Sertraline effectiveness and safety in depressed oncological patients

Goals of work Cancer is often burdened by psychological comorbidity, mainly represented by depression, anxiety and adjustment disorders. Efficacy and tolerability of sertraline in the treatment of depressive disorders is well known; however, its efficacy and safety in patients with cancer has been poorly studied. This study was aimed to provide evidences of effectiveness, safety, tolerability and rapidity of action of sertraline in a population of oncological outpatients affected by mood disorders and its effects on quality of life. Materials and methods Thirty-five adult cancer outpatients with mood depression, during chemotherapy, were enrolled to a 12-week trial with a flexible dose regime of sertraline. The treatment response was assessed at baseline, week 4 and week 12, with hospital anxiety and depression scale (HADS) and Montgomery Asberg depression rating scale (MADRS), to rate depression and anxiety; mini mental adjustment to cancer scale (Mini-MAC), to assess the psychological response to the diagnosis of cancer; clinical global impression (CGI) to evaluate severity of illness; dosage record and treatment emergent symptom scale (DOTES), to assess the adverse effects of the clinical treatments and their possible relation with the drug used; and QL index to rate quality of life. Main results Both mean depression scores, analysed by HADS and MADRS scales, and HADS anxiety scores significantly decreased during the 12 weeks of study. Mean MINI-MAC scores show that hopelessness and anxious preoccupation decreased significantly at T2 compared with T0. No severe adverse effects were observed. Conclusion In this preliminary study, sertraline was found to be effective and well tolerated in the treatment of depressed outpatients with cancer.     

抑郁症患者自我效能感、刻板印象及抑郁症状的关系研究

目的 探讨抑郁症患者自我效能感、刻板印象及抑郁症状三者之间的相关性.方法 选取2016年9月至2018年10月南京医科大学附属无锡精神卫生中心113例抑郁症患者为研究对象,均接受自我效能感[一般自我效能感量表(GSES评分)]、外显刻板印象、内隐刻板印象、抑郁症状[抑郁自评量表(SDS评分)、汉密尔顿抑郁量表(HAMD...     

Exercise barrier and task self-efficacy in breast cancer patients during treatment

Understanding exercise self-efficacy in breast cancer patients during treatment is important for enhancing physical activity adherence. Therefore, the primary study purpose was to determine, among breast cancer patients during treatment, the psychometric properties of scales to measure exercise barrier and task self-efficacy. The study also aimed to determine the following: (1) level of self-efficacy, (2) associations between barrier and task self-efficacy, and (3) associations between self-efficacy and patient age, race, and treatment type. Eighty-six female breast cancer patients recruited from a medical oncologists office completed the scales once, and 46 repeated the scales 2 weeks later. The majority were Caucasian (95%), with 26% receiving chemotherapy, 64% hormonal therapy alone, and 5% radiation/other. The mean age was 59±14 years. The Cronbachs alpha for the nine-item barrier self-efficacy scale was 0.96, with a test–retest correlation of 0.89 (p<0.001). The Cronbachs alpha for the four-item task self-efficacy scale was 0.89, with a test–retest correlation of 0.83 (p<0.001). The mean barrier self-efficacy was slightly to moderately confident, with the lowest confidence reported in the ability to exercise when nauseated. The mean task self-efficacy was slightly to moderately confident, with the lowest confidence reported in the ability to jog for 10 min without stopping. Although no significant associations were found between self-efficacy and participants race or treatment type, lower task self-efficacy was associated with older age (r=–0.36, p=0.001). Both self-efficacy scales demonstrated good internal consistency and test–retest reliability. Self-efficacy may be a useful target for physical activity interventions among breast cancer patients during treatment.     

Screening for depressive symptoms in patients with unresectable lung cancer

Introduction Early identification of psychological distress and depression is important to optimise the quality of life in patients with advanced non-small cell lung cancer (NSCLC). The prevalence of depression may vary, depending on the time since diagnosis of cancer, results of the treatment and the prognosis. The purpose of this study was to compare the efficacy of a self-administered screening tool (Hospital Anxiety and Depression Scale (HADS)) with a health professional administered tool (Montgomery–Asberg Depression Rating Scale (MADRS)) and to explore the variability of major affective symptoms in patients with unresectable lung cancer during the initial 7–8 weeks of chemotherapy treatment for their illness. Material and methods Patients with newly diagnosed unresectable lung cancer were screened on four occasions for anxiety and depressive symptoms simultaneously using the self-rated HADS and the MADRS administered by a psycho-oncologist or a trained research associate. The first assessment was done within 1 week of diagnosis and was repeated on 3 occasions during the initial 2 cycles of chemotherapy. Results Forty-nine patients, aged 38–82 years (median age 63 years) were enrolled. All patients had advanced NSCLC (stages 3A, 3B and 4) and 61% (30 patients) had an ECOG performance status (PS) of 1 or greater. The point prevalence of depression measured by an interviewer using the MADRS at visits 1–4 was 49%, 51%, 47%, and 41%, respectively. The point prevalence of self-reported depression (HADS) was significantly (p < 0.001) lower at each assessment point (18%, 20%, 6%, 12%) compared to health professional detected depression (MADRS). Although MADRS and HADS showed very strong (Pearson’s correlation = 0.8) and significant (p < 0.001) correlation, the concordance rate in identifying the same cases of depression was only 54%. Clinical implication and conclusion The prevalence of depression among advanced lung cancer patients is high and varies very little during the first 2 cycles of chemotherapy. Among a variety of tools available for the screening of depression, a semi-structured interview is more effective at identifying clinically significant depression than a self-administered questionnaire.     

Cytokine gene variations associated with subsyndromal depressive symptoms in patients with breast cancer

PurposeThis study explored the relationships between variations in cytokines genes and depressive symptoms in a sample of patients who were assessed prior to and for six months following breast cancer surgery. Phenotypic differences between Resilient (n = 155) and Subsyndromal (n = 180) depressive symptom classes, as well as variations in cytokine genes were evaluated.MethodPatients were recruited prior to surgery and followed for six months. Growth mixture modeling was used to identify distinct latent classes based on Center for Epidemiological Studies Depression (CES-D) Scale scores. Eighty-two single nucleotide polymorphisms and 35 haplotypes among 15 candidate cytokine genes were evaluated.ResultsPatients in the Subsyndromal class were significantly younger, more likely to be married or partnered, and reported a significantly lower functional status. Variation in three cytokine genes (i.e., interferon gamma receptor 1 (IFNGR1 rs9376268), interleukin 6 (IL6 rs2069840), tumor necrosis factor alpha (TNFA rs1799964)), as well as age and functional status predicted membership in the Subsyndromal versus the Resilient class.ConclusionsA variation in TNFA that was associated with Subsyndromal depressive symptoms in a sample of patients and their family caregivers was confirmed in this sample. Variations in cytokine genes may place these patients at higher risk for the development of Subsyndromal levels of depressive symptoms.     

Predictors of postbereavement depressive symptomatology among family caregivers of cancer patients

The present study investigated two aspects of the sequelae of recent bereavement among family caregivers following the death of their cancer patient: (1) the extent to which depressive symptomatology among family caregivers measured following the death of their patient could be predicted by their levels of depressive symptomatology in the months prior to death, their physical health, the setting in which the patient's death occurred, patient age, gender of the caregiver, consanguinity, financial stress, social support from family and friends during the terminal stage, impact of caregiving activities on caregiver's daily schedule, caregiver optimism, perceived esteem attributed to caregiving, the time between the prebereavement assessment and death, and the time between death and the postbereavement assessment; and (2) whether these same explanatory variables could successfully differentiate those bereaved caregivers whose psychological health improved during the first 3 months following bereavement from those who did not improve. A sample of 114 family caregivers of cancer patients were surveyed for approximately 3 months before and 3 months after the death of their patient. A multivariate analysis of variance using the regression approach was undertaken to determine the primary predictors of postbereavement depressive symptomatology. In addition, a logistic regression analysis was used to attempt to predict those caregivers whose depressive symptomatology would improve during the postbereavement period. Critical factors in determining levels of postbereavement depressive symptomatology were caregiver optimism, prebereavement depressive symptomatology, and levels of social support from friends. Caregiver optimism and prebereavement depressive symptomatology were important in predicting whether caregivers' depressive symptomatology would improve or not. Physicians must be aware that if the social history of a patient reveals that he/she is anticipating or has recently experienced the loss of a family member for whom they were the primary caregiver, this information may be critical in determining whether the illness behavior exhibited by the patient has medical or psychosocial origins.     

Modifiable correlates of physical symptoms and health-related quality of life in patients with heart failure: A cross-sectional study

BackgroundHeart failure is associated with high rates of hospitalization and mortality. The majority of patients with heart failure suffer from physical symptoms, and these symptoms are strongly associated with poor health-related quality of life. To improve physical symptoms and health-related quality of life, the modifiable factors associated with physical symptoms need to be examined.PurposeTo examine modifiable psychosocial and behavioral factors associated with physical symptoms and health-related quality of life, and the mediator effects of physical symptoms on the relationships between the modifiable factors and health-related quality of life in patients with heart failure.MethodsData on potential correlates of physical symptoms (i.e., depressive symptoms, perceived control, social support, medication adherence, sodium intake, and self-care management) were collected from 109 patients with heart failure (mean age 58 ± 14 years, 46% male, 89% New York Heart Association class II/III). Data on physical symptoms (Symptom Status Questionnaire-Heart Failure) and health-related quality of life (Minnesota Living with Heart Failure) also were collected. Simple and multiple regression analyses were used to analyze the data.ResultsAmong the potential correlates, depressive symptoms and sodium intake were associated with physical symptoms (F = 11.63, p < .001), and depressive symptoms and perceived control were associated with health-related quality of life (F = 9.917, p < .001). Physical symptoms mediated the relationship between depressive symptoms and health-related quality of life.ConclusionImproving depressive symptoms and eating the appropriate amount of sodium may be primary intervention targets to improve physical symptoms. To improve health-related quality of life, depressive symptoms as well as physical symptoms need to be managed appropriately.     

维持性血液透析患者抑郁症状及其相关因素分析

目的调查维持性血液透析(maintenance hemodialysis,MHD)患者中抑郁症状发生情况并分析其相关因素,为提高患者生存质量提供依据。方法采用横断面调查,应用Zung抑郁自评量表(SDS)对复旦大学附属华山医院血液净化中心64例MHD患者进行评估,将患者分为存在抑郁症状组和无抑郁症状组,同时收集患者的一般临床资料、社会背景资料及实验室检查结果,进行统计分析,探讨抑郁症状及其相关因素。结果SDS的测定结果显示,MHD患者中抑郁症状的发生率为60.9%。抑郁症状组独身率、血清CRP水平明显高于无抑郁症状组(独身率:14/39比3/25,P<0.05;CRP(3.22±3.39)mg/L比(2.58±2.81)mg/L,P<0.05),而血红蛋白、血清白蛋白水平则显著偏低(血红蛋白:(101.0±18.7)g/L比(109.2±14.8)g/L,P<0.05;白蛋白(38.7±3.6)g/L比(40.5±2.7)g/L,P<0.05)。进一步进行多因素Logistic回归分析发现婚姻状况、血红蛋白水平是抑郁症状的主要相关因素,发生抑郁的概率方程Ln[P/(1-P)]=6.611+1.627X1-0....     

Adaptive functioning and depressive symptoms in school-aged children

AIM: This paper is a report of a secondary data analysis to the hypothesis that a child's resourcefulness moderates the relationships between the primary female caregiver's variables (depressive symptoms and learned resourcefulness) and the child's outcomes (depressive symptoms and adaptive functioning). BACKGROUND: School-aged children between 10 and 12 years of age are at an important stage of development characterized by dramatic biological and psychosocial challenges. Maladaptive functioning and depressive symptoms increase markedly in this stage. To prevent long-term effects of depressive symptoms and impaired adaptive functioning, identifying moderators of the relationship between stress and these mental health indicators is critical. METHODS: A secondary analysis was conducted in 2004 using the data obtained in 2000 from a community-based sample of 122 school students aged 10-12 years and their primary female caregivers in four suburban public schools in Northeastern Ohio. Instruments included the Self-Control Schedule, Beck Depression Inventory, the Children's version of the Self-Control Schedule, the Children's Community Living Skills Scale, and the Children's Depression Inventory. FINDINGS: Children's resourcefulness significantly moderated the relationship between their female caregiver's depressive symptoms and their own adaptive functioning (P<0.01). Children's resourcefulness had a statistically significant impact on depressive symptoms and adaptive functioning (P<0.001). CONCLUSION: The key to reducing depressive symptoms and enhancing adaptive functioning among middle school children is to build their resourcefulness skills, especially in children whose female caregivers are depressed. This is an important role for school nurses.     

Association of auditory hallucination and anxiety symptoms with depressive symptoms in patients with schizophrenia: A three-month follow-up

This study was to investigate the association of auditory hallucinations and anxiety symptoms with depressive symptoms in patients with schizophrenia for three months. The participants (N?=?189) were evaluated using Characteristics of Auditory Hallucination Questionnaire (CAHQ), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II. Forty-two participants suffered from depressive symptoms at both baseline and 3-month follow-up. Higher CAHQ and BAI at both periods predicted depressive symptoms at three-month end. Being male, increased severity of CAHQ and BAI were risk factors of depressive symptoms. Psychiatric professionals must educate patients to manage auditory hallucinations and anxiety symptoms to decrease depressive symptoms.     

运动处方改善乳腺癌术后化疗患者体能的探讨

目的:促进乳腺癌术后化疗患者的体能恢复.方法:将120例行乳腺癌标准根治术术后化疗的患者随机分成实验组和对照组,对照组根据身体状况自行运动,实验组按护士为其制定的运动处方进行规律锻炼.分别在入院时、术后1周、术后5周、术后9周对患者进行体能指标的测定.结果:实验组术后的心功能、肺活量明显高于对照组,两组握力无显著性差异.结论:运动处方可显著提高乳腺癌术后化疗患者的体能储备,此方法也为I临床提高乳腺癌患者体能提出了积极、有效的干预模式.     

以躯体症状为主的抑郁症患者述情障碍特征分析

目的探讨以躯体症状为主的抑郁症患者述情障碍的临床特征。方法对52例以躯体症状为主诉(A组)和56例以情感症状为主诉(B组)的抑郁症患者与50名正常健康者(C组),采用汉密顿抑郁量表和多伦多述情障碍量表进行评定分析。结果A组汉密顿抑郁量表焦虑/躯体化、睡眠障碍及绝望感因子分和多伦多述情障碍量表因子Ⅲ评分均显著高于B组及C组(P<0.05或0.01);多伦多述情障碍量表评分除B组因子Ⅲ与C组比较无显著性差异外,A、B两组总分和其他各因子分均显著高于C组(P均<0.05)。结论以躯体症状为主的抑郁症患者可能有更多的消极观念,并且缺乏幻想和想象力。     

普外科患者手术前后抑郁状态的研究

目的探讨手术与抑郁之间的联系,以及抑郁的影响因素。方法手术前后应用抑郁自评量表(SDS)对患者进行评估。结果手术前后患者抑郁水平均高于常模,手术前后抑郁水平和程度变化无差异,而女性患者抑郁水平高于男性。结论抑郁情绪不因手术结束而减弱或消失,应及时提供心理干预,尤其注重女性患者的护理。     

尿毒症血液透析患者抑郁的相关性调查

目的:对尿毒症血液透析患者抑郁发病率及其相关因素进行调查与分析,为临床心理护理提供参考.方法:对137例尿毒症血液透析患者进行问卷调查.采用汉密尔顿抑郁量表对尿毒症患者的抑郁情况进行判定并分析其形成因素.结果:137例尿毒症血液透析患者抑郁的发生率为55.5%,与性别、年龄、病程及医疗费用类别有关,而与残余肾功能情况、原发疾病及文化程度无关.结论:性别、年龄、病程及医疗费用类别为尿毒症血液透析患者抑郁的相关因素,提示在此类患者的日常护理时应采取相应的护理措施,缓解患者的抑郁情绪,保护患者的心理健康.     

The impacts of migraine and anxiety disorders on painful physical symptoms among patients with major depressive disorder

Background

No study has simultaneously investigated the impacts of migraine and anxiety disorders on painful physical symptoms (PPS) among patients with major depressive disorder (MDD). The study aimed to investigate this issue.

Methods

This open-label study enrolled 155 outpatients with MDD, who were then treated with venlafaxine 75 mg per day for four weeks. Eighty-five participants with good compliance completed the treatment. Migraine was diagnosed according to the International Classification of Headache Disorders. MDD and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The visual analog scale (VAS) was used to evaluate the severity of eight PPS. Multiple linear and logistic regressions were used to investigate the impacts of migraine and anxiety disorders on PPS.

Results

Compared with patients without migraine, patients with migraine had a greater severity of PPS at baseline and post-treatment. After controlling for demographic variables and depressive severity, migraine independently predicted the intensities of eight PPS at baseline and four PPS post-treatment. Moreover, migraine independently predicted poorer treatment responses of chest pain and full remission of pains in the head, chest, neck and/or shoulder. Anxiety disorders predicted less full remission of pains in the abdomen and limbs.

Conclusion

Migraine and anxiety disorders have negative impacts on PPS among patients with MDD. Integrating the treatment of migraine and anxiety disorders into the management of depression might help to improve PPS and the prognosis of MDD.     

The treatment of depression in cancer patients: a systematic review

Goals of the work: To evaluate the efficacy of pharmacological and nonpharmacological treatments for depression in cancer populations. Materials and methods: The Supportive Care Guidelines Group conducted a systematic review of the published literature through June 2005. Search sources includes MEDLINE, EMBASE, CINAHL, PsycInfo, and the Cochrane Library. Comparative studies of treatments for depression in cancer patients were selected for review by two group members based on predefined criteria. Main results: Seven trials of pharmacological agents and four of nonpharmacological interventions were identified. Two trials detected a significant reduction in depressive symptoms for mianserin compared with placebo, and one trial found alprazolam to be superior to progressive muscle relaxation. Four drug trials found no significant difference between groups on depression measures although posttreatment reduction of symptoms was observed for all groups in two trials comparing active treatments (fluoxetine vs desipramine and paroxetine vs amitriptyline). Of the four trials involving nonpharmacological therapies for the management of depression, two detected a benefit for treatment (a multicomponent nurse delivered intervention and an orientation program) over usual care. Conclusion: There is limited evidence for the effectiveness of pharmacological and psychosocial interventions in the treatment of cancer patients with depressive disorders, and no evidence for the superiority of one treatment modality over another. Based on evidence from the general population and other medically ill populations, combined approaches to the treatment of depression may be the most effective. Further research is necessary in cancer patients to determine the relative effectiveness of psychosocial, pharmacological, and combined treatments. A paper presented as an invited lecture at the MASCC/ISOO 18th International Symposium of Supportive Care in Cancer in Toronto, Canada, June 2006, was based in part on this review. A complete list of Supportive Care Guidelines Group members is available at: .     

Relationship between improvements of subjective well-being and depressive symptoms during acute treatment of schizophrenia with atypical antipsychotics

What is known and Objective: It has been suggested that atypical antipsychotics may exert beneficial effects on subjective well‐being as well as depressive symptoms in schizophrenia. However, the relationship between the two remains to be clarified. The authors examined the relationship between subjective well‐being and depressive symptoms across the course of acute treatment with atypical antipsychotics in patients with schizophrenia. Methods: Thirty‐five inpatients with schizophrenia were examined for subjective well‐being, psychopathology, and extrapyramidal side effects before and 8 weeks after the initiation of new treatment with atypical antipsychotics. Results and Discussion: Significant improvement was observed in subjective well‐being, psychotic symptoms, and depressive symptoms. No change was observed in the severity of extrapyramidal side effect. The subjective well‐being score had significant negative correlations with depressive symptom score both at baseline and at week 8. The mean change in subjective well‐being score was significantly correlated with that in depressive symptom score. The severity of depressive symptoms at baseline was significantly correlated with the subsequent change in subjective well‐being score and the change in depressive symptom score was the only predictor of change in subjective well‐being score. What is new and Conclusion: Depressive symptoms were significantly associated with subjective well‐being in patients with schizophrenia and may moderate the acute effects of atypical antipsychotic treatment on subjective well‐being. Further investigations are necessary to fully define the place of depressive symptoms in the conceptualization of subjective well‐being in schizophrenia and the optimal use of atypical antipsychotics.