Biomedical subjects

A D Simons

Publications and source records attributed to A D Simons.

34 records · Page 2Linked to original sources

PubMed1992

Are personality assessments valid in acute major depression?

A number of recent studies indicate that identification of Axis II comorbidity in depressed patients may influence both the initial treatment plan and subsequent prognosis. Nevertheless, the validity of personality disorder diagnoses may be compromised by the effects of the patients' depression on historical recall, which distort presentation of their premorbid strengths and liabilities. These problems are illustrated in this study of 53 acutely depressed unipolar outpatients, with (N = 14) or without (N = 39) personality disorder diagnoses as defined by the Personality Disorder Examination (PDE). We found that: 1) pretreatment PDE diagnoses had no significant associations with any measure of demography, symptomatic status, illness course, or treatment response; and 2) pretreatment PDE diagnoses typically were not confirmed when patients were reassessed following effective treatment with cognitive behavior therapy. These findings provide strong empirical support for the wisdom of deferring definitive assessment of Axis II until an acute depressive disorder has been optimally treated.

Acute Disease↗

PubMed1992

Social factors and the psychobiology of depression: relations between life stress and rapid eye movement sleep latency.

We examined psychosocial factors (i.e., life stress) and biological factors (i.e., REM sleep latency) that are hypothesized to be of complementary importance for defining depressive subtypes in a sample of 61 nonpsychotic, endogenous major depressives. Subjects were evaluated on several diagnostic scales for life stress, on electroencephalographic sleep data, and on 2 symptom measures for depression. As predicted, persons with severe stress that occurred shortly before depression onset had essentially normal REM latency values; patients without such stress had reduced REM latency values. Both stress and REM latency were also associated with greater severity of self-reported depressive symptoms. Alternative explanations of these findings are discussed, with particular emphasis on different roles of pre-onset and post-onset stressors.

Adaptation, Psychological↗

PubMed1992

Biological markers, treatment outcome, and 1-year follow-up in endogenous depression: electroencephalographic sleep studies and response to cognitive therapy.

Although there are now considerable data attesting to the efficacy of several forms of treatment for depression, there is surprisingly little information to guide the selection of the treatment most likely to benefit a given patient. Biologic markers of depression have received much attention for their potential to provide theoretically and clinically meaningful subgroups for specific treatments. The relationship between electroencephalographic (EEG) sleep disturbances, treatment outcome, and 1-year follow-up was examined for a sample of 53 patients with endogenous major depression receiving cognitive-behavioral therapy. Overall, there was little support for the prediction of a difference in short- or long-term outcome between patients with and without EEG sleep disturbances.

Adult↗

PubMed1992

Relapse after cognitive behavior therapy of depression: potential implications for longer courses of treatment.

OBJECTIVE: The authors studied the risk of relapse among depressed patients after cognitive behavior therapy in order to document the need and potential indications for longer-term models of treatment. METHOD: Forty-eight patients with major depression who responded during a 16-week course of cognitive behavior therapy entered a 1-year prospective follow-up study, as did two patients who received 20 weeks of therapy. Standardized, independent clinical assessments were completed 1, 3, 6, 9, and 12 months after treatment. Relapse was defined as, at minimum, a 2-week period in which the subject met the DSM-III-R criteria for major depression and had a Hamilton depression scale score of 15 or more. RESULTS: Sixteen patients (32%) relapsed during the 1-year follow-up. Correlates of relapse included a history of depressive episodes, higher levels of depressive symptoms and dysfunctional attitudes, slower response to therapy, and being unmarried. Patients who fully recovered during therapy (Hamilton depression score of 6 or less for 8 weeks or more) were at significantly lower risk for relapse than those who partially recovered (9% and 52%, respectively). Slower response to therapy, unmarried status, and high residual scores on the Dysfunctional Attitudes Scale were independently and additively related to increased risk of relapse. CONCLUSIONS: These findings provide further evidence of a relation between residual symptoms and relapse after cessation of active treatment. The authors strongly recommend that models of longer-term psychotherapy be developed for depressed patients who do not recover fully during time-limited cognitive behavior therapy.

Adult↗

PubMed1992

Cognitive behavior therapy and relapse of nonbipolar depression: parallels with pharmacotherapy.

The risk of relapse was studied in 44 major depressives following successful acute treatment with cognitive behavior therapy (CBT). Patients entered a 1-year prospective followup with independent clinical assessments at 1, 3, 6, 9, and 12 months. Of these patients, 15 (34%) relapsed; correlates included marital status, recurrent subtype, higher initial and residual ratings of depressive severity, and slower response to therapy. Both married status (p = .008) and fully recovered status (p = .02) were significantly and independently related to decreased risk of relapse using the Cox proportional hazard method. These findings provide further documentation of a relationship between residual symptomatology and relapse after cessation of active treatment and closely parallel findings pertaining to risk of relapse after acute antidepressant pharmacotherapy of unipolar depression. As in pharmacotherapy, a longer period of continuation treatment may be indicated for patients at risk for relapse after an initial course of time-limited therapy with CBT.

Adult↗

PubMed1991

Onset of depression and time to treatment entry: roles of life stress.

Patients with depression vary greatly in the time between onset of disorder and entry into treatment. Few data exist on the dimensions of this time interval and the forces that influence it. The present article outlines considerations for research on this topic and presents findings for outpatient depressives (N = 61) on life stress and the time lag between onset and treatment entry. Results indicate that life stress occurring before the onset of depression is highly predictive of time to treatment entry. In marked contrast, stress occurring after onset is not associated with this time interval. Further analyses suggest different mechanisms of association between different stress variables and time to treatment entry. The clinical implications for alleviating suffering from a depressive episode and for decreasing the likelihood that depression will lead to disruption in other spheres of the person's life are discussed. Overall, the results add to the emerging literature on life stress and depression, enlarging the scope to include forces operative in seeking formal treatment.

Adult↗

PubMed1991

Diathesis-stress theories in the context of life stress research: implications for the depressive disorders.

Advances in the conceptualization and measurement of life stress in the past 2 decades raise several questions concerning traditional diathesis-stress theories of psychopathology. First, comprehensive measures of life stress force investigators to become more precise about the particular stressful circumstances hypothesized to interact with diatheses. Second, the influence of the diathesis on a person's life is typically ignored, which results in several types of possible bias in the assessment of life stress. Finally, information is available on diatheses and stress for specific disorders to provide a foundation for more empirically based hypotheses about diathesis-stress interactions. This possibility is outlined for depression. Such an approach provides the basis for developing broader, yet more specific, frameworks for investigating diathesis-stress theories of psychopathology in general and of depression in particular.

Depressive Disorder↗

PubMed1991

Severity of depression and response to cognitive behavior therapy.

OBJECTIVE: The authors studied the relationship between clinical severity of depression and response to cognitive behavior therapy. METHOD: Fifty-nine outpatients with major depression with endogenous features, according to Research Diagnostic Criteria, were stratified into more severe (score of 20 or more on the Hamilton Rating Scale for Depression; N = 38) or less severe (Hamilton score of 19 or less; N = 21) subgroups. Patients were treated with a 16-week, 20-session cognitive behavior therapy protocol. Outcome was assessed with the Hamilton scale, the Global Adjustment Scale, and the Beck Depression Inventory. RESULTS: The more severe group was significantly more symptomatic across the 16-week protocol and had a significantly lower response rate on the Beck inventory (50% versus 81%). However, the groups did not significantly differ at end point on any of the three measures, and they showed comparable rates of symptomatic improvement (i.e., percent change in scores and interactions between severity classification and time). CONCLUSIONS: These results partially replicate the National Institute of Mental Health's Treatment of Depression Collaborative Research Program's findings of poorer response to cognitive behavior therapy in patients with Hamilton scale scores of 20 or more. However, both groups experienced robust and clinically significant reductions in depressive symptoms, and the response of the more severe patients in the current study could hardly be considered poor. While these findings do not support the view that a Hamilton scale score of 20 or more is a relative contraindication for cognitive behavior therapy, the symptoms of the more severely depressed patients did tend to remit less completely (particularly on the Beck inventory) and thus these patients may benefit from a more intensive or extended course of therapy.

Adult↗

PubMed1990

Sleep, gender, and depression: an analysis of gender effects on the electroencephalographic sleep of 302 depressed outpatients.

Gender-related differences in electroencephalographic (EEG) sleep were examined in 151 pairs of men and women with major depression, all outpatients, matched for age and severity of depression. Across five decades (age 21-69), depressed men had less slow-wave sleep than did depressed women. Gender differences were small with respect to visually scored measures of slow-wave sleep time and percent, but moderate for gender differences in automated measures of slow-wave density. The time constant of the polygraph preamplifier significantly affected both visually scored and automatically scored slow-wave sleep. Other measures such as REM sleep latency, first REM period duration, sleep efficiency, and early morning awakening, showed robust age effects, but no main effects for gender or gender-by-age interactions. Gender effects on slow-wave sleep and delta-wave counts in depression parallel gender effects seen in healthy aging. The possibility of occult alcohol use by depressed male outpatients cannot be definitely excluded as a partial explanation of the current findings. However, covarying for past alcohol abuse did not negate the statistical significance of the observed gender effects on slow-wave sleep and delta-wave density. The possibility of gender differences in slow-wave regulatory mechanisms is suggested, but similarity in temporal distribution of delta-wave density between the first and second non-rapid-eye-movement (NREM) periods does not support gender differences in slow-wave sleep regulation.

Adult↗

PubMed1987

An integrated system for interstitial 192Ir implants.

An efficient system for preparing, afterloading, and removing interstitial 192Ir strands has been developed. Use of the system reduces the risk of personnel exposure and eliminates some patient discomfort. The system is "integrated" in that all aspects of the implantation process are considered, from source preparation to source removal. Strand preparation is facilitated by an "assembly line" process using shielded equipment. Components include a handling block for measuring and cutting active strands, a mirror, and a transport container. Afterloading and removal techniques use quick release devices and several forms of afterloading tubing and catheters, each terminated by a Luer lock adapter. Both blind-end and through-and-through implants are possible. Each 192Ir strand, threaded through an injection cap that mates with the Luer lock adapter, is quickly inserted into its tubing or catheter and locked into place. No crimping is required and no additional positioning of the sources is needed. Strand removal is easily accomplished by unlocking and removing the injection cap. The strands receive no mechanical damage and can be reused after appropriate cleaning. More than 100 cases have been performed without incident. Applications include head/neck, breast, and template and non-template vaginal wall treatments.

Brachytherapy↗

PubMed1986

Cognitive therapy and pharmacotherapy for depression. Sustained improvement over one year.

Seventy patients with nonbipolar affective disorder who completed a 12-week course of either cognitive therapy (CT), pharmacotherapy, CT plus active placebo, or CT plus pharmacotherapy were assessed one month, six months, and one year after termination of active treatment. Of the 44 patients who had originally responded to treatment, 16 relapsed as defined by reentry into treatment or by self-reported depression scores in the moderately depressed range. Twenty-eight patients remained well during the one-year follow-up. Patients with relatively high levels of remaining depressive symptoms on completion of treatment relapsed more often than those who had little or no residual depression. Further, at treatment termination, patients who relapsed had significantly higher scores on a measure of dysfunctional attitudes. Patients who had received CT (with or without tricyclic antidepressants) were less likely to relapse in the one-year follow-up period than patients who received pharmacotherapy.

Adolescent↗

PubMed1984

Cognitive therapy and pharmacotherapy. Singly and together in the treatment of depression.

Eight-seven moderately to severely depressed psychiatric outpatients were randomly assigned to 12 weeks of cognitive therapy (CT) (n = 24), pharmacotherapy (n = 24), CT plus pharmacotherapy (n = 22), or CT plus active placebo (n = 17). Seventy patients completed the treatment protocol. Seventeen dropped out before the end of the treatment period. Patients who completed treatment showed significant improvement in mean scores on two common measures of severity of depression (the Beck Depression Inventory and the Hamilton Rating Scale for Depression) between evaluation and termination. Improvement did not differ as a function of the different treatment modalities. Inclusion of dropout patients' end-point scores did not alter these results. Treatment gains in all groups were maintained at one-month follow-up assessment. A portion of this study replicated an earlier study. While the results were not identical, they indicated that either CT or antidepressant drug treatment can be effective in treating outpatients with primary, nonbipolar depression of moderate or greater severity. Combining treatments did not lead either to additive effects or negative interactions.

Adult↗

PubMed1984

The process of change in cognitive therapy and pharmacotherapy for depression. Changes in mood and cognition.

Twenty-eight moderately depressed outpatients were randomly assigned to 12 weeks of cognitive therapy (N = 14) or pharmacotherapy (N = 14). Significant changes in mood, cognitive processes, and content were similar to those found in previous studies demonstrating effectiveness of cognitive therapy. Patients treated with medication, however, demonstrated nearly identical change on all measures, including cognitive measures, despite the absence of direct focus on cognitive activity. Further analyses disclosed that cognitive change may be an important feature of overall clinical improvement, as patients whose conditions did not improve (regardless of treatment modality) showed significantly less change on cognitive measures. These findings suggest that cognitive change may be more accurately seen as a part of improvement rather than the primary cause of improvement. This suggests a more complex conceptualization of the role of cognitions in the change secured by cognitive therapy.

Adult↗

PubMed1984

Patient attrition in a comparative outcome study of depression. A follow-up report.

Eighty-seven moderately to severely depressed psychiatric outpatients were randomly assigned to 12 weeks of cognitive therapy (n = 24), pharmacotherapy (n = 24), cognitive therapy plus pharmacotherapy (n = 22) or cognitive therapy plus active placebo (n = 17). Seventy patients completed the treatment protocol; 17 dropped out before the end of the treatment period. Completers and dropouts did not differ at pretreatment on demographic variables, measures of depression, cognitive functioning or social adjustment. Sixteen of the 17 patients who dropped out were followed up and interviewed to assess their clinical status and reasons for discontinuing treatment. Neither group remained depressed at follow-up. Practical matters and issues related to the type of treatment received seemed to contribute most to patients' decision to drop out. Patients assigned to the combination therapies were more likely to complete the research protocol than those assigned to single treatment modalities. These findings are discussed in terms of their implications for clinical practice and outcome research.

Adolescent↗

PubMedDate not supplied

Plasma nortriptyline and clinical response in depression.

Plasma levels of nortriptyline below 50 ng/ml or above 150 ng/ml have been reported to yield results inferior to intermediate levels. In the present study, patients with uncomplicated primary, nonbipolar depression were randomly assigned to 12 weeks of treatment with NT alone or with cognitive therapy. Nine of 35 patients had mean NT plasma levels less than 50 ng/ml. Five of them improved clinically to the criterion level of less than or equal to 7 on the Hamilton Rating Scale for Depression. This improvement rate was not at all different from that of patients with mean plasma levels within the presumed therapeutic window. The upper limit of 150 ng/ml was not tested. This study is presented in the hope of reviving the apparently dormant search for optimal therapeutic plasma levels of antidepressants.

Antidepressive Agents↗

PubMedDate not supplied

Is cognitive behavior therapy just a 'nonspecific' intervention for depression? A retrospective comparison of consecutive cohorts treated with cognitive behavior therapy or supportive counseling and pill placebo.

BACKGROUND: There is a dearth of placebo-controlled studies of cognitive behavior therapy (CBT) of depression and the largest such study, by Elkin et al. (Arch. Gen. Psychiatry 46 (1989) 971-982), failed to find a significant difference between CBT and a clinical management plus placebo condition. METHODS: The outcomes of two consecutive cohorts of out-patients with major depressive disorder, treated with either CBT (n=90) or a nonspecific control condition (support-counseling-placebo; SCP: n=100), were compared. Although the principal comparisons between the CBT and SCP conditions were delimited to the first 4 weeks of treatment, a secondary set of analyses addressed the subset of 16 patients who received 12 additional weeks of supportive therapy. RESULTS: A consistent pattern of statistically and clinically significant differences favoring CBT over SCP was found in both weeks 4 and 16. LIMITATIONS: Interpretation of these findings are subject to several potential confounds, including the non-randomized nature of the groups and the greater amount of therapeutic contact during the first 4 weeks of CBT. CONCLUSIONS: While these results do not lessen the need for additional prospective studies, our findings do suggest that CBT has therapeutic effects beyond those attributable to placebo-expectancy and other nonspecific factors.

Adult↗