The Interdependence of Subtype and Severity: Contributions of Clinical and Neuropsychological Features to Melancholia and Non-melancholia in an Outpatient Sample

Published on Mar 1, 2012in Journal of The International Neuropsychological Society 2.78
· DOI :10.1017/S1355617711001858
Candice R Quinn7
Estimated H-index: 7
(University of Sydney),
Anthony Harris43
Estimated H-index: 43
(University of Sydney),
Andrew H. Kemp56
Estimated H-index: 56
(University of Sydney)
Abstract
Major depressive disorder is often considered to be a homogenous disorder that changes in terms of severity; however, the presence of distinct subtypes and a variety of presenting symptoms suggests much heterogeneity. Aiming to better understand the relationship between heterogeneity and diagnosis we used an exploratory approach to identify subtypes of depression on the basis of clinical symptoms and neuropsychological performance. Cluster analysis identified two groups of patients distinguished by level of cognitive dysfunction with the more severe cluster being associated with melancholic depression. While the relationship between cluster and subtype was significant, only 58% of melancholic patients were assigned to cluster 1 (the more severe cluster) and 66% of non-melancholic patients assigned to cluster 2. Subtypes also displayed a distinctive profile of impairment such that melancholic patients (n 5 65) displayed more variability in attention while non-melancholic patients (n 5 59) displayed memory recall impairment. While melancholia and non-melancholia are associated with a more severe and less severe form of depression respectively, findings indicate that differences between melancholia and non-melancholia are more than simple variation on severity. In summary, findings provide support for the heterogeneity of depression. (JINS, 2012, 18, 361–369)
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References44
Published on Jul 1, 2008in Cns Spectrums 3.50
Dan J. Stein102
Estimated H-index: 102
The heterogeneity of major depression suggests that multiple neurocircuits and neurochemicals are involved in its pathogenesis. Anhedonia and psychomotor symptoms are, however, particularly characteristic features of major depression and may provide insights into its underlying psychobiology. Importantly, these symptoms appear to be mediated by dopaminergic mesolimbic and mesostriatal projections, the function of which is, in turn, influenced by key gene variants and environment stressors. Indee...
78 Citations Source Cite
Published on Jul 1, 1985in Journal of Clinical Psychology 2.33
David L. Roth62
Estimated H-index: 62
(University of Kansas),
Bruce Crosson36
Estimated H-index: 36
(University of Oklahoma Health Sciences Center)
Des mesures de l'empan mnemonique verbal et visuo-spatial ont ete effectuees chez 21 patients atteints de lesions cerebrales organiques et 21 patients medicalises sans atteintes neurologiques, de la Veterans Administration
12 Citations Source Cite
Published on Nov 1, 2002in Comprehensive Psychiatry 2.13
Stewart A. Shankman23
Estimated H-index: 23
(Stony Brook University),
Daniel N. Klein71
Estimated H-index: 71
(Stony Brook University)
Abstract It has long been debated whether depression is best classified with a categorical or dimensional diagnostic system. There has been surprisingly little discussion, however, of what the contents of a dimensional classification should include, with most studies employing a single dimension based on symptom severity. The present study explored whether a dimension based on prior course of depression increases the validity of a dimensional model based on symptom severity alone and whether the...
17 Citations Source Cite
Published on Jan 1, 2004in Nordic Journal of Psychiatry 1.76
Kirsten I. Stordal13
Estimated H-index: 13
(University of Bergen),
Astri J. Lundervold40
Estimated H-index: 40
(University of Bergen)
+ 8 AuthorsKetil J. Oedegaard22
Estimated H-index: 22
(University of Bergen)
Depression is associated with impairment of cognitive functions, and especially executive functions (EFs). Despite the fact that most depressed patients experience recurrence of episodes, the pattern and the severity of executive impairment have not been well characterized in this group of depressed patients. We asked if and to what extent these patients were impaired on a range of neuropsychological tests measuring EFs, and also when confounding factors were adjusted for. Forty-five patients (a...
127 Citations Source Cite
Published on Mar 1, 1990in Clinical Neuropsychologist 1.81
Gina Geffen42
Estimated H-index: 42
,
K. J. Moar1
Estimated H-index: 1
+ 2 AuthorsL. B. Geffen21
Estimated H-index: 21
Abstract This study reports Auditory Verbal Learning Test (AVLT) data for 153 adults in age groups spanning seven decades, with approximately equal numbers of males and females and matched for intelligence, education, and occupation. Overall performance deteriorated with increased age, females performing better than males. Older subjects recalled fewer words, were more susceptible to information overload during input, showed diminished retrieval efficiency, and had a decline in memory for the so...
229 Citations Source Cite
Published on Aug 1, 2000in American Journal of Psychiatry 13.40
Gordon Parker81
Estimated H-index: 81
OBJECTIVE: Classification of the depressive disorders has long been controversial. The dominant current model is unitarian, with disorders largely distinguished on the basis of severity. Both the unitarian and the contrasting binarian views (of two principal types) have proved to be unsatisfactory. The binarian model’s procrustean requirements are too inflexible to address the evident heterogeneity contributed to by clinical manifestations and underlying personality features. METHOD: This articl...
229 Citations Source Cite
Published on Apr 1, 2005in Clinical Eeg and Neuroscience 1.81
Evian Gordon69
Estimated H-index: 69
(Westmead Hospital),
Nicholas R. Cooper18
Estimated H-index: 18
+ 2 AuthorsLea Williams78
Estimated H-index: 78
(University of Sydney)
Most brain related databases bring together specialized information, with a growing number that include neuroimaging measures. This article outlines the potential use and insights from the first entirely standardized and centralized database, which integrates information from neuroimaging measures (EEG, event related potential (ERP), structural/functional MRI), arousal (skin conductance responses (SCR)s, heart rate, respiration), neuropsychological and personality tests, genomics and demographic...
172 Citations Source Cite
Published on Mar 1, 1991in Australian and New Zealand Journal of Psychiatry 5.08
Gordon Parker81
Estimated H-index: 81
(University of New South Wales),
Wayne Hall86
Estimated H-index: 86
(University of New South Wales)
+ 6 AuthorsKerrie Eyers14
Estimated H-index: 14
(University of New South Wales)
The strongest statistical support for the binary view of depression has been provided by factor (principal components) analytic studies which delineate a bipolar factor with features interpreted as reflecting “endogenous depression” and “neurotic depression” at opposing poles. We review the seminal studies to suggest instead that the bipolar factor has generally polarised depression and anxiety, and that no such entity or symptom complex of “neurotic depression” has been isolated. Instead, “neur...
15 Citations Source Cite
Published on Jan 1, 1998in European Psychiatry 4.13
Yves Lecrubier43
Estimated H-index: 43
,
David V. Sheehan44
Estimated H-index: 44
+ 1 AuthorsEmmanuelle Weiller11
Estimated H-index: 11
5,224 Citations Source Cite
Published on Oct 1, 2004in Neuropsychopharmacology 6.54
Gregor Hasler37
Estimated H-index: 37
,
Wayne C. Drevets78
Estimated H-index: 78
+ 1 AuthorsCharney Ds148
Estimated H-index: 148
The limited success of genetic studies of major depression has raised questions concerning the definition of genetically relevant phenotypes. This paper presents strategies to improve the phenotypic definition of major depression by proposing endophenotypes at two levels: First, dissecting the depressive phenotype into key components results in narrow definitions of putative psychopathological endophenotypes: mood bias toward negative emotions, impaired reward function, impaired learning and mem...
798 Citations Source Cite
Cited By20
Published on May 1, 2013in Annals of Clinical Psychiatry 1.47
Leonardo Zaninotto11
Estimated H-index: 11
,
Daniel Souery45
Estimated H-index: 45
+ 7 AuthorsAlessandro Serretti67
Estimated H-index: 67
BACKGROUND: Depressive subtypes generally have been neglected in research on treatment efficacy. We studied a sample of 699 severe unipolar depressed patients to detect any association between depressive features and treatment resistance. METHODS: Participants were divided into psychotic (PSY, n = 90), melancholic (MEL, n = 430) and non-melancholic (n = 179) subjects according to clinical features. Formal diagnostic criteria (Mini International Neuropsychiatric Interview items), and items from 1...
6 Citations
Published on May 1, 2015in Annals of the New York Academy of Sciences 4.28
Marc S. Lener4
Estimated H-index: 4
(Icahn School of Medicine at Mount Sinai),
Dan V. Iosifescu42
Estimated H-index: 42
(Icahn School of Medicine at Mount Sinai)
Over the last few decades, neuroimaging techniques have advanced the identification of structural, functional, and neurochemical brain abnormalities that are associated with the increased risk, clinical course, and treatment outcomes of major depressive disorder (MDD). This paper reviews specific neuroimaging abnormalities that, on the basis of early studies, may discriminate between MDD patients who do or do not respond to current therapeutic modalities, such as antidepressants, cognitive behav...
39 Citations Source Cite
Published on Jan 1, 2015in Current Psychiatry Reports 3.86
Gordon Parker81
Estimated H-index: 81
(Black Dog Institute),
Georgia McClure5
Estimated H-index: 5
(Black Dog Institute),
Amelia Paterson9
Estimated H-index: 9
(Black Dog Institute)
The fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 defines mental disorders as syndromes and also introduced disorder “specifiers” with the aim of providing increased diagnostic specificity by defining more homogeneous subgroups of those with the disorder and who share certain features. While the majority of specifiers in DSM-5 define a specific aspect of the disorder such as age at onset or severity, some define syndromes that appear to meet the DSM-5 definit...
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Published on Nov 27, 2014in Frontiers in Psychology 2.09
Andrew H. Kemp56
Estimated H-index: 56
(University of São Paulo),
Daniel Quintana24
Estimated H-index: 24
(University of Sydney)
+ 2 AuthorsAnthony Harris43
Estimated H-index: 43
(University of Sydney)
Background: Major depressive disorder (MDD) is associated with increased heart rate and reductions in its variability (HRV) – markers of future morbidity and mortality – yet prior studies have reported contradictory effects. We hypothesised that increases in heart rate and reductions in HRV would be more robust in melancholia relative to controls, than in patients with non-melancholia. Methods: A total of 72 patients with a primary diagnosis of MDD (age M: 36.26, SE: 1.34; 42 females) and 94 con...
30 Citations Source Cite
Published on Jul 1, 2012in Expert Review of Neurotherapeutics 3.70
Claire V. Day4
Estimated H-index: 4
(University of Sydney),
Lea Williams78
Estimated H-index: 78
(University of Sydney)
Melancholia is typified by features of psychomotor slowing, anxiety, appetite loss and sleep changes. It is usually observed in 20–30% of individuals meeting diagnostic criteria for major depressive disorder (MDD). There is currently no agreement on whether melancholic MDD represents a distinct entity defined by neurobiological as well as clinical features or, rather, a specifier for MDD. This situation is reflected in the revisions to DSM, including in the DSM-5 due for release in 2013. With th...
8 Citations Source Cite
Published on Jan 1, 2014in Current Opinion in Psychiatry 4.27
Gordon Parker81
Estimated H-index: 81
,
Amelia Paterson9
Estimated H-index: 9
11 Citations Source Cite
Published on May 1, 2015in Journal of Affective Disorders 3.79
Claire V. Day4
Estimated H-index: 4
,
Justine M. Gatt20
Estimated H-index: 20
+ 3 AuthorsLea Williams78
Estimated H-index: 78
(Stanford University)
Abstract Background Depressed patients with melancholic features have distinct impairments in cognition and anhedonia, but it remains unknown whether these impairments can be quantified on neurocognitive biomarker tests of behavioral performance. We compared melancholic major depressive disorder (MDD) patients to non-melancholic MDD patients and controls on a neurocognitive test battery that assesses eight general and emotional cognitive domains including the hypothesized decision-making and rew...
14 Citations Source Cite
Published on Jun 11, 2014in Cns & Neurological Disorders-drug Targets 2.08
Mariana Alves2
Estimated H-index: 2
,
Tetsuya Yamamoto4
Estimated H-index: 4
+ 4 AuthorsAdriana Cardoso4
Estimated H-index: 4
Depression, the most prevalent psychiatric disorder, has a lifelong risk of 20% and is related to high rates of death among the patients. Thus, this study aims to conduct a systematic review of changes in executive functions of adult patients diagnosed with depression. We found 1381 articles; however, only 28 were selected and recovered. The inclusion criteria was the assessment of executive functions with at least one neuropsychological test, and articles that evaluated primarily adult individu...
5 Citations Source Cite
Published on Mar 1, 2015in Journal of Affective Disorders 3.79
Claire V. Day4
Estimated H-index: 4
,
A. J. Rush108
Estimated H-index: 108
(National University of Singapore)
+ 7 AuthorsLea Williams78
Estimated H-index: 78
(Stanford University)
Background: This study seeks to provide a comprehensive and systematic evaluation of baseline clinical and psychological features and treatment response characteristics that differentiate Major Depressive Disorder (MDD) outpatients with and without melancholic features. Reflecting the emphasis in DSM-5, we also include impairment and distress. Methods: Participants were assessed pre-treatment on clinical features (severity, risk factors, comorbid conditions, illness course), psychological profil...
7 Citations Source Cite
Published on Oct 1, 2014in Journal of Affective Disorders 3.79
Kangguang Lin7
Estimated H-index: 7
(Guangzhou Medical University),
Guiyun Xu8
Estimated H-index: 8
(Guangzhou Medical University)
+ 8 AuthorsKwok-Fai So54
Estimated H-index: 54
(Jinan University)
Abstract Background Considerable evidence has demonstrated that melancholic and atypical major depression have distinct biological correlates relative to undifferentiated major depression, but few studies have specifically delineated neuropsychological performance for them. Method In a six-week prospective longitudinal study, we simultaneously compared neuropsychological performance among melancholic depression ( n =142), atypical depression ( n =76), undifferentiated major depression ( n =91), ...
16 Citations Source Cite