A clinically useful self-report measure of the DSM-5 mixed features specifier of major depressive disorder

BackgroundDraft DSM-5 criteria for a mixed major depressive episode have been proposed, but their predictive validity has not yet been established. We hypothesized that such symptoms would be associated with poorer antidepressant treatment outcomes.MethodWe examined outcomes among individuals with major depressive disorder participating in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, an effectiveness study conducted at primary and specialty care centers in the USA. Mixed features were derived from the six self-report items of the mania subscale of the Psychiatric Diagnosis Screening Questionnaire. Primary analyses examined the association between the presence of at least two of these in the 6 months before study entry, and remission across up to four sequential treatment trials, as well as adverse outcomes.ResultsOf the 2397 subjects with a major depressive episode of at least 6 months' duration, 449 (18.7%) reported at least two mixed symptoms. The presence of such symptoms was associated with a greater likelihood of remission across up to four sequential treatments, which persisted after adjustment for potential confounding clinical and demographic variables (adjusted hazard ratio 1.16, 95% confidence interval 1.03–1.28). Two individual items, expansive mood and cheerfulness, were strongly associated with a greater likelihood of remission.ConclusionsProposed DSM-5 mixed state features were associated with a greater rather than a lesser likelihood of remission. While unexpected, this result suggests the potential utility of further investigation of depressive mixed states in major depression.

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Measures of the DSM–5 mixed-features specifier of major depressive disorder

CNS Spectrums ◽

10.1017/s1092852916000857 ◽

2017 ◽

Vol 22 (2) ◽

pp. 196-202 ◽

Cited By ~ 4

Author(s):

Mark Zimmerman

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Antidepressant Medication ◽

Reliability And Validity ◽

Mixed States ◽

Major Depressive ◽

Manic Symptoms ◽

Dsm 5 ◽

Depressed Patients ◽

Mixed Features

During the past two decades, a number of studies have found that depressed patients frequently have manic symptoms intermixed with depressive symptoms. While the frequency of mixed syndromes are more common in bipolar than in unipolar depressives, mixed states are also common in patients with major depressive disorder. The admixture of symptoms may be evident when depressed patients present for treatment, or they may emerge during ongoing treatment. In some patients, treatment with antidepressant medication might precipitate the emergence of mixed states. It would therefore be useful to systematically inquire into the presence of manic/hypomanic symptoms in depressed patients. We can anticipate that increased attention will likely be given to mixed depression because of changes in the DSM–5. In the present article, I review instruments that have been utilized to assess the presence and severity of manic symptoms and therefore could be potentially used to identify the DSM–5 mixed-features specifier in depressed patients and to evaluate the course and outcome of treatment. In choosing which measure to use, clinicians and researchers should consider whether the measure assesses both depression and mania/hypomania, assesses all or only some of the DSM–5 criteria for the mixed-features specifier, or assesses manic/hypomanic symptoms that are not part of the DSM–5 definition. Feasibility, more so than reliability and validity, will likely determine whether these measures are incorporated into routine clinical practice.

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A Clinically Useful Self-Report Measure of theDSM-5Anxious Distress Specifier for Major Depressive Disorder

The Journal of Clinical Psychiatry ◽

10.4088/jcp.13m08961 ◽

2014 ◽

Vol 75 (06) ◽

pp. 601-607 ◽

Cited By ~ 28

Author(s):

Mark Zimmerman ◽

Iwona Chelminski ◽

Diane Young ◽

Kristy Dalrymple ◽

Emily Walsh ◽

...

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Self Report ◽

Major Depressive ◽

Report Measure

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Validating a two-dimensional bipolar spectrum model integrating DSM-5's mixed features specifier for Major Depressive Disorder

Comprehensive Psychiatry ◽

10.1016/j.comppsych.2017.06.007 ◽

2017 ◽

Vol 77 ◽

pp. 89-99 ◽

Cited By ~ 7

Author(s):

Panagiotis Ferentinos ◽

Konstantinos N. Fountoulakis ◽

Cathryn M. Lewis ◽

Evgenia Porichi ◽

Dimitris Dikeos ◽

...

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Two Dimensional ◽

Bipolar Spectrum ◽

Major Depressive ◽

Dsm 5 ◽

Mixed Features ◽

Spectrum Model

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The Mixed-Features Specifier of Major Depressive Disorder in DSM-5: Is It Practical?

Psychiatry Investigation ◽

10.30773/pi.2018.11.10 ◽

2018 ◽

Vol 15 (11) ◽

pp. 1009-1010 ◽

Cited By ~ 4

Author(s):

Young-Min Park

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Major Depressive ◽

Dsm 5 ◽

Mixed Features

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Lurasidone for the Treatment of Major Depressive Disorder With Mixed Features: Do Manic Symptoms Moderate Treatment Response?

10.26226/morressier.5885d719d462b8028d892953 ◽

2017 ◽

Author(s):

Andrei Pikalov

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Treatment Response ◽

Major Depressive ◽

Manic Symptoms ◽

Mixed Features

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Comparing Effectiveness of a Combined Herbal Drug Based on Echium Amoenum with Citalopram in the Treatment of Major Depressive Disorder

Current Drug Discovery Technologies ◽

10.2174/1570163815666180219115844 ◽

2019 ◽

Vol 16 (2) ◽

pp. 232-238 ◽

Cited By ~ 2

Author(s):

Majid Anushiravani ◽

Ali A. Manteghi ◽

Ali Taghipur ◽

Mahdi Eslami

Keyword(s):

Randomized Controlled Trial ◽

Major Depressive Disorder ◽

Depressive Disorder ◽

Controlled Trial ◽

Herbal Drug ◽

Medical Sciences ◽

Major Depressive ◽

Dsm 5 ◽

Randomized Controlled ◽

Echium Amoenum

Background: According to new studies, only 60% of depressed patients respond to pharmaceutical treatment while suffering from their side effects. Natural products as adjuvant or alternative therapies should be examined to find safer and more effective ways to cope with depression. Objective: To find out the potential benefits of a combined herbal drug based on Echium amoenum compared with citalopram in the treatment of Major Depressive Disorder. Design and Setting: In psychiatry clinics of Mashhad University of Medical Sciences, 50 patients who met the criteria for Major Depressive Disorder based on DSM-5 were studied in a parallel randomized controlled trial. Design and Setting: In psychiatry clinics of Mashhad University of Medical Sciences, 50 patients who met the criteria for Major Depressive Disorder based on DSM-5 were studied in a parallel randomized controlled trial. Intervention: Subjects were randomly assigned to receive Echium amoenum compound syrup (EACS) or citalopram tablet for 8 weeks. Outcome Measures: The efficacy of treatments and recurrence of disease were surveyed and compared according to Hamilton depression rating scale at weeks 0, 4, 8, 12. Results: Patients in both groups of citalopram and EACS showed remarkable reduction in scores of Hamilton questionnaire. At the eighth week of treatment, the mean scores in EACS group were significantly lower than citalopram group (p-value = 0.03). 52% of patients suffered from various complications in citalopram group while just 12% of patients in EACS group reported few complications. Conclusion: Clinical efficacy of this herbal drug was significantly higher than citalopram, and complications were also less and lower in EACS group. Further studies with larger groups and para-clinical assessments such as serologic tests and QEEG would improve our understanding of the impacts and mechanisms of EACS.

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The Symptom Structure of Postdisaster Major Depression: Convergence of Evidence from 11 Disaster Studies Using Consistent Methods

Behavioral Sciences ◽

10.3390/bs11010008 ◽

2021 ◽

Vol 11 (1) ◽

pp. 8

Author(s):

Carol S. North ◽

David Baron

Keyword(s):

Major Depressive Disorder ◽

Major Depression ◽

Depressive Disorder ◽

Diagnostic Assessment ◽

Self Report ◽

Depression Symptoms ◽

Symptom Scale ◽

Major Depressive ◽

Report Symptom ◽

Symptom Patterns

Agreement has not been achieved across symptom factor studies of major depressive disorder, and no studies have identified characteristic postdisaster depressive symptom structures. This study examined the symptom structure of major depression across two databases of 1181 survivors of 11 disasters studied using consistent research methods and full diagnostic assessment, addressing limitations of prior self-report symptom-scale studies. The sample included 808 directly-exposed survivors of 10 disasters assessed 1–6 months post disaster and 373 employees of 8 organizations affected by the September 11, 2001 terrorist attacks assessed nearly 3 years after the attacks. Consistent symptom patterns identifying postdisaster major depression were not found across the 2 databases, and database factor analyses suggested a cohesive grouping of depression symptoms. In conclusion, this study did not find symptom clusters identifying postdisaster major depression to guide the construction and validation of screeners for this disorder. A full diagnostic assessment for identification of postdisaster major depressive disorder remains necessary.

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