[Show abstract][Hide abstract] ABSTRACT: Dr Cuijpers and Colleagues Reply To the Editor: We thank Dr Gaudiano and colleagues for their contribution to the discussion about psychotherapy for dysthymia. We agree very much with Gaudiano et al that we should be careful about drawing definite conclusions about the comparative efficacy of psychotherapy on the basis of 5 trials. Therefore, we have been careful in our meta-analysis of comparative studies to describe this as an important limitation of our study, and we have repeatedly indicated that our results should be considered with caution and our conclusions should not be seen as definite.1 On the other hand, we do not agree with their interpretation of the evidence to date on psychological treatments of dysthymia. First, Gaudiano et al argue that 2 of the 5 trials were based on brief problem-solving therapy (PST)2,3 and that this treatment may be too brief for treating dysthymia adequately. This may be true, but as we described in our article, removal of these 2 studies did not reduce the effect size. On the contrary, as can be seen in Table 2 of our article, the effect size indicating the difference between psychotherapy and pharmacotherapy for dysthymia increased from 0.28 to 0.44 after removal of the PST studies. Further, as can be seen in Figure 1 of our article, in each of the 2 studies on PST, the difference between psychotherapy and pharmacotherapy was very small (nonsignificant effect sizes of 0.12 and 0.15). Apparently, PST does not do such a bad job compared to pharmacotherapy, even with only 4 to 6 sessions of 30 minutes! Second, Gaudiano et al argue that interpersonal psychotherapy (IPT) may also be less effective in dysthymia because it was originally designed for acute depressive illness and may require further adaptation for chronically depressed patients. This could also very well be true and could give some explanation for our findings. However, the fact that IPT was not designed for chronic depression does not imply that it cannot be effective. Cognitive-behavioral therapy (CBT) and PST were also originally designed for acute depression, and above we saw that PST may be quite effective in dysthymia compared to pharmacotherapy. However, we disagree most on the third issue Gaudiano et al bring forward. They say that the most appropriate interpretation of the evidence is that “comprehensive CBT adapted for chronic depression is a promising treatment for dysthymia.” In our meta-analysis, we included 1 study in which CBT was examined in patients with dysthymia.4 Of the 5 studies among dysthymia patients, this study showed the largest difference between psychotherapy and pharmacotherapy (effect size = 0.71 in favor of pharmacotherapy; see Figure 1 of our article). However, Gaudiano et al point to the larger retention rate in CBT compared with pharmacotherapy. And this observation is correct. In the pharmacotherapy condition, 6 of the 18 patients (33%) dropped out, while in the CBT condition only 3 of the 13 patients (23%) dropped out. It would in theory be possible that this difference in dropout rate (10%) is indeed in part responsible for the difference between psychotherapy and pharmacotherapy. However, it seems very unlikely that this difference can explain a differential effect size of 0.71. Dr Gaudiano and colleagues bring forward that earlier research has suggested that psychotherapy for dysthymia may require a greater number of sessions than are typically used in acute depression treatment. However, this suggestion is based on an open study5 of 10 patients, which can hardly be considered a strong suggestion. Furthermore, we saw above that PST with only 4 to 6 sessions of 30 minutes is almost as good as pharmacotherapy in the treatment of dysthymia. We think therefore that the issue of how many sessions are required needs more research before a statement like this can be made. Gaudiano et al also refer to the cognitive-behavioral analysis system of psychotherapy (CBASP) for chronic depression.6 They suggest that the study on CBASP gives evidence that CBT is effective in dysthymia.6 However, CBASP is a combination of different types of psychotherapy techniques including not only CBT, but also interpersonal, psychodynamic, and behavioral approaches.6,7 Furthermore, the study by Keller et al6 focused on patients with chronic major depression, not dysthymia. No patients with pure dysthymia were included in this study, and therefore it is difficult to see how this study gives evidence that CBASP, let alone CBT, is effective in dysthymia! So what is the evidence for the statement that “comprehensive CBT adapted for chronic depression is a promising treatment for dysthymia”? We have one study that finds negative findings compared to pharmacotherapy and another study that is not about CBT and not about dysthymia. Would this not meet the definition of “premature conclusions”? Finally, our last comment is that we do not exclude the possibility that psychotherapy could be a promising treatment for dysthymia. We just do not have the evidence available yet. References 1. Cuijpers P, van Straten A, van Oppen P, et al. Are psychological and pharmacological interventions equally effective in the treatment of adult depressive disorders? a meta-analysis of comparative studies. J Clin Psychiatry. 2008;69(11):1675–1685. PubMed 2. Williams JW, Barrett J, Oxman T, et al. Treatment of dysthymia and minor depression in primary care: a randomized controlled trial in older adults. JAMA. 2000;284(12):1519–1526. PubMed doi:10.1001/jama.284.12.1519 3. Barrett JE, Williams JWJ, Oxman TE, et al. Treatment of dysthymia and minor depression in primary care: a randomized trial in patients aged 18 to 59 years. J Fam Pract. 2001;50(5):405–412. PubMed 4. Dunner DL, Schmaling KB, Hendrickson H, et al. Cognitive therapy versus fluoxetine in the treatment of dysthymic disorder. Depression. 1996;4(1):34–41. PubMed doi:10.1002/(SICI)1522-7162(1996)4:13.0.CO;2-F 5. McCullough JP. Psychotherapy for dysthymia: a naturalistic study of ten patients. J Nerv Ment Dis. 1991;179(12):734–740. PubMed doi:10.1097/00005053-199112000-00004 6. Keller MB, McCullough JP, Klein DN, et al. A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. N Engl J Med. 2000;342(20):1462–1470. PubMed doi:10.1056/NEJM200005183422001 7. Wiersma JE, van Schaik DJ, van Oppen P, et al. Treatment of chronically depressed patients: a multisite randomized controlled trial testing the effectiveness of “Cognitive Behavioral Analysis System of Psychotherapy” (CBASP) for chronic depressions versus usual secondary care. BMC Psychiatry. 2008;8:18
The Journal of Clinical Psychiatry 08/2009; 70(8):1188; author reply 1188-89. DOI:10.4088/JCP.09lr05075 · 5.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to determine if combined psychotherapy and pharmacotherapy reduces reported depressive symptoms compared to an assessment only condition for active drug injectors over nine months. Using a randomized controlled trial at an outpatient academic research office, the researchers applied psychotherapy (eight sessions of cognitive behavioral therapy) plus pharmacotherapy (citalopram) to active injection drug users with a DSM-IV diagnosis of major depression, dysthymia, substance-induced mood disorder with symptoms persisting for at least three months, or major depression plus dysthymia, and a Modified Hamilton Rating Scale for Depression (MHRSD) score greater than 13. The MHRSD scale scores were then assessed at the completion of three, six, and nine months. Participants (n = 109) were 64% male and 82% Caucasian, with a mean baseline MHRSD score of 20.7. Depression subtypes included major depression only (63%), substance-induced depression (17%), and double-depression (17%). Study retention at nine months was 89%. At the completion of three months of acute treatment, 26% of combined treatment patients (n = 53), compared to 12% of control patients (n = 56), were in remission (p = .047). At both six and nine months, the between-group differences in remission rates and mean MHRSD scores were insignificant, although the overall mean MHRSD score decreased from baseline (p < .01). At all follow-up assessments, depression remission was significantly associated with lower heroin use. Among active drug injectors diagnosed with depression, symptoms decline over time. Combined treatment is superior to an assessment-only condition in depression remission rates at the end-of-treatment, but this difference does not persist.
American Journal on Addictions 07/2009; 14(4):346-57. DOI:10.1080/10550490591003684 · 1.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In order to characterize depression treatment-as-usual in a large primary care practice in the United States with colocated mental health care, and to examine predictors of receiving any treatment and receiving adequate treatment, primary care patients were systematically approached in waiting rooms. Those with a minimum level of depression symptoms (n = 91) were asked to participate in a study in which they completed assessments of mental health service use, depression symptoms, and related problems. Results suggested that most patients with elevated depressive symptoms were receiving some type of mental health care, indicating they had been identified as depressed. However, only half were receiving "minimally adequate care." Minority patients were less likely to receive any care. Patients who were more depressed, demonstrated poorer problem-solving ability, and had poorer physical health were more likely to receive any treatment and to receive minimally adequate treatment for depression. These results suggest that, even in the context of colocated mental health care, there is still room for improving treatment of depressed patients.
Families Systems & Health 07/2009; 27(2):161-71. DOI:10.1037/a0015847 · 1.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Previous research has shown that psychotic major depression (PMD) is often associated with higher rates of nonsuppression on the dexamethasone suppression test (DST) compared with nonpsychotic major depression (NMD), suggesting the potential importance of cortisol hypersecretion in the psychotic subtype of the disorder. However, these patient groups also are known to differ from one another on a variety of other clinical variables, and there are numerous factors independent of diagnostic status known to affect the DST. Thus, we investigated possible confounds that could help account for the apparent DST abnormalities in PMD sometimes reported in past research. Hospitalized patients with PMD (n = 11) and NMD (n = 58) were compared on the DST and other clinical variables. As expected, PMD patients showed significantly higher rates of DST nonsuppression (55% vs. 24%; p = 0.04). However, PMD patients also had significantly higher levels of anxiety severity (p = 0.01). The higher rates of nonsuppression in the PMD group were attenuated when these patients were compared with a subsample of NMD patients matched on anxiety severity (55% vs. 55%). Implications for future research on biological markers of PMD are discussed.
The Journal of nervous and mental disease 07/2009; 197(6):395-400. DOI:10.1097/NMD.0b013e3181a775cf · 1.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine whether family functioning is uniquely associated with caregiver depressive symptoms in the immediate aftermath of stroke.
Cross-sectional data from the baseline assessment of an intervention study for stroke survivors and their families.
Neurology inpatient service of a large urban hospital.
Stroke survivors (n=192), each with a primary caregiver. The mean age of stroke survivors was 66 years, and most, 57%, were men (n=110). The mean age of caregivers was 57 years, and 73% (n=140) of the caregivers were women. Eighty-five percent of caregivers were white.
Measures were chosen to assess caregivers' depressive symptoms (Centers for Epidemiologic Studies Depression Scale), family functioning (Family Assessment Device), and additional factors such as health status (Medical Outcomes Study 36-Item Short-Form Health Survey) and stroke survivors' cognitive abilities (modified Mini-Mental State Examination) and functional impairments (FIM and Frenchay Activities Index).
Depressive symptoms were mild to moderate in 14% and severe in 27% of caregivers. Family functioning was assessed as unhealthy in 34% of caregiver-patient dyads. In statistical regression models, caregiver depression was associated with patients' sex, caregivers' general health, and family functioning.
Forty-one percent of caregivers experienced prominent depressive symptoms after their family member's stroke. Higher depression severity in caregivers was associated with caring for a man, and having worse health and poor family functioning. After stroke, the assessment of caregivers' health and family functioning may help determine which caregivers are most at risk for a depressive syndrome.
Archives of physical medicine and rehabilitation 07/2009; 90(6):947-55. DOI:10.1016/j.apmr.2008.12.014 · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although major depression is characteristic of both bipolar disorder and major depressive disorder, there is disagreement as to whether there are distinct features of depression that differentiate these two conditions. The primary aim of this study was to use methods based in item response theory to evaluate differences in DSM-IV depression symptom endorsement in an epidemiological sample of individuals with a history of mania (i.e., bipolar depression) versus those without (i.e., unipolar depression).
Clinical interview data were drawn from a subsample (n = 13,058) of individuals with bipolar or unipolar depression who had participated in the National Epidemiologic Survey on Alcohol and Related Conditions. Using these data, a two-parameter item response model was used to estimate differential item functioning of DSM-IV depressive symptoms between these two groups.
Differences in severity parameter estimates revealed that suicidal ideation and psychomotor disturbance were more likely to be endorsed across most levels of depression severity in bipolar versus unipolar depression. Differences in discrimination parameter estimates revealed that fatigue was significantly less discriminating in bipolar versus unipolar depression.
Equating for level of depression symptom severity, study results revealed that suicidal ideation and psychomotor disturbance are endorsed more frequently in bipolar versus unipolar depression. Study data also suggested that fatigue may be endorsed more frequently in unipolar relative to bipolar samples at moderate (versus low or high) levels of depression symptom severity.
[Show abstract][Hide abstract] ABSTRACT: Major depressive disorder is commonly treated in primary care settings. Psychotherapy occurring in primary care should take advantage of the unique aspects of the setting and must adapt to the problems and limitations of the setting. In this open trial, the authors used a treatment development model to adapt behavior therapy for primary care patients (n = 12) with persistent symptoms of depression, despite antidepressant medication treatment. Ten of 12 participants completed 10 sessions of therapy over the course of 4 months, and all endorsed high levels of treatment satisfaction. Participants' depression scores declined significantly over time, and 75% of participants experienced at least 50% change on a self-report measure of depression symptoms. There were trends for social functioning, pain, and general health perceptions to improve over time. These results highlight the acceptability and feasibility of adapting behavior therapy for primary care, and support the continuation of this research.
[Show abstract][Hide abstract] ABSTRACT: Treatment trials for psychogenic nonepileptic seizures (PNES) are few, despite the high prevalence and disabling nature of the disorder. We evaluated the effect of cognitive behavioral therapy (CBT) on reduction of PNES. Secondary measures included psychiatric symptom scales and psychosocial variables. We conducted a prospective clinical trial assessing the frequency of PNES in outpatients treated using a CBT for PNES manual. Subjects diagnosed with video/EEG-confirmed PNES were treated with CBT for PNES conducted in 12 weekly sessions. Seizure calendars were charted prospectively. Twenty-one subjects enrolled, and 17 (81%) completed the CBT intervention. Eleven of the 17 completers reported no seizures by their final CBT session. Mean scores on scales of depression, anxiety, somatic symptoms, quality of life, and psychosocial functioning showed improvement from baseline to final session. CBT for PNES reduced the number of PNES and improved psychiatric symptoms, psychosocial functioning, and quality of life.
[Show abstract][Hide abstract] ABSTRACT: This study compared the efficacy of three treatment conditions in preventing recurrence of bipolar I mood episodes and hospitalization for such episodes: individual family therapy plus pharmacotherapy, multifamily group therapy plus pharmacotherapy, and pharmacotherapy alone.
Patients with bipolar I disorder were enrolled if they met criteria for an active mood episode and were living with or in regular contact with relatives or significant others. Subjects were randomly assigned to individual family therapy plus pharmacotherapy, multifamily group therapy plus pharmacotherapy, or pharmacotherapy alone, which were provided on an outpatient basis. Individual family therapy involved one therapist meeting with a single patient and the patient's family members, with the content of each session and number of sessions determined by the therapist and family. Multifamily group psychotherapy involved two therapists meeting together for six sessions with multiple patients and their respective family members, with the content of each session preset. All subjects were prescribed a mood stabilizer, and other medications were used as needed. Subjects were assessed monthly for up to 28 months. Following recovery from the index mood episode, subjects were assessed for recurrence of a mood episode and for hospitalization for such episodes.
Of a total of 92 subjects that were enrolled in the study, 53 (58%) recovered from their intake mood episode. The analyses in this report focus upon these 53 subjects, 42 (79%) of whom entered the study during an episode of mania. Of the 53 subjects who recovered from their intake mood episode, the proportion of subjects within each treatment group who suffered a recurrence by month 28 did not differ significantly between the three treatment conditions. However, only 5% of the subjects receiving adjunctive multifamily group therapy required hospitalization, compared to 31% of the subjects receiving adjunctive individual family therapy and 38% of those receiving pharmacotherapy alone, a significant difference. Time to recurrence and time to hospitalization did not differ significantly between the three treatment groups.
For patients with bipolar I disorder, adjunctive multifamily group therapy may confer significant advantages in preventing hospitalization for a mood episode.
[Show abstract][Hide abstract] ABSTRACT: There is a paucity of research on the emergence of suicidal ideation in recently hospitalized patients undergoing treatment for depression. As part of a larger clinical trial, patients (N = 103) with major depression without suicidal ideation at hospital discharge were followed for up to 6 months while receiving study-related outpatient treatments. Fifty-five percent reported the emergence of suicidal ideation during the outpatient period, with the vast majority (79%) exhibiting this problem within the first 2 months post-discharge. Seventy percent of those reporting severe suicidality prior to hospitalization exhibited a reemergence of suicidal ideation post-discharge. However, 29% without significant suicidality at the index hospitalization later developed suicidal ideation during the outpatient treatment period. A faster time to the emergence of suicidal ideation was predicted by both higher prehospitalization levels of suicidal ideation as well as greater depression severity at hospital discharge. Overall, rates of emergent suicidal ideation found in the current sample of recently hospitalized patients were higher than those reported in previous outpatient samples.
[Show abstract][Hide abstract] ABSTRACT: Dementia caregivers often report feeling burdened by caretaking responsibilities. Caregiver burden is correlated with caregiver depression, but the interrelationship between burden and depression requires further investigation. This study hypothesized that persisting elevated burden results in subsequent depressive symptoms. Participants were 33 dementia caregivers divided into two groups based on their Zarit Burden Interview score. The outcome variable was the total score on the Geriatric Depression Scale after 12 months. Caregivers who had persisting high burden showed significantly worse depression scores after 12 months compared to those caregivers without persisting high burden. Regression analysis controlling for baseline depression also demonstrated burden as a significant predictor of subsequent depression. These data suggest that longitudinal burden may be predictive of higher depressive symptoms; therefore, reducing burden could decrease depressive symptoms in dementia caregivers.
Journal of Geriatric Psychiatry and Neurology 10/2008; 21(3):198-203. DOI:10.1177/0891988708320972 · 2.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Research suggests that treatments for depression among individuals with chronic physical disease do not improve disease outcomes significantly, and chronic disease management programs do not necessarily improve mood. For individuals experiencing co-morbid depression and chronic physical disease, demands on the self-regulation system are compounded, leading to a rapid depletion of self-regulatory resources. Because disease and depression management are not integrated, patients lack the understanding needed to prioritize self-regulatory goals in a way that makes disease and depression management synergistic. A framework in which the management of co-morbidity is considered alongside the management of either condition alone offers benefits to researchers and practitioners and may help improve clinical outcomes.
[Show abstract][Hide abstract] ABSTRACT: Depressed breastfeeding women may have concerns about taking antidepressant medications due to fears regarding infant exposure. We examined the clinical records of 73 breastfeeding women who sought depression treatment, to identify characteristics of those who took antidepressants. Compared to women who were not treated with pharmacotherapy, breastfeeding patients who took antidepressants had more severe symptoms, greater functional impairment, more extensive psychiatric histories, and were less likely to be involved in a committed relationship. No differences were found in age, race, or education.
Depression and Anxiety 10/2008; 25(10):888-91. DOI:10.1002/da.20299 · 4.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Reports an error in "Life events as predictors of mania and depression in bipolar I disorder" by Sheri L. Johnson, Amy K. Cueller, Camilo Ruggero, Carol Winett-Perlman, Paul Goodnick, Richard White and Ivan Miller (Journal of Abnormal Psychology, 2008[May], Vol 117, 268-277). In the aforementioned article, Amy K. Cuellar's last name was misspelled. The corrected list of author names is: Sheri L. Johnson, Amy K. Cuellar, Camilo Ruggero, Carol Winett-Perlman, Paul Goodnick, Richard White, and Ivan Miller. (The following abstract of the original article appeared in record 2008-05639-002.) To date, few prospective studies of life events and bipolar disorder are available, and even fewer have separately examined the role of life events in depression and mania. The goal of this study was to prospectively examine the role of negative and goal-attainment life events as predictors of the course of bipolar disorder. One hundred twenty-five individuals with bipolar I disorder were interviewed monthly for an average of 27 months. Negative and goal-attainment life events were assessed with the Life Events and Difficulties Schedule. Changes in symptoms were evaluated using the Modified Hamilton Rating Scale for Depression and the Bech-Rafaelsen Mania Scale. The clearest results were obtained for goal-attainment life events, which predicted increases in manic symptoms over time. Negative life events predicted increases in depressive symptoms within regression models but were not predictive within multilevel modeling of changes in depressive symptoms. Given different patterns for goal attainment and negative life events, it appears important to consider specific forms of life events in models of bipolar disorder. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
[Show abstract][Hide abstract] ABSTRACT: Given the high lifetime prevalence rates of bipolar disorder and comorbid substance use disorders (SUDs), the aim of the study was to examine the effect of a remitted SUD on the future course of bipolar I disorder in patients taking part in a clinical trial. Patients with bipolar I disorder were enrolled in a larger study examining the effects of pharmacotherapy plus family interventions. These patients were recruited during an acute mood episode and their mood symptoms and substance abuse were assessed longitudinally for up to 28 months. Patients with a remitted SUD showed a poorer acute treatment response, a longer time to remission of their acute mood episode, and a greater percentage of time with subthreshold but clinically significant depression and manic symptoms over follow-up compared to those without this comorbidity pattern. Subsequent substance abuse during follow-up could not fully account for the poorer course of illness. As remitted SUDs appear to negatively predict treatment outcome, current findings have implications for both clinical trials of bipolar patients as well as clinical practice.
Psychiatry Research 08/2008; 160(1):63-71. DOI:10.1016/j.psychres.2007.05.014 · 2.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Psychological literature and clinical lore suggest that there may be systematic differences in how various demographic groups experience depressive symptoms, particularly somatic symptoms. The aim of the current study was to use methods based on item response theory (IRT) to examine whether, when equating for levels of depression symptom severity, there are demographic differences in the likelihood of reporting DSM-IV depression symptoms.
We conducted a secondary analysis of a subset (n=13 753) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) dataset, which includes a large epidemiological sample of English-speaking Americans. We compared data from women and men, Hispanics and non-Hispanic Whites, African Americans and Whites, Asian Americans and Whites, and American Indians and Whites.
There were few differences overall, although the differences that we did find were primarily limited to somatic symptoms, and particularly appetite and weight disturbance.
For the most part, individuals responded similarly to the criteria used to diagnose major depression across gender and across English-speaking racial and ethnic groups in the USA.
Psychological Medicine 07/2008; 39(4):591-601. DOI:10.1017/S0033291708003875 · 5.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Treatment adherence is a frequent problem in bipolar disorder, with research showing that more than 60% of bipolar patients are at least partially nonadherent to medications. Treatment nonadherence is consistently predictive of a number of negative outcomes in bipolar samples, and the discontinuation of mood stabilizers places these patients at high risk for relapse. Several types of adjunctive treatment (family, psychoeducational, cognitive-behavioral) have been investigated for improving symptoms and functioning in bipolar patients with some success. To date, less attention has been paid to developing treatments specifically to promote treatment adherence to and engagement with pharmacological as well as behavioral treatments in patients with bipolar disorder. First, we review the effects of adjunctive interventions specifically on treatment adherence outcomes in 14 published clinical trials. Based on this empirical knowledge base, we present a preliminary description of the treatment strategies that appear most promising for improving adherence. The article also provides research recommendations for developing more effective interventions for the purpose of improving bipolar treatment adherence. Finally, special treatment considerations, including the potential impact of comorbid substance abuse and bipolar depression, are discussed.
[Show abstract][Hide abstract] ABSTRACT: To date, few prospective studies of life events and bipolar disorder are available, and even fewer have separately examined the role of life events in depression and mania. The goal of this study was to prospectively examine the role of negative and goal-attainment life events as predictors of the course of bipolar disorder. One hundred twenty-five individuals with bipolar I disorder were interviewed monthly for an average of 27 months. Negative and goal-attainment life events were assessed with the Life Events and Difficulties Schedule. Changes in symptoms were evaluated using the Modified Hamilton Rating Scale for Depression and the Bech-Rafaelsen Mania Scale. The clearest results were obtained for goal-attainment life events, which predicted increases in manic symptoms over time. Negative life events predicted increases in depressive symptoms within regression models but were not predictive within multilevel modeling of changes in depressive symptoms. Given different patterns for goal attainment and negative life events, it appears important to consider specific forms of life events in models of bipolar disorder.
[Show abstract][Hide abstract] ABSTRACT: Most prior research has focused on functional impairment as a consequence, rather than a predictor, of mood symptoms in bipolar disorder (BD). Yet the majority of this research has been cross-sectional, thus limiting conclusions regarding directionality of effects. Indeed, just as functional impairment may represent an important outcome of BD, it may also serve as a risk factor for future affective symptoms or episodes. Thus, the primary aim of this study was to evaluate functional impairment as a predictor of mood symptoms in BD.
Ninety-two patients with bipolar I disorder, recruited from hospital settings, were administered the Modified Hamilton Rating Scale for Depression, Bech-Rafaelson Mania Scale, and UCLA Social Attainment Survey (SAS) at baseline and at four-month follow-up.
Overall, patients evidenced a moderate level of functional impairment at both time points. Whereas baseline functional impairment was not associated with subsequent manic symptoms, baseline functional impairment was significantly predictive of depressive symptom levels at four-month follow-up. When individual SAS subscales were evaluated, impaired romantic relationship functioning and activity involvement were each significantly predictive of subsequent depressive symptoms, whereas baseline peer functioning was not.
The study results suggest that functional impairment may be predictive of subsequent depressive, but not manic, symptoms over a relatively short-term follow-up period. Future studies that evaluate illness course over longer follow-up periods would be useful to further clarify the potential bidirectional relationship between depression and functional impairment in BD.
[Show abstract][Hide abstract] ABSTRACT: Increased understanding of the treatment goals of depressed patients may lead to improved treatments and assist researchers and program evaluators in choosing clinically relevant outcome measures. To characterize patients' depression treatment goals, we interviewed hospitalized depressed patients about their treatment goals. Common responses included improving relationships, decreasing sadness or anxiety, and finding a job or improving job performance. On a written questionnaire, patients also ranked decreasing suicidal thoughts highly. These results suggest that for many severely depressed individuals, primary treatment goals include improvements in social and occupational functioning in addition to symptomatic improvement.
The Journal of nervous and mental disease 04/2008; 196(3):217-22. DOI:10.1097/NMD.0b013e3181663520 · 1.69 Impact Factor