Montgomery And Asberg Depression Rating Scale Research Articles

Phenomenology of Depressive Disorders with and without Psychotic Features: A Comparative Study

ABSTRACT Background: Depressive disorders can present with psychotic features, which warrants a different diagnosis and a different phenomenological study. Aim: To study the phenomenology of depressive disorders with and without psychotic features. Methodology: One hundred and forty-eight patients presenting to psychiatry outpatient department of a tertiary care center were screened using Mini International Neuropsychiatric Interview questionnaire to select patients for our study. Sociodemographic data and some clinical variables of these patients were collected. These patients were further assessed for depression severity and psychotic symptoms by using Montgomery and Asberg Depression Rating Scale (MADRS) and Modified Psychotic Symptoms Ratings Scale (PSYRATS), respectively. Results: Mean MADRS score for patients with depression without psychotic features was 38.38 and for patients with depression with psychotic features was 44.51. Result was found to be significant. Suicidality was found to be on a higher side in patients of depression with psychotic features. Conclusion: Main finding related to our study was that depression severity was found to be more in patients of depression with psychotic features. There are certain phenomenological differences which warrant a separate diagnosis of depression with psychotic features. These include the increased intensity of suicidality, visible sadness, inner stress, difficulty in concentration, lassitude, altered ability to feel, and thoughts of suicide present in patients of depression with psychotic features.

The association between neuroendocrine/glucose metabolism and clinical outcomes and disease course in different clinical states of bipolar disorders.

The treatment of bipolar disorder (BD) remains challenging. The study evaluated the impact of the hypothalamic-pituitary-adrenal (HPA) axis/hypothalamic-pituitary-thyroid (HPT) axis and glucose metabolism on the clinical outcomes in patients with bipolar depression (BD-D) and manic bipolar (BD-M) disorders. The research design involved a longitudinal prospective study. A total of 500 BD patients aged between 18 and 65 years treated in 15 hospitals located in Western China were enrolled in the study. The Young Mania Rating Scale (YMRS) and Montgomery and Asberg Depression Rating Scale (MADRS) were used to assess the BD symptoms. An effective treatment response was defined as a reduction in the symptom score of more than 25% after 12 weeks of treatment. The score of symptoms was correlated with the homeostatic model assessment of insulin resistance (HOMA-IR) index, the HPA axis hormone levels (adrenocorticotropic hormone (ACTH) and cortisol), and the HPT axis hormone levels (thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), free triiodothyronine (fT3), and free thyroxine (fT4)). In the BD-M group, the YMRS was positively correlated with baseline T4 (r = 0.349, p = 0.010) and fT4 (r = 0.335, p = 0.013) and negatively correlated with fasting insulin (r = -0.289, p = 0.013). The pre-treatment HOMA-IR was significantly correlated with adverse course (p = 0.045, OR = 0.728). In the BD-D group, the baseline MADRS was significantly positively correlated with baseline fT3 (r = 0.223, p = 0.032) and fT4 (r = 0.315, p = 0.002), while baseline T3 (p = 0.032, OR = 5.071) was significantly positively related to treatment response. The HPT axis and glucose metabolism were closely associated with clinical outcomes at 12 weeks in both BD-D and BD-M groups. If confirmed in further longitudinal studies, monitoring T3 in BD-D patients and HOMA-IR for BD-M could be used as potential treatment response biomarkers.

New ways to cope with depression—study protocol for a randomized controlled mixed methods trial of bouldering psychotherapy (BPT) and mental model therapy (MMT)

BackgroundDue to the growing gap between the demand and supply of therapeutic services for people suffering from depression, with this study, we are investigating the effectiveness and factors of influence of new approaches in group treatments for depression. Two previous studies have already identified bouldering psychotherapy (BPT) as an effective option. It combines psychotherapeutic interventions with action- and body-oriented bouldering exercises. Mental model therapy (MMT) is a new cognitive-behavioral approach for treating depression. It focuses on identifying cognitive distortions, biases in decision making, and false assumptions and aims to correct and replace them with useful mental models. We aim to investigate the effectiveness of the interventions compared with a control group (CG) and to assess the factors of influence in a mixed methods approach.MethodsThe study is being conducted as a randomized controlled intervention trial. Adult participants with unipolar depression are being randomized into three groups (BPT, MMT, or CG), and the first two groups are undergoing a 10-week treatment phase. CG follows their individual standard treatment as usual. A priori power analysis revealed that about 120 people should be included to capture a moderate effect. The primary outcome of the study is depression rated with the Montgomery and Asberg Depression Rating Scale (MADRS) before (t0), directly after (t1), and 12 months after the intervention phase (t2). Data are being collected via questionnaires, computer-assisted video interviews, and physical examinations. The primary hypotheses will be statistically analyzed by mixed model ANOVAs to compare the three groups over time. For secondary outcomes, further multivariate methods (e.g., mixed model ANOVAs and regression analyses) will be conducted. Qualitative data will be evaluated on the basis of the qualitative thematic analysis.DiscussionThis study is investigating psychological and physical effects of BPT and MMT and its factors of influence on outpatients suffering from depression compared with a CG in a highly naturalistic design. The study could therefore provide insight into the modes of action of group therapy for depression and help to establish new short-term group treatments. Methodological limitations of the study might be the clinical heterogeneity of the sample and confounding effects due to simultaneous individual psychotherapy.Trial registrationISRCTN, ISRCTN12347878. Registered 28 March 2022, https://www.isrctn.com/ISRCTN12347878.

Demographic and clinical correlates of suicidal ideation in individuals with at-risk mental state (ARMS): A study from Pakistan.

Suicide is a major public health concern and one of the leading causes of mortality worldwide. People with an at-risk-mental-state (ARMS) for psychosis are more vulnerable to psychiatric co-morbidity and suicide, however, there are limited data from low-middle-income countries. The present study aimed to identify the prevalence of depressive symptoms and suicidal ideation along with sociodemographic and clinical correlates of suicidal ideation in individuals with ARMS from Pakistan. Participants between the age of 16 and 35 years who met the criteria for ARMS based on the Comprehensive Assessment of At-Risk Mental State (CAARMS), were recruited from the community, general practitioner clinics and psychiatric units across Pakistan (n = 326). Montgomery and Asberg Depression Rating Scale (MADRS) and Social-Occupational-Functional-Assessment-Scale (SOFAS) were administered to participants. The prevalence of depressive symptoms and suicidal thoughts in the sample at baseline were 91.1% (n = 297) and 61.0% (n = 199), respectively. There were significant mean differences between groups (mean difference [95% CI]; p-value) without suicidal ideation and with suicidal ideation on measures of MADRS (-5.47 [-7.14, -3.81]; p < .001), CAARMS non-bizarre ideas (-0.29 [-0.47, -0.11]; p = .002) and perceptual abnormalities (-0.23 [-0.41, -0.04]; p = .015). These findings indicate that suicidal ideation and depressive symptoms are highly prevalent in individuals with ARMS in Pakistan. Given the pivotal developmental stages that ARMS presents, and the poor outcomes associated with co-morbid depression, there is an urgent need to prioritize the development of low-cost and scalable evidence-based interventions to address psychiatric comorbidity and suicidality in the ARMS population in Pakistan.

Long-term safety and efficacy, including anhedonia, of vortioxetine for major depressive disorder: findings from two open-label studies

Objective Evaluate the long-term safety and efficacy of vortioxetine in the management of major depressive disorder (MDD) in two open-label one-year studies, including a post-hoc analysis of its effects on symptoms related to anhedonia. Methods Both studies were 52-week, open-label, flexible-dose extension studies to evaluate the safety and efficacy of vortioxetine in adult patients with MDD following prior double-blind studies. Patients in the first study (NCT00761306) were flexibly treated with vortioxetine 5 or 10 mg/day (N = 74), and patients in the second study (NCT01323478) received vortioxetine 15 or 20 mg/day (N = 71). Results The safety and tolerability profile of vortioxetine was similar between the two studies; treatment-emergent adverse events with the highest incidence were nausea, dizziness, headache, and nasopharyngitis. Across both studies, improvements achieved during the preceding double-blind studies period were maintained, and additional improvements were observed with open-label treatment. Patients showed a mean ± SD reduction (improvement) in Montgomery and Åsberg Depression Rating Scale (MADRS) total score from open-label baseline to Week 52 of 4.3 ± 9.2 points in the 5–10 mg study, and 10.9 ± 10.0 in the 15–20 mg study. Post-hoc MMRM analyses of MADRS anhedonia factor scores also showed continued improvements over long-term treatment; patients showed a mean ± SE reduction from an open-label baseline to Week 52 of 3.10 ± 0.57 points in the 5–10 mg study, and 5.62 ± 0.60 in the 15–20 mg study. Conclusions Data from both studies confirm the safety and efficacy of flexibly dosed vortioxetine over 52 weeks of treatment and demonstrate that MADRS anhedonia factor scores continue to improve with long-term maintenance treatment.

Randomized and parallel-group study of cost-effectiveness analysis of escitalopram and desvenlafaxine in moderate-to-severe depression

Background: Cost-effectiveness analysis (CEA) measures costs and outcomes in monetary terms, it can be used to compare net benefits of all types of interventions. CEA is most important for chronic conditions such as depression requiring long-term/lifelong medications. Depression is a mood disorder affecting all age groups with a considerable impact on the quality of life. It imposes an economic burden on the individual, family, and society. Among antidepressants, selective serotonin reuptake inhibitors and serotonin-noradrenaline reuptake inhibitors are commonly preferred since they are well-tolerated and efficacious. As there are only few studies done in Indian population to compare the efficacy and tolerability of Escitalopram and Desvenlafaxine, and no CEA have been done to compare the cost-effectiveness of Escitalopram and Desvenlafaxine, the present study was taken up. Therefore, the present study was undertaken. Aims and Objectives: The aim of the study was to evaluate the cost-effectiveness of Escitalopram and Desvenlafaxine in the treatment of moderate-to-severe depression. Materials and Methods: A randomized, open-label, standard controlled, parallel-group, and 8-week study of CEA of Escitalopram and Desvenlafaxine was performed in 60 subjects with newly diagnosed moderate-to-severe depression. Clinical improvement was assessed using the montgomery and asberg depression rating scale (MADRS). CEA was analyzed using average cost-effectiveness ratio (ACER) and increment cost-effectiveness ratio (ICER). Results: Escitalopram and Desvenlafaxine showed a significant reduction in the total MADRS scores. Escitalopram showed a faster onset of action and was more efficacious than Desvenlafaxine in reducing depressive symptoms. ACER shows a lesser cost required for Escitalopram over Desvenlafaxine. Negative ICER and increment net benefit analysis demonstrate that Escitalopram is cost-effective versus Desvenlafaxine. Study drugs were well tolerated, with mild nausea in the Desvenlafaxine group. Conclusion: Escitalopram was more cost-effective in comparison to Desvenlafaxine in moderate to severe depression.

Brain Connectivity and Symptom Changes After Transcranial Magnetic Stimulation in Patients With Borderline Personality Disorder.

ObjectivesRepetitive transcranial magnetic stimulation (rTMS) is an innovative method in the treatment of borderline personality disorder (BPD). We hypothesized that prefrontal rTMS in patients with BPD leads to improved BPD symptoms and that these effects are associated with brain connectivity changes.MethodsFourteen patients with BPD received 15 sessions of individually navigated prefrontal rTMS over the right dorsolateral prefrontal cortex. Clinical effects were measured by the Borderline Symptom List 23, UPPS-P, the Difficulties in Emotion Regulation Scale (DERS), the Zung Self-Rating Anxiety Scale (SAS), and the Montgomery and Åsberg Depression Rating Scale (MADRS). Effects of rTMS on brain connectivity were observed with a seed correlation analysis on resting-state fMRI and with a beta series correlation analysis on Go/No Go tasks during fMRI. Assessments were made before and immediately after the treatment.ResultsThe assessments after rTMS showed significant reductions in two subscales of UPPS-P, and in DERS, SAS, and MADRS. The brain connectivity analysis revealed significant decreases in amygdala and insula connectivity with nodes of the posterior default mode network (pDMN; precuneus, posterior cingulate cortex, parietal lobules). Connectivity changes were observed both in the resting state and during inhibition. The decrease of amygdala-pDMN connectivity was positively correlated with reduced depression and lack of premeditation after rTMS.ConclusionsDespite the study limitations (open single-arm study in a small sample), our findings suggest a possible neural mechanism of rTMS effect in BPD, reduced amygdala connectivity with the pDMN network, which was positively associated with symptom reduction.

Skin conductance while facing emotional pictures at day 7 helps predicting antidepressant response at three months in patients with a major depressive episode

There are currently no reliable biological markers to identify antidepressant responders in patients suffering from major depressive disorder. In this longitudinal pilot study, we measured skin conductance response (SCR) to assess patients’ emotional reactivity after antidepressant treatment initiation. Fifty-four adult patients with a major depressive episode were recruited and followed up for 3 months. After one day of antidepressant treatment (D1) and then at day 7 (D7), emotional stimuli were presented on a computer screen while SCR and subjective emotional response were recorded. Three months later, we used Montgomery and Åsberg Depression Rating Scale (MADRS) to screen patients for treatment response, and distinguished responders (N = 28) from non-responders (N = 15). While SCR at D1 did not differ between responders and non-responders, SCR at D7 was higher in responders for both positive, negative and neutral stimuli. Skin conductance rates at D7 had a relatively poor negative predictive value (38%) but a strong positive predictive value (95%). Further studies are needed to replicate in a larger sample, and validate, these preliminary results which suggest that electrodermal activity after treatment initiation could help predict antidepressant efficacy.

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Salient symptoms and course of depression in elderly diabetes mellitus patients in South Indian populationBackground -Depression and diabetes have a bidirectional relationship . Due to high prevalence and immense hidden burden for both conditions , the association should be considered as an important public health concern .Characteristics of depression in diabetes patients remains poorly studied . A clear understanding of the qualitative nature of depression in a highly vulnerable population like the elderly will provide promising avenues for reducing the disease burden for both entities .Aim -To explore the salient features and course of depression in elderly diabetes patients in south indiaMaterials and Methods -Elderly diabetic patients with scores of >5 (N= 52) on the Patient Health Questionnaire-9 were evaluated . Hamilton depression and anxiety ( HAM-A , HAM -D ) scales along with Montgomery and Asberg Depression Rating Scale (MADRS) were administered . Qualitative aspects were obtained via detailed clinical interview by a psychiatrist .Results -80% individuals (N=42) had ‘mild to moderate’ symptoms with multiple recurrences or a long ( >1yr) course for 86.5 % (N= 45) individuals . Fatigue , insomnia , somatic anxiety and inner tension dominated the clinical picture. Persistent symptoms were positively correlated with higher HbA1c , higher BMI and multimorbid state .Discussion -Elderly diabetes patients had a chronic and recurrent course with milder nature of symptoms with multiple factors influencing the clinical picture . Regular patients at the medicine OPD were found to have depressive features on incidental screening , emphasising the importance of physicians in tackling the burden .

An Ayurvedic Management of Depression in Hypothyroidism - A Case Report

Background: Hypothyroidism is one of the most common endocrinal disorders which are mainly diagnosed basing on the laboratory investigations. In hypothyroidism, most of the patients present with non-specific symptoms. Depression is one of the common non specific symptoms of hypothyroidism. Grading and management of depression along with the management of hypothyroidism is essential to prevent the risk of harm and provide potential benefit to the patient. Method: A 35 year old woman presented with a depressive disorder for the past one year. On thyroid screening she was found to have subclinical hypothyroidism. Depression was graded according to Montgomery and Asberg Depression Rating Scale (MADRS). Patient was managed with Ayurvedic drugs Kanchanara Gutika and Manasamitra vatakam on OPD basis. Result: She had a very good clinical improvement following the therapy. Thyroid screening assured the maintenance of Thyroid hormone levels and TSH in the normal range. MADR Scale showed marked improvement. Conclusion: We conclude that it is better to have a special focus on the management of depression along with thyroid screening when patients present with non specific symptoms as depression. Ayurvedic management showed good results on MADRS as well as thyroid hormone levels.

Evidence for Reduced Long-Term Potentiation-Like Visual Cortical Plasticity in Schizophrenia and Bipolar Disorder.

Several lines of research suggest that impairments in long-term potentiation (LTP)-like synaptic plasticity might be a key pathophysiological mechanism in schizophrenia (SZ) and bipolar disorder type I (BDI) and II (BDII). Using modulations of visually evoked potentials (VEP) of the electroencephalogram, impaired LTP-like visual cortical plasticity has been implicated in patients with BDII, while there has been conflicting evidence in SZ, a lack of research in BDI, and mixed results regarding associations with symptom severity, mood states, and medication. We measured the VEP of patients with SZ spectrum disorders (n = 31), BDI (n = 34), BDII (n = 33), and other BD spectrum disorders (n = 2), and age-matched healthy control (HC) participants (n = 200) before and after prolonged visual stimulation. Compared to HCs, modulation of VEP component N1b, but not C1 or P1, was impaired both in patients within the SZ spectrum (χ 2 = 35.1, P = 3.1 × 10−9) and BD spectrum (χ 2 = 7.0, P = 8.2 × 10−3), including BDI (χ 2 = 6.4, P = .012), but not BDII (χ 2 = 2.2, P = .14). N1b modulation was also more severely impaired in SZ spectrum than BD spectrum patients (χ 2 = 14.2, P = 1.7 × 10−4). N1b modulation was not significantly associated with Positive and Negative Syndrome Scale (PANSS) negative or positive symptoms scores, number of psychotic episodes, Montgomery and Åsberg Depression Rating Scale (MADRS) scores, or Young Mania Rating Scale (YMRS) scores after multiple comparison correction, although a nominal association was observed between N1b modulation and PANSS negative symptoms scores among SZ spectrum patients. These results suggest that LTP-like plasticity is impaired in SZ and BD. Adding to previous genetic, pharmacological, and electrophysiological evidence, these results implicate aberrant synaptic plasticity as a mechanism underlying SZ and BD.

Relationship between childhood physical abuse and clinical severity of treatment-resistant depression in a geriatric population.

IntroductionWe assessed the correlation between childhood maltreatment (CM) and severity of depression in an elderly unipolar Treatment-Resistant Depression (TRD) sample.MethodsPatients were enrolled from a longitudinal cohort (FACE-DR) of the French Network of Expert TRD Centres.ResultsOur sample included 96 patients (33% of the overall cohort) aged 60 years or above, with a mean age of 67.2 (SD = 5.7). The majority of the patients were female (62.5%). The Montgomery and Asberg Depression Rating Scale (MADRS) and Quick Inventory Depression Scale-Self Report (QIDS-SR) mean scores were high, 28.2 (SD = 7.49) [MADRS score range: 0–60; moderate severity≥20, high severity≥35] and 16.5 (SD = 4.94) [IDS-SR score range: 0–27; moderate severity≥11, high severity≥16], respectively. Mean self-esteem scores were 22.47 (SD = 6.26) [range 0–30]. In an age- and sex-adjusted model, we found a positive correlation between childhood trauma (CTQ scores) and depressive symptom severity [MADRS (β = 0.274; p = 0.07) and QIDS-SR (β = 0.302; p = 0.005) scores]. We detected a statistically significant correlation between physical abuse and depressive symptom severity [MADRS (β = 0.304; p = 0.03) and QIDS-SR (β = 0.362; p = 0.005) scores]. We did not observe any significant correlation between other types of trauma and depressive symptom severity. We showed that self-esteem (Rosenberg scale) mediated the effect of physical abuse (PA) on the intensity of depressive symptoms [MADRS: b = 0.318, 95% BCa C.I. [0.07, 0.62]; QIDS-SR: b = 0.177, 95% BCa C.I. [0.04, 0.37]]. Preacher & Kelly’s Kappa Squared values of 19.1% (k2 = 0.191) and 16% (k2 = 0.16), respectively for the two scales, indicate a moderate effect.ConclusionTo our knowledge, this is the first study conducted in a geriatric TRD population documenting an association between childhood trauma (mainly relating to PA) and the intensity of depressive symptoms.

Subsyndromal symptoms in bipolar disorder

Introduction The inter-critical phase in bipolar disorder may contain symptoms that do not meet the diagnostic criteria for a thymic episode. According to studies, these symptoms are common and usually associated with impaired psychosocial and family functioning.ObjectivesStudy the subsyndromal symptoms in remitted patients with bipolar disorder, and their functioning repercussions.MethodsWe conducted a cross-sectional, descriptive and analytical study, in the outpatient psychiatry department of the University Hospital in Sfax (Tunisia) among 30 remitted patients with bipolar disorder. We used: the Montgomery And Asberg Depression Rating Scale (MADRS), the Angst Hypomania Questionnaire and the FAST test to assess functioning levels.ResultsThe average age of our population was 44.37±15.45 years with a sex ratio (M/F) =0.66. Most of them lived in urban areas (60%) and half of them did not go beyond the primary school level. Most did not have a constant job (76.6%). The average number of previous thymic episodes was 2±1.33 times/year. A quarter of the patients (26.6%) had hypomanic symptoms in the intercritical phase and 20% had depressive symptoms. Hypomanic symptoms were correlated with tobacco use (p=0.035). Depressive symptoms weremore frequent in men (p=0.074). Functioninglevel was lower in subjects living in rural areas (p=0.065).ConclusionsOur study suggests that residual symptoms were frequent with a significant functional impact. As a result, their identification and management are highly essential to improve the overall functioning of patients with bipolar disorder.

Screening for Depression in Old Age With Very Short Instruments: The DIA-S4 Compared to the GDS5 and GDS4.

Purpose of the Study: This article presents a short form of the Depression in old Age Scale with four items (DIA-S4). The diagnostic accuracy of the DIA-S4 was tested and compared to short forms of the Geriatric Depression Scale (GDS5, GDS4). Methods: Using the Montgomery and Asberg Depression Rating Scale (MADRS) as gold standard, the scales were validated with a sample of N = 331 geriatric inpatients. Results: The DIA-S4 had an internal consistency of .70, the GDS5 of .55, and the GDS4 of .58. The test efficiency considering ROC analyses for the DIAS-4 was AUC = .86, for the GDS5 AUC = .78, and for the GDS4 AUC = .74. The best cut-off score for the DIA-S4 was 1.5 with a sensitivity of 87% and a specificity of 68%, for the GDS4 1.5 with a sensitivity of 58% and a specificity of 81%, and for the GDS5 1.5 with a sensitivity of 88% and a specificity of 49%. Conclusion: Based on the data of this study, the DIA-S4 shows better psychometrical qualities than the GDS5 and the GDS4. It can be used as a very short screening scale for depression in old age in research and clinical practice.

Pharmacological interventions for treatment-resistant depression in adults.

Pharmacological interventions for treatment-resistant depression in adults.

A German climbing study on depression: a bouldering psychotherapeutic group intervention in outpatients compared with state-of-the-art cognitive behavioural group therapy and physical activation \u2013 study protocol for a multicentre randomised controlled trial

BackgroundBesides classical approaches for treating depression, physical activity has been demonstrated to be an effective option. Bouldering psychotherapy (BPT) combines psychotherapeutic interventions with action-oriented elements from the field of climbing. The aim of this study is to investigate the effectiveness of BPT compared with a home-based exercise program (EP - active control group, superiority trial) and state-of-the-art cognitive behavioural therapy (CBT – non-inferiority trial).MethodsThe study is being conducted as a multicentre randomised controlled intervention trial at three locations in Germany. Participants are being randomised into three groups: BPT, CBT, or EP, each with a 10-week treatment phase. A power analysis indicated that about 240 people should initially be included. The primary outcome of the study is the Montgomery and Asberg Depression Rating Scale (MADRS) directly after the intervention. Additional measurement points are located three, six, and 12 months after the end of the intervention. The data are being collected via computer-assisted telephone interviews. Statistical analyses comprise regression analyses to test for the superiority of BPT over EP. To test for the non-inferiority of BPT and CBT, a non-inferiority margin of 1.9 points in the Patient Health Questionnaire (PHQ-9) and two non-inferiority margins for the MADRS (half of the two smallest Cohen’s d values from the current meta-analyses) was predefined. The mean difference between CBT and EP is being used as a supplementary equivalence margin.DiscussionThis is the first study to investigate the effect of a bouldering psychotherapy (BPT) on outpatients’ depressive symptoms compared with mere physical activity (superiority analysis) and state-of-the-art cognitive behavioural therapy (CBT, non-inferiority analysis).Methodological strengths of the study are the elaborated, multicentred, randomised, controlled design. Assessors are blinded with regard to group allocation which leads to high objectivity. The study is conducted in a naturalistic setting, which leads to high external validity. Methodological limitations might be the clinical heterogeneity of the sample, which may dilute the intervention effects.Trial registrationISRCTN12457760 (Registration date: 26 July 2017, retrospectively registered).

Comorbid hypertension in patients with major depressive disorder – Results from a European multicenter study

The objective of the present multicenter study was to elucidate relevant associations between major depressive disorder (MDD) and comorbid hypertension that are known for their frequent co-occurrence and interaction with regard to functional disability. Demographic and clinical information of altogether 1410 patients were retrieved cross-sectionally. Consecutively, a comparison of patient characteristics between MDD subjects with and without comorbid hypertension were conducted by descriptive statistics, analyses of covariance (ANCOVA) and binary logistic regression analyses. The point prevalence rate for comorbid hypertension was 18.9%. Patients with MDD+comorbid hypertension were significantly older, heavier, more likely to be in a relationship, inpatient and diagnosed with further comorbid chronic somatic diseases including heart disease, diabetes and thyroid dysfunction. In addition, individuals with MDD and comorbid hypertension exhibited a higher score at the Montgomery and Åsberg Depression Rating Scale (MADRS) at onset of the current depressive episode. Melancholic features of depression showed a higher probability. The first line antidepressant treatment did not differ significantly between MDD subjects with versus without comorbid hypertension. Augmentation with pregabalin and combination with one additional antidepressant, however, were more common in the MDD+hypertension group. In conclusion, high blood pressure may influence illness severity and is associated with a distinct psychopathology in MDD patients. Patients with MDD and comorbid hypertension, that seems to be underdiagnosed in MDD patients compared to the general population, are subject to additional somatic diseases in almost 100 percent of the cases and hence, need to be screened and treated accordingly.

Clinical factors predicting treatment resistant depression: affirmative results from the European multicenter study.

ObjectivesClinical variables were investigated in the ‘treatment resistant depression (TRD)‐ III’ sample to replicate earlier findings by the European research consortium ‘Group for the Study of Resistant Depression’ (GSRD) and enable cross‐sample prediction of treatment outcome in TRD.Experimental procedures TRD was defined by a Montgomery and Åsberg Depression Rating Scale (MADRS) score ≥22 after at least two antidepressive trials. Response was defined by a decline in MADRS score by ≥50% and below a threshold of 22. Logistic regression was applied to replicate predictors for TRD among 16 clinical variables in 916 patients. Elastic net regression was applied for prediction of treatment outcome.ResultsSymptom severity (odds ratio (OR) = 3.31), psychotic symptoms (OR = 2.52), suicidal risk (OR = 1.74), generalized anxiety disorder (OR = 1.68), inpatient status (OR = 1.65), higher number of antidepressants administered previously (OR = 1.23), and lifetime depressive episodes (OR = 1.15) as well as longer duration of the current episode (OR = 1.022) increased the risk of TRD. Prediction of TRD reached an accuracy of 0.86 in the independent validation set, TRD‐I.ConclusionSymptom severity, suicidal risk, higher number of lifetime depressive episodes, and comorbid anxiety disorder were replicated as the most prominent risk factors for TRD. Significant predictors in TRD‐III enabled robust prediction of treatment outcome in TRD‐I.

Reversible psychiatric adverse effects related to deep brain stimulation of the anterior thalamus in patients with refractory epilepsy

ObjectiveAnterior nucleus of thalamus (ANT) deep brain stimulation (DBS) is becoming a more common treatment for drug-resistant epilepsy. Epilepsy and depression display a bidirectional association. Anterior nucleus of thalamus has connections to anterior cingulate cortex and orbitomedial prefrontal cortex, hence, a possible role in emotional and executive functions, and thus, ANT DBS might exert psychiatric adverse effects. Our aim was to evaluate previous and current psychiatric symptoms in patients with epilepsy undergoing ANT DBS surgery and assess the predictability of psychiatric adverse effects. Programming-related psychiatric adverse effects are also reported. MethodTwenty-two patients with ANT DBS for retractable epilepsy were examined, and a psychiatric evaluation of depressive and other psychiatric symptoms was performed with Montgomery and Åsberg Depression Rating Scale (MADRS), Beck Depression Inventory (BDI), and Symptom Checklist prior to surgery, concentrating on former and current psychiatric symptoms and medications. The follow-up visit was one year after surgery. ResultsAt the group level, no changes on mood were observed during ANT DBS treatment. Two patients with former histories of depression experienced sudden depressive symptoms related to DBS programming settings; these were quickly alleviated after changing the stimulation parameters. In addition, two patients with no previous histories of psychosis gradually developed clear paranoid and anxiety symptoms that also relieved slowly after changing the programming settings. ConclusionThe majority of our ANT DBS patients did not experience psychiatric adverse effects. Certain DBS parameters might predispose to sudden depressive or slowly manifesting paranoid symptoms that are reversible via programming changes.

Utilisation problématique d’Internet et des jeux vidéo chez des étudiants en médecine

Dependence on the Internet and video games would have an impact on academic performance and mental health.Objective Highlight some of the interest factors in a first-year medical student population who will be subjected during their studies and future to the intensive use of these technologies.Method A self-questionnaire was proposed, from a free access link from February to March 2014, to all first-year medical students at the University of Namur in Belgium. It consisted of questions related to socio-demographic data, Perceived Stress Scale (PSS14), the Internet Addiction Test (IAT), the Problem Video Game Playing (PVP) and the Montgomery and Asberg Depression Rating Scale (MADRS).Results According to the Internet Addiction Test (IAT), 1% of the students are addicted to the Internet and 24,4% have occasional problematic use. According to Problem Video Game Playing (PVP), 11,4% of the students playing video games are problem gamblers. The data also show significantly higher scores for problematic use of the Internet and video games among stressed students, depressed students and those with poor academic performance.Conclusion We draw attention to the necessary debate between the rational use and the problematic use of new technologies as well as the need for longitudinal prevention from the beginning of studies.