Suicide risk in patients with major depressive disorder

Understanding the origins of suicide is the first step in preventing it. Review of the current literature has revealed only limited data from general practice and community samples; most research has been performed on inpatient psychiatric populations, and extended follow-ups are rare. Mood disorders were found to be highly associated with suicide, especially in patients with major depressive disorder. Depression is an important factor in suicides of adolescents and the elderly, but those with late-onset depression are at higher risk. Both comorbidity with other disorders, such as anxiety and agitation, and rapid changes in the depressive state, for instance after release from the hospital, increase the risk for suicide.     

Duloxetine-induced liver injury in patients with major depressive disorder

Duloxetine is a balanced serotonin-norepinephrine reuptake inhibitor. Duloxetine-induced liver injury in patients with preexisting liver disease or chronic alcohol use is known. However, we have found that duloxetine can also induce liver injury in cases without those risk factors. We recommend that clinicians should monitor liver function carefully following duloxetine treatment.     

首发抑郁症患者与正常对照认知功能的比较研究

目的 探讨首发抑郁症的认知功能损害特点.方法 对112例首发抑郁症患者和47例正常对照采用韦氏成人智力量表、韦氏记忆量表、威斯康星卡片分类测验(WCST)进行检测.采用汉密尔顿抑郁量表(HAMD)对抑郁症患者进行抑郁状态评估.结果 抑郁症组的心智、图片、再认、再生、联想、理解、背数、记忆商数、言语智商数、操作智商数、智商数均明显低于对照组(P＜0.05).抑郁症组的WCST完成分类数明显低于对照组,总测验数明显高于对照组, 差异均有统计学意义(P＜0.05).相关分析显示, HAMD总分和心智、图片、再认、再生、联想、触觉、理解、背数、记忆商数、言语智商、操作智商、智商和完成分类数呈负相关(P＜0.05);焦虑/躯体化因子和再认、再生、背数呈负相关(P＜0.05);体重因子和图片、触觉呈负相关(P＜0.05);认识障碍因子和图片、再生、联想、触觉、背数、完成分类数呈负相关(P＜0.05);阻滞因子和心智、图片、再生、联想、理解、背数、记忆商数、言语智商、完成分类数呈负相关(P＜0.05);睡眠障碍因子和心智、图片、再认、再生、联想、触觉、理解、背数、记忆商数、言语智商、操作智商、智商、完成分类数、概念化水平、百分数呈负相关(P＜0.05).结论 首发抑郁症患者可能存在比较严重的全面认知功能损害,范围比较广,且抑郁症症状能够影响患者的认知能力.     

Impaired interhemispheric connectivity in medication-naive patients with major depressive disorder

Background: Abnormalities in the anterior interhemispheric connections provided by the corpus callosum (CC) have long been implicated in major depressive disorder (MDD). The purpose of this study was to investigate interhemispheric connectivity in medication-naive patients with MDD by measuring fractional anisotropy in the CC with diffusion tensor imaging (DTI) techniques. Methods: We obtained DTI scans from medication-naive patients with MDD and from matched healthy controls. Fractional anisotropy values were compared using semiautomatic region of interest methods to localize the regional CC differences between these 2 groups. Results: We enrolled 27 patients and 27 controls in our study. Fractional anisotropy values were significantly lower in the anterior genu of the CC in the MDD group than in the control group (p = 0.009, corrected); results were not significantly different in any other CC subregions. Limitations: As patients with MDD were already experiencing acute episodes, future studies of individuals at risk for MDD are warranted to elucidate the interhemispheric connectivity abnormalities associated with the predisposition to MDD. Conclusion: The findings demonstrate abnormalities in the structural integrity of the anterior genu of the CC in medication-naive individuals with MDD, which may contribute to impairment of interhemispheric connectivity in patients with this disorder.     

Hyperstable regulation of vigilance in patients with major depressive disorder

Abstract

Objectives. This study tested the hypothesis that patients with depression show less and later declines into lower EEG vigilance stages (different global functional brain states) under resting conditions than healthy controls, as proposed by the vigilance theory of affective disorders. Methods. Thirty patients with Major Depressive Disorder (19 female; mean age: 37.2 years, SD: 12.6) without psychotropic medication and 30 carefully age- and sex-matched controls (19 female; mean age: 37.3 years, SD: 12.8) without past or present mental disorders underwent a 15-min resting EEG. EEG-vigilance regulation was determined with a computer-based vigilance classification algorithm (VIGALL, Vigilance Algorithm Leipzig), allowing a classification of vigilance stages A (with substages A1, A2 and A3), B (with substages B1 and B2/3) and C. Results. Depressive patients spent significantly more time in the highest EEG vigilance substage A1, and less time in substages A2, A3 and B2/3 than controls. In depressive patients, a significantly longer latency until the occurrence of substages A2, A3 and B2/3 was observed. No significant group differences in the percentage of B1 segments or the latency until occurrence of B1 were found. Conclusions. The results confirm the hypothesis that patients with depression show less (and later) declines into lower EEG vigilance stages under resting conditions than healthy controls, and support the vigilance theory of affective disorders linking a hyperstable vigilance regulation to depression.     

Predictors of depressive symptoms at hospital discharge in patients with major depressive disorder

Abstract

Objective. Often patients with major depressive disorder (MDD) leave the hospital with continued significant symptomatology. This study sought to evaluate demographic, clinical, and psychosocial predictors of the presence of clinically significant depressive symptoms, defined as a Modified Hamilton Rating Scale for Depression score of ≥ 14, immediately following hospitalization for MDD. Methods. The study enrolled 135 patients with MDD as part of a larger clinical trial investigating the efficacy of post-hospitalization pharmacologic and psychosocial treatments for depressed inpatients. Structured clinical interview and self-report data were available from 126 patients at hospital admission and discharge. Results. Despite the significant decreases in depressive symptoms over the course of hospitalization, 91 (72%) displayed clinically significant depressive symptoms at discharge. Multivariate logistic regression analysis revealed that female sex, earlier age of onset, and poorer social adjustment were unique predictors of symptom outcome. Conclusions. Results suggest that a large proportion of patients leave the hospital with continued significant symptomatology, and the presence of such symptoms following hospitalization for MDD is likely to be explained by a combination of factors.     

Beta-adrenoceptors on lymphocytes of patients with major depressive disorder

3H-Dihydroalprenolol binding to lymphocyte membranes of patients with primary, unipolar major depressive disorder was compared to that of a normal, healthy control population. No significant difference could be demonstrated between the Kd values of the two different groups, but the Bmax values of the depressed patients were significantly lower than those of the controls. Positive correlations were observed between the lymphocyte beta-adrenoceptor Bmax values of the patients and their Beck self-evaluation and Hamilton depression ratings. We propose that decreased lymphocyte beta-adrenoceptor Bmax values may be used as a biological marker for major depressive disorder.     

Plasma metabolome analysis of patients with major depressive disorder

Aim

This study sought to characterize the plasma metabolite profiling of patients with major depressive disorder (MDD).

Methods

Psychiatric assessments were made with the Structured Clinical Interview for DSM‐IV Axis I Disorders. In the exploratory cohort, plasma metabolite profiles of 34 MDD patients and 31 mentally healthy controls were compared using capillary electrophoresis‐mass spectrometry. Among the candidate metabolites, we focused on a metabolite showing the largest difference. The absolute concentrations were measured in two cohorts from a psychiatric primary care clinic to characterize the accuracy of the metabolite biomarker.

Results

Among 23 metabolites significantly lower in the MDD group than in healthy controls, we focused on phosphoethanolamine (PEA) as a candidate. The reduction of PEA levels in MDD was checked in independent clinical sample sets. An ion‐chromatography‐fluorescence detection method was developed to measure plasma PEA levels. In the preliminary cohort, we examined 34 MDD and 43 non‐MDD subjects. The area under the receiver–operator curve (AUC) was 0.92, with sensitivity/specificity greater than 88%, at a cut‐off of 1.46 μM. In the checking cohort, with 10 MDD and 13 non‐MDD subjects, AUC was 0.89, with sensitivity/specificity of 86% and 100%, respectively, at a cut‐off of 1.48 μM. Plasma PEA inversely correlated with MDD severity, depressed mood, loss of interest, and psychomotor retardation.

Conclusion

These results suggest that plasma PEA level could be a candidate biomarker of MDD in the clinical setting. Further studies comparing MDD and mentally healthy controls are needed to confirm the utility of PEA as a biomarker for depression.     

抑郁症首次发病患者认知功能的研究

目的探讨抑郁症首次发病(以下简称首发)患者的认知功能特点及其影响因素。方法采用韦氏成人智力量表、韦氏记忆量表、威斯康星卡片分类测验(WCST)分别评定116例首发抑郁症患者(抑郁症组)和41名健康人(对照组)的认知状况,采用汉密尔顿抑郁量表(24项,HAMD)评定病情严重程度。对影响神经心理学测验成绩的临床症状进行逐步多元回归分析。结果(1)抑郁症组的长时记忆[(35.28±7.27)分]、短时记忆[(51.32±13.41)分]、记忆商数[(89.46±17.84)]、语言智商数[(110.96±13.72)]、操作智商数[101.90±15.98)]、智商数[(107.41±15.78)]均明显低于对照组[长时记忆(44.05±5.06)分,短时记忆(71.41±8.51)分,记忆商数(121.90±11.26),语言智商数(117.49±10.99),操作智商数(117.24±10.54),智商数[(118.98±10.95)],差异均有统计学意义(均P<0.01)。抑郁症组的WCST总测验数[(74.70±27.96)个]、持续错误数[(26.07±15.31)个]、随机错误数[(24.46±17.54)个]均明显高于对照组[WCST总测验数(60.15±23.05)个,持续错误数(17.56±11.44)个,随机错误数(17.73±14.27)个],差异有统计学意义(P<0.01或<0.05)。抑郁症组长时记忆成绩、短时记忆成绩和记忆商数低于对照组2个标准差。(2)逐步多元回归分析显示,抑郁症患者的长时记忆成绩及记忆商数与绝望感因子分均呈负相关(均P=0.00),短时记忆成绩和即刻记忆成绩与阻滞因子分均呈负相关(均P=0.00),语言智商与焦虑/躯体化因子分呈负相关(P=0.01),操作智商及智商与HAMD总分均呈负相关(均P=0.01),WCST总测验数和持续错误数与HAMD总分均呈正相关(P=0.01,P=0.02),随机错误数与阻滞因子分呈正相关(P=0.02)。结论首发抑郁症患者急性期的记忆、语言智商、操作智商和执行功能明显减退,临床症状严重程度影响认知功能的改变。     

Impaired interhemispheric connectivity in medication-naive patients with major depressive disorder

Background

Abnormalities in the anterior interhemispheric connections provided by the corpus callosum (CC) have long been implicated in major depressive disorder (MDD). The purpose of this study was to investigate interhemispheric connectivity in medication-naive patients with MDD by measuring fractional anisotropy in the CC with diffusion tensor imaging (DTI) techniques.

Methods

We obtained DTI scans from medication-naive patients with MDD and from matched healthy controls. Fractional anisotropy values were compared using semiautomatic region of interest methods to localize the regional CC differences between these 2 groups.

Results

We enrolled 27 patients and 27 controls in our study. Fractional anisotropy values were significantly lower in the anterior genu of the CC in the MDD group than in the control group (p = 0.009, corrected); results were not significantly different in any other CC subregions.

Limitations

As patients with MDD were already experiencing acute episodes, future studies of individuals at risk for MDD are warranted to elucidate the interhemispheric connectivity abnormalities associated with the predisposition to MDD.

Conclusion

The findings demonstrate abnormalities in the structural integrity of the anterior genu of the CC in medication-naive individuals with MDD, which may contribute to impairment of interhemispheric connectivity in patients with this disorder.     

抑郁症首次发病患者脑白质的弥散张量成像研究

目的 探讨抑郁症首次发病（以下简称首发）患者全脑白质纤维的完整性是否受到损害。方法 对14例未接受过治疗的首发抑郁症患者（抑郁症组）和14名与抑郁症组按性别、年龄匹配的正常人（正常人组）进行全脑弥散张量成像扫描，使用以像素为基础的分析方法比较两组各向异性分数（FA）。结果 抑郁症组的右侧额中回（x=36，y=49．x=10；t=4．89，像素集合=258）、左侧枕颞外侧回（x=-42，y=-56，z=-1；t=5．00，像素集合=96）、右侧顶叶的角回（x=24，y=-47，z=41；t=5．23，像素集合=120）和深部（x=42，y=-65，z=27；t=4．56，像素集合=76）白质FA值低于正常人（未校正，P〈0．001），上述FA值差异有统计学意义的区域与抑郁症组的症状严重程度（BDI和HAMD评分）以及病程之间无显著相关性。未发现抑郁症组比正常人组FA值高的脑区。结论 白质病变在抑郁症发病早期即已存在，其完整性的损害可能破坏了调节心境的神经环路。     

Depression and major depressive disorder in patients with Parkinson's disease

The prevalence of depression in Parkinson's disease (PD) varies greatly. In this study, we investigated major depressive disorder (MDD) and depressive symptoms without MDD in patients with PD. The psychopathological characteristics of depressive symptoms were assessed by a psychiatric interview. A total of 105 Japanese patients with PD without dementia were included. The Japanese version of the Beck Depression Inventory‐II (BDI‐II) with a cutoff score of 13/14 was used to screen for depression. Using a structured interview, a comprehensive psychiatric evaluation of patients with BDI‐II scores >13 (high BDI patients) was completed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM)‐IV‐TR. Forty patients (38%) had a BDI‐II >13, but 29 did not show any depressed mood. Five cases met the criteria for MDD (three current, two past) and one patient was diagnosed with minor depressive disorder. A slight depressed mood that was associated with worrying about PD was seen in 6 of 34 patients without any depressive disorder and fluctuated with aggravation of PD symptoms in two of these patients. For the diagnosis of MDD, the number of positive items from the DSM‐IV‐TR definition of MDD is most important and useful for differentiating MDD and non‐MDD. The low‐prevalence rate of MDD in our patient population suggests that PD may be a psychological stressor for MDD, but does not necessarily induce MDD. © 2009 Movement Disorder Society     

Characteristics of implicit schemas in patients with major depressive disorder

BackgroundMany psychotherapy theories emphasise the importance of self-schema and other-schema, but most previous studies focused on the explicit self-schema in major depressive disorder (MDD). However, the limited studies of implicit self-schema in MDD have shown inconsistencies in their findings. Furthermore, only a few studies have investigated the implicit other-schema, and the pathway illustrating how implicit schemas influence depression remains unclear.AimsThe primary aim of our study was to explore the characteristics of implicit self-schema and other-schema in patients with MDD. We also examine the chain-mediating effect of attachment relationships and interpersonal trust.MethodsThe present study included 88 patients with MDD and 88 healthy controls (HCs). The Hamilton Depression Rating Scale-17, Experiences in Close Relationships Inventory—Revised Questionnaire, Trust Scale and the Extrinsic Affective Simon Task (EAST) were used to assess depressive symptoms, attachment relationships, interpersonal trust and implicit schemas, respectively. Paired sample t-test was used to compare the reaction time (RT) for positive and negative words within the two groups. Analysis of covariance was used to explore the difference between two groups from the perspective of implicit schemas and interpersonal patterns. The chain mediation model was verified by bootstrap.Results(1) For interpersonal patterns, patients with MDD scored significantly higher on attachment anxiety (F=82.150, p<0.001) and attachment avoidance (F=23.192, p<0.001) and scored significantly lower on the predictability (F=30.297, p<0.001), dependence (F=39.728, p<0.001) and faith (F=60.997, p<0.001) dimensions of interpersonal trust. (2) As for implicit schemas, no significant difference was found between the RT for positive self-words and negative self-words in patients with MDD (t=−1.056, p=0.294). However, the HC responded faster to positive self-words than negative self-words (t=−3.286, p=0.001). The RT for positive other-words and negative other-words were significantly different in both patients with MDD (t=2.943, p=0.004) and HCs (t=−2.482, p=0.015), with opposite directions. The EAST effect of other-schema in patients with MDD was significantly different from that in HCs (F=13.051, p<0.001). (3) For the total sample, the EAST effect of other-schema significantly correlated with attachment avoidance, interpersonal trust and depressive symptoms. Attachment avoidance and interpersonal trust were the chain mediators between the EAST effect of other-schema and depressive symptoms (95% CI: −0.090 to −0.008). However, no significant results were found for the EAST effect of other-schema when correlation and mediation analyses were performed for HCs and patients with MDD separately.ConclusionsThis study verified that patients with MDD have abnormal interpersonal patterns and negative implicit schemas. However, no mediating effect of attachment relationships and interpersonal trust was found.     

重性抑郁障碍患者认知功能损害的研究进展

重性抑郁障碍（Major Depressive Disorder,MDD）是以持久自发性的情绪低落为主的二系列抑郁症状,常导致患者心理、生理和社会功能紊乱。