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Major depression: the importance of clinical characteristics and treatment response to prognosis.

Depress Anxiety. 2010;27(1):19-26

Authors: Katon W, Unützer J, Russo J

BACKGROUND: This article analyzed data from the intervention arm of a large treatment trial to demonstrate the importance of clinical severity, course, comorbidity, and treatment response in patient prognosis. METHODS: This is a secondary analysis of data from a large primary care-based geriatric depression treatment trial that analyzes outcomes from the measurement-based stepped-care intervention arm (N=871 patients) to determine: whether increasing severity levels of depression at baseline were linked with other factors associated with poor depression outcomes such as double depression, anxiety, medical disorders, and high levels of neuroticism and pain; and whether patients with increasing levels of depressive severity would have more intervention visits and treatment trials based on a stepped-care algorithm, but would be less likely to reach remission and have a greater likelihood of re-emerging depression in the year after intervention. RESULTS: Increasing levels of depression severity were a robust predictor of lack of remission and were associated with other clinical variables that have been associated with lack of remission in earlier studies such as double depression, anxiety, medical comorbidity, high neuroticism levels, and chronic pain. Patients with higher levels of severity received significantly more intervention visits, more months of antidepressant treatment and more antidepressant trials, but had fewer depression-free days during the 12-month intervention and in the postintervention year. CONCLUSION: Patients with higher levels of depression severity had worse clinical outcomes despite receiving greater intensity of treatment. A new classification of depression is proposed based on clinical severity, course of illness and treatment experience.

PMID: 19798766 [PubMed - indexed for MEDLINE]

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Overgenerality of autobiographical memory in people with amnestic mild cognitive impairment and early Alzheimer’s disease.

Arch Clin Neuropsychol. 2010 Feb;25(1):22-7

Authors: Donix M, Brons C, Jurjanz L, Poettrich K, Winiecki P, Holthoff VA

Episodic autobiographical memory (ABM) is important for social functioning. Loss of specificity in ABM retrieval has been observed in people with mild to moderate Alzheimer’s disease (AD). Our aim was to extend these findings to subjects with amnestic mild cognitive impairment (aMCI) and very early AD. We performed a cued ABM task with both subject groups and healthy elderly controls. Although aMCI participants performed better than early AD subjects both showed reduced specificity of ABM retrieval when compared with controls. We conclude that qualitative memory retrieval deficits could contribute to social functioning impairment in people with aMCI and early AD, and highlight the complexity of symptoms already present in early stages of cognitive impairment.

PMID: 19955095 [PubMed - indexed for MEDLINE]

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Efficacy of interpersonal therapy-group format adapted to post-traumatic stress disorder: an open-label add-on trial.

Depress Anxiety. 2010;27(1):72-7

Authors: Campanini RF, Schoedl AF, Pupo MC, Costa AC, Krupnick JL, Mello MF

BACKGROUND: Post-traumatic stress disorder (PTSD) is a highly prevalent condition, yet available treatments demonstrate only modest efficacy. Exposure therapies, considered by many to be the “gold-standard” therapy for PTSD, are poorly tolerated by many patients and show high attrition. We evaluated interpersonal therapy, in a group format, adapted to PTSD (IPT-G PTSD), as an adjunctive treatment for patients who failed to respond to conventional psychopharmacological treatment. METHODS: Research participants included 40 patients who sought treatment through a program on violence in the department of psychiatry of Federal University of São Paulo (UNIFESP). They had received conventional psychopharmacological treatment for at least 12 weeks and failed to have an adequate clinical response. After signing an informed consent, approved earlier by the UNIFESP Ethics Review Board, they received a semi-structured diagnostic interview (SCID-I), administered by a trained mental health worker, to confirm the presence of a PTSD diagnosis according to DSM-IV criteria. Other instruments were administered, and patients completed out self-report instruments at baseline, and endpoint to evaluate clinical outcomes. RESULTS: Thirty-three patients completed the trial, but all had at least one second outcome evaluation. There were significant improvements on all measures, with large effect sizes. CONCLUSIONS: IPT-G PTSD was effective not only in decreasing symptoms of PTSD, but also in decreasing symptoms of anxiety and depression. It led to significant improvements in social adjustment and quality of life. It was well tolerated and there were few dropouts. Our results are very preliminary; they need further confirmation through randomized controlled clinical trials.

PMID: 20013958 [PubMed - indexed for MEDLINE]

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An adjunctive Management of Depression Program for difficult-to-treat depressed patients and their families.

Depress Anxiety. 2010;27(1):27-34

Authors: Ryan CE, Keitner GI, Bishop S

BACKGROUND: The goal of this open-label feasibility trial was to test a short-term, adjunctive intervention, the Management of Depression (MoD) Program, to determine if patients with difficult-to-treat forms of depression and their family members could learn to cope more effectively with their illness. METHODS: Nineteen patients meeting The Diagnostic and Statistical Manual IV criteria for major depressive disorder, dysthymia, or chronic/recurrent depression and their family members participated in an open-label study testing the efficacy of the MoD Program. The intervention consisted of nine sessions over 16 weeks, followed by an 8-month maintenance phase. Outcome measures focused on quality of life, psychological and family functioning, and level of depression. RESULTS: Fourteen patients and their family members improved significantly in psychosocial and family functioning, and depression severity (all P-values <.05) by the end of the 16-week intervention. There was also significant improvement in quality of life, psychosocial and family functioning, and depression scores (all P-values<.05) for the 10 patients who completed the maintenance phase. CONCLUSION: The MoD Program is a useful adjunctive intervention that helped patients and their family members deal more effectively with their persisting depression. The disease management approach improved the patient’s perceived quality of life and functioning, reduced depressive symptoms, and improved perception of their family’s functioning.

PMID: 20013959 [PubMed - indexed for MEDLINE]

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The projective identifications of everyday life.

Psychoanal Rev. 2009 Dec;96(6):871-94

Authors: Mendelsohn R

PMID: 20030484 [PubMed - indexed for MEDLINE]

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Whose hate is it? Encountering emotional turbulence in the crosscurrents of projective identification and countertransference experience.

Psychoanal Rev. 2009 Dec;96(6):895-915

Authors: Carlson SN

PMID: 20030485 [PubMed - indexed for MEDLINE]

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The dramatic meaning of madness in psycho(analy)sis: the ear-rationality of treating illusion as reality.

Psychoanal Rev. 2009 Dec;96(6):983-1005

Authors: Kavanaugh PB

PMID: 20030488 [PubMed - indexed for MEDLINE]

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Do ask, do tell? Narcissistic need as a determinant of analyst self-disclosure.

Psychoanal Rev. 2009 Dec;96(6):1007-24

Authors: Kuchuck S

PMID: 20030489 [PubMed - indexed for MEDLINE]

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The extermination of extimacy: an internal view of a city hospital community.

Psychoanal Rev. 2009 Dec;96(6):1055-78

Authors: Tsolas V

PMID: 20030491 [PubMed - indexed for MEDLINE]

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Psychological treatment of obsessive-compulsive disorder in patients with major depression: a pilot randomized controlled trial.

Can J Psychiatry. 2009 Dec;54(12):846-51

Authors: Rector NA, Cassin SE, Richter MA

OBJECTIVE: To examine the efficacy of cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD) in patients with comorbid major depressive disorder (MDD). METHOD: Participants (n = 29) diagnosed with comorbid OCD and MDD were randomized to receive standard CBT for OCD or integrated CBT that included an exclusive focus on treating MDD in the first phase of treatment and OCD in the second phase of treatment. RESULTS: Both treatments resulted in statistically significant improvements in OCD and MDD symptoms. Treatment effects and recovery rates in the intent-to-treat sample were lower in both treatments, compared with past studies that excluded patients with MDD. However, among treatment completers, both treatments resulted in statistically significant and clinically meaningful improvements in OCD and MDD symptoms. CONCLUSIONS: CBT holds promise as an efficacious treatment for people with comorbid OCD and MDD. The high treatment dropout rate with comorbid patients suggests that additional treatment strategies are required to enhance retention and optimize clinical outcomes.

PMID: 20047724 [PubMed - indexed for MEDLINE]

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