Podcasts about beck depression inventory bdi

Welcome back to THE IAS COMPANION. Follow us on YouTube: ⁠www.youtube.com/@IASCompanion⁠. Today, we will explore the questionnaire method in psychology, a widely used tool for collecting data on various psychological constructs. This method allows researchers to gather information efficiently from large samples, making it essential in both academic and applied research. A questionnaire is a research instrument comprising a series of questions designed to gather information from respondents, administered in-person, by mail, over the phone, or online. It has historical roots in the early 20th century with significant contributions from social scientists like Charles Booth and Karl Pearson. Notable examples of questionnaire use in psychology include the Minnesota Multiphasic Personality Inventory (MMPI), Beck Depression Inventory (BDI), and Rosenberg Self-Esteem Scale. Understanding the strengths and limitations of this method is crucial for effectively designing and administering questionnaires in psychological research. #UPSC #IASprep #civilserviceexam #IASexamination #IASaspirants #UPSCjourney #IASexam #civilservice #IASgoals #UPSC2024 #IAS2024 #civilservant #IAScoaching #aUPSCmotivation #IASmotivation #UPSCpreparation #IASpreparation #UPSCguide #IASguide #UPSCtips #IAStips #UPSCbooks #IASbooks #UPSCexamstrategy #IASexamstrategy #UPSCmentorship #IASmentorship #UPSCcommunity #IAScommunity #UPSCpreparation #IASpreparation #UPSCguide #IASguide #UPSCtips #IAStips #UPSCbooks #IASbooks #UPSCexamstrategy #IASexamstrategy #UPSCmentorship #IASmentorship #UPSCcommunity #IAScommunity

Episode 161: Depression FundamentalsFuture doctors Madeline Tena and Jane Park define depression and explain different methods to diagnose it. Non-pharmacologic and pharmacologic treatment is mentioned briefly at the end.  Written by Madeline Tena, MSIII, and Jane Park, MSIII. Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Editing by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition. Per the language of Mental Health, depression can be defined as a mood, a symptom, a syndrome of associated disorders, or a specific mental disorder. As a state of mood, depression is associated with feelings of sadness, despair, emptiness, discouragement, and hopelessness. The sense of having no feelings or appearing tearful can also be a form of depressed mood. A depressed mood also can be a part of a collection of symptoms that explain a syndrome. Depression as a mental disorder can encompass depressive syndromes. Per the American Psychiatric Association DSM-5-TR, depressive disorders commonly include sad, empty, irritable mood, accompanied by changes in one's functional capacity. They can be classified by severity and recurrence, and associated with hypomania, mania, or psychosis. Depressive disorders include major depressive disorder (including major depressive episodes), persistent depressive disorder, premenstrual dysphoric disorder, substance-induced depressive disorder, depressive disorder due to medical condition, other specified depressive disorder, and unspecified depressive disorder.Today, we will cover unipolar depressive disorder, also known as major depressive disorder. MDD.Major depressive disorder is a mood disorder primarily characterized by at least one major depressive episode without manic or hypomanic episodes. Depressive episode is a period of at least 2 weeks of depressed mood or anhedonia in nearly all activities for most of the day nearly every day, with four or more associated symptoms in the same 2 weeks. We will discuss specific symptoms for diagnosis further on. Epidemiology of depression.Nationally or regionally representative surveys in 21 countries estimate that the 12-month prevalence of major depressive disorder across all countries is 5 percent. Furthermore, the prevalence of major depressive disorder plus persistent depressive disorder in developed countries (United States and Europe) is approximately 18 percent. Multiple studies consistently indicate that in the general population of the United States, the average age of onset for unipolar major depression and for persistent depressive disorder (dysthymia) is approximately 30 years old. During 2020, approximately ⅕ US adults have reported receiving a diagnosis by a healthcare provider, with the highest prevalence found among young adults age (18-24 year age… generation Z). Within the US there was considerable geographic variation in the prevalence of depression, with the highest state and county estimates of depression observed along the Appalachian and southern Mississippi Valley regions. Why do we care about depression?Because depression is associated with impaired life quality. It can impair a patient's social, physical, and psychological functioning. Also, depression is associated with mortality. A study done by UPenn Family Practice and Community Medicine in 2005 showed that among older, primary-care patients over a 2-year follow-up interval, depression contributed as much to mortality as did myocardial infarction or diabetes. A prospective study from 2005-2017 that followed 186 patients for up to 38 years further showed that patients with major depressive disorder had 27 times higher incidence rate of suicide than the general population. (1, 2). Also, patients dying by suicide visit primary care physicians more than twice as often as mental health clinicians. It is estimated that 45% of patients who died by suicide saw their primary care physician in the month before their death. Only 20% saw a mental health professional a month before their death. (3)Suicidality in depression.It seems that primary care physicians often do not ask about suicidal symptoms in depressive patients. A 2007 study by Mitchell Feldman at the University of California San Francisco showed that 152 family physicians and internists who participated in a standardized patient with antidepressants, suicide was explored in only 36% of the encounters. (4)Physicians, including primary care physicians, should ask patients with depression about suicidality with questions such as: Do you wish you were dead? In the past few weeks, have you been thinking about killing yourself? Do you have a plan to kill yourself? Have you ever tried to kill yourself? (5) Screening for depression.The USPSTF recommends screening for depression in all adults: 18 years old and over regardless of risk factors. Some factors increase the risk of positive screening, such as temperament (negative affectivity/neuroticism), general medical illness, and family history. First-degree family members of people with MDD have a 2-4 times higher risk of MDD than the general population. Furthermore, social history can increase risk as well: sexual abuse, racism, and other forms of discrimination.It is important to highlight the risk in women because they may also be at risk related to specific reproductive life stages (premenstrual period, postpartum, perimenopause). The USPSTF includes pregnant individuals and patients in the postpartum period to be screened for depression. Screening tools. The US Preventive Services Task Force recommends depression screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years (grade B). Similarly, the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) has also recommended annual screening for depression in children aged 12 and older. (6) Some tools used for screening in this age group are the Patient Health Questionnaire for Adolescents (PHQ-A) and the primary care version of the Beck Depression Inventory (BDI). For the general adult population, it is recommended that all patients not currently receiving treatment for depression be screened using the Patient Health Questionnaire-2 (PHQ-2) (7)PHQ 2 is a survey scored 0-6. The survey asks two questions: Over the last 2 weeks, how often have you been bothered by any of the following problems?Little interest or pleasure in doing things.Feeling down, depressed, or hopeless.Answers should be given in a numerical rating. 0=Not at all; 1=Several days; 2=More than half the days; 3=Nearly every day. A score ≥ 3 is considered positive, and a follow-up full clinical assessment is recommended. The PHQ-2 has a sensitivity of 91% and a specificity of 67% when compared to a semi-structured interview. Keep in mind that the PHQ-2 may be slightly less sensitive to older individuals. Individuals who screen positive with PHQ-2 should have additional screening with the PHQ-9, which is a nine-item, self or clinician-administered, brief questionnaire that is specific to depression. (8) Its content maps directly to the DSM-5 criteria for major depression. (9)The PHQ-9 is a set of 9 questions. The answers are scored similarly to PHQ-2, with a numerical scoring between 0 and 3. (0=Not at all; 1=Several days; 2=More than half the days; 3=Nearly every day). Dr. Arreaza, you will be my patient today, are you ready? It's important that you think about the last 2 weeks.Over the last 2 weeks, how often have you been bothered by any of the following problems?Little interest or pleasure in doing things. [Dr. Arreaza answers, “sometimes”. Jane asks, “is it several days or nearly every day?”. Dr. Arreaza answers, “nearly every day” 3]Feeling down, depressed or hopeless [Dr. Arreaza: every day 3]Trouble falling or staying asleep, or sleeping too much [Dr. Arreaza: not at all 0]Feeling tired or having little energy [Dr. Arreaza: not at all 0]Poor appetite or overeating [Dr. Arreaza: every day 3]Feeling bad about yourself- or that you are a failure or have let yourself or your family down [Dr. Arreaza: several days 1]Trouble concentrating on things, such as reading the newspaper or watching television [Dr. Arreaza: Several days 2]Moving or speaking so slowly that other people could have noticed. Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual. [Dr. Arreaza: Not at all 0]Thoughts that you would be better off dead, or of hurting yourself [Not at all 0]Jane: Your score is 12.Maddy: Regarding severity, a total score of 1-4 suggests minimal depression. 5-9 suggests mild, 10-14 moderate, 15-19 moderately severe, and 20-27 severe depression. PHQ-9 with patients' scores over 10 had a specificity of 88% and sensitivity of 88% for MDD. (10)But if there are at least 4 non-zero items, including question #1 or #2, consider a depressive disorder and add up the scores. If there are at least 5 non-zero items including questions #1 or #2, consider major depressive disorder specifically. The questionnaire is the starting point for a conversation about depression.A couple of things to note: 1. Physicians should make sure to verify patient responses given the questionnaire can be self-administered. Diagnosis also requires impairment in the patient's job, social, or other important areas of functioning. 2. Diagnosis requires a ruling-out of normal bereavement, histories of manic episodes, depressive episodes better explained by schizoaffective disorder, any superimposed schizophrenia, a physical disorder, medication, or other biological cause of depressive symptoms.Once a patient is newly diagnosed and/or started on treatment, a regular interval administration (e.g. 2 weeks or at every appointment) of PHQ-9 is recommended. The PHQ-9 has good reliability, validity, and high adaptability for MDD patients in psychiatric hospitals for screening and evaluation of depression severity. (12) Other than PHQ-9, there is also Geriatric Depression Scale-15 for older patients with mini mental status exam (MMSE) that scored over 10. (13)For postpartum depression, the preferred screening tool is the Edinburgh postnatal depression scale[Click here (stanford.edu)].Non-pharmacologic and pharmacologic treatment.Now that we have diagnosed the patient, we have to start management. Patients can consider non-pharmacologic treatment such as lifestyle modifications. This can include sleep hygiene, reduction in drug use, increased social support, regular aerobic exercise, finding time for relaxation, and improved nutrition. Furthermore, based on severity, patients can start psychotherapy alone or psychotherapy + pharmacotherapy. Admission is required for pts with complex/severe depression or suicidality. There should be an assessment of efficacy at 6 weeks.There is a warning about patients aged 18-24 who are at increased risk of suicide when taking SSRI within the first couple weeks of treatment. Mediations: SSRI, SNRI, tricyclic antidepressants, MAOIs, and Atypical antidepressants: including trazodone, mirtazapine (Remeron), bupropion (Wellbutrin SR). More research is being done on psychedelic drugs such as ketamine and psilocybin as possible treatments. There are therapies such as ECT available too.Potential Harm of Tx: Potential harms of pharmacotherapy: -SNRI:  initial increases in anxiety, insomnia, and restlessness, and possible sexual dysfunction and headaches as well. Compared with the SSRI class, the SNRI class tends to induce more nausea, insomnia, dry mouth, and in rare cases hypertension.-Tricyclic: Cause of numerous side effects, very infrequently prescribed unless the patient is not responding to other forms of treatment. Side effects that are included are: dry mouth. slight blurring of vision, constipation, problems passing urine, drowsiness, dizziness,  weight gain, excessive sweating (especially at night). Avoid TCAs in elderly patients.-MAOIS: MAO-IS can cause side effects too, including dizziness or lightheadedness, dry mouth, nausea, diarrhea or constipation, drowsiness, and insomnia. Furthermore, other less common side effects can include involuntary muscle jerks, hypotension, reduced sexual desire/ ability to orgasm, weight gain, difficulty starting urine flow, muscle cramps, and paresthesia.Remember to screen your patients. In case you establish a diagnosis, discuss treatments, including non-pharmacologic and pharmacologic options. Warn your patients about side effects and the timing to see the benefits of the medication, usually after 6 weeks. __________________Conclusion: Now we conclude episode number 161, “Depression Fundamentals.” Future doctors Park and Tena discussed depression and its risk factors, screening, and treatment. They went through the PHQ2 and PHQ9 as screening tools, as well as commonly used treatments and their side effects, such as SSRIs. Dr. Arreaza also highlighted the importance of asking about suicidality in your depressed patients, there is a lot of room for improvement in that aspect. This week we thank Hector Arreaza, Madeline Tena, and Jane Park. Audio editing by Adrianne Silva.Talk_OutroEven without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Angst F, Stassen HH, Clayton PJ, Angst J. Mortality of patients with mood disorders: follow-up over 34-38 years. J Affect Disord. 2002;68(2-3):167-181. doi:10.1016/s0165-0327(01)00377-9. https://pubmed.ncbi.nlm.nih.gov/12063145/Miron O, Yu KH, Wilf-Miron R, Kohane IS. Suicide Rates Among Adolescents and Young Adults in the United States, 2000-2017. JAMA. 2019;321(23):2362-2364. doi:10.1001/jama.2019.5054. https://pubmed.ncbi.nlm.nih.gov/31211337/ Feldman MD, Franks P, Duberstein PR, Vannoy S, Epstein R, Kravitz RL. Let's not talk about it: suicide inquiry in primary care. Ann Fam Med. 2007;5(5):412-418. doi:10.1370/afm.719. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2000302/.Brief Suicide Safety Assessment,National Institute of Mental Health (NIMH), July 11, 2020. https://www.nimh.nih.gov/sites/default/files/documents/research/research-conducted-at-nimh/asq-toolkit-materials/adult-outpatient/bssa_outpatient_adult_asq_nimh_toolkit.pdfBeck A, LeBlanc JC, Morissette K, et al. Screening for depression in children and adolescents: a protocol for a systematic review update. Syst Rev. 2021;10(1):24. Published 2021 Jan 12. doi:10.1186/s13643-020-01568-3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802305/Williams, John; Nieuwsma, Jason. Screening for depression in adults, UpToDate, updated on November 30, 2023. https://www.uptodate.com/contents/screening-for-depression-in-adults.Instrument: Patient Health Questionnaire-9 (PHQ-9), National Institute on Drug Abuse, https://cde.nida.nih.gov/instrument/f226b1a0-897c-de2a-e040-bb89ad4338b9.Lowe B, et al. Monitoring depression-treatment outcomes with the Patient Health Questionnaire-9 (PHQ-9). Med Care, 42, 1194-1201, 2004.Sun, Y., Fu, Z., Bo, Q. et al.The reliability and validity of PHQ-9 in patients with major depressive disorder in psychiatric hospital. BMC Psychiatry20, 474 (2020). https://doi.org/10.1186/s12888-020-02885-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701937/Conradsson M, Rosendahl E, Littbrand H, Gustafson Y, Olofsson B, Lövheim H. Usefulness of the Geriatric Depression Scale 15-item version among very old people with and without cognitive impairment. Aging Ment Health. 2013;17(5):638-645. doi:10.1080/13607863.2012.758231. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701937/.Royalty-free music used for this episode: Old Mexican Sunset by Videvo, downloaded on Nov 06, 2023 from https://www.videvo.net

Imagine having access to all the money in the world, but all your life you've been withdrawing mere pennies. Muslims have access to Allah. To ask Allah, converse with Allah, plead Allah, but we forsake this special gift we've been given. NEW EPISODE EVERY FRIDAY! PODCAST PLATFORMS: SPOTIFY: https://open.spotify.com/show/71zKZ8rtlkTbyjrzt9rrpL?si=10a72c7ae10f49e0 APPLE PODCASTS: https://podcasts.apple.com/sa/podcast/the-hippiearab-podcast/id1689933853 GOOGLE PODCASTS: https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vVk4xMjIxNzE0MDI1?sa=X&ved=2ahUKEwjCkPjEypqAAxWhVqQEHWOoCaQQ9sEGegQIARAC MY SOCIAL MEDIA: Instagram: hippiearab Tiktok: hippiearab references: 1. extrinsic, intrinsic orientation - https://www.researchgate.net/publication/271692272_Religion_Intrinsic-Extrinsic_Orientation_and_Depression 2. Beck's Depression Inventory- https://www.ismanet.org/doctoryourspirit/pdfs/Beck-Depression-Inventory-BDI.pdf 3. Dua etiquette- https://muslimhands.org.uk/latest/2021/04/how-to-make-dua-according-to-quran-and-hadith Learn more about your ad choices. Visit megaphone.fm/adchoices

PT, PTA, OT, COTA, SLP – this podcast may help you meet your continuing education requirements. Access Relias Academy to review course certificate information.   Did you know that there are over 200 mental health disorders and illnesses, and that many go undiagnosed? These conditions can lead to reduced engagement, resistance to change, and challenging behaviors that ultimately derail a person's therapy. In this episode, we talk with Angela Edney, OTR/L and national AOTA and ASHA conference presenter on mental health, about the most prevalent mental disorders, their impact on patient presentation and the plan of care, and how rehab professionals can help. How are we doing? Click here to give us feedback (01:38) Key Takeaways From Today's Discussion (02:52) Mental Health vs. Mental Illness (04:05) Prevalence of Mental Illness in the U.S. (05:51) Why This Topic Is Important and Your Role (10:19) General Signs and Symptoms of Mental Health Disorders (11:02) Anxiety: General Presentation and Recommendations (13:15) Depression and Major Depressive Disorder (17:06) Determining Interests: The Life Story Questionnaire (20:48) Suicidal Thoughts: Signs, Statements, and Action Steps (23:37) PTSD: Presentation and Management (29:39) Bipolar Disorder: General Presentation and Recommendations (33:07) Obsessive-Compulsive Disorder: Presentation and Treatment (39:17) Gratification: Why It Is Important to Treatment (40:50) Schizophrenia: General Presentation and Recommendations (46:20) Borderline Personality Disorder: General Presentation (48:32) Determining the Cause of Behaviors Using Behavioral Mapping (52:12) Additional Tools and Strategies for Effective Treatments (1:00:03) Managing Higher Intensity Levels of Behavior: The CPI Mode (1:03:28) Screening for Mental Health Disorders (1:05:08) Documentation Concerns (1:06:41) Conclusion  The content for this course was created by Angela Edney, OTR/L. The content for this course was created by Wendy Phillips, PT, BSPT. Here is how Relias can help you earn continuing education credits:  Access your Relias Library offered by your employer to see course certificate information and exam;   or   Access the continuing education library for clinicians at Relias Academy. Review the course certificate information, and if eligible, you can purchase the course to access the course exam and receive your certificate.  Learn more about Relias at www.relias.com.    Legal Disclaimer: The content of Stretch: Relias Rehab Therapy Education is provided only for educational and training purposes for healthcare professionals. The educational material provided in this podcast should not be used as medical advice to treat any medical condition in either yourself or others.  Resources  Mental Health Resources: https://www.mentalhealthfirstaid.org/mental-health-resources/ OT Innovations: https://www.ot-innovations.com/   Screens and Assessments Depression and Anxiety: Beck's Depression Inventory: https://www.ismanet.org/doctoryourspirit/pdfs/Beck-Depression-Inventory-BDI.pdf Beck's Anxiety Inventory: https://www.jolietcenter.com/storage/app/media/beck-anxiety-inventory.pdf Geriatric Depression Scale (GDS): https://geriatrictoolkit.missouri.edu/cog/GDS_SHORT_FORM.PDF Hamilton Anxiety Rating Scale (HAM-A): https://dcf.psychiatry.ufl.edu/files/2011/05/HAMILTON-ANXIETY.pdf Patient Health Questionnaire (PHQ-9): https://med.stanford.edu/fastlab/research/imapp/msrs/_jcr_content/main/accordion/accordion_content3/download_256324296/file.res/PHQ9%20id%20date%2008.03.pdf Quality of Life: Interest Checklist: https://www.pdffiller.com/201199180-Modified-Interest-Checklistpdf-interest-checklist- Life Story Questionnaire – Crisis Prevention Institute: https://www.crisisprevention.com/CPI/media/Media/Specialties/dcs/Life-Story-Questionnaire.pdf Post-Traumatic Stress Disorder: Short Post-Traumatic Stress Disorder Rating Interview (SPRINT): https://www.ptsd.va.gov/professional/assessment/screens/sprint.asp

On this episode of Sanity, Dr. Jason Duncan and Dr. Jacqueline Persons discuss the importance of cognitive-behavioral case formulation and tracking progress. The case formulation approach includes hypothesis testing of maintaining factors. It allows the clinician to pivot in treatment, when necessary, if specific interventions designed to target a certain mechanism are not successful in symptom reduction. Effective case formulations cover the three P's: predisposing factors, precipitating factors, and perpetuating factors. The various benefits of progress monitoring are also discussed, and Dr. Persons provides resources for how to manage client progress, including how to effectively implement them in therapy. Dr. Persons describes how using a case formulation approach and using progress monitoring measures allow clinicians to adhere to evidence-based practice, especially when they may stray from a particular manualized treatment. This podcast is a great listen for both beginning and more experienced therapists seeking to improve treatment outcomes and learn effective strategies to adhere to evidence based practice! Dr. Persons is a clinical psychologist that has worked in a private practice setting providing Cognitive Behavioral Therapy, training and consultation to professionals, and research, for more than 35 years. She is a Clinical Professor in the Department of Psychology at the University of California at Berkeley. She was past-president of the Association of Cognitive and Behavioral Therapies and the Society for a Science of Clinical Psychology. She is a Distinguished Founding Fellow, Certified Cognitive Therapist, and Certified Trainer of the Academy of Cognitive Therapy. She is the recipient of the Outstanding Clinician award from the Association for Behavioral and Cognitive Therapies and recipient of the Distinguished Contributions to Applied Research and Practice in Psychology award from the American Association of Applied and Preventive Psychology. She has authored 3 books and more than 70 articles and chapters. Resources: The Case Formulation Approach to Cognitive-Behavioral Therapy: https://www.thriftbooks.com/w/the-case-formulation-approach-to-cognitive-behavior-therapy_jacqueline-b-persons/389465/item/44330553/?gclid=CjwKCAiAm7OMBhAQEiwArvGi3EOG7IK_Kv3DTFgqVJBF3jAfgzJX0BkN3l0Gei_txoK4UiXIbbHMYBoCCskQAvD_BwE#idiq=44330553&edition=46713094 PsychSurveys: https://www.psychsurveys.com/ Midas Practice: electronic medical records system https://midas.umich.edu/application/electronic-medical-record-data/ Beck Depression Inventory https://www.ismanet.org/doctoryourspirit/pdfs/Beck-Depression-Inventory-BDI.pdf OQ-45: https://www.oqmeasures.com/oq-45-2/ Website: www.oaklandcbt.com

Michelle Magid, MD, conducts a Masterclass lecture on botulinum toxin for depression from the Psychopharmacology Update in Cincinnati. The meeting was sponsored by Global Academy for Medical Education and Current Psychiatry. Dr. Magid is associate professor University of Texas in Austin, and associate professor of Texas A&M University in College Station. She disclosed serving as a speaker for Ipsen, maker of Dysport (abobotulinumtoxinA, or ABO), and as a consultant for Allergan, maker of Botox (onabotulinumtoxinA). *  *  *   Help us make this podcast better! Please take this short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019  *  *  *   This week in psychiatry: Conduct disorder in girls gets overdue research attention by Bruce Jancin The physiological and emotion-procession abnormalities that underpin conduct disorder in teen girls are essentially the same as in teen boys. however, the clinical presentation of conduct disorder in the two groups is often different.  What we know about botulinum toxin Botulinum toxin is the product of Clostridium botulinum. The neurotoxin inhibits the release of acetylcholine, resulting in flaccid muscle relaxation. Its clinical use started in 1989 to treat strabismus (crossed eyes) and blepharospasm, a dystonic reaction in the eyes. Currently, botulinum is a Food and Drug Administration–approved treatment of chronic migraine in adults. For use in depression, 30-40 units of botulinum toxin is injected into the glabellar region of the face (the forehead). A purported mechanism of action of botulism for depression includes the “facial feedback hypothesis,” in which the activation of muscles of facial expression, consciously or unconsciously, influences emotions. Botulinum toxin for depression is an off-label treatment with four case series, five randomized, controlled studies, and a phase 2 trial by supported by Allergan. New findings on use of botulinum toxin for depression  Magid and colleagues completed a pooled analysis of three randomized, controlled trials totaling 134 patients. Fifty-nine people were included in the botulinum toxin intervention group with a Beck Depression Inventory (BDI) score of 29, and 75 individuals in the placebo group with BDI of 26. In each group, 64% of patients were continued on other medications for depression, and the groups had similar histories of long-standing depression. In the botulinum toxin group, 52% had a response to the intervention, with an at least 50% reduction in their baseline depression scores, compared with a limited response in the placebo group. In the pooled analysis, Dr. Magid’s group analyzed whether the cosmetic effect of botulinum toxin could be a confounding factor. The investigators ruled out that effect by using a subanalysis to evaluate whether the decrease in wrinkles correlated with decrease in depression, and it did not. Allergan moved forward with a phase 2 proof-of-concept trial; the results were mixed. The endpoint was response rate in Montgomery-Åsberg Depression Rating Scale (MADRS) at week 6. With a 30-unit Botox dose, there was a statistically significant decrease in MADRS at week 9, but not at week 6. There was no statistically significant divergence in data between the placebo and intervention group with the 50-unit dose. Given the response rate at week 9, Allergan is proceeding with a phase 3 trial. The cost is about $400 per treatment, and the treatment is given three to four times a year, which makes the cost comparable to that of other psychopharmacologic treatments. Adverse events are mild and include headache and local site irritation. In the current studies, botulinum treatment has been used as both monotherapy and augmentation; however, there are not enough data to know whether one is more effective than the other. In conclusion, burgeoning psychopharmacology research on treatments such as botulinum toxin for depression and novel medications, such as esketamine and brexanolone, broaden our understanding of the etiology of depression. This research is generating novel modes of treatment that will help more patients with refractory illness. References Magid M et al. Treating depression with botulinum toxin: A pooled analysis of randomized controlled trials. Psychopharmacology. 2015 Sep;48(6):205-10. Magid M et al. Treatment of major depressive disorder using botulinum toxin: A 24-week randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2014 Aug;75(8):837-44.  *  *  *   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgePsych  

The primary aim of the study was to investigate the predictive value of patients´ characteris-tics for treatment outcome in outpatient and inpatient settings. Study took place between 2003 and 2006. It was a prospective observational study with par-ticipation of 290 alcohol-dependent patients. Patients entered an outpatient treatment (12 months duration), short term inpatient treatment with duration of 8 weeks, or long term inpa-tient treatment (duration between 12 and 16 weeks). Analyzes implied patients´ characteristics and characteristics of mental illness. Assessments were made using medical basic documenta-tion, European Addiction Severity Index (EuropASI), Timeline Followback Interview, Beck Depression Inventory (BDI), State- Trait Anxiety Inventory (STAI), and Obsessive-Compulsive Drinking Scale (OCDS). Higher secondary school qualifications, finished professional training, onset of alcohol de-pendence at a later time, longer duration of alcohol dependence, less previous treatments for somatic problems, and a history without or of less attempted suicide were found to be predic-tive for a preferable treatment outcome. Furthermore, family satisfaction and employment were variables which differed between treatments with respect to the treatment outcome. As-sociation between craving and treatment outcome were found as follows: In the short term, patients who reported less craving had better treatment outcome than patients with a larger extent of craving.

Background: Despite limited effectiveness of short-term psychotherapy for chronic depression, there is a lack of trials of long-term psychotherapy. Our study is the first to determine the effectiveness of controlled long-term psychodynamic and cognitive-behavioral (CBT) treatments and to assess the effects of preferential vs. randomized assessment. Methods/design: Patients are assigned to treatment according to their preference or randomized (if they have no clear preference). Up to 80 sessions of psychodynamic or psychoanalytically oriented treatments (PAT) or up to 60 sessions of CBT are offered during the first year in the study. After the first year, PAT can be continued according to the `naturalistic' usual method of treating such patients within the system of German health care (normally from 240 up to 300 sessions over two to three years). CBT therapists may extend their treatment up to 80 sessions, but focus mainly maintenance and relapse prevention. We plan to recruit a total of 240 patients (60 per arm). A total of 11 assessments are conducted throughout treatment and up to three years after initiation of treatment. The primary outcome measures are the Quick Inventory of Depressive Symptoms (QIDS, independent clinician rating) and the Beck Depression Inventory (BDI) after the first year. Discussion: We combine a naturalistic approach with randomized controlled trials(RCTs)to investigate how effectively chronic depression can be treated on an outpatient basis by the two forms of treatment reimbursed in the German healthcare system and we will determine the effects of treatment preference vs. randomization.

Die transkranielle Gleichstromstimulation (tDCS) stellt eine neue, nicht-invasive Methode zur Hirnstimulation dar. Mit Hilfe einer Konstantstromquelle und zweier Elektroden kann die Stimulation eines Hirnareals erfolgen. Vorläufige Studien weisen darauf hin, dass dieses Verfahren eine neue Therapieoption bei verschiedenen Hirnleistungsstörungen darstellen könnte. In einem randomisierten cross-over Design erhielten 22 therapieresistente depressive Patienten in unterschiedlicher Reihenfolge zwei Wochen eine Verum- und zwei Wochen eine Plazebo-tDCS-Behandlung des linken DLPFC. Es wurde jeweils fünf Tage pro Woche 20 Minuten lang stimuliert. Die ersten 10 Patienten erhielten eine Stimulation mit 1 mA, die 12 folgenden mit 2 mA. Zwei Patienten brachen die Studie im Verlauf ab. Die Anode wurde über dem linken DLPFC, die Kathode über dem rechten supraorbitalen Kortex fixiert. Zu Beginn und zum Abschluss jeder Stimulationsbedingung wurde eine Testbatterie durchgeführt, sowie Blut zur Messung des BDNF-Spiegels abgenommen. Als klinische Tests wurde die Hamilton Depression Rating Scale (HAMD) und der Beck Depression Inventory (BDI) verwendet. Als neuropsychologische Tests wurden der formallexikalische Wortflüssigkeitstest (RWT), die Buchstaben-Zahlen-Folge (BZF) aus dem Wechsler-Intelligenztest für Erwachsene und der verbale Lern- und Merkfähigkeitstest (VLMT) durchgeführt. Die Ergebnisse nach Verum-tDCS zeigten keinen signifikanten Unterschied zu den Ergebnissen nach Plazebo-Behandlung, weder in den klinischen- und neuropsychologischen Tests, wie auch in dem Verlauf des BDNF-Spiegels. Zwischen der Stimulation mit 1 mA und der mit 2 mA waren ebenfalls keine signifikanten Unterschiede zu erkennen. Die vorliegende Pilotstudie stellt die Effekte der tDCS auf kognitive Faktoren und auf den BDNF-Spiegel bei therapieresistenten depressiven Patienten in Frage. Vermutlich sind bei schwerkranken, therapieresistenten Patienten andere Stimulationsparameter zu verwenden.

The present case study describes a behavior therapy with 30 treatment sessions for a patient with genital cancer, somato-form disorder and dyspareunia. On the basis of a bio-psycho-social model, daily pain appraisals and relaxation techniques were used. Treatment procedures to reduce depressive symptoms involved cognitive strategies, diary method, pleasure scales and resource acquisition. The patient repeatedly described her feelings of sadness, hopelessness and fear in respect to her cancer. On the basis of her sexual history `sensate focus' treatment was gradually introduced. The patient underwent role-play and performance feedback of conflict situations with her husband who was partially involved in the psychotherapy. The patient was able to accomplish the set objectives to a great extent after 30 treatment sessions: The vaginal pains and the depressive symptoms strongly decreased. The patient describes herself as being more encouraged, shows more interests and is more active even outside of her family. Through the instructions she was able to acquire practical knowledge which helped her experience a more fulfilling sexual life. Having completed treatment the couple now talks about feelings and needs more often. The patient also learned to stand up more to her husband and children. Finally, she was able to deal with her fears about her genital cancer, especially regarding her fear of pain and death. The evaluation of the therapy progress reflects these changes: The scores obtained from the Beck-Depression-Inventory (BDI) and the Symptom-Checklist (SCL 90-R) had decreased to normal range at the end of the therapy ( BDI: 8; SCL 90-R: GSI: 0,49; T-score: 55) compared to scores at the beginning of the treatment (BDI: 26; SCL 90-R: GSI: 0,92; T-score: 67). In conclusion the study emphasizes the importance of offering psychosomatic treatment to gynecological patients.