TY - JOUR
T1 - Discrepancy between subjective and objective severity as a predictor of response to chronotherapeutics in bipolar depression
AU - Suzuki, Masahiro
AU - Dallaspezia, Sara
AU - Locatelli, Clara
AU - Uchiyama, Makoto
AU - Colombo, Cristina
AU - Benedetti, Francesco
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Background Chronotherapeutic techniques (sleep deprivation and light therapy) are effective treatments for bipolar depression, but viable predictors of response for the daily clinical practice have not yet been established. The discrepancy between subjective and objective severity of the depressive syndrome has been proposed as a possible predictor of treatment outcome in depression. This study examined whether this discrepancy could predict response to chronotherapeutics in bipolar depression. Method We studied 149 consecutively admitted inpatients with a major depressive episode in course of bipolar disorder. Patients were treated with the combination of repeated sleep deprivation and bright light therapy. Severity of depression was evaluated using self-rated (Beck Depression Inventory: BDI) and observer-rated (Hamilton Depression Rating Scale: HDRS) measures. BDI-HDRS discrepancy score at baseline was calculated, and its associations with clinical response and with depressive cognitive distortions, as measured on the Cognitions Questionnaire, were examined. Results Among the 147 completers, 66% responded to treatment (50% reduction of HDRS score). The response rate in patients with low discrepancy scores and in patients with high discrepancy scores were 80.2% and 48.5%, respectively. High BDI-HDRS discrepancy predicted negative response to treatment with odds ratio of 3.79 (95%CI: 1.61-8.93). BDI-HDRS discrepancy was positively associated with depressive cognitive distortions. Limitations Potential factors affecting the discrepancy and outcome other than cognitive distortion were not examined in this study. Conclusion Higher BDI-HDRS discrepancy can predict poorer response to chronotherapeutics in bipolar depression. The tendency to generalize hopelessness may be a factor influencing the link between the discrepancy and outcome.
AB - Background Chronotherapeutic techniques (sleep deprivation and light therapy) are effective treatments for bipolar depression, but viable predictors of response for the daily clinical practice have not yet been established. The discrepancy between subjective and objective severity of the depressive syndrome has been proposed as a possible predictor of treatment outcome in depression. This study examined whether this discrepancy could predict response to chronotherapeutics in bipolar depression. Method We studied 149 consecutively admitted inpatients with a major depressive episode in course of bipolar disorder. Patients were treated with the combination of repeated sleep deprivation and bright light therapy. Severity of depression was evaluated using self-rated (Beck Depression Inventory: BDI) and observer-rated (Hamilton Depression Rating Scale: HDRS) measures. BDI-HDRS discrepancy score at baseline was calculated, and its associations with clinical response and with depressive cognitive distortions, as measured on the Cognitions Questionnaire, were examined. Results Among the 147 completers, 66% responded to treatment (50% reduction of HDRS score). The response rate in patients with low discrepancy scores and in patients with high discrepancy scores were 80.2% and 48.5%, respectively. High BDI-HDRS discrepancy predicted negative response to treatment with odds ratio of 3.79 (95%CI: 1.61-8.93). BDI-HDRS discrepancy was positively associated with depressive cognitive distortions. Limitations Potential factors affecting the discrepancy and outcome other than cognitive distortion were not examined in this study. Conclusion Higher BDI-HDRS discrepancy can predict poorer response to chronotherapeutics in bipolar depression. The tendency to generalize hopelessness may be a factor influencing the link between the discrepancy and outcome.
KW - Bipolar disorder
KW - Chronotherapeutics
KW - Clinical rating scales
KW - Cognitive distortion
KW - Prediction of outcome
KW - Sleep deprivation
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U2 - 10.1016/j.jad.2016.06.044
DO - 10.1016/j.jad.2016.06.044
M3 - Article
AN - SCOPUS:84975256342
VL - 204
SP - 48
EP - 53
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
SN - 0165-0327
ER -