Psychosocial Interventions for Patients With Heart Failure and Their Impact on Depression, Anxiety, Quality of Life, Morbidity, and Mortality: A Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of this systematic review and meta-analysis was to evaluate the ability of psychosocial interventions to reduce depression and anxiety, improve quality of life, and reduce hospitalization and mortality rates in patients with heart failure. METHODS: Studies of psychosocial interventions published from 1970 to 2021 were identified through four databases (PubMed, Ovid MEDLINE, PsycINFO, Cochrane). Two authors independently conducted a focused analysis and reached a final consensus on the studies to include, followed by a quality check by a third author. A risk of bias assessment was conducted. RESULTS: Twenty-three studies were identified, but only 15 studies of mostly randomized controlled trials with a total of 1370 patients with heart failure were included in the meta-analysis. Interventions were either cognitive behavioral therapy (CBT) or stress management. The pooled intervention effect was in favor of the intervention for depression (combined difference in standardized mean change [DSMC]: -0.41; 95% confidence interval [CI] = -0.66 to -0.17; p = .001) and anxiety (combined DSMC: -0.33; 95% CI = -0.51 to -0.15; p < .001) but was only a trend for quality of life (combined DSMC: 0.14; 95% CI = -0.00 to 0.29; p = .053). Evidence was limited that interventions produced lower rates of hospitalization (5 of 5 studies showing a beneficial effect) or death (1 of 5 with a beneficial effect). CONCLUSIONS: CBT and stress management interventions significantly reduced depression and anxiety compared with control conditions. CBT significantly improved quality of life compared with controls, but stress management did not. Longer treatment duration seemed to be an important factor related to treatment success.

The impact of depression on heart transplant outcomes: A retrospective single-center cohort study.

BACKGROUND: Depression is prevalent in patients with heart failure and after heart transplant. We identified the prevalence of pre- and post-transplant depression and its association with clinical characteristics and post-transplant outcomes. METHODS: We reviewed 114 adults transplanted 1/1/2015 to 12/31/2015 and identified patients with pre- and post-transplant depression. Clinical characteristics and outcomes were compared. RESULTS: Of 114 patients, 35.1% had pre-transplant depression and 26.3% had post-transplant depression. Patients with post-transplant depression within the first year were significantly more likely to have acute rejection (10% vs 0%), longer intensive care unit (11.7 days vs 7.8 days) and hospital stay (31.7 days vs 16.3 days), and discharge to inpatient rehabilitation (26.7% vs 8.3%). Patients with post-transplant depression within the first year had significantly higher 5-year mortality (30% vs 9.5%, p = .009). However, after adjustment for total artificial heart/biventricular assist device, acute rejection, intensive care unit, and hospital length of stay, this relationship was no longer significant (HR 2.11; 95% CI 0.18-25.27; p = .556). CONCLUSIONS: Depression is common among heart transplant candidates and recipients. While pre-transplant depression did not impact outcomes, patients with post-transplant depression were more likely to have had a complicated course, suggesting the need for increased vigilance regarding depression in such patients.

Quality of life and recreational cannabis use.

INTRODUCTION: Cannabis is now the most commonly used illicit drug in the United States and use is increasing. Frequent cannabis use has been associated with adverse social and health effects. We sought to evaluate the relationship between recreational cannabis use and Quality of Life (QoL), a person-centered measure that characterizes the overall sense of health and wellbeing. We hypothesized that QoL would be unchanged or increased among recreational cannabis users, who did not meet criteria for a Cannabis Use Disorder (CUD) and that QoL would be lower among those who met criteria for a CUD. METHODS: We conducted a systematic review, employing guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The results were categorized into tables and identified trends. RESULTS: Fourteen studies met our pre-defined selection criteria. The studies were heterogeneous and their quality was low. With one exception, we did not identify any population for whom cannabis use was associated with improved QoL. QoL was lower in persons who used cannabis heavily, or who met criteria for CUD. However, this association was inconsistent and the magnitude was weaker than the relationship between QoL and use of other addictive substances (including tobacco and illicit drugs). CONCLUSION: In this systematic review, heavy cannabis use or CUD was associated with reduced QoL. It is unknown whether reduced QoL drives cannabis use, or whether cannabis use can lead to reduced QoL. Prospective studies are needed to evaluate the causal relationship between cannabis and QoL. SCIENTIFIC SIGNIFICANCE: Furthering the understanding of the relationship between cannabis and QoL can inform public policy, prevention efforts, outcomes, and an objective understanding of the effects of cannabis users. (Am J Addict 2017;26:8-25).

Maintenance treatment for obsessive-compulsive disorder: findings from a naturalistic setting.

BACKGROUND: Although the utility of medication in the acute treatment of adult obsessive-compulsive disorder (OCD) is well-established, the role of maintenance therapy is not as well-studied. This study examines the efficacy of long-term treatment for, and predictors of, stability in medicated patients with adult OCD. METHODS: Using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), we retrospectively evaluated 84 OCD patients who responded to a 10- to 12-week, open-label, acute treatment in a naturalistic clinic setting. Patients were followed based on their medication response for 1 to 92 months (mean 34.3), or until they terminated therapy. We evaluated Y-BOCS scores every 6 months or sooner, if clinically indicated. RESULTS: Of the 84 patients, 39 (46.4%) responded, having relapsed within a 5-year period. Predictors of longer duration of stability were adjunctive cognitive-behavioral therapy (CBT), lack of comorbid disorders, lower Y-BOCS score after treatment, and larger decrease in Y-BOCS score during treatment phase. CONCLUSIONS: Our results show the importance of maintenance treatment of OCD, noting the benefits of long-term response to adjunctive CBT and of achieving maximal acute response. It is becoming crucial to develop larger maintenance studies with more uniform design to better assess the natural course of treated OCD and improve treatment strategies.

Patient-reported outcomes of quality of life, functioning, and depressive symptom severity in major depressive disorder comorbid with panic disorder before and after SSRI treatment in the star*d trial.

BACKGROUND: Panic disorder (PD) is highly comorbid with major depressive disorder (MDD) with potential impact on patient-reported outcomes of quality of life (QOL), functioning, and depressive symptom severity. METHODS: Using data from the sequenced treatment alternatives to relieve depression (STAR*D) trial, we compared entry and post-SSRI-treatment QOL, functioning, and depressive symptom severity scores in MDD patients with comorbid PD (MDD+PD) to MDD patients without PD (MDDnoPD). We also compared pre- and posttreatment proportions of patients with severe impairments in quality of life and functioning. RESULTS: MDD+PD patients experienced significantly lower QOL and functioning and more severe depressive symptoms than MDDnoPD patients at entry. Following treatment with citalopram, both groups showed significant improvements, however, nearly 30-60% of patients still suffered from severe quality of life and functioning impairments. MDD+PD patients exited with lower QOL and functioning than MDDnoPD patients, a difference that became statistically insignificant after adjusting for baseline measures of depressive symptom severity, functioning, and QOL, comorbid anxiety disorders (PTSD, GAD, social, and specific phobias), age, and college education. CONCLUSIONS: Functional outcomes using QOL and functioning measures should be utilized in treating and researching MDD so that shortfalls in traditional treatment can be identified and additional interventions can be designed to address severe baseline QOL and functioning deficits in MDD comorbid with PD.

Quality of life before and after cosmetic surgery.

This article reviews the literature regarding the impact of cosmetic surgery on health-related quality of life (QOL). Studies were identified through PubMed/Medline and PsycINFO searches from January 1960 to December 2011. Twenty-eight studies were included in this review, according to specific selection criteria. The procedures and tools employed in cosmetic surgery research studies were remarkably diverse, thus yielding difficulties with data analysis. However, data indicate that individuals undergoing cosmetic surgery began with lower values on aspects of QOL than control subjects, and experienced significant QOL improvement post-procedurally, an effect that appeared to plateau with time. Despite the complexity of measuring QOL in cosmetic surgery patients, most studies showed an improvement in QOL after cosmetic surgery procedures. However, this finding was clouded by measurement precision as well as heterogeneity of procedures and study populations. Future research needs to focus on refining measurement techniques, including developing cosmetic surgery-specific QOL measures.

Quality of life and smoking.

BACKGROUND AND OBJECTIVES: Smoking tobacco is the leading cause of preventable illness in the United States and around the world. However, much remains unknown about the factors that motivate individuals to smoke. Quality of life (QoL) has become an important measure of outcomes across all medical specialties, in both research and clinical settings. To date, there has not been a critical review of the research relevant to QoL in smokers. In this review, we describe which scales are used to quantify the QoL of smokers, the relationship between smoking and QoL and the positive impact of smoking cessation. METHODS: Fifty-four relevant studies are included in our review. RESULTS: Low QoL and depression are associated with higher odds of smoking initiation and lower odds of successful smoking cessation. There is a negative relationship between smoking and QoL and the magnitude of this association is related to the number of cigarettes smoked. Secondhand smoke also appears to be negatively associated with QoL. Smoking cessation significantly improves QoL. These findings have been replicated across populations with diverse socioeconomic and cultural groups around the world. DISCUSSION AND CONCLUSIONS: QoL data promotes smokers and practitioners to become more sensitive to the sub-clinical adverse effects of cigarette smoking, thereby improving motivation to quit, cessation rates, and treatment outcomes. SCIENTIFIC SIGNIFICANCE: Understanding the relationship between QoL and tobacco smoking is important for patients, clinicians, and researchers.

Comparative Effectiveness of Psychotherapy vs Antidepressants for Depression in Heart Failure: A Randomized Clinical Trial.

Importance: Heart failure (HF) affects more than 6 million adults in the US and more than 64 million adults worldwide, with 50% prevalence of depression. Patients and clinicians lack information on which interventions are more effective for depression in HF. Objective: To compare the effectiveness of behavioral activation psychotherapy (BA) vs antidepressant medication management (MEDS) on patient-centered outcomes inpatients with HF and depression. Design, Setting, and Participants: This pragmatic randomized comparative effectiveness trial was conducted from 2018 to 2022, including 1-year follow-up, at a not-for-profit academic health system serving more than 2 million people from diverse demographic, socioeconomic, cultural, and geographic backgrounds. Participant included inpatients and outpatients diagnosed with HF and depression, and data were analyzed as intention-to-treat. Data were analyzed from 2022 to 2023. Interventions: BA is an evidence-based manualized treatment for depression, promoting engagement in personalized pleasurable activities selected by patients. MEDS involves the use of an evidence-based collaborative care model with care managers providing coordination with patients, psychiatrists, and primary care physicians to only administer medications. Main Outcomes and Measures: The primary outcome was depressive symptom severity at 6 months, measured using the Patient Health Questionnaire 9-Item (PHQ-9). Secondary outcomes included physical and mental health-related quality of life (HRQOL), measured using the Short-Form 12-Item version 2 (SF-12); heart failure-specific HRQOL, measured using the Kansas City Cardiomyopathy Questionnaire; caregiver burden, measured with the Caregiver Burden Questionnaire for Heart Failure; emergency department visits; readmissions; days hospitalized; and mortality at 3, 6, and 12 months. Results: A total of 416 patients (mean [SD] age, 60.71 [15.61] years; 243 [58.41%] male) were enrolled, with 208 patients randomized to BA and 208 patients randomized to MEDS. At baseline, mean (SD) PHQ-9 scores were 14.54 (3.45) in the BA group and 14.31 (3.60) in the MEDS group; both BA and MEDS recipients experienced nearly 50% reduction in depressive symptoms at 3, 6, and 12 months (eg, mean [SD] score at 12 months: BA, 7.62 (5.73); P < .001; MEDS, 7.98 (6.06); P < .001; between-group P = .55). There was no statistically significant difference between BA and MEDS in the primary outcome of PHQ-9 at 6 months (mean [SD] score, 7.53 [5.74] vs 8.09 [6.06]; P = .88). BA recipients, compared with MEDS recipients, experienced small improvement in physical HRQOL at 6 months (mean [SD] SF-12 physical score: 38.82 [11.09] vs 37.12 [10.99]; P = .04), had fewer ED visits (3 months: 38% [95% CI, 14%-55%] reduction; P = .005; 6 months: 30% [95% CI, 14%-40%] reduction; P = .008; 12 months: 27% [95% CI, 15%-38%] reduction; P = .001), and spent fewer days hospitalized (3 months: 17% [95% CI, 8%-25%] reduction; P = .002; 6 months: 19% [95% CI, 13%-25%] reduction; P = .005; 12 months: 36% [95% CI, 32%-40%] reduction; P = .001). Conclusions and Relevance: In this comparative effectiveness trial of BA and MEDS in patients with HF experiencing depression, both treatments significantly reduced depressive symptoms by nearly 50% with no statistically significant differences between treatments. BA recipients experienced better physical HRQOL, fewer ED visits, and fewer days hospitalized. The study findings suggested that patients with HF could be given the choice between BA or MEDS to ameliorate depression. Trial Registration: ClinicalTrials.gov Identifier: NCT03688100.

Quality of life in obsessive compulsive disorder.

Obsessive-compulsive disorder (OCD) has a profound impact with a high disease burden. In order to truly understand the scope of the effect OCD has on the patient population, one must take into account not only the relentless symptoms beleaguering the patients but also examine their overall ability to enjoy their life. Quality of life (QOL) assessments/improvements are becoming an increasingly important component of healthcare, especially in the mental health field. This review examines QOL in OCD, as well as the influence of comorbidities, and the impact that OCD treatment has on QOL. We searched MEDLINE/PUBMED and PsycINFO databases from 1980-2011 using keywords "obsessive compulsive disorder" OR "OCD" AND "quality of life" OR "QOL." Fifty-eight studies meeting specific selection criteria were ultimately included in this review. The results show that QOL in OCD is significantly impaired when compared to QOL in the general population and in patients with other psychiatric and medical disorders. Likewise, QOL in OCD also appears to be largely affected by comorbid conditions, which should be taken into account when developing a treatment plan. Furthermore, QOL in OCD has been shown to improve with medications and with both individual and group psychotherapy, albeit not to the levels enjoyed by community norms. QOL assessment in both clinical and research settings is important to examine the disease burden, to monitor treatment effectiveness, and to determine full recovery from OCD. Treatment providers should strive to not only reach symptom abatement, but also to assure that patients have regained satisfaction and functioning in their daily lives.

A descriptive analysis of quality of life using patient-reported measures in major depressive disorder in a naturalistic outpatient setting.

PURPOSE: Major depressive disorder (MDD) negatively impacts different aspects of an individual's life leading to grave impairments in quality of life (QOL). We performed a detailed analysis of the interaction between depressive symptom severity, functioning, and QOL in outpatients with MDD in order to better understand QOL impairments in MDD. METHODS: This cross-sectional study was conducted with 319 consecutive outpatients seeking treatment for DSM-IV-diagnosed MDD at an urban hospital-based outpatient clinic from 2005 to 2008 as part of the Cedars-Sinai Psychiatric Treatment Outcome Registry, a prospective cohort study of clinical, functioning, and patient-reported QOL outcomes in psychiatric disorders using a measurement-based care model. This model utilizes the following measures: (a) Depressive symptom severity: Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR); (b) Functioning measures: Global Assessment of Functioning (GAF), Sheehan Disability Scale (SDS), Work and Social Adjustment Scale, and the Endicott Work Productivity Scale; and (c) Quality of Life measure: Quality of Life, Enjoyment, and Satisfaction Questionnaire-Short Form (Q-LES-Q). RESULTS: QOL is significantly impaired in MDD, with a mean Q-LES-Q score for this study population of 39.8 % (SD = 16.9), whereas the community norm average is 78.3 %. Regression modeling suggested that depressive symptom severity, functioning/disability, and age all significantly contributed to QOL. QIDS-SR (measuring depressive symptom severity), GAF, and SDS (measuring functioning/disability) scores accounted for 48.1, 17.4, and 13.3 % (semi-partial correlation values) of the variance in Q-LES-Q, respectively. CONCLUSIONS: Our results show that impairment of QOL increases in a monotonic fashion with depressive symptom severity; however, depression symptom severity only accounted for 48.1 % of the QOL variance in our patient population. Furthermore, QOL is uniquely associated with measures of Functioning. We believe these results demonstrate the need to utilize not only Symptom Severity scales, but also Functioning and Quality of Life measures in MDD assessment, treatment, and research.

Delusional disorder, somatic type: olfactory reference syndrome in a patient with delusional trimethylaminuria.

Delusions of foul body odors (often referred to as olfactory reference syndrome [ORS]) currently fall under the category of delusional disorder, somatic type (DDST), in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). We present the case of a 51-year-old man with no previous psychiatric history who presented with perceived foul odors that he delusionally attributed to trimethylaminuria (TMAU). TMAU is a rare metabolic disorder associated with foul body odors. The patient also experienced severe concurrent mood symptoms because of social isolation resulting from his delusion about his body odors. After considerable discussion of differential diagnoses, a diagnosis of DDST was ultimately made, given the patient's unrelenting nonbizarre delusions and lack of insight pertaining to his body odors. However, this case proved to be very useful in exploring the diagnostic challenges in this type of disorder and recent discussions of ORS and its proposed inclusion in the DSM-5.

Quality of life in anorexia nervosa: a review of the literature.

The aim of this study was to compare quality of life in anorexia nervosa patients to that of subjects without eating disorders, with other eating disorders, or with other psychiatric disorders. Results showed reduced quality of life for eating disorder patients, including anorexia nervosa, as compared to normal controls and individuals with other psychiatric disorders; however, whether anorexia nervosa treatment resulted in improved quality of life remains controversial. Furthermore, anorexia nervosa had a modest impact in the physical domain, although this may reflect self-report limitations as well as the psychopathology of the disorder rather than healthy functioning.

Development and validation of the Individual Burden of Illness Index for Major Depressive Disorder (IBI-D).

This study aims at developing a single numerical measure that represents a depressed patient's individual burden of illness. An exploratory study examined depressed outpatients (n = 317) followed by a hypothesis confirmatory study using the NIMH STAR*D trial (n = 2,967). Eigenvalues/eigenvectors were obtained from the Principal Component Analyses of patient-reported measures of symptom severity, functioning, and quality of life. The study shows that a single principal component labeled as the Individual Burden of Illness Index for Depression (IBI-D) accounts for the vast majority of the variance contained in these three measures providing a numerical z score for clinicians and investigators to determine an individual's burden of illness, relative to other depressed patients.

The Impact of Psilocybin on Patients Experiencing Psychiatric Symptoms: A Systematic Review of Randomized Clinical Trials.

Objective: This systematic review aims to evaluate the impact of psilocybin on patients experiencing psychiatric symptoms, with a focus on health-related quality of life (HRQoL) and safety. Method of Research: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the PubMed database and identified studies published from January 2011 to December 2021 pertaining to the impact of psilocybin on psychiatric symptoms. Two authors independently conducted a focused analysis and reached a final consensus on five studies meeting the specific selection criteria. Study bias was addressed using the Cochrane risk of bias tool. Results: The impact of psilocybin on psychiatric symptoms was examined in five randomized controlled trials (RCTs). Four studies administered 1 to 2 doses of psilocybin, with doses ranging from 14mg/70kg to 30mg/70kg, and one study administered a fixed dose of 25mg to all participants. Administration of psilocybin resulted in significant and sustained reduction in symptoms of anxiety and depression, enhanced sense of wellbeing, life satisfaction, and positive mood immediately after psilocybin administration and up to six months after conclusion of treatment. All studies included some form of psychotherapy, and none reported serious adverse effects. Conclusion: RCTs show the efficacy of psilocybin in the treatment of anxiety and depression symptoms, as well as improvement in HRQoL, and no serious side effects. However, additional research is necessary to characterize predictors of treatment response, patient screening requirements, effectiveness in broader clinical populations, and guidelines for psilocybin-assisted psychotherapy.

Health-related quality of life in bipolar disorder.

OBJECTIVES: Health-related quality of life (HRQOL) refers to an individual's overall sense of wellbeing, and subjective physical, psychological, and social functioning. HRQOL is significantly affected in patients with bipolar disorder (BD), a chronic affective disorder characterized by mood fluctuations, sleep and cognitive impairment, and impact on inter-personal relationships, all of which contribute to HRQOL impairment. This article reviews the relevant literature on the potential causes and magnitude of HRQOL impairment in BD and role of treatment interventions in restoring HRQOL in this patient population. METHODS: A systematic database search was conducted using Medline, Cochrane Database of Systematic Reviews, and PsycINFO from 1959 to 2010 with the key words: bipolar disorder, mania, quality of life, and wellbeing health-related quality of life. A total of 52 studies were initially identified, leading to the selection of 30 studies that focused on measurement of quality of life in adult population. RESULTS: While there is no one standard assessment of HRQOL, most measures incorporate a broad range of questions regarding the patient's own valuation of their physical, psychological, and social wellbeing. Three main findings are highlighted: (i) BD results in impairment of HRQOL compared to healthy individuals and variable negative impact as compared to other chronic psychiatric and medical conditions; (ii) comorbidities of BD have a further multi-factorial negative impact on HRQOL; and (iii) various pharmacological and non-pharmacological treatment modalities have a positive or equivocal effect on HRQOL in BD. CONCLUSIONS: HRQOL is significantly adversely affected in BD patients. Additionally, the presence of comorbid conditions highly prevalent in BD further decreases HRQOL for these patients. In spite of these factors, this review offers renewed hope as several treatment regimens correlate with higher post-intervention HRQOL scores.

Quality of life in body dysmorphic disorder.

Body dysmorphic disorder (BDD) has a significant impact on the patients' quality of life (QOL). This is an initial literature review of QOL in patients with BDD, examining the extent of QOL impairments, the impact of psychiatric comorbidity on QOL, and the effect of treatment on QOL in BDD. Studies were identified through PubMed, MEDLINE, and PsycINFO searches from 1960-2011 using the keywords: "quality of life," "body dysmorphic disorder," "dysmorphophobia," and "body image." Studies included in this review were selected using specific criteria by two authors reaching consensus. Most BDD research studies have used symptom severity measures mainly to study BDD and its treatments. BBD with or without comorbidities is significantly associated with poor QOL and functioning. Studies show that treatment of BDD, either by psychopharmacological treatments such as selective serotonin reuptake inhibitors (SSRIs) or cognitive behavior therapy, might have positive effects on QOL, although these results need to be replicated in larger studies. In conclusion, QOL could add significant value to the assessment of BDD if used as one of the primary measures in research and clinical work in BDD, by providing more information and clearer understanding on the impact of the illness on satisfaction with activities of daily life and overall sense of wellbeing before and after treatment.

Quality of life in panic disorder: looking beyond symptom remission.

PURPOSE: Panic Disorder (PD) is a classic example of a disease where symptom remission may be achieved, yet patient quality of life (QOL) remains low, providing further support for the need to measure QOL as an additional outcome in patient care. The objectives of this review are to examine the substantial QOL impairments in PD and to determine whether modern treatments for PD, which have been proven to achieve symptom remission, have been shown to restore QOL. METHODS: We identified studies on QOL in PD from 1980 to 2010 by searching MEDLINE, PsycINFO, and PubMed databases. RESULTS: The literature reveals substantial QOL impairments in PD, often resulting in poor sense of health, frequent utilization of medical services, occupational deficiency, financial dependency, and marital strife. Modern therapies have been demonstrated to achieve symptom remission and improve QOL in PD; however, post-treatment QOL is still significantly lower than community averages. CONCLUSIONS: QOL needs to be added as an essential outcome measure in patient care. Further research should be conducted to better understand the nature of comorbidities in PD as well as to determine whether additional interventions that have been studied in other psychiatric disorders, such as exercise, meditation, yoga, humor, massage, and nutritional supplements, can be utilized to improve QOL in PD to normal community levels.

Integration of Advanced Health Technology Within the Healthcare System to Fight the Global Pandemic: Current Challenges and Future Opportunities.

The COVID-19 pandemic presents a significant challenge for providing adequate healthcare services in the context of patient isolation. DISCUSSION: The ability of our current healthcare system to cope with the current situation is mainly dependent on advanced health technology, such as telehealth, chatbots, virtual reality (VR), and artificial intelligence (AI). Telehealth can be a novel tool for improving our current healthcare system and allowing for greater delivery of healthcare services during global crises (i.e., the COVID-19 pandemic). Technology, such as chatbots, VR, and AI, could be utilized to reduce the burden of both communicable and noncommunicable diseases, as well as to build a patient-centered decision-making healthcare system. OBJECTIVES: Understanding the various methods of enhancing healthcare services using advanced health technology will help to develop new applications that can be integrated into regular healthcare and in time of healthcare crises. CONCLUSION: Advanced health technology is a main tool to face a pandemic that decreased the burden on physicians and patients as well as the entire healthcare system.

Personalized treatments for depressive symptoms in patients with advanced heart failure: A pragmatic randomized controlled trial.

OBJECTIVES: Heart Failure is a chronic syndrome affecting over 5.7 million in the US and 26 million adults worldwide with nearly 50% experiencing depressive symptoms. The objective of the study is to compare the effects of two evidence-based treatment options for adult patients with depression and advanced heart failure, on depressive symptom severity, physical and mental health related quality of life (HRQoL), heart-failure specific quality of life, caregiver burden, morbidity, and mortality at 3, 6 and 12-months. METHODS: Trial design. Pragmatic, randomized, comparative effectiveness trial. Interventions. The treatment interventions are: (1) Behavioral Activation (BA), a patient-centered psychotherapy which emphasizes engagement in enjoyable and valued personalized activities as selected by the patient; or (2) Antidepressant Medication Management administered using the collaborative care model (MEDS). Participants. Adults aged 18 and over with advanced heart failure (defined as New York Heart Association (NYHA) Class II, III, and IV) and depression (defined as a score of 10 or above on the PHQ-9 and confirmed by the MINI International Neuropsychiatric Interview for the DSM-5) selected from all patients at Cedars-Sinai Medical Center who are admitted with heart failure and all patients presenting to the outpatient programs of the Smidt Heart Institute at Cedars-Sinai Medical Center. We plan to randomize 416 patients to BA or MEDS, with an estimated 28% loss to follow-up/inability to collect follow-up data. Thus, we plan to include 150 in each group for a total of 300 participants from which data after randomization will be collected and analyzed. CONCLUSIONS: The current trial is the first to compare the impact of BA and MEDS on depressive symptoms, quality of life, caregiver burden, morbidity, and mortality in patients with depression and advanced heart failure. The trial will provide novel results that will be disseminated and implemented into a wide range of current practice settings. REGISTRATION: ClinicalTrials.Gov Identifier: NCT03688100.

Disorders of orgasm in women: a literature review of etiology and current treatments.

INTRODUCTION: Disorders of orgasm in women, defined as the persistent or recurrent delay in or absence of orgasm, affect up to a quarter of the female population. AIM: To review existing research findings on the etiology and treatments of disorders of orgasm in women to provide a useful reference tool for clinicians who evaluate and treat patients with these conditions. METHODS: PubMed and PsycINFO search for articles published between 1980 and 2009 using the keywords "orgasm*,""anorgasmia," and "female*,""woman," or "women," in addition to "female orgasmic disorder" and "disorders of orgasm in women." MAIN OUTCOME MEASURES: Findings on the etiological factors and effects of a variety of treatment interventions on improving disorders of orgasm in women. Results. Literature on prevalence and causes of disorders of orgasm in women is abundant, yet more reports of successful treatments are needed. Nevertheless, many promising approaches have been suggested, and data support several potential treatments such as bupropion, sildenafil, estrogen, and testosterone among others. CONCLUSIONS: Although more research is needed to better understand and manage disorders of orgasm in women, significant progress is being made.