Six-year longitudinal course and outcomes of subtypes of depression

2016 ◽  
Vol 208 (1) ◽  
pp. 62-68 ◽  
Author(s):  
F. Lamers ◽  
A. T. F. Beekman ◽  
A. M. van Hemert ◽  
R. A. Schoevers ◽  
B. W. J. H. Penninx
Keyword(s):  
Latent Class ◽  
Clinical Course ◽  
Depression And Anxiety ◽  
Major Depressive ◽  
Longitudinal Course ◽  
Baseline Severity ◽  
Depressive Subtypes ◽  
Depression Subtypes ◽  
Over Time

BackgroundClinical and aetiological heterogeneity have impeded our understanding of depression.AimsTo evaluate differences in psychiatric and somatic course between people with depression subtypes that differed clinically (severity) and aetiologically (melancholic v. atypical).MethodData from baseline, 2-, 4- and 6-year follow-up of The Netherlands Study of Depression and Anxiety were used, and included 600 controls and 648 people with major depressive disorder (subtypes: severe melancholic n = 308; severe atypical n = 167; moderate n = 173, established using latent class analysis).ResultsThose with the moderate subtype had a significantly better psychiatric clinical course than the severe melancholic and atypical subtype groups. Suicidal thoughts and anxiety persisted longer in those with the melancholic subtype. The atypical subtype group continued to have the highest body mass index and highest prevalence of metabolic syndrome during follow-up, although differences between groups became less pronounced over time.ConclusionsCourse trajectories of depressive subtypes mostly ran parallel to each other, with baseline severity being the most important differentiator in course between groups.

Situational Depression: Validity of the Concept

1981 ◽  
Vol 139 (4) ◽  
pp. 297-305 ◽  
Author(s):  
Robert M. A. Hirschfeld
Keyword(s):  
Clinical Course ◽  
Psychosocial Stressors ◽  
Major Depressive ◽  
Recent Onset ◽  
Reactive Depression ◽  
Collaborative Program ◽  
Depressive Subtypes ◽  
Personality Features ◽  
Depressive Patients

SummaryThe validity of the concept of situational (i.e. reactive) depression as distinct from other major depressive subtypes is examined in terms of psychosocial stressors, personality features, current symptomatology, and clinical course and follow-up. Thirty-eight patients with a recent onset of situational major depressive disorder (i.e. the disorder developed after an event or in a situation the diagnostician deemed likely to have contributed to the episode at that time) were compared with 68 non-situational major depressive patients. These patients were participants in the clinical studies of the NIMH-Clinical Research Branch Collaborative Program on the Psychobiology of Depression. No significant differences between the two groups were found in the total number, content areas, or other categorizations of life events, experienced prior to onset. Some statistically significant differences in current symptomatology and in clinical course and follow-up measures were obtained, but there were none in personality traits. Implications of these results in relation to previously published reports are discussed and caution is recommended in the use of the term situational depression until more definitive data become available.

Stability and transitions of depressive subtypes over a 2-year follow-up

2012 ◽  
Vol 42 (10) ◽  
pp. 2083-2093 ◽  
Author(s):  
F. Lamers ◽  
D. Rhebergen ◽  
K. R. Merikangas ◽  
P. de Jonge ◽  
A. T. F. Beekman ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Overweight And Obesity ◽  
Depression And Anxiety ◽  
Major Depressive ◽  
Transition Analysis ◽  
Depressive Subtypes ◽  
The Stability ◽  
Time Point

BackgroundIdentifying depressive subtypes is an important tool in reducing the heterogeneity of major depressive disorder. However, few studies have examined the stability of putative subtypes of depression over time.MethodThe sample included 488 persons from the Netherlands Study of Depression and Anxiety (NESDA) who had major depressive disorder at baseline and at the 2-year follow-up assessment. A latent transition analysis (LTA) was applied to examine the stability of depressive subtypes across time-points. Differences in demographic, clinical, psychosocial and health correlates between subtypes were evaluated in a subsample of persons with stable subtypes.ResultsThree subtypes were identified at each time-point: a moderate subtype (prevalence T0 39%, T1 42%), a severe typical subtype (T0 30%, T1 25%), and a severe atypical subtype (T0 31%, T1 34%). The LTA showed 76% stability across the 2-year follow-up, with the greatest stability in the severe atypical class (79%). Analyses of correlates in the stable subtypes showed a predominance of women and more overweight and obesity in the severe atypical subtype, and a greater number of negative life events and higher neuroticism and functioning scores in the severe typical subtype.ConclusionsSubtypes of major depressive disorder were found to be stable across a 2-year follow-up and to have distinct determinants, supporting the notion that the identified subtypes are clinically meaningful.

scholarly journals Sleep symptoms and long-term outcome in adolescents with major depressive disorder: a naturalistic follow-up study

2019 ◽  
Vol 29 (5) ◽  
pp. 595-603 ◽  
Author(s):  
Anna S. Urrila ◽  
◽  
Olli Kiviruusu ◽  
Henna Haravuori ◽  
Linnea Karlsson ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Young Adulthood ◽  
Psychosocial Functioning ◽  
Anxiety Symptoms ◽  
Depression And Anxiety ◽  
Major Depressive ◽  
Term Outcome ◽  
Long Term Outcome

Abstract Sleep abnormalities in major depressive disorder (MDD) have been suggested to represent a vulnerability trait, which might predispose the individual to long-term psychiatric morbidity. In this study, we sought to assess whether the presence of sleep symptoms among adolescents with MDD is associated with poorer long-term outcome in young adulthood during naturalistic follow-up. Adolescent outpatients diagnosed with MDD (n = 166; age 13–19 years, 17.5% boys) were followed up during 8 years in naturalistic settings. N = 112 adolescents (16.1% boys) completed the 8-year assessment. Sleep symptoms and psychosocial functioning were assessed with structured clinical interviews, and depressive and anxiety symptoms with questionnaires. The severity of sleep symptoms at baseline was not associated with worse outcome at 8 years in terms of any of the outcome measures tested. In particular, the presence of a disturbed sleep–wake rhythm at baseline was associated with a more favourable outcome at 8 years: less depression and anxiety symptoms and higher level of psychosocial functioning. The presence of sleep symptoms in young adulthood was associated with the presence of current depression and anxiety symptoms and poorer psychosocial functioning. The presence of sleep symptoms at follow-up seems to be state-dependent: they are observed in conjunction with other psychiatric symptoms. Contrary to our hypothesis, our results suggest that sleep complaints among adolescents with MDD do not lead to poorer long-term clinical outcome in young adulthood. The link between sleep–wake rhythm disturbance and better long-term outcome needs to be confirmed and examined in detail in further studies, but here we speculate about possible explanations.

scholarly journals Disease activity flares and pain flares in an early rheumatoid arthritis inception cohort; characteristics, antecedents and sequelae

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Daniel F. McWilliams ◽  
Shimin Rahman ◽  
Richard J. E. James ◽  
Eamonn Ferguson ◽  
Patrick D. W. Kiely ◽  
...  
Keyword(s):  
Disease Activity ◽  
Latent Class ◽  
Clinical Course ◽  
Bodily Pain ◽  
Inception Cohort ◽  
Pain Mechanisms ◽  
Low Disease Activity ◽  
Persistent Disability ◽  
Underlying Inflammation

Abstract Background RA flares are common and disabling. They are described in terms of worsening inflammation but pain and inflammation are often discordant. To inform treatment decisions, we investigated whether inflammatory and pain flares are discrete entities. Methods People from the Early RA Network (ERAN) cohort were assessed annually up to 11 years after presentation (n = 719, 3703 person-years of follow up). Flare events were defined in 2 different ways that were analysed in parallel; DAS28 or Pain Flares. DAS28 Flares satisfied OMERACT flare criteria of increases in DAS28 since the previous assessment (≥1.2 points if active RA or ≥ 0.6 points if inactive RA). A ≥ 4.8-point worsening of SF36-Bodily Pain score defined Pain Flares. The first documented episode of each of DAS28 and Pain Flare in each person was analysed. Subgroups within DAS28 and Pain Flares were determined using Latent Class Analysis. Clinical course was compared between flare subgroups. Results DAS28 (45%) and Pain Flares (52%) were each common but usually discordant, with 60% of participants in DAS28 Flare not concurrently in Pain Flare, and 64% of those in Pain Flare not concurrently in DAS28 Flare. Three discrete DAS28 Flare subgroups were identified. One was characterised by increases in tender/swollen joint counts (14.4%), a second by increases in symptoms (13.1%), and a third displayed lower flare severity (72.5%). Two discrete Pain Flare subgroups were identified. One occurred following low disease activity and symptoms (88.6%), and the other occurred on the background of ongoing active disease and pain (11.4%). Despite the observed differences between DAS28 and Pain Flares, each was associated with increased disability which persisted beyond the flare episode. Conclusion Flares are both common and heterogeneous in people with RA. Furthermore our findings indicate that for some patients there is a discordance between inflammation and pain in flare events. This discrete flare subgroups might reflect different underlying inflammation and pain mechanisms. Treatments addressing different mechanisms might be required to reduce persistent disability after DAS28 and Pain Flares.

scholarly journals Longitudinal relationships between subjective fatigue, cognitive function, and everyday functioning in old age

2012 ◽  
Vol 25 (2) ◽  
pp. 275-285 ◽  
Author(s):  
Feng Lin ◽  
Ding-Geng Chen ◽  
David E. Vance ◽  
Karlene K. Ball ◽  
Mark Mapstone
Keyword(s):  
Older Adults ◽  
Cognitive Function ◽  
Latent Class ◽  
Growth Mixture Modeling ◽  
Community Dwelling ◽  
Everyday Functioning ◽  
Subjective Fatigue ◽  
Community Dwelling Older Adults ◽  
Over Time

ABSTRACTBackground: The present study examined the prospective relationships between subjective fatigue, cognitive function, and everyday functioning.Methods: A cohort study with secondary data analysis was conducted using data from 2,781 community-dwelling older adults without dementia who were enrolled to participate in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized intervention trial. Measures included demographic and health information at baseline, and annual assessments of subjective fatigue, cognitive function (i.e. speed of processing, memory, and reasoning), and everyday functioning (i.e. everyday speed and everyday problem-solving) over five years.Results: Four distinct classes of subjective fatigue were identified using growth mixture modeling: one group complaining fatigue “some of the time” at baseline but “most of the time” at five-year follow-up (increased fatigue), one complaining fatigue “a good bit of the time” constantly over time (persistent fatigue), one complaining fatigue “most of the time” at baseline but “some of the time” at five-year follow-up (decreased fatigue), and the fourth complaining fatigue “some of the time” constantly over time (persistent energy). All domains of cognitive function and everyday functioning declined significantly over five years; and the decline rates, but not the baseline levels, differed by the latent class of subjective fatigue. Except for the decreased fatigue class, there were different degrees of significant associations between the decline rates of subjective fatigue and all domains of cognitive function and everyday functioning in other classes of subjective fatigue.Conclusion: Future interventions should address subjective fatigue when managing cognitive and functional abilities in community-dwelling older adults.

Typology of clinical course in bipolar disorder based on 18-month naturalistic follow-up

2012 ◽  
Vol 43 (4) ◽  
pp. 789-799 ◽  
Author(s):  
R. Uher ◽  
O. Mantere ◽  
K. Suominen ◽  
E. Isometsä
Keyword(s):  
Bipolar Disorder ◽  
Latent Class ◽  
Clinical Course ◽  
Clinical Sample ◽  
Type I ◽  
Medium Term ◽  
Phase Switching ◽  
Therapeutic Implications ◽  
Co Morbidity

BackgroundIndividual variation in the clinical course of bipolar disorder may have prognostic and therapeutic implications but is poorly reflected in current classifications. We aimed to establish a typology of the individual clinical trajectories based on detailed prospective medium-term follow-up.MethodLatent class analysis (LCA) of nine characteristics of clinical course (time depressed, severity of depression, stability of depression, time manic, severity of mania, stability of mania, mixed symptoms, mania-to-depression and depression-to-mania phase switching) derived from life charts prospectively tracking the onsets and offsets of (hypo)manic, depressive, mixed and subsyndromal episodes in a representative sample of 176 patients with bipolar disorder.ResultsThe best-fitting model separated patients with bipolar disorder into large classes of episodic bipolar (47%) and depressive type (32%), moderately sized classes characterized by prolonged hypomanias (10%) and mixed episodes (5%) and five small classes with unusual course characteristics including mania-to-depression and depression-to-mania transitions and chronic mixed affective symptoms. This empirical typology is relatively independent of the distinction between bipolar disorder type I and type II. Lifetime co-morbidity of alcohol use disorders is characteristic of the episodic bipolar course type.ConclusionsThere is potential for a new typology of clinical course based on medium-term naturalistic follow-up of a representative clinical sample of patients with bipolar disorder. Predictive validity and stability over longer follow-up periods remain to be established.

The Clinical Course of Depression: Chronicity is the Rule Rather than the Exception

2017 ◽  
Vol 41 (S1) ◽  
pp. S144-S145 ◽  
Author(s):  
J. Verhoeven ◽  
J. Verduijn ◽  
Y. Milaneschi ◽  
A. Beekman ◽  
B. Penninx
Keyword(s):  
Recovery Rate ◽  
Multiple Time ◽  
Depression And Anxiety ◽  
Major Depressive ◽  
Chronic Disorder ◽  
Co Morbidity ◽  
Multiple Time Points ◽  
Chronic Course ◽  
Course Of Depression

IntroductionMajor depressive disorder (MDD) is often considered an episodic disorder. However, literature might underestimate the chronicity of MDD since results depend on follow-up duration and the extent to which psychiatric co-morbidity is taken into account.AimTo determine, whether MDD should be considered an episodic or chronic disorder.ObjectiveTo examine the 6 year course of MDD, incorporating data of multiple time points and taking common psychiatric comorbidities into account.MethodsData were from 903 patients with current MDD at baseline in the Netherlands study of depression and anxiety, with subsequent data from 2 year, 4 year and 6 year follow-up. Four course trajectories were created taking all information during follow-up into account classifying patients as (1) recovered, (2) recurrent without chronic episodes, (3) recurrent with chronic episodes or (4) consistently chronic. A chronic episode was defined as having symptoms consistently over 2 years.ResultsThe recovery rate of MDD was 58% at 2 year follow-up but looking at 6 year follow-up and taking into account co-morbid dysthymia, (hypo) mania and anxiety disorders reduced this recovery rate to 17%. Moreover, more than half of the patients experienced chronic episodes.ConclusionsLongitudinal data of this psychiatric cohort study showed that full recovery is the exception rather than the rule. MDD follows a chronic course and, moreover, persons are prone to switch to other psychiatric disorders.

Baló's disease showing benign clinical course and co-existence with multiple sclerosis-like lesions in Chinese

2008 ◽  
Vol 14 (3) ◽  
pp. 418-424 ◽  
Author(s):  
Chaodong Wang ◽  
Kun-Nan Zhang ◽  
Xiao-Mu Wu ◽  
Gang Huang ◽  
Xu-Fang Xie ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Clinical Features ◽  
Clinical Course ◽  
Demyelinating Disorder ◽  
Baló’S Concentric Sclerosis ◽  
Chinese Subjects ◽  
Over Time

Baló's concentric sclerosis (BCS) is a rare demyelinating disorder usually considered a variant of multiple sclerosis (MS). However, its pathogenesis and its correlation with MS remains unclear and controversial. This report presents seven Hans Chinese subjects diagnosed as BCS on the basis of the pathognomonic MR (magnetic resonance) findings. Upon diagnosis, all the cases displayed good responses to corticosteroids and showed an overall benign prognosis during a follow-up period of 4—13.5 years, although three relapsed later. MR findings suggest that the characteristic concentric lesions of BCS frequently (5/7) coexist with multiple sclerosis-like lesions. During follow-up, the Baló-like lesions may either dissolve over time or transform into an MS-like lesion. Moreover, the Balóand MS-like lesions occurred one after another at the onset and relapse phases of the same patient in two cases. These clinical features suggest that Baló's disease showing benign clinical course and co-existence of multiple sclerosis (MS)-like lesion is not rare among the Chinese, and strengthens the notion that BCS correlates intrinsically with MS. Multiple Sclerosis 2008; 14: 418—424. http://msj.sagepub.com

Duration and severity of depression predict mortality in older adults in the community

2002 ◽  
Vol 32 (4) ◽  
pp. 609-618 ◽  
Author(s):  
S. W. GEERLINGS ◽  
A. T. F. BEEKMAN ◽  
D. J. H. DEEG ◽  
J. W. R. TWISK ◽  
W. VAN TILBURG
Keyword(s):  
Clinical Course ◽  
Depression Scale ◽  
Epidemiologic Studies ◽  
Treatment Of Depression ◽  
Mortality Effect ◽  
Severity Of Depression ◽  
High Degree ◽  
Over Time ◽  
Course Of Depression

Background. The association between depression and mortality has become a topic of interest. Little is known about the association between the course of depression and mortality.Methods. In an initially non-depressed cohort (N = 325) and a depressed cohort (N = 327), depression was measured using the Center for Epidemiologic Studies Depression scale (CES-D) at eight successive waves over a period of 3 years. Both cohorts were then followed with respect to mortality status for up to 3·5 additional years. Clinical course types as well as theoretical course type parameters (basic symptom levels, increases in symptoms and instability over time) were distinguished to study the effect of the course of depression on mortality.Results. Contrary to transient states of depression, both chronic depression and chronic intermittent depression predicted mortality at follow-up. Additionally, evidence was found that the effect on mortality is related to severity of depression; high basic symptom levels and increases in symptoms over time were predictive of mortality. A high degree of instability over time was not associated with mortality.Conclusions. Since the mortality effect of depression is a function of both exposure time and symptom severity, more attention should be paid to the treatment of depression in order to prevent severe longstanding depression.

Frequency, Clinical Associations, and Longitudinal Course of Major Depressive Disorder in Adults With Cerebral Glioma

2011 ◽  
Vol 29 (32) ◽  
pp. 4307-4312 ◽  
Author(s):  
Alasdair G. Rooney ◽  
Shanne McNamara ◽  
Mairi Mackinnon ◽  
Mary Fraser ◽  
Roy Rampling ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Functional Impairment ◽  
Odds Ratio ◽  
Previous History ◽  
Cerebral Glioma ◽  
Major Depressive ◽  
Longitudinal Course ◽  
Clinical Associations

Purpose There is a need for high-quality evidence regarding the frequency, independent clinical associations, and longitudinal course of depression in patients with cerebral glioma. Patients and Methods This was a twin-center, prospective, observational cohort study with 6-month follow-up. Consenting adults with a new diagnosis of cerebral glioma received the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition to diagnose major depressive disorder (MDD). Interviews occurred shortly after the start of radiotherapy (T1), with follow-up interviews 3 months later (T2) and 6 months later (T3). Independent associations between MDD and clinical variables were analyzed using logistic regression. Results One hundred fifty-five patients participated. The frequency of MDD was 13.5% ± 5.4% at T1 (n = 155); 14.8% ± 6.7% at T2 (n = 108); and 6.8% ± 5.3% at T3 (n = 88). Overall, 32 individuals were diagnosed with MDD during the study period (20.6% ± 6.4%). Inter-rater diagnostic agreement for MDD was good (κ = 0.81; 95% CI, 0.60 to 1.00). Independent predictors of MDD were functional impairment (odds ratio, 3.9; 95% CI, 1.5 to 10.8) and a previous history of depression (odds ratio, 2.7; 95% CI, 0.99 to 7.3). MDD persisted for at least 3 months in half of the patients with adequate follow-up, but many depressed patients also dropped out of the study as a result of clinical deterioration. Conclusion In this longitudinal study, one in five patients with glioma developed clinical depression in the 6 months after starting radiotherapy. Patients with functional impairment or previous depression were at higher risk. MDD often persisted for at least 3 months. Clinicians should seek and treat depression in adults with glioma.

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