Comorbid Major Depression Research Articles

Childhood maltreatment moderates the influence of genetic load for obesity on reward related brain structure and function in major depression

Obesity is a clinically relevant and highly prevalent somatic comorbidity of major depression (MDD). Genetic predisposition and history of childhood trauma have both independently been demonstrated to act as risk factors for obesity and to be associated with alterations in reward related brain structure and function. We therefore aimed to investigate the influence of childhood maltreatment and genetic risk for obesity on structural and functional imaging correlates associated with reward processing in MDD. 161 MDD patients underwent structural and functional MRI during a frequently used card guessing paradigm. Main and interaction effects of a polygenic risk score for obesity (PRS) and childhood maltreatment experiences as assessed using the Childhood Trauma Questionnaire (CTQ) were investigated. We found that maltreatment experiences and polygenic risk for obesity significantly interacted on a) body mass index b) gray matter volume of the orbitofrontal cortex as well as on c) BOLD response in the right insula during reward processing. While polygenic risk for obesity was associated with elevated BMI as well as with decreased OFC gray matter and increased insular BOLD response in non-maltreated patients, these associations were absent in patients with a history of childhood trauma. No significant main effect of PRS or maltreatment on gray matter or BOLD response could be detected at the applied thresholds. The present study suggests that childhood maltreatment moderates the influence of genetic load for obesity on BMI as well as on altered brain structure and function in reward related brain circuits in MDD.

SELF-TRANSCENDENCE IN OBSESSIVE COMPULSIVE DISORDER: AN EXPLORATORY STUDY OF PSYCHOPATHOLOGICAL, SOCIODEMOGRAPHIC AND CLINICAL ASPECTS

The obsessive-compulsive disorder (OCD) is a chronic disease that can cause serious functional and family impairment. According to Cloninger 's personality model some temperament and character factors have been associated with specific psychopathology and disease severity of OCD. However, some trait characters like self-transcendence (ST) still wasn’t properly explored in this context. Descriptions of religious content of OCD symptoms are found in sacred books from the 2nd century and are called scrupulosity. There are few studies evaluating the role of spirituality in the OCD concept, which differs from religion, since spirituality could be defined as the focus on spiritual things and the spirit world rather than on earthly and physical things, while religion is a set of beliefs and rituals that claim to put his followers in a right relationship with God. This article aims to assess whether the construct of SF in Temperament and Character Inventory (TCI) may be related to the concept of spirituality and if it could have a protective property in OCD psychopathology. This is an exploratory case-control study involving 49 patients with OCD divided into two groups: high and low ST. Variables with a P<0,2 in the univariate analysis, respecting multicollinearity and clinical-epidemiologic relevance, were included in a multiple logistic regression analysis (with forward variable selection and Wald statistics to denote significance of variables in the model) to determine if the factors were independently associated to higher ST. Results: High ST was associated to the diagnosis of major depression (Odds ratio =7.87, p=0.042), and to the scores of contamination and cleaning dimensions according of the DYBOCS (Dimensional Yale Brown Obsessive-Compulsive Scale) (Odds ratio =1.56, p=0.004). Patients with high ST also showed higher family suffering (p=0.02) and better quality of life (QoL) (specifically on physical dimension (p=0.05) and social concerns (p=0.03)), but those variables did not remain at the regression model. According to literature, the association of high ST and Harm Avoidance and low Self-Directness traits can constitute a schizotypy marker, and therefore may represent vulnerability to mood disorders, such as major depression. This aspect could also explain the association of high-ST with higher family suffering (also found in this study), since these patients have higher unemployment and social withdrawal and thus require greater family care. One hypothesis to explain the strong association to major depression comorbidity is that the ST is high in more severe OCD patients as those with comorbid major depression and, in this case, it could be associated with magical thinking, thought-action fusion and even psychotic symptoms. That is, instead of representing transpersonal identification and spiritual acceptance transcendence could reflect loss in the definition of the self. However, longitudinal studies are necessary to further investigate the direction of cause and effect of these aspects. ST could not be considered a protective factor in OCD as it is associated with worsening of contamination/cleaning OCD symptoms and comorbid depression.

There is more to mental illness than negative affect: comprehensive temperament profiles in depression and generalized anxiety

BackgroundTemperament and mental illness are thought to represent varying degrees along the same continuum of neurotransmitter imbalances. A taxonomy of temperament could provide the basis for a new taxonomy of mental illness. Most popular models of temperament, being based heavily on emotionality traits, show very poor ability to discriminate between mental disorders. The main goal of this study was to examine whether a temperament model based on modern neurophysiology and possessing an extensive set of non-emotionality traits provides better discrimination between Major Depression (MD), Generalized Anxiety (GAD) and Comorbid MD and GAD, in comparison to emotionality-based temperament models.MethodsUsing the Structure of Temperament Questionnaire, the temperament profiles of 687 individuals (396 clients of private psychiatric and psychological practice, and 291 control subjects) were compared across four adult age groups (18–24, 25–45, 46–65, 66–84).ResultsMD and GAD appear to be accurately distinguished by the traits of Motor Endurance and Motor Tempo (much lower values in depression), and Neuroticism (much higher value in anxiety). Comorbids can be distinguished based on a significant decrease in the traits of Plasticity, Intellectual Endurance, Sensitivity to Probabilities, and increased Impulsivity. These effects seemed independent of age and gender.ConclusionsThe results suggest the benefits of including non-emotionality-related traits and the usefulness of a functional approach to both taxonomy of temperament and classification of mental disorders.

Effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) in patients with comorbid panic disorder and major depression.

To explore the role of dorsolateral prefrontal cortex (DLPFC) stimulation in the treatment of panic disorder with comorbid depression. The present study reports findings from retrospective analysis of 13 treatment-resistant patients diagnosed with comorbid panic disorder and depression, given 20 sessions of high-frequency transcranial magnetic stimulation (rTMS) over left-DLPFC over a period of 1 month. There was a significant reduction in both the panic and depressive symptom severity, assessed by applying Panic Disorder Severity Scale (PDSS) and Hamilton Depression Rating Scale (HDRS) at baseline and after 20 sessions of rTMS. There was a 38% and 40% reduction of PDSS and HDRS scores, respectively, in the sample. The changes in PDSS and HDRS scores were not significantly correlated (ρ = -0.103, p = 0.737). High-frequency rTMS delivered at left-DLPFC may have a potential role in treatment of comorbid panic disorder and depression. Future studies done on a larger sample in a controlled environment are required to establish its role.

Generalized Anxiety Disorder (GAD) and Comorbid Major Depression with GAD Are Characterized by Enhanced Nitro-oxidative Stress, Increased Lipid Peroxidation, and Lowered Lipid-Associated Antioxidant Defenses.

Accumulating evidence shows that nitro-oxidative pathways play an important role in the pathophysiology of major depressive disorder (MDD) and bipolar disorder (BD) and maybe anxiety disorders. The current study aims to examine superoxide dismutase (SOD1), catalase, lipid hydroperoxides (LOOH), nitric oxide metabolites (NOx), advanced oxidation protein products (AOPP), malondialdehyde (MDA), glutathione (GSH), paraoxonase 1 (PON1), high-density lipoprotein cholesterol (HDL), and uric acid (UA) in participants with and without generalized anxiety disorder (GAD) co-occurring or not with BD, MDD, or tobacco use disorder. Z unit-weighted composite scores were computed as indices of nitro-oxidative stress driving lipid and protein oxidation. SOD1, LOOH, NOx, and uric acid were significantly higher and HDL and PON1 significantly lower in participants with GAD than in those without GAD. GAD was more adequately predicted by increased SOD + LOOH + NOx and lowered HDL + PON1 composite scores. Composite scores of nitro-oxidative stress coupled with aldehyde and AOPP production were significantly increased in participants with comorbid GAD + MDD as compared with all other study groups, namely MDD, GAD + BD, BD, GAD, and healthy controls. In conclusion, GAD is characterized by increased nitro-oxidative stress and lipid peroxidation and lowered lipid-associated antioxidant defenses, while increased uric acid levels in GAD may protect against aldehyde production and protein oxidation. This study suggests that increased nitro-oxidative stress and especially increased SOD1 activity, NO production, and lipid peroxidation as well as lowered HDL-cholesterol and PON1 activity could be novel drug targets for GAD especially when comorbid with MDD.

F131. Genome-Wide Association Study Identifies Glutamate Ionotropic Receptor GRIA4 as a Risk Gene for Comorbid Nicotine Dependence and Major Depression

Smoking and major depression frequently co-occur. However, the genetic basis is poorly understood. This study aimed to detect genetic risk variants for comorbid nicotine dependence (ND) and major depression (MD).

Does depression treatment improve the survival of depressed patients with cancer? A long-term follow-up of participants in the SMaRT Oncology-2 and 3 trials

Comorbid major depression has been associated with worse survival in patients with cancer. However, we do not know if treating depression improves survival. In the SMaRT Oncology-2 (good prognosis cancers) and SMaRT Oncology-3 (lung cancer, a poor prognosis cancer) trials, we found that a depression treatment programme, Depression Care for People with Cancer (DCPC), was effective in reducing comorbid major depression. In this analysis, we aimed to identify whether DCPC also had an effect on survival. The trials were conducted in three cancer centres and their associated clinics in Scotland, UK. In SMaRT Oncology-2, outpatients with good prognosis cancers and major depression were randomly assigned in a 1:1 ratio to DCPC or usual care, with stratification (by trial centre) and minimisation (by age, primary cancer, and sex) with allocation concealment. In SMaRT Oncology-3, outpatients with lung cancer and major depression were randomly assigned (1:1 ratio) to DCPC or usual care with stratification (by trial centre) and minimisation (by age, sex, and cancer type) with allocation concealment. For this analysis, we obtained long-term data on deaths (all causes) in the SMaRT Oncology-2 and 3 trial participants, censored at July 31, 2015, and analysed survival as a trial outcome. We estimated unadjusted hazard ratios (HRs) for each trial using Cox regression, and pooled the log HRs in a fixed-effects meta-analysis. We recruited 642 participants; between May 12, 2008, and May 13, 2011, 500 participants were recruited to the SMaRT Oncology-2 trial and between Jan 5, 2009, and Sept 9, 2011, 142 participants were recruited to the SMaRT Oncology-3 trial. We followed up SMaRT Oncology-2 and SMaRT Oncology-3 participants for a median of 5 years and 1 year, respectively. 135 (27%) of 500 SMaRT Oncology-2 participants and 114 (80%) of 142 SMaRT Oncology-3 participants died within this period. We found no significant effect of DCPC on survival in the total follow-up period for either SMaRT Oncology 2 (HR 1·02, 95% CI 0·72-1·42, p=0·93) or SMaRT Oncology-3 (HR 0·82, 95% CI 0·56-1·18, p=0·28; pooled HR 0·92, 95% CI 0·72-1·18, p=0·51). DCPC is highly effective in improving depression and quality of life in depressed patients with cancer, but there was no evidence for a significant effect on survival. Despite the absence of an effect on length of life, the management of depression remains important for its beneficial effect on quality of life. NIHR CLAHRC Oxford, Cancer Research UK, and the Chief Scientist Office of the Scottish Government.

Emotion Regulation and Social Cognition as Functional Targets of Mechanism-Based Psychotherapy in Major Depression With Comorbid Personality Pathology.

This article characterizes functional systems as targets of integrated modular psychotherapy for episodes of major depression (MD) with a comorbid condition of borderline personality disorder (BPD) or chronic depression (CD). Both types of comorbidities to MD are conceptualized as a trait-like concept dominated by impairments in interpersonal functioning. Despite differences in psychopathology, existing data show significant similarities in impairments of emotion regulation and social cognition in BPD and CD, thought to reflect common disease mechanisms linked to early-life adversity. The preexistence of BPD and CD and related functional impairments inhibits the remission of episodic MD and calls for mechanism-based interventions that complement existing treatments of MD by targeting these dysfunctions. Contemporary methods of psychotherapy already provide interventions to address such complicated states of comorbidity by specifically improving dysfunctions of emotion regulation and social cognition. We suggest a layout of modular interventions that can address identified dysfunctions in comorbid MD.

Genetic Risk Variants Associated With Comorbid Alcohol Dependence and Major Depression

ImportanceAlcohol dependence (AD) and major depression (MD) are leading causes of disability that often co-occur. Genetic epidemiologic data have shown that AD and MD share a common possible genetic cause. The molecular nature of this shared genetic basis is poorly understood.ObjectivesTo detect genetic risk variants for comorbid AD and MD and to determine whether polygenic risk alleles are shared with neuropsychiatric traits or subcortical brain volumes.Design, Setting, and ParticipantsThis genome-wide association study analyzed criterion counts of comorbid AD and MD in African American and European American data sets collected as part of the Yale-Penn study of the genetics of drug and alcohol dependence from February 14, 1999, to January 13, 2015. After excluding participants never exposed to alcohol or with missing information for any diagnostic criterion, genome-wide association studies were performed on 2 samples (the Yale-Penn 1 and Yale-Penn 2 samples) totaling 4653 African American participants and 3169 European American participants (analyzed separately). Tests were performed to determine whether polygenic risk scores derived from potentially related traits in European American participants could be used to estimate comorbid AD and MD. Main Outcomes and MeasuresComorbid criterion counts (ranging from 0 to 14) for AD (7 criteria) and MD (9 criteria, scaled to 7) as defined by the DSM-IV.ResultsOf the 7822 participants (3342 women and 4480 men; mean [SD] age, 40.1 [10.7] years), the median comorbid criterion count was 6.2 (interquartile range, 2.3-10.9). Under the linear regression model, rs139438618 at the semaphorin 3A (SEMA3A [OMIM 603961]) locus was significantly associated with AD and MD comorbidity in African American participants in the Yale-Penn 1 sample (β = 0.89; 95% CI, 0.57-1.20; P = 2.76 × 10−8). In the independent Yale-Penn 2 sample, the association was also significant (β = 0.83; 95% CI, 0.39-1.28; P = 2.06 × 10−4). Meta-analysis of the 2 samples yielded a more robust association (β = 0.87; 95% CI, 0.61-1.12; P = 2.41 × 10−11). There was no significant association identified in European American participants. Analyses of polygenic risk scores showed that individuals with a higher risk of neuroticism (β = 1.01; 95% CI, 0.50-1.52) or depressive symptoms (β = 0.87; 95% CI, 0.32-1.42) and a lower level of subjective well-being (β = –0.94; 95% CI, –1.46 to –0.42) and educational attainment (β = –1.00, 95% CI, −1.57 to –0.44) had a higher level of AD and MD comorbidity, while larger intracranial (β = 1.07; 95% CI, 0.50 to 1.64) and smaller putamen volumes (β = –1.16; 95% CI, –1.86 to –0.46) were associated with higher risks of AD and MD comorbidity.Conclusions and RelevanceSEMA3A variation is significantly and replicably associated with comorbid AD and MD in African American participants. Analyses of polygenic risk scores identified pleiotropy with neuropsychiatric traits and brain volumes. Further studies are warranted to understand the biological and genetic mechanisms of this comorbidity, which could facilitate development of medications and other treatments for comorbid AD and MD.

Challenges in the Study of Genetic Variants of Comorbid Alcohol Use Disorder and Major Depression

Challenges in the Study of Genetic Variants of Comorbid Alcohol Use Disorder and Major Depression

Quality of life in workplace trauma victims seeking treatment for posttraumatic stress disorder

ABSTRACTTraumatic events at work can have debilitating effects on employees. This pilot study aims to describe the trauma exposure, posttraumatic stress disorder (PTSD) severity, functioning level, and general and work-related quality of life of employees who experienced a workplace trauma and consequently developed PTSD. Forty-four participants with current PTSD were recruited and assessed using semistructured interviews and questionnaires. ANOVAs were performed to assess differences in outcomes between employees from different work settings. Specific types of traumatic events appear to occur in particular types of occupations. Participants manifested severe PTSD, low levels of current functioning, and poor general and work-related quality of life. Overall, these results did not significantly differ between employees in different occupations. Unemployed participants showed poorer outcomes than those who were still working despite their current difficulties. PTSD severity and the presence of comorbid major depression significantly predicted several quality-of-life outcomes. In conclusion, PTSD stemming from workplace trauma appears to have major consequences for employees. Clinical implications are discussed.

Anxiety Disorders in Old Age: Psychiatric Comorbidities, Quality of Life, and Prevalence According to Age, Gender, and Country

Previous estimates of the prevalence of anxiety disorders in late life vary greatly due to the lack of reliable diagnostic tools. This MentDis_ICF65+ study assessed 12-month prevalence rates of anxiety disorders and age- and gender-related differences in comorbidities, as well as impact on quality of life. The study used a cross-sectional multicenter survey. The study sample comprised 3,142 men and women aged 65 to 84 years, living in five European countries and Israel. Anxiety disorders were assessed using computer-assisted face-to-face interviews with an age-appropriate diagnostic interview (CIDI65+). The prevalence of anxiety disorders was 17.2%. Agoraphobia was the most frequent disorder (4.9%), followed by panic disorder (3.8%), animal phobia (3.5%), general anxiety disorder (3.1%), post-traumatic stress disorder (1.4%), social phobia (1.3%), and obsessive-compulsive disorder (0.8%). The prevalence rate of any anxiety disorder dropped by 40% to 47% in adults aged 75-84 years compared with those aged 65-74 years. Women were twice as likely to present with agoraphobia or general anxiety disorder as men. Only panic disorder and phobia were associated with comorbid major depression. The negative relationship with quality of life was limited to agoraphobia and generalized anxiety disorder. The age-appropriate CIDI65+ led to higher prevalence rates of anxiety disorders in the elderly, yet to weaker associations with comorbidities and impaired quality of life compared with previous studies.

Changes in EEG signal after 5-Hz Dorsolateral Prefrontal cortex (DLPFC) Transcranial Magnetic Stimulation in patients with Comorbid Posttraumatic Stress Disorder and Major Depression

Changes in EEG signal after 5-Hz Dorsolateral Prefrontal cortex (DLPFC) Transcranial Magnetic Stimulation in patients with Comorbid Posttraumatic Stress Disorder and Major Depression

IL-17A causes depression-like symptoms via NFκB and p38MAPK signaling pathways in mice: Implications for psoriasis associated depression

Psoriasis has been shown to be associated with an increased prevalence of comorbid major depression. IL-17A plays an important role in both depression and psoriasis. IL-17A has been shown to be elevated in systemic circulation of psoriatic patients. IL-17A released from different immune cells during psoriasis may be responsible for the development of neuropsychiatric symptoms associated with depression. Therefore, this study explored the association of systemic IL-17A with depression. The present study utilized imiquimod model of psoriatic inflammation as well as IL-17A administration in mice to investigate the effect of IL-17A on depression-like behavior. Psoriatic inflammation led to enhanced IL-17A expression in peripheral immune cells of both innate and adaptive origin. This was associated with increased NFκB/p38MAPK signaling and inflammatory mediators in different brain regions, and depression-like symptoms (as reflected by sucrose preference and tail suspension tests). The role of IL-17A was further confirmed by administering it alone for ten days, followed by assessment of the same parameters. IL-17A administration produced effects similar to psoriasis-like inflammation on neurobehavior and NFκB/p38MAPK pathways. Moreover, both NFκB and p38MAPK inhibitors led to attenuation in IL-17A associated with depression-like behavior via reduction in inflammatory mediators, such as MCP-1, iNOS, IL-6, and CXCL-2. Furthermore, anti-IL17A antibody also led to a reduction in imiquimod-induced depression-like symptoms, as well as NFκB/p38MAPK signaling. The present study shows that IL-17A plays an important role in comorbid depression associated with psoriatic inflammation, where both NFκB and p38MAPK pathways play significant roles via upregulation of inflammatory mediators in the brain.

132. EEG Signal after 5-Hz Transcranial Magnetic Stimulation in Patients with Comorbid Posttraumatic Stress Disorder and Major Depression

132. EEG Signal after 5-Hz Transcranial Magnetic Stimulation in Patients with Comorbid Posttraumatic Stress Disorder and Major Depression

Dual diagnosis in Depression: treatment recommendations.

Comorbidity between substance use disorders (SUD) and major depression (MD) is the most common dual pathology in the field of addiction to substances and has prevalence rates ranging between 12% and 80%, which complicates the response to treatment and worsens the prognosis of patients. Differentiating between diagnoses of induced depressive episodes and primary depressive episodes concurrent to substance use is especially relevant for therapeutic management. This article presents the state of the art of the currently available pharmacologic treatments of comorbid depression in patients with SUD, taking into account the safety and risk of abuse of antidepressant drugs. Due to the fact that comorbidity of MD and SUD is frequent and presents greater psychopathological and medical severity, as well as worse social functioning, it is crucial to treat MD and SUD simultaneously using the integrated treatment model and not to treat both conditions separately.

Comorbidity, age of onset and suicidality in obsessive–compulsive disorder (OCD): An international collaboration

ObjectivesTo collate data from multiple obsessive–compulsive disorder (OCD) treatment centers across seven countries and five continents, and to report findings in relation to OCD comorbidity, age of onset of OCD and comorbid disorders, and suicidality, in a large clinical and ethnically diverse sample, with the aim of investigating cultural variation and the utility of the psychiatric diagnostic classification of obsessive–compulsive and related disorders. MethodsResearchers in the field of OCD were invited to contribute summary statistics on current and lifetime psychiatric comorbidity, age of onset of OCD and comorbid disorders and suicidality in their patients with OCD. ResultsData from 3711 adult patients with primary OCD came from Brazil (n=955), India (n=802), Italy (n=750), South Africa (n=565), Japan (n=322), Australia (n=219), and Spain (n=98). The most common current comorbid disorders were major depressive disorder (28.4%; n=1055), obsessive–compulsive personality disorder (24.5%, n=478), generalized anxiety disorder (19.3%, n=716), specific phobia (19.2%, n=714) and social phobia (18.5%, n=686). Major depression was also the most commonly co-occurring lifetime diagnosis, with a rate of 50.5% (n=1874). OCD generally had an age of onset in late adolescence (mean=17.9years, SD=1.9). Social phobia, specific phobia and body dysmorphic disorder also had an early age of onset. Co-occurring major depressive disorder, generalized anxiety disorder and psychotic disorders tended to have a later age of onset than OCD. Suicidal ideation within the last month was reported by 6.4% (n=200) of patients with OCD and 9.0% (n=314) reported a lifetime history of suicide attempt. ConclusionsIn this large cross-continental study, comorbidity in OCD was common. The high rates of comorbid major depression and anxiety disorders emphasize the need for clinicians to assess and monitor for these disorders. Earlier ages of onset of OCD, specific phobia and social phobia may indicate some relatedness between these disorders, but this requires further study. Although there do not appear to be significant cultural variations in rates or patterns of comorbidity and suicidality, further research using similar recruitment strategies and controlling for demographic and clinical variables may help to determine whether any sociocultural factors protect against suicidal ideation or psychiatric comorbidity in patients with OCD.

Self-esteem in military patients with post-traumatic stress disorder

IntroductionMaintaining self-esteem is a fundamental human motivation. Trauma may lower self-esteem, which contributes to the development and maintenance of Post-Traumatic Stress Disorder (PTSD).ObjectivesAssessment of self-esteem in Tunisian military patients suffering from PTSD. Study of correlation between the severity of the PTSD symptoms and the rate of self-esteem.MethodsTransversal descriptive study of a sample of 22 patients treated for PTSD in the Tunisian Military Hospital during the period between August and October 2016.The PTSD Cheklist for DSM-5 (PCL-5), Hospital Anxiety and Depression scale (HAD), and the Rosenberg Self-Esteem Scale were administered for patients.ResultsAll the patients assessed were male. The mean age of the sample was 29.6 years. Fifty percent of the patients presented with a co-morbid major depression. Based on the score of the Rosenberg Self-Esteem Scale, patients had a self-esteem, which was very low in 45.45% of case, low in 45.45% of cases, average in 4.54% of cases and high in 4.54% of cases. The results also showed that lower levels of self-esteem are significantly correlated to the severity of the PTSD symptoms as measured by the PCL-5 score.ConclusionsThis study highlights the magnitude of self-esteem deficiency among patients suffering from PTSD. It remains unclear as to whether the relationship between trauma and depression is consistently mediated by a negative cognitive schema, such as low self-esteem, or whether trauma influences mood independently of low self-esteem. Further studies are required.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Assessment of chronic pain in military patients with PTSD

IntroductionPatients with post-traumatic stress disorder (PTSD) presents often with several concomitant physical and mental health problems. Recent evidence suggests that pain is one of the most commonly reported symptoms in patients with PTSD, regardless of the nature of their traumatic experience.Aim of the studyTo evaluate chronic pain in patients with PTSD in a Tunisian military sample.MethodsTransversal descriptive study of a sample of 22 patients treated for PTSD in the Principal Military Hospital of Instruction of Tunis during the period between August and October 2016.The PTSD Checklist for DSM-5 (PCL-5), Hospital Anxiety and Depression scale (HAD), and the Brief Pain Inventory Short Form (BPI-SF) were administered for patients.ResultsAll the patients of the study were male. The mean age of the sample was 29.6 years. Fifty percent presented with a co-morbid major depression and 59.1% with chronic pain symptoms. Locations of chronic pain were as follow: limb pain (69.23%), back pain (38.46%), headache (30.76%) and torso pain (7.69%). Sequelae from combat-related trauma were present in 31.8% of cases.ConclusionThe results of this study illustrate a high rate of chronic pain symptoms among PTSD patients. This suggests that closer attention should be given to the interaction of medical problems, especially pain, with PTSD symptomatology in clinical management and in future research.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Are Patients with Childhood Onset of Insomnia and Depression More Difficult to Treat Than Are Those with Adult Onsets of These Disorders? A Report from the TRIAD Study.

To determine if patients with childhood onsets (CO) of both major depression and insomnia disorder show blunted depression and insomnia treatment responses to concurrent interventions for both disorders compared to those with adult onsets (AO) of both conditions. This study was a secondary analysis of data obtained from a multisite randomized clinical trial designed to test the efficacy of combining a psychological/behavior insomnia therapy with antidepressant medication to enhance depression treatment outcomes in patients with comorbid major depression and insomnia. This study included 27 adults with CO of depression and insomnia and 77 adults with AO of both conditions. They underwent a 16-week treatment including: (1) a standardized two-step pharmacotherapy for depression algorithm, consisting of escitalopram, sertraline, and desvenlafaxine in a prescribed sequence; and (2) either cognitive behavioral insomnia therapy (CBT-I) or a quasi-desensitization control (CTRL) therapy. Main outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Insomnia Severity Index (ISI) completed pre-treatment and every 2 weeks thereafter. The AO and CO groups did not differ significantly in regard to their pre-treatment HRSD-17 and ISI scores. Mixed model analyses that adjusted for the number of insomnia treatment sessions attended showed that the AO group achieved significantly lower, subclinical scores on the HRSD-17 and ISI than did the CO group by the time of study exit. Moreover, a significant group by treatment arm interaction suggested that HRSD-17 scores at study exit remained significantly higher in the CO group receiving the CTRL therapy than was the case for the participants in the CO group receiving CBT-I. Greater proportions of the AO group achieved a priori criteria for remission of insomnia (49.3% vs. 29.2%, p = 0.04) and depression (45.5% vs. 29.6%, p = 0.07) than did those in the CO group. Patients with comorbid depression and insomnia who experienced the first onset of both disorders in childhood are less responsive to the treatments offered herein than are those with adult onsets of these comorbid disorders. Further research is needed to identify therapies that enhance the depression and insomnia treatment responses of those with childhood onsets of these two conditions.