Validity of the Shahin Mixed Depression Scale: A Self-Rated Instrument Designed to Measure the Non-DSM Mixed Features in Depression.

BACKGROUND: The DSM5-defined mixed features in depression do not include psychomotor agitation, irritability or distractibility because they are considered overlapping symptoms. A growing number of modern psychiatrists have expressed dissatisfaction with this and proposed alternative sets of mixed symptoms that are much more common and clinically relevant. Among such alternative criteria were those proposed by Koukopoulos. He utilized the research diagnostic criteria of agitated depression (RDC-A) as a mixed depression subtype, and validated another form of mixed depression, the Koukopoulos criteria for mixed depression (K-DMX). PURPOSE: This study provides psychometric validation for the first self-rated scale designed to measure the most common mixed symptoms in depression as proposed by Koukopoulos. PATIENTS AND METHODS: We conducted a multicenter cross-sectional study of 170 patients with unipolar depression. They completed the Shahin Mixed Depression Scale (SMDS) and underwent expert interviews as a gold standard reference. SMDS' psychometric properties were assessed, including Cronbach's alpha, factor analysis, sensitivity, specificity, predictive value and accuracy. RESULTS: We found significant association and agreement between mixity according to SMDS and the gold standard (K-DMX and RDC-A according to expert interview) with good internal consistency (Cronbach's alpha=0.87), high sensitivity (=91.4%), specificity (=98.0%), positive predictive value (=96.9%), negative predictive value (= 94.2%) and accuracy (=95.2%). Factor analysis identified one factor for psychomotor agitation and another for mixity without psychomotor agitation. CONCLUSION: SMDS was a reliable and valid instrument for assessing the frequently encountered and clinically relevant mixed features in depression.

The association of BDNF gene polymorphism with cognitive impairment in insomnia patients.

BACKGROUND: Reductions in BDNF activity have shown associations with depressed mood. Other evidence has demonstrated that the BDNF Val66Met polymorphism (rs6265) appears to reduce neural plasticity. A limited number of studies have investigated the influence of these genetic polymorphisms in insomnia. The present study sought to confirm the presence of associations between BDNF Val66Met polymorphism (rs6265) occurrence in normal sleepers and those with insomnia. METHOD: The study subjects consisted of a patient group (n = 199) complaining of insomnia and a control group (n = 51). Each subject was clinically interviewed using questions taken from the Brief Insomnia Questionnaire. After the interview, the subjects were asked to complete the Insomnia Severity Index, The Hamilton Depression Rating Scale, and the Montreal Cognitive Assessment Test. An overnight polysomnography test was also administered. Blood samples were collected for genetic study. RESULTS: The insomnia patients showed a greater prevalence of heterozygous (A/G) VAL/MET polymorphism than the normal controls (p = ≤ 0.0001). This finding confirmed that this genetic polymorphism, which impairs BDNF activity, is an important correlate of disturbed sleep. Further, the finding of significantly greater (p = ≤ 0.0001) depression scores among the insomnia group suggested that BDNF is an important factor in the development of depressive symptoms. CLINICAL IMPLICATIONS: The results of the present study indicate that BDNF gene polymorphism plays a prominent role in the variation of symptoms among insomnia patients and, further, that this polymorphism is strongly related to the severity of depression.

Predictors of postpartum depression in a sample of Egyptian women.

INTRODUCTION: Postpartum depression (PPD) represents a considerable health problem affecting women and their families. The aims of this study were to: (a) compare female patients with PPD to normal controls with regard to some biopsychosocial variables, (b) correlate between the severity of PPD and some clinical and biological variables, and (c) to predict some risk factors for PPD. METHOD: Sixty female patients with PPD were compared with 60 healthy postpartum females (control group). Patient and controls were subjected to: (1) a complete psychiatric and obstetric examination, (2) psychometric studies using the Edinburgh Postnatal Depression Scale, Fahmy and El-Sherbini's Social Classification Scale for Egyptian socioeconomic classification and Horowitz et al's Impact of Event Scale, (3) quantities of thyroid hormone (T3), cortisol hormone, and estrogen were assessed. RESULTS: There were high statistical differences between PPD females and controls as regard psychosocial stressors, level of (estradiol, thyroxin [T3], and cortisol), marital status, residence, parity, method of delivery, complicated puerperium, positive history of premenstrual tension syndrome and baby variables (eg, unwelcomed, with a negative attitude of parents toward the baby, underweight, female, artificially feeding, unhealthy baby). While there were moderate statistical differences in attitude toward spouse and social support and mild statistical difference in socioeconomic status between them. Severity of depression is positively highly correlated with onset of depression, psychosocial stress, levels of T3 and cortisol. However, severity of depression is negatively high when correlated with socioeconomic status. Stepwise linear regression indicated that PPD was significantly predicted by social support, socioeconomic status, feeding of baby, and prior psychiatric problems. CONCLUSION: Many factors may lead to development of PPD. These factors include some psychosocial, socioeconomic, obstetric, and hormonal variables. Early detection of these factors could help in prediction of the development of PPD.

Primary lifelong delayed ejaculation: characteristics and response to bupropion.

INTRODUCTION: In contrast to premature ejaculation and secondary delayed ejaculation (DE), primary lifelong DE has not been studied extensively. In addition, there is no approved drug treatment. AIMS: To explore the clinical and laboratory characteristics of a series of men complaining of lifelong DE and to report the response to bupropion. METHODS: Nineteen consecutive men with primary lifelong DE were prospectively enrolled in this study. Study group was compared with an age-matched group of 19 healthy men. Both groups underwent history taking, physical examination, International Index of Erectile Function (IIEF), anxiety, and depression scores, ejaculation latency time (IELT) using stop watch and measurement of serum prolactin (PRL) and serum total testosterone (T). Patients received open-label bupropion-SR 150 mg/day for 2 months. MAIN OUTCOME MEASURES: Stopwatch-measured IELT values, global efficacy question, IIEF, anxiety, and depression scores. RESULTS: The mean age was 30.8 ± 5.5 year (range 25-42 years). Men with DE exhibited significantly higher masturbatory activity during marital period, lower night emissions, longer IELT, lower orgasmic, and intercourse satisfaction domains of IIEF, higher anxiety and depression scores compared with the controls (all P<0.05). Both serum T and PRL levels did not differ significantly between patients and controls (all P<0.05). Four DE patients (21%) showed history of infertility. The percentage of DE men rating control over ejaculation as "fair to good" increased from 0 to 21.1% after bupropion therapy. The fold decreases of the geometric mean IELT was 0.74 after treatment. The intercourse satisfaction and the orgasmic domains of IIEF and depression score were significantly improved from baseline in the bupropion group (all P<0.05). CONCLUSIONS: Lifelong DE is mainly associated with higher and idiosyncratic masturbatory activity, lower night emissions, infertility, longer IELT, lower orgasmic, and intercourse satisfaction domains of IIEF, higher anxiety and depression scores. Bupropion-SR in a daily dosage of 150 mg seemed to be of limited benefit in lifelong DE.