Bálint Andó

The Edinburgh Postnatal Depression Scale: Translation and antepartum validation for a Hungarian sample

OBJECTIVE the Edinburgh Postnatal Depression Scale (EPDS) is an important screening instrument routinely used during the peripartum period for the identification of depression. The purpose of the study was to assess the validity of the 10-item EPDS in screening for antepartum depression (APD) in Hungary. DESIGN validation study carried out between July and December 2010. SETTING Department of Obstetrics and Gynecology, University of Szeged, Hungary. PARTICIPANTS 219 women attending a routine check-up at 12 weeks antepartum. INTERVENTIONS participants completed the newly translated Hungarian version of the EPDS and underwent a clinical assessment with the Structured Clinical Interview for DSM-IV disorders (SCID-I). MEASUREMENT AND FINDINGS seven (3.2%) of the mothers were diagnosed with major antepartum depression and 15 persons (6.85%) with minor depression on the basis of the SCID. Internal consistency of the EPDS was satisfactory (Cronbach α coefficients ≥0.728). The best cut-off on the Hungarian version of the EPDS for major depression was 8/9, with a sensitivity of 71.4%, and a specificity of 91.5%. The area under the ROC curve was found significant for combined depression as well and at a cut-off of 6/7 indicated a sensitivity of 81.8% and a specificity of 83.2%. KEY CONCLUSIONS the EPDS showed acceptable validity despite a considerable scatter in the total scores in our sample. IMPLICATION FOR PRACTICE the EPDS is a reliable instrument for the screening of depressive disorders, especially major depressive disorder in early pregnancy among Hungarian women.

Obstetric and psychosocial risk factors for depressive symptoms during pregnancy

We aimed to determine the psychosocial and obstetric correlates of depressive symptomatology during pregnancy in South-Eastern Hungary. A total of 1719 women were screened for depression in four counties in 2006 and 2007, based on a Leverton Questionnaire (LQ) score of ≥12 at 14-24 weeks of gestation. The LQ scores indicated a probable depressive illness (PDI) in 17.2% of the study group. The best predictors in a multiple regression analysis were history of major depression (adjusted odds ratio [AOR]=3.23), and major life events (AOR=2.43). A perceived lack of social support from partner (AOR=1.79) and lack of support by family (AOR=1.23) were also significant determinants. Lack of planning of pregnancy (AOR=1.12) and a history of unfavourable obstetric outcome (AOR=1.42) also seem to predispose to PDI. Overall, psychosocial factors appeared important in the prediction of PDI, whereas economic features did not.

Validation of the Edinburgh Postnatal Depression Scale as a screening tool for postpartum depression in a clinical sample in Hungary

BACKGROUND the purpose of the study was to assess the validity of the 10-item Edinburgh Postnatal Depression Scale (EPDS) in screening for postnatal depression (PND) in Hungary. METHODS between July 2010 and March 2011, a sample of 266 women attending a routine check-up at six weeks post partum completed the newly translated Hungarian version of the EPDS at the Department of Obstetrics and Gynecology, University of Szeged, Hungary, and underwent clinical assessments based on the Structured Clinical Interview for DSM-IV disorders (SCID-I). FINDINGS eight (3.0%) of the mothers were diagnosed with major postnatal depression, and 36 (13.5%) with minor depression on the basis of the SCID. Internal consistency of the Hungarian version of the EPDS was satisfactory (Cronbach α coefficients ≥0.727). The best cut-off for major depression was 12/13, with a sensitivity of 100.0%, and a specificity of 97.7%. The area under the ROC curve was found significant for combined (major+minor) depression as well and at a cut-off of 7/8 indicated a sensitivity of 72.7% and a specificity of 86.0%. A factor analysis suggested multidimensionality with two factors (anxiety and depression). CONCLUSIONS the EPDS showed good validity in the postnatal period in a clinical sample in Hungary.

The two-faceted nature of impulsivity in patients with borderline personality disorder and substance use disorder

BACKGROUND Impulsivity, which has been the subject of extensive debate in psychiatric research, is a clinically important concept, especially with respect to Borderline Personality Disorder (BPD) and Substance Use Disorders (SUD). The current study aims to examine the presence of two aspects of impulsivity (self-reported impulsivity and delay discounting) in patients with BPD, SUD (alcohol use=AUD or drug use=DUD) and the combination of both disorders (BPD+SUD). METHODS Patients were recruited from eight different mental health treatment service facilities. A total of 345 participants were assessed and divided into six groups: (1) healthy controls (non-BPD, non-SUD), (2) patients with BPD (non-SUD), (3) DUD (non-BPD), (4) AUD (non-BPD), (5) BPD+AUD and (6) BPD+DUD. RESULTS The behavioural measure of impulsivity is more conservative than the results of self-reported impulsivity. Furthermore, ANOVA indicated that BPD and SUD have significant effects on self-reported impulsivity, even when demographic variables, income, other psychiatric symptoms or depression are considered as covariates. On the other hand, the main effects of BPD and SUD are mediated by psychiatric symptoms and depression when delay discounting is considered as a dependent variable. CONCLUSIONS When self-reported, impulsivity is over-estimated as compared to reports based on behavioural measures. These results provide support for the notion that impulsivity is not a unitary construct, and that it instead has different manifestations in BPD and SUD patients.

Direct and Indirect Symptom Severity Indicators of Alcohol Dependence and the Personality Concept of the Biosocial Model

Temperament and character factors are strongly related to the developmental, clinical, and treatment aspects of alcohol dependence. This study had the aim of revealing the underlying personality structure and individual differences in the symptoms of alcohol dependence measured by multiple severity indicators. Patients with alcohol dependence exhibited higher levels of novelty seeking and harm avoidance, and lower levels of persistence, self-directedness, and cooperativeness. Especially novelty seeking was connected with more severe alcohol dependence. These characteristics could be useful targets of interventions and Temperament and Character Inventory is therefore a useful measurement to identify patients with more severe alcohol-related problems.

Decision making measured by the Iowa Gambling Task in alcohol use disorder and gambling disorder: a systematic review and meta-analysis

BACKGROUND AND AIMS Gambling disorder (GD) and alcohol use disorder (AD) have similar features, such as elevated impulsivity and decision-making deficits, which are directly linked to relapse and poor therapeutic outcomes. Our aim was to assess decision-making characteristics in GD and AD patients compared to healthy controls (HC) based on one of the most frequently used measures of decision-making: the Iowa Gambling Task (IGT). METHODS In our systematic literature search of three databases, we identified 1198 empirical articles that mentioned decision-making deficits with the use of the IGT in patients diagnosed with either AD or GD. Possible effects were calculated using meta-analysis. In the end, 17 studies (including 1360 participants) were suitable for inclusion in the meta-analysis reporting data for 23 group contrasts. RESULTS The random effects estimate indicated impaired IGT performance in both AD patients (N=500; d=-0.581, CI:-89.5<δ<-26.6%) and an even greater deficit in GD patients (N=292; d=-1.034, CI:-156.1<δ<50.7%) compared to HCs. Sampling variances were calculated for both AD (v1=0.0056) and GD groups (v2=0.0061), from which the z-score was calculated (z=-21.0785; p<0.05), which indicates a statistically significant difference between AD and GD groups. No significant moderating effects of age, gender or education were found. CONCLUSIONS There is enough evidence to support that decision-making deficit associated with addictive disorders, and that the deficit is more expressed in gambling disorder than in alcohol use disorder. Impaired decision-making plays an important part in poor therapeutic outcomes, thus provides a promising opportunity for cognitive intervention.

Cognitive Functioning of Depressed Patients with History of Suicidal Attempt

Introduction Major Depressive Disorder (MDD) is a complex disease characterized by cognitive dysfunctions. The subgroups of MDD show different cognitive profile. Aims The aim of this study to examine whether depressed suicide attempters show impaired executive functions. Objectives We hypothesised that patients from this subgroup have decision making, cognitive inhibition and verbal working memory deficits. Methods 17 depressed patients with history of suicide attempt and 13 healthy subjects completed the reward and punishment-related versions of a decision making task (Iowa Gambling Task, IGT), an irrelevant-respond inhibition task (Stroop Task), a respond inhibition task (Stop Task) and a measure of verbal working memory (Digit Span). Results Depressed patients showed impairment in the reward-related version of IGT (ABCD) and higher error-interference effect in the Stroop Task. There was a tendency toward higher reaction time-interference in Stroop Task and worse performance in Digit Span. Their performance did not differ from healthy controls in the punishment-related version of IGT (EFGH) and in the Stop Task. Conclusions Reward-related decision making, irrelevant-respond inhibition and verbal working memory dysfunctions were more frequently found among the patient group. They perform normally in the punishment-related version of IGT, while preliminary studies show that patients who attempt suicide within 72 hours perform poorly in this task. Further studies should examine whether punishment-related version can differentiate high-risk suicide attempters. Download full-size image

Spirituality mediates state anxiety but not trait anxiety and depression in alcohol recovery

Abstract Background and objectives: Twelve-step based interventions promote the recovery from alcohol dependence, support relapse prevention and are associated with improved mental status indices (e.g. depression). This treatment model largely relies on spiritual experience. We tested three different alcohol treatment settings, which differently involve elements of spirituality in order to reveal its possible mediator effect on the level of depressive and anxiety symptoms. Methods: Patients were involved from (1) detoxification (n = 34), (2) long-term – 12-step based – therapeutic community treatment (n = 89), (3) and from Alcoholics Anonymous (AA) groups after at least 3 years of attendance (n = 46). Anxiodepressive symptoms and spirituality/transcendence were compared and the potential mediator role of spirituality was assessed in the levels of depressive and anxiety symptoms. Results: Long-term 12-step based rehabilitation and sustained AA attendance was connected to lower levels of anxiodepressive symptoms and to more pronounced spirituality. The spiritual component of the different treatments played a mediator role in the decrease of state anxiety but this mediation was not detected in the case of depressive symptoms and trait anxiety. Conclusions/Importance: The role of spirituality in the decrease of state anxiety indicates acute beneficial effect. Therefore, long term, regular attendance in AA groups is essential.

The impact of intermediate-term alcohol abstinence on memory retrieval and suppression.

Background: The nature of episodic memory deficit in intermediate-term abstinence from alcohol in alcohol dependence (AD) is not yet clarified. Deficits in inhibitory control are commonly reported in substance use disorders. However, much less is known about cognitive control suppressing interference from memory. The Think/No-think (TNT) paradigm is a well established method to investigate inhibition of associative memory retrieval. Methods: Thirty-six unmedicated patients with AD and 36 healthy controls (HCs) performed the TNT task. Thirty image–word pairs were trained up to a predefined accuracy level. Cued recall was examined in three conditions: Think (T) for items instructed to-be-remembered, No-think (NT) assessing the ability to suppress retrieval and Baseline (B) for general relational memory. Premorbid IQ, clinical variables and impulsivity measures were quantified. Results: AD patients had a significantly increased demand for training. Baseline memory abilities and effect of practice on retrieval were not markedly different between the groups. We found a significant main effect of group (HC vs. AD) × condition (B, T, and NT) and a significant difference in mean NT–B scores for the two groups. Discussion: AD and HC groups did not differ essentially in their baseline memory abilities. Also, the instruction to focus on retrieval improved episodic memory performance in both groups. Crucially, control participants were able to suppress relational words in the NT condition supporting the critical effect of cognitive control processes over inhibition of retrieval. In contrast to this, the ability of AD patients to suppress retrieval was found to be impaired.

P01-408 - Investigation of the effects of emotional context and psychosocial stress on response inhibition

Introduction Response inhibition (RI) is a basic component of human behaviour responsible for suppressing actions or thoughts which are inappropriate in a certain context. This cognitive function is well-studied in laboratory conditions, but there is limited data how it is influenced by emotional context and psychosocial stress. Objectives The effect of emotional factors on RI can be investigated with an emotional go/nogo task, while psychosocial stress can be induced with the Trier Social Stress Test (TSST). Electroencephalography (EEG) is an excellent method for studying the neural correlates of RI: the two major event-related potentials (ERPs) implicated in the process are the frontal N2 and P3 components. Aims In this respect, our aim was to investigate how psychosocial stress and emotional context modulate these ERPs. Methods Seven healthy adult volunteers performed emotional go/no go tasks while brain responses were recorded by EEG. The task was carried out on two different occasions: at baseline condition and after moderate psychosocial stress induced by the TSST. Results We successfully replicated the robust go vs. nogo effect on the frontal N2 and P3 amplitudes. However, ERPs were not affected by positive or negative emotional context in the baseline condition. In contrast, after TSST a significantly enhanced valence effect was observed on the go-related N2 amplitude and a greater go vs. nogo N2 latency difference was detected. Conclusions These findings highlight the importance of the stress-regulating system on emotionally modulated RI and render this paradigm a promising tool for investigating RI in anxiety and mood disorders.