Affective Disorders Research Articles

Longitudinal Symptom Burden and Pharmacologic Management of Catatonia in Autism with and without Profound Impairment: An Observational Study.

Catatonia is a highly morbid psychomotor and affective disorder which can affect autistic individuals with and without profound impairment. Catatonic symptoms are treatable with pharmacotherapy and electroconvulsive therapy, but the longitudinal effectiveness of these treatments has not been described. We conducted a prospective observational cohort study of patients with autism and co-morbid catatonia who received outpatient care in a specialized outpatient clinic from July 1st, 2021 to May 31st, 2024. Data investigating pharmacologic interventions, and clinical measures including the Bush Francis Catatonia Rating Scale (BFCRS), Kanner Catatonia Severity Scale (KCS), Kanner Catatonia Examination (KCE), and Clinical Global Impression - Improvement (CGI-I) were collected. Forty-five patients were identified with 39 (86.7%) meeting criteria for profound autism. All patients received pharmacotherapy. 44 (97.8%) were treated with benzodiazepines with a mean maximal daily dose of 17.4 mg (SD=15.8) lorazepam equivalents. Thirty-five patients (77.8%) required more than one medication class for treatment. Fourteen patients (31.1%) attempted to taper off benzodiazepines during the study period; of these, 5 patients (11.1%) were successfully tapered off, and the remaining 9 (17.8%) discontinued the taper due to a return of catatonic symptoms. Statistically significant improvement was observed across all clinical domains except the KCS. However, the majority remained symptomatic over the study period. Despite clinical improvements while receiving the gold standard for psychopharmacologic management of catatonia, chronic symptoms remained for the majority of catatonia patients over the study period, and few were able to taper and discontinue benzodiazepine treatment.

Screen time, problematic screen use, and eating disorder symptoms among early adolescents: findings from the Adolescent Brain Cognitive Development (ABCD) Study

PurposeEmerging research evidence suggests positive relationships between higher screen time and eating disorders. However, few studies have examined the prospective associations between screen use and eating disorder symptoms in early adolescents and how problematic screen use may contribute to symptom development.MethodsWe analyzed prospective cohort data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 10,246, 2016–2020, ages 9–14). Logistic regression analyses were used to estimate the longitudinal associations between baseline self-reported screen time and eating disorder symptoms in year two. Logistic regression analyses were also used to estimate cross-sectional associations between problematic screen use in year two (either problematic social media or mobile phone use) and eating disorder symptoms in year two. Eating disorder symptoms based on the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5) included fear of weight gain, self-worth tied to weight, engaging in compensatory behaviors, binge eating, and distress with binge eating.ResultsEach additional hour of total screen time and social media use was associated with higher odds of fear of weight gain, self-worth tied to weight, compensatory behaviors to prevent weight gain, binge eating, and distress with binge eating two years later (odds ratio [OR] 1.05–1.55). Both problematic social media and mobile phone use were associated with higher odds of all eating disorder symptoms (OR 1.26–1.82).ConclusionsFindings suggest greater total screen time, social media use, and problematic screen use are associated with more eating disorder symptoms in early adolescence. Clinicians should consider assessing for problem screen use and, when high, screen for disordered eating.Level of evidenceLevel III: Evidence obtained from well-designed cohort or case–control analytic studies.

Psychopathology in Infants, Toddlers, and Preschool Children with Nonsyndromic Clefts of the Lip and/or Palate: A Case-Control Study.

The aim of this study is to assess psychopathology and maternal interactions in infants, toddlers, and preschool children with nonsyndromic clefts of the lip and/or palate (NSCLP) and association of psychopathology with cleft-related factors and maternal interactions. Twenty-six children from 4 to 72 months of age with NSCLP, who were attending the Plastic, Reconstructive and Aesthetic Surgery Department were included as the case group. Fifty-two healthy children who were matched on age and sex with the case group were taken as controls. Children were assessed in aspects of psychiatric diagnosis, articulation, and development. Speech and language disorders (SLD) (P<0.001), disorders of affect (DA) (P=0.005), feeding behavior disorder (P=0.002), sleep-behavior disorder (SBD) (P=0.038), and disordered mother-child relationship (P<0.001) were more prevalent in children with NSCLP. Dental alignment (P=0.024), number of operations (P=0.006), and type of operations (P=0.012) were associated with DA. The children in the case group, who had disordered relationship with their mothers had significantly more SLD (P=0.036) and SBD (P=0.039). Children with NSCLP are at risk of developing psychopathology, especially SLD and DA. Maternal interactions and the above cleft-related factors and may be the target of interventions to prevent and treat psychiatric disorders in these children.

Intermittent theta burst stimulation of the left dorsolateral prefrontal cortex has no additional effect on the efficacy of virtual reality exposure therapy for acrophobia. A randomized double-blind placebo-controlled study

Anxiety disorders are among the most common mental disorders. Treatment guidelines recommend pharmacotherapy and cognitive behavioral therapy as standard treatment. Although cognitive behavioral therapy is an effective therapeutic approach, not all patients benefit sufficiently from it. In recent years, non-invasive brain stimulation techniques, such as transcranial magnetic stimulation, have been investigated as promising adjuncts in the treatment of affective disorders. The aim of this study is to investigate whether a combination of intermittent theta burst stimulation (iTBS) and virtual reality exposure therapy leads to a significantly greater reduction in acrophobia than virtual reality exposure with sham stimulation. In this randomized double-blind placebo-controlled study, 43 participants with acrophobia received verum or sham iTBS over the left dorsolateral prefrontal cortex prior to two sessions of virtual reality exposure therapy. Stimulation of the left dorsolateral prefrontal cortex with iTBS was motivated by an experimental study showing a positive effect on extinction memory retention. Acrophobic symptoms were assessed using questionnaires and two behavioral approach tasks one week before, after treatment and six months after the second diagnostic session. The results showed that two sessions of virtual reality exposure therapy led to a significant reduction in acrophobic symptoms, with an overall remission rate of 79 %. However, there was no additional effect of iTBS of the left dorsolateral prefrontal cortex on the therapeutic effects. Further research is needed to determine how exactly a combination of transcranial magnetic stimulation and exposure therapy should be designed to enhance efficacy.

Melatonin attenuates affective disorders and cognitive deficits induced by perinatal exposure to a glyphosate-based herbicide via antioxidant pathway in adult male and female rats.

The massive use of herbicides, particularly glyphosate-based herbicides (GBHs), raises several worries, notably their neurotoxic effects. Several studies have explored the consequences of developmental exposure. Our work aims to determine the impact of maternal exposure to GBH on behavioral disorders and memory deficits, as well as the involvement of oxidative stress in the hippocampus and prefrontal cortex. In addition, our study explores the neuroprotective properties of melatonin in male and female offspring. Pregnant Wistar rats were injected with GBH 75 mg/kg during gestation and lactation. After weaning, the offspring were treated with melatonin (4mg/kg) from postnatal days 30-58. Our results show that GBH increases anxiety-like behavior levels in offspring, as well as depression-like behavior. GBH also impairs working memory in progeny. While markers of oxidative stress show a disturbance in lipid peroxidation and catalase activity, with a more pronounced effect in females, on the other hand, melatonin considerably attenuated the neurotoxic impact observed in the offspring, with higher efficacy in females. The oxidative stress results confirm the antioxidant power of melatonin to counteract the damaging effects of exposure to environmental contaminants such as glyphosate-based pesticides. It will then be interesting to further our work to fully understand the sex-dependent effect of melatonin.

Cognitive subgroups of affective and non-affective psychosis show differences in medication and cortico-subcortical brain networks

Cognitive deficits are prevalent in individuals with psychosis and are associated with neurobiological changes, potentially serving as an endophenotype for psychosis. Using the HCP-Early-Psychosis-dataset (n = 226), we aimed to investigate cognitive subtypes (deficit/intermediate/spared) through data-driven clustering in affective (AP) and non-affective psychosis patients (NAP) and controls (HC). We explored differences between three clusters in symptoms, cognition, medication, and grey matter volume. Applying principal component analysis, we selected features for clustering. Features that explained most variance were scores for intelligence, verbal recognition and comprehension, auditory attention, working memory, reasoning and executive functioning. Fuzzy K-Means clustering on those features revealed that the subgroups significantly varied in cognitive impairment, clinical symptoms, and, importantly, also in medication and grey matter volume in fronto-parietal and subcortical networks. The spared cluster (86%HC, 37%AP, 17%NAP) exhibited unimpaired cognition, lowest symptoms/medication, and grey matter comparable to controls. The deficit cluster (4%HC, 10%AP, 47%NAP) had impairments across all domains, highest symptoms scores/medication dosage, and pronounced grey matter alterations. The intermediate deficit cluster (11%HC, 54%AP, 36%NAP) showed fewer deficits than the second cluster, but similar symptoms/medication/grey matter to the spared cluster. Controlling for medication, cognitive scores correlated with grey matter changes and negative symptoms across all patients. Our findings generally emphasize the interplay between cognition, brain structure, symptoms, and medication in AP and NAP, and specifically suggest a possible mediating role of cognition, highlighting the potential of screening cognitive changes to aid tailoring treatments and interventions.

The Utility of Neuromuscular Assessment to Identify ADHD Among Patients with a Complex Symptom Picture

Objective: Diagnostic assessment of ADHD is challenging due to comorbid psychopathologies and symptoms overlapping with other psychiatric disorders. In this study, we investigate if a distinct pattern of neuromuscular dysregulation previously reported in ADHD, can help identifying ADHD in psychiatric patients with diverse and complex symptoms. Method: We explored the impact of neuromuscular dysregulation, as measured by The Motor Function Neurologic Assessment (MFNU), on the likelihood of being diagnosed with ADHD, affective disorder, anxiety disorder, or personality disorder among adults (n = 115) referred to a psychiatric outpatient clinic. Results: Logistic regression revealed that neuromuscular dysregulation was significantly associated with ADHD diagnosis only (OR 1.15, p < .01), and not with affective-, anxiety-, or personality disorders. Sensitivity and specificity for ADHD at different MFNU scores is provided. Conclusions: A test of neuromuscular dysregulation may promote diagnostic accuracy in differentiating ADHD from other psychiatric disorders in patients with an overlapping symptom picture. This may have important implications for clinical practice. More studies are needed.

Boltzmann's Theorem Revisited: Inaccurate Time-to-Action Clocks in Affective Disorders.

Timely goal-oriented behavior is essential for survival and is shaped by experience. In this paper, a multileveled approach was employed, ranging from the polymorphic level through thermodynamic molecular, cellular, intracellular, extracellular, non-neuronal organelles and electrophysiological waves, attesting for signal variability. By adopting Boltzmann's theorem as a thermodynamic conceptualization of brain work, we found deviations from excitation-inhibition balance and wave decoupling, leading to wider signal variability in affective disorders compared to healthy individuals. Recent evidence shows that the overriding on-off design of clock genes paces the accuracy of the multilevel parallel sequencing clocks and that the accuracy of the time-to-action is more crucial for healthy behavioral reactions than their rapidity or delays. In affective disorders, the multilevel clocks run free and lack accuracy of responsivity to environmentally triggered time-to-action as the clock genes are not able to rescue mitochondria organelles from oxidative stress to produce environmentally-triggered energy that is required for the accurate time-to-action and maintenance of the thermodynamic equilibrium. This maintenance, in turn, is dependent on clock gene transcription of electron transporters, leading to higher signal variability and less signal accuracy in affective disorders. From a Boltzmannian thermodynamic and energy-production perspective, the option of reversibility to a healthier time-toaction, reducing entropy is implied. We employed logic gates to show deviations from healthy levelwise communication and the reversed conditions through compensations implying the role of nonneural cells and the extracellular matrix in return to excitation-inhibition balance and accuracy in the time-to-action signaling.

Early specialised treatment for bipolar disorder: Long-term follow-up from the early intervention in affective disorders (EIA) randomised controlled trial.

It is unclear whether treatment early after onset in bipolar disorder may improve the long-term illness course. The early intervention in affective disorders (EIA) randomised controlled trial found that 2-years treatment in a specialised mood disorder clinic combining evidence-based pharmacological treatment with group psychoeducation improved clinical outcomes compared with standard treatment in patients with bipolar disorder discharged after their 1st, 2nd, or 3rd hospital admission. We aimed to assess the 16 years long-term outcomes after randomisation of the participants in the EIA trial. Data were obtained by linking nation-wide Danish population-based registers. All 158 participants of the EIA trial (Trial Registration Number NCT00253071) were followed from time of randomisation (2005-2009) to end of study (31 December 2021). The primary outcome was risk of psychiatric readmission. Secondary outcomes were total admissions and costs, medication use, intentional self-harm or suicide attempt or suicide, and socio-economic measures. The absolute mean risk of psychiatric readmission was 49.3% in the intervention group and 59.8% in the control group, with no statistically significant difference between the groups (b = -0.10, 95% CI: -0.26 to 0.047, p = 0.18). Compared with the control group, patients in the intervention group had numerically fewer total admission days (mean (SD) 44 (77) versus 62 (109)), lower total cost of psychiatric hospital admissions and hospital-based outpatient visits (mean (SD) 22,001 (36793) euros versus 29,822 (52671) euros) and higher use of lithium and antipsychotics, but the differences were not statistically significant. Fewer patients in the intervention group had an event of intentional self-harm or suicide attempt or suicide during follow-up (OR 0.25, 95% CI: 0.15-0.40, p < 0.001) compared with the control group and more patients in the intervention group used antiepileptics (OR 2.21, 95% CI: 1.08-4.60, p = 0.031). Analyses of very long-term outcomes of the EIA trial may potentially indicate a beneficial effect of the intervention at the long term but were likely underpowered to detect a more subtle effect and for most outcomes the differences between groups were not statistically significant.

A systematic review on investigating major depressive disorder and bipolar disorder using MRI and genetic data from 2018 to 2024

AbstractThe incidence of affective disorders, of which major depression disorder (MDD) and bipolar disorder (BD) are two main types, has increased rapidly in recent years. They significantly impact patients, their families, and society. However, while affective disorders have become a major issue worldwide, their pathogenesis remains unclear. In the last 6 years, research using magnetic resonance imaging (MRI) and genetic data has gained prominence in understanding their pathophysiology and etiology. This systematic review collected the studies of MDD and BD research published between January 1, 2018, and February 1, 2024, focusing on studies using MRI and genetic data and indexed in the Web of Science and PubMed database. It aims to investigate the similarities and differences in their imaging phenotypes and underlying molecular bases. After exclusions, a total of 80 articles were included in this review. Research on MDD and BD reveals the critical role of epigenetic modifications, such as DNA methylation, in brain structure and function changes. The genes and pathways implicated in MDD are directly associated with depressive symptoms. In contrast, those implicated in BD are associated with mood regulation and cognitive functions. In addition, functional imaging studies have revealed that abnormalities in MDD are frequently concentrated in regions involved in emotion regulation and stress response. In contrast, those in BD are frequently concentrated in the neural circuits related to reward processing and emotional stability. Further multimodal and multiscale studies are needed to advance the field of mood disorder research.

Cerebellar cognitive affective syndrome and vertebrobasilar ischemia. From cerebello-cerebral diaschisis to "dysmetria of thought"

Cerebellum, along with it' s role in coordinating motor functions, exercises a significant regulatory influence in fields of cognitive and affective functions. Therefore, studying the effect of cerebrovascular atherosclerotic pathology on mood and cognition should not be limited to stenotic dysfunctions of carotid arteries, but also extend its methodological framework to the consideration of the integrity of vertebrobasilar system (VBS), cerebellar perfusion and posterior cerebral circulation in general, as it has not been yet sufficiently addressed whether VBS insufficiency is associated with deterioration of patients' mental and emotional status and quality of life (QoL). Vertebrobasilar circulatory dysfunction has been pointed out, since decades, as a cause of progressive memory impairment and dementia, due to multiple infarcts in cerebral areas which are topographically critical for mental and emotional functions. Indicative of the pathophysiological and anatomic-functional association of VBS with these neuro-psychiatric domains are cerebellar cognitive-affective syndrome (CCAS) and crossed cerebello-cerebral diaschisis (CCCD). Mental and psychiatric components of CCAS, along with ataxic motor disability, constitute the conceptual hypothesis of "dysmetry of thought", while diagnostic significance of mental dysfunctions and psychopathological manifestations, in terms of symptoms preceding motor impairments that ascribe cerebellar malfunction in the epicenter of their pathophysiology, such as cerebellar ataxias, in which, early recognition of CCAS may facilitate therapeutic interventions aimed at improving QoL, reveal that cerebellar pathology, either of degenerative etiology or vascular substrate on the ground of vertebrobasilar insufficiency (VBI) or other surgical conditions of the posterior fossa, is associated with deterioration of patients' QoL which is related to significant impairments in their cognitive functions with (co)manifested emotional disorders. Studies in animal models also support these conclusions. Since VBI is responsible for a wide range of psychiatric and neurological symptoms, new findings concurred with current indications advocating that, without consideration of VBS disorders, it is impossible to clarify the connection of cerebral perfusion dysfunctions to neurocognitive deficits. The inclusion of cerebellar perfusion disorders in scientific research and clinical approaches to cognitive and affective disorders that may occur in patients with cerebrovascular lesions constitutes a paradigm of best clinical practices implementation and interdisciplinary convergence of neurosciences and vascular medicine.

Prevalence of mental disorders among family members of individuals on the autism spectrum: systematic review and meta-analysis.

Parenting a child on the autism spectrum presents particular challenges that can lead to increased stress, anxiety, and depression among family members. Therefore, we aimed to investigate the prevalence of mental disorders in first-degree relatives of individuals on the autism spectrum. This article adheres to the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) guidelines, including studies indexed in PubMed/Medline, Embase, PsycINFO, Biblioteca Virtual em Saúde (BVS), and SciELO. Nineteen articles met eligibility criteria for the systematic review. Using a random-effects model (N = 93,876), we found a pooled prevalence of affective disorders of 13% in mothers of people on the autism spectrum (95% CI 7-21%; I2 = 99%, p < 0.01). Additionally, another random-effects model pointed out that first-degree relatives of people on the autism spectrum (N = 93,263) were more likely to present affective disorders than relatives of people with neurotypical development (N = 152,455) (pooled OR: 2.17; 95% CI 1.81-2.61). Careful assessment for mental disorders in parents and siblings of individuals on the autism spectrum is crucial to ensure appropriate treatment for these family members. This approach can also contribute to optimizing care for the individuals on the autism spectrum.

Технологии виртуальной реальности в терапии постинсультных эмоциональных расстройств

AIM. To evaluate psychoemotional status and the influence of affective, motivational and asthenic disorders on the efficiency of rehabilitation using virtual reality technologies in patients in the acute period of ischemic stroke. MATERIAL AND METHODS. 160 patients diagnosed with ischemic stroke were examined. Depending on the volume of therapy, the patients were divided into two groups: the 1-st group – 80 patients who received therapy using virtual reality (VR) technologies in addition to basic therapy and standard methods of early rehabilitation; the 2-nd group – 80 patients who received only basic therapy and standard methods of early rehabilitation. Neuropsychological testing was performed on the 4-th day of hospitalisation using scales to assess cognitive function, apathy, aggression, asthenia, depression, and anxiety. From the 5-th day of hospitalisation, patients in the 1-st group underwent VR-therapy for 10 days with evaluation of the dynamics of the main psychoemotional parameters and their impact on the effectiveness of rehabilitation (Δ RE). RESULTS AND DICUSSION. All patients had subclinical depression, clinically expressed anxiety, moderate levels of physical, mental, general asthenia, apathy and physical aggression with prevalence of physical asthenia and the combination of depression/physical aggression in the 1-st group of patients. The greatest comorbidity was found with respect to depression, physical asthenia, anxiety and physical aggression scores. Significant improvement was demonstrated with respect to all indicators except the level of apathy and mental asthenia in both groups and general asthenia in the 2-nd group after therapy. A more significant regression was found with regard to anxiety, general aggression, mental and physical asthenia in the 1-st group of patients. The negative correlation of Δ RE with the level of apathy and the combination of apathy/depression indicated a negative impact of these disorders on the effectiveness of VR - rehabilitation. Positive correlations of Δ RE with the parameters of physical aggression and the combination of anxiety/physical aggression show the expediency of VR-therapy in the rehabilitation of patients with a high level of these emotional disorders. CONCLUSION. The positive effect of VR-intervention on the regression of anxiety, asthenic and aggressive post-stroke disorders determines the prospect of introducing this method into the program of early rehabilitation of patients with ischemic stroke. KEYWORDS: ischemic stroke, emotional disorders, virtual reality, rehabilitation

Late-Life Bipolar Disorder Subtypes According to Age Onset

Abstract: This article characterizes the clinical differences between bipolar disorder (BD) subtypes in 44 early-onset (EOBD), 32 late-onset (LOBD), and 30 very-late-onset (VLOBD) disorders. We considered vascular mania in five LOBD and 17 VLOBD, with an association with right-sided lesions for VLOBD. Other nonvascular-related brain injuries preceded the emergence of mania: traumatic brain injury (one LOBD, two VLOBD), epilepsy/brain tumor (one LOBD), multiple sclerosis (one LOBD), and HIV-encephalopathy/cerebral toxoplasmosis (two VLOBD). No secondary mania was identified in 21.4% of the VLOBD and 64% of the LOBDd, corresponding to presumptive idiopathic/primary BD. A transdiagnostic conversion within the affective disorder spectrum occurred in 50% of the VLOBD, 30.8% of the LOBD, and 20.5% of the EOBD across the lifespan. An interplay between genetics and age-specific processes may underlie the neurobiological underpinnings of late-life-onset idiopathic/primary BD.

Study of Migraine in Headache Patients and its Association with Anxiety, Depression, and Insomnia: A Hospital-based Study

Background: Migraine is a common disabling disease with a higher global prevalence among the adult population. Moreover, there is a frequent coexistence of affective disorders, especially depression, anxiety, and sleep disturbances. This association may cause aggravation of migraine symptoms resulting in the persistence of headache and poor quality of life. This study is designed to investigate the prevalence of migraine in patients with headache. The study has also assessed the prevalence of anxiety, depression, and insomnia and their association with migraine. Disability caused by migraine has also been explored in this study. Materials and Methods: This cross-sectional study included 250 patients of headache. Participants were screened for migraine using ID Migraine. Assessment was made using sociodemographic details, Migraine Disability Assessment Questionnaire, Patient health questionnaire-9, Generalized anxiety disorder-7, and Insomnia Severity Index. Results: Nearly 71.2% of patients had migraine and 28.8% had other types of headache. Depression, anxiety, and insomnia were reported in 33.15%, 37.64%, and 23.03% of participants with migraine, respectively. Patients with migraine had 48% and 85% more chances of developing depression and insomnia, respectively, and more than twice the chance of having anxiety. Moderate and severe disability was reported by 32% and 30.9% of participants, respectively. Depression, anxiety, and insomnia were predisposing risk factors for disability. Conclusion: The association of insomnia, anxiety, and depression is common with migraine and may cause disability in these patients. Hence, their timely assessment may reduce the risk of developing disability in migraine patients.

Acute Stress Affects the Relaxin/Insulin-Like Family Peptide Receptor 3 mRNA Expression in Brain of Pubertal Male Wistar Rats.

The current literature suggests that relaxin-3/relaxin/insulin-like family peptide receptor 3 (RLN-3/RXFP-3) system is involved in the pathophysiology of affective disorders because the results of anatomical and pharmacological studies have shown that the RLN-3 signaling pathway plays a role in modulating the stress response, anxiety, arousal, depression-like behavior, and neuroendocrine homeostasis. The risk of developing mental illnesses in adulthood is increased by exposure to stress in early periods of life. The available data indicate that puberty is especially characterized by the development of the neural system and emotionality and is a "stress-sensitive" period. The presented study assessed the short-term changes in the expression of RLN-3 and RXFP-3 mRNA in the stress-dependent brain regions in male pubertal Wistar rats that had been subjected to acute stress. Three stressors were applied from 42 to 44 postnatal days (first day: a single forced swim; second day: stress on an elevated platform that was repeated three times; third day: restraint stress three times). Anxiety (open field, elevated plus maze test) and anhedonic-like behavior (sucrose preference test) were estimated during these tests. The corticosterone (CORT) levels and blood morphology were estimated. We found that the RXFP-3 mRNA expression decreased in the brainstem, whereas it increased in the hypothalamus 72h after acute stress. These molecular changes were accompanied by the increased levels of CORT and anxiety-like behavior detected in the open field test that had been conducted earlier, that is, 24h after the stress procedure. These findings shed new light on the neurochemical changes that are involved in the compensatory response to adverse events in pubertal male rats and support other data that suggest a regulatory interplay between the RLN-3 pathway and the hypothalamus-pituitary-adrenal axis activity in the mechanisms of anxiety-like behavior.

Neuropsychological performance in women at risk of postpartum depression and postpartum psychosis.

While neuropsychological deficits are commonly observed in affective and psychotic disorders, this remains unexplored in these disorders when they occur during pregnancy and the postpartum period. A neuropsychological test battery was administered to women defined at risk of postpartum depression (PD, N = 53) because having either a current or past diagnosis of major depressive disorder, women at risk of postpartum psychosis (PP, N = 43) because of a diagnosis of bipolar disorder or schizoaffective disorder and/or a previous episode of PP and women not at risk (NR, N = 48) in the third trimester of pregnancy. Generalized and specific cognitive abilities were compared between groups. Women at risk of PP presented worse executive functions and processing speed compared to NR and worse performance compared to women at risk of PD across all cognitive domains. In addition, women at risk of PP who developed a psychiatric relapse in the first four weeks post-partum showed worse verbal learning and memory, visual memory, executive functions and processing speed in pregnancy compared to NR, whereas women at risk of PP who remained well presented neuropsychological performance that was intermediate between that of the women NR and those at risk of PP who developed symptoms. There were no differences in performance between women at risk of PD and the NR women, even if 31 women at risk of PD presented depressive symptoms at the time of cognitive assessment. Our findings in women at risk of PP align with neuropsychological findings in individuals with, or at risk of psychosis unrelated to pregnancy. In addition, initial evidence that women at risk of PP who develop a psychiatric relapse in the postpartum show a particularly poor neuropsychological performance in pregnancy suggests that this could be considered part of a phenotype for the disease and help guiding future preventive strategies in this clinical population. In women at risk of PD, the presence of depressive symptoms did not influence cognitive performance.

Use of ECT in patients with Organic Catatonia

BackgroundElectroconvulsive therapy (ECT) is considered to be a treatment of choice in patients with catatonia, who do not respond to lorazepam, irrespective of the underlying aetiology. Although, significant data is available for successful use of ECT in patients with catatonia secondary to affective and psychotic disorders, little information is available for use of ECT in organic catatonia. AimTo assess demographic and clinical profile of patients with organic catatonia receiving ECT. MethodologyUsing a retrospective study design, ECT register of the department was reviewed for the period of 2019 to 2023 to identify the patients with organic catatonia, who received ECT. The treatment records of these patients were reviewed to extract the demographic and clinical profile. ResultsDuring the study period, out of the 926 patients who received ECT, 12 (1.3%) patients diagnosed with organic catatonia received ECT. The mean age of study sample was 41.67 (SD- 20.68) years and mean number of ECTs given in a course of ECT were 8 (SD- 4.3). In majority of the patients, ECT was considered after the failure of lorazepam challenge test. Majority (75%) of the patients showed good response to ECT and only 16.67% of the patients experienced complications during the course of ECT. ConclusionECT is an effective and well-tolerated treatment for organic catatonia.

Treatment of unipolar affective disorders in pregnant women – benefits and risks

Treatment of unipolar affective disorders in pregnant women – benefits and risks

Hypothalamic-pituitary-adrenal axis functioning in offspring of parents with a major affective disorder: a meta-analytic review.

Because the offspring of parents with an affective disorder (OAD) are at high risk for developing mental disorders, and persons with an affective disorder (AD) show dysfunctional hypothalamic-pituitary-adrenal (HPA) axis activity, changes in HPA functioning in OAD might be an etiological risk factor that precedes the development of ADs. The primary aim of the meta-analysis was to quantitatively summarize the existing data on different indices of diurnal cortisol in the OAD. The secondary aim was to explore potential moderators of this relation. Following PRISMA guidelines, we included 26 studies (3052 offspring) on diurnal cortisol in our meta-analysis after an initial screening of 3408 articles. Intercept-only and meta-regression models were computed using the robust variance estimation method. Analyses examining mean cortisol levels at discrete timepoints, total cortisol output, and the cortisol rise in response to awakening (CAR) were conducted separately. The results demonstrated that the OAD had higher mean levels of cortisol at different timepoints throughout the day compared to controls (Hedge's g = 0.21). There was evidence of publication bias in studies examining CAR, such that effect sizes were positively biased. The present findings are consistent with a meta-analysis showing elevated cortisol in youth having an AD. Notable limitations across studies include the method of cortisol measurement and assessment of ADs. Altogether, these results highlight the fact that increased cortisol levels may act as a potential neuroendocrine antecedent and/or risk factor for the development of ADs among high risk youth.