Changes in Capacity to Consent Over Time in Patients Involved in Psychiatric Research.

Changes in capacity to consent over time in patients involved in psychiatric research.

Br J Psychiatry. 2013 May 9;
Palmer BW, Savla GN, Roesch SC, Jeste DV

BACKGROUND: Informed consent is a key element of ethical clinical research. Patients with serious mental illness may be at risk for impaired consent capacity. Corrective feedback improves within-session comprehension of consent-relevant information, but little is known about the trajectory of patients’ comprehension after the initial enrolment session. AIMS: To examine whether within-session gains in understanding after feedback were maintained between study visits and to examine stability of decisional capacity over time. METHOD: This was a longitudinal, within-participants comparison of decisional capacity assessed at baseline, 1 week, 3 months, 12 months and 24 months in 161 people with schizophrenia or bipolar disorder. RESULTS: Within-session gains from corrective feedback generally dissipated over each follow-up interval. Decisional capacity showed a general pattern of stability, but there was significant between-participant heterogeneity. Better neuropsychological performance was associated with better decisional capacity across time points. Positive symptoms of schizophrenia did not predict any aspects of decisional capacity, but general psychopathology, negative symptoms and depression evidenced some modest associations with certain subdomains of decisional capacity. CONCLUSIONS: Informed consent may be most effectively construed as an ongoing dialogue with participants at each study visit. HubMed – depression

Day-to-day associations between subjective sleep and affect in regard to future depression in a female population-based sample.

Br J Psychiatry. 2013 May 9;
de Wild-Hartmann JA, Wichers M, van Bemmel AL, Derom C, Thiery E, Jacobs N, van Os J, Simons CJ

BACKGROUND: Poor sleep is a risk factor for depression, however little is known about the underlying mechanisms. AIMS: Disentangling potential mechanisms by which sleep may be related to depression by zooming down to the ‘micro-level’ of within-person daily life patterns of subjective sleep and affect using the experience sampling method (ESM). METHOD: A population-based twin sample consisting of 553 women underwent a 5-day baseline ESM protocol assessing subjective sleep and affect together with four follow-up assessments of depression. RESULTS: Sleep was associated with affect during the next day, especially positive affect. Daytime negative affect was not associated with subsequent night-time sleep. Baseline sleep predicted depressive symptoms across the follow-up period. CONCLUSIONS: The subtle, repetitive impact of sleep on affect on a daily basis, rather than the subtle repetitive impact of affect on sleep, may be one of the factors on the pathway to depression in women. HubMed – depression

Association Between Symptom Dimensions and Categorical Diagnoses of Psychosis: A Cross-sectional and Longitudinal Investigation.

Schizophr Bull. 2013 May 9;
Russo M, Levine SZ, Demjaha A, Di Forti M, Bonaccorso S, Fearon P, Dazzan P, Pariante CM, David AS, Morgan C, Murray RM, Reichenberg A

Context:Cross-sectional studies of the signs and symptoms of psychosis yield dimensional phenotypes. However, the validity and clinical utility of such dimensions remain debated. This study investigated the structure of psychotic symptomatology, the stability of the structure over time, and the concordance between symptom dimensions and categorical diagnoses.Methods:Sample consisted of 500 first-episode psychotic patients. A cross-sectional study (N = 500) investigated the organizational structure of symptom dimensions at the onset of psychosis and its concordance with categorical diagnoses; next, a nested longitudinal study (N = 100) examined the stability of the symptom dimensions structure after 5-10 years of follow-up.Results:Factor analyses identified 6 first-order factors (mania, negative, disorganization, depression, hallucinations, and delusions) and 2 high-order factors (affective and nonaffective psychoses). Cumulative variance accounted for by the first and high-order factors was 63%: 31% by the first-order factors and 32% by the high-order factors. The factorial structure of psychotic symptoms during first episode remained stable after 5-10 years of follow-up. The overall concordance between 4 categorical diagnostic groups (schizophrenia, mania with psychosis, psychotic depression and schizoaffective disorder) and dimensional symptom ranged from 62.2% to 73.1% (when the schizoaffective group was excluded).Conclusions:Symptoms of psychosis assume a multidimensional hierarchical structure. This hierarchical model was stable over time and showed good concordance with categorical diagnoses. The combined use of dimensional and categorical approach to psychotic disorders would be of clinical and research utility. HubMed – depression

Behavioral profile of Hypericum perforatum (St. John’s Wort) extract. A comparison with standard antidepressants in animal models of depression.

Eur Rev Med Pharmacol Sci. 2013 Apr; 17(8): 1082-9
Bukhari IA, Dar A

Hypericum (H.) perforatum, popularly called St. John’s Wort has been used traditionally for the treatment of anxiety, depression and as a nerve tonic. Large amount of clinical and animal experimental data demonstrate that H. perforatum acts by biochemical mechanisms similar to the tricyclic antidepressants or serotonin reuptake inhibitors. However, its efficacy in comparison to standard antidepressant drugs is not well studied. The present study evaluated H. perfortum extract in animal models of depression compared to clinically used antidepressants.The effects of standardized extract of H. perforatum was compared with standard antidepressants using animal models of depression such as forced swim test (FST), yohimbine induced lethality test, pnetylenetetrazole (PTZ) induced convulsion and locomotor activity tests. Different doses of the plant extract and standard drugs were administered to rats or mice intraperitoneally (i.p).In the FST, H. perforatum extract (30-90 mg/kg i.p.) caused a dose dependent reduction in immobility time in rats with maximal effect being 53% at 90 mg/kg. This effect was reversed at higher doses (100 mg/kg) showing a U-shaped dose response curve. Fluoxetine and imipramine (30-70 mg/kg i.p.) produced similar reduction in the immobility time in rats. Venlafaxine exhibited weak antidepressant effect. H. perforatum extract (30-100 mg/kg i.p.), dothiepin (10-50 mg/kg i.p.), fluoxetine (30-60 mg/kg i.p.) and venlafaxine (20-40 mg/kg i.p.) potentiated yohimbine induced lethality. PTZ induced toxicity was also enhanced with these agents. In the locomotor activity test H. perforatum decreased the locomotor counts of mice similar to standard antidepressants.H. perforatum has antidepressant properties similar to standard antidepressants. The antidepressant profile of H. perforatum is closely related to the selective serotonin reuptake inhibitors class of antidepressants. HubMed – depression