A blinded,controlled evaluation of anxiety and depressive symptoms in patients with fibromyalgia,as measured by standardized psychometric interview scales

The objective of the study was to evaluate the presence of psychopathology in fibromyalgia patients compared with a control group of other rheumatologic patients with pain. Forty-nine fibromyalgia patients and 33 control patients were interviewed blinded, using standardized psychometric scales. Pain was scored on a visual analogue scale. Fibromyalgia patients scored significantly higher than the controls on the Bech-Rafaelsen Melancholia Scale, the Atypical Depression Scale and the Hamilton Anxiety Rating Scale. On the Newcastle Depression Scale there was no difference. In both groups a correlation was found between pain score and psychometric scoring. The fibromyalgia patients scored significantly higher on pain than the controls. After correcting for this difference, the fibromyalgia patients still scored higher on anxiety and depression.     

Executive function in fibromyalgia: Comparing subjective and objective measures

BackgroundThere is evidence to suggest the existence of an executive dysfunction in people diagnosed with fibromyalgia, although there are certain inconsistencies between studies. Here, we aim to compare executive performance between patients with fibromyalgia and a control group by using subjective and objective cognitive tests, analyzing the influence of patient mood on the results obtained, and studying associations between the two measures.Method82 patients diagnosed with fibromyalgia and 42 healthy controls, matched by age and years of education, were assessed using the Behavioral Rating Inventory of Executive Function – Adult Version (BRIEF-A) as a subjective measure of executive functioning. A selection of objective cognitive tests were also used to measure a series of executive functions and to identify symptoms of depression and anxiety.ResultsPatients with fibromyalgia perceived greater difficulties than the control group on all of the BRIEF-A scales. However, after adjustments were made for depression and anxiety the only differences that remained were those associated with the working memory scale and the Metacognition and Global Executive Composite index. In the case of the objective cognitive tests, a significantly worse overall performance was evidenced for the fibromyalgia patients. However, this also disappeared when adjustments were made for depression and anxiety. After this adjustment, fibromyalgia patients only performed significantly worse for the interference effect in the Stroop Test. Although there were no significant associations between most of the objective cognitive tests and the BRIEF-A scales, depression and anxiety exhibited strong associations with almost all of the BRIEF-A scales and with several of the objective cognitive tests.ConclusionsPatients with fibromyalgia showed executive dysfunction in subjective and objective measures, although most of this impairment was associated with mood disturbances. Exceptions to this general rule were observed in the impairment of working memory evidenced on the BRIEF-A scale and the inhibition impairment exhibited by the interference effect from the Stroop Test. The two types of measurement provide different yet complementary information.     

A test of the tripartite model's prediction of anhedonia's specificity to depression: patients with major depression versus patients with schizophrenia

The tripartite model of depression and anxiety suggests that anhedonia represents a relatively specific marker of depression. A strong version of this view is that anhedonic symptoms would particularly characterize depressed patients, even when compared to another diagnostic group-schizophrenic patients-for whom anhedonic symptoms represent a well-studied feature. This prediction was tested among 102 VA psychiatric inpatients (95 men), ages 21-72 (M=43.56; S.D.=8.47), all of whom received diagnoses of either major depression (n=50) or schizophrenia (n=52) based on structured diagnostic interviews. As predicted, patients with major depression scored significantly higher on the anhedonic symptoms scale of the Beck Depression Inventory (BDI) than did patients with schizophrenia. However, there was no difference between the two groups on the BDI total score or the BDI non-anhedonic symptoms score. Consistent with the tripartite model, anhedonic symptoms were more related to depressive vs. schizophrenic diagnostic status, whereas non-anhedonic depressive symptoms were not. Within the study's limitations, results were interpreted as relatively strong support for the validity and extension of the tripartite model.     

Gender differences in anxiety-related traits in patients with panic disorder

This study examined gender differences in anxiety-related personality traits in patients with panic disorder with or without agoraphobia (PD+/-AG). Outpatients (101 total) with SCID confirmed PD+/-AG completed the Anxiety Sensitivity Index (ASI), the Trait form of the State-Trait Anxiety Inventory (STAI-T), the NEO Personality Inventory Revised (NEO PI-R), and the Retrospective Self-Report of Inhibition (RSRI) as part of their assessment. Significant gender differences were not detected for the total ASI scores. Females scored significantly higher than males on the Physical Concerns subscale of the ASI, whereas males scored significantly higher than women on the Social Concerns subscale. Women scored higher than men on the Extraversion scale of the NEO PI-R as well as on certain subscales of this domain. Although a significant gender difference was not detected on the Neuroticism subscale, men scored higher on the angry hostility and depression facets of this trait. Significant gender differences were not found for the STAI-T or the RSRI. These findings suggest that gender differences exist among patients with PD+/-AG in the feared consequences of anxiety symptoms as well as in the personality characteristics of extraversion.     

Evidence for psychopathology in patients with rhythmic midtemporal discharges

In order to obtain further evidence of possible psychopathology, the Minnesota Multiphasic Personality Inventory (MMPI) was administered to 25 patients (pts) who had the controversial EEG pattern of rhythmic midtemporal discharges--(RMTD) psychomotor variant. The pts were divided into a retrospective and prospective group, the former consisting of only a minority (36%) of pts who had previously agreed to cooperate and the latter consisting of every pt (100%) showing the pattern in a 3-year period. The scores of all RMTD pts were abnormal (approximately 2 SD above the normal mean) for hypochondriasis, schizophrenia, depression, and hysteria and were classified as Abnormal on Rule 1 on the Goldberg sequential diagnostic system. Patients with intermediate or many bursts of this pattern were also classified as Abnormal, scored higher on every clinical scale, significantly so on five of the clinical scales and were significantly different with regard to the number of clinical scale scores at or over the T value of 70 as well as 80. The MMPI profile of RMTD pts is similar to those with definite temporal lobe epilepsy but different from pts with general medical disorders.     

Depression among cancer patients

Abstract This study was done to investigate the frequency of co-morbidity and to demonstrate the best method for assessing depression among cancer patients. The subjects were 50 (25 male and 25 female) cancer patients and 50 (25 male and 25 female) medically ill patients. All subjects were interviewed by psychiatrists and were administered psychological tests such as SAS (self-rating anxiety scale), SDS (self-rating depression scale), POMS (Profile of Mood States), HADS (Hospital Anxiety and Depression Scale) and DRP (Depression-related personality traits). The psychiatric interview revealed that 44% of cancer patients and 38% of the medical patients had mental disorders according to DSM-IV. The most frequently observed disorder was depression, which was seen in 28% of the cancer patients and 30% of the medical patients. The cancer patients with depression scored significantly higher on the DRP and the Anger mood state of POMS than did the medically ill patients with depression. In addition, most psychological tests employed had no discrimination between depressed and normal subjects among the cancer and the medical patients. However, it was found that the Depression scale in HADS (HADS-D) split depressed patients from normal subjects since the HADS-D was composed of items that were not concerned with physically ill conditions.     

The specificity of depressive symptoms in patients with Alzheimer's disease

OBJECTIVE: This study assessed the specificity of depressive symptoms in patients with Alzheimer's disease and examined the discrepancies between patient and caregiver symptom reports. METHOD: The study group was composed of a series of 233 patients with Alzheimer's disease, 47 patients with depression but without dementia, and 20 healthy comparison subjects; the latter two groups were comparable in age with the patients with Alzheimer's disease. The patients and comparison subjects received a comprehensive psychiatric evaluation, which included administration of the Hamilton Depression Rating Scale and the Structured Clinical Interview for DSM-IV. RESULTS: Patients with Alzheimer's disease with a score of 2 or higher on the "depressed mood" item of the Hamilton depression scale, as scored by their respective caregivers, comprised a group with depressed mood (N=92), whereas patients who scored 0 on this item comprised a group without depressed mood (N=62). A statistical comparison of the scores on the remaining Hamilton depression scale items (2-16) between the Alzheimer's disease patients with and without depressed mood revealed significant differences on all items, except "loss of appetite." However, there were no significant differences on any single Hamilton depression scale item between the Alzheimer's disease patients without depressed mood and the age-comparable healthy comparison subjects. CONCLUSIONS: Depressive symptoms are not widespread among patients with Alzheimer's disease but are significantly related to an underlying depressed mood. Patients with Alzheimer's disease may not be fully aware of the extent of their depressive symptoms.     

MMPI profiles in anorexia nervosa patients with and without major depression

Anorexia nervosa patients with (AN-RDC+) and without (AN-RDC-) a current episode of nonbipolar major depression (MDD) differed with respect to their Minnesota Multiphasic Personality Inventory (MMPI) profiles. Mean MMPI scores in AN-RDC+ significantly differed from AN-RDC-patients in all but two MMPI scales. AN-RDC+ patients had a significantly higher number of abnormal (T greater than 70) MMPI scales per subject and significantly more subjects with greater than or equal to 3 abnormal scales compared with AN-RDC-patients. These MMPI data suggest that the presence or absence of MDD in anorectic patients may distinguish meaningful subtypes and provide further support for the validity of the stratification of anorectic patients into those with and without nonbipolar MDD.     

A psycho-social study of surviving male coronary patients and controls followed over nine years

28 white males who had survived at least one well-documented myocardial infarction and 28 individually matched white male healthy controls were given the Minnesota Multiphasic Personality Inventory (MMPI) at the onset and end of a 7 yr research project and again at 2 yr follow-up. The MMPI showed remarkable similarity between three testing periods over the 9 yr period. As a group surviving patients were similar to the controls on all of the MMPI scales, except for higher K scores among the controls, over the 9 yr period. No significant differences were found on any of the MMPI scales over the nine years when surviving patients and controls ≤ 50 years and 51 ≥ yr were compared. “White collar” patients scored significantly higher on K and Mf and lower on Ma and A than did those in the “blue collar” social classes. There were no significant differences on any of the MMPI scales between surviving patients who engaged in short-term group psychotherapy and patients who did not participate in therapy. The finding that surviving patients look more like controls on all of the MMPI scales, except K, over the 9 yr period would indicate that survivors lack the element of chronic depression previously found among non-survivors of myocardial infarction.     

Frontal lobe dysfunction in patients with chronic migraine: a clinical-neuropsychological study

Neuropsychological tests have demonstrated a frontal lobe dysfunction in several psychiatric and neurological disorders. Our purpose was to examine whether similar functional differences would be found in patients with chronic migraine. The Gambling Task (GT), the Tower of Hanoi-3 (TOH-3) and the Object Alternation Test (OAT) were administered to 23 female patients previously treated for chronic migraine and to 23 healthy women who were similar to the patients in age and educational level, and the mean test scores of the two groups were compared (Student's t and Pearson correlation coefficient). The patient group scored significantly higher than the controls on the TOH-3 and, especially, the OAT. In the patients, no significant relationship was found between the neuropsychological test scores and those for the Minnesota Multiple Personality Inventory (MMPI), the Spielberg State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). In conclusion, the data suggest a relation between chronic headache and dorsolateral function (as tested by the TOH-3) and orbitofrontal function (as tested by the OAT). The decision-making function related to ventromedial prefrontal cortex (tested by the GT) did not show a statistically significant difference between patients and controls. These neuropsychological findings seem to be partly independent of the patient's psychological traits and psychiatric disorders.     

MMPI delineation of a subgroup of depressed patients refractory to lithium carbonate therapy.

The authors found that in a sample of 26 severely depressed hospitalized patients, 5 patients with low depression and psychasthenia profiles on the Minnesota Multiphasic Personality Inventory did not show an antidepressant response to lithium carbonate. Seventeen of 21 depressed patients with high depression and psychasthenia profiles did respond to the antidepressant effects of the drug. They tentatively conclue that by using the MMPI it is possible to delineate a subgroup of depressed patients who are refractory to lithium carbonate therapy.     

Personality traits on the basis of the Temperament and Character Inventory in female fibromyalgia syndrome patients

The study was designed to investigate personality traits in fibromyalgia syndrome (FMS) patients by means of the Temperament and Character Inventory (TCI) and, furthermore, to relate the personality traits to the presence of psychiatric disorders. Thirty-eight female FMS patients and sex- and age-matched healthy control subjects (HCS) completed the 238-item self-rating personality inventory TCI. The Structured Clinical Interview for DSM-III-R (SCID) I was used to determine psychiatric disorders. To expand the diagnostic procedure for depression, the self-rating Beck Depression Inventory (BDI) was also used. The results of the TCI rating showed that 82% of the FMS patients had a temperament type with high Harm Avoidance. The FMS patients scored significantly higher than the HCS in this variable (P=0.0001), regardless of concomitant psychiatric disorder. High Harm Avoidance is suggested to be strongly correlated to anxiety and depression. Thirty-seven per cent of the FMS patients fulfilled the SCID I criteria for major or minor depression, and 16% were diagnosed as having an anxiety disorder. Forty-five per cent were depressed according to the BDI; however, 26% were of a milder degree. The results suggest that the FMS patients are characterized by a partly inherited tendency to react with pessimistic thoughts and increased uneasiness to everyday and future problems. This in combination with additionally perceived prolonged distress may lead to excessive anxiety/distress, tension, and fatigability. The personality trait Harm Avoidance may therefore be part of the pathophysiologic mechanisms in the development of FMS.     

Increased 24-hour urinary cortisol excretion in patients with post-traumatic stress disorder and patients with major depression,but not h patients with fibromyalgia

There is now firm evidence that major depression is accompanied by increased baseline activity of the hypothalamic-pituitary-adrenal (HPA) axis, as assessed by means of 24-h urinary cortisol (UC) excretion. Recently, there were some reports that fibromyalgia and post-traumatic stress disorder (PTSD), two disorders which show a significant amplitude of depressive symptoms, are associated with changes in the baseline activity of the HPA axis, such as low 24-h UC excretion. The aim of the present study was to examine 24-h UC excretion in fibromyalgia and PTSD patients compared to normal controls and patients with major depression. In the three patient groups, severity of depressive symptoms was measured by means of the Hamilton Depression Rating Scale (HDRS) score. Severity of fibromyalgia was measured using a dolorimetrically obtained myalgic score, and severity of PTSD was assessed by means of factor analytical scores computed on the items of the Composite International Diagnostic Interview (CIDI), PTSD Module. Patients with PTSD and major depression had significantly higher 24-h UC excretion than normal controls and fibromyalgia patients. At a threshold value of ≥240 μg/24 h, 80% of PTSD patients and 80% of depressed patients had increased 24-h UC excretion with a specificity of 100%. There were no significant differences in 24-h UC excretion either between fibromyalgia patients and normal controls, or between patients with major depression and PTSD patients. In the three patient groups, no significant correlations were found between 24-h UC excretion and The HDRS score. In fibromyalgia, no significant correlations were found between 24-h UC excretion and the myalgic score. In PTSD, no significant correlations were found between 24-h UC excretion and severity of either depression-avoidance or anxiety-arousal symptoms. In conclusion, this study found increased 24-h UC excretion in patients with PTSD comparable to that in patients with major depression, whereas in fibromyalgia no significant changes in 24-h UC were found.     

The Minnesota Multiphasic Personality Inventory in predicting response to pharmacotherapy of neurotic outpatients.

The utility of the Minnesota Multiphasic Personality Inventory (MMPI) in predicting treatment response to pharmacotherapy for a group of 54 anxious and 43 depressed outpatients was examined. Discriminant function analyses using the MMPI scales were conducted on groups of improved and unimproved patients. Several significant function, as well as zero-order, differences were found. In general, improved patients scored significantly lower on scales reflecting depression and obsessive-compulsive or schizoid tendencies. They also obtained lower scores on scales measuring interpersonal sensitivity and suggestive of character traits such as low frustration tolerance, impulsivity, and resentment toward authority figures. Additional analyses in which several different profile types were compared for treatment outcome revealed few differences among groups.     

Alcoholism and attention deficit disorder: MMPI correlates

Previous research suggests that the alcoholic population can be meaningfully divided into subtypes, one of which is attention deficit disorder, residual type (ADDRT). The purpose of this study was to identify differences in personality profiles, as measured by the Minnesota Multiphasic Personality Inventory (MMPI), between ADDRT alcoholics and other alcoholics. Groups of 50 male ADDRT alcoholics and 50 male nonADDRT alcoholics were administered the MMPI. Statistically significant differences were found for the D, PD, Pa, Pt. Sc. MA, Si, F and K scales: the ADDRT alcoholics scored significantly higher than the nonADDRT alcoholics on most of the scales, but significantly lower on the K scale.     

Subjective memory complaints, mood, and memory deficits among HIV/AIDS patients in Hong Kong

Diagnosis of HIV-associated neurobehavioral disorders often heavily relies upon patient complaints of cognitive difficulties. Yet, research in North America suggests that such complaints may be heavily influenced by affective factors. However, no work in this area has been done in China. The present study examined the relationships among depressed mood, anxiety, memory performance and subjective memory complaints among HIV/AIDS patients in Hong Kong. A total of 90 individuals with HIV were administered the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory, Patient's Assessment of Own Functioning Inventory (PAOF), and Hong Kong List Learning Test. Forward regression analysis indicated that the BDI Cognitive-Affective score was the most significant predictor of subjective memory complaints on the PAOF. Furthermore, present results also supported previous findings that some individuals with HIV infection are more "accurate" than others in the self-appraisal of their memory ability. Given inaccuracies that exist in subjective memory complaints, these findings highlight the importance of comprehensive cognitive assessment when evaluating the neuropsychological status of individuals of HIV.     

Ethnicity and sex as correlates of depression symptoms in a Canadian university sample

Differences in the extent of depression symptoms were explored in a sample of Canadian university students representing Anglo-Celtic, South European, North European, East European, South Asian, and East Asian ethnocultural backgrounds in Toronto, one of the world's most ethnically diverse cities. Consistent with expectations, sex and ethnic differences in the self-reported strength of depression symptoms, as measured by the Beck Depression Inventory (BDI), were found. Women scored higher overall on total BDI scores and were proportionally more apt to be classified as mildly depressed (by having scored 10 or more on the BDI) than men. Similarly, as regards ethnicity, students from South Asian and South European ethnic backgrounds scored higher on the BDI and were also more likely to be classifiable as mildly depressed than those from either East European or Anglo-Celtic backgrounds. An explanation emphasizing the role of societal discrimination in producing feelings of learned helplessness and subsequent depression is proposed to account for the sex and ethnic differences in depression symptoms we and others have observed.     

Depression among general hospital patients in Greece

We estimated the prevalence of depression in 150 medical and surgical inpatients. Forty-three patients (29%) scoring at 14 or above on the Beck Depression Inventory (BDI) were classified as depressed. An excess of women and white-collar workers and more stressful life events during the last 12 months were found among the depressed patients. Of the 21 BDI items, 6 differentiated the 43 medical-surgical depressed patients from a group of 43 psychiatric inpatients with a diagnosis of primary or secondary depression (Feighner's criteria). Medically ill depressed patients scored higher in social withdrawal, work inhibition and irritability but lower in loss of libido, sleep disturbance, and lack of satisfaction. Our results show rates of depression in a medical inpatient population in Greece comparable with those in other studies. The use of BDI may help assessment of depression in general hospital patients.     

抑郁症首次发病患者认知功能的研究

目的探讨抑郁症首次发病(以下简称首发)患者的认知功能特点及其影响因素。方法采用韦氏成人智力量表、韦氏记忆量表、威斯康星卡片分类测验(WCST)分别评定116例首发抑郁症患者(抑郁症组)和41名健康人(对照组)的认知状况,采用汉密尔顿抑郁量表(24项,HAMD)评定病情严重程度。对影响神经心理学测验成绩的临床症状进行逐步多元回归分析。结果(1)抑郁症组的长时记忆[(35.28±7.27)分]、短时记忆[(51.32±13.41)分]、记忆商数[(89.46±17.84)]、语言智商数[(110.96±13.72)]、操作智商数[101.90±15.98)]、智商数[(107.41±15.78)]均明显低于对照组[长时记忆(44.05±5.06)分,短时记忆(71.41±8.51)分,记忆商数(121.90±11.26),语言智商数(117.49±10.99),操作智商数(117.24±10.54),智商数[(118.98±10.95)],差异均有统计学意义(均P<0.01)。抑郁症组的WCST总测验数[(74.70±27.96)个]、持续错误数[(26.07±15.31)个]、随机错误数[(24.46±17.54)个]均明显高于对照组[WCST总测验数(60.15±23.05)个,持续错误数(17.56±11.44)个,随机错误数(17.73±14.27)个],差异有统计学意义(P<0.01或<0.05)。抑郁症组长时记忆成绩、短时记忆成绩和记忆商数低于对照组2个标准差。(2)逐步多元回归分析显示,抑郁症患者的长时记忆成绩及记忆商数与绝望感因子分均呈负相关(均P=0.00),短时记忆成绩和即刻记忆成绩与阻滞因子分均呈负相关(均P=0.00),语言智商与焦虑/躯体化因子分呈负相关(P=0.01),操作智商及智商与HAMD总分均呈负相关(均P=0.01),WCST总测验数和持续错误数与HAMD总分均呈正相关(P=0.01,P=0.02),随机错误数与阻滞因子分呈正相关(P=0.02)。结论首发抑郁症患者急性期的记忆、语言智商、操作智商和执行功能明显减退,临床症状严重程度影响认知功能的改变。