A 10-year prospective-longitudinal study of daily hassles and incident psychopathology among adolescents and young adults: interactions with gender, perceived coping efficacy, and negative life events.

Soc Psychiatry Psychiatr Epidemiol. 2017 Sep 09;:

Authors: Asselmann E, Wittchen HU, Lieb R, Beesdo-Baum K

Abstract
PURPOSE: To prospectively examine whether higher daily hassles predict a variety of incident mental disorders and respective associations vary by gender, age, perceived coping efficacy and number of negative life events.
METHODS: Data comes from the Early Developmental Stages of Psychopathology Study (EDSP), a prospective-longitudinal study among adolescents and young adults from the community (n = 2797, aged 14-24 at baseline) followed up in up to 3 assessment waves over 10 years. Mental disorders were assessed at each wave using the DSM-IV/M-CIDI. Daily hassles, perceived coping efficacy, and negative life events were assessed at baseline using the Daily Hassles Scale, Scale for Self-Control and Coping Skills, and Munich Life Event List.
RESULTS: In logistic regressions adjusted for gender, age, other mental disorders, perceived coping efficacy and number of negative life events at baseline, higher daily hassles at baseline predicted the incidence of any anxiety disorder, specific phobia, obsessive-compulsive disorder, any affective disorder, and major depressive episodes at follow-up (OR 1.2-1.9 per standard deviation). Daily hassles interacted with perceived coping efficacy at baseline in predicting incident panic attacks (OR 1.3) and panic disorder (OR 1.3) at follow-up, i.e., higher daily hassles only predicted incident panic pathology among individuals with low perceived coping efficacy (OR 1.6-2.0) but not high perceived coping efficacy. Moreover, the associations between daily hassles and incident mental disorders partially varied by gender and age but not by negative life events at baseline.
CONCLUSIONS: Targeted stress management interventions among individuals with increased daily hassles might be useful to prevent the onset of anxiety and affective disorders.

PMID: 28889251 [PubMed – as supplied by publisher]

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Treatment of Depression: A Systematic Review

Book. 2004 03

Authors: Swedish Council on Health Technology Assessment

Abstract
Conclusions: Treatment of depression should aim at full recovery, i.e., that the patient is not only symptom free but also able to fully function socially and at work. That objective can be achieved for the great majority of patients if available treatment options are consistently exploited (strong scientific evidence). There are a large number of antidepressants and several types of psychotherapy that have been shown to be effective for treating major depression in adults (strong scientific evidence). For the acute treatment of mild or moderate depression in adults, several types of psychotherapy are as effective as tricyclic antidepressants (TCAs) (strong scientific evidence) and probably as effective as selective serotonin reuptake inhibitors (SSRIs) (moderately strong scientific evidence). Antidepressants and electroconvulsive therapy (ECT) have proven to be most effective for severe depression, such as melancholia and psychotic depression (moderately strong scientific evidence). Antidepressants and ECT produce more rapid results than psychotherapy (moderately strong scientific evidence). Maintenance psychotherapy reduces or delays relapses, particularly in cases where acute antidepressant treatment or psychotherapy has not rendered the patient symptom free (strong scientific evidence). No significant differences have emerged in the effectiveness of various antidepressants for the treatment of mild and moderate depression (strong scientific evidence). Due to either side effects or lack of effectiveness, initial antidepressant treatment produces unsatisfactory results in an average of one third of the patients (strong scientific evidence). Once antidepressant treatment has resulted in remission, there is a high risk of relapse unless the same dosage is prescribed for at least another 6 months (strong scientific evidence). Extension of the treatment to 1 year further reduces the risk of relapse. Prophylactic antidepressant treatment for as long as 3 years reduces the risk of recurrence by 50 percent in patients who suffer frequent or particularly severe depressive episodes (strong scientific evidence). Sudden discontinuation of treatment with SSRIs, or TCAs that affect serotonin uptake, can cause severe withdrawal symptoms (moderately strong scientific evidence). But these symptoms do not indicate dependence, given that its classic signs – such as a significant dosage increase, preoccupation with tablet intake, or neglect of work, friends and normal interests – are absent. Antidepressants are more effective than psychotherapy for the treatment of chronic low-grade depression (dysthymia) (strong scientific evidence). ECT is safe and effective, both more rapid and more effective than antidepressant treatment (strong scientific evidence). But there is a high probability of relapse, and only limited knowledge is available about which antidepressants are effective in preventing relapse (moderately strong scientific evidence). Transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS) are experimental treatments that lack sufficient scientific basis for use in routine medical care. Light therapy has not been shown to be significantly more effective than placebos for treating seasonal affective disorder. St. John’s Wort (Hypericum perforatum) has been shown to be effective for short-term and mild depression (moderately strong scientific evidence), but its effectiveness in long-term treatment has not been studied. The preparation increases the metabolism of many common medications (including cholesterol lowering drugs, anticoagulants, oral contraceptives and immunosupressive drugs following organ transplants), as a result of which their effectiveness may be reduced or eliminated. Primary care studies in several countries produced better results than routine medical care when the provider offered patient instruction, telephone support and computerized reminders about treatment protocols, as well as ready access to psychiatrists and psychologists trained in short-term psychotherapy (strong scientific evidence). One antidepressant, (fluoxetine), has been shown to be effective for short-term treatment of depression in children and adolescents (moderately strong scientific evidence). No antidepressant has been approved in Sweden for treating that age group. Controlled long-term trials are completely lacking, though the risk of relapse after short-term treatment is just as high as in adults. There is moderate scientific support for treating depression in children and adolescents with cognitive behavioral therapy and interpersonal psychotherapy (moderately strong scientific evidence), but the long-term effectiveness is insufficiently documented. The effectiveness of antidepressant treatment and psychotherapy in the elderly up to the age of 75 is well documented (strong scientific evidence), but there are no studies of people over 80. Research on effective treatments for bipolar disorder has been very limited, and the results of the numerous trials now under way are not expected for several years. Lithium has been proven to be the most effective drug for the acute treatment of both manic and depressive episodes, as well as for preventive treatment (strong scientific evidence). Several new antipsychotic drugs have also been proven to be effective with acute manic episodes (strong scientific evidence), but there is only moderately strong scientific evidence for their preventive effect (moderately strong scientific evidence). Although some drugs originally developed to treat epilepsy are effective with both mania and depression (strong scientific evidence), only lamotrigine has been shown to have a preventive effect, primarily against depressive episodes (strong scientific evidence). There are several key areas in which research provides no basis for choosing a particular treatment. Studies are totally lacking when it comes to treating depression in people over 80. There are no studies of antidepressant treatment in children and adolescents that have lasted longer than 10 weeks, and documentation of the long-term effectiveness of psychotherapy in these age groups is very limited.

PMID: 28876724

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Authors: Gonzalez C
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Clinical outcomes of psychotherapy dropouts: does dropping out of psychotherapy necessarily mean failure?

Rev Bras Psiquiatr. 2017 Aug 30;:0

Authors: Lopes RT, Gonçalves MM, Sinai D, Machado PP

Abstract
Objective:: A large proportion of psychotherapy patients remain untreated, mostly because they drop out. This study compares the short- and long-term outcomes of patients who dropped out of psychotherapy to those of therapy completers.
Methods:: The sample included 63 patients (23 dropouts and 40 completers) from a controlled clinical trial, which compared narrative therapy vs. cognitive-behavioral therapy for major depressive disorder. Patients were assessed at the eighth session, post-treatment, and at 31-month follow-up.
Results:: Dropouts improved less than completers by the last session attended, but continued to improve significantly more than completers during the follow-up period. Some dropout patients improved with a small dose of therapy (17% achieved a clinically significant change before abandoning treatment), while others only achieved clinically significant change after a longer period (62% at 31-month follow-up).
Conclusion:: These results emphasize the importance of dealing effectively with patients at risk of dropping out of therapy.Patients who dropped out also reported improvement of depressive symptoms without therapy, but took much longer to improve than did patients who completed therapy. This might be attributable to natural remission of depression. Further research should use a larger patient database, ideally gathered by meta-analysis.

PMID: 28876379 [PubMed – as supplied by publisher]

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Modulation of defensive reactivity by GLRB allelic variation: converging evidence from an intermediate phenotype approach.

Transl Psychiatry. 2017 Sep 05;7(9):e1227

Authors: Lueken U, Kuhn M, Yang Y, Straube B, Kircher T, Wittchen HU, Pfleiderer B, Arolt V, Wittmann A, Ströhle A, Weber H, Reif A, Domschke K, Deckert J, Lonsdorf TB

Abstract
Representing a phylogenetically old and very basic mechanism of inhibitory neurotransmission, glycine receptors have been implicated in the modulation of behavioral components underlying defensive responding toward threat. As one of the first findings being confirmed by genome-wide association studies for the phenotype of panic disorder and agoraphobia, allelic variation in a gene coding for the glycine receptor beta subunit (GLRB) has recently been associated with increased neural fear network activation and enhanced acoustic startle reflexes. On the basis of two independent healthy control samples, we here aimed to further explore the functional significance of the GLRB genotype (rs7688285) by employing an intermediate phenotype approach. We focused on the phenotype of defensive system reactivity across the levels of brain function, structure, and physiology. Converging evidence across both samples was found for increased neurofunctional activation in the (anterior) insular cortex in GLRB risk allele carriers and altered fear conditioning as a function of genotype. The robustness of GLRB effects is demonstrated by consistent findings across different experimental fear conditioning paradigms and recording sites. Altogether, findings provide translational evidence for glycine neurotransmission as a modulator of the brain’s evolutionary old dynamic defensive system and provide further support for a strong, biologically plausible candidate intermediate phenotype of defensive reactivity. As such, glycine-dependent neurotransmission may open up new avenues for mechanistic research on the etiopathogenesis of fear and anxiety disorders.

PMID: 28872638 [PubMed – in process]

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Epigenetics at the crossroads between genes, environment and resilience in anxiety disorders.
Genes Brain Behav. 2017 Sep 05;:
Authors: Schiele MA, Domschke K
Abstract
The pathogene…

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Effect of short-term heart rate variability biofeedback on long-term abstinence in alcohol dependent patients – a one-year follow-up.

BMC Psychiatry. 2017 Sep 06;17(1):325

Authors: Penzlin AI, Barlinn K, Illigens BM, Weidner K, Siepmann M, Siepmann T

Abstract
BACKGROUND: A randomized controlled study (RCT) recently showed that short-term heart rate variability (HRV) biofeedback in addition to standard rehabilitation care for alcohol dependence can reduce craving, anxiety and improve cardiovascular autonomic function. In this one-year follow-up study we aimed to explore whether completion of 2-week HRV-Biofeedback training is associated with long-term abstinence. Furthermore, we sought to identify potential predictors of post-treatment abstinence.
METHODS: We conducted a survey on abstinence in patients with alcohol dependence 1 year after completion of an RCT comparing HRV-biofeedback in addition to inpatient rehabilitation treatment alone (controls). Abstinence rates were compared and analysed for association with demographic data as well as psychometric and autonomic cardiac assessment before and after completion of the biofeedback training using bivariate and multivariate regression analyses.
RESULTS: Out of 48 patients who participated in the RCT, 27 patients (9 females, ages 42.9 ± 8.6, mean ± SD) completed our one-year follow-up. When including in the analysis only patients who completed follow-up, the rate of abstinence tended to be higher in patients who underwent HRV-biofeedback 1 year earlier compared to those who received rehabilitative treatment alone (66.7% vs 50%, p = ns). This non-significant trend was also observed in the intention-to-treat analysis where patients who did not participate in the follow-up were assumed to have relapsed (46,7% biofeedback vs. 33.3% controls, p = ns). Neither cardiac autonomic function nor psychometric variables were associated with abstinence 1 year after HRV-biofeedback.
CONCLUSION: Our follow-up study provide a first indication of possible increase in long-term abstinence after HRV-biofeedback for alcohol dependence in addition to rehabilitation.
TRIAL REGISTRATION: The original randomized controlled trial was registered in the German Clinical Trials Register ( DRKS00004618 ). This one-year follow-up survey has not been registered.

PMID: 28874146 [PubMed – in process]

Subclinical levels of anxiety but not depression are associated with planning performance in a large population-based sample.

Psychol Med. 2017 Sep 06;:1-7

Authors: Unterrainer JM, Domschke K, Rahm B, Wiltink J, Schulz A, Pfeiffer N, Lackner KJ, Münzel T, Wild PS, Beutel M

Abstract
BACKGROUND: Major depression and anxiety disorders are known to negatively influence cognitive performance. Moreover, there is evidence for greater cognitive decline in older adults with generalized anxiety disorder. Except for clinical studies, complex executive planning functions and subclinical levels of anxiety have not been examined in a population-based sample with a broad age range.
METHODS: Planning performance was assessed using the Tower of London task in a population-based sample of 4240 participants aged 40-80 years from the Gutenberg Health Study (GHS) and related to self-reported anxiety and depression by means of multiple linear regression analysis.
RESULTS: Higher anxiety ratings were associated with lower planning performance (β = -0.20; p < 0.0001) independent of age (β = 0.03; p = 0.47). When directly comparing the predictive value of depression and anxiety on cognition, only anxiety attained significance (β = -0.19; p = 0.0047), whereas depression did not (β = -0.01; p = 0.71).
CONCLUSIONS: Subclinical levels of anxiety but not of depression showed negative associations with cognitive functioning independent of age. Our results demonstrate that associations observed in clinical groups might differ from those in population-based samples, also with regard to the trajectory across the life span. Further studies are needed to uncover causal interrelations of anxiety and cognition, which have been proposed in the literature, in order to develop interventions aimed at reducing this negative affective state and to improve executive functioning.

PMID: 28874209 [PubMed – as supplied by publisher]