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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 3.10
· DOI :10.1017/S1355617711001858
Candice R Quinn7
Estimated H-index: 7
(USYD: University of Sydney),
Anthony Harris43
Estimated H-index: 43
(USYD: University of Sydney),
Andrew H. Kemp58
Estimated H-index: 58
(USYD: University of Sydney)
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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)
  • References (43)
  • Citations (20)
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References43
Newest
Published on Nov 9, 2010in Journal of Clinical and Experimental Neuropsychology 1.99
Steven M. Silverstein44
Estimated H-index: 44
(UMDNJ: University of Medicine and Dentistry of New Jersey),
Judith Jaeger18
Estimated H-index: 18
(AstraZeneca)
+ 10 AuthorsStephanie Marcello2
Estimated H-index: 2
(UMDNJ: University of Medicine and Dentistry of New Jersey)
Cognitive impairment is prevalent in schizophrenia and is related to poorer functional and treatment outcomes. Cognitive assessment is therefore now a routine component of clinical trials of new treatments for schizophrenia. The current gold-standard for cognitive assessment in clinical trials for schizophrenia is the MATRICS (Measurement and Treatment Research to Improve Cognition in Schizophrenia) Consensus Cognitive Battery (MCCB), which was developed based on expert consensus and incorporate...
26 Citations Source Cite
Published on Jan 1, 2009in Cns Spectrums 3.94
Andrew H. Kemp58
Estimated H-index: 58
5 Citations
Published on Jul 1, 2008in Cns Spectrums 3.94
Dan J. Stein104
Estimated H-index: 104
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 Jan 1, 2008in European Psychiatry 3.94
Franco Benazzi3
Estimated H-index: 3
Abstract Objective To review the diagnostic validity and utility of mixed depression, i.e. co-occurrence of depression and manic/hypomanic symptoms. Methods PubMed search of all English-language papers published between January 1966 and December 2006 using and cross-listing key words: bipolar disorder, mixed states, criteria, utility, validation, gender, temperament, depression-mixed states, mixed depression, depressive mixed state/s, dysphoric hypomania, mixed hypomania, mixed/dysphoric mania, ...
44 Citations Source Cite
Published on Feb 1, 2007in Acta Psychiatrica Scandinavica 4.69
William Coryell85
Estimated H-index: 85
(UI: University of Iowa)
Objective: To clarify the role of melancholia' in psychiatric nomenclature. Most clinicians and researchers are convinced that the syndrome currently termed major depressive disorder encompasses multiple subgroups that differ meaningfully in phenomenology, natural history, treatment response, and pathophysiology. Delusional depression and melancholia have attracted the most empirical work, but efforts to define the latter condition have declined in recent years following a number of failures to ...
32 Citations Source Cite
Published on Feb 1, 2007in Acta Psychiatrica Scandinavica 4.69
Jules Angst81
Estimated H-index: 81
(UZH: University of Zurich),
Alex Gamma45
Estimated H-index: 45
(UZH: University of Zurich)
+ 2 AuthorsWulf Rössler59
Estimated H-index: 59
(UZH: University of Zurich)
Objective: A comparison of psychiatric, psychological and somatic characteristics in specified subgroups of major depressive episodes (MDE). Method: In a stratified community sample of young adults investigated prospectively from age 20/21 to 40/41, we defined four MDE subgroups: i) DSM-IV melancholia or atypical depression (the 'combined group'), ii) pure melancholia, iii) pure atypical depression, and iv) unspecified MDE. Results: The cumulative incidence rates of the four groups were 4.1 %, 7...
66 Citations Source Cite
Published on Feb 1, 2007in Acta Psychiatrica Scandinavica 4.69
Gordon Parker81
Estimated H-index: 81
(UNSW: University of New South Wales)
Objective: To argue that melancholia is a categorically distinct depressive condition, able to be differentiated from other depressive conditions by a neuropathological marker [observable psychomotor disturbance (PMD)] and having a differential response to various antidepressant treatments. Method: The above statements are addressed by review of a wide body of research, which identified observable PMD as the cardinal marker of melancholia and developed the CORE measure as a strategy for assessin...
58 Citations Source Cite
Published on Apr 1, 2005in Psychological Medicine 5.64
Gordon Parker81
Estimated H-index: 81
(UNSW: University of New South Wales)
Background. The DSM concept of 'major depression' has accrued increased status but demonstrated limited utility since inception. Method. An historical overview of models of depression and the initially perceived advantages presented by the concept of 'major depression' are presented before detailing its limitations in application. Results. Challenges to the utility of 'major depression' are provided by examining its conceptual model, its validity, its utility and the limited information generate...
142 Citations Source Cite
Published on Apr 1, 2005in Clinical Eeg and Neuroscience 1.82
Evian Gordon71
Estimated H-index: 71
(Westmead Hospital),
Nicholas R. Cooper18
Estimated H-index: 18
+ 2 AuthorsLea Williams79
Estimated H-index: 79
(USYD: 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...
174 Citations Source Cite
Published on Mar 1, 2005in Journal of Integrative Neuroscience 1.14
Andrew H. Kemp58
Estimated H-index: 58
,
Blossom C. M. Stephan32
Estimated H-index: 32
+ 6 AuthorsLea Williams79
Estimated H-index: 79
Clinical depression is one of the most common psychiatric disorders in adults, yet non-clinical depression in the community may go unnoticed, despite high prevalence rates and significant psychosocial impairment. The aim of the current study was to classify 1,226 individuals from a community sample on the basis of depression scores (using the Depression Anxiety Stress Scales, DASS) and to determine whether depression in a non-clinical sample differed significantly from healthy controls on a prof...
24 Citations Source Cite
Cited By20
Newest
Published on Dec 1, 2017in Psychiatry Research-neuroimaging 2.21
André Comiran Tonon2
Estimated H-index: 2
(UFRGS: Universidade Federal do Rio Grande do Sul),
Daniel Fernando Paludo Fuchs1
Estimated H-index: 1
(UFRGS: Universidade Federal do Rio Grande do Sul)
+ 4 AuthorsLuciano da Silva Alencastro1
Estimated H-index: 1
(UFRGS: Universidade Federal do Rio Grande do Sul)
Abstract Differentiation of melancholic (MEL) and non-melancholic (N-MEL) depression results from subjective assessment of psychomotor disturbance, which obscures their accurate diagnosis. CORE instrument assigned participants with severe or refractory depression to MEL or N-MEL group. Participants underwent 7 days of actigraphy. Data was fitted to a cosinusoidal curve corresponding to a 24-h rhythm. Nocturnal activity was significantly higher in N-MEL. ROC curve shows that average night activit...
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Published on Dec 1, 2017in Neuroscience & Biobehavioral Reviews 8.00
Andrew H. Kemp58
Estimated H-index: 58
(Swansea University),
Julian Koenig17
Estimated H-index: 17
(Heidelberg University),
Julian F. Thayer71
Estimated H-index: 71
(OSU: Ohio State University)
Abstract Heart rate variability (HRV) indexes functioning of the vagus nerve, arguably the most important nerve in the human body. The Neurovisceral Integration Model has provided a structural framework for understanding brain-body integration, highlighting the role of the vagus in adaptation to the environment. In the present paper, we emphasise a temporal framework in which HRV may be considered a missing, structural link between psychological moments and mortality, a proposal we label as Neur...
11 Citations Source Cite
Published on Sep 1, 2017in Journal of Affective Disorders 4.08
Giordano D’Urso8
Estimated H-index: 8
(University of Naples Federico II),
Bernardo Dell’Osso16
Estimated H-index: 16
(Stanford University)
+ 6 AuthorsA.C. Altamura39
Estimated H-index: 39
(University of Milan)
Abstract Background Transcranial direct current stimulation (tDCS) is a promising neuromodulation intervention for poor-responding or refractory depressed patients. However, little is known about predictors of response to this therapy. The present study aimed to analyze clinical predictors of response to tDCS in depressed patients. Methods Clinical data from 3 independent tDCS trials on 171 depressed patients (including unipolar and bipolar depression), were pooled and analyzed to assess predict...
9 Citations Source Cite
Published on Feb 1, 2017in Neuroscience & Biobehavioral Reviews 8.00
Nayanne Beckmann Bosaipo1
Estimated H-index: 1
(USP: University of São Paulo),
Maria Paula Foss6
Estimated H-index: 6
(USP: University of São Paulo)
+ 1 AuthorsMario Francisco Juruena25
Estimated H-index: 25
Abstract There is not a consensus as to whether neuropsychological profiling can distinguish depressive subtypes. We aimed to systematically review and critically analyse the literature on cognitive function in patients with melancholic and atypical depression. We searched in databases PubMed, SCOPUS, Web of Knowledge and PsycInfo for papers comparing the neuropsychological performance of melancholic patients (MEL) to non-melancholic depressive patients (NMEL), including atypical depressives, an...
10 Citations Source Cite
Published on Jan 1, 2017in Journal of Affective Disorders 4.08
Gordon Parker81
Estimated H-index: 81
(Black Dog Institute),
Stacey McCraw9
Estimated H-index: 9
(Black Dog Institute)
Abstract Background The CORE measure was designed to assess a central feature of melancholia - signs of psychomotor disturbance (PMD) - and so provide an alternate non-symptom based measure of melancholia or of its probability. This review evaluates development and application studies undertaken over the last 25 years to consider how well it has met its original objectives. Methods All studies published using the CORE measure as either the only or an adjunctive measure of melancholia were obtain...
5 Citations Source Cite
Published on Jan 1, 2017
Andrew H. Kemp58
Estimated H-index: 58
(Swansea University),
Juan Antonio Arias1
Estimated H-index: 1
(Swansea University),
Zoe Fisher1
Estimated H-index: 1
(Morriston Hospital)
Humanity is facing an increasing burden of chronic disease and an ageing population that will lead to more years lived with disability. Dealing with these issues is difficult, especially if we consider the deterioration of social ties and the decline in social connectedness, which may also impact on health and wellbeing. However, research on the association between social ties and health outcomes has been characterized by conceptual difficulties, controversy and simplistic models. Here, we (1) r...
5 Citations Source Cite
Published on Sep 1, 2016in Journal of Affective Disorders 4.08
Leonardo Zaninotto11
Estimated H-index: 11
(UNIBO: University of Bologna),
Marco Solmi26
Estimated H-index: 26
(UNIPD: University of Padua)
+ 4 AuthorsAlessandro Serretti66
Estimated H-index: 66
(UNIBO: University of Bologna)
Abstract Background Recently there is increasing recognition of cognitive dysfunction as a core feature of Major Depressive Disorder (MDD). The goal of the current meta-analysis was to review and examine in detail the specific features of cognitive dysfunction in Melancholic (MEL) versus Non-Melancholic (NMEL) MDD. Methods An electronic literature search was performed to find studies comparing cognitive performance in MEL versus NMEL. A meta-analysis of broad cognitive domains ( processing speed...
14 Citations Source Cite
Published on Jan 1, 2016
Thomas Beblo26
Estimated H-index: 26
(Bethel University)
Neuropsychological impairment is one of the most common and persistent symptoms of depressive disorders. Studies indicate impairment in the domains of executive functions, attention, and memory. However, a definite profile of these impairments has yet not been identified possibly due to the fact that the neuropsychological performance is influenced by several clinical and demographic factors, e.g., depression subtype, rumination, and age. Depression also further deteriorates cognitive performanc...
2 Citations Source Cite
Published on May 1, 2015in Annals of the New York Academy of Sciences 4.29
Marc S. Lener4
Estimated H-index: 4
(ISMMS: Icahn School of Medicine at Mount Sinai),
Dan V. Iosifescu44
Estimated H-index: 44
(ISMMS: 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...
41 Citations Source Cite
Published on May 1, 2015in Journal of Affective Disorders 4.08
Claire V. Day4
Estimated H-index: 4
,
Justine M. Gatt20
Estimated H-index: 20
+ 3 AuthorsLea Williams79
Estimated H-index: 79
(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