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1.
Adv Exp Med Biol ; 1140: 585-600, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31347073

RESUMO

Major depressive disorder (MDD) is common. Despite numerous available treatments, many individuals fail to improve clinically. Diagnosis of MDD continues to be commonly accomplished via behavioral rather than biological methods. Biomarkers may provide objective diagnosis of MDD, and could include measurements of genes, proteins, and patterns of brain activity. Proteomic analysis and validation of biomarkers is less explored than other areas of biomarker research in MDD. Mass spectrometry (MS) is a comprehensive, unbiased means of proteomic analysis, which can be complemented by directed protein measurements, such as Western Blotting. Prior studies have focused on MS analysis of several human biomaterials in MDD, including human post-mortem brain, cerebrospinal fluid (CSF), blood components, and urine. Further studies utilizing MS and proteomic analysis in MDD may help solidify and establish biomarkers for use in diagnosis, identification of new treatment targets, and understanding of the disorder. A biomarker or a biomarker signature that facilitates a convenient and inexpensive predictive test for depression treatment response is highly desirable.


Assuntos
Biomarcadores/análise , Transtorno Depressivo Maior/diagnóstico , Espectrometria de Massas , Proteoma/análise , Humanos , Proteômica
2.
Nord J Psychiatry ; 73(6): 380-386, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31322453

RESUMO

Objective: In the present study, we compared social anxiety disorder (SAD) patients with (n = 31) and without childhood and adulthood separation anxiety disorder (SeAD) (n = 50) with respect to suicidal behavior, avoidant personality disorder (AvPD), other anxiety disorders (ADs), and major depression as well as some sociodemographic variables. Methods: In assessment of patients, we used Structured Clinical Interview for Separation Anxiety Symptoms, childhood and adulthood Separation Anxiety Symptom Inventories, Liebowitz Social Anxiety Scale, The SCID-II Avoidant Personality Disorder Module, Beck Depression Inventory, and Beck Scale for Suicidal Ideation. Results: SAD patients with SeAD had higher comorbidity rates of AvPD, other lifetime ADs and panic disorder, and current major depression than those without SeAD. The current scores of SAD, depression, and suicide ideation and the mean number of AvPD symptoms were significantly higher in comorbid group compared to pure SAD subjects. The SAD and SeAD scores had significant associations with current depression, suicide ideations, and AvPD. The mean number of AvPD criteria and the current severity of depression were significantly associated with the comorbidity between SAD and SeAD. Conclusion: Our findings might indicate that the comorbidity of SeAD with SAD may increase the risk of the severity of AvPD and current depression.


Assuntos
Ansiedade de Separação/complicações , Ansiedade de Separação/psicologia , Fobia Social/complicações , Fobia Social/psicologia , Adulto , Ansiedade de Separação/diagnóstico , Comorbidade , Depressão/diagnóstico , Depressão/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/psicologia , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/psicologia , Fobia Social/diagnóstico , Escalas de Graduação Psiquiátrica , Ideação Suicida
3.
Z Psychosom Med Psychother ; 65(2): 162-177, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31154932

RESUMO

Objectives: The aim of this article is to outline the relevance of mentalization for the understanding of the dynamics and the psychotherapeutic treatment of depression, and to systematically review the literature on mentalization as it relates to the diagnosis of depression and the evaluation of depression treatment. Methods: The first part of the article consists of an overview of the theory of mentalization and its relevance for depression and its treatment. For the second part, a literature research was conducted in Scopus and PubMed to retrieve and then manually select empirical studies on depression and mentalization, focusing on studies applying the Reflective Functioning Scale based on the Adult Attachment Interview. Results: For our review, 15 studies were selected. These suggest that severe chronic and/ or treatment resistant depression is related to more pronounced mentalizing deficits. With respect to psychotherapy process and outcome, mentalization is a specific focus of psychodynamic therapy approaches, and proves to be an important mediating and moderating variable. Conclusion: Mentalization with its linkages to attachment theory offers rich possibilities for an in-depth understanding of the dynamics of depression and resulting mentalization based approaches to the treatment of the disorder. The small number of studies and their heterogeneous design allow only preliminary assumptions on the difference between severe, chronic and milder or episodic courses of depression with respect to mentalizing deficits and urge for further research.


Assuntos
Depressão/terapia , Pesquisa Empírica , Mentalização , Psicoterapia , Depressão/diagnóstico , Depressão/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/terapia , Humanos
4.
Tijdschr Psychiatr ; 61(6): 384-391, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31243748

RESUMO

BACKGROUND: There is an average 10-year delay in diagnosing bipolar disorder, hampering the application of effective therapeutic interventions.
AIM: To investigate factors contributing to early recognition.
METHOD: We give a stage-oriented overview of the opportunities for early recognition.
RESULTS: Recognition in stage 0 (at-risk) and stage 1 (prodromal) is yet impossible. In stage 2 (syndromal) there are opportunities for better recognition in patients presenting with depression by conducting a thorough (collateral) psychiatric assessment, family history and by applying additional screening tools. CONCLUSIONS There are opportunities for better recognition of bipolar disorder in the syndromal stage.


Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Transtorno Bipolar/psicologia , Transtorno Depressivo Maior/psicologia , Diagnóstico Diferencial , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Escalas de Graduação Psiquiátrica
5.
East Asian Arch Psychiatry ; 29(2): 41-47, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31237245

RESUMO

OBJECTIVE: To examine the prevalence and comorbidity of gastro-oesophageal reflux disease (GORD) with generalised anxiety disorder (GAD) and major depressive episodes (MDE) in a general population using DSM-IV, and to evaluate the associations between these conditions and healthcare utilisation. METHODS: A random population-based telephone survey was conducted to record frequency of GORD symptoms, symptoms of GAD and MDE based on DSM-IV, and healthcare utilisation. RESULTS: Of 2011 respondents, 4.2% had weekly GORD and 13.9% had monthly GORD, whereas 3.8% reported GAD and 12.4% reported MDE. Those with monthly GORD had higher risk of GAD (p = 0.01) and MDE (p < 0.001). GORD symptom frequency was independently correlated with MDE and GAD in a dose-response manner. The number of psychiatric diagnoses was independently correlated with GORD. GORD symptom frequency, GAD, and MDE were correlated with consultation frequency. GORD symptom frequency was corelated with high investigation expenditure. CONCLUSION: GORD had a strong dose-response relationship with GAD and MDE in a Hong Kong population. Excessive healthcare utilisation should alert clinicians to the risk of psychiatric comorbidity.


Assuntos
Transtornos de Ansiedade , Transtorno Depressivo Maior , Refluxo Gastroesofágico , Adulto , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/fisiopatologia , Comorbidade , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/fisiopatologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/psicologia , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prevalência , Medição de Risco
6.
East Asian Arch Psychiatry ; 29(2): 66-70, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31237249

RESUMO

OBJECTIVE: To investigate association between major depressive disorder (MDD) and quality of life in patients with neurological disorder. METHODS: This cross-sectional study was carried out at a Malaysian hospital between April 2016 and December 2016 using convenience sampling. Patients aged ≥18 years with intracranial tumour or other brain disorders were invited to participate. Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life questionnaire version 3.0; diagnosis of MDD was made using Mini International Neuropsychiatric Interview. RESULTS: Of 122 patients approached, 100 (66 women and 34 men) were included (response rate, 93.5%), with a mean age of 45.3 years. The prevalence of MDD in patients with neurological disorder was 30%. Compared with non-depressed patients, patients with MDD had poorer global health status / quality of life (p = 0.003), and reduced physical (p = 0.003), role (p = 0.021), emotional (p < 0.001), cognitive (p = 0.004), and social (p = 0.007) functioning, as well as more symptoms of fatigue (p = 0.004), pain (p < 0.001), dyspnoea (p = 0.033), insomnia (p < 0.001), appetite loss (p = 0.002), constipation (p = 0.034), diarrhoea (p = 0.021), and financial difficulties (p = 0.039). CONCLUSION: Patients with MDD had reduced quality of life. Fatigue, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea, and financial difficulties were prevalent among patients with MDD.


Assuntos
Transtorno Depressivo Maior , Doenças do Sistema Nervoso , Qualidade de Vida , Estudos Transversais , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/etiologia , Transtorno Depressivo Maior/fisiopatologia , Feminino , Humanos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/psicologia , Prevalência , Pesquisa Qualitativa
7.
BMJ ; 365: l1476, 2019 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-30967483

RESUMO

OBJECTIVE: To determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression. DESIGN: Individual participant data meta-analysis. DATA SOURCES: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-February 2015). INCLUSION CRITERIA: Eligible studies compared PHQ-9 scores with major depression diagnoses from validated diagnostic interviews. Primary study data and study level data extracted from primary reports were synthesized. For PHQ-9 cut-off scores 5-15, bivariate random effects meta-analysis was used to estimate pooled sensitivity and specificity, separately, among studies that used semistructured diagnostic interviews, which are designed for administration by clinicians; fully structured interviews, which are designed for lay administration; and the Mini International Neuropsychiatric (MINI) diagnostic interviews, a brief fully structured interview. Sensitivity and specificity were examined among participant subgroups and, separately, using meta-regression, considering all subgroup variables in a single model. RESULTS: Data were obtained for 58 of 72 eligible studies (total n=17 357; major depression cases n=2312). Combined sensitivity and specificity was maximized at a cut-off score of 10 or above among studies using a semistructured interview (29 studies, 6725 participants; sensitivity 0.88, 95% confidence interval 0.83 to 0.92; specificity 0.85, 0.82 to 0.88). Across cut-off scores 5-15, sensitivity with semistructured interviews was 5-22% higher than for fully structured interviews (MINI excluded; 14 studies, 7680 participants) and 2-15% higher than for the MINI (15 studies, 2952 participants). Specificity was similar across diagnostic interviews. The PHQ-9 seems to be similarly sensitive but may be less specific for younger patients than for older patients; a cut-off score of 10 or above can be used regardless of age.. CONCLUSIONS: PHQ-9 sensitivity compared with semistructured diagnostic interviews was greater than in previous conventional meta-analyses that combined reference standards. A cut-off score of 10 or above maximized combined sensitivity and specificity overall and for subgroups. REGISTRATION: PROSPERO CRD42014010673.


Assuntos
Confiabilidade dos Dados , Transtorno Depressivo Maior/diagnóstico , Programas de Rastreamento/métodos , Questionário de Saúde do Paciente/estatística & dados numéricos , Idoso , Transtorno Depressivo Maior/epidemiologia , Feminino , Humanos , Entrevista Psicológica/métodos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica/normas , Sensibilidade e Especificidade
8.
Behav Ther ; 50(3): 504-514, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31030869

RESUMO

Depression is a common and costly problem. Behavioral Activation (BA) is an effective treatment for depression when delivered 1:1, but group treatments often do not perform as well as 1:1 treatments. One way to begin to understand how group treatments perform is to assess the process of change during treatment. This study examined trajectories of change across 10-session group BA for individuals with severe, chronic, or recurrent forms of depression. We also tested whether individuals who had associated sudden gains or depression spikes had better outcomes than those who did not have these change patterns. We examined psychological and sociodemographic predictors of the patterns of change. Participants were 104 individuals who met diagnostic criteria for major depressive disorder and participated in one of 10 BA groups, provided over a 2-year period. A linear, but not quadratic or cubic, rate of change fit the data and the effect size for the change in mood symptoms from baseline to posttreatment was large, Cohen's d = 1.25. Although 34% (26 of the 77 who provided outcome data) of individuals had a sudden gain and 10% (7/77) had a depression spike, neither sudden gains nor depression spikes predicted posttreatment outcomes. None of the demographic or psychological factors (rumination, behavioral activation) predicted the pattern of change. These results suggest that although group BA may help to reduce depressive symptoms in individuals with severe, recurrent, and/or chronic forms of depression, the overall linear pattern of change is different from quadratic patterns of change reported for 1:1 BA.


Assuntos
Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/terapia , Psicoterapia de Grupo/métodos , Índice de Gravidade de Doença , Adulto , Terapia Comportamental/métodos , Terapia Comportamental/tendências , Transtorno Depressivo Maior/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Psicoterapia de Grupo/tendências , Recidiva , Resultado do Tratamento
9.
Behav Ther ; 50(3): 646-658, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31030880

RESUMO

Interpretation Bias Modification (IBM) interventions have been effective in reducing negative interpretation biases theorized to underlie depressive psychopathology. Although these programs have been highlighted as potential short-term interventions for depression, mixed evidence has been found for their effects on depressive symptoms. There is a need to examine attitudes towards training as well as individual difference factors that may impact symptom outcomes for IBM depression interventions. Seventy-two dysphoric young adults were randomly assigned to receive either an IBM targeting negative interpretation bias in personal evaluations or interpersonal situations or a healthy video control (HVC) condition. Compared to those who received HVC, participants in the IBM condition reported lower negative interpretation bias at posttreatment. No differences between conditions were found for symptom outcomes. Greater perceived treatment credibility and expectancy were associated with better treatment outcomes for both the IBM and HVC groups. Within the IBM group, a greater tendency toward assimilation with treatment scenarios was significantly associated with better treatment outcomes for both depressive and anger symptoms. This effect was unique from treatment credibility and expectancy. Pretreatment psychological reactance did not predict treatment response for either condition. Implications and future research directions are discussed.


Assuntos
Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/terapia , Motivação , Terapia Assistida por Computador/métodos , Adolescente , Ira/fisiologia , Depressão/diagnóstico , Depressão/psicologia , Depressão/terapia , Transtorno Depressivo Maior/diagnóstico , Feminino , Humanos , Masculino , Motivação/fisiologia , Valor Preditivo dos Testes , Distribuição Aleatória , Resultado do Tratamento , Adulto Jovem
10.
Nat Commun ; 10(1): 1941, 2019 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-31028273

RESUMO

Mendelian randomization (MR) has emerged as a major tool for the investigation of causal relationship among traits, utilizing results from large-scale genome-wide association studies. Bias due to horizontal pleiotropy, however, remains a major concern. We propose a novel approach for robust and efficient MR analysis using large number of genetic instruments, based on a novel spike-detection algorithm under a normal-mixture model for underlying effect-size distributions. Simulations show that the new method, MRMix, provides nearly unbiased or/and less biased estimates of causal effects compared to alternative methods and can achieve higher efficiency than comparably robust estimators. Application of MRMix to publicly available datasets leads to notable observations, including identification of causal effects of BMI and age-at-menarche on the risk of breast cancer; no causal effect of HDL and triglycerides on the risk of coronary artery disease; a strong detrimental effect of BMI on the risk of major depressive disorder.


Assuntos
Algoritmos , Neoplasias da Mama/genética , Doença da Artéria Coronariana/genética , Transtorno Depressivo Maior/genética , Genoma Humano , Análise da Randomização Mendeliana/estatística & dados numéricos , Fatores Etários , Índice de Massa Corporal , Neoplasias da Mama/sangue , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/etiologia , HDL-Colesterol/sangue , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/etiologia , Conjuntos de Dados como Assunto , Transtorno Depressivo Maior/sangue , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/etiologia , Feminino , Estudo de Associação Genômica Ampla , Humanos , Menarca/sangue , Menarca/genética , Característica Quantitativa Herdável , Fatores de Risco , Triglicerídeos/sangue
11.
Neuron ; 102(1): 91-103, 2019 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-30946830

RESUMO

There have been several recent studies addressing the genetic architecture of depression. This review serves to take stock of what is known now about the genetics of depression, how it has increased our knowledge and understanding of its mechanisms, and how the information and knowledge can be leveraged to improve the care of people affected. We identify four priorities for how the field of MD genetics research may move forward in future years, namely by increasing the sample sizes available for genome-wide association studies (GWASs), greater inclusion of diverse ancestries and low-income countries, the closer integration of psychiatric genetics with electronic medical records, and the development of the neuroscience toolkit for polygenic disorders.


Assuntos
Transtorno Depressivo Maior/genética , Grupos de Populações Continentais/genética , Transtorno Depressivo Maior/classificação , Transtorno Depressivo Maior/diagnóstico , Estudo de Associação Genômica Ampla , Humanos , Herança Multifatorial , Estudos em Gêmeos como Assunto
12.
J Affect Disord ; 250: 284-288, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30875670

RESUMO

BACKGROUND: Recent reports have suggested a relationship between affective disorder including depression and bipolar disorder (BP) and frontotemporal dementia (FTD). TAR DNA binding protein (TDP) -43 is a protein found in the brain and peripheral fluid of patients with FTD. To examine a possible association between affective disorders and FTD, serum levels of TDP-43 were evaluated in late-life patients with major depressive episode (MDE). METHODS: The subjects were 74 late-life (≥50 years old) inpatients with DSM-IV or -5 MDE (58 had major depressive disorders and 16 had BP) and 58 healthy subjects. Patients were recruited from Juntendo Koshigaya Hospital, Saitama, Japan, between January 2005 and May 2017. Serum TDP-43 levels were measured using an ELISA kit. RESULTS: Serum levels of TDP-43 were significantly higher in the MDE group than the control group independent of age and sex. LIMITATIONS: All patients were on antidepressant medication. CONCLUSIONS: Our finding suggests that some depressive patients may be in a prodromal stage of FTD or very-early stage of FTD comorbid with depression.


Assuntos
Proteínas de Ligação a DNA/sangue , Transtorno Depressivo Maior/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Transtorno Depressivo Maior/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Ensaio de Imunoadsorção Enzimática , Feminino , Demência Frontotemporal/sangue , Demência Frontotemporal/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/sangue , Transtornos do Humor/diagnóstico
13.
Behav Ther ; 50(2): 270-284, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30824245

RESUMO

Depressed individuals are less reactive than healthy individuals to positive stimuli in the laboratory, but accumulating evidence suggests that they are more emotionally reactive to positive events in their daily lives. The present study probed the boundaries of this curious "mood brightening" effect and investigated its specificity to major depressive disorder (MDD) vis-à-vis generalized anxiety disorder (GAD), its closest boundary condition. We used ecological momentary assessment to measure reactions to positive events over one week in individuals with MDD (n = 38), GAD (n = 36), comorbid MDD-GAD (n = 38), and no psychopathology (n = 33). Depressed individuals responded to positive events with larger changes in affect, cognition, reported withdrawal (but not approach) behavior, and symptoms than healthy controls. More severe depression assessed before the sampling week predicted greater brightening. Altered reactivity to positive events was relatively specific to MDD when compared with GAD, similar to patterns found for other positive emotional processes. The robustness, scope, and relative specificity of the brightening effect highlights the need to resolve conflicting findings across laboratory and non-laboratory studies to advance understanding of altered reactivity in emotional disorders.


Assuntos
Transtornos de Ansiedade/psicologia , Transtorno Depressivo Maior/psicologia , Avaliação Momentânea Ecológica , Emoções , Otimismo/psicologia , Adolescente , Adulto , Afeto/fisiologia , Transtornos de Ansiedade/diagnóstico , Comorbidade , Transtorno Depressivo Maior/diagnóstico , Emoções/fisiologia , Feminino , Humanos , Masculino , Transtornos do Humor/diagnóstico , Transtornos do Humor/psicologia , Comportamento Social , Adulto Jovem
14.
J Affect Disord ; 250: 380-390, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30877861

RESUMO

BACKGROUND: Both of the modern medicine and the traditional Chinese medicine classify depressive disorder (DD) and chronic fatigue syndrome (CFS) to one type of disease. Unveiling the association between depressive and the fatigue diseases provides a great opportunity to bridge the modern medicine with the traditional Chinese medicine. METHODS: In this work, 295 general participants were recruited to complete Zung Self-Rating Depression Scales and Chalder Fatigue Scales, and meanwhile, to donate plasma and urine samples for 1H NMR-metabolic profiling. Artificial intelligence methods was used to analysis the underlying association between DD and CFS. Principal components analysis (PCA) and partial least squares discriminant analysis (PLS-DA) were used to analyze the metabolic profiles with respect to gender and age. Variable importance in projection and t-test were employed in conjunction with the PLS-DA models to identify the metabolite biomarkers. Considering the asymmetry and complexity of the data, convolutional neural networks (CNN) model, an artificial intelligence method, was built to analyze the data characteristics between each groups. RESULTS: The results showed the gender- and age-related differences for the candidate biomarkers of the DD and the CFS diseases, and indicated the same and different biomarkers of the two diseases. PCA analysis for the data characteristics reflected that DD and CFS was separated completely in plasma metabolite. However, DD and CFS was merged into one group. LIMITATION: Lack of transcriptomic analysis limits the understanding of the association of the DD and the CFS diseases on gene level. CONCLUSION: The unmasked candidate biomarkers provide reliable evidence to explore the commonality and differences of the depressive and the fatigue diseases, and thereby, bridge over the traditional Chinese medicine with the modern medicine.


Assuntos
Inteligência Artificial , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/diagnóstico , Síndrome de Fadiga Crônica/complicações , Síndrome de Fadiga Crônica/diagnóstico , Adulto , Biomarcadores/sangue , Transtorno Depressivo , Feminino , Perfilação da Expressão Gênica , Humanos , Análise dos Mínimos Quadrados , Espectroscopia de Ressonância Magnética , Masculino , Metabolômica , Pessoa de Meia-Idade , Análise de Componente Principal
15.
J Affect Disord ; 251: 91-99, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30913472

RESUMO

BACKGROUND: Decisions about antidepressant use in pregnancy are complex. We performed a pilot randomized controlled trial assessing the feasibility of a trial protocol for an online patient decision aid (PDA) for women deciding about antidepressant use in pregnancy. METHODS: 96 preconception and pregnant Canadian women recruited from specialist (n = 51) and non-specialist (n = 45) settings with Decisional Conflict Scale (DCS, range 0-100) score of ≥25 signifying moderate-to-high decisional conflict were randomly allocated to either the PDA or a control condition that guided participants to publicly available resources for advice around antidepressants and pregnancy. Follow-up data were collected at 4 weeks post-randomization. RESULTS: About 88.9% of eligible participants consented to participate. Women's views of the tool were positive; 88.7% of participants provided follow-up data. At follow-up, mean DCS score had decreased by 19.9 points in the PDA group vs. 13.3 in controls (adjusted mean difference, MD, 7.01, 95% CI -14.3 to 0.30). In the non-specialist setting, DCS scores decreased more for PDA users (25.5 points) than controls (10.5 points; adjusted MD -15.1, 95% CI -25.6 to -4.55); the MD was negligible in the specialist setting. LIMITATIONS: The main limitation is the highly educated, high-income nature of our sample. CONCLUSIONS: Evaluation of an online PDA for antidepressant use in pregnancy with national recruitment is feasible. Pilot results suggest that the tool is acceptable and reduces decisional conflict more than clinical care alone in a non-specialist setting. Evaluation of the PDA's impact on longer-term maternal and child clinical outcomes is a key next step.


Assuntos
Antidepressivos/uso terapêutico , Técnicas de Apoio para a Decisão , Transtorno Depressivo Maior/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Adulto , Canadá , Conflito (Psicologia) , Tomada de Decisões , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Método Duplo-Cego , Feminino , Humanos , Participação do Paciente , Projetos Piloto , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/psicologia , Adulto Jovem
16.
J Affect Disord ; 251: 121-129, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30921595

RESUMO

BACKGROUND: Patient outcome expectancy - the belief that treatment will lead to an improvement in symptoms - is linked to favourable therapeutic outcomes in major depressive disorder (MDD). The present study extends this literature by investigating the temporal dynamics of expectancy, and by exploring whether expectancy during treatment is linked to differential outcomes across treatment modalities, for both optimistic versus pessimistic expectancy. METHODS: A total of 104 patients with MDD were randomized to receive either cognitive behavioral therapy (CBT) or pharmacotherapy for 16 weeks. Outcome expectancy was measured throughout treatment using the Depression Change Expectancy Scale (DCES). Depression severity was measured using both the Hamilton Depression Rating Scale and Beck Depression Inventory-II. RESULTS: Latent growth curve models supported improvement in expectancy across both treatments. Cross-lagged panel models revealed that both higher optimistic and lower pessimistic expectancy at mid-treatment predicted greater treatment response in pharmacotherapy. For CBT, the associative patterns between expectancy and depression differed as a function of expectancy type; higher optimistic expectancy at pre-treatment and lower pessimistic expectancy at mid-treatment predicted greater treatment response. LIMITATIONS: The sample size limited statistical power and the complexity of models that could be explored. CONCLUSIONS: Results suggest that outcome expectancy improved during treatment for depression. Whether outcome expectancy represents a specific mechanism for the reduction of depression warrants further investigation.


Assuntos
Antidepressivos/uso terapêutico , Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo Maior/terapia , Adolescente , Adulto , Idoso , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pessimismo , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários , Resultado do Tratamento
17.
J Affect Disord ; 251: 156-161, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30925266

RESUMO

OBJECTIVE: Major depression disorder (MDD) is one of the most prevalent mental disorders worldwide. Diagnosing depression in the early stage is crucial to treatment process. However, due to depression's comorbid nature and the subjectivity in diagnosis, an early diagnosis could be challenging. Recently, machine learning approaches have been used to process Electroencephalography (EEG) and neuroimaging data to facilitate the diagnosis. In the present study, we used a multimodal machine learning approach involving EEG, eye tracking and galvanic skin response data as input to classify depression patients and healthy controls. METHODS: One hundred and forty-four MDD depression patients and 204 matched healthy controls were recruited. They were required to watch a series of affective and neutral stimuli while EEG, eye tracking information and galvanic skin response were recorded via a set of low-cost, portable devices. Three machine learning algorithms including Random Forests, Logistic Regression and Support Vector Machine (SVM) were trained to build dichotomous classification model. RESULTS: The results showed that the highest classification f1 score was obtained by Logistic Regression algorithms, with accuracy = 79.63%, precision = 76.67%, recall = 85.19% and f1 score = 80.70% LIMITATIONS: No hospitalized patients were available; only outpatients were included in the present study. The sample consisted mostly of young adult, and no elder patients were included. CONCLUSIONS: The machine learning approach can be a useful tool for classifying MDD patients and healthy controls and may help for diagnostic processes.


Assuntos
Transtorno Depressivo Maior/diagnóstico , Eletroencefalografia/métodos , Medições dos Movimentos Oculares , Resposta Galvânica da Pele/fisiologia , Aprendizado de Máquina , Adulto , Algoritmos , Estudos de Casos e Controles , Feminino , Humanos , Modelos Logísticos , Masculino , Máquina de Vetores de Suporte , Adulto Jovem
18.
Behav Ther ; 50(2): 285-299, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30824246

RESUMO

Little is known about whether or not a consistently high level of homework adherence over the course of therapy benefits patients. This question was examined in two samples of patients who were receiving individual Cognitive Behavioral Therapy (CBT) for depression (Ns = 128 [Sequenced Treatment Alternatives to Relieve Depression: STAR-D] and 183 [Continuation Phase Cognitive Therapy Relapse Prevention: C-CT-RP]). Logistic and linear regression and propensity score models were used to identify whether or not clinician assessments of homework adherence differentiated symptom reduction and remission, as assessed by the Hamilton Depression Rating Scale-17 (HDRS-17), the Quick Inventory of Depressive Symptomatology-Self-Reported Scale (QIDS-SR), and the QIDS-Clinician Scale (QIDS-C). CBT-related response and remission were equally likely between both high and low homework adherers in both studies and in all models. But in propensity adjusted models that adjusted for session attendance, for both the STAR-D and C-CT-RP samples, greater homework adherence was significantly associated with greater response and remission from depression in the first and last 8 sessions of CBT. Our results suggest that homework adherence can account for response and remission early and late in treatment, with adequate session attendence.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/terapia , Educação de Pacientes como Assunto/métodos , Pontuação de Propensão , Autocuidado/métodos , Autocuidado/psicologia , Adulto , Doença Crônica , Terapia Cognitivo-Comportamental/tendências , Transtorno Depressivo Maior/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
19.
Nord J Psychiatry ; 73(2): 125-131, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30856038

RESUMO

BACKGROUND: In addition to psychiatric disorders, childhood adversities may increase the risk of suicidal behavior. In previous studies, the effects of clinical co-morbidity and overlap of childhood adversities has rarely been taken into account. AIM: The study aims to search associations of psychiatric diagnoses and childhood adversities and trauma (CAT) with suicide risk. METHODS: Altogether 415 adult patients attending primary and psychiatric outpatient care filled in the Trauma and Distress Scale, including assessment of five core CAT domains (emotional, physical and sexual abuse, and emotional and physical neglect). The study patients' current psychiatric disorders and suicide risk were assessed by the Mini International Neuropsychiatric Interview. RESULTS: Age, poor perceived health, poor social support, current psychiatric treatment, all psychiatric disorders, except hypomania, emotional and physical abuse, and emotional neglect did associate significantly with suicide risk. Number of psychiatric disorders and CAT domains had dose-dependent effects on suicide risk. In multivariate analysis, current psychiatric treatment, current and life-time major depression, social phobia, alcohol, and drug dependency, as well as emotional abuse had direct associations with suicide risk. In females, manic disorders and drug dependence, and in males, dysthymia, social phobia, and emotional abuse associated with suicide risk. CONCLUSIONS: Psychiatric disorders and most CAT domains associate with suicide risk. However, when the effect of co-morbidity and overlap of CAT domains is controlled, major depression, social phobia, alcohol, and drug dependency and emotional abuse seem to increase the risk of suicide. The risk profile varies between the genders.


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Maus-Tratos Infantis/psicologia , Transtornos Mentais/psicologia , Ideação Suicida , Suicídio/psicologia , Adulto , Criança , Maus-Tratos Infantis/diagnóstico , Maus-Tratos Infantis/tendências , Comorbidade , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Suicídio/tendências
20.
Trop Doct ; 49(3): 170-177, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30885057

RESUMO

Major depressive disorder (MDD) is a major global health challenge and postnatal women may be at an increased risk for this disorder. Very few studies have tested this hypothesis in sub-Saharan Africa (SSA), so it is uncertain whether risk factors implicated elsewhere in the world are relevant in SSA. We explored prevalence and risk factors for MDD and depressive symptomatology among postnatal mothers in Kampala. Three hundred postnatal mothers at Nsambya Hospital were assessed for MDD using the DSM IV-based MINI; prevalence and risk factors were determined using frequencies and regressions, respectively. Four women (1.33%) had MDD; however, 94 (31%) had 'sub-threshold' or depressive symptomatology, with which partner violence is particularly associated. MDD is rare among postnatal women in a paying hospital in Kampala; however, the high prevalence of depressive symptomatology suggests susceptibility to MDD. Longitudinal studies should investigate this hypothesis and the susceptibility due to partner violence should guide appropriate interventions.


Assuntos
Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Adulto , Depressão Pós-Parto/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Feminino , Humanos , Violência por Parceiro Íntimo/estatística & dados numéricos , Mães/psicologia , Mães/estatística & dados numéricos , Prevalência , Fatores de Risco , Uganda/epidemiologia
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