A Rare Case: Is It Hemodialysis Encephalopathy, Dialysis Anxiety, or Both?

We present a case of a 59-year-old female who presented with progressively worsening altered mental status, seizures, and neuropsychiatric symptoms. Over the course of her emergency visit and admission to the hospital, laboratory tests failed to find an offending agent to her presentation. Her clinical presentations supported the diagnosis of encephalopathy, but the actual underlying cause was not found. After careful exclusion of bacterial, viral, and other types of encephalopathy, hemodialysis encephalopathy was a possible diagnosis. The presentation and symptoms of our patient led to a wide range of differentials, and a high index of suspicion was needed throughout her admission in order to obtain the appropriate tests. Computed tomography head (CTH) and electroencephalogram (EEG) were performed and showed results that supported our diagnosis of hemodialysis encephalopathy. Despite the supportive testing results of the brain, there are still some neuropsychiatric symptoms of our patient that remain unexplained. This led us to account for the physical exam, clinical judgment, and the process of elimination to diagnose our patient with anxiety due to dialysis concurrent with hemodialysis encephalopathy. Despite little evidence in the literature supporting the presence of anxiety disorders in patients receiving dialysis, our patient showed alleviated clinical presentation after being prescribed an anti-anxious medication, making this presentation uncommon. In this rare case, we present a patient with possible comorbidity of both hemodialysis encephalopathy and dialysis anxiety that the result from EEG and other tests failed to explain all the symptoms our patient experienced.

Optimal features selection in the high dimensional data based on robust technique: Application to different health database.

Bio-informatics and gene expression analysis face major hurdles when dealing with high-dimensional data, where the number of variables or genes much outweighs the number of samples. These difficulties are exacerbated, particularly in microarray data processing, by redundant genes that do not significantly contribute to the response variable. To address this issue, gene selection emerges as a feasible method for identifying the most important genes, hence reducing the generalization error of classification algorithms. This paper introduces a new hybrid approach for gene selection by combining the Signal-to-Noise Ratio (SNR) score with the robust Mood median test. The Mood median test is beneficial for reducing the impact of outliers in non-normal or skewed data since it may successfully identify genes with significant changes across groups. The SNR score measures the significance of a gene's classification by comparing the gap between class means and within-class variability. By integrating both of these approaches, the suggested approach aims to find genes that are significant for classification tasks. The major objective of this study is to evaluate the effectiveness of this combination approach in choosing the optimal genes. A significant P-value is consistently identified for each gene using the Mood median test and the SNR score. By dividing the SNR value of each gene by its significant P-value, the Md score is calculated. Genes with a high signal-to-noise ratio (SNR) have been considered favorable due to their minimal noise influence and significant classification importance. To verify the effectiveness of the selected genes, the study utilizes two dependable classification techniques: Random Forest and K-Nearest Neighbors (KNN). These algorithms were chosen due to their track record of successfully completing categorization-related tasks. The performance of the selected genes is evaluated using two metrics: error reduction and classification accuracy. These metrics offer an in-depth assessment of how well the selected genes improve classification accuracy and consistency. According to the findings, the hybrid approach put out here outperforms conventional gene selection methods in high-dimensional datasets and has lower classification error rates. There are considerable improvements in classification accuracy and error reduction when specific genes are exposed to the Random Forest and KNN classifiers. The outcomes demonstrate how this hybrid technique might be a helpful tool to improve gene selection processes in bioinformatics.

Regulatory adverse drug reaction analyses support a temporal increase in psychiatric reactions after initiation of cystic fibrosis combination modulator therapies.

INTRODUCTION: Despite improved outcomes for many people with cystic fibrosis, there have been reports of adverse neuropsychiatric effects of modulator therapy. The aim of this research is to define temporal associations in adverse drug reaction (ADR) reports for available CFTR modulators. METHODS: Methods include an analysis of the UK Yellow Card Scheme data for ADRs through accessing interactive Drug Analysis Profiles (iDAPs) to define temporal trends in absolute and proportional counts. RESULTS: Since the introduction of ETI, there has been an increase in the absolute number of psychiatric ADRs reported as well as a statistically significant increase in the proportion of psychiatric ADRs in the pre-ETI and post-ETI periods. CONCLUSION: In the post-ETI period, psychiatric ADRs are the most prevalent ADR reported via the Yellow Card scheme. Despite an unclear mechanism, there is significant clinical relevance in counselling and monitoring regarding psychiatric effects of CFTR modulator therapy.

Sleep duration and sleep loss during pregnancy: a longitudinal FinnBrain birth cohort study.

PURPOSE: To investigate sleep duration and sleep loss during antenatal period and assess associative factors, including maternal characteristic and mood symptoms. METHODS: A cohort of 3038 women was enrolled. Self-reported sleep duration and sleep loss, the latter being calculated from preferred sleep need and actual sleep duration, were measured in early, mid- and late pregnancy, and at delivery. The associations with age, BMI, parity, education, smoking, napping, and depressive and anxiety symptoms were evaluated. RESULTS: Sleep duration was longest in early pregnancy and shortest at delivery (7.93 h-7.76 h, p < 0.001). The proportion of short sleepers (< 6 h) increased from 1.4% to 5.9% throughout the studied period (p < 0.001). Mean sleep loss remained stable in early- and mid-pregnancy, lowering in late pregnancy (p < 0.001) and increasing again until delivery (p = 0.003). The number of women with notable sleep loss (> 2 h) was similar during the first three measurement points (9.4%, 8.9% and 9.5%), but increased until delivery (14.1%, p < 0.001). Older, multiparous, and more-depressive women slept less (p < 0.001, p < 0.001, p = 0.017). Women with higher BMI were more likely to sleep < 6 h in late pregnancy (p = 0.012). Multiparous, more-depressive, and higher-BMI women reported more sleep loss (p < 0.001, p < 0.001, p = 0.049). CONCLUSION: We confirmed earlier reported decrease in sleep duration at the end of pregnancy. As a novel finding, we showed a notable increase in sleep loss during the last month of pregnancy. Various factors were associated with both short sleep and sleep loss, especially multiparity, napping and depressive symptoms.

Protective and harmful social and psychological factors associated with mood and anxiety disorders in perimenopausal women: A narrative review.

Perimenopause is often called a window of vulnerability for the development or exacerbation of mood and anxiety disorders. Evidence points to social and psychological factors contributing to the onset of mood and anxiety disorders or the symptoms of depression and anxiety during perimenopause. Therefore, the purpose of this narrative review was to synthesize the findings of studies examining associations between social and psychological factors and the development of mood and anxiety disorders and the symptoms of depression and anxiety during perimenopause. PsychINFO, Ovid MEDLINE, and CINAHL were searched for studies (published between January 2014 and November 2023) assessing the social and psychological factors associated with perimenopausal mood and anxiety disorders and the symptoms of depression and anxiety. These factors were categorized as either protective or harmful. Study quality was assessed using STROBE guidelines. The search yielded 17 studies. Social support was identified as a social factor protective against perimenopausal depression and anxiety. Resiliency characteristics were reported to be protective psychological factors associated with fewer depressive symptoms. Mental health history, family history of major depressive disorder, trait anxiety and neuroticism, stressful life events, adverse childhood events, and chronic stress were categorized as harmful psychological factors associated with depression during perimenopause. Limited research has been conducted to understand factors associated with perimenopausal anxiety. The identification of these social and psychological factors associated with mood and anxiety disorders during perimenopause will help lead to earlier detection of women at risk and the development of multifaceted interventions.

Prescribing Trends and Associated Outcomes of Antiepileptic Drugs and Other Psychotropic Medications in US Nursing Homes: Proposal for a Mixed Methods Investigation.

BACKGROUND: Pilot data suggest that off-label, unmonitored antiepileptic drug prescribing for behavioral and psychological symptoms of dementia is increasing, replacing other psychotropic medications targeted by purposeful reduction efforts. This trend accelerated during the COVID-19 pandemic. Although adverse outcomes related to this trend remain unknown, preliminary results hint that harms may be increasing and concentrated in vulnerable populations. OBJECTIVE: Using a mixed methods approach including both a retrospective secondary data analysis and a national clinician survey, this study aims to describe appropriate and potentially inappropriate antiepileptic and other psychoactive drug prescribing in US nursing homes (NHs), characteristics and patient-oriented outcomes associated with this prescribing, and how these phenomena may be changing under the combined stressors of the COVID-19 pandemic and the pressure of reduction initiatives. METHODS: To accomplish the objective, resident-level, mixed-effects regression models and interrupted time-series analyses will draw on cohort elements linked at an individual level from the Centers for Medicare and Medicaid Services' (CMS) Minimum Data Set, Medicare Part D, Medicare Provider Analysis and Review, and Outpatient and Public Use Files. Quarterly cohorts of NH residents (2009-2021) will incorporate individual-level data, including demographics; health status; disease variables; psychotropic medication claims; comprehensive NH health outcomes; hospital and emergency department adverse events; and NH details, including staffing resources and COVID-19 statistics. To help explain and validate findings, we will conduct a national qualitative survey of NH prescribers regarding their knowledge and beliefs surrounding changing approaches to dementia care and associated outcomes. RESULTS: Funding was obtained in September 2022. Institutional review board exemption approval was obtained in January 2023. The CMS Data Use Agreement was submitted in May 2023 and signed in March 2024. Data access was obtained in June 2024. Cohort creation is anticipated by January 2025, with crosswalks finalized by July 2025. The first survey was fielded in October 2023 and published in July 2024. The second survey was fielded in March 2024. The results are in review as of July 2024. Iterative survey cycles will continue biannually until December 2026. Multidisciplinary dissemination of survey analysis results began in July 2023, and dissemination of secondary data findings is anticipated to begin January 2025. These processes are ongoing, with investigation to wrap up by June 2027. CONCLUSIONS: This study will detail appropriate and inappropriate antiepileptic drug use and related outcomes in NHs and describe disparities in long-stay subpopulations treated or not treated with psychotropics. It will delineate the impact of the pandemic in combination with national policies on dementia management and outcomes. We believe this mixed methods approach, including processes that link multiple CMS data sets at an individual level and survey-relevant stakeholders, can be replicated and applied to evaluate a variety of patient-oriented questions in diverse clinical populations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/64446.

Effect of pharmacological treatment of attention-deficit/hyperactivity disorder on later psychiatric comorbidity: a population-based prospective long-term study.

BACKGROUND: Psychiatric comorbidity is frequent among persons with attention-deficit/hyperactivity disorder (ADHD). Whether pharmacological treatment of ADHD influences the incidence of psychiatric comorbidity is uncertain. OBJECTIVE: To investigate associations and causal relations between pharmacological treatment of ADHD and incidence of subsequent comorbid psychiatric diagnoses. METHODS: We employed registry data covering all individuals aged 5-18 years in Norway who were diagnosed with ADHD during 2009-2011 (n=8051), followed until 2020. We used linear probability models (LPM) and instrumental variable (IV) analyses to examine associations and causal effects, respectively, between pharmacological treatment and subsequent comorbidity. FINDINGS: From time of ADHD diagnosis to 9 years of follow-up, 63% of patients were registered with comorbid psychiatric disorders. For males, LPM showed associations between ADHD medication and several incident comorbidities, but strength and direction of associations and consistency over time varied. For females, no associations were statistically significant. IV analyses for selected categories isolating effects among patients 'on the margin of treatment' showed a protective effect for a category of stress-related disorders in females and for tic disorders in males for the first 2 and 3 years of pharmacological treatment, respectively. CONCLUSIONS: Overall, LPM and IV analyses did not provide consistent or credible support for long-term effects of pharmacological treatment on later psychiatric comorbidity. However, IV results suggest that for patients on the margin of treatment, pharmacological treatment may initially reduce the incidence of certain categories of comorbid disorders. CLINICAL IMPLICATIONS: Clinicians working with persons with ADHD should monitor the effects of ADHD medication on later psychiatric comorbidity. TRIAL REGISTRATION NUMBER: ISRCTN11891971.

Neuroimaging aspects of interception in mood disorders: A systematic review.

INTRODUCTION: Mood disorders often involve attenuated interoception, which impairs the accurate perception and interpretation of internal bodily signals. Functional magnetic resonance imaging has been used to explore the neurobiology of interoception in vivo while participants are performing interoceptive tasks. AIM: The aim of this review is to present the progress in neuroimaging studies of interoception in mood disorders. METHODS: We performed a systematic search in Pubmed, Scopus and Web of Science with the terms "interoception", "depression", "bipolar disorder", "mood disorders", "neuroimaging" and derivative terms. RESULTS: 461 records have been identified in the 3 databases, 34 records were assessed for eligibility and finally 17 reports were selected. The main findings were: disrupted cardioception in Major Depressive Disorder which was related to reduced insular activity; altered visceroception in major depression has been linked to hypoactivation in the dorsal mid-insula; reduced nociception was reflected by hypoactivation in the insula in both MDD and Bipolar Disorder, and altered insular activity has been linked to maladaptive eating behavior. DISCUSSION & CONCLUSION: The current review demonstrated that neuroimaging studies focusing on interoceptive tasks in mood disorders are limited in both number and sample size. This is notably relevant to bipolar disorder where only one publication was found. Nevertheless, we were able to outline the findings on four separate aspects of interoception - cardioception, visceroception, nociception and appetite all of which are pointing to the insula as core dysfunctional region. Further research is needed to draw more conclusive insights and improve our understanding of interoception in mood disorders.

Causal Relationship Between Mood Swing and Gynecological Disorders: A Mendelian Randomization Study.

Background: Gynecological disorders are a wide range of health problems affecting the female reproductive system, which poses substantial health challenges worldwide. Increasing number of observational studies have associated mood instability to common female diseases, but the underlying causal relationship remains unclear. In this work, Mendelian randomization (MR) analysis was applied to explore the genetically predicted causal relationship of mood swings and several prevalent gynecological disorders. Methods: Instrumental variables (IVs) of mood swings were selected from UK Biobank (UKB), with 204,412 cases and 247,207 controls being incorporated. The genetic variants for female disorders were obtained from genome-wide association studies (GWASs) and FinnGen consortium. To avoid biases caused by racial difference, only European population was included here. Five strong analytical methodologies were used to increase the validity of the results, the most substantial of which was the inverse variance weighting (IVW) method. Pleiotropy, sensitivity, and heterogeneity were assessed to strengthen the findings. Results: We found mood swings was significantly positively associated with risk of endometrial cancer (OR= 2.60 [95% CI= 1.36, 4.95], P= 0.0037), cervical cancer (OR= 1.01[95% CI= 1.00,1.02], P= 0.0213) and endometriosis (OR= 2.58 [95% CI= 1.18, 5.60], P= 0.0170) by IVW method. However, there was no causal relationship between mood swing and ovarian cancer. No pleiotropy and heterogeneity existed and sensitivity tests were passed. Conclusion: This study reveals that mood swing may serve as a genetically predicted causal risk factor for endometrial cancer, cervical cancer, and endometriosis in the European population, while no such association was observed for ovarian cancer. These findings make up for observational research's inherent limitations and may improve patient outcomes in the field of gynecological health. However, the study's focus on European populations may limit the applicability of these results globally.

Research status of hormone replacement therapy on mood and sleep quality in menopausal women.

Menopausal syndrome is a common disease of clinical women, which refers to a series of physical and mental symptoms caused by the fluctuation or reduction of sex hormones before and after menopause. Many of these patients have sleep and mood abnormalities that affect their health and quality of life. At present, the understanding of it is gradually improving. This paper mainly analyzes its background and current treatment.

Cognitive behavioral interventions for depression and anxiety in adults with neurological disorders: a systematic review and meta-analysis.

We examined the efficacy of cognitive and behavioral interventions for improving symptoms of depression and anxiety in adults with neurological disorders. A pre-registered systematic search of Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, Embase, and Neurobite was performed from inception to May 2024. Randomized controlled trials (RCTs) which examined the efficacy of cognitive and behavioral interventions in treating depression and/or anxiety among adults with neurological disorders were included. Estimates were pooled using a random-effects meta-analysis. Subgroup analyses and meta-regression were performed on categorical and continuous moderators, respectively. Main outcomes were pre- and post-intervention depression and anxiety symptom scores, as reported using standardized measures. Fifty-four RCTs involving 5372 participants with 11 neurological disorders (including multiple sclerosis, epilepsy, stroke) were included. The overall effect of interventions yielded significant improvements in both depression (57 arms, Hedges' g = 0.45, 95% confidence interval [CI] 0.35-0.54) and anxiety symptoms (29 arms, g = 0.38, 95% CI 0.29-0.48), compared to controls. Efficacy was greater in studies which employed a minimum baseline symptom severity inclusion criterion for both outcomes, and greater in trials using inactive controls for depression only. There was also evidence of differential efficacy of interventions across the neurological disorder types and the outcome measure used. Risk of bias, intervention delivery mode, intervention tailoring for neurological disorders, sample size, and study year did not moderate effects. Cognitive and behavioral interventions yield small-to-moderate improvements in symptoms of both depression and anxiety in adults with a range of neurological disorders.

Symptom clusters of patients with advanced thyroid cancer: a cross-sectional study.

PURPOSE: To investigate and analyze the symptom clusters of patients with advanced thyroid cancer and provide a basis for developing targeted symptom management measures. METHODS: Patients who visited a multidisciplinary outpatient service for advanced thyroid cancer at a tertiary A hospital in Sichuan Province from April 2022 to April 2023 were selected using convenience sampling. A cross-sectional survey was conducted using the M.D. Anderson Symptom Inventory-Thyroid Cancer module (MDASI-THY). Symptom clusters were extracted by exploratory factor analysis. RESULTS: Disturbed sleep had the highest incidence (75.7%) and severity (3.0 points), while mood distress had the highest incidence (63.5%) and severity (2.0 points) of symptom interference. Three symptom clusters were identified: mood-fatigue-sleep, digestive tract-sensation, and thyroid cancer-specific symptom clusters. CONCLUSION: Patients with advanced thyroid cancer have multiple symptom clusters that seriously affect their daily lives. Health care professionals should conduct targeted observation and preventive treatment to reduce the burden of symptoms on patients.

Psychiatric predictors of quality of life in Parkinson's disease: A three-year longitudinal study.

INTRODUCTION: Parkinson's disease (PD) is associated with worsened quality of life (QOL) over time. Few longitudinal studies exist investigating the relationship of psychiatric comorbidities with QOL in people with PD (PwP). We sought to determine specific psychiatric symptoms associated with decreasing QOL in PwP over time. METHODS: We recruited PwP without dementia from a movement disorders clinic at an academic medical center. Participants were evaluated annually with motor and neuropsychological assessments at each visit. QOL was measured using the Parkinson's Disease Questionnaire-39 (PDQ-39). We assessed psychiatric symptoms, including depression (Beck Depression Inventory II, BDI-II), anxiety (Beck Anxiety Index, BAI), and apathy (Apathy Scale). Psychosis and impulse control disorders (ICDs) were recorded as present or absent. Using random coefficient regression, we analyzed psychiatric features associated with worsened QOL in PwP over three years. RESULTS: From the 105 participants enrolled at baseline, 67 completed three years of follow up. Mean PDQ-39 scores increased from 16.0 at baseline to 19.8 at year three. In multivariate analysis, higher BDI-II scores, BAI scores, and apathy scores were uniquely associated with worsened QOL over time (p < 0.001 for all measures), while presence of ICDs (p = 0.18) or psychosis (p = 0.10) were not. Changes in the BAI score and the BDI-II score exerted similar effects on the overall PDQ-39 score. CONCLUSION: Depression, anxiety, and apathy are all associated with worsening quality of life over time in PwP, while presence of ICDs and psychosis are not. Treatment of these symptoms may lead to improved QOL in PwP.

Network Structure of Interpersonal Sensitivity in Patients With Mood Disorders: A Network Analysis.

OBJECTIVE: Interpersonal sensitivity, characterized by a heightened awareness of others' behavior and emotions, is linked to mood disorders. However, current literature lacks a comprehensive analysis of how some items of the Interpersonal Sensitivity Measure (IPSM) interrelate and contribute to the overall construct. This study constructed a network for interpersonal sensitivity symptomatology to identify core IPSM items in patients with mood disorders. METHODS: The IPSM, a 36-item self-report scale, was utilized to evaluate interpersonal sensitivity symptoms in 837 participants (major depressive disorder [MDD], n=265; bipolar I disorder [BD I], n=126; and bipolar II disorder [BD II], n=446). We performed exploratory graph analysis, employing regularized partial correlation models to estimate the network structure. Centrality analysis identified core IPSM symptoms for each mood disorder group. Network comparison tests assessed structural differences between the MDD and BD subgroups. RESULTS: Network analysis detected five communities. Item 10 ("I worry about being criticized for things that I have said or done") showed the highest value in strength. Multiple items on "Interpersonal Worry/Dependency" and "Low Self-Esteem" showed high strength centrality. Network structure invariance and global strength invariance test results indicated no significant differences between the MDD and BD subgroups. CONCLUSION: Our findings emphasize the importance of addressing "Interpersonal Worry/Dependency" and "Low Self-Esteem" in the IPSM network among mood disorder patients based on core items of the network. Additionally, targeted treatments and comprehensive strategies in this aspect could be crucial for managing mood disorders.

Euthymia, Psychological Well-Being, and Professional Quality of Life in Health Care Workers.

Objective: Euthymia is a transdiagnostic construct characterized by the presence of positive mood states, psychological flexibility and resilience. These components contribute to psychological wellbeing and support mental functioning. Exposure to suffering and high levels of stress can lead to the onset of burnout and secondary traumatic stress, but also lack of compassion satisfaction. The study aimed to test the existing relationships between euthymia, psychological well-being, and factors associated with quality of life of healthy participants involved in medical settings. Method: The sample was composed of 177 healthy participants involved in medical settings, 118 women (66.7%) and 59 men (33.3%) aged between 19 and 69 years old (mean = 27.16; SD = 8.47). Standardized psychodiagnostics instruments were used to assess euthymia (Euthymia Scale-ES), psychological well-being (The Well-Being Index scale-WHO-5) and the quality of life of the involved participants (Professional Quality of Life Measure-ProQOL-5). Results: The results showed that gender, well-being and psychological well-being were predictors of compassion satisfaction and secondary traumatic stress. Specifically, female gender predicted higher levels of compassion satisfaction. Well-being and psychological flexibility predicted higher levels of compassion satisfaction and lower secondary traumatic stress. Psychological well-being predicted higher levels of compassion satisfaction. Conclusions: Promoting euthymia and well-being helps individuals to preserve psychological well-being and increase tolerance to stressful life situations. Results highlighted the need for promoting health care professionals' euthymia and well-being. In line with evidence, encouraging interventions based on evidence appears relevant.

The Therapeutic Role of Lamotrigine in Borderline Personality Disorder: A Comprehensive Review of Outcomes, Mechanisms, and Treatment Strategies.

Borderline personality disorder (BPD) is a severe mental health condition characterized by pervasive instability in mood, self-image, and interpersonal relationships, significantly impacting individuals' personal, social, and occupational functioning. Current treatment strategies primarily include psychotherapy and pharmacotherapy, but there remains a need for more effective and targeted pharmacological options. This review examines the therapeutic role of lamotrigine in BPD, focusing on its efficacy, safety, mechanisms of action, and practical treatment strategies. A comprehensive review of the existing literature was conducted, including clinical trials, observational studies, and relevant pharmacological data. Key focus areas included lamotrigine's impact on BPD symptoms, pharmacological profile, and comparative effectiveness with other treatments. Lamotrigine has shown promise in managing BPD symptoms, particularly in stabilizing mood and reducing emotional dysregulation and impulsivity. Clinical trials suggest that lamotrigine can effectively address core symptoms of BPD, with a safety profile generally comparable to other treatments. The medication's mechanism of action, which involves modulation of glutamate release and mood stabilization, aligns with the therapeutic goals for BPD. Lamotrigine represents a potential adjunctive treatment for BPD, offering benefits in mood stabilization and symptom management. Integrating psychotherapy and other pharmacological options should be considered within a multimodal treatment approach. Further research is needed to better understand its long-term efficacy and safety and its role in combination therapy.

Mind wandering, poor sleep, and negative affect: a threefold vicious cycle?

Mind wandering (MW) is intricately linked to sleep and affect, bearing clinical relevance for various psychiatric conditions, notably attention deficit/hyperactivity disorder, depression, and anxiety disorders. Most reviews concur that the relationship between disturbed sleep and negative affect is bidirectional. The directional relationships between MW propensity and disturbed sleep, as well as MW propensity and negative affect, are less clear. Therefore, this brief review aims to examine the limited studies that have directly explored temporally sequential relationships. These studies provide clear evidence for an impact of affect on MW and of MW on sleep, along with less unequivocal evidence for an influence of MW on affect and sleep on MW. Collectively, these individual reinforcement loops may constitute a threefold vicious cycle, which may contribute to the development and perpetuation of psychiatric disorders. Available data convincingly suggest an impact cycle in the direction "MW propensity → disturbed sleep → negative affect → MW propensity," while evidence for the inverse impact cycle is less pronounced.

Efficacy of Dichrostachys Glomerata Supplementation on Overweight and Mildly Obese Adult's Weight, Mood, and Health-Related Quality of Life: A Randomized Double-Blind Placebo-Controlled Trial.

Despite their widespread use, research is needed to evaluate the weight loss and related health/wellness outcomes of herbal plants. Preliminary research found that the fruit of Dichrostachys glomerata is safe and has potential weight loss effects. This study aimed to examine the effect of a standardized powder of D. glomerata fruit pods (DYG-400®) on weight, food cravings, mood, and health-related quality of life of overweight and mildly obese adults. In this CONSORT-compliant double-blind placebo-controlled trial, 56 adults (Mean [M] age = 44.50, M [body mass index] BMI = 31.66) were randomized to either the D. glomerata Group (DG; 300 mg/d) or Placebo Group (PG; rice protein, 300 mg/d) for 60 days. Participants weight was assessed along with self-report assessments of the Food Cravings Questionnaire, CDC Health-related Quality of Life, Perceived Stress Scale, Trait Anxiety Inventory, and Profile of Mood States at Baseline, Day 30, and Day 60. The data were collected from March 2023 to June 2023 and stored electronically, and analyzed using general linear models with repeated measures. DG lost more weight at Day 60 compared to PG, p = .05 (4.11 vs. 2.19 lbs). DG had reduced food cravings from Baseline to Day 30 and Day 60 compared to PG, p < .001. Perceived stress, p < .001, and mood, p = .017, improved from Baseline to Day 60 for DG compared to PG. Anxiety decreased from Baseline to Day 60 for DG and from Baseline to Day 30 for PG, p < .001. Health-related Quality of Life improved for DG compared to PG, p < .001. D. glomerata (DYG-400®) may be an effective herbal intervention to promote weight loss and health. Extended clinical trials across diverse populations and settings are needed.Clinical trial registry number and website: ISRCTN10099861, https://doi.org/10.1186/ISRCTN10099861.

A cross-sectional study of the association between physical activity and depressive symptoms among adolescents in southwest China stratified by parental absence: the mediating role of insomnia and the moderating role of resilience.

OBJECTIVES: This study explored the mechanisms by which physical activity was associated with depressive symptoms in multi-ethnic (Han, Yi and Tibetan) adolescents in southwest China. The mediating role of insomnia in the association of physical activity with depressive symptoms, the moderating role of resilience in this mediation model and the moderating role of parental absence in the moderated mediation model were also examined. DESIGN: A cross-sectional survey. SETTING: In southwest China (Sichuan Province and Tibet Autonomous Region). PARTICIPANTS: 3195 adolescents from a school-based survey conducted between April and October 2020. METHODS: There were 3143 valid samples in this study (47.2% males with mean age=12.88±1.68 years). Structural equation models were developed to estimate the direct and mediating effect, and the moderating effect. Multigroup comparison was performed to examine the differences and similarities of the moderated mediation model across three parental absence subgroups: (1) both parents present, (2) one parent absent and (3) both parents absent. RESULTS: As hypothesised, physical activity was significantly and positively associated with the reduction of depressive symptoms in adolescents. Insomnia partially mediated the effect of physical activity on depressive symptoms. In addition, resilience moderated the direct and indirect effects of physical activity (through insomnia) on depressive symptoms. Finally, the multigroup comparison indicated the moderating effect of parental absence on the moderated mediation model. CONCLUSIONS: Physical activity was associated with alleviating insomnia symptoms among adolescents, thus correlating with the improvement of their depressive symptoms. Resilience was associated with enhancing the beneficial effects of physical activity, further improving depressive symptoms among adolescents, especially those with both absent parents. It is evident that physical activity interventions should be further incorporated into public health programmes to foster the physical and mental health of left-behind adolescents in southwest China.

Digital Mental Health Interventions for Alleviating Depression and Anxiety During Psychotherapy Waiting Lists: Systematic Review.

BACKGROUND: Depression and anxiety have become increasingly prevalent across the globe. The rising need for treatment and the lack of clinicians has resulted in prolonged waiting times for patients to receive their first session. Responding to this gap, digital mental health interventions (DMHIs) have been found effective in treating depression and anxiety and are potentially promising pretreatments for patients who are awaiting face-to-face psychotherapy. Nevertheless, whether digital interventions effectively alleviate symptoms for patients on waiting lists for face-to-face psychotherapy remains unclear. OBJECTIVE: This review aimed to synthesize the effectiveness of DMHIs for relieving depression and anxiety symptoms of patients on waiting lists for face-to-face therapy. This review also investigated the features, perceived credibility, and usability of DMHIs during waiting times. METHODS: In this systematic review, we searched PubMed, PsycINFO, Cochrane, and Web of Science for research studies investigating the effectiveness of DMHIs in reducing either depression or anxiety symptoms among individuals waiting for face-to-face psychotherapy. The search was conducted in June 2024, and we have included the studies that met the inclusion criteria and were published before June 6, 2024. RESULTS: Of the 9267 unique records identified, 8 studies met the eligibility criteria and were included in the systematic review. Five studies were randomized controlled trials (RCTs), and 3 studies were not. Among the RCTs, we found that digital interventions reduced depression and anxiety symptoms, but the majority of interventions were not more effective compared to the control groups where participants simply waited or received a self-help book. For the non-RCTs, the interventions also reduced symptoms, but without control groups, the interpretation of the findings is limited. Finally, participants in the included studies perceived the digital interventions to be credible and useful, but high dropout rates raised concerns about treatment adherence. CONCLUSIONS: Due to the lack of effective interventions among the reviewed studies, especially among the RCTs, our results suggest that waiting list DMHIs are not more effective compared to simply waiting or using a self-help book. However, more high-quality RCTs with larger sample sizes are warranted in order to draw a more robust conclusion. Additionally, as this review revealed concerns regarding the high dropout rate in digital interventions, future studies could perhaps adopt more personalized and human-centered functions in interventions to increase user engagement, with the potential to increase treatment adherence and effectiveness.