Diagnosis Of Depressive Episode Research Articles

A Suicide-Specific Diagnosis – The Case Against

A Suicide-Specific Diagnosis – The Case Against

IL-4 as a potential biomarker for differentiating major depressive disorder from bipolar depression.

We aimed to investigate the differential diagnosis of depressive episodes in patients with major depressive disorder (MDD) and bipolar disorder (BD) using peripheral blood cytokine expression levels. The levels of interleukin (IL)-2, IL-6, IL-10, IL-17, IL4, and IL-12; interferon (IFN)-γ; and tumor necrosis factor (TNF)-α were measured in patients with MDD and BD presenting acute episodes in an inpatient psychiatric setting. The expression levels of IL-6, IL-10, IL-17, and IFN-γ in the MDD and BD groups were higher than those in the control group (P < .05), but there was no significant difference between the patient groups and control group. Only the expression levels of TNF-α and IL-4 were higher in both groups than in the control group, and the BD group had higher levels than the MDD group (P < .05). The expression levels of IL-17, IFN-γ, IL-10, and IL-4 were significantly higher in BD-related manic episodes than in BD-related depressive episodes (P < .05). IL-6, IFN-γ, TNF-α, IL-10, and IL-4 levels were higher in BD-related depressive episodes than in MDD-related depressive episodes (P < .05). The receiver operating characteristic curve test for MDD and BD and the area under the curve for IL-4 revealed good clinical predictability. Patients with MDD and BD exhibited different cytokine profiles when experiencing acute episodes; patients with BD exhibited a more severe immune-inflammatory response system-compensatory immunoregulatory response system (CIRS) imbalance. IL-4 was found to have diagnostic value in differentiating between active depressive episodes in MDD and BD.

Adverse Childhood Experiences in Patients Admitted with Depression at A Tertiary Care Hospital in Pakistan

Objective: To consider adverse childhood experiences in patients admitted to a tertiary care hospital in Pakistan with depressive disorder.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Fauji Foundation Hospital, Rawalpindi Pakistan from Sep 2018 to Aug 2020.&#x0D; Methodology: All the patients who were admitted to the psychiatry ward of the hospital after being diagnosed with depression were included in the study. Detailed history and mental state examination were carried out on all patients by a psychiatrist, and the adverse childhood experience questionnaire was administered. &#x0D; Results: Out of 400 patients admitted with a diagnosis of depressive episode in the hospital during the study period, 59(14.75%) were males, and 341(85.25%) were females. The mean age of the study participants was 39.49±8.926 years. 153(38.25%) did not have significant adverse childhood experiences, while 247(61.75%) had significant adverse childhood experiences. The severity of depressive episodes and substance use had a statistically significant relationship with the presence of significant adverse childhood experiences in our study participants (p-value&lt;0.001).&#x0D; Conclusion: The presence of significant adverse childhood experiences was alarmingly high in patients admitted with a depressive episode in our study. These experiences were associated with the more severe forms of depressive illness and comorbid illicit substance use.

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BACKGROUNDStudies conducted in various parts of world as well as in India have revealed that Subclinical Hypothyroidism (SCH) is one of the risk factors for Depression. Several studies have found depression symptoms as a prevalent finding in patients with SCH. SCH has been found to have a negative effect in treatment of depression as well.AIMTo study the prevalence of SCH in patients with diagnosis of depressive episode, attending tertiary medical careMETHODSCross sectional Study conducted on 78 patients (selected by consecutive sampling) with a diagnosis of Depressive episode visited Govt Hospital for Mental Care, Visakhapatnam from March 2021 to September 2021. Hamilton Scale for Depression (HAM-D) and Montgomery-Asberg Depression Rating Scale (MADRS) were applied and blood levels of TSH, T4 and T3 were evaluated.RESULTSIn our study 6.78% of study population were found to have SCH with mildly elevated TSH level and T3, T4 level WNL. HAMD and MADRS Scale scores revealed mild to moderate depression in 73.8% of patients.CONCLUSIONSimilar to studies conducted elsewhere, our study also revealed SCH to be an important associated finding in patients with depression. Treating subclinical hypothyroidism may be a game changer in treating depressive episodes in such patients.

Adjustment for Covariates of Major Depressive Episodes among Men and Women Aged 65 Years Old and Older

The current study aimed to examine if sex can significantly predict risk for lifetime major depressive episodes among adults aged 65 and older with and without adjustment for covariate variables of race, education, marital status, health, and poverty. Secondary data was obtained from the National Survey on Drug Use and Health public-use data file to achieve study goals. The study participants were males and females aged 65 years or older. The unweighted sample included 3,969 adults aged 65 years or older, representing a weighted population size of 50,986,065.86 in the US. Lifetime major depressive episode.The study findings confirmed that sex could significantly predict risk for lifetime major depressive episodes among adults aged 65 or older with and without adjustment for health determinants of race, education, marital status, health, and poverty. Four of the five variables, including race, education, health, and poverty, were significant once as covariate variables adjusted for and once as predictor variables. In contrast, marital status was insignificant both as a covariate and a predictor variable. Close attention is required to the adults aged 65 or older at risk for lifetime major depressive episode diagnosis, particularly women, to meet their unique needs.

Transcriptomic profiling as biological markers of depression – A pilot study in unipolar and bipolar women

Objectives A significant challenge in psychiatry is the differential diagnosis of depressive episodes in the course of mood disorders. Gene expression profiling may provide an opportunity for such distinguishment. Methods We studied differentially expressed genes in women with a depressive episode in the course of unipolar depression (UD) (n = 24) and bipolar disorder types I (BDI) (n = 13) and II (BDII) (n = 19), and healthy controls (n = 15). Results Different types of depression varied in the number and type of up or down-regulated genes. The pathway analysis showed: in UD, up-regulated rheumatoid arthritis pathway (including ITGB2, CXCL8, TEK, TLR4 genes), and down-regulated taste transduction pathway (TAS2R10, TAS2R46, TAS2R14, TAS2R43, TAS2R45, TAS2R19, TAS2R13, TAS2R20, GNG13); in BDI, eight down-regulated pathways: glutamatergic synapse, retrograde endocannabinoid signalling, axon guidance, calcium signalling, nicotine addiction, PI3K-Akt signalling, drug metabolism – cytochrome P450, and morphine addiction; in BDII, up-regulated osteoclast differentiation and Notch signalling pathway, and down-regulated type I diabetes mellitus pathway. Distinct expression markers analysis uncovered the unique for UD, up-regulated bladder cancer pathway (HBEGF and CXCL8 genes). Conclusions This pilot study suggests a probability of differentiating depression in the course of UD, BDI, and II, based on transcriptomic profiling.

Antisuicidal efficacy of ketamine infusion in suicidal patients of depressive disorder.

Background:The efficacy of ketamine in the rapid alleviation of depressive and suicidal symptoms has been observed over the past few years around the globe. Exploration of rapid antisuicidal efficacy of ketamine in Indian subpopulation can be a good preventive pharmacological option for unprecedented rise in suicides in India.Aim:To assess efficacy of ketamine infusions on suicidal patients of depressive disorder. Severity of depression and suicidality were quantified daily over 1 week.Materials and Methods:This was a randomized control study, comprised sixty patients of age group 18–60 years, with a diagnosis of depressive episode, having the Modified Scale for Suicidal Ideations (MSSI) score >20 with exclusion of severe medical or surgical illness, pregnancy, and breast-feeding females. Patient were assigned to ketamine and normal saline group. Three infusions were given over 1 week on day 0, day 2, and day 4. Assessments were made at baseline using the 17-item Hamilton Depression Rating Scale (HAM-D17) and MSSI, for depression and suicidality, respectively. Assessments were repeated at 6 h after first infusion and then every day for 1 week.Results:There were significant reductions in HAM-D17 score and MSSI score within 6 h of the first dose in the ketamine group as compared to the normal saline group. Significant sustained improvement was seen on further days till 1 week in the ketamine group as compared to the normal saline group.Conclusion:Ketamine might be a reasonable choice to fulfil the efficacy gap created by the delayed antisuicidal onset of standard treatments.

A pilot study of antidepressant therapy on sleep architecture in patients with depression in Congo

Background: A pilot prospective cohort study was conducted to study the sleep architecture and correlated perceived sleep disturbances in depressed Congolese patients with objective changes in sleep architecture using polysomnography (PSG) before and after antidepressant therapy. Methods: Patients were recruited into the study after applying strict inclusion and exclusion criterion to rule out other comorbidities which could influence sleep. A diagnosis of depressive episode was made based on the International Classification of Diseases-10 Edition DCR. Patients were evaluated using Beck Depressive inventory (BDI) and (Hamilton Depression Rating Scale (HAM-D) insomnia subscale on day 1 of admission. Patients also received sleep study using polysomnography on day 3 of the hospitalization. Patients were started on antidepressant treatment after polysomnography. Patients received an eight-week adequate trial of antidepressants, and BDI score being lower than 9 was considered as being remitted from depression. Polysomnography was repeated after that the patients achieved remission. Statistical analysis was done using Kruskal–Wallis test and Pearson's correlation coefficient. Results: The study results showed that significantly improved polysomnographic findings existed in total sleep time (p < 0.001), sleep efficiency (p < 0.001), wake after sleep onset (p < 0.001), and percentage wake time (p < 0.001) after taking antidepressants. HAM-D insomnia subscale was correlated with total sleep time (p < 0.001), sleep efficiency (p < 0.001), wake after sleep onset (p < 0.001), total wake time (p < 0.001), and N2 stage percentage (p < 0.001). Conclusion: Antidepressant treatment effectively improved sleep architecture in depressive disorder. HAM-D insomnia subscale was correlated with objective findings of total sleep time, sleep efficiency, wake after sleep onset, as well as total wake time and duration of N2 stage of nonrapid eye movement (NREM).

Relationship Between Stressful Life Events And Depression

Introduction: Stressful life events are associated with mental health breakdown. Many researches had shown that depression was preceded by stressful life events. The objective of this study was to measure the prevalence of significant score of stress scale in patients diagnosed as depressive episode. The next objective was to find out the association between the different sociodemographic variables and stress score and whether age is the predictor of stress score or not.&#x0D; Material And Method: The patients diagnosed as depressive episodes were selected from the out-patient unit of Department of Psychiatry of Manipal Teaching Hospital, Pokhara, Nepal. The proforma was used to collect the sociodemographic profile of the patient and Holmes and Rahe’s stress scale was applied. The diagnosis of depressive episode was made according to the International Classification of Disease-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. The stress score more than 150 was considered as significant stress score in this study.&#x0D; Results: The prevalence of significant stressful life events was 42%. The sociodemographic variables found that prevalence of stressful life events was found higher in female gender, illiterate individual, married and business/employed individual. The age of the patient was not the predictors of stress score in this study.&#x0D; Conclusion: These findings help us to understand that stressful life events were associated with depression. Effective coping skills and psychological interventions will improve quality of life in stressed individual.

The validity of child and adolescent depression diagnoses in the Danish psychiatric central research register.

This study examined the validity of childhood depression diagnoses in the Danish Psychiatric Central Research Register (DPCRR) and identified predictors of validity. A nationwide random sample of 500 children (6-17years) diagnosed with depression between 1996 and 2016 was identified in the DPCRR. Psychiatric hospital records were reviewed and rated using an online checklist. The primary outcome was whether depressive symptoms and functional impairment documented in hospital records justified a depressive disorder diagnosis based on ICD-10 or DSM-5 diagnostic criteria. Diagnostic validity was calculated as the positive predictive value. Binary logistic regression analysis was used to identify potential predictors of diagnostic validity, and these were included in a multiple logistic regression. Psychiatric hospital records were available for 393 patients (78.6%). The documentation in the records justified an ICD-10 depressive episode diagnosis in 72.8%, and DSM-5 major depressive disorder in 73.3% of the patients registered with a depression diagnosis. We identified three predictors of diagnostic validity: (i) The validity increased almost linearly from 2000 to 2016 (OR 1.14, 95% CI 1.07-1.20, p<0.001), (ii) antidepressant use was associated with increased diagnostic validity (OR 2.27, 95% CI 1.35-3.82, p=0.002) and (iii) emergency department admission predicted low diagnostic validity (OR 0.33, 95% CI 0.12-0.93, p=0.036). Childhood depression diagnoses registered in the DPCRR show a satisfactory validity according to both ICD-10 and DSM-5 diagnostic criteria. Diagnostic validity increased steadily from 2000 to 2016 and was positively correlated with antidepressant use. Depression diagnoses assigned in emergency departments had low diagnostic validity.

Depression and the Risk of Fractures in Later Life: the Health In Men Cohort Study

IntroductionFractures are common and disabling health events, particularly later in life. The presence of clinically significant depressive symptoms has been associated with increased risk of fractures, and we designed the present study to clarify if this association is likely to be causal or due to the confounding effect of measures associated with both fractures and depression. MethodCohort study of a community-derived sample of 4224 men aged 70 to 88 years at the start of the follow-up period of up to 17 years. Clinically significant symptoms of depression were defined as a recorded diagnosis of depressive episode in the Western Australian Data Linkage System (WADLS) or by a total score of 7 or greater on the 15-item Geriatric Depression Scale. Health contacts associated with fractures were retrieved from WADLS. Other measures included age, past history of fractures, education, smoking, frailty, poor vision, falls, medications, and the concentration of vitamin D, homocysteine, hsCRP and testosterone. Death was considered a competing risk for fractures. Results911 (21.6%) participants had a bone fracture during follow-up. After adjustment for multiple potential confounders, past and current depression were associated with an increase in the risk of novel fractures; respective odds ratios were 1.41 (95%CI = 1.03, 1.93) and 1.64 (95%CI = 1.20, 2.25). Parsimonious competing risk regression showed that both past and current depression were associated with an increase in the risk of novel fractures: sub-hazard ratio = 1.29 (95%CI = 1.03, 1.63) and 1.27 (95%CI = 1.05, 1.55) respectively. Estimation of confounding due to unmeasured factors showed that a small additional effect could potentially dilute the association between depression and fractures. DiscussionHistory of clinically significant symptoms of depression is associated with an increased risk of future fractures. This association may be due to multiple other associated risk factors, both measured and unmeasured, but nevertheless the presence of depression should alert clinicians to the need to develop a management plan that includes the management not only of depression but also of fracture risk.

Religiosity, spirituality, suicide risk and remission of depressive symptoms: a 6-month prospective study of tertiary care Brazilian patients

Religiosity and spirituality (R/S) are increasingly recognized as significant aspects in the evaluation of depressed patients. Limited research, however, has investigated the impact of R/S on outcomes of more severe or chronic depressed patients. The present study investigated the impact of different religiosity dimensions in tertiary care Brazilian depressed patients over suicide risk scores measured at baseline and remission of depressive symptoms in a 6-month prospective follow-up. In 277 individuals interviewed, 226 presented a diagnosis of depressive episode and 192 were assessed in the follow-up. Religiosity was evaluated using the Duke University Religion Index, comprising three dimensions of religiosity (organizational religiosity, non-organizational religiosity, intrinsic religiosity). Other potential predictors of outcomes included the Childhood Trauma Questionnaire (CTQ), Maudsley Staging of illness (MSM), Medical Outcomes Study Social Support Survey (MOS), World Health Organization Spirituality, Religiousness and Personal Beliefs instrument (WHOQOL-SRPB) and Hamilton Depression Scale (HAM-D). Results showed that almost half (46.1%) of the patients reported previous suicide attempts. Linear regression models identified that religious attendance (t-statistic -2.17, P=0.03), intrinsic religiosity (t-statistic -2.42, P=0.01) and WHOQOL-SRPB (t-statistic -3.67, P=0.00) were inversely correlated to suicide risk scores. In a prospective follow-up 16.7 % of patients (n=32/192) achieved remission of depressive symptoms (HAM-D scores ≤7). Religious attendance (OR 1.83, P=0.02) was identified as the main predictor of remission. Findings reinforce the importance of attending to religiosity/spirituality in order to improve outcomes and promote the recovery especially among severely depressed patients with increased suicide risk.

Male depression – actual a male specific disorder or potentially a new subtype of depression?

IntroductionAlthough depression is one of the most prevalent disorders around the world we know only little about the effect of factors like gender-related norms or personality-related aspects in the expression of depressive symptoms. Current findings of studies are heterogeneous and lead to the conclusion that depression is more prevalent in women as well as that they have a higher risk for depression. Women express more typical depressive symptoms while men offer more atypical symptoms like aggressiveness, irritability, alcohol misuse which is constituted as male depression (MD).ObjectiveMale and female patients with a diagnosis of depressive episode or recurrent depressive disorder (ICD-10) who are treated in in-patient or day clinic setting of two psychiatric institutions in Lower Saxony and one psychiatric university hospital in Austria. Study period: November 2016 to November 2017. No limitations to further diagnosis, age or other factors.MethodsTo analyze the expression of (a) typical depressive symptoms as well as causes of and factors of influence in diverse types of depression different questionnaires and quantitative methods will be used.AimsInvestigate gender-specific differences in the expression of symptoms in male and female patients with a depressive disorder. Focus: whether symptoms of MD are more prevalent for depressive men than women. Furthermore, causes and factors of (a)typical depressive symptoms should be analyzed.ResultsFirst results will be presented.ConclusionThe results of the study should lead to the conclusion whether there exist any gender-specific differences in the expression of depressive symptoms and what they might be caused by.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A clinical study to compare hyponatremia induced by the use of two different tricyclic antidepressants – Amitriptyline and imipramine

Aims & Objectives: To compare the occurrence of hyponatremia in the patients receiving two different Tricyclic Antidepressants (TCAs)–Amitriptyline and Imipramine Methodology: Fifty OPD patients attendingthe Psychiatry outpatient clinic of Mahatma Gandhi Institute of Medical Sciences, Sewagram having diagnosis of Depressive episode as per DSM-IV-TR criteria were included in the study. Patients with normalserum sodium levels before treatment with antidepressant were included in the study. Repeat serum Sodium levels were done after one month of being on treatment. EPI Info-6 software was used to analyze the data. Results: Average serum sodium concentrations of the patients receiving different TCAs before treatment were 139.4+2.45 (Mean+SD). Out of the 44% patients who developed hyponatremia, 45.45% were amongst the Imipramine group and 54.54% were amongst the Amitriptyline group. Although of mild severity only, hyponatremia was more in patients receiving Amitriptyline compared to those receiving Imipramine. Conclusion: Patients receiving Amitriptyline have fairly more chance of developing hyponatremiathan Imipramine receiving patients. Hence precaution should be observed while using TCA group of antidepressants.

Study of prodromal and residual symptoms of depression.

Background:The definitive diagnosis of depression calls for fulfillment of certain criteria in terms of symptoms, severity, and duration, but subthreshold cases are not uncommon. These may evolve to become clinically diagnosable depression preceded by prodrome. The current study was conducted to study prodromal and residual symptoms in depression.Materials and Methods:Eighty follow-up patients of depressive episode (F32, International Classification of Diseases-10) in remission defined by Hamilton Depression Rating Scale score <8 were interviewed. A symptom was identified as prodromal if it appeared at any time before the period of onset of symptoms sufficient to fulfill the criteria to make a diagnosis of depressive episode. Clinical Interview for Depression and Related Syndromes was used to identify the presence of symptoms. Statistical analysis was done with McNemar test and Pearson's Chi-square test using SPSS software version 20.0.Results:The mean age of patients was 41.25 (±8.58) years and the sample was predominately female patients (80%). All the eighty patients had at least one prodromal symptom. The mean duration of prodrome was 115 (±64.46) days. Irritability (45%), insomnia (45%), and reduced energy (43.8%) were the most frequent prodromal symptoms. Frequency of irritability was comparable in prodromal and residual phases of depression (P = 0.074) and significantly associated with a positive family history of depression (P = 0.004).Conclusion:Prodrome is present in most cases of depression lasting from weeks to months. Prodrome is frequented by irritability, anxiety, sleep problems, and fatigability. Irritability is associated with genetic loading of depression and likely to present as residual symptom if it is present in prodromal phase.

Gene-Environment Interaction in Youth Depression: Replication of the 5-HTTLPR Moderation in a Diverse Setting.

Replication of scientific findings is a major challenge in biomedical research. In psychiatry, the identification of measured gene-environment interactions (G×E) has promoted a heated debate over the past decade, with controversial results about its influence on disorders such as major depression. The authors sought to replicate a 2003 study on G×E in youth depression in a large birth cohort from a diverse setting. Using data from the 1993 Pelotas Birth Cohort Study, and adopting a design as similar as possible to that of the original study, the authors tested whether the relationship between childhood maltreatment and a subsequent depressive episode diagnosis was moderated by 5-HTTLPR genotype. Of 5,249 individuals assessed at birth and followed up to age 18, data on the evaluation for depressive episodes in early adulthood, on childhood maltreatment, and on genotype were available for 3,558 participants, of whom 2,392 remained after conservative screening for previous depressive symptoms. Associations were investigated with logistic regression analyses and controlling for potential confounders. The results replicated important findings of the original study, this time in a sample of young adults from a middle-income country: there was a differential dose-response relationship between childhood maltreatment and major depression according to 5-HTTLPR genotype. After following a research strategy as comparable as possible to that of the original study, the results corroborated the existence of a measured G×E, now in a large sample from a different sociocultural context. These findings provide further evidence that a genetic variant in the 5-HTTLPR moderates the link between childhood maltreatment and youth depression.

Mood Disorders in ICD-11

Clinical reality presents us with a series of continua in the area of mood disorders: those between 'normal” sadness and depression, between 'normal” elation and hypomania, between a 'pure” depressive episode and a 'pure” manic episode, between unipolar depression and bipolar disorder, between anxiety disorders and depression, and between mood disorders and psychotic disorders. Most of our classificatory efforts and controversies in this area center around how to deal with these continua, where to fix boundaries and how to delineate intermediate or mixed conditions. In this presentation, I briefly review the expected convergences and divergences between the ICD-11 and the DSM-5 in handling these continua, and the research evidence supporting the proposals made for the ICD-11. Among the convergences are the inclusion of activation/increased energy as a defining symptom for hypomania/mania, and the acknowledgement that a manic/hypomanic syndrome emerging during antidepressant treatment, and persisting beyond the physiological effect of that treatment, qualifies for the diagnosis of manic/hypomanic episode. Furthermore, bipolar II disorder will be recognized as a distinct diagnostic entity in the ICD-11, as in the DSM-5, while in ICD-10 it is just mentioned among 'other bipolar affective disorders”. Finally, the ICD-11, as the DSM-5, will allow the clinician to record the occurrence of prominent anxiety symptoms in a patient with a major depressive episode, by using a specifier. Expected divergences between the ICD-11 and the DSM-5 will include a different characterization of mixed states and schizoaffective disorders. Furthermore, the ICD-11 is going to exclude from the diagnosis of depressive episode, in line with the ICD-10 but differently from the DSM-5, bereavement reactions appropriate to the individual's cultural and religious background.

Depressive symptoms and major depressive disorder in patients affected by subclinical hypothyroidism: a cross-sectional study.

The relationship between subclinical hypothyroidism and depression is still controversial. Our objective was to compare the prevalence of depressive symptoms and major depressive disorder in a population of patients affected by subclinical hypothyroidism and a control group without thyroid disease. The authors enrolled 123 consecutive outpatients affected by subclinical hypothyroidism undergoing follow-up at the endocrinology department of San Paolo Hospital in Milan and 123 controls without thyroid disease under the charge of general physicians.All patients and controls underwent an evaluation by means of a psychiatric interview; Hamilton Rating Scale for Depression (HAM-D); Montgomery-Asberg Depression Rating Scale (MADRS); and serum thyroid stimulating hormone, free T4, and free T3 levels. Patients were also screened for thyroid peroxidase antibodies and thyroglobulin antibodies. Patients affected by subclinical hypothyroidism had a prevalence of depressive symptoms of 63.4% at HAM-D and 64.2% at MADRS; 22 patients (17.9%) had a diagnosis of depressive episode (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria). The control group had a prevalence of depressive symptoms of 27.6% at HAM-D and 29.3% at MADRS, and only seven controls had a diagnosis of depressive episode. The prevalence of depressive symptoms between these two groups was statistically different. This study underlines a strong association between subclinical hypothyroidism and depressive symptoms, which could have some important diagnostic and therapeutic implications in the clinical practice.

Proposals for ICD-11: a report for WPA membership.

Proposals for ICD-11: a report for WPA membership.

Following the development of ICD-11 through World Psychiatry (and other sources).

Following the development of ICD-11 through World Psychiatry (and other sources).