Emotional blunting in patients with depression. Part I: clinical characteristics

Background: Emotional blunting-inability to feel positive or negative emotions, detachment, or reduced emotional responsiveness-is common in people with depression. However, there is a paucity of studies comprehensively investigating this symptom and its functional impact. This study investigated the experience of emotional blunting, and its impact on overall functioning and quality of life, in the acute and remission phases of depression from the perspective of patients and healthcare providers. This paper presents data on the clinical presentation of emotional blunting in depression from the patient perspective. Methods: Cross-sectional, observational study conducted in Brazil, Canada, and Spain between April 15 and May 18, 2021. Data were collected via a self-completed online survey. Respondents were adults with depression (acute or remission phase), who were currently using a prescribed antidepressant, and who reported emotional blunting during the past 6 weeks. Emotional blunting was assessed using the Oxford Depression Questionnaire (ODQ; total score range 26-130, higher scores indicate greater emotional blunting). Results: In all, 752 patients completed the survey (62% female; mean age, 45 years). Overall, 44% of patients rated their emotional blunting as extremely severe (acute phase [n = 300], 72%; remission phase [n = 452], 25%; difference, p < 0.01). In all, 56% of patients considered their emotional blunting to be caused by their depression (acute phase, 62%; remission phase, 52%). Mean ODQ total score was 94.8 for patients in the acute phase of depression and 85.7 for those in remission (difference, p < 0.01). Mean score for the ODQ 'antidepressant as cause' domain (maximum possible score, 30) was 18.0 in patients in the acute phase and 17.6 in those in remission. Overall, 45% of patients believed that their antidepressant medication was blunting their emotions and 39% were considering stopping or had already stopped their antidepressant because of perceived emotion-related side effects. Conclusions: Almost three-quarters of patients in the acute phase of depression and one-quarter of those in remission reported severe emotional blunting. Approximately 56% of patients considered their emotional blunting to be caused by their depression, while 45% believed that their antidepressant medication was negatively affecting their emotions. Just over one-third of patients were considering stopping or had stopped their antidepressant as a result

Emotional blunting in patients with depression. Part II: relationship with functioning, well-being, and quality of life

Background Emotional blunting is a common symptom in people with depression and an important factor preventing full functional recovery. This international survey investigated the experience of emotional blunting in the acute and remission phases of depression from the perspective of patients and healthcare providers. This paper presents data on the impact of emotional blunting on overall functioning and health-related quality of life from the patient perspective. Methods Respondents were adults diagnosed with depression by a physician, currently prescribed an antidepressant, and reporting emotional blunting during the past 6 weeks. Assessments included the Oxford Depression Questionnaire (ODQ), the Functioning Assessment Short Test (FAST), and the World Health Organization-Five Well-being Index (WHO-5). Pearson correlation and multivariate regression analyses were applied to examine the relationship between ODQ and FAST scores. Results Data are available for 752 patients (62% female; mean age, 45 years). Mean ODQ total score was 94.8 in patients in the acute phase of depression (n = 300) and 85.7 in those in remission (n = 452; possible maximum, 130). Mean FAST total scores were 47.0 and 33.5, respectively (possible maximum, 72). Patients in the acute phase of depression had significantly greater impairment in functioning across all FAST domains than those in the remission phase (all differences, p < 0.01). Mean WHO-5 scores were 6.4 and 9.8 in the acute and remission phases, respectively (lower scores indicate poorer well-being). Overall, 65% of patients in the acute phase and 36% of those in remission reported that emotional blunting had a significant impact on their quality of life. Pearson correlation analysis showed a moderate positive correlation between ODQ and FAST total scores (r = 0.52) and a weak negative correlation between ODQ total score and WHO-5 score (r = - 0.26; both p < 0.01). In multivariate regression analysis, ODQ total score (in combination with other covariates) was the strongest significant predictor of poor patient functioning. Conclusions Emotional blunting has a substantial negative impact on patients' daily functioning, well-being, and quality of life in both the acute and remission phases of depression. These findings highlight the importance of recognizing and treating emotional blunting in patients with major depressive disorder in order to achieve full functional recovery

Emotional blunting in patients with depression. Part IV: differences between patient and physician perceptions

Background Emotional blunting is common in patients with depression. An online survey was undertaken to assess the experience of emotional blunting, and its impact on functioning and quality of life, in the acute and remission phases of depression from the perspective of patients and healthcare providers (HCPs). This paper presents data on the level of concordance between patient and HCP perspectives. Methods This was a cross-sectional, observational study. Patient respondents were adults with a diagnosis of depression, who were currently using a prescribed antidepressant, and who reported emotional blunting during the past 6 weeks. HCPs completed the survey for the last two eligible patients they had seen, one in each phase of depression. Assessments included the Oxford Depression Questionnaire (ODQ) 'antidepressant as cause' domain and the Functioning Assessment Short Test (FAST). Results Mean ODQ 'antidepressant as cause' domain scores were significantly higher in the patient-reported cohort (n = 752) than in the HCP-assessed cohort (n = 766) in both the acute (18.0 vs 12.5, respectively; p < 0.01) and remission phases (17.6 vs 12.6; p < 0.01). Overall, 45% of patients believed that their antidepressant medication was negatively affecting their emotions and 39% were considering stopping or had stopped their antidepressant because of perceived emotion-related side effects. In the HCP-assessed cohort, the antidepressant was considered responsible for emotional blunting in 30% of patients and only 18% of patients were believed to be considering stopping their medication due to emotional blunting. Patients reported a greater impact of emotional blunting on activities of daily living than HCPs. Mean FAST score was significantly higher in each phase of depression in the patient-reported cohort than in the HCP-assessed cohort (acute phase, 47.0 vs 39.1; remission phase, 33.5 vs 19.4; both p < 0.01). Conclusions Compared with previous studies, our results suggest that HCPs may underestimate the prevalence of emotional blunting in patients with depression. HCPs also appear to underestimate the severity and impact of emotional blunting on patient functioning and treatment adherence compared with patients' own perspectives. Differences between patient and HCP perspectives were most pronounced during the acute phase of the disease

Emotional blunting in patients with depression. Part III: relationship with psychological trauma

Background This international online survey investigated the experience and impact of emotional blunting in the acute and remission phases of depression from the perspective of patients and healthcare providers (HCPs). This paper presents data on the history and severity of psychological trauma and its potential impact on emotional blunting in major depressive disorder (MDD); differences between patient and HCP perceptions are explored. Methods Patient respondents (n = 752) were adults with a diagnosis of depression who were currently taking antidepressant therapy and reported emotional blunting during the past 6 weeks. HCPs provided details on two eligible patients: one in the acute phase of depression and one in remission from depression (n = 766). Trauma was assessed using questions based on the Childhood Trauma Questionnaire; emotional blunting was assessed using the Oxford Depression Questionnaire (ODQ). Multivariate regression analyses were applied to examine the relationship between trauma and ODQ score. Results A history of any childhood or recent traumatic event was reported by 97% of patients in the self-assessed cohort and for 83% of those in the HCP-assessed cohort (difference, p < 0.01). Patients were more likely than HCPs to feel that this trauma had contributed to their/the patient's depression (58% vs 43%, respectively; p < 0.01) and that the depression was more severe because of trauma (70% vs 61%, respectively; p < 0.01). Emotional blunting was significantly worse in patients who reported severe trauma than in those who had not experienced severe trauma (mean total ODQ score, 90.1 vs 83.9, respectively; p < 0.01). In multivariate regression analyses, experiencing both severe childhood and recent trauma had a statistically significant impact on ODQ total score (p = 0.001). Conclusions A high proportion of patients with depression and emotional blunting self-reported exposure to childhood and/or recent traumatic events, and emotional blunting was more severe in patients who reported having experienced severe trauma. However, history of psychological trauma in patients with MDD appeared to be under-recognized by HCPs. Improved recognition of patients who have experienced psychological trauma and are experiencing emotional blunting may permit more targeted therapeutic interventions, potentially resulting in improved treatment outcomes

Phytotoxic Activity of the Natural Compound Norharmane on Crops, Weeds and Model Plants

[EN] Norharmane is a secondary metabolite that appears in different species of land plants. In this paper, we investigated for the first time the specificity of norharmane through germination and growth tests on some crops as Zea mays L. (maize), Triticum aestivum L. (wheat), Oryza sativa L. (rice) and Lactuca sativa L. (lettuce) and weeds as Amaranthus retroflexus L. (amaranth), Echinochloa crus-galli L. (barnyard grass), Plantago lanceolata L. (ribwort), Portulaca oleracea L. (common purslane) and Avena fatua L. (wild oat), and its phytotoxic capacity on the metabolism of adult Arabidopsis thaliana L. (thale cress) by measuring chlorophyll a fluorescence, pigment content, total proteins, osmotic potential and morphological analysis. Norharmane had an inhibitory effect on the germination of A. fatua and P. lanceolata, and the growth of P. oleracea, E. crus-galli and A. retroflexus. On adult A. thaliana plants, the compound was more effective to watering, leading to water stress that compromised the growth of the plants and ultimately affected the photosynthetic apparatus. Therefore, this research shows that norharmane not only affects seedlings' metabolism, but also damages the metabolism of adult plants and can be a potential model for a future bioherbicide given its specificity.This research was funded by the Spanish Ministry of Science and Innovation, through the Faculty Training Subprogram (FPU) (FPU14-02243), and by the Spanish Ministry of Economy and Competitiveness (AGL2013-41281-R).López-González, D.; Ledo, D.; Cabeiras-Freijanes, L.; Verdeguer Sancho, MM.; Reigosa, MJ.; Sánchez-Moreiras, AM. (2020). Phytotoxic Activity of the Natural Compound Norharmane on Crops, Weeds and Model Plants. Plants. 9(10):1-24. https://doi.org/10.3390/plants9101328S12491

Faceted Subject Access to Music: An Evaluation of the Music Thesaurus Project

The Music Thesaurus Project is an initiative to develop a faceted thesaurus for music materials. The Library of Congress Subject Headings provide inadequate subject access to music in many ways, such as a lack of specificity and an incomplete syndetic structure, and its music headings are complex and difficult to construct. In addition, current music cataloging practice does not provide adequate access to non-Western and popular music. The Music Thesaurus would solve these problems by separating concepts into facets and building a complete syndetic structure, practices that will aid in the retrieval of Western art music as well as non-Western and popular music. This study evaluates the proposed structure for the Music Thesaurus and makes recommendations for improvement

Sociala faktorers betydelse för äldres välbefinnande- en studie i KASAM

Bakgrund: Andelen åldrande i Sverige ökar. Dock ökar också den psykiskta ohälsan bland äldre. Jag tror att meningsfulla sociala relationer, sociala aktiviteter samt ett förbättrat socialt stöd för utsatta äldre kan öka deras psykiska välbefinnande genom en större känsla av delaktighet, sammanhang och möjlighet att påverka. Syfte: Syftet med min undersökning är att avslöja orsakssambanden mellan olika sociala faktorer och psykiskt välbefinnade för åldrande kvinnor och män. Beskrivning: I denna studie vill jag undersöka sociala faktorers orsakssamband med psykiskt välbefinnande bland äldre personer i Sverige genom regressionanalys. Jag kommer först att redogöra för Aaron Antovskys salutogena forskningsansats och hans modell KASAM, som står för ”känslan av sammanhang”. Jag kommer sedan att presentera tidigare forskning och studier gällande äldres sociala liv och dess påverkan på psykiskt välbefinnande. Jag ämnar att använda mig av KASAMs centrala begrepp: mening, begriplighet och hanterbarhet, för att se vilka sociala faktorer som ger äldre kvinnor och män ökat psykiskt välbefinnande och mening i livssituationen. Slutsatser: Kvinnor och män uppvisar efter kontroll av hälsa jämnastarka samband för sociala kontakter generellt, för sociala kontakter med vänner och för föreningsdeltagande med index för psykiskt välmående. Kvinnors och mäns samband för gudtjänstdeltagande, sammanboende samt sociala stöd skiljer sig kraftigt åt. Sociala stöd är viktigt för kvinnor medan gudtjänst-besök och sammanboende är viktigt för män med hänsyn till psykiskt välbefinnande. Nivån av hälsa har stor betydelse för kvinnors samband med psykiskt välbefinnande men påverkar inte männens samband avsevärt

Development of an Instrument for the Measurement of Originality in Preschool Children

Family Relations and Child Developmen

Vortioxetine in patients with major depressive disorder and high levels of anxiety symptoms: An updated analysis of efficacy and tolerability

Background: Patients with major depressive disorder (MDD) often experience comorbid anxiety symptoms. Vortioxetine has demonstrated efficacy in treating anxiety symptoms in patients with MDD; however, efficacy and tolerability have not been assessed across the entire approved dosage range. Methods: The efficacy and tolerability of vortioxetine 5-20 mg/day were assessed in patients with MDD and high levels of anxiety symptoms (Hamilton Anxiety Rating Scale [HAM-A] total score ≥ 20) using pooled data from four randomized, fixed-dose, placebo-controlled studies (n = 842). Data from a randomized, double-blind study of vortioxetine 10-20 mg/day versus agomelatine 25-50 mg/day in patients with an inadequate response to prior therapy (n = 299) were analyzed separately. Mean changes from baseline in Montgomery-Åsberg Depression Rating Scale (MADRS), HAM-A, and Sheehan Disability Scale (SDS) total scores were analyzed by vortioxetine dosage. Results: The pooled analysis of fixed-dose studies demonstrated a clear dose-response relationship for vortioxetine 5-20 mg/day for improvements in MADRS, HAM-A, and SDS total scores. Vortioxetine 20 mg/day demonstrated significant effects versus placebo from week 4 onwards. In the post hoc analysis of the active-controlled study in patients with inadequate response to prior therapy, vortioxetine 10-20 mg/day was superior to agomelatine across all outcome measures from week 4 onwards. Up-titration of vortioxetine to 20 mg/day was not associated with an increase in adverse events. Limitations: Short-term trials. Conclusions: Vortioxetine is efficacious and well tolerated in patients with MDD and high levels of anxiety symptoms, including those with an inadequate response to prior therapy. The greatest therapeutic benefits were observed with vortioxetine 20 mg/day. Trial registration: NCT01140906, NCT01153009, NCT01163266, NCT01255787, NCT01488071