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International Journal of Molecular... Sep 2022Depressive disorders (DDs) are an increasingly common health problem that affects all age groups. DDs pathogenesis is multifactorial. However, it was proven that stress... (Review)
Review
Depressive disorders (DDs) are an increasingly common health problem that affects all age groups. DDs pathogenesis is multifactorial. However, it was proven that stress is one of the most important environmental factors contributing to the development of these conditions. In recent years, there has been growing interest in the role of the glutamatergic system in the context of pharmacotherapy of DDs. Thus, it has become increasingly important to explore the functioning of excitatory synapses in pathogenesis and pharmacological treatment of psychiatric disorders (including DDs). This knowledge may lead to the description of new mechanisms of depression and indicate new potential targets for the pharmacotherapy of illness. An excitatory synapse is a highly complex and very dynamic structure, containing a vast number of proteins. This review aimed to discuss in detail the role of the key postsynaptic proteins (e.g., NMDAR, AMPAR, mGluR5, PSD-95, Homer, NOS etc.) in the excitatory synapse and to systematize the knowledge about changes that occur in the clinical course of depression and after antidepressant treatment. In addition, a discussion on the potential use of ligands and/or modulators of postsynaptic proteins at the excitatory synapse has been presented.
Topics: Brain; Depressive Disorder; Disks Large Homolog 4 Protein; Humans; Ligands; Synapses
PubMed: 36232725
DOI: 10.3390/ijms231911423 -
The Journal of Clinical Psychiatry May 2020 Being able to recognize inadequate response to antidepressant treatment and distinguish it from treatment-resistant depression is key in order for... (Review)
Review
Being able to recognize inadequate response to antidepressant treatment and distinguish it from treatment-resistant depression is key in order for clinicians to provide appropriate therapies. Although definitions vary, nonresponse is often defined as less than 25% improvement on a standardized rating scale, and partial response, as more than 25% but less than 50% improvement. Residual symptoms characteristic of inadequate response (less than 50% improvement) include low mood, anxiety, irritability, guilt, and somatic symptoms. Various factors that may contribute to inadequate response to an antidepressant include inadequate dose or duration, poor adherence, and misdiagnosis. .
Topics: Antidepressive Agents; Depressive Disorder, Major; Humans; Psychiatric Status Rating Scales; Treatment Failure
PubMed: 32369684
DOI: 10.4088/JCP.OT19037BR2 -
Psychiatry Research Oct 2020Psychopathology research has increasingly sought to study the etiology and treatment of individual symptoms, rather than categorical diagnoses. However, it is unclear...
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.
Topics: Adolescent; Adult; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Interview, Psychological; Male; Psychometrics; Reproducibility of Results; Young Adult
PubMed: 32738552
DOI: 10.1016/j.psychres.2020.113313 -
JAMA Health Forum Feb 2024Telehealth utilization for mental health care remains much higher than it was before the COVID-19 pandemic; however, availability may vary across facilities, geographic...
IMPORTANCE
Telehealth utilization for mental health care remains much higher than it was before the COVID-19 pandemic; however, availability may vary across facilities, geographic areas, and by patients' demographic characteristics and mental health conditions.
OBJECTIVE
To quantify availability, wait times, and service features of telehealth for major depressive disorder, general anxiety disorder, and schizophrenia throughout the US, as well as facility-, client-, and county-level characteristics associated with telehealth availability.
DESIGN, SETTINGS, AND PARTICIPANTS
Cross-sectional analysis of a secret shopper survey of mental health treatment facilities (MHTFs) throughout all US states except Hawaii from December 2022 and March 2023. A nationally representative sample of 1938 facilities were contacted; 1404 (72%) responded and were included. Data analysis was performed from March to July 2023.
EXPOSURE
Health facility, client, and county characteristics.
MAIN OUTCOME AND MEASURES
Clinic-reported availability of telehealth services, availability of telehealth services (behavioral treatment, medication management, and diagnostic services), and number of days until first telehealth appointment. Multivariable logistic and linear regression analyses were conducted to assess whether facility-, client-, and county-level characteristics were associated with each outcome.
RESULTS
Of the 1221 facilities (87%) accepting new patients, 980 (80%) reported offering telehealth. Of these, 97% (937 facilities) reported availability of counseling services; 77% (726 facilities), medication management; and 69% (626 facilities) diagnostic services. Telehealth availability did not differ by clinical condition. Private for-profit (adjusted odds ratio [aOR], 1.75; 95% CI, 1.05-2.92) and private not-for-profit (aOR, 2.20; 95% CI, 1.42-3.39) facilities were more likely to offer telehealth than public facilities. Facilities located in metropolitan counties (compared with nonmetropolitan counties) were more likely to offer medication management services (aOR, 1.83; 95% CI, 1.11-3.00) but were less likely to offer diagnostic services (aOR, 0.67; 95% CI, 0.47-0.95). Median (range) wait time for first telehealth appointment was 14 (4-75) days. No differences were observed in availability of an appointment based on the perceived race, ethnicity, or sex of the prospective patient.
CONCLUSIONS AND RELEVANCE
The findings of this cross-sectional study indicate that there were no differences in the availability of mental telehealth services based on the prospective patient's clinical condition, perceived race or ethnicity, or sex; however, differences were found at the facility-, county-, and state-level. These findings suggest widespread disparities in who has access to which telehealth services throughout the US.
Topics: Humans; Health Services Accessibility; Cross-Sectional Studies; Pandemics; Depressive Disorder, Major; Prospective Studies; Telemedicine; Anxiety Disorders
PubMed: 38306092
DOI: 10.1001/jamahealthforum.2023.5142 -
Progress in Neuro-psychopharmacology &... Mar 2021During the period extending from 1780 to 1880, the conceptualization of melancholia changed from an intellectual to a mood model. The modern view of depression, based on... (Review)
Review
During the period extending from 1780 to 1880, the conceptualization of melancholia changed from an intellectual to a mood model. The modern view of depression, based on Kraepelinian dualism, has reflected changes in opinion on psychiatric taxonomy of individual melancholia. From the point of view of an "operational revolution," the diagnostic criteria for major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) were based on a neoKraepelinian approach rooted in disease essentialism. In the revision process from the DSM-IV to the DSM-5, a combined dimensional and categorial approach was used. In the DSM-5, the diagnostic criteria for major depressive disorder are polythetic and operational in approach reflecting the heterogeneity of major depressive disorder. Although 227 different symptom combinations fulfilling the diagnostic criteria for major depressive disorder can be theoretically calculated, certain symptom combinations are more prevalent than others in real clinical situations. The heterogeneity of these operational criteria for major depressive disorder have been criticized in a manner informed by the Wittgensteinian analogy of the language game. Herein, our network analysis proposes a novel perspective on the psychopathology of major depressive disorder. The novel approach suggested here may lay the foundation for a redefinition of the traditional taxonomy of depression.
Topics: Depressive Disorder, Major; Humans; Psychiatric Status Rating Scales
PubMed: 33049324
DOI: 10.1016/j.pnpbp.2020.110133 -
Journal of Neurology Sep 2019Cervical dystonia (CD) is the most common form of dystonia. The onset of CD is usually before 60 years of age and it may cause severe functional and psychosocial...
BACKGROUND
Cervical dystonia (CD) is the most common form of dystonia. The onset of CD is usually before 60 years of age and it may cause severe functional and psychosocial impairment in everyday life. Recently non-motor symptoms have been reported to occur in CD substantially affecting the quality of life.
METHODS/PATIENTS
We studied comorbidities of patients with primary focal CD in Finland based on ICD-10 codes obtained from the care registry and patient records of 937 confirmed adult isolated focal CD patients between the years 2007-2016. The retirement months and diagnosis of retirement were calculated from pension registry information. The results were compared with 3746 age and gender-matched controls.
RESULTS
Most prominent comorbidities with primary focal CD were depression (14%), anxiety (7%), and back pain (11%). The retirement age was significantly younger in CD patients compared to control group controls (59.0 years, 95% CI 58.5-59.5 vs. 61.7 years, 95% CI 61.6-61.9) years, p < 0.001). For dystonia patients the most common diagnoses for retirement due to sickness were dystonia (51%), depression (14%), and anxiety (8%). Patients with anxiety and depression retired earlier than other dystonia patients.
DISCUSSION
Cervical dystonia considerably reduces working ability and leads to earlier retirement. Anxiety and depression are most notable comorbidities and their co-occurrence further reduces working ability. Our results suggest that more health care resources should be administered in treatment of CD to longer maintain working ability of CD patients. Further, psychiatric comorbidities should be taken into consideration in CD treatment.
Topics: Aged; Anxiety Disorders; Comorbidity; Depressive Disorder; Female; Finland; Humans; Male; Middle Aged; Registries; Retirement; Torticollis
PubMed: 31152297
DOI: 10.1007/s00415-019-09402-0 -
PloS One 2022People with drug-resistant tuberculosis (DR-TB) are known to suffer from many mental-health disorders. This study aims to describe the proportion of patients diagnosed...
BACKGROUND
People with drug-resistant tuberculosis (DR-TB) are known to suffer from many mental-health disorders. This study aims to describe the proportion of patients diagnosed with psychiatric comorbidities, the different psychiatric diagnoses made, and treatment outcomes among DR-TB patients with or without psychiatric comorbidity and initiated on DR-TB treatment between January 2012 and March 2019 at Médecins Sans Frontières independent clinic in Mumbai, India.
METHODS
This is a retrospective study using routinely collected clinical data. DR-TB care included individualised treatment, psychosocial support, and integrated psychiatric care.
RESULTS
During the study period, 341 DR-TB patients were enrolled, with a median age of 25 years (IQR:20.0-36.5 years), 185 (54.2%) females, 143 (41.9%) with PreXDR-TB, and 140 (41.0%) with XDR-TB. All 341 patients were screened by a counsellor, 119 (34.9%) were referred for psychiatric evaluation, and 102 (29.9% of 341) were diagnosed with a psychiatric comorbidity. Among 102 diagnosed with a psychiatric comorbidity, 48 (47.0%) were diagnosed at baseline, and 86 (84.3%), or 25.2% of all 341 patients enrolled, were treated with psychotropic drugs. Depressive disorders were diagnosed in 49 (48.0%), mixed anxiety and depression in 24 (23.5%), neurocognitive disorders and anxiety in five (4.9%), and medication induced psychosis in two (2.0%). No anti-TB drugs were significantly associated with psychiatric comorbidities developed during treatment. Of 102 DR-TB patients with a psychiatric comorbidity, 75.5% (77) had successful DR-TB treatment outcomes, compared to 61.1% (146/239) not diagnosed with a psychiatric comorbidity (p = 0.014).
CONCLUSION
In our setting, among people started on DR-TB treatment, and with a complex TB resistance profile, about one in three patients experienced a psychiatric comorbidity, of which half developed this comorbidity during treatment. With comprehensive psychiatric care integrated into DR-TB care delivery, treatment outcomes were at least as good among those with psychiatric comorbidities compared to those without such comorbidities.
Topics: Adult; Antitubercular Agents; Anxiety; Depressive Disorder; Female; Humans; Male; Neurocognitive Disorders; Psychotropic Drugs; Retrospective Studies; Treatment Outcome; Tuberculosis, Multidrug-Resistant; Young Adult
PubMed: 35148328
DOI: 10.1371/journal.pone.0263759 -
The American Journal of Psychiatry May 2021Preclinical studies point to the KCNQ2/3 potassium channel as a novel target for the treatment of depression and anhedonia, a reduced ability to experience pleasure. The... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Preclinical studies point to the KCNQ2/3 potassium channel as a novel target for the treatment of depression and anhedonia, a reduced ability to experience pleasure. The authors conducted the first randomized placebo-controlled trial testing the effect of the KCNQ2/3 positive modulator ezogabine on reward circuit activity and clinical outcomes in patients with depression.
METHODS
Depressed individuals (N=45) with elevated levels of anhedonia were assigned to a 5-week treatment period with ezogabine (900 mg/day; N=21) or placebo (N=24). Participants underwent functional MRI during a reward flanker task at baseline and following treatment. Clinical measures of depression and anhedonia were collected at weekly visits. The primary endpoint was the change from baseline to week 5 in ventral striatum activation during reward anticipation. Secondary endpoints included depression and anhedonia severity as measured using the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Snaith-Hamilton Pleasure Scale (SHAPS), respectively.
RESULTS
The study did not meet its primary neuroimaging endpoint. Participants in the ezogabine group showed a numerical increase in ventral striatum response to reward anticipation following treatment compared with participants in the placebo group from baseline to week 5. Compared with placebo, ezogabine was associated with a significantly larger improvement in MADRS and SHAPS scores and other clinical endpoints. Ezogabine was well tolerated, and no serious adverse events occurred.
CONCLUSIONS
The study did not meet its primary neuroimaging endpoint, although the effect of treatment was significant on several secondary clinical endpoints. In aggregate, the findings may suggest that future studies of the KCNQ2/3 channel as a novel treatment target for depression and anhedonia are warranted.
Topics: Adult; Anhedonia; Carbamates; Depressive Disorder; Depressive Disorder, Major; Double-Blind Method; Female; Functional Neuroimaging; Humans; KCNQ2 Potassium Channel; KCNQ3 Potassium Channel; Magnetic Resonance Imaging; Male; Membrane Transport Modulators; Middle Aged; Phenylenediamines; Reward; Ventral Striatum
PubMed: 33653118
DOI: 10.1176/appi.ajp.2020.20050653 -
Ugeskrift For Laeger Dec 2022The Italian Medieval doctor Thaddeus Florentinus (AD 1210-1295) claimed that herbs could cure or relieve various symptoms such as obstipation, melancholia and... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
The Italian Medieval doctor Thaddeus Florentinus (AD 1210-1295) claimed that herbs could cure or relieve various symptoms such as obstipation, melancholia and nervousness. Additionally, certain herbs were proposed to be able to predict the weather and induce the vision of elves. Therefore, the aim of this study was to investigate whether herbs could have medical properties as claimed.
METHODS
A randomized controlled trial with three arms was conducted: 1) Gin with St. John's wort, 2) Gin with angelica and 3) Gin with sweet woodruff. Participants were 21 anesthesia registrars. The primary outcome was visual induction of elves (yes/no) whereas secondary outcomes included melancholia (VAS 0-100), nervousness (VAS 0-100), weather prediction capabilities (yes/no) obstipation (Bristol Stool Chart 1-7) and others. Baseline recordings were obtained and hourly registrations of outcomes were undertaken. Confounding factors such as alcohol intoxication and vivid imagination was controlled by the means of alcohol breathalyzers and assessment of cerebral oxygenation by near infrared spectroscopy.
RRESULTS
The vision of elves was induced in 10 out of 21 participants (48.6%) and was associated with male sex (p = 0.01), young age (p = 0.03) and increase in cerebral oxygenation (p = 0.04) but not with sweet woodruff (p = 0.83) or alcohol intoxication (p = 0.26). Participants were not capable of predicting the weather forecast (p = 0.55). Melancholia and nervousness were not relieved by St. John's wort, and obstipation could not be relieved by the intake of angelica.
CONCLUSION
Sweet woodruff, St. John's wort and angelica were unable to relieve relevant Christmas symptoms as proposed by a medieval doctor. Alcohol ingestion might have influenced results, and data should be interpreted in the light of these precautions.
FUNDING
none.
TRIAL REGISTRATION
not applicable.
Topics: Male; Humans; Hypericum; Alcoholic Intoxication; Depressive Disorder; Phytotherapy
PubMed: 36510811
DOI: No ID Found -
Sichuan Da Xue Xue Bao. Yi Xue Ban =... Mar 2023The intestinal barrier, a complex structure consisting of multiple layers of defense barriers, blocks the transfer of intestinal and foreign bacteria and their... (Review)
Review
The intestinal barrier, a complex structure consisting of multiple layers of defense barriers, blocks the transfer of intestinal and foreign bacteria and their metabolites into the internal environment of the human body. Intestinal permeability can be used to evaluate the integrity of the intestinal barrier. Increased intestinal permeability has been observed in patients with depressive disorder. Some studies have reported an interaction between depressive disorder and intestinal barrier. Herein, we reviewed reported findings on the mechanisms of how systematic low-grade inflammation, vagal nerve dysfunction, and hypothalamic-pituitary-adrenal axis dysfunction cause changes in intestinal permeability in patients with depressive disorder and the pathogenic mechanism of how bacterial translocation caused by damaged intestinal barrier leads to depressive disorder. In addition, the potential mechanisms of how antidepressants improve intestinal permeability and how probiotics improve depressive disorder have been discussed.
Topics: Humans; Hypothalamo-Hypophyseal System; Pituitary-Adrenal System; Intestines; Permeability; Depressive Disorder; Intestinal Mucosa
PubMed: 36949682
DOI: 10.12182/20230360503