High-definition transcranial direct current stimulation (HD-tDCS) as augmentation therapy in late-life depression (LLD) with suboptimal response to treatment-a study protocol for a double-blinded randomized sham-controlled trial.

BACKGROUND: Late-life depression (LLD) has a poorer prognosis and higher relapse rate than younger adults, with up to one third of patients with LLD showing suboptimal response to antidepressant therapy. LLD has been associated with significant impairment in cognition and daily functioning. Few studies have evaluated the therapeutic effects of high-definition transcranial direct current stimulation (HD-tDCS) on depressive and cognitive symptoms of LLD. The current randomized controlled trial assesses the efficacy of HD-tDCS as an augmentation therapy with antidepressants compared to sham-control in subjects with LLD. METHODS: Fifty-eight patients with LLD will be recruited and randomly assigned to the active HD-tDCS or sham HD-tDCS group. In both groups, patients will receive the active or sham intervention in addition to their pre-existing antidepressant therapy, for 2 weeks with 5 sessions per week, each lasting 30 min. The primary outcome measures will be the change of depressive symptoms, clinical response and the remission rate as measured with the Hamilton Depression Rating scale (HAMD-17) before and after the intervention, and at the 4th and 12th week after the completed intervention. Secondary outcome measures include cognitive symptoms, anxiety symptoms, daily functioning and adverse effects.  DISCUSSION: Older adults with depression are associated with poorer outcomes or unsatisfactory responses to antidepressant therapy, and significant cognitive decline. Therefore, a new effective treatment option is needed. This randomized control trial aims at assessing the efficacy of HD-tDCS on ameliorating the depressive, cognitive and anxiety symptoms, and improving the daily functioning of subjects with LLD. TRIAL REGISTRATION: ClinicalTrials.gov NCT05322863. Registered on 11 April 2022.

Lifetime Prevalence and Correlates of Schizophrenia-Spectrum, Affective, and Other Non-affective Psychotic Disorders in the Chinese Adult Population.

Lifetime prevalence of psychotic disorders varies widely across studies. Epidemiological surveys have rarely examined prevalences of specific psychotic disorders other than schizophrenia, and the majority used a single-phase design without employing clinical reappraisal interview for diagnostic verification. The current study investigated lifetime prevalence, correlates and service utilization of schizophrenia-spectrum, affective, and other non-affective psychotic disorders in a representative sample of community-dwelling Chinese adult population aged 16-75 years (N = 5719) based on a territory-wide, population-based household survey for mental disorders in Hong Kong. The survey adopted a 2-phase design comprising first-phase psychosis screening and second-phase diagnostic verification incorporating clinical information from psychiatrist-administered semi-structured interview and medical record review to ascertain DSM-IV lifetime diagnosis for psychotic disorders. Data on sociodemographics, psychosocial characteristics and service utilization were collected. Our results showed that lifetime prevalence was 2.47% for psychotic disorder overall, 1.25% for schizophrenia, 0.15% for delusional disorder, 0.38% for psychotic disorder not otherwise specified, 0.31% for bipolar disorder with psychosis, and 0.33% for depressive disorder with psychosis. Schizophrenia-spectrum disorder was associated with family history of psychosis, cigarette smoking and variables indicating socioeconomic disadvantage. Victimization experiences were significantly related to affective psychoses and other non-affective psychoses. Around 80% of participants with any psychotic disorder sought some kind of professional help for mental health problems in the past year. Using comprehensive diagnostic assessment involving interview and record data, our results indicate that approximately 2.5% of Chinese adult population had lifetime psychotic disorder which represents a major public health concern.

Acute angle closure glaucoma after sertraline.

Glaucoma is a rare complication of selective serotonin reuptake inhibitor treatment. We report a case of acute angle closure glaucoma related to sertraline.

Dementia with lewy bodies in meige syndrome.

Meige syndrome is a rare form of segmental dystonia characterized by blepharospasm and oromandibular dystonia. A few case reports of Meige syndrome have been associated with Lewy body pathologies, and the syndrome was also proposed for inclusion in the spectrum of Lewy body disease. We report a case of an elderly gentleman with a history of Meige syndrome for more than 10 years who developed dementia with Lewy bodies. Updated clinical and pathological evidence of linkages between these two conditions is also presented.

Depression in patients receiving peritoneal dialysis.

OBJECTIVES: To identify the prevalence and correlates of depression among Chinese peritoneal dialysis patients. METHODS: In this cross-sectional study, from October 2007 to June 2008, 141 peritoneal dialysis patients were recruited from a local renal clinic. All participants were interviewed by the first author using the Chinese bilingual version of the Structured Clinical Interview for DSM-IV (Axis I) to identify patients suffering from major depressive disorders and psychiatric illnesses associated with elevated depressive symptoms. Socio-demographic and clinical data were collected. Co-morbid medical illnesses and perceived social support were assessed by standardised questionnaires, namely: the Cumulative Illness Rating Scale, and the Chinese version of Multidimensional Scale of Perceived Social Support (MSPSSC). RESULTS: The point prevalence of a current major depressive episode was 16%; another 21% had had at least 1 past episode of major depression. Low MSPSS-C score, muscle cramps, chronic back pain, joint stiffness, and receipt of Social Security Allowance were independent correlates of elevated depressive symptoms. CONCLUSIONS: The prevalence of depression was higher in Chinese patients receiving peritoneal dialysis. Independent correlates are useful to help physicians identify patients suffering from depressive disorders in busy renal clinics.

The geriatric depression scale as a screening tool for depression and suicide ideation: a replication and extention.

OBJECTIVES: To examine a) whether the Geriatric Depression Scale (GDS) can predict clinician-rated suicide ideation and depression, using the 15-, 5-, and 4-item versions, b) whether an additional suicide-ideation item would improve the performance, and c) whether the results vary by age groups. METHODS: First-time psychiatric outpatients responded to the GDS. They were subsequently assessed by psychiatrists blind to the GDS, who also indicated whether suicide ideation was present. The performance of the GDS scales was evaluated using receiver operating characteristic curves. Analyses were conducted separately for young-old (aged 60-74 years) and old-old (aged 75 years or older) adults. RESULTS: Areas under the curves showed that the different GDS versions were comparable in detecting depression and suicide ideation. For identifying depression, thresholds of 7, 2, and 2 for the 15-, 5-, and 4-item versions were optimal, respectively. In terms of detecting suicide ideation, all measures performed better in old-old than in young-old adults. A single, self-report suicide-ideation item performed better than all multiitem GDS measures. CONCLUSIONS: Both the 4- and the 5-item versions are excellent alternatives to the 15-item version, and all are reasonable tools for detecting the presence of suicide ideation also. However, to improve the effectiveness of screening, brief measures of suicide risk should also be included. Even a 1-item measure of suicide ideation can improve clinical decisions tremendously.