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Polysomnography and depressive symptoms in primary alcoholics with and without a lifetime diagnosis of secondary depression and in patients with primary major depression.

BACKGROUND: There is evidence suggesting that there is: (1) additive polysomnographic effects of alcoholism and depression; and (2) elevated baseline REM density in primary alcoholics with (PASD) and without lifetime history of secondary depression (NPA). METHODS: 23 PASDs, 59 NPAs, and 23 primary major depression patients (PMD) underwent polysomnography. Any drinking within 3 months after a 1-month inpatient alcohol rehabilitation defined relapse. RESULTS: PASDs' polysomnography was more like NPAs than PMDs. Polysomnography reflected 3-month sobriety status more than diagnosis. LIMITATIONS: Not all PASD's met full major depression criteria upon admission. CONCLUSIONS: Alcoholism affected polysomnography more than depression. Elevated admission REM density predicted 3-month relapse in PASDs and NPAs.

Adult↗

The Beck Depression Inventory, Center for Epidemiological Studies Depression Scale (CES-D), and General Well-Being Schedule depression subscale in rheumatoid arthritis. Criterion contamination of responses.

Three widely used depression scales--the Beck Depression Inventory (BDI), Center for Epidemiological Studies Depression scale (CES-D), and General Well-Being Schedule depression subscale (GWB-D)--were studied in rheumatoid arthritis (RA). Twenty-three rheumatologists identified 19 of the 45 items on these three questionnaires as likely to differ in patients with RA and control subjects because of the presence of RA, regardless of psychological status. Responses to 13 of these 19 individual scale items, designated as "RA-related items," differed significantly in 41 RA patients versus 57 age-matched control subjects. Only three of the other 26 items differed significantly in the two groups. These data extend evidence that responses of people with RA on widely used depression scales might be affected by somatic disease regardless of psychological status.

Activities of Daily Living↗

Depression following acute coronary syndromes: a comparison between the Cardiac Depression Scale and the Beck Depression Inventory II.

OBJECTIVE: This study compared the Cardiac Depression Scale (CDS) and the Beck Depression Inventory II (BDI-II). METHOD: Depression was assessed in 81 participants, 2 weeks post-ACS, using the BDI-II and the Composite International Diagnostic Interview. RESULTS: The CDS had a strong concurrent validity with the BDI-II (r=.69). Cross-validation of the BDI-II and the CDS with the structured interview demonstrated the ability of both measures to detect severe symptoms. More patients were classified as depressed using the CDS. The CDS also had a significantly higher correlation with a trait anxiety measure than the BDI-II did. CONCLUSION: The CDS is a more suitable scale for assessing the less severe depressive symptoms typically seen in a cardiac population.

Acute Disease↗

Validating Kraepelin's two types of depressive mixed states: "depression with flight of ideas" and "excited depression".

Despite a venerable classic tradition going back to at least Kraepelin, depressive mixed states (DMX) are not represented in official diagnostic manuals in psychiatry. We have operationalised this condition as a major depressive episode (MDE) with three or more intra-episode hypomanic signs and symptoms (DMX3). Of 320 consecutive bipolar II outpatients, presenting for MDE treatment and interviewed using the Structured Clinical Interview for DSM-IV, modified to permit the systematic evaluation of hypomanic features during the index MDE, 200 met our criteria for DMX3 (62.5%). When compared with the remaining non-DMX bipolar II, they had significantly earlier age at onset, higher percentage of females, atypical features and bipolar family history. Multivariate logistic regression ofintra-MDE hypomanic signs and symptoms found evidence supporting an "excited depression" subtype (defined by the core feature of psychomotor agitation, and further characterised by talkativeness, irritable mood and distractability) and a "depression with flight of ideas" subtype (defined by the core feature of racing/crowded thoughts, and further characterised by risky pleasurable impulses including, among others, those with intense sexual arousal). We thereby documented the existence of two distinct DMX subtypes which testify to the clinical acumen of Kraepelin (and his pupil Weygandt) who in 1899 described these two subforms of depressive mixed states in more severely ill hospitalised patients.

Adult↗

Screening for adolescent depression: comparison of the Kutcher Adolescent Depression Scale with the Beck depression inventory.

Self-report instruments commonly used to assess depression in adolescents have limited or unknown reliability and validity in this age group. We describe a new self-report scale, the Kutcher Adolescent Depression Scale (KADS), designed specifically to diagnose and assess the severity of adolescent depression. This report compares the diagnostic validity of the full 16-item instrument, brief versions of it, and the Beck Depression Inventory (BDI) against the criteria for major depressive episode (MDE) from the Mini International Neuropsychiatric Interview (MINI). Some 309 of 1,712 grade 7 to grade 12 students who completed the BDI had scores that exceeded 15. All were invited for further assessment, of whom 161 agreed to assessment by the KADS, the BDI again, and a MINI diagnostic interview for MDE. Receiver operating characteristic (ROC) curve analysis was used to determine which KADS items best identified subjects experiencing an MDE. Further ROC curve analyses established that the overall diagnostic ability of a six-item subscale of the KADS was at least as good as that of the BDI and was better than that of the full-length KADS. Used with a cutoff score of 6, the six-item KADS achieved sensitivity and specificity rates of 92% and 71%, respectively-a combination not achieved by other self-report instruments. The six-item KADS may prove to be an efficient and effective means of ruling out MDE in adolescents.

Adolescent↗

Assessment of depression in college students: Geriatric Depression Scale versus Center for Epidemiological Studies Depression Scale.

103 college students took the Geriatric Depression Scale and Center for Epidemiological Studies Depression Scale along with five measures of life satisfaction. The correlation between scores on the first scales was .66. Both depression scales had moderate negative correlations (-.34 to -.71) with each measure of life satisfaction. However, on every measure of life satisfaction, the correlation with scores on the Geriatric Depression Scale was higher than with those on the CES-Depression Scale.

Adult↗

[Comparison of masked and endogenous depression using psychometric scales, endocrinological markers and pharmacological responses. Masked depression versus endogenous depression].

Masked depression refers to a concept of a phenomenological state, either endogenous or psychogenic where somatic symptoms replace sadness: Thirty patients were evaluated by RDC (22 endogenous and 8 masked depressions) wherein in the latter dysphoria was replaced by a nonreactive persistent somatic complaint. They were rated on Beck and Hamilton Depression Scales, on Hamilton and Trait-State Anxiety Scales and the NOSIE. All patients presented with insomnia, anorexia, loss of weight, diminished libido and anhedonia. Initial ratings were similar for both diagnostic groups except for a significantly higher agitation factor and lower retardation in masked depression. Although 59.9 percent of the subjects are positive on the dexamethasone test, only 1 masked depression did not suppress secretion of cortisol. After a randomized 30-day drug trial where patients were assigned to Clomipramine or Desipramine, patients in both groups show significant improvement on rating scales but diagnostic group drug treatment interaction exists on anxiety and agitation criteria.

Adult↗

[Depression and dementia: contribution to the French validation of 2 depression scales: the Cornell Scale for Depression in Dementia and the Dementia Mood Assessment Scale].

This study establishes, in a sample of elderly demented patients, the validity of a french translation of two depression rating scales: Cornell Scale for Depression in Dementia (CSDD, Alexopoulos 1988), Dementia Mood Assessment Scale (DMAS, Sunderland 1988). Cognitive performances of 24 patients (mean age 77.9 +/- 7.4, 7 men 17 women), meeting DSM III-R criteria for dementia, have been evaluated. Four clinicians, blind to the clinical diagnosis of depression established by a psychogeriatrist, have evaluated the sample with the two scales. All patients present middle to severe dementia: MMS = 16.8 +/- 3.45. Eleven patients (45%) present moreover depression. Concurrent validity has been established against Hamilton Depression Rating Scale, test retest reliability, inter-rater reliability and internal consistency are established for each scale. These characteristics are pleading for a good reliability of the french translation of CSDD and DMAS, in the presence of cognitive impairment.

Aged↗

Depression followed by suicide: a comparison of depressed suicides with living depressives.

The characteristics of 64 suicides with a retrospective diagnosis of depression and 128 depressives referred for psychiatric treatment were compared. The following items differentiated the suicide group: male sex, older age in females, single status, living alone, the symptoms of insomnia, impaired memory and self neglect, and a history of suicide attempts. The value of these items in assessing suicide risk in depressive illness is discussed.

Age Factors↗

Separation of subtypes of depression using discriminant analysis. I. Separation of unipolar endogenous depression from non-endogenous depression.

We derived a discriminant function based on clinical features to classify patients with endogenous depression ('melancholia') and non-endogenous ('neurotic') depression. The difference between the groups was not one of overall severity of illness alone. Bipolar melancholic patients were classified less well than were unipolars, supporting previous findings of clinical differences between these groups. The discriminant function (DF) was reduced to a discriminant index (DI) which classified a separate group of unipolar melancholic and non-endogenous patients with comparable accuracy. Approximately 80 per cent of all cases received a definite classification by the DI. The agreement between the 105 definite DI classifications and the clinical diagnoses was 90 per cent when results from the derivation and validation groups were combined. The DI classification was then validated against an objective biological marker, the dexamethasone suppression test (DST). The diagnostic discriminant index predicted the DST result with the same accuracy as the clinical diagnoses. The discriminant index can serve as an operational definition of the patients diagnosed as endogenous or nonendogenous unipolar depression in future studies by ourselves and other groups of investigators.

Adult↗

[Cyclothymic depression and performance. Comparison of the efficiency of agitated and non-agitated cyclothymic depression patients on a brief test of severe depression].

Agitated and non-agitated cyclothym depressive patients were compared relative to their results in a short achievement test for measuring degree of depression; the agitated patients worked significantly less slowly in two of the five subtests. These differences may exist premorbidly and can be explained by a theoretical concept of arousal. We propose to control the subject's activational states which -- besides the control of age and intelligence -- might possibly precise the test results relative to the depth of depression.

Adult↗

[Culture specific or universal depressive diseases? Comparison of depressive symptoms of WHO/SADD (Standardized Assessment of Depressive Disorders) in Mannheim, West Germany and Addis Abeba, Ethiopia].

In an international comparative study the symptomatology of depressive patients from psychiatric services in Addis Ababa, Ethiopia (N = 52) and in Mannheim, Federal Republic of Germany (N = 136) was investigated with the WHO Schedule for Standardized Assessment of Depressive Disorders (WHO/SADD). Controlled for differences in the sex-, age- and diagnostic-distribution of the two samples, depressive patients in Addis Ababa showed significantly more somatic symptoms, hypochondrias, psychomotor restlessness and delusions of reference and persecution, but markedly less feelings of guilt. Nevertheless, the same core of symptomatology was found to build in both samples the first and most important factor of 17, mainly psychological complaints. Only "feelings of guilt" did not belong to this core in Addis Ababa. In contrast to what is often believed to be the case in African patients, the more frequently expressed somatic complaints came in addition to, but did not replace the core-psychological symptomatology. The investigators stress the importance of a separate analysis of the frequencies of symptoms and of dimensions these symptoms build.

Cross-Cultural Comparison↗

Depression, depressive symptoms, and depressed mood among a community sample of adolescents.

Using a structured interview, the authors found that the prevalence of major depression and dysthymic disorder was 4.7% and 3.3%, respectively, in a community sample of 150 adolescents. All of the adolescents who met the criteria for major depression and dysthymic disorder had other psychiatric disorders as well; anxiety was the most frequent accompanying DSM-III diagnosis.

Adolescent↗

Separation of subtypes of depression using discriminant analysis. Separation of bipolar endogenous depression from nonendogenous ("Neurotic") depression.

We derived a discriminant function separating patients with bipolar endogenous depression ("melancholia") from patients with nonendogenous ("neurotic") depression, and showed that the difference between the groups was not one of overall severity of illness alone. The discriminant function (DF) included 5 clinical items. We reduced the DF to a discriminant index (DI) with integral item weights, and trichotomized the DI scores into two definite classifications and an intermediate, uncertain classification. We cross-validated this DI in a separate group of patients, and found no decrease in the accuracy of classification on cross-validation. Thirty-three of 41 (80%) of the patients in the cross-validation group were classified by the DI; 26 of 33 (79%) correctly. We also validated the DI classification against an external, biological marker, the dexamethasone suppression test (DST). The DI predicted the DST result with the same accuracy as the clinical diagnoses did, supporting the validity of the DI.

Adult↗

[Validation of HARD (Hamilton depression rating scale) a diagram of the evaluation of depression by MADRS (Montgomery-Asberg depression rating scale) Multicentric study of mianserin].

A national multicentric trial has included 402 depressed patients (DSM III Criteria) and has validated diagram HARD by MADRS. A constant and similar decrease in the total of the two rating scales has been shown at several times of assessment, Day 0, 10, 20, 60, and 90. High coefficents of correlation are found between HARD and MADRS. The sensitivity to change under treatment (mianserin 60 mg) is equal for the two rating scales.

Adult↗

Further distinctions between manic-depressive illness (bipolar disorder) and primary depressive disorder (unipolar depression)

OBJECTIVE: Patients with bipolar disorder differ from patients with unipolar depression by having family histories of mania with an earlier onset and by having more episodes over a lifetime. This study was designed to determine whether additional aspects of course of illness, the presence of medical diseases, childhood traits, and other familial illnesses separate the two groups. METHOD: In a large collaborative study, consecutively admitted bipolar and unipolar patients were systematically given clinical interviews. Data were collected on medical diseases and childhood behavioral traits. Systematic family history and family study data were also obtained. The patients were studied every 6 months for 5 years. RESULTS: The group of bipolar patients had an earlier onset, a more acute onset, more total episodes, and more familial mania and were more likely to be male. These differences were relatively independent of each other. The bipolar patients were also more likely to have shown traits of hyperactivity as children. The unipolar patients had a significantly greater number of lifetime medical/surgical interventions than the bipolar patients, even when age was controlled. Alcoholism was more frequently found in the families of the bipolar patients, even when alcoholism in the probands was controlled; however, this difference was not significant. CONCLUSIONS: This study supports the usefulness of distinguishing between bipolar and unipolar patients in treatment and research studies.

Adult↗

[A study of the Edinburgh Postnatal Depression Scale (EPDS) on 859 mothers: detection of mothers at risk for postpartum depression].

The postpartum is a high-risk period for the occurrence of anxious and depressive episodes. Indeed, during the first few days after delivery, mothers can present postpartum blues symptomatology: fatigue, anxiety, disordered sleeping and a changing mood. Postpartum depression is characterised by a changing mood, anxiety, irritability, depression, panic and obsessional phenomena. It occurs in approximately 10 to 20% mothers. The exact prevalence depending on the criteria used for detection. The first symptoms usually appear between the fourth and sixth week postpartum. However, postpartum depression can start from the moment of birth, or may result from depression evolving continuously since pregnancy. We can add that the intensity of postpartum blues is a risk factor that can perturb maternal development. So it is important for health professionals to dispose of predictive tools. This study is a validation of the French version of the EPDS. The aims of the study were to evaluate the postpartum depression predictive value at 3 days postpartum and to determine a cut-off score for major depression. Subjects participating in this study were met in 3 obstetrical clinics in, or in the vicinity of, Toulouse. Mothers with psychological problems, under treatment for psychological problems or mothers whose babies present serious health problems were excluded from the study. The EPDS was presented to 859 mothers (mean age=30.3; SD=4.5) met at one of the clinics at 3 days postpartum (period 1). They had an EPDS mean score of 6.4 (SD=4.6); 258 (30%) mothers had an EPDS score 9. 82.6% of these mothers experienced a natural childbirth and 17.3% a caesarean section; 51.5% gave birth to their first child, 36.2% to their second child and 12.3% to their third or more. All subjects were given a second EPDS with written instructions to complete the scale during the period 4 to 6 weeks postpartum and return it for analysis (period 2). Between the 4 to 6 weeks postpartum period, 722 mothers replied again to the EPDS. 131 mothers had an EPDS score 11 (mean age=30.3; SD=4.8). They had an EPDS mean score of 13.6 (SD=3.3). Mothers with probable depression were interviewed and assessed, using the Mini (Mini Neuropsychiatric Interview, Lecrubier et al. 1997), the SIGH-D (Structured Interview Guide for the Hamilton Depression Scale) and the BDI (Beck Depression Inventory) in order to diagnose a major depressive episode. They had a HDRS mean score of 13.7 (SD=5.1) and a BDI mean score of 13.6 (SD=5). At 3 days postpartum, we observed that 258 mothers (30%) had an EPDS scores 9 and 164 mothers (19%) had an EPDS scores 11. Between 4 and 6 weeks postpartum, we observed 18.1% of postpartum depression (EPDS 11) and 16.8% (EPDS 12) of major postpartum depression. The analysis of the sensitivity and the specificity at 3 days postpartum provides a cut-off score of 9 (Sensibility: 0.88) (Specificity: 0.50) as predictive of postpartum depression, for this cut-off score, the type I error is low (5.8%) but the type II error is more higher (18.9%). The analysis of the sensitivity and the specificity between 4 and 6 weeks postpartum provides a cut-off score of 12 (Sensibility: 0.91) (Sensibility: 0.74) for the detection of major postpartum depression. Factor analysis shows at 3 days postpartum that the internal structure of the scale is composed of two subscales. The first factor F1 "anxiety" accounts 28% of the variance and the second factor F2 "depression" accounts 20% of the variance. Between 4 and 6 weeks postpartum, factor analysis suggests an unidimensional model in the evaluation of postpartum depression which is better than a two factor model. This factor accounts 40% of the variance. The scale has a good predictive value, and we can observe a significant correlation with the EPDS periods 1 and 2 (r=0.56; p<0.05). This result shows that the depressive mothers mood intensity predicts a future depressive risk. Furthermore, correlations between EPDS and BDI (r=0.68; p<0.05) and EPDS and HDRS (r=0.67; p<0.05) show a good convergent validity. The reliability study confirms the good internal consistency of the EPDS, at 3 days postpartum and in the postpartum depression -symptomatology evaluation (Cronbach's Alpha>0.80). In conclusion, this scale demonstrates good validity and is fast and easy use in obstetrical services, allowing early detection of women who risk to develop postpartum depression and, in the first week of postpartum, of mothers who suffer from a major postpartum depression. The use of the EPDS for an early screening of the risk of postnatal depression which is essential considering the consequences that postnatal depression can have on the development of the infant, on the quality of the relationship within the couple and on other social relationships. Mothers at risk for postnatal depression should be controlled and surveyed by the health professionals in obstetrical clinics.

Adult↗

Recognizing increased risk of depressive comorbidity after myocardial infarction: looking for 4 symptoms of anxiety-depression.

BACKGROUND: Screening for depression in myocardial infarction (MI) patients must be improved: (1) depression often goes unrecognized and (2) anxiety has been largely overlooked as an essential feature of depression in these patients. We therefore examined the co-occurrence of anxiety and depression after MI, and the validity of a brief mixed anxiety-depression index as a simple way to identify post-MI patients at increased risk of comorbid depression. METHODS: One month after MI, 176 patients underwent a psychiatric interview and completed the Beck Depression Inventory (BDI) and the Symptoms of Anxiety-Depression index (SAD(4)) containing four symptoms of anxiety (tension, restlessness) and depression (feeling blue, hopelessness). RESULTS: Thirty-one MI patients (18%) had comorbid depression and 37 (21%) depressive or anxiety disorder. High factor loadings and item-total correlations (SAD(4), alpha = 0.86) confirmed that symptoms of anxiety and depression co-occurred after MI. Mixed anxiety-depression (SAD(4)>or=3) was present in 90% of depressed MI patients and in 100% of severely depressed patients. After adjustment for standard depression symptoms (BDI; OR = 4.4, 95% CI 1.6-12.1, p = 0.004), left ventricular ejection fraction, age and sex, mixed anxiety-depression symptomatology was associated with an increased risk of depressive comorbidity (OR = 11.2, 95% CI 3.0-42.5, p < 0.0001). Mixed anxiety-depression was also independently associated with depressive or anxiety disorder (OR = 9.2, 95% CI 3.0-27.6, p < 0.0001). CONCLUSIONS: Anxiety is underrecognized in post-MI patients; however, the present findings suggest that anxiety symptomatology should not be overlooked in these patients. Depressive comorbidity after MI is characterized by symptoms of mixed anxiety-depression, after controlling for standard depression symptoms. The SAD(4) represents an easy way to recognize the increased risk of post-MI depression.

Anxiety Disorders↗