Criteria For Major Depressive Episode Research Articles

Evaluating psychiatric co-morbidities of Huntington's disease

This is a case report of Mrs. A, she is a 76-year-old South Asian woman who was referred to geriatric psychiatry for mood symptoms (primarily anxiety, agitation, and depression) approximately 13 years after gene confirmed Huntington's disease (HD) diagnosis. Possible triggers for worsening of her symptoms included choreiform movement, suicidal ideation with Deutetrabenazine trial, and increased effort to maintain baseline function about 10 years before confirmed HD with worsening of cognition and physical limitations. Family involvement was a strength from before HD and it seemed to provide sufficient and effective emotional support in the early years.In review of her symptoms, they met criteria for Major depressive episode and Generalized anxiety disorder with panic attacks. Initial treatment plan included scheduled Mirtazapine and Lorazepam as needed for panic attacks. Lorazepam was effective though she experienced a return of anxiety after a short time, it was switched to Clonazepam and better tolerated. Trazodone was added to assist with insomnia, specifically onset of sleep, and to decrease breakthrough anxiety. She did not tolerate previous trials of medications including SNRI such as venlafaxine, SSRIs such as Paroxetine, Sertraline, and Citalopram, nor Benzodiazepine such as Diazepam.The anxiety and mood symptoms seemed to stabilize, although her cognitive function was declining. She was initially engaged in follow-up visits, would answer most questions in English, and used full sentences. Over time her responses had increased latency, were more fragmented, and she would reply in her native language. Her family felt confident interpreting and described her vocabulary as simple and child-like. In collaboration with neurology team, we reviewed the use of second-generation antipsychotics for mood and HD symptoms. Low dose Olanzapine was effective in both improvement of chorea and decreased need for daytime Clonazepam and Trazodone. Overall mood symptoms improved though her cognitive and function skills did not return to her evaluation baseline level.This case was especially inspiring to our team for several reasons: 1) Despite anxiety symptoms being commonly reported in HD, this topic has received limited attention in the literature, 2) There is insufficient data for evidence-based guidelines to treat psychiatric symptoms in HD, 3) It was a learning experience for the geriatric psychiatry fellows to handle HD psychiatric manifestations and management of its challenges.

Associations between traumatic event experiences, psychiatric disorders, and suicidal behavior in the general population of Afghanistan: findings from Afghan National Mental Health Survey

BackgroundThe role of traumatic event exposure and psychiatric disorders as central risk factors for suicidal behavior has been established, but there are limited data in high conflict regions with significant trauma exposures such as Afghanistan.MethodsA nationally representative, cross-sectional survey was conducted through systematic stratified random sampling in 8 regions of Afghanistan in 2017 (N = 4474). Well-validated instruments were used to establish trauma exposure, psychiatric disorders. Death preference, suicidal ideation, plan, and attempts were assessed.ResultsIn the total sample, 2.2% reported suicidal ideation in the past 12 months, and 7.1% of respondents reported that they had suicidal ideation at some point in their lives; 3.4% reported a suicide attempt. Women were at higher risk than men. All traumatic event exposures were strongly associated with suicidal behavior. Respondents who reported experiencing sexual violence were 4.4 times more likely to report lifetime suicide attempts (95% CI 2.3–8.4) and 5.8 times more likely to report past 12-month suicidal ideation (95% CI 2.7–12.4). Associations were strong and significant for all psychiatric disorders related to suicidal behavior. Respondents who met criteria for major depressive episodes (OR = 7.48; 95% CI 4.40–12.72), generalized anxiety disorder (OR = 6.61; 95% CI 3.54–12.33), and PTSD (OR = 7.26; 95% CI 4.21–12.51) had the highest risk of past 12-month suicidal ideation.ConclusionTraumatic event exposures and psychiatric disorders increase risk of suicidal behavior in the Afghan general population; women are at high risk. Interventions to reduce trauma exposure, including expansion of a mental health workforce in the region, are critically important.

Depressive, Anxious, and Post-Traumatic Stress Symptoms Related to Violence during the COVID-19 Pandemic, by Sex, COVID-19 Status, and Intervention-Seeking Conditions among the General Population.

Worldwide, three out of four of the general population have reported experiencing violence. Governments should address solutions to violence and its effects on mental health. The study aimed to determine depressive, anxious, and posttraumatic stress symptoms related to the violence experienced during the COVID-19 pandemic in the general population. The study was conducted with 18,449 Mexicans of 33 years (SD = 11.00, range = 18–59), with 12,188 (66.10%) being women, 3559 (19.29%) having COVID-19, 2706 (14.67%) seeking psychological care, and 5712 (30.96%) experiencing violence. Subjects completed the Major Depressive Episode (MDE) Checklist, Generalized Anxiety (GA) Scale, and the Posttraumatic Stress (PTS) Checklists (PCL-5) programmed in a WebApp application. We assessed the dimensionality of the scales through the Confirmatory Factor Analysis (CFA), the measurement invariance, and a structural equation model (SEM). In the total sample, 28.10% fulfilled the MDE criteria, and 42.30% had high levels of GA. In the sample of those experiencing violence, 48.40% met the MDE criteria, 61.70% had high GA symptoms, and 50% met the criteria for a PTS disorder. Experiencing violence was associated with GA and severe PTS symptoms when the discomfort had bothered them for over a month since the onset of these symptoms. Subjects who had experienced violence and had mental health symptoms seemed ready for treatment. Further studies will evaluate the effect of remote psychological care to help reduce the treatment gap.

"I am African American": Racial-ethnic self-designation, self-concept, and major depression among African Americans.

Research remains mixed on whether racial-ethnic self-designation impacts psychological health and well-being among Americans of African descent. Existing studies mainly use non-representative samples to address this question. Some scholars argue that Black people who express an African-centered identity should experience improved mental health because it enhances one's sense of self. However, what role self-designation may have on depression, one of the most common forms of disability, is largely unknown among African Americans. There is also limited evidence on whether one's self-concept can help us understand the relationship between self-designation and mental health among African Americans. Using data from a national probability sample of African American adults (n = 3,329), I examined whether self-designation as African American, Afro-American, Negro, Black American, or some other label versus Black was associated with self-esteem, mastery, and major depressive episodes. Using OLS models, I found that respondents who preferred the terms African American or Afro-American exhibited higher mastery levels compared to individuals who preferred the label Black, the most common term used among respondents. African American identifying respondents also exhibited significantly higher levels of self-esteem compared to Black identifying individuals. Using logistic regression models, I found that only African American identifying respondents were significantly less likely than Black identifying respondents to meet the criteria for major depressive episodes in the past-year. Higher levels of mastery and self-esteem helped to explain such differences. In sum, among Americans of African descent, identification as African American rather than Black may help fight depressive episodes because such self-designation may enhance one's self-concept. Further research is necessary to explore other possible psychological implications of self-designation among the African American/Black population.

Effect of Tramadol on Corticosteroid Receptor Function in patients with Major Depression

IntroductionIt is important to study the corticosteroid receptors hypothesis of Depression.ObjectivesThe goal of current study was - to test the influence of the opioid, adrenergic and benzodiazepine drugs on the immunosuppressive levels of leukocyte pyruvat dehydrogenase activity (LPDG) during the DST in patients with Major Depression and Anxiety Disorder.MethodsPatients. 40 male/ mean age, 33,1+3,2 years/ and 20 premenopausal female /35,1+1,6 years/ patients with Primary Major Depressive Episode were studied. All patients were diagnosed by a psychologist and fulfilled DSM- IV criteria for Major Depressive Episode. The DST was conducted to 60 patients with Primary Depressive Episode and 30 healthy subjectsResultsIn the cases of Primary Major Depressive Episode in separation with an Anxiety Disorder after TRAMADOL and DIASEPAM administration activity of LPDG increased more than 25%. Tramadol of a 50 mg dose and Diasepam of a 10 mg dose had a higher immunosuppressive effect than L-DOPA (0,5 g) on alteration of LPDG activity (more than 5 mmol/l/hour, p <0,05/.ConclusionsTRAMADOL immunosuppresssive action was higher than L-DOPA and DIASEPAM on LPDG activity in patients with an Anxiety Disorder and Major Depression. Diasepam immunosuppressive action did not correlate with positive dynamics of LPDG levels of DST in patients with Anxiety Disorder (after the 4-5 th week of Diasepam treatment). From other side, mechanism of L-DOPA action on corticosteroid receptors stimulated LPDG-activity (L-DOPA therapeutic effective dose-3 g). It means that opiate, adrenergic and benzodiazepine receptors are interactiing with each other and influencing on the corticosteroid receptors in different ways during immunosuppression.DisclosureNo significant relationships.

Effectiveness of a web-based behavioural activation intervention for individuals with depression based on the Health Action Process Approach: protocol for a randomised controlled trial with a 6-month follow-up

IntroductionBehavioural activation is a highly effective treatment for depression. However, there is considerable heterogeneity of interventions grouped under the term ‘behavioural activation’. A main reason for the heterogeneity is the...

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Background:Medically unexplained physical symptoms are frequently reported in depression and are often as distressing as changes in mood. These somatic presentations often present differently depending on the developmental age of the patient.Aim:To compare the prevalence of somatic symptoms associated with depression in children and adolescent with adults.Method:Patients from age group 6 to 60 years of either gender presenting to inpatient and outpatient Psychiatry clinic of a tertiary health-care centre, fulfilling the criteria of major depressive episode were recruited for the study after obtaining an informed consent. The study population was divided into 2 groups (i.e., children & adolescents and adults) that were compared for the somatic symptoms using Bradford Somatic Inventory (44-items scale).Results:In the present study, symptoms of heaviness in head, body feeling heavy, difficulty breathing, burning urination, trembling, needles sensation in hands and feet’s were found to be significantly more among the children & adolescent group.Conclusion:Children & Adolescents often present with atypical depressive features among which somatic symptoms are often a common presentation. Compared to adult patients with depression, children & adolescents have higher prevalence of certain somatic symptoms.

Accuracy in detecting major depressive episodes in older adults using the Swedish versions of the GDS-15 and PHQ-9.

ObjectivesThe purpose of this study was to evaluate the diagnostic accuracy at different cut-off values for the Swedish versions of the 15-item Geriatric Depression Scale (GDS-15) and Patient Health Questionnaire (PHQ-9) compared with a structured clinical psychiatric interview in older adults.MethodsCommunity-dwelling participants (N = 113) aged 65 years or older completed the Swedish versions of the GDS-15 and PHQ-9 and were then interviewed using the Mini International Neuropsychiatric Interview (MINI) to establish the presence or absence of current major depressive episodes (MDEs). Areas under the curve (AUC) were calculated for each scale, as well as the sensitivity, specificity, and Youden’s index for different cut-off values.ResultsSeventeen participants met the criteria for MDEs. The AUC was 0.97 for the GDS-15 and 0.95 for the PHQ-9. A cut-off of ≥6 on the GDS-15 yielded a sensitivity of 94%, a specificity of 88%, and a Youden’s index of 0.82. A cut-off of ≥5 on the PHQ-9 yielded a sensitivity of 100%, a specificity of 81%, and a Youden’s index of 0.81. The proposed cut-off of ≥10 on the PHQ-9 produced excellent specificity of 95% but a lower sensitivity of 71%.ConclusionsThis study indicates that the Swedish versions of the GDS-15 and PHQ-9 have comparable accuracy as screening instruments for older adults with MDEs. However, the proposed cut-off of 10 on the PHQ-9 might be too high when applied to older individuals in Sweden, and further investigations in larger samples in different healthcare settings are warranted.

Heterogeneity in major depression and its melancholic and atypical specifiers: a secondary analysis of STAR*D

ObjectivesThe melancholic and atypical specifiers for a major depressive episode (MDE) are supposed to reduce heterogeneity in symptom presentation by requiring additional, specific features. Fried et al. (2020) recently showed that the melancholic specifier may increase the potential heterogeneity in presenting symptoms. In a large sample of outpatients with depression, our objective was to explore whether the melancholic and atypical specifiers reduced observed heterogeneity in symptoms.MethodsWe used baseline data from the Inventory of Depression Symptoms (IDS), which was available for 3,717 patients, from the Sequenced Alternatives to Relieve Depression (STAR*D) trial. A subsample met criteria for MDE on the IDS (“IDS-MDE”; N =2,496). For patients with IDS-MDE, we differentiated between those with melancholic, non-melancholic, atypical, and non-atypical depression. We quantified the observed heterogeneity between groups by counting the number of unique symptom combinations pertaining to their given diagnostic group (e.g., counting the melancholic symptoms for melancholic and non-melancholic groups), as well as the profiles of DSM-MDE symptoms (i.e., ignoring the specifier symptoms).ResultsWhen considering the specifier and depressive symptoms, there was more observed heterogeneity within the melancholic and atypical subgroups than in the IDS-MDE sample (i.e., ignoring the specifier subgroups). The differences in number of profiles between the melancholic and non-melancholic groups were not statistically significant, irrespective of whether focusing on the specifier symptoms or only the DSM-MDE symptoms. The differences between the atypical and non-atypical subgroups were smaller than what would be expected by chance. We found no evidence that the specifier groups reduce heterogeneity, as can be quantified by unique symptom profiles. Most symptom profiles, even in the specifier subgroups, had five or fewer individuals.ConclusionWe found no evidence that the atypical and melancholic specifiers create more symptomatically homogeneous groups. Indeed, the melancholic and atypical specifiers introduce heterogeneity by adding symptoms to the DSM diagnosis of MDE.

Development and Validation of a Model to Predict Posttraumatic Stress Disorder and Major Depression After a Motor Vehicle Collision

A substantial proportion of the 40 million people in the US who present to emergency departments (EDs) each year after traumatic events develop posttraumatic stress disorder (PTSD) or major depressive episode (MDE). Accurately identifying patients at high risk in the ED would facilitate the targeting of preventive interventions. To develop and validate a prediction tool based on ED reports after a motor vehicle collision to predict PTSD or MDE 3 months later. The Advancing Understanding of Recovery After Trauma (AURORA) study is a longitudinal study that examined adverse posttraumatic neuropsychiatric sequalae among patients who presented to 28 US urban EDs in the immediate aftermath of a traumatic experience. Enrollment began on September 25, 2017. The 1003 patients considered in this diagnostic/prognostic report completed 3-month assessments by January 31, 2020. Each patient received a baseline ED assessment along with follow-up self-report surveys 2 weeks, 8 weeks, and 3 months later. An ensemble machine learning method was used to predict 3-month PTSD or MDE from baseline information. Data analysis was performed from November 1, 2020, to May 31, 2021. The PTSD Checklist for DSM-5 was used to assess PTSD and the Patient Reported Outcomes Measurement Information System Depression Short-Form 8b to assess MDE. A total of 1003 patients (median [interquartile range] age, 34.5 [24-43] years; 715 [weighted 67.9%] female; 100 [weighted 10.7%] Hispanic, 537 [weighted 52.7%] non-Hispanic Black, 324 [weighted 32.2%] non-Hispanic White, and 42 [weighted 4.4%] of non-Hispanic other race or ethnicity were included in this study. A total of 274 patients (weighted 26.6%) met criteria for 3-month PTSD or MDE. An ensemble machine learning model restricted to 30 predictors estimated in a training sample (patients from the Northeast or Midwest) had good prediction accuracy (mean [SE] area under the curve [AUC], 0.815 [0.031]) and calibration (mean [SE] integrated calibration index, 0.040 [0.002]; mean [SE] expected calibration error, 0.039 [0.002]) in an independent test sample (patients from the South). Patients in the top 30% of predicted risk accounted for 65% of all 3-month PTSD or MDE, with a mean (SE) positive predictive value of 58.2% (6.4%) among these patients at high risk. The model had good consistency across regions of the country in terms of both AUC (mean [SE], 0.789 [0.025] using the Northeast as the test sample and 0.809 [0.023] using the Midwest as the test sample) and calibration (mean [SE] integrated calibration index, 0.048 [0.003] using the Northeast as the test sample and 0.024 [0.001] using the Midwest as the test sample; mean [SE] expected calibration error, 0.034 [0.003] using the Northeast as the test sample and 0.025 [0.001] using the Midwest as the test sample). The most important predictors in terms of Shapley Additive Explanations values were symptoms of anxiety sensitivity and depressive disposition, psychological distress in the 30 days before motor vehicle collision, and peritraumatic psychosomatic symptoms. The results of this study suggest that a short set of questions feasible to administer in an ED can predict 3-month PTSD or MDE with good AUC, calibration, and geographic consistency. Patients at high risk can be identified in the ED for targeting if cost-effective preventive interventions are developed.

Evaluation of Early Psychological symptoms of Major Limb Amputation in a Tertiary Hospital

Amputation may be used to treat a diseased limb or improve its function, and it is considered the last, albeit valuable option when limb salvage is impossible. The decision to amputate a limb is an emotional process for the patient and the patient's family. The result is often loss of economic power of the individual and his/her independence when not sufficiently rehabilitated back into the society. The aim of the study was to determine early psychological outcome of major limb amputation. This was a prospective study, where 54 consenting patients admitted via either the accident and emergency unit or general outpatient clinic of a tertiary hospital for major limb amputation that met the inclusion criteria were recruited into the study consecutively over a period of one year. They were assessed for depression with Mini International Neuropsychiatric Interview (MINI) Instrument, while Rehabilitation outcome was graded using functional independence measure. Intensive counseling with psycho education was commence before amputation and continues after amputation by counselors. Physiotherapy, occupational therapy, coping skills and other life skill training commence after amputation to 3 months of follow up. Only 1 (1.9%) of the respondents was diagnosed with major depressive episode out of the 54 that completed the study. Some of the remaining 53 (98.1%) had few symptoms of depression but did not fulfilled the diagnostic criteria for major depressive episode according to M.I.N.I. The rehabilitation of all the patients were good with a mean functional measure score of 117.59 (sd=3.328) and a P-value of 0.00 at discharge and even after follow up. Our findings show that early and proper rehabilitation of amputees seem to reduce their psychological symptoms. Tendency to get depressed following amputation is more common in the younger age group, female gender and in amputations as a result of trauma while rehabilitation seems better in same and vice versa.

Symptom networks in acute depression across bipolar and major depressive disorders: A network analysis on a large, international, observational study

Major Depressive Episode (MDE) is a transdiagnostic nosographic construct straddling Major Depressive (MDD) and Bipolar Disorder (BD). Prognostic and treatment implications warrant a differentiation between these two disorders. Network analysis is a novel approach that outlines symptoms interactions in psychopathological networks. We investigated the interplay among depressive and mixed symptoms in acutely depressed MDD/BD patients, using a data-driven approach. We analyzed 7 DSM-IV-TR criteria for MDE and 14 researched-based criteria for mixed features (RBDC) in 2758 acutely depressed MDD/BD patients from the BRIDGE-II-Mix study. The global network was described in terms of symptom thresholds and symptom centrality. Symptom endorsement rates were compared across diagnostic subgroups. Subsequently, MDD/BD differences in symptom-network structure were examined using permutation-based network comparison test. Mixed symptoms were the most central and highly interconnected nodes in the network, particularly agitation followed by irritability. Despite mixed symptoms, appetite gain and hypersomnia were significantly more endorsed in BD patients, associations between symptoms were highly correlated across MDD/BD (Spearman's r = 0.96, p<0.001). Network comparison tests showed no significant differences among MDD/BD in network strength, structure, or specific edges, with strong edges correlations (0.66–0.78). Upstream differences in MDD/BD may produce similar symptoms networks downstream during acute depression. Yet, mixed symptoms, appetite gain and hypersomnia are associated to BD rather than MDD. Symptoms during mixed-MDE might aggregate according to 2 different clusters, suggesting a possible stratification within mixed states. Future symptom-based studies should implement clinical, longitudinal, and biological factors, in order to establish tailored therapeutic strategies for acute depression.

Alcohol Use Disorder and the Persistence/Recurrence of Major Depression: Le trouble de l'usage de l'alcool et la persistance/récurrence de la dépression majeure.

This study aims to determine the role of alcohol use disorder and other potential risk factors on persistence/recurrence of major depression in a Canadian population sample. Data were drawn from the National Population Health Survey (1994/1995 to 2010/2011), a prospective epidemiologic survey of individuals 12 years and older, living in 10 Canadian provinces (N = 17,276). Participants were reinterviewed every 2 years for 9 cycles. This study population was a cohort of individuals who at baseline met the diagnosis of a major depressive episode (MDE) in the previous 12 months (n = 908). After the 6-year (cycle 4) and 16-year (cycle 9) follow-up period, 124 of 718 participants and 79 of 461 participants met the criteria for MDE, respectively. Persistence or recurrence of major depression was defined as meeting a diagnosis of MDE after 6 years and 16 years. Modified Poisson regression models were used to assess the role of alcohol dependence and other risk factors on the persistence/recurrence of major depression using Stata 14. Alcohol use disorder was significantly correlated with a 6-year (odds ratio [OR]: 3.03; 95% confidence interval [CI], 1.68 to 5.48; P < .0001) and 16-year (OR, 3.17; 95% CI, 1.15 to 8.77, P = 0.003) persistence/recurrence of major depression. Other factors associated with the persistence/recurrence of major depression include female sex, childhood traumatic events, chronic pain restricting activities, daily smoking, and low self-esteem. Comorbid alcohol use disorder was found to be a strong risk factor for the persistence or recurrence of major depression.

Differential associations between passive and active forms of screen time and adolescent mood and anxiety disorders.

To quantify the strength of association between passive and active forms of screen time and adolescent major depressive episode and anxiety disorders. Data from the 2014 Ontario Child Health Study, a representative sample of 2,320 adolescents aged 12-17years in Ontario (mean age = 14.58, male = 50.7%) were used. Screen time was measured using adolescent self-report on time spent on screen-based activities. Past 6-month occurrence of DSM-IV-TR defined major depressive episode, social phobia, generalized anxiety disorder, and specific phobia which were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents. Adolescents reporting 4 or more hours of passive screen time per day, compared to those reporting less than 2h, were three times more likely to meet the DSM-IV-TR criteria for major depressive episode [OR = 3.28(95% CI = 1.71-6.28)], social phobia [OR = 3.15 (95% CI = 1.57-6.30)] and generalized anxiety disorder [OR = 2.92 (95% CI = 1.64-5.20)]. Passive screen time continued to be significantly associated with increased odds of disorders, after adjusting for age, sex, low income, active screen time use, sleep and physical activity. A small-to-moderate attenuation of the estimated ORs was observed in the fully adjusted model. In contrast, associations between active screen time use and depression and anxiety disorders were smaller in magnitude and failed to reach statistical significance. Passive screen time use was associated with mood and anxiety disorders, whereas active screen time was not. Further research is needed to better understand the underlying processes contributing to differential risk associated with passive versus active screen time use and adolescent mood and anxiety disorders.

Predicting Remission in Late-Life Major Depression: A Clinical Algorithm Based Upon Past Treatment History.

To determine the likelihood of antidepressant response in older adults with major depression as a function of their prior antidepressant trials. 500 older adults with major depression as diagnosed by DSM-IV criteria for major depressive episode were treated with venlafaxine extended release for 12 weeks. Participants were recruited from July 2009 to January 2014. For each participant, we collected detailed data on prior antidepressant trials for the current episode of depression. We examined the prospective remission rates as a function of number and class of prior antidepressant trials in a post hoc analysis of pooled data from 2 prior trials. Remission rates with venlafaxine were inversely correlated with the number of prior adequate medication trials (66% for no prior adequate trials, 45% for 1 prior adequate trial, 23% for 2 or more prior adequate trials; P < .0001). Additionally, if prior treatment trials included a serotonin-norepinephrine reuptake inhibitor, participants were even less likely to achieve remission with venlafaxine (32% for 1 prior adequate trial, 18% for 2 or more prior adequate trials; P < .0001). Those with prior adequate trials were also more likely to require a higher dosage of venlafaxine to achieve remission. Information on an individual patient's number and class of prior adequate antidepressant trials can be used to predict the likelihood of a successful treatment outcome with a given antidepressant in older adults with major depression. Further work is needed to refine this approach to provide personalized antidepressant treatment. ClinicalTrials.gov identifiers: NCT00892047 and NCT02263248.

Mood spectrum symptoms during a major depressive episode: Differences between 145 patients with bipolar disorder and 155 patients with major depressive disorder. Arguments for a dimensional approach.

Several studies have challenged the traditional unipolar-bipolar dichotomy in favor of a more dimensional approach. To evaluate the differences in mood spectrum between patients with bipolar disorder (BD) and major depressive disorder (MDD) during a major depressive episode (MDE). Study participants were 145 patients with BD and 155 patients with MDD recruited at three University Medical Centers in Italy. All study subjects met Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for MDE and completed the Mood Spectrum-Self-Report-Last Month questionnaire. Patients with BD endorsed more items in the mood manic/hypomanic and energy depressive subdomains of the MOODS-SR questionnaire. Significant differences were also found for specific depressive and manic items, which were more frequently endorsed by patients with BD. A large number of patients with BD, but also a considerable number of patients with MDD, endorsed manic items during a depressive episode. There are differences between BD and MDD in terms of the number and type of mood spectrum items that are endorsed during a MDE, which may help to identify patients with BD when a retrospective assessment of a history of mania or hypomania is not possible or not reliable. A high number of patients with BD and a considerable number of patients with MDD endorsed several items in the manic section of the mood, energy, and cognition domains, this confirming the centrality of mixed features in patients with mood disorders and the need for a unitary, dimensional, descriptive and dynamic approach to MDD and BD, such as the recently proposed ACE (Activity, Cognition, Energy) model.

Prevalence of Metabolic Syndrome and Associated Factors in a Cohort of Individuals With Treatment-Resistant Depression: Results From the FACE-DR Study.

The aim of this study was to estimate the prevalence of metabolic syndrome (MetS) and its components in a cohort of French patients with treatment-resistant depression (TRD) and to determine correlations with sociodemographic, clinical, and treatment-related factors. From 2012 to 2018, 205 patients who met DSM-IV criteria for major depressive episode with moderate-to-severe symptoms (Montgomery-Asberg Depression Rating Scale score ≥ 20), and at least Stage II resistance according to Thase and Rush criteria were enrolled in the FondaMental Advanced Centers of Expertise in Resistant Depression (FACE-DR) cohort. Data on sociodemographic and clinical characteristics, lifestyle information, and treatment and comorbidities were collected, and a blood sample was drawn. MetS was defined according to the criteria of the International Diabetes Federation. Overall, 38% of individuals with TRD met criteria for MetS. The frequency of MetS was significantly higher in men than in women only for patients aged 40 years or older (46.3% vs 35.2%, P = .0427). Moreover, whereas the management for diabetes was good, less than one-third of the patients with high blood pressure or dyslipidemia were treated for these conditions. Multivariate analysis showed that individuals with abnormal plasma c-reactive protein levels had a 3-fold increased risk (95% CI, 1.5-5.2) of having MetS, independent of other potential confounders. The prevalence of MetS is higher in patients with TRD than in those with other psychiatric disorders and characterized by a considerable undertreatment of some components of MetS in this population. Diagnosis and treatment of the components of MetS should be systematically performed to prevent the occurrence of cardiovascular diseases in patients with TRD. These findings highlight the need for integrated care, with more interaction and coordination between psychiatrists and primary care providers.

Intimate partner violence and depression in rural Bangladesh: Accounting for violence severity in a high prevalence setting

Intimate partner violence (IPV) against women is highly prevalent globally, and is associated with adverse health outcomes, including depression. Though women living in low- and middle-income countries (LMICs) face a larger burden of IPV, little is known about whether IPV increases the risk of depression among non-pregnant women and in contexts of high prevalence. Within the setting of rural Bangladesh, this study examined the relationship between the severity of marital IPV against women and the risk of depression.Data were drawn from a nationally-representative study focused on individual and contextual determinants of IPV among married women aged 16–37 years in rural Bangladesh, collected through a multistage, stratified sample in 77 villages in 2014 (n=3290). Multivariable log-binomial regression models were used to estimate the association between the severity of IPV (operationalized as the frequency of different acts of psychological, physical, and sexual abuse, as well as injury due to IPV) and risk of major depressive episode (MDE) using the Edinburgh Postnatal Depression Scale (EPDS).One in six women (16.8%) met the criteria for MDE. Past year IPV was endemic; psychological (77.2%) was most common, followed by sexual (58.8%) and physical (44.4%). Nearly a third of women experienced IPV-related injury. There was a positive dose-response relationship between severity of each type of IPV and MDE above the lowest level of exposure. In adjusted models, the highest levels of psychological (RR=2.27, 95% CI: 1.62, 3.17), physical (RR=2.44, 95% CI: 1.94, 3.08), and sexual (RR=1.65, 95% CI: 1.08, 2.52) IPV severity remained significantly associated with MDE, as well as experiencing IPV-related injury (RR=1.72, 95% CI: 1.23, 2.40).In rural Bangladesh, the severity of all types of marital IPV against women is strongly related to increased risk of MDE. Results suggest the limited utility of standard dichotomous IPV indicators in high prevalence settings.

Relapse prevention in adults with major depressive disorder treated with vilazodone: a randomized, double-blind, placebo-controlled trial.

This randomized withdrawal study assessed relapse prevention with vilazodone in adults with major depressive disorder. After 20 weeks of open-label treatment with vilazodone 40 mg/day, responders were randomized (1 : 1 : 1) to 28 weeks of double-blind, fixed-dose treatment with vilazodone 20 mg/day, vilazodone 40 mg/day, or placebo. The primary efficacy endpoint was time to first relapse, defined as Montgomery-Åsberg Depression Rating Scale total score of at least 18 and meeting major depressive episode criteria, Montgomery-Åsberg Depression Rating Scale total score of at least 18 at two consecutive visits, or discontinuation for an insufficient therapeutic response. Of 1204 patients who received open-label treatment, 564 completed treatment and were randomized (placebo=192, vilazodone 20 mg/day=185, vilazodone 40 mg/day=187). No significant difference was detected in time to relapse during the double-blind period (P>0.05). The crude percentage of patients that relapsed was similar between treatment groups (placebo=12.6%; vilazodone 20 mg/day=11.4%; vilazodone 40 mg/day=13.4%). The most common treatment-emergent adverse events were diarrhea (29.6%), nausea (24.0%), and headache (14.0%) during open-label treatment and headache (8.9%), nasopharyngitis (8.4%), and diarrhea (7.5%) during double-blind treatment in the combined vilazodone groups (20 and 40 mg/day). In conclusion, time to relapse with vilazodone was not statistically different from placebo. Vilazodone was generally well tolerated in adults with major depressive disorder.

Modes of Resting Functional Brain Organization Differentiate Suicidal Thoughts and Actions

A major target in suicide prevention is interrupting the progression from suicidal thoughts to action. Use of complex algorithms in large samples has identified individuals at very high risk for suicide. We tested the ability of data-driven pattern classification analysis of brain functional connectivity to differentiate recent suicide attempters from patients with suicidal ideation. We performed a cross-sectional study using resting-state functional magnetic resonance imaging in depressed inpatients and outpatients of both sexes recruited from a university hospital between March 2014 and June 2016: recent suicide Attempters within 3 days of an attempt (n = 10), Suicidal Ideators (n = 9), Depressed Non-Suicidal Controls (n = 17), and Healthy Controls (n = 18). All depressed patients fulfilled DSM-IV-TR criteria for major depressive episode and either major depressive disorder, bipolar disorder, or depression not otherwise specified. A subset of suicide attempters (n = 7) were rescanned within 7 days. We used a support vector machine data-driven neural pattern classification analysis of resting-state functional connectivity to characterize recent suicide attempters and then tested the classifier's specificity. A binary classifier trained to discriminate patterns of resting-state functional connectivity robustly differentiated Suicide Attempters from Suicidal Ideators (mean accuracy = 0.788, signed rank test: P = .002; null hypothesis: area under the curve = 0.5), with distinct functional connectivity between the default mode and the limbic, salience, and central executive networks. The classifier did not discriminate stable Suicide Attempters from Suicidal Ideators (mean accuracy = 0.58, P = .33) or presence from absence of lifetime suicidal behavior (mean accuracy = 0.543, P = .348) and was not improved by modeling clinical variables (mean accuracy = 0.736, P = .002). Measures of intrinsic brain organization may have practical value as objective measures of suicide risk and its underlying mechanisms. Further incorporation of serum or cognitive markers and use of a prospective study design are needed to validate and refine the clinical relevance of this candidate biomarker of suicide risk.