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2.
Neurosurg Focus ; 49(6): E11, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33260128

RESUMO

OBJECTIVE: The ongoing coronavirus disease 2019 (COVID-19) pandemic has considerably affected the delivery of postoperative care to patients who have undergone deep brain stimulation (DBS) surgery. DBS teleprogramming technology was developed and deployed in China before the COVID-19 outbreak. In this report, the authors share their experiences with telemedical DBS treatment of patients with psychiatric disorders during the COVID-19 outbreak. METHODS: Four patients (2 with obsessive-compulsive disorder, 1 with major depressive disorder, and 1 with anorexia nervosa) underwent DBS surgery at Ruijin Hospital and received continuous postoperative DBS telemedicine case management from January 2020 to July 2020. DBS teleprogramming, individualized psychological support, and medical consultations were provided via the authors' DBS telemedicine platform, which also incorporated a synchronous real-time video communication system. RESULTS: Forty-five DBS telemedicine sessions were conducted; there was no unexpected loss of network connection during the sessions. Of these, 28 sessions involved DBS teleprogramming. Adjustments were made to the stimulation voltage, frequency, pulse width, and contact site in 21, 12, 9, and 9 sessions, respectively. Psychological support and troubleshooting were provided during the remaining telemedicine sessions. Modest to substantial clinical improvements after DBS surgery were observed in some but not all patients, whereas stimulation-related side effects were reported by 2 patients and included reversible sleep and mood problems, headache, and a sensation of heat. CONCLUSIONS: DBS telemedicine seems to offer a feasible, safe, and efficient strategy for maintaining the delivery of medical care to psychiatric patients during the COVID-19 outbreak. The authors propose that implementation of a comprehensive DBS telemedicine system, which combines DBS teleprogramming with psychological counseling, medical consultations, and medication prescriptions and delivery, could be an efficient and effective approach to manage the mental health and quality of life of patients with psychiatric disorders during future local or global public health crises.


Assuntos
Anorexia Nervosa/cirurgia , Estimulação Encefálica Profunda/métodos , Transtorno Depressivo Maior/cirurgia , Transtorno Obsessivo-Compulsivo/cirurgia , Telemedicina/métodos , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/psicologia , Estimulação Encefálica Profunda/normas , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Seguimentos , Humanos , Transtornos Mentais , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/psicologia , Estudos Retrospectivos , Telemedicina/normas , Resultado do Tratamento
3.
BMJ ; 371: m4022, 2020 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-33177069

RESUMO

OBJECTIVE: To evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression in pregnant and postpartum women. DESIGN: Individual participant data meta-analysis. DATA SOURCES: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (from inception to 3 October 2018). ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Eligible datasets included EPDS scores and major depression classification based on validated diagnostic interviews. Bivariate random effects meta-analysis was used to estimate EPDS sensitivity and specificity compared with semi-structured, fully structured (Mini International Neuropsychiatric Interview (MINI) excluded), and MINI diagnostic interviews separately using individual participant data. One stage meta-regression was used to examine accuracy by reference standard categories and participant characteristics. RESULTS: Individual participant data were obtained from 58 of 83 eligible studies (70%; 15 557 of 22 788 eligible participants (68%), 2069 with major depression). Combined sensitivity and specificity was maximised at a cut-off value of 11 or higher across reference standards. Among studies with a semi-structured interview (36 studies, 9066 participants, 1330 with major depression), sensitivity and specificity were 0.85 (95% confidence interval 0.79 to 0.90) and 0.84 (0.79 to 0.88) for a cut-off value of 10 or higher, 0.81 (0.75 to 0.87) and 0.88 (0.85 to 0.91) for a cut-off value of 11 or higher, and 0.66 (0.58 to 0.74) and 0.95 (0.92 to 0.96) for a cut-off value of 13 or higher, respectively. Accuracy was similar across reference standards and subgroups, including for pregnant and postpartum women. CONCLUSIONS: An EPDS cut-off value of 11 or higher maximised combined sensitivity and specificity; a cut-off value of 13 or higher was less sensitive but more specific. To identify pregnant and postpartum women with higher symptom levels, a cut-off of 13 or higher could be used. Lower cut-off values could be used if the intention is to avoid false negatives and identify most patients who meet diagnostic criteria. REGISTRATION: PROSPERO (CRD42015024785).


Assuntos
Depressão Pós-Parto/psicologia , Transtorno Depressivo Maior/psicologia , Complicações na Gravidez/psicologia , Psicometria , Feminino , Humanos , Gravidez , Cuidado Pré-Natal , Sensibilidade e Especificidade
4.
PLoS One ; 15(11): e0240914, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33170839

RESUMO

BACKGROUND: The potential role of perceived learning difficulty on depressive symptoms and substance use in the context of student population was seldom studied. This study aimed to investigate the association of perceived learning difficulty with depressive symptoms and substance use among university students in northwest Ethiopia. METHODS: A cross sectional study was conducted on 710 pre-engineering students. A locally validated version of Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms at a cut off 5-9 indicating mild depressive symptoms and at a cut off 10 for major depressive symptoms. Perceived difficulty in school work was assessed by items dealing about difficulties in areas of course work. The response alternatives of these items were 0 = not at all, 1 = not so much, 2 = quite much, 3 = very much. The types of substances that students had used in their life and in the last three months were assessed. Negative binomial regression and multinomial regressions were employed to investigate the predictors of number of substance use and depressive symptoms respectively. RESULTS: The prevalence of depressive symptoms was 71.4% (Mild: 30% and Major 41.4%). About 24.6% of participants had the experience of using at least one substance. Increment in perceived difficulties in learning score was associated with more use of substances (aRRR = 1.03, 95% CI: 1.01-1.06), mild level depressive symptoms (aOR = 1.10, 95% CI: 1.04, 1.56 and major depressive symptoms (aOR = 1.19, 95% CI: 1.13, 1.26). Every increment in anxiety score was associated with increased risk of mild level of depressive symptoms (aOR = 1.09, 95% CI: 1.01, 1.17) and major depressive symptoms (aOR = 1.28, 95% CI: 1.18, 1.37). Being male (aRRR = 5.54, 95% CI: 3.28, 9.36), urban residence (aRRR = 2.46, 95% CI: 1.62, 3.72) and increment in number of life threatening events (aRRR = 1.143, 95% CI: 1.08, 1.22) were associated with increased risk of substance use. CONCLUSION: Perceived difficulties in learning independently predicted increased depressive symptoms as well as substance use among participants.


Assuntos
Depressão/epidemiologia , Deficiências da Aprendizagem/epidemiologia , Estudantes/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estudos Transversais , Depressão/psicologia , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Etiópia/epidemiologia , Feminino , Humanos , Deficiências da Aprendizagem/psicologia , Masculino , Percepção , Prevalência , Análise de Regressão , Estudantes/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e Questionários , Universidades , Adulto Jovem
5.
Niger J Clin Pract ; 23(10): 1431-1436, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33047702

RESUMO

Background: Diabetes mellitus (DM) and depression are common chronic disease states of public health importance with huge burden and the potential to impact many aspects of life. They are said to be related though this relationship is not fully understood. The presence of depression among patients with DM is associated with poor glycemic control, complications, and poor self-care. Method: This was a descriptive cross-sectional study conducted at the Diabetes Clinic of the Jos University Teaching Hospital. Three hundred and ten (310) patients with diabetes mellitus were recruited consecutively. The depression module of the Mini International Neuropsychiatric Interview (M.I.N.I.) version 5.0 was used to ascertain depression among these patients. Other demographic data were obtained using a questionnaire. Blood pressure, weight, and height were also measured and the body mass index (BMI) calculated. Results: One hundred and eighty four (59.35%) of the study population were females and the mean age (SD) of the study population was 54 ± 12 years. The mean age (SD) of the females was 53 ± 11 years and that of the males was 54 ± 12 years with no significant statistical difference (P = 0.35). Two hundred and forty nine (80.32%) of the study population were urban dwellers with 140 (45.16%) earning less than N500, 000 (794 USD) yearly. Current major depression was found in 35 (11.3%) patients, among whom 7 (2.3%) had recurrent depression. The presence of DM complications (OR: 3.50, 95% CI 1.16-10.61) and a positive family history of depression (OR: 4.03, 95% CI 1.32-12.29) were found to be correlates of current major depression. Conclusion: The prevalence of current major depression among patients with diabetes mellitus in this study is high. We recommend that all patients with DM should be screened for depression and treated appropriately to reduce its consequences.


Assuntos
Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Complicações do Diabetes/epidemiologia , Diabetes Mellitus/epidemiologia , Adulto , Idoso , Índice de Massa Corporal , Peso Corporal , Estudos Transversais , Transtorno Depressivo Maior/psicologia , Diabetes Mellitus/sangue , Diabetes Mellitus/psicologia , Feminino , Hemoglobina A Glicada/análise , Hospitais de Ensino , Humanos , Hiperglicemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prevalência , Escalas de Graduação Psiquiátrica , Autocuidado , Inquéritos e Questionários
6.
Medicine (Baltimore) ; 99(39): e22319, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991440

RESUMO

OBJECTIVE: Postpartum depression (PPD) is an episode of major depressive disorder that affecting women of childbearing age. 5-HTTLPR is 1 of the most extensively investigated polymorphisms in PPD. However, the previous results were inconsistent and inclusive. Hence, we performed a meta-analysis to precisely evaluate the association between 5-HTTLPR polymorphism and PPD susceptibility. METHODS: The studies were retrieved through databases including PubMed, web of science, EMASE, and CNKI. The odd ratios (ORs) and 95% confidence interval (CIs) were applied for evaluating the genetic association between 5-HTTLPR (L/S) polymorphism and PPD risk. RESULTS: Six studies with 519 cases and 737 controls were enrolled in the present study. The frequencies of allelic (OR = 0.72, 95%CI = 0.60-0.85, P = .0001) and dominant (OR = 0.57, 95%CI = 0.44-0.73, P = .004) models of 5-HTTLPR polymorphism significantly decreased in patients with PPD than those in the healthy controls. Subgroup analysis based on ethnicity revealed that the allelic (OR = 0.71, 95%CI = 0.60-0.85, P = .0001) and dominant (OR = 0.51, 95%CI = 0.32-0.79, P = .003) models of 5-HTTLPR polymorphism were significantly associated with PPD risk in Asian population (P > .05). No evidence was observed between the recessive model of 5-HTTLPR polymorphism and PPD risk (P > .05). CONCLUSIONS: The allelic and dominant models of 5-HTTLPR polymorphism might be protective factors for PPD. To confirm these results, larger number of association studies or multicenter case-control studies are necessary in the future.


Assuntos
Depressão Pós-Parto/genética , Transtorno Depressivo Maior/psicologia , Polimorfismo de Nucleotídeo Único/genética , Proteínas da Membrana Plasmática de Transporte de Serotonina/genética , Adulto , Alelos , Grupo com Ancestrais do Continente Asiático/genética , Estudos de Casos e Controles , Depressão Pós-Parto/epidemiologia , Feminino , Predisposição Genética para Doença/epidemiologia , Humanos , Incidência , Gravidez
7.
PLoS Comput Biol ; 16(9): e1008162, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32997653

RESUMO

Psychiatric disorders are ubiquitously characterized by debilitating social impairments. These difficulties are thought to emerge from aberrant social inference. In order to elucidate the underlying computational mechanisms, patients diagnosed with major depressive disorder (N = 29), schizophrenia (N = 31), and borderline personality disorder (N = 31) as well as healthy controls (N = 34) performed a probabilistic reward learning task in which participants could learn from social and non-social information. Patients with schizophrenia and borderline personality disorder performed more poorly on the task than healthy controls and patients with major depressive disorder. Broken down by domain, borderline personality disorder patients performed better in the social compared to the non-social domain. In contrast, controls and major depressive disorder patients showed the opposite pattern and schizophrenia patients showed no difference between domains. In effect, borderline personality disorder patients gave up a possible overall performance advantage by concentrating their learning in the social at the expense of the non-social domain. We used computational modeling to assess learning and decision-making parameters estimated for each participant from their behavior. This enabled additional insights into the underlying learning and decision-making mechanisms. Patients with borderline personality disorder showed slower learning from social and non-social information and an exaggerated sensitivity to changes in environmental volatility, both in the non-social and the social domain, but more so in the latter. Regarding decision-making the modeling revealed that compared to controls and major depression patients, patients with borderline personality disorder and schizophrenia showed a stronger reliance on social relative to non-social information when making choices. Depressed patients did not differ significantly from controls in this respect. Overall, our results are consistent with the notion of a general interpersonal hypersensitivity in borderline personality disorder and schizophrenia based on a shared computational mechanism characterized by an over-reliance on beliefs about others in making decisions and by an exaggerated need to make sense of others during learning specifically in borderline personality disorder.


Assuntos
Transtorno da Personalidade Borderline , Tomada de Decisões/fisiologia , Esquizofrenia/fisiopatologia , Psicologia do Esquizofrênico , Aprendizado Social/fisiologia , Anedonia , Teorema de Bayes , Transtorno da Personalidade Borderline/fisiopatologia , Transtorno da Personalidade Borderline/psicologia , Transtorno Depressivo Maior/fisiopatologia , Transtorno Depressivo Maior/psicologia , Humanos , Modelos Psicológicos , Recompensa , Análise e Desempenho de Tarefas
9.
Psychiatry Res ; 291: 113287, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32763548

RESUMO

Transcranial magnetic stimulation (TMS) can be used to evaluate the effects of pharmacological interventions. The aim of this study was to assess the impact of the selective serotonin reuptake inhibitor, sertraline, and the atypical antipsychotic drugs quetiapine and olanzapine, on cortical excitability in unmedicated patients with major depressive disorder (MDD). The study included 45 medication-free MDD patients diagnosed according to DSM V. They were divided randomly into three groups who received a single oral dose of one of the three drugs sertraline (50 mg), quetiapine (100 mg) and olanzapine (10 mg). Psychological evaluation was conducted using the Mini-Mental State Examination (MMSE) and Beck Depression Inventory Scale (BDI). Resting and active motor thresholds (rMT and aMT) together with contralateral and ipsilateral cortical silent periods (cSP, and iSP) were measured for each participant before and at the time of maximum concentration of drug intake. There was significant increase in excitability of motor cortex after sertraline without changes in GABAB neurotransmission. Quetiapine and olanzapine potentiated inhibitory GABAB neurotransmission (prolongation of cSP); olanzapine additionally prolonged the iSP. Thus TMS can differentiate between the impact of different psychotropic drugs on excitatory and inhibitory transmission in motor cortex.


Assuntos
Antipsicóticos/uso terapêutico , Excitabilidade Cortical/efeitos dos fármacos , Transtorno Depressivo Maior/fisiopatologia , Córtex Motor/efeitos dos fármacos , Córtex Motor/fisiopatologia , Estimulação Magnética Transcraniana/efeitos dos fármacos , Adulto , Antipsicóticos/farmacologia , Excitabilidade Cortical/fisiologia , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/psicologia , Potencial Evocado Motor/efeitos dos fármacos , Potencial Evocado Motor/fisiologia , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Estimulação Magnética Transcraniana/psicologia , Adulto Jovem
10.
Eur J Obstet Gynecol Reprod Biol ; 253: 90-94, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32829231

RESUMO

OBJECTIVE: To explore the impact of the COVID-19 pandemic on the mental health of Obstetricians and Gynaecologists. STUDY DESIGN: A cross-section survey-based study amongst doctors working within Obstetrics and Gynaecology in the United Kingdom. RESULTS: A total of 207 doctors completed the survey. Obstetricians and Gynaecologists reported significantly higher rates of both Major Depressive Disorder (versus, p = 0.023) and Generalised Anxiety Disorder (versus, p = 0.044) as compared to the UK-wide estimates. Sub-group analysis showed that anxiety was more common amongst female doctors as compared to males (versus, p = 0.047). Although the prevalence of GAD was higher amongst registrars compared to their Consultant and/or Senior House Officer counterparts, this was not statistically significant. Respondents felt that the most significant factor for work-related changes to mental health was keeping up to date with frequently changing guidelines and protocols related to COVID-19. Only of respondents felt able to talk to colleagues about their mental health. CONCLUSIONS: Key findings include the high prevalence of mental health conditions amongst doctors, demonstration of the persistent taboo that mental health carries within the speciality and the key contributory factors to poor mental health. Further work should be done to assess if changes to the way new and updating guidelines, protocols and pathways are disseminated reduces the impact on the mental health of doctors. With the threat of a second COVID-19 peak looming, now more than ever, it is vital that steps are taken to break the stigmatisation of mental health amongst doctors, encouraging doctors to seek help when required.


Assuntos
Infecções por Coronavirus/psicologia , Ginecologia/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Obstetrícia/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Médicos/psicologia , Pneumonia Viral/psicologia , Adulto , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Betacoronavirus , Estudos Transversais , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Doenças Profissionais/psicologia , Pandemias , Inquéritos e Questionários , Reino Unido/epidemiologia
11.
Psychiatry Res ; 292: 113313, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32738552

RESUMO

Psychopathology research has increasingly sought to study the etiology and treatment of individual symptoms, rather than categorical diagnoses. However, it is unclear whether commonly used measures have adequate psychometric properties for assessing individual symptoms. This study examined the test-retest reliability and familial concordance (an indicator of validity) of the symptoms of Major Depressive Disorder (MDD), a disorder consisting of nine core symptoms, most of which are aggregated (e.g., symptom 7 of the DSM criteria for MDD is worthlessness or guilt). Lifetime MDD symptoms were measured in 504 young adults (237 sibling pairs) using the Structured Clinical Interview for DSM-5 (SCID). Fifty-one people completed a second SCID within three weeks of their first SCID. Results indicated that aggregated and unaggregated symptoms demonstrated moderate to substantial test-retest reliability and generally significant, but slight to fair familial concordance (with the highest familial concordance being for markedly diminished interest or pleasure and its unaggregated components - decreased interest and decreased pleasure). Given the increasing focus on the differential validity of individual MDD symptoms, the present study suggests that interview-based assessments of depression can assess most individual symptoms with adequate levels of reliability and validity.


Assuntos
Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/genética , Entrevista Psicológica/normas , Psicometria/normas , Adolescente , Adulto , Transtorno Depressivo Maior/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Entrevista Psicológica/métodos , Masculino , Psicometria/métodos , Reprodutibilidade dos Testes , Adulto Jovem
12.
Artigo em Inglês | MEDLINE | ID: mdl-32784694

RESUMO

The relationships between dimensions of personality (sociotropy and autonomy), coping strategies (rumination: brooding and reflection subtypes, and immature defenses) and symptoms of depression and anxiety were explored in patients with Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD). A total of 279 patients completed questionnaires including measures of personality dimensions, rumination, immature defenses, depression and anxiety. Our findings suggested that sociotropy and autonomy may be associated with both depressive and anxious symptoms in patients with MDD and with GAD. Multiple mediation analyses indicated that brooding always acted as a mediating link between personality vulnerabilities (sociotropy and autonomy) and depressive and anxiety symptoms, independently of the patient group. In addition, in patients with MDD and those with GAD, brooding and immature defenses functioned together by linking sociotropy and autonomy, respectively, with depressive symptoms. Our results also showed that, in patients with GAD, both types of rumination explained the relationship between sociotropy and autonomy and anxiety symptoms. Overall, our findings provided evidence of the transdiagnostic role of the brooding, linking the vulnerability of personality dimensions and emotional symptoms. They also indicated that reflection and immature defenses can operate in conjunction with brooding, depending on the type of vulnerability and emotional context.


Assuntos
Sintomas Afetivos/psicologia , Ansiedade/psicologia , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Adulto , Ansiedade/diagnóstico , Dependência Psicológica , Depressão/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Feminino , Humanos , Masculino , Pensamento
13.
Psychiatry Res ; 291: 113262, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32763535

RESUMO

BACKGROUND: Double depression (DD), the co-existence of DSM-IV major depressive disorder (MDD) and dysthymia, is a poorly known and sparsely studied phenomenon. Nevertheless, it is prevalent in clinical samples of patients with depression. Thus, it is important to understand the efficacy of its treatment. METHODS: We conducted a meta-analysis of studies in which antidepressant medication was used to treat depression. Systematic searches in bibliographical databases resulted in 11 samples, including 775 patients that met inclusion criteria. RESULTS: The overall effect size indicating the differences in depressive symptoms before and after pharmacotherapy was 1.81 (95% CI: 1.47, 2.16), suggesting that individuals with depression exhibited a significant reduction in their depressive symptoms following treatment. Importantly, a moderation analysis indicated that a higher proportion of individuals with DD within a sample was associated with lower effect sizes. Publication bias did not pose a major threat to the stability of the findings. LIMITATIONS: High observed heterogeneity indicated substantial variability in effect sizes and elucidation of the potential moderators of treatment outcome was limited due to a paucity of relevant data. CONCLUSIONS: Pharmacotherapy seems to be effective in treating DD, but DD may be more difficult to treat than either MDD or dysthymia alone. More research specifically focusing on the treatment of DD with larger sample sizes using randomized control trials is needed to make a firm conclusion.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/psicologia , Transtorno Distímico/tratamento farmacológico , Transtorno Distímico/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Distímico/diagnóstico , Humanos , Resultado do Tratamento
14.
Psychiatry Res ; 291: 113275, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32763538

RESUMO

Repetitive transcranial magnetic stimulation (rTMS) is an effective and evidence-based treatment for major depression, which is now as a mainstream treatment in clinical practice. However, there is limited data concerning its use in Australian private psychiatric hospital settings. This retrospective study examined routinely collected data of 153 inpatients, who received 20 rTMS treatments over four weeks. Primary outcomes measures were the 17-item Hamilton Depression Rating Scale (HAMD-17) and the 21-item Depression, Anxiety and Stress Scale (DASS-21). At post-treatment, response and remission rates were 54% and 28%, respectively, for the HAMD-17; and 53% response and 16% remission rates, for the DASS-21 Depression subscale, respectively. Although no gender differences were observed, younger patients demonstrated more improvements during acute rTMS but the effect was not significant after accounting for pre-treatment symptom severity. The findings of this naturalistic study suggest that an acute course of rTMS provided in private clinical settings resulted in similar response and remission rates to longer rTMS courses. Shorter rTMS courses appear to have satisfactory efficacy in treating major depression, in clinically diverse and real-world practice.


Assuntos
Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/terapia , Hospitais Privados/tendências , Estimulação Magnética Transcraniana/métodos , Estimulação Magnética Transcraniana/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
15.
Am J Geriatr Psychiatry ; 28(10): 1025-1029, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32753340

RESUMO

OBJECTIVE: Electroconvulsive therapy (ECT) is an essential psychiatric service with an important role in treating older adults with severe or treatment-resistant depression. During the COVID-19 pandemic, ECT services have be constrained by infection control measures. We report a case of a 66-year-old female patient with a severe major depressive episode who had previously responded to right unilateral ECT and was treated with two modified accelerated intermittent theta-burst stimulation (aiTBS) protocols. METHODS: The two aiTBS courses consisted of eight daily sessions over five consecutive days, followed by gradual tapering, using 1,800 pulses per session pre-COVID-19 (first course), and 600 pulses per session during the pandemic (second course). RESULTS: Moderate to severe baseline depressive symptoms reached remission levels after both courses. CONCLUSION: The 600-pulses aiTBS treatment protocol reported here warrants further study and evaluation, but may be a potential option in cases where older adults with severe depressive symptoms cannot access ECT during the COVID-19 pandemic.


Assuntos
Transtorno Depressivo Maior/terapia , Transtorno Depressivo Resistente a Tratamento/terapia , Estimulação Magnética Transcraniana/métodos , Idoso , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Resistente a Tratamento/psicologia , Eletroconvulsoterapia , Feminino , Acesso aos Serviços de Saúde , Humanos , Pandemias , Questionário de Saúde do Paciente , Pneumonia Viral/epidemiologia , Resultado do Tratamento
16.
Brain Behav Immun ; 89: 594-600, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32738287

RESUMO

Infection-triggered perturbation of the immune system could induce psychopathology, and psychiatric sequelae were observed after previous coronavirus outbreaks. The spreading of the Severe Acute Respiratory Syndrome Coronavirus (COVID-19) pandemic could be associated with psychiatric implications. We investigated the psychopathological impact of COVID-19 in survivors, also considering the effect of clinical and inflammatory predictors. We screened for psychiatric symptoms 402 adults surviving COVID-19 (265 male, mean age 58), at one month follow-up after hospital treatment. A clinical interview and a battery of self-report questionnaires were used to investigate post-traumatic stress disorder (PTSD), depression, anxiety, insomnia, and obsessive-compulsive (OC) symptomatology. We collected sociodemographic information, clinical data, baseline inflammatory markers and follow-up oxygen saturation levels. A significant proportion of patients self-rated in the psychopathological range: 28% for PTSD, 31% for depression, 42% for anxiety, 20% for OC symptoms, and 40% for insomnia. Overall, 56% scored in the pathological range in at least one clinical dimension. Despite significantly lower levels of baseline inflammatory markers, females suffered more for both anxiety and depression. Patients with a positive previous psychiatric diagnosis showed increased scores on most psychopathological measures, with similar baseline inflammation. Baseline systemic immune-inflammation index (SII), which reflects the immune response and systemic inflammation based on peripheral lymphocyte, neutrophil, and platelet counts, positively associated with scores of depression and anxiety at follow-up. PTSD, major depression, and anxiety, are all high-burden non-communicable conditions associated with years of life lived with disability. Considering the alarming impact of COVID-19 infection on mental health, the current insights on inflammation in psychiatry, and the present observation of worse inflammation leading to worse depression, we recommend to assess psychopathology of COVID-19 survivors and to deepen research on inflammatory biomarkers, in order to diagnose and treat emergent psychiatric conditions.


Assuntos
Transtornos de Ansiedade/epidemiologia , Infecções por Coronavirus/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Pneumonia Viral/epidemiologia , Sobreviventes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Ansiedade/imunologia , Ansiedade/psicologia , Transtornos de Ansiedade/imunologia , Transtornos de Ansiedade/psicologia , Betacoronavirus , Proteína C-Reativa/imunologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/psicologia , Depressão/epidemiologia , Depressão/imunologia , Depressão/psicologia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/imunologia , Transtorno Depressivo/psicologia , Transtorno Depressivo Maior/imunologia , Transtorno Depressivo Maior/psicologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Inflamação , Itália/epidemiologia , Tempo de Internação/estatística & dados numéricos , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/imunologia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Monócitos , Neutrófilos , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtorno Obsessivo-Compulsivo/imunologia , Transtorno Obsessivo-Compulsivo/psicologia , Pandemias , Pneumonia Viral/imunologia , Pneumonia Viral/psicologia , Índice de Gravidade de Doença , Fatores Sexuais , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/imunologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia
17.
PLoS One ; 15(8): e0231995, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833958

RESUMO

Current practice of assessing mood episodes in affective disorders largely depends on subjective observations combined with semi-structured clinical rating scales. Motor activity is an objective observation of the inner physiological state expressed in behavior patterns. Alterations of motor activity are essential features of bipolar and unipolar depression. The aim was to investigate if objective measures of motor activity can aid existing diagnostic practice, by applying machine-learning techniques to analyze activity patterns in depressed patients and healthy controls. Random Forrest, Deep Neural Network and Convolutional Neural Network algorithms were used to analyze 14 days of actigraph recorded motor activity from 23 depressed patients and 32 healthy controls. Statistical features analyzed in the dataset were mean activity, standard deviation of mean activity and proportion of zero activity. Various techniques to handle data imbalance were applied, and to ensure generalizability and avoid overfitting a Leave-One-User-Out validation strategy was utilized. All outcomes reports as measures of accuracy for binary tests. A Deep Neural Network combined with SMOTE class balancing technique performed a cut above the rest with a true positive rate of 0.82 (sensitivity) and a true negative rate of 0.84 (specificity). Accuracy was 0.84 and the Matthews Correlation Coefficient 0.65. Misclassifications appear related to data overlapping among the classes, so an appropriate future approach will be to compare mood states intra-individualistically. In summary, machine-learning techniques present promising abilities in discriminating between depressed patients and healthy controls in motor activity time series.


Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Atividade Motora/fisiologia , Adulto , Algoritmos , Depressão/diagnóstico , Depressão/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Aprendizado de Máquina , Masculino , Transtornos do Humor/psicologia , Redes Neurais de Computação , Sensibilidade e Especificidade
18.
Lancet Psychiatry ; 7(8): 682-691, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32711709

RESUMO

BACKGROUND: Self-harm is a leading cause of morbidity in prisoners. Although a wide range of risk factors for self-harm in prisoners has been identified, the strength and consistency of effect sizes is uncertain. We aimed to synthesise evidence and assess the risk factors associated with self-harm inside prison. METHODS: In this systematic review and meta-analysis, we searched four electronic databases (PubMed, Embase, Web of Science, and PsycINFO) for observational studies on risk factors for self-harm in prisoners published from database inception to Oct 31, 2019, supplemented through correspondence with authors of studies. We included primary studies involving adults sampled from general prison populations who self-harmed in prison and a comparison group without self-harm in prison. We excluded studies with qualitative or ecological designs, those that reported on lifetime measures of self-harm or on selected samples of prisoners, and those with a comparison group that was not appropriate or not based on general prison populations. Data were extracted from the articles and requested from study authors. Our primary outcome was the risk of self-harm for risk factors in prisoners. We pooled effect sizes as odds ratios (OR) using random effects models for each risk factor examined in at least three distinct samples. We assessed study quality on the basis of the Newcastle-Ottawa Scale and examined between-study heterogeneity. The study protocol was registered with PROSPERO, CRD42018087915. FINDINGS: We identified 35 independent studies from 20 countries comprising a total of 663 735 prisoners, of whom 24 978 (3·8%) had self-harmed in prison. Across the 40 risk factors examined, the strongest associations with self-harm in prison were found for suicide-related antecedents, including current or recent suicidal ideation (OR 13·8, 95% CI 8·6-22·1; I2=49%), lifetime history of suicidal ideation (8·9, 6·1-13·0; I2=56%), and previous self-harm (6·6, 5·3-8·3; I2=55%). Any current psychiatric diagnosis was also strongly associated with self-harm (8·1, 7·0-9·4; I2=0%), particularly major depression (9·3, 2·9-29·5; I2=91%) and borderline personality disorder (9·2, 3·7-22·5; I2=81%). Prison-specific environmental risk factors for self-harm included solitary confinement (5·6, 2·7-11·6; I2=98%), disciplinary infractions (3·5, 1·2-9·7; I2=99%), and experiencing sexual or physical victimisation while in prison (3·2, 2·1-4·8; I2=44%). Sociodemographic (OR range 1·5-2·5) and criminological (1·8-2·3) factors were only modestly associated with self-harm in prison. We did not find clear evidence of publication bias. INTERPRETATION: The wide range of risk factors across clinical and custody-related domains underscores the need for a comprehensive, prison-wide approach towards preventing self-harm in prison. This approach should incorporate both population and targeted strategies, with multiagency collaboration between the services for mental health, social care, and criminal justice having a key role. FUNDING: Wellcome Trust.


Assuntos
Prisioneiros/psicologia , Comportamento Autodestrutivo/psicologia , Tentativa de Suicídio/prevenção & controle , Transtorno da Personalidade Borderline/psicologia , Estudos de Casos e Controles , Vítimas de Crime/psicologia , Direito Penal/organização & administração , Transtorno Depressivo Maior/psicologia , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Saúde Mental/normas , Estudos Observacionais como Assunto , Prisioneiros/estatística & dados numéricos , Fatores de Risco , Comportamento Autodestrutivo/mortalidade , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos
19.
Psychiatry Res Neuroimaging ; 303: 111134, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32652482

RESUMO

Major depressive disorder (MDD) is characterized by heterogeneous clinical performance and neurocognitive impairment. It is important to explore the correlation between global functioning and regional homogeneity (ReHo)/amplitude of low-frequency fluctuation (ALFF) values in MDD patients. 67 first-episode, drug naïve MDD patients and 69 healthy subjects were enrolled in the study. The MATRICS Consensus Cognitive Battery (MCCB) and the Functioning Assessment Short Test (FAST) were used to assess functional impairment in patients. Brain activity was assessed using ReHo and ALFF measurements. The relationship between the clinical features and altered brain function was evaluated using correlation analysis. There were significant differences in the ReHo and ALFF values between MDD patients and healthy subjects. The reduction in ReHo in the left calcarine/lingual gyrus/cuneus was negatively correlated with occupational functioning and the total FAST scores. The reduction in ALFF in the right calcarine/lingual gyrus was positively correlated with the verbal learning aspects of the MCCB. These findings suggest that the altered brain function in the default mode network (DMN) may be related to functional impairments in patients with first-episode, drug naïve major depressive disorder.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Transtorno Depressivo Maior/diagnóstico por imagem , Transtorno Depressivo Maior/fisiopatologia , Imagem por Ressonância Magnética/métodos , Adolescente , Adulto , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Sci Rep ; 10(1): 12649, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32724131

RESUMO

To elucidate the genetic underpinnings of the antidepressant efficacy of S-ketamine (esketamine) nasal spray in major depressive disorder (MDD), we performed a genome-wide association study (GWAS) in cohorts of European ancestry (n = 527). This analysis was followed by a polygenic risk score approach to test for associations between genetic loading for psychiatric conditions, symptom profiles and esketamine efficacy. We identified a genome-wide significant locus in IRAK3 (p = 3.57 × 10-8, rs11465988, ß = - 51.6, SE = 9.2) and a genome-wide significant gene-level association in NME7 (p = 1.73 × 10-6) for esketamine efficacy (i.e. percentage change in symptom severity score compared to baseline). Additionally, the strongest association with esketamine efficacy identified in the polygenic score analysis was from the genetic loading for depressive symptoms (p = 0.001, standardized coefficient ß = - 3.1, SE = 0.9), which did not reach study-wide significance. Pathways relevant to neuronal and synaptic function, immune signaling, and glucocorticoid receptor/stress response showed enrichment among the suggestive GWAS signals.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/genética , Marcadores Genéticos , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Ketamina/uso terapêutico , Transtorno Depressivo Maior/patologia , Transtorno Depressivo Maior/psicologia , Feminino , Genoma Humano , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
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