Life events can trigger depressive exacerbation in the early course of schizophrenia.

Previous studies have linked life events with depression in chronic schizophrenia, but those studies had methodological limitations. Using a prospective research design and examining events that were clearly independent of the patients' illnesses, the authors sought to determine whether stressful life events could trigger depressive symptoms in the early course of schizophrenia. Schizophrenia patients (n?=?99) were followed for 1 year from a point of outpatient stabilization. Life event interviews were conducted every 4 weeks and symptom assessments every 2 weeks. Survival analyses showed a significantly increased risk for an exacerbation of significant depressive symptoms following an independent life event. Of interest is that an analysis of competing risk showed that the odds of psychotic exacerbation following a major independent life event were not significantly greater than the odds of depressive exacerbation. The risk of depression and of psychosis after experiencing a stressful life event is significantly increased for the first month, but the risk period can extend to 3 months. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The early course of depression: A longitudinal investigation of prodromal symptoms and their relation to the symptomatic course of depressive episodes.

The present study explored longitudinal evidence for prodromal symptoms of depression episodes. A model based on previous findings of the relations between prodromal and residual symptoms was described and used to generate hypotheses tested in this study. Data were analyzed from 160 participants from the Cognitive Vulnerability to Depression (CVD) project (L. Alloy & L. Abramson, 1999) who experienced an episode of depression during the prospective follow-up period and 60 CVD participants who did not. Congruent with the hypothesis, individuals who subsequently developed an episode of depression experienced significantly greater numbers of depression symptoms in the period of time leading up to the acute episode compared with those who did not develop a depressive episode. Seven depression symptoms were particularly likely to appear before the onset of an acute episode. Furthermore, all 3 predictions from the model were supported: the durations of prodromal and residual phases were correlated, the prodromal and residual symptom profiles were quite similar, and the order of symptom onset was significantly and highly negatively correlated with the order of symptom remission. Additionally, residual symptom profiles were similar to subsequent prodromal symptom profiles in individuals who experienced more than 1 depressive episode. These findings are discussed in terms of the importance of understanding the earliest prodromal symptoms to appear and their relation to the symptomatic course of depression episodes. Implications for early intervention are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of depressive symptoms and depressive disorder in primary care patients over 65 years of age

Several reports suggest that pretreatment of intracoronary thrombus with fibrinolytic agents may reduce the risk for complications during subsequent balloon angioplasty. We report a case, for the first time, of successful lysis of an extensive thrombus in a native coronary artery by administering a prolonged intracoronary infusion of streptokinase to facilitate subsequent angioplasty and discuss the management strategy when intracoronary thrombus is encountered.     

Maternal depressive symptoms and depressive symptoms in adolescents

The relationship between maternal depressive symptoms and rates of adolescent (15-16 years) depressive symptoms was studied in a birth cohort of 934 New Zealand children. There was a clear correlation between maternal depressive symptoms and subsequent depressive symptoms in adolescent females (r = .44) but no association (r = -.01) between maternal depressive symptoms and depressive symptoms in adolescent males. Subsequent analysis suggested that the correlation between maternal depression and depressive symptoms in adolescent females was largely explained by the associations of both measures with a series of social and contextual factors including social disadvantage, marital discord and family adversity. It is concluded that maternal depression is only associated with depression in adolescence insofar as maternal depression is associated with social disadvantage, marital discord or family adversity.     

Early intervention, untreated psychosis and the course of early schizophrenia

BACKGROUND: Studies have proved that early intervention can delay psychotic relapses, and prevent psychosocial deterioration in people with schizophrenia and related disorders. METHOD: Our study with young people with recent onset schizophrenia has shown that an intensive intervention programme had a beneficial effect on the occurrence of psychotic relapse and the course of psychotic syndromes. This effect lasted until the end of the 15-month intervention. No significant effect of the two different intervention conditions became apparent. RESULTS: The results of a follow-up study showed that this beneficial effect did not last. Fifteen per cent of the people had a psychotic relapse during the intervention, whereas 64% relapsed during follow-up. CONCLUSIONS: These results show that referral to other mental health agencies after intervention is not sufficient and that more support is required to continue disease management, medication compliance and stress management.     

Prevalence of depressive symptoms among rural elderly: Examining the need for mental health services.

Reexamined the prevalence of depressive symptoms among 1,724 rural, noninstitutionalized older adults (aged 59–99 yrs) and documented the need for mental health services as they relate to depression and potential barriers to receiving needed services. A telephone survey was conducted in North Dakota, with a random sample drawn from each of 8 human service districts. Instruments included the Geriatric Depression Scale and the CAGE. Results indicate that the prevalence of depression was relatively low. Controlling for potential alcohol abuse, cognitive impairment, and medical problems, the study found that 5% of older adults reported current depressive symptomatology. When using a cutoff score that is likely to correspond to a diagnosis of major depression, the study found a prevalence rate of 1.6%. Of those reporting significant levels of depression, only 27.6% were currently being treated for an emotional problem. The survey data suggested that cost, transportation, and concern about stigma are not major barriers to receiving needed mental health services. Rather, lack of awareness of available services and a lack of routine contact with mental health service providers are important factors that limit service utilization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prodromal symptoms vs. early warning signs and clinical action in schizophrenia

The term "prodromal symptoms" has traditionally referred to prepsychotic changes in thought, affect, and cognition that precede the initial onset of schizophrenia. Recently, however, the term has been extended into a clinical action context to refer to the early warning signs (EWS) of impending relapse in patients already diagnosed as having schizophrenia. However, recent reports reviewed by Norman and Malla (1995, this issue) use a narrow definition of prodromal symptoms and question their use in the clinical action context. We argue that the dual use of the term "prodromal symptoms" has led to conceptual confusion and to the impression that EWS cannot be used effectively for clinical action. The ability to base clinical action on EWS is central to schizophrenia therapeutics and is the cornerstone of pharmacological strategies based on early intervention. Our review of the evidence suggests that the effective clinical use of EWS depends on (1) the inclusion of both psychotic and nonpsychotic symptoms as EWS; (2) the use of clinician judgment in combination with predefined symptom changes to define the occurrence of EWS; (3) frequent clinical visits; and (4) the use of family or caregiver informants. We therefore suggest that, in the clinical action context, the terminology "early warning signs of impending relapse" should be used instead.     

Explaining the gender difference in depressive symptoms.

It was hypothesized that women are more vulnerable to depressive symptoms than men because they are more likely to experience chronic negative circumstances (or strain), to have a low sense of mastery, and to engage in ruminative coping. The hypotheses were tested in a 2-wave study of approximately 1,100 community-based adults who were 25 to 75 years old. Chronic strain, low mastery, and rumination were each more common in women than in men and mediated the gender difference in depressive symptoms. Rumination amplified the effects of mastery and, to some extent, chronic strain on depressive symptoms. In addition, chronic strain and rumination had reciprocal effects on each other over time, and low mastery also contributed to more rumination. Finally, depressive symptoms contributed to more rumination and less mastery over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Two factors of experienced deficits in schizophrenia and their relationships with positive, negative, and depressive symptoms

Benign prostatic hyperplasia (BPH) is the most common benign tumor in men and is responsible for urinary symptoms in the majority of men older than 50 years of age. Although transurethral resection of the prostate (TURP) is the gold standard, its complications have impacted upon its utility. As a consequence, new pharmacologic and minimally invasive approaches to the management of BPH have been developed. One minimally invasive approach that employs interstitial laser coagulation by the Indigo 830e LaserOptic system heats the prostate to the point of irreversible necrosis while preserving the urethral lining, potentially resulting in fewer complications. To test the efficacy of this device we evaluated the interim results obtained in 25 patients treated for BPH. Parameters evaluated included the AUA symptom score, uroflowometry, post-void residual, and prostate size. Following treatment, patients were discharged home and the catheter was removed within 3-7 days. Patients were assessed at 1 month and at subsequent 3-month intervals following the procedure using a questionnaire, AUA symptom score, and uroflowometry. The results of the paired t-tests demonstrated a significant increase in the maximal and average flow rates from baseline. The mean baseline maximal flow rate was 8.3 ml/s and increased to 10, 12.7, 14.1, and 12.0 ml/s at 1, 3, 6, and 9 months, respectively, and the mean baseline average flow rate was 4.4 ml/s and increased to 5.3, 6.0, 6.6, and 6.2 ml/s at 1, 3, 6, and 9 months, respectively. The AUA symptom scores decreased from 20.2 to 9.8 at 9 months. There was no intraoperative complication. Six patients developed transient retention. No patient developed bladder neck contractures, urinary incontinence, impotence, or urinary tract infections. One patient developed retrograde ejaculation and one patient required retreatment by TURP. Hence, improvements in symptom scores and voiding parameters suggest that the laser interstitial coagulation prostatectomy is safe and effective for the treatment of BPH.     

Self-blame and depressive symptoms.

Investigated whether internal attributions for bad events are always associated with depression. The depressive symptoms of 86 female undergraduates correlated with blame directed at their own characters. In contrast, blame directed at their own behaviors correlated with lack of depressive symptoms. Behaviorally attributed bad events were seen as more controllable and their causes less stable and less global than were characterologically attributed bad events and their causes. Characterological blame increased with more negative life events during the last year, implying that individuals who blame their character may arrive at this attributional style by a covariation analysis. Finally, characterological blame did not precede the onset of depressive symptoms 6 or 12 wks later. As a result, characterological blame may be a strong concomitant of depression but not a cause. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in depressive self-schemata and depressive symptoms following cognitive therapy.

Examined the effects of 6–8 sessions of Beck's cognitive therapy on mildly and moderately depressed college students' depressive symptoms and depressive self-schemata. Participants were randomly assigned to either cognitive therapy (n?=?31) or no treatment (n?=?43). The Beck Depression Inventory was used to assess depressive symptoms, and self-referent judgment, recall, and reaction time (RT) measures were used to assess depressive self-schemata. Results support the efficacy of cognitive therapy in reducing depressive symptoms and depressive self-schemata, as measured by self-referent judgment and self-referent recall. The reduction in the recall of negative self-referent judgments may play a role in the outcome of cognitive therapy for depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive correlates of depressive symptoms in hospitalized adolescents

This study examined the relationship between self-reported depression and cognitive style in adolescent inpatients. Attributional style, perceived control over environmental events, and hopelessness were assessed in 80 consecutive admissions to an adolescent psychiatric unit. BDI scores were used to classify 36 patients as depressed and 44 as nondepressed. Adolescents who reported depression also reported significantly more internal attributions for negative events and less internal attributions for positive events, evidenced a more external locus of control, and described themselves as significantly more hopeless than did the nondepressed adolescents. Hopelessness and internal attributions for negative events were the strongest predictors of depressive symptoms. In contrast to the findings of most studies using clinical populations of depressed children and adolescents, a maladaptive cognitive style and self-reported depression were highly, positively correlated.     

The core symptoms of schizophrenia

We have compared light chain immunohistochemistry in reactive lymphoid tissue and a series of paraffin-embedded B-cell lymphomas using standard trypsin digestion with a heat mediated epitope retrieval method. Fifty-seven B-cell lymphomas (18 high grade, 29 low grade and 10 cases of nodular lymphocyte predominance Hodgkin's disease), two reactive lymph nodes and eight tonsils fixed for known times between 12 h and 2 years were studied. Paraffin-embedded tissue was stained with polyclonal anti-kappa and anti-lambda antibodies. For each antibody staining was performed on two sections, one treated with trypsin digestion and one with microwave heating. Sections were scored from 0 to + + + with 0 representing poor staining and + + + excellent staining. A score of ++ was considered satisfactory. Light chain restriction was recorded if present. Satisfactory staining was obtained in 34/59 cases using trypsin digestion and 56/59 cases using heat retrieval. Light chain restriction was demonstrated in 32/57 (56%) B-cell lymphomas using trypsin digestion and 52/57 (91%) using heat retrieval. Satisfactory staining was obtained in tonsils fixed for up to 48 h using trypsin digestion and up to 2 years using heat retrieval. We have shown that for light chain immunostaining a heat mediated epitope retrieval method produces more consistent and satisfactory results and is effective over a greater range of fixation times than traditional trypsin digestion.     

Attention and clinical symptoms in schizophrenia

Attentional deficits, long established to characterize patients with schizophrenia spectrum disorders, have traditionally been regarded as part of the disorder's clinical syndrome. In this paper we provide evidence to indicate that: a) impaired attention is a dimension of schizophrenia that is independent of clinical state, and b) that attention does not appear to respond to the medication (i.e. standard neuroleptics) most typically used to treat clinical symptoms. Since intact attention and other cognitive processes appear critical to successful functioning in the community after hospital discharge, these findings have major implications for treatment.     

The relationship of catatonia symptoms to symptoms of schizophrenia

OBJECTIVE: To evaluate the relationships of symptoms of catatonic schizophrenia to 77 symptoms relevant for diagnosing schizophrenia and to socioanamnestic variables. METHOD: Data from a sample of 112 Canadian patients diagnosed with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) were evaluated via phi correlation coefficients. RESULTS: Forty-five (40.2%) of our 112 patients had catatonic symptoms, either at the time of this study or in the past. However, only weak correlations (phi < 0.31) to other symptoms relevant for diagnosing schizophrenia were found, and no significant correlations to socioanamnestic variables were found. CONCLUSION: Symptoms of catatonia appear to be independent of the key symptoms of schizophrenia.     

The direct and interactive effects of neuroticism and life stress on the severity and longitudinal course of depressive symptoms.

The direct and interactive effects of neuroticism and stressful life events (chronic and episodic stressors) on the severity and temporal course of depression symptoms were examined in 826 outpatients with mood and anxiety disorders, assessed on 3 occasions over a 1-year period (intake and 6- and 12-month follow-ups). Neuroticism, chronic stress, and episodic stress were uniquely associated with intake depression symptom severity. A significant interaction effect indicated that the strength of the effect of neuroticism on initial depression severity increased as chronic stress increased. Although neuroticism did not have a significant direct effect on the temporal course of depression symptoms, chronic stress significantly moderated this relationship such that neuroticism had an increasingly deleterious effect on depression symptom improvement as the level of chronic stress over follow-up increased. In addition, chronic stress (but not episodic stress) over follow-up was uniquely predictive of less depression symptom improvement. Consistent with a stress generation framework, however, initial depression symptom severity was positively associated with chronic stress during follow-up. The results are discussed in regard to diathesis–stress conceptual models of emotional disorders and the various roles of stressful life events in the onset, severity, and maintenance of depressive psychopathology. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Age differences and similarities in the correlates of depressive symptoms.

The authors investigated whether several life events or concerns were differentially related to depressive symptoms across 3 adult age groups (young adults, middle-aged adults, and older adults). They examined the relationships of 2 measures of depressive symptoms to work status and satisfaction, relationship status and satisfaction, loneliness, recent losses, parenting strain, and caregiving. Some differences between age groups in these relationships were found. Yet, most results suggested that, although the frequency with which people experience specific life events or concerns varies across the adult life span, the relationships between these events or concerns and depressive symptoms are similar across age groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)