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Sample records for resembling clinical depression

  1. Resemblance of symptoms for major depression assessed at interview versus from hospital record review.

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    Ying Chen

    Full Text Available Diagnostic information for psychiatric research often depends on both clinical interviews and medical records. Although discrepancies between these two sources are well known, there have been few studies into the degree and origins of inconsistencies.We compared data from structured interviews and medical records on 1,970 Han Chinese women with recurrent DSM-IV major depression (MD. Correlations were high for age at onset of MD (0.93 and number of episodes (0.70, intermediate for family history (+0.62 and duration of longest episode (+0.43 and variable but generally more modest for individual depressive symptoms (mean kappa = 0.32. Four factors were identified for twelve symptoms from medical records and the same four factors emerged from analysis of structured interviews. Factor congruencies were high but the correlation of factors between interviews and records were modest (i.e. +0.2 to +0.4.Structured interviews and medical records are highly concordant for age of onset, and the number and length of episodes, but agree more modestly for individual symptoms and symptom factors. The modesty of these correlations probably arises from multiple factors including i inconsistency in the definition of the worst episode, ii inaccuracies in self-report and iii difficulties in coding medical records where symptoms were recorded solely for clinical purposes.

  2. Rhythmicity in mice selected for extremes in stress reactivity: behavioural, endocrine and sleep changes resembling endophenotypes of major depression.

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    Chadi Touma

    Full Text Available Dysregulation of the hypothalamic-pituitary-adrenal (HPA axis, including hyper- or hypo-activity of the stress hormone system, plays a critical role in the pathophysiology of mood disorders such as major depression (MD. Further biological hallmarks of MD are disturbances in circadian rhythms and sleep architecture. Applying a translational approach, an animal model has recently been developed, focusing on the deviation in sensitivity to stressful encounters. This so-called 'stress reactivity' (SR mouse model consists of three separate breeding lines selected for either high (HR, intermediate (IR, or low (LR corticosterone increase in response to stressors.In order to contribute to the validation of the SR mouse model, our study combined the analysis of behavioural and HPA axis rhythmicity with sleep-EEG recordings in the HR/IR/LR mouse lines. We found that hyper-responsiveness to stressors was associated with psychomotor alterations (increased locomotor activity and exploration towards the end of the resting period, resembling symptoms like restlessness, sleep continuity disturbances and early awakenings that are commonly observed in melancholic depression. Additionally, HR mice also showed neuroendocrine abnormalities similar to symptoms of MD patients such as reduced amplitude of the circadian glucocorticoid rhythm and elevated trough levels. The sleep-EEG analyses, furthermore, revealed changes in rapid eye movement (REM and non-REM sleep as well as slow wave activity, indicative of reduced sleep efficacy and REM sleep disinhibition in HR mice.Thus, we could show that by selectively breeding mice for extremes in stress reactivity, clinically relevant endophenotypes of MD can be modelled. Given the importance of rhythmicity and sleep disturbances as biomarkers of MD, both animal and clinical studies on the interaction of behavioural, neuroendocrine and sleep parameters may reveal molecular pathways that ultimately lead to the discovery of new

  3. An unusual clinical presentation resembling superior vena cava syndrome post heart surgery

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    Pellegrini Ronald

    2005-10-01

    Full Text Available Abstract Background An unusual sequence of post operative events heralded by hemodynamic deterioration followed by dyspnea and rapidly progressive dilatation of superficial neck and facial veins, resembling a superior vena cava syndrome, two days post surgical resection of filamentous aortic valve masses, closure of a patent foramen ovale, and performance of a modified Maze procedure for atrial fibrillation in a patient that presented with transient neurologic findings is presented. Case Presentation Although both clinical findings and hemodynamic derangements completely resolved following tricuspid valve repair aimed to correct the new onset severe tricuspid regurgitation noted post operatively; a clear mechanism was not readily obvious and diagnostic testing data somewhat conflictive. We present a careful retrospective examination of all clinical data and review possible clinical entities that could have been implicated in this particular case and recognize that transesophageal echocardiographic findings were most useful in identifying the best course of action. Conclusion After reviewing all clinical data and despite the inconclusive nature of test results; the retrospective examination of transesophageal echocardiographic findings proved to be most useful in identifying the best course of action. We postulate that in our case, resolution of the suspected pulmonary embolism with anticoagulation and reestablishment of a normal right ventricular geometry with tricuspid valve repair worked in unison in restoring normal hemodynamics and resolving both dyspnea and venous dilatation.

  4. Clinical Presentation Resembling Mucosal Disease Associated with 'HoBi'-like Pestivirus in a Field Outbreak.

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    Weber, M N; Mósena, A C S; Simões, S V D; Almeida, L L; Pessoa, C R M; Budaszewski, R F; Silva, T R; Ridpath, J F; Riet-Correa, F; Driemeier, D; Canal, C W

    2016-02-01

    The genus Pestivirus of the family Flaviviridae consists of four recognized species: Bovine viral diarrhoea virus 1 (BVDV-1), Bovine viral diarrhoea virus 2 (BVDV-2), Classical swine fever virus (CSFV) and Border disease virus (BDV). Recently, atypical pestiviruses ('HoBi'-like pestiviruses) were identified in batches of contaminated foetal calf serum and in naturally infected cattle with and without clinical symptoms. Here, we describe the first report of a mucosal disease-like clinical presentation (MD) associated with a 'HoBi'-like pestivirus occurring in a cattle herd. The outbreak was investigated using immunohistochemistry, antibody detection, viral isolation and RT-PCR. The sequence and phylogenetic analysis of 5'NCR, N(pro) and E2 regions of the RT-PCR positive samples showed that four different 'HoBi'-like strains were circulating in the herd. The main clinical signs and lesions were observed in the respiratory and digestive systems, but skin lesions and corneal opacity were also observed. MD characteristic lesions and a pestivirus with cytopathic biotype were detected in one calf. The present study is the first report of a MD like presentation associated with natural infection with 'HoBi'-like pestivirus. This report describes the clinical signs and provides a pathologic framework of an outbreak associated with at least two different 'HoBi'-like strains. Based on these observations, it appears that these atypical pestiviruses are most likely underdiagnosed in Brazilian cattle. © 2014 Blackwell Verlag GmbH.

  5. Atypical feline sporotrichosis resembling vaccine-induced sarcoma: clinical and histopathological aspects.

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    dos Santos, Isabele Barbieri; Quintella, Leonardo Pereira; de Miranda, Luisa Helena Monteiro; de Sousa Trotte, Marcele Nogueira; Schubach, Tânia Maria Pacheco; Tortelly, Rogerio

    2013-06-01

    A 7-year-old Siamese cat presenting with three ulcerated cutaneous nodules in the lumbosacral region was seen at the Laboratory for Clinical Research on Dermatozoonoses in Domestic Animals in Rio de Janeiro, Brazil. Histopathological analysis showed that the lesions consisted of polyhedral and spindle-shaped voluminous mononuclear cells with loose chromatin and clearly visible nucleoli, few giant cells, and foci of coagulative and caseous necrosis -- findings suggestive of a vaccine-induced sarcoma. No significant mitotic rate, cytological atypias or asteroid bodies were observed. Special histopathological staining with periodic acid-Schiff and Grocott's silver stain demonstrated the presence of small yeast cells characterized by simple and narrow-base budding compatible with Sporothrix schenckii. Mycological culture grew S schenckii. Cytopathology was negative for yeast cells. These atypical clinical and histopathological signs support the importance of histopathological analysis with special staining techniques, in addition to mycological culture in the diagnosis of feline sporotrichosis.

  6. Clinical profile of depressive disorder in children.

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    Krishnakumar, P; Geeta, M G

    2006-06-01

    The aim of this retrospective study was to evaluate the risk factors, clinical features and co-morbid disorders of depressive disorder in children below the age of 12 years. Children who attended the child guidance clinic between January 2000 and December 2003 formed the subjects for the study. The diagnosis of depressive disorder was based on DSMIV diagnostic criteria for Major Depressive Disorder, Single episode. There were 26 boys and 19 girls. Stress at school and in the family was significantly associated with depressive disorder. Children with depressive disorder had significantly more family members affected with mental illnesses. The clinical features included diminished interest in play and activities, excessive tiredness, low self- esteem, problems with concentration, multiple somatic complaints, behavior symptoms like anger and aggression, recent deterioration in school performance and suicidal behavior. Majority of children had other associated psychiatric disorders which included dysthymic disorder, anxiety disorders, conduct disorder and conversion disorder.

  7. Clinical risk and depression (continuing education credit).

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    Sharkey, S

    1997-01-22

    This article provides information and guidance to nurses on clinical risks in mental health, particularly that of depression. It relates to UKCC professional development category: Reducing risk and Care enhancement.

  8. Distinguishing bipolar II depression from major depressive disorder with comorbid borderline personality disorder: demographic, clinical, and family history differences.

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    Zimmerman, Mark; Martinez, Jennifer H; Morgan, Theresa A; Young, Diane; Chelminski, Iwona; Dalrymple, Kristy

    2013-09-01

    Because of the potential treatment implications, it is clinically important to distinguish between bipolar II depression and major depressive disorder with comorbid borderline personality disorder. The high frequency of diagnostic co-occurrence and resemblance of phenomenological features has led some authors to suggest that borderline personality disorder is part of the bipolar spectrum. Few studies have directly compared patients with bipolar disorder and borderline personality disorder. In the present study from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we compared these 2 groups of patients on demographic, clinical, and family history variables. From December 1995 to May 2012, 3,600 psychiatric patients presenting to the outpatient practice at Rhode Island Hospital (Providence, Rhode Island) were evaluated with semistructured diagnostic interviews for DSM-IV Axis I and Axis II disorders. The focus of the present study is the 206 patients with DSM-IV major depressive disorder and borderline personality disorder (MDD-BPD) and 62 patients with DSM-IV bipolar II depression without borderline personality disorder. The patients with MDD-BPD were significantly more often diagnosed with posttraumatic stress disorder (P depression had a significantly higher morbid risk for bipolar disorder in their first-degree relatives than the MDD-BPD patients (P depression and major depressive disorder with comorbid borderline personality disorder differed on a number of clinical and family history variables, thereby supporting the validity of this distinction. © Copyright 2013 Physicians Postgraduate Press, Inc.

  9. Clinical manifestations of geriatric depression in a memory clinic: toward a proposed subtyping of geriatric depression.

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    Dillon, Carol; Machnicki, Gerardo; Serrano, Cecilia M; Rojas, Galeno; Vazquez, Gustavo; Allegri, Ricardo F

    2011-11-01

    As the older population increases so does the number of older psychiatric patients. Elderly psychiatric patients manifest certain specific and unique characteristics. Different subtypes of depressive syndromes exist in late-life depression, and many of these are associated with cognitive impairment. A total of 109 depressive patients and 30 normal subjects matched by age and educational level were evaluated using a neuropsychiatric interview and an extensive neuropsychological battery. Depressive patients were classified into four different groups by SCAN 2.1 (schedules for clinical assessment in Neuropsychiatry): major depression disorder (n: 34), dysthymia disorder (n: 29), subsyndromal depression (n: 28), and depression due to mild dementia of Alzheimer's type (n: 18). We found significant associations (pdepressive status and demographic or clinical factors that include marital status (OR: 3.4, CI: 1.2-9.6), level of daily activity (OR: 5.3, CI: 2-14), heart disease (OR: 12.5, CI: 1.6-96.3), and high blood cholesterol levels (p:.032). Neuropsychological differences were observed among the four depressive groups and also between depressive patients and controls. Significant differences were observed in daily life activities and caregivers' burden between depressive patients and normal subjects. Geriatric depression is associated with heart disease, high cholesterol blood levels, marital status, and daily inactivity. Different subtypes of geriatric depression have particular clinical features, such as cognitive profiles, daily life activities, and caregivers' burden, that can help to differentiate among them. The cohort referred to a memory clinic with memory complaints is a biased sample, and the results cannot be generalized to other non-memory symptomatic cohorts. Copyright © 2011 Elsevier B.V. All rights reserved.

  10. The clinical effectiveness of cognitive therapy for depression in an outpatient clinic.

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    Gibbons, Carly J; Fournier, Jay C; Stirman, Shannon Wiltsey; DeRubeis, Robert J; Crits-Christoph, Paul; Beck, Aaron T

    2010-09-01

    Cognitive therapy (CT) has been shown to be efficacious in the treatment of depression in numerous randomized controlled trials (RCTs). However, little evidence is available that speaks to the effectiveness of this treatment under routine clinical conditions. This paper examines outcomes of depressed individuals seeking cognitive therapy at an outpatient clinic (N=217, Center for Cognitive Therapy; CCT). Outcomes were then compared to those of participants in a large NIMH-funded RCT of cognitive therapy and medications as treatments for depression. The CCT is shown to be a clinically representative setting, and 61% of participants experienced reliable change in symptoms over the course of treatment; of those, 45% (36% of the total sample) met criteria for recovery by the end of treatment. Participants at CCT had similar outcomes to participants treated in the RCT, but there was some evidence that those with more severe symptoms at intake demonstrated greater improvement in the RCT than their counterparts at CCT. The CCT may not be representative of all outpatient settings, and the structure of treatment there was considerably different from that in the RCT. Treatment fidelity was not assessed at CCT. Depressed individuals treated with cognitive therapy in a routine clinical care setting showed a significant improvement in symptoms. When compared with outcomes evidenced in RCTs, there was little evidence of superior outcomes in either setting. However, for more severe participants, outcomes were found to be superior when treatment was delivered within an RCT than in an outpatient setting. Clinicians treating such patients in non-research settings may thus benefit from making modifications to treatment protocols to more closely resemble research settings. Published by Elsevier B.V.

  11. Thyroid hormones association with depression severity and clinical outcome in patients with major depressive disorder

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    Berent, Dominika; Zboralski, Krzysztof; Orzechowska, Agata; Gałecki, Piotr

    2014-01-01

    The clinical implications of thyroid hormones in depression have been studied extensively and still remains disputable. Supplementation of thyroid hormones is considered to augment and accelerate antidepressant treatment. Studies on the role of thyroid hormones in depression deliver contradictory results. Here we assess theirs impact on depression severity and final clinical outcome in patients with major depression. Thyrotropin, free thyroxine (FT4), and free triiodothyronine (FT3) concentra...

  12. To fail or not to fail : clinical trials in depression

    NARCIS (Netherlands)

    Santen, Gijs Willem Eduard

    2008-01-01

    To fail or not to fail – Clinical trials in depression investigates the causes of the high failure rate of clinical trials in depression research. Apart from the difficulties in the search for new antidepressants during drug discovery, faulty clinical trial designs hinder their evaluation during

  13. Clinical relevance of findings in trials of CBT for depression

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    Lepping, P.; Whittington, R.; Sambhi, R.S.; Lane, S.; Poole, R.; Leucht, S.; Cuijpers, P.; McCabe, R.; Waheed, W.

    2017-01-01

    Cognitive behavioural therapy (CBT) is beneficial in depression. Symptom scores can be translated into Clinical Global Impression (CGI) scale scores to indicate clinical relevance. We aimed to assess the clinical relevance of findings of randomised controlled trials (RCTs) of CBT in depression. We

  14. Post-Adoption Depression: Clinical Windows on an Emerging Concept

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    Speilman, Eda

    2011-01-01

    In recent years, the concept of post-adoption depression--with both parallels and differences from postpartum depression--has emerged as a salient descriptor of the experience of a significant minority of newly adoptive parents. This article offers a clinical perspective on post-adoption depression through the stories of several families seen in…

  15. Ethnic Variation in the Cross-sectional Association between Domains of Depressive Symptoms and Clinical Depression.

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    Assari, Shervin; Moazen-Zadeh, Ehsan

    2016-01-01

    The degree by which depressive symptoms and clinical depression reflect each other may vary across populations. The present study compared Blacks and Whites for the magnitude of the cross-sectional associations between various domains of depressive symptoms and endorsement of clinical disorders of depression. Data came from the National Survey of American Life, 2001-2003. We included 3570 Black (African-Americans) and 891 Non-Hispanic Whites. Predictors were positive affect, negative affect, and interpersonal problems measured using the 12-item Center for Epidemiologic Studies Depression Scale (CES-D). Outcomes were lifetime major depressive disorder (MDD), lifetime major depressive episode (MDE), 12-month MDE, 30-day MDE, and 30-day major depressive disorder with hierarchy (MDDH) based on the Composite International Diagnostic Interview (CIDI). Logistic regression models were applied in the pooled sample as well as Blacks and Whites. Regarding CES-D, Blacks had lower total scores, positive affect, negative affect, and interpersonal problems compared to Whites (p < 0.05 for all comparisons). Blacks also had lower odds of meeting criteria for lifetime MDD and MDE, 12-month MDE, and 30-day MDE and MDDH (p < 0.05 for all comparisons). For most depressive diagnoses, ethnicity showed a positive and significant interaction with the negative affect and interpersonal problems domains, suggesting stronger associations for Blacks compared to Whites. The CES-D total score and CES-D positive affect domain did not interact with ethnicity on CIDI-based depressive diagnoses. Stronger associations between multiple domains of depressive symptoms and clinical depression may be due to higher severity of depression among Blacks, when they endorse the CIDI criteria for the disorder. This finding may explain some of previously observed ethnic differences in social, psychological, and medical correlates of depressive symptoms and clinical depression in the general population as

  16. Inferior Cerebellar Hypoplasia Resembling a Dandy-Walker-Like Malformation in Purebred Eurasier Dogs with Familial Non-Progressive Ataxia: A Retrospective and Prospective Clinical Cohort Study

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    Bernardino, Filipa; Rentmeister, Kai; Schmidt, Martin J.; Bruehschwein, Andreas; Matiasek, Kaspar; Matiasek, Lara A.; Lauda, Alexander; Schoon, Heinz A.; Fischer, Andrea

    2015-01-01

    Cerebellar malformations can be inherited or caused by insults during cerebellar development. To date, only sporadic cases of cerebellar malformations have been reported in dogs, and the genetic background has remained obscure. Therefore, this study`s objective was to describe the clinical characteristics, imaging features and pedigree data of a familial cerebellar hypoplasia in purebred Eurasier dogs. A uniform cerebellar malformation characterized by consistent absence of the caudal portions of the cerebellar vermis and, to a lesser degree, the caudal portions of the cerebellar hemispheres in association with large retrocerebellar fluid accumulations was recognized in 14 closely related Eurasier dogs. Hydrocephalus was an additional feature in some dogs. All dogs displayed non-progressive ataxia, which had already been noted when the dogs were 5 – 6 weeks old. The severity of the ataxia varied between dogs, from mild truncal sway, subtle dysmetric gait, dysequilibrium and pelvic limb ataxia to severe cerebellar ataxia in puppies and episodic falling or rolling. Follow-up examinations in adult dogs showed improvement of the cerebellar ataxia and a still absent menace response. Epileptic seizures occurred in some dogs. The association of partial vermis agenesis with an enlarged fourth ventricle and an enlarged caudal (posterior) fossa resembled a Dandy-Walker-like malformation in some dogs. Pedigree analyses were consistent with autosomal recessive inheritance. PMID:25668516

  17. Structure of the clinical and geriatric depression: Similarities and differences

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    Novović Zdenka

    2006-01-01

    Full Text Available Studies demonstrating the uniqueness of depression in old age are numerous, but conclusions on the fact if the problems of the elderly people cause depression or if they are a part of depression are not unique. The aim of this paper is to compare the structure of depression of old people without the history of mental illness and middle-aged people treated for depression. The sample consists of 82 healthy inmates of different Homes for the Aged and 78 patients diagnosed with some sort of affective disorder. A depression has been assessed with the shorten version of the MMPI D-scale. The structure of the geriatric and clinical depression has been compared with the method of maximum likelihood, over the matrix of co-variances of answers on the items on the depression scale. The results point out to the statistically significant difference in the structure of depression of the old and clinically depressed individuals. However, half of the items of the D-scale have significant loadings on the factor of depression in both groups. The essence of the depression in both samples is made of cognitive subject matters, depressive affect, decline of motivation and a negative estimate of one's basic abilities. Symptoms concerning low self-esteem, experiencing cognitive deficit, energy and impaired physical health have been significant in describing the clinical depression, while a feeling of reduced positive stimulation and the affective liability is typical for the depression of geriatric sample. The conclusion is that, despite the differences, there is a common core of symptoms that makes the essence of depression, apart from the samples.

  18. Thyroid hormones association with depression severity and clinical outcome in patients with major depressive disorder.

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    Berent, Dominika; Zboralski, Krzysztof; Orzechowska, Agata; Gałecki, Piotr

    2014-01-01

    The clinical implications of thyroid hormones in depression have been studied extensively and still remains disputable. Supplementation of thyroid hormones is considered to augment and accelerate antidepressant treatment. Studies on the role of thyroid hormones in depression deliver contradictory results. Here we assess theirs impact on depression severity and final clinical outcome in patients with major depression. Thyrotropin, free thyroxine (FT4), and free triiodothyronine (FT3) concentrations were measured with automated quantitative enzyme immunoassay. Depression severity and final clinical outcome were rated with 17-itemic Hamilton Rating Scale for Depression [HDRS(17)] and Clinical Global Impression Scales for severity and for improvement (CGIs, CGIi). FT3 and FT4 concentrations were significantly positively correlated with clinical improvement evaluated with CGIi (R = 0.38, P = 0.012; R = 0.33, P = 0.034, respectively). There was a significant correlation between FT4 concentrations and depression severity assessed in HDRS(17) (R = 0.31, P = 0.047). Male patients presented significantly higher FT3 serum levels (Z = 2.34, P = 0.018) and significantly greater clinical improvement (Z = 2.36, P = 0.018) when compared to female patients. We conclude that free thyroid hormones concentrations are associated with depression severity and have an impact on final clinical outcome. It can be more efficient to augment and accelerate the treatment of major depressive disorder with triiodothyronine instead of levothyroxine because of individual differences in thyroid hormones metabolism.

  19. Childhood Depression: Relation to Adaptive, Clinical and Predictor Variables

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    Garaigordobil, Maite; Bernar?s, Elena; Jaureguizar, Joana; Machimbarrena, Juan M.

    2017-01-01

    The study had two goals: (1) to explore the relations between self-assessed childhood depression and other adaptive and clinical variables (2) to identify predictor variables of childhood depression. Participants were 420 students aged 7–10 years old (53.3% boys, 46.7% girls). Results revealed: (1) positive correlations between depression and clinical maladjustment, school maladjustment, emotional symptoms, internalizing and externalizing problems, problem behaviors, emotional reactivity, and...

  20. Predictors of Suicide Attempts in Clinically Depressed Korean Adolescents

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    Kwon, Ahye; Song, Jungeun; Yook, Ki-Hwan; Jon, Duk-In; Jung, Myung Hun; Hong, Narei; Hong, Hyun Ju

    2016-01-01

    We examined predictors of suicide attempts in clinically depressed adolescents in Korea and gender differences in suicidal behavior. In total, 106 adolescents diagnosed with depressive disorder were recruited in South Korea. We assessed various variables that might affect suicide attempts, and used a structured interview for the diagnosis of depression and comorbidities and to evaluate suicidality. Demographic and clinical characteristics of the subjects were compared between suicide attempt ...

  1. [Bulimia and depression. Their clinical relations].

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    Criquillion-Doublet, S; Samuel-Lajeunesse, B

    1989-01-01

    The multiplicity of actual studies about a possible correlation between eating disorders and affective disorders is found on clinical and family studies, biological, genetic and therapeutic studies. As depressive symptoms are associated to eating disorders in 30 to 88% of the cases according to the authors, family studies suggest the existence of a relationship between eating and affective disorders but no causal link between the two can be proved. Biological tests are difficult to interpret (the dexamethasone suppression test, the TRH stimulation test, a study of platelet MAO activity, of the metabolism of neurotransmitters). The imbrication of metabolic and neuroendocrine disorders being a characteristic of both affective and eating disorders. On the level of therapy, if the results of antidepressants--essentially tricyclics and IMAO--on bulimia are effective on a short-term basis, this is not enough to prove the dysthimic nature of eating disorders. Moreover, their efficiency on the long term (over 6 months) is very controversial. It is the research on genetic and biological index which will allow the precise characterization of the nature of the relationship between eating (bulimia) and affective disorders.

  2. On electroconvulsive therapy in depression : Clinical, cognitive and neurobiological aspects

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    Nordanskog, Pia

    2015-01-01

    Electroconvulsive therapy (ECT) is used worldwide to treat severe mental disorders. The most common mental disorder, and the third leading cause of disease burden in the world is depression. The clinical efficacy of ECT for severe depression is well-established. However, both the pathophysiology of depression and the mechanism of action of ECT remain elusive. The main aims of this thesis are to address the following issues: 1) the use and practice of ECT in Sweden has not been systematically ...

  3. Demographic and clinical predictors of depressive symptoms among incarcerated women

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    Pinese Carmen SV

    2010-09-01

    Full Text Available Abstract Background Imprisonment may lead to the development of mental illness, especially depression. This study examines the clinical and sociodemographic profiles of imprisoned women, identifies indicative signs of depression, and relates these indicators to other variables. Methods This study took the form of descriptive exploratory research with a psychometric evaluation. A total of 100 of 300 women in a female penitentiary were interviewed. A questionnaire with sociodemographic, clinical and penal situation information was used, along with the Beck Depression Inventory. The authors performed bivariate and multivariate analysis regarding depression. Results In all, 82 women presented signs of depression (light = 33, mild = 29 and severe = 20. Comorbidities, lack of religious practice, absence of visitors and presence of eating disorders were risk factors for depression (P = 0.03, 0.03, 0.02, 0.04, and 0.01. Being older was a protection factor against severe depression; for women over 30, the risk of depression was multiplied by 0.12. The rate of depression among women prisoners was high. Conclusions Comorbidities, the lack of religious practice, not having visitors and eating disorders are significant risk factors for depression, while age is a protective factor, among incarcerated women.

  4. What Does the Term "Clinical Depression" Mean?

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    ... most or all normal activities, such as sex, hobbies or sports Sleep disturbances, including insomnia or sleeping ... Accessed April 20, 2017. May 13, 2017 Original article: http://www.mayoclinic.org/diseases-conditions/depression/expert- ...

  5. Depression Screening Patterns for Women in Rural Health Clinics

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    Tudiver, Fred; Edwards, Joellen Beckett; Pfortmiller, Deborah T.

    2010-01-01

    Context: Rates and types of screening for depression in rural primary care practices are unknown. Purpose: To identify rates of depression screening among rural women in a sample of rural health clinics (RHCs). Methods: A chart review of 759 women's charts in 19 randomly selected RHCs across the nation. Data were collected from charts of female…

  6. Clinical Correlates of Depression among Diabetics in Jos, Nigeria ...

    African Journals Online (AJOL)

    Background: Studies have consistently shown that depression among diabetics is associated with poor glyceamic control and an increase risk for the complications of diabetes. However, few studies have look at the clinical correlates of depression among diabetics in this environment. The aim of this study was to identify ...

  7. Breast cancer and depression: issues in clinical care

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    Thingbaijam B. Singh

    2012-11-01

    Full Text Available Many of breast-cancer patients experience distress and most of them experience depression which may lead to amplification of physical symptoms, increased functional impairment, and poor treatment adherence. We did a review on available literature from PubMed about prevalence, distress magnitudes, coping styles, and treatment methods of major depression in women with breast cancer from 1978 to 2010. Diagnosis and treatment of depressive episodes in women with breast cancer is challenging because of overlapping symptoms and co-morbid conditions. Major depression is often under-recognized and undertreated among breast cancer patients. This review highlighted the issues on identifying and managing depression in breast cancer patients in clinical settings. (Med J Indones. 2012;21:240-6Keywords: Breast cancer, coping, depression, distress

  8. Ethnic Variation in the Cross-sectional Association between Domains of Depressive Symptoms and Clinical Depression

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    Shervin eAssari

    2016-04-01

    Full Text Available BackgroundThe degree by which depressive symptoms and clinical depression reflect each other may vary across populations. The present study compared Blacks and Whites for the magnitude of the cross-sectional associations between various domains of depressive symptoms and endorsement of clinical disorders of depression. MethodsData came from the National Survey of American Life (NSAL, 2001–2003. We included 3,570 Black (African Americans, and 891 Non-Hispanic Whites. Predictors were positive affect, negative affect, and interpersonal problems measured using the 12-item Center for Epidemiologic Studies Depression Scale (CES-D. Outcomes were lifetime MDD, lifetime MDE, 12 month MDE, 30 days MDE, and 30 days MDDH based on the Composite International Diagnostic Interview (CIDI. Logistic regression models were applied in the pooled sample, as well as Blacks and Whites.ResultsRegarding CES-D, Blacks had lower total scores, positive affect, negative affect, and interpersonal problems compared to Whites (p < 0.05 for all comparisons. Blacks also had lower odds of meeting criteria for lifetime MDD and MDE, 12 month MDE, and 30 days MDE and MDDH (p < 0.05 for all comparisons. For most depressive diagnoses, ethnicity showed a positive and significant interaction with the negative affect and interpersonal domains, suggesting stronger associations for Blacks compared to Whites. CES-D total and CES-D positive affect did not interact with ethnicity on CIDI based diagnoses.ConclusionStronger associations between multiple domains of depressive symptoms and clinical MDD may be due to higher severity of depression among Blacks, when they endorse the disorder. This finding may explain some of previously observed ethnic differences in social, psychological, and medical correlates of depressive symptoms and clinical depression in the general population as well as clinical settings.

  9. A survey of the clinical acceptability of screening for postnatal depression in depressed and non-depressed women

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    Ericksen Jennifer

    2006-08-01

    Full Text Available Abstract Background Information on clinical acceptability is needed when making cost-utility decisions about health screening implementation. Despite being in use for two decades, most data on the clinical acceptability of the Edinburgh Postnatal Depression Scale (EPDS come from qualitative reports, or include relatively small samples of depressed women. This study aimed to measure acceptability in a survey of a relatively large, community sample with a high representation of clinically depressed women. Methods Using mail, telephone and face-to-face interview, 920 postnatal women were approached to take part in a survey on the acceptability of the EPDS, including 601 women who had screened positive for depression and 245 who had received DSM-IV diagnoses of depression. Acceptability was measured on a 5-point Likert scale of comfort ranging from "Not Comfortable", through "Comfortable" to "Very Comfortable". Results The response rate was just over half for postal surveys (52% and was 100% for telephone and face-to-face surveys (432, 21 and 26 respondents for postal, telephone and face-to-face surveys respectively making 479 respondents in total. Of these, 81.2% indicated that screening with the EPDS had been in the range of "Comfortable" to "Very Comfortable". The other 18.8 % rated screening below the "Comfortable" point, including a small fraction (4.3% who rated answering questions on the EPDS as "Not Comfortable" at the extreme end of the scale. Comfort was inversely related to EPDS score, but the absolute size of this effect was small. Almost all respondents (97% felt that screening was desirable. Conclusion The EPDS had good acceptability in this study for depressed and non-depressed women. Women's views on the desirability of postnatal depression screening appear to be largely independent of personal level of comfort with screening. These results should be useful to policy-makers and are broadly supportive of the Edinburgh Postnatal

  10. A Pilot Evaluation of Associations Between Displayed Depression References on Facebook and Self-reported Depression Using a Clinical Scale

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    Moreno, Megan Andreas; Christakis, Dimitri A.; Egan, Katie G.; Jelenchick, Lauren A.; Cox, Elizabeth; Young, Henry; Villiard, Hope; Becker, Tara

    2011-01-01

    The objective of this study was to determine associations between displayed depression symptoms on Facebook and self-reported depression symptoms using a clinical screen. Public Facebook profiles of undergraduates from two universities were examined for displayed depression references. Profiles were categorized as depression symptom displayers or non-displayers. Participants completed an online PHQ-9 depression scale. Analyses examined associations between PHQ-9 score and depression symptom d...

  11. Does facial resemblance enhance cooperation?

    Directory of Open Access Journals (Sweden)

    Trang Giang

    Full Text Available Facial self-resemblance has been proposed to serve as a kinship cue that facilitates cooperation between kin. In the present study, facial resemblance was manipulated by morphing stimulus faces with the participants' own faces or control faces (resulting in self-resemblant or other-resemblant composite faces. A norming study showed that the perceived degree of kinship was higher for the participants and the self-resemblant composite faces than for actual first-degree relatives. Effects of facial self-resemblance on trust and cooperation were tested in a paradigm that has proven to be sensitive to facial trustworthiness, facial likability, and facial expression. First, participants played a cooperation game in which the composite faces were shown. Then, likability ratings were assessed. In a source memory test, participants were required to identify old and new faces, and were asked to remember whether the faces belonged to cooperators or cheaters in the cooperation game. Old-new recognition was enhanced for self-resemblant faces in comparison to other-resemblant faces. However, facial self-resemblance had no effects on the degree of cooperation in the cooperation game, on the emotional evaluation of the faces as reflected in the likability judgments, and on the expectation that a face belonged to a cooperator rather than to a cheater. Therefore, the present results are clearly inconsistent with the assumption of an evolved kin recognition module built into the human face recognition system.

  12. Job strain as a risk factor for clinical depression

    DEFF Research Database (Denmark)

    Madsen, I. E. H.; Nyberg, S. T.; Magnusson Hanson, L. L.

    2017-01-01

    BACKGROUND: Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain...... as a risk factor for clinical depression. METHOD: We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD......-Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol. RESULTS: We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From...

  13. Correlation between bullying and clinical depression in adolescent patients

    Directory of Open Access Journals (Sweden)

    Kaltiala-Heino R

    2011-03-01

    Full Text Available Riittakerttu Kaltiala-Heino1, Sari Fröjd21University of Tampere Medical School, Tampere, Finland; 2Tampere School of Public Health, University of Tampere, FinlandAbstract: A literature review of the associations between involvement in bullying and depression is presented. Many studies have demonstrated a concurrent association between involvement in bullying and depression in adolescent population samples. Not only victims but also bullies display increased risk of depression, although not all studies have confirmed this for the bullies. Retrospective studies among adults support the notion that victimization is followed by depression. Prospective follow-up studies have suggested both that victimization from bullying may be a risk factor for depression and that depression may predispose adolescents to bullying. Research among clinically referred adolescents is scarce but suggests that correlations between victimization from bullying and depression are likely to be similar in clinical and population samples. Adolescents who bully present with elevated numbers of psychiatric symptoms and psychiatric and social welfare treatment contacts.Keywords: depression, bullying, adolescence 

  14. Differential reporting of depressive symptoms across distinct clinical subpopulations: What DIFference does it make?

    NARCIS (Netherlands)

    Wanders, R.B.; Wardenaar, K.J.; Kessler, R.C.; Penninx, B.W.; Meijer, R.R.; de Jonge, P.

    2015-01-01

    Objective: To investigate the impact of differences in depressive symptom reporting across clinical groups (healthcare setting, chronic illness, depression diagnosis and anxiety diagnosis) on clinical interpretability and comparability of depression scores. Methods: Participants from the Netherlands

  15. Predictors of Suicide Attempts in Clinically Depressed Korean Adolescents

    Science.gov (United States)

    Kwon, Ahye; Song, Jungeun; Yook, Ki-Hwan; Jon, Duk-In; Jung, Myung Hun; Hong, Narei; Hong, Hyun Ju

    2016-01-01

    We examined predictors of suicide attempts in clinically depressed adolescents in Korea and gender differences in suicidal behavior. In total, 106 adolescents diagnosed with depressive disorder were recruited in South Korea. We assessed various variables that might affect suicide attempts, and used a structured interview for the diagnosis of depression and comorbidities and to evaluate suicidality. Demographic and clinical characteristics of the subjects were compared between suicide attempt and non-suicide attempt groups and we examined significant predictors of suicide attempts. Gender differences in suicidal ideation and suicidal behavior were also analyzed. Among 106 depressed participants, 50 (47.2%) adolescents were classified in the suicide attempt group. Generally, the suicide attempt and non-suicide attempt group shared similar clinical characteristics. The suicide attempt group had more females, more major depressive disorder diagnoses, more depressive episodes, and higher suicidal ideation than the non-suicide attempt group. Suicidal ideation was the only significant predictor of suicidal attempt, regardless of gender. Higher suicidal ideation frequency scores and more non-suicidal self-injurious behaviors were shown in the female suicide attempt group than the male suicide attempt group. It is recommended that suicidal ideation be assessed regularly and managed rigorously to decrease suicide risks in depressive adolescents. PMID:27776392

  16. Clinical guidelines for the treatment of depressive disorders. VII. Comorbidity.

    Science.gov (United States)

    Enns, M W; Swenson, J R; McIntyre, R S; Swinson, R P; Kennedy, S H

    2001-06-01

    The Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments partnered to produce clinical guidelines for psychiatrists for the treatment of depressive disorders. A standard guidelines development process was followed. Relevant literature was identified using a computerized Medline search supplemented by review of bibliographies. Operational criteria were used to rate the quality of scientific evidence, and the line of treatment recommendations included consensus clinical opinion. This section, on Axis I, Axis II, and Axis III comorbidity, is 1 of 7 articles that were drafted and reviewed by clinicians. Revised drafts underwent national and international expert peer review. Comorbid depression on Axis I is particularly prevalent in patients with anxiety disorders, substance use disorders, and eating disorders, but it also occurs in patients with schizophrenia, attention-deficit hyperactivity disorder (ADHD), and dementia. Depressive comorbidity has implications for assessment, management, and outcome. The relation between depression and personality disorders is complex. Patient with this comorbidity often require longer, more intense, and multimodal therapies. Depression is also prevalent in medical illnesses, requires careful diagnosis, and responds to standard antidepressant treatments. Comorbidity can influence the course and outcome of both associated conditions. Depression-specific psychotherapy and/or pharmacotherapy should be considered when comorbid depression is diagnosed.

  17. Depression in young people: initial presentation and clinical course.

    Science.gov (United States)

    McCauley, E; Myers, K; Mitchell, J; Calderon, R; Schloredt, K; Treder, R

    1993-07-01

    This project was designed to provide prospective data on the clinical presentation and longitudinal course of depression in children and adolescents. Children and their parent(s) completed a structured diagnostic interview (Schedule for Affective Disorders and Schizophrenia for School Age Children) at intake, and then yearly for 3 years. Collateral data were collected on school, social, and family functioning. Mean length of initial depressive episode was 35.6 weeks, SD of 26 weeks. Of the 65 depressed youths who completed the 3-year follow-up, 35 (54%) disclosed another episode of depression. Demographic, family-environment, and diagnostic variables were explored as predictors of characteristics of initial episode, recurrence of depression, and psychosocial competence at follow-up. Female gender and presence of a coexisting anxiety disorder were significantly related to severity of initial depression. Family environment was the only predictor significantly related to overall psychosocial competence over 3 years. The findings confirm depression in youth as a valid clinical phenomenon, with substantial risk of recurrence. Increased levels of stress in the family environment were associated with poorer overall outcomes.

  18. Clinical neuroprediction: Amygdala reactivity predicts depressive symptoms 2 years later.

    Science.gov (United States)

    Mattson, Whitney I; Hyde, Luke W; Shaw, Daniel S; Forbes, Erika E; Monk, Christopher S

    2016-06-01

    Depression is linked to increased amygdala activation to neutral and negatively valenced facial expressions. Amygdala activation may be predictive of changes in depressive symptoms over time. However, most studies in this area have focused on small, predominantly female and homogenous clinical samples. Studies are needed to examine how amygdala reactivity relates to the course of depressive symptoms dimensionally, prospectively and in populations diverse in gender, race and socioeconomic status. A total of 156 men from predominately low-income backgrounds completed an fMRI task where they viewed emotional facial expressions. Left and right amygdala reactivity to neutral, but not angry or fearful, facial expressions relative to a non-face baseline at age 20 predicted greater depressive symptoms 2 years later, controlling for age 20 depressive symptoms. Heightened bilateral amygdala reactivity to neutral facial expressions predicted increases in depressive symptoms 2 years later in a large community sample. Neutral facial expressions are affectively ambiguous and a tendency to interpret these stimuli negatively may reflect to cognitive biases that lead to increases in depressive symptoms over time. Individual differences in amygdala reactivity to neutral facial expressions appear to identify those at most risk for a more problematic course of depressive symptoms across time. © The Author (2016). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

  19. Factors associated with risk of depression and relevant predictors of screening for depression in clinical practice

    DEFF Research Database (Denmark)

    Slot, Maria; Sodemann, Morten; Gabel, C

    2015-01-01

    ) in 55 patients (26%). There was also a high prevalence of co-occurring mental illness. In a multivariate model, self-reported stress, self-reported perception that HIV infection affects all aspects of life, self-reported poor health, not being satisfied with one's current life situation, previous...... alcohol abuse, nonadherence to antiretroviral therapy and previously having sought help because of psychological problems were independently associated with risk of depression. CONCLUSIONS: Symptoms of depression and co-occurring mental illness are under-diagnosed and under-treated among HIV......OBJECTIVES: Depression and psychiatric disorders are frequent among HIV-infected individuals. The aim of this study was to determine the prevalence of depression and describe the psychiatric history of HIV-infected individuals in an out-patient clinic in Denmark and to identify factors of clinical...

  20. Clinical staging of major depressive disorder: an empirical exploration

    NARCIS (Netherlands)

    Verduijn, J.; Milaneschi, Y.; van Hemert, A.M.; Schoevers, R.A.; Hickie, I.B.; Penninx, B.W.J.H.; Beekman, A.T.F.

    2015-01-01

    Objective: Clinical staging has been proposed to supplement psychiatric diagnoses. We examined the construct and predictive validity of a clinical staging model for major depressive disorder (MDD) that distinguishes 8 consecutive stages (0, 1A, 1B, 2, 3A, 3B, 3C, 4) based on symptom severity

  1. Therapeutic horticulture in clinical depression: a prospective study.

    Science.gov (United States)

    Gonzalez, Marianne Thorsen; Hartig, Terry; Patil, Grete Grindal; Martinsen, Egil W; Kirkevold, Marit

    2009-01-01

    Clinically depressed persons suffer from impaired mood and distortion of cognition. This study assessed changes in depression severity and perceived attentional capacity of clinically depressed adults (N=18) during a 12-week therapeutic horticulture program. The Beck Depression Inventory (BDI) and Attentional Function Index (AFI) were administered at baseline, twice during (4 and 8 weeks), and immediately after the intervention (12 weeks), and at a 3-month follow-up. Experiences of being away and fascination related to the intervention were measured at 4, 8, and 12 weeks. The mean BDI score declined 9.7 points from pretest (27.3) to posttest (p or =6) for 72% of the cases. The mean AFI score increased 10.2 points from pretest (68.8) to posttest (p = .06). The greatest change in BDI and AFI scores occurred in the initial weeks of the intervention. The reduction in BDI scores remained significant and clinically relevant at the 3-month follow-up (N=16). The decline in depression severity during the intervention correlated strongly with the degree to which the participants found that it captured their attention. Therapeutic horticulture may decrease depression severity and improve perceived attentional capacity by engaging effortless attention and interrupting rumination.

  2. Childhood Depression: Relation to Adaptive, Clinical and Predictor Variables

    Directory of Open Access Journals (Sweden)

    Maite Garaigordobil

    2017-05-01

    Full Text Available The study had two goals: (1 to explore the relations between self-assessed childhood depression and other adaptive and clinical variables (2 to identify predictor variables of childhood depression. Participants were 420 students aged 7–10 years old (53.3% boys, 46.7% girls. Results revealed: (1 positive correlations between depression and clinical maladjustment, school maladjustment, emotional symptoms, internalizing and externalizing problems, problem behaviors, emotional reactivity, and childhood stress; and (2 negative correlations between depression and personal adaptation, global self-concept, social skills, and resilience (sense of competence and affiliation. Linear regression analysis including the global dimensions revealed 4 predictors of childhood depression that explained 50.6% of the variance: high clinical maladjustment, low global self-concept, high level of stress, and poor social skills. However, upon introducing the sub-dimensions, 9 predictor variables emerged that explained 56.4% of the variance: many internalizing problems, low family self-concept, high anxiety, low responsibility, low personal self-assessment, high social stress, few aggressive behaviors toward peers, many health/psychosomatic problems, and external locus of control. The discussion addresses the importance of implementing prevention programs for childhood depression at early ages.

  3. Clinical relevance of findings in trials of CBT for depression.

    Science.gov (United States)

    Lepping, P; Whittington, R; Sambhi, R S; Lane, S; Poole, R; Leucht, S; Cuijpers, P; McCabe, R; Waheed, W

    2017-09-01

    Cognitive behavioural therapy (CBT) is beneficial in depression. Symptom scores can be translated into Clinical Global Impression (CGI) scale scores to indicate clinical relevance. We aimed to assess the clinical relevance of findings of randomised controlled trials (RCTs) of CBT in depression. We identified RCTs of CBT that used the Hamilton Rating Scale for Depression (HAMD). HAMD scores were translated into Clinical Global Impression - Change scale (CGI-I) scores to measure clinical relevance. One hundred and seventy datasets from 82 studies were included. The mean percentage HAMD change for treatment arms was 53.66%, and 29.81% for control arms, a statistically significant difference. Combined active therapies showed the biggest improvement on CGI-I score, followed by CBT alone. All active treatments had better than expected HAMD percentage reduction and CGI-I scores. CBT has a clinically relevant effect in depression, with a notional CGI-I score of 2.2, indicating a significant clinical response. The non-specific or placebo effect of being in a psychotherapy trial was a 29% reduction of HAMD. Copyright © 2017. Published by Elsevier Masson SAS.

  4. Clinical correlates of resilience factors in geriatric depression.

    Science.gov (United States)

    Laird, Kelsey T; Lavretsky, Helen; Paholpak, Pattharee; Vlasova, Roza M; Roman, Michael; St Cyr, Natalie; Siddarth, Prabha

    2018-01-16

    Traditional perspectives conceptualize resilience as a trait and depression as resulting from resilience deficiency. However, research indicates that resilience varies substantially even among adults who are clinically depressed, as well as across the lifespan of an individual. Few studies have investigated resilience in depression, and even fewer have examined resilience in depressed older adults. Three hundred thirty-seven adults ≥60 years with major depressive disorder completed the Connor-Davidson Resilience Scale (CD-RISC) and measures of mental health, quality of life (QOL), and medical comorbidity. Exploratory factor analysis was used to explore the factor structure of the CD-RISC. Correlations and general linear models were used to examine associations between resilience and other variables. The rotated component matrix indicated a four-factor model. Sorting of items by highest factor loading revealed constructs associated with (1) grit, (2) active coping self-efficacy, (3) accommodative coping self-efficacy, and (4) spirituality. Resilience was significantly correlated with increased age, lower cognitive functioning, greater cerebrovascular risk, and greater medical comorbidity. Resilience was negatively associated with mental health symptoms (depression, apathy, and anxiety) and positively associated with QOL. The final optimal model identified less depression, less apathy, greater medical comorbidity, higher QOL, and minority (non-White) race as factors that significantly explained variability in resilience. Resilience was significantly associated with a range of mental health constructs in a sample of older adults with depression. Future clinical trials and dismantling studies may help determine whether interventions targeting grit, active coping, accommodative coping, and spirituality can increase resilience and help prevent and treat depression in older adults.

  5. Depression in prison population: Demographic and clinical predictors

    Directory of Open Access Journals (Sweden)

    Oluyinka Emmanuel Majekodunmi

    2017-01-01

    Full Text Available Studies have shown that mental illnesses are more common among the prison population than the general population. However, most studies in this environment had only looked at nonspecific psychiatric morbidities. The objective of this study was to assess the prevalence of major depressive disorder, its associated sociodemographic and clinical variables in a population of inmates in Nigeria. Institution-based cross-sectional study was conducted among 196 prisoners consisting of 136 awaiting trials (AT and 60 convicted inmates (CI. Simple random sampling technique was used to select the study participants. Data were collected using a structured interviewer-administered questionnaire. Depression was assessed with the depression module of the Structured Clinical Interview Schedule for Axis 1 Diagnostic Statistical Manual-IV (DSM-IV Disorders. The diagnosis was made according to the DSM-IV criteria and severity assessed with the Montgomery–Asberg Depression Rating Scale (MADRS. Forty-one (30.1% of AT compared with 21 (35.0% of the CI were depressed. The mean total MADRS score for AT was 23.90 standard deviation (SD ±7.97 while the mean total MADRS score for the convicted was 25.50 SD ± 8.70, P= 0.479. Unlike the general population, there were no sociodemographic predictors of depression. Among the ATs, depression was associated with the presence of physical complaints, having a chronic illness and family history of psychiatric illness among the CI. The prevalence of depression among prisoners was found to be high and associated with clinical variables. Due attention needs to be given to address the mental health needs of the prisoners.

  6. A pilot evaluation of associations between displayed depression references on Facebook and self-reported depression using a clinical scale.

    Science.gov (United States)

    Moreno, Megan Andreas; Christakis, Dimitri A; Egan, Katie G; Jelenchick, Lauren A; Cox, Elizabeth; Young, Henry; Villiard, Hope; Becker, Tara

    2012-07-01

    The objective of this study was to determine associations between displayed depression symptoms on Facebook and self-reported depression symptoms using a clinical screen. Public Facebook profiles of undergraduates from two universities were examined for displayed depression references. Profiles were categorized as depression symptom displayers or non-displayers. Participants completed an online PHQ-9 depression scale. Analyses examined associations between PHQ-9 score and depression symptom displayers versus non-displayers. The mean PHQ-9 score for non-displayers was 4.7 (SD = 4.0), the mean PHQ-9 score for depression symptom displayers was 6.4 (SD = 5.1; p = 0.018). A trend approaching significance was noted that participants who scored into a depression category by their PHQ-9 score were more likely to display depression symptom references. Displayed references to depression symptoms were associated with self-reported depression symptoms.

  7. Synchrony of change in depressive symptoms, health status, and quality of life in persons with clinical depression

    OpenAIRE

    Diehr, Paula H; Derleth, Ann M; McKenna, Stephen P; Martin, Mona L; Bushnell, Donald M; Simon, Gregory; Patrick, Donald L

    2006-01-01

    Abstract Background Little is known about longitudinal associations among measures of depression, mental and physical health, and quality of life (QOL). We followed 982 clinically depressed persons to determine which measures changed and whether the change was synchronous with change in depressive symptoms. Methods Data were from the Longitudinal Investigation of Depression Outcomes (LIDO). Depressive symptoms, physical and mental health, and quality of life were measured at baseline, 6 weeks...

  8. Autism and psychosis: Clinical implications for depression and suicide.

    Science.gov (United States)

    Upthegrove, Rachel; Abu-Akel, Ahmad; Chisholm, Katharine; Lin, Ashleigh; Zahid, Sofia; Pelton, Mirabel; Apperly, Ian; Hansen, Peter C; Wood, Stephen J

    2017-08-18

    There is increasing recognition of the co-occurrence of autism and schizophrenia spectrum disorders. However, the clinical significance of this on outcomes such as depression and suicidal thinking has not been explored. This study examines the association of autism spectrum traits, depressive symptoms and suicidal behaviour in individuals with psychotic experiences. In two cross sectional studies, individuals from a non-help seeking university student sample and patients with first episode psychosis (FEP) service completed standardized measures of autism spectrum traits, psychotic experiences, depressive symptoms and suicidal thinking. In healthy non-help seeking students, increased autism traits and increased subclinical psychotic experiences were significantly associated with depressive symptoms; a significant interaction effect suggests their combined presence has a greater impact on depression. In FEP, high autism traits and positive symptoms were associated with increased depression, hopelessness and suicidality, however there was no significant interaction effect. In FEP a multiple mediation model revealed that the relationship between autism traits and risk for suicidality was mediated through hopelessness. Young people with subclinical psychotic experiences and all patients with FEP should be screened for autism spectrum traits, which may have significant impact on clinical outcomes. Tailored interventions for patients with high levels of autistic spectrum co-morbidities in FEP should be a priority for future research. Copyright © 2017. Published by Elsevier B.V.

  9. Detection of Clinical Depression in Adolescents’ Speech During Family Interactions

    Science.gov (United States)

    Low, Lu-Shih Alex; Maddage, Namunu C.; Lech, Margaret; Sheeber, Lisa B.; Allen, Nicholas B.

    2013-01-01

    The properties of acoustic speech have previously been investigated as possible cues for depression in adults. However, these studies were restricted to small populations of patients and the speech recordings were made during patients’ clinical interviews or fixed-text reading sessions. Symptoms of depression often first appear during adolescence at a time when the voice is changing, in both males and females, suggesting that specific studies of these phenomena in adolescent populations are warranted. This study investigated acoustic correlates of depression in a large sample of 139 adolescents (68 clinically depressed and 71 controls). Speech recordings were made during naturalistic interactions between adolescents and their parents. Prosodic, cepstral, spectral, and glottal features, as well as features derived from the Teager energy operator (TEO), were tested within a binary classification framework. Strong gender differences in classification accuracy were observed. The TEO-based features clearly outperformed all other features and feature combinations, providing classification accuracy ranging between 81%–87% for males and 72%–79% for females. Close, but slightly less accurate, results were obtained by combining glottal features with prosodic and spectral features (67%–69% for males and 70%–75% for females). These findings indicate the importance of nonlinear mechanisms associated with the glottal flow formation as cues for clinical depression. PMID:21075715

  10. Clinical features of depressive disorders in patients with brain tumors

    Directory of Open Access Journals (Sweden)

    Ogorenko V.V.

    2014-03-01

    Full Text Available The aim of the study was to examine the structure of psychopathology and clinical features of depressive disorders in patients with brain oncopathology. Polymorphic mental disorders of various clinical content and severity in most cases not only are comorbid to oncological pathology of the brain, but most often are the first clinical signs of early tumors. The study was conducted using the following methods: clinical psychiatric, questionnaire Simptom Check List- 90 -Revised-SCL- 90 -R, Luscher test and mathematical processing methods. Sample included 175 patients with brain tumors with non-psychotic level of mental disorders. The peculiarities of mental disorders and psychopathological structure of nonpsychotic depressive disorders have been a clinical option of cancer debut in patients with brain tumors. We found that nonpsychotic depression is characterized by polymorphism and syndromal incompletion; this causes ambiguity of diagnoses interpretation on stages of diagnostic period. Features of depressive symptoms depending on the signs of malignancy / nonmalignancy of brain tumor were defined.

  11. Emotional Demands at Work and the Risk of Clinical Depression

    DEFF Research Database (Denmark)

    Vammen, Marianne Agergaard; Mikkelsen, Sigurd; Kolstad, Henrik

    2016-01-01

    OBJECTIVE: This study is a 2-year follow-up study of different dimensions of work-related emotional demands as a predictor for clinical depression. METHODS: In a two-wave study, 3224 (72%) public employees from 474 work-units participated twice by filling in questionnaires. Sixty-two cases of cli....... CONCLUSIONS: The personal perception of emotional demands was a risk factor for clinical depression but specific emotionally demanding work tasks were not.......OBJECTIVE: This study is a 2-year follow-up study of different dimensions of work-related emotional demands as a predictor for clinical depression. METHODS: In a two-wave study, 3224 (72%) public employees from 474 work-units participated twice by filling in questionnaires. Sixty-two cases...... of clinical depression were diagnosed. Emotional demands were examined as perceived and content-related emotional demands, individually reported and work-unit based. Support, meaningful work, and enrichment were considered as potential effect modifiers. RESULTS: Individually reported perceived emotional...

  12. Job strain as a risk factor for clinical depression

    DEFF Research Database (Denmark)

    Madsen, I. E. H.; Nyberg, S. T.; Magnusson Hanson, L. L.

    2017-01-01

    -Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol. RESULTS: We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From...

  13. Clinical features of emergency department patients with depression ...

    African Journals Online (AJOL)

    Clinical features of emergency department patients with depression who had attempted to commit suicide by poisoning. ... MDD patients. Conclusion: In poisoning patients with MDD, physicians in the ED must consider that they have a higher tendency to show suicidal behavior and to have ingested multiple types of drugs.

  14. Forensic neuropsychological assessment: clinical case of depression and working incapacity

    OpenAIRE

    Monti, Camila; Saffi, Fabiana; Barros, Daniel Martins de; Dias, Alvaro Machado; Akiba, Henrique Teruo; Serafim, Antonio de Pádua

    2015-01-01

    Issues related to mental health in relation to court matters have increasingly required the participation of the psychologist. We present the use of forensic neuropsychological assessment in a case of retirement reversal. Incapacity was attested due to disability resulting from depression of a 35-year-old attorney, and the case was forwarded from the courts to the Forensic Psychiatry and Psychology Unit at the USP Clinical Hospital. A clinical interview and application of cognitive tests was ...

  15. Clinical correlates of loss of insight in bipolar depression

    Directory of Open Access Journals (Sweden)

    Rafael de Assis da Silva

    Full Text Available Abstract Introduction Affective state may influence insight, especially regarding mania. Nevertheless, studies have so far suggested that depression seems not to significantly impair insight. To the best of our knowledge, this study pioneers the evaluation of how insight variations in bipolar depression correlate with clinical variables. Method A group of 165 bipolar patients, 52 of whom had depressive episodes according to DSM-5 criteria, were followed during a year. All patients underwent clinical assessment, and insight was evaluated through the Insight Scale for Affective Disorders (ISAD. Repeated-measures ANOVA was calculated comparing scores on the four ISAD factors (insight into symptoms, the condition itself, self-esteem and social relationships in order to investigate differences in insight according to different objects. Correlational analysis explored which clinical symptoms were linked to reduced insight. Results Worse total insight correlated with suicide attempt/ideation and fewer subsyndromal manic symptoms such as mood elevation, increased energy and sexual interest. Worse self-esteem insight was associated with not only suicide ideation/attempt but also with activity reduction and psychomotor retardation. Worse symptom insight also correlated with psychomotor retardation. Better insight into having an affective disorder was associated with more intense hypochondria symptoms. Finally, worse insight into having an illness was associated with psychotic episodes. Conclusion Our study found that symptoms other than psychosis – suicide ideation, psychomotor retardation and reduction of activity and work – correlate with insight impairment in bipolar depression.

  16. Generalizability of Clinical Trial Results for Adolescent Major Depressive Disorder.

    Science.gov (United States)

    Blanco, Carlos; Hoertel, Nicolas; Franco, Silvia; Olfson, Mark; He, Jian-Ping; López, Saioa; González-Pinto, Ana; Limosin, Frédéric; Merikangas, Kathleen R

    2017-12-01

    Although there have been a number of clinical trials evaluating treatments for adolescents with major depressive disorder (MDD), the generalizability of those trials to samples of depressed adolescents who present for routine clinical care is unknown. Examining the generalizability of clinical trials of pharmacological and psychotherapy interventions for adolescent depression can help administrators and frontline practitioners determine the relevance of these studies for their patients and may also guide eligibility criteria for future clinical trials in this clinical population. Data on nationally representative adolescents were derived from the National Comorbidity Survey: Adolescent Supplement. To assess the generalizability of adolescent clinical trials for MDD, we applied a standard set of eligibility criteria representative of clinical trials to all adolescents in the National Comorbidity Survey: Adolescent Supplement with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of MDD ( N = 592). From the overall MDD sample, 61.9% would have been excluded from a typical pharmacological trial, whereas 42.2% would have been excluded from a psychotherapy trial. Among those who sought treatment ( n = 412), the corresponding exclusion rates were 72.7% for a pharmacological trial and 52.2% for a psychotherapy trial. The criterion leading to the largest number of exclusions was "significant risk of suicide" in both pharmacological and psychotherapy trials. Pharmacological and, to a lesser extent, psychotherapy clinical trials likely exclude most adolescents with MDD. Careful consideration should be given to balancing eligibility criteria and internal validity with applicability in routine clinical care while ensuring patient safety. Copyright © 2017 by the American Academy of Pediatrics.

  17. Does Age at Onset of First Major Depressive Episode Indicate the Subtype of Major Depressive Disorder?: The Clinical Research Center for Depression Study

    Science.gov (United States)

    Park, Seon-Cheol; Hahn, Sang-Woo; Hwang, Tae-Yeon; Kim, Jae-Min; Jun, Tae-Youn; Lee, Min-Soo; Kim, Jung-Bum; Yim, Hyeon-Woo

    2014-01-01

    Purpose The purpose of this study was to evaluate the effects of age at onset of the first major depressive episode on the clinical features of individuals with major depressive disorder (MDD) in a large cohort of Korean depressed patients. Materials and Methods We recruited 419 MDD patients of age over 18 years from the Clinical Research Center for Depression study in South Korea. At the start of the study, the onset age of the first major depressive episode was self-reported by the subjects. The subjects were divided into four age-at-onset subgroups: childhood and adolescent onset (ages depressive episodes (F=3.475, p=0.016) and higher scores on the brief psychiatric rating scale (F=3.254, p=0.022), its negative symptom subscale (F=6.082, pdepressive episode is a promising clinical indicator for the clinical presentation, course, and outcome of MDD. PMID:25323911

  18. Does age at onset of first major depressive episode indicate the subtype of major depressive disorder?: the clinical research center for depression study.

    Science.gov (United States)

    Park, Seon-Cheol; Hahn, Sang-Woo; Hwang, Tae-Yeon; Kim, Jae-Min; Jun, Tae-Youn; Lee, Min-Soo; Kim, Jung-Bum; Yim, Hyeon-Woo; Park, Yong Chon

    2014-11-01

    The purpose of this study was to evaluate the effects of age at onset of the first major depressive episode on the clinical features of individuals with major depressive disorder (MDD) in a large cohort of Korean depressed patients. We recruited 419 MDD patients of age over 18 years from the Clinical Research Center for Depression study in South Korea. At the start of the study, the onset age of the first major depressive episode was self-reported by the subjects. The subjects were divided into four age-at-onset subgroups: childhood and adolescent onset (ages depressive episodes (F=3.475, p=0.016) and higher scores on the brief psychiatric rating scale (F=3.254, p=0.022), its negative symptom subscale (F=6.082, pdepressive episode is a promising clinical indicator for the clinical presentation, course, and outcome of MDD.

  19. Clinical pharmacology review of escitalopram for the treatment of depression.

    Science.gov (United States)

    Pastoor, Devin; Gobburu, Joga

    2014-01-01

    Depression is a serious and debilitating psychiatric condition with serious societal health and economic implications. Escitalopram , the S-enantiomer of racemic citalopram, is an effective treatment for major depressive disorder. This review covers the clinical pharmacology of escitalopram, with emphasis on regulatory approval. Its pharmacokinetics, pharmacodynamics and clinical efficacy for major depressive disorder are evaluated, along with data regarding safety and tolerability. Drug development of escitalopram was heavily guided by prior approval of citalopram. Select safety and efficacy studies for escitalopram in combination with supportive evidence from the results of prior citalopram studies allowed for regulatory approval for acute and maintenance claims in both adults and adolescents, while minimizing burden on the sponsor. Escitalopram has been shown to have better efficacy and safety profile than other selective serotonin reuptake inhibitor and serotonin norepinephrine reuptake inhibitor drugs, including racemic citalopram. The first generic escitalopram was approved in 2012, along with Abbreviated New Drug Applications. The associated cost savings have helped reduce the burden of weighing the benefits of escitalopram over less-expensive alternatives.

  20. [Placebo effect: clinical, biological and therapeutical involvements in depression].

    Science.gov (United States)

    Gourion, D; Mouchabac, S

    2016-02-01

    The placebo effect is an excellent model for understanding the mechanisms underlying the interaction between a subjective and complex mental activity (beliefs, expectations, hopes, learning, patient-physician relationship, socio-cultural context .) with different neural and biological systems. Initially, research on the placebo effect has focused on the mechanisms of pain and analgesia. The cognitive processes of conditioning and reward anticipation (hope of a relief) were highlighted. The involvement of different neurobiological pathways has been clearly shown: endogenous opioids, CCK, dopaminergic pathways, endocannabinoids, immunological factors... More recently, the field has open towards new perspectives: depression and anxiety, motor disorders, immune system, endocrine system. Intensive research in the field emerges because of its fundamental implications in neuroscience research but also because of the ethical, clinical and therapeutical issues. Moreover, the placebo effect is considered as a main methodological mean issue in clinical trials that allows the demonstration of the efficacy and tolerance of new drugs. In the field of psychiatry, depression is a placebo highly-sensitive disorder: placebo response rates in clinical trials are of the order of 30 % to 40 %. The identification of biological markers of placebo response, such as neuroimaging and quantitative electroencephalography may lead to develop more efficient models in clinical research. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. A comparison of the clinical features of depression in HIV-positive ...

    African Journals Online (AJOL)

    Conclusion: These findings show that the clinical and associated features of depression differ between HIV-Positive and HIV-Negative patients, thus requiring different management approaches and further studies related to HIV-related depression. Key words: Clinical features; Depression; HIV/AIDS; Uganda ...

  2. Different Cognitive Complaint Profiles in Memory Clinic and Depressive Patients.

    Science.gov (United States)

    Miebach, Lisa; Wolfsgruber, Steffen; Frommann, Ingo; Buckley, Rachel; Wagner, Michael

    2018-04-01

    Cognitive complaints are considered early indicators of incipient Alzheimer's disease (AD) but are very common in geriatric patients, especially in patients with major depressive disorder (MDD). The clinical assessment of cognitive complaints is still poorly operationalized. Recent qualitative research suggests that certain phenomenologic complaint themes may have some specificity for prodromal AD. The aim of the study was to replicate and explore their occurrence in a clinical setting. In a cross-sectional, case-control study using a mixed-methods approach, 23 memory clinic (cognitive complainers [CC]) patients, 21 psychiatric inpatients with MDD, and 21 healthy control subjects, aged 55-86 years, were assessed at the Department of Psychiatry and Psychotherapy and German Center for Neurodegenerative Diseases, Bonn. A newly developed semistructured interview addressing 12 complaint themes was used, and transcribed open format responses were coded by qualitative expert rating (theme absent versus present) and compared between the groups. Seven complaint themes (e.g., sense of predomination, progression) were significantly more often endorsed by the CC group, together with a novel theme of "distractible speech." Complaint themes in those with depression aligned with the depressive symptoms and appeared to be partly different from the complaint pattern of the CC group. Previously established themes were found to be feasible for conversion into a semistructured interview. Several complaint phenotypes were confirmed and previous themes significantly expanded by providing first evidence for a qualitatively different complaint profile in MDD compared with CC. Future investigations may benefit from better characterizing the phenomenologic and qualitative characteristics of AD-related complaints. Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  3. Relationship between perception of facial emotions and anxiety in clinical depression : Does anxiety-related perception predict persistence of depression?

    NARCIS (Netherlands)

    Bouhuys, AL; Geerts, E; Mersch, PPA

    Within the framework of interpersonal theories on depression, it was postulated 1) that an anxiety-related mood-congruent bias with respect to the perception of facial expressions could be demonstrated in clinically depressed patients; 2) that the perception of negative facial emotions would be

  4. Depression in elderly primary health care clinic attendees in Ilorin ...

    African Journals Online (AJOL)

    Depression in the elderly presenting at primary care settings is usually under- detected by primary care physicians. This study assessed the prevalence of depression and the utility of the Geriatric Depression Scale (Short Form) in detecting depression in elderly patients in primary care populations in Ilorin, Nigeria. This was ...

  5. Reduced anterior cingulate gray matter volume in treatment-naïve clinically depressed adolescents☆

    Science.gov (United States)

    Pannekoek, Justine Nienke; van der Werff, Steven J.A.; van den Bulk, Bianca G.; van Lang, Natasja D.J.; Rombouts, Serge A.R.B.; van Buchem, Mark A.; Vermeiren, Robert R.J.M.; van der Wee, Nic J.A.

    2014-01-01

    Adolescent depression is associated with increased risk for suicidality, social and educational impairment, smoking, substance use, obesity, and depression in adulthood. It is of relevance to further our insight in the neurobiological mechanisms underlying this disorder in the developing brain, as this may be essential to optimize treatment and prevention of adolescent depression and its negative clinical trajectories. The equivocal findings of the limited number of studies on neural abnormalities in depressed youth stress the need for further neurobiological investigation of adolescent depression. We therefore performed a voxel-based morphometry study of the hippocampus, amygdala, superior temporal gyrus, and anterior cingulate cortex (ACC) in 26 treatment-naïve, clinically depressed adolescents and 26 pair-wise matched healthy controls. Additionally, an exploratory whole-brain analysis was performed. Clinically depressed adolescents showed a volume reduction of the bilateral dorsal ACC compared to healthy controls. However, no association was found between gray matter volume of the ACC and clinical severity scores for depression or anxiety. Our finding of a smaller ACC in clinically depressed adolescents is consistent with literature on depressed adults. Future research is needed to investigate if gray matter abnormalities precede or follow clinical depression in adolescents. PMID:24501702

  6. Reduced anterior cingulate gray matter volume in treatment-naïve clinically depressed adolescents

    Directory of Open Access Journals (Sweden)

    Justine Nienke Pannekoek

    2014-01-01

    Full Text Available Adolescent depression is associated with increased risk for suicidality, social and educational impairment, smoking, substance use, obesity, and depression in adulthood. It is of relevance to further our insight in the neurobiological mechanisms underlying this disorder in the developing brain, as this may be essential to optimize treatment and prevention of adolescent depression and its negative clinical trajectories. The equivocal findings of the limited number of studies on neural abnormalities in depressed youth stress the need for further neurobiological investigation of adolescent depression. We therefore performed a voxel-based morphometry study of the hippocampus, amygdala, superior temporal gyrus, and anterior cingulate cortex (ACC in 26 treatment-naïve, clinically depressed adolescents and 26 pair-wise matched healthy controls. Additionally, an exploratory whole-brain analysis was performed. Clinically depressed adolescents showed a volume reduction of the bilateral dorsal ACC compared to healthy controls. However, no association was found between gray matter volume of the ACC and clinical severity scores for depression or anxiety. Our finding of a smaller ACC in clinically depressed adolescents is consistent with literature on depressed adults. Future research is needed to investigate if gray matter abnormalities precede or follow clinical depression in adolescents.

  7. Clinical Patterns and Treatment Outcome in Patients with Melancholic, Atypical and Non-Melancholic Depressions

    Science.gov (United States)

    Gili, Margalida; Roca, Miquel; Armengol, Silvia; Asensio, David; Garcia-Campayo, Javier; Parker, Gordon

    2012-01-01

    Objective To assess sociodemographic, clinical and treatment factors as well as depression outcome in a large representative clinical sample of psychiatric depressive outpatients and to determine if melancholic and atypical depression can be differentiated from residual non-melancholic depressive conditions. Subjects/Materials and Method A prospective, naturalistic, multicentre, nationwide epidemiological study of 1455 depressive outpatients was undertaken. Severity of depressive symptoms was assessed by the Hamilton Depression Rating Scale (HDRS) and the Self Rated Inventory of Depressive Symptomatology (IDS-SR30). IDS-SR30 defines melancholic and atypical depression according to DSM-IV criteria. Assessments were carried out after 6–8 weeks of antidepressant treatment and after 14–20 weeks of continuation treatment. Results Melancholic patients (16.2%) were more severely depressed, had more depressive episodes and shorter episode duration than atypical (24.7%) and non-melancholic patients. Atypical depressive patients showed higher rates of co-morbid anxiety disorders and substance abuse. Melancholic patients showed lower rates of remission. Conclusion Our study supports a different clinical pattern and treatment outcome for melancholic and atypical depression subtypes. PMID:23110213

  8. Clinical Significance of Psychotherapy for Unipolar Depression: A Meta-Analytic Approach to Social Comparison.

    Science.gov (United States)

    Nietzel, Michael T.; And Others

    1987-01-01

    Used meta-analysis to study the clinical significance of psychotherapy for symptoms of unipolar depression, using the Beck Depression Inventory. Results indicated that psychotherapy produces outcomes of moderate clinical significance which are well-maintained at follow-up, that individual therapy is associated with greater clinical significance…

  9. Clinical and Cognitive Correlates of Depressive Symptoms among Youth with Obsessive Compulsive Disorder

    Science.gov (United States)

    Peris, Tara S.; Bergman, R. Lindsey; Asarnow, Joan R.; Langley, Audra; McCracken, James T.; Piacentini, John

    2010-01-01

    Depression is the most common comorbidity among adults with obsessive compulsive disorder (OCD), yet little is known about depressive symptoms in childhood OCD. This study examined clinical and cognitive variables associated with depressive symptomatology in 71 youths (62% male, mean age= 12.7 years) with primary OCD. Youths presented with a range of depressive symptoms, with 21% scoring at or above the clinical cutoff on the self-report measure of depression. Higher levels of depressive symptoms were associated with higher levels of cognitive distortions assessed on measures of insight, perceived control, competence, and contingencies. Depressive symptoms were also linked to older age and more severe OCD. Low perceived control and self-competence and high OCD severity independently predicted depression scores. PMID:20706915

  10. Paediatric Obsessive-Compulsive Disorder and Depressive Symptoms: Clinical Correlates and CBT Treatment Outcomes.

    Science.gov (United States)

    Brown, H M; Lester, K J; Jassi, A; Heyman, I; Krebs, G

    2015-07-01

    Depression frequently co-occurs with paediatric obsessive-compulsive disorder (OCD), yet the clinical correlates and impact of depression on CBT outcomes remain unclear. The prevalence and clinical correlates of depression were examined in a paediatric specialist OCD-clinic sample (N = 295; Mean = 15 [7 - 18] years, 42 % female), using both dimensional (Beck Depression Inventory-youth; n = 261) and diagnostic (Development and Wellbeing Assessment; n = 127) measures of depression. The impact of depressive symptoms and suspected disorders on post-treatment OCD severity was examined in a sub-sample who received CBT, with or without SSRI medication (N = 100). Fifty-one per-cent of patients reported moderately or extremely elevated depressive symptoms and 26 % (95 % CI: 18 - 34) met criteria for a suspected depressive disorder. Depressive symptoms and depressive disorders were associated with worse OCD symptom severity and global functioning prior to CBT. Individuals with depression were more likely to be female, have had a psychiatric inpatient admission and less likely to be attending school (ps depressive symptom severity significantly decreased after CBT. Depressive symptoms and depressive disorders predicted worse post-treatment OCD severity (βs = 0.19 and 0.26, ps Depression is common in paediatric OCD and is associated with more severe OCD and poorer functioning. However, depression severity decreases over the course of CBT for OCD and is not independently associated with worse outcomes, supporting the recommendation for treatment as usual in the presence of depressive symptoms.

  11. Suicide attempts among depressed inpatients with depressive disorder in a Malaysian sample. Psychosocial and clinical risk factors.

    Science.gov (United States)

    Chan, L F; Maniam, T; Shamsul, A S

    2011-01-01

    Depressed inpatients constitute a high-risk population for suicide attempts. To describe the interactions of clinical and psychosocial risk factors influencing suicide attempts among a Malaysian sample of depressed inpatients. Seventy-five subjects were diagnosed with a depressive disorder according to the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinical Version (SCID-CV). Data on suicide attempts, suicidal ideation (Scale for Suicidal Ideation, SSI), depression severity (Beck's Depression Inventory, BDI), recent life-event changes (Social Readjustment Rating Scale, SRRS), sociodemographic and other relevant clinical factors were collected. A third of the subjects presented after a current suicide attempt. Significant factors for a current suicide attempt were race, religion, recent life-event changes, suicidal ideation, and alcohol use disorder. Independent predictive risk factors for a current suicide attempt were Chinese race, recent marital separation, major mortgage or loans, and being newly diagnosed with depression. Any recent change in personal habits was shown to be a protective factor against current suicide attempt. Age and gender were nonsignificant factors. The findings are generally consistent with existing studies and highlight the role of psychosocial risk factors.

  12. Tele-Interpersonal Psychotherapy Acutely Reduces Depressive Symptoms in Depressed HIV-Infected Rural Persons: A Randomized Clinical Trial.

    Science.gov (United States)

    Heckman, Timothy G; Heckman, Bernadette D; Anderson, Timothy; Lovejoy, Travis I; Markowitz, John C; Shen, Ye; Sutton, Mark

    2017-01-01

    Human immunodeficiency virus (HIV)-positive rural individuals carry a 1.3-times greater risk of a depressive diagnosis than their urban counterparts. This randomized clinical trial tested whether telephone-administered interpersonal psychotherapy (tele-IPT) acutely relieved depressive symptoms in 132 HIV-infected rural persons from 28 states diagnosed with Diagnostic and Statistical Manual of Mental Disorders-IV major depressive disorder (MDD), partially remitted MDD, or dysthymic disorder. Patients were randomized to either 9 sessions of one-on-one tele-IPT (n = 70) or standard care (SC; n = 62). A series of intent-to-treat (ITT), therapy completer, and sensitivity analyses assessed changes in depressive symptoms, interpersonal problems, and social support from pre- to postintervention. Across all analyses, tele-IPT patients reported significantly lower depressive symptoms and interpersonal problems than SC controls; 22% of tele-IPT patients were categorized as a priori "responders" who reported 50% or higher reductions in depressive symptoms compared to only 4% of SC controls in ITT analyses. Brief tele-IPT acutely decreased depressive symptoms and interpersonal problems in depressed rural people living with HIV.

  13. Duplication of C7orf58, WNT16 and FAM3C in an obese female with a t(7;22)(q32.1;q11.2) chromosomal translocation and clinical features resembling Coffin-Siris Syndrome.

    Science.gov (United States)

    Zhu, Jun; Qiu, Jun; Magrane, Gregg; Abedalthagafi, Malak; Zanko, Andrea; Golabi, Mahin; Chehab, Farid F

    2012-01-01

    We characterized the t(7;22)(q32;q11.2) chromosomal translocation in an obese female with coarse features, short stature, developmental delay and a hypoplastic fifth digit. While these clinical features suggest Coffin-Siris Syndrome (CSS), we excluded a CSS diagnosis by exome sequencing based on the absence of deleterious mutations in six chromatin-remodeling genes recently shown to cause CSS. Thus, molecular characterization of her translocation could delineate genes that underlie other syndromes resembling CSS. Comparative genomic hybridization microarrays revealed on chromosome 7 the duplication of a 434,682 bp region that included the tail end of an uncharacterized gene termed C7orf58 (also called CPED1) and spanned the entire WNT16 and FAM3C genes. Because the translocation breakpoint on chromosome 22 did not disrupt any apparent gene, her disorder was deemed to result from the rearrangement on chromosome 7. Mapping of yeast and bacterial artificial chromosome clones by fluorescent in situ hybridization on chromosome spreads from this patient showed that the duplicated region and all three genes within it were located on both derivative chromosomes 7 and 22. Furthermore, DNA sequencing of exons and splice junctional regions from C7orf58, WNT16 and FAM3C revealed the presence of potential splice site and promoter mutations, thereby augmenting the detrimental effect of the duplicated genes. Hence, dysregulation and/or disruptions of C7orf58, WNT16 and FAM3C underlie the phenotype of this patient, serve as candidate genes for other individuals with similar clinical features and could provide insights into the physiological role of the novel gene C7orf58.

  14. Duplication of C7orf58, WNT16 and FAM3C in an obese female with a t(7;22(q32.1;q11.2 chromosomal translocation and clinical features resembling Coffin-Siris Syndrome.

    Directory of Open Access Journals (Sweden)

    Jun Zhu

    Full Text Available We characterized the t(7;22(q32;q11.2 chromosomal translocation in an obese female with coarse features, short stature, developmental delay and a hypoplastic fifth digit. While these clinical features suggest Coffin-Siris Syndrome (CSS, we excluded a CSS diagnosis by exome sequencing based on the absence of deleterious mutations in six chromatin-remodeling genes recently shown to cause CSS. Thus, molecular characterization of her translocation could delineate genes that underlie other syndromes resembling CSS. Comparative genomic hybridization microarrays revealed on chromosome 7 the duplication of a 434,682 bp region that included the tail end of an uncharacterized gene termed C7orf58 (also called CPED1 and spanned the entire WNT16 and FAM3C genes. Because the translocation breakpoint on chromosome 22 did not disrupt any apparent gene, her disorder was deemed to result from the rearrangement on chromosome 7. Mapping of yeast and bacterial artificial chromosome clones by fluorescent in situ hybridization on chromosome spreads from this patient showed that the duplicated region and all three genes within it were located on both derivative chromosomes 7 and 22. Furthermore, DNA sequencing of exons and splice junctional regions from C7orf58, WNT16 and FAM3C revealed the presence of potential splice site and promoter mutations, thereby augmenting the detrimental effect of the duplicated genes. Hence, dysregulation and/or disruptions of C7orf58, WNT16 and FAM3C underlie the phenotype of this patient, serve as candidate genes for other individuals with similar clinical features and could provide insights into the physiological role of the novel gene C7orf58.

  15. Clinical and Physiological Correlates of Irritability in Depression: Results from the Netherlands Study of Depression and Anxiety

    Directory of Open Access Journals (Sweden)

    Floor E. A. Verhoeven

    2011-01-01

    Full Text Available Objective. Irritable and nonirritable depressed patients differ on demographic and clinical characteristics. We investigated whether this extends to psychological and physiological measures. Method. We compared irritable and nonirritable unipolar depressed patients on symptomatology, personality, and (psychophysiological measures (cortisol, cholesterol, and heart rate variability. Symptomatology was reassessed after one year, and we also compared depressed patients who were irritable or non-irritable at both time points (Irr++ versus Irr−−. Results. Almost half (46%; N=420 of the sample was classified as irritable. These patients scored higher on depression severity, anxiety, hypomanic symptoms, and psychological variables. No differences were observed on physiological markers after correction for depression severity. The same pattern was found when comparing Irr++ and Irr−− groups. Conclusion. Irritable and non-irritable depressed patients differ on clinical and psychological variables, but not on the currently investigated physiological markers. The clinical relevance of the distinction and the significance of the hypomanic symptoms remain to be demonstrated.

  16. Depression and Smoking Cessation: Evidence from a Smoking Cessation Clinic with 1-Year Follow-Up.

    Science.gov (United States)

    Stepankova, Lenka; Kralikova, Eva; Zvolska, Kamila; Pankova, Alexandra; Ovesna, Petra; Blaha, Milan; Brose, Leonie S

    2017-06-01

    Smoking is more prevalent among people with depression. Depression may make cessation more difficult and cessation may affect depression symptoms. The aims of this study were to assess the associations between (1) baseline depression and 1-year smoking abstinence and (2) abstinence and change in depression. Observational study using data collected routinely in a smoking cessation clinic in the Czech Republic from 2008 to 2014. Aim 1: N = 3775 patients; 14.3% reported mild and 15.4% moderate/severe baseline depression levels measured using Beck's Depression Inventory (BDI-II). Logistic regressions assessed if depression level predicted 1-year biochemically verified abstinence while adjusting for patient and treatment characteristics. Aim 2: N = 835 patients abstinent at 1 year; change in depression was analysed using Chi-square statistics, t test and mixed method analyses of variance. Rate of abstinence was lower for patients with mild (32.5%, OR = 0.68; 95% CI: 0.54 to 0.87, p = 0.002) and moderate/severe depression (25.8%; OR = 0.57, 95% CI: 0.45 to 0.74, p smoking cessation clinic, depression at the start of treatment predicted reduced smoking abstinence 1 year later. Patients abstinent from smoking experienced considerable improvement in depression.

  17. Comorbid Depressive Disorders in Anxiety-Disordered Youth: Demographic, Clinical, and Family Characteristics

    Science.gov (United States)

    O'Neil, Kelly A.; Podell, Jennifer L.; Benjamin, Courtney L.; Kendall, Philip C.

    2010-01-01

    Research indicates that depression and anxiety are highly comorbid in youth. Little is known, however, about the clinical and family characteristics of youth with principal anxiety disorders and comorbid depressive diagnoses. The present study examined the demographic, clinical, and family characteristics of 200 anxiety-disordered children and…

  18. Relation Between Emotional Intelligence, Socio-Demographic and Clinical Characteristics of Patients with Depressive Disorders.

    Science.gov (United States)

    Abdellatif, Sayeda Ahmed; Hussien, El-Sayed Saleh; Hamed, Warda Elshahat; Zoromba, Mohamed Ali

    2017-02-01

    The present study aims to assess the emotional intelligence in relation to socio-demographic and clinical characteristics of patients with depressive disorders. A descriptive correlational study was utilized with a sample of (106) depressed patients who were diagnosed by a psychiatrist with depressive disorders at psychiatric outpatient clinics in Mansoura University Hospital. Data were collected through assessing socio demographic and clinical characteristics, assessing level of depression using Beck Depression Inventory BDI-II, and assessing emotional intelligence using Barchard emotional intelligence scales. Results revealed that emotional intelligence not related significantly to socio demographic and clinical characteristics of patients with depressive disorders, there is a highly significant relationship between emotional intelligence in relation to level of depression and other practices used to alleviate depression. Therefore, it is recommended to conduct a periodical workshops and training programs for adolescents and young in the universities, schools, social clubs, camps and youth organizations to enhance their emotional intelligence in order to prevent depression. In addition, assessing the effect of emotional intelligence programs on preventing and managing depression. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Comparison of demographic and clinical characteristics between children and adolescents with major depressive disorder.

    Science.gov (United States)

    Fu-I, Lee; Wang, Yuan Pang

    2008-06-01

    To compare clinical characteristics of major depressive disorder symptoms between children and adolescents. The subjects were 58 patients of a Child and Adolescent Affective Disorder Clinic consecutively admitted during a six-month period. Children aged 5-9 years old and adolescents from 10-17 years old currently meeting DSM-IV criteria diagnosis of major depressive disorder were chosen. Current MDD diagnosis and depressive psychopathology were assessed by a clinical interview and the Diagnostic Interview for Children and Adolescents-DSM-IV version. The Children's Depression Rating Scale-Revised Version and the Children Global Assessment Scale rated the severity and global functioning of major depressive disorder. The most common depressive symptoms were: anhedonia (72.4%), depressed mood (72.4%), decreased concentration (62.1%), and irritability (58.6%). The intensity of depressive episodes of this sample ranged from mild to moderate. Fifty percent reported thoughts of death, and 29.3% presented a variety of psychotic symptoms. When compared with children, adolescents reported a significantly more depressed mood (p = 0.043), lower self-esteem (p = 0.002), and had more difficulty concentrating (p = 0.020). Female adolescents had lower self-esteem (p = 0.003), and male adolescents showed more decreased concentration (p = 0.016). This study suggests that age and gender differences might influence the clinical presentation of major depressive disorder in children and adolescents. Further studies with larger samples are needed.

  20. Clinical and psychometric validation of the psychotic depression assessment scale

    DEFF Research Database (Denmark)

    Østergaard, Søren D; Pedersen, Christina H; Uggerby, Peter

    2015-01-01

    BACKGROUND: Recent studies have indicated that the 11-item Psychotic Depression Assessment Scale (PDAS), consisting of the 6-item melancholia subscale (HAM-D6) of the Hamilton Depression Rating Scale and 5 psychosis items from the Brief Psychiatric Rating Scale (BPRS), is a valid measure for the ......BACKGROUND: Recent studies have indicated that the 11-item Psychotic Depression Assessment Scale (PDAS), consisting of the 6-item melancholia subscale (HAM-D6) of the Hamilton Depression Rating Scale and 5 psychosis items from the Brief Psychiatric Rating Scale (BPRS), is a valid measure...

  1. Managing comorbid obesity and depression through clinical pharmacotherapies.

    Science.gov (United States)

    McElroy, Susan L; Guerdjikova, Anna I; Mori, Nicole; Keck, Paul E

    2016-08-01

    Obesity and mood disorders co-occur more often than expected by chance alone. As no randomized, controlled pharmacotherapy trials have been conducted in obese patients with an active mood disorder, it is unclear how to use medication to treat this patient group. We briefly overview the relationship between obesity and mood disorders; the effects of psychotropic medications commonly used in mood disorders on body weight; the psychiatric effects of available anti-obesity medications; and highlight the few treatment studies of medications in obese patients with mood disorders or depressive symptoms. As binge eating and psychotropic-induced weight gain are common correlates of obese patients with mood disorders, we also provide brief overviews of the pharmacotherapy of these conditions. When treating a patient with a mood disorder and obesity, both conditions need to be a focus of clinical attention. Psychotropic medications that have minimal weight gain effects should be used if possible. Weight-loss agents can probably be used in some mood disorder patients, but must be done so cautiously and with a full understanding of their potential psychiatric effects and interactions with psychotropic medications. Knowledge of the pharmacotherapy of binge eating and psychotropic-induced weight gain is also crucial.

  2. Depressive Symptoms, Anatomical Region, and Clinical Outcomes for Patients Seeking Outpatient Physical Therapy for Musculoskeletal Pain

    Science.gov (United States)

    Coronado, Rogelio A.; Beneciuk, Jason M.; Valencia, Carolina; Werneke, Mark W.; Hart, Dennis L.

    2011-01-01

    Background Clinical guidelines advocate the routine identification of depressive symptoms for patients with pain in the lumbar or cervical spine, but not for other anatomical regions. Objective The purpose of this study was to investigate the prevalence and impact of depressive symptoms for patients with musculoskeletal pain across different anatomical regions. Design This was a prospective, associational study. Methods Demographic, clinical, depressive symptom (Symptom Checklist 90–Revised), and outcome data were collected by self-report from a convenience sample of 8,304 patients. Frequency of severe depressive symptoms was assessed by chi-square analysis for demographic and clinical variables. An analysis of variance examined the influence of depressive symptoms and anatomical region on intake pain intensity and functional status. Separate hierarchical multiple regression models by anatomical region examined the influence of depressive symptoms on clinical outcomes. Results Prevalence of severe depression was higher in women, in industrial and pain clinics, and in patients who reported chronic pain or prior surgery. Lower prevalence rates were found in patients older than 65 years and those who had upper- or lower-extremity pain. Depressive symptoms had a moderate to large effect on pain ratings (Cohen d=0.55–0.87) and a small to large effect on functional status (Cohen d=0.28–0.95). In multivariate analysis, depressive symptoms contributed additional variance to pain intensity and functional status for all anatomical locations, except for discharge values for the cervical region. Conclusions Rates of depressive symptoms varied slightly based on anatomical region of musculoskeletal pain. Depressive symptoms had a consistent detrimental influence on outcomes, except on discharge scores for the cervical anatomical region. Expanding screening recommendations for depressive symptoms to include more anatomical regions may be indicated in physical therapy

  3. Systemic oxidatively generated DNA/RNA damage in clinical depression

    DEFF Research Database (Denmark)

    Jorgensen, Anders; Krogh, Jesper; Miskowiak, Kamilla

    2013-01-01

    oxidatively generated DNA and RNA damage, 8-oxo-7,8-dihydro-2-deoxyguanosine (8-oxodG) and 8-oxo-7,8-dihydroguanosine (8-oxoGuo), respectively, were determined in healthy controls (N=28), moderately depressed, non-medicated patients (N=26) and severely depressed patients eligible for electroconvulsive therapy...

  4. Quality of Affectional Bonding, Learned Helplessness, and Clinical Depression.

    Science.gov (United States)

    Kessler, Ronald P.

    John Bowlby's theory of affectional bonding and the reformulated learned helplessness theory of depression were integrated into a multivariate model in order to expand the breadth of current attributional theories of depression. This retrospective study focused upon the quality of parent-child relations, the types of discipline parents employed,…

  5. Unrevealed Depression Involves Dysfunctional Coping Strategies in Crohn’s Disease Patients in Clinical Remission

    Directory of Open Access Journals (Sweden)

    Caterina Viganò

    2016-01-01

    Full Text Available Background and Aims. This study investigated the proportion of CD patients in clinical remission with clinical depression, and coping strategies in those with severe depressive disorders. Materials and Methods. One hundred consecutive CD patients in clinical remission were screened for anxiety and depression by using Hospital Anxiety and Depression Scale and patients with depressive symptoms were further investigated by means of Cognitive Behavioural Assessment 2.0 and Beck Depression Inventory (BDI. Afterwards the coping strategies were assessed through the Brief-COPE questionnaire. Results. Twenty-one patients had anxious symptoms and 16 had depressive symptoms with or without anxiety. Seven of these patients (43.8% showed significant depressive symptoms. Compared to patients without psychiatric disorders, these patients showed significant lower score in “positive reframing” (p: 0.017 and in “planning” (p: 0.046 and higher score in “use of instrumental social support” (p<0.001, in “denial” scale (p: 0.001, and in “use of emotional social support” (p: 0.003. Conclusions. Depressed CD patients in clinical remission may have dysfunctional coping strategies, meaning that they may not be able to implement functional strategies to manage at best stress related with their disease.

  6. Depressive Symptoms and Relationship Between Genders: Differences in Young Adults in a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Mariane Ricardo Acosta Lopez Molina

    Full Text Available Abstract: Depression has a high prevalence in the general population, especially among women. There is no consensus in the scientific literature about differences between men and women in the manifestations of depressive symptoms, nor about psychotherapy indications according to gender. This research aimed to verify differences in depressive symptoms and symptoms improvement between young adult men and women with current Major Depressive Disorder and to identify differences between two brief Cognitive Psychotherapy models. Randomized clinical trial in which participants were randomized between: Cognitive Behavioral Therapy and Narrative Cognitive Therapy. Depressive symptoms pre and post-intervention were evaluated using the Hamilton Depression Rating Scale. The sample was composed of 25 men and 95 women. Genital symptoms and insight were significantly different between genders. Concerning improvement in symptoms according to the psychotherapy model, CBT presented a trend toward being more effective in men. Therefore, the symptoms and improvement in depressive symptoms are manifested differently between genders.

  7. Digital technology and clinical decision making in depression treatment: Current findings and future opportunities.

    Science.gov (United States)

    Hallgren, Kevin A; Bauer, Amy M; Atkins, David C

    2017-06-01

    Clinical decision making encompasses a broad set of processes that contribute to the effectiveness of depression treatments. There is emerging interest in using digital technologies to support effective and efficient clinical decision making. In this paper, we provide "snapshots" of research and current directions on ways that digital technologies can support clinical decision making in depression treatment. Practical facets of clinical decision making are reviewed, then research, design, and implementation opportunities where technology can potentially enhance clinical decision making are outlined. Discussions of these opportunities are organized around three established movements designed to enhance clinical decision making for depression treatment, including measurement-based care, integrated care, and personalized medicine. Research, design, and implementation efforts may support clinical decision making for depression by (1) improving tools to incorporate depression symptom data into existing electronic health record systems, (2) enhancing measurement of treatment fidelity and treatment processes, (3) harnessing smartphone and biosensor data to inform clinical decision making, (4) enhancing tools that support communication and care coordination between patients and providers and within provider teams, and (5) leveraging treatment and outcome data from electronic health record systems to support personalized depression treatment. The current climate of rapid changes in both healthcare and digital technologies facilitates an urgent need for research, design, and implementation of digital technologies that explicitly support clinical decision making. Ensuring that such tools are efficient, effective, and usable in frontline treatment settings will be essential for their success and will require engagement of stakeholders from multiple domains. © 2017 Wiley Periodicals, Inc.

  8. Depression

    DEFF Research Database (Denmark)

    Kessing, Lars Veddel; Bukh, Jens Otto Drachmann

    2014-01-01

    , that these diagnostic criteria represent an oversimplification, which has blurred the concept of depression. We suggest a greater emphasis on the depressed mood as the core symptom of depression, which may increase the specificity of the diagnosis. Furthermore, basic principles for the treatment of depression......The prevalence of depression is not clearly established, but estimated to 3-4% in a Danish questionnaire study. Lifetime's prevalences of 12-17% are reported in other community samples. In the current diagnostic system depression is defined categorically and operationally. It has been argued...

  9. Depression

    DEFF Research Database (Denmark)

    Kessing, Lars Veddel; Bukh, Jens Drachmann

    2014-01-01

    The prevalence of depression is not clearly established, but estimated to 3-4% in a Danish questionnaire study. Lifetime's prevalences of 12-17% are reported in other community samples. In the current diagnostic system depression is defined categorically and operationally. It has been argued......, that these diagnostic criteria represent an oversimplification, which has blurred the concept of depression. We suggest a greater emphasis on the depressed mood as the core symptom of depression, which may increase the specificity of the diagnosis. Furthermore, basic principles for the treatment of depression...

  10. Clinical psychological tests useful for differentiating depressive state with Alzheimer's disease from major depression of the elderly.

    Science.gov (United States)

    Hattori, Hideyuki; Yoshiyama, Kenji; Miura, Rina; Fujie, Sachiko

    2010-03-01

    A depressive state with Alzheimer's disease (AD) is difficult to differentiate from major depression (MD) in many cases. The purpose of this study was to identify differences between the two disorders using a battery of clinically available psychological tests. We evaluated depression and apathy using the Geriatric Depression Scale consisting of 30 items (GDS30) and Apathy Scale in 38 patients with AD and 31 with MD who were diagnosed based on clinical symptoms and radiological findings. In addition, the Cornel Medical Index (CMI) was employed to compare the psychological features of the two disorders. In AD patients, the Apathy Scale score was greater than the GDS30 score, suggesting a strong tendency toward apathy. There was a significant difference in the GDS30/Apathy Scale score ratio between the two groups (P depression-category parameters were significantly higher in MD patients. In individual patients, we compared the scores for the two categories, and there was a marked difference (P < 0.001, OR: 10.6). These results suggest that the GDS30, Apathy Scale, and CMI are useful for differentiating MD from AD and evaluating their psychological features.

  11. Effectiveness of Collaborative Care for Depression in Public-Sector Primary Care Clinics Serving Latinos.

    Science.gov (United States)

    Lagomasino, Isabel T; Dwight-Johnson, Megan; Green, Jennifer M; Tang, Lingqi; Zhang, Lily; Duan, Naihua; Miranda, Jeanne

    2017-04-01

    Quality improvement interventions for depression care have been shown to be effective for improving quality of care and depression outcomes in settings with primarily insured patients. The aim of this study was to determine the impact of a collaborative care intervention for depression that was tailored for low-income Latino patients seen in public-sector clinics. A total of 400 depressed patients from three public-sector primary care clinics were enrolled in a randomized controlled trial of a tailored collaborative care intervention versus enhanced usual care. Social workers without previous mental health experience served as depression care specialists for the intervention patients (N=196). Depending on patient preference, they delivered a cognitive-behavioral therapy (CBT) intervention or facilitated antidepressant medication given by primary care providers or both. In enhanced usual care, patients (N=204) received a pamphlet about depression, a letter for their primary care provider stating that they had a positive depression screen, and a list of local mental health resources. Intent-to-treat analyses examined clinical and process-of-care outcomes at 16 weeks. Compared with patients in the enhanced usual care group, patients in the intervention group had significantly improved depression, quality of life, and satisfaction outcomes (pclinics. Social workers without prior mental health experience can effectively provide CBT and manage depression care.

  12. Depressive Disorder, Anxiety Disorder and Chronic Pain: Multiple Manifestations of a Common Clinical and Pathophysiological Core.

    Science.gov (United States)

    Arango-Dávila, Cesar A; Rincón-Hoyos, Hernán G

    A high proportion of depressive disorders are accompanied by anxious manifestations, just as depression and anxiety often present with many painful manifestations, or conversely, painful manifestations cause or worsen depressive and anxious expressions. There is increasingly more evidence of the pathophysiological, and neurophysiological and technical imaging similarity of pain and depression. Narrative review of the pathophysiological and clinical aspects of depression and chronic pain comorbidity. Research articles are included that emphasise the most relevant elements related to understanding the pathophysiology of both manifestations. The pathological origin, physiology and clinical approach to these disorders have been more clearly established with the latest advances in biochemical and cellular techniques, as well as the advent of imaging technologies. This information is systematised with comprehensive images and clinical pictures. The recognition that the polymorphism of inflammation-related genes generates susceptibility to depressive manifestations and may modify the response to antidepressant treatments establishes that the inflammatory response is not only an aetiopathogenic component of pain, but also of stress and depression. Likewise, the similarity in approach with images corroborates not only the structural, but the functional and pathophysiological analogy between depression and chronic pain. Knowledge of depression-anxiety-chronic pain comorbidity is essential in the search for effective therapeutic interventions. Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  13. When the Black Dog Barks: An Autoethnography of Adult Learning in and on Clinical Depression

    Science.gov (United States)

    Brookfield, Stephen

    2011-01-01

    The U.S. government's National Institute of Mental Health (NIMH) estimates that in any given year, 14.8 million American adults (about 6.7 percent of the adult population) suffer from clinical depression or major depressive disorder, as it is sometimes called (NIMH, n.d.). In Canada, a recent study projected the estimate of sufferers much higher…

  14. Depressants

    Science.gov (United States)

    ... system. Doctors use them to treat things like insomnia or anxiety . But if depressant drugs (like sedatives, tranquilizers, or barbiturates) are abused, they can cause addiction , serious injury, or death. Depressants are usually ...

  15. Women and major depressive disorder: clinical perspectives on causal pathways.

    Science.gov (United States)

    Accortt, Eynav Elgavish; Freeman, Marlene P; Allen, John J B

    2008-12-01

    Epidemiological data on the prevalence of mood disorders demonstrate that major depressive disorder (MDD) is approximately twice as common in women as in men and that its first onset peaks during the reproductive years. We aimed to review key social, psychological, and biological factors that seem strongly implicated in the etiology of major depression and to focus on sex-specific aspects of depression, such as the role of a woman's reproductive life cycle in depressive symptomatology. A review of the literature, from 1965 to present, was conducted. An integrated etiological model best explains gender and sex differences in depression. Social, psychological, and biological variables must be simultaneously taken into account. These vulnerabilities include (but are not limited to) gender-specific roles in society, life stress such as trauma, a tendency toward ruminative coping strategies, and the effects of sex hormones and genetic factors. To effectively treat MDD in women and to prevent the recurrence of illness in vulnerable women, clinicians must understand the sex-specific aspects of mood disorders over the longitudinal course of women's reproductive lives. A biopsychosocial approach should, therefore, be the main focus of future research and practice, to eventually result in an integrated etiological model of depression in women. Based on the prevalence of MDD in women, timely screening, diagnosis, and intervention should be public health priorities.

  16. Genetic risk of major depressive disorder: the moderating and mediating effects of neuroticism and psychological resilience on clinical and self-reported depression.

    Science.gov (United States)

    Navrady, L B; Adams, M J; Chan, S W Y; Ritchie, S J; McIntosh, A M

    2017-11-29

    Polygenic risk scores (PRS) for depression correlate with depression status and chronicity, and provide causal anchors to identify depressive mechanisms. Neuroticism is phenotypically and genetically positively associated with depression, whereas psychological resilience demonstrates negative phenotypic associations. Whether increased neuroticism and reduced resilience are downstream mediators of genetic risk for depression, and whether they contribute independently to risk remains unknown. Moderating and mediating relationships between depression PRS, neuroticism, resilience and both clinical and self-reported depression were examined in a large, population-based cohort, Generation Scotland: Scottish Family Health Study (N = 4166), using linear regression and structural equation modelling. Neuroticism and resilience were measured by the Eysenck Personality Scale Short Form Revised and the Brief Resilience Scale, respectively. PRS for depression was associated with increased likelihood of self-reported and clinical depression. No interaction was found between PRS and neuroticism, or between PRS and resilience. Neuroticism was associated with increased likelihood of self-reported and clinical depression, whereas resilience was associated with reduced risk. Structural equation modelling suggested the association between PRS and self-reported and clinical depression was mediated by neuroticism (43-57%), while resilience mediated the association in the opposite direction (37-40%). For both self-reported and clinical diagnoses, the genetic risk for depression was independently mediated by neuroticism and resilience. Findings suggest polygenic risk for depression increases vulnerability for self-reported and clinical depression through independent effects on increased neuroticism and reduced psychological resilience. In addition, two partially independent mechanisms - neuroticism and resilience - may form part of the pathway of vulnerability to depression.

  17. Prevalence of clinically elevated depressive symptoms in college athletes and differences by gender and sport.

    Science.gov (United States)

    Wolanin, Andrew; Hong, Eugene; Marks, Donald; Panchoo, Kelly; Gross, Michael

    2016-02-01

    There are approximately 400,000 National Collegiate Athletic Association (NCAA) student athletes and 5-7 million high school student athletes competing each year. According to the US Department of Health and Human Services, the depression prevalence rate for young adults, which ranges from 10% to 85% across studies, is higher than that of other age groups. Given the relatively high prevalence of depression in individuals of collegiate age in the general population, the prevalence of depression among athletes in this age group warrants further study. This multiyear study examined the prevalence of depressive symptoms in college athletes, as well as demographic factors related to increased or decreased rates of depressive symptoms by gender and sport. To describe the prevalence of depression symptoms among NCAA division I student athletes at a single institution over 3 consecutive years. Participants (n=465) completed a battery of measures during their yearly spring sports medicine physical across 3 consecutive years. The battery included the Center for Epidemiological Studies Depression Scale (CES-D) and a demographic questionnaire, administered during the course of routine sports medicine physical examinations. Differences in depressive symptoms prevalence and relative risk ratios were calculated by gender and sport. The prevalence rate for a clinically relevant level of depressive symptoms, as measured on the CES-D (CES-D ≥16), was 23.7%. A moderate to severe level of depressive symptoms was reported by 6.3%. There was a significant gender difference in prevalence of depressive symptoms, χ(2) (1)=7.459, p=0.006, with female athletes exhibiting 1.844 times the risk of male athletes for endorsing clinically relevant symptoms. The CES-D identified clinically relevant levels of depressive symptoms in nearly one-quarter of college student athletes in this large cross-sectional sample. Female college athletes reported significantly more depressive symptoms than males

  18. Collaborative care for depression symptoms in an outpatient cardiology setting: A randomized clinical trial.

    Science.gov (United States)

    Carney, Robert M; Freedland, Kenneth E; Steinmeyer, Brian C; Rubin, Eugene H; Ewald, Gregory

    2016-09-15

    Depression is a risk factor for morbidity and mortality in patients with coronary heart disease. Finding effective methods for identifying and treating depression in these patients is a high priority. The purpose of this study was to determine whether collaborative care (CC) for patients who screen positive for depression during an outpatient cardiology visit results in greater improvement in depression symptoms and better medical outcomes than seen in patients who screen positive for depression but receive only usual care (UC). Two hundred-one patients seen in an outpatient cardiology clinic who screened positive for depression during an outpatient visit were randomized to receive either CC or UC. Recommendations for depression treatment and ongoing support and monitoring of depression symptoms were provided to CC patients and their primary care physicians (PCPs) for up to 6months. There were no differences between the arms in mean Beck Depression Inventory-II scores(CC, 15.9; UC, 17.4; p=.45) or in depression remission rates(CC, 32.5%; UC, 26.2%; p=0.34) after 6months, or in the number of hospitalizations after 12months (p=0.73). There were fewer deaths among the CC (1/100) than UC patients (8/101) (p=0.03). This trial did not show that CC produces better depression outcomes than UC. Screening led to a higher rate of depression treatment than was expected in the UC group, and delays in obtaining depression treatment from PCPs may have reduced treatment effectiveness for the CC patients. A different strategy for depression treatment following screening in outpatient cardiology services is needed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. Sensitivity to detect change and the correlation of clinical factors with the Hamilton Depression Rating Scale and the Beck Depression Inventory in depressed inpatients.

    Science.gov (United States)

    Schneibel, Rebecca; Brakemeier, Eva-Lotta; Wilbertz, Gregor; Dykierek, Petra; Zobel, Ingo; Schramm, Elisabeth

    2012-06-30

    Discrepancies between scores on the Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI), as well as differences regarding their sensitivity to detect change, have been reported. This study investigates discrepancies and their potential prediction on the basis of demographic, personality, and clinical factors in depressed inpatients and analyzes the sensitivity to change. The HAMD and the BDI were administered to 105 inpatients with major depressive disorder randomized to 5 weeks of either interpersonal psychotherapy or clinical management. Personality was assessed with the NEO Five-Factor Inventory. Low extraversion and high neuroticism were associated with relatively higher endorsement of depressive symptoms on the BDI compared with the HAMD. The HAMD presented a greater reduction of symptom scores than the BDI. Patients with high BDI scores, high HAMD scores or both revealed the greatest change, possibly due to a statistical effect of regression to the mean. Restricted by sample size, analyses were not differentiated by treatment condition. Regression to the mean cannot be tested directly, but it might be considered as a possible explanation. The HAMD and the BDI should be regarded as two complementary rather than redundant or competing instruments as the discrepancy is associated with personality characteristics. Attributing large effect sizes solely to effective treatment and a sensitive measure may be misleading. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. Therapeutic horticulture in clinical depression: a prospective study of active components.

    Science.gov (United States)

    Gonzalez, Marianne Thorsen; Hartig, Terry; Patil, Grete Grindal; Martinsen, Egil W; Kirkevold, Marit

    2010-09-01

    This paper is a report of a study conducted to assess change in depression severity, perceived attentional capacity and rumination (brooding) in individuals with clinical depression during a therapeutic horticulture programme and to investigate if the changes were mediated by experiences of being away and fascination. Individuals with clinical depression suffer from distortion of attention and rumination. Interventions can help to disrupt maladaptive rumination and promote restoration of depleted attentional capacity. A single-group study was conducted with a convenience sample of 28 people with clinical depression in 2009. Data were collected before, twice during, and immediately after a 12-week therapeutic horticulture programme, and at 3-month follow-up. Assessment instruments were the Beck Depression Inventory, Attentional Function Index, Brooding Scale, and Being Away and Fascination subscales from the Perceived Restorativeness Scale. Mean Beck Depression Inventory scores declined by 4.5 points during the intervention (F = 5.49, P = 0.002). The decline was clinically relevant for 50% of participants. Attentional Function Index scores increased (F = 4.14, P = 0.009), while Brooding scores decreased (F = 4.51, P = 0.015). The changes in Beck Depression Inventory and Attentional Function Index scores were mediated by increases in Being Away and Fascination, and decline in Beck Depression Inventory scores was also mediated by decline in Brooding. Participants maintained their improvements in Beck Depression Inventory scores at 3-month follow-up. Being away and fascination appear to work as active components in a therapeutic horticulture intervention for clinical depression.

  1. Impact of bariatric surgery on clinical depression. Interrupted time series study with matched controls.

    Science.gov (United States)

    Booth, Helen; Khan, Omar; Prevost, A Toby; Reddy, Marcus; Charlton, Judith; Gulliford, Martin C

    2015-03-15

    Obesity is associated with depression. This study aimed to evaluate whether clinical depression is reduced after bariatric surgery (BS). Obese adults who received BS procedures from 2002 to 2014 were sampled from the UK Clinical Practice Research Datalink. An interrupted time series design, with matched controls, was conducted from three years before, to a maximum of seven years after surgery. Controls were matched for body mass index (BMI), age, gender and year of procedure. Clinical depression was defined as a medical diagnosis recorded in year, or an antidepressant prescribed in year to a participant ever diagnosed with depression. Adjusted odds ratios (AOR) were estimated. There were 3045 participants (mean age 45.9; mean BMI 44.0kg/m(2)) who received BS, including laparoscopic gastric banding in 1297 (43%), gastric bypass in 1265 (42%), sleeve gastrectomy in 477 (16%) and six undefined. Before surgery, 36% of BS participants, and 21% of controls, had clinical depression; between-group AOR, 2.02, 95%CI 1.75-2.33, P<0.001. In the second post-operative year 32% had depression; AOR, compared to time without surgery, 0.83 (0.76-0.90, P<0.001). By the seventh year, the prevalence of depression increased to 37%; AOR 0.99 (0.76-1.29, P=0.959). Despite matching there were differences in depression between BS and control patients, representing the highly selective nature of BS. Depression is frequent among individuals selected to undergo bariatric surgery. Bariatric surgery may be associated with a modest reduction in clinical depression over the initial post-operative years but this is not maintained. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

  2. Depression literacy in women attending university hospital clinics in Riyadh Saudi Arabia.

    Science.gov (United States)

    Siddiqui, Amna Rehana; Mahasin, Sarah; Alsajjan, Roa; Hassounah, Marwah; Alhalees, Zeinah; AlSaif, Norah; Alosaimi, Fahad D; AlQuaiz, AlJohara

    2017-03-01

    Depression literacy in general population constitutes an ability to understand depression, with knowledge of disease, its risk factors and symptoms. High levels of depression literacy promote early intervention, potentially reducing related disability. This study investigated the depression literacy in women visitors to clinics of a tertiary care hospital in Riyadh, Saudi Arabia. Women of 18 and more years were surveyed during their visit to primary and other healthcare clinics of a public hospital in Riyadh. Knowledge on depression symptoms, causes and management approaches identified depression literate women scoring more than 30 points on a 42-item tool. Of the 409 participants, 65.5% were depression literate, 50% educated as college and above, 64.3% married, 50.7% housewives, 62.4% reported use of multiple information sources (range, 0-8) and had a mean age of 34.9 (standard deviation ( SD), 12.4) years. In a logistic regression model, participants scoring less than 30 for depression literacy were significantly associated with women having less than college-level education, divorced marital status and use of decreasing number of learning resources. Women with low education divorced; using fewer information sources need specific considerations by healthcare providers for assessment of depressive disorders in this setting.

  3. Disturbances of Embodiment as Core Phenomena of Depression in Clinical Practice.

    Science.gov (United States)

    Doerr-Zegers, Otto; Irarrázaval, Leonor; Mundt, Adrian; Palette, Virginie

    2017-01-01

    This paper proposes a phenomenological approach to the diagnosis of depression, with the aim of overcoming the broadness and nonspecificity of the concept of major depressive disorder (MDD) in current systems of diagnostic classification of mental disorders. Firstly, we outline the methodological limitations of the current classification systems for the diagnosis of MDD. Secondly, we offer a conceptual differentiation between a "symptomatological" versus a "phenomenological" diagnosis of depression. Thirdly, we propose characteristic "disturbances of embodiment" as the fundamental phenomena of "core depression", which manifest themselves in 3 dimensions: embodied self, embodied intentionality, and embodied time. A more useful diagnosis of depression may be achieved by describing the phenomena that constitute a core depression, in order to avoid the overdiagnosis of MDD and its negative consequences in clinical practice. © 2017 S. Karger AG, Basel.

  4. ESRD QIP - Clinical Depression Screening and Follow-up - Payment Year 2018

    Data.gov (United States)

    U.S. Department of Health & Human Services — This dataset includes facility details, measure score, and the state and national average measure scores for the clinical depression screening and follow up...

  5. Clinical variables associated with depression in patients with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Mari Cassol Ferreira

    2015-08-01

    Full Text Available SummaryBackground:the aim of the study was to evaluate the relationship between type 2 diabetes (T2DM, depression and depressive symptoms and their clinical impact on T2DM.Methods:the authors evaluated 214 outpatients, 105 with diabetes (T2DM group and 109 non-diabetics (control group, with ages ranging between 50 and 75 years (T2DM group 65.1 ± 5.6 years, control group 63.4 ± 5.8 years. Use of antidepressant treatment or score ≥ 16 on the Beck depression inventory (BDI was considered depression. Complications of diabetes and total symptom score (TSS for peripheral neuropathy were reported by patients.Results:diabetes group had a higher frequency of depression (35.2% compared to controls (21.1% (p=0,021, with 2.4 times increased risk of depression. The presence of depressive symptoms was also higher in T2DM group (mean BDI 9.5 ± 8.8 versus 6.9 ± 6.2; p=0.039. Symptoms of diabetic neuropathy were higher in depressed subjects. The metabolic control and presence of complications in T2DM group were not associated with depression.Conclusion:T2DM led to an increased risk of depression, but this did not influence the metabolic control or the presence of other complications.

  6. Depression screening with patient-targeted feedback in cardiology: DEPSCREEN-INFO randomised clinical trial.

    Science.gov (United States)

    Löwe, Bernd; Blankenberg, Stefan; Wegscheider, Karl; König, Hans-Helmut; Walter, Dirk; Murray, Alexandra M; Gierk, Benjamin; Kohlmann, Sebastian

    2017-02-01

    International guidelines advocate depression screening in patients with coronary heart disease (CHD) and other chronic illnesses, but evidence is lacking. To test the differential efficacy of written patient-targeted feedback v. no written patient feedback after depression screening. Patients with CHD or hypertension from three cardiology settings were randomised and screened for depression (ClinicalTrials.gov Identifier: NCT01879111). Compared with the control group, where only cardiologists received written feedback, in the intervention group both cardiologists and patients received written feedback regarding depression status. Depression severity was measured 1 month (primary outcome) and 6 months after screening. The control group (n = 220) and the patient-feedback group (n = 155) did not differ in depression severity 1 month after screening. Six months after screening, the patient-feedback group showed significantly greater improvements in depression severity and was twice as likely to seek information about depression compared with the control group. Patient-targeted feedback in addition to screening has a significant but small effect on depression severity after 6 months and may encourage patients to take an active role in the self-management of depression. © The Royal College of Psychiatrists 2017.

  7. The relationship between cognitive insight, clinical insight, and depression in patients with schizophrenia.

    Science.gov (United States)

    Ekinci, Okan; Ugurlu, Görkem Karakas; Albayrak, Yakup; Arslan, Murat; Caykoylu, Ali

    2012-02-01

    Despite comorbid depression being relatively common even in subjects with schizophrenia, to the best of our knowledge, there is, to date, no report in the literature specifically and detailed examining the cognitive and clinical insight in subjects with schizophrenia and a comorbid depressive syndrome. Hence, in this study, we sought to compare the cognitive and clinical insight in our subjects with schizophrenia with and without a comorbid depressive syndrome. We found that participants in the depressive group scored significantly higher on self-reflectiveness and the reflectiveness-certainty (R-C) index scores than those in the nondepressive group. There was no significant difference among groups on the Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and clinical insight scores assessed by the Scale to Assess Unawareness of Mental Disorder. In addition, self-reflectiveness scores significantly correlated with depression, observed depression, hopelessness, and suicidality subscores of the Calgary Depression Scale for Schizophrenia. A better understanding of the cognitive component of insight in schizophrenia with comorbid depression may contribute to develop more efficient cognitive strategies, thus improving patient outcome. However, clinicians should be aware of the possibility of exacerbating a sense of hopelessness and suicide risk during the interventions that improve cognitive insight. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. Feeling connected again: interventions that increase social identification reduce depression symptoms in community and clinical settings.

    Science.gov (United States)

    Cruwys, Tegan; Alexander Haslam, S; Dingle, Genevieve A; Jetten, Jolanda; Hornsey, Matthew J; Desdemona Chong, E M; Oei, Tian P S

    2014-04-01

    Clinical depression is often preceded by social withdrawal, however, limited research has examined whether depressive symptoms are alleviated by interventions that increase social contact. In particular, no research has investigated whether social identification (the sense of being part of a group) moderates the impact of social interventions. We test this in two longitudinal intervention studies. In Study 1 (N=52), participants at risk of depression joined a community recreation group; in Study 2 (N=92) adults with diagnosed depression joined a clinical psychotherapy group. In both the studies, social identification predicted recovery from depression after controlling for initial depression severity, frequency of attendance, and group type. In Study 2, benefits of social identification were larger for depression symptoms than for anxiety symptoms or quality of life. Social identification is subjective and psychological, and therefore participants could not be randomly assigned to high and low social identification conditions. Findings have implications for health practitioners in clinical and community settings, suggesting that facilitating social participation is effective and cost-effective in treating depression. Copyright © 2014 Elsevier B.V. All rights reserved.

  9. Predictors of treatment response for depression and inadequate social support--the ENRICHD randomized clinical trial.

    Science.gov (United States)

    Cowan, Marie J; Freedland, Kenneth E; Burg, Matthew M; Saab, Patrice G; Youngblood, Marston E; Cornell, Carol E; Powell, Lynda H; Czajkowski, Susan M

    2008-01-01

    To determine whether the 'dose' of treatment exposure, delivery of specific components of cognitive behavior therapy (CBT), patient adherence and/or use of antidepressants predict favorable depression and social support outcomes after 6 months of cognitive behavioral treatment. Secondary analyses of the intervention arm of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial involving persons with acute myocardial infarction (MI): n = 641 for the depression outcomes and n = 523 for the social support outcomes. The outcome measures were, for depression: the Beck Depression Inventory (BDI) and Hamilton Rating Scale for Depression (HAM-D); for social support: the ENRICHD Social Support Instrument (ESSI) and Perceived Social Support Scale (PSSS). Better depression outcomes (measured by the BDI) were receiving a high number of depression-specific intervention components, p depression outcomes (measured by the HAM-D) were receiving a high number of the social communication and assertiveness components of the intervention, p social support outcomes (measured by the ESSI and PSSS) were predicted by membership in a racial or ethnic minority group, p social communication and assertiveness components of the intervention was an independent predictor of a worse social support outcome, p depression are useful in treating comorbid depression in post-MI patients. Working on communication skills may help to improve depression but not necessarily social support outcomes in this patient population, while adherence to cognitive-behavioral homework assignments is important for both outcomes. Other components of the ENRICHD intervention that were designed to improve social support had no discernible effects on outcomes. Intervention refinements may be needed in order to achieve better results in future post-MI clinical trials. A greater emphasis on CBT homework adherence could improve both depression and social support outcomes. 2008 S. Karger AG, Basel

  10. Anti-ribosomal P antibodies related to depression in early clinical course of systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Mansoor Karimifar

    2013-01-01

    Full Text Available Background: Diagnosis and treatment of neuropsychiatric lupus is still a major challenge in clinical practice. We investigated the association between depression and anti-ribosomal P (anti-P antibodies in a sample of Iranian patients with systemic lupus erythematosus (SLE. Materials and Methods: This cross-sectional study was conducted on adult patients with SLE referring to a referral out-patient clinic of rheumatology. Demographic data and clinical data with regards to measuring disease activity with the systemic lupus erythematosus disease activity index were gathered. Anti-P antibodies were measured with the enzyme-linked immunosorbent assay method. Depression severity was measured by the Beck Depression Inventory-II. Results: One hundred patients (80% female and 20% male, age = 34.8 ± 10.9 years were included. Anti-P antibodies were present more frequently in depressed than non-depressed patients (30% vs. 10%, P = 0.015. Depression severity was correlated with anti-P antibodies level only in patients with disease duration of less than 2 years (r = 0.517, P = 0.019. There was no association between the depression severity and disease activity. Binary logistic regression analysis showed age (B = 0.953, CI 95%: 0.914-0.993 and positive anti-P antibodies (B = 4.30, CI 95%: 1.18-15.59 as factors that independently associated with depression. Conclusion: We found an association between depression and presence of anti-P antibodies, and also strong correlation between depression severity and anti-P antibodies level in newly diagnosed SLE patients. Depression severity in newly diagnosed SLE patients may reflect a neuropsychiatric involvement, and in later phases, it is more affected by the chronicity of the disease as well as other environmental factors.

  11. Screening and diagnosing depression in women visiting GPs' drop in clinic in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Johansson Sven-Erik

    2008-06-01

    Full Text Available Abstract Background Only half of all depressions are diagnosed in Primary Health Care (PHC. Depression can remain undetected for a long time and entail high costs for care and low quality of life for the individuals. Drop in clinic is a common form of organizing health care; however the visits are short and focus on solving the most urgent problems. The aim of this study was to investigate the prevalence and severity of depression among women visiting the GPs' drop in clinic and to identify possible clues for depression among women. Methods The two-stage screening method with "high risk feedback" was used. Beck's Depression Inventory (BDI was used to screen 155 women visiting two GPs' drop in clinic. Women who screened positive (BDI score ≥10 were invited by the GP to a repeat visit. Major depression (MDD was diagnosed according to DSM-IV criteria and the severity was assessed with Montgomery-Asberg Depression Rating Scale (MADRS. Women with BDI score Results The two-stage method worked well with a low rate of withdrawals in the second step, when the GP invited the women to a repeat visit. The prevalence of depression was 22.4% (95% CI 15.6–29.2. The severity was mild in 43%, moderate in 53% and severe in 3%. The depressed women mentioned mental symptoms significantly more often (69% than the controls (15% and were to a higher extent sick-listed for a longer period than 14 days. Nearly one third of the depressed women did not mention mental symptoms. The majority of the women who screened as false positive for depression had crisis reactions and needed further care from health professionals in PHC. Referrals to a psychiatrist were few and revealed often psychiatric co-morbidity. Conclusion The prevalence of previously undiagnosed depression among women visiting GPs' drop in clinic was high. Clues for depression were identified in the depressed women's symptom presentation; they often mention mental symptoms when they visit the GP for somatic

  12. Clinical utility of the Montgomery-Åsberg Depression Rating Scale for the detection of depression among bariatric surgery candidates.

    Science.gov (United States)

    Duarte-Guerra, Leorides Severo; Gorenstein, Clarice; Paiva-Medeiros, Paula Francinelle; Santo, Marco Aurélio; Lotufo Neto, Francisco; Wang, Yuan-Pang

    2016-04-30

    Clinical assessment of depression is an important part of pre-surgical assessment among individuals with morbid obesity. However, there is no agreed-upon instrument to identify mood psychopathology in this population. We examined the reliability and criterion validity of the clinician-administered Montgomery-Åsberg Depression Rating Scale (MADRS) and the utility of a short version for bariatric surgery candidates. The sample was 374 patients with obesity, consecutively recruited from the waiting list of a bariatric surgery clinic of University Hospital, Brazil: women 80%, mean BMI 47 kg/m(2), mean age 43.0 years. The 10-item MADRS was analyzed against the SCID-I. Items that showed small relevance to sample's characteristics and contribution to data variability were removed to develop the short 5-item version of scale. We calculated the sensitivity and specificity of cutoff points of both versions MADRS, and values were plotted as a receiver operating characteristic curve. For the 10-item MADRS, the Cronbach's alpha coefficient was 0.93. When compared against SCID-I, the best cut-off threshold was 13/14, yielding sensitivity of 0.81 and specificity 0.85. Following items were removed: reduced appetite, reduced sleep, concentration difficulties, suicide thought and lassitude. The 5-item version showed an alpha coefficient of 0.94 and a best cut-off threshold of 10/11, yielding sensitivity of 0.81 and specificity 0.87. Similar overall ability to discriminate depression of almost 90% was found for both 10-item and 5-item MADRS. The MADRS is a reliable and valid instrument to assess depressive symptoms among treatment-seeking bariatric patients. Systematic application of the abbreviated version of the MADRS can be recommended for enhancing the clinical detection of depression during perioperative period.

  13. [A computerised clinical decision-support system for the management of depression in Primary Care].

    Science.gov (United States)

    Aragonès, Enric; Comín, Eva; Cavero, Myriam; Pérez, Víctor; Molina, Cristina; Palao, Diego

    Despite its clinical relevance and its importance as a public health problem, there are major gaps in the management of depression. Evidence-based clinical guidelines are useful to improve processes and clinical outcomes. In order to make their implementation easier these guidelines have been transformed into computerised clinical decision support systems. In this article, a description is presented on the basics and characteristics of a new computerised clinical guideline for the management of major depression, developed in the public health system in Catalonia. This tool helps the clinician to establish reliable and accurate diagnoses of depression, to choose the best treatment a priori according to the disease and the patient characteristics. It also emphasises the importance of systematic monitoring to assess the clinical course, and to adjust therapeutic interventions to the patient's needs at all times. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  14. Clinical Perspective Level of depression among adolescents of ...

    African Journals Online (AJOL)

    Objective: This study investigated the level of depression among religious minority adolescents(Christians and Hindus) in comparison with their dominant counterparts (Muslims) in Pakistan. For this purpose, based on literature available, we hypothesised that adolescents of religious minorities would have a higher level of ...

  15. Body Mass Index, Self-Esteem, and Suicide Risk in Clinically Depressed African American and White American Females.

    Science.gov (United States)

    Palmer, Charles James, Jr.

    2003-01-01

    Assessed whether clinically depressed healthy-weight, overweight, and obese females would differ on self-esteem and suicide risk measures. Data on clinically depressed females from an inpatient psychiatric unit indicated that the three groups did not differ significantly on measures of self-esteem and suicide risk, but depressed, obese, white…

  16. Depression

    DEFF Research Database (Denmark)

    Pouwer, Frans

    2017-01-01

    There is ample evidence that depression is000  a common comorbid health issue in people with type 1 or type 2 diabetes. Reviews have also concluded that depression in diabetes is associated with higher HbA1c levels, less optimal self-care behaviours, lower quality of life, incident vascular...... complications and higher mortality rates. However, longitudinal studies into the course of depression in people with type 1 diabetes remain scarce. In this issue of Diabetologia, Kampling and colleagues (doi: 10.1007/s00125-016-4123-0 ) report the 5 year trajectories of depression in adults with newly diagnosed...... type 1 diabetes (mean age, 28 years). Their baseline results showed that shortly after the diagnosis of type 1 diabetes a major depressive episode was diagnosed in approximately 6% of participants, while 8% suffered from an anxiety disorder. The longitudinal depression data showed that, in a 5 year...

  17. Clinical and non-clinical depression and anxiety in young people: A scoping review on heart rate variability.

    Science.gov (United States)

    Paniccia, Melissa; Paniccia, David; Thomas, Scott; Taha, Tim; Reed, Nick

    2017-12-01

    Heart rate variability (HRV), a measure of cardiac autonomic nervous system functioning, has emerged as a physiological indicator for emotional regulation and psychological well-being. HRV is understudied in the context of depression and anxiety in young people (10-24years old). Main objectives: (1) describe the nature and breadth of reviewed studies; and (2) synthesize main findings in the context of clinical and non-clinical populations of young people with depression and/or anxiety. The Arksey and O'Malley methodology was utilized for this scoping review. CINHAL, EMBASE, Medline, PsychInfo, Scopus, Web of Science, as well as grey literature, were searched. Two reviewers screened titles, abstracts and full papers for inclusion. A total of 20 citations were included in the final review (19 citations peer-reviewed journal articles, 1 journal abstract). Numerical and thematic analysis was used to summarize study findings. In clinical populations of either depression or anxiety, HRV was lower compared to controls. In non-clinical populations of either depression or anxiety, HRV was found to be lower in those who reported more depression or anxiety symptoms. The quality of the reviewed articles was not assessed which limits the ability to generate conclusions regarding study findings. Changes in HRV were found across the spectrum of clinical and non-clinical populations of young people with depression or anxiety. Neurophysiological research on depression and anxiety in young people can act as a first step to understanding how physiological flexibility (i.e. HRV) is related to psychological flexibility (i.e. adaptive or maladaptive responses to life events). Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Clinical and cognitive correlates of young adult at-risk gamblers with and without depression.

    Science.gov (United States)

    Redden, Sarah A; Leppink, Eric W; Grant, Jon E

    2015-11-01

    Depression is commonly found among young adults who have problems with gambling. Although depression and gambling frequently co-occur, it is unclear whether this relationship has clinical or cognitive importance. The study analyzed 215 young adults (age 18 to 29) with "at-risk" gambling behavior. Scores on the Mini International Neuropsychiatric Interview were used to assess lifetime major depressive disorder. The participants were categorized by 2 groups: those with (81 [37.7%]) and those without (134 [62.3%]) depressive symptoms. The groups were compared using various measures assessing gambling severity, quality of life, comorbidity, and psychosocial dysfunction, as well as various cognitive tasks assessing impulsivity and working memory. Participants with depression who gambled had significantly worse gambling urges and behaviors. In addition, they reported significantly higher rates of anxiety (P compulsive buying (P = .004), and lower quality of life (P = .007). The depressed participants also demonstrated significantly greater impairments on cognitive tasks assessing spatial working memory. This research suggests that at-risk gamblers with depression differ clinically and cognitively from at-risk gamblers without depressive symptoms. These findings may have implications for treatment interventions.

  19. Depression

    Science.gov (United States)

    ... and insomnia References American Psychiatric Association. Depressive disorders. Diagnostic and Statistical Manual of Mental Disorders . 5th ed. Arlington, VA: American Psychiatric Publishing; 2013: ...

  20. The Effect of Peers Support on Postpartum Depression: A Single-Blind Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Mahin Kamalifard

    2013-08-01

    Full Text Available Introduction: Postpartum depression and its consequences not only involve mothers and their children but it will also affect their families. Therefore, this study aimed to investigate the effect of mothers receiving peer support on postpartum depression. Methods: 100 eligible primiparous women participated in a randomized clinical trial. The intervention group received phone calls by their peers from the last three months of pregnancy until two months after delivery. The control group only had access to routine care. Both groups in the second month after delivery were checked regarding depression using Edinburgh Postnatal Depression Scale. Data analysis was performed using independent t-test, chi-square test and covariance analysis. Results: Mean depression score before intervention was 13.92 (3.23 in the control group and 14.06 (3.12 in the intervention group. In week 8 after delivery, mean score of depression in control group was 13.29 (4.08 but in the intervention group it was reduced to 10.25 (4.18. Difference in the reduction of mean postpartum depression score between the two groups showed statistically significant difference (p < 0.001. Conclusion: This study showed that peer support was effective in the prevention of postpartum depression, therefore, it is recommended to be used in the reduction of postpartum depression.

  1. Knowledge of and attitudes toward clinical depression among health providers in Gujarat, India.

    Science.gov (United States)

    Almanzar, Santiago; Shah, Nirsarg; Vithalani, Suril; Shah, Sandip; Squires, James; Appasani, Raghu; Katz, Craig L

    2014-01-01

    Clinical depression is a major leading cause of morbidity and mortality but it is oftentimes overlooked and undertreated. The negative perception and lack of understanding of this condition prevents millions of people from seeking appropriate and on-time medical help, leading to distress and increased burden for affected people and their families. The implementation of public education campaigns and training of non-psychiatric health professionals on mental health and clinical depression has been neglected in several countries, including India, which is the second most populous country in the world with a population of more than 1.2 billion people, almost one-fifth of the world's population. This study sought to explore the knowledge and attitudes toward the diagnosis and treatment of clinical depression in nonpsychiatric health care providers in Vadodara, Gujarat, India. A cross-sectional survey was conducted over a 4-week period In Gujarat, India among resident physicians and community health workers about their knowledge and views on clinical depression. We found considerable stigma and misinformation about depression especially among health care workers in India. Most of the community health workers had a great deal of difficulty when defining clinical depression, and a large majority said that they never heard about depression or its definition and although the overwhelming majority of respondents did not believe that clinical depression results from a punishment from God (82% disagreed or strongly disagreed with this belief) or evil spirits (77.5%), a much smaller proportion disagreed with the assertions that depression was either solely due to difficult circumstances (38.2%) or that sufferers only had themselves to blame (47.2%). Meanwhile, only 32.6% disagreed with the position that clinical depression is a sign of weakness and 39.4% disagreed with the statement that suicide was a sign of weakness. Our findings underscore the considerable public health

  2. Cognitive functioning throughout the treatment history of clinical late-life depression

    Science.gov (United States)

    Dzierzewski, Joseph M.; Potter, Guy G.; Jones, Richard N.; Rostant, Ola S.; Ayotte, Brian; Yang, Frances M.; Sachs, Bonnie C.; Feldman, Betsy J.; Steffens, David C.

    2015-01-01

    Objective Previous investigations into the relationship between late-life depressive symptoms and cognitive functioning have resulted in mixed findings concerning whether or not depressive symptoms and cognitive functioning are related. The mixed reports may be due in part to differences in clinical and nonclinical samples and to inadequate consideration of the dynamic nature (i.e., fluctuating course) of depressive symptoms and cognitive functioning in older adults. The current study examined the chronic, acute, and longitudinal relationships between depressive symptoms and cognitive functioning in older adults in an ongoing treatment study of major depressive disorder (MDD). Methods The neurocognitive outcomes of depression in the elderly study operates in a naturalistic treatment milieu using a pharmacological treatment algorithm and regular psychiatric assessment. Four hundred and fifty-three older adults [mean age 70 years, standard deviation (SD) = 7.2] meeting criteria for MDD at study enrollment received annual neuropsychological testing and depressive symptom monitoring for an average of 8.5 years (SD = 4.5). Results Hierarchical linear modeling revealed that higher age, lower education, and higher average/chronic levels of depressive symptoms were related to lower cognitive functioning. Additionally, results revealed that when an individual’s depressive symptoms are higher than is typical for a specific individual, general cognitive function was worse than average. There was no evidence of lagged/longitudinal relationships between depressive symptoms and cognitive functioning in older adults in treatment for MDD. Conclusions Cognitive functioning and depressive symptoms are concurrently associated in older adults with MDD, highlighting the potential importance for stabilizing mood symptoms as a means to manage cognitive deficits in late-life depression. PMID:25703072

  3. Design and methods for a randomized clinical trial treating comorbid obesity and major depressive disorder.

    Science.gov (United States)

    Schneider, Kristin L; Bodenlos, Jamie S; Ma, Yunsheng; Olendzki, Barbara; Oleski, Jessica; Merriam, Philip; Crawford, Sybil; Ockene, Ira S; Pagoto, Sherry L

    2008-09-15

    Obesity is often comorbid with depression and individuals with this comorbidity fare worse in behavioral weight loss treatment. Treating depression directly prior to behavioral weight loss treatment might bolster weight loss outcomes in this population, but this has not yet been tested in a randomized clinical trial. This randomized clinical trial will examine whether behavior therapy for depression administered prior to standard weight loss treatment produces greater weight loss than standard weight loss treatment alone. Obese women with major depressive disorder (N = 174) will be recruited from primary care clinics and the community and randomly assigned to one of the two treatment conditions. Treatment will last 2 years, and will include a 6-month intensive treatment phase followed by an 18-month maintenance phase. Follow-up assessment will occur at 6-months and 1- and 2 years following randomization. The primary outcome is weight loss. The study was designed to provide 90% power for detecting a weight change difference between conditions of 3.1 kg (standard deviation of 5.5 kg) at 1-year assuming a 25% rate of loss to follow-up. Secondary outcomes include depression, physical activity, dietary intake, psychosocial variables and cardiovascular risk factors. Potential mediators (e.g., adherence, depression, physical activity and caloric intake) of the intervention effect on weight change will also be examined. Treating depression before administering intensive health behavior interventions could potentially boost the impact on both mental and physical health outcomes. NCT00572520.

  4. Diagnostic stability in depressive disorder as according to ICD-10 in clinical practice

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel

    2005-01-01

    BACKGROUND: The diagnostic stability of the ICD-10 diagnosis of depressive disorder has not been investigated in clinical practice. SAMPLING AND METHODS: All patients who were diagnosed with depressive disorder at least once in a period from 1994 to 2002 in psychiatric out- or inpatient settings ....... CONCLUSIONS: When the ICD-10 diagnoses are used in clinical practice, the diagnosis of depressive disorder has a low stability over time. These findings emphasize the need for a longitudinally based diagnostic process in the diagnostic systems.......BACKGROUND: The diagnostic stability of the ICD-10 diagnosis of depressive disorder has not been investigated in clinical practice. SAMPLING AND METHODS: All patients who were diagnosed with depressive disorder at least once in a period from 1994 to 2002 in psychiatric out- or inpatient settings...... in Denmark were identified in a nationwide register. RESULTS: A total of 39,741 patients were diagnosed with depressive disorder at least once; among these, 81% were diagnosed at the first contact. In approximately 56% of patients, the initial diagnosis of depressive disorder eventually changed during follow...

  5. Depression

    DEFF Research Database (Denmark)

    Cizza, G; Ravn, Pernille; Chrousos, G P

    2001-01-01

    Existing studies of the relationship between depression and osteoporosis have been heterogeneous in their design and use of diagnostic instruments for depression, which might have contributed to the different results on the comorbidity of these two conditions. Nevertheless, these studies reveal a...

  6. Depression

    DEFF Research Database (Denmark)

    Johansen, Jon O. J.

    2013-01-01

    Nyhederne er fulde af historier om depression. Overskrifter som: ’Danskerne propper sig med lykkepiller’ eller ‘depression er stadigvæk tabu’ går tit igen i dagspressen. Men hvor er nuancerne, og hvorfor gider vi læse de samme historier igen og igen? Måske er det fordi, vores egne forestillinger er...

  7. The validity of dysthymia to predict clinical depressive symptoms as measured by the Hamilton Depression Scale at the 5-year follow-up of patients with first episode depression

    DEFF Research Database (Denmark)

    Bech, Per; Kessing, Lars Vedel; Bukh, Jens Drachmann

    2016-01-01

    as measured by the two self-rating scales ENS and BDI can be considered part of a 'double depression' in patients with first episode depression, implying an existence of depressive symptoms at the 5-year follow-up. CLINICAL IMPLICATIONS: Evaluation of dysthymia or neuroticism is important to perform, even...

  8. Bulimia and anorexia nervosa in winter depression: lifetime rates in a clinical sample.

    Science.gov (United States)

    Gruber, N P; Dilsaver, S C

    1996-01-01

    Symptoms of an eating disorder (hyperphagia, carbohydrate craving, and weight gain) are characteristic of wintertime depression. Recent findings suggest that the severity of bulimia nervosa peaks during fall and winter months, and that persons with this disorder respond to treatment with bright artificial light. However, the rates of eating disorders among patients presenting for the treatment of winter depression are unknown. This study was undertaken to determine these rates among 47 patients meeting the DSM-III-R criteria for major depression with a seasonal pattern. All were evaluated using standard clinical interviews and the Structured Clinical Interview for DSM-III-R. Twelve (25.5%) patients met the DSM-III-R criteria for an eating disorder. Eleven patients had onset of mood disorder during childhood or adolescence. The eating disorder followed the onset of the mood disorder. Clinicians should inquire about current and past symptoms of eating disorders when evaluating patients with winter depression. PMID:8580121

  9. Diagnosis of depression in children and adolescents. Clinical pointers to a difficult diagnosis.

    Science.gov (United States)

    2010-04-01

    It is now accepted that depression can also affect children and adolescents, but its diagnosis is not straightforward. We examined review articles published on this subject over the last 15 years by large specialist groups and multidisciplinary teams. Most studies of symptoms of psychological distress and depression in children are mainly based on clinical experience of specialists and therefore provide only modest evidence. Isolated, transient unhappiness is not in itself a symptom of depression, but recurrent and persistent mood disorders constitute important warning signs. A French consensus jury recommended attentive listening to potentially depressed children, and those closest to them, focusing on phrases that might reflect a loss of interest, enjoyment, self-esteem and self-confidence; feelings of guilt, shame, loss of affection and hope; and morbid or suicidal ideas. British clinical practice guidelines recommend evaluating the severity of a depressive episode on the basis of the type and number of symptoms, and the family context. Scores designed to diagnose depression and assess its severity are controversial. In practice, diagnosis of depression in children and adolescents with persistent psychological distress is not based on a simple list of symptoms. In difficult cases, it is better to adopt a multidisciplinary approach in order to gauge severity and to determine the most appropriate treatment, which, in most cases, does not involve the use of drugs.

  10. Comparison of Effect of Lavandula officinalis and Venlafaxine in Treating Depression: A Double Blind Clinical Trial.

    Science.gov (United States)

    Nikfarjam, Masoud; Rakhshan, Reza; Ghaderi, Hourivash

    2017-07-01

    Major depressive disorder is a chronic disease which may be associated with other mental illnesses. Lavandula officinalis and venlafaxine, herbal and chemical drugs respectively, are used to treat depression. Despite pharmacotherapy, major depressive disorder has a complicated pattern of resistance and recurrence. The aim of this study was to determine the effect of L. officinalis and venlafaxine in treating depression. For this study, 120 patients referred to the psychiatry clinic of the Shahrekord University of Medical Sciences, Shahrekord, Iran, were randomly selected. The participants were randomly assigned to three groups: venlafaxine (Control Group), venlafaxine + L. officinalis ( L. officinalis Group), and venlafaxine + placebo (Placebo Group). All the patients underwent treatment for six weeks. Depression test was administered to the three groups at different time intervals before the treatment, four weeks after the treatment and at completion of the treatment. The data were analysed by SPSS version17.0. Depression scores of all the groups decreased over time (p=0.001). The depression scores were significantly different between the control and L. officinalis groups (p=0.004), and the control and placebo groups (p=0.002), but were not significantly different between the L. officinalis and placebo groups (p=0.95). Adding L. officinalis or a placebo is equally effective in decreasing mean depression score and venlafaxine obviously decreased this score.

  11. A Clinical Trial of In-Home CBT for Depressed Mothers in Home Visitation

    Science.gov (United States)

    Ammerman, Robert T.; Putnam, Frank W.; Altaye, Mekibib; Stevens, Jack; Teeters, Angelique R.; Van Ginkel, Judith B.

    2013-01-01

    Despite negative outcomes for depressed mothers and their children, no treatment specifically designed to address maternal depression in the context of home visitation has emerged. In-Home Cognitive Behavioral Therapy (IH-CBT) is an adapted treatment that is delivered in the home, focuses on the needs of new mothers, and leverages ongoing home visiting to optimize engagement and outcomes. This study examined the efficacy of IH-CBT using a randomized clinical trial. Subjects were 93 new mothers in a home visiting program. Mothers with major depressive disorder identified at 3 months postpartum were randomized into IH-CBT and ongoing home visitation (n=47) or standard home visitation (SHV; n=46) in which they received home visitation alone and could obtain treatment in the community. Depression was measured at pre- and posttreatment, and 3-month follow-up using interviews, clinician ratings, and self-report. Mothers receiving IH-CBT showed improvements in all indicators of depression relative to the SHV condition and these gains were maintained at follow-up. For example, 70.7% of mothers receiving IH-CBT were no longer depressed at posttreatment in terms of meeting criteria for major depressive disorder compared to 30.2% in the SHV group. These findings suggest that IH-CBT is an efficacious treatment for depressed mothers in home visitation programs. PMID:23768664

  12. A clinical trial of in-home CBT for depressed mothers in home visitation.

    Science.gov (United States)

    Ammerman, Robert T; Putnam, Frank W; Altaye, Mekibib; Stevens, Jack; Teeters, Angelique R; Van Ginkel, Judith B

    2013-09-01

    Despite negative outcomes for depressed mothers and their children, no treatment specifically designed to address maternal depression in the context of home visitation has emerged. In-Home Cognitive Behavioral Therapy (IH-CBT) is an adapted treatment that is delivered in the home, focuses on the needs of new mothers, and leverages ongoing home visiting to optimize engagement and outcomes. This study examined the efficacy of IH-CBT using a randomized clinical trial. Subjects were 93 new mothers in a home visiting program. Mothers with major depressive disorder identified at 3months postpartum were randomized into IH-CBT and ongoing home visitation (n=47) or standard home visitation (SHV; n=46) in which they received home visitation alone and could obtain treatment in the community. Depression was measured at pre- and posttreatment, and 3-month follow-up using interviews, clinician ratings, and self-report. Mothers receiving IH-CBT showed improvements in all indicators of depression relative to the SHV condition and these gains were maintained at follow-up. For example, 70.7% of mothers receiving IH-CBT were no longer depressed at posttreatment in terms of meeting criteria for major depressive disorder compared to 30.2% in the SHV group. These findings suggest that IH-CBT is an efficacious treatment for depressed mothers in home visitation programs. Copyright © 2013. Published by Elsevier Ltd.

  13. Clinical and non-clinical depressive symptoms and risk of long-term sickness absence among female employees in the Danish eldercare sector

    DEFF Research Database (Denmark)

    Hjarsbech, PU; Andersen, Rikke Voss; Christensen, Karl Bang

    2011-01-01

    non-clinical and clinical depressive symptoms are prospectively associated to subsequent LTSA. Methods: In a cohort study of 6985 femaleemployees fromthe Danish eldercare sector depressive symptoms were measured by the Major Depression Inventory (MDI) and scores (0–50) were divided into groups of 0......, and occupational group. Limitations: Missing information on the cause of sickness absence and prevalent somatic illness. Conclusion: A clear dose–response relationship exists between increasing depressive symptoms and risk of LTSA. The adverse effect of non-clinical depressive symptoms on LTSA already manifests...

  14. Resemblances in the Wedding and Natal Customs

    OpenAIRE

    Reneta Zlateva; Zlatozhivka Zdravkova

    2011-01-01

    The present article describes the natal rites and customs of the Azerbaijan and Bulgarian nations. Special attention is paid to the resemblances in the practicing and understanding of the traditions. Despite the fact that the two nations live in regions remote from each other, they have common beliefs and strive to provide prosperity for the home, family and children.

  15. Mixed-state bipolar I and II depression: time to remission and clinical characteristics.

    Science.gov (United States)

    Shim, In Hee; Woo, Young Sup; Jun, Tae-Youn; Bahk, Won-Myong

    2014-01-01

    We compared the time to achieve remission and the clinical characteristics of patients with bipolar depressive mixed state and those with bipolar depressive non-mixed state. The subjects (N=131) were inpatients diagnosed between 2006 and 2012 with bipolar I or II disorder, depression and were classified into the following three groups: "pure depressive state" (PD, n=70), "sub-threshold mixed state" (SMX, n=38), and "depressive mixed state" (DMX, n=23). Diagnosis of a DMX was in accordance with Benazzi's definition: three or more manic symptoms in a depressive episode. The subjects' charts were retrospectively reviewed to ascertain the time to achieve remission from the index episode and to identify other factors, such as demographic and clinical characteristics, specific manic symptoms, and pharmacological treatment, that may have contributed to remission. The time to achieve remission was significantly longer in the DMX (p=0.022) and SMX (p=0.035) groups than in the PD group. Adjustment for covariates using a Cox proportional hazards model did not change these results. Clinically, subjects with a DMX were more likely to have manic symptoms in the index episode, especially inflated self-esteem and psychomotor agitation than those in the PD. We investigated only inpatients and therefore could not comment on outpatients. These findings showed that sub-syndromal manic symptoms in bipolar depression had different clinical characteristics and a more severe illness course, including a longer time to achieve remission, than did a pure depressive state. © 2013 Elsevier B.V. All rights reserved.

  16. Insomnia severity is an indicator of suicidal ideation during a depression clinical trial.

    Science.gov (United States)

    McCall, W Vaughn; Blocker, Jill N; D'Agostino, Ralph; Kimball, James; Boggs, Niki; Lasater, Barbara; Rosenquist, Peter B

    2010-10-01

    Insomnia has been linked to suicidal ideas and suicide death in cross-sectional and longitudinal population-based studies. A link between insomnia and suicide has not been previously examined in the setting of a clinical trial. Herein we describe the relationship between insomnia and suicidal thinking during the course of a clinical trial for depression with insomnia. Sixty patients aged 41.5±12.5 years (2/3 women) with major depressive episode and symptoms of insomnia received open-label fluoxetine for 9 weeks and also received blinded, randomized eszopiclone 3mg or placebo at bedtime after the first week of fluoxetine. Insomnia symptoms were assessed with the Insomnia Severity Index (ISI), and suicidal ideation was assessed with The Scale for Suicide Ideation (SSI). Depression symptoms were assessed with the depressed mood item and the anhedonia item from the Hamilton Rating Scale for Depression-24 (HRSD24), as well as a sum score for all non-sleep and non-suicide items from the HRSD (HRSD20). Measurements were taken at baseline and weeks 1, 2, 4, 6, and 8. SSI was examined by generalized linear mixed models for repeated measures as the outcome of interest for all 60 participants with ISI and various mood symptoms as independent variables, with adjustment for age, gender, treatment assignment, and baseline SSI. Higher levels of insomnia corresponded to significantly greater intensity of suicidal thinking (pmodel, the ISI remained an independent predictor of suicidal thinking. The results support the concept that insomnia may be a useful indicator for suicidal ideation and now extend this idea into clinical trials. Insomnia remains an independent indicator of suicidal ideation, even taking into account the core symptoms of depression such as depressed mood and anhedonia. The complaint of insomnia during a depression clinical trial might indicate that more direct questioning about suicide is warranted.

  17. Antidepressant Prescribing Patterns in Korea: Results from the Clinical Research Center for Depression Study

    OpenAIRE

    Bae, Kyung-Yeol; Kim, Sung-Wan; Kim, Jae-Min; Shin, Il-Seon; Yoon, Jin-Sang; Jung, Sung-Won; Lee, Min-Soo; Yim, Hyeon-Woo; Jun, Tae-Youn

    2011-01-01

    Objective This study aimed to investigate antidepressant prescribing patterns, including initial choice, switching and combining, and concomitant use of non-antidepressant agents, for depressive disorders in naturalistic clinical care settings in Korea. Methods Patients with depressive disorder were recruited from both outpatient and inpatient settings in 18 hospitals from all over Korea. Treatment was performed in naturalistic patterns based on each clinician's decision. Data were collected ...

  18. Light treatment in seasonal and nonseasonal depression : diagnostic, clinical and neurendocrine studies

    OpenAIRE

    Thalen, Björn Erik

    1996-01-01

    There is a need for evaluation of new treatment modalities in depression. The aims of thisthesis were to investigate the effect of 2 hours of daily light treatment for 10 days in patientswith a major depression with seasonal or nonseasonal pattern and to study subgroups ofdepressed patients with respect to clinical, demographic, and neuroendocrine factors, theeffect of exposure to bright light, dexamethasone suppression test, CRH stimulation and thehormonal effect of light exposure on healthy...

  19. Clinical Findings Documenting Cellular and Molecular Abnormalities of Glia in Depressive Disorders

    OpenAIRE

    Boldizsár Czéh; Boldizsár Czéh; Szilvia A. Nagy; Szilvia A. Nagy; Szilvia A. Nagy; Szilvia A. Nagy

    2018-01-01

    Depressive disorders are complex, multifactorial mental disorders with unknown neurobiology. Numerous theories aim to explain the pathophysiology. According to the “gliocentric theory”, glial abnormalities are responsible for the development of the disease. The aim of this review article is to summarize the rapidly growing number of cellular and molecular evidences indicating disturbed glial functioning in depressive disorders. We focus here exclusively on the clinical studies and present the...

  20. Clinical role of brexpiprazole in depression and schizophrenia

    Directory of Open Access Journals (Sweden)

    Parikh NB

    2017-03-01

    Full Text Available Nishant B Parikh, Diana M Robinson, Anita H Clayton Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA Abstract: Brexpiprazole, a serotonin–dopamine activity modulator, is the second D2 partial agonist to come to market and has been approved for the treatment of schizophrenia and as an adjunctive treatment in major depressive disorder. With less intrinsic activity than aripiprazole at the D2 receptor and higher potency at 5-HT2A, 5-HT1A, and α1B receptors, the pharmacological properties of brexpiprazole suggest a more tolerable side effect profile with regard to akathisia, extrapyramidal dysfunction, and sedation. While no head-to-head data are currently available, double-blind placebo-controlled studies show favorable results, with the number needed to treat (NNT vs placebo of 6–15 for response in acute schizophrenia treatment and 4 for maintenance. NNT is 12 for response and 17–31 for remission vs placebo in major depression. In schizophrenia trials, treatment-emergent adverse effects (TEAEs and discontinuation rates due to TEAEs were lower in treatment groups vs placebo (7.1%–9.2% vs 14.7%, respectively. Meanwhile, discontinuation rates due to TEAEs in depression studies were higher in treatment groups vs placebo (1.3%–3.5% vs 0–1.4%, respectively and appeared dose dependent. Rates of akathisia are lower compared to those with aripiprazole and cariprazine, weight gain is more prominent than with aripiprazole, cariprazine, or ziprasidone, and sedation is less than with aripiprazole but more than with cariprazine. Brexpiprazole target dosing is 2–4 mg in schizophrenia and 2 mg in depression augmentation. Dose adjustments should be considered in hepatic or renal dysfunction and/or in poor cytochrome P450 2D6 metabolizers. While brexpiprazole represents an exciting second entry for D2 partial agonists with positive studies thus far, direct head-to-head comparisons will

  1. Dimensional approach to delusions in psychotic depression in the elderly: factor structure and clinical correlates.

    Science.gov (United States)

    Gournellis, Rossetos; Oulis, Panagiotis; Michalopoulou, Panagiota; Kaparoudaki, Adamantia; Dimitrakopoulos, Christos; Lykouras, Lefteris

    2009-04-01

    The present study attempted to investigate the clinically important broader dimensions of clinical characteristics of delusions, through multivariate analysis, in a pure sample of elderly unipolar delusional depressives as well as to test their external validity against a set of demographic, anamnestic and psychopathological validators. Fifty inpatients suffering from psychotic major depression (PMD) in the context of major depressive disorder, 60 years old or older, were assessed on the basis of SCID IV, HRSD, MMSE and by three-point ordinal scales of 12 clinical, intrinsic or relational characteristics of delusions tested for their inter-rater reliability. Principal Component Analysis resulted in the extraction of five factors, jointly accounting for 69.7% of the total variance. The five factors were interpreted as representing the dimensions of delusional strength, acute upsetting, delusional organization, incomprehensibility and incitation to actions. Most of the factors were differentially associated with patients' demographic, anamnestic and clinical variables. Our results overlap in part with those of another similar study in delusional depressives of all age-ranges, differing, however, in respects possibly attributable to peculiarities of elderly depressives. Overall, the findings of the present study contribute to the further elucidation of major clinical dimensions of delusions in PMD in the elderly and the testing of their external validity. (c) 2008 John Wiley & Sons, Ltd.

  2. Depression

    Science.gov (United States)

    ... don't have the right balance of chemicals. Hormonal factors – Menstrual cycle changes, pregnancy, miscarriage, postpartum period, perimenopause, and menopause may all cause a woman to develop depression. ...

  3. Clinical effectiveness of cognitive therapy v. interpersonal psychotherapy for depression: results of a randomized controlled trial.

    Science.gov (United States)

    Lemmens, L H J M; Arntz, A; Peeters, F; Hollon, S D; Roefs, A; Huibers, M J H

    2015-07-01

    Although both cognitive therapy (CT) and interpersonal psychotherapy (IPT) have been shown to be effective treatments for major depressive disorder (MDD), it is not clear yet whether one therapy outperforms the other with regard to severity and course of the disorder. This study examined the clinical effectiveness of CT v. IPT in a large sample of depressed patients seeking treatment in a Dutch outpatient mental health clinic. We tested whether one of the treatments was superior to the other at post-treatment and at 5 months follow-up. Furthermore, we tested whether active treatment was superior to no treatment. We also assessed whether initial depression severity moderated the effect of time and condition and tested for therapist differences. Depressed adults (n = 182) were randomized to either CT (n = 76), IPT (n = 75) or a 2-month waiting list control (WLC) condition (n = 31). Main outcome was depression severity, measured with the Beck Depression Inventory - II (BDI-II), assessed at baseline, 2, 3, and 7 months (treatment phase) and monthly up to 5 months follow-up (8-12 months). No differential effects between CT and IPT were found. Both treatments exceeded response in the WLC condition, and led to considerable improvement in depression severity that was sustained up to 1 year. Baseline depression severity did not moderate the effect of time and condition. Within our power and time ranges, CT and IPT appeared not to differ in the treatment of depression in the acute phase and beyond.

  4. Clinical characteristics of depression among adolescent females: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Abdou Tarek A

    2010-10-01

    Full Text Available Abstract Background Adolescents rarely seek psychiatric help; they even hesitate to disclose their feelings to their parents. However; the adolescents especially the females experience depressive symptoms more frequently than general population. Do they experience classic depressive symptoms? Are there symptoms specific to this subpopulation? Aim of the study Through this study, the authors aimed to estimate the prevalence of depressive disorders in Egyptian adolescent female students. They also expected a characteristic profile of symptoms for the adolescent females. However available literature provides no guidance in the description of this profile of symptoms. Methods A number of 602 adolescent females were interviewed, and subjected to General Health Questionnaire (GHQ; Children Depression Inventory (CDI, Structured Clinical Interview for DSM-IV Axis-I Disorders (SCID-I, then Hamilton Rating Scale for Depression (Ham-D. Results were analyzed by the use of SPSS-15. Results The study revealed the prevalence of depression in the sample of the study to be 15.3% (measured by CDI, and 13.3% (measured by SCID-I. Fatigue was the most common presenting depressive symptom (81.3%, in addition to other emotional, cognitive and physiological symptoms. Suicidal ideations were the most common suicidal symptoms in depressed adolescent females (20%, with 2.5% serious suicidal attempts. Conclusions The somatic symptoms were by far the most common presenting symptom for female adolescents suffering from depressive disorders. Depressive phenomena including unexplained fatigue, decreased energy, psychomotor changes, lack of concentration, weight changes and suicidal ideations may be the presenting complaints instead of the classic sad mood.

  5. Relationships among pain and depressive and anxiety symptoms in clinical trials of pregabalin in fibromyalgia.

    Science.gov (United States)

    Arnold, Lesley M; Leon, Teresa; Whalen, Ed; Barrett, Jeannette

    2010-01-01

    Fibromyalgia, as defined by the American College of Rheumatology, is characterized by widespread pain lasting for at least 3 months, with pain in at least 11 out of 18 tender points when palpated with digital pressure. The authors investigated the relationship between changes in pain and symptoms of anxiety and depression, using data from pregabalin clinical trials. Results from three double-blind, placebo-controlled trials of pregabalin monotherapy in fibromyalgia (8-14 weeks) were pooled, and baseline to end-point changes in pain and Hospital Anxiety and Depression Scale (HADS) scores were analyzed. Path-analysis evaluated the association between improvements in anxiety and depression and pain relief. Baseline HADS scores indicated moderate-to-severe anxiety in 38% of patients and moderate-to-severe depressive symptoms in 27%. The improvement in pain was not related to baseline levels of anxiety or depression. The correlation between changes in pain and depressive or anxiety symptoms was low-to-moderate. Path-analysis showed that most of the pain relief observed with pregabalin treatment was a direct analgesic effect and was not explained by improvement in mood. Response to treatment of pain in the pregabalin trials did not depend on baseline levels of anxiety or depressive symptoms, and pregabalin improved pain in fibromyalgia patients with or without depressive or anxiety symptoms. Changes in the level of anxiety or depression had a low-to-moderate impact on pain reduction. Pain reduction with pregabalin treatment appeared to result mostly from a direct treatment effect, rather than an indirect effect mediated through improvement in anxiety or depressive symptoms.

  6. Cognitive behavioral therapy for depression among adults in Japanese clinical settings: a single-group study

    Directory of Open Access Journals (Sweden)

    Kikuchi Toshiaki

    2010-06-01

    Full Text Available Abstract Background Empirical support for cognitive behavioral therapy (CBT for treating Japanese patients with major depression is lacking, therefore, a feasibility study of CBT for depression in Japanese clinical settings is urgently required. Findings A culturally adapted, 16-week manualized individual CBT program for Japanese patients with major depressive disorder was developed. A total of 27 patients with major depression were enrolled in a single-group study with the purpose of testing the feasibility of the program. Twenty six patients (96% completed the study. The mean total score on the Beck Depression Inventory-II (BDI-II for all patients (Intention-to-treat sample improved from 32.6 to 11.7, with a mean change of 20.8 (95% confidence interval: 17.0 to 24.8. Within-group effect size at the endpoint assessment was 2.64 (Cohen's d. Twenty-one patients (77.7% showed treatment response and 17 patients (63.0% achieved remission at the end of the program. Significant improvement was observed in measurement of subjective and objective depression severity (assessed by BDI-II, Quick Inventory of Depressive Symptomatology-Self Rated, and Hamilton Depression Rating Scale, dysfunctional attitude (assessed by Dysfunctional Attitude Scale, global functioning (assessed by Global Assessment of Functioning of DSM-IV and subjective well-being (assessed by WHO Subjective Well-being Inventory (all p values Conclusions Our manualized treatment comprised of a 16-week individual CBT program for major depression appears feasible and may achieve favorable treatment outcomes among Japanese patients with major depression. Further research involving a larger sample in a randomized, controlled trial design is warranted. Trial registration UMIN-CTR UMIN000002542.

  7. Cognitive behavioral therapy for depression among adults in Japanese clinical settings: a single-group study

    Science.gov (United States)

    2010-01-01

    Background Empirical support for cognitive behavioral therapy (CBT) for treating Japanese patients with major depression is lacking, therefore, a feasibility study of CBT for depression in Japanese clinical settings is urgently required. Findings A culturally adapted, 16-week manualized individual CBT program for Japanese patients with major depressive disorder was developed. A total of 27 patients with major depression were enrolled in a single-group study with the purpose of testing the feasibility of the program. Twenty six patients (96%) completed the study. The mean total score on the Beck Depression Inventory-II (BDI-II) for all patients (Intention-to-treat sample) improved from 32.6 to 11.7, with a mean change of 20.8 (95% confidence interval: 17.0 to 24.8). Within-group effect size at the endpoint assessment was 2.64 (Cohen's d). Twenty-one patients (77.7%) showed treatment response and 17 patients (63.0%) achieved remission at the end of the program. Significant improvement was observed in measurement of subjective and objective depression severity (assessed by BDI-II, Quick Inventory of Depressive Symptomatology-Self Rated, and Hamilton Depression Rating Scale), dysfunctional attitude (assessed by Dysfunctional Attitude Scale), global functioning (assessed by Global Assessment of Functioning of DSM-IV) and subjective well-being (assessed by WHO Subjective Well-being Inventory) (all p values < 0.001). Conclusions Our manualized treatment comprised of a 16-week individual CBT program for major depression appears feasible and may achieve favorable treatment outcomes among Japanese patients with major depression. Further research involving a larger sample in a randomized, controlled trial design is warranted. Trial registration UMIN-CTR UMIN000002542. PMID:20529252

  8. Associations between social anxiety and emotional intelligence within clinically depressed patients.

    Science.gov (United States)

    Nolidin, Karen; Downey, Luke A; Hansen, Karen; Schweitzer, Issac; Stough, Con

    2013-12-01

    Impairments in emotional intelligence (EI) have been found in individuals with high general and social anxiety; however, no studies have examined this relationship in a clinically depressed population. Thirty-one patients (11 male, 20 female) with a DSM-IV-TR diagnosis of a major affective disorder and 28 non-clinical controls (5 male, 23 female) completed self-report instruments assessing EI, depression and social anxiety. Compared to a control group, the clinical group scored lower on the EI dimensions of Emotional Recognition and Expression, Understanding Emotions, Emotional Management, and Emotional Control. Regression analyses revealed Emotional Control was a significant predictor of interaction, performance, and generalised social anxiety. Self-report measures of EI may have predictive value in terms of early identification of those at risk of developing social anxiety and depression. The current study points to the potential value of conducting further studies of a prospective nature.

  9. Art therapy for patients with depression: expert opinions on its main aspects for clinical practice.

    Science.gov (United States)

    Blomdahl, Christina; Gunnarsson, Birgitta A; Guregård, Suzanne; Rusner, Marie; Wijk, Helle; Björklund, Anita

    2016-12-01

    Art therapy is based mainly on clinical experience and is rarely described and evaluated scientifically. There is a need for further exploration of its use in patients with depression. The aim of this study was to explore what experts consider to be the main aspects of art therapy in clinical practice for patients with depression. Eighteen occupational therapists experienced and educated in art therapy participated. The experts answered three rounds of Delphi questionnaires and ranked their agreement with 74 assertions. Consensus was defined as 70% or higher. The experts agreed more on assertions about theoretical frames of reference than about clinical practice. The main aspects of art therapy were agreed to be the patients' opportunity to express themselves verbally and through making art. It was equally important that art tasks provided an opportunity to address depressive thoughts, feelings, life experiences, and physical symptoms. Experts in the field of art therapy considered that the main aspect of clinical practice in art therapy for patients with depression is that art themes should promote expression related to both to depression and personal history.

  10. Depression, social support, and clinical outcomes following lung transplantation: a single-center cohort study.

    Science.gov (United States)

    Smith, Patrick J; Snyder, Laurie D; Palmer, Scott M; Hoffman, Benson M; Stonerock, Gregory L; Ingle, Krista K; Saulino, Caroline K; Blumenthal, James A

    2017-11-12

    Depressive symptoms are common among lung transplant candidates and have been associated with poorer clinical outcomes in some studies. Previous studies have been plagued by methodologic problems, including small sample sizes, few clinical events, and uncontrolled confounders, particularly perioperative complications. In addition, few studies have examined social support as a potential protective factor. We therefore examined the association between pretransplant depressive symptoms, social support, and mortality in a large sample of lung transplant recipients. As a secondary aim, we also examined the associations between psychosocial factors, perioperative outcomes [indexed by hospital length of stay (LOS)], and mortality. We hypothesized that depression would be associated with longer LOS and that the association between depression, social support, and mortality would be moderated by LOS. Participants included lung transplant recipients, transplanted at Duke University Medical Center from January 2009 to December 2014. Depressive symptoms were evaluated using the Beck Depression Inventory (BDI-II) and social support using the Perceived Social Support Scale (PSSS). Medical risk factors included forced vital capacity (FVC), partial pressure of carbon dioxide (PCO 2 ), donor age, acute rejection, and transplant type. Functional status was assessed using six-minute walk distance (6MWD). We also controlled for demographic factors, including age, gender, and native disease. Transplant hospitalization LOS was examined as a marker of perioperative clinical outcomes. Participants included 273 lung recipients (174 restrictive, 67 obstructive, 26 cystic fibrosis, and six "other"). Pretransplant depressive symptoms were common, with 56 participants (21%) exhibiting clinically elevated levels (BDI-II ≥ 14). Greater depressive symptoms were associated with longer LOS [adjusted b = 0.20 (2 days per 7-point higher BDI-II score), P social support (P social support were

  11. Feasibility of Providing Culturally Relevant, Brief Interpersonal Psychotherapy for Antenatal Depression in an Obstetrics Clinic: A Pilot Study

    Science.gov (United States)

    Grote, Nancy K.; Bledsoe, Sarah E.; Swartz, Holly A.; Frank, Ellen

    2004-01-01

    Objective: To minimize barriers to care, ameliorate antenatal depression, and prevent postpartum depression, we conducted a pilot study to assess the feasibility of providing brief interpersonal psychotherapy (IPT-B) to depressed, pregnant patients on low incomes in an obstetrics and gynecological (OB/GYN) clinic. Method: Twelve pregnant,…

  12. Clinical effectiveness of online computerised cognitive-behavioural therapy without support for depression in primary care: randomised trial

    NARCIS (Netherlands)

    Graaf, de L.E.; Gerhards, S.A.H.; Arntz, A.; Riper, H.; Metsemakers, J.F.M.; Evers, S.M.; Severens, J.L.; Widdershoven, G.A.M.; Huibers, M.J.H.

    2009-01-01

    BACKGROUND: Computerised cognitive-behavioural therapy (CCBT) might offer a solution to the current undertreatment of depression. AIMS: To determine the clinical effectiveness of online, unsupported CCBT for depression in primary care. METHOD: Three hundred and three people with depression were

  13. Research setting versus clinic setting: Which produces better outcomes in cognitive therapy for depression?

    Science.gov (United States)

    Gibbons, Carly R; Stirman, Shannon Wiltsey; Derubeis, Robert J; Newman, Cory F; Beck, Aaron T

    2013-06-01

    To compare the outcomes of cognitive therapy for depression under controlled and clinically representative conditions, while holding several therapist and clinical assessment factors constant. Treatment outcomes for a sample of 23 adults with a primary diagnosis of Major Depressive Disorder who received cognitive therapy in an outpatient clinic were compared with outcomes of 18 clients who were treated in the cognitive therapy condition of a large, multi-site randomized clinical trial of treatments for depression. All participants had been treated by one of two therapists who served as clinicians in both settings. Individuals in the two samples were diagnostically and demographically similar (approximately 50% Female, 83% White). A variety of client characteristics, assessed prior to treatment, as well as the outcomes of treatment, were examined. Significantly superior treatment outcomes were observed in the individuals treated in the research study, relative to clients in the outpatient clinic, and the difference was not accounted for by intake characteristics. Individuals treated by the therapists in the RCT experienced almost three times as much improvement in depressive symptoms as clients seen in the outpatient setting. If replicated, the findings suggest that differences exist between treatment outcomes in research and outpatient settings and that these differences may not simply be due to therapist experience and training, or differences in patient populations. Future research should further examine the impact of fidelity monitoring, treatment expectation and motivation, and the duration and timing of treatment protocols on clinical outcomes.

  14. Long term follow up of suicide in a clinically depressed community sample.

    Science.gov (United States)

    Thomson, Wendy

    2012-06-01

    The purpose of this study was to examine how sex differences in suicide rates unfolded in a long-term follow up of patients who had been diagnosed with major depression. Patients who were diagnosed with major depression in the Chichester/Salisbury Catchment Area Study were followed for 49 years. Recorded deaths from suicide were compared with rates that were predicted from historical data on suicide mortality rates from 1960 onwards. An overall suicide rate of 3.4% was found in the present sample. Sixteen women and three men died from suicide. Women's suicide rates were significantly higher than the level predicted based on general population trends. Men showed a barely non-significant trend in the same direction. The diagnosis of clinical depression was associated more strongly with increased risk for suicide among women compared with men. Of the female suicides, 13 had been diagnosed with endogenous depression. While suicide rates are significantly higher for men in the general population, and for depressed patients of both sexes, the depression may be a particularly strong predictor of suicide risk among women. The dataset does not provide information about processes that mediate the relationship between depression and suicide mortality. Copyright © 2012 Elsevier B.V. All rights reserved.

  15. The Depressive Experiences Questionnaire: validity and psychological correlates in a clinical sample.

    Science.gov (United States)

    Riley, W T; McCranie, E W

    1990-01-01

    This study sought to compare the original and revised scoring systems of the Depressive Experiences Questionnaire (DEQ) and to assess the construct validity of the Dependent and Self-Critical subscales of the DEQ in a clinically depressed sample. Subjects were 103 depressed inpatients who completed the DEQ, the Beck Depression Inventory (BDI), the Hopelessness Scale, the Automatic Thoughts Questionnaire (ATQ), the Rathus Assertiveness Schedule (RAS), and the Minnesota Multiphasic Personality Inventory (MMPI). The original and revised scoring systems of the DEQ evidenced good concurrent validity for each factor scale, but the revised system did not sufficiently discriminate dependent and self-critical dimensions. Using the original scoring system, self-criticism was significantly and positively related to severity of depression, whereas dependency was not, particularly for males. Factor analysis of the DEQ scales and the other scales used in this study supported the dependent and self-critical dimensions. For men, the correlation of the DEQ with the MMPI scales indicated that self-criticism was associated with psychotic symptoms, hostility/conflict, and a distress/exaggerated response set, whereas dependency did not correlate significantly with any MMPI scales. Females, however, did not exhibit a differential pattern of correlations between either the Dependency or the Self-Criticism scales and the MMPI. These findings suggest possible gender differences in the clinical characteristics of male and female dependent and self-critical depressive subtypes.

  16. Depression in diabetic patients attending University of Gondar Hospital Diabetic Clinic, Northwest Ethiopia

    Directory of Open Access Journals (Sweden)

    Birhanu AM

    2016-05-01

    Full Text Available Anteneh Messele Birhanu,1 Fekadu Mazengia Alemu,2 Tesfaye Demeke Ashenafie,3 Shitaye Alemu Balcha,4 Berihun Assefa Dachew5 1School of Medicine, College of Medicine and Health Sciences, Wollo University, Dessie, 2Department of Midwifery, 3Department of Nursing, 4Department of Internal Medicine, College of Medicine and Health Sciences, 5Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia Background: Diabetes mellitus, frequently associated with comorbid depression, contributes to the double burden of individual patients and community. Depression remains undiagnosed in as many as 50%–75% of diabetes cases. This study aimed to determine the prevalence and associated factors of depression among diabetic patients attending the University of Gondar Hospital Diabetic Clinic, Northwest Ethiopia. Methods: An institution-based cross-sectional study was conducted from March to May 2014 among 422 sampled diabetic patients attending the University of Gondar Hospital Diabetic Clinic. The participants were selected using systematic random sampling. Data were collected by face-to-face interview using a standardized and pretested questionnaire linked with patient record review. Depression was assessed using the Patient Health Questionnaire-9. Data were entered to EPI INFO version 7 and analyzed by SPSS version 20 software. Binary logistic regression analysis was performed to identify factors associated with depression. Results: A total of 415 diabetic patients participated in the study with a response rate of 98.3%. The prevalence of depression among diabetic patients was found to be 15.4% (95% confidence interval (CI: 11.7–19.2. Only religion (adjusted odds ratio [AOR] =2.65 and 95% CI: 1.1–6.0 and duration of diabetes (AOR =0.27 and 95% CI: 0.07–0.92 were the factors associated with depression among diabetic patients. Conclusion: The prevalence of depression was low as compared to other

  17. Factors associated with risk of depression and relevant predictors of screening for depression in clinical practice: a cross-sectional study among HIV-infected individuals in Denmark.

    Science.gov (United States)

    Slot, M; Sodemann, M; Gabel, C; Holmskov, J; Laursen, T; Rodkjaer, L

    2015-08-01

    Depression and psychiatric disorders are frequent among HIV-infected individuals. The aim of this study was to determine the prevalence of depression and describe the psychiatric history of HIV-infected individuals in an out-patient clinic in Denmark and to identify factors of clinical importance that may be used to identify patients at risk of depression. In 2013, 212 HIV-infected patients were included in a questionnaire study. We used the Beck Depression Inventory II (BDI-II) to assess the prevalence and severity of depressive symptoms. Patients with a BDI-II score ≥ 20 were offered a clinical evaluation by a consultant psychiatrist. Logistic regression was used to determine predictors associated with risk of depression. Symptoms of depression (BDI-II score ≥ 14) were observed in 75 patients (35%), and symptoms of moderate to major depression (BDI-II score ≥ 20) in 55 patients (26%). There was also a high prevalence of co-occurring mental illness. In a multivariate model, self-reported stress, self-reported perception that HIV infection affects all aspects of life, self-reported poor health, not being satisfied with one's current life situation, previous alcohol abuse, nonadherence to antiretroviral therapy and previously having sought help because of psychological problems were independently associated with risk of depression. Symptoms of depression and co-occurring mental illness are under-diagnosed and under-treated among HIV-infected individuals. We recommend that screening of depression should be conducted regularly to provide a full psychiatric profile to decrease the risk of depression and improve adherence and quality of life in this population. © 2015 British HIV Association.

  18. Time to improve and recover from depressive symptoms and interpersonal problems in a clinical trial.

    Science.gov (United States)

    Lopes, Rodrigo T; Gonçalves, Miguel M; Fassnacht, Daniel; Machado, Paulo P P; Sousa, Inês

    2015-01-01

    Results from an earlier clinical trial comparing narrative therapy with cognitive-behavioural therapy (Lopes et al., 2013) suggested that narrative therapy is efficacious for depression. However, there were significant differences in symptom reduction on the Beck Depression Inventory-II, favouring cognitive-behavioural therapy, if dropouts were included in the analysis, suggesting that time to recovery or improvement would differ in both treatments. Contrarily, results showed that treatment assignment was not a predictor for differential effect. Using a survival analytic approach, it was found that four sessions were necessary for 50% improvement and 16 sessions for 50% recovery. Additionally, depressive symptoms changes occurred significantly faster than interpersonal changes, again regardless of treatment assignment. These results support previous findings of the dose-response literature and of the phase model of change, with the advantage of being specific to psychotherapy with depressive clients. Copyright © 2013 John Wiley & Sons, Ltd.

  19. Post-stroke depression: Main phenomenological clusters and their relationships with clinical measures.

    Science.gov (United States)

    Quaranta, Davide; Marra, Camillo; Gainotti, Guido

    2012-01-01

    To investigate the principal psychopathological dimensions of post-stroke depression (PSD) through the assessment of the factorial structure of the Post-Stroke Depression Rating Scale (PSDRS). We enrolled ninety-eight subjects with PSD, who underwent the PSDRS, MMSE and Barthel Index. Information about demographic, clinical, and neuroanatomical factors was collected. The factor analysis extracted three factors accounting for 63.4% of the total variance, and identified as: 1) "Depressive and Anxious Symptoms" (DAS); 2) "Lack of Emotional Control" (LEC); 3) "Reduced Motivation" (RM). On multivariate statistics, DAS severity was predicted by previous history of mood disorders and Barthel Index; LEC severity was predicted by Barthel Index; RM severity was predicted by age. The PSDRS displayed a reliable factor structure that agreed with previous interpretation of PSD. In particular, core depressive symptoms seem to be related to premorbid personality and functional status, whereas apathy/anhedonia may be connected to brain aging.

  20. Clinical utility of Standardised Assessment of Personality - Abbreviated Scale (SAPAS) among patients with first episode depression

    DEFF Research Database (Denmark)

    Bukh, Jens Drachmann; Bock, Camilla; Vinberg, Maj

    2010-01-01

    for comorbid personality disorder among patients suffering from depression would be of clinical use. METHOD: The present study aimed to assess the utility of the Standardised Assessment of Personality - Abbreviated Scale (SAPAS) as a screen for personality disorder in a population of patients recently......BACKGROUND: Personality disorder frequently co-occurs with depression and seems to be associated with a poorer outcome of treatment and increased risk for recurrences. However, the diagnosing of personality disorder can be lengthy and requires some training. Therefore, a brief screening interview...... diagnosed with first episode depression. A total number of 394 patients with an ICD-10 diagnosis of a single depressive episode were sampled consecutively via the Danish Psychiatric Central Research Register during a 2years inclusion period and assessed by the screening interview and, subsequently...

  1. Social perception of facial resemblance in humans.

    Science.gov (United States)

    DeBruine, Lisa M; Jones, Benedict C; Little, Anthony C; Perrett, David I

    2008-02-01

    Two lines of reasoning predict that highly social species will have mechanisms to influence behavior toward individuals depending on their degree of relatedness. First, inclusive fitness theory leads to the prediction that organisms will preferentially help closely related kin over more distantly related individuals. Second, evaluation of the relative costs and potential benefits of inbreeding suggests that the degree of kinship should also be considered when choosing a mate. In order to behaviorally discriminate between individuals with different levels of relatedness, organisms must be able to discriminate cues of kinship. Facial resemblance is one such potential cue in humans. Computer-graphic manipulation of face images has made it possible to experimentally test hypotheses about human kin recognition by facial phenotype matching. We review recent experimental evidence that humans respond to facial resemblance in ways consistent with inclusive fitness theory and considerations of the costs of inbreeding, namely by increasing prosocial behavior and positive attributions toward self-resembling images and selectively tempering attributions of attractiveness to other-sex faces in the context of a sexual relationship.

  2. Depression and suicide risk of outpatients at specialized hospitals for substance use disorder: comparison with depressive disorder patients at general psychiatric clinics.

    Science.gov (United States)

    Matsumoto, Toshihiko; Matsushita, Sachio; Okudaira, Kenichi; Naruse, Nobuya; Cho, Tetsuji; Muto, Takeo; Ashizawa, Takeshi; Konuma, Kyohei; Morita, Nobuaki; Ino, Aro

    2011-12-01

    The present study used a self-reporting questionnaire to compare suicide risk in outpatients being treated for substance use disorder at specialized hospitals to suicide risk in outpatients being treated for depressive disorder at general psychiatric clinics. Although patients in both groups exhibited an equal severity of depression, the patients with drug use disorder had a higher suicide risk than those with depressive disorder. These findings indicate that drug-abusing patients at specialized hospitals may have a severe risk of committing suicide, suggesting that carefully assessing the comorbidity of depression with drug abuse may be required for preventing suicide in drug-abusing patients.

  3. The relationship between body esteem, exercise motivations, depression, and social support among female free clinic patients.

    Science.gov (United States)

    Kamimura, Akiko; Christensen, Nancy; Al-Obaydi, Sarah; Solis, Silvia Patricia; Ashby, Jeanie; Greenwood, Jessica L J; Reel, Justine J

    2014-01-01

    Obesity is a significant public health problem in women's health. This study examined relationship between body esteem, exercise motivations, depression, and social support among female free clinic patients. Low-income women who are at risk for obesity and other health concerns would benefit from health education efforts. We compared 299 female and 164 male free clinic patients 18 years or older using assessments for body esteem, motivation to exercise, depression, and social support. Although female participants reported lower levels of body esteem and higher levels of depression compared with male participants (p depression lowers levels of body esteem (p body image and physical activity. It is important for health educators to engage a myriad of physical activity motives to increase the likelihood that clients will experience enjoyment and sustained adoption of exercise into their lifestyle. Future practice and research should warrant the implementation of body image and physical activity programs and the potential impact of using exercise to reducing depression among female patients at free clinics. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  4. “Female preponderance” of depression in non-clinical populations: A meta-analytic study

    Directory of Open Access Journals (Sweden)

    Kui Wang

    2016-09-01

    Full Text Available Clinical observations and research suggest a female preponderance in major depressive disorder (MDD. However, it is unclear whether a similar gender difference is found for the reporting of depressive symptoms in non-clinical populations. The present meta-analysis was conducted to address this issue. We searched for published papers targeting non-clinical populations in which the 21-item Beck Depression Inventory (BDI was used. Eighty-four papers (91 studies published between 1977 and 2014 were included in the final meta-analysis, which comprised 23,579 males and 29,470 females. Females in the general population reported higher level of depressive symptoms than males (d = -0.187, corresponding to 1.159 points in the 21-item BDI. This pattern was not found to influence by years of publication, socioeconomic status or version of the BDI used. Using age group as a moderator, studies with adolescents and young adults were found to show a smaller effect size than studies with older participants. Our results appear to confirm the female preponderance in the level of self-report depressive symptoms in the general population, and support the social gender role theory in explaining gender difference over biological susceptibility theory and evolutionary theory.

  5. Design and methods for a randomized clinical trial treating comorbid obesity and major depressive disorder

    Directory of Open Access Journals (Sweden)

    Crawford Sybil

    2008-09-01

    Full Text Available Abstract Background Obesity is often comorbid with depression and individuals with this comorbidity fare worse in behavioral weight loss treatment. Treating depression directly prior to behavioral weight loss treatment might bolster weight loss outcomes in this population, but this has not yet been tested in a randomized clinical trial. Methods and design This randomized clinical trial will examine whether behavior therapy for depression administered prior to standard weight loss treatment produces greater weight loss than standard weight loss treatment alone. Obese women with major depressive disorder (N = 174 will be recruited from primary care clinics and the community and randomly assigned to one of the two treatment conditions. Treatment will last 2 years, and will include a 6-month intensive treatment phase followed by an 18-month maintenance phase. Follow-up assessment will occur at 6-months and 1- and 2 years following randomization. The primary outcome is weight loss. The study was designed to provide 90% power for detecting a weight change difference between conditions of 3.1 kg (standard deviation of 5.5 kg at 1-year assuming a 25% rate of loss to follow-up. Secondary outcomes include depression, physical activity, dietary intake, psychosocial variables and cardiovascular risk factors. Potential mediators (e.g., adherence, depression, physical activity and caloric intake of the intervention effect on weight change will also be examined. Discussion Treating depression before administering intensive health behavior interventions could potentially boost the impact on both mental and physical health outcomes. Trial registration NCT00572520

  6. Serum levels of brain-derived neurotrophic factor in major depressive disorder : state-trait issues, clinical features and pharmacological treatment

    NARCIS (Netherlands)

    Molendijk, M. L.; Bus, B. A. A.; Spinhoven, Ph; Penninx, B. W. J. H.; Kenis, G.; Prickaerts, J.; Voshaar, R. C. Oude; Elzinga, B. M.

    2011-01-01

    Recent evidence supports 'the neurotrophin hypothesis of depression' in its prediction that brain-derived neurotrophic factor (BDNF) is involved in depression. However, some key questions remain unanswered, including whether abnormalities in BDNF persist beyond the clinical state of depression,

  7. Serum levels of brain-derived neurotrophic factor in major depressive disorder: state-trait issues, clinical features and pharmacological treatment

    NARCIS (Netherlands)

    Molendijk, M.L.; Bus, B.A.A.; Spinhoven, P.; Penninx, B.W.J.H.; Kenis, G.; Prickaerts, J.; Voshaar, R.C.O.; Elzinga, B.M.

    2011-01-01

    Recent evidence supports 'the neurotrophin hypothesis of depression' in its prediction that brain-derived neurotrophic factor (BDNF) is involved in depression. However, some key questions remain unanswered, including whether abnormalities in BDNF persist beyond the clinical state of depression,

  8. Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomised controlled trial.

    Science.gov (United States)

    Richards, David A; Hill, Jacqueline J; Gask, Linda; Lovell, Karina; Chew-Graham, Carolyn; Bower, Peter; Cape, John; Pilling, Stephen; Araya, Ricardo; Kessler, David; Bland, J Martin; Green, Colin; Gilbody, Simon; Lewis, Glyn; Manning, Chris; Hughes-Morley, Adwoa; Barkham, Michael

    2013-08-19

    To compare the clinical effectiveness of collaborative care with usual care in the management of patients with moderate to severe depression. Cluster randomised controlled trial. 51 primary care practices in three primary care districts in the United Kingdom. 581 adults aged 18 years and older who met ICD-10 (international classification of diseases, 10th revision) criteria for a depressive episode on the revised Clinical Interview Schedule. We excluded acutely suicidal patients and those with psychosis, or with type I or type II bipolar disorder; patients whose low mood was associated with bereavement or whose primary presenting problem was alcohol or drug abuse; and patients receiving psychological treatment for their depression by specialist mental health services. We identified potentially eligible participants by searching computerised case records in general practices for patients with depression. Collaborative care, including depression education, drug management, behavioural activation, relapse prevention, and primary care liaison, was delivered by care managers. Collaborative care involved six to 12 contacts with participants over 14 weeks, supervised by mental health specialists. Usual care was family doctors' standard clinical practice. Depression symptoms (patient health questionnaire 9; PHQ-9), anxiety (generalised anxiety disorder 7; GAD-7), and quality of life (short form 36 questionnaire; SF-36) at four and 12 months; satisfaction with service quality (client satisfaction questionnaire; CSQ-8) at four months. 276 participants were allocated to collaborative care and 305 allocated to usual care. At four months, mean depression score was 11.1 (standard deviation 7.3) for the collaborative care group and 12.7 (6.8) for the usual care group. After adjustment for baseline depression, mean depression score was 1.33 PHQ-9 points lower (95% confidence interval 0.35 to 2.31, P=0.009) in participants receiving collaborative care than in those receiving usual

  9. Clinical depression, posttraumatic stress disorder, and comorbid depression and posttraumatic stress disorder as risk factors for in-hospital mortality after coronary artery bypass grafting surgery.

    Science.gov (United States)

    Dao, Tam K; Chu, Danny; Springer, Justin; Gopaldas, Raja R; Menefee, Deleene S; Anderson, Thomas; Hiatt, Emily; Nguyen, Quang

    2010-09-01

    The goal of this study was to examine the effect of clinical depression, posttraumatic stress disorder, and comorbid depression and posttraumatic stress disorder on in-hospital mortality after a coronary artery bypass grafting surgery. It is hypothesized that depression, posttraumatic stress disorder, and comorbid depression and posttraumatic stress disorder will independently contribute to an increased risk for in-hospital mortality rates after coronary artery bypass grafting surgery. We performed a retrospective analysis of the 2006 Nationwide Inpatient Sample database. The Nationwide Inpatient Sample database provides information on approximately 8 million US inpatient stays from about 1000 hospitals. We performed chi(2) and unpaired t tests to evaluate potential confounding group demographic and medical variables. Hierarchic logistic regression was used with forced order entry of depression, posttraumatic stress disorder, and comorbid depression and posttraumatic stress disorder. Deceased patients were more likely to have had depression (alive, 24.8%; deceased, 60.3%; P posttraumatic stress disorder (alive, 13.4%; deceased, 56.1%; P posttraumatic stress disorder (alive, 7.8%; deceased, 48.5%; P posttraumatic stress disorder (odds ratio, 2.09; 95% confidence interval, 1.65-2.64), and comorbid depression and posttraumatic stress disorder (odds ratio, 4.66; 95% confidence interval, 3.46-6.26) had an increased likelihood of in-hospital mortality compared with that seen in patients who were alive. Two findings were noteworthy. First, depression, posttraumatic stress disorder, and comorbid depression and posttraumatic stress disorder are prevalent in patients undergoing coronary artery bypass grafting procedures. Second, depression, posttraumatic stress disorder, and comorbid depression and posttraumatic stress disorder increase the risk of death by magnitudes comparable with well-established physical health risk factors after coronary artery bypass grafting surgery

  10. Depression and African Americans

    Science.gov (United States)

    ... You are here Home » Depression And African Americans Depression And African Americans Not “Just the Blues” Clinical ... or spiritual communities. Commonly Asked Questions about Clinical Depression How do I get help for clinical depression? ...

  11. Attitudes of psychology students to depression and its treatment: Implications for clinical practice.

    Science.gov (United States)

    Economou, M; Peppou, L E; Geroulanou, K; Kontoangelos, K; Prokopi, A; Pantazi, A; Zervakaki, A; Stefanis, C N

    2017-01-01

    . The core misconception espoused pertains to the view that major depression is not a medical illness; a finding which can also be interpreted in light of the lingering controversy on the medicalization of normal sadness and human predicament. The clinical implications of these findings are substantial. Mental health professionals-educators should reflect on their own beliefs and attitudes towards depression, as they may convey stigmatizing messages to their students and thus perpetuate the stigmatization of the illness. Concomitantly, psychology students' attitudes to depression and its treatment might render them incapable of understanding their patients, responding to their needs and providing them with appropriate help, while they may hinder their effective collaboration with psychiatrists.

  12. Depression symptoms in people with diabetes attending outpatient podiatry clinics for the treatment of foot ulcers.

    Science.gov (United States)

    Pearson, Sue; Nash, Toni; Ireland, Vanessa

    2014-01-01

    The purpose of this study was to examine the prevalence of depressive symptoms, diabetes self-management, and quality of life in people with diabetes and foot ulcers. Ulcer status, mortality and amputations were also assessed at six months follow-up. This was a cross-sectional survey of people attending outpatient podiatry clinics at a major tertiary referral hospital. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ). Diabetes self-care was assessed using the Summary of Diabetes Self Care Activities (SDSCA) measure. Health-related quality of life was measured using the physical component summary score (PCS) and the mental component summary score (MCS) of the SF-12. Of the 60 participants in the study 14 (23.3%) reported mild symptoms of depression (PHQ score 5-9) and 17 (28.3%) moderate to severe depressive symptoms (PHQ score > 9). Twenty-one (35%) met the criteria for previously recognized depression (on antidepressants and/or a diagnosis of depression in the last 12 months) and 17 (28.3%) for depression not previously recognized (PHQ > 4). Seventeen (28%) participants had been receiving antidepressant treatment for a median duration of 104 weeks (IQR 20, 494 weeks). Despite antidepressant treatment 12 participants (70.6% of those taking antidepressants) still reported moderate to severe depressive symptoms at the time of the study. Patients with PHQ scores > 4 reported poorer adherence to diabetes self-care activities including general diet, exercise, blood sugar monitoring and foot care when compared to those participants with PHQ scores  4 compared with no deaths and 2 amputations in participants with PHQ scores < 5. There was no association between depressive symptoms and ulcer healing or ulcer recurrence at the six-month follow-up. This study found a high prevalence of depressive symptoms both recognized and unrecognized in people with diabetes and foot ulcers. Depressive symptoms were associated with overall

  13. A Structured Protocol Model of Depression Care versus Clinical Acumen: A Cluster Randomized Trial of the Effects on Depression Screening, Diagnostic Evaluation, and Treatment Uptake in Ugandan HIV Clinics.

    Science.gov (United States)

    Wagner, Glenn J; Ngo, Victoria; Goutam, Prodyumna; Glick, Peter; Musisi, Seggane; Akena, Dickens

    2016-01-01

    Depression is common among people living with HIV, and it has consequences for both HIV prevention and treatment response, yet depression treatment is rarely integrated into HIV care in sub-Saharan Africa, partly due to the paucity of mental health professionals. We conducted a cluster randomized controlled trial of two task-shifting models to facilitating depression care delivered by medical providers: one that utilized a structured protocol, and one that relied on clinical acumen, in 10 HIV clinics in Uganda. Both models started with routine depression screening of all clients at triage using the 2-item Patient Health Questionnaire (PHQ-2), from which we enrolled 1252 clients (640 at structured protocol clinics, 612 at clinical acumen clinics) who had screened positive over 12 months. We compared the two models on (1) proportion of all client participants, and those clinically depressed (based on survey-administered 9-item PHQ-9>9), who received post-screening evaluation for depression using the PHQ-9; and (2) proportion of clinically depressed who were prescribed antidepressant therapy. Linear probability regression analyses were conducted using a wild cluster bootstrap to control for clustering; patient characteristics, clinic size and time fixed effects were included as covariates. Among all client participants, those in the structured protocol arm were far more likely to have received further evaluation by a medical provider using the PHQ-9 (84% vs. 49%; beta = .33; p = .01). Among the clinically depressed clients (n = 369), the advantage of the structured protocol model over clinical acumen was not statistically significant with regard to PHQ-9 depression evaluation (93% vs. 68%; beta = .21; p = .14) or prescription of antidepressants (69% vs. 58%; beta = .10; p = .50), in part because only 30% of clients who screened positive were clinically depressed. These findings reveal that in both models depression care practices were widely adopted by providers, and

  14. Comparative clinical characteristics of depression in bipolar affective disorders types I and II

    Directory of Open Access Journals (Sweden)

    N. A. Tyuvina

    2016-01-01

    Full Text Available Objective: to investigate the clinical features of depression within bipolar affective disorders types I and II (BADI and BADII.Patients and methods. An examination was made in 100 depressive patients, including 25 with BADI, 37 with BADII, and 38 with recurrent depressive disorder (RDD (a comparison group. The patients' status was evaluated in accordance with the ICD-10 and DSM-V affective disorder criteria, by using a specially developed questionnaire.Results. BAD-related depression has features distinguishing it from RDD: sexual preference (men; an earlier age of disease onset; a shorter duration, but a higher frequency of exacerbations; a greater tendency for the continuum; a more marked decrease in social and family adaptation; development in people with predominantly hyperthymic premorbid; more frequently a family history of affective disorders, schizophrenia, and alcoholism; high comorbidity with metabolic diseases and psychoactive substance abuse; worse health more commonly in autumn and winter; a predominant anxious affect and an obviously decreasing interest in the structure of depression; a higher incidence of atypical sleep, appetite, and weight disorders; high suicidal activity; higher motor retardation (in BADI; relatively small involvement of somatic complaints in BAD I and frequent panic attacks in BADII.Conclusion. Knowledge of the specific features of BAD-related depression will be able to make a more accurate differential diagnosis and to perform more effective treatment in these patients.

  15. Pro-inflammatory cytokines associated with clinical severity of dry eye disease of patients with depression.

    Science.gov (United States)

    Mrugacz, Małgorzata; Ostrowska, Lucyna; Bryl, Anna; Szulc, Agata; Zelazowska-Rutkowska, Beata; Mrugacz, Grzegorz

    2017-09-01

    The aim of this study was to assess the correlation of inflammatory cytokines levels in tears with severity of dry eye disease in a cohort of patients with depression. Tear fluid samples were collected from 32 patients with depression treated with antidepressants, and 34 healthy subjects. Cytokines were assessed by ELISA. All the subjects completed the Beck Depression Inventory and performed the ophthalmic examination, including dry eye tests. The tear fluid levels of IL-6, IL-17 and TNF-α in depressive patients were higher than in controls. The clinical severity of dry eye disease correlated significantly with the IL-17 and TNF-α levels. Our results suggest a crucial role of inflammatory cytokines, especially IL-17 and TNF-α, in the development of severe dry eye disease in patients with depression. Clarification of the role pro-inflammatory cytokines in the pathogenesis of ocular findings in depressive patients may be useful in establishing immunotherapeutic strategies for this disease. Copyright © 2017 Medical University of Bialystok. Published by Elsevier B.V. All rights reserved.

  16. 76 FR 63355 - Proposed Information Collection (Prevalence and Clinical course of Depression Among patients with...

    Science.gov (United States)

    2011-10-12

    ...: Prevalence and Clinical Course of Depression Among Patients with Heart Failure, VA HSR&D, Nursing Research... practical utility; (2) the accuracy of VHA's estimate of the burden of the proposed collection of information; (3) ways to enhance the quality, utility, and clarity of the information to be collected; and (4...

  17. Cognitive-behavioral versus psychodynamic therapy for major depression: secondary outcomes of a randomized clinical trial

    NARCIS (Netherlands)

    Driessen, E.; Van, H.L.; Peen, J.; Don, F.J.; Twisk, J.W.R.; Cuijpers, Pim; Dekker, J.J.M.

    2017-01-01

    Objective: In a randomized clinical trial, we compared the efficacy of cognitive–behavioral therapy (CBT) and psychodynamic therapy for adult outpatient depression on measures of psychopathology, interpersonal functioning, pain, and quality of life. Method: There were 341 Dutch adults (70.1% female,

  18. Comparative Studies of Collaborative Team Depression Care Adoption in Safety Net Clinics

    Science.gov (United States)

    Ell, Kathleen; Wu, Shinyi; Guterman, Jeffrey; Schulman, Sandra-Gross; Sklaroff, Laura; Lee, Pey-Jiuan

    2018-01-01

    Purpose: To evaluate three approaches adopting collaborative depression care model in Los Angeles County safety net clinics with predominantly Latino type 2 diabetes patients. Methods: Pre-post differences in treatment rates and symptom reductions were compared between baseline, 6-month, and 12-month follow-ups for each approach: (a) Multifaceted…

  19. Multiple ureterolithiasis resembling steinstrasse: An unusual presentation

    Directory of Open Access Journals (Sweden)

    Praveen Kumar Pandey

    2014-12-01

    Full Text Available Steinstrasse or “stone street” is an expected complication after extracorporeal shock wave lithotripsy in patients with high stone burden. However, there are published reports of multiple ureterolithiasis resembling steinstrasse in patients with distal renal tubular acidosis. Here we report an uncommon case of a 60-year-old woman who presented with right renal calculi. Her right ureter was studded with multiple calculi up to the vesicoureteric junction. The affected right kidney was nonfunctional and was managed by nephroureterectomy.

  20. Clinical repetitive transcranial magnetic stimulation for veterans with major depressive disorder.

    Science.gov (United States)

    Kozel, F Andrew; Hernandez, Michael; Van Trees, Kimberly; Phillips, Sean; Hashimie, Jaffrey; Weisman, Mark; Obregon, Demian; Sanchez, Deborah L; Catalano, Glenn; Schultz, Susan K

    2017-11-01

    Repetitive transcranial magnetic stimulation (TMS) is a relatively new treatment modality for patients with major depressive disorder (MDD). Numerous studies have demonstrated the efficacy of TMS for MDD in the general population. However, there is limited information regarding clinical outcomes among veterans receiving TMS for MDD. The clinical outcome and characteristics of all veterans with MDD who were treated with TMS as outpatients at the James A. Haley Veterans' Hospital from October 2013 to December 2016 were assessed. Among 40 patients who received TMS, there was a significant improvement of depressive symptoms using the Quick Inventory of Depressive Symptomatology-Self-Report (45% response, 20% remission) and the Montgomery-Åsberg Depression Rating Scale (61.9% response, 42.9% remission). In addition to significant improvement in depressive symptoms, self-report of anxiety symptoms and function significantly improved. TMS was generally well tolerated, with only a small percentage of patients discontinuing treatment due to side effects. No seizures or persistent adverse effects were observed or reported. TMS is an effective and well-tolerated option for MDD in a veteran population with significant treatment resistance and multiple comorbidities.

  1. Cognitive-behavioral versus psychodynamic therapy for major depression: Secondary outcomes of a randomized clinical trial.

    Science.gov (United States)

    Driessen, Ellen; Van, Henricus L; Peen, Jaap; Don, Frank J; Twisk, Jos W R; Cuijpers, Pim; Dekker, Jack J M

    2017-07-01

    In a randomized clinical trial, we compared the efficacy of cognitive-behavioral therapy (CBT) and psychodynamic therapy for adult outpatient depression on measures of psychopathology, interpersonal functioning, pain, and quality of life. There were 341 Dutch adults (70.1% female, mean age = 38.9, SD = 10.3) meeting Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition ( DSM-IV ) criteria for a major depressive episode and with a Hamilton Depression Rating Scale (HAM-D) score ≥14, who were randomized to 16 sessions of individual manualized CBT or short-term psychodynamic supportive psychotherapy. Severely depressed patients (HAM-D >24) received additional antidepressant medication according to a protocol. Outcome measures included the Brief Symptom Inventory, Beck Anxiety Inventory, Outcome Questionnaire, a visual analogue scale for pain, and EuroQol. Data were analyzed with mixed model analyses using intention-to-treat samples. Noninferiority margins were prespecified as Cohen's d = -0.30. Across treatment conditions, 45-60% of the patients who completed posttreatment assessment showed clinically meaningful change for most outcome measures. We found no significant differences between the treatment conditions on any of the outcome measures at both posttreatment and follow-up. Noninferiority of psychodynamic therapy to CBT was shown for posttreatment and follow-up anxiety measures as well as for posttreatment pain and quality of life measures, but could not be consistently demonstrated for the other outcomes. This is the first study that shows that psychodynamic therapy can be at least as efficacious as CBT for depression on important aspects of patient functioning other than depressive symptom reduction. These findings extend the evidence-base of psychodynamic therapy for depression, but replication is needed by means of rigorously designed noninferiority trials. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  2. Biomarkers of systemic inflammation and depression and fatigue in moderate clinically stable COPD

    Directory of Open Access Journals (Sweden)

    Singh Dave

    2011-01-01

    Full Text Available Abstract Introduction COPD is an inflammatory disease with major co-morbidities. It has recently been suggested that depression may be the result of systemic inflammation. We aimed to explore the association between systemic inflammation and symptoms of depression and fatigue in patients with mainly moderate and clinically stable COPD using a range of inflammatory biomarkers, 2 depression and 2 fatigue scales. Method We assessed 120 patients with moderate COPD (FEV1% 52, men 62%, age 66. Depression was assessed using the BASDEC and CES-D scales. Fatigue was assessed using the Manchester COPD-fatigue scale (MCFS and the Borg scale before and after 6MWT. We measured systemic TNF-α, CRP, TNF-α-R1, TNF-α-R2 and IL-6. Results A multivariate linear model of all biomarkers showed that TNF-α only had a positive correlation with BASDEC depression score (p = 0.007. TNF-α remained positively correlated with depression (p = 0.024 after further adjusting for TNF-α-R1, TNF-α-R2, 6MWD, FEV1%, and pack-years. Even after adding the MCFS score, body mass and body composition to the model TNF-α was still associated with the BASDEC score (p = 0.044. Furthermore, patients with higher TNF-α level (> 3 pg/ml, n = 7 had higher mean CES-D depression score than the rest of the sample (p = 0.03. Borg fatigue score at baseline were weakly correlated with TNF-α and CRP, and with TNF-α only after 6MWT. Patients with higher TNF-α had more fatigue after 6MWD (p = 0.054. Conclusion This study indicates a possible association between TNF-α and two frequent and major co-morbidities in COPD; i.e., depression and fatigue.

  3. DEMO-II trial. Aerobic exercise versus stretching exercise in patients with major depression-a randomised clinical trial

    DEFF Research Database (Denmark)

    Krogh, Jesper; Videbech, Poul; Thomsen, Carsten

    2012-01-01

    The effect of referring patients from a clinical setting to a pragmatic exercise intervention for depressive symptoms, cognitive function, and metabolic variables has yet to be determined.......The effect of referring patients from a clinical setting to a pragmatic exercise intervention for depressive symptoms, cognitive function, and metabolic variables has yet to be determined....

  4. Clinical relevance of comorbidity in anxiety disorders : A report from the Netherlands Study of Depression and Anxiety (NESDA)

    NARCIS (Netherlands)

    Hofmeijer-Sevink, Mieke Klein; Batelaan, Neeltje M.; van Megen, Harold J. G. M.; Penninx, Brenda W.; Cath, Danielle C.; van den Hout, Marcel A.; van Balkom, Anton J. L. M.

    Background: To study the clinical relevance of type of comorbidity and number of comorbid disorders in anxiety disorders. Four groups were compared according to sociodemographic-, vulnerability- and clinical factors: single anxiety disorder, anxiety-anxiety comorbidity, anxiety-depressive

  5. Clinical relevance of comorbidity in anxiety disorders: A report from the Netherlands Study of Depression and Anxiety (NESDA)

    NARCIS (Netherlands)

    Klein Hofmeijer-Sevink, M.; Batelaan, N.M.; van Megen, H.J.G.M.; Penninx, B.W.J.H.; Cath, D.C.; van Hout, M.A.; van Balkom, A.J.L.M.

    2012-01-01

    Background: To study the clinical relevance of type of comorbidity and number of comorbid disorders in anxiety disorders. Four groups were compared according to sociodemographic-, vulnerability- and clinical factors: single anxiety disorder, anxiety-anxiety comorbidity, anxiety-depressive

  6. SEMIOTICS, DIAGNOSTICS AND THERAPY TACTICS OF DEPRESSIVE DISORDERS IN CLINICAL MEDICINE

    Directory of Open Access Journals (Sweden)

    N. A. Kornetov

    2014-01-01

    Full Text Available Study objectives are dedicated to brief synthesized establishment of diagnostics general standard, management and therapy of major depressive disorders (MDD in clinical medicine to provide education in medical practice.Study methods are based on short-term, medium-term and long-term educational programs in 24 Russian and Ukraine cities, which were based on original educational programs under the direction of World Psychiatric Association (WPA and International Committee For Prevention and Treatment of Depression (PTD. There, about 1450 doctors of different occupations were acquainted with the detection, management and treatment of MDD. The Russian version of WPA/PTD programs was created. The program of education included 4 modules. The Core module included an overview of the epidemiology, impact, concepts and classification, and etiology of depressive disorders as well as their recognition, diagnosis, and management in the primary care setting. The second module focused on depressive disorders in physical illness and covered those major illnesses for which is reasonable evidence for an association with depressive disorders. The third module included the development of the depressive disorders in older persons. The forth module included training physicians in mental health skills. 39 theme improvements for 858 primary care setting physicians within the framework of faculty training program of physicians’ development were the part of other programs of physicians’ occupations.Results. A number of highlights were included in the general algorithm of the educational programs. The creation of optimum «physician-depressive patient» contact demands a number of new skills to establish effective communication. These skills involve training of meeting of depressive patient and physician, the ability to follow a certain communication style; identify emotional, cognitive, psychomotor and nonverbal patterns of behavior. Besides that, the education

  7. Universal depression screening, diagnosis, management, and outcomes at a student-run free clinic.

    Science.gov (United States)

    Soltani, Maryam; Smith, Sunny; Beck, Ellen; Johnson, Michelle

    2015-06-01

    Student-run free clinics (SRFCs) are now present at most medical schools. Reports regarding SRFCs have focused on the infrastructure of established clinics, characteristics of the patient populations served, and their contribution to patient care. Few studies discuss their role in preventive medicine and even fewer discuss mental health care. This study examined the outcomes of a medical student-run universal depression screening, diagnosis, and management program at two SRFC sites. Medical students implemented a universal depression screening, diagnosis, and management program within the electronic health record during routine adult primary care visits utilizing the Patient Health Questionnaire-2 (PHQ-2) as an initial screening tool, with a protocol to administer the Patient Health Questionnaire-9 (PHQ-9) if the PHQ-2 score was ≥3. This is a retrospective medical record review of visits from August 13, 2013, through February 13, 2014, to assess this program. Overall, 95.8 % (206/215) of the patients received either the PHQ-2 or the PHQ-9. Among the 174 patients without a previous diagnosis of depression, 166 were screened (95.4 %), of which 33 (19.9 %) had a positive PHQ-2 score of ≥3; 30 (of 33; 90.9 %) appropriately received a PHQ-9. Nineteen (of 166 screened; 11.4 %) previously undiagnosed patients were confirmed to have depression. Fourteen patients had two or more PHQ-9 tests at least 4 weeks apart and eight (57.1 %) had a clinically significant improvement, defined as PHQ-9 score decrease of ≥5. The prevalence of depression diagnosed prior to the implementation of this program in this cohort was 19.1 % (41/215) and after was 27.9 % (60/215). This study demonstrated that medical students with faculty supervision can successfully implement a universal depression screening, diagnosis, and management program at multiple SRFC sites, identify previously undiagnosed depression, and work with interdisciplinary support services to provide treatment options

  8. American tertiary clinic-referred bipolar II disorder versus bipolar I disorder associated with hastened depressive recurrence.

    Science.gov (United States)

    Dell'Osso, Bernardo; Shah, Saloni; Do, Dennis; Yuen, Laura D; Hooshmand, Farnaz; Wang, Po W; Miller, Shefali; Ketter, Terence A

    2017-12-01

    Bipolar disorder (BD) is a chronic, frequently comorbid condition characterized by high rates of mood episode recurrence and suicidality. Little is known about prospective longitudinal characterization of BD type II (BD II) versus type I (BD I) in relation to time to depressive recurrence and recovery from major depressive episode. We therefore assessed times to depressive recurrence/recovery in tertiary clinic-referred BD II versus I patients. Outpatients referred to Stanford BD Clinic during 2000-2011 were assessed with Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation and with Clinical Monitoring Form during up to 2 years of naturalistic treatment. Prevalence and clinical correlates of bipolar subtype in recovered (euthymic ≥8 weeks) and depressed patients were assessed. Kaplan-Meier analyses assessed the relationships between bipolar subtype and longitudinal depressive severity, and Cox proportional hazard analyses assessed the potential mediators. BD II versus BD I was less common among 105 recovered (39.0 vs. 61.0%, p = 0.03) and more common among 153 depressed (61.4 vs. 38.6%, p = 0.006) patients. Among recovered patients, BD II was associated with 6/25 (24.0%) baseline unfavorable illness characteristics/mood symptoms/psychotropics and hastened depressive recurrence (p = 0.015). Among depressed patients, BD II was associated with 8/25 (33.0%) baseline unfavorable illness characteristics/mood symptoms/psychotropics, but only non-significantly associated with delayed depressive recovery. BD II versus BD I was significantly associated with current depression and hastened depressive recurrence, but only non-significantly associated with delayed depressive recovery. Research on bipolar subtype relationships with depressive recurrence/recovery is warranted to enhance clinical management of BD patients.

  9. Prevalence of depression among women attending a primary urban care clinic in Malaysia.

    Science.gov (United States)

    Sidik, Sherina Mohd; Arroll, Bruce; Goodyear-Smith, Felicity; Ahmad, Rozali

    2012-07-01

    Depression affects more women than men in Malaysia. The objective of this paper was to determine the prevalence of depression and its associated factors among women attending a government primary care clinic. A cross-sectional study was conducted in a government-funded primary care clinic in Malaysia. Consecutive adult female patients attending the clinic during the data collection period were invited to participate. The participants completed self-administered questionnaires (including the validated Patient Health Questionnaire [PHQ-9], which was translated into the Malay language). A total of 895 female patients participated in the study (response rate 87.5%). The prevalence of depression (PHQ-9 scores ≥ 10) was 12.1%. Based on multiple logistic regression analysis, certain stressful life events were found to be associated with depression (p history of serious illness (OR 2.4, 95% CI 1.1-5.2), unhappiness in family relationships (OR 2.3, 95% CI 1.1-4.7) and unhappiness at work (OR 2.2, 95% CI 1.1-4.3) (p Malaysia should be aware of this prevalence when making diagnoses in primary care.

  10. Dissecting the determinants of depressive disorders outcome: an in depth analysis of two clinical cases

    Directory of Open Access Journals (Sweden)

    Oasi Osmano

    2007-02-01

    Full Text Available Abstract Clinicians face everyday the complexity of depression. Available pharmacotherapies and psychotherapies improve patients suffering in a large part of subjects, however up to half of patients do not respond to treatment. Clinicians may forecast to a good extent if a given patient will respond or not, based on a number of data and sensations that emerge from face to face assessment. Conversely, clinical predictors of non response emerging from literature are largely unsatisfactory. Here we try to fill this gap, suggesting a comprehensive assessment of patients that may overcome the limitation of standardized assessments and detecting the factors that plausibly contribute to so marked differences in depressive disorders outcome. For this aim we present and discuss two clinical cases. Mr. A was an industrial manager who came to psychiatric evaluation with a severe depressive episode. His employment was demanding and the depressive episode undermined his capacity to manage it. Based on standardized assessment, Mr. A condition appeared severe and potentially dramatic. Mrs. B was a housewife who came to psychiatric evaluation with a moderate depressive episode. Literature predictors would suggest Mrs. B state as associated with a more favourable outcome. However the clinician impression was not converging with the standardized assessment and in fact the outcome will reverse the prediction based on the initial formal standard evaluation. Although the present report is based on two clinical cases and no generalizability is possible, a more detailed analysis of personality, temperament, defense mechanisms, self esteem, intelligence and social adjustment may allow to formalize the clinical impressions used by clinicians for biologic and pharmacologic studies.

  11. Implementation of Depression Screening and Global Health Assessment in Pediatric Subspecialty Clinics.

    Science.gov (United States)

    Iturralde, Esti; Adams, Rebecca N; Barley, Regan C; Bensen, Rachel; Christofferson, Megan; Hanes, Sarah J; Maahs, David M; Milla, Carlos; Naranjo, Diana; Shah, Avni C; Tanenbaum, Molly L; Veeravalli, Sruthi; Park, K T; Hood, Korey K

    2017-11-01

    Adolescents with chronic illness face greater risk of psychosocial difficulties, complicating disease management. Despite increased calls to screen for patient-reported outcomes, clinical implementation has lagged. Using quality improvement methods, this study aimed to investigate the feasibility of standardized screening for depression and assessment of global health and to determine recommended behavioral health follow-up, across three pediatric subspecialty clinics. A total of 109 patients aged 12-22 years (median = 16.6) who were attending outpatient visits for treatment of diabetes (80% type 1), inflammatory bowel disease, or cystic fibrosis completed the 9-item Patient Health Questionnaire (PHQ-9) depression and Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Global Health measures on electronic tablets. Patients screening positive on the PHQ-9 received same-day behavioral health assessment and regular phone check-ins to facilitate necessary follow-up care. Overall, 89% of 122 identified patients completed screening during a 6-month window. Patients completed measures in a timely manner (within 3 minutes) without disruption to clinic flow, and they rated the process as easy, comfortable, and valuable. Depression scores varied across disease type. Patients rated lower global health relative to a previously assessed validation cohort. Depression and global health related significantly to certain medical outcomes. Fifteen percent of patients screened positive on the PHQ-9, of whom 50% confirmed attending behavioral health appointments within 6 months of screening. A standardized depression and global health assessment protocol implemented across pediatric subspecialties was feasible and effective. Universal behavioral health screening for adolescents and young adults living with chronic disease is necessary to meet programmatic needs in pediatric subspecialty clinics. Copyright © 2017 Society for Adolescent Health and Medicine

  12. Belief in a concerned god predicts response to treatment for adults with clinical depression.

    Science.gov (United States)

    Murphy, Patricia E; Fitchett, George

    2009-09-01

    Belief in a concerned God has been shown to be associated with lower depression through the mediation of hopelessness. This study hypothesized that this relationship would also be true longitudinally. Shortly after admission to treatment and 8 weeks later, 136 adults with clinical depression completed the Beck Depression Inventory, the Beck Hopelessness Scale, and the Religious Well-Being Scale (RWB). Logistic regression models supported an association of baseline RWB, but not baseline hopelessness, with a 50% reduction in symptoms after 8 weeks. Persons in the upper third of RWB at admission were 75% more likely to have a response to treatment than persons in the lower third. Clinicians need to be aware of the role of religion for their clients.

  13. Clinical issues in the treatment of anxiety and depression in older adults with Parkinson's disease.

    Science.gov (United States)

    Pachana, Nancy A; Egan, Sarah J; Laidlaw, Ken; Dissanayaka, Nadeeka; Byrne, Gerard J; Brockman, Simone; Marsh, Rodney; Starkstein, Sergio

    2013-12-01

    A significant proportion of persons affected by Parkinson's disease (PD) are over age 65 years. Mental health issues are often less a focus of treatment in this population than physical manifestations of the illness. Anxiety or depression alone, as well as comorbid depression and anxiety, are underrecognized in patients with PD and are associated with deleterious effects on physical and interpersonal functioning, negatively impacting quality of life and well-being. We offer a brief overview of salient clinical points with respect to assessment and treatment approaches to enhance efficacy of the treatment of mental health symptoms in older adults with PD. Cognitive behavior therapy involves the patient learning to overcome behavioral avoidance associated with anxiety and challenge unhelpful negative cognitions. It is suggested that cognitive behavior therapy is an effective approach to treatment of anxiety and depression in PD and should be offered as a treatment to patients. © 2013 Movement Disorder Society.

  14. Clinical impact of the temporal relationship between depression and type 2 diabetes: the Fremantle diabetes study phase II.

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    David G Bruce

    Full Text Available BACKGROUND: The clinical features of type 2 diabetes may differ depending on whether first depression episode precedes or follows the diagnosis of diabetes. METHODS: Type 2 patients from the observational community-based Fremantle Diabetes Study Phase II underwent assessment of lifetime depression using the Brief Lifetime Depression Scale (developed and validated for this study supplemented by information on current depression symptoms (Patient Health Questionnaire, 9-item version and use of antidepressants. Patients were categorized as never depressed (Group 1, having had depression before diabetes diagnosis (Group 2, diagnosed with depression and diabetes within 2 years of each other (Group 3 and having depression after diabetes diagnosis (Group 4. RESULTS: Of 1391 patients, 20.8% were assigned to Group 2, 6.0% to Group 3 and 14.5% to Group 4. In Group 2, depression occurred a median 15.6 years before diabetes onset at age 37.2±14.7 years. These patients had similar clinical characteristics to never depressed patients except for reduced self-care behaviours and having more symptomatic peripheral arterial disease. In Group 4, depression occurred a median 9.9 years after diabetes onset at age 59.8±13.0 years. These patients had long duration diabetes, poor glycaemic control, more intensive management and more diabetic complications. Group 4 patients had more current depression than Group 2 but were less likely to be receiving antidepressants. CONCLUSIONS/INTERPRETATION: The clinical features of depression and type 2 diabetes are heterogeneous depending on their temporal relationship. There may be corresponding differences in the pathogenesis of depression in diabetes that have implications for diagnosis and management.

  15. The Use and Effectiveness of Mobile Apps for Depression: Results From a Fully Remote Clinical Trial.

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    Arean, Patricia A; Hallgren, Kevin A; Jordan, Joshua T; Gazzaley, Adam; Atkins, David C; Heagerty, Patrick J; Anguera, Joaquin A

    2016-12-20

    Mobile apps for mental health have the potential to overcome access barriers to mental health care, but there is little information on whether patients use the interventions as intended and the impact they have on mental health outcomes. The objective of our study was to document and compare use patterns and clinical outcomes across the United States between 3 different self-guided mobile apps for depression. Participants were recruited through Web-based advertisements and social media and were randomly assigned to 1 of 3 mood apps. Treatment and assessment were conducted remotely on each participant's smartphone or tablet with minimal contact with study staff. We enrolled 626 English-speaking adults (≥18 years old) with mild to moderate depression as determined by a 9-item Patient Health Questionnaire (PHQ-9) score ≥5, or if their score on item 10 was ≥2. The apps were (1) Project: EVO, a cognitive training app theorized to mitigate depressive symptoms by improving cognitive control, (2) iPST, an app based on an evidence-based psychotherapy for depression, and (3) Health Tips, a treatment control. Outcomes were scores on the PHQ-9 and the Sheehan Disability Scale. Adherence to treatment was measured as number of times participants opened and used the apps as instructed. We randomly assigned 211 participants to iPST, 209 to Project: EVO, and 206 to Health Tips. Among the participants, 77.0% (482/626) had a PHQ-9 score >10 (moderately depressed). Among the participants using the 2 active apps, 57.9% (243/420) did not download their assigned intervention app but did not differ demographically from those who did. Differential treatment effects were present in participants with baseline PHQ-9 score >10, with the cognitive training and problem-solving apps resulting in greater effects on mood than the information control app (χ22=6.46, P=.04). Mobile apps for depression appear to have their greatest impact on people with more moderate levels of depression. In

  16. Interaction between anxiety, depression, quality of life and clinical parameters in chronic tension-type headache.

    Science.gov (United States)

    Peñacoba-Puente, Cecilia; Fernández-de-Las-Peñas, César; González-Gutierrez, Jose L; Miangolarra-Page, Juan C; Pareja, Juan A

    2008-10-01

    Our aim was to investigate the mediating or moderating role of anxiety and depression in the relationship between headache clinical parameters and quality of life in Chronic Tension-Type Headache (CTTH). Twenty-five patients diagnosed with CTTH according to the criteria of the International Headache Society were studied. A headache diary was kept for 4 weeks in order to substantiate the diagnosis and record the pain history. Quality of life was assessed by means of the Medical Outcome Study (MOS) 36-Item Short-Form (SF-36) questionnaire. The Beck Depression Inventory (BDI-II) was used to assess depression, and the Trait Anxiety Scale (TA) from the State-Trait Anxiety Inventory was administered in order to assess anxiety. Moderating and mediating analyses were conducted with ordinary least squares multiple regression analysis using the SPSS General Linear Model procedure. Anxiety mediated the effect between headache frequency and quality of life, but not the effect of either headache intensity or duration. Anxiety totally mediated the effects of headache frequency on vitality, social functioning and mental health. On the other hand, depression modulated the effect in the mental health domain. The effect in the mental health domain was a function of the interaction between headache duration and depression (beta=-0.34, p<0.05), after controlling for age, gender, the main effects of headache duration, and depression. We did not find anxiety to be a moderating factor between intensity, frequency or duration of headache and perceived quality of life. Anxiety exerts a mediating effect, conditioning the relationship between headache frequency and some quality of life domains; depression seems to play an inherent role in the reduced quality of life of these patients, that is, it has a moderating effect.

  17. Stress-related Clinical Pain and Mood in Women with Chronic Pain: Moderating Effects of Depression and Positive Mood Induction

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    Davis, Mary C.; Thummala, Kirti; Zautra, Alex J.

    2014-01-01

    Background Chronic pain with co-morbid depression is characterized by poor mood regulation and stress-related pain. Purpose Compare depressed and non-depressed pain patients in mood and pain stress reactivity and recovery, and test whether a post-stress positive mood induction moderates pain recovery. Methods Women with fibromyalgia and/or osteoarthritis (N=110) underwent interpersonal stress and were then randomly assigned by pain condition and depression status, assessed via the Center for Epidemiological Studies-Depression scale, to positive versus neutral mood induction. Results Depression did not predict stress-related reactivity in despondency, joviality, or clinical pain. However, depression X mood condition predicted recovery in joviality and clinical pain; depressed women recovered only in the positive mood condition, whereas non-depressed women recovered in both mood conditions. Conclusions Depression does not alter pain and mood stress reactivity, but does impair recovery. Boosting post-stress jovial mood ameliorates pain recovery deficits in depressed patients, a finding relevant to chronic pain interventions. PMID:24532393

  18. Depression

    DEFF Research Database (Denmark)

    Eriksen, Stine Aistrup

    2017-01-01

    Use of antidepressants is associated with an increased risk of fractures, and may be a result of both negative effects on the skeleton as well as increased risk of falling; however, the specific mechanisms are not yet known. Vitamin D play important roles for bone and muscle, and has previously...... shown positive effects in lowering the risk of osteoporosis and risk of falling. In addition, vitamin D may improve mental health, and deficiency of vitamin D is a common condition among patients suffering from depression. This thesis investigates bone and factors related to fall risk (including muscle...

  19. A Web-based clinical decision support system for depression care management.

    Science.gov (United States)

    Fortney, John C; Pyne, Jeffrey M; Steven, Christopher A; Williams, J Silas; Hedrick, Richard G; Lunsford, Amanda K; Raney, William N; Ackerman, Betty A; Ducker, Loretta O; Bonner, Laura M; Smith, Jeffrey L

    2010-11-01

    To inform the design of future informatics systems that support the chronic care model. We describe the development and functionality of a decision support system for the chronic care model of depression treatment, known as collaborative care. Dissemination of evidence-based collaborative care models has been slow, and fidelity to the evidence base has been poor during implementation initiatives. Implementation could be facilitated by a decision support system for depression care managers, the cornerstone of the collaborative care model. The Net Decision Support System (https://www.netdss.net/) is a free Web-based system that was developed to support depression care manager activities and to facilitate the dissemination of collaborative care models that maintain high fidelity to the evidence base. The NetDSS was based on intervention materials used for a randomized trial of depression care management that improved clinical outcomes compared with usual care. The NetDSS was developed jointly by a cross-functional design team of psychiatrists, depression care managers, information technology specialists, technical writers, and researchers. The NetDSS has the following functional capabilities: patient registry, patient encounter scheduler, trial management, clinical decision support, progress note generator, and workload and outcomes report generator. The NetDSS guides the care manager through a self-documenting patient encounter using evidence-based scripts and self-scoring instruments. The NetDSS has been used to provide evidence-based depression care management to more than 1700 primary care patients. Intervention protocols can be successfully converted to Web-based decision support systems that facilitate the implementation of evidence-based chronic care models into routine care with high fidelity.

  20. Agomelatine in the treatment of depressive disorders in clinical practice: multicenter observational CHRONOS study

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    Ivanov SV

    2014-04-01

    Full Text Available Stanislav V Ivanov, Marina A Samushiya Department of “Borderline” Mental Pathology and Psychosomatic Disorders, Mental Health Research Center of the Russian Academy of Medical Science, Moscow, Russian Federation Background: CHRONOS was a large naturalistic study designed to evaluate the effectiveness and safety of agomelatine in the management of patients with major depression in routine clinical practice. Methods: Patients (n=6,276 with a moderate or severe major depressive episode without psychotic symptoms were treated initially as outpatients (80.2% or in psychiatric facilities (19.8% in 54 regions of the Russian Federation. Patients received a flexible-dosing regimen of agomelatine 25 mg or 50 mg once daily for 8 weeks, with frequent study visits (weeks 1, 2, 3, 4, 6, and 8. Results: Patients (mean age 44 years, 72.6% female showed progressive improvement on the 17-item Hamilton Rating Scale for Depression (HAMD-17 total score from 22±6.9 at baseline to 4.7±4.7 at week 8 (P<0.0001. The proportion of responders (HAMD-17 decrease of ≥50% was 90.1% and the proportion of remitters (HAMD-17 <7 was 79.1% at week 8. All individual HAMD-17 item scores improved rapidly, and the change relative to baseline was significant (P<0.0001 at week 1 and at each subsequent visit in all cases. There were corresponding rapid improvements in Clinical Global Impression Severity and Improvement scores. In the subgroup of patients with more severe illness (HAMD-17 ≥21 at baseline; n=3,478, the proportions of responders and remitters were 92.4% and 72.8%, respectively, at week 8. Conclusion: Agomelatine was effective and well tolerated in a large sample of depressed patients in an observational treatment setting, and showed a rapid onset of benefit across all HAMD-17 items. Keywords: agomelatine, antidepressant, Hamilton Rating Scale for Depression, major depressive disorder, observational study

  1. Heterogeneity in comorbidity between major depressive disorder and generalized anxiety disorder and its clinical consequences.

    Science.gov (United States)

    Unick, George J; Snowden, Lonnie; Hastings, Julia

    2009-04-01

    Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are highly comorbid and, as diagnoses, problematic because they are heterogeneous, may impair functioning even in subclinical manifestations, and may not predict important external criteria as well as empirically-derived classifications. The present study employed a latent class analysis using data from National Comorbidity Survey (1990-1992) and focused on respondents who endorsed at least 1 screening question for MDD and 1 for GAD (N = 1009). Results revealed 4 symptom domains (somatic anxiety, somatic depression, psychological anxiety, and psychological depression) reflecting the heterogeneity of MDD and GAD, and 7 respondent classes. Analysis revealed that people in classes with a high prevalence of either somatic anxiety or somatic depression symptoms presented with the highest levels of disability, distress, and service utilization. Evidence also was found for clinically meaningful subthreshold comorbid conditions. Anxiety-related and depression-related symptoms can be meaningfully differentiated, but differentiating between somatic and psychological symptoms has the greatest practical significance.

  2. Season of birth, clinical manifestations and Dexamethasone Suppression Test in unipolar major depression

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    Kaprinis George S

    2007-08-01

    Full Text Available Abstract Background Reports in the literature suggest that the season of birth might constitute a risk factor for the development of a major psychiatric disorder, possibly because of the effect environmental factors have during the second trimester of gestation. The aim of the current paper was to study the possible relationship of the season of birth and current clinical symptoms in unipolar major depression. Methods The study sample included 45 DSM-IV major depressive patients and 90 matched controls. The SCAN v. 2.0, Hamilton Depression Rating Scale (HDRS and Hamilton Anxiety Scale (HAS were used to assess symptomatology, and the 1 mg Dexamethasone Suppression Test (DST was used to subcategorize patients. Results Depressed patients as a whole did not show differences in birth season from controls. However, those patients born during the spring manifested higher HDRS while those born during the summer manifested the lowest HAS scores. DST non-suppressors were almost exclusively (90% likely to be born during autumn and winter. No effect from the season of birth was found concerning the current severity of suicidal ideation or attempts. Discussion The current study is the first in this area of research using modern and rigid diagnostic methodology and a biological marker (DST to categorize patients. Its disadvantages are the lack of data concerning DST in controls and a relatively small size of patient sample. The results confirm the effect of seasonality of birth on patients suffering from specific types of depression.

  3. Shame, depressive symptoms and eating, weight and shape concerns in a non-clinical sample.

    Science.gov (United States)

    Gee, A; Troop, N A

    2003-03-01

    Shame has been shown to be related both to symptoms of depression and eating pathology. However, the independence of this relationship has not yet been established. The purpose of the present study was to determine whether the relationship between shame and eating disorder symptoms was independent of the relationships of these variables with depression. Seventy non-clinical female participants completed measures of eating disorder-related concerns using the Eating Disorder Examination-Questionnaire version (EDE-Q), depressive symptoms using the Beck Depression Inventory (BDI-II) and two measures of shame, the Other As Shamer Scale (QAS) and the Test of Self-Conscious Affect (TOSCA). Despite a strong association between BDI-II and EDE-Q scores and a moderate relationship between the shame measures, the two measures of shame showed some specificity in their relationships with symptom measures. The OAS was independently related to levels of BDI-II scores while the TOSCA was independently related to scores on the EDE-Q. There are a number of differences between the two measures of shame used in this study. The fact that each was differentially related to eating concerns and depressive symptoms may give clues as to which aspects of shame are important in each of the two types of pathology.

  4. Sick leave and depression - determining factors and clinical effect in outpatient care.

    Science.gov (United States)

    Bermejo, Isaac; Kriston, Levente; Schneider, Frank; Gaebel, Wolfgang; Hegerl, Ulrich; Berger, Mathias; Härter, Martin

    2010-12-30

    Sickness leave is a major source of societal costs in depression treatment. However, very little is known about the rationale behind sick leave and their effects on depressive symptoms. Aim of the paper is to evaluate the effect of sick leave on treatment outcome and the association of sick leave with patient, depression and treatment-related factors. For this we compared patients with sick leave and non-sick leave regarding symptom reduction following 6 weeks of treatment. A total of 118 patients of 41 physicians in a controlled clinical trial with a naturalistic prospective design were analysed. After 8 weeks of treatment no significant differences were found between patients who had or did not have sick leave, in terms of improvement of depressive symptoms. The analyses of physician, patient and illness-related variables regarding their predictive value showed no significant effect. No systematic effect of sick leave and no clear criteria were found that were related to receiving a sick leave certificate. It can be assumed that physicians do not only base the decision of whether to sign a depressive patient off sick on illness-specific factors. For a targeted implementation of sick leave as therapeutic measure predictors for effectiveness should be defined. Copyright © 2010 Elsevier Ltd. All rights reserved.

  5. Depression and anxiety in a case series of amyotrophic lateral sclerosis: frequency and association with clinical features.

    Science.gov (United States)

    Prado, Laura de Godoy Rousseff; Bicalho, Isabella Carolina Santos; Vidigal-Lopes, Mauro; Prado, Vitor de Godoy Rousseff; Gomez, Rodrigo Santiago; de Souza, Leonardo Cruz; Teixeira, Antônio Lúcio

    2017-01-01

    To investigate the frequency of anxiety and depression and their association with clinical features of amyotrophic lateral sclerosis. This is a cross-sectional and descriptive study including a consecutive series of patients with sporadic amyotrophic lateral sclerosis according to Awaji's criteria. Patients underwent clinical and psychiatric assessment (anxiety and depression symptoms). We included 76 patients. The men/women ratio was 1.6:1. Participants' mean age at disease onset was 55 years (SD±12.1). Sixty-six patients (86.8%) were able to complete psychiatric evaluation. Clinically significant anxiety was found in 23 patients (34.8%) while clinically significant depression was found in 24 patients (36.4%). When we compared patients with and without depression a significant difference was seen only in the frequency of anxiety symptoms (pescala funcional. Foi encontrada correlação positiva entre os sintomas de ansiedade e depressão (pescala funcional.

  6. The criterion validity of the web-based Major Depression Inventory when used on clinical suspicion of depression in primary care

    Directory of Open Access Journals (Sweden)

    Nielsen MG

    2017-07-01

    Full Text Available Marie Germund Nielsen,1 Eva Ørnbøl,2 Per Bech,3 Mogens Vestergaard,1,4 Kaj Sparle Christensen1 1Research Unit for General Practice, Department of Public Health, Aarhus University, 2Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, 3Psychiatric Research Unit, Psychiatric Centre North Zealand, University Hospital of Copenhagen, Hillerød, 4Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark Background: The Major Depression Inventory (MDI is widely used in Danish general practice as a screening tool to assess depression in symptomatic patients. Nevertheless, no validation studies of the MDI have been performed. The aim of this study was to validate the web-based version of the MDI against a fully structured telephone interview in a population selected on clinical suspicion of depression (ie, presence of two or three core symptoms of depression in general practice.Materials and methods: General practitioners (GPs invited consecutive persons suspected of depression to complete the web-based MDI in a primary care setting. The validation was based on the Munich-Composite International Diagnostic Interview (M-CIDI by phone. GPs in the 22 practices in our study included 132 persons suspected of depression. Depression was rated as yes/no according to the MDI and M-CIDI. Sensitivity, specificity, and positive predictive value of the International Classification of Diseases, Tenth Revision (ICD-10 algorithms of the MDI were examined.Results: According to the M-CIDI interview, 87.9% of the included population was depressed and 64.4% was severely depressed. According to the MDI scale, 59.1% of the population was depressed and 31.8% was severely depressed. The sensitivity of the MDI for depression was 62.1% (95% confidence interval [95% CI]: 52.6–70.9 and the specificity was 62.5% (95% CI: 35.4–84.8. The sensitivity for severe depression was 42.2% (95% CI

  7. Effects of hyperthermic baths on depression, sleep and heart rate variability in patients with depressive disorder: a randomized clinical pilot trial.

    Science.gov (United States)

    Naumann, Johannes; Grebe, Julian; Kaifel, Sonja; Weinert, Tomas; Sadaghiani, Catharina; Huber, Roman

    2017-03-28

    Despite advances in the treatment of depression, one-third of depressed patients fail to respond to conventional antidepressant medication. There is a need for more effective treatments with fewer side effects. The primary aim of this study was to determine whether hyperthermic baths reduce depressive symptoms in adults with depressive disorder. Randomized, two-arm placebo-controlled, 8-week pilot trial. Medically stable outpatients with confirmed depressive disorder (ICD-10: F32/F33) who were moderately depressed as determined by the 17-item Hamilton Scale for Depression (HAM-D) score ≥18 were randomly assigned to 2 hyperthermic baths (40 °C) per week for 4 weeks or a sham intervention with green light and follow-up after 4 weeks. Main outcome measure was the change in HAM-D total score from baseline (T0) to the 2-week time point (T1). A total of 36 patients were randomized (hyperthermic baths, n = 17; sham condition, n = 19). The intention-to-treat analysis showed a significant (P = .037) difference in the change in HAM-D total score with 3.14 points after 4 interventions (T1) in favour of the hyperthermic bath group compared to the placebo group. This pilot study suggests that hyperthermic baths do have generalized efficacy in depressed patients. DRKS00004803 at drks-neu.uniklinik-freiburg.de, German Clinical Trials Register (registration date 2016-02-02), retrospectively registered.

  8. Anxiety and depression among Nigerian patients with asthma; Association with sociodemographic, clinical, and personality factors.

    Science.gov (United States)

    Adewuya, Abiodun O; Adeyeye, Olufunke O

    2017-04-01

    To estimate the rate of anxiety and depression in adult asthma patients and examine the possible association with sociodemographic, clinical and other significant variables. Adult asthmatics (n = 203) were recruited from the asthma outpatient clinic and assessed for sociodemographic and clinical profiles, their levels of disability, social support, asthma treatment stigma and personality traits. The Mini International Neuropsychiatric Interview (M.I.N.I) was used to assess for the diagnosis of Anxiety and Depression in comparison with matched healthy controls (n = 205). Seventy (34.5%) of the patients with asthma have a diagnosis of Anxiety or Depression compared with 15 (7.3%) of matched healthy controls and the difference was significant (OR 6.67, 95% CI 3.58-13.04). Although older age, lower income, use of oral corticosteroid, patients perceived severity of asthma, disability, social support and personality traits were initially significant in univariate analysis, a subsequent logistic regression analysis revealed that only disability scores above the group mean (OR 4.50, 95% CI 2.28-8.87) and not having a strong social support (OR 2.88, 95% CI 1.443-5.78) were the only variables independently associated with diagnosis of Anxiety and Depression in the group of patients with asthma. Anxiety and depression are significantly more common in adult outpatients with asthma when compared with healthy control in Nigeria and was significantly associated with levels of disability and social support. These factors should be considered while formulating predictive models for management of psychosocial problems in asthma in this environment.

  9. Clinical preference for factors in treatment of geriatric depression

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    Riepe MW

    2014-12-01

    Full Text Available Matthias W Riepe Mental Health and Geriatric Psychiatry, Psychiatry II, Ulm University, Ulm, Germany Abstract: Little is known about symptom preferences of clinical psychiatrists in the treatment of geriatric depression and preferences for avoiding adverse drug effects. Participants (board-certified psychiatrists were recruited prior to a lecture on geriatric depression during a continuing education program. An analytic hierarchy process was performed and participants were asked for pairwise comparison of criteria guiding them in appraising therapeutic efficacy, and in avoiding toxicity and adverse events. Of the 61 participants from the continuing education program, 42 (69% returned their data sheet. Avoidance of cardiotoxicity was regarded as more important than avoidance of hepatotoxicity or hematotoxicity. Concerning adverse events, highest preference was given to avoidance of falls and drug interactions, followed by avoidance of sedation, weight change, and impairment of sexual function. The most important preferences for appraisal of therapeutic efficacy were suicidality over ability to concentrate and sleep. Clinical psychiatrists have a hierarchy of preferences for treatment goals and avoidance of adverse events and toxicity. This raises the question for future research whether these preferences cause differences in prescription patterns in clinical practice even though a multitude of antidepressants are similarly effective when judged with instruments used in clinical trials. Keywords: depressive disorder, symptoms, analytic hierarchy process, toxicity, adverse events, symptoms

  10. The improved Clinical Global Impression Scale (iCGI: development and validation in depression

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    Kadouri Alane

    2007-02-01

    Full Text Available Abstract Background The Clinical Global Impression scale (CGI is frequently used in medical care and clinical research because of its face validity and practicability. This study proposes to improve the reliability of the Clinical Global Impression (CGI scale in depressive disorders by the use of a semi-standardized interview, a new response format, and a Delphi procedure. Methods Thirty patients hospitalised for a major depressive episode were filmed at T1 (first week in hospital and at T2 (2 weeks later during a 5' specific interview. The Hamilton Depressive Rating Scale and the Symptom Check List were also rated. Eleven psychiatrists rated these videos using either the usual CGI response format or an improved response format, with or without a Delphi procedure. Results The new response format slightly improved (but not significantly the interrater agreement, the Delphi procedure did not. The best results were obtained when ratings by 4 independent raters were averaged. In this situation, intraclass correlation coefficients were about 0.9. Conclusion The Clinical Global Impression is a useful approach in psychiatry since it apprehends patients in their entirety. This study shows that it is possible to quantify such impressions with a high level of interrater agreement.

  11. The impact of educational status on the clinical features of major depressive disorder among Chinese women.

    Science.gov (United States)

    Gan, Zhaoyu; Li, Yihan; Xie, Dong; Shao, Chunhong; Yang, Fuzhong; Shen, Yuan; Zhang, Ning; Zhang, Guanghua; Tian, Tian; Yin, Aihua; Chen, Ce; Liu, Jun; Tang, Chunling; Zhang, Zhuoqiu; Liu, Jia; Sang, Wenhua; Wang, Xumei; Liu, Tiebang; Wei, Qinling; Xu, Yong; Sun, Ling; Wang, Sisi; Li, Chang; Hu, Chunmei; Cui, Yanping; Liu, Ying; Li, Ying; Zhao, Xiaochuan; Zhang, Lan; Sun, Lixin; Chen, Yunchun; Zhang, Yueying; Ning, Yuping; Shi, Shenxun; Chen, Yiping; Kendler, Kenneth S; Flint, Jonathan; Zhang, Jinbei

    2012-02-01

    Years of education are inversely related to the prevalence of major depressive disorder (MDD), but the relationship between the clinical features of MDD and educational status is poorly understood. We investigated this in 1970 Chinese women with recurrent MDD identified in a clinical setting. Clinical and demographic features were obtained from 1970 Han Chinese women with DSM-IV major depression between 30 and 60 years of age across China. Analysis of linear, logistic and multiple logistic regression models were used to determine the association between educational level and clinical features of MDD. Subjects with more years of education are more likely to have MDD, with an odds ratio of 1.14 for those with more than ten years. Low educational status is not associated with an increase in the number of episodes, nor with increased rates of co-morbidity with anxiety disorders. Education impacts differentially on the symptoms of depression: lower educational attainment is associated with more biological symptoms and increased suicidal ideation and plans to commit suicide. Findings may not generalize to males or to other patient populations. Since the threshold for treatment seeking differs as a function of education there may an ascertainment bias in the sample. The relationship between symptoms of MDD and educational status in Chinese women is unexpectedly complex. Our findings are inconsistent with the simple hypothesis from European and US reports that low levels of educational attainment increase the risk and severity of MDD. Copyright © 2011 Elsevier B.V. All rights reserved.

  12. Implementation of depression screening in antenatal clinics through tablet computers: results of a feasibility study.

    Science.gov (United States)

    Marcano-Belisario, José S; Gupta, Ajay K; O'Donoghue, John; Ramchandani, Paul; Morrison, Cecily; Car, Josip

    2017-05-10

    Mobile devices may facilitate depression screening in the waiting area of antenatal clinics. This can present implementation challenges, of which we focused on survey layout and technology deployment. We assessed the feasibility of using tablet computers to administer a socio-demographic survey, the Whooley questions and the Edinburgh Postnatal Depression Scale (EPDS) to 530 pregnant women attending National Health Service (NHS) antenatal clinics across England. We randomised participants to one of two layout versions of these surveys: (i) a scrolling layout where each survey was presented on a single screen; or (ii) a paging layout where only one question appeared on the screen at any given time. Overall, 85.10% of eligible pregnant women agreed to take part. Of these, 90.95% completed the study procedures. Approximately 23% of participants answered Yes to at least one Whooley question, and approximately 13% of them scored 10 points of more on the EPDS. We observed no association between survey layout and the responses given to the Whooley questions, the median EPDS scores, the number of participants at increased risk of self-harm, and the number of participants asking for technical assistance. However, we observed a difference in the number of participants at each EPDS scoring interval (p = 0.008), which provide an indication of a woman's risk of depression. A scrolling layout resulted in faster completion times (median = 4 min 46 s) than a paging layout (median = 5 min 33 s) (p = 0.024). However, the clinical significance of this difference (47.5 s) is yet to be determined. Tablet computers can be used for depression screening in the waiting area of antenatal clinics. This requires the careful consideration of clinical workflows, and technology-related issues such as connectivity and security. An association between survey layout and EPDS scoring intervals needs to be explored further to determine if it corresponds to a survey layout effect

  13. The effect of exercise in clinically depressed adults: systematic review and meta-analysis of randomized controlled trials

    DEFF Research Database (Denmark)

    Krogh, Jesper; Nordentoft, Merete; Sterne, Jonathan A C

    2011-01-01

    these, the estimated beneficial effect of exercise was more modest (SMD, -0.19; 95% CI, -0.70 to 0.31) than the pooled result for all 13 studies, with no strong evidence of benefit. CONCLUSIONS: Our results suggest a short-term effect of exercise on depression: on average, depression scores 0......OBJECTIVE: To assess the effectiveness of exercise in adults with clinical depression. DATA SOURCES: The databases CINAHL, Embase, Cochrane Database of Systematic reviews, Cochrane Controlled Trials Register, MEDLINE, and PsycINFO were searched (1806-2008) using medical subject headings (Me......SH) and text word terms depression, depressive disorder and exercise, aerobic, non-aerobic, physical activity, physical fitness, walk*, jog*, run*, bicycling, swim*, strength, and resistance. STUDY SELECTION: Randomized trials including adults with clinical depression according to any diagnostic system were...

  14. MACI personality scale profiles of depressed adolescent suicide attempters: a pilot study. Million Adolescent Clinical Inventory.

    Science.gov (United States)

    Velting, D M; Rathus, J H; Miller, A L

    2000-10-01

    Employing the Millon Adolescent Clinical Inventory (MACI), we examined differences in the maladaptive personality style profiles of clinically referred, depressed adolescents presenting with (n = 26) and without (n = 23) a history of previous suicide attempts. Relative to the comparison group, adolescent attempters experienced more severe overall levels of personality dysfunction. At the trait level, attempters obtained higher scores on the forceful and borderline tendency scales and lower scores on the submissive and conforming scales of the MACI, reflecting negative mood regulation deficits (e.g., anger control problems) and persistently high levels of aggressive impulsivity. These preliminary findings suggest that MACI personality scales may be useful in discriminating adolescents with and without previous suicidal behavior, especially among depressed outpatient samples.

  15. The Clinical Interview for Depression: A Comprehensive Review of Studies and Clinimetric Properties

    DEFF Research Database (Denmark)

    Guidi, Jenny; Fava, Giovanni A; Bech, Per

    2011-01-01

    , including descriptive studies, classification by means of factor analysis and cluster analysis, and predictor variables of response to treatment or relapse. The CID has also been used as an outcome measure in several controlled clinical trials and follow-up studies of pharmacotherapy and psychotherapy...... of affective disorders. It has been shown to be valid and reliable, to discriminate depressives from controls, or different subgroups of depressed patients, and to reflect changes during the course of treatment, particularly when individual symptoms are considered. Conclusions: Evidence from these studies...... highlights the utility of the CID in clinical research and practice. Its clinimetric characteristics, particularly the broad evaluation of affective symptomatology and the sensitivity to change, make it an instrument of choice in therapeutic trials....

  16. Efficacy of a Maternal Depression Prevention Strategy in Head Start: A Randomized Clinical Trial.

    Science.gov (United States)

    Silverstein, Michael; Diaz-Linhart, Yaminette; Cabral, Howard; Beardslee, William; Hegel, Mark; Haile, Winta; Sander, Jenna; Patts, Gregory; Feinberg, Emily

    2017-08-01

    Low-income and minority mothers experience a disproportionate incidence of depression and lack access to treatment services. Development of prevention strategies in accessible community-based venues is a potentially important public health strategy. To determine the efficacy of a depression prevention strategy embedded in Head Start. This randomized clinical trial was performed from February 15, 2011, through May 9, 2016, at 6 Head Start agencies serving families at or below the federal poverty level. Participants included mothers with depressed mood, anhedonia, or depression history but who were not in a current major depressive episode. Participants were followed up for 12 months with masked outcome assessments. Final follow-up was completed on May 9, 2016. Participants were randomized to a problem-solving education (PSE) intervention (n = 111) or usual Head Start services (n = 119). Primary outcomes were problem-solving skills and depressive symptoms. To capture the chronicity and intensity of symptoms, the Quick Inventory of Depressive Symptoms was administered bimonthly, and rates of clinically significant symptom elevations were compared across groups. Secondarily, the presence of a major depressive episode was assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders. Among the 230 participants, 152 (66.1%) were Hispanic, with a mean (SD) age of 31.4 (7.3) years. An intention-to-treat analysis among 223 participants contributing follow-up data found no differences in problem-solving skills across groups. The mean (SD) number of depressive symptom elevations among the PSE participants was 0.84 (1.39) compared with 1.12 (1.47) among the usual service participants (adjusted incident rate ratio [aIRR], 0.60; 95% CI, 0.41-0.90). In analyses stratified according to baseline depressive symptoms, PSE exerted a preventive effect among those with lower-level baseline symptoms, with a mean (SD) of 0.39 (0.84) elevations among PSE participants

  17. Donepezil treatment of older adults with cognitive impairment and depression (DOTCODE study): clinical rationale and design.

    Science.gov (United States)

    Pelton, Gregory H; Andrews, Howard; Roose, Steven P; Marcus, Sue M; D'Antonio, Kristina; Husn, Hala; Petrella, Jeffrey R; Zannas, Anthony S; Doraiswamy, P Murali; Devanand, D P

    2014-03-01

    Treatment strategies for patients with depression and cognitive impairment (DEP-CI), who are at high risk to develop a clinical diagnosis of dementia, are not established. This issue is addressed in the donepezil treatment of cognitive impairment and depression (DOTCODE) pilot clinical trial. The DOTCODE study is the first long-term treatment trial that assesses differences in conversion to dementia and cognitive change in DEP-CI patients using a study design of open antidepressant medication plus add-on randomized, double-blind, placebo-controlled treatment with the acetylcholinesterase inhibitor donepezil. In Phase 1, DEP-CI patients receive optimized antidepressant treatment for 16 weeks. In Phase 2, antidepressant treatment is continued with the addition of randomized, double-blind treatment with donepezil or placebo. The total study duration for each patient is 78 weeks (18 months). Eighty DEP-CI outpatients (age 55 to 95 years) are recruited: 40 at New York State Psychiatric Institute/Columbia University and 40 at Duke University Medical Center. The primary outcome is conversion to a clinical diagnosis of dementia. The secondary outcomes are cognitive change scores in Selective Reminding Test (SRT) total recall and the modified Alzheimer's Disease Assessment Scale (ADAS-cog). Other key assessments include the 24-item Hamilton Depression Rating Scale and antidepressant response; Clinical Global Impression (CGI) for depression, cognition, and global status; neuropsychological test battery for diagnosis; informant report of functional abilities (Pfeffer FAQ); and Treatment Emergent Symptom Scale (TESS) for somatic side effects. Apolipoprotein E ε4 status, odor identification deficits, and MRI entorhinal/hippocampal cortex atrophy at baseline are evaluated as neurobiological moderators of donepezil treatment effects. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Pathophysiology of major depressive disorder: mechanisms involved in etiology are not associated with clinical progression

    OpenAIRE

    Verduijn, J; Milaneschi, Y; Schoevers, R A; van Hemert, A M; Beekman, A T F; Penninx, B W J H

    2015-01-01

    Meta-analyses support the involvement of different pathophysiological mechanisms (inflammation, hypothalamic-pituitary (HPA)-axis, neurotrophic growth and vitamin D) in major depressive disorder (MDD). However, it remains unknown whether dysregulations in these mechanisms are more pronounced when MDD progresses toward multiple episodes and/or chronicity. We hypothesized that four central pathophysiological mechanisms of MDD are not only involved in etiology, but also associated with clinical ...

  19. The Strategy of Combining Antidepressants in the Treatment of Major Depression: Clinical Experience in Spanish Outpatients

    OpenAIRE

    Luis M. Martín-López; Jose E. Rojo; Karina Gibert; Juan Carlos Martín; Lyli Sperry; Lurdes Duñó; Antonio Bulbena; Julio Vallejo

    2011-01-01

    Introduction. The combination of antidepressants is a useful tool in the treatment of major depression, especially in cases where there is a partial response to antidepressant monotherapy. However, the use of this strategy is a matter of controversy, and its frequency of use in clinical practice is not clear. The aim of our study is to assess the use of antidepressants combination in Spain by reviewing three databases used between 1997 and 2001. Methods. Databases pertain to patien...

  20. The Strategy of Combining Antidepressants in the Treatment of Major Depression: Clinical Experience in Spanish Outpatients

    Directory of Open Access Journals (Sweden)

    Luis M. Martín-López

    2011-01-01

    The most frequent combinations are SSRIs and tricyclic antidepressants. The active principle most widely combined is fluoxetine. Conclusions. The prevalence of use of antidepressant combination therapy is 2.2% of the global sample and 8.3% of treated patients. Other than duration of the depressive episode, no clinical characteristics exclusive to patients who received combination rather than monotherapy were found. Our study found that the most frequent combination is SSRIs + TCAs, also being the most studied.

  1. Prevalence of clinical anxiety, clinical depression and associated risk factors in chinese young and middle-aged patients with osteonecrosis of the femoral head.

    Directory of Open Access Journals (Sweden)

    Sheng-Bao Chen

    Full Text Available To investigate the prevalence of clinical anxiety and clinical depression in Chinese young and mid-aged patients with osteonecrosis of the femoral head (ONFH and to analyze their potential risk factors.Two hundred and sixteen Chinese patients with ONFH were consecutively enrolled in this cross-sectional study from January 2010 to December 2010. The Zung self-rating anxiety scale (SAS and the Zung self-rating depression scale (SDS were used to assess the prevalence of clinical anxiety and clinical depression. An additional questionnaire containing seventeen items of potential risk factors was completed by all patients. Binary logistic regression analysis was employed to reveal potential risk factors of anxiety and depression.The prevalence of clinical anxiety and clinical depression was 20.4% and 21.8% in Chinese young and middle-aged patients with ONFH, respectively. Binary regression analysis showed that independent risk factors correlated with high incidence of clinical anxiety included involved femoral head (OR = 3.168, 95% CI: 1.496 - 6.708 and stages of ONFH (ORIV-V / II = 5.383, 95% CI: 1.664-17.416. Independent risk factors correlated with high incidence of depression included gender (OR = 2.853, 95% CI: 1.467-5.778, comorbid diseases (OR = 4.243, 95% CI: 1.940-9.278 and stages of the disease (OR IV-V/II = 16.963, 95% CI: 4.404-65.331.Patients with bilateral ONFH are inclined to have clinical anxiety, while female patients and patients with comorbid diseases might tend to get clinical depression. Advanced stages of ONFH are independent risk factors for both clinical anxiety and clinical depression.

  2. Poor social support as a risk factor for antenatal depressive symptoms among women attending public antennal clinics in Penang, Malaysia.

    Science.gov (United States)

    Rashid, Abdul; Mohd, Rokiah

    2017-11-02

    Depression, a type of mental disorder which is portrayed by marked alterations in mood, is associated with distress and/or impaired functioning. Poor social support is an important risk factor for depression in pregnancy. An extensive literature search failed to show any published study conducted in Malaysia on antenatal depressive symptoms and the risk of poor social support on it. The aim of the study was to determine the risk of antenatal depressive symptoms due to poor social support. This cross sectional study was conducted among 3000 pregnant women attending antenatal clinics in Penang, Malaysia. Edinburgh Postnatal Depression Scale (EPDS) was used to screen for antenatal depressive symptoms and the Oslo-3 Social Support Scale (OSS-3) was used to measure social support. Odds ratio and adjusted odds ratio were used to quantify the risk of antenatal depressive symptoms due to poor social support. The prevalence of depressive symptoms was 20%. Using OSS-3 scale to gauge social support, most of the participants had moderate support (61.3%) followed by poor support (22%) and strong support (16.7%). Social support was found to be significantly associated with depressive symptoms in this study (OR 2.2, aOR 2.1, AR 45%). Considering that an expecting mother's psychological factors are important in the wellbeing of the mother and child, antenatal depression must be quickly identified. Screening pregnant women for social support can help identify women with higher risk of depression.

  3. Emotional Demands at Work and the Risk of Clinical Depression: A Longitudinal Study in the Danish Public Sector.

    Science.gov (United States)

    Vammen, Marianne Agergaard; Mikkelsen, Sigurd; Hansen, Åse Marie; Bonde, Jens Peter; Grynderup, Matias B; Kolstad, Henrik; Kærlev, Linda; Mors, Ole; Rugulies, Reiner; Thomsen, Jane Frlund

    2016-10-01

    This study is a 2-year follow-up study of different dimensions of work-related emotional demands as a predictor for clinical depression. In a two-wave study, 3224 (72%) public employees from 474 work-units participated twice by filling in questionnaires. Sixty-two cases of clinical depression were diagnosed. Emotional demands were examined as perceived and content-related emotional demands, individually reported and work-unit based. Support, meaningful work, and enrichment were considered as potential effect modifiers. Individually reported perceived emotional demands predicted depression (odds ratio: 1.40; 95% confidence intervals: 1.02 to 1.92). The work-unit based odds ratio was in the same direction, though not significant. Content-related emotional demands did not predict depression. Support, meaningful work, and enrichment did not modify the results. The personal perception of emotional demands was a risk factor for clinical depression but specific emotionally demanding work tasks were not.

  4. Development and impact of computerised decision support systems for clinical management of depression: A systematic review.

    Science.gov (United States)

    Triñanes, Yolanda; Atienza, Gerardo; Louro-González, Arturo; de-las-Heras-Liñero, Elena; Alvarez-Ariza, María; Palao, Diego J

    2015-01-01

    One of the proposals for improving clinical practice is to introduce computerised decision support systems (CDSS) and integrate these with electronic medical records. Accordingly, this study sought to systematically review evidence on the effectiveness of CDSS in the management of depression. A search was performed in Medline, EMBASE and PsycInfo, in order to do this. The quality of quantitative studies was assessed using the SIGN method, and qualitative studies using the CASPe checklist. Seven studies were identified (3 randomised clinical trials, 3 non-randomised trials, and one qualitative study). The CDSS assessed incorporated content drawn from guidelines and other evidence-based products. In general, the CDSS had a positive impact on different aspects, such as the screening and diagnosis, treatment, improvement in depressive symptoms and quality of life, and referral of patients. The use of CDSS could thus serve to optimise care of depression in various scenarios by providing recommendations based on the best evidence available and facilitating decision-making in clinical practice. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

  5. Hippocampal volume in relation to clinical and cognitive outcome after electroconvulsive therapy in depression.

    Science.gov (United States)

    Nordanskog, P; Larsson, M R; Larsson, E-M; Johanson, A

    2014-04-01

    In a previous magnetic resonance imaging (MRI) study, we found a significant increase in hippocampal volume immediately after electroconvulsive therapy (ECT) in patients with depression. The aim of this study was to evaluate hippocampal volume up to 1 year after ECT and investigate its possible relation to clinical and cognitive outcome. Clinical and cognitive outcome in 12 in-patients with depression receiving antidepressive pharmacological treatment referred for ECT were investigated with the Montgomery-Asberg Depression Rating Scale (MADRS) and a broad neuropsychological test battery within 1 week before and after ECT. The assessments were repeated 6 and 12 months after baseline in 10 and seven of these patients, respectively. Hippocampal volumes were measured on all four occasions with 3 Tesla MRI. Hippocampal volume returned to baseline during the follow-up period of 6 months. Neither the significant antidepressant effect nor the significant transient decrease in executive and verbal episodic memory tests after ECT could be related to changes in hippocampal volume. No persistent cognitive side effects were observed 1 year after ECT. The immediate increase in hippocampal volume after ECT is reversible and is not related to clinical or cognitive outcome. © 2013 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.

  6. Body elimination attitude family resemblance in Kuwait.

    Science.gov (United States)

    Al-Fayez, Ghenaim; Awadalla, Abdelwahid; Arikawa, Hiroko; Templer, Donald I; Hutton, Shane

    2009-12-01

    The purpose of the present study was to determine the family resemblance of attitude toward body elimination in Kuwaiti participants. This study was conceptualized in the context of the theories of moral development, importance of cleanliness in the Muslim religion, cross-cultural differences in personal hygiene practices, previous research reporting an association between family attitudes and body elimination attitude, and health implications. The 24-item Likert-type format Body Elimination Attitude Scale-Revised was administered to 277 Kuwaiti high school students and 437 of their parents. Females scored higher, indicating greater disgust, than the males. Moreover, sons' body elimination attitude correlated more strongly with fathers' attitude (r = .85) than with that of the mothers (r = .64). Daughters' attitude was similarly associated with the fathers' (r = .89) and the mothers' attitude (r = .86). The high correlations were discussed within the context of Kuwait having a collectivistic culture with authoritarian parenting style. The higher adolescent correlations, and in particular the boys' correlation with fathers than with mothers, was explained in terms of the more dominant role of the Muslim father in the family. Public health and future research implications were suggested. A theoretical formulation was advanced in which "ideal" body elimination attitude is relative rather than absolute, and is a function of one's life circumstances, one's occupation, one's culture and subculture, and the society that one lives in.

  7. A clinical prediction rule for detecting major depressive disorder in primary care : the PREDICT-NL study

    NARCIS (Netherlands)

    Zuithoff, Nicolaas P A; Vergouwe, Yvonne; King, Michael; Nazareth, Irwin; Hak, Eelko; Moons, Karel G M; Geerlings, Mirjam I

    BACKGROUND: Major depressive disorder often remains unrecognized in primary care. OBJECTIVE: Development of a clinical prediction rule using easily obtainable predictors for major depressive disorder in primary care patients. METHODS: A total of 1046 subjects, aged 18-65 years, were included from

  8. Indicators of Anxiety and Depression in Women with the Fragile X Premutation: Assessment of a Clinical Sample

    Science.gov (United States)

    Lachiewicz, A.; Dawson, D.; Spiridigliozzi, G.; Cuccaro, M.; Lachiewicz, M.; McConkie-Rosell, A.

    2010-01-01

    Background: Current research suggests that depression and anxiety may be common problems in women with the fragile X (FMR1) premutation. Methods: To learn more about this in a clinical setting, we asked 33 women with the FMR1 premutation and 20 women without the FMR1 premutation to complete the Brief Carroll Depression Scale (Brief CDS) and the…

  9. Role of magnesium supplementation in the treatment of depression: A randomized clinical trial.

    Directory of Open Access Journals (Sweden)

    Emily K Tarleton

    Full Text Available Current treatment options for depression are limited by efficacy, cost, availability, side effects, and acceptability to patients. Several studies have looked at the association between magnesium and depression, yet its role in symptom management is unclear. The objective of this trial was to test whether supplementation with over-the-counter magnesium chloride improves symptoms of depression. An open-label, blocked, randomized, cross-over trial was carried out in outpatient primary care clinics on 126 adults (mean age 52; 38% male diagnosed with and currently experiencing mild-to-moderate symptoms with Patient Health Questionnaire-9 (PHQ-9 scores of 5-19. The intervention was 6 weeks of active treatment (248 mg of elemental magnesium per day compared to 6 weeks of control (no treatment. Assessments of depression symptoms were completed at bi-weekly phone calls. The primary outcome was the net difference in the change in depression symptoms from baseline to the end of each treatment period. Secondary outcomes included changes in anxiety symptoms as well as adherence to the supplement regimen, appearance of adverse effects, and intention to use magnesium supplements in the future. Between June 2015 and May 2016, 112 participants provided analyzable data. Consumption of magnesium chloride for 6 weeks resulted in a clinically significant net improvement in PHQ-9 scores of -6.0 points (CI -7.9, -4.2; P<0.001 and net improvement in Generalized Anxiety Disorders-7 scores of -4.5 points (CI -6.6, -2.4; P<0.001. Average adherence was 83% by pill count. The supplements were well tolerated and 61% of participants reported they would use magnesium in the future. Similar effects were observed regardless of age, gender, baseline severity of depression, baseline magnesium level, or use of antidepressant treatments. Effects were observed within two weeks. Magnesium is effective for mild-to-moderate depression in adults. It works quickly and is well tolerated

  10. Low vision depression prevention trial in age-related macular degeneration: a randomized clinical trial.

    Science.gov (United States)

    Rovner, Barry W; Casten, Robin J; Hegel, Mark T; Massof, Robert W; Leiby, Benjamin E; Ho, Allen C; Tasman, William S

    2014-11-01

    To compare the efficacy of behavior activation (BA) + low vision rehabilitation (LVR) with supportive therapy (ST) + LVR to prevent depressive disorders in patients with age-related macular degeneration (AMD). Single-masked, attention-controlled, randomized, clinical trial with outcome assessment at 4 months. Patients with AMD and subsyndromal depressive symptoms attending retina practices (n = 188). Before randomization, all subjects had 2 outpatient LVR visits, and were then randomized to in-home BA+LVR or ST+LVR. Behavior activation is a structured behavioral treatment that aims to increase adaptive behaviors and achieve valued goals. Supportive therapy is a nondirective, psychological treatment that provides emotional support and controls for attention. The Diagnostic and Statistical Manual IV defined depressive disorder based on the Patient Health Questionnaire-9 (primary outcome), Activities Inventory, National Eye Institute Vision Function Questionnaire-25 plus Supplement (NEI-VFQ), and NEI-VFQ quality of life (secondary outcomes). At 4 months, 11 BA+LVR subjects (12.6%) and 18 ST+LVR subjects (23.4%) developed a depressive disorder (relative risk [RR], 0.54; 95% CI, 0.27-1.06; P = 0.067). In planned adjusted analyses the RR was 0.51 (95% CI, 0.27-0.98; P = 0.04). A mediational analysis suggested that BA+LVR prevented depression to the extent that it enabled subjects to remain socially engaged. In addition, BA+LVR was associated with greater improvements in functional vision than ST+LVR, although there was no significant between-group difference. There was no significant change or between-group difference in quality of life. An integrated mental health and low vision intervention halved the incidence of depressive disorders relative to standard outpatient LVR in patients with AMD. As the population ages, the number of persons with AMD and the adverse effects of comorbid depression will increase. Promoting interactions between ophthalmology, optometry

  11. Effect of anti-inflammatory treatment on depression, depressive symptoms and side effects: A systematic review and meta-analysis of randomized clinical trials

    DEFF Research Database (Denmark)

    Köhler, Karl Ole

    2014-01-01

    of pharmacological anti-inflammatory treatment in adults with depressive symptoms including adults who fulfill criteria for depression. Data Extraction and Synthesis: Data were extracted by two independent reviewers. Pooled standard mean difference (SMD) and Odds Ratios (OR) were calculated. Main Outcome Measures...... depressive symptoms (SMD=-0.34; 95%-CI: -0.57 to -0.11; I2=90%) compared to placebo. This effect was observed both in studies including patients with depression (SMD=-0.54; 95%-CI: -1.08 to -0.01; I2=68%) and depressive symptoms (SMD=-0.27; 95%-CI: -0.53 to -0.01; I2=93%). The heterogeneity of the studies...... was not explained by differences in inclusion of clinical depression versus depressive symptoms or NSAIDs versus cytokine inhibitors. Sub-analyses particularly emphasized antidepressant properties for the selective COX-2 inhibitor celecoxib in general (SMD=-0.29; 95%-CI: -0.49 to -0.08; I2=73%), on remission (OR=7...

  12. Long-term potentiation and long-term depression: a clinical perspective

    Directory of Open Access Journals (Sweden)

    Timothy V.P. Bliss

    2011-01-01

    Full Text Available Long-term potentiation and long-term depression are enduring changes in synaptic strength, induced by specific patterns of synaptic activity, that have received much attention as cellular models of information storage in the central nervous system. Work in a number of brain regions, from the spinal cord to the cerebral cortex, and in many animal species, ranging from invertebrates to humans, has demonstrated a reliable capacity for chemical synapses to undergo lasting changes in efficacy in response to a variety of induction protocols. In addition to their physiological relevance, long-term potentiation and depression may have important clinical applications. A growing insight into the molecular mechanisms underlying these processes, and technological advances in non-invasive manipulation of brain activity, now puts us at the threshold of harnessing long-term potentiation and depression and other forms of synaptic, cellular and circuit plasticity to manipulate synaptic strength in the human nervous system. Drugs may be used to erase or treat pathological synaptic states and non-invasive stimulation devices may be used to artificially induce synaptic plasticity to ameliorate conditions arising from disrupted synaptic drive. These approaches hold promise for the treatment of a variety of neurological conditions, including neuropathic pain, epilepsy, depression, amblyopia, tinnitus and stroke.

  13. Combined treatment with atypical antipsychotics and antidepressants in treatment-resistant depression: preclinical and clinical efficacy.

    Science.gov (United States)

    Rogóż, Zofia

    2013-01-01

    Several clinical reports have documented a beneficial effect of adding atypical antipsychotic drugs to ongoing treatments with antidepressants, particularly selective serotonin reuptake inhibitors, in ameliorating drug-resistant depression. The aim of this paper was to summarize some preclinical evidence describing the mechanism responsible for the therapeutic action of combined treatment with antidepressants and atypical antipsychotics and also some clinical data supporting the efficacy and safety of the augmentation strategy for improving antidepressant-resistant depression using atypical antipsychotics. This analysis is based on five microdialysis studies and nine behavioral studies assessing the impact of combined atypical antipsychotic and antidepressant treatments on extracellular levels of dopamine, serotonin and noradrenaline in the prefrontal cortex of freely moving rats and on antidepressant-induced effects, respectively. In addition, clinical data demonstrating the efficacy and safety of augmentation strategies for treatment-resistant depression using atypical antipsychotics were included. Combined treatment of rats with all studied atypical antipsychotics (olanzapine, risperidone, clozapine and quetiapine) and antidepressants (citalopram, fluoxetine and fluvoxamine) increased the extracellular level of dopamine in the prefrontal cortex compared to a respective drug given alone; in addition, a combination of olanzapine or quetiapine plus fluoxetine or fluvoxamine increased the levels of dopamine and noradrenaline. Moreover, atypical antipsychotics administered in a low dose enhanced the antidepressant-like activity of antidepressants, with (among other mechanisms) the serotonin 5-HT1A, 5-HT2A and adrenergic α2 receptors likely playing an important role in their action. The results support the conclusion that atypical antipsychotics may be effective as adjunctive therapy in treatment-resistant depression; however, their adverse effect profile may be

  14. Comparing the acceptability of a positive psychology intervention versus a cognitive behavioural therapy for clinical depression.

    Science.gov (United States)

    Lopez-Gomez, Irene; Chaves, Covadonga; Hervas, Gonzalo; Vazquez, Carmelo

    2017-09-01

    There is growing evidence on the efficacy of positive psychology interventions (PPI) to treat clinical disorders. However, very few studies have addressed their acceptability. The present study aimed to analyse 2 key components of acceptability (i.e., client satisfaction and adherence to treatment) of a new PPI programme, the Integrative Positive Psychological Intervention for Depression (IPPI-D), in comparison to a standard cognitive behavioural therapy (CBT) programme in the treatment of clinical depression. One hundred twenty-eight women with a DSM-IV diagnosis of major depression or dysthymia were allocated to a 10-session IPPI-D or CBT group intervention condition. Results showed that both interventions were highly acceptable for participants. Attendance rates were high, and there were no significant differences between conditions. However, the IPPI-D condition showed significantly higher client satisfaction than the CBT condition. Moreover, acceptability did not differ based on participants' severity of symptoms, regardless of condition. These findings encourage further investigations of the applicability of PPI in clinical settings in order to broaden the range of acceptable and suitable therapies for depressed patients. Key Practitioner Message This study sheds light on the client satisfaction and adherence to a positive intervention. For participants, positive psychology interventions (PPI) may be more satisfactory than CBT as PPI are framed within a positive mental health model and, consequently, may reduce the risk of stigmatization Because acceptability of treatments and preferences may affect the efficacy of treatments, this study provides an excellent opportunity to offer professionals more therapeutic options to tailor treatments to clients' needs and expectations. Copyright © 2017 John Wiley & Sons, Ltd.

  15. Sociodemographic and clinical predictors of compliance with antidepressants for depressive disorders: systematic review of observational studies

    Directory of Open Access Journals (Sweden)

    Rivero-Santana A

    2013-03-01

    Full Text Available Amado Rivero-Santana,1 Lilisbeth Perestelo-Perez,2,3 Jeanette Pérez-Ramos,1 Pedro Serrano-Aguilar,2,3 Carlos De las Cuevas2,4 1Canary Islands Foundation of Health and Research, 2Red de Investigacion en Servicios de Salud en Enfermedades Cronicas (REDISSEC, Santa Cruz de Tenerife, 3Evaluation Unit, Canary Islands Health Service, Santa Cruz de Tenerife, 4Department of Psychiatry, University of La Laguna, Canary Islands, Spain Background: The literature shows that compliance with antidepressant treatment is unsatisfactory. Several personal and disease-related variables have been shown to be related to compliance behavior. The objective of this study was to review the literature about sociodemographic and clinical predictors of compliance in patients with depressive disorders. Methods: The Medline, Embase, Cochrane Central, PsycInfo, and Cinahl databases were searched until May 2012. Studies that analyzed sociodemographic and clinical predictors or correlates of compliance in patients with depressive disorder were included. A quantitative synthesis was not performed because of the heterogeneity and availability of the data reported. For similar reasons, the results were not classified according to the different phases of treatment. The search was limited to studies published in English and Spanish. Results: Thirty-two studies fulfilled the inclusion criteria. The most consistent associations with compliance were found for age (older patients showed more compliance and race (white patients were more likely to adhere to treatment than minority ethnic groups. Few studies assessed clinical factors, and the most plausible predictors of compliance were certain comorbidities and substance abuse. Severity of depression did not play an important role in predicting compliance. Conclusion: The impact of the variables studied on compliance behavior appeared to be inconsistent. Identifying potential predictors of compliance with antidepressant treatment is

  16. The effect of exercise in clinically depressed adults: systematic review and meta-analysis of randomized controlled trials

    DEFF Research Database (Denmark)

    Krogh, Jesper; Nordentoft, Merete; Sterne, Jonathan A C

    2011-01-01

    SH) and text word terms depression, depressive disorder and exercise, aerobic, non-aerobic, physical activity, physical fitness, walk*, jog*, run*, bicycling, swim*, strength, and resistance. STUDY SELECTION: Randomized trials including adults with clinical depression according to any diagnostic system were...... with depression (P = .002). No other characteristics were related to between-study heterogeneity. Pooled analysis of 5 trials with long-term follow-up (ie, that examined outcomes beyond the end of the intervention) suggested no long-term benefit (SMD, -0.01; 95% CI, -0.28 to 0.26), with no strong evidence...... these, the estimated beneficial effect of exercise was more modest (SMD, -0.19; 95% CI, -0.70 to 0.31) than the pooled result for all 13 studies, with no strong evidence of benefit. CONCLUSIONS: Our results suggest a short-term effect of exercise on depression: on average, depression scores 0...

  17. Benefits and harms in clinical trials of duloxetine for treatment of major depressive disorder

    DEFF Research Database (Denmark)

    Maund, Emma; Tendal, Britta; Hróbjartsson, Asbjørn

    2014-01-01

    , with respect to benefits and major harms. DESIGN: Data on primary efficacy analysis and major harms extracted from each data source and compared. SETTING: Nine randomised placebo controlled trials of duloxetine (total 2878 patients) submitted to the European Medicines Agency (EMA) for marketing approval...... inconsistencies in the population in the primary efficacy analysis between the protocol and clinical study report and within the clinical study report for one trial. Furthermore, we found contradictory information within the reports for seven serious adverse events and eight adverse events that led......OBJECTIVE: To determine, using research on duloxetine for major depressive disorder as an example, if there are inconsistencies between protocols, clinical study reports, and main publicly available sources (journal articles and trial registries), and within clinical study reports themselves...

  18. Benefits and harms in clinical trials of duloxetine for treatment of major depressive disorder

    DEFF Research Database (Denmark)

    Maund, Emma; Tendal, Britta; Hróbjartsson, Asbjørn

    2014-01-01

    OBJECTIVE: To determine, using research on duloxetine for major depressive disorder as an example, if there are inconsistencies between protocols, clinical study reports, and main publicly available sources (journal articles and trial registries), and within clinical study reports themselves......, with respect to benefits and major harms. DESIGN: Data on primary efficacy analysis and major harms extracted from each data source and compared. SETTING: Nine randomised placebo controlled trials of duloxetine (total 2878 patients) submitted to the European Medicines Agency (EMA) for marketing approval.......gov and the manufacturer's online clinical trial registry were searched for trial results. RESULTS: Clinical study reports fully described the primary efficacy analysis and major harms (deaths (including suicides), suicide attempts, serious adverse events, and discontinuations because of adverse events). There were minor...

  19. Stuck in the past: negative bias, explanatory style, temporal order, and evaluative perspectives in life narratives of clinically depressed individuals.

    Science.gov (United States)

    Habermas, Tilmann; Ott, Lisa-M; Schubert, Merve; Schneider, Beatrix; Pate, Anna

    2008-01-01

    This study attempted to replicate negative bias and depressive explanatory style in depression using life narratives. The two central aspects of narrative, temporal succession and evaluation, were also explored. These aspects were tested for the first time using entire life narratives of 17 depressed inpatients and non-depressed controls matched for sex and educational level. Negative bias and depressive explanatory style were replicated as typical for the depressed group. Life narratives of depressed patients also deviated more from a linear temporal order and compared less frequently the past with the present. Contrary to expectations, the depressed did not differ in the overall frequency of evaluations. However, they used more past than present evaluations and more experience-near evaluations than cognitive evaluations, suggesting that they are more immersed in past experiences. It is concluded that negative bias and depressive explanatory style can be found also in a naturalistic narrative measure, and that depression affects the two major aspects of narrative. It is argued that life narratives, as measures close to everyday clinical practice and as the most encompassing form of self-representation, should complement more experimental procedures in the study of cognitive and communicative processes in psychopathology. 2007 Wiley-Liss, Inc.

  20. Clinically significant depressive symptoms and sexual behaviour among men who have sex with men.

    Science.gov (United States)

    Miltz, Ada R; Rodger, Alison J; Sewell, Janey; Speakman, Andrew; Phillips, Andrew N; Sherr, Lorraine; Gilson, Richard J; Asboe, David; Nwokolo, Nneka C; Clarke, Amanda; Gompels, Mark M; Allan, Sris; Collins, Simon; Lampe, Fiona C

    2017-05-01

    The relationship between depression and sexual behaviour among men who have sex with men (MSM) is poorly understood. To investigate prevalence and correlates of depressive symptoms (Patient Health Questionnaire-9 score ≥10) and the relationship between depressive symptoms and sexual behaviour among MSM reporting recent sex. The Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) is a cross-sectional study of UK genitourinary medicine clinic attendees without diagnosed HIV (2013-2014). Among 1340 MSM, depressive symptoms (12.4%) were strongly associated with socioeconomic disadvantage and lower supportive network. Adjusted for key sociodemographic factors, depressive symptoms were associated with measures of condomless sex partners in the past 3 months (≥2 (prevalence ratio (PR) 1.42, 95% CI 1.17-1.74; P =0.001), unknown or HIV-positive status (PR 1.43, 95% CI 1.20-1.71; P payments for presentations made at meetings sponsored by Gilead in spring 2015. N.C.N. has received support for attendance at conferences, speaker fees and payments for attendance at advisory boards from Gilead Sciences, Viiv Healthcare, Janssen Pharmaceuticals and Bristol-Myers Squibb and a research grant from Gilead Sciences. D.A. served on the advisory board for Gilead in January 2016. M.M.G. has had sponsorship to attend conferences by Bristol-Myers Squibb, been on the BioCryst advisory board and run trials for Merck, Gilead, SSAT, BioCryst and Novartis. © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

  1. The effect of exercise in clinically depressed adults: systematic review and meta-analysis of randomized controlled trials

    DEFF Research Database (Denmark)

    Krogh, Jesper; Nordentoft, Merete; Sterne, Jonathan A C

    2011-01-01

    OBJECTIVE: To assess the effectiveness of exercise in adults with clinical depression. DATA SOURCES: The databases CINAHL, Embase, Cochrane Database of Systematic reviews, Cochrane Controlled Trials Register, MEDLINE, and PsycINFO were searched (1806-2008) using medical subject headings (Me......SH) and text word terms depression, depressive disorder and exercise, aerobic, non-aerobic, physical activity, physical fitness, walk*, jog*, run*, bicycling, swim*, strength, and resistance. STUDY SELECTION: Randomized trials including adults with clinical depression according to any diagnostic system were...... with depression (P = .002). No other characteristics were related to between-study heterogeneity. Pooled analysis of 5 trials with long-term follow-up (ie, that examined outcomes beyond the end of the intervention) suggested no long-term benefit (SMD, -0.01; 95% CI, -0.28 to 0.26), with no strong evidence...

  2. The effects of combined sertraline and aspirin therapy on depression severity among patients with major depressive disorder: A randomized clinical trial.

    Science.gov (United States)

    Sepehrmanesh, Zahra; Fahimi, Hosein; Akasheh, Goudarz; Davoudi, Mohamadreza; Gilasi, Hamidreza; Ghaderi, Amir

    2017-11-01

    Different studies have been conducted to find the best adjuvant therapies for depression management. There are controversies over the effects of aspirin as an adjuvant therapy for depression. To determine the effects of combined sertraline and aspirin therapy on depression severity among patients with major depressive disorder. This randomized clinical trial was conducted at Kargarnejad Psychiatric Hospital in Kashan, Isfahan, Iran, from September 1, 2016 to November 1, 2016. The study participants included 100 patients with major depressive disorder who were assigned to aspirin and placebo groups by the use of computer-generated random numbers. Patients in these groups respectively received sertraline-aspirin and sertraline-placebo for eight consecutive weeks. Patients were prescribed 80 milligrams of aspirin twice a day. Also, sertraline was administered at a dose of 50-200 milligrams daily. Beck Depression Inventory was employed for depression severity assessment at four time points, namely before, two, four, and eight weeks after the beginning of the intervention. Medication side effects were also assessed eight weeks after the beginning of the intervention. Data were analyzed by SPSS version 12.0, using Chi-square and the Independent-samples t-test (α=0.05). Both groups were matched in terms of age (p=0.46), gender (p=0.539), and depression severity (p=0.509, with mean score 33.5±4.1 vs. 32.8±5.9) at baseline. However, depression scores were reduced significantly four and eight weeks after initiation of therapy just in the sertraline-aspirin group (pdepression severity among patients with major depressive disorder. Yet, further studies are needed to prove the effectiveness of aspirin and other anti-inflammatory agents in reducing depression severity. The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2016082829556N1. The authors received financial support from Research Deputy of Kashan University

  3. Venlafaxine extended-release for depression following spinal cord injury: a randomized clinical trial.

    Science.gov (United States)

    Fann, Jesse R; Bombardier, Charles H; Richards, J Scott; Wilson, Catherine S; Heinemann, Allen W; Warren, Ann Marie; Brooks, Larry; McCullumsmith, Cheryl B; Temkin, Nancy R; Warms, Catherine; Tate, Denise G

    2015-03-01

    Depression is prevalent and associated with negative outcomes in individuals with spinal cord injury (SCI). Antidepressants are used routinely to treat depression, yet no placebo-controlled trials have been published in this population to our knowledge. To determine the efficacy and tolerability of venlafaxine hydrochloride extended-release (XR) for major depressive disorder (MDD) or dysthymic disorder in persons with chronic SCI. Multisite, randomized (1:1), double-blind, placebo-controlled Project to Improve Symptoms and Mood After SCI (PRISMS) trial. All research staff conducting screening, intervention, and outcome procedures were blinded to randomization status. We screened 2536 patients from outpatient clinics at 6 SCI treatment centers in the United States and randomized 133 participants into the trial. Participants were 18 to 64 years old and at least 1 month after SCI, with MDD or dysthymic disorder. Seventy-four percent of participants were male, and participants were on average 40 years old and 11 years after SCI. Forty-seven percent had cervical injuries, 53.4% had American Spinal Injury Association injury severity A (complete injury) SCI, 24.1% had at least 2 prior MDD episodes, and 99.2% had current MDD. Common comorbidities included chronic pain (93.9%), significant anxiety (57.1%), and history of substance dependence (44.4%). Twelve-week trial of venlafaxine XR vs placebo using a flexible-dose algorithm. The Hamilton Depression Rating Scale (HAM-D 17-item version and Maier subscale, which focuses on core depression symptoms and excludes somatic symptoms) over 12 weeks. Mixed-effects models revealed a significant difference between the venlafaxine XR and placebo groups in improvement on the Maier subscale from baseline to 12 weeks (treatment effect, 1.6; 95% CI, 0.3-2.9; P = .02) but not on the HAM-D 17-item version (treatment effect, 1.0; 95% CI, -1.4 to 3.4; P = .42). Participants receiving venlafaxine XR reported significantly less SCI

  4. Cognitive Behavioral Insomnia Therapy for Those With Insomnia and Depression: A Randomized Controlled Clinical Trial.

    Science.gov (United States)

    Carney, Colleen E; Edinger, Jack D; Kuchibhatla, Maragatha; Lachowski, Angela M; Bogouslavsky, Olya; Krystal, Andrew D; Shapiro, Colin M

    2017-04-01

    To compare cognitive behavioral therapy for insomnia (CBT-I) + antidepressant medication (AD) against treatments that target solely depression or solely insomnia. A blinded, randomized split-plot experimental study. Two urban academic clinical centers. 107 participants (68% female, mean age 42 ± 11) with major depressive disorder and insomnia. Randomization was to one of three groups: antidepressant (AD; escitalopram) + CBT-I (4 sessions), CBT-I + placebo pill, or AD + 4-session sleep hygiene control (SH). Subjective sleep was assessed via 2 weeks of daily sleep diaries (use of medication was covaried in all analyses); although there were no statistically significant group differences detected, all groups improved from baseline to posttreatment on subjective sleep efficiency (SE) and total wake time (TWT) and the effect sizes were large. Objective sleep was assessed via overnight polysomnographic monitoring at baseline and posttreatment; analyses revealed both CBT groups improved on TWT (p = .03), but the AD + SH group worsened. There was no statistically significant effect for PSG SE (p = .07). There was a between groups medium effect observed for the AD + SH and CBT + placebo group differences on diary TWT and both PSG variables. All groups improved significantly from baseline to posttreatment on the Hamilton Rating Scale for Depression (HAMD-17); the groups did not differ. Although all groups self-reported sleeping better after treatment, only the CBT-I groups improved on objective sleep, and AD + SH's sleep worsened. This suggests that we should be treating sleep in those with depression with an effective insomnia treatment and relying on self-report obscures sleep worsening effects. All groups improved on depression, even a group with absolutely no depression-focused treatment component (CBT-I + placebo). The depression effect in CBT-I only group has been reported in other studies, suggesting that we should further investigate the antidepressant properties of

  5. GENetic and clinical Predictors Of treatment response in Depression: the GenPod randomised trial protocol

    Directory of Open Access Journals (Sweden)

    O'Donovan Michael

    2008-05-01

    Full Text Available Abstract Background The most effective pharmacological treatments for depression inhibit the transporters that reuptake serotonin (Selective Serotonin Reuptake Inhibitors – SSRIs and noradrenaline (Noradrenaline Reuptake Inhibitors – NaRIs into the presynaptic terminal. There is evidence to suggest that noradrenaline and serotonin enhancing drugs work through separate mechanisms to produce their clinical antidepressant action. Although most of the current evidence suggests there is little difference in overall efficacy between SSRIs and NaRIs, there are patients who respond to one class of compounds and not another. This suggests that treatment response could be predicted by genetic and/or clinical characteristics. Firstly, this study aims to investigate the influence of a polymorphism (SLC6A4 in the 5HT transporter in altering response to SSRI medication. Secondly, the study will investigate whether those with more severe depression have a better response to NaRIs than SSRIs. Methods/design The GenPod trial is a multi-centre randomised controlled trial. GPs referred patients aged between 18–74 years presenting with a new episode of depression, who did not have any medical contraindications to antidepressant medication and who had no history of psychosis or alcohol/substance abuse. Patients were interviewed to ascertain their suitability for the study. Eligible participants (with a primary diagnosis of depression according to ICD10 criteria and a Beck Depression Inventory (BDI score > 14 were randomised to receive one of two antidepressant treatments, either the SSRI Citalopram or the NaRI Reboxetine, stratified according to severity. The final number randomised to the trial was 601. Follow-up assessments took place at 2, 6 and 12 weeks following randomisation. Primary outcome was measured at 6 weeks by the BDI. Outcomes will be analysed on an intention-to-treat basis and will use multiple regression models to compare treatments

  6. Prevalence and prediction of primary sleep disorders in a clinical trial of depressed patients with insomnia.

    Science.gov (United States)

    McCall, W Vaughn; Kimball, James; Boggs, Niki; Lasater, Barbara; D'Agostino, Ralph B; Rosenquist, Peter B

    2009-10-15

    Insomnia-pharmacology clinical trials routinely exclude primary sleep disorders, such as obstructive sleep apnea (OSA) and periodic limb movement disorder (PLMD), with a single night of polysomnography (PSG). Given the expense of PSG, we examined whether a thorough clinical screening, combined with actigraphy, would successfully identify OSA and PLMD as part of baseline screening for a clinical trial of insomnia treatment in depressed patients. Of the 73 patients with a complete baseline dataset, 12 screened positive for OSA/PLMD (AHI > 15, or PLMAI > 15), while 61 "passed" the PSG screen. The OSA/PLMD+ patients were older (51.4 +/- 10.2 y) and took more naps (2.6 per week) than the OSA/PLMD- patients (41.3 +/- 12.8 y; and 1.1 naps per week). The combination of age and nap frequency produced a "good" receiver operating characteristic (ROC) model for predicting OSA/PLMD+, with the area under the curve of 0.82. There were no other demographic, sleep diary, or actigraphic variables, which differed between OSA/PLM + or -, and no other variable improved the ROC model. Still, the best model misclassified 16 of 73 persons. We conclude that while age and the presence of napping were helpful in identifying OSA and PLM in a well-screened sample of depressed insomniacs, PSG is required to definitively identify and exclude primary sleep disorders in insomnia clinical trials.

  7. [Which are the recent clinical findings regarding the association between depression and suicide?].

    Science.gov (United States)

    Chachamovich, Eduardo; Stefanello, Sabrina; Botega, Neury; Turecki, Gustavo

    2009-05-01

    Suicide is one of the leading causes of mortality worldwide, especially among young subjects. Suicide is considered the outcome of a multidimensional and complex phenomenon, which is a result of the interaction between several factors. The association between psychopathology and suicide has been extensively investigated. Major depression plays an important role among the psychiatric diagnoses associated with suicide. This finding seems to be confirmed by different study designs, and in distinct populations. The present paper aims to briefly review the recent findings regarding the suicide-related clinical features of depression. Moreover, strategies for suicide prevention were also reviewed. Recent references were identified and grouped in order to illustrate the main contributions about depression and suicide. Briefly, the literature review stresses the high prevalence of major depression among subjects presenting suicide behaviors. Psychopathological traits, such as aggression and impulsivity play a relevant role in triggering suicidal behaviors. Strategies for suicide prevention were also reviewed in Brazil and internationally. In general, detection and treatment are effective in reducing suicide rates. Studies regarding suicide behaviors have had a pragmatic approach, and generated a large body of evidence about correlates of suicide. However, these studies have not been able to provide a consistent theoretical explanation for this phenomenon. The recent adoption of modern strategies represents a possibility of enhancing the research capability of such studies. In order to be clinically useful, findings should make it possible to deepen the understanding over the experience of a suicidal person, as well as to design specific strategies for prevention and treatment in population subgroups.

  8. A case of cervical radiation radiculopathy resembling motor neuron disease

    International Nuclear Information System (INIS)

    Mitsunaga, Yoshihiro; Yoshimura, Takeo; Hara, Hideo; Yamada, Takeshi; Kira, Jun-ichi; Kobayashi, Takuro

    1998-01-01

    A 67-year-old man developed slowly progressive muscular weakness in the bilateral upper extremities (C5-7 regions) without signs of sensory deficit following the cervical radiation therapy (70.5 Gy) for right laryngeal cancer 4 years before. These clinical signs resembled those of lower motor neuron disease. MRI with gadolinium-DTPA, however, showed enhancement in the bilateral C5 and C6 anterior roots, suggesting the cervical radiculopathy due to radiotherapy. It is known that radiation to the spinal cord can lead to ''selective anterior horn cell injury''. This is the first case report of the cervical radiation radiculopathy, which, if without MRI, might be classified into selective anterior horn cell injury. Suggestion is made for the hypothesis that the spinal motoneuron loss in radiation myelopathy would be caused by retrograde degeneration due to anterior root damages. (author)

  9. A case of cervical radiation radiculopathy resembling motor neuron disease

    Energy Technology Data Exchange (ETDEWEB)

    Mitsunaga, Yoshihiro; Yoshimura, Takeo; Hara, Hideo; Yamada, Takeshi; Kira, Jun-ichi; Kobayashi, Takuro [Kyushu Univ., Fukuoka (Japan). Faculty of Medicine

    1998-05-01

    A 67-year-old man developed slowly progressive muscular weakness in the bilateral upper extremities (C5-7 regions) without signs of sensory deficit following the cervical radiation therapy (70.5 Gy) for right laryngeal cancer 4 years before. These clinical signs resembled those of lower motor neuron disease. MRI with gadolinium-DTPA, however, showed enhancement in the bilateral C5 and C6 anterior roots, suggesting the cervical radiculopathy due to radiotherapy. It is known that radiation to the spinal cord can lead to ``selective anterior horn cell injury``. This is the first case report of the cervical radiation radiculopathy, which, if without MRI, might be classified into selective anterior horn cell injury. Suggestion is made for the hypothesis that the spinal motoneuron loss in radiation myelopathy would be caused by retrograde degeneration due to anterior root damages. (author)

  10. Depressive Symptoms and Clinical Status during the Treatment of Adolescent Suicide Attempters (TASA) Study

    Science.gov (United States)

    Vitiello, Benedetto; Brent, David A.; Greenhill, Laurence L.; Emslie, Graham; Wells, Karen; Walkup, John T.; Stanley, Barbara; Bukstein, Oscar; Kennard, Betsy D.; Compton, Scott; Coffey, Barbara; Cwik, Mary F.; Posner, Kelly; Wagner, Ann; March, John S.; Riddle, Mark; Goldstein, Tina; Curry, John; Capasso, Lisa; Mayes, Taryn; Shen, Sa; Gugga, S. Sonia; Turner, J. Blake; Barnett, Shannon; Zelazny, Jamie

    2009-01-01

    Objective: To examine the course of depression during the treatment of adolescents with depression who had recently attempted suicide. Method: Adolescents (N = 124), ages 12 to 18 years, with a 90-day history of suicide attempt, a current diagnosis of depressive disorder (96.0% had major depressive disorder), and a Children's Depression Rating…

  11. Systematic Review of Clinical Practice Guidelines for Failed Antidepressant Treatment Response in Major Depressive Disorder, Dysthymia, and Subthreshold Depression in Adults.

    Science.gov (United States)

    MacQueen, Glenda; Santaguida, Pasqualina; Keshavarz, Homa; Jaworska, Natalia; Levine, Mitchell; Beyene, Joseph; Raina, Parminder

    2017-01-01

    This systematic review critically evaluated clinical practice guidelines (CPGs) for treating adults with major depressive disorder, dysthymia, or subthreshold or minor depression for recommendations following inadequate response to first-line treatment with selective serotonin reuptake inhibitors (SSRIs). Searches for CPGs (January 2004 to November 2014) in English included 7 bibliographic databases and grey literature sources using CPG and depression as the keywords. Two raters selected CPGs on depression with a national scope. Data extraction included definitions of adequate response and recommended treatment options. Two raters assessed quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. From 46,908 citations, 3167 were screened at full text. From these 21 CPG were applicable to adults in primary care and outpatient settings. Five CPGs consider patients with dysthymia or subthreshold or minor depression. None provides recommendations for those who do not respond to first-line SSRI treatment. For adults with MDD, most CPGs do not define an "inadequate response" or provide specific suggestions regarding how to choose alternative medications when switching to an alternative antidepressant. There is variability between CPGs in recommending combination strategies. AGREE II ratings for stakeholder involvement in CPG development, editorial independence, and rigor of development are domains in which depression guidelines are often less robust. About half of patients with depression require second-line treatment to achieve remission. Consistency and clarity in guidelines for second-line treatment of depression are therefore important for clinicians but lacking in most current guidelines. This may reflect a paucity of primary studies upon which to base conclusions.

  12. A clinically useful self-report measure of the DSM-5 anxious distress specifier for major depressive disorder.

    Science.gov (United States)

    Zimmerman, Mark; Chelminski, Iwona; Young, Diane; Dalrymple, Kristy; Walsh, Emily; Rosenstein, Lia

    2014-06-01

    To acknowledge the clinical significance of anxiety in depressed patients, DSM-5 included criteria for an anxious distress specifier for major depressive disorder. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we modified our previously published depression scale to include a subscale assessing the DSM-5 anxious distress specifier. From December 1995 to August 2013, 773 psychiatric outpatients with major depressive disorder completed the Clinically Useful Depression Outcome Scale (CUDOS) supplemented with questions for the DSM-5 anxious distress specifier (CUDOS-A). To examine discriminant and convergent validity, the patients were rated on clinician severity indices of depression, anxiety, and irritability. Discriminant and convergent validity was further examined in a subset of patients who completed other self-report symptom severity scales. Test-retest reliability was examined in a subset who completed the CUDOS-A twice. We compared patients who did and did not meet the DSM-5 anxious distress specifier on indices of psychosocial functioning and quality of life. The CUDOS-A subscale had high internal consistency and test-retest reliability; was more highly correlated with other self-report measures of anxiety than with measures of depression, substance use problems, eating disorders, and anger; and was more highly correlated with clinician severity ratings of anxiety than depression and irritability. CUDOS-A scores were significantly higher in depressed outpatients with a current anxiety disorder than in depressed patients without a comorbid anxiety disorder (P depressive disorder. © Copyright 2014 Physicians Postgraduate Press, Inc.

  13. Atypical mycobacterial infection resembles sporotrichosis in elderly patient

    Directory of Open Access Journals (Sweden)

    Siti Nurani Fauziah

    2016-06-01

    Full Text Available Atypical mycobacterial (AM infection is caused by Mycobacterium species other than M.tuberculosis. AM skin infection has clinical manifestations that resemble M. tuberculosis infection and deep fungal infection. Laboratory workup is necessary to confirm the diagnosis. An 83-year old female came with a painful lump and swelling on her right lower extremity since three months before admission. Physical examination revealed a plaque consisting, of multiple erythematous and hyperpigmented papules and nodules, diffuse erythematous lesion, and shallow ulcers partially covered with pus and crust. Histopathological features showed tuberculoid granuloma. Direct test and periodic acid-Schiff (PAS staining of the skin biopsy found no fungal element nor acid-fast bacilli (AFB. Culture and polymerase chain reaction (PCR of M. tuberculosis were negative. The working diagnosis was atypical mycobacterial infection and treatment with 450 mg rifampicin and 100 mg minocycline daily were administered accordingly. In two months observation following the treatment, the pain was no longer exist, the ulcers were completely healed, and some nodules were in the process of healing Among other Mycobacterium spp, M.marinum is the most common cause of AM infrections. Clinical manifestation of M. marinum infection may present as solitary or multiple nodules on the hands, feet, elbows and knees with sporotrichoid spreading patern. The diagnosis of AM was established based on clinical and laboratory examination. The diagnosis was also confirmed by good clinical response to minocycline and rifampicin.

  14. Aspectos clínicos da depressão em crianças e adolescentes: clinical features Depression in childhood and adolescence

    Directory of Open Access Journals (Sweden)

    Saint-Clair Bahls

    2002-10-01

    Full Text Available Objetivo: apresentar uma revisão sobre o quadro clínico, a evolução, a comorbidade e o comportamento suicida na depressão em crianças e adolescentes, com o objetivo de contribuir com o esclarecimento desta patologia grave, comum e ainda pouco reconhecida. Fontes dos dados: foram realizados levantamento no sistema Medline no período de 1991 a 2000, e levantamento manual da literatura. Síntese dos dados: o interesse científico pela depressão em crianças e adolescentes é bastante recente, pois até a década de 70 acreditava-se que fosse rara ou inexistente. Os sistemas diagnósticos atuais definem que os sintomas básicos de um episódio depressivo maior são os mesmos em crianças, adolescentes e adultos; entretanto, os pesquisadores destacam a importância do processo de maturação na apresentação sintomatológica da depressão, com características predominantes em cada fase do desenvolvimento. Conclusões: atualmente a depressão maior em crianças e adolescentes é considerada comum, debilitante e recorrente, envolvendo um alto grau de morbidade e mortalidade, representando um sério problema de saúde pública.Objective: this study reviews clinical features, evolution, comorbidity and suicidal behavior in childhood and adolescence depression. Its objective is to provide clear information on this common, severe and not very easily recognized pathology. Sources: literature searches were performed through Medline (1991-2000, with secondary-source follow-up. Summary of the findings: scientific concern about depression in childhood and adolescence is recent and up to the 70's depression was considered rare or inexistent in this period. Current diagnostic systems define as basic features of depression in children and adolescents are the same ones found in adults for major depression episodes; however, researches emphasize the significance of the developmental process in the clinical manifestations, with predominant features in each

  15. Depressive Symptoms and Associated Clinical Characteristics in Outpatients Seeking Community-Based Treatment for Alcohol and Drug Problems.

    Science.gov (United States)

    Sanchez, Katherine; Walker, Robrina; Campbell, Aimee N C; Greer, Tracy L; Hu, Mei-Chen; Grannemann, Bruce D; Nunes, Edward V; Trivedi, Madhukar H

    2015-01-01

    Comorbid psychiatric and substance use disorders are common and associated with poorer treatment engagement, retention, and outcomes. This study examines the presence of depressive symptoms and the demographic and clinical correlates in a diverse sample of substance abuse treatment seekers to better characterize patients with co-occurring depressive symptoms and substance use disorders and understand potential treatment needs. Baseline data from a randomized clinical effectiveness trial of a computer-assisted, Web-delivered psychosocial intervention were analyzed. Participants (N = 507) were recruited from 10 geographically diverse outpatient drug treatment programs. Assessments included the self-report Patient Health Questionnaire, and measures of coping strategies, social functioning, physical health status, and substance use. One fifth (21%; n = 106) of the sample screened positive for depression; those screening positive for depression were significantly more likely to screen positive for anxiety (66.9%) and posttraumatic stress disorder (PTSD; 42.9%). After controlling for anxiety and PTSD symptoms, presence of depressive symptoms remained significantly associated with fewer coping strategies (P = .001), greater impairment in social adjustment (P Depression is a clinically significant problem among substance abusers, and, in this study, patients who screened positive for depression were more likely to have co-occurring symptoms of anxiety and PTSD. Additionally, the presence of depressive symptoms was associated with fewer coping strategies and poorer social adjustment. Coping skills are a significant predictor of addiction outcomes, and it may be especially important to screen for and enhance coping among depressed patients. Evidence-based interventions that target coping skills and global functioning among substance abusers with depressive symptoms may be important adjuncts to usual treatment.

  16. [Literature regarding clinical research of acupuncture for depression in the worldwide:comparison and discussion].

    Science.gov (United States)

    Kou, Renzhong; Jiang, Yu; Xu, Tiancheng; Yu, Meiling; Wang, Xinjun; Lu, Shengfeng

    The literature regarding clinical research of acupuncture for depression published in Wanfang database, VIP database, CNKI database and PubMed from January of 2004 to March of 2005 was collected, and the quality of randomized controlled trial (RCT) that met the inclusive criteria was evaluated with Jadad. The research designs (research objective, intervention, effect assessment) were compared and analyzed by using the 2010 version of Consolidated Standards of Reporting Trials (CONSORT) and Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). As a result, a total of 57 articles were included in the comparative study, 46 of which were RCTs (36 articles were published in China core journals, 6 articles written by China were published in foreign countries, and 4 articles were foreign researches). It was found the literature of Chinese researches attached great importance to the syndrome differentiation of acupuncture, and various types of acupuncture intervention and biological effect indicators were applied; the literature of foreign researches presented advantages on RCT quality, and the baseline evaluation and effect evaluation systems were more comprehensive, in addition, more attention was paid to quantitative design of clinical parameters. It was concluded the differences between Chinese and foreign clinical research of acupuncture for depression were unfavorable for the evidence-based research, and the overall quality of researches was in need of improvement. It was recommended the future researchers should be designed and reported in accord with unified criteria, and the registration of acupuncture clinical trial should be valued, which could promote the integration of research results and improve the overall researches level. In this process, the research model of real world might be introduced to stimulate new development trends of acupuncture clinical research.

  17. Clinical and sociodemographic correlates of suicidality in patients with major depressive disorder from six Asian countries

    Science.gov (United States)

    2014-01-01

    Background East Asian countries have high suicide rates. However, little is known about clinical and sociodemographic factors associated with suicidality in Asian populations. The aim of this study was to evaluate the factors associated with suicidality in patients with major depressive disorder (MDD) from six Asian countries. Methods The study cohort consisted of 547 outpatients with MDD. Patients presented to study sites in China (n = 114), South Korea (n = 101), Malaysia (n = 90), Singapore (n = 40), Thailand (n = 103), and Taiwan (n = 99). All patients completed the Mini-International Neuropsychiatric Interview (MINI), the Montgomery–Asberg Depression Rating Scale (MADRS), the Global Severity Index(SCL-90R), the Fatigue Severity Scale, the 36-item short-form health survey, the Sheehan Disability Scale, and the Multidimensional Scale of Perceived Social Support (MSPSS). Patients were classified as showing high suicidality if they scored ≥6 on the MINI suicidality module. Multivariate logistic regression analysis was used to examine sociodemographic and clinical factors related to high suicidality. Results One hundred and twenty-five patients were classed as high suicidality. Unemployed status (adjusted odds ratio [OR] 2.43, p suicidality. Hindu (adjusted OR 0.09, p suicidality. Conclusions A variety of sociodemographic and clinical factors were associated with high suicidality in Asian patients with MDD. These factors may facilitate the identification of MDD patients at risk of suicide. PMID:24524225

  18. Using clinical decision support as a means of implementing a universal postpartum depression screening program.

    Science.gov (United States)

    Loudon, Holly; Nentin, Farida; Silverman, Michael E

    2016-06-01

    A major barrier to the diagnosis of postpartum depression (PPD) includes symptom detection. The lack of awareness and understanding of PPD among new mothers, the variability in clinical presentation, and the various diagnostic strategies can increase this further. The purpose of this study was to test the feasibility of adding clinical decision support (CDS) to the electronic health record (EHR) as a means of implementing a universal standardized PPD screening program within a large, at high risk, population. All women returning to the Mount Sinai Hospital OB/GYN Ambulatory Practice for postpartum care between 2010 and 2013 were presented with the Edinburgh Postnatal Depression Scale (EPDS) in response to a CDS "hard stop" built into the EHR. Of the 2102 women who presented for postpartum care, 2092 women (99.5 %) were screened for PPD in response to a CDS hard stop module. Screens were missing on ten records (0.5 %) secondary to refusal, language barrier, or lack of clarity in the EHR. Technology is becoming increasingly important in addressing the challenges faced by health care providers. While the identification of PPD has become the recent focus of public health concerns secondary to the significant social burden, numerous barriers to screening still exist within the clinical setting. The utility of adding CDS in the form of a hard stop, requiring clinicians to enter a standardized PPD mood assessment score to the patient EHR, offers a sufficient way to address a primary barrier to PPD symptom identification at the practitioner level.

  19. Clinical and sociodemographic correlates of suicidality in patients with major depressive disorder from six Asian countries.

    Science.gov (United States)

    Lim, Ah-Young; Lee, Ah-Rong; Hatim, Ahmad; Tian-Mei, Si; Liu, Chia-Yih; Jeon, Hong Jin; Udomratn, Pichet; Bautista, Dianne; Chan, Edwin; Liu, Shen-Ing; Chua, Hong Choon; Hong, Jin Pyo

    2014-02-13

    East Asian countries have high suicide rates. However, little is known about clinical and sociodemographic factors associated with suicidality in Asian populations. The aim of this study was to evaluate the factors associated with suicidality in patients with major depressive disorder (MDD) from six Asian countries. The study cohort consisted of 547 outpatients with MDD. Patients presented to study sites in China (n = 114), South Korea (n = 101), Malaysia (n = 90), Singapore (n = 40), Thailand (n = 103), and Taiwan (n = 99). All patients completed the Mini-International Neuropsychiatric Interview (MINI), the Montgomery-Asberg Depression Rating Scale (MADRS), the Global Severity Index(SCL-90R), the Fatigue Severity Scale, the 36-item short-form health survey, the Sheehan Disability Scale, and the Multidimensional Scale of Perceived Social Support (MSPSS). Patients were classified as showing high suicidality if they scored ≥ 6 on the MINI suicidality module. Multivariate logistic regression analysis was used to examine sociodemographic and clinical factors related to high suicidality. One hundred and twenty-five patients were classed as high suicidality. Unemployed status (adjusted odds ratio [OR] 2.43, p suicidality. Hindu (adjusted OR 0.09, p suicidality. A variety of sociodemographic and clinical factors were associated with high suicidality in Asian patients with MDD. These factors may facilitate the identification of MDD patients at risk of suicide.

  20. Evolutionary cognitive therapy versus standard cognitive therapy for depression: a protocol for a blinded, randomized, superiority clinical trial.

    Science.gov (United States)

    Giosan, Cezar; Cobeanu, Oana; Mogoase, Cristina; Muresan, Vlad; Malta, Loretta S; Wyka, Katarzyna; Szentagotai, Aurora

    2014-03-19

    Depression is estimated to become the leading cause of disease burden globally by 2030. Despite existing efficacious treatments (both medical and psychotherapeutic), a large proportion of patients do not respond to therapy. Recent insights from evolutionary psychology suggest that, in addition to targeting the proximal causes of depression (for example, targeting dysfunctional beliefs by cognitive behavioral therapy), the distal or evolutionary causes (for example, inclusive fitness) should also be addressed. A randomized superiority trial is conducted to develop and test an evolutionary-driven cognitive therapy protocol for depression, and to compare its efficacy against standard cognitive therapy for depression. Romanian-speaking adults (18 years or older) with elevated Beck Depression Inventory (BDI) scores (>13), current diagnosis of major depressive disorder or major depressive episode (MDD or MDE), and MDD with comorbid dysthymia, as evaluated by the Structured Clinical Interview for DSM-IV (SCID), are included in the study. Participants are randomized to one of two conditions: 1) evolutionary-driven cognitive therapy (ED-CT) or 2) cognitive therapy (CT). Both groups undergo 12 psychotherapy sessions, and data are collected at baseline, mid-treatment, post-treatment, and the 3-month follow-up. Primary outcomes are depressive symptomatology and a categorical diagnosis of depression post-treatment. This randomized trial compares the newly proposed ED-CT with a classic CT protocol for depression. To our knowledge, this is the first attempt to integrate insights from evolutionary theories of depression into the treatment of this condition in a controlled manner. This study can thus add substantially to the body of knowledge on validated treatments for depression. Current Controlled Trials ISRCTN64664414The trial was registered in June 2013. The first participant was enrolled on October 3, 2012.

  1. A critical review of exercise as a treatment for clinically depressed adults: time to get pragmatic.

    Science.gov (United States)

    Schuch, Felipe Barreto; Morres, Ioannis Dimitrios; Ekkekakis, Panteleimon; Rosenbaum, Simon; Stubbs, Brendon

    2017-04-01

    Although considerable evidence supports the efficacy of exercise as an antidepressant treatment, critical reviews informing routine practice and future research directions are scarce. We critically reviewed exercise studies for clinically depressed adults, focussing on the PICOS criteria referred to participants, interventions, comparisons, outcomes, and study designs. Most studies have not screened their samples for symptom heterogeneity. Also, they have employed heterogeneous exercise interventions and control groups that may lead to an underestimation of the benefits of exercise. In addition, pragmatic trials allowing scalable replication and implementation in routine practice are scarce. Future studies, can consider the research domain criteria as a diagnostic framework, and conduct moderator analyses to identify depressed subgroups with symptomatology and biopsychosocial characteristics associated with differential responses to exercise interventions. The search for biomarkers of the antidepressant responses to exercise should be prioritised. Further, non-physically active comparison groups should be used to minimise treatment cross-overs and thus the underestimation of the effects of exercise interventions. Finally, the use of outcome measures that maintain their validity at low and moderate levels of symptom severity and the development of trials with a pragmatic design are essential. The current evidence base is fraught with methodological considerations that need to be taken into account in order to increase further our understanding on the impact of exercise as medicine in depression. Future research should include moderator analyses, incorporate biomarker assays, use appropriate control and comparison groups, assess outcomes with psychometrically sensitive measures, and prioritise pragmatic trials towards transition to routine practice.

  2. A prospective study of group cohesiveness in therapeutic horticulture for clinical depression.

    Science.gov (United States)

    Gonzalez, Marianne Thorsen; Hartig, Terry; Patil, Grete Grindal; Martinsen, Egil W; Kirkevold, Marit

    2011-04-01

    This study aimed to assess changes in psychological distress and social participation in adults diagnosed with clinical depression during and after participating in a therapeutic horticulture programme, and to investigate if the changes covaried with levels of group cohesiveness during the intervention. An intervention with a single-group design was repeated with different samples in successive years (pooled n = 46). In each year, five groups of 3-7 participants went through the intervention. Data were collected before, twice during, and immediately after a 12-week therapeutic horticulture programme, as well as at 3-months' follow up. Mental health assessments included the Beck Depression Inventory, the State Subscale of Spielberger State-Trait Anxiety Inventory, the Positive Affect Scale from the Positive and Negative Affect Scale, the Perceived Stress Scale, and the Therapeutic Factors Inventory-Cohesiveness Scale. The analysis of the pooled data confirmed significant beneficial change in all mental health variables during the intervention. Change from baseline in depression severity persisted at 3-months' follow up. Increased social activity after the intervention was reported for 38% of the participants. The groups quickly established strong cohesiveness, and this continued to increase during the intervention. The average level of group cohesiveness correlated positively, but not significantly, with change in all mental health outcome variables. © 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

  3. The association between giant hydrocele and depression in a rural clinic in Nigeria.

    Science.gov (United States)

    Dienye, Paul O; Gbeneol, Precious K; Akani, Alexander B

    2011-09-01

    One of the dreaded disfiguring disease conditions among the Andoni tribesmen in the Nigerian Niger delta region is hydrocele, especially when its size is large (giant hydrocele) and it cannot be concealed. This case-control study was designed to evaluate the prevalence of depression among patients with giant hydrocele presenting to Bethesda Clinic Ngo, Andoni, Nigeria. A total of 52 patients were recruited into this study: 26 in the giant hydrocele group and 26 in the control group. Their age range was 23 to 78 years, with a mean age of 53.4 ± 15.5 years for the giant hydrocele group and 53.6 ± 14.2 years for the control group. The difference between the prevalence of depression among patients that presented with giant hydrocele (61.54%) and the controls (15.38%) was statistically significant (p = .0015). The authors conclude that depression is common among patients with giant hydrocele when compared with patients with other disease conditions.

  4. Blood transcriptomic markers for major depression: from animal models to clinical settings.

    Science.gov (United States)

    Redei, Eva E; Mehta, Neha S

    2015-05-01

    Depression is a heterogeneous disorder and, similar to other spectrum disorders, its manifestation varies by age of onset, severity, comorbidity, treatment responsiveness, and other factors. A laboratory blood test based on specific biomarkers for major depressive disorder (MDD) and its subgroups could increase diagnostic accuracy and expedite the initiation of treatment. We identified candidate blood biomarkers by examining genome-wide expression differences in the blood of animal models representing both the genetic and environmental/stress etiologies of depression. Human orthologs of the resulting transcript panel were tested in pilot studies. Transcript abundance of 11 blood markers differentiated adolescent subjects with early-onset MDD from adolescents with no disorder (ND). A set of partly overlapping transcripts distinguished adolescent patients who had comorbid anxiety disorders from those with only MDD. In adults, blood levels of nine transcripts discerned subjects with MDD from ND controls. Even though cognitive behavioral therapy (CBT) resulted in remission of some patients, the levels of three transcripts consistently signaled prior MDD status. A coexpression network of transcripts seems to predict responsiveness to CBT. Thus, our approach can be developed into clinically valid diagnostic panels of blood transcripts for different manifestations of MDD, potentially reducing diagnostic heterogeneity and advancing individualized treatment strategies. © 2015 New York Academy of Sciences.

  5. An integrated analysis of olanzapine/fluoxetine combination in clinical trials of treatment-resistant depression.

    Science.gov (United States)

    Trivedi, Madhukar H; Thase, Michael E; Osuntokun, Olawale; Henley, David B; Case, Michael; Watson, Susan B; Campbell, Giedra M; Corya, Sara A

    2009-03-01

    To evaluate the efficacy of olanzapine/fluoxetine combination (OFC) versus olanzapine or fluoxetine monotherapy across all clinical trials of treatment-resistant depression sponsored by Eli Lilly and Company. Efficacy and safety data from 1146 patients with a history of nonresponse during the current depressive episode who subsequently exhibited nonresponse during a 6- to 8-week antidepressant open-label lead-in phase and were randomly assigned to OFC (N = 462), fluoxetine (N = 342), or olanzapine (N = 342) for double-blind treatment were analyzed. All patients had a diagnosis of major depressive disorder as defined by DSM-III or DSM-IV criteria. The dates in which the trials were conducted ranged from May 1997 to July 2005. After 8 weeks, OFC patients demonstrated significantly greater Montgomery-Asberg Depression Rating Scale improvement (mean change = -13.0) than fluoxetine (-8.6, p or= 10% of OFC patients were weight gain, increased appetite, dry mouth, somnolence, fatigue, headache, and peripheral edema. Random glucose mean change (mg/dL) was +7.92 for the OFC group, +1.62 for the fluoxetine group (p = .020), and +9.91 for the olanzapine group (p = .485). Random cholesterol mean change (mg/dL) was +12.4 for OFC, +2.3 for fluoxetine (p or= 240 subsequently) was significantly higher for the OFC group (10.2%) than for the fluoxetine group (3.1%, p = .017) but not the olanzapine group (8.0%, p = .569). Mean weight change (kg) was +4.42 for OFC, -0.15 for fluoxetine (p or= 7% body weight (vs. olanzapine: 42.9%, p = .515; fluoxetine: 2.3%, p < .001). Results of this analysis showed that OFC-treated patients experienced significantly improved depressive symptoms compared with olanzapine- or fluoxetine-treated patients following failure of 2 or more antidepressants within the current depressive episode. Safety results for OFC were generally consistent with those for its component monotherapies. The total cholesterol increase associated with OFC was more pronounced

  6. Irritability Trajectories, Cortical Thickness, and Clinical Outcomes in a Sample Enriched for Preschool Depression.

    Science.gov (United States)

    Pagliaccio, David; Pine, Daniel S; Barch, Deanna M; Luby, Joan L; Leibenluft, Ellen

    2018-05-01

    Cross-sectional, longitudinal, and genetic associations exist between irritability and depression. Prior studies have examined developmental trajectories of irritability, clinical outcomes, and associations with child and familial depression. However, studies have not integrated neurobiological measures. The present study examined developmental trajectories of irritability, clinical outcomes, and cortical structure among preschoolers oversampled for depressive symptoms. Beginning at 3 to 5 years old, a sample of 271 children enriched for early depressive symptoms were assessed longitudinally by clinical interview. Latent class mixture models identified trajectories of irritability severity. Risk factors, clinical outcomes, and cortical thickness were compared across trajectory classes. Cortical thickness measures were extracted from 3 waves of magnetic resonance imaging at 7 to 12 years of age. Three trajectory classes were identified among these youth: 53.50% of children exhibited elevated irritability during preschool that decreased longitudinally, 30.26% exhibited consistently low irritability, and 16.24% exhibited consistently elevated irritability. Compared with other classes, the elevated irritability class exhibited higher rates of maternal depression, early life adversity, later psychiatric diagnoses, and functional impairment. Further, elevated baseline irritability predicted later depression beyond adversity and personal and maternal depression history. The elevated irritability class exhibited a thicker cortex in the left superior frontal and temporal gyri and the right inferior parietal lobule. Irritability manifested with specific developmental trajectories in this sample enriched for early depression. Persistently elevated irritability predicted poor psychiatric outcomes, higher risk for later depression, and decreased overall function later in development. Greater frontal, temporal, and parietal cortical thickness also was found, providing neural

  7. Dimensional approach to symptom factors of major depressive disorder in Koreans, using the Brief Psychiatric Rating Scale: The Clinical Research Center for Depression of South Korea Study

    Directory of Open Access Journals (Sweden)

    Seon-Cheol Park

    2015-01-01

    Full Text Available Although major depressive disorder (MDD has a variety of symptoms beyond the affective dimensions, the factor structure and contents of comprehensive psychiatric symptoms of this disorder have rarely been explored using the 18-item Brief Psychiatric Rating Scale (BPRS. We aimed to identify the factor structure of the 18-item BPRS in Korean MDD patients. A total of 258 MDD patients were recruited from a multicenter sample of the Clinical Research Center for Depression of South Korea study. Psychometric scales were used to assess overall psychiatric symptoms (BPRS, depression (Hamilton Depression Rating Scale, anxiety (Hamilton Anxiety Rating Scale, global severity (Clinical Global Impression of Severity Scale, suicidal ideation (Scale for Suicide Ideation, functioning (Social and Occupational Functioning Assessment Scale, and quality of life (World Health Organization Quality of Life Assessment-abbreviated version. Common factor analysis with oblique rotation was used to yield factor structure. A four-factor structure was designed and interpreted by the symptom dimensions to reflect mood disturbance, positive symptoms/apathy, bipolarity, and thought distortion/mannerism. These individual factors were also significantly correlated with clinical variables. The findings of this study support the view that the BPRS may be a promising measuring tool for the initial assessment of MDD patients. In addition, the four-factor structure of the BPRS may be useful in understanding the mood and psychotic characteristics of these patients.

  8. An interactional test of the reformulated helplessness theory of depression in women receiving clinical treatment for eating disorders.

    Science.gov (United States)

    Rotenberg, Ken J; Costa, Paula; Trueman, Mark; Lattimore, Paul

    2012-08-01

    The study tested the Reformulated Helplessness model that individuals who show combined internal locus of control, high stability and high globality attributions for negative life events are prone to depression. Thirty-six women (M=29 years-8 months of age) receiving clinical treatment for eating disorders completed: the Attribution Style Questionnaire, the Beck Depression Inventory, and the Stirling Eating Disorder Scales. An HRA yielded a three-way interaction among the attributional dimensions on depressive symptoms. Plotting of the slopes showed that the attribution of negative life events to the combination of internal locus of control, high stability, and a high globality, was associated with the optimal level of depressive symptoms. The findings supported the Reformulated Helplessness as a model of depression. Copyright © 2012 Elsevier Ltd. All rights reserved.

  9. Cognitive Impairments and Depressive Symptoms Did Not Impede Upper Extremity Recovery in a Clinical Repetitive Task Practice Program after Stroke

    Science.gov (United States)

    Skidmore, Elizabeth R.; Becker, James T.; Whyte, Ellen M.; Huber, Lynne M.; Waterstram, Laura F.; Ward, Amalie Andrew; Grattan, Emily S.; Holm, Margo B.

    2012-01-01

    Objective We examined whether cognitive impairments or depressive symptoms impeded improvement in upper extremity function in a clinical repetitive task practice program. Design Participants had mild to moderate upper extremity impairment after stroke (n=20). We characterized baseline cognitive function and depressive symptoms with the Repeatable Battery of Neuropsychological Status and the Hamilton Rating Scale for Depression. We measured upper extremity function at baseline, week 4 and week 24 with the Action Research Arm Test. Results Participants with and without cognitive impairments improved significantly over time (F1,17=84.48, pstroke (t17=.07, p=.95). Participants with and without depressive symptoms improved significantly over time (F1,18=86.29, pstroke (t17=.06, p=.95). Conclusions Preliminary findings suggest that cognitive impairments and depressive symptoms may not impede benefit from repetitive task practice after stroke. PMID:22311057

  10. 'Third wave' cognitive therapy versus mentalization-based therapy for major depressive disorder. A protocol for a randomised clinical trial

    DEFF Research Database (Denmark)

    Jakobsen, Janus Christian; Gluud, Christian Nyfeldt; Kongerslev, Mickey Toftkjær

    2012-01-01

    Background: Most interventions for depression have shown small or no effects. 'Third wave' cognitive therapy and mentalization-based therapy have both gained some ground as treatments of psychological problems. No randomised trial has compared the effects of these two interventions for patients...... with major depression.Methods/ design: We plan a randomised, parallel group, assessor-blinded superiority clinical trial. During two years we will include 84 consecutive adult participants diagnosed with major depressive disorder. The participants will be randomised to either 'third wave' cognitive therapy...... versus mentalization-based therapy. The primary outcome will be the Hamilton Rating Scale for Depression at cessation of treatment at 18 weeks. Secondary outcomes will be the proportion of patients with remission, Symptom Checklist 90 Revised, Beck's Depression Inventory, and The World Health...

  11. Heart rate variability measurement and clinical depression in acute coronary syndrome patients: narrative review of recent literature

    Science.gov (United States)

    Harris, Patricia RE; Sommargren, Claire E; Stein, Phyllis K; Fung, Gordon L; Drew, Barbara J

    2014-01-01

    Aim We aimed to explore links between heart rate variability (HRV) and clinical depression in patients with acute coronary syndrome (ACS), through a review of recent clinical research literature. Background Patients with ACS are at risk for both cardiac autonomic dysfunction and clinical depression. Both conditions can negatively impact the ability to recover from an acute physiological insult, such as unstable angina or myocardial infarction, increasing the risk for adverse cardiovascular outcomes. HRV is recognized as a reflection of autonomic function. Methods A narrative review was undertaken to evaluate state-of-the-art clinical research, using the PubMed database, January 2013. The search terms “heart rate variability” and “depression” were used in conjunction with “acute coronary syndrome”, “unstable angina”, or “myocardial infarction” to find clinical studies published within the past 10 years related to HRV and clinical depression, in patients with an ACS episode. Studies were included if HRV measurement and depression screening were undertaken during an ACS hospitalization or within 2 months of hospital discharge. Results Nine clinical studies met the inclusion criteria. The studies’ results indicate that there may be a relationship between abnormal HRV and clinical depression when assessed early after an ACS event, offering the possibility that these risk factors play a modest role in patient outcomes. Conclusion While a definitive conclusion about the relevance of HRV and clinical depression measurement in ACS patients would be premature, the literature suggests that these measures may provide additional information in risk assessment. Potential avenues for further research are proposed. PMID:25071372

  12. Familial and Clinical Correlates in Depressed Adolescents with Borderline Personality Disorder Traits.

    Science.gov (United States)

    Guilé, Jean-Marc; Huynh, Christophe; Breton, Jean-Jacques; De La Rivière, Sébastien Garny; Berthiaume, Claude; St-Georges, Marie; Labelle, Réal

    2016-01-01

    Chart review is a low-cost, but highly informative, method to describe symptoms, treatment, and risk factors associated with borderline personality disorder (BPD) and to adapt screening and intervention to clinical reality. Previous chart review studies report more aggressiveness/anger and psychotic features in youths with BPD. They show that adverse family environment and parental psychopathology constitute important factors for BPD pathology. To examine clinical characteristics of depressed BPD adolescents (12-17 years old) outpatients according to gender and to explore variables which are associated with BPD traits. A retrospective chart review using the child and adolescent version of the retrospective diagnostic instrument for borderlines was conducted on 30 depressed adolescents with BPD traits and 28 depressed patients without BPD traits. Participants who reached the retrospective diagnostic instrument for borderlines threshold for BPD were included in the BPD traits group. Comparison analyses were performed using Pearson's Chi-square test. Associated factors were determined using regression analyses. BPD traits participants were characterized by higher family problems (parental psychopathology, parent disagreement/argument, and parent-child relational problem), more aggressive symptoms, and higher rates of family intervention and hospitalization. A number of familial factors (parental history of delinquency, substance use, personality disorders, having siblings, or parental disagreement/argument in boys) were associated with BPD traits. Attention seeking and problematic functioning (does not adapt well to group activities) were also associated with BPD traits. Our study stresses the need to assess BPD traits in adolescent psychiatric evaluation, especially in the presence of aggressive behaviors, family problems and attention seeking. Our results also highlight the importance of exploring family characteristics intervention in adolescents with BPD traits.

  13. Familial and Clinical Correlates in Depressed Adolescents with Borderline Personality Disorder Traits

    Directory of Open Access Journals (Sweden)

    Jean Marc Guile

    2016-09-01

    Full Text Available Introduction: Chart review is a low-cost, but highly informative, method to describe symptoms, treatment and risk factors associated with Borderline Personality Disorder (BPD and to adapt screening and intervention to clinical reality. Previous chart review studies report more aggressiveness/anger and psychotic features in youths with BPD. They show that adverse family environment and parental psychopathology constitute important factors for BPD pathology. Objectives: To examine clinical characteristics of depressed BPD adolescents (12-17 years old outpatients according to gender and to explore variables which are associated with BPD traits. Methods: A retrospective chart review using the Child and Adolescent Version of the Retrospective Diagnostic Instrument for Borderlines was conducted on 30 depressed BPD adolescents with BPD traits and 28 non-BPD depressed patients without BPD traits. Participants who reached the C-DIB threshold for BPD were included in the BPD traits group. The Child and Adolescent Version of the Retrospective Diagnostic Interview for Borderlines was used to determine the presence of BPD. Comparisons analyses were performed using Pearson’s Chi-square test. Associated factors were determined using regression analyses. Results: BPD traits participants outpatients were characterised by higher family problems (parental psychopathology, parent disagreement/argument, parent-child relational problem, more aggressive symptoms, and higher rates of family intervention and hospitalisation. A number of familial factors (parental history of delinquency, substance use, or personality disorders, having siblings, parental disagreement/argument in boys were associated with BPD symptomatologytraits. Attention seeking and problematic functioning (does not adapt well to group activities were also associated with BPD traits. Discussion: Our study stresses the need to assess BPD traits in adolescent psychiatric evaluation, especially in

  14. Neural activity in relation to clinically derived personality syndromes in depression using a psychodynamic fMRI paradigm

    Directory of Open Access Journals (Sweden)

    Svenja eTaubner

    2013-12-01

    Full Text Available Objective: The heterogeneity between patients with depression cannot be captured adequately with existing descriptive systems of diagnosis and neurobiological models of depression. Furthermore, considering the highly individual nature of depression, the application of general stimuli in past research efforts may not capture the essence of the disorder. This study aims to identify subtypes of depression by using empirically-derived personality-syndromes, and to explore neural correlates of the derived personality syndromes.Method: In the present exploratory study an individually tailored and psychodynamically based fMRI paradigm using dysfunctional relationship patterns was presented to 20 chronically depressed patients. Results from the Shedler-Westen-Assessment-Procedure (SWAP-200 were analyzed by Q-factor analysis to identify clinically relevant subgroups of depression and related brain activation.Results: The principle component analysis of SWAP-200 items from all 20 patients lead to a 2-factor solution: Depressive Personality and Emotional-Hostile-Externalizing Personality. Both factors were used in a whole-brain correlational analysis but only the second factor yielded significant positive correlations in four regions: A large cluster in the right orbitofrontal cortex (OFC, the left ventral striatum, a small cluster in the left temporal pole and another small cluster in the right middle frontal gyrus. Discussion: The degree to which patients with depression score high on the factor Emotional-Hostile-Externalizing Personality correlated with relatively higher activity in three key areas involved in emotion processing, evaluation of reward/punishment, negative cognitions, depressive pathology and social knowledge (OFC, ventral striatum, temporal pole. Results may contribute to an alternative description of neural correlates of depression showing differential brain activation dependent on the extent of specific personality syndromes in

  15. Escitalopram—translating molecular properties into clinical benefit: reviewing the evidence in major depression

    Science.gov (United States)

    Leonard, Brian; Taylor, David

    2010-01-01

    The majority of currently marketed drugs contain a mixture of enantiomers; however, recent evidence suggests that individual enantiomers can have pharmacological properties that differ importantly from enantiomer mixtures. Escitalopram, the S-enantiomer of citalopram, displays markedly different pharmacological activity to the R-enantiomer. This review aims to evaluate whether these differences confer any significant clinical advantage for escitalopram over either citalopram or other frequently used antidepressants. Searches were conducted using PubMed and EMBASE (up to January 2009). Abstracts of the retrieved studies were reviewed independently by both authors for inclusion. Only those studies relating to depression or major depressive disorder were included. The search identified over 250 citations, of which 21 studies and 18 pooled or meta-analyses studies were deemed suitable for inclusion. These studies reveal that escitalopram has some efficacy advantage over citalopram and paroxetine, but no consistent advantage over other selective serotonin reuptake inhibitors. Escitalopram has at least comparable efficacy to available serotonin-norepinephrine reuptake inhibitors, venlafaxine XR and duloxetine, and may offer some tolerability advantages over these agents. This review suggests that the mechanistic advantages of escitalopram over citalopram translate into clinical efficacy advantages. Escitalopram may have a favourable benefit-risk ratio compared with citalopram and possibly with several other antidepressant agents. PMID:20147575

  16. Escitalopram--translating molecular properties into clinical benefit: reviewing the evidence in major depression.

    LENUS (Irish Health Repository)

    Leonard, Brian

    2010-08-01

    The majority of currently marketed drugs contain a mixture of enantiomers; however, recent evidence suggests that individual enantiomers can have pharmacological properties that differ importantly from enantiomer mixtures. Escitalopram, the S-enantiomer of citalopram, displays markedly different pharmacological activity to the R-enantiomer. This review aims to evaluate whether these differences confer any significant clinical advantage for escitalopram over either citalopram or other frequently used antidepressants. Searches were conducted using PubMed and EMBASE (up to January 2009). Abstracts of the retrieved studies were reviewed independently by both authors for inclusion. Only those studies relating to depression or major depressive disorder were included. The search identified over 250 citations, of which 21 studies and 18 pooled or meta-analyses studies were deemed suitable for inclusion. These studies reveal that escitalopram has some efficacy advantage over citalopram and paroxetine, but no consistent advantage over other selective serotonin reuptake inhibitors. Escitalopram has at least comparable efficacy to available serotonin-norepinephrine reuptake inhibitors, venlafaxine XR and duloxetine, and may offer some tolerability advantages over these agents. This review suggests that the mechanistic advantages of escitalopram over citalopram translate into clinical efficacy advantages. Escitalopram may have a favourable benefit-risk ratio compared with citalopram and possibly with several other antidepressant agents.

  17. Pharmacologic treatments effective in both generalized anxiety disorder and major depressive disorder: clinical and theoretical implications.

    Science.gov (United States)

    Casacalenda, N; Boulenger, J P

    1998-09-01

    To review the efficacy of anxiolytics (alprazolam and azapirones) in major depressive disorder (MDD) and that of antidepressants in generalized anxiety disorder (GAD), thereby exploring the possible theoretical and clinical implications of this efficacy. A Medline literature search was performed for the period January 1980 to September 1997 of randomized, double-blind comparison studies between anxiolytics and antidepressants in the acute treatment of adult patients with either MDD or GAD. Alprazolam, at doses double those generally recommended for anxiety disorders, appears to be as effective as tricyclic antidepressants (TCAs) in the acute treatment of mild to moderate MDD. Alprazolam was also found to have a more rapid onset of action than to TCAs, particularly for the improvement of anxiety, somatization, and insomnia. Two azapirones (buspirone and gepirone) also have demonstrated a modest acute antidepressant effect in preliminary studies, albeit only in a depressed outpatient sample with considerable anxiety at baseline. Finally, various antidepressant drugs (imipramine, trazodone, paroxetine) were shown to have, at the least, comparable efficacy to benzodiazepines (BZDs) in the acute treatment of GAD. The nonspecificity of treatment response suggests that GAD and MDD are 1) different expressions of a similar disorder with a common neurobiological substrate, 2) discrete diagnostic entities that respond to independent pharmacological effects of the same drugs, or 3) a combination of the two (heterogeneity hypothesis). The most relevant clinical finding is the efficacy of antidepressants in the acute treatment of GAD.

  18. Clinical use of nutraceuticals in the adjunctive treatment of depression in mood disorders.

    Science.gov (United States)

    Sarris, Jerome

    2017-08-01

    The aim of this paper is to detail a summary of the current evidence in this area, to better inform clinical practice. Our recent systematic reviews and meta-analyses of nutrient pharmacotherapies in the treatment unipolar depression revealed primarily positive results for replicated studies testing S-adenosyl methionine (SAMe), methylfolate, omega-3 (EPA or ethyl-EPA), and Vitamin D; with supportive isolated studies found for creatine and an amino acid combination. Mixed results were found for zinc, folic acid, Vitamin C, and tryptophan; and non-significant study results for inositol. In bipolar depression, omega-3 and N-acetyl cysteine (NAC) were found to have supportive evidence, with an isolated study using a chelated mineral formula also displaying efficacy. No major adverse effects were noted in the studies (aside from occasional minor digestive disturbances with omega-3 and NAC). Several clinical considerations are needed when psychiatrists are considering prescribing nutrients, including knowledge of drug interactions, supplement safety and quality issues, individual psychological and biochemical individualities, in addition to cost factors.

  19. Attachment-based family therapy for depressed and suicidal adolescents: theory, clinical model and empirical support.

    Science.gov (United States)

    Ewing, E Stephanie Krauthamer; Diamond, Guy; Levy, Suzanne

    2015-01-01

    Attachment-Based Family Therapy (ABFT) is a manualized family-based intervention designed for working with depressed adolescents, including those at risk for suicide, and their families. It is an empirically informed and supported treatment. ABFT has its theoretical underpinnings in attachment theory and clinical roots in structural family therapy and emotion focused therapies. ABFT relies on a transactional model that aims to transform the quality of adolescent-parent attachment, as a means of providing the adolescent with a more secure relationship that can support them during challenging times generally, and the crises related to suicidal thinking and behavior, specifically. This article reviews: (1) the theoretical foundations of ABFT (attachment theory, models of emotional development); (2) the ABFT clinical model, including training and supervision factors; and (3) empirical support.

  20. Clinical and CNS effects of oral and I.V. Thyrotropin-releasing hormone in depressed patients.

    Science.gov (United States)

    Itil, T M; Patterson, C D; Polvan, N; Bigelow, A; Bergey, B

    1975-09-01

    Both oral and intravenous TRH produce systematic alterations in brain function of depressive patients as determined by scalp-recorded computerized cerebral biopotentials (computer EEG). The computer EEG (CEEG) profiles of both formulations are not only very similar to each other, but also resemble the CEEG profiles of psychostimulant compounds (Bio-availability). As in CEEG findings, TSH plasma levels also indicate that oral TRH is indeed an active compound. Although some "antidepressive" effects were observed after both formulations, they were not present in every patient, and it was not always the case after repetitive TRH administration, nor were the effects on depressed mood too impressive. On the other hand, in almost all patients certain behavioral effects of TRH were seen which related to "life instincts" and "life performance". The increase of interest, desire and drive for work, food and sex was one of the most striking findings, particularly after intravenous TRH. This may be responsible for the "antidepressive" effects of TRH in patients in whom depression may be the result of an inhibition of "instinctive" functions.

  1. The Relationship Between the Religious Beliefs of the Diabetic Patients and Depression in a Diabetes Clinic in Iran.

    Science.gov (United States)

    Kiani, Fatemeh; Hesabi, Nasrin

    2017-08-01

    Nowadays, diabetes is prevalent, and it can leave severe psychotic effects and causes depression; thus, it is necessary to consider effective factors to fight against diabetic patients' mental conditions. It seems that the role of religion is significant, and by augmenting religious attitudes, diabetic patient's depression intensity can be decreased. The purpose of the present study is to examine the relationship between religious beliefs and depression of diabetic patients in diabetes clinic of Ali Asghar Hospital in Zahedan. This is a descriptive analytical and cross-sectional study. Out of total 350 diabetic patients, 70 were selected by easy sampling method. Data gathering tool was Bach's religious beliefs and depression standard questionnaires. K 2 statistical test and Pearson's correlation index have been used for data analysis. SPSS software version 16 was used to analyze the data. The results of the study showed that there was not any relationship among age, sex, education, illness duration and family member's history of depression and depression. Results of the study showed that stronger religious beliefs decrease the depression severity (P religious attitudes by proper plans to decrease depression, and some strategies are presented in the study for these plans.

  2. Development and Validation of the Sleep Inertia Questionnaire (SIQ) and Assessment of Sleep Inertia in Analogue and Clinical Depression.

    Science.gov (United States)

    Kanady, Jennifer C; Harvey, Allison G

    2015-10-01

    Sleep inertia is the transitional state from sleep to wake. Research on sleep inertia is important in depression because many people with depression report having difficulty getting out of bed, which contributes to impairment and can impede the implementation of interventions. The first aim was to develop and validate the first self-report measure of sleep inertia, the Sleep Inertia Questionnaire (SIQ). The second aim was to compare reports of sleep inertia across three groups: (1) No-to-Mild-Depression, (2) Analogue-Depression, and (3) Syndromal-Depression. The SIQ demonstrates strong psychometric properties; it has good to excellent internal consistency, strong construct validity, and SIQ severity is associated with less prior sleep duration. Sleep inertia is more severe in the Analogue-Depression and Syndromal-Depression groups compared to the No-to-Mild-Depression group. In conclusion, the SIQ is a reliable measure of sleep inertia and has potential for improving the assessment of sleep inertia in clinical and research settings.

  3. Neurocognitive Predictors of Clinical Improvement in Selective Serotonin Reuptake Inhibitor-Treated Adolescents with Major Depressive Disorder.

    Science.gov (United States)

    Maalouf, Fadi; Bakhti, Rinad; Tamim, Hani; Shehab, Safa; Brent, David

    2018-04-13

    Numerous studies have suggested cognitive deficits as consistently associated with adolescent depression. No study to date, however, has assessed neurocognitive predictors of selective serotonin reuptake inhibitor (SSRI) treatment response in adolescents with depression. This study examined neurocognitive tasks at baseline as predictors of clinical improvement with SSRI treatment (fluoxetine) at week 6 and 12 in an adolescent population. Adolescents with depression were recruited from a child and adolescent psychiatry outpatient clinic at a university medical center. Twenty-four adolescents (mean age 14.8 years) with Major Depressive Disorder completed tasks of the Cambridge Neuropsychological Test Automated Battery, including visual memory, executive functioning, sustained attention, and impulsivity. Depression severity, measured by the Children's Depression Rating Scale-Revised (CDRS-R), was assessed at week 6 and 12 and clinical improvement was defined as percentage (%) change in CDRS-R from baseline. Clinical improvement is noted at both week 6 (mean % change in CDRS-R [M] = 46.8, standard deviation [SD] = 51.9) and week 12 (M = 87.9, SD = 57.2). Results reveal that less difficulty in sustained attention (p = 0.02), lower impulsivity (p = 0.00), and better planning (p = 0.04) at baseline were predictors of greater clinical improvement at week 6. Lower impulsivity at baseline remained significantly predictive of clinical improvement at week 12 (p = 0.01). Neurocognitive assessments could potentially help identify a subset of depressed adolescents who may not respond to conventional SSRI treatment and who may be better candidates for alternative or augmentation treatments.

  4. Impact of collaborative care for depression on clinical, functional, and work outcomes: a practice-based evaluation.

    Science.gov (United States)

    Shippee, Nathan D; Shah, Nilay D; Angstman, Kurt B; DeJesus, Ramona S; Wilkinson, John M; Bruce, Steven M; Williams, Mark D

    2013-01-01

    The impact of collaborative care (CC) on depression and work productivity in routine, nonresearch primary care settings remains unclear due to limited evidence. This prospective study examined depression and work outcomes (eg, absenteeism, presenteeism) for 165 individuals in CC for depression versus 211 patients in practice as usual in a multisite primary care practice. CC predicted greater adjusted 6-month improvements in treatment response, remission, and absenteeism versus practice as usual. Response/remission increased productivity overall. CC increased clinical and work improvements in a nonresearch care setting. Insurers and employers should consider CC's work benefits in developing payment structures.

  5. Efficacy and Safety of Basimglurant as Adjunctive Therapy for Major Depression: A Randomized Clinical Trial.

    Science.gov (United States)

    Quiroz, Jorge A; Tamburri, Paul; Deptula, Dennis; Banken, Ludger; Beyer, Ulrich; Rabbia, Michael; Parkar, Nikhat; Fontoura, Paulo; Santarelli, Luca

    2016-07-01

    Antagonism of the postsynaptic metabotropic glutamate subtype 5 receptor is a novel approach to modulate glutamatergic function and has proven efficacy in a number of preclinical behavioral models of depression. To evaluate the safety and efficacy of basimglurant modified-release (MR) vs placebo as adjunctive therapy to ongoing antidepressant medication therapy in patients with MDD who had inadequate response within the current episode. In this phase 2b, double blind, randomized clinical trial of 333 adult patients with a DSM-IV-TR diagnosis of MDD across 59 research clinics globally, patients were assigned to 1 of 2 doses of basimglurant MR (0.5 or 1.5 mg) or placebo once daily, adjunctive to ongoing antidepressant medication therapy (selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor). Patients were enrolled from October 5, 2011, through July 26, 2013. Six-week treatment with 0.5 mg of basimglurant MR, 1.5-mg basimglurant MR, or placebo once daily, adjunctive to ongoing antidepressant medication therapy. The primary end point was the mean change from baseline score on the Montgomery-Åsberg Depression Rating Scale (MADRS), as rated by the clinician at week 6. Other measures included patient-rated MADRS, Quick Inventory of Depressive Symptomatology-Self-Report, Clinical Global Impression-Improvement, Patient Global Impression-Improvement, and Clinical Global Impression-Severity Scales and adverse events. A total of 596 patients were screened, and 333 were randomized into the study (mean [SD] age, 47 [11.2] years; 216 female [65.1%]). The primary end point (mean change in clinician-rated MADRS score from baseline to end of treatment) was not met (effect size [ES] = 0.16, P = .42; intent-to-treat [ITT] mixed-effects model for repeated measures [MMRM] analysis for comparing 1.5-mg basimglurant MR and placebo). Across secondary and exploratory end points, 1.5-mg basimglurant MR revealed larger improvements vs placebo on

  6. Using an imaginary scrapbook for neurolinguistic programming in the aftermath of a clinical depression: a case history.

    Science.gov (United States)

    Hossack, A; Standidge, K

    1993-04-01

    We employed neurolinguistic programming (NLP) principles to develop a positive self-identity in an elderly male patient in England recovering from clinical depression. This novel technique encouraged recall of intrinsically rewarding past experiences. Each experience was conceptualized in an image and compiled chronologically in an imaginary book, providing continuity to what were chaotic and fragmented recollections during the immediate postdepressive stage. The patient's anxiety and depression were alleviated and his own functional goals largely realized.

  7. The Effect of Debriefing and Brief Cognitive-Behavioral Therapy on Postpartum Depression in Traumatic Childbirth: A Randomized Clinical Trial

    OpenAIRE

    Sedigheh Abdollahpour; Afsaneh Keramat; Seyyed Abbas Mousavi; Ahmad Khosravi; zahra motaghi

    2018-01-01

    Background & aim: Childbirth is a stressful event in women’s lives, and if a mother perceives it as an unpleasant event, it can influence her postpartum mental health. Depression is a common mental disorder, which can has serious consequences depending on its severity. Therefore, this study aimed to investigate the effect of debriefing and brief cognitive-behavioral therapy on postpartum depression in traumatic childbirth. Methods: This clinical trial was performed on 179 mothers who experien...

  8. ?Third wave? cognitive therapy versus mentalization-based therapy for major depressive disorder. A protocol for a randomised clinical trial

    OpenAIRE

    Jakobsen, Janus Christian; Gluud, Christian; Kongerslev, Mickey; Larsen, Kirsten Aaskov; S?rensen, Per; Winkel, Per; Lange, Theis; S?gaard, Ulf; Simonsen, Erik

    2012-01-01

    Abstract Background Most interventions for depression have shown small or no effects. ‘Third wave‘ cognitive therapy and mentalization-based therapy have both gained some ground as treatments of psychological problems. No randomised trial has compared the effects of these two interventions for patients with major depression. Methods/ design We plan a randomised, parallel group, assessor-blinded superiority clinical trial. During two years we will include 84 consecutive adult participants diag...

  9. Cognitive-Behavioral Therapy for Depression in an Older Gay Man: A Clinical Case Study

    Science.gov (United States)

    Satterfield, Jason M.; Crabb, Rebecca

    2010-01-01

    Although strong evidence supports cognitive-behavioral therapy for late-life depression and depression in racial and ethnic minorities, there are no empirical studies on the treatment of depression in older sexual minorities. Three distinct literatures were tapped to create a depression treatment protocol for an older gay male. Interventions were…

  10. To what extent do single symptoms from a depression rating scale predict risk of long-term sickness absence among employees who are free of clinical depression?

    DEFF Research Database (Denmark)

    Rugulies, R; Hjarsbech, PU; Aust, B

    2013-01-01

    PURPOSE: Depression rating scales have predicted long-term sickness absence (LTSA) in previous studies. With this study, we investigated to what extent single symptoms from a depression rating scale predicted LTSA among employees who were free of clinical depression. METHODS: We studied 6...... symptoms, three predicted LTSA after adjustment for covariates: "felt low in spirits and sad" (HR = 1.41, 95 % CI = 1.05-1.89), "felt lacking in energy and strength" (HR = 1.33, 95 % CI = 1.08-1.64), and "had trouble sleeping at night" (HR = 1.38, 95 % CI = 1.09-1.74). CONCLUSION: Among female eldercare...... workers free of clinical depression, feelings of low spirits and sadness, feelings of lack of energy and strength, and sleep disturbances predict risk of LTSA. Interventions that decrease the prevalence of these symptoms might contribute to a reduction in LTSA in this population....

  11. Diffuse glioblastoma resembling acute hemorrhagic leukoencephalitis.

    Science.gov (United States)

    Schettino, Carla; Caranci, Ferdinando; Lus, Giacomo; Signoriello, Elisabetta; Eoli, Marica; Anghileri, Elena; Pollo, Bianca; Melone, Mariarosa A B; Di Iorio, Giuseppe; Finocchiaro, Gaetano; Ugga, Lorenzo; Tedeschi, Enrico

    2017-10-01

    We report the case of a young man with sudden onset of diplopia after an upper respiratory tract infection. Based on the first radiological findings acute hemorrhagic leukoencephalitis, a variant of acute disseminated encephalomyelitis, was suspected and treatment with high dose intravenous dexamethasone was started but it was stopped for intolerance. The patient clinically worsened, developing gait instability, ataxia and ophthalmoplegia; brain MRI performed 20 days later showed severe progression of the disease with subependymal dissemination. After brain biopsy of the right temporal lesion the histological diagnosis was glioblastoma. These findings suggest that MRI features of acute hemorrhagic leukoencephalitis may dissimulate the diagnosis of diffuse glioma/glioblastoma. This case underscores the importance of considering diffuse glioma in the differential diagnosis of atypical signs and symptoms of acute hemorrhagic leukoencephalitis and underlines the relevant role of integrating neuroradiologic findings with neuropathology.

  12. Rumination as a Mediator between Childhood Trauma and Adulthood Depression/Anxiety in Non-clinical Participants

    Science.gov (United States)

    Kim, Ji S.; Jin, Min J.; Jung, Wookyoung; Hahn, Sang W.; Lee, Seung-Hwan

    2017-01-01

    Objective: Although there is strong evidence that childhood trauma is associated with the development of depression and anxiety, relatively few studies have explored potential mediating factors for this relationship. The present study aimed to evaluate the mediating role of rumination in the link between childhood trauma and mood status such as depression, anxiety and affective lability. Materials and Methods: Two hundred and seven non-clinical participants completed the Childhood Trauma Questionnaire, the Ruminative Response Scale, the Beck Depression Inventory, the State Anxiety Inventory, and the Affective Lability Scale. Structural equation modeling was used to evaluate the results. Results: Our results supported that rumination is a meaningful mediator between childhood trauma and depression/anxiety in non-clinical participants. The mediation model indicated that childhood trauma and its subtypes are linked to depression and anxiety through three subtypes of rumination, thereby supporting a significant indirect relationship (Standardized coefficient [SC] = 0.56, p childhood trauma and mood symptoms was also significant in a model including rumination (SC = 0.68, p childhood trauma and mood was more predominant in female participants. Conclusions: The present study found that rumination mediates the influence of childhood trauma on the development of mood symptoms in non-clinical participants. Childhood trauma appears to be a critical determinant for developing symptoms of depression and anxiety. PMID:28993746

  13. Autosomal dominant syndrome resembling Coffin-Siris syndrome.

    Science.gov (United States)

    Flynn, Maureen A; Milunsky, Jeff M

    2006-06-15

    Coffin-Siris syndrome is a multiple congenital anomaly/mental retardation syndrome with phenotypic variability [OMIM 135900]. The diagnosis is based solely on clinical findings, as there is currently no molecular, biochemical, or cytogenetic analysis available to confirm a diagnosis. Although typically described as an autosomal recessive disorder, autosomal dominant inheritance has also been infrequently reported. We describe a mother and her two daughters who all have features that resemble Coffin-Siris syndrome. However, this is not a completely convincing diagnosis given that hypertelorism is not a feature of Coffin-Siris syndrome and the family is relatively mildly affected. Yet, this family provides further evidence of an autosomal dominant mode of inheritance for a likely variant of Coffin-Siris syndrome (at least in some families). In addition, Sibling 1 had premature thelarche. She is the second reported individual within the spectrum of Coffin-Siris syndrome to have premature thelarche, indicating that it may be a rare clinical feature. Copyright 2006 Wiley-Liss, Inc.

  14. Transcutaneous vagus nerve stimulation for the treatment of depression: a study protocol for a double blinded randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Rong Pei-Jing

    2012-12-01

    Full Text Available Abstract Background Depressive disorders are the most common form of mental disorders in community and health care settings. Unfortunately, the treatment of Major Depressive Disorder (MDD is far from satisfactory. Vagus nerve stimulation (VNS is a relatively new and promising physical treatment for depressive disorders. One particularly appealing element of VNS is the long-term benefit in mood regulation. However, because this intervention involves surgery, perioperative risks, and potentially significant side effects, this treatment has been limited to those patients with treatment-resistant depression who have failed medication trials and exhausted established somatic treatments for major depression, due to intolerance or lack of response. This double-blinded randomized clinical trial aims to overcome these limitations by introducing a novel method of stimulating superficial branches of the vagus nerve on the ear to treat MDD. The rationale is that direct stimulation of the afferent nerve fibers on the ear area with afferent vagus nerve distribution should produce a similar effect as classic VNS in reducing depressive symptoms without the burden of surgical intervention. Design One hundred twenty cases (60 males of volunteer patients with mild and moderate depression will be randomly divided into transcutaneous vagus nerve stimulation group (tVNS and sham tVNS group. The treatment period lasts 4 months and all clinical and physiological measurements are acquired at the beginning and the end of the treatment period. Discussion This study has the potential to significantly extend the application of VNS treatment for MDD and other disorders (including epilepsy, bipolar disorder, and morbid obesity, resulting in direct benefit to the patients suffering from these highly prevalent disorders. In addition, the results of this double-blinded clinical trial will shed new light on our understanding of acupuncture point specificity, and development of

  15. The Preclinical and Clinical Effects of Vilazodone for the Treatment of Major Depressive Disorder.

    Science.gov (United States)

    Sahli, Zeyad T; Banerjee, Pradeep; Tarazi, Frank I

    2016-01-01

    Major depressive disorder (MDD) is the leading cause of disability worldwide, and according to the STAR*D trial, only 33% of patients with MDD responded to initial drug therapy. Augmentation of the leading class of antidepressant treatment, selective serotonin reuptake inhibitors (SSRIs), with the 5-HT1A receptor agonist buspirone has been shown to be effective in treating patients that do not respond to initial SSRI therapy. This suggests that newer treatments may improve the clinical picture of MDD. The US Food and Drug Administration (FDA) approved the antidepressant drug vilazodone (EMD 68843), a novel SSRI and 5-HT1A receptor partial agonist. Vilazodone has a half-life between 20-24 hours, reaches peak plasma concentrations at 3.7-5.3 hours, and is primarily metabolized by the hepatic CYP450 3A4 enzyme system. The authors review the preclinical and clinical profile of vilazodone. The roles of serotonin, the 5-HT1A receptor, and current pharmacotherapy approaches for MDD are briefly reviewed. Next, the preclinical pharmacological, behavioral, and physiological effects of vilazodone are presented, followed by the pharmacokinetic properties and metabolism of vilazodone in humans. Last, a brief summary of the main efficacy, safety, and tolerability outcomes of clinical trials of vilazodone is provided. Vilazodone has shown efficacy versus placebo in improving depression symptoms in several double-blind, placebo-controlled trials. The long-term safety and tolerability of vilazodone treatment has also been established. Further studies are needed that directly compare patients treated with an SSRI (both with and without an adjunctive 5-HT1A partial agonist) versus patients treated with vilaozodone.

  16. Clinical Findings Documenting Cellular and Molecular Abnormalities of Glia in Depressive Disorders

    Directory of Open Access Journals (Sweden)

    Boldizsár Czéh

    2018-02-01

    Full Text Available Depressive disorders are complex, multifactorial mental disorders with unknown neurobiology. Numerous theories aim to explain the pathophysiology. According to the “gliocentric theory”, glial abnormalities are responsible for the development of the disease. The aim of this review article is to summarize the rapidly growing number of cellular and molecular evidences indicating disturbed glial functioning in depressive disorders. We focus here exclusively on the clinical studies and present the in vivo neuroimaging findings together with the postmortem molecular and histopathological data. Postmortem studies demonstrate glial cell loss while the in vivo imaging data reveal disturbed glial functioning and altered white matter microstructure. Molecular studies report on altered gene expression of glial specific genes. In sum, the clinical findings provide ample evidences on glial pathology and demonstrate that all major glial cell types are affected. However, we still lack convincing theories explaining how the glial abnormalities develop and how exactly contribute to the emotional and cognitive disturbances. Abnormal astrocytic functioning may lead to disturbed metabolism affecting ion homeostasis and glutamate clearance, which in turn, affect synaptic communication. Abnormal oligodendrocyte functioning may disrupt the connectivity of neuronal networks, while microglial activation indicates neuroinflammatory processes. These cellular changes may relate to each other or they may indicate different endophenotypes. A theory has been put forward that the stress-induced inflammation—mediated by microglial activation—triggers a cascade of events leading to damaged astrocytes and oligodendroglia and consequently to their dysfunctions. The clinical data support the “gliocentric” theory, but future research should clarify whether these glial changes are truly the cause or simply the consequences of this devastating disorder.

  17. Rumination as a Vulnerability Factor to Depression in Adolescents in Mainland China: Lifetime History of Clinically Significant Depressive Episodes

    Science.gov (United States)

    Hong, Wei; Abela, John R. Z.; Cohen, Joseph R.; Sheshko, Dana M.; Shi, Xiao Ting; Hamel, Anton Van; Starrs, Claire

    2010-01-01

    The current study tested the vulnerability and sex differences hypotheses of the response styles theory of depression (Nolen-Hoeksema, 1991). Participants included 494 tenth-grade students (M = 15.25 years, SD = 0.47) recruited from two secondary schools in Beijing, China. Participants completed self-report measures assessing rumination and…

  18. Eating disorders with and without comorbid depression and anxiety: similarities and differences in a clinical sample of children and adolescents.

    Science.gov (United States)

    Hughes, Elizabeth K; Goldschmidt, Andrea B; Labuschagne, Zandre; Loeb, Katharine L; Sawyer, Susan M; Le Grange, Daniel

    2013-09-01

    This study aimed to describe and compare the demographic and clinical characteristics of children and adolescents with an eating disorder (ED) and comorbid depression or anxiety. Data were drawn from intake assessments of children and adolescents at a specialist ED clinic. Demographic characteristics (e.g. age and gender) and clinical characteristics (e.g. body mass, binge eating and purging) were compared between 217 ED participants without comorbidity, 32 with comorbid anxiety, 86 with comorbid depression and 36 with comorbid anxiety and depression. The groups with comorbid depression had more complex and severe presentations compared with those with an ED and no comorbid disorder and those with comorbid anxiety alone, especially in regard to binge eating, purging, dietary restraint and weight/shape concerns. Depression and anxiety were differentially related to clinical characteristics of EDs. The findings have implications for understanding the relations between these disorders and their potential to impact outcome of ED treatments. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.

  19. Social Problem Solving and Depressive Symptoms over Time: A Randomized Clinical Trial of Cognitive-Behavioral Analysis System of Psychotherapy, Brief Supportive Psychotherapy, and Pharmacotherapy

    Science.gov (United States)

    Klein, Daniel N.; Leon, Andrew C.; Li, Chunshan; D'Zurilla, Thomas J.; Black, Sarah R.; Vivian, Dina; Dowling, Frank; Arnow, Bruce A.; Manber, Rachel; Markowitz, John C.; Kocsis, James H.

    2011-01-01

    Objective: Depression is associated with poor social problem solving, and psychotherapies that focus on problem-solving skills are efficacious in treating depression. We examined the associations between treatment, social problem solving, and depression in a randomized clinical trial testing the efficacy of psychotherapy augmentation for…

  20. The Validity of the Different Versions of the Hamilton Depression Scale in Separating Remission Rates of Placebo and Antidepressants in Clinical Trials of Major Depression

    DEFF Research Database (Denmark)

    Kyle, Phillip Raphael; Lemming, Ole Michael; Timmerby, Nina

    2016-01-01

    . The traditional HAM-D17 version was compared with the shorter HAM-D6 and the longer HAM-D21 or HAM-D24 in a fixed-dose placebo-controlled vortioxetine study. Clinical Global Impression of Severity scores were used to establish standardized cutoff scores for remission across each scale. Using these cutoff scores......Our objective was to validate the different versions of the Hamilton Depression Scale (HAM-D) both psychometrically (scalability) and clinically in discriminating antidepressants from placebo in terms of remission rates in an 8-week clinical trial in the acute treatment of major depression...... in the longer HAM-D versions indicated smaller discriminating validity over placebo. The HAM-D6 indicated a dose effect on remission for vortioxetine in both moderate and severe major depression. The brief HAM-D6 was thus found superior to HAM-D17, HAM-D21, and HAM-D24 both in terms of scalability...

  1. Clinical utility of the Hospital Anxiety and Depression Scale (HADS) for an outpatient fibromyalgia education program.

    Science.gov (United States)

    Nam, Seungree; Tin, Diane; Bain, Lorna; Thorne, J Carter; Ginsburg, Liane

    2014-05-01

    This paper examines the clinical utility of the Hospital Anxiety and Depression Scale (HADS) in the context of evaluating the Fibromyalgia Outpatient Education Program at Southlake Regional Health Centre (Newmarket, Canada). A pre-test/post-test design was implemented for data analysis. A total of 232 patients' data were obtained through retrospective patient chart review. Complete pre-post data were available for 70 patients and qualitative analysis was done for 12 patients. Main outcome measures included HADS and Arthritis Self-Efficacy (ASE) scores. At the end of the education program, subgroups of patients (high attendance, high exercise habit, low medication) experienced significant improvement on HADS-depression and ASE scores. Linear regression analysis found that HADS pre-program scores explain far more variance in HADS post-test scores than ASE pre-program scores explain in ASE post-program scores; more variance in ASE post-program scores was explained by other variables. In contrast to the quantitative analysis of the Anxiety subscale of HADS, patients in the focus group indicated that their anxiety level decreased through attending the education program. These findings suggest that HADS is an appropriate tool for evaluating fibromyalgia and related patient education programs. Moreover, patient education programs have positive effects on enhancing patients' psychological well-being and self-confidence in controlling fibromyalgia-related symptoms.

  2. Clinical relevance of fatigue as a residual symptom in major depressive disorder.

    Science.gov (United States)

    Fava, Maurizio; Ball, Susan; Nelson, J Craig; Sparks, Jondavid; Konechnik, Thomas; Classi, Peter; Dube, Sanjay; Thase, Michael E

    2014-03-01

    Residual symptoms of major depressive disorder (MDD) following treatment are increasingly recognized as having a negative impact on the patient because of their association with lack of remission, poorer psychosocial functioning, and a more chronic course of depression. Although the effects of specific residual symptoms have not been as systematically studied, several symptoms, including fatigue, sleep disturbance, anxiety, and concentration difficulties, commonly occur as part of the residual state in MDD. In particular, the relatively high prevalence of residual fatigue suggests that this symptom is not being adequately addressed by standard antidepressant therapies. A review of the clinical relevance of residual fatigue was undertaken, using the published literature with respect to its assessment, neurobiology, and treatment implications. The findings of this review suggest that fatigue is highly prevalent as a residual symptom; its response to treatment is relatively poor or delayed; and the presence of residual fatigue is highly predictive of inability to achieve remission with treatment as well as impaired psychosocial functioning. Recognition of the significant consequences of residual fatigue should reinforce the need for further therapeutic interventions to help reduce the impact of this symptom of MDD. © 2013 Wiley Periodicals, Inc.

  3. Long-term effects of cognitive therapy on biological rhythms and depressive symptoms: A randomized clinical trial.

    Science.gov (United States)

    Mondin, Thaíse Campos; Cardoso, Taiane de Azevedo; Jansen, Karen; Silva, Giovanna Del Grande da; Souza, Luciano Dias de Mattos; Silva, Ricardo Azevedo da

    2015-11-15

    To evaluate the effect of cognitive therapy on biological rhythm and depressive and anxious symptoms in a twelve-month follow-up period. In addition, correlations between the reduction of depression and anxiety symptoms and the regulation of biological rhythm were observed. This was a randomized clinical trial with young adults from 18 to 29 years of age who were diagnosed with depression. Two models of psychotherapy were used: Cognitive Behavioral Therapy (CBT) and Narrative Cognitive Therapy (NCT). Biological rhythm was assessed with the Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN). Severity of depressive and anxious symptoms was assessed by the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS), respectively. The sample included 97 patients who were divided within the protocols of psychotherapy. There was a significant reduction in depressive and anxious symptoms (pbiological rhythm (pbiological rhythm (r=0.638; pbiological rhythm (r=0.438; pbiological rhythm at a twelve-month follow-up evaluation. This study highlights the association between biological rhythm and symptoms of depression and anxiety. We did not assess genetic, hormonal or neurochemical factors and we did not include patients under pharmaceutical treatment or those with severe symptomatology. Copyright © 2015 Elsevier B.V. All rights reserved.

  4. Depressive symptoms in patients with systemic sclerosis: Association between clinical variables, functional status and the quality of life

    Directory of Open Access Journals (Sweden)

    Mustafa Akif Sarıyıldız

    2013-03-01

    Full Text Available Objective: The aim of this study is to evaluate the relationshipbetween the depressive symptoms with diseaserelatedvariables, functional status and quality of life inpatients with systemic sclerosis (SSc.Material and methods: Forty patients diagnosed withSSc and 36 healthy control subjects were enrolled in thestudy. The demographic and clinical characteristics of thepatients such as the Raynaud’s phenomenon, SSc subtype,digital ulcers, gastrointestinal and lung involvementand disease activity were recorded. All patients were assessedusing the Short Form-36 Quality of Life (SF-36QoL scale, the Health Assessment Questionnaire (HAQand the Beck Depression Inventory (BDI. Generalizedpain and fatigue was assessed with the Visual AnalogueScale.Results: The patients with SSc had significantly higherscores in the depressive symptoms in terms of the BDIscore compared to the healthy control group. Accordingto the results of Spearman’s analysis, there was a significantlycorrelation between the depressive symptomswith education level, generalized pain, dyspnea, diseaseactivity score, gastroesophageal reflux, dysphagia, functionalstatus, mental and physical score of the SF-36.Conclusion: Depressive symptoms is enhanced in patientswith SSc. Depressive symptoms is especially associatedwith the generalised pain, disease activity, dysphagia,functional status, mental and quality of life in patientswith SSc.Key words: Systemic sclerosis, depressive symptom,pain, functional status, quality of life

  5. DEPRESSION MEDIATES THE RELATION OF INSOMNIA SEVERITY WITH SUICIDE RISK IN THREE CLINICAL SAMPLES OF U.S. MILITARY PERSONNEL.

    Science.gov (United States)

    Bryan, Craig J; Gonzales, Jacqueline; Rudd, M David; Bryan, AnnaBelle O; Clemans, Tracy A; Ray-Sannerud, Bobbie; Wertenberger, Evelyn; Leeson, Bruce; Heron, Elizabeth A; Morrow, Chad E; Etienne, Neysa

    2015-09-01

    A growing body of empirical research suggests insomnia severity is directly related to suicide ideation, attempts, and death in nonmilitary samples, even when controlling for depression and other suicide risk factors. Few studies have explored this relationship in U.S. military personnel. The present study entailed secondary data analyses examining the associations of insomnia severity with suicide ideation and attempts in three clinical samples: Air Force psychiatric outpatients (n = 158), recently discharged Army psychiatric inpatients (n = 168), and Army psychiatric outpatients (n = 54). Participants completed the Beck Scale for Suicide Ideation, the Beck Depression Inventory-II or Patient Health Questionnaire-9, the Insomnia Severity Index, and the Posttraumatic Stress Disorder Checklist at baseline; two samples also completed these measures during follow-up. Sleep disturbance was associated with concurrent (β's > 0.21; P's 0.39; P's suicide ideation in all three samples. When adjusting for age, gender, depression, and posttraumatic stress, insomnia severity was no longer directly associated with suicide ideation either concurrently (β's 0.200) or prospectively (β's 0.063), but depression was (β's > 0.22; P's depression mediated the relation of insomnia severity with suicide ideation. Across three clinical samples of military personnel, depression explained the relationship between insomnia severity and suicide risk. © 2015 Wiley Periodicals, Inc.

  6. Right brain, left brain in depressive disorders: Clinical and theoretical implications of behavioral, electrophysiological and neuroimaging findings.

    Science.gov (United States)

    Bruder, Gerard E; Stewart, Jonathan W; McGrath, Patrick J

    2017-07-01

    The right and left side of the brain are asymmetric in anatomy and function. We review electrophysiological (EEG and event-related potential), behavioral (dichotic and visual perceptual asymmetry), and neuroimaging (PET, MRI, NIRS) evidence of right-left asymmetry in depressive disorders. Recent electrophysiological and fMRI studies of emotional processing have provided new evidence of altered laterality in depressive disorders. EEG alpha asymmetry and neuroimaging findings at rest and during cognitive or emotional tasks are consistent with reduced left prefrontal activity in depressed patients, which may impair downregulation of amygdala response to negative emotional information. Dichotic listening and visual hemifield findings for non-verbal or emotional processing have revealed abnormal perceptual asymmetry in depressive disorders, and electrophysiological findings have shown reduced right-lateralized responsivity to emotional stimuli in occipitotemporal or parietotemporal cortex. We discuss models of neural networks underlying these alterations. Of clinical relevance, individual differences among depressed patients on measures of right-left brain function are related to diagnostic subtype of depression, comorbidity with anxiety disorders, and clinical response to antidepressants or cognitive behavioral therapy. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Changes in depressive symptoms and correlates in HIV+ people at An Hoa Clinic in Ho Chi Minh City, Vietnam.

    Science.gov (United States)

    Huynh, Van-Anh N; To, Kien G; Do, Dung Van; To, Quyen G; Nguyen, Mai T H

    2017-01-21

    Understanding of depression among Vietnamese people living with HIV (PLWH) is limited. This longitudinal study examines changes in depressive symptoms and identifies its correlates among people living with HIV under antiretroviral therapy at An Hoa Clinic. People living with HIV ≥18 years and undergoing antiretroviral therapy for ≥3 months were eligible. Those at final AIDS stage, too ill, or illiterate were excluded due to their inability to complete the self-administered questionnaire. One researcher was present in the clinic for a month inviting PLWH to participate. Data were collected from 242 PLWH at baseline (T1) and 234 after three months (T2). Depressive symptoms was measured by the Center for Epidemiologic Studies Depression Scale (CESD). Social relationship was measured using questions created by World Health Organization. Generalized Estimating Equations were used examining changes in depressive symptoms with CESD cut-off  0.05). Those with a co-morbidity were more likely to have depressive symptoms than those without a co-morbidity (OR = 1.76, p economy, and adherence were not correlates.

  8. Pattern of Changes during Treatment: A Comparison between a Positive Psychology Intervention and a Cognitive Behavioral Treatment for Clinical Depression.

    Science.gov (United States)

    Lopez-Gomez, Irene; Chaves, Covadonga; Hervas, Gonzalo; Vazquez, Carmelo

    2017-10-26

    Research on psychotherapy has traditionally focused on analyzing changes between the beginning and the end of a treatment. Few studies have addressed the pattern of therapeutic change during treatment. The aim of this study was to examine the pattern of changes in clinical and well-being variables during a cognitive behavioral therapy (CBT) program compared with an integrative positive psychology interventions program for clinical depression IPPI-D. 128 women with a diagnosis of major depression or dysthymia were assigned to the CBT or PPI group. A measure of depressive symptoms (i.e., Beck Depression Inventory) and well-being (i.e., Pemberton Happiness Index) were administered four times: at the beginning and end of the treatment, as well as during treatment (at sessions 4 and 7). Through mixed-model repeated measures ANOVAs, both depressive symptoms (p .08). The percentage of improvement in depressive symptoms in the first treatment period was higher than in the later ones (ps < .005). On the contrary, well-being showed a more gradual improvement (p = .15). These results highlight the importance of assessing the pattern of changes in symptoms and well-being separately.

  9. 'Third wave' cognitive therapy versus mentalization-based therapy for major depressive disorder. A protocol for a randomised clinical trial.

    Science.gov (United States)

    Jakobsen, Janus Christian; Gluud, Christian; Kongerslev, Mickey; Larsen, Kirsten Aaskov; Sørensen, Per; Winkel, Per; Lange, Theis; Søgaard, Ulf; Simonsen, Erik

    2012-12-19

    Most interventions for depression have shown small or no effects. 'Third wave' cognitive therapy and mentalization-based therapy have both gained some ground as treatments of psychological problems. No randomised trial has compared the effects of these two interventions for patients with major depression. We plan a randomised, parallel group, assessor-blinded superiority clinical trial. During two years we will include 84 consecutive adult participants diagnosed with major depressive disorder. The participants will be randomised to either 'third wave' cognitive therapy versus mentalization-based therapy. The primary outcome will be the Hamilton Rating Scale for Depression at cessation of treatment at 18 weeks. Secondary outcomes will be the proportion of patients with remission, Symptom Checklist 90 Revised, Beck's Depression Inventory, and The World Health Organisation-Five Well-being Index 1999. Interventions for depression have until now shown relatively small effects. Our trial results will provide knowledge about the effects of two modern psychotherapeutic interventions. ClinicalTrials: NCT01070134.

  10. The Center for Epidemiologic Studies-Depression (CES-D) scale measures a continuum from well-being to depression: Testing two key predictions of positive clinical psychology.

    Science.gov (United States)

    Siddaway, Andy P; Wood, Alex M; Taylor, Peter J

    2017-04-15

    Two core but untested predictions of Positive Clinical Psychology (PCP) are that (1) Many psychiatric problems can be understood as one end of bipolar continua with well-being, and (2) that reducing psychiatric symptoms will provide an equal (near linear) decrease in risk for several other psychiatric variables, irrespective of position on continua. We test these predictions in relation to a purported well-being/depression continuum, as measured by the Center for Epidemiologic Studies-Depression (CES-D), a popular measure of depressive experiences in research and clinical practice. A large (N=4138), diverse sample completed the CES-D, which contains a mixture of negatively worded and positively worded items (e.g., "I felt sad," "I enjoyed life"). The latter are conventionally reverse scored to compute a total score. We first examined whether purportedly separate well-being and depression CES-D factors can be reconceptualised as a bipolar well-being/depression continuum. We then characterised the (linear or nonlinear) form of the relationship between this continuum and other psychiatric variables. Both predictions were supported. When controlling for shared method bias amongst positively worded items, a single factor well-being/depression continuum underlies the CES-D. Baseline levels on this continuum are found to have near linear relationships with changes in anxiety symptoms, aggression, and substance misuse over time, demonstrating that moving from depression to well-being on the CES-D provides an equal decrease in risk for several other psychological problems irrespective of position on the continuum. The CES-D does not measure well-being as comprehensively as established scales of well-being. Results support calls for mental health services to jointly focus on increasing well-being and reducing distress, and point to the value of early intervention and instilling resilience in order to prevent people moving away from high levels of well-being. Copyright

  11. Parental Investment and Resemblance: Replications, Refinements, and Revisions

    Directory of Open Access Journals (Sweden)

    Anthony A. Volk

    2007-01-01

    Full Text Available Evolutionary theory predicts that men should be more concerned with issues of false paternity than women should be concerned with false maternity. In an earlier study (Volk and Quinsey, 2002, we studied how infant cues of resemblance influenced adults' hypothetical adoption decisions. We found that self-perceived cues of resemblance were significantly more important in men's decisions than in women's. Since that study was published, conflicting results have been reported regarding a sex-difference in the importance of cues of resemblance for adoption preference. We therefore sought to replicate our findings in three new studies. In all three studies, we replicated the initial finding of a larger correlation between ratings of resemblance and ratings of adoption preference among men than among women. We also found a trend towards slightly higher global resemblance scores in younger children, suggesting that adults view infants as more anonymous and/or less uniquely distinctive than older children. However, there was wide variance in both the global resemblance and developmental changes in resemblance amongst the different child stimuli used.

  12. Schwannoma of the Lower Eyelid Resembling a Recurrent Chalazion : A Case Report

    OpenAIRE

    Fukuyama, Junichiro; Hayasaka, Seiji; Setogawa, Tomoichi

    1990-01-01

    A 55-year-old man complained of foreign body sensation and a solid mass in the lower eyelid of the right eye. Clinically, the lesion resembled a chalazion, and it was excised. Histopathologic examination of the excised specimen revealed a schwannoma (neurilemmoma). We believe that this is a rare case of a schwannoma of the lower eyelid simulating a chalazion.

  13. Gait analysis in a mouse model resembling Leigh disease.

    Science.gov (United States)

    de Haas, Ria; Russel, Frans G; Smeitink, Jan A

    2016-01-01

    Leigh disease (LD) is one of the clinical phenotypes of mitochondrial OXPHOS disorders and also known as sub-acute necrotizing encephalomyelopathy. The disease has an incidence of 1 in 77,000 live births. Symptoms typically begin early in life and prognosis for LD patients is poor. Currently, no clinically effective treatments are available. Suitable animal and cellular models are necessary for the understanding of the neuropathology and the development of successful new therapeutic strategies. In this study we used the Ndufs4 knockout (Ndufs4(-/-)) mouse, a model of mitochondrial complex I deficiency. Ndusf4(-/-) mice exhibit progressive neurodegeneration, which closely resemble the human LD phenotype. When dissecting behavioral abnormalities in animal models it is of great importance to apply translational tools that are clinically relevant. To distinguish gait abnormalities in patients, simple walking tests can be assessed, but in animals this is not easy. This study is the first to demonstrate automated CatWalk gait analysis in the Ndufs4(-/-) mouse model. Marked differences were noted between Ndufs4(-/-) and control mice in dynamic, static, coordination and support parameters. Variation of walking speed was significantly increased in Ndufs4(-/-) mice, suggesting hampered and uncoordinated gait. Furthermore, decreased regularity index, increased base of support and changes in support were noted in the Ndufs4(-/-) mice. Here, we report the ability of the CatWalk system to sensitively assess gait abnormalities in Ndufs4(-/-) mice. This objective gait analysis can be of great value for intervention and drug efficacy studies in animal models for mitochondrial disease. Copyright © 2015 Elsevier B.V. All rights reserved.

  14. Komorbidnost depresije in spolne disfunkcije pri pacientih ambulante za zdravljenje spolnih motenj: Comorbidity of depression and sexual dysfunction among patients of outpatient clinic for sexual disorders' treatment:

    OpenAIRE

    Lučovnik, Miha; Prokšelj, Tatjana

    2006-01-01

    Sexual dysfunction and depression often occur together, however the causal relation is unclear and has not been studied enough. Sexual dysfunction secondary to depression has been well studied, but less is known about prevalence of depressive symptoms among patients with sexual dysfunction. The aim of our study was to find out whether the depression was more common among young people with psychogenic sexual dysfunction waiting to be treated at the clinic for sexual disorders than among young ...

  15. Clinical, Functional, and Biological Correlates of Cognitive Dimensions in Major Depressive Disorder ? Rationale, Design, and Characteristics of the Cognitive Function and Mood Study (CoFaM-Study)

    OpenAIRE

    Baune, Bernhard T.; Air, Tracy

    2016-01-01

    Cross-sectional and longitudinal studies exploring clinical, functional, and biological correlates of major depressive disorder are frequent. In this type of research, depression is most commonly defined as a categorical diagnosis based on studies using diagnostic instruments. Given the phenotypic and biological heterogeneity of depression, we chose to focus the phenotypic assessments on three cognitive dimensions of depression including (a) cognitive performance, (b) emotion processing, and ...

  16. A naturalistic study of high-dose unilateral ECT among severely depressed inpatients: how does it work in the clinical practice?

    OpenAIRE

    Alves, Lucas P. C.; Freire, Thiago F. V.; Fleck, Marcelo P. A.; Rocha, Neusa S.

    2016-01-01

    Background Naturalistic studies can be useful tools to understand how an intervention works in the real clinical practice. This study aims to investigate the outcomes in a naturalistically treated depressed inpatients cohort, who were referred, or not, to unilateral ECT. Methods Depressed adults according to MINI admitted in a psychiatric unit were divided in unilateral ECT treated and non-ECT treated. Main outcomes were: depression improvement in Hamilton Rating Scale for Depression (HDRS-17...

  17. Clinical variations modulate patterns of gene expression and define blood biomarkers in major depression.

    Science.gov (United States)

    Belzeaux, Raoul; Formisano-Tréziny, Christine; Loundou, Anderson; Boyer, Laurent; Gabert, Jean; Samuelian, Jean-Claude; Féron, François; Naudin, Jean; Ibrahim, El Chérif

    2010-12-01

    The aim of the study is to compare the expression level of candidate genes between patients suffering from a severe major depressive episode (MDE) and controls, and also among patients during MDE evolution. After a comprehensive review of the biological data related to mood disorders, we initiated a hypothesis-driven exploration of candidate mRNAs. Using RT-qPCR, we analyzed peripheral blood mononuclear cells (PBMCs) mRNA obtained from a homogeneous population of 11 patients who suffered from severe melancholic MDE. To assess the evolution of MDE, we analyzed PBMC mRNAs that were collected on Day 1 and 8 weeks later. Data from these patient samples were analyzed in comparison to age- and sex-matched healthy controls. Among 40 candidate genes consistently transcribed in PBMCs, 10 were differentially expressed in at least one comparison. We found that variations of mRNA levels for NRG1, SORT1 and TPH1 were interesting state-dependent biological markers of the disease. We also observed that variations in other mRNA expression were associated with treatment efficacy or clinical improvement (CREB1, HDAC5, HSPA2, HTR1B, HTR2A, and SLC6A4/5HTT). Significantly, 5HTT exhibited a strong correlation with clinical score evolution. We also found a state-independent marker, IL10. Moreover, the analysis of 2 separate MDEs concerning a same patient revealed comparable results for the expression of CREB1, HSPA2, HTR1B, NRG1 and TPH1. Overall, our results indicate that PBMCs obtained at different time points during MDE progression represent a promising avenue to discover biological markers for depression. Copyright © 2010 Elsevier Ltd. All rights reserved.

  18. MRI findings of uterine tumor resembling ovarian sex-cord tumor: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Sung Hwan; Kim, Hee Jin; Han, Hyun Young; Hwang, In Taek; Kim, Ju Heon; Lee, Seung Yeon [Eulji University Hospital, Eulji University School of Medicine, Daejeon (Korea, Republic of)

    2017-04-15

    Uterine tumor resembling ovarian sex-cord tumor is a very rare uterine neoplasm that was first described by Clement and Scully in 1976. Since then, approximately 70 cases have been reported. However, these case reports have mainly described and discussed the pathologic and clinical features, and few radiologic findings have been presented. We experienced a case of a uterine tumor resembling ovarian sex-cord tumor, which was considered a uterine leiomyoma or leiomyosarcoma upon initial impression at preoperative evaluation including transvaginal ultrasonography and pelvic magnetic resonance imaging. Its diagnosis was pathologically confirmed after total abdominal hysterectomy.

  19. The potential of predictive analytics to provide clinical decision support in depression treatment planning.

    Science.gov (United States)

    Kessler, Ronald C

    2018-01-01

    To review progress developing clinical decision support tools for personalized treatment of major depressive disorder (MDD). Over the years, a variety of individual indicators ranging from biomarkers to clinical observations and self-report scales have been used to predict various aspects of differential MDD treatment response. Most of this work focused on predicting remission either with antidepressant medications versus psychotherapy, some antidepressant medications versus others, some psychotherapies versus others, and combination therapies versus monotherapies. However, to date, none of the individual predictors in these studies has been strong enough to guide optimal treatment selection for most patients. Interest consequently turned to decision support tools made up of multiple predictors, but the development of such tools has been hampered by small study sample sizes. Design recommendations are made here for future studies to address this problem. Recommendations include using large prospective observational studies followed by pragmatic trials rather than smaller, expensive controlled treatment trials for preliminary development of decision support tools; basing these tools on comprehensive batteries of inexpensive self-report and clinical predictors (e.g., self-administered performance-based neurocognitive tests) versus expensive biomarkers; and reserving biomarker assessments for targeted studies of patients not well classified by inexpensive predictor batteries.

  20. Identifying predictive clinical characteristics of the treatment efficacy of mirtazapine monotherapy for major depressive disorder

    Directory of Open Access Journals (Sweden)

    Tsutsumi T

    2016-10-01

    Full Text Available Takahiro Tsutsumi,1 Hiroko Sugawara,1,2 Ryoko Ito,1 Mizuho Asano,1 Satoru Shimizu,3 Jun Ishigooka,1 Katsuji Nishimura1 1Department of Psychiatry, 2Support Center for Women Health Care Professionals and Research, 3Department of Research, Medical Research Institute, Tokyo Women’s Medical University, Tokyo, Japan Background: Mirtazapine, which is classified as a noradrenergic and specific serotonergic antidepressant, is widely prescribed for the treatment of major depressive disorder. The potential predictive factors of the efficacy of mirtazapine and the tolerability based on the incidence of oversedation and jitteriness/anxiety syndrome were evaluated. Patients and methods: Patients with major depressive disorder were retrospectively investigated. Study subjects comprised 68 patients with depression who received mirtazapine as an initial antidepressant at the Department of Psychiatry of the Tokyo Women’s Medical University Hospital from September 2009 to March 2013. The efficacy of mirtazapine monotherapy was evaluated based on the Clinical Global Impression Improvement score. Clinical characteristics were compared between remission and nonremission groups to determine the factors predicting the efficacy. Moreover, discontinuation rates due to adverse effects, including oversedation and jitteriness/anxiety syndrome, were examined, and the effects of confounding factors were evaluated. Results: The remission rate of mirtazapine monotherapy was 36.8% among the 68 enrolled subjects. The mean final doses in the remission and nonremission groups were 27.6±13.5 mg and 26.0±14.1 mg, respectively, and there was no significant difference between them. Multiple logistic analyses revealed that the absence of guilt (odds ratio [OR] =0.15; 95% CI [1.66–37.24], P=0.006 and the presence of psychomotor retardation (OR =4.30; 95% CI [1.30–16.60], P=0.016 were significantly related to the efficacy of mirtazapine monotherapy. The discontinuation rates

  1. Circadian cortisol profiles, anxiety and depressive symptomatology, and body mass index in a clinical population of obese children.

    Science.gov (United States)

    Pervanidou, Panagiota; Bastaki, Despoina; Chouliaras, Giorgos; Papanikolaou, Katerina; Laios, Eleftheria; Kanaka-Gantenbein, Christina; Chrousos, George P

    2013-01-01

    Obesity is highly co-morbid with anxiety and/or depression in children, conditions that may further worsen the metabolic and cardiovascular risks for obese individuals. Dysregulation of the hypothalamic-pituitary-adrenal axis is involved in the pathophysiology of anxiety disorders, depression, and obesity, and diverse cortisol concentrations may be found in obese children, depending on their degree of psychological distress. The aim of this study was to examine cortisol profiles among obese children with or without symptoms of anxiety and depression. A group of 128 children (53% females; mean age ± SD: 11.2 ± 2.2 years) derived from a pediatric obesity clinic were studied. Anxiety and depressive symptomatology were assessed with appropriate instruments. Morning serum and five diurnal salivary cortisol concentrations were measured. Obese children were 3.1/2.3 times more likely to report state and trait anxiety, respectively, and 3.6 times more likely to report depressive symptoms than children of the same age group, from a contemporary Greek sample. Trait anxiety and noon salivary cortisol concentrations were significantly positively correlated (p = 0.002). Overall, salivary cortisol concentrations were increased in children with anxiety or depression symptomatology compared to obese children without any affective morbidity (p = 0.02) and to those with anxiety and depression co-morbidity (p = 0.02). In conclusion, in obese children, emotional distress expressed by symptoms of anxiety and/or depression is associated with circadian cortisol profiles reflecting a potential pathway for further morbidity. Longitudinal studies may reveal a role of cortisol in linking obesity, anxiety, and depression to the development of further psychological and physical morbidity.

  2. Randomised controlled trial of the clinical and cost effectiveness of a specialist team for managing refractory unipolar depressive disorder

    Directory of Open Access Journals (Sweden)

    Fox Richard

    2010-11-01

    Full Text Available Abstract Background Around 40 per cent of patients with unipolar depressive disorder who are treated in secondary care mental health services do not respond to first or second line treatments for depression. Such patients have 20 times the suicide rate of the general population and treatment response becomes harder to achieve and sustain the longer they remain depressed. Despite this there are no randomised controlled trials of community based service delivery interventions delivering both algorithm based pharmacotherapy and psychotherapy for patients with chronic depressive disorder in secondary care mental health services who remain moderately or severely depressed after six months treatment. Without such trials evidence based guidelines on services for such patients cannot be derived. Methods/design Single blind individually randomised controlled trial of a specialist depression disorder team (psychiatrist and psychotherapist jointly assessing and providing algorithm based drug and psychological treatment versus usual secondary care treatment. We will recruit 174 patients with unipolar depressive disorder in secondary mental health services with a Hamilton Depression Rating Scale (HDRS score ≥ 16 and global assessment of function (GAF ≤ 60 after ≥ 6 months treatment. The primary outcome measures will be the HDRS and GAF supplemented by economic analysis incuding the EQ5 D and analysis of barriers to care, implementation and the process of care. Audits to benchmark both treatment arms against national standards of care will aid the interpretation of the results of the study. Discussion This trial will be the first to assess the effectiveness and implementation of a community based specialist depression disorder team. The study has been specially designed as part of the CLAHRC Nottinghamshire, Derbyshire and Lincolnshire joint collaboration between university, health and social care organisations to provide information of direct relevance

  3. No association between anxiety and depression and adverse clinical outcome among patients with cardiovascular disease

    DEFF Research Database (Denmark)

    Kornerup, Henriette; Zwisler, Ann-Dorthe Olsen; Prescott, Eva

    2011-01-01

    Anxiety and depression have been linked to adverse prognostic outcome in patients with cardiovascular disease (CVD) with mixed results. The timing of anxiety and depression measurement has received little attention so far....

  4. Major depressive disorder in DSM-5: implications for clinical practice and research of changes from DSM-IV.

    Science.gov (United States)

    Uher, Rudolf; Payne, Jennifer L; Pavlova, Barbara; Perlis, Roy H

    2014-06-01

    The changes in diagnostic criteria for major depressive disorder (MDD) from the fourth to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) may appear small but have important consequences for how the diagnosis is used. In DSM-5, MDD is part of the new "Depressive disorders" section, which is separate from "Bipolar disorders", marking a division in what had been known as "Mood disorders". A small wording change has expanded the core mood criterion to include hopelessness, potentially broadening the diagnosis. The replacement of an operationalized bereavement exclusion with a call for clinical judgment in distinguishing normal reactions to significant loss from a disorder in need of clinical attention makes the diagnosis less objective and complicates investigations of the relationship between adversity and depression. A new persistent depressive disorder category is intended to encompass both dysthymia and chronic depression, but its relationship to MDD is ambiguous with conflicting statements on whether the two diagnoses should be concurrent if both sets of criteria are fulfilled. Clarification is also needed on whether MDD can be concurrent with the new broad "other specified bipolar and related disorders". New specifiers of MDD "with anxious distress" and "with mixed features" allow characterization of additional symptoms. The specifier "with perinatal onset" expands on the DSM-IV "postnatal onset" to include onset during pregnancy. We review the changes in MDD definition, provide guidance on their implementation and discuss their implications for clinical practice and research. © 2013 Wiley Periodicals, Inc.

  5. Clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients: Australian guidelines.

    Science.gov (United States)

    Butow, Phyllis; Price, Melanie A; Shaw, Joanne M; Turner, Jane; Clayton, Josephine M; Grimison, Peter; Rankin, Nicole; Kirsten, Laura

    2015-09-01

    A clinical pathway for anxiety and depression in adult cancer patients was developed to guide best practice in Australia. The pathway was based on a rapid review of existing guidelines, systematic reviews and meta-analyses, stakeholder interviews, a Delphi process with 87 multidisciplinary stakeholders and input from a multidisciplinary advisory panel. The pathway recommends formalized routine screening for anxiety and depression in patients with cancer at key points in the patient's journey. The Edmonton Symptom Assessment System or distress thermometer with problem checklist is recommended as brief screening tools, combined with a more detailed tool, such as the Hospital Anxiety and Depression Scale, to identify possible cases. A structured clinical interview will be required to confirm diagnosis. When anxiety or depression is identified, it is recommended that one person in a treating team takes responsibility for coordinating appropriate assessment, referral and follow-up (not necessarily carrying these out themselves). A stepped care model of intervention is proposed, beginning with the least intensive available that is still likely to provide significant health gain. The exact intervention, treatment length and follow-up timelines, as well as professionals involved, are provided as a guide only. Each service should identify their own referral network based on local resources and current service structure, as well as patient preference. This clinical pathway will assist cancer services to design their own systems to detect and manage anxiety and depression in their patients, to improve the quality of care. Copyright © 2015 John Wiley & Sons, Ltd.

  6. Lung irradiation induces pulmonary vascular remodelling resembling pulmonary arterial hypertension.

    Science.gov (United States)

    Ghobadi, G; Bartelds, B; van der Veen, S J; Dickinson, M G; Brandenburg, S; Berger, R M F; Langendijk, J A; Coppes, R P; van Luijk, P

    2012-04-01

    Pulmonary arterial hypertension (PAH) is a commonly fatal pulmonary vascular disease that is often diagnosed late and is characterised by a progressive rise in pulmonary vascular resistance resulting from typical vascular remodelling. Recent data suggest that vascular damage plays an important role in the development of radiation-induced pulmonary toxicity. Therefore, the authors investigated whether irradiation of the lung also induces pulmonary hypertension. Different sub-volumes of the rat lung were irradiated with protons known to induce different levels of pulmonary vascular damage. Early loss of endothelial cells and vascular oedema were observed in the irradiation field and in shielded parts of the lung, even before the onset of clinical symptoms. 8 weeks after irradiation, irradiated volume-dependent vascular remodelling was observed, correlating perfectly with pulmonary artery pressure, right ventricle hypertrophy and pulmonary dysfunction. The findings indicate that partial lung irradiation induces pulmonary vascular remodelling resulting from acute pulmonary endothelial cell loss and consequential pulmonary hypertension. Moreover, the close resemblance of the observed vascular remodelling with vascular lesions in PAH makes partial lung irradiation a promising new model for studying PAH.

  7. Extended retroperitoneal necrotizing fasciitis with genital involvement, resembling fournier gangrene.

    Science.gov (United States)

    Sugimoto, Motokazu; Matsuura, Kenji; Takayama, Hiroshi; Kayo, Munefumi; Ie, Tomotsugu

    2010-10-01

    Necrotizing fasciitis is a serious infection that originates in the subcutaneous tissues. Although many reports have been published about necrotizing infections of other anatomical sites, retroperitoneal necrotizing soft tissue infection is a rare entity that has been described in only a few case reports. The etiology and clinical course of retroperitoneal necrotizing fasciitis can be variable and it is often difficult to identify the etiology of the infective process. We report a 58-year-old man with rapidly progressive, gas-producing, necrotizing inflammation in the retroperitoneum, complicated with genital involvement resembling Fournier gangrene. The patient was managed successfully by aggressive drainage, debridement, and sequential laparotomies to track and control the extensive necrosis of the retroperitoneum and perineum, in addition to systemic care to control sepsis. After his general condition stabilized, early rectosigmoid adenocarcinoma was identified and resected curatively. He remained well at follow up, six months after discharge. In retrospect, the trigger of the disease process was unclear. Although it was believed possibly to be due to the colon lesion, adenocarcinoma of the rectosigmoid colon was identified and the patient was managed successfully. Similar to necrotizing infections at other anatomical sites, early diagnosis and timely surgical intervention and systemic antimicrobial therapy are mandatory for treating patients with retroperitoneal necrotizing fasciitis.

  8. Fasting leptin and glucose in normal weight, over weight and obese men and women diabetes patients with and without clinical depression.

    Science.gov (United States)

    Haleem, Darakhshan Jabeen; Sheikh, Shehnaz; Fawad, Asher; Haleem, Muhammad A

    2017-06-01

    A large number of diabetes patients suffer from major depression and are at high risk of mortality. In view of a role of leptin in diabetes, depression and energy homeostasis, the present study concerns circulating levels of leptin in different BMI groups of un-depressed and depressed diabetes patients. Six hundred thirty male and female patients with a primary diagnosis of diabetes were grouped according to BMI and with or without clinical symptoms of depression. Age matched healthy, normal weight male and female volunteers without clinical symptoms of depression or diabetes were taken as controls. Blood samples were obtained after an overnight fast of 12 h. Serum was stored for the determination of leptin and glucose. We found that there were more female than male diabetes patients with comorbid depression. Fasting leptin was higher in normal weight non-diabetes women than men; but comparable in normal weight men and women diabetes patients. Fasting glucose levels were higher in diabetes than non diabetes groups; values were comparable in men and women. Depression was associated with a decrease and increase in leptin respectively in normal-overweight and obese men and women diabetes patients. Glucose levels were also higher in obese depressed than un-depressed diabetes patients. The results suggested that the female gender is at greater risk to comorbid diabetes with depression. Adipo-insular axis plays an important role in diabetes, associated depression and in the greater risk of the female gender to comorbid diabetes with depression.

  9. No association between anxiety and depression and adverse clinical outcome among patients with cardiovascular disease

    DEFF Research Database (Denmark)

    Kornerup, Henriette; Zwisler, Ann-Dorthe Olsen; Prescott, Eva

    2011-01-01

    Anxiety and depression have been linked to adverse prognostic outcome in patients with cardiovascular disease (CVD) with mixed results. The timing of anxiety and depression measurement has received little attention so far.......Anxiety and depression have been linked to adverse prognostic outcome in patients with cardiovascular disease (CVD) with mixed results. The timing of anxiety and depression measurement has received little attention so far....

  10. Heart rate variability measurement and clinical depression in acute coronary syndrome patients: narrative review of recent literature

    Directory of Open Access Journals (Sweden)

    Harris PR

    2014-07-01

    Full Text Available Patricia RE Harris,1 Claire E Sommargren,2 Phyllis K Stein,3 Gordon L Fung,4,5 Barbara J Drew6,7 1ECG Monitoring Research Lab, 2Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA; 3Heart Rate Variability Laboratory, School of Medicine, Washington University, St Louis, MO, USA; 4Asian Heart & Vascular Center at Mount Zion, Division of Cardiology, University of California, 5Cardiology Consultation Service, Cardiac Noninvasive Laboratory, and The Enhanced External Counterpulsation Unit, Department of Medicine, University of California, San Francisco Medical Center, 6Division of Cardiology, 7Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA Aim: We aimed to explore links between heart rate variability (HRV and clinical depression in patients with acute coronary syndrome (ACS, through a review of recent clinical research literature. Background: Patients with ACS are at risk for both cardiac autonomic dysfunction and clinical depression. Both conditions can negatively impact the ability to recover from an acute physiological insult, such as unstable angina or myocardial infarction, increasing the risk for adverse cardiovascular outcomes. HRV is recognized as a reflection of autonomic function. Methods: A narrative review was undertaken to evaluate state-of-the-art clinical research, using the PubMed database, January 2013. The search terms “heart rate variability” and “depression” were used in conjunction with “acute coronary syndrome”, “unstable angina”, or “myocardial infarction” to find clinical studies published within the past 10 years related to HRV and clinical depression, in patients with an ACS episode. Studies were included if HRV measurement and depression screening were undertaken during an ACS hospitalization or within 2 months of hospital discharge. Results: Nine clinical studies met the inclusion criteria. The

  11. Depression in China: Integrating Developmental Psychopathology and Cultural-Clinical Psychology

    Science.gov (United States)

    Ryder, Andrew G.; Sun, Jiahong; Zhu, Xiongzhao; Yao, Shuqiao; Chentsova-Dutton, Yulia E.

    2012-01-01

    With a starting point in John Abela's groundbreaking developmental psychopathology research on adolescent depression in China, we aimed to review the state of the literature on Chinese depression across the lifespan. We began with Dr. Abela's published studies relevant to depression in China and our own research with adults before turning to the…

  12. A clinically useful self-report measure of the DSM-5 mixed features specifier of major depressive disorder.

    Science.gov (United States)

    Zimmerman, Mark; Chelminski, Iwona; Young, Diane; Dalrymple, Kristy; Martinez, Jennifer H

    2014-10-01

    To acknowledge the clinical significance of manic features in depressed patients, DSM-5 included criteria for a mixed features specifier for major depressive disorder (MDD). In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project we modified our previously published depression scale to include a subscale assessing the DSM-5 mixed features specifier. More than 1100 psychiatric outpatients with MDD or bipolar disorder completed the Clinically Useful Depression Outcome Scale (CUDOS) supplemented with questions for the DSM-5 mixed features specifier (CUDOS-M). To examine discriminant and convergent validity the patients were rated on clinician severity indices of depression, anxiety, agitation, and irritability. Discriminant and convergent validity was further examined in a subset of patients who completed other self-report symptom severity scales. Test-retest reliability was examined in a subset who completed the CUDOS-M twice. We compared CUDOS-M scores in patients with MDD, bipolar depression, and hypomania. The CUDOS-M subscale had high internal consistency and test-retest reliability, was more highly correlated with another self-report measure of mania than with measures of depression, anxiety, substance use problems, eating disorders, and anger, and was more highly correlated with clinician severity ratings of agitation and irritability than anxiety and depression. CUDOS-M scores were significantly higher in hypomanic patients than depressed patients, and patients with bipolar depression than patients with MDD. The study was cross-sectional, thus we did not examine whether the CUDOS-M detects emerging mixed symptoms when depressed patients are followed over time. Also, while we examined the correlation between the CUDOS-M and clinician ratings of agitation and irritability, we did not examine the association with a clinician measure of manic symptomatology such as the Young Mania Rating Scale In the

  13. The Socio-Demographic and Clinical Characteristics of the Adult Epileptic Patients Applying to the Neurology Clinic of Erciyes University and the Relation of These Phenomena to Depression

    Directory of Open Access Journals (Sweden)

    Vesile Şenol

    2007-08-01

    Full Text Available OBJECTIVE: The epidemiological characteristics of epilepsy vary from society to society. Epilepsy, whose prevalence is between 0.5-1.0%, is usually seen in early and late ages, at the both of ends of life, and more often in males, and in people who have low income and education. Besides ıts neuropsychologic effects, epilepsy is a disease which has psychological, socilogical aspects such as social isolation, low self-esteem and depression. Depression is seen more often in people with epilepsy than people who don’t have this disease. The percentage of depression for the whole life-time for people with epilepsy is 10-30%. Age at onset of epilepsy, seizure type, frequency, time and the type of treatment (mono-poly therapy affect the incidence and degree of depression. OBJECTIVES: To define the socio-demographic and clinical characteristics of epilepsy cases, to determine the percentage of depressive disorders in epilepsy cases, to probe the characteristics of epileptic seizure and its relation to depression. METHODS: The study was conducted through a face-to-face survey of 102 adult epileptic patients who applied to the Erciyes University Epilepsy Outpatient Clinic between October 2004 and 2005. In order to gather the data, which was prepared by the researcher “A survey form for the epileptic individuals” and “The Turkish Version of Beck Depression Inventory”, whose accuracy and validity was checked by Hisli, was used. RESULTS: The average age for the cases is 34.3±12.6, the average age at seizure onset is 21.4±14.6 and in 66% of them the seizure started when they were under 25. Majority of the cases were male and lower than the minimum wage. Among the patients, 45.6% had generalized (tonic-clonic seizures, and 36% had been ≥1/month seizures and 32% seizure-free during the previous year. CONCLUSION: The average of depressive disorder was 29.4%. 15.7% of the cases were with major depression. Age at onset epilepsy, seizure type and

  14. Implementation outcomes of evidence-based quality improvement for depression in VA community based outpatient clinics

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    Fortney John

    2012-04-01

    Full Text Available Abstract Background Collaborative-care management is an evidence-based practice for improving depression outcomes in primary care. The Department of Veterans Affairs (VA has mandated the implementation of collaborative-care management in its satellite clinics, known as Community Based Outpatient Clinics (CBOCs. However, the organizational characteristics of CBOCs present added challenges to implementation. The objective of this study was to evaluate the effectiveness of evidence-based quality improvement (EBQI as a strategy to facilitate the adoption of collaborative-care management in CBOCs. Methods This nonrandomized, small-scale, multisite evaluation of EBQI was conducted at three VA Medical Centers and 11 of their affiliated CBOCs. The Plan phase of the EBQI process involved the localized tailoring of the collaborative-care management program to each CBOC. Researchers ensured that the adaptations were evidence based. Clinical and administrative staff were responsible for adapting the collaborative-care management program for local needs, priorities, preferences and resources. Plan-Do-Study-Act cycles were used to refine the program over time. The evaluation was based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance Framework and used data from multiple sources: administrative records, web-based decision-support systems, surveys, and key-informant interviews. Results Adoption: 69.0% (58/84 of primary care providers referred patients to the program. Reach: 9.0% (298/3,296 of primary care patients diagnosed with depression who were not already receiving specialty care were enrolled in the program. Fidelity: During baseline care manager encounters, education/activation was provided to 100% (298/298 of patients, barriers were assessed and addressed for 100% (298/298 of patients, and depression severity was monitored for 100% (298/298 of patients. Less than half (42.5%, 681/1603 of follow-up encounters during the acute

  15. Antidepressant use and risk for mortality in 121,252 heart failure patients with or without a diagnosis of clinical depression

    DEFF Research Database (Denmark)

    Brouwers, Corline; Christensen, Stefan B; Damen, Nikki L

    2016-01-01

    of clinical depression were independently associated with antidepressant use. Patients using no antidepressants with clinical depression and patients using antidepressants, with or without clinical depression, had a significantly higher risk for all-cause mortality (HR, 1.25; 95% CI, 1.15-1.36; HR, 1.24; 95....... CONCLUSION: Patients with HF taking antidepressants had an increased risk for all-cause and CV-mortality, irrespectively of having clinical depression. These results highlight the importance of further examining the antidepressant prescription pattern in patients with HF, as this may be crucial......BACKGROUND: Depression is a risk factor for mortality in patients with heart failure (HF), however, treating depression with antidepressant therapy does not seem to improve survival. We examined the prevalence of antidepressant use in HF patients, the correlates of antidepressant use subsequent...

  16. Do general radiographic examinations resemble a person-centred environment?

    International Nuclear Information System (INIS)

    Hayre, C.M.; Blackman, S.; Eyden, A.

    2016-01-01

    Aim and objective: It is argued whether general radiographic examinations adhere to a person-centred approach within the direct digital radiography (DDR) environment. General radiographic examinations continue to increase and constitute approximately 90% of all examinations undertaken in the clinical environment. This study explored the potential impact patients experience whilst undergoing general imaging examinations. Method: An ethnographic methodology provided insight of two general radiography environments in the United Kingdom (UK) using participant observation and semi-structured interviews. Findings: The findings highlighted an ‘in and out’ culture whereby patients are ‘hurried’ and ‘rushed’ out of X-ray rooms in response to increasing time pressures experienced by diagnostic radiographers. In addition, this study challenged that patients may begin to rank ‘speed’ and ‘waiting times’ above other elements of radiographic care thus presenting new challenges for radiographers within the clinical environment. Conclusion: It is asserted that radiographers should remain holistic healthcare professionals and not begin to resemble operators on the production line. Further, it challenges whether patients are beginning to rank aspects of radiographic care within contemporary practices. Advances in knowledge: Few studies have explored the radiographer–patient relationship within the DDR environment, yet this study provides insight of person-centred practices within contemporary practices. - Highlights: • Challenges whether the use of DDR conforms to a person-centred approach. • Challenges whether radiographers are ‘treating patients as persons’ using DDR. • Patients may begin to rank ‘speed’ and ‘waiting times’ above other aspects of radiographic care.

  17. Enhancing Hispanic participation in mental health clinical research: development of a Spanish-speaking depression research site.

    Science.gov (United States)

    Aponte-Rivera, Vivianne; Dunlop, Boadie W; Ramirez, Cynthia; Kelley, Mary E; Schneider, Rebecca; Blastos, Beatriz; Larson, Jacqueline; Mercado, Flavia; Mayberg, Helen; Craighead, W Edward

    2014-03-01

    Hispanics, particularly those with limited English proficiency, are underrepresented in psychiatric clinical research studies. We developed a bilingual and bicultural research clinic dedicated to the recruitment and treatment of Spanish-speaking subjects in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study, a large clinical trial of treatment-naïve subjects with major depressive disorder (MDD). Demographic and clinical data derived from screening evaluations of the first 1,174 subjects presenting for participation were compared between the Spanish-speaking site (N = 275) and the primary English-speaking site (N = 899). Reasons for ineligibility (N = 888) for the PReDICT study were tallied for each site. Compared to English speakers, Spanish speakers had a lower level of education and were more likely to be female, uninsured, and have uncontrolled medical conditions. Clinically, Spanish speakers demonstrated greater depression severity, with higher mean symptom severity scores, and a greater number of previous suicide attempts. Among the subjects who were not randomized into the PReDICT study, Spanish-speaking subjects were more likely to have an uncontrolled medical condition or refuse participation, whereas English-speaking subjects were more likely to have bipolar disorder or a non-MDD depressive disorder. Recruitment of Hispanic subjects with MDD is feasible and may enhance efforts at signal detection, given the higher severity of depression among Spanish-speaking participants presenting for clinical trials. Specific approaches for the recruitment and retention of Spanish-speaking participants are required. © 2013 Wiley Periodicals, Inc.

  18. Vitamin C as an adjuvant for treating major depressive disorder and suicidal behavior, a randomized placebo-controlled clinical trial.

    Science.gov (United States)

    Sahraian, Ali; Ghanizadeh, Ahmad; Kazemeini, Fereshteh

    2015-03-14

    There are some animal studies suggesting the possible role of vitamin C for treating depression. However, the efficacy of vitamin C for treating adult patients with major depressive disorder (MDD) has never been examined. This 8-week randomized double-blind placebo-controlled clinical trial included adult patients with major depressive disorder according to DSM-IV diagnostic criteria. Twenty-one patients in the treatment group received citalopram plus vitamin C and the 22 patients in the control group received citalopram plus placebo. The Hamilton Depression Rating Scale was used to measure depressive symptoms at baseline, week 2, week 4, and week 8. We also checked for the presence of adverse effects. While depression symptoms decreased in both groups during this trial, there was no statistically significant difference between the 2 groups (P = .5). The rate of remission, partial response, and complete response was not different between the two groups. The rate of adverse effects were not different between the two groups. Adding vitamin C to citalopram did not increase the efficacy of citalopram in MDD patients. Vitamin C plus citalopram is as effective as placebo plus citalopram for treating adult patients with suicidal behavior. No serious adverse effect for this combination was identified during this trial. This trial was registered at http://www.irct.ir . The registration number of this trial was: IRCT201312263930N31 . Date registered: 5 July 2014.

  19. State anxiety and depression as factors modulating and influencing postoperative pain in dental implant surgery. A prospective clinical survey

    Science.gov (United States)

    Gómez-de Diego, Rafael; Cutando-Soriano, Antonio; Montero-Martín, Javier; Prados-Frutos, Juan C.

    2014-01-01

    Objetives: To determine whether preoperative state anxiety and depression modulate or influence objective and subjective postoperative pain following dental implant insertion. Study Design: Prospective, clinical study with 7-day follow-up of a sample of 105 subjects who preoperatively completed the state anxiety questionnaire (STAI-E) and Beck Depression Inventory (BDI) and postoperatively, at 2 and 7 days, recorded objective pain with the Semmes-Weinstein mechanical esthesiometer (SW test) and subjective pain with the Visual Analog Scale (VAS). Results: 85.6% and 81.5% of patients, respectively, recorded no signs of state anxiety or depression. The correlation between anxiety and depression for both maxillary bones was the lower (P=0.02). The correlation between subjective and objective pain at 2 and 7 days, and the anatomic regions intervened, was statistically significant in the mandible at day 7 (P<0.01), and highly significant (P<0.001) for the other variables. The correlation between state anxiety and objective pain at day 7 was nearly statistically significant (P=0.07). Conclusions: The correlation between state anxiety and depression, and objective and subjective pain at day 7 was not statistically significant. A strong correlation was found between objective and subjective pain in the immediate postoperative period. Key words:Anxiety, depression, postoperative pain, dental implants. PMID:24880447

  20. The Effect of Aromatherapy with Lavender Essential Oil on Depression, Anxiety and Stress in Hemodialysis Patients: A Clinical Trial

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    Ali Tayebi

    2015-06-01

    Full Text Available Background: Depression, anxiety and stress are common among hemodialysis patients affecting their mental health and quality of life, leading to multiple dysfunctions. Anti-anxiety effects of aromatherapy, as one of the domains of complementary medicine, have been investigated in several studies. Aim: Investigation of the effect of aromatherapy with lavender essential oil on depression, anxiety and stress rates in hemodialysis patients. Methods: This study was a randomized controlled clinical trial performed on 60 patients undergoing hemodialysis in Tehran, Iran in 2014. The patients were randomly divided into intervention and control groups. To measure the rate of depression, anxiety and stress, the Depression Anxiety Stress Scales-21 was used. In the intervention group, the patients were asked to inhale the lavender essential oil smeared on a piece of cloth (three drops of oil for one hour during the hemodialysis procedure. After 4 weeks, the rates of depression, anxiety and stress were re-measured. Data analysis was performed by SPSS software version 14 using chi-square, Wilcoxon and Mann-Whitney U statistical tests. Results: In this study, 33(60% of the participants were male, and 53(96.4% were married.  After the intervention, the scores of depression (P

  1. The Effect of Debriefing and Brief Cognitive-Behavioral Therapy on Postpartum Depression in Traumatic Childbirth: A Randomized Clinical Trial

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    Sedigheh Abdollahpour

    2018-01-01

    Full Text Available Background & aim: Childbirth is a stressful event in women’s lives, and if a mother perceives it as an unpleasant event, it can influence her postpartum mental health. Depression is a common mental disorder, which can has serious consequences depending on its severity. Therefore, this study aimed to investigate the effect of debriefing and brief cognitive-behavioral therapy on postpartum depression in traumatic childbirth. Methods: This clinical trial was performed on 179 mothers who experienced a traumatic childbirth and were admitted in postnatal ward of Nohom Dey Hospital in Torbat-e Heydarieh, North East of Iran in 2016. The subjects were randomly allocated into three groups, including two intervention groups of debriefing and brief cognitive-behavioral counseling and a control group. The intervention groups received appropriate counseling for 40-60 minutes in the first 48 postpartum hours and the control group received the routine postpartum care. Edinburgh Postnatal Depression Scale was used to evaluate postpartum depression 4-6 weeks and also three months after the intervention. Post-traumatic stress symptoms in were compared in three groups using t-test, chi-square test, and repeated measures analysis of variance. Results: No significant differences were observed between the mean depression scores of the two intervention groups and that of the control group 4-6 weeks after childbirth. However, three months after delivery, the mean depression scores of the two intervention groups was lower than the control group (P

  2. The DEMO trial: a randomized, parallel-group, observer-blinded clinical trial of strength versus aerobic versus relaxation training for patients with mild to moderate depression

    DEFF Research Database (Denmark)

    Krogh, Jesper; Saltin, Bengt; Gluud, Christian

    2009-01-01

    OBJECTIVE: To assess the benefit and harm of exercise training in adults with clinical depression. METHOD: The DEMO trial is a randomized pragmatic trial for patients with unipolar depression conducted from January 2005 through July 2007. Patients were referred from general practitioners or psych......: Our findings do not support a biologically mediated effect of exercise on symptom severity in depressed patients, but they do support a beneficial effect of strength training on work capacity. TRIAL REGISTRATION: (ClinicalTrials.gov) Identifier: NCT00103415....

  3. Effectiveness Research: Transporting Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) From the Lab to School-Based Health Clinics

    Science.gov (United States)

    Mufson, Laura H.; Dorta, Kristen Pollack; Olfson, Mark; Weissman, Myrna M.; Hoagwood, Kimberly

    2004-01-01

    This paper describes the process of modifying and transporting an evidence-based treatment, Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), from a university setting to school-based health clinics. It addresses conceptual issues involved in the shift from efficacy to effectiveness research as well as operational issues specific to…

  4. Cognitive-Behavioral Therapy versus Usual Clinical Care for Youth Depression: An Initial Test of Transportability to Community Clinics and Clinicians

    Science.gov (United States)

    Weisz, John R.; Southam-Gerow, Michael A.; Gordis, Elana B.; Connor-Smith, Jennifer K.; Chu, Brian C.; Langer, David A.; McLeod, Bryce D.; Jensen-Doss, Amanda; Updegraff, Alanna; Weiss, Bahr

    2009-01-01

    Community clinic therapists were randomized to (a) brief training and supervision in cognitive-behavioral therapy (CBT) for youth depression or (b) usual care (UC). The therapists treated 57 youths (56% girls), ages 8-15, of whom 33% were Caucasian, 26% were African American, and 26% were Latino/Latina. Most youths were from low-income families…

  5. Conducting a fully mobile and randomised clinical trial for depression: access, engagement and expense.

    Science.gov (United States)

    Anguera, Joaquin A; Jordan, Joshua T; Castaneda, Diego; Gazzaley, Adam; Areán, Patricia A

    2016-01-01

    Advances in mobile technology have resulted in federal and industry-level initiatives to facilitate large-scale clinical research using smart devices. Although the benefits of technology to expand data collection are obvious, assumptions about the reach of mobile research methods ( access ), participant willingness to engage in mobile research protocols ( engagement ), and the cost of this research ( cost ) remain untested. To assess the feasibility of a fully mobile randomised controlled trial using assessments and treatments delivered entirely through mobile devices to depressed individuals. Using a web-based research portal, adult participants with depression who also owned a smart device were screened, consented and randomised to 1 of 3 mental health apps for treatment. Assessments of self-reported mood and cognitive function were conducted at baseline, 4, 8 and 12 weeks. Physical and social activity was monitored daily using passively collected phone use data. All treatment and assessment tools were housed on each participant's smart phone or tablet. A cognitive training application, an application based on problem-solving therapy, and a mobile-sensing application promoting daily activities. Access : We screened 2923 people and enrolled 1098 participants in 5 months. The sample characteristics were comparable to the 2013 US census data. Recruitment via Craigslist.org yielded the largest sample. Engagement : Study engagement was high during the first 2 weeks of treatment, falling to 44% adherence by the 4th week. Cost : The total amount spent on for this project, including staff costs and β testing, was $314 264 over 2 years. These findings suggest that mobile randomised control trials can recruit large numbers of participants in a short period of time and with minimal cost, but study engagement remains challenging. NCT00540865.

  6. A web-based clinical trial management system for a sham-controlled multicenter clinical trial in depression.

    Science.gov (United States)

    Durkalski, Valerie; Wenle Zhao; Dillon, Catherine; Kim, Jaemyung

    2010-04-01

    Clinical trial investigators and sponsors invest vast amounts of resources and energy into conducting trials and often face daily challenges with data management, project management, and data quality control. Rather than waiting months for study progress reports, investigators need the ability to use real-time data for the coordination and management of study activities across all study team members including site investigators, oversight committees, data and safety monitoring boards, and medical safety monitors. Web-based data management systems are beginning to meet this need but what distinguishes one system from the other are user needs/requirements and cost. To illustrate the development and implementation of a web-based data and project management system for a multicenter clinical trial designed to test the superiority of repeated transcranial magnetic stimulation versus sham for the treatment of patients with major depression. The authors discuss the reasons for not using a commercially available system for this study and describe the approach to developing their own web-based system for the OPT-TMS study. Timelines, effort, system architecture, and lessons learned are shared with the hope that this information will direct clinical trial researchers and software developers towards more efficient, user-friendly systems. The developers use a combination of generic and custom application code to allow for the flexibility to adapt the system to the needs of the study. Features of the system include: central participant registration and randomization; secure data entry at the site; participant progress/study calendar; safety data reporting; device accounting; monitor verification; and user-configurable generic reports and built-in customized reports. Hard coding was more time-efficient to address project-specific issues compared with the effort of creating a generic code application. As a consequence of this strategy, the required maintenance of the system is

  7. [Suicide Risk Assessment in the Clinical Practice Guidelines for the Diagnosis and Management of Depression in Colombia].

    Science.gov (United States)

    Gómez Restrepo, Carlos; Bohórquez Peñaranda, Adriana Patricia; Gil Lemus, Laura Marcela; Jaramillo, Luis Eduardo; García Valencia, Jenny; Bravo Narváez, Eliana; de la Hoz Bradford, Ana María; Palacio, Carlos

    2013-01-01

    Suicide is the most serious complications of depression. It has high associated health costs and causes millions of deaths worldwide per year. Given its implications, it is important to know the factors that increase the risk of its occurrence and the most useful tools for addressing it. To identify the signs and symptoms that indicate an increased risk of suicide, and factors that increase the risk in patients diagnosed with depression. To establish the tools best fitted to identify suicide risk in people with depression. Clinical practice guidelines were developed, following those of the methodmethodological guidelines of the Ministry of Social Protection, to collect evidence and to adjust recommendations. Recommendations from the NICE90 and CANMAT guidelines were adopted and updated for questions found in these guidelines, while new recommendations were developed for questions not found in them. Basic points and recommendations are presented from a chapter of the clinical practice guidelines on depressive episodes and recurrent depressive disorder related to suicide risk assessment. Their corresponding recommendation levels are included. Copyright © 2013 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  8. Effect of Talbinah food consumption on depressive symptoms among elderly individuals in long term care facilities, randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Badrasawi MM

    2013-03-01

    Full Text Available Manal M Badrasawi, Suzana Shahar, Zahara Abd Manaf, Hasnah HaronDietetics program, School of Health Care Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, MalaysiaAbstract: Talbinah is a barley syrup cooked with milk and sweetened by honey. In his famous Hadith on Talbinah, the Prophet Mohammad (SAW recommended it when sad events happen for its effect on soothing hearts and relieving sadness. This 3-week crossover designed, randomized clinical trial was conducted to determine the effect of Talbinah on mood and depression among institutionalized elderly people in Seremban. A sample of 30 depressed elderly subjects (21 men and 9 women was selected from the long term care facility. Three different interview-based validated scales (Geriatric Depression Scale, Depression Anxiety Stress Scales, and Profile of Mood States were used to determine mood, depression, stress, and anxiety at week 0, 3, 4, and 7. The nutritional value of Talbinah was examined using proximate food analysis, minerals content analysis, and differential amino acid analysis. The results indicated that Talbinah is a high carbohydrate food (86.4% and has a high tryptophan: branch chain amino acids ratio (1:2. A Wilcoxon nonparametric test showed that there was a statistically significant decrease on depression, stress, and mood disturbances scores among the intervention group (P < 0.05 for all parameters. In conclusion, Talbinah has the potential to reduce depression and enhance mood among the subjects. Ingestion of functional foods such as Talbinah may provide a mental health benefit to elderly people.Keywords: Talbinah, food and depression, cross over study, elderly

  9. Effectiveness and cost effectiveness of cognitive behavioral therapy (CBT) in clinically depressed adolescents: individual CBT versus treatment as usual (TAU).

    Science.gov (United States)

    Stikkelbroek, Yvonne; Bodden, Denise Hm; Deković, Maja; van Baar, Anneloes L

    2013-11-21

    Depressive disorders occur in 2 to 5% of the adolescents and are associated with a high burden of disease, a high risk of recurrence and a heightened risk for development of other problems, like suicide attempts. The effectiveness of cognitive behaviour therapy (CBT), cost-effectiveness of this treatment and the costs of illness of clinical depression in adolescents are still unclear. Although several Randomized Controlled Trials (RCT) have been conducted to establish the efficacy of CBT, the effectiveness has not been established yet. Aim of this study is to conduct a RCT to test the effectiveness of CBT and to establish the cost-effectiveness of CBT under rigorous conditions within routine care provided by professionals already working in mental health institutions. CBT is investigated with a multi-site, RCT using block randomisation. The targeted population is 140 clinically referred depressed adolescents aged 12 to 21 years old. Adolescents are randomly assigned to the experimental (N = 70, CBT) or control condition (N = 70, TAU). Four assessments (pre, post, follow up at 6 and 12 months) and two mediator assessments during treatment are conducted. Primary outcome measure is depression diagnosis based on a semi-structured interview namely the K-SADS-PL. Secondary outcome measures include depressive symptoms, severity and improvement of the depression, global functioning, quality of life, suicide risk, comorbidity, alcohol and drug use, parental depression and psychopathology, parenting and conflicts. Costs and treatment characteristics will also be assessed. Furthermore, moderator and mediator analyses will be conducted. This trial will be the first to compare CBT with TAU under rigorous conditions within routine care and with a complex sample. Furthermore, cost-effectiveness of treatment and cost-of-illness of clinical depression are established which will provide new insights on depression as a disorder and its treatment. Dutch Trial register number

  10. Clinical utility of the Calgary Depression Scale for Schizophrenia in individuals at ultra-high risk of psychosis.

    Science.gov (United States)

    Rekhi, Gurpreet; Ng, Wai Yee; Lee, Jimmy

    2018-03-01

    There is a pressing need for reliable and valid rating scales to assess and measure depression in individuals at ultra-high risk (UHR) of psychosis. The aim of this study was to examine the clinical utility of the Calgary Depression Scale for Schizophrenia (CDSS) in individuals at UHR of psychosis. 167 individuals at UHR of psychosis were included as participants in this study. The Structured Clinical Interview for DSM-IV Axis I Disorders, CDSS, Beck Anxiety Inventory and Global Assessment of Functioning were administered. A receiver operating characteristic (ROC) curve analysis and factor analyses were performed. Cronbach's alpha was computed. Correlations between CDSS factor scores and other clinical variables were examined. The median CDSS total score was 5.0 (IQR 1.0-9.0). The area under ROC curve was 0.886 and Cronbach's alpha was 0.855. A score of 7 on the CDSS yielded the highest sensitivity and specificity in detecting depression in UHR individuals. Exploratory factor analysis of the CDSS yielded two factors: depression-hopelessness and self depreciation-guilt, which was confirmed by confirmatory factor analysis. Further analysis showed that the depression-hopelessness factor predicted functioning; whereas the self depreciation-guilt factor was related to the severity of the attenuated psychotic symptoms. In conclusion, the CDSS demonstrates good psychometric properties when used to evaluate depression in individuals at UHR of psychosis. Our study results also support a two-factor structure of the CDSS in UHR individuals. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  11. Proximity to healthcare clinic and depression risk in South Africa: geospatial evidence from a nationally representative longitudinal study.

    Science.gov (United States)

    Tomita, Andrew; Vandormael, Alain M; Cuadros, Diego; Slotow, Rob; Tanser, Frank; Burns, Jonathan K

    2017-08-01

    Proximity to primary healthcare facilities may be a serious barrier to accessing mental health services in resource-limited settings. In this study, we examined whether the distance to the primary healthcare clinic (PHCC) was associated with risk of depression in KwaZulu-Natal Province, South Africa. Depressive symptoms and household coordinates data were accessed from the nationally representative South African National Income Dynamics Study. Distances between households and their nearest PHCCs were calculated and mixed-effects logistic regression models fitted to the data. Participants residing technology could improve mental health.

  12. Relationship between obesity and the risk of clinically significant depression: Mendelian randomisation study.

    Science.gov (United States)

    Hung, Chi-Fa; Rivera, Margarita; Craddock, Nick; Owen, Michael J; Gill, Michael; Korszun, Ania; Maier, Wolfgang; Mors, Ole; Preisig, Martin; Rice, John P; Rietschel, Marcella; Jones, Lisa; Middleton, Lefkos; Aitchison, Kathy J; Davis, Oliver S P; Breen, Gerome; Lewis, Cathryn; Farmer, Anne; McGuffin, Peter

    2014-07-01

    Obesity has been shown to be associated with depression and it has been suggested that higher body mass index (BMI) increases the risk of depression and other common mental disorders. However, the causal relationship remains unclear and Mendelian randomisation, a form of instrumental variable analysis, has recently been employed to attempt to resolve this issue. To investigate whether higher BMI increases the risk of major depression. Two instrumental variable analyses were conducted to test the causal relationship between obesity and major depression in RADIANT, a large case-control study of major depression. We used a single nucleotide polymorphism (SNP) in FTO and a genetic risk score (GRS) based on 32 SNPs with well-established associations with BMI. Linear regression analysis, as expected, showed that individuals carrying more risk alleles of FTO or having higher score of GRS had a higher BMI. Probit regression suggested that higher BMI is associated with increased risk of major depression. However, our two instrumental variable analyses did not support a causal relationship between higher BMI and major depression (FTO genotype: coefficient -0.03, 95% CI -0.18 to 0.13, P = 0.73; GRS: coefficient -0.02, 95% CI -0.11 to 0.07, P = 0.62). Our instrumental variable analyses did not support a causal relationship between higher BMI and major depression. The positive associations of higher BMI with major depression in probit regression analyses might be explained by reverse causality and/or residual confounding. Royal College of Psychiatrists.

  13. Biomarkers of systemic inflammation and depression and fatigue in moderate clinically stable COPD

    DEFF Research Database (Denmark)

    Al-shair, Khaled; Kolsum, Umme; Dockry, Rachel

    2011-01-01

    COPD is an inflammatory disease with major co-morbidities. It has recently been suggested that depression may be the result of systemic inflammation. We aimed to explore the association between systemic inflammation and symptoms of depression and fatigue in patients with mainly moderate and clini......COPD is an inflammatory disease with major co-morbidities. It has recently been suggested that depression may be the result of systemic inflammation. We aimed to explore the association between systemic inflammation and symptoms of depression and fatigue in patients with mainly moderate...

  14. Profiles of sociodemographic, behavioral, clinical and psychosocial characteristics among primary care patients with comorbid obesity and depression

    Directory of Open Access Journals (Sweden)

    Jun Ma

    2017-12-01

    Full Text Available The objective of this study is to characterize profiles of obese depressed participants using baseline data collected from October 2014 through December 2016 for an ongoing randomized controlled trial (n=409 in Bay Area, California, USA. Four comorbidity severity categories were defined by interaction of the binary levels of body mass index (BMI and depression Symptom Checklist 20 (SCL20 scores. Sociodemographic, behavioral, clinical and psychosocial characteristics were measured. Mean (SD age was 51 (12.1 years, BMI 36.7 (6.4 kg/m2, and SCL20 1.5 (0.5. Participants in the 4 comorbidity severity categories had similar sociodemographic characteristics, but differed significantly in the other characteristics. Two statistically significant canonical dimensions were identified. Participants with BMI≥35 and SCL20≥1.5 differed significantly from those with BMI<35 and SCL20<1.5 on dimension 1, which primarily featured high physical health (e.g., central obesity, high blood pressure and impaired sleep and mental health comorbidities (e.g., post-traumatic stress and anxiety, poor health-related quality of life (in general and problems specifically with obesity, anxiety, depression, and usual daily activities, and an avoidance problem-solving style. Participants with BMI<35 and SCL20≥1.5 differed significantly from those with BMI≥35 and SCL20<1.5 on dimension 2, which primarily included fewer Hispanics, less central obesity, and more leisure-time physical activity, but greater anxiety and post-traumatic stress and poorer obesity- or mental health-related quality of life. In conclusion, patients with comorbid obesity and depression of varying severity have different profiles of behavioral, clinical and psychosocial characteristics. This insight may inform analysis of treatment heterogeneity and development of targeted intervention strategies.Trial registration: ClinicalTrials.gov #NCT02246413 Keywords: Obesity, Depression, Behavior, Clinical

  15. [The effectiveness of therapeutic touch on pain, depression and sleep in patients with chronic pain: clinical trial].

    Science.gov (United States)

    Marta, Ilda Estefani Ribeiro; Baldan, Sueli Santiago; Berton, Ani Fabiana; Pavam, Michele; da Silva, Maria Júlia Paes

    2010-12-01

    This research aimed to check the effectiveness of Therapeutic Touch on decreased pain intensity, depression self-assessment scores and improved sleep quality. A clinical before-after trial is presented. The study was carried out at a Basic Health Unit in Fernandópolis, SP-Brazil, involving 30 elderly patients with chronic non-oncologic pain who received 8 sessions of Therapeutic Touch in accordance with the Krieger-Kunz method. The Visual Analogue Scale for pain was applied before and after each session, and Beck Depression Inventory and the Pittsburgh Sleep Quality Index before the first and after the last session. Data analysis showed a significant decrease (p Touch was effective to decrease pain intensity and depressive attitudes and symptoms, as well as to improve sleep quality.

  16. Observing the determinants of the psychotherapeutic process in depressive disorders. A clinical case study within a psychodynamic approach

    Directory of Open Access Journals (Sweden)

    Osmano eOasi

    2015-04-01

    Full Text Available This paper focuses on the relationship between depressive disorders, personality configurations, and mental functioning. A years treatment of a young man with the diagnosis of Depression is presented: the clinical and empirical points of view are described in depth through an assessment at the beginning and at one year after of an oriented psychodynamic psychotherapy. SCID I and II and HAMRS were administered to the patient in assessement phase. In the same phase he filled in BDI-II, and DEQ; the psychotherapist completed SWAP-200. These clinician instruments were used again after one year of the treatment. The PDM point of view is also presented. All sessions are audiotaped: twelve verbatim transcripts were coded with the Defense Mechanisms Rating Scale and CCRT. The results show a decrease in depressive symptoms, a change in some personality configurations, but a substantial invariance of the introjective profile, and a modification in mental functioning.

  17. Relationship between dental anxiety, general anxiety level and depression in patients attending a university hospital dental clinic in Turkey.

    Science.gov (United States)

    Pekkan, G; Kilicoglu, A; Hatipoglu, H

    2011-06-01

    To evaluate the relationship between dental anxiety, general anxiety and depression levels in patients attending a university hospital dental clinic in Turkey. A cross sectional study. 250 first visit patients seeking dental treatment. Modified Dental Anxiety Scale (MDAS), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were used to assess the dental anxiety, general anxiety and depression level in these patients. The mean MDAS, BAI, and BDI scores were 10.5, 9.4, and 10.7, respectively. The prevalence of dental anxiety was found to be 20.8% (52/250) at the cut-off point > or = 15 and 6.8% (17/250) at the cut-off point > or = 19 according to MDAS score evaluation. MDAS and BAI scores were significantly higher in women (p or = 19 (p Dental anxiety was positively correlated with patients' general anxiety level and was higher in women and at younger age.

  18. Comparison of paroxetine and agomelatine in depressed type 2 diabetes mellitus patients: a double-blind, randomized, clinical trial

    Directory of Open Access Journals (Sweden)

    Kang RY

    2015-05-01

    acceptability.Conclusion: These results showed that compared to paroxetine, agomelatine might have some advantages in treating symptoms of depression/anxiety and glycemic control in depressed type 2 DM patients. The clinical applicability of agomelatine shows greater promise and should be explored further. Limited by the relatively small samples, future studies are needed to verify and support our findings. Keywords: paroxetine, agomelatine, depression, diabetes mellitus

  19. "There are too many, but never enough": qualitative case study investigating routine coding of clinical information in depression.

    Science.gov (United States)

    Cresswell, Kathrin; Morrison, Zoe; Kalra, Dipak; Sheikh, Aziz

    2012-01-01

    We sought to understand how clinical information relating to the management of depression is routinely coded in different clinical settings and the perspectives of and implications for different stakeholders with a view to understanding how these may be aligned. Qualitative investigation exploring the views of a purposefully selected range of healthcare professionals, managers, and clinical coders spanning primary and secondary care. Our dataset comprised 28 semi-structured interviews, a focus group, documents relating to clinical coding standards and participant observation of clinical coding activities. We identified a range of approaches to coding clinical information including templates and order entry systems. The challenges inherent in clearly establishing a diagnosis, identifying appropriate clinical codes and possible implications of diagnoses for patients were particularly prominent in primary care. Although a range of managerial and research benefits were identified, there were no direct benefits from coded clinical data for patients or professionals. Secondary care staff emphasized the role of clinical coders in ensuring data quality, which was at odds with the policy drive to increase real-time clinical coding. There was overall no evidence of clear-cut direct patient care benefits to inform immediate care decisions, even in primary care where data on patients with depression were more extensively coded. A number of important secondary uses were recognized by healthcare staff, but the coding of clinical data to serve these ends was often poorly aligned with clinical practice and patient-centered considerations. The current international drive to encourage clinical coding by healthcare professionals during the clinical encounter may need to be critically examined.

  20. “There Are Too Many, but Never Enough": Qualitative Case Study Investigating Routine Coding of Clinical Information in Depression

    Science.gov (United States)

    Cresswell, Kathrin; Morrison, Zoe; Sheikh, Aziz; Kalra, Dipak

    2012-01-01

    Background We sought to understand how clinical information relating to the management of depression is routinely coded in different clinical settings and the perspectives of and implications for different stakeholders with a view to understanding how these may be aligned. Materials and Methods Qualitative investigation exploring the views of a purposefully selected range of healthcare professionals, managers, and clinical coders spanning primary and secondary care. Results Our dataset comprised 28 semi-structured interviews, a focus group, documents relating to clinical coding standards and participant observation of clinical coding activities. We identified a range of approaches to coding clinical information including templates and order entry systems. The challenges inherent in clearly establishing a diagnosis, identifying appropriate clinical codes and possible implications of diagnoses for patients were particularly prominent in primary care. Although a range of managerial and research benefits were identified, there were no direct benefits from coded clinical data for patients or professionals. Secondary care staff emphasized the role of clinical coders in ensuring data quality, which was at odds with the policy drive to increase real-time clinical coding. Conclusions There was overall no evidence of clear-cut direct patient care benefits to inform immediate care decisions, even in primary care where data on patients with depression were more extensively coded. A number of important secondary uses were recognized by healthcare staff, but the coding of clinical data to serve these ends was often poorly aligned with clinical practice and patient-centered considerations. The current international drive to encourage clinical coding by healthcare professionals during the clinical encounter may need to be critically examined. PMID:22937106

  1. The Prevalence and Specificity of Depression Diagnosis in a Clinic-Based Population of Adults With Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Golden, Sherita Hill; Shah, Nina; Naqibuddin, Mohammad; Payne, Jennifer L; Hill-Briggs, Felicia; Wand, Gary S; Wang, Nae-Yuh; Langan, Susan; Lyketsos, Constantine

    To estimate the crude prevalence of minor depressive disorder (MinD) in a clinic-based population of adults with type 2 diabetes. We screened a clinical sample of 702 adults with type 2 diabetes for depressive symptoms using the Patient Health Questionnaire-2 and performed a structured diagnostic psychiatric interview on 52 screen-positive and a convenience sample of 51 screen-negative individuals. Depressive disorder diagnoses were made using Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) Text Revised criteria and categorized as MinD, major depressive disorder (MDD), or no depressive disorder. We estimated prevalence of MinD and MDD and derived 95% CIs. The crude prevalence of current, past, and current or past MinD was 4.3% (95% CI: 0.9-9.2%), 9.6% (95% CI: 3.9-15.9%), and 13.9% (95% CI: 7.7-21.2%), respectively. The crude prevalence of current, past, and current or past MDD was slightly higher-5.0% (95% CI: 1.9-9.4%), 12.0% (95% CI: 6.1-19.5%), and 17.0% (95% CI: 10.1-24.8%), respectively. There was a high prevalence of coexisting anxiety disorders in individuals with MinD (42.2%) and MDD (8.1%). Hemoglobin A1c levels were not significantly different in individuals with MinD or MDD compared to those without a depressive disorder. MinD is comparably prevalent to MDD in patients with type 2 diabetes; both disorders are associated with concomitant anxiety disorders. MinD is not included in the DSM-5; however, our data support continuing to examine patients with chronic medical conditions for MinD. Copyright © 2017 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  2. Effects of structured exercise and pharmacotherapy vs. pharmacotherapy for adults with depressive symptoms: A randomized clinical trial.

    Science.gov (United States)

    Carneiro, Lara S F; Fonseca, António Manuel; Vieira-Coelho, Maria Augusta; Mota, Maria Paula; Vasconcelos-Raposo, José

    2015-12-01

    Physical exercise has been consistently documented as a complementary therapy in the treatment of depressive disorders. However, despite a higher prevalence among women compared to men, the trials developed in women are scarce. In addition, the optimal dosage of exercise capable of producing benefits that reduce depressive symptoms remains unclear. This clinical trial is designed to measure the effect of a structured physical exercise program as a complement to antidepressant medication in the treatment of women with depression. From July 2013 to May 2014, we implemented a randomized controlled trial (HAPPY BRAIN study). A total of 26 women (aged 50.16 ± 12.08) diagnosed with clinical depression were randomized either to a supervised aerobic exercise group (45-50 min/week three times a week for four months) plus pharmacotherapy (intervention group), or only antidepressant medication (control group). The exercise group presented a decrease in BDI-II and DASS-21 total score scales. Relatively to DASS-21, it showed a significant decrease in anxiety and stress. The exercise group when compared to a control group showed improvement in relation to physical functioning parameters between baseline and post-intervention. Moreover, anthropometric parameters presented only significant differences between groups in fat mass percentage. Nonetheless, no differences were found between groups in weight, body mass index, waist circumference, and self-esteem. Our results showed that supervised structured aerobic exercise training could be an effective adjuvant therapy for treating women with depression, reducing depressive symptomatology and improving physical fitness. A key factor of this improvement included strict control of exercise workload parameters and adjustment to each subject's capacity. In our study, due to the sample size there is an increase in the probability of type II errors. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Clinical, Functional, and Biological Correlates of Cognitive Dimensions in Major Depressive Disorder - Rationale, Design, and Characteristics of the Cognitive Function and Mood Study (CoFaM-Study).

    Science.gov (United States)

    Baune, Bernhard T; Air, Tracy

    2016-01-01

    Cross-sectional and longitudinal studies exploring clinical, functional, and biological correlates of major depressive disorder are frequent. In this type of research, depression is most commonly defined as a categorical diagnosis based on studies using diagnostic instruments. Given the phenotypic and biological heterogeneity of depression, we chose to focus the phenotypic assessments on three cognitive dimensions of depression including (a) cognitive performance, (b) emotion processing, and (c) social cognitive functioning. Hence, the overall aim of the study is to investigate the long-term clinical course of these cognitive dimensions in depression and its functional (psychosocial) correlates. We also aim to identify biological "genomic" correlates of these three cognitive dimensions of depression. To address the above overall aim, we created the Cognition and Mood Study (CoFaMS) with the key objective to investigate the clinical, functional, and biological correlates of cognitive dimensions of depression by employing a prospective study design and including a healthy control group. The study commenced in April 2015, including patients with a primary diagnosis of a major depressive episode of major depressive disorder or bipolar disorder according to DSM-IV-TR criteria. The assessments cover the three cognitive dimensions of depression (cognitive performance, emotion processing, and social cognition), cognitive function screening instrument, plus functional scales to assess general, work place, and psychosocial function, depression symptom scales, and clinical course of illness. Blood is collected for comprehensive genomic discovery analyses of biological correlates of cognitive dimensions of depression. The CoFaM-Study represents an innovative approach focusing on cognitive dimensions of depression and its functional and biological "genomic" correlates. The CoFaMS team welcomes collaborations with both national and international researchers.

  4. Effects of Depression Alleviation on ART Adherence and HIV Clinic Attendance in Uganda, and the Mediating Roles of Self-Efficacy and Motivation.

    Science.gov (United States)

    Wagner, Glenn J; Ghosh-Dastidar, Bonnie; Robinson, Eric; Ngo, Victoria K; Glick, Peter; Mukasa, Barbara; Musisi, Seggane; Akena, Dickens

    2017-06-01

    With depression known to impede HIV care adherence and retention, we examined whether depression alleviation improves these disease management behaviors. A sample of 1028 depressed HIV clients in Uganda enrolled in a cluster randomized controlled trial of two depression care models, and were surveyed over 12 months. Serial regression analyses examined whether depression alleviation was associated with self-reported antiretroviral therapy (ART) adherence and clinic attendance at month 12, and whether these relationships were mediated by self-efficacy and motivation. Among those with major depression, depression alleviation was associated with better ART adherence and clinic attendance at month 12; these relationships were fully mediated by self-efficacy at month 12, while adherence motivation partially mediated the relationship between depression alleviation and ART adherence. When both mediators were entered simultaneously, only self-efficacy was a significant predictor and still fully mediated the relationship between depression alleviation and adherence. These findings suggest that depression alleviation benefits both ART adherence and clinic attendance, in large part through improved confidence and motivation to engage in these disease management behaviors.

  5. Follow-up of Mothers with Suspected Postpartum Depression from Pediatrics Clinics

    Directory of Open Access Journals (Sweden)

    Nerissa S. Bauer

    2017-10-01

    Full Text Available PurposePediatric providers are increasingly screening for postpartum depression (PD, yet, it is unknown how often mothers comply with recommendations to seek treatment. The objectives were to describe the rate at which mothers with suspected PD seek treatment and explore factors that predict help-seeking behavior.Design and methodsMothers were recruited from four pediatric clinics after identification using the Child Health Improvement through Computer Automation (CHICA system. Mothers with a positive screen were invited to participate in a telephone interview between January 2012 and December 2014. Mothers reported if they sought treatment or called a community resource.Results73 of 133 eligible mothers participated (55% response rate. Fifty women recalled a recommendation to seek help. Only 43.8% (32/73 made a follow-up appointment with an adult provider and even fewer kept the appointment.ConclusionA majority of mothers suspected of having PD recalled a referral for further intervention; yet, less than half took action. Further investigation of barriers of help-seeking behavior is warranted.

  6. COMMON DRUGS ADMINISTERED FOR DEPRESSION IN CHILDREN AND ADOLESCENTS: A CLINIC - BASED STUDY IN NOOR HOSPITAL (1996-98

    Directory of Open Access Journals (Sweden)

    M MAROOFI

    2002-12-01

    Full Text Available Introduction. There are increasing interests about pharmacotherapy in depressed children and adolescents. Althought TCAs (such as imipramine are approved for use in enuresis and ADHD, but controlled studies have failed to demonstrate efficacy of them over placebo in the treatment of depressive disorders in both children or adolescents. On the other hand, a relatively more amount of studies address SSRls (such as fluoxetine, as the drug of choice for treatment of depressed children and adolescents, because of theire effectiveness and safety.
    Methods. In this retrospective study, 306 depressed child and adolescent (7-18 year old who admitted to a psychiatric out patient clinic were studied (196 male and 110 female. Imipramine and fluoxetin were administered for 47 percent and 43 percent of cases, respectively.
    Results. In imipramin geoup and fluoxetine group the symptoms of 126 (87 percent and 102 (77 percent patient was improved, respectively. The frequency of side effects was 21 percent for imipramin (specialy sedation, dizziness and palpitation and 22 percent for fluoxatine (specially headache, insomnia and agitation.
    Discussion. This study suggests that both imipramin and fluoxetine are efficient for tratment of children and adolescents depression. However, because of high theraputic index of fluoxetine, this drug may be a better choice.

  7. Clinical predictors of conversion to bipolar disorder in a prospective longitudinal familial high-risk sample: focus on depressive features.

    Science.gov (United States)

    Frankland, Andrew; Roberts, Gloria; Holmes-Preston, Ellen; Perich, Tania; Levy, Florence; Lenroot, Rhoshel; Hadzi-Pavlovic, Dusan; Breakspear, Michael; Mitchell, Philip B

    2017-11-07

    Identifying clinical features that predict conversion to bipolar disorder (BD) in those at high familial risk (HR) would assist in identifying a more focused population for early intervention. In total 287 participants aged 12-30 (163 HR with a first-degree relative with BD and 124 controls (CONs)) were followed annually for a median of 5 years. We used the baseline presence of DSM-IV depressive, anxiety, behavioural and substance use disorders, as well as a constellation of specific depressive symptoms (as identified by the Probabilistic Approach to Bipolar Depression) to predict the subsequent development of hypo/manic episodes. At baseline, HR participants were significantly more likely to report ⩾4 Probabilistic features (40.4%) when depressed than CONs (6.7%; p conversion' to threshold BD (hazard ratio = 6.9, p conversion were psychomotor retardation and ⩾5 MDEs. Behavioural disorders only predicted conversion to subthreshold BD (hazard ratio = 5.23, p disorders did not predict either threshold or subthreshold hypo/mania. This study suggests that specific depressive characteristics substantially increase the risk of young people at familial risk of BD going on to develop future hypo/manic episodes and may identify a more targeted HR population for the development of early intervention programs.

  8. The relationship of marital status and clinical characteristics in middle-aged and older patients with schizophrenia and depressive symptoms.

    Science.gov (United States)

    Nyer, Maren; Kasckow, John; Fellows, Ian; Lawrence, Edith C; Golshan, Shah; Solorzano, Ellen; Zisook, Sidney

    2010-08-01

    This study examines the relationship of marital status to depression, positive and negative symptoms, quality of life, and suicidal ideation among 211 patients with schizophrenia-spectrum disorders and subsyndromal depressive symptoms. We hypothesized that single participants would have more severe symptomatology than married and cohabitating participants. Outpatients, age 40 or older, were diagnosed with schizophrenia or schizoaffective disorders using the MINI Structured Clinical Interview for DSM-IV Axis 1 Disorders. Participants exhibited a score of >8 on the Hamilton Rating Scale for Depression but did not meet criteria for a major depressive episode. Participants who were married or cohabitating had a later age of onset of first psychotic episode or hospitalization than those who were single (age, 29.35 vs 24.21). Married participants rated their quality of life higher than those who were single (mean Quality of Life Scale scores, 72.28 vs 53.87) and had less suicidal ideation than those who were divorced, widowed, or separated (7.4% vs 29.2%). In middle-aged and older individuals with schizophrenia or schizoaffective disorder and depressive symptoms, marriage appeared to enhance quality of life and protect against suicidal ideation. Efforts that focus on providing additional support for those who are experiencing divorce or separation could prove to be lifesaving for these individuals.

  9. Interaction between FKBP5 gene and childhood trauma on psychosis, depression and anxiety symptoms in a non-clinical sample.

    Science.gov (United States)

    de Castro-Catala, Marta; Peña, Elionora; Kwapil, Thomas R; Papiol, Sergi; Sheinbaum, Tamara; Cristóbal-Narváez, Paula; Ballespí, Sergi; Barrantes-Vidal, Neus; Rosa, Araceli

    2017-11-01

    Childhood trauma has been associated with a heightened risk for presenting clinical and non-clinical psychopathology in adulthood. Genes related with the stress response, such as the FK506 binding protein 51 (FKBP5), are plausible candidates moderating the effects of childhood trauma on the emergence of such symptoms later on. The present study aimed to explore the moderating role of FKBP5 genetic variability on the association of different types of childhood trauma with subclinical psychosis, depression and anxiety in a non-clinical sample. Schizotypy, psychotic-like experiences, depression and anxiety symptoms and childhood trauma were assessed in 808 young adults. Two FKBP5 haplotypic blocks were detected: block 1 (rs3800373 - rs9296158 - rs1360780) and block 2 (rs9470080 - rs4713916). Subjects were classified in two groups according to whether they carried or not the risk haplotype previously described in the literature (block 1: CAT and block 2: TA). Linear regression analyses were used to study (i) the main effects of childhood trauma and FKBP5 haplotype blocks and (ii) their interaction effects on the mentioned forms of psychopathology. All childhood trauma scales, except sexual abuse, were associated with schizotypy, psychotic-like experiences, depression and anxiety symptoms. None of the analysed symptoms was associated with the main effects of FKBP5 genetic variability. However an interaction effect between block 1 and physical abuse was observed on anxiety, with lower scores in CAT carriers. This effect was driven by SNP 1 and 2. Moreover, an interaction effect between block 2 and physical abuse was identified on the variables tapping depressive and anxiety symptoms. Specifically, non-TA carrier subjects who were exposed to physical abuse were found to be at higher risk for depressive and anxiety symptoms. These effects were driven by SNP 5. No interaction effect was observed for the other variables. Our data suggest that exposure to childhood physical

  10. Positive Psychology Intervention to Alleviate Child Depression and Increase Life Satisfaction: A Randomized Clinical Trial

    Science.gov (United States)

    Kwok, Sylvia Y. C. L.; Gu, Minmin; Kit, Katrina Tong Kai

    2016-01-01

    Purpose: The study aims to examine the effectiveness of a positive psychology group-based intervention program, incorporating elements of hope and gratitude, in decreasing depression and increasing life satisfaction among primary school students in Hong Kong. Method: A total of 68 children, with the Depression score of Chinese Hospital Anxiety and…

  11. Screening for Depression and Thoughts of Suicide: A Tool for Use in Alaska's Village Clinics

    Science.gov (United States)

    Niven, Julie A.

    2007-01-01

    Depression occurs at a significant rate in the U.S. population. Untreated depressive symptoms are a primary risk factor for suicide. Studies show that a significant percentage of individuals who commit suicide had visited their health care providers in the months before their deaths. Alaska ranks number one in the nation for suicide. Routine…

  12. A comparison of the clinical features of depression in hiv-positive ...

    African Journals Online (AJOL)

    and the direct and indirect effects of HIV on the brain.7,8. Depressive symptoms in HIV/AIDS have been ... diagnosis of depression was then confirmed using the Mini. International Neuropsychiatric Interview (MINI) and the ... assessed using the Mini Mental State Examination (MMSE). A standardized sociodemographic ...

  13. CBT for insomnia in patients with high and low depressive symptom severity: adherence and clinical outcomes.

    Science.gov (United States)

    Manber, Rachel; Bernert, Rebecca A; Suh, Sooyeon; Nowakowski, Sara; Siebern, Allison T; Ong, Jason C

    2011-12-15

    To evaluate whether depressive symptom severity leads to poorer response and perceived adherence to cognitive behavioral therapy for insomnia (CBTI) and to examine the impact of CBTI on well-being, depressive symptom severity, and suicidal ideation. Pre- to posttreatment case replication series comparing low depression (LowDep) and high depression (HiDep) groups (based on a cutoff of 14 on the Beck Depression Inventory [BDI]). 127 men and 174 women referred for the treatment of insomnia. Seven sessions of group CBTI. Improvement in the insomnia severity, perceived energy, productivity, self-esteem, other aspects of wellbeing, and overall treatment satisfaction did not differ between the HiDep and LowDep groups (p > 0.14). HiDep patients reported lower adherence to a fixed rise time, restricting time in bed, and changing expectations about sleep (p self-esteem, and other aspects of well-being were similar among patients with and without elevation in depressive symptom severity. Thus, the benefits of CBTI extend beyond insomnia and include improvements in non-sleep outcomes, such as overall well-being and depressive symptom severity, including suicidal ideation, among patients with baseline elevations. Results identify aspects of CBTI that may merit additional attention to further improve outcomes among patients with insomnia and elevated depressive symptom severity.

  14. Relationship between obesity and the risk of clinically significant depression: Mendelian randomisation study.

    LENUS (Irish Health Repository)

    Hung, Chi-Fa

    2014-07-01

    Obesity has been shown to be associated with depression and it has been suggested that higher body mass index (BMI) increases the risk of depression and other common mental disorders. However, the causal relationship remains unclear and Mendelian randomisation, a form of instrumental variable analysis, has recently been employed to attempt to resolve this issue.

  15. Episodic Visual Learning/Memory and Attentional Flexibility in Patients With Major Depressive Disorder After Clinically Effective Electroconvulsive Therapy.

    Science.gov (United States)

    Kalogerakou, Stamatina; Oulis, Panagiotis; Anyfandi, Eleni; Konstantakopoulos, George; Papakosta, Vasiliki-Maria; Kontis, Dimitrios; Theochari, Eirini; Angelopoulos, Elias; Zervas, Ioannis M; Mellon, Robert C; Papageorgiou, Charalambos C; Tsaltas, Eleftheria

    2015-12-01

    This study is a follow-up of a previous one reporting that the neuropsychological profile of pharmacoresistant patients with major depressive disorder referred for electroconvulsive therapy (ECT, ECT group) contrasted with that of their pharmacorespondent counterparts (NECT group). The NECT group exhibited severe visuospatial memory and minor executive deficits; the ECT group presented the reverse pattern. In that same ECT group, the current follow-up study examined the effects of clinically effective ECT on both cognitive domains 2 months later. Fifteen ECT patients were administered Hamilton Depression (HAMD-24), Hamilton Anxiety (HAMA), Mini-Mental State Examination Scales and 5 tests of Cambridge Neuropsychological Test Automated Battery at intake (pre-ECT), end of ECT course (post-ECT), and 2 months thereafter (follow-up). Electroconvulsive therapy was effective in relieving clinical depression. After a post-ECT decline, the patients exhibited significant improvement in both Cambridge Neuropsychological Test Automated Battery, paired associate learning, and Stockings of Cambridge. By contrast, their major pre-ECT deficit in intra/extradimensional set shifting remained virtually unaffected. Our findings suggest that attentional flexibility deficits may constitute a neuropsychological trait-like feature of pharmacoresistant, ECT-referred major depressive disorder patients. However, this deficit does not seem generalized, given patient improvement in episodic visual learning/memory and some indication of improvement in spatial planning after ECT.

  16. Impact of a Student Pharmacist Driven Medication Reconciliation and Antidepressant Treatment History Project at a Depression Clinic: A Pilot Study

    Science.gov (United States)

    Tang, Stella S.; Jaward, Leanna; Ward, Kristen; Parikh, Sagar V.; Bostwick, Jolene R.

    2017-01-01

    Objectives To improve treatment of patients with depression, a new pilot service project involving student pharmacists who would conduct medication reconciliation and review of antidepressant treatment history was created and evaluated. Experimental design A prospective study conducted at the University of Michigan Depression Center. Principal observations From an initial sample of 78 referrals, 41 subjects were reached by phone, with 34 completing medication reconciliation and antidepressant treatment history. Of the 34 patients, 25 (73.5%) had at least one discrepancy identified in their medication list, resulting in 164 medication changes in the electronic medical record (EMR). A total of 105 past antidepressant trials were documented in the 34 individuals, with 34 (32.4%) trials found to be inadequate. Thirteen (38.2%) patients reported failure to respond to two different antidepressants from different classes. All 34 patients participated well in the phone calls and were willing to consult a pharmacist at their upcoming clinic visit. Conclusions A student pharmacist pilot was feasible, identified many discrepancies in the medication record, and identified important medication treatment history in patients with depression in advance of the clinic visit. The project provides support for a specialized role for student pharmacists and demonstrates that interprofessional care can contribute to improved treatment of depression. PMID:28626270

  17. Vitamin D Supplementation Affects the Beck Depression Inventory, Insulin Resistance, and Biomarkers of Oxidative Stress in Patients with Major Depressive Disorder: A Randomized, Controlled Clinical Trial.

    Science.gov (United States)

    Sepehrmanesh, Zahra; Kolahdooz, Fariba; Abedi, Fatemeh; Mazroii, Navid; Assarian, Amin; Asemi, Zatollah; Esmaillzadeh, Ahmad

    2016-02-01

    Vitamin D may decrease depression symptoms through its beneficial effects on neurotransmitters, metabolic profiles, biomarkers of inflammation, and oxidative stress. This study was designed to assess whether vitamin D supplementation can reduce symptoms of depression, metabolic profiles, serum high-sensitivity C-reactive protein (hs-CRP), and biomarkers of oxidative stress in patients with major depressive disorder (MDD). This randomized, double-blind, placebo-controlled clinical trial was performed in 40 patients between 18 and 65 y of age with a diagnosis of MDD based on criteria from the Diagnostic and Statistical Manual of Mental Disorders. Patients were randomly assigned to receive either a single capsule of 50 kIU vitamin D/wk (n = 20) or placebo (n = 20) for 8 wk. Fasting blood samples were taken at baseline and postintervention to quantify relevant variables. The primary [Beck Depression Inventory (BDI), which examines depressive symptoms] and secondary (glucose homeostasis variables, lipid profiles, hs-CRP, and biomarkers of oxidative stress) outcomes were assessed. Baseline concentrations of mean serum 25-hydroxyvitamin D were significantly different between the 2 groups (9.2 ± 6.0 and 13.6 ± 7.9 μg/L in the placebo and control groups, respectively, P = 0.02). After 8 wk of intervention, changes in serum 25-hydroxyvitamin D concentrations were significantly greater in the vitamin D group (+20.4 μg/L) than in the placebo group (-0.9 μg/L, P < 0.001). A trend toward a greater decrease in the BDI was observed in the vitamin D group than in the placebo group (-8.0 and -3.3, respectively, P = 0.06). Changes in serum insulin (-3.6 compared with +2.9 μIU/mL, P = 0.02), estimated homeostasis model assessment of insulin resistance (-1.0 compared with +0.6, P = 0.01), estimated homeostasis model assessment of β cell function (-13.9 compared with +10.3, P = 0.03), plasma total antioxidant capacity (+63.1 compared with -23.4 mmol/L, P = 0.04), and glutathione

  18. Correlation and characteristics of self-rating and clinical rating of depression among alcoholics in the course of early abstinence

    Directory of Open Access Journals (Sweden)

    Mandić-Gajić Gordana

    2015-01-01

    Full Text Available Background/Aim. Depression is an alcoholism relapse risk factor, but frequently stays underdiagnosed among treated alcoholics. The correlation and characteristics of self-reported and clinically assessed depression in the course of early alcohol abstinence were explored. Methods. A total of 100 inpatient, primary male alcoholics (20-60 years diagnosed according to Classificaton of Mental and Behavioural Disorders (ICD-10 and Diagnostic and Statistical Manual of Mental Disorders (DSM-IV were recruited consecutively. The Hamilton Depression Rating Scale (HDRS and Beck Depression Inventory (BDI were scored on admission (T1, after 4 weeks (T2 and after 8 weeks (T3. Student's t-test, repeated measures ANOVA and Pearson's correlation between the scores were done (p < 0.05. Factor analyses of symptoms were performed. Results: On HDRS T1, T2, T3 90,7%, 39.5%, 17.4% alcoholics were depressive, respectively. The mean HDRS vs BDI scores on T1, T2 and T3 were 15.16 ± 6.34, 7.35 ± 4.18, 4.23 ± 2.93 vs 14.20 ± 9.56, 8.14 ± 7.35, 5.30 ± 4.94, respectively. Depression severity significantly lowered in the course of abstinence (ANOVA. The HRDS and BDI correlations on T1, T2 and T3 were significant (r1 = 0.763, r2 = 0.684, r3 = 0.613 respectively. Dysphoric mood, anxious, vegetative and cognitive HDRS subscales on T1, T2 and T3 were detected, but not BDI factors, thus BDI symptoms were analysed. Conclusions. The majority of alcoholics had depression on admission. A predominant mild-degree with a significant lowering of depression severity and positive significant correlations between HRDS and BDI scores in the course of abstinence were detected. The dysphoric mood on the HDRS sub-scale, and self-blame, anhedonia and guilt BDI symptoms were most prominent and persisted. The BDI could be a useful tool not only for routine screening and reassessment of depression, but also for exploring emotional content during early abstinence and planning tailored

  19. Nortriptyline versus fluoxetine in the treatment of major depressive disorder: a six-month, double-blind clinical trial

    Directory of Open Access Journals (Sweden)

    Hashemi SN

    2012-01-01

    Full Text Available SN Hashemi1, HR Ghafarian Shirazi2,3, A Mohamadi4, GH Zadeh-Bagheri5, KH Noorian5, M Malekzadeh21Department of Psychiatry, Faculty of Medicine, 2Research Center of Social Factors Affecting Health, Yasuj University of Medical Sciences, Yasuj, 3School of Public Health, Tehran University of Medical Sciences, Tehran, 4Department of Psychiatry, 5School of Medicine, Yasuj University of Medical Sciences, Yasuj, IranBackground: Depression is a common psychiatric disorder worldwide, including in Iran, and is estimated to affect 10%–15% of the population. Antidepressant drugs can have multiple side effects, so a good choice of drug is important for successful treatment. This study compared the efficacy of nortriptyline with that of fluoxetine in the treatment of patients with major depressive disorder and assessed related factors, including age, gender, and level of education.Methods: The study was a double-blind, randomized clinical trial with a six-month follow-up period. Participants were 120 patients aged 15–60 years with a diagnosis of major depressive disorder based on a psychiatry interview and the Beck depression rating scale, which were performed at the beginning, middle, and end of the study. The patients were treated with nortriptyline or fluoxetine. The paired t-test, independent t-test, and the k chi-square test were used to analyze the data.Results: Twenty-three patients dropped out and 97 remained in the trial. Before intervention, the mean depression score was 32.85 ± 6.23 in the nortriptyline group and 33.12 ± 6.50 in the fluoxetine group. The results of the independent t-test showed a significant difference between depression score means before and after treatment in both groups. Changes at the end of the trial compared with baseline scores were 13.4 ± 4.68 and 16.96 ± 4.96 for nortriptyline and fluoxetine, respectively. Paired t-testing showed a significant difference in the mean depression score for both the nortriptyline and

  20. Gastrointestinal symptoms resembling ulcerative proctitis caused by larvae of the drone fly Eristalis tenax.

    Science.gov (United States)

    Desoubeaux, Guillaume; Gaillard, Julien; Borée-Moreau, Diane; Bailly, Éric; Andres, Christian R; Chandenier, Jacques

    2014-04-01

    We report a case of facultative intestinal myiasis due to larvae of the drone fly Eristalis tenax, also named the rat-tailed maggots. The development of larvae in the lower bowel was responsible for non-specific gastrointestinal symptoms that resembled ulcerative proctitis. The diagnosis was established upon the observation of four spontaneously excreted mobile larvae. The definite identification of the E. tenax species was made possible by scanning electron microscopy. The clinical outcome was satisfactory.

  1. Obsessive compulsive symptoms in individuals at clinical risk for psychosis: association with depressive symptoms and suicidal ideation.

    Science.gov (United States)

    DeVylder, Jordan E; Oh, Amy J; Ben-David, Shelly; Azimov, Neyra; Harkavy-Friedman, Jill M; Corcoran, Cheryl M

    2012-09-01

    Obsessive-compulsive symptoms, particularly aggressive obsessions, are prevalent in schizophrenia patients and associated with other symptom severity, suicidal ideation and functional impairment. In a psychosis-risk cohort, obsessive-compulsive diagnosis and symptoms were assessed in terms of prevalence and content, and for associations with clinical measures. Obsessive-compulsive symptoms were prevalent in the CHR cohort, as was suicidal ideation. The presence and severity of aggressive obsessions were associated with depression, suicidal ideation and social impairment. The high prevalence of aggressive obsessions and associated suicidal ideation in a clinical high risk cohort, and their relationship to depression, is relevant for risk assessment and treatment strategies. Copyright © 2012 Elsevier B.V. All rights reserved.

  2. Depressive symptoms and clinical status during the Treatment of Adolescent Suicide Attempters (TASA) Study.

    Science.gov (United States)

    Vitiello, Benedetto; Brent, David A; Greenhill, Laurence L; Emslie, Graham; Wells, Karen; Walkup, John T; Stanley, Barbara; Bukstein, Oscar; Kennard, Betsy D; Compton, Scott; Coffey, Barbara; Cwik, Mary F; Posner, Kelly; Wagner, Ann; March, John S; Riddle, Mark; Goldstein, Tina; Curry, John; Capasso, Lisa; Mayes, Taryn; Shen, Sa; Gugga, S Sonia; Turner, J Blake; Barnett, Shannon; Zelazny, Jamie

    2009-10-01

    To examine the course of depression during the treatment of adolescents with depression who had recently attempted suicide. Adolescents (N = 124), ages 12 to 18 years, with a 90-day history of suicide attempt, a current diagnosis of depressive disorder (96.0% had major depressive disorder), and a Children's Depression Rating Scale-Revised (CDRS-R) score of 36 or higher, entered a 6-month treatment with antidepressant medication, cognitive-behavioral therapy focused on suicide prevention, or their combination (Comb), at five academic sites. Treatment assignment could be either random or chosen by study participants. Intent-to-treat, mixed effects regression models of depression and other relevant ratings were estimated. Improvement and remission rates were computed with the last observation carried forward. Most patients (n = 104 or 84%) chose treatment assignment, and overall, three fourths (n = 93) received Comb. In Comb, CDRS-R declined from a baseline adjusted mean of 49.6 (SD 12.3) to 38.3 (8.0) at week 12 and to 27.0 (10.1) at week 24 (p rate of 58.0% at week 12 and 72.2% at week 24 and a remission (CDRS-R ≤ 28) rate of 32.5% at week 12 and 50.0% at week 24. The CDRS-R and the Scale for Suicidal Ideation scores were correlated at baseline (r = 0.43, p depression who have recently attempted suicide show rates of improvement and remission of depression that seem comparable to those observed in nonsuicidal adolescents with depression. Copyright © 2009 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  3. Depression and Menopause: Current Knowledge and Clinical Recommendations for a Critical Window.

    Science.gov (United States)

    Soares, Claudio N

    2017-06-01

    Depression is a disabling condition, which often leads to significant personal, societal, and economic costs. Windows of vulnerability for depression in women likely are associated with an increased sensitivity experienced by some women to changes in the hormonal milieu that occur during the luteal phase of their cycles, during the postpartum period, and/or during the menopause transition. The controversy surrounding a menopause-related depression has been fueled by conflicting methodologies used to characterize reproductive staging or assess psychiatric conditions during midlife years. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. A prospective study of existential issues in therapeutic horticulture for clinical depression.

    Science.gov (United States)

    Gonzalez, Marianne Thorsen; Hartig, Terry; Patil, Grete Grindal; Martinsen, Egil Wilhelm; Kirkevold, Marit

    2011-01-01

    Two studies with single-group design (Study 1 N = 18, Study 2 N = 28) addressed whether horticultural activities ameliorate depression severity and existential issues. Measures were obtained before and after a 12-week therapeutic horticulture program and at 3-month follow-up. In both studies, depression severity declined significantly during the intervention and remained low at the follow-up. In both studies the existential outcomes did not change significantly; however, the change that did occur during the intervention correlated (rho > .43) with change in depression severity. Participants' open-ended accounts described the therapeutic horticulture experience as meaningful and influential for their view of life.

  5. DEMO-II trial. Aerobic exercise versus stretching exercise in patients with major depression-a randomised clinical trial.

    Science.gov (United States)

    Krogh, Jesper; Videbech, Poul; Thomsen, Carsten; Gluud, Christian; Nordentoft, Merete

    2012-01-01

    The effect of referring patients from a clinical setting to a pragmatic exercise intervention for depressive symptoms, cognitive function, and metabolic variables has yet to be determined. Outpatients with major depression (DSM-IV) were allocated to supervised aerobic or stretching exercise groups during a three months period. The primary outcome was the Hamilton depression score (HAM-D(17)). Secondary outcomes were cognitive function, cardiovascular risk markers, and employment related outcomes. 56 participants were allocated to the aerobic exercise intervention versus 59 participants to the stretching exercise group. Post intervention the mean difference between groups was -0.78 points on the HAM-D(17) (95% CI -3.2 to 1.6; P = .52). At follow-up, the participants in the aerobic exercise group had higher maximal oxygen uptake (mean difference 4.4 l/kg/min; 95% CI 1.7 to 7.0; P = .001) and visuospatial memory on Rey's Complex Figure Test (mean difference 3.2 points; 95% CI 0.9 to 5.5; P = .007) and lower blood glucose levels (mean difference 0.2 mmol/l; 95% CI 0.0 to 0.5; P = .04) and waist circumference (mean difference 2.2 cm; 95% CI 0.3 to 4.1; P = .02) compared with the stretching exercise group. The results of this trial does not support any antidepressant effect of referring patients with major depression to a three months aerobic exercise program. Due to lower recruitment than anticipated, the trial was terminated prior to reaching the pre-defined sample size of 212 participants; therefore the results should be interpreted in that context. However, the DEMO-II trial does suggest that an exercise program for patients with depression offer positive short-term effects on maximal oxygen uptake, visuospatial memory, fasting glucose levels, and waist circumference. ClinicalTrials.gov NCT00695552.

  6. Major depressive disorder: Longitudinal analysis of impact on clinical and behavioural outcomes in Uganda.

    Science.gov (United States)

    Kinyanda, Eugene; Levin, Jonathan; Nakasujja, Noeline; Birabwa, Harriet; Nakku, Juliet; Mpango, Richard; Grosskurth, Heiner; Seedat, Soraya; Araya, Ricardo; Shahmanesh, Maryam; Patel, Vikram

    2018-02-07

    There is still wide variability in HIV disease course and other HIV related outcomes, attributable in part to psychosocial factors such as major depressive disorder (MDD), a subject that has received little attention in sub-Saharan Africa. Using a longitudinal cohort of 1099 HIV positive antiretroviral therapy (ART) naïve persons, we investigated the impact of MDD on four HIV related negative outcome domains in Uganda. MDD was assessed using a Diagnostic Statistical Manual IV based tool. Also collected was data on surrogate measures of the HIV related outcome domains. Data was collected at the three time points of baseline, 6 and 12 months. Multiple regression and discrete time survival models were used to investigate the relationship between MDD and indices of the HIV outcomes. MDD was a significant predictor of 'missed ART doses' (aOR=4.75, 95% CI, 1.87-12.04, p=0.001), 'time to first visit to healthy facility' (aOR=1.71; 95% CI, 1.07-2.73; p=0.024), 'time to first self-reported risky sexual activity' (aOR=2.11, 95% CI, 1.27-3.49; p=0.004) but not of 'CD4 counts at months 6 and 12' (estimated effect 29.0; 95% CI, -7.8-65.7; p=0.12) and 'time to new WHO stage 3 or 4 clinical event' (aOR=0.52, 95% CI, 0.12-2.20, p=0.37). MDD significantly impacted three of the four investigated outcome domains. These results by demonstrating the adverse consequences of an untreated mental health disorder (MDD) on HIV related outcomes, further strengthen the need to urgently act on WHO's call to integrate mental health care in general HIV care.

  7. The validity and clinical utility of the hospital anxiety and depression scale (HADS) with older adult New Zealanders.

    Science.gov (United States)

    Roberts, Margaret H; Fletcher, Richard B; Merrick, Paul L

    2014-02-01

    The Hospital Anxiety and Depression Scale (HADS) has established use with older adult populations in New Zealand but few studies have evaluated its psychometric properties. Research with the psychometric properties of the HADS in elderly populations has primarily used correlational methods that do not allow for the effects of measurement error to be observed. The hypothesized tripartite model of anxiety and depression within the HADS was evaluated using confirmatory factor analysis (CFA) methods. Overall, 203 community-dwelling older adults who were recruited from older adult community groups completed the HADS. Competing two- and three-factor structures were trialled using CFA. A three-factor model indicated a lack of differentiation between factors and poor clinical utility and was rejected in favor of a two-factor model. Significant correlations were observed between the anxiety and depression factors on the two-factor model, but it was considered to have validity for older adult samples. Good internal consistency was found for the HADS. A two-factor model of the HADS was favored due to the lack of differentiation between factors on the three-factor model, and the higher clinical utility of a two-factor solution. The validity of the HADS may be limited by over-diagnosing anxiety in non-clinical populations. It is recommended that the HADS be used to measure change over time through treatment and not be used as a diagnostic tool until future research establishes appropriate norms and cut-offs.

  8. Assistant professor Andrea Wittenborn, research team conduct clinical trial to treat couples' depression, marital problems

    OpenAIRE

    Micale, Barbara L.

    2010-01-01

    Andrea Wittenborn, assistant professor, human development, is heading a research team conducting the Strengthening Bonds Couples Therapy Study to treat depression and marital problems (dyadic distress) in married/committed couple relationships.

  9. A Novel Religious/Spiritual Group Psychotherapy Reduces Depressive Symptoms in a Randomized Clinical Trial.

    Science.gov (United States)

    Chida, Yoichi; Schrempft, Stephanie; Steptoe, Andrew

    2016-10-01

    This randomized controlled trial aimed to examine the effect of the Happy Science doctrine-based group psychotherapy on depressive symptoms in 118 Japanese mental disorder outpatients. The treatment group (n = 58) took part in five 90-min sessions at one-week intervals, while the control group (n = 60) received standard care including medication. Depressive symptoms were assessed before the intervention, 5 weeks after the intervention, and at 3-month follow-up. Compared to the control group, the treatment group showed a significant reduction in depressive symptoms both at post-intervention and at 3-month follow-up. In conclusion, this group psychotherapy might be of benefit in treating depressive symptoms.

  10. Psychosocial Adaptation and Depressive Manifestations in High-Risk Pregnant Women: Implications for Clinical Practice.

    Science.gov (United States)

    Fiskin, Gamze; Kaydirak, Meltem Mecdi; Oskay, Umran Yesiltepe

    2017-02-01

    High-risk pregnancy research has focused primarily on psychological well-being. The aim is to determine psychosocial adaptation and depression levels of pregnant women who were admitted to hospital with diagnosis of high-risk pregnancy. This study was descriptive. Sampling was composed of 122 high-risk pregnant women who were hospitalized in the perinatology service of Istanbul University Medical School, Department of Obstetrics and Gynecology between January 1, 2014, and May 31, 2014, and met the study criteria. The Pregnant Introduction Form, Psychosocial Adjustment of Illness Scale-Self Report, and CES Depression Scale were used. Of high-risk pregnant women, 47% were found to have a poor level of psychosocial adaptation and 57% presented with depressive symptoms. There were statistically significant difference found between the levels of psychosocial adaptation and status of depressive manifestations. The difference between the average scores increased as the adaptation levels weaken and the pregnant women with a poor level of psychosocial adaptation showed more depressive manifestations. The results of this study indicate that, depending on the high-risk pregnancy status, pregnant women experience difficulty in adaptation to their current status and pregnant women with a poor level of psychosocial adaptation showed more depressive manifestations. Nurses should deliver care in high-risk pregnancies with the awareness of physiological needs as well the psychosocial needs of pregnant women, and information meetings should be held in order to increase the psychosocial support of their families and decrease their tendency toward depression. Nursing initiatives should be developed with further studies for the psychosocial adaptation of high-risk pregnancy and reduction of the depressive manifestations. © 2016 Sigma Theta Tau International.

  11. Clinical study on role of life events in genesis of neurotic disorders and depression

    Directory of Open Access Journals (Sweden)

    Deepanjali Medhi

    2015-07-01

    Full Text Available Background: This study was conducted to know about the role of life events in genesis of neurotic disorders and depression in four groups of patients with dissociative disorder, somatisation disorder, generalized anxiety disorder (GAD, and depression. It was conducted in the Department of Psychiatry, Gauhati Medical College and Hospital, Guwahati, Assam, India. Methods and materials: It was a case control study with 100 cases of neurotic disorders and depression (25 cases in each group attending indoor and outdoor, and diagnosed using research diagnostic criteria of the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10. The groups were compared with similar number of matched controls, in respect to number, scoring, and type of life events occurring within one year prior to the onset of illness using the Presumptive Stressful Life Events Scale (PSLES. Variables related to socio-demographic characteristics were also seen between cases and controls. Result and conclusion: Number of life events was significantly higher in depressive and generalized anxiety groups than control group. Total life events scores were significantly higher in depressive and generalized anxiety group than control group. Undesirable events were significantly higher in all groups. Personal events were significantly higher in depressives than control. Events related to interpersonal relation were significantly higher in depressive, dissociative, and GAD groups than control. Bereavement was closely associated with depression and GAD. Events related to health, finance, and education were higher in dissociative group than control. Events related to move were found significantly higher in GAD group than control. Implications of the findings are discussed.

  12. A clinical trial of cranial electrotherapy stimulation for anxiety and comorbid depression.

    Science.gov (United States)

    Barclay, Timothy H; Barclay, Raymond D

    2014-08-01

    Anxiety disorders are among the most prevalent mental disorders and are usually treated with medication and/or psychotherapy. When anxiety disorders are accompanied with comorbid depression, this further complicates the treatment process. Medication compliance is a common problem due to adverse side effects and new and effective treatments that have minimal side effects are needed for the treatment of anxiety and depression. This study used a randomized, double-blind, sham controlled design to examine the effectiveness of CES as a treatment for anxiety disorders and comorbid depression in a primary care setting. The study was registered at clinicaltrials.gov, NCT01533415. One hundred and fifteen participants, age 18 years and over, with a primary diagnosis of an anxiety disorder were enrolled from February 2012 to December 2012 The Hamilton Rating Scale for Anxiety (HAM-A) and the Hamilton Depression Rating Scale17 (HAM-D17) were used for baseline and outcome measures at weeks one, three, and five. Response to treatment was defined as a reduction of ≥50% or more on these measures. Analysis of covariance revealed a significant difference between the active CES group and the sham CES group on anxiety (p=0.001, d=0.94) and on depression (p=0.001, d=0.78) from baseline to endpoint of study in favor of the active CES group. CES significantly decreases anxiety and comorbid depression. Subjects reported no adverse events during the study. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. Clinical and cost-effectiveness of computerised cognitive behavioural therapy for depression in primary care: Design of a randomised trial

    Directory of Open Access Journals (Sweden)

    Severens Johan L

    2008-06-01

    Full Text Available Abstract Background Major depression is a common mental health problem in the general population, associated with a substantial impact on quality of life and societal costs. However, many depressed patients in primary care do not receive the care they need. Reason for this is that pharmacotherapy is only effective in severely depressed patients and psychological treatments in primary care are scarce and costly. A more feasible treatment in primary care might be computerised cognitive behavioural therapy. This can be a self-help computer program based on the principles of cognitive behavioural therapy. Although previous studies suggest that computerised cognitive behavioural therapy is effective, more research is necessary. Therefore, the objective of the current study is to evaluate the (cost- effectiveness of online computerised cognitive behavioural therapy for depression in primary care. Methods/Design In a randomised trial we will compare (a computerised cognitive behavioural therapy with (b treatment as usual by a GP, and (c computerised cognitive behavioural therapy in combination with usual GP care. Three hundred mild to moderately depressed patients (aged 18–65 will be recruited in the general population by means of a large-scale Internet-based screening (N = 200,000. Patients will be randomly allocated to one of the three treatment groups. Primary outcome measure of the clinical evaluation is the severity of depression. Other outcomes include psychological distress, social functioning, and dysfunctional beliefs. The economic evaluation will be performed from a societal perspective, in which all costs will be related to clinical effectiveness and health-related quality of life. All outcome assessments will take place on the Internet at baseline, two, three, six, nine, and twelve months. Costs are measured on a monthly basis. A time horizon of one year will be used without long-term extrapolation of either costs or quality of life

  14. Assessment of anxiety and depression in adolescents with acne vulgaris related to the severity of clinical features and gender

    Directory of Open Access Journals (Sweden)

    Nermina Kurtalić

    2010-11-01

    Full Text Available Objective. To determine anxiety and depression levels in adolescents with acne vulgaris in relation to clinical severity and gender. Patients and methods. Using a sectional study, the anxiety and depression level was analyzed of 90 adolescents of both sexes, aged 16 to 21 years, who were suffering from acne vulgaris. The study was conducted between February 1st 2008 and January 31st 2009 at the Dermatovenerology department of the Cantonal Hospital “Dr. Irfan Ljubijankić”, Bihac. According to the type of efflorescence, its localization and severity of clinical features, respondents were classified in three groups: the first group consisted of adolescents with mild forms of acne, the second group had moderate forms of acne and the third had severe forms of acne. Evaluation of anxiety levels in patients with acne vulgaris was made using STAI questionnaire (Spielberger’s state and trait Anxiety Inventory that consists of 20 questions about the essential characteristics of anxiety as the condition, and the level of depression was determined using the BDS-scale (Back Depression Inventory which consists of 18 items that were used by the respondents to perform self-evaluation of depression level. Results. In the study group there were 54 (60% female respondents and 36 (40% male, mean age 17.5 years (range 15.6-20.6. Of the total number of patients with acne vulgaris, nine of them or 10% (4 female and 5 male had a mild form of acne (first group, 72 of them or 80% (46 female and 26 male a moderate form of acne (second group and 9 of them or 10 % (4 female and 5 male a severe form of acne (third group (p > 0.95. 1.1% of the respondents had an exceptionally low anxiety level, 13.3% had low level, moderate 76.8% and 8.8% had a high level. 37.8% had distinct signs of depression, the risk group consisted of 44.4%, and a normal value was found in 17.7%. The values of the STAI questionnaire expressed as median (range in the first, second and third groups

  15. Quantifying the importance of disease burden on perceived general health and depressive symptoms in patients within the Mayo Clinic Biobank.

    Science.gov (United States)

    Ryu, Euijung; Takahashi, Paul Y; Olson, Janet E; Hathcock, Matthew A; Novotny, Paul J; Pathak, Jyotishman; Bielinski, Suzette J; Cerhan, James R; Sloan, Jeff A

    2015-07-03

    Deficits in health-related quality of life (HRQOL) may be associated with worse patient experiences, outcomes and even survival. While there exists evidence to identify risk factors associated with deficits in HRQOL among patients with individual medical conditions such as cancer, it is less well established in more general populations without attention to specific illnesses. This study used patients with a wide range of medical conditions to identify contributors with the greatest influence on HRQOL deficits. Self-perceived general health and depressive symptoms were assessed using data from 21,736 Mayo Clinic Biobank (MCB) participants. Each domain was dichotomized into categories related to poor health: deficit (poor/fair for general health and ≥3 for PHQ-2 depressive symptoms) or non-deficit. Logistic regression models were used to test the association of commonly collected demographic characteristics and disease burden with each HRQOL domain, adjusting for age and gender. Gradient boosting machine (GBM) models were applied to quantify the relative influence of contributors on each HRQOL domain. The prevalence of participants with a deficit was 9.5 % for perception of general health and 4.6 % for depressive symptoms. For both groups, disease burden had the strongest influence for deficit in HRQOL (63 % for general health and 42 % for depressive symptoms). For depressive symptoms, age was equally influential. The prevalence of a deficit in general health increased slightly with age for males, but remained stable across age for females. Deficit in depressive symptoms was inversely associated with age. For both HRQOL domains, risk of a deficit was associated with higher disease burden, lower levels of education, no alcohol consumption, smoking, and obesity. Subjects with deficits were less likely to report that they were currently working for pay than those without a deficit; this association was stronger among males than females. Comorbid health burden has the

  16. Depression as a Clinical Determinant of Dependence and Low Quality of Life in Elderly Patients with Cardiovascular Disease

    Directory of Open Access Journals (Sweden)

    Giselle Helena de Paula Rodrigues

    2015-06-01

    Full Text Available Background: The aging process promotes a progressive increase in chronic-degenerative diseases. The effect of these diseases on the functional capacity has been well recognized. Another health parameter concerns “quality of life related to health”. Among the elderly population, cardiovascular diseases stand out due to the epidemiological and clinical impact. Usually, these diseases have been associated with others. This set of problems may compromise both independence and quality of life in elderly patients who seek cardiologic treatment. These health parameters have not been well contemplated by cardiologists. Objective: Evaluating, among the elderly population with cardiovascular disease, which are the most relevant clinical determinants regarding dependence and quality of life. Methods: This group was randomly and consecutively selected and four questionnaires were applied: HAQ, SF-36, PRIME-MD e Mini Mental State. Results: The study included 1,020 elderly patients, 63.3% women. The group had been between 60 and 97 years-old (mean: 75.56 ± 6.62 years-old. 61.4% were independent or mild dependence. The quality of life total score was high (HAQ: 88.66 ± 2.68. 87.8% of patients had a SF-36 total score > 66. In the multivariate analysis, the association between diagnoses and high degrees of dependence was significant only for previous stroke (p = 0.014, obesity (p < 0.001, lack of physical activity (p = 0.016, osteoarthritis (p < 0.001, cognitive impairment (p < 0.001, and major depression (p < 0.001. Analyzing the quality of life, major depression and physical illness for depression was significantly associated with all domains of the SF-36. Conclusion: Among an elderly outpatient cardiology population, dependence and quality of life clinical determinants are not cardiovascular comorbidities, especially the depression.

  17. Clinical pilot study of transcranial direct current stimulation combined with Cognitive Emotional Training for medication resistant depression.

    Science.gov (United States)

    Martin, D M; Teng, J Z; Lo, T Y; Alonzo, A; Goh, T; Iacoviello, B M; Hoch, M M; Loo, C K

    2018-05-01

    While the clinical results from transcranial direct current stimulation (tDCS) for the treatment of depression have been promising, antidepressant effects in patients with medication resistance have been suboptimal. There is therefore a need to further optimise tDCS for medication resistant patients. In this clinical pilot study we examined the feasibility, safety, and clinical efficacy of combining tDCS with a psychological intervention which targets dysfunctional circuitry related to emotion regulation in depression, Cognitive Emotional Training (CET). tDCS was administered during CET three times a week for a total of 18 sessions over 6 weeks. Mood, cognition and emotion processing outcomes were examined at baseline and after 3 and 6 weeks of treatment. Twenty patients with medication resistant depression participated, of whom 17 were study completers. tDCS combined with CET was found to be feasible, safe, and associated with significant antidepressant efficacy at 6 weeks, with 41% of study completers showing treatment response (≥ 50% improvement in depression score). There were no significant cognitive enhancing effects with the exception of improved emotion recognition. Responders demonstrated superior recognition for the emotions fear and surprise at pre-treatment compared to non-responders, suggesting that better pre-treatment emotion recognition may be associated with antidepressant efficacy. This was an open label study. tDCS combined with CET has potential as a novel method for optimising the antidepressant efficacy of tDCS in medication resistant patients. Future controlled studies are required to determine whether tDCS combined with CET has greater antidepressant efficacy compared to either intervention alone. Copyright © 2018 Elsevier B.V. All rights reserved.

  18. Illness Perception and Depressive Symptoms among Persons with Type 2 Diabetes Mellitus: An Analytical Cross-Sectional Study in Clinical Settings in Nepal.

    Science.gov (United States)

    Joshi, Suira; Dhungana, Raja Ram; Subba, Usha Kiran

    2015-01-01

    Background. This study aimed to assess the relationship between illness perception and depressive symptoms among persons with diabetes. Method. This was an analytical cross-sectional study conducted among 379 type 2 diabetic patients from three major clinical settings of Kathmandu, Nepal. Results. The prevalence of depressive symptoms was 44.1% (95% CI: 39.1, 49.1). Females (p perception and depressive symptoms among diabetic patients. Study finding indicated that persons living with diabetes in Nepal need comprehensive diabetes education program for changing poor illness perception, which ultimately helps to prevent development of depressive symptoms.

  19. Spousal resemblance in psychopathology: A comparison of parents of children with and without psychopathology

    NARCIS (Netherlands)

    Wesseldijk, L. W.; Dieleman, G. C.; Lindauer, R. J. L.; Bartels, M.; Willemsen, G.; Hudziak, J. J.; Boomsma, D. I.; Middeldorp, C. M.

    2016-01-01

    Spouses resemble each other for psychopathology, but data regarding spousal resemblance in externalizing psychopathology, and data regarding spousal resemblance across different syndromes (e.g. anxiety in wives and attention deficit/hyperactivity disorder [ADHD] in husbands) are limited. Moreover,

  20. International Study to Predict Optimized Treatment for Depression (iSPOT-D, a randomized clinical trial: rationale and protocol

    Directory of Open Access Journals (Sweden)

    Cooper Nicholas J

    2011-01-01

    Full Text Available Abstract Background Clinically useful treatment moderators of Major Depressive Disorder (MDD have not yet been identified, though some baseline predictors of treatment outcome have been proposed. The aim of iSPOT-D is to identify pretreatment measures that predict or moderate MDD treatment response or remission to escitalopram, sertraline or venlafaxine; and develop a model that incorporates multiple predictors and moderators. Methods/Design The International Study to Predict Optimized Treatment - in Depression (iSPOT-D is a multi-centre, international, randomized, prospective, open-label trial. It is enrolling 2016 MDD outpatients (ages 18-65 from primary or specialty care practices (672 per treatment arm; 672 age-, sex- and education-matched healthy controls. Study-eligible patients are antidepressant medication (ADM naïve or willing to undergo a one-week wash-out of any non-protocol ADM, and cannot have had an inadequate response to protocol ADM. Baseline assessments include symptoms; distress; daily function; cognitive performance; electroencephalogram and event-related potentials; heart rate and genetic measures. A subset of these baseline assessments are repeated after eight weeks of treatment. Outcomes include the 17-item Hamilton Rating Scale for Depression (primary and self-reported depressive symptoms, social functioning, quality of life, emotional regulation, and side-effect burden (secondary. Participants may then enter a naturalistic telephone follow-up at weeks 12, 16, 24 and 52. The first half of the sample will be used to identify potential predictors and moderators, and the second half to replicate and confirm. Discussion First enrolment was in December 2008, and is ongoing. iSPOT-D evaluates clinical and biological predictors of treatment response in the largest known sample of MDD collected worldwide. Trial registration International Study to Predict Optimised Treatment - in Depression (iSPOT-D ClinicalTrials.gov Identifier

  1. Clinical implications of anterior S-T segment depression in patients with acute inferior myocardial infarction

    International Nuclear Information System (INIS)

    Croft, C.H.; Woodward, W.; Nicod, P.; Corbett, J.R.; Lewis, S.E.; Willerson, J.T.; Rude, R.E.

    1982-01-01

    To assess various factors associated with anterior S-T segment depression during acute inferior myocardial infarction, 47 consecutive patients with electrocardiographic evidence of a first transmural inferior infarction were studied prospectively with radionuclide ventriculography an average of 7.3 hours (range 2.9 to 15.3) after the onset of symptoms. Thirty-nine patients (Group I) had anterior S-T depression in the initial electrocardiogram and 8 (Group II) did not have such reciprocal changes. There was no difference between the two groups in left ventricular end-diastolic or end-diastolic volume index or left ventricular ejection fraction. Stroke volume index was greater in Group I than in Group II. There were no group differences in left ventricular total or regional wall motion scores. A weak correlation existed between the quantities (mV) or inferior S-T segment elevation and reciprocal S-T depression. No relation between anterior S-T segment depression and the left ventricular end-diastolic volume index could be demonstrated; the extent of left ventricular apical and right ventricular wall motion abnormalities, both frequently associated with inferior infarction, did not correlate with the quantity of anterior S-T depression. These data show that anterior S-T segment depression occurs commonly during the early evolution of transmural inferior infarction, is not generally a marker of functionally significant anterior ischemia and cannot be used to predict left ventricular function in individual patients. Anterior S-T segment depression may be determined by reciprocal mechanisms

  2. RESEMBLANCE OF INDIRECTNESS IN POLITENESS OF EFL LEARNERS’ REQUEST REALIZATIONS

    Directory of Open Access Journals (Sweden)

    Indawan Syahri

    2013-07-01

    Full Text Available Abstract: Politeness principles are universally utilized by the speakers of any language when realizing various speech acts. However, the speakers of particular languages relatively apply politeness due to the cultural norms embedded. The present study attempts to delineate how the Indonesian learners of English (ILE apply the politeness principles in request realizations. Specifically it devotes to the types of politeness strategies applied and resemblance of the indirectness in politeness strategies in requesting acts. The FTAs and indirectness are the theoretical bases used to trace the typologies of both politeness and request strategies. The data werere collected by means of certain elicitation techniques, i.e. DCTs and Role-plays. The analyses werere done through three stages; determining request strategies, politeness strategies, and resemblance of indirectness in politeness. The results show that the indirectness generally is parallel to politeness. Besides, some pragmatic transfers are found in terms of applying native-culture norms in realizing target speech acts.

  3. Social Support as a Key Protective Factor against Depression in HIV-Infected Patients: Report from large HIV clinics in Hanoi, Vietnam.

    Science.gov (United States)

    Matsumoto, Shoko; Yamaoka, Kazue; Takahashi, Kenzo; Tanuma, Junko; Mizushima, Daisuke; Do, Cuong Duy; Nguyen, Dung Thi; Nguyen, Hoai Dung Thi; Nguyen, Kinh Van; Oka, Shinichi

    2017-11-14

    Depression is the most common mental health issue among people living with HIV/AIDS (PLWHA). This study explored how different types and sources of social support are associated with depression among HIV-infected patients in Vietnam. We carried out a cross-sectional survey on 1,503 HIV-infected patients receiving antiretroviral therapy at two HIV clinics in Hanoi in 2016. Depression was prevalent in 26.2% of participants. Higher score of social support, especially emotional/informational support and positive social interaction, showed significant association with lower depression rate. Although family was primary source of all types of social support, receiving emotional/informational support not only from family but also from outside of family correlated with a lower proportion of depression. In countries with constrained social resources and/or with family-oriented social structures, as in Vietnam, expanding social networks between HIV populations and society is a potentially important option for reducing depression.

  4. The long-term association of OCD and depression and its moderators: A four-year follow up study in a large clinical sample.

    Science.gov (United States)

    Tibi, L; van Oppen, P; van Balkom, A J L M; Eikelenboom, M; Rickelt, J; Schruers, K R J; Anholt, G E

    2017-07-01

    Depression is the most common comorbidity in obsessive-compulsive disorder (OCD). However, the mechanisms of depressive comorbidity in OCD are poorly understood. We assessed the directionality and moderators of the OCD-depression association over time in a large, prospective clinical sample of OCD patients. Data were drawn from 382 OCD patients participating at the Netherlands Obsessive-Compulsive Disorder Association (NOCDA) study. Cross-lagged, structural equation modeling analyses were used to assess the temporal association between OCD and depressive symptoms. Assessments were conducted at baseline, two-year and four-year follow up. Cognitive and interpersonal moderators of the prospective association between OCD and depressive symptoms were tested. Cross-lagged analyses demonstrated that OCD predicts depressive symptoms at two-year follow up and not vice a versa. This relationship disappeared at four-year follow up. Secure attachment style moderated the prospective association between OCD and depression. Depressive comorbidity in OCD might constitute a functional consequence of the incapacitating OCD symptoms. Both OCD and depression symptoms demonstrated strong stability effects between two-year and four-year follow up, which may explain the lack of association between them in that period. Among OCD patients, secure attachment represents a buffer against future depressive symptoms. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  5. Allergic Contact Dermatitis to Benzoyl Peroxide Resembling Impetigo.

    Science.gov (United States)

    Kim, Changhyun; Craiglow, Brittany G; Watsky, Kalman L; Antaya, Richard J

    2015-01-01

    A 17-year-old boy presented with recurring severe dermatitis of the face of 5-months duration that resembled impetigo. He had been treated with several courses of antibiotics without improvement. Biopsy showed changes consistent with allergic contact dermatitis and patch testing later revealed sensitization to benzoyl peroxide, which the patient had been using for the treatment of acne vulgaris. © 2015 Wiley Periodicals, Inc.

  6. Native valve endocarditis caused by an organism resembling Corynebacterium striatum.

    OpenAIRE

    Markowitz, S M; Coudron, P E

    1990-01-01

    An organism resembling Corynebacterium striatum was isolated from the blood of a patient with acute aortic valvular insufficiency and no history of valvular heart disease. At autopsy, histopathologic examination of the aortic valve revealed pleomorphic gram-positive bacilli and destruction of valvular tissue. Our isolate differed from other nondiphtherial corynebacteria, including the type strain of C. striatum (ATCC 6940), in its ability to reduce nitrite. Nitrite reduction may be useful for...

  7. Activation of cell-mediated immunity in depression: association with inflammation, melancholia, clinical staging and the fatigue and somatic symptom cluster of depression.

    Science.gov (United States)

    Maes, Michael; Mihaylova, Ivana; Kubera, Marta; Ringel, Karl

    2012-01-10

    Depression is characterized by activation of cell-mediated immunity (CMI), including increased neopterin levels, and increased pro-inflammatory cytokines (PICs), such as interleukin-1 (IL-1) and tumor necrosis factor-α (TNFα). These PICs may induce depressive, melancholic and chronic fatigue (CF) symptoms. We examined serum neopterin and plasma PIC levels in depressive subgroups in relation to the depressive subtypes and the melancholic and CF symptoms of depression. Participants were 85 patients with depression and in 26 normal controls. Severity of depression was assessed with the Hamilton Depression Rating Scale (HDRS) and severity of CF with the Fibromyalgia and Chronic Fatigue Syndrome (FF) Rating Scale. Serum neopterin was significantly higher in depressed patients and in particular in those with melancholia. There were positive correlations between serum neopterin, the plasma PICs and the number of previous depressive episodes. Neopterin and TNFα were associated with melancholia, while both PICs were associated with CF. Melancholia-group membership was predicted by the HDRS and neopterin, and CF group membership by age, the FF score and serum TNFα. Depression and melancholia are accompanied by CMI activation, suggesting that neopterin plays a role in their pathophysiology, e.g. through activation of oxidative and nitrosative stress and apoptosis pathways. The intertwined CMI and inflammatory responses are potentially associated with the onset of depression and with the melancholic and CF symptoms of depression. Exposure to previous depressive episodes may magnify the size of CMI and PIC responses, possibly increasing the likelihood of new depressive episodes. CMI activation and inflammation may contribute to the staging or recurrence of depression. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. Cognitive Behavior Therapy for Depression and Self-Care in Heart Failure Patients: A Randomized Clinical Trial

    Science.gov (United States)

    Freedland, Kenneth E.; Carney, Robert M.; Rich, Michael W.; Steinmeyer, Brian C.; Rubin, Eugene H.

    2016-01-01

    Importance Depression and inadequate self-care are common and interrelated problems that increase the risks of hospitalization and mortality in patients with heart failure (HF). Objective To determine the efficacy of an integrative cognitive behavior therapy (CBT) intervention for depression and HF self-care. Design, Setting, and Participants Randomized clinical trial with single-blind outcome assessments. Eligible patients were enrolled at Washington University Medical Center in St. Louis between January 4, 2010 and June 28, 2013. The participants were 158 outpatients in New York Heart Association Class I, II, and III heart failure with comorbid major depression. Interventions Cognitive behavior therapy delivered by experienced therapists plus usual care (UC), or usual care alone. Usual care was enhanced in both groups with a structured HF education program delivered by a cardiac nurse. Main Outcomes and Measures The primary outcome was severity of depression at 6 months as measured by the Beck Depression Inventory. The Self-Care of Heart Failure Index Confidence and Maintenance subscales were co-primary outcomes. Secondary outcomes included measures of anxiety, depression, physical functioning, fatigue, social roles and activities, and quality of life. Hospitalizations and deaths were exploratory outcomes. Results One hundred fifty-eight patients were randomized to UC (n=79) or CBT (n=79). Within each arm, 26 (33%) of the patients were taking an antidepressant at baseline. One hundred thirty-two (84%) of the participants completed the 6-month posttreatment assessments; 60 (76%) of the UC and 58 (73%) of the CBT participants completed every follow-up assessment (P−.88). Six-month depression scores were lower in the CBT than the UC arm on the Beck Depression Inventory (BDI-II) (12.8 [10.6] vs 17.3 [10.7]; P−.008). Remission rates differed on the BDI-II (46% vs 19%; number needed to treat [NNT] = 3.76; 95% CI, 3.62-3.90; PSelf-Care Maintenance or Confidence

  9. Cognitive Behavior Therapy for Depression and Self-Care in Heart Failure Patients: A Randomized Clinical Trial.

    Science.gov (United States)

    Freedland, Kenneth E; Carney, Robert M; Rich, Michael W; Steinmeyer, Brian C; Rubin, Eugene H

    2015-11-01

    Depression and inadequate self-care are common and interrelated problems that increase the risks of hospitalization and mortality in patients with heart failure (HF). To determine the efficacy of an integrative cognitive behavior therapy (CBT) intervention for depression and HF self-care. Randomized clinical trial with single-blind outcome assessments. Eligible patients were enrolled at Washington University Medical Center in St Louis between January 4, 2010, and June 28, 2013. The primary data analyses were conducted in February 2015. The participants were 158 outpatients in New York Heart Association Class I, II, and III heart failure with comorbid major depression. Cognitive behavior therapy delivered by experienced therapists plus usual care (UC), or UC alone. Usual care was enhanced in both groups with a structured HF education program delivered by a cardiac nurse. The primary outcome was severity of depression at 6 months as measured by the Beck Depression Inventory. The Self-Care of Heart Failure Index Confidence and Maintenance subscales were coprimary outcomes. Secondary outcomes included measures of anxiety, depression, physical functioning, fatigue, social roles and activities, and quality of life. Hospitalizations and deaths were exploratory outcomes. One hundred fifty-eight patients were randomized to UC (n = 79) or CBT (n = 79). Within each arm, 26 (33%) of the patients were taking an antidepressant at baseline. One hundred thirty-two (84%) of the participants completed the 6-month posttreatment assessments; 60 (76%) of the UC and 58 (73%) of the CBT participants completed every follow-up assessment (P = .88). Six-month depression scores were lower in the CBT than the UC arm on the Beck Depression Inventory (BDI-II) (12.8 [10.6] vs 17.3 [10.7]; P = .008). Remission rates differed on the BDI-II (46% vs 19%; number needed to treat [NNT] = 3.76; 95% CI, 3.62-3.90; P Beck Depression Inventory scores 6 months after randomization were lower in the CBT

  10. Detecting analogical resemblance without retrieving the source analogy.

    Science.gov (United States)

    Kostic, Bogdan; Cleary, Anne M; Severin, Kaye; Miller, Samuel W

    2010-06-01

    We examined whether people can detect analogical resemblance to an earlier experimental episode without being able to recall the experimental source of the analogical resemblance. We used four-word analogies (e.g., robin-nest/beaver-dam), in a variation of the recognition-without-cued-recall method (Cleary, 2004). Participants studied word pairs (e.g., robin-nest) and were shown new word pairs at test, half of which analogically related to studied word pairs (e.g., beaver-dam) and half of which did not. For each test pair, participants first attempted to recall an analogically similar pair from the study list. Then, regardless of whether successful recall occurred, participants were prompted to rate the familiarity of the test pair, which was said to indicate the likelihood that a pair that was analogically similar to the test pair had been studied. Across three experiments, participants demonstrated an ability to detect analogical resemblance without recalling the source analogy. Findings are discussed in terms of their potential relevance to the study of analogical reasoning and insight, as well as to the study of familiarity and recognition memory.

  11. Patient specific modeling of the HPA axis related to clinical diagnosis of depression

    DEFF Research Database (Denmark)

    Bangsgaard, Elisabeth; Ottesen, Johnny T.

    2017-01-01

    A novel model of the hypothalamic-pituitary-adrenal axis is presented. The axis is an endocrine system responsible for coping with stress and it is likely to be involved in depression. The dynamics of the system is studied and existence, uniqueness and positivity of the solution and the existence...... of an attracting trapping region are proved. The model is calibrated and compared to data for healthy and depressed subjects. A sensitivity analysis resulting in a set of identifiable physiological parameters is provided. A subset is selected for parameter estimation and a reduced version of the model is stated...... method for diagnosing depression and suggesting individual treatment protocols. Finally, the method may inspire pharmaceutical companies to develop target specific psychopharmaca for more effective and individual treatment....

  12. Effects of relaxation on depression levels in women with high-risk pregnancies: a randomised clinical trial.

    Science.gov (United States)

    Araújo, Wanda Scherrer de; Romero, Walckiria Garcia; Zandonade, Eliana; Amorim, Maria Helena Costa

    2016-09-09

    to analyse the effects of relaxation as a nursing intervention on the depression levels of hospitalised women with high-risk pregnancies. a randomised clinical trial realised in a reference centre for high-risk pregnancies. The sample consisted of 50 women with high-risk pregnancies (25 in the control group and 25 in the intervention group). The Benson relaxation technique was applied to the intervention group for five days. Control variables were collected using a predesigned form, and the signs and symptoms of depression were evaluated using the Edinburgh Postnatal Depression Scale (EPDS). The Statistical Package for Social Sciences (SPSS), version 20.0, was used with a significance level of 5%. The Wilcoxon and paired t-tests were used to evaluate depression levels between two timepoints. Using categorical data, the McNemar test was used to analyse differences in depression severity before and after the intervention. depression levels decreased in the intervention group five days after the relaxation technique was applied (4.5 ± 3, pembarazos de alto riesgo. un ensayo clínico aleatorizado realizado en un centro de referencia para embarazos de alto riesgo. La muestra consistía en 50 mujeres con embarazos de alto riesgo (25 en el grupo control y 25 en el grupo de intervención). Se aplicó la técnica de relajación de Benson al grupo de intervención durante cinco días. Las variables control se recogieron usando un formulario prediseñado, y los signos y síntomas de depresión se evaluaron usando la Escala de Depresión Postparto de Edimburgo (EDPE, Edinburgh Postnatal Depression Scale - EPDS). El Paquete Estadístico para Ciencias Sociales (SPSS, del inglés Statistical Package for Social Sciences), versión 20.0, se usó con un nivel de significación del 5%. La prueba de Wilcoxon y la prueba de t de Student pareada se usaron para evaluar los niveles de depresión entre dos puntos en el tiempo. Usando datos categóricos, la prueba de McNemar se usó para

  13. Factor structure and clinical utility of the Beck depression inventory in patients with binge eating disorder and obesity.

    Science.gov (United States)

    Udo, Tomoko; McKee, Sherry A; Grilo, Carlos M

    2015-01-01

    The Beck Depression Inventory (BDI) is often used to assess depression symptoms, but its factor structure and its clinical utility have not been evaluated in patients with binge eating disorder (BED) and obesity. A total of 882 treatment-seeking obese patients with BED were administered structured interviews (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders) and completed self-report questionnaires. Exploratory and confirmatory factor analyses supported a brief 16-item BDI version with a three-factor structure (affective, attitudinal and somatic). Both 21- and 16-item versions showed excellent internal consistency (both α=0.89) and had significant correlation patterns with different aspects of eating disorder psychopathology; three factors showed significant but variable associations with eating disorder psychopathology. Area under the curves (AUC) for both BDI versions were significant in predicting major depressive disorder (MDD; AUC=0.773 [16-item], 73.5% sensitivity/70.2% specificity, AUC=0.769 [21-item], 79.5% sensitivity/64.1% specificity) and mood disorders (AUC=0.763 [16-item], 67.1% sensitivity/71.5% specificity, AUC=0.769 [21-item], 84.2% sensitivity/55.7% specificity). The 21-item BDI (cutoff score ≥16) showed higher negative predictive values (94.0% vs. 93.0% [MDD]; 92.4% vs. 88.3% [mood disorders]) than the brief 16-item BDI (cutoff score ≥13). Both BDI versions demonstrated moderate performance as a screening instrument for MDD/mood disorders in obese patients with BED. Advantages and disadvantages for both versions are discussed. A three-factor structure has potential to inform the conceptualization of depression features. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

    Science.gov (United States)

    McIntosh, Diane; Wang, JianLi; Enns, Murray W.; Kolivakis, Theo; Michalak, Erin E.; Sareen, Jitender; Song, Wei-Yi; Kennedy, Sidney H.; MacQueen, Glenda M.; Milev, Roumen V.; Parikh, Sagar V.; Ravindran, Arun V.

    2016-01-01

    Background: The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. Methods: Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. This section is the first of six guidelines articles. Results: In Canada, the annual and lifetime prevalence of MDD was 4.7% and 11.3%, respectively. MDD represents the second leading cause of global disability, with high occupational and economic impact mainly attributable to indirect costs. DSM-5 criteria for depressive disorders remain relatively unchanged, but other clinical dimensions (sleep, cognition, physical symptoms) may have implications for depression management. e-Mental health is increasingly used to support clinical and self-management of MDD. In the 2-phase (acute and maintenance) treatment model, specific goals address symptom remission, functional recovery, improved quality of life, and prevention of recurrence. Conclusions: The burden attributed to MDD remains high, whether from individual distress, functional and relationship impairment, reduced quality of life, or societal economic cost. Applying core principles of care, including comprehensive assessment, therapeutic alliance, support of self-management, evidence-informed treatment, and measurement-based care, will optimize clinical, quality of life, and functional outcomes in MDD. PMID:27486151

  15. Subjective Cognitive Decline Correlates With Depression Symptoms and Not With Concurrent Objective Cognition in a Clinic-Based Sample of Older Adults.

    Science.gov (United States)

    Zlatar, Zvinka Z; Muniz, Martha; Galasko, Douglas; Salmon, David P

    2017-01-19

    Subjective cognitive decline (SCD) is common in older adults; however, its utility in clinic-based samples remains controversial given its strong associations with mood symptoms. Five hundred nineteen individuals aged 60-95 with a wide range of cognitive performance scores were referred by community health clinics for brief screening of cognitive complaints. Linear regression models examined the cross-sectional associations between SCD (5-item self-reported questions), symptoms of depression (Beck Depression Inventory [BDI]), and concurrent objective cognitive performance (Cognitive Composite) adjusting for demographics. There was not a significant association between SCD and concurrent objective cognition after adjusting for demographics and depression. In contrast, there was a significant association between SCD and depression after adjusting for demographics and objective cognition. There was also a consistent association between SCD and depression, but not between SCD and objective cognition, in those with high and low levels of SCD reporting, in all ranges of cognitive performance, and in those with mild to moderate depression. Results are consistent with previous findings and suggest that SCD does not accurately reflect concurrent cognitive performance in a clinic-based sample of older adults. Clinical interpretation of SCD should account for the role of depression. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  16. Does Pharmacogenomic Testing Improve Clinical Outcomes for Major Depressive Disorder? A Systematic Review of Clinical Trials and Cost-Effectiveness Studies.

    Science.gov (United States)

    Rosenblat, Joshua D; Lee, Yena; McIntyre, Roger S

    2017-06-01

    Pharmacogenomic testing has become scalable and available to the general public. Pharmacogenomics has shown promise for predicting antidepressant response and tolerability in the treatment of major depressive disorder (MDD). In theory, pharmacogenomics can improve clinical outcomes by guiding antidepressant selection and dosing. The current systematic review examines the extant literature to determine the impact of pharmacogenomic testing on clinical outcomes in MDD and assesses its cost-effectiveness. The MEDLINE/PubMed and Google Scholar databases were systematically searched for relevant articles published prior to October 2015. Search terms included various combinations of the following: major depressive disorder (MDD), depression, mental illness, mood disorder, antidepressant, response, remission, outcome, pharmacogenetic, pharmacogenomics, pharmacodynamics, pharmacokinetic, genetic testing, genome wide association study (GWAS), CYP450, personalized medicine, cost-effectiveness, and pharmacoeconomics. Of the 66 records identified from the initial search, relevant clinical studies, written in English, assessing the cost-effectiveness and/or efficacy of pharmacogenomic testing for MDD were included. Each publication was critically examined for relevant data. Two nonrandomized, open-label, 8-week, prospective studies reported overall greater improvement in depressive symptom severity in the group of MDD subjects receiving psychiatric care guided by results of combinatorial pharmacogenomic testing (GeneSight) when compared to the unguided group. One industry-sponsored, randomized, double-blind, 10-week prospective study reported a trend for improved outcomes for the GeneSight-guided group; however, the trend did not reach statistical significance. Another industry-sponsored, randomized, double-blind, 12-week prospective study reported a 2.5-fold increase in remission rates in the CNSDose-guided group (P < .0001). One naturalistic, unblinded, industry

  17. Clinical effectiveness of cognitive therapy v. interpersonal psychotherapy for depression: results of a randomized controlled trial

    NARCIS (Netherlands)

    Lemmens, L.H.J.M.; Arntz, A.; Peeters, F.; Hollon, S.D.; Roefs, A.; Marcus, J.H.; Huibers, M.J.H.

    2015-01-01

    Background: Although both cognitive therapy (CT) and interpersonal psychotherapy (IPT) have been shown to be effective treatments for major depressive disorder (MDD), it is not clear yet whether one therapy outperforms the other with regard to severity and course of the disorder. This study examined

  18. Effects of Coping-Oriented Couples Therapy on Depression: A Randomized Clinical Trial

    Science.gov (United States)

    Bodenmann, Guy; Plancherel, Bernard; Beach, Steven R. H.; Widmer, Kathrin; Gabriel, Barbara; Meuwly, Nathalie; Charvoz, Linda; Hautzinger, Martin; Schramm, Elisabeth

    2008-01-01

    The aim of this study was to evaluate the effectiveness of treating depression with coping-oriented couples therapy (COCT) as compared with cognitive-behavioral therapy (CBT; A. T. Beck, C. Ward, & M. Mendelson, 1961) and interpersonal psychotherapy (IPT; M. M. Weissman, J. C. Markowitz, & G. L. Klerman, 2000). Sixty couples, including 1…

  19. Clinical effectiveness of cognitive therapy v. interpersonal psychotherapy for depression: results of a randomized controlled trial

    NARCIS (Netherlands)

    Lemmens, L.H.J.M.; Arntz, A.; Peeters, F.; Hollon, S.D.; Roefs, A.; Huibers, M.J.H.

    2015-01-01

    Background Although both cognitive therapy (CT) and interpersonal psychotherapy (IPT) have been shown to be effective treatments for major depressive disorder (MDD), it is not clear yet whether one therapy outperforms the other with regard to severity and course of the disorder. This study examined

  20. Parent Depression and Child Anxiety: An Overview of the Literature with Clinical Implications

    Science.gov (United States)

    Colletti, Christina J. M.; Forehand, Rex; Garai, Emily; Rakow, Aaron; McKee, Laura; Fear, Jessica M.; Compas, Bruce E.

    2009-01-01

    The association of parental depression with child anxiety has received relatively little attention in the literature. In this paper we initially present several reasons for examining this relationship. We then summarize the empirical support for a link between these two variables. Finally, we discuss directions for future research and clinical…

  1. Correlates of memory complaints and personality, depression, and anxiety in a memory clinic.

    Science.gov (United States)

    Arbabi, Mohammad; Zhand, Naista; Eybpoosh, Sana; Yazdi, Narges; Ansari, Sahar; Ramezani, Marjan

    2015-01-01

    The aim of the study was to find whether there is an association between subjective memory complaint and memory impairment and probable underlying psychological conditions. A total of 90 patients with subjective memory complaint enrolled in this study. Short history and demographic information were obtained and then the patients underwent memory and mental health assessments, using Wechsler Memory Scale (WMS), Hospital Anxiety and Depression Scale (HADS) and Minnesota Multiphasic Personality Inventory (MMPI) test tools. The mean age of the participants was 52.31 ± 17.97. Forty patients out of 90 (44.4%) were male. The prevalence of depression, anxiety and memory impairment was 10%, 12.2%, and 28.8%, respectively. Memory impairment has only shown a significant association with the presence of anxiety disorder according to the HADS findings (P=0.001). Regarding the MMPI, considerable differences were observed in the average grade of hysteria among patients with and without memory impairment: 8.38 ± 2.27 vs. 4.35 ± 1.96. There was also significant statistical association between the average score of depression on the MMPI in patients with and without memory impairment that were 13.7 ± 3.33 and 8.31 ±3.86, (P=0.03). The result of the current study shows that underlying psychological conditions such as anxiety, depression, and histrionic personality are associated with memory impairment.

  2. Correlates of memory complaints and personality, depression, and anxiety in a memory clinic.

    Directory of Open Access Journals (Sweden)

    Mohammad Arbabi

    2015-05-01

    Full Text Available The aim of the study was to find whether there is an association between subjective memory complaint and memory impairment and probable underlying psychological conditions. A total of 90 patients with subjective memory complaint enrolled in this study. Short history and demographic information were obtained and then the patients underwent memory and mental health assessments, using Wechsler Memory Scale (WMS, Hospital Anxiety and Depression Scale (HADS and Minnesota Multiphasic Personality Inventory (MMPI test tools. The mean age of the participants was 52.31 ± 17.97. Forty patients out of 90 (44.4% were male. The prevalence of depression, anxiety and memory impairment was 10%, 12.2%, and 28.8%, respectively. Memory impairment has only shown a significant association with the presence of anxiety disorder according to the HADS findings (P=0.001. Regarding the MMPI, considerable differences were observed in the average grade of hysteria among patients with and without memory impairment: 8.38 ± 2.27 vs. 4.35 ± 1.96. There was also significant statistical association between the average score of depression on the MMPI in patients with and without memory impairment that were 13.7 ± 3.33 and 8.31 ±3.86, (P=0.03. The result of the current study shows that underlying psychological conditions such as anxiety, depression, and histrionic personality are associated with memory impairment.

  3. Clinical Reasoning in the Assessment and Intervention Planning for Major Depression

    Science.gov (United States)

    Hanchon, Timothy A.; Phelps, Kenneth W.; Fernald, Lori N.; Splett, Joni W.

    2017-01-01

    Accurate assessment and effective treatment of mood disorders, particularly depression, is critically important for the millions of youth who are experiencing such symptomatology and who are at risk for a multitude of deleterious outcomes. Although the extant empirical literature provides substantial guidance for the assessment and treatment of…

  4. Pharmacological treatment of unipolar depression during pregnancy and breast-feeding -a clinical overview

    DEFF Research Database (Denmark)

    Nielsen, René Ernst; Damkier, Per

    2012-01-01

    This overview is aimed at clinicians working with patients in the fertile age who suffer from depressive disorders. The study of adverse effects of antidepressants on the foetus is hampered by difficulty in distinguishing between the behavioural changes that are related to the disorder itself and...

  5. The cost-effectiveness of depression treatment for co-occurring disorders: a clinical trial.

    Science.gov (United States)

    Watkins, Katherine E; Cuellar, Alison E; Hepner, Kimberly A; Hunter, Sarah B; Paddock, Susan M; Ewing, Brett A; de la Cruz, Erin

    2014-02-01

    The authors aimed to determine the economic value of providing on-site group cognitive behavioral therapy (CBT) for depression to clients receiving residential substance use disorder (SUD) treatment. Using a quasi-experimental design and an intention-to-treat analysis, the incremental cost-effectiveness and cost-utility ratio of the intervention were estimated relative to usual care residential treatment. The average cost of a treatment episode was $908, compared to $180 for usual care. The incremental cost effectiveness ratio was $131 for each point improvement of the BDI-II and $49 for each additional depression-free day. The incremental cost-utility ratio ranged from $9,249 to $17,834 for each additional quality adjusted life year. Although the intervention costs substantially more than usual care, the cost effectiveness and cost-utility ratios compare favorably to other depression interventions. Health care reform should promote dissemination of group CBT to individuals with depression in residential SUD treatment. © 2013 Elsevier Inc. All rights reserved.

  6. Prevalence of major depressive disorder among hemodialysis patients compared with healthy people in Japan using the Structured Clinical Interview for DSM-IV

    Directory of Open Access Journals (Sweden)

    Tomita T

    2016-09-01

    Full Text Available Tetsu Tomita,1 Norio Yasui-Furukori,1 Norio Sugawara,1,2 Kohei Ogasawara,3 Koki Katagai,3 Hisao Saito,4 Kaori Sawada,5 Ippei Takahashi,5 Kazuhiko Nakamura1 1Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan; 2Aomori Prefectural Center for Mental Health and Welfare, Aomori, Japan; 3School of Medicine, Hirosaki University, Hirosaki, Japan; 4Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan; 5Department of Social Medicine, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan Background: We investigated the prevalence of depression in hemodialysis (HD patients using the Center for Epidemiologic Studies for Depression (CES-D scale and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID and compared the rates with those of community dwelling people in Japan.Patients and methods: A total of 99 patients undergoing HD were recruited. Blood sampling was performed no later than 2 weeks prior to assessment. As a reference group for SCID and CES-D evaluation, 404 age- and sex-matched healthy controls who had participated in the Iwaki Health Promotion Project were included in this study. The SCID and the CES-D scale were administered to all participants to diagnose their depression. Participants who met the criteria of a major depressive episode according to the SCID were classified as SCID depression and the participants whose CES-D score was 16 or higher were classified as CES-D depression.Results: Ninety-nine HD patients completed the evaluation and data collection. There were no significant differences in age, sex, or CES-D scores between HD patients and controls. There were 12 cases of SCID depression in HD patients and four cases in controls. There was a significant difference between HD patients and controls in the prevalence of SCID depression. There were no significant differences between the two groups

  7. Relation between clinical depression risk and physical activity and time spent watching television in older women: a 10-year prospective follow-up study.

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    Lucas, Michel; Mekary, Rania; Pan, An; Mirzaei, Fariba; O'Reilly, Eilis J; Willett, Walter C; Koenen, Karestan; Okereke, Olivia I; Ascherio, Alberto

    2011-11-01

    Although physical activity (PA) has been inversely associated with depressive symptoms, it is not clear whether regular PA and television watching are associated with clinical depression risk. The authors conducted a prospective analysis involving 49,821 US women from the Nurses' Health Study who were free from depressive symptoms at baseline (1996). Information on PA was obtained from validated questionnaires completed in 1992, 1994, 1996, 1998, and 2000; analyses were conducted using the cumulative average of PA (minutes/day) with a 2-year latency period applied. Participants were asked about television-watching habits in 1992. Cox proportional hazards regression models adjusted for multiple risk factors were used to estimate relative risks of clinical depression (self-reported physician-diagnosed depression or use of antidepressants). During 10 years of follow-up (1996-2006), 6,505 incident cases of depression were documented. Higher levels of PA were associated with lower depression risk. The multivariate relative risk comparing the highest level of PA (≥ 90 minutes/day) with the lowest (television-watching time. The multivariate relative risk comparing women who spent 21 hours/week or more watching television with those who spent 0-1 hour/week was 1.13 (95% confidence interval: 1.00, 1.27; P(trend) = 0.01). Analyses simultaneously considering PA and television watching suggested that both contributed independently to depression risk.

  8. Agreement for depression diagnosis between DSM-IV-TR criteria, three validated scales, oncologist assessment, and psychiatric clinical interview in elderly patients with advanced ovarian cancer.

    Science.gov (United States)

    Rhondali, Wadih; Freyer, Gilles; Adam, Virginie; Filbet, Marilène; Derzelle, Martine; Abgrall-Barbry, Gaelle; Bourcelot, Sophie; Machavoine, Jean-Louis; Chomat-Neyraud, Muriel; Gisserot, Olivier; Largillier, Rémi; Le Rol, Annick; Priou, Frank; Saltel, Pierre; Falandry, Claire

    2015-01-01

    Depression, a major outcome in cancer patients, is often evaluated by physicians relying on their clinical impressions rather than patient self-report. Our aim was to assess agreement between patient self-reported depression, oncologist assessment (OA), and psychiatric clinical interview (PCI) in elderly patients with advanced ovarian cancer (AOC). This analysis was a secondary endpoint of the Elderly Women AOC Trial 3 (EWOT3), designed to assess the impact of geriatric covariates, notably depression, on survival in patients older than 70 years of age. Depression was assessed using the Geriatric Depression Scale-30 (GDS), the Hospital Anxiety Depression Scale, the distress thermometer, the mood thermometer, and OA. The interview guide for PCI was constructed from three validated scales: the GDS, the Hamilton Depression Rating Scale, and the Montgomery Asberg Depression Rating Scale (MADRS). The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, revised (DSM) criteria for depression were used as a gold standard. Out of 109 patients enrolled at 21 centers, 99 (91%) completed all the assessments. Patient characteristics were: mean age 78, performance status ≥2: 47 (47%). Thirty six patients (36%) were identified as depressed by the PCI versus 15 (15%) identified by DSM. We found moderate agreement for depression identification between DSM and GDS (κ=0.508) and PCI (κ=0.431) and high agreement with MADRS (κ=0.663). We found low or no agreement between DSM with the other assessment strategies, including OA (κ=-0.043). Identification according to OA (yes/no) resulted in a false-negative rate of 87%. As a screening tool, GDS had the best sensitivity and specificity (94% and 80%, respectively). The use of validated tools, such as GDS, and collaboration between psychologists and oncologists are warranted to better identify emotional disorders in elderly women with AOC.

  9. Role of omega-3 fatty acids in the treatment of depressive disorders: a comprehensive meta-analysis of randomized clinical trials.

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    Giuseppe Grosso

    Full Text Available BACKGROUND: Despite omega-3 polyunsaturated fatty acids (PUFA supplementation in depressed patients have been suggested to improve depressive symptomatology, previous findings are not univocal. OBJECTIVES: To conduct an updated meta-analysis of randomized controlled trials (RCTs of omega-3 PUFA treatment of depressive disorders, taking into account the clinical differences among patients included in the studies. METHODS: A search on MEDLINE, EMBASE, PsycInfo, and the Cochrane Database of RCTs using omega-3 PUFA on patients with depressive symptoms published up to August 2013 was performed. Standardized mean difference in clinical measure of depression severity was primary outcome. Type of omega-3 used (particularly eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA] and omega-3 as mono- or adjuvant therapy was also examined. Meta-regression analyses assessed the effects of study size, baseline depression severity, trial duration, dose of omega-3, and age of patients. RESULTS: Meta-analysis of 11 and 8 trials conducted respectively on patients with a DSM-defined diagnosis of major depressive disorder (MDD and patients with depressive symptomatology but no diagnosis of MDD demonstrated significant clinical benefit of omega-3 PUFA treatment compared to placebo (standardized difference in random-effects model 0.56 SD [95% CI: 0.20, 0.92] and 0.22 SD [95% CI: 0.01, 0.43], respectively; pooled analysis was 0.38 SD [95% CI: 0.18, 0.59]. Use of mainly EPA within the preparation, rather than DHA, influenced final clinical efficacy. Significant clinical efficacy had the use of omega-3 PUFA as adjuvant rather than mono-therapy. No relation between efficacy and study size, baseline depression severity, trial duration, age of patients, and study quality was found. Omega-3 PUFA resulted effective in RCTs on patients with bipolar disorder, whereas no evidence was found for those exploring their efficacy on depressive symptoms in young populations

  10. Depression as a Clinical Determinant of Dependence and Low Quality of Life in Elderly Patients with Cardiovascular Disease.

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    Rodrigues, Giselle Helena de Paula; Gebara, Otavio Celso Eluf; Gerbi, Catia Cilene da Silva; Pierri, Humberto; Wajngarten, Mauricio

    2015-06-01

    The aging process promotes a progressive increase in chronic-degenerative diseases. The effect of these diseases on the functional capacity has been well recognized. Another health parameter concerns "quality of life related to health". Among the elderly population, cardiovascular diseases stand out due to the epidemiological and clinical impact. Usually, these diseases have been associated with others. This set of problems may compromise both independence and quality of life in elderly patients who seek cardiologic treatment. These health parameters have not been well contemplated by cardiologists. Evaluating, among the elderly population with cardiovascular disease, which are the most relevant clinical determinants regarding dependence and quality of life. This group was randomly and consecutively selected and four questionnaires were applied: HAQ, SF-36, PRIME-MD e Mini Mental State. The study included 1,020 elderly patients, 63.3% women. The group had been between 60 and 97 years-old (mean: 75.56 ± 6.62 years-old). 61.4% were independent or mild dependence. The quality of life total score was high (HAQ: 88.66 ± 2.68). 87.8% of patients had a SF-36 total score > 66. In the multivariate analysis, the association between diagnoses and high degrees of dependence was significant only for previous stroke (p = 0.014), obesity (p quality of life, major depression and physical illness for depression was significantly associated with all domains of the SF-36. Among an elderly outpatient cardiology population, dependence and quality of life clinical determinants are not cardiovascular comorbidities, especially the depression.

  11. Age at onset of major depressive disorder in Han Chinese women: Relationship with clinical features and family history☆

    Science.gov (United States)

    Yang, Fuzhong; Li, Yihan; Xie, Dong; Shao, Chunhong; Ren, Jianer; Wu, Wenyuan; Zhang, Ning; Zhang, Zhen; Zou, Ying; Zhang, Jiulong; Qiao, Dongdong; Gao, Chengge; Li, Youhui; Hu, Jian; Deng, Hong; Wang, Gang; Du, Bo; Wang, Xumei; Liu, Tiebang; Gan, Zhaoyu; Peng, Juyi; Wei, Bo; Pan, Jiyang; Chen, Honghui; Sun, Shufan; Jia, Hong; Liu, Ying; Chen, Qiaoling; Wang, Xueyi; Cao, Juling; Lv, Luxian; Chen, Yunchun; Ha, Baowei; Ning, Yuping; Chen, YiPing; Kendler, Kenneth S.; Flint, Jonathan; Shi, Shenxun

    2011-01-01

    Background Individuals with early-onset depression may be a clinically distinct group with particular symptom patterns, illness course, comorbidity and family history. This question has not been previously investigated in a Han Chinese population. Methods We examined the clinical features of 1970 Han Chinese women with DSM-IV major depressive disorder (MDD) between 30 and 60 years of age across China. Analysis of linear, logistic and multiple logistic regression models was used to determine the association between age at onset (AAO) with continuous, binary and discrete characteristic clinical features of MDD. Results Earlier AAO was associated with more suicidal ideation and attempts and higher neuroticism, but fewer sleep, appetite and weight changes. Patients with an earlier AAO were more likely to suffer a chronic course (longer illness duration, more MDD episodes and longer index episode), increased rates of MDD in their parents and a lower likelihood of marriage. They tend to have higher comorbidity with anxiety disorders (general anxiety disorder, social phobia and agoraphobia) and dysthymia. Conclusions Early AAO in MDD may be an index of a more severe, highly comorbid and familial disorder. Our findings indicate that the features of MDD in China are similar to those reported elsewhere in the world. PMID:21782247

  12. Age at onset of major depressive disorder in Han Chinese women: relationship with clinical features and family history.

    Science.gov (United States)

    Yang, Fuzhong; Li, Yihan; Xie, Dong; Shao, Chunhong; Ren, Jianer; Wu, Wenyuan; Zhang, Ning; Zhang, Zhen; Zou, Ying; Zhang, Jiulong; Qiao, Dongdong; Gao, Chengge; Li, Youhui; Hu, Jian; Deng, Hong; Wang, Gang; Du, Bo; Wang, Xumei; Liu, Tiebang; Gan, Zhaoyu; Peng, Juyi; Wei, Bo; Pan, Jiyang; Chen, Honghui; Sun, Shufan; Jia, Hong; Liu, Ying; Chen, Qiaoling; Wang, Xueyi; Cao, Juling; Lv, Luxian; Chen, Yunchun; Ha, Baowei; Ning, Yuping; Chen, Yiping; Kendler, Kenneth S; Flint, Jonathan; Shi, Shenxun

    2011-12-01

    Individuals with early-onset depression may be a clinically distinct group with particular symptom patterns, illness course, comorbidity and family history. This question has not been previously investigated in a Han Chinese population. We examined the clinical features of 1970 Han Chinese women with DSM-IV major depressive disorder (MDD) between 30 and 60 years of age across China. Analysis of linear, logistic and multiple logistic regression models was used to determine the association between age at onset (AAO) with continuous, binary and discrete characteristic clinical features of MDD. Earlier AAO was associated with more suicidal ideation and attempts and higher neuroticism, but fewer sleep, appetite and weight changes. Patients with an earlier AAO were more likely to suffer a chronic course (longer illness duration, more MDD episodes and longer index episode), increased rates of MDD in their parents and a lower likelihood of marriage. They tend to have higher comorbidity with anxiety disorders (general anxiety disorder, social phobia and agoraphobia) and dysthymia. Early AAO in MDD may be an index of a more severe, highly comorbid and familial disorder. Our findings indicate that the features of MDD in China are similar to those reported elsewhere in the world. Copyright © 2011 Elsevier B.V. All rights reserved.

  13. A dance movement therapy group for depressed adult patients in a psychiatric outpatient clinic: effects of the treatment.

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    Pylvänäinen, Päivi M; Muotka, Joona S; Lappalainen, Raimo

    2015-01-01

    We were interested in investigating the effects of dance movement therapy (DMT) in a psychiatric outpatient clinic with patients diagnosed with depression. DMT aims to engage the patients in physical and verbal exploration of their experiences generated in movement based interaction. The assumption was that DMT, which includes both physical engagement as well as emotional and social exploration, would alleviate the mood and psychiatric symptoms. All adult patients (n = 33) included in the study received treatment as usual (TAU). Twenty-one patients participated in a 12-session DMT group intervention, and the remaining 12 patients chose to take TAU only. The majority of the patients suffered from moderate or severe depression, recurrent and/or chronic type. The effects of the interventions were investigated after the intervention, and at 3-month follow-up. Compared to the TAU, adding DMT seemed to improve the effect of the treatment. The effect of the DMT was observable whether the patient was taking antidepressant medication or not. At follow-up, between group effect sizes (ES) were medium in favor for the DMT group (d = 0.60-0.79). In the DMT group, the within ES at the 3 months follow-up varied from 0.62 to 0.82 as compared to TAU 0.15-0.37. The results indicated that DMT is beneficial in the treatment of depressed patients.

  14. A dance movement therapy group for depressed adult patients in psychiatric outpatient clinic: Effects of the treatment

    Directory of Open Access Journals (Sweden)

    Päivi Maria Pylvänäinen

    2015-07-01

    Full Text Available AbstractWe were interested in investigating the effects of dance movement therapy (DMT in a psychiatric outpatient clinic with patients diagnosed with depression. DMT aims to engage the patients in physical and verbal exploration of their experiences generated in movement based interaction. The assumption was that DMT, which includes both physical engagement as well as emotional and social exploration, would alleviate the mood and psychiatric symptoms.All adult patients (n = 33 included in the study received treatment as usual (TAU. 21 patients participated in a 12-session DMT group intervention, and the remaining 12 patients chose to take TAU only. The majority of the patients suffered from moderate or severe depression, recurrent and/or chronic type. The effects of the interventions were investigated after the intervention, and at 3-month follow-up. Compared to the TAU, adding DMT seemed to improve the effect of the treatment. The effect of the DMT was observable whether the patient was taking antidepressant medication or not. At follow-up, between group effect sizes (ES were medium in favor for the DMT group (d= 0.60-0.79. In the DMT group, the within ES at the 3 months follow-up varied from 0.62 to 0.82 as compared to TAU 0.15 – 0.37. The results indicated that DMT is beneficial in the treatment of depressed patients.

  15. The "DOC" screen: Feasible and valid screening for depression, Obstructive Sleep Apnea (OSA) and cognitive impairment in stroke prevention clinics.

    Science.gov (United States)

    Swartz, Richard H; Cayley, Megan L; Lanctôt, Krista L; Murray, Brian J; Cohen, Ashley; Thorpe, Kevin E; Sicard, Michelle N; Lien, Karen; Sahlas, Demetrios J; Herrmann, Nathan

    2017-01-01

    Post-stroke Depression, Obstructive sleep apnea (OSA) and Cognitive impairment ("DOC") are associated with greater mortality, worse recovery and poorer quality of life. Best practice recommendations endorse routine screening for each condition; yet, all are under-assessed, diagnosed and treated. We seek to determine the feasibility and validity of an integrated tool ("DOC" screen) to identify stroke clinic patients at high-risk of depression, OSA, and cognitive impairment. All consecutive new referrals to a regional Stroke Prevention Clinic who were English-speaking and non-aphasic were eligible to be screened. Time for screen completion was logged. DOC screen results were compared to the neuropsychological battery and polysomnogram assessments using a modified receiver operator characteristic and area under the curve analysis. Data is reported to conform to STARD guidelines. 1503 people were screened over 2 years. 89% of eligible patients completed the screen in 5 minutes or less (mean 4.2 minutes), less than half the time it takes to complete the Montreal Cognitive Assessment (MoCA). 437 people consented to detailed testing. Of those, 421 completed the Structured Clinical Interview for Depression within 3 months of screening, 387 completed detailed neuropsychological testing within 3 months, and 88 had overnight polysomnograms. Screening scores combined with demographic variables (age, sex, education, body mass index), had excellent validity compared to gold standard diagnoses: DOC-Mood AUC 0.90; DOC-Apnea AUC 0.80; DOC-Cog AUC 0.81. DOC screen scores can reliably categorize patients in to low-, intermediate- or high-risk groups for further action and can do so with comparable accuracy to more time-consuming screens. Systematic screening of depression, obstructive sleep apnea, and cognitive impairment in 5 minutes or less is feasible and valid in a high volume stroke clinic using the DOC screen. The DOC screen may facilitate improved identification and treatment

  16. The "DOC" screen: Feasible and valid screening for depression, Obstructive Sleep Apnea (OSA and cognitive impairment in stroke prevention clinics.

    Directory of Open Access Journals (Sweden)

    Richard H Swartz

    Full Text Available Post-stroke Depression, Obstructive sleep apnea (OSA and Cognitive impairment ("DOC" are associated with greater mortality, worse recovery and poorer quality of life. Best practice recommendations endorse routine screening for each condition; yet, all are under-assessed, diagnosed and treated. We seek to determine the feasibility and validity of an integrated tool ("DOC" screen to identify stroke clinic patients at high-risk of depression, OSA, and cognitive impairment.All consecutive new referrals to a regional Stroke Prevention Clinic who were English-speaking and non-aphasic were eligible to be screened. Time for screen completion was logged. DOC screen results were compared to the neuropsychological battery and polysomnogram assessments using a modified receiver operator characteristic and area under the curve analysis. Data is reported to conform to STARD guidelines.1503 people were screened over 2 years. 89% of eligible patients completed the screen in 5 minutes or less (mean 4.2 minutes, less than half the time it takes to complete the Montreal Cognitive Assessment (MoCA. 437 people consented to detailed testing. Of those, 421 completed the Structured Clinical Interview for Depression within 3 months of screening, 387 completed detailed neuropsychological testing within 3 months, and 88 had overnight polysomnograms. Screening scores combined with demographic variables (age, sex, education, body mass index, had excellent validity compared to gold standard diagnoses: DOC-Mood AUC 0.90; DOC-Apnea AUC 0.80; DOC-Cog AUC 0.81. DOC screen scores can reliably categorize patients in to low-, intermediate- or high-risk groups for further action and can do so with comparable accuracy to more time-consuming screens.Systematic screening of depression, obstructive sleep apnea, and cognitive impairment in 5 minutes or less is feasible and valid in a high volume stroke clinic using the DOC screen. The DOC screen may facilitate improved identification and

  17. DEMO-II trial. Aerobic exercise versus stretching exercise in patients with major depression-a randomised clinical trial.

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    Jesper Krogh

    Full Text Available The effect of referring patients from a clinical setting to a pragmatic exercise intervention for depressive symptoms, cognitive function, and metabolic variables has yet to be determined.Outpatients with major depression (DSM-IV were allocated to supervised aerobic or stretching exercise groups during a three months period. The primary outcome was the Hamilton depression score (HAM-D(17. Secondary outcomes were cognitive function, cardiovascular risk markers, and employment related outcomes.56 participants were allocated to the aerobic exercise intervention versus 59 participants to the stretching exercise group. Post intervention the mean difference between groups was -0.78 points on the HAM-D(17 (95% CI -3.2 to 1.6; P = .52. At follow-up, the participants in the aerobic exercise group had higher maximal oxygen uptake (mean difference 4.4 l/kg/min; 95% CI 1.7 to 7.0; P = .001 and visuospatial memory on Rey's Complex Figure Test (mean difference 3.2 points; 95% CI 0.9 to 5.5; P = .007 and lower blood glucose levels (mean difference 0.2 mmol/l; 95% CI 0.0 to 0.5; P = .04 and waist circumference (mean difference 2.2 cm; 95% CI 0.3 to 4.1; P = .02 compared with the stretching exercise group.The results of this trial does not support any antidepressant effect of referring patients with major depression to a three months aerobic exercise program. Due to lower recruitment than anticipated, the trial was terminated prior to reaching the pre-defined sample size of 212 participants; therefore the results should be interpreted in that context. However, the DEMO-II trial does suggest that an exercise program for patients with depression offer positive short-term effects on maximal oxygen uptake, visuospatial memory, fasting glucose levels, and waist circumference.ClinicalTrials.gov NCT00695552.

  18. Clinical and sociodemographic correlates of severe insomnia in psychotropic drug-free, Asian outpatients with major depressive disorder.

    Science.gov (United States)

    Srisurapanont, Manit; Likhitsathian, Surinporn; Chua, Hong Choon; Udomratn, Pichet; Chang, Sungman; Maneeton, Narong; Maneeton, Benchaluk; Chen, Chia-Hui; Shih-Yen Chan, Edwin; Bautista, Dianne; Bin Sulaiman, Ahmad Hatim

    2015-11-01

    Little has been known regarding the correlates of severe insomnia in major depressive disorder (MDD). This post-hoc analysis aimed to examine the sociodemographic and clinical correlates of severe insomnia in psychotropic drug-free, Asian adult outpatients with MDD. Participants were psychotropic drug-free patients with MDD, aged 18-65 years. By using the Symptom Checklist-90 Items, Revised (SCL-90-R), a score of 4 (severe distress) on any one of three insomnia items was defined as severe insomnia. Other measures included the Montgomery-Asberg Depression Rating Scale (MADRS), the Fatigue Severity Scale (FSS), the nine psychopathology subscales of SCL-90-R, the Physical and Mental Component Summaries of Short Form Health Survey (SF-36 PCS and SF-36 MCS), and the Sheehan Disability Scale (SDS). Of 528 participants, their mean age being 39.5 (SD=13.26) years, 64.2% were females, and 239 (45.3%) had severe insomnia. The logistic regression model revealed that low educational qualifications (less than secondary school completion), high SCL-90-R Depression scores, high SCL-90-R Anxiety scores, and low SF-36 PCS scores were independently correlated with severe insomnia (p'sfree patients with MDD are not commonly seen in psychiatric practice. Severe insomnia is common in patients with MDD. It is closely related with low educational qualification, subjective depression and anxiety severity, and poor physical health. These findings may implicate the treatment of comorbid MDD and severe insomnia, for example, sleep hygiene education, pharmacological treatment. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Parkinson's disease and depression.

    Science.gov (United States)

    Rihmer, Zoltán; Seregi, Krisztina; Rihmer, Annamária

    2004-06-01

    The prevalence of depression in Parkinson's disease is around 40%, but, unfortunately, such depression is frequently unrecognized and untreated. However, recognition and appropriate treatment of depression in patients with Parkinson's disease is essential for clinical practice. This review focuses on the epidemiology, pathophysiology and treatment of depression associated with Parkinson's disease.

  20. The cost-effectiveness of depression treatment for co-occurring disorders: a clinical trial

    OpenAIRE

    Watkins, Katherine E.; Cuellar, Alison E.; Hepner, Kimberly A.; Hunter, Sarah B.; Paddock, Susan M.; Ewing, Brett A.; de la Cruz, Erin

    2013-01-01

    The authors aimed to determine the economic value of providing on-site group cognitive behavioral therapy (CBT) for depression to clients receiving residential substance use disorder (SUD) treatment. Using a quasi-experimental design and an intention-to-treat analysis, the incremental cost-effectiveness and cost-utility ratio of the intervention were estimated relative to usual care residential treatment. The average cost of a treatment episode was $908, compared to $180 for usual care. The i...

  1. Predicting the Naturalistic Course of Major Depressive Disorder Using Clinical and Multimodal Neuroimaging Information: A Multivariate Pattern Recognition Study.

    Science.gov (United States)

    Schmaal, Lianne; Marquand, Andre F; Rhebergen, Didi; van Tol, Marie-José; Ruhé, Henricus G; van der Wee, Nic J A; Veltman, Dick J; Penninx, Brenda W J H

    2015-08-15

    A chronic course of major depressive disorder (MDD) is associated with profound alterations in brain volumes and emotional and cognitive processing. However, no neurobiological markers have been identified that prospectively predict MDD course trajectories. This study evaluated the prognostic value of different neuroimaging modalities, clinical characteristics, and their combination to classify MDD course trajectories. One hundred eighteen MDD patients underwent structural and functional magnetic resonance imaging (MRI) (emotional facial expressions and executive functioning) and were clinically followed-up at 2 years. Three MDD trajectories (chronic n = 23, gradual improving n = 36, and fast remission n = 59) were identified based on Life Chart Interview measuring the presence of symptoms each month. Gaussian process classifiers were employed to evaluate prognostic value of neuroimaging data and clinical characteristics (including baseline severity, duration, and comorbidity). Chronic patients could be discriminated from patients with more favorable trajectories from neural responses to various emotional faces (up to 73% accuracy) but not from structural MRI and functional MRI related to executive functioning. Chronic patients could also be discriminated from remitted patients based on clinical characteristics (accuracy 69%) but not when age differences between the groups were taken into account. Combining different task contrasts or data sources increased prediction accuracies in some but not all cases. Our findings provide evidence that the prediction of naturalistic course of depression over 2 years is improved by considering neuroimaging data especially derived from neural responses to emotional facial expressions. Neural responses to emotional salient faces more accurately predicted outcome than clinical data. Copyright © 2015 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  2. Prevalence, correlates and under-diagnosis of clinical depression among adults on highly active antiretroviral therapy in a Tertiary Health Institution in northeastern Nigeria

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    Abdu Wakawa Ibrahim

    2014-11-01

    Full Text Available Clinical depression is a highly debilitating illness, which is often under-diagnosed and negatively impacts on the quality of life of its sufferers. When it co-exists with other medical conditions, its effect is even more incapacitating. Undiagnosed depression in the context of HIV infection leads to accelerated decline in CD4+ cell counts with concomitant increase in the viral load and poor adherence to the antiretroviral medications which lead to viral mutation and the evolution of resistant strains. This study examined the prevalence of depression, its correlates and the frequency of the diagnosis of the condition among HIV+ subjects on highly active antiretroviral therapy (HAART by the internists and general physicians at the University of Maiduguri Teaching Hospital in Northeastern Nigeria. Three hundred and fifty representative samples of HIV+ adults on HAART were drawn from the Antiretroviral Therapy Clinic of the Institution. Diagnosis of depression was made using the International Classification of Diseases-10 criteria based on Composite International Diagnostic Interview generated data. Socio-demographic and clinical variables were also analyzed for their correlation with depression in the subjects. About 20% of the respondents were diagnosed with clinical depression and no diagnosis of the condition was hitherto entertained in all the respondents. The independent determinants of depression in the participants were: female gender [odds ratio (OR=3.87 (95% confidence interval, CI: 2.089-7.183], past history of psychiatric illness [OR=43.81 (95% CI: 9.731-197.30] and family history of psychiatric illness in first-degree relatives of the subjects [OR=14.364 (95% CI=5.327- 38.729]. Depression is a relatively common psychiatric condition among adults on HAART, there is therefore the need for routine screening of this condition among HIV+ subjects in order to optimize patient care and improve clinical outcomes.

  3. Resemblance operations and conceptual complexity in animal metaphors

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    Aneider Iza Ervitia

    2012-07-01

    Full Text Available For over thirty years cognitive linguists have devoted much effort to the study of metaphors based on the correlation of events in human experience to the detriment of the more traditional notion of resemblance metaphor, which exploits perceived similarities among objects. Grady (1999 draws attention to this problem and calls for a more serious study of the latter type of metaphor. The present paper takes up this challenge on the basis of a small corpus of ‘animal’ metaphors in English, which are essentially based on resemblance. Contrary to previous analyses by cognitive linguists (e.g. Lakoff & Turner 1989, Ruiz de Mendoza Ibáñez, 1998, who claim that such metaphors are based on a single mapping generally involving comparable behavioral attributes, I will argue that we have a more complex situation which involves different patterns of conceptual interaction. In this respect, I have identified cases of (i animal metaphors interacting with high-level (i.e. grammatical metaphors and metonymies, of (ii (situational animal metaphors whose source domains are constructed metonymically (cf. Goossens 1990; Ruiz de Mendoza Ibáñez & Díez Velasco 2002, and of (iii animal metaphors interacting with other metaphors thereby giving rise to metaphoric amalgams (cf. Ruiz de Mendoza Ibáñez & Galera Masegosa 2011.

  4. Electroconvulsive therapy and age: Age-related clinical features and effectiveness in treatment resistant major depressive episode.

    Science.gov (United States)

    Socci, Chiara; Medda, Pierpaolo; Toni, Cristina; Lattanzi, Lorenzo; Tripodi, Beniamino; Vannucchi, Giulia; Perugi, Giulio

    2018-02-01

    This study was aimed to compare clinical features, treatments outcomes and tolerability between young (18-45 years), middle age (46-64 years) and old (≥ 65 years) patients treated with bilateral ECT for treatment resistant major depressive episode. 402 patients were evaluated 1 day prior to ECT and a week after the treatment termination using the Clinical Global Impression Scale (CGI), the Hamilton Rating Scale for Depression-17 items (HAM-D-17), the Brief Psychiatric Rating Scale (BPRS), the Young Mania Rating Scale (YMRS) and the Mini Mental State Examination (MMSE). Response was defined as a reduction of at least 50% from baseline on the HAM-D-17 score. Remission was defined as a score ≤ 7 on the HAM-D-17 at the final evaluation. Rates of response were not statistically different in the three groups (69.6% in old versus 63.5% in young and 55.5% in middle age groups). No significant differences were also observed in the proportions of remitters between the age groups (31.4% in young group, 27.7% in middle age group and 29.3% in old group). One week after the end of the ECT course the middle and old age groups showed a statistically significant increase in the MMSE score compared to baseline. We did not find significant differences between the three age groups in rates of premature drops-out due to ECT-related side effects. Our data support the use of ECT in elderly patients with treatment-resistant major depressive episode, with rates of response around 70% and effectiveness being independent from age. In the old age group the baseline cognitive impairment improved after ECT and no life-threatening adverse event was detected. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. A case of secondary syphilis with HIV, resembling borderline lepromatous leprosy

    Science.gov (United States)

    Mani, Mohan Zachariah; Kanish, Bimal; Kwatra, Kanwardeep; Chaudhary, Paulina R.; Bhatia, Anuradha

    2015-01-01

    We are reporting an unusual case of secondary syphilis, in a homosexual male patient, which resembled borderline lepromatous leprosy, and in whom the diagnosis was considered on clinical grounds. The patient also had concomitant HIV infection, with asymptomatic neurosyphilis. His rapid plasma reagin test was reactive in 1:128 dilution. He improved with three standard, weekly injections of benzathine penicillin, along with 2 g of intravenous ceftriaxone daily for 15 days. This case is being reported to highlight the need for a high index of suspicion in diagnosing unusual cases of secondary syphilis, especially in those with concomitant HIV infection. PMID:26692613

  6. Depression of home cage wheel running: a reliable and clinically relevant method to assess migraine pain in rats.

    Science.gov (United States)

    Kandasamy, Ram; Lee, Andrea T; Morgan, Michael M

    2017-12-01

    The development of new anti-migraine treatments is limited by the difficulty inassessing migraine pain in laboratory animals. Depression of activity is one of the few diagnostic criteria formigraine that can be mimicked in rats. The goal of the present study was to test the hypothesis thatdepression of home cage wheel running is a reliable and clinically relevant method to assess migraine painin rats. Adult female rats were implanted with a cannula to inject allyl isothiocyanate (AITC) onto the dura to induce migraine pain, as has been shown before. Rats recovered from implantation surgery for 8 days in cages containing a running wheel. Home cage wheel running was recorded 23 h a day. AITC and the migraine medication sumatriptan were administered in the hour prior to onset of the dark phase. Administration of AITC caused a concentration-dependent decrease in wheel running that lasted 3 h. The duration and magnitude of AITC-induced depression of wheel running was consistent following three repeated injections spaced 48 h apart. Administration of sumatriptan attenuated AITC-induced depressionof wheel running when a large dose (1 mg/kg) was administered immediately following AITC administration. Wheel running patterns did not change when sumatriptan was given to naïve rats. These data indicate that home cage wheel running is a sensitive, reliable, and clinically relevant method to assess migraine pain in the rat.

  7. Peer-level patient presenters decrease pharmacy students' social distance from patients with schizophrenia and clinical depression.

    Science.gov (United States)

    Buhler, Amber V; Karimi, Reza M

    2008-10-15

    To create a doctor of pharmacy curricular experience that will decrease students' social barriers to interaction with and treatment of mentally-ill patients. We created a survey instrument to measure 4 aspects of students' conceptions of schizophrenia and clinical depression: (1) understanding of the medical nature of each disease, (2) understanding of patient behavior, (3) belief in the efficacy of treatment, and (4) social distance. We delivered this instrument before and after a neuropsychiatry curriculum including "peer-level patient presenters" in addition to the traditional first-year pharmacy curriculum. Social-distance scores significantly decreased in first-year pharmacy students who attended peer-level patient presentations, indicating increased willingness to interact with persons with schizophrenia and clinical depression. In addition, students' understanding of the causes of illness, behavior of patients, and most importantly, efficacy of drug counseling for these diseases increased. Changes to the curriculum including the addition of peer-level patient presentations can quantitatively decrease pharmacy students' social barriers to the treatment of mentally-ill patients.

  8. Social Support as a Key Protective Factor against Depression in HIV-Infected Patients: Report from large HIV clinics in Hanoi, Vietnam

    OpenAIRE

    Matsumoto, Shoko; Yamaoka, Kazue; Takahashi, Kenzo; Tanuma, Junko; Mizushima, Daisuke; Do, Cuong Duy; Nguyen, Dung Thi; Nguyen, Hoai Dung Thi; Nguyen, Kinh Van; Oka, Shinichi

    2017-01-01

    Depression is the most common mental health issue among people living with HIV/AIDS (PLWHA). This study explored how different types and sources of social support are associated with depression among HIV-infected patients in Vietnam. We carried out a cross-sectional survey on 1,503 HIV-infected patients receiving antiretroviral therapy at two HIV clinics in Hanoi in 2016. Depression was prevalent in 26.2% of participants. Higher score of social support, especially emotional/informational supp...

  9. Screening medical patients for distress and depression: does measurement in the clinic prior to the consultation overestimate distress measured at home?

    NARCIS (Netherlands)

    Hansen, C.H.; Walker, J.; Thekkumpurath, P.; Kleiboer, A.M.; Beale, C.; Sawhney, A.; Murray, G.; Sharp, M.

    2013-01-01

    Background Medical patients are often screened for distress in the clinic using a questionnaire such as the Hospital Anxiety and Depression Scale (HADS) while awaiting their consultation. However, might the context of the clinic artificially inflate the distress score? To address this question we

  10. The criterion validity of the web-based Major Depression Inventory when used on clinical suspicion of depression in primary care

    DEFF Research Database (Denmark)

    Nielsen, Marie Germund; Ørnbøl, Eva; Bech, Per

    2017-01-01

    the web-based MDI in a primary care setting. The validation was based on the Munich-Composite International Diagnostic Interview (M-CIDI) by phone. GPs in the 22 practices in our study included 132 persons suspected of depression. Depression was rated as yes/no according to the MDI and M-CIDI. Sensitivity...

  11. Using Mobile Sensing to Test Clinical Models of Depression, Social Anxiety, State Affect, and Social Isolation Among College Students

    Science.gov (United States)

    Chow, Philip I; Fua, Karl; Huang, Yu; Bonelli, Wesley; Xiong, Haoyi; Teachman, Bethany A

    2017-01-01

    associated with more time or greater likelihood of spending time at home, and more negative or less positive affect was linked to longer homestay. Interactions indicated that, among individuals higher in social anxiety, higher negative affect and lower positive affect within a day was associated with greater likelihood of spending time at home the following day. Conclusions Results demonstrate the feasibility and utility of modeling the relationship between affect and homestay using fine-grained GPS data. Although these findings must be replicated in a larger study and with clinical samples, they suggest that integrating repeated state affect assessments in situ with continuous GPS data can increase understanding of how actual homestay is related to affect in everyday life and to symptoms of anxiety and depression. PMID:28258049

  12. Low-dose ketamine for treatment resistant depression in an academic clinical practice setting.

    Science.gov (United States)

    Feifel, David; Malcolm, Benjamin; Boggie, Danielle; Lee, Kelly

    2017-10-15

    Recent studies demonstrating a rapid, robust improvement in treatment resistant depression (TRD) following a single sub-anesthetic infusion of ketamine have generated much excitement. However, these studies are limited in their generalizability to the broader TRD population due to their subject exclusion criteria which typically limit psychiatric comorbidity, concurrent medication, and level of suicide risk. This paper describes the safety and efficacy of sub-anesthetic ketamine infusions in a naturalistic TRD patient sample participating in a real-world TRD treatment program within a major university health system. The effects of a sub-anesthetic dose (0.5mg/kg) of ketamine infused IV over forty minutes on TRD patients participating in a treatment program at the University of California, San Diego was investigated by retrospectively analyzing the medical charts of 41 adult TRD patients with a diagnosis of Major Depressive Disorder (MDD) or Bipolar Disorder (BD). Subjects were aged 48.6, 78% white, 36.6% female, and 82.9% had MDD. Significant psychiatric comorbidity existed in 73%. Average pre-infusion BDI score was 32.6 ± 8.4 (S.D) and dropped to 16.8 ± 3.1 at 24-h post-infusion (p Ketamine infusions were well tolerated with occasional nausea or anxiety and mild hemodynamic effects during the infusion. Retrospective nature of this study, lack of control group and use of self-report depression ratings scales. This is the first published study of sub-anesthetic ketamine infusions in a real-world TRD population. The results suggest that this treatment is effective and well tolerated in this population. Copyright © 2017. Published by Elsevier B.V.

  13. A clinical genetic method to identify mechanisms by which pain causes depression and anxiety

    Directory of Open Access Journals (Sweden)

    Pao Maryland

    2006-04-01

    Full Text Available Abstract Background Pain patients are often depressed and anxious, and benefit less from psychotropic drugs than pain-free patients. We hypothesize that this partial resistance is due to the unique neurochemical contribution to mood by afferent pain projections through the spino-parabrachial-hypothalamic-amygdalar systems and their projections to other mood-mediating systems. New psychotropic drugs for pain patients might target molecules in such brain systems. We propose a method to prioritize molecular targets by studying polymorphic genes in cohorts of patients undergoing surgical procedures associated with a variable pain relief response. We seek molecules that show a significant statistical interaction between (1 the amount of surgical pain relief, and (2 the alleles of the gene, on depression and anxiety during the first postoperative year. Results We collected DNA from 280 patients with sciatica due to a lumbar disc herniation, 162 treated surgically and 118 non-surgically, who had been followed for 10 years in the Maine Lumbar Spine Study, a large, prospective, observational study. In patients whose pain was reduced >25% by surgery, symptoms of depression and anxiety, assessed with the SF-36 Mental Health Scale, improved briskly at the first postoperative measurement. In patients with little or no surgical pain reduction, mood scores stayed about the same on average. There was large inter-individual variability at each level of residual pain. Polymorphisms in three pre-specified pain-mood candidate genes, catechol-O-methyl transferase (COMT, serotonin transporter, and brain-derived neurotrophic factor (BDNF were not associated with late postoperative mood or with a pain-gene interaction on mood. Although the sample size did not provide enough power to persuasively search through a larger number of genes, an exploratory survey of 25 other genes provides illustrations of pain-gene interactions on postoperative mood – the mu opioid

  14. RESEMBLANCE OPERATIONS AND CONCEPTUAL COMPLEXY IN ANIMAL METAPHORS

    Directory of Open Access Journals (Sweden)

    Aneider Iza Ervitia

    2012-07-01

    Full Text Available

    For over thirty years cognitive linguists have devoted much effort to the study of metaphors based on the correlation of events in human experience to the detriment of the more traditional notion of resemblance metaphor, which exploits perceived similarities among objects. Grady (1999 draws attention to this problem and calls for a more serious study of the latter type of metaphor. The present paper takes up this challenge on the basis of a small corpus of ‘animal’ metaphors in English, which are essentially based on resemblance. Contrary to previous analyses by cognitive linguists (e.g. Lakoff & Turner 1989, Ruiz de Mendoza Ibáñez, 1998, who claim that such metaphors are based on a single mapping generally involving comparable behavioral attributes, I will argue that we have a more complex situation which involves different patterns of conceptual interaction. In this respect, I have identified cases of (i animal metaphors interacting with high-level (i.e. grammatical metaphors and metonymies, of (ii (situational animal metaphors whose source domains are constructed metonymically (cf. Goossens 1990; Ruiz de Mendoza Ibáñez & Díez Velasco 2002, and of (iii animal metaphors interacting with other metaphors thereby giving rise to metaphoric amalgams (cf. Ruiz de Mendoza Ibáñez & Galera Masegosa 2011.

  15. Neurobiology of Anxious Depression: A Review

    OpenAIRE

    Ionescu, Dawn F; Niciu, Mark J; Mathews, Daniel C; Richards, Erica M; Zarate, Carlos A

    2013-01-01

    Anxious depression is a common, distinct clinical subtype of major depressive disorder (MDD). This review summarizes current neurobiological knowledge regarding anxious depression. Peer-reviewed articles published January 1970 through September 2012 were identified via PUBMED, EMBASE, and Cochrane Library, using the following key words: anxious depression electroencephalography (EEG), anxious depression functional magnetic resonance imaging (fMRI), anxious depression genetics, anxious depress...

  16. Effects of asenapine on depressive symptoms in patients with bipolar I disorder experiencing acute manic or mixed episodes: a post hoc analysis of two 3-week clinical trials

    Directory of Open Access Journals (Sweden)

    Nations Kari R

    2011-06-01

    Full Text Available Abstract Background Asenapine demonstrated superiority over placebo for mania in bipolar I disorder patients experiencing acute current manic or mixed episodes in 2 randomized, placebo-and olanzapine-controlled trials. We report the results of exploratory pooled post hoc analyses from these trials evaluating asenapine's effects on depressive symptoms in patients from these trials with significant baseline depressive symptoms. Methods In the original trials (A7501004 [NCT00159744], A7501005 [NCT00159796], 977 patients were randomized to flexible-dose sublingual asenapine (10 mg twice daily on day 1; 5 or 10 mg twice daily thereafter, placebo, or oral olanzapine 5-20 mg once daily for 3 weeks. Three populations were defined using baseline depressive symptoms: (1 Montgomery-Asberg Depression Rating Scale (MADRS total score ≥20 (n = 132; (2 Clinical Global Impression for Bipolar Disorder-Depression (CGI-BP-D scale severity score ≥4 (n = 170; (3 diagnosis of mixed episodes (n = 302 by investigative site screening. For each population, asenapine and olanzapine were independently compared with placebo using least squares mean change from baseline on depressive symptom measures. Results Decreases in MADRS total score were statistically greater with asenapine versus placebo at days 7 and 21 in all populations; differences between olanzapine and placebo were not significant. Decreases in CGI-BP-D score were significantly greater with asenapine versus placebo at day 7 in all categories and day 21 in population 1; CGI-BP-D score reductions were significantly greater with olanzapine versus placebo at day 21 in population 1 and day 7 in populations 2 and 3. Conclusions These post hoc analyses show that asenapine reduced depressive symptoms in bipolar I disorder patients experiencing acute manic or mixed episodes with clinically relevant depressive symptoms at baseline; olanzapine results appeared to be less consistent. Controlled studies of asenapine in

  17. Is there any evidence to support the use of anti-depressants in painful rheumatological conditions? Systematic review of pharmacological and clinical studies.

    Science.gov (United States)

    Perrot, S; Javier, R-M; Marty, M; Le Jeunne, C; Laroche, F

    2008-08-01

    The aim of this study was to review the evidence supporting the use of anti-depressants in painful rheumatological conditions. A systematic review of papers published between 1966 and 2007, in five European languages, on anti-depressants in rheumatological conditions was performed. Papers were scored using Jadad method and analgesic ES was calculated. We selected 78 clinical studies and 12 meta-analyses, from 140 papers. The strongest evidence of an analgesic effect of anti-depressants has been obtained for fibromyalgia. A weak analgesic effect is observed for chronic low back pain, with an efficacy level close to that of analgesics. In RA and AS, there is no analgesic effect of anti-depressants, but these drugs may help to manage fatigue and sleep disorders. There is no clear evidence of an analgesic effect inOA, but studies have poor methodological quality. Analgesic effects of anti-depressants are independent of their anti-depressant effects. Tricyclic anti-depressants (TCAs), even at low doses, have analgesic effects equivalent to those of serotonin and noradrenalin reuptake inhibitors (SNRIs), but are less well tolerated. Selective serotonin reuptake inhibitors (SSRIs) have modest analgesic effects, but higher doses are required to achieve analgesia. Anti-depressant drugs, particularly TCAs and SNRIs, have analgesic effects in chronic rheumatic painful states in which analgesics and NSAIDs are not very efficient, such as fibromyalgia and chronic low back pain. In inflammatory rheumatic diseases, anti-depressants may be useful for managing fatigue and sleep disorders. Further studies are required to compare anti-depressants with other analgesics in the management of chronic painful rheumatological conditions.

  18. Clinical Features of Patients with Dysthymia in a Large Cohort of Han Chinese Women with Recurrent Major Depression

    Science.gov (United States)

    Wu, Wenqing; Wang, Zhoubing; Wei, Yan; Zhang, Guanghua; Shi, Shenxun; Gao, Jingfang; Li, Youhui; Tao, Ming; Zhang, Kerang; Wang, Xumei; Gao, Chengge; Yang, Lijun; Li, Kan; Shi, Jianguo; Wang, Gang; Liu, Lanfen; Zhang, Jinbei; Du, Bo; Jiang, Guoqin