To report the symptomatic and functional outcomes in patients with major depressive disorder (MDD) during a 2-phase treatment trial and to estimate the value of early improvement after 2 weeks in ...predicting clinical response to escitalopram and subsequently to adjunctive treatment with aripiprazole.
Participants with MDD (N = 211) identified with the Montgomery-Asberg Depression Rating Scale (MADRS) and confirmed with the Mini-International Neuropsychiatric Interview were recruited from 6 outpatient centers across Canada (August 2013 through December 2016) and treated with open-label escitalopram (10-20 mg) for 8 weeks (Phase 1). Clinical and functional outcomes were evaluated using the MADRS, Quick Inventory of Depressive Symptomatology-Self-Rated (QIDS-SR), Sheehan Disability Scale (SDS), and Lam Employment Absence and Productivity Scale (LEAPS). Participants were evaluated at 8 and 16 weeks for clinical and functional response and remission. Phase 1 responders continued escitalopram while nonresponders received adjunctive aripiprazole (2-10 mg) for a further 8 weeks (Phase 2).
After Phase 1, MADRS response (≥ 50% decrease from baseline) and remission (score ≤ 10) were, respectively, 47% and 31%, and SDS response (score ≤ 12) and remission (score ≤ 6) were, respectively, 53% and 24%. Response to escitalopram was maintained in 91% of participants at week 16, while 61% of the adjunctive aripiprazole group achieved MADRS response during Phase 2. Response and remission rates with the QIDS-SR were lower than with the MADRS. The LEAPS demonstrated significant occupational improvement (P < .05). Early symptomatic improvement predicted outcomes with modest accuracy.
This study demonstrates comparable symptomatic and functional outcomes to those of other large practical-design studies. There was a high response rate with the adjunctive use of aripiprazole in escitalopram nonresponders. Given the limited value of early clinical improvement to predict outcome, integration of clinical and biological markers deserves further exploration.
ClinicalTrials.gov identifier: NCT01655706.
Impaired illness awareness or inability to recognize that one has a substance use disorder can be a barrier to treatment seeking and rehabilitation. A validated scale is needed to better understand ...the clinical impact of impaired substance use disorder awareness. This study aimed to examine the psychometric properties of the Substance Use Awareness and Insight Scale (SAS), a novel scale to assess impaired illness awareness in individuals with substance use disorder.
We developed the SAS, a 7-item self-report measure to assess the theoretical constructs of illness awareness in substance use disorder (www.illnessawarenessscales.com). Participants 18 years of age or older with a score of 8 or more on the Drug Use Disorders Identification Test (DUDIT) were included. Data were collected via Dynata, an online survey platform.
A total of 299 participants were included (mean (SD) age = 47.3-years (15.4), 54% women). The SAS demonstrated good convergent (r = 0.82, p < 0.001) and discriminant validity (r = −0.23, p < 0.001) with a measure of illness recognition and positive affect, respectively. SAS also demonstrated good internal consistency (Cronbach’s alpha = 0.86) and one-month test-retest reliability (intra-class correlation = 0.87). An exploratory factor analysis suggested the retention of two components. Separate analyses of the SAS in individuals with cannabis, opioid, and other substance use showed similar results.
The results of this study provide initial support for the psychometric validation of the SAS in adults with substance use disorder. The SAS holds promise for use in research and clinical settings to assess the influence of impaired substance use disorder awareness on treatment outcomes.
•Impaired illness awareness in substance use disorder may be a barrier to treatment seeking and rehabilitation.•SAS is a novel, brief self-report scale that assesses addiction awareness in substance use disorder.•SAS demonstrated good convergent and discriminant validity, internal consistency, and test-retest reliability.•SAS may be applied in both clinical and research settings.
The DSM-5 Personality and Personality Disorders workgroup and their consultants have developed the 220-item, self-report Personality Inventory for the DSM-5 (PID-5) for direct assessment of the ...proposed personality trait system for DSM-5; however, most practicing clinical psychologists will likely continue to rely on separate omnibus measures to index symptoms and traits associated with psychopathology. The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) is one such measure and assesses the Personality Psychopathology Five (PSY-5) domains, which are conceptual cognates of the DSM-5 trait domains. The current study examined the associations between the MMPI-2-RF PSY-5 scales and the DSM-5 trait domains and facets indexed by the PID-5. A clear pattern of convergence was found indicating that each of the PSY-5 scales was most highly correlated with its conceptually expected PID-5 counterpart (rs = .44-.67; Mdn r = .53) and facet correlations generally showed the same pattern. Similarly, when each of the PSY-5 scales was regressed onto the PID-5 domains, the conceptually expected pattern of associations emerged even more clearly. Finally, a joint exploratory factor analysis with the PSY-5 and PID-5 trait facet scales indicated a five-factor solution that clearly resembled both of the PSY-5/DSM-5 trait domains. These results show clear evidence that the MMPI-2-RF has utility in the assessment of dimensional personality traits proposed for the upcoming DSM-5.
•The influence of anxiety on outcomes in cognitive behavioral group therapy (CBGT) for depression is unclear.•Anxiety sensitivity – the fear of anxiety symptoms due to their perceived harmful effects ...– is linked to depression, and may be relevant to its treatment.•Greater fear of losing control over one's thoughts was linked to improvements in depression nearing the end of CBGT (weeks 10–14).•Greater fear of the physical effects of anxiety was linked to CBGT non-completion.•Controlling for anxiety sensitivity, women were less likely to complete CBGT compared to men.
We examined how anxiety sensitivity – the fear of symptoms of anxiety due to their perceived harmful effects – and gender are associated with treatment trajectory and outcomes in a large outpatient sample (N = 278) who received 14-weeks of cognitive-behavioral group therapy (CBGT) for depression. Three dimensions of anxiety sensitivity (cognitive, physical, and social concerns) and depression were assessed at pre-treatment, and the latter was assessed weekly during treatment. Latent growth curve models supported a link between cognitive concerns (fears of losing control over thoughts) and greater improvement in depression near the end of treatment (i.e., weeks 10–14); gender did not moderate trajectory. Gender (i.e., identifying as a woman) and greater physical concerns (fears of physical consequences of arousal symptoms) were associated with completion of < 8 sessions. Results suggest that those with more cognitive concerns might require greater time in treatment and/or benefit most from the focus on maladaptive assumptions and core beliefs in later CBGT sessions. Future research, including investigation of intervening variables, may elucidate the mechanisms through which greater physical concerns and gender are associated with treatment non-completion. Results supported differential associations of anxiety sensitivity dimensions with depression treatment outcomes, though further research attention is needed.
•Impaired illness awareness may be a barrier to seeking treatment in individuals with alcohol use disorder.•AAS is a novel scale to assess subjective illness awareness in alcohol use disorder.•AAS ...demonstrated good convergent and discriminant validity, internal consistency, and test-retest reliability.•AAS can be used in clinical or research settings to understand the effects of illness awareness on treatment outcomes.
Impaired illness awareness in individuals with alcohol use disorder can negatively affect treatment adherence, rehabilitation, and other clinical outcomes. However, the construct of illness awareness in alcohol use disorder and its clinical implications remain to be better conceptualized and understood. The objective of this study was to develop and psychometrically test a scale designed to assess impaired illness awareness in individuals with alcohol use disorder.
We developed the Alcohol Use Awareness and Insight Scale (AAS), a self-report measure that assesses the core theoretical domains of illness awareness, including general disorder or problem awareness, accurate symptom attribution, awareness of the need for treatment, and the negative consequences of the disorder in individuals with alcohol use disorder (www.illnessawarenessscales.com). Data from 99 participants was obtained using a web-based survey platform, Dynata.
The AAS displayed good convergent (r = 0.88, p < 0.001) and discriminant validity with measures of illness recognition and affect states, respectively. The AAS also exhibited good internal consistency (Cronbach’s α = 0.89) and one-month test-retest reliability (intra-class correlation = 0.84). Exploratory factor analysis resulted in the retention of a single component.
The AAS is a novel instrument developed to measure impaired illness awareness in individuals with alcohol use disorder. The AAS may be useful in clinical or research settings in evaluating the influence of subjective alcohol use disorder awareness on interventions to promote treatment adherence and other clinical outcomes.
Ruch and colleagues (Ruch, Willibald, Gabriele Köhler & Christoph Van Thriel. 1996. Assessing the “humorous temperament”: Construction of the facet and standard trait forms of the ...state-trait-cheerfulness-inventory — STCI.
9(3–4). 303–340) postulated high cheerfulness, low seriousness, and low bad mood contribute to exhilaration and enjoyment of humor. Although robust findings have corroborated that cheerfulness is associated with well-being and greatly enhances one’s social desirability, no studies have investigated the effects of social desirability on the assessment of cheerfulness. For this study, 997 undergraduate students completed the State-Trait Cheerfulness Inventory (STCI) and validity measures. Exploratory factor analyses that controlled for social desirability suggest several items on the STCI cheerfulness subscale loaded on social desirability, whereas seriousness subscale items showed few positive loadings on social desirability and bad mood subscale items loaded negatively on social desirability. Despite associations with social desirability, items overall showed strong loadings onto their respective factors. Factor loadings free of social desirability ranged from 0.39 to 0.84 in cheerfulness, 0.49 to 0.76 in seriousness, and 0.50 to 0.81 in bad mood. Cheerfulness, seriousness, and bad mood subscale scores demonstrated partial correlations in the expected directions with well-being when controlling for social desirability, albeit smaller in size but not significantly different. The STCI scores demonstrated strong psychometric properties with good reliability, structural validity, and criterion validity when controlling for social desirability.
Impaired control over alcohol is an important risk factor for heavy drinking among young adults and may mediate, in part, the association between personality risk and alcohol problems. Research ...suggests that trait impulsivity is associated with impaired control over alcohol; however, few studies of this association have included a range of impulsivity facets. The purpose of this study was to examine specific pathways from higher order impulsivity factors to alcohol problems mediated via impaired control over alcohol. We also examined the moderating role of working memory in these associations. Young heavy drinkers (N = 300) completed 2 multidimensional impulsivity measures along with self-report measures of impaired control over alcohol, alcohol use, and alcohol problems. Working memory was assessed using a computerized digit span task. Results showed that the impulsivity facets loaded onto 2 higher order factors that were labeled Response and Reflection Impulsivity. Response impulsivity predicted unique variance in self-reported impaired control and alcohol problems, whereas reflection impulsivity predicted unique variance in heavy drinking frequency only. Further, significant indirect associations were observed from response and reflection impulsivity to alcohol problems mediated via impaired control and heavy drinking frequency, respectively. Working memory and sensation seeking were not uniquely associated with the alcohol variables, and no support was found for the moderating role of working memory. The results help to clarify associations among impulsivity, impaired control, and alcohol problems, suggesting that impaired control may play a specific role in the pathway to alcohol problems from response impulsivity but not from reflection impulsivity.
BackgroundPatients with major depressive disorder (MDD) display cognitive deficits in acutely depressed and remitted states. Childhood maltreatment is associated with cognitive dysfunction in adults, ...but its impact on cognition and treatment related cognitive outcomes in adult MDD has received little consideration. We investigate whether, compared to patients without maltreatment and healthy participants, adult MDD patients with childhood maltreatment display greater cognitive deficits in acute depression, lower treatment-associated cognitive improvements, and lower cognitive performance in remission.MethodsHealthy and acutely depressed MDD participants were enrolled in a multi-center MDD predictive marker discovery trial. MDD participants received 16 weeks of standardized antidepressant treatment. Maltreatment and cognition were assessed with the Childhood Experience of Care and Abuse interview and the CNS Vital Signs battery, respectively. Cognitive scores and change from baseline to week 16 were compared amongst MDD participants with (DM+, n = 93) and without maltreatment (DM−, n = 90), and healthy participants with (HM+, n = 22) and without maltreatment (HM−, n = 80). Separate analyses in MDD participants who remitted were conducted.ResultsDM+ had lower baseline global cognition, processing speed, and memory v. HM−, with no significant baseline differences amongst DM−, HM+, and HM− groups. There were no significant between-group differences in cognitive change over 16 weeks. Post-treatment remitted DM+, but not remitted DM−, scored significantly lower than HM− in working memory and processing speed.ConclusionsChildhood maltreatment was associated with cognitive deficits in depressed and remitted adults with MDD. Maltreatment may be a risk factor for more severe and persistent cognitive deficits in adult MDD.
The American Psychiatric Association supported the development of several instruments to assess personality pathology according to the
(5th ed.;
) Section III. These instruments include self- and ...informant report forms as well as clinician-rated measures of personality traits and impairment. To date, the psychometric properties of the
Section III clinician-rated measures have received limited investigation. The objective of the current investigation was to evaluate the convergence between self-report and clinician-rated measures of
personality pathology in a diagnostically heterogeneous psychiatric patient sample. A total of 201 outpatients with current psychiatric symptoms were recruited from a psychiatric hospital patient research registry. Participants completed both clinician-rated and self-reported measures of personality pathology. Self-reported personality traits converged with clinician-rated personality traits, with medium to large effect sizes. Current and Section III personality disorder criteria demonstrated significant convergence, most with medium to large effect sizes. Self-reported and clinician-rated personality impairment correlated with small to medium effect sizes. The current investigation incorporates a multi-informant assessment of personality in a psychiatric outpatient sample. These results provide evidence for the validity of the scores of the clinician-rated instruments used to implement this model. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Rumination is strongly associated with depressive symptom severity and course. However, changes in rumination during outpatient cognitive behavioral therapy (CBT), and their links to baseline ...features such as distress tolerance and clinical outcomes, have received limited attention.
278 outpatients with depression received group or individual CBT. Measures of rumination, distress tolerance, and depression symptom severity were assessed at baseline and periodically during treatment. Mixed effect and regression-based models evaluated changes over time, and associations between rumination, distress tolerance and depression severity.
Depression and rumination decreased throughout acute treatment. Rumination reduction was concurrently associated with depressive symptom reduction. Lower levels of rumination at each time point prospectively predicted lower depressive symptoms at the next time point. Distress tolerance measured at baseline was positively associated with depression symptom severity; the indirect effect on post-treatment depression symptoms via rumination measured mid-treatment was nonsignificant when rumination at baseline was accounted for. Changes in and associations between depression and rumination were replicated in sensitivity analyses; although changes in depression and rumination were smaller in magnitude in patients receiving treatment during COVID-19.
Additional assessment points would permit a more nuanced assessment of the role rumination may play in mediating the associations between distress tolerance and depression severity. Additional investigation of treatments in community settings may also further our understanding of variability in rumination during depression treatment.
The current study provides unique real-world support for variability in rumination as a key indicator of change over the course of CBT for depression.
•Depression and rumination declined during cognitive behavioral therapy.•Reductions in rumination during treatment were associated with reduced depression.•Rumination and distress tolerance were associated with depression at all timepoints.•Rumination did not mediate the links between distress tolerance and depression.•Results replicated across in-person group and virtual individual CBT.
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