Montgomery-Aasberg Depression Rating Scale Research Articles

The role of rehabilitation and vitamin D supplementation on motor and psychological outcomes in poststroke patients.

Post-Stroke depression affects between 12% and 72% of patients who have suffered a stroke. The association between low serum levels of 25-hydroxyvitamin D (25(OH) D) and increased risk of depression is reported in both stroke and non-stroke patients. Similarly, high 25(OH) D levels might be associated with greater functional improvement during rehabilitation program.We wanted to investigate the effects of an intensive rehabilitation on poststroke outcomes. We wondered if the daily rehabilitation of motor and cognitive functions could also have an effect on mood and functional abilities in addition to or as an alternative to vitamin D supplementation.We conducted a 12-week, randomized trial, double blind, parallel, monocentric clinical trial of 40 patients undergoing intensive neuro-rehabilitation treatment at a specialized care facility for ischemic or hemorrhagic brain stroke. Participants were randomly assigned, in a 1:1 ratio, to 1 of 2 parallel groups: in the experimental group, 2000 IU/day of oral cholecalciferol was administered; in the control group patients were not taking vitamin D supplementation. Patients underwent a text evaluation to investigate psychological and motor outcomes.Significant intra-group difference in outcomes measures was found but not between control group and experimental group. In the vitamin D group, we highlighted significant differences between T0 and T1 in calcium (P < .001), vitamin D (P < .001), in Montgomery Aasberg Depression Rating Scale (P = .001), and in Functional Independent Measures (P < .001). In the health control group, we found a significant difference in calcium (P = .003), vitamin D (P < .001), Montgomery Aasberg Depression Rating Scale (P = 0.006), in general self-efficacy (P = .009), and in Functional Independent Measures (P < .001).Our results show that the beneficial effect on mood and functional recovery is mainly due to neurorehabilitation rather than vitamin D supplementation.

Applicability of the locus of control of behaviour scale for people with dementia

Objective To investigate the applicability of the Locus of Control of Behaviour scale (LoCB) for people with dementia. Method A sample of 534 participants with dementia (78.4 mean age, 58% female) were included. Assessment included the LoCB, the Montgomery–Aasberg Depression Rating Scale (MADRS), the Mini-Mental Status Examination Norwegian revised (MMSE-NR) and the Instrumental Activities of Daily Living (I-ADL). Completion percentages and internal reliability of LoCB were examined for predefined MMSE-NR groups (0–4, 5–9, 10–14, 15–19, 20–24, 25–27, and 28–30). Factors associated with completion were analysed, and a principal component analysis (PCA) of the LoCB was performed. Sum score and component subscale scores were compared to MADRS and MMSE-NR scores. Results In total, 234 participants completed the LoCB. Completion percentages ranged from 74% (MMSE-NR 28–30) to 0% (MMSE-NR 0–9). Internal reliability was between 0.80 and 0.72 in groups with MMSE-NR > 9, except in MMSE-NR 20–24 (0.52). Age, MMSE-NR and education were associated with completion. The PCA yielded three components – powerful others, internal, and luck/fate – with explained variance of 41.3%. Participants with MADRS > 7 scored higher on the LoCB sum score, powerful others and internal subscale scores. No difference was found regarding the luck/fate subscale score. MMSE-NR did not affect LoCB scores. Conclusion Older age, less education, and more cognitive impairment decreased the likelihood of completion. However, psychometric test results indicate that those who completed the LoCB understood the questions, even with severe cognitive impairment. We conclude, therefore, that the LoCB is applicable for investigating control orientation among people with dementia.

Research on rating scales for depressive symptoms in patients with dementia

Depression is one of the most common psychiatric symptoms in patients with dementia. It can reduce the daily living ability of dementia patients, accelerate cognitive decline and disease progression, seriously affect the quality of life and increase mortality. Attention has been paid to depression assessment and intervention evaluation. At present, the scales using for rating depressive symptoms in dementia patients include Cornell Scale for Depression in Dementia (CSDD) , Dementia Mood Assessment Scale (DMAS) , Montgomery-Aasberg Depression Rating Scale (MADRS) , Hamilton Depression Scale (HAMD) , Geriatric Depression Scale (GDS) , Patient Health Questionnaire-9-Observation Version (PHQ-9-OV) and Depressive Signs Scale (DSS) . In this paper, the main contents, characteristics and limitations of the 7 kinds of rating scales are discussed comprehensively, in order to provide reference in selecting suitable rating tools in the process of assessment, intervention and evaluation, and provide basis for developing and improving rating tools of depressive symptoms in dementia patients. Key words: Dementia; Depression; Review; Rating scales

Anxiety Symptoms in Older Adults with Depression Are Associated with Suicidality

Objective: Anxiety symptoms are common in older adults with depression, but whether severe anxiety is associated with poorer outcomes of depression is unknown. The objective of the present study was to examine the association between severity of anxiety and severity of depression and physical illness, suicidality, and physical and cognitive functioning in older adults with depression. Methods: We included 218 older adults with diagnoses of a depressive disorder according to the ICD-10 criteria; their mean age (SD) was 75.6 (7.2), and 67.0% were women. The Geriatric Anxiety Inventory (GAI) was used to measure the severity of anxiety symptoms. The Montgomery-Aasberg Depression Rating Scale (MADRS) was used to assess the severity of depression. We obtained information on the level of functioning with the Physical Self-Maintenance Scale (PSMS) by Lawton and Brody and on cognition with the Mini-Mental State Examination (MMSE) and the Clock-Drawing Test (CDT). Physical health was determined based on information regarding falls and weight loss and an assessment of each patient’s general medical condition. The treating physician evaluated current suicidality in a comprehensive and standardized way. Results: Higher GAI scores were significantly associated with scores on the MADRS (β = 0.233, p = 0.002) and suicidality (β = 0.206, p = 0.006). Levels of physical or cognitive functioning were not associated with the GAI score. Conclusion: The severity of anxiety symptoms was associated with the severity of depression and suicidality in older adults with depressive disorders. The results could indicate a need to focus greater attention on the treatment of anxiety and suicidality in older patients with depression.

The Relationships among Tryptophan, Kynurenine, Indoleamine 2,3-Dioxygenase, Depression, and Neuropsychological Performance.

It has been suggested that the metabolic enzyme indoleamine 2,3-dioxygenase (IDO) is a biological mediator of inflammation related to the psychopathology of depression, with a Kynurenine (KYN) increase in the Tryptophan (TRP) metabolic pathway, resulting in reduced Serotonin. In this study, we examined KYN, TRP, and the ratio of KYN to TRP concentrations × 103 (KT Ratio) in serum and cerebrospinal fluid (CSF) in (a) a group of depressed patients and (b) a control group of patients referred to a neurologic outpatient clinic for whom no specific diagnosis could be established. The KT Ratio is considered an index that represents IDO. The participants were examined with the Beck Depression Inventory II (BDI-II), the Montgomery Aasberg Depression Rating Scale (MADRS), and a neuropsychological test battery. We found no significant differences between the two study groups with respect to TRP, KYN, or KT Ratio in serum or CSF. Differences in neuropsychological performance between the two patient groups could be seen in the following tests: Animal Fluency, Digit Symbol, the DKEFS Color-Interference Test (Naming Part), Trail Making Test A and B, and the Grooved Pegboard Non-dominant Hand. KYN in serum correlated highly with KYN in CSF. KYN in serum correlated significantly with both age and gender. When analyzing males and females separately, we found that women had a lower level of TRP in both serum (Mann–Whitney U-test: TRP in Serum; p = 0.001) and CSF (Mann–Whitney U-test: TRP in CSF; p = 0.003). Women had a lower level of KYN in serum (p = 0.029) than men did. Age was positively associated with KYN. KYN in CSF correlated only with age, however; there were no gender differences. No significant relationship was seen between BDI-II and MADRS on the one hand, and KYN and TRP on the other. KYN in CSF as the KT Ratio in both serum and CSF was associated with neuropsychological performance. Thus, we suggest that KYN and KT Ratio are related more strongly to neuropsychological performance than to affective symptoms in depression.

Association between C-reactive protein (CRP) with depression symptom severity and specific depressive symptoms in major depression

IntroductionPopulation-based studies have associated inflammation, particularly higher C-reactive protein (CRP), with depressive severity, but clinical trials in major depressive disorder were rather non-specific without examining the role of gender. We aimed to investigate the association between CRP and overall depression severity including specific depressive symptoms and to examine potential gender differences. MethodsWe included 231 individuals with major depressive disorder from the Genome-Based Therapeutics Drugs for Depression (GENDEP) study. At baseline, we assessed high-sensitivity CRP levels and psychopathology with the Montgomery Aasberg Depression Rating Scale (MADRS). We performed linear regression analyses to investigate the association between baseline CRP levels with overall MADRS severity and specific symptoms at baseline and adjusted for age, gender, anti-inflammatory and psychotropic drug treatment, body mass index, smoking, inflammatory diseases, and recruitment center. ResultsHigher CRP levels were significantly associated with greater overall MADRS symptom severity (p=0.02), which was significant among women (p=0.02) but not among men (p=0.68). Among women, higher CRP was associated with increased severity on observed mood, cognitive symptoms, interest-activity, and suicidality, but we found no significant associations among men. Interaction analyses showed no significant gender differences on the overall MADRS score or specific symptoms. DiscussionOur results support the sickness syndrome theory suggesting that chronic low-grade inflammation may be associated with a subtype of depression. The potential gender differences in psychopathology may be explained by biological and/or psychosocial factors, e.g. differential modulation of immune responses by sex hormones. Clinical studies should investigate symptom-specific and/or gender-specific treatment guided by peripheral inflammatory markers.

White blood cell count correlates with mood symptom severity and specific mood symptoms in bipolar disorder.

Immune alterations may play a role in bipolar disorder etiology; however, the relationship between overall immune system functioning and mood symptom severity is unknown. The two comparative effectiveness trials, the Clinical and Health Outcomes Initiatives in Comparative Effectiveness for Bipolar Disorder Study (Bipolar CHOICE) and the Lithium Treatment Moderate-Dose Use Study (LiTMUS), were similar trials among patients with bipolar disorder. At study entry, white blood cell count and bipolar mood symptom severity (via Montgomery-Aasberg Depression Rating Scale and Bipolar Inventory of Symptoms Scale) were assessed. We performed analysis of variance and linear regression analyses to investigate relationships between deviations from median white blood cell and multinomial regression analysis between higher and lower white blood cell levels. All analyses were adjusted for age, gender, body mass index, smoking, diabetes, hypertension and hyperlipidemia. Among 482 Bipolar CHOICE participants, for each 1.0 × 109/L white blood cell deviation, the overall Bipolar Inventory of Symptoms Scale severity increased significantly among men (coefficient = 2.13; 95% confidence interval = [0.46, -3.79]; p = 0.013), but not among women (coefficient = 0.87; 95% confidence interval = [-0.87, -2.61]; p = 0.33). Interaction analyses showed a trend toward greater Bipolar Inventory of Symptoms Scale symptom severity among men (coefficient = 1.51; 95% confidence interval = [-0.81, -3.82]; p = 0.2). Among 283 LiTMUS participants, higher deviation from the median white blood cell showed a trend toward higher Montgomery-Aasberg Depression Rating Scale scores among men (coefficient = 1.33; 95% confidence interval = [-0.22, -2.89]; p = 0.09), but not among women (coefficient = 0.34; 95% confidence interval = [-0.64, -1.32]; p = 0.50). When combining LiTMUS and Bipolar CHOICE, Montgomery-Aasberg Depression Rating Scale scores increased significantly among men (coefficient = 1.09; 95% confidence interval = [0.31, -1.87]; p = 0.006) for each 1.0 × 109/L white blood cell deviation, whereas we found a weak association among women (coefficient = 0.55; 95% confidence interval = [-0.20, -1.29]; p = 0.14). Lower and higher white blood cell levels correlated with greater symptom severity and specific symptoms, varying according to gender. Deviations in an overall immune system marker, even within the normal white blood cell range, correlated with mood symptom severity in bipolar disorder, mostly among males. Studies are warranted investigating whether white blood cell count may predict response to mood-stabilizing treatment.

Health-related quality of life in older depressed psychogeriatric patients: one year follow-up

BackgroundKnowledge about long-term change in health related quality of life (HQoL) among older adults after hospitalization for treatment of depression has clinical relevance. The aim was firstly to describe the change of HQoL one year after admission for treatment of depression, secondly to explore if improved HQoL was associated with remission of depression at follow-up and lastly to study how HQoL in patients with remission from depression were compared to a reference group of older persons without depression.MethodThis study had the one year follow-up information of 108 older patients (≥60 years), all hospitalized for depression at baseline, and a reference sample of 106 community-living older adults (≥60 years) without depression. HQoL was measured using the EuroQol Group’s EQ-5D Index and a visual analog scale (EQ-VAS). Depression and remission were diagnosed according to ICD-10. Socio-demographic variables (age, gender, and education), depressive symptom score (Montgomery-Aasberg Depression Rating Scale), cognitive functioning (Mini Mental State Examination scale), instrumental activities of daily living (the Lawton and Brody’s Instrumental Activities of Daily Living Scale), and poor general physical health (General Medical Health Rating) were included as covariates.ResultsHQoL had improved at follow-up for the total group of depressed patients, as indicated by better scores on the EQ-5D Index and EQ-VAS. In the multivariate linear regression model, improved EQ-5D Index and EQ-VAS was significantly better in those with remission of depression and those with better baseline physical health. In adjusted analyses, the HQoL in patients with remission from depression at follow-up did not differ from the HQoL in a reference group without depression.ConclusionOlder hospital patients with depression who experienced remission one year after admission gained HQoL and their HQoL was comparable with the HQoL in a reference group of older adults without depression when adjusting for differences in socio-demographics and health conditions.

A Comparison of the Cornell Scale for Depression in Dementia and the Montgomery-Aasberg Depression Rating Scale in a Memory Clinic Population

Background: The aim of this study was to explore the correlation between the Cornell Scale for Depression in Dementia (CSDD) and the Montgomery-Aasberg Depression Rating Scale (MADRS) among memory clinic patients. Methods: The CSDD (based on an interview with the caregiver) and the MADRS (based on the patient's opinion) were filled in independently of each other among 520 patients. Principal component and correlation analyses were performed. Results: The mean score of the CSDD was 7.6 (SD: 6.0), and the mean MADRS score was 9.7 (SD: 6.7). The correlation between the two scales was 0.36 for the whole group, 0.22 in the group with dementia and 0.48 for those without dementia, respectively. Principal component analyses revealed four factors for the CSDD and two factors for the MADRS. Conclusions: Using two different sources of information, we found a poor correlation between the two scales. We suggest that evaluation of depression among memory clinic patients should be done by interviewing both the patient and the caregiver.

Social provision and loneliness among older people suffering from chronic physical illness. A mixed‐methods approach

To describe and compare the perceived social provision for a group reporting never feeling lonely with that of a group reporting feeling lonely and to explore the meaning of loneliness. Participants (N = 101) were recruited from geriatric wards. Inclusion criteria were as follows: aged 65 years or more, the absence of dementia, one or more chronic physical disorders and plans to be discharged from the hospital to their home. The mean age was 81.3 years (range: 65-96 years), 68% were women, and 66% lived alone. Assessments of social provisions and loneliness were collected by a subjective report using the Social Provision Scale (SPS), and the Montgomery-Aasberg Depression Rating Scale (MADRS) was used to assess depression. The participants were also asked whether they felt lonely and were then asked to describe the meaning of loneliness if they had indicated feeling lonely. Narratives were then condensed by the participants into short sentences. Seventy-five per cent of the participants reported feeling lonely, of these 54% were living alone, and 18% identified with depression. Three subscales of SPS scores were significantly lower in the lonely group: attachment (p < 0.001), a sense of reliable alliance (p = 0.001) and the obtaining of guidance (p = 0.01). The overall view of the experience of loneliness was dominated by emptiness and negative emotions. The following themes were identified: Emotions were dominated by sadness, anxiety and restlessness, anger and guilt. Relationships were dominated by being left alone, being confined and feeling useless. Existential dimensions were characterised by emptiness, endless boredom, isolation and the potential for change. The study shows that loneliness is prevalent among older people suffering from chronic physical illness and confirms the complexity of the concept. A mixed-methods design contributed to nuanced and detailed information about the meaning of loneliness.

A cross-cultural comparison of the phenotype of depression as measured by the Cornell Scale and the MADRS in two elderly outpatient populations

Different cutoff points for a depressive disorder on depression scales exist in different countries. The reasons could be that the presence or the intensity of the various symptoms on the scales differ. We wanted to explore differences in scores on depression scales among patients in Brazil and Norway. The Cornell Scale for Depression in Dementia (CSDD) and the Montgomery-Aasberg Depression Rating Scale (MADRS) were completed independently among 211 elderly outpatients in Brazil and Norway. A psychiatrist, blind to the results, diagnosed depression using the ICD-10 and DSM-IV criteria. According to the ICD-10 criteria, 29 (33.7%) Brazilian and 51 (40.8%) Norwegian patients had depression (p=0.3). Mean CSDD score was 14.4 (SD 8.9) in Brazil and 6.8 (SD 4.9) in Norway (p<0.001). Mean MADRS score was 13.2 (SD 12.1) in Brazil and 8.4 (SD 6.8) in Norway (p=0.02). We analyzed the scores for the depressed and the non-depressed patients separately. In both groups the Brazilian patients had significantly higher scores on both scales compared to the Norwegian patients. In an adjusted linear regression analysis the variable "country" was associated with the CSDD score (beta=-0.29, p=0.01). The protocols in the two countries were not exactly the same. Only one psychiatrist evaluated the patients. The scores on the MADRS and the CSDD were higher in patients in Brazil than in Norway. In an adjusted linear regression analysis, "country" was the only variable associated with the higher CSDD score.

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.

A Comparison of the Validity of the Cornell Scale and the MADRS in Detecting Depression among Memory Clinic Patients

Background: The aim of the study was to compare the validity of the Cornell Scale for Depression in Dementia (CSDD) and the Montgomery-Aasberg Depression Rating Scale (MADRS) among memory clinic patients. Methods: The scales were independently completed for 125 patients. The diagnosis of depression was made by psychiatrists blinded to the depression scores. Results: The mean score of the Mini-Mental State Examination was 25.5 (SD: 4.6), of the CSDD 6.8 (SD: 4.9), and of the MADRS 8.5 (SD: 6.8). In receiver operation characteristics (ROC) analyses, the AUC for the CSDD was 0.73 (95% CI: 0.63–0.82) using the International Classification of Diseases-10 (ICD-10) criteria for depression, and 0.68 (95% CI: 0.57–0.79) using the DSM-IV criteria. The AUC was 0.88 (95% CI: 0.81–0.95) for the MADRS using the ICD-10 criteria, and 0.84 (95% CI: 0.76–0.92) using the DSM-IV criteria. Conclusion: Both scales are suitable as screening tools. According to the ROC analyses, the MADRS seems better at distinguishing depressed from nondepressed patients.

A psychometric evaluation of the Hospital Anxiety and Depression Scale for the medically hospitalized elderly

Background: Few psychometric studies of the Hospital Anxiety and Depression Scale (HADS) scale have been performed with clinical samples of elderly individuals. Methods: The participants were 484 elderly (65–101 years, 241 men) patients in an acute medical unit. The HADS, the Montgomery–Aasberg Depression Rating Scale (MADRS) and questionnaires assessing quality of life, functional impairment, and cognitive function were used. The psychometric evaluation of the HADS included the following analyses: 1) the internal construct validity by means of principal component analysis followed by an oblique rotation and corrected item–total correlation; 2) the internal consistency reliability by means of the alpha coefficient (Cronbach's) and 3) concurrent validity by means of Spearman's rho. Results: We found a two-factor solution explaining 45% of the variance. Six of seven items loaded adequately (≥0.40) on the HADS-A subscale (item 7 did not) and five of seven items loaded adequately on the HADS-D subscale (items 8 and 10 did not). Cronbach's alpha for the HADS-A and HADS-D subscale was 0.78 and 0.71, respectively. The correlation between HADS-D and the MADRS, a measure of the concurrent validity, was 0.51. Conclusion: The HADS appears to differentiate well between depression and anxiety. The internal consistency of the HADS in a sample of elderly persons was as satisfactory as it is in samples with younger persons. In contrast to younger samples, item 8 (“I feel as if I have slowed down”) did not load adequately on the HADS-D subscale. This may be attributed to the way elderly people experience and describe their symptoms.

Factor analysis of the Montgomery Aasberg depression rating scale in an elderly stroke population

Depression is frequent in elderly stroke patients, and the pathophysiology may involve psychological as well as organic mechanisms. To explore construct validity of the Montgomery Aasberg Depression Rating Scale using factor analysis and investigate whether symptom clusters of depression after stroke are associated with patient characteristics. A sample of 163 stroke patients was assessed by the Montgomery Aasberg Depression Rating Scale. Pre-stroke assessment was accomplished by means of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), the Barthel ADL Index and patient's medical history. Post-stroke assessment was performed with the Mini Mental State Examination (MMSE), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Star Cancellation Test, the Barthel ADL Index, the modified Rankin Scale (mRS) and the National Institute of Health Stroke Scale (NIHSS). Information was collected from the patients' records. A principal components factor analysis followed by oblique rotation was performed. Among the patients, 56.4% scored between 7 and 19 on the Montgomery Aasberg Depression Rating Scale, and 13% had a score above 19. The factor analysis resulted in three factors, called anhedonia (lassitude, inability to feel, suicidal thoughts, loss of appetite), sadness (observed sadness, reported sadness, pessimism) and agitation (inner tension, lack of concentration, disturbed sleep). Anhedonia correlated with cognitive impairment, whereas sadness correlated with sensorimotor and cranial nerve deficits. Agitation had low internal reliability and did not correlate with any systematic patients characteristics. We found three distinct factors. The factor anhedonia is related to cognitive impairment, sadness to neurological impairment due to the stroke and agitation to somatic factors not directly related to the stroke.

Anxiety and depression in patients with self-reported food hypersensitivity

Objective Self-reported food hypersensitivity (SFH) is common. Psychological factors are assumed to be associated. We assessed anxiety and depression in SFH patients, using both questionnaires and interview. Methods Consecutive patients ( n=130) and randomly selected healthy volunteers ( n=75) completed the Hospital Anxiety and Depression Scale (HADS), the neuroticism scale of the Eysenck Personality Questionnaire (EPQ-N) and the General Health Questionnaire (GHQ). Seventy-six of the patients were also interviewed by use of the Mini International Neuropsychiatric Interview and the Montgomery–Aasberg Depression Rating Scale. All patients underwent extensive allergological, gastroenterological and dietary examinations. Results According to interviews, 57% of patients fulfilled the DSM-IV criteria for at least one psychiatric disorder. Anxiety disorders (34%) and depression (16%) predominated. According to questionnaires, patients scored significantly higher than controls on all psychometric scales except for depression (HADS). We also found an underreporting of depression in HADS compared with interviews (2.5% vs. 16%, P=.001). Food hypersensitivity was rarely confirmed by provocation tests (8%). Eighty-nine percent of the patients had irritable bowel syndrome. Conclusions Anxiety and depression are common in patients with IBS-like complaints self-attributed to food hypersensitivity. Anxiety disorders predominate. In this setting, depression may be underreported by HADS.

“The Day the Music Died”

Background: The nursing home Valerengen bo– og servicesenter in Oslo, Norway, a long–term institution with 84 residents, has continually had regular music therapy activities with a music therapist in full–time employment since 1999. The institution was without music therapy services during the fall of 2003. Method: At the end of the period without a music therapist, measurement of depression level by the use of Montgomery Aasberg Depression Rating Scale (MADRS) was conducted on residents (n=72). Two months after music therapy services had been resumed with music therapy groups twice a week in each ward and individualized services other days, a new measurement of depression level of all residents was conducted. Results: Depression rating show a significant fall in the music therapy condition, compared with the no music therapy condition in a crossover design: MADRS 20.4 on an average in the no music condition, 12.2 on an average in the music condition (p < .05). Staff at the institution was stable, and there were no significant changes in medication. Conclusion: A significant reduction in the average level of depression in a nursing home when music therapy services are resumed warrants recommendation for a larger controlled follow–up study.

Early supported discharge of patients with acute stroke: a randomized controlled trial

Purpose: To evaluate the feasibility and effectiveness of early supported discharge (ESD) following acute stroke. Method: An ESD scheme was compared to conventional rehabilitation in a randomized controlled trial. All patients admitted with acute stroke were considered for inclusion. Eighty-eight (20.2%) were found to be eligible and 82 were randomized either to early supported discharge (n=42) or conventional rehabilitation (n=40). The primary outcome measure was the Nottingham Extended Activities of Daily Living Scale. The General Health Questionnaire, the Montgomery Aasberg Depression Rating Scale, mortality, placement and patient and carer satisfaction served as secondary outcome measures. Results: Median length of stay was reduced from 31 days in the conventional hospital rehabilitation group to 22 days in the early supported discharge group (p=0.09). No differences were found regarding primary outcome. The General Health Questionnaire score showed a significant difference in favour of the early supported discharge group at three months (19.5/24, p =0.02), but not at six. At six months, the proportion of patients being dead or in institution showed a trend of being higher in the conventional rehabilitation group (OR 3.8, 95 % CI 0.8-23). Conclusions: Early supported discharge after stroke is feasible and it is possible that it has benefits compared with conventional rehabilitation.

Pre-operative [correction of Properative] psychological variables predict immunological status in patients with operable breast cancer.

In a prospective study of psychobiological responses in patients with operable breast cancer, psychological data were collected one day before surgery and immunological data one day before and seven days after surgery. Explore psychoimmunological correlates related to primary surgical treatment of women with operable breast cancer. Distress was assessed with Impact of Event Scale (IES), depression with Montgomery-Aasberg Depression Rating Scale (MADRS), coping with Mental Adjustment to Cancer (MAC) scale, emotional suppression with Courtauld Emotional Control scale (CECS) and neuroticism with EPQ-N. Number of lymphocytes and subsets of lymphocytes were analyzed using a flow-cytometric method. Intrusive anxiety and anxious preoccupation were statistically significant inversely correlated to number of lymphocytes, B, T total and T4 lymphocytes and depression to B and T4 lymphocytes using Bonferroni's correction for multiple testing. Multivariate analyses including menopausal status, type of surgery and health behaviour variables demonstrated an independent, inverse effect of depression on total number of lymphocytes, T total and T4 lymphocytes 7 days after surgery. Pre-post immune changes were influenced reversely by depression (decreased) and intrusion (increased). Psychological parameters have a statistically significant impact on the number of lymphocytes and subsets of lymphocytes.

Risk factors for depression in Parkinson disease.

To evaluate whether depression in Parkinson disease (PD) is more closely related to the underlying neuropathological process or to environmental and psychological factors by correlating depression in PD with various clinical and demographic variables. Major depression, level of depressive symptoms as measured with the Montgomery-Aasberg Depression Rating Scale (MADRS), and clinical characteristics were investigated in a community-based cross-sectional study of carefully diagnosed patients with PD. Both bivariate and multivariate correlation analyses were performed to investigate correlations and predictive values of possible risk factors for major depression and MADRS score in PD. Depression among patients with PD derived from a prevalence study in the county of Rogaland, Norway. Two hundred forty-five patients with PD. Impaired cognitive function and the presence of a thought disorder were significant predictors of major depression. A Mini-Mental State Examination sum score below 24 and level 2 or higher on the thought disorder subscale of the Unified Parkinson Disease Rating Scale increased the probability of major depression by a factor of 6.6 and 3.5, respectively. Higher MADRS scores were also associated with lower Mini-Mental State Examination score and higher thought disorder score. In addition, MADRS scores also correlated with more impairment in activities of daily living, presence of motor fluctuations, more evidence of atypical parkinsonism, higher daily doses of levodopa, and younger age on the day on which prevalence was determined. Most of the observations of this study favor the hypothesis that depression in PD is a primary consequence of brain dysfunction. Situational factors may, however, also contribute to mood changes in PD.