Table of Contents - Academy of Psychosomatic Medicine

Poster Presentations
Thursday, November 12, 2009
4:00 PM – 6:00 PM
1. Symptom Indicator of Severity of
Depression in Cancer Patients: A Comparison
of the DSM-IV Criteria with Alternative
Diagnostic Criteria
Presenting Author: Tatsuo Akechi, MD, PhD
Co-Authors: Tetsuji Ietsugu, PhD, Masune Sukigara, PhD,
Hitoshi Okamura, MD, PhD, Tomohito Nakano, MD, PhD,
Nobuya Akizuki, MD, PhD, Masako Okamura, MD, PhD, Ken
Shimizu, MD, PhD, Toru Okuyama, MD, PhD, Toshiaki Furukawa,
MD, PhD, Yosuke Uchitomi, MD, PhD
Purpose: Although the severity of major depression should
be a relevant indicator for treatment implementation in cancer
patients, especially the administration of antidepressants,
determining the severity of major depression in cancer
patients as well as diagnosing major depression has been
challenging. The objective of this study was to explore the
performances of several diagnostic criteria items for judging
the severity of major depression among cancer patients.
Methods: Using modern item response theory, we examined
the performances of the diagnostic criteria outlined by the
DSM-IV and two sets of conceptual diagnostic criteria (the
Endicott and the Cavanaugh criteria) in a series of 728 cancer
patients who had been referred to the Psychiatry Division
and diagnosed with major depression using an inclusive
approach.
Results: While all the DSM-IV diagnostic criteria had a low
ability for discriminating the severity of depression, two proposed
items (not participating in medical care and social
withdrawal) appeared to be good markers of moderately severe
major depression among cancer patients. In addition,
the items, “fearfulness or depressed appearance in face or
body posture” and “brooding, self-pity, or pessimism” may
be good markers for mild major depression, while the item,
“cannot be cheered up, doesn’t smile, no response to good
news or funny situations” may be a good marker for severe
major depression.
Conclusions: The present study suggests alternative criteria
may have utility in diagnosing depression severity in cancer
patients.
References:
Judd FK, et al. Handbook of studies on general hospital psychiatry.
New York: Elsevier, 1991
2. Randomized Placebo-Controlled Trial of
Ramelteon for Seasonal Affective Disorder
Presenting Author: Edward Norris, MD, FAPM
1
Co-Authors: Karen Burke, RN, Carol Foltz, PhD, Michael
Kaufmann, MD
Purpose: One major theory regarding the etiology of seasonal
affective disorder (SAD) suggests that the lack of natural
light accompanying the winter season is the central cause
of a misalignment of the circadian rhythm. This study assessed
if ramelteon, a novel sleep-promoting agent with high
selectivity for the MT1/MT2 receptors in the brain’s SCN,
could resynchronize the circadian rhythm and decrease depressive
symptoms associated with SAD.
Methods: In this single-site, single-blind, parallel-group
study, participants with a DSM-IV diagnosis of SAD were
randomly assigned to receive either ramelteon 8 mg or placebo
in addition to their usual care by a Psychiatrist and
assessed monthly for four months. The mean change from
baseline in the Zung depression scale and the Structured
Interview Guide for the Hamilton Depression Rating Scale,
SAD version (SIGH-SAD) were used to assess depressive
symptoms. Takeda Pharmaceuticals North America, Inc
sponsored the investigator who initiated this clinical trial.
Results: Fifty participants were enrolled, 49 were randomized
to receive ramelteon (n=25) or placebo (n=24). Allowing
for drop-outs, the efficacy sample included 45 participants
who had at least 1 follow-up (ramelteon, n=24; placebo,
n=21). At baseline, there were no significant demographic
differences between the 2 treatment groups, with a mean
age of 46.6 years and predominantly female (74%). The ramelteon
group had significantly lower Zung scores at month
2 (ramelteon 52, placebo 59, p