Stress processes and depressive symptomatology.

75 community-residing married White couples (age ranges for husbands and wives were 26–54 yrs and 35–45 yrs, respectively) were interviewed once a month for 5 mo about the most stressful encounter they had experienced the previous week. Depressive symptomatology was assessed monthly with the Center for Epidemiological Studies Depression Scale. Ss high and low in depressive symptoms were compared on appraisal, coping, emotion, and encounter outcome. Compared with Ss low in depressive symptoms, those high in symptoms felt they had more at stake in stressful encounters; used more confrontative coping, self-control, and escape-avoidance, and accepted more responsibility; and responded with more disgust/anger and worry/fear. The overall pattern suggested that high-depressive Ss were more vulnerable and hostile than those who were low. However, high-depressive Ss were not negative in all facets of their appraisal and coping processes. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Platelet serotonin markers and depressive symptomatology

Dysfunction of brain serotonergic symptoms may be a factor in the mood and behavioral disturbances associated with depression. Platelet serotonin measures represent indirect but easily obtainable indices of brain serotonin function. To examine the specificity of relationships between cognitive and vegetative symptom groupings and platelet serotonin measures, we assessed 35 depressed outpatients using the Hamilton Rating Scale for Depression and collected platelets after a minimum 3-week drug-free period. Platelets were also collected from 14 controls. The results showed that depressed patients had lower platelet serotonin (5-HT) uptake site density values than controls and that 5-HT uptake site density values were inversely correlated with the severity of cognitive symptoms of depression. Platelet 5-HT2 receptor density values were higher in depressed patients than controls, and there was a trend toward a direct correlation between the cognitive symptoms of depression and 5-HT2 receptor density values. Neither platelet measure showed any relationship with the severity of the vegetative symptoms of depression.     

Addressing comorbid depressive symptomatology in alcohol treatment.

Clinicians often encounter patients who have comorbid alcoholism and depression. The presence of both disorders makes treatment especially challenging. Among individuals seeking treatment for alcohol dependence, depression and depressive symptoms are associated with poorer treatment outcomes, and depressed mood may play an important role in relapse to drinking. Results of a recent study suggest that adding cognitive-behavioral treatment of depression to alcohol treatment can be an effective means of reducing depressive symptoms and improving drinking outcomes in alcoholics with elevated levels of depressive symptoms. This approach may be particularly useful for clinicians seeking a nonmedical intervention to reduce depression during alcohol treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial correlates of depressive symptomatology in adult women.

Investigated the relationship between depressive symptomatology and a set of demographic and psychosocial variables presumed to be depression-susceptibility factors. 499 22–59 yr old women completed the Center for Epidemiologic Studies—Depression Scale (CESD), a demographic assessment, and measures of 4 psychosocial variables: life control, perceived accomplishment, derived identity, and social support. Higher CESD scores were associated with less perceived life control, less perceived accomplishment, higher derived identity, lower social support, lower education, lower or unemployment, younger age, and lower family income. A hierarchical multiple regression was conducted with demographic variables entered first, followed by the psychosocial variables, and then the interaction variables. Psychosocial variables accounted for an additional 28% of depression variance beyond the 11% accounted for by the demographic variables. Perceived life control was the strongest contributor to the final regression equation. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral correlates of maternal depressive symptomatology in conduct-disorder children.

We contrasted two predictive models of the impact of maternal depressive symptomatology on child behavior in a study of 51 mothers and their conduct-disorder children. Relations between global measures of maternal distress and child adjustment and observational measures of mother–child interaction were examined. Children of distressed mothers were more maladjusted than children of nondistressed mothers, when maladjustment was measured on the basis of a global rating, but "better" adjusted when measured on the basis of interactional measures. Measures of maternal indiscriminate responding to the child may account for these findings. Results suggest that (a) although conduct-disorder children are generally more maladjusted when their mothers are distressed, they display this maladjustment in a selective fashion, and (b) maternal distress acts as an adverse contextual factor that maintains mother–child interactional difficulties by disrupting the attentional and monitoring skills required for contingent responding. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diurnal mood variation in major depressive disorder.

Depression disturbs mood, but a clear picture of diurnal mood rhythms in depression has yet to emerge. This study examined variations in positive affect (PA) and negative affect (NA), two dimensions of mood that generate diurnal patterns among healthy individuals. Repeated measurements of NA and PA in daily life were obtained over 6 days from 47 depressed outpatients and 39 healthy individuals using the Experience Sampling Method. Relative to healthy individuals, depressed individuals exhibited increasing PA levels during the day with a later acrophase. In contrast, depressed persons' NA exhibited a more pronounced diurnal rhythm and was more variable from moment to moment than healthy individuals'. Ambulatory mood measurements in depression suggest distinct diurnal disturbances of positive and negative affect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Seizure disorders presenting with psychiatric symptomatology

Seizure disorders can be mistaken for psychiatric disorders and, the two have a number of poorly understood interrelations. Disruptions of consciousness, motor activity, hallucinations, and abrupt mood and anxiety changes can all be seizure manifestations caused by cortical neuronal discharges. This article presents the classification and proposed psychopathology of seizure disorders. It then reviews the psychiatric conditions that frequently mimic elements of such seizure disorders, giving hints that will allow the clinician to correctly identify seizures that are creating psychiatric presentations. Finally, this article makes clear the situations in which anticonvulsant medications may be of value when nothing else seems to be working.     

Psychiatric morbidity and depressive symptomatology in patients with permanent pacemakers

Implantation of a permanent pacemaker requires a psychological effort on the patient's part for adaptation in the acute term, and chronically, it restricts activities of the patient and may cause some psychiatric disturbances. To investigate psychiatric morbidity and depressive symptomatology of the patients with permanent pacemakers, 84 pacemaker patients were diagnosed using the DSM-III-R criteria and depressive symptoms were determined by modified Hamilton Depression Rating Scale (mHDRS). Sixteen (19.1%) patients had been given a psychiatric diagnosis. The most frequent diagnoses were adjustment disorder (5.9%) and major depressive episode (4.7%). Nine patients (10.7%) were diagnosed as having clinical depression (mHDRS > or = 17). The mean score of mHDRS was 7.57 +/- 7.46, and the severity of depression was significantly higher in females. The most frequent symptoms are difficulties in work and activities (53.6%), psychic anxiety (48.8%), loss of energy (42.9%), and hypochondriasis and insomnia (39.3%). Depressed mood, psychic anxiety, loss of energy, loss of interest, insomnia, and hypochondriasis were significantly more frequent in females. Uneducated patients had a more significant loss of energy than educated patients. Depressed mood, psychic anxiety, and somatic concerns and symptoms were more frequent in patients with permanent pacemakers than in the general population. These symptoms, resembling mixed anxiety-depression disorder, were related to fears of having a permanent pacemaker, since our series were composed of uneducated patients who did not have enough knowledge about the device.     

The composition and structure of depressive symptomatology in renal disease.

Renal disease is an increasingly common illness among middle-aged and older adults, and is often associated with depression. The Center for Epidemiologic Studies Depression Scale (CES–D) is a widely used self-report screening measure on which responses generally conform to a 4-factor structure, with each factor loading onto a higher-order Depression factor. The current study examines whether this structure is supported among individuals with renal disease (both predialysis and posttransplant kidney disease patients). Persons with renal disease (n = 225) and healthy control participants (n = 230) were recruited from Vancouver General Hospital and the community. Participants completed the CES–D as part of an extended assessment. Confirmatory factor analytic models were computed for the renal disease and healthy control groups. Results support a 4-factor structure for CES–D responses in persons with renal disease and healthy controls. The hierarchical structure of CES–D responses also appears invariant between groups. Factor structure was similar between groups; only for Depressive Affect was the strength of association with the second-order factor greater among the renal disease than healthy control participants. Findings support similarity of CES–D factor structures between patients with renal disease and healthy individuals. Results suggest that the CES–D's 4 factors contribute to measurement of a higher-order Depression factor in both groups; furthermore, 3 of 4 factors appear invariant between groups. As such, this measure can be used confidently to quantify depressive symptoms in individuals with renal disease. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Assessing unipolar mood disorders in women

OBJECTIVES: Iso-osmotic bowel preparation (Klean Prep) improves the accuracy of iliac duplex examination and reduces the time of each examination. Full-dose Klean Prep entails 4 l of fluid. We studied the effect of 2 l of Klean Prep (half-dose) and Picolax on image quality. DESIGN: Prospective study comparing clarity of duplex examination after three different bowel preparation regimes with that after 12 h starvation. MATERIALS AND METHODS: Thirty patients underwent iliac duplex examination after 12 h starvation. Scans were scored subjectively for grey scale and colour image quality, and Doppler signal-to-noise ratio. Patients were allocated blindly to: (a) full-dose Klean Prep, (b) half-dose Klean Prep, or (c) Picolax. After out-patient preparation, the scan was repeated and scored by the same observer, blinded to the preparation. RESULTS: Both full- and half-dose Klean Prep produced significant improvements in image quality for all three modalities; Picolax produced minimal change. There was minimal advantage of full-dose over half-dose Klean Prep. Patients preferred half-dose Klean Prep to full-dose. CONCLUSION: Klean Prep significantly improves the image obtained by iliac duplex examination; Picolax does not. Half-dose Klean Prep is an acceptable preparation to patients.     

Correlates of change in depressive symptomatology among gay men with AIDS

The present experiment investigated the ability of the opiate receptor antagonist naltrexone to block the increased locomotion and rearing produced acutely by amphetamine as well as the sensitization of these responses produced when this drug is administered repeatedly. Rats in different groups received an injection of amphetamine (1.5 mg/kg, i.p.) or saline preceded 30 min earlier by an injection of naltrexone (0, 0.5, 1.0, 5.0 or 10.0 mg/kg, i.p.). Naltrexone dose-dependently reduced the rearing but had no effect on the locomotion produced by this dose of amphetamine. The locomotion and rearing observed following saline were not affected. This pattern of results was observed following each of six additional pairs of injections, one pair of injections given every third day. Once, soon (2-4 days) and once, long (9-12 days) after the last injection, all animals were injected with amphetamine (0.75 mg/kg, i.p.) in the absence of naltrexone (tests for sensitization). Animals having been pre-exposed to amphetamine preceded by naltrexone showed no evidence of sensitized rearing on either test, indicating that naltrexone blocked sensitization of this response to amphetamine. These animals, however, exhibited sensitized locomotion on both tests. These results suggest an important but complex role for dopamine-opioid interactions not only in the production of acute locomotor responding to amphetamine but also in the sensitization of locomotor responding when this drug is administered repeatedly. The present findings also suggest that amphetamine-induced rearing is more dependent than locomotion on neuronal mechanisms involving dopamine-opioid interactions.     

Cognitive bibliotherapy for mild and moderate adolescent depressive symptomatology

OBJECTIVE: To compare patterns of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) mortality in 11 selected industrialized countries with highly developed death registration systems and a broad range of cumulative AIDS incidence rates. METHODS: Data on HIV/AIDS mortality were obtained from the World Health Organization (WHO) and Statistics Canada for the years 1987-1991. We obtained data for Australia, Canada, Denmark, France, the former Federal Republic of Germany, Italy, the Netherlands, New Zealand, Spain, Switzerland, and the US, stratified by sex and 5-year age groups. Population figures were obtained from national censal, post-censal or interpolated annual estimates compiled by WHO and from Statistics Canada. RESULTS: A total of 141534 deaths were attributed to HIV/AIDS (126224 in men and 15310 in women) in the 11 countries from 1987 to 1991. The majority of deaths (73.7%) occurred in the US. Other countries contributing substantially to the number of deaths were France (7.1%), Italy (4.9%), Spain (4.9%), former West Germany (3.5%), and Canada (3.0%). Age-specific death rates for men aged 25-44 years in 1991 were highest in the USA at 47.1 per 100000 population and highest for women in Switzerland at 7.7 per 100000 population. Potential years of life lost (PYLL) before age 75 years were highest for males in the US (2388 per 100000 population) and for females in Switzerland (373 per 100000 population). The lowest rates were in New Zealand (339 per 100000 population in men and 6.5 per 100000 population in women). CONCLUSIONS: This historical demographic analysis indicates that mortality resulting from HIV infection and AIDS among men and women varies considerable by country. Rates of death were highest in the US and lowest in Australia, the Netherlands, and New Zealand.     

The relationship between interpersonal schemas and depressive symptomatology.

Turkish university students (187 men and 191 women), 17–27 years old, participated in this study. They completed the Interpersonal Schema Questionnaire (C. Hill & J. Safran, 1994) and the Beck Depression Inventory (A. Beck, A. Rush, B. Shaw, and G. Emery, 1979). This study extended the research that was conducted by Hill and Safran (1994). The results of this study revealed that individuals in the high-depressive symptomatology group expected less complementary responses from significant others in friendly, dominant, and submissive situations. They expected more complementary responses from them in hostile situations. They also rated their expected responses from others as more undesirable than did individuals in the low-depressive symptomatology group. These findings seem to be congruent with cognitive and interpersonal theories of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relations between observer-rating and self-report of depressive symptomatology.

Sources of discrepancy between the Hamilton Rating Scale for Depression (HRSD) and the Beck Depression Inventory (BDI) were investigated in 114 depressed inpatients treated with ECT. Three previously reported observations were found to occur within the same sample: (1) There was only a moderate baseline correlation between the measures; (2) this correlation improved markedly at later assessment; (3) the HRSD had a greater effect size for change. The modest baseline correlation was largely due to patients who rated themselves as substantially less depressed than clinicians had rated them. Improvement in the correlation with repeated assessment was due to the representation of clinical responders. The larger effect size with the HRSD was mainly attributable to a small subgroup that showed marked deterioration on the BDI, a phenomenon not observed with clinical evaluation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ecological momentary assessment of mood disorders and mood dysregulation.

In this review, we discuss ecological momentary assessment (EMA) studies on mood disorders and mood dysregulation, illustrating 6 major benefits of the EMA approach to clinical assessment: (a) Real-time assessments increase accuracy and minimize retrospective bias; (b) repeated assessments can reveal dynamic processes; (c) multimodal assessments can integrate psychological, physiological, and behavioral data; (d) setting- or context-specific relationships of symptoms or behaviors can be identified; (e) interactive feedback can be provided in real time; and (f) assessments in real-life situations enhance generalizability. In the context of mood disorders and mood dysregulation, we demonstrate that EMA can address specific research questions better than laboratory or questionnaire studies. However, before clinicians and researchers can fully realize these benefits, sets of standardized e-diary questionnaires and time sampling protocols must be developed that are reliable, valid, and sensitive to change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol dependence and mood disorders

This article explores the complex relationships between alcohol dependence and mood disorders. Although many alcoholics present with substance-induced depressions, once appropriate methodological controls are used, there does not appear to be a significant relationship between independent unipolar depression and alcohol dependence. However, the data support a small, but significant, relationship between bipolar manic-depressive disease and alcoholism. The literature does not support the relevance of self-medication as a course of alcoholism, unless one includes the use of alcohol to alleviate alcohol-induced psychological and neurochemical perturbations. The clinical importance of distinguishing between substance-induced and independent mood disorders is reviewed.     

The young widow: depressive symptomatology throughout the grief process

The purpose of this investigation was to examine patterns of abatement of depressive symptomatology in 30 young widows at three time periods: immediately following the death of the husband, a year later, and at present. Data on all three time periods were gathered during one interview. The study thus provides retrospective information on patterns of depressive symptomatology. It was expected that such information would enhance understanding of the stages of the grief process described by Glick et al. and by Maddison.     

Predicting depressive symptomatology: Cognitive-behavioral models and postpartum depression.

170 women (mean age 26.6 yrs), seen in their 2nd trimester of pregnancy, were followed-up about 3 mo postpartum. Level of depression (Beck Depression Inventory) was just as high during pregnancy as during the postpartum period. Several variables assessed during pregnancy and during the postpartum period were significant predictors of postpartum depression level, including measures of prepartum depression, attributional style, delivery stress, and stressful life events. The predictor variables accounted for about 40% of the variance in level of postpartum depression. Predictor variables from earlier research such as history of menstrual problems, parity, education, and income did not account for significant variance in postpartum depression level. These findings provide some evidence for the role of cognitive-behavioral factors and stressful life events in depression. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Serotonergic function and negative and depressive symptomatology in schizophrenia and major depression

BACKGROUND: Serotonergic abnormalities are found in both major depressive disorder (MDD) and schizophrenia. Depressive symptoms commonly occur alongside the negative or defect symptoms in schizophrenia and antiserotonergic drugs may be particularly effective in their treatment. We wished to explore whether these symptoms could be distinguished biologically by directly comparing serotonergic function in these two illnesses. METHOD: Fifteen patients with MDD and 13 patients with schizophrenia underwent testing with the specific serotonin releasing agent D-fenfluramine (D-FEN). Prolactin and cortisol responses were measured to ascertain central serotonergic function. Individual patient results were compared with their own carefully matched control to correct for the effect of age, sex, weight and menstrual cycle, before the two patient groups were then compared. RESULTS: Prolactin responses differed significantly between the two patient groups, being lower in MDD patients and higher in schizophrenia patients than their individually matched controls. Cortisol responses did not differ. Within the schizophrenia group, increased serotonergic function correlated positively with depressive symptoms, but there was no such correlation with defect symptoms. Depressive scores were negatively correlated with the presence of negative symptoms in the schizophrenic group. CONCLUSIONS: Schizophrenia and MDD have distinct and opposite neuroendocrine responses to D-FEN. There is no evidence that depressive symptoms in these two conditions have a common serotonergic basis. Moreover, these responses distinguished between negative and depressive symptoms in our schizophrenic group.     

Recent developments in the pharmacotherapy of mood disorders

This article reviews recent developments in the pharmacotherapy of mood disorders. Pharmacotherapy is the best studied and most widely validated approach for acute phase treatment and prevention of relapse-recurrence for patients with major depression, dysthymia, and bipolar affective disorder. Antidepressants are also the mainstay of inpatient treatment and, when considered together with electroconvulsive therapy, represent the first line of treatment for the most severe and incapacitating forms of depression. Similarly, pharmacotherapy with mood stabilizers is the first line of treatment for bipolar depression and mania. Despite such efficacy, problems associated with pharmacotherapy include acceptability, tolerability, adherence, incomplete remission, and high rates of recurrence after drug discontinuation. Moreover, a small subset of patients do not respond to multiple medication trials.