Evolution of sexual functioning of men through treated and untreated depression

ObjectivesDepression as well as a treatment by antidepressant are factors that may interfere with sexuality. Due to this complex relationship between depression, antidepressant and sexuality, it is difficult to incontestably establish the exclusive accountability of a treatment or of a psychiatric disorder on sexual dysfunctions. The main purpose of the SADD (for Sexuality, Anti-Depressant and Depression) study is to evaluate sexual dysfunctions in depressed men treated with antidepressant or not.MethodsParticipants of this transversal, observational study were men aged over 18 years old, suffering from unipolar major depressive disorder and treated by a psychiatrist, with or without antidepressant. Assessment of sexual functioning through three times: euthymia (before depression), untreated depression and treated depression if applicable was performed based on the ASEX scale.ResultsSeventy patients were included. Eight percent of euthymic patients presented a sexual dysfunction (average score on the ASEX = 12.4) whereas 56% of untreated patients presented a sexual dysfunction (average total score on the ASEX = 17.7) and 62% (34/55) of patients treated with antidepressant (average total score on ASEX = 18.5) (P < 0.001). Sexual functioning of men receiving treatment is not significantly different to that among men not receiving any antidepressant, even if patients treated with antidepressant reported that they had a better mood than those untreated.ConclusionsOur results reveal a high prevalence of sexual dysfunction within the framework of major depressive disorder and its treatment and underlines the complex relationship between major depressive disorder, antidepressant and sexuality.     

Increasing escitalopram dose is associated with fewer discontinuations than switch or combination approaches in patients initially on escitalopram 10 mg

PurposeTo examine the relationship between different intervention approaches and subsequent real-life outcomes in patients changing treatment from escitalopram 10 mg.MethodThis was a retrospective cohort study of patients starting antidepressant treatment between 2002 and 2004. Data were extracted from a US health-insurance reimbursement claims database. Eligible patients started escitalopram 10 mg and changed within 3 months to: escitalopram ≥ 20 mg; another antidepressant; or a combination of escitalopram with another antidepressant. Medication persistence and healthcare costs over 3 months were compared between the treatment groups.ResultsOverall, 37,791 patients started escitalopram 10 mg. Of the 12,830 patients (34%) who changed treatment, 56% increased escitalopram dose, 26% switched antidepressant and 18% combined escitalopram with another antidepressant. Patients in the switch and combination groups had significantly higher rates of non-persistence (56% and 91%, respectively) vs the dose-increase group (39%; both P < 0.001). Combination-group patients incurred significantly greater costs vs the dose-increase group ($ 2805 vs $ 1767, respectively; P < 0.001).ConclusionResults suggest that increasing escitalopram dose in patients responding inadequately to 10 mg is associated with higher persistence rates vs the other treatment approaches. Receiving an increased dose of escitalopram was associated with significantly lower costs than combining escitalopram 10 mg with another antidepressant.     

Sleep parameters associated with long-term outcome following subthalamic deep brain stimulation in Parkinson's disease

IntroductionWe aimed to investigate the effects of changes in sleep architecture on long-term clinical outcome in patients with Parkinson's disease (PD) who underwent deep brain stimulation of subthalamic nuclei (STN DBS).MethodsWe followed up eight PD patients before and three years after STN DBS surgery. In addition to clinical assessments, polysomnography (PSG) followed by multiple sleep latency tests was performed before and after STN DBS, while stimulator was ON and OFF.ResultsSubjective sleep latency was significantly decreased (P = 0.033) and sleep duration was increased (P = 0.041), as measured by Pittsburgh sleep quality index. Latency to REM sleep stage was shortened after surgery with STN DBS ON (P = 0.002). Index of central type of abnormal respiratory events was significantly increased while stimulator was ON (P = 0.034). Total number of major body movements was found to be increased when stimulator was turned OFF (P = 0.012). Among PSG data obtained during STN DBS ON, it was observed that duration of N3 sleep was negatively correlated with UPDRS scores at 1st (P = 0.038) and 3rd (P = 0.045) post-operative years. Among PSG variables during STN DBS OFF, durations of N3 sleep (P = 0.017) and REM sleep (P = 0.041) were negatively correlated with UPDRS scores at post-operative 1st year.ConclusionDisturbances in sleep architecture are associated with higher UPDRS scores and worse prognosis at 1st and 3rd post-operative years. Similar results obtained while stimulator was OFF at the end of 1st year support the presence of microlesion effect after STN DBS, which is probably not long lasting.     

Risky use and misuse of alcohol and cigarettes in psychiatric inpatients: a screening questionnaire study

BackgroundMental disorders are associated with an increased prevalence of substance use disorders (SUDs). Despite this comorbidity being firmly established, alcohol and nicotine risky use and misuse are not routinely and systematically assessed in clinical practice.ObjectiveThe aim of this study is to examine the prevalence of risky use of alcohol, alcohol use disorder (AUD), smoking, and nicotine use disorder in people with psychiatric diagnoses and their association with age, gender, and occupational functioning.MethodParticipants were 210 patients from an inpatient psychiatric ward. Three self-reporting questionnaires were used: the Alcohol Use Disorders Identification Test (AUDIT), the Lübeck Alcoholism Screening Test (LAST), and the Fagerström Test for Nicotine Dependence (FTND).ResultsRisky alcohol use or AUD was found in more than one third of patients and was more common in males than in females (p < 0.01) and in young people as compared to older adults (p = 0.04). Current nicotine consumption concerned over a half participants and was significantly associated with risky alcohol use and AUD (p < 0.01). Patients with current SUD had the highest prevalence of both smoking (80%) and alcohol misuse (80%). Low occupational functioning was associated with both alcohol use (p = 0.02) and concurrent alcohol and SUDs (p = 0.03).ConclusionsBoth alcohol and nicotine risky use and misuse are highly prevalent in people with psychiatric disorders and their concurrent abuse is common. The simultaneous use of different screening questionnaires allows the identification not only of people with frank use disorders, but also those with harmful use, facilitating early detection of people at risk.     

The prevalence of impaired glucose regulation in psychiatric patients with sleep disorders and its relationship with altered hypothalamopituitary–adrenal and hypothalamopituitary–thyroid axis activity

BackgroundSleep restriction, an important symptom of psychiatric diseases, is associated with adverse effects on glucose regulation, but few studies have examined its association with impaired glucose regulation and altered hypothalamic activity. Our study was designed to evaluate the sleep duration, fasting glucose, tolerance glucose, and concentration of plasma insulin; to assess the function of both the hypothalamopituitary–thyroid (HPT) and hypothalamopituitary–adrenal (HPA) axis; and to investigate the relationship of altered hypothalamic function with glucose metabolism in psychiatric patients with a sleep disorders.MethodsFrom January 2010 to December 2011, 324 women (64.7%) and 177 men (35.32%) with a diagnosis of a sleep disorder participated in our cross-sectional study in the psychiatric outpatient department of the West China Hospital of Sichuan University. Results from 75-g glucose tolerance tests, insulin-releasing tests, morning (8:00 am) serum cortisol, and thyroid-stimulating hormone (TSH) (TT_3, TT_4, FT_3, FT₄) were collected, as well as body mass index and waist–hip ratio to assess the prevalence of impaired glucose regulation and function of the HPA and HPT axis. Sleep quality was assessed through self-reported questionnaires.ResultsThere were 301 patients previously diagnosed with an anxiety disorder (78%), and 200 patients previously diagnosed with depression and other psychiatric diseases (22%). Crude prevalence rates were 15.0% for diabetes mellitus (DM), 11.6% for impaired glucose tolerance, 15.8% for impaired fasting glucose, and 11.6% for impaired glucose regulation (impaired glucose tolerance [IGT] + impaired fasting glucose [IFG]). Total prevalence of impaired glucose regulation in patients with a sleep disorder was 48.8%. Mean cortisol level was 463.5 ± 178.8 nmol/L, and the cortisol concentration at 8:00 am was significantly associated with a higher prevalence of impaired glucose regulation and insulin resistance. TSH values above 2.5 mU/L accounted for over 58% and were significantly associated with insulin resistance.ConclusionsThese results partially confirm that a high level of cortisol and an increased activity of the HPT axis are associated with impaired glucose regulation. Therefore, as a pathophysiologic event abnormal activity of the hypothalamic function of psychiatric patients with sleep disorders could be viewed as a potential risk factor for increasing incidence of DM.     

The relationship of oxidative metabolism to treatment response in major depression: A biological basis for treatment duration

BackgroundWe aimed to determine the relationship between antidepressant treatment and oxidative metabolism in patients with major depression.Materials and methodsTwo groups, the patients diagnosed with depression (N = 21), and healthy controls (N = 40), were enrolled in the study. The patients received naturalistic antidepressant treatment. Serum samples were collected prior to treatment and at the end of the 8 weeks of antidepressant treatment. Those participants in the control group were sampled only once. The total antioxidant status (TAS) and total oxidant status (TOS) were measured and oxidative stress index (OSI) was calculated. Severity of depression in patients was also measured both prior to and after 8 weeks of antidepressant treatment.ResultsIn terms of TAS, TOS, and OSI there were significant differences between the groups both at the baseline. Baseline and final HAM-D scores of the patient group differed significantly. The baseline TAS, TOS, and OSI levels of patients did not change significantly after antidepressant treatment. The duration of illness was not correlated with baseline serum levels of TAS, TOS, and OSI. Patients who were deemed to be unresponsive to the antidepressant treatment differed significantly from the controls both at the baseline and at the final visit for TAS, TOS, and OSI. Additionally, treatment responsive patients did not show any similar difference in terms of TOS and OSI levels.DiscussionChronic increase in anti-oxidant and oxidant levels in patients with major depression may be related to the elevation of anti-oxidant defenses that were developed in response to increased oxidative metabolism.     

Association between sleep duration,weight gain,and obesity for long period

BackgroundAlthough previous studies showed the long-term effects of sleep duration on risk of weight gain, Western tends to gain weight irrespective of sleep duration over a long period. Conversely, it is showed that body mass index (BMI) decreases during a long period in Japanese and thus, the long-term effect of sleep duration on weight gain and obesity is still unclear in Asia.MethodsWe followed up 13,629 participants aged 40–79 years and prospectively collected data from 1995 to 2006. We divided the participants into five groups according to their self-reported sleep duration: ⩽5 h (short sleep), 6 h, 7 h (reference), 8 h, and ⩾9 h (long sleep). The main outcome was ⩾5 kg weight gain or BMI ⩾ 25 kg/m² (obesity). We used logistic regression analyses to derive odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for several confounding factors.ResultsWe observed no association between sleep duration and risk of ⩾5 kg weight gain and obesity. After stratification by BMI, long sleepers had a significantly increased risk of ⩾5 kg weight gain (OR: 1.36, 95%CI: 1.09–1.70) in obese participants.ConclusionsAmong community-dwelling Japanese, only obese long sleepers have a significantly increased long-term risk of ⩾5 kg weight gain.     

Depression and quality of life in Spanish-speaking immigrant persons with epilepsy compared with those in English-speaking US-born persons with epilepsy

ObjectiveThis study aimed to examine levels of depression and quality of life in Spanish-speaking (less acculturated) immigrants with epilepsy compared with those in English-speaking US-born persons with epilepsy (PWEs).MethodsThe study included 85 PWEs — 38 Spanish-speaking immigrants with epilepsy and 47 US-born PWEs. All patients underwent video-EEG monitoring and completed depression and quality-of-life inventories in their dominant language (Spanish/English). Chart review of clinical epilepsy variables was conducted by an epileptologist.ResultsOur study revealed that depression scores were significantly higher in Hispanic PWEs (21.65 ± 14.6) than in US-born PWEs (14.50 ± 10.2) (t (64.02) = − 2.3, two-sided p = .025). Marital status, medical insurance, antidepressant use, seizure frequency, and number of antiepileptic drugs (AEDs) were tested as covariates in the ANCOVA framework and were not statistically significant at the 0.05 significance level.Fewer Hispanics were prescribed antidepressant medications (13.15% for Hispanics and 40.42% for US-born, χ² (1,85) 7.71, p = .005) and had access to comprehensive health insurance coverage (χ² (1,85) = 13.70, p = 0.000). Hispanic patients were also found to be receiving significantly less AEDs compared with their US-born peers (t (83, 85) = 2.33, p = .02). Although quality of life was diminished in both groups, Seizure Worry was worse for Hispanics after accounting for potential effects of marital status, medical insurance, use of antidepressants, seizure frequency, and number of antiepileptic drugs (AEDs) ((1, 83), F = 7.607, p = 0.007).SignificanceThe present study is the first of its kind to examine depression and quality of life in Spanish-speaking US immigrants with epilepsy. Spanish-speaking immigrants with epilepsy have been identified as a group at risk. They demonstrated higher depression scores and more Seizure Worry independent of epilepsy and demographic characteristics compared with their US-born peers. The Hispanic group was receiving less treatment for depression, was taking less AEDs, and had less access to comprehensive health coverage compared with non-Hispanics.     

Prevalence and correlates of major depressive disorder (MDD) among adolescent patients with epilepsy attending a Nigerian neuropsychiatric hospital

BackgroundA high prevalence of mood disorders exists in patients with epilepsy. In most cases, this is not detected and, consequently, not treated. This study aimed to determine the prevalence and correlates of major depressive disorder (MDD) among adolescents with epilepsy attending a child and adolescent clinic in Nigeria.MethodsWe recruited 156 participants consecutively for the study. Adherence was assessed using the 8-item Morisky Medication Adherence Questionnaire, while the K-SADS was used to assess the presence of major depressive disorder. Seizure control was evaluated by the frequency of seizures within a year.ResultsMajor depressive disorder (DSM-IV criteria) was diagnosed in 28.2% of the participants. The age of participants (p = 0.013), seizure control (p = 0.03), medication adherence (p = 0.045), frequency of seizures in the preceding 4 weeks (p < 0.001), and duration of illness (p < 0.001) were all significantly associated with the presence of MDD. Participants with seizures occurring more than once weekly in the preceding 4 weeks were 16 times more likely to have a MDD compared with those with no seizures in the preceding 4 weeks (p < 0.001, 95% C.I. [4.13, 65.43]), while participants with a duration of illness more than 10 years were more than four times likely to have MDD compared with those with an illness duration of 5–10 years (p < 0.01, 95% C.I. [0.07, 0.70]).ConclusionThe prevalence of MDD among patients with epilepsy was high. Poor seizure control, poor medication adherence, and long duration of illness were associated with the presence of MDD among such patients. Intervention should focus on ensuring good seizure control and optimal adherence in order to mitigate the impact of MDD in patients with epilepsy.     

Screening,rubella vaccination,and childhood hearing impairment in Taiwan

Childhood hearing impairment (CHI) is a major developmental disability, but data at the national level are limited, especially those on the changes in the prevalence over time. In Taiwan, the government began to certify disabled residents for providing various services in 1980 and maintains a registry of certified cases, which provides a rare opportunity for studying the trends of CHI prevalence. Using the registry data, we estimated the prevalence of CHI by age and severity and explored factors affecting its changes over time. From 2000 to 2011, the registered cases under 17 years old ranged from 3427 to 4075. The overall prevalence increased from 2000 to 2006, but then decreased till 2011. While the prevalence of mild CHI increased over the years, such a pattern was not observed in moderate or severe CHI. In general, the overall prevalence increased over the years in the age groups <3 years, 3–5 years, and 6–11 years (p < 0.01), and the largest increase was observed in the age group <3 years, particularly after the promotion of screening by the government in 2003. The decrease after 2006 was mainly attributable to decreases in the age groups 12–14 (with a decreasing trend from 2001, p < 0.01) and 15–17 years (with a decreasing trend from 2004, p < 0.01). The timing was related to the implementation of a nationwide rubella vaccination program. Similar decreases had been observed in countries with rubella vaccination programs.     

Perceptions of short and long sleep duration and comorbid conditions: the PLATINO study

ObjectivesWe aimed to describe the distribution of self-reported sleep duration in adults over the age of 40 years and to analyze the associated risk factors, comorbid conditions, and quality of life (QoL).MethodsOur study was constructed as a cross-sectional population-based study and is part of the PLATINO (Spanish acronym for the Latin American Project for Research in Pulmonary Obstruction) study. It includes data from Mexico City (Mexico), Montevideo (Uruguay), Santiago (Chile), and Caracas (Venezuela). Data from 4533 individuals were analyzed using a single questionnaire entitled, PLATINO, which was designed to collect data on self-reported sleep symptoms. Spirometry also was performed in accordance with international standards. All statistical analyses took the study design into consideration with adjustments for each city.ResultsThe prevalence of subjects who reported sleeping <7 h was 38.4%, ⩾7 to <9 h was 51.4%, and ⩾9 h was 10.2%. In the multivariate analysis, individuals with shorter sleep duration had higher frequencies of insomnia, increased forced expiratory volume in one second in liters and percentage/forced vital capacity in liters (FEV1/FVC) of predicted ratios, and a higher presence of coughing and phlegm. The main risk factor associated with longer duration of sleep was the number of comorbidities.ConclusionsSelf-reported sleep duration discriminated among groups that differed in sleep-related symptoms, respiratory symptoms, QoL and comorbid conditions.     

Gender differences in nighttime sleep and daytime napping as predictors of mortality in older adults: The Rancho Bernardo Study

ObjectiveMany studies suggest optimal sleep duration for survival is 7–8 h/night. We report the gender-specific independent association of all-cause mortality with nighttime sleep and daytime nap duration in older adults who were followed for up to 19 years.MethodsBetween 1984 and 1987, 2001 community-dwelling, mostly retired, adults (1112 women), age 60–96 years, answered questions about health, mood, medications, life-style, daytime napping, and nighttime sleep duration. Vital status was confirmed for 96% through July 2001.ResultsAt baseline, men reported significantly longer nighttime sleep and daytime napping than women. In both men and women, nighttime sleep <6 h was associated with depressed mood and sleep-related medication, and ⩾9 h was associated with more alcohol consumption. Napping ⩾30 min was associated with prevalent depressed mood, coronary heart disease, and cancer. Of the group, 61% died over the next 19 years, at an average age of 85.6 years. Mortality risk was lowest among those sleeping 7–7.9 h/night in both men and women. Multiple-adjusted analyses showed that increased mortality was associated with nighttime sleep ⩾9 h in women (HR 1.51: 95% CI = 1.05–2.18), and with daytime napping ⩾30 min in men (HR 1.28: 95% CI, 1.00–1.64).ConclusionsMechanisms for these differences are unknown.     

Depression and anxiety in patients with diabetes in a Moroccan region

AimsTo estimate prevalence of anxiety and depression in patients with diabetes mellitus and identify their determinants.MethodsA cross-sectional study was conducted at Hassan II University-Hospital of Fes in 2019–2020. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariate analysis by logistic regression was used to determine factors associated with depression and anxiety, adjusting for confounding factors. All statistical analyses were conducted using EPIINFO7.ResultsA total of 243 diabetics were included in the study. The average age of the participants was 48.07 ± 14.25 years, 58% were females and 72% were diagnosed with diabetes type II. The prevalence of depressive symptoms and anxiety symptoms was (18, 1%, CI_95% = (13–23)) and (29.6%, CI_95% = (24–35)), respectively. The prevalence of depression and anxiety was higher among women than man and increases with increasing duration of the disease. In multivariate analysis, illiterates (OR = 3.19, CI_95% = (1.46–6.98)), those with depression (OR = 3.61, CI_95% = (1.78–7.32)), and type 1 diabetics (OR = 3.22, CI_95% = (1.44–7.21)) are a higher risk of developing anxiety. Depression was associated with older age (OR = 2, 65, CI_95% = (1, 14–6, 14)), use of insulin (OR = 3.77 CI_95% = (1.50–9.44)) and anxiety symptoms (OR = 4, 27, CI_95% = (2, 05–8, 91)).ConclusionHigh prevalence of depressive and anxiety symptoms in diabetics suggests consideration of psychological aspect in implementation of diabetes managing program.     

Prognosis of status epilepticus (SE): Relationship between SE duration and subsequent development of epilepsy

In animal models, SE duration is related to epileptogenesis. Data in humans are scarce, mainly in NCSE; therefore, we aimed to study the prognosis of SE de novo and which factors may influence subsequent development of epilepsy.MethodsWe evaluated patients with SE without previous epilepsy at our hospital (February 2011–February 2014), including demographics, etiology, number of AEDs, duration of SE, mortality, and occurrence of seizures during follow-up.ResultsEighty-nine patients were evaluated. Median age was 69 (19–95) years old. Among them, 33.7% were convulsive. Regarding etiology, 59 were considered acute symptomatic (41 lesions, 18 toxic–metabolic), 17 remote or progressive symptomatic, and 13 cryptogenic. The median recovery time was 24 h (30 min–360 h). In-hospital mortality was 29% (n = 26). After a median follow-up of 10 months, 58.7% of survivors (n = 37) showed seizures. Subsequently, we analyzed which factors might be related to the development of epilepsy, and we found that epilepsy development was more frequent with longer SE duration (37 vs. 23 h, p = 0.004); furthermore, patients with a toxic–metabolic etiology developed epilepsy less frequently (33% vs. 67%; p = 0.022). Epilepsy was also correlated (tendency) with focal SE (p = 0.073), a lesion in neuroimaging (p = 0.091), and the use of 2 or more AEDs (p = 0.098). Regarding SE duration, a cutoff of above 24 h was clearly related to chronic seizures (p = 0.014); however, combining etiology and duration, the association of longer SE and epilepsy was significant in acute lesional SE (p = 0.034), but not in epilepsy with cryptogenic or remote/progressive etiology. After a logistic regression, only a duration longer than 24 h (OR = 3.800 (1.277–11.312), p = 0.016) was found to be an independent predictor of the development of epilepsy.ConclusionIn patients with SE, the longer duration is associated with an increased risk of subsequent epilepsy at follow-up, mainly in symptomatic SE due to an acute lesion. It is unclear if it might be the result of a more severe injury causing both prolonged seizures and subsequent epilepsy, and therefore whether more aggressive treatment in this group might avoid this possibility. Most of the patients with cryptogenic or remote/progressive SE developed epilepsy regardless of SE duration.This article is part of a Special Issue entitled “Status Epilepticus”.     

Potential biochemical pathways for the relationship between sleep duration and mortality

ObjectiveThe objective of this study was to elucidate new evidence on the presence of a relationship among sleep duration, cardiovascular mortality and total mortality, and to investigate sleep duration-related multiple biochemical changes.MethodsThe longitudinal study is based on the SAKUCESS study of 12,489 residents of Japan aged 20–79 years at baseline.ResultsIn the study, compared to respondents who reported 7 h of sleep, long sleep duration (⩾9 h) was associated with an increased risk of cardiovascular disease mortality and total mortality in men, hazard ratios (HRs) were 1.70 (95% confidence interval [CI] = 1.07–2.70) and 2.73 (95% CI = 1.22–6.11) and an increased risk of total mortality in women, HR was 1.85 (95% CI = 1.09–3.13). Sleep duration was significantly associated with changes in blood biochemical levels. The results of the logistic regression analysis showed that the levels of multiple biochemical parameters are associated with increased risk of total mortality.ConclusionsThis is the first large longitudinal study to indicate that sleep duration was associated with changes in multiple biochemical levels in the blood and total mortality.     

Influence of combinations of drugs that act on the CYP2D6 metabolic pathway in the treatment of major depressive disorder: A population-based study

ObjectiveTo describe the frequency of drug combinations (substrate-substrate or substrate-inhibitor) with the potential to interfere with the CYP2D6 metabolic pathway in patients receiving antidepressant medication for major depressive disorder.MethodsWe carried out an observational study using outpatient medical records. We included adult subjects who initiated antidepressant medication during 2008–2010. Patients were assigned to three study groups: no combination, substrate-substrate, and substrate-inhibitor. Follow-up period was 12 months. Main measures: demographics, comorbidity and medication persistence. Statistical analysis included a logistic regression model, P < 0.05.ResultsFive thousand six hundred and thirty patients were recruited (61.9 years, 76.9% female), 24.4% (CI: 23.8 – 26.0%) received some kind of drug combination (substrate-substrate: 15.4%, substrate-inhibitor: 9.0%). Variables significantly associated with drugs combinations that may act on the CYP2D6 metabolic pathway were: dementia (OR = 4.2), neuropathy (OR = 4.2) and stroke (OR = 1.9), P < 0.001. Medication persistence at 12 months was longer in patients with no combination (55.3%) than in patients receiving substrate-substrate (50.5%) or substrate-inhibitor (45.0%) combinations, P < 0.001.ConclusionsTwenty-five percent of major depressive disorder patients received a combination of drugs with the potential to interfere with CYP2D6 metabolic pathway. These combinations increased with comorbidity and resulted in shorter medication persistence of antidepressant treatment.     

Interactions between transcranial direct current stimulation (tDCS) and pharmacological interventions in the Major Depressive Episode: Findings from a naturalistic study

BackgroundTranscranial direct current stimulation (tDCS) is a non-invasive, neuromodulatory technique with an emerging role for treating major depression.ObjectiveTo investigate the interactions between tDCS and drug therapy in unipolar and bipolar depressed patients who were refractory for at least one pharmacological treatment.MethodsThis was a naturalistic study using data from 54 female and 28 male patients (mean age of 54 years) that consecutively visited our psychiatric unit. They received active tDCS (five consecutive days, 2 mA, anodal stimulation over the left and cathodal over the right dorsolateral prefrontal cortex, twice a day, 20 minutes). The outcome variable (mood) was evaluated using the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale (HDRS). Predictor variables were age, gender, disorder and pharmacological treatment (seven dummy variables). We performed univariate and multivariate analyses as to identify predictors associated to the outcome.ResultsAfter 5 days of treatment, BDI and HDRS scores decreased significantly (29% ± 36%, 18% ± 9%, respectively, P < 0.01 for both). Benzodiazepine use was independently associated with a worse outcome in both univariate (β = 4.92, P < 0.01) and multivariate (β = 5.8, P < 0.01) analyses; whereas use of dual-reuptake inhibitors positively changed tDCS effects in the multivariate model (β = –4.7, P = 0.02). A similar trend was observed for tricyclics (β = –4, P = 0.06) but not for antipsychotics, non-benzodiazepine anticonvulsants and other drugs.ConclusiontDCS over the DLPFC acutely improved depressive symptoms. Besides the inherent limitations of our naturalistic design, our results suggest that tDCS effects might vary according to prior pharmacological treatment, notably benzodiazepines and some antidepressant classes. This issue should be further explored in controlled studies.     

Suicide attempt in first-episode psychosis: A 7.4 year follow-up study

BackgroundIndividuals with first-episode psychosis demonstrate high rates of suicide attempt (SA).Aims1) To examine the prevalence of, and risk factors for, SA in a first-episode psychosis (FEP) cohort over a 7.4 year follow-up period. 2) To investigate differences between single versus multiple suicide attempters.MethodsThis study reports baseline and follow-up data from a naturalistic, prospective follow-up of 413 FEP patients treated at a specialist early psychosis centre. Assessments were conducted at treatment entry, initial symptom remission or stabilization, and long term follow-up. Binary logistic regression models were used to assess unadjusted and adjusted associations between early illness and sociodemographic characteristics and two outcome measures: any SA during follow-up; and multiple SAs.ResultsFollow-up data were available for 282 participants. Sixty-one (21.6%) made a suicide attempt over the follow-up period, including 12 successful suicides. The following baseline risk factors increased the risk of any SA: history of self-harm (OR = 4.27; p < 0.001), suicidal tendencies (OR = 2.30; p = 0.022), being depressed for > 50% of the initial psychotic episode (OR = 2.49; p = 0.045), and hopelessness (OR = 2.03; p = 0.030). History of problem alcohol use increased the risk of multiple SAs (OR = 4.43; 95% CI (1.05–18.7); p = 0.043).DiscussionThe prevalence of suicide attempt in this study exceeds reports from short-term FEP studies but is comparable to longer term follow-up studies, indicating that risk remains elevated for at least 7 years following commencement of treatment. The key predictor of future suicide attempt was previous self-harm, indicating that interventions for self-harm are required.     

Type-2 diabetes mellitus in schizophrenia: Increased prevalence and major risk factor of excess mortality in a naturalistic 7-year follow-up

ObjectivePhysical co-morbidity including type 2 diabetes mellitus is more prevalent in patients with schizophrenia compared to the general population. However, there is little consistent evidence that co-morbidity with diabetes mellitus and/or other diseases leads to excess mortality in schizophrenia. Thus, we investigated whether co-morbidity with diabetes and other somatic diseases is increased in schizophrenics, and if these are equally or more relevant predictors of mortality in schizophrenia than in age- and gender-matched hospitalised controls.MethodsDuring 2000–2007, 679 patients with schizophrenia were admitted to University Hospital Birmingham NHS Trust. Co-morbidities were compared with 88,778 age- and gender group-matched hospital controls. Predictors of mortality were identified using forward Cox regression models.ResultsThe prevalence of type 2 diabetes mellitus was increased in schizophrenia compared to hospitalised controls (11.3% versus 6.3%). The initial prevalence of type 2 diabetes mellitus was significantly higher in the 100 later deceased schizophrenic patients (24.0%) than in those 579 surviving over 7 years (9.2%). Predictors of mortality in schizophrenia were found to be age (relative risk [RR] = 1.1/year), type 2 diabetes mellitus (RR = 2.2), pneumonia (RR = 2.7), heart failure (RR = 2.9) and chronic renal failure (RR = 3.2). The impact of diabetes mellitus on mortality was significantly higher in schizophrenia than in hospital controls (RR = 2.2 versus RR = 1.1). In agreement, deceased schizophrenics had significantly suffered more diabetes mellitus than deceased controls (24.0 versus 10.5%). The relative risks of mortality for other disorders and their prevalence in later deceased subjects did not significantly differ between schizophrenia and controls.ConclusionSchizophrenics have more and additionally suffer more from diabetes: co-morbidity with diabetes mellitus is increased in schizophrenia in comparison with hospital controls; type 2 diabetes mellitus causes significant excess mortality in schizophrenia. Thus, monitoring for and prevention of type 2 diabetes mellitus is of utmost relevance in hospitalised patients with schizophrenia.