Is interpersonal sensitivity specific to non-melancholic depressions?

Background: We investigated whether melancholic and non-melancholic Japanese depressive patients differed in regard to a personality feature, interpersonal sensitivity, as measured by the Interpersonal Sensitivity Measure (IPSM). Methods: In addition to 154 normal controls, 66 remitted melancholic patients and 55 remitted non-melancholic patients filled out the IPSM and two widely-used comprehensive personality inventories, the Temperament and Character Inventory (TCI) and the Munich Personality Test (MPT). The subdivision of patients was made according to three major symptom-based criteria for melancholia (those of RDC, DSM-III, DSM-IV). Results: Multivariate and post-hoc univariate analyses of variance revealed significant differences among the three groups in several personality dimensions after Bonferroni's adjustments of P values. While reported scores of both melancholic and non-melancholic patients deviated from normative scores on several personality dimensions, non-melancholic patients reported significantly higher scores on the total IPSM and the 'fragile inner-self' (a subscore of the IPSM) than did normal controls or melancholic depressives. The principal component analysis isolated two factors related to depressive disorders: one factor corresponding to the five IPSM scores; and the other corresponding to harm avoidance, neuroticism and frustration tolerance. The scores on the former factor differentiated non-melancholic depressives from melancholic depressives and normal controls. The scores on the latter factor differentiated both melancholic and non-melancholic depressives from normal controls. Limitations: Prospective studies in which depressive subjects are subdivided into melancholic and non-melancholic subjects will be required to see whether the personality deviations here related to depressive disorders strongly reflect the premorbid personality function. Conclusions: These results indicate that the IPSM scales (particularly, the fragile inner-self scale and the total IPSM scale) are relatively independent of all dimensions included in the two comprehensive personality inventories, and have a capability to describe personality differences between non-melancholic depression and melancholia.     

The association between the high interpersonal sensitivity type of personality and a lifetime history of depression in a sample of employed Japanese adults

BACKGROUND: Although the 'high interpersonal sensitivity' type of personality has repeatedly been shown to be related to depression by case-control studies, no studies have confirmed whether this association also exists in a non-clinical sample. METHODS: Scores on the Interpersonal Sensitivity Measure (IPSM) were compared between employed Japanese adults with and without a lifetime diagnosis of major depressive disorder. The diagnosis was provided by the Inventory to Diagnose Depression, Lifetime version. A multiple logistic regression analysis estimated the odds ratios for having a lifetime diagnosis of depression. RESULTS: The scores on the IPSM were higher in the subjects with a lifetime history of depression than those without a lifetime history of depression. On the five subscales of the IPSM, the subjects with a lifetime history of depression showed higher scores on 'interpersonal awareness', 'need for approval', and 'separation anxiety' than those without a lifetime history of depression. The multiple logistic regression analysis showed that the subjects with the high interpersonal sensitivity type of personality had an increased risk for experiencing lifetime depression. CONCLUSIONS: The results suggest that high interpersonal sensitivity is a risk factor for depression even in a non-clinical sample from non-Western culture.     

The relationship between interpersonal sensitivity, anxiety disorders and major depression

BACKGROUND: While interpersonal sensitivity, as rated by the Interpersonal Sensitivity Measure (IPSM) has previously been found to be an efficient predictor of depression, there has been less interest in the relationship between the IPSM and anxiety disorders. This study examines the performance of the IPSM in discriminating between cases and non-cases of the various anxiety disorders. The contribution of depression and the perception of parental environment, to any relationships found, are also examined. METHODS: A cohort of 156 men and women has been assessed at 5-yearly intervals since baseline in 1978, in their last year of teacher training. In this fourth wave of follow-up, subjects completed a series of self-report questionnaires, including the IPSM, and scales measuring neuroticism and trait depression. Perceived parental environment, measured at baseline, was also included. DSM-III-R major depression and anxiety disorders were generated using the Composite International Diagnostic Interview. The IPSM subscales were moderately stable over time. 'Timidity' was associated with agoraphobia and simple phobia, and 'separation anxiety' with agoraphobia, panic disorder and generalised anxiety disorder. 'Separation anxiety' and 'timidity' showed differential gender effects for simple phobia. 'Fragile inner self' and 'separation anxiety' were associated with subjects with a history of repeated episodes of major depression, and the former, with perception of poor parental care. LIMITATIONS: The IPSM was not available for inclusion prior to the 1988 wave. CONCLUSIONS: While the IPSM subscales were consistently correlated with neuroticism, they displayed differential associations with specific anxiety disorders, episodes of major depression and early parental environment. These findings offer greater understanding of mechanisms concerning the relationship of vulnerability to anxiety disorders and depression.     

Comparison of the effects of fluoxetine,imipramine and placebo on personality in atypical depression

BACKGROUND: Atypical depression is associated with elevated rates of personality disorders. Studies have confirmed the efficacy of a several antidepressants in the treatment of atypical depression. Whether their pathological dimensions of personality diminish after benefitting from effective medication treatment is unclear. AIMS: To determine the extent that pathological dimensions of character improved among patients who benefitted from treatment. METHOD: One-hundred and fifty-four outpatients with DSM-IV Major Depression who met Columbia criteria for atypical depression were randomized to receive fluoxetine, imipramine or placebo for a 10-week double-blind clinical trial. The Temperament and Character Inventory (TCI) was administered at the initiation of treatment and 8 weeks later. Low scores on either of two Character dimensions (Self-Directiveness or Cooperativeness) indicate psychopathology. RESULTS: Responders had a substantial reduction in Harm Avoidance, but post-treatment scores remained significantly higher than the normal control group (NCG). Fluoxetine and Imipramine did not produce different changes on personality, except for Self-Transcendence. LIMITATIONS: High proportion of missing data, inadequate sample size, post-hoc analysis. CONCLUSIONS: Among responders, Self-Directiveness improved and normalized; Harm Avoidance also improved but did not normalize. These data suggests that effective treatments reduce some pathological personality traits as well as improving mood.     

Alexithymia and the temperament and character model of personality

OBJECTIVE: In our study we explored the associations between alexithymia (Toronto Alexithymia Scale 20, TAS-20) and the dimensions and subscales of Cloninger's theoretically based and empirically validated psychobiological model of personality to further clarify the relationship between alexithymia and personality traits. METHODS: Psychiatric in- and outpatients (n = 254) were investigated with the TAS-20, the Temperament and Character Inventory (TCI) and the Symptom Check List SCL-90-R to control for the severity of current psychopathology. Correlation and regression analyses were performed. RESULTS: The regression analysis identified the TCI dimensions low self-directedness (SD), low reward dependence (RD) and to a minor degree harm avoidance (HA) as independent predictors for alexithymia. At the level of subscales, interpersonal detachment (RD3), low resourcefulness (SD3), low responsibility and blaming (SD1) and shyness with strangers (HA3) were predictors for alexithymia. The degree of explained variance of the TAS-20 scores by the TCI dimensions and subscales ranged between 43 and 45% whereas the inclusion of the general severity index into the regression models accounted for an additional 5% of the variance. CONCLUSIONS: Alexithymia is best explained by a mixture across different dimensions and subscales within Cloninger's psychobiological model of personality. However, alexithymia is captured only partly by current concepts of personality, and additional contributing psychological and biological factors need to be identified to understand alexithymia more extensively.     

A comparison of paroxetine and amisulpride in the treatment of dysthymic disorder

Background: The purpose of this study was to provide preliminary data on the effects of paroxetine and amisulpride on depressive dimensions, analyzed by factor analysis, in dysthymic patients. Methods: One hundred and eighteen patients with DSM IV criteria for DD without concurrent major depression were enrolled in this 8-week, open study, and 100 completed it. Symptom dimensions were identified by principal components analysis with the SAS Factor procedure. Results: Results of the symptom rating scales indicated that both drugs were equally effective. Response rate was 65% both in the paroxetine and the amisulpride group and the proportions of patients achieving a final HRSD score ≤7 were 46.7 and 55%, respectively. MADRS factor analysis identified two factors at baseline: the first corresponding to the global severity of depression and the second to somatic symptoms. After 8 weeks of treatment only one factor could be substantiated. At week 4 both paroxetine and amisulpride produced significant improvements on factor 1 while at week 8 mean changes of factor 1 were greater in the amisulpride-treated patients. Limitations: The main limitation was the open-label design. Conclusions: Both paroxetine and amisulpride appear to be effective in the short-term management of DD, improving its most characteristic symptoms.     

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.     

Dimensional and categorical approaches to hypochondriasis

BACKGROUND: The DSM-IV definition of hypochondriasis is contrasted with hypochondriacal dimensions as provided by the Whiteley Index (WI) and Illness Attitude Scales (IAS). METHODS: Exploratory factor analysis was conducted on self-report data from 570 patients with mental and psychophysiological disorders. Of these, 319 were additionally diagnosed according to DSM-IV by structured interviews. RESULTS: The three 'classic' factors of the WI labelled disease phobia, somatic symptoms and disease conviction were confirmed. The IAS consisted of two dimensions indicating health anxiety and illness behaviour. The overall scores of both instruments were highly correlated (0.80). Optimal cut-off points for case identification yielded sensitivity/specificity rates of 71/80% (WI) and 72/79% (IAS). The IAS was superior to the WI when patients with hypochondriacal disorder were to be discriminated from non-hypochondriacal somatizers. Largest group differences were found for scales related to affective components (health anxieties), smallest for illness behaviours. Affective components of hypochondriasis explained more variance of diagnostic group membership than somatization symptoms. The subscales of disease phobia (WI) and health anxiety (IAS) were most sensitive to treatment-related changes. CONCLUSIONS: The self-rating scales are valid for screening, case definition and dimensional assessment of hypochondriacal disorder, including the differentiation between hypochondriasis and somatization. The existence of distinguishable affective and cognitive components was confirmed.     

Use of the diagnostic criteria for psychosomatic research in oncology

BACKGROUND: Psycho-oncology literature has shown that 30-50% of cancer patients meet the criteria for a psychiatric diagnosis, according to the usual nosographic classification (e.g. DSM). The Diagnostic Criteria for Psychosomatic Research (DCPR) have been shown to be useful in identifying psychological constellations in patients with medical illness. The aims of the study were to compare the DSM-IV and the DCPR in their application to cancer patients. METHOD: One hundred and forty-six patients with cancer underwent semistructured interviews to assess psychiatric morbidity and psychosocial syndromes according to the DSM-IV and the DCPR, respectively. The Brief Symptom Inventory (BSI) was also used to assess psychological stress symptoms. RESULTS: Sixty-five subjects (44.5%) met the criteria for a DSM-IV diagnosis (DSM cases), while 104 patients (71.2%) presented symptoms meeting the criteria for at least one DCPR syndrome. Three DCPR dimensions were more frequent than others, specifically Health Anxiety (37.7%), Demoralization (28.8%) and Alexithymia (26%). Among the subjects with no formal DSM-IV diagnosis (n = 81), 58% had at least one DCPR syndrome. DSM-IV cases had higher scores on several BSI subscales in comparison with patients with only one DCPR syndrome, while no difference was found in patients with more than one DCPR diagnosis. CONCLUSIONS: The DCPR system was found to be useful in oncology in investigating psychological conditions which are not identified by the DSM-IV alone. Assessment of more specific constructs, other than intensity of general stress symptoms, may give more specific information and help in tailoring psychological intervention for patients with cancer.     

Residual symptoms at remission from depression: impact on long-term outcome

Background: Although residual symptoms after remission from depression are common and predict early relapse, little is known about the impact of residual symptoms on longer-term clinical course of depression or social functioning. Methods: Sixty severe recurrent depressives, who remitted from an index episode of depression with residual symptoms or below residual symptomatology, were followed-up at 8–10 years. Subjects underwent detailed longitudinal interviewing on course of depression, treatment and socioecomonic functioning over follow-up. Results: Long-term follow-up data was obtained on all living subjects and 55 (95%) were interviewed. The residual symptoms group spent more time with depressive symptoms over follow-up but not at full criteria for major depression and showed greater impairment in longitudinal and follow-up social adjustment. No significant differences were found between the two groups in percentage recurring long-term, mean number of recurrences, readmissions, chronic episodes or clinical global outcome criteria. Limitations: Long-term clinical and social outcomes were assessed by a single retrospective longitudinal interview. Conclusions: Patients who remit from depression with residual symptomatology continue to have more depressive symptoms and impaired social functioning long-term and may need more aggressive treatment.     

The relationship between personality, dysfunctional parenting in childhood, and lifetime depression in a sample of employed Japanese adults

BACKGROUND: Few studies have explored the relationship between personality, dysfunctional parenting in childhood, and adult depression. METHODS: Parental rearing styles and personality scores as measured by the Parental Bonding Instrument (PBI) and the Interpersonal Sensitivity Measure (IPSM) were compared in a group of employed Japanese adults with and without a lifetime history of depression. The diagnosis was provided by the Inventory to Diagnose Depression, Lifetime version (IDDL). To estimate the effects of the PBI and the IPSM scores on lifetime depression, a multiple logistic regression analysis was performed. RESULTS: Subjects with lifetime depression were seen to have significantly lower scores on the PBI 'care' and higher scores on the IPSM than the subjects without lifetime depression. Lower levels of maternal care and higher levels of 'interpersonal sensitivity' each independently increased the risk for lifetime depression. LIMITATIONS: The findings of the present study may not be conclusive since the data were retrospectively obtained. CONCLUSION: Dysfunctional parenting and personality seem to be correlated by lifetime depression, but it is uncertain whether they are independent risk factors     

Atypical symptoms in hospitalised patients with major depressive episode: frequency, clinical characteristics, and internal validity

OBJECTIVE: The objective was (1) to assess the frequency of atypical depression (AD) in depressed inpatients; (2) to compare clinical features of patients with atypical and nonatypical depression (Non-AD) (3) to evaluate the meaning of single psychopathological symptoms with special respect to mood reactivity. METHOD: Diagnoses of 1073 inpatients were assessed according to DSM-IV using SCID (Structured Clinical Interview for the DSM-IV) and AMDP (Association for Methodology and Documentation). Diagnosis of atypical depression was defined according to criteria of the DSM-IV specifier for AD. All patients were rated using HAMD-21 (Hamilton Depression Scale). RESULTS: A high percentage of patients met criteria for AD (15.3%, 95% CI 13.0-17.9%). Women were more likely to suffer from AD (OR=1.54, p=0.037). There were no significant differences between AD and Non-AD patients regarding age, HAMD total baseline score, and diagnosis of any bipolar illness. In terms of psychopathology patients with AD were significantly more likely to suffer from somatic anxiety, somatic symptoms, guilt, genital symptoms, depersonalisation and suspiciousness as defined by HAMD-21 items. Interestingly, mood reactivity was not found to be significantly associated with the presence of two or more additional symptoms of AD. LIMITATIONS: Results were assessed by a post-hoc analysis, based on prospectively collected data. Compared to other inpatient samples with MDE, prevalence of bipolar disorder was rather low. CONCLUSION: (1) Frequency of AD may be underestimated, especially in inpatient samples. Further studies of inpatient samples are recommended. (2) Quality of distinct anxiety symptoms may be different in both groups, with AD patients being more likely to suffer from somatic symptoms and somatic anxiety. The presence of suspiciousness and even paranoid phenomena may not exclude a diagnosis of AD, but may be related to rejection sensitivity. (3) The mandatory presence of mood reactivity for the diagnosis of AD needs further consideration, regarding its validity for the concept.     

The role of cyclothymia in atypical depression: toward a data-based reconceptualization of the borderline-bipolar II connection

OBJECTIVE: Recent data, including our own, indicate significant overlap between atypical depression and bipolar II. Furthermore, the affective fluctuations of patients with these disorders are difficult to separate, on clinical grounds, from cyclothymic temperamental and borderline personality disorders. The present analyses are part of an ongoing Pisa-San Diego investigation to examine whether interpersonal sensitivity, mood reactivity and cyclothymic mood swings constitute a common diathesis underlying the atypical depression-bipolar II-borderline personality constructs. METHOD: We examined in a semi-structured format 107 consecutive patients who met criteria for major depressive episode with DSM-IV atypical features. Patients were further evaluated on the basis of the Atypical Depression Diagnostic Scale (ADDS), the Hopkins Symptoms Check-list (HSCL-90), and the Hamilton Rating Scale for Depression (HRSD), coupled with its modified form for reverse vegetative features as well as Axis I and SCID-II evaluated Axis II comorbidity, and cyclothymic dispositions ('APA Review', American Psychiatric Press, Washington DC, 1992). RESULTS: Seventy-eight percent of atypical depressives met criteria for bipolar spectrum-principally bipolar II-disorder. Forty-five patients who met the criteria for cyclothymic temperament, compared with the 62 who did not, were indistinguishable on demographic, familial and clinical features, but were significantly higher in lifetime comorbidity for panic disorder with agoraphobia, alcohol abuse, bulimia nervosa, as well as borderline and dependent personality disorders. Cyclothymic atypical depressives also scored higher on the ADDS items of maximum reactivity of mood, interpersonal sensitivity, functional impairment, avoidance of relationships, other rejection avoidance, and on the interpersonal sensitivity, phobic anxiety, paranoid ideation and psychoticism of the HSCL-90 factors. The total number of cyclothymic traits was significantly correlated with 'maximum' reactivity of mood and interpersonal sensitivity. A significant correlation was also found between interpersonal sensitivity and 'usual' and 'maximum' reactivity of mood. LIMITATION: Correlational study. CONCLUSIONS: Mood lability and interpersonal sensitivity traits appear to be related by a cyclothymic temperamental diathesis which, in turn, appears to underlie the complex pattern of anxiety, mood and impulsive disorders which atypical depressive, bipolar II and borderline patients display clinically. We submit that conceptualizing these constructs as being related will make patients in this realm more accessible to pharmacological and psychological interventions geared to their common temperamental attributes. More generally, we submit that the construct of borderline personality disorder is better covered by more conventional diagnostic entities.     

Toward validation of atypical depression in the community: results of the Zurich cohort study

AIMS: This paper (1) examines the validity of the atypical subtype of depression in a community-based longitudinal cohort study, (2) presents estimates of the prevalence and sex differences of DSM-IV atypical depression and a newly more broadly defined atypical syndrome in the community and (3) compares the clinical correlates and treatment patterns of those with atypical depression with other depressives. METHODS: The Zurich cohort study is comprised of 591 subjects selected from a population-based cohort of young adults representative of the canton of Zurich in Switzerland, who were screened in 1978 with the Symptom Checklist 90-R [L.R. Derogatis (1977)] and followed prospectively with five interviews between 1979 and 1993. Atypical depression was defined on a spectrum ranging from atypical major to minor to atypical depressive symptoms alone. RESULTS: The rate of DSM-IV atypical major depressive episodes in this community is 4.8% and for major atypical depression syndrome is 7.3%. Whereas there was no marked sex difference for nonatypical features, there was a significant female preponderance for DSM-IV and broadly defined atypical depressive subtypes. Systematic investigation of the diagnostic criteria for atypical depression revealed that a nonhierarchical definition of atypical depression with respect to mood reactivity yielded as valid a syndromic definition as the current hierarchy based on mood reactivity as an essential feature. Very high comorbidity (odd ratios>2.0) was found with seasonality, bipolar II, social phobia, binge eating, neurasthenia and sociopathy. LIMITATIONS: Atypical depression was not defined à priori, its criteria were derived from two sections of the Zurich interview. CONCLUSIONS: Atypical depression has high population prevalence and substantial significance in terms of clinical severity, impairment, and service use. The intriguing finding that the sex difference in depression may be attributed to atypical features of depression will need further investigation. Overall, our data indicate that the atypical subtype of depression is a valid entity based on evidence from such traditional indicators of validity as inclusion criteria and indicators of course. However, there are some problems with discriminatory validity from other disorders. Although comorbidity with these disorders may in part reflect an operational artifact of symptom overlap, further work needs to be done in distinguishing atypical depression from bipolar II.     

The Thought Control Questionnaire--psychometric properties in a clinical sample, and relationships with PTSD and depression

BACKGROUND: Recent developments in research suggest that particular attempts to control thoughts may contribute to the problem of intrusion. An instrument capable of identifying strategies for dealing with unwanted intrusions in clinical populations may be used for differentiating between thought control strategies that may or may not be helpful. METHODS: The Thought Control Questionnaire (TCQ) (Wells & Davies, 1994) developed and validated on a normal sample, was administered to a clinical sample in order to investigate the consistency of the original factor structure and its psychometric properties. The sensitivity of the scale to change associated with recovery was also examined. Relationships between individual differences in thought control strategies and psychiatric symptoms in patients with DSM-IV major depression, and PTSD with or without major depression were investigated. RESULTS: The Scree Test suggested a six-factor solution which was rotated. This solution split the original distraction subscale into separate behavioural and cognitive distraction, otherwise the subscales were almost identical to those obtained in non-clinical subjects. As this split has been shown to be unreliable, further analyses in this study were based on the five-factor version of the TCQ obtained by Wells & Davies (1994). Predictors of recovery and of symptoms in PTSD and depression were explored. CONCLUSIONS: Correlations between the TCQ subscales and other measures suggest that particular thought control strategies may be associated with the symptoms of PTSD and depression. The TCQ scales appear to be sensitive to changes associated with recovery. Significant differences emerged in thought control strategies between depressed and PTSD patients. Hierarchical regression analysis showed distraction, punishment and reappraisal control strategies predicted depression scores in depressed patients while use of distraction predicted intrusions in PTSD.     

大学生抑郁与人际性格特征的相关性研究

目的 探讨大学生抑郁与其人际性格特征之间的关系。方法 采用BDI和PTDS两种量表对324名大学本科生进行测试，抑郁程度分为重、中、轻、正常4种。结果、大学生的抑郁与其人际性格特征得分呈负相关；不同抑郁程度的大学生人际性格特征有显著差异；重度抑郁的男女大学生在Fx上出现高峰，在Sy,Wb,Cm,Ie上出现低谷。结论 大学生抑郁与其人际性格特征之间是相互影响的。     

Increased (E)-4-hydroxy-2-nonenal and asymmetric dimethylarginine concentrations and decreased nitric oxide concentrations in the plasma of patients with major depression

Background: (E)-4-Hydroxy-2-nonenal (HNE) is a highly electrophilic end-product of lipid peroxidation. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of endothelial nitric oxide synthase (NOS). ADMA is metabolised by dimethylarginine dimethylaminohydrolase (DDAH). DDAH contains a nucleophilic cysteine residue in its active site. There is an increase in lipid peroxidation in major depression. Major depression is associated with the development of coronary heart disease (CHD) and greatly increases morbidity and mortality. There is an increase in circulating ADMA in CHD and vascular risk factors. Objectives: To determine plasma HNE, ADME and nitric oxide (NO) concentrations in patients with major depression compared to normal volunteers and to examine the effect of HNE on ADMA formation and DDAH activity in cultured endothelial cells. Methods: The study was conducted in 25 patients with major depression (DSM-IV criteria) and 25 healthy control subjects. Plasma concentrations of HNE were determined as the O-pentafluorylbenzyl oxime using capillary column GC–MS and deuterated HNE as the internal standard; ADME by LC–MS–MS using ¹³C⁶- -arginine as the internal standard; and NO by GC–MS following reduction to nitrate and nitrite and derivatisation to the pentafluorobenzyl derivative using [¹⁵N]nitrate and [¹⁵N]nitrite as the internal standards. Human umbilical vein endothelial cells were incubated in serum-free medium in the presence of HNE. The concentration of ADMA in the medium was determined by LC–MS–MS. DDAH activity was determined by measuring -citrulline in endothelial cell lysates using LC–MS. Results: There was a significant increase in the plasma concentration of HNE (P<0.0001) and ADMA (P<0.0002) in patients with major depression. There was a significant decrease in the plasma concentration of NO (P<0.0001). A significant positive correlation was found between the plasma concentrations of HNE and ADMA (r=0.63, P<0.0001). A significant negative correlation was detected between the plasma concentrations of ADMA and NO (r=−0.595, P<0.0001). HNE significantly increased ADMA formation (P<0.0001) and significantly decreased DDAH activity (P<0.0001) in cultured endothelial cells. The effects of HNE on DDAH activity were significantly attenuated by the addition of glutathione (P<0.0001). Limitations: No allowance was made for the phase of the menstrual cycle which could influence plasma nitric oxide concentrations. Conclusions: There is an increase in circulating HNE in major depression. HNE inactivates the cysteine residue in the active site of endothelial DDAH leading to the accumulation of ADMA in the circulation. The ADMA then decreases the production of eNOS. This could reduce the amount of NO diffusing from cerebral blood vessels to nearby neurons and influence the release of neurotransmitters. ADMA also constricts cerebral blood vessels and may contribute to the decreased regional perfusion in major depression. The accumulation of ADMA could explain the increased risk of CHD in major depression. The preservation of DDAH activity and the reduction of ADMA accumulation may represent a novel therapeutic approach to the treatment of major depression.     

残疾人与正常群体心理生活质量的比较研究

目的了解残疾人心理生活质量的现状及各维度间的关系。方法随机选取宁波市某社区居民135名,分别用人脸量表、生活满意度量表、自尊量表、症状自评量表(SCL-90)和信赖他人量表进行调查。结果①残疾人在抑郁、焦虑、敌对和人际敏感4个因子上得分均显著高于正常人(t=3.148,3.807,3.088,4.155;P<0.01),而在生活满意度因子上,残疾人得分显著低于正常人(t=-3.943,P<0.01);②主观幸福感与生活满意度(P<0.01)、信赖他人(P<0.05)呈正相关,而与焦虑、敌对和人际敏感呈负相关(P<0.01);生活满意度与自我价值感呈正相关(P<0.05),与抑郁(P<0.01)、焦虑(P<0.01)、敌对(P<0.05)和人际敏感(P<0.05)呈负相关;自我价值感与抑郁(P<0.05)、人际敏感(P<0.01)呈负相关,与信赖他人呈正相关(P<0.01)。结论与正常人群体相比,残疾人心理生活质量整体较差;残疾人的幸福感、自我价值感、情绪状况及人际关系各维度之间相互影响。