Person: Iosifescu, Dan
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Iosifescu
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Dan
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Iosifescu, Dan
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Publication Feasibility of studying brain morphology in major depressive disorder with structural magnetic resonance imaging and clinical data from the electronic medical record: A pilot study(Elsevier BV, 2013) Hoogenboom, Wouter S.; Perlis, Roy; Smoller, Jordan; Zeng-Treitler, Qing; Gainer, Vivian S.; Murphy, Shawn; Churchill, Susanne; Kohane, Isaac; Shenton, Martha; Iosifescu, DanFor certain research questions related to long-term outcomes or to rare disorders, designing prospective studies is impractical or prohibitively expensive. Such studies could instead utilize clinical and magnetic resonance imaging data (MRI) collected as part of routine clinical care, stored in the electronic medical record (EMR). Using major depressive disorder (MDD) as a disease model, we examined the feasibility of studying brain morphology and associations with remission using clinical and MRI data exclusively drawn from the EMR. Advanced automated tools were used to select MDD patients and controls from the EMR who had brain MRI data, but no diagnosed brain pathology. MDD patients were further assessed for remission status by review of clinical charts. Twenty MDD patients (eight full-remitters, six partial-remitters, and six nonremitters), and fifteen healthy control subjects met all study criteria for advanced morphometric analyses. Compared to controls, MDD patients had significantly smaller right rostral-anterior cingulate volume, and level of non-remission was associated with smaller left hippocampus and left rostral-middle frontal gyrus volume. The use of EMR data for psychiatric research may provide a timely and cost-effective approach with the potential to generate large study samples reflective of the real population with the illness studied.Publication Recognition of Depressive Symptoms by Physicians(Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 2009) Henriques, Sergio Gonçalves; Fráguas, Renério; Iosifescu, Dan; Menezes, Paulo Rossi; de Lucia, Mara Cristina Souza; Gattaz, Wagner Farid; Martins, Milton ArrudaOBJECTIVE: To investigate the recognition of depressive symptoms of major depressive disorder (MDD) by general practitioners. INTRODUCTION: MDD is underdiagnosed in medical settings, possibly because of difficulties in the recognition of specific depressive symptoms. METHODS: A cross-sectional study of 316 outpatients at their first visit to a teaching general hospital. We evaluated the performance of 19 general practitioners using Primary Care Evaluation of Mental Disorders (PRIME-MD) to detect depressive symptoms and compared them to 11 psychiatrists using Structured Clinical Interview Axis I Disorders, Patient Version (SCID I/P). We measured likelihood ratios, sensitivity, specificity, and false positive and false negative frequencies. RESULTS: The lowest positive likelihood ratios were for psychomotor agitation/retardation (1.6) and fatigue (1.7), mostly because of a high rate of false positive results. The highest positive likelihood ratio was found for thoughts of suicide (8.5). The lowest sensitivity, 61.8%, was found for impaired concentration. The sensitivity for worthlessness or guilt in patients with medical illness was 67.2% (95% CI, 57.4–76.9%), which is significantly lower than that found in patients without medical illness, 91.3% (95% CI, 83.2–99.4%). DISCUSSION: Less adequately identified depressive symptoms were both psychological and somatic in nature. The presence of a medical illness may decrease the sensitivity of recognizing specific depressive symptoms. CONCLUSIONS: Programs for training physicians in the use of diagnostic tools should consider their performance in recognizing specific depressive symptoms. Such procedures could allow for the development of specific training to aid in the detection of the most misrecognized depressive symptoms.Publication Reduced Hedonic Capacity in Major Depressive Disorder: Evidence from a Probabilistic Reward Task(Elsevier, 2008) Pizzagalli, Diego; Iosifescu, Dan; Hallett, Lindsay A.; Ratner, Kyle G.; Fava, MaurizioObjective: Anhedonia, the lack of reactivity to pleasurable stimuli, is a cardinal feature of depression that has received renewed interest as a potential endophenotype of this debilitating disease. The goal of the present study was to test the hypothesis that individuals with major depression are characterized by blunted reward responsiveness, particularly when anhedonic symptoms are prominent. Methods: A probabilistic reward task rooted within signal-detection theory was utilized to objectively assess hedonic capacity in 23 unmedicated subjects meeting DSM-IV criteria for major depressive disorder (MDD) and 25 matched control subjects recruited from the community. Hedonic capacity was defined as reward responsiveness – i.e., the participants’ propensity to modulate behavior as a function of reward. Results: Compared to controls, MDD subjects showed significantly reduced reward responsiveness. Trial-by-trial probability analyses revealed that MDD subjects, while responsive to delivery of single rewards, were impaired at integrating reinforcement history over time and expressing a response bias toward a more frequently rewarded cue in the absence of immediate reward. This selective impairment correlated with self-reported anhedonic symptoms, even after considering anxiety symptoms and general distress. Conclusions: These findings indicate that MDD is characterized by an impaired tendency to modulate behavior as a function of prior reinforcements, and provides initial clues about which aspects of hedonic processing might be dysfunctional in depression.