BMC Psychiatry - Latest Articles

A new clinical rating scale for work absence and productivity: validation in patients with major depressive disorder

Raymond Lam — 2009-12-03T00:00:00Z

Background: The prevalence of major depressive disorder (MDD) is highest in working age people and depression causes significant impairment in occupational functioning. Work productivity and work absence should be incorporated into clinical assessments but currently available scales may not be optimized for clinical use. This study seeks to validate the Lam Employment Absence and Productivity Scale (LEAPS), a 10-item self-report questionnaire that takes 3-5 minutes to complete. Methods: The study sample consisted of consecutive patients attending a Mood Disorders outpatient clinic who were in full- or part-time paid work. All patients met DSM-IV criteria for MDD and completed during their intake assessment the LEAPS, the self-rated version of the Quick Inventory for Depressive Symptomatology (QIDS-SR), the Sheehan Disability Scale (SDS) and the Health and Work Performance Questionnaire (HPQ). Standard psychometric analyses for validation were conducted. Results: A total of 234 patients with MDD completed the assessments. The LEAPS displayed excellent internal consistency as assessed by Cronbach's alpha of 0.89. External validity was assessed by comparing the LEAPS to the other clinical and work functioning scales. The LEAPS total score was significantly correlated with the SDS work disability score (r=0.63, p<0.01) and the Global Work Performance rating from the HPQ (r=-0.79, p<0.01). The LEAPS total score also increased with greater depression severity. Conclusions: The LEAPS displays good internal and external validity in a population of patients with MDD attending an outpatient clinic, which suggests that it may be a clinically useful tool to assess and monitor work functioning and productivity in depressed patients.

Association of various reproductive rights, domestic violence and marital rape with depression among Pakistani women

Faridah Ali — 2009-12-01T00:00:00Z

Background: Depression among women is common in developing countries. Gender inequality can contribute to women's risk for depression. Lack of reproductive and sexual rights is an important marker of gender inequality and women do not have the freedom to express their reproductive and sexual needs in many parts of the world. Therefore we designed this study to determine the association of depression with lack of various reproductive rights and domestic violence among married women in Karachi, Pakistan. Methods: A case-control study with 152 cases and 152 controls, which included women 15-48 years, recruited from two teaching hospitals from 1st June 2007 through 31st August 2007. The SRQ was administered to all subjects. A cut off score of 8 was used to confirm cases of depression diagnosed by physicians, and to exclude cases of depression from the controls. Self-administered questionnaire was used to assess the risk factors. Results: 61% of the cases and 43% of the controls were ever abused by spouse and the frequency of marital rape was 33% in cases and 13% in controls. After adjusting for the effects of other variables in the model, less than 18 years of age at marriage (OR 2.00; 95% CI=1.07, 3.7), decision for marriage by parents (OR 3.51; 95% CI=1.67, 7.37), abuse by in laws (OR 4.91; 95% CI=2.66, 9.06), [less than or equal to] 3 hours per day spent with husband (OR 2.33; 95% CI=1.34, 4.08), frequency of intercourse [less than or equal to] 2 times per week (OR 1.85; 95% CI=1.06, 3.22) and marital rape (OR 3.03; 95% CI=1.50, 6.11) were associated with depression among women. Conclusion: In our study depression in married women was associated with younger age at marriage, lack of autonomy in marriage decisions, marital rape and domestic abuse by in-laws. Efforts should be directed towards creating awareness about the reproductive and sexual rights of women in Pakistan. Physicians should be trained to screen and identify women who may be at risk for psychological distress as a result of denial of reproductive rights so that they can support positive mental health outcomes through individual, family or marital counseling.

An ongoing process: A qualitative study of how the alcohol-dependent free themselves of addiction through progressive abstinence

Mei-Yu Yeh — 2009-11-24T00:00:00Z

Background: Most people being treated for alcoholism are unable to successfully quit drinking within their treatment programs. In few cases do we know the full picture of how abstinence is achieved in Taiwan. We tracked processes of abstinence in alcohol-dependency disorders, based on study evidence and results. This research explores the process of recovery from the viewpoint of the alcohol-dependent. Methods: Semi-structured interviews were conducted in two different settings, using purpose sampling, during 2003-2004. The data were analyzed using content analysis. Participants were 32 adults, purposefully selected from an Alcoholics Anonymous group and a psychiatric hospital in North Taiwan. Results: We found that the abstinence process is an ongoing process, in which the alcohol-dependent free themselves of addiction progressively. This process never ends or resolves in complete recovery. We have identified three stages in the struggle against alcoholism: the Indulgence, Ambivalence and Attempt (IAA) cycle, in which the sufferer is trapped in a cycle of attempting to give up and failing; the Turning Point, in which a Personal Nadir is reached, and the Ongoing Process of abstinence, in which a constant effort is made to remain sober through willpower and with the help of support groups. We also discuss Influencing Factors that can derail abstinence attempts, pushing the sufferer back into the IAA cycle. Conclusion: This study provides important points of reference for alcohol and drug service workers and community healthcare professionals in Taiwan, casting light on the abstinence process and providing a basis for intervention or rehabilitation services.

Modifiable risk factors predicting major depressive disorder at four year follow-up: a decision tree approach

Philip Batterham — 2009-11-22T00:00:00Z

Background: Relative to physical health conditions such as cardiovascular disease, little is known about risk factors that predict the prevalence of depression. The present study investigates the expected effects of a reduction of these risks over time, using the decision tree method favoured in assessing cardiovascular disease risk. Methods: The PATH through Life cohort was used for the study, comprising 2,105 20-24 year olds, 2,323 40-44 year olds and 2,177 60-64 year olds sampled from the community in the Canberra region, Australia. A decision tree methodology was used to predict the presence of major depressive disorder after four years of follow-up. The decision tree was compared with a logistic regression analysis using ROC curves. Results: The decision tree was found to distinguish and delineate a wide range of risk profiles. Previous depressive symptoms were most highly predictive of depression after four years, however, modifiable risk factors such as substance use and employment status played significant roles in assessing the risk of depression. The decision tree was found to have better sensitivity and specificity than a logistic regression using identical predictors. Conclusion: The decision tree method was useful in assessing the risk of major depressive disorder over four years. Application of the model to the development of a predictive tool for tailored interventions is discussed.

Filicide in Austria and Finland - A register-based study on all filicide cases in Austria and Finland 1995-2005

Hanna Putkonen — 2009-11-21T00:00:00Z

Background: Filicide is the tragic crime of murdering one's own child. Previous research has found that the offending parents are commonly depressed and that suicide is often associated as an actual act or an intention. Yet, filicide is an underreported crime and previous studies have been strained with methodological problems. No comprehensive international studies on filicide have been presented in the literature until now. Methods: This was a descriptive, comprehensive, register-based study of all filicides in Austria and Finland during 1995-2005. Filicide-suicide cases were also included. Results: Most of the perpetrators were the biological mothers; in Austria 72%, in Finland 52%. Suicide followed filicide either as an attempt or a fulfilled act in 32% and 54% of the cases in Austria and Finland, respectively. Psychotic mood disorders were diagnosed for 10% of the living perpetrators in Austria, and 12% in Finland. Non-psychotic depression was diagnosed in 9% of surviving perpetrators in Austria, 35% in Finland. Conclusion: The data from the two countries demonstrated that filicide is such a multifaceted and rare phenomenon that national data from individual countries seldom offer sufficient scope for its thorough study. Further analyses are needed to produce a complete picture of filicide.

Prevalence and correlates of alcohol and other substance use disorders in young adulthood: A population-based study

Antti Latvala — 2009-11-19T00:00:00Z

Background: Several risk factors for alcohol and other substance use disorders (SUDs) have been identified, but it is not well understood whether their associations with SUD are independent of each other. In particular, it is not well known, whether the associations between behavioral and affective factors and SUDs are independent of other risk factors. The incidence of SUDs peaks by young adulthood making epidemiological studies of SUDs in young adults informative. Methods: In a comprehensive population-based survey of mental health in Finnish young adults (aged 21-35 years, n = 605), structured clinical interview (SCID-I) complemented by medical record data from all lifetime hospital and outpatient treatments were used to diagnose SUDs. We estimated the prevalences of lifetime DSM-IV SUDs, and investigated their associations with correlates from four domains representing: (1) behavioral and affective factors, (2) parental factors, (3) early initiation of substance use, and (4) educational factors. Independence of the association of behavioral and affective factors with SUD was investigated. Results: Lifetime prevalences of abuse or dependence of any substance, alcohol, and any illicit substance were 14.2%, 13.1%, and 4.4%, respectively. Correlates from all four domains were associated with SUD. The associations between behavioral and affective factors (attention or behavior problems at school, aggression, anxiousness) and SUD were largely independent of other correlates, whereas only daily smoking and low education associated with SUD after adjustment for behavioral and affective factors. Conclusion: Alcohol use disorders are common in Finnish young adults, whereas other SUDs are less common than in many other developed countries. Our cross-sectional analyses suggested that the association between behavioral and affective factors and SUD was only partly accounted for by other correlates, such as early initiation of substance use and parental alcohol problems. In contrast, associations between many other factors and SUD were non-significant when adjusted for behavioral and affective factors.

Psychotropic medication in the French child and adolescent population: prevalence estimation from health insurance data and national self-report survey data

Eric Acquaviva — 2009-11-17T00:00:00Z

Background: The aim of this work is to estimate the French frequencies of dispensed psychotropic prescriptions in children and adolescents. Prevalence estimations of dispensed prescriptions are compared to the frequencies of use of psychotropic reported by 17 year-old adolescents. Methods: Prescription data is derived from national health insurance databases. Frequencies of dispensed prescriptions are extrapolated to estimate a range for the 2004 national rates. Self-report data is derived from the 2003 and 2005 ESCAPAD study, an epidemiological study based on a questionnaire focused on health and drug consumption. Results: The prevalence estimation shows that the prevalence of prescription of a psychotropic medication to young persons between 3 and 18 years is about 2.2%.In 2005, the self-report study (ESCAPAD) shows that 14.9% of 17 year-old adolescents took medication for "nerves" or "to sleep" during the previous 12 months. The same study in 2003 also shows that 62.3% of adolescents aged 17 and 18 reporting psychotropic use, took the medication for anxiety and 56.8% to sleep. Only 49.7% of these medications are suggested by a doctor. Conclusion: This study underlines a similar range of prevalence of psychotropic prescriptions in France to that observed in other European countries. Nevertheless, the proportion of antipsychotics and benzodiazepines seems to be higher, whereas the proportion of methylphenidate is lower.Secondly, a disparity between the prevalence of dispensed prescriptions and the self-report of actual use of psychotropics has been highlighted by the ESCAPAD study which shows that these treatments are widely used as "self-medication".

Glutamatergic deficits and parvalbumin-containing inhibitory neurons in the prefrontal cortex in schizophrenia

B Bitanihirwe — 2009-11-16T00:00:00Z

Background: We have previously reported that the expression of the messenger ribonucleic acid (mRNA) for the NR2A subunit of the N-methyl-D-aspartate (NMDA) class of glutamate receptor was decreased in a subset of inhibitory interneurons in the cerebral cortex in schizophrenia. In this study, we sought to determine whether a deficit in the expression of NR2A mRNA was present in the subset of interneurons that contain the calcium buffer parvalbumin (PV) and whether this deficit was associated with a reduction in glutamatergic inputs in the prefrontal cortex (PFC) in schizophrenia. Methods: We examined the expression of NR2A mRNA, labeled with a 35S-tagged riboprobe, in neurons that expressed PV mRNA, visualized with a digoxigenin-labeled riboprobe via an immunoperoxidase reaction, in twenty schizophrenia and twenty matched normal control subjects. We also immunohistochemically labeled the glutamatergic axon terminals with an antibody against vGluT1. Results: The density of the PV neurons that expressed NR2A mRNA was significantly decreased by 48-50% in layers 3 and 4 in the subjects with schizophrenia, but the cellular expression of NR2A mRNA in the PV neurons that exhibited a detectable level of this transcript was unchanged. In addition, the density of vGluT1-immunoreactive boutons was significantly decreased by 79% in layer 3, but was unchanged in layer 5 of the PFC in schizophrenia. Conclusion: These findings suggest that glutamatergic neurotransmission via NR2A-containing NMDA receptors on PV neurons in the PFC may be deficient in schizophrenia. This may disinhibit the postsynaptic excitatory circuits, contributing to neuronal injury, aberrant information flow and PFC functional deficits in schizophrenia.

Evidence for Genetic Association of RORB with Bipolar Disorder

Casey McGrath — 2009-11-12T00:00:00Z

Background: Bipolar disorder, particularly in children, is characterized by rapid cycling and switching, making circadian clock genes plausible molecular underpinnings for bipolar disorder. We previously reported work establishing mice lacking the clock gene D-box binding protein (DBP) as a stress-reactive genetic animal model of bipolar disorder. Microarray studies revealed that expression of two closely related clock genes, RAR-related orphan receptors alpha (RORA) and beta (RORB), was altered in these mice. These retinoid-related receptors are involved in a number of pathways including neurogenesis, stress response, and modulation of circadian rhythms. Here we report association studies between bipolar disorder and single-nucleotide polymorphisms (SNPs) in RORA and RORB. Methods: We genotyped 355 RORA and RORB SNPs in a pediatric cohort consisting of a family-based sample of 153 trios and an independent, non-overlapping case-control sample of 152 cases and 140 controls. Bipolar disorder in children and adolescents is characterized by increased stress reactivity and frequent episodes of shorter duration; thus our cohort provides a potentially enriched sample for identifying genes involved in cycling and switching. Results: We report that four intronic RORB SNPs showed positive associations with the pediatric bipolar phenotype that survived Bonferroni correction for multiple comparisons in the case-control sample. Three RORB haplotype blocks implicating an additional 11 SNPs were also associated with the disease in the case-control sample. However, these significant associations were not replicated in the sample of trios. There was no evidence for association between pediatric bipolar disorder and any RORA SNPs or haplotype blocks after multiple-test correction. In addition, we found no strong evidence for association between the age-at-onset of bipolar disorder with any RORA or RORB SNPs. Conclusion: Our findings suggest that clock genes in general and RORB in particular may be important candidates for further investigation in the search for the molecular basis of bipolar disorder.

A investigation of cognitive 'branching' processes in major depression

Nicholas Walsh — 2009-11-10T00:00:00Z

Background: Patients with depression demonstrate cognitive impairment on a wide range of cognitive tasks, particularly putative tasks of frontal lobe function. Recent models of frontal lobe function have argued that the frontal pole region is involved in cognitive branching, a process requiring holding in mind one goal while performing sub-goal processes. Evidence for this model comes from functional neuroimaging and frontal-pole lesion patients. We have utilised these new concepts to investigate the possibility that patients with depression are impaired at cognitive 'branching'. Methods: 11 non-medicated patients with major depression were compared to 11 matched controls in a behavioural study on a task of cognitive 'branching'. In the version employed here, we recorded participant's performance as they learnt to perform the task. This involved participants completing a control condition, followed by a working memory condition, a dual-task condition and finally the branching condition, which integrates processes in the working memory and dual-task conditions. We also measured participants on a number of other cognitive tasks as well as mood-state before and after the branching experiment. Results: Patients took longer to learn the first condition, but performed comparably to controls after six runs of the task. Overall, reaction times decreased with repeated exposure on the task conditions in controls, with this effect attenuated in patients. Importantly, no differences were found between patients and controls on the branching condition. There was, however, a significant change in mood-state with patients increasing in positive affect and decreasing in negative affect after the experiment. Conclusion: We found no clear evidence of a fundamental impairment in anterior prefrontal 'branching processes' in patients with depression. Rather our data argue for a contextual learning impairment underlying cognitive dysfunction in this disorder. Our data suggest that MDD patients are able to perform high-level cognitive control tasks comparably to controls provided they are well trained. Future work should replicate these preliminary findings in a larger sample of MDD patients.