Stability, reliability, and validity of the THINC-it screening tool for cognitive impairment in depression: A psychometric exploration in healthy volunteers.

OBJECTIVES: There is a need for a brief, reliable, valid, and sensitive assessment tool for screening cognitive deficits in patients with Major Depressive Disorders. This paper examines the psychometric characteristics of THINC-it, a cognitive assessment tool composed of four objective measures of cognition and a self-rated assessment, in subjects without mental disorders. METHODS: N = 100 healthy controls with no current or past history of depression were tested on four sequential assessments to examine temporal stability, reliability, and convergent validity of the THINC-it tests. We examined temporal reliability across 1 week and stability via three consecutive assessments. Consistency of assessment by the study rater (intrarater reliability) was calculated using the data from the second and third of these consecutive assessments. RESULTS: Test-retest reliability correlations varied between Pearson's r = 0.75 and 0.8. Intrarater reliability between 0.7 and 0.93. Stability for the primary measure for each test yielded within-subject standard deviation values between 5.9 and 11.23 for accuracy measures and 0.735 and 17.3 seconds for latency measures. Convergent validity for three tasks was in the acceptable range, but low for the Symbol Check task. CONCLUSIONS: Analysis shows high levels of reliability and stability. Levels of convergent validity were modest but acceptable in the case of all but one test.

The THINC-Integrated Tool (THINC-it) Screening Assessment for Cognitive Dysfunction: Validation in Patients With Major Depressive Disorder.

OBJECTIVE: To validate the THINC-integrated tool (THINC-it)-a freely available, patient-administered, computerized screening tool integrating subjective and objective measures of cognitive function in adults with major depressive disorder (MDD). METHODS: Subjects aged 18 to 65 years (n = 100) with recurrent MDD experiencing a major depressive episode of at least moderate severity were evaluated and compared to age-, sex-, and education-matched healthy controls (n = 100). Between January and June 2016, subjects completed the THINC-it, which includes variants of the Choice Reaction Time Identification Task (IDN), One-Back Test, Digit Symbol Substitution Test, Trail Making Test-Part B, and the Perceived Deficits Questionnaire for Depression-5-item (PDQ-5-D). RESULTS: The THINC-it required approximately 10 to 15 minutes for administration and was capable of detecting cognitive deficits in adults with MDD. A total of 44.4% of adults with MDD exhibited cognitive performance at ≥ 1.0 SD below that of healthy controls on standardized mean scores of the THINC-it. Concurrent validity of the overall tool, based on a calculated composite score, was acceptable (r = 0.539, P < .001). Concurrent validity of the component tests ranged from -0.083 (IDN) to 0.929 (PDQ-5-D). Qualitative survey results indicated that there was a high level of satisfaction and perceived value in administering the THINC-it regarding its impact on the appropriateness and quality of care being received. CONCLUSIONS: The THINC-it is a valid and sensitive tool for detecting cognitive dysfunction in adults with MDD that is free, easy to use, and rapidly administered. The THINC-it should be incorporated into the assessment and measurement of all patients with MDD, particularly among those with enduring functional impairment. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02508493.

Relief of serotonin selective reuptake inhibitor induced sexual dysfunction with low-dose mianserin in patients with traumatic brain injury.

RATIONALE: Serotonin selective reuptake inhibitors (SSRI) are commonly used in the treatment of many psychiatric disorders. Although possessing a relatively mild side effect profile, these drugs can cause a number of difficulties, including sexual dysfunction. A variety of strategies have been reported in the management of SSRI-induced sexual dysfunction, including dose reduction, drug holidays, substitution of another antidepressant drug, and various augmentation strategies, including use of sildenafil citrate (Viagra), buspirone, and others. OBJECTIVES: We aimed to examine the effect of adding another medication, mianserin, a mainly postsynaptic serotonin 2A agonist, to ongoing SSRI treatment in order to alleviate sexual side effects caused by SSRIs. METHODS: The patients included in this study suffered from traumatic brain injury and from psychiatric complications that necessitated the use of SSRIs. Seventeen patients were included in this study, all were being treated with SSRIs, and all complained of sexual dysfunction. Mianserin was added to on-going treatment at low doses, 7.5-15 mg/day. Patients were followed for at least 3 months. RESULTS: Fifteen of the 17 patients (88%) included in this study reported improvement in sexual dysfunction following this intervention. Ten (59%) reported that sexual function achieved pretreatment level. Five (29%) reported "significant improvement," and two (12%) did not respond to this intervention and were given sildenafil citrate, with good results. Side effects were minimal and included dry mouth, drowsiness, headaches, and agitation. CONCLUSIONS: The use of low-dose mianserin as an add-on treatment to SSRIs appears to be an effective and well tolerated intervention for sexual dysfunction caused by SSRIs.