Symptoms Of Varying Severity Research Articles

First Report of Bacterial Blight of Carrot in Indiana Caused by Xanthomonas hortorum pv. carotae.

In summer 2012, bacterial blight symptoms (2) were observed on leaves of carrot plants in 7 out of 70 plots of carrot breeding lines at the Purdue University Meig Horticulture Research Farm, Lafayette, IN. Symptoms included small to large, variably shaped, water-soaked to dry, necrotic lesions, with or without chlorosis, at <5% incidence. Microscopic examination of symptomatic leaf sections revealed bacterial streaming from the cut ends of each leaf piece. For each of the seven plots, symptomatic leaf sections (each 5 to 10 mm2) were surface-sterilized in 1.2% NaOCl for 60 s, triple-rinsed in sterilized, deionized water, dried on sterilized blotter paper, macerated in sterilized water, and a loopful of the suspension was streaked onto yeast dextrose carbonate (YDC) agar medium (1). Colonies with morphology similar to that of strain Car001 of Xanthomonas hortorum pv. carotae from California (3) were obtained consistently from all seven plots, and serial dilutions streaked onto YDC agar medium to obtain pure cultures. One bacterial strain/plot was then subjected to a PCR assay for X. hortorum pv. carotae using the protocol of Meng et al. in (5), except for an annealing temperature of 60°C. All seven Indiana strains and Car001 produced a 355-bp DNA fragment indicative of X. hortorum pv. carotae. The Indiana strains and Car001 were each tested for pathogenicity on five 11-week-old carrot plants of a proprietary Nantes inbred line grown from a seed lot that tested negative for X. hortorum pv. carotae (1,3). Each strain was grown for 16 h in 523 broth (4) on a shaker (200 rpm) at 28°C, and diluted in 0.0125M phosphate buffer to 108 CFU/ml. Approximately 24 h prior to inoculation, the five plants for each strain were enclosed in a large plastic bag to create a moist chamber. The plants were inoculated by atomizing 30 ml of the appropriate bacterial suspension onto the foliage using an airbrush. Five plants inoculated with sterilized phosphate buffer served as a negative control treatment. The plants were re-sealed in plastic bags for 72 h, and placed in a randomized complete block design in a greenhouse set at 25 to 28°C. Symptoms of bacterial blight were first observed 14 days after inoculation, and developed on all inoculated plants by 21 to 28 days after inoculation, with slight variation in severity of symptoms among strains. Symptoms did not develop on negative control plants. Re-isolations were done 32 days after inoculation from symptomatic leaves of three replicate plants/strain and from three plants of the negative control treatment, using the protocol described for the original samples. Bacterial colonies typical of X. hortorum pv. carotae were obtained from symptomatic leaves for all seven Indiana strains and the control strain, but not from the negative control plants. Identity of the re-isolated strains as X. hortorum pv. carotae was confirmed by PCR assay. To our knowledge, this is the first report of bacterial blight of carrot in Indiana.

Comparison of categorical alcohol dependence versus a dimensional measure for predicting weekly alcohol use in heavy drinkers

BackgroundThe DSM specifies categorical criteria for psychiatric disorders. In contrast, a dimensional approach considers variability in symptom severity and can significantly improve statistical power. The current study tested whether a categorical, DSM-defined diagnosis of Alcohol Dependence (AD) was a better fit than a dimensional dependence measure for predicting change in alcohol consumption among heavy drinkers following a brief alcohol intervention (BI). DSM-IV and DSM-5 alcohol use disorder (AUD) measures were also evaluated. MethodsParticipants (N=246) underwent a diagnostic interview after receiving a BI, then reported daily alcohol consumption using an Interactive Voice Response system. Dimensional AD was calculated by summing the dependence criteria (mean=4.0; SD=1.8). The dimensional AUD measure was a summation of positive Alcohol Abuse plus AD criteria (mean=5.8; SD=2.5). A multi-model inference technique was used to determine whether the DSM-IV categorical diagnosis or dimensional approach would provide a more accurate prediction of first week consumption and change in weekly alcohol consumption following a BI. ResultsThe Akaike information criterion (AIC) for the dimensional AD model (AIC=7625.09) was 3.42 points lower than the categorical model (AIC=7628.51) and weight of evidence calculations indicated there was 85% likelihood that the dimensional model was the better approximating model. Dimensional AUD models fit similarly to the dimensional AD model. All AUD models significantly predicted change in alcohol consumption (p's=.05). ConclusionA dimensional AUD diagnosis was superior for detecting treatment effects that were not apparent with categorical and dimensional AD models.

Autism spectrum disorder: advances in evidence-based practice

Autism spectrum disorder (ASD) encompasses wide variation in symptom severity and functional impact. The core features of ASD include impairments in social communication, repetitive behaviours and restricted interests. Not all people with ASD identify their challenges as a disorder. Autism spectrum

The Association of Pain With Protein Inflammatory Biomarkers

Pain is a key diagnostic criterion in many medical conditions. In the absence of self-reported pain, measurement of a proxy for pain, such as an inflammatory biomarker, could aid in diagnosis and disease management. The aim was to determine if there is an association between inflammatory biomarkers and self-reported pain in individuals with medical conditions associated with the symptom of pain and to clarify whether inflammatory biomarkers might aid in the diagnostic process. An integrative literature review was conducted. PubMed, CINAHL, and Cochrane databases were searched for articles published between January 2000 and September 2012. Inclusion criteria were original research testing a relationship between inflammatory biomarkers and pain, pain measurement, laboratory measure of inflammatory biomarkers, and a prospective single-group experimental design or comparative nonrandomized or randomized design. Excluded were studies describing an association between inflammatory biomarkers and treatment, risk, and generation; pathophysiology; or genetic polymorphisms/transcripts. Ten studies meeting inclusion criteria were reviewed. In most of the studies, baseline elevations in both proinflammatory and anti-inflammatory cytokines were reported in painful conditions compared with healthy controls. In half of the studies, higher levels of proinflammatory markers (C-reactive protein, tumor necrosis factor-alpha, interleukin-2 [IL-2], IL-6, IL-8, IL-10, and CD40 ligand) were associated with greater pain. Proinflammatory cytokines decreased after treatment for pain in only two studies. The association between inflammatory markers varied in the direction and magnitude of expression, which may be explained by differences in designs and assays, disease condition and duration, variations in symptom severity, and timing of measurement. Elevation in anti-inflammatory cytokines in the presence of pain represents a homeostatic immune response. Further study is required to determine the value of cytokines as biomarkers of pain.

Detection and characterisation of Plum pox virus (PPV) isolates from Eastern Slovakia revealed the presence of three main viral strains.

Plum pox virus (PPV), the agent responsible for Sharka disease, is the most important viral pathogen of stone fruit trees world-wide, having an endemic status in Slovakia. To increase knowledge of PPV diversity in Slovakia, a set of 11 isolates, originated from the eastern part of the country, was characterised. The isolates were chip-budded from their original Prunus hosts to the susceptible GF305 indicators, exhibiting the symptoms of variable severity. A genomic region encompassing the partial NIb and the hypervariable 5´terminal region of the CP gene was amplified from all 11 isolates in RT-PCR and directly sequenced. The phylogenetic analysis revealed the grouping of the 11 Slovak isolates into 3 distinct clusters, representing the PPV-M (2 isolates), D (7 isolates) and Rec strains (2 isolates). The strain affiliation of isolates was further confirmed by strain-specific RT-PCR, using which the presence of additional mixed infection by minor PPV variants was detected in 2 samples. The results further contribute to the understanding of PPV diversity in Slovakia and confirm the specificity and sensitivity of molecular approaches used for the virus strain determination.

Autism: Metabolism, Mitochondria, and the Microbiome

New approaches are needed to examine the diverse symptoms and comorbidities of the growing family of neurodevelopmental disorders known as autism spectrum disorder (ASD). ASD originally was thought to be a static, inheritable neurodevelopmental disorder, and our understanding of it is undergoing a major shift. It is emerging as a dynamic system of metabolic and immune anomalies involving many organ systems, including the brain, and environmental exposure. The initial detailed observation and inquiry of patients with ASD and related conditions and the histories of their caregivers and families have been invaluable. How gastrointestinal (GI) factors are related to ASD is not yet clear. Nevertheless, many patients with ASD have a history of previous antibiotic exposure or hospitalization, GI symptoms, abnormal food cravings, and unique intestinal bacterial populations, which have been proposed to relate to variable symptom severity.In addition to traditional scientific inquiry, detailed clinical observation and recording of exacerbations, remissions, and comorbidities are needed. This article reviews the role that enteric short-chain fatty acids, particularly propionic (also called propanoic) acid, produced from ASD-associated GI bacteria, may play in the etiology of some forms of ASD. Human populations that are partial metabolizers of propionic acid are more common than previously thought. The results from pre-clinical laboratory studies show that propionic acid-treated rats display ASD-like repetitive, perseverative, and antisocial behaviors and seizure. Neurochemical changes, consistent and predictive with findings in ASD patients, including neuroinflammation, increased oxidative stress, mitochondrial dysfunction, glutathione depletion, and altered phospholipid/acylcarnitine profiles, have been observed. Propionic acid has bioactive effects on (1) neurotransmitter systems, (2) intracellular acidification and calcium release, (3) fatty acid metabolism, (4) gap junction gating, (5) immune function, and (6) alteration of gene expression that warrant further exploration. Traditional scientific experimentation is needed to verify the hypothesis that enteric short-chain fatty acids may be a potential environmental trigger in some forms of ASD. Novel collaborative developments in systems biology, particularly examining the role of the microbiome and its effects on host metabolism, immune and mitochondrial function, and gene expression, hold great promise in ASD.

Cumulative exposure to traumatic events in older adults

Objectives: The present study examined the impact of cumulative trauma exposure on current posttraumatic stress disorder (PTSD) symptom severity in a nonclinical sample of adults in their 60s. The predictive utility of cumulative trauma exposure was compared to other known predictors of PTSD, including trauma severity, personality traits, social support, and event centrality.Method: Community-dwelling adults (n = 2515) from the crest of the Baby Boom generation completed the Traumatic Life Events Questionnaire, the PTSD Checklist, the NEO Personality Inventory, the Centrality of Event Scale, and rated their current social support.Results: Cumulative trauma exposure predicted greater PTSD symptom severity in hierarchical regression analyses consistent with a dose–response model. Neuroticism and event centrality also emerged as robust predictors of PTSD symptom severity. In contrast, the severity of individuals’ single most distressing life event, as measured by self-report ratings of the A1 PTSD diagnostic criterion, did not add explanatory variance to the model. Analyses concerning event categories revealed that cumulative exposure to childhood violence and adulthood physical assaults were most strongly associated with PTSD symptom severity in older adulthood. Moreover, cumulative self-oriented events accounted for a larger percentage of variance in symptom severity compared to events directed at others.Conclusion: Our findings suggest that the cumulative impact of exposure to traumatic events throughout the life course contributes significantly to posttraumatic stress in older adulthood above and beyond other known predictors of PTSD.

Lung Cancer Stigma, Anxiety, Depression and Symptom Severity

Objectives: Compared to other cancers, lung cancer patients report the highest levels of psychological distress and stigma. Few studies have examined the relationship between lung cancer stigma (LCS) and symptom burden. This study was designed to investigate the relationship between LCS, anxiety, depression and physical symptom severity. Methods: This study employed a cross-sectional, correlational design to recruit patients online from lung cancer websites. LCS, anxiety, depression and physical symptoms were measured by patient self-report using validated scales via the Internet. Hierarchical multiple regression was performed to investigate the individual contributions of LCS, anxiety and depression to symptom severity. Results: Patients had a mean age of 57 years; 93% were Caucasian, 79% were current or former smokers, and 74% were female. There were strong positive relationships between LCS and anxiety (r = 0.413, p < 0.001), depression (r = 0.559, p < 0.001) and total lung cancer symptom severity (r = 0.483, p < 0.001). Although its contribution was small, LCS provided a unique and significant explanation of the variance in symptom severity beyond that of age, anxiety and depression, by 1.3% (p < 0.05). Conclusions: Because LCS is associated with psychosocial and physical health outcomes, research is needed to develop interventions to assist patients to manage LCS and to enhance their ability to communicate effectively with clinicians.

PTSD in Paramedics: Resilience and Sense of Coherence

Paramedics are frequently subjected to traumatic experiences and have higher PTSD prevalence rates than people in the general population. However, the vast majority of paramedics do not develop PTSD. While several risk factors for PTSD have been established, little is known about protective factors. It has been suggested that a good sense of coherence (SOC) and high resilience lower the risk for developing PTSD. To examine whether SOC and resilience are associated with PTSD severity in paramedics. A cross-sectional study investigated SOC, resilience and PTSD in paramedics (N = 668). PTSD was assessed with the Posttraumatic Stress Diagnostic Scale (PDS); resilience and SOC were measured with the Resilience Scale (RS-11) and the Sense of Coherence Scale (SOC-L9). Further measures included preparation of dealing with traumatic events and availability of psychological help. As expected, both resilience and SOC were negatively correlated with PTSD symptoms. The regression analysis showed that 19.2% of the total variance in symptom severity was explained by these variables. However, SOC was a better predictor than resilience for PTSD severity, as it accounted for more unique variance. Paramedics who were prepared for dealing with work-related traumatic events and who received psychological help had less severe PTSD symptoms and higher SOC scores than paramedics for whom these services were not available. Enhancing resilience, and especially SOC, seems a promising approach to reduce PTSD symptom severity in high risk groups like paramedics.

Evaluation of the Mental Fatigue Scale and its relation to Cognitive and Emotional Functioning after Traumatic Brain Injury or Stroke

Objective: After traumatic brain injury (TBI) or stroke, long-term mental fatigue may occur with significant impact on work and social interactions. With the intention to measure mental fatigue irrespective of neurological illness, we developed the Mental Fatigue Scale (MFS). The scale incorporates affective, cognitive and sensory symptoms, duration of sleep and daytime variation in symptom severity. In this study, we evaluated the MFS and its relationship to cognitive and emotional functions. Participants: Healthy controls and well-rehabilitated subjects suffering from mental fatigue after mild TBI, TBI or stroke (age 19-69) were included in the study. Results: The results showed MFS to be invariant to age, gender and education. A cutoff score at 10.5 is suggested. Of the cognitive functions measured, information processing speed was found to be a significant predictor for the rating on MFS. We found that a significant effect on depression between controls and brain injured subjects can be a misleading conclusion if the effect of mental fatigue is not considered. Conclusions: We suggest MFS to be linked to mental impairment after brain injury. This study also demonstrated that mental fatigue must be treated as a separate construct and should not be mixed up with depression or anxiety.

A Preliminary Study of White Matter in Adolescent Depression: Relationships with Illness Severity, Anhedonia, and Irritability

Major depressive disorder (MDD) during adolescence is a common and disabling psychiatric condition; yet, little is known about its neurobiological underpinning. Evidence indicates that MDD in adults involves alterations in white and gray matter; however, sparse research has focused on adolescent MDD. Similarly, little research has accounted for the wide variability of symptom severity among depressed teens. Here, we aimed to investigate white matter (WM) microstructure between 17 adolescents with MDD and 16 matched healthy controls (HC) using diffusion tensor imaging. We further assessed within the MDD group relationships between WM integrity and depression severity, as well as anhedonia and irritability – two core symptoms of adolescent MDD. As expected, adolescents with MDD manifested decreased WM integrity compared to HC in the anterior cingulum and anterior corona radiata. Within the MDD group, greater depression severity was correlated with reduced WM integrity in the genu of corpus callosum, anterior thalamic radiation, anterior cingulum, and sagittal stratum. However, anhedonia and irritability were associated with alterations in distinct WM tracts. Specifically, anhedonia was associated with disturbances in tracts related to reward processing, including the anterior limb of the internal capsule and projection fibers to the orbitofrontal cortex. Irritability was associated with decreased integrity in the sagittal stratum, anterior corona radiata, and tracts leading to prefrontal and temporal cortices. Overall, these preliminary findings provide further support for the hypotheses that there is a disconnect between prefrontal and limbic emotional regions in depression, and that specific clinical symptoms involve distinct alterations in WM tracts.

Social cognition in 22q11.2 microdeletion syndrome: Relevance to psychosis?

22q11.2 deletion syndrome (22qDS) represents one of the largest known genetic risk factors for schizophrenia. Approximately 30% of individuals with 22qDS develop psychotic illness in adolescence or young adulthood. Given that deficits in social cognition are increasingly viewed as a central aspect of idiopathic schizophrenia, we sought to investigate abilities in this domain as a predictor of psychotic symptoms in 22qDS participants. We assessed multiple domains of social and non-social cognition in 22qDS youth to: 1) characterize performance across these domains in 22qDS, and identify whether 22qDS participants fail to show expected patterns of age-related improvements on these tasks; and 2) determine whether social cognition better predicts positive and negative symptoms than does non-social cognition. Task domains assessed were: emotion recognition and differentiation, Theory of Mind (ToM), verbal knowledge, visuospatial skills, working memory, and processing speed. Positive and negative symptoms were measured using scores obtained from the Structured Interview for Prodromal Symptoms (SIPS). 22qDS participants (N=31, mean age: 15.9) showed the largest impairment, relative to healthy controls (N=31, mean age: 15.6), on measures of ToM and processing speed. In contrast to controls, 22qDS participants did not show age-related improvements on measures of working memory and verbal knowledge. Notably, ToM performance was the best predictor of positive symptoms in 22qDS, accounting for 39% of the variance in symptom severity. Processing speed emerged as the best predictor of negative symptoms, accounting for 37% of the variance in symptoms. Given that ToM was a robust predictor of positive symptoms in our sample, these findings suggest that social cognition may be a valuable intermediate trait for predicting the development of psychosis.

Ten Years’ Follow-Up of a Family With Myokymia and Muscle Cramps Without Ataxia

We report 10 years' follow-up of the previously described family with a novel mutation of the KCNA1 gene. The family consisted of 3 affected boys (first seen at ages 3, 11, and 12) and their affected mother and asymptomatic father and sister. They clinically presented with diffuse myokymia, muscle cramps, and lower limb spasticity without ataxia, but episodic ataxia developed later during adolescence and early adulthood. Long-term follow-ups of families with known KCNA1 gene mutation are rarely mentioned in the literature. Treatment with carbamazepine, 600 to 800mg daily resulted in cessation of muscle cramps and marked improvement of lower leg symptoms. In the youngest child, after 2 years carbamazepine had to be changed to oxcarbazepine because of side effects. Carbamazepine and oxcarbazepine are both effective in treatment of symptoms related to KCNA1 gene mutation. Symptoms will reoccur if treatment is stopped and there is variability of symptom severity between family members.

Erythropoietic Protoporphyria: Spectrum of Three Cases

Erythropoietic protoporphyria is a rare photodermatosis of childhood, and the diagnosis can be delayed. A deficient ferrochelatase enzyme leads to accumulation of protoporphyrins in the dermis, causing phototoxic burning. To report three cases with great variability in severity of symptoms and age at diagnosis. We discuss clinical and biochemical findings, mutation analysis, and therapeutic options. We report three cases with different degrees of photosensitivity, laboratory results, psychosocial impact, and preventive and therapeutic treatments. The diagnosis of erythropoietic protoporphyria was confirmed by both typical elevation of plasma porphyrins and the discovery of a mutated FECH gene. Erythropoietic protoporphyria should be suspected in any cases of childhood photosensitivity. Systemic complications are unusual. Mutation analysis confirms the diagnosis. Photoprotection is the cornerstone of treatment.

Long-term course and outcome in schizophrenia: a 34-year follow-up study in Alberta, Canada

The aim of this study was to extend an earlier retrospective cohort study of schizophrenia via a prospective study to a follow-up of 34 years, with an emphasis on describing the life-course of the illness. Subjects were 128 first-ever admissions for schizophrenia in 1963 to either of two mental hospital in Alberta, Canada. Follow-up continued until death or 1997. A symptom severity scale, with scores ranging from 0 (no symptoms) to 3 (hospitalized), was used to collect time-series data on each subject and create life-course curves. Indices were constructed to summarize the information in each curve. Information on social functioning was also collected. Results were similar for men and women. The life-course curves showed marked variability of symptom severity across subjects and over time. The average score over the entire period of follow-up for the cohort indicated 'moderate' symptoms, and the change in average score from beginning to end of follow-up demonstrated a slight worsening of symptoms. The measures of social functioning indicated that only about one quarter of the patients had a good to excellent outcome. The long-term course in schizophrenia is one of varying symptom severity, and for many patients, there is a poor overall outcome.

Differences in obsessional beliefs and emotion appraisal in obsessive compulsive symptom presentation

Obsessive-compulsive disorder (OCD) is a heterogeneous condition with symptom presentation that includes contamination, harm, unacceptable thoughts, and symmetry. Researchers have begun to examine the ideographic nature of OCD symptoms to aid the development of specialized treatment approaches. Obsessional beliefs are often implicated in the development and maintenance of the disorder; however, much of the variance in symptom severity is not accounted for by these beliefs. Less attention has been paid to the role of emotions in OCD, and to date, no study has investigated beliefs about emotions (i.e., emotion appraisal) in clinical samples of OCD. In the present study, 44 participants were recruited from residential and intensive outpatient facilities and private practitioners specializing in OCD treatment. Participants completed measures of OCD severity, obsessional beliefs and emotion appraisal. Results indicated that both obsessional beliefs and emotion appraisal were correlated with each of the symptom presentations to varying degrees, and severity in each of the subtypes was predicted by a different model. Implications for cognitive and emotional conceptualizations of OCD are discussed.

Reliability in One-Repetition Maximum Performance in People with Parkinson's Disease

Strength training is an effective modality to improve muscular strength and functional performance in people with Parkinson's disease (PWP). One-repetition maximum (1-RM) is the gold standard assessment of strength; however, PWP suffer from day-to-day variations in symptom severity and performance characteristics, potentially adversely affecting the reliability of 1-RM performance. Herein, we assessed the reliability of 1-RM in PWP. Forty-six participants completed two sessions of 1-RM testing of knee extension, knee flexion, chest press, and biceps curl at least 72 hours apart. Significantly differences between testing sessions were identified for knee extension (P < 0.001), knee flexion (P = 0.042), and biceps curl (P = 0.001); however, high reliability (ICC > 0.90) was also identified between sessions. Interestingly, almost third of subjects failed to perform better on the second testing session. These findings suggest that 1-RM testing can be safely performed in PWP and that disease-related daily variability may influence 1-RM performance.

Hypersensitivity to fennel is frequent in peach allergic patients and LTP is a major fennel allergen

Methods within a population of patients with peach allergic symptoms of variable severity we investigated which patients also had documented allergy to fresh fennel (Clinical Trials.gov, protocol ID NCT00715156). We examined the type of allergic reaction to fennel by means of a clinical questionnaire, skin prick test, prickprick with fresh fennel, open challenge and IgE-specific levels to fennel and to the following recombinant allergens: anti-rPru p 1, 3, 4, anti-rBet v 1, 2 and 4. We compared the different clinical reactions to fennel between patients with mild symptoms to peach (group A, 21pts) and patients with severe systemic symptoms to peach (group B, 16 pts). SDS-Page and IgE immunoblotting were performed with fennel extract and the Nterminal sequences of the allergenic molecules were determined analyzing the proteins eluted by SDS-gel on a protein sequencer. Immunoblotting inhibition was performed to evaluate the cross-reactivity between fennel and peach extract.

Postpartum depression: the distribution of severity in a community sample

Dear Editor, The prevalence of postpartum depression (PPD) is well established by a wealth of epidemiological studies (Gavin et al. 2005). Nevertheless, because PPD status is often dichotomous and based on DSM-IV criteria for major depressive disorder (MDD) or on an established cutoff score, little is known about the variation in symptom severity among those diagnosed as depressed. Accounting for variation in severity levels among depressed women would not only inform treatment referrals, but would also improve specificity in the identification of research participants for treatment trials and may more accurately account for differential treatment responses. To describe variation in depression severity in a sample of clinically depressed women, we analyzed a previously collected data set (O'Hara et al. 2000) with demographic and diagnostic data from 292 women who were recruited for a treatment trial. The data reflect pretreatment depression status. Demographically, these women were predominantly white (96.9%, n=283), non-Hispanic (97.9%, n=286), and married (87.7%, n=256,) with an average age of 28.4 years. Over half (59.9%, n=175) were employed with an average annual household income of approximately US $40,200 and average educational level of 14.6 years. All women were diagnosed with MDD according to the Structured Clinical Interview for DSM-IV Disorders (SCID); women with minor depression were not included in the data set. Scores on the Hamilton Rating Scale for Depression (HRSD) were available for each woman. Using five previously established levels of depression severity based on HRSD scores (Furukawa et al. 2007), we calculated the frequency of depressed women at each severity level. These severity levels have been defined as “level 1—normal/no illness” (HRSD 0–3), “level 2—borderline ill” (HRSD 4–7), “level 3—mildly ill” (HRSD 8–15), “level 4—moderately ill” (HRSD 16–26), and “level 5—severely ill” (HRSD 27–50). The results indicate that even within a clinically depressed sample of women, there is a wide range of depression severity (Table 1). Noteworthy are the 5% of women who were diagnosed with MDD based on the SCID, yet received low HRSD scores. One explanation for this discrepancy is that the SCID and HRSD assess slightly different time periods; the SCID assesses the worst 2 weeks in the last month while the HRSD assesses the past week. Table 1 Prevalence of postpartum depression by severity level These results have important treatment and research implications. From a stepped care model perspective, depressed women with symptoms in the mild range may require less intensive treatment, such as a support group, while depressed women with more severe symptoms may require more aggressive treatment, like therapy or medication. Tailored treatment plans for women suffering from different severity levels of PPD have the potential to be efficient in terms of both time and cost. These results are also potentially informative for clinical research where treatments might have differential efficacy based on depressive severity level. Future treatment trials might examine outcome based on clusters of depression severity to better account for variation in treatment response. Although these results are not surprising, to our knowledge, this is the first study to analyze the frequency of PPD by severity level. Admittedly, the data set of the present analysis is homogenous in terms of both ethnicity and marital status, so it would be valuable for future studies to examine varying severities of PDD in a more diverse sample. In conclusion, given the aforementioned treatment and research benefits of identifying clinically depressed women by severity level, it is hoped that clinicians and researchers will consider this factor in the future.

Association between health related quality of life and severity of depression in patients with major depressive disorder

To investigate the association between health related quality of life (HRQoL) and severity of depression in patients with major depressive disorder (MDD). Short Form 36 Health Survey Questionnaire (SF-36) was administered to 103 MDD patients at the baseline and 6-week follow-up. Hamilton Depression Rating for Depression (HAMD) and Clinical Global Impression (CGI) were administered at the baseline, 2- and 6-week follow-up, respectively. All SF-36 component scores in the 6-week follow-up were significantly higher than those at the baseline (P<0.01). The overall and subscale scores of HAMD except weight and CGI scores at the 2- and 6-week follow-up were significantly lower than those at the baseline (all P<0.01). The role-emotion score of the clinical remission group was significantly lower than that of the non-remission group. After a 6-week antidepressant treatment, all SF-36 component scores in both groups were significantly higher than those at the baseline, except body pain in the non-remission group. While scores of role-physical, general health, vitality, social functioning, role-emotion and mental health were significantly higher in the remission group than those in the non-remission group (P<0.05 or P<0.01). A higher overall score of HAMD, scores of cognitive disturbance and CGI were significantly associated with a worse SF-36 at the baseline (P<0.05 or P<0.01). After the 6-week treatment, a worse health transition was significantly associated with higher scores of HAMD and sleep disturbance at the baseline (P<0.01), a worse general health and role-emotion were strongly associated with higher score of anxiety/somatization at the baseline (both P<0.05). Score of general health was positively associated with reduction rate of cognitive disturbance at the 2-week endpoint (P<0.05) and scores of vitality and reported health transition were positively associated with the reduction rate of sleep disturbance at the 2-week endpoint (both P<0.05). The increasing severity of depression was significantly associated with a worse HRQoL in patients with MDD. A 6-week antidepressant treatment may result in comparable HRQoL improvements. The components of HRQoL vary with severity of various symptoms of depression at the baseline and their early improvement after the treatment.