The Road to Recovery from Depression – Don’t Drive Today with Yesterday’s Map

120

Background: We have recently developed the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ), a brief scale to measure cognitive and executive dysfunction in mood and anxiety disorders, and we here report on its reliability and validity. Methods: The internal consistency of the CPFQ was assessed by computing Cronbach’s coefficient α based upon the average intercorrelation of the 7 items of the CPFQ in a sample of depressed outpatients and by factor analyzing data from the same sample to confirm that the scale is unifactorial and measuring a single construct. Test-retest reliability of the CPFQ was assessed in a different sample of depressed outpatients by computing Pearson’s correlation coefficient between pretreatment screening scores and pretreatment baseline scores. Sensitivity to change of the CPFQ was assessed by computing the dependent t test for the subjects in the active treatment condition in the second sample of depressed outpatients. Finally, convergent validity for the CPFQ was assessed in two different ways. Results: We found that the CPFQ is a unifactorial scale, with strong internal consistency. It has good temporal stability as indicated by high test-retest reliability. The CPFQ was also found to be sensitive to change with treatment and displayed convergent validity by significant correlations with other measures of sleepiness, fatigue, apathy and neuropsychological functioning. Although, as expected, the CPFQ was significantly correlated with a measure of depression, the moderate correlation (r ∼ 0.30) indicates that the CPFQ is measuring a different construct. Conclusion: In summary, the CPFQ is a unifactorial scale, with strong internal consistency, good temporal stability and sensitivity to change with treatment. Further studies will be needed to assess the validity and reliability of this instrument in other psychiatric and neuropsychiatric conditions associated with cognitive dysfunction.

Section: Discussionmentioning

confidence: 99%

Reliability and Validity of the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire

Fava¹,

Iosifescu²,

Pedrelli³

et al. 2009

120

“…There is a dearth of these randomized controlled trials in recurrently depressed patients. Results of such studies may help prevent recurrence in this high-risk group by tailoring treatments to specific patient characteristics [52]. …”

Section: Discussionmentioning

confidence: 99%

Continuation and Maintenance Use of Antidepressants in Recurrent Depression

Bockting

Doesschate

Spijker

et al. 2007

108

Background: Maintenance antidepressant (AD) medication is the most commonly used preventive strategy in a highly recurrent disease, i.e. depression. Little is known about the discontinuation of maintenance AD use and the association with recurrence in daily clinical practice. The purpose was to examine the discontinuation rate of maintenance AD in daily clinical practice in recurrently depressed patients and the associated risk of recurrence. Methods: Prospectively AD maintenance medication and recurrence were examined in 172 euthymic patients with recurrent depression. AD user profiles before recurrence (nonusers, intermittent users, continuous users) were examined and related to recurrence over a 2-year follow-up period. Results: Less than half of the patients (42%) used AD continuously. Taking into account the minimal required adequate used dosage (≧20 mg fluoxetine equivalent), only 26% of the patients used AD as recommended by international guidelines. Despite continuous use of AD, 60.4% relapsed in 2 years. This relapse rate was comparable to the rate of the intermittent users (63.6%). In patients who stopped taking AD after remission and who received additional preventive CT, the recurrence rates were significantly lower than in non-AD-using patients treated with usual care (8 vs. 46%). Conclusions: The majority of recurrently depressed patients treated with AD discontinue maintenance AD therapy in daily primary and secondary clinical practice. AD seems to offer poor protection against relapse in this patient group. Patients who stopped using AD experienced less relapse, especially if they were treated with preventive CT. Alternative maintenance treatments (including preventive cognitive therapy after discontinuation of AD) should be studied in recurrently depressed patients with intermittent good remission, not only in secondary but also in primary care.

“…It is important to note that in spite of the extensive treatment, the response and remissions rates were quite modest at follow-up. This may partly reflect the difficulties in achieving recovery for this particular group of recurrently depressed patients with high psychiatric comorbidity, and the importance of developing alternate or sequential forms of treatments [6, 45, 46]. The limited treatment response, however, could also be due to the relatively brief family intervention (7 sessions), and it is possible that a longer treatment might have led to greater improvements.…”

Section: Discussionmentioning

confidence: 99%

“…Major depression is a highly prevalent, often recurring and persistent disorder [1,2,3,4,5,6]. One of the factors that has consistently been linked with its course and treatment response is the patient’s family environment [7].…”

Section: Introductionmentioning

confidence: 99%

The Effects on Mood of Adjunctive Single-Family and Multi-Family Group Therapy in the Treatment of Hospitalized Patients with Major Depression

Lemmens

Eisler

Buysse

et al. 2009

Background: Family-based interventions have been shown to be effective in the treatment of depression, but they have seldom been studied in hospitalized depressed patients. This study assesses the value of the additional use of single-family or multi-family group therapy within this patient population. Methods: Eighty-three patients were randomly assigned to: (1) the treatment programme as usual (n = 23), (2) treatment as usual combined with single-family therapy (n = 25) or (3) treatment as usual combined with multi-family group therapy (n = 35). Follow-up assessments were made at 3 months and 15 months. Results: Multi-family group and single-family therapy conditions showed significantly higher rates of treatment responders than the group receiving the usual treatment (49, 24 and 9%, respectively), and higher rates of patients no longer using antidepressant medication (26, 16 and 0%, respectively) at 15 months. Partners taking part in the family treatments were significantly more likely to notice the improvements in the emotional health of the patient early on compared to those in the treatment as usual condition. Conclusions: This study suggests that single-family and multi-family therapy may benefit hospitalized patients with major depression, and may help the partners of the patients to become aware of the patient’s improvement more quickly.