Clinical Global Impression Scale Scores Research Articles

Investigation of optical coherence tomography angiography findings in patients with bipolar disorder

ObjectivesBipolar Disorder (BD) is an important psychiatric disease that progresses with attacks, can be chronic and causes serious mental problems. In this study, we aimed to identify the retinal vascular pathologies in BD patients by optical coherence tomography angiography (OCTA) imaging. MethodsRetinal vascular analysis from 35 BD patients and 30 healthy controls (HCs) were scanned using the OCTA machine. In addition, psychometric tests such as the Young Mania Rating Scale (YMRS) and Clinical Global Impression Scale (CGI-S) were applied to BD patients to assess the severity of the disease and determine the patient's level of functionality. ResultsAs a result of OCTA scans, there were significant differences between the groups as following; Deep retinal vessel density (VD) in the total, parafoveal and perifoveal area, Macular thickness in the inner parafoveal area, VD of retinal capillary plexuses in the inside disk and the Choroidal thickness (p < 0.05). Furthermore, according to the results of Pearson correlation analysis between OCTA scans and YMRS and CGI-S scores, it was determined that there was no significant relationship in any measurement (p > 0.05). ConclusionIn our study, it was determined that there were general differences in deep retinal vascular density and inner macular thickness in BD patients. These findings demonstrate that the deep and inner zone of the retina is affected in BD patients.

Efficacy of antipsychotics in delusional infestation.

Data remain scarce for the first-line antipsychotic choice in treating delusional infestation (DI). We evaluated the treatment responses associated with different antipsychotics in DI patients. We undertook a multicentre, retrospective observational study using anonymised electronic patient records from two hospitals in the United Kingdom from 1 January 2011 to 1 January 2023. Eligible participants were adults (≥18 years) diagnosed with DI treated with an antipsychotic, and had both an assigned baseline and follow-up Clinical Global Impression Scale (CGI-S) score. The CGI-S is a validated psychiatric research tool. Participants were excluded if they had known limited or non-adherence to an antipsychotic, or if no CGI-S scores were present at follow-up. First clinic visits before the initiation of an antipsychotic were assigned as the baseline CGI-S score. The last available CGI-S score before the patient either changed antipsychotic or left the clinic for any reason was used to assign follow-up CGI-S scores. The primary outcome was the response to each individual antipsychotic treatment, measured by the difference in the baseline and last available follow-up CGI-S scores. Differences in CGI-S changes between antipsychotic episodes were tested by analysis of variance (ANOVA). In total, 414 patient records were analysed, and data were extracted. The mean age was 61.8 years (SD 14.1). One hundred seventy (41%) of 414 patients were men and 244 (59%) were women. In total, 156 (38%) of 414 patients were eligible, yielding a total of 315 antipsychotic prescribing episodes. The ANOVA, ranking in order of treatment response, showed that the highest mean score (expressing highest treatment response) was observed in amisulpride (31 [67%] of 46) and risperidone (95 [57%] of 167), followed by some distance by quetiapine (9 [36%] of 25), aripiprazole (13 [28%] of 46) and olanzapine (7 [25%] of 28). Amisulpride and risperidone were associated with a higher treatment response than quetiapine, aripiprazole and olanzapine. Amisulpride and risperidone should therefore be considered the first-line treatment options in DI patients.

Guanfacine for the Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents with Down Syndrome: A Retrospective Chart Review.

Study Design: Retrospective case series. Objectives: The objective of this study was to provide naturalistic data on the use of guanfacine for the treatment of attention-deficit/hyperactivity disorder (ADHD) in a clinically referred sample of youth with Down syndrome (DS). Methods: The medical records of children and adolescents with DS who received guanfacine for the treatment of ADHD from a multidisciplinary neurodevelopmental disorder clinic between September 1, 2011, and September 10, 2021, were reviewed. Demographic and clinical characteristics, guanfacine dose and treatment duration, and adverse effects were recorded. Clinical Global Impression Scale (CGI) scores for ADHD symptom severity (S) and improvement (I) were retrospectively assigned by a child and adolescent psychiatrist based on review of the clinic notes. Response to guanfacine was defined as completion of at least 12 weeks of treatment and a Clinical Global Impression Improvement subscale rating ≤2 (1 = "very much improved" or 2 = "much improved"). Results: Twenty-one patients were eligible for inclusion, of whom 17 (81%) completed at least 12 weeks of guanfacine. Ten of the 21 patients (48%; 95% confidence interval [CI]: 28%-68%) responded to treatment. The median time on guanfacine treatment covered by the clinic notes was 50.4 weeks, with a range of 0.3 weeks to 7.5 years. Thirteen patients (62%) remained on guanfacine at the time of their most recent clinic note. Nine patients had adverse events documented in their clinic notes (43%; 95% CI: 24%-63%), most commonly sleepiness (n = 7) and constipation (n = 2). Conclusion: About half of patients with DS responded to guanfacine for the treatment of ADHD and many tolerated long-term use. Study limitations primarily relate to the retrospective nature of the study and small sample size.

Inflammatory biotype of ADHD is linked to chronic stress: a data-driven analysis of the inflammatory proteome

The association between Attention Deficit Hyperactivity Disorder (ADHD) and low-grade inflammation has been explored in children but rarely in adults. Inflammation is characteristic of some, but not all, patients with ADHD and might be influenced by ADHD medication but also lifestyle factors including nutrition, smoking, and stress. It is also still unclear if any specific symptoms are related to inflammation. Therefore, we assessed 96 inflammatory proteins in a deeply phenotyped cohort of 126 adult ADHD participants with a stable medication status using OLINK technology. A data-based, unsupervised hierarchical clustering method could identify two distinct biotypes within the 126 ADHD participants based on their inflammatory profile: a higher inflammatory potential (HIP) and a lower inflammatory protein potential (LIP) group. Biological processes that differed strongest between groups were related to the NF-κB pathway, chemokine signaling, IL-17 signaling, metabolic alterations, and chemokine attraction. A comparison of sample characteristics revealed that the HIP group was more likely to have higher levels of chronic stress (p < 0.001), a higher clinical global impression scale score (p = 0.030), and a higher risk for suicide (p = 0.032). Medication status did not influence protein levels significantly (p ≥ 0.074), but psychotropic co-medication (p ≤ 0.009) did. In conclusion, our data suggest the presence of two distinct biotypes in adults with ADHD. Higher levels of inflammatory proteins in ADHD are linked to higher levels of chronic perceived stress in a linear fashion. Further research on inflammation in adults with ADHD should take stress levels into account.

Improvement of restless leg syndrome in maintenance hemodialysis patients with limb ischemic preconditioning: a single-center randomized controlled clinical trial

Objective This study evaluated the efficacy and safety of limb ischemic preconditioning (LIPC) in treating restless leg syndrome (RLS) in maintenance hemodialysis (MHD) patients. Methods A total number of 45 patients participated in the study. They were randomly divided into LIPC group and control group. The LIPC was performed by inflating the limb ischemic preconditioning training device in the patient’s thigh to 200 mmHg to create transient ischemia, whereas control group inflated the device to 20 mmHg. International Restless Legs Syndrome (IRLS), Clinical Global Impression Scale (CGI-S), and Medical Outputs Study Sleep Scale were employed to evaluate LIPC effectiveness. The primary endpoint was the ‘rate of clinical improvement in RLS severity’, defined as the percentage of patients who had an IRLS score decrease of ≥5 points in each group. Results After intervention, the rate of clinical improvement in RLS severity was 56.5% in the LIPC group and 13.6% in the control group (13 (56.5) vs 3 (13.6), p = 0.003). In addition, the LIPC group’s IRLS, CGI-S scores, the sleep disturbance and somnolence scores showed a significant downward trend compared to the control group (−5.5 ± 5.3 vs − 1.0 ± 3.8, p = 0.002; −1.7 ± 1.2 vs − 0.5 ± 1.4, p = 0.003; −15.5 ± 17.8 vs 3.7 ± 12.0, p < 0.001; −9.9 ± 18.8 vs − 2.4 ± 8.6, p = 0.003). During the study, there were no serious adverse event in any of the patients. Conclusions LIPC could be employed to effectively and safely alleviate the RLS symptoms in MHD patients.

Etomidate versus Propofol for Electroconvulsive Therapy in Patients with Major Depressive Disorders in Terms of Clinical Responses to Treatment: A Retrospective Analysis.

General anesthetic agents may be associated with the clinical efficacy of electroconvulsive therapy (ECT), as they may influence seizure quality and duration. Hence, a retrospective study was conducted to compare the clinical effects and seizure variables of etomidate and propofol during ECT. Patients treated with ECT under anesthesia with etomidate (n = 43) or propofol (n = 12) were retrospectively analyzed. Seizure variables (seizure duration, intensity, and threshold) and hemodynamic changes during ECT were assessed and recorded. Clinical responses to treatment were evaluated using the Clinical Global Impression scale and mood at discharge after the course of ECT. Adverse effects were also recorded. The demographic characteristics were similar between the two groups. There were no significant differences in the Clinical Global Impression scale scores, mood at discharge, and adverse effects between the two groups (p > 0.05); however, etomidate was associated with a significantly longer motor (42.0 vs. 23.65 s, p < 0.001) and electroencephalogram (51.8 vs. 33.5 s, p < 0.001) seizure duration than propofol. In conclusion, etomidate showed more favorable seizure profiles than propofol during ECT; however, both agents (etomidate and propofol) were associated with similar clinical efficacy profiles at discharge.

Ictal Electroencephalogram Visual Pattern Recognition of Seizure Adequacy During Electroconvulsive Therapy Treatment: A Step-by-Step Approach.

The NEURON (Neuropsychiatry and Neuromodulation Unit) electroconvulsive therapy electroencephalogram (ECT-EEG) Algorithmic Rating Scale (NEARS) is a step-by-step approach to ictal electroencephalogram visual pattern recognition of seizure adequacy based on recruitment, amplitude, symmetry, duration and degree of post-ictal suppression. The objectives of this clinical audit were to determine the degree of agreement on the NEARS operational criteria between two neuropsychiatrists, the reliability of electroconvulsive therapy practitioners' administration of NEARS during ECT procedures and the correlation of NEARS scores with Clinical Global Impression scale scores after each ECT treatment session. Systematic random sampling was conducted. Even numbers of ictal tracings were selected for analysis from the total samples collected over 8 consecutive days of ECT overseen by a total of eight different ECT practitioners. Cohen's kappa coefficient was used to measure the inter-rater reliability of the two neuropsychiatrists and determine the level of agreement between NEARS scores and those of the ECT practitioners. The correlation using NEARS scores and post-ECT Clinical Global Impression scores was measured with Spearman's test. The significance level was set at P < 0.05. Cohen's kappa showed perfect agreement between the two neuropsychiatrists, at κ = 1.00 (SE = 0.001; P < 0.001), and strong agreement between NEARS scores of overall seizure adequacy and the scores interpreted by the ECT practitioners, at κ = 0.83 (95% CI: 0.66, 0.99; P < 0.001). Spearman's test showed a weak negative association between NEARS scores and post-ECT Clinical Global Impression scores (r = -0.018; P = 0.900). NEARS may facilitate a brief, objectively reliable and practical assessment of ictal electroencephalogram quality. The scale is readily applicable by any trained ECT practitioner during an ongoing ECT procedure, especially when a prompt treatment decision is required.

Clinical and sociodemographic characteristics of patients hospitalized in a child and adolescent psychiatry inpatient unit

Objective: In this study, it was aimed to examine the clinical and sociodemographic characteristics of patients hospitalized in Ankara City Hospital Child and Adolescent Psychiatry Inpatient Unit during the pandemic period. Material and Methods: Medical records of children and adolescents who were hospitalized in Ankara City Hospital Child and Adolescent Psychiatry Inpatient Unit between March 2021 and March 2022 were retrospectively analyzed. Patients were evaluated in terms of sociodemographic characteristics, clinical diagnosis and treatment, duration of hospitalization, and Clinical Global Impression Scale (CGI) scores at admission and discharge. Results: In our study, the mean age of 132 cases (86 girls, 46 boys) was found 15.1±1.8 years. The main diagnoses of the subjects were 30.3% (n=40) major depressive disorder, 25% (n=33) psychotic disorder, 14.4% (n=19) eating disorders, and the remaining 30.3% (n=40) were other disorders. Comorbidity was found in 63.6% (n=84) of the cases. The presence of eating disorders, comorbidity and antidepressant use were found significantly higher in females. There was a significant differences in major depressive disorder (MDD), bipolar disorder (BD), psychotic disorder, eating disorder, conduct disorder, and post-traumatic stress disorder (PTSD) between admission and discharge CGI-Severity (CGI-S) scores. In addition, there was a significant difference between admission and discharge CGI side effects scores only for BD. Conclusion: In our study, major depressive disorder, psychotic disorder, and eating disorder were the most common diagnoses of cases hospitalized in inpatient unit. There was a comorbidity accompanying two out of every three cases. There are few child and adolescent psychiatry services in our country, and studies on this subject are scarce. It is thought that our study will contribute to the literature on child and adolescent psychiatry inpatient units.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as inflammation markers for early-onset schizophrenia.

The studies on the pathogenesis of schizophrenia reported data indicating that abnormal immune responses might play a role in the development of schizophrenia. One of the markers of systemic inflammation is the neutrophil-to-lymphocyte ratio (NLR). In our study, the relationship between the early-onset schizophrenia, NLR, platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) was investigated. The study included 30 patients and 57 healthy controls matched in age and gender. Hematological parameters and Clinical Global Impressions Scale (CGI) scores were obtained from the medical records of the patients. Hematological parameters in the patient group were compared to those in the healthy control groups. The relationship between inflammation markers and CGI scores was investigated in the patient group. NLR, and neutrophil and platelet counts were found to be higher in the patient group as compared to the control group. A positive correlation was found between NLR and CGI scores. The results of the study support the multisystem inflammatory process model related to schizophrenia, which was revealed in previous studies, also in children and adolescents in the patient group (Tab. 4, Ref. 36). Text in PDF www.elis.sk Keywords: neutrophil-to-lymphocyte ratio, inflammation, early‑onset schizophrenia.

Amisulpride augmentation therapy improves cognitive performance and psychopathology in clozapine-resistant treatment-refractory schizophrenia: a 12-week randomized, double-blind, placebo-controlled trial

BackgroundAlthough clozapine is an effective option for treatment-resistant schizophrenia (TRS), there are still 1/3 to 1/2 of TRS patients who do not respond to clozapine. The main purpose of this randomized, double-blind, placebo-controlled trial was to explore the amisulpride augmentation efficacy on the psychopathological symptoms and cognitive function of clozapine-resistant treatment-refractory schizophrenia (CTRS) patients.MethodsA total of 80 patients were recruited and randomly assigned to receive initial clozapine plus amisulpride (amisulpride group) or clozapine plus placebo (placebo group). Positive and Negative Syndrome Scale (PANSS), Scale for the Assessment of Negative Symptoms (SANS), Clinical Global Impression (CGI) scale scores, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Treatment Emergent Symptom Scale (TESS), laboratory measurements, and electrocardiograms (ECG) were performed at baseline, at week 6, and week 12.ResultsCompared with the placebo group, amisulpride group had a lower PANSS total score, positive subscore, and general psychopathology subscore at week 6 and week 12 (PBonferroni < 0.01). Furthermore, compared with the placebo group, the amisulpride group showed an improved RBANS language score at week 12 (PBonferroni < 0.001). Amisulpride group had a higher treatment response rate (P = 0.04), lower scores of CGI severity and CGI efficacy at week 6 and week 12 than placebo group (PBonferroni < 0.05). There were no differences between the groups in body mass index (BMI), corrected QT (QTc) intervals, and laboratory measurements. This study demonstrates that amisulpride augmentation therapy can safely improve the psychiatric symptoms and cognitive performance of CTRS patients.ConclusionThis study indicates that amisulpride augmentation therapy has important clinical significance for treating CTRS to improve clinical symptoms and cognitive function with tolerability and safety.Trial registration Clinicaltrials.gov identifier- NCT03652974. Registered August 31, 2018, https://clinicaltrials.gov/ct2/show/NCT03652974

Şizofreni hastalarında TSH, fT3 ve fT4 düzeylerinin nörobilişsel belirtiler üzerine etkisi

Purpose: The aim of this study is to examine the relationship between thyroid hormone levels and positive, negative, general, and cognitive symptoms in euthyroid patients with psychosis.&#x0D; Materials and Methods: Thirty-three schizophrenia patients were included in this cross-sectional study. Sociodemographic and clinical data of the participants, positive and negative symptoms assessment scale (PANSS), general assessment of functionality scale (GAF), and clinical global impression scale (CGI) scores were recorded. The relationships between TSH, fT3, and fT4 levels and cognitive performances of patients which is measured via a neurocognitive battery consisting of Trail Making Test (TMT) A, TMT B, verbal fluency test (VFT), digit span (DS), forward and backward, and Wisconsin Card Sorting Test (WCST) were investigated.&#x0D; Results: Significant correlations were found between fT3 levels and WCST performances. fT3 levels was significantly correlated with the number of categories achieved in WCST (r=.508; p=0.003). A significant correlation was found between fT4 levels and TMT B (r=-.376; p=0.031) and VFT (p=.355; p=0.043) performances. In the linear regression model, it was found that fT3 levels significantly predicted the number of categories achieved in WCST (UB=1.680; p=0.029). &#x0D; Conclusion: The results of our study suggested that fT3 has more significant effects, primarily on executive functions, compared to T4.

Metabolic disturbances during treatment with second generation antipsychotics

Second generation antipsychotics (SGA) cause side effects through weight gain, dyslipidemias (cholesterolemia, hypertriglyceridemia) as well as affected glucose homeostasis in terms of hyperglycemia,insulin resistance and the incidence of type 2 diabetes mellitus. The aim of this study was to investigate metabolic changes in patients treated with SGA. Materials and methods: This was a prospective study of 50 patients treated with SGA (olanzapine, clozapine, risperidone, quetiapine, aripiprazole) at the PHI University Clinic of Psychiatry who met the relevant ICD-10 criteria. The following parameters were monitored: history and clinical examination, blood pressure and pulse, height, weight, body mass index (BMI), Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression Scale (CGI-S), dose of prescribed SGA,as well as: fasting glycemia, lipid status, HDL, LDL, glycosylated hemoglobin (HgA1C). The parameters were determined at the beginning and after three months of treatment. Results: The subjects in terms of the criteria of metabolic syndrome were: 64% with a larger waist circumference, 53.2% with an increase in systolic and/or diastolic blood pressure, 31.3% with a BMI&gt;30, and 39% with an increase in glycaemia and reduced HDL values ​​at 23.4%. Also,18% of the respondents met three or more criteria. Statistical analysis of the differences in the analyzed parameters showed statistically significant differences for the CGI-S score (p = 0.00007) and for the diastolic pressure (p = 0.038). Correlation of equivalent doses of SGA with BMI (r = -0.637) was obtained. Discussion: The study confirmed presence of metabolic disorders in patients treated with SGA. Although there was no significant difference of metabolic syndrome parameters in relation to the general population, a correlation with BMI has been established. Conclusion: This study showed that patients treated with second-generation antipsychotics should be monitored during their treatment for the parameters of the metabolic syndrome, particularly BMI.

Resource utilization in mental illness – evaluation of an instrument for measuring direct costs of treatment for patients with severe mental illness (SMI)

Purpose Serious mental illnesses (SMIs) exert a considerable financial burden on health-care systems. In this study, the resource utilization in mental illness (RUMI) tool was developed and employed to evaluate resource utilization in patients with SMI. Materials and methods Data from 107 patients with SMI treated in four psychiatric outpatient clinics in Sweden were collected. The relationships between costs for physical and psychiatric care, social services, and the justice system, to self-reported health and quality of life, educational level, Global Assessment of Functioning (GAF), the Clinical Global Impressions scale score (CGI), and body mass index (BMI) were studied. Results Sixteen out of 107 patients accounted for 74% of the total costs. The mean and median cost for 6 months included in the survey for social services, family and social welfare and healthcare, psychiatric and physical treatment interventions, mean 8349 EUR, median 2599 EUR per patient (currency value for 2021). Education and psychosocial function (GAF) were both negatively correlated with costs for the social services (education, r=–0.207, p < 0.014; GAF, r=–0.258, p < 0.001). CGI was correlated with costs for physical and psychiatric healthcare (r = 0.161, p < 0.027), social services support (r = 0.245, p = 0.002) and total cost (r = 0.198, p = 0.007). BMI correlated with costs for psychiatric and physical health settings interventions (r = 0.155, p < 0.019) and for somatic and psychiatric medicines (r = 0.154, p < 0.019). Conclusion The RUMI scale was acceptable and enabled estimation of resource utilization in a comparable manner across different care settings. Such comparable data have potential to provide a basis for budgeting and resource allocation.

Clinical efficacy of Shugan granule in the treatment of mixed anxiety-depressive disorder: A multicenter, randomized, double-blind, placebo-controlled trial

Ethnopharmacological relevanceShugan granule is derived from Xiaoyao powder, a traditional Chinese medicine that has been shown to be effective in treating emotional disorders. At present, there is no standard drug treatment for mixed anxiety-depressive disorder (MADD), and no evidence-based clinical trial has been performed for any drug, meaning MADD patients are unable to obtain standardized treatment. Aim of the studyThe purpose of this clinical trial was to test the clinical efficacy and safety of Shugan granules in the treatment of MADD, and to provide clinical trial-based support along with drug recommendations for the treatment of MADD. Materials and methodsA multicenter, randomized, double-blind, placebo-controlled study was conducted on 400 patients with MADD recruited from January 1, 2019 to December 31, 2020, and they were randomly divided into test and placebo groups with a 1:1 ratio. Subjects in the test group (n = 200) received oral administration of Shugan granules, while subjects in the placebo group (n = 200) received oral administration of a Shugan granule simulator. The treatment lasted for 8 weeks. The Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale-17 (HAMD-17), Clinical Global Impression Scale (CGIS), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) were used to evaluate efficacy. In addition, the traditional Chinese medicine (TCM) syndrome scale for MADD was developed to observe improvements of related symptoms in patients after treatment based on the disease guidelines of TCM and the clinical manifestations of depression. Furthermore, the safety of Shugan granules was evaluated during and after treatment. ResultsAfter 8 weeks of treatment, the total scores for HAMA, HAMD, SAS, and SDS in the test group were significantly lower than those in the placebo group (P < 0.01). The proportion of patients with efficacy index (EI) > 1 for the CGIS score in the test group was significantly higher than that in the placebo group (P < 0.01). The efficacy of treatment in the test group based on the TCM syndrome scale was 70.16% and 88.27% after 4 weeks and 8 weeks, respectively, which was significantly higher than that in the placebo group (44.27% and 66.67% after 4 weeks and 8 weeks, respectively; P < 0.01). The disappearance rate of single symptoms in the test group was 20–30% higher than that in the placebo group, with a significant difference between groups (P < 0.05). During the treatment period, the incidence of adverse reactions was 2.05% in the test group and 2.06% in the placebo group, with no significant differences noted (P = 1.0000). ConclusionShugan granule was more effective than placebo in the treatment of MADD. Moreover, there was no significant difference between the two groups in terms of safety. This paper provides a clinical therapeutic regime using Shugan granule for the treatment of MADD.

Safety and efficacy of aviandr in patients with generalized anxiety disorder: A multicenter, randomized, double-blind, placebo-controlled, dose-finding, pilot study

Generalized anxiety disorder (GAD) is associated with an imbalance in the functioning of the stimulating neurotransmitter systems in human's brain. We studied the safety and therapeutic efficacy of aviandr, the new noradrenergic and specific serotonergic antidepressant, for GAD patients in the phase II, double-blind, placebo-controlled, randomized, multicenter, pilot trial at 17 clinical sites of the Russian Federation. 129 eligible patients were 18 years and older and met the criteria for GAD diagnosis. The patients were randomly assigned (1:1:1) to receive oral aviandr at daily dose of 40 mg (cohort 1, n = 41) or 60 mg (cohort 2, n = 43) or placebo (cohort 3, n = 43) for 8 weeks. The patients were assessed by the Hamilton anxiety scale (HAM-A), Hamilton Depression Scale (HAM-D), Clinical Global Impression Scale (CGI-S), Visual Analogue Scale and vital signs. At week 8, the decreases of the HAM-A score were achieved in 53∙7%, 47∙7% and 16∙3% in cohorts 1, 2 and 3, respectively. Changes of HAM-A, HAM-D, CGI-S, and CGI-I scores in aviandr-treated patients were superior to placebo (p < 0∙001). The psychic components of anxiety decreased on the first day, throughout the 8 weeks of treatment and on a follow-up week after aviandr discontinuation. Aviandr (40 mg daily dose) reduced drowsiness compared to baseline, was safe, well-tolerated and did not cause serious or severe adverse events or signs of withdrawal syndrome within one week after treatment completion. Aviandr at both 40 and 60 mg daily doses demonstrated therapeutic efficacy in GAD patients over placebo.

Clinical efficacy and safety of intravenous ferric carboxymaltose treatment of pediatric restless legs syndrome and periodic limb movement disorder

BackgroundIron supplementation is the most commonly considered treatment option for children with restless legs syndrome (RLS) or periodic limb movement disorder (PLMD); however, there is a scarcity of evidence on the effectiveness of intravenous preparations. In this study, we evaluated the effectiveness and tolerability of intravenous ferric carboxymaltose (IV FCM) on clinical symptoms and iron indices in children with RLS or PLMD. MethodsThis was a single-center retrospective data analysis. Children with a diagnosis of RLS or PLMD, who underwent a single infusion of IV FCM, were included. Clinical Global Impression (CGI) Scale scores, serum ferritin, and serum iron profile at baseline and after eight weeks post infusion were obtained. Adverse effects were assessed. ResultsThirty-nine children received IV FCM, 29 with RLS and 10 with PLMD. Pre-infusion CGI-Severity revealed moderate illness, with post-infusion CGI-Improvement between “very much improved” and “much improved”. Ferritin increased from 14.6 μg/L±7.01 to 112.4 μg/L±65.86 (p < 0.00001), together with improvements in iron, total iron binding capacity, and transferrin levels from baseline to post-treatment. When compared to children with RLS, those with PLMD had a similar improvement in clinical symptoms and laboratory parameters. Seven subjects (14.3%) experienced one or two adverse events; all were mild. ConclusionsChildren with RLS and PLMD responded to IV iron supplementation with improvement in both clinical severity and laboratory parameters. Treatment was well tolerated. Although larger, randomized-controlled trials are needed, IV FCM appears to be a promising alternative to oral iron supplementation for the treatment of pediatric RLS or PLMD.

Compliance process and disease symptoms of children and adolescent with chronic medical disease in the pandemi days

Amaç: Bu çalışmada kronik tıbbi hastalığı olan psikiyatrik takipteki çocuk ve gençlerin pandemi ile ilgili uyum süreci ve psikiyatrik belirtilerindeki değişikliklerin Teletıp uygulaması ile değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmaya, Konsültasyon Liyezon Polikliniği’nde takipli, 0-18 yaş arasındaki olgular dahil edilmiştir. Olgular randevularının oldukları gün ve saatlerde, Teletıp yolu ile aranarak ebeveyn ve kendileri ile psikiyatrik görüşme yapılıp son durumları değerlendirilmiştir. Pandemi ile ilgili uyum sürecini araştırmak amacıyla araştırmacılar tarafından hazırlanan anket soruları olgu ve ailelerine sorulmuş, cevapları olgu veri formuna kaydedilmiştir. Olguların pandemi öncesi Klinik Global İzlenim (KGİ) ölçeği puanları dosyalarındaki bilgilere göre, pandemi dönemindeki KGİ puanları da telefonla yapılan görüşme sonucuna göre kaydedilmiştir. Bulgular: Çalışmamıza katılan olguların %49’u (n=25) kız, %51’i (n=26) ise erkektir. En sık görülen kronik tıbbi hastalıklar nörolojik (%21,6, n=11) ve metabolik-genetik (%21,6, n=11) hastalıklar olarak tespit edilmiştir. Olgularımızda pandemi öncesi tespit edilen psikiyatrik tanılarda birinci sırada Dikkat Eksikliği/ Aşırı Hareketlilik Bozukluğu (%35,3), ikinci sırada Depresyon Bozuklukları (%17,6) ve Anlıksal Gelişimsel Bozukluk (Ağır Olmayan) (%17,6) gelmektedir. Olguların pandemi öncesi KGİ puanı 2,62±0,59, pandemi sürecindeki KGİ puanı 2,90±0,80 olarak değerlendirilmiştir. Aradaki fark istatistiksel olarak anlamlıdır (p=0,003). Evde sağlık çalışanı olup olmaması ve yakınlarında hastalıktan etkilenen birey olup olmaması ile KGİ puanı arasında anlamlı bir fark saptanmamıştır (p&amp;gt;0,05). Sonuç: Çalışmamız kronik tıbbi hastalığı olan ve psikiyatrik takipteki olgularda, pandemi sürecinde ruh sağlığının olumsuz etkilendiğini, sinirlilik ve kaygı gibi belirtilerde artma olduğunu ve immatür davranışlar, uyku düzeninde değişiklik gibi yeni ruhsal belirtilerin eklendiğini göstermesi bakımından önemlidir.

Hippocampal volume as treatment predictor in antidepressant naïve patients with major depressive disorder

Major depression disorder (MDD) limits psychosocial functioning and quality of life. One of the biological alterations is a hippocampal volume (HV) reduction. Previous prospective neuroimaging studies present inconsistencies regarding HV reductions and clinical features and response of antidepressant treatment of the participants. To clarify the relationship between antidepressant response and the HV reported, we prospectively evaluated antidepressant-naïve subjects diagnosed with MDD for the first time. We recruited twenty-one subjects and applied the Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS), Beck Depression Inventory (BDI), and the Clinical Global Impression (CGI) scale. The participants underwent brain Magnetic Resonance Imaging (MRI) scanning to measure the HV, and subsequently were treated naturalistically with first-line antidepressant medication for eight weeks. Thirteen subjects met the criteria for remission at eight weeks of treatment. The baseline right and left hippocampal volumes were larger in subjects who achieved remission (p = 0.012) and (p = 0.001), respectively. The main finding of this study is that the antidepressant naïve subjects who met the criteria for clinical remission according to the HAM-D, MADRS, and the CGI scale scores, had larger pretreatment hippocampal volumes. Our results assess the HV as a treatment outcome predictor.

Psychiatric, Motor, and Autonomic Effects of Bifrontal ECT in Depressed Parkinson's Disease Patients.

Depressive symptoms are a source of significant morbidity in Parkinson's disease (PD). Electroconvulsive therapy (ECT) is a promising treatment for depression in PD (dPD); however, data remain limited, including data on optimal electrode placement. In this retrospective study, the investigators aimed to characterize the effects of bifrontal ECT for dPD on psychiatric and motor symptoms, as well as autonomic response. Clinical data were retrieved from a university-affiliated ECT service in Vancouver, British Columbia, for patients with dPD receiving bifrontal ECT between 2014 and 2018. Clinical Global Impression (depressive symptoms) and Unified Parkinson's Disease Rating Scale (motor symptoms) scores and cardiovascular measurements during ECT, as well as doses of dopaminergic medications, were recorded. Eight patients met criteria for inclusion. Six patients (75%) met response criteria for improvement of depressive symptoms, including 83% of patients who completed a full ECT course. Five patients went on to receive maintenance ECT, with only one patient relapsing by the 1-year follow-up (20%). For patients with motor scales reported, 60% showed a clinically significant improvement in motor symptoms. Among patients who completed ECT, a reduction in the median dopaminergic medication dose was also observed (-350 mg). Two patients discontinued ECT as a result of tolerability concerns. Participants demonstrated a relatively typical pattern of autonomic response to ECT, with low incidence of bradycardic events. The results provide preliminary evidence of the benefit of bifrontal ECT in dPD for both depressive and motor symptoms. The autonomic data suggest that most patients with dPD respond in a typical physiological manner to ECT stimulus; however, further investigation is needed.

Covid-19 Pandemisi’nin 7-12 Yaş Arası Çocukların Uyum Sürecine ve Psikiyatrik Belirtilerine Etkisi: Bir Teletıp Çalışması

Objective: The aim of the presented study is to evaluate the adaptive process and psychiatric symptoms in the 7-12 age group followed-up with telemedicine interviews during the height of the pandemic. Method: Patients between the ages of 7-12 who were followed up in our outpatient clinic were called by telemedicine service at the appointment date. The questionnaire prepared by the researchers in order to investigate the adaptation process to the pandemic was administered, the answers provided by the patients and their families were recorded in the case data form together with Clinical Global Impression (CGI) Scale score appraised by the interviewing psychiatrist. Medical records pertaining to each patient were also reviewed, their psychiatric diagnoses, according to DSM 5 criteria and CGI scores recorded in their last face-to-face interviews during the pandemic period, were included in the case data form. Results: Fifty patients were included in the study. The mean age of the participants was 9.14±1.61 years. Attention deficit hyperactivity disorder (60%) was the most common psychiatric diagnosis detected in the participants before the pandemic, followed closely by anxiety and related disorders (20%) and specific learning difficulty (16%). The CGI scores of the cases before, and during the pandemic were 2.72±0.75, and 2.92±0.94, respectively. The difference between the mean scores was statistically significant (p=0.024). Conclusion: Our study emphasizes the importance of follow-up by telemental health practices in cases where face-to-face psychiatric interviews are not applicable, i.e., due to the risk of transmission of COVID-19 disease during the current pandemic