Types of childhood trauma and spirituality in adult patients with depressive disorders

ObjectiveThe aim of this study was to investigate the differences in spirituality among adult patients with depressive disorders, who had suffered various types of abuse or neglect in childhood.MethodsA total of 305 outpatients diagnosed with depressive disorders completed questionnaires on socio-demographic variables, childhood trauma history, and spirituality. We used the Childhood Trauma Questionnaire-Short Form (CTQ-SF) to measure five different types of childhood trauma (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-Sp-12) to assess spirituality.ResultsDepressive symptoms and total CTQ-SF scores showed a negative correlation with spirituality. In the regression model, being older and belonging to a religion significantly predicted greater spirituality. Depressive symptoms significantly predicted lower spirituality. From among the five types of childhood trauma assessed by the CTQ-SF, only emotional neglect significantly predicted lower spirituality.ConclusionA history of childhood emotional neglect was significantly related to lower spirituality, especially in the case of the Meaning aspect of spirituality. This finding suggests the potential harmful influence of childhood emotional neglect on the development of spirituality in psychiatric patients. Investigating different aspects of childhood trauma might be important in order to develop a more comprehensive psychiatric intervention that aids in the development of spirituality.     

Gender differences in treatment response to sertraline versus imipramine in patients with nonmelancholic depressive disorders

There is evidence of gender differences in depressive disorders in terms of epidemiology and clinical manifestations. However, few studies have addressed the gender differences in terms of antidepressant treatment response in clinical practice. The aim of this study was to examine gender differences in the acute antidepressant response to sertraline and imipramine in nonmelancholic depressive disorders. A total of 239 patients with nonmelancholic major depression or dysthymia (DSM-III-R) and a score of >/=18 at baseline on the Hamilton Depression Rating Scale (HAM-D) were randomised in a 1:1 ratio treatment with flexible doses of sertraline (50-200 mg/day) or imipramine (75-225 mg/day) for 8 weeks in a multicenter, randomised, open-labeled, parallel group comparative trial. Depressive and anxiety symptoms were assessed using the HAM-D and the Hamilton Anxiety Rating Scale (HAM-A). Using HAM-D criteria, women were significantly more likely to respond to sertraline than to imipramine (72.2% vs. 52.1%, P=.008), whilst men respond similarly to sertraline and to imipramine (56.5% vs. 59.3%, P>.05). Response analysis based on HAM-A shows similar results (women: 68.9% vs. 43.6%, P=.001; men: 56.5% vs. 51.9%, P>.05). Women taking sertraline show statistically significant higher reductions in HAM-D, HAM-A, and in CGI-S than women taking imipramine. The proportion of women who dropped out due to adverse events was much lower in sertraline than in imipramine (10.9% vs. 27.8%, P=.006), with no differences between treatments in men (8.3% vs. 11.5%, P>.05). It was concluded that sertraline is more effective and better tolerated than imipramine in the acute treatment of nonmelancholic depressive disorders in women, whereas men responded similarly to sertraline and to imipramine.     

Satisfaction with treatment among patients with depressive and bipolar disorders

BACKGROUND: Patients' satisfaction with care may be an important factor in relation to adherence to treatment and continued psychiatric care. Few studies have focused on satisfaction in patients with depressive and bipolar disorders. METHOD: A comprehensive multidimensional questionnaire scale, the Verona Service Satisfaction Scale-Affective, was mailed to a large population of patients with depressive or bipolar disorders representative of outpatients treated at their first contact to hospital settings in Denmark. RESULTS: Among the 1,005 recipients, 49.9% responded to the letter. Overall, patients were satisfied with the help provided, but satisfaction with the professionals' contact to relatives was low. Younger patients (age below 40 years) were consistently more dissatisfied with care especially with the efficacy of treatment, professionals' skills and behaviour and the information given. There was no difference in satisfaction between genders or between patients with depressive disorder and patients with bipolar disorder. CONCLUSION: There is a need to strengthen outpatient treatment for patients discharged from a psychiatric hospital diagnosed of having affective disorders, focusing more on information and psychoeducation for patients and relatives.     

The predictive value of early response in patients with depressive disorders

Objective: Several randomized controlled trials have identified early response to psychotherapy as a predictor for later treatment outcome among patients with depressive disorders. However, supporting evidence under routine conditions is rare. This study evaluated the predictive value of early improvement for final outcomes in psychotherapy among depressive patients in the naturalistic setting of a German university outpatient clinic. Method: We used the method of percent symptom reduction to classify 639 patients with major depression or dysthymic disorder who underwent an average of 40.0 sessions (SD?=?16.3) of naturalistic cognitive–behavioral therapy (CBT) as having either an early response or an early nonresponse. Results: Early response was a good predictor for final response and remission regarding depressive symptoms (OR?=?8.75 and OR?=?5.32, respectively), as well as overall psychological distress (OR?=?3.95 and OR?=?3.16, respectively). Early nonresponse was distinctly associated with later deterioration of both depressive (OR?=?9.56) and general psychological symptomatology (OR?=?4.92). Conclusions: Early response to psychotherapy has high predictive qualities for positive later treatment outcome in depressive patients under routine CBT. Therefore, early treatment effects should be considered in clinical decision-making and treatment planning in everyday clinical practice.     

阿戈美拉汀治疗抑郁障碍患者快感缺失的疗效研究

目的 评价阿戈美拉汀治疗抑郁障碍患者快感缺失的疗效。方法 本研究共纳入58 例抑郁障碍患者,所有受试者接受阿戈美拉汀（25～50 mg/d,可变剂量）治疗8 周。采用Snaith 汉密尔 顿快感缺失量表（SHAPS）、蒙哥马利抑郁评定量表（MADRS）评估患者抑郁及快感缺失的情况,采 用Sheehan 残疾量表（SDS）和世界卫生组织的5 项健康指数（WHO-5）量表评估患者功能损害和生 活质量。结果 （1）阿戈美拉汀治疗8 周后,SHAPS 终点的临床应答和缓解率分别为64.71%（33/51）和 58.82%（30/51）,SHAPS 和MADRS 快感缺失因子分较基线显著改善（P＜ 0.01）。（2）回归分析显示,性别、 首发年龄和精神疾病家族史影响患者快感缺失的缓解。（3）治疗8 周末,SHAPS 和MADRS 快感缺失因 子分较基线的改善,与WHO-5 和SDS 评分较基线的改善显著相关（P＜ 0.01）。（4）中介分析显示,快感缺 失的改善可调节抑郁症状严重程度和社会功能改善之间的关联。结论 阿戈美拉汀对抑郁症快感缺失 疗效显著,且快感缺失的改善是抑郁症状与社会功能改善之间强有力的中介。     

抑郁障碍抗抑郁治疗早期反应对治疗结局的预测作用研究

目的探讨抗抑郁治疗的早期疗效能否有效预测治疗效果。方法138例抑郁障碍患者,符合国际疾病分类第10版（ICD—10）精神与行为障碍分类系统中中重度抑郁发作、中重度复发性抑郁障碍或双相情感障碍重度抑郁发作的诊断标准,用汉密顿抑郁量表（HAMD）评定疗效。根据治疗1周后HAMD减分率是否大于25％,将研究病例分为早期治疗反应组和早期治疗无反应组。采用末次观察推进法弥补缺省值。结果（1）意向分析结果表明,经过住院抗抑郁治疗后评估期末两组患者治疗均有效（F1=215．98,P=0．000）,但早期反应组治疗效果好于早期治疗无反应组（F2=16．47,P=0．000）。（2）治疗早期反应组痊愈率59．2％（61例）远高于治疗早期无反应组20％（7例）（x2=16．03,P=0．000）。（3）早期反应组住院时间短于早期无反应组（30．7±13．2：68．9±14．8;t=2．92,P=0．004）。（4）治疗早期无反应组男性比例高于早期反应组（71．4％：41．7％;x2=9．27,P=0．002）。结论抗抑郁治疗1周时的HAMD评分变化是治疗5周末疗效的一个重要预测指标,早期治疗反应愈好,终末疗效越好。     

Effects of phosphatidylserine therapy in geriatric patients with depressive disorders.

The effects of phosphatidylserine (BC-PS) on cognitive, affective and behavioural symptoms were studied in a group of 10 elderly women with depressive disorders. Patients were treated with placebo for 15 days, followed by BC-PS (300 mg/day) for 30 days. The Hamilton Rating Scale for Depression, Gottfries-Bråne-Steen Rating Scale, Nurse's Observation Scale for Inpatient Evaluation and Buschke Selective Reminding Test were administered before and after placebo and after BC-PS therapy, to monitor changes in depression, memory and general behaviour. At the same time, basal plasma levels of noradrenaline, MHPG, DOPAC, HVA and 5-HIAA, and GH/β-endorphin/β-lipotropin responses to clonidine stimulation were measured. BC-PS induced consistent improvement of depressive symptoms, memory and behaviour. No changes in amine metabolite levels or in hormonal responses to α₂-adrenoceptor stimulation were observed.     

抑郁症患者SPECT研究

目的 探讨抑郁症脑血流灌注的特点及与临床症状的相关性。方法 开放式收集门诊及住院诊断为抑郁症患者37例,进行治疗前后的^99mTc-双半胱乙脂（ECD）单光子发射型计算机断层扫描（SPECT）技术,测量患者治疗前后脑血流灌注（rCBF）显像,半定量测定rCBF,并与12例正常对照者比较。结果 37例抑郁症患者双侧额叶、双侧颞叶、双侧顶叶,双侧枕叶、左基底核有脑低灌注现象。治疗后临床康复者各部位脑灌注明显改善,差异有显著性（P〈0.05）。结论 抑郁症患者存在额叶、颡叶、顶叶及枕叶多区域的脑血流低灌注,其中以左侧较为明显,治疗后明显改善。     

Relation of intelligence and religiosity to depressive disorders in offspring of depressed and nondepressed mothers

OBJECTIVE: To examine the relation of IQ and religiosity to depressive disorders in adolescents who varied with respect to the chronicity of their mothers' depression history. METHOD: Participants were 240 adolescents first evaluated when they were in 6th grade and then annually for 6 years. Adolescents' depressive diagnoses were assessed initially with the Schedule for Affective Disorders and Schizophrenia for School-Age Children and then annually with the Longitudinal Interval Follow-up Evaluation for children. RESULTS: IQ, but not religiosity, moderated the relation between chronicity of maternal depression and depressive disorders in adolescents. For children of mothers with no or less chronic depression, higher IQ was associated with a lower likelihood of depression; in contrast, for children of mothers with a history of more chronic depression, higher levels of IQ were significantly associated with a greater likelihood of depression. Depressive episodes during grades 7 through 11 predicted lower religious attendance during 12th grade, controlling for prior religiosity. There also was a marginally significant trend for religious attendance in 6th grade to predict lower odds of developing depressive diagnoses during grades 7 through 12. CONCLUSIONS: These results highlight the complex relation between IQ and depression and indicate the possibility of a bidirectional relation between religious attendance and adolescent depression.     

Sertraline in the treatment of depressive disorders in patients with Parkinson’s disease

We studied 54 idiopathic Parkinson’s disease (PD) patients with depressive disorders (DD) to compare the efficacy and the effect of treatment with sertraline in the usual formulation and in the liquid oral concentrate (LOC) formulation. After 6 months of sertraline treatment, the Hamilton Depression Rating Scale and the Montgomery and Asberg Depression Rating Scale showed a decrement (p<0.001, for both formulations). Parkinson’s Disease Questionnaire scores improved (p<0.005 for usual formulation and p<0.001 for LOC formulation), as did Clinical Global Impression-Severity of Illness scale and Clinical Global Impression-Global Improvement scale scores (p=0.1, for both formulations). Mini Mental State Examination and Unified Parkinson’s Disease Rating Scale motor subscores did not change. These results suggest that sertraline LOC may also be a useful treatment for DD in PD patients, especially for those with swallowing problems, and have significant benefit for quality of life, without worsening of parkinsonian features.     

The moderating effect of religiosity on caregiving burden and depressive symptoms in caregivers of patients with dementia

Objectives: This study explored whether religiosity/spirituality has a protective role against negative caregiving outcomes, in a large multicenter nationwide sample of caregivers of patients with dementia in South Korea. Additionally, this study was the first to examine whether religiosity/spirituality could affect caregiving outcomes according to the various religious affiliations of caregivers.

Methods: The study was conducted on a sample of 476 caregivers of patients with dementia participated in the Clinical Research Center for Dementia of South Korea (CREDOS). We examined the moderating effect of each of the three dimensions of religiosity/spirituality (organizational religious activity, ORA; non-organizational religious activity, NORA; intrinsic religiosity, IR) on the relationship between activities of daily living (ADL) of patients with dementia and caregiving burden and depressive symptoms of caregivers, using a series of hierarchical regression analyses. In addition, these analyses were conducted according to the religious affiliations of the caregivers.

Results: ORA, NORA, and IR of religiosity/spirituality alleviated the effect of ADL of patients on caregiving burden. ORA and IR moderated the relationship between ADL of patients and depressive symptoms of caregivers. These moderating effects of religiosity on caregiving outcomes were different according to various religious groups.

Conclusion: We have identified religiosity/spirituality as a protective factor for caregivers of patients with dementia. The sub-dimensions of religiosity as moderators were different by religious affiliations of caregivers. Further studies are needed to investigate the specific religiosity-related factors which could positively impact the mental health of the caregivers of patients with dementia by religions.     

Anger in elderly patients with depressive disorders

Objective

This study was conducted to investigate anger in elderly patients with depressive disorders.

Methods

The subjects included 216 elderly patients with depression and 198 controls. All subjects were assessed by the State and Trait Anger Inventory (STAXI), Aggression Questionnaire (AQ), Reaction Inventory (RI).

Results

Elderly patients with depressive disorder showed lower levels of trait anger and anger expression on the STAXI, lower levels of verbal aggression and hostility on the AQ, and lower levels of anger reaction to the unpredictable disruption and disturbances factor, the embarrassing circumstances factor, and the personal disrespect factor on the RI than the controls. In the depression group, the severity of their depression was positively correlated with the trait anger, state anger, anger expression (except ''anger control'') scores on the STAXI; the physical aggression, anger, and hostility scores on the AQ; and the anger reaction to unpredictable disruption and disturbances factor, the embarrassing circumstances factor, and the personal disrespect factor scores on the RI. However, the severity of depression negatively correlated with only anger control on the STAXI. In the linear logistic regression analysis, as there were higher levels of state anger seen in the STAXI, anger on the AQ, anger reaction to unpleasant factors on the RI, and therefore the likelihood of depression would be higher.

Conclusion

Elderly depressive patients are less likely to have anger traits and to express anger than normal elderly. However, in elderly depressive patients, the higher they have severity of depressive symptoms, the higher they reported anger experience and anger expression.     

抑郁障碍急性期单药治疗和联合治疗对患者生活质量的影响

背景 目前,抑郁障碍患者的临床治疗缺乏有针对性的治疗结局评估。生活质量作为一种以患者价值为导向的次要结局,具有较高的评估价值,国内缺少关于评估抑郁障碍急性期不同治疗方案对患者生活质量影响的大样本前瞻性队列研究。目的 探讨抑郁障碍患者急性期单药治疗和联合治疗对其生活质量的影响,以期为抑郁障碍患者优化治疗结局提供参考。方法 采用前瞻性随访队列研究,于2020年8月24日-2021年11月29日,在中国18个城市的22家医院中,纳入符合《精神障碍诊断与统计手册（第5版）》（DSM-5）抑郁发作或复发性抑郁障碍的患者1 330例。根据抑郁障碍急性期治疗方案,将患者分为单药治疗组（n=969）和联合治疗组（n=361）。分别于基线期、治疗半月末以及治疗1、2、3、6、9、12个月末,采用抑郁症状量表（IDS-SR30）、简明幸福与生活质量满意度问卷（Q-LES-Q-SF）、简明健康风险跟踪量表（CHRT）以及席汉残疾量表（SDS）进行评定,于治疗后各访视时间点进行频率、强度及负担自评量表（FIBSER）评定。采用Spearman相关分析考查两组患者生活质量与自杀风险、不良反应以及社会功能损害的相关性。结果 治疗3个月末,单药治疗组Q-LES-Q-SF评分高于联合治疗组,差异有统计学意义（Z=2.008,P<0.05）。两种治疗方案时间效应有统计学意义（F=111.393,P<0.01）。治疗3个月末,单药治疗组和联合治疗组Q-LES-Q-SF评分与CHRT和SDS评分均呈负相关（r=-0.660、-0.712、-0.634、-0.718,P均<0.01）。结论 单药治疗和联合治疗均有助于改善急性期抑郁障碍患者的生活质量,但单药治疗对患者生活质量的改善可能优于联合治疗。     

Electrolytes in erythrocytes of patients with depressive disorders

The concentrations of calcium, sodium, potassium and magnesium in the erythrocytes of patients were measured in the active and remission phases of depressive disorders. Twelve patients in the active phase and 19 patients in remission with major depression were studied and compared with 20 age-matched healthy controls. Patients with major depression in both active and remission phases showed significantly lower calcium concentrations in the erythrocytes compared with controls, although no significant differences in sodium, potassium or magnesium concentrations were found among the three groups. In addition, no differences were found in the electrolyte concentrations between the active and remission phases in the same patients. This calcium concentration had no relationship to the age, gender, or medication drugs of the subjects. Low calcium concentrations were found in the erythrocytes of depressed patients, which may be a relevant marker for depression.     

Interactive effects of systemic inflammation and life stressors on treatment response of depressive disorders

Inflammation is an important contributor in the pathophysiology of depression and recent evidence suggests that systemic inflammation and life stressors have interactive roles in depression onset. The aim of the present study was to investigate the individual and interactive effects of systemic inflammation and life stressors with short- and long-term treatment responses in outpatients with depressive disorders in a naturalistic one-year prospective design.Serum high-sensitivity C-reactive protein (hsCRP) levels were measured and number of stressful life events (SLEs) during the last 3 months were ascertained from 1094 patients at baseline. These patients received initial antidepressant monotherapy, then, for patients with an insufficient response or uncomfortable side effects, next treatment with alternative strategies were administered at every 3 weeks in the acute treatment phase (3, 6, 9, and 12 weeks) and at every 3 months in the continuation treatment phase (6, 9, and 12 months). 12-week and 12-month remission was estimated, defined as a Hamilton Depression Rating Scale score of ≤ 7.In multivariable logistic regression analyses, individual effects were found only between higher baseline serum hsCRP levels (≥1.0 vs. < 1.0 mg/L) and 12-week non-remission. Significant interactive effects between higher hsCRP levels and higher number of SLEs (≥2 vs. < 2) on both 12-week and 12-month non-remission were observed.Combining serum hsCRP levels and number of SLEs might therefore be a useful predictor for short- and long-term treatment responses in patients with depressive disorders receiving pharmacotherapy.     

Psychological treatment of depressive symptoms in patients with medical disorders: A meta-analysis

Objective

It is widely acknowledged that the prevalence of depression in the general population is high, but that it is even higher for patients with medical disorders. Yet, the effectiveness of psychological treatments in these patient populations has not been firmly established.

Methods

We conducted a meta-analysis of randomized controlled studies examining the effects of psychological treatments in patients with 1 of 10 different medical disorders and elevated levels of depression. Extensive searches were performed in PubMed, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials.

Results

We included 23 studies. The overall effect size of the 15 studies that compared psychological treatments with a waitlist or care-as-usual control group was d=1.00 [95% confidence interval (CI), 0.57-1.44] but declined to d=0.42 (95% CI, 0.27-0.58) after removing two outliers with extremely high effects. We tested the type of disorder, inclusion based on diagnostic criteria or symptoms, type of treatment, treatment format, type of control group, and intention-to-treat or completers analyses, but none of these variables were significantly associated with the effect. The four studies that compared one type of psychotherapy to another showed a positive effect of cognitive behavioral therapy and interpersonal therapy compared to supportive therapy (d=0.42; 95% CI, 0.14-0.69). There were not enough studies (n=3) to draw any conclusions about the comparison of psychotherapy to pharmacotherapy.

Conclusion

We conclude that the effects of psychological treatment of patients with medical disorders are very similar to those found in otherwise healthy patients. Treating this comorbid depression should be one of the priorities in medical care settings.     

抑郁障碍患者与焦虑障碍患者的个性测定比较

目的 探讨抑郁障碍患者与焦虑障碍患者的个性特征差异。方法 使用本土化的人格测量工具《中国人个性测量表2》（CPAI-2）对抑郁障碍患者和焦虑障碍患者进行调查。结果 在一般性格特征上两类人群在新颖性（t=2．39,P〈0．05）、多元思考（t=3．01,P〈0．01）、理智-情感（t=3．09,P〈0．01）、阿Q精神（t=2．26,P〈0．05）、老实-圆滑（t=-1．98,P〈0．05）、人际触觉（t=2．57,P〈0．05）等六个方面存在显著差异,在病态性格特征上两类人群在焦虑紧张（t=2．15,P〈0．05）、抑郁（t=-2．48,P〈0．01）、病态依赖（t=-2．34,P〈0．05）、兴奋性（t=2．42,P〈0．05）等四个方面存在显著差异。结论 抑郁障碍患者和焦虑障碍患者的个性特征存在有共性和个性。