A prospective international multi-center study on safety and efficacy of deep brain stimulation for resistant obsessive-compulsive disorder.

Deep brain stimulation (DBS) has been proposed for severe, chronic, treatment-refractory obsessive-compulsive disorder (OCD) patients. Although serious adverse events can occur, only a few studies report on the safety profile of DBS for psychiatric disorders. In a prospective, open-label, interventional multi-center study, we examined the safety and efficacy of electrical stimulation in 30 patients with DBS electrodes bilaterally implanted in the anterior limb of the internal capsule. Safety, efficacy, and functionality assessments were performed at 3, 6, and 12 months post implant. An independent Clinical Events Committee classified and coded all adverse events (AEs) according to EN ISO14155:2011. All patients experienced AEs (195 in total), with the majority of these being mild (52% of all AEs) or moderate (37%). Median time to resolution was 22 days for all AEs and the etiology with the highest AE incidence was 'programming/stimulation' (in 26 patients), followed by 'New illness, injury, condition' (13 patients) and 'pre-existing condition, worsening or exacerbation' (11 patients). Sixteen patients reported a total of 36 serious AEs (eight of them in one single patient), mainly transient anxiety and affective symptoms worsening (20 SAEs). Regarding efficacy measures, Y-BOCS reduction was 42% at 12 months and the responder rate was 60%. Improvements in GAF, CGI, and EuroQol-5D index scores were also observed. In sum, although some severe AEs occurred, most AEs were mild or moderate, transient and related to programming/stimulation and tended to resolve by adjustment of stimulation. In a severely treatment-resistant population, this open-label study supports that the potential benefits outweigh the potential risks of DBS.

Overgeneral autobiographical memory predicts diagnostic status in depression.

Major depressive disorder (MDD) is characterised by difficulties in retrieving specific autobiographical memories, with a significant propensity towards categoric memories (i.e. memories of a summary type). Previous studies have demonstrated that this overgeneral memory is a valid predictor of the course of depression, with reduced specificity being associated with worse outcome. Most of these studies have employed continuous measures of depression to assess the course of the symptoms. This study investigated whether overgeneral memory also predicts clinical status at follow-up (i.e. whether patients still meet criteria for depression). Patients who fulfilled criteria for major depressive disorder were tested shortly after admission to the hospital and were retested some weeks later. It was found that lower levels of specificity or a higher number of categoric memories were associated with a higher probability of still being diagnosed with MDD. These memory variables outperformed other relevant indices, such as depression severity, rumination, level of self-esteem and dysfunctional attitudes.

Reduced autobiographical memory specificity and rumination in predicting the course of depression.

Reduced autobiographical memory (AM) specificity is a known vulnerability factor for depression. AM specificity was investigated as a predictor of depression with the Autobiographical Memory Test (J. M. G. Williams & K. Broadbent, 1986). When baseline depression scores were partialed, reduced AM specificity to negative cue words predicted higher levels of depression at 7-month follow-up. Once rumination was taken into account by means of the Rumination on Sadness Scale (M. Conway, P. A. R. Csank, S. L. Holm, & C. K. Blake, 2000), AM specificity no longer predicted depression, suggesting that the predictive value of AM specificity observed in previous studies might be--at least partly--explained as an effect of rumination. Further mediation analyses indeed revealed support for rumination as a mediator of the relation between reduced AM specificity and poor outcome of depression.

Dual task performance of working memory and postural control in major depressive disorder.

OBJECTIVE: Previous studies with patients diagnosed with Major Depressive Disorder (MDD) revealed deficits in working memory and executive functions. In the present study we investigated whether patients with MDD have the ability to allocate cognitive resources in dual task performance of a highly challenging cognitive task (working memory) and a task that is seemingly automatic in nature (postural control). METHOD: Fifteen young (18-35 years old) patients with MDD and 24 healthy age-matched controls performed a working memory task and two postural control tasks (standing on a stable or on a moving platform) both separately (single task) and concurrently (dual task). RESULTS: Postural stability under single task conditions was similar in the two groups, and in line with earlier studies, MDD patients recalled fewer working memory items than controls. To equate working memory challenges for patients and controls, task difficulty (number of items presented) in dual task was individually adjusted such that accuracy of working memory performance was similar for the two groups under single task conditions. Patients showed greater postural instability in dual task performance on the stable platform, and more importantly when posture task difficulty increased (moving platform) they showed deficits in both working memory accuracy and postural stability compared with healthy controls. CONCLUSIONS: We interpret our results as evidence for executive control deficits in MDD patients that affect their task coordination. In multitasking, these deficits affect not only cognitive but also sensorimotor task performance.