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Background: Signatures from the metabolome and microbiome have already been introduced as candidates for diagnostic and treatment support. The aim of this study was to investigate the utility of volatile organic compounds (VOCs) from the breath for detection of schizophrenia and depression. Methods: Patients with a diagnosis of major depressive disorder (MDD) or schizophrenia, as well as healthy controls, were recruited to participate. After being clinically assessed and receiving instruction, each participant independently collected breath samples for subsequent examination by proton transfer-reaction mass spectrometry. Results: The sample consisted of 104 participants: 36 patients with MDD, 34 patients with schizophrenia and 34 healthy controls. Through mixed-model and deep learning analyses, 5 VOCs contained in the participants' breath samples were detected that significantly differentiated between diagnostic groups and healthy controls, namely VOCs with mass-to-charge ratios (m/z) 60, 69, 74, 88 and 90, which had classification accuracy of 76.8% to distinguish participants with MDD from healthy controls, 83.6% to distinguish participants with schizophrenia from healthy controls and 80.9% to distinguish participants with MDD from those with schizophrenia. No significant associations with medication, illness duration, age of onset or time in hospital were detected for these VOCs. Limitations: The sample size did not allow generalization, and confounders such as nutrition and medication need to be tested. Conclusion: This study established promising results for the use of human breath gas for detection of schizophrenia and MDD. Two VOCs, 1 with m/z 60 (identified as trimethylamine) and 1 with m/z 90 (identified as butyric acid) could then be further connected to the interworking of the microbiota-gut-brain axis., Introduction Psychiatric disorders represent one of the leading causes of disability worldwide. (1) However, while modern medicine in general has been steadily developing with regard to therapeutic outcomes and efficacy, [...]

Background: Schizophrenia, bipolar disorder and major depressive disorder are increasingly being conceptualized as a transdiagnostic continuum. Disruption of white matter is a common alteration in these psychiatric disorders, but the molecular mechanisms underlying the disruption remain unclear. Neuregulin 1 (NRG1) is genetically linked with susceptibility to schizophrenia, bipolar disorder and major depressive disorder, and it is also related to white matter. Methods: Using a transdiagnostic approach, we aimed to identify white matter differences associated with NRG1 and their relationship to transdiagnostic symptoms and cognitive function. We examined the white matter of 1051 participants (318 healthy controls and 733 patients with major psychiatric disorders: 254 with schizophrenia, 212 with bipolar disorder and 267 with major depressive disorder) who underwent diffusion tensor imaging. We measured the plasma NRG1-[beta]1 levels of 331 participants. We also evaluated clinical symptoms and cognitive function. Results: In the patient group, abnormal white matter was negatively associated with NRG1-[beta]1 levels in the genu of the corpus callosum, right uncinate fasciculus, bilateral inferior fronto-occipital fasciculus, right external capsule, fornix, right optic tract, left straight gyrus white matter and left olfactory radiation. These NRG1-associated white matter abnormalities were also associated with depression and anxiety symptoms and executive function in patients with a major psychiatric disorder. Furthermore, across the 3 disorders we observed analogous alterations in white matter, NRG1-[beta]1 levels and clinical manifestations. Limitations: Medication status, the wide age range and our cross-sectional findings were limitations of this study. Conclusion: This study is the first to provide evidence for an association between NRG1, white matter abnormalities, clinical symptoms and cognition in a transdiagnostic psychiatric cohort. These findings provide further support for an understanding of the molecular mechanisms that underlie the neuroimaging substrates of major psychiatric disorders and their clinical implications., Introduction Schizophrenia, bipolar disorder and major depressive disorder have been separate diagnoses since the time of Kraepelin in the 1920s. (1) However, diagnostic categories based on presenting signs and symptoms [...]

PURPOSE The US Preventive Services Task Force recommends screening for depression in the general adult population. Although screening questionnaires for depression and anxiety exist in primary care settings, electronic health tools such as computerized adaptive tests based on item response theory can advance screening practices. This study evaluated the validity of the Computerized Adaptive Test for Mental Health (CAT-MH) for screening for major depressive disorder (MDD) and assessing MDD and anxiety severity among adult primary care patients. METHODS We approached 402 English-speaking adults for participation from a primary care clinic, of whom 271 adults (71% female, 65% black) participated. Participants completed modules from the CAT-MH (Computerized Adaptive Diagnostic Test for MDD, CAT-Depression Inventory, CAT-Anxiety Inventory); brief paper questionnaires (9-item Patient Health Questionnaire [PHQ-9], 2-item Patient Health Questionnaire [PHQ-2], Generalized Anxiety Disorder 7-item Scale [GAD7]); and a reference-standard interview, the Structured Clinical Interview for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) Diagnoses. RESULTS On the basis of the interview, 31 participants met criteria for MDD and 29 met criteria for GAD. The diagnostic accuracy of the Computerized Adaptive Diagnostic Test for MDD (area under curve [AUC] = 0.85) was similar to that of the PHQ-9 (AUC = 0.84) and higher than that of the PHQ-2 (AUC = 0.76) for MDD screening. Using the interview as the reference standard, the accuracy of the CAT-Anxiety Inventory (AUC = 0.93) was similar to that of the GAD-7 (AUC = 0.97) for assessing anxiety severity. The patient-preferred screening method was assessment via tablet/computer with audio. CONCLUSIONS Computerized adaptive testing could be a valid and efficient patient-centered screening strategy for depression and anxiety screening in primary care settings. Key words: screening; depression; anxiety; mental health; symptom assessment; surveys and questionnaires; health informatics; electronic health records; vulnerable populations; primary care; practice-based research, INTRODUCTION Major depressive disorder (MDD) and generalized anxiety disorder (GAD) affect nearly 10% of adults (1) and are largely managed in primary care settings. (2,3) At least one-half of patients [...]

Objective A higher rate of depressive symptoms is found among mothers of children with disabilities compared to other parents. However, there is a lack of study of mothers with children, Author(s): Linda S. Beeber [sup.1] , Samantha Meltzer-Brody [sup.2] , Maria Martinez [sup.3] , Yui Matsuda [sup.4] , Anne C. Wheeler [sup.5] , Marcia Mandel [sup.6] , Dore LaForett [sup.7] [...]

The effect of engaging in an intensive research protocol that inquired extensively about psychiatric and suicide symptoms and exposed participants to a number of images, including suicide-related content was explored. Individuals experiencing a major depressive episode were called at 1 and 3 months after the initial protocol. Participants were asked about changes in suicide ideation and the occurrence of self-harm or suicide attempts following participation. Participants reported experiencing reductions in suicide ideation at the first follow-up and no changes at the second follow-up. No participant reported having engaged in self-harm or having attempted suicide at either follow-up. Results suggest that basic science/nontreatment research can be conducted safely with suicidal participants and in a manner that does not increase suicide symptoms or suicide risk.

A study was conducted to investigate and describe the major depressive disorder (MDD) rates, predictors, clinical outcomes and treatment methodologies during the first year following traumatic brain injury (TBI). Results indicated that 53.1% of patients with TBI had MDD during the first year and was an independent predictor of poorer quality of life.

Whether magnetic resonance imaging studies can provide useful information to clinicians who treat people with major depressive disorder remains to be established. There are, however, several recent findings that suggest that likelihood of response may be predicted by imaging findings. For example, morphometric studies have examined whether hippocampus volume is associated with clinically meaningful outcomes such as response to treatment. In general, patients who remit have larger pretreatment hippocampus volumes bilaterally compared with those who do not remit. There are similar preliminary findings for the anterior cingulate cortex. There are also a number of functional imaging studies that have identified different activity patterns in those who are likely to respond to treatment compared with those who are not. Using positron emission tomography, investigators have reported different patterns of response to treatment in those treated with medication compared with those treated with psychotherapy. Some of the potential barriers to the routine use of imaging in psychiatric practice are reviewed briefly., Introduction Magnetic resonance imaging (MRI) is included in clinical trials investigating a variety of neurologic disorders, including Alzheimer disease, multiple sclerosis and stroke. Ciumas and colleagues (1) recently argued that [...]

Treatment data from a university counseling center (UCC) that utilized the Outcome Questionnaire--45.2 (OQ-45; M. J. Lambert et al., 2004), a self-report general clinical symptom measure, was compared against treatment efficacy benchmarks from clinical trials of adult major depression that utilized similar measures. Statistical analyses suggested that the treatment effect size estimate obtained at this counseling center with clients whose level of psychological distress was above the OQ-45 clinical cutoff score was similar to treatment efficacy observed in clinical trials. Analyses on OQ-45 items suggested that clients elevated on 3 items indicating problematic substance use resulted in poorer treatment outcomes. In addition, clients who reported their relational status as separated or divorced had poorer outcomes than did those who reported being partnered or married, and clients reporting intimacy issues resulted in greater numbers of sessions. Although differential treatment effect due to training level was found where interns and other trainees had better pre-post outcome than did staff, interpretation of this result requires great caution because clients perceived to have complicated issues are actively reassigned to staff. More effectiveness investigations at UCCs are warranted. Keywords: university counseling centers, benchmarking, treatment effectiveness, therapist effect, clinical assessment

The authors tested the effects of continuation-phase cognitive therapy (C-CT) on remission and recovery from recurrent major depressive disorder, defined as 6 weeks and 8 months, respectively, of continuously absent or minimal symptoms. Responders to acute-phase cognitive therapy were randomized to 8 months of C-CT (n = 41) or assessment control (n = 43), and they were followed 16 additional months (R. B. Jarrett et al., 2001). Relative to controls, a few more patients in C-CT remitted (88% vs. 97%), and significantly more recovered (62% vs. 84%). All patients without remission and recovery relapsed, but most patients who remitted (60%) and who recovered (75%) did not later relapse or recur. The authors discuss the importance of defining efficacious treatment as producing remission and recovery. Keywords: major depressive disorder, remission, recovery, cognitive therapy, continuation-phase cognitive therapy

Knowledgeable informants may be able to provide useful information about depressive symptoms and suicidal actions when a suicidal patient is uncooperative with a clinical interview or not available for a psychiatric evaluation. The present study was designed to examine information gathered from psychiatric inpatients who bad attempted suicide as compared to similar information obtained from a close friend or family member. From a larger sample of adult psychiatric inpatients diagnosed with major depression, 25 suicide attempters were assessed and their reports were compared to similar information solicited from a close friend or family member. The assessment focused on depressive symptoms from the SCID and the presence of various suicidal actions. Moderate to high agreement was found on all measures. Psychiatric patients and their informants tended to agree on the presence of depressive symptoms, the presence of recent stressful life events, and specific actions taken during the suicidal crisis, suggesting that informants may be capable of providing useful information about the patient.

Background: Some, although not all, studies report small hippocampal volume in patients with major depressive disorder (MDD) relative to healthy controls. Here, we explore the contribution of key demographic and clinical variables to this difference. Methods: We used meta-analytic techniques to provide an updated analysis of data from 32 magnetic resonance imaging studies of hippocampal volume in patients with MDD. Results: Our analysis confirmed the difference in hippocampal volume, but only among patients with MDD whose duration of illness was longer than 2 years or who had more than 1 disease episode. We found no such effect in studies that included patients who did not fit these criteria. The effect was limited to children and middle-aged or older adults. Analyzed collectively, studies including young adult patients showed equivalent hippocampal volumes across MDD patients and controls, a result that may be attributable to a reduced burden of illness in this population. Age at onset of disease, severity of depression at the time of scanning, sex and slice thickness did not contribute to differences in hippocampal volume between patients with MDD and controls. Limitations: The small size of many of the clinical and demographic subgroups may have limited statistical power to detect between-group differences. Conclusion: Although all studies were cross-sectional, our results suggest that hippocampal volume reductions generally occur after disease onset in patients with MDD. These findings have implications for the timing of clinical interventions aimed at reducing the impact of MDD on neuronal structure and function. Contexte: Certaines etudes, mais pas toutes, signalent que le volume de l'hippocampe est plus petit chez les patients atteints de syndrome depressif majeur (SDM) que chez les temoins en bonne sante. Nous explorons ici la contribution a cette difference de variables demographiques et cliniques cles. Methodes : Nous avons utilise des techniques meta-analytiques pour effectuer une synthese a jour des donnees de 32 etudes ayant mesure le volume de l'hippocampe chez des patients atteints de SDM au moyen de l'imagerie par resonance magnetique. Resultats : Notre analyse a confirme la difference de volume de l'hippocampe, mais uniquement chez les patients qui souffraient de SDM depuis plus de 2 ans, ou qui avaient presente plus d'un episode de la maladie. Nous n'avons pas observe d'effets semblables dans les etudes qui incluaient des patients ne repondant pas a ces criteres. L'effet a semble se limiter aux enfants et aux adultes d'age moyen ou plus avance. Regroupees aux fins de l'analyse, les etudes incluant des patients adultes moins ages ont fait etat de volumes hippocampiques equivalents chez les patients souffrant de SDM et les temoins, un resultat potentiellement attribuable au fardeau moins lourd de la maladie chez cette population. Le sexe du patient, son age lors du declenchement de la maladie, la gravite de la depression au moment de l'epreuve d'imagerie et l'epaisseur des coupes n'ont pas influe sur les differences de volume hippocampique entre les patients atteints de SDM et les temoins. Limites : Le petit echantillon de plusieurs des sous-groupes cliniques et demographiques peut avoir reduit la puissance statistique et empeche la detection des differences entre les groupes. Conclusion : Meme s'il s'agissait dans tous les cas d'etudes transversales, nos resultats indiquent qu'une diminution du volume de l'hippocampe survient generalement apres le declenchement de la maladie chez les patients atteints de SDM. De telles observations ont une incidence sur le moment choisi pour intervenir cliniquement dans le but d'attenuer l'impact du SDM sur la structure et la fonction neuronales., Introduction A number of factors implicate the hippocampus in the pathogenesis of major depressive disorder (MDD), including the fact that the hippocampus is a highly stress-sensitive brain region (1) and [...]

Objective: The purpose of our study was to investigate alterations of white matter integrity in adults with major depressive disorder (MDD) using magnetic resonance imaging (MRI). Methods: We performed diffusion [...]

The current report used confirmatory factor analysis to examine the latent structures of both key features and associated symptoms of three disorders that commonly develop following a traumatic event: posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD). Participants were 228 motor-vehicle accident survivors who sought treatment for emotional difficulties. PTSD, MDD, and GAD were assessed with a combination of self-report and interview-based measures. The results of construct level analyses suggested that PTSD, MDD. and GAD are distinguishable but highly correlated disorders following a traumatic event. Symptom level analyses supported a model where the Reexperiencing, Avoidance, and Hypervigilance factors were subsumed under the PTSD construct. However, in this model the Dysphoria factor was a higher order construct correlated with the PTSD, MDD, and GAD factors, suggesting that the Dysphoria cluster may not be unique to PTSD. Diagnostic and theoretical implications of these results are discussed. Keywords: trauma, comorbidity, posttraumatic stress disorder, major depressive disorder, generalized anxiety disorder

The authors conducted a meta-analytic review to assess the prevalence of major depressive disorder and depressive symptoms among Latinos compared with non-Latino Whites in the United States using community-based data. Random-effects estimates were calculated for 8 studies meeting inclusion criteria that reported lifetime prevalence of major depressive disorder (combined N = 76,270) and for 23 studies meeting inclusion criteria that reported current prevalence of depressive symptoms (combined N = 38,997). Findings did not indicate a group difference in lifetime prevalence of major depressive disorder (odds ratio = 0.89, 95% confidence interval = 0.72, 1.10). Latinos reported more depressive symptoms than non-Latino Whites (standardized mean difference = 0.19, 95% confidence interval = 0.12, 0.25); however, this effect was small and does not appear to suggest a clinically meaningful preponderance of depressive symptoms among Latinos. Findings are examined in the context of theories on vulnerability and resilience, and recommendations for future research are discussed. Keywords: major depressive disorder, depressive symptoms, Latinos, meta-analysis

A randomized clinical trial was undertaken to investigate the relative efficacy of rational-emotive behavior therapy (REBT), cognitive therapy (CT), and pharmacotherapy in the treatment of 170 outpatients with nonpsychotic major depressive disorder. The patients were randomly assigned to one of the following: 14 weeks of REBT, 14 weeks of CT, or 14 weeks of pharmacotherapy (fluoxetine). The outcome measures used were the Hamilton Rating Scale for Depression and the Beck Depression Inventory. No differences among treatment conditions at posttest were observed. A larger effect of REBT (significant) and CT (nonsignificant) over pharmacotherapy at 6 months follow-up was noted on the Hamilton Rating Scale for Depression only. Keywords: major depressive disorder; rational emotive behavior therapy; cognitive therapy; selective serotonin reuptake inhibitors; efficacy/outcome study

Objective: In patients with major depressive disorder (MDD), enhanced activation of the rostral anterior cingulate cortex (rACC) during conflict resolution has been demonstrated with the use of functional magnetic resonance [...]

This study examined the psychosocial consequences of experiencing major depressive disorder (MDD). In a 7-year longitudinal study of 496 female adolescents, the authors identified 49 girls who experienced their first episode of MDD and then recovered. They were compared with a randomly selected group of 98 never depressed participants on 13 psychological, social, psychiatric, and life events variables. None of the variables fit the scar pattern (i.e., a group difference that emerges during the first MDD episode and remains elevated post-recovery). All 13 variables were elevated before, during, and after the MDD episode, although some increased during the MDD episode. Results provide little support for the scar hypothesis among adolescent girls but instead suggest that many risk variables are elevated before and after the MDD episode. Interventions that modify these factors may help to reduce depression incidence and recurrence among female adolescents. Keywords: major depression, consequences, psychosocial scars, adolescence, longitudinal

The authors examined interpersonal correlates of emotional intelligence (EI) in a sample of individuals with a history of depression. The authors focused on potentially adaptive relationship dynamics associated with EI that may help protect these vulnerable individuals from further distress. Participants with high EI, as measured with the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT; J. D. Mayer, P. Salovey, & D. R. Caruso, 2002), saw their partners as less hostile, critical, and rejecting in their support styles than did participants with low EI. Partners' own reports mostly corroborated these findings. Unexpectedly, although partners of high EI participants reported offering less active and directive support than did partners of low EI participants, high EI participants perceived their partners as more supportive than did low EI participants. Partners of emotionally intelligent participants also reported being more conscientious and open to experiences, offering some evidence of the stress-buffering hypothesis associated with higher EI. Keywords: assortive mating, depression, emotional intelligence, social support, EMOTIONAL INTELLIGENCE (EI) and its possible association with various facets of human functioning became the focus of much theoretical and empirical research during the 1990s (Salovey & Sluyter, 1997). Accompanying [...]

The authors examined the amount and durability of change in the cognitive content of 156 adult outpatients with recurrent major depressive disorder after treatment with cognitive therapy. The pre-post magnitude of change was large for the Attributional Style Questionnaire Failure composite (d=0.79), Dysfunctional Attitudes Scale (d=1.05), and Self-Efficacy Scale (d=0.83), and small for the Attributional Style Questionnaire Success composite (d=0.30). Changes in cognitive content were clinically significant, as defined by their 64%-87% scores overlapping with score distributions from community dwellers. Improvement was durable over a 2-year follow-up. Changes in negative cognitive content could be detected early and distinguished responders from nonresponders. In responders, continuation-phase cognitive therapy was associated with further improvements on only 1 measure of cognitive content. Early changes in negative cognitive content did not predict later changes in depressive symptoms, which the authors discuss in the context of methodological challenges and the cognitive theory of depression. Keywords: depression, cognition, acute phase cognitive therapy, continuation phase cognitive therapy

Objective. To examine the role of self-reported depressive symptoms in predicting hospitalization for complications of diabetes mellitus over a period of up to 2 years. Study Design. Two hundred thirty-one adolescent outpatients (age range: 11-18 years) with type 1 diabetes completed the Center for Epidemiological Studies Depression Scale, a self-report measure of depressive symptoms. Glycosylated hemoglobin levels were also assessed, to account for this known predictor of hospitalization. With survival analysis methods, hospitalizations for medical complications that occurred up to 2 years after this assessment were recorded. Results. After controlling for age, gender, socioeconomic status, and glycosylated hemoglobin levels at baseline, the odds ratio for prediction offered by Center for Epidemiological Studies Depression Scale scores above the cutoff point (12 for boys and 22 for girls) was 2.58 (95% confidence interval: 1.12-5.98). Conclusions. Young people with type 1 diabetes who show high levels of depressive symptoms are at increased risk for hospitalization for disease complications. Interventions aimed at improving their depressive symptoms may result in positive health outcomes, as well as improved quality of life. depression, type 1 diabetes mellitus, hospitalization, adolescent., ABBREVIATIONS. MDD, major depressive disorder; CES-D, Center for Epidemiological Studies Depression Scale; [HbA.sub.1c], hemoglobin [A.sub.1c]. Depressive disorders occur at high rates among individuals with diabetes mellitus, (1) with controlled studies [...]

Objective: To test the hypothesis that there is increased low-frequency activity located predominantly in the frontal lobe in patients with major depressive disorder using magnetoencephalography. Methods: We carried out an [...]