الفهرس 
BACKGROUND AND GENDER DIFFERENCES IN PROFILE OF SYMPTOMS OF MAJOR DEPRESSIVE DISORDER
MDD Secondary to Medical DiseasesOnly 14 pages are availabe for public view
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Abstract
The clinical manifestations of MDD are not limited to
mood symptoms, but also include a range of cognitive
and motor symptoms. Thus, MDD is considered a
multifactorial disorder which varies in terms of symptom
severity, psychiatric co-morbidity, and clinical course,
including recurrence and response to treatment (Seok et al.,
2012).
In the last years, cognitive impairment in depression has
been widely reported. It is clear that cognitive symptoms persist
after remission of psychopathological symptoms but little is
known about the pathophysiological events linking depression
and cognitive impairment. Novel biological, structural and
functional neuroimaging techniques have allowed a better
definition of this relation. Depression and cognitive dysfunction
share a common neuropathological platform in cortical and
sub-cortical brain areas implicated in emotional and cognitive
processing which may be under the control of genetic and
environmental factors (Lam et al., 2014).
Cognitive gender differences are still reported, typically
with a life-long advantage for men in tasks assessing
visuospatial (Voyer et al., 1995) and mathematical abilities
(Halpern et al., 2007), whereas women are often found to
outperform men in tasks assessing episodic memory and
reading literacy (Pauls et al., 2013). In other cognitive tasks,such as category fluency and vocabulary, gender differences are
typically not observed (Capitani et al., 1998). Although
biologically based explanations for these differences have been
proposed, there are also studies indicating that societal factors
influence cognitive gender differences (Miller et al., 2014).
This thesis was designed aiming at covering the
following areas in the theoretical part: (1) An overview of
major depressive disorder and gender differences in profile of
symptoms, (2) Review of cognitive functions and gender
differences in cognitive dysfunction in major depressive
disorder and (3) Review of the management strategies of
cognitive dysfunction associated with major depression in
terms of gender difference.
The practical part aimed at:
1- Assessing the gender difference in cognitive performance
among Egyptian patients with major depressive disorder.
2- Assessing the risk factors related to cognitive dysfunction in
Egyptian patients with major depressive disorder.
We hypothesized that euthymic major depressive disorder
patients show a poorer performance in tasks of executive
functioning, attention and memory compared to their control
group. We also hypothesized that gender differences in cognitive
performance in euthymic patients with major depression might
exist. We attempted to ascertain whether specific cognitive deficits could be observed in euthymic patients and whether they
showed different patterns of performance depending on their
gender, and also the role of different factors correlated with
neuropsychological performance.
The present study evaluated collectively 60 euthymic
patients with MDD who were equally divided into male and
female groups and one control group composing of 30 healthy
subjects (15 males and 15 females). The study was carried out
at the outpatient department of the institute of psychiatry, Ain
shams university.
We obtained an informed consent and inclusion criteria
were insured before the study was conducted which included
age between 18-45 years, Egyptian male and female subjects,
MDD subjects in euthymic state.
The tools were precisely selected to fulfil the purpose of
the study, that included the Structured Clinical Interview for
DSM-IV (SCID-I), Hamilton Rating Scale for Depression,
Wechsler adult intelligence scale (WAIS), Wechsler memory
scale (WMS), Wisconsin card sorting test (WCST) and Trail
Making Test (TMT).
All data gathered were recorded, tabulated and
transferred on Statistical Package for Social Sciences (SPSS)
using personal computer and the suitable statistical parameterswere used. Results were displayed to answer questions raised in
the hypothesis of this study.
On Demographic characteristics, the patient groups and
the control group were matched for age, gender, years of
education, social class, marital status and occupation. There
was a significant difference in social class, marital status
between male and female subjects with MDD and the control
group.
On clinical characteristics:
Our study demonstrated no statistically significant
differences between male and female subjects with MDD as
regards age of onset, duration of illness, family history of
depression, ECT and number of previous hospitalization.
On tests of general intelligence:
On all domains of Wechsler Adult Intelligence Scale
(WAIS), we found that the control group had a significantly
higher mean score than the other groups. We also found that
male subjects with MDD scored higher than female subjects
with MDD in the following domains of WAIS: Verbal IQ,
Performance IQ, Total IQ, verbal comprehension, verbal
arithmetic, and verbal similarities. On the other hand, female
subjects with MDD scored higher than male subjects with
MDD in the following domains of WAIS: Verbal digital span,Performance picture completion, Performance block design,
and Performance digital symbol.
On tests of memory:
On all domains of Wechsler Memory Scale (WMS),
control group scored higher than the other groups. Also, male
subjects with MDD scored higher than female subjects with
MDD on all domains of WMS.
On tests of executive functions:
In WCST, the control group scored less than the other
groups in the following domains: total error, percent of error,
non-preservative error, percent of non-preservative error and
failure to maintain set. The difference between groups was
statistically significant. On the other hand, the control group
scored higher than the other groups in those domains: total
correct responses, preservative responses, percent of
preservative responses, conceptual level responses, percent of
conceptual level responses, and categories. The difference
between groups was statistically significant. Male subjects with
MDD group scored higher than female subjects with MDD in
the following domains of WCST: Total correct responses,
preservative responses, percent of preservative responses,
preservative error, percent of preservative error, conceptual
level responses, percent of conceptual level responses,
categories completed, trials to complete categories and failure to maintain set. On the other hand, male subjects with MDD
scored less than female subjects with MDD in the following
domains of WCST: Total error, percent of error, nonpreservative
error, percent of non-preservative error.
On tests of attention:
In TMT, the control group had statistically significant
lower mean A-score and lower mean B-score than the other 2
groups than both male and female subjects with MDD groups.
Also, Female subjects with MDD scored less than male
subjects with MDD in A and B scores.
We concluded that patients with major depressive
disorder in-between episodes performed poorer than control
group on tests of intelligence, memory, executive functions and
attention. Also, female subjects with MDD performed even
poorly than male subjects with MDD and control group on the
same tests.
So far, there is no clear evidence on whether or not there
are any gender differences in cognitive performance among
euthymic patients with major depressive disorder. Our study is
considered as the first study to address this issue in an Egyptian
sample. We hope that this work will have contributed to the
growing knowledge in this area.
Our clinical recommendations included routine assessment
of cognitive functions in outpatient clinic throughout the management of MDD, better screening for cognitive deficits in
patients with mental illnesses, family counselling about the
hazards of cognitive impairment in patients with mental illnesses,
developing strategies for cognitive enhancement and
rehabilitation and considering the impact of cognitive side effects
of medications when prescribing to patients. Our research
recommendations included conducting epidemiologic surveys on
large scales to assess cognitive dysfunction in Egyptian patients
with MDD, considering repeated assessment of cognitive
functions in clinical trials on antidepressants as a measure of
improving quality of life in MDD patients and studying cognitive
dysfunction in other subtypes of depression such as adolescents
and late life depression and depression with psychotic features.