Anxiety,depression and suicidal ideation in patients with rheumatoid arthritis in use of methotrexate,hydroxychloroquine, leflunomide and biological drugs

Objective

This paper aims to investigate the prevalence of anxiety, depression and suicidal ideation in patients with rheumatoid arthritis taking different drugs to control the disease.

Methods

The study included 105 patients with rheumatoid arthritis who were treated with methotrexate, leflunomide, hydroxychloroquine and biological drugs. All patients were assessed using the Mini International Neuropsychiatric Interview, the Beck Scale for Suicide Ideation and the Hospital Anxiety and Depression Scale.

Results

Difference was statistically significant (p < 0.001) for both depression and anxiety as to suicidal ideation among groups of patients according to the medication used. Furthermore, the value reached by those patients taking biological drugs was alarming with higher scores for all measures, including suicide ideation. The patients using methotrexate and leflunomide reported lower scores on suicidal ideation than those using hydroxychloroquine and biological drugs. Patients using leflunomide showed less mental health impairment than other groups.

Conclusion

Greater scores for depression, as a comorbidity of rheumatoid arthritis, increase the rate of suicidal ideation and depression also can worsen general pain, hardships, treatment denial, and prognosis, as well as cause a faster reduction in quality of life. Patients taking biologic DMARDs (drugs known as disease-modifying drugs) had the highest rates of depression, anxiety and suicidal ideation among all patients studied. The current analysis showed that psychiatric aspects such as depression, anxiety and even suicide ideation, may differ between groups of patients with arthritis according to the drug used, serving as an alert to the importance of considering also this factors in therapeutic decisions.     

Cognitive Vulnerability Profiles of Highly Anxious and Non-anxious Children

Current theoretical notions emphasise the role of cognitive variables in the development and maintenance of childhood anxiety. The purpose of this study was to explore whether there are different types of cognitive vulnerability to anxiety among children. The participants were 118 children between the ages of 7 and 13 who completed a set of questionnaires to measure cognitive errors, threat-related interpretation bias, and anxiety-related control. Cluster analysis identified three relevant clusters: (1) a High Cognitive Vulnerability cluster, characterised by high levels of cognitive errors and threat interpretation and low levels of control; (2) a Low Cognitive Vulnerability cluster, characterised by low levels of cognitive errors and threat interpretation and high levels of control; and (3) an Inconsistent Cognitive Vulnerability cluster, characterised by low levels of cognitive errors and threat interpretation and low levels of control. Differences between the clusters were found in terms of anxiety symptoms, coping strategies, and gender. The theoretical and clinical implications of these findings are discussed.     

Suramin attenuates dystrophin‐deficient cardiomyopathy in the mdx mouse model of duchenne muscular dystrophy

Introduction: The purpose of this study was to determine the effects of suramin, an antifibrotic agent, on cardiac function and remodeling in mdx mice. Methods: mdx mice (8 months old) received intraperitoneal injections of suramin twice a week for 3 months. Control mdx mice (8 months old) were injected with saline. Results: Suramin improved the electrocardiography profile with the main corrections seen in S‐ to R‐wave ratio, PR interval, and Q amplitude, and a significant decrease in the cardiomyopathy index. Suramin decreased myocardial fibrosis, inflammation, and myonecrosis. Conclusions: These findings suggest that suramin may be a new adjunctive therapy to help improve cardiomyopathy in DMD. Muscle Nerve 48 : 911–919, 2013     

Differences in attention and impulsivity between borderline personality disorder and bipolar disorder

This study aims at investigating attention and impulsivity differences between borderline personality disorder and bipolar disorder, as both diseases may share neuropsychological deficits. Differential cognitive outcomes on the Continuous Performance Test-II were observed between disorders, and also when compared to healthy controls.     

SSRI adverse events: How to monitor and manage

Antidepressants are efficacious for pediatric major depressive disorder, obsessive compulsive disorder (OCD), and non-OCD anxiety disorders. Antidepressants should be used in an evidence-based fashion, with frequent monitoring for side effects, especially when initiating treatment and adjusting dosage. With diligence to appropriate prescribing and monitoring, the benefits of therapy outweigh the potential of treatment related risk.