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The Impact of Individual Depressive Symptoms on Impairment of Psychosocial Functioning  [PDF]
Eiko I. Fried, Randolph M. Nesse
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0090311
Abstract: Previous studies have established that scores on Major Depressive Disorder scales are correlated with measures of impairment of psychosocial functioning. It remains unclear, however, whether individual depressive symptoms vary in their effect on impairment, and if so, what the magnitude of these differences might be. We analyzed data from 3,703 depressed outpatients in the first treatment stage of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Participants reported on the severity of 14 depressive symptoms, and stated to what degree their depression impaired psychosocial functioning (in general, and in the five domains work, home management, social activities, private activities, and close relationships). We tested whether symptoms differed in their associations with impairment, estimated unique shared variances of each symptom with impairment to assess the degree of difference, and examined whether symptoms had variable impacts across impairment domains. Our results show that symptoms varied substantially in their associations with impairment, and contributed to the total explained variance in a range from 0.7% (hypersomnia) to 20.9% (sad mood). Furthermore, symptoms had significantly different impacts on the five impairment domains. Overall, sad mood and concentration problems had the highest unique associations with impairment and were among the most debilitating symptoms in all five domains. Our findings are in line with a growing chorus of voices suggesting that symptom sum-scores obfuscate relevant differences between depressed patients and that substantial rewards will come from close attention to individual depression symptoms.
Biomarkers and Depressive Symptoms in Older Women with and without Cognitive Impairment  [PDF]
James R. Hall, Leigh A. Johnson, Hoa T. Vo, Robert C. Barber, A. Scott Winter, Sid E. O’Bryant
Journal of Behavioral and Brain Science (JBBS) , 2012, DOI: 10.4236/jbbs.2012.22031
Abstract: A number of biological markers have been implicated in late life depression with inconsistent results. The present study examined the relationship between several serum based biomarkers and symptoms of depression in a sample of elderly women with AD or cognitively intact. Methods 171 females (58 with AD and 113 cognitively intact) were recruited from the Longitudinal Research Cohort of the Texas Alzheimer’s Research and Consortium (TARC). Stepwise regressions were conducted with GDS total and subscales and a panel of biomarkers (CRP, IL-10, IL-1α, TNF-α, ICAM-1, BDNF, and MIF). ApoE4 status was coded (carrier or non-carrier), and the results were analyzed by cognitive status (AD or controls). Results: None of the biomarkers significantly predicted total GDS score for AD cases, controls or sample as a whole. For the Controls, ICAM significantly predicted Dysphoria and level of Apathy. Among AD patients, MIF, ICAM, and CRP, were significantly associated with Apathy. MIF and ICAM were inversely associated with reported Apathy. CRP was positively associated with Apathy. CRP was also positively related to level of perceived Cognitive Impairment. Conclusions: The present study was one of the first to examine biomarkers related to depression symptoms in elderly women with AD and normal controls. For Controls ICAM alone predicted level of apathy. In the AD group, MIF, CRP, and ICAM were significantly associated with apathy. More research examining the relationship between biomarkers and depression is needed in older patients with and without cognitive impairment across genders.
Peak oxygen uptake and left ventricular ejection fraction, but not depressive symptoms, are associated with cognitive impairment in patients with chronic heart failure
Steinberg G,Lossnitzer N,Schellberg D,Mueller-Tasch T
International Journal of General Medicine , 2011,
Abstract: Gerrit Steinberg1,2*, Nicole Lossnitzer2*, Dieter Schellberg2, Thomas Mueller-Tasch2, Carsten Krueger3, Markus Haass4, Karl Heinz Ladwig5, Wolfgang Herzog2, Jana Juenger21University Hospital of Psychiatry, University of Bern, Bern, Switzerland; 2Department of Psychosomatic and General Internal Medicine, Medical Hospital, University of Heidelberg, Heidelberg, 3Department of Cardiology, Josefs Hospital, Heidelberg, 4Department of Cardiology, Theresien Hospital, Mannheim, 5Institute of Epidemiology, German Research Center for Environmental Health, Munich, Germany*both authors contributed equally to this paperBackground: The aim of the present study was to assess cognitive impairment in patients with chronic heart failure (CHF) and its associations with depressive symptoms and somatic indicators of illness severity, which is a matter of controversy.Methods and results: Fifty-five patients with CHF (mean age 55.3 ± 7.8 years; 80% male; New York Heart Association functional class I–III) underwent assessment with an expanded neuropsychological test battery (eg, memory, complex attention, mental flexibility, psychomotor speed) to evaluate objective and subjective cognitive impairment. Depressive symptoms were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID) and a self-report inventory (Hospital Anxiety and Depression Scale [HADS]). A comprehensive clinical dataset, including left ventricular ejection fraction, peak oxygen uptake, and a 6-minute walk test, was obtained for all patients. Neuropsychological functioning revealed impairment in 56% of patients in at least one measure of our neuropsychological test battery. However, the Mini Mental State Examination (MMSE) could only detect cognitive impairment in 1.8% of all patients, 24% had HADS scores indicating depressive symptoms, and 11.1% met SCID criteria for a depressive disorder. No significant association was found between depressive symptoms and cognitive impairment. Left ventricular ejection fraction was related to subjective cognitive impairment, and peak oxygen uptake was related to objective cognitive impairment.Conclusion: Cognitive functioning was substantially reduced in patients with CHF and should therefore be diagnosed and treated in routine clinical practice. Caution is advised when the MMSE is used to identify cognitive impairment in patients with CHF.Keywords: chronic heart failure, cognitive impairment, neuropsychological testing, depressive symptoms, peak oxygen uptake, quality of life
Peak oxygen uptake and left ventricular ejection fraction, but not depressive symptoms, are associated with cognitive impairment in patients with chronic heart failure
Steinberg G, Lossnitzer N, Schellberg D, Mueller-Tasch T, Krueger C, Haass M, Ladwig KH, Herzog W, Juenger J
International Journal of General Medicine , 2011, DOI: http://dx.doi.org/10.2147/IJGM.S23841
Abstract: k oxygen uptake and left ventricular ejection fraction, but not depressive symptoms, are associated with cognitive impairment in patients with chronic heart failure Original Research (2895) Total Article Views Authors: Steinberg G, Lossnitzer N, Schellberg D, Mueller-Tasch T, Krueger C, Haass M, Ladwig KH, Herzog W, Juenger J Published Date December 2011 Volume 2011:4 Pages 879 - 887 DOI: http://dx.doi.org/10.2147/IJGM.S23841 Gerrit Steinberg1,2*, Nicole Lossnitzer2*, Dieter Schellberg2, Thomas Mueller-Tasch2, Carsten Krueger3, Markus Haass4, Karl Heinz Ladwig5, Wolfgang Herzog2, Jana Juenger2 1University Hospital of Psychiatry, University of Bern, Bern, Switzerland; 2Department of Psychosomatic and General Internal Medicine, Medical Hospital, University of Heidelberg, Heidelberg, 3Department of Cardiology, Josefs Hospital, Heidelberg, 4Department of Cardiology, Theresien Hospital, Mannheim, 5Institute of Epidemiology, German Research Center for Environmental Health, Munich, Germany *both authors contributed equally to this paper Background: The aim of the present study was to assess cognitive impairment in patients with chronic heart failure (CHF) and its associations with depressive symptoms and somatic indicators of illness severity, which is a matter of controversy. Methods and results: Fifty-five patients with CHF (mean age 55.3 ± 7.8 years; 80% male; New York Heart Association functional class I–III) underwent assessment with an expanded neuropsychological test battery (eg, memory, complex attention, mental flexibility, psychomotor speed) to evaluate objective and subjective cognitive impairment. Depressive symptoms were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID) and a self-report inventory (Hospital Anxiety and Depression Scale [HADS]). A comprehensive clinical dataset, including left ventricular ejection fraction, peak oxygen uptake, and a 6-minute walk test, was obtained for all patients. Neuropsychological functioning revealed impairment in 56% of patients in at least one measure of our neuropsychological test battery. However, the Mini Mental State Examination (MMSE) could only detect cognitive impairment in 1.8% of all patients, 24% had HADS scores indicating depressive symptoms, and 11.1% met SCID criteria for a depressive disorder. No significant association was found between depressive symptoms and cognitive impairment. Left ventricular ejection fraction was related to subjective cognitive impairment, and peak oxygen uptake was related to objective cognitive impairment. Conclusion: Cognitive functioning was substantially reduced in patients with CHF and should therefore be diagnosed and treated in routine clinical practice. Caution is advised when the MMSE is used to identify cognitive impairment in patients with CHF.
Adult separation anxiety in patients with complicated grief versus healthy control subjects: relationships with lifetime depressive and hypomanic symptoms
Liliana Dell'Osso, Claudia Carmassi, Martina Corsi, Irene Pergentini, Chiara Socci, Angelo GI Maremmani, Giulio Perugi
Annals of General Psychiatry , 2011, DOI: 10.1186/1744-859x-10-29
Abstract: A total of 53 patients with CG and 50 healthy control subjects were consecutively recruited and assessed by means of the Structured Clinical Interview for DSM-IV Axis-I disorders (SCID-I/P), Inventory of Complicated Grief (ICG), Adult Separation Anxiety Questionnaire (ASA-27), Work and Social Adjustment Scale (WSAS) and Mood Spectrum-Self Report (MOODS-SR) lifetime version.Patients with CG reported significantly higher scores on the MOODS-SR, ASA-27, and WSAS with respect to healthy control subjects. The scores on the ASA-27 were significantly associated with the MOODS-SR depressive and manic components amongst both patients and healthy control subjects, with a stronger association in the latter.A major limitation of the present study is the small sample size that may reduce the generalizability of the results. Moreover, lifetime MOODS-SR does not provide information about the temporal sequence of the manic or depressive symptoms and the loss. The frequent comorbidity with MD and the association with both depressive and manic lifetime symptoms do not support the independence of CG from mood disorders. In our patients, CG is associated with high levels of separation anxiety in adulthood. However, the presence of lifetime mood instability, as measured by the frequent presence of depressive and hypomanic lifetime symptoms, suggests that cyclothymia might represent the common underlying feature characterizing the vulnerability to both adult separation anxiety and CG.A growing body of literature provides evidence that a minority of individuals (9% to 20%) that experience the loss of a relative or a significant other may report symptoms of unresolved grief that are associated with significant distress and impairment, heightened risk for depression, anxiety, alcohol and tobacco consumption, and suicidal ideation [1-8]. Increasing amounts of research have been focused on identifying the specific set of psychiatric symptoms that characterize this condition, corroborating the
Depressive Symptom Endorsement among Alzheimer’s Disease, Vascular Dementia and Mild Cognitive Impairment  [PDF]
James R. Hall, Leigh Johnson, April Wiechmann, Robert C. Barber, Sid O’Bryant
Open Journal of Medical Psychology (OJMP) , 2012, DOI: 10.4236/ojmp.2012.13006
Abstract: Background: The Geriatric Depression Scale (GDS) is widely used to assess depressive symptoms in clinical and research settings. This study utilized a 4 factor solution for the 30-item GDS to explore differences in the presentation of depressive symptoms in various types of cognitive impairment. Method: Retrospective chart review was conducted on 254 consecutive cases of community dwelling elderly newly diagnosed with mild Alzheimer’s Dementia (AD) n = 122, mild Vascular Dementia (VaD) n = 71 or Amnestic Mild Cognitive Impairment (aMCI) n = 32 and Non-Amnestic MCI (nMCI) n = 29. Results: Analysis revealed no significant differences (p < 0.05) between the groups for total GDS score, the Dysphoria subscale or Cognitive Impairment subscale. AD endorsed significantly fewer symptoms than VaD on Apathy, Meaninglessness and Dysphoria. AD did not endorse a significantly different number of items than aMCI on any of the subscales. AD endorsed significantly fewer items than nMCI on Apathy and Meaninglessness. VaD endorsed significantly more items than the aMCI only on the Meaninglessness subscale (p > 05). No statistically significant differences were found between VaD and nMCI or between the MCI groups. Conclusions: Support is provided for the use of GDS subscales in a wide range of cognitively impaired elderly. This study suggests in mild dementia the number and type of depressive symptoms vary significantly between AD and VaD. There are indications that aMCI patients are similar in their symptom endorsement to AD and nMCI are similar to VaD which is consistent with some of the notions regarding likely trajectories of the respective MCI groups.
Prevalence of depressive symptoms among non insulin treated Greek type 2 diabetic subjects
Alexios Sotiropoulos, Athanasia Papazafiropoulou, Ourania Apostolou, Anthi Kokolaki, Aristofanis Gikas, Stavros Pappas
BMC Research Notes , 2008, DOI: 10.1186/1756-0500-1-101
Abstract: The study sample consisted of 320 T2D subjects without overt macrovascular disease attending the diabetes outpatient clinic of our hospital, from June 2007 to December 2007. Depressive symptoms were measured using the 21-item Beck Depression Inventory, modified for use in diabetic subjects.Of the study subjects 107 (33.4%) reported elevated depressive symptoms. More women than men with diabetes reported symptoms of depression (48.4% vs. 12.7%, P < 0.001). In the female study group, depressive symptoms were correlated with HbA1c (P = 0.04), and duration of diabetes (P = 0.004). In the male study group, univariate linear regression analysis showed no significant relationships between depressive symptoms and the testing variables.The prevalence of depression in Greek T2D subjects is high. Diabetic female subjects showed increased levels of depressive symptoms compared with male subjects. Independent risk factors of depressive symptoms in diabetic female subjects were diabetes duration and glycemic control.Depression is common among people with diabetes [1], especially among those with diabetic complications [2]. Depression has been associated with poor adherence to medication [3], poor glycemic control [4], as well as with the development of diabetic complications [5] and increased mortality [6]. Several studies focusing on the prevalence of depression in people with diabetes have been done, showing different depression rates [7,8].The available data regarding the prevalence of depression among subjects with type 2 diabetes (T2D) in Greece are limited. We, therefore, conducted the present study to evaluate the prevalence of depressive symptoms as well as gender differences in subjects with T2D. In addition, the relationship between depressive symptoms and glycemic control was examined.The study sample consisted of 320 subjects (age 35–70 years) with T2D attending the diabetes outpatient clinic of our hospital, from June 2007 to December 2007. T2D was diagnosed accordin
Biomarkers and Depressive Symptoms in a Sample of Cognitively Intact and Alzheimer’s Disease Elderly Males  [PDF]
James R. Hall, Hoa T. Vo, Leigh A. Johnson, Scott Winter, Robert C. Barber, Sid E. O’Bryant
Neuroscience & Medicine (NM) , 2011, DOI: 10.4236/nm.2011.24040
Abstract: Serum-based biomarkers and GDS-30 score and subscales of depressive symptoms were examined in a cross-sectional sample of 81 elderly men drawn from the TARCC cohort. Measurements included neuropsychological assessment and serum. Thirty three patients met consensus diagnosis for probable AD and forty eight were cognitively intact. Although initial regression analysis of all subjects showed significant relationships between depression and specific biomarkers, analyses based on diagnosis indicated that none of the biomarkers were significantly associated with depression among the controls. Among AD males MIF was significantly associated with total GDS scores and subscales of dysphoria, meaninglessness, and cognitive impairment. TNF-α was significantly associated with the apathy in AD males. Higher levels of MIF were associated with less depression in AD men. TNF-α was positively associated with degree of apathy. This study suggests the importance of cognitive status, gender and subtypes of depression when investigating biomarkers and depression in the elderly.
Comparison of Pulmonary Function, Physical Function, Quality of Life, Depressive Symptoms and Cognitive Abilities between Patients with Chronic Obstructive Pulmonary Disease and Healthy Subjects  [PDF]
B. Taspinar,S. Gursoy,S. Baser,F. Evyapan
Journal of Medical Sciences , 2010,
Abstract: The aim of this study is to compare pulmonary function, physical function, quality of life, depressive symptoms and cognitive abilities of patients with COPD and healthy subjects in order to describe how patients are affected and to organize the most suitable treatment program. The study was carried out in School of Physical Therapy and Rehabilitation at Pamukkale University. Fifty COPD patients aged between 47-81 years who were followed by Pamukkale University, Medical Faculty, Department of Pulmonary Disease were included in the study. Fifty healthy subjects aged between 55-83 years participated as controls. The average age of all subjects was 65.24±7.45. Pulmonary function tests, physical performance test, St. George Respiratory Questionnaire, Beck Depression Questionnaire and Mini Mental Test were used to evaluate all the subjects. The results of this study showed that COPD affects quality of life, physical function, psychological and cognitive function, beside pulmonary functions. When the results belonging to the groups were compared, there was significant difference between the groups in terms of all measurements (p = 0.0001). Therefore, physical therapists should evaluate COPD patients with these functional tests to prepare the most suitable rehabilitation program.
Depressive Symptom Clusters and Neuropsychological Performance in Mild Alzheimer's and Cognitively Normal Elderly  [PDF]
James R. Hall,Sid E. O'Bryant,Leigh A. Johnson,Robert C. Barber
Depression Research and Treatment , 2011, DOI: 10.1155/2011/396958
Abstract: Objectives. Determine the relationship between depressive symptom clusters and neuropsychological test performance in an elderly cohort of cognitively normal controls and mild Alzheimer's disease (AD). Design. Cross-sectional analysis. Setting. Four health science centers in Texas. Participants. 628 elderly individuals (272 diagnosed with mild AD and 356 controls) from ongoing longitudinal study of Alzheimer's disease. Measurements. Standard battery of neuropsychological tests and the 30-item Geriatric Depression Scale with regressions model generated on GDS-30 subscale scores (dysphoria, apathy, meaninglessness and cognitive impairment) as predictors and neuropsychological tests as outcome variables. Follow-up analyses by gender were conducted. Results. For AD, all symptom clusters were related to specific neurocognitive domains; among controls apathy and cognitive impairment were significantly related to neuropsychological functioning. The relationship between performance and symptom clusters was significantly different for males and females in each group. Conclusion. Findings suggest the need to examine disease status and gender when considering the impact of depressive symptoms on cognition. 1. Introduction A number of studies have reported an association between depressive symptoms and cognitive dysfunction in the elderly [1–3] with scores on depression scales being significantly related to specific neurocognitive domains of visuospatial skills, executive functioning, psychomotor speed, as well as memory [4–6]. Depressed but cognitively normal elderly subjects often differ in their performance on neuropsychological tests from Alzheimer’s disease (AD) patients [7]. Specific patterns of performance on neuropsychological tests have been found to differentiate depression from AD [8]. However, little research has examined the potential impact of specific depressive symptoms or symptom clusters on detailed neuropsychological functioning. The majority of research examining the neurocognitive consequences of depression has utilized total scores on depression scales, groupings based on cutoff scores on a rating scale, or diagnosis of a depressive disorder based on a variety of criteria (e.g., DSM-IV-TR). However, symptom clusters as well as depressive endophenotypes have been well documented to have clinical relevance. Furthermore, the treatment of depression as a unitary concept obscures the link between specific areas of cognitive functioning and these depressive symptom clusters. The limited research that has been conducted with depressive symptom
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