Group Of Depressed Patients Research Articles

The influence of age on the natural history of unipolar depression when treated with electroconvulsive therapy.

The influence of age on the natural history of unipolar depression when treated with electroconvulsive therapy (ECT) was studied using a naturalistic/archival study design. A sample of 125 patients who received no somatic treatment were compared with 128 patients who all received a course of ECT with at least four treatments. Patients were separated according to age at admission. Treated patients, aged 40 or older, who were clearly remitters showed no differences in previous episodes, subsequent episodes, subsequent hospitalizations, or likelihood of experiencing a period of full recovery when compared with a similar group of untreated patients. Hospitalization greater than 1 year and chronicity were significantly more common in the untreated older subjects. Treated patients aged 39 or younger, who also were clearly remitters, showed significant increases in subsequent episodes and subsequent hospitalizations when compared with a group of depressed patients of similar age who received no somatic treatment. Hospitalization greater than 1 year was also more common in the untreated younger patients. ECT clearly reduces the rate of chronicity in older patients but may be associated with an increase in episodes after treatment in the younger population.

Cardiac Beta-Adrenergic Sensitivity in Depression: Relation with Endogenous Subtype and Desipramine Response

The authors studied the responsiveness of cardiac beta-receptors to isoproterenol, a noradrenergic agonist, in 29 depressed patients and 13 control subjects. They showed a significantly lower sensitivity in depressed patients as compared with the control subjects. Focussing on the group of depressed patients without antidepressant treatment in the month preceding the study (n = 15) in order to avoid a bias, the following significant results were obtained: cardiac beta-adrenergic receptor sensitivity was lower in patients suffering from endogenous depression than in those suffering from reactive depression (as classified by Newcastle Scale). There was a negative linear relation between cardiac beta-adrenergic sensitivity and the posttreatment clinical state (as expressed by the MADRS score) for the 9 patients who ended a 3-week desipramine treatment period.

Reduced natural killer cell activity in major depression: neuroendocrine implications

Natural killer cell activity (NKCA) was significantly reduced in a group of depressed patients, melancholic subtype, compared to sex- and age-matched controls. Corticotropin and cortisol values were significantly higher in the depressed subjects than in the controls, but no correlation between high hormone levels and low immunological activity was found in the patients.

Effect of depression on processing interactions in group psychotherapy.

Two studies were conducted to investigate the possibility of individual differences in the ability of inpatients to process interactions in group psychotherapy. The first was a pilot study conducted on groups of major depressive patients and matched normal subjects. Subjects were asked to give process comments after viewing simulations of typical group therapy interactions. These comments were later rated on the extent to which they reflected process qualities and accuracy. These data led to a more rigorous and extensive study that included more appropriate control groups as well as measures of potential confounding factors, such as simulation realism, verbal ability, and interaction comprehension. Results indicated that major depressives suffer from deficits in the ability to process group interactions, relative to three types of control groups, including normals. These differences in processing were not significantly positively correlated with any of the potential confounding factors. The implications for understanding interactional processing and group psychotherapy are discussed.

Self-ratings of memory dysfunction: different findings in depression and amnesia.

An 18-item self-rating test of memory functions was administered to two patient groups: seven patients with amnesia resulting from Korsakoff's syndrome and six other amnesic patients. These results were compared to results obtained previously for depressed psychiatric inpatients (n = 19) and depressed inpatients prescribed electroconvulsive therapy (ECT) (n = 35). The latter group was tested both before and 1 week after completion of the course of ECT. One pattern of memory self-ratings was reported by the two groups of depressed patients. These two groups reported an approximately equivalent level of impairment across all test items. A different pattern of memory self-ratings was reported by the two groups of amnesic patients and by the group tested after ECT. These patients reported considerably more impairment on some items than others, such that performance was not equivalent across test items. Finally, the patients with Korsakoff's syndrome underestimated their memory problems, reporting a less severe impairment than the other amnesic patients. The results show that the memory problems experienced in depression and in amnesia are distinguishable with self-assessment techniques. In addition, the similarity between memory self-ratings reported by patients after ECT and by amnesic patients supports the idea that memory complaints after ECT reflect primarily the experience of amnesia. Self-rating forms like the one described here may have useful application to many diagnostic groups where questions arise about the nature of reported memory problems.

Marked reduction in the number of platelet-tritiated imipramine binding sites in geriatric depression.

The number (Bmax) and affinity (Kd) of platelet-tritiated imipramine binding sites was determined in young and middle-aged controls 50 years of age and younger (n = 25), elderly normal controls over 60 years of age (n = 18), patients who fulfilled DSM-III criteria for major depression who were under 50 years of age (n = 29), patients who fulfilled DSM-III criteria for major depression who were 60 years of age and older (n = 19), and patients who fulfilled both DSM-III criteria for primary degenerative dementia and National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer's disease (n = 13). Both groups of depressed patients (under 50 and over 60 years of age) exhibited significant reductions (decreases 42%) in the number of platelet-tritiated imipramine binding sites with no change in affinity, when compared with their age-matched controls. There was little overlap in Bmax values between the elderly depressed patients and their controls. The patients with probable Alzheimer's disease showed no alteration in platelet-tritiated imipramine binding. There was no statistically significant relationship between postdexamethasone plasma cortisol concentrations and tritiated imipramine binding. These results indicate that platelet-tritiated imipramine binding may have potential utility as a diagnostic adjunct in geriatric depression, and moreover that the reduction in the number of platelet-tritiated imipramine binding sites is not due to hypercortisolemia.

Typology of mood assessment curves by means of cluster analysis of computerized mathematical descriptions of time-series mood data collected from depressive inpatients treated with antidepressants.

A recently developed method for the computerized description of mood curves was applied to self-evaluation mood data of a large sample of 136 depressive inpatients. The values of the mathematical parameters from this description were analysed by cluster analysis to determine different types of mood courses of patients undergoing therapy with antidepressants. In general, the most unfavorable type of mood course was overrepresented in the group of neurotic depressive patients, the most favorable one in the group of endogenous depressive patients. But in this latter diagnostic group, a remarkable proportion of patients with the unfavorable mood course was observed, indicating the well-known phenomenon of non-response to antidepressants. The results can be interpreted as a validation of the new method of computerized description of mood curves. This method might lead to interesting possibilities in drug treatment evaluation.

Post-diction of suicide in a group of depressive patients.

Prediction of suicides was made on the basis of 99 psychiatric patients included in a study of anti-depressive therapy during 1961-63. These patients were followed up until 31 December 1984. Eight of them committed suicide. The prediction was based on two test methods, the Serial Colour-Word Test (CWT), which registers style of adaptation to a conflicting situation, and the Meta-Contrast Technique (MCT), where incongruous or threatening stimulation is introduced by degrees into neutral pictures and various defense misrepresentations of the threat are spotted. Both tests could predict suicide, but MCT was most successful. The sensitivity of the test was 0.80 and the specificity 0.75. The main risk symptom appeared to be depressive retardation together with lack of functional defensive structures.

Destructive bruxism: sleep stage relationship.

Despite apparent similar amounts of bruxism, two groups that had been evaluated polysomnographically differed dramatically in symptomatology. Patients with severe symptoms were referred to as the destructive bruxism group and were compared with (a) a group with sleep disturbance complaints who had bruxism and (b) a group of insomniac depressed patients chosen without regard to bruxism. It was hypothesized that not only the presence of bruxism during sleep but its pattern and sleep stage relationship were factors affecting clinical symptoms. The results indicated that the sleep stage relationship was an important factor. Patients with severe symptoms attributed to nocturnal bruxism were likely to have more bruxism in REM sleep than the other groups. These results if replicated prospectively would help explain some of the discrepancies in the literature concerning sleep stage relationship of bruxism, as well as help explain differences in symptomatology of bruxism patients.

High Intercorrelations Among Urinary Outputs of Norepinephrine and Its Major Metabolites

We examined the intercorrelations among urinary outputs of norepinephrine (NE) and its three major metabolites in unipolar depressed patients (n = 28) and normal controls (n = 24). Among the depressed patients, levels of NE correlated with normetanephrine (NM), 3-methoxy-4-hydroxyphenylglycol (MHPG), and vanillylmandelic acid (VMA), and VMA correlated with NM and MHPG. In the total group of depressed and control subjects (n = 52), the sum of NE and its major metabolites correlated with urinary outputs of NE, NM, MHPG, and VMA. These highly significant correlations among urinary outputs of NE and its major metabolites replicate a previous report of strong correlations among these same four urinary substances in a smaller group of depressed patients.

Life stressors and social resources: an integrated assessment approach.

The Life Stressors and Social Resources Inventory (LISRES) is described. The inventory provides an integrated assessment of an individual's life context. It taps both relatively stable and new aspects of life stressors and social resources in eight domains: physical health, home/neighborhood, financial, work, spouse/partner, children, extended family, and friends. The indices were developed on data obtained at two points in time from groups of depressed patients, alcoholic patients, arthritic patients, and healthy adults. The indices are internally consistent, moderately intercorrelated, and relatively stable over time. In addition, they are predictably related to changes in respondents' functioning. Although more developmental work is needed, the LISRES has some potential clinical and research applications and may be helpful in examining the process of stress and coping.

The thyrotropin-releasing hormone test in depressed and non-depressed psychiatric patients

SummaryThe thyrotropin-releasing hormone (TRH) test was carried out in 231 depressed patients undergoing a dexamethasone suppression test (DST), and in 63 psychiatric control patients. The patients were classified according to DSM-III. Thyrotropin-secreting hormone (TSH) was determined in basal conditions, 20 and 60 min after the administration of 200 μg TRH. The Δ max TSH values (peak TSH response minus basal TSH) showed no significant difference between psychiatrie Controls and patients with major depression (296.00X2, 296.00X3, 296.00X4) or with depression (major and minor depression; 300,40, 296,82, 309.00). Consequently, the TRH test is not specifie either for depression or for major depression. Within the selected group of depressive patients, major depressives showed significantly (P<0.005) lower Δ max TSH responses than minor depressives. The TRH test could barely be used as a clinical diagnostic aid for major depression, since the predictive value for a positive test resuit was too low (maximal 70.2%). To separate major from minor depression, a single DST was more suitable than the TRH test or the combination of both tests. Age showed a negative correlation (P<0.005) with the Δ max TSH responses and could be considered as a predisposing factor for a blunted TSH response to TRH in depressive patients.

Electrodermal activity in antidepressant medicated and unmedicated depressive patients and in matched healthy subjects.

A group of 59 depressive in- and outpatients displayed statistically significantly subnormal electrodermal activity (EDA) according to the skin conductance level, the skin conductance response magnitude, the skin conductance response rate, and the index of nonresponding during neutral tone stimulation, compared to 59 mentally and somatically healthy subjects, individually matched for age and sex. Comparisons between 20 antidepressant medicated and 20 unmedicated patients, matched for age, and comparisons between 21 drug-free patients and 10 patients medicated exclusively with antidepressants yielded no statistically significant difference in any EDA variable. However, all the electrodermal central values were somewhat lower in the medicated patients, possibly an effect of greater severity of symptoms. The present and previous findings offer strong support to the hypothesis of a subnormal function of the electrodermal activity in groups of depressive patients.

Pituitary-adrenal disinhibition and suicide attempts in depressed patients

Recognition of the biological correlates of suicidal behavior is extremely important for identifying high-risk subjects. Of the possible biological correlates, neuroendocrine parameters have received special attention. Various clinical observations suggest that hypothalamus-pituitary-adrenal axis activity is abnormally increased in depressed patients who exhibit suicidal behavior. Bunney et al. (1969) observed an association between suicidal behavior and adrenal hyperactivity, which was reflected in urine levels of 17-hydroxycorticosteroids. The urine concentrations of five patients who later committed suicide were among the 12 highest recorded in a sample of 145 depressed patients. However, these results have not been confirmed by other studies (Levy and Hansen 1969; Krieger 1970). Carroll (1972) found no differences in the serum cortisol levels of eight patients who made serious suicide attempts and those of other subjects in a group of depressed patients (n = 40). More recently, Coryell and Schlesser (1981) published the results of Dexamethasone Suppression Tests (DST) performed on 205 sub-

Estimation of premorbid intellectual status in depression.

The validity of the NART and Vocabulary subtest of the WAIS as measures of premorbid IQ in depression was assessed by comparing a group of depressed patients (n = 39) with matched controls. The Vocabulary performance of the depressed group was significantly poorer than controls but there was no significant difference in NART performance.

The effects of dexamethasone on plasma homovanillic acid and 3-methoxy-4-hydroxyphenylglycol. Evidence for abnormal corticosteroid-catecholamine interactions in major depression.

We investigated the possible interactions between corticosteroids and catecholamines in depression by studying the effects of the synthetic glucocorticoid dexamethasone on plasma levels of homovanillic acid (HVA) and 3-methoxy-4-hydroxyphenylglycol (MHPG) in a group of depressed patients and normal controls. In comparison with metabolite levels on a control day, normal controls showed a significant dexamethasone-induced increase in the plasma HVA level and a trend toward a decrease in the plasma MHPG level at 4 PM following dexamethasone administration (1 mg orally at 11 PM). Conversely, depressed patients, particularly those with psychotic features, showed a significant dexamethasone-induced increase in the plasma MHPG level and a blunting of the plasma HVA response relative to the normal controls. Dexamethasone-induced increases in the plasma MHPG level were directly correlated with the severity of depressive symptoms and with postdexamethasone cortisol levels in the depressed patients. These data suggest abnormal corticosteroid-catecholamine interactions in depression and, specifically, in depressed patients with psychotic features.

The relationship between anxiety and depression in children: rating scales and clinical variables.

The present study examined the relationship between anxiety and depression in children in the context of proposed adult models. The results support the qualitative distinction between anxious and depressed patient groups on subsets of rating scale measures and clinical variables. In contrast to anxious children who were younger, (day patients) had been ill for longer than one year, presented with behavioral problems, and were low on observer ratings of depressive symptoms; depressed children were older, (inpatients) had been ill for less than one year, presented with emotional problems and were high on observer ratings of both anxious and depressive symptoms. The finding that the older depressed children were concurrently anxious while the younger anxious children were not concurrently depressed is discussed from the viewpoint of a hypothesized temporal sequence between anxiety and depression. The implication of this and other related findings are discussed in regard to their importance for differential diagnosis and prognosis.

Verbal memory deficits associated with major affective disorders: a comparison of unipolar and bipolar patients

The verbal learning and fluency of patients with unipolar and bipolar depression were compared to those of normal controls and patients with Huntington's disease. The data demonstrated that the recall and recognition performance of both groups of depressed patients were imparred relative to the performance of normal control subjects. The bipolar patients, however, were more impaired than the unipolar patients on both tasks ( P<0.024 and P<0.022, respectively). In addition, the unipolar patients generated more correct responses on a test of verbal fluency ( P<0.04). The performance of the bipolar patients was, in fact, similar to that of patients with Huntington's disease, a progressive degenerative disorder that primarily affects subcortical areas.

A study of negative symptoms in schizophrenia and depression

The Scale for the Assessment of Negative Symptoms (SANS) was administered to 59 patients satisfying Research Diagnostic Criteria (RDC) for the diagnosis of definite schizophrenia and an equal number of patients satisfying Research Diagnostic Criteria (RDC) for the diagnosis of major depressive disorder. As compared to schizophrenic patients, depressives obtained significantly higher scores on ratings of subjective complaints, total score, global ratings, and various items of all subscales. Schizophrenic patients were noted to have significantly higher scores on global rating of alogia, poor eye contact, inappropriate affect, and blocking. When the same scale was applied to a group of 12 “negative schiozphrenics” also satisfying RDC for the diagnosis of schizophrenia and the ratings compared with depressed patients group, these differences disappeared to a great extent. The results of the study suggest that the SANS can also be used for the assessment of behavioral changes in depression.

Platelet Tritiated Imipramine Binding and Serotonin Uptake in Depressed Patients and Controls

We measured platelet tritiated imipramine binding and serotonin uptake in 51 depressed patients and 43 normal controls. Although there were no significant differences in platelet 3H-imipramine binding or serotonin uptake when the total group of depressed patients was compared with controls, depressed women (n = 32) had a significantly lower maximal density of 3H-imipramine binding sites (beta max) than control women (n = 25). Moreover, among the total group of depressed patients, there were significant negative correlations between the beta max values and plasma cortisol levels at 4 PM (n = 41) and 11 PM (n = 41) following dexamethasone administration. These negative correlations between beta max and cortisol levels were strongest among melancholic patients both at 4 PM before dexamethasone administration (n = 14) and at 11 PM after dexamethasone administration (n = 15). These data suggest that the reported decrease in beta max found among depressed patients may be related to and is perhaps secondary to the hypercortisolemia of depression.