Early growth response 1 (EGR1) is downregulated in peripheral blood from patients with major psychiatric disorders.

OBJECTIVES: To evaluate relative expression of genes with the potential to translate environmental stimuli into long-term alterations in the brain - namely Early Growth Response (EGR)1, EGR3, and Cryptochrome Circadian Regulator 2 (CRY2) - in peripheral blood from patients with Bipolar Disorder (BD), Schizophrenia (SZ), Major Depressive Disorder (MDD) and healthy controls (HC). METHODS: Thirty individuals ranging from 18 to 60 years were recruited for each group (BD, SZ, MDD or HC) from a Brazilian public hospital. Therefore, individuals' peripheral blood was collected and EGR1, EGR3 and CRY2 gene expression analyzed by PCR Real Time. RESULTS: EGR1 mRNA levels are significantly lower in psychiatric patients when compared to HC, but there is no difference for EGR3 and CRY2. Exploring the findings for each diagnosis, there is a significant difference between each diagnosis group only for EGR1, which was lower in BD, MDD and SZ as compared to HC. No significant correlations were found between gene expression and clinical features. CONCLUSIONS: EGR1 is downregulated in psychiatric patients, regardless of the diagnosis and may be a potential common target in major psychiatric disorders. EGR1, as a transcription factor, modulates many other genes and participates in crucial neuronal and synaptic processes, such as plasticity, neurotransmitters metabolism, vesicular transport and signaling pathways. The study of EGR1 and its upstream regulators in psychiatry might lead to potential new therapeutic targets.

Earlier age of onset is associated with a pro-inflammatory state in major depressive disorder.

Major depressive disorder (MDD) is a common condition that affects the general population over a wide range of ages, regardless of gender and social background. Early-onset of MDD in adulthood, between ages of 18 and 30 years, is associated with worse outcomes and increased years of disability. Stress load and physical health have been associated with age of onset in MDD. We aim to investigate whether early onset MDD might be associated with changes in systemic inflammatory markers. We examined levels of following cytokines: IL-1ß, IL-6, IL-10 and TNFα in 234 patients with MDD. Higher serum levels of TNFα and IL-1ß are associated with the early onset of the disorder in patients with MDD. IL-6 levels were also higher in the early onset group and IL-10 levels were higher in the late onset group, but with no significant difference. Changes in the anti-inflammatory/pro-inflammatory balance have been described in mood disorders and may be implicated in its severity and pattern of progression. Our findings reinforce that higher serum levels of IL-1ß and TNFα may be associated with the earlier onset subgroup of MDD patients. Future research that target inflammatory markers of immune modulation may be, key in the search for novel preventative therapeutics.

Implementation of Group Interpersonal Psychotherapy in primary care.

OBJECTIVE: To show the implementation process of IPT-G in primary care, including facilitating and obstructing factors, implementation strategies, and training and supervision of primary care professionals. METHODS: Quantitative (cross-sectional and longitudinal) analysis of pre and post-knowledge tests; qualitative analyses of the training courses; patient recruitment; conduction of IPT-G sessions; supervision of IPT-G therapists; application of a semi-structured questionnaire to assess, investigate, and develop strategies against the identified barriers. RESULTS: About 120 clinicians answered the pre-test; 84 completed the post-test. Pre- and post-test scores of IPT-G knowledge were significantly different. Twenty initially trained clinicians completed additional supervision in IPT-G. Qualitative analysis identified twelve barriers and six facilitators to IPT-G implementation in individual, organizational, and systemic contexts. CONCLUSIONS: Implementation of IPT-G in primary care is a complex process with several steps. In the first step, health professionals were successfully trained in IPT-G. However, subsequent steps were more complex. Therefore, careful planning of IPT-G implementation is essential to maximize the success of this innovation.

Quality of life of family primary caregivers of individuals with bipolar disorder and schizophrenia in south of Brazil.

BACKGROUND: The process of deinstitutionalization of individuals with mental disorders (MD) brought greater family responsibility in terms of patient care. AIMS: Evaluate the Quality of Life (QoL) and its associated factors of primary caregivers of bipolar and schizophrenic subjects. METHODS: A cross-sectional survey was conducted from 2012 to 2015 with 125 caregivers at an outpatient service of a teaching hospital in the South of Brazil. QoL instruments (WHOQOL-Bref, SF-36), questionnaires regarding socio-demographic, clinical data and depressive symptoms (BDI) were applied. RESULTS: Caregivers of schizophrenic individuals presented lower QoL scores than caregivers of bipolar individuals, with moderate effect in physical, and social domains of WHOQOL-Bref, and in physical functioning, role-physical, and role-emotional domains of SF-36. QoL scores of caregivers were lower when compared with the normative data of the Brazilian population. The factors associated with lower QoL scores were: patient diagnosis of schizophrenia, female gender, presence of clinical disease and presence of depressive symptoms in the caregiver. CONCLUSIONS: Caregivers of patients with schizophrenia or bipolar disorder present a significant impairment in their QoL when compared with the general population, highlighting the relevance of developing support programs in the mental health services that include these caregivers.

Latent structure and factor reliability of the National Health Service Community Mental Health Service User Questionnaire.

BACKGROUND: National Health Service use the Community Mental Health Service User Questionnaire (NHS-CMH) to assess care quality. However, its reliability and internal validity is uncertain. AIMS: To test the NHS-CMH structure, reliability and item-level characteristics. METHODS: We used data from 11,373 participants who answered the 2017 NHS-CMH survey. First, we estimated the NHS-CMH structure using Exploratory Factor Analysis (EFA) in half of the dataset. Second, we tested the best EFA-derived model with Confirmatory Factor Analysis (CFA). We tested the internal validity, construct reliability (omega - ω), explained common variance of each factor (ECV), and item thresholds. RESULTS: EFA suggested a 4-factor solution. The structure derived from the EFA was confirmed, demonstrating good reliability for the four correlated dimensions: "Relationship with Staff" (ω = 0.952, ECV = 40.1%), "Organizing Care" (ω = 0.855, ECV = 21.4%), "Medication and Treatments" (ω = 0.837, ECV = 13.3%), and "Support and Well-being" (ω = 0.928, ECV = 25.3%). A second-order model with a high-order domain of "Quality of Care" is also supported. CONCLUSIONS: The NHS-CMH can be used to reliably assess four user-informed dimensions of mental health care quality. This model offers an alternative for its current use (item-level and untested sum scores analysis).

Implementation of Group Interpersonal Psychotherapy in primary care

ABSTRACT OBJECTIVE To show the implementation process of IPT-G in primary care, including facilitating and obstructing factors, implementation strategies, and training and supervision of primary care professionals. METHODS Quantitative (cross-sectional and longitudinal) analysis of pre and post-knowledge tests; qualitative analyses of the training courses; patient recruitment; conduction of IPT-G sessions; supervision of IPT-G therapists; application of a semi-structured questionnaire to assess, investigate, and develop strategies against the identified barriers. RESULTS About 120 clinicians answered the pre-test; 84 completed the post-test. Pre- and post-test scores of IPT-G knowledge were significantly different. Twenty initially trained clinicians completed additional supervision in IPT-G. Qualitative analysis identified twelve barriers and six facilitators to IPT-G implementation in individual, organizational, and systemic contexts. CONCLUSIONS Implementation of IPT-G in primary care is a complex process with several steps. In the first step, health professionals were successfully trained in IPT-G. However, subsequent steps were more complex. Therefore, careful planning of IPT-G implementation is essential to maximize the success of this innovation.

Factors associated with adherence to sports and exercise among outpatients with major depressive disorder.

INTRODUCTION: Individuals with major depressive disorder (MDD) face more barriers to engagement in sports and exercise interventions. Evaluating clinical and demographic factors associated with adherence to sports and exercise among MDD outpatients could support development of new options and strategies to increase their participation. METHODS: In a cross-sectional study, 268 depressed outpatients were evaluated (83.51% females; mean age = 50.74 [standard deviation {SD} = 10.39]). Sports and exercise participation were assessed using a question about participation frequency during the previous month. Clinical and demographic factors were evaluated. Linear regression was used to identify predictors of participation in sports and exercise. RESULTS: MDD patients with mild symptoms of depression (odds ratio [OR] = 2.42; 95% confidence interval [95%CI] 1.00, 5.88; p = 0.04) and patients with mild to moderate symptoms (OR = 3.96; 95%CI 1.41, 11.15; p = 0.009) were more likely to engage regularly in sports and exercise than patients with more severe depression. Moreover, smoking (OR = 0.23; 95%CI 0.67, 0.80; p = 0.007) and being divorced (OR = 0.22; 95%CI 0.57, 0.86; p = 0.03) were associated with lower rates of engagement in sports and exercise. CONCLUSION: Our findings indicate a significant association between clinical and demographic factors and participation in sports and exercise among MDD outpatients.

Psychotropic medication use among women seeking assisted reproductive technology (ART) therapy: A cross-sectional study.

Background Infertility is associated with increased anxiety, depressive symptoms and mood disorders. Unfortunately, mental health is not often addressed in infertility treatment and infertile patients could be at higher risk of self-administration of not prescribed drugs or/and be exposed to alternative emotional treatments. Therefore, the aim of the present study is to investigate the use of psychotropic medication and to evaluate the frequency of psychiatric diagnosis among infertile women seeking assisted reproductive technology (ART) therapy. Methods All infertile women starting treatment at an ART clinic who agreed to participate in the study were included. Patients were submitted to a structured psychiatric interview, the Mini International Neuropsychiatric Interview (M.I.N.I.). Current and lifetime use of psychotropic medication were assessed. Results Ninety patients who agreed to participate completed the research protocol.  A total of 12/90  were on current use of psychotropic medication.Thirty-six out of ninety patients  had at least one psychiatric disorder. Mood disorders were detected in 19 of the 90. Anxiety disorders were highly frequent, reaching 27/90 of the patients, as agoraphobia the most common diagnosis (12/90). Limitations The study has several limitations, such as the absence of a control group of fertile patients and strict inclusion criteria, in which only subjects that spontaneously agreed to participate were enrolled. Conclusion Women suffering from infertility seeking ART treatment are at high risk for depression and anxiety disorders and a considerable number of them are in use of medication. Its implications on infertility treatments and offspring are uncertain.

Factors associated with adherence to sports and exercise among outpatients with major depressive disorder

Abstract Introduction Individuals with major depressive disorder (MDD) face more barriers to engagement in sports and exercise interventions. Evaluating clinical and demographic factors associated with adherence to sports and exercise among MDD outpatients could support development of new options and strategies to increase their participation. Methods In a cross-sectional study, 268 depressed outpatients were evaluated (83.51% females; mean age = 50.74 [standard deviation {SD} = 10.39]). Sports and exercise participation were assessed using a question about participation frequency during the previous month. Clinical and demographic factors were evaluated. Linear regression was used to identify predictors of participation in sports and exercise. Results MDD patients with mild symptoms of depression (odds ratio [OR] = 2.42; 95% confidence interval [95%CI] 1.00, 5.88; p = 0.04) and patients with mild to moderate symptoms (OR = 3.96; 95%CI 1.41, 11.15; p = 0.009) were more likely to engage regularly in sports and exercise than patients with more severe depression. Moreover, smoking (OR = 0.23; 95%CI 0.67, 0.80; p = 0.007) and being divorced (OR = 0.22; 95%CI 0.57, 0.86; p = 0.03) were associated with lower rates of engagement in sports and exercise. Conclusion Our findings indicate a significant association between clinical and demographic factors and participation in sports and exercise among MDD outpatients.

Potential predictors of depressive symptoms during the initial stage of the COVID-19 outbreak among Brazilian adults.

BACKGROUND: In early 2020, Sars-Cov-2 was identified in China as a new coronavirus. Due to its transmission, Sars-Cov-2 has spread rapidly across the world. In the early stage of the disease outbreak, psychiatric symptoms have been reported, including depressive symptoms. In this study, we assessed the prevalence of depressive symptoms in quarantine and its association with sociodemographic variables and known protective factors for depression, such as spirituality, social support, resilience, and quality of life. METHODS: A cross-sectional web-based questionnaire was distributed via social media. The instruments consisted of the 8-item EUROHIS-QOL, PHQ-9, Social Support Questionnaire, WHOQoL-SRPB, and CD-RISC. RESULTS: A total of 3,274 participants were included in this study. 23.67% of the participants met the criteria for a depressive episode. Higher age, spirituality, social support, resiliency, and quality of life were associated with less depressive symptoms. Quarantine length; mental health treatment; chronic disease; age; sex; lower levels of spirituality, social support, resilience, quality of life, physical exercise, and education; and unpaid occupation were found to be predictors of depressive symptoms during COVID-19 quarantine. LIMITATIONS: The data are limited to the pandemic initial period, the sample isn't random and the use of self-reported questionnaires are some limitations of our study. CONCLUSIONS: During the initial phase of the COVID-19 outbreak in Brazil, quarantine time, treatment for mental health, chronic illness, lower levels of education, and unpaid occupation were positively associated with depressive symptoms. Age, sex, spirituality, social support, resilience, quality of life, and physical exercise showed a negative relationship with depressive symptoms.

Perceived barriers, benefits and correlates of physical activity in outpatients with Major Depressive Disorder: A study from Brazil.

OBJECTIVES: To evaluate the barriers, benefits and correlates of physical activity (PA) in outpatients with Major Depressive Disorder (MDD). METHODS: Data were collected from outpatients under treatment for MDD at Hospital de Clínicas de Porto Alegre. Barriers and benefits were assessed with the Exercise Barriers/Benefits Scale (EBBS). Objective and self-reported PA were assessed with pedometers and the International Physical Activity Questionnaire (IPAQ), respectively. RESULTS: The sample consisted of 65 outpatients (82% female; mean age = 50.9 years; SD = 10.1). Improvement in physical performance was the most reported benefit (mean = 3.00; SD = 0.3) while the most reported barrier was physical exertion (mean = 2.95; SD = 0.4). Depression symptom severity was negatively correlated with life enhancement (r = -0.337; p = 0.009), physical performance (r=-0.348; p = 0.007), psychological outlook (r=-0.364; p = 0.005), social interaction (r=-0.317; p = 0.015) and preventive health (r=-0.352; p = 0.007). CONCLUSION: Physical exertion is the most perceived barrier for PA in people with MDD. Symptom severity is associated with higher barrier levels, whilst higher current PA levels are associated with more benefits and lesser barriers. Interventions targeting PA promotion should consider the identified benefits and barriers when developing PA programs for people with MDD in outpatient settings.

Assessment of the psychometric properties of the 17- and 6-item Hamilton Depression Rating Scales in major depressive disorder, bipolar depression and bipolar depression with mixed features.

Assessing therapeutic response in depression requires scales that adequately measure the core symptoms of depressive symptomatology. The main goal of this study was to assess the psychometric properties of the 17-item Hamilton Depression Rating Scale (HAM-D17) and the 6-item Hamilton Depression Rating Scale (HAM-D6) in patients with Major Depressive Disorder (MDD), bipolar depression and bipolar depression with mixed features. We conducted a reanalysis of a pragmatic clinical trial in an outpatient clinic for mood disorders that included eight weeks of follow-up. A Mokken analysis was performed to evaluate the unidimensionality of the HAM-D17 and HAM-D6, and the Spearman correlation was used to assess concurrent validity between the HAM-D17, the HAM-D6 and quality of life scale (SF-36 and WHOQOL-BREF) scores. A total of 237 patients with a mean age of 40.2 years (±11.7) were included. According to the DSM-IV criteria, 58 (24.5%) were diagnosed with MDD and 73 (30.8%) were diagnosed with bipolar depression. Bipolar depression with mixed features was diagnosed in 106 (44.7%) patients according to the DSM-IV and supplemented by the Cincinnati criteria. Only the HAM-D6 scale proved to be unidimensional, showing strong homogeneity for evaluating MDD, moderate homogeneity for bipolar depression and weak homogeneity for bipolar depression with mixed features. Both the HAM-D17 and the HAM-D6 had inverse, significant correlations at baseline with SF-36 and WHOQOL-BREF scores. This is the first study to include bipolar depression patients with mixed features in an assessment of HAM-D6 unidimensionality.

Readmission in psychiatry inpatients within a year of discharge: The role of symptoms at discharge and post-discharge care in a Brazilian sample.

INTRODUCTION: Readmission into inpatient psychiatric beds is a useful outcome for patients, care providers, and policymakers. This study aims to investigate the role of level of symptoms at discharge and type of post-discharge care in determining readmissions after a year before a psychiatric admission. METHODS: We performed a prospective and observational study in a general hospital psychiatric facility. Patients were assessed at admission, discharge, and one year after discharge. We used a multivariable logistic regression to determine predictors of readmission. RESULTS: In total, 488 patients were included at admission, and 401 (82,17%) were accessed in the follow-up period. Psychiatric readmissions occurred in 29.17% of the followed patients. The number of previous admissions represents a 38% higher chance of being readmitted (OR 1.38; CI 1.16-1.60). For patients admitted in a depressive episode, not being in remission at discharge increases 140% the chance to be readmitted (OR 2.40; CI 1.14-5.07) as well as the follow-up at primary (OR 5.27; CI 1.06-26.15). For those with Schizophrenia and related disorders, higher scores in BPRS at discharge increases the chance to be readmitted (OR 1.28, CI 1.11-1.48). CONCLUSION: Level of symptoms at discharge was related to higher chance to be readmitted in patients admitted in a depressive episode and those with schizophrenia and related disorders. Findings of the type of care raise the need for further investigation. Also, this finding confirms the importance of the history of previous admissions in predicting future admissions.

Premenstrual syndrome diagnosis: A comparative study between the daily record of severity of problems (DRSP) and the premenstrual symptoms screening tool (PSST) / Diagnóstico de síndrome pré-menstrual: um estudo comparativo entre o relato diário da gravidade dos problemas (DRSP) e o instrumento de rastreamento de sintomas pré-menstruais (PSST)

Abstract Objective To validate the premenstrual symptoms screening tool (PSST) in relation to the daily record of severity of problems (DRSP) for premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) diagnoses. Methods A cross-sectional study with 127 women (20 45 years) with PMS complaints. The women were evaluated in terms of weight, height and body mass index (BMI). After using the primary care evaluation of mental disorders (PRIME-MD) questionnaire to exclude the diagnosis of depression, the PSST was completed and the women were instructed to fill out the DRSP for two consecutive menstrual cycles. The agreement between the two questionnaires was assessed by the Kappa (k) and the prevalence-adjusted, bias-adjusted kappa (PABAK) values. Results Two-hundred and eighty-two women met the eligibility criteria and answered the PSST. The DRSP was completed for two cycles by 127 women. The percentages of women with PMS and PMDD diagnoses by the DRSP were 74.8% and 3.9% respectively; by PSST, the percentages were41.7% and 34.6% respectively. The number of patients considered "normal" (with symptoms below the threshold for the diagnosis of PMS) was similar in both questionnaires. There was no agreement (Kappa = 0.12) in the results of PMS/ PMDD diagnosis (the PABAK coefficient confirmed this result = 0.39). The PSST had a high sensitivity (79%) and a low specificity (33.3%) for PMS/PMDD diagnosis. Conclusion The PSST should be considered a diagnostic screening tool. Positive PMS/PMDD cases by PSST should be further evaluated by DRSP to confirm the diagnosis.

Resumo Objetivo Validar o instrumento de rastreamento de sintomas pré-menstruais (PSST) em relação ao relato diário da gravidade dos problemas (DRSP) para o diagnóstico de síndrome pré-menstrual (SPM) e de transtorno disfórico pré-menstrual (TDPM). Métodos Um estudo transversal com 127 mulheres entre 20 e 45 anos com queixas de SPM. As mulheres foram avaliadas quanto ao peso, à altura e ao índice de massa corporal (IMC). Depois de excluir o diagnóstico de depressão pelo questionário de avaliação de distúrbios mentais para atenção primária (PRIME-MD), o PSST foi respondido e as mulheres receberam orientações sobre como preencher o DRSP por dois meses. A concordância entre os dois questionários foi conduzida através do índice de Kapa (k) e pelo PABAK. Resultados Duzentos e oitenta e duas mulheres com critérios elegíveis responderam ao PSST. O DRSP foi preenchido por dois ciclos por 127 mulheres. As porcentagens de mulheres com diagnósticos de SPM e de TDPM pelo DRSP foram de 74,8% e 3,9%, respectivamente; pelo PSST, as porcentagens foram de 41,7% e 34,6%, respectivamente. O número de pacientes consideradas "normais" (com sintomas abaixo do necessário para o diagnóstico de SPM) foi similar nos dois questionários. Análises demonstraram não haver concordância entre ambos os instrumentos para os resultados diagnósticos de SPM e TDPM (Kappa = 0,12, coeficiente de PABAK = 0,39). Para o diagnóstico de SPM/TDPM, o PSST apresentou uma alta sensibilidade (79%) e baixa especificidade (33,3%). Conclusão O PSST é considerado uma ferramenta de triagem. Conclui-se que casos positivos de SPM/TDPM pelo PSST devem ser melhor investigados pelo DRSP para confirmar o diagnóstico.

Premenstrual Syndrome Diagnosis: A Comparative Study between the Daily Record of Severity of Problems (DRSP) and the Premenstrual Symptoms Screening Tool (PSST).

OBJECTIVE: To validate the premenstrual symptoms screening tool (PSST) in relation to the daily record of severity of problems (DRSP) for premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) diagnoses. METHODS: A cross-sectional study with 127 women (20-45 years) with PMS complaints. The women were evaluated in terms of weight, height and body mass index (BMI). After using the primary care evaluation of mental disorders (PRIME-MD) questionnaire to exclude the diagnosis of depression, the PSST was completed and the women were instructed to fill out the DRSP for two consecutive menstrual cycles. The agreement between the two questionnaires was assessed by the Kappa (k) and the prevalence-adjusted, bias-adjusted kappa (PABAK) values. RESULTS: Two-hundred and eighty-two women met the eligibility criteria and answered the PSST. The DRSP was completed for two cycles by 127 women. The percentages of women with PMS and PMDD diagnoses by the DRSP were 74.8% and 3.9% respectively; by PSST, the percentages were41.7% and 34.6% respectively. The number of patients considered "normal" (with symptoms below the threshold for the diagnosis of PMS) was similar in both questionnaires. There was no agreement (Kappa = 0.12) in the results of PMS/ PMDD diagnosis (the PABAK coefficient confirmed this result = 0.39). The PSST had a high sensitivity (79%) and a low specificity (33.3%) for PMS/PMDD diagnosis. CONCLUSION: The PSST should be considered a diagnostic screening tool. Positive PMS/PMDD cases by PSST should be further evaluated by DRSP to confirm the diagnosis.

OBJETIVO: Validar o instrumento de rastreamento de sintomas pré-menstruais (PSST) em relação ao relato diário da gravidade dos problemas (DRSP) para o diagnóstico de síndrome pré-menstrual (SPM) e de transtorno disfórico pré-menstrual (TDPM). MéTODOS: Um estudo transversal com 127 mulheres entre 20 e 45 anos com queixas de SPM. As mulheres foram avaliadas quanto ao peso, à altura e ao índice de massa corporal (IMC). Depois de excluir o diagnóstico de depressão pelo questionário de avaliação de distúrbios mentais para atenção primária (PRIME-MD), o PSST foi respondido e as mulheres receberam orientações sobre como preencher o DRSP por dois meses. A concordância entre os dois questionários foi conduzida através do índice de Kapa (k) e pelo PABAK. RESULTADOS: Duzentos e oitenta e duas mulheres com critérios elegíveis responderam ao PSST. O DRSP foi preenchido por dois ciclos por 127 mulheres. As porcentagens de mulheres com diagnósticos de SPM e de TDPM pelo DRSP foram de 74,8% e 3,9%, respectivamente; pelo PSST, as porcentagens foram de 41,7% e 34,6%, respectivamente. O número de pacientes consideradas "normais" (com sintomas abaixo do necessário para o diagnóstico de SPM) foi similar nos dois questionários. Análises demonstraram não haver concordância entre ambos os instrumentos para os resultados diagnósticos de SPM e TDPM (Kappa = 0,12, coeficiente de PABAK = 0,39). Para o diagnóstico de SPM/TDPM, o PSST apresentou uma alta sensibilidade (79%) e baixa especificidade (33,3%). CONCLUSãO: O PSST é considerado uma ferramenta de triagem. Conclui-se que casos positivos de SPM/TDPM pelo PSST devem ser melhor investigados pelo DRSP para confirmar o diagnóstico.

The association of electroconvulsive therapy to pharmacological treatment and its influence on cytokines.

INTRODUCTION: A growing body of evidence shows that disturbances in the immune system are involved in the pathogenesis of depression. Although the immune-modulating effects of antidepressants have been described, few studies have addressed the functioning of the immune system in relation to electroconvulsive therapy (ECT). This study aims to investigate if the addition of ECT to pharmacotherapy is associated with changes in cytokine levels. METHODS: Adult inpatients were invited to participate in this study on admission to a psychiatric unit. Those with a diagnosis of depression by Mini-International Neuropsychiatric Interview were included. At treatment discharge, patients were retrospectively divided into those who used combined ECT and pharmacotherapy (31 subjects) and those who used only pharmacotherapy (68 subjects). Pro-inflammatory cytokines IL-2, IL-6, TNF-α, IFN-γ, and IL-17, and anti-inflammatory IL-4 and Il-10, were measured in blood samples collected at admission and discharge. A generalized estimating equation model and the post hoc Bonferroni test were performed for statistical analysis. RESULTS: The combination of ECT with pharmacotherapy was associated with a decrease of IL-6 and an increase of TNF-α. Depressive inpatients, as a whole group, had a decrease of IL-6 and an increase of IFN-γ. No significant results were found for IL-2, IL-4, Il-10 and IL-17. CONCLUSION: This study is clinically relevant because we highlight that, in agreement with the previous literature, IL-6 appears to be a useful marker in depression, and we show for the first time that its reduction is closely related to the use of ECT.

Factors that influence the neurobiological effects of exercise likely extend beyond age and intensity in people with major depression.

We recently conducted a comprehensive systematic review of neurobiological effects of exercise on major depressive disorder. A subsequent letter suggested that we should consider children and adolescent and raised the importance of how intensity may mediate neurobiological response in people with depression. Here, we discuss these comments regarding our review, in addition to proposing that other factors, such type, duration, frequency, and adherence, may also importantly influence neurobiological response, based on recent meta-analyses demonstrating these other aspects of physical activity also moderate dropout rates and effect sizes from exercise upon depression.

Association between Spirituality and Adherence to Management in Outpatients with Heart Failure / Associação entre Espiritualidade e Adesão ao Tratamento em Pacientes Ambulatoriais com Insuficiência Cardíaca

Abstract Background: Spirituality may influence how patients cope with their illness. Objectives: We assessed whether spirituality may influence adherence to management of outpatients with heart failure. Methods: Cross sectional study enrolling consecutive ambulatory heart failure patients in whom adherence to multidisciplinary treatment was evaluated. Patients were assessed for quality of life, depression, religiosity and spirituality utilizing validated questionnaires. Correlations between adherence and psychosocial variables of interest were obtained. Logistic regression models explored independent predictors of adherence. Results: One hundred and thirty patients (age 60 ± 13 years; 67% male) were interviewed. Adequate adherence score was observed in 38.5% of the patients. Neither depression nor religiosity was correlated to adherence, when assessed separately. Interestingly, spirituality, when assessed by both total score sum (r = 0.26; p = 0.003) and by all specific domains, was positively correlated to adherence. Finally, the combination of spirituality, religiosity and personal beliefs was an independent predictor of adherence when adjusted for demographics, clinical characteristics and psychosocial instruments. Conclusion: Spirituality, religiosity and personal beliefs were the only variables consistently associated with compliance to medication in a cohort of outpatients with heart failure. Our data suggest that adequately addressing these aspects on patient’s care may lead to an improvement in adherence patterns in the complex heart failure management.

Resumo Fundamento: A espiritualidade pode influenciar a maneira com que os pacientes lidam com sua doença. Objetivos: Avaliamos a possibilidade de a espiritualidade influenciar a adesão ao tratamento de pacientes ambulatoriais com insuficiência cardíaca. Métodos: Estudo transversal com pacientes ambulatoriais com insuficiência cardíaca, cuja adesão ao tratamento multidisciplinar foi avaliada. Os pacientes foram avaliados sobre qualidade de vida, depressão, religiosidade e espiritualidade, utilizando questionários validados. Foram obtidas correlações entre adesão e variáveis psicossociais de interesse. Modelos de regressão logística exploraram preditores independentes de adesão. Resultados: Cento e trinta pacientes (idade 60 ± 13 anos; 67% masculinos) foram entrevistados. Observou-se adequado escore de adesão em 38,5% dos pacientes. Nem a depressão ou a religiosidade foram correlacionados à adesão, quando avaliados separadamente. É interessante notar que quando a espiritualidade foi avaliada por ambos, o somatório total de score (r = 0,26; p = 0,003) e os domínios específicos, ela estava positivamente correlacionada à adesão. Por fim, a combinação de espiritualidade, religiosidade e crenças pessoais mostrou-se um preditor independente de adesão quando ajustado às características demográficas, clínicas e a instrumentos psicossociais. Conclusão: Espiritualidade, religiosidade e crenças pessoais foram as únicas variáveis consistentemente associadas à adesão em relação à medicação em uma coorte de pacientes ambulatoriais com insuficiência cardíaca. Nossos dados sugerem que abordar adequadamente esses aspectos no cuidado com o paciente pode auxiliar a melhorar o padrão de adesão no complexo tratamento da insuficiência cardíaca.