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Dimensional personality traits and treatment outcome in patients with major depressive disorder
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
positive thinking pattern and the emotional stance versus pregnancy. The improvement was reported from the second week of LT. Side effects were minimal and included nausea and headache during the first 2 weeks of treatment. Conclusion: LT in the treatment of depression during pregnancy is a safe and realistic alternative if medication is no option or not accepted by the patient. Keywords: Light therapy, Preganancy, Depression
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multivariate model. Additional information from predictors will be evaluated with a stepwise backward elimination method. Discussion: With this study we will present a clinical prognostic model that can easily be used in practice. When a clinician considers paroxetine for a specific patient with depressive disorder, our model could give insight into the prognosis for this patient. Keywords: Major depressive disorder, SSRI, Treatment response, Prognosis, Multivariate logistic regression
doi:10.1016/j.jad.2007.12.073 doi:10.1016/j.jad.2007.12.074
[P1.41] Prediction of response to paroxetine treatment in patients with a depressive disorder K.A. Wittkampf *, H.G. Ruhe, H.C. van Weert, J. Huyser, P.E. Bindels, A.H. Schene
[P1.42] Dimensional personality traits and treatment outcome in patients with major depressive disorder R.M. Bagby*,a,b, L.C. Quilty a,b, F. De Fruyt d, J.-P. Rolland e, S.H. Kennedy b,c, F. Rouillon e
University of Amsterdam, The Netherlands a
Introduction: Despite the introduction of different antidepressants, an unfavourable response to pharmacological intervention in the treatment of depression (MDD) occurs in 40–60% of the patients. The ability to select the most successful treatment and to predict the outcome of therapy for a patient would be of great value to both patients and physicians. The aim of this study is to investigate the prognostic value of a number of determinants for insufficient response to paroxetine treatment in patients with a depressive disorder. Methods: A set of predictors, based on a systematic review of prognostic factors in MDD, was collected in 107 primary care patients with MDD meeting DSM-IV criteria (assessed with the Structured Clinical Interview for DSMIV (SCID)), with Hamilton-scores (HDRS) of 19 and higher. These patients were openly treated with paroxetine for 6 weeks. After 6 weeks response was measured with Hamilton-scores. Response was defined as 50% decrease or more in Hamilton score compared to baseline. The following predictors will be analysed with multivariate logistic regression analysis: duration of the depressive episode, number of prior episodes, severity, psychiatric comorbidity, somatic comorbidity, social support, life events and Internal or External Locus of Control. After analysis a prognostic model will be constructed. Results: As the cohort was recently completed, we have not yet finished the analyses, which will be presented at the conference. We will first present univariate odds ratios per predictor with confidence intervals. Predictors with p = 0.1 in univariate models will be entered in a
Centre for Addiction & Mental Health, Canada University of Toronto, Canada c University Health Network, Canada d Ghent University, Belgium e Université de Paris, France b
Background: The aim of this study was to investigate the association between dimensional personality traits from the Five-Factor Model (FFM) and treatment outcome in patients with Major Depressive Disorder (MDD). Methods: Six hundred forty-nine outpatients with MDD participated in a multi-centre, randomised double-blind longitudinal study for 6 months. All patients received a combination of antidepressant medication and psychotherapy; they were randomised to medication condition (tianeptine or fluoxetine), and nonrandomly assigned to psychotherapy condition (supportive, cognitive-behavioural, or psychodynamic therapy). Patients were required to have a diagnosis of MDD based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The Montgomery Asberg Depression Rating Scale was used to assess depression severity at pre- and post-treatment. The Système de Description en Cinq Dimensions was used to assess the personality domains of the FFM at pre-treatment. Results: Group comparisons revealed that patients who responded had lower Neuroticism (t = 4.22, p b .001), and higher Extraversion (t = 4.01, p b .001) and Openness to Experience (t = 3.57, p b .001) scores compared to non-responders. Regression analyses, which controlled
S88
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
for shared variance among the five personality domains, indicated that Neuroticism (χ 2 = 4.06, p = .04) and Conscientiousness (χ2 = 8.98, p = .003) were significantly and uniquely associated with response. The twoway interactions between Neuroticism × Extraversion (χ2 = 4.49, p = .03) and Extraversion × Conscientiousness (χ2 = 5.91, p = .01) were also associated with response. These were mostly replicated across the treatment completer and intent-to-treat samples. Conclusions: Dimensional personality traits predict of response for individuals with MDD. Keywords: Major depression, Treatment outcome, Personality, Prognosis doi:10.1016/j.jad.2007.12.075
[P1.43] Predictors of patient non-adherence to continuation and maintenance antidepressant use in recurrent depression M.C. ten Doesschatea, C.L.H Bocktingb, A.H. Schene*,a a
University of Amsterdam, The Netherlands University of Groningen, The Netherlands
b
Introduction: In chronic diseases adherence to medication is a problem. In recurrent depression adequate adherence to antidepressants (AD) is needed to achieve optimal benefit from treatment, i.e. to prevent recurrence. Little is known about adherence to AD and its predictors after the acute phase in depression. Finding predictors for non-adherence to AD in the continuation and maintenance phase might help to identify high risk patients and to develop tailored interventions for this particular group. Methods: We studied 131 patients with recurrent depression (DSM-IV) remitted on AD participating in a trial comparing preventive cognitive therapy vs. treatment as usual (1,2). The intervention was not aimed at improving adherence to AD. First, we prospectively assessed (non-) adherence every three months over 2 years with the Medication Adherence Questionnaire (3). Secondly, we quantified the association of non-adherence with future recurrence. Finally, we examined patient-, illness- and treatment related factors as potential predictors of nonadherence to continuation and maintenance AD use. Results: Non-adherence during 2 year follow-up ranged from 39.7% to 52.7%. Based on these prevalences over two years 20.9% was always non-adherent, 48.4% was
intermittently non-adherent and 30.8% was always adherent. Non-adherence predicted time to recurrence. The prediction model for non-adherence over two years included lower education level, more personality disorder symptomatology and more previous episodes (R2 = 18%). Discussion: Non-adherence to continuation and maintenance AD treatment (the longest phase of treatment) in recurrent depression is frequent (like in other chronic diseases) and a potential risk for recurrence. Nonadherence seems difficult to predict. Clinical implications of these findings and suggestions for future research will be addressed. References Bockting, C.L., Schene, A.H., Spinhoven, P., et al. (2005) Preventing relapse/recurrence in recurrent depression with cognitive therapy: a randomized controlled trial. J. Consult. Clin. Psychol., 73, 647–657. Bockting, C.L., ten Doesschate, M.C., Spijker, J., et al. (in press) Continuation and maintenance use of antidepressants in recurrent depression. Psychother. Psychosom. Morisky, D.E., Green, L.W., and Levine, D.M. (1986) Concurrent and predictive validity of a selfreported measure of medication adherence. Med. Care, 24, 67–74. Keywords: Recurrent depression, Non-adherence, Antidepressants, Prediction doi:10.1016/j.jad.2007.12.076
[P1.44] The effect of olanzapine monotherapy on subjective sleep estimates in acute mania B.H. Yoon*,a, W.M. Bahkb, S.Y. Leec , J.G. Leed, D.I. Jone, K.J. Minf a
Naju National Hospital, Republic of Korea Catholic University of Korea, Republic of Korea c Wonkwang University, Republic of Korea d Dong-Seo Hospital, Republic of Korea e Hallym University, Republic of Korea f Chung-Ang University, Republic of Korea b
Objective: The aim of this study was to investigate the effect of 6-week olanzapine monotherapy on subjective estimates of sleep and hangover in patients with acute bipolar disorder. Method: In a Korean multi-center, open-label, 6-week study, patients with a DSM-IV diagnosis of bipolar I disorder (manic or mixed episodes) were included to
positive thinking pattern and the emotional stance versus pregnancy. The improvement was reported from the second week of LT. Side effects were minimal and included nausea and headache during the first 2 weeks of treatment. Conclusion: LT in the treatment of depression during pregnancy is a safe and realistic alternative if medication is no option or not accepted by the patient. Keywords: Light therapy, Preganancy, Depression
S87
multivariate model. Additional information from predictors will be evaluated with a stepwise backward elimination method. Discussion: With this study we will present a clinical prognostic model that can easily be used in practice. When a clinician considers paroxetine for a specific patient with depressive disorder, our model could give insight into the prognosis for this patient. Keywords: Major depressive disorder, SSRI, Treatment response, Prognosis, Multivariate logistic regression
doi:10.1016/j.jad.2007.12.073 doi:10.1016/j.jad.2007.12.074
[P1.41] Prediction of response to paroxetine treatment in patients with a depressive disorder K.A. Wittkampf *, H.G. Ruhe, H.C. van Weert, J. Huyser, P.E. Bindels, A.H. Schene
[P1.42] Dimensional personality traits and treatment outcome in patients with major depressive disorder R.M. Bagby*,a,b, L.C. Quilty a,b, F. De Fruyt d, J.-P. Rolland e, S.H. Kennedy b,c, F. Rouillon e
University of Amsterdam, The Netherlands a
Introduction: Despite the introduction of different antidepressants, an unfavourable response to pharmacological intervention in the treatment of depression (MDD) occurs in 40–60% of the patients. The ability to select the most successful treatment and to predict the outcome of therapy for a patient would be of great value to both patients and physicians. The aim of this study is to investigate the prognostic value of a number of determinants for insufficient response to paroxetine treatment in patients with a depressive disorder. Methods: A set of predictors, based on a systematic review of prognostic factors in MDD, was collected in 107 primary care patients with MDD meeting DSM-IV criteria (assessed with the Structured Clinical Interview for DSMIV (SCID)), with Hamilton-scores (HDRS) of 19 and higher. These patients were openly treated with paroxetine for 6 weeks. After 6 weeks response was measured with Hamilton-scores. Response was defined as 50% decrease or more in Hamilton score compared to baseline. The following predictors will be analysed with multivariate logistic regression analysis: duration of the depressive episode, number of prior episodes, severity, psychiatric comorbidity, somatic comorbidity, social support, life events and Internal or External Locus of Control. After analysis a prognostic model will be constructed. Results: As the cohort was recently completed, we have not yet finished the analyses, which will be presented at the conference. We will first present univariate odds ratios per predictor with confidence intervals. Predictors with p = 0.1 in univariate models will be entered in a
Centre for Addiction & Mental Health, Canada University of Toronto, Canada c University Health Network, Canada d Ghent University, Belgium e Université de Paris, France b
Background: The aim of this study was to investigate the association between dimensional personality traits from the Five-Factor Model (FFM) and treatment outcome in patients with Major Depressive Disorder (MDD). Methods: Six hundred forty-nine outpatients with MDD participated in a multi-centre, randomised double-blind longitudinal study for 6 months. All patients received a combination of antidepressant medication and psychotherapy; they were randomised to medication condition (tianeptine or fluoxetine), and nonrandomly assigned to psychotherapy condition (supportive, cognitive-behavioural, or psychodynamic therapy). Patients were required to have a diagnosis of MDD based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The Montgomery Asberg Depression Rating Scale was used to assess depression severity at pre- and post-treatment. The Système de Description en Cinq Dimensions was used to assess the personality domains of the FFM at pre-treatment. Results: Group comparisons revealed that patients who responded had lower Neuroticism (t = 4.22, p b .001), and higher Extraversion (t = 4.01, p b .001) and Openness to Experience (t = 3.57, p b .001) scores compared to non-responders. Regression analyses, which controlled
S88
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
for shared variance among the five personality domains, indicated that Neuroticism (χ 2 = 4.06, p = .04) and Conscientiousness (χ2 = 8.98, p = .003) were significantly and uniquely associated with response. The twoway interactions between Neuroticism × Extraversion (χ2 = 4.49, p = .03) and Extraversion × Conscientiousness (χ2 = 5.91, p = .01) were also associated with response. These were mostly replicated across the treatment completer and intent-to-treat samples. Conclusions: Dimensional personality traits predict of response for individuals with MDD. Keywords: Major depression, Treatment outcome, Personality, Prognosis doi:10.1016/j.jad.2007.12.075
[P1.43] Predictors of patient non-adherence to continuation and maintenance antidepressant use in recurrent depression M.C. ten Doesschatea, C.L.H Bocktingb, A.H. Schene*,a a
University of Amsterdam, The Netherlands University of Groningen, The Netherlands
b
Introduction: In chronic diseases adherence to medication is a problem. In recurrent depression adequate adherence to antidepressants (AD) is needed to achieve optimal benefit from treatment, i.e. to prevent recurrence. Little is known about adherence to AD and its predictors after the acute phase in depression. Finding predictors for non-adherence to AD in the continuation and maintenance phase might help to identify high risk patients and to develop tailored interventions for this particular group. Methods: We studied 131 patients with recurrent depression (DSM-IV) remitted on AD participating in a trial comparing preventive cognitive therapy vs. treatment as usual (1,2). The intervention was not aimed at improving adherence to AD. First, we prospectively assessed (non-) adherence every three months over 2 years with the Medication Adherence Questionnaire (3). Secondly, we quantified the association of non-adherence with future recurrence. Finally, we examined patient-, illness- and treatment related factors as potential predictors of nonadherence to continuation and maintenance AD use. Results: Non-adherence during 2 year follow-up ranged from 39.7% to 52.7%. Based on these prevalences over two years 20.9% was always non-adherent, 48.4% was
intermittently non-adherent and 30.8% was always adherent. Non-adherence predicted time to recurrence. The prediction model for non-adherence over two years included lower education level, more personality disorder symptomatology and more previous episodes (R2 = 18%). Discussion: Non-adherence to continuation and maintenance AD treatment (the longest phase of treatment) in recurrent depression is frequent (like in other chronic diseases) and a potential risk for recurrence. Nonadherence seems difficult to predict. Clinical implications of these findings and suggestions for future research will be addressed. References Bockting, C.L., Schene, A.H., Spinhoven, P., et al. (2005) Preventing relapse/recurrence in recurrent depression with cognitive therapy: a randomized controlled trial. J. Consult. Clin. Psychol., 73, 647–657. Bockting, C.L., ten Doesschate, M.C., Spijker, J., et al. (in press) Continuation and maintenance use of antidepressants in recurrent depression. Psychother. Psychosom. Morisky, D.E., Green, L.W., and Levine, D.M. (1986) Concurrent and predictive validity of a selfreported measure of medication adherence. Med. Care, 24, 67–74. Keywords: Recurrent depression, Non-adherence, Antidepressants, Prediction doi:10.1016/j.jad.2007.12.076
[P1.44] The effect of olanzapine monotherapy on subjective sleep estimates in acute mania B.H. Yoon*,a, W.M. Bahkb, S.Y. Leec , J.G. Leed, D.I. Jone, K.J. Minf a
Naju National Hospital, Republic of Korea Catholic University of Korea, Republic of Korea c Wonkwang University, Republic of Korea d Dong-Seo Hospital, Republic of Korea e Hallym University, Republic of Korea f Chung-Ang University, Republic of Korea b
Objective: The aim of this study was to investigate the effect of 6-week olanzapine monotherapy on subjective estimates of sleep and hangover in patients with acute bipolar disorder. Method: In a Korean multi-center, open-label, 6-week study, patients with a DSM-IV diagnosis of bipolar I disorder (manic or mixed episodes) were included to