Herbal medicine (Gan Mai Da Zao decoction) for depression: A systematic review and meta-analysis of randomized controlled trials

The objective of this review was to analyze the trial data on the efficacy and safety of Gan Mai Da Zao (GMDZ) decoction for depression. PubMed, the Cochrane Library, and EMBASE, AMED, Korea Med, DBPIA, OASIS, RISS, KISS, CNKI, Wan Fang Database, and VIP were searched through to May 2014. Randomized controlled trials (RCTs) testing GMDZ decoction for any type of depression were considered. All RCTs of GMDZ decoction or modified GMDZ decoction were included. Data were extracted by 2 independent reviewers. Meta-analysis was used for the pooled data. A total of 298 potentially relevant studies were identified, and 13 RCTs met our inclusion criteria. All of the included RCTs had a high risk of bias across their domains. Three RCTs failed to show favorable effects of GMDZ decoction on response rate or HAMD score in major depression. One RCT showed a beneficial effect of GMDZ decoction on response rate in post-surgical depression, while another failed to do so. Two studies showed favorable effects on response rate in post-stroke depression, while another two failed to do so. A meta-analysis, however, showed that GMDZ decoction produced better response rates than anti-depressants in post-stroke depression (RR: 1.17, I² = 15%). One trial failed to show any beneficial effects of GMDZ decoction on response rate or HAMD score in depression in an elderly sample. Two trials tested GMDZ decoction in combination with anti-depressants but failed to show effects on response rate in major depression, while another did show beneficial effects on response rate in post-stroke depression. In summary, our systematic review and meta-analysis failed to provide evidence of the superiority of GMDZ decoction over anti-depressant therapies for major depression, post-surgical depression, or depression in the elderly, although there was evidence of an effect in post-stroke depression. The quality of evidence for this finding was low, however, because of a high risk of bias.     

Herbal medicine (Shaofu Zhuyu decoction) for treating primary dysmenorrhea: A systematic review of randomized clinical trials

Shaofu Zhuyu decoction (SFZY) or Sobokchugeo-tang, a traditional herbal formula, is used as a treatment for primary dysmenorrhea. We searched four English, seven Korean, three Chinese, and one Japanese database from inception through January 2016 without a language restriction. All randomized controlled trials (RCTs) of SFZY or modified SFZY (MSFZY) were included. Data extraction and risk of bias assessments were performed by two independent reviewers. A total of 51 potentially relevant studies were identified, and 9 RCTs met our inclusion criteria. Seven RCTs tested the effects of SFZY or modified SFZY in treating dysmenorrhea. Three RCTs showed superior effects of (M)SFZY on the response rate, while the other three RCTs failed to do so (n = 531, RR: 1.17, 95% CI: 1.09 to 1.26, P < 0.0001, I² = 0%). Three RCTs showed favorable effects of MSFZY for pain reduction compared with conventional drugs (n = 340, SMD: −1.39, 95% CI: −2.23 to −0.55, P = 0.01). Two RCTs examined the effects of modified SFZY plus conventional drugs and conventional drugs alone. The meta-analysis showed favorable effects of MSFZY (n = 206; RR, 1.12; 95% CI 1.08 to 1.36; P = 0.0009, I² = 0%). Our systemic review and meta-analysis provide suggestive evidence of the superiority of SFZY over conventional drugs for treating primary dysmenorrhea. However, the level of evidence is low because of a high risk of bias.     

Aromatherapy for stress reduction in healthy adults: a systematic review and meta-analysis of randomized clinical trials

The aim of this review was to systematically assess the effectiveness of aromatherapy for stress management. Seven databases were searched from their inception through April 2014. RCTs testing aromatherapy against any type of controls in healthy human person that assessed stress level and cortisol level were considered. Two reviewers independently performed the selection of the studies, data abstraction and validations. The risk of bias was assessed using Cochrane criteria. Five RCTs met our inclusion criteria, and most of them had high risk of bias. Four RCTs tested the effects of aroma inhalation compared with no treatment, no aroma, and no odour oil. The meta-analysis suggested that aroma inhalation has favourable effects on stress management (n = 80; standard mean difference (SMD), −0.96; 95% CI, −1.44 to −0.48; P < 0.0001; I² = 0%). Three of included RCTs tested aroma inhalation on saliva or serum cortisol level compared with control and meta-analysis failed to show significant difference between two groups (n = 88, SMDs −0.62; 95% CIs −1.26 to 0.02, P = 0.06, I² = 46%). In conclusion, there is limited evidence suggesting that aroma inhalation may be effective in controlling stress. However, the number, size and quality of the RCTs are too low to draw firm conclusions.     

The impact of medical informatics on patient satisfaction: A USA-based literature review

PurposePatient satisfaction is increasingly recognized as an important component of quality. The expansion of health information technologies (HIT) might have an impact on patient satisfaction – either positively or negatively. We conducted a literature review to explore the impact of these technologies on patient satisfaction.MethodsThe database of PubMed was searched from inception through May 2010, using the MeSH terms “Medical Informatics” and “Patient Satisfaction”. We included all original interventional studies regardless of their study design that were published in English and were evaluating HIT impact on patient satisfaction. Studies were categorized by technology type according to the American Medical Informatics Association framework and by study design. The major outcome of interest was the HIT impact on patient satisfaction.ResultsOf 1293 citations reviewed, 56 studies met our inclusion criteria. Design of these studies included mostly randomized controlled trials (RCTs) (n = 20, 36%), cross-sectional surveys (n = 17, 30%), and a pre and post studies (n = 14, 25%). Overall, 54% (n = 30) of the studies demonstrated a positive effect of HIT on patient satisfaction, 34% (n = 19) failed to show any effect, 11% (n = 6) had inconclusive results, and 2% (n = 1) revealed a negative effect. Of the 20 RCTs, 40% (n = 8) showed a positive effect of HIT on patient satisfaction, 50% (n = 10) failed to show any effect, and 10% (2) had inconclusive results.ConclusionsAnalysis suggested that while there is some evidence that HIT improves patient satisfaction, studies in this literature review, and in particularly RCTs, were not consistent in their findings. Although HIT may be a promising tool to improve patient satisfaction, more well-designed research studies are needed in order to get a better understanding of this domain and accordingly find new opportunities to improve quality of care.     

Effects of aripiprazole adjunctive to standard antidepressant treatment on the core symptoms of depression: A post-hoc,pooled analysis of two large,placebo-controlled studies

BackgroundAlthough antipsychotic agents have a long history of use in depression, their effectiveness in treating core symptoms of depression such as loss of interest has been questioned. Adjunctive aripiprazole is beneficial for the treatment of patients with major depressive disorder but its effects on specific symptoms have not been reported. The objective of this study was to examine the effects of aripiprazole on core symptoms of depression.MethodsThis is a post-hoc, pooled analysis of two trials of aripiprazole augmentation of standard antidepressants (ADT) in patients with major depression. Patients with an inadequate response to ADT received adjunctive aripiprazole (n = 373) or placebo (n = 368) for 6 weeks. Change on four subscales of the 17-item Hamilton Depression Rating Scale (HAM-D17) that capture core depression symptoms was determined and change on individual HAM-D items also was assessed. The magnitude of within-group change for the subscales and individual items was expressed as effect size (ES) and between-group significance tested with ANCOVA. The magnitude of change was also examined comparing the response rates for aripiprazole and placebo on HAM-D17 and the four subscales. Change on three composite subscales — anxiety, insomnia and drive was also examined.ResultsWithin-group change on the four core subscales was substantial (ES = 1.1–1.2) and similar to that for the 17-item HAM-D total score. Between-group comparisons indicated mean change and response rates were significantly greater with adjunctive aripiprazole than placebo for each core subscale (all p < 0.01). Individual HAM-D17 items showing the greatest change from baseline with adjunctive aripiprazole: depressed mood (within-group ES = 1.03) work and activities (ES = 0.86), guilt (ES = 0.77) and psychic anxiety (ES = 0.67) are the same symptoms identified by each of the core subscales and each of these items differed significantly from change on that item with placebo (p < 0.01). On three composite scales, adjunctive aripiprazole was significantly more effective than placebo with respect to mean change for anxiety, insomnia and drive (all p < 0.001).ConclusionsAripiprazole augmentation of standard ADT results in significant, clinically meaningful changes in the core symptoms of depression. It is also associated with significant change in anxiety, insomnia, and drive components of the 17-item HAM-D.     

Fluoxetine and aripiprazole treatment following prenatal immune activation exert longstanding effects on rat locomotor response

AimStudies characterizing treatment interventions in a naturalistic setting suggest that antidepressant and antipsychotic medications may be equally effective in improving clinical outcome in individuals at high risk for first-episode psychosis. Of interest, both beneficial as well as potentially adverse effects have been observed following fluoxetine treatment in a mouse prenatal immune activation model of relevance to psychosis prevention. We sought to extend those findings by examining the effects of fluoxetine, as well as the antipsychotic medication aripiprazole, in a rat prenatal immune activation model.MethodsPregnant Sprague–Dawley rats were injected with poly I:C or saline on gestational day 14. Offspring of poly I:C and saline-treated dams received fluoxetine (10.0 mg/kg/d), aripiprazole (0.66 mg/kg/d), or vehicle from postnatal days 35 to 70. Locomotor responses to novelty, saline injection, and amphetamine (1 and 5 mg/kg) were determined at three months, i.e., 21 days following drug discontinuation.ResultsBoth fluoxetine and aripiprazole had beneficial effects on behavioral response to amphetamine (1 mg/kg) at 3 months, ameliorating the impact of prenatal immune activation on offspring of poly I:C-treated dams. Significantly, both drugs also exerted effects in offspring of control (saline-treated) dams on locomotor response to injection.ConclusionsFluoxetine and aripiprazole pretreatment of poly I:C offspring from postnatal days 35 to 70 stabilized response to amphetamine exposure persisting through 3 months of age, similar to earlier findings in mice that fluoxetine treatment following prenatal immune activation prevented altered locomotor response to amphetamine. The current data also confirm earlier findings of potential adverse behavioral effects in offspring of control dams following treatment with fluoxetine and antipsychotic medications, highlighting the potential for both therapeutic as well as safety concerns with exposure to preventive pharmacological treatments over the course of adolescent development. Further study is needed to determine clinical and epidemiological consequences of these pre-clinical findings.     

The effect of whole body vibration exposure on balance and functional mobility in older adults: A systematic review and meta-analysis

The aim of this review was to systematically evaluate the effect of WBV exposure alone on balance and functional mobility in older adults. A literature search of randomized controlled trials (RCT) reporting the effects of WBV on balance or functional mobility outcomes in older adults, was conducted using multiple databases. WBV-plus-exercise was only included if the control group performed the same exercises as the WBV group, but without vibration. The methodological quality of studies was assessed using the PEDro scale. Meta-analysis was performed if three or more studies measured the same outcome. Twenty RCTs met the inclusion criteria. Eight RCTs compared WBV-only with control and eight RCTs compared WBV-plus-exercise with the same-exercise only group. Meta-analysis indicated that WBV improved single-leg stance (p = 0.05) and timed up and go (p = 0.004) measures compared with controls. WBV improved other balance and mobility outcomes with inconsistent results. Although balance and mobility appeared to be responsive to WBV-plus-exercise, particularly in lower-functioning patients, compared with WBV-only, caution is required when interpreting the findings. Although there is some evidence for an overall effect of WBV on selected balance and mobility measures, its impact remains inconclusive. Robust RCTs examining WBV-only exposure on balance and functional mobility in older adults are warranted.     

Does evidence support the use of mobile phone apps as a driver for promoting healthy lifestyles from a public health perspective? A systematic review of Randomized Control Trials

ObjectiveThe aim of this systematic review was to find a scientific evidence on the efficacy of apps in promoting healthy lifestyles.MethodsThe research was carried out according to PRISMA Statement. Pubmed, Embase and Google Scholar searches were carried out up to September 2016 focusing on randomized control trials (RCTs).ResultsForty RCTs were selected. Most of the studies targeted weight management, PA and healthy eating (N = 35). A few RCTs focused on apps designed to sun protection, smoking cessation and alcohol consumption (N = 5). Only 10 RCTs (25%) found statistical difference between intervention and control groups for all the outcomes measured. Most of the studies had a short follow-up (65%, less than 6 months) and half of them a very small sample size (fewer than 100 subjects).ConclusionOverall, the evidence so far showed a modest efficacy of apps in health promotion.Practice implicationsThere is a need to improve the overall quality of intervention studies focused on mobile apps in order to understand if they could became a valuable tool in support of health professionals and their efforts to promote education and health.     

Optimized light therapy for non-seasonal major depressive disorder: effects of timing and season

BackgroundLight Therapy (LT) when combined with standard antidepressant treatment for unipolar depression hastens recovery. We studied the influence of LT timing on the antidepressant efficacy of LT and the influence of the season of treatment and recurrence on the response to treatment.MethodsWe studied 70 inpatients affected by Unipolar Depression, treated for three weeks with combined LT and venlafaxine. Two-third of the patients received LT following a predictive algorithm based on MEQ scores; the others received LT at 11:00 a.m. Severity of depression was rated on the Hamilton Depression Rating Scale (HDRS). A subgroup of patients wore activity monitors.ResultsHDRS scores significantly decreased during treatment (Friedman's ANOVA: χ2 = 186.82, p < 0.00001). LT administered in the early morning showed a better relative efficacy than late morning (F = 4.576; p = 0.012) with the clinical improvement correlating with an advance in rest–activity rhythm acrophase (r = ? 0.336; p = 0.017). Season of hospitalization interacted with LT timing and time in influencing response to treatment (F = 3.101; p = 0.049) and season of episode recurrence significantly interacted with LT timing, season of hospitalization and time (F = 5.925; p = 0.0035).LimitationsThe major limitation of the study is the small sample size when considering simultaneously LT schedules, season of treatment and recurrence. Moreover, even if none of the patients fulfilled DSM-IV criteria for seasonal pattern of recurrence, they were not administered any questionnaire about seasonality.ConclusionsWe confirmed the usefulness of LT as a non-pharmacological antidepressant therapy for non-seasonal depression. Season and timing of administration and timing of the rest–activity cycle affected response to treatment.     

A meta-analytic review of psychodynamic therapies for anxiety disorders

Recent randomized controlled trials (RCTs) suggest that psychodynamic therapy (PDT) may be useful in the treatment of anxiety disorders. This paper presents the most comprehensive meta-analysis to date examining the controlled effects of PDT for anxiety disorders. 14 RCTs totaling 1073 patients were included. PDT was found to be significantly more effective than control conditions (g = 0.64). PDT did not differ significantly from alternative treatments at post-treatment (g = 0.02), follow-up (FU) up to a year (g = − 0.11), and FU past a year (g = − 0.26). Medium-to-high levels of heterogeneity were detected, indicating significant differences between studies. Nevertheless, our findings remained unchanged when heterogeneity outliers were removed (termination g = − 0.06/short FU g = − 0.01/long FU g = − 0.10). Power analyses indicated that large or medium effect size differences between PDT and other active treatments could be detected even with high heterogeneity. Exploratory moderator analyses found few significant predictors of effect (e.g., relative risk of dropout). No differences were found examining remission rates or relative risk of dropout. Overall, PDT was shown to be as efficacious as other active treatments that have been studied for anxiety disorders.     

Body mass index as a predictor of outcome in total knee replace: A systemic review and meta-analysis

Background

To conduct a meta-analysis with randomized controlled trials (RCTs) published in full text to demonstrate database to show the associations of perioperative, postoperative outcomes of normal and high body mass index (BMI) to provide the predictive diagnosis for clinic.

Depression,traumatic stress and interleukin-6

BackgroundRecent evidence indicates that various types of interactions between nervous and immune system are important in pathogenesis of depression. These findings show that a significant role in developing depression play pro-inflammatory cytokines that may mediate its psychological, and neurobiological manifestations. Great importance among these cytokine molecules plays interleukin-6 (IL-6). There is growing evidence that this inflammatory process related to depression may be influenced by psychological stress as well as organic inflammatory conditions. These findings suggest that specific influences related to traumatic stress and dissociation could be found in close relationship to increased level of cytokine IL-6.MethodsIn the present study we have performed psychometric measurement of depression (BDI-II), traumatic stress symptoms (TSC-40) and dissociation (DES, SDQ-20), and immunochemical measure of serum IL-6 in 40 inpatients with unipolar depression (mean age 42.3 ± 6.8).ResultsThe results show that IL-6 is significantly correlated to BDI-II (Spearman R = 0.47, p < 0.01), TSC-40 (Spearman R = 0.32, p < 0.05), SDQ-20 (Spearman R = 0.34, p < 0.05) but not to DES (Spearman R = 0.25, p = 0.11).ConclusionThe findings of the present study indicate that increased level of IL-6 in depression could be directly related to symptoms of traumatic stress and somatoform dissociation.     

Exercise training for managing behavioral and psychological symptoms in people with dementia: A systematic review and meta-analysis

This systematic review and meta-analysis of randomized controlled trials assessed the effects of exercise on behavioral and psychological symptoms of dementia (BPSD, including depression) in people with dementia (PWD). Secondary outcomes for the effects of exercise were mortality and antipsychotic use. Twenty studies were included in this review (n = 18 in the meta-analysis). Most studies used a multicomponent exercise training (n = 13) as intervention; the control group was often a usual care (n = 10) or a socially-active (n = 8) group. Exercise did not reduce global levels of BPSD (n = 4. Weighted mean difference −3.884; 95% CI −8.969–1.201; I² = 69.4%). Exercise significantly reduced depression levels in PWD (n = 7). Standardized mean difference −0.306; 95% CI −0.571 to −0.041; I² = 46.8%); similar patterns were obtained in sensitivity analysis performed among studies with: institutionalized people (p = 0.038), multicomponent training (p = 0.056), social control group (p = 0.08), and low risk of attrition bias (p = 0.11). Exploratory analysis showed that the principal BPSD (other than depression) positively affected by exercise was aberrant motor behavior. Exercise had no effect on mortality. Data on antipsychotics were scarce. In conclusion, exercise reduces depression levels in PWD. Future studies should examine whether exercise reduces the use (and doses) of antipsychotics and other drugs often used to manage BPSD.     

The validity of the severity-psychosis hypothesis in depression

BackgroundPsychotic depression (PD) is classified as a subtype of severe depression in the current diagnostic manuals. Accordingly, it is a common conception among psychiatrists that psychotic features in depression arise as a consequence of depressive severity. The aim of this study was to determine whether the severity of depressive and psychotic symptoms correlate in accordance with this “severity–psychosis” hypothesis and to detect potential differences in the clinical features of PD and non-psychotic depression (non-PD).MethodsQuantitative analysis of Health of the Nation Outcome Scales (HoNOS) scores from all patients admitted to a Danish general psychiatric hospital due to a severe depressive episode in the period between 2000 and 2010 was performed.ResultsA total of 357 patients with severe depression, of which 125 (35%) were of the psychotic subtype, formed the study sample. Mean HoNOS scores at admission differed significantly between patients with non-PD and PD on the items hallucinations and delusions (non-PD = 0.33 vs. PD = 1.37, p < 0.001), aggression (non-PD = 0.20 vs. PD = 0.36, p = 0.044) and on the total score (non-PD = 10.55 vs. PD = 11.87, p = 0.024). The HoNOS scores on the two items “depression” and “hallucinations and delusions” were very weakly correlated.LimitationsDiagnoses were based on normal clinical practice and not formalized research criteria.ConclusionsThe symptomatology of PD and non-PD differs beyond the mere psychosis. Furthermore, severity ratings of depressive and psychotic symptoms are very weakly correlated. These findings offer further support to the hypothesis stating that the psychotic- and non-psychotic subtypes of depression may in fact be distinct clinical syndromes.     

A 12 months follow-up study of depression among nursing-home patients in Norway

BackgroundDepression is common in nursing-home patients and is often of chronic nature.AimsTo examine the prevalence, incidence and the persistence rates of clinically significant depressive symptoms, and their risk factors among nursing-home patients.DesignA 12 months follow-up study.MethodsA sample of 902 randomly selected nursing-home patients was assessed using the Cornell Scale, the Clinical Dementia Rating Scale, the Self-Maintenance Scale and a measurement of physical health. Information was collected from the patients' records. Clinically significant depression was defined as 8+ on the Cornell Scale.ResultsAt 12 months 231 had died, and depression was together with higher age, worse physical health, poor function in activities of daily living, higher CDR score and cancer a significant predictor of death (0.03). The prevalence of depression was 21.2% at baseline and follow-up, incidence rate was 14.9% and persistence rate was 44.8%. Predictors of depression at 12 months were: high Cornell score at baseline (p < 0.001), a shorter stay in a nursing home (0.011) and use of antidepressants (p = 0.050); for incident depression: higher Cornell score at baseline (p = 0.019), a shorter stay (p = 0.002) and higher CDR score (p = 0.003); for persistent depression: higher Cornell score at baseline (0.011), use of anxiolytics (p = 0.045) and not being married (p = 0.037).ConclusionThe incidence and persistence rates of clinical significant depressive symptoms are high in nursing-home patients. A higher score on Cornell Scale at baseline and a shorter stay in a nursing home were predictors for both incidence and persistence of clinically significant depressive symptoms.     

Prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder

ContextThe draft proposal to add Chronic Depressive Disorder to DSM-5 will combine DSM-IV Dysthymic Disorder and Major Depressive Disorder, with chronic specifier, into a single diagnosis.ObjectiveThe objective of this study is to estimate the prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder using unit record data from the 2007 Australian National Survey of Mental Health and Wellbeing.DesignSecondary analysis of a nationally representative household survey.SettingUrban and rural census tracts.ParticipantsOne individual between the ages of 16 and 85 years from 8841 households was interviewed for the survey.Main outcome measureLifetime prevalence estimates for chronic and non-chronic depression were determined using data from the World Health Organization's Composite International Diagnostic Interview, version 3.0 (WMH-CIDI 3.0).ResultsChronic depression of at least two years' duration had a lifetime prevalence of 4.6% (95% CI: 3.9–5.3%) and was found in 29.4% (95% CI: 25.6–33.3%) of individuals with a lifetime depressive disorder. Higher rates of psychiatric co-morbidity (OR = 1.42; 95% CI = 1.26–1.61), older age (OR = 1.04; 95% CI = 1.02–1.05), a younger age of onset (OR = 0.97; 95% CI = 0.95–0.98) and more frequent episodes of depression (OR = 1.75; 95% CI = 1.07–2.86) were found to be significant correlates of chronic depression. The first episode of depression for individuals with chronic depression often developed after the death of someone close (OR = 2.38; 95% CI 1.16–5.79).ConclusionsChronic depression is highly prevalent among community-residing persons and has a set of correlates that discriminate it from non-chronic depression. The distinction between chronic and non-chronic depression proposed for DSM-5, in the form of Chronic Depressive Disorder, seems to be warranted.     

Pretreatment cerebral metabolic activity correlates with antidepressant efficacy of vagus nerve stimulation in treatment-resistant major depression: A potential marker for response?

BackgroundPretreatment brain activity in major depressive disorder correlates with response to antidepressant therapies, including pharmacotherapies and transcranial magnetic stimulation. The purpose of this trial was to examine whether pretreatment regional metabolic activity in selected regions of interest (ROIs) predicts antidepressant response following 12 months of vagus nerve stimulation (VNS) in 15 patients with treatment-resistant major depression (TRMD).MethodsFluorodeoxyglucose positron emission tomography (FDG PET) was used to assess regional mean relative cerebral metabolic rate for glucose (CMRGlu) in four ROIs (anterior insular, orbitofrontal, anterior cingulate, and dorsolateral prefrontal cortices) at baseline (prior to VNS activation). Depression severity was assessed at baseline and after 12 months of VNS using the Hamilton Depression Rating Scale (HDRS), with response defined as ≥ 50% reduction in HDRS from baseline.ResultsBaseline CMRGlu in the anterior insular cortex differentiated VNS responders (n = 11) from nonresponders (n = 4) and correlated with HDRS change (r = .64, p = .01). In a regression analysis, lower anterior insular cortex CMRGlu (p = .004) and higher orbitofrontal cortex CMRGlu (p = .047) together predicted HDRS change (R² = .58, p = .005). In a whole brain, voxel-wise analysis, baseline CMRGlu in the right anterior insular cortex correlated with HDRS change (r = .78, p = .001).LimitationsSample size was small, limiting statistical power; patients remained on their psychiatric medications; study was open-label and uncontrolled.ConclusionsThis preliminary study suggests that pretreatment regional CMRGlu may be useful in predicting response to VNS in TRMD patients.     

Relationship between depression and frailty in older adults: A systematic review and meta-analysis

AimDepression and frailty are prevalent and burdensome in older age. However, the relationships between these entities are unclear and no quantitative meta- analysis exists. We conducted a systematic review and meta-analysis to investigate the associations between depression and frailty.MethodsTwo authors searched major electronic databases from inception until November-2016 for cross-sectional/longitudinal studies investigating depression and frailty. The strength of the reciprocal associations between frailty and depression was assessed through odds ratios (ORs) adjusted for potential confounders.ResultsFrom 2306 non duplicated hits, 24 studies were included. The overall prevalence of depression in 8023 people with frailty was 38.60% (95% CI 30.07–47.10, I² = 94%). Those with frailty were at increased odds of having depression (OR adjusted for publication bias 4.42, 95%CI 2.66–7.35, k = 11), also after adjusting for potential confounders (OR = 2.64; 95%CI: 1.59–4.37, I² = 55%, k = 4). The prevalence of frailty in 2167 people with depression was 40.40% (95%CI 27.00–55.30, I² = 97%). People with depression were at increased odds of having frailty (OR = 4.07, 95%CI 1.93–8.55, k = 8). The pooled OR for incident frailty, adjusted for a median of 7 confounders, was 3.72 (95%CI 1.95–7.08, I² = 98%, k = 4), whilst in two studies frailty increased the risk of incident depression with an OR = 1.90 (95%CI 1.55–2.32, I² = 0%).ConclusionThis meta-analysis points to a reciprocal interaction between depression and frailty in older adults. Specifically, each condition is associated with an increased prevalence and incidence of the other, and may be a risk factor for the development of the other. However, further prospective investigations are warranted.     

Incomplete response to colchicine in M694V homozygote FMF patients

BackgroundPrevious studies have shown that with prophylactic colchicine 65% of the patients suffering from Familial Mediterranean fever (FMF) will show a complete response, 30% a partial response and about 5% will show minimum or no response. These studies were performed before the isolation of the disease gene. Genotyping enables us to study the response rates according to specific mutations. We have witnessed a large number of M694V homozygotes who do not respond well to colchicine despite being treated with maximal sustained doses.AimTo assess the response rates to colchicine in M694V homozygote FMF patients in comparison to other prevalent genotypes.MethodsWe conducted a telephonic survey which included 112 FMF patients: 40 M694V homozygotes, and 2 comparison groups of 41 M694V/V726A compound heterozygotes and 31 V726A homozygotes. The questionnaire included demographic, social and clinical features, colchicine dose, response rates and reported side effects.ResultsM694 homozygotes showed a more severe disease, and were treated with higher doses of colchicine (average dose 1.98 ± 0.56 compared to 1.47 ± 0.58, p = 0.0001 and 1.13 ± 0.41, p < 0.001 in the M694V/V726A compound heterozygotes and the V726A homozygotes, respectively); Colchicine related side effects were noted in 40% of the M694V homozygotes. The average rate of attacks in treated M694V homozygotes (0.70 ± 1.06) was higher compared to the two other groups (0.14 ± 0.26, p = 0.002 and 0.08 ± 0.20, p = 0.0009, respectively) and only 25% of them reported no attacks in the last year. None of the patients who took part in this study had amyloidosis. Side effects limiting the dose of colchicine were noted in 40% of the M694V homozygotes.ConclusionsDespite receiving higher doses of colchicine the prevalence of complete responders among M694V homozygotes is much lower than previously appreciated. The results highlight the need for additional treatment modalities for these patients.     

Depression and PTSD symptoms among bereaved adolescents 6(1/2) years after the 1988 Spitak earthquake

ObjectiveTo compare depression and PTSD symptoms of parentally bereaved adolescents and a comparison group after a catastrophic natural disaster.MethodSix and a half years after the Spitak earthquake, 48 parentally bereaved adolescents and a comparison group of 44 subjects with no parental loss were evaluated using the Depression Self - Rating Scale (DSRS) and Child Posttraumatic Stress Disorder Reaction Index (CPTSD-RI).ResultsOrphans scored significantly higher on depression than those who lost a father (Mean DSRS scores: 20.2 ± 3.3 vs. 16.6 ± 5.2; p < 0.001), who in turn scored significantly higher than those who lost a mother (Mean DSRS scores: 16.6 ± 5.2 vs. 12.7 ± 4.1; p < 0.002). Depression scores for orphans fell above the cut-off for clinical depression, while those who lost a father scored slightly below. PTSD scores within each group fell in the moderate range of severity, with girls scoring higher than boys (Mean CPTSD-RI scores: 35.9 ± 11.3 vs. 29.3 ± 10.1; p < 0.04).LimitationAs self-report instruments were used, responses may have been over- or under- reported. Participants belonged to the same ethnic group and therefore the results may not be generalizable to other populations.ConclusionLoss of both parents and, to a lesser degree, loss of a father is a significant risk factor for depression, but not for PTSD. This study extends prior findings documenting post-disaster chronicity of depression and PTSD among bereaved adolescents, and underscores the need for post-disaster mental health and social programs, especially for those who suffer the loss of both parents.