Clinical Global Impression Scale Research Articles

Radiofrequency thalamotomy for tremor produces focused and predictable lesions shown on magnetic resonance images.

Radiofrequency thalamotomy is a neurosurgical management option for medically-refractory tremor. In this observational study, we evaluate the MRI features of the resultant lesion, their temporal dynamics, and how they vary depending on surgical factors. We report on lesion characteristics including size and location, as well as how these vary over time and across different MRI sequences. Data from 12 patients (2 essential tremor, 10 Parkinson's disease) who underwent unilateral radiofrequency thalamotomy for tremor were analysed. Lesion characteristics were compared across five structural sequences. Volumetric analysis of lesion features was performed at early (<5 weeks) and late (>5 months) timepoints by manual segmentation. Lesion location was determined after registration of lesions to standard space. All patients showed tremor improvement (clinical global impressions scale) postoperatively. Chronic side-effects included balance disturbances (n = 4) and worsening mobility due to parkinsonism progression (n = 1). Early lesion features including a necrotic core, cytotoxic oedema and perilesional oedema were best demarcated on T2-weighted sequences. Multiple lesions were associated with greater cytotoxic oedema compared with single lesions (T2-weighted mean volume: 537 ± 112 mm³ versus 302 ± 146 mm³, P = 0.028). Total lesion volume reduced on average by 90% between the early and late scans (T2-weighted mean volume: 918 ± 517 versus 75 ± 50 mm³, t = 3.592, P = 0.023, n = 5), with comparable volumes demonstrated at ∼6 months after surgery. Lesion volumes on susceptibility-weighted images were larger than those of T2-weighted images at later timepoints. Radiofrequency thalamotomy produces focused and predictable lesion imaging characteristics over time. T2-weighted scans distinguish between the early lesion core and oedema characteristics, while lesions may remain more visible on susceptibility-weighted images in the months following surgery. Scanning patients in the immediate postoperative period and then at 6 months is clinically meaningful for understanding the anatomical basis of the transient and permanent effects of thalamotomy.

Symptom Management for Distal Sensory Peripheral Neuropathy in T2DM: A Preliminary RCT using Moxibustion

Distal sensory peripheral neuropathy (DSP) is a chronic, painful condition in the lower limbs of many individuals with Type 2 Diabetes (T2DM). DSP is the most prevalent complication of T2DM. Moxibustion, a traditional Chinese medicine therapy, offers a non-invasive and promising treatment for DSP pain. This study examined Traditional and Smokeless Moxibustion in a prospective, randomized, placebo-and waitlist-controlled, subject-and evaluator-blinded, parallel-group clinical trial. Participants received twice weekly moxibustion treatments for three weeks and were followed for two months. Participants in this preliminary study completed symptom diaries, Gracely Pain Scale (GPS), Subjective Peripheral Neuropathy Scale (SPNS), and Clinical Global Impression Scale (CGIS) patient-rated outcomes. In both Traditional and Smokeless Moxibustion groups, not control groups, GPS symptom severity decreased from baseline to end of treatment, and the benefit was sustained for two months post-treatment, p&lt; 0.001. In treated groups, all three SPNS characteristics (pain, pins/needles, numbness) decreased by &gt;3 severity levels at the end of treatment and were unchanged from baseline in control groups, p &lt;0.001. Traditional and Smokeless Moxibustion show promise as a non-invasive and non-pharmacologic therapy in DSP symptoms associated with T2DM. Standards for Reporting Interventions in Controlled Trials of Acupuncture-Moxibustion (STRICTA-M) guided the development and design of this study.

Development and validation of Ayurveda based assessment scale for anxiety

BackgroundAnxiety scale based on Ayurveda would help Ayurveda physicians to measure and initiate appropriate treatment strategies. ObjectivesThe objective of the study was to develop a clinical assessment scale for anxiety based on Ayurveda science. Materials and methodsAyurveda assessment scale for anxiety (AAA) was developed and subjected to various psychometric evaluations. Patients of generalized anxiety disorder with social phobia (GAD with SP) (n = 31) meeting DSM-IV-TR criteria and age, sex-matched healthy subjects (n = 31) were enrolled from NIMHANS Psychiatry OPD. Two independent Ayurveda experts evaluated both patients and healthy subjects using AAA, Hamilton Anxiety Rating Scale (HARS), and Beck Anxiety Inventory (BAI). Reliability and validity assessments were carried out. The sensitivity to treatment-induced change was evaluated in a randomized controlled clinical trial. 72 patients of GAD with SP meeting DSM-IV-TR criteria, aged between 20 and 55 years, and either sex participated in the study. The duration of intervention was 30 days. The assessments were done through HARS, BAI, Beck Depression Inventory (BDI), AAA and Clinical Global Impression scales (Severity, Improvement, and Efficacy). ResultsThe Interrater reliability was between - good to very good score. Validity of AAA with HARS and BAI was significant (p < 0.001). Scales recorded significant differences when compared between patients and healthy subjects (p < 0.001). AAA also recorded the sensitivity to treatment-induced changes in a randomized controlled study and noted a large effect size (>0.60). ConclusionsThe psychometric properties such as interrater reliability, validity (criteria, convergent, divergent, face) and sensitivity to change of AAA were promising.

Group interpersonal psychotherapy (IPT-G) for borderline personality disorder: A randomized controlled study

Recent evidence supported the notion that add-on group therapy should be provided to individuals with borderline personality disorder (BPD) who already undergo individual psychotherapy. The present 20 week-study was aimed to evaluate the efficacy of the adjunction of group interpersonal psychotherapy (IPT-G) to individual interpersonal psychotherapy adapted for BPD - revised (IPT-BPD-R) in comparison with individual IPT-BPD-R alone in a group of BPD patients. In addition, demographical and clinical characteristics that can be considered predictors of response to add-on group therapy were investigated. Forty-six patients were randomly assigned to 1) IPT-BPD-R plus IPT-G or to 2) IPT-BPD-R in the waiting list for IPT-G. Patients were assessed at baseline and after 20 weeks with: the Clinical Global Impression Scale, Severity item (CGI-S); the Social Occupational Functioning Assessment Scale (SOFAS); the Satisfaction Profile (SAT-P); the Borderline Personality Disorder Severity Index (BPDSI); the Modified Overt Aggression Scale (MOAS); the Childhood Trauma Questionnaire - Short Form (CTQ-SF); the Inventory of Interpersonal Problems (IIP-32); and the Reading the Mind in the Eyes Test (RMET). Statistical analyses included: ANOVA for repeated measures to compare score changes of the rating scales within groups (trial duration) and between groups (treatment modalities), and multiple regression analysis to identify which clinical factors are significantly and independently related to the difference of BPDSI score between baseline and week 20 (Δ BPDSI). The significance level was P ≤ 0.05. Both significant within-subjects effects (duration) and between-subjects effects (treatment modalities) were found for the following rating scales: MOAS; BPDSI items “feelings of emptiness”, “outbursts of anger,” and “affective instability”; RMET; SAT-P items “work” and “sleep, food, free time”; and IIP-32 scale “domineering/controlling”. At the multiple regression analysis BPDSI item “impulsivity”, RMET, and the subscale “socially inhibited” of the IIP-32 were significantly and independently related to Δ BPDSI score. In conclusion, the add-on of IPT-G produced higher improvement in core BPD symptoms, social cognition, a dysfunctional interpersonal style, and subjective quality of life. Subjects who were less impulsive, less socially inhibited, and with higher abilities in social cognition obtained greater benefits from the adjunction of group therapy. Clinical trials registration numberACTRN12623000002684, Australian New Zealand Clinical Trials Registry (ANZCTR).

Сariprazine in the treatment of schizophrenia spectrum disorders in a hospital setting

The aim of the study was to evaluate the possibility of using cariprazine for the treatment of productive and negative symptoms in schizophrenic spectrum disorders in a hospital setting.Materials and methods: A group of 35 patients with leading productive and negative symptoms in patients with schizophrenic spectrum disorders treated in a psychiatric hospital constituted the material of the study. The condition of patients was objectified according to the Clinical Global Impression Scale (CGI-S and CGI-I) and the Positive and Negative Syndrome Scale (PANSS) — at the beginning of the study and in dynamics on the 30th and 60th day of treatment. The mean PANSS score at the beginning of the study was 94.45±14.49 points. After the drug administration, the patients were followed up for up to 60 days.Results: Cariprazine was administered both as first-line treatment and after prior therapy. The dose range was from 1.5 mg to 6 mg daily. In 3 patients (8.57%), cariprazine therapy was discontinued due to the development of adverse events or worsening of the condition. The remaining 32 patients (91.43%) showed positive dynamics.Conclusions: The study showed high efficacy of cariprazine when administered for the treatment of productive and negative symptoms in schizophrenic spectrum disorders in a hospital setting. The drug was well tolerated in the majority of patients.

Sertraline versus escitalopram in South Asians with moderate to severe major depressive disorder: (SOUTH-DEP) a double-blind, parallel, randomized controlled trial.

The study design included the double-blind, parallel, randomized controlled trial. The aim of this randomized controlled trial was to compare the efficacy and safety of sertraline and escitalopram in participants with moderate to severe major depressive disorder (MDD). The study was conducted in South Asian participants. A total of 744 participants with moderate to severe MDD were randomly assigned to receive either sertraline or escitalopram for 8 weeks. Drug dosages and titration schedules were based on the recommendations of the prescribing information for each product and according to the judgment of the clinicians involved in the study. The primary outcome measures were changes from baseline on the Montgomery-Åsberg Depression Rating Scale (MADRS) and the clinical global impression (CGI) scale as well as the frequency of adverse events in both groups. Baseline MADRS scores in the escitalopram and sertraline groups were 28.2±0.47 (mean±SD) and 29.70±0.46 (mean±SD) respectively, and was no variability in the baseline assessments. Changes in MADRS as well as CGI scales at the end of the study were significant only for the sertraline group whereas they remained statistically nonsignificant for the escitalopram group. Results: The results of the study showed that sertraline was more efficacious than escitalopram in reducing depression rating scales such as MADRS and CGI, and that participants subjectively felt better regarding their symptoms in the sertraline group. Sertraline displays enhanced safety or tolerability than other groups of antidepressants, which frequently cause high levels of drowsiness, dizziness, blurred vision, and other undesirable effects. Adverse events were seen in both groups, but delayed ejaculation was the most frequent adverse event seen in both groups. However, a greater number of participants reported having nausea and insomnia in the sertraline group compared to the escitalopram group. Our study clearly highlights that there is a statistically significant difference in efficacy between sertraline and escitalopram at the doses used in our study. Sertraline was able to significantly lower the depression rating scales like MADRS and CGI in participants with moderate to severe MDD. Participants subjectively felt better regarding their symptoms in the sertraline group. The most frequent adverse event in both groups was delayed ejaculation. From an efficacy standpoint, sertraline was more efficacious than escitalopram. The study indicates that the prevalence of depressive disorders in South Asia is comparable to the global estimate, and Bangladesh and India has higher proportions of people with depressive disorders in South Asia. Additionally, females and older adults (75-79 years) have the highest burden of depressive disorders across all countries in the region. This study's limitation included the absence of a placebo arm. An additional limitation of the current study was the lack of an evaluation of inter-rater reliability and the research sample could not have been uniform in terms of the kind of depressive disorders and bipolarity.

Neutrophil/high-density lipoprotein cholesterol (HDL), monocyte/HDL and platelet/HDL ratios are increased in acute mania as markers of inflammation, even after controlling for confounding factors

Objective Recent studies show that inflammation is related to the pathogenesis of acute mania of bipolar disorder. Neutrophil/high-density lipoprotein (HDL) ratio (NHR), lymphocyte/HDL ratio (LHR), monocyte/HDL ratio (MHR) and platelet/HDL ratio (PHR) have recently been investigated as novel markers of inflammation. In addition, the atherogenic index of plasma (AIP) and atherogenic coefficient (AC) are the leading atherogenic indices. The study aimed to investigate these inflammation and atherogenic index markers in acute mania of bipolar disorder. Another aim was to determine whether there is a relationship between these markers and disease severity and psychotic symptoms. Methods A total of 109 BD-M and 101 (HC) were enrolled in the study. The differences in NHR, LHR, MHR, PHR, AIP and AC and their association with illness severity and psychotic symptoms were analyzed after adjusting for age, sex, total cholesterol level, body-mass index and smoking status. Then, a receiver operating characteristic (ROC) curve and linear discriminant analysis (LDA) were used to analyze these parameters’ diagnostic potential. Moreover, the Young Mania Rating Scale (YMRS) and Clinical Global Impression Scale for use in bipolar illness-Severity subscale (CGI-BP-S) were used to assess the severity of clinical symptoms. Results We found higher levels of NHR, MHR, PHR and AIP, but not LHR and AC, after adjusting confounding factors in patients with BD-M compared to HCs. In logistic regression analysis, higher levels of MHR and NHR were associated with BD-M. MHR, NHR and PHR were predictors for differentiating the BD-M group from the HC group. However, the severity of the illness or the psychotic feature of the manic episode did not significantly affect the parameters. In the ROC curve analysis of BD-M, the indicators with an area under the curve (AUC) higher than 0.6 were the MHR, NHR, PHR and LHR. Conclusions These results provide information about the role of inflammation in the pathophysiology of BD-M. Even after controlling for confounding factors, MHR, NHR, PHR and AIP are potential biomarkers for BD-M. Moreover, the increase in AIP may explain the co-morbidity between BD and cardiovascular diseases. However, the severity of the illness or the psychotic feature of the manic episode did not significantly affect the levels of inflammation ratios used in our study. Due to the low cost and widespread use of lipid metabolism and related inflammation rates, it may be beneficial to know the MHR, NHR, PHR and AIP levels in BD-M patients.

Plum-blossom needle therapy for Tourette syndrome: A case report

IntroductionTourette syndrome (TS) is a neurodevelopmental disorder characterized by the childhood onset of motor and phonic tics, frequently accompanied by behavioral and psychiatric comorbidities. Existing treatments for tics raise safety concerns. In China, acupuncture has been a widely utilized approach for TS, and one specific traditional acupuncture method, plum-blossom needle therapy (PBNT), has exhibited favorable tolerance among pediatric patients. In this report, we present a case of TS treated using PBNT. Case presentationAn 11-year-old boy diagnosed with Tourette syndrome for over five years presented with frequent loud throat clearing, eye blinking, severe abdominal tensing, shoulder shrugging, and upper limb twitching. Plum-blossom needle therapy (PBNT) was administered for 8 weeks, involving two sessions per week. The boy's tic symptoms gradually ameliorated, ultimately becoming minimal following the 8-week treatment period. Specifically, the Yale Global Tic Severity Scale (YGTSS) score decreased from 71 to 20, and the TS Clinical Global Impression Scale of Improvement (CGI-I) score reached 1, signifying 'very much improved' post-treatment. However, the Children and Adolescents' Quality of Life Scale (CAQOL) score exhibited minimal variation, moving from 146 to 150. ConclusionThis case suggests that plum-blossom needle therapy (PBNT) is well-tolerated by children and may be effective in alleviating tics associated with Tourette syndrome (TS). However, further research, particularly large-sample randomized controlled trials, is imperative to establish the efficacy and effectiveness of PBNT.

Improvements in Treatment Adherence after Family Psychoeducation in Patients Affected by Psychosis: Preliminary Findings.

(1) Background: Family psychoeducation is a well-recognized intervention which aims to improve the outcomes of illness in patients affected by psychosis. It has benefits in treatment adherence and leads to a reduction in relapses, higher levels of patient insight, and lower levels of stress within the family and among caregivers. (2) Methods: Eight patients and their families were recruited and randomly assigned to a Falloon-based family psychoeducation (FPP) intervention, and nine patients and their families were randomized to a Gestalt-based family intervention (GT). We compared the outcomes of these two treatment groups at a baseline assessment (T0), at the end of the programs (T1), and 6 and 12 months after the end of the programs (T2 and T3). The assessments included examinations of cognition (The Mini-Mental State Examination (MMSE) and The Five Point Test (5 Point)), the psychopathology and severity of illness (The Brief Psychiatric Rating Scale (BPRS), The Positive and Negative Syndrome Scale (PANSS), and The Clinical Global Impression Scale (CGI)), expressed emotion in families (Expressed Emotionality (Family Questionnaire-EE)), patient quality of life (The World Health Organization Quality of Life-BREF (WHOQOL-B)), social functioning (The Personal Social Performance (SPS)), aggression (Modified Overt Aggression Scale (MOAS)), and treatment adherence (The Brief Medication Adherence Report Scale (BMARS)). The primary aim was to test whether the FFP vs. GT program was more effective in improving treatment adherence over time. (3) Results: treatment adherence improved much more in the FFP group over time at any follow-up: +43.1% at T1, +24.0% at T2, and +41.6% at T3. Other characteristics, including psychopathology and the clinical stability of the subject, did not change over time. (4) Discussion: Family psychoeducation based on the Falloon program was effective at improving treatment adherence and contributed to avoiding relapses in the long term. Further studies on larger samples should be conducted to confirm this evidence, and similar psychoeducational programs should be routinely promoted in the clinical setting.

Paliperidone Palmitate in Morocco: A Practical Study

Schizophrenia can be effectively treated with the various antipsychotics on the market, but relapses, especially following poor compliance, can always recur and cause multiple complications. For this reason, long-acting antipsychotics have been developed. In Morocco, we only have paliperidone palmitate in its two monthly and quarterly forms. Objective: To describe the experience of Arrazi Hospital in Salé in the introduction of long-acting antipsychotics. Materials and methods: A retrospective descriptive and analytical study of 45 patients hospitalized and followed at Arrazi hospital in Salé, over a period between June 2020 and May 2023. The PANSS scale and the CGI clinical global impression scale were used. Results: The median age was 31 years, 88.9% were male, 86.7% had no occupation, 84.4% of participants had schizophrenia. 35.6% of patients had been hospitalized for between 5 and 10 years, and 35.6% for between 10 and 20 years. 84.4% of patients smoked, 80% used cannabis, and 15.56% had attempted suicide. The mean duration of treatment with paliperidone was 9.51 months ± 7.65. There was a statistically significant difference (p&lt;0.001) between PANSS scores at admission, at D30 and at last observation, and also a statistically significant difference between PANSS scores at admission, at D30 and at last observation. Conclusion: Today, several formulations of long-acting antipsychotics are available, of which only paliperidone palmitate is available in Morocco. These treatments have proven their effectiveness in ensuring good therapeutic compliance.

A multicenter retrospective study of patients treated in the thalamus with responsive neurostimulation.

For drug resistant epilepsy patients who are either not candidates for resective surgery or have already failed resective surgery, neuromodulation is a promising option. Neuromodulatory approaches include responsive neurostimulation (RNS), deep brain stimulation (DBS), and vagal nerve stimulation (VNS). Thalamocortical circuits are involved in both generalized and focal onset seizures. This paper explores the use of RNS in the centromedian nucleus of the thalamus (CMN) and in the anterior thalamic nucleus (ANT) of patients with drug resistant epilepsy. This is a retrospective multicenter study from seven different epilepsy centers in the United States. Patients that had unilateral or bilateral thalamic RNS leads implanted in the CMN or ANT for at least 6 months were included. Primary objectives were to describe the implant location and determine changes in the frequency of disabling seizures at 6 months, 1 year, 2 years, and > 2 years. Secondary objectives included documenting seizure free periods, anti-seizure medication regimen changes, stimulation side effects, and serious adverse events. In addition, the global clinical impression scale was completed. Twelve patients had at least one lead placed in the CMN, and 13 had at least one lead placed in the ANT. The median baseline seizure frequency was 15 per month. Overall, the median seizure reduction was 33% at 6 months, 55% at 1 year, 65% at 2 years, and 74% at >2 years. Seizure free intervals of at least 3 months occurred in nine patients. Most patients (60%, 15/25) did not have a change in anti-seizure medications post RNS placement. Two serious adverse events were recorded, one related to RNS implantation. Lastly, overall functioning seemed to improve with 88% showing improvement on the global clinical impression scale. Meaningful seizure reduction was observed in patients who suffer from drug resistant epilepsy with unilateral or bilateral RNS in either the ANT or CMN of the thalamus. Most patients remained on their pre-operative anti-seizure medication regimen. The device was well tolerated with few side effects. There were rare serious adverse events. Most patients showed an improvement in global clinical impression scores.

Clozapine for the treatment of aggressiveness and agitation in advanced dementia.

Distressing behavioural symptoms, particularly agitation and aggressiveness, remain a difficult problem in everyday clinical practice in the treatment of multimorbid patients with dementia. Clozapine may be an effective therapeutic alternative in this context. In a retrospective study, patients who had a diagnosis of dementia and had been treated in a specialized geriatric psychiatry unit with clozapine between August 2018 and February 2022 were included, and medical records were systematically reviewed. The Clinical Global Impressions Scale was used to assess improvement, and the Pittsburgh Agitation Scale for symptom reduction. In addition, side effects and clinical features were documented in detail. A total of 31 patients (median age 82 years) were identified with a mean clozapine dose of 47.2 (SD 35.6) mg. A total of 13 patients tolerated clozapine very well, 10 showed tolerable side effects, and in 10 patients side effects were the reason for stopping clozapine. Behavioural symptoms improved significantly, as indicated by the assessment scores. In summary, clozapine was effective and well tolerated in 23 patients, suggesting that low-dose clozapine may help to alleviate the suffering of difficult-to-treat multimorbid patients with advanced dementia and their caregivers. However, particular attention should be paid to adverse drug reactions, especially in patients with cardiovascular and pulmonary impairment.

The Validity and Applicability of the Revised Delirium Rating Scale (DRS-R98) for Delirium Severity Assessment in a Critical Care Setting.

Delirium is a neuropsychiatric syndrome common in critical illness. Worsening delirium severity is associated with poorer clinical outcomes, yet its assessment remains under-reported with most severity assessment tools not validated for critical care. The DRS-R98 is a widely applied and validated tool. The aim of this project is to report the validation and utility of the DRS-R98 in critical illness. This prospective, cohort study was conducted in adults with delirium admitted to a critical care unit and predicted to stay for ≥ 24 h. We excluded patients with severe neurological or communication barriers that would have interfered with the DRS-R98 assessment. Patients were screened using a delirium detection algorithm and the Confusion Assessment Method for the Intensive Care Unit. Eligible patient informations were collected and reported to qualified assessor/s before visiting clinical areas, confirming delirium presence and undertaking DRS- R98 assessments. To assess the tool's construct validity, an intensivist completed the Clinical Global Impression-Scale (CGI-S). To calculate the inter-rater reliability (IRR) a subset of patients were simultaneously evaluated by two assessors. We assessed 22 patients, 73% were male, with a median age of 65 years (IQR14). The DRS -R98 mean (SD) severity score was 24 (+/-7.7), total scale was 29 (+/18.0), and CGI-S 3.5 (+/11.5). Assessment duration was 90 min (+/-55) and 15 min (+/-5) for record data extraction and clinical assessment respectively. The CGI-S significantly correlated with DRS-R98 severity (r = 0.626) and total (r = 0.628) scales. The DRS-R98 Cronbach's alpha was 0.896 for severity scale and 0.886 for total scale. The inter-rater reliability (IRR) was assessed in six patients and reported an inter-correlation coefficient of 0.505 (p = 0.124) and 0.565 (p = 0.93) for the severity and total scale respectively. In critical care, the Delirium Rating Scale R98 had good construct validity, excellent internal consistency, and moderate inter-rater reliability.

An adapted clinical global Impression of improvement for use in Angelman syndrome: Validation analyses utilizing data from the NEPTUNE study

PurposeAngelman Syndrome (AS) is a rare, severe neurogenetic disorder that causes symptoms such as intellectual disability and motor impairments and is typically diagnosed in early childhood. The complexity and heterogeneity of AS confound characterization of disease severity and pose unique challenges when determining an individual's response to treatment. There is therefore a substantial unmet need for rating scales specifically designed for complex conditions such as AS. To address this, the Clinical Global Impressions (CGI) scale, which has components for both symptom severity (CGI-S) and improvement (CGI-I) was specifically adapted to measure severity (CGI-S-AS) and improvement (CGI-I-AS) in AS. MethodsThe modified CGI-S/I-AS was used in the NEPTUNE trial of gaboxadol for the treatment of AS. Here we report on the validation of the CGI-I-AS using data from NEPTUNE and discuss insights for its potential use in future trials. ResultsImprovements in the CGI-I-AS rating tended to be consistent with changes on other relevant rating scales. Sleep-related symptoms were particularly well represented, while communication-related symptoms were not. ConclusionsOur validation analysis of the CGI-I-AS demonstrates its usefulness along with possible areas of improvement. The CGI-I-AS is a potential tool for use in other trials of AS drug candidates, and the process for its development can serve as a road map for the development of assessment tools for other neuropsychiatric disorders with similar complexities and heterogeneity.

Correlates of severity in a clinical staging model of schizophrenia: a cross-sectional study among 158 subjects

BackgroundClinical staging has been widely used to predict and optimize the treatment of medical disorders. Different models have been proposed to map the development, progression, and extension of psychiatric disorders over time, mainly for schizophrenia. The primary objective of this study was to classify patients with psychosis according to the McGorry staging model and compare factors between the different stages.MethodsThis was a cross-sectional study, collecting data from 158 patients hospitalized for schizophrenia/psychosis. The survey included the Mini International Neuropsychiatric Interview (MINI), Positive and Negative Symptom Scale (PANSS), Montgomery-Asberg Depression Rating Scale (MADRS), Yong Mania Rating Scale (YMRS), Clinical Global Impression (CGI) scale, and the McGorry staging model.ResultsPatients have been classified into three clinical stages: relapse of psychotic disorder (43%), multiple relapses (47.5%), and persistent and severe illness (9.5%). A higher mean duration of hospitalization, psychotic symptoms (PANSS total scale and subscales), chlorpromazine equivalent dose, and number of antipsychotic treatments were found among participants in Stage 4 as compared to the other groups. However, a significantly higher mean GAF scale was found among participants in stage 3b as compared to the other groups.ConclusionEach stage in the McGorry staging model of schizophrenia is associated with well-defined clinical presentations, which help decide the appropriate treatment. Using such models in psychiatry can improve the diagnostic process and potential therapeutic interventions for patients suffering from mental disorders.

Oxytocin Levels in Children with Separation Anxiety and Their Mothers before and after Treatment.

The purpose of this study was to compare the plasma oxytocin levels of children with separation anxiety disorder (SAD) and their mothers with those of healthy controls and to examine the relationship between oxytocin levels and changes in anxiety three months after treatment. Thirty children aged 6-12 years with SAD, 30 healthy children, and mothers of both groups were included in the study. All cases were evaluated with semi-structured interview and Clinical Global Impression Scale. All cases and mothers of both groups filled out scales to determine various psychological variables (anxiety, depression, and attachment). The patient group children were re-evaluated with their mothers after three months, following treatment. Plasma oxytocin levels were evaluated from both groups and their mothers before and after treatment. The plasma oxytocin levels of mothers of children with SAD were significantly lower than those of the controls and increased significantly three months after their children were treated. No difference was found between the plasma oxytocin levels of children with SAD and the control group, and these children's levels decreased significantly after treatment. A positive correlation was found between changes in the plasma oxytocin levels of children with SAD and the change in anxiety scores. Our results show that the change in plasma oxytocin levels in both children and mothers after treatment suggests that oxytocin may be important in the etiology of SAD.

The Relationship of Perceived Social Support with Level of Insight and Treatment Adherence in Individuals Diagnosed with Schizophrenia and Bipolar Disorder

Purpose: This study aims to examine the relationship between perceived social support, insight, and treatment adherence in patients with schizophrenia and bipolar disorder. &#x0D; Materials and Methods:This study was conducted with 110 individuals, 55 of whom were bipolar and 55 patients with schizophrenia, who received inpatient treatment in the last 1 year, were in remission. Sociodemographic and clinical data form, Young Mania Rating Scale (YMDS), Clinical Global Impressions Scale (CGI), Schedule for Assessment of Insight (SAI), Morisky Medication Adherence Scale (MMAS), and Multidimensional Scale of Perceived Social Support (MSPSS) were administered to the participants. &#x0D; Results: The mean age was 40.47±12.96 for bipolar patients and 40.45±11.71 for schizophrenics. Perceived family, friend, significant others support, and total support was found to be higher (p=0.000, p=0.000, p=0.004, p=0.000, respectively) in bipolar patients, and the highest support was perceived from family, followed by friends and significant people. Although the groups did not differ in terms of treatment adherence (p=0.083), the insight score was significantly higher in bipolar patients (p=0.001). Groups were evaluated with hierarchical regression analysis in terms of factors affecting perceived social support. Gender, years of education, insight, and treatment adherence were found to be predictive of social support (p=0.04, p=0.01, p

Experience with agomelatine therapy for non-psychotic depression with a single and recurrent course

Therapy of depression is a current problem in psychiatry. Agomelatine is not inferior to other modern drugs in terms of antidepressant efficacy (response and remission rates) and is characterized by the best tolerability.Objective: to evaluate the efficacy and safety of agomelatine in the treatment of nonpsychotic depression with a single and recurrent course.Material and methods. Patients (n=37) with a current depressive episode (DE; F32 according to ICD-10), mean age 41.2±2.07 years, were studied. Clinical psychopathological and psychometric methods were used in the study (Hamilton Hospital Depression Scale – HAMD-17; Spielberger–Khanin Anxiety Self-Assessment Scale, Sheehan Anxiety Scale, Clinical Global Impression Scale – CGI-I). A single DE was diagnosed in 62.2% of patients, and recurrent depressive disorder in 37.8%. Stress-related onset of current DE was found in 56.8% of cases, autochthonous in 43.2%.Results. 94.6% of patients were responders, including 68.6% who went into remission. A statistically significant decrease in scores on the HAMD-17 scale was noted in the remission group from the 7th day of agomelatine therapy (p&lt;0.05), in the responder group – from the 14th day of therapy (p&lt;0.05). According to the Sheehan scale, a statistically significant decrease in scores was noted at the end of the first week of therapy (p&lt;0.05), according to the Spielberger–Khanin scale – in the second week (p&lt;0.05) in all patients. According to the CGI-I scale, the condition at the end of therapy improved in 57.1% of patients, significantly in 42.9%. Clinical predictors of therapeutic response in patients with remission included significantly higher frequency of a single DE (p&lt;0.02), moderate severity of current depression (p&lt;0.02), dizziness among autonomic disorders (p&lt;0.01), a significantly lower representation of the melancholic type of depression (p&lt;0.05), a symptom of a gloomy and pessimistic vision of the future (p&lt;0.05), sleep disturbances (p&lt;0.04), a factor of personal significance in the form of a threat in patients with stress-provoked onset of the current DE (p&lt;0.05).Adverse events occurred in the first week of treatment with agomelatine in 14.3% of cases (nausea – 8.6%, headache and dizziness – 2.9% each), they were mild and did not require discontinuation of the drug. Two patients taking agomelatine at a dose of 50 mg discontinued the study: in one case persisted social phobia, increased fatigue, motor retardation, and persistent modern insomnia; in the other case – a pronounced senestoalgic syndrome with cerebral localization.Conclusion. Agomelatine therapy has been shown to be highly effective and well tolerated in nonpsychotic depression.

Investigating the factors associated with meaningful improvement on the SF-36-PFS and exploring the appropriateness of this measure for young people with ME/CFS accessing an NHS specialist service: a prospective cohort study

ObjectivesPaediatric myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is relatively common and disabling, but little is known about the factors associated with outcome. We aimed to describe the number and characteristics of...

Algorithms of diagnosis and therapy of a primary depressive episode

Depressive disorders are among the most widespread forms of mental pathology with significant medical and social consequences and require adequate and timely medical assistance. It is known that algorithms are effective methods of optimizing the provision of psychiatric care in order to prevent the development of therapy-resistant forms of mental pathology and reduce their treatment costs, which is particularly relevant in the case of a primary depressive episode (PDE). The aim of the work is to develop algorithms for rapid diagnosis and therapy of the PDE. Materials and methods. During 2018–2021, 131 patients (49 men and 82 women) with the PDE who sought outpatient psychiatric help were clinically examined. All subjects were tested to determine the level of depressive disorder, according to the unified clinical protocol of highly specialized medical care, according to the Hamilton Rating Scale for Depression, Hamilton Anxiety Rating Scale, and the Clinical Global Impressions Scale. The clinical-ethological description consisted of three stages: at the first stage, at a patients’ first visit, a general description within the framework of a clinical and psychopathological examinations; at the second stage, the clinical-ethological characteristics of non-verbal behavior were studied; at the last, third stage, non-verbal behavior was recoded into ethological elements according to A. A. Korobov’s glossary (1991). Statistical analysis was performed using the Statistica 10 license package of application programs. Results. An algorithm for the PDE diagnosis has been developed based upon four stages: the first one – the symptomatic state diagnosis; the second – clinical-ethological analysis of depressive phenomenon signs and a neurophysiological electroencephalographic (EEG) examination; the third – psycho-experimental examinations using appropriate tools; the fourth – structuring of the obtained diagnostic data, diagnosis verification and development of therapeutic intervention tactics. A therapeutic algorithm for the PDE treatment was also developed and proposed: at the first stage – use of existing antidepressants with proven clinical effectiveness; at the second – switching from a drug in case of its ineffectiveness within 3–4 weeks to another drug with a different mechanism of action; at the third – in case of the previous stage ineffectiveness, using a combination antidepressant therapy (combining drugs of different groups); at the fourth – application of therapeutic schemes using diuretics, pathogenetic psychotherapy and electroconvulsive therapy. Conclusions. The proposed diagnostic and treatment algorithms are reliable enough to detect and treat such a category as the primary depressive episode. The effectiveness of personalized comprehensive diagnostic and treatment methods for these conditions should be based on the principles of phasing, comprehensiveness, using integrated approaches, combining therapies aimed at developing an adequate attitude to a disease state, mitigating the intensity of negative emotions, restoring internal and external resources of patients.