Matthias Backenstrass

Prevalence, onset and comorbidity of postpartum anxiety and depressive disorders

Objective:  The study presents data on the 3‐month prevalences of postpartum anxiety disorders (PAD) and postpartum depressive disorders (PDD) and their comorbidity in a German community sample. Associations with sociodemographic variables and previous history of psychopathology were analysed.

The German version of the Postpartum Bonding Instrument: Psychometric properties and association with postpartum depression

SummaryBackground: To date there has been no study investigating mother–infant bonding impairment and its link to pospartum depressive symptoms in a representative German population sample. The present study therefore aimed to carry out initial analyses of the psychometric properties of the German version of the Postpartum Bonding Questionnaire (PBQ). Methods: Eight hundred and sixty two mothers provided the data for a principal component analysis of the original 25 item PBQ. This analysis was used to assess the validity of the four scale structure of the questionnaire. Correlations between postpartum depression, sociodemographic variables and bonding impairment were additionally calculated. Findings: On the basis of our data, the original 4 factor structure of the PBQ scale was not confirmed. Nine items did not meaningfully load onto the single factor accounting for the most variance. Mother–infant bonding impairment and postpartum depression were shown to be significantly positively correlated. According to the factor solution of Brockington we found a 7.1% rate of mothers with bonding impairment two weeks postpartum (with 95% confidence ranging from 5.5 to 9%). Interpretation: An abridged 16 item German version of the PBQ can be implemented as a reliable screening instrument for bonding impairment.

Response inhibition in borderline personality disorder: performance in a Go/Nogo task.

Background: Borderline personality disorder is associated with subtle neuropsychological deficits. A potential impairment of response inhibition is of major interest, since it could be related to impulsivity as a clinical feature of borderline personality disorder. Sampling and Methods: Response inhibition was studied in an auditory Go/Nogo paradigm in a sample of 20 female inpatients with borderline personality disorder and 18 healthy controls. The main measures of interest were general task performance, errors and reaction times. Results: Patients with borderline personality disorder performed worse in the Nogo task but not in the Go task. In the Nogo task, when response inhibition was essential, patients made more errors of commission, revealing problems to inhibit a prepotent response. Additionally, the borderline group was characterized by significantly shorter reaction times in both tasks compared to the nonclinical control group. The results for errors of commission in the Nogo task remained significant even after controlling for reaction time. Conclusions: The present results suggest a double impairment on this response inhibition task. First, borderline personality disorder patients have inadequately fast reaction times and a speed-accuracy tradeoff. Second, they show a genuine deficit of response inhibition. These results are discussed in the context of the conflicting literature on response inhibition and executive control in borderline personality disorder.

Validity of Current Somatoform Disorder Diagnoses : Perspectives for Classification in DSM-V and ICD-11

Background: The impending revisions of DSM-IV and ICD-10 provide an excellent opportunity to improve the diagnostic accuracy of the current somatoform disorder classification. To prepare for these revisions, this study systematically investigates the validity of the current classification of somatoform disorders. Methods: We searched Medline, Psycinfo and reference lists to investigate convergent, divergent, criterion and predictive validity of the current somatoform disorder classification. Results: Substantial associations of somatoform disorders with functional impairment and elevated health care costs give evidence for the clinical and societal importance of somatoform disorders and for the convergent validity of the current operationalization. The specificity of the current somatoform disorder classification, i.e. their divergent validity, is demonstrated by the fact that functional somatic syndromes and their consequences are only partially explained by association with anxiety and depression. However, the imprecision of the diagnostic criteria, which are not based on positive criteria but on the exclusion of organic disease, largely limits the criterion validity of the current classification systems. Finally, studies investigating the predictive potential of somatoform disorders are lacking, and to date predictive validity has to be considered as low. Conclusions: The insufficient criterion and predictive validity of the present somatoform classification underlines the need to revise the diagnostic criteria. However, an abolishment of the whole category of somatoform disorders would ignore the substantial convergent and divergent validity of the current classification and would exclude patients with somatoform symptoms from the current health care system. A careful revision of the current somatoform disorder diagnoses, based on positive criteria of psychological, biological and social features, has the potential to substantially improve the reproducibility and clinical utility of the existing classification system.

Reconfirming the role of life events for the timing of depressive episodes: A two-year prospective follow-up study

BACKGROUND Since the 1960s the association of stressful life events and depression seemed to be firmly established. However, a few recent studies did not confirm those earlier findings. One of the reasons discussed for the inconsistencies was the sampling of milder depressed neurotic out-patients in the earlier studies vs. more severely ill endogenous type in-patients in recent studies. METHODS This investigation was carried out with 50 consecutively admitted in-patients with endogenous depression according to ICD 9 and unipolar major depression according to DSM-III-R as ascertained by SCID. The control sample consisted of 26 healthy volunteers. Life events and chronic distressing life conditions were recorded with the Munich Interview for the Assessment of Life Events and Conditions (MEL) every 3 months over a period of 2 years along with psychopathological symptoms and recurrencies. Hence the design was prospective in the sense that life events were recorded for one 3-month cross-section, the depressive reaction for the subsequent one. BDI scores taken at the respective cross section were used to control for depressive bias of the subjective part of the patients life event evaluation. RESULTS Three months prior to the index hospitalization patients were more often affected by life events and conditions than controls. The number of stressful conditions prior to the index hospitalization indicated the time to relapse after discharge. Controls showed more desirable positive conditions than patients. Relapse patients suffered more often stressful life events and conditions than non-relapsers 3 months prior to their relapse. Multivariate analysis indicates that the cumulative number of life events within the 2-year course is the best predictor of the BDI score at the end of the follow-up period. LIMITATIONS Since the subjective component of life event assessment by MEL displayed a higher impact on the course of depression than the objective part of the assessment, confounding of subjective ratings, attributional styles, and depressive symptoms may be a problem although controlled for in this study. CONCLUSION The results support the importance of stressful life events and chronic distressing conditions for the 2-year course and outcome of major depression in an in-patient sample. Since the overall consistency of significant results was more pronounced in the subjective than in the objective part of the MEL the results fit best a circular pathogenetic model of interactions between life events, their individual evaluation by the patient, and depressive symptoms.

Validation of a German Version of the Confusion Assessment Method for Delirium Detection in a Sample of Acute Geriatric Patients with a High Prevalence of Dementia

Objectives: To assess validity and interrater reliability of an operationalized German version of the Confusion Assessment Method (CAM) in geriatric patients with comorbid dementia and high delirium risk. Design: Prospective cross-sectional cohort study with double CAM assessment by a medical and nonmedical rater. Setting: Random sample of frail, cognitively impaired elderly with acute disease requiring hospital care. Participants: A total of 39 frail elderly, mean age 83 ± 7 years, 72% (n = 28) female, with cognitive impairments, a high prevalence of dementia (86%, n = 33) and a significant risk of delirium. Of these, 13 revealed delirium, which was superimposed on dementia in 11. Measurements: A translated and operationalized version of the CAM was validated against a neuropsychiatric and geriatric consensus reference standard based on DSM-IV. Additional measures included the Short Portable Mental Status Questionnaire, the Mini-Mental State Examination and the Delirium Index for cognitive impairment severity, the Informant Questionnaire on Cognitive Decline for dementia diagnosis and the Barthel Index, illness severity (Cumulative Illness Rating Scale) and medication. Results: Delirium was correctly detected by CAM algorithm in 10 out of 13 delirious patients resulting in a high sensitivity of 0.77 and a specificity of 0.96–1.00 for both raters. Likelihood ratio revealed an almost 20-fold risk of delirium with positive CAM testing. Interrater reliability was excellent with a Cohen’s ĸ of 0.95 (CI 0.74–1.0) for the algorithm, single items’ ĸ values varied between 0.5 and 1. Conclusions: The German CAM is a reliable and valid measure of delirium, even in frail, acutely diseased elderly with concomitant dementia.

Dimensions of the Typus melancholicus personality type.

AbstractThe Typus melancholicus personality type (TMP) is characterised by orderliness, conscientiousness and interpersonal dependence. Several standardised instruments have been developed for the assessment of the Typus melancholicus personality. To date there has been no systematic comparison of these instruments and in particular it has been unclear whether TMP represents a single trait or a personality trait constellation. The aim of this study was the comparison of four TMP questionnaires and the investigation of the dimensionality of the personality as revealed by these questionnaires. The factorial validity of four TMP questionnaires was examined based on a sample of n = 264 psychiatric inpatients and normal controls. In a factor analysis of the items of the TMP questionnaires, four dimensions could be differentiated: Dependence, Intolerance of Ambiguity, Norm–Orientation, and Perfectionism. Psychometric evaluation showed good values for the individual items and the new TMP scales. The four subscales had a differential correlation profile in relation to the dimensions of the five–factor model of personality. The TMP scales could distinguish a group of depressed patients from a group of normal controls. The results show that TMP personality is not a single trait but consists of four related but separate traits. These can be clearly distinguished from those of the five–factor model of personality. The analysis of the TM concept therefore also represents a theoretical perspective for the integration of the personality characteristics which are relevant for depression. Based on this analysis, we constructed a multidimensional TMP inventory which forms the basis for the investigation of the effect of TM personality on clinical outcome and on psychotherapeutic treatment.

Effect of Disorder-Specific vs Nonspecific Psychotherapy for Chronic Depression: A Randomized Clinical Trial

Importance Chronic depression is a highly prevalent and disabling disorder. There is a recognized need to assess the value of long-term disorder-specific psychotherapy. Objective To evaluate the efficacy of the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) compared with that of nonspecific supportive psychotherapy (SP). Design, Setting, and Participants A prospective, multicenter, evaluator-blinded, randomized clinical trial was conducted among adult outpatients with early-onset chronic depression who were not taking antidepressant medication. Patients were recruited between March 5, 2010, and October 16, 2012; the last patient finished treatment on October 14, 2013. Data analysis was conducted from March 5, 2014, to October 27, 2016. Interventions The treatment included 24 sessions of CBASP or SP for 20 weeks in the acute phase, followed by 8 continuation sessions during the next 28 weeks. Main Outcomes and Measures The primary outcome was symptom severity after 20 weeks (blinded observer ratings) as assessed by the 24-item Hamilton Rating Scale for Depression (HRSD-24). Secondary outcomes were rates of response (reduction in HRSD-24 score of ≥50% from baseline) and remission (HRSD-24 score ⩽8), as well as self-assessed ratings of depression, global functioning, and quality of life. Results Among 622 patients assessed for eligibility, 268 were randomized: 137 to CBASP (96 women [70.1%] and 41 men [29.9%]; mean [SD] age, 44.7 [12.1] years) and 131 to SP (81 women [61.8%] and 50 men [38.2%]; mean [SD] age, 45.2 [11.6] years). The mean (SD) baseline HRSD-24 scores of 27.15 (5.49) in the CBASP group and 27.05 (5.74) in the SP group improved to 17.19 (10.01) and 20.39 (9.65), respectively, after 20 weeks, with a significant adjusted mean difference of –2.51 (95% CI, –4.16 to –0.86; P = .003) and a Cohen d of 0.31 in favor of CBASP. After 48 weeks, the HRSD-24 mean (SD) scores were 14.00 (9.72) for CBASP and 16.49 (9.96) for SP, with an adjusted difference of –3.13 (95% CI, –5.01 to –1.25; P = .001) and a Cohen d of 0.39. Patients undergoing CBASP were more likely to reach response (48 of 124 [38.7%] vs 27 of 111 [24.3%]; adjusted odds ratio, 2.02; 95% CI, 1.09 to 3.73; P = .03) or remission (27 of 124 [21.8%] vs 14 of 111 [12.6%]; adjusted odds ratio, 3.55; 95% CI, 1.61 to 7.85; P = .002) after 20 weeks. Patients undergoing CBASP showed significant advantages in most other secondary outcomes. Conclusions and Relevance Highly structured specific psychotherapy was moderately more effective than nonspecific therapy in outpatients with early-onset chronic depression who were not taking antidepressant medication. Adding an extended phase to acute psychotherapy seems promising in this population. Trial Registration clinicaltrials.gov Identifier: NCT00970437.

„Expressed Emotion” (EE), Ehequalität und das Rückfallrisiko depressiver Patienten

ZusammenfassungDie Langzeitverläufe depressiver Erkrankungen scheinen in erheblichem Maße von der Qualität der ehelichen bzw. partnerschaftlichen Beziehung abhängig zu sein. Ziel der vorliegenden Studie ist die Überprüfung bereits früher mitgeteilter Befunde, nach denen sich ein in Partnerschaften depressiver Patienten gefundenes „Expressed-Emotion” (EE) auch im Bereich depressiver Störungen als rückfallbedeutsam erweist. Gleichzeitig sollen 2 weitere Befundgruppen früherer Studien erneut überprüft werden: a) die möglichen Zusammenhänge zwischen Partner-EE und Schwere der Depression sowie b) die Rückfallbedeutsamkeit der von Patienten erlebten Qualität ihrer ehelichen Beziehung. Zusammengefaßt lassen die dargestellten Analysen folgende Schlußfolgerungen zu: Mit dem von uns bestimmten Partner-EE lassen sich Rückfälle depressiver Patienten nicht voraussagen. Der EE-Index hängt nicht mit dem Symptomstatus der Patienten zusammen. Wie in 2 Vorläuferstudien lassen sich auch durch uns 2 spezifische Selbstratingmerkmale von Patienten erneut als rückfallprädiktiv validieren: die „Ehezufriedenheit” der Patienten und die von ihnen „wahrgenommene Kritik” durch den Partner. Zusätzlich erweist sich eine Diskrepanz beider Partner hinsichtlich der Einschätzung ihrer Ehezufriedenheit als rückfallprädiktiv. In der Diskussion wird auf die klinisch-praktische Bedeutung der Ergebnisse eingegangen.SummaryLong-term course of depression appears to be clearly correlated to marital quality and quality of the relationship with spouses. Aim of the present study is the replication of results, indicating that expressed emotion (EE) is an important factor in prediction of relapse in depression. Additionally, the correlation between EE shown by spouses and the severeness of depressive symptomatology as well as the importance of marital quality as seen by patients for relapse are investigated. Results of our study indicate that spouses EE does not predict relapse, and status of EE does not correlate with the extent of depressive symptoms. However, patient self ratings of satisfaction with marital relationship and of perceived criticism are related to relapse frequency. Additionally, discrepant ratings of marital satisfaction given by spouses predict relapse to some extent. Implications for research in affective disorders and clinical practice are discussed.

Reliabilität und Validität der deutschsprachigen Version der Generalized Expectancies for Negative Mood Regulation (NMR) Scale

Zusammenfassung. Generalisierten Erwartungen uber die Regulation negativer Stimmungen (im englischen Original: generalized expectancies for negative mood regulation; NMR) wird in Bezug auf die Affektregulation grose Bedeutung beigemessen. Catanzaro und Mearns (1990) hatten zur Messung dieser Erwartungen einen Fragebogen mit 30 Items konstruiert (NMR Scale). An mehreren Stichproben konnten sie die psychometrische Gute der NMR Scale bestatigen. Die vorliegende Studie untersuchte mit einer Stichprobe von N = 474 Personen die Reliabilitat und Validitat der deutschen Form der NMR Scale. Die Gesamtskala wies ein Cronbachs Alpha von .84 und eine Retest-Reliabilitat von .88 uber ein Zeitintervall von 4 Wochen auf. Eine explorative Faktorenanalyse legte eine eindimensionale Struktur des Itempools nahe. Bedeutsame Zusammenhange zum Geschlecht oder Alter der Probanden ergaben sich nicht. Die NMR Skala korrelierte signifikant mit Masen des affektiven und insbesondere depressiven Befindens (PANAS und BDI), was im Eink...