Browsing by Subject "Depressive Disorder"
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Item Defining and Differentiating Treatment-Resistant Depression(2012-08-13) Trevino, Kenneth; McClintock, Shawn M.Individuals diagnosed with major depressive disorder (MDD), who are unable to achieve an adequate therapeutic response despite completing multiple antidepressant therapies, are commonly referred to as experiencing treatment-resistant depression (TRD). Despite the common occurrence and debilitating nature of TRD, currently there is no standardized and universally accepted definition for TRD. The Maudsley Staging Method (MSM) is a novel, multidimensional staging method for TRD that incorporates clinical and treatment factors. Although the multidimensional nature of the MSM makes it an ideal method for staging and identifying TRD, additional research is needed to better understand this newly developed staging method. The objective of this study was to evaluate the psychometric characteristics and clinical utility of the MSM. This involved (1) determining a reliable MSM cutoff score to differentiate TRD from non-TRD, (2) examining the extent of agreement between the MSM and another commonly used method of defining TRD, and (3) examining the construct validity of the MSM. This study also used the MSM to identify patients with TRD in order to perform a preliminary examination of the frequency of individual depressive symptoms associated with TRD. The data for this study was derived from four clinical investigations and included socio-demographic, clinical, and antidepressant treatment information for 88 patients diagnosed with MDD. This study identified an optimal cutoff score (7.5) for the MSM for differentiating TRD from non-TRD, and demonstrated moderate agreement between the MSM and another commonly used method for defining TRD. Depression symptom severity and current MDE duration had a significant, positive relationship with the MSM, which provided support for its construct validity. However, the MSM was not associated with certain demographic characteristics (e.g., female sex, older age) assumed to be related to TRD. This study provided an initial description of the frequency of individual depressive symptoms experienced by patients with TRD. Future research should further evaluate the individual subscales that comprise the MSM and the impact different prescription guideline may have on a patient’s MSM score and TRD classification. The MSM should also be evaluated outside of a research setting to determine its practical use in a clinical setting. [Keywords: treatment resistant depression, treatment refractory depression, defining treatment resistance, Maudsley Staging Method, major depressive disorder, unipolar depression, depression, symptoms, pharmacotherapy, antidepressant]Item Developing and Evaluating the Efficacy and Feasibility of Delivering a Psychoeducational Individual Intervention to Women with Advanced Stage Ovarian Cancer: A Two Phase Study(2007-08-08) Doyle, Kimberly Cecile; Gershenfeld, HowardMethod: This study was conducted in two phases. Phase I consisted of a psychosocial needs assessment (n = 15) to determine the appropriate elements necessary for inclusion in an individual intervention. Perceived barriers to participation in psychosocial services, including group support, were also assessed. The outcome of the needs assessment combined with an extensive literature review was used to develop the Phase II intervention. In Phase II, participants (n = 30) were recruited from the gynecologic oncology practice at Baylor Sammons Cancer Center. Participants were randomized to intervention (n = 15) vs. control (n=15) groups. Intervention sessions lasted 60 minutes and were conducted weekly over a period of 8 weeks. Sessions consisted of a combination of education and psychosocial support. Growth modeling was used to evaluate variation in within-individual rate of change in outcome measures during the treatment (weeks 1-8) and followup (weeks 16-48) periods of the study. Repeated measures ANOVA was used to evaluate average group differences in outcome measures during the treatment and follow-up periods of the study. Results: No main effects of time, group, age, or education were observed with regard to rate of change of psychosocial adjustment to illness during the treatment period of the study using growth modeling. However, during the follow-up period of the study, time and group were significant predictors of within-individual variation in rate of change in psychosocial adjustment to illness. Similarly, repeated measures ANOVA yielded no main effects of time or group in psychosocial adjustment to illness during the treatment period of the study; however, a main effect of group (p<.05) and an interaction between group and time (p<.05) were noted during the follow-up period of the study with the most significant differences in group means occurring at week 48 (effect size = .70). Although not stable across all models created, time was the only significant predictor of within-individual variation in rate of change in depression symptoms during the treatment and follow-up periods. A main effect of time without consideration of group (p<.01) and an interaction between group and time (p<.01) with regard to depression symptoms was noted in the treatment phase of the study, most significantly at week 8. A main effect of group (p<.05), most significantly at week 48, was observed during the follow-up phase (effect size = .69). Similar to depression scores, withinindividual variation in anxiety symptom scores was significantly predicted by time during the treatment period of the study. Although no main effects of predictors were observed with regard to anxiety symptoms during the follow-up period of the study, the model with the greatest goodness of fit included the predictors education, group, and time. Repeated measures ANOVA suggest a main effect of time (p<.05) with regard to anxiety symptoms during the treatment period of the study but no main effect of group. However, during the follow-up period of the study, a main effect of time (p<.05) and group (p<.05) were noted with regard to differences in the average state anxiety symptom score between groups, with the most significant difference occurring at week 48 (effect size = .43). Cost analyses suggest minimal differences in the number of medical office visits and phone calls between groups and a moderate difference in usage of psychiatric and pain medication between groups. Treatment satisfaction was high across all intervention topics, with participants rating sessions 1 and 8 the most helpful. Research and Clinical Implications: Concordant with the literature, the results of this study suggest that individual interventions wiItem Neurocognitive Functioning in Severe Depression(2006-12-19) McClintock, Shawn Michael; Cullum, C. MunroResearch has suggested that major depressive disorder can negatively impact neurocognitive functioning. Depression has been implicated in affecting many cognitive domains, including executive function, attention, memory, and psychomotor and processing speed. However, there has been limited examination of the relationship between neurocognitive functioning and depressive characteristics such as depression severity, depressive subtypes, number of depressive episodes, and episode duration. The primary goal of this study was to explore the relationship between neurocognitive functioning and depressive characteristics in severe unipolar major depressive disorder. Baseline socio-demographic, clinical, and neuropsychological information was examined in 145 inpatients enrolled in a large electroconvulsive therapy study (the Consortium for Research in ECT). Results revealed that depression severity was unrelated to global cognitive functioning and executive functioning. However, performance on certain neurocognitive variables accounted for 25% of the variability in the magnitude of depression severity. Various clinical dimensions of depression, including depressive subtype, number of episodes, and episode duration did not show a systematic relationship to neurocognitive functioning. Patients with psychotic depression performed similarly to patients without psychosis, and the ability to predict the presence of psychosis by neuropsychological performance was low. Those with atypical depression performed similarly to patients with typical depression, although patients with atypical depression showed better performance on a measure of verbal memory. No significant differences were found between subjects with multiple versus single episodes of depression, and the number of depressive episodes was unrelated to neurocognitive performance. These data indicate that the depressive characteristics examined were not systematically related to neurocognitive functioning among severely depressed patients in this well characterized and carefully selected sample.Item Serotonin Reuptake Inhibitor Use During Pregnancy: Perinatal Outcomes(2008-04-10) Jordan, Allison E.; Dashe, Jodi S.Objective: To assess severity of neonatal behavioral syndrome (NBS) in infants of serotonin reuptake inhibitor (SRI)-treated pregnancies, compared with infants of women with psychiatric illness not treated with medication. Methods: Retrospective cohort study of pregnancies followed in a prenatal clinic for women with psychiatric illness. Infants of women who received SRI medication through delivery (SRI-treated) were compared with those who did not receive treatment or discontinued medication before the last month of pregnancy (SRI-untreated). NBS was defined as one or more of the following: jitteriness, irritability, lethargy, hypotonia, hypertonia, hyperreflexia, apnea, respiratory distress, vomiting, poor feeding, or hypoglycemia. Results: Findings of NBS were identified in 28% of 46 SRI-treated pregnancies and 17% of 59 untreated pregnancies. There were no differences in rates of prematurity (4% vs. 7%), fetal growth restriction (6% vs. 2%), transfer to a higher nursery for NBS (11% vs. 10%), respiratory abnormality (7% vs. 5%), or hospitalization duration among infants with NBS findings (2 vs. 6 days). Conclusions: Findings of NBS were identified in 28% of SRI-exposed neonates. However, these infants were not more likely than unexposed infants to be admitted to a higher nursery, experience respiratory abnormalities, or have prolonged hospitalization.