Vagus nerve stimulation: a new form of therapeutic brain stimulation

Although the vagus nerve has traditionally been considered to perform efferent functions, in reality it performs significant afferent functions as well, carrying information from the body, head, and neck to the brain. Preliminary studies examining this afferent activity led to the theory that vagus nerve stimulation (VNS) could successfully control seizure activity in persons who are refractory to antiepileptic medications. Unlike other forms of brain stimulation, VNS is unable to directly stimulate multiple discrete areas of the brain; however, through several pathways, it is able to relay sensory information to higher brain regions. An implantable VNS device known as the VNSTM NeuroCybernetic Prosthesis (NCP) System has been used in approximately 9,000 epilepsy patients in Europe and the United States since 1994. The implant has reduced seizure frequency by an average of 25% to 30%, with minimal side effects. Studies underway are also showing some degree of success in the management of treatment-refractory depression. The future efficacy of the implantable system in other disorders may depend on whether the implant can be more precisely focused to affect different brain regions. Research in this area is underway.     

Evaluation of the effect of Spiritual care on patients with generalized anxiety and depression: a randomized controlled study

The present study was conducted to assess the effect of spiritual care in patients with depression, anxiety or both in a randomized controlled design. The participants were randomized either to receive spiritual care or not and Hamilton anxiety rating scale-A (HAM-A), Hamilton depression rating scale-D (HAM-D), WHO-quality of life-Brief (WHOQOL-BREF) and Functional assessment of chronic illness therapy – Spiritual well-being (FACIT-Sp) were assessed before therapy and two follow-ups at 3 and 6 week. However, with regard to the spiritual care therapy group, statistically significant differences were observed in both HAM-A and HAM-D scales between the baseline and visit 2 (p < 0.001), thus significantly reducing symptoms of anxiety and depression, respectively. No statistically significant differences were observed for any of the scales during the follow-up periods for the control group of participants. When the scores were compared between the study groups, HAM-A, HAM-D and FACIT-Sp 12 scores were significantly lower in the interventional group as compared to the control group at both third and sixth weeks. This suggests a significant improvement in symptoms of anxiety and depression in the spiritual care therapy group than the control group; however, large randomized controlled trials with robust design are needed to confirm the same.     

Feasibility of telephone-based cognitive behavioral therapy targeting major depression among urban dwelling African-American people with co-occurring HIV

Given the burden of depression among those with HIV, and the impact of HIV on urban minority communities there is an urgent need to assess innovative treatment interventions that not only treat depression but do so in a way that allows for increased access to mental health care. This single site, uncontrolled, pilot study sought to determine the feasibility and depression outcomes of an 11-session telephone-based cognitive behavioral therapy intervention delivered over 14 weeks targeting low-income, urban-dwelling, HIV-infected African-American people with major depression. The diagnosis of major depression was made using the Mini International Neuropsychiatric Interview. The primary outcome was the Hamilton Depression Rating Scale (HAM-D) and the secondary outcome was the Quick Inventory of Depression Symptomatology-Self Report (QIDS-SR). Feasibility and satisfaction were also assessed. Assessments occurred at baseline, midpoint and at study conclusion (14 weeks). Fifteen people were screened for the study. Six HIV-infected, low-income, African-American people individuals (five females and one male) were eligible and participated in the study. All patients finished the study. On average, participants completed nine sessions. The sessions lasted for an average of 48 min (SD = 11.5). Compared to mean HAM-D score at baseline (HAM-D = 22.8 (SD = 3.1), the mean HAM-D score was significantly reduced at study conclusion (HAM-D = 9.8 (SD = 7.4); (t (5) = 4.6, p = 0.006); (Cohen d = 1.9)). Compared to the mean QIDS-SR score at baseline (QIDS-SR = 15.5 (SD = 4.2) the mean QIDS score was significantly reduced at study conclusion (QIDS = 7.0 (SD = 5.4);(t (5) = 3.2, p = 0.02); (Cohen d = 1.3)).The mean satisfaction scores across all participants at post-treatment was 5.7 (SD = 0.3) with of a maximum score of 6. Telephone-based CBT can be delivered to low-income, urban-dwelling ethnic minority HIV-infected people resulting in significant reductions in depression symptoms with high satisfaction. The efficacy of this intervention will be assessed in a planned randomized control trial.     

Correlates of relative lethality and suicidal intent among deliberate self-harm patients

Conflicting findings have been reported regarding the relationship between the potential lethality of acts of deliberate self-harm (DSH) and suicidal intent, and how each relates to patient characteristics. This study examines the relationship of suicidal intent of DSH to lethality, the relationship of both to patient characteristics, and determines if intent or lethality are risk factors for repetition of DSH. Potential lethality and Suicide Intent Scale (SIS) scores for DSH episodes were examined in a representative sample of 150 patients presenting to a general hospital. Follow-up interviews were completed 12 to 20 months later. Lethality was strongly associated with high intent. Both lethality and intent were associated with male gender. Suicidal intent but not lethality was associated with the presence of psychiatric disorder and depression. Intent was significantly correlated with hopelessness scale score. Although intent was correlated with both depression and self-esteem scale scores, these correlations became nonsignificant when the effect of hopelessness was removed. Repetition of DSH during the follow-up period was related to neither lethality nor intent scores for the original episodes. Lethality and suicidal intent, although related, have somewhat different correlates. Both should be considered when assessing DSH patients, but their relationship to further suicidal behavior does not appear to be straightforward.     

Beyond the treatment of epilepsy: new applications of vagus nerve stimulation in psychiatry

Vagus nerve stimulation (VNS) in humans generally refers to stimulation of the left vagus nerve at the cervical level VNS is an established treatment largely devoid of severe side effect for medically refractory partial onset seizures and has been used in more than 16,000 patients. Over the past 5 years, applications in other neuropsychiatric disorders have been investigated with a special emphasis on depression. Recent data from an open-label, multi-center pilot study involving 60 patients suggest a potential clinical usefulness in the acute and maintenance treatment of drug-resistant depressive disorder. The perspective of VNS as along-term treatment with the advantage of assured compliance makes it an interesting technique to potentially treat drug-resistant depression. However, definite therapeutic effects of clinical significance remain to be confirmed in large placebo-controlled trial. Results of clinical pilot studies involving patients suffering from obesity and Alzheimer's disease indicate that VNS might induce weight loss and improve cognition. Besides its clinical usefulness, VNS can be used as a research tool, allowing neurophysiologic investigations of the parasympathetic system and its interactions with other parts of the central nervous system.     

Predicting change in depression following renal transplantation: effect of patient coping preferences.

Improvement in patient quality of life is a central goal of renal transplantation. This study examined the hypothesis that change in depression following transplantation would vary as a function of patient coping preferences. Sixty patients were assessed with the Krantz Health Opinion Survey and the Beck Depression Inventory while on the waiting list for a cadaveric renal transplant. Patients were reassessed approximately 12 months later. Among the 33 patients receiving a transplant during the follow-up period, those with a high preference for health-related information exhibited a substantial reduction in depression. In contrast, patients low in preference for information showed a slight increase in depression. Among the 27 patients who were not transplanted during the follow-up period, preference for information had no effect on depression. Patient differences in preference for behavioral involvement did not exert a significant effect on depression.     

Blunted amygdala activity is associated with depression severity in treatment-resistant depression

Up to 50% of individuals with major depressive disorder (MDD) do not recover after two antidepressant medication trials, and therefore meet the criteria for treatment-resistant depression (TRD). Mindfulness-based cognitive therapy (MBCT) is one promising treatment; however, the extent to which MBCT influences clinical outcomes relative to baseline neural activation remains unknown. In the present study we investigated baseline differences in amygdala activation between TRD patients and healthy controls (HCs), related amygdala activation to depression symptoms, and examined the impacts of MBCT and amygdala activation on longitudinal depression outcomes. At baseline, TRD patients (n = 80) and HCs (n = 37) participated in a functional magnetic resonance imaging task in which they identified either the emotion (affect labeling) or the gender (gender labeling) of faces, or passively viewed faces (observing). The TRD participants then completed eight weeks of MBCT or a health enhancement program (HEP). Relative to HCs, the TRD patients demonstrated less amygdala activation during affect labeling, and marginally less during gender labeling. Blunted amygdala activation in TRD patients during affect labeling was associated with greater depression severity. MBCT was associated with greater depression reductions than was HEP directly following treatment; however, at 52 weeks the treatment effect was not significant, and baseline amygdala activation across the task conditions predicted depression severity in both groups. TRD patients have blunted amygdala responses during affect labeling that are associated with greater concurrent depression. Furthermore, although MBCT produced greater short-term improvements in depression than did HEP, overall baseline amygdala reactivity was predictive of long-term clinical outcomes in both groups.     

The relationship between locus of control and long-term stuttering treatment outcome in adult stutterers

The present study was designed to investigate the extent to which adult stutterers' scores on the Locus of Control of Behaviour (LCB) scale are predictive of their ability to maintain speech fluency immediately following intensive treatment and approximately 2 years later. Twenty-one subjects participated in a 3-week intensive treatment program based on the Precision Fluency Shaping Program. Thirteen subjects could be contacted again 2 years later to participate in a follow-up evaluation. While most subjects showed a significant long-term improvement in fluency, no predictive relationship was found between scores on the LCB scale and the level of fluency, measured in percentage of words stuttered, post-treatment or at follow-up. However, LCB scores were found to be predictive of the subjects' fluency self-evaluation measured post-treatment and at follow-up. Overall, the present study suggests that while the LCB scale may contribute to the prediction of long-term treatment outcome, particularly as perceived by the client, other client and process variables will need to be considered as well.     

Therapy of treatment resistant depression: focus on the management of TRD with atypical antipsychotics

Treatment-resistant depression (TRD) represents a significant challenge for physicians. About one third of patients with major depressive disorder fail to experience sufficient symptom improvement despite adequate treatment. Despite this high occurrence of TRD there was no general consensus on diagnosis criteria for TRD until 1997 when researchers proposed a model of defining and staging TRD. In 1999, others defined operational criteria for the definition of TRD. Treatment of TRD is commonly separated into pharmacologic and nonpharmacologic methods. This review gives a short overview of these two methods. The nonpharmacologic methods include psychotherapy, electroconvulsive therapy, and vagus nerve stimulation. Pharmacologic methods include switching to another antidepressant monotherapy, and augmentation or combination with two or more antidepressants or other agents. This review especially focuses on the augmentation of the antidepressant therapy with atypical antipsychotics.     

Why Me? The Persistence of Negative Appraisals Over the Course of Illness1

This paper examines the relationship of illness appraisals and causal attributions to later psychological adjustment among individuals coping with a chronic illness. Data on threat and challenge appraisals, causal attributions, and depression were collected twice over an 18-month period from patients with recently diagnosed rheumatoid arthritis (RA). Appraisals and attributions were differentially related to psychological adjustment. Challenge appraisals were stable over time but were unrelated to depression. Internal, stable, global attributions about the diagnosis were associated with greater depression at follow-up for subjects who were initially high on the depression measure but were related to lowered depression for individuals with initially low depression. An interaction between initial threat appraisals and depression was also found for depression 18 months later. For individuals with low depression scores initially, threat appraisals were related to greater depression later; when initial depression was high, threat appraisals were unrelated to later depression. In addition, initial threat appraisals mediated the relationship between initial level of depression and rumination (continuing to ask, “Why me?”) 18 months later. These findings are discussed in terms of the failure to achieve some resolution about the place of the illness in one's life and of theories of dysphoric rumination that suggest that negative self-focus contributes to a continuing depressed mood.     

Clinical Predictors of Depression in Patients with Low-Grade Brain Tumors: Consideration of a Neurologic Versus a Psychogenic Model

Few studies have examined quality of life issues in patients with brain tumors, though coping with cancer is stressful and is associated with heightened levels of depression. We used regression to examine the clinical factors that might predict depression in a group of 57 adults with low-grade brain tumors after surgery but prior to radiotherapy and chemotherapy. A neurological model comprised of tumor characteristics and treatment was compared with a psychogenic model comprised of both psychosocial and psychodynamic variables. Demographic variables and level of fatigue were also included. A model consisting primarily of fatigue (also clinically elevated) and secondarily of tumor location and aggressiveness of surgical treatment accounted for 33% of the depression score. In a small group at a later follow-up when patient depression was clinically elevated (4–6 years after baseline), fatigue, female sex, cognitive dysfunction, increased family support, and increased report of physical symptoms were associated with depression. The late out findings remain exploratory because of the small sample size, but they suggest that depression develops over time and results from a combination of neurological and psychosocial problems that ensue initial treatments. Treating these collateral problems may reduce the complications from depression.     

Using subtests of the Brain Age Quotient to screen for cognitive deficits among substance abusers.

The subtests of the Brain Age Quotient, a brief neuropsychological battery, were used to screen for cognitive impairment in a sample of 112 substance abusers. Each of the subtests was scored, using newly developed T scores corrected for age, education, and gender, for which a mean battery score of T less than 40 indicates general cognitive impairment. The chance-corrected agreement in finding cognitive dysfunction between this battery and the Average Impairment Rating T score from the Halstead-Reitan battery was adequate, kappa = .81. This result suggests that, for discerning global cognitive impairment, this relatively brief neurodiagnostic screening device may be an attractive alternative to the more time-consuming Halstead-Reitan battery.     

Treatment-resistant depression: A systematic review of systematic reviews

The objective of this research study was to assess pharmacological, somatic and/or psychological treatments in adults with a diagnosis of major depressive disorder who have not responded to at least one course of antidepressant medication. We conducted a systematic review to identify systematic scientific reviews and meta-analyses on treatment-resistant depression (TRD) published until February 2012. Of the sixty studies selected, sixteen met the inclusion criteria and were therefore included in the review. We considered eight main themes, including the definition of TRD, long-term results, and different treatment strategies, including so-called somatic therapies. Based on the review, the definition of TRD should be standardized in order to achieve a shared conceptualization of this disorder. This would allow a better understanding among clinicians and researchers in the field, promoting a homogeneous research methodology and thus leading to more reliable and comparable results. This essential conceptual clarification would also have a positive impact on patients with TRD, their families, and social and health systems.     

The test–retest reliability of the latent construct of executive function depends on whether tasks are represented as formative or reflective indicators

This study investigates the test–retest reliability of a battery of executive function (EF) tasks with a specific interest in testing whether the method that is used to create a battery-wide score would result in differences in the apparent test–retest reliability of children’s performance. A total of 188 4-year-olds completed a battery of computerized EF tasks twice across a period of approximately two weeks. Two different approaches were used to create a score that indexed children’s overall performance on the battery—i.e., (1) the mean score of all completed tasks and (2) a factor score estimate which used confirmatory factor analysis (CFA). Pearson and intra-class correlations were used to investigate the test–retest reliability of individual EF tasks, as well as an overall battery score. Consistent with previous studies, the test–retest reliability of individual tasks was modest (rs ≈ .60). The test–retest reliability of the overall battery scores differed depending on the scoring approach (r_mean = .72; r_{factor_score} = .99). It is concluded that the children’s performance on individual EF tasks exhibit modest levels of test–retest reliability. This underscores the importance of administering multiple tasks and aggregating performance across these tasks in order to improve precision of measurement. However, the specific strategy that is used has a large impact on the apparent test–retest reliability of the overall score. These results replicate our earlier findings and provide additional cautionary evidence against the routine use of factor analytic approaches for representing individual performance across a battery of EF tasks.     

Need for closure and anxiety in delusions: a longitudinal investigation in early psychosis

This study investigated the role of need for closure (NFC) and anxiety in delusions. The Need For Closure Scale (NFCS) and measures of trait and state anxiety were administered to an early psychosis group with current delusions, a clinical (generalised anxiety disorder--GAD) control group and a non-clinical control group. The battery of questionnaires was repeated at follow-up one year later. The NFCS did not meet criteria for a unidimensional scale and two sub-scales were removed from all further analyses. At baseline the deluded and GAD groups scored significantly higher on the reduced NFCS (NFCS-R) than the control group. Trait anxiety was related to NFCS-R in the GAD and non-clinical control groups, but not in the deluded group. At follow-up all groups scored significantly lower on the NFCS-R, perhaps suggesting a practice effect, although the two clinical groups continued to have higher scores than the non-clinical control group. The recovered and non-recovered deluded groups did not differ on the NFCS-R one year later, unlike in the GAD group where recovered participants had significantly lower scores than the non-recovered. Change scores on the NFCS-R and trait anxiety were correlated at trend level in the GAD and non-clinical control groups, but not in the deluded group. These findings suggest that whilst NFC and trait anxiety are related in non-psychotic groups, NFC may be implicated in the formation of delusions, independently of anxiety, in psychotic individuals.     

Incidence of depression related to isotretinoin treatment in 100 acne vulgaris patients

The incidence of depression in acne patients using isotretinoin was assessed in 100 patients with moderate and nodulocystic acne. All patients received 0.75-1.00 mg/kg/day of isotretinoin for 20-28 weeks after acne was assessed. All patients' acne lesions were improved at the end of the treatment period. Psychological state was evaluated at baseline, at Month 3, and Month 6 by a psychiatrist using a Turkish version of the Hamilton Depression Rating Scale. Only one patient's score increased to the clinical level of depression at Month 3 of treatment and declined to subclinical levels at Month 6. Although Hamilton scores increased at Month 3 over baseline scores, except for one patient, others' scores remained below the subclinical level for depression. At the end of Month 6, the mean score decreased below that at Month 3. These changes in means might be related to the onset of clinical effect of isotretinoin.     

Mentalisierung und chronische Depression

Mentalization has mainly been studied in borderline patients but in this study the capacity for mentalization was investigated in patients suffering from chronic depression. Mentalization was measured with the reflective functioning scale (RFS) in patients with chronic depression (n=20) who started long-term psychoanalytic treatment and the results were compared to healthy controls. The results showed that global RF scores did not differ significantly between patients and controls. However, depressed patients had a lower RF score for depression relevant topics in comparison to the initial individual values. Furthermore, RF appears to be related to general psychological competence but unrelated to clinical parameters [Beck Depression Inventory (BDI) and symptom check list (SCL-90)]. Therapeutic outcome as measured with BDI and SCL-90 was not moderated by RF scores at baseline. Correlations between RF and the helping alliance questionnaire (HAQ) indicate that patients with higher RF scores establish a therapeutic alliance more easily than patients with lower RF scores.     

Primary care counsellors’ experiences of working with treatment resistant depression: A qualitative pilot study

Treatment resistant depression (TRD) is a severe and enduring form of depression that does not respond fully to medication. Although the evidence base for effective psychological treatments is not yet established, it is inevitable that counsellors working in primary care will encounter patients with this presentation. This pilot study explores the experience of four primary care counsellors with this patient group using Interpretative Phenomenological Analysis (IPA) and considers the implications for training and practice.     

LAC-Depressionsstudie

The study on long-term therapy of chronic depression (LAC depression study) is one of the first prospective studies to compare psychoanalytic with cognitive behavioral long-term treatment and also investigates the impact of patient assignment by randomization and preference. This comprehensive multicenter study combines a naturalistic and a randomized controlled approach. The long-term follow-up is based on a broad spectrum of quantitative and qualitative research methods and is expected to contribute to the further development of psychotherapeutic treatment methods in this hard to treat patient group as well as to research on the effectiveness of long-term treatment. The background, design and current state of the assessment are presented. A total of 402 patients with chronic depression were included in the trial and the 1 and 2?year follow-up results are currently being analyzed.     

Induction of depressive affect after prolonged exposure to a mildly depressed individual

Scores on the Beck Depression Inventory (BDI) were periodically obtained from the roommates of college students who exhibited a persistent mild depression over a 3-month period. For comparative purposes, BDI scores were also obtained from roommates of individuals who were transiently depressed and from subjects with nondepressed roommates. In comparison with control subjects, the roommates of persistently depressed persons displayed a progressive increase in BDI score over the course of the study.