Cognitive Dysfunction in Asian Patients with Depression (CogDAD): A Cross-Sectional Study.

BACKGROUND: Cognitive dysfunction is a predominant symptom of Major Depressive Disorder (MDD), contributing to functional impairment. OBJECTIVE: The primary objective of this study was to assess and describe perceived cognitive dysfunction amongst Asian patients diagnosed with MDD. The secondary objective was to explore the associations between depression severity, perceived cognitive dysfunction and functional disability. METHODS: This was a multi-country, multi-centre, cross-sectional study. Adults with a current episode of MDD were recruited from 9 university/general hospital clinics in Asia. During a single study visit, psychiatrists assessed depression severity (Clinical Global Impression-Severity, CGI-S); patients completed questionnaires assessing depression severity (Patient Health Questionnaire-9 items, PHQ-9), perceived cognitive dysfunction (Perceived Deficit Questionnaire-Depression, PDQ-D) and functional disability (Sheehan Disability Scale, SDS). RESULTS: Patients (n=664), predominantly women (66.3%), were aged 46.5±12.5 years, lived in urban areas (81.3%) and were employed (84.6%). 51.5% of patients were having their first depressive episode; 86.7% were receiving treatment; 82.2% had a current episode duration >8 weeks. Patients had mild-to-moderate depression (CGI-S=3.3±1.0; PHQ-9=11.3±6.9). Patients reported perceived cognitive dysfunction (PDQ-D=22.6±16.2) and functional disability (SDS=11.3±7.9). PHQ-9, PDQ-D and SDS were moderately-to-highly correlated (PHQ-9 and SDS: r=0.72; PHQ-9 and PDQ-D: r=0.69; PDQ-D and SDS, r=0.63). ANCOVA showed that after controlling for patient-reported depression severity (PHQ-9), perceived cognitive dysfunction (PDQ-D) was significantly associated with functional disability (SDS) (p<0.001). CONCLUSIONS: Asian patients with MDD reported perceived cognitive dysfunction. There is a need for physicians to evaluate cognitive dysfunction in the clinical setting in order to reach treatment goals, including functional recovery beyond remission of mood symptoms.

Is early-onset in major depression a predictor of specific clinical features with more impaired social function? / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Early-onset major depressive disorder (MDD) (EOD) is often particularly malignant due to its special clinical features, accompanying impaired social function, protracted recovery time, and frequent recurrence. This study aimed to observe the effects of age onset on clinical characteristics and social function in MDD patients in Asia.</p><p><b>METHODS</b>In total, 547 out-patients aged 18-65 years who were from 13 study sites in five Asian countries were included. These patients had MDD diagnose according to the Diagnostic and Statistical Manual of Mental Disorders, 4 th Edition criteria. Clinical features and social function were assessed using Symptom Checklist-90-revised (SCL-90-R) and Sheehan Disability Scale (SDS). Quality of life was assessed by a 36-item Short-form Health Survey (SF-36). Analyses were performed using a continuous or dichotomous (cut-off: 30 years) age-of-onset indicator.</p><p><b>RESULTS</b>Early-onset MDD (EOD, <30 years) was associated with longer illness (P = 0.003), unmarried status (P < 0.001), higher neuroticism (P ≤ 0.002) based on the SCL-90-R, and more limited social function and mental health (P = 0.006, P = 0.007) based on the SF-36 and SDS. The impairment of social function and clinical severity were more prominent at in-patients with younger onset ages. Special clinical features and more impaired social function and quality of life were associated with EOD, as in western studies.</p><p><b>CONCLUSIONS</b>EOD often follows higher levels of neuroticism. Age of onset of MDD may be a predictor of clinical features and impaired social function, allowing earlier diagnosis and treatment.</p>

Benzodiazepine overuse in an internal medicine outpatient department: a prospective study

Objective: This study aims to assess benzodiazepine overuse, in particular indications, prolonged use, and dependence for usage in out-patients treated at the internal medicine clinic of Chiang Mai University Hospital. Methods: The indications of benzodiazepine usage were examined by using the Thai Hospital Anxiety and Depression Scale in patients who were started on benzodiazepines. The duration of benzodiazepine usage was classified into: i) less than 1 month; ii) 1-6 months; and iii) longer than 6 months, and benzodiazepine dependence was assessed by using the Severity of Dependence Scale. Results: Of 40 out-patients started on benzodiazepines, only one of them (2.5%) had clinically significant anxiety. Of 58 outpatients receiving benzodiazepines, 42 patients (72.4%) had used benzodiazepines longer than 6 months. In addition, 8 patients (13.8%) were dependent on benzodiazepines. Conclusions: Benzodiazepine overuse is common in physically ill out-patients, even in the university hospital. Almost half of the surveyed patients appear to have prolonged benzodiazepine use; however, only a few patients are dependent on benzodiazepines.