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1.
Adv Exp Med Biol ; 1191: 219-235, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002932

RESUMO

Although anxiety and depression have been considered as two distinct entities according to the diagnostic criteria, anxious depression (comorbid anxiety and depression) is relatively a common syndrome. According to the DSM-5 criteria, it uses "with anxious distress specifier" to define anxious depression in its MDD section. Anxious depression is known to have different neurobiological profiles compared to non-anxious depression. Several studies have revealed significant differences between anxious depression and non-anxious depression regarding the hypothalamic-pituitary-adrenal (HPA) axis function, structural and functional brain imaging findings, inflammation markers, etc. Patients with anxious depression were significantly more likely to be found in primary care setting and more likely to be associated with female gender, non-single, unemployed, less educated, and more severe depression. Previous reports also showed that patients with anxious depression had more frequent episodes of major depression and a higher risk of suicidal ideation and previous suicide attempts than those with non-anxious depression. Although anxious depression is known to be associated with poor treatment outcomes in several studies, recent researches have sought to find better treatment strategy to improve patients with anxious depression.


Assuntos
Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/terapia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/terapia , Ansiedade/complicações , Ansiedade/diagnóstico , Ansiedade/terapia , Transtornos de Ansiedade/diagnóstico , Comorbidade , Depressão/complicações , Depressão/diagnóstico , Depressão/terapia , Transtorno Depressivo Maior/diagnóstico , Humanos
2.
Praxis (Bern 1994) ; 109(1): 9-12, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31910766

RESUMO

PsyCoLaus: A Prospective Study of the Links between Mental Health and Cardiovascular Diseases Abstract. PsyCoLaus, which includes an investigation of mental disorders and cognitive functioning, aims to determine the prevalence and the course of mental disorders in the general population and to study the mechanisms underlying the association between these disorders and cardiovascular diseases. This investigation revealed a very high lifetime prevalence rate of 43.6 % for major depressive disorder in Lausanne. We have also observed that the association between major depression and cardio-metabolic risk factors is essentially attributable to the atypical subtype, characterized by an increased appetite, heaviness in limbs, hypersomnia and conserved affective reactivity. Patients who suffer from this type of depression have an increased risk to develop overweight, diabetes and the metabolic syndrome and deserve particular clinical attention on the metabolic level.


Assuntos
Transtorno Depressivo Maior , Síndrome Metabólica , Comorbidade , Depressão , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/epidemiologia , Humanos , Síndrome Metabólica/complicações , Estudos Prospectivos
3.
Psychiatr Hung ; 35(1): 58-67, 2020.
Artigo em Húngaro | MEDLINE | ID: mdl-31854323

RESUMO

INTRODUCTION: Several long-term follow-up studies investigate the progression of adolescent onset major depressive disorder but much less explore short and long-term consequences and prognosis into adulthood of childhood- onset depression. The aim of the present study is to follow childhood-onset depression, lifetime comorbid psychiatric disorders and suicidal behavior into adulthood. METHODS: Subjects (N=166) were 25.95+2.42 years old on average, 54.2% were women. Follow-up period lasted for a mean of 14.74+1.31 years. Psychiatric diagnosis was assessed by a DSM-IV based semi-structured interview. Subjects reported on 4 stages of suicidal behavior as one of the symptoms of depressive disorder. RESULTS: The onset of the first depressive episode was at the mean age of 10.17+2.34 years. 40,4% of the sample had only 1 episode while recurrent depressive episode presented in 32.5% above 18 years of age. Lifetime comorbid psychiatric disorders were present in more than 1/3 of the sample. The most frequent lifetime comorbidity was anxiety (42.4%), and specific phobia among anxiety disorders. Lifetime attention deficit-hyperactivity disorder and oppositional/conduct disorder were also frequent (25.9% and 16.9%, respectively). Suicidal behavior was not present life-time in 19.1% of the sample. Thoughts of death and thoughts of suicide were quite frequent (80.8% and 69.5%, respectively), specific plans and suicidal attempt were more frequent in girls (plan:female vs male 53.9% vs 38.4%, attempt: 33.3% vs 9.6%) during follow-up. CONCLUSION: About one-third of childhood-onset depression had recurrence above 18 years of age, which is lower than the recurrence rate for adolescent onset depression. A high rate of lifetime comorbidity was found between depression and anxiety disorders. The assessment of the actual level of suicidal behavior is important in the prevention of selfdestructive behavior.


Assuntos
Depressão/diagnóstico , Depressão/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Suicídio/psicologia , Adolescente , Adulto , Idade de Início , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Criança , Comorbidade , Depressão/complicações , Transtorno Depressivo Maior/complicações , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Fatores de Risco , Adulto Jovem
4.
Medicine (Baltimore) ; 98(37): e17174, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517872

RESUMO

HIV-positive individuals encounter a number of negative life events (NLEs). This cross-sectional study aimed to evaluate the association between NLEs and major depressive disorder (MDD) among HIV-positive individuals in Guangdong, China, about which little is known.HIV-positive individuals were recruited from the Centers for Disease Prevention and Control of Guangzhou, Zhongshan, and Yangjiang from September 2007 to September 2008. Data on NLEs were collected using a questionnaire. The Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Patient Edition (SCID-I/P) based on the DSM-IV criteria was used to diagnose MDD. Multiple logistic regression analyses were conducted to evaluate the association between NLEs and MDD.Among the 339 participants, 306 (90.27%) reported that one or more NLEs had ever occurred. Participants who reported NLEs that included HIV infection, financial problems, AIDS diagnosis, HIV/AIDS discrimination, conflict with spouse or lover, conflict with other family members, problems in childbearing, and conflict with nonfamily were at a higher risk of MDD. Participants who reported more NLEs in the last year had a higher risk of MDD (OR = 2.86, 95%CI: 1.76-4.65) than individuals who reported fewer NLEs. Individuals with higher chronic stress scores had a higher risk of MDD (OR = 4.36, 95%CI: 2.44-7.78) than individuals with lower chronic stress scores. However, acute stress was not associated with MDD.NLEs were common among HIV-positive individuals. MDD was associated with a greater number of NLEs and the increased chronic stress caused by the NLEs. Interventions should be tailored to those who reported NLEs to help reduce the risk of MDD and increase the quality of life among HIV-positive individuals.


Assuntos
Transtorno Depressivo Maior/complicações , Infecções por HIV/complicações , Infecções por HIV/psicologia , Adolescente , Adulto , China , Estudos Transversais , Transtorno Depressivo Maior/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estresse Psicológico/complicações , Estresse Psicológico/epidemiologia , Adulto Jovem
5.
J Clin Neurosci ; 69: 21-25, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31473092

RESUMO

This study evaluated suicidality and its risk factors in patients with tension-type headache (TTH). We recruited new patients with TTH who visited general hospitals. We recorded their clinical characteristics and conducted the Headache Impact Test-6 (HIT-6) and the Insomnia Severity Index (ISI) for assessment. We also interviewed the patients to identify major depressive disorder (MDD), generalized anxiety disorder (GAD), and suicidality with the Mini International Neuropsychiatric Interview-Plus Version 5.0.0 (MINI). The frequency of suicidality was compared between TTH patients and healthy controls. Major risk factors for suicidality were also determined. A total of 332 TTH patients with the same number of healthy controls were recruited from five general hospitals. Suicidality was observed in 82 (24.7%) TTH patients. The frequency of suicidality was significantly higher in patients with TTH than in the controls. Furthermore, the frequency of suicidality was higher in patients with chronic TTH (CTTH) than in the controls. The major risk factors for suicidality were MDD, GAD, a low education level, insomnia, chronicity of TTH, and pericranial tenderness. Suicidal ideation or attempt seems to be a common feature in TTH. Therefore, it is important to identify risk factors related to suicidality in TTH patients, which may help reduce suicidality.


Assuntos
Ideação Suicida , Cefaleia do Tipo Tensional/psicologia , Adulto , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/psicologia , Estudos de Casos e Controles , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Fatores de Risco
6.
BMJ Case Rep ; 12(8)2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401578

RESUMO

This paper describes a patient who presented with treatment-resistant depression with comorbid anxiety symptoms in the context of Huntington's disease (HD) and developed worsening movement disorder symptoms after commencing electroconvulsive therapy (ECT) for depression. The aim of this case report is to provide medical practitioners with a greater awareness of the possibility of worsening movement disorders when using ECT for depression in a patient with HD.


Assuntos
Transtorno Depressivo Maior/terapia , Progressão da Doença , Eletroconvulsoterapia/efeitos adversos , Doença de Huntington/psicologia , Ansiedade/complicações , Transtorno Depressivo Maior/complicações , Feminino , Humanos , Doença de Huntington/complicações , Pessoa de Meia-Idade
7.
Lancet Psychiatry ; 6(10): 851-861, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31422920

RESUMO

BACKGROUND: Substantial evidence suggests that cognitive deficits might persist after remission of a major depressive episode. However, results are inconsistent relative to the importance, pattern, severity, and moderating factors of this impairment. We aimed to determine how cognitive function following a major depressive episode compares with normal function, to specify the pattern and severity of persistent cognitive dysfunctions, and to examine the potential moderator effect of ten prespecified clinical and demographic variables. METHODS: We did a systematic review and meta-analysis of the published research. We searched systematically MEDLINE, Embase, PsycARTICLES, PsycINFO, the Cochrane Library, and relevant reviews identified by our database search, for research published from Jan 1, 1972, up to Jan 31, 2018, for studies of patients with past depression. We included all independent studies of patients who were assessed while in remission from a major depressive episode with at least one cognitive test, with inclusion of a healthy control group assessed with either the same test(s) as the major depressive episode group or with a standardised test with published age-stratified normative data. The main outcome was the difference in cognitive performance between major depressive episode remitters and healthy controls. Effect sizes were calculated using random-effects models for cognitive outcomes classified into 18 standard domains. Moderators of between-study variability were assessed using mixed-effects subgroup analyses and meta-regressions. FINDINGS: Of 10 126 citations identified by our search, 75 cognitive variables from 252 eligible studies (11 882 major depressive episode remitters and 8533 healthy controls) were included in our meta-analysis. Significant deficits following major depressive episode remission were observed in 55 (73%) of the 75 cognitive variables. These deficits (in the domains of processing speed, visual selective attention, working memory, verbal learning, and executive functioning), were generally small (30 [40%] of the 75 variables) or medium (22 [29%]) in size, although three long-term memory variables showed large deficits: g=-0·81 [95% CI -1·01 to -0·61] for logical memory immediate recall, g=-0·88 [-1·19 to -0·57] for logical memory delayed recall, and g=-0·84 [-1·18 to -0·50] for Cambridge Neuropsychological Test Automated Battery pattern recognition latency. Auditory attention, general autobiographical memory, inhibition ability unconstrained by speed, and intellectual functioning unconstrained by speed were equivalent between major depressive episode remitters and matched controls. The number of previous depressive episodes explained heterogeneity in the majority of variables (z=-2·06 [p=0·039] to z=-4·26 [p<0·0001]). INTERPRETATION: Deficits in selective attention, working memory, and long-term memory persist in remission from a major depressive episode and worsen with repeated episodes. Depression treatments, including relapse prevention, need to target these cognitive functions to optimise prognosis. FUNDING: None.


Assuntos
Disfunção Cognitiva/etiologia , Transtorno Depressivo Maior/complicações , Humanos
9.
J Diabetes Res ; 2019: 2634094, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31218230

RESUMO

Introduction: Diabetes mellitus type 1 and type 2 are linked to higher prevalence and occurrences of depression. Internet-based depression- and diabetes-specific cognitive behavioral therapies (CBT) can be effective in reducing depressive symptom severity and diabetes-related emotional distress. The aim of the study was to test whether disease-specific severity indicators moderate the treatment outcome in a 6-week minimally guided web-based self-help intervention on depression and diabetes (GET.ON Mood Enhancer Diabetes (GET.ON M.E.D.)) and to determine its effectiveness in a nonsuicidal severely depressed subgroup. Methods: Randomized controlled trial- (RCT-) based data (N = 253) comparing GET.ON M.E.D. to an online psychoeducation control group was used to test disease-specific severity indicators as predictors/moderators of a treatment outcome. Changes in depressive symptom severity and treatment response were examined in a nonsuicidal severely depressed subgroup (CES - D > 40; N = 40). Results: Major depressive disorder diagnosis at the baseline (p prf6 = 0.01), higher levels of depression (Beck Depression Inventory II; p prpo = 0.00; p prf6 = 0.00), and lower HbA1c (p prpo = 0.04) predicted changes in depressive symptoms. No severity indicator moderated the treatment outcome. Severely depressed participants in the intervention group showed a significantly greater reduction in depressive symptom severity (d prpo = 2.17, 95% Confidence Interval (CI): 1.39-2.96) than the control condition (d prpo = 0.92; 95% CI: 0.001-1.83), with a between-group effect size of d prpo = 1.05 (95% CI: 0.11-1.98). Treatment response was seen in significantly more participants in the intervention (4/20; 20%) compared to the control group (0/20, 0%; χ 2 (2)(N = 40) = 4.44; p < 0.02). At the 6-month follow-up, effects were maintained for depressive symptom reduction (d pr6f = 0.71; 95% CI: 0.19-1.61) but not treatment response. Conclusion: Disease-specific severity indicators were not related to a differential effectiveness of guided self-help for depression and diabetes. Clinical meaningful effects were observed in nonsuicidal severely depressed individuals, who do not need to be excluded from web-based guided self-help. However, participants should be closely monitored and referred to other treatment modalities in case of nonresponse.


Assuntos
Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/terapia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Internet , Autocuidado , Grupos de Autoajuda , Adulto , Afeto , Terapia Cognitivo-Comportamental/métodos , Comorbidade , Interpretação Estatística de Dados , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Linguagem , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Psicoterapia , Índice de Gravidade de Doença , Ideação Suicida , Inquéritos e Questionários , Resultado do Tratamento
10.
Expert Opin Pharmacother ; 20(11): 1341-1349, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31046480

RESUMO

INTRODUCTION: Insomnia in Major Depressive Disorder (MDD) is highly prevalent and associated with increased suffering and functional impairment. Effective, evidence-based treatments for insomnia in MDD are an unmet need in clinical practice. AREAS COVERED: Herein, the authors provide a review of the clinical correlates, putative neurobiological mechanisms and treatment options for the management of insomnia in individuals with MDD. EXPERT OPINION: Sleep disturbances in MDD should be recognized as at least one of the following: (1) a domain of depressive psychopathology; (2) a consequence of rhythm disruptions; (3) a manifestation of comorbidities of sleep disturbances; (4) a manifestation of the influence of sex hormones in the brain in MDD; (5) a general medical comorbidity; and (6) a side effect of antidepressant medications. Assessment of insomnia in clinical practices is routinely performed with the use of non-structured interviews. Other methods such as standardized questionnaires and sleep diaries, along with complementary methods such as actigraphy and polysomnography are more scarcely applied. Smartphones and personal devices offer a promising strategy with the use of passive, long lasting, and ecologically valid assessments despite the lack of studies specifically targeting insomnia in individuals with MDD. New therapeutic approaches are essential, including novel targets such as orexins/hypocretins and the endocannabinoid system.


Assuntos
Antidepressivos/efeitos adversos , Transtorno Depressivo Maior/patologia , Inibidores de Captação de Serotonina/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Antidepressivos/farmacologia , Antidepressivos/uso terapêutico , Ritmo Circadiano/efeitos dos fármacos , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/tratamento farmacológico , Prática Clínica Baseada em Evidências , Humanos , Orexinas/antagonistas & inibidores , Orexinas/metabolismo , Inibidores de Captação de Serotonina/farmacologia , Distúrbios do Início e da Manutenção do Sono/etiologia
11.
PLoS One ; 14(4): e0216108, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31039196

RESUMO

BACKGROUND: Few studies have investigated the associations of comorbid migraine with other painful physical symptoms (PPS) in patients with major depressive disorder (MDD) at the two-year follow-up point. This study aimed to investigate this issue. METHODS: At baseline, 155 outpatients with MDD were enrolled. Migraine was diagnosed at baseline according to the International Classification of Headache Disorders. At follow-up, data of 101 subjects were analyzed. The average intensities of head, bone and/or joints, back, chest, abdomen, neck and/or shoulder, general muscle, and limb pain in the past week were evaluated using a visual analog scale (VAS). At follow-up, active headache was defined as a score on the VAS > 3. Multiple linear regressions were used to investigate the associations of migraine at baseline with other PPS at follow-up. RESULTS: Compared with the migraine with inactive headache group and the non-migraine group, patients with migraine with active headache had significantly higher intensities of other PPS and a lower remission rate of depression. There were no significant differences in the pain intensities of the other seven PPS between the migraine with inactive headache group and the non-migraine group. Headache intensity was significantly correlated with the intensities of other PPS at baseline and follow-up. Migraine with active headache independently predicted other PPS after controlling for depression and anxiety at baseline. CONCLUSIONS: Migraine with active headache among MDD patients could predict other PPS. Prevention and treatment of headache might help to decrease other PPS and improve the prognosis of depression. Integration of treatment for depression and headache is indicated.


Assuntos
Transtorno Depressivo Maior/complicações , Cefaleia/complicações , Transtornos de Enxaqueca/complicações , Dor/complicações , Adulto , Feminino , Seguimentos , Humanos , Masculino , Psicometria
12.
N Z Med J ; 132(1495): 48-53, 2019 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-31095544

RESUMO

AIM: To report dispensing of disulfiram, naltrexone, antidepressants and quetiapine for New Zealanders diagnosed with alcohol use disorder. METHOD: The Pharmaceutical Collection is the national dispensing database for medications in New Zealand. PRIMHD is the national mental health and addiction service database. Dispensing data was extracted from the Pharmaceutical Collection and merged with diagnostic data from PRIMHD to report pharmacological treatment of alcohol use disorders in New Zealand. RESULTS: In 2014, there were 5,004 individuals diagnosed with an alcohol use disorder by mental health and addiction services. Four hundred and eighty-nine individuals also received a major depressive disorder diagnosis. 2.1% of the group with alcohol use disorder were dispensed disulfiram and 0.7% were dispensed naltrexone. Treatment with antidepressants (12.7%) and quetiapine (5.6%) was more common. In the group with comorbid alcohol use disorder and depression, 2% were dispensed disulfiram, 0.2% were dispensed naltrexone, 27.4% were dispensed antidepressants and 11.2% were dispensed quetiapine. CONCLUSION: Overall rates of dispensing were relatively low. Antidepressants followed by quetiapine were the most common treatments. In contrast, disulfiram and naltrexone were only used for a minority of clients. This suggests inadequate and poorly targeted pharmacological treatments are used for the treatment of alcohol use disorders in New Zealand.


Assuntos
Dissuasores de Álcool , Alcoolismo , Antidepressivos , Transtorno Depressivo Maior , Dissuasores de Álcool/administração & dosagem , Dissuasores de Álcool/uso terapêutico , Alcoolismo/complicações , Alcoolismo/tratamento farmacológico , Alcoolismo/epidemiologia , Antidepressivos/administração & dosagem , Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/epidemiologia , Dissulfiram/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Naltrexona/uso terapêutico , Nova Zelândia , Fumarato de Quetiapina/uso terapêutico
13.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(1. Vyp. 2): 50-54, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31006792

RESUMO

AIM: To study the influence of depression on the quality of remission in patients with schizoaffective disorder (SAD) and develop recommendations for anti-relapse therapy. MATERIAL AND METHODS: Eighty-nine outpatients with the diagnosis of SAD were examined, in whom 348 remission cases were studied. In accordance with the characteristics of the episodes, the patients were divided into 2 main groups: patients with only depressive manifestations (group 1) and patients with affective disorders of both poles (group 2). Clinical-psychopathological, clinical-anamnestic, clinical-follow-up and statistical methods were used. RESULTS AND CONCLUSION: The type of SAD did not have a significant effect on the duration of remission and the duration of subsequent hospitalization. Patients of group 2 had residual symptoms in remission almost 2 times less often and the level of affective-delusional disorders in this group was higher compared to group 1. In both groups, affective symptoms are represented by subdepression. Patients without residual symptoms had a longer remission compared to patients with subdepression. Subdepressive disorders are associated with lower treatment adherence. Prescribing anti-relapse treatment of SAD, one should consider not only the current state and features of the last episode, but also the features of previous episodes. Patients with depressive episodes are characterized by subdepressive residual symptoms in remission. For patients with different variants of affective disorders in SAD, emotional disorders in remission are as specific as elements of affective-delusional disorders. Anti-relapse therapy should include neuroleptics and normothymics. In case of residual depressive symptoms, the authors recommend the addition of antidepressants.


Assuntos
Antipsicóticos , Depressão , Transtorno Depressivo Maior , Transtornos Psicóticos , Antidepressivos/uso terapêutico , Depressão/complicações , Depressão/tratamento farmacológico , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/tratamento farmacológico , Humanos , Transtornos Psicóticos/complicações
14.
Depress Anxiety ; 36(8): 723-731, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30958907

RESUMO

BACKGROUND: Anxiety symptoms are common in major depressive disorder. Whilst therapeutic efficacy of repetitive transcranial magnetic stimulation (rTMS) in depression is well-established, minimal research has investigated rTMS's efficacy in treating anxiety symptoms in depression. METHODS: This study investigates the effectiveness of rTMS in treating anxiety symptoms in depression, specifically the relative efficacy of the three rTMS protocols commonly used in clinical practice: left-sided high-frequency, right-sided low-frequency and sequential bilateral rTMS. Antidepressant efficacy of each rTMS protocol is also investigated. Treatment data for 697 patients were pooled from three studies across five sites. Changes in Beck's Anxiety Inventory (BAI) and the Hamilton Depression Rating Scale over 4-week rTMS courses were analysed using latent growth curve modelling. RESULTS: All rTMS protocols were effective in treating anxiety symptoms (mean BAI reduction, 8.13 points; p < 0.001) and depressive symptoms. Near therapeutic equivalence was seen across the three protocols. Improvement in depressive severity positively correlated with improvement in anxiety. Both high- and low-baseline anxiety scores showed overall symptom reduction. CONCLUSIONS: This study addresses the clinical knowledge gap pertaining to rTMS's therapeutic efficacy in treating anxiety symptoms in depression and the relative efficacy of three commonly used stimulation protocols. Our findings suggest therapeutic equivalence across left-sided high-frequency, right-sided low-frequency, and sequential bilateral rTMS approaches.


Assuntos
Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/terapia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/psicologia , Estimulação Magnética Transcraniana/métodos , Adulto , Transtornos de Ansiedade/psicologia , Protocolos Clínicos , Transtorno Depressivo Maior/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
15.
J Affect Disord ; 252: 221-229, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30986737

RESUMO

BACKGROUND: Depression and chronic musculoskeletal pain commonly occur as comorbid conditions, which increases their negative effects on health outcomes. The objective of this study was to assess the effectiveness of the DROP (DepRessiOn and Pain) programme designed for the management of major depression and chronic musculoskeletal pain in primary care. METHODS: A cluster-randomised controlled trial was carried out between June 2015 and December 2017 with 328 patients with major depression and chronic musculoskeletal pain, randomly allocated to either intervention arm or usual care arm. The intervention included care management, optimised management of depression, and a psychoeducational programme. Outcomes were monitored using blinded interviews over a 12-month period. TRIAL REGISTRATION: NCT02605278 (ClinicalTrials.gov). RESULTS: After 12 months, 274 patients were evaluated (83.5% participation). The severity of depression (Hopkins Symptom Checklist score) was 0.23 points lower in the intervention arm [1.11 vs. 1.34; CI95% = -0.42 to -0.04]. Intervention arm's response rate to antidepressant treatment was 18.9% higher [39.6% vs. 20.7%; OR = 2.74; CI95% = 1.12-6.67] and its remission rate for depression was 9.0% higher [20.1% vs. 11.1%; OR = 2.13; CI95% = 0.94-4.85] compared to the usual care arm. There were no significant differences between the two arms in terms of pain severity (Brief Pain Inventory severity score) [6.23 vs. 6.66; difference = -0.39; CI95% = -1.13-0.35] or pain response rate [18.7% vs. 18.5%; OR = 1.02; CI95% = 0.46-2.26]. LIMITATIONS: This is a pragmatic study, and poor adherence to the programme by patients and physicians was a main limitation. CONCLUSION: The programme improves clinical outcomes for depression, although no clinical benefits were seen for pain.


Assuntos
Dor Crônica/terapia , Transtorno Depressivo Maior/terapia , Colaboração Intersetorial , Dor Musculoesquelética/terapia , Atenção Primária à Saúde/métodos , Adulto , Antidepressivos/uso terapêutico , Dor Crônica/psicologia , Análise por Conglomerados , Transtorno Depressivo Maior/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/psicologia , Educação de Pacientes como Assunto/métodos , Avaliação de Programas e Projetos de Saúde , Resultado do Tratamento
17.
J Affect Disord ; 251: 248-255, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30953891

RESUMO

BACKGROUND: As there has been a demonstrated link between sleep disturbance and suicide, the present study investigated the relationship between self-reported sleep disturbance during inpatient psychiatric treatment and clinical outcomes at discharge and six months post-discharge. METHODS: Participants were 2,970 adults receiving care in a long-term inpatient psychiatric hospital. Greater than 90% of inpatients reported at least mild sleep disturbance throughout treatment. Group-based trajectory modeling was used to determine patterns of sleep disturbance changes over time. RESULTS: Participants fit into distinct categories based on their trajectories of sleep problems across treatment: No Sleep Problems (10.3% of participants, no sleep problems endorsed over the course of inpatient psychiatric treatment), Resolvers (sleep problems completely resolved over the course of inpatient psychiatric treatment; 10.6%), Non-Responders (did not respond to inpatient psychiatric treatment; 35.7%) and Responders (sleep problems decreased but did not fully resolve over the course of inpatient psychiatric treatment; 43.4%). Individuals with comorbid major depressive disorder and generalized anxiety disorder were significantly more likely to demonstrate higher rates of sleep disturbance throughout inpatient psychiatric treatment and their sleep problems did not respond to treatment as usual (Non-Responders). Further, patients in the Non-Responder group had significantly more suicidal ideation and worse clinical outcomes (higher anxiety, more disability, and lower well-being) at discharge and six months post-discharge, as well as were on more medication including hypnotics throughout treatment. CONCLUSIONS: Findings indicate the urgent need to design and implement inpatient psychiatry sleep protocols to not only improve sleep and clinical outcomes, but also reduce the risk for suicide post-discharge.


Assuntos
Transtornos de Ansiedade/complicações , Transtorno Depressivo Maior/complicações , Transtornos do Sono-Vigília/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Alta do Paciente , Questionário de Saúde do Paciente , Autorrelato , Ideação Suicida , Adulto Jovem
18.
Neuropsychiatr ; 33(3): 123-130, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-30875025

RESUMO

Major depressive disorder is characterized by changes in the emotional state, e. g. the diminished experience of positive emotions, as well as cognitive impairments such as concentration and memory difficulties. These emotional and cognitive dysfunctions are closely interrelated and play a key role for the development and maintenance of depressive symptoms. For instance, patients with depression show negatively biased information processing that affects attention and memory as well as their reaction to feedback. In addition, there is an increased motivation to avoid negatively evaluated conditions and at the same time a reduced motivation to approach positive goals. Furthermore, depressed patients often show a specific style of thinking, called rumination, which involves repeated, intensive thinking about the causes, consequences and symptoms of one's own negative feelings. In this review, the different relationships between emotional, motivational and cognitive symptoms of depressive patients will be presented and the influence of their interaction on cognitive performance will be discussed. The highlighted clinical relevance of emotional-cognitive dysfunctions should be considered more often in therapeutic interventions for depressed patients.


Assuntos
Viés de Atenção , Disfunção Cognitiva/complicações , Disfunção Cognitiva/psicologia , Depressão/complicações , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/psicologia , Emoções , Memória , Disfunção Cognitiva/terapia , Depressão/psicologia , Depressão/terapia , Transtorno Depressivo Maior/terapia , Humanos , Motivação , Ruminação Cognitiva
20.
J Affect Disord ; 250: 380-390, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30877861

RESUMO

BACKGROUND: Both of the modern medicine and the traditional Chinese medicine classify depressive disorder (DD) and chronic fatigue syndrome (CFS) to one type of disease. Unveiling the association between depressive and the fatigue diseases provides a great opportunity to bridge the modern medicine with the traditional Chinese medicine. METHODS: In this work, 295 general participants were recruited to complete Zung Self-Rating Depression Scales and Chalder Fatigue Scales, and meanwhile, to donate plasma and urine samples for 1H NMR-metabolic profiling. Artificial intelligence methods was used to analysis the underlying association between DD and CFS. Principal components analysis (PCA) and partial least squares discriminant analysis (PLS-DA) were used to analyze the metabolic profiles with respect to gender and age. Variable importance in projection and t-test were employed in conjunction with the PLS-DA models to identify the metabolite biomarkers. Considering the asymmetry and complexity of the data, convolutional neural networks (CNN) model, an artificial intelligence method, was built to analyze the data characteristics between each groups. RESULTS: The results showed the gender- and age-related differences for the candidate biomarkers of the DD and the CFS diseases, and indicated the same and different biomarkers of the two diseases. PCA analysis for the data characteristics reflected that DD and CFS was separated completely in plasma metabolite. However, DD and CFS was merged into one group. LIMITATION: Lack of transcriptomic analysis limits the understanding of the association of the DD and the CFS diseases on gene level. CONCLUSION: The unmasked candidate biomarkers provide reliable evidence to explore the commonality and differences of the depressive and the fatigue diseases, and thereby, bridge over the traditional Chinese medicine with the modern medicine.


Assuntos
Inteligência Artificial , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/diagnóstico , Síndrome de Fadiga Crônica/complicações , Síndrome de Fadiga Crônica/diagnóstico , Adulto , Biomarcadores/sangue , Transtorno Depressivo , Feminino , Perfilação da Expressão Gênica , Humanos , Análise dos Mínimos Quadrados , Espectroscopia de Ressonância Magnética , Masculino , Metabolômica , Pessoa de Meia-Idade , Análise de Componente Principal
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