Challenges in the treatment of dysthymia: a narrative review.

INTRODUCTION: Despite its milder severity, the chronic nature of dysthymia leads to significant impairments and functional limitations. The treatment of dysthymia has received considerably less research attention compared to major depressive disorder (MDD). AREAS COVERED: The authors have conducted a comprehensive review on the treatment of dysthymia. Their primary objective was to identify therapeutic options that have demonstrated genuine efficacy. To do this, they searched the PubMed database, without any time restrictions, to retrieve original studies. The samples were exclusively comprised individuals diagnosed with dysthymia according to the diagnostic criteria outlined in DSM-III, DSM-III-R, DSM-IV, or DSM-IV-TR. EXPERT OPINION: Within the realm of dysthymia treatment, several antidepressants, including imipramine, sertraline, paroxetine, minaprine, moclobemide, and amineptine, in addition to the antipsychotic agent amisulpride, have demonstrated superiority over placebo. In certain studies, psychotherapeutic interventions did not distinguish themselves significantly from pharmacological treatments and failed to exhibit greater efficacy than a placebo. However, these findings remain inconclusive due to the limited number of studies and substantial methodological limitations prevalent in a significant proportion of them. Limitations include factors like small sample sizes, the absence of placebo comparisons, and a lack of study blinding.

A reduced P300 prospectively predicts increased depressive severity in adults with clinical depression.

Neurocognitive impairments commonly observed in depressive disorders are thought to be reflected in reduced P300 amplitudes. To date, depression-related P300 amplitude reduction has mostly been demonstrated cross-sectionally, while its clinical implication for the course of depression remains largely unclear. Moreover, the relationship between P300 and specific clinical characteristics of depression is uncertain. To shed light on the functional significance of the P300 in depression, we examined whether initial P300 amplitude prospectively predicted changes in depressive symptoms among a community sample of 58 adults (mean age = 38.86 years old, 81% female) with a current depressive disorder. This sample was assessed at two-time points, separated by approximately nine months (range = 6.6-15.9). At the initial visit, participants completed clinical interviews, self-report measures, and a flanker task, while EEG was recorded to derive P300 amplitude. At the follow-up visit, participants again completed the same clinical interviews and self-report measures. Results indicated that a reduced P300 amplitude at the initial visit was associated with higher total depressive symptoms at follow-up, even after controlling for initial depressive symptoms. These data indicate the potential clinical utility for the P300 as a neural marker of disease course among adults with a current depressive disorder. Future research may target P300 in interventions to determine whether depression-related outcomes can be improved.

Parent- and child-reported anxiety disorders differentiating major depressive disorder and dysthymic disorder in children and adolescents.

OBJECTIVE: To date, specific parent- and child-defined anxiety disorders associated with dysthymic disorder (DD; DSM-5 persistent depressive disorder equivalent) with and without major depressive disorder (MDD) have not been investigated in children and adolescents. METHOD: In a cross-sectional study, we compared point prevalence rates of parent- and child-reported anxiety disorders in DD alone (N = 154), MDD alone (N = 29), comorbid DD and MDD (N = 130) and anxiety disorders alone (N = 126) groups. RESULTS: DD alone and MDD alone did not differ with respect to comorbid anxiety disorders from parent and child reports, while parent-reported panic disorder (PD) was significantly increased in the DD and MDD group compared to the other three groups as was child-reported post-traumatic stress disorder (PTSD) compared to the MDD alone and anxiety disorders alone groups. In contrast, specific phobia (SpPh) was significantly increased in the anxiety disorders alone group compared to the DD and MDD group. CONCLUSION: The findings suggest that specific fear-related anxiety disorders, especially parent-reported PD and child-reported PTSD, may aid the early recognition of DD and MDD.

Simulation study to demonstrate biases created by diagnostic criteria of mental illnesses: major depressive episodes, dysthymia, and manic episodes.

OBJECTIVES: Composite diagnostic criteria alone are likely to create and introduce biases into diagnoses that subsequently have poor relationships with input symptoms. This study aims to understand the relationships between the diagnoses and the input symptoms, as well as the magnitudes of biases created by diagnostic criteria and introduced into the diagnoses of mental illnesses with large disease burdens (major depressive episodes, dysthymic disorder, and manic episodes). SETTINGS: General psychiatric care. PARTICIPANTS: Without real-world data available to the public, 100 000 subjects were simulated and the input symptoms were assigned based on the assumed prevalence rates (0.05, 0.1, 0.3, 0.5 and 0.7) and correlations between symptoms (0, 0.1, 0.4, 0.7 and 0.9). The input symptoms were extracted from the diagnostic criteria. The diagnostic criteria were transformed into mathematical equations to demonstrate the sources of biases and convert the input symptoms into diagnoses. PRIMARY AND SECONDARY OUTCOMES: The relationships between the input symptoms and diagnoses were interpreted using forward stepwise linear regressions. Biases due to data censoring or categorisation introduced into the intermediate variables, and the three diagnoses were measured. RESULTS: The prevalence rates of the diagnoses were lower than those of the input symptoms and proportional to the assumed prevalence rates and the correlations between the input symptoms. Certain input or bias variables consistently explained the diagnoses better than the others. Except for 0 correlations and 0.7 prevalence rates of the input symptoms for the diagnosis of dysthymic disorder, the input symptoms could not fully explain the diagnoses. CONCLUSIONS: There are biases created due to composite diagnostic criteria and introduced into the diagnoses. The design of the diagnostic criteria determines the prevalence of the diagnoses and the relationships between the input symptoms, the diagnoses, and the biases. The importance of the input symptoms has been distorted largely by the diagnostic criteria.

Review of dysthymia and persistent depressive disorder: history, correlates, and clinical implications.

Persistent depressive disorder is a chronic mood disorder that is common and often more disabling than episodic major depression. In DSM-5, the term subsumes several chronic depressive presentations, including dysthymia with or without superimposed major depressive episodes, chronic major depression, and recurrent major depression without recovery between episodes. Dysthymia can be difficult to detect in psychiatric and primary care settings until it intensifies in the form of a superimposed major depressive episode. Although information is scarce concerning the cause of persistent depressive disorder including dysthymia, the causation is likely to be multifactorial. In this narrative Review, we discuss current knowledge about the nosology and neurobiological basis of dysthymia and persistent depressive disorder, emphasising a dimensional perspective based on course for further research. We also review new developments in psychotherapy and pharmacotherapy for persistent depressive disorder, and propose a tailored, modular approach to accommodate its multifaceted nature.

Treatment of double depression: A meta-analysis.

BACKGROUND: Double depression (DD), the co-existence of DSM-IV major depressive disorder (MDD) and dysthymia, is a poorly known and sparsely studied phenomenon. Nevertheless, it is prevalent in clinical samples of patients with depression. Thus, it is important to understand the efficacy of its treatment. METHODS: We conducted a meta-analysis of studies in which antidepressant medication was used to treat depression. Systematic searches in bibliographical databases resulted in 11 samples, including 775 patients that met inclusion criteria. RESULTS: The overall effect size indicating the differences in depressive symptoms before and after pharmacotherapy was 1.81 (95% CI: 1.47, 2.16), suggesting that individuals with depression exhibited a significant reduction in their depressive symptoms following treatment. Importantly, a moderation analysis indicated that a higher proportion of individuals with DD within a sample was associated with lower effect sizes. Publication bias did not pose a major threat to the stability of the findings. LIMITATIONS: High observed heterogeneity indicated substantial variability in effect sizes and elucidation of the potential moderators of treatment outcome was limited due to a paucity of relevant data. CONCLUSIONS: Pharmacotherapy seems to be effective in treating DD, but DD may be more difficult to treat than either MDD or dysthymia alone. More research specifically focusing on the treatment of DD with larger sample sizes using randomized control trials is needed to make a firm conclusion.

From dysthymia to treatment-resistant depression: evolution of a psychopathological construct.

Dysthymia is a psychopathological construct historically described and often reconsidered through the centuries. Its first description is dated back to 400 b.C., when Hippocrates proposed his theory about the 'black bile' and the melancholic temperament. The concept of dysthymia (dys-, 'ill', thymia-, 'emotions') has been largely elaborated in the XIX and XX centuries by Burton, Cullen, Schneider, Kretschmer, Akiskal and other authors, and recently re-formulated in the various editions of the modern Diagnostic and Statistical Manual of Mental Disorders under different diagnostic labels: neurotic depression, dysthymic disorder, persistent depressive disorder. Beyond the nosology, dysthymia issues some other challenges, including the need for further research to characterise the peculiar pathophysiological framework of this syndrome (compared with major depressive disorder) and to better define evidences about tailored-treatment options and their effectiveness.

Validation of a spanish version of the brief experiential avoidance questionnaire (beaq) in clinical population / Validación de la versión española del Cuestionario Breve de Evitación Experiencial (BEAQ) en población clínica

Background: The Brief Experiential Avoidance Questionnaire (BEAQ) has been suggested as the most appropriate instrument for measuring experiential avoidance. However, no Spanish validation has been published. The aim of this study was to validate a Spanish version of the BEAQ in a clinical sample treated at a community mental health unit. Methods: Participants (N = 332) completed the BEAQ as well as other self-report measures of experiential avoidance and psychopathology. Results: Internal consistency was satisfactory (α = .82). No statistically significant gender differences were found in the BEAQ scores. The data also showed high test-retest reliability after four to six weeks, acceptable concurrent validity with another experiential avoidance measure and acceptable convergent validity with the psychopathology measure. The principal component analysis, forcing the one factor solution proposed in the original scale, produced indicators similar to the English version of the BEAQ. Conclusions: These results firmly support the reliability and validity of this Spanish validation, stressing its usefulness as a measure of experiential avoidance in clinical populations

Antecedentes: el Cuestionario Breve de Evitación Experiencial (BEAQ) ha sido propuesto como el instrumento más adecuado para medir la evitación experiencial. Sin embargo, todavía no ha sido publicada ninguna validación en español. Por lo tanto, el objetivo del presente estudio ha sido la validación de una versión española del BEAQ, en una muestra clínica atendida en un Centro de Salud Mental Comunitario. Método: los participantes (N = 332) completaron el BEAQ, así como otras medidas de autoinforme de evitación experiencial y psicopatología. Resultados: la consistencia interna fue satisfactoria (α = .82). No se encontraron diferencias de género estadísticamente significativas en las puntuaciones del BEAQ. Los datos también mostraron una alta fiabilidad test-retest en un intervalo de cuatro a seis semanas, validez concurrente aceptable con otra medida de evitación experiencial y validez convergente aceptable con la medida de psicopatología. El análisis de componentes principales forzando a la solución de un factor, como se propuso en la escala original, obtuvo unos indicadores similares a los obtenidos en dicha versión inglesa. Conclusiones: los resultados confirman la adecuada fiabilidad y validez de la presente versión española del BEAQ, destacando su utilidad como medida de la evitación experiencial en población clínica

Validation of a Spanish version of the Brief Experiential Avoidance Questionnaire (BEAQ) in clinical population.

BACKGROUND: The Brief Experiential Avoidance Questionnaire (BEAQ) has been suggested as the most appropriate instrument for measuring experiential avoidance. However, no Spanish validation has been published. The aim of this study was to validate a Spanish version of the BEAQ in a clinical sample treated at a community mental health unit. METHODS: Participants ( N = 332) completed the BEAQ as well as other self-report measures of experiential avoidance and psychopathology. RESULTS: Internal consistency was satisfactory (α = .82). No statistically significant gender differences were found in the BEAQ scores. The data also showed high test-retest reliability after four to six weeks, acceptable concurrent validity with another experiential avoidance measure and acceptable convergent validity with the psychopathology measure. The principal component analysis, forcing the one factor solution proposed in the original scale, produced indicators similar to the English version of the BEAQ. CONCLUSIONS: These results firmly support the reliability and validity of this Spanish validation, stressing its usefulness as a measure of experiential avoidance in clinical populations.

Predicting the naturalistic course of depression from a wide range of clinical, psychological, and biological data: a machine learning approach.

Many variables have been linked to different course trajectories of depression. These findings, however, are based on group comparisons with unknown translational value. This study evaluated the prognostic value of a wide range of clinical, psychological, and biological characteristics for predicting the course of depression and aimed to identify the best set of predictors. Eight hundred four unipolar depressed patients (major depressive disorder or dysthymia) patients were assessed on a set involving 81 demographic, clinical, psychological, and biological measures and were clinically followed-up for 2 years. Subjects were grouped according to (i) the presence of a depression diagnosis at 2-year follow-up (yes n = 397, no n = 407), and (ii) three disease course trajectory groups (rapid remission, n = 356, gradual improvement n = 273, and chronic n = 175) identified by a latent class growth analysis. A penalized logistic regression, followed by tight control over type I error, was used to predict depression course and to evaluate the prognostic value of individual variables. Based on the inventory of depressive symptomatology (IDS), we could predict a rapid remission course of depression with an AUROC of 0.69 and 62% accuracy, and the presence of an MDD diagnosis at follow-up with an AUROC of 0.66 and 66% accuracy. Other clinical, psychological, or biological variables did not significantly improve the prediction. Among the large set of variables considered, only the IDS provided predictive value for course prediction on an individual level, although this analysis represents only one possible methodological approach. However, accuracy of course prediction was moderate at best and further improvement is required for these findings to be clinically useful.

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.

Effect of Disorder-Specific vs Nonspecific Psychotherapy for Chronic Depression: A Randomized Clinical Trial.

IMPORTANCE: Chronic depression is a highly prevalent and disabling disorder. There is a recognized need to assess the value of long-term disorder-specific psychotherapy. OBJECTIVE: To evaluate the efficacy of the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) compared with that of nonspecific supportive psychotherapy (SP). DESIGN, SETTING, AND PARTICIPANTS: A prospective, multicenter, evaluator-blinded, randomized clinical trial was conducted among adult outpatients with early-onset chronic depression who were not taking antidepressant medication. Patients were recruited between March 5, 2010, and October 16, 2012; the last patient finished treatment on October 14, 2013. Data analysis was conducted from March 5, 2014, to October 27, 2016. INTERVENTIONS: The treatment included 24 sessions of CBASP or SP for 20 weeks in the acute phase, followed by 8 continuation sessions during the next 28 weeks. MAIN OUTCOMES AND MEASURES: The primary outcome was symptom severity after 20 weeks (blinded observer ratings) as assessed by the 24-item Hamilton Rating Scale for Depression (HRSD-24). Secondary outcomes were rates of response (reduction in HRSD-24 score of ≥50% from baseline) and remission (HRSD-24 score ≤8), as well as self-assessed ratings of depression, global functioning, and quality of life. RESULTS: Among 622 patients assessed for eligibility, 268 were randomized: 137 to CBASP (96 women [70.1%] and 41 men [29.9%]; mean [SD] age, 44.7 [12.1] years) and 131 to SP (81 women [61.8%] and 50 men [38.2%]; mean [SD] age, 45.2 [11.6] years). The mean (SD) baseline HRSD-24 scores of 27.15 (5.49) in the CBASP group and 27.05 (5.74) in the SP group improved to 17.19 (10.01) and 20.39 (9.65), respectively, after 20 weeks, with a significant adjusted mean difference of -2.51 (95% CI, -4.16 to -0.86; P = .003) and a Cohen d of 0.31 in favor of CBASP. After 48 weeks, the HRSD-24 mean (SD) scores were 14.00 (9.72) for CBASP and 16.49 (9.96) for SP, with an adjusted difference of -3.13 (95% CI, -5.01 to -1.25; P = .001) and a Cohen d of 0.39. Patients undergoing CBASP were more likely to reach response (48 of 124 [38.7%] vs 27 of 111 [24.3%]; adjusted odds ratio, 2.02; 95% CI, 1.09 to 3.73; P = .03) or remission (27 of 124 [21.8%] vs 14 of 111 [12.6%]; adjusted odds ratio, 3.55; 95% CI, 1.61 to 7.85; P = .002) after 20 weeks. Patients undergoing CBASP showed significant advantages in most other secondary outcomes. CONCLUSIONS AND RELEVANCE: Highly structured specific psychotherapy was moderately more effective than nonspecific therapy in outpatients with early-onset chronic depression who were not taking antidepressant medication. Adding an extended phase to acute psychotherapy seems promising in this population. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00970437.

Avoidance in Anxiety and Depression: Adaptation of the Cognitive-Behavioral Avoidance Scale in a Spanish Sample.

This study examines how cognitive, behavioral and experiential avoidance differs between clinical patients (N = 100), the general population (N = 100), and undergraduate students (N = 54). For this purpose, a Spanish adaptation of the Cognitive-Behavioral Avoidance Scale (CBAS; Ottenbreit & Dobson, 2004) was made. Confirmatory factor analysis supports the four factors structure similar to the original one, yet question the value of three of the items (CFI = .929, RMSEA = .057, SRMR = .051, χ2(333) = 603.28, p < .001, χ2/df = 1.81). Effect sizes calculated using Cohen's ƒ2 were between 0.30 and 2.57 in all cases, and only one item showed value < 0.35. The internal consistency for the total scale was .95, and adequate alpha values for the four subscales were found (α between .74 and .93). Statistical differences were found between the clinical and non-clinical groups, and also between the clinical and undergraduate groups (GLM, p < .001). The validity was verified using correlations with AAQ-II, MAAS, BDI-II and BAI. There is a correlation between cognitive-behavioral avoidance and experiential avoidance in both the clinical and control groups (rho = .382, rho = .361, p < .01). Patients with higher levels of cognitive-behavioral avoidance have higher levels of depression (rho = .36, p < .01). A score of 53 is suggested as the optimum cut-off point, because at this point, sensitivity and specificity are both 86%. The results suggest that cognitive-behavioral avoidance represents a significant factor in psychopathology. Recommendations for future studies are discussed.

Prevalence and correlates of DSM-5 major depressive and related disorders in the community.

Although the DSM-5 has suggested the two new categories of Persistent Depressive Disorders (PDD) and Other Specified Depressive Disorders (OSDD), no study so far has applied the DSM-5 criteria throughout the range of depressive disorders. The aims of the present study were to 1) establish the lifetime prevalence of specific depressive disorders according to the new DSM-5 definitions in a community sample, and 2) determine their clinical relevance in terms of socio-demographic characteristics, comorbidity, course and treatment patterns. The semi-structured Diagnostic Interview for Genetic Studies was administered by masters-level psychologists to a random sample of an urban area (n=3720). The lifetime prevalence was 15.2% for PDD with persistent major depressive episode (MDE), 3.3% for PDD with pure dysthymia, 28.2% for Major Depressive Disorder (MDD) and 9.1% for OSDD. Subjects with PDD with persistent MDE were the most severely affected, followed by those with recurrent MDD, single episode MDD, PDD with pure dysthymia and OSDD and finally those without depressive disorders. Our data provide further evidence for the clinical significance of mild depressive disorders (OSDD), but cast doubt on the pertinence of lumping together PDD with persistent MDE and the former DSM-IV dysthymic disorder within the new PDD category.

Developing Emotion-Based Case Formulations: A Research-Informed Method.

OBJECTIVES: New research-informed methods for case conceptualization that cut across traditional therapy approaches are increasingly popular. This paper presents a trans-theoretical approach to case formulation based on the research observations of emotion. METHODS: The sequential model of emotional processing (Pascual-Leone & Greenberg, 2007) is a process research model that provides concrete markers for therapists to observe the emerging emotional development of their clients. We illustrate how this model can be used by clinicians to track change and provides a 'clinical map,' by which therapist may orient themselves in-session and plan treatment interventions. RESULTS: Emotional processing offers as a trans-theoretical framework for therapists who wish to conduct emotion-based case formulations. First, we present criteria for why this research model translates well into practice. Second, two contrasting case studies are presented to demonstrate the method. CONCLUSIONS: The model bridges research with practice by using client emotion as an axis of integration. Key Practitioner Message Process research on emotion can offer a template for therapists to make case formulations while using a range of treatment approaches. The sequential model of emotional processing provides a 'process map' of concrete markers for therapists to (1) observe the emerging emotional development of their clients, and (2) help therapists develop a treatment plan. Copyright © 2016 John Wiley & Sons, Ltd.

Predictors of new-onset depressive disorders - Results from the longitudinal Finnish Health 2011 Study.

BACKGROUND: Identifying risk factors for depression is important for understanding etiological mechanisms and targeting preventive efforts. No prior studies have compared risk factors of dysthymia and major depressive disorder (MDD) in a longitudinal setting. METHODS: Predictors of new-onset MDD and dysthymia were examined in a longitudinal general population study (Health 2000 and 2011 Surveys, BRIF8901). 4057 persons free of depressive disorders at baseline were followed up for 11 years. DSM-IV MDD and dysthymia were diagnosed with the Composite International Diagnostic Interview. RESULTS: 126 persons (4.4%, 95%CI 3.6-5.2) were diagnosed with MDD or dysthymia at follow-up. Predictors of new-onset depressive disorders were younger age (adjusted OR 0.97, 95%CI 0.95-0.99 per year), female gender (aOR 1.46, 95%CI 1.01-2.12), multiple childhood adversities (aOR 1.76, 95%CI 1.10-2.83), low trust dimension of social capital (aOR 0.58, 95%CI 0.36-0.96 for high trust), baseline anxiety disorder (aOR 2.75, 95%CI 1.36-5.56), and baseline depressive symptoms (aOR 1.65, 95%CI 1.04-2.61 for moderate and aOR 2.49, 95%CI 1.20-5.17 for severe symptoms). Risk factors for MDD were younger age, female gender, anxiety disorder and depressive symptoms, whereas younger age, multiple childhood adversities, low trust, and having 1-2 somatic diseases predicted dysthymia. LIMITATIONS: We only had one follow-up point at eleven years, and did not collect information on the subjects' health during the follow-up period. CONCLUSIONS: Persons with subclinical depressive symptoms, anxiety disorders, low trust, and multiple childhood adversities have a higher risk of depressive disorders. Predictors of MDD and dysthymia appear to differ. This information can be used to target preventive efforts and guide social policies.

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.

Recognizing and Assessing Risk Factors for Difficult-to-Treat Depression and Treatment-Resistant Depression.

Many patients will not respond adequately to their initial trial of antidepressant medication or subsequent trials. By identifying features that can signal potential treatment-resistant or difficult-to-treat depression early in the course of illness, clinicians may be able to find the right balance of treatment strategies to help patients achieve remission. Here, follow the case of Alice, a 32-year-old lawyer with a treatment-resistant depressive episode.

Prevalence and Recognition of Depressive Disorder in Three Medical Outpatient Departments of General Hospitals in Beijing, China.

This purpose of this study was to explore the prevalence and recognition of depressive disorders in cardiology, gastroenterology, and neurology outpatient departments of general hospitals. Patients screened with a Hospital Anxiety and Depression Scale score of 8 or higher were interviewed by psychiatrists using Mini-International Neuropsychiatric Interview (MINI). Prevalence of depressive disorders within the cohort was determined, sociodemographic data were analyzed for correlations to a depression diagnosis, and comparisons between the surveys and the clinical diagnosis were done to assess recognition of depressive disorders by physicians. Of the patients screened for this study (1552 cases), 12.8% were diagnosed with depressive disorders by MINI, with major depressive disorder, depression due to general medical conditions, and dysthymia having prevalence values of 10.8%, 1.4%, and 0.6%, respectively. As compared with MINI, physicians only recognized 27.6% of any of the depressive disorders. Among the complaints examined, both mood problems and sleeping problems predicted the probability of recognition.