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A Rating Scale for Depression

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... The main outcome measure was the Y-BOCS score, but two additional measures were also considered to complete the assessment with data on functional and mood dimensions (the GAF and HDRS scores respectively) [19,23]. The questionnaires were administered at the beginning of the study, at 3, 6, 9 and 12 months after implantation and annually thereafter by three trained psychiatrists with extensive experience in the treatment and evaluation of OCD (PA, CS, ER), who were the clinical referents of each of the patients and were responsible for optimizing the neurostimulation parameters based on clinical response. ...
... Depressive disorders are the most frequent comorbidity in patients with OCD treated with DBS [13,25], and therefore, the 17-item Hamilton Depression Rating Scale (HDRS) [23] was used to quantitatively assess the severity of depressive symptoms (score range: 0 to 54) and to monitor changes therein during follow-up [23]. Global functioning was evaluated at each visit using the GAF [26,27]. ...
... Depressive disorders are the most frequent comorbidity in patients with OCD treated with DBS [13,25], and therefore, the 17-item Hamilton Depression Rating Scale (HDRS) [23] was used to quantitatively assess the severity of depressive symptoms (score range: 0 to 54) and to monitor changes therein during follow-up [23]. Global functioning was evaluated at each visit using the GAF [26,27]. ...
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Background Twenty years after the first use of Deep Brain Stimulation (DBS) in obsessive-compulsive disorder (OCD), our knowledge of the long-term effects of this therapeutic option remains very limited. Objective Our study aims to assess the long-term effectiveness and tolerability of DBS in OCD patients and to look for possible predictors of long-term response to this treatment. Methods We studied the course of 25 patients with severe refractory OCD treated with DBS over an average follow-up period of 6.4 years (±3.2) and compared them with a control group of 25 patients with severe OCD who refused DBS and maintained their usual treatment. DBS was implanted at the ventral anterior limb of the internal capsule and nucleus accumbens (vALIC-Nacc) in the first six patients and later at the bed nucleus of stria terminalis (BNST) in the rest of patients. Main outcome was change in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score between the two groups assessed using mixed models. Secondary effectiveness outcomes included Hamilton Depression Rating Scale (HDRS) and Global Assessment of Functioning (GAF) scores. Results Obsessive symptoms fell by 42.5% (Y-BOCS score) in patients treated with DBS and by 4.8% in the control group. Fifty-six per cent of DBS-treated patients could be considered responders at the end of follow-up and 28% partial responders. Two patients among those who rejected DBS were partial responders (8%), but none of the non-DBS group achieved criteria for complete response. HDRS and GAF scores improved significantly in 39.2% and 43.6% among DBS-treated patients, while did not significantly change in those who rejected DBS (improvement limited to 6.2% in HDRS and 4.2% in GAF scores). No statistically significant predictors of response were found. Mixed models presented very large comparative effect sizes for DBS (4.29 for Y-BOCS, 1.15 for HDRS and 2.54 for GAF). Few patients experienced adverse effects and most of these effects were mild and transitory. Conclusions The long-term comparative effectiveness and safety of DBS confirm it as a valid option for the treatment of severe refractory OCD.
... Regarding DSM-IV criteria, SCID-I was used to diagnose BD-I and rule out other psychiatric illnesses [23]. The Hamilton Depression Rating Scale (HAM-D) [24] and Young Mania Rating Scale (YMRS) [25] were utilized to confirm remission. ...
... Every individual has been assessed utilizing the following semistructured and standardized structured clinical instruments: semi-structured sheet includes family history, course of illness, information on diagnostic and clinical features, and actual and past pharmacotherapy: Structured Clinical Interview for Axis-I Disorders (SCID-I) [23]. Hamilton Depression Scale (HAM-D) with 17 items [24]; Young Mania Rating Scale (YMRS) [25] to ensure euthymic state. ...
... Inclusion Criteria Were: (a) Age ranged between 18 and 45 (b) Males and females included (b) Diagnosis of BD type I according to (DSM-IV) criteria using SCID-I [23]. (c) Score 7 or less in both HAM-D with 17 items [24] and YMRS [26]. ...
Article
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Background: Recently, several studies have detected cognitive impairment and microstructural anomalies of white matter (WM) in bipolar disorder type I (BD-I). It is still unclear if these structural and cognitive anomalies in BD are progressive or static.
... This post hoc analysis 1 is based on the SET arm of the clinical trial; 51 patients participated in a brief 16-session psychodynamic psychotherapy for depression, 33 of whom completed the treatment. Of the 33 completed treatments, seven patients could not be considered for this post hoc study due to unusable video recording of sessions, and four could not be included because they did not have a main outcome score (Hamilton Rating Scale of Depression [HRSD]; Hamilton, 1960) at Week 32 that was used to define treatment outcome, resulting in a usable sample of 22. Compared to dropouts, treatment completers had lower baseline depression severity on the HRSD (Hamilton, 1960; completers: M = 18.97, SD = 3.63; dropouts: M = 21.39, ...
... This post hoc analysis 1 is based on the SET arm of the clinical trial; 51 patients participated in a brief 16-session psychodynamic psychotherapy for depression, 33 of whom completed the treatment. Of the 33 completed treatments, seven patients could not be considered for this post hoc study due to unusable video recording of sessions, and four could not be included because they did not have a main outcome score (Hamilton Rating Scale of Depression [HRSD]; Hamilton, 1960) at Week 32 that was used to define treatment outcome, resulting in a usable sample of 22. Compared to dropouts, treatment completers had lower baseline depression severity on the HRSD (Hamilton, 1960; completers: M = 18.97, SD = 3.63; dropouts: M = 21.39, ...
... Specifically, from the sample of 22 patients who had available video and outcome data, we selected the two patients with the best treatment outcomes to resemble a "good outcome" and the two patients with the poorest treatment outcomes to resemble a "poor outcome." The two "good outcome" cases had a superior outcome on the HRSD (Hamilton, 1960) in terms of achieving remission at the end of active treatment (Week 16) and sustaining at follow-up (Week 32). The two "poor outcome" cases did not achieve remission and demonstrated the least change in depression symptoms from baseline to the end of active treatment and at follow-up. ...
Article
This exploratory study assesses the use and quality of therapeutic immediacy in short-term psychodynamic psychotherapy for depression. We aimed to identify what constitutes effective here-and-now discussions of the therapeutic relationship by examining a sample of four treatment cases drawn from a previous randomized clinical trial for depression. Transcripts of 16 treatment sessions (four time points per treatment) were analyzed using the consensual qualitative research for case study method. The therapists' contributions to therapeutic immediacy were assessed qualitatively by independent judges and then quantitatively analyzed in relation to immediate session outcome as well as overall treatment outcome (reduction in depressive symptoms). A total of 41 immediacy events were identified across 16 sessions, of which 35 were therapist-initiated and subsequently organized into 18 discrete categories. High-quality immediacy events (as assessed by the judges) were associated with higher patient involvement. Two immediacy categories were significantly different between good and poor outcome cases. Therapists "acknowledged their patient's progress in therapy" more often in good outcome cases, whereas they "assessed patients' feelings about the overall progress of therapy" more often in poor outcome cases. No significant relationship was found between frequency, rated quality of immediacy events, and treatment outcome. Four immediacy events rated by the judges as high- and low-quality are presented as clinical examples illustrating positive and negative therapists' contributions to therapeutic immediacy. Therapist behaviors that may improve the effectiveness of therapeutic immediacy are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... The HDRS-24, created by Hamilton (1960), is a widely used depression diagnostic scale (Hamilton, 1960;Trajković et al., 2011). In the present study, the Chinese version of the HDRS-24, a mature questionnaire published in the Rating Scales for Mental Health (Wang et al., 1999), was used to measure the level of depression (a list of explanations of the measurement scales used in this article is shown in Appendix A). ...
... The HDRS-24, created by Hamilton (1960), is a widely used depression diagnostic scale (Hamilton, 1960;Trajković et al., 2011). In the present study, the Chinese version of the HDRS-24, a mature questionnaire published in the Rating Scales for Mental Health (Wang et al., 1999), was used to measure the level of depression (a list of explanations of the measurement scales used in this article is shown in Appendix A). ...
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This study aims to investigate the impact of musicokinetic and exercise therapies on the depression level of elderly patients undergoing post-stroke rehabilitation and its possible moderators, the promotion focus (i.e., achieve gains) and prevention focus (i.e., avoid losses or non-gains), which are the two motivational orientations of health regulatory focus. An eight-week randomized controlled trial was employed. Sixty-five elderly patients undergoing post-stroke rehabilitation in a hospital in Shanghai, China. Patients were randomly assigned to the musicokinetic (n = 32) therapy group or the exercise (n = 33) therapy group. The Mini-mental State Examination Scale measuring the patients’ cognitive functions was used to screen participants. The Hamilton Depression Rating Scale and the Health Regulatory Focus Scale were applied to assess their levels of depression and health regulatory focus on weeks 0, 4, and 8, respectively. The musicokinetic therapy had a significantly better effect than the exercise therapy for individuals who had a lower level of prevention focus, whereas the exercise therapy had a significantly better effect than the musicokinetic therapy for individuals who had a higher level of prevention focus. Musicokinetic therapy and exercise therapy were both effective in decreasing post-stroke depression for elderly patients. But it is important to choose an appropriate type of therapy per the health regulatory focus of elderly patients with post-stroke rehabilitation.
... A total of 120 hospitalized adolescent patients with depressive disorders in the Department of Psychiatry from July 2016 to July 2019 were included in this study. The inclusion criteria were as follows: (1) confirmed diagnosis of a depressive disorder (i.e., MDD or BD) according to the DSM-5 (American Psychiatric Association, 2013); (2) total score on the 17-item Hamilton Depression Scale (HDRS-17) ≥ 10 points (Hamilton, 1960); and (3) between 14 and 24 years of age (Zubrick et al., 2017). Patients were excluded if (1) they were diagnosed with additional mental disorders; ...
... The higher the score, the worse the depressive symptoms. The reliability and validity of HDRS were 0.88−0.99 and 0.92, respectively (Hamilton, 1960). ...
Article
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Background Non-suicidal self-injury (NSSI) is an important risk factor for suicide in adolescents with depressive disorders; therefore, it is important to predict NSSI occurrence as early as possible. Disturbances in biological rhythms are characteristic manifestations of depressive disorders and can lead to immune dysfunction, leading to changes in tumor markers. This study aimed to produce an index that utilizes tumor markers to predict NSSI behaviors among adolescents with depressive disorders. Methods A total of 120 hospitalized adolescent patients with depressive disorders aged 14–24 years were included in this study. Participants were divided into NSSI and non-NSSI groups based on self-reports using the Ottawa Self-Injury Inventory. Demographics, tumor marker concentrations, other peripheral blood indices, Hamilton Depression Rating Scale (HDRS) scores, and Hamilton Anxiety Rating Scale (HAMA) scores were compared between the two groups. Logistic regression analysis was conducted to develop a joint index, and a receiver operating characteristic (ROC) curve was created to predict NSSI behaviors among adolescents with depressive disorders. Results Compared with the non-NSSI group, the NSSI group had significantly higher insight, retardation, insomnia, hopelessness, psychiatric anxiety, total HDRS and HAMA scores, and significantly higher levels of cancer antigen 125 (CA-125), cancer antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA). In addition, a joint index was developed by combining CA-125, CA19-9, CEA, HDRS total score, HAMA total score and age using multiple logistic regression to predict NSSI behaviors. The area under the curve was 0.831, with a sensitivity and specificity of 0.734 and 0.891, respectively. Conclusion A combination of depression score, tumor marker levels, and age can identify NSSI behaviors among adolescents with depressive disorders.
... The scale consists of 21 clinician-rated items, compiled by Hamilton (1960) and measures the severity of depressive symptoms. [21] The Internal consistency reliability of different versions of HAM-D ranges from 0.48 to 0.92 and inter-rater reliability is 0.60 for 21-item scale. ...
... The scale consists of 21 clinician-rated items, compiled by Hamilton (1960) and measures the severity of depressive symptoms. [21] The Internal consistency reliability of different versions of HAM-D ranges from 0.48 to 0.92 and inter-rater reliability is 0.60 for 21-item scale. The concurrent validity of HAM-D is reported to be ranging from 0.65 to 0.90 with MADRS. ...
Article
Background: The fertility problem inventory (FPI) is one of the most widely used measures that tap the diverse psychological problems faced by infertile couples. Research on translated versions of FPI has also reflected its high clinical significance. Aim: This research aimed to explore the psychometric properties and the clinical validity of the original 46-item FPI in an Indian sample. Setting and design: This cross-sectional study was conducted in a tertiary hospital setup of a medical college. Materials and methods: The original FPI was translated and pilot tested. The translated FPI was taken by 205 consenting infertile patients (113 women and 92 men). The psychometric properties of FPI were thus explored. Statistical analysis: Exploratory factor analysis with minimum residual method of extraction followed by oblimin rotation was performed. Perceived Stress Scale was used to establish the convergent validity of the newly developed FPI-Kannada version (FPI-K). A cut-off score for the FPI-K was obtained separately for males and females using ROC analysis in which hamilton anxiety scale was used as the gold standard. Results: Only 32 items of the original FPI had factor loadings above 0.3 and overall six factors explained these items with a cumulative percentage variation of 32%. Overall Cronbach's alpha for FPI-K was 0.671 and it had a good convergent validity. Conclusions: The new FPI-K had 6 sub-domains and the clinical utility of same is discussed.
... One problem in research and development of (novel) antidepressant treatments is the lack of objective, clinically relevant outcome measures. For instance, in major depressive disorder, conventional efficacy measures include the Hamilton Depression Rating Scale (HAM-D) (2) and the Montgomery-Åsberg Depression Rating Scale (MADRS) (3), which are subjective clinician rating scales. While these measures are well-established and broadly implemented, they tend to be administered infrequently (as single time point assessments), and are subject to rater bias and exhibit high variability, which translates into the need for large clinical trials to detect clinically meaningful treatment differences. ...
... The Epworth Sleepiness Scale (ESS, normal < 6 points) was used to assess sleep quality [21] whereas self-reported memory difficulties were evaluated using everyday Memory Questionnaire-Revised (EMQ-R, normal < 13 points) [22]. Hamilton Depression Rating Scale (HDRS, normal < 7 points) was used to evaluate depression [23] whereas Hamilton Anxiety Rating Scale (HARS, normal < 7 points) was used to assess anxiety of CP patients [24]. Quality of life (QoL) was evaluated using anterior skull base questionnaire (ASBQ, abnormal < 105 points) [25]. ...
Article
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Purpose Identifying relationships between craniopharyngiomas (CPs) and contiguous structures, and tumor origin are crucial for treatments. This study attempted to explore the relationships and tumor origin. Methods CPs that underwent endoscopic surgeries were enrolled. The interfacial specimens of CPs attaching the hypothalamus, pituitary stalk (PS), pituitary grand (PG), optic chiasma (OC) and brain tissue (BT) were pathologically examined. Boundaries between CPs and these structures were observed during operations. Expression of β-catenin and stem cell markers were analyzed to explore the tumor origin. Outcomes of patients were assessed. Results A total of 34 CPs were categorized into two groups based on the locations of finger-like protrusions (FP). Group A comprised 18 CPs with FP only present in the specimens attaching to hypothalamus. The surface of these CPs was fused with hypothalamus under endoscopic videos. However, the specimens attaching to the PS, PG, OC, and BT showed no FP. Clear boundaries was observed between these CPs and these structures. Group B comprised 16 CPs with FP only present in the specimens attaching to PS. The tumor surface was fused with PS. Specimens attaching to the hypothalamus, PG, OC and BT showed no FP. Clear boundary was observed among these CPs with these structures. These results implied CPs only invaded a certain part of hypothalamic-pituitary axis. β-catenin and stem cells markers mainly distributed in the FP tissues of both groups. Patients in group B achieved better outcomes than group A. Conclusions CPs only invade the hypothalamic-pituitary axis with FP and the FP would be the tumor origin.
... International Journal of Bipolar Disorders (2022) 10:20 measure was the time from entry into the RD phase to intervention for relapse and/or recurrence of a mood episode (TIME). Secondary efficacy outcome measures included: time to intervention for manic, hypomanic or mixed episode (TIMan); time to intervention for depressive episode (TIDep); overall survival in the study (TIME-SIS); changes from baseline to Week 36 in CGI-S (Guy 1976), CGI-I (Guy 1976), HAMD (Hamilton 1960), YMRS (Young et al. 1978), GAS (Endicott et al. 1976); and change in weight from baseline during the RD phase. Safety assessments included: monitoring of AEs, including treatment-emergent adverse events (TEAEs); clinical laboratory tests; vital signs; ECGs; physical examinations; and suicidality, as determined by the Columbia Suicide Severity Rating Scale (C-SSRS). ...
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Background Lamotrigine is approved as a maintenance therapy for bipolar I disorder in many countries, including China in 2021. This study evaluated the efficacy and safety of lamotrigine in controlling relapse and/or recurrence of mood episodes in Chinese patients with bipolar I disorder. Methods Patients aged ≥ 18 years with bipolar I disorder who met response criteria (Clinical Global Impression–Severity [CGI-S] score of ≤ 3 for ≥ 4 consecutive weeks) during treatment with lamotrigine in a 6–16 week open-label (OL) phase, and who were maintained for ≥ 1 week on lamotrigine 200 mg/day monotherapy, were randomised (1:1) to continue receiving lamotrigine 200 mg/day or switch to placebo in a 36-week randomised double-blind (RD) phase. The primary efficacy outcome measure was time from entry into the RD phase to intervention for relapse and/or recurrence of a mood episode (TIME). Post hoc analyses assessed the impact of OL baseline mood severity on TIME. Safety assessments were conducted throughout the study. Results Of 420 patients treated in the OL phase, 264 were randomised to receive lamotrigine (n = 131) or placebo (n = 133). Overall, 112 patients had an intervention for relapse and/or recurrence of a mood episode (lamotrigine, n = 50/130 [38.5%]; placebo, n = 62/133 [46.6%]), with no significant difference in TIME between groups (adjusted hazard ratio [95% confidence interval (CI)] 0.93 [0.64, 1.35]; p = 0.701). Post hoc analyses indicated a significant difference in TIME, favouring lamotrigine over placebo, for patients with baseline CGI-S score ≥ 4 (hazard ratio [95% CI] 0.52 [0.30, 0.89]; p = 0.018) and with baseline Hamilton Depression Rating Scale ≥ 18 or Young Mania Rating Scale ≥ 10 (0.44 [hazard ratio [95% CI] 0.25, 0.78]; p = 0.005). Lamotrigine was well tolerated with no new safety signals. Conclusions Lamotrigine was not significantly superior to placebo in preventing relapse and/or recurrence of mood episodes in this study of Chinese patients with bipolar I disorder but post hoc analyses suggested a therapeutic benefit in patients with moderate/severe mood symptoms at baseline. The discrepancy between these findings and the positive findings of the pivotal studies may be attributable to the symptom severity of the bipolar patients recruited, a high dropout rate, and the comparatively short duration of the RD phase rather than race/ethnicity differences. Clinical trial registration ClinicalTrial.gov Identifier NCT01602510; 21st May 2012; https://clinicaltrials.gov/ct2/show/NCT01602510 .
... Prior to the development of the PHQ-9 a bottom-up approach had been used to devise a diverse array of questionnaires, by first collating a list of potentially diagnostic questions drawn from a pool of possible symptoms. These were then administered to groups of people diagnosed with depression, subjecting their responses to statistical methods to identify items with the greatest diagnostic potential, which were then collated into questionnaires (Hamilton, 1960, Lubin, 1965, Montgomery and Asberg, 1979, Uher et al., 2007. An assortment of measures produced a new problem in terms of measuring the effectiveness of any treatments across groups assessed with different questionnaires. ...
Thesis
Being classified as depressed raised questions for me about how I had become a mentally ill teacher. Reading Foucault had led me to reflect on the veracity of the psycho/medical model that had classified my emotions as evidence of depression. So, rather than asking ‘What is wrong with the person and how can they be healed?’, this thesis sought to interrogate the psycho/medical account by deploying Foucault’s analytical attitudes of being sceptical, transformational, and experimental, addressing the question of ‘How is the subject of the depressed teacher produced within discourses of good teaching and a medicalised model of depression?’. A narrative method was employed to elicit eight life histories from teachers who identified as being depressed. Viewed through the Foucauldian lenses of truth, discourse, power/knowledge, and subjectivity, three overarching findings were traceable in the narratives. First, there were contradictory accounts of the causes of depression, rendering its diagnosis problematic. Second, the teaching world was described as riven with conflicts over what constitutes good teaching, how to assess good teaching, and how to be a good teacher. Third, the classroom observation stood out as a site amplifying these conflicts, described as one of the most emotionally intense encounters in schools. The conclusion drawn from this analysis was that the emotions indicative of depression could be considered a normal, if problematic, part of teaching. The accountability practices in contemporary schools, framed by policies that require teachers to view themselves as never good enough, contextualise these expressed emotions within a tyranny of continuous improvement. A psycho/medical diagnosis can be seen as a means of managing these problematic emotions and maintaining a particular discourse of the ‘good teacher’. The thesis, therefore, constitutes an argument for de-pathologising teacher emotions and a recognition that it is not necessarily the teacher that is abnormal but work environments.
... The Hamilton Depression Rating Scale (HDRS) was used to assess the severity of depressive symptoms, acting as an indirect measure of the biopsychosocial impact of underlying disorders on the mood and social life of the patient. 26 This is the most widely used clinician-administered depression assessment scale. ...
Article
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Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) are two psychiatric disorders that often overlap or are diagnosed as distinct disorders in the same individual. Although neurosurgical treatment is currently reserved for patients with refractory chronic OCD, it has been evidenced that it is also effective for the treatment of AN, since these two disorders share some pathophysiological neurocircuits. The present study aimed to report the case of a patient with AN, OCD, schizophrenia, and comorbid depression who underwent thermocoagulation of the nucleus accumbens associated with anterior cingulotomy and anterior capsulotomy, all of them bilaterally. Follow-up, performed 16 months after the procedure, showed substantial improvement in AN, OCD, and schizophrenia symptoms, demonstrating the effectiveness of this type of intervention in patients refractory to conservative treatment.
... The clinical diagnoses were confirmed using the Structured Clinical Interview for DSM Disorders (SCID-5-CV) [53]. Symptom severity was assessed using the Brief Symptom Inventory (BSI-18), the Beck Depression Inventory (BDI-II 40) [54] and the Hamilton Rating Scale for Depression (HRSD-17) [55]. A psychomotor vigilance task (PVT) battery was carried out assessing alertness and sustained attention [56]. ...
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We study the statistical properties of facial behaviour altered by the regulation of brain arousal in the clinical domain of psychiatry. The underlying mechanism is linked to the empirical interpretation of the vigilance continuum as behavioral surrogate measurement for certain states of mind. We name the presented measurement in the sense of the classical scalp based obtrusive sensors Opto Electronic Encephalography (OEG) which relies solely on modern camera based real-time signal processing and computer vision. Based upon a stochastic representation as coherence of the face dynamics, reflecting the hemifacial asymmetry in emotion expressions, we demonstrate an almost flawless distinction between patients and healthy controls as well as between the mental disorders depression and schizophrenia and the symptom severity. In contrast to the standard diagnostic process, which is time-consuming, subjective and does not incorporate neurobiological data such as real-time face dynamics, the objective stochastic modeling of the affective responsiveness only requires a few minutes of video-based facial recordings. We also highlight the potential of the methodology as a causal inference model in transdiagnostic analysis to predict the outcome of pharmacological treatment. All results are obtained on a clinical longitudinal data collection with an amount of 100 patients and 50 controls.
... All participants completed a demographic questionnaire. Two trained evaluators independently scored patients according to the 17-item Hamilton Depression Scale (HAMD-17) (20) and the 14-item Hamilton Anxiety Scale (HAMA-14) (21). They ensured that the HAMD-17 scores in the depression group were greater than 17 points and the HAMA-14 scores were not higher than 7 points. ...
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Background Due to substantial comorbidities of major depressive disorder (MDD) and anxiety disorder (AN), these two disorders must be distinguished. Accurate identification and diagnosis facilitate effective and prompt treatment. EEG biomarkers are a potential research hotspot for neuropsychiatric diseases. The purpose of this study was to investigate the differences in EEG power spectrum at theta oscillations between patients with MDD and patients with AN. Methods Spectral analysis was used to study 66 patients with MDD and 43 patients with AN. Participants wore 16-lead EEG caps to measure resting EEG signals. The EEG power spectrum was measured using the fast Fourier transform. Independent samples t -test was used to analyze the EEG power values of the two groups, and p < 0.05 was statistically significant. Results EEG power spectrum of the MDD group significantly differed from the AN group in the theta oscillation on 4–7 Hz at eight electrode points at F3, O2, T3, P3, P4, FP1, FP2, and F8. Conclusion Participants with anxiety demonstrated reduced power in the prefrontal cortex, left temporal lobe, and right occipital regions. Confirmed by further studies, theta oscillations could be another biomarker that distinguishes MDD from AN.
... Fourth, in the current study, we assessed students' stress, anxiety, and depression using the DASS-21 scale (Tran et al., 2013). Other scales or measures related to these variables, such as the Hamilton Depression Rating Scale (HDRS) (Hamilton, 1960) and/or the Patient Health Questionnaire (PHQ-9) (Kroenke et al., 2001) could be adapted and used in future research. Finally, the data were gathered from respondents' self-reported assessment. ...
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The COVID-19 pandemic clearly has various detrimental psychological effects on people’s mental health, emphasizing the importance of mindfulness in overcoming such repercussions. This is in line with the growing number of studies that have been conducted to assess the effects of mindfulness in diverse settings. However, the role of mindfulness in reducing mental health issues among university students has received little attention. Therefore, the current work seeks to investigate how mindfulness could reduce the anxiety, depression, and stress of university students and how self-compassion and psychological well-being could mediate the links between mindfulness and these mental health disorders. To that end, an explanatory sequential mixed-method design was adopted. Quantitative data collected, through a two-wave survey, from 560 Vietnamese students having an average age of 18.7 years were used to test the hypotheses. To measure the six variables in the research models, we opted for the Five Facet Mindfulness Questionnaire (FFMQ), Self-Compassion Scale (SCS-26), Depression Anxiety Stress Scale (DASS-21–7 items for each subscale), and World Health Organization-Five Well-Being Index (WHO-5). Additionally, qualitative data from 19 in-depth interviews were utilized to explain the quantitative findings and explore students’ experiences in practicing mindfulness and self-compassion to decrease stress, depression, and anxiety. The results elucidated that self-compassion and psychological well-being serially mediated the relationships between mindfulness (as a predictor) and anxiety, stress, and depression (as outcome variables). The findings demonstrated the key role of mindfulness in increasing students’ self-compassion and psychological well-being as well as reducing anxiety, depression, and stress. This research holds substantial contributions by providing universities and psychotherapists with recommendations to deal with negative psychological consequences caused by COVID-19.
... For psychometric features at clinic intake, we included affective temperament with the 39-item Temperament Evaluation of Memphis, Pisa, San Diego scale (TEMPS-A) (Akiskal et al. 2005); depression using the 21-item Hamilton Depression Rating Scale (HDRS 21 ) (Hamilton 1960) and the Montgomery-Åsberg Depression Rating Scale (MADRS) (Montgomery and Åsberg 1979); likelihood of lifetime presence of BD with the Mood Disorder Questionnaire (MDQ) (Hirschfeld et al. 2000); current [hypo]manic status with the Young Mania Rating Scale (YMRS) (Young et al. 1978), and anxiety with the Hamilton Anxiety Rating Scale (HARS) (Hamilton 1959). HDRS 21 and YMRS were also administered at follow-up visits. ...
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Objective To compare characteristics of bipolar disorder patients diagnosed as DSM-5 types I (BD-1) vs. II (BD-2). Methods We compared descriptive, psychopathological, and treatment characteristics in a sample of 1377 consenting, closely and repeatedly evaluated adult BD patient-subjects from a specialty clinic, using bivariate methods and logistic multivariable modeling. Results Factors found more among BD-2 > BD-1 cases included: [a] descriptors (more familial affective disorder, older at onset, diagnosis and first-treatment, more education, employment and higher socioeconomic status, more marriage and children, and less obesity); [b] morbidity (more general medical diagnoses, less drug abuse and smoking, more initial depression and less [hypo]mania or psychosis, longer episodes, higher intake depression and anxiety ratings, less mood-switching with antidepressants, less seasonal mood-change, greater %-time depressed and less [hypo]manic, fewer hospitalizations, more depression-predominant polarity, DMI > MDI course-pattern, and less violent suicidal behavior); [c] specific item-scores with initial HDRS 21 (higher scores for depression, guilt, suicidality, insomnia, anxiety, agitation, gastrointestinal symptoms, hypochondriasis and weight-loss, with less psychomotor retardation, depersonalization, or paranoia); and [d] treatment (less use of lithium or antipsychotics, more antidepressant and benzodiazepine treatment). Conclusions BD-2 was characterized by more prominent and longer depressions with some hypomania and mixed-features but not mania and rarely psychosis. BD-2 subjects had higher socioeconomic and functional status but also high levels of long-term morbidity and suicidal risk. Accordingly, BD-2 is dissimilar to, but not necessarily less severe than BD-1, consistent with being distinct syndromes.
... Data from a total of 150 patients (112 with MDD and 38 with BD) was included and extracted after selection based on the following exclusion criteria: (1) a diagnosis of Lewy body disease (LBD; PD and dementia with Lewy bodies) or PD-related diseases (multiple system atrophy, progressive supranuclear palsy, and corticobasal ganglia degeneration), (2) suspected LBD or PD-related disease for which dopamine replacement therapy was clinically indicated by a neurologist (3) a diagnosis of substance-related disorders, and (4) a diagnosis of other neurological diseases, such as extensive cerebrovascular disease and brain tumor. Clinical information was obtained, including sex, age, severity of depression assessed using the Hamilton Depression Rating Scale (17 items) (HDRS17) [24], the duration of illness (months), the total number of MDEs, and the history of ECT with one year. Also included was information on smoking [25] and medications that is, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs), and memantine, which may affect the values in DAT-SPECT. ...
Article
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Dopamine dysfunction has been associated with depression. However, results of recent neuroimaging studies on dopamine transporter (DAT), which reflect the function of the dopaminergic system, are inconclusive. The aim of this study was to apply texture analysis, a novel method to extract information about the textural properties of images (e.g., coarseness), to single-photon emission computed tomography (SPECT) imaging in depression. We performed SPECT using 123I-ioflupane to measure DAT binding in 150 patients with major depressive disorder (N = 112) and bipolar disorder (N = 38). The texture features of DAT binding in subregions of the striatum were calculated. We evaluated the relationship between the texture feature values (coarseness, contrast, and busyness) and severity of depression, and then examined the effects of medication and diagnosis on such relationship. Furthermore, using the data from 40 healthy subjects, we examined the effects of age and sex on the texture feature values. The degree of busyness of the limbic region in the left striatum linked to the severity of depression (p = 0.0025). The post-hoc analysis revealed that this texture feature value was significantly higher in both the severe and non-severe depression groups than in the remission group (p = 0.001 and p = 0.028, respectively). This finding remained consistent after considering the effect of medication. The effects of age and sex in healthy individuals were not evident in this texture feature value. Our findings imply that the application of texture analysis to DAT-SPECT may provide a state-marker of depression.
... The 17-item Hamilton Rating Scale for Depression (HAM-D) [38] assessed depression severity; EEfRT, a multi-trial game in which participants choose between two task difficulty levels across varying probabilities of success on each trial in order to obtain monetary rewards [39] that is sensitive to pharmacological manipulation with dopaminergic drugs [40] and inflammation [41], assessed motivation; SHAPS, which has high psychometric validity for assessing the present state of anhedonia [42] and correlates with ecological momentary assessments of negative affect [43], assessed change in hedonic capacity pre and post-L-DOPA and placebo (see Supplement). ...
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Increased inflammation in major depressive disorder (MDD) has been associated with low functional connectivity (FC) in corticostriatal reward circuits and symptoms of anhedonia, relationships which may involve the impact of inflammation on synthesis and release of dopamine. To test this hypothesis while establishing a platform to examine target engagement of potential therapies in patients with increased inflammation, medically stable unmedicated adult MDD outpatients enrolled to have a range of inflammation (as indexed by plasma C-reactive protein [CRP] levels) were studied at two visits involving acute challenge with the dopamine precursor levodopa (L-DOPA; 250 mg) and placebo (double-blind, randomized order ~1-week apart). The primary outcome of resting-state (rs)FC in a classic ventral striatum to ventromedial prefrontal cortex reward circuit was calculated using a targeted, a priori approach. Data available both pre- and post-challenge (n = 31/40) established stability of rsFC across visits and determined CRP > 2 mg/L as a cut-point for patients exhibiting positive FC responses (post minus pre) to L-DOPA versus placebo (p < 0.01). Higher post-L-DOPA FC in patients with CRP > 2 mg/L was confirmed in all patients (n = 40) where rsFC data were available post-challenge (B = 0.15, p = 0.006), and in those with task-based (tb)FC during reward anticipation (B = 0.15, p = 0.013). While effort-based motivation outside the scanner positively correlated with rsFC independent of treatment or CRP, change in anhedonia scores negatively correlated with rsFC after L-DOPA only in patients with CRP > 2 mg/L (r = -0.56, p = 0.012). FC in reward circuitry should be further validated in larger samples as a biomarker of target engagement for potential treatments including dopaminergic agents in MDD patients with increased inflammation.
... Aiming at contributing to research reproducibility, we sought to address the controversy in the literature about the differential association between CYP2C19 enzyme activity, mood phenotype and hippocampus anatomy. Here, rather than using the Hamilton Rating Scale for Depression [21] or the Beck Depression Inventory [22] that assess the current level of depression, we decided for an instrument with a lifetime perspective-the global assessment of functioning (GAF) [23], additionally to the Center for Epidemiologic Studies Depression Scale (CES-D) [24] and a diagnostic label of lifetime major depressive disorder (MDD) according to the DSM-IV [23]. Along the same lines, given major demographic and brain imaging acquisition differences between testing and validation cohorts in the literature [3], we sample data from a single-center large-scale cohort with a representative age distribution. ...
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Given controversial findings of reduced depressive symptom severity and increased hippocampus volume in CYP2C19 poor metabolizers, we sought to provide empirical evidence from a large-scale single-center longitudinal cohort in the community-dwelling adult population—Colaus|PsyCoLaus in Lausanne, Switzerland ( n = 4152). We looked for CYP2C19 genotype-related behavioral and brain anatomy patterns using a comprehensive set of psychometry, water diffusion- and relaxometry-based magnetic resonance imaging (MRI) data (BrainLaus, n = 1187). Our statistical models tested for differential associations between poor metabolizer and other metabolizer status with imaging-derived indices of brain volume and tissue properties that explain individuals’ current and lifetime mood characteristics. The observed association between CYP2C19 genotype and lifetime affective status showing higher functioning scores in poor metabolizers, was mainly driven by female participants (ß = 3.9, p = 0.010). There was no difference in total hippocampus volume between poor metabolizer and other metabolizer, though there was higher subiculum volume in the right hippocampus of poor metabolizers (ß = 0.03, p FDR corrected = 0.036). Our study supports the notion of association between mood phenotype and CYP2C19 genotype, however, finds no evidence for concomitant hippocampus volume differences, with the exception of the right subiculum.
... In this meta-analysis no other eating disorder related symptoms than BMI could be used as primary outcome data, because of inconsistencies in outcome assessment selection between the included studies. The secondary outcome data was represented using several scales: Yale-Brown-Cornell Eating Disorder Scale [26], Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) [27], Hamilton Anxiety Rating Scale (HAM-A) [28], and Hamilton Depression Rating Scale (HAM-D) [29]. Quality of life was assessed using the Quality of Life Scale [30], SF36 [31], and Eating Disorder Quality of Life [32]. ...
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Background Several pioneering studies investigated deep brain stimulation (DBS) in treatment-refractory anorexia nervosa (AN) patients, but overall effects remain yet unclear. Aim of this study was to obtain estimates of efficacy of DBS in AN-patients using meta-analysis. Methods We searched three electronic databases until 1st of November 2021, using terms related to DBS and AN. We included trials that investigated the clinical effects of DBS in AN-patients. We obtained data including psychiatric comorbidities, medication use, DBS target, and study duration. Primary outcome was Body Mass Index (BMI), secondary outcome was quality of life, and the severity of psychiatric symptoms, including eating disorder, obsessive-compulsive, depressive, and anxiety symptoms. We assessed the risk of bias using the ROBINS-I tool. Results Four studies were included for meta-analysis, with a total of 56 patients with treatment-refractory AN. Follow-up ranged from 6–24 months. Random effects meta-analysis showed a significant increase in BMI following DBS, with a large effect size (Hedges’s g = 1 ∙ 13; 95% CI = 0 ∙ 80 to 1 ∙ 46; Z -value = 6 ∙ 75; P < 0 ∙ 001), without heterogeneity ( I 2 = 0 ∙ 00, P = 0 ∙ 901). Random effects meta-analysis also showed a significant increase in quality of life (Hedges’s g = 0 ∙ 86; 95% CI = 0 ∙ 44 to 1 ∙ 28; Z -value = 4 ∙ 01, P < 0 ∙ 001). Furthermore, DBS decreased the severity of psychiatric symptoms (Hedges’s g = 0 ∙ 89; 95% CI = 0 ∙ 57 to 1 ∙ 21; Z -value = 5 ∙ 47; P < 0 ∙ 001, I 2 = 4 ∙ 29, P = 0 ∙ 371). Discussion In this first meta-analysis, DBS showed statistically large beneficial effects on weight restoration, quality of life, and reduction of psychiatric symptoms in patients with treatment-refractory AN. These outcomes call for more extensive naturalistic studies to determine the clinical relevance for functional recovery. This study is preregistered in PROSPERO,CRD42022295712.
... Trials used a range of diagnostic interviews and self-report measures to diagnose and assess depression outcomes. These included the Hamilton Depression Rating Scale (HAM-D) (Hamilton, 1960(Hamilton, , 1967 ...
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The current understanding of domestic violence is largely nomothetic by design and does not adequately address the treatment and rehabilitation needs of survivors. This thesis aimed to gain a qualitative understanding of the culture-specific experiences of domestic violence in south Indian female survivors, with a focus on the treatment of posttraumatic stress disorder (PTSD), and comorbid psychopathology. An interpretative phenomenological analysis was undertaken with five south Indian women to investigate the in-depth, lived experiences of domestic violence and its mental health sequelae. Responses to, and appraisals of abuse were found to be heavily influenced by pre-abuse identity, interpersonal childhood experiences, societal perceptions of, and stigmatising attitudes towards survivors. These factors impact the experience of disclosure and help-seeking among survivors, with a clear preference for informal sources of support such as family and social care organisations. Further, the findings shed light on the experience of resisting and counteracting the abuse in this context, as well as the complex, non-linear and iterative process of leaving abusive relationships. This was found to be rooted in the sociocultural framework of Indian society, patriarchal ideologies of gender roles, and the systemic and structural disempowerment of women, perpetuating the perpetration and experience of abuse and violence. The treatment protocol examined in this thesis is Narrative Exposure Therapy (NET), which is a short-form psychotherapeutic technique originally developed for survivors of war and organised violence in low-resource contexts. The comprehensive and up-to-date meta-analysis of its current evidence base along with a quality appraisal of the trials included was conducted. The findings revealed low- to medium-quality evidence of NET efficacy for the alleviation of PTSD. High heterogeneity estimates and low powered trials significantly impact the interpretation of the pooled intervention effect estimates. This review also revealed an overreliance on randomised controlled trial findings and a paucity of idiographic research investigating change mechanisms through NET. In the final study, an inductive and deductive thematic analysis was undertaken to investigate the change mechanisms through NET for survivors of domestic violence. NET was administered to seven south Indian women and was well tolerated by the sample. Paired sample t-tests revealed a statistically significant improvement in PTSD and somatic symptoms at post-test. The raw testimony data was qualitative analysed, and a theoretically-informed framework of recovery was developed through thematic analysis to elucidate the specific processes that contribute to change and underlie improvement on symptom scores. There was evidence for several proposed mechanisms based on seminal PTSD theories, as well as some data-driven mechanisms such as positive memories and a focus on future aspirations that contributed to recovery in this sample. There are no published accounts of NET’s use or efficacy in India, and practice implications include culture-specific and stressor-specific applications of NET using the template from the recovery framework. These findings complement the limited RCT evidence of NET from an idiographic perspective. Importantly, the need to consider and explore culture- and context-specific change mechanisms is demonstrated through the framework, which found additional processes contributing to recovery in this sample. Recommendations for the adaptation of individual-focused, empirically supported treatments such as NET that are culturally sensitive and consider the complex socio-ecological milieu of the Indian context are discussed.
... Diagnoses were confirmed with the modified version of the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI) (34). Psychopathology was assessed weekly during hospital stay by continuously trained raters using the 21-item Hamilton Depression Rating Scale (HAM-D) (35). Patients with at least moderately severe depression (HAM-D≥14) entered the analysis. ...
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More than 700,000 people worldwide die by suicide every year, and the number of suicide attempts is estimated as 20 times higher, most of them being associated with psychiatric disorders, especially major depression. Knowledge about effective methods for preventing suicide attempts in individuals at high risk for suicide is still scarce. Dysregulation of the neuroendocrine stress response system, i.e ., the hypothalamic-pituitary-adrenocortical (HPA) axis, is one of the most consistent neurobiological findings in both major depression and suicidality. While the HPA axis is mostly overactive in depression, individuals with a history of suicide attempts exhibit an attenuated hormonal response to stress. It is unknown, however, whether the HPA axis is constantly attenuated in repeated suicide attempters or whether it regains normal responsivity after recovery from depression. Using the combined dexamethasone suppression/corticotropin-releasing hormone (dex/CRH) test, we assessed HPA axis regulation in acute depression ( N = 237) and after recovery with respect to previous suicide attempts. Patients without previous suicide attempts show normalization of the stress hormone response to the second dex/CRH (basal ACTH response and cortisol response) after recovery from acute depression, while patients with multiple previous SA show an increased ACTH response. The change in HPA axis responsivity in patients with only one previous SA lies between the response patterns of the other groups with no change in HPA axis reactivity. Our findings suggest that patients with a history of suicide attempts belong to a subgroup of individuals that exhibit a distinct pattern of stress hormone response during acute depression and after recovery. Future studies may extend our approach by investigating additional psychological stress tasks to gain a broader understanding of the stress pathology of recurrent suicide attempters.
... The evaluation for most items is the result of the integration between the objective observation of signs and subjective exposure of symptoms, although the severity criterion mainly refers to the former. Scores 0-9 indicate subclinical depression, 10-13 mild depression, 14-17 moderate depression, and greater than17 indicate severe depression (Hamilton, 1960). ...
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Background/Aim Misophonia is a disorder characterized by reduced tolerance to specific sounds or stimuli known as “triggers,” which tend to evoke negative emotional, physiological, and behavioral responses. In this study, we aimed to better characterize participants with misophonia through the evaluation of the response of the autonomic nervous system to “trigger sounds,” a psychometric assessment, and the analysis of the neurological pathways. Materials and methods Participants included 11 adults presenting with misophonic disturbance and 44 sex-matched healthy controls (HCs). Following recently proposed diagnostic criteria, the participants listened to six “trigger sounds” and a “general annoyance” sound (baby crying) during a series of physiological tests. The effects were examined through functional magnetic resonance imaging (fMRI), the analysis of heart rate variability (HRV), and of galvanic skin conductance (GSC). The fMRI was performed on a 3T Scanner. The HRV was obtained through the analysis of electrocardiogram, whereas the GSC was examined through the positioning of silver-chloride electrodes on fingers. Furthermore, the psychometric assessment included questionnaires focused on misophonia, psychopathology, resilience, anger, and motivation. Results Participants with misophonia showed patterns of increased sympathetic activation in response to trigger sounds and a general annoyance sound, the low frequency (LF) component of HRV, the sympathetic index, and the number of significant GSC over the threshold, where the amplitude/phasic response of GSC was higher. The fMRI analysis provided evidence for the activation of the temporal cortex, the limbic area, the ventromedial prefrontal/premotor/cingulate cortex, and the cerebellum in participants with misophonia. In addition, the psychometric assessment seemed to differentiate misophonia as a construct independent from general psychopathology. Conclusion These results suggest the activation of a specific auditory-insula-limbic pathway at the basis of the sympathetic activation observed in participants with misophonia in response to “trigger and general annoyance sounds.” Further studies should disentangle the complex issue of whether misophonia represents a new clinical disorder or a non-pathological condition. These results could help to build diagnostic tests to recognize and better classify this disorder. The relevance of this question goes beyond purely theoretical issues, as in the first case, participants with misophonia should receive a diagnosis and a targeted treatment, while in the second case, they should not.
... After informed written consent, all participants underwent a thoroughly assessment by medicine or psychology Ph.D. students verifying the diagnosis/lack of diagnosis using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) [21] categorizing patients as BD type I or type II and assessing comorbid psychiatric illness. Clinical assessments of the severity of depressive and manic symptoms during the preceding three days were done using the Hamilton Depression Scale-17 items (HAMD-17) [22] and the Young Mania Rating Scale (YMRS) [23]. Careful clinical evaluation was made including records of smoking habits, medication use, educational level, weekly alcohol intake, and objective measures of height, weight, and waist circumference as well as an assessment of physical activity level during the previous week using the International Physical Activity Questionnaire (IPAQ) [24]. ...
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Enhanced oxidative stress-generated nucleoside damage may contribute to the increased cardiovascular disease mortality in patients with bipolar disorder (BD) but the association has never been investigated. We investigated the associations between oxidative stress-generated damage to DNA (8-oxodG) and RNA (8-oxoGuo), respectively, and three measures reflecting cardiovascular risk; namely, the Framingham 30-year risk score of cardiovascular diseases, the metabolic syndrome, and the insulin resistance index in 360 patients newly diagnosed with BD, 102 of their unaffected relatives (UR) and 197 healthy control individuals (HC). In sex- and age-adjusted models, the 30-year cardiovascular risk score increased by 20.8% (CI = 7.4–35.9%, p = 0.002) for every one nM/mM creatinine increase in 8-oxoGuo and by 15.6% (95% CI = 5.8–26.4%, p = 0.001) for every one nM/mM creatinine increase in 8-oxodG, respectively. Further, insulin resistance index increased by 24.1% (95% CI = 6.7–43%, p = 0.005) when 8-oxoGuo increased one nM/mM creatinine. The associations between cardiovascular measures and oxidative nucleoside damage were more pronounced in patients with BD compared with UR, and HC. Metabolic syndrome was not associated with nucleoside damage. Overall, higher oxidative stress-generated nucleoside damage was associated with a higher cardiovascular risk score and a higher degree of insulin resistance index, and having BD impacted the associations. Further, within patients, treatment with psychotropics seemed to enhance the associations between 30-year CVD risk score and insulin resistance index, respectively, and oxidatively stress-generated nucleoside damage. Our findings support enhanced oxidative stress-generated nucleoside damage as a putative pathophysiological mechanism that may mediate the higher cardiovascular risk observed in patients with BD already at the time of diagnosis.
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Brain structural bases of individual differences in attachment are not yet fully clarified. Given the evidence of relevant cerebellar contribution to cognitive, affective, and social functions, the present research was aimed at investigating potential associations between attachment dimensions (through the Attachment Style Questionnaire, ASQ) and cerebellar macro- and micro-structural measures (Volumetric and Diffusion Tensor Imaging data). In a sample of 79 healthy subjects, cerebellar and neocortical volumetric data were correlated with ASQ scores at the voxel level within specific Regions Of Interest. Also, correlations between ASQ scores and age, years of education, anxiety and depression levels were performed to control for the effects of sociodemographic and psychological variables on neuroimaging results. Positive associations between scores of the Preoccupation with Relationships (ASQ subscale associated to insecure/anxious attachment) and cortical volume were found in the cerebellum (right lobule VI and left Crus 2) and neocortex (right medial OrbitoFrontal Cortex, OFC) regions. Cerebellar contribution to the attachment behavioral system reflects the more general cerebellar engagement in the regulation of emotional and social behaviors. Cerebellar properties of timing, prediction, and learning well integrate with OFC processing, supporting the regulation of attachment experiences. Cerebellar areas might be rightfully included in the attachment behavioral system.
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Unintentional weight loss is defined as a more than 5% decrease in body weight within 1 year. Various physical and psychiatric etiologies cause unintentional weight loss, including major depressive disorder (MDD). We present the case of a 69-year-old woman who lost 10 kg in 2 months. She had anhedonia, mobility limitations, and incontinence. Her Mini Nutritional Assessment score indicated malnutrition, whereas her Geriatric Depression Scale score indicated a diagnosis of MDD. Whole-body fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography showed intensely increased FDG uptake in the muscles adjacent to the right and left mandibular rami and the temporal muscle, compatible with jaw clenching associated with the patient's MDD. Subsequent temporal muscle biopsy did not suggest the causes of malignant disorders, dermatomyositis, or polymyositis. Having ruled out all possible organic pathologies, the patient was thus diagnosed with MDD. Escitalopram was prescribed for her MDD, and oral nutritional supplement treatments were initiated for her malnutrition. Patients who present with unintentional weight loss should be assessed first for physical etiologies, and then psychiatric etiologies, particularly as weight loss may be a major symptom of MDD in older adults.
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Background Depression and overweight/obesity often cooccur but the underlying neural mechanisms for this bidirectional link are not well understood. Methods In this functional magnetic resonance imaging study, we scanned 54 individuals diagnosed with depressive disorders (DD) and 48 healthy controls (HC) to examine how diagnostic status moderates the relationship between body mass index (BMI) and brain activation during anticipation and pleasantness rating of food versus nonfood stimuli. Results We found a significant BMI‐by‐diagnosis interaction effect on activation in the right inferior frontal gyrus (RIFG) and anterior cingulate cortex (ACC) during food versus nonfood anticipation (p < .0125). Brain activation in these regions was greater in HC with higher BMI than in HC with lower BMI. Individuals with DD showed an opposite pattern of activation. Structural equation modeling revealed that the relationship between BMI, activation in the RIFG and ACC, and participants’ desire to eat food items shown in the experiment depended on the diagnostic status. Conclusions Considering that food anticipation is an important component of appetitive behavior and that the RIFG and ACC are involved in emotion regulation, response inhibition and conflict monitoring necessary to control this behavior, we propose that future clinical trials targeting weight loss in DD should investigate whether adequate mental preparation positively affects subsequent food consumption behaviors in these individuals.
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Background Cognitive impairment is one of the common symptoms in patients with neuromyelitis optica spectrum disorder (NMOSD). However, the underlying mechanism remains unclear. Resting-state functional magnetic resonance imaging (rs-fMRI) offers the opportunity to reveal the patterns of brain activity in patients with different cognitive states. Accordingly, this study investigated functional connectivity (FC) abnormalities within and between the main cognitive networks in cognitively impaired (CI) patients with NMOSD and their correlations with cognitive performance. Methods Thirty-four patients with NMOSD and 39 healthy controls (HC) were included. Neuropsychological evaluations and rs-fMRI scanning were performed. Patients were classified as CI (n = 16) or cognitively preserved (CP; n = 18) according to neuropsychological evaluations. Seven components representing six main cognitive networks were selected by group independent component analysis. The differences in inter- and intranetwork FC among CI, CP, and HC groups were assessed. The correlation between FC values and neuropsychological data in NMOSD was calculated. Results The CI group showed decreased intranetwork connectivity in the posterior default mode network (pDMN) compared with the HC group (P < 0.05, GRF corrected), and decreased internetwork connectivity between the salience network (SN) and pDMN, and between the SN and right frontoparietal network (rFPN) compared with CP and HC groups. The altered FC values were significantly correlated with cognitive performance in the whole NMOSD group. Conclusion The disconnection within the pDMN and between the SN and pDMN or rFPN might suggest the neural substrates underlying cognitive impairment in NMOSD.
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Evidence suggests that locally developed and/or adapted screening tools for mental ill-health can have higher validity than directly translated tools developed in other settings. We administered the locally developed Liberian Distress Screener (LDS) and the Liberian-adapted Patient Health Questionnaire-9 (PHQ-9L) to a random sample of 142 outpatients at a regional hospital in Maryland County, Liberia. In the LDS, seven items demonstrated poor model fit and were excluded, resulting in an 11-item screener (LDS-11). Exploratory factor analysis of the 11-item screener (LDS-11) showed a single latent variable construct with significant factor loadings. Cronbach’s alpha revealed good internal consistency (α = 0.81). Rasch analyses showed that “brain hot” and “heart fall down” were the most difficult idioms of distress to endorse while “things playing on the mind” was the easiest. All LDS-11 elements were associated with elevated function impairment, with “things playing on the mind,” “worry too much,” “head is hurting,” and “heart cut/beat fast” achieving statistical significance. One item in the PHQ-9L demonstrated poor model fit and was excluded from psychometric analyses. The resultant eight-item PHQ demonstrated internal consistency (α = 0.76) and Rasch analysis revealed that “moving/talking too slowly/fast” was the most difficult item to endorse, while “not happy when doing things” was the easiest. Twelve items were significantly associated with functional impairment. Exploratory analyses reveal items that demonstrate ease and appropriateness of use for assessing mental distress in this population. Implementation research is needed to incorporate idioms of distress and screeners into Liberia’s mental healthcare system.
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Background Sexual dysfunction, a potential side effect of selective serotonin reuptake inhibitors (SSRIs), can lead to marital dissatisfaction in remitted depression patients, affecting their quality of life (QOL), and all of these are risk factors for treatment noncompliance. We aimed to estimate the proportion of female sexual dysfunction and its subtypes compared to the general population and correlate it with various factors, including marital satisfaction and QOL, in remitted depressive patients on SSRI treatment. Methods This analytical cross-sectional study assessed 116 women, comprising 58 patients aged 18– to 45 years with remitted depression on SSRI monotherapy for a minimum of six weeks and their age-matched comparative group. Hamilton Depression Rating Scale was used to assess depression severity and Female Sexual Functional Index, to assess sexual dysfunction. Couple Satisfaction Index and WHOQOL-BREF version were used to assess marital satisfaction and QOL, respectively. Results In total, 56.89% of the patients had sexual dysfunction, compared to 39.65% in the general population. Exploratory analyses revealed that overall sexual functioning had a significant positive correlation with education (P = .002), marital satisfaction ( P < .001), and QOL ( P <.01), and a significant negative correlation with the age of onset of depression ( P = .004), total marital duration ( P = .02), and duration of current treatment ( P = .02). Conclusion Sexual dysfunction is common in remitted female depression patients on SSRI treatment, which may further impair their marital satisfaction and QOL. Hence, routine screening for sexual dysfunction is necessary for them.
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Objective: Recognition memory is widely accepted as a dual process-based model, namely familiarity and recollection. However, the location of their specific neurobiological substrates remains unclear. Similar to hippocampal damage, fornix damage has been associated with recollection memory but not familiarity memory deficits. To understand the neural basis of recognition memory, determining the importance of the fornix and its hippocampal connections is essential. Methods: Recognition memory was examined in a 45-year-old male who underwent a complete bilateral fornix section following the removal of a third ventricle colloid cyst. The application of familiarity and recollection for recognition memory decisions was investigated via an immediate and delayed associative recognition test and an immediate and delayed forced-choice task in the patient and a control group (N = 15) over a two-year follow-up period. Complete demographic, neuropsychological, neuropsychiatric, and neuroradiological characterizations of this patient were performed. Results: Persistent immediate and delayed verbal recollection memory deficits were observed in the patient. Moreover, delayed familiarity-based recognition memory declined gradually over the follow-up period, immediate familiarity-based recognition memory was unaffected, and reduced non-verbal memory improved. Conclusion: The present findings support models that the extended hippocampal system, including the fornices, does not appear to play a role in familiarity memory but is particularly important for recollection memory. Moreover, our study suggests that bilateral fornix transection may be associated with relatively functional recovery of non-verbal memory. Keywords: Bilateral fornix transection; colloid cyst; familiarity; fornix; hippocampus; non-verbal memory; recognition memory; recollection.
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Language production has often been described as impaired in psychiatric diseases such as in psychosis. Nevertheless, little is known about the characteristics of linguistic difficulties and their relation with other cognitive domains in patients with a first episode of psychosis (FEP), either affective or non-affective. To deepen our comprehension of linguistic profile in FEP, 133 patients with FEP (95 non-affective, FEP-NA; 38 affective, FEP-A) and 133 healthy controls (HC) were assessed with a narrative discourse task. Speech samples were systematically analyzed with a well-established multilevel procedure investigating both micro- (lexicon, morphology, syntax) and macro-linguistic (discourse coherence, pragmatics) levels of linguistic processing. Executive functioning and IQ were also evaluated. Both linguistic and neuropsychological measures were secondarily implemented with a machine learning approach in order to explore their predictive accuracy in classifying participants as FEP or HC. Compared to HC, FEP patients showed language production difficulty at both micro- and macro-linguistic levels. As for the former, FEP produced shorter and simpler sentences and fewer words per minute, along with a reduced number of lexical fillers, compared to HC. At the macro-linguistic level, FEP performance was impaired in local coherence, which was paired with a higher percentage of utterances with semantic errors. Linguistic measures were not correlated with any neuropsychological variables. No significant differences emerged between FEP-NA and FEP-A (p≥0.02, after Bonferroni correction). Machine learning analysis showed an accuracy of group prediction of 76.36% using language features only, with semantic variables being the most impactful. Such a percentage was enhanced when paired with clinical and neuropsychological variables. Results confirm the presence of language production deficits already at the first episode of the illness, being such impairment not related to other cognitive domains. The high accuracy obtained by the linguistic set of features in classifying groups support the use of machine learning methods in neuroscience investigations.
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Bipolar disorder (BD) is one of the most disabling psychiatric illnesses. Over half of BD patients experienced early onset of the disease, and in most cases, it begins with a depressed mood episode. Up to 50% of adolescents initially diagnosed with major depressive disorder (MDD) convert to bipolar spectrum disorder. Diagnostic tools or biomarkers to facilitate the prediction of diagnosis conversion from MDD to BD are still lacking. Our study aimed to find biomarkers of diagnosis conversion in young patients with mood disorders. We performed a 2-year follow-up study on 69 adolescent patients diagnosed with MDD or BD. The control group consisted of 31 healthy youths. We monitored diagnosis change from MDD to BD. Impulsiveness was assessed using Barratt Impulsiveness Scale (BIS-11) and defense mechanisms using Defense Style Questionnaire (DSQ-40). According to the immunological hypothesis of mood disorders, we investigated baseline cytokines levels either in depressive or hypomanic/manic episodes. We correlated interleukin 8 (IL-8) and Tumor Necrosis Factor-alpha (TNF-alpha) levels with clinical factors. We detected higher IL-8 and TNF-alpha in patients in hypomanic/manic compared to depressed episodes. We found correlations of cytokine levels with immature defense style. We did not discover predictors of diagnosis conversion from MDD to BD.
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Despite the well-recognized effects of endogenous opioids on mood and behavior, research on its role in bipolar disorder (BD) is still limited to small or anecdotal reports. Considering that Beta-endorphins (β-END) and Mu-opioid receptors (MOR), in particular, have a crucial activity in affective modulation, we hypothesized their alteration in BD. A cross-sectional study was conducted. We compared: (1) BD type I (BD-I) patients (n=50) vs healthy controls (n=27), (2) two BD-I subject subgroups: manic (MAN; n=25) vs depressed (DEP; n=25) subjects. Plasma levels of β-END and MOR gene expression in peripheral blood mononuclear cells were analyzed using ELISA Immunoassay qRT-PCR. We found that subjects with BD exhibited a significant upregulation of MOR gene expression and a decrease of β-END (p<0.0001 for both). MAN display higher MOR levels than DEP (p<0.001) and HC (p<0.0001). Plasma levels of β-END were lower in DEP compared to MAN (p<0.05) and HC (p<0.0001). The main limitations are the cross-sectional design and the lack of a group of euthymic subjects. Although preliminary, our results suggest a dysregulation of the endogenous opioid systems in BD. In particular, both MAN and DEP showed a reduction of β-END levels, whereas MAN was associated with MOR gene overexpression.
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Background Postpartum depression has a high prevalence in the United States (~13 %) and often goes undertreated/untreated. We conducted a multicenter, open-label, proof-of-concept trial to assess the Nēsos wearable, non-invasive, transcutaneous auricular vagus nerve stimulation (taVNS) system for the treatment of major depressive disorder with peripartum onset (PPD). Methods Women (n = 25), ages 18 to 45, within 9 months postpartum, and diagnosed with PPD were enrolled at 3 sites. The study included 6 weeks open-label therapy and 2 weeks observation. Efficacy outcomes included change from baseline (CFB) in Hamilton Rating Scale for Depression (HAMD17) total scores, HAM-D17 response and remission, and patient and clinician global impression of change (PGIC, CGIC) scores. Analysis included descriptive statistics and mixed-effects models for repeated measures. Results The most common AEs (≥5 %) were discomfort (n = 5), headache (n = 3), and dizziness (n = 2); all resolved without intervention. No serious AEs or deaths occurred. Baseline mean HAM-D17 score was 18.4. Week 6 least squares (LS) mean CFB in HAM-D17 score was −9.7; 74 % achieved response and 61 % achieved remission. At week 6, at least some improvement was reported by 21 of 22 (95 %) clinicians on CGIC and 22 of 23 (96 %) participants on PGIC. Limitations This was a single-arm, open-label study, and enrollment was limited to participants with mild-to-moderate peripartum depression. Conclusion Results from this proof-of-concept study suggest that the Nēsos taVNS system is well tolerated and may be an effective non-invasive, non-pharmacological treatment for major depressive disorder with peripartum onset. Further evaluation in larger sham-controlled studies is needed. ClinicalTrials.gov NCT03972995
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Early research into neural correlates of obsessive compulsive disorder (OCD) has focused on individual components, several network-based models have emerged from more recent data on dysfunction within brain networks, including the the lateral orbitofrontal cortex (lOFC)-ventromedial caudate, limbic, salience, and default mode networks. Moreover, the interplay between multiple brain networks has been increasingly recognized. As the understanding of the neural circuitry underlying the pathophysiology of OCD continues to evolve, so will too our ability to specifically target these networks using invasive and noninvasive methods. This review discusses the rationale for and theory behind neuromodulation in the treatment of OCD.
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Background: Post-stroke depression (PSD) is a common complication of stroke, which seriously affects the functional outcome of patients. Systemic low-grade inflammation associated with PSD has been shown to occur at several months to years, however, whether these inflammatory markers predicted PSD at an acute stage of stroke is controversial. Method: A total of 625 patients with acute ischemic stroke (219 female, 35.40%) were included in this study. PSD was diagnosed using the 17-item Hamilton depression scale (HAMD) at 7 days following discharge (7–14 days after stroke onset). Multivariable logistic regression analysis was applied to build a prediction model for PSD at discharge. Discrimination and calibration of the model were assessed by C-index, calibration plot. Internal validation was conducted using bootstrapping validation. Results: At discharge of hospitalization, 95 patients (15.20%) were diagnosed with PSD. Multivariable logistic regression suggested that female gender (OR = 2.043, 95% CI = 1.287–3.245, p = 0.002), baseline NIHSS (OR = 1.108, 95% CI = 1.055–1.165, p < 0.001) and fibrinogen (OR = 1.388, 95% CI = 1.129–1.706, p = 0.002) were independent predictors for PSD at discharge. The cut-off of the fibrinogen plasma level was 3.08 g/L. These predictors were included in the nomogram. The model displayed good discrimination, with a C-index of 0.730 (95% CI = 0.683–0.777) and good calibration. Conclusion: Female gender, baseline stroke severity and a higher level of fibrinogen were independently associated with PSD at discharge. A nomogram based on these three predictors can be used to provide an individual, visual prediction of the risk probability of PSD.
Article
Background Anxiety frequently occurs with major depressive disorder (MDD) but to a different extent in the various subtypes. Psychotic major depression (PMD) is a severe subtype of MDD that is under-identified and under-studied. We investigated the prevalence and related risk factors of anxiety in PMD patients. Methods A total of 1718 first episode and drug naïve MDD patients were recruited. Measures included the Hamilton Depression Scale (HAMD), Clinical Global Impression-Severity scale (CGI-S), Hamilton Anxiety Scale (HAMA), and positive symptom scale of the Positive and Negative Syndrome Scale (PANSS), thyroid hormone levels, and metabolic parameters. Results 171 of the entire MDD study sample met the criteria for the PMD subtype. The prevalence of severe anxiety was much higher in PMD patients (22.8 %) than in non-PMD patients (0.4 %) (χ² = 294.69, P < 0.001, OR = 75.88, 95 % CI = 31.55–182.52). Compared to PMD patients without severe anxiety, PMD patients with severe anxiety had higher HAMD score, CGI-S score, positive symptom subscale score, suicide attempts, blood pressure, thyroid-stimulating hormone (TSH), anti-thyroglobulin (TgAb), and thyroid peroxidases antibody (TPOAb) levels. Furthermore, logistic regression analysis indicated that HAMD score and TSH levels were associated with severe anxiety in PMD patients. Limitations Our cross-sectional study cannot explain the causal relationship between anxiety severity and risk factors in PMD patients. Conclusions Our results suggest that PMD patients are more likely to experience severe anxiety than non-PMD patients. The severity of depression and TSH levels are independent risk factors for anxiety in PMD patients.
Article
Network psychometric models are often estimated using a single indicator for each node in the network, thus failing to consider potential measurement error. In this study, we investigate the impact of measurement error on cross-sectional network models. First, we conduct a simulation study to evaluate the performance of models based on single indicators as well as models that utilize information from multiple indicators per node, including average scores, factor scores, and latent variables. Our results demonstrate that measurement error impairs the reliability and performance of network models, especially when using single indicators. The reliability and performance of network models improves substantially with increasing sample size and when using methods that combine information from multiple indicators per node. Second, we use empirical data from the STAR*D trial (n = 3731) to further evaluate the impact of measurement error. In the STAR*D trial, depression symptoms were assessed via three questionnaires, providing multiple indicators per symptom. Consistent with our simulation results, we find that when using sub-samples of this dataset, the discrepancy between the three single-indicator networks (one network per questionnaire) diminishes with increasing sample size. Together, our simulated and empirical findings provide evidence that measurement error can hinder network estimation when working with smaller samples and offers guidance on methods to mitigate measurement error.
Preprint
Recovery from depression often demonstrates a nonlinear pattern of treatment response, where the largest reduction in symptoms is observed early followed by smaller improvements. This study investigated whether this exponential pattern could model the antidepressant response to repetitive transcranial magnetic stimulation (TMS). Symptom ratings from 97 patients treated with TMS for depression were collected at baseline and after every five sessions. A nonlinear mixed-effects model was constructed using an exponential decay function. This model was also applied to group-level data from several published clinical trials of TMS for treatment-resistant depression. These nonlinear models were compared to corresponding linear models. In our clinical sample, response to TMS was well modeled with the exponential decay function, yielding significant estimates for all parameters and demonstrating superior fit compared to a linear model. Similarly, when applied to multiple studies comparing TMS modalities as well as to previously identified treatment response trajectories, the exponential decay models yielded consistently better fits compared to linear models. These results demonstrate that the antidepressant response to TMS follows a nonlinear pattern of improvement that is well modeled with an exponential decay function. This modeling offers a simple and useful framework to inform clinical decisions and future studies.
Article
Background Childhood trauma is negatively associated with depression severity in bipolar disorder; however, the underlying mechanisms remain unclear. We investigated whether personality traits (neuroticism, extraversion, openness, agreeableness, conscientiousness) mediate the relationship between childhood trauma and the severity of bipolar depression. Methods Data from 209 individuals with bipolar disorder recruited for the Prechter Longitudinal Study of Bipolar Disorder were analysed. Using structural equation modelling, we examined the direct and indirect associations between childhood trauma (Childhood Trauma Questionnaire) and depression severity (Hamilton Depression Rating Scale) – with the personality traits (NEO Personality Inventory–Revised) as mediators. Results The direct effect of childhood trauma on depression severity (standardised β = 0.32, 95% bootstrap confidence interval [CI] = 0.20–0.45, p < 0.001) and the indirect effect via neuroticism (standardised β = 0.03, 95% bootstrap CI [0.002, 0.07], p = 0.039) were significant; supporting a partial mediation model. The indirect effect accounted for 9% of the total effect of childhood trauma on depression severity (standardised β = 0.09, 95% bootstrap CI [0.002, 0.19], p = 0.046). The final model had a good fit with the data (comparative fit index = 0.96; root mean square error of approximation = 0.05, 90% CI = [0.02, 0.07]). Conclusion Personality traits may be relevant psychological mediators that link childhood trauma to a more severe clinical presentation of bipolar depression. Consequently, a person’s personality structure may be a crucial operative factor to incorporate in therapeutic plans when treating individuals with bipolar disorder who report a history of childhood trauma.
Article
Background Major depressive disorder (MDD) is a clinically heterogenous condition and its treatment should be individualized according to the presence of particular symptom clusters. The aim of this pooled analysis was to investigate the effects of adjunctive brexpiprazole on different symptom clusters in MDD. Methods Data were included from four similarly designed, short-term, randomized, double-blind, placebo-controlled studies of adjunctive brexpiprazole in adults with MDD and inadequate response to 2–4 antidepressant treatments (ADTs), including 1 administered by investigators. Mean changes from baseline and Cohen's d effect sizes (ES) versus placebo were determined for the following Montgomery–Åsberg Depression Rating Scale symptom clusters: core, anhedonia, dysphoria, retardation, vegetative, loss of interest, and lassitude. Results Over 6 weeks, ADT + brexpiprazole 2 mg (n = 486) showed greater improvement than ADT + placebo (n = 585) for all symptom clusters: core (ES = 0.36; p < 0.0001), anhedonia (ES = 0.43; p < 0.0001), dysphoria (ES = 0.27; p < 0.0001), retardation (ES = 0.32; p < 0.0001), vegetative (ES = 0.29; p < 0.0001), loss of interest (ES = 0.30; p < 0.0001), and lassitude (ES = 0.33; p < 0.0001). Improvements of similar magnitude were observed for ADT + brexpiprazole 2–3 mg (n = 770) versus ADT + placebo (n = 788) (ES = 0.24–0.38; all clusters p < 0.0001). In most cases, improvement over ADT + placebo was observed from Week 1 onwards. Limitations Post hoc analysis with no adjunctive active comparator. Conclusions Patients receiving adjunctive brexpiprazole versus adjunctive placebo showed improvements across a range of MDD symptom clusters. Improvements appeared early (generally from Week 1) and were maintained over 6 weeks. These data indicate that adjunctive brexpiprazole may benefit multiple subtypes of patient with MDD and inadequate response to ADTs.
Article
Sarcoidosis is a multisystem disease of unknown etiology which is characterized by the formation of granulomatous inflammation in various organs and tissues, most commonly in the lungs and lymph nodes. Glucocorticoids are the therapy of choice for the initial treatment of symptomatic disease, but their prolonged use is associated with significant toxicity. Alternative therapies that reduce glucocorticoid use are also available. Fatigue and depression are often present in patients with sarcoidosis. Their occurrence in practice is mostly underestimated, although it is related to a lower quality of life. As fatigue and depression cannot be assessed using objective measures, the use of validated questionnaires is recommended. They enable the detection and monitoring of fatigue and depression related to the underlying disease and may indicate the need for appropriate therapy.
Article
In the present study, we aimed to investigate the resting-state functional connectivity (RS-FC) of the globus pallidus (GP) in patients with amyotrophic lateral sclerosis (ALS) compared to healthy controls, and the relationship between RS-FC changes and disgust recognition. Twenty-six pure-motor ALS patients and 52 healthy controls underwent RS functional MRI and a neuropsychological assessment including the Comprehensive Affect Testing System. A seed-based RS-FC analysis was performed between the left and right GP and the rest of the brain and compared between groups. Correlations between RS-FC significant changes and subjects’ performance in recognizing disgust were tested. Compared to controls, patients were significantly less able to recognize disgust. In ALS compared to controls, the seed-based analysis showed: reduced RS-FC between bilateral GP and bilateral middle and superior frontal and middle cingulate gyri, and increased RS-FC between bilateral GP and bilateral postcentral, supramarginal and superior temporal gyri and Rolandic operculum. Decreased RS-FC was further observed between left GP and left middle and inferior temporal gyri and bilateral caudate; and increased RS-FC was also shown between right GP and left lingual and fusiform gyri. In patients and controls, lower performance in recognizing disgust correlated with reduced RS-FC between left GP and left middle and inferior temporal gyri. In pure-motor ALS patients, we demonstrated altered RS-FC between GP and the rest of the brain. The reduced left pallidum-temporo-striatal RS-FC may have a role in the lower ability of patients in recognizing disgust.
Article
Background Psychosis presentation can be affected by genetic and environmental factors. Differentiating between affective and non-affective psychosis (A-FEP and NA-FEP, respectively) may influence treatment decisions and clinical outcomes. The objective of this paper is to examine differences between patients with A-FEP or NA-FEP in a Latin American sample. Methods Patients from two cohorts of patients with a FEP recruited from Brazil and Chile. Subjects included were aged between 15 and 30 years, with an A-FEP or NA-FEP (schizophrenia-spectrum disorders) according to DSM-IV-TR. Sociodemographic data, duration of untreated psychosis and psychotic/mood symptoms were assessed. Generalized estimating equation models were used to assess clinical changes between baseline-follow-up according to diagnosis status. Results A total of 265 subjects were included. Most of the subjects were male (70.9 %), mean age was 21.36 years. A-FEP and NA-FEP groups were similar in almost all sociodemographic variables, but A-FEP patients had a higher probability of being female. At baseline, the A-FEP group had more manic symptoms and a steeper reduction in manic symptoms scores during the follow- up. The NA-FEP group had more negative symptoms at baseline and a higher improvement during follow-up. All domains of The Positive and Negative Syndrome Scale improved for both groups. No difference for DUP and depression z-scores at baseline and follow-up. Limitations The sample was recruited at tertiary hospitals, which may bias the sample towards more severe cases. Conclusions This is the largest cohort comparing A-FEP and NA-FEP in Latin America. We found that features in FEP patients could be used to improve diagnosis and support treatment decisions.
Article
Résumé La dépression est le trouble psychiatrique le plus fréquent dans la population générale, et les consultations aux urgences pour dépression seraient en hausse depuis plusieurs années. Le Centre Psychiatrique d’Orientation et d’Accueil est un service d’urgences psychiatriques à vocation régionale situé à Paris qui recense environ 10 000 consultations par an. Parmi ces consultations, on retrouve près de 40 % de diagnostics de troubles de l’humeur. La prise en charge du patient aux urgences repose sur une évaluation globale, qui ne doit pas se limiter à l’entretien psychiatrique. Le contexte d’arrivée, l’environnement et l’entourage du patient doivent être pris en compte afin d’aboutir à une orientation optimale. Une attention particulière doit être portée aux premiers épisodes (élimination d’un diagnostic différentiel, dépistage d’un éventuel trouble bipolaire) et à l’évaluation du risque suicidaire. L’existence d’un facteur causal externe ou d’un trouble de personnalité comorbide ne doit pas faire banaliser la consultation et mener à un sous-diagnostic de dépression caractérisée. Le traitement médicamenteux aux urgences est le plus souvent symptomatique (traitement anxiolytique par benzodiazépines ou neuroleptiques selon les situations), et l’orientation ambulatoire doit toujours être privilégiée. Des adaptations thérapeutiques peuvent alors être envisagées. La décision d’une hospitalisation doit toujours être argumentée, et le consentement aux soins rigoureusement évalué. La prise en compte et éventuellement l’accompagnement de l’entourage sont presque toujours nécessaires. Tous ces éléments doivent être argumentés dans le dossier.
Article
Background: Autonomy describes a psychological state of self-regulation of motivation and action, which is a central characteristic of healthy functioning. In neurodegenerative diseases measures of self-perception have been found to be affected by the disease. However, it has never been investigated whether measures of self-perception, like autonomy, is affected in Huntington's disease. Objective: We investigated whether autonomy is affected in Huntington's disease and if the degree of autonomy is associated with motor function, neuropsychiatric symptoms, cognitive impairments, and apathy. Methods: We included 44 premanifest and motor-manifest Huntington's disease gene expansion carriers and 19 controls. Autonomy was examined using two self-report questionnaires, the Autonomy-Connectedness Scale-30 and the Index of Autonomous Functioning. All participants were examined according to motor function, cognitive impairments, and neuropsychiatric symptoms, including apathy. Results: Statistically significant differences were found between motor-manifest Huntington's disease gene expansion carriers and premanifest Huntington's disease gene expansion carriers or controls on two measures of autonomy. Between 25-38% of motor-manifest Huntington's disease gene expansion carriers scored significantly below the normal level on subscales of autonomy as compared to controls. One autonomy subscale was associated with apathy (r = -0.65), but not with other symptoms of Huntington's disease. Conclusion: This study provides evidence for impaired autonomy in individuals with Huntington's disease and an association between autonomy and apathy. The results underline the importance of maintaining patient autonomy and involvement in care throughout the disease.
Article
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Background Restless Legs Syndrome (RLS) is a common neurological disorder. Growing evidence shows that dopaminergic dysfunction and iron deficiency are associated with the pathogenesis of RLS. Additionally, the dopaminergic system is linked with the hypothalamic-pituitary-thyroid (HPT) axis. Thus, the current study aimed to compare thyroid function between RLS patients and healthy subjects and investigate the associations with clinical characteristics of RLS. Methods Serum levels of thyroid hormones were investigated in 102 first-episode drug-naïve RLS patients and 80 matched healthy controls (HCs). Baseline data and clinical characteristics were performed by professional personnel. In addition, multivariate regression was used to analyze the relationship between thyroid function and RLS. Results Compared with control group, RLS patients had significantly higher serum thyroid-stimulating hormone (TSH) levels ( p < 0.001), and higher prevalence of subclinical hypothyroidism [Odds ratio (OR) 8.00; 95% confidence interval (CI) = 3.50–18.30; p < 0.001]. The Subclinical hypothyroidism rate (47.1 vs. 10%, p < 0.001) in RLS patients was higher than the HCs group. Regression analysis revealed that serum TSH (OR = 1.77; 95% CI = 1.41–2.23; p < 0.001) was independently associated with RLS. There was a statistically significant positive correlation between TSH and the Pittsburgh sleep quality index (PSQI) scores ( r = 0.728, p < 0.001), and the International Restless Legs Scales (IRLS) points ( r = 0.627, p < 0.001). Spearman correlation analysis showed that FT 3 was positive correlated with HAMA 14 score ( r = 0.239, p = 0.015). In addition, compared with the good-sleeper group, poor-sleeper patients had significantly higher serum TSH levels ( p < 0.001). Conclusion Serum levels of TSH and the prevalence of subclinical hypothyroidism were higher in RLS patients, indicating the imbalance between thyroid hormones (TH) and the dopaminergic system may contribute to the development of primary RLS. Additionally, the TH axis may influence the quality of sleep in RLS patients.
  • M Hamilton
  • J White
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