Depressive Disorder

The frequency of DSM-III and DSM-III-R schizotypal personality disorder (SPD) symptoms and diagnosis was explored in 39 inpatients classified as borderline by the Diagnostic Interview for Borderlines (DIB) and 19 inpatient major depressive disorder (MDD) controls. Most SPD symptoms in all groups, except the nondepressed borderlines, derived from social-interpersonal items. By DSM-III, 24 borderlines (62%) but only six controls (32%) had cognitive-perceptual SPD symptoms (P = .03), whereas by DSM-III-R only 14 borderlines (36%) and seven controls (37%) had such symptoms. Of the 24 borderlines showing cognitive-perceptual symptoms, 16 also had MDD, a significant difference from the non-MDD borderlines (P = .04). This difference disappears in DSM-III-R. The results suggest that some SPD symptoms in borderlines may be related to a concurrent affective episode. 0 1990 by W. B. Saunders Company.

Little is known about why clinical depression feels so bad, perhaps because optimal neural circuit-based animal models of depression do not yet exist. Our goal here was to develop a strategy of inducing and measuring depressive-like states in the rat using neural circuits as both the independent and major dependent variables. We hypothesized that repeated electrical stimulation of the brain (ESB) within the dorsal periaqueductal gray (dPAG) aversion circuits would lead to a long-lasting suppression of 50 kHz ultrasonic vocalizations (USVs), a validated measure of positive social affect. Fifteen consecutive daily 10 min sessions of intermittent PAG-ESB reduced systematically evoked 50 kHz USVs for up to 29 days following termination of ESB treatment, along with altering traditional measures of negative affect, including behavioral agitation, sucrose intake, and decreased exploratory behavior. These findings suggest a new affective circuit-based preclinical model of depression.

Bé né fice d'un programme cognitivo-comportemental et pluridisciplinaire de prise en charge de la maladie d'Alzheimer sur l'anxié té du conjoint : é tude française ELMMA Beneficial effect of a cognitive behavioral and multidisciplinary program in Alzheimer Disease on spouse caregiver anxiety: French study ELMMA

Previous research has supported the immediate activation of patient's strengths (resource activation) as an important mechanism of change in psychotherapy. We designed a brief (10 min) priming procedure in which therapists' attention was focused on the patients' individual strengths before each therapy session (resource priming). In a preliminary study, the priming procedure was carried out before each of the first five sessions (N 5 20). Preliminary results indicated that this brief preparatory intervention boosted resource activation as perceived by independent observers, fostered attachment and mastery experiences by the patient, and improved therapy outcome at Session 20. Improvement was assessed in comparison to a pairwise matched, nonrandomized control group of patients treated previously with the same treatment protocol at the same clinic.

Although several studies have assessed the relationships between the temperament dimensions of the Cloninger model of personality and depression\ little is known about the role played by the character dimensions proposed by the seven!factor model of Cloninger in depression[ In this study\ the relationships between the Temperament and Character Inventory "TCI# and depression were examined in a sample of 39 major depressive patients and 39 healthy controls[ Depressed patients exhibit higher harm avoidance and self!transcendence scores as well as lower self!directedness and cooperativeness scores as compared to healthy controls[ However\ the three other dimensions do not di}er between depressive patients and controls[ Among the depressive group\ harm avoidance\ self!directedness and cooperativeness dimensions are related to the severity of depression as assessed by the Hamilton scale[ This study con_rms the state dependence of the harm avoidance dimension and suggests a relationship between the character dimensions of the Cloninger model and depression[ Þ 0888 Elsevier Science Ltd[ All rights reserved[

BACKGROUND CONTEXT: Optimal treatment of nonmalignant chronic spinal disorders (CSDs) may require the use of one or more nonopioid psychotropic medications. Vast research literature has documented high rates of psychiatric disorders in patients with CSDs. Psychotropic medications are one type of effective treatment for these disorders. Many medications of this type are also used as adjuvants to primary analgesic medications. PURPOSE: Physicians treating CSDs may have little training and experience in prescribing psychotropic medications. Further, they may possess limited information about the efficacy of these types of medications in treating psychiatric disorders comorbid with CSDs or as adjunctive analgesics. Because of the wide variety (antidepressants, anxiolytics, sleep-promoting agents, anticonvulsants, neuroleptics, muscle relaxants) and numerous indications for psychiatric medications, a concise review of the use of psychotropic medications with CSD patients is offered for the spine specialist. STUDY DESIGN: A systematic review of the contemporary English literature on psychotropic medications in the CSD population. METHODS: A computerized search of MEDLINE was performed on all English literature published from 1982 to August 2002. RESULTS: Psychotropic medications have been found to be very efficacious in the large subgroup of patients with CSDs with psychiatric comorbidity, particularly patients with the common constellation of depression, anxiety, excessive somatic complaints, insomnia and irritability. Although the type of medication indicated depends on the particular psychiatric syndrome(s), antidepressants have been found to be extremely useful with the constellation described above. There is less evidence to support the use of nonopioid psychotropic medications in the treatment of nociceptive pain, although clinical experience indicates that some individuals demonstrate a marked analgesic response. Research support for the efficacy of particular psychotropic medications in treating neuropathic pain is stronger, although more controlled research is clearly needed. CONCLUSIONS: Psychotropic medications are extremely useful in the treatment of psychiatric disorders comorbid with CSDs and modestly useful as analgesic adjuvants, particularly with pain of neuropathic etiology. Familiarity with these medications will aid the primary treating physician in optimizing outcomes in this difficult group of patients. Ć

This article reviews the state-of-the-art research in posttraumatic stress disorder (PTSD) from several perspectives: (1) Sex differences: PTSD is more frequent among women, who tend to have different types of precipitating traumas and higher rates of comorbid panic disorder and agoraphobia than do men. (2) Risk and resilience: The presence of Group C symptoms after exposure to a disaster or act of terrorism may predict the development of PTSD as well as comorbid diagnoses. (3) Impact of trauma in early life: Persistent increases in CRF concentration are associated with early life trauma and PTSD, and may be reversed with paroxetine treatment. (4) Imaging studies: Intriguing findings in treated and untreated depressed patients may serve as a paradigm of failed brain adaptation to chronic emotional stress and anxiety disorders. (5) Neural circuits and memory: Hippocampal volume appears to be selectively decreased and hippocampal function impaired among PTSD patients. (6) Cognitive behavioral approaches: Prolonged exposure therapy, a readily disseminated treatment modality, is effective in modifying the negative cognitions that are frequent among PTSD patients. In the future, it would be useful to assess the validity of the PTSD construct, elucidate genetic and experiential contributing factors (and their complex interrelationships), clarify the mechanisms of action for different treatments used in PTSD, discover ways to predict which treatments (or treatment combinations) will be successful for a given individual, develop an operational definition of remission in PTSD, and explore ways to disseminate effective evidence-based treatments for this condition.

Background: The development of a brief valid tool to screen for depression in patients with advanced cancer is important. This paper reports data on the psychometric properties of the Brief Edinburgh Depression Scale. Method: Two hundred and forty six patients who fulfilled the inclusion criteria completed the 10-item EDS and Present State Examination. Results: Factor extraction revealed 6 items from the ten item EDS. The most valid cut off for defining a case, using the PSE diagnosis as the "gold-standard", was a score of 6 out of 18 on the Brief Edinburgh Depression Scale which gave a sensitivity of 72% and specificity of 83% with a PPV of 65.1% and NPV of 87.1%. Conclusions: The six item EDS is a brief and sensitive method of screening for depression in advanced cancer patientsthis novel use of the Edinburgh depression scale may have a significant impact on the assessment and thus management of this distressing symptom.

An epidemiological study of Attention Deficit / Hyperactivity Disorder (ADHD) suggests that the prevalence may be two to three times higher than the figure of 3 ± 5% often cited. In addition, the data suggest that both underdiagnosis and overdiagnosis occur frequently. Rodent animal models of ADHD, like the Spontaneously Hypertensive Rat (SHR) and other rat models such as those with chemical and radiationinduced brain lesions and cerebellar stunting, and the Coloboma mouse model exhibit clear similarities with several aspects of the human disorder and should prove useful in studying specific traits. Operant behavioral tasks that model learning, short -term memory and simple discriminations are sensitive to ADHD and methylphenidate has been shown to normalize ADHD performance in a short -term memory task. Recent findings challenge not only the current postulate that response inhibition is a unique deficit in ADHD, but also the concepts of ADHD and its treatment, which presume intact perceptual abilities. Time perception deficits may account, in part, for the excessive variability in motor response times on speeded reaction time tasks, motor control problems and motor clumsiness associated with ADHD. The Multimodality Treatment Study of ADHD (MTA) provided data suggesting that pharmacological interventions that included systematic and frequent follow -up with parents and teachers, with or without psychosocial interventions, are superior to psychosocial interventions or standard community care alone. Additionally, the MTA was one of the first studies to demonstrate benefits of multimodal and pharmacological interventions lasting longer than 1 year. Imaging studies have demonstrated differences in brain areas in children with ADHD: anterior corpus callosum, right anterior white matter, and cerebellar volumes are all decreased in children with ADHD and there is less brain asymmetry in ADHD subjects. Additionally, functional imaging studies, coupled with pharmacological manipulations, suggest decreased blood flow and energy utilization in prefrontal cortex and striatum, and the dysregulation of catecholamine systems in persons with ADHD. D (M.G. Paule).

The current investigation represents the first meta-analysis of the depressive realism literature. A search of this literature revealed 75 relevant studies representing 7305 participants from across the US and Canada, as well as from England, Spain, and Israel. Results generally indicated a small overall depressive realism effect (Cohen's d = −.07). Overall, however, both dysphoric/depressed individuals (d = .14) and nondysphoric/ nondepressed individuals evidenced a substantial positive bias (d = .29), with this bias being larger in nondysphoric/nondepressed individuals. Examination of potential moderator variables indicated that studies lacking an objective standard of reality (d = −.15 versus −.03, for studies possessing such a standard) and that utilize self-report measures to measure symptoms of depression (d = .16 versus −.04, for studies which utilize structured interviews) were more likely to find depressive realism effects. Methodological paradigm was also found to influence whether results consistent with depressive realism were found (d's ranged from −.09 to .14).

Excerpts of therapist-patient dialogue are presented to demonstrate three important elements of a successful session of psychodynamic therapy. These are the provision of insight through the use of transference, a focus on patient affect, and the therapist's attention to aspects of the therapeutic alliance. The article, in addition to explicating the clinical process in psychodynamic therapy, gives a theoretical explanation for the emphasis on each of these three elements and provides research support for their application.

To examine the prevalence of depressive symptoms and suicidal ideation, their comorbidity, and associated risk factors in adolescence. A self-administered questionnaire was completed in class by students in three middle schools (grades 6 through 8) enrolling more than 3,200 students. Usable questionnaires were obtained from 2,614 (81.5%), of which 924 were Anglo and 1,354 were of Mexican origin Depression was measured using the 20-item Center for Epidemiologic Studies Depression Scale and suicidal ideation using four items on thoughts of death and suicide. The minority adolescents reported significantly higher crude prevalence rates of symptoms of depression and thoughts of suicide than their Anglo counterparts. Prevalence rates were highest for females of Mexican origin. There was a strong association between depression and suicidal ideation in both ethnic groups. Multivariate logistic regression analyses indicated significant correlates of depressive symptoms were suicidal ideation (adjusted odds ratio = 10.9), loneliness, and use of English, in that order. Significant correlates of suicidal ideation were depression (adjusted odds ratio = 10.6), loneliness, two-parent household, use of English, and being of Mexican origin. More than 80% of those with high ratings on suicidal ideation scored as depressed in both ethnic groups. Results are consistent with other studies suggesting rates of suicidal ideation among adolescents are in the 10% to 20% range, while rates of depressive symptoms are in the 35% to 50% range using standard caseness scores. Mexican-American youths appear to be at higher risk than Anglo youths, particularly for suicidal ideation. In addition, it appears that youths who are lonely are more likely to report higher rates of both depression and suicidal ideation. The data also indicate that youths who spoke only or mostly English reported lower rates of depression and suicidal ideation, suggesting that acculturation may play a role as well.

Despite the growing evidence that perfectionism is associated with adolescent psychological distress, few studies have investigated this relationship prospectively with measures designed for use in adolescent populations. In the present study, within a diathesis-stress framework, we investigated the extent to which perfectionism and acute life stress predict depression, anxiety and self-harm among adolescent school children (n ¼ 515) over a 6 month period (Time 1-Time 2). Socially prescribed perfectionism (SPP), self-oriented perfectionism-critical (SOP-critical) and the associated interactions with acute life stress differentially predicted anxiety, depression and self-harm. Acute life stress was an independent predictor of depression, anxiety and self-harm. SPP predicted depression and interacted with acute life stress to predict self-harm. SOP-critical and the SOP-critical by acute life stress interaction predicted anxiety. Self-oriented perfectionismstriving (SOP-striving) did not predict any of the Time 2 measures of distress. The dimensions of perfectionism are differentially associated with psychological distress. Tailored clinical interventions focused on adolescent perfectionism should offer promise in tackling psychological morbidity in adolescence.

The purpose of the study was to investigate the psycho-social factors such as self-esteem, stress, and family support that affect the depression in pregnant women. Methods: The participants were 149 pregnant women who were seen at the urban G and M woman hospital. Data were collected using structured questionnaires from January 10 to May 20, 2011, and were analyzed using descriptive statistics, t-test, ANOVA, Pearson Correlation Coefficients, and Stepwise Multiple Regression with SPSS/WIN 17.0 program. Results: Mean age was 31 years, and 28.9% of the participants reported depression. Depression in the pregnant women showed a negative correlation with self-esteem (r=-.47, p<.001) and family support (r=-.38, p<.001), but a positive correlation with stress (r=.42, p<.001). In addition, variables that predicted depression in pregnant women were general health condition, stress, self-esteem, communication with husband, and planned pregnancy (39.0%). Conclusion: The findings from this study indicate the need to screen pregnant women for depression. There is also a need for programs to prevent depression in pregnant women and assess risk considering psycho-social factors.

Objective: Definitions and measures of significant others' mental health vary, but stress processes have been associated with caregiver outcomes of this kind. Thus, various mental health outcomes probably appear, either as specific responses to particular types of caregiver stressors, or as part of a general response resulting from an accumulation of various stressors. The present study explores the occurrence of symptoms of strain with regard to depression, exhaustion, and emotional well-being in significant others of patients dying from lung cancer, and how these symptoms coexist.Methods: Measures used were the Montgomery Åsberg Depression Rating Scale, the OLdenburg Burnout Inventory, and the Swedish Health-Related Quality of Life Survey. Data from 84 significant others of patients dying from lung cancer were collected at a time-point during the last 4 months before the patients died and subsequently analysed. The occurrence of symptoms of strain was established by creating cut-off scores from the general population. To explore how the different symptoms coexisted, hierarchical agglomerative cluster analyses were conducted using Ward's method.Results: Approximately 40% of the significant others reported symptoms of strain for each of the three outcomes, and a coexistence was found since the significant others clustered as subgroups, ranging from ‘high on all scales’ to ‘low on all scales’.Conclusion: A considerable proportion of the significant others were thus negatively affected in terms of mental health. We conclude that being a significant other of a person dying from lung cancer most likely results in a general response to this major life event. Copyright © 2009 John Wiley & Sons, Ltd.

Objective: Depression and insomnia are closely linked, yet our understanding of their prospective relationships remains limited. The aim of the current study was to investigate the directionality of association between depression and insomnia. Methods: Data were collected from a prospective population-based study comprising the most recent waves of the Nord-TrLndelag Health Study (HUNT) (the HUNT2 in 1995Y1997 and the HUNT3 in 2006Y2008). A total of 24,715 persons provided valid responses on the relevant questionnaires from both surveys. Study outcomes were onset of depression or insomnia at HUNT3 in persons not reporting the other disorder in HUNT2. Results: Both insomnia and depression significantly predicted the onset of the other disorder. Participants who did not have depression in HUNT2 but who had insomnia in both HUNT2 and HUNT3 had an odds ratio (OR) of 6.2 of developing depression at HUNT3. Participants who did not have insomnia in HUNT2 but who had depression in both HUNT2 and HUNT3 had an OR of 6.7 of developing insomnia at HUNT3. ORs were only slightly attenuated when adjusting for potential confounding factors. Conclusions: The results support a bidirectional relationship between insomnia and depression. This finding stands in contrast to the previous studies, which have mainly focused on insomnia as a risk factor for the onset of depression.

e Abstract-Objective: The aim of this study was to determine the prevalence of anxiety and depressive disorders in patients presenting with chest pain to the Emergency Department (ED) and determine if there is a relationship between these and cardiac vs. non-cardiac chest pain. Methods: This prospective cross-sectional study was performed in an urban tertiary care hospital between March and October 2005. Consecutive patients presenting with chest pain were enrolled in the study. The prevalence of anxiety and depressive disorders in patients with chest pain were determined by using the Hospital Anxiety and Depression Scale. Results: A total of 324 patients presented to the ED with chest pain during the study period. The mean age of the patients studied was 50.5 ؎ 14 years; 67% were men and 33% were women. Of the 324 study patients, 194 (59.9%) patients were diagnosed with non-cardiac chest pain, 16 (4.9%) with stable angina, 84 (25.9%) with unstable angina, and 30 (9.3%) with acute myocardial infarction. No statistically significant differences were determined between patients with cardiac and non-cardiac chest pain both for anxiety (40% vs. 38.1%, respectively; p ‫؍‬ 0.737) and depressive disorders (52.3% vs. 52.1%, respectively; p ‫؍‬ 0.965). Conclusion: Anxiety and depressive disorders are common among patients presenting with chest pain to the ED. However, the prevalence of anxiety and depressive disorders is similar between patients with chest pain of cardiac and non-cardiac origin. Chest pain should not be attributed to an anxiety or depressive disorder before organic etiologies are excluded.

Objective: To translate the theoretical constructs from a model of resilience into a structural equation model and evaluate relationships among the model's theoretical constructs associated with resilience and the occurrence of depressive symptoms. Design: Quantitative descriptive research design using structural equation modeling (SEM). Participants: Two-hundred and fifty-five individuals with SCI recruited from the Canadian Paraplegic Association (CPA). Outcome Measures: Outcome was measured by the Center for Epidemiologic Studies-Depression Scale. Results: The resilience model fit the data relatively well: 2 (200, N ϭ 255) ϭ 451.57, p Ͻ .001; 2 /df ϭ 2.26; CFI ϭ .92, RMSEA ϭ 0.070 (90% CI: 0.062-0.079), explaining 77% of the variance in depressive symptomatology. Severity of SCI-related stressors significantly influenced perceived stress (␤ ϭ .60) and perceived stress, in turn, affected depressive symptoms (␤ ϭ .66), characteristics of resilience (␤ ϭ Ϫ.43), and social support (␤ ϭ Ϫ.26). The resilience characteristics had an inverse relationship with depressive symptoms (␤ ϭ Ϫ.29). No direct relationship was found between severity of SCI-related stressors and depressive symptoms. Conclusions: Findings provide support for the resilience model and suggests characteristics of resilience "buffer" the perceptions of stress on depressive symptoms. The resilience model may be useful to guide clinical interventions designed to improve the mental health of individuals with SCI.

Background. Research on the dimensional structure and reliability of the Hospital Anxiety and Depression Scale (HADS) and its relationship with age is scarce. Moreover, its efficacy in determining the presence of depression in different patient groups has been questioned. Methods. Psychometric properties of the HADS were assessed in six different groups of Dutch subjects (N l 6165) : (1) a random sample of younger adults (age 18-65 years) (N l 199) ; (2) a random sample of elderly subjects of 57 to 65 years of age (N l 1901) ; (3) a random sample of elderly subjects of 66 years or older (N l 3293) ; (4) a sample of consecutive general practice patients (N l 112) ; (5) a sample of consecutive general medical outpatients with unexplained somatic symptoms (N l 169) ; and (6) a sample of consecutive psychiatric outpatients (N l 491). Results. Evidence for a two-factor solution corresponding to the original two subscales of the HADS was found, although anxiety and depression subscales were strongly correlated. Homogeneity and test-retest reliability of the total scale and the subscales were good. The dimensional structure and reliability of the HADS was stable across medical settings and age groups. The correlations between HADS scores and age were small. The total HADS scale showed a better balance between sensitivity and positive predictive value (PPV) in identifying cases of psychiatric disorder as defined by the Present State Examination than the depression subscale in identifying cases of unipolar depression as defined by ICD-8. Conclusions. The moderate PPV suggests that the HADS is best used as a screening questionnaire and not as a ' case-identifier ' for psychiatric disorder or depression.

Background: Transcranial magnetic stimulation (TMS) has become, over the last few years, a promising avenue for new research in affective disorders. In this study we have evaluated the clinical effect of slow TMS on posttraumatic stress disorder (PTSD) symptoms. Methods: Ten PTSD patients were given one session of slow TMS with 30 pulses of 1 m/sec each, 15 to each side of the motor cortex. Results: Symptoms of PTSD were assessed by using three psychological assessment scales, at four different time points. In this first, pilot, open study, TMS was found to be effective in lowering the core symptoms of PTSD: avoidance (as measured by the Impact of Event Scale), anxiety, and somatization (as measured by the Symptom Check List-90). A general clinical improvement was found (as measured by the Clinical Global Impression scale); however, the effect was rather short and transient. Conclusions: The present study showed TMS to be a safe and tolerable intervention with possibly indications of therapeutic efficacy for PTSD patients.

This paper explores how symptoms of mental health problems influence acquired immune deficiency syndrome-related risk behaviors, and how changes in those symptoms relate to risk behaviors engaged in by young adults. Repeated interviews with 602 youths since 1984 provide a history of change in behaviors. Mental health symptoms during adolescence (alcohol/drug [r = .28]; conduct disorder [r = .27]; depression [r = .16]; suicide [r = .14]; anxiety [r = .16]; and posttraumatic stress [r = .09]) are associated with higher numbers of risk behaviors (specifically, prostitution, use of intravenous drugs, and choice of a high-risk sex partner) during young adulthood. Changes in mental health symptoms between adolescence and young adulthood are related to the number of risk behaviors engaged in by young adulthood (total number of symptoms [B = .10], alcohol/drug abuse or dependence [B = .34], depression [B = .20], suicidality [B = .35], anxiety [B = .13], and posttraumatic stress [B = .14]). Changes in symptoms of mental health problems are associated specifically with those risk behaviors that are initiated primarily in young adulthood: intravenous drug use, prostitution, and choice of risky partners. The findings show that prevention and treatment of mental health problems are important components of preventive interventions for human immunodeficiency virus infection in high-risk teens and young adults.

The 30 patients who underwent lung transplantation between 1990 and 1996 were included in this study, and data were analyzed to find predictors of 1-year survival posttransplantation. All patients were followed throughout the posttransplantation period. Fifteen patients had ...

Objective: To determine whether cognitive behaviour therapy is an effective treatment for childhood and adolescent depressive disorder. Design: Systematic review of six randomised trials comparing the efficacy of cognitive behaviour therapy with inactive interventions in subjects aged 8 to 19 years with depressive disorder. Main outcome measure: Remission from depressive disorder. Results: The rate of remission from depressive disorder was higher in the therapy group (129/208; 62%) than in the comparison group (61/168; 36%). The pooled odds ratio was 3.2 (95% confidence interval 1.9 to 5.2), suggesting a significant benefit of active treatment. Most studies, however, were based on relatively mild cases of depression and were of only moderate quality. Conclusions: Cognitive behaviour therapy may be of benefit for depressive disorder of moderate severity in children and adolescents. It cannot, however, yet be recommended for severe depression. Definitive large trials will be required to determine whether the results of this systematic review are reliable.

Several recent studies have found an association between conduct problems and bipolar disorder in adolescents. However, prospective studies are rare and most do not apply multivariable analysis strategies to control for important variables (e.g. socio-demographics). The aim of this study was to test the association between certain conduct problems and bipolar disorders. The sample consisted of 591 adolescents (male and female) representative for 2,600 persons from the Canton of Zurich in Switzerland. Data were prospectively collected through an interviewing procedure, with the first screening taking place at the age of 19-20. The incidence rate was computed using sampling weights, and risk factors of bipolar II disorder were estimated using a multivariable logistic regression model. The 9-year incidence rate of bipolar II disorder in the canton of Zurich was 8.4% (n = 65). Adolescents and children showing behavior such as repeated running away from home and physical fighting were 2.6-3.5 times more likely to experience a bipolar II disorder than those with no indication of conduct problems. Sensitivity analysis showed that the conduct problems were not the result of low socioeconomic status.

Major depressive disorder is a severe psychiatric condition which forms a substantial burden to patients and society. Despite continuous efforts to unravel its etiology and pathophysiology, many questions remain. The majority of neurobiological research and classical pharmacotherapy regimens have approached this illness as the consequence of a failing monoaminergic neurotransmitter system. In the last decades, involvement of adult hippocampal neurogenesis in the pathogenesis and treatment of depressive disorder has gained an enormous interest. Numerous neurobiological systems and circuits thus appear to underlie this complex multi-factorial disease. One of them is the cholinergic system, which plays a major role in the regulation of various CNS functions, such as arousal, attention, cognition and memory. Cognitive impairments are often observed in depression, next to low mood, anhedonia and other clinical symptoms. Cholinergic dysfunctions may account for the development of cognitive symptoms during the course of depression. Changes in hippocampal neurogenesis, often associated with chronic stress in animal models, may be in part mediated by cholinergic dysfunction, which in turn could underlie the cognitive disturbances observed in depression. Here, we discuss the involvement of the cholinergic system in depressive disorder, with particular focus on its role in associated cognitive impairment. Since such deficits are often modified by cholinergic drugs, application of these neuropharmacological findings may provide a new therapeutic niche while yielding valuable insight into the pathophysiology of this complex illness.

Objective: This study aimed to examine the stability of psychiatric emergency diagnoses and factors influencing diagnostic concordance. Methods: The concordance between psychiatric emergency and inpatient diagnoses was calculated using kappa coefficient. The groups with and without psychiatric diagnostic stability were compared to determine factors influencing diagnostic stability. Results: Agreement between psychiatric emergency and inpatient diagnoses was fair (range of j = .48-.56) for bipolar, schizophrenia, schizoaffective and depressive disorders. Results indicated that patients with stable diagnoses between psychiatric emergency and inpatient settings are likely to arrive on legal holds and that patients without concurring diagnoses are likely to have a higher medical burden. Conclusion: Further studies exploring ways to improve diagnostic stability in psychiatric emergency setting are warranted. D

Objectives-To determine (a) the proportion of patients referred to general neurology outpatient clinics whose symptoms are medically unexplained; (b) why they were referred; (c) health status and emotional disorder in this group compared with patients whose symptoms are explained by "organic" neurological disease. Methods-The prospective cohort study with case note follow up at 6 months was carried out in the regional neurology service in Lothian, Scotland with 300 newly referred outpatients. Neurologists rated the degree to which patients' symptoms were explained by organic disease (organicity), GPs' reasons for referral, health status (SF-36), anxiety, and depressive disorders (PRIME-MD), Results-Of 300 new patients 11% (95% confidence interval (95% CI) 7%-14%) had symptoms that were rated as "not at all explained" by organic disease, 19% (15% to 23%) "somewhat explained", 27% (22% to 32%) "largely explained", and 43% (37% to 49%) "completely explained" by organic disease. Reason for referral was not associated with "organicity". Comparison of these groups showed that although physical function was similar, the median number of physical symptoms and pain were greater in patients with lower organicity ratings (p<0.0005, p<0.0005). Depressive and anxiety disorders were more common in patients with symptoms of lower organicity (70% of patients in the not at all group had an anxiety or depressive disorder compared with 32% in the completely explained group (p<0.0005). Conclusion-One third of new referrals to general neurology clinics have symptoms that are poorly explained by identifiable organic disease. These patients were disabled and distressed. They deserve more attention.

Background: Stressful life events increase the probability of depressive problems in early adolescence. Several genetic and environmental risk factors may change individual sensitivity to the depressogenic effect of these events. We examined modification by parental depression and gender, and mediation of the former by temperament and family environment. Methods: Data were collected as part of a longitudinal cohort study of (pre)adolescents (n = 2127). During the first assessment wave at approximately age 11, we assessed parental depression, family functioning, perceived parenting behaviours, and temperamental frustration and fearfulness. At the second wave, about two and a half years later, stressful life events between the first and second assessment were assessed. Depressive problems were measured at both waves. Results: Adolescents with parents who had a (lifetime) depressive episode were more sensitive to the depressogenic effect of stressful events than adolescents without depressed parents. Furthermore, girls are more sensitive to these effects than boys. The modifying effect of parental depression was not mediated by temperament, family functioning and perceived parenting. Limitations: Life events were assessed without consideration of contextual information. Depressive problems were measured by questionnaires that did not directly represent DSM-IV criteria. The measure of parental depression was unspecific regarding severity and timing of depressive episodes. Conclusion: The results suggest that gender and parental depression are associated with increased sensitivity to depression after experiencing stressful life events during adolescence.

Objectives To study the relationship between the prevalence of depressive symptoms in newly admitted nursing home residents and their previous place of residence. Methods In 65 nursing homes in the Netherlands trained physicians assessed 562 residents (mean age 78.5, range 28-101, 64.6% female) within 10 days after admission. Depressive symptoms were assessed with the Minimum Data Set (MDS) Depression Rating Scale (DRS), and the MDS items: 'diagnosis of major or minor depression', 'change in depression' and 'indicators of persistent depressed, sad or anxious mood disorder present'. Previous place of residence was categorized as 'own home', 'hospital' or 'sheltered living facility'. Adjustments were performed for demographic and health related factors measured with the MDS. Results The prevalence of depressive symptoms (DRS ! 3) for all 562 residents was 26.9%; it was higher in residents admitted from their own home (34.3%) than in residents admitted from the hospital (19.7%) (p ¼ 0.002). Residents who were admitted from the hospital have an adjusted Odds Ratio for having many depressive symptoms of 0.54 (95% CI 0.31-0.94) compared to residents admitted from their own home. There is, after adjustment, no statistical significant difference between residents admitted from their own home, or residents admitted from a sheltered living facility. Conclusions Depressive symptoms are very prevalent in nursing homes. Residents who are admitted from their own home, or from a residential facility, have more depressive symptoms than residents admitted from the hospital. This may reflect different conceptualizations or different adjustment patterns for those groups. For a better understanding of the factors associated with nursing home depression, future studies in detection, prevention and management of depressive symptoms should start prior to or directly after admission, especially for those who have no prior institutional history.

Two hundred one non-treatment seeking women with alcoholism, anxiety disorders, alcoholism and anxiety disorders, or neither alcoholism nor anxiety disorders were interviewed to assess core psychopathology associated with eating disorders using the Eating Disorders Examination and DSM-IIIR psychiatric diagnoses using the Schedule of Affective Disorders and Schizophrenia-Lifetime version. Alcoholic women had significantly higher mean scores on each of the Eating Disorders Examination subscales of Restraint, Overeating, Eating Concern, Shape Concern, and Weight Concern compared with nonalcoholic women. Women with anxiety disorders had significantly elevated scores on subscales of Overeating, Eating Concern, and Weight Concern compared with women without anxiety disorders. Women with both alcoholism and anxiety disorders had higher rates of bulimia nervosa and/or eating disorder NOS compared with women wfth either disorder alone. Implications of these findings are discussed in the context of the co-morbid association between alcoholism, eating disorders, and anxiety disorders.

We evaluated the effects of an enriched environment, based on a paired-choice preference assessment, on both rates of self-injurious behavior (SIB) and percentage of session intervals during which signs of negative affect were displayed by a woman with mental retardation and a mood disorder. Results suggested that SIB and signs of negative affect were highly correlated and that the enriched environment effectively reduced both.

Major depression is a mood disorder that is often accompanied by the impairment of cognitive functions. Although suggestive, the large range of existing neuropsychological, neuropsychiatric, and, lately, neuroimaging investigations have not yet given a consistent picture of the psychological and biological disturbances involved in this psychiatric disorder. The present study of the cognitive functions in depression was part of an extensive investigation, including neuropsychological testing, psychiatric examination, and neuroimaging. A representative sample of 40 severely depressed hospitalized patients and a group of 49 closely matched control subjects were tested with an extensive neuropsychological test battery. Results, corrected for various confounding factors, confirmed the current notion that depressed patients suffer from widespread cognitive impairments. The group analysis did not allow any hypothesis on a possible pattern to the dysfunctions, but heterogeneity in the test performances calls for further analysis of the data in patient subgroups in relation to neuroimaging results. psychological test battery. The neuropsychological test battery was composed to include a number of tests of attention, 240 B. Ravnkilde et al.

This research explored the consolidation phase of emotion-focused therapy (EFT) for depression and studies-through a task-analysis method-how client-therapist dyads evolved from the exploration of the problem to self-narrative reconstruction. Innovative moments (IMs) were used to situate the process of self-narrative reconstruction within sessions, particularly through reconceptualization and performing change IMs. We contrasted the observation of these occurrences with a rational model of self-narrative reconstruction, previously built. This study presents the rational model and the revised rational-empirical model of the self-narrative reconstruction task in three EFT dyads, suggesting nine steps necessary for task resolution: (1) Explicit recognition of differences in the present and steps in the path of change; (2) Development of a meta-perspective contrast between present self and past self; (3) Amplification of contrast in the self; (4) A positive appreciation of changes is co...

The Children's Depression Rating Scale, revised version (CDRS-R), is a reliable, clinician-rated scale which differentiates the depressed from the nondepressed child. The sum score of the CDRS-R appears to provide a better estimate of depressive symptomatology than does clinical impression. The relationship of the sum of the CDRS-R with global clinical ratings of depression indicates that the scale measures the severity of depression which is its primary purpose. The scale is not affected by the age of the child in our clinical sample, and the content of the items grouped as mood, somatic, subjective, and behavior all show good correlations with depression. The CDRS-R has been shown to be useful in a variety of settings, suggesting it is useful in both primary and secondary depressions.