Major depression as a predictor of premature deaths in lderly people in Finland: a community study

In order to analyse the survival of elderly Finnish people with major depression, a total of 29 elderly (≥65 years) subjects suffering from major depression (DSM-III criteria) and 853 non-depressed elderly subjects were followed up for 6 years. The Kaplan-Meier survival curves showed the survival of patients suffering from major depression to be poorer than that of non-depressed subjects. When age, sex, marital status, level of education, smoking habits, physical health, functional abilities and major depression were introduced into the Cox model, advanced age, male sex, smoking, poor physical health, reduced functional abilities and the occurrence of major depression were found to be related to higher levels of mortality. The results suggest that major depression in the elderly predicts higher mortality which is not explained by their poor baseline level of physical health alone.     

Childhood sibling relationships as a predictor of major depression in adulthood: a 30-year prospective study

OBJECTIVE: The authors examined the quality of sibling relationships in childhood as a predictor of major depression in adulthood. METHOD: Study subjects were 229 men selected for mental and physical health and followed from ages 20 through 50 and beyond as part of a study of adult psychosocial development. Data were obtained from interviews with participants and their parents at intake and from follow-up interviews and self-report questionnaires completed by participants at regular intervals. These data were used to rate the quality of relationships with siblings, the quality of parenting received in childhood, and family history of depression as well as the occurrence, by age 50, of major depression, alcoholism, and use of mood-altering drugs (tranquilizers, sleeping pills, and stimulants). RESULTS: Poorer relationships with siblings prior to age 20 and a family history of depression independently predicted both the occurrence of major depression and the frequency of use of mood-altering drugs by age 50, even after adjustment for the quality of childhood relationships with parents. Poor relationships with parents in childhood did not predict the occurrence of depression by age 50 when family history of depression and the quality of relationships with siblings were taken into account. Quality of sibling relationships and family history of depression did not predict later alcohol abuse or dependence. CONCLUSIONS: Poor sibling relationships in childhood may be an important and specific predictor of major depression in adulthood. Further study of links between childhood sibling relationships and adult depression is warranted.     

Involvement in bullying as predictor of suicidal ideation among 12- to 15-year-old Norwegian adolescents

The aim of this study was to examine relationships between bullying and suicidal ideation. A total of 2,464 adolescents in Norway were assessed at two time points, 1 year apart [i.e., at ages 14 (T1) and 15 (T2)], with identical questionnaires. Suicidal ideation was measured by four items including both active and passive suicidal thoughts. ANOVA and standard linear regression methods were applied. Both bullied adolescents and adolescents who were aggressive toward others had significantly higher levels of suicidal ideation (p < 0.001) at age 14 (T1) than noninvolved adolescents. In the group being bullied, girls had higher levels of suicidal ideation than boys did. This was not the case for the group of adolescents who were the aggressors. In cross-sectional multivariate analyses, both being bullied and being aggressive toward others were significant (p < 0.001) predictors of suicidal ideation at age 14 (T1), when gender, age and socioeconomic status, and depressing symptom levels were controlled for. In the controlled longitudinal multivariate analyses, being bullied (p < 0.001) at age 14 (T1) predicted suicidal ideation at age 15 (T2), while aggressiveness toward others did not. Bullied adolescents (both genders) were at risk for suicidal ideation, and having an additional risk if they were depressed.     

Childhood loneliness as a predictor of adolescent depressive symptoms: an 8-year longitudinal study

Childhood loneliness is characterised by children’s perceived dissatisfaction with aspects of their social relationships. This 8-year prospective study investigates whether loneliness in childhood predicts depressive symptoms in adolescence, controlling for early childhood indicators of emotional problems and a sociometric measure of peer social preference. 296 children were tested in the infant years of primary school (T1 5 years of age), in the upper primary school (T2 9 years of age) and in secondary school (T3 13 years of age). At T1, children completed the loneliness assessment and sociometric interview. Their teachers completed externalisation and internalisation rating scales for each child. At T2, children completed a loneliness assessment, a measure of depressive symptoms, and the sociometric interview. At T3, children completed the depressive symptom assessment. An SEM analysis showed that depressive symptoms in early adolescence (age 13) were predicted by reports of depressive symptoms at age 8, which were themselves predicted by internalisation in the infant school (5 years). The interactive effect of loneliness at 5 and 9, indicative of prolonged loneliness in childhood, also predicted depressive symptoms at age 13. Parent and peer-related loneliness at age 5 and 9, peer acceptance variables, and duration of parent loneliness did not predict depression. Our results suggest that enduring peer-related loneliness during childhood constitutes an interpersonal stressor that predisposes children to adolescent depressive symptoms. Possible mediators are discussed.     

Verbal fluency as a possible predictor for psychosis

BackgroundNeurocognitive abnormalities are prevalent in both first episode schizophrenia patients and in ultra high risk (UHR) patients.AimTo compare verbal fluency performance at baseline in UHR in patients that did and did not make the transition to psychosis.MethodBaseline verbal fluency performance in UHR-patients (n = 47) was compared to match first episode patients (n = 69) and normal controls (n = 42).ResultsVerbal fluency (semantic category) scores in UHR-patients did not differ significantly from the score in first episode schizophrenia patients. Both the UHR group (p < 0.003) and the patient group (p < 0.0001) performed significantly worse than controls. Compared to the non-transition group, the transition group performed worse on verbal fluency, semantic category (p < 0.006) at baseline.ConclusionsVerbal fluency (semantic category) is disturbed in UHR-patients that make the transition to psychosis and could contribute to an improved prediction of transition to psychosis in UHR-patients.     

The depressed woman as a mother

Summary Maternal role performance was examined in a group of acutely depressed women and compared with matched normal controls. The depressed women were significantly more impaired mothers. Their impairments with the children included diminished emotional involvement, impaired communication, disaffection, increased hostility and resentment. These disturbances were examined clinically within the context of the family life cycle from post partum to the empty nest. The specific problems between mother and children were found to vary with the stages of the life cycle. Depressed mothers of infants were helpless in caring for the children, over concerned or directly hostile, laying the ground work for future problems with the child. Mothers of school age children were irritable, uninvolved and intolerant of the children's noise and activity. Most school age children, however, did not develop overt psychological symptoms. The most severe problems occurred with the adolescents who reacted to the mothers hostility and withdrawal with serious deviant behavior. While conflict existed between the depressed mothers and the children leaving home, most children were able to make the physical break from home. These findings are discussed in light of scattered reports about the effect of maternal depression on children. Early and intensive treatment of the depressed mother can facilitate major preventive work for the entire family.

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Zusammenfassung In einer Gruppe akut depressiver Frauen wurde die Erfüllung der mütterlichen Rolle untersucht und mit entsprechenden normalen Kontrollfällen verglichen. Die depressiven Frauen waren als Mütter signifikant mehr beeinträchtigt. Ihre Behinderung im Umgang mit den Kindern äusserte sich in verminderter emotionaler Zuwendung, schlechter Kommunikation, Unzufriedenheit, vermehrter Feindseligkeit und Ressentiment. Diese Störungen wurden klinisch innerhalb des Kontextes des familiären Lebenscyclus von der Geburt an bis zum leeren Nest untersucht. Danach variieren die besonderen Probleme zwischen Mutter und Kindern mit den jeweiligen Stadien des Lebenscyclus. Depressive Mütter von Säuglingen waren hilflos bei der Versorgung ihrer Kinder, übermäßig besorgt oder direkt feindselig und legten damit den Grund für zukünftige Probleme mit dem Kind. Mütter von Kindern im Schulalter waren reizbar, unengagiert und intolerant gegenüber dem Lärm und der Aktivität der Kinder. Die meisten Kinder im Schulalter entwickelten jedoch keine deutlichen psychischen Probleme. Die schwersten Probleme ereigneten sich mit Jugendlichen, die auf die Feindseligkeit und das Zurückziehen der Mütter mit ernstlich abnormen Verhaltensweisen reagierten. Obwohl zwischen den depressiven Müttern und den Kindern, wenn sie das Elternhaus verließen, ein Konflikt bestand, konnten die meisten Kinder sich physisch vom Elternhaus lösen. Diese Befunde werden im Hinblick auf verstreute Berichte über die Wirkung mütterlicher Depression auf Kinder diskutiert. Frühzeitige und intensive Behandlung der depressiven Mutter kann einen Großteil der präventiven Arbeit für die gesamte Familie erleichtern.

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Résumé L'accomplissement du rôle maternel a été examiné dans un groupe de femmes souffrant de dépression aiguë et comparé avec des cas normaux de contrôle correspondants. Les femmes déprimées présentaient, de façon significative, davantage de troubles dans leur fonction maternelle. Ce comportement pertubé avec leurs enfants se traduisait par une réduction de l'investissement émotionnel, des troubles de la communication, de l'indifférence, une augmentation de l'hostilité et du ressentiment. Ces troubles ont été examinés cliniquement dans le cadre du cycle de l'a vie familiale, du post-partum à ce qu'il est convenu d'appeler le moment du nid vide. On a trouvé que les problèmes spécifiques entre mère et enfants variaient selon les stades de ce cycle. Les mères déprimées d'enfants en bas âge étaient incapables de s'occuper convenablement d'eux, trop concernées ou carrément hostiles, jettant ainsi les bases des problèmes futurs avec l'enfant. Les mères d'enfants en âge scolaire étaient irritables, désinvesties et intolérantes au bruit et à l'activité des enfants. La plupart des enfants en âge scolaire, cependant, ne présentaient pas de symptômes psychologiques manifestes. Les problèmes les plus graves sont apparus chez les adolescents, qui réagissaient à l'hostilité et au désintérêt de leur mère par un comportement sérieusement perturbé. Bien qu'il existât un conflit entre les mères déprimées et les enfants quittant la maison, la plupart des enfants étaient capables de réaliser la rupture physique d'avec leur foyer. Ces résultats sont discutés à la lumière de travaux dispersés sur l'effet de la dépression maternelle sur les enfants. Un traitement précoce et intensif de la mère déprimée peut faciliter un important travail de prévention pour la famille tout entière.

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This study was supported by U. S. P. H. S. Grant MH 13738 from the National Institute of Mental Health, Department of Health, Education and Welfare. Mrs. Weissman is a Assistant Professor in Psychiatry, Yale University School of Medicine, 34 Park Street, New Haven, Connecticut, 06519. Drs. Paykel and Klerman were at Yale University when this research was done. Dr. Paykel is currently Consultant Psychiatrist, St. George's Hospital, London, S. W. 17, England and Dr. Klerman is Professor of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, 02114.     

Vasomotor reactivity as a predictor for syncope in patients with orthostatism

Gur AY, Auriel E, Korczyn AD, Gadoth A, Shopin L, Giladi N, Bornstein NM, Gurevich T. Vasomotor reactivity as a predictor for syncope in patients with orthostatism.
Acta Neurol Scand: 2012: 126: 32–36.
© 2011 John Wiley & Sons A/S. Objectives – Syncope in patients with orthostatic hypotension (OH) may be the result of impaired cerebral autoregulation. Cerebral autoregulation status can be determined by assessing cerebral vasomotor reactivity (VMR). We assessed and compared VMR in patients with OH with and without syncope. Material and methods – Twenty‐nine patients with OH underwent transcranial Doppler (TCD) and the Diamox test (1 g acetazolamide IV) for assessing VMR during elaboration of their OH syndrome. The percent difference between cerebral blood flow velocities (BFV) in the middle cerebral (MCA) and vertebral (VA) arteries before and after acetazolamide was defined as VMR%. We considered increases of BFV of ≥40% as being indicative of good VMR and classified our study patients as having good or impaired VMRs accordingly. Results – Mean VMR% values of the MCA and VA in patients with OH with syncope (n = 12) were significantly lower as compared with patients with OH without syncope (n = 17): 25.2 ± 20.5% and 42.5 ± 18.6%; 20.9 ± 15.5% and 40.8 ± 28.5%, respectively (P < 0.05). Conclusions – Among patients with OH, we found an association between the presence of syncope and impaired VMR. Assessment of VMR among patients with OH may predict those who are at higher risk to faint and fall and to support more aggressive intervention.     

Disruptive behavior as a predictor in Alzheimer disease

BACKGROUND: Disruptive behavior is common in Alzheimer disease (AD). There are conflicting reports regarding its ability to predict cognitive decline, functional decline, institutionalization, and mortality. OBJECTIVE: To examine whether the presence of disruptive behavior has predictive value for important outcomes in AD. DESIGN: Using the Columbia University Scale for Psychopathology in Alzheimer Disease (administered every 6 months, for a total of 3438 visit-assessments and an average of 6.9 per patient), the presence of disruptive behavior (wandering, verbal outbursts, physical threats/violence, agitation/restlessness, and sundowning) was extracted and examined as a time-dependent predictor in Cox models. The models controlled for the recruitment cohort, recruitment center, informant status, sex, age, education, a comorbidity index, baseline cognitive and functional performance, and neuroleptic use. SETTING: Five university-based AD centers in the United States and Europe (Predictors Study). PARTICIPANTS: Four hundred ninety-seven patients with early-stage AD (mean Folstein Mini-Mental State Examination score, 20 of 30 at entry) who were recruited and who underwent semiannual follow-up for as long as 14 (mean, 4.4) years. MAIN OUTCOME MEASURES: Cognitive (Columbia Mini-Mental State Examination score, < or = 20 of 57 [approximate Folstein Mini-Mental State Examination score, < or = 10 of 30]) and functional (Blessed Dementia Rating Scale score, parts I and II, > or = 10) ratings, institutionalization equivalent index, and death. RESULTS: At least 1 disruptive behavioral symptom was noted in 48% of patients at baseline and in 83% at any evaluation. Their presence was associated with increased risks of cognitive decline (hazard ratio 1.45 [95% confidence interval (CI), 1.03-2.03]), functional decline (1.66 [95% CI, 1.17-2.36]), and institutionalization (1.47 [95% CI, 1.10-1.97]). Sundowning was associated with faster cognitive decline, wandering with faster functional decline and institutionalization, and agitation/restlessness with faster cognitive and functional decline. There was no association between disruptive behavior and mortality (hazard ratio, 0.94 [95% CI, 0.71-1.25]). CONCLUSION: Disruptive behavior is very common in AD and predicts cognitive decline, functional decline, and institutionalization but not mortality.     

Neuroticism as a predictor of outcome in depression

Low levels of neuroticism have variably been associated with a better outcome of depressive disorders but the interpretation of this phenomenon is clouded by the knowledge that severity of depression may itself confound ratings of neuroticism. To clarify any relationship between neuroticism and outcome, the authors assessed the predictability of neuroticism (as assessed by questionnaire, psychiatrist rating, and subject self-report) in separate groups of psychiatric patients and symptomatic volunteers with nonmelancholic depression. Depressives' judgments of their own neuroticism correlated with neuroticism scores on the Eysenck Personality Inventory (EPI), but neither of these measures predicted improvement at 6 nor 20 weeks. Judgments of neuroticism made by psychiatrists, which did not correlate with EPI neuroticism scores, did predict improvement. The study suggests that differences in defining neuroticism contribute to its variable association with outcome and further suggests the relevance of clinically assessing neuroticism as a personality variable.     

Childhood abuse as a risk factor for psychotic experiences

OBJECTIVE: To examine the hypothesis that individuals from the general population who report childhood abuse are at increased risk of developing positive psychotic symptoms. METHOD: Data were derived from a general population sample of 4045 subjects aged 18-64 years. First ever onset of positive psychotic symptoms at 2-year follow-up were assessed using the Composite International Diagnostic Interview and additional clinical interviews if necessary. Childhood abuse was assessed at baseline. RESULTS: Baseline reported childhood abuse predicted development of positive psychotic symptoms associated with need for care [odds ratio (OR) = 11.5, 95% CI 2.6-51.6]. This association remained after adjustment for demographic variables, reported risk factors and presence of any lifetime psychiatric diagnosis at baseline (OR = 7.3, 95% CI 1.1-49.0). CONCLUSION: The results suggest that early childhood trauma increases the risk for positive psychotic symptoms. This finding fits well with recent models that suggest that early adversities may lead to psychological and biological changes that increase psychosis vulnerability.     

Quality of life as a predictor for change in disability in MS

OBJECTIVE: To investigate the predictive value of quality of life on changes in disability measured by the Expanded Disability Status Scale (EDSS). BACKGROUND: There are few good prognostic factors for disease development in MS. Quality of life and self-rated health have been shown to be highly predictive of morbidity and disease development in heart disease and cancer. METHODS: Data on quality of life (SF-36 Health Survey) were ascertained at baseline for 97 relapsing-remitting patients with MS participating in a short-term clinical trial on interferon alpha-2a. These scores were correlated with change in EDSS scores 1 year later, 6 months after treatment ended. RESULTS: Low scores on the SF-36 mental health scale were correlated with increased (worsened) EDSS scores 1 year later (r = -0.29, p = 0.006). The results were not altered by adjusting for disease activity at baseline, which was measured by the number gadolinium-enhanced MRI lesions, relapse rate for the preceding 2 years, and baseline EDSS score. Similar results were found for self-rated health (according to the first question of the SF-36). CONCLUSIONS: These findings reinforce the importance of incorporating the patients' evaluation of their quality of life during treatment. Further, assessing such measures is important in evaluating effects in treatment trials in MS.     

Health outcomes and self-labeling as a victim of workplace bullying

Objective

This study investigated the extent to which self-labeling as a victim of workplace bullying mediates or moderates the relationship between exposure to bullying and the target's health outcomes.

Methods

Data were collected by means of anonymous self-report questionnaires. A total of 1024 employees in a transport organization participated in the study, among whom 116 self-labeled victims were identified. Exposure to bullying was measured by a short version of the Negative Acts Questionnaire, while the respondents' health outcomes were measured by the Bergen Health Checklist.

Results

The findings showed that self-labeling both moderated and partially mediated the relationship between exposure to bullying and the targets' health. However, the moderator analyses indicate that self-labeling only acts as moderator in cases of low exposure. Intense exposure to bullying behaviors is related to increased levels of health complaints regardless of the target's subjective appraisal of being a victim or not.

Conclusion

Self-labeling as a victim plays an important role in the victimizing process, although persistent exposure to workplace bullying seems to have considerable harmful effects on the target's health independently of whether the experience is labeled as bullying or not.     

Ictal central apnea as a predictor for sudden unexpected death in epilepsy

Epidemiological evidence associating ictal hypoventilation during focal seizures with a heightened risk for subsequent sudden unexpected death in epilepsy (SUDEP) is lacking. We describe a patient with temporal lobe epilepsy with two focal seizures recorded in the epilepsy monitoring unit that were associated with central apnea lasting 57 and 58 seconds. During these events, she demonstrated oxygen desaturation down to 68 and 62%. The patient subsequently died at home from autopsy-confirmed SUDEP. The family was not alerted of any seizure activity by the auditory alarm system in her room nor by sleeping in the adjacent room with open doors. This case emphasizes the fact that ictal hypoxia and SUDEP may occur in seizures without noticeable convulsive activity. The report gives credibility to the growing body of literature suggesting that epilepsies affecting the autonomic nervous system may predispose to SUDEP independent of the effects of a secondary generalized convulsion.     

Learning potential as a predictor of readiness for psychosocial rehabilitation in schizophrenia

It has been suggested that learning potential (LP), a patient's ability to benefit from training and practice, may mediate the relationship between cognition and functional outcome. Aims of this study were to (1) assess whether performance on a verbal memory-based measure of LP is associated with readiness for psychosocial rehabilitation; and (2) assess whether explicit cognitive training in memory strategies improves task performance beyond any implicit learning of organizational strategies that occurs with repeated exposure to to-be-learned material. Fifty outpatients with schizophrenia or schizoaffective disorder were administered three different versions of a list-learning test, the California Verbal Learning Test (CVLT-II). Some patients also received explicit training in semantic memory strategies before administration of the second word list. Based on performance across the three assessments, participants were categorized as "learners", "high scorers", and "non-learners". Participants were also administered the Micromodule Learning Test (MMLT), a measure that predicts performance in manualized skill training groups. LP categorization was associated with performance on the MMLT. High scorers performed better than the other two groups, and as found in earlier studies, education level was associated with performance for the learners. Explicit semantic clustering training was associated with increases in the use of the trained strategy.     

Structural and functional underconnectivity as a negative predictor for language in autism

The development of language, social interaction, and communicative skills are remarkably different in the child with autism spectrum disorder (ASD). Atypical brain connectivity has frequently been reported in this patient population. However, the interplay between their brain connectivity and language performance remains largely understudied. Using diffusion tensor imaging tractography and resting‐state fMRI, the authors explored the structural and functional connectivity of the language network and its relation to the language profile in a group of healthy control subjects (N = 25) and a group of children with ASD (N = 17). The authors hypothesized that in children with ASD, a neural connectivity deficit of the language network can be related to the observed abnormal language function. They found an absence of the right‐hemispheric arcuate fascicle (AF) in 28% (7/25) of the healthy control children and in 59% (10/17) of the children with ASD. In contrast to healthy control children, the absence of the right‐hemispheric AF in children with autism was related to a lower language performance as indicated by a lower verbal IQ, lower scores on the Peabody Picture Vocabulary Test, and lower language scores on the Dutch version of the Clinical Evaluation of Language Fundamentals (CELF‐4NL). In addition, through iterative fMRI data analyses, the language impairment of children with ASD could be linked to a marked loss of intrahemispheric functional connectivity between inferior frontal and superior temporal regions, known as the cortical language network. Both structural and functional underconnectivity patterns coincide and are related to an abnormal language function in children with ASD. Hum Brain Mapp 35:3602–3615, 2014. © 2013 Wiley Periodicals, Inc .     

Insomnia as a predictor for symptom worsening following antipsychotic withdrawal in schizophrenia

Sleep disturbances have been associated with schizophrenia, and are an especially prominent feature during the prodrome preceding psychotic relapse. In this study, we examined the changes in sleep quality following withdrawal of antipsychotic treatment, as well as the predictive value of sleep disturbances on symptom exacerbation. One hundred twenty-two patients with schizophrenia, schizophreniform disorder, or schizoaffective disorder underwent a 3-week medication wash-out prior to neuroimaging studies. Sleep quality was rated using items on the Hamilton Rating Scale for Depression (HAM-D), while symptom severity was measured using the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS). Sleep quality deteriorated progressively following antipsychotic discontinuation. Total insomnia score prior to antipsychotic withdrawal had a significant effect on the severity of psychotic symptoms at the last weekly assessment, while baseline terminal insomnia had a significant effect on disorganized symptoms at the end of the medication-free period. These findings were independent of baseline symptom severity. Our findings suggest that schizophrenia patients with sleep disturbances are at a greater risk for worsening of positive symptoms after antipsychotic discontinuation. The implications of these findings in research and clinical settings are discussed.