Influence of panic-agoraphobic spectrum symptoms on treatment response inpatients with recurrent major depression

11sireservedObjective: The authors tested the hypothesis that a lifetime history of panic-agoraphobic spectrum symptoms predicts a poorer response to depression treatment. Method: A threshold for clinically meaningful panic-agoraphobic spectrum symptoms was defined by means of receiver operating characteristic curve analysis of total scores on the Structured Clinical Interview for Panic-Agoraphobic Spectrum in a group of 88 outpatients with and without panic disorder. This threshold was then applied to a group of 61 women with recurrent major depression, who completed a self-report version of the same instrument, in order to compare treatment outcomes for patients above and below this clinical threshold. Results: Women with high scores (≥35) on the Panic-Agoraphobic Spectrum Self-Report were less likely than women with low scores (<35) to respond to interpersonal psychotherapy alone (43.5% versus 68.4%, respectively). Women with high scores also took longer (18.1 versus 10.3 weeks) to respond to a sequential treatment paradigm (adding a selective serotonin reuptake inhibitor when depression did not remit with interpersonal psychotherapy alone). This effect was only partially accounted for by the higher likelihood that patients with high scores required the addition of antidepressants. Although four domains from the Panic-Agoraphobic Spectrum Self-Report were individually associated with a longer time to remission, only stress sensitivity emerged as significant in multivariate regression analyses. Conclusions: A lifetime burden of panic-agoraphobic spectrum symptoms predicted a poorer response to interpersonal psychotherapy and an 8- week delay in sequential treatment response among women with recurrent depression. These results lend clinical validity to the spectrum construct and highlight the need for alternate psychotherapeutic and pharmacologic strategies to treat depressed patients with panic spectrum features.mixedFRANK, E.; SHEAR, M.K.; RUCCI, P.; CYRANOWSKI, J.; ENDICOTT, J.; FAGIOLINI, A.; GROCHOCINSKI, V.; HOUCK, P.; KUPFER, D.J.; MASER, J.D.; CASSANO, G.B.Frank, E.; Shear, M. K.; Rucci, P.; Cyranowski, J.; Endicott, J.; Fagiolini, A.; Grochocinski, V.; Houck, P.; Kupfer, D. J.; Maser, J. D.; Cassano, G. B

Measuring Mood spectrum: comparison of interview (SCI-MOODS) and self-report (MOODS-SR)instruments

Spectrum phenomena include, in addition to the typical DSM core symptoms, isolated or atypical symptoms, often of low severity, as well as trait-like behavioral features that arise as a result of coping with the psychopathology. We have demonstrated the psychometric properties of five Structured Clinical Interviews for the assessment of specific mood and anxiety spectrum conditions, including the Structured Clinical Interview for Mood Spectrum (SCI-MOODS). The present report describes the reliability of the self-report version (MOODS-SR) of the SCI-MOODS in a sample of 21 patients with a mood disorder and 20 control subjects. Agreement between the self-report and the interview formats was substantial. Intraclass correlation coefficients (ICC) ranged from 0.88 to 0.97. Our findings provide support for the reliability of the MOODS-SR questionnair

Internal consistency and discriminant validity of the Structured Clinical Interview for Panic Agoraphobic Spectrum (SCI-PAS)

This paper reports on the feasibility, acceptability and psychometric properties of the Structured Clinical Interview for Panic-Agoraphobic Spectrum (SCI-PAS). This interview was designed to assess the lifetime presence of symptoms and other clinical features considered to comprise the panic-agoraphobic spectrum. The interview has 114 items grouped into nine domains. A total of 422 subjects, from 11 centres located throughout Italy, participated in this study. Data were collected from three groups of subjects: psychiatric patients meeting DSM-IV criteria for panic disorder (n = 141), cardiovascular patients (n = 140), including 29 with post-myocardial infarction, and university students (n = 141). The inter-rater reliability and the internal consistency of the SCI-PAS measures were assessed using the intra-class correlation coefficient and the Kuder-Richardson coefficient, respectively. Discriminant validity was assessed by comparing results in patients with panic disorder to those in the other groups. The interview required an average of 25 (±5) minutes to administer. Patients and clinicians found the scale to be highly useful, providing information not previously obtained. Internal consistency was good (>0.70) for six out of nine SCI-PAS domains. The inter-rater reliability was excellent (>0.70) for all the domains except for ‘other phobias’ (0.467). Patients with panic disorder scored significantly higher on each domain, and on the overall panic spectrum, than did the control subjects. In conclusion, the SCI-PAS is a useful clinical interview, which can be administered in a reasonable period of time. This assessment further demonstrates good internal consistency, discriminant validity, and inter-rater reliability

Randomized trial of weekly, twice-monthly, and monthly interpersonal psychotherapy as maintenance treatment for women with recurrent depression.

Abstract OBJECTIVE: The authors sought to determine whether a greater frequency of interpersonal psychotherapy (IPT) sessions during maintenance treatment has a greater prophylactic effect than a previously validated once-a-month treatment. METHOD: A total of 233 women 20-60 years of age with recurrent unipolar depression were treated in an outpatient research clinic. After participants had achieved remission with weekly IPT or, if required, with weekly IPT plus antidepressant pharmacotherapy, they were randomly assigned to weekly, twice-monthly, or monthly maintenance IPT monotherapy for 2 years or until a recurrence of their depression occurred. RESULTS: Among participants who remitted with IPT alone and entered maintenance treatment (N=99), 19 (26%) of the 74 who remained in the study throughout the 2-year maintenance phase experienced a recurrence of depression. Among participants who required the addition of a selective serotonin reuptake inhibitor to achieve remission (N=90), 32 (36%) sustained that remission through continuation treatment and drug discontinuation and began maintenance treatment; of these, 13 (50%) of the 26 who remained in the study throughout the maintenance phase experienced a recurrence. Survival analysis of time to recurrence by randomized treatment frequency showed no effect on recurrence-free survival in either treatment subgroup. CONCLUSIONS: These results suggest that maintenance IPT, even at a frequency of only one visit per month, is a good method of prophylaxis for women who can achieve remission with IPT alone. In contrast, among those who require the addition of pharmacotherapy, IPT monotherapy represents a significantly less efficacious approach to maintenance treatment

Panic-agoraphobic spectrum: Reliability and validity of assessment instruments

DSM IV is a simple, reliable diagnostic system with many advantages. However, DSM diagnostic criteria may not provide sufficient characterization of clinically significant symptoms. We have undertaken a project to assess an array (spectrum) of clinical features associated with different DSM Disorders. The purpose of this paper is to report on reliability of assessment instruments for Panic-Agoraphobic Spectrum (PAS), to document convergent validity of PAS symptom groupings, and to confirm the relationship between PAS and DSM IV Panic Disorder (PD). We studied 22 normal controls and 95 outpatients who met criteria for Panic Disorder with and without lifetime Major Depression, and Major Depression or Obsessive Compulsive Disorder without lifetime Panic Disorder. Assessment instruments had excellent reliability and there was good concordance between interview and self-report formats. PAS scores were highest in subjects with PD, followed by outpatients without PD, and were lowest in normal controls. PAS scores varied among PD patients, and a subgroup of patients without PD scored high on PAS. We conclude that PAS can be reliably assessed, and that it describes a valid, coherent constellation of features associated with DSM IV Panic Disorder, but providing additional important clinical information. Copyright © 2001 Elsevier Science Ltd