Effects of religion on the course of suicidality among geriatric patients with mood disorders.

BACKGROUND: A growing volume of research suggests that religion protects against late-life suicide, but it remains unclear whether effects are relevant to clinical samples, which facets of religion are most relevant, and variations over the course of mood disorders (e.g. during periods of euthymia, depression, and/or heightened suicidality). METHOD: Eighty adults aged 55-85 years with mood disorders completed assessments of religion (affiliation, service attendance, importance of religion, belief and faith in God), depression, and suicidality over time (M = 7.31 measurements over M = 727 days). We computed metrics to identify mean and maximum levels of depression and suicidality, and the number of episodes of significant depression and suicidality experienced by each participant. RESULTS: Religious affiliation and importance of religion, but not service attendance, belief, or faith in God, were associated with lower mean and maximum depression. Conversely, all facets of religion predicted significantly lower mean and maximum levels of suicidality (rs ranging from -0.24 to -0.39), and substantially less likelihood of experiencing significant suicidality during the study (ORs ranging from 0.19 to 0.33). Service attendance, belief, and faith in God predicted less suicidality even among individuals who did not affiliate with a religious group. CONCLUSIONS: Religious factors, particularly faith in God, are associated with substantially less suicidality over time among older adults with mood disorders, irrespective of religious affiliation.

Obesogenic Medications and Weight Gain Over 24 Weeks in Patients with Depression: Results from the GUIDED Study.

Weight gain is a common side-effect of medications used to treat major depressive disorder (MDD). We sought to estimate the frequency of weight gain for obesogenic medications prescribed for MDD and to evaluate if bupropion mitigated risk for weight gain. We analyzed a prospective cohort of patients with weight available at baseline and 12 weeks (n = 1,032) or 24 weeks (n = 871) in a post hoc analysis of the Genomics Used to Improve DEpression Decisions (GUIDED) study of patients with MDD who failed at least one medication trial. We compared weight gain between those on versus not on medications with high risk for weight gain, including a subgroup receiving combination treatment with bupropion. A second analysis evaluated weight gain across traditional medication classes, adjusting for potential confounding variables. Those on medications identified as high risk for weight gain were significantly more likely to experience clinically significant weight gain (≥3%) at 12 weeks (29.3% vs. 16.3%, p < .001) and 24 weeks (33.5% vs. 23.5%, p = .015). No protection from clinically significant weight gain was observed among patients treated with a high-risk medication concomitantly with bupropion (N = 31, 35% and 52% with clinically significant weight gain at 12 and 24 weeks). Antipsychotic medications and tricyclic antidepressants were most often associated with clinically significant weight gain. This study helps quantify the real-world risk of weight gain for patients with MDD on medications with high risk for weight gain, especially for patients taking antipsychotics. Concurrent treatment with bupropion does not appear to mitigate the weight gain risk.

Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment.

In this article, a clinical protocol for delivering a flexible, spiritually integrated cognitive-behavioral therapy, called spiritual psychotherapy for inpatient, residential, and intensive treatment (SPIRIT), is presented, and its implementation is described.

Effects of α-linolenic acid-enriched diets on gene expression of key inflammatory mediators in immune and milk cells obtained from Holstein dairy cows.

Immune system and inflammatory responses are affected by α-linolenic acid (αLA: 18:3 ω-3). The objective of this study was to determine the effects of αLA-enriched rations on gene expression of systemic (blood) and local (mammary gland) inflammatory markers in Holstein dairy cattle. Further, the effect of dietary treatments was evaluated on the concentration of αLA in serum phospholipids. Camelina (Camelina sativa) meal (containing 24.2% αLA) was fed at 0, 3, 6, and 9% (dry matter basis) replacing canola meal (rich in 18:1 ω-9) to provide rations with incremental concentrations of αLA. Lactating primiparous Holstein cows (n = 18) were randomly assigned to a treatment sequence in a 4 × 4 Latin square design. Each period lasted 16 d and milk and blood samples were collected during the final 2 d of each period. Peripheral blood mononuclear cells (PBMC) and milk cells (MC) were harvested, and RNA extracted and converted to complementary DNA for quantitative real time PCR analysis. The effect of dietary treatments (αLA) on the relative abundance of pro- and anti-inflammatory genes in the PBMC and MC was tested by the MIXED procedure of SAS. Expression of pro-inflammatory tumour necrosis factor (TNF)-α in MC was linearly reduced (up to 40%) as dietary αLA increased. Expression of pro-inflammatory markers interleukin (IL)-1ß, IL-8, and TNF-α was reduced (29, 20, and 27%, respectively) in PBMC isolated from cows fed 6% camelina meal ration as compared with cows fed 0% (control). Expression of IL-6 was, however, increased with inclusion of camelina meal. Greater dietary αLA linearly increased serum phospholipids αLA contents, and when fed up to 6% DM down-regulated expression of some of the local (milk) and systemic (blood) pro-inflammatory markers in vivo.

Brain levels of high-energy phosphate metabolites and executive function in geriatric depression.

OBJECTIVES: Depression in late life has been associated with difficulties in cognitive processing, particularly in the domains of executive function, processing speed and memory, and increases the risk of developing dementia suggesting a neurodegenerative phenotype. Mitochondrial dysfunction is frequently an early event in neurodegenerative illnesses and may be operative in patients with late life depression. Phosphorus magnetic resonance spectroscopy (31P MRS) allows for the quantification of bioenergetic molecules produced by mitochondria. METHODS: Ten patients with late life depression and eight normal elderly controls were studied with Stroop color and interference tests, which are widely used measures of processing speed and executive function, respectively, followed by (31P) MRS 3-dimensional chemical-shift imaging measuring levels of adenosine triphosphate, phosphocreatine, inorganic phosphate, and pH over the whole brain. RESULTS: In all subjects, gray matter phosphocreatine was positively associated with Stroop interference. Levels of white matter adenosine triphosphate were associated with Stroop interference in subjects with late life depression but not normal elderly. There was also a complementary association between white matter inorganic phosphate and Stroop interference in late life depression patients. CONCLUSIONS: These findings suggest two independent sources of executive function dependence on bioenergetic state in the aging brain. The dependence of executive function performance in subjects with late life depression on ATP in white matter may be associated with mitochondrial impairment and is consistent with predictions of the vascular depression hypothesis. Further research with wider neuropsychological testing targeting bioenergetic markers could help clarify the scope of these effects. Copyright © 2016 John Wiley & Sons, Ltd.

Interest in spiritually integrated psychotherapy among acute psychiatric patients.

OBJECTIVE: Spiritually integrated psychotherapy (SIP) is increasingly common, though systematic assessment of interest in such treatments, and predictors of such interest, has not yet been conducted among acute psychiatric patients. METHODS: We conducted a survey with 253 acute psychiatric patients (95-99% response rate) at a private psychiatric hospital in Eastern Massachusetts to assess for interest in SIP, religious affiliation, and general spiritual or religious involvement alongside clinical and demographic factors. RESULTS: More than half (58.2%) of patients reported "fairly" or greater interest in SIP, and 17.4% reported "very much" interest. Demographic and clinical factors were not significant predictors except that current depression predicted greater interest. Religious affiliation and general spiritual or religious involvement were associated with more interest; however, many affiliated patients reported low or no interest (42%), and conversely many unaffiliated patients reported "fairly" or greater interest (37%). CONCLUSIONS: Many acute psychiatric patients, particularly individuals with major depression, report interest in integrating spirituality into their mental health care. Assessment of interest in SIP should be considered in the context of clinical care.

Spiritual struggle and affective symptoms among geriatric mood disordered patients.

OBJECTIVES: We explored relationships between general religiousness, positive religious coping, negative religious coping (spiritual struggle), and affective symptoms among geriatric mood disordered outpatients, in the northeastern USA. METHODS: We assessed for general religiousness (religious affiliation, belief in God, and private and public religious activity) and positive/negative religious coping, alongside interview and self-report measures of affective functioning in a diagnostically heterogeneous sample of n = 34 geriatric mood disordered outpatients (n = 16 bipolar and n = 18 major depressive) at a psychiatric hospital in eastern Massachusetts. RESULTS: Except for a modest correlation between private prayer and lower Geriatric Depression Scale scores, general religious factors (belief in God, public religious activity, and religious affiliation) as well as positive religious coping were unrelated to affective symptoms after correcting for multiple comparisons and controlling for significant covariates. However, a large effect of spiritual struggle was observed on greater symptom levels (up to 19.4% shared variance). Further, mean levels of spiritual struggle and its observed effects on symptoms were equivalent irrespective of religious affiliation, belief, and private and public religious activity. CONCLUSIONS: Previously observed effects of general religiousness on (less) depression among geriatric mood disordered patients may be less pronounced in less religious areas of the USA. However, spiritual struggle appears to be a common and important risk factor for depressive symptoms, regardless of patients' general level of religiousness. Further research on spiritual struggle is warranted among geriatric mood disordered patients.

Coenzyme Q10 effects on creatine kinase activity and mood in geriatric bipolar depression.

INTRODUCTION: Despite the prevalence, associated comorbidities, and functional consequences of bipolar depression (BPD), underlying disease mechanisms remain unclear. Published studies of individuals with bipolar disorder implicate abnormalities in cellular energy metabolism. This study tests the hypotheses that the forward rate constant (k(for)) of creatine kinase (CK) is altered in older adults with BPD and that CoEnzyme Q10 (CoQ10), known to have properties that enhance mitochondrial function, increases k(for) in elderly individuals with BPD treated with CoQ10 compared with untreated age- and sex-matched controls. METHODS: Ten older adults (ages 55 and above) with Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition [DSM IV]) bipolar disorder, current episode depressed and 8 older controls underwent two 4 Tesla (31)Phosphorus magnetic resonance spectroscopy ((31)PMRS) scans 8 weeks apart using a magnetization transfer (MT) acquisition scheme to calculate k(for). The BPD group was treated with open-label CoEnzyme Q10 400 mg/d titrated up by 400 mg/d every 2 weeks to a maximum of 1200 mg/d. The Montgomery Asberg Depression Rating Scale (MADRS) was used to measure depression symptom severity. Baseline k(for) and changes in k(for) were compared between individuals with BPD and controls, not receiving CoQ. Clinical ratings were compared across time and associated with k(for) changes using repeated measures linear regression. RESULTS: The k(for) of CK was nonsignificantly lower for BPD than healthy controls at baseline (BPD mean (standard deviation [SD]) = 0.19 (0.02), control mean (SD) = 0.20 (0.02), Wilcoxon rank sum exact P = .40). The k(for) for both CoQ10-treated BPD and controls increased after 8 weeks (mean increase (SD) = 0.03 (0.04), Wilcoxon signed rank exact P = .01), with no significant difference in 8-week changes between groups (BPD mean change (SD) = 0.03 (0.03), control mean change (SD) = 0.03 (0.05), Wilcoxon rank sum exact P = .91). In an exploratory analysis, depression severity decreased with CoQ10 treatment in the group with BPD (F (3,7) = 4.87, P = .04) with significant reductions in the MADRS at weeks 2 (t (9) = -2.40, P = .04) and 4 (t (9) = -3.80, P = .004). CONCLUSIONS: This study employing the novel MRS technique of MT did not demonstrate significance between group differences in the k(for) of CK but did observe a trend that would require confirmation in a larger study. An exploratory analysis suggested a reduction in depression symptom severity during treatment with high-dose CoEnzyme Q10 for older adults with BPD. Further studies exploring alterations of high-energy phosphate metabolites in geriatric BPD and efficacy studies of CoQ10 in a randomized controlled trial are both warranted.

Characteristics of drug use on sheep farms in Ontario, Canada.

This study examined characteristics of the use of drugs, especially antimicrobials, on Ontario sheep farms. Forty-nine sheep farms participated in a 12-month prospective study. Producers documented treatment events during the study period and drug use data from the records were summarized. The most frequently used drugs of the 15 drug categories used by producers belonged to the following categories: antimicrobial (40.7%, n=2710), vitamin/mineral (12.0%), and biological (11.1%). Short-acting penicillin (27.2%, n=1103), long-acting oxytetracycline (22.9%), and long-acting penicillin (21.9%) were the most frequently used antimicrobials. The drugs that were used most frequently on sheep farms were antimicrobials, of which 93% of treatments were extra-label. Extensive extra-label drug use may be the result of the limited number of drugs that are approved in Canada for use in sheep.

Copper deficiency myeloneuropathy due to occult celiac disease.

INTRODUCTION: Copper deficiency is an increasingly recognized cause of gait unsteadiness. Recognized causes of copper deficiency include excess zinc ingestion, and malabsorption. Although hematologic abnormalities have been attributed to copper deficiency in patients with celiac disease, myeloneuropathy due to copper deficiency has not been well described in patients with celiac disease. CASE REPORT: A 69-year-old woman was evaluated for a 5-year history of progressive gait unsteadiness and weight loss. She had no other gastrointestinal symptoms. Her neurologic examination revealed a sensory ataxia, and electrodiagnostic testing confirmed a myeloneuropathy. She had decreased serum copper levels and markedly elevated gliadin and tissue transglutaminase antibodies. Subsequent duodenal biopsy showed findings consistent with celiac disease. The patient was diagnosed with copper deficiency myeloneuropathy due to celiac disease. Adoption of a gluten-free diet along with copper supplementation resulted in significant clinical improvement, including improvement on electrodiagnostic testing. CONCLUSIONS: Celiac disease should be considered in patients found to have copper deficiency, even in patients without gastrointestinal symptoms. Furthermore, the authors suggest that some cases of ataxia associated with celiac disease are likely due to copper deficiency myeloneuropathy.

Improving mental health assessment and service planning practices for older adults: a controlled comparison study.

This study evaluated the effectiveness of a guided assessment and service planning intervention in improving the clinical practices of non-physician community mental health providers caring for older persons. Thirteen agencies, 44 clinicians, and 100 consumers (age 60 and older) were assigned to the intervention or a comparison group receiving usual care. Baseline interviews of clinicians and chart reviews found that clinicians' routine evaluation and service planning practices showed inattention to key domains such as substance abuse (over 33% of clinicians), suicide risk and dangerous behaviors (over 40%), and caregiver burden and risk of neglect or abuse (over 75%). At 1-year follow-up, the intervention was associated with increased rates of routine assessments of major symptom, functioning, and support domains. There was also significant improvement in the specificity of treatment planning within the intervention condition. Implications for quality improvement are discussed.

Maggot therapy in "lower-extremity hospice" wound care: fewer amputations and more antibiotic-free days.

We sought to assess, in a case-control model, the potential efficacy of maggot debridement therapy in 60 nonambulatory patients (mean +/- SD age, 72.2 +/- 6.8 years) with neuroischemic diabetic foot wounds (University of Texas grade C or D wounds below the malleoli) and peripheral vascular disease. Twenty-seven of these patients (45%) healed during 6 months of review. There was no significant difference in the proportion of patients healing in the maggot debridement therapy versus control group (57% versus 33%). Of patients who healed, time to healing was significantly shorter in the maggot therapy than in the control group (18.5 +/- 4.8 versus 22.4 +/- 4.4 weeks). Approximately one in five patients (22%) underwent a high-level (above-the-foot) amputation. Patients in the control group were three times as likely to undergo amputation (33% versus 10%). Although there was no significant difference in infection prevalence in patients undergoing maggot therapy versus controls (80% versus 60%), there were significantly more antibiotic-free days during follow-up in patients who received maggot therapy (126.8 +/- 30.3 versus 81.9 +/- 42.1 days). Maggot debridement therapy reduces short-term morbidity in nonambulatory patients with diabetic foot wounds.

Maggot debridement therapy: a primer.

Treatment of chronic wounds of the lower extremity requires a systematic, multidisciplinary approach as well as flexibility in order to achieve acceptable, consistent short-term and long-term results. Maggots, once considered an obsolete therapeutic modality, can be a useful addition to the armamentarium of the foot and ankle specialist. This article describes the use of maggot debridement therapy for intractable wounds of the lower extremity.

Characterization of the late steps of microbial heme synthesis: conversion of coproporphyrinogen to protoporphyrin.

Cell-free extracts of various cytochrome-containing, heterotrophic microorganisms were examined for ability to convert coproporphyrinogen to protoporphyrin. Extracts of Escherichia coli and Pseudomonas denitrificans readily accumulated large amounts of protoporphyrin when assayed under aerobic conditions. However, protoporphyrin did not accumulate under either aerobic or anaerobic conditions of assay or in the presence of various supplements in extracts of the aerobe Micrococcus lysodeikticus, the facultative anaerobe Staphylococcus aureus, or the anaerobe Vibrio succinogenes. Protoporphyrin also accumulated when extracts of E. coli and P. denitrificans were incubated aerobically with the early heme precursor, delta-amino levulinic acid (ALA). This protoporphyrin accumulation was markedly stimulated by the iron chelator, o-phenanthroline. Extracts of S. aureus and M. lysodeikticus accumulated coproporphyrin, but not protoporphyrin when incubated with ALA. The enzyme system in extracts of E. coli which converts coproporphyrinogen to protoporphyrin under aerobic conditions of assay was also partially characterized. This conversion was stimulated by the iron chelator, o-phenanthroline, the respiratory inhibitor, cyanide, and the reducing agent, thioglycolate. Dialysis of the extract did not diminish enzyme activity. Certain alternate electron acceptors and nitrite caused a marked inhibition of the conversion. These results indicate that this late step in heme synthesis, the conversion of coproporphyrinogen to protoporphyrin, can be readily demonstrated in extracts of some, but not all, cytochrome-containing bacteria and that the aerobic conversion in E. coli exhibits many characteristics similar to those demonstrated for the aerobic conversion previously studied in liver mitochondria.