58% of people recovering from a major depressive episode are unlikely to relapse after 5 years.
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Comment↗
Biomedical subjects
W E Craighead
Publications and source records attributed to W E Craighead.
The role of psychotherapy in treating psychiatric disorders.
Psychotherapy has shifted from long-term to short-term approaches, which have been found to be effective for the treatment of specific psychiatric disorders. These psychotherapy interventions (primarily behavior therapy, CBT, and IPT) have been found useful in presenting an educational framework for disorders and the treatment rationale for intervention programs. Short-term and maintenance empirical data support the effectiveness of using behavior therapy and CBT as adjunctive interventions with medications for bipolar I disorder and schizophrenia. In major randomized clinical trials, psychotherapy interventions (primarily behavior therapy, CBT, and IPT) have been shown to be effective as primary treatments (treatments of choice) for the major psychiatric problems of obsessive-compulsive disorder, panic disorder, and major depression as well as several other psychiatric disorders. The combination of psychotherapy and psychotropic medications is not always additive for acute treatment effects or especially for the maintenance of treatment effects so that the combination of psychotherapy and medications is not the most effective treatment for all psychiatric disorders. Badly needed, additional randomized controlled trials of psychotherapy, medications, and their combinations are under way in large, NIMH-supported studies of the treatment of several psychiatric disorders.
Combined Modality Therapy↗
Predicting recurrence of major depressive disorder in young adults: a prospective study.
Sixty-five young adults with remitted major depressive disorder (MDD) were followed for 18 months. Recurrence of MDD was reported by 41.5% of the initial sample and 49.1% of those who completed the study (n = 53). Survival analyses were used to identify predictors of recurrence so that individuals at greatest risk could be targeted for intervention. Potential predictors included measures of comorbid psychopathology (Axis II pathology, and current and lifetime nonmood Axis I diagnoses), depression-specific clinical features (number of episodes, past treatment, and suicidality), and self-reported cognitive and interpersonal constructs (hope, dysfunctional attitudes, and interpersonal problems). Only personality pathology (specifically, the total dimensional and Cluster B dimensional scores on the International Personality Disorder Examination) significantly predicted hazard of recurrence.
Adolescent↗
Psychosocial interventions for bipolar disorder.
Patients with bipolar disorder are prone to recurrences even when they are maintained on lithium or anticonvulsant regimens. The authors argue that the outpatient treatment of bipolar disorder should involve both somatic and psychosocial components. Psychosocial interventions can enhance patients' adherence to medications, ability to cope with environmental stress triggers, and social-occupational functioning. Family and marital psychoeducational interventions and individual interpersonal and social rhythm therapy have received the most empirical support in experimental trials. These interventions, when combined with medications, appear effective in improving symptomatic functioning during maintenance treatment. A beginning literature also supports the utility of individual cognitive-behavioral and psychoeducational approaches, particularly in enhancing medication adherence. Identifying the optimal format for psychosocial treatments and elucidating their mechanisms of action are topics for further study.
Ambulatory Care↗
Effects of exercise training on older patients with major depression.
BACKGROUND: Previous observational and interventional studies have suggested that regular physical exercise may be associated with reduced symptoms of depression. However, the extent to which exercise training may reduce depressive symptoms in older patients with major depressive disorder (MDD) has not been systematically evaluated. OBJECTIVE: To assess the effectiveness of an aerobic exercise program compared with standard medication (ie, antidepressants) for treatment of MDD in older patients, we conducted a 16-week randomized controlled trial. METHODS: One hundred fifty-six men and women with MDD (age, > or = 50 years) were assigned randomly to a program of aerobic exercise, antidepressants (sertraline hydrochloride), or combined exercise and medication. Subjects underwent comprehensive evaluations of depression, including the presence and severity of MDD using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI) scores before and after treatment. Secondary outcome measures included aerobic capacity, life satisfaction, self-esteem, anxiety, and dysfunctional cognitions. RESULTS: After 16 weeks of treatment, the groups did not differ statistically on HAM-D or BDI scores (P = .67); adjustment for baseline levels of depression yielded an essentially identical result. Growth curve models revealed that all groups exhibited statistically and clinically significant reductions on HAM-D and BDI scores. However, patients receiving medication alone exhibited the fastest initial response; among patients receiving combination therapy, those with less severe depressive symptoms initially showed a more rapid response than those with initially more severe depressive symptoms. CONCLUSIONS: An exercise training program may be considered an alternative to antidepressants for treatment of depression in older persons. Although antidepressants may facilitate a more rapid initial therapeutic response than exercise, after 16 weeks of treatment exercise was equally effective in reducing depression among patients with MDD.
Aged↗
The relationship between personality pathology and dysfunctional cognitions in previously depressed adults.
Multivariate and univariate regression models were used to examine the relationship between Axis II personality pathology and dysfunctional cognitions in a follow-up study of 40 formerly depressed inpatients. A dimensionalized measure of overall Axis II pathology was significantly and positively related to dysfunctional attitudes (Dysfunctional Attitudes Scale [DAS]) and maladaptive negative event attributions (Attributional Style Questionnaire-Negative Composite [ASQ-N]); the Axis II measure accounted for approximately 29% of the variance in DAS and 14% of the variance in ASQ-N, after controlling statistically for subsyndromal depressive symptoms (Beck Depression Inventory [BDI]). Axis II pathology was not significantly associated with positive event attributions, and no significant Axis II x BDI interaction effects were observed. A secondary canonical analysis of Axis II clusters was largely consistent with a hypothesized general personality pathology factor associated with dysfunctional cognitions, though a more specific association between Axis II Cluster C pathology and dysfunctional attitudes was also observed.
Adult↗
Modeling relapse in unipolar depression: the effects of dysfunctional cognitions and personality disorders.
Survival analytic models were used to determine the effects of Axis II pathology and dysfunctional cognitions on depressive relapse in a sample of 50 depressed inpatients followed 33 to 84 months (M = 49.9) postdischarge. In analyses based on follow-up interview measures, expected remission duration among patients without personality disorders was approximately 7.4 times longer than among patients with Axis II comorbidity. Attributional style also accounted for unique variance in the relapse model, with adaptive positive event attributions inversely related to relapse probability. Neither dysfunctional attitudes nor negative event attributions were significantly related to relapse. Dimensional Axis II Cluster B and C pathology ratings were associated with decreased survival time, whereas Cluster A pathology was associated with increased survival. Among measures obtained during index hospitalization, only the dimensional rating of Axis II pathology was significantly predictive, with a cumulative 8% decrease in expected survival for each Axis II criterion item met.
Adult↗
Factor analysis of the Montgomery-Asberg Depression Rating Scale.
A maximum likelihood factor analysis with Promax rotation was performed on the Montgomery-Asberg Depression Rating Scale for 340 adult inpatients in an Affective Disorders Program. Four factors were identified and labeled cognitive-pessimism, affective, cognitive-anxiety, and vegetative. Recommendations were offered for the research and clinical use of the factor scores.
Adjustment Disorders↗
Further studies on platelet serotonin transporter binding in depression.
OBJECTIVE: There is an impressive literature implicating abnormalities in serotonergic neural systems in depression. Many investigators, but not all, have reported low numbers of platelet and brain serotonin (5-HT) transporter sites in drug-free depressed patients. In the present study the authors sought to determine whether the low platelet 5-HT transporter binding in depressed patients is due to previous antidepressant drug exposure. In addition, the binding of both [3H]imipramine and the more specific ligand [3H]paroxetine to the platelet 5-HT transporter was compared in drug-free depressed patients and age- and sex-matched normal comparison subjects. METHOD: In the first experiment blood samples were obtained from 12 depressed patients who had never received antidepressant drugs and 12 normal comparison subjects, and platelet 5-HT transporter binding was measured by using [3H]imipramine. In the second experiment blood samples were obtained from 28 drug-free depressed patients and 28 age- and sex-matched comparison subjects, and platelet 5-HT transporter binding was assessed by using both [3H]imipramine and [3H]paroxetine. RESULTS: In the first experiment the never-medicated depressed patients exhibited fewer platelet [3H]imipramine binding sites than did the comparison subjects. In the second experiment the drug-free depressed patients had fewer platelet binding sites for both [3H]imipramine and [3H]paroxetine than did the comparison subjects. CONCLUSIONS: The low number of platelet [3H]imipramine binding sites does not appear to be due to prior antidepressant drug exposure. The Bmax of platelet binding sites for both [3H]imipramine and [3H]paroxetine, ligands used to measure 5-HT transporter binding, is abnormally low in depressed patients.
Antidepressive Agents↗
Attributional style in clinically depressed and conduct disordered adolescents.
We tested the reformulated learned helplessness theory of depression with adolescent inpatients (N = 63) who were diagnosed by Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) criteria as depressed, or conduct disordered, or both. Adolescents with major depression diagnoses differed from nondepressed adolescents with significantly lower attributional style scores for positive events. The study also evaluated the relation of self-reported depression, anxiety, and social maladjustment to attributional style. Subjects who reported more severe depression had a significantly lower composite score for internal, stable, and global attributions for positive events. The composite of internal, stable, and global attributions for negative events was not significantly related to either diagnosed or self-reported depression.
Adolescent↗
A clinical trial of a behavioral therapy to reduce urinary incontinence in nursing homes. Outcome and implications.
One hundred thirty-three incontinent women in seven nursing homes were assigned randomly to a 13-week behavior therapy program for urinary incontinence or to a control group that received usual incontinence-related care. The therapy became effective after 6 weeks of training. By the final month of training, the treatment women's wet episodes had been reduced by 0.6 episodes per day, a 26% reduction over baseline. This reduction in the number of wet episodes was statistically significant, both with respect to this group's baseline levels of incontinence and in comparison with the performance of the control women. The number of wet episodes in the control group remained about the same throughout training and the 22-week follow-up period. The treatment women improved partly because they learned to request help, a response prompted and reinforced by the program. Trainees with a high frequency of incontinence during baseline, the more cognitively intact residents, and residents with normal bladder capacity responded better to this behavior therapy program.
Aged↗
Control-related cognitions and depression among inpatient children and adolescents.
In previous studies, children with numerous depressive symptoms have shown two patterns of control-related cognition: (1) low levels of perceived personal competence, and (2) "contingency uncertainty"--confusion regarding the causes of significant events. The generality of these findings was tested for more seriously disturbed children. Three child inpatient samples, from separate psychiatric hospitals, completed the Children's Depression Inventory (CDI) plus measures of control-related beliefs. In all three samples, the findings resembled those of previous studies: CDI scores were significantly related to low perceived competence and to contingency uncertainty; by contrast, CDI scores were only weakly related to perceived noncontingency. The findings suggest that depressive symptoms in children may be (1) more closely linked to "personal helplessness" than to "universal helplessness," and (2) more closely linked to uncertainty about the causes of events than to firm beliefs in noncontingency. The findings carry implications for etiology and treatment of child depression.
Adolescent↗
The ISQ-P tool: measuring stress associated with incontinence.
1. ISQ-P is a useful tool in measuring psychological stress associated with urinary incontinence. 2. ISQ-P can be used in conjunction with bladder training programs. 3. Patients with urinary incontinence show depressive symptoms, have somatic concerns regarding urinary incontinence, and exhibit a feeling of shame.
Aged↗
Advances in biological psychiatry and psychotherapy are not mutually exclusive.
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Biological Psychiatry↗
Normative and reliability data for the Children's Depression Inventory.
The present study was undertaken to examine some of the psychometric properties of the Children's Depression Inventory (CDI), a self-report inventory devised by Kovacs and Beck (1977) to measure depression in children and adolescents. Normative and reliability data were obtained from three independent samples taken from eight public schools in central Pennsylvania. Age- and gender-related differences in reported characteristics of depression were also investigated. The subjects were 594 males and 658 females whose ages ranged from 8 to 16 years and whose combined mean age was 11.67 years (SD = 1.91). The CDI was group-administered to all 1,252 subjects; 155 fifth-grade subjects (77 males and 78 females) were retested after 3 weeks, and 107 seventh- and eight-grade subjects (45 males and 62 females) were retested after 1 year. The distribution statistics for the combined samples yielded an overall CDI mean of 9.09, a standard deviation of 7.04, and a cutoff score of 19 for the upper 10% of the distribution. Reliability assessed through coefficient alpha, item-total score product-moment correlations, and test-retest coefficients proved acceptable. Gender differences were obtained for several item-total score correlations and for test-retest reliability of CDI scores.
Adolescent↗
A conceptual model for cognitive-behavior therapy with children.
This paper briefly reviews the historical and conceptual developments that produced the cognitive-behavioral model for clinical interventions with children. It is suggested that this model should be expanded by including the person variables of emotion and developmental level and by broadening the scope of environmental variables to include the family, school, and other social/community contexts. The implications of this expansion of the cognitive-behavioral model for psychopathology, assessment, and intervention are discussed.
Behavior Therapy↗
Human development and intervention in childhood psychopathology.
Changes sought by interventionists can be influenced by the classes of changes labeled "development." We argue there are several features of the child's developing physical, psychological, and behavioral characteristics that suggest the sorts of interventions that may be efficacious and the ones that may be less efficient or counterproductive. Illustrations are drawn from the literatures pertinent to such topics as systematic desensitization, cognitive-behavioral self-control therapy, interventions for social isolates, and parent training programs, and involve preventive as well as remedial/therapeutic interventions. The combined efforts of developmentalists and interventionists may contribute to clarifying one of the major issues in human development today, that of constancy and change over the life course.
Behavior Therapy↗
Mood changes, physiological responses, and self-statements during social rejection imagery.
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Affect↗