Chronic depression: development and evaluation of the luebeck questionnaire for recording preoperational thinking (LQPT)

<p>Abstract</p> <p>Background</p> <p>A standardized instrument for recording the specific cognitive psychopathology of chronically depressed patients has not yet been developed. Up until now, preoperational thinking of chronically depressed patients has only been described in case studies, or through the external observations of therapists. The aim of this study was to develop and evaluate a standardized self-assessment instrument for measuring preoperational thinking that sufficiently conforms to the quality criteria for test theory.</p> <p>Methods</p> <p>The "Luebeck Questionnaire for Recording Preoperational Thinking (LQPT)" was developed and evaluated using a german sample consisting of 30 episodically depressed, 30 chronically depressed and 30 healthy volunteers. As an initial step the questionnaire was subjected to an item analysis and a final test form was compiled. In a second step, reliability and validity tests were performed.</p> <p>Results</p> <p>Overall, the results of this study showed that the LQPT is a useful, reliable and valid instrument. The reliability (split-half reliability 0.885; internal consistency 0.901) and the correlations with other instruments for measuring related constructs (control beliefs, interpersonal problems, stress management) proved to be satisfactory. Chronically depressed patients, episodically depressed patients and healthy volunteers could be distinguished from one another in a statistically significant manner (p < 0.001).</p> <p>Conclusion</p> <p>The questionnaire fulfilled the classical test quality criteria. With the LQPT there is an opportunity to test the theory underlying the CBASP model.</p

Messung von schmerzbezogener Erlebensvermeidung: Analyse des Acceptance and Action Questionnaire-II-Pain bei Patienten mit chronischem Schmerz

Einleitung und Fragestellung: Erlebensvermeidung ('experiential avoidance') stellt einen zentralen störungsrelevanten Prozess im Rahmen der Akzeptanz- und Commitment-Therapie (ACT) dar. Zur Erfassung wurde der 'Acceptance and Action Questionnaire II' (AAQ-II) entwickelt und in den Niederlanden für eine Patientengruppe mit chronischem Schmerz adaptiert und validiert (AAQ-II-P). Hohe Werte im AAQ-II-P bedeuten hohe schmerzbezogene Erlebensvermeidung. Ziel der vorgestellten Untersuchung ist die Erfassung von schmerzbezogener Erlebensvermeidung mit einer deutschen Version des AAQ-II-P bei chronischen Schmerzpatienten und die Prüfung psychometrischer Merkmale des Messverfahrens. Methodik: Der AAQ-II wurde mittels eines Vorwärts-Rückwärts-Verfahrens ins Deutsche übersetzt, für chronischen Schmerz adaptiert (AAQ-II-P) und von 168 Patienten einer universitären Schmerzambulanz beantwortet. Zusätzlich wurden Daten zu schmerzbedingter Beeinträchtigung (CPG: Schweregrad nach von Korff) und Schmerzkatastrophisieren (PCS) erhoben sowie zu gesundheitsbezogener Lebensqualität (SF-12), Angst und Depressivität (HADS-D). Ebenfalls erfasst wurden allgemeine Persönlichkeitsmerkmale (BFI-K) und habituelle Achtsamkeit (KIMSS). Ausgewertet wurden Reliabilität und faktorielle Validität des AAQ-II-P sowie seine Beziehung zu den anderen psychometrischen Verfahren. Ergebnisse: Der AAQ-II-P erzielte eine hohe interne Konsistenz mit alpha= 0,89 sowie eine eindimensionale Faktorenstruktur mit 61 % aufgeklärter Varianz. Geringe Korrelationen ergaben sich zu Persönlichkeitsdimensionen (maximal r= 0,44 zu Neurotizismus) und Achtsamkeit (maximal r= -0,43 zu Akzeptanz). Ein hoher Zusammenhang fand sich zu Schmerzkatastrophisieren (r= 0,75), Depression (r= 0,73) und Angst (r= 0,66). Die Beziehung zu Lebensqualität war am stärksten ausgeprägt auf der Psychischen Summenskala (r= -0,58). Diskussion und Schlussfolgerung: Die deutsche Version des AAQ-II-P hat eine gute Reliabilität und weist hinsichtlich Zuverlässigkeit und Faktorenstruktur hohe Vergleichbarkeit mit der Originalversion auf. Die Beziehungen zu den Skalen der psychometrischen Verfahren sind zumeist in erwarteter Richtung und Höhe. Patienten mit chronischem Schmerz und hoher schmerzbezogener Erlebensvermeidung tendieren deutlich zum Schmerzkatastrophisieren und zeichnen sich durch schlechtere psychische Lebensqualität aus. Dies spricht für die Relevanz des Konstrukts hinsichtlich therapeutischer Zielvariablen

Quality of life in aortic valve replacement: pulmonary autografts versus mechanical prostheses

AbstractOBJECTIVESWe sought to determine whether the quality of life (QoL) is different in patients after aortic valve replacement with mechanical prostheses or pulmonary autografts.BACKGROUNDQuality of life after mechanical valve replacement may be affected by the risk of thromboembolism and anticoagulation, and after autograft implantation, by the risk of degeneration and re-operation especially of the homograft.METHODSTwo groups of 40 patients each—one after the autograft procedure (group I) and one after mechanical valve implantation (group II)—were matched for age, gender and length of follow-up. At latest follow-up, all patients underwent routine echocardiography, the short-form health survey (SF-36) QoL survey and an extensive psychological investigation.RESULTSPatients with an autograft showed better QoL scales, as compared with mechanical valve recipients. The difference was significant for both the physical (72.72 ± 20.00 vs. 60.27 ± 26.07, p = 0.021) and psychological health sum scores (74.71 ± 21.03 vs. 64.71 ± 23.49, p = 0.046) and for the subtests of physical functioning (73.72 ± 22.44 vs. 62.77 ± 25.42, p = 0.049), physical pain (88.39 ± 19.13 vs. 73.36 ± 27.08, p ≤ 0.006), general health perception (64.37 ± 17.88 vs. 51.86 ± 22.86, p ≤ 0.008) and health change (61.89 ± 18.94 vs. 50.11 ± 24.37, p = 0.02). The QoL variables did not correlate to pressure gradients, ejection fraction and New York Heart Association functional class. Psychometric tests revealed no meaningful differences between the groups.CONCLUSIONSThis study provides some evidence that patients with pulmonary autografts have greater benefit in terms of QoL, as compared with recipients of mechanical valve substitutes

All Unhappy Childhoods Are Unhappy in Their Own Way—Differential Impact of Dimensions of Adverse Childhood Experiences on Adult Mental Health and Health Behavior

Adverse childhood experiences have consistently been linked with poor mental and somatic health in adulthood. However, due to methodological restraints of the main lines of research using cumulative or selective models, little is known about the differential impact of different dimensions of adverse childhood experiences. Therefore, we gathered data from 396 psychiatric in-patients on the Adverse Childhood Experiences (ACE) questionnaire, extracted dimensions using factor analysis and compared this dimensional model of adverse childhood experiences to cumulative and selective models. Household Dysfunction (violence against the mother, parental divorce, substance abuse or incarceration of a household member) was associated with poor health behaviors (smoking, alcohol dependency and obesity as proxy marker for an imbalance between energy intake and physical activity) and with poorer socio-economic achievement (lower education and income) in adulthood. The previously reported associations of maltreatment and sexual abuse with these outcome criteria could not be corroborated. Both Maltreatment (emotional and physical neglect and abuse) and Sexual Abuse predicted BPD, PTSD and suicidal behavior. However, the two ACE dimensions showed sufficiently divergent validity to warrant separate consideration in future studies: Maltreatment was associated with affective and anxiety disorders such as social phobia, panic disorder and major depressive disorder, whereas Sexual Abuse was associated with dysregulation of bodily sensations such as pain intensity and hunger/satiation. Also, we found both quantitative and qualitative evidence for the superiority of the dimensional approach to exploring the consequences of adverse childhood experiences in comparison to the cumulative and selective approaches

Psychometric evaluation of a screening question for persistent depressive disorder

Abstract Background About one in five patients with depression experiences a chronic course. Despite the great burden associated with this disease, there is no current screening instrument for Persistent Depressive Disorder (PDD). In the present study, we examine a short screening test, the persistent depression screener (PDS), that we developed for DSM-5 PDD. The PDS is comprised of one question that is administered following an initial self-assessment for depression. Methods Ninety patients from an inpatient clinic/day clinic specialized in treating depression completed the PDS. They were also assessed using a structured clinical interview covering the DSM-5 criteria for PDD. Retest reliability was examined after two weeks (n = 69, 77%). Results In this sample, the prevalence of PDD was 64%. Sensitivity of the PDS was 85% with a positive predictive value of 80%. Specificity was 63%. Positive and negative likelihood ratios were 2.3 and .24, respectively. Agreement between the PDS results and the outcome of the clinical interview was moderate (Cohen’s Kappa κ = .48 ([95%-CI .28, .68], p < .001, SE = 0.10)). Prevalence-adjusted bias-adjusted Kappa was PABAK = .53. Retest reliability of the PDS was moderate (Cohen’s Kappa κ = .52 ([95%-CI .3, .74], p < .001, SE = 0.11)). Conclusions The present study shows that the PDS - when applied following a self-rating depression scale - might be a valid and reliable way to detect PDD. However, the results of the PDS must be confirmed by a diagnostic interview

The Use of Antidepressive Agents and Bone Mineral Density in Women: A Meta-Analysis

Antidepressive agents are one of the fastest-growing classes of prescribed drugs. However, the effects of antidepressive agents on bone density are controversial. The aim of this meta-analysis is to evaluate the state of research on the relationship between the use of tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) and bone mineral density (BMD) in women. The database searched was Pubmed. The meta-analysis included human studies in women fulfilling the following criteria: (i) an assessment of bone mineral density in the lumbar spine, the femoral neck or the total hip; (ii) a comparison of the BMD of depressed individuals using antidepressive agents (SSRIs or TCAs), and a control group that did not use antidepressive agents; (iii) measurement of BMD using dual-energy X-ray absorptiometry (DXA); and (iv) calculations of the mean BMD and standard deviation or standard error. Four studies were identified, which, in total, included 934 women using antidepressive agents and 5767 non-using individuals. The results showed that no significant negative composite weighted mean effect sizes were identified for the comparisons between SSRI users and non-users. Similarly, no significant negative composite weighted mean effect sizes were identified for the comparisons between TCA users and non-users, indicating similar BMD in SSRI or TCA users and non-users. The meta-analysis shows that the association between antidepressant medication and bone mineral density has not been extensively researched. Only four studies fulfilled the inclusion criteria. The global result of the literature review and meta-analysis was that the use of antidepressive agents was not associated with lower or higher BMD. This result applies to both SSRIs and TCAs and to all measurement locations (lumbar spine, femoral neck and total hip)

Das Kognitive Inventar für Borderline-Persönlichkeitsstörung (KIB). Eine Untersuchung zur Reliabilität und Validität

Theoretischer Hintergrund: Das Kognitive Inventar der Borderline-Persönlichkeitsstörung (KIB) wurde zur Messung von störungstypischen Überzeugungen sowie assoziierten behavioralen und emotionalen Symptomen entwickelt. Fragestellung: Die psychometrischen Kennwerte des KIB wurden untersucht und ergänzen die Erkenntnisse einer Pilotstudie. Methode: Die Reliabilität, die faktorielle, konvergente, divergente und differenzielle Validität sowie die Änderungssensitivität wurden anhand von zwei klinischen (Borderline-Persönlichkeitsstörung und Achse I-Störungen; n = 150) und einer nicht-klinischen Stichprobe (n = 70) untersucht. Ergebnisse: Die Ergebnisse zeigen eine hohe Reliabilität, eine hohe konvergente Validität und eine zufriedenstellende divergente Validität. Die differenzielle Validität ist als gut und die Änderungssensitivität als zufriedenstellend zu bewerten. Schlussfolgerungen: Das KIB ermöglicht eine reliable und valide Erfassung störungstypischer Regeln und Einstellungen bei BPS. Seine Besonderheit liegt in der Berücksichtigung subjektiver Funktionen selbstschädigender Verhaltensweisen