Concordance of Psychiatric Symptom Ratings Between a Subject and Informant, Relevancy to Post-Mortem Research.

Concordance of psychiatric symptom ratings between a subject and informant, relevancy to post-mortem research.

Filed under: Depression Treatment

Transl Psychiatry. 2013; 3: e214
Thompson PM, Bernardo CG, Cruz DA, Ketchum NS, Michalek JE

Investigators are interested in determining whether lifetime behavioral traits and specific mood states experienced close to death affect brain gene and protein expression as assessed in post-mortem human brains. Major obstacles to conducting this type of research are the uncertain reliability of the post-mortem psychiatric diagnoses and clinical information because of the retrospective nature of the information. In this study, we addressed the concordance of clinical information obtained through an informant compared with information obtained through a clinician interview of the subject. To test this, we measured both lifetime and within the week psychiatric symptoms of subjects (n=20) and an informant, their next-of-kin (n=20) who were asked identical questions. We found Diagnostic and Statistical Manual (DSM)-IV axis 1 diagnoses by Mini-International Neuropsychiatric Interview proportion of positive agreement for major depression was 0.97, bipolar disorder was 0.81, whereas proportion of negative agreement was 0.97 for schizophrenia. Symptom scale intra-class correlation coefficients and 95% confidence interval were: Bipolar Inventory of Signs and Symptoms=0.59 (0.23, 0.81), Brief Psychiatric Rating Scale=0.58 (0.19, 0.81), Hamilton Depression Rating Scale=0.44 (0.03, 0.72), Montgomery Asberg Depression Rating Scale=0.44 (0.03, 0.72), Young Mania Rating Scale=0.61 (0.30, 0.82), Barratt Impulsiveness Score=0.36 (-0.11, 0.70) and Childhood Trauma Questionnaire=0.48 (-0.15, 0.83). We show that DSM-IV diagnoses; lifetime impulsivity severity, childhood trauma score and symptom scores were significantly consistent between the subjects and their informants. These data suggest, with some limitations, that both retrospective and informant obtained information can provide useful clinical information in post-mortem research.
HubMed – depression

 

Antidepressant effects of sleep deprivation require astrocyte-dependent adenosine mediated signaling.

Filed under: Depression Treatment

Transl Psychiatry. 2013; 3: e212
Hines DJ, Schmitt LI, Hines RM, Moss SJ, Haydon PG

Major depressive disorder is a debilitating condition with a lifetime risk of ten percent. Most treatments take several weeks to achieve clinical efficacy, limiting the ability to bring instant relief needed in psychiatric emergencies. One intervention that rapidly alleviates depressive symptoms is sleep deprivation; however, its mechanism of action is unknown. Astrocytes regulate responses to sleep deprivation, raising the possibility that glial signaling mediates antidepressive-like actions of sleep deprivation. Here, we found that astrocytic signaling to adenosine (A1) receptors was required for the robust reduction of depressive-like behaviors following 12 hours of sleep deprivation. As sleep deprivation activates synaptic A1 receptors, we mimicked the effect of sleep deprivation on depression phenotypes by administration of the A1 agonist CCPA. These results provide the first mechanistic insight into how sleep deprivation impacts mood, and provide a novel pathway for rapid antidepressant development by modulation of glial signaling in the brain.
HubMed – depression

 

Use of the Minnesota Living With Heart Failure Questionnaire Among Elderly Patients With Aortic Stenosis: Results From a Pilot Study.

Filed under: Depression Treatment

J Cardiovasc Nurs. 2013 Jan 14;
Sandau KE, Boisjolie C, Hodges JS

BACKGROUND:: Past studies of health-related quality of life (HRQL) in aortic stenosis (AS) have focused on valve replacement, using generic or heart failure measures because no disease-specific measure exists. The literature is lacking in both performance of these measures among patients with AS and HRQL outcomes in the nonsurgical elderly AS population. OBJECTIVE:: The aims of this study were to measure HRQL and test the reliability of the Minnesota Living With Heart Failure Questionnaire (MLHFQ), Geriatric Depression Scale (GDS), and Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-Sp) in persons older than 70 years with AS receiving nonsurgical treatment. METHODS:: The prospective, descriptive design in this study included baseline administration of questionnaires to a consecutive convenience sample of patients aged 75 to 97 years (mean, 85 years) enrolled in a clinical trial for AS (n = 25). RESULTS:: Mean aortic valve area was 0.54 cm (range, 0.37-0.96 cm). Patients reported angina (52%) and light-headedness (72%); these 2 items were not included on the MLHFQ but were added as investigator-developed items. Scores for MLHFQ varied widely (median, 52; range, 7-101). Although the median GDS was 4 (range, 1-13), almost half (48%) scored higher than 5, indicating a positive depression screen. Scores for FACIT-Sp were moderately high (median, 37.5; range, 18-45), indicating strong spiritual well-being among many participants. A significant inverse relationship (r = -0.73, P < .0001; 95% confidence interval, -0.87 to -0.48) was found between depression and spiritual well-being. Cronbach ? was 0.91, 0.83, and 0.81 for the MLHFQ, GDS, and FACIT, respectively. CONCLUSIONS:: The HRQL measures selected had good internal consistency reliability, but use of the MLHFQ alone would have missed common disease-specific concerns (eg, angina, light-headedness); studies for minimally invasive aortic valve replacement should include these items. Because higher spiritual well-being was associated with less depressive symptoms, both should receive further study in HRQL assessment. Larger samples may clarify appropriate education and interventions for depressive symptoms, spiritual well-being, as well as safe physical activity and fall prevention for those with light-headedness. HubMed – depression

 

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