Association of NOS3 rs1799983 Polymorphism with Cognitive Function in Patients with First Episode Depression.

Background:Mood disorders and psychosis has been reported among the patients with macrocytosis; however, its prevalence among the first episode of psychosis and depression is unknown. The purpose of the study was to establish the prevalence of macrocytosis among the patients with the first episode of depression and psychosis.Materials and Methods:In this cross-sectional study, three groups comprising patients with first episode of depression (n = 100), patients with the first episode of psychosis (n = 100), and healthy controls (n = 100) were included. Blood samples were collected from each participant and analyzed using the automated coulter counter. The hematological variables (e.g., macrocytosis, anemia) in the three groups were compared using the Chi-square and analysis of variance tests.Results:The prevalence of macrocytosis among patients with depression and psychosis was 2.6 (8%) and 3.3 times (11%) higher, respectively than that among the healthy controls (3%). In addition, the hemoglobin concentration, mean corpuscular volume and mean platelet volume in patients with first episodes of psychosis and depression significantly differed from those in healthy controls P < 0.001.Conclusion:This study showed that the prevalence of macrocytosis among the first episode of depression and psychosis was higher than healthy controls. Macrocytosis may have etiological and prognostic significance among these patients. Prospective studies are needed to explore the clinical significance of macrocytosis among the patients with depression and psychosis in the clinical practice.

Enlargement of the amygdala in patients with a first episode of major depression

BackgroundThe role of brain metabolites as biological correlates of the intensity, symptoms, and course of major depression has not been determined. It has also been inconclusive whether the change in brain metabolites, measured with proton magnetic spectroscopy, could be correlated with the treatment outcome.MethodsProton magnetic spectroscopy was performed in 29 participants with a first episode of moderate depression occurring in the left dorsolateral prefrontal cortex and left amygdala at baseline and after 8 weeks of antidepressant treatment with escitalopram. The Montgomery-Asberg Depression Rating Scale, the Hamilton Rating Scale for Depression, and the Beck Depression Inventory were used to assess the intensity of depression at baseline and at the endpoint of the study. At endpoint, the participants were identified as responders (n=17) or nonresponders (n=12) to the antidepressant therapy.ResultsThere was no significant change in the N-acetyl aspartate/creatine ratio (NAA/Cr) after treatment with antidepressant medication. The baseline and endpoint NAA/Cr ratios were not significantly different between the responder and nonresponder groups. The correlation between NAA/Cr and changes in the scores of clinical scales were not significant in either group.ConclusionThis study could not confirm any significant changes in NAA after antidepressant treatment in the first episode of moderate depression, or in regard to therapy response in the left dorsolateral prefrontal cortex or left amygdala. Further research is necessary to conclude whether NAA alterations in the first episode of depression could possibly be different from chronic or late-onset depression, and whether NAA alterations in stress-induced (reactive) depression are different from endogenous depression. The potential role of NAA as a biomarker of a treatment effect has yet to be established.

To describe the cognitive and functional impairment in individuals with the first episode of major depressive disorder (MDD) as compared to controls and individuals with recurrent MDD. Also to describe the functional and cognitive trajectory after the first episode of MDD. A total of 52studies were included in our systematic review. 32studies compared the cognitive performance between first episode of depression (FED) and controls, 11studies compared the cognitive performance between recurrent depression (RD) and FED, 10 compared global functioning between RD and FED, fourstudies assessed cognition in FED over time, and twostudies assessed global functioning in FED over time. The majority of studies (n=22/32, 68.8%) found that FED subjects performed significantly worse than controls on cognitive tests, with processing speed (n=12) and executive/working memory (n=11) being the most commonly impaired domains. Seven out of 11studies (63.6%) found that RD performed significantly worse than FED, with verbal learning and memory being the most commonly impaired domain (n=4). Most studies (n=7/10, 70%) did not find a significant difference in global functioning between RD and FED. In three of fourlongitudinal studies assessing cognition, subgroup analyses were used instead of directly assessing cognition in FED over time while the remaining study found significant cognitive declines over time in FED when compared to controls. The two longitudinal studies assessing functional trajectory found that functioning significantly improved over time, possibly due to the improvement of depressive symptoms. There is strong evidence that cognitive impairment is present during the first episode of depression, and individuals with multiple episodes display greater cognitive impairment than individuals with a single episode. Future studies aimed at identifying predictors of cognitive and functional impairment after the first episode of depression are needed to describe the functional and cognitive trajectory of individuals with the first episode of MDD over time.

Background: Bipolar disorder is a serious mental disease marked by episodes of depression, mania, hypomania, or mixed states. Patients with bipolar disorder may present with different symptoms at first onset. The aim of this study is to compare demographic and clinical variables based on a patient's first episode of bipolar disorder, including risk of recurrence over a 2-year period.Methods: A large cohort (N = 742) of patients with bipolar disorder in China was analyzed. Patients were divided into two groups according to their first episode of bipolar disorder, either depression or mania. Patients in mixed state first episode were classified based on predominant symptoms. Three hundred eighteen patients of the cohort had a first episode of mania and 424 patients had initial symptoms of depression. Demographic and clinical data were collected. All patients were followed up for 24 months. Data on compliance with follow-up appointments and recurrence of symptoms after 6, 12, 18, and 24 months were collected. Clinical characteristics (course of disease, age of onset, psychiatric family history, etc.) were compared between the mania group and depression groups.Results: More patients with bipolar disorder had a first episode of depression than mania (57.14 vs. 42.86%). Compared with the depression group, the mania group had later age of diagnosis of bipolar disorder [(38.64 ± 13.50) vs. (36.34 ± 14.94), P = 0.028], lower education level [(9.37 ± 4.34) vs. (10.17 ± 4.81), P = 0.017] and longer latency between an initial episode of psychiatric symptoms and formal bipolar diagnosis [(10.80 ± 10.76) vs. (8.85 ± 9.90), P = 0.012]. More patients in the mania group were male and without psychotic symptoms (all P < 0.05). In comparison with the mania group, more patients in the depression group were female, with higher frequency of a reported precipitating event before first mood episode (all P < 0.05). Compared with the depression group, the mania group had more recurrences of illness at the end of 12 months (Z =-2.156, P = 0.031), 18 months (Z =-2.192, P = 0.028), and 24 months (Z = −2.364, P = 0.018).Conclusions: In our study, there are a number of differences in demographic and clinical characteristics of patients with different onset syndromes of bipolar disorder. These differences include gender, education level, diagnosis age, the rate of recurrences, and others. These data of a cohort of Chinese patients add to the growing international literature on the relationship between index episode of bipolar disorder and clinical variables and outcomes. These results and further study may allow clinicians to offer patients and families more reliable prognostic information at the onset of disease.

Objectives:To explore levels of anti-oxidative molecules and inflammatory factors in patients with vascular dementia (VD) and their clinical significance.Methods:Sixty VD patients admitted in our hospital from January 2016 to January 2019 were classified into an experimental group, while another 60 healthy patients seeking physical examinations in the corresponding period were selected as a control group. Various indexes related to serum inflammatory factors and anti-oxidative molecules were compared among patients in such two groups. For the purpose of comparing anti-oxidative molecular expression levels and inflammatory factor levels in patients with VD of different severities, 60 cases in the experimental group were divided, based on a Mini-mental State Examination (MMSE) scale, into patients with mild symptoms (n=20, score: 21~26), patients with moderate symptoms (n=22, score: 10~20) and patients with severe symptoms (n=18, score: 0~9).Results:By contrast to the control group, levels of inflammatory factors (e.g., TNF-a, CRP and IL-6) in VD patients are all significantly increased and their differences show statistical significance (p<0.05); and, expression levels of anti-oxidative factors, including superoxide dismutase (SOD), glutathion peroxidase (GSH-Px), total antioxidant capacity (TAC), catalase (CAT) and glutathione reductase (GR), in the experimental group are apparently below those of the control group (P<0.05). As dementia degree increases, expression levels of serum anti-oxidative molecules in such patients are inclined to drop in a significant way (P<0.05), while inflammatory factor levels tend to go up gradually (P<0.05).Conclusions:If compared with the normal population, inflammatory factor levels in serum of VD patients are higher; however, expression levels of anti-oxidative molecules become below those of the normal population. Additionally, levels of inflammatory factors and anti-oxidative molecules may change obviously as severity of illness increases. This suggests that inflammation and oxidation play a certain role of auxoaction in VD patients.

Timing, quantity and quality of stressful life events in childhood and preceding the first episode of bipolar disorder

Hippocampal volume in first episode and recurrent depression

The Risk for Depression Comorbidity in Patients With COPD

Objective A case-control study was conducted to explore the correlation between serum inflammatory factor monitoring and cognitive function, language, and memory ability of Alzheimer's disease (AD) and its clinical significance. Methods Thirty-six patients with AD treated from April 2019 to August 2021 in our hospital were enrolled as the study subjects (AD group), and 30 healthy volunteers from the physical examination center and the AD group with the same sex, age, education, and no complaints of memory loss were enrolled as the control group. Montreal Cognitive Assessment (MoCA) and AD Rating Scale-Cognitive (ADAS-cog) were employed to assess the cognitive function of AD and the control group. The Chinese Standard aphasia Test of China Rehabilitation Research Center (CRRCAE) was employed to assess the language function of AD and NC population. The World Health Organization-University of California, Los Angeles Auditory Word Learning Test (WHO-UCLAAV-LT) scale was employed to evaluate the memory function of AD group and control group. The levels of inflammatory factors in serum of the AD group and control group were detected by enzyme-linked immunosorbent assay (ELISA). The serum inflammatory factors levels were compared between the AD group and the control group, and the correlation between the level of serum inflammatory factors and cognitive function, language, and memory ability in the AD group was analyzed. Results In terms of the demographic data of the two groups, there exhibited no significant difference in gender, age, education level, and other general data (P > 0.05). In terms of cognitive function, MoCA scores were remarkably lower compared to the AD group. In the comparison of memory ability, the scores of long-term delayed recognition, delayed memory, and instantaneous memory in the AD group were remarkably lower (P < 0.05). In the comparison of language ability, the scores of listening comprehension, reading, and naming in the AD group exhibited remarkably lower (P < 0.05). With regard to the levels of serum inflammatory factors, the levels of serum interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α), and CCL-12 in AD group were remarkably higher, while the level of TNF-β in the AD group was lower compared to the control group. Furthermore, there exhibited no significant correlation between the levels of serum IL-4, IL-6, IL-10, TNF-α, CCL-2, and the total scores, MoCA, and ADAS-cog, but there exhibited a positive relationship between the level of serum TNF-β and the score of MoCA scale. The correlations between IL-4, IL-6, IL-10, TNF-α, TNF-β, CCL-2, and the scores of long-term delayed recognition, delayed memory, and instantaneous memory were analyzed in the AD group. The serum levels of IL-4, IL-6, IL-10, TNF-α, CCL-2, and TNF-β were not remarkably correlated with the scores of long-term delayed recognition, delayed memory, and instantaneous memory. The correlations between IL-4, IL-6, IL-10, TNF-α, TNF-β, CCL-2, and the scores of listening comprehension, reading, and naming were analyzed in the AD group, but with no significant correlation between the serum levels of IL-4, IL-6, IL-10, CCL-2, TNF-α, and TNF-β and the scores of listening comprehension, reading, and naming. Conclusion Compared with the control group, the levels of serum IL-4, IL-6, IL-10, TNF-α, and CCL-2 in patients with AD exhibited remarkably higher, while the level of serum TNF-β exhibited remarkably lower. The level of serum TNF-β was remarkably correlated with cognitive function in patients with AD, which may reflect the severity of cognitive impairment in patients with AD.

Recent changes in the finance and delivery of health care have increased the interest in time-limited, empirically tested psychotherapy programs. However, clinicians often are concerned that these short-term approaches will not be appropriate for patients with long-standing or multiple problems. We present a case of a middle-aged woman with a chronic mood disorder and multiple psychosocial and economic problems who was treated with a 12-week program of interpersonal psychotherapy. This case illustrates the changes that can occur with time-limited treatment. Interpersonal psychotherapy is a timelimited psychotherapeutic approach that has shown efficacy in the treatment of several psychiatric disorders, including major depression and dysthymia, in several controlled trials (1–4). It rests upon the premise that major depression, regardless of etiology, is initiated and maintained within an interpersonal context (5). The goal of interpersonal psychotherapy is to achieve symptomatic relief for depression by addressing current interpersonal problems associated with the onset of the depression. It does not seek to attribute interpersonal problems to underlying personality characteristics or unconscious motivations. Rather, interpersonal psychotherapy works under the assumption that little can really be said about the patient’s personality until the depression is alleviated. From the technical point of view, sessions are viewed as an opportunity to examine the interpersonal relationships of the patient, link them to the changes in mood, and discuss possible alternatives to the patient’s behavior patterns. The therapist helps the patient devise new strategies to use in similar situations and coaches the patient on how to implement them. The therapist may even engage in role playing to give the patient an opportunity to rehearse these strategies. In contrast to brief therapies of analytic orientation, transference plays a much smaller role. In interpersonal psychotherapy, the therapist is aware of the development of transference and countertransference in the treatment relationship but typically avoids focusing on them and rarely uses transference as a therapeutic tool. Consistent with the emphasis on the relationship of interpersonal problems and mood symptoms, the focus in interpersonal psychotherapy is the “here and now” of the life of the patient outside the session rather than the process of the session and its relationship with the patient’s past.

Professor Du has provided a succinct summary of child and adolescent depression and its treatment with antidepressants.[1] There remains some controversy over the prevalence of depression in children and adolescents: Professor Du reports that 20% of individuals experience depression prior to the age of 18 while other epidemiological reports indicate that the rate is closer to 17%.[2]–[4] But this difference in rates is relatively small and may be due to methodological differences in the studies. As noted by Professor Du, suicidal ideation may increase in depressed children and adolescents who receive antidepressant treatment, but the rates of suicidal acts do not appear to increase. Overall, the beneficial effects of antidepressants, at least among depressed teenagers, appear to outweigh the risks.[5] Fortunately, the incidence of depression is lower in children than in adolescents. Antidepressant use is of greatest concern in younger children: physicians are more willing to prescribe fluoxetine and other selective serotonin reuptake inhibitors (SSRIs) ‘off label’ for older adolescents with depression than they are for younger adolescents and children. For children, non-pharmacological psychosocial treatments such as Behavioral Activation[6],[7] (that may more easily be rendered age-appropriate than cognitive-behavioral therapy [CBT] or interpersonal psychotherapy [IPT]) are increasingly available and appear to be efficacious. A new and important direction of research on childhood depression is the focus on preventing depression. Investigators throughout the world have implemented and evaluated specific interventions to prevent the occurrence of a first full-criteria episode of depression in children. Universal prevention programs are applied to entire populations of children (e.g., all the students in a school). Indicated prevention programs are targeted on selected ‘high-risk’ (or ‘at-risk’) children–those with identifiable risk factors (e.g., cognitive distortions) or subsyndromal depressive symptoms.[8],[9] Universal programs have produced small effect sizes and their long-term results have, at best, been described as ‘mixed’.[10] Findings for Indicated prevention programs have been more encouraging: a CBT-based prevention program[11] effectively prevented depressive episodes among children of parents who suffered from depressive disorders; and a large U.S. prevention study based on CBT principles[12] prevented depression among at-risk children (unless there was a depressed mother in the child's household). Similarly, a school-based CBT program[13] administered by current school staff to at-risk 14- and 15-year olds (the peak age for the onset of adolescent depression) in Iceland prevented an initial episode of depression and the preventive effects were maintained over a 1-year follow-up period. This program is currently being evaluated in a prevention program in schools in Portugal. These findings about the prevention of childhood depression are important for a number of reasons. First, the prevention of an initial episode of depression among children at risk prevents the personal, social and societal effects of a Major Depressive Episode. Second, data show clearly that once a first episode of depression has occurred, the risk of a second episode is greatly increased, so the prevention (or at least delay) of an initial episode may forestall the development of a chronic relapsing condition.[3] The delay in onset of the initial episode also allows more time for the development of academic and social skills and more time for the maturation of neural pathways of resilience among at-risk youth. And since antidepressant use is more acceptable in older than younger adolescents, delay of the initial episode of depression will have the result that a wider range of alternative treatments are available if and when a Major Depressive Episode occurs.

The association between the disruption of motor imagery and the number of depressive episodes of major depression

Objective To investigate the variations of error related negativity(ERN)in first episode depression(FED)after treatment and the effect of different clinical features on ERN in FED patients. Methods 80 FED patients were divided into different subgroups according to their severity of depression, anxiety and retardation. According to the total score of Hamilton Depression Rating Scale, they were divided into severe depression subgroup(n=34)and moderate depression subgroup(n=46). According to the total score of Hamilton Anxiety Rating Scale, they were divided into severe anxiety subgroup(n=43)and moderate anxiety subgroup(n=37). According to the retardation factor score of Hamilton Depression Rating Scale, they were divided into severe retardation subgroup(n=30)and moderate retardation subgroup(n=50).Their ERN were tested before and after single treatment of escitalopram 10-20 mg per day for 8 weeks, and the differences of ERN indexes were compared between FED patients and healthy controls(HC), between FED patients before and after their treatment, and among subgroups of FED patients with different clinical features. Results The baseline ERN amplitudes of FED group were significantly higher than those of HC group(Z =-2.081, P 0.05; Z =-1.456, P>0.05).There were significant differences on ERN amplitude among severe depression subgroup, moderate depression subgroup and HC group(Z=7.648, P< 0.05), there were significant differences on ERN amplitude among severe anxiety subgroup, moderate anxiety subgroup and HC group(Z=8.097, P<0.05),there were also significant differences on ERN latency and amplitude among severe retardation subgroup, moderate retardation subgroup and HC group(F=7.437, P<0.05; Z=7.896, P<0.05). Conclusions The increased ERN amplitude in first episode depression is a possible trait mark. The variations of ERN indexes in depressive disorder are probably related with the severity of anxiety and retardation. Key words: Depressive disorder; Evoked potentials; Error related negativity

BackgroundHypothermia is associated with many adverse clinical outcomes in pediatric patients, and thus, it is important to find an effective and safe method for preventing peri-operative hypothermia and its associated adverse outcomes in pediatric patients. This study aimed to investigate the effect of forced-air warming blankets with different temperatures on changes in the transforming growth factor-β (TGF-β), tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-10 levels in children undergoing surgical treatment for developmental displacement of the hip (DDH).MethodsThe study included 123 children undergoing surgery for DDH under general anesthesia. The patients were randomly assigned to three groups, using a random number table: the 32, 38, and 43°C groups according to the temperature setting of the forced-air warming blankets. For each patient, body temperature was recorded immediately after anesthesia induction and intubation (T0), at initial incision (T1), at 1 h after incision (T2), at 2 h after incision (T3), at the end of surgery (T4), immediately upon return to the ward after surgery (T5), and then at 12 h (T6), 24 h (T7), 36 h (T8), and 48 h (T9) after the surgery. The serum levels of TGF-β, TNF-α, IL-1β, and IL-10 were measured at T0 and T4 for all groups.ResultsThe number of patients with fever in the 38°C group was significantly less than those in the 32 and 43°C groups (χ2 = 6.630, P = 0.036). At T0, the body temperatures in the 38 and 43°C groups were significantly higher than that in the 32°C group (F = 17.992, P < 0.001). At T2, the body temperature was significantly higher in the 43°C group than those in the 32 and 38°C groups (F = 12.776, P < 0.001). Moreover, at T4, the serum levels of TGF-β (F = 3286.548, P < 0.001) and IL-10 (F = 4628.983, P < 0.001) were significantly increased in the 38°C group, and the serum levels of TNF-α (F = 911.415, P < 0.001) and IL-1β (F = 322.191, P < 0.001) were significantly decreased in the 38°C group, compared with the levels in the 32 and 43°C groups.ConclusionForce-air warming blankets set at 38°C maintained stable body temperature with less adverse outcome and effectively inhibited the inflammatory response in pediatric patients undergoing surgery for DDH.Clinical trial registrationChiCTR1800014820; http://www.chictr.org.cn/showproj.aspx?proj=25240.