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ABSTRACT: Background: The 'Onset of Depression Inventory' (ODI) is a patient interview developed for systematically registering the speed of onset of depression. The ODI might contribute to the detection of hidden bipolarity because in previous studies a more rapid depression onset was found in patients with bipolar compared to unipolar depression. The aim of this study was to evaluate the test-retest stability of the ODI. Patients were asked concerning the speed of onset at the time of hospitalization and again before discharge. Sampling and Methods: Test-retest stability of the ODI was investigated in 37 patients with a depressive episode. Each patient was interviewed concerning his present depressive episode by the same person at two different time points. Severity of depression at the different time points was assessed using the Hamilton Depression Rating Scale (HAMD-17) and the Inventory of Depressive Symptomatology (IDS-C). Results: The speed of onset as assessed with the ODI showed good test-retest stability (rho = 0.83, p < 0.001). This parameter was not influenced by changes in depression severity. Conclusions: The ODI allows reliable assessment of the speed of onset of depressive episodes. The instrument might be useful for the detection of hidden bipolarity.
Psychopathology 03/2013; · 1.82 Impact Factor
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ABSTRACT: OBJECTIVE: The aim of the study was to compare criterion validities of the WHO-Five Well-being Index (WHO-5) and the Geriatric Depression Scale 15-item version (GDS-15) and 4-item version (GDS-4) as screening instruments for depression in nursing home residents. METHODS: Data from 92 residents aged 65-97 years without severe cognitive impairment (Mini Mental State Examination ≥15) were analysed. Criterion validities of the WHO-5, the GDS-15 and the GDS-4 were assessed against diagnoses of major and minor depression provided by the Structured Clinical Interview for DSM-IV. Subanalyses were performed for major and minor depression. Areas under the receiver operating curve (AUCs) as well as sensitivities and specificities at optimal cut-off points were computed. RESULTS: Prevalence of depressive disorder was 28.3%. The AUC value of the WHO-5 (0.90) was similar to that of the GDS-15 (0.82). Sensitivity of the WHO-5 (0.92) at its optimal cut-off of ≤12 was significantly higher than that of the GDS-15 (0.69) at its optimal cut-off of ≥7. The WHO-5 was equally sensitive for the subgroups of major and minor depression (0.92), whereas the GDS-15 was sensitive only for major depression (0.85), but not for minor depression (0.54). For specificity, there was no significant difference between WHO-5 (0.79) and GDS-15 (0.88), but both instruments outperformed the GDS-4 (0.53). CONCLUSIONS: The WHO-5 demonstrated high sensitivity for major and minor depression. Being shorter than the GDS-15 and superior to the GDS-4, the WHO-5 is a promising screening tool that could help physicians improve low recognition rates of depression in nursing home residents. Copyright © 2013 John Wiley & Sons, Ltd.
International Journal of Geriatric Psychiatry 03/2013; · 2.42 Impact Factor
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Cosima Rhein,
Julia Naumann,
Christiane Mühle,
Peter Zill,
Mazda Adli,
Ulrich Hegerl,
Christoph Hiemke, Roland Mergl,
Hans-Jürgen Möller,
Martin Reichel,
Johannes Kornhuber
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ABSTRACT: Rare loss-of-function mutations in the sphingomyelin phosphodiesterase 1 (SMPD1) gene are known to dramatically decrease the catalytic activity of acid sphingomyelinase (ASM), resulting in an autosomal recessive lysosomal storage disorder known as Niemann-Pick disease (NPD) type A and B. In contrast to the general low frequency of those deleterious mutations, we found a relatively high frequency for the proposed type B NPD variant c.1460C>T (p.A487V) in our sample of 58 patients suffering from Major Depressive Disorder. We therefore investigated the biochemical consequences of this variant more closely. Our in vivo data derived from blood cell analyses indicated cellular ASM activity levels in the normal range. The secreted ASM activity levels in blood plasma were slightly lower, but still above those levels reported for type B NPD patients. In vitro expression studies of this ASM variant in different cell lines confirmed these results, showing cellular and secreted enzymatic activities equivalent to those of wild-type ASM and similar expression levels. Thus, we conclude that the ASM variant c.1460C>T (p.A487V) is not a rare missense mutation but an SMPD1 sequence variant that yields a protein with functional catalytic characteristics.
JIMD reports. 01/2013; 8:1-6.
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ABSTRACT: The temporal dynamics of electroencephalogram (EEG)-vigilance as a measure of tonic cortical arousal are discussed as pathogenetic factors in neuropsychiatric disorders. Although there is broad knowledge about the interaction of cortical arousal and activity of the autonomous nervous system (ANS) during different sleep stages, the association and temporal interaction between fine-graded EEG-vigilance stages and markers of sympathetic and parasympathetic activity during the transition from wakefulness to sleep onset warrants more detailed exploration and was focus of the presented study. A 15-min resting-EEG, electrocardiogram (ECG), and skin conductance level (SCL) were recorded from 54 healthy subjects. Using an EEG-algorithm (VIGALL), 1-s segments were classified into seven different vigilance stages. Associations and temporal interactions between EEG-vigilance stages and heart rate variability (HRV), heart rate (HR), and SCL were computed using correlation analysis, regression analysis, and cross-correlations of EEG-vigilance and ANS time series. EEG-vigilance stages and ANS activity showed a significant association between increased HRV parameters including total and (normalized) very low frequency power and low vigilance stages. Regression analysis revealed significantly increased values of SCL and HR for high vigilance stages in comparison to lower ones. In these relationships, for SCL but not HR most of the covariance was explained by the effect of time. Phasic increases in EEG-vigilance were paralleled by significant increases of HR but not of SCL. Cross-correlations between EEG-vigilance and ANS time series yielded highest correlations when there was no or only a minimal temporal lag. ANS activity during the transition from wakefulness to sleep onset gradually changes along with different fine-graded EEG-vigilance stages. Associations between cortical and autonomic activity are better reflected by HR than by SCL. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Journal of Psychophysiology 10/2012; 25(4):190-200. · 1.54 Impact Factor
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ABSTRACT: BACKGROUND: Following the railway suicide of Robert Enke, a famous German football goal keeper, short-term copycat effects have been found. Main aims of the present study were to analyze long-term effects of this incidence and to compare them with overall national suicide data, as well as to investigate possible "anniversary effects". METHODS: For long-term effects, the number of railway suicidal acts in the two years before and after Robert Enke's suicide (10th November 2009) were compared. For anniversary effects, the corresponding 2-week-periods in 2009, 2010 and 2011 were analyzed. Incidence ratios with 95% confidence intervals were computed. RESULTS: Compared to the two years before Enke's suicide the incidence ratio of the number of railway suicidal acts in the 2-year-period following this event increased by 18.8% (95% confidence interval (CI)=11.0-27.1%; p<0.001). The median number of suicidal acts per day increased from 2 to 3 (p<0.001). This effect remains significant after excluding short-term 2-week effects of Enke's suicide. An anniversary effect was not present. The increase of fatal railway suicides between 2007 and 2010 (25%) was significantly different from that for the total number of suicides in Germany (6.6%) (p<0.0001). LIMITATIONS: Due to missing data, analyses regarding gender were limited and regarding age not feasible. CONCLUSIONS: Long-term effects of Enke's suicide on railway suicidal acts in Germany in the sense of copycat behavior are probable as this increase cannot be explained by corresponding changes of the total number of suicides in Germany.
Journal of affective disorders 10/2012; · 3.76 Impact Factor
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ABSTRACT: BACKGROUND: The development of a full blown depressive episode may be very rapid, taking less than one hour, or be very slow, taking up to months. In a previous study with outpatients it was found that the majority (58%) of depressive episodes within bipolar affective disorders (BD) develop within one week whereas this is rarely the case (7.4%) in unipolar depression (UD). Apart from a replication of these findings, the present study aimed to investigate the speed of onset in patients with BD compared to UD patients with either a depressive episode (DE) or recurrent depressive disorder (RD). METHODS: Speed of onset of depression was assessed using the structured patient interview "Onset of Depression Inventory" (ODI). In total, 24 BD patients, 42 patients with a DE and 80 patients with a RD within unipolar affective disorders were included. RESULTS: The speed of onset of depressive episodes differed significantly between the three patient groups (Kruskal-Wallis-test: Chi²=12.493, p=0.002): 50% of the BD patients developed a depressive episode within a week, compared with only 16.7% of DE patients and 25.0% of RD patients. LIMITATIONS: The ODI has not yet been validated. CONCLUSIONS: The earlier finding of a faster onset of depressive episodes in BD compared to UD patients is replicated. Clinicians should consider the possibility of a hidden bipolarity in patients who develop a depressive episode within a few days.
Journal of affective disorders 07/2012; · 3.76 Impact Factor
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Hubertus Himmerich,
Luise Schmidt,
Susen Becker,
Linda Kortz,
Jeremias Schonherr, Roland Mergl,
Katrin Bauer,
Ulrich Sack,
Abigail J Sheldrick,
Joachim Thiery,
Uta Ceglarek
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ABSTRACT: Thromboxane A2 (TxA2) and the activation of its receptor have been shown to modulate vasoconstriction and platelet aggregation as well as dopaminergic and serotonergic signalling. Dopaminergic and serotonergic systems play a crucial role in the pathophysiology of schizophrenia and these systems are the main targets of antipsychotics (APs). As the first antipsychotic (AP) chlorpromazine (CPZ) has already been shown to reduce TxA2, we hypothesized that the AP clozapine and its metabolite N-desmethylclozapine (NDMC) might also influence TxA2 production. We measured levels of thromboxane B2 (TxB2), the metabolite of the very unstable molecule TxA2, in unstimulated and stimulated blood samples of 10 healthy female subjects in a whole blood assay using toxic shock syndrome toxin-1 (TSST-1) and monoclonal antibody against surface antigen CD3 combined with protein CD40 (OKT3/CD40) as stimulants. Blood was supplemented with the APs CPZ, clozapine or NDMC in one of four different concentrations. Additionally, thromboxane levels were measured in blood without the addition of APs under different stimulation conditions. Under TSST-1 as well as OKT3/CD40 stimulation, mean T�B2 concentrations were significantly (p < 0.05) decreased by clozapine over all applied concentrations. NDMC led to a decrease in TxB2 levels under unstimulated conditions as well as under TSST-1 stimulation. CPZ reduced TxB2 production at low concentrations under unstimulated and TSST-1- stimulated conditions. Clozapine, NDMC and CPZ possibly act on neurotransmitter systems via modulation of TxA2 or TxB2 production. Additionally, known side effects of APs such as orthostatic hypotension may be a result of changes in the concentrations of TxA2 or TxB2.
Medicinal chemistry (Shāriqah (United Arab Emirates)) 07/2012; 8(6):1032-8. · 1.64 Impact Factor
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ABSTRACT: Depression rating scales play a decisive role in the assessment of the severity of depression and the evaluation of the efficacy
of antidepressant treatments. The Hamilton Depression Rating Scale (HAMD) is regarded as the ‘gold standard’; nevertheless,
studies suggest that the Inventory of Depressive Symptomatology (IDS) is more sensitive to detect symptom changes. The aim
of the present study was to investigate whether the IDS is more sensitive in detecting changes in depression symptoms in patients
with mild major, minor or subsyndromal depression (MIND). Biweekly IDS-C28 and HAMD17 data from 340 patients of a 10-week randomized, placebo-controlled trial comparing the effectiveness of sertraline and cognitive-behavioural
therapy in patients with MIND were analysed. We investigated sensitivity to change for both scales (1) from assessment-to-assessment,
(2) in relation to depression severity level, and (3) in relation to DSM-IV depression criterion symptoms. The IDS-C28 was more sensitive in detecting changes in depression symptomatology over the treatment course as well as for different severity
levels, especially in patients with a low depression severity. It assesses the DSM-IV criteria more thoroughly, is better
able to track the change of cognitive symptoms and to identify residual symptoms. Both scales are well able to assess depressive
symptomatology. However, the IDS-C28 surpasses the HAMD17 in detecting small changes especially in the core symptoms of depression. This is important for an optimal treatment by capturing
early improvements, enabling prompt reactions and detecting residual symptoms.
KeywordsMinor depression–Hamilton Depression Rating Scale (HAMD17)–Inventory of Depressive Symptomatology (IDS-C28)–Sensitivity to change–Depression severity
European Archives of Psychiatry and Clinical Neuroscience 04/2012; 261(5):357-367. · 3.49 Impact Factor
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ABSTRACT: Depressionen gehören zu den häufigsten psychischen Erkrankungen im Alter. Besonders bei alten Menschen werden diese nach wie
vor nur unzureichend erkannt und nicht suffizient behandelt. Ein möglichst frühzeitiges Erkennen depressiver Erkrankungen
ist angesichts der damit verbundenen Risiken und Komplikationen essentiell, insbesondere um eine Exazerbation oder Chronifizierung
der depressiven Symptomatik zu vermeiden und der erhöhten Suizidgefahr sowie negativen Auswirkungen auf bestehende somatische
Erkrankungen entgegenzuwirken. Wie keine andere Berufsgruppe nehmen Altenpflegekräfte eine Schlüsselposition im Kontakt mit
Klienten, Angehörigen sowie behandelnden Hausärzten ein. Daher wurden zwischen März 2006 und August 2007 insgesamt 3.487 Altenpflegekräfte
aus 448 ambulanten Pflegediensten in ganz Bayern in 196 vierstündigen Fortbildungen zu den Themen Depression und Suizidalität
im Alter geschult. Ziel der Maßnahme war es, vorurteilsbehaftete Einstellungen abzubauen und spezifisches Wissen über Depression
und Suizidalität im Alter zu vermitteln. Die Maßnahme wurde anhand speziell konzipierter Fragebogen evaluiert, die unmittelbar
vor und nach der Fortbildung (Prä und Post) sowie nach drei Monaten (Follow-up) ausgegeben wurden. In die Auswertung gingen
die individuellen Veränderungen von 473 Teilnehmern im Längsschnitt ein. Ausgeprägte Vorbehalte und Wissenslücken betrafen
die Themenkomplexe „Pharmakotherapie mit Antidepressiva“ und „Umgang mit Suizidalität“. Es zeigten sich signifikante Veränderungen
in allen Fragekategorien. Besonders deutliche Effekte wurden hinsichtlich der Einstellung gegenüber Depression und Suizidalität
sowie der Behandelbarkeit mit Antidepressiva erreicht. Diese Veränderungen erwiesen sich bis zum Follow-up als stabil.
Depressive disorders rank among the most frequent mental disorders in the elderly. Especially in the elderly, depressive disorders
are still underrecognized and not sufficiently treated. In view of the associated risks and complications, early and timely
recognition of depressive disorders is essential to avoid exacerbation and chronic manifestation of the depressive symptoms
and to antagonize the increased suicide risk as well as negative effects on concomitant somatic diseases. More than any other
occupational group, geriatric caregivers have a key position in the contact with clients, relatives and treating primary care
providers. Therefore, 3487 geriatric caregivers from 448 outpatient nursing services throughout Bavaria participated in 196
four-hour training courses about depressive disorders and suicidality in the elderly between March 2006 and August 2007. Aim
of this activity was to reduce attitudes enclosed in a wall of prejudice and to teach specific knowledge about depression
and suicidality in the elderly. This training was evaluated using specially tailored questionnaires which were completed immediately
before and after the continuing education as well as three months later (at follow-up). The analysis included the individual
changes of 473 participants in longitudinal sections. Pronounced knowledge deficits and reservations were found regarding
pharmacotherapy with antidepressants and suicidality. In this context, significant changes in all categories were present.
Especially pronounced effects were found for the attitudes towards depression and suicidality as well as treatability with
antidepressants. These changes were stable, as indicated by the follow-up evaluation.
SchlüsselwörterAltenpflegekräfte-Fortbildung-Depression-Suizidalität-Effektivität
Keywordsgeriatric caregivers-further training-depression-suicidality-effectiveness
Zeitschrift für Gerontologie + Geriatrie 04/2012; 42(3):228-235. · 0.61 Impact Factor
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ABSTRACT: Recently, a framework has been presented that links vigilance regulation, i.e. tonic brain arousal, with clinical symptoms of affective disorders. Against this background, the aim of this study was to deepen the knowledge of vigilance regulation by (1) identifying different patterns of vigilance regulation at rest in healthy subjects (n = 141) and (2) comparing the frequency distribution of these patterns between unmedicated patients with major depression (MD; n = 30) and healthy controls (HCs; n = 30).
Each 1-second segment of 15-min resting EEGs from 141 healthy subjects was classified as 1 of 7 different vigilance stages using the Vigilance Algorithm Leipzig. K-means clustering was used to distinguish different patterns of EEG vigilance regulation. The frequency distribution of these patterns was analyzed in independent data of 30 unmedicated MD patients and 30 matched HCs using a χ² test.
The 3-cluster solution with a stable, a slowly declining and an unstable vigilance regulation pattern yielded the highest mathematical quality and performed best for separation of MD patients and HCs (χ² = 13.34; p < 0.001). Patterns with stable vigilance regulation were found significantly more often in patients with MD than in HCs.
A stable vigilance regulation pattern, derived from a large sample of HCs, characterizes most patients with MD and separates them from matched HCs with a sensitivity between 67 and 73% and a specificity between 67 and 80%. The pattern of vigilance regulation might be a useful biomarker for delineating MD subgroups, e.g. for treatment prediction.
Neuropsychobiology 04/2012; 65(4):188-94. · 2.67 Impact Factor
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Handbook of Clinical Neurology 01/2012; 106:265-78.
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ABSTRACT: In minor depression, the number, severity or duration of symptoms are insufficient to diagnose a major depression or dysthymia. Nevertheless, minor depression is a prevalent disorder associated with functional disability, impairment of quality of life, and intense healthcare use. The aim of this article is to discuss the evidence for the effectiveness of antidepressants in patients with minor depression taking into account a recent meta-analysis and further clinical trials as well as methodological problems associated with the common approach to deducing the clinical significance of therapeutic effects of antidepressants from placebo-verum differences in randomized clinical trials (RCTs).
A recent meta-analysis, comprising six RCTs, and two newer studies do not provide evidence for the efficacy of antidepressants in patients with minor depression, but do not have the power and the methodological quality to exclude efficacy. Possible risks of underestimating the clinical significance of antidepressants based on RCT data are discussed.
For minor depression, unspecific support like active monitoring, unspecific group counselling or internet-based guided self-help activities are reasonable treatment options. Antidepressants can be considered in special cases with, for example, suicidality, previous suicide attempts, family history of affective disorders or previous major depressive episodes.
Current opinion in psychiatry 01/2012; 25(1):1-6. · 3.57 Impact Factor
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ABSTRACT: As a contact person for mental health problems, occupational physicians have a wide range of tasks including the assessment and adaption of company-related psychosocial conditions and the implementation of treatment and rehabilitation measures. It is of interest how they perceive the relevance and occurrence of mental disorders on one hand, and the prevention and treatment of employees' mental disorders within the company on the other.
Data collection with paper-and-pencil and Internet survey. Statistical analysis was performed with PASW.
The majority said that sickness absence and occupational invalidity due to mental disorders have increased in the past years. 65.4 % of the company physicians said that their company has not implemented any prevention programmes. About one third said that mental disorders are handled differently in comparison to physical disorders (insecurity, concealment and social exclusion of the persons affected). Information and education of the company's management are of great importance.
There is need for action when it comes to the qualification and further education of occupational physicians and the implementation of prevention programmes.
Psychiatrische Praxis 01/2012; 39(1):40-2. · 1.64 Impact Factor
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ABSTRACT: In the efficacy evaluation of antidepressant treatments, the total score of the Hamilton Depression Rating Scale (HAMD) is still regarded as the 'gold standard'. We previously had shown that the Inventory of Depressive Symptomatology (IDS) was more sensitive to detect depressive symptom changes than the HAMD17 (Helmreich et al. 2011). Furthermore, studies suggest that the unidimensional subscales of the HAMD, which capture the core depressive symptoms, outperform the full HAMD regarding the detection of antidepressant treatment effects. The aim of the present study was to compare several unidimensional subscales of the HAMD and the IDS regarding their sensitivity to changes in depression symptoms in a sample of patients with mild major, minor or subsyndromal depression (MIND). Biweekly IDS-C28 and HAMD17 data from 287 patients of a 10-week randomised, placebo-controlled trial comparing the effectiveness of sertraline and cognitive-behavioural group therapy in patients with MIND were converted to subscale scores and analysed during the antidepressant treatment course. We investigated sensitivity to depressive change for all scales from assessment-to-assessment, in relation to depression severity level and placebo-verum differences. The subscales performed similarly during the treatment course, with slight advantages for some subscales in detecting treatment effects depending on the treatment modality and on the items included. Most changes in depressive symptomatology were detected by the IDS short scale, but regarding the effect sizes, it performed worse than most subscales. Unidimensional subscales are a time- and cost-saving option in judging drug therapy outcomes, especially in antidepressant treatment efficacy studies. However, subscales do not cover all facets of depression (e.g. atypical symptoms, sleep disturbances), which might be important for comprehensively understanding the nature of the disease depression. Therefore, the cost-to-benefit ratio must be carefully assessed in the decision for using unidimensional subscales.
Archiv f ur Psychiatrie und Nervenkrankheiten 09/2011; 262(4):291-304. · 2.75 Impact Factor
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ABSTRACT: In most countries worldwide suicide rates are higher for males whereas attempted suicide rates are higher for females. The aim is to investigate if the choice of more lethal methods by males explains gender differences in suicide rates.
Data on completed and attempted suicides were collected (n=3235, Nuremberg and Wuerzburg, years 2000-2004). The research question was analyzed by comparing the method-specific case fatality (= completed suicides/completed+attempted suicides) for males and females.
Among the events captured, men chose high-risk methods like hanging significantly more often than women (φ=-0.27; p<0.001). However, except for drowning, case fatalities were higher for males than for females within each method. This was most apparent in "hanging" (men 83.5%, women 55.3%; φ=-0.28; p<0.001) and "poisoning by drugs" (men 7.2%, women 3.4%; φ=-0.09; p<0.001).
The sample size (n=3235) was not enough for comparing method and gender specific case fatalities with a fine-meshed stratification regarding age.
Higher suicide rates in males not only result from the choice of more lethal methods. Other factors have to be considered.
Journal of affective disorders 09/2011; 136(1-2):9-16. · 3.76 Impact Factor
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ABSTRACT: How to define clinical significance of antidepressants has become a matter of far-reaching clinical and regulatory consequences. A mean difference of at least 3 points on the Hamilton Depression Rating Scale (HAMD-17) between active treatment and placebo has been proposed as cut-off score for clinical significance in antidepressant trials.
We aimed to present arguments that this, and other commonly used related approaches to establish clinical significance are likely to be misleading and risky depriving patients with mild depression of efficient treatments.
These problems are exemplified with the data from a randomized placebo-controlled five-arm clinical trial with primary care patients with milder depressive syndromes (MIND-study).
Designs for studying clinical significance have to be distinguished from those assessing efficacy. Moreover, evaluation of the clinical significance of psychotherapy as a possible alternative to antidepressants faces the problem of how to define a valid control group where blinding of neither therapists nor patients is possible.
Journal of affective disorders 06/2011; 138(3):183-91. · 3.76 Impact Factor
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ABSTRACT: To assess and compare the validity of the German 15-item version and shortened versions of the Geriatric Depression Scale (GDS) for early detection of depression in nursing home residents with mild to moderate cognitive impairment (MMSE ≥ 15).
Data from 92 patients were analysed. The Structural Clinical Interview for DSM-IV (SCID) was used as the gold standard. The diagnoses covered in this assessment were current major depression (MD) and minor depression (MinD). The performance of the GDS scales was evaluated using receiver operating characteristics (ROC). Main outcome measures were AUC (area under curve) values, as well as sensitivity and specificity.
Overall diagnostic validity of the GDS-15 was better for MD than for MinD (AUC: 89.7 % and 73.4 %, respectively). In assessing MD, AUC values as well as sensitivity and specificity were comparable for the GDS-15 and the GDS-8. A cut-off point ≥ 5 on the GDS-8 gave optimum performance (sensitivity: 76.9 %, specificity: 88.6 %). For the best cut-off point ≥ 2, the corresponding values of the GDS-4 were 53.8 % and 92.4 %.
The GDS-8 appears to be a less time-consuming alternative for the nursing home setting. However, the GDS-4 is not suitable for this population.
Psychiatrische Praxis 05/2011; 38(6):280-6. · 1.64 Impact Factor
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Georg Juckel, Roland Mergl,
Martin Brüne,
Isabelle Villeneuve,
Thomas Frodl,
Gisela Schmitt,
Thomas Zetzsche,
Christine Born,
Klaus Hahn,
Maximilian Reiser,
Hans-Jürgen Möller,
Karl-Jürgen Bär,
Ulrich Hegerl,
Eva Maria Meisenzahl
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ABSTRACT: Humour involves the ability to detect incongruous ideas violating social rules and norms. Accordingly, humour requires a complex array of cognitive skills for which intact frontal lobe functioning is critical. Here, we sought to examine the association of facial expression during an emotion inducing experiment with frontal cortex morphology in healthy subjects. Thirty-one healthy male subjects (mean age: 30.8±8.9 years; all right-handers) watching a humorous movie ("Mr. Bean") were investigated. Markers fixed at certain points of the face emitting high-frequency ultrasonic signals allowed direct measurement of facial movements with high spatial-temporal resolution. Magnetic resonance images of the frontal cortex were obtained with a 1.5-T Magnetom using a coronar T2- and protondensity-weighted Dual-Echo-Sequence and a 3D-magnetization-prepared rapid gradient echo (MPRAGE) sequence. Volumetric analysis was performed using BRAINS. Frontal cortex volume was partly associated with slower speed of "laughing" movements of the eyes ("genuine" or Duchenne smile). Specifically, grey matter volume was associated with longer emotional reaction time ipsilaterally, even when controlled for age and daily alcohol intake. These results lend support to the hypothesis that superior cognitive evaluation of humorous stimuli - mediated by larger prefrontal grey and white matter volume - leads to a measurable reduction of speed of emotional expressivity in normal adults.
Cortex 05/2011; 47(5):569-74. · 6.08 Impact Factor
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ABSTRACT: This study examined the effects of individual and regional characteristics on receiving depression-specific treatment in the statutory health-insured population of Bavaria (83% of the population).
Data of the Association of Statutory Health Insurance Physicians in Bavaria were analysed for prevalence, diagnosis of and treatment for depression in outpatient care by considering individual and regional characteristics.
Prevalence of diagnosed depression was 9.2% for the statutory health-insured population aged 18-100 years. More than half of all individuals diagnosed with depression (F32.x/F33.x) and more than one-third of persons diagnosed with severe depression (F32.2/.3 and F33.2/.3) did not receive depression-specific treatment. Rates of a depression-specific treatment were higher for females, the middle aged, individuals with more severe depression diagnoses, those with psychiatric comorbidity and those without physical comorbidity and for individuals living in more rural areas.
The pathways to depression-specific treatment for persons diagnosed with moderate and severe depression need to be improved. Training for physicians, stepped care approaches, psycho-education for patients and anti-stigma campaigns are possible measures to reach this goal. The knowledge on individual characteristics that influence receiving a depression-specific treatment is important to target the groups at increased risk for under-treatment.
Social Psychiatry 02/2011; 47(3):475-86. · 2.05 Impact Factor
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ABSTRACT: Depression is common in nursing home residents, but is still underrecognized. Screening for depression could be a first step to increase recognition rates within this high-risk group. Therefore, we investigated the validity of the WHO (Five) Well-Being Index (WHO-5) for early detection of depression in nursing home residents.
The Structural Clinical Interview for DSM-IV (SCID) was used as the gold standard for the validation of the WHO-5. The diagnoses covered in this assessment were both current major depression as well as minor depression according to DSM-IV research criteria.
In our sample of 92 nursing home residents in Munich aged 65-97 years, (73.9% female, 26.1% male) 14.1% fulfilled the criteria of major depression and again 14.1% fulfilled the criteria of minor depression in the SCID. Overall diagnostic validity (area under the ROC curve) of the WHO-5 was .90 (95% confidence interval: .84- .97). The best cut-off-point according to Youden's index yielded a sensitivity of .92 and a specificity of .79.
The diagnostic accuracy of the WHO-5 in our study is promising. The WHO-5 might be an efficient screening tool for nursing home residents, but results have to be replicated in a larger sample.
Neuropsychiatrie: Klinik, Diagnostik, Therapie und Rehabilitation: Organ der Gesellschaft Österreichischer Nervenärzte und Psychiater 01/2011; 25(4):208-15. · 1.38 Impact Factor
