Psychomotor symptoms in depression: A diagnostic, pathophysiological and therapeutic tool

Contains fulltext : 72983.pdf (publisher's version ) (Closed access)Psychomotor disturbances have been described repeatedly over many centuries. More recently, Sobin and Sackeim [Sobin, C., Sackeim, H.A., 1997. Psychomotor symptoms of depression. Am. J. Psychiatry. 154, 4–17.] discussed the relevance of psychomotor symptoms in depression in an extensive review. Since their report, new pathophysiological, diagnostic and therapeutic findings have been published. In the current review of the recent literature, we aim to argue the importance of psychomotor symptoms in depression and propose directions for future research

Psychomotor retardation in elderly untreated depressed patients

Contains fulltext : 152631.pdf (publisher's version ) (Open Access)BACKGROUND: Psychomotor retardation (PR) is one of the core features in depression according to DSM V (1), but also aging in itself causes cognitive and psychomotor slowing. This is the first study investigating PR in relation to cognitive functioning and to the concomitant effect of depression and aging in a geriatric population ruling out contending effects of psychotropic medication. METHODS: A group of 28 non-demented depressed elderly is compared to a matched control group of 20 healthy elderly. All participants underwent a test battery containing clinical depression measures, cognitive measures of processing speed, executive function and memory, clinical ratings of PR, and objective computerized fine motor skill-tests. Statistical analysis consisted of a General Linear Method multivariate analysis of variance to compare the clinical, cognitive, and psychomotor outcomes of the two groups. RESULTS: Patients performed worse on all clinical, cognitive, and PR measures. Both groups showed an effect of cognitive load on fine motor function but the influence was significantly larger for patients than for healthy elderly except for the initiation time. LIMITATIONS: Due to the restrictive inclusion criteria, only a relatively limited sample size could be obtained. CONCLUSION: With a medication free sample, an additive effect of depression and aging on cognition and PR in geriatric patients was found. As this effect was independent of demand of effort (by varying the cognitive load), it was apparently not a motivational slowing effect of depression.10 p

Action monitoring in major depressive disorder: Longitudinal results

Contains fulltext : 73596.pdf (Publisher’s version ) (Closed access)1 p

Disturbance of action control in major depression

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Cognitive and psychomotor effects of three months of escitalopram treatment in elderly patients with major depressive disorder

Item does not contain fulltextBackground Although psychomotor retardation (PR) and cognitive disfunctioning are essential symptoms of elderly depressed patients, the differential effect of treatment with an SSRI in the elderly on these symptoms has hardly got any attention in studies with objective experimental measures. Since effects appear relatively slower in elderly, this study evaluates the effect on cognitive and psychomotor functioning as compared to mood, on four points during a twelve week follow up of monotreatment with escitalopram. Method 28 non-demented elderly unipolar depressive patients on 5–20 mg escitalopram were compared to 20 matched healthy elderly. All participants underwent a test battery containing clinical depression measures, cognitive measures of processing speed, executive function and memory, clinical ratings of PR, and objective computerized fine motor skill-tests at the start and after 2, 6 and 12 weeks. Statistical analysis consisted of a General Linear Model (GLM) repeated measures multivariate analysis of variance of completers to compare the psychomotor and cognitive outcomes of the two groups. Results Although, apart from the significant mood effect, no interaction effects were found for the psychomotor and cognitive tasks, the means in general show a trend of differential effects in cognitive and psychomotor functions, with smaller effects and delayed timeframes and with presence of subgroups compared to mood effects. Limitation Longer follow up studies are necessary to evaluate differential long term effects. Conclusion In elderly, moderate effects of SSRI treatment on mood precede slow or limited effects on cognition and psychomotor retardation.6 p

Action monitoring in major depressive disorder with psychomotor retardation

Major depressive disorder (MDD) is characterized by disturbances of mood and affect, but also by a distinct pattern of psychomotor and cognitive deficits such as motor retardation and impaired executive functioning. An important aspect of executive functioning is performance monitoring, i.e., a continuous checking whether intended action goals have been reached and whether correction of the applied strategy is necessary. A well-known marker for action monitoring is the error negativity (Ne) or error-related negativity (ERN), an event-related potential (ERP) component generated in the anterior cingulate cortex (ACC) following erroneous responses. To date, Ne/ERN amplitudes have been investigated in moderately depressed patients only. The present study is the first to investigate action monitoring in severely depressed patients (mean Hamilton score ¼ 28.4). In addition, the patients’ psychomotor performance was assessed to see whether there is a relationship between action monitoring and psychomotor retardation. Behavioural and ERP measurements were obtained during performance on a speeded two-choice reaction task in 26 patients with MDD and 25 healthy, matched controls. Psychomotor performance measures were speed of simple movements in various psychomotor tasks and the score on the Salpetriere retardation rating scale (SRRS). Relative to the controls, the patients’ behavioural results revealed a similar, but slower performance pattern. Overall between-group differences were demonstrated for the error positivity (Pe) amplitudes, but not for the Ne/ERN amplitudes. However, correlations of the Ne/ERN amplitude with several psychomotor variables were strong. In the depressed patients taking benzodiazepines an additional attenuation of Ne/ERN amplitudes was observed. Only severely depressed patients manifesting retardation showed impeded action monitoring. The correlations between action monitoring and psychomotor performance indicate that in MDD these two processes are highly interdependent, both being deregulated. Moreover, the same network of brain regions is likely to be implicated in both processes

Trait and state aspects of internal and external performance monitoring in schizophrenia

Item does not contain fulltextDisturbed internal performance monitoring has been repeatedly demonstrated in schizophrenia. Along with internal monitoring, efficiently processing external task-relevant performance feedback that goes unnoticed by the internal monitoring system is crucial for adequate performance. It is unknown whether external monitoring is disturbed in schizophrenia and whether it is trait or state dependent. The current study investigated the effects of treatment on both internal and external performance monitoring in schizophrenia. Twelve schizophrenia patients and twelve matched healthy controls performed a modified flanker task while ERPs and behavioral measures were obtained. Both groups were assessed twice, with a six-week interval, during which the patients received antipsychotic treatment. Internal monitoring was investigated by means of the response-locked error-related negativity (Ne/ERN), an event-related potential component elicited by erroneous responses. External monitoring was investigated by analyzing the feedback-locked P300 elicited by task-relevant external response-time feedback (late feedback). Compared to controls, schizophrenia patients showed diminished Ne/ERN amplitudes, which were insensitive to six weeks of treatment. Patients also had reduced P300 amplitudes in response to late feedback at the first assessment, but these were normalized at the second assessment. Also, patients showed increased performance following negative external feedback at the second session. This study demonstrates the importance of considering both forms of performance monitoring in schizophrenia. Diminished internal error processing seems to be an important ‘trait’ marker of the disorder, while processing of externally presented feedback appears to have a ‘state’ character, susceptible to treatment at both a neurophysiological and a behavioral level.10 p

Hair cortisol in patients with a depressive episode treated with electroconvulsive therapy

Background: There is substantial evidence showing changes in hypothalamic pituitary adrenal (HPA)-axis ac-tivity in patients with major depressive disorder (MDD). Also, there seem to be differences in HPA-axis func-tioning between MDD subgroups. It is however unclear whether hair cortisol concentrations (HCC), which are a stable marker of long-term cortisol levels, are suitable as a biomarker for identifying subgroups in MDD. Methods: We were able to attain valid HCC from a scalp hair sample of sixty-two patients with a major de-pressive episode right before electroconvulsive therapy (ECT). HCC were our main biological outcome measure. We created subgroups using depression severity as defined by the Hamilton Depression Rating Scale, the pre-sence/absence of psychotic symptoms, the presence of melancholia as defined by the CORE and catatonia as defined by the Bush-Francis Catatonia Rating Scale. Results: Our analyses of the total group showed a median HCC of 4.4 pg/mg. We found patients with catatonia (N = 10) to have substantially higher median HCC (8.3 pg/mg) than patients without catatonia (3.8 pg/mg). Although presence of melancholia and depression severity were not significantly associated with HCC, more severe psychomotor agitation was associated with higher HCC. Pre-treatment HCC was not associated with ECT outcome. Strengths and limitations: A complicating factor in interpretation of our results was the large variability in HCC. This could be related to potential confounders such as cardiometabolic and other comorbidities, that were however addressed to the extent possible. Conclusions: HCC is a potential biomarker for MDD patients with severe agitation and/or catatonia. ClinicalTrials.gov: Identifier: NCT02562846.Stress-related psychiatric disorders across the life spa