Attentional biases to body shape images in adolescents with anorexia nervosa: an exploratory eye-tracking study.

Body image distortion (BID) plays an important role in the etiology and maintenance of anorexia nervosa (AN). Previous studies of BID in AN showed small biases in visual scanning behavior (VSB) towards images of body shapes. The aim of this study is to investigate biases in VSB when body shape images compete with images with a different theme (social interactions) for subjects׳ attention. When images of thin body shapes (TBS) were presented alongside images of social interactions, AN patients (n=13) spent significantly more time looking at TBSs rather than at social interactions, but controls (n=20) did not. When images of fat body shapes (FBS) were presented alongside images of social interactions, AN patients spent significantly more time looking at FBSs rather than at social interactions, but controls did not. When images of TBSs, FBSs and social interactions were presented alongside each other, AN patients demonstrated a hierarchy in their attention allocation, choosing to spend the most viewing time on TBS images, followed by FBS images and then images with social interactions. Under the three experimental conditions, AN patients demonstrated large biases in their visual scanning behavior (VSB). Biases in VSB may provide physiologically objective measures that characterize patients with AN.

Calculated bioavailable testosterone levels and depression in middle-aged men.

BACKGROUND: The association between circulating total testosterone (TT) levels and depressive symptoms remains unclear. We sought to determine the relationship between physiologically active bioavailable testosterone (BT) and depressive symptoms in middle-aged men with and without major depressive disorder (MDD). METHODS: We assessed and compared calculated BT levels in two groups of middle-aged men (40-65 years): untreated subjects meeting DSM-IV-TR-defined criteria for a major depressive episode as part of major depressive disorder (N=44) and a matched non-depressed control group (N=50). RESULTS: Depressed men had lower mean BT levels (3.51+/-1.69 vs. 4.69+/-2.04 nmol/L; p=0.008) and TT levels (11.94+/-4.63 vs. 17.64+/-1.02 nmol/L; p<0.001) when compared to the control group. Biochemical hypogonadism (i.e., BT level< or =2.4 nmol/L or TT level< or =12.14 nmol/L) was also more prevalent in depressed men vs. non-depressed controls (34% vs. 6%, p<0.001; 61% vs. 14%, p<0.001, respectively). CONCLUSIONS: Changes in physiologically active BT concentration may be a vulnerability factor for depressive symptoms in middle-aged depressed men.

Measuring the severity of depression and remission in primary care: validation of the HAMD-7 scale.

BACKGROUND: Symptomatic remission is the optimal outcome in depression. A brief, validated tool for symptom measurement that can indicate when remission has occurred in mental health and primary care settings is unavailable. We evaluated a 7-item abbreviated version (HAMD-7) of the 17-item Hamilton Depression Rating Scale (HAMD-17) in a randomized controlled clinical trial of patients with major depressive disorder being cared for in primary care settings. METHODS: We enrolled 454 patients across 47 primary care settings who met DSM-IV-TR criteria for a major depressive disorder. Of these, 410 patients requiring antidepressant medication were randomized to have their symptoms rated with either HAMD-7 (n = 205) or HAMD-17 (n = 205) as the primary measurement tool. The primary outcome was the proportion of patients who achieved a-priori defined responses to 8 weeks of therapy using each instrument. RESULTS: Of the 205 participants per group, 67% of those evaluated with HAMD-7 were classified as having responded to therapy (defined as a > or = 50% reduction from the pretreatment score), compared with 74% of those evaluated with HAMD-17 (p = 0.43). The difference between the groups' changes in scores from baseline (pretreatment) to endpoint was significant (p < 0.001), without a main effect of group (p = 0.84) or group-by-time (p = 0.83) interaction. The HAMD-7 test was brief to administer (e.g., 3-4 min for 85% of the primary care physicians evaluated), which facilitated the efficient and structured evaluation of salient depressive symptoms. INTERPRETATION: The abbreviated HAMD-7 depression scale is equivalent to the HAMD-17 in assessing remission in patients with a major depressive disorder undergoing drug therapy.

Is the cerebellum relevant in the circuitry of neuropsychiatric disorders?

Contemporary mechanistic models of several psychiatric disorders propose abnormalities in the structure and function of distinct neural networks. The cerebellum has both anatomic and functional connections to the prefrontal cortex, the subcortical limbic structures and monoamine-producing brainstem nuclei. Conspicuously, however, the cerebellum has been underemphasized in neuropsychiatric research. A growing confluence of scientific data indicate that the cerebellum may not be irrelevant, which suggests that an integrated model of neuropsychiatric disorders should include a role for the cerebellum and its relevant neural connections. This review summarizes the published data describing and characterizing the putative role of the cerebellum in normal and abnormal mood regulation, with specific attention to states of psychosis, depression and mania. The available evidence suggests that a functional role for the cerebellum should be considered in future neuropsychiatric studies.

A naturalistic visual scanning approach to assess selective attention in major depressive disorder.

Cognitive biases in information processing play an important role in the etiology and maintenance of emotional disorders. A new methodology to measure attentional biases is presented; this approach encourages subjects to scan and re-scan images with different thematic content, while the pattern of their attentional deployment is continuously monitored by an eye-tracking system. Measures of attentional bias are the total fixation time and the average glance duration on images belonging to a particular theme. Results showed that subjects with depressive disorder (n=8; Beck Depression Inventory Score>/=16) spent significantly more time looking at images with dysphoric themes than subjects in the control group (n=9). Correlation analysis revealed that the differences between the fixation times of the two groups are significantly correlated with the valence ratings, but not with the arousal ratings of the images. The average glance duration on images with social, neutral and threatening themes were similar for both groups, while the average glance duration on images with dysphoric themes was significantly larger for subjects with depressive disorder. The above results suggest that subjects with depressive disorder selectively attend to mood-congruent material and that depression appears to influence the elaborative stages of processing when dysphoric images are viewed.