Validation of self‐report depression rating scales in Huntington's disease

The aim of this study was to assess the criterion validity of three self‐report measures of depression in a sample of patients with Huntington's disease (HD). Fifty patients with HD completed the Beck Depression Inventory‐II (BDI‐II), the Hospital Anxiety and Depression Scale (HADS), and the Depression Intensity Scale Circles (DISCs). Current psychiatric status was assessed using the schedules for clinical assessment in neuropsychiatry (SCAN), and ICD‐10 diagnosis was used as the gold standard. Receiver operating characteristics (ROC) curves were obtained and the sensitivity, specificity, positive, and negative predictive values were calculated for different cut‐off scores on each rating scale. Twelve patients (24%) met ICD‐10 criteria for depressive disorder. The depression sub‐scale of the HADS (HADS‐D) at an optimal cut‐off of 6/7 was found to discriminate maximally between depressed and nondepressed patients in this population. The DISCs at a cut‐off of 1/2 also performed well at detecting possible “cases” of depression, whereas the BDI‐II performed the least satisfactorily of all scales. The HADS‐D and DISCs are good screening measures for depression in the HD population and the DISCs may be particularly useful in those patients with more severe communicative and cognitive deficits. © 2009 Movement Disorder Society     

Does admission to a hospital geriatric psychiatry programme improve benzodiazepine and other drug use?

Seventy-five consecutive patients admitted to a hospital geriatric psychiatry unit had their medication reviewed on admission and at discharge. Use of benzodiazepines declined significantly from 40% to 20% of patients, but use of other therapeutic groups showed no significant change. The number of patients taking drug combinations with potentially adverse side-effects decreased significantly between admission (21) and discharge (7). The use of relatively contraindicated drugs also declined. Drug utilization review is a valuable technique for drawing attention to potential problems of prescribing for elderly people.     

Evaluation of three aggression/agitation behaviour rating scales for use on an acute admission and assessment psychogeriatric ward

Background. In recent years many instruments measuring aggressive and agitated behaviours among the elderly in a variety of settings have emerged. Individual instruments have only occasionally been compared with each other. Method. Some psychometric properties of three aggression/agitation scales on an acute assessment and admission psychogeriatric ward were examined. The correlation between the Rating Scale for Aggressive Behaviour in the Elderly (RAGE), the Cohen-Mansfield Agitation Inventory (CMAI) and the Brief Agitation Rating Scale (BARS) and their internal consistencies and test–retest and interrater reliabilites were measured. Results. The RAGE was strongly correlated with the CMAI (rho=+0.73) and the BARS (rho=+0.72). The CMAI was strongly correlated with the CMAI (rho=+0·84). The internal consistency, as measured by Cronbach's alpha, was greater than 0·8 on all three scales. The test–retest and interrater reliability correlations were 0·75 or greater for all three scales (except the BARS interrater reliability correlation of 0·6). Conclusions. All three scales have good psychometric properties for use in acute admission and assessment psychogeriatric wards. © 1998 John Wiley & Sons, Ltd.     

A comparison of the performance of rating scales used in the diagnosis of postnatal depression

The results of a study looking into the association between thyroid status and depression in the postpartum period were reanalysed to explore the psychometric properties of the rating scales employed. The performance of the Edinburgh Postnatal Depression Scale was found to be superior to that of the Hospital Anxiety and Depression Scale in identifying RDC-defined depression, and on a par with the observer-rated Hamilton Rating Scale for Depression, which it also matched for sensitivity to change in mood state over time. The anxiety subscale of the Hospital Anxiety and Depression Scale performed well, reflecting the fact that anxiety represents a prominent symptom in postnatal depression.     

Comorbidity of depression and anxiety disorders in later life.

Since psychiatric disorders differ throughout the lifespan in phenomenology, course, and treatment, there is need for study of comorbidity of such disorders in geriatric populations. Prior findings of low prevalence of comorbid late-life anxiety disorders in depressed elderly are now disputed by recent studies. Risk factors for comorbid late-life depression and anxiety may be different from those for depression without anxiety. Similar to adults, elderly depressives with comorbid anxiety symptoms present with more severe pathology and have a more difficult course of illness, including decreased or delayed treatment response. In this paper, we review the literature on anxiety and depression comorbidity in late life, and we make recommendations for the assessment and treatment of comorbid late-life anxiety and depression. We also recommend directions for future research in the area of psychiatric comorbidity in late life.     

The practice of geriatric psychiatry in three countries: observations of an American in the British Isles

The author compares the practice of geriatric psychiatry among three countries: Ireland, the United Kingdom and the United States. The two main areas reviewed are how the practice of geriatric psychiatry is done, and the mental health services available in each country, including organizational characteristics. The US is the most entrepreneurial of the three, Britain's greatest strength is the uniformity and comprehensiveness of its services, and Ireland provides an excellent model for nations of comparable size. Considerable change is occurring in all three countries. © 1997 John Wiley & Sons, Ltd.     

Decreased between‐hemisphere connectivity strength and network efficiency in geriatric depression

White matter (WM) lesions have been recognized as a key etiological factor in geriatric depression. However, little is known about the topological pattern changes of WM in geriatric depression in the remitted state (RGD) and its relationship to depressive episodes. To address these questions, we acquired diffusion tensor images in 24 RGD and 24 healthy participants. Among them, 10 patients and 19 healthy controls completed a 1‐year follow up. Between‐hemisphere connectivity and graph theoretical methods were used to analyze the data. We found significantly reduced WM connectivity between the left and right hemisphere in the RGD group compared with the control group. Those with multiple depression episodes had greater reduction in between‐hemisphere connectivity strength than those with fewer episodes. In addition, the RGD group had a reduced global clustering coefficient, global efficiency, and network strength, and an increased shortest path length compared with the controls. A lower clustering coefficient was correlated with poorer memory function. The reduction of nodal clustering coefficient, global efficiency, and network strength in several regions were associated with slower information processing speed. At 1‐year follow up, the network properties in the RGD subjects were significantly changed suggesting instability of WM network properties of depressed patients. Together, our study provides direct evidence of reduced between‐hemisphere WM connectivity with greater depressive episodes, and of alterations of network properties with cognitive dysfunction in geriatric depression. Hum Brain Mapp 38:53–67, 2017. © 2016 Wiley Periodicals, Inc.     

Subjective health measures and acute treatment outcomes in geriatric depression.

BACKGROUND: Prior research suggests that elderly patients are less likely to respond to antidepressant treatment if they have low self-rated health. However, successful treatment for depression has been associated with improvement in self-rated health and other health measures. OBJECTIVES: To examine measures of self-rated health, physical disability, and social function as predictors of treatment response in late-life depression, and to assess these same health measures as treatment outcomes. We hypothesized that greater impairment in these measures would predict poorer treatment response, and that these measures would show significant improvements with recovery from depression. METHOD: Subjects were enrolled in a depression intervention study for people aged 60 and older with recurrent unipolar major depression; they were assessed with measures of self-rated health, physical disability, and social functioning at baseline and at the end of treatment. Baseline measures were compared between the 88 remitters, 11 non-remitters, and seven dropouts. Additionally, changes in the measures were examined in subjects who recovered from the index depressive episode. RESULTS: Subjects with poorer self-rated health at baseline were more likely both to drop out of treatment and to not respond to adequate treatment. This relationship was independent of demographic measures, severity of depression, physical and social functioning, medical illness, personality, hopelessness, overall medication use, and side effects or non-compliance with treatment. CONCLUSION: Although this finding is preliminary because of the small number of dropouts and non-remitters, it suggests that lower self-rated health may independently predict premature discontinuation of treatment for depression. Additionally, subjects who recovered from depression showed significant improvements in self-rated health, physical disability, and social functioning.     

Plasma BDNF and tPA are associated with late‐onset geriatric depression

Aims: Studies in the recent decade have shown that brain‐derived neurotrophic factor (BDNF) may play an important role in the pathogenesis of major depressive disorder (MDD). Tissue‐type plasminogen activator (tPA) has been implicated in the control of the direction of BDNF action. The aim of the study was therefore to investigate the changes of BDNF/tPA levels and their clinical meanings in geriatric depression. Methods: Plasma BDNF and tPA levels were measured in late‐onset geriatric depression (LGD) before treatment (n = 24) and after 6 weeks of antidepressant treatment (n = 24) compared with control subjects (n = 30) using enzyme‐linked immunosorbent assay. The severity of depression was assessed with the Hamilton Depression Rating Scale. Results: Baseline plasma BDNF and tPA levels were significantly lower in LGD patients compared to controls (P = 0.037 and P = 0.000, respectively). There was a heightening tendency of plasma BDNF level after treatment. Conclusions: Plasma BDNF and tPA levels are associated with LGD. The complex mechanism of BDNF and tPA in LGD should be further explored in future studies.     

Evaluation of the hospital anxiety and depression scale as a screening instrument in geriatric medical inpatients

The Hospital Anxiety and Depression Scale (HAD) was developed as a screening instrument for use in medical patients. The depression subscale has been validated as a measure of severity in elderly depressed psychiatric inpatients. This study assessed its usefulness as a screening instrument in inpatients in a geriatric medical unit. One hundred geriatric inpatients were evaluated using the Geriatric Mental State (Community Version) to identify cases. The HAD lacked sensitivity and specificity in this situation.     

Anxiety impairs depression remission in partial responders during extended treatment in late‐life

Objectives: More than half of older adults with major depressive disorder require extended treatment because of incomplete response during acute treatment. This study characterizes the effect of anxiety on remission during extended treatment for partial responders. Methods: Following 6 weeks of escitalopram 10 mg/day+depression care management (DCM), 124 partial responders (Hamilton Rating Scale for Depression (HRSD) scores of 11–14) were randomly assigned to receive extended treatment with escitalopram 20 mg/day+DCM with or without interpersonal psychotherapy (IPT) for 16 weekly sessions. Remission was defined as three consecutive weekly scores ≤7 on the HRSD. We assessed concurrent symptoms of anxiety using the Hamilton Rating Scale for Anxiety at pretreatment and after 6 weeks. We conducted Cox regression analysis of time to remission and logistic modeling of rates of remission. We also explored whether anxiety severity altered any impact of IPT. Results: Pretreatment anxiety was not associated with time to or rates of remission during 16 weeks of extended treatment. In contrast, more severe psychological symptoms of anxiety after 6 weeks of treatment was associated with both longer time to and lower rates of remission. However, there was no evidence that IPT showed any differential effects as a function of anxiety. Conclusions: In partial responders to 6 weeks of lower‐dose escitalopram and DCM, planning for extended treatment should account for psychological symptoms of anxiety. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

An informant interview for the diagnosis of dementia and depression in older adults (IDD-GMS)

Background. There has been no instrument developed for the differential diagnosis of psychiatric conditions using an informant. The present study describes the development and validation of an informant interview for the diagnosis of dementia and depression in older adults (IDD-GMS). The IDD-GMS, as its name indicates, is based upon the well-established Geriatric Mental State Schedule (GMS). Method. Thirty older adults with psychiatric illnesses were identified. An informant/carer was interviewed using the IDD-GMS. Questions from the GMS were altered to reflect the informant nature of the interview. Validity was compared to ICD-10 diagnoses. Interrater reliability was determined. Results. Using a hierarchical diagnostic system, receiver operating characteristics demonstrated one optimal cutpoint for sensitivity, >13 for dementia and >16 for depression, and one for specificity, >13 for dementia and >10 for depression. Conclusion. The validity and reliability of the IDD-GMS falls within acceptable limits and indicates that the IDD-GMS can be used as a diagnostic instrument for dementia and depression. The IDD-GMS represents the first informant interview to achieve this. © 1998 John Wiley & Sons, Ltd.