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Clinical Practice and Epidemiology in... 2023Depressive disorders (DD) are common, and their prevalence is expected to rise over the next decade. Depressive disorders are linked to significant morbidity and... (Review)
Review
Depressive disorders (DD) are common, and their prevalence is expected to rise over the next decade. Depressive disorders are linked to significant morbidity and mortality. The clinical conundrum of depressive disorders lies in the heterogeneity of their phenomenology and etiology. Further, the currently available antidepressants have several limitations, including a delayed onset of action, limited efficacy, and an unfavorable side effect profile. In this review, Dexmedetomidine (DEX), a highly selective and potent α2-adrenergic receptor (α2-AR) agonist, is proposed as a potentially novel antidepressant with multiple mechanisms of action targeting various depression pathophysiological processes. These mechanisms include modulation of the noradrenergic system, regulation of neuroinflammation and oxidative stress, influence on the Brain-Derived Neurotrophic Factor (BDNF) levels, and modulation of neurotransmitter systems, such as glutamate. The review begins with an introduction before moving on to a discussion of DEX's pharmacological features. The pathophysiological and phenomenological targets of DD are also explored, along with the review of the existing preclinical and clinical evidence for DEX's putative anti-depressant effects. Finally, the review ends by presenting the pertinent conclusions and future directions.
PubMed: 37916205
DOI: 10.2174/17450179-v19-230823-2023-4 -
Behavioral Sciences (Basel, Switzerland) Mar 2024Panic buying poses significant challenges for individuals and societies. This paper provides a literature review on the process by which a pandemic crisis evolves into... (Review)
Review
Panic buying poses significant challenges for individuals and societies. This paper provides a literature review on the process by which a pandemic crisis evolves into panic buying behavior. The review offers a comprehensive perspective on studies related to panic buying and mitigation efforts, categorizing them based on their contributions in three stages: factors influencing panic buying, the process of transforming panic into increased demand and stockpiling, and applicable intervention strategies to mitigate panic situations. The paper introduces the Socio-Economic Framework of Panic (SEFP) to illustrate the interaction between demand and supply during a panic. The review identifies a lack of quantitative models explicitly correlating influencing factors with panic and estimating panic demand. Additionally, it reveals that suggested intervention strategies often lack practical implementation guidelines. Using the SEFP, the importance of considering interventions at various stages is highlighted, ranging from controlling influencing factors and panic demands to overseeing stockpiling and supply-related activities. The paper also identifies research gaps in both qualitative and quantitative modeling, policymaking, and governance.
PubMed: 38540525
DOI: 10.3390/bs14030222 -
Child's Nervous System : ChNS :... Feb 2024Awake craniotomy (AC) is the treatment of choice for the resection of brain tumors within eloquent brain regions for adults, but not much is known about its... (Review)
Review
PURPOSE
Awake craniotomy (AC) is the treatment of choice for the resection of brain tumors within eloquent brain regions for adults, but not much is known about its psychological impact on children and adolescents. Patient immaturity and difficulty in cooperating during surgery could result in psychological sequelae postoperatively, such as anxiety, panic, and worry.
METHODS
In this review, we examined eight studies assessing AC performed on patients under 18 years of age (N = 85), noting exclusion criteria, interventions used, and psychological assessments implemented.
RESULTS
Initial assessments of cognitive functioning and maturity were conducted primarily to determine patient eligibility for AC instead of an age restriction. No standardized interventions were used to minimize anxiety associated with AC. Interventions ranged from almost nothing specified to exposure to videos of the operating room, hypnosis, repeated meetings with psychologists and speech therapists, extensive meetings with the surgery team, and thorough exposure to the operating room theater. With a few exceptions, there were no standardized pre- and post-AC assessments of psychological sequelae. Qualitative evaluations indicated that most children and adolescents tolerated AC well, but one study indicated detrimental effects on school attendance postoperatively.
CONCLUSION
Given that most AC teams have a psychologist, it seems desirable to have pre- and post-AC psychological assessments using standardized measures of anxiety, trauma, and worry, as well as measures tailored to AC, such as time to return to school, worry about MRIs following surgery, and self-assessment of post-surgery functioning. In short, comprehensive psychological assessment of AC patients is clearly needed.
Topics: Adult; Child; Humans; Adolescent; Wakefulness; Craniotomy; Brain Neoplasms; Anxiety; Brain
PubMed: 37610695
DOI: 10.1007/s00381-023-06117-6 -
Journal of Personalized Medicine Oct 2023Mast cell activation syndrome (MCAS) is an immune disease with an estimated prevalence of 17%. Mast cell chemical mediators lead to heterogeneous multisystemic...
Mast cell activation syndrome (MCAS) is an immune disease with an estimated prevalence of 17%. Mast cell chemical mediators lead to heterogeneous multisystemic inflammatory and allergic manifestations. This syndrome is associated with various neurologic and psychiatric disorders, including headache, dysautonomia, depression, generalized anxiety disorder, and many others. Although MCAS is common, it is rarely recognized, and thus, patients can suffer for decades. The syndrome is caused by aberrant mast cell reactivity due to the mutation of the controller gene. A case series is presented herein including eight patients with significant neuropsychiatric disorders that were often refractory to standard medical therapeutics. Five patients had depression, five had generalized anxiety disorder, and four had panic disorder. Other psychiatric disorders included attention-deficit hyperactivity disorder, obsessive compulsive disorder, phobias, and bipolar disorder. All eight patients were subsequently diagnosed with mast cell activation syndrome; six had comorbid autonomic disorders, the most common being postural orthostatic tachycardia syndrome; and four had hypermobile Ehlers-Danlos syndrome. All patients experienced significant improvements regarding neuropsychiatric and multisystemic symptoms after mast-cell-directed therapy. In neuropsychiatric patients who have systemic symptoms and syndromes, it is important to consider the presence of an underlying or comorbid MCAS.
PubMed: 38003876
DOI: 10.3390/jpm13111562 -
World Psychiatry : Official Journal of... Feb 2024Anxiety disorders are very prevalent and often persistent mental disorders, with a considerable rate of treatment resistance which requires regulatory clinical trials of...
Anxiety disorders are very prevalent and often persistent mental disorders, with a considerable rate of treatment resistance which requires regulatory clinical trials of innovative therapeutic interventions. However, an explicit definition of treatment-resistant anxiety disorders (TR-AD) informing such trials is currently lacking. We used a Delphi method-based consensus approach to provide internationally agreed, consistent and clinically useful operational criteria for TR-AD in adults. Following a summary of the current state of knowledge based on international guidelines and an available systematic review, a survey of free-text responses to a 29-item questionnaire on relevant aspects of TR-AD, and an online consensus meeting, a panel of 36 multidisciplinary international experts and stakeholders voted anonymously on written statements in three survey rounds. Consensus was defined as ≥75% of the panel agreeing with a statement. The panel agreed on a set of 14 recommendations for the definition of TR-AD, providing detailed operational criteria for resistance to pharmacological and/or psychotherapeutic treatment, as well as a potential staging model. The panel also evaluated further aspects regarding epidemiological subgroups, comorbidities and biographical factors, the terminology of TR-AD vs. "difficult-to-treat" anxiety disorders, preferences and attitudes of persons with these disorders, and future research directions. This Delphi method-based consensus on operational criteria for TR-AD is expected to serve as a systematic, consistent and practical clinical guideline to aid in designing future mechanistic studies and facilitate clinical trials for regulatory purposes. This effort could ultimately lead to the development of more effective evidence-based stepped-care treatment algorithms for patients with anxiety disorders.
PubMed: 38214637
DOI: 10.1002/wps.21177 -
Insects Nov 2023Ants are one of the largest insect groups, with the most species and individuals in the world, and they have an important ecological function. Ants are not only an... (Review)
Review
Ants are one of the largest insect groups, with the most species and individuals in the world, and they have an important ecological function. Ants are not only an important part of the food chains but are also one of the main decomposers on the Earth; they can also improve soil fertility, etc. However, some species of ants are harmful to human beings, which leads to people's panic or worry about coming into contact with these insects during their daily home life or in their tourism or leisure activities. The presence of ants in indoor living facilities and in outdoor green spaces, parks, gardens, and tourist attractions seriously interferes with the leisure life and entertainment activities of all people (especially children). How can we control ants in these environments? Do we kill them by spraying insecticides, or do we adopt green prevention and control technology for the ecological management of ants? This topic is related to healthy life for the public and the protection of the ecological environment. In this paper, the species and diversity of ants are introduced, and research progress regarding ant tropism is introduced according to the three aspects of phototaxis, chromotaxis, and chemotaxis (i.e., "3-tropisms"). The research on repellent substances from plants and insects and the related ant attractants are also summarized, analyzed, and discussed, in order to help the research and application of green prevention and control technology for ant diversity protection and conservation.
PubMed: 37999091
DOI: 10.3390/insects14110892 -
Neuropsychopharmacology Reports Sep 2023The development of clinical practice guidelines for social anxiety disorder began in March 2018 when the Joint Clinical Practice Guideline Development Committee for...
The development of clinical practice guidelines for social anxiety disorder began in March 2018 when the Joint Clinical Practice Guideline Development Committee for Anxiety and Obsessive-Compulsive Disorders was formed by the Japanese Society of Anxiety and Related Disorders and Japanese Society of Neuropsychopharmacology to jointly develop guidelines for anxiety and obsessive-compulsive disorders. Based on the universal concept of evidence-based medicine, three clinical questions (CQs) about pharmacotherapy and psychotherapy were developed for clinical guidelines for social anxiety disorder, panic disorders, and obsessive-compulsive disorder in accordance with the Minds "Manual for Guidelines Development 2017 by the Japan Council for Quality Health Care: CQ1-"What is the recommended pharmacotherapy for social anxiety disorder in adults?"; CQ2-"What is the recommended psychotherapy (psychological intervention) for social anxiety disorder in adults?"; and CQ3-"What are the recommendations regarding monotherapy and combination therapy for social anxiety disorder in adults in terms of pharmacotherapy and psychotherapy (psychological interventions)?" Summarized recommendations for social anxiety disorder in adults are selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitor for CQ1, cognitive behavioral therapy for CQ2, and there are no recommendations regarding monotherapy and combination therapy for CQ3. These were answered by considering the balance between benefits and harms based on systematic reviews of each. The aim of this brief guideline for the standard-of-care (i.e., medical treatment) for social anxiety disorder in adults (18 years and older) was to help "shared decision making," in which medical professionals, including physicians, and patients share scientific evidence to decide on a course of treatment.
Topics: Adult; Humans; Anxiety; Anxiety Disorders; Cognitive Behavioral Therapy; East Asian People; Phobia, Social; Japan; Anti-Anxiety Agents; Combined Modality Therapy
PubMed: 37624975
DOI: 10.1002/npr2.12365 -
BMJ Open Oct 2023Depression and anxiety afflict millions worldwide causing considerable disability. MULTI-PSYCH is a longitudinal cohort of genotyped and phenotyped individuals with...
PURPOSE
Depression and anxiety afflict millions worldwide causing considerable disability. MULTI-PSYCH is a longitudinal cohort of genotyped and phenotyped individuals with depression or anxiety disorders who have undergone highly structured internet-based cognitive-behaviour therapy (ICBT). The overarching purpose of MULTI-PSYCH is to improve risk stratification, outcome prediction and secondary preventive interventions. MULTI-PSYCH is a precision medicine initiative that combines clinical, genetic and nationwide register data.
PARTICIPANTS
MULTI-PSYCH includes 2668 clinically well-characterised adults with major depressive disorder (MDD) (n=1300), social anxiety disorder (n=640) or panic disorder (n=728) assessed before, during and after 12 weeks of ICBT at the internet psychiatry clinic in Stockholm, Sweden. All patients have been blood sampled and genotyped. Clinical and genetic data have been linked to several Swedish registers containing a wide range of variables from patient birth up to 10 years after the end of ICBT. These variable types include perinatal complications, school grades, psychiatric and somatic comorbidity, dispensed medications, medical interventions and diagnoses, healthcare and social benefits, demographics, income and more. Long-term follow-up data will be collected through 2029.
FINDINGS TO DATE
Initial uses of MULTI-PSYCH include the discovery of an association between PRS for autism spectrum disorder and response to ICBT, the development of a machine learning model for baseline prediction of remission status after ICBT in MDD and data contributions to genome wide association studies for ICBT outcome. Other projects have been launched or are in the planning phase.
FUTURE PLANS
The MULTI-PSYCH cohort provides a unique infrastructure to study not only predictors or short-term treatment outcomes, but also longer term medical and socioeconomic outcomes in patients treated with ICBT for depression or anxiety. MULTI-PSYCH is well positioned for research collaboration.
Topics: Adult; Pregnancy; Female; Humans; Sweden; Depression; Depressive Disorder, Major; Autism Spectrum Disorder; Genome-Wide Association Study; Anxiety Disorders; Anxiety; Psychotherapy; Treatment Outcome; Internet
PubMed: 37793927
DOI: 10.1136/bmjopen-2022-069427 -
Revista Brasileira de Psiquiatria (Sao... Jun 2024Panic disorder (PD) is a common disabling condition characterized by recurrent panic attacks. Emotional and behavioral impairments are associated with functional...
BACKGROUND
Panic disorder (PD) is a common disabling condition characterized by recurrent panic attacks. Emotional and behavioral impairments are associated with functional connectivity (FC) and network abnormalities. We used the whole brain FC, modular networks, and graph-theory analysis to investigate extensive network profiles in PD.
METHOD
The functional MRI data from 82 PD and 97 controls were included. Intrinsic FC between each pair of 160 regions, 6 intra-networks, and 15 inter-networks were analyzed. The topological properties were explored.
RESULTS
PD patients showed altered FCs within the right insula, between frontal cortex-posterior cingulate cortex (PCC), frontal cortex-cerebellum, and PCC-occipital cortex (corrected P values < 0.001). Lower connections within the Sensorimotor Network (SMN) and SMN-Occipital Network (OCN) were detected (P values < 0.05). Various decreased global and local network features were found in PD (P values < 0.05). In addition, significant correlations were found between PD symptoms and nodal efficiency (Ne) in the insula (r = -0.273, P = 0.016), and the FC of the intra-insula (r = -0.226, P = 0.041).
CONCLUSIONS
PD patients present with abnormal functional brain networks, especially the decreased FC and Ne within insula, suggesting that dysfunction of information integration plays an important role in PD.
PubMed: 38870426
DOI: 10.47626/1516-4446-2023-3520 -
CNS Drugs Dec 2023Depression, anxiety, and/or panic disorder are often comorbid and have a complex etiology mediated through the same neuronal network. Cholecystokinin-tetrapeptide... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Depression, anxiety, and/or panic disorder are often comorbid and have a complex etiology mediated through the same neuronal network. Cholecystokinin-tetrapeptide (CCK-4), a synthetic analog of the endogenous neuropeptide cholecystokinin (CCK), is thought to be implicated in this network. The CCK-4 challenge model is an accepted method of investigating the pathophysiology of panic and has been shown to mediate neuronal activation via the transient receptor potential canonical (TRPC) ion channels.
OBJECTIVES
This study aimed to assess the pharmacodynamic effects of BI 1358894, a small-molecule inhibitor of TRPC ion channel members 4 and 5 (TRPC4/5), on CCK-4-induced anxiety/panic-like symptoms and evaluate circuit engagement.
METHODS
Twenty healthy male CCK-4-sensitive volunteers entered a Phase I, double blind, randomized, two-way cross-over, single dose, placebo-controlled trial. Randomization was to oral BI 1358894 100 mg in the fed state followed by oral placebo in the fed state, or vice versa. Treatments were administered 5 h prior to intravenous CCK-4 50 µg. The primary endpoint was maximum change from baseline of the Panic Symptom Scale (PSS) sum intensity score after CCK-4 injection. Further endpoints included the emotional faces visual analog score (EVAS), the Spielberger State-Trait Anxiety Inventory (STAI), plasma adrenocorticotropic hormone (ACTH), and serum cortisol values. The safety and tolerability of BI 1358894 was assessed based on a number of parameters including occurrence of adverse events (AEs). All pharmacodynamic, pharmacokinetic, and safety endpoints were analyzed using descriptive statistics.
RESULTS
Single oral doses of BI 1358894 were generally well tolerated by the healthy male volunteers included in this study. Adjusted mean maximum change from baseline in PSS sum intensity score was 24.4 % lower in volunteers treated with BI 1358894 versus placebo, while adjusted mean maximum change from baseline of EVAS was reduced by 19.2 % (BI 1358894 vs placebo). The STAI total score before CCK-4 injection was similar in both groups (placebo: 25.1; BI 1358894: 24.3). Relative to placebo, BI 1358894 reduced CCK-4-induced mean maximum plasma ACTH and serum cortisol values by 58.6 % and 27.3 %, respectively. Investigator-assessed drug-related AEs were reported for 13/20 participants (65.0 %). There were no serious or severe AEs, AEs of special interest, AEs leading to discontinuation of trial medication, or deaths.
CONCLUSIONS
Overall, BI 1358894 reduced psychological and physiological responses to CCK-4 compared with placebo, as measured by PSS, subjective EVAS and objectively measured stress biomarkers. BI 1358894 had a positive safety profile, and single oral doses were well tolerated by the healthy volunteers. This trial (NCT03904576/1402-0005) was registered on Clinicaltrials.gov on 05.04.19.
Topics: Humans; Male; Tetragastrin; Hydrocortisone; Adrenocorticotropic Hormone; Anxiety; Double-Blind Method; Biomarkers
PubMed: 38019356
DOI: 10.1007/s40263-023-01042-3