A three-factor model of the MADRS in major depressive disorder

Major Depressive Disorder (MDD) may be composed of some symptom clusters with distinct neurochemical disturbances, suggesting the importance of the factor analysis of depressive symptoms; however, the results of previous studies using the Montgomery-Asberg Depression Rating Scale (MADRS) have been inconsistent. In the present study, factor analysis of the MADRS was performed in 132 Japanese patients (range 23-74 years, mean 47.6 years) with MDD without any psychiatric comorbidity. The principal component analysis with Varimax rotation identified three factors, accounting for 61% of the total variance: The first factor, labeled dysphoria, included pessimistic thoughts, suicidal thoughts, and reported sadness; the second factor, labeled retardation, included lassitude, inability to feel, apparent sadness, and concentration difficulties; and the third factor, labeled vegetative symptoms, included reduced sleep, reduced appetite, and inner tension. The score of the vegetative factor showed a significant positive correlation with age and was significantly higher in females than in males. This study suggests that the symptoms of MDD, as assessed by the MADRS, cluster into three factors (dysphoria, retardation, and vegetative symptoms).     

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.     

Diagnosing major depressive disorder I: A psychometric evaluation of the DSM-IV symptom criteria

The diagnostic criteria for depression were developed on the basis of clinical experience rather than empirical study. Although they have been available and widely used for many years, few studies have examined the psychometric properties of the DSM criteria for major depression. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined whether criteria such as insomnia, fatigue, and impaired concentration that are also diagnostic criteria for other disorders are less specific than the other DSM-IV depression symptom criteria. We also conducted a regression analysis to determine whether all criteria are independently associated with the diagnosis of major depressive disorder. A total of 1538 psychiatric outpatients were administered a semistructured diagnostic interview. We inquired about all of the symptoms of depression for all patients. All of the DSM-IV symptom criteria for major depressive disorder were significantly associated with the diagnosis. Contrary to our prediction, symptoms such as insomnia, fatigue, and impaired concentration, which are also criteria of other disorders, generally performed as well as the criteria that are unique to depression such as suicidality, worthlessness, and guilt. The results of the regression analysis, which controlled for symptom covariation, indicated that five symptoms (increased weight, decreased weight, psychomotor retardation, indecisiveness, and suicidal thoughts) were not independently associated with the diagnosis of depression. The implications of these results for revising the diagnostic criteria for major depression are discussed.     

Clinical characteristics of depressive symptoms in children and adolescents with major depressive disorder

OBJECTIVE: Very few studies have compared the symptoms of major depressive disorder (MDD) and rates of comorbid psychiatric disorders between depressed children and adolescents. The aim of this study was to reproduce and extend these findings. METHOD: The Kiddie Schedule for Affective Disorders and Schizophrenia, present version (KSADS-P) was administered to parents (about their children) and in face-to-face interviews with 916 subjects aged 5.6 to 17.9 years with MDD (DSM criteria) (715 adolescents and 201 children; 348 male and 568 female). The subjects were consecutive referrals to an outpatient mood and anxiety disorders clinic. RESULTS: Depressed adolescents had significantly more hopelessness/helplessness, lack of energy/tiredness, hypersomnia, weight loss, and suicidality compared with children (p values < or = .001). In comparison with children, adolescents had significantly more substance abuse and less comorbid separation anxiety disorder and attention-deficit/hyperactivity disorder (p values < or = .001). Depressed female adolescents had significantly more suicidality than depressed male adolescents (p < or = .001). There were no other sex differences between males and females. The symptoms of depressed adolescents grouped into 3 factors (endogenous, negative cognitions/suicidality, and appetite/weight), whereas the symptoms in children grouped into 2 factors (endogenous/negative cognitions/suicidality and appetite/weight). CONCLUSIONS: These results provide further evidence for the continuity of MDD from childhood to adolescence.     

Increasing depressive symptoms in children of Alzheimer parents

Children of persons with Alzheimer disease (AD) are at increased risk of developing AD themselves, but specific factors that predict AD in this population have yet to be elucidated. Various studies indicate depressive symptoms may predate clinical AD and represent a risk factor and/or prodrome of incipient dementia, but their relevance for AD offspring remains uncertain. As part of a longitudinal family study of AD, we assessed depressive symptomatology in 30 middle aged AD offspring (mean age at baseline: 41.2). Their mean total scores on the Hamilton Depression Rating scale increased from 1.8 to 5.3 (P < .001) across a 20-year interval. Neurocognitive performance remained stable in a subset of this cohort (N = 25) over the same interval. Findings from this small convenience sample suggest emerging depressive symptoms may be among the earliest signs of subsequent dementia in this high-risk population but require confirmation through further longitudinal follow-up and replication in larger populations.     

Depression and depressive symptoms in preschool children from the general population

This multiphasic study used four independent sources of information to investigate depression and depressive symptoms in a sample of preschool-age children from a general population. The study provides evidence that major depressive disorder exists in preschoolers and that stressful life events are associated with depressive symptoms; it underscores the importance of the teacher's report for identifying the presence of depression in this age group. Details of the findings, including a new scale for rating depression in young children, are discussed.     

Difficulties in the evaluation of depressive symptoms in patients with dementia

Depressive symptoms are often found in dementia (up to 86 %). Therefore, adequate treatment is necessary. Depressive symptoms appear significantly more often in vascular dementia than in dementia in Alzheimer's disease, but severity and profile of depressive symptomatology are independent of the etiology of dementia. The aim of this review is to help clinicians to select appropriate psychometric instruments to identify and measure depressive symptomatology in dementia. Frequently used scales are described, e.g. the Dementia Mood Assessment Scale and the Cornell Scale for Depression in Dementia - specific scales developed for rating severity of depression in dementia - and the Geriatric Depression Screening Scale. Methodological problems and limitations of psychopathological assessment in dementia caused by restriction of self-report, information gathered by collateral sources, manifestations of age and interference of somatic symptoms are discussed.     

Assessing self-reported clinical high risk symptoms in community-derived adolescents: A psychometric evaluation of the Prodromal Questionnaire-Brief

BackgroundThe reliable early identification of individuals at risk for psychosis requires well-validated screening measures. To date, there is little information about the psychometric properties of the screening measures for psychosis risk in nonclinical adolescents. The main purpose of the present study was to validate the Prodromal Questionnaire-Brief (PQ-B) in a community sample of non-clinical Spanish adolescents. We also analyzed the prevalence, factorial validity, and reliability of the PQ-B scores as well as the relationship between self-reported clinical high risk symptoms and schizotypal traits.MethodFour hundred and forty-nine high-school students participated in a cross-sectional survey. The PQ-B and the Oviedo Schizotypy Assessment Questionnaire (ESQUIZO-Q) were used.ResultsAlthough 85.1% of the total sample reported at least one clinical high risk symptom, only 16% of the adolescents scored above the standardized cut-off. The PQ-B revealed an essentially unidimensional structure. The internal consistency of the PQ-B total score was 0.93. Pearson correlation coefficients indicated a high degree of overlap between self-reported clinical high risk symptoms and Positive and Disorganized schizotypal traits. A Canonical correlation between the PQ-B total score and ESQUIZO-Q dimensions showed that the associated variance between both sets of variables was 45.4% (adjusted R² = 0.45).ConclusionsThe PQ-B is a brief, easy, and reliable tool for screening self-reported clinical high risk symptoms in adolescents from the general population. These results also indicated that self-reported clinical high risk symptoms and schizotypal traits are closely associated at the subclinical level. The assessment of psychosis risk symptoms and their relationship with other distal risk factors, in a close-in strategy, may enhance the early identification of individuals at heightened risk for psychosis spectrum disorders.     

Incidence of depressive symptoms among sexually abused children in Kenya

Background

Children who experience sexual abuse undergo various negative psychosocial outcomes such as depressive symptoms. Unfortunately, not many studies have been conducted on the incidence of depressive symptoms among sexually abused children in Kenya. This study sought to ascertain the incidence of depressive symptoms among children who have experienced sexual abuse in Kenya.

Methods

This was a longitudinal study design. It was conducted at Kenyatta National Teaching and Referral Hospital and Nairobi Women’s Hospitals in Kenya. One hundred and ninety-one children who had experienced sexual abuse and their parents/legal guardians were invited to participate in the study. The study administered the Becks Depression Inventory and the Child Depression Inventory to the children.

Results

The incidence of depressive symptoms after 1 month of sexual abuse revealed that amongst children who were below 16 years old, 14.6% had minimal-mild depressive symptoms while 85.4% had moderate-severe depressive symptoms. In comparison, children who were 16 years or older, 6.4% had minimal-mild depressive symptoms while 93.6% had moderate-severe depressive symptoms. Children below 16 years old whose parents were separated were found to have depressive symptoms (p?<?0.001) as well as those who were presented early for medical care (p?<?0.004), while children aged 16 years and above who were abused by strangers were more likely to have depressive symptoms (p?<?0.024) and those who were not attending school (p?<?0.002).

Conclusion

Sexual abuse of children is world-wide and the Kenyan situation is comparable. Being the victim of sexual abuse as a child has major psychological and emotional sequlae which need to be addressed in Kenya. Children who experience sexual abuse have very high incidence of developing depressive symptoms. All the sexually abused children studied suffered from depressive symptoms and a large majority suffered from major depressive symptoms that should be promptly and effectively addressed to ameliorate psychological suffering among children.

     

Anxiety and depressive symptoms in children presenting with a first seizure

We investigated whether children presenting with a first seizure experienced anxiety and depressive signs. Children (aged 7-17 years) with a first unprovoked afebrile seizure participated. These patients (mean age, 12 +/- 2.7 years S.D.; 14 female/8 male) completed the Revised Child Manifest Anxiety Scale (n = 22) and Children's Depression Inventory (n = 20). Scores were compared with: (1) published norms, and (2) control patients with new medical signs. Compared with the published norms, children reported greater total anxiety (P < 0.02), worry/oversensitivity (P < 0.008), and social concerns/concentration (P < 0.005). However, compared with the control patients, no difference was seen between groups. Total Children's Depression Inventory scores were higher than for published norms (P = 0.05) and control patients (P = 0.04). Children with a first seizure reported greater interpersonal problems (P < 0.01), ineffectiveness (P < 0.03), and negative self-esteem (P < 0.05) than published norms, and increased negative mood (P = 0.04), ineffectiveness (P = 0.04), anhedonia (P = 0.05), and negative self-esteem (P = 0.05) than control patients. Our results suggest that anxiety may be related to an illness or to the hospital experience itself, whereas depressive signs may be a comorbidity present at time of presentation of the first seizure. If a larger cohort substantiates these results, early screening for these signs would be of clinical importance.     

Self-reported depressive symptoms in a school sample of Italian children and adolescents

This study reports on self-reported depressive symptoms, assessed with the Children's Depression Inventory (CDI), in a school sample of 685 Italian students. The participants were 254 males and 431 females, the age range of the subjects was 8 to 17 years (mean age 13.0 ± 2.8 years). The CDI mean score was 10.49 ± 2.76. According to our data, about 10% of the subjects scored higher than the clinical threshold of 20. More than 1/3 of the students reported thoughts of death, but only 2.2% had explicit suicidal ideation. Girls scored higher than boys, and young adolescents (11–13 years) scored lower than pre-pubertal children and older adolescents, and showed fewer thoughts of death. Factorial analysis yielded seven factors, a general factor with no predominant theme, two factors related to academic self-image and body image, and four related to anhedonia-withdrawal, hypocondria-asthenia, irritability-opposition, and loss of appetite.     

A longitudinal evaluation of the Resilient Families randomized trial to prevent early adolescent depressive symptoms

This study aimed to evaluate whether an intervention prevented the development of depressive symptoms through the early years of secondary school (Grades 7 to 9 – mean ages 12.3 to 14.5 years) in Victoria, Australia. Twelve schools were randomized to a universal preventative intervention (including a student social relationship/emotional health curriculum, and parent/caregiver parenting education); 12 were randomized as control schools. Multivariate regression analyses used student self-report to predict depressive symptoms at 26-month follow-up (13-months after intervention completion) from baseline measures and intervention status (N = 2027). There was no overall intervention effect on depressive symptoms. However, intervention students with moderate symptoms whose parents attended parent education events had a significantly reduced risk of depressive symptoms at follow-up. Future evaluations of interventions of this type should investigate: therapeutic processes; methods to increase recruitment into effective parent education events; and the potential to target assistance to students with high depressive symptoms.     

抑郁症的强迫症状及强迫与抑郁关系的研究

自从Ｎｅｉｍａｎ(1980)提出强迫与抑郁为常见的共存症状以来,许多的临床研究表明:强迫症最常见的并发症是焦虑、抑郁,而抑郁症中也常伴有强迫症状[1～3]。目前临床公认的Ｈａｍｉｌｔｏｎ抑郁量表(ＨＡＭＤ)[4]中,强迫症状被列入评定抑郁症状的一项常规内容,可见两者的密切联系。本研究调查了伴强迫症状抑郁症患者的症状学特征,并与不伴强迫症状的抑郁症及强迫症患者进行病例对照分析。现报道如下。1　资料和方法11　病例选择与分组111　伴强迫症状的抑郁症组(以下简称抑郁伴强迫组):收集我院1996年8月至1997年12月入院150例符合中国精神疾…     

A psychometric evaluation of the acute tremulous state

Summary Human choroid plexus was submitted to low temperature ashing (LTA) in order to isolate the calcification. The ashing residue was then subjected to morphological, chemical and structural studies using technics such as scanning electron microscopy, flame and flameless atomic absorption spectrometry, infrared spectrometry and X-ray diffraction. Morphologically, the calcification consisted of wound-up fibers forming granules with a diameter of 0.05 to 0.15 mm. The concretions were identified as cristalline Ca₃(PO₄)₂ and hydroxylapatite. The content of trace elements was high, but within the limits found in other biological apatites. In some cases, however, the Fe content exceeded these limit values.

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Zusammenfassung Plexus chorioidei menschlicher Gehirne wurden bei niedriger Temperatur verascht, um die Verkalkungen zu isolieren. Der Aschenrückstand wurde dann morphologisch, chemisch sowie in bezug auf seine Struktur mit Hilfe von Scanning-Elektronenmikroskopie, Atomabsorptionsspektrometrie mit und ohne Flamme sowie infraroter Spektrometrie und Röntgendiffraktionsmethode untersucht. Morphologisch bestanden die Verkalkungen aus aufgewickelten Fasern, die Granula mit einem Durchmesser zwischen 0,05 und 0,15 mm bildeten. Diese bestanden aud kristallinem Ca₃(PO₄)₂ und Hydroxylapatit. Der Gehalt an Spurenelementen ist hoch, jedoch innerhalb der bei anderen biologischen Apatiten üblichen Grenzen. In einzelnen Fällen allerdings überschreitet der Eisengehalt diese Grenzwerte.