Psychophysiological characteristics in the ChNPP accident clean-up workers, exclusion zone evacuees and anti-terrorist operation servicemen. / PSYKhOFIZIOLOGIChNI OSOBLYVOSTI UChASNYKIV AVARIÏ NA ChAES, EVAKUY̆OVANYKh IZ ZONY VIDChUZhENNIa TA UChASNYKIV ANTYTERORYSTYChNOÏ OPERATsIÏ.

OBJECTIVE: Evaluation of interdependencies between psychometric parameters and spontaneous cerebral electric activity in the ChNPP accident clean up workers, evacuees from exclusion zone, and anti terrorist operation service men. OBJECT AND METHODS: Psychometric and neurophysiological parameters were reviewed in the study subjects retro spectively and in comparison. Study population included the ChNPP accident clean up workers (ACUW), evacuees from the 30 kilometer exclusion zone, specifically in a sample from a cohort of the NRCRM Clinical Epidemiological Register (n=316), and anti terrorist operation servicemen (n=81) undergoing rehabilitation in the NRCRM Radiation psychoneurology department. A control group of persons (n=84) was also involved in the study. Diagnostic method ology for the characteristic personality features, namely the personality test of character accentuation by G. Shmishek and K. Leonhard, and Eysenck Personality Inventory (by H. J. Eysenck) were applied. Computer EEGs were registered and analyzed on the 16 channel electroencephalograph DX 4000 (Kharkiv, Ukraine). RESULTS: In the aftermath of the emergency period, a personality deformation occurs in the clean up workers and survivors of the ChNPP accident, which is characterized by aggravation of such personality traits as jam (fixedness), emotiveness, pedantry, anxiety, cyclothymia, excitability and disthymia, with diminished hyperthymia and ostenta tion (demonstrability). Increased incidence of fixedness, pedantry, cyclothymia, affectability and disthymia with decreased hyperthymia were revealed in the group of ATO participants. Cerebral bioelectrical activity in the ChNPP ACUW was characterized by an increased delta activity power with decreased beta and theta activity power and dom inant frequency in comparison with all groups of survivors and control group. The ATO group was different from groups of survivors and control group with a lower power of delta, theta and beta activity, and a higher dominant frequency. Introversion featured a negative correlation with delta and theta activity index along with positive cor relation with alpha activity index. The absolute spectral power of beta, alpha and theta bands positively correlated with introversion. Increase in neuroticism featured a decrease in theta activity index and an increase in beta activ ity index along with decreased theta and delta band absolute spectral power. CONCLUSIONS: There is a deformation of personality in the group of ChNPP ACUW, evacuees from the 30 kilometer zone and ATO servicemen. Deformation of personality correlates with abnormal cerebral bioelectrical activity.

Evaluación neuropsicológica de los procesos cognitivos básicos en pacientes distímicos con intento de suicidio / Neuropsychological assessment of basic cognitive processes in dysthymic patients attempted suicide

La distimia incluye síntomas crónicos que interfieren en el funcionamiento y bienestar de la persona, pudiendo traer consecuencias fatales como el intento de suicidio, así como alteraciones neuropsicológicas en los procesos afectivos y cognitivos que afectan el comportamiento. En el municipio de Guisa, Provincia Granma, existe un alto número de pacientes distímicos que son infradiagnosticados, por lo que las conductas suicidas se tornan más frecuentes. Por este motivo se realizó la investigación que se muestra bajo el título “Evaluación neuropsicológica de los procesos cognitivos básicos en pacientes distímicos con intento de suicidio”, con el objetivo de caracterizar el estado neuropsicológico de dichos procesos. Se aplicaron métodos del nivel teórico: análisis-síntesis y el inductivo-deductivo, así como las siguientes técnicas: entrevista inicial, anamnesis, observación, Inventario de Beck, test Gestáltico Bisomotor, Tarea de denominación de objetos, Tarea go/no go, Series gráficas y motoras alternantes, Test de memoria acortado y el Test de la figura compleja de Rey. A través de los cuales se obtuvo que el estado neuropsicológico de los procesos cognitivos básicos en estos pacientes está alterado, manifestando déficits en la percepción, atención y memoria, sustentados en posibles hallazgos biológicos en determinadas áreas cerebrales. Este trabajo investigativo es de vital importancia, permitirá diseñar intervenciones terapéuticas acertadas para el tratamiento, convirtiéndose de esta manera la exploración neuropsicológica en un elemento clave para el diagnóstico e intervención en los pacientes.

Dysthymia includes chronic symptoms that interfere with the functioning and well-being of the person and can bring fatal consequences such as suicide attempt, and neuropsychological alterations in affective and cognitive processes that affect behavior. In the municipality of Guisa, Granma Province there is a high number of dysthymic patients are underdiagnosed, so suicidal behavior become more frequent. For this reason, research shown under the title "Neuropsychological assessment of basic cognitive processes in dysthymic patients attempted suicide" in order to characterize the neuropsychological status of basic cognitive processes in these patients was performed. Analysis-synthesis and inductive-deductive and the following techniques: initial interview, anamnesis, observation, Inventory Beck, test Gestalt Bisomotor,Task object naming, Task go / no go, graphics series theoretical methods were applied and alternating motor, shortened memory test and test the complex figure of Rey. Through which was obtained that the neuropsychological status of basic cognitive processes in these patients is altered, showing deficits in perception, attention and memory, sustained in possible biological findings in certain brain areas. This research work is vital, it will allow designing successful therapeutic interventions for treatment, thus becoming the neuropsychological a key for diagnosis and intervention in these patient’s element.

Improving early detection of childhood depression in mental health care: the Children׳s Depression Screener (ChilD-S).

Diagnosing childhood depression can pose a challenge, even for mental health specialists. Screening tools can aid clinicians within the initial step of the diagnostic process. For the first time, the Children׳s Depression Screener (ChilD-S) is validated in a mental health setting as a novel field of application beyond the previously examined pediatric setting. Based on a structured interview, DSM-IV-TR diagnoses of depression were made for 79 psychiatric patients aged 9-12, serving as the gold standard for validation. For assessing criterion validity, receiver operating characteristic (ROC) curves were calculated. Point prevalence of major depression and dysthymia was 28%. Diagnostic accuracy in terms of the area under the ROC curve was high (0.97). At the optimal cut-off point ≥12 according to the Youden׳s index, sensitivity was 0.91 and specificity was 0.81. The findings suggest that the ChilD-S is not only a valid screening instrument for childhood depression in pediatric care but also in mental health settings. As a brief tool it can easily be implemented into daily clinical practice of mental health professionals facilitating the diagnostic process, especially in case of comorbid depression.

Psychiatric comorbidity in diabetes type 1: a cross-sectional observational study / Comorbidade psiquiátrica no diabetes tipo 1: um estudo transversal observacional

Objective This study aims to investigate the prevalence of psychiatric disorders, i.e., the presence of signs and symptoms of anxiety and depression in type 1 diabetic patients, as well as to investigate the prevalence of psychiatric disorders in insulin dependent patients. Methods A cross-sectional observational study of 110 diabetic outpatients (mean = 58.3, SD = 14.5; 50 male and 60 female) was conducted in a public health clinic with patients diagnosed with diabetes mellitus who were under the medical supervision of an endocrinologist. The patients were evaluated through the Mini International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale(HADS). Results With respect to anxiety symptoms, we found a prevalence of 60% (n = 66) among patients, while in depression symptoms we found a prevalence of 53.6% (n = 59) concerning the 110 patients evaluated. More specifically, we found 28.2% (n = 31) of patients without depression or anxiety, 13.6% (n = 15) of patients with depression, 16.4% (n = 18) of patients with anxiety and 41.8% (n = 46) of patients with depression combined with anxiety. The most remarkable data were generalized anxiety disorder (22.7%), dysthymia (18.2%), panic disorder (8.2%) and social phobia (5.5%). Conclusion The need for accurate assessments about the presence of symptoms related to psychopathology in patients with type 1 diabetes is evident. .

Objetivo Elementos relacionados à saúde mental do paciente diabético tipo 1 são encontrados em várias pesquisas. O objetivo desse estudo é avaliar sinais e sintomas depressivos nesse grupo de pacientes, como também investigar as principais prevalências psiquiátricas que os acometem. Métodos Pesquisa realizada em 110 pacientes diabéticos atendidos em ambulatórios (média = 58.3, D = 14.5; 50 masculinos e 60 femininos) conduzida em Postos de Saúde Pública nos momentos de consulta médica com endocrinologista. A avaliação transcorreu com as escalas Mini International Neuropsychiatric Interview and Hospital Anxiety and Depression Scale (HADS). Resultados Os sintomas de ansiedade tiveram prevalência de 60% (n = 66), enquanto para depressão encontramos resultados de 53.6% (n = 59), considerando que 110 pacientes foram avaliados. Mais especificamente, nós encontramos 28,2 (n. 31) pacientes sem depressão ou ansiedade, 13,6 (n. 15) pacientes com depressão, 16,4 pacientes (n. 18) com ansiedade e 41,8 (n. 46) pacientes com depressão combinada com ansiedade. Outros transtornos comórbidos tiveram prevalência de ansiedade generalizada (22,7%), distimia (18,2%), pânico (8,2%) e fobia social (5,5%). Conclusão Sintomas ansiosos e depressivos são comuns em pacientes diabéticos do tipo 1, porém há prevalência de psicopatologias diversas nesse grupo de pacientes, levando em conta novas necessidades de pesquisas futuras para validar protocolos de tratamentos mais adequados para diabéticos do tipo 1. .

The mental component of the short-form 12 health survey (SF-12) as a measure of depressive disorders in the general population: results with three alternative scoring methods.

OBJECTIVES: To evaluate the performance of the Mental Component of the Short-Form 12 Health Survey, Version 1(SF-12v1), as a screening measure of depressive disorders. METHODS: Data come from the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional survey carried out on representative samples of 21,425 individuals from the noninstitutionalized adult general population of six European countries (response rate = 61.2%). The SF-12 was administered and scored according to three algorithms: the "original" method (mental component summary of SF-12 [MCS-12]), the RAND-12 (RAND-12 Mental Health Composite [RAND-12 MHC]), and the Bidemensional Response Process Model 12 mental health score (BRP-12 MHS), based on a two-factor Item Response Theory graded response model. Thirty-day and 12-month depressive disorders (major depressive episode or dysthymia) were assessed with the Composite International Diagnostic Interview, Version 3.0, by using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Receiver operating characteristic curves analysis was carried out, and optimal cutoff points maximizing balance between sensitivity (SN) and specificity (SP) were chosen for the three methods. RESULTS: Prevalence of 30-day and 12-month depressive disorders in the overall sample was 1.5% and 4.4%, respectively. The area under the curve for 30-day depressive disorders was 0.92, and it decreased to 0.85 for 12-month disorders, regardless of the scoring method. Optimal cutoff for 30-day depressive disorders was 45.6 (SN = 0.86; SP = 0.88) for the MCS-12, 44.5 for the RAND-12 MHC (SN = 0.87, SP = 0.86), and 40.2 for the BRP-12 MHS (SN = 0.87, SP = 0.87). The selected 12-month cutoffs for MCS-12 and RAND-12 MHC were between 4.2 and 5.8 points below the general population means of each country, with SN range 0.67 to 0.78 and SP range 0.77 to 0.87. CONCLUSIONS: The SF-12 yielded acceptable results for detecting both active and recent depressive disorders in general population samples, suggesting that the questionnaire could be used as a useful screening tool for monitoring the prevalence of affective disorders and for targeting treatment and prevention.

Maternal postnatal depression and the development of depression in offspring up to 16 years of age.

OBJECTIVE: The aim of this study was to determine the developmental risk pathway to depression by 16 years in offspring of postnatally depressed mothers. METHOD: This was a prospective longitudinal study of offspring of postnatally depressed and nondepressed mothers; child and family assessments were made from infancy to 16 years. A total of 702 mothers were screened, and probable cases interviewed. In all, 58 depressed mothers (95% of identified cases) and 42 nondepressed controls were recruited. A total of 93% were assessed through to 16-year follow-up. The main study outcome was offspring lifetime clinical depression (major depression episode and dysthymia) by 16 years, assessed via interview at 8, 13, and 16 years. It was analysed in relation to postnatal depression, repeated measures of child vulnerability (insecure infant attachment and lower childhood resilience), and family adversity. RESULTS: Children of index mothers were more likely than controls to experience depression by 16 years (41.5% versus 12.5%; odds ratio = 4.99; 95% confidence interval = 1.68-14.70). Lower childhood resilience predicted adolescent depression, and insecure infant attachment influenced adolescent depression via lower resilience (model R(2) = 31%). Family adversity added further to offspring risk (expanded model R(2) = 43%). CONCLUSIONS: Offspring of postnatally depressed mothers are at increased risk for depression by 16 years of age. This may be partially explained by within child vulnerability established in infancy and the early years, and by exposure to family adversity. Routine screening for postnatal depression, and parenting support for postnatally depressed mothers, might reduce offspring developmental risks for clinical depression in childhood and adolescence.

The effects of continuous antidepressant treatment during the first 6 months on relapse or recurrence of depression.

BACKGROUND: To examine whether continuous antidepressant treatment during the first 6 month reduces the risk of relapse/recurrence of depression in South Korea. METHODS: We used National Health Insurance Data covering the period from 2001 through 2004. The study population consisted of 117,087 adult patients who received antidepressants after being diagnosed with depression. The continuous antidepressant was defined as evidence of antidepressant prescriptions for 75% of the first 6 months of treatment. Relapse or recurrence during the next 18-month period was defined by evidence of a new episode requiring antidepressant treatment, psychiatric hospitalization, electroconvulsive therapy, emergency department visit or attempted suicide. We compared the relapse/recurrence rate during the 18-month follow-up period in patients receiving continuous treatment and those who discontinued early using a Cox's proportional hazard model. RESULTS: Patients receiving continuous antidepressant treatment experienced a lower risk of relapse/recurrence (Hazard ratio: 0.42, 95% CI: 0.40-0.44). Three or more follow-up visits in the first 3 months also reduced the risk of relapse/recurrence. Factors associated with a significant increase of relapse/recurrence were comorbid medical illness, anxiety disorder, and alcohol abuse. The small benefit of SSRIs was appeared only in the early discontinued treatment subgroup, not in the continuous treatment subgroup. LIMITATIONS: We were not able to consider the antidepressant utilization pattern. CONCLUSIONS: Continuous antidepressant treatment and frequent follow-up visits during the acute phase were associated with a significant reduction in the likelihood of relapse or recurrence of depression. Our results provide important evidence on the effectiveness of antidepressant treatment in South Korea.

Natural killer cell cytotoxity and course of illness in depressed mood.

There is now some evidence that depressed mood is associated with activation of the immune system. First, we evaluated, within a cross-sectional design, NKCA (in vitro) in 49 subjects meeting inclusion criteria either for a major depressive episode, for dysthymia, or for "double depression". We found that recent and long depressive episodes (dysthymia) are associated with a lower immunodepression. Second, we compared two subset of subjects: 14 patients meeting criteria of major depression to 14 healthy controls. The data show a significant improvement in major depression when compared to controls througout a treatment combining supportive psychotherapy and 8 mg Reboxetine™.

Hopelessness, temperament, and health perception in heroin addicts.

The aim of this study was to investigate temperament, hopelessness (a measure of suicide risk), and health perception in heroin addicts. The study involved the administration of the TEMPS-A Rome, the Beck Hopelessness Scale (BHS), the MINI Neuropsychiatric Interview, and the Multidimensional Health Questionnaire. Participants were 100 heroin addicts who were matched by age and sex with 100 randomly selected non-users. Heroin addicts obtained higher scores on TEMPS-A Dys/Cyc/Anx temperament and on the irritable temperament. In the heroin addicts, anxiety, depression, preoccupation with health, health illness self-blame, health monitoring, and negative thinking about health were positively associated with hopelessness, dysthymic/anxious/cyclothymic temperament, and irritable temperament. Motivation to avoid unhealthiness, health assertiveness, health expectation optimism, and health satisfaction were negatively associated with hopelessness, dysthymic/anxious/cyclothymic temperament, and irritable temperament. More knowledge on health attitudes in heroin addicts may help in delivering a treatment plan for this selective population.

Screening for emotional distress in cancer patients: a systematic review of assessment instruments.

Screening for emotional distress is becoming increasingly common in cancer care. This systematic review examines the psychometric properties of the existing tools used to screen patients for emotional distress, with the goal of encouraging screening programs to use standardized tools that have strong psychometrics. Systematic searches of MEDLINE and PsycINFO databases for English-language studies in cancer patients were performed using a uniform set of key words (eg, depression, anxiety, screening, validation, and scale), and the retrieved studies were independently evaluated by two reviewers. Evaluation criteria included the number of validation studies, the number of participants, generalizability, reliability, the quality of the criterion measure, sensitivity, and specificity. The literature search yielded 106 validation studies that described a total of 33 screening measures. Many generic and cancer-specific scales satisfied a fairly high threshold of quality in terms of their psychometric properties and generalizability. Among the ultrashort measures (ie, those containing one to four items), the Combined Depression Questions performed best in patients receiving palliative care. Among the short measures (ie, those containing five to 20 items), the Center for Epidemiologic Studies-Depression Scale and the Hospital Anxiety and Depression Scale demonstrated adequate psychometric properties. Among the long measures (ie, those containing 21-50 items), the Beck Depression Inventory and the General Health Questionaire-28 met all evaluation criteria. The PsychoSocial Screen for Cancer, the Questionnaire on Stress in Cancer Patients-Revised, and the Rotterdam Symptom Checklist are long measures that can also be recommended for routine screening. In addition, other measures may be considered for specific indications or disease types. Some measures, particularly newly developed cancer-specific scales, require further validation against structured clinical interviews (the criterion standard for validation measures) before they can be recommended.

Dimensions of social support and depression in patients at increased psychosocial risk recovering from myocardial infarction.

BACKGROUND: There is considerable evidence that depression and low social support are associated with increased morbidity and mortality for patients with coronary heart disease (CHD). However, there is a lack of consensus regarding the measurement of social support and its relation to depression. PURPOSE: The primary purpose of the present study was to identify key dimensions of existing social support and depression measures for patients with CHD using factor analysis. METHOD: Seven hundred-five patients with a recent acute myocardial infarction and either depression, low social support, or both, completed measures of several types of social support and depression. Exploratory and confirmatory factor analysis were used to examine the underlying dimensions of the existing social support and depression measures, and to compare theoretically plausible models specifying the relation between the social support and depression factors. RESULTS: Confirmatory factor analysis indicated that an approach in which smaller facets of depression are measured (somatic, cognitive/affective, anxious) and social support (perceived emotional support from intimate relationships; perceived tangible support from peripheral contacts; and the number of children, relatives, and friends in a patient's support network), may be the most optimal way to measure social support and depression in this population RMSEA = 0.05; CFI = 0.81; TLI = 0.88). CONCLUSION: Efforts to identify patients at increased psychosocial risk may be improved by screening for these subcomponents of social support and depression.

Screening for depression in the older long-term unemployed.

BACKGROUND: Misdiagnosis and undertreatment of depression in older, long-term unemployed people may not only pose a serious medical problem, but may also be an obstacle for their vocational reintegration. Screening for depression could be a first step to increasing treatment rates within this high-risk group. Therefore, the WHO-5 Well-Being Index was tested for its validity in unemployment offices. METHODOLOGY: Three hundred and sixty-five participants in a German programme for the vocational reintegration of long-term unemployed people were screened with the WHO-5 Well-Being Index. In 104 of these subjects, ICD-10 diagnoses were made using DIA-X Structured Clinical Interview. RESULTS: Using the DIA-X data as a gold standard, the WHO-5 Well-Being Index obtained satisfactory results for sensitivity (82.5%) and specificity (70.3%) as a screening tool for affective disorders when used with an adjusted cut-off-point of < or = 12. While none of the 18.5% male participants diagnosed with major depression received treatment, half of the 24% of female participants with major depression received treatment. CONCLUSION: Screening with the WHO-5 within unemployment offices is useful to detect people with depressive disorders. Many of them do not receive optimal treatment and can be motivated to seek professional help. Reducing depression by better treatment will also increase the chances of reemployment.

Comorbidades entre dependência química, distimia, HIV e HCV: relato de caso / Comorbidity between addiction, dysthymia, HIV and HCV: case report

INTRODUÇÃO: A comorbidade entre dependência química e doenças infectocontagiosas é bem conhecida, assim como a relação entre transtornos de humor e uso de substâncias. Entretanto, o transtorno distímico nestes pacientes recebe pouca atenção. Em parte, isso se justifica porque a realização do diagnóstico de distimia é mais difícil do que de outros transtornos do humor em razão do tempo de abstinência (2 anos) necessário para o diagnóstico, tendo em vista que toxicodependentes apresentam diversas recaídas durante o curso de suas vidas. As infecções pelos vírus HIV e HCV, frequentemente associadas ao consumo injetável de substâncias, contribuem para alterações do estado mental e o próprio tratamento pode causar diversas flutuações no humor. RELATO DE CASO: O paciente é um homem de 40 anos de idade que apresenta comorbidade entre dependência química (heroína e álcool) e distimia, complicada por recaídas, consumo injetável e status sorológico positivo aos vírus HIV-1 e HCV. CONCLUSÃO: Pacientes dependentes químicos com comorbidades psiquiátricas e infectocontagiosas são desafiadores no que tange diagnóstico, tratamento e definição de abordagens terapêuticas para os diferentes problemas apresentados. Investigar e abordar adequadamente, entretanto, traz diversos benefícios na qualidade de vida do indivíduo afetado, assim como potenciais benefícios financeiros.

BACKGROUND: Comorbidity between chemical dependence and infectious diseases is well known, as is the relationship between mood disorders and substance misuse. Nevertheless, dysthymia in these patients is not well explored. That is partly justified since the diagnoses of dysthymia is more difficult than other mood disorders due to the abstinence time (2 years) required for the diagnoses, and since addiction patients present several relapses during the course of their lifetimes. HIV and HCV infections, frequently associated to intravenous (IV) drug use, contribute to mental status deterioration and the treatment for such conditions can cause fluctuations on mood. CASE REPORT: A 40 years old patient with comorbidity between chemical dependence (heroin and alcohol) and dysthymia, complicated by relapses, IV drug use and serological status positive to HIV-1 and HCV. CONCLUSION: Addiction patients with psychiatric and infectious comorbidity are challenging to diagnose, treat and define therapeutical approaches to the different conditions. Proper clinical investigation and approach leads to benefits in health quality and potential financial benefits.

Associations between depression subtypes and substance use disorders.

Evaluating whether certain subtypes of Major Depressive Disorder (MDD) are more strongly associated with Substance Use Disorders (SUDs) may help clarify reasons for MDD-SUD relations. Therefore, this study compared DSM-IV-defined non-atypical/non-melancholic depression (undifferentiated depression; n=365), atypical depression (n=117), melancholic depression (n=245), and atypical-melancholic depression (n=68) in the prevalence of current SUDs, while controlling for relevant demographic and clinical variables. Psychiatric outpatients with a current diagnosis of unipolar MDD were assessed using the Structured Clinical Interview for DSM-IV, supplemented by questions from the Schedule for Affective Disorders and Schizophrenia. Results showed that compared with patients with undifferentiated depression, melancholic patients had higher rates of current nicotine dependence (34% vs. 26%) and drug abuse/dependence (8% vs. 3%), Ps<0.05. These differences were explained by the association between specific melancholic features (marked psychomotor agitation and weight loss/decreased appetite) and nicotine and drug use disorders. Atypical depression, atypical-melancholic depression, and other subtype symptoms were not significantly associated with any SUDs. Although this study is limited by low prevalence of alcohol and drug use disorders, the present findings suggest that different symptomatic expressions of MDD differentially associate with some SUDs.

Predictors of a new depression diagnosis among older adults admitted to complex continuing care: implications for the depression rating scale (DRS).

BACKGROUND: depression is a major disabling condition among older adults, where it may be under-diagnosed for a number of reasons, including a different presentation for younger people with depression. The Minimum Data Set 2.0 (MDS 2.0) assessment system provides a measurement scale for depression, the Depression Rating Scale (DRS), in addition to other items that may represent depressive phenomenology. OBJECTIVE: the ability of the DRS to predict the presence of new depression diagnoses at follow-up, among hospitalised older adults admitted without depression, is examined. METHODS: the study sample consists of all persons aged 65 years or more admitted between 1996 and 2003 to a complex continuing care (CCC) bed in Ontario without a recorded depression diagnosis. The sample was restricted to those who remained in hospital for about 3 months (n = 7,818) in order to obtain follow-up assessment information. Logistic regression was used to explore the relationship between admission characteristics (i.e. DRS scale items, other MDS 2.0 items related to DSM-IV criteria for depression) and receipt of a depression diagnosis on the follow-up assessment. RESULTS: a new depression diagnosis at follow-up was present in 7.5% of the individuals. The multivariate model predicting depression diagnosis included only the DRS scale, sadness over past roles, and withdrawal from activities. CONCLUSIONS: the DRS score at admission was predictive of receiving a depression diagnosis on a follow-up assessment among older adults admitted to the CCC. Further, the predictive ability of the DRS is only modestly improved by the addition of other items related to DSM-IV criteria.

Hypomania with and without Dysphoria: comparison of comorbidity and clinical characteristics of respondents from a national community sample.

OBJECTIVE: To compare rates of comorbidity, treatment utilization, the course of illness, and past year social functioning of Hypomania with and without Dysphoria Hypomania (mixed state). METHOD: The National Epidemiological Survey on Alcohol and Related Conditions (NESARC) was a nationally representative face-to-face survey of 43,093 respondents, aged 18 years and older, conducted in 2001 through 2002. The target population of the survey is the civilian, noninstitutionalized population residing in the United States. RESULTS: Dysphoric Hypomania was associated with an increased lifetime risk for major depression, dysthymic disorder, anxiety disorders and personality disorders compared to Non-Dysphoric Hypomania. The former group had an earlier onset age of major depression, more episodes major depression and hypomania, and had a higher rate of treatment contact than the later group. Past year personal income and the frequency of full-time employment were lower in the Dysphoric Hypomania compared to Non-Dysphoric Hypomania. CONCLUSIONS: Dysphoric Hypomania is a more severe and persistent mood disorder compared to Non-Dysphoric Hypomania.

Leptin in depressed women: cross-sectional and longitudinal data from an epidemiologic study.

BACKGROUND: There is conflicting evidence regarding levels of leptin in depression. In this study we aimed to investigate the relationship between serum leptin level and depression in a community sample of women using both cross-sectional and longitudinal data. METHODS: From among 510 women aged 20-78 yr, 83 were identified with a lifetime history of major depressive disorder or dysthymia, ascertained using the Structured Clinical Interview for DSM-IV-TR Research Version, Non-patient edition (SCID-I/NP). Serum leptin levels were measured by radioimmunoassay. Medication use and lifestyle were self-reported and body mass index (BMI) determined from measures of height and weight. RESULTS: Using multiple linear regression, serum leptin levels were greater among women with a lifetime history of depression compared to women without any history of depression, independent of BMI. Adjusted geometric mean values of serum leptin were 16.37 (95%CI 14.70-18.23) ng/mL for depressed and 14.46 (95%CI 13.79-15.16) ng/mL for non-depressed women (P=0.039). The hazard ratio (HR) for a de novo depressive disorder over five years increased 2.56-fold for each standard deviation increase in log-transformed serum leptin among non-smokers and this was not explained by differences in BMI, medications or other lifestyle factors (HR=2.56, 95%CI 1.52-4.30). No association was observed for smokers. LIMITATIONS: There is potential for unrecognised confounding, recall bias and transient changes in body composition. CONCLUSION: Women with a lifetime history of depression have elevated levels of serum leptin, and elevated serum leptin predicts subsequent development of a depressive disorder.

Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life.

CONTEXT: Epidemiological findings demonstrating an increased risk for individuals with social anxiety disorder (SAD) to develop depression have been challenged by discrepant findings from prospective longitudinal examinations in childhood and early adolescence. OBJECTIVES: To examine patterns of SAD incidence, the consistency of associations of SAD with subsequent depression, and distal and proximal predictors for subsequent depression. DESIGN: Face-to-face, 10-year prospective longitudinal and family study of up to 4 waves. The DSM-IV Munich-Composite International Diagnostic Interview was administered by clinically trained interviewers. SETTING: Community sample in Munich. PARTICIPANTS: Three thousand twenty-one individuals aged 14 to 24 years at baseline and 21 to 34 years at follow-up. MAIN OUTCOME MEASURES: Cumulative incidence of SAD and depression (major depressive episode or dysthymia). RESULTS: Cumulative incidence for SAD was 11.0%; for depression, 27.0%. Standardized person-years of incidence for SAD were highest for those aged 10 to 19 years (0.72%) and were low before (0.20%) and after (0.19%) that age range. Depression incidence was different, characterized by delayed and continued high rates. Social anxiety disorder was consistently associated with subsequent depression, independent of age at onset for SAD (relative risk range, 1.49-1.85, controlling for age and sex). Crude Cox regressions showed significant distal (eg, parental anxiety or depression, behavioral inhibition) and proximal SAD characteristics (eg, severity measures, persistence) as predictors. Most associations were attenuated in multiple models, leaving behavioral inhibition (hazard ratio, 1.30 [95% confidence interval, 1.04-1.62; P = .02]) and, less consistently, panic (hazard ratio, 1.85 [95% confidence interval, 1.08-3.18; P = .03]) as the remaining significant predictors. CONCLUSIONS: Social anxiety disorder is an early, adolescent-onset disorder related to a substantially and consistently increased risk for subsequent depression. The demonstration of proximal and particularly distal predictors for increased depression risks requires further exploration to identify their moderator or mediator role. Along with previous evidence that comorbid SAD is associated with a more malignant course and character of depression, these results call for targeted prevention with the aim of reducing the burden of SAD and its consequences.

Intrapersonal conflict in goals and values of patients with unipolar depression.

BACKGROUND: Although increased conflicts between attitudes and beliefs about certain goals or values are often discussed as important factors in depression, there are only few empirical studies investigating these relations among patients with depressive disorders. METHODS: In the present study, we used the Intrapersonal Conflict Test to assess cognitive inconsistencies in goals or values. A total of 53 inpatients with unipolar depression and 24 nondepressed controls (inpatients of an internal and a surgery ward) participated in the study. In addition to the Intrapersonal Conflict Test, patients completed the Beck Depression Inventory, the Dysfunctional Attitude Scale, the Inventory of Interpersonal Problems as well as the Problem Solving Inventory. RESULTS: Compared with controls, patients with depressive disorders showed significantly higher scores for global inconsistencies, inconsistencies within different goals/values, as well as between goals/values and their perceived realization. Significant correlations were found between conflict measures and the Inventory of Interpersonal Problems, as well as the Problem Solving Inventory. Path analyses show that group differences in intrapersonal conflicts were partially mediated by interpersonal problems but not by depressive symptoms or cognitive vulnerability factors. CONCLUSIONS: Given the cross-sectional design of the study, the findings of this exploratory study do not allow for conclusions regarding the role of intrapersonal conflicts in the development and course of depression. Nevertheless, the high levels of intrapersonal conflicts observed in the study suggest that inconsistencies in goals or values should be considered in the psychological treatment of depression.