Background. Depression and anxiety are common and debilitating disorders, and at least one third of patients do not respond to available interventions. Morita Therapy, a Japanese psychological therapy which contrasts with established Western approaches, is currently untested in the UK and may represent a potentially effective alternative approach. Aim. To optimise and investigate the feasibility and acceptability of Morita Therapy as a treatment for depression and anxiety in the UK. Design. Three studies were undertaken in line with the MRC framework (2008) for complex interventions. Study One: scoping and systematic review to describe the extent, range and nature of Morita Therapy research activity reported in English. Study Two: intervention optimisation study, integrating literature synthesis with qualitative research, to develop the UK Morita Therapy outpatient protocol. Study Three: mixed methods feasibility study encompassing a pilot randomised controlled trial (RCT) and embedded qualitative interviews to prepare for a fully-powered RCT of Morita Therapy versus treatment as usual (TAU). Results. Study One: 66 papers meeting the inclusion criteria highlighted heterogeneity in the implementation of Morita Therapy, and an absence of both UK-based research and relevant unbiased RCTs. Study Two: a potentially deliverable and acceptable therapy protocol and tailored therapist training programme were developed for a UK population. Study Three: 68 participants were recruited and 94% retained at four month follow-up; 70.6% of Morita Therapy participants adhered to the minimum treatment dose, and 66.7% achieved remission in depressive symptoms (compared to 30.0% in TAU). Qualitative and mixed methods findings indicated that Morita Therapy was broadly acceptable to therapists and participants, and highlighted potential moderators of acceptability, treatment adherence and outcomes. Conclusions. Patients in the UK can accept the premise of Morita Therapy and find the approach beneficial. It is feasible to conduct a large-scale UK-based trial of Morita Therapy with minor modifications to the pilot trial protocols.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-02-23T12:27:50Z No. of bitstreams: 2 Tese - Rodrigo Bernini de Brito - 2015.pdf: 2201255 bytes, checksum: a184a6bcdb4f9d15e5944a689b43f0e5 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-02-23T12:33:46Z (GMT) No. of bitstreams: 2 Tese - Rodrigo Bernini de Brito - 2015.pdf: 2201255 bytes, checksum: a184a6bcdb4f9d15e5944a689b43f0e5 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2016-02-23T12:33:46Z (GMT). No. of bitstreams: 2 Tese - Rodrigo Bernini de Brito - 2015.pdf: 2201255 bytes, checksum: a184a6bcdb4f9d15e5944a689b43f0e5 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-08-26 / The aim of pharmacogenetics is to understand the hereditary basis of therapeutic response and side effects of pharmacological agents for each individual. Antipsychotics and antidepressants are effective drugs for schizophrenia and major depressive disorder (MDD) treatment, respectively. Although a number of patients respond satisfactorily to antipsychotics and antidepressants, 20-40% of them present inadequate response, and the treatment with ineffective medication may take weeks of unremitted illness, potential adverse drug reactions and nonadherence to treatment. This study aims to identify polymorphisms in genes that potentially influence the treatment response to clozapine in schizophrenic patients and the treatment with escitalopram in MDD patients. This approach involved the study of CYP1A2 and CYP2C19 genes related to the metabolism of these drugs and which may to affect the efficacy of treatment. It was studied 54 schizophrenic patients taking clozapine and 31 patients with MDD treated with escitalopram, both for long term. The investigated polymorphisms, CYP1A2*1F in schizophrenic patients and CYP2C19*2 and CYP2C19*17 in depressive patients, were analyzed by polymerase chain reaction (PCR), followed by sequencing (CYP1A2*1F) or by restriction fragment length polymorphism (RFLP) (CYP2C19*2 and *17) techniques. The results pointed for the association between CYP1A2*1F polymorphism and super-refractory clozapine treatment and for the association between CYP2C19*17 polymorphism and the decreased response to escitalopram treatment. No association was observed between CYP2C19*2 and the response to escitalopram treatment. These findings suggest that these genetic variants have an important influence on the treatment effectiveness of antipsychotics and antidepressants in psychiatric disorders, as schizophrenia and MDD. The pharmacogenetics may be useful to the psychiatrists helping in the choice of drugs and doses more efficient for each patient, reducing suffering and costs and contributing to improve the quality of life for patients and families. / A farmacogenética busca compreender a base hereditária da variabilidade da resposta e dos efeitos adversos dos agentes farmacológicos entre os indivíduos. Os medicamentos antipsicóticos e antidepressivos são utilizados em tratamentos bastante efetivos para a esquizofrenia e transtorno depressivo maior (TDM), respectivamente. Embora boa parte dos pacientes responda às terapias com antipsicóticos e antidepressivos, 20-40% mostram resposta inadequada, e o custo de cada tentativa de medicação não-efetiva para os pacientes pode levar a semanas de permanência da doença, ocorrência de efeitos adversos potenciais e nãoaderência ao tratamento. Este estudo teve como objetivo identificar polimorfismos genéticos que podem potencialmente influenciar a resposta ao tratamento à clozapina em pacientes esquizofrênicos e ao escitalopram em pacientes com TDM. Essa abordagem envolveu o estudo de genes das enzimas metabolizadoras de fármacos CYP1A2 e CYP2C19, potencialmente envolvidas no metabolismo desses fármacos e que podem afetar a eficácia do tratamento. Foram estudados 54 pacientes esquizofrênicos em uso de clozapina e 31 pacientes com TDM em tratamento com escitalopram, ambos por longo prazo. Os polimorfismos investigados, CYP1A2*1F em pacientes esquizofrênicos e CYP2C19*2 e CYP2C19*17 em pacientes depressivos, foram estudados por métodos baseados na reação em cadeia da polimerase (PCR) seguido por sequenciamento (CYP1A2*1F) ou pela técnica de polimorfismo no comprimento de fragmentos de restrição (RFLP) (CYP2C19*2 e *17). Os resultados encontrados apontam a associação do polimorfismo CYP1A2*1F com a super-refratariedade ao tratamento à clozapina e a associação do polimorfismo CYP2C19*17 com resposta diminuída ao tratamento com escitalopram. Não foi encontrada associação entre o polimorfismo CYP2C19*2 e a resposta ao tratamento ao escitalopram. Os resultados obtidos sugerem que as variantes genéticas CYP1A2*1F e CYP2C19*17 podem desempenhar um papel importante na efetividade do tratamento com antipsicóticos e antidepressivos em transtornos psiquiátricos incapacitantes como a esquizofrenia e o TDM. A farmacogenética pode auxiliar na psiquiatria como ferramenta para a escolha de medicamentos e doses mais adequadas para cada paciente, diminuindo o sofrimento, reduzindo custos e trazendo qualidade de vida a pacientes e familiares.

Submitted by Cristiane Chim (cristiane.chim@ucpel.edu.br) on 2018-05-17T12:35:39Z No. of bitstreams: 1 Rosiene (2) (1).pdf: 1412096 bytes, checksum: eca79137111d0656bc5f944d945626b1 (MD5) / Made available in DSpace on 2018-05-17T12:35:40Z (GMT). No. of bitstreams: 1 Rosiene (2) (1).pdf: 1412096 bytes, checksum: eca79137111d0656bc5f944d945626b1 (MD5) Previous issue date: 2017-11-30 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq# / #-2555911436985713659# / #600 / Introduction: Dropout in psychotherapy is a recurrent outcome in both scientific research and clinical practice, its prevalence is around 17.5%, being one of the most frequent and serious negative outcomes. Aim: to verify associated factors with dropout in two brief psychotherapy models for depression in adults patients attended at an outpatient clinic for research and extension in mental health. Method: Clinical trial randomized with two models of psychotherapy for major depressive disorder (MDD): Cognitive Behavioral Therapy (CBT) and Supportive-Expressive Dynamic Psychotherapy (SEDP). Sociodemographic data will be collected from the sample through a questionnaire prepared by the research team, the economic class will be evaluated through the Brazilian Association of Research Companies (ABEP) classification. In addition, TDM and Anxiety Disorders will be evaluated through the Mini International Neuropsychiatric Interview - Plus (MINI Plus). Personality Disorders will be evaluated by the Millon Clinical Multiaxial Inventory III (MCMI-III). Finally, the severity of depressive symptoms will be measured using the Beck Depression Inventory (BDI) and resilience through Resilience Scale (RS). / Introdução: O abandono em psicoterapia é um desfecho recorrente tanto na pesquisa científica quanto na prática clínica, sua prevalência fica em torno de 17,5% sendo um dos desfechos negativos mais frequentes e graves. Objetivo: Analisar os fatores associados ao abandono do tratamento de psicoterapia breve por adultos com Transtorno Depressivo Maior (TDM) atendidos em um ambulatório de pesquisa e extensão em saúde mental na cidade de Pelotas. Método: Ensaio clínico randomizado com dois modelos de psicoterapia para TDM: Terapia Cognitivo Comportamental (TCC) e Psicoterapia Dinâmica Suportivo-expressiva (PDSE). Serão coletados dados sociodemográficos da amostra através de um questionário elaborado pela equipe de pesquisa, a classe econômica será avaliada através da classificação da Associação Brasileira de Empresas de Pesquisas (ABEP). Além disso, o TDM e os Transtornos de Ansiedade serão avaliados através da Mini International Neuropsychiatric Interview - Plus (MINI Plus). Os Transtornos de Personalidade serão avaliados pelo Millon Clinical Multiaxial Inventory III (MCMI-III). Por fim, a gravidade dos sintomas depressivos será mensurada através do Inventário de Depressão de Beck (BDI) e a resiliência através da Resilience Scale (RS)

Submitted by Cristiane Chim (cristiane.chim@ucpel.edu.br) on 2018-04-18T12:38:31Z No. of bitstreams: 1 Sally Knevitz da Silva_ok.pdf: 2056051 bytes, checksum: 2da37b9dbf4e6fb43925245cf821fc34 (MD5) / Made available in DSpace on 2018-04-18T12:38:31Z (GMT). No. of bitstreams: 1 Sally Knevitz da Silva_ok.pdf: 2056051 bytes, checksum: 2da37b9dbf4e6fb43925245cf821fc34 (MD5) Previous issue date: 2017-11-24 / Introduction: Research has shown that depressive episodes are influenced by biological, psychosocial and socio-cultural aspects, that can determine the symptoms, course and treatment of depressive disorder. Among the biological aspects, are the neurotrophins, which can be considered as potential biomarkers for depression. Between psychosocial and socio-cultural aspects, are the sexual roles as cognitive structure of subject identity constructs for you. Objective: This thesis aims to develop the evaluation of Biopsychosocial Factors associated with the diagnosis and treatment of major depressive disorder (MDD), from the research on the influence of sexual roles and of neurotrophins in the diagnosis and treatment of this disorder. Methods: Two studies with patients between 18 and 65 years old, diagnosed with major depressive disorder by current Mini International Neuropsychiatric Interview (M.I.N.I.) Plus and met in the outpatient and research in Mental Health in the city of Pelotas, RS. The first study was developed by cross-sectional method, selecting as participants all patients diagnosed with TDM and who fulfilled the eligibility criteria for the randomized clinical trial, regardless of the model of psychotherapeutic treatment to which they were randomized (Psychodynamic or cognitive-behavioral therapy). In this study, we used as verification of depressive symptoms by the Beck Depression Inventory (BDI)-II, and the observation of sexual roles through the Right Sex Role Inventory (BSRI), both performed in the first date of treatment. The second study was developed by the quasi-experimental method, nested randomized clinical trial to evaluate the efficacy of two models of psychotherapy for Depression, considering only those patients randomized to the follow-up in therapy Cognitive-Behavioral (CBT). In this study, patients were followed-up with the measurement of depressive symptoms through the BDI-II, in 3 different times along the psychotherapeutic monitoring (before starting, during, and after finishing). Also blood collections were performed to measure serum levels of three neurotrophins, which are factors of neuronal growth and development that can be associated with depressive symptoms and the course of the disorder, which were: Brain-Derived Neurotrophic Factor (BDNF), Glial cell-line Derived Neurotrophic Factor (GDNF) and beta-Nerve Growth Factor (NGF). Results: In the first study, it were not observed significantly differences between NGF levels, depressive symptoms and sexual roles. For the second study, patients had a significant change of severity symptoms after the treatment. It was not verified associations between depressive scores at Beck Depression Inventory II (BDI) and any independent variable, with statistical significance. Also, no correlations were observed between BDNF and GDNF levels, neither depressive scores at BDI pre-treatment and post-treatment, but we found a tendency of having statistical significance on the NGF levels. Conclusion: BDNF, NGF and GDNF were not influenciable by psychotherapy effects in symptomatology reduction. / Introdução: Pesquisas tem demonstrado que os episódios depressivos são influenciados por aspectos biológicos, psicossociais e socioculturais, que podem determinar a sintomatologia, o curso e o tratamento do transtorno depressivo. Entre os aspectos biológicos, estão as neurotrofinas, que podem ser consideradas potenciais biomarcadores para depressão. Entre os aspectos psicossociais e socioculturais, estão os papéis sexuais enquanto estrutura cognitiva de identidade que o sujeito constrói para si. Objetivo: Esta Tese tem por objetivo desenvolver a Avaliação de Fatores Biopsicossociais associados ao diagnóstico e tratamento do Transtorno Depressivo Maior (TDM), a partir da investigação sobre a influência dos papéis sexuais e das neurotrofinas no diagnóstico e tratamento deste transtorno. Métodos: Trata-se de dois estudos com pacientes entre 18 e 65 anos de idade, diagnosticados com Transtorno Depressivo Maior atual pela entrevista Mini Internacional Neuropsychiatric Interview (M.I.N.I.) Plus e atendidos no Ambulatório de Pesquisa e Extensão em Saúde Mental da cidade de Pelotas, RS. O primeiro estudo foi desenvolvido pelo método transversal, selecionando-se como participantes todos pacientes diagnosticados com TDM e que preencheram os critérios de elegibilidade para o Ensaio Clínico Randomizado, independente do modelo de tratamento psicoterapêutico para o qual foram randomizados (Psicodinâmica ou Terapia CognitivoComportamental). Neste estudo, utilizou-se como medidas a verificação dos sintomas depressivos pelo Beck Depression Inventory (BDI)-II e a observação dos papéis sexuais através do Bem Sex Role Inventory (BSRI), ambos realizados no primeiro encontro do tratamento. O segundo estudo foi desenvolvido pelo método quase-experimental, aninhado a Ensaio Clínico Randomizado para avaliar a eficácia de dois modelos de Psicoterapia para Depressão, considerando-se apenas os pacientes randomizados para o acompanhamento em Terapia Cognitivo-Comportamental (TCC). Neste estudo, os pacientes foram acompanhados com a mensuração dos sintomas depressivos também através do BDI-II, em 3 momentos distintos ao longo do acompanhamento psicoterapêutico (antes de iniciar, durante e após terminar). Também foram realizadas coletas de sangue para medir os níveis séricos de três neurotrofinas, as quais são fatores de crescimento e desenvolvimento neuronal que podem estar associadas à sintomatologia depressiva e ao curso do transtorno, que foram: Brain-Derived Neurotrophic Factor (BDNF), Glial cell-line Derived Neurotrophic Factor (GDNF) e beta-Nerve Growth Factor (NGF). Resultados: No primeiro estudo, não foram observadas diferenças estatisticamente significativas entre os níveis séricos de NGF, os sintomas depressivos e os papéis sexuais. No segundo estudo, foi observada redução significativa da severidade dos sintomas após o término do tratamento. Não foram verificadas associações significativas entre os escores de sintomatologia depressiva pelo BDI e qualquer uma das variáveis independentes. Em relação as neurotrofinas, não foram observadas correlações significativas dos níveis séricos de BDNF e GDNF com os escores de sintomas depressivos pré-tratamento e pós-tratamento.

The purpose of this study was to compare outcomes for patients with Bipolar Disorder or Major Depressive Disorder based on severity of diagnosis. This study also compared psychotherapy providers and therapy modalities on total cost, number of sessions, and dropout. Our data set (N=136,439) came from Cigna, a national health care company. Results showed significant differences by severity of diagnosis. The comparison of providers showed that psychologists had higher costs and session numbers, while the other providers were not significantly different. However, all providers successfully provided low cost treatment on both MDD and BD. There is no support for the idea that one profession is more successful at providing low cost treatment for MDD and BD. Family therapy did significantly better on all outcomes except dropout rate when compared to individual or mixed (individual and family sessions) therapy. It is a low-cost option when treating MDD and BD, regardless of severity.

Family and twin studies have shown a heritable component to seasonal affective disorder (SAD). While a few studies have examined individual genetic variants in SAD, many methodological issues exist in the current literature. First, most studies combined major depression (MDD) and bipolar (BD) cases in the genetic analysis of SAD. This makes it difficult to differentiate the effect from MDD and BD. Second, most studies adopted a candidate gene approach and used fairly small sample sizes. This does not allow for testing across a wide variety of genes, and it yields less robust P-values. Third, healthy controls have been used, but not case comparisons, which makes it difficult to differentiate the effects of seasonality from that of the primary illness (MDD and BD). To overcome these issues, seasonal MDD and BD cases were separated into two different studies in this thesis; sample sizes for both studies are the largest in the current SAD molecular genetics literature; GWAS was used to test for potential risk loci in a hypothesis-free fashion; case comparisons were incorporated to exclude potential genetic contributions related generally to the primary diseases themselves (MDD and BD). For MDD, we performed a GWAS with 562 seasonal MDD cases and 1,225 comparison cases with non-seasonal MDD. Subjects were drawn from two iterations of the Genetics of Recurrent Early Onset Depression (GenRED) study. Seasonal cases were those whose depressive episodes typically started in fall or winter. A mega-analysis of the two GWAS datasets was done using SNPTEST. We found that two single nucleotide polymorphisms (SNPs), rs149882931 and rs77073398, on chromosome 16p12.1 were associated with seasonal depression, at a genome-wide significant level (OR= 1.66, P= 3.59 x 10-8 and OR=1.62, 4.76 x 10-8, respectively). Since SAD is more prevalent in females, a female-specific analysis was carried out. The two variants were more significant in this analysis: P=2.18x10-9 (OR=1.89) and P=2.79x10-9 (OR=1.82), respectively, and a significant sex-by-SNP interaction was observed. These SNPs are located in a conserved intergenic region between the genes HS3ST4 and C16orf82. The protein product of HS3ST4 modifies the side chains of heparan sulfate proteoglycans. We therefore tested the hypothesis that the heparan sulfate biosynthesis pathway would be enriched in nominally significant SNPs using the SNP ratio test, and found evidence for such enrichment (P=0.008, SNP ratio test, P=0.027, SKAT). For BD, the GWAS analysis of 818 seasonal BD cases and 1,515 healthy controls showed that BD-S is most strongly associated with two SNPs within the ZBTB20 genes. BD subjects were drawn from NIMH Bipolar Genetics Study (BIGS), and seasonal cases were defined as those with depressive episodes starting in fall or winter. An association study was carried out with SNPTEST, and we found two single nucleotide polymorphisms (SNPs) in the intronic region of ZBTB20 gene to be associated with BD-S (rs7646282, OR=2.34, P= 7.23 x 10-8 and rs139459337, OR=2.37, 8.05 x 10-8). A similar case-only study was carried out with 818 BD-S cases and 1239 cases without seasonal depressive symptoms (non-BDS), though no SNP was found to be significantly associated in this analysis. rs7646282 is the strongest SNP in cis-association with ZBTB20 gene expression, and ZBTB20 has been shown to affect the neural development of the hippocampus, a brain region implicated in the pathophysiology of BD. Finally, we sought to determine whether there is a role for circadian rhythm genes in BD susceptibility. In this study, we used a discovery set of 189 exome-sequenced BD patients and 105 healthy controls to look for circadian genes associated with BD. We found the DRD2 gene to be the circadian gene most strongly associated with BD. Among the rare damaging variants in the DRD2 gene, the S311C variant was the predominant SNP. To test whether this variant segregates in family members with BD, we genotyped the family members of probands from the discovery sample. This data was used for a linkage and family-based association study. Even though the linkage analysis was only very weakly positive, the family-based association study showed significant segregation of the variant in family members with BD (P< 0.05). To follow up on this finding, we further genotyped 2,185 unrelated BD cases and 1,982 healthy controls. We found no support for the S311C variant in this replication dataset. Sub-phenotype study of psychotic features and mood-incongruence also did not show significant association. Meta-analysis with 2,994 BD cases and 3,661 controls, however, revealed no association between the S311C variant and BD.

Certain electrophysiological markers hold promise in distinguishing individuals with major depressive disorder (MDD) and in predicting antidepressant response, thereby assisting with assessment and optimizing treatment, respectively. This thesis examined resting brain activity via electroencephalographic (EEG) recordings, as well as EEG-derived event-related potentials (ERPs) to auditory stimuli and facial expression presentations in individuals with MDD and controls. Additionally, the utility of resting EEG as well as auditory ERPs (AEPs), and the associated loudness-dependence of AEPs (LDAEP) slope, were assessed in predicating outcome to chronic treatment with one of three antidepressant regimens [escitalopram (ESC); bupropion (BUP); ESC+BUP]. Relative to controls, depressed adults had lower pretreatment cortical activity in regions implicated in approach motives/positive processing. Increased anterior cingulate cortex (ACC)-localized theta was observed, possibly reflecting emotion/cognitive regulation disturbances in the disorder. AEPs and LDAEPs, putative indices of serotonin activity (implicated in MDD etiology), were largely unaltered in MDD. Assessment of ERPs to facial expression processing indicated slightly blunted late preconscious perceptual processing of expressions, and prolonged processing of intensely sad faces in MDD. Faces were rated as sadder overall in MDD, indicating a negative processing bias. Treatment responders (vs. non-responders) exhibited baseline cortical hypoactivity; after a week of treatment, cortical arousal emerged in responders. Increased baseline left fronto-cortical activity and early shifts towards this profile were noted in responders (vs. non-responders). Responders exhibited a steep, and non-responders shallow, baseline N1 LDAEP derived from primary auditory cortex activity. P2 LDAEP slopes (primary auditory cortex-derived) increased after a week of treatment in responders and decreased in non-responders. Consistent with overall findings, ESC responders displayed baseline cortical hypoactivity and steep LDAEP-sLORETA slopes (vs. non-responders). BUP responders also exhibited steep baseline slopes and high ACC theta. These results indicate that specific resting brain activity profiles appear to distinguish depressed from non-depressed individuals. Subtle ERP modulations to simple auditory and emotive processing also existed in MDD. Resting alpha power, ACC theta activity and LDAEP slopes predicted antidepressant response in general, but were limited in predicting outcome to a particular treatment, which may be associated with limited sample sizes.

Social interactions affect the onset and maintenance of major depressive disorder (MDD; e.g., Hammen, 2006). However, little research has examined depressed people’s communications in daily life. This dissertation’s primary aim is to test three models of the association between MDD and everyday communication. The disclosure model suggests that people with MDD, particularly if currently depressed, communicate about themselves and their distress. The social disengagement model suggests that people with MDD, particularly if currently depressed, communicate less. The selectivity model suggests that people with MDD, particularly if currently depressed, communicate more negatively only with people with whom they have closer relationships. This dissertation’s second aim is to investigate associations between communication patterns of individuals with MDD and residual depressive symptoms. Sixteen women with MDD and 15 never-depressed women submitted a year’s worth of their e-mails with up to ten correspondents. For participants with MDD the year included at least one month of depression and one month of remission. E-mails were submitted to computerized text analysis. For the primary research question, the study design was conceptualized as a 2x2 between-subjects (MDD vs. never-depressed) x within-subjects (currently depressed vs. not currently depressed) ANOVA missing one cell (never-depressed individuals with currently depression). Data were e-mails nested within correspondents within participants and were analyzed using multi-level regression. For the second research question, OLS regression analyses were used. People with MDD e-mailed their correspondents marginally more frequently when in a depressive episode, suggesting increased efforts at engagement. During episodes, however, participants showed less verbal synchrony with their correspondents. This suggests that despite reaching out more, currently depressed people are less attuned with others. People with major depressive disorder used more positive emotion words and fewer negative emotion words than never-depressed controls. Although there was a general pattern among participants of using more negative emotion words with correspondents with whom they had closer relationships, this tendency was accentuated in depressed individuals in current major depressive episodes. These findings are consistent with the view that individuals – particularly when depressed – regulate aspects of their communication to protect and manage their social relationships. / text

Depression is commonly associated with abnormal sleep architecture. This thesis undertook to assess sleep architecture as a biological correlate of self and observer-rated depressive state, and consists of three studies. The first used a categorical approach to examine the association of sleep architecture with subjective mood in a community sample of 74 preoperative patients, and found no association between high depression scores and hypothesized sleep markers. The second followed 16 patients with Major Depression who were treated with the antidepressant mirtazapine in an 8 week longitudinal study during which they underwent polysomnography on 6 occasions. It was found that classes of sleep markers (REM latency or REM, arousal index, and slow wave sleep) tend to predict response when analyzed concurrently. The third study was methodological in nature, and found that commercially available software for automating eye movement counts did not show strong correspondence with visually scored polysomnographic data.

Depression is commonly associated with abnormal sleep architecture. This thesis undertook to assess sleep architecture as a biological correlate of self and observer-rated depressive state, and consists of three studies. The first used a categorical approach to examine the association of sleep architecture with subjective mood in a community sample of 74 preoperative patients, and found no association between high depression scores and hypothesized sleep markers. The second followed 16 patients with Major Depression who were treated with the antidepressant mirtazapine in an 8 week longitudinal study during which they underwent polysomnography on 6 occasions. It was found that classes of sleep markers (REM latency or REM, arousal index, and slow wave sleep) tend to predict response when analyzed concurrently. The third study was methodological in nature, and found that commercially available software for automating eye movement counts did not show strong correspondence with visually scored polysomnographic data.