DSM-IV Criteria For Major Depression Research Articles

Depression in Children with Epilepsy in a Teaching Hospital South/South Nigeria

Background: Epilepsy affects over 50 million in the world with a life time prevalence of 7.6%. It is the commonest paediatric neurological disorder and about 80% of these children live in the developing countries. Depression is the most common psychiatric comorbid condition in children with epilepsy.
 Objective: To investigate the prevalence of depression among children aged 9-18yr with epilepsy and evaluate factors associated with depression.
 Methods: 380 children with epilepsy were interviewed using researcher designed questionnaire, the clinical version of DICA-IV in a 2nd stage design, after having been screened with CES-DC. The study was descriptive with psychometric evaluation. Data obtained were analysed using SPSS version 22.0. p-values<0.05 were statistically significant.
 Results: Using the CES-DC with a cut- off point of 15 and above, 117 (30.8%) of the respondents had significant scores for depression. All the 117 who were interviewed with DICA-IV met the DSM-IV criteria for major depression with 40 (10.5%) of them currently very depressed requiring urgent attention. Sociodemographic factors of; sex revealed that males were more depressed than females p=0.000, OR: 0.86, Age showed 9-11yr with a strong association p=0.001, OR:1.91. Marital status- Divorced or separated parents showed a higher association p=0.01 OR:2.233. Children with longer duration of illness had a strong association p=0,025, OR:1.203 and the more frequent the seizures, the stronger the association p=0.001, OR:1,411.
 Conclusion: There is relativelhjy high prevalence of depression in children with epilepsy in Port Harcourt. More health education is needed to provide a comprehensive care.

Stress Related Determinants for Severity of Depression in Young Girls

Based on former empirical studies and theoretical considerations the present study investigated, whether stress load and stress coping are influencing severity of depression over time in young girls. Stepwise multiple regression with different specific predictors was used to obtain the best predictive power. 148 girls with a mean age of 15 years where studied. 74 fulfilled DSM-IV criteria for major depression. Stress symptoms and stress coping was measured with SSKJ 3-8 and SVFKJ. The best predictor after a time interval of six months was severity of depression at first assessment with an explained variance of 62 %. Psychological stress load and destructive stress coping also added significantly to explained variance in depression severity. The results were interpreted with respect to treatment and prevention of depression in adolescents.

Dimensions of Poststroke Depression and Neuropsychological Deficits in Older Adults

ObjectivePoststroke depression (PSD) has a heterogeneous presentation and is often accompanied by cognitive impairment. This study aimed to identify distinct dimensions of depressive symptoms in older adults with PSD and to evaluate their relationship to cognitive functioning. DesignCross-sectional factor and correlational analyses of patients with poststroke depression. SettingPatients were recruited from the community and from acute inpatient stroke rehabilitation hospitals. ParticipantsParticipants had suffered a stroke and met DSM-IV criteria for major depression (≥18 Montgomery Åsberg Depression Scale; MADRS). InterventionNone. MeasurementsMADRS was used to quantify depression severity at study entry. Neuropsychological assessment at the time of study entry consisted of measures of Global Cognition, Attention, Executive Function, Processing Speed, Immediate Memory, Delayed Memory, and Language. ResultsThere were 135 (age ≥50) older adult participants with PSD and varying degrees of cognitive impairment (MMSE Total ≥20). Factor analysis of the MADRS identified three factors, that is sadness, distress, and apathy. Items comprising each factor were totaled and correlated with neuropsychological domain z-score averages. Symptoms of the apathy factor (lassitude, inability to feel) were significantly associated with greater impairment in executive function, memory, and global cognition. Symptoms of the sadness and distress factors had no relationship to cognitive impairment. ConclusionPSD consists of three correlated dimensions of depressive symptoms. Apathy symptoms are associated with cognitive impairment across several neuropsychological domains. PSD patients with prominent apathy may benefit from careful attention to cognitive functions and by interventions that address both psychopathology and behavioral deficits resulting from cognitive impairment.

Diagnostic accuracy and treatment approach to depression in primary care: predictive factors.

The study assessed the predictive factors of diagnostic accuracy and treatment approach (antidepressants versus active monitoring) for depression in primary care. This is a cross-sectional study that uses information from a naturalistic prospective controlled trial performed in Barcelona (Spain) enrolling newly diagnosed patients with mild to moderate depression by GPs. Treatment approach was based on clinical judgement. Diagnosis was later assessed according to DSM-IV criteria using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) interview by an external researcher. Patients (sociodemographic, psychiatric diagnosis, severity of depression and anxiety, health-related quality of life, disability, beliefs about medication and illness and comorbidities) and GP factors associated with diagnostic accuracy and treatment approach were assessed using multilevel logistic regression. Variables with missing data were imputed through multiple imputations. Two hundred sixty-three patients were recruited by 53 GPs. Mean age was 51 years (SD = 15). Thirty percent met DSM-IV criteria for major depression. Mean depression symptomatology was moderate-severe. Using multivariate analyses, patients' beliefs about medicines were the only variable associated with the antidepressant approach. Specialization in general medicine and being a resident tutor were associated with a more accurate diagnosis. Clinical depression diagnosis by GPs was not always associated with a formal diagnosis through a SCID-I. GPs' training background was central to an adequate depression diagnosis. Patients' beliefs in medication were the only factor associated with treatment approach. More resources should be allocated to improving the diagnosis of depression.

The centrality of DSM and non-DSM depressive symptoms in Han Chinese women with major depression

IntroductionWe compared DSM-IV criteria for major depression (MD) with clinically selected non-DSM criteria in their ability to represent clinical features of depression. MethodWe conducted network analyses of 19 DSM and non-DSM symptoms of MD assessed at personal interview in 5952 Han Chinese women meeting DSM-IV criteria for recurrent MD. We estimated an Ising model (the state-of-the-art network model for binary data), compared the centrality (interconnectedness) of DSM-IV and non-DSM symptoms, and investigated the community structure (symptoms strongly clustered together). ResultsThe DSM and non-DSM criteria were intermingled within the same symptom network. In both the DSM-IV and non-DSM criteria sets, some symptoms were central (highly interconnected) while others were more peripheral. The mean centrality of the DSM and non-DSM criteria sets did not significantly differ. In at least two cases, non-DSM criteria were more central than symptomatically related DSM criteria: lowered libido vs. sleep and appetite changes, and hopelessness versus worthlessness. The overall network had three sub-clusters reflecting neurovegetative/mood symptoms, cognitive changes and anxiety/irritability. LimitationsThe sample were severely ill Han Chinese females limiting generalizability. ConclusionsConsistent with prior historical reviews, our results suggest that the DSM-IV criteria for MD reflect one possible sub-set of a larger pool of plausible depressive symptoms and signs. While the DSM criteria on average perform well, they are not unique and may not be optimal in their ability to describe the depressive syndrome.

Assessing depression in Greek dementia patients: Which scale to use?

Depression in dementia is known to deteriorate patients' cognitive function and Quality of Life and to increase the burden of care. Although detecting depression in dementia is crucial, there is no gold standard for its screening and diagnosis. We examined the psychometric properties of 3 different scales in detecting depression in dementia. Results will be useful as community services for dementia in the country are developing and the need for reliable detection of depression in dementia patients is urgent. Our sample consisted of 136 Greek dementia patients who consulted a memory clinic. For the diagnosis of depression, DSM-IV criteria for major depression and 3 different depression measures were used: a self-assessment scale (Geriatric Depression Scale; GDS), a caregiver assessment scale (Neuropsychiatric Inventory-Depression; NPI-D) and a clinician rated scale (Cornell Scale for Depression in Dementia; CSDD). For the evaluation of the screening performance of the three depression scales receiver operating characteristic curve (ROC) analysis was applied. The DSMIV criteria served as the gold standard method for the diagnosis of major depression. CSDD showed the best psychometric properties for the diagnosis of depression in dementia. The ROC curve analysis revealed that among the three measures, the CSDD had the wider AUC (0.919), second in the width of the AUC was the GDS (0.871), and last was the NPI-D (0.812). The prevalence of depression ranged from 18.4% according to DSM-IV criteria to 42.6% using the NPI-D. Using the GDS (cut off point: 7/8) and the CSDD (cut off point: 6/7), depression was present in 26.9% and 33.1% of the patients, respectively. Correlations between scales used were significant (r from 0.432 to 0.660; p<0.001). Caregivers tend to report more depressive symptoms in dementia compared to patients' and clinicians' ratings. CSDD should be used in specialized centers, but GDS may be an alternative in patients able to complete the assessment. The need to establish valid criteria for the diagnosis of depression in dementia is urgent.

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

Stigma and mental health literacy affect access to and quality of treatment of major depression. Though mental health professionals seem better able to recognize major depression than the general public, they often hold similarly stigmatizing attitudes towards people suffering from the disorder. These attitudes are shaped jointly by the public stigma attached to mental illnesses as well as by the content and delivery of mental health professionals' undergraduate training. In line with this, the present study aimed to explore psychology students' ability to recognize major depression, their attitudes towards the disorder, and their views surrounding helpfulness of various interventions. A random sample of 167 undergraduate students was recruited from the psychology department of one public university in Athens. During one university hour, students were administered a vignette describing a woman fulfilling the DSM-IV criteria for major depression. A self-report questionnaire exploring students' recognition abilities, attitudes to depression and views on the helpfulness of various treatment modes was also administered. In total, 80.2% of students correctly recognized major depression from the vignette. Concerning their attitudes, students were unsure about the illness and ambivalent towards the person who suffers from it. With regard to available treatments for depression, students considered discussion with a friend to be the most helpful intervention. Counseling, cognitive behavioural therapy and psychoanalysis were also viewed in a positive light. On the contrary, antidepressants were not deemed helpful by most students. Finally, recognition of as well as attitudes towards depression and its treatments seemed to improve during the second year of undergraduate study; however they remained unchanged thereafter. Consistent with these, psychology students seem to have only a rudimentary knowledge on depression, that cannot not be qualified as mental health literacy. The core misconception espoused pertains to the view that major depression is not a medical illness; a finding which can also be interpreted in light of the lingering controversy on the medicalization of normal sadness and human predicament. The clinical implications of these findings are substantial. Mental health professionals-educators should reflect on their own beliefs and attitudes towards depression, as they may convey stigmatizing messages to their students and thus perpetuate the stigmatization of the illness. Concomitantly, psychology students' attitudes to depression and its treatment might render them incapable of understanding their patients, responding to their needs and providing them with appropriate help, while they may hinder their effective collaboration with psychiatrists.

A cluster randomized clinical trial of a stepped care intervention for depression in primary care (STEPCARE)--study protocol.

BackgroundDepression constitutes a significant public health burden and is associated is with high level of individual suffering. Insufficient human and material resources impede the provision of adequate care for persons with the condition in low- and middle-income countries. It is commonly recognized that, to bridge this treatment gap, it is essential to integrate the treatment of depression into primary health care system.Methods/DesignSTEPCARE is a two-arm parallel cluster randomized controlled trial to compare a stepped-care intervention package for depression in primary health care with care as usual in Nigeria. Randomization was conducted at the level of the participating primary health care clinics, while interventions are delivered to consenting individual participants who screen positive on the 9-item patient health questionnaire (PHQ-9 score ≥ 11) and fulfil the DSM-IV criteria for major depression. Intervention delivered by trained primary health care workers (PHCW) supported by general physicians and psychiatrists as needed is in 3 steps determined by response to treatment. Each step consists of psychological interventions (including psychoeducation, activity scheduling, social network reactivation and problem solving treatment) offered to all participants and, depending on severity and response, medication. Primary outcome, assessed at 12 months following recruitment into the trial, is recovery from depression as shown by a PHQ-9 score of less than 6. Secondary outcomes include changes in disability, quality of life and service utilization assessed at 6 and 12 months.DiscussionThe stepped care model examines the effectiveness of an intervention package for depression in which the intensity of treatment is determined by the clinical need of the patients. This approach is designed to make the most efficient use of available resources.Trial registrationISRCTN46754188 (ISRTCN registry at isrtcn.com; registered 23 September 2013)

The similarity of the structure of DSM-IV criteria for major depression in depressed women from China, the United States and Europe.

Do DSM-IV diagnostic criteria for major depression (MD) in Chinese and Western women perform in a similar manner? The CONVERGE study included interview-based assessments of women of Han Chinese descent with treated recurrent MD. Using Mplus software, we investigated the overall degree of between-sample measurement invariance (MI) for DSM-IV diagnostic criteria for MD in the CONVERGE sample and samples selected from four major Western studies from the USA and Europe matched to the inclusion criteria of CONVERGE. These analyses were performed one pair at a time. We then compared the results from CONVERGE paired with Western samples to those obtained when examining levels of MI between pairs of the Western samples. Assuming a single factor model for the nine diagnostic criteria for MD, the level of MI based on global fit indexes observed between the CONVERGE and the four Western samples was very similar to that seen between the Western samples. Comparable results were obtained when using a two-factor structure for MI testing when applied to the 14 diagnostic criteria for MD disaggregated for weight, appetite, sleep, and psychomotor changes. Despite differences in language, ethnicity and culture, DSM criteria for MD perform similarly in Chinese women with recurrent MD and comparable subjects from the USA and Europe. The DSM criteria for MD may assess depressive symptoms that are relatively insensitive to cultural and ethnic differences. These results support efforts to compare findings from depressed patients in China and Western countries.

Is essential fatty acid status in late pregnancy predictive of post-natal depression?

We tested the hypothesis that abnormal levels of omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) during late pregnancy are associated with antenatal and post-natal depression. We interviewed a sample of more than 900 women in late pregnancy. We assessed whether they met criteria for depression on a standardized measure of post-natal depression [the Edinburgh Post-natal Depression Scale (EPDS)] and met DSM-IV criteria for major depression and/or were in receipt of antidepressant medication. Blood was collected at that time to generate data on nine PUFA variables. Sample members were re-interviewed post-natally to determine depressive experience in the 3months following the birth of their baby. Univariate associations were demonstrated between pre-natal depression categorized using DSM criteria and measures of blood fatty acids including total omega-3, the ratio of omega-6 to omega-3, docosahexaenoic acid (DHA) omega-3 and DHA plus eicosapentaenoic acid (EPA) omega-3. Such associations were not found post-natally, but different associations were quantified between EPDS-diagnosed depression and total omega-6, total omega-3 and EPA omega-3. In multivariate analyses, slight associations were maintained between EPDS and lower omega-3, lower EPA and higher omega-6 when neuroticism, stress during pregnancy, a lifetime episode of depression and older age were included in the analysis. Findings in such a large sample indicate that PUFA status in late pregnancy is only slightly linked with the risk of post-natal depression when depression was quantified by the EPDS. There were no associations between post-natal depression diagnosed by DSM criteria and any fatty acid variables.

Physical complaints in girls with major depression – A controlled study

Major depression is a frequent affective disorder in young adolescents. Patients do not only suffer from severe psychological but also from physical impairments. Aim of the present study is a description of physical complaints in girls with major depression. Seventy-three patients fulfilling DSM-IV criteria for major depression were compared to 72 controls. Physical complaints were assessed by a standardised and validated German questionnaire (Giessen Scale of Physical Complaints in Children and Adolescents). Patients reported significantly more complaints, in particular exhaustion and circulation problems. Physical problems are more likely to be a consequence rather than a cause of depression. Treatment of adolescents׳ depression should consider coping with body dysfunction during depressive episodes.

Conceptions of Mental Illness: Attitudes of Mental Health Professionals and the General Public

The authors compared attitudes of the U.S. general public and of mental health professionals about the competence and perceived dangerousness of people with mental health problems and the desire for social distance from them. Factors related to negative attitudes and the desire for social distance also were examined. Vignettes describing individuals meeting DSM-IV criteria for major depression and schizophrenia were included in the 2006 General Social Survey (GSS) and a 2009 study of mental health professionals, and responses were descriptively compared (GSS, N=397 responses to depression vignette, N=373 responses to schizophrenia vignette; 731 mental health professionals responded to both vignettes). Regression analyses examined whether demographic and provider characteristics were associated with perceptions of less competence and perceived dangerousness of the vignette character and with respondents' desire for social distance. Compared with the American public, mental health professionals had significantly more positive attitudes toward people with mental health problems. However, some providers' conceptions about the dangerousness of people with schizophrenia and provider desire for social distance from clients in work and personal situations were concerning. Younger age, self-identifying as non-Hispanic white, being female, having at least a four-year college degree, being familiar with mental illness, and certain job titles and more years of experience in the mental health field were predictive of more positive conceptions. Although mental health professionals held more positive attitudes than the general public about people with mental health problems, strong stereotypes persisted in both groups, especially concerning schizophrenia. This study identified several demographic and provider characteristics that can inform intervention strategies in both groups.

Assessment of depression in medical patients: A systematic review of the utility of the Beck Depression Inventory-II

To perform a systematic review of the utility of the Beck Depression Inventory for detecting depression in medical settings, this article focuses on the revised version of the scale (Beck Depression Inventory-II), which was reformulated according to the DSM-IV criteria for major depression. We examined relevant investigations with the Beck Depression Inventory-II for measuring depression in medical settings to provide guidelines for practicing clinicians. Considering the inclusion and exclusion criteria seventy articles were retained. Validation studies of the Beck Depression Inventory-II, in both primary care and hospital settings, were found for clinics of cardiology, neurology, obstetrics, brain injury, nephrology, chronic pain, chronic fatigue, oncology, and infectious disease. The Beck Depression Inventory-II showed high reliability and good correlation with measures of depression and anxiety. Its threshold for detecting depression varied according to the type of patients, suggesting the need for adjusted cut-off points. The somatic and cognitive-affective dimension described the latent structure of the instrument. The Beck Depression Inventory-II can be easily adapted in most clinical conditions for detecting major depression and recommending an appropriate intervention. Although this scale represents a sound path for detecting depression in patients with medical conditions, the clinician should seek evidence for how to interpret the score before using the Beck Depression Inventory-II to make clinical decisions.

A retrospective comparison of the effects of propofol and etomidate on stimulus variables and efficacy of electroconvulsive therapy in depressed inpatients

To compare the effects of propofol and etomidate on the stimulus variables and efficacy of electroconvulsive therapy (ECT) in depressed inpatients. This retrospective study included 54 inpatients (aged 18-75 years) who met the DSM-IV criteria for major depression and were treated with bilateral ECT. For the first part of the study, the primary outcome was the mean stimulus charge per ECT session. For the second part, the main outcome measure was the proportion of patients achieving full remission. Propofol-treated patients showed a higher mean stimulus charge (etomidate = 227.58 ± 130.44, propofol = 544.91 ± 237.56, p<0.001) despite the lack of a significant difference in starting threshold doses. The propofol group had shorter mean electroencephalogram (etomidate = 69.41 ± 22.50, propofol = 42.95 ± 22.26, p<0.001) seizure duration and motor (etomidate = 46.11 ± 14.38, propofol = 22.89 ± 7.13, p<0.001) seizure duration and a higher mean number of inadequate seizures (etomidate = 0.12 ± 0.15, propofol = 0.47 ± 0.26, p<0.001). No significant differences were found between the groups for the effects of the anesthetics on the efficacy of ECT. Our study is limited by a retrospective design and the small number of patients treated with propofol restricted the sample size. Anesthesia with propofol has a significant reducing effect on seizure duration during the course of ECT which results in more inadequate seizures, despite the use of a higher mean stimulus charge. Regarding the possible effect of the anesthetics on ECT, randomized clinical trials with sufficient power to detect differences are warranted.

Evidence for Multiple Genetic Factors Underlying DSM-IV Criteria for Major Depression

We do not know whether the clinical criteria for major depression (MD) reflect a single or multiple dimensions of genetic risk. To determine the structure of genetic and environmental risk factors for the 9 DSM-IV symptomatic MD criteria. Population-based twin registry. Virginia. Seven thousand five hundred members of adult twin pairs from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. Symptoms of lifetime MD as assessed at personal interview. The best-fit twin model was multidimensional, requiring 3 genetic, 1 common environmental and 3 unique environmental common factors, and criterion-specific unique environmental factors. The first genetic factor was characterized by high loadings on cognitive and psychomotor depressive symptoms. The second and third genetic factors had strong loadings for mood and neurovegetative depressive symptoms, respectively. Genetic factor scores derived from these 3 factors differentially predicted patterns of comorbidity, other historical/clinical features of MD, and demographic variables. These results suggested that the first genetic factor reflected a general liability to internalizing disorders, while the third genetic factor was more specific for melancholic MD. The 3 unique environmental common factors reflected, respectively, global depressive, core mood, and cognitive depressive symptoms. The DSM-IV syndrome of MD does not reflect a single dimension of genetic liability. Rather, these criteria reflect 3 underlying dimensions that index genetic risk for cognitive/psychomotor, mood, and neurovegetative symptoms. While in need of replication, these results, validated by predictions using estimated genetic factor scores, have implications for gene-finding efforts for MD.

Differences between unipolar depression and bipolar II depression in women

BackgroundBipolar disorder II (BPII) and unipolar depression (UD) are both characterized by episodes of major depression (MDE), however DSM-IV criteria for MDE are identical, regardless of diagnosis. As a result, misdiagnosis of BP II and UD is common, leading to inappropriate treatment. Because women are twice as likely as men to experience MDE, differentiating UD from BP II in the context of depression is especially important for women. We examined symptoms and clinical features of MDE in women with UD and BPII to compare presentations of the two disorders in women. MethodsWe compared characteristics of depressed women meeting DSM-IV criteria for BPII (n=48) or UD (n=48), matched on age. ResultsFeelings of worthlessness occurred in 98% of participants with UD versus 85% with BPII (p=0.03). Participants with UD experienced either insomnia or hypersomnia, but participants with BPII were more likely to experience both simultaneously (p=0.04). Those with UD were significantly less likely to have >5 prior mood episodes compared to those with BP II (12% versus 61%; p<0.0001) and had a later age of onset (p=0.003). LimitationsSmall sample size and exclusion criteria (i.e., comorbid substance abuse) may limit generalizability of findings. ConclusionsAmong a sample of women, number of prior episodes, feelings of worthlessness, age of onset, and sleep patterns distinguished between UD and BP II depressive episodes. A better understanding of differential presentation of BP II versus UD depression in women may help guide clinicians to more accurate diagnoses and, ultimately, better treatment.

Prävalenz und Korrelate von Angst und Depression bei Hämodialysepatienten

Depressive symptoms are common among patients with end-stage renal disease (ESRD). They are associated with both high morbidity and high mortality. In this explorative study we investigated the frequency of Major Depression and Generalized Anxiety Disorder in a German dialysis center. We further investigated the correlation between expert-rating and self-report questionnaires as well as the extent to which somatic, dialysis-specific and sociodemographic parameters are associated with depressive and anxious symptoms. During dialysis treatment 52 patients (21 women and 31 men) aged 29 to 85 years with end-stage renal disease (ESRD) completed the Beck Depression Inventory (BDI) and the Hospital Anxiety and Depression Scale (HADS-D). A physician administered the Structured Clinical Interview for DSM-IV (SCID) for the expert diagnosis of Major Depression and Generalized Anxiety Disorder. Nine patients met DSM-IV criteria for Major Depression (17 %). The self-report scales showed depressive symptoms in 17 patients (33 %) and 8 patients (15 %), respectively. Generalized Anxiety Disorder according to SCID was diagnosed in 9 patients (17 %), while 12 patients (23 %) scored higher than seven points on the HADS Anxiety subscale. Depressive and anxious symptoms were associated with gender, employment status, and physical activity; anxious symptoms were also associated with the body-mass-index (BMI). The higher agreement between the HADS depression subscale and the SCID diagnosis of Major Depression suggests that the HADS-D depression subscale is more useful than the BDI when screening for depression in patients with ESRD. Physical activity seems to be a protective factor for patients with ESRD and should be further investigated.

Treatment Course With Antidepressant Therapy in Late-Life Depression

In order to assess the effect of gray matter volumes and cortical thickness on antidepressant treatment response in late-life depression, the authors examined the relationship between brain regions identified a priori and Montgomery-Åsberg Depression Rating Scale (MADRS) scores over the course of an antidepressant treatment trial. In a nonrandomized prospective trial, 168 patients who were at least 60 years of age and met DSM-IV criteria for major depression underwent MRI and were enrolled in a 12-week treatment study. Exclusion criteria included cognitive impairment or severe medical disorders. The volumes or cortical thicknesses of regions of interest that differed between the depressed group and a comparison group (N=50) were determined. These regions of interest were used in analyses of the depressed group to predict antidepressant treatment outcome. Mixed-model analyses adjusting for age, education, age at depression onset, race, baseline MADRS score, scanner, and interaction with time examined predictors of MADRS scores over time. Smaller hippocampal volumes predicted a slower response to treatment. With the inclusion of white matter hyper-intensity severity and neuropsychological factor scores, the best model included hippocampal volume and cognitive processing speed to predict rate of response over time. A secondary analysis showed that hippocampal volume and frontal pole thickness differed between patients who achieved remission and those who did not. These data expand our understanding of the prediction of treatment course in late-life depression. The authors propose that the primary variables of hippocampal volume and cognitive processing speed, subsuming other contributing variables (episodic memory, executive function, language processing) predict antidepressant response.

Depression in Parkinson&amp;rsquo;s disease

Depression in Parkinson’s disease Mohammed A. Rana, Kevin Hafez Parkinson’s Clinic of Eastern Toronto, Toronto, Canada Parkinson's disease (PD) has both motor and non-motor symptoms. There is growing evidence that some of the non-motor symptoms may antedate the motor symptoms and can cause increasing disabling as the disease progresses. Depression is one of the important symptoms of PD.1 About 40 percent of patients with PD may have anhedonia, lack of initiative and assertiveness. The majority of the patients have dysthymia; however, some patients may meet the DSM-IV criteria for major depression. Nonetheless, loss of interest, fatigue, irritability, lack of energy, indecisiveness and sadness are more frequent in PD. Depression may precede the onset of motor symptoms of PD by many years in some cases.2

The validity of the Montgomery–Aasberg depression rating scale as a screening tool for depression in later life

The aims of the study were to examine the validity of the MADRS and to compare it with the validity of the Cornell Scale for Depression in Dementia (CSDD). We included 140 patients without dementia, with mean age 81.5 (sd 7.7) years. Trained psychiatric nurses interviewed all of them using the MADRS. In addition, for 70 patients caregivers were interviewed using the CSDD. A psychiatrist who had no access to the MADRS or the CSDD results made a diagnosis of depression according to the DSM-IV criteria for major depression, and the ICD-10 criteria was also applied for the 70 patients assessed with the CSDD. Twenty-two out of the 140 had depression according to the DSM IV criteria, whereas 25 out of 70 had depression according to the ICD-10 criteria. The area under the curve (auc) in a receiver operating characteristic analysis was 0.86 (95% CI 0.79-0.93) for the MADRS using the DSM-IV criteria. The best cut-off point was 16/17 with sensitivity of 0.80 and specificity of 0.82. The AUC for the CSDD was 0.83 (95% CI 0.71-0.95). The recommended cut-off score on the CSDD of 7/8 was valid but not the best in this study. The patients were diagnosed with a diagnosis of depression by only one psychiatrist, and the procedures in the two centres were not exactly the same. The MADRS has good discriminating power to detect depression in elderly persons and should be preferred to the CSDD for use with persons without dementia.