Pharmacological treatment for insomnia in patients with major depressive disorder

Introduction: Insomnia in Major Depressive Disorder (MDD) is highly prevalent and associated with increased suffering and functional impairment. Effective, evidence-based treatments for insomnia in MDD are an unmet need in clinical practice.

Areas covered: Herein, the authors provide a review of the clinical correlates, putative neurobiological mechanisms and treatment options for the management of insomnia in individuals with MDD.

Expert opinion: Sleep disturbances in MDD should be recognized as at least one of the following: (1) a domain of depressive psychopathology; (2) a consequence of rhythm disruptions; (3) a manifestation of comorbidities of sleep disturbances; (4) a manifestation of the influence of sex hormones in the brain in MDD; (5) a general medical comorbidity; and (6) a side effect of antidepressant medications. Assessment of insomnia in clinical practices is routinely performed with the use of non-structured interviews. Other methods such as standardized questionnaires and sleep diaries, along with complementary methods such as actigraphy and polysomnography are more scarcely applied. Smartphones and personal devices offer a promising strategy with the use of passive, long lasting, and ecologically valid assessments despite the lack of studies specifically targeting insomnia in individuals with MDD. New therapeutic approaches are essential, including novel targets such as orexins/hypocretins and the endocannabinoid system.     

Neurocognitive markers of suicidal ideation in patients with anxiety and mood disorders

Abstract

Objective: This study aims at identifying associations between cognitive function and suicidal ideation in the sample of patients with anxiety and mood disorders (AMD).

Methods: In sum, 186 (age = 39?±?12.3 years; 142 [76.3%] females) patients with AMD were enrolled in the study. Assessment included evaluation of socio-demographic information, medication use, anxiety and depression symptoms. Cognitive tests included measures of psychomotor performance and incidental learning using the Digit Symbol Test. Trail Making Tests respectively measured perceptual speed, task-switching and executive control. Additionally, 21 patients completed tests from the Cambridge Automated Neuropsychological Test Battery measuring set shifting (Interdimensional/extradimensional set-shift), executive planning (Stockings of Cambridge), and decision making (Cambridge Gamble Task [CGT]).

Results: Almost half (45.0%, n?=?86) of the study sample patients had experienced suicidal ideations. In multivariable regression analysis, suicidal ideation was associated with a greater overall proportion of bet and risk taking on the CGT task (β?=?0.726, p?=?.010 and β?=?0.634, p?=?.019), when controlling for socio-demographic characteristics, medication use, anxiety and depression symptoms.

Conclusions: Outpatients with AMD and suicidal ideation could be distinguished by the presence of cognitive deficits in the executive function domain, particularly in impulse-control and risk taking.     

Disruptive mood dysregulation disorder (DMDD) symptoms in children with autism,ADHD, and neurotypical development and impact of co-occurring ODD,depression, and anxiety

Disruptive mood dysregulation disorder (DMDD) is a controversial diagnosis introduced in the DSM-5 that is particularly relevant to autism and other disorders in which DMDD symptoms (irritable-angry mood and temper outbursts) are common. Mothers rated DMDD symptoms in 1593 children with autism, ADHD, and neurotypical development (6–16 years, IQ ≥ 80). Percentages with DMDD symptoms (often or very often) were autism 45%, ADHD-Combined type 39%, ADHD-Inattentive type 12%, and neurotypical 3%. Almost all (91%) with DMDD symptoms met DSM-5 criteria for ODD, and 79% with ODD had DMDD symptoms. Only 5% without ODD had DMDD symptoms, and most of these had autism. Children with autism had significantly higher DMDD scores than all other groups, even when the oppositional behavior score (excluding the two DMDD symptoms) was controlled. The findings suggest that DMDD and ODD are not meaningfully differentiated based on their symptoms and that DMDD symptoms are particularly common in autism, more so than expected by comorbid ODD alone.