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1.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5004-5007, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019110

RESUMO

Depression is the leading cause of disability worldwide, yet rates of missed- and mis-diagnoses are alarmingly high. The introduction of objective biomarkers, to aid diagnosis, informed by depression's physiological pathology may alleviate some of the burden on strained mental health services. Three minutes of eyes-closed resting state heart rate and skin conductance response (SCR) data were acquired from 27 participants (16 healthy controls, 11 with major depressive disorder (MDD)). Various classifiers were trained on state-of-the-art and novel features. We are aware of no previous studies analysing the utility of multimodal vs. individual modalities for classification. We found no improvement using multimodal classifiers over using heart rate variability (HRV) alone, which achieved 81% test accuracy. The best multimodal and SCR only classifiers were only slightly less accurate at 78%. Despite not improving depression detection, SCR features did show stronger correlation with suicidal ideation than HRV. SD1/SD22 is a novel HRV feature proposed in this paper, similar to the commonly used ratio SD1/SD2 but with more marked separation between classes, having the largest Rank Biserial Correlation of all examined features (p-value = 0.002, RBC = -0.73). We recommend further studies in this area.


Assuntos
Transtorno Depressivo Maior , Adulto , Biomarcadores , Depressão , Transtorno Depressivo Maior/diagnóstico , Frequência Cardíaca , Humanos , Ideação Suicida
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5280-5283, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019175

RESUMO

Depression is a harmful disease with high incidence. However, no effective method based on physiological information detection has been published to diagnose depression. Electroencephalography (EEG) has been used as a tool to detect physiological information of depressed patients and the symmetry of EEG receives much attention. This research focused on the symmetry of EEG in left and right homologous brain regions. 22 healthy volunteers and 41 volunteers of major depression were tested and three methods, average power ratio, waveform correlation and power spectral correlation, were adopted to measure the symmetry in all frequency bands and all brain regions. After t-test, homologous site pairs in particular frequency bands with significant differences between major depressed patients and controls were found out. Then sample entropy analysis was adopted, trying to figure out further connections between EEG symmetry and major depression. The accuracy tests were also taken and the average accuracy of some tests could reach 93.7%. The result of this research can hopefully serve as a theoretical basis for pattern recognition in the diagnosis of depression. The accuracy of pattern recognition based on multiple processing methods and sites will increase dramatically.


Assuntos
Transtorno Depressivo Maior , Atenção , Encéfalo , Transtorno Depressivo Maior/diagnóstico , Eletroencefalografia , Entropia , Humanos
4.
Artigo em Inglês | MEDLINE | ID: mdl-32784694

RESUMO

The relationships between dimensions of personality (sociotropy and autonomy), coping strategies (rumination: brooding and reflection subtypes, and immature defenses) and symptoms of depression and anxiety were explored in patients with Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD). A total of 279 patients completed questionnaires including measures of personality dimensions, rumination, immature defenses, depression and anxiety. Our findings suggested that sociotropy and autonomy may be associated with both depressive and anxious symptoms in patients with MDD and with GAD. Multiple mediation analyses indicated that brooding always acted as a mediating link between personality vulnerabilities (sociotropy and autonomy) and depressive and anxiety symptoms, independently of the patient group. In addition, in patients with MDD and those with GAD, brooding and immature defenses functioned together by linking sociotropy and autonomy, respectively, with depressive symptoms. Our results also showed that, in patients with GAD, both types of rumination explained the relationship between sociotropy and autonomy and anxiety symptoms. Overall, our findings provided evidence of the transdiagnostic role of the brooding, linking the vulnerability of personality dimensions and emotional symptoms. They also indicated that reflection and immature defenses can operate in conjunction with brooding, depending on the type of vulnerability and emotional context.


Assuntos
Sintomas Afetivos/psicologia , Ansiedade/psicologia , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Adulto , Ansiedade/diagnóstico , Dependência Psicológica , Depressão/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Feminino , Humanos , Masculino , Pensamento
5.
PLoS One ; 15(8): e0231995, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833958

RESUMO

Current practice of assessing mood episodes in affective disorders largely depends on subjective observations combined with semi-structured clinical rating scales. Motor activity is an objective observation of the inner physiological state expressed in behavior patterns. Alterations of motor activity are essential features of bipolar and unipolar depression. The aim was to investigate if objective measures of motor activity can aid existing diagnostic practice, by applying machine-learning techniques to analyze activity patterns in depressed patients and healthy controls. Random Forrest, Deep Neural Network and Convolutional Neural Network algorithms were used to analyze 14 days of actigraph recorded motor activity from 23 depressed patients and 32 healthy controls. Statistical features analyzed in the dataset were mean activity, standard deviation of mean activity and proportion of zero activity. Various techniques to handle data imbalance were applied, and to ensure generalizability and avoid overfitting a Leave-One-User-Out validation strategy was utilized. All outcomes reports as measures of accuracy for binary tests. A Deep Neural Network combined with SMOTE class balancing technique performed a cut above the rest with a true positive rate of 0.82 (sensitivity) and a true negative rate of 0.84 (specificity). Accuracy was 0.84 and the Matthews Correlation Coefficient 0.65. Misclassifications appear related to data overlapping among the classes, so an appropriate future approach will be to compare mood states intra-individualistically. In summary, machine-learning techniques present promising abilities in discriminating between depressed patients and healthy controls in motor activity time series.


Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Atividade Motora/fisiologia , Adulto , Algoritmos , Depressão/diagnóstico , Depressão/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Aprendizado de Máquina , Masculino , Transtornos do Humor/psicologia , Redes Neurais de Computação , Sensibilidade e Especificidade
6.
Lancet Psychiatry ; 7(9): 801-812, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32828168

RESUMO

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.


Assuntos
Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/terapia , Transtorno Distímico/diagnóstico , Transtorno Distímico/terapia , Antidepressivos/uso terapêutico , Doença Crônica , Terapia Combinada , Comorbidade , Transtorno Depressivo Maior/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtorno Distímico/epidemiologia , Humanos , Psicoterapia/métodos , Recidiva
7.
J Fr Ophtalmol ; 43(7): 586-597, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32631695

RESUMO

Major depressive disorder, bipolar disorder and schizophrenia are currently among the most common psychiatric disorders, known to constitute a serious public health issue in terms of morbidity, mortality and functional handicap. Their pathophysiology is still unclear, but there is now increasing evidence supporting the existence of abnormalities of neurotransmission. As the retina is an extension of the central nervous system, it may be an interesting site of study which might provide a better understanding of the pathophysiology of psychiatric disorders. Several studies have demonstrated retinal abnormalities, with abnormal cone and rod responses on electroretinography (ERG), suggesting a process of functional neuronal loss, structurally supported by a decrease in the retinal nerve fiber layer thickness (RNFL) on optical coherence tomography (OCT), which suggests involvement of the molecular signal pathways of neurotransmission. These tests could be useful tools for diagnosing and monitoring psychiatric disorders. This article is an overview of the literature on retinal abnormalities observed in patients with major depressive disorder, bipolar disorder or schizophrenia, and discusses how they could be pathophysiologic markers.


Assuntos
Transtorno Bipolar/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Retina/diagnóstico por imagem , Retina/fisiologia , Esquizofrenia/fisiopatologia , Acuidade Visual/fisiologia , Transtorno Bipolar/complicações , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/patologia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/patologia , Eletrorretinografia , Humanos , Fibras Nervosas/patologia , Fibras Nervosas/fisiologia , Retina/patologia , Células Fotorreceptoras Retinianas Cones/patologia , Células Fotorreceptoras Retinianas Cones/fisiologia , Células Ganglionares da Retina/patologia , Células Ganglionares da Retina/fisiologia , Esquizofrenia/complicações , Esquizofrenia/diagnóstico , Esquizofrenia/patologia , Tomografia de Coerência Óptica
8.
East Asian Arch Psychiatry ; 30(2): 39-43, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32611825

RESUMO

BACKGROUND: The DSM-IV and the DSM-5 eliminated the importance of the syndromal identity of melancholic depression in favour of a dimensional model within the domain of major depressive disorders. Melancholic depression was excluded from DSM as a distinct disorder owing to the impact of ageing, genetics, and course of illness. We challenge these assertions using retrospective data collected from patients with depression. METHOD: Electronic medical records of 1073 patients with depressive-spectrum disorders in 12 centres across Germany spanning from January 2010 to June 2013 were retrospectively reviewed. The diagnosis of melancholia was made using the Hamilton Depression Rating Scale 21 items (HAMD-21). Patients were followed up every 2 weeks and yearly until discharge from inpatient units. The final dataset consisted of 1014 patients; each had received a minimum of two complete observations. RESULTS: At baseline, patients with melancholic depression had higher HAMD-21 score than did patients with non-melancholic depression (32.6 vs 23.13, p < 0.001). At the final visit, patients with melancholic depression responded to treatment more often than did patients with non-melancholic depression (81.3% vs 69.04%, p = 0.0156), whereas the two groups were comparable in terms of remission status (50.55 vs 48.68%, p = 0.1943). The relapse rate was higher in patients with melancholic depression than in patients with non-melancholic depression after 1 year (60% vs 45.01%, p = 0.0599), 2 years (77.78% vs 60.36%, p = 0.0233), and 4 years (80% vs 64.45%, p = 0.0452). CONCLUSION: Melancholic depression has an identifiable constellation of symptoms and it is not just a severe form of major depression. Melancholic depression is not the result of age-related or pathoplastic changes. We advocate including melancholia as its own illness entity in the next edition of the DSM.


Assuntos
Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo/diagnóstico , Adulto , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Recidiva , Indução de Remissão , Estudos Retrospectivos , Fatores de Tempo
9.
PLoS One ; 15(7): e0235268, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32701959

RESUMO

Chronic social defeat (CSD) can lead to impairments in social interaction and other behaviors that are supposed to model features of major depressive disorder (MDD). Not all animals subjected to CSD, however, develop these impairments, and maintained social interaction in some animals is widely used as a model for resilience to stress-induced mental dysfunctions. So far, animals have mainly been studied shortly (24 hours and 7 days) after CSD exposure and longitudinal development of behavioral phenotypes in individual animals has been mostly neglected. We have analyzed social interaction and novel object recognition behavior of stressed mice at different time points after CSD and have found very dynamic courses of behavior of individual animals. Instead of the two groups, resilient or susceptible, that are found at early time points our data suggest four groups with (i, ii) animals behaving resilient or susceptible at early and late time points, respectively (iii) animals that start susceptible and recover with time or (iv) animals that are resilient at early time points but develop vulnerability later on.


Assuntos
Transtorno Depressivo Maior/psicologia , Suscetibilidade a Doenças/psicologia , Relações Interpessoais , Resiliência Psicológica , Estresse Psicológico/complicações , Agressão/psicologia , Animais , Técnicas de Observação do Comportamento , Comportamento Animal , Doença Crônica/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/etiologia , Modelos Animais de Doenças , Humanos , Estudos Longitudinais , Masculino , Camundongos , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia , Fatores de Tempo
10.
PLoS One ; 15(7): e0235272, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628698

RESUMO

BACKGROUND: Recent studies have uncovered a peculiar finding: that the strength and dimensionality of depression symptoms' inter-relationships vary systematically across study samples with different average levels of depression severity. Our aim was to examine whether this phenomenon is driven by the proportion of non-affected subjects in the sample. METHODS: Cross-sectional data from the "Cohort Study on Substance Use Risk Factors" was analyzed. Self-reported depression symptoms were assessed via the Major Depressive Inventory. Symptom data were analyzed via polychoric correlations, principal component analysis, confirmatory factor analysis, Mokken scale analysis, and network analysis. Analyses were carried out across 22 subsamples containing increasingly higher proportions of non-depressed participants. Results were examined as a function of the proportion of non-depressed participants. RESULTS: A strong influence of the proportion of non-depressed participants was uncovered: the higher the proportion, the stronger the symptom correlations, higher their tendency towards unidimensionality, better their scalability, and higher the network edge strengths. Comparing the depressed sample with the general population sample, the average symptom correlation increased from 0.29 to 0.51; variance explained by the first eigenvalue increased from 0.36 to 0.56; fit measures from confirmatory one-factor analysis increased from 0.81 to 0.97; the H coefficient of scalability increased from 0.26 to 0.48; and the median network edge increased from 0.00 to 0.07. CONCLUSIONS: Results of psychometric analyses vary substantially as a function of the proportion of non-depressed participants in the sample being studied. This provides a possible explanation for the lack of reproducibility of previous psychometric studies.


Assuntos
Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Psicometria/estatística & dados numéricos , Adolescente , Estudos Transversais , Depressão/diagnóstico , Depressão/fisiopatologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/fisiopatologia , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Amostragem , Autorrelato , Índice de Gravidade de Doença , Suíça/epidemiologia , Adulto Jovem
11.
Niger Postgrad Med J ; 27(3): 224-229, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687123

RESUMO

Background: Tension-type headache (TTH) is one of the most common reasons patients seek medical treatment. Psychiatric co-morbidities such as anxiety and depression have been commonly observed in patients with TTH. Objective: The objective was to study the prevalence and severity of co-morbid generalized anxiety disorder (GAD) and major depressive disorder (MDD) in patients with TTH. Materials and Methods: The present cross-sectional study was conducted in the Tertiary Health Care Centre in Central Rural India, with a sample size of 85. Data were recorded in the predesigned, semi-structured questionnaire. Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HDRS) were used to categorise the co-morbid anxiety and depression. Results: About 48.2% of the study participants were in the age group of 31-40 years with a mean age of 36.8 ± 7.1 years. Higher proportions of female study participants (64.7%) were observed. Majority of the study participants were literate (76.5%), employed (57.7%), married (78.8%) and had rural residence (54.1%). The prevalence of co-morbid GAD was 70.6%, whereas the prevalence of co-morbid MDD was 54.1%. According to HAM-A, 31.8% had mild, 21.2% had moderate, while 17.6% had severe anxiety levels. According to HDRS, 34.1% had mild, 16.5% had moderate and 3.5% had severe co-morbid depression. Conclusion: TTH is frequently associated with co-morbid GAD and MDD.


Assuntos
Transtornos de Ansiedade/epidemiologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Transtorno Depressivo Maior/epidemiologia , Cefaleia do Tipo Tensional/epidemiologia , Adolescente , Adulto , Transtornos de Ansiedade/diagnóstico , Grupo com Ancestrais do Continente Asiático/psicologia , Comorbidade , Estudos Transversais , Transtorno Depressivo Maior/diagnóstico , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente , Prevalência , Escalas de Graduação Psiquiátrica , População Rural , Índice de Gravidade de Doença , Fatores Socioeconômicos , Inquéritos e Questionários , Cefaleia do Tipo Tensional/diagnóstico , Centros de Atenção Terciária
13.
Epidemiol Psychiatr Sci ; 29: e134, 2020 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-32484148

RESUMO

AIMS: To examine the factors that are associated with changes in depression in people with type 2 diabetes living in 12 different countries. METHODS: People with type 2 diabetes treated in out-patient settings aged 18-65 years underwent a psychiatric assessment to diagnose major depressive disorder (MDD) at baseline and follow-up. At both time points, participants completed the Patient Health Questionnaire (PHQ-9), the WHO five-item Well-being scale (WHO-5) and the Problem Areas in Diabetes (PAID) scale which measures diabetes-related distress. A composite stress score (CSS) (the occurrence of stressful life events and their reported degree of 'upset') between baseline and follow-up was calculated. Demographic data and medical record information were collected. Separate regression analyses were conducted with MDD and PHQ-9 scores as the dependent variables. RESULTS: In total, there were 7.4% (120) incident cases of MDD with 81.5% (1317) continuing to remain free of a diagnosis of MDD. Univariate analyses demonstrated that those with MDD were more likely to be female, less likely to be physically active, more likely to have diabetes complications at baseline and have higher CSS. Mean scores for the WHO-5, PAID and PHQ-9 were poorer in those with incident MDD compared with those who had never had a diagnosis of MDD. Regression analyses demonstrated that higher PHQ-9, lower WHO-5 scores and greater CSS were significant predictors of incident MDD. Significant predictors of PHQ-9 were baseline PHQ-9 score, WHO-5, PAID and CSS. CONCLUSION: This study demonstrates the importance of psychosocial factors in addition to physiological variables in the development of depressive symptoms and incident MDD in people with type 2 diabetes. Stressful life events, depressive symptoms and diabetes-related distress all play a significant role which has implications for practice. A more holistic approach to care, which recognises the interplay of these psychosocial factors, may help to mitigate their impact on diabetes self-management as well as MDD, thus early screening and treatment for symptoms is recommended.


Assuntos
Transtorno Depressivo Maior/diagnóstico , Diabetes Mellitus Tipo 2/complicações , Programas de Rastreamento/métodos , Qualidade de Vida , Estresse Psicológico/etiologia , Adulto , Idoso , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente , Estudos Prospectivos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Angústia Psicológica , Estresse Psicológico/epidemiologia , Inquéritos e Questionários , Adulto Jovem
14.
JAMA ; 323(22): 2290-2300, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32515813

RESUMO

Importance: The Patient Health Questionnaire depression module (PHQ-9) is a 9-item self-administered instrument used for detecting depression and assessing severity of depression. The Patient Health Questionnaire-2 (PHQ-2) consists of the first 2 items of the PHQ-9 (which assess the frequency of depressed mood and anhedonia) and can be used as a first step to identify patients for evaluation with the full PHQ-9. Objective: To estimate PHQ-2 accuracy alone and combined with the PHQ-9 for detecting major depression. Data Sources: MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-May 2018). Study Selection: Eligible data sets compared PHQ-2 scores with major depression diagnoses from a validated diagnostic interview. Data Extraction and Synthesis: Individual participant data were synthesized with bivariate random-effects meta-analysis to estimate pooled sensitivity and specificity of the PHQ-2 alone among studies using semistructured, fully structured, or Mini International Neuropsychiatric Interview (MINI) diagnostic interviews separately and in combination with the PHQ-9 vs the PHQ-9 alone for studies that used semistructured interviews. The PHQ-2 score ranges from 0 to 6, and the PHQ-9 score ranges from 0 to 27. Results: Individual participant data were obtained from 100 of 136 eligible studies (44 318 participants; 4572 with major depression [10%]; mean [SD] age, 49 [17] years; 59% female). Among studies that used semistructured interviews, PHQ-2 sensitivity and specificity (95% CI) were 0.91 (0.88-0.94) and 0.67 (0.64-0.71) for cutoff scores of 2 or greater and 0.72 (0.67-0.77) and 0.85 (0.83-0.87) for cutoff scores of 3 or greater. Sensitivity was significantly greater for semistructured vs fully structured interviews. Specificity was not significantly different across the types of interviews. The area under the receiver operating characteristic curve was 0.88 (0.86-0.89) for semistructured interviews, 0.82 (0.81-0.84) for fully structured interviews, and 0.87 (0.85-0.88) for the MINI. There were no significant subgroup differences. For semistructured interviews, sensitivity for PHQ-2 scores of 2 or greater followed by PHQ-9 scores of 10 or greater (0.82 [0.76-0.86]) was not significantly different than PHQ-9 scores of 10 or greater alone (0.86 [0.80-0.90]); specificity for the combination was significantly but minimally higher (0.87 [0.84-0.89] vs 0.85 [0.82-0.87]). The area under the curve was 0.90 (0.89-0.91). The combination was estimated to reduce the number of participants needing to complete the full PHQ-9 by 57% (56%-58%). Conclusions and Relevance: In an individual participant data meta-analysis of studies that compared PHQ scores with major depression diagnoses, the combination of PHQ-2 (with cutoff ≥2) followed by PHQ-9 (with cutoff ≥10) had similar sensitivity but higher specificity compared with PHQ-9 cutoff scores of 10 or greater alone. Further research is needed to understand the clinical and research value of this combined approach to screening.


Assuntos
Transtorno Depressivo Maior/diagnóstico , Programas de Rastreamento/métodos , Questionário de Saúde do Paciente , Adulto , Transtorno Depressivo Maior/classificação , Feminino , Humanos , Entrevistas como Assunto , Masculino , Curva ROC , Sensibilidade e Especificidade
15.
JAMA Netw Open ; 3(6): e206653, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32568399

RESUMO

Importance: Despite the high prevalence and potential outcomes of major depressive disorder, whether and how patients will respond to antidepressant medications is not easily predicted. Objective: To identify the extent to which a machine learning approach, using gradient-boosted decision trees, can predict acute improvement for individual depressive symptoms with antidepressants based on pretreatment symptom scores and electroencephalographic (EEG) measures. Design, Setting, and Participants: This prognostic study analyzed data collected as part of the International Study to Predict Optimized Treatment in Depression, a randomized, prospective open-label trial to identify clinically useful predictors and moderators of response to commonly used first-line antidepressant medications. Data collection was conducted at 20 sites spanning 5 countries and including 518 adult outpatients (18-65 years of age) from primary care or specialty care practices who received a diagnosis of current major depressive disorder between December 1, 2008, and September 30, 2013. Patients were antidepressant medication naive or willing to undergo a 1-week washout period of any nonprotocol antidepressant medication. Statistical analysis was conducted from January 5 to June 30, 2019. Exposures: Participants with major depressive disorder were randomized in a 1:1:1 ratio to undergo 8 weeks of treatment with escitalopram oxalate (n = 162), sertraline hydrochloride (n = 176), or extended-release venlafaxine hydrochloride (n = 180). Main Outcomes and Measures: The primary objective was to predict improvement in individual symptoms, defined as the difference in score for each of the symptoms on the 21-item Hamilton Rating Scale for Depression from baseline to week 8, evaluated using the C index. Results: The resulting data set contained 518 patients (274 women; mean [SD] age, 39.0 [12.6] years; mean [SD] 21-item Hamilton Rating Scale for Depression score improvement, 13.0 [7.0]). With the use of 5-fold cross-validation for evaluation, the machine learning model achieved C index scores of 0.8 or higher on 12 of 21 clinician-rated symptoms, with the highest C index score of 0.963 (95% CI, 0.939-1.000) for loss of insight. The importance of any single EEG feature was higher than 5% for prediction of 7 symptoms, with the most important EEG features being the absolute delta band power at the occipital electrode sites (O1, 18.8%; Oz, 6.7%) for loss of insight. Over and above the use of baseline symptom scores alone, the use of both EEG and baseline symptom features was associated with a significant increase in the C index for improvement in 4 symptoms: loss of insight (C index increase, 0.012 [95% CI, 0.001-0.020]), energy loss (C index increase, 0.035 [95% CI, 0.011-0.059]), appetite changes (C index increase, 0.017 [95% CI, 0.003-0.030]), and psychomotor retardation (C index increase, 0.020 [95% CI, 0.008-0.032]). Conclusions and Relevance: This study suggests that machine learning may be used to identify independent associations of symptoms and EEG features to predict antidepressant-associated improvements in specific symptoms of depression. The approach should next be prospectively validated in clinical trials and settings. Trial Registration: ClinicalTrials.gov Identifier: NCT00693849.


Assuntos
Antidepressivos/uso terapêutico , Citalopram/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Eletroencefalografia/métodos , Aprendizado de Máquina/estatística & dados numéricos , Sertralina/uso terapêutico , Cloridrato de Venlafaxina/uso terapêutico , Adulto , Algoritmos , Regras de Decisão Clínica , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Resultado do Tratamento
16.
Nord J Psychiatry ; 74(8): 613-619, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32496844

RESUMO

Background: Major depressive disorder (MDD) is a mental health and emotional disorder that affects children and adolescents worldwide. This study aimed to evaluate serum nesfatin-1, ghrelin, and lipid levels as biological markers of adolescent MDD and their relationship with the severity of depression-anxiety and suicide risk in MDD. Methods:This study included 37 drug naïve adolescents between the ages of 12 and 18 who were diagnosed with a first episode MDD according to the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) and DSM-V diagnostic criteria. Thirty-three healthy adolescents between the ages of 12 and 18 were included as the control group. The Children's Depression Inventory (CDI), Screen for Child Anxiety Related Disorders (SCARED), and Suicide Probability Scale (SPS) were used to evaluate the subjects in the MDD and control groups. In the first stage, serum nesfatin-1, ghrelin, and lipid levels were compared between the adolescents diagnosed with MDD and the control group. Next, the correlations between these levels and the CDI, SCARED, and SPS scores were evaluated. Results: Nesfatin-1 levels were significantly lower in the MDD group than the control group (p < 0.001) A positive correlation was found between the nesfatin-1 levels and the SPS scores. Conclusions: This is the first study to evaluate nesfatin-1 levels in adolescent depression, suggesting that nesfatin-1, ghrelin, total cholesterol, and low-density lipoprotein cholesterol (LDL) levels can be used as biomarkers in child-adolescent MDD. However, it is evident that further studies with larger samples and post-treatment measurements are needed.


Assuntos
Transtorno Depressivo Maior , Grelina , Adolescente , Transtornos de Ansiedade , Criança , Transtorno Depressivo Maior/diagnóstico , Humanos , Lipídeos , Transtornos do Humor
17.
J Psychosom Res ; 134: 110126, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32387817

RESUMO

OBJECTIVE: Individuals with immune-mediated inflammatory disease (IMID) have a higher prevalence of psychiatric disorders than the general population. We utilized machine-learning to identify patient-reported outcome measures (PROMs) that accurately predict major depressive disorder (MDD) and anxiety disorder in an IMID population. METHODS: Participants with IMID were enrolled in a cohort study and completed a Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID), and multiple PROMs. PROM items were ranked separately for MDD and anxiety disorder by the standardized mean difference between individuals with and without psychiatric disorders. Items were added sequentially to logistic regression (LR), neural network (NN), and random forest (RF) models. Discriminative performance was assessed with area under the receiver operator curve (AUC) and calibration was assessed with Brier scores. Ten-fold cross-validation was used. RESULTS: Of 637 participants, 75% were female and average age was 51 years. AUC and Brier scores respectively ranged from 0.87-0.91 and 0.07 (i.e., no variation) for MDD models, and from 0.79-0.83 and 0.09-0.11 for anxiety disorder models. In LR and NN, few PROM items were required to obtain optimal discriminatory performance. RF did not perform as well as LR and NN when few PROM items were included. CONCLUSIONS: Predictive model performance was respectable and revealed insight into PROM items that are predictive of MDD and anxiety disorder. Models that included only the items 'I felt depressed' and 'I felt like I needed help for my anxiety' performed similarly to models that included all items from multiple PROMs.


Assuntos
Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/diagnóstico , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/diagnóstico , Aprendizado de Máquina , Adulto , Estudos de Coortes , Feminino , Humanos , Inflamação/complicações , Inflamação/imunologia , Inflamação/psicologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Prevalência , Adulto Jovem
18.
Sci Rep ; 10(1): 7878, 2020 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-32398710

RESUMO

In the last forty years therapy outcomes for depression have remained the same with approximately 50% of patients responding to treatments. Advances are urgently required. We hypothesised that a recent treatment, metacognitive therapy (MCT), might be more effective, by targeting mental control processes that directly contribute to depression. We assessed the clinical efficacy of MCT compared to current best psychotherapy practice, CBT, in adults with major depressive disorder. A parallel randomized single-blind trial was conducted in a primary care outpatient setting. This trial is registered with the ISCRTN registry, number ISRCTN82799488. In total 174 adults aged 18 years or older meeting Diagnostic and Statistical Manual of Mental Disorders IV criteria for major depressive disorder were eligible and consented to take part. 85 were randomly allocated to MCT and 89 to CBT. Randomisation was performed independently following pre-treatment assessment and was stratified for severity of depression (low < 20 vs high > =20) on the Hamilton Depression Rating Scale (HDRS) and on sex (male/female). Assessors and trial statisticians were blind to treatment allocation. Each treatment arm consisted of up to 24 sessions of up to 60 minutes each, delivered by trained clinical psychologists. The co-primary outcome measures were assessor rated symptom severity on the HDRS and self-reported symptom severity on the Beck Depression Inventory II (BDI-II) at post treatment. Secondary outcomes were scores six months post treatment on these measures and a range of symptom and mechanism variables. A key trial design feature was that each treatment was implemented to maximize individual patient benefit; hence time under therapy and number of sessions delivered could vary. Treated groups in the trial were very similar on most baseline characteristics. Data were analyzed on the basis of intention to treat (ITT). No differences were found on the HDRS at post treatment or follow-up (-0.95 [-2.88 to 0.98], p = 0.336; and -1.61 [-3.65 to 0.43], p = 0.122), but floor effects on this outcome were high. However, a significant difference favouring MCT was found on the BDI-II at post treatment (-5.49 [95% CI -8.90 to -2.08], p = 0.002), which was maintained at six-month follow-up (-4.64 [-8.21 to -1.06], p = 0.011). Following MCT 74% of patients compared with 52% in CBT met formal criteria for recovery on the BDI-II at post treatment (odds-ratio=2.42 [1.20 to 4.92], p = 0.014). At follow-up the proportions were 74% compared to 56% recovery (odds-ratio=2.19 [1.05 to 4.54], p = 0.036). Significant differences favouring MCT, also maintained over time, were observed for most secondary outcomes. The results were robust against controlling for time under therapy and when outcomes were assessed at a common 90 day mid-term time-point. Limitations of the study include the use of only two therapists where one treated 69% of patients, possible allegiance effects as the study was conducted in an established CBT clinic and the chief investigator is the originator of MCT and group differences in time under therapy. Never the less evidence from this study suggests that MCT had considerable beneficial effects in treating depression that may exceed CBT.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo Maior/terapia , Metacognição , Pacientes Ambulatoriais/estatística & dados numéricos , Psicoterapia/métodos , Adulto , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Autorrelato , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem
19.
J Fr Ophtalmol ; 43(5): e157-e166, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32381369

RESUMO

Major depressive disorder, bipolar disorder and schizophrenia are currently among the most common psychiatric disorders, known to constitute a serious public health issue in terms of morbidity, mortality and functional handicap. Their pathophysiology is still unclear, but there is now increasing evidence supporting the existence of abnormalities of neurotransmission. As the retina is an extension of the central nervous system, it may be an interesting site of study which might provide a better understanding of the pathophysiology of psychiatric disorders. Several studies have demonstrated retinal abnormalities, with abnormal cone and rod responses on electroretinography (ERG), suggesting a process of functional neuronal loss, structurally supported by a decrease in the retinal nerve fiber layer thickness (RNFL) on optical coherence tomography (OCT), which suggests involvement of the molecular signal pathways of neurotransmission. These tests could be useful tools for diagnosing and monitoring psychiatric disorders. This article is an overview of the literature on retinal abnormalities observed in patients with major depressive disorder, bipolar disorder or schizophrenia, and discusses how they could be pathophysiologic markers.


Assuntos
Transtorno Bipolar/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Retina/diagnóstico por imagem , Retina/patologia , Retina/fisiopatologia , Esquizofrenia/fisiopatologia , Transtorno Bipolar/complicações , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Eletrorretinografia , Humanos , Esquizofrenia/complicações , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Transmissão Sináptica/fisiologia , Tomografia de Coerência Óptica
20.
PLoS One ; 15(5): e0232459, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32442169

RESUMO

BACKGROUND: The association between temperament characteristics and mood disorders has gained much attention in recent years. The Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A) is a self-rating scale measuring 5 affective temperament dimensions. In this study, we aimed to clarify whether each affective temperament of TEMPS-A is a differentiating factor between major depressive disorder (MDD), bipolar I disorder (BD-I), and bipolar II disorder (BD-II), and analyzed the utility of TEMPS-A in their differential diagnosis in a clinical setting. METHODS: A total of 346 patients (MDD, n = 176; BD-II, n = 112; BD-I, n = 58) filled out TEMPS-A. To assess the patients' mood state at the time of temperament assessment, Patient Health Questionnaire-9 (PHQ-9) and Young Mania Rating Scale (YMRS) were also conducted. RESULTS: Multivariate logistic regression analysis demonstrated that cyclothymic and anxious temperament scores were significant factors differentiating the diagnosis of BD-I and BD-II from the diagnosis of MDD, and hyperthymic temperament score was a specific factor for the differential diagnosis of BD-I versus the diagnosis of BD-II. LIMITATIONS: All of the patients included in our study received treatment in large general hospitals. Because the nature of the present study was cross-sectional, some MDD subjects in this study might have unrecognized BD-I/BD-II. CONCLUSIONS: Cyclothymic and anxious temperament scores assessed by TEMPS-A might enable differentiation between MDD and BD, and hyperthymic temperament score on TEMPS-A might be useful in distinguishing between BD-I and BD-II.


Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Inventário de Personalidade , Temperamento , Adulto , Afeto , Ansiedade , Transtorno Bipolar/classificação , Transtorno Bipolar/psicologia , Estudos Transversais , Transtorno Depressivo Maior/psicologia , Diagnóstico Diferencial , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Autorrelato
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