Marie Åsberg

A comprehensive psychopathological rating scale.

Very few rating scales have been constructed explicitly for the measurement of change in psychopathology despite the large number of scales available for the assessment of psychiatric illness. The introduction of new intervention techniques in psychiatry has created a need for instruments to evaluate and compare the efficacy of various treatments. Scales that were initially constructed for diagnostic and classificatory purposes have therefore been used to assess treatment effects although it is sometimes doubtful whether they are sensitive enough for that purpose. In 1971, an interdisciplinary group of 15 psychiatrists, psychologists and clinical pharmacologists was formed under the auspices of the Swedish Medical Research Council to study the problem of evaluating change in psychiatric disorders with treatment. An attempt was made to reach agreement on the standardization of measuring techniques. Inquiries were made to all psychiatric university departments in Scandinavia and to the companies producing psychotropic drugs. These revealed a large number of widely differing and overlapping rating scales in current use. None of the scales examined met the requirements of the group and it was felt that no single scale in use could be elaborated or refined sufficiently to adequately measure change over the range of psychiatric syndromes. It was therefore decided to construct a new scale covering psychopathological variables likely to be changed by treatment. Such a scale should be capable of being used either in full, to cover the range of psychopathology or used as a pool of items from which subscales could be drawn for particular psychiatric syndromes.

Markers for vulnerability to psychopathology: temperament traits associated with platelet MAO activity.

ABSTRACT: The functional linkage between platelet MAO activity and psychopathology was explored by analyzing temperamental correlates in 40 male subjects by means of scales from the Eysenck Personality Questionnaire (EPQ), the Zuckerman Sensation Seeking Inventory, and the Karolinska Scales of Personality (KSP). Linear correlations were found with two sensation seeking scales, replicating earlier findings. However, nonlinear correlations predominated. Subjects with intermediate platelet MAO activity had higher scores in conformity scales and lower scores in anxiety and hostility scales than low and high MAO subgroups. Low MAO subjects showed a pattern of higher scores in KSP Impulsiveness, EPQ Neuroticism, and KSP Somatic Anxiety and Irritability and lower scores in KSP Socialization, in line with personality profiles found in alcoholics, psychopaths, and suicide attempters who also tend to have low platelet MAO activity. High MAO subjects scored lower in sensation seeking and conformity scales and higher in KSP Psychasthenia, Muscular Tension and Suspicion scales, consistent with clinical links between high platelet MAO activity and anxiety and paranoia.

A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale.

Self‐assessment scales have long been used in psychiatric research even if their validity has often been questioned, one reason being poor the concordance of expert ratings. In clinical practice the use of rating scales is restricted, since they are considered to be time‐consuming and perhaps even to disrupt the clinicians rapport with the patient. In the present study, a self‐assessment scale, the CPRS Self‐rating Scale for Affective Syndromes (CPRS‐S‐A), was constructed by re‐phrasing in a self‐rating format 19 items from the original Comprehensive Psychopathological Rating Scale (CPRS) and covering depression, anxiety and obsessional symptoms. In a group of 30 patients with depression syndromes and anxiety syndromes, the CPRS‐S‐A and the original CPRS were both used on 2 occasions. The patients Global Assessment of Functioning scores ranged from 30 to 76 (mean 58), which suggests a moderate severity of illness, as does the fact that the majority were outpatients. There was a high degree of concordance between the instruments for most items and for the scores on the subscales for both diagnostic groups (i.e., the Montgomery‐Åsberg Depression Rating Scale and the Brief Anxiety Scale, which are both subscales drawn from the CPRS). The time taken to complete the CPRS‐S‐A varied from 5 to 30 min (mean 19 min for depressive and 16 min for anxiety patients on the first occasion, 13 min for both groups on the second), and the self‐rating procedure was readily accepted by both groups of patients. The CPRS‐S‐A would thus seem to be a promising instrument for quantitative rating of symptoms in ambulatory patients, both in clinical practice and in research.

Platelet MAO activity and monoamine metabolites in cerebrospinal fluid in depressed and suicidal patients and in healthy controls

Platelet monoamine oxidase (MAO) activity and cerebrospinal fluid (CSF) concentrations of 5-hydroxyindoleacetic acid (5HIAA), homovanillic acid (HVA), and 4-hydroxy-3-methoxyphenylglycol (HMPG) were simultaneously measured in 20 currently depressed patients, 11 recovered depressed patients, 15 nondepressed suicide attempters, and 42 healthy control subjects. Both 5HIAA and HVA were positively and significantly correlated to platelet MAO activity in the healthy subjects, but not in any of the patient groups. Suicide attempters had significantly lower CSF 5HIAA than nonsuicidal patients.

CSF monoamine metabolites in melancholia

ABSTRACT– The neurotransmitter metabolites 5‐hydroxyindoleacetic acid (5‐HIAA), homovanillic acid (HVA) and 4‐hydroxy‐3‐methoxy‐phenyl glycol (HMPG) in cerebrospinal fluid (CSF) were measured by mass fragmentography in 83 patients with melancholia (diagnosed by the Newcastle Inventory and the Research Diagnostic Criteria), and 66 healthy volunteer controls. After adjustment by analysis of covariance for differences between the subject groups in body height, age and sex distribution, significantly (P < 0.001) lower concentrations of 5‐HIAA and HVA were found in the melancholia patients than in the controls. HMPG did not differ between the groups. The differences could not be accounted for by differences in timing or examination techniques, and not by previously administered drugs (all patients were drug‐free at the examination, but a minority had taken small amounts of psychotropic drugs prior to the wash‐out period). The differences persisted after excluding the suicidal patients. There were no clear‐cut differences between unipolar and bipolar patients. It is suggested that the reduced concentrations of 5‐HIAA and HVA in the melancholic patients may be due to altered serotonin and/or dopamine functions in the central nervous system, which may be connected with an increased vulnerability to certain types of affective illness.

A comparison between the Beck Depression Inventory (BDI) and the self-rating version of the Montgomery Åsberg Depression Rating Scale (MADRS)

BACKGROUND The Beck Depression Inventory BDI is the most often used self-rating instrument for depressive symptoms. In the present study, the BDI was compared with a self-rating version of the Montgomery Asberg Depression Rating Scale (MADRS-S) in 86 psychiatric patients with mainly affective and anxiety disorders. METHODS The patients were interviewed with the SCID-I Interview for a DSM-IV Major depression, and self-assessed the BDI and the MADRS. They were rated to have either mild, moderate or severe depressive symptomatology. After recovery, criteria for DSM-IV Personality disorders were self-assessed. RESULTS The instruments were about equal in differentiating between different Axis-I diagnoses and did not differ according to sensitivity to change during antidepressive treatment. Although the scales were highly intercorrelated (r=0.869), the BDI was demonstrated to tap more maladaptive personality traits compared to the MADRS-S. LIMITATIONS Because the sample consisted of psychiatric patients with prominent psychiatric symptomatology, the discriminative power of the BDI and the MADRS-S should be further evaluated in a sample with milder symptoms. CONCLUSIONS The MADRS-S is equivalent to the BDI as a self-assessment instrument for depression, but the MADRS-S focuses on core depressive symptoms, and is less influenced by maladaptive personality traits.

Neurotransmitters and suicidal behavior. The evidence from cerebrospinal fluid studies.

ABSTRACT: Studies of neurotransmitter metabolites in cerebrospinal fluid (CSF) were initially focused on depressive illness. Although several studies have demonstrated low concentrations of the serotonin metabolite, 5‐hydroxyindoleacetic acid (5‐HIAA), and the dopamine metabolite, homovanillic acid (HVA), in depressed patients, these early studies may have been biased by concomitant administration of antidepressant drugs (which tend to lower CSF 5‐HIAA), amount of CSF drawn (there is a concentration gradient for both metabolites), and selection of control subjects. Once these methodological details are controlled for, the differences between depressed patients and controls are unimpressive.

Homicide, suicide and CSF 5‐HIAA

ABSTRACT– Concentrations of 5‐hydroxyindoleacetic acid (5‐HIAA), homovanillic acid (HVA), and 4‐hydroxy‐3‐methoxyphenyl glycol (HMPG) in lumbar spinal fluid were measured by mass fragmentography in 16 men convicted for criminal homicide, 22 men who had attempted suicide, and 39 healthy male control subjects. Those men who had killed a sexual partner, and those who had attempted suicide, had lower levels of the serotonin metabolite, 5‐HIAA in spinal fluid than the controls. It is suggested that low levels of 5‐HIAA in spinal fluid reflect a disorder of serotonin turnover, which makes the individual more prone to acts of violence in states of emotional turmoil.

Burnout and physical and mental health among Swedish healthcare workers

AIM This paper is a report of a study to investigate how burnout relates to self-reported physical and mental health, sleep disturbance, memory and lifestyle factors. BACKGROUND Previous research on the possible relationship between lifestyle factors and burnout has yielded somewhat inconsistent results. Most of the previous research on possible health implications of burnout has focused on its negative impact on mental health. Exhaustion appears to be the most obvious manifestation of burnout, which also correlates positively with workload and with other stress-related outcomes. METHOD A cross-sectional study was conducted, using questionnaires sent to all employees in a Swedish County Council (N = 6118) in 2002. The overall response rate was 65% (n = 3719). A linear discriminant analysis was used to look for different patterns of health indicators and lifestyle factors in four burnout groups (non-burnout, disengaged, exhausted and burnout). RESULTS Self-reported depression, anxiety, sleep disturbance, memory impairment and neck- and back pain most clearly discriminated burnout and exhausted groups from disengaged and non-burnout groups. Self-reported physical exercise and alcohol consumption played a minor role in discriminating between burnout and non-burnout groups, while physical exercise discriminated the exhausted from the disengaged group. CONCLUSION Employees with burnout had most symptoms, compared with those who experienced only exhaustion, disengagement from work or no burnout, and the result underlines the importance of actions taken to prevent and combat burnout.

Correlation of subjective side effects with plasma concentrations of nortriptyline.

Plasma levels of tricyclic antidepressant drugs vary considerably between individuals receiving the same amount of drug. The bearing of this variation on the occurrence of subjective side effects was investigated in 40 psychiatric inpatients with depressive disorders. Plasma levels were determined before and during four weeks of treatment with nortriptyline 50 mg. three times a day and patients were rated for subjective side effects, the assessors being unaware of the plasma levels of the drug. Plasma levels varied widely between individual patients, but in any given patient the plasma level tended to be constant over a period of time. The side effects of nortriptyline diminished significantly with time and were in most cases absent during the fourth week of treatment. There was a significant positive correlation between plasma level of nortriptyline and subjective side effects. The steady-state plasma level of a drug which is metabolized is usually a more important determinant for its effect than dosage, since it reflects the amount of drug available for biological action. Very high plasma levels of nortriptyline should presumably be avoided, since there is no evidence that they are needed for therapeutic effect and they are potentially harmful.