Objective: Primarily, to determine the effect of olanzapine augmentation therapy on sleep architecture, specifically slow wave sleep (SWS), in the treatment of depression. Secondarily, to determine the effect of olanzapine augmentation therapy on illness severity and cognitive function. Finally, to examine the correlation between sleep architecture, illness severity and cognition. Methods: Prospective, double-blind, randomized, placebo-controlled study. Patients with major depressive disorder or bipolar disorder currently experiencing a major depressive episode were included. Patients were on a stable medication regime for 4 weeks prior and throughout the study. Sleep architecture was measured by overnight, ambulatory, polysomnography. Illness severity was determined using the Hamilton Depression Rating Scale (HDRS), Montgomery Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HARS). Cognitive function was examined using Cambridge Neuropsychological Test Automated Battery (CANTAB): Spatial Working Memory (SWM), Spatial Span (SSP), and Reaction Time (RTI) tasks. Polysomnographs, clinical measures and cognitive test were administered at baseline, after 2-4 days of treatment and after 28-31 days of treatment. Results: Twenty-five patients participated in the study. There was no significant difference between olanzapine and placebo treated groups on age, gender, diagnosis, education level, employment or marital status and number of children. Latency to SWS, duration of SWS, sleep efficiency, total sleep time, total wake time and sleep latency significantly improved in olanzapine treated participants over placebo treated participants. Latency to and duration of rapid eye movement sleep was not significantly different between olanzapine and placebo treated participants. HDRS scores were significantly improved in olanzapine treated versus placebo treated participants. No significant difference between treatment groups was seen in MADRS, HARS, and subjective sleep quality scores. There was no significant difference between olanzapine and placebo treated participants in SWM, SSP or RTI tasks. Change in sleep architecture was not significantly correlated to clinical change or change in SWM, SSP or RTI. Clinical change was not significantly correlated to SWM or SSP. Clinical change, however, was significantly correlated to change in RTI, in the placebo treated group only. Conclusion: Olanzapine augmentation treatment improves SWS, sleep continuity and depressive symptoms. / Thesis (Master, Neuroscience Studies) -- Queen's University, 2009-09-09 13:46:57.159

Evidence is accumulating that the imposed lifestyle associated with shift-work can adversely affect many aspects of nurses’ mental health. The 2005 National Survey of the Work and Health of Nurses stated depression is more common in nurses than in the general population. Minimal research has focused on depression as a direct outcome of shift-work for registered nurses. The purpose of this study was to examine the relationship between shift-work and depressive symptoms in female nurses. This study was a discrete analysis of data collected from 151 registered nurses enrolled in the primary study entitled “Work and health: Optimizing nurses’ physical health in hospital work environments” (Tranmer, McGillis-Hall, Katzmarzyk, Parry, et al, 2007). A descriptive correlational design was utilized to describe the relationships between shift-work and depressive symptoms. Shift work was categorized as participants working 8 hours, 12 hours, or a combination of both 8 and 12 hour shifts. Depressive symptoms were measured with the Centre for Epidemiological Studies Depression Scale (CES-D). Bivariate analysis showed no statistical significant correlations between CES-D scores and shift-work. However, correlational analysis between individual CES-D questions showed a positive association between shift-work and lack of concentration, decreased motivation to complete tasks, feeling depressed and difficulty sleeping as adverse effects. Fifty-two percent of these shift workers identified problems with keeping focus on the tasks they were performing, 40% described an alteration in motivation, 31% felt depressed and 69% reported sleep disturbances. This study found no direct association between shift-work and depression but found that individual symptoms of depression were related to the shift-work schedule. Studies addressing the effects of shift-work on mental health need to explore options to decrease depressive symptoms, such as impaired cognition and motivation, that were shown to impact upon the worker’s quality of life and quality of care provided. / Thesis (Master, Nursing) -- Queen's University, 2009-09-23 17:05:53.606

Objective: To primarily determine the effect of ziprasidone augmentation therapy on sleep architecture, specifically slow wave sleep (SWS) and rapid eye movement sleep (REM), in the treatment of bipolar depression. Secondarily, to determine the effect of ziprasidone augmentation treatment on clinical measures of subjective sleep quality and illness severity. Finally, to examine the correlation between change in sleep architecture and change in clinical measures. Methods: This was a prospective, double-blind, randomized, placebo-controlled study. 14 patients with bipolar disorder currently experiencing a major depressive episode were included. Patients were on a stable medication regime for 4 weeks prior to study enrollment and throughout the study. Sleep architecture was measured by overnight, ambulatory polysomnography. Subjective sleep quality was assessed using the self-reported Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and a visual analogue scale. Illness severity was determined using the 17 item Hamilton Depression Rating Scale (HAMD-17), the Montgomery Asberg Depression Rating Scale (MADRS), the Hamilton Anxiety Rating Scale (HAMA) and the Clinical Global Impression-Severity scale (CGI-S). Polysomnographs and clinical measures were administered at baseline, after 2-5 days and after 28-31 days of treatment. Results: There was no significant difference between ziprasidone and placebo treated groups on age, gender, diagnosis, education level, employment or marital status and number of children. Duration of SWS, latency to REM, duration of stage 2 sleep, total sleep time, onset to sleep latency, sleep efficiency and number of awakenings significantly improved in ziprasidone treated participants over placebo, whereas duration of REM sleep did not. CGI-S and HAMA scores were significantly improved with ziprasidone treatment. No significant difference between treatment groups was seen on the HAMD-17 and MADRS or in self-reported sleep quality. Change in REM sleep significantly correlated to change in subjective sleep quality in the ziprasidone group. Conclusion: Ziprasidone augmentation treatment in bipolar depression improves SWS duration, REM latency, and sleep continuity while also having a beneficial effect on overall illness severity and anxiety symptoms. / Thesis (Master, Neuroscience Studies) -- Queen's University, 2011-08-02 17:39:05.883

Major Depressive Disorder is a highly prevalent and recurrent psychological disorder, affecting approximately 12% of Canadians across their lifetime and 5% each year. Studies have shown that a history of childhood maltreatment increases risk for depression by conferring a vulnerability to the effects of stressful life events (i.e., stress sensitization). The goal of the current investigation was to examine whether the relation between childhood maltreatment and stress sensitization in depression is influenced by age group and depression history. This study also sought to investigate whether specific characteristics of the maltreatment experience differentially relate to stress sensitization. Two hundred and seven clinically depressed adolescents (i.e., 12 – 17 years; n = 59) and adults (i.e., 18 – 64 years; n = 148) participated in this study. Childhood accounts of maltreatment were assessed using the Childhood Experience of Care and Abuse Scale, and stressful life events experienced 3 months prior to depression onset were assessed using the Life Events and Difficulties Schedule. Results revealed that individuals with a history of severe maltreatment reported lower severity levels of stressful life events prior to depression onset than did those without such a history, but only among adolescents. Further, this relation was specific to independent stressors (i.e., those totally or nearly totally independent of the behaviour of the individual) and not dependent stressors (i.e., those at least partly due to the individual’s behaviour), and was specific to emotional abuse. Results also suggested that it is the experience of severe maltreatment, rather than particular aspects of it, that sensitizes individuals to the effects of stress. In summary, this study provides support for the relation of childhood maltreatment to stress sensitization in adolescents. Maltreated adolescents may be especially vulnerable to the depressogenic effects of stress, perhaps because their maltreatment experience is more proximal to depression onset. In contrast, other relevant processes (e.g., cognitive schema and neurobiological consolidation, chronic stress) may drive stress sensitization in adulthood; however, further research is required to investigate such mechanisms. Limitations and clinical implications are discussed. / Thesis (Master, Psychology) -- Queen's University, 2011-08-31 19:15:16.313

Hypoxic condition is a naturally occurring environmental stressor in aquatic ecosystems. However, due to modern anthropocentric activities, hypoxia has been increasing in prevalence and severity. Rainbow trout, a keystone species in many North American lakes, is hypoxia intolerant. As a result, this species is of particular concern when studying the effects of hypoxia on an organism’s physiological functioning. Chronic starvation was used as a tool to induce metabolic depression to determine the effect that depressed metabolic rate had on hypoxia tolerance. Juvenile rainbow trout were deprived of food for five weeks at 15oC. Each week, routine metabolic rate (RMR) and critical oxygen tension (Pcrit) were measured. Concomitantly, resting and post-hypoxia fish (8 h at ~50% air saturation) were sampled to measure metabolites in blood, liver and muscle, as well as enzyme activities in select tissues. Food deprivation resulted in a decrease in routine metabolic rate (RMR) and shift towards an increased reliance on aerobic metabolism. Pcrit decreased significantly following four weeks of food deprivation respectively, indicating that metabolic depression induced by food deprivation may confer an increased tolerance to low environmental oxygen concentration ([O2]). However, marginal metabolic scope (MMS), another indicator of hypoxia tolerance, did not change in response to metabolic depression. Furthermore, subjecting trout to O2 limitation resulted in mobilization of carbohydrates from the liver subsequently leading to hyperglycemia. This was likely a survival technique ensuring that if severe hypoxia ensues, anaerobic substrates are ready for transport to the necessary tissues. / Thesis (Master, Biology) -- Queen's University, 2011-10-12 23:21:04.517

Given the pervasive, debilitating nature of major depressive disorder, a large body of clinical research has evaluated the efficacy of short-term treatments for depression. Researchers have attempted to understand the complex mechanism of therapeutic change by examining treatment response, which is typically defined as the extent of symptom change between the intake and termination sessions. However, this approach fails to recognize that therapy is a non-linear, dynamic longitudinal process. An alternative approach involves analysis of longitudinal repeated measures process and outcome indicators in order to examine change both during treatment as well as following treatment. In order to evaluate dynamic, longitudinal hypotheses, it is necessary to use an appropriate analytical framework. A structural modelling technique termed Latent Difference Score Analysis (LDS) is well suited for this purpose, allowing for evaluation of longitudinal growth within a time series, while also considering multivariate relationships and determinants. / The purpose of this research was to evaluate established theories of depression vulnerability as well as theories of psychotherapy process, both during and following depression treatment. The research described in Chapter 2 examined several theories of the longitudinal relationship between depression and perfectionism during depression treatment, while considering the role of the therapeutic alliance. Longitudinal LDS analyses supported a "personality vulnerability" model of depression, in which perfectionism predicted the subsequent rate of depression change throughout treatment. Results indicate that patients with high levels of perfectionism experience less reduction in their depression scores throughout treatment. Furthermore, the strength of the therapeutic alliance significantly predicted the rate of change in personality vulnerability throughout therapy. The research described in Chapter 3 examined several theories of the longitudinal relationship between depression and stress following treatment termination. Results supported a "stress reactivity" model, in which stressful events led to elevations in the rate of depression change following therapy. Multigroup LDS analysis indicated that stress reactivity only occurred for patients who had been treated with medication, and not for those who had received psychotherapy. / These findings have several implications. First, comprehensive analyses of treatment efficacy can move beyond symptom reduction by examining mechanisms underlying treatment response using an appropriate statistical framework. The first paper demonstrates that an efficient route to symptom reduction involves establishing an adequate therapeutic alliance in order to target personality vulnerability. The second paper demonstrates that importance of evaluating treatment efficacy by considering whether a treatment leads to enduring change. Specifically, results indicate that the enduring effects of psychotherapy (in comparison to medication treatments) following treatment termination involves increased resiliency to stressful life events.

The present study investigated discrepancy between reports of depressive symptoms of 36 psychogeriatric patients and their family informants. It also examined factors potentially affecting this discrepancy such as selected characteristics of the patients and their informants, the type of measure assessing depression, and the type of depressive symptoms being assessed. The 15-item Geriatric Depression Scale (GDS-15) and the Clinically Useful Depression Outcome Scale (CUDOS) were completed by the patient, and the informant version of both the GDS-15 and CUDOS were completed by their informant. A sizable discrepancy was found between patient and informant reports of depressive symptomatology; informants reported significantly more symptoms than patients themselves. The discrepancy in reports was greater on the GDS-15 than on the CUDOS. Multiple regression analyses revealed that both patient‟s gender and type of setting (inpatient vs. day hospital) significantly influenced the discrepancy. The highest kappa agreement was obtained on items related to feelings of worthlessness and life satisfaction on the GDS-15, and suicidal ideation and intent on the CUDOS. The study‟s strengths and limitations, implications for clinical practice and research, and directions for future research are discussed.

No description available.

Fysisk aktivitet och beteendeaktivering har i tidigare forskning påvisats vara effektiv i behandling av depressionstillstånd. Syftet med ACTUA-studien var att utvärdera ett internetbaserat självhjälpsprogram med terapeutstöd via e-post. Totalt deltog 71 individer med egentlig depression som randomiserades till fyra olika behandlingsgrupper, två som ägnade sig åt fysisk aktivitet (FA), två som ägnade sig åt beteendeaktivering (BA) samt en väntelista. Behandlingsprogrammet bestod av åtta moduler som tilldelades deltagaren under en 12 veckor lång behandlingsperiod. Sudden gains, vilket är en företeelse som allmänt anses påverka det slutgiltiga behandlingsresultatet för en individ positivt, kunde påvisas i 47 (66%) deltagares behandlingsprocess. Något samband mellan förekomst av sudden gains och total förbättring under behandlingen kunde inte påvisas i denna studie och det fanns heller inget samband mellan förekomst av sudden gains och typ av behandling. / Physical activity and behavioral activation has been shown in previous research to be effective in the treatment of depressive disorders. The purpose of ACTUA was to evaluate an Internet-based self-help program with therapist support via e-mail. A total of 71 individuals with major depressive disorder were randomized into four treatment groups, two of which contained physical activity (FA), two others comprised of behavioral activation (BA) and one waiting list. The treatment program consisted of eight modules and they were distributed to participants during a 12 week treatment period. Sudden gains, which is a phenomenon that is generally considered to influence the final outcome of treatment for an individual in a positive way was detected in 47 (66%) participants treatment process. A correlation between the occurrence of sudden gains and overall improvement during treatment could not be demonstrated in this study and there was no association between the occurrence of sudden gains and type of treatment.

No description available.