On the Differential Diagnosis of Anxious from Nonanxious Major Depression by means of the Hamilton Scales

Objective. Anxious major depressive disorder (A-MDD) is differentially diagnosed from nonanxious MDD (NA-MDD) as MDD with a cut-off score ≥7 on the HAM-D anxiety-somatization factor (ASF). We investigated whether additional HAM-D items discriminate A-MDD from NA-MDD. Moreover, we tested the validity of ASF criterion against HAM-A, gold standard of anxiety severity assessment. Methods. 164 consecutive female middle-aged inpatients, diagnosed as A-MDD () or NA-MDD () by the normative HAM-A score for moderate-to-severe anxiety (≥25), were compared regarding 17-item HAM-D scores. The validity of ASF ≥7 criterion was assessed by receiver-operating characteristics (ROC) analysis. Results. We found medium and large effect size differences between A-MDD and NA-MDD patients in only four out of the six ASF items, as well as in three further HAM-D items, namely, those of agitation, middle insomnia, and delayed insomnia. Furthermore, the ASF cut-off score ≥9 provided the optimal trade-off between sensitivity and specificity for the differential diagnosis between A-MDD and NA-MDD. Conclusion. Additional HAM-D items, beyond those of ASF, discriminate A-MDD from NA-MDD. The ASF ≥7 criterion inflates false positives. A cut-off point ≥9 provides the best trade-off between sensitivity and specificity of the ASF criterion, at least in female middle-aged inpatients

Pregabalin augmentation in treatment-resistant obsessive-compulsive disorder

The therapeutic limitations of mainstay psychopharmacological treatments of obsessive-compulsive disorder (OCD) warrant the clinical testing of further add-on agents to improve patients’ clinical symptoms. One such agent might be pregabalin, which has been found efficacious in other anxiety disorders. We report on the findings of a small, 8-week open-label trial of adjunctive pregabalin with a 4-week follow-up in 10 OCD patients resistant or only partial responders to a combination of serotonin reuptake inhibitors with atypical antipsychotics. Adjunctive pregabalin at 225-675 mg/d was well tolerated and led to patients’ substantial improvement in their OCD symptoms, as reflected in their scores on the Yale-Brown Obsessive Compulsive Scale. Despite the several limitations of the study, its results suggest that adjunctive pregabalin might be a safe and efficacious new augmentation agent in the treatment of drug-resistant OCD. We hypothesize that pregabalin’s mechanism of action in OCD might consist in its inhibition of glutamatergic neurotransmission. Int Clin Psychopharmacol 26:221-224 (C) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

On the Differential Diagnosis of Anxious from Nonanxious Major Depression by means of the Hamilton Scales

Objective. Anxious major depressive disorder (A-MDD) is differentially diagnosed from nonanxious MDD (NA-MDD) as MDD with a cut-off score ≥7 on the HAM-D anxiety-somatization factor (ASF). We investigated whether additional HAM-D items discriminate A-MDD from NA-MDD. Moreover, we tested the validity of ASF criterion against HAM-A, gold standard of anxiety severity assessment. Methods. 164 consecutive female middle-aged inpatients, diagnosed as A-MDD ( = 92) or NA-MDD ( = 72) by the normative HAM-A score for moderate-to-severe anxiety (≥25), were compared regarding 17-item HAM-D scores. The validity of ASF ≥7 criterion was assessed by receiver-operating characteristics (ROC) analysis. Results. We found medium and large effect size differences between A-MDD and NA-MDD patients in only four out of the six ASF items, as well as in three further HAM-D items, namely, those of agitation, middle insomnia, and delayed insomnia. Furthermore, the ASF cut-off score ≥9 provided the optimal trade-off between sensitivity and specificity for the differential diagnosis between A-MDD and NA-MDD. Conclusion. Additional HAM-D items, beyond those of ASF, discriminate A-MDD from NA-MDD. The ASF ≥7 criterion inflates false positives. A cut-off point ≥9 provides the best trade-off between sensitivity and specificity of the ASF criterion, at least in female middle-aged inpatients

Measuring the needs of mental health patients in Greece:Reliability and validity of the Greek version of the Camberwell Assessment of Need

Background: Evaluation of mental health services based on patients’ needs assessments has never taken place in Greece, although it is a crucial factor for the efficient use of their limited resources. Aim: To examine the inter-rater and test–retest reliability and the concurrent/convergent validity of the Greek research version of the Camberwell Assessment of Need–Research (CAN-R). Method: A total of 53 schizophrenic patient–staff pairs were interviewed twice to test the inter-rater and test–retest reliability of the Greek version of the CAN-R. The World Health Organization Quality of Life–Brief Form (WHOQOL-BREF) and World Health Organization Disability Assessment Schedule–2.0 (WHODAS-2.0) were administered to the patients to examine concurrent validity. Results: The inter-rater and test–retest reliability of patient and staff interviews for the 22 individual items and the eight summary scores of the instrument’s four sections were good to excellent. Significant correlations emerged between CAN scores and the WHOQOL-BREF and WHODAS-2.0 domains for both patient and staff ratings, indicating good concurrent validity. Conclusion: Our results suggest that the Greek version of the CAN-R is a reliable instrument for assessing mental health patients’ needs. Moreover, it is the first CAN-R validity study with satisfactory results using WHOQOL-BREF and WHODAS-2.0 as criterion variables. </jats:sec