• Patients with depression who self-refer for transcranial magnetic stimulation treatment: exploratory qualitative study

      Clarke, Martin; Lankappa, Sudheer (2018)
      Aims and methodAs part of a larger clinical trial concerning the use of transcranial magnetic stimulation (TMS) for treatment-resistant depression, the current study aimed to examine referral emails to describe the clinical characteristics of people who self-refer and explore the reasons for self-referral for TMS treatment. We used content analysis to explore these characteristics and thematic analysis to explore the reasons for self-referral.RESULTSOf the 98 referrals, 57 (58%) were for women. Depressive disorder was the most commonly cited diagnosis, followed by bipolar affective disorder. Six themes emerged from the thematic analysis: treatment resistance, side-effects of other treatments, desperation for relief, proactively seeking information, long-term illness and illness getting worse.Clinical implicationsTMS has recently been recommended in the UK for routine use in clinical practice. Therefore, the number of people who self-refer for TMS treatment is likely to increase as its availability increases.Declaration of interestNone.
    • Preferred intensity exercise for adolescents receiving treatment for depression: A pragmatic randomised controlled trial

      Guo, Boliang; Armstrong, Marie (2015)
      Background: Exercise has been shown to be effective in treating depression, but trials testing the effect of exercise for depressed adolescents utilising mental health services are rare. The aim of this study was to determine the effectiveness of a preferred intensity exercise intervention on the depressive symptoms of adolescents with depression.; Methods: We randomly assigned 87 adolescents who were receiving treatment for depression to either 12 sessions of aerobic exercise at preferred intensity alongside treatment as usual or treatment as usual only. The primary outcome was depressive symptom change using the Children's Depression Inventory 2(nd) Version (CDI-2) at post intervention. Secondary outcomes were health-related quality of life and physical activity rates. Outcomes were taken at baseline, post intervention and at six month follow up.; Results: CDI-2 score reduction did not differ significantly between groups at post-intervention (est. 95% CI -6.82, 1.68, p = 0.23). However, there was a difference in CDI-2 score reduction at six month follow-up in favour of the intervention of -4.81 (est. 95% CI -9.49, -0.12, p = 0.03). Health-related quality of life and physical activity rates did not differ significantly between groups at post-intervention and follow-up.; Conclusions: There was no additional effect of preferred intensity exercise alongside treatment as usual on depressive reduction immediately post intervention. However, effects were observed at six months post-intervention, suggesting a delayed response. However, further trials, with larger samples are required to determine the validity of this finding.; Trial Registration: ClinicalTrials.gov NCT01474837, March 16 2011.;
    • Prefrontal cortex function in remitted major depressive disorder

      Nixon, Neil L.; Liddle, Peter F.; Worwood, Graham; Nixon, Elena (2013)
      BACKGROUND: Recent models of major depressive disorder (MDD) have proposed the rostral anterior cingulate (rACC) and dorsomedial prefrontal cortex (dmPFC) as nexus sites in the dysfunctional regulation of cognitive-affective state. Limited evidence from remitted-state MDD supports these theories by suggesting that aberrant neural activity proximal to the rACC and the dmPFC may play a role in vulnerability to recurrence/relapse within this disorder. Here we present a targeted analysis assessing functional activity within these two regions of interest (ROIs) for groups with identified vulnerability to MDD: first, remitted, high predicted recurrence-risk patients; and second, patients suffering observed 1-year recurrence. Method Baseline T2* images sensitive to blood oxygen level-dependent (BOLD) contrast were acquired from patients and controls during a Go/No-Go (GNG) task incorporating negative feedback, with 1-year patient follow-up to identify recurrence. BOLD contrast data for error commission (EC) and visual negative feedback (VNF) were used in an ROI analysis based on rACC and dmPFC coordinates from the literature, comparing patients versus controls and recurrence versus non-recurrence versus control groups.
    • Primary care depression advice clinic

      Ludvigsen, Anna; Nixon, Neil L. (2018)
      This innovative project aims to improve the care delivered to people suffering from treatment resistant and recurrent depression through the provision of a specialist Depression Advice Clinic (DAC) in a primary care setting. The concept of collaboration across primary and secondary care is in line with the NHS Five Year Forward Plan and the local Rushcliffe CCG multi-specialty provider vanguard. It also enables a key aim of the Shape of training Review into Postgraduate Medical Training to be met by giving a Health Education England funded Fellow the opportunity to experience training that bridges traditional boundaries of primary and secondary care.
    • Primary care depression advice clinic

      Ludvigsen, Anna; Nixon, Neil L. (2019)
      Aims and Objectives: The aim of the Depression Advice Clinic (DAC) was to provide timely specialist advice on depression management within a primary care setting for individuals suffering from treatment resistant or recurrent depression. Method(s): The clinic was located in a primary care centre and offered one-off 90 minute assessments to patients referred by their GPs. Patients were seen by a senior psychiatry trainee who conducted a comprehensive psychiatric history, examination, diagnosis and bio-psycho-social formulation. Following discussion with the supervising consultant psychiatrist a letter with recommendations for next step treatments was sent to patient and their GP. The clinic employed one full time senior trainee, a consultant psychiatrist at 12.5% full time equivalent and an administrator at 25% full time equivalent as well as incurring overheads for consultation room rental. Result(s): During the 12 month operational period 127 referrals were received and 124 assessment appointments were offered. The mean wait for assessment was 23 days (in secondary care this is closer to 70 days) and the completed assessment rate was 92% (in local audit of secondary care services this was 81%). Following initial assessment 96% patients were discharged to their GP with advice on lifestyle, self-care and next step pharmacological and psychotherapeutic management option. 4% of patients were transferred directly to secondary/ tertiary care psychiatry, for reasons including severity, risk or initiation of medications that could not be carried out in primary care (e.g. Lithium). Discussion(s): The DAC achieved its aim of providing timely assessment and advice for people suffering from persistent or recurrent depression with most patients being seen much sooner than they would have had they been referred to secondary care. There were also some surprising, and potentially significant, findings from the clinic: more men were referred to the clinic than would have been expected to be seen in secondary services and one third of patients referred with an existing diagnosis of depression had this diagnosis changed following assessment (primarily to one of the anxiety disorders). Each of the patients referred from the DAC into secondary and tertiary care disclosed that they had made plans to end their life which they had concealed form their families and GPs and that being seen in the clinic had prevented them from acting on their plans. Conclusion(s): Referral rates, completed appointment rates and stakeholder feedback suggest that the DAC was an operationally feasible way of working across primary, secondary and tertiary care, whilst also being acceptable to GPs and patients. It is estimated that the average cost per completed suicide for those of working age in England is 1.67m. Since at least three patients reported that being seen in the clinic had prevented them from ending their lives the DAC was also a cost effective way of decreasing the mortality and morbidity resulting from chronic and recurring depression.
    • Psychiatric emergencies: Assessing and managing suicidal ideation

      Michail, Maria (2017)
      The assessment of suicide risk is a daunting, but increasingly frequent task for outpatient practitioners. Guidelines for depression screening identify more individuals at risk for treatment and mental health resources are not always easily accessible. For those patients identified as in need of a formal suicide risk assessment, this article reviews established risk and protective factors for suicide and provides a framework for the assessment and management of individuals at risk of suicide. The assessment should be explicitly documented with a summary of the most relevant risk/protective factors for that individual with a focus on interventions that may mitigate risk. Copyright © 2016
    • Psychological management of mood disorders

      Morriss, Richard K. (2009)
      Evidence-based psychological treatments for adults with unipolar depressive disorder and bipolar disorder are reviewed. There is most empirical evidence for cognitive behavioural therapy (CBT), which is examined in terms of what it is and its evidence base in unipolar depression, including severe, chronic, and treatment-resistant cases. The evidence base for the combination of CBT plus antidepressant treatment, including where continuation CBT may be usefully employed, reveals greater effectiveness than antidepressant treatment with continuing clinical support or other forms of psychotherapy in patients with severe, chronic, and treatment-resistant depression or depression with co-morbid personality disorder. Briefer descriptions and evidence for the role of mindfulness-based cognitive therapy, behaviour therapy, problem-solving, interpersonal therapy, psychodynamic therapy and cognitive analytical therapy are reviewed. All of these have some evidence for effectiveness and the roles of some of these treatments are starting to become clearer. Simple psychological treatments for bipolar disorder, such as medication adherence and early warning symptoms interventions, can improve some types of clinical outcome, but longer psychological interventions delivered by highly skilled therapists such as CBT and group psycho-education may have more comprehensive evidence of effectiveness. There is some preliminary evidence for the effectiveness of some psychological treatments in bipolar depression. Overall, the effectiveness of psychological treatments for unipolar depressive disorder and bipolar disorder is now well established and an understanding is starting to be obtained as to when they may be employed most usefully. © 2009 Elsevier Ltd. All rights reserved.
    • Psychological models of mood disorders

      Morriss, Richard K. (2006)
      A number of psychological models for depression and bipolar disorder have at least some empirical support, are in common use and spawned effective psychological treatments for mood disorder. The article will discuss cognitive behaviour therapy and life events and social support models for unipolar depressive episodes, and more briefly review psychodynamic and medication adherence models for depression, and the development of psychological models in bipolar disorder. These models fit well with the view of many patients that their mood disorder is at least in part psychologically and socially caused. They also promote active self-management of their condition rather than passive compliance with treatment. As a result, these psychological approaches tend to improve the outcomes from medication. Effective care plans can be based on a formulation of cases with mood disorders using these psychological models without employing a formal course of psychological treatment. However, people who do not improve with such a plan may require a formal course of psychological treatment based on these models from an experienced therapist. Since these models tend to utilize information from the past that often cannot be verified, they are open to reporting and recall bias. Also, severely ill or immature patients may not be able to utilize these techniques. However, in suitable patients the use of these psychological models in addition to optimal prescribing of medication and continuity of care probably represent the current gold standard of care for mood disorders. © 2006 Elsevier Ltd. All rights reserved.
    • Psychological treatments for depression and anxiety in dementia and mild cognitive impairment

      Orrell, Martin (2022)
      BACKGROUNDExperiencing anxiety and depression is very common in people living with dementia and mild cognitive impairment (MCI). There is uncertainty about the best treatment approach. Drug treatments may be ineffective and associated with adverse effects. Guidelines recommend psychological treatments. In this updated systematic review, we investigated the effectiveness of different psychological treatment approaches.OBJECTIVESPrimary objective To assess the clinical effectiveness of psychological interventions in reducing depression and anxiety in people with dementia or MCI. Secondary objectives To determine whether psychological interventions improve individuals' quality of life, cognition, activities of daily living (ADL), and reduce behavioural and psychological symptoms of dementia, and whether they improve caregiver quality of life or reduce caregiver burden.SEARCH METHODSWe searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE, Embase, four other databases, and three trials registers on 18 February 2021.SELECTION CRITERIAWe included randomised controlled trials (RCTs) that compared a psychological intervention for depression or anxiety with treatment as usual (TAU) or another control intervention in people with dementia or MCI.DATA COLLECTION AND ANALYSISA minimum of two authors worked independently to select trials, extract data, and assess studies for risk of bias. We classified the included psychological interventions as cognitive behavioural therapies (cognitive behavioural therapy (CBT), behavioural activation (BA), problem-solving therapy (PST)); 'third-wave' therapies (such as mindfulness-based cognitive therapy (MBCT)); supportive and counselling therapies; and interpersonal therapies. We compared each class of intervention with control. We expressed treatment effects as standardised mean differences or risk ratios. Where possible, we pooled data using a fixed-effects model. We used GRADE methods to assess the certainty of the evidence behind each result.MAIN RESULTSWe included 29 studies with 2599 participants. They were all published between 1997 and 2020. There were 15 trials of cognitive behavioural therapies (4 CBT, 8 BA, 3 PST), 11 trials of supportive and counselling therapies, three trials of MBCT, and one of interpersonal therapy. The comparison groups received either usual care, attention-control education, or enhanced usual care incorporating an active control condition that was not a specific psychological treatment. There were 24 trials of people with a diagnosis of dementia, and five trials of people with MCI. Most studies were conducted in community settings. We considered none of the studies to be at low risk of bias in all domains.  Cognitive behavioural therapies (CBT, BA, PST) Cognitive behavioural therapies are probably slightly better than treatment as usual or active control conditions for reducing depressive symptoms (standardised mean difference (SMD) -0.23, 95% CI -0.37 to -0.10; 13 trials, 893 participants; moderate-certainty evidence). They may also increase rates of depression remission at the end of treatment (risk ratio (RR) 1.84, 95% CI 1.18 to 2.88; 2 studies, with one study contributing 2 independent comparisons, 146 participants; low-certainty evidence). We were very uncertain about the effect of cognitive behavioural therapies on anxiety at the end of treatment (SMD -0.03, 95% CI -0.36 to 0.30; 3 trials, 143 participants; very low-certainty evidence). Cognitive behavioural therapies probably improve patient quality of life (SMD 0.31, 95% CI 0.13 to 0.50; 7 trials, 459 participants; moderate-certainty evidence) and activities of daily living at end of treatment compared to treatment as usual or active control (SMD -0.25, 95% CI -0.40 to -0.09; 7 trials, 680 participants; moderate-certainty evidence). Supportive and counselling interventions Meta-analysis showed that supportive and counselling interventions may have little or no effect on depressive symptoms in people with dementia compared to usual care at end of treatment (SMD - .05, 95% CI -0.18 to 0.07; 9 trials, 994 participants; low-certainty evidence). We were very uncertain about the effects of these treatments on anxiety, which was assessed only in one small pilot study. Other interventions There were very few data and very low-certainty evidence on MBCT and interpersonal therapy, so we were unable to draw any conclusions about the effectiveness of these interventions.AUTHORS' CONCLUSIONSCBT-based treatments added to usual care probably slightly reduce symptoms of depression for people with dementia and MCI and may increase rates of remission of depression. There may be important effect modifiers (degree of baseline depression, cognitive diagnosis, or content of the intervention). CBT-based treatments probably also have a small positive effect on quality of life and activities of daily living. Supportive and counselling interventions may not improve symptoms of depression in people with dementia. Effects of both types of treatment on anxiety symptoms are very uncertain. We are also uncertain about the effects of other types of psychological treatments, and about persistence of effects over time. To inform clinical guidelines, future studies should assess detailed components of these interventions and their implementation in different patient populations and in different settings.
    • Psychological treatments for depression and anxiety in dementia and mild cognitive impairment: Systematic review and meta-analysis

      Orrell, Martin (2015)
      BACKGROUND: Anxiety and depression are common in people with dementia and mild cognitive impairment (MCI), but there is uncertainty about the effectiveness of both pharmacological and psychological therapies.
    • Psychometric properties of the five facets mindfulness questionnaire in moderate-to-severe, persistent depression

      Sweeney, Timothy; Morriss, Richard K.; Nixon, Elena; Guo, Boliang; Callaghan, Patrick (2021)
      ObjectivesMindfulness has been increasingly incorporated into modern psychotherapies and healthcare services. The importance of psychometrically quantifying the construct of mindfulness has become paramount. One of the most reliable and valid instruments for the assessment of different aspects of dispositional mindfulness is the Five Facets Mindfulness Questionnaire (FFMQ). However, the psychometric properties of the FFMQ are yet to be tested in individuals with high levels of persistent depression. This study therefore investigated the psychometric properties of the FFMQ in a clinical sample with moderate-to-severe, persistent depression.MethodsThe data of 187 participants recruited from a funded randomised controlled trial were utilised. Internal consistency was assessed and construct validity was examined with confirmatory factor analyses (CFA) and by statistically correlating the FFMQ to measures of depression, self-compassion, rumination and experiential avoidance.ResultsFindings supported the internal consistency of the FFMQ. CFA fit indices indicated that all correlated and hierarchical models fitted the data acceptably, with results slightly favouring the correlated model. Contrary to predictions however, individual facet loadings showed that the facet Observe loaded strongly onto an overarching factor of mindfulness, whilst Nonjudge loaded marginally. Nonjudge further showed a non-significant correlation with depression. However, exploratory post hoc analysis presented findings inconsistent with CFA.ConclusionsIn a sample of severely depressed individuals, psychometric investigation of the validity of the FFMQ highlighted contradictory findings relating to “Nonjudge”. Whilst such findings potentially challenge the validity of the FFMQ for use in its current structure in this sample, further investigation with a larger population is warranted.Trial RegistrationClinicalTrials.gov (NCT01047124) and the ISRCTN registry (ISRCTN10963342) (PsycInfo Database Record (c) 2021 APA, all rights reserved) (Source: journal abstract)
    • A randomised controlled trial investigating the clinical and cost-effectiveness of Alpha-Stim AID cranial electrotherapy stimulation (CES) in patients seeking treatment for moderate severity depression in primary care (Alpha-Stim-D Trial)

      Patel, Shireen; Boutry, Clement; Patel, Priya; Craven, Michael P.; Guo, Boliang; Butler, Debbie; Higton, Fred; McNaughton, Rebecca; Briley, Paul M.; Nixon, Neil L.; et al. (2022)
      BACKGROUNDMajor depression is the second leading cause of years lost to disability worldwide and is a leading contributor to suicide. However, first-line antidepressants are only fully effective for 33%, and only 40% of those offered psychological treatment attend for two sessions or more. Views gained from patients and primary care professionals are that greater treatment uptake might be achieved if people with depression could be offered alternative and more accessible treatment options. Although there is evidence that the Alpha-Stim Anxiety Insomnia and Depression (AID) device is safe and effective for anxiety and depression symptoms in people with anxiety disorders, there is much less evidence of efficacy in major depression without anxiety. This study investigates the effectiveness of the Alpha-Stim AID device, a cranial electrotherapy stimulation (CES) treatment that people can safely use independently at home. The device provides CES which has been shown to increase alpha oscillatory brain activity, associated with relaxation.METHODSThe aim of this study is to investigate the clinical and cost-effectiveness of Alpha-Stim AID in treatment-seeking patients (aged 16 years upwards) with moderate to moderately severe depressive symptoms in primary care. The study is a multi-centre parallel-group, double-blind, non-commercial, randomised controlled superiority trial. The primary objective of the study is to examine the clinical efficacy of active daily use of 8 weeks of Alpha-Stim AID versus sham Alpha-Stim AID on depression symptoms at 16 weeks (8 weeks after the end of treatment) in people with moderate severity depression. The primary outcome is the 17-item Hamilton Depression Rating Scale at 16 weeks. All trial and treatment procedures are carried out remotely using videoconferencing, telephone and postal delivery considering the COVID-19 pandemic restrictions.DISCUSSIONThis study is investigating whether participants using the Alpha-Stim AID device display a reduction in depressive symptoms that can be maintained over 8 weeks post-treatment. The findings will help to determine whether Alpha-Stim AID should be recommended, including being made available in the NHS for patients with depressive symptoms.TRIAL REGISTRATIONISRTCN ISRCTN11853110 . Registered on 14 August 2020.
    • Randomised controlled trial of the clinical and cost effectiveness of a specialist team for managing refractory unipolar depressive disorder

      Garland, Anne; Nixon, Neil L.; McDonald, Ruth; Sweeney, Timothy; Flambert, Heather; Fox, Richard (2010)
      Background: Around 40 per cent of patients with unipolar depressive disorder who are treated in secondary care mental health services do not respond to first or second line treatments for depression. Such patients have 20 times the suicide rate of the general population and treatment response becomes harder to achieve and sustain the longer they remain depressed. Despite this there are no randomised controlled trials of community based service delivery interventions delivering both algorithm based pharmacotherapy and psychotherapy for patients with chronic depressive disorder in secondary care mental health services who remain moderately or severely depressed after six months treatment. Without such trials evidence based guidelines on services for such patients cannot be derived. Methods/design: Single blind individually randomised controlled trial of a specialist depression disorder team (psychiatrist and psychotherapist jointly assessing and providing algorithm based drug and psychological treatment) versus usual secondary care treatment. We will recruit 174 patients with unipolar depressive disorder in secondary mental health services with a Hamilton Depression Rating Scale (HDRS) score >= 16 and global assessment of function (GAF) <= 60 after <= 6 months treatment. The primary outcome measures will be the HDRS and GAF supplemented by economic analysis incuding the EQ5 D and analysis of barriers to care, implementation and the process of care. Audits to benchmark both treatment arms against national standards of care will aid the interpretation of the results of the study. Discussion: This trial will be the first to assess the effectiveness and implementation of a community based specialist depression disorder team. The study has been specially designed as part of the CLAHRC Nottinghamshire, Derbyshire and Lincolnshire joint collaboration between university, health and social care organisations to provide information of direct relevance to decisions on commissioning, service provision and implementation.
    • Randomized controlled trial of computerized cognitive behavioural therapy for depressive symptoms: Effectiveness and costs of a workplace intervention

      Schneider, Justine; Morriss, Richard K. (2014)
      BACKGROUND: Depression and anxiety are major causes of absence from work and underperformance in the workplace. Cognitive behavioural therapy (CBT) can be effective in treating such problems and online versions offer many practical advantages. The aim of the study was to investigate the effectiveness of a computerized CBT intervention (MoodGYM) in a workplace context.
    • Recent advances in electroconvulsive therapy and physical treatments for depression

      Waite, Jonathan (2021)
      This article gives an update for practitioners on recent developments in the use of electroconvulsive therapy (ECT) and related treatment modalities in the contemporary treatment of depression in the UK. Details are provided on new information on the efficacy and side-effects of ECT both in research studies and in the real world, together with recent research on ECT's mode of delivery. There is a focus on the safe administration of ECT in clinical practice. An update on the regulatory framework for ECT in the UK is provided, together with up-to-date information on the legal situation regarding its prescription. Finally, brief summaries of the current position for other neuromodulatory treatment modalities are given.
    • Recurrent hyponatremia associated with sertraline and lofepramine

      Bouman, Walter P.; Johnson, Hazel (1997)
      Reports a case of recurrent hyponatremia in a 78-yr-old woman with depression. One week after the start of sertraline (50 mg/day) therapy, S was admitted to hospital for complaints of feeling depressed, weak, and lethargic. The setraline treatment was discontinued and fluids were restricted to 1 liter/day. After 1 wk, the hyponatremia had resolved and a regimen of lofepramine (70 mg/day) was started. Two weeks after starting the lofepramine, her serum sodium level fell, and the serum and urine osmolality rose. Lofepramine was discontinued and the 1 liter restriction was reinstated. Everything normalized within a week. Finally, the S was treated with ECT. She made a full recovery and was placed on clozapine. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Repeated self-wounding: Women's recollection of pathways to cutting and of the value of different interventions

      Huband, Nick (2004)
      Background: More information is needed on the processes that result in self-wounding and how these are modulated by the selection and delivery of interventions available to those working in non-specialist settings.; Methods: Ten women participated in a semi-structured interview where they recalled their experiences of cutting and the helpfulness of specific interventions. Transcripts of these self-reports were analysed using grounded theory methods.; Results: Having a long-term relationship with a key worker and being encouraged to express feelings were viewed as the most helpful strategies, whereas relaxation was often reported as making self-injury worse. The helpfulness of a given intervention was reduced when delivered by someone perceived as underconcerned, overprotective or incompetent. Two pathways to self-wounding were identified: cutting may result when there is a steady increase of tension until a threshold is reached (the 'spring' path), or as a result of the 'switching on' of the impulse (the 'switch' path). Dissociation during cutting and a craving for cutting were more often associated with switching to the impulse. Different management strategies are called for when the switch path has developed, which appears particularly the case for individuals who have been repeatedly self-wounding over a substantial period of time.;
    • Repetitive transcranial magnetic stimulation versus electroconvulsive therapy for major depression: A systematic review and meta-analysis

      Palaniyappan, Lena (2014)
      Electroconvulsive therapy (ECT) is the most effective treatment of depression. During the last decades repetitive transcranial magnetic stimulation (rTMS), an alternative method using electric stimulation of the brain, has revealed possible alternative to ECT in the treatment of depression. There are some clinical trials comparing their efficacies and safeties but without clear conclusions, mainly due to their small sample sizes. In the present study, a meta-analysis had been carried out to gain statistical power. Outcomes were response, remission, acceptability and cognitive effects in depression. Following a comprehensive literature search that included both English and Chinese language databases, we identified all randomized controlled trials that directly compared rTMS and ECT for major depression. 10 articles (9 trials) with a total of 425 patients were identified. Methodological quality, heterogeneity, sensitivity and publication bias were systematically evaluated. ECT was superior to high frequency rTMS in terms of response (64.4% vs. 48.7%, RR = 1.41, p = 0.03), remission (52.9% vs. 33.6%, RR = 1.38, p = 0.006) while discontinuation was not significantly different between the two treatments (8.3% vs. 9.4%, RR = 1.11, p = 0.80). According to the subgroup analysis, the superiority of ECT was more apparent in those with psychotic depression, while high frequency rTMS was as effective as ECT in those with non-psychotic depression. The same results were obtained in the comparison of ECT with low frequency rTMS. ECT had a non-significant advantage over high frequency rTMS on the overall improvement in HAMD scores (p = 0.11). There was insufficient data on medium or long term efficacy. Both rTMS and ECT were well tolerated with only minor side effects reported. Results based on 3 studies suggested that specific cognitive domains such as visual memory and verbal fluency were more impaired in patients receiving ECT. In conclusion, ECT seemed more effective than and at least as acceptable as rTMS in the short term, especially in the presence of psychotic depression. This review identified the lack of good quality trials comparing the long-term outcome and cognitive effects of rTMS and ECT, especially using approaches to optimize stimulus delivery and reduce clinical heterogeneity.Copyright © 2014 Elsevier Inc. All rights reserved.
    • Review: Validation of a new concept: Aptitudes of psychiatric nurses caring for depressed patients

      Hall, Julie E. (2012)
      Comments on an article by Marc Haspeslagh et al. (see record 2012-22761-004). This paper reports on the validation of a questionnaire capable of measuring at an ordinal level the aptitude of psychiatric nurses caring for depressed patients. It outlines the significance of knowledge, skills and aptitude—and how the latter is integral to developing therapeutic relations. There is significant interest in the mental health profession in the assessment of these requisites, and in reducing unhelpful variations in the quality and effectiveness of interactions. The authors describe the complexity of conceptualizing, developing and validating such a tool. Particular attention is paid to the different types of validity and their influence on developing the measures. A mixed methods approach including expert panels, experimentation and statistical analysis was used to develop the questionnaire and assess its validity. The authors suggest how these methods are able to overcome the absence of existing theory, and the research report offers a coherent framework that can be followed in replication. The discussion acknowledges how issues such as language, culture and job context would influence the use of the questionnaire in a wider population—aspects which are worthy of onward consideration. The authors introduce discussion about the validity of translated questionnaires and types of equivalence. This paper serves as a framework for others to use in their consideration prior to questionnaire development, with a method proposed to support such an endeavor. (PsycINFO Database Record (c) 2016 APA, all rights reserved)