White matter hyperintensities on magnetic resonance imaging among elderly depressed patients and its association with the severity of depression and cognition

Introduction: Depression in the elderly can have a different pathophysiology and clinical profile, and studies have shown pathological changes in the brain on radio imaging. The present study aimed to find out the association of white matter hyperintensities (WMH) on magnetic resonance imaging (MRI) with the severity of illness and cognition in elderly depressed patients. Methodology: This cross-sectional study included 68 elderly (>60 years of age) depressed patients who had undergone MRI at a tertiary care center, and based on the severity of WMH, they were divided into two groups: no or slight WMH group and moderate or severe WMH group. The severity of depression was assessed using the Hamilton Depression Rating Scale (HAM-D) scale, and neuropsychological assessments were made for testing attention, concentration and executive function. Results: HAM?D scores were found significantly higher in patients with moderate?to?severe WMH groups (22.6 ± 5.2) compared to those with no or slight WMH (16.3 ± 4.2). The cognitive performance evaluated by backward digit span test, Trail making Test A and B, and Color Stroop test was significantly poor in the moderate?to?severe WMH group. Conclusion: Elderly depressed patients having a greater WMH had more severe depression and poor cognitive performance, especially psychomotor and executive functioning. WMH could be a potential marker for the severity of illness and cognition in depression in elderly persons.

Association between quality of life and clinical symptoms in patients with the first-episode depression / 西安交通大学学报(医学版)

【Objective】 To study the relationship between quality of life and clinical symptoms of patients with the first-episode depression. 【Methods】 The untreated patients (n=36) with the first-episode depression and the depression patients (n=71) on drug treatment were included according to the strict screening and exclusion criteria. Subjects in control group (n=59), who matched in age, gender and education, were included according to the corresponding enrollment criteria. World Health Organization Quality of Life—Brief (WHOQOL-BREF) and The Social Adaptation Self-evaluation Scale (SASS) were used to evaluate all the subjects. The Hamilton Depression Rating Scale (HAMD), The Hamilton Anxiety Scale (HAMA) and Montgomery-Asberg Depression Rating Scale (MADRS) were used to evaluate the depressive patients. 【Results】 There was no significant difference in age or education level between all the groups. The quality of life was significantly lower in the first group and the treatment group than in the control group; no significant difference was found between patients in the two depression groups. Correlation analysis showed that the total scores of physiology, environment and quality of life in the first group and the treatment group were negatively correlated with HAMD, HAMA and MADRS. SASS was positively correlated with the total scores of physiology, psychology, environment and quality of life. 【Conclusion】 The quality of life and social adaptation of patients with the first-episode depression and those with depression after treatment were significantly reduced. More serious depression symptoms are linked to the worse quality of life, while better social adaptation is linked to the better quality of life.

A Study to Assess Depression among Cancer Patients at Our Tertiary Care Hospital Ajmer: An Hospital Based Study

Background: Individuals and families who face a diagnosis ofcancer will experience varying levels of stress and emotionalupset. Depression in patients with cancer not only affects thepatients themselves but also features a major negative impacton their families.Aims & Objectives: The aim of this study to assess theassociation between demographic data and level of depressionamong cancer patient admitted at our tertiary care hospitalAjmer.Material and Methods: This descriptive survey approach, 50samples by using structured interview technique (Hamiltondepression rating scale) employed by convenience samplingtechnique.Results: Consistent with Hamilton depression rating scale,level of depression 20 (40%) are in mild depression, 17 (34%)are in Moderate depression, 12 (24%) are in normal stage and1 (2%) are in severe depression. Nobody in very severedepression. No association between demographic variables.Conclusion: The most outcome of the study that some cancerpatients are always in depression. Any interventional programor awareness program on depression will help the cancerpatients to attenuate Depression and that they will developcertain coping strategies.

Mood versus energy/activity symptoms in bipolar disorder: which cluster of Hamilton Depression Rating Scale better distinguishes between mania, depression, and euthymia? / Sintomas de humor versus sintomas de energia/atividade no transtorno bipolar: qual grupo da Escala de Depressão de Hamilton distingue melhor entre mania, depressão e eutimia?

Abstract Introduction Although bipolar disorder (BD) is traditionally included among mood disorders, some authors believe that changes in energy and motor activity, rather than mood changes, represent the true cardinal symptoms in mania and depression. The aim of the current study was to identify which cluster of the Hamilton Depression Rating Scale (HAM-D) better distinguishes between mania, depression and euthymia. Method A group of 106 patients with BD were followed for 13 years and repeatedly assessed with the HAM-D as well as with other clinical scales. To perform a comparison, HAM-D items were classified according to clinical criteria into three clusters: energy/activity symptoms, mood symptoms, and other symptoms. Item response theory (IRT) analyses were performed to provide a test information curve for those three clusters. We measured the prevalence of one cluster of symptoms over the other two throughout the latent trait. Results Considering HAM-D items individually, the IRT analysis revealed that there was a mixture of mood and energy/activity symptoms among the most discriminative items, both in depression and in euthymia. However, in mania, only energy/activity symptoms - i.e., general somatic symptoms and retardation - were among the most informative items. Considering the classification of items, both in depression as in mania, the energy/activity cluster was more informative than the mood cluster according to the IRT analysis. Conclusion Our data reinforce the view of hyperactivity and motor retardation as cardinal changes of mania and depression, respectively.

Resumo Introdução Embora o transtorno bipolar (TB) seja tradicionalmente incluído entre os transtornos do humor, alguns autores acreditam que as alterações na energia e na atividade motora, em vez das alterações no humor, representam os verdadeiros sintomas cardinais na mania e na depressão. O objetivo do presente estudo foi identificar qual grupo da Escala de Depressão de Hamilton (HAM-D) distingue melhor entre mania, depressão e eutimia. Método Um grupo de 106 pacientes com TB foram acompanhados por 13 anos e avaliados repetidamente com a HAM-D e com outras escalas clínicas. Para realizar uma comparação, os itens da HAM-D foram classificados de acordo com critérios clínicos em três grupos: sintomas de energia/atividade, sintomas de humor e outros sintomas. Foram realizadas análises da teoria da resposta ao item (TRI) para fornecer uma curva de informações de teste para esses três grupos. Medimos a prevalência de um grupo de sintomas em comparação aos outros dois através do traço latente. Resultados Considerando os itens da HAM-D individualmente, a análise da TRI revelou que havia uma mistura de sintomas de humor e de energia/atividade entre os itens mais discriminativos, tanto na depressão quanto na eutimia. No entanto, na mania, apenas os sintomas de energia/atividade - ou seja, sintomas somáticos gerais e retardo - estavam entre os itens mais informativos. Considerando a classificação dos itens, tanto na depressão quanto na mania, o grupo energia/atividade foi mais informativo que o grupo humor, de acordo com a análise da TRI. Conclusão Nossos dados reforçam a visão da hiperatividade e do retardo motor como as alterações cardinais de mania e depressão, respectivamente.

A double-blind randomized placebo-controlled study of low dose mirtazapine once daily in patients of major depressive disorders on escitalopram

Background: The SSRIs being used as 1st line therapy in treatment of depression have delayed therapeutic effect which makes the patient vulnerable to an increased risk of suicide and decreased adherence to the treatment and will prematurely discontinue the therapy. The present study was conducted to evaluate if low dose mirtazapine-escitalopram combination therapy has any add on benefit over monotherapy with escitalopram.Methods: In a single-centered, comparative study involving patients with depression attending the out-patient after screening and exclusion, 60 eligible patients were randomly assigned to receive tablet mirtazapine 7.5 mg plus tablet escitalopram 10 mg intervention or tablet escitalopram 10 mg plus placebo intervention in a double-blind 6-week treatment phase. The primary outcome measure was the change in the 17-item Hamilton Depression Rating Scale (HDRS) and Montgomery-Asberg Depression Rating Scale (MADRS) score from baseline. Participants were evaluated at baseline, 1st, 2nd,4th and 6th week. Results were analyzed using Chi-Square test for adverse effects and independent t-test analysis for efficacy parameter.Results: In the analysis of results at 6th week the numbers of patients achieved remission in mirtazapine group are more with a p-value of 0.018 which is significant and the numbers of responders in mirtazapine group are also more which is statistically significant on chi-square test. There is no significant difference was observed between the two groups with reference to occurrence of adverse effect.Conclusions: Adding low dose mirtazapine has an added benefit in terms of efficacy and getting remission early with more number of responders in the treatment of major depression.

Factor Structure of the Hamilton Depression Rating Scale for Patients with Major Depression with the Anxious Distress Specifier in DSM-5 / 우울ㆍ조울병

BACKGROUND: The factor structure of the Hamilton Depression Rating Scale (HDRS) is well validated for patients with major depressive disorder (MDD). We examined whether HDRS factors can measure the anxious distress specifier in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, in patients with MDD.METHODS: A retrospective chart review of patients with MDD between March 2012 and June 2015 was conducted. We extracted data on anxious distress symptoms and detailed clinical information and examined how the 5 HDRS factors (anhedonia/retardation, guilt/agitation, bodily symptoms, insomnia, and appetite) were related to the anxious distress specifier using the receiver operating characteristic (ROC) curve analysis and the area under the ROC curve analysis.RESULTS: We observed significant differences in the HDRS and Beck Depression Inventory scores between anxious distress and non-anxious distress groups at the index episode. The score for guilt/agitation factor was significantly higher than that for other factors in the anxious distress group and exhibited good predictive efficiency at baseline.CONCLUSION: Further investigation of the anxious distress specifier as a diagnostic entity would be worthwhile. In addition, the scores for guilt/agitation factor on the HDRS might be a promising marker for distinguishing patients with anxious distress from those with other subtypes of major depression, especially for the index episode.

Impacto de la Prostatectomía en Síntomas Depresivos en pacientes con Hipertrofia Prostática Benigna / Impact of prostatectomy on depressive symptoms in patients with symptomatic Benign Prostatic Hypertrophy

Introducción: La hiperplasia prostática benigna (HPB) es una enfermedad caracterizada por síntomas del tracto urinario inferior (1). Estos síntomas suelen causar un impacto negativo en la calidad de vida del paciente llevándolo a padecer trastornos depresivos (7). Se han encontrado síntomas depresivos hasta en el 22.5% de los pacientes con HPB sin embargo, hay poca evidencia de que estos síntomas disminuyan luego de tratar la HPB (5). Una herramienta útil para medir los síntomas depresivos es la Escala de Medición de Depresión de Hamilton (3). Objetivos: Este estudio pretende evaluar la presencia de síntomas depresivos en pacientes con HPB y comprobar si estos síntomas disminuyen posteriormente al tratamiento quirúrgico para HPB. Métodos. Se utilizó un muestra de 30 pacientes, edad (promedio 67 ± 8 años), sometidos a tratamiento quirúrgico para HPB y quienes presentaran por lo menos un síntoma depresivo según la escala de medición de depresión de Hamilton. Resultados. Todos tuvieron resección transuretral de próstata (RTUP). Previo a la cirugía se encontraron síntomas depresivos en el 76%. Un mes posterior a la cirugía se encontraron síntomas depresivos en 28, sin embargo, se encontró depresión leve en el 23.3% (vs pre op 30%), depresión moderada en el 16.6% (vs pre op 30%) y depresión severa en el 13.3% (vs pre-op 16.6%). La Escala de Medición de Depresión de Hamilton tuvo una puntuación media preoperatoria de 13.93 puntos. Un mes posterior a la cirugía la puntuación media fue de 9.36 puntos. La diferencia fue de 4.56 puntos, lo cual es estadísticamente significativo (P=0.05). Hubo complicaciones quirúrgicas en 3 pacientes quienes tuvieron un aumento en el puntaje postoperatorio y hubo aumento del nivel de depresión. En el estudio 15 refirieron disfunción eréctil previo a la cirugía y únicamente 8 persistieron con disfunción luego de la cirugía. Conclusiones. Los pacientes con HBP constituyen una población en riesgo de padecer síntomas depresivos. Los síntomas depresivos están relacionados con padecer STUI y disfunción eréctil; ambas condiciones afectan la calidad de vida. El tratamiento quirúrgico para tratar la HPB es efectivo en disminuir los síntomas depresivos mejorando la calidad de vida causando mínimos efectos negativos.

Introduction: Benign Prostatic Hyperplasia (BPH) is a condition that leads to inferior urinary tract symptoms (1). These symptoms often cause a negative impact on the quality of life leading to depressive symptoms (7). Depressive symptoms are present in up to 22.5% of patients with BPH, however, there is limited evidence that these symptoms decrease with HPB treatment (5). A useful tool to measure depressive symptoms is the Hamilton Depression Rating Scale (HDRS) (3). Objective: Main purpose of the study is to assess the prevalence of depressive symptoms in patients with BPH and determine whether these symptoms decreased after a corrective surgery. Methods: A sample of 30 male patients, average age 67 ± 8 years old, with surgical treatment indication for BPH, with at least one depressive symptom according to the HDRS was obtained. Results: All patients in the study underwent transurethral resection of the prostate (TURP). Prior to surgery, depressive symptoms found in 76.6%. A month post-surgery depressive symptoms found in 28, however mild depression was present in 23.3% (vs pre-op 30%) moderate depression in 16.6% (vs pre-op 30.0%) and severe depression in 13.3% (vs pre-op 16.6%). Measurement with HDRS had a mean preoperative score 13.93 points; a post-surgery month the average score was 9.36. The difference was 4.56 points; which is statistically significant (P = 0.05). Three patients had surgical complications and they had an increase in postoperative score and also increased in the level of depression. In the study 15 patients reported erectile dysfunction prior to surgery; out of these patients only 8 persisted with dysfunction after surgery. Conclusions: BPH patients is a population at risk for developing depressive symptoms. Depressive symptoms are related to developing lower urinary tract symptoms and erectile dysfunction; both conditions affecting the quality of life. Surgery to treat BPH is effective in reducing depressive symptoms by improving the quality of life and with minimal adverse effects.

Depression and quality of life in patients with severe chronic obstructive pulmonary disease – A cross sectional study.

Background: We assessed the prevalence of depression and quality of life and their associations in patients with severe and very severe COPD. Materials and methods: Sixty individuals who gave consent and who met the gold criteria for severe and very severe COPD were recruited for the study. The results of spirometry (FEV1%) which gives the severity of COPD were noted. The recruited individuals were screened for depression through a clinical interview and ICD-10 criterion was used to diagnose depression. The severity of depression of each individual participating in the study was estimated using Hamilton Depression Rating and the quality of life of each individual was estimated using the WHO Quality of Life Questionnaire –BREF Version. Results: Mean age of the patients was 53±4.5 years. The duration of COPD was 8.68±4.3 years. 93.3% of the individuals recruited for the study had severe COPD. 68.3% had been mild to severe depression while 31.7% were normal. The mean HAM-D and quality of life total score of these patients were 17±9.09 and 52±15.1 respectively. HAM-D scores in patients suffering from very severe COPD were much higher when compared to that of patients suffering with severe COPD. Patients with severe depression have poor quality of life on all aspects in comparison with moderate and mildly depressed. Numbers of exacerbations and hospitalizations have a significant correlation with severity of depression and a significant negative correlation with all domains of quality of life. Lakshmi Rajesh Channareddy, Eshwar Reddy Ravula, G. P. Vignan Kumar. Depression and quality of life in patients with severe chronic obstructive pulmonary disease - A cross sectional study. IAIM, 2016; 3(4): 78-83. Page 79 Conclusion: The prevalence of depression in patients with severe to very severe COPD is as high as 68.3%. There was a positive correlation between the number of hospitalizations and exacerbations to the severity of depression. Quality of life in COPD patients with depression was found to be poor in all the four domains namely physical, psychological, social and environmental when compared to those having only COPD as an illness. The severity of COPD was positively correlated with severity of depression and showed a negative correlation with the quality of life.

The value of serum thyroid hormone levels in the treatment of patients with refractory depression / 中国生化药物杂志

Objective To investigate the value of serum thyroid hormone (Thyroid hormone, TH) levels on prognosis in patients with treatment-resistant depression ( Refractory depression, RD) .Methods 108 cases of RD patients collected in Hangzhou First People's hospital from March 2014 to February 2016 were divided into observation group and control group according to the method of random numbers, and each had 54 patients.Patients in the observation group were given antidepressant treatment program and the control group a placebo.Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) score changes, and TSH, T3, T4, FT3, FT4 levels of two groups pre-and post-treatment were compared.Results After treatment, the HAMD and HAMA scores in observation group were (14.4 ±2.5) and (15.2 ±2.7) significantly lower than that in control group, which were (25.6 ±5.2) and (25.9 ±4.8),separately, the differences were significant(P<0.05);the TSH, T3, T4, FT3, FT4 levels in observation group post-treatment were (4.54 ±0.68) mIU/L, (1.21 ±0.56) nmol /L, (55.4 ±6.1) nmol/L, (3.16 ±0.42) pmol/L and (8.53 ±0.62) pmol/L, TSH decreased significantly, and T3, T4, FT3 , FT4 were significantly increased than pre-treatment(P<0.05); the indexes in control group were (5.16 ±0.62) mIU /L, (0.91 ±0.42) nmol/L, (51.9 ±3.2) nmol /L, (2.82 ±0.40) pmol/L and (7.76 ±0.64) pmol/L (P<0.05), the differences with observation group were significant ( P <0.05 ) .Conclusion The severity of the symptoms of patients is closely related with TH RD level, antidepressant therapy can improve TH, thereby improving the patient's symptoms, so it is important to pay attention to TH levels in the treatment process of RD.

Marital Adjustment in Patients of Depression Under Going Treatment at an Outpatient Clinic of Tertiary Care Hospital.

Background: Depression is projected to become the 2nd worldwide leading cause of disability by 2020. Marriage is one of the principal facets when it comes to interpersonal context of Depression. Th ere is evidence supporting bidirectional casual eff ect between Depression and marital satisfaction. However the phenomenon of marital adjustment and its related variable has not been given much attention in the Pakistan. Aim of the study: Th e primary objective is to determine the frequency of marital adjustment by using validated Urdu version of Kansas Marital Satisfaction Scale in patients with Depression, who are under treatment at Psychiatry outpatient clinics at tertiary care hospital in Karachi. Method: Patient presenting in outpatient clinic and diagnosed with Depression for at least last 6 months according to ICD-10 criteria by Consultant psychiatrist, who were aged between 15-65 were included. Patients who had documented co morbid of substance use or any unstable serious general medical condition were excluded. Th e severity of Depression was evaluated by using Urdu validated Hamilton Depression Rating Scale. Marital adjustment is determined by using Urdu validated version of Kansas Marital Satisfaction Scale. Result: Only 8.6% were well adjusted in their marital life, and all were females; most of them were living in nuclear setting, unemployed, severely depressed, educated above intermediate, aged above 30 years, and had duration of illness more than 12 months. Th e association of marital adjustment and severity of Depression is insignifi cant. It further revealed to have insubstantial diff erence on KANSAS scale between both genders. Th e odd ratio of duration of illness was 7.6, which indicated that the longer the duration of illness, the more positively it is interrelated to the marital adjustment. Being employedand above 30 years of age wereinversely related to marital satisfaction with odd ratio of 6.1 and 5.4 respectively. However, the correlation between other independent variables and marital adjustment were insignifi cant in both genders. Conclusion: Th is study confi rms the presence of high frequency i.e. 91.4% of marital dissatisfaction in Depression in both male and females, irrespective of their severity of Depression. No substantial diff erence was established between both the genders based on KANSAS score. Longer duration of illness, unemployment, and above 30 age have protective eff ect on quality of marital life.

Comparisons of Depressive Symptoms of the Hamilton Depression Rating Scale between Elderly and Non-Elderly Outpatients with Major Depressive Disorder / 신경정신의학

OBJECTIVES: Previous studies have reported that symptoms of patients with major depressive disorder (MDD) are different according to age groups, and the Hamilton Depression Rating Scale (HDRS) is the most widely used measure to evaluate the symptoms of MDD. However, few previous studies have compared the symptoms of HDRS between the elderly and non-elderly groups. METHODS: The study population consisted of 574 subjects with MDD who were > or =18 years old, evaluated using the Mini International Neuropsychiatric Interview and 17 items of HDRS. Differences between two groups were analyzed using independent t-test. A multivariate logistic regression model was used to evaluate associations between age and 17 items from HDRS after controlling for gender, years of education, marital status, and employment status. RESULTS: Among 574 patients with MDD, there were 80 elderly patients (age> or =65) and 494 non-elderly patients (age between 18 and 64). Elderly patients had higher scores on item 5 (middle insomnia) (t=-2.271, p=0.024) and item 6 (late insomnia) (t=-2.280, p=0.023), whereas they had lower scores on item 1 (depressed mood) (t=2.860, p=0.004), item 3 (suicide) (t=2.258, p=0.024), and item 9 (agitation) (t=2.031, p=0.043), although no significant difference in the total HDRS scores was observed between elderly and non-elderly. Multivariate logistic regression showed significant association of elderly with hypochondriasis [adjusted odds ratio (AOR)=1.894, 95% confidence interval (CI) 1.01-3.56] and agitation (AOR=0.50, 95% CI 0.29-0.87). CONCLUSION: Elderly MDD patients showed more insomnia and hypochondriasis and less depressed mood, suicidal ideation, and agitation than non-elderly.

Association between the Daytime Plasma Cortisol Level and Depression Component of Hamilton Depression Rating Scale in Korean Depression Clinic Outpatients / 신경정신의학

OBJECTIVES: There is evidence that Hypothalamic-Pituitary-Adrenocortical (HPA) system dysregulation plays a role in the pathophysiology of depression. However which psychiatric symptoms are related to HPA system dysregulation has not been studied well. The primary aim of this study was to investigate which symptom components of the Hamilton Depression Rating Scale (HAM-D) are related to HPA system dysregulation in Korean psychiatric outpatients. The secondary aim was to find other variables that have association with HAM-D components. METHODS: This study was a retrospective review of the charts of outpatients who first visited Samsung Medical Center Depression Clinic between July 2012 and October 2013. Among them those who checked the plasma cortisol level and HAM-D within one week of their first visit were selected. Fifty nine patients were selected. The HAM-D was divided into four components, including depression, anxiety, insomnia, and somatic components. Multiple regression of cortisol level was used for four subscales. RESULTS: Significant positive correlations were observed between the plasma cortisol level and depression component of HAM-D (beta=0.251, p=0.049). Age also showed negative correlation with the depression component of HAM-D (beta=-0.427, p=0.002). However anxiety, insomnia and somatic components of HAM-D did not show correlation with plasma cortisol level. CONCLUSION: Our study suggests that in Korean depression clinic outpatients, the depression component of HAM-D is related to plasma cortisol level.

Latent growth curve modeling for improvement of clinical symptoms on depression / 中华流行病学杂志

To explore the improvement of clinical symptoms after treatment on patients with depression under the latent growth curve modeling.514 patients were studied with Hamilton Depression Rating Scale for depression and nonlinear conditional.Latent growth curve modeling was constructed to assess the features of outcome growth trajectory and possible related influencing factors.Results indicated that the outcome measure showing nonlinear growth trajectory and rapid drop during the first follow-up period and then declining or leveling off for the rest of the observation period on symptoms of anxiety,cognitive disturbance,retardation,sleeping disorder and HAMD scores.The variances of both latent intercept and the slope growth factor were statistically significant,indicating they varied across individuals.Gender did not show significant effect on both the intercept and the slope growth factor for the six outcomes,while age had a significant positive effect on initial weight loss,sleep disorder and HAMD scores at the baseline (0.015,0.048 and 0.068,P＜0.05) survey.Marriage showed significant positive effect on intercept factor of anxiety symptoms (0.563,P＜0.05) but negative effect on slope growth factor (-0.244,P＜0.05) while family history had significant positive effect on intercept factor regarding retardation (0.471,P＜0.05).The level of received education had a significant negative effect on intercept factor of anxiety symptoms and HAMD scores (-0.424 and-0.914,P＜0.05).Latent growth curve models allowed the researchers to study the overall growth trajectory as well as the captured individual differences on these trajectories over time,that also provided a powerful tool for the analysis on longitudinal data.

Effect of electroacupuncture on therapeutic effects and onset time of paroxetine for mild or moderate depression patients / 中华行为医学与脑科学杂志

Objective To observe the effect of electroacupuncture on onset time and effectiveness of Paroxetine for mild or moderate depression patients and on the scores of Hamilton depression rating scale for depression(HAMD) and self-rating depression scale(SDS). Methods Fifty-five patients with mild or moderate depression were randomly divided into A group( Paroxetine group,29 patients) and B group (Electroacupuncture combining with Paroxetine group,26 patients). Therapeutic periods for the two groups were 6 weeks. HAMD and SDS were used to evaluate the efficacy before the research and after treatment on 1 week,2 weeks,4 weeks,6 weeks.Results HAMD scores and SDS scores for A group were significant difference after 2 weeks treatment compared with the beginning of the research (P＜ 0.05 ) ;HAMD scores and SDS scores for B group were significant difference after 1 week treatment compared with the beginning of the research(P＜0. 05 ). Total effective rate of HAMD for A group was 71.4% ,total effective rate of SDS for A group was 75% ,total effective rate of HAMD for B group was 88% ,total effective rate of SDS for B group was 84%. The total effective rate between the two groups ordered by the individual chi-square test was significant difference( X2 = 4. 1790, P= 0. 0408). Conclusion Electroacupuncture can shorten the onset time and increase the effectiveness of paroxetine for mild or moderate depression patients.

Inventário de Depressão de Beck (BDI) e Escala de Avaliação de Depressão de Hamilton (HAM-D) em pacientes com epilepsia / Beck Depression Inventory (BDI) and Hamilton Rating Scale for Depression (HAM-D) in patients with epilepsy

OBJETIVO: Determinar os pontos de melhor sensibilidade e especificidade do Inventário de Depressão de Beck (BDI) e da Escala de Avaliação de Depressão de Hamilton (HAM-D) no diagnóstico de depressão associada à epilepsia. MÉTODOS: Setenta e três pacientes de um centro de referência no tratamento da epilepsia foram submetidos à avaliação neuropsiquiátrica. Foram colhidos dados clínicos e sociodemográficos, sendo utilizados os seguintes instrumentos: entrevista clínica estruturada (MINI-PLUS) para diagnóstico psiquiátrico conforme o DSM-IV, HAM-D e BDI. RESULTADOS: No momento da entrevista, 27,4 por cento dos pacientes estavam deprimidos e 37 por cento preenchiam critérios para diagnóstico de depressão maior ao longo da vida. A análise da curva ROC indicou que o ponto de corte em 16 (> 16) para o BDI (sensibilidade de 94,4 por cento, especificidade de 90,6 por cento) e em 16 (> 16) para a HAM-D (sensibilidade de 95 por cento, especificidade de 75,5 por cento) representou dicotomização ótima entre deprimidos e não deprimidos. Ambos os instrumentos apresentaram um valor preditivo negativo superior a 95 por cento. CONCLUSÃO: A frequência de depressão maior é elevada em pacientes com epilepsia. BDI e a HAM-D podem auxiliar o clínico na identificação da depressão associada à epilepsia, diminuindo seu subdiagnóstico.

OBJECTIVE: To determine cutoff points of highest sensitivity and specificity on the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HAM-D) for depression diagnosis in epilepsy. METHODS: Seventy-three patients from a referral center for the treatment of epilepsy underwent neuropsychiatric evaluation. We collected clinical and socio-demographic data, and applied the following instruments: Structured Clinical Interview (MINI-PLUS) for psychiatric diagnosis according to DSM-IV, HAM-D and BDI. RESULTS: At assessment, 27.4 percent of the patients were depressed and 37 percent met diagnostic criteria for lifetime major depression. The ROC curve analysis indicated that a score > 16 on the BDI (94.4 percent sensitivity, 90.6 percent specificity) and > 16 on the HAM-D (95 percent sensitivity, 75.5 percent specificity) revealed great dichotomy between depressed and nondepressed patients. Both instruments showed a negative predictive value exceeding 95 percent. CONCLUSION: The frequency of major depression is elevated in patients with epilepsy. BDI and HAM-D can help physicians in the identification of depression in epilepsy, reducing its underdiagnosis.

High-frequency transcranial magnetic stimulation for alleviating post-stroke depression / 中华物理医学与康复杂志

Objective To explore the clinical effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on post-stroke depression (PSD). Methods Sixty PSD patients were randomly divided into an rTMS group and a control group, each of 30 patients. In addition to conventional treatment, rTMS group members were given high-frequency rTMS treatment for 10 d while the control group were given sham stimulation. In order to test the efficacy, the two groups were compared using the Hamilton depression rating scale (HAMD) before and after 10 and 30 days treatment. Results After 10 days of treatment the rTMS group had significantly lower HAMD scores than before treatment, and average HAMD scores differed significantly between the rTMS group and the controls, with the former performing significantly better. There was no obvious difference in HAMD scores after 30 days of treatment between the two groups. Conclusions High-frequency rTMS is a safe and effective treatment for PSD.

The Factor Structure of the Korean Hamilton Depression Rating Scale(K-HDRS): A Confirmatory Factor Analysis / 신경정신의학

OBJECTIVES: The present study was conducted to examine the factor structure of a Korean version of the Hamilton Depression Rating Scale (K-HDRS), and we did so by performing a confirmatory factor analysis (CFA). METHODS: The data from the 17-item K-HDRS data was obtained from 319 South Koreans who met the DSM-IV Criteria of Major Depressive Disorder. We examined the fit of ten competing models. The CFAs were evaluated in their original first-order structures and in their hierarchically related counterparts. RESULTS: The alternative models obtained unsatisfactory fit indices, although the five-factor intercorrelated model (model 5a) demonstrated a relatively good fit to the data. The model 5a also performed better than its hierarchically related counterpart (model 5b). The Modification Indices (MIs) were used to provide a more satisfactory account of the data. The MIs suggested correlations between the unique variances of items (item 1 & 3, item 10 & 15), and these parameters were added to the model 5a. After introducing minor modifications, the 'final' model (5m) yielded an improved model fit. CONCLUSION: This study suggests that the symptoms of depression, as assessed by the K-HDRS, cluster into five factors: anhedonia/retardation, guilt/agitation, bodily symptoms, insomnia and appetite. This study provides evidence for the cross-cultural generalizability of the HDRS, although some refinement of the scale is still required.

Study of Bushen Tiaogan Qingxin Prescription in Treatment of Sleep Disorder in Climacteric Depression / 中国中医药信息杂志

Objective To explore the relationship between genital endocrine hormones and sleep disorder in climacteric depression,and study the therapeutical functions of Bushen Tiaogan Qingxin Prescription.Methods Sixty patients were randomly divided into Bushen Tiaogan Qingxin prescription group(n=30) and HRT group(n =30).The effects were appraised by both Hamilton depression rating scale(HAMD) and sleep disorder scores before and after the treatment of 12 weeks.The values of blood E2,FSH,LH were measured.Results Decreasing rate of HAMD and sleep disorder improving rate were significant in Bushen Tiaogan Qingxin prescription group than HRT group(P

Characteristics of HAMD at Different Stages after Cerebral Concussion / 中国康复理论与实践

@#ObjectiveTo observe the manifestations of depression at different stages after cerebral concussion. Methods77 cerebral concussion patients received Hamilton Depression Rating Scale (HAMD) examination at acute stage (in the 7 days after disease) and convalescence stage (at about 30 days after disease), and then compared with 48 health adults. ResultsThe scores of anxietas somatization, cognitive handicap, retardation, dyssomnia, feeling of despair conclude the total score in the cerebral concussion patients at acute stage were all significantly higher than that of the control (P<0.05). During the convalescence stage, the scores of anxietas somatization, the change of body weight, cognitive handicap, diurnal variation, retardation, dyssomnia, feeling of despair conclude the total score were all significantly higher than that of the control (P<0.05). The scores of almost all the item of HAMD were significantly higher than that of the control at both acute stage and convalescence stage, and the scores of athymia, suicide, difficulty falling asleep, early awake, agitate, somatization, constitutional symptom, hypochondriasis, loss of weight, insight, diurnal variation, feeling of despair, anosognosia, sense of inferiority and total HAMD scores at convalescence stage were all significantly higher than that at the acute stage, but the scores of blockage, psychoanxietas, derealization, symptom of over-absorption mind, compel symptom, sense of capability decrease at the acute stage were all significantly higher than that at the convalescence stage (P<0.05).ConclusionThe manifestations of depression in the cerebral concussion patients were not completely the same, so the mental intervention should be in direction.

Validity and Reliability of the Korean Version of the Hamilton Depression Rating Scale(K-HDRS) / 신경정신의학

OBJECTIVES: The reliability and validity of the Korean version of Hamilton Depression Rating Scale (K-HDRS) were examined in Korean patients depressive symptoms. METHODS: 33 inpatients and 70 outpatients diagnosed as major depressive disorder or depressive episode of bipolar I disorder according to the DSM-IV criteria were assessed with K-HDRS, Clinical Global Impression score(CGI), Beck Depression Inventory (BDI) and Montgomery-Aberg Depression Rating Scale (MADRS). RESULTS: Internal consistency (Cronhach's alpha coefficeint=0.76) and interrater reliability (r=0.94, p<0.001) were statistically significant. Principal axis factoring analysis revealed 4 factors that accounted for 50.4% of the total variance. The correlations of K-HDRS with CGI, BDI and MADRS were 0.84, 0.54, 0.58 respectively. CONCLUSION: These results showed that the K-HDRS could be a reliable and valid tool for the assessment of depressive Korean patients. The K-HDRS will be a useful tool for assessing depressive symptoms in Korea.