Latent classes of nonresponders, rapid responders, and gradual responders in depressed outpatients receiving antidepressant medication and psychotherapy

BackgroundWe used growth mixture modeling (GMM) to identify subsets of patients with qualitatively distinct symptom trajectories resulting from treatment. Existing studies have focused on 12-week antidepressant trials. We used data from a concurrent antidepressant and psychotherapy trial over a 6-month period. MethodEight hundred twenty-one patients were randomized to receive either fluoxetine or tianepine and received cognitive-behavioral therapy, supportive therapy, or psychodynamic therapy. Patients completed the Montgomery-angstrom sberg depression rating scale (MADRS) at the 0, 1, 3, and 6-month periods. Patients also completed measures of dysfunctional attitudes, functioning, and personality. GMM was conducted using MADRS scores and the number of growth classes to be retained was based on the Bayesian information criterion. ResultsCriteria supported the presence of four distinct latent growth classes representing gradual responders of high severity (42% of sample), gradual responders of moderate severity (31%), nonresponders (15%), and rapid responders (11%). Initial severity, greater use of emotional coping strategies, less use of avoidance coping strategies, introversion, and less emotional stability predicted nonresponder status. Growth classes were not associated with different treatments or with proportion of dropouts. ConclusionsThe longer time period used in this study highlights potential overestimates of nonresponders in previous research and the need for continued assessments. Our findings demonstrate distinct growth trajectories that are independent of treatment modality and generalizable to most psychotherapy patients. The correlates of class membership provide directions for future studies, which can refine methods to predict likely nonresponders as a means to facilitate personalized treatments

The Dutch language version of the Toronto structured interview for Alexithymia: reliability, concurrent validity, and factor structure

The aim of this study was to evaluate the psychometric properties of the Dutch version of the Toronto Structured Interview for Alexithymia (TSIA) in a clinical sample. The TSIA and the 20-item Toronto Alexithymia Scale (TAS-20) were administered to 85 psychiatric inpatients and to 76 medical outpatients with the symptom of tinnitus. Both internal and inter-rater reliability were acceptable. Confirmatory factor analyses supported the hierarchical, 4-factor structure with 4 lower-order factors nested within 2 higher-order latent factors, previously obtained with English, German, and Italian versions. Concurrent validity was supported by significant correlations between the TSIA and the TAS-20 total scores although there were some differences between the psychiatric subsample and the medical subsample. While further studies are needed to assess the convergent and discriminant validity of the TSIA, the results support its use as a measure of alexithymia

LAST: Scalable Lattice-Based Speech Modelling in JAX

We introduce LAST, a LAttice-based Speech Transducer library in JAX. With an emphasis on flexibility, ease-of-use, and scalability, LAST implements differentiable weighted finite state automaton (WFSA) algorithms needed for training \& inference that scale to a large WFSA such as a recognition lattice over the entire utterance. Despite these WFSA algorithms being well-known in the literature, new challenges arise from performance characteristics of modern architectures, and from nuances in automatic differentiation. We describe a suite of generally applicable techniques employed in LAST to address these challenges, and demonstrate their effectiveness with benchmarks on TPUv3 and V100 GPU

Cognitive Structure and Processing During Cognitive Behavioral Therapy vs. Pharmacotherapy for Depression

Background: Evidence has converged to suggest that cognitive processing and content covary with depression severity, whereas indices of cognitive structure exhibit greater stability and promise as markers of vulnerability for depression. The objective of the current study was to investigate the temporal dynamics and causal role of cognitive structure and processing in treatment for depression. Method: A total of 104 patients with major depressive disorder were randomized to receive cognitive behavioral therapy (CBT; n = 54) or pharmacotherapy (n = 50). Patients completed the Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory-II (BDI-II), Psychological Distance Scaling Task (PDST), Redundancy Card-Sorting Task (RCST), and Self-Referent Encoding Task (SRET) before, during, and after treatment. Results: Most cognitive indices exhibited change over treatment to a similar degree across both treatments. Evidence for the mediating role of cognition was limited, and not specific to CBT. Discussion: Results suggest that both cognitive structure and processing may be amenable to change, by both CBT and pharmacotherapy. The role of cognitive structure in the course of depression may require qualification

Cognitive change in cognitive-behavioural therapy

BACKGROUND: Although cognitive-behavioural therapy (CBT) is a well-established treatment for adult depression, its efficacy and efficiency may be enhanced by better understanding its mechanism(s) of action. According to the theoretical model of CBT, symptom improvement occurs via reductions in maladaptive cognition. However, previous research has not established clear evidence for this cognitive mediation model. METHODS: The present study investigated the cognitive mediation model of CBT in the context of a randomized controlled trial of CBT v. antidepressant medication (ADM) for adult depression. Participants with major depressive disorder were randomized to receive 16 weeks of CBT (n = 54) or ADM (n = 50). Depression symptoms and three candidate cognitive mediators (dysfunctional attitudes, cognitive distortions and negative automatic thoughts) were assessed at week 0 (pre-treatment), week 4, week 8 and week 16 (post-treatment). Longitudinal associations between cognition and depression symptoms, and mediation of treatment outcome, were evaluated in structural equation models. RESULTS: Both CBT and ADM produced significant reductions in maladaptive cognition and depression symptoms. Cognitive content and depression symptoms were moderately correlated within measurement waves, but cross-lagged associations between the variables and indirect (i.e. mediated) treatment effects were non-significant. CONCLUSIONS: The results provide support for concurrent relationships between cognitive and symptom change, but not the longitudinal relationships hypothesized by the cognitive mediation model. Results may be indicative of an incongruence between the timing of measurement and the dynamics of cognitive and symptom change

Depressive personality and dysthymia: Evaluating symptom and syndrome overlap

Background: Depressive Personality (DP) is being evaluated for future inclusion in DSM. One recurring issue has been conceptual and empirical redundancy with Dysthymia (i.e., Dysthymic Disorder; DD). Methods: The symptom and syndrome overlap of DP and DD were tested in a clinical sample (N = 125) using both self-report and clinician ratings. Results: Confirmatory factor analyses of the DP and DD symptoms indicated that models which separate these two syndromes had a better fit than a model in which all symptoms were classified together, particularly for the clinician-rated data. At the same time, the syndromes were highly correlated. Binary diagnostic analysis showed that over 80% of the individuals meeting criteria for DP also met criteria for DD. As predicted, the best fit was obtained when the 'psychological' symptoms of DD - low self-esteem and feelings of hopelessness - were allowed to be part of both syndromes, and 82% of patients who met criteria for both DP and DD endorsed these two symptoms. Limitations: Clinical ratings rather than structured diagnostic interviews were used. As well, some models required modification to improve fit. Conclusions: Depressive personality traits can be empirically separated from DD symptoms, but including DP as a categorical diagnosis would lead to a high degree of diagnostic overlap. Much of this overlap is due to sharing psychological features in common. Revisions in the diagnostic system should find a way to incorporate depressive personality traits without insisting that they be diagnosed in a categorical manner. © 2006 Elsevier B.V. All rights reserved

The role of outcome expectancy in therapeutic change across psychotherapy versus pharmacotherapy for depression.

BACKGROUND: Patient outcome expectancy - the belief that treatment will lead to an improvement in symptoms - is linked to favourable therapeutic outcomes in major depressive disorder (MDD). The present study extends this literature by investigating the temporal dynamics of expectancy, and by exploring whether expectancy during treatment is linked to differential outcomes across treatment modalities, for both optimistic versus pessimistic expectancy. METHODS: A total of 104 patients with MDD were randomized to receive either cognitive behavioral therapy (CBT) or pharmacotherapy for 16 weeks. Outcome expectancy was measured throughout treatment using the Depression Change Expectancy Scale (DCES). Depression severity was measured using both the Hamilton Depression Rating Scale and Beck Depression Inventory-II. RESULTS: Latent growth curve models supported improvement in expectancy across both treatments. Cross-lagged panel models revealed that both higher optimistic and lower pessimistic expectancy at mid-treatment predicted greater treatment response in pharmacotherapy. For CBT, the associative patterns between expectancy and depression differed as a function of expectancy type; higher optimistic expectancy at pre-treatment and lower pessimistic expectancy at mid-treatment predicted greater treatment response. LIMITATIONS: The sample size limited statistical power and the complexity of models that could be explored. CONCLUSIONS: Results suggest that outcome expectancy improved during treatment for depression. Whether outcome expectancy represents a specific mechanism for the reduction of depression warrants further investigation