Use of virtual reality in bipolar disorder: a systematic review.

Virtual reality (VR) is a technology that allows to interact with recreated digital environments and situations with enhanced realism. VR has shown good acceptability and promise in different mental health conditions. No systematic review has evaluated the use of VR in Bipolar Disorder (BD). This PRISMA-compliant systematic review searched PubMed and Web of Science databases (PROSPERO: CRD42023467737) to identify studies conducted in individuals with BD in which VR was used. Results were systematically synthesized around four categories (cognitive and functional evaluation, clinical assessment, response to VR and safety/acceptability). Eleven studies were included (267 individuals, mean age = 36.6 years, 60.7% females). Six studies using VR to carry out a cognitive evaluation detected impairments in neuropsychological performance and delayed reaction times. VR was used to assess emotional regulation. No differences in well-being between VR-based and physical calm rooms were found. A VR-based stress management program reduced subjective stress, depression, and anxiety levels. VR-based cognitive remediation improved cognition, depressive symptoms, and emotional awareness. 48.7% of the individuals with BD considered VR-based cognitive remediation 'excellent', whereas 28.2% considered it 'great'. 87.2% of individuals did not report any side effects. 81.8% of studies received a global quality rating of moderate. Emerging data point towards a promising use of VR in BD as an acceptable assessment/intervention tool. However, multiple unstudied domains as comorbidity, relapse and prodromal symptoms should be investigated. Research on children and adolescents is also recommended. Further research and replication of findings are required to disentangle which VR-interventions for which populations and outcomes are effective.

Brief Psychotic Episodes and Depressed Mood in a Patient With Borderline Personality Disorder and Antiphospholipid Syndrome.

Psychiatric disorders are reported to be associated with systemic inflammatory conditions and autoimmune diseases. Antiphospholipid syndrome (APS) is a rare condition with poorly understood prevalence and incidence in the general population. Case reports have described co-occurrences of psychiatric conditions and APS. Previous case reports have indicated that patients with APS can have comorbid psychosis, anxiety, depression, and other psychiatric conditions. The association between APS and psychiatric illness, however, remains under-investigated in longitudinal studies. In this report, we present the case of a woman in her 40s who was voluntarily admitted to the psychiatric inpatient unit for treatment of auditory hallucinations within the context of borderline personality disorder. She reported a rather extensive medical and psychiatric history of several previous illnesses, musculoskeletal injuries, and hospitalizations. Due to the significant social stress and multiple comorbidities, she may be at increased vulnerability to acute exacerbations of both APS and brief psychotic episodes. In this case report, the patient had a history of three hypercoagulability incidents that were shortly followed by psychiatric admissions. This report highlights the importance of considering systemic conditions such as APS in patients presenting with psychiatric illness. Patients with APS and concomitant psychosis may benefit from screening for APS flares in the case of a psychotic break.

Suicide warning signs of self-identification in patients with mood disorders: a qualitative analysis based on safety planning.

Introduction: Warning signs serve as proximal indicators of suicide risk, making early recognition imperative for effective prevention strategies. This study aimed to explore self-identified suicide warning signs among Chinese patients with mood disorders based on safety planning framework. Methods: Researchers collaborated with patients to develop a safety plan and compiled warning signs based on it. Word frequency and network analysis were conducted to identify key warning signs. Directed content analysis categorized these signs into cognitive, emotional, behavioral, or physiological themes according to the suicide mode theory. Additionally, we examined potential variations in reported warning signs among participants with different demographic characteristics, including age, gender, and history of suicide attempts. Results: "Low mood" and "crying" emerged as prominent warning signs, with "social withdrawal" closely following. Patients commonly reported emotional themes during suicidal crises, often experiencing two to three themes simultaneously, primarily focusing on emotional, behavioral, and physiological themes. Males exhibited a higher proportion of concurrently reporting three sign themes compared to females (P < 0.05), while no difference was observed in warning signs among patients with other demographic traits. Discussion: This study offers a nuanced understanding of warning signs among mood disorder patients in China. The findings underscore the necessity for comprehensive suicide risk management strategies, emphasizing interventions targeting emotional regulation and social support. These insights provide valuable information for enhancing suicide prevention and intervention efforts.

The Emerging Role of Neurosteroids: Novel Drugs Brexanalone, Sepranolone, Zuranolone, and Ganaxolone in Mood and Neurological Disorders.

This review investigates the potential of neurosteroids, including brexanolone, zuranolone, sepranolone, and ganaxalone, as therapeutic agents for a range of mood and neurological disorders. Notably, these disorders encompass postpartum depression, post-traumatic stress disorder (PTSD), major depressive disorder (MDD), epilepsy, and Alzheimer's disease. Brexanolone and zuranolone have emerged as frontrunners in the treatment of postpartum depression, offering rapid relief from debilitating symptoms. Their mechanism of action involves modulation of the gamma-aminobutyric acid (GABA) system, which plays a pivotal role in mood regulation. Clinical trials have demonstrated their efficacy, heralding a potential breakthrough in addressing this often-overlooked condition. In the context of PTSD and MDD, neurosteroids have demonstrated significant promise. Their positive allosteric modulation of GABA-A receptors translates into improved mood stabilization and reduced symptoms. This novel approach represents a departure from conventional treatments and could offer newfound hope for individuals grappling with these disorders. Beyond mood disorders, neurosteroids, especially ganaxalone, exhibit potential in the realm of epilepsy management. Ganaxalone's capacity to control seizures is attributed to its GABAergic activity, which helps restore the delicate balance of neurotransmission in epileptic brains. Moreover, neurosteroids have revealed neuroprotective properties in Alzheimer's disease models. By influencing the GABAergic system, they mitigate excitotoxicity, a hallmark of Alzheimer's pathology. This neuroprotection opens a novel avenue for slowing neurodegeneration, although further research and clinical validation are essential. In conclusion, this review underscores the substantial therapeutic promise of neurosteroids in mood and neurological disorders. Their modulation of the GABA system emerges as a central mechanism of action, emphasizing the importance of GABAergic signaling in these conditions. The path forward entails continued investigation and clinical trials to fully unlock the potential of neurosteroids, offering hope for enhanced treatments in these challenging clinical domains.

A systematic review of postpartum psychosis resulting in infanticide: missed opportunities in screening, diagnosis, and treatment.

PURPOSE: Impacting 1 in 1000 women, untreated postpartum psychosis is associated with a 4% infanticide rate. This systematic review aims to identify factors that are associated with infanticide resulting from psychosis in the puerperal period and pinpoint areas of missed opportunity for intervention. METHODS: A systematic literature review was conducted in accordance with PRISMA guidelines to identify and synthesize cases of maternal infanticide among perinatal females with evidence of postpartum psychosis. Four independent reviewers screened 231 articles identified in searches of three databases (PsycInfo, PubMed, and Web of Science) for studies conducted from 2013 to 2023. RESULTS: Twelve studies were included in the final review. Findings indicate that those experiencing puerperal psychosis have increased incidence of infanticide suggesting missed opportunities for intervention and treatment. Common factors in mothers who committed infanticide as a result of delusions and/or hallucinations associated with PMADs were identified, including lack of standardized screening tools, preference for traditional and/or cultural healing practices, and access to care. CONCLUSION: The current body of evidence supports developing and evaluating clinical interventions aimed at improving maternal mental health outcomes and infant outcomes in perinatal women experiencing puerperal psychosis.

Red kratom and red corvette: A case of mania induced by kratom withdrawal.

Background: Kratom, derived from the Mitragyna speciose, a  plant native to Southeast Asia, is a substance that is gaining popularity in the United States as a self-medication tool for opiate withdrawal and pain management. Its active compounds, mitragynine, and 7-hydroxymitragynine, interact with various receptors in the body, resulting in a spectrum of clinical effects.Case: A 56-year-old male with a history of depression and cannabis use disorder arrived at the Emergency Department in a state of severe agitation with erratic behavior and aggression. Further evaluation revealed a recent abrupt discontinuation of Kratom use. A psychiatric consultation was requested and done by our consultation-liaison team, diagnosing Kratom withdrawal as the most likely cause of his acute mania. Neuropsychiatric symptoms arising from Kratom toxicity is a well-documented phenomenon; however, to our knowledge, this may be the first documented case of acute mania induced by Kratom withdrawal.

Glymphatic System and Psychiatric Disorders: A Rapid Comprehensive Scoping Review.

BACKGROUND: Since discovering the glymphatic system, there has been a looming interest in exploring its relationship with psychiatric disorders. Recently, increasing evidence suggests an involvement of the glymphatic system in the pathophysiology of psychiatric disorders. However, clear data are still lacking. In this context, this rapid comprehensive PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) scoping review aims to identify and analyze current evidence about the relation between the glymphatic system and psychiatric disorders. METHODS: We conducted a comprehensive review of the literature and then proceeded to discuss the findings narratively. Tables were then constructed and articles were sorted according to authors, year, title, location of study, sample size, psychiatric disorder, the aim of the study, principal findings, implications. RESULTS: Twenty papers were identified as eligible, among which 2 articles on Schizophrenia, 1 on Autism Spectrum Disorders, 2 on Depression, 1 on Depression and Trauma-related Disorders, 1 on Depression and Anxiety, 2 on Anxiety and Sleep Disorders, 8 on Sleep Disorders, 2 on Alcohol use disorder and 1 on Cocaine Use Disorder. CONCLUSION: This review suggests a correlation between the glymphatic system and several psychiatric disorders: Schizophrenia, Depression, Anxiety Disorders, Sleep Disorders, Alcohol Use Disorder, Cocaine Use Disorder, Trauma-Related Disorders, and Autism Spectrum Disorders. Impairment of the glymphatic system could play a role in Trauma-Related Disorders, Alcohol Use Disorders, Cocaine Use Disorders, Sleep Disorders, Depression, and Autism Spectrum Disorders. It is important to implement research on this topic and adopt standardized markers and radio diagnostic tools.

Momentary Associations Between Physical Activity, Affect, and Purpose in Life.

BACKGROUND: Physical activity is associated with both the hedonic (e.g., affect) and eudaimonic (e.g., purpose in life) aspects of well-being. While there is evidence linking momentary physical activity and affect in daily life, the examination of momentary purpose remains largely unexplored. PURPOSE: This study investigates the bidirectional associations between physical activity, positive and negative affect, and momentary purpose using Ecological Momentary Assessment (EMA) and accelerometer data. METHODS: Middle-aged participants (40-70 years old, n = 291) wore accelerometers and completed three daily EMA surveys on momentary experiences for 8 consecutive days. Physical activity (active time and counts) from 20- to 60-min periods before and after EMA surveys were used in the analyses. Multilevel models were adjusted for temporal and contextual factors, age, sex, education, work status, and race/ethnicity. RESULTS: When participants were more physically active than usual, they reported feeling more purpose-driven and positive affect. Similarly, when participants reported feeling more purpose-driven or experiencing positive affect, they engaged in more physical activity in the subsequent time period. These associations were similar for physical activity from 20- to 60-min periods before and after the EMA survey. Physical activity and negative affect were not related in either direction. CONCLUSIONS: In middle-aged adults' daily lives, physical activity has bidirectional relations with purpose and positive affect. This study highlights the dynamic associations between physical activity and the positive aspects of both hedonic and eudaimonic well-being. Future interventions or public health programs should integrate physical activity and mental well-being to maximize mutual benefits.

This study examined how physical activity relates to feelings of purpose and positive and negative affect in daily life among middle-aged adults (aged 40­70). Participants wore activity trackers and completed surveys on their smartphones about their feelings three times a day for 8 days. The study found that when participants were more physically active than usual, they experienced higher levels of purpose and more positive emotions. Conversely, feeling more purposeful or positive also led to more physical activity later on. The results suggest that physical activity and positive well-being are interconnected and reinforce each other in daily life.

Association between apathy and caregiver burden in patients with amyotrophic lateral sclerosis: a cross-sectional study.

OBJECTIVES: To investigate the relationship among patients' apathy, cognitive impairment, depression, anxiety, and caregiver burden in amyotrophic lateral sclerosis (ALS). DESIGN: A cross-sectional study design was used. SETTING: The study was conducted at a tertiary hospital in Wuhan, Hubei, China. PARTICIPANTS: A total of 109 patients with ALS and their caregivers were included. OUTCOME MEASURES: Patients with ALS were screened using the Edinburgh Cognitive and Behavioural Screen, Beck Depression Inventory-II, Generalised Anxiety Disorder-7 and Apathy Scale to assess their cognition, depression, anxiety and apathy, respectively. The primary caregivers completed the Zarit Burden Interview. The association between apathy, cognitive impairment, depression, anxiety and caregiver burden was analysed using logistic regression. Mediation models were employed to investigate the mediating effect of patients' apathy on the relationship between depression/anxiety and caregiver burden. RESULTS: Patients in the high caregiver burden group exhibited significantly higher levels of depression, anxiety and apathy compared with those in the low caregiver burden group (p<0.05). There was a positive association observed between caregiver burden and disease course (rs=0.198, p<0.05), depression (rs=0.189, p<0.05), anxiety (rs=0.257, p<0.05) and apathy (rs=0.388, p<0.05). There was a negative association between caregiver burden and the Revised ALS Functional Rating Scale (rs=-0.275, p<0.05). Apathy was an independent risk factor for higher caregiver burden (OR 1.121, 95% CI 1.041 to 1.206, p<0.05). Apathy fully mediated the relationship between depression and caregiver burden (ß=0.35, 95% CI 0.16 to 0.54, p<0.05) while partially mediating the relationship between anxiety and caregiver burden (ß=0.34, 95% CI 0.16 to 0.52, p<0.05). CONCLUSIONS: Apathy, depression and anxiety exerted a detrimental impact on caregiver burden in individuals with ALS. Apathy played a mediating role in the relationship between depression and caregiver burden and between anxiety and caregiver burden. These findings underscore the importance of identifying apathy and developing interventions for its management within the context of ALS.

A 6-month, prospective, randomized controlled trial of customized adherence enhancement versus a bipolar-specific educational control in poorly adherent adolescents and young adults living with bipolar disorder.

OBJECTIVE: Few studies have addressed medication adherence in adolescents and young adults (AYAs) with bipolar disorder (BD). This 6-month prospective randomized-controlled trial (RCT) tested customized adherence enhancement for adolescents and young adults (CAE-AYA), a behavioral intervention for AYAs versus enhanced treatment as usual (ETAU). METHODS: Inclusion criteria were AYAs age 13-21 with BD type I or II with suboptimal adherence defined as missing ≥20% of medications. Assessments were conducted at Screening, Baseline, and weeks 8, 12 and 24. Primary outcome was past 7 day self-reported Tablets Routine Questionnaire (TRQ) validated by electronic pillbox monitoring (SimpleMed). Symptom measures included the Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS). RESULTS: The mean sample age (N = 36) was 19.1 years (SD = 2.0); 66.7% (N = 24) female, BD Type I (81%). The mean missed medication on TRQ for the total sample was 35.4% (SD = 28.8) at screening and 30.4% (SD = 30.5) at baseline. Both CAE-AYA and ETAU improved on TRQ from screening to baseline. Baseline mean missed medication using SimpleMed was 51.6% (SD = 38.5). Baseline HAM-D and YMRS means were 7.1 (SD = 4.7) and 6.0 (SD = 7.3), respectively. Attrition rate at week 24 was 36%. Baseline to 24-week change on TRQ, adjusting for age, gender, educational level, living situation, family history, race, and ethnicity, showed improvement favoring CAE-AYA versus ETAU of 15%. SimpleMed interpretation was limited due to substantial missing data. There was a significant reduction in depression favoring CAE-AYA. CONCLUSIONS: CAE-AYA may improve adherence in AYAs with BD, although conclusions need to be made cautiously given study limitations. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov identifier: NCT04348604.

Natural Language Processing for Depression Prediction on Sina Weibo: Method Study and Analysis.

Background: Depression represents a pressing global public health concern, impacting the physical and mental well-being of hundreds of millions worldwide. Notwithstanding advances in clinical practice, an alarming number of individuals at risk for depression continue to face significant barriers to timely diagnosis and effective treatment, thereby exacerbating a burgeoning social health crisis. Objective: This study seeks to develop a novel online depression risk detection method using natural language processing technology to identify individuals at risk of depression on the Chinese social media platform Sina Weibo. Methods: First, we collected approximately 527,333 posts publicly shared over 1 year from 1600 individuals with depression and 1600 individuals without depression on the Sina Weibo platform. We then developed a hierarchical transformer network for learning user-level semantic representations, which consists of 3 primary components: a word-level encoder, a post-level encoder, and a semantic aggregation encoder. The word-level encoder learns semantic embeddings from individual posts, while the post-level encoder explores features in user post sequences. The semantic aggregation encoder aggregates post sequence semantics to generate a user-level semantic representation that can be classified as depressed or nondepressed. Next, a classifier is employed to predict the risk of depression. Finally, we conducted statistical and linguistic analyses of the post content from individuals with and without depression using the Chinese Linguistic Inquiry and Word Count. Results: We divided the original data set into training, validation, and test sets. The training set consisted of 1000 individuals with depression and 1000 individuals without depression. Similarly, each validation and test set comprised 600 users, with 300 individuals from both cohorts (depression and nondepression). Our method achieved an accuracy of 84.62%, precision of 84.43%, recall of 84.50%, and F1-score of 84.32% on the test set without employing sampling techniques. However, by applying our proposed retrieval-based sampling strategy, we observed significant improvements in performance: an accuracy of 95.46%, precision of 95.30%, recall of 95.70%, and F1-score of 95.43%. These outstanding results clearly demonstrate the effectiveness and superiority of our proposed depression risk detection model and retrieval-based sampling technique. This breakthrough provides new insights for large-scale depression detection through social media. Through language behavior analysis, we discovered that individuals with depression are more likely to use negation words (the value of "swear" is 0.001253). This may indicate the presence of negative emotions, rejection, doubt, disagreement, or aversion in individuals with depression. Additionally, our analysis revealed that individuals with depression tend to use negative emotional vocabulary in their expressions ("NegEmo": 0.022306; "Anx": 0.003829; "Anger": 0.004327; "Sad": 0.005740), which may reflect their internal negative emotions and psychological state. This frequent use of negative vocabulary could be a way for individuals with depression to express negative feelings toward life, themselves, or their surrounding environment. Conclusions: The research results indicate the feasibility and effectiveness of using deep learning methods to detect the risk of depression. These findings provide insights into the potential for large-scale, automated, and noninvasive prediction of depression among online social media users.

Network Structure of Interpersonal Sensitivity in Patients With Mood Disorders: A Network Analysis.

OBJECTIVE: Interpersonal sensitivity, characterized by a heightened awareness of others' behavior and emotions, is linked to mood disorders. However, current literature lacks a comprehensive analysis of how some items of the Interpersonal Sensitivity Measure (IPSM) interrelate and contribute to the overall construct. This study constructed a network for interpersonal sensitivity symptomatology to identify core IPSM items in patients with mood disorders. METHODS: The IPSM, a 36-item self-report scale, was utilized to evaluate interpersonal sensitivity symptoms in 837 participants (major depressive disorder [MDD], n=265; bipolar I disorder [BD I], n=126; and bipolar II disorder [BD II], n=446). We performed exploratory graph analysis, employing regularized partial correlation models to estimate the network structure. Centrality analysis identified core IPSM symptoms for each mood disorder group. Network comparison tests assessed structural differences between the MDD and BD subgroups. RESULTS: Network analysis detected five communities. Item 10 ("I worry about being criticized for things that I have said or done") showed the highest value in strength. Multiple items on "Interpersonal Worry/Dependency" and "Low Self-Esteem" showed high strength centrality. Network structure invariance and global strength invariance test results indicated no significant differences between the MDD and BD subgroups. CONCLUSION: Our findings emphasize the importance of addressing "Interpersonal Worry/Dependency" and "Low Self-Esteem" in the IPSM network among mood disorder patients based on core items of the network. Additionally, targeted treatments and comprehensive strategies in this aspect could be crucial for managing mood disorders.

Evaluation of Catatonia with Different Assessment Scales in Psychiatry and Neurology. / Psikiyatri ve Nörolojide Katatoninin Farkli Ölçeklerle Degerlendirilmesi.

OBJECTIVE: Catatonia is a syndrome that can be missed in clinical settings. Diagnosis of catatonia is important because the condition can be reversible and is associated with severe complications. This study aims to screen patients with catatonia admitted to a university hospital's psychiatry and neurology services, examine their characteristics, and compare the coverage of different catatonia scales. METHOD: During a consecutive 20 months study period, the Turkish adaptations of the Bush-Francis Catatonia Rating and the KANNER scales were administered in psychiatry and neurology inpatient units and patients on the waiting list for psychiatric hospitalization. The participants were also evaluated with DSM-5 criteria. In addition, the sociodemographic and clinical characteristics of the patients in the psychiatric group were compared. RESULTS: A total of 214 patients were evaluated. Twenty-eight (13.1%) screened positive for catatonia, and 23 (82.1%) were diagnosed with catatonia according to DSM-5 criteria. KANNER and Bush- Francis identified the same patients as having catatonia. In addition to schizophrenia and mood disorders; neurodevelopmental disorder, encephalitis, postpartum psychosis, obsessive-compulsive disorder, delirium, cerebrovascular disease, functional neurological symptom disorder have also been found to be associated with catatonia. The most common complication was urinary tract infection. Life-threatening complications were also observed. CONCLUSION: Overlooking catatonia may have dire consequences. Adhering solely to the DSM-5 criteria may miss some patients with catatonia. Widely and efficiently using standardized catatonia scales can improve detection capacity and enhance the management of morbidity and mortality.

Clinical experience with parenteral trazodone in mood disorders: A literature review. / Doswiadczenia kliniczne z trazodonem stosowanym droga pozajelitowa w zaburzeniach nastroju: przeglad literatury.

Trazodone is a serotonin antagonist/reuptake inhibitor, approved for treating major depressive disorder (MDD). Oral formulations are widely studied and marketed in several countries worldwide while there is little evidence to support use of parenteral formulation. Our narrative review summarizes pharmacological properties and clinical data concerning use of parenteral trazodone in mood disorders. PubMed and Web of Science were used to identify the most relevant literature. The main evidence concerns four studies evaluating efficacy in major depressive disorder and indicates that trazodone was well tolerated and effective. Off-label use in agitation associated with bipolar disorder is also reported in three studies, although prescription of concomitant treatment, as a confounding factor, may have influenced outcome measures. The limited available evidence supports parenteral trazodone use in major depressive disorder and suggests that trazodone is a suitable option in patients at high risk of treatment-emergent mania (TEM).

Trends in Electroconvulsive Therapy Utilization in South Korea: Health Insurance Review Data From 2008 to 2018.

OBJECTIVE: The study aimed to analyze and clinically correlate 10-year trends in the demographic characteristics of patients receiving electroconvulsive therapy (ECT) to provide an overview of ECT utilization in South Korea. METHODS: Using health insurance claims data from 2008 to 2018 retrieved from Health Insurance Review and Assessment Service database in South Korea, we identified individuals undergoing ECT based on procedural codes. Descriptive analysis evaluated baseline clinical characteristics, and trend analysis used a linear regression model. RESULTS: The prevalence of ECT increased by 240.49% (0.405/105 inhabitants in 2008 to 0.974/105 inhabitants in 2018). The increasing trend was more pronounced in younger and older patients. The proportion of women consistently exceeded that of men. A rise in the proportion of patients with affective disorders, and a decrease in the proportion of psychotic disorders was observed. More antidepressants and atypical antipsychotics were prescribed to patients undergoing ECT. The proportion of ECT sessions conducted in large hospital inpatient settings also decreased during the observation period. Despite increasing global trends, ECT prevalence in South Korea remains significantly lower than worldwide rates. CONCLUSION: This study demonstrated an increasing trend of ECT across a wide range of population demographics and in more accessible settings. The comparatively low prevalence of ECT in Korea compared to other countries might be attributed to insufficient mental health literacy and the stigma associated with ECT. Given the elevated suicide rates in Korea, more extensive adoption of ECT appears imperative.

Prevalence of Depression in Patients and Survivors of Breast Cancer: A Systematic Review.

Depression is an illness prevalent worldwide and much more common in certain groups of people. Individuals suffering from breast cancer as well as the survivors of breast cancer are at an increased risk of developing depression. We conducted this systematic review using articles from different countries of the world to get an estimate of the prevalence of depression in this specified population. For this, we collected about 262 articles from Google Scholar, PubMed, and ScienceDirect, and after strict scrutiny, 13 articles were used to extract our data. From our collected data, we were able to get an estimate of depression prevalence rates among breast cancer patients and survivors globally and identify different factors that affected these rates. More cohort studies must be done so that more precise information about the causes, preventions, and therapies of depression specifically in breast cancer patients and survivors may be gathered.

MoodCapture: Depression Detection Using In-the-Wild Smartphone Images.

MoodCapture presents a novel approach that assesses depression based on images automatically captured from the front-facing camera of smartphones as people go about their daily lives. We collect over 125,000 photos in the wild from N=177 participants diagnosed with major depressive disorder for 90 days. Images are captured naturalistically while participants respond to the PHQ-8 depression survey question: "I have felt down, depressed, or hopeless". Our analysis explores important image attributes, such as angle, dominant colors, location, objects, and lighting. We show that a random forest trained with face landmarks can classify samples as depressed or non-depressed and predict raw PHQ-8 scores effectively. Our post-hoc analysis provides several insights through an ablation study, feature importance analysis, and bias assessment. Importantly, we evaluate user concerns about using MoodCapture to detect depression based on sharing photos, providing critical insights into privacy concerns that inform the future design of in-the-wild image-based mental health assessment tools.

Pharmaceutical-mediated neuroimmune modulation in psychiatric/psychological adverse events.

The therapeutic use of many pharmaceuticals, including small molecules and biological therapies, has been associated with the onset of psychiatric and psychological adverse events (PPAEs), posing substantial concerns to patients' health and safety. These events, which encompass mood (e.g., depression, schizophrenia, suicidal ideation) and cognitive changes (e.g., learning and memory impairment, dementia) often remain undetected until advanced stages of clinical trials or pharmacovigilance, mostly because the mechanisms underlying the onset of PPAEs remain poorly understood. In recent years, the role of neuroimmune modulation (comprising an intricate interplay between various cell types and signaling pathways) in PPAEs has garnered substantial interest. Indeed, understanding these complex interactions would substantially contribute to increase the ability to predict the potential onset of PPAEs during preclinical stages of a new drug's R&D. This review provides a comprehensive summary of the most recent advances in neuroimmune modulation-related mechanisms contributing to the onset of PPAEs and their association with specific pharmaceuticals. Reported data strongly support an association between neuroimmune modulation and the onset of PPAEs. Pharmaceuticals may target specific molecular pathways and pathway elements (e.g., cholinergic and serotonergic systems), which in turn may directly or indirectly impact the inflammatory status and the homeostasis of the brain, regulating inflammation and neuronal function. Also, modulation of the peripheral immune system by pharmaceuticals that do not permeate the blood-brain barrier (e.g., monoclonal antibodies) may alter the neuroimmunomodulatory status of the brain, leading to PPAEs. In summary, this review underscores the diverse pathways through which drugs can influence brain inflammation, shedding light on potential targeted interventions.

Are Depressive Symptoms in Obstructive Sleep Apnea Attributable to a Syndrome of Dysregulation of Rhythms and Hyperactivity (DYMERS)?

Background: Obstructive sleep apnea (OSA) is characterized by repeated airway obstructions during sleep, causing hypopnea, apnea, intermittent hypoxia, and sleep fragmentation. The severity of OSA is measured using the apnea-hypopnea index (AHI), with AHI ≥ 5 indicating OSA. This study aims to assess the frequency and type of depressive disorder characteristics of OSA patients and to evaluate the impact on quality of life, also considering the presence of hyperactivity. Methods: A case-control study using OSA patients referred to Cagliari's sleep disorder center. Controls were matched by age and sex from community databases. OSA diagnoses were made with AHI > 15. Depressive episodes were identified using BDI-SF, and H-QoL (Health related Quality of Life) was measured with the SF-12, focusing on item 10 for hyper-energy. Results: The clinical sample (n = 25) had a higher frequency of depressive episodes (36%) compared to controls (7% and 4%). Depressed OSA patients had worse H-QoL and higher hyper-energy scores, but the additional burden from depression was relatively low. Conclusions: The OSA sample has a higher frequency of depressive episodes compared to the general population. Depressive episodes in OSA patients are linked to higher scores on item 10 of the SF-12, indicating hyper-energy despite lower overall quality of life scores. While OSA significantly impacts quality of life, the additional burden from depression is less severe than in other chronic diseases. These findings suggest that depressive episodes in OSA may be related to rhythm dysregulation and hyperactivity (DYMERS).