Influence of Total Sleep Deprivation on Event-Related Potentials in Man

The contingent negative variation (CNV) can be spontaneously followed in psychiatric patients by a postimperative negative variation (PINV), and also in normal subjects who have undergone sufficiently intense interference during the CNV paradigm. Our hypothesis was that sleep deprivation could facilitate the induction of a spontaneous PINV which would reflect a transient psychophysiological perturbation. The present experiment investigates the influence of total sleep deprivation on event-related potentials (PINV, CNV, auditory evoked potential), behavioral performance (reaction time), and autonomic response (heart rate). Nineteen subjects participated in the experiment. The subjects were studied before and after 2 consecutive nights of total sleep deprivation. The event-related potentials resulted from the summation of 16 trials. The warning stimulus (tone burst) was followed 1.5 sec later by an imperative stimulus (continuous tone) which was stopped by the subject. After the deprivation, 6 subjects underwent the CNV paradigm with interference. None of the subjects showed a PINV after sleep deprivation either spontaneously or with an interference which had induced it under non-deprived conditions. The CNV and auditory evoked potential (AEP) amplitudes were reduced after the deprivation whereas AEP latencies increased. The unobtainable PINV after sleep deprivation and the low CNV amplitude could suggest a common neurophysiological origin for these two slow potentials.     

Getting what you ask for: on the selectivity of depression rating scales

A large number of rating scales has been developed to assess depression severity and change during antidepressant therapy. When reviewing the literature, the choice of the rating scales used in a particular study often seems arbitrary. The most frequently used observer rating scales, the Hamilton Depression Rating Scale (HDRS) and the Montgomery-Asberg Depression Rating Scale (MADRS), and the most frequently used self-rating scale (the Beck Depression Inventory, or BDI) were developed more than 20 years ago. Their historical background is too often forgotten and they are reflections of their origin: the HDRS and the MADRS reflect antidepressant activity while the BDI reflects psychotherapy. Moreover, the HDRS is at risk of putting 'all depressions in one basket', while the MADRS is at risk of putting 'all antidepressants in one basket'. Therefore, the question whether a particular antidepressant could be more effective in a particular subtype of depression cannot be answered. Observer rating scales are more frequently used than self-rating scales, and when scales are used that do exist in an observer rating and a self-rating version, interesting differences are found. The present paper does not suggest that one scale is better than another, but suggests that a better knowledge of their differential background can help the researcher choose the correct scale for his purposes.     

Diurnal variation: reliability of measurement and relationship to typical and atypical symptoms of depression.

We used three rating scales to study diurnal variation of mood in 37 patients with major depressive disorder (17 drug-free patients and 20 treatment refractory patients on stable regimens of antidepressant medication). The three rating scales included global self-ratings administered twice a day; an itemized, prospective, observer-rated scale administered twice a day; and the retrospective item on the Hamilton Depression Rating Scale. Z scores and Intraclass Correlation Coefficients demonstrated a poor level of agreement between the itemized, prospective scale and the self-ratings. In addition, stepwise multiple regression analysis and point bi-serial correlation showed no systematic relationship between atypical diurnal variation (i.e., mood worsening in the evening) and atypical depressive symptoms (weight gain, hypersomnia, etc.), or between typical diurnal variation (i.e., mood worsening in the morning) and typical depressive symptoms (weight loss, insomnia, etc.). This lack of relationship was observed in both drug-free and medicated patients using each of the three rating scales. We discuss possible explanations for these negative findings.     

老年性抑郁症患者的伴随负电位变异研究

目的：探讨老年性抑郁症患者的伴随负电位（CNV）变异。方法：记录21例老年性抑郁症患者的事件相关电位CNV，并与33例正常对照者和39例非老年期的抑郁症患者的CNV进行比较。结果：老年性抑郁症患者的CNV变化与非老年期的抑郁症患者的CNV变异基本类似，但CV波幅降低更明显、命令后伴随负电位（PINV）出现率更高，反应时间进一步延长。结论：CNV可以作为评定老年性抑郁症患者大脑综合功能的辅助方法之一。     

BRAIN DYSFUNCTION OF PATIENTS WITH QIGONG INDUCED MENTAL DISORDER REVEALED BY EVOKED POTENTIALS RECORDING

Objective: In order to investigate the brain function of patients with Qigong induced mental disorder (QIMD), this study was carried out. Methods: Four kinds of evoked potentials, including contingent negative variation ( CNV) , auditory evoked potentials ( AEP) , visual evoked potentials ( VEP), and so-matosensory evoked potentials (SEP), were recorded from 12 patients with Qigong induced mental disorder. Comparison of their evoked potentials with the data from some normal controls was made. Results: The results revealed that there were 3 kinds of abnormal changes in evoked potentials of patients with QIMD that is latency prolongation, amplitude increase and amplitude decrease, as compared with normal controls. Conclusion: Brain dysfunction of patients with QIMD was confirmed. Its biological mechanism needs further studying.     

Average Evoked Potential Changes as a Function of Processing Complexity

Electrophysiologic potentials (average evoked potentials (AEP) and contingent negative variation (CNV)) recorded during simple recognition and discriminative responses to tachistoscopically presented letter-pair stimuli showed a systematic shift toward greater overall positivity (i.e., smaller CNVs and larger late positive components) during increased processing load. In addition, more positive P2 components were found in the right as compared to the left hemisphere during simple recognition, and this asymmetry was enhanced during the more complex processing condition.     

THE COMPARATIVE STUDY OF EVENT RELATED POTENTIALSIN PATIENTS WITH OBSESSIVE COMPULSIVE DISORDER,DEPRESSION AND ANXIETY

Objective: To investigate the variations of contingent negative variations (CNV) , P300 and mismatch negativity ( MMN) in patients with obsessive compulsive disorder ( OCD) , depression and anxiety. Methods: Event - related potentials CNV, P300 and MMN were recorded in 31 patients with OCD by Nicolet Spirit Instrument, and were compared with that of 20 depression controls (DC) and 17 anxiety controls (AC) and 28 normal controls (NC) . Results: A significant difference of CNV among 4 subject groups was found in both post - imperative negative variation (PINV) and amplitudes (M1) (P < 0.01) (emergence of PINV were 45% , 60% , 35% , and 4% in OCD, DC, AC and NC groups respectively) . Compared with NC group, DC and AC groups showed decreased Ml amplitude ( P < 0.01) . A significant difference of P300 among 4 groups was found in both latencies (Cz/N2) and P3 and nontarget - P2 amplitudes (P<0.05-0.01). The delayed MMN latencies of OCD and DC were similar to that of P300 changes. Conclusions: CNV, P300 and MM     

Correlates of cerebral event-related slow potentials and psychopathology

The study explored associations between the cerebral event-related slow potentials (ERSP) and psychiatric symptoms and syndromes as reflected by the Present State Examination (PSE) in 36 randomly selected psychiatric in-patients. Independent raters measured the readiness potential (RP), contingent negative variation (CNV) and post-imperative negative variation (PINV) in terms of their amplitude and duration. The 360 individual PSE items were grouped into units of analysis (UA) and further collapsed into groups of units of analysis (GUA). Canonical correlations were computed between two sets of variables (psychological and electrophysiological). Kendall's rank-order correlation was used as the main statistical approach. Some psychotic signs were associated with increased PINV amplitude. Obsessive thoughts, ideas of reference and verbal hallucinations correlated with longer PINV duration. Hopelessness and suicidal thoughts (affect-laden thoughts) as well as first-rank Schneiderian symptoms (FRS) were negatively correlated with CNV amplitude. The results support the hypothesis that CNV and PINV, alone or in combination, can be used to indicate the presence or absence of identifiable psychiatric symptoms and syndromes. The implications of electrophysiological correlates of psychopathology for psychiatric nosology and for the validity of psychiatric symptoms and syndromes were discussed.     

Anticipation of affect in dysthymia: behavioral and neurophysiological indicators

Anticipation for future affective events and prediction uncertainty were examined in healthy controls and individuals with dysthymia (DYS) using behavioral responses and the contingent negative variation (CNV) and post-imperative negative variation (PINV) event-related potential (ERP) components. Warning stimuli forecasted the valence of subsequently presented adjectives ("+", positive; "=", neutral; "-", negative), and participants indicated whether each adjective would describe them over the next two weeks. Controls expected fewer negative, and individuals with DYS expected fewer positive, adjectives to apply to them. CNV amplitudes were enhanced in controls prior to positive versus other adjectives. Response times and PINV amplitudes were greater following neutral compared to other adjectives, and PINV was larger overall in dysthymics compared to controls. In sum, healthy controls and individuals with DYS exhibit different behavioral and neurophysiological biases in anticipation for future affective events. These results are discussed in the context of cognitive theories of depression.     

A STUDY ON CNV OF PATIENTS WITH MENTAL RETARDATION

Objective:To investigate the variations of contingent negative variation(CNV)of petientswith mental retardation.Methods:The CNV was recorded in 16 children with mental retardation(MR)and 14healthly age-matched controls.And CNV retest was carried out in 11 children with MR after one yeat treatment ofPiracetam.Results:Compared with the normal control,the CNV of MR group showed prolonged postimperativenegative variation(PINV)duration(P<0.01)and total A-C duration(P<0.01),decreased amplitude B(P<0.01),and reduced preimperative A-S2 area(P<0.01).A comparison of the CNV of MR group was made be-tween before and after one year treatment of Piracetam and no significant difference was found.Conclusions:The significant CNV variations were found in children with MR and these abnormal changes presisted throughoutthe Piracetam treatment.     

3H]Paroxetine binding to human peripheral lymphocyte membranes of patients with major depression before and after treatment with fluoxetine

Serotonin has been involved in major depression and is also related to central and peripheral mechanisms of neuroimmunomodulation. Recently, the uptake of [3H]serotonin into human peripheral blood lymphocytes has been reported. We determined the density of serotonin uptake sites by the binding of [3H]paroxetine to blood peripheral lymphocyte membrane preparations of controls and of patients with major depression before and after treatment with fluoxetine for six weeks. The severity of depression was assessed by the use of Hamilton Rating Scale for Depression and of Beck Depression Inventory. There was a reduction in the number of sites for [3H]paroxetine in patients before administration of the antidepressant respecting controls, and a recovery after the treatment. Affinity was unchanged. No correlation was obtained between the severity of symptoms determined by Hamilton Rating Scale for Depression or by Beck Depression Inventory, and the number of binding sites for [3H]paroxetine. The levels of the plasma serotonin metabolite, 5-hydroxyindoleacetic acid, did not differ between the three groups of subjects, but serotonin was lower in patients after treatment respecting controls and in patients before treatment. The significant correlation between specific binding of [3H]paroxetine and plasma serotonin levels in controls was not present in the patients. Lymphocyte serotonin transporter is decreased in major depressed patients and is modulated by antidepressant treatment. In addition of counting with a peripheral marker in depression, the study of serotonin system in lymphocytes might contribute to understand the bi-directional interaction between the nervous and the immune systems.     

Assessment of depression: a comparison of rating scales

Six depression rating scales (RS) (Beck Depression Inventory, BDI; Zung Self-Rating Scale, SDS; Visual Analogue Scale, VAS; Hamilton Depression Rating Scale, HRSD; Wechsler Depression Rating Scale; Bunney and Hamburg Rating Scale, BHRS) were administered to the same 100 depressed patients and compared as regards ease of use, reliability, distribution, and validity. Separate factor analyses carried out on the items of the single scales showed considerably different factorial structures, thus revealing that different concepts of depression are at the basis of the various scales. These differences suggest that comparison of results derived by the use of different scales must be regarded with caution.     

The Manchester Nurse Rating Scales for the daily simultaneous assessment of depressive and manic ward behaviours

Two nurses' rating scales, the Manchester Nurse Rating Scale for Depression (MNRS-D) and the Manchester Nurse Rating Scale for Mania (MNRS-M) are described. The scales were designed for the daily rating of depressive and manic ward behaviours. The inter-rater reliability coefficients (r) for pairs of qualified nurses were found to be 0.790 (MNRS-D) and 0.949 (MNRS-M). All but one of the individual items yielded significant reliability coefficients. The validity coefficients, using psychiatrists' global ratings as the criterion, were 0.533 (MNRS-D) and 0.650 (MNRS-M); somewhat higher correlations were obtained between the MNRS-D and the Montgomery-Asberg Scale and the Beck Depression Inventory, and between the MNRS-M and the Young Mania Scale. The MNRS-D was shown to be sensitive to clinical change following treatment with antidepressant drugs.     

Depressive symptomatology in young people with Gilles de la Tourette Syndrome-- a comparison of self-report scales

BACKGROUND: Few studies have examined depressive symptomatology in children and adolescents with Tourette Syndrome (TS) using standardised measures and none have compared different self-report scales in the context of TS. METHODS: Seventy-two consecutive young people attending a TS clinic were evaluated using standardised rating scales for TS and associated behaviours, severity and psychopathology. All the patients completed the Birleson Depression Self Report Scale (BDSRS) and the Children's Depression Inventory (CDI). RESULTS: A strong correlation was noted between BDSRS and CDI. Depression scores were also noted to correlate with Obsessive Compulsive Behaviours (OCB) and Attention Deficit Hyperactivity Disorder (ADHD). Other correlates of depressive symptomatology included current severity of TS as indicated by Yale Global Tic Severity Rating Scale (YGTSS) and the lifetime cumulative severity as evidenced by scores on the Diagnostic Confidence Index (DCI). LIMITATIONS: The study was undertaken in a tertiary referral specialized clinic for TS thus limiting the generalizability of the findings, and the study did not include any control subjects. CONCLUSIONS: The results provide support for the need and usefulness of both BDSRS and CDI as screening tools for depressive symptoms in children and adolescents with TS. Furthermore, the findings suggest the possibility of a complex inter-relationship between TS severity, comorbid OCB and ADHD as well as the occurrence of depression.     

Depression in patients with dementia of Alzheimer type

Depression in dementia of Alzheimer type (DAT) has classically been considered to diminish as the disorder progresses. Using the Zung Self-Rating Depression Scale and the Mini-Mental State Examination to gauge the severity of depression and dementia, respectively, the authors found that the magnitude of depression did not differ as a function of disease severity in patients with DAT. The use of appropriate antidepressant therapy is therefore encouraged at any stage of disease in these patients.     

Comorbid medical illness and relapse of major depressive disorder in the continuation phase of treatment

The authors examined the impact of comorbid medical illness on the rate of relapse of major depressive disorder during continuation therapy. Subjects (N = 128) with major depressive disorder (according to DSM-III-R criteria) achieved clinical remission (a 17-item Hamilton Depression Rating Scale score < or = 7) after 8 weeks of treatment with fluoxetine and entered the continuation phase of antidepressant treatment. They used the Cumulative Illness Rating Scale to measure the severity of comorbid medical illness. Eight patients (6.3%) relapsed during the 28-week continuation phase. With logistic regression, the total burden and the severity of comorbid medical illness significantly predicted the relapse of major depressive disorder during continuation therapy with fluoxetine. Greater medical comorbidity was also associated with higher increases in self-reported symptoms of depression, anxiety, and anger during the follow-up.     

Irritable colon and depression.

Numerous attempts have been made to relate specific emotional conflicts to colonic symptoms in the irritable colon syndrome. Depression has been described as an accompaniment of the illness. This paper investigates the relationship between irritable colon and depression using self-rating symptom scales and the Zung Self-Rating Depression Scale. Thirty-one subjects were followed for two months in a double-blind study employing a tricyclic antidepressant and an inactive placebo. The study demonstrates the frequency of depression in patients with the syndrome; it shows a clearly positive treatment effect with placebo alone for both depressive symptoms and gastrointestinal complaints, and suggests that tricyclic antidepressant therapy results in moderately greater improvement in symptoms than does treatment with placebo alone.     

Evaluating the state dependency of the Temperament and Character Inventory dimensions in patients with major depression: a methodological contribution

BACKGROUND: Little is known as to whether or not the seven personality dimensions of Cloninger's theory, particularly the three character dimensions newly included in the theory, are independent of the states of depression. METHODS: One hundred and eight patients with major depression filled out the Temperament and Character Inventory (TCI) before and after a 16-week antidepressant treatment. RESULTS: The level of depression, as assessed by the Hamilton Rating Scale for Depression, was correlated positively to the harm avoidance score and negatively to the self-directedness and cooperativeness scores. During the treatment, the scores on these three dimensions significantly changed toward normal values in treatment-responders, but were stable in treatment-nonresponders. The changes in these dimensions were significantly explained by the change in the depression severity during treatment. Scores on novelty seeking, reward dependence, persistence, and self-transcendence were not correlated significantly to the level of depression and did not change significantly during the treatment in either treatment-responders or nonresponders. LIMITATIONS: The changes in the TCI scores during treatment in this study may reflect a non-specific tendency for the scores to change on retest. CONCLUSIONS: The results suggest that a depressive state can significantly affect assessments of harm avoidance, self-directedness, and cooperativeness in major depression. The administration of the TCI during a depressive episode may elevate the HA score, and may lower the SD and C scores. These findings highlight the importance of considering the state of depression before drawing conclusions about the TCI personality traits, when a patient with major depression is still experiencing a depressive episode.