Validation and internal consistency of Patient Health Questionnaire-9 for major depression in Parkinson's disease.

BACKGROUND: depression is common in Parkinson's disease (PD), although frequently under-recognised. Among the scales used to investigate depressive features in PD, the Patient Health Questionnaire-9 (PHQ-9) has been largely used, but no specific cut-off scores for depression have been established thus far, which hinders the use of the PHQ-9 in clinical and research settings. OBJECTIVE: we assessed the discriminant validity of the PHQ-9 in order to establish the best cut-off score for the diagnosis of major depression in PD patients. METHOD: one hundred and ten patients with a diagnosis of PD without dementia were evaluated with the Structured Clinical Interview for DSM-IV (SCID), considered as the gold standard for the diagnosis of major depression. Eighty-four PD patients completed the PHQ-9, the 15-item Geriatric Depression Scale (GDS-15) and the Zung Self-rating Depression Scale (SDS). RESULTS: the prevalence of current depression in the sample of PD patients was 25.5%. Maximal discrimination between depressed and non-depressed patients was reached with a cut-off score of 9 in the PHQ-9 (sensitivity of 100% and specificity of 83.1%). The internal consistency of the scale was 0.83 and, when used as a diagnostic instrument, the PHQ-9 had a sensitivity of 52.6% and specificity of 95.4%. The correlation coefficient between the PHQ-9 and the other two scales was 0.63. CONCLUSIONS: the PHQ-9 is an adequate instrument for the screening-but not diagnosis-of depression in PD patients, with optimal sensitivity and specificity attained with a cut-off score of 9.

Neuroimaging of depression in Parkinson's disease: a review.

BACKGROUND: Depression is the most common psychiatric manifestation in patients with Parkinson's disease (PD). In addition, depressive symptoms may be considered to be a prodromal manifestation of PD. In recent years, the association between PD and depression has been the focus of neuroimaging studies using functional and structural techniques. METHODS: The aim of this study was to review the main neuroimaging studies assessing the comorbidity between depression and PD. Literature searches were conducted to find the major neuroimaging studies that consider primarily the comorbidity between depression and PD using the indices Web of Science and Lilacs. RESULTS: In total, 296 papers were identified, and 18 of these studies were selected for the current review. The principal neuroimaging technique used was SPECT. The structural neuroimaging studies that have evaluated the impact of current or previous bouts of depression on the neurodegenerative process of PD are scarce and inclusive. The instruments that were used to evaluate depression differed among the studies. Several brain regions appear to be involved in depression, particularly the limbic system and the basal ganglia. In addition, the serotonergic, dopaminergic, and noradrenergic systems also appear to be associated with depressive symptoms in PD. CONCLUSION: Several brain regions and neurotransmitter systems are involved in depression in PD; however, the variety of criteria used to evaluate depressive symptoms precludes more specific conclusions.

Effects of the Acute and Chronic Administration of Cannabidiol on Cognition in Humans and Animals: A Systematic Review.

Introduction: The effects of cannabidiol (CBD) on cognition has been investigated in recent years to determine the therapeutic potential of this cannabinoid for a broad gamut of medical conditions, including neuropsychiatric disorders. The aim of the present study was to perform a systematic review of studies that analyzed the effects of the acute and chronic administration of CBD on cognition in humans and animals both to assess the cognitive safety of CBD and to determine a beneficial potential of CBD on cognition. Methods: The PubMed, Web of Science, PsycINFO, and Scopus databases were searched in December of 2022 for relevant articles using the following combinations of keywords: ("cannabidiol" OR "CBD") AND ("cognition" OR "processing cognitive" OR "memory" OR "language" OR "attention" OR "executive function" OR "social cognition" OR "perceptual motor ability" OR "processing speed"). Results: Fifty-nine articles were included in the present review (36 preclinical and 23 clinical trials). CBD seems not to have any negative effect on cognitive processing in rats. The clinical trials confirmed these findings in humans. One study found that repeated dosing with CBD may improve cognitive in people who use cannabis heavily but not individuals with neuropsychiatric disorders. Considering the context of neuropsychiatric disorders in animal models, CBD seems to reverse the harm caused by the experimental paradigms, such that the performance of these animals becomes similar to that of control animals. Conclusions: The results demonstrate that the chronic and acute administration of CBD seems not to impair cognition in humans without neuropsychiatric disorders. In addition, preclinical studies report promising results regarding the effects of CBD on the cognitive processing of animals. Future double-blind, placebo-controlled, randomized clinical trials with larger, less selective samples, with standardized tests, and using different doses of CBD in outpatients are of particular interest to elucidate the cognitive effects of CBD.

Oxytocin interference in the effects induced by inhalation of 7.5% CO(2) in healthy volunteers.

OBJECTIVE: The objective of this study was to assess the acute effect of intranasally administered oxytocin (OT) on subjective states, cardiovascular, and endocrine parameters in healthy volunteers who inhaled 7.5% CO(2) . METHODS: Forty-five subjects were allocated into three matched groups of subjects who received 24 international units (IU) of OT, 2 mg of lorazepam (LZP), or placebo (PL). The challenge consisted of medical air inhalation for 20 min, 10 min of rest, and CO(2) 7.5% inhalation for 20 min. Subjective effects were evaluated by self-assessment scales; heart rate, blood pressure, skin conductance, and salivary cortisol were also measured. Assessments were performed at four time points: (i) baseline (-15 min); (ii) post-air inhalation (90 min); (iii) post-CO(2) inhalation (120 min), and (iv) post-test (160 min). RESULTS: CO(2) inhalation significantly increased the anxiety score in the PL group compared with the post-air measurement but not in the OT or LZP groups. The LZP reduced anxiety after medical air inhalation. Other parameters evaluated were not affected by OT. CONCLUSION: OT, as well as LZP, prevented CO(2) -induced anxiety, suggesting that this hormone has anxiolytic properties.

Are facial emotion recognition tasks adequate for assessing social cognition in older people? A review of the literature.

OBJECTIVE: Facial emotion recognition (FER) is a component of social cognition and important to interpersonal relations. Therefore, tasks have been developed to assess this skill in different population. Regarding older people, even healthy individuals have a poorer performance compared to rate of correct answers commonly used to assess such tasks. Perform a systematic review to analyze studies addressing the performance of healthy older adults on FER tasks compared to the 70% correct response rate commonly used for the creation of stimulus banks. MATERIAL AND METHODS: Searches were conducted up to May 2019 in the Pubmed, PsycInfo, Web of Science, and Scopus databases using the keywords ("faces" OR "facial") AND ("recognition" OR "expression" OR "emotional") AND ("elderly" OR "older adults"). RESULTS: Twenty-seven articles were included in the present review. In 16 studies (59.2%), older people had correct response rates on FER lower than 70% on at least one of the emotions evaluated. Among the studies that evaluated each emotion specifically, 62.5% found correct response rates lower than 70% for the emotion fear, 50% for surprise, 50% for sadness, 37.5% for anger, 21.4% for disgust, and 5.9% for happiness. Moreover, the studies that evaluated the level of intensity of the emotions demonstrated a lower rate of correct responses when the intensity of the facial expression was low. CONCLUSION: That studies employ methods and facial stimuli that may not be adequate for measuring this skill in older people. Thus, it is important to create adequate tasks for assessing the skill in this population.

[Guidelines of the Brazilian Medical Association for the diagnosis and differential diagnosis of social anxiety disorder]. / Diretrizes da Associação Médica Brasileira para o diagnóstico e diagnóstico diferencial do transtorno de ansiedade social.

OBJECTIVE: Social anxiety disorder is the most common anxiety disorder. The condition has a chronic course usually with no remission and is frequently associated with significant functional and psychosocial impairment. The Brazilian Medical Association, with the project named Diretrizes ('Guidelines', in English), endeavors to develop diagnostic and treatment protocols for the most common disorders. This work presents the most relevant findings regarding the guidelines of the Brazilian Medical Association concerning the diagnosis and differential diagnosis of social anxiety disorder. METHOD: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes project. The search was performed on the online databases Medline (PubMed), Scopus, Web of Science, and Lilacs, with no time restraints. Searchable questions were structured using PICO format (acronym for "patient or population"; "intervention, indicator or exposition"; "control or comparison" and; "outcome or ending"). RESULTS: We present data regarding the clinical manifestations of social anxiety disorder, impairments and implications related to the condition, differences between the generalized and specific subtypes, and the relationship with depression, drug dependence and abuse, and other anxiety disorders. Additionally, the main differential diagnoses are discussed. CONCLUSION: The guidelines are intended to serve as references to the general practitioner and the specialist as well, facilitating the diagnosis of social anxiety disorder.

Acute effects of oxytocin in music performance anxiety: a crossover, randomized, placebo-controlled trial.

RATIONALE: Individuals with music performance anxiety (MPA) present physical, behavioral, and cognitive manifestations of anxiety, in addition to information processing deficits, especially in facial emotion recognition (FER). OBJECTIVES: To assess the effects of a single dose of intranasal oxytocin (24 IU) on FER in a sample of musicians with high and low MPA (primary outcome), as well as indicators of mood/anxiety and self-assessed performance (secondary outcomes). METHODS: Crossover, randomized, double-blind, placebo-controlled trial involving 43 male musicians with different levels of MPA. Participants completed a static facial emotion recognition task and self-rated mood and performance scales. Data were analyzed using ANOVA 2 × 0 for crossover trials and the Omnibus test (measure of separability between intervention and carryover effects). RESULTS: Only musicians with high MPA treated with oxytocin had a higher accuracy in the recognition of happiness (p < 0.03; d > 0.72). No effects of oxytocin were found on mood indicators or on self-perceived performance, regardless of MPA level. CONCLUSIONS: The results indicate possible benefits of the acute treatment with oxytocin in MPA, which may improve the management of this common and disabling condition that affects professional musicians. The appropriate perception of positive feedback may increase confidence and feelings of social acceptance, reducing symptoms associated with the condition. The lack of effects on mood/anxiety and cognition may be explained by the context-dependent characteristic of the effects of oxytocin, since the experiment did not represent an actual situation of social threat. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (Registro Brasileiro de Ensaios Clínicos): No. RBR-9cph2q.

Frailty and cognitive decline.

Frailty and cognitive impairment are among the 2 most common geriatric syndromes. Their presence poses major risks to the elderly including greater disability, reduced quality of life, and higher morbi-mortality. Recent evidence suggest that frailty can be a risk factor for incident dementia. The opposite is also true since subjects with Alzheimer's disease and other dementia also present with more severe frailty measures. The mechanisms for the association between frailty and cognitive impairment is not clear, but possibly involves abnormalities in biological processes related to aging. Here, we will review the current evidence of the association between frailty and cognitive impairment. We will also review the possible biological mechanistic links between the 2 conditions. Finally, we will address potential therapeutic targets and interventions that can mitigate both conditions.

Facial Recognition of Happiness Is Impaired in Musicians with High Music Performance Anxiety.

INTRODUCTION: Music performance anxiety (MPA) can be defined as a lasting and intense apprehension connected with musical performance in public. Studies suggest that MPA can be regarded as a subtype of social anxiety. Since individuals with social anxiety have deficits in the recognition of facial emotion, we hypothesized that musicians with high levels of MPA would share similar impairments. OBJECTIVE: The aim of this study was to compare parameters of facial emotion recognition (FER) between musicians with high and low MPA. METHODS: 150 amateur and professional musicians with different musical backgrounds were assessed in respect to their level of MPA and completed a dynamic FER task. The outcomes investigated were accuracy, response time, emotional intensity, and response bias. RESULTS: Musicians with high MPA were less accurate in the recognition of happiness (p = 0.04; d = 0.34), had increased response bias toward fear (p = 0.03), and increased response time to facial emotions as a whole (p = 0.02; d = 0.39). CONCLUSION: Musicians with high MPA displayed FER deficits that were independent of general anxiety levels and possibly of general cognitive capacity. These deficits may favor the maintenance and exacerbation of experiences of anxiety during public performance, since cues of approval, satisfaction, and encouragement are not adequately recognized.

Factors associated with happiness in the elderly persons living in the community.

OBJECTIVE: The aim of the present study was to evaluate factors associated with happiness in a sample of Brazilian older adults. METHODS: A study was conducted with 263 elderly people in the area of coverage of a family health unit located in the state of São Paulo, Brazil. The Subjective Happiness Scale was used to measure happiness, the final score of which determined one of three outcomes: not happy, intermediate, and happy. Disability, sociodemographic characteristics, and psychological, cognitive, and physical factors were considered for the multinomial logistic regression analysis. RESULTS: Statistically significant differences were found among the three groups regarding satisfaction with life, disability, social phobia, anxiety, depression, and frailty (p≤0.05). In the multinomial regression analysis, being "not happy" was significantly associated with satisfaction with life (RRR: 0.53), depression (RRR: 1.46), social phobia (RRR: 1.24), and age (RRR: 1.06). CONCLUSION: The present findings indicate that psychological factors and age influence the levels of happiness in older adults living in the community. Furthermore, better screening, diagnosis, and treatment of mental health disorders could increase the feeling of happiness among older adults.

Neuroimaging of major depression in Parkinson's disease: Cortical thickness, cortical and subcortical volume, and spectroscopy findings.

Depression is the most common psychiatric disorder in Parkinson's disease (PD). The aim of this study was to compare PD patients with current Major Depressive Disorder (MDD), lifetime MDD, and no MDD using three neuroimaging techniques. A total of 43 PD patients were selected and divided into three groups: (i) current MDD (n = 15), (ii) previous MDD without current MDD (n = 10); and (iii) control group (no current or lifetime MDD; n = 18). All participants underwent magnetic resonance imaging to evaluate cortical thickness, cortical and subcortical volume, and spectroscopy in the bilateral putamen and cingulate cortex. Volumetric analysis showed volume decreases in frontal and temporal areas, bilateral amygdala, and left cerebellar white matter in the lifetime MDD group compared to the control group. Furthermore, the volumes of the anterior cingulate cortex, right amygdala, and left cerebellar white matter were smaller in the group with current MDD compared to the control group. Regarding cortical thickness, the left rostral anterior cingulate gyrus of the group with previous MDD was thinner compared to the control group. There was a weak negative correlation between the NAA/Cre ratio in the right putamen and depressive symptoms. The results suggested current and lifetime MDD have a negative impact on the neurodegenerative process of PD, with decreased volume and/or reduction of cortical thickness in temporal and frontal areas, anterior cingulate cortex, amygdala, and cerebellar white matter.

Effects of psychotropic drugs used in the treatment of anxiety disorders on the recognition of facial expressions of emotion: Critical analysis of literature.

Deficits in recognition of facial expressions of emotion (RFEE) play a central role in the manifestation of anxiety disorders (AD). We systematically reviewed the literature to determine effects of drugs used in AD treatment on RFEE, based on outcomes of accuracy rate, reaction time, and intensity. Electronic databases, including Pubmed, PsycINFO, and Scielo, were used without time constraints. Twenty-six clinical/experimental studies on healthy subjects, focusing on 11 drugs, published in English, Portuguese, and Spanish, were selected. We found that increased recognition of happiness was associated with acute use of citalopram, fluoxetine, duloxetine, and reboxetine. Increased and decreased recognition of negative emotions were associated with the use of selective serotonin and/or norepinephrine reuptake inhibitors, respectively. Benzodiazepine favored recognition of negative emotions. Differences in reaction time were rarely observed. Stimuli with distinct emotion intensities produced similar effects. Specific changes occurred in RFEE depending on the drug, its administration route and dose, and emotion valence. Evidences indicate significant effects on emotional processing relevant to clinical practice, particularly in treating patients with emotional disorders.

Screening tools for psychiatry disorders in cancer setting: Caution when using.

This study evaluated sensitivity/specificity of self-report instruments for the screening of psychiatric disorders/symptoms in cancer outpatients like: current/past major depression, dysthymia, alcohol abuse and dependence, tobacco abuse and dependence, panic disorder, social anxiety disorder, generalized anxiety disorder, obsessive compulsive disorder, posttraumatic stress disorder, phobias, current mania, delusion and hallucination. First, 1384 patients responded to several self-assessment instruments. Then, 400 patients, were then interviewed by telephone to confirm the presence/absence of psychiatric diagnosis. The ROC analyses showed moderate/excellent specificity (Patient Health Questionnaire-4 (PHQ-4)=0.75-0.88, Generalized Anxiety Disorder (GAD-7)=0.77, Fast Alcohol Screening Test (FAST)=0.83-0.86, Fagerström Test for Nicotine Dependence (FTND)=0.72, Brief version of the Patient Health Questionnaire-Panic Disorder Module (Brief-PD)=0.75, and Self Reporting Questionnaire - psychosis items=(0.68-0.91) but low sensitivity (PHQ-4=0.53-0.54, GAD-7=0.52, FAST=0.48-0.58, FTND=0.97, and Brief-PD=0.66)). These results suggest that sensitivity indicators should be used with caution in the cancer clinical setting.

Assessment and screening of panic disorder in cancer patients: performance of the PHQ-PD.

OBJECTIVE: This study's objective was to promote the transcultural adaptation of the Patient Health Questionnaire-Panic Disorder Module (PHQ-PD) for Brazilian Portuguese and to evaluate the discriminative validity of this scale in detecting PD among cancer patients. METHODS: Adult cancer outpatients (n=400) from a specialized cancer hospital (61.50% female; 68.40% married; 56% incomplete elementary education or elementary school as the highest educational level) were assessed with the Structured Clinical Interview for DSM-IV and PHQ-PD. Using receiver operating characteristic (ROC) analyses, we determined the sensitivity and specificity values for the original PD algorithm and the PD screening. RESULTS: The prevalence of PD in cancer patients (8.75%) was higher than the prevalence of PD for the general population. The original PD algorithm demonstrated an accuracy of 0.66, sensitivity of 0.31 and specificity of 0.94. The PD screening question in the PHQ-PD had a sensitivity of 0.66 and a specificity of 0.75 (accuracy=0.80). CONCLUSION: PD screening questions in the PHQ-PD may be useful for identifying cancer patients with PD because of the high prevalence of PD in this population and because the questionnaire's sensitivity is greater than that of the original PD algorithm. Nevertheless, researchers and clinical practitioners should consider the original PD algorithm (five items) in the PHQ-PD when they investigate PD in patients because of the algorithm's high specificity. Individuals who are found to be positive for PD on screening should be referred for assessment and a thorough psychiatric interview that focuses on the differential diagnosis of an anxiety disorder relating to cancer.

Diagnostic criteria and prevalence of mild cognitive impairment in older adults living in the community: a systematic review and meta-analysis

Abstract Background Mild Cognitive Impairment (MCI) is a disorder in which the patient presents a cognitive decline, but without negative impact on the activities of daily living. Objective To carry out a systematic review of published studies that analyzed the prevalence of Mild Cognitive Impairment (MCI) in older adults living in the community, and the criteria used for the diagnosis of this disorder. Methods A search was carried out in May 2017 using the descriptors: "epidemiology" or "prevalence", "mild cognitive impairment", and "community" in the PubMed, PsycInfo, SciELO, Web of Science, and Scopus databases. Two independent researchers extracted and documented the data. We used a random effect model to calculate pooled prevalence of MCI for overall studies and for each subgroup divided by diagnostic criteria. Results We found initially 1996 articles, and we selected 35 studies. The prevalence of MCI in the selected studies ranged from 0.5% to 41.8%. The overall pooled prevalence of MCI was 17.3% (CI 95%, 13.8-20.8), with significant heterogeneity between estimates (I2 = 99.6%). Discussion The standardization of the diagnostic criteria for MCI, as well as the tests used in the cognitive evaluation, could allow the comparison between the studies and would be an important step in the researches of this area.

Oxytocin does not improve performance of patients with schizophrenia and healthy volunteers in a facial emotion matching task.

The neuropeptide oxytocin improves the performance in facial emotion recognition tests in healthy volunteers and in individuals with schizophrenia. Different paradigms are used in emotion recognition tasks, engaging different neurobiological bases. To date, the effects of oxytocin in facial emotion matching tasks have not been studied. The objective of this study was to evaluate the effects of intranasal oxytocin in a facial emotion matching task in patients with schizophrenia and healthy volunteers. Twenty patients and 20 healthy volunteers received 48 IU intranasal oxytocin and placebo in a double-blind, randomized, placebo-controlled, within subjects design. Fifty minutes after treatment, subjects completed a facial emotion matching task and three control tests. Oxytocin failed to improve facial affect processing, in contrast with previous results. Possible explanations are the fact that we used a facial emotion matching paradigm instead of emotion labeling tasks and a higher dose of oxytocin than the one used in most similar studies.

Depression increases in patients with Parkinson?s disease according to the increasing severity of the cognitive impairment.

OBJECTIVE: To test the hypothesis that severity of cognitive impairment modifies the association between depression and Parkinson's disease (PD). METHOD: One-phase population-based door-to-door surveys. This is a secondary analysis of 1,451 people aged 65 years and older with cognitive impairment living in defined catchment areas. Depression was estimated according to ICD-10, self-reported PD, disability according to WHODAS-II and cognitive status according to the CSI-D. RESULTS: The mean age of the sample was 79.3 years old and most (69%) were women. Of the total sample, 16.1% had depression and it was significantly higher among participants with PD. There was an increase on the ORs of the association between depression and PD with decreased scores in the cognitive test (Adjusted OR from 0.98 to 8.04). CONCLUSION: The association between depression and PD increases with the severity of the cognitive impairment.

Effects of cannabidiol in the treatment of patients with Parkinson's disease: an exploratory double-blind trial.

INTRODUCTION: Parkinson's disease (PD) has a progressive course and is characterized by the degeneration of dopaminergic neurons. Although no neuroprotective treatments for PD have been found to date, the endocannabinoid system has emerged as a promising target. METHODS: From a sample of 119 patients consecutively evaluated in a specialized movement disorders outpatient clinic, we selected 21 PD patients without dementia or comorbid psychiatric conditions. Participants were assigned to three groups of seven subjects each who were treated with placebo, cannabidiol (CBD) 75 mg/day or CBD 300 mg/day. One week before the trial and in the last week of treatment participants were assessed in respect to (i) motor and general symptoms score (UPDRS); (ii) well-being and quality of life (PDQ-39); and (iii) possible neuroprotective effects (BDNF and H(1)-MRS). RESULTS: We found no statistically significant differences in UPDRS scores, plasma BDNF levels or H(1)-MRS measures. However, the groups treated with placebo and CBD 300 mg/day had significantly different mean total scores in the PDQ-39 (p = 0.05). CONCLUSIONS: Our findings point to a possible effect of CBD in improving quality of life measures in PD patients with no psychiatric comorbidities; however, studies with larger samples and specific objectives are required before definitive conclusions can be drawn.

Effects of acute systemic administration of cannabidiol on sleep-wake cycle in rats.

UNLABELLED: Cannabidiol (CBD) is one of the main components of Cannabis sativa and has a wide spectrum of action, including effects in the sleep-wake cycle. OBJECTIVE: The objective of this paper is to assess the effects on sleep of acute systemic administration of CBD. METHOD: Adult male Wistar rats were randomly distributed into four groups that received intraperitoneal injections of CBD 2.5 mg/kg, CBD 10 mg/kg, CBD 40 mg/kg or vehicle (n=seven animals/group). Sleep recordings were made during light and dark periods for four days: two days of baseline recording, one day of drug administration (test), and one day after drug (post-test). RESULTS: During the light period of the test day, the total percentage of sleep significantly increased in the groups treated with 10 and 40 mg/kg of CBD compared to placebo. REM sleep latency increased in the group injected with CBD 40 mg/kg and was significantly decreased with the dose of 10 mg/kg on the post-test day. There was an increase in the time of SWS in the group treated with CBD 40 mg/kg, although this result did not reach statistical significance. CONCLUSION: The systemic acute administration of CBD appears to increase total sleep time, in addition to increasing sleep latency in the light period of the day of administration.