Comorbid Major Depressive Disorder Research Articles

PW148 Modified Pot technique (Proximal Optimization Technique) to avoid complex bifurcation stenting

Lcx 99% 2.5x12 3 x 18 16 20 P O ST E R A B ST R A C T S Results: First phase comprised 120 subjects, second phase 80 and third phase 56 subjects. Mean age was 53 (45-61) years. Mean BMI was 28.35 3.59 kg/m. After one month 22 (27.5%) of the subjects had acute stress disorder (ASD) and 13.8% had major depressive disorder (MDD). After six months 15 (37.5%) subjects had PTSD and 12 (27.3%) had MDD. Alcohol consumption showed to be predictive for development of MDD in the second phase (P1⁄40.002, OR1⁄42.48), while physical inactivity showed to be predictive for the development of comorbidity of MDD and ASD in the second phase (P1⁄40.036, OR1⁄4100.00). Conclusion: Our results showed that cardiovascular disorders can cause anxious and depressive disorders among frequent alcohol consumers and physically inactive individuals. So, depression, anxiety, physical inactivity, and alcohol consumption cannot only be considered as risk factors for cardiovascular disorders, but should also be regarded as a consequence of cardiovascular disorders. Disclosure of Interest: None Declared

Gender Difference in Major Depression and Generalized Anxiety Disorder Comorbidity in Patients of Obsessive Compulsive Disorder

Context : Obsessive Compulsive Disorder is a disease with controversies regarding co-morbidities. Studies have noted there are some doubts due to the disease's heterogeneity and cultural influence. Some studies have reflected that women are more likely to have Major depressive disorder(MDD) as co-morbidity while the impact of gender on co-morbid generalized anxiety disorder(GAD) was inconclusive. There are few Indian studies in this regard and hence this cross-sectional study was performed in a tertiary referral centre in Eastern India. Material and method : 100 consecutive eligible patients with OCD(Male=41,Female=59) were interviewed. The data were recorded for socio-demographic profile, depression and anxiety comorbidities. Results : The mean age of the study sample was 32.73 yrs, mostly from rural background(82%) and nuclear families (62%).The subjects were found to be suffering mostly from co-morbid MDD(85%) and GAD(83%).93% of our female subjects had co-morbid MDD while 90% of them had co-morbid GAD. The corresponding percentages for 41 males was 73%(for both MDD and GAD). Gender had an impact on both these co-morbid diagnoses(P-value<0.05)though the association with depression was more. Conclusion : Our study showed both MDD and GAD were highly comorbid with OCD and gender(i.e female sex) having influence on diagnosis. This may be due to long-term suppression&underreporting of our patients due to the taboo of suchi-bai,distress caused by this suppression and denial in family life and the female majority. Recommendations : 1)Early diagnosis and prompt management of MDD and GAD in female OCD subjects to reduce morbidity. 2) Further longitudinal community-based studies.

Chronic multisite pain in major depression and bipolar disorder: cross-sectional study of 149,611 participants in UK Biobank

BackgroundChronic pain has a strong association with major depressive disorder (MDD), but there is a relative paucity of studies on the association between chronic multisite pain and bipolar disorder (BD). Such studies are required to help elucidate the complex biological and psychological overlap between pain and mood disorders. The aim of this study is to investigate the relationship between chronic multisite pain and mood disorder across the unipolar-bipolar spectrum.MethodsWe conducted a cross-sectional study of 149,611 UK Biobank participants. Self-reported depressive and bipolar features were used to categorise participants into MDD and BD groups and a non-mood disordered comparison group. Multinomial logistic regression was used to establish whether there was an association between extent of chronic pain (independent variable) and mood disorder category (dependent variable), using no pain as the referent category, and adjusting for a wide range of potential sociodemographic, lifestyle and comorbidity confounders.ResultsMultisite pain was significantly more prevalent in participants with BD and MDD, for example, 4–7 pain sites: BD 5.8%, MDD 4.5%, and comparison group 1.8% (p < 0.001). A relationship was observed between extent of chronic pain and risk of BD and persisted after adjusting for confounders (relative to individuals with no chronic pain): 2–3 sites RRR of BD 1.84 (95% CI 1.61, 2.11); 4–7 sites RRR of BD 2.39 (95% CI 1.88, 3.03) and widespread pain RRR of BD 2.37 (95% CI 1.73, 3.23). A similar relationship was observed between chronic pain and MDD: 2–3 sites RRR of MDD 1.59 (95% CI 1.54, 1.65); 4–7 sites RRR of MDD 2.13 (95% CI 1.98, 2.30); widespread pain RRR of MDD 1.86 (95% CI 1.66, 2.08).ConclusionsIndividuals who report chronic pain and multiple sites of pain are more likely to have MDD and are at higher risk of BD. These findings highlight an important aspect of comorbidity in MDD and BD and may have implications for understanding the shared neurobiology of chronic pain and mood disorders.

Comorbid Depressive Disorders in ADHD: The Role of ADHD Severity, Subtypes and Familial Psychiatric Disorders.

ObjectiveTo evaluate the presence of Major Depressive Disorder (MDD) and Dysthymic Disorder (DD) in a sample of Italian children with Attention Deficit Hyperactivity Disorder (ADHD) and to explore specific features of comorbid depressive disorders in ADHD.MethodsThree hundred and sixty-six consecutive, drug-naïve Caucasian Italian outpatients with ADHD were recruited and comorbid disorders were evaluated using DSM-IV-TR criteria. To evaluate ADHD severity, parents of all children filled out the ADHD Rating Scale. Thirty-seven children with comorbid MDD or DD were compared with 118 children with comorbid conduct disorder and 122 without comorbidity for age, sex, IQ level, family psychiatric history, and ADHD subtypes and severity.Results42 of the ADHD children displayed comorbid depressive disorders: 16 exhibited MDD, 21 DD, and 5 both MDD and DD. The frequency of hyperactive-impulsive subtypes was significantly lower in ADHD children with depressive disorders, than in those without any comorbidity. ADHD children with depressive disorders showed a higher number of familial psychiatric disorders and higher score in the Inattentive scale of the ADHD Rating Scale, than children without any comorbidity. No differences were found for age, sex and IQ level between the three groups.ConclusionConsistent with previous studies in other countries, depressive disorders affect a significant proportion of ADHD children in Italy. Patient assessment and subsequent treatment should take into consideration the possible presence of this comorbidity, which could specifically increase the severity of ADHD attention problems.

Impact of Comorbid Depression on Serial Position Effects in Alzheimer’s Disease

Hippocampal dysfunction and deficits in episodic memory have been reported for both Alzheimer’s disease (AD) and major depressive disorder (MDD). Primacy performance has been associated with hippocampus-dependent episodic memory, while recency may reflect working memory performance. In this study, serial position profiles were examined in a total of 73 patients with MDD, AD, both AD and MDD, and healthy controls (HC) by means of CERAD-NP word list memory. Primacy performance was most impaired in AD with comorbid MDD, followed by AD, MDD, and HC. Recency performance, on the other hand, was comparable across groups. These findings indicate that primacy in AD is impaired in the presence of comorbid MDD, suggesting additive performance decrements in this specific episodic memory function.

Major Depressive Disorder: A Case of an Adolescent Female with Russell-Silver Syndrome

RSS is a congenital genetic disorder characterized by discrete aberrations in genes that account for growth and development. A number of genetic configurations may play a formative role in the development of RSS. The syndrome may result from: (1) Maternal uniparental disomy of chromosome 7 (matUPD7) - the child essentially inherits two copies of chromosome 7 from the maternal parent. This defect is found in 10% of cases. (2)Imprinting - a hypomethylation process for chromosome 11p15 is responsible for paternal expression of gene. Imprinting is responsible for 38% of cases. The genes that are known to be affected are H19 and IGF2. The H19 gene correlates with the phenotypic expression of skeletal abnormalities; the patient case presented below had corrective surgery for her scoliosis. The diagnosis of RSS is primarily based on clinical presentation. Prenatal genetic confirmation is available for intrauterine growth retardation (IUGR). Furthermore, researchers have elaborated upon the tangible association that exists between Russell-Silver Syndrome and Asperger Syndrome. Major depressive disorder often coincides with RSS; therefore it is of utmost importance for the clinician to adequately identify and treat depression in RSS children before it progresses to suicidal thoughts and/or psychosis. Objective: Our goal is to assess the clinical presentation of RSS within the context of comorbid conditions, in particular, MDD and Asperger's Syndrome (AS). The purpose of this case report is to highlight the importance of early recognition and management of individuals afflicted with RSS - to raise awareness for a congenital disorder that often coincides with serious symptoms of depression, including suicidal ideation and/or psychosis. Method: A literature search via PubMed and Google on the topics of RSS. Conclusion: RSS can present with clinical depression which also affects medical management, and patients should be carefully monitored for the development of new symptoms and/or side effects.

Major Depressive Disorder: A Case of an Adolescent Female with Russell-Silver Syndrome

RSS is a congenital genetic disorder characterized by discrete aberrations in genes that account for growth and development. A number of genetic configurations may play a formative role in the development of RSS. The syndrome may result from: (1) Maternal uniparental disomy of chromosome 7 (matUPD7) - the child essentially inherits two copies of chromosome 7 from the maternal parent. This defect is found in 10% of cases. (2)Imprinting - a hypomethylation process for chromosome 11p15 is responsible for paternal expression of gene. Imprinting is responsible for 38% of cases. The genes that are known to be affected are H19 and IGF2. The H19 gene correlates with the phenotypic expression of skeletal abnormalities; the patient case presented below had corrective surgery for her scoliosis. The diagnosis of RSS is primarily based on clinical presentation. Prenatal genetic confirmation is available for intrauterine growth retardation (IUGR). Furthermore, researchers have elaborated upon the tangible association that exists between Russell-Silver Syndrome and Asperger Syndrome. Major depressive disorder often coincides with RSS; therefore it is of utmost importance for the clinician to adequately identify and treat depression in RSS children before it progresses to suicidal thoughts and/or psychosis. Objective: Our goal is to assess the clinical presentation of RSS within the context of comorbid conditions, in particular, MDD and Asperger's Syndrome (AS). The purpose of this case report is to highlight the importance of early recognition and management of individuals afflicted with RSS - to raise awareness for a congenital disorder that often coincides with serious symptoms of depression, including suicidal ideation and/or psychosis. Method: A literature search via PubMed and Google on the topics of RSS. Conclusion: RSS can present with clinical depression which also affects medical management, and patients should be carefully monitored for the development of new symptoms and/or side effects.

Major depressive disorder and sleep disturbance in patients with chronic pain.

Disturbed sleep is a common problem in both chronic pain and major depressive disorder (MDD). Moreover, many patients with chronic pain are depressed. To examine the effects of depression on the sleep behaviour of chronic pain patients by comparing patients who did or did not meet diagnostic criteria for MDD. A total of 60 patients with chronic musculoskeletal pain underwent structured diagnostic interviews for MDD and insomnia, and completed questionnaires assessing pain severity, disability, sleep quality, beliefs and attitudes about sleep, and sleep hygiene. For four consecutive days, they also completed a sleep diary, and reported on sleep hygiene practices and presleep arousal. Thirty-three patients (55%) met diagnostic criteria for MDD, most of whom (n=32 [97%]) also fulfilled criteria for insomnia disorder. Insomnia was also common among patients without MDD (21 of 27&nbsp;[78%]). Participants with MDD had higher self-reports of pain, disability, dysfunctional beliefs about sleep, and, on a prospective basis, greater presleep arousal and poorer sleep hygiene. However, diary assessments of specific sleep parameters (eg, sleep onset latency, total sleep time, sleep efficiency) did not differ between the groups. Chronic pain patients with comorbid MDD exhibited more dysfunctional beliefs about sleep, poorer sleep hygiene practices and greater presleep arousal; however, diary-recorded sleep characteristics may not differ from those of patients without MDD. Chronic pain itself may disturb sleep so extensively that MDD introduces little additive effect. MDD in chronic pain may be related to the cognitive and behavioural aspects of insomnia, rather than to an incremental disturbance in the initiation or maintenance of sleep.

Altered functional connectivity in posttraumatic stress disorder with versus without comorbid major depressive disorder: a resting state fMRI study

Posttraumatic stress disorder (PTSD) is an anxiety disorder that is often diagnosed with comorbid depressive disorder. Therefore, neuroimaging studies investigating PTSD typically include both patients with and without comorbid depression. Differences in activity of the anterior cingulate cortex (ACC) and insula have been shown to differentiate PTSD patients with and without major depressive disorder (MDD). Whether or not comorbid MDD affects resting state functional connectivity of PTSD patients has not been investigated to our knowledge. Here, resting state functional connectivity of PTSD patients with (PTSD+MDD; n=27) and without (PTSD-MDD; n=23) comorbid MDD was investigated. The subgenual ACC and insula were investigated as seed regions. Connectivity between the subgenual ACC and perigenual parts of the ACC was increased in PTSD+MDD versus PTSD-MDD. Reduced functional connectivity of the subgenual ACC with the thalamus was found in the PTSD+MDD group versus the PTSD-MDD group. These results remained significant after controlling for PTSD severity. In addition, the PTSD+MDD group showed reduced functional connectivity of the insula with the hippocampus compared to the PTSD-MDD group. However, this cluster was no longer significantly different when controlling for PTSD severity. Thus, resting state functional connectivity of the subgenual ACC may distinguish PTSD+MDD from PTSD-MDD. As PTSD patients with comorbid MDD are more treatment resistant, this result may be important for treatment development.

Implicit alcohol cognitions in risky drinking nicotine users with and without co-morbid major depressive disorder

ObjectiveAlcohol consumption, nicotine use, and major depressive disorder (MDD) are highly co-morbid. The negative reinforcement model of addiction would suggest that smokers may consume alcohol to relieve negative affective symptoms, such as those associated with MDD and withdrawal from nicotine. Over time, these behaviors may become so strongly paired together that they automatically activate a desire to use alcohol, even in the absence of conscious or deliberate intention. This study examined implicit alcohol cognitions in 146 risky drinking nicotine users (n=83) and non-users (n=63), to help uncover cognitive mechanisms that link drinking, nicotine use, and depression together. We proposed that nicotine users with a history of MDD would have stronger implicit motivations to drink than non-nicotine users without MDD. MethodParticipants were assessed on lifetime MDD (n=84) or no MDD (n=62), and then completed an Implicit Association Task designed to test the strength of associations between alcohol pictures and “approach” words. ResultsRegression analyses showed that implicit alcohol–approach attitudes were stronger among risky drinking nicotine users than non-users. Alcohol–approach motivations were also stronger among risky drinking nicotine users compared to non-users with a history of MDD; nicotine use was unrelated to implicit alcohol cognitions for risky drinkers without MDD. ConclusionsImplicit cognitive processes may be targeted in behavioral and pharmacological treatments in risky drinking nicotine users, particularly those with depression comorbidity.

Panic symptom clusters differentially predict suicide ideation and attempt

Increasingly strong evidence links anxiety disorders in general and panic attacks in particular to suicidality. The underlying causes and specifics of this relation, however, remain unclear. The present article sought to begin addressing this question by clarifying the association between panic symptoms and suicidality. Data were sampled from the NESARC epidemiological data set from the US and analyzed as four independently, randomly selected subsets of 1000 individuals using structural equation modeling analyses and replicating results across samples. Evidence is presented for four symptom clusters (cognitive symptoms, respiratory distress, symptoms of alpha and beta adrenergic activation) and the differential association of each with suicidal ideation and attempts. Symptoms of alpha adrenergic activation predicted prior suicide attempt whereas cognitive symptoms predicted prior suicidal ideation. These findings were independent of comorbid major depressive disorder. It is suggested that assessment of suicide risk in the community includes the presentation of cognitive symptoms and symptoms related to alpha adrenergic activation.

Disruption of fetal hormonal programming (prenatal stress) implicates shared risk for sex differences in depression and cardiovascular disease

Comorbidity of major depressive disorder (MDD) and cardiovascular disease (CVD) represents the fourth leading cause of morbidity and mortality worldwide, and women have a two times greater risk than men. Thus understanding the pathophysiology has widespread implications for attenuation and prevention of disease burden. We suggest that sex-dependent MDD-CVD comorbidity may result from alterations in fetal programming consequent to the prenatal maternal environments that produce excess glucocorticoids, which then drive sex-dependent developmental alterations of the fetal hypothalamic-pituitary-adrenal (HPA) axis circuitry impacting mood, stress regulation, autonomic nervous system (ANS), and the vasculature in adulthood. Evidence is consistent with the hypothesis that disruptions of pathways associated with gamma aminobutyric acid (GABA) in neuronal and vascular development and growth factors have critical roles in key developmental periods and adult responses to injury in heart and brain. Understanding the potential fetal origins of these sex differences will contribute to development of novel sex-dependent therapeutics.

Repetitive transcranial magnetic stimulation enhances sleep quality of patients with comorbid major depressive disorder and insomnia

Insomnia impacts the course of major depressive disorder (MDD), obstructs response to treatment, and raises risk of depression relapse. This study approached how repetitive transcranial magnetic stimulation (rTMS) relieves depression and enhances sleep quality of patients with comorbid major depressive disorder and insomnia. A randomized, controlled, pilot study was conducted in our hospital. The study was approved by local Ethics Committee. All subjects signed informed consents. 30 patients, conforming to meet the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV–TR) criteria for MDD, and Montgomery–Asberg Depression Scale (MADRS) score between 12 and 29 were randomly chosen as the MDD group. Another 30 patients, meeting the DSM–IV–TR criteria for MDD and insomnia, MADRS score between 12 and 29, and Pitts-burgh Sleep Quality Index (PSQI) scores >7, were randomly selected as the MDD and insomnia group. Both groups received rTMS (10 Hz for 4 weeks) once per day. After treatment, patients’ depression was assessed with MADRS, and their sleep quality was evaluated by PSQI. Raters were masked to treatment assignment. There were 30 subjects in MDD group (60% female, mean age 38.56¡‘À12.13 s.d. mean course of disease 11.35¡‘À7.53 months). MDD and insomnia group consisted of 30 subjects (66.67% female, mean age 32.72¡‘À14.69 s.d. mean course of disease 9.23¡‘À4.81 months). Although the rate of depression remission in MDD and insomnia group (59.36%) was higher than MDD group (57.21%), this difference was not significant. After 4 weeks treatment, both MDD group (12.56¡‘À6.73) and MDD insomnia group (11.38¡‘À7.16 s.d.) were significantly improved in MADRS scores (P<0.05). MDD and insomnia group was significantly improved (P<0.05) in PSQI sleep quality (1.40¡‘À0.41), time for falling asleep (1.73¡‘À1.21), sleep time (1.90¡‘À1.28), sleep efficiency (0.90¡‘À1.52), Function during the daytime (1.87¡‘À0.84), total score (8.57 ¡‘À3.74). This pilot study offers the evidence that rTMS improves depression and sleep quality of patients with comorbid major depressive disorder and insomnia. This research was supported by Fund Projects of International Cooperation and Exchanges of Ministry of Science and Technology of China. Grant No. 2011DFA30960.

Functional Impairment in Patients with Major Depressive Disorder and Comorbid Anxiety Disorder

To analyze the potential for different aspects of anxiety to modify the effect of impaired functioning in major depressive disorder (MDD). Participants (n = 1226) were psychiatric outpatients with MDD. A cross-sectional, multicentre, nationwide study was designed. The 12-item version of the World Health Organization Disability Assessment Schedule II was used to assess functional limitation. Anxiety was measured using the Hamilton Anxiety Rating Scale and the State-Trait Anxiety Inventory (STAI). Depression severity was measured using the Quick Inventory of Depressive Symptomatology. About 43.1% of patients had a comorbid MDD and anxiety disorder. Poorer functioning correlated significantly with severity of depression (Pearson r = 0.78, P = 0.001), severity of anxiety (r = 0.65, P = 0.001), and higher anxiety trait scores (r = 0.40, P = 0.001), but not significantly with STAI-State scores (r = 0.03, P = 0.26). The overall regression model was significant and explained 66% of the functioning variability in patients with MDD, mostly attributable to depression severity. Results indicate that anxiety has a moderate impact on functioning impairment in patients with MDD. Our findings suggest that MDD and anxiety severity appear to be associated significantly with impaired functioning in patients with MDD but explains only a moderate proportion of variance.

PTSD, comorbid depression, and the cortisol waking response in victims of intimate partner violence: preliminary evidence

Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) are two highly comorbid and debilitating disorders experienced by more than half of intimate partner violence victims (IPV). Hypothalamic–pituitary–adrenal (HPA) abnormalities are common in both disorders, though the direction of abnormalities often differs. The present study examined the relationship between comorbid PTSD and MDD, and the (salivary) cortisol waking response in 104 recently abused IPV victims. Waking cortisol levels, area under the waking curve with respect to ground (AUCg), and AUC with respect to increase (AUCi) were examined to determine the relation of HPA dynamics to comorbidity for basal versus more dynamic measures. Prior to accounting for comorbidity, women with PTSD or MDD showed significantly greater AUCi than women without the respective disorder. Accounting for comorbidity, PTSD only did not differ from other groups, while MDD only and PTSD + MDD showed greater AUCi than women with neither disorder. Results were nonsignificant for waking cortisol levels or AUCg. Results suggest that MDD drives elevated waking cortisol response, but not basal cortisol activity in recently abused IPV victims. Results demonstrate the importance of examining comorbid diagnoses and HPA activity from a dynamic perspective. Therapeutic implications are discussed.

Integrated care for comorbid alcohol dependence and anxiety and/or depressive disorder: study protocol for an assessor-blind, randomized controlled trial

BackgroundA major barrier to successful treatment in alcohol dependence is psychiatric comorbidity. During treatment, the time to relapse is shorter, the drop-out rate is increased, and long-term alcohol consumption is greater for those with comorbid major depression or anxiety disorder than those with an alcohol use disorder with no comorbid mental disorder. The treatment of alcohol dependence and psychological disorders is often the responsibility of different services, and this can hinder the treatment process. Accordingly, there is a need for an effective integrated treatment for alcohol dependence and comorbid anxiety and/or depression.Methods/DesignWe aim to assess the effectiveness of a specialized, integrated intervention for alcohol dependence with comorbid anxiety and/or mood disorder using a randomized design in an outpatient hospital setting. Following a three-week stabilization period (abstinence or significantly reduced consumption), participants will undergo complete formal assessment for anxiety and depression. Those patients with a diagnosis of an anxiety and/or depressive disorder will be randomized to either 1) integrated intervention (cognitive behavioral therapy) for alcohol, anxiety, and/or depression; or 2) usual counseling care for alcohol problems. Patients will then be followed up at weeks 12, 16, and 24. The primary outcome measure is alcohol consumption (total abstinence, time to lapse, and time to relapse). Secondary outcome measures include changes in alcohol dependence severity, depression, or anxiety symptoms and changes in clinician-rated severity of anxiety and depression.DiscussionThe study findings will have potential implications for clinical practice by evaluating the implementation of specialized integrated treatment for comorbid anxiety and/or depression in an alcohol outpatient service.Trial registrationClinicalTrials.gov Identifier: NCT01941693

Characterizing impulsivity profile in patients with obsessive–compulsive disorder

Objective. Impulsivity represents a key dimension in obsessive–compulsive disorder (OCD), in relation to outcome and course. It can be assessed through the Barratt Impulsiveness Scale (BIS), which explores three main areas: attentional, motor, and nonplanning. Present study was aimed to assess level of impulsivity in a sample of OCD patients, in comparison with healthy controls, using the BIS. Methods. Seventy-five OCD outpatients, 48 of them having psychiatric comorbidities and 70 healthy controls, were assessed through the BIS, and their scores were analyzed using Student's t-test for independent samples, on the basis of demographic and clinical characteristics. Results. BIS total scores were significantly higher (P: 0.01) in patients compared to controls, with no difference between pure and comorbid patients. Attentional impulsivity scores were significantly higher than controls in patients with pure (P < 0.001) and comorbid OCD (P < 0.001), without differences among them. Patients with multiple OC phenotypes showed higher, though statistically non significant, total and attentional scores, compared to single phenotype patients. In addition, patients with comorbid major depressive disorder had higher, though statistically non significant, total and attentional scores, compared to patients with comorbid bipolar disorder, generalized anxiety disorder, and other disorders. Conclusions. Present findings showed higher impulsivity levels in OCD patients versus controls, particularly in the attentional area, and ultimately suggest a potential cognitive implication.

Suicide Attempts in Major Depressed Patients with Personality Disorder

Suicide attempters who met criteria for borderline personality disorder (BPD) comorbid with major depressive disorder (MDD) were compared to both suicide attempters suffering from MDD alone and to attempters with comorbid MDD and other personality disorders (PD). Participants were 239 (158 patients with comorbid PD and 81 patients with MDD without comorbidity) inpatients consecutively admitted after a suicide attempt made in the last 24hours. Suicide attempters with comorbid MDD and BPD had more frequent previous suicide attempts and were more likely to have a history of aggressive behaviors and alcohol and drug use disorders compared with patients suffering from MDD without Axis II comorbidity.

Posttraumatic Stress Disorder Increases Sensitivity to Long Term Losses among Patients with Major Depressive Disorder

BackgroundDecisions under risk and with outcomes that are delayed in time are ubiquitous in real life and can have a significant impact on the health and wealth of the decision-maker. Despite its potential relevance for real-world choices, the degree of aberrant risky and intertemporal decision-making in patients suffering from major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) has received little attention to date.MethodWe used a case-control design to compare decision-making in healthy control subjects (N=16) versus untreated depressed subjects in a current major depressive episode (N=20). In order to examine how major depressive disorder (MDD) may impact decision-making, subjects made decisions over (1) risky outcomes and (2) delayed outcomes in the domain of gains and losses using choice paradigms from neuroeconomics. In a pre-planned analysis, depressed subjects were subdivided into those with primary PTSD along with comorbid MDD (MDD+PTSD) versus those with primary MDD without PTSD (MDD-only). Choice behavior was modeled via a standard econometric model of intertemporal choice, a quasi-hyperbolic temporal discounting function, which was estimated for each subject group separately.ResultsUnder conditions of potential gain, depressed subjects demonstrated greater discounting for gains across all time frames compared to controls. In the realm of losses, both subgroups of depressed subjects discounted more steeply than controls for short time frames. However, for delayed losses ranging from >1-10 years, MDD+PTSD subjects showed shallower discounting rates relative to MDD-only subjects, who continued to discount future losses steeply. Risk attitudes did not contribute to differences in intertemporal choice.ConclusionsDepressed patients make choices that minimize current pain and maximize current reward, despite severe later consequences or lost opportunities. Anxiety associated with PTSD may serve as a partially protective factor in decision-making about long-term potential losses compared to MDD patients without PTSD.

Genetic risk score analysis indicates migraine with and without comorbid depression are genetically different disorders.

Migraine and major depressive disorder (MDD) are comorbid, moderately heritable and to some extent influenced by the same genes. In a previous paper, we suggested the possibility of causality (one trait causing the other) underlying this comorbidity. We present a new application of polygenic (genetic risk) score analysis to investigate the mechanisms underlying the genetic overlap of migraine and MDD. Genetic risk scores were constructed based on data from two discovery samples in which genome-wide association analyses (GWA) were performed for migraine and MDD, respectively. The Australian Twin Migraine GWA study (N = 6,350) included 2,825 migraine cases and 3,525 controls, 805 of whom met the diagnostic criteria for MDD. The RADIANT GWA study (N = 3,230) included 1,636 MDD cases and 1,594 controls. Genetic risk scores for migraine and for MDD were used to predict pure and comorbid forms of migraine and MDD in an independent Dutch target sample (NTR-NESDA, N = 2,966), which included 1,476 MDD cases and 1,058 migraine cases (723 of these individuals had both disorders concurrently). The observed patterns of prediction suggest that the 'pure' forms of migraine and MDD are genetically distinct disorders. The subgroup of individuals with comorbid MDD and migraine were genetically most similar to MDD patients. These results indicate that in at least a subset of migraine patients with MDD, migraine may be a symptom or consequence of MDD.