[Assessing Change of Depressive Symptoms and Severity of Depression in an Inpatient Setting : Performance of the HoNOS (Health of the Nation Outcome Scales)]. / Die Eignung der HoNOS (Health of the Nation Outcome Scales) zur Erfassung des Verlaufs und des Schweregrads depressiver Symptomatik im stationären Setting.

Objectives This study investigates the assessment of change of depressive symptoms and severity of depression with the "Health of the Nation Outcome Scales" (HoNOS) in an inpatient setting. Method Participants were 132 adults diagnosed with depressive disorder (F32: n=102; F33: n=30). Bivariate correlations were used to determine the correlation of the HoNOS with self-reported (BDI) and observer-rated depressive symptoms (HAMD). The predictive validity of the HoNOS was analysed with linear regression models. Results The HoNOS differentiated significantly between patients with moderate versus severe depression at baseline (p<0,05). It correlated with the HAMD change score (r=0,25, p<0,008), but not with the BDI change score (r=0,19, p>0,008).The HoNOS was not a significant predictor of observer-rated depression at discharge (ß=0,03, p>0,05). Conclusion As the HoNOS only partially seems to assess the change and severity of depressive symptoms, it should only be used in combination with depression-specific instruments.

Distinct seasonality of depressive episodes differentiates unipolar depressive patients with and without depressive mixed states.

BACKGROUND: The bipolar nature of unipolar depression with depressive mixed states (DMX) needs further validation studies. The seasonality of depressive episodes is indicated to be different between unipolar and bipolar depressions. We therefore explored the seasonal pattern of depressive episodes in unipolar depressive patients with DMX. METHODS: The subjects were 958 consecutive depressive inpatients for a 6-year period. For defining DMX, previously validated operational criteria were used (2 or more of 8 manic or mania-related symptoms: flight of idea, logorrhea, aggression, excessive social contact, increased drive, irritability, racing thoughts, and distractibility). Onsets of the index depressive episodes during each of the 12 calendar months were summed up over the 6-year for bipolar depressive patients (N = 95), and unipolar depressive patients with (N = 77) and without DMX (N = 786) separately. An appropriate statistic was used for testing seasonality. RESULTS: A significant seasonal variation with a large peak in spring was recognized in unipolar depression without DMX, while both bipolar depression and unipolar depression with DMX had a significant fall peak. The monthly distribution of depressive episodes was significantly different between unipolar depression without DMX and other 2 diagnostic categories. Similar results were obtained in separate analyses for each gender. LIMITATIONS: Further replication study using an epidemiological or outpatient sample is needed. Bipolar I and II patients were combined due to a small number of bipolar II patients in this sample. CONCLUSION: Unipolar depression with DMX has a seasonal pattern similar to bipolar depression. The finding provides further evidence of the bipolar nature of unipolar depression with DMX.

Evaluating the inter-episode stability of depressive mixed states.

BACKGROUND: Depressive mixed state (DMX) is understudied, although this diagnostic concept may be of clinical and theoretical importance. Our goal was to provide preliminary evidence of the inter-episode stability of DMX. The inter-episode stability is known to be an important validator for establishing a distinct clinical entity. METHODS: Out of depressive patients consecutively hospitalized at our institute, those who experienced two or more hospitalizations due to discrete depressive recurrences during a 6-year period were selected. All depressive episodes were directly observed and assessed using a standardized rating instrument in terms of eight intra-episode manic symptoms (flight of idea, logorrhea, aggression, excessive social contact, increased drive, irritability, racing thoughts, and distractibility). Assessments for subsequent episodes were performed blindly to those for previous episodes within each patient. RESULTS: The inter-episode stability of categorical DMX diagnoses and the number of intra-episode manic symptoms was moderate but significantly high. Approximately 50% of patients with DMX in the index episode obtained a DMX diagnosis in the second episode. Approximately 40% of the total variance of the number of intra-episode manic symptoms was explained by agreements across several depressive episodes. Depressive patients who experienced a diagnostic switch from unipolar to bipolar disorder had a higher frequency of DMX and a greater number of intra-episode manic symptoms in the index as well as subsequent episodes. LIMITATIONS: All consecutive patients were not followed up. Bipolar I and II patients were combined due to a small number of bipolar II patients in this sample. CONCLUSION: The inter-episode stability of DMX may not be so high as is required for establishing a distinct clinical entity. However, the findings strongly suggest that some depressive patients have a long-lasting liability to DMX. It is important to determine whether such a liability to DMX is mediated by affective temperaments, as was originally hypothesized by Akiskal [J. Clin. Psychopharmacol. 16 (1996) 4S-14S]. DMX may be a risk factor to the diagnostic switch from unipolar to bipolar disorder.