Can We Clinically Recognize a Vascular Depression?

The vascular depression (VD) hypothesis postulates that cerebrovascular disease may ‘‘predispose, precipitate, or perpetuate’’ a depressive syndrome in elderly patients. Clinical presentation of VD has been shown to differ to major depression in quantitative disability; however, as little research has been made toward qualitative phenomenological differences in the personality aspects of the symptom profile, clinical diagnosis remains a challenge. We attempted to identify differences in clinical presentation between depression patients (n1⁄4 50) with (n1⁄4 25) and without (n1⁄4 25) vascular disease using questionnaires to assess depression, affect regulation, object relations, aggressiveness, alexithymia, personality functioning, personality traits, and counter transference. We were able to show that patients with vascular dysfunction and depression exhibit significantly higher aggressive and auto-aggressive tendencies due to a lower tolerance threshold. These data indicate that VD is a separate clinical entity and secondly that the role of personality itself may be a component of the disease process. We propose an expanded threshold disease model incorporating personality functioning and mood changes. Such findings might also aid the development of a screening program, by serving as differential criteria, ameliorating the diagnostic procedure. (Medicine 94(18):e743) Abbreviations: AREQ = Affect Experience and Affect Regulation Q-sort , BDI = Beck Depression Inventory, CTQ = Countertransference Questionnaire, FAF = Freiburg Agression Questionnaire, IIP = Inventory of Interpersonal problems, SCORS = Social Cognition and Object Relations Scale, SWAP-200 = Shedler-Westen Assessment Procedure-200, TAS-20 = 20 Item Toronto-Alexithymia-Scale, VD = vascular depression. INTRODUCTION la Mauerhofer, and Henriette Löffler-Stastka Whilst this broad definition attempts to encompass both clinical and morphological substrate of an expression of late life depression, divergent diagnostic concepts, both in criteria and approach complicate the diagnostic and scientific investigation. Clinical presentation of VD has been shown to differ to major depression in quantitative disability; however, as little research has been made toward qualitative phenomenological differences in the personality aspects of the symptom profile; clinical diagnosis remains a challenge. The need for investigations into psychological and interpersonal factors has been stressed. Refinement of the VD hypothesis has led to varying emergent criteria. On the contrary, a functional and treatment outcome-based proposal to population definition; the depressed executive function (DED), on the other hand, imaging hallmarks, which characterize vascular elicited deterioration in regional brain function, such as white matter lesions (WML) or subcortical ischemic lesions (SIL), characterized by white matter hyper-intensities and deep white matter hyper-intensities (WMH and DWMH), in MRI imaging are described. METHOD In this case-controlled study, we investigated the phenomenological differences in personality and interpersonal functioning between depressive patients, with, and without vascular dysfunction. The symptom profile assessment was performed on 2 groups and focused on depression, affect regulation, object relations, aggressiveness, alexithymia, personality functioning, personality traits, and counter transference. As a lack of consensus on criteria complicates the eligibility criteria of VD, we attempted to bypass these manifold classifications by selecting the concurrent underlying pathology as our inclusion criteria: vascular dysfunction. Subjects included in the VD group were patients pertaining both: a diagnosis of depression or depressive episode (ICD-10 F31.3, F31.4, F31.5, F32, F33) and a diagnosis of peripheral vascular disease (ICD-10 I73.9). Patient recruitment was performed at 2 hotspots, consecutively including all in-patients who fulfilled the aforementioned criteria during a predefined matched-pairs enrollment period of 12 months. Matching concerned sex and age ( 2 years). Both groups were assessed using 4 self-assessment methods: The Beck Depression Inventory (BDI), the Freiburg Aggression Questionnaire (FAF), the Inventory of Interpersonal Problems (IIP), and the 20-Item Toronto-Alexithymia-Scale (TAS-20). Additionally 4 expert-rated scores were performed: The Shedler-Westen Assessment Procedure200 (SWAP-200), the Affect Experience and Affect Regulation ocial Cognition and Object Relations the Countertransference Questionnaire www.md-journal.com | 1 The study complied with the Helsinki Declaration and was approved by the ethics committee of the Medical University of Vienna.