Structured Clinical Interview For DSM Disorders Research Articles

Application of network analysis to identify interactive systems of eating disorder psychopathology

Traditional approaches for the classification of eating disorders (EDs) attribute symptoms to an underlying, latent disease entity. The network approach is an alternative model in which mental disorders are represented as networks of interacting, self-reinforcing symptoms. This project was the first to use network analysis to identify interconnected systems of ED symptoms. Adult participants (n = 143; 77.6% women) with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) ED were recruited from the community to take part in a larger ongoing longitudinal study. The Structured Clinical Interview for DSM Disorders (SCID-I) was used to establish diagnoses. An undirected network of ED symptoms was created using items from the Eating Pathology Symptoms Inventory (EPSI) and the R package qgraph. Body checking emerged as the strongest and most important single symptom in the entire network by having the shortest average distance to other symptoms in the network, and by being the most frequent symptom on the path between any two other symptoms. Feeling the need to exercise every day and two symptoms assessing dietary restraint/restricting emerged as 'key players', such that their removal from the network resulted in maximal fracturing of the network into smaller components. Although cognitive-behavioral therapy for EDs focuses on reducing body checking to promote recovery, our data indicate that amplified efforts to address body checking may produce stronger (and more enduring) effects. Finally, results of the 'key players analysis' suggested that targeting interventions at these key nodes might prevent or slow the cascade of symptoms through the 'network' of ED psychopathology.

Assessing depression in a geriatric cancer population.

To examine the ability of three popular self-report measures of depression to assess depression in a geriatric cancer setting. Cancer patients 70years or older and on active treatment completed the Geriatric Depression Scale-Short Form, the Hospital Anxiety and Depression Scale, and the Center for Epidemiological Studies Depression Scale-Revised, and were interviewed using the depression module of the Structured Clinical Interview for DSM disorders (SCID) as the 'gold standard.' Analyses included calculating internal consistency, ROC curves, and the sensitivity and specificity to detect major depression (MDD) or minor depression (i.e. subthreshold depression). In a sample of 201 cancer patients (85% White; 64% completed college degree or higher), all three of the self-report measures produced adequate internal consistency and predicted depression greater than chance. However, the published cutoff scores for detecting MDD produced inadequate sensitivity, suggesting these scores will miss as many as 33%-83% of geriatric cancer patients who are depressed. Revised cutoff scores were lower than published cutoff scores. Although these measures produced good internal consistency and were better than chance at predicting depression in a geriatric cancer sample, the published cutoff scores for these measures did not perform well in predicting MDD nor minor depression. Of the three measures, the CES-D appeared to have the most utility. This data suggests that these popular screening measures may be inadequate for reliably identifying depression in a geriatric cancer population. Researchers and clinicians, therefore, should use caution when selecting depression measures for geriatric cancer patients and consider using the lower cut-off scores presented here.

Diagnosing Depression in Chronic Pain Patients: DSM-IV Major Depressive Disorder vs. Beck Depression Inventory (BDI).

BackgroundDiagnosing depression in chronic pain is challenging due to overlapping somatic symptoms. In questionnaires, such as the Beck Depression Inventory (BDI), responses may be influenced more by pain than by the severity of depression. In addition, previous studies have suggested that symptoms of negative self-image, a key element in depression, are uncommon in chronic pain-related depression. The object of this study is to assess the relationship of the somatic and cognitive-emotional items of BDI with the diagnosis of depression, pain intensity, and disability.MethodsOne hundred consecutive chronic pain patients completed the Structured Clinical Interview for DSM Disorders (SCID) for the diagnosis of major depressive disorder (MDD) according to DSM-IV. Two subscales of BDI (negative view of self and somatic-physical function) were created according to the factor model presented by Morley.ResultsIn the regression analysis, the somatic-physical function factor associated with MDD, while the negative view of self factor did not. Patients with MDD had higher scores in several of the BDI items when analysed separately. Insomnia and weight loss were not dependent on the depression diagnosis.LimitationsThe relatively small sample size and the selected patient sample limit the generalisability of the results.ConclusionsSomatic symptoms of depression are also common in chronic pain and should not be excluded when diagnosing depression in pain patients. Regardless of the assessment method, diagnosing depression in chronic pain remains a challenge and requires careful interpretation of symptoms.

PHQ-9 and PHQ-2 for Screening Depression in Chinese Rural Elderly.

ObjectivesThis study aimed to explore cut-off scores of the 9-item Patient Health Questionnaire (PHQ-9) and 2-item Patient Health Questionnaire (PHQ-2) for depression screening in Chinese rural elderly.MethodsA cross-sectional study was conducted on 839 residents aged 60 years and above in rural areas of Liuyang County. PHQ-9 was adopted to evaluate depression. The Structured Clinical Interview for DSM Disorders (SCID-I) was adopted to diagnose major depressive disorder (MDD) as a golden standard. Sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio, Youden’s index and the receiver operating characteristic (ROC) curve were analyzed on PHQ-9 and PHQ-2.ResultsThe Cronbach's alphas of PHQ-9 and PHQ-2 were 0.82 and 0.76, respectively. The score of 8 of the PHQ-9 showed the highest Youden’s index of 0.85, with a sensitivity of 0.97 and specificity of 0.89 respectively, and the area under the ROC curve (AUC) was 0.97 (95% CI: 0.96–0.98). The score of 3 of PHQ-2 showed the highest Youden’s index of 0.79, with both sensitivity and specificity were 0.90 and the AUC was 0.94 (95% CI: 0.90–0.97).ConclusionsBoth PHQ-9 and PHQ-2 are valid screening instruments for depression in the rural elderly in China, with recommended cut-off scores of 8 and 3 respectively.

Prevalence of depression in Type 1 diabetes and the problem of over-diagnosis.

To determine the prevalence of depression and diabetes distress in adults with Type 1 diabetes and the rate of false-positives when compared with rates of major depressive disorder. The sample consisted of 368 individuals with Type 1 diabetes, aged > 19 years. Individuals completed: the eight-item Patient Health Questionnaire depression scale (PHQ8), which was coded using four scoring criteria (scores > 10, >12 and >15, and Diagnostic and Statistical Manual of Mental Disorders 5 (DSM) algorithm scores); the Type 1 Diabetes Distress Scale; and the Structured Clinical Interview for DSM Disorders (SCID) to assess major depressive disorder. The prevalence rates of depression according to the eight-item Patient Health Questionnaire were: score >10, 11.4%; score >12, 7.1%; score >15, 3.8%; and positive algorithm result, 4.6%. The prevalence of major depressive disorder was 3.5%; and the prevalence of at least moderate diabetes distress was 42.1%. Depending on the criterion used, the false-positive rate when using the Patient Health Questionnaire compared with the results when using the SCID varied from 52 to 71%. Of those classified as depressed on the PHQ-8 or Structured Clinical Interview for DSM Disorders, between 92.3 and 96.2% also reported elevated diabetes distress. No significant association was found between any group classed as having depression according to the PHQ8 or the SCID and HbA1c concentration. Depression was significantly associated with more other life stress, more complications and a lower level of education. We found an unexpectedly low rate of current depression and major depressive disorder in this diverse sample of adults with Type 1 diabetes, and a very high rate of false-positive results using the Patient Health Questionnaire. Considering the high prevalence of diabetes distress, much of what has been considered depression in adults with Type 1 diabetes may be attributed to the emotional distress associated with managing a demanding chronic disease and other life stressors and not necessarily to underlying psychopathology.

Evaluation of neurocognitive deficits in obsessive compulsive disorder with Adas-cog: A comparative study with the healthy control group

Objective: Obsessive compulsive disorder (OCD) is cha racterized by recurrent intrusive thoughts and repetitive behaviors or mental acts compulsions. Previous studies obviously indicate that OCD patients have several impairments in memory and other neurocognitive functions. Our primary aim is to assess the cognitive impairment in OCD patients through Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-Cog) which is widely used in Alzheimer's Dementia. Method: Thirty two patients with a diagnosis of OCD and twenty six healthy controls were administrated Structured Clinical Interview for DSM Disorders (SCID-I), Yale Brown Obsessive Compulsive Scale (Y-BOKS), ADAS-Cog Scale, Mini Mental Status Examination (MMSE), Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scales (HARS). Results: When we compared two groups, OCD subjects performed significantly worse in the fields of ADAS-Cog Total (p<0.0001), Word Recall (p<0.0001), Word Recognition (p<0.0001) Commands (p<0.0001), Constructional Praxis (p<0.05) and Orientation (p<0.05) Tests of ADAS-Cog compared to the healthy control group. Conclusion: We suggest that ADAS-Cog might be used as an available tool to assess some neurocognitive deficits in OCD patients. Further studies in larger samples of OCD patients are needed to assess the availability of ADAS-Cog in measuring the neurocognitive impairments.

Examination of a four-step treatment algorithm for postpartum psychosis

ABSTRACT FROM: Bergink V, Burgerhout KM, Koorengevel KM, et al . Treatment of psychosis and mania in the postpartum period. Am J Psychiatry 2015;172:115–23. Postpartum psychosis (PPP) is a severe...

Social cognition in children at familial high-risk of developing an eating disorder.

Objective: Diagnosis of an eating disorder (ED) has been associated with differences in social cognition. To date research investigating social cognition and ED has mainly employed patient and recovered samples. It is therefore unclear whether differences in social cognition are present prior to onset of ED, potentially contributing to development, or whether differences observed are a consequence of the disorder. We aimed to further explore whether individuals at high-risk for ED present social cognition characteristics previously found in ED groups.Methods: Our sample was drawn from a population-based cohort, the Avon Longitudinal Study of Parents and Children (ALSPAC). Data on maternal ED behaviors over the lifetime were collected through in-depth clinical interviews (n = 1128) conducted using the Structured Clinical Interview for DSM disorders (SCID), and were used to categorize mothers according to ED behaviors over the lifetime: Restricting and Excessive Exercising (n = 58), Purging (n = 70), Binge-eating (n = 72), Binging and Purging (n = 66), no ED (n = 862). High-risk status of children was determined using these maternal lifetime behavioral phenotypes. Children at high-risk (maternal ED exposure) were compared to children at low-risk (born to mothers with no ED) on three measures of social cognition: the Social Communication Disorders Checklist (SCDC) (n = 922), the faces subtest of the Diagnostic Analysis of Non-Verbal Accuracy (DANVA) (n = 722), and the Emotional Triangles Task (n = 750).Results: Children at high-risk for ED showed poorer performance on measures of social cognition compared to children at low-risk. Maternal lifetime binge-eating, and maternal lifetime binging and purging were associated with poorer social communication in children (OR: 2.4, 95% CI: 1.0, 5.7, p = 0.05; and OR: 2.7, 95% CI: 1.1, 6.5, p = 0.03 respectively). Maternal binging and purging was also found to be associated with differential facial emotion processing and poorer recognition of fear from social motion cues (B: −0.7, 95% CI: −1.1, −0.2, p = 0.004).Discussion: Children at high-risk for ED showed slight differences in some areas of social cognition when compared to children at low-risk. Characteristic patterns in social cognition are present in children at high-risk for ED, particularly among children whose mothers have binge-eating and purging behaviors over the lifetime. Our findings support the hypothesis that these differences may be part of an intermediate phenotype for ED: perhaps contributing to development, or perhaps indexing a shared liability with psychiatric disorders characterized by abnormal social cognition.

Web-based screening for Panic Disorder: Validity of a single-item instrument

BackgroundPanic Disorder (PD) is a common mental disorder with an important social and economic cost. Web-based screening tools for early detection of PD are useful for clinical and research purposes. However, there is a paucity of instruments that specifically measure PD online. The aim of this study is to analyze the validity of one item from the Web Screening Questionnaire designed to detect PD symptoms (WSQ-Panic). MethodsA total of 171 participants completed the WSQ-Panic online and were assessed by telephone using the Structured Clinical Interview for DSM Disorders (SCID-I). The sensitivity, the specificity, predictive values (PPV, NPV), and area under the ROC curve (AUC) were calculated, and the optimal cut-off point was determined. ResultsThe WSQ-Panic showed a sensitivity of 0.83 and a specificity of 0.74. The PPV was 0.46 and NPV was 0.94. The AUC was 0.82 (95% CI: 0.74–0.90), which indicates a moderate accuracy. The optimal cut-off point is ≥2. LimitationsThe representativeness of the sample is limited. All the interviews were conducted by phone. Six-month prevalence according to SCID-I criteria was considered, whereas the WSQ-Panic assesses current symptoms. ConclusionThe WSQ-Panic accuracy is acceptable as an Internet screening tool, comparable to longer instruments for PD detection. This instrument is valid to quickly identify patients who suffer from panic symptoms, which can cause important distress and possibly lead to PD. It can also be very useful for screening participants in online self-help treatments and for research purposes.

PTSD and loss: preliminary findings from a territory-wide epidemiology study in Hong Kong

BackgroundThe study examined the prevalence of trauma and posttraumatic stress disorder (PTSD) symptoms among community dwelling Chinese adults in Hong Kong. The relationship of traumatic life events (including loss) and mental health has been investigated.MethodsThe sampling of the collaborative study (HKMMS: Hong Kong Mental Morbidity Survey) adopts a multi-stage stratification approach with the distribution of residential premises in different geographical districts and the relative proportion of private versus public housing units taken into consideration. In Phase I of this study, 4,644 adults were screened for PTSD with the Trauma Screening Questionnaire (TSQ) and Life Event Checklist (LEC), Beck's scales and CIS-R (Revised Clinical Interview Schedule). In Phase II of the study, clinical psychologists conducted the Structured Clinical Interview for DSM Disorders (SCID) for 92 participants (results not reported here).ResultsAmong Phase I participants, 65% reported traumatic experience (including 18% who reported personal experience of sudden death of significant others). Age and gender make a difference in traumatic experience. When compared to participants who reported no traumatic experience in the past, participants who reported to have personal experience of sudden death of significant others or other traumatic experiences were found to have higher TSQ scores, higher psychological distress, lower social support (PSS: Multidimensional Scale of Perceived Social Support), and lower life functioning (SOFAS: Social and Occupational Functioning Assessment Scale), p<0.001. Findings of hierarchical regression showed that type of trauma (i.e., loss, other trauma, or no trauma) contributed significantly to the prediction of all the mental health indices after demographic and social variables were controlled.ConclusionsPublic education on the association of traumatic experience and psychological health, as well as the monitoring of mental health for at-risk individuals are suggested for early identification of people in need of mental health services.

New Report Provides National Data on Mental Disorder Prevalence

New Report Provides National Data on Mental Disorder Prevalence

Patterns and frequency of the treatment of depression in persons with epilepsy

ObjectiveThough depression is common in persons with epilepsy, it often remains undiagnosed and/or untreated. The current study aimed to determine the proportion of persons with epilepsy receiving depression-related treatment and to characterize the type of treatment received. MethodsPersons with epilepsy (n=185) from the only epilepsy clinic in a city of 1.2 million people completed questionnaires and the gold-standard Structured Clinical Interview for DSM Disorders (SCID) to assess current and past depression. Treatment for depression (pharmacological and nonpharmacological) was ascertained through patient self-report and chart review. ResultsOf those with current depression (n=27), the majority (70.3%) were not on any depression-related treatment. In persons with current depression, nonpharmacological management was the most common treatment method, followed by treatment with psychotropic medications such as selective serotonin reuptake inhibitors. More individuals with a past history of depression but without a current episode (n=43) were treated (37.2%); it was more common for these individuals to be treated with pharmacological measures. After using an algorithm that adjusts the treated prevalence for those who are successfully treated, the adjusted proportion of depression treatment was 53.1%. ConclusionsThe proportion of people treated for current depression in this cohort was very low. Future studies should investigate barriers to treatment and how depression treatment can be optimized for those with epilepsy.

Online cognitive behaviour training for the prevention of postnatal depression in at-risk mothers: a randomised controlled trial protocol

BackgroundPostnatal depression (PND) is the most common disorder of the puerperium with serious consequences for both mother and child if left untreated. While there are effective treatments, there are many barriers for new mothers needing to access them. Prevention strategies may offer a more acceptable means of addressing the problem. Internet interventions can help overcome some barriers to reducing the impact of PND. However, to date there are no published studies that investigate the efficacy of internet interventions for the prevention of PND.Methods/DesignThe proposed study is a two-arm double blind randomised controlled trial. 175 participants will be recruited in the immediate postnatal period at an Australian community hospital. Women who meet inclusion criteria (internet access, email address, telephone number, over 18, live birth, fluent English) will complete the Edinburgh Postnatal Depression Scale (EPDS). Those with a score above 9 will undertake the Structured Clinical Interview for DSM Disorders (SCID). Those with a clinical diagnosis of depression, or a lifetime diagnosis of bipolar disorder or psychosis on the SCID will be excluded. Following completion of the baseline battery women will be randomised using a computer-generated algorithm to either the intervention or control condition. The intervention will consist of 5 modules of automated, interactive cognitive behaviour training (CB training), completed weekly with email reminders. The control will replicate the level of contact participants experience with the intervention, but the content will be of a general health nature. Participants will complete questionnaires immediately post-intervention (6 weeks) and 3-, 6- and 12 months follow-up. There will also be a second SCID delivered via telephone at 6 months. We hypothesise that relative to the control group, the intervention group will show a greater reduction in postnatal distress on the EPDS (primary outcome measure). We also hypothesise that the intervention group will demonstrate lower levels of anxiety and stress and higher levels of parenting confidence than the control group following intervention and/or follow-up.DiscussionThe proposed study addresses a number of limitations of earlier trials.Trial registrationAustralia and New Zealand Clinical Trials Registers, ACTRN12609001032246.

Maternal age and number of children are risk factors for depressive disorders in non-perinatal women of reproductive age

Objective. It remains unclear whether or not the vulnerability of depression in women of reproductive age is related with pregnancy or perinatal period. The aim of the study was to determine the prevalence of depressive disorders and related factors in a large sample of non-perinatal women of reproductive age. Method. This study involved 589 women of reproductive age. At baseline, sociodemographic data and premenstrual assessment forms were completed, and screening tests for the assessment of the severity of depressive symptoms were administered to all of the participants. Participants who had over scale scores of the cut-off point in the screening instruments were assessed with module A of the Structured Clinical Interview for DSM Disorders (SCID-I) to determine DSM IV Axis I disorders. Results. The prevalence of depressive disorders was 32.8%. Depressive disorders had high rates in women who were married at younger ages and who had three or more children. Although the prevalence of depressive disorders was 32.8%, only 10.4% of the women had follow-up and treatment in a psychiatric outpatient clinic. Conclusion. Low education levels, early maternal age, and having more than three children and higher premenstrual symptom scores were risk factors for depressive disorders in non-perinatal reproductive age.

Recruitment strategies for the detection of individuals at clinical high risk of developing psychosis.

Dear Editor Over the past decade, there has been an increase in studies of individuals at clinical high risk (CHR) of developing psychosis characterized by subthreshold psychotic symptoms and functional decline before the emergence of a diagnosable psychotic disorder. Typically, this research focuses on an improved understanding of the prodromal period, the predictors of developing psychosis as well as potential interventions (Addington & Heinssen, 2012). Conducting prospective research with young people at CHR of psychosis poses many challenges, including the recruitment of an adequate sample size to increase the power of the study (Heinssen et al. 2003). Based on the low incidence rates (<1 case per 10 000 persons per year in the general population) research centres that are involved in this research recruited 18–30 individuals per year (Addington et al. 2007). However, it should be noted that first these participants are help-seeking, and are not recruited through targeted screening and secondly since these individuals are help-seeking, sampling strategies will be different across CHR research centres. Although much of the research focuses on understanding the development of psychosis, of those who do not go on to develop psychosis, many remain disabled with poor functional outcome and potentially chronic subthreshold symptoms (Addington et al. 2011). Collaborative multi-site research, an alternative to the typical single-site, single principal investigator approach to early psychosis research, does address the issue of having adequately powered samples. However, from a public health perspective it fails to address the issue of population-based identification and treatment of those at CHR of developing psychosis. This paper describes the attempts at recruiting and engaging youth at CHR of psychosis through the joint efforts of an integrated research and clinical service in the Canadian health system. The research programme was conducted at the University of Calgary site of the North American Prodrome Longitudinal Study (NAPLS) and the PRIME clinic is for those at CHR for psychosis. Initial phone screening is done through NAPLS by an experienced clinician who screens and invites appropriate referrals for consultation. All sources of referrals are encouraged to call to discuss any young person whom they may have had concerns with respect to impending psychosis. Potentially suitable participants are offered an initial screening appointment through NAPLS within 1 week of referral. This screening is conducted by experienced clinical raters, under the supervision of J.A., who are trained in the Structured Clinical Interview for DSM Disorders (SCID) and the Structured Interview of Prodromal Syndromes (SIPS) which is one of the most widely used assessments to determine the prodromal status (McGlashan et al. 2010). Once it is established that individuals meet relevant criteria, they are invited to participate in the NAPLS project and to attend the PRIME clinic.

Is autism spectrum disorder common in schizophrenia?

A century ago, Kraepelin and Bleuler observed that schizophrenia is often antedated by “premorbid” abnormalities. In this study we explore how the childhood neurodevelopmental problems found in patients with schizophrenia relate to the current concept of autism spectrum disorder (ASD). Forty-six young adult individuals with clinical diagnoses of schizophrenic psychotic disorders were assessed. The Structured Clinical Interview for DSM Disorders (SCID-I) was used in face-to-face psychiatric examination of each individual. In 32 of the 46 cases (70%), collateral information was provided by one or both parents. The Diagnostic Interview for Social and Communication Disorders — eleventh version (DISCO-11) was used when interviewing these relatives. This instrument covers, in considerable depth, childhood development, adaptive functioning, and symptoms of ASD — current and lifetime. There is a strict algorithm for ASD diagnosis. About half of the cases with schizophrenic psychosis had ASD according to the results of the parental interview. The rate of ASD was strikingly high (60%) in the group with a SCID-I diagnosis of schizophrenia paranoid type. The findings underscore the need to revisit the DSM's “either or” stance between ASD and schizophrenia.

Impulsivity and functional impairment in bipolar disorder

Impulsivity is substantially higher in bipolar patients (BP) and may be associated with a more severe course of illness, but no studies have so far examined the relationship between impulsivity and functional outcome in BP. Our goal was to investigate the functional impact of trait-impulsivity in BP. 138 euthymic BP were recruited. All patients were assessed using an interview based on the Structured Clinical Interview for DSM Disorders (SCID). The Functioning Assessment Short Test (FAST) and the Barratt Impulsiveness Scale (BIS-11) were used to assess functional outcome and impulsivity, respectively. Seven multiple linear regressions, with each individual FAST subscale scores and overall FAST score as dependant variables, were conducted in order to evaluate the predictive role of trait-impulsivity on functional outcome. After a multiple linear regression model, with the FAST total score as dependent variable, we found that depressive symptoms (β=1.580; p<0.001), number of hospitalizations (β=0.837; p=0.019) and impulsivity (β=0.319; p=0.004) were independently associated with overall functional impairment (F=6.854, df=9, p<0.001, adjusted R2=0.311). The cross-sectional design of the study. Our results indicate that impulsivity, as well as depressive symptoms and the number of hospitalizations, is associated with overall functional impairment in BP. The assessment and treatment of impulsivity may be useful in improving functional outcome in BP.

Glucocorticoid receptor polymorphism is associated with major depression and predominance of depression in the course of bipolar disorder

A strong association has been found between dysregulation of hypothalamic-pituitary-adrenal (HPA) axis and depression and bipolar disorder. Glucocorticoid receptor is one of the involved receptors and its gene has been recognized as a candidate gene for major depressive disorder and bipolar disorder. Therefore, we investigated if polymorphism of the glucocorticoid receptor gene (NR3C1), involved in the regulation of HPA axis, may alter susceptibility as well as the course of major depressive disorder and bipolar disorder. In the study we included 514 patients with bipolar disorder and 193 patients with major depressive disorder. Consensus diagnosis by at least two psychiatrists was made, according to DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) criteria, using SCID (Structured Clinical Interview for DSM Disorders). Control group consisted of 732 healthy subjects. Genotyping for eight NR3C1 polymorphisms was done with use of TaqMan SNP (single nucleotide polymorphism) Genotyping Assays. Linkage disequilibrium analysis was done in Haploview. We have found three polymorphisms (rs6198, rs6191 and rs33388) to be associated with major depressive disorder (MDD) and the same polymorphisms were associated with the predominance of depressive symptoms in the course of bipolar disorder. In linkage disequilibrium analysis we observed two haplotype blocks, however, none of those shows involvement in susceptibility to MDD or bipolar disorder. The main limitation of this study is relatively small sample size of MDD patients group. Polymorphisms of NR3C1 gene analyzed in this study may modify susceptibility to major depressive disorder and seem to influence the course of bipolar disorder.

Prevalence of Major Depressive Episode among Patients with Pre-Dialysis Chronic Kidney Disease

To ascertain the prevalence of depression among pre-dialysis chronic kidney disease (CKD) patients. A cross-sectional study was carried out using the Structured Clinical Interview for DSM IV (SCID) to detect major depressive episode. Study was carried out in a nephrology outpatient clinic in Sri Lanka. Every fifth patient with CKD diagnosed according to the K/DQOI of the National Kidney Foundation of U.S.A. criteria stages 2-5 not undergoing dialysis was recruited. Primary outcome was major depressive episode diagnosed using the Structured Clinical Interview for DSM disorders (SCID). Sample consisted of 140 patients. Eighty-nine (63.6%) were male. The mean age was 57.9 years (SD = 10.4). Only 41 (29.3%) were in paid employment. Percentage of patients in CKD stages 2, 3, 4, and 5 were 2.9%, 19.6%, 51.4%, and 25%, respectively. Only three patients had diabetes. One hundred and five were on treatment for hypertension. Prevalence of a major depressive episode was 27.9%. Among males, prevalence was 27% (95% CI 17.6-36.3) and among females, 29.4% (95% CI 16.5-42.4). Age, gender, income, employment status, and education were not associated with depression. The only significant variable associated with depression was patient's understanding of prognosis. Prevalence of major depressive episode among pre-dialysis CKD patients was 27.9%. Rate of depression diagnosed using a structured clinical interview was lower than that reported when screening instruments were used. The only significant variable associated with depression was patient's understanding of prognosis. Future studies should aim to identify risk factors for depression among patients with kidney disease.

Pseudocataplexy and Transient Functional Paralysis: A Spectrum of Psychogenic Motor Disorder

Pseudocataplexy and Transient Functional Paralysis: A Spectrum of Psychogenic Motor Disorder