ABSTRACT
Psychotic depression is a frequent, severe psychiatric condition in older depressive inpatients aged 60 years and older. Older adults with a psychotic depression exhibit specific symptoms that are different from those in younger adults with psychotic depression. Moreover, the symptoms are also different from those in older adults with a major depression without psychotic features. The recommended treatment consists of a tricyclic antidepressant, with or without addition of an antipsychotic, or electroconvulsive therapy. These treatments may however produce significant side effects that require intensive monitoring. In this article we present an overview of clinical topics regarding the diagnosis and treatment of older people with a psychotic depression.
ABSTRACT
OBJECTIVE: To investigate the potential role of the Maudsley Staging Method (MSM) in the prediction of electroconvulsive therapy (ECT) outcome in severely depressed adults. METHOD: Between August 2015 and August 2017, 73 consecutive patients with a major depressive episode (DSM-IV-TR) scheduled for ECT were recruited. Prior to their first ECT session, the MSM was completed to assess the level of therapy resistance. To determine the reduction in depression severity and response and remission rates, symptom severity was assessed at baseline and within one week after the last ECT session using the 17-item Hamilton Depression Rating Scale (HDRS17). RESULTS: The percentage of symptom reduction following ECT was best predicted by the MSM episode duration and depression severity factors (R2 completer sample 0.24). Episode duration alone was the best predictor of remission (area under the ROC curve for completers: 0.72). Adding age to the models increased their predictive capacity. CONCLUSION: An adapted version of the MSM gauging shorter episode duration, more severe depressive symptoms and older age is significantly associated with ECT effectiveness in adults with severe recurrent depression and is thus highly suitable for use in clinical practice, promoting the shared treatment decision-making process.
Subject(s)
Depressive Disorder, Major/therapy , Depressive Disorder, Treatment-Resistant/therapy , Electroconvulsive Therapy/methods , Outcome Assessment, Health Care/methods , Adult , Aged , Female , Humans , Male , Middle Aged , Remission Induction , Severity of Illness Index , Time FactorsABSTRACT
OBJECTIVE: To explore the correlations between observer ratings and instrumental parameters across domains of psychomotor functioning in depression. METHOD: In total, 73 patients with major depressive disorder underwent extensive psychomotor and clinical testing. Psychomotor functioning was assessed with (i) an observer-rated scale (the CORE measure) and also objectively with (ii) 24-h actigraphy, and (iii) a fine motor drawing task. RESULTS: Observer ratings of retardation correlated with instrumental assessments of fine and gross motor functioning. In contrast, observer ratings of agitation did not correlate with observer ratings of retardation or with the instrumental measures. These associations were partly influenced by age and, to a lesser extent, by depression severity. CONCLUSION: Psychomotor disturbance is a complex concept with different manifestations in depressed patients. Although observer ratings of retardation correspond well with instrumental measures of the motor domains, objective measurement of agitation and other aspects of psychomotor disturbance require further research.
Subject(s)
Depressive Disorder/diagnosis , Psychomotor Agitation/diagnosis , Psychomotor Disorders/diagnosis , Depressive Disorder/complications , Depressive Disorder/psychology , Female , Humans , Male , Middle Aged , Observer Variation , Psychiatric Status Rating Scales , Psychomotor Agitation/etiology , Psychomotor Disorders/etiology , Psychomotor Performance , Reproducibility of ResultsABSTRACT
This notice describes a correction to the above mentioned paper.
ABSTRACT
BACKGROUND: Electroconvulsive therapy (ECT) is considered to be the most effective treatment in severe major depression. The identification of reliable predictors of ECT response could contribute to a more targeted patient selection and consequently increased ECT response rates. Aims To investigate the predictive value of age, depression severity, psychotic and melancholic features for ECT response and remission in major depression. METHOD: A meta-analysis was conducted according to the PRISMA statement. A literature search identified recent studies that reported on at least one of the potential predictors. RESULTS: Of the 2193 articles screened, 34 have been included for meta-analysis. Presence of psychotic features is a predictor of ECT remission (odds ratio (OR) = 1.47, P = 0.001) and response (OR = 1.69, P < 0.001), as is older age (standardised mean difference (SMD) = 0.26 for remission and 0.35 for response (P < 0.001)). The severity of depression predicts response (SMD = 0.19, P = 0.001), but not remission. Data on melancholic symptoms were inconclusive. CONCLUSIONS: ECT is particularly effective in patients with depression with psychotic features and in elderly people with depression. More research on both biological and clinical predictors is needed to further evaluate the position of ECT in treatment protocols for major depression. Declaration of interest None.
