Treatment-Resistant Depression and Axis II Comorbidity

129

153

Psychometric theory is the basis for the development of assessment instruments in psychiatric research. However, the psychometric model appears to be largely inadequate in the clinical setting because of its lack of sensitivity to change and its quest for homogeneous components. Clinimetrics offers a viable alternative to psychometrics, both from a conceptual and a methodological viewpoint. Current diagnostic entities (DSM) are based on clinimetric principles, but their use is still influenced by psychometric models. Suggestions for switching gears in assessment research are offered.

Section: Assessment Of Changementioning

confidence: 99%

Psychometric Theory Is an Obstacle to the Progress of Clinical Research

Fava

Ruini

Rafanelli³

2004

129

153

“…There have also been reports of maladaptive personality traits improving with treatment of a comorbid major depressive episode [2, 16]. Interestingly, at least in one study, the presence of axis II disorders does not predispose subjects to resistance to treatment with antidepressants [17]. …”

Section: Introductionmentioning

confidence: 99%

Tridimensional Personality Questionnaire Factors in Major Depressive Disorder: Relationship to Anxiety Disorder Comorbidity and Age of Onset

Öngür¹,

Farabaugh²,

Iosifescu³

et al. 2005

Self Cite

Objective: We used the Tridimensional Personality Questionnaire (TPQ) to study the relationship between temperamental traits and comorbid anxiety disorders as well as age of onset of major depressive disorder (MDD) in 263 patients with MDD. Methods: Patients recruited for a large clinical study on MDD underwent a Structured Clinical Interview for DSM-III-R assessment and were administered the self-rated TPQ [mean age = 39.5 ± 10.5 years, women = 138 (53%), initial 17-item Hamilton Rating Scale for Depression (HAM-D-17) score = 19.6 ± 3.4]. The TPQ was scored for three previously identified factors – harm avoidance (HA), novelty seeking (NS), and reward dependence (RD). Multiple linear regression methods were used to evaluate the relationship between TPQ factors and each comorbid anxiety disorder as well as between early- vs. late-onset MDD, after controlling for age, gender and initial HAM-D-17 score (when these were related to the dependent variable in simple regressions). Results: Social anxiety disorder in MDD was strongly associated with higher scores on HA and lower scores on NS and RD (t = 5.4, p < 0.0001; t = 2.6, p = 0.009; t = 2.2, p = 0.028, respectively). A diagnosis of generalized anxiety disorder in MDD was significantly related to higher HA scores (t = 2.8, p = 0.006). The presence of comorbid obsessive-compulsive disorder was associated with lower NS scores (t = 2.3, p = 0.023) as was that of comorbid panic disorder (t = 2.0, p = 0.051). Finally, the presence of simple phobias was associated with lower scores on RD (t = 2.4, p = 0.016). HA scores were higher in patients with early onset of MDD (adjusted p = 0.05). Early versus late onset of MDD was not significantly related to NS or RD scores. Limitations: Since our sample consisted of moderately depressed outpatients, our ability to generalize our findings to other populations is limited. Conclusions: Features of temperament are related to patterns of anxiety disorder comorbidity and age of onset among patients with MDD. Higher levels of HA and lower levels of RD and NS were associated with an increased risk of anxiety disorder comorbidity in our sample. HA may also be related to early onset of depression.

“…In addition to being associated with more debilitating consequences, this comorbidity significantly complicates the identification and treatment of both problems [1, 3, 8, 13, 14, 15]. However, as most existing research has been retrospective or cross-sectional in design, very little is known about the specific nature of this relationship.…”

Section: Introductionmentioning

confidence: 99%

Do Somatic Complaints Predict Subsequent Symptoms of Depression?

Terre

Poston

Foreyt

et al. 2003

Background: Evidence suggests substantial comorbidity between symptoms of somatization and depression in clinical as well as nonclinical populations. However, as most existing research has been retrospective or cross-sectional in design, very little is known about the specific nature of this relationship. In particular, it is unclear whether somatic complaints may heighten the risk for the subsequent development of depressive symptoms. Methods: We report findings on the link between symptoms of somatization (assessed using the SCL-90-R) and depression 5 years later (assessed using the CES-D) in an initially healthy cohort of community adults, based on prospective data from the RENO Diet-Heart Study. Results: Gender-stratified multiple regression analyses revealed that baseline CES-D scores were the best predictors of subsequent depressive symptoms for men and women. Baseline scores on the SCL-90-R somatization subscale significantly predicted subsequent self-reported symptoms of depressed mood 5 years later, but only in women. However, somatic complaints were a somewhat less powerful predictor than income and age. Conclusions: Our findings suggest that somatic complaints may represent one, but not necessarily the most important, risk factor for the subsequent development of depressive symptoms in women in nonclinical populations. The results also highlight the importance of including social variables in studies on women’s depression as well as conducting additional research to further examine predictors of depressive symptoms in men.