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1.
JAMA ; 324(5): 471-480, 2020 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-32749491

RESUMO

Importance: Low levels of 25-hydroxyvitamin D have been associated with higher risk for depression later in life, but there have been few long-term, high-dose large-scale trials. Objective: To test the effects of vitamin D3 supplementation on late-life depression risk and mood scores. Design, Setting, and Participants: There were 18 353 men and women aged 50 years or older in the VITAL-DEP (Vitamin D and Omega-3 Trial-Depression Endpoint Prevention) ancillary study to VITAL, a randomized clinical trial of cardiovascular disease and cancer prevention among 25 871 adults in the US. There were 16 657 at risk for incident depression (ie, no depression history) and 1696 at risk for recurrent depression (ie, depression history but no treatment for depression within the past 2 years). Randomization occurred from November 2011 through March 2014; randomized treatment ended on December 31, 2017, and this was the final date of follow-up. Intervention: Randomized assignment in a 2 × 2 factorial design to vitamin D3 (2000 IU/d of cholecalciferol) and fish oil or placebo; 9181 were randomized to vitamin D3 and 9172 were randomized to matching placebo. Main Outcomes and Measures: The primary outcomes were the risk of depression or clinically relevant depressive symptoms (total of incident and recurrent cases) and the mean difference in mood scores (8-item Patient Health Questionnaire depression scale [PHQ-8]; score range, 0 points [least symptoms] to 24 points [most symptoms]; the minimal clinically important difference for change in scores was 0.5 points). Results: Among the 18 353 randomized participants (mean age, 67.5 [SD, 7.1] years; 49.2% women), the median treatment duration was 5.3 years and 90.5% completed the trial (93.5% among those alive at the end of the trial). Risk of depression or clinically relevant depressive symptoms was not significantly different between the vitamin D3 group (609 depression or clinically relevant depressive symptom events; 12.9/1000 person-years) and the placebo group (625 depression or clinically relevant depressive symptom events; 13.3/1000 person-years) (hazard ratio, 0.97 [95% CI, 0.87 to 1.09]; P = .62); there were no significant differences between groups in depression incidence or recurrence. No significant differences were observed between treatment groups for change in mood scores over time; mean change in PHQ-8 score was not significantly different from zero (mean difference for change in mood scores, 0.01 points [95% CI, -0.04 to 0.05 points]). Conclusions and Relevance: Among adults aged 50 years or older without clinically relevant depressive symptoms at baseline, treatment with vitamin D3 compared with placebo did not result in a statistically significant difference in the incidence and recurrence of depression or clinically relevant depressive symptoms or for change in mood scores over a median follow-up of 5.3 years. These findings do not support the use of vitamin D3 in adults to prevent depression. Trial Registration: ClinicalTrials.gov Identifiers: NCT01169259 and NCT01696435.


Assuntos
Afeto/efeitos dos fármacos , Colecalciferol/uso terapêutico , Depressão/tratamento farmacológico , Transtorno Depressivo/prevenção & controle , Vitaminas/uso terapêutico , Idoso , Colecalciferol/farmacologia , Depressão/prevenção & controle , Suplementos Nutricionais , Método Duplo-Cego , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Recidiva , Inquéritos e Questionários , Vitaminas/farmacologia
3.
Psychopharmacology (Berl) ; 237(8): 2293-2304, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32500212

RESUMO

RATIONALE: Although both psilocybin and dextromethorphan (DXM) produce psychedelic-like subjective effects, rates of non-medical use of psilocybin are consistently greater than DXM. OBJECTIVE: New data are presented from a study of psilocybin and DXM relevant to understanding the features of psilocybin subjective effects that may account for its higher rates of non-medical use. METHODS: Single, acute oral doses of psilocybin (10, 20, 30 mg/70 kg), DXM (400 mg/70 kg), and placebo were administered under double-blind conditions to 20 healthy participants with histories of hallucinogen use. RESULTS: High doses of both drugs produced similar time courses and increases in participant ratings of peak overall drug effect strength. Nine subjective effect domains are proposed to be related to the reinforcing effects of psilocybin: liking, visual effects, positive mood, insight, positive social effects, increased awareness of beauty (both visual and music), awe/amazement, meaningfulness, and mystical experience. For most ratings, (1) psilocybin and DXM both produced effects significantly greater than placebo; (2) psilocybin showed dose-related increases; 3, DXM was never significantly higher than psilocybin; (4) the two highest psilocybin doses were significantly greater than DXM. These differences were consistent with two measures of desire to take the drug condition again. CONCLUSIONS: This analysis provides new information about domains of psilocybin subjective effects proposed to be related to its reinforcing effects (alternatively described as the "motivation" to use). Observed differences on these domains between psilocybin and DXM are consistent with the relative rates of non-medical use of psilocybin and DXM.


Assuntos
Afeto/efeitos dos fármacos , Dextrometorfano/administração & dosagem , Alucinógenos/administração & dosagem , Motivação/efeitos dos fármacos , Psilocibina , Reforço Psicológico , Adulto , Afeto/fisiologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Antagonistas de Aminoácidos Excitatórios/administração & dosagem , Feminino , Seguimentos , Humanos , Masculino , Motivação/fisiologia , Música/psicologia , Psilocibina/administração & dosagem , Estudos Retrospectivos , Autoadministração/psicologia , Adulto Jovem
4.
Psychiatry Res ; 288: 112990, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32353695

RESUMO

Antidepressants have been hypothesized to cause tardive dysphoria-the delayed development of negative emotional symptoms. We assessed the risk of tardive dysphoria in a cohort of persons with migraine taking anti-migraine antidepressants with no known diagnosis of any mood or anxiety disorder. We included all outpatient encounters in a university hospital system for migraine from January 2008 through October 2018, excluding subjects with prior psychiatric diagnoses. Kaplan-Meier survival curves and multivariable Cox proportional hazards analyses were conducted. 13,048 subjects were included; 1191 took an antidepressant; 402 discontinued an antidepressant. In multivariable analyses examining the first year after exposure, antidepressant use was not significantly associated with risk of a depression, any mood disorder (including depression, mania, and other mood disorders), or anxiety. Antidepressant discontinuation was significantly associated with increased risk of depression, but not any mood disorder or anxiety. Among persons with migraine with no known psychiatric diagnosis, antidepressants did not appear to be associated with indicators of tardive dysphoria. Antidepressant discontinuation, however, was associated with increased risk of a depression diagnosis.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/psicologia , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/psicologia , Suspensão de Tratamento/tendências , Adulto , Afeto/efeitos dos fármacos , Afeto/fisiologia , Antidepressivos/farmacologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino
5.
Nat Commun ; 11(1): 2335, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393738

RESUMO

Selective serotonin reuptake inhibitors (SSRIs) constitute a first-line antidepressant intervention, though the precise cognitive and computational mechanisms that explain treatment response remain elusive. Using week-long SSRI treatment in healthy volunteer participants, we show serotonin enhances the impact of experimentally induced positive affect on learning of novel, and reconsolidation of previously learned, reward associations. Computational modelling indicated these effects are best accounted for by a boost in subjective reward perception during learning, following a positive, but not negative, mood induction. Thus, instead of influencing affect or reward sensitivity directly, SSRIs might amplify an interaction between the two, giving rise to a delayed mood response. We suggest this modulation of affect-learning dynamics may explain the evolution of a gradual mood improvement seen with these agents and provides a novel candidate mechanism for the unfolding of serotonin's antidepressant effects over time.


Assuntos
Afeto/efeitos dos fármacos , Serotonina/farmacologia , Adulto , Feminino , Humanos , Aprendizagem/efeitos dos fármacos , Masculino , Recompensa , Inibidores de Captação de Serotonina/farmacologia , Análise e Desempenho de Tarefas , Adulto Jovem
6.
Psychopharmacology (Berl) ; 237(5): 1557-1575, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32236836

RESUMO

RATIONALE: Coping with negative affect is central to several prominent etiological models of alcohol use. These models posit that alcohol use becomes negatively reinforced due to its ability to alleviate negative affect. However, there have been mixed findings when testing this association at the event-level. OBJECTIVES: The current experience sampling study sought to clarify this by testing if (1) within-person changes in the perceived difficulty of managing emotional distress is a significant predictor of alcohol consumption, over and above levels negative and positive affect and (2) whether acute changes in affective experiences give rise to increased attentional bias toward alcohol-related cues in the environment and if attentional bias mediates the association between difficulty managing emotions and alcohol consumption. Participants were 92 college students aged 18-25, who drink alcohol at least moderately. METHODS: Participants completed 28 days of experiencing sampling measures on their mood, difficulty managing emotions, alcohol-related attentional biases, and drinking. RESULTS: Findings showed that neither negative affect nor difficult managing emotions had significant effects on alcohol use. However, positive affect exhibited the expected associations with both attentional biases and drinking. State positive affect predicted acute increases in attentional biases and drinking, whereas trait positive affect was inversely associated with trait attentional biases and alcohol use. Alcohol-related attentional biases exhibited significant within-person variance; however, its relationship with drinking was only significant when the constructs were assessed concurrently at night and did not mediate the relationship between affect and alcohol use. CONCLUSIONS: Results highlight the importance of positive affect in this population.


Assuntos
Afeto/fisiologia , Consumo de Bebidas Alcoólicas/psicologia , Viés de Atenção/fisiologia , Avaliação Momentânea Ecológica , Emoções/fisiologia , Estudantes/psicologia , Adaptação Psicológica/efeitos dos fármacos , Adaptação Psicológica/fisiologia , Adolescente , Adulto , Afeto/efeitos dos fármacos , Viés de Atenção/efeitos dos fármacos , Emoções/efeitos dos fármacos , Feminino , Humanos , Masculino , Reforço Psicológico , Adulto Jovem
7.
Behav Pharmacol ; 31(2&3): 122-135, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32168024

RESUMO

A significant number of patients (30%) do not adequately respond to commonly prescribed antidepressants (e.g. SSRIs, SNRIs, and TCAs). Opioid receptors and their endogenous peptides have demonstrated a clear role in the regulation of mood in animal models and may offer an alternative approach to augment existing therapies. Nevertheless, there is an urgent need to find better ways to predict a patient's response to drug treatment, to improve overall drug responding, and to reduce the time to symptom remission using novel diagnostic and efficacy biomarkers. Cognitive processes, such as perception, attention, memory, and learning, are impaired in patients with mood disorders. These processes can be altered by emotions, a phenomenon called cognitive affective bias. Negative affective biases are a key feature of major depressive disorder (MDD) and may present concurrently with other cognitive deficits. Importantly, a significant percentage of patients report residual cognitive impairments even after effective drug treatment. This approach offers a new opportunity to predict patient treatment responses, potentially improving residual cognitive symptoms and patient outcomes. This review will (1) describe the underlying neurocircuitry of affective cognition and propose how negative biases may occur, (2) outline the role of opioid receptors in affective cognition, executive function, and MDD, and (3) present evidence from the published literature supporting a modulatory role for opioid drugs on negative affective bias, with a focus on kappa-opioid receptor antagonists, currently in development for clinical use for treatment-resistant MDD.


Assuntos
Analgésicos Opioides/farmacologia , Cognição/efeitos dos fármacos , Transtornos do Humor/tratamento farmacológico , Afeto/efeitos dos fármacos , Sintomas Afetivos/tratamento farmacológico , Analgésicos Opioides/metabolismo , Antidepressivos/farmacologia , Atenção/fisiologia , Viés , Transtornos Cognitivos/tratamento farmacológico , Disfunção Cognitiva/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Emoções/fisiologia , Função Executiva , Humanos , Aprendizagem , Memória/fisiologia , Transtornos do Humor/fisiopatologia , Testes Neuropsicológicos , Inibidores de Captação de Serotonina/farmacologia , Inibidores da Recaptação de Serotonina e Norepinefrina/farmacologia
8.
Psychopharmacology (Berl) ; 237(6): 1737-1744, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32157328

RESUMO

RATIONALE: Nicotine patches may be less effective in female compared with male smokers. However, it is unknown if negative affect and physical symptoms influence transdermal nicotine patch-related effects on smoking behaviors. METHODS: Eighty-one acutely tobacco-abstinent premenopausal female smokers attended three counter-balanced experimental sessions across the menstrual cycle (early follicular, late follicular, and mid-luteal) and were randomized to patch condition (nicotine [21 mg] vs. placebo [0 mg] transdermal patch). Negative affect and physical symptoms were assessed prior to patch administration. The patch was removed 5 h post-administration, and participants completed a smoking reinstatement task. Multilevel linear models tested associations of patch condition, negative affect and physical symptoms, and their interaction on smoking behavior. RESULTS: There was a significant patch condition × Negative Affect and Pain symptoms interaction on the number of cigarettes smoked (p < 0.05). When Negative Affect and Pain were lower-than-usual, females administered a nicotine patch smoked significantly fewer cigarettes than females administered a placebo patch (p < .05), but there were no significant patch differences when Negative Affect and Pain were higher-than-usual. There was also a significant patch condition × Negative Affect interaction on time delay. The effects of patch condition on time delay to smoking were greater during sessions in which Negative Affect was higher-than-usual. CONCLUSIONS: Results suggest that among female smokers transdermal nicotine patch effectiveness may interact with negative affect and pain. Understanding and considering female-specific factors that may impact the efficacy of one of the most commonly used cessation medications is important for improving smoking cessation in female smokers.


Assuntos
Afeto/fisiologia , Fumar Cigarros/psicologia , Pré-Menopausa/psicologia , Fumantes/psicologia , Abandono do Hábito de Fumar/psicologia , Dispositivos para o Abandono do Uso de Tabaco , Administração Cutânea , Adulto , Afeto/efeitos dos fármacos , Fumar Cigarros/tratamento farmacológico , Feminino , Humanos , Nicotina/administração & dosagem , Pré-Menopausa/efeitos dos fármacos , Pré-Menopausa/fisiologia , Abandono do Hábito de Fumar/métodos , Resultado do Tratamento
9.
Epilepsy Behav ; 104(Pt A): 106883, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32045874

RESUMO

OBJECTIVE: The objective of this study was to evaluate the efficacy and tolerability of perampanel (PER) in late adjunctive treatment of focal epilepsy. We assessed outcomes 1) according to patients' clinical profiles and the broad mechanism of action (MoA) of concomitant antiepileptic drugs (AEDs) and 2) the effects of PER on adverse events, irritability, mood, and quality of life (QOL). METHODS: Consecutive patients commenced on PER at two epilepsy centers in Melbourne, Australia were identified. A nested cohort underwent detailed prospective assessment, while the remainder were retrospectively analyzed. Six- and 12-month efficacy endpoints were at least a 50% reduction in seizure frequency (responders) and complete seizure freedom. The prospective cohort underwent standardized validated questionnaires at 0, 1, 3, 6, and 12 months using the modified semi-structured seizure interview (SSI), Liverpool Adverse Events Profile (LAEP), Quality of Life in Epilepsy-Patient-Weighted (QOLIE-10-P), Neurological Disorders Depression Inventory Epilepsy (NDDI-E), and an Irritability Questionnaire. RESULTS: One hundred sixty patients were followed for a median of 6 months: the mean number of prior AEDs was 6, 99% had drug-resistant epilepsy, and 72% had never experienced a prior seizure-free period of at least 6 months (=continuously refractory epilepsy). Perampanel was associated with responder and seizure freedom rates of 30.6% and 9.4% at 6 months and 19.4% and 4.4% (5.6% adjusted for the titration period) at 12 months. Having "continuously refractory epilepsy" was associated with a reduced likelihood of seizure freedom at 6 months (5% vs. 30%; p = 0.001) and 12 months (3% vs. 13%; p = 0.058). Quality of Life in Epilepsy-Patient-Weighted, irritability, and NDDI-E showed mean improvement at 6 months from baseline. SIGNIFICANCE: Even when used as late add-on adjunctive therapy in patients with highly refractory focal epilepsy, PER can result in 12-month seizure freedom of 5.6%. The likelihood of seizure freedom was associated with prior "continuous medication refractoriness". Six months after introduction of PER patients reported improved mood, QOL, and decreased irritability.


Assuntos
Anticonvulsivantes/administração & dosagem , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Epilepsia Resistente a Medicamentos/psicologia , Humor Irritável/efeitos dos fármacos , Piridonas/administração & dosagem , Qualidade de Vida/psicologia , Adulto , Afeto/efeitos dos fármacos , Afeto/fisiologia , Estudos de Coortes , Quimioterapia Combinada , Feminino , Humanos , Humor Irritável/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Convulsões/tratamento farmacológico , Convulsões/psicologia , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
10.
Psychopharmacology (Berl) ; 237(5): 1407-1420, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32009196

RESUMO

RATIONALE: The role of negative affect as a motivational factor in animal models of drug addiction has been underexplored in the context of cocaine self-administration. OBJECTIVES: The present investigation studied the relationship between magnitude of affective response and quantity of cocaine consumed in order to clarify the affective components that drive drug use in a preclinical model. METHODS: Rats self-administered (SA) cocaine 6 h/day for 14 consecutive days while their ultrasonic vocalizations (USVs) were recorded. RESULTS: Animals displayed an increase in 50-kHz call rates (indicating positive affect) when their drug levels were rapidly rising and an increase in 22-kHz call rates (indicating negative affect) when forced to abstain. The rate of 50-kHz calls predicted drug consumption during the 1st week of SA, but not week two. Contrarily, there was a strongly predictive positive association between rate of 22-kHz calls and amount of drug consumed during the 2nd week of SA. CONCLUSIONS: Experimental results indicate that after chronic cocaine self-administration, negative affect emerges when animals are deprived of expected drug during withdrawal. Moreover, the increase in USVs indicating negative affect when deprived of drug was directly related to drug intake, concurrent with a decay in the direct relationship between USVs indicating positive affect and drug intake. The present preclinical support for the widely hypothesized shift from positive to negative affect as a salient motivational factor in human drug abuse adds to growing evidence of the unique value of rat USVs for understanding the role of emotion in drug addiction.


Assuntos
Afeto/efeitos dos fármacos , Cocaína/administração & dosagem , Motivação/efeitos dos fármacos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Vocalização Animal/efeitos dos fármacos , Afeto/fisiologia , Animais , Inibidores da Captação de Dopamina/administração & dosagem , Feminino , Masculino , Motivação/fisiologia , Ratos , Ratos Long-Evans , Autoadministração/psicologia , Vocalização Animal/fisiologia
11.
Cerebrovasc Dis ; 49(1): 19-25, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32023608

RESUMO

BACKGROUND: We aimed to examine sex differences in symptom characteristics and pharmacological responses in post-stroke depressive (PSD) symptoms. METHODS: This is a post hoc analysis of EMOTION (ClinicalTrials.gov, NCT01278498), a randomized, placebo-controlled, double-blind trial that examined the efficacy of escitalopram for 3 months on depression in patients with acute stroke. Depressive symptoms were evaluated using the 10-item Montgomery-Åsberg Depression Rating Scale (MADRS). Baseline characteristics, clinical variables, and treatment responses to escitalopram were compared between male and female patients. Treatment responses were defined as changes in MADRS (total score and its components) between baseline and 3 months and were compared between the escitalopram and placebo groups within each sex group. The least square mean was calculated to determine the independent effect of escitalopram, of which interaction was evaluated with patient sex. RESULTS: Of the 478 patients (intention-to-treat population), 187 (39%) were female. Female patients were significantly older than male patients and demonstrated more severe depressive symptoms at baseline (male vs. female, MADRS score, mean [SD]: 9.7 ± 8.0 vs. 12.2 ± 8.4, p = 0.001), especially in apparent sadness, reported sadness, and reduced appetite items. These differences were significant after adjustment for age and the severity of neurologic deficits. The female escitalopram group showed a significant 3-month improvement in MADRS scores (placebo [n = 86] vs. escitalopram [n = 101], least square mean [95% CI] -2.7 [-4.1 to -1.2] vs. -5.0 [-6.4 to -3.6], p = 0.007), and this efficacy was prominent in apparent sadness, reported sadness, and pessimistic thoughts items. However, there was no significant effect of escitalopram on depressive symptoms in the male group. The treatment responses of escitalopram tended to be more pronounced in the female group, particularly in alleviating a subset of depressive symptoms such as apparent sadness (p for interaction = 0.009). CONCLUSION: PSD may differ according to sex in its symptom characteristics and treatment responses to escitalopram, and tailored treatment strategies for PSD may therefore be needed.


Assuntos
Afeto/efeitos dos fármacos , Antidepressivos de Segunda Geração/uso terapêutico , Citalopram/uso terapêutico , Depressão/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Acidente Vascular Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , Depressão/diagnóstico , Depressão/etiologia , Depressão/psicologia , Método Duplo-Cego , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/psicologia , Fatores de Tempo , Resultado do Tratamento
12.
J Stroke Cerebrovasc Dis ; 29(5): 104664, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32093988

RESUMO

OBJECTIVE: The purpose of our study is to evaluate the efficacy of paroxetine in poststroke depression (PSD) patients by conducting a meta-analysis. METHODS: We searched Web of Science (science and social science citation index), PubMed, the Cochrane Central Register of Controlled Trials, Embase up to August 2019. Randomized controlled trials that paroxetine compared to other antidepressants or control treatments as monotherapy for patients with PSD. RESULTS: This review identified a total of 4 studies including 212 patients. This meta-analysis presented that paroxetine exhibits beneficial efficacy than routine treatment in PSD patients in terms of the reducing score of Hamilton Depression Scale (HAMD). Control treatment is more effective than paroxetine. No significant advantage was found with paroxetine. CONCLUSIONS: The efficacy of paroxetine maybe not very significant compared to other pharmacological and nonpharmacological interventions. Further high quality and large sample size studies are needed to evaluate the efficacy and safety of paroxetine in treating PSD in future.


Assuntos
Afeto/efeitos dos fármacos , Antidepressivos de Segunda Geração/uso terapêutico , Depressão/tratamento farmacológico , Paroxetina/uso terapêutico , Inibidores de Captação de Serotonina/uso terapêutico , Acidente Vascular Cerebral/complicações , Antidepressivos de Segunda Geração/efeitos adversos , Depressão/diagnóstico , Depressão/etiologia , Depressão/psicologia , Humanos , Paroxetina/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Inibidores de Captação de Serotonina/efeitos adversos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/psicologia , Fatores de Tempo , Resultado do Tratamento
13.
Plast Reconstr Surg ; 145(2): 316e-323e, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985627

RESUMO

BACKGROUND: Perioperative use of opioids is common in surgical practice and frequently results in troublesome opioid-related side effects that often lead to suboptimal postsurgical outcomes. As such, multiple studies have sought to identify alternatives that may reduce reliance on opioid-based perioperative pain management. Recently, it has been shown that patient education and patient involvement in care positively impact surgical outcomes. This study evaluates how patient education regarding the role of endogenous beta-endorphins in reducing pain and the opposing effect of opioid analgesics impacts opioid consumption and mood after surgery. METHODS: Patients scheduled for breast augmentation were divided into two groups, A and B. Both groups received identical multimodal anesthesia regimens; however, only patients in group B were educated on the role of endogenous beta-endorphins in pain control and mood enhancement, and how opioids block their action. RESULTS: Patients in the group receiving preoperative education on the analgesic and mood-enhancing role of endogenous beta-endorphins and how opioids block their action consumed significantly less opioids and had better postsurgical outcomes as determined by self-reported measures of pain level and mood/sense of well-being. CONCLUSIONS: The findings of this study suggest that opioid use was significantly reduced and patients' mood/sense of well-being was significantly enhanced when patients received preoperative education on the oppositional relationship between beta-endorphins and opioids. Such patient education may be linked to a significant reduction in opioid use and improved patient mood/sense of well-being, especially when combined with opioid-free multimodal anesthesia. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Afeto/efeitos dos fármacos , Analgésicos Opioides/efeitos adversos , Mamoplastia , Manejo da Dor/métodos , Educação de Pacientes como Assunto/métodos , Adulto , Feminino , Humanos , Estudos Prospectivos , Adulto Jovem
14.
Nutrients ; 12(1)2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31963141

RESUMO

Vitamins and minerals are essential to humans as they play essential roles in a variety of basic metabolic pathways that support fundamental cellular functions. In particular, their involvement in energy-yielding metabolism, DNA synthesis, oxygen transport, and neuronal functions makes them critical for brain and muscular function. These, in turn, translate into effects on cognitive and psychological processes, including mental and physical fatigue. This review is focused on B vitamins (B1, B2, B3, B5, B6, B8, B9 and B12), vitamin C, iron, magnesium and zinc, which have recognized roles in these outcomes. It summarizes the biochemical bases and actions of these micronutrients at both the molecular and cellular levels and connects them with cognitive and psychological symptoms, as well as manifestations of fatigue that may occur when status or supplies of these micronutrients are not adequate.


Assuntos
Transtornos Cognitivos/tratamento farmacológico , Cognição/efeitos dos fármacos , Metabolismo Energético/efeitos dos fármacos , Fadiga/tratamento farmacológico , Minerais/administração & dosagem , Vitaminas/administração & dosagem , Afeto/efeitos dos fármacos , Animais , Ácido Ascórbico/administração & dosagem , Deficiência de Ácido Ascórbico/metabolismo , Deficiência de Ácido Ascórbico/fisiopatologia , Deficiência de Ácido Ascórbico/prevenção & controle , Deficiência de Ácido Ascórbico/psicologia , Transtornos Cognitivos/metabolismo , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Fadiga/metabolismo , Fadiga/fisiopatologia , Fadiga/psicologia , Humanos , Ferro/administração & dosagem , Magnésio/administração & dosagem , Minerais/efeitos adversos , Estado Nutricional , Complexo Vitamínico B/administração & dosagem , Deficiência de Vitaminas do Complexo B/metabolismo , Deficiência de Vitaminas do Complexo B/fisiopatologia , Deficiência de Vitaminas do Complexo B/prevenção & controle , Deficiência de Vitaminas do Complexo B/psicologia , Vitaminas/metabolismo , Zinco/administração & dosagem
15.
J Stroke Cerebrovasc Dis ; 29(4): 104561, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31941579

RESUMO

BACKGROUND: Poststroke depression (PSD) affects one-third of stroke patients and is linked with higher stroke morbidity, mortality, and recurrence. Current guidelines do not direct when to screen for PSD, and predictors of PSD are not well understood. We sought to understand progression of PSD symptoms early after ischemic stroke, identify predictors of PSD, and describe the use of antidepressants in PSD. METHODS: We collected demographic, clinical, and PSD (Patient Health Questionnaire-9; PHQ-9) data from ischemic stroke patients hospitalized at our Comprehensive Stroke Center and followed up in our clinic. PHQ-9 was obtained during hospitalization and again in clinic within 180 days of discharge. We performed univariate analysis and logistic regression to detect variables associated with PSD. RESULTS: Among 201 patients, PSD symptoms (PHQ-9 > 4) were identified in 30% of patients during hospitalization and 46% during follow-up (54% of which had no symptoms during hospitalization). At follow-up, 36% were worse by PHQ-9 category. In univariate analysis, follow-up modified Rankin Scale (mRS) greater than or equal to 2 (P = .03) and antidepressant prescription (P < .001) were associated with worsening PHQ-9 category. In logistic regression analysis, follow-up mRS greater than or equal to 2 (P = .02), posterior circulation stroke (P = .03), and antidepressant prescription (P < .01) were associated with worsening PHQ-9 category. CONCLUSIONS: Almost half of ischemic stroke patients develop PSD symptoms and more than one-third worsen between hospitalization and follow-up. Poststroke disability (mRS ≥ 2) and posterior circulation stroke were associated with worsening PSD. Worsening PSD symptoms prompted treatment change in 29% of patients. Screening for PSD during hospitalization should be repeated during early follow-up.


Assuntos
Afeto , Isquemia Encefálica/complicações , Depressão/diagnóstico , Questionário de Saúde do Paciente , Acidente Vascular Cerebral/complicações , Afeto/efeitos dos fármacos , Idoso , Antidepressivos/uso terapêutico , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/psicologia , Isquemia Encefálica/terapia , Depressão/tratamento farmacológico , Depressão/etiologia , Depressão/psicologia , Avaliação da Deficiência , Progressão da Doença , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Prevenção Secundária , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/psicologia , Fatores de Tempo , Resultado do Tratamento
16.
Proc Natl Acad Sci U S A ; 117(5): 2338-2346, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-31964815

RESUMO

Past research suggests that use of psychedelic substances such as LSD or psilocybin may have positive effects on mood and feelings of social connectedness. These psychological effects are thought to be highly sensitive to context, but robust and direct evidence for them in a naturalistic setting is scarce. In a series of field studies involving over 1,200 participants across six multiday mass gatherings in the United States and the United Kingdom, we investigated the effects of psychedelic substance use on transformative experience, social connectedness, and positive mood. This approach allowed us to test preregistered hypotheses with high ecological validity and statistical precision. Controlling for a host of demographic variables and the use of other psychoactive substances, we found that psychedelic substance use was significantly associated with positive mood-an effect sequentially mediated by self-reported transformative experience and increased social connectedness. These effects were particularly pronounced for those who had taken psychedelic substances within the last 24 h (compared to the last week). Overall, this research provides robust evidence for positive affective and social consequences of psychedelic substance use in naturalistic settings.


Assuntos
Afeto/efeitos dos fármacos , Alucinógenos/farmacologia , Relações Interpessoais , Personalidade/efeitos dos fármacos , Adolescente , Adulto , Feminino , Alucinógenos/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Fatores de Tempo , Reino Unido , Estados Unidos , Adulto Jovem
17.
Psychopharmacology (Berl) ; 237(4): 1223-1231, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31938877

RESUMO

RATIONALE: Barriers to smoking cessation, including negative affect and cognitive dysfunction, may contribute to high smoking rates among people living with HIV/AIDS (PLWH). Varenicline may help PLWH quit smoking by improving mood and cognition, yet this has not been explored. OBJECTIVES: The goal of this study was to evaluate the effect of varenicline on mood and cognition among PLWH enrolled in a smoking cessation clinical trial. METHODS: In this secondary analysis of a varenicline trial (NCT01710137), we assessed mood (depression, anxiety) and cognition (attention, working memory) at weeks 0 (baseline), 1, 3, and 12 (end-of-treatment, EOT). Primary outcomes were changes in mood and cognition from baseline to EOT. Secondarily, mood and cognition were evaluated as predictors of biochemically confirmed 7-day point-prevalence abstinence at EOT. RESULTS: Overall, 173 subjects (87 varenicline, 86 placebo) were included. At EOT, varenicline reduced anxiety (P < 0.001), vs. placebo (P = 0.31; interaction P = 0.05). Across both treatment arms, reductions in anxiety from baseline to EOT were associated with a higher likelihood of abstinence (OR = 1.3, 95% CI 1.1 to 1.6, P = 0.01). There were no significant treatment by time interactions for cognition or depression. CONCLUSIONS: These data suggest that varenicline operates, at least in part, by reducing anxiety. Anxiety should be an intervention target for smokers with HIV interested in quitting.


Assuntos
Afeto/efeitos dos fármacos , Fumar Cigarros/psicologia , Cognição/efeitos dos fármacos , Infecções por HIV/psicologia , Fumantes/psicologia , Vareniclina/uso terapêutico , Adulto , Afeto/fisiologia , Ansiedade/tratamento farmacológico , Ansiedade/epidemiologia , Ansiedade/psicologia , Fumar Cigarros/tratamento farmacológico , Fumar Cigarros/epidemiologia , Cognição/fisiologia , Feminino , Seguimentos , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/psicologia , Agentes de Cessação do Hábito de Fumar/farmacologia , Agentes de Cessação do Hábito de Fumar/uso terapêutico , Vareniclina/farmacologia , Adulto Jovem
18.
J Manag Care Spec Pharm ; 26(1): 16-20, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31880219

RESUMO

DISCLOSURES: Funding for this summary was contributed by the Laura and John Arnold Foundation, National Institute for Health Care Management, California Health Care Foundation, Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Healthcare, and Kaiser Foundation Health Plan to the Institute for Clinical and Economic Review (ICER), an independent organization that evaluates the evidence on the value of health care interventions. ICER's annual policy summit is supported by dues from Aetna, America's Health Insurance Plans, Anthem, AstraZeneca, Allergan, Alnylam, Biogen, Blue Shield of California, Cambia Health Services, CVS Caremark, Editas, Express Scripts, Genentech, GlaxoSmithKline, Harvard Pilgrim Health Care, Health Care Service Corporation, HealthPartners, HealthFirst, Johnson & Johnson (Janssen), Kaiser Permanente, LEO Pharma, Mallinkrodt Pharmaceuticals, Merck, Novartis, National Pharmaceutical Council, Premera, Prime Therapeutics, Regeneron, Sanofi, Spark Therapeutics, and United Healthcare. Agboola, Fazioli, and Pearson are employed by ICER. Touchette reports grants from ICER during the course of this work and personal fees from Monument Analytics, unrelated to this work. Atlas has nothing to disclose.


Assuntos
Afeto/efeitos dos fármacos , Antidepressivos/administração & dosagem , Antidepressivos/economia , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/economia , Custos de Medicamentos , Ketamina/administração & dosagem , Ketamina/economia , Administração Intranasal , Adolescente , Adulto , Aerossóis , Idoso , Antidepressivos/efeitos adversos , Pesquisa Comparativa da Efetividade , Análise Custo-Benefício , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Transtorno Depressivo Resistente a Tratamento/psicologia , Medicina Baseada em Evidências , Feminino , Humanos , Ketamina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Formulação de Políticas , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Adulto Jovem
20.
Psychopharmacology (Berl) ; 237(3): 869-876, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31844937

RESUMO

BACKGROUND: Gaze direction is an important cue of the eye region. Previous studies have revealed that oxytocin (OXT) increases orienting to the eye region of face. However, little has been known about the effect of OXT in men and women on the perception of gaze direction particularly when associated with different emotions. OBJECTIVES: We investigated how oxytocin would affect gaze direction judgments for threatening, angry, and neutral facial expressions and whether this effect would be modulated by observers' sex. METHODS: We used the cone of direct gaze (CoDG) task. Participants were required to judge the gaze direction of face between directed and averted gaze. RESULTS: Results showed opposing sex-dependent effects of OXT such that OXT, as compared with placebo, tended to decrease the CoDG in men but increase it in women. The CoDG was marginally wider in men than in women in the placebo condition, and however, this difference was abolished following OXT treatment. We also found that the perception of gaze direction varied as a function of emotional expression such that the CoDG for angry and neutral faces was wider than that for fearful faces and the CoDG for angry faces was marginally wider than that for neutral ones. However, there was no significant interaction between treatment and facial expression. CONCLUSIONS: Our findings provide the first evidence for sex-dependent effects of OXT on gaze direction perception, suggesting that OXT attenuates the self-referential judgment of gaze directions of others in men and enhances it in women despite differentiated emotions of faces.


Assuntos
Expressão Facial , Fixação Ocular/efeitos dos fármacos , Ocitocina/farmacologia , Estimulação Luminosa/métodos , Caracteres Sexuais , Percepção Visual/efeitos dos fármacos , Adolescente , Adulto , Afeto/efeitos dos fármacos , Afeto/fisiologia , Estudos Cross-Over , Método Duplo-Cego , Emoções/efeitos dos fármacos , Emoções/fisiologia , Feminino , Fixação Ocular/fisiologia , Humanos , Julgamento/efeitos dos fármacos , Julgamento/fisiologia , Masculino , Orientação/efeitos dos fármacos , Orientação/fisiologia , Percepção Visual/fisiologia , Adulto Jovem
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