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Cognitive Behavioural Analysis System of Psychotherapy (CBASP) is an evidenced based treatment model for chronically depressed patients.
The main aim of this service evaluation was to assess the acceptability and clinical impact of CBASP for chronic depression within an Improving Access to Psychological Therapies (IAPT) service.
Routinely collected data were analysed for all patients that received CBASP treatment focussing on the recovery rates of these patients in terms of depression, anxiety and social functioning. Interviews were conducted with patients who had recently been discharged from CBASP therapist within one month of the follow-up date, explore their experiences of therapy.
Outcome data for 27 patients suggested substantial reduction in scoring on measures of depression and anxiety following CBASP treatment. Across all interviews it was clear that patients developed an insight and understanding of how their behaviours affect the outcome of interpersonal situations.
Results from this service evaluation suggest that CBASP is acceptable to service users and has a positive clinical impact in terms of IAPT recovery targets for anxiety, depression and social functioning.
Value-based decision-making impairment in depression is a complex phenomenon: while some studies did find evidence of blunted reward learning and reward-related signals in the brain, others indicate no effect. Here we test whether such reward sensitivity deficits are dependent on the overall value of the decision problem.
We used a two-armed bandit task with two different contexts: one ‘rich’, one ‘poor’ where both options were associated with an overall positive, negative expected value, respectively. We tested patients (N = 30) undergoing a major depressive episode and age, gender and socio-economically matched controls (N = 26). Learning performance followed by a transfer phase, without feedback, were analyzed to distangle between a decision or a value-update process mechanism. Finally, we used computational model simulation and fitting to link behavioral patterns to learning biases.
Control subjects showed similar learning performance in the ‘rich’ and the ‘poor’ contexts, while patients displayed reduced learning in the ‘poor’ context. Analysis of the transfer phase showed that the context-dependent impairment in patients generalized, suggesting that the effect of depression has to be traced to the outcome encoding. Computational model-based results showed that patients displayed a higher learning rate for negative compared to positive outcomes (the opposite was true in controls).
Our results illustrate that reinforcement learning performances in depression depend on the value of the context. We show that depressive patients have a specific trouble in contexts with an overall negative state value, which in our task is consistent with a negativity bias at the learning rates level.
Mood disorders have a wide range of presentation – from major depressive episodes to mania. Both depression and mania can present with irritability; the notable differences between them are discussed in this chapter. Persistent sad mood and lack of enjoyment in usual activities is typically noted in depression, while a lack of need for sleep along with euphoric mood is typical for mania. Due to the spectrum of intervening mood disorders such as bipolar II illness and persistent depressive disorder, a thorough psychiatric evaluation is important. Since mood disorders may lead to dangerousness in the form of self-harm behavior, suicidality, and violence, a sudden and persistent change in mood should be considered a psychiatric emergency. Suicide is rare but unpredictable. Direct questions on whether a patient has thoughts about self-harm are important to differentiate habitual threatening statements from real intent. Treatment options for mood disorders including psychotherapy and medication management are discussed. Episodic mood disorders covered in this chapter are all treatable conditions when identified promptly and under the care of experienced mental health providers.
Cognitive-behavioural therapy (CBT) has been shown to be an effective treatment for depression and anxiety. However, most research has focused on the sum scores of symptoms. Relatively little is known about how individual symptoms respond.
Longitudinal models were used to explore how depression and generalised anxiety symptoms behave over the course of CBT in a retrospective, observational cohort of patients from primary care settings (n = 5306). Logistic mixed models were used to examine the probability of being symptom-free across CBT appointments, using the 9-item Patient Health Questionnaire and the 7-item Generalised Anxiety Disorder scale as measures.
All symptoms improve across CBT treatment. The results suggest that low mood/hopelessness and guilt/worthlessness improved quickest relative to other depressive symptoms, with sleeping problems, appetite changes, and psychomotor retardation/agitation improving relatively slower. Uncontrollable worry and too much worry were the anxiety symptoms that improved fastest; irritability and restlessness improved the slowest.
This research suggests there is a benefit to examining symptoms rather than sum scores alone. Investigations of symptoms provide the potential for precision psychiatry and may explain some of the heterogeneity observed in clinical outcomes when only sum scores are considered.
The course of Bipolar Disorder (BD) is highly variable, with marked inter and intra-individual differences in symptoms and functioning. In this study, we identified illness trajectories across major clinical domains that could have etiological, prognostic, and therapeutic relevance.
Using the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study, we performed univariate and multivariate trajectory modeling of depressive symptoms, manic symptoms, and psychosocial functioning. Multinomial regression was performed to identify baseline variables associated with poor outcome trajectories.
Depressive symptoms predominated, with most subjects being found in trajectories characterized by various degrees of depressive symptoms and 13% of subjects being classified in a poor outcome ‘persistently depressed’ trajectory. Most subjects experienced few manic symptoms, although approximately 10% of subjects followed a trajectory of persistently manic symptoms. Trajectory analysis of psychosocial functioning showed impairment in most of the sample, with little improvement during follow up. Multi-trajectory analyses highlighted significant impairment in subjects with persistently mixed and persistently depressed trajectories of illness. In general, poor outcome trajectories were marked by lower educational attainment, higher unemployment and disability, and a greater likelihood of adverse clinical features (rapid cycling and suicide attempts) and comorbid diagnoses (anxiety disorders, PTSD, and substance abuse/dependence disorders).
Subjects with BD can be classified into several trajectories of clinically relevant domains that are prognostically relevant and show differing degrees of associations with a broad range of negative clinical risk factors. The highest level of psychosocial disability was found in subjects with chronic mixed and depressive symptoms, who show limited improvement despite guideline-based treatment.
The individual of our times is often characterized by a tendency toward narcissism and depression. What is the dynamic underlying these phenomena? How do these aspects correlate to the body image concept? Today we can also note that dynamics of counter-power inhabit the social system and trigger some processes: in the contemporary approach to the body, where frequently there is no “healthy distance,” there are difficulties in harmonizing sexual performance and tenderness, because people are often treated like things, or simply like soulless bodies (which is the point of view associated with pornography). The experience of falling in love also tends to assume the typical connotations of mercantile exchange in respect of particularly desirable personal and social characteristics, reflecting a more or less unconscious drive to obtain the best and most convenient things that concrete reality can offer. Contemporary psychological and anthropological perspectives on these topics are presented.
The present study examines the association of diet with depressive symptoms among stroke survivors from a community cohort of older adults. Depression is common after stroke. A healthy diet has previously been associated with fewer depressive symptoms in older individuals, but it is unknown if this effect is also seen in stroke survivors. Eighty-six participants from the Memory and Aging Project with a history of stroke at their study baseline enrolment, complete dietary data and two or more assessments for depression were included in this observational prospective cohort analysis. Depressive symptoms were assessed annually with a 10-item version of the Center for Epidemiologic Studies Depression scale. Diet was assessed using a validated food-frequency questionnaire administered at baseline. Diet scores were based on analysis of participants’ reported intakes of 144 food items. A generalised estimating equation (GEE) model was applied to examine the association of diet score with depressive symptoms. The study participants had a mean age of 82 ± 7⋅17 years and 14⋅42 ± 2⋅61 years of education, and 82⋅56 % were female. Western diet score was positively associated with depressive symptoms over time (diet score tertile 3 v. tertile 1: β = 0⋅22, se = 0⋅09, P = 0⋅02; P for trend = 0⋅022). Interaction with sex suggested a stronger effect in females. A Western diet was associated with more post-stroke depressive symptoms, suggesting nutrition is important not only for reducing cerebrovascular risk, but for protecting post-stoke mental health as well.
Fatigue is frequently co-existing with other symptoms and is highly prevalent among patients with cancer and geriatric population. There was a lack of knowledge that focus on fatigue clusters in older adults with cancer in hospice care.
To identify fatigue-related symptom clusters in older adult hospice patients and discover to what extent fatigue-related symptom clusters predict functional status while controlling for depression.
This was a cross-sectional study in a sample of 519 older adult hospice patients with cancer, who completed the Memorial Symptom Assessment Scale, the Center for Epidemiological Studies Depression, Boston Short Form Scale, and the Palliative Performance Scale. Data from a multi-center symptom trial were extracted for this secondary analysis using exploratory factor analysis and hierarchical multiple regression analysis.
Data from 519 patients (78 ± 7 years) with terminal cancer who received hospice care under home healthcare services revealed that 39% of the participants experienced fatigue-related symptom clusters (lack of energy, feeling drowsy, and lack of appetite). The fatigue cluster was significantly associated positively with depression (r = 0.253, p < 0.01), and negatively with functional status (r = −0.117, p < 0.01) and was a strong predictor of participants’ low functional status. Furthermore, depression made a significant contribution to this predictive relationship.
Older adult hospice patients with cancer experienced various concurrent symptoms. The fatigue-specific symptom cluster was identified significantly associated with depression and predicted functional status. Fatigue should be routinely monitored in older adults, especially among hospice cancer patients, to help reduce psychological distress and prevent functional decline.
According to a WHO report, the number of patients with coronavirus disease 2019 (COVID-19) has reached 456,797,217 worldwide as of 15 March, 2022. In Wuhan, China, large teams of healthcare personnel were dispatched to respond to the COVID-19 emergency. This study aimed to determine the sociodemographic and psychological predictors of resilience among frontline nurses fighting the current pandemic.
A total of 143 nurses were recruited from February 15 to February 20, 2020 to participate in this study. The 10-item Connor–Davidson Resilience Scale and the 21-item Depression Anxiety Stress Scale were used to estimate the participants’ resilience and mental wellbeing.
Results showed that the nurses displayed a moderate resilience level. Their median depression, anxiety, and stress scores were 1, 2, and 3, respectively, which were negatively correlated with resilience. Female gender, being dispatched to Wuhan, and depression levels were the significant predictors of resilience.
The results suggest that particular attention should be given to female nurses who were dispatched to Wuhan and who exhibited depression symptoms, and appropriate measures should be taken to boost their resilience.
Despite a large descriptive literature linking creativity and risk for psychiatric illness, the magnitude and specificity of this relationship remain controversial.
We examined, in 1 137 354 native Swedes with one of 59 3-digit official and objective occupational codes in managerial and educated classes, their familial genetic risk score (FGRS) for ten major disorders, calculated from 1st through 5th degree relatives. Mean FGRS across disorders were calculated, in 3- and 4-digit occupational groups, and then controlled for those whose disorder onset preceded occupational choice. Using sequential analyses, p values were evaluated using Bonferroni correction.
3-digit professions considered to reflect creativity (e.g. ‘artists’ and ‘authors’) were among those with statistically significant elevations of FGRS. Among more specific 4-digit codes, visual artists, actors, and authors stood out with elevated genetic risks, highest for major depression (MD), anxiety disorders (AD) and OCD, more modest for bipolar disorders (BD) and schizophrenia and, for authors, for drug and alcohol use disorders. However, equal or greater elevations in FGRS across disorders were seen for religious (e.g. ministers), helping (e.g. psychologists, social workers), and teaching/academic occupations (e.g. professors). The potential pathway from FGRS → Disorder → Occupation accounts for a modest proportion of the signal, largely for MD and AD risk.
While traditional creative occupations were associated with elevated genetic risk for a range of psychiatric disorders, this association was not unique, as similar, or greater elevations were seen for religious, helping and teaching professions and was stronger for internalizing than psychotic disorders.
Staging has been increasingly used in unipolar depression since its introduction in the nineties. Several models are available, but their differential features and implications are not completely clear. We systematically reviewed: (a) staging models of longitudinal development of unipolar depression; (b) staging models of treatment-resistant unipolar depression; (c) their applications. MEDLINE, PsycINFO, EMBASE, and Web of Science were examined according to PRISMA guidelines from inception to December 2021. Search terms were: ‘stage/staging’, combined using the Boolean ‘AND’ operator with ‘psychiatric disorder/mental disorder/depressive/mood disorder’. A total of 169 studies were identified for inclusion: 18 described staging models or applications, 151 described treatment-resistant staging models or applications. Staging models of longitudinal development were found to play a key role in formulating sequential treatment, with particular reference to the use of psychotherapy after pharmacotherapy. Staging methods based on treatment resistance played a crucial role in setting entry criteria for randomized clinical trials and neurobiological investigations. Staging is part of clinimetrics, the science of clinical measurements, and its role can be enhanced by its association with other clinimetric strategies, such as repeated assessments, organization of problematic areas, and evaluation of phenomena that may affect responsiveness. In research, it may allow to identify more homogeneous populations in terms of treatment history that may diminish the likelihood of spurious results in comparisons. In clinical practice, the use of staging in a clinimetric perspective allows clinicians to make full use of the information that is available for an individual patient at a specific time.
Polycystic ovary syndrome (PCOS) is associated with a high prevalence of mental health disorders, including depression, anxiety and eating disorders. There are numerous clinic-based and population studies from around the world showing a high prevalence of both depressive symptoms and depression in reproductive-age women with PCOS compared to controls. These studies indicate that the risk of depression may be independent of obesity and associated with clinical and biochemical hyperandrogenism, with genetic data supporting closely linked biological pathways. Similarly, the risk of anxiety is significantly higher in women with PCOS as compared to a control population. Longitudinal studies depicted a persistence of both depression and anxiety symptoms in women with PCOS over time. First-line treatments for PCOS, including weight-loss interventions and use of hormonal contraceptives, may improve depression and anxiety scores. Recent publications indicate an increased risk of disordered eating and eating disorders in women with PCOS. Given that lifestyle modifications are a first-line treatment for PCOS, early screening and treatment of depression, anxiety and disordered eating are essential for comprehensive management of this population.
Waves 1 to 3 (March 2020 to May 2020) of the UK COVID-19 Mental Health and Wellbeing study suggested an improvement in some indicators of mental health across the first 6 weeks of the UK lockdown; however, suicidal ideation increased.
To report the prevalence of mental health and well-being of adults in the UK from March/April 2020 to February 2021.
Quota sampling was employed at wave 1 (March/April 2020), and online surveys were conducted at seven time points. Primary analyses cover waves 4 (May/June 2020), 5 (July/August 2020), 6 (October 2020) and 7 (February 2021), including a period of increased restrictions in the UK. Mental health indicators were suicidal ideation, self-harm, suicide attempt, depression, anxiety, defeat, entrapment, loneliness and well-being.
A total of 2691 (87.5% of wave 1) individuals participated in at least one survey between waves 4 and 7. Depressive symptoms and loneliness increased from October 2020 to February 2021. Defeat and entrapment increased from July/August 2020 to October 2020, and remained elevated in February 2021. Well-being decreased from July/August 2020 to October 2020. Anxiety symptoms and suicidal ideation did not change. Young adults, women, those who were socially disadvantaged and those with a pre-existing mental health condition reported worse mental health.
The mental health and well-being of the UK population deteriorated from July/August 2020 to October 2020 and February 2021, which coincided with the second wave of COVID-19. Suicidal thoughts did not decrease significantly, suggesting a need for continued vigilance as we recover from the pandemic.
To evaluate prevalence and risk factors of posttraumatic stress disorder (PTSD) and depression among directly exposed (DE) and indirectly or nonexposed (INE) populations in Sri Lanka 8 y after the Indian Ocean Tsunami in 2004.
Population-based structured survey study was conducted among Sri Lankan adults living in 5 coastal districts, Hamboantha, Matara, Galle, Kalutara, and Colombo in 2012-2013. A total of 430 individuals, 325 in DE, 105 in INE, participated in the survey. DE and INE groups were compared for demographics and outcomes. Bivariate and multiple logistic regressions with backward selection were used to identify risk factors for partial PTSD and depression.
The prevalence of PTSD, partial PTSD and depression were 2.8%, 10.5%, and 18.8% in DE group, respectively. In multivariable analyses tsunami exposure, female gender, subjective physical health before the tsunami, previous trauma, and depression were significantly associated with partial PTSD. Female gender, high frequency of religious activity, previous trauma, social support, and PTSD were significantly associated with depression.
The psychological impacts of the tsunami did wane over time, but still present at lower rate even in 8 y. It is important to address these lingering sequelae and expand access to at risk individuals.
The Spitak earthquake offered a unique opportunity to conduct family studies of the genetics of post-traumatic stress disorder (PTSD) and related conditions, including depression and anxiety. The multigenerational families that participated in the Spitak Earthquake Genetic Study (SEGS) were recruited from the devastated city of Gumri. The participants (3 to 5 generations) were exposed to horrific earthquake-related traumatic experiences contemporaneously. After adjusting for sex, age, and multiple environmental risk factors, the heritability of vulnerability of PTSD (42%) was significant. Additionally, vulnerabilities for depression and anxiety were also significantly heritable. These three phenotypes were genetically correlated, indicating pleiotropy, i.e., they shared genes. Using complex co-variate analyses, we found an association of specific serotonergic genes (THP2 and THP1) and a dopaminergic gene (COMT) with PTSD and a serotonergic gene (5HTTLRP) with depression. These findings suggest that carriers of variants of these genes are at risk for PTSD and depression, respectively. Whole genome sequencing found another interesting gene, OR4C3, among those with PTSD. The gene codes for an olfactory receptor that shares a domain structure with many neurotransmitters. The chapter also discusses recent advances and challenges in genetic research.
This chapter traces developments in American Protestant responses to mental illness. The professionalization of medicine, shifting theological emphases, and cultural forces shaped reactions that ranged from benign neglect by many to impassioned advocacy by a few. Christians enter the narrative in various roles: ministers, physicians, sufferers, family members, advocates, seminary professors, and a variety of mental health professionals. The identities of some spanned those categories. Across time, churchgoers and religious leaders deployed terms for distress that included distraction, possession, madness, melancholy, insanity, mental illness, and later, diagnostic terms such as depression, bipolar disorder, post-traumatic stress disorder, and schizophrenia. Regardless of labels, as individuals and groups of believers thought about mental illness, sought meaning, and responded amid distress, their context-specific claims of what seemed awry shaped assessments of how best to deploy available resources.
At 1.5- and five-year follow-ups after the Spitak earthquake, there was a significant dose–response relation between earthquake exposure and severity of PTSD and depression. The more severely exposed Spitak group had higher PTSD and depression scores than the less severely exposed group from Gumri. However, at twenty-five years, this relation had dissipated. PTSD severity of the Spitak group that had experienced comparatively fewer post-earthquake adversities (lack of heat, electricity, food, medicine, housing, transportation) and post-earthquake traumatic experiences (e.g., fights, accidents) was comparable to that of the Gumri group; while depression severity of the Gumri group, which had been significantly lower than the Spitak group at baseline, was higher at follow-up. The detrimental impact of adversities was greater for depression than for PTSD.
Risk factors for PTSD and depression at twenty-five years included adversities, baseline PTSD and separation anxiety severity, loss of home, and chronic medical illnesses. Social support by family and friends emerged as a protective factor. Compared with those who lost one parent and controls, orphans were at greater risk for clinical depression.
Although there was a decrease in PTSD rates from baseline to twenty-five years post-earthquake (48% to 22%), earthquake-related PTSD remained a significant public health problem. Alleviation of adversities, improving the social ecology, and monitoring chronic medical illnesses should be considered essential components of disaster recovery programs.
Relocation of residents to a safer location may be necessary when homes are destroyed during a natural disaster. Relocation involves economic hardship and separation from one’s community, where support systems and safety networks are established. These changes compound stress reactions to the trauma of the disaster, such as post-traumatic stress disorder (PTSD), depression, and anxiety. This chapter reviews our work in Armenia and the work of others who studied the effects of relocation on stress reactions after natural disasters worldwide. It also describes variables involved with relocation which potentially impact the severity of stress reactions, such as degree of exposure to the disaster, timing, duration and the place of relocation (within or outside the city) and the extent of losses (including the life of family members, home, employment, and social support) necessitating relocation. The general consensus is that relocation contributes to the emotional sequelae of a disaster. The studies describe factors that minimize the impact of relocation to stress reactions. A consistent mitigating factor is emotional support. Recommendations for future research are included in this chapter for a better understanding of the effect of variables involved with relocation on stress reaction.
There is a paucity of long-term treatment outcome studies among children and adolescents after natural disasters. This chapter summarizes findings from three long-term studies among severely traumatized early adolescents after the 1988 Spitak earthquake in Armenia, including a twenty-five-year follow-up that represents the most extended prospective treatment outcome study to date after a disaster. School-based trauma-grief-focused psychotherapy was provided at 1.5 years post-earthquake. The intervention addressed trauma and loss experiences due to the earthquake; post-trauma distress reactions, including PTSD and grief; current problems and adversities; trauma and loss reminders, interpersonal conflicts, and developmental progression. The findings showed significant long-term benefits of treatment in reducing PTSD and depressive symptoms. We also present findings regarding differences in recovery trajectories among treated and not treated subjects and risk and protective factors associated with PTSD and depression. Despite the improvements, a sub-group of the students continued to experience earthquake-related chronic PTSD and depressive symptoms at twenty-five-year follow-up, indicating the need for ongoing surveillance of severely traumatized survivors. The findings underscore the benefit of post-disaster therapeutic intervention, social support by family members and friends, and the need for assistance by governmental and non-governmental agencies to mitigate post-disaster adversities that contributed significantly to the chronicity of symptoms.