Newcastle Scales Research Articles

Is there a dysfunction in the visual system of depressed patients?

BackgroundThe aim of the current study was to identify a possible locus of dysfunction in the visual system of depressed patients.Materials and MethodsFifty Major Depressive patients aged 21–60 years and 15 age-matched controls took part in the study The diagnosis was obtained with the SCAN v 2.0. The psychometric assessment included the HDRS, the HAS, the Newcastle Scales, the Diagnostic Melancholia Scale and the GAF scale. Flash Electroretinogram and Electrooculogram were performed in all subjects. The statistical analysis included ANCOVA, Student's t-test and Pearson Product Moment Correlation Coefficient were used.ResultsThe Electro-oculographic findings suggested that all subtypes of depressed patients had lower dark trough and light peak values in comparison to controls (p < 0.001), while Arden ratios were within normal range. Electroretinographic recordings did not reveal any differences between patients and controls or between subtypes of depression.DiscussionThe findings of the current study provide empirical data in order to assist in the understanding of the international literature and to explain the mechanism of action of therapies like sleep deprivation and light therapy.

The relationship of regional cerebral blood flow with subtypes of major depression

The aim of the present study was to search for differences between subtypes of major depression with the use of single photon emission tomography. Materials and methods: Fifty (50) patients aged 21–60 years suffering from Major Depression according to DSM-IV took part in the study. The SCAN v 2.0 was used to assist clinical diagnosis. The psychometric assessment included the HDRS, the HAS, the GAF, the Newcastle scales and the Diagnostic Melancholia Scale (DMS). Single Photon Emission Computerized Tomography (HMPAO SPECT) was used to assess regional cerebral blood flow. The methods of analysis included chi-square test, ANCOVA, and Discriminant Function Analysis. Results: Forty one (82%) depressed patients had abnormal SPECT findings. The most consistent finding in all patients across all subtypes was a global brain hypoperfusion, which did not include the frontal lobes. The most impressive finding was the relative increase of right frontal lobe perfusion in atypicals, in contrast to the relative decrease of perfusion in both the melancholic and the ‘undifferentiated’ patients in that particular region. The reverse was true for the right occipital lobe. Conclusion: The results of the current study provide support for the old hypothesis on the existence of two distinct types of depression, characterized by different underlying psychopathologies, but also provide strong evidence for a neurobiological abnormality underlying atypical depression, the subtype closer to the old concept of ‘neurotic’ depression, which was considered to be psychological or reactive in origin.

Pattern-reversed visual evoked potentials in subtypes of major depression

There are no articles in the international psychiatric literature reporting subclinical visual system disorders in depressed patients, although a disturbance of circadian rhythms is one of the prominent theories of the etiopathogenesis of depression. Fifty patients aged 21–60 years suffering from major depression according to DSM-IV criteria, and 20 controls took part in the study. Diagnosis was obtained with the aid of the Schedules for Clinical Assessment in Neuropsychiatry version 2.0. Psychometric assessment included the Hamilton Depression Rating Scale, the Hamilton Anxiety Scale, the 1965 and 1971 Newcastle Scales, and the Diagnostic Melancholia Scale. All subjects had normal electroretinographic and flash-visual evoked potential (VEP) recordings. Pattern-reversed VEPs (PR-VEPs) were recorded from each eye separately. Three-way analysis of covariance, Student's t-test and Pearson product–moment correlation coefficients were used for the analysis. All recordings were within the normal range. N80 and P100 latency were significantly shorter in atypical and significantly longer in melancholic patients. There was a positive correlation between N80 and P100 latency and age of onset and melancholic indices, and a negative correlation with the presence and the number of life events precipitating onset. The results of the current study suggest that PR-VEPs are consistent with other biological data supporting the atypical-melancholic distinction. The most important finding was the strong negative relationship between PR-VEP latency and stressful life events. The current study also provided data inconsistent with the hyperarousal theory and in support of an arousal dysregulation hypothesis for major depression.

Morning and Evening Plasma Melatonin and Dexamethasone Suppression Test in Patients with Nonseasonal Major Depressive Disorder from Northern Greece (Latitude 40–41.5°)

Introduction: The present study aimed to search for correlations between melatonin (MT) levels and the dexamethasone suppression test (DST) and clinical variables. Methods: Fifty depressed patients aged 21–60 years took part in the study. The Schedules for Clinical Assessment in Neuropsychiatry, version 2.0, and the International Personality Disorders Examination were used for diagnosis. Psychometric assessment included the Hamilton Depression Rating Scale, the Hamilton Anxiety Scale, the General Assessment of Funtioning Scale, the Newcastle scales and the Diagnostic Melancholia Scale. The DST and 9.00 and 23.00 h MT values were assessed. Statistical analysis included Student’s t test, Pearson product moment correlation coefficient and forward stepwise multiple linear regression analysis. Results: Melancholic patients had lower 23.00 h MT values in comparison to the rest of the patients and the atypical and ‘undifferentiated’ patients. Conclusion: The current study shows that low MT values were closely related to melancholic depression. Distinct quality of mood, psychomotor agitation or retardation and anorexia or weight loss seemed to be responsible for this relationship.

The relationship of regional cerebral blood flow with subtypes of major depression

Abstract The aim of the present study was to search for differences between subtypes of major depression with the use of single photon emission tomography. Materials and methods : Fifty (50) patients aged 21–60 years suffering from Major Depression according to DSM-IV took part in the study. The SCAN v 2.0 was used to assist clinical diagnosis. The psychometric assessment included the HDRS, the HAS, the GAF, the Newcastle scales and the Diagnostic Melancholia Scale (DMS). Single Photon Emission Computerized Tomography (HMPAO SPECT) was used to assess regional cerebral blood flow. The methods of analysis included chi-square test, ANCOVA, and Discriminant Function Analysis. Results : Forty one (82%) depressed patients had abnormal SPECT findings. The most consistent finding in all patients across all subtypes was a global brain hypoperfusion, which did not include the frontal lobes. The most impressive finding was the relative increase of right frontal lobe perfusion in atypicals, in contrast to the relative decrease of perfusion in both the melancholic and the ‘undifferentiated’ patients in that particular region. The reverse was true for the right occipital lobe. Conclusion : The results of the current study provide support for the old hypothesis on the existence of two distinct types of depression, characterized by different underlying psychopathologies, but also provide strong evidence for a neurobiological abnormality underlying atypical depression, the subtype closer to the old concept of ‘neurotic’ depression, which was considered to be psychological or reactive in origin.

Depressive psychomotor disturbance, cortisol, and dexamethasone

We examine the dexamethasone suppression test as a biological correlate of melancholia as defined by the CORE system, a scale for rating objective signs of psychomotor disturbance. Postdexamethasone cortisol concentrations and rates of nonsuppression were higher in CORE, Newcastle, and DSM-III-R defined melancholic groups. These differences, however, were no longer significant after partialling out the combined effects of age, dexamethasone, and basal cortisol concentrations. There was a significant correlation between the CORE (but not the Newcastle) scale and 8:00 AM postdexamethasone cortisol levels, which persisted after partialling out those same three covariates. Dexamethasone concentrations themselves were lower in CORE- and Newcastle-defined melancholics, though these were no longer significant after covarying for cortisol concentrations. Dexamethasone levels were also significantly inversely correlated with CORE and Newcastle scales. A significant correlation between CORE (but not Newcastle) scores and dexamethasone levels at 4:00 PM persisted after partialling out the effects of age and cortisol. These findings indicate an intriguing relationship between the CORE system as a dimensional construct for rating psychomotor disturbance, and both postdexamethasone cortisol and dexamethasone concentrations.

O-26-1 - Depressive psychomotor disturbance, cortisol and dexamethasone

We examine the dexamethasone suppression test as a biological correlate of melancholia as defined by the CORE system, a scale for rating objective signs of psychomotor disturbance. Postdexamethasone cortisol concentrations and rates of nonsuppression were higher in CORE, Newcastle, and DSM-III-R defined melancholic groups. These differences, however, were no longer significant after partialling out the combined effects of age, dexamethasone, and basal cortisol concentrations. There was a significant correlation between the CORE (but not the Newcastle) scale and 8:00 am postdexamethasone cortisol levels, which persisted after partialling out those same three covariates. Dexamethasone concentrations themselves were lower in CORE- and Newcastle-defined melancholics, though these were no longer significant after covarying for cortisol concentrations. Dexamethasone levels were also significantly inversely correlated with CORE and Newcastle scales. A significant correlation between CORE (but not Newcastle) scores and dexamethasone levels at 4:00 pm persisted after partialling out the effects of age and cortisol. These findings indicate an intriguing relationship between the CORE system as a dimensional construct for rating psychomotor disturbance, and both postdexamethasone cortisol and dexamethasone concentrations.

Cognitive function in major depression

Forty patients with a major depressive episode were divided into equal endogenous and neurotic sub-groups using the Newcastle scale. They were all rated on the 17-item Hamilton scale and with a variety of neuropsychological tests. They were compared with 20 age- and education-matched control subjects. Both endogenous and neurotic groups had impaired memory function on the auditory verbal learning test; recall and recognition were equally impaired suggesting that effort was not a major determinant of performance. The endogenous group was more impaired on digit symbol substitution and the Trail making Test (A and B). Impairment was correlated with symptom scores on the Hamilton and Newcastle scales, even after allowing for the effect of age. It is concluded that the conventional distinction between organic and functional impairment breaks down in severe depressive illness. The implications of this for clinical neuropsychological testing and the anatomy of the brain dysfunction in depressive illness are discussed.

Rating scales for mood disorders: applicability, consistency and construct validity.

Rating scales for mood disorders have been reviewed with special reference to their consistency, applicability, and validity. Diagnostic scales with a biometric reference to antidepressants have been developed on the basis of the Newcastle Scales. This Diagnostic Melancholia Scale (DMS) includes two dimensions, one measuring endogenous depression, and one measuring reactive depression. These dimensions were found not to be mutually exclusive as 30% of the depressed patients scored high on both dimensions. Scales measuring outcomes of treatment were subdivided into (a) scales measuring disability of clinical depression (melancholia), anxiety, and mania, (b) scales measuring distress as a construct of side-effects during treatment, and (c) scales measuring discomfort or quality of life. Disability, distress and discomfort should be separately validated as they reflect different aspects of outcome of treatment. Self-rating scales have their main applicability in the measurement of discomfort.

The diagnostic Melancholia scale (DMS): dimensions of endogenous and reactive depression with relationship to the newcastle scales

The two diagnostic Newcastle Scales for depression have been evaluated in a drug trial with antidepressants. By use of latent structure analysis (Rasch models) it was found that two dimensions are necessary for describing the diagnosis of depression, one for endogenous features and one for reactive features. Of the depressed patients 50% had a pure endogenous depression, 14% had a pure reactive depression, 32% had mixed endogenous and reactive depression, and 4% had uncertain diagnosis. In the pure endogenous depression group 77% had a monotonically non-decreasing improvement curve during treatment whereas in the other diagnostic categories around 50% had such an improvement.

Reliability and validity of the Newcastle Scales in relation to ICD-9-classification.

The assessment of endogenous depression by means of the Newcastle Scales (1965, 1971) has been validated by their correlation with biological findings in many previous studies. However, reliability and cross validation studies are lacking for these scales. We found the reliability of the Newcastle Scales to be sufficient or at least moderate in a sample of 70 inpatients with major depression. In order to cross validate both scales, the clinical classification according to ICD-9 and the assessment of the Newcastle Scales have been performed independently in a sample of 112 inpatients with Major Depressive Disorder (RDC). The rate of agreement between clinical diagnosis and classification according to the Newcastle Scales of endogenous depression is only fair. However, a modification of the diagnostic algorithm applied to the items of the Newcastle Scales I (1965) improves the rate of agreement considerably. The Newcastle Scale I turned out to represent a heterogenous concept without sufficient transferability. Modifications of both scales are proposed.

Afternoon cortisol levels before (spontaneous) and after suppression with dexamethasone or oxazepam in depressed patients

In 35 hospitalized depressed patients afternoon plasma cortisol (15.00–15.20 h) was measured in 3 ways: (1) spontaneous, (2) 2 h after administration of 45 mg oxazepam, and (3) 16 h after administration of 2 mg dexamethasone. Dexamethasone and oxazepam caused a marked suppression of cortisol secretion, the former being the most pronounced. A significant correlation between spontaneous and suppressed cortisol levels was found and a correlation between the suppressed cortisol levels was also demonstrated. Both spontaneous and suppressed cortisol values correlated with measures of type (Newcastle scales) and severity (Hamilton rating scale) of depression, and the highest correlations were obtained with cortisol values after dexamethasone suppression. Analysis of the items of the Hamilton rating scale for depression showed a high correlation with retardation (items 7 + 8) and somatic complaints (items12 + 13). A high correlation with the items 8 + 9 + 10 + 12, as found in an earlier study, was also found in this study. On the basis of these findings it is concluded that hypersecretion of cortisol measured spontaneously or after suppression is not a true diagnostic measure (within a group of depressed patients), but reflects differences in the intensity of certain psychiatric symptoms constituting the depressive syndrome.

World Health Organization Schedule for Standardized Assessment of Depressive Disorders (WHO/SADD-5). Item combinations and interobserver reliability.

In this study we have examined four parts of the 5th revision of the World Health Organization schedule for Standardized Assessment of Depressive Disorders (WHO/SADD-5): (I) items that cover the present depressive state; (II) items that cover the psychiatric history; (III) a global assessment scale for the severity of depression, and (IV) the current ICD-9 diagnosis. Our analysis was based on a comparison of the interobserver reliability of item combinations leading to DSM-III, RDC, Newcastle and Melancholia Scale classifications of patients with depressive disorders. To facilitate these combinations we had added 4 items to SADD: (a) quality of depression, (b) persistence of depression, (c) reactivity of symptoms, and (d) accusations of others. Our results showed that WHO/SADD-5 has an acceptable degree of interobserver reliability both at the levels of global assessment of severity of depression and ICD-9 diagnosis, whereas the item combinations obtained lower intraclass coefficients. However, the items analysis focused on two SADD subscales of acceptable interobserver reliability: a severity scale of 16 items selected from our Melancholia Scale, and a diagnostic scale of another 10 items selected from the two Newcastle Scales.

The instrumental use of rating scales for depression.

This statistical analysis of the instrumental use of rating scales for depression has considered the following issues: Comprehensiveness, item definition, item combination, administration, applicability, homogeneity, inter-observer reliability, and validity. Within the compartment or dimension of severity of depression a subscale of the Hamilton Depression Scale (or the Melancholia Scale) was shown to have reached an instrumental perfection, e.g. as an outcome measure of antidepressant treatment. Within the compartment of personality scales the Marke Nyman Temperament Scale demonstrated that unipolar depressed patients with a score pattern similar to bipolar patients responded well and favourably to lithium. Within the compartment of diagnostic rating scales for depression the Newcastle Scales showed that for patients with an endogenous score, but not for patients with a non-endogenous score, a significant correlation existed between plasma levels of imipramine or clomipramine and clinical response.

Depression and Newcastle scales. Their relationship to Hamilton's scale.

Ninety-seven patients, treated with E.C.T. and followed up to three months, were rated initially on the Newcastle diagnosis and E.C.T. prediction scales and Hamilton's scale. After E.C.T. and at three months they were rated on a four-point global scale and Hamilton's scale. With respect to original diagnoses of endogenous and neurotic depression, only eight patients were misclassified by the diagnosis scale. Patients categorized as \`endogenous' had a significantly better outcome at three months as judged by Hamilton's and global scales than those classified as \`neurotic'. Patients for whom a good outcome was predicted by the E.C.T. scale also had a significantly better outcome as judged by the two assessment methods than those for whom a poor outcome was predicted. Increasing scores on the diagnosis and E.C.T. scales were closely correlated with mean falls in Hamilton's score. On rating 11 patients independently on the two Newcastle scales, two or more raters achieved complete concordance with respect to differential diagnosis and good or bad E.C.T. response. Severity of illness as judged by Hamilton's scale was found to be equal for both types of depression, a finding supporting the binary view of depression. With regard to the categorical versus the dimensional question the evidence was inconclusive but was felt to fit a compromise hypothesis—that neurotic depression is dimensional and endogenous categorical.