Effectiveness of a Serious Video Game (MOON) for Attention Deficit Hyperactivity Disorder: Protocol for a Randomized Clinical Trial.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood and adolescence, with a prevalence of 5% and associated difficulties and worse prognosis if undetected. Multimodal treatment is the treatment of choice. However, sometimes treatment can be insufficient or have drawbacks. OBJECTIVE: This study protocol aims to demonstrate the effectiveness of cognitive training through the serious video game The Secret Trail of Moon (MOON) in improving emotional regulation in people with ADHD. METHODS: This is a prospective, unicenter, randomized, unblinded, pre- and postintervention study. The groups will be randomized (MOON vs control) via an electronic case report form. The MOON intervention will be performed 2 times per week for 10 weeks (30 minutes per session). The first 5 weeks (10 sessions) will be conducted face-to-face at the Puerta de Hierro University Hospital, and the remaining weeks will be conducted via the internet at the participants' homes. The total sample consists of 152 patients aged between 7 and 18 years. All participants have a clinical diagnosis of ADHD under pharmacological treatment. Data collection will be used to obtain demographic and clinical data. The data will be recorded using REDCap. Measures will be made through clinical scales for parents and objective tests of cognitive functioning in patients. Additional information on academic performance will be collected. The study has a power greater than 80% to detect differences. Student t test, 2-factor analysis of variance (ANOVA), and Mann-Whitney analyses will be performed according to each variable's characteristics. RESULTS: The study was approved by the Research Ethics Committee of the Puerta de Hierro University Hospital on December 14, 2022. As of September 26, 2023, we have enrolled 62 participants, and 31 participants have completed the study. This clinical trial was funded by the Comunidad de Madrid (IND2020/BMD-17544). The approximate completion date is March 2024. CONCLUSIONS: Serious video games such as MOON can be motivational tools that complement multimodal treatment for ADHD. TRIAL REGISTRATION: ClinicalTrials.gov; NCT06006871; https://clinicaltrials.gov/study/NCT06006871. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/53191.

Effects of elevated emotional symptoms on metabolic disease development: a 10-year follow-up study.

Background: In recent decades, the relationship between emotional disorders (i.e., depression and anxiety) and alterations in physiological functions (i.e., inflammation or metabolism) have been well supported. However, studies on a symptom-based approach have provided mixed results. Our study aims to gain insight into how subclinical statuses, featured by elevated depressive and/or anxious symptoms, may influence immunometabolic alterations in the concurrent relationship; and the development of metabolic diseases at 10-year follow-up: diabetes, hypertension and hypercholesterolemia. Methods: Data from 758 Greek adults [394 men (aged 41 ± 10 years) and 364 women (aged 37 ± 12 years)] were used. Four groups were created according to the levels of depressive and anxiety symptoms: (1) control group (CG), (2) depressive group (DG), (3) anxiety group (AG) and (4) depressive and anxiety group (DAG). Multi-indicator multi-causes (MIMIC) modeling was used to estimate metabolic function and inflammatory response scores, on a wide selection of blood biomarkers. Finally, a binary logistic regression was carried out to study the influence of symptoms on the development of the aforementioned metabolic diseases on a 10-year follow-up. Results: Group membership was not associated with metabolic function score. Conversely, DAG membership was related with higher inflammatory response score (B = 0.20, CI95 = 0.01, 0.40), with respect to the CG (p < 0.05). Both age and sex were significant variables in the calculation of both scores. Regarding disease at 10-year follow-up effect, risk of developing diabetes, hypertension and hypercholesterolemia was associated with age and socioeconomic status. Moreover, DG membership was significant for diabetes risk (OR = 2.08, CI95 = 1.00, 4.22) and DAG for hypercholesterolemia (OR = 1.68, CI95 = 1.16, 2.43). Limitations: Data on anti-inflammatory drugs and psychopharmacological medication were not collected in this study. Conclusions: Elevated symptoms of depression and anxiety accounts for inflammatory alterations at concurrent relationship and a higher risk of 10-year follow-up metabolic diseases.

Importance of immunometabolic markers for the classification of patients with major depressive disorder using machine learning.

BACKGROUND: Although there is scientific evidence of the presence of immunometabolic alterations in major depression, not all patients present them. Recent studies point to the association between an inflammatory phenotype and certain clinical symptoms in patients with depression. The objective of our study was to classify major depression disorder patients using supervised learning algorithms or machine learning, based on immunometabolic and oxidative stress biomarkers and lifestyle habits. METHODS: Taking into account a series of inflammatory and oxidative stress biomarkers (C-reactive protein (CRP), tumor necrosis factor (TNF), 4-hydroxynonenal (HNE) and glutathione), metabolic risk markers (blood pressure, waist circumference and glucose, triglyceride and cholesterol levels) and lifestyle habits of the participants (physical activity, smoking and alcohol consumption), a study was carried out using machine learning in a sample of 171 participants, 91 patients with depression (71.42% women, mean age = 50.64) and 80 healthy subjects (67.50% women, mean age = 49.12). The algorithm used was the support vector machine, performing cross validation, by which the subdivision of the sample in training (70%) and test (30%) was carried out in order to estimate the precision of the model. The prediction of belonging to the patient group (MDD patients versus control subjects), melancholic type (melancholic versus non-melancholic patients) or resistant depression group (treatment-resistant versus non-treatment-resistant) was based on the importance of each of the immunometabolic and lifestyle variables. RESULTS: With the application of the algorithm, controls versus patients, such as patients with melancholic symptoms versus non-melancholic symptoms, and resistant versus non-resistant symptoms in the test phase were optimally classified. The variables that showed greater importance, according to the results of the area under the ROC curve, for the discrimination between healthy subjects and patients with depression were current alcohol consumption (AUC = 0.62), TNF-α levels (AUC = 0.61), glutathione redox status (AUC = 0.60) and the performance of both moderate (AUC = 0.59) and vigorous physical exercise (AUC = 0.58). On the other hand, the most important variables for classifying melancholic patients in relation to lifestyle habits were past (AUC = 0.65) and current (AUC = 0.60) tobacco habit, as well as walking routinely (AUC = 0.59) and in relation to immunometabolic markers were the levels of CRP (AUC = 0.62) and glucose (AUC = 0.58). In the analysis of the importance of the variables for the classification of treatment-resistant patients versus non-resistant patients, the systolic blood pressure (SBP) variable was shown to be the most relevant (AUC = 0.67). Other immunometabolic variables were also among the most important such as TNF-α (AUC = 0.65) and waist circumference (AUC = 0.64). In this case, sex (AUC = 0.59) was also relevant along with alcohol (AUC = 0.58) and tobacco (AUC = 0.56) consumption. CONCLUSIONS: The results obtained in our study show that it is possible to predict the diagnosis of depression and its clinical typology from immunometabolic markers and lifestyle habits, using machine learning techniques. The use of this type of methodology could facilitate the identification of patients at risk of presenting depression and could be very useful for managing clinical heterogeneity.

[Relationship between healthy lifestyle behaviours and subjective wellbeing: an european observational study.] / Relación entre los estilos de vida saludables y el bienestar subjetivo: estudio observacional europeo.

OBJECTIVE: A healthy lifestyle is related to physical and mental health. The aim of this study was to assess whether different healthy lifestyle behaviours are associated with experiential and evaluative well-being. METHODS: A total of 10,800 participants from Finland, Poland and Spain were interviewed in 2011-2012. Physical activity, fruit and vegetable consumption, smoking, alcohol use, and sleep quality were self-reported. Life satisfaction was measured with the Cantril Self-Anchoring Striving Scale. Positive and negative affect were assessed using an abbreviated version of the Day Reconstruction Method. Multivariate regression analyses were performed. RESULTS: Healthy lifestyle behaviours (consumption of five or more servings of fruit and vegetables per day, moderate or high physical activity, being a non-daily smoker, and having a good sleep quality) were positively associated with evaluative well-being (ß=0.23 p<0.001; ß=0.16, p<0.001; ß=0.26, p<0.001; ß=0.23, p<0.001, respectively), after controlling for confounding variables such as health and depression. Good sleep quality was related with higher positive affect (ß=0.29, p<0.001), lower negative affect (ß=-0.15, p<0.001) and higher life satisfaction (ß=0.23, p<0.001), after adjusting for those confounding variables. CONCLUSIONS: A healthy lifestyle is an important correlate of well-being independently of its effects on health. Healthy lifestyles could be considered when developing strategies to improve not only the physical health, but also the well-being of the population.

OBJETIVO: Un estilo de vida saludable está relacionado con la salud física y mental. El objetivo de este trabajo fue evaluar si diferentes comportamientos de estilo de vida saludable estaban asociados con el bienestar subjetivo. METODOS: Se entrevistó a un total de 10.800 participantes de Finlandia, Polonia y España en 2011-2012. La actividad física, el consumo de frutas y verduras, el tabaco, el alcohol y la calidad del sueño fueron autoinformados. La satisfacción con la vida se midió con la Cantril Self-Anchoring Striving Scale. El afecto positivo y negativo se evaluaron utilizando una versión abreviada del Método de Reconstrucción del Día. Se llevaron a cabo análisis de regresión múltiple. RESULTADOS: Las conductas de estilo de vida saludable (consumo de cinco o más frutas y verduras al día, actividad física moderada o alta, no fumar a diario y tener una buena calidad del sueño) se asociaron positivamente con el bienestar evaluativo (ß=0,23, p<0,001; ß=0,16, p<0,001; ß=0,26, p<0,001; ß=0,23, p<0,001, respectivamente), después de controlar por variables de confusión como la salud y la depresión. La buena calidad del sueño se relacionó con mayor afecto positivo (ß=0,29, p<0,001), menor afecto negativo (ß=-0,15, p<0,001) y mayor satisfacción con la vida (ß=0,23, p<0,001), después de ajustar por dichas variables de confusión. CONCLUSIONES: Un estilo de vida saludable se correlaciona de manera importante con el bienestar, independientemente de sus efectos en la salud. Los estilos de vida saludables podrían ser considerados a la hora de desarrollar estrategias que mejoren no solo la salud física, sino también el bienestar de la población.

Relación entre los estilos de vida saludables y el bienestar subjetivo: estudio observacional europeo / Relationship between healthy lifestyle behaviours and subjective wellbeing: an european observational study

FUNDAMENTOS: Un estilo de vida saludable está relacionado con la salud física y mental. El objetivo de este trabajo fue evaluar si diferentes comportamientos de estilo de vida saludable estaban asociados con el bienestar subjetivo. MÉTODOS: Se entrevistó a un total de 10.800 participantes de Finlandia, Polonia y España en 2011-2012. La actividad física, el consumo de frutas y verduras, el tabaco, el alcohol y la calidad del sueño fueron autoinformados. La satisfacción con la vida se midió con la Cantril Self-Anchoring Striving Scale. El afecto positivo y negativo se evaluaron utilizando una versión abreviada del Método de Reconstrucción del Día. Se llevaron a cabo análisis de regresión múltiple. RESULTADOS: Las conductas de estilo de vida saludable (consumo de cinco o más frutas y verduras al día, actividad física moderada o alta, no fumar a diario y tener una buena calidad del sueño) se asociaron positivamente con el bienestar evaluativo (ß=0,23,p<0,001; ß=0,16, p<0,001; ß=0,26, p<0,001; ß=0,23, p<0,001, respectivamente), después de controlar por variables de confusión comola salud y la depresión. La buena calidad del sueño se relacionó con mayor afecto positivo (ß=0,29, p<0,001), menor afecto negativo (ß=-0,15, p<0,001) y mayor satisfacción con la vida (ß=0,23, p<0,001), después de ajustar por dichas variables de confusión. CONCLUSIONES: Un estilo de vida saludable se correlaciona de manera importante con el bienestar, independientemente de sus efectos en la salud. Los estilos de vida saludables podrían ser considerados a la hora de desarrollar estrategias que mejoren no solo la salud física, sino también el bienestar de la población.(AU)

BACKGROUND:A h ealthy lifestyle is related to physical and mental health. The aim of this study was to assess whether different healthy lifestyle behaviours are associated with experiential and evaluative well-being. METHODS: A total of 10,800 participants from Finland, Poland and Spain were interviewed in 2011-2012. Physical activity, fruit and vegetable consumption, smoking, alcohol use, and sleep quality were selfeported. Life satisfaction was measured with the Cantril Self-Anchoring Striving Scale. Positive and negative affect were assessed using an abbreviated version of the Day Reconstruction Method. Multivariate regression analyses were performed. RESULTS: Healthy lifestyle behaviours (consumption of five or more servings of fruit and vegetables per day, moderate or high physical activity, being a non-daily smoker, and having a good sleep quality) were positively associated with evaluative well-being (ß=0.23 p<0.001; ß=0.16, p<0.001; ß=0.26, p<0.001; ß=0.23, p<0.001, respectively), after controlling for confounding variables such as health and depression. Good sleep quality was related with higher positive affect (ß=0.29, p<0.001), lower negative affect (ß=-0.15, p<0.001) and higher life satisfaction (ß=0.23, p<0.001), after adjusting for those confounding variables. CONCLUSIONS: A healthy lifestyle is an important correlate of well-being independently of its effects on health. Healthy lifestyles could be considered when developing strategies to improve not only the physical health, but also the well-being of the population.(AU)

Relationship between immunometabolic status and cognitive performance among major depression disorder patients.

BACKGROUND: Alterations in cognitive performance have been described in patients with major depressive disorder (MDD). However, the specific risk factors of these changes are not yet known. This study aimed to explore whether inmunometabolic parameters are related to cognitive performance in MDD in comparison to healthy controls (HC) METHODS: Sample consisted of 84 MDD patients and 78 HC. Both groups were compared on the results of cognitive performance measured with the Cambridge Neuropsychological Test Automated Battery (CANTAB), the presence of metabolic syndrome (MetS) and an inflammatory/oxidative index calculated by a principal component analysis of peripheral biomarkers (tumor necrosis factor, C-reactive protein and 4-hydroxynonenal). A multiple linear regression was carried out, to study the relationship between inmunometabolic variables and the global cognitive performance, being the latter the dependent variable. RESULTS: Significant differences were obtained in the inflammatory/oxidative index between both groups (F(1157)= 12.93; p < .001), also in cognitive performance (F(1157)= 56.75; p < .001). The inmunometabolic covariate regression model (i.e., condition (HC/MDD), sex, age and medication loading, MetS, inflammatory/oxidative index and the interaction between MetS and inflammatory/oxidative index) was statistically significant (F(7157)= 11.24; p < .01) and explained 31% of variance. The condition, being either MDD or HD, (B=-0.97; p < .001), age (B=-0.28; p < .001) and the interaction between inflammatory/oxidative index and MetS (B=-0.38; p = .02) were factors associated to cognitive performance. LIMITATIONS: Sample size was relatively small. The cross-sectional design of the study limits the possibilities of analysis. CONCLUSIONS: Our results provide evidence on the conjoint influence of metabolic and inflammatory dysregulation on cognitive dysfunction in MDD patients. In this way, our study opens a line of research in immunometabolic agents to deal with cognitive decline associated with MDD.

Detección de ansiedad y depresión en Atención Primaria: utilidad de 2 escalas breves adaptadas a los nuevos criterios CIE-11-AP / Screening for anxiety and depression in Primary Care: Utility of 2 brief scales adapted to the ICD-11-PC

Introducción La Organización Mundial de la Salud ha desarrollado una nueva clasificación de trastornos mentales para su uso en Atención Primaria (AP), la CIE-11-AP, que incorpora cambios en los criterios diagnósticos de los trastornos de ansiedad y depresión. Como complemento, también ha desarrollado 2 instrumentos de cribado de síntomas ansiosos y depresivos adaptados a los criterios de la nueva clasificación. Objetivos Evaluar la capacidad de la versión española de las 2 escalas breves (Dep5 y Anx5) para identificar casos de depresión y ansiedad en una muestra de pacientes españoles de AP. Método Estudio transversal realizado por 37 médicos de AP que seleccionaron 284 pacientes con sospecha de malestar emocional. A esta muestra se les administraron las escalas de cribado (Anx5 y Dep5) y, como comparador, un instrumento diagnóstico estructurado (Clinical Interview Schedule-Revised) adaptado a los nuevos criterios CIE-11. Resultados La Anx5, utilizando un punto de corte de 3, presentó una sensibilidad de 0,75 y una especificidad de 0,53. La Dep5 mostró una sensibilidad de 0,48 y una especificidad de 0,8 utilizando un punto de corte de 4. Las 2 escalas utilizadas conjuntamente, con un punto de corte de 3 en ambas, clasificaban correctamente como casos o no casos un 73,57% de los sujetos. El diagnóstico más frecuentemente observado en la muestra fue el de depresión ansiosa. Conclusiones Las 2 escalas de cribado de síntomas ansiosos y depresivos (Anx5 y Dep5) son instrumentos sencillos y fáciles de utilizar para evaluar síntomas ansiosos y depresivos en AP. Los niveles de fiabilidad y validez de cada una de las escalas por separado son limitados y mejoran cuando se utilizan de forma conjunta. (AU)

Introduction The World Health Organization has developed a new classification of mental disorders in Primary Health Care (PHC), the ICD-11-PHC, in which there are changes in the diagnostic criteria of anxiety and depression disorder. In addition, 2 screening instruments have been developed for the detection of anxious and depressive symptoms according to the criteria of the new classification.Objectives To evaluate the capacity of the Spanish version of the 2 brief scales Dep5 and Anx5 to identify cases of depression and anxiety in PHC in Spain. Method A cross-sectional study conducted by 37 PHC physicians who selected 284 patients with suspected emotional distress. This sample was administered the screening scales (Anx5 and Dep5) and a diagnostic instrument (Clinical Interview Schedule-Revised) contemplating the new ICD-11 criteria as used as gold standard. Results The Anx5, using a cut-off point of 3, showed a sensitivity of 0.75 and specificity of 0.53. Using a cut-off point of 4, the Dep5 showed a sensitivity of 0.48 and a specificity of 0.8. The 2 scales together, with a cut-off point of 3 for each, classified correctly 73,57% as cases or non-cases. The diagnosis most frequently observed was anxious depression. Conclusions The screening scales for anxious and depressive symptoms (Anx5 and Dep5) are simple and easy-to-use instruments for assessing anxious and depressive symptoms in PHC. The reliability and validity data of each of the scales separately are limited but the figures improve when they are used together. (AU)

Screening for anxiety and depression in Primary Care: Utility of 2 brief scales adapted to the ICD-11-PC.

INTRODUCTION: The World Health Organization has developed a new classification of mental disorders in Primary Health Care (PHC), the ICD-11-PHC, in which there are changes in the diagnostic criteria of anxiety and depression disorder. In addition, 2 screening instruments have been developed for the detection of anxious and depressive symptoms according to the criteria of the new classification. OBJECTIVES: To evaluate the capacity of the Spanish version of the 2 brief scales Dep5 and Anx5 to identify cases of depression and anxiety in PHC in Spain. METHOD: A cross-sectional study conducted by 37 PHC physicians who selected 284 patients with suspected emotional distress. This sample was administered the screening scales (Anx5 and Dep5) and a diagnostic instrument (Clinical Interview Schedule-Revised) contemplating the new ICD-11 criteria as used as gold standard. RESULTS: The Anx5, using a cut-off point of 3, showed a sensitivity of 0.75 and specificity of 0.53. Using a cut-off point of 4, the Dep5 showed a sensitivity of 0.48 and a specificity of 0.8. The 2 scales together, with a cut-off point of 3 for each, classified correctly 73,57% as cases or non-cases. The diagnosis most frequently observed was anxious depression. CONCLUSIONS: The screening scales for anxious and depressive symptoms (Anx5 and Dep5) are simple and easy-to-use instruments for assessing anxious and depressive symptoms in PHC. The reliability and validity data of each of the scales separately are limited but the figures improve when they are used together.

Intracellular calcium and inflammatory markers, mediated by purinergic stimulation, are differentially regulated in monocytes of patients with major depressive disorder.

The P2X7 receptor (P2X7R) is a ligand-gated ion channel that is being recognized as a major player in neuropsychiatric disorders such as Major Depressive Disorder (MDD). P2X7R activation is triggered by high extracellular ATP concentrations, leading to channel opening and inducing an increase in cytosolic calcium concentration ([Ca2+]c), that activates the inflammatory pathway. Those receptors are expressed not only in CNS cells but also in peripheral blood cells, where they are activated in response to inflammatory molecules such as bacterial lipopolysaccharide (LPS). LPS induced-tissue damage promotes an elevation of extracellular ATP, triggering the NRLP3-inflammasome assembly and activation that, sequentially, induces caspase-1 cleavage and IL-1ß processing and secretion. In this context, we attempt to understand the role of P2X7R in [Ca2+]c homeostasis regulation, inflammasome expression and its pharmacological modulation in MDD. For this purpose, monocytes were isolated from peripheral blood of MDD patients and [Ca2+]c was monitored with the intracellular probe Fura-2. Our results point out to P2X7R as the responsible of the Ca2+ imbalance, as well as TNF-α-dependent activation of caspase-1 in MDD patients. In addition, P2X7R blockade with its specific antagonist, JNJ-47965567, reduces the Ca2+ entry upon Bz-ATP exposure. Altogether, our results point that MDD patients have both, Ca2+ homeostasis alteration and an inflammatory status, which promote an independent-inflammasome activation of caspase-1. Therefore, we propose the pharmacological modulation of P2X7R as a therapeutic approach against MDD symptoms.

The interplay between functioning problems and symptoms in first episode of psychosis: An approach from network analysis.

The relationship between psychotic symptoms and global measures of functioning has been widely studied. No previous study has assessed so far the interplay between specific clinical symptoms and particular areas of functioning in first-episode psychosis (FEP) using network analysis methods. A total of 191 patients with FEP (age 24.45 ±â€¯6.28 years, 64.9% male) participating in an observational and longitudinal study (AGES-CM) comprised the study sample. Functioning problems were assessed with the WHO Disability Assessment Schedule (WHODAS), whereas the Positive and Negative Syndrome Scale (PANSS) was used to assess symptom severity. Network analysis were conducted with the aim of analysing the patterns of relationships between the different dimensions of functioning and PANSS symptoms and factors at baseline. According to our results, the most important nodes were "conceptual disorganization", "emotional withdrawal", "lack of spontaneity and flow of conversation", "delusions", "unusual thought content", "dealing with strangers" and "poor rapport". Our findings suggest that these symptoms and functioning dimensions should be prioritized in the clinical assessment and management of patients with FEP. These areas may also become targets of future early intervention strategies, so as to improve quality of life in this population.

Metabolic dysregulation in older adults with depression and loneliness: The ATHLOS study.

This study aimed to examine how loneliness contributes to metabolic dysregulation among older adults with depression and determine the relative contribution of loneliness to the development of chronic diseases in late adulthood. Harmonised data from the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project were used. Concretely, the sample comprised 6195 participants (53.95% women; M = 61.30 years, SD = 7.11) from three European cohorts. Three groups were considered: control group (CG); depressive symptom episode group (DEP); and a group with depression and loneliness (DEP + LONE). A metabolic score was estimated using anthropometric and blood indicators, by means of multi-indicator multi-causes (MIMIC) modelling and after controlling for sociodemographic and health-related covariates. Group-comparison was based on measurement-invariance procedures. Multimorbidity development was predicted at follow-up considering the study group and relevant covariates. All the analyses were sex-specific. As a result, measurement invariance revealed the influence of group (ΔCFI = -0.017 for male participants and ΔCFI = -0.009 for female ones) on metabolic scores in both sexes. Metabolic scores were significantly lower (i.e., they had more metabolic risk) in DEP + LONE women in comparison to women from the other groups. DEP men showed the lowest metabolic scores but those from the DEP + LONE group showed meaningfully lower scores than CG men (d = 1.35). In terms of multimorbidity prediction, DEP + LONE group membership significantly predicted the outcome in both sexes; DEP group membership significantly predicted multimorbidity at follow-up in women. In summary, these results highlight the relevant contribution of loneliness in depression-related metabolic dysregulation in the short- (concurrent metabolic risk) and long-term (chronic condition development). Moreover, sex-specific mechanisms seem to be involved in metabolic alterations of depressed people showing loneliness feelings. This study calls for action to reduce the impact of loneliness in old age and to promote healthy ageing.

Age at illness onset and physical activity are associated with cognitive impairment in patients with current diagnosis of major depressive disorder.

BACKGROUND: Cognitive impairment has been reported in patients with Major Depressive Disorder (MDD). This study aims to explore the association between lifestyle habits and health-related factors and the presence of cognitive symptoms in MDD patients. METHODS: Demographic, clinical, health-related variables and cognitive scores measured with the Cambridge Neuropsychological Test Automated Battery (CANTAB) were compared between 74 patients with current MDD and 68 healthy controls (HC). To test the hypothesis of associated factors to cognitive symptoms, multivariate backward stepwise linear regression models were run. RESULTS: Significant neuropsychological deficits were evident in MDD compared with HC in the global cognitive index (F=8.29; df=1, 140; p=0.005). In the regression analysis performed on MDD and HC, years of schooling (ß=-0.11; p=<0.001), job status (ß=-0.50; p=0.016), physical activity (ß=-0.25; p=0.04) and age at illness onset (ß=0.17; p=0.017) were statistically significant factors associated to cognitive impairment. The regression model ran in HC showed that only years of schooling were significant (ß=-0.07; p=<0.001) in this group. LIMITATIONS: Sample size was relatively small. Everyday cognitive skills were not evaluated. CONCLUSIONS: MDD patients have cognitive deficits. These deficits are linked with the years of education, job status, age of onset of the disease and the performance of physical activity. These results support the importance of the implementation of interventions targeting the cognitive reserve and lifestyle habits of MDD patients, in addition to the conventional therapeutic approach focused on symptoms control.

Diet and Neurocognition in Mood Disorders - An Overview of the Overlooked.

Bipolar disorder and major depression are associated with significant disability, morbidity, and reduced life expectancy. People with mood disorders have shown higher ratios of unhealthy lifestyle choices, including poor diet quality and suboptimal nutrition. Diet and nutrition impact on brain /mental health, but cognitive outcomes have been less researched in psychiatric disorders. Neurocognitive dysfunction is a major driver of social dysfunction and a therapeutic target in mood disorders, although effective cognitive-enhancers are currently lacking. This narrative review aimed to assess the potential cognitive benefits of dietary and nutritional interventions in subjects diagnosed with mood disorders. Eight clinical trials with nutrients were identified, whereas none involved dietary interventions. Efficacy to improve select cognitive deficits has been reported, but results are either preliminary or inconsistent. Methodological recommendations for future cognition trials in the field are advanced. Current evidence and future views are discussed from the perspectives of precision medicine, clinical staging, nutritional psychiatry, and the brain-gut-microbiota axis.

Screening for anxiety and depression in Primary Care: Utility of 2 brief scales adapted to the ICD-11-PC. / Detección de ansiedad y depresión en Atención Primaria: utilidad de 2 escalas breves adaptadas a los nuevos criterios CIE-11-AP.

INTRODUCTION: The World Health Organization has developed a new classification of mental disorders in Primary Health Care (PHC), the ICD-11-PHC, in which there are changes in the diagnostic criteria of anxiety and depression disorder. In addition, 2 screening instruments have been developed for the detection of anxious and depressive symptoms according to the criteria of the new classification. OBJECTIVES: To evaluate the capacity of the Spanish version of the 2 brief scales Dep5 and Anx5 to identify cases of depression and anxiety in PHC in Spain. METHOD: A cross-sectional study conducted by 37 PHC physicians who selected 284 patients with suspected emotional distress. This sample was administered the screening scales (Anx5 and Dep5) and a diagnostic instrument (Clinical Interview Schedule-Revised) contemplating the new ICD-11 criteria as used as gold standard. RESULTS: The Anx5, using a cut-off point of 3, showed a sensitivity of 0.75 and specificity of 0.53. Using a cut-off point of 4, the Dep5 showed a sensitivity of 0.48 and a specificity of 0.8. The 2 scales together, with a cut-off point of 3 for each, classified correctly 73,57% as cases or non-cases. The diagnosis most frequently observed was anxious depression. CONCLUSIONS: The screening scales for anxious and depressive symptoms (Anx5 and Dep5) are simple and easy-to-use instruments for assessing anxious and depressive symptoms in PHC. The reliability and validity data of each of the scales separately are limited but the figures improve when they are used together.

Inflammatory and metabolic disturbances are associated with more severe trajectories of late-life depression.

Late-life depression is a highly prevalent mental health condition with devastating consequences even from its earliest stages. Alterations in physiological functions, such as inflammatory and metabolic, have been described in patients with depression. However, little is known on the association between depression symptom course and metabolic and inflammation dysregulation. This study aimed to depict the course of depression symptoms while ageing, taking into consideration inter-individual heterogeneity. Moreover, it intended to study the associations between inflammatory and metabolic risk profiles and symptom trajectories. To do so, data from 13,203 adults aged 50-90 years (52.75% women; mean age at baseline = 65.07, SD = 10.00) were used. Blood sample and blood pressure measures were taken from 1536 participants (56.58% women; mean age at baseline = 61.73 years, sd = 7.64). Depression symptoms were assessed every two years across a 10-year follow-up. Trajectories were identified by means of latent class mixed modelling. Inflammation and metabolic risk profile scores were obtained from plasma and diagnostic-based indicators in the follow-up, using a robust latent-factor approach. Multigroup modelling was used to study the associations between the profiles and symptom trajectories. As a result, three heterogeneous trajectories of symptoms were identified (low-symptom, moderate-symptom and high-symptom trajectory). Participants depicting a high-symptom trajectory showed the greatest inflammation profile score and high metabolic risk. Moderate-symptom trajectory was also related to high inflammation and metabolic risk. To sum up, at-risk trajectories of symptoms were associated with high inflammation and risk of metabolic diseases. This study provides valuable evidence to advance personalised medicine and mental health precision, considering person-specific profiles and physiological concomitants.

Infección de prótesis articular por Streptococcus mutans / Joint prosthesis infection by Streptococcus mutans

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Effective methods for knowledge transfer to strengthen mental health systems in low- and middle-income countries.

BACKGROUND: The Emerald project's focus is on how to strengthen mental health systems in six low- and middle-income countries (LMICs) (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda). This was done by generating evidence and capacity to enhance health system performance in delivering mental healthcare.A common problem in scaling-up interventions and strengthening mental health programmes in LMICs is how to transfer research evidence, such as the data collected in the Emerald project, into practice. AIMS: To describe how core elements of Emerald were implemented and aligned with the ultimate goal of strengthening mental health systems, as well as their short-term impact on practices, policies and programmes in the six partner countries. METHOD: We focused on the involvement of policy planners, managers, patients and carers. RESULTS: Over 5 years of collaboration, the Emerald consortium has provided evidence and tools for the improvement of mental healthcare in the six LMICs involved in the project. We found that the knowledge transfer efforts had an impact on mental health service delivery and policy planning at the sites and countries involved in the project. CONCLUSIONS: This approach may be valid beyond the mental health context, and may be effective for any initiative that aims at implementing evidence-based health policies for health system strengthening.

Clinical and neurodevelopmental correlates of aggression in early psychosis.

BACKGROUND: Although mental illness accounts for only 4% of aggressive behavior in the general population, there remains a modest association between aggressive behavior and psychotic disorders, particularly in the early stages of the illness. However, little is known about the specific factors associated to this increased risk. AIMS: The present study aims to assess the rates, characteristics and risk factors of aggressive behavior in first episode psychosis patients (FEP). METHOD: We conducted a retrospective chart review of 449 FEP patients recruited from an outpatient early psychosis clinic. Aggressive behavior and clinical information were rated based upon information gathered from the chart review of data collected at baseline and after 6 months of follow-up. RESULTS: Rates of aggressive behavior were 54.3% in FEP patients. Aggressive behavior was significantly associated with higher rates of history of birth complications, neurodevelopmental delays, learning difficulties, alcohol use disorders, and the clinical domain of poverty symptoms. In addition to aggressive behavior, 16.7% of FEP patients exhibited suicidal ideation or behaviors and 11.4% exhibited non-suicidal self-injurious behavior (NSSIB). In contrast to baseline, aggressive behaviors at 6 months follow up were almost entirely absent. CONCLUSIONS: Patients at early stages of psychosis have high rates of aggressive and suicidal behavior prior to contact with clinical services. Neurodevelopmental adversities, alcohol use disorders and poverty symptoms are associated to higher risk of aggression in early psychosis. Participation in early psychosis specialty care resulted in a dramatic reduction in aggressive behavior.

WHO-mhGAP Training in Mexico: Increasing Knowledge and Readiness for the Identification and Management of Depression and Suicide Risk in Primary Care.

BACKGOUND: In order to reduce the treatment gap of mental disorders, the World Health Organization (WHO) has proposed the mhGAP guidelines to be implemented globally. AIM OF THE STUDY: To examine the effectivity of a training course based on the WHO-mhGAP guidelines to increase knowledge and readiness for identification and management of depression and suicide risk in primary care (PC) in Mexico. METHODS: PC clinicians were invited to participate in a traning course; before and after it, all completed an evaluation of knowledge of mhGAP and depression (0-10 points), and self-efficacy in suicide risk management (0-40 points), and were classified according to Prochaska and Diclemente transtheorical model in their particular stage of readiness for identification and management of these conditions. RESULTS: The sample included 60 health professionals. Before training, clinicians had adequate knowledge of depression and its treatment (8.1 ± 1.66), but not on the mhGAP model and/or suicide risk management, which increased by the end of training (mhGAPpre:7.91 ± 2.19 vs. mhGAPpost:8.77 ± 1.34, p = 0.01; SuicidePRE:29.16 ± 9.35 vs. SuicidePOST:39.24 ± 6.83, p = 0.0001). Before training, most clinicians were at the contemplation stage (42.6% vs. 37.7% at the action and 19.7% at the precontemplation stage). By the end of the training, a decrease in the number of clinicians at both the contemplation and precontemplation stages (to 36.1% and to zero, respectively) and a significant increase of clinicians at the action stage (to 63.9%) was observed. CONCLUSIONS: A training course based on the WHO-mhGAP could be an effective tool for increasing PC clinicians' willingness to implement mental health services.