia
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Visted E, Vøllestad J, Nielsen MB, Schanche E. Emotion Regulation in Current and Remitted Depression: A Systematic Review and Meta-Analysis. Front Psychol 2018; 9:756. [PMID: 29867700 PMCID: PMC5968125 DOI: 10.3389/fpsyg.2018.00756] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 04/30/2018] [Indexed: 01/19/2023] Open
Abstract
Background: Major Depressive Disorder (MDD) is a highly prevalent, recurrent, and potentially chronic disorder. Identifying risk factors and underlying mechanisms to inform preventive and therapeutic interventions is therefore imperative. Emotion regulation is a proposed factor in the development and maintenance of MDD. The aim of the present review was to summarize and synthesize research on self-reported emotion regulation strategy use and emotion regulation abilities in adults diagnosed with current and remitted MDD. Methods: Seventy-two eligible studies were retrieved from databases through a systematic literature search. Group differences between individuals with current MDD, remitted MDD, and healthy controls were calculated using meta-analytic procedures. Meta-regression analyses investigated potential moderator effects on emotion regulation difficulties. Results: Results indicated that individuals with current MDD report higher maladaptive emotion regulation strategy use for avoidance (Hedges' g = 1.3), rumination (g = 2.1), and suppression (g = 1.1) compared to healthy controls. Also, they reported lower adaptive emotion regulation strategy use for acceptance (g = −1.0), problem solving (g = −1.0), and reappraisal (g = −0.7). Individuals with current MDD reported limited general emotion regulation abilities, indicated by higher alexithymia (g = 1.45), lower emotional awareness (g = −0.95), emotional clarity (g = −1.50) and emotional tolerance (g = −1.89). Similar results were found in individuals with remitted MDD for avoidance (g = 1.0), rumination (g = 1.1), suppression (g = 0.6), and general emotion regulation abilities. However, no difference was found between individuals with remitted MDD and healthy controls for adaptive emotion regulation strategies. Meta-regression analyses suggest that age of illness onset, comorbid anxiety and duration of remission influence emotion regulation. Conclusion: The present review and meta-analysis indicates that individuals with current and remitted MDD have difficulties with emotion regulation compared to individuals who have never been depressed. Although depressive symptoms improve, emotion regulation difficulties may continue, and could be a contributing factor to relapse. Our findings inform future research on emotion regulation and psychotherapeutic interventions.
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Affiliation(s)
- Endre Visted
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jon Vøllestad
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Solli District Psychiatric Centre (DPS), Bergen, Norway
| | - Morten Birkeland Nielsen
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
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23
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Abstract
The existing literature in the field demonstrates that in the majority of cases depressive disorder has a recurrent course that resulted in negative consequences: an increase in a number of chronic and marked episodes, a higher risk of suicide and stable cognitive deficit. An analysis of predictors promoting the formation of recurrent depressive disorder allows an identification of a constellation of biological, psychological, therapeutic, social factors which should be taken into account in the choice of methods of prevention of the next episode of depression. Currently, the prolonged supporting psychopharmacotherapy, including antidepressant therapy, is a main tactics in the prevention of recurrent dynamics of depressive disorder though its efficacy is understudied.
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Affiliation(s)
- D Yu Veltishchev
- Moscow Research Institute of Psychiatry: branch of the Serbsky Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | - O B Kovalevskaya
- Moscow Research Institute of Psychiatry: branch of the Serbsky Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | - O F Seravina
- Moscow Research Institute of Psychiatry: branch of the Serbsky Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
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24
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Abstract
Objective There is a close link between major depressive disorder (MDD) and cardiovascular disease (CVD). Increasing oxidative stress, changes in hypothalamic-pituitary-adrenal axis and platelet clotting cascade may lead to subclinical myocardial damage in MDD patients without overt CVD. The aim of the study was to investigate whether MDD is associated with fragmented QRS (fQRS) on electrocardiogram (ECG) which may reflect myocardial fibrosis/scarring and ischaemia. Methods and results A total of 66 MDD patients without overt CVD and 35 age- and sex-matched control subjects were enrolled in this study. Twelve-lead surface ECGs were analysed for the presence of fQRS and echocardiographic examination was performed for each individual. Multivariate logistic regression analysis was used to assess the relationship between MDD and fQRS. The baseline characteristics in terms of age, gender, body mass index and cardiovascular risk factors were comparable in the groups (all P values >0.05). Left ventricular ejection fraction, left ventricular wall thickness and diastolic blood pressure were also similar in the two groups. The presence of fQRS was more prevalent (P < 0.001) and SBP values (P = 0.007) were higher in patients with MDD compared to controls. Moreover, multivariate binary logistic regression analysis indicated the recurrent MDD as the only independent predictor of fQRS on ECG (beta =0.196, 95% CI 0.046 - 0.827, P = 0.014). Conclusion The presence of fQRS on the ECG is associated with MDD, and may be a beneficial tool for detecting subclinical cardiac damage in this population.
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Affiliation(s)
- Abdulselam Ilter
- Department of Cardiology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Murat Aslan
- Department of Psychiatry, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Zeynep Caliskan Ilter
- Department of Psychiatry, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Feyzullah Besli
- Department of Cardiology, Medical Faculty, Harran University, Sanliurfa, Turkey
| | - Eyyup Tusun
- Department of Cardiology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
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25
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Aagaard J, Foldager L, Makki A, Hansen V, Müller-Nielsen K. The efficacy of psychoeducation on recurrent depression: a randomized trial with a 2-year follow-up. Nord J Psychiatry 2017; 71:223-229. [PMID: 27997274 DOI: 10.1080/08039488.2016.1266385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The efficacy of psychoeducation is well documented in the treatment of relapse prevention of schizophrenia, and recently also in bipolar disorder; however, for recurrent depression only few controlled studies focusing on the efficacy of psychoeducation have been conducted. AIMS This randomized study tests the efficacy of treatment-as-usual supplemented with a psychoeducative programme for patients with recurrent depression, treated at Community Mental Health Centres (CMHC) in Denmark. The primary outcome measurements concern was decline in consumption of psychiatric inpatient services and decline in Beck's Depression Inventory (BDI). METHODS Eighty patients were randomized, either to the psychoeducative programme (consisting of eight sessions, each of 2 hours duration) and 2-year outpatient follow-up (42 cases), or only to 2-year outpatient follow-up (38 controls). The patients were monitored during 2 years after randomization. Data were collected from interviews including BDI, drug treatment and social measurements, and register data concerning use of psychiatric services. RESULTS At 2-year follow-up, a significant reduction in the consumption of psychiatric inpatient services and in BDI was found; however, it was uniform for case and control patients. Drop-out/non-compliance was significantly more frequent among patients randomized to the control group. Furthermore, during follow-up the case group got a significant stronger attachment to the Labour market than the control group. CONCLUSIONS The primary hypothesis could not be confirmed. Secondary outcome measurements concerning drop-out/non-compliance and attachment to the Labour market were significantly in favour of cases.
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Affiliation(s)
- Jørgen Aagaard
- a Unit for Psychiatric Research and Department M, Aarhus University Hospital , Risskov , Denmark.,b Aalborg University Hospital, Psychiatric Hospital , Unit for Psychiatric Research and Clinic South , Aalborg , Denmark
| | - Leslie Foldager
- c Department of Animal Science , Aarhus University , Aarhus , Denmark.,d Bioinformatics Research Centre, Aarhus University , Aarhus , Denmark
| | - Ahmad Makki
- b Aalborg University Hospital, Psychiatric Hospital , Unit for Psychiatric Research and Clinic South , Aalborg , Denmark
| | - Vibeke Hansen
- a Unit for Psychiatric Research and Department M, Aarhus University Hospital , Risskov , Denmark
| | - Klaus Müller-Nielsen
- e Department for Child and Youth Psychiatry , Kolding Hospital , Kolding , Denmark
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26
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Smulevich AB, Dubnitskaya EB, Voronova EI, Morozova YV, Radaev SM. Efficiency of Umbilical Cord Blood Cells in Patients with Treatment-Resistant Depressions. Bull Exp Biol Med 2016; 160:583-8. [PMID: 26899842 PMCID: PMC7087609 DOI: 10.1007/s10517-016-3222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Indexed: 12/05/2022]
Abstract
We studied the efficacy of umbilical cord blood cells in the therapy of treatment-resistant depressive states in women. Concentrated umbilical cord blood cells were administered in a dose of 250 millions cells (4 injections at 1-week intervals). The control group received placebo. In both groups, reduction of depressive disorders and the decrease in hypothymia severity were observed. Infusions of cell concentrate contributed to delayed correction of treatment resistance and reduced the severity of depression to moderate. In the main group, significant, persistent, and long-term positive dynamics was observed in the cognitive sphere. The therapeutic potential of umbilical cord blood cell concentrate can be used to overcome treatment resistance formed in depressive patients.
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Affiliation(s)
- A B Smulevich
- Research Center of Mental Health, Russian Academy of Medical Sciences, Moscow, Russia
| | - E B Dubnitskaya
- Research Center of Mental Health, Russian Academy of Medical Sciences, Moscow, Russia
| | - E I Voronova
- Research Center of Mental Health, Russian Academy of Medical Sciences, Moscow, Russia
| | - Ya V Morozova
- Russian Cardiology Research-and-Production Complex, Ministry of Health of the Russian Federation, Moscow, Russia.
| | - S M Radaev
- CryoCenter Umbilical Cord Blood Bank, Moscow, Russia
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Thapar A, Hammerton G, Collishaw S, Potter R, Rice F, Harold G, Craddock N, Thapar A, Smith DJ. Detecting recurrent major depressive disorder within primary care rapidly and reliably using short questionnaire measures. Br J Gen Pract 2014; 64:e31-7. [PMID: 24567580 DOI: 10.3399/bjgp14X676438] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is often a chronic disorder with relapses usually detected and managed in primary care using a validated depression symptom questionnaire. However, for individuals with recurrent depression the choice of which questionnaire to use and whether a shorter measure could suffice is not established. AIM To compare the nine-item Patient Health Questionnaire (PHQ-9), the Beck Depression Inventory, and the Hospital Anxiety and Depression Scale against shorter PHQ-derived measures for detecting episodes of DSM-IV major depression in primary care patients with recurrent MDD. DESIGN AND SETTING Diagnostic accuracy study of adults with recurrent depression in primary care predominantly from Wales METHOD Scores on each of the depression questionnaire measures were compared with the results of a semi-structured clinical diagnostic interview using Receiver Operating Characteristic curve analysis for 337 adults with recurrent MDD. RESULTS Concurrent questionnaire and interview data were available for 272 participants. The one-month prevalence rate of depression was 22.2%. The area under the curve (AUC) and positive predictive value (PPV) at the derived optimal cut-off value for the three longer questionnaires were comparable (AUC = 0.86-0.90, PPV = 49.4-58.4%) but the AUC for the PHQ-9 was significantly greater than for the PHQ-2. However, by supplementing the PHQ-2 score with items on problems concentrating and feeling slowed down or restless, the AUC (0.91) and the PPV (55.3%) were comparable with those for the PHQ-9. CONCLUSION A novel four-item PHQ-based questionnaire measure of depression performs equivalently to three longer depression questionnaires in identifying depression relapse in patients with recurrent MDD.
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Callesen P, Jensen AB, Wells A. Metacognitive therapy in recurrent depression: a case replication series in Denmark. Scand J Psychol 2013; 55:60-4. [PMID: 24256292 DOI: 10.1111/sjop.12089] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 09/02/2013] [Indexed: 12/28/2022]
Abstract
Metacognitive therapy (MCT) for depression is derived from the Wells and Matthews (1994) self-regulatory model, in which a Cognitive-Attentional Syndrome (CAS) is the cause of psychological disorders. MCT for depression focuses on identifying patients' CAS and helps them to stop it. The CAS consists of worry, rumination and dysfunctional coping strategies. The focus in MCT is on removing the CAS by challenging positive and negative metacognitive beliefs and eliminating dysfunctional behaviors. In this case series, MCT was delivered to four depressed Danes and treatment was evaluated in 5-11 sessions of up to one hour each. An A-B design with follow-up at 3 and 6 months was conducted and the primary outcome was Beck's Depression Inventory II (BDI-II). We measured CAS processes with the Major depressive Disorder Scale (MDD-S). The results of the case series showed clinically significant improvements in depressive symptoms, rumination and metacognitive beliefs and the effects were still present at follow-up for all patients. The small number of patients and decreasing baselines observed in some cases limits the conclusions. However, the results suggest that this treatment is feasible and was associated with large improvements in symptoms when delivered away from its point of origin and in a Danish help-seeking sample.
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Affiliation(s)
- Pia Callesen
- University of Manchester, School of Psychological Sciences, Manchester, United Kingdom
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29
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Jarrett RB, Minhajuddin A, Gershenfeld H, Friedman ES, Thase ME. Preventing depressive relapse and recurrence in higher-risk cognitive therapy responders: a randomized trial of continuation phase cognitive therapy, fluoxetine, or matched pill placebo. JAMA Psychiatry 2013; 70:1152-60. [PMID: 24005123 PMCID: PMC4204630 DOI: 10.1001/jamapsychiatry.2013.1969] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Strategies to improve the course of recurrent major depressive disorder have great public health relevance. To reduce the risk of relapse/recurrence after acute phase cognitive therapy (CT), a continuation phase model of therapy may improve outcomes. OBJECTIVES To test the efficacy of continuation phase CT (C-CT) and fluoxetine for relapse prevention in a pill placebo (PBO)-controlled randomized trial and compare the durability of prophylaxis after discontinuation of treatments. DESIGN A sequential, 3-stage design with an acute phase (all patients received 12 weeks of CT); 8-month experimental phase (responders at higher risk were randomized to C-CT, fluoxetine, or PBO); and 24 months of longitudinal, posttreatment follow-up. SETTING Two university-based specialty clinics. PATIENTS A total of 523 adults with recurrent major depressive disorder began acute phase CT, of which 241 higher-risk responders were randomized and 181 subsequently entered the follow-up. INTERVENTIONS Cognitive therapy responders at higher risk for relapse were randomized to receive 8 months of C-CT (n = 86), fluoxetine (n = 86), or PBO (n = 69). MAIN OUTCOMES AND MEASURES Survival analyses of relapse/recurrence rates, as determined by blinded evaluators using DSM-IV criteria and the Longitudinal Interval Follow-up Evaluation. RESULTS As predicted, the C-CT or fluoxetine groups were significantly less likely to relapse than the PBO group across 8 months. Relapse/recurrence rates for C-CT and fluoxetine were nearly identical during the 8 months of treatment, although C-CT patients were more likely to accept randomization, stayed in treatment longer, and attended more sessions than those in the fluoxetine and PBO groups. Contrary to prediction, relapse/recurrence rates following the discontinuation of C-CT and fluoxetine did not differ. CONCLUSIONS AND RELEVANCE Relapse risk was reduced by both C-CT and fluoxetine in an enriched randomization sampling only CT responders. The preventive effects of C-CT were not significantly more durable than those of fluoxetine after treatment was stopped, suggesting that some higher-risk patients may require alternate longer-term interventions. TRIAL REGISTRATION clinicaltrials.gov Identifiers: NCT00118404, NCT00183664, and NCT00218764.
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Affiliation(s)
- Robin B. Jarrett
- Department of Psychiatry, The University of Texas Southwestern Medical Center
| | - Abu Minhajuddin
- Department of Clinical Sciences, The University of Texas Southwestern Medical Center
| | - Howard Gershenfeld
- Department of Psychiatry, The University of Texas Southwestern Medical Center
| | | | - Michael E. Thase
- Departments of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia Veterans Affairs Medical Center and the University of Pittsburgh Medical Center
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30
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Hansson PB, Murison R, Lund A, Hammar Å. Cognitive functioning and cortisol suppression in recurrent major depression. Psych J 2013; 2:167-74. [PMID: 26271361 DOI: 10.1002/pchj.29] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 04/02/2013] [Indexed: 12/30/2022]
Abstract
Major Depressive Disorder (MDD) is often associated with high levels of stress and disturbances in the hypothalamic-pituitary-adrenal (HPA) system, yielding high levels of cortisol in addition to cognitive dysfunction. The aim of the present study was to examine the relation between cortisol levels after the dexamethasone suppression test and cognitive function in recurrent unipolar MDD patients. Twenty-four patients meeting the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) criteria for a recurrent MDD diagnosis were included in the study. The control group was matched for age, sex, and education level. Cortisol was measured in saliva collected with Salivette sampling devices. Saliva samples were collected four times during a 24-hr period over two consecutive days: at awakening, after 45 min, after 7 hr, and at 11:00 p.m. One milligram of dexamethasone was given on Day 1 at 11:00 p.m. The neuropsychological test battery consisted of standardized tests measuring cognitive functioning within verbal and visual memory, as well as executive functioning. Cortisol levels did not differ between patients and controls on Day 1. Cortisol levels in patients were higher than in controls at awakening on Day 2 (D2S1), after dexamethasone administration the previous evening. All significant correlations between cognitive measures and cortisol at D2S1 were negative, indicating that low suppression after intake of dexamethasone is related to poor cognitive functioning. Significant relations were found in three of the cognitive tests measuring verbal memory, semantic fluency, and inhibition. The present findings indicate that dysregulation of the HPA-axis is related to poor verbal memory functioning. There was no firm evidence that abnormal cortisol levels were associated with inhibition difficulties.
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Affiliation(s)
- Pia Berner Hansson
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Robert Murison
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Anders Lund
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway.,Moodnet Research Group, Haukeland University Hospital, Bergen, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway.,Moodnet Research Group, Haukeland University Hospital, Bergen, Norway
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Renner F, Jarrett RB, Vittengl JR, Barrett MS, Clark LA, Thase ME. Interpersonal problems as predictors of therapeutic alliance and symptom improvement in cognitive therapy for depression. J Affect Disord 2012; 138:458-67. [PMID: 22306232 PMCID: PMC3306447 DOI: 10.1016/j.jad.2011.12.044] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 12/07/2011] [Accepted: 12/29/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND The degree to which interpersonal problems of depressed patients improve over the course of cognitive therapy (CT) and relate to the quality of the therapeutic alliance and to symptom improvement, remains unclear. METHODS We analyzed data of adult outpatients (N=523) with major depressive disorder participating in a clinical trial to determine the factor structure of the Inventory of Interpersonal Problems-Circumplex (IIP-C) and to relate the observed factor scores to the quality of the therapeutic alliance and symptom improvement over the course of CT. Patients received 16-20 sessions protocol (50-60 min each) of individual CT according to the treatment manual by Beck et al. (1979). RESULTS We found a three-factor structure (interpersonal distress, agency, and communion) of interpersonal problems. Interpersonal distress decreased (d=.90), but interpersonal style did not change substantively during CT (communion d=.03; agency d=.14). High initial agency scores related negatively to the therapeutic alliance (β=-.12), whereas high initial communion scores related positively to the therapeutic alliance (β=.15). Elevated pre-treatment interpersonal distress scores were related to both weaker therapeutic alliances (β=.13) and higher symptom levels throughout treatment (β=.10). LIMITATIONS All patients in this study had recurrent MDD and it is therefore uncertain whether the results would generalize to patients with other psychiatric disorders. CONCLUSIONS This study supports the use of the IIP-C as a comprehensive measure of patients' interpersonal style and interpersonal distress. The IIP-C measured before CT showed some predictive validity with respect to therapeutic alliance measured at the midpoint and therapy outcome. The clinical importance of these findings is discussed.
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Affiliation(s)
- Fritz Renner
- Department of Clinical Psychological Science, Maastricht University, The Netherlands.
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32
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Jarrett RB, Thase ME. Comparative efficacy and durability of continuation phase cognitive therapy for preventing recurrent depression: design of a double-blinded, fluoxetine- and pill placebo-controlled, randomized trial with 2-year follow-up. Contemp Clin Trials 2010; 31:355-77. [PMID: 20451668 PMCID: PMC2936266 DOI: 10.1016/j.cct.2010.04.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 04/22/2010] [Accepted: 04/25/2010] [Indexed: 01/14/2023]
Abstract
BACKGROUND Major Depressive Disorder (MDD) is highly prevalent and associated with disability and chronicity. Although cognitive therapy (CT) is an effective short-term treatment for MDD, a significant proportion of responders subsequently suffer relapses or recurrences. PURPOSE This design prospectively evaluates: 1) a method to discriminate CT-treated responders at lower vs. higher risk for relapse; and 2) the subsequent durability of 8-month continuation phase therapies in randomized higher risk responders followed for an additional 24 months. The primary prediction is: after protocol treatments are stopped, higher risk patients randomly assigned to continuation phase CT (C-CT) will have a lower risk of relapse/recurrence than those randomized to fluoxetine (FLX). METHODS Outpatients, aged 18 to 70 years, with recurrent MDD received 12-14 weeks of CT provided by 15 experienced therapists from two sites. Responders (i.e., no MDD and 17-item Hamilton Rating Scale for Depression RESULTS The trial began in 2000. Enrollment is complete (n=523). The follow-up continues. CONCLUSIONS The trial evaluates the preventive effects and durability of acute and continuation phase treatments in the largest known sample of CT responders collected worldwide.
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Affiliation(s)
- Robin B. Jarrett
- Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9149, United States of America; 214-648-5345; fax 214-648-5340
| | - Michael E. Thase
- The University of Pennsylvania School of Medicine, 3535 Market Street, Suite 670, Philadelphia, PA, 19104, United States of America. Philadelphia, Veterans Affairs Medical Center and University of Pittsburgh Medical Center
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Strong DR, Cameron A, Feuer S, Cohn A, Abrantes AM, Brown RA. Single versus recurrent depression history: differentiating risk factors among current US smokers. Drug Alcohol Depend 2010; 109:90-5. [PMID: 20074868 PMCID: PMC2890270 DOI: 10.1016/j.drugalcdep.2009.12.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 12/03/2009] [Accepted: 12/04/2009] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The strong relationship between persistent tobacco use and Major Depressive Disorder (MDD) has motivated clinical trials of specialized treatments targeting smokers with a history of MDD. Meta-analyses suggest positive responses to specialized treatments have been observed consistently among smokers with history of recurrent rather than a single episode of MDD. Approximately 15% of current US smokers have a history of recurrent MDD. Little is known about the risk factors that contribute to persistent smoking and differentiate these at-risk smokers, US. METHODS The National Comorbidity Survey - Replication (NCS-R) included a survey of 1560 smokers participants aged 18 and older in the United States. Lifetime history of MDD was categorized according to chronicity: no history (No MDD), single episode (MDD-S) and recurrent depression (MDD-R). The relationship between the chronicity of MDD, smoking characteristics, cessation history, nicotine dependence, comorbidity with psychiatric disorders, and current functional impairments were examined. RESULTS MDD-R smokers reported fewer lifetime cessation efforts, smoked more cigarettes, had higher levels of nicotine dependence, had higher rates of comorbid psychiatric disorders and greater functional impairment than smokers with No MDD. MDD-S smokers were not consistently distinguished from No MDD smokers on cessation attempts, level of daily smoking, nicotine dependence or functional impairment indices. CONCLUSIONS The study highlights the importance of chronicity when characterizing depression-related risk of persistent smoking behavior. Although, clinical trials suggest MDD-R smokers specifically benefit from specialized behavioral treatments, these services are not widely available and more efforts are needed to engage MDD-R smokers in efficacious treatments.
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Affiliation(s)
- David R. Strong
- Butler Hospital, The Warren Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI, 02906 USA
| | - Amy Cameron
- Department of Psychology, Clark University, 950 Main Street, Worcester, MA 01610 USA
| | - Shelley Feuer
- Butler Hospital, The Warren Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI, 02906 USA
| | - Amy Cohn
- Center of Alcohol Studies, Rutgers, the State University of New Jersey, 607 Allison Road, Piscataway, New Jersey 08854 USA
| | - Ana M. Abrantes
- Butler Hospital, The Warren Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI, 02906 USA
| | - Richard A. Brown
- Butler Hospital, The Warren Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI, 02906 USA
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Abstract
Agenesis of corpus callosum can have various neuropsychiatric manifestations. Following case report highlights the case of a young man presenting with features of recurrent brief depressive disorder, each lasting for about 3 to 7 days, for over a year. He had history of occasional headache and episodes of swooning attack in between, usually precipitated by emotional events. His neuroimaging revealed agenesis of corpus callosum. He was experiencing swooning attacks as he became aware that some 'unusual' findings were present in his reports. Recurrent brief depression can be a manifestation of this congenital anomaly, and conversion disorder can be present as comorbid diagnosis perhaps due to ignorance and fear of this apparently innocuous congenital malformation.
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Shabani A, Zolfigol F, Akbari M. Brief major depressive episode as an essential predictor of the Bipolar Spectrum Disorder. J Res Med Sci 2009; 14:29-35. [PMID: 21772858 PMCID: PMC3129066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 01/13/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND A bipolar spectrum definition presented to help the designation of more appropriate diagnostic criteria for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) is Ghaemi et al. Bipolar Spectrum Disorder (BSD). The present study evaluates the BSD frequency among inpatients with major depressive disorder (MDD) and tries to elucidate the contribution of second degree diagnostic items of BSD in the BSD definition. METHODS One hundred individuals aged 18-65 with current MDD consecutive admitted in three university affiliated psychiatric center were clinically interviewed. The patients with mental retardation or the history of substance dependence/ abuse were excluded. The interviews were carried out by a trained general practitioner according to an 11-item checklist comprised of criteria C (2 items) and D (9 items) of Ghaemi et al. BSD. RESULTS Fifty three males and 47 females entered the study. Patients' mean age was 34.16 ± 9.58. Thirty eight patients (39.2%: 18 males and 20 females) met the complete diagnostic criteria of BSD. Early onset depression (53.0%), recurrent depression (40.0%) and treatment resistant depression (38.8%) were the most frequent accessory items of BSD, but using logistic regression three items recurrent major depressive episodes (MDEs), treatment resistant depression, and brief MDE- had the significant weight to predict the BSD. Then, three mentioned items were simultaneously entered the logistic regression model: brief MDE (β = 1.5, EXP (β) = 4.52, p = 0.007), treatment resistant depression (β = 1.28, EXP (β) = 3.62, p = 0.01), and recurrent MDEs (β = 1.28, EXP (β) = 3.62, p = 0.01) had the highest strength in predicting BSD and account for 21-30% of BSD diagnosis variance in sum. CONCLUSIONS Regarding the greater diagnostic strength of some accessory items - especially brief MDE - to predict the BSD, it is suggested that these items were considered as the main ones in the BSD criterion C.
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Affiliation(s)
- Amir Shabani
- Iran Hospital of Psychiatry, Iran University of Medical Sciences, Tehran, Iran,Correspondence to: Amir Shabani, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. E-mail:
| | - Fatemeh Zolfigol
- Bipolar Disorders Research Group, Mental Health Research Centre, Tehran Psychiatric Institute, Iran University of Medical Sciences,Tehran, Iran
| | - Mehdi Akbari
- Iran Hospital of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
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