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1.
Int J Geriatr Psychiatry ; 39(9): e6147, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39237369

RESUMO

OBJECTIVES: There is a large treatment gap for mental health conditions in sub-Saharan Africa where most patients who receive any care do so from lay primary health care workers (PHCW). We sought to examine the experiences of PHCW who provide care for older people with depression in Nigerian primary health care (PHC) settings. METHODS: Qualitative study design. A total of 24 PHCW participated. Using in-depth key informant interviews (KIIs), we explored the views of 15 PHCW selected from 10 rural and urban PHCs in South-Western Nigeria. An additional focus group discussion comprising nine participants was also conducted to discuss emerging themes from KIIs. Data were analysed using thematic analysis. RESULTS: Three overall themes were identified: views about depression, treatment options, and community outreach implications. Participants perceived depression in older people as being characterised by a range of mood, behavioural, and cognitive symptoms which made clinical assessments particularly challenging. Common treatment options used by PHCW included general advice and counselling, as well as frequent need to prescribe mild analgesics, vitamins and occasional sedatives in line with patients' expectations. Antidepressants were rarely used even though PHCW are authorised. While home visits are part of their expected work schedule, PHCW rarely implemented these due to non-availability of transport facilities. Mobile technology was identified as a possible way of overcoming this constraint to providing community based mental healthcare for older people. CONCLUSION: PHCWs perceived that patients' poor cognitive performance, expectations to prescribe sedatives, analgesics and vitamins, as well as non-existence of community-based services were existing barriers to providing evidenced based continued care for older people with depression in the study settings.


Assuntos
Atenção Primária à Saúde , Pesquisa Qualitativa , Humanos , Nigéria , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Transtorno Depressivo/terapia , Adulto , Grupos Focais , Atitude do Pessoal de Saúde
2.
Adv Exp Med Biol ; 1456: 3-25, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39261421

RESUMO

Depressive disorder exhibits heterogeneity in clinical presentation, progression, and treatment outcomes. While conventional antidepressants based on the monoamine hypothesis benefit many patients, a significant proportion remains unresponsive or fails to fully recover. An individualized integrative treatment approach, considering diverse pathophysiologies, holds promise for these individuals. The endocrine system, governing physiological regulation and organ homeostasis, plays a pivotal role in central nervous system functions. Dysregulations in endocrine system are major cause of depressive disorder due to other medical conditions. Subtle endocrine abnormalities, such as subclinical hypothyroidism, are associated with depression. Conversely, depressive disorder correlates with endocrine-related biomarkers. Fluctuations in sex hormone levels related to female reproduction, elevate depression risk in susceptible subjects. Consequently, extensive research has explored treatment strategies involving the endocrine system. Treatment guidelines recommend tri-iodothyronine augmentation for resistant depression, while allopregnanolone analogs have gained approval for postpartum depression, with ongoing investigations for broader depressive disorders. This book chapter will introduce the relationship between the endocrine system and depressive disorders, presenting clinical findings on neuroendocrinological treatments for depression.


Assuntos
Antidepressivos , Transtorno Depressivo , Humanos , Antidepressivos/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/metabolismo , Sistema Endócrino/efeitos dos fármacos , Sistema Endócrino/metabolismo , Feminino , Tri-Iodotironina/uso terapêutico , Tri-Iodotironina/metabolismo
3.
Adv Exp Med Biol ; 1456: 199-226, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39261431

RESUMO

Depressive disorders are an enormous societal burden given their high prevalence and impact on all facets of being human (e.g., relationships, emotions, motivation). There is a variety of evidence-based psychological treatments, with cognitive behavioral therapy (CBT) being the gold standard for major depression. Research has shown that mindfulness-based interventions (MBIs) such as mindfulness-based cognitive therapy (MBCT) are an effective relapse prevention and treatment for depression and that MBIs can be integrated in individual therapy. Furthermore, various delivery modes (e.g., digital-delivered therapy) and settings are offered to best meet different needs and improve accessibility: Evidence suggests that therapist-guided digital CBT, blended therapy, and, to some degree, digitalized MBIs may be an efficacious supplement to traditional face-to-face therapy. This chapter provides an overview of the principles and evidence base for CBT and MBCT as well as different delivery modes for depressive disorders in adults. Finally, chances and challenges of integration are discussed as implications for practice, as well as recommendations and ideas for future research.


Assuntos
Terapia Cognitivo-Comportamental , Atenção Plena , Humanos , Atenção Plena/métodos , Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo/terapia , Acessibilidade aos Serviços de Saúde , Resultado do Tratamento
4.
Artigo em Russo | MEDLINE | ID: mdl-39269291

RESUMO

The article presents an analytical review of the data on the effectiveness of agomelatine as an augmentation of antipsychotics in the treatment of post-schizophrenic depression (PSD). The results of 5 published studies with a total sample size of 137 patients, the duration of therapy from 28 to 180 days with the appointment of agomelatin in combination with antipsychotics, including cases of additional use of drugs of other classes (normotimics, antidepressants, anxiolytics, anticholinergic correctors) were used. As a result, a pronounced effect was established in the indicators of respondents and patients in remission, combined with a favorable tolerability and safety profile, determining the prospects for the use of agomelatin in the therapy of PSD. Certain limitations in the methodology, including open and uncontrolled research design and small sample sizes, determine the relevance of systematic controlled trials to confirm the results obtained.


Assuntos
Acetamidas , Antidepressivos , Antipsicóticos , Esquizofrenia , Humanos , Acetamidas/uso terapêutico , Antipsicóticos/uso terapêutico , Esquizofrenia/tratamento farmacológico , Antidepressivos/uso terapêutico , Quimioterapia Combinada , Resultado do Tratamento , Transtorno Depressivo/tratamento farmacológico , Naftalenos
5.
Brain Behav ; 14(9): e3629, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39262200

RESUMO

BACKGROUND: As the methodological quality and evidence level of the existing systematic reviews (SRs) on music as an intervention for depression have not been thoroughly evaluated, a systematic evaluation and re-evaluation (SERE) was conducted. METHODS: Multiple databases including PubMed, Web of Science, Embase, China National Knowledge Infrastructure, SinoMed, Wanfang, and the VIP database were searched for SRs and meta-analyses (MAs) on the effectiveness of music as an intervention for depression. The literature screening, evaluation of methodological quality, and assessment of evidence level were carried out by a team of researchers. The methodological quality was evaluated using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) scale in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria were utilized to assess the level of evidence. RESULTS: A total of 18 SRs were included in the analysis. The 2020 PRISMA guidelines were utilized to evaluate various aspects such as search terms, funding sources, statistical methods for missing values, subgroup and sensitivity analyses, certainty assessment, excluded literature citations, assessment of publication bias, protocol information, conflicts of interest, and data availability, which were rarely reported. The evaluation of the studies using the AMSTAR 2 scale revealed that one article was rated as high quality, six were rated as low quality, and 11 were rated as very low quality. Based on the GRADE criteria evaluation, the quality of the evidence was found to be inconsistent, with reports primarily consisting of medium-quality evidence. CONCLUSION: The methodological quality of SRs/MAs of music as an intervention in depression is generally poor, and the level of evidence is generally low.


Assuntos
Musicoterapia , Humanos , Musicoterapia/métodos , Musicoterapia/normas , Depressão/terapia , Revisões Sistemáticas como Assunto , Transtorno Depressivo/terapia
8.
Psychiatr Pol ; 58(3): 377-401, 2024 Jun 30.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-39217420

RESUMO

The Polish standard of treatment with racemic ketamine for patients with depressive disorders was developed by a Working Group appointed by the National Consultant in the field of psychiatry. Despite the wide range of available medications, as many as one-third of depressed patients do not respond to standard antidepressant treatment, raising the need for an ongoing search for new effective and safe therapies. In recent years, the possible role of overactivity of the glutamatergic system in the etiopathogenesis of depression has again attracted the attention of many experts. The possibility of using substances with a modulating effect on the glutamatergic system in the treatment of depressive disorders has been postulated, among others, the long-known anesthetic ketamine, which is a noncompetitive NMDA receptor antagonist. This paper summarizes the results of studies on the efficacy and safety of racemic ketamine (administered intravenously) in the treatment of patients with depressive symptoms in the course of both unipolar and bipolar affective disorder, and, meeting the expectations of many practicing psychiatrists wishing to broaden the range of therapies offered to their patients, presents recommendations on indications, contraindications, precautions and the treatment regimen itself with intravenous ketamine for patients with mood disorders.


Assuntos
Antidepressivos , Ketamina , Psiquiatria , Humanos , Antidepressivos/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Ketamina/uso terapêutico , Polônia , Resultado do Tratamento
9.
Medicine (Baltimore) ; 103(36): e39543, 2024 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-39252313

RESUMO

Evidence shows that the composition of the gut microbiota (GM) is associated with depression and anxiety disorders. However, the causal relationship between them remains controversial. To investigate the potential causal relationship between the GM and depression/anxiety disorders and to identify specific bacterial taxa, we conducted a 2-sample Mendelian randomization (MR) analysis on the gut microbiome implicated in depression and anxiety disorders. We incorporated summary data from genome-wide association studies (GWAS) of the microbiome derived from 7738 individuals in the Dutch Microbiome Project and 18,340 individuals in the MiBioGen consortium as our exposure variable. Concurrently, the GWAS of depression and anxiety disorders was employed as our outcome variable. The principal estimates were procured using the inverse-variance weighted test complemented by 4 robust methods: MR Egger, weighted median, simple mode, and weighted mode. In addition, we performed comprehensive sensitivity and directionality analyses. The results showed that 5 bacterial taxa were positively correlated with depression, 6 were negatively correlated; 5 were positively correlated with anxiety disorders, and 11 were negatively correlated. This study provides new insights into the connection between the GM and the pathogenesis of depression and anxiety disorders and offers new perspectives for the diagnosis and treatment of these disorders.


Assuntos
Transtornos de Ansiedade , Microbioma Gastrointestinal , Estudo de Associação Genômica Ampla , Análise da Randomização Mendeliana , Humanos , Microbioma Gastrointestinal/genética , Transtornos de Ansiedade/microbiologia , Transtornos de Ansiedade/genética , Transtorno Depressivo/microbiologia , Transtorno Depressivo/genética , Depressão/microbiologia
10.
Medicine (Baltimore) ; 103(36): e39505, 2024 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-39252333

RESUMO

BACKGROUND: Fibromyalgia syndrome (FMS) affects 2% to 4% of people, with increasing prevalence in Saudi Arabia reaching 13.4%. FMS can occur in adolescents, known as juvenile-onset fibromyalgia (JFM) with comorbidities including depression, anxiety, and psychological stress. Our patient presented to the child and adolescent psychiatry clinic at King Saud University Hospital Medical City. A year before coming to our clinic, at the age of 15 she was initially diagnosed with JFM followed by a comorbid persistent depressive disorder. METHODS: As a novel treatment method, a combination treatment approach was used, including a pharmacological intervention with Duloxetine, and a non-pharmacological intervention with interpersonal psychotherapy for adolescents. She completed 16 weeks of therapy while monitoring for duloxetine response and side effects. RESULTS: Depressive symptoms were in remission by treatment's end and continued to be in her first month posttreatment follow-up, and the FMS symptoms were also controlled. CONCLUSION: Our present case highlights a combined approach to treat depression and JFM in adolescents as a novel intervention method thus we strongly recommend utilizing it for similar cases.


Assuntos
Cloridrato de Duloxetina , Fibromialgia , Humanos , Feminino , Fibromialgia/terapia , Fibromialgia/complicações , Fibromialgia/psicologia , Adolescente , Cloridrato de Duloxetina/uso terapêutico , Psicoterapia Interpessoal/métodos , Antidepressivos/uso terapêutico , Terapia Combinada , Transtorno Depressivo/terapia , Transtorno Depressivo/complicações
11.
BMC Psychiatry ; 24(1): 604, 2024 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-39243081

RESUMO

OBJECTIVE: To assess the effectiveness of Internet-based self-help interventions in treating depression in adolescents and young adults. METHODS: A systematic search was conducted across six databases, including PubMed, to identify randomized controlled trials (RCTs) that satisfied the specified inclusion and exclusion criteria. The intervention measure consisted of Internet-based self-help interventions. RESULTS: A total of 23 randomized controlled trials (RCTs) were included in this analysis. Meta-analysis indicated that Internet-based self-help therapies significantly reduced depression scores in adolescents and young adults. (OR = -0.68, 95%CI [-0.88, -0.47], P < 0.001). We examined the effects of patient recruitment from various regions, medication usage, therapist involvement, weekly intervention time, and intervention duration. Patients selected from school, primary healthcare centers, clinics and local communities had better results. Intervention lasting 30 to 60 min and 60 to180 minutes per week were effective in the short term. CONCLUSION: The internet-based self-help intervention can be effective in treating depression in adolescents and young adults. However, factors such as patient recruitment locations, medication usage, Therapists' involvement, weekly intervention time, and intervention duration interacted with the outcome. Subgroup analysis on potential adverse effects and gender was impossible due to insufficient data from the included studies.


Assuntos
Intervenção Baseada em Internet , Autocuidado , Humanos , Adolescente , Adulto Jovem , Autocuidado/métodos , Depressão/terapia , Internet , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtorno Depressivo/terapia , Adulto , Resultado do Tratamento
12.
J Clin Psychiatry ; 85(3)2024 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-39240697

RESUMO

Objective: While collaborative care is known to improve depressive and anxiety symptoms in primary care, comparative effectiveness studies of virtual collaborative care versus virtual specialty psychiatry treatment in real world settings are lacking. This study examined patient depressive and anxiety symptoms over 6 months in collaborative care versus specialty psychiatry.Methods: This was an observational study with target trial emulation in a large, community-based, integrated health care system. Participants were ≥18 years old with mild-moderate depressive or anxiety symptoms measured by the Patient Health Questionnaire-9 or Generalized Anxiety Disorder-7 Scale. Exclusion criteria included acute suicide risk. Patients were assigned to collaborative care or specialty psychiatry, and symptoms were measured 6 months after treatment initiation using linear mixed-effects regression with inverse probability of treatment weighting.Results: There were N = 10,380 patients (n = 1,607 in collaborative care; n = 8,773 in specialty psychiatry) with depressive disorders and N = 2,935 (n = 570 in collaborative care; n = 2,365 in specialty psychiatry) with anxiety disorders. Model effects at 6 months showed significant symptom improvement for patients in collaborative care (adjusted mean difference [AMD] = -9.0, 95% CI, -9.7, -8.4 for depression; -5.4, 95% CI, -6.2, -4.7 for anxiety) and in specialty psychiatry (AMD = -5.0, 95% CI, -5.6, -4.5 for depression; -2.8, 95% CI, -3.6, -2.1 for anxiety), with patients in collaborative care showing significantly greater improvement compared to those in specialty psychiatry (AMD = -4.0, 95% CI, -4.7, -3.3, P < .0001 for depression; AMD = -2.6, 95% CI, -3.4, -1.8, P < .0001 for anxiety).Conclusions: Virtual collaborative care was at least as effective as specialty psychiatry for depression and anxiety. Collaborative care implementation can support national guidelines regarding depression and anxiety screening and treatment.


Assuntos
Transtornos de Ansiedade , Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Transtornos de Ansiedade/terapia , Telemedicina , Psiquiatria , Transtorno Depressivo/terapia
13.
Brain Behav Immun ; 122: 433-443, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-39197544

RESUMO

Over the last thirty years, substantial evidence has accumulated in support of the hypothesis that dysregulation of inflammatory processes plays a critical role in the pathophysiology of depression. This review traces the evolution of research supporting this link, discussing key findings from several major investigative fronts: Alterations in inflammatory markers associated with depression; Mood changes following the exogenous administration of inflammatory challenges; The anti-inflammatory properties of traditional antidepressants and the promising antidepressant effects of anti-inflammatory drugs. Additionally, it explores how inflammatory processes interact with specific brain regions and neurochemical systems to drive depressive pathology. A thorough analysis of the 100 most-cited experimental studies on the topic ensures a comprehensive, transparent and unbiased collection of references. This methodological approach offers a panoramic view of the inflammation-depression nexus, shedding light on the complexity of its mechanisms and their connections to psychiatric categorizations, symptoms, demographics, and life events. Synthesizing insights from this extensive research, the review presents an integrative model of the biological foundations of inflammation-associated depression. It posits that we have reached a critical juncture where the translation of this knowledge into personalized immunomodulatory treatments for depression is not just possible, but imperative.


Assuntos
Antidepressivos , Encéfalo , Depressão , Inflamação , Humanos , Inflamação/metabolismo , Antidepressivos/uso terapêutico , Antidepressivos/farmacologia , Depressão/tratamento farmacológico , Depressão/metabolismo , Encéfalo/metabolismo , Animais , Anti-Inflamatórios/uso terapêutico , Anti-Inflamatórios/farmacologia , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/metabolismo , Transtorno Depressivo/imunologia
14.
Psychiatry Res Neuroimaging ; 344: 111867, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39153231

RESUMO

Studies have revealed that somatization symptoms are associated with emotional memory in adolescents with depressive disorders. This study investigated somatization symptoms and emotional memory among adolescents with depressive disorders using low-frequency amplitude fluctuations (ALFF). Participants were categorized into the somatization symptoms (FSS) group, non-FSS group and healthy control group (HC). The correctness of negative picture re-recognition was higher in the FFS and HC group than in the non-FSS group. The right superior occipital gyrus and right inferior temporal gyrus were significantly larger in the FSS group than those in the non-FSS and HC groups. Additionally, the ALFF in the superior occipital and inferior temporal gyrus were positively correlated with CSI score. Furthermore, the ALFF values in the temporal region positively correlated with correct negative image re-recognition. The negative image re-recognition rate was positively correlated with the ALFF in the left and right middle occipital gyri. These findings indicated that somatization symptoms in adolescent depression are associated with the superior occipital gyrus and inferior temporal gyrus. Notably, somatization symptoms play a role in memory bias within depressive disorders, with middle occipital and inferior temporal gyri potentially serving as significant brain regions.


Assuntos
Emoções , Imageamento por Ressonância Magnética , Transtornos Somatoformes , Humanos , Adolescente , Feminino , Transtornos Somatoformes/fisiopatologia , Transtornos Somatoformes/psicologia , Transtornos Somatoformes/diagnóstico por imagem , Masculino , Emoções/fisiologia , Memória/fisiologia , Encéfalo/fisiopatologia , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico/métodos , Depressão/fisiopatologia , Depressão/psicologia , Transtorno Depressivo/fisiopatologia , Transtorno Depressivo/psicologia , Transtorno Depressivo/diagnóstico por imagem , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/fisiopatologia
15.
Asian J Psychiatr ; 100: 104185, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39106588

RESUMO

This meta-analysis aims to estimate the association between adolescent depression and adult suicidal behavior, while systematically evaluating gender differences reported in literature. A random-effects model was used to determine the pooled association, reporting odds ratios (ORs) with corresponding 95 % confidence intervals (CIs). Nine articles comprising over 6084 adolescents together showed that people with a history of depression in adolescence are more likely to gain suicidal behaviors during adulthood (OR = 3.97, 95 % Cl: 2.79, 5.63). Sex-specific analysis indicated that males who experienced depression in adolescence developed a higher incidence of suicidal behavior in adulthood compared to females with a similar history (Males: OR = 3.61, 95 % Cl: 1.02, 12.78; Females: OR = 3.56, 95 % Cl: 1.71, 7.43). Furthermore, suicide attempts emerged as the predominant outcome among various suicidal behaviors (OR = 3.43, 95 % Cl: 1.75, 6.71). This meta-analysis provides robust evidence that depression in adolescence significantly increases the risk of suicidal behavior in adulthood.


Assuntos
Tentativa de Suicídio , Humanos , Adolescente , Adulto , Tentativa de Suicídio/estatística & dados numéricos , Masculino , Transtorno Depressivo/epidemiologia , Feminino , Ideação Suicida , Fatores Sexuais , Depressão/epidemiologia , Adulto Jovem
16.
World J Biol Psychiatry ; 25(7): 384-392, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39126213

RESUMO

INTRODUCTION: The acute antidepressant effect of sleep deprivation (SD) in patients with depressive disorders has been studied for more than 60 years. However, hypomanic mood swings after partial or total SD have also been described in people without diagnosed mental disorders. Studying this phenomenon in the general population may yield insights about the mechanisms of therapeutic SD, mania and bipolar disorders. METHODS: A cross-sectional sample of young adults was recruited and classified into those who described having regularly occurring subclinical hypomanic experiences (ROHE) after SD and those who did not. History of psychiatric and physical illness, with screening for depression and mania, as well as alcohol or drug consumption, family history of depressive disorders or suicide, 5-HTTLPR polymorphism, and MEQ-SA chronotype were collected. RESULTS: A total of 251 participants were included; 39.0% indicated regularly having subclinical hypomanic experiences after SD. These experiences were not associated with depressive or mania screening, history of psychiatric illness, family history, 5-HTTLPR polymorphism, or MEQ-SA chronotype. CONCLUSIONS: ROHE after non-therapeutic SD seem to be a relatively common phenomenon in young adults, independent of depressive mood state. Our results suggest that therapeutic SD may depend on a physiological phenomenon of subclinical affective disturbance after SD that affects a part of the general population, independent of psychiatric diagnosis. Further studies could elucidate associated factors and contribute to our understanding of (hypo-)manic mood states.


Assuntos
Transtorno Depressivo , Polimorfismo Genético , Proteínas da Membrana Plasmática de Transporte de Serotonina , Privação do Sono , Humanos , Masculino , Feminino , Privação do Sono/genética , Proteínas da Membrana Plasmática de Transporte de Serotonina/genética , Estudos Transversais , Adulto Jovem , Adulto , Transtorno Depressivo/genética , Mania/genética , Transtorno Bipolar/genética , Adolescente , Ritmo Circadiano/genética , Cronotipo
17.
Neurobiol Dis ; 200: 106627, 2024 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-39111702

RESUMO

An increasing number of people undergo anesthesia and surgery. Perioperative neurocognitive and depressive disorders are common central nervous system complications with similar pathogeneses. These conditions pose a deleterious threat to human health and a significant societal burden. In recent years, numerous studies have focused on the role of the gut microbiota and its metabolites in the central nervous system via the gut-brain axis. Its involvement in perioperative neurocognitive and depressive disorders has attracted considerable attention. This review aimed to elucidate the role of the gut microbiota and its metabolites in the pathogenesis of perioperative neurocognitive and depressive disorders, as well as the value of targeted interventions and treatments.


Assuntos
Eixo Encéfalo-Intestino , Transtorno Depressivo , Microbioma Gastrointestinal , Humanos , Microbioma Gastrointestinal/fisiologia , Eixo Encéfalo-Intestino/fisiologia , Transtorno Depressivo/metabolismo , Transtorno Depressivo/terapia , Transtornos Neurocognitivos/etiologia , Transtornos Neurocognitivos/metabolismo , Animais , Encéfalo/metabolismo , Complicações Pós-Operatórias/microbiologia
18.
J Affect Disord ; 366: 8-15, 2024 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-39173928

RESUMO

BACKGROUND: Bipolar disorder (BD) is often misidentified as unipolar depression (UD) during its early stages, typically until the onset of the first manic episode. This study aimed to explore both shared and unique neurostructural changes in patients who transitioned from UD to BD during follow-up, as compared to those with UD. METHODS: This study utilized high-resolution structural magnetic resonance imaging (MRI) to collect brain data from individuals initially diagnosed with UD. During the average 3-year follow-up, 24 of the UD patients converted to BD (cBD). For comparison, the study included 48 demographically matched UD patients who did not convert and 48 healthy controls. The MRI data underwent preprocessing using FreeSurfer, followed by surface-based morphometry (SBM) analysis to identify cortical thickness (CT), surface area (SA), and cortical volume (CV) among groups. RESULTS: The SBM analysis identified shared neurostructural characteristics between the cBD and UD groups, specifically thinner CT in the right precentral cortex compared to controls. Unique to the cBD group, there was a greater SA in the right inferior parietal cortex compared to the UD group. Furthermore, no significant correlations were observed between cortical morphological measures and cognitive performance and clinical features in the cBD and UD groups. LIMITATIONS: The sample size is relatively small. CONCLUSIONS: Our findings suggest that while cBD and UD exhibit some common alterations in cortical macrostructure, numerous distinct differences are also present. These differences offer valuable insights into the neuropathological underpinnings that distinguish these two conditions.


Assuntos
Transtorno Bipolar , Imageamento por Ressonância Magnética , Humanos , Transtorno Bipolar/diagnóstico por imagem , Transtorno Bipolar/patologia , Feminino , Masculino , Adulto , Seguimentos , Estudos Prospectivos , Transtorno Depressivo/diagnóstico por imagem , Transtorno Depressivo/patologia , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Pessoa de Meia-Idade , Adulto Jovem , Estudos de Casos e Controles
19.
J Affect Disord ; 366: 210-216, 2024 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-39187199

RESUMO

BACKGROUND: There is a robust relationship between depression and substance use in youth, with higher levels of substance use associated with greater depressive symptomatology. However, previous research has examined individual substances, without consideration of psychiatric comorbidities. Here, we investigate patterns of substance use among depressed and/or suicidal youth within the context of psychiatric comorbidities. METHODS: 945 youth with depression and/or suicidality from the Texas Youth Depression and Suicide Research Network (TX-YDSRN) were assessed for current use of alcohol, nicotine, cannabis, and other drugs and comorbid psychiatric diagnoses. We used latent class analysis to identify patterns of past-year substance use, then examined if demographics or psychiatric disorders predicted class membership. RESULTS: We identified three patterns of substance use: non-use (63.4 %), moderate likelihood of using alcohol, nicotine and cannabis (23.8 %), and high likelihood of using all substances (12.7 %). Compared to non-users, individuals in the moderate and high likelihood classes were more likely to be older. Individuals in the high likelihood class were more likely to have a substance use disorder, ADHD, and higher suicidality scores. LIMITATIONS: We cannot ascertain the causal or temporal ordering of substance use and psychiatric diagnoses due to the cross-sectional nature of the study. CONCLUSIONS: Using a brief, self-report measure of substance use, we identified three classes of substance users differing in probability of past-year use, which were predicted by older age and some psychiatric comorbidities. While research on universal screening of substance use in youth remains limited, we discuss who may benefit from such screening among depressed youth.


Assuntos
Comorbidade , Transtornos Relacionados ao Uso de Substâncias , Humanos , Masculino , Feminino , Adolescente , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Texas/epidemiologia , Depressão/epidemiologia , Depressão/psicologia , Ideação Suicida , Suicídio/estatística & dados numéricos , Suicídio/psicologia , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Criança , Transtorno Depressivo/epidemiologia
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