Jean Endicott

Major depressive disorder: a prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse.

BACKGROUND The study tested whether level of recovery from major depressive episodes (MDEs) predicts duration of recovery in unipolar major depressive disorder (MDD) patients. METHODS MDD patients seeking treatment at five academic centers were followed naturalistically for 10 years or longer. Patients were divided on the basis of intake MDE recovery into residual depressive symptoms (SSD; N=82) and asymptomatic (N=155) recovery groups. They were compared on time to first episode relapse/recurrence, antidepressant medication, and comorbid mental disorders. Recovery level was also compared to prior history of recurrent MDEs ( > 4 lifetime episodes) as a predictor of relapse/recurrence. RESULTS Residual SSD compared to asymptomatic recovery patients relapsed to their next MDE > 3 times faster (median=68 vs. 23 weeks) and to any depressive episode > 5 times faster (median=33 vs. 184 weeks). Residual SSD recovery status was significantly associated with early episode relapse (OR=3.65) and was stronger than history of recurrent MDEs (OR=1.64). Rapid relapse in the SSD group could not be attributed to higher comorbidity or lower antidepressant treatment. LIMITATIONS Although inter-rater agreement on weekly depressive symptom ratings was very high (ICC > 0.88), some error may exist in assigning recovery levels. Antidepressant treatments were recorded, but were not controlled. CONCLUSIONS MDE recovery is a powerful predictor of time to episode relapse/recurrence. Residual SSD recovery is associated with very rapid episode relapse which supports the idea that SSD is an active state of illness. Asymptomatic recovery is associated with prolonged delay in episode recurrence. These findings of this present study have important implications for the goals of treatment of MDD and for defining true MDE recovery.

The diversity of premenstrual changes as reflected in the Premenstrual Assessment Form

The Premenstrual Assessment Form (PAF) is a new self report procedure designed to measure changes in mood, behavior, and physical condition during the premenstrual period. It reflects the great variability of premenstrual syndromes as opposed to the common practice of viewing these changes as a single entity. In comparison to commonly used procedures, the PAF 1) contains a broader variety and more specific descriptions of positive as well as negative changes; 2) provides Unipolar Summary Scales and Bipolar Continua which are sensitive measures for indexing levels of severity on various types of change; and 3) provides specific criteria for Typological Categories descriptive of different syndromes of change, especially those of mood and behavior. The paper describes the development of the PAF and the three scoring Systems and illustrates the sensitivity of the individual items and scoring Systems in reflecting the great diversity of change manifested during the premenstrual period.

Diagnostic criteria for psychosis in Parkinson's disease: Report of an NINDS, NIMH work group

There are no standardized diagnostic criteria for psychosis associated with Parkinsons disease (PDPsy). As part of an NIH sponsored workshop, we reviewed the existing literature on PDPsy to provide criteria that distinguish PDPsy from other causes of psychosis. Based on these data, we propose provisional criteria for PDPsy in the style of the Diagnostic and Statistical Manual of Mental Disorders IV‐TR. PDPsy has a well‐characterized temporal and clinical profile of hallucinations and delusions, which is different than the pattern seen in other psychotic disorders such as substance induced psychosis or schizophrenia. PDPsy is associated with a poor prognosis of chronic psychosis, nursing home placement, and death. Medications used to treat Parkinsons disease (PD) contribute to PDPsy but may not be sufficient or necessary contributors to PDPsy. PDPsy is associated with Lewy bodies pathology, imbalances of monoaminergic neurotransmitters, and visuospatial processing deficits. These findings suggest that PDPsy may result from progression of the disease process underlying PD, rather than a comorbid psychiatric disorder or drug intoxication. PDPsy is not adequately described by existing criteria for psychotic disorders. We established provisional diagnostic criteria that define a constellation of clinical features not shared by other psychotic syndromes. The criteria are inclusive and contain descriptions of the full range of characteristic symptoms, chronology of onset, duration of symptoms, exclusionary diagnoses, and associated features such as dementia. These criteria require validation and may be refined, but form a starting point for studies of the epidemiology and pathophysiology of PDPsy, and are a potential indication for therapy development.

The epidemiology of perimenstrual psychological symptoms.

OBJECTIVE The purpose of this paper is to examine the prevalence, clinical significance and comorbidity of perimenstrual symptoms/syndrome (PERI-MS) in a community sample of women. METHOD Premenstrual and menstrual physical and psychological symptoms were assessed in a prospective longitudinal study of a representative community cohort of women (N=299) who were interviewed five times between the ages of 21 and 35 years. RESULTS When classified according to the severity of distress, the prevalence rates were 8.1% for severe and 13.6% for moderate PERI-MS, respectively. Clinical indicators of severity were all greater among PERI-MS women with than without depressed mood. CONCLUSION The results of this study suggest that irritability, nervousness and tension irrespective of the presence of concomitant depressed mood are core elements of the perimenstrual syndrome.

Bipolar II. Combine or keep separate

Data on prior course, characteristics of index episode, and familial aggregation of patients with bipolar II disorder is discussed. The data supports the separation of this condition from both bipolar I and recurrent unipolar disorder.

Daily Record of Severity of Problems (DRSP): reliability and validity

SummaryThe Daily Record of Severity of Problems (DRSP) form was developed to aid in the diagnosis and evaluation of DSM-IV Premenstrual Dysphoric Disorder (PMDD). The reliability and validity of the procedure was tested in two studies. Study A included 27 subjects who ranged from having few or no premenstrual problems to those who met criteria for PMDD. Study B included 243 subjects, all of whom met criteria for PMDD. Individual items and Summary Scores had high test–retest reliability in both studies. Internal consistency of Summary Scores was also high in both studies. Summary Scores had moderate to high correlations with other measures of severity of illness. In addition, items and Summary Scores have been shown to be sensitive to change and to treatment differences in Study B. The DRSP provides sensitive, reliable, and valid measures of the symptoms and impairment criteria for PMDD.

Bipolar I: a five-year prospective follow-up.

We explored the course of bipolar I illness in 172 probands who were followed up prospectively for up to 5 years. Probands were grouped into three categories based on whether the symptoms of the index episode were only depressed, only manic, or mixed/cycling. Data were available for recovery from the index episode, subsequent relapse, and rates of recovery from the first prospective episode. Pure manic probands had a significantly faster rate of recovery (median, 6 weeks) than the mixed/cycling probands (median, 17 weeks), and the pure depressive probands had an intermediate rate (median, 11 weeks). After 5 years of follow-up the mixed/cycling patients continue to have the lowest cumulative probability of recovery from the index episode. Mixed/cycling probands also had a substantially faster time to relapse after recovery from the index episode compared with pure manic patients. For those patients who relapsed, the mixed/cycling patients had the lowest cumulative probability of recovery from the first prospectively observed episode. The treatment received by these patients is described and there is a discussion of how this treatment may have influenced the findings on course and outcome.

Linkage analysis of psychosis in bipolar pedigrees suggests novel putative loci for bipolar disorder and shared susceptibility with schizophrenia

The low-to-moderate resolution of linkage analysis in complex traits has underscored the need to identify disease phenotypes with presumed genetic homogeneity. Bipolar disorder (BP) accompanied by psychosis (psychotic BP) may be one such phenotype. We previously reported a genome-wide screen in a large bipolar pedigree sample. In this follow-up study, we reclassified the disease phenotype based on the presence or absence of psychotic features and subgrouped pedigrees according to familial load of psychosis. Evidence for significant linkage to psychotic BP (genome-wide P<0.05) was obtained on chromosomes 9q31 (lod=3.55) and 8p21 (lod=3.46). Several other sites were supportive of linkage, including 5q33 (lod=1.78), 6q21 (lod=1.81), 8p12 (lod=2.06), 8q24 (lod=2.01), 13q32 (lod=1.96), 15q26 (lod=1.96), 17p12 (lod=2.42), 18q21 (lod=2.4), and 20q13 (lod=1.98). For most loci, the highest lod scores, including those with genome-wide significance (at 9q31 and 8p21), occurred in the subgroup of families with the largest concentration of psychotic individuals (≥3 in a family). Interestingly, all regions but six—5q33, 6q21, 8p21, 8q24, 13q32 and 18q21—appear to be novel; namely, they did not show notable linkage to BP in other genome scans, which did not employ psychosis for disease classification. Also of interest is possible overlap with schizophrenia, another major psychotic disorder: seven of the regions presumed linked in this study—5q, 6q, 8p, 13q, 15q, 17p, and 18q—are also implicated in schizophrenia, as are 2p13 and 10q26, which showed more modest support for linkage. Our results suggest that BP in conjunction with psychosis is a potentially useful phenotype that may: (1) expedite the detection of susceptibility loci for BP and (2) cast light on the genetic relationship between BP and schizophrenia.

Relationship of dysphoric premenstrual changes to depressive disorders

ABSTRACT An association between premenstrual dysphoric changes and depressive disorders is demonstrated in 170 women. Each woman underwent an evaluation for current and life‐time diagnosis using the Research Diagnostic Criteria (RDC). Premenstrual dysphoric changes were evaluated with the Premenstrual Assessment Form (PAF). Criteria for PAF Full Depressive Syndrome were met by 57 % of women with a life‐time diagnosis of Major Depressive Disorder. Only 14 % of the Never Mentally 111 women met these PAF criteria. Eighty‐four percent of those who had PAF Full Depressive Syndrome also had RDC Major Depressive Disorder while only 9 % were Never Mentally Ill.

The Range of Impaired Functioning Tool (LIFE–RIFT): a brief measure of functional impairment

BACKGROUND The literature documents that functional impairment is associated with affective disorders. Nevertheless, the choice among thorough, yet brief, well-validated assessments of functional impairment is limited. The objective of this study was to evaluate the psychometric properties of a brief scale of functional impairment, the Range of Impaired Functioning Tool (LIFE-RIFT). METHOD The study sample included subjects who presented with major depressive disorder at intake into the NIMH Collaborative Depression Study (CDS). The LIFE-RIFT is composed of items that are included in the Longitudinal Interval Follow-up Evaluation (LIFE). The reliability and validity were examined using data from LIFE-RIFT assessments conducted at four points in time: 6, 12, 18 and 24 months after intake into the CDS. RESULTS Cross-sectional one factor models accounted for the covariance structure among the four scale items. A longitudinal factor model, with an invariant factor structure over time, also fitted the data well and indicated that the scale items are measures of one construct, namely functional impairment. The internal consistency reliability of the scale was supported with alpha coefficients ranging from 0.81 to 0.83. The inter-rater reliability intraclass correlation coefficient (ICC) was 0.94. Mixed-effect linear regression models showed that those in episode were significantly more impaired than those in recovery. Furthermore, in analyses of predictive validity, impairment was positively associated with subsequent recurrence and negatively associated with subsequent recovery. CONCLUSIONS This psychometric evaluation provides empirical support for the reliability and validity of the LIFE-RIFT, a brief measure of functional impairment.