Escitalopram add-on in stable Schizophrenia with subsyndromal depression

Background: Significant proportion of the patients of schizophrenia suffer from subsyndromal symptomatic depressive symptoms (SSD) which not only add to the burden of disease but also to the already pre-existing challenges of living with this serious mental illness. Many psychiatrists prescribe antidepressants to patients with schizophrenia who have subsyndromal symptomatic depressive symptoms but data regarding SSD in schizophrenia is meagre. Aim was to study the effect of addition of Escitalopram on psychopathology, cognition and functioning in patients with stable schizophrenia having subsyndromal depressive symptoms and to compare these parameters with patients treated with antipsychotics alone.Methods: The study was a prospective, 8-week randomized double-blind placebo-controlled trial. Seventy four patients who fulfilled the diagnostic criteria of Schizophrenia on the basis of the ICD10-DCR, adjudged to be stable clinically and not requiring any increase in dose of antipsychotic medication over the last eight weeks were recruited into the study. The patients randomly received either Antipsychotics with add-on Escitalopram (10 mg/day) or Antipsychotics with placebo for 8 weeks. The patients were assessed using the HAM-D, CDRS, PANSS, SCoRS, SOFAS and CGI scores at the end of 8 weeks. Patients were also assessed for adverse events at baseline, week 4 and week 8.Results: A total of sixty-six patients who completed the study were analyzed. The HAM-D, CDRS and PANSS score showed significantly better cognition and functioning in the patients of add-on Escitalopram group when compared with the placebo group. There was no significant difference between the two groups in terms of observed side effects.Conclusions: Escitalopram addition to the standard anti-psychotic treatment of schizophrenia, in patients having subsyndromal depressive symptoms, results in better cognition and improved functioning.

Bibliometrics analysis of subsyndromal delirium / 中国实用护理杂志

Objective@#To analyze the current status of subsyndromal delirium in recent years, to provide information for the study of subsyndromal delirium in China.@*Methods@#Bibliometric methods were used to analyze the subsyndromal delirium related literature published in Pubmed, Embase, Web of Science, EBSCO, Cochrane Library, Wanfang and CNKI.@*Results@#A total of 68 articles were included in 48 journals, Literature was mainly published in Canada and the United States, including observational research, systematic reviews, and experimental research. The main subjects are elderly patients from ICU, Nursing Home and Orthopedics. The research content mainly focuses on the incidence, influencing factors and prognosis of subsyndromal delirium.@*Conclusion@#In recent years, the related literature of subsyndromal delirium abroad has increased step by step, but the number of studies is generally low, and the regional development is unbalanced. Chinese researchers should pay more attention to the topic of subsyndromal delirium. The early identification and nursing intervention programs for Chinese patients are the key research directions in the future.

Bibliometrics analysis of subsyndromal delirium / 中国实用护理杂志

Objective To analyze the current status of subsyndromal delirium in recent years, to provide information for the study of subsyndromal delirium in China. Methods Bibliometric methods were used to analyze the subsyndromal delirium related literature published in Pubmed, Embase, Web of Science, EBSCO, Cochrane Library, Wanfang and CNKI. Results A total of 68 articles were included in 48 journals, Literature was mainly published in Canada and the United States, including observational research, systematic reviews, and experimental research. The main subjects are elderly patients from ICU, Nursing Home and Orthopedics. The research content mainly focuses on the incidence, influencing factors and prognosis of subsyndromal delirium. Conclusion In recent years, the related literature of subsyndromal delirium abroad has increased step by step, but the number of studies is generally low, and the regional development is unbalanced. Chinese researchers should pay more attention to the topic of subsyndromal delirium. The early identification and nursing intervention programs for Chinese patients are the key research directions in the future.

Psychosocial, Physical, and Autonomic Correlates of Depression in Korean Adults: Results from a County-Based Depression Screening Study

OBJECTIVE: We aimed to investigate the prevalence and psychosocial and neurophysiological correlates of depression in a large county-based cohort of Korean adults. METHODS: We recruited 2355 adults from a rural county-based health promotion program. The following psychometric scales were used: the Center for Epidemiologic Studies Depression scale (CES-D) was used to assess depression, the General Health Questionnaire (GHQ) was used to evaluate stress, and the Medical Outcome Study Social Support Survey (MOS-SSS) was used to determine perceived social support. Heart rate variability (HRV) was used to assess neurophysiological properties. The psychosocial and neurophysiological variables of adults with depression (CES-D score > or =25) and without depression (CES-D score <25) were statistically compared. A logistic regression model was constructed to identify factors independently associated with depression. RESULTS: We estimated that 17.7% of the subjects had depression, which was associated with old age, being female, being single, less religious affiliation, high education, low body mass index (BMI), low levels of aerobic exercise, low social support, and a low HRV triangular index. The explanatory factors of depression included high education, less religious affiliation, low levels of current aerobic exercise, low BMI, and low social support. CONCLUSION: Given the relatively high prevalence of overall depression, subsyndromal depression should also be regarded as an important issue in screening. The independent factors associated with depression suggest that practical psychosocial intervention, including brief psychotherapy, aerobic exercise, and other self-help methods should be considered. In addition, the HRV results suggest that further depression screening accompanied by neurophysiological features would require fine methodological modifications with proactive efforts to prevent depressive symptoms.

Cognitive Impairment and Decreased Quality of Life in Elderly Patients with Subsyndromal Depression

OBJECTIVES: Non-major depression with fewer symptoms than required for a Diagnostic and Statistical Manual of Mental Disorders-4th edition diagnosis of major depressive disorder (MDD) has consistently been found to be associated with functional impairment. In this study, we aim to estimate the cognitive impairment and the quality of life in elderly patients with subsyndromal depression (SSD) compared with non-depressive elderly (NDE). METHODS: The Korean version of Mini International Neuropsychiatric Interview was administered to 194 outpatients with depression and 108 normal controls. SSD is defined as having five or more current depressive symptoms with core depressive symptoms (depressive mood or loss of interest or pleasure) during more than half a day and more than seven days over two weeks. Depression was evaluated by the Korean form of Geriatric Depression Scale of a 15-item short version. Global cognition was assessed by Mini-Mental State Examination in the Korean version of CERAD assessment packet (MMSE-KC). Subjective cognitive impairment was assessed by the Subjective Memory Complaint Questionnaire. Quality of life was evaluated by the Korean Version of Short-Form 36-Item Health Survey. RESULTS: The mean score of the MMSE-KC in the SSD group was lower than that in the NDE group with adjustment for age, gender, and education [F = 4.270, p = 0.04, analysis of covariance (ANCOVA)]. If we defined those having Z-score of MMSE-KC < -1.5 as a high risk group of cognitive impairment, the odds ratio for the high risk group of cognitive impairment was 1.86 [95% confidence intervals (CI) 1.04-3.34] in SSD and 7.57 (95% CI 3.50-16.40) in MDD compared to NDE. The scores of physical component summary (F = 9.274, p = 0.003, ANCOVA) and mental component summary (F = 53.166, p < 0.001, ANCOVA) in the SSD group were lower than those in the NDE group with adjustment for age, gender, and education. CONCLUSIONS: The subjects with SSD, as well as those with MDD, showed impairment of global cognition and also experienced low quality of life in both physical and mental aspects, compared to the NDE group.

Subsyndromal Depressive Symptoms in Bipolar II Disorder: a Community Mental Health Services Cohort Study (SIN-DEPRES) / Síntomas depresivos subsintomáticos en trastorno bipolar II: un estudio de cohorte de servicios de salud comunitarios

Objectives: The aim of this study was to assess the prevalence and the impact of subclinical depressive symptoms (SDS) on the functional outcome of bipolar II (BD) outpatients in remission. Methods: Cross-sectional and prospective 16-week study of a cohort of 739 euthymic BD patients included by 94 investigators in Spain. Clinical stability was assessed at baseline and week 16 with the Clinical Global Impression scale for BD (CGI-BP-M), depressive symptoms at baseline with the Hamilton Depression Rating Scale (HDRS), the Montgomery-Asberg Scale (MADRS) and the self-applied Center for Epidemiologic Studies-Depression Scale (CES-D). Functional status was evaluated with the Social and Occupational Functioning Assessment Scale (SOFAS) and Social Adaptation Self-evaluation Scale (SASS). Results: The sample of type II BD was composed by 202 patients. SDS were detected in 21.3% of patients (95% IC =15.9 to 27.6) at baseline. In apparently symptom-free patients, the incidence of SDS after 16 weeks was 29% (MADRS >7). At baseline, SDS patients compared to non-SDS presented poorer social-occupational performance (SOFAS mean difference -13.3, 95% CI from -17.1 to -9.5) and poorer social adjustment (SASS mean difference -4.3, 95% CI from -7.0 to -1.7). Depressive symptoms were inversely related to functional status and social adjustment: MADRS-SOFAS correlation coefficients r = -0.55 (p<0.0001) and MADRS-SASS correlation coefficients r = -0.43 (p<0.0001). The self-applied questionnaire identified additional cases with depressive symptoms at baseline, showing a SDS-Total prevalence of 51% identified by any method. A MADRS score 5 showed 0.75 sensitivity and 0.69 specificity in the detection of cases with possible SDS based on self-reported results as gold standard. Conclusions: Depressive symptoms in apparently remitted type II BD outpatients are common and as frequent as in other BD subtypes. These subclinical symptoms result in adverse occupational outcome and social maladjustment. MADRS and self-applied questionnaires during follow-up visits may provide important information about type II BD patients’ mood status and functionality.

Objetivos: Evaluar la prevalencia y el impacto de los síntomas depresivos subclínicos (SDS) en el resultado funcional de pacientes externos de bipolaridad II (TB) en remisión. Métodos: Estudio transversal y prospectivo, de 16 semanas de duración, de una cohorte de 739 pacientes eutímicos de TB incluidos por 94 investigadores en España. La estabilidad clínica se evaluó, en la línea base y en la semana 16, con la Escala Impresión Global Clínica para TB (CGI-BP-M); los síntomas depresivos, en la línea base, con la Escala de Calificación de la Depresión de Hamilton (HDRS), la Escala Montgomery-Asberg (MADRS) y la Escala Autoaplicada para la Depresión del Centro de Estudios Epidemiológicos (CES-D). El estado funcional se evaluó con la Escala de Evaluación del Funcionamiento Social y Ocupacional (SOFAS), y la Escala de Autoevaluación de la Adaptación Social (SASS). Resultados: La muestra de TB tipo II estuvo compuesta de 202 pacientes. Se detectaron SDS en 21,3% de los pacientes (95% IC = 15,9 a 27,6) en la línea base. En pacientes que aparentemente no presentaban síntomas, la incidencia de SDS después de 16 semanas era de un 29% (MADRS>7). En la línea base, los pacientes SDS, en comparación con los no SDS, demostraban un desempeño social-ocupacional más pobre (diferencia media SOFAS -13,3, 95% IC de -17,1 a -9,5) y un ajuste social más pobre (diferencia media SASS -4,3, 95% IC de -7,0 a -1,7). Los síntomas depresivos estaban relacionados inversamente con el estado funcional y el ajuste social: coeficientes de correlación MADRS-SOFAS r = -0,55 (p<0,0001) y coeficientes de correlación MADRS-SASS r = -0,43 (p<0,0001). El cuestionario autoaplicado identificó casos adicionales con síntomas depresivos en la línea base, y mostró una prevalencia total de SDS de 51% identificada por cualquier método. Un puntaje MADRS ≥ 5 mostró una sensibilidad de 0,75 y una especificidad de 0,69 en la detección de casos con posible SDS, basándose en los resultados autoreportados como el estándar de oro. Conclusiones: Los síntomas depresivos en pacientes externos de TB de tipo II aparentemente en remisión son comunes y son tan frecuentes como para los demás subtipos de TB. Estos síntomas subclínicos tienen resultados ocupacionales adversos así como inadaptación social. La MADRS y los cuestionarios autoaplicados durante las visitas de seguimiento pueden ofrecer información importante acerca del estado de ánimo y la funcionalidad del paciente de TB tipo II.

Characteristics of Subsyndromal Anxiety Disorder and Its Clinical Importance

Subsyndromal anxiety disorder indicates mental states of having anxiety symptoms not fulfilling criteria for anxiety disorders. Despite of the lack of previous objective findings of the subsyndromal anxiety disorder, its clinical importance has increased. It can cause many kinds of clinical anxiety symptoms and functional disabilities. But the early intervention and early treatment make it possible not only to attenuate the anxiety symptoms and functional disabilities but also to prevent disease progression to a full syndromal anxiety disorder. In this article, we will review the previous studies about the subsyndromal anxiety disorder and discuss its clinical characteristics and importance.

Subsyndromal Depression

Subsyndromal depression (SSD) is found to be more prevalent than major depressive disorder (MDD) and minor depressive disorder (MnDD). SSD is also associated with adverse clinical outcomes, increased risk of suicide, increased social dysfunction and disability, increased risk for future mood disorders, and increased uses of medical and mental health services. DSM-IV diagnostic criteria are not suitable for capturing SSD. Although there is no agreement on gold standard to define SSD so far, three definitions of SSD are available. First, SSD is defined as having two or more current depressive symptoms without core depressive symptoms (depressive mood or loss of interest) and with time threshold (most of the day and nearly every day over at least two weeks). Second, SSD is defined as having two or more current depressive symptoms with core depressive symptoms and without time threshold. Third, SSD is defined by using cutoff points of depression rating scales. SSD may represent a prodromal, residual, or interepisode symptomatic state in the course of MDD and MnDD. More than a half of SSD patients became any type of depressive disorders (SSD, MnDD and MDD) at 1 year. SSD may represent a discrete category of its own, without prior or consequent episodes of MDD. Considering clinical significance of SSD such as its high prevalence, significant psychosocial impairment and chronicity and serious outcomes, researchers and clinicians should be more vigilant in capturing and caring for patients with SSD.

Subsyndromal Bipolar Disorder

Subsyndromal bipolar symptoms are common during maintenance treatment and appear to be associated with relapse into an episode of the same polarity. This implies subsyndromal symptoms are an important problem in recurrent bipolar disorder and require more additive and infallible therapeutic intervention. Undetected, untreated subsyndromal states lead patients to have poor prognosis and quality of life. The combination of a long undetected illness and significant psychosocial impairment renders early identification and intervention vital for the treatment of bipolar disorders. Methods for early identification includes finding prodromes, using screening tools such as the HCL-32 (Hypomania Checklist-32) and the BSDS (bipolar spectrum diagnostic scale). Various augmentation treatment methods would be needed to reduce subsyndromal symptoms, especially, psychosocial treatment has the potential to help patients address the multiple psychosocial problems associated with this chronic illness. To overcome difficulties of diagnosing subsyndromal disorder and to treat it appropriately, a staging system was suggested by some researchers. It assumes that earlier stages have better prognosis and require simpler therapeutic regimens. Staging may assist in treatment planning and prognosis of bipolar disorder, and emphasize the importance of early intervention. Further research is required in this exciting and novel area.

Geriatric Depression

Geriatric depression is a major public health problem. There has been significant progress in our understanding of the nature, clinical course, and treatment of geriatric depression. Important new findings have emerged in a number of areas directly affecting clinical care and have, in turn, stimulated further research. These findings include the association of geriatric depression with brain abnormality and vascular disease;clinical importance of subsyndromal depression;the possible role of sex hormone;the clinical utility of new antidepressant treatments:and clear relationship between depression and suicide. These new findings in various area of geriatric depression were discussed in the present article.