Cognitive Depressive Symptoms Research Articles

Depressive disorder and gastrointestinal dysfunction after myocardial infarct are associated with abnormal tryptophan-5-hydroxytryptamine metabolism in rats.

In this study, we investigated the relationship between tryptophan-5-hydroxytryptamine metabolism, depressive disorder, and gastrointestinal dysfunction in rats after myocardial infarction. Our goal was to elucidate the physiopathologic bases of somatic/psychiatric depression symptoms after myocardial infarction. A myocardial infarction model was established by permanent occlusion of the left anterior descending coronary artery. Depression-like behavior was evaluated using the sucrose preference test, open field test, and forced swim test. Gastric retention and intestinal transit were detected using the carbon powder labeling method. Immunohistochemical staining was used to detect indoleamine 2,3-dioxygenase expression in the hippocampus and ileum. High-performance liquid chromatography with fluorescence and ultraviolet detection determined the levels of 5-hydroxytryptamine, its precursor tryptophan, and its metabolite 5-hydroxyindoleacetic acid in the hippocampus, distal ileum, and peripheral blood. All data were analyzed using one-way analyses of variance. Three weeks after arterial occlusion, rats in the model group began to exhibit depression-like symptoms. For example, the rate of sucrose consumption was reduced, the total and central distance traveled in the open field test were reduced, and immobility time was increased, while swimming, struggling and latency to immobility were decreased in the forced swim test. Moreover, the gastric retention rate and gastrointestinal transit rate were increased in the model group. Expression of indoleamine 2,3-dioxygenase was increased in the hippocampus and ileum, whereas 5-hydroxytryptamine metabolism was decreased, resulting in lower 5-hydroxytryptamine and 5-hydroxyindoleacetic acid levels in the hippocampus and higher levels in the ileum. Depressive disorder and gastrointestinal dysfunction after myocardial infarction involve abnormal tryptophan-5-hydroxytryptamine metabolism, which may explain the somatic, cognitive, and psychiatric symptoms of depression commonly observed after myocardial infarction. Peripheral 5-hydroxytryptamine is an important substance in the gut-brain axis, and its abnormal metabolism is a critical finding after myocardial infarct.

Validation de la traduction française d’un questionnaire court de dépression de Beck (BDI-FS-Fr)

IntroductionDepression is a public health problem and constitutes the most frequently psychic manifestation observed among students. Its prevalence is much higher (30%) than in the other populations. Depression among students can have negative impacts on their social, relational situation and significantly impact their quality of life. Depression is misdiagnosed, misdetected and thus mistreated. In clinical practice at the University, the clinician finds difficulty in correctly diagnosing depression comorbidity including depression with a physical illness and/or somatic problems. It underestimates or overestimates depression (false negative diagnosis or false positive diagnosis). The difficulties of diagnosing depression and overlap with the physical symptoms of the disease are the challenges for the clinician to differentiate if certain symptoms are related to depression or physical illness. Thus, the difficulty in detecting and/or diagnosing depression can lead to false diagnoses of depression. So to avoid the false diagnosis of depression in the university context or in the disease, we must take into account the cognitions of depression. The BDI-FS, self-assessment scale to detect depression, considers these cognitions and therefore avoids the false diagnosis of depression in the presence of problems (such as a physical illness or somatic problems) and properly detects the depression. ObjectiveThis article presents the French validation of the Beck Depression Inventory-Fast Screen (BDI-FS Inventory) on a sample of students. MethodA cross-sectional study was conducted on 473 students of the University of Caen Normandy. ResultsThe Beck Depression Inventory-Fast Screen-France (BDI-FS-Fr) gets a good sensitivity, specificity and good positive and negative predictive value, a coefficient of Yule very strong and area under the curve satisfactory. He has a very good internal validity of structure: an exploratory factor analysis identified a factor that explains 40.21% of the total variance of the BDI-FS-Fr, and he has a satisfactory internal consistency (0.74). The BDI-FS-Fr has a very good external validity of structure (construct validity: convergent and divergent validity; P<0.001) and discriminate validity (P<0.001), and concurrent validity (P<0.001). The split-half reliability (odd-even) was 0.73 (P<0.001). The test-retest reliability was 0.82 (P<0.001). Regarding clinical practice in the University, clinicians can use a simple questionnaire include 7 items (Beck Depression Inventory-Fast Screen-French: BDI-FS-Fr) to assess depression avoiding false diagnosis of depression in the University. The BDI-FS-Fr only evaluates the non-somatic symptoms (cognitive) rather than physical symptoms (somatic), which may overlap with problems due to the university or physical illness and depression may overlap. The BDI-FS-Fr only includes items the BDI-II that are related to the direct psychological experience of depression. Thus, the key strength of the BDI-FS-Fr is that it prevents symptoms of physical illness (e.g., weight loss, difficulty concentrating) from confounding the psychodiagnostic picture. The BDI-FS-Fr also allows us to evaluate the two diagnoses DSM-IV-TR (the main symptoms of depression: sadness and anhedonia). It also allows us to observe and assess the risk of suicide in people (ex. students and patients) by observing the items 2 (pessimism) and 7 (thoughts or desires of suicide) that are considered suicidal risk indicators. The BDI-FS is a diagnostic tool that minimizes the risk of giving falsely high estimates of depression in subjects focusing on the cognitive symptoms of depression. For pre-cited reasons, the clinicians can use the BDI-FS-Fr among students to diagnose their depression and assess their risk for suicide without false negative or false positive diagnosis. ConclusionThe French version of the BDI-FS has very favourable psychometric properties. It is valid for self-assess depression, its intensity and its evolution, and it is a good complement to BDI for students. The BDI-FS-Fr thus has very good psychometric properties and is a useful tool for researchers and practitioners.

Abstract WP172: Increased Prevalence of Early Post Stroke Depression Among Single Women

Introduction: Post stroke depression (PSD) is a common, yet under recognized sequelae of stroke. Detection and management of early PSD can enhance participation in rehabilitation and improve motor recovery. Early studies identified women as being at higher risk of developing PSD. Identifying gender specific features of PSD would assist better recognition and management of this syndrome. Our hypothesis was that PSD would be more common among women and gender differences would exist in features of PSD. Methods: Adult subjects admitted with ischemic stroke were recruited. The Beck Depression inventory II was administered between 30-90 days after the stroke. Depression symptoms and scores were analyzed by gender. Results: A total of 91 patients were included [Men: 42 (46.1%); Women 49 (53.9%); median age: men 55 (18-80) vs. women 57 (29-85); p 0.41]. Women had somewhat more diabetes (37.8% vs. 20.5% in men, p 0.08) and more likely to be single (68.7% vs. 42.5% in men, p 0.006). There was a high prevalence of early PSD, 42.8%. There was a higher frequency of PSD among women 49% vs. 35.7%, though not statistically significant. Women had a higher frequency of mild and moderate scores, whereas men had more severe PSD (figure). Both genders had similar scores for cognitive and somatic symptoms of depression. The most frequently reported symptoms were "loss of energy"(higher in women 89.8% vs. 71.4% in men, p 0.02), "fatigue", "loss of pleasure" and "change in sleep pattern"; similar among both genders. Among single women, median scores were 16 (0-53), more than double that of men: 7 (0-40); p 0.08. Scores in cognitive and somatic domains were higher among single women than single men. In conclusion, PSD is very frequent, affecting nearly half of female stroke patients, particularly if they are single. The symptoms may be somatic, affecting energy levels and sleep. Identification of patients at high risk of PSD will enable early treatment, with improved outcomes and quality of life.

Health Insurance in Old Age and Differences in Cognition, Depressive Symptoms and Health-Related Quality of Life

We aimed at identifying differences regarding cognition, depressive symptoms and health-related quality of life between members of private and statutory health insurance (SHI) in very old age in Germany. Cross-sectional data were gathered from the multicenter prospective "Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)" (AgeQualiDe), covering primary care patients aged ≥ 85 years (n = 854; with 773 members of SHI). The Global Deterioration Scale measured cognition, the Geriatric Depression Scale assessed depressive symptoms, and health-related quality of life was measured by using a Visual Analogue Scale (EQ-VAS). While members of private health insurance showed slightly better cognitive function, less depressive symptoms and better health-related quality of life descriptively, regression models showed that none of these differences was statistically significant. There are no differences between members of private health insurance and SHI regarding cognitive function, depressive symptoms and health-related quality of life in very old age.

A systematic review of cognitive effects of exercise in depression.

The aim of the present systematic review and meta-analysis was to evaluate the impact of physical exercise on cognitive symptoms in depressed adult patients. Systematic literature search was performed in Web of Science™ and CINAHL from inception to August 2016. Two reviewers independently selected randomized trials evaluating the effect of exercise on cognitive functions in patients with a validated diagnosis of depression. Outcome measures included global cognition and different cognitive domains (speed of processing, attention/vigilance, working memory, verbal and visual memory, and reasoning). Eight trials met inclusion criteria (637 patients). A fixed-effects model showed absence of beneficial effect on global cognition (Hedges' g=0.07, 95% CI -0.08 to 0.24, I2 =0%) as well as on specific cognitive domains. Sensitivity analyses did not show an impact of exercise in studies with shorter intervention duration compared to longer trials (between group heterogeneity Q=3.564, df=1, P=0.059), single session per week compared to multiple sessions (Q=2.691, df=1, P=0.101) and low exercise intensity compared with moderate/high intensity (Q=2.952, df=1, P=0.086). Our meta-analysis did not observe a substantial benefit of physical exercise on cognitive symptoms in depression.

Beyond Emotional and Spatial Processes: Cognitive Dysfunction in a Depressive Phenotype Produced by Long Photoperiod Exposure.

Cognitive dysfunction in depression has recently been given more attention and legitimacy as a core symptom of the disorder. However, animal investigations of depression-related cognitive deficits have generally focused on emotional or spatial memory processing. Additionally, the relationship between the cognitive and affective disturbances that are present in depression remains obscure. Interestingly, sleep disruption is one aspect of depression that can be related both to cognition and affect, and may serve as a link between the two. Previous studies have correlated sleep disruption with negative mood and impaired cognition. The present study investigated whether a long photoperiod-induced depressive phenotype showed cognitive deficits, as measured by novel object recognition, and displayed a cognitive vulnerability to an acute period of total sleep deprivation. Adult male Wistar rats were subjected to a long photoperiod (21L:3D) or a normal photoperiod (12L:12D) condition. Our results indicate that our long photoperiod exposed animals showed behaviors in the forced swim test consistent with a depressive phenotype, and showed significant deficits in novel object recognition. Three hours of total sleep deprivation, however, did not significantly change novel object recognition in either group, but the trends suggest that the long photoperiod and normal photoperiod groups had different cognitive responses to total sleep deprivation. Collectively, these results underline the extent of cognitive dysfunction present in depression, and suggest that altered sleep plays a role in generating both the affective and cognitive symptoms of depression.

Somatic-Affective, But Not Cognitive-Depressive Symptoms are Associated With Reduced Health–Related Quality of Life in Patients With Congestive Heart Failure

Depression has been associated with poor health-related quality of life (HRQoL) in patients with congestive heart failure (CHF). However, to date, whether somatic-affective and cognitive-depressive symptoms differently contribute to poor HRQoL and behavioral functional capacity in patients with CHF has yet to be investigated. To examine the differential influence of somatic-affective vs cognitive-depressive symptoms on HRQoL and behavioral functional capacity in CHF patients. Overall, 55 patients with CHF completed a psychologic evaluation, including the Minnesota Living with Heart Failure Questionnaire, the Beck Depression Inventory-II, and the Beck Anxiety Inventory for HRQoL, depressive, and anxiety symptoms, respectively. The patients completed the Instrumental Activities of Daily Living Questionnaire and the 6-minute walk test for behavioral functional capacity. Hierarchical regression analyses were used to predict HRQoL and behavioral functional capacity from Beck Depression Inventory-II and Beck Anxiety Inventory scores. Somatic-affective depressive symptoms were associated with physical (β = 0.37, p = 0.005) and emotional (β = 0.39, p = 0.008) Minnesota Living with Heart Failure Questionnaire subscale scores. Likewise, somatic-affective depressive symptoms predicted Instrumental Activities of Daily Livings Scores (β = 0.43, p = 0.004) and distance ambulated during the 6-minute walk test (β = -0.36, p = 0.029). By contrast, cognitive-depressive symptoms and anxiety were unrelated to HRQoL and behavioral functional capacity (all p > 0.05). These findings showed that somatic-affective depressive symptoms, but not cognitive-depressive symptoms and anxiety, are associated with poor HRQoL and behavioral functional capacity independent of age, clinical functional status, and medical comorbidities. This study suggests that patients with CHF with somatic-affective rather than cognitive-depressive symptoms or anxiety may be at greater risk of poor HRQoL and behavioral functional capacity.

The Effect of Aerobic Indoor Exercise Compared with Green Exercise on Different Symptoms of Depression: An Investigation of Psychological Mediators of Stress and Coping

Objectives: Considering the growing need for using a variety of new nonpharmacological methods in treating depression, this quasi experimental study was conducted to investigate the effect of aerobic indoor exercise in a gym compared with green exercise in an outdoor green environment of an urban park on triple categories of affective, cognitive and somatic symptoms of depression and to examine its psychological mediators of perceived stress and coping strategies. Methods: Forty six female outpatients with major depressive disorder were divided into 3 conditions of indoor exercise + routine pharmacotherapy (n = 15), green exercise + routine pharmacotherapy (n = 15), and a routine pharmacotherapy alone as the control group (n = 16). The exercise used for both indoor and green exercise conditions consisted of 36 one hour sessions (three times per week) with an intensity of 50% - 70% of the maximum heart rate. The participants completed the pre- and post-intervention depression, stress and coping questionnaires including Beck Depression Inventory-II, Perceived Stress Scale and Coping Inventory for Stressful Situations. Results: The findings indicated a significant decrease in the post-intervention scores of all three categories of affective, cognitive and somatic symptoms of depression and perceived stress in both exercise groups compared with the control group, but there was no significant difference between two exercise groups. With respect to the use of problem-focused, emotion-focused and avoidant-focused coping methods, there was no significant difference between post-intervention scores of all groups. Conclusion: In the clinical settings, both of the indoor exercise and green exercise programs can help to further improvement in all three categories of affective, cognitive and somatic symptoms of depression as an adjunct (or independent) treatment to the same degree, especially mediated by reducing the amount of perceived stress, but not through any significant changes in cognitive-behavioral coping strategies.

The Effect of Aerobic Exercise on Different Symptoms of Depression: An Investigation of Psychological Mechanisms of Stress and Coping

Objectives: Considering the growing need for encouraging greater use of a variety of non-pharmacological methods in treating depression, the aim of this quasi experimental study was to examine the effect of aerobic exercise on triple categories of affective, cognitive and somatic symptoms of depression and to investigate its psychological mediators of perceived stress and coping strategies. Methods: Forty five female outpatients with major depressive disorder were divided into three groups including exercise + usual pharmacotherapy (n = 15), psychotherapy + usual pharmacotherapy (n = 14) and a control group receiving only usual pharmacotherapy (n = 16). The exercise used was included 36 one hour session (three sessions per week) with a low to medium intensity of 50% to 70% of the maximal heart rate. The psychotherapy used in this study was the behavioral activation treatment for depression revised. The Persian version of Beck Depression Inventory-II, Perceived Stress Scale and Coping Inventory for Stressful Situations were applied to assess the pre- and post-intervention depression, perceived stress, and coping strategies. Results: The findings indicated a significant decrease in the post-intervention scores of all three categories of affective, cognitive and somatic symptoms of depression and the perceived stress level in the adjunctive exercise and psychotherapy conditions compared with the control condition (p = 0.001), but there was no significant difference between the exercise and psychotherapy groups. In addition, no significant improvement was observed regarding the problem-centered, emotion-centered and avoidant-centered stress coping methods in the post-intervention scores of the exercise group compared with the control group. Conclusion: An adjunctive aerobic exercise program can be as effective as adding the psychotherapy to usual pharmacotherapy in further improvement in all three categories of depression symptoms especially mediated by reducing the amount of perceived stress, but not through any significant change in cognitive-behavioral coping strategies.

지역사회 노인의 인지기능과 우울감이 도구적 일상생활동작에 미치는 영향

지역사회 노인의 인지기능과 우울감이 도구적 일상생활동작에 미치는 영향

The effects of the gender-culture interaction on self-reports of depressive symptoms: cross-cultural study among Egyptians and Canadians.

PurposeResearch in depression has revealed differences in the way depressed individuals across cultures report their symptoms. This literature also points to possible differences in symptom reporting patterns between men and women. Using data from a larger dataset (Beshai et al. 2016), the current study examined whether non-depressed and depressed Egyptian and Canadian men and women differed in their self-report of the various domains of the Beck Depression Inventory –II (BDI-II).MethodWe recruited a total of 131 depressed and non-depressed participants from both Egypt (n = 29 depressed; n = 29 non-depressed) and Canada (n = 35 depressed; n = 38 non-depressed). Depression status was ascertained using a structured interview. All participants were asked to complete the BDI-II along with other self-report measures of depression. BDI-II items were divided into two subscales in accordance with Dozois, Dobson & Ahnberg (1998) factor analysis: cognitive-affective and somatic-vegetative subscales.ResultsWe found a significant three-way interaction effect on the cognitive-affective (F(1,121) = 9.51, p = .003) and main effect of depression status on somatic-vegetative subscales (F(1,121) = 42.80, p < .001). Post hoc analyses revealed that depressed Egyptian men reported lower scores on the cognitive-affective subscale of the BDI-II compared to their depressed Canadian male counterparts.ConclusionsThese results suggest that males across cultures may differentially report cognitive symptoms of depression. These results also suggest that clinicians and clinical scientists need to further examine the interaction effect of culture and gender when investigating self-reported symptoms of depression.

Recursive Associations Among Maladaptive Cognitions and Symptoms of Social Anxiety and Depression: Implications for Sex Differences

Recent theories suggest that relationships between cognitive factors and symptoms of anxiety and depression are reciprocal and recursive. The first aim of this study was to evaluate the recursive relationships among two types of maladaptive cognitions (negative automatic thoughts and social looming cognitive style) and symptoms of social anxiety and depression. The second aim of the study was to test whether these reciprocal relationships help to explain sex differences in emotional problems and maladaptive cognitions. A total of 640 adolescents and young adults (52.65% women) participated in this study and filled in questionnaires at two waves, spaced 6 months apart. Participants were between 16 and 25 years old (Mage = 18.27, SDage = 2.21). The path analyses indicated that social looming at T1 predicted social anxiety at T2 and negative self-concept thoughts at T1 predicted social anxiety and depressive symptoms at T2. In addition, social anxiety at T1 predicted social looming at T2 and social anxiety a...

Lifetime Multiple Mild Traumatic Brain Injuries Are Associated with Cognitive and Mood Symptoms in Young Healthy College Students.

Repetitive mild traumatic brain injury (mTBI, also known as concussion) has been associated with a range of long-term mood and cognitive deficits, including executive dysfunction. Previous research in athletes suggests that cognitive and mood problems are associated with a history of repetitive mTBI. However, to date, no studies have examined the impact of a lifetime accumulation of repetitive mTBIs on cognition, particularly executive functioning, and mood in a sample of young adults who were not athletes. Therefore, the present study looked at potential effects of repetitive mTBIs on self-reported cognitive complaints, executive functioning, and mood in young adults. Eighty-four total students responded, and 26 of those were excluded from analyses due to reporting only 1 mTBI. The final sample consisted of 58 healthy young adults (mean age = 22.84, STD = 4.88) who completed the Cognitive Complaint Index (CCI), the Behavior Rating Inventory of Executive Function, adult version (BRIEF-A), and the Beck Depression Inventory, second edition (BDI-II). Twenty-nine participants denied having an mTBI history, and 29 reported 2 or more lifetime mTBIs (range 2-7). Young otherwise healthy adults with a lifetime history of repetitive mTBI compared to those that reported no history of mTBI reported more change in cognitive functioning over the past 5 years, worse executive functioning, and more symptoms of depression. As the number of lifetime mTBIs increased, scores on the CCI, BRIEF-A, and BDI-II also increased, indicating worse functioning. These findings suggest that a lifetime accumulation of two or more mTBIs as compared to a history of no reported mTBIs may result in worse cognitive functioning and symptoms of depression in young adults.

Analysing UK clinicians’ understanding of cognitive symptoms in major depression: A survey of primary care physicians and psychiatrists

BackgroundCognitive dysfunction occurs in depression and can persist into remission. It impacts on patient functioning but remains largely unrecognised, unmonitored and untreated. We explored understanding of cognitive dysfunction in depression among UK clinicians. MethodsA multi-step consultation process. Step 1: a multi-stakeholder steering committee identified key themes of burden, detection and management of cognitive dysfunction in depression, and developed statements on each to explore understanding and degree of agreement among clinicians. Step 2: 100 general practitioners (GPs) and 100 psychiatrists indicated their level of agreement with these statements. Step 3: the steering committee reviewed responses and highlighted priority areas for future education and research. ResultsThere was agreement that clinicians are not fully aware of cognitive dysfunction in depression. Views of the relationship between cognitive dysfunction and other depressive symptom severities was not consistent with the literature. In particular, there was a lack of recognition that some cognitive dysfunction can persist into remission. There was understandable uncertainty around treatment options, given the current limited evidence base. However, it was recognised that cognitive dysfunction is an area of unmet need and that there is a lack of objective tests of cognition appropriate for depressed patients that can be easily implemented in the clinic. LimitationsRespondents are likely to be ‘led’ by the direction of the statements they reviewed. The study did not involve patients and carers. ConclusionsUK clinicians should undergo training regarding cognitive dysfunction in depression, and further research is needed into its assessment, treatment and monitoring.

Specificity of relations between adolescents’ cognitive emotion regulation strategies and symptoms of depression and anxiety

ABSTRACTThe aim of this study was to examine the extent to which cognitive emotion regulation strategies were “common or transdiagnostic correlates” of symptoms of depression and anxiety and/or “specific correlates” distinguishing one problem category from the other. The sample comprised 582 13- to 16-year-old secondary school students. Symptoms of depression and anxiety were measured by the SCL-90, and cognitive emotion regulation strategies were measured by the CERQ, in a cross-sectional design. Multivariate regression analyses were performed. Before controlling for comorbidity, the same cognitive emotion regulation strategies that were related to symptoms of depression were also related to symptoms of anxiety. However, after controlling for comorbid anxiety symptoms, rumination, self-blame (only girls), positive reappraisal, and positive refocusing (the latter two inversely) were uniquely (and significantly) associated with depression symptoms; and after controlling for comorbid depression symptoms, catastrophising and other-blame were uniquely related to anxiety symptoms. The results supported the cognitive content-specificity model, in which anxiety is supposed to be uniquely characterised by thoughts concerning the overestimation of threats and harm, and depression is supposed to be uniquely characterised by negative evaluations of self, and of past and future events.

IMPACT OF CAROTID ENDARTERECTOMY ON COGNITIVE PERFORMANCE AND DEPRESSIVE SYMPTOMS

OBJECTIVES: This study aims to evaluate the impact of carotid endarterectomy (CEA) on cognitive performance in patients with severe carotid disease and depressive symptoms, and to explore the possible associations between certain demographics, clinical characteristics, and cognitive function and depression.MATERIALS AND METHODS: The study included 48 patients, who were referred for endarterectomy. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) scale, while depressive symptoms were assessed using the patient health questionnaire(PHQ-9) scale. An assessment of cognitive and depressive symptoms was performed 1–3 days before surgery, and then six months after.RESULTS: A paired sample t-test found that the difference in the mean MoCA score between the before (=23.37; SD ± 3.27) and the after (=24.69; SD ± 3.68) surgery results was 1.32 (95% CI = 0.48 – 2.16; p= 0.003; Cohen’s d value = 0.95). A paired sample t-test showed that a decrease in mean PHQ-9 score of &gt; 10 for patients six months after CEA (7.5±4.6) was statistically significant (p= 0.019; Cohen’s d value = 1.32) compared with the PHQ-9 scores at baseline (12.6 ± 2.8).CONCLUSION: Carotid artery endarterectomy seems to have beneficial effects on the course of cognitive impairment and depressive symptoms in patients with severe carotid artery stenosis. Demographic, clinical characteristics (age, gender, comorbidities, previous stroke) did not have impact on course of cognitive and depressive symptoms. A limitation in our study was that the number of patients was relatively small, therefore we intend to perform further study with larger case volume to estimate the impact of carotid artery endarterectomy on cognitive functions and depressive symptoms.

Intérêt d’un traitement par scopolamine dans les troubles dépressifs

IntroductionThe number of patients with depression in the world is 350 millions according to estimates. The search for new treatments, particularly in forms of resistant depression, is necessary given the growing number of patients experiencing treatment failure and resistance. Scopolamine, an anticholinergic antimuscarinic molecule, is one of the treatments under evaluation. It falls within the assumptions of cholinergic disruption of the pathophysiology of depression, at different levels (genetic, receptorial [muscarinic and glutamate receptors], hormonal, synaptic…). In 2006, a pilot study made to evaluate the role of the cholinergic system in cognitive symptoms of depression found unexpected results regarding the antidepressant effect of scopolamine in depressive patients. Since that time other studies have been conducted to evaluate the benefits of treatment with intravenous injections of scopolamine. ObjectiveOur main objective was to evaluate the interest of scopolamine as an antidepressant treatment in depressed populations. MethodsWe conducted a literature review with the aim of assessing the effectiveness of treatment with scopolamine in uni- and bipolar patients with depressive symptoms. The protocol consisted of two injection blocks (each block consisting of three injections spaced fifteen minutes apart within three to five days) of active ingredient or placebo crossover. The selected patients were between 18 and 45years and had the DSM-IV major depressive disorder or bipolar disorder criteria. Regarding the methods of measurement, the primary endpoint was the reduction in scores of the Montgomery Asberg Depression Rating Scale (MADRS) with a total response defined by a decrease of more than 50 % of the score and remission corresponding to a MADRS score<10. Seven sessions of evaluations were performed. ResultsThe published results are promising in terms of efficiency with rapid antidepressant effect, a total response rate ranging from 59–64% and a remission rate of between 37 and 55% in uni- and bipolar patients, which persists at least 15days. The treatment was well tolerated by patients with relatively mild and transient side effects the most common being the sensation of sleepiness that was also found in the placebo group. There were no serious side effects such as heart failure or confusion. In terms of mood, there was no becoming manic or hypomanic even for bipolar patients. ConclusionThe results are encouraging, but there is concern for the moment because of the few studies, so to date there is little data on the subject including medium and long term.

Anxiety and depression after stroke: Report of 64 cases

Depression affects many people following their stroke (between 30 and 60%). It can occur in the days following the attack but several years later. Our objective was to investigate the incidence of depression and anxiety in our patients after stroke followed for post-stroke hemiplegia. Prospective study over 6 months from 10 September 2014 to 10 March 2015. It covered all cases of stroke supported the MPR service during this period were excluded patients with severe aphasia. We used wide HAD depression (Hospital Anxiety and Depression Scale Sigmond and Snaith). Of 64 hemiplegic patients treated in our department had only 18 patients post-stroke depression (26.5%) and 14 patients a state of anxiety (20.6%), the mean age was 57.14 years with a range from 17 to 87 years, the sex-ratio was 1.1 for women, all had an ischemic stroke; 4 patients had impaired depression (5.9%) and 14 patients (2to 6%) a depression; 8 patients a questionable state of anxiety (11.8%) and 6 patients (0.9%) a state of anxiety. Antidepressant treatment was instituted for the 18 patients with good evolution. Post-stroke depression is common. In our study, we found a relatively low frequency, due to our small sample. It compromises the functional prognosis source of demotivation patients especially for rehabilitation. Its onset is early after stroke, its incidence is high and there is a clear predominance of somatic and cognitive symptoms of depression: relationship to certain encephalic locations. Post-stroke depression should be sought systematically in all hemiplegic, especially in the early phase and at regular interviews with family, adequate antidepressant treatment is to achieve.

Alpha7 nicotinic acetylcholine receptor agonists and PAMs as adjunctive treatment in schizophrenia. An experimental study

Nicotine has been found to improve cognition and reduce negative symptoms in schizophrenia and a genetic and pathophysiological link between the α7 nicotinic acetylcholine receptors (nAChRs) and schizophrenia has been demonstrated. Therefore, there has been a large interest in developing drugs affecting the α7 nAChRs for schizophrenia. In the present study we investigated, in rats, the effects of a selective α7 agonist (PNU282987) and a α7 positive allosteric modulator (PAM; NS1738) alone and in combination with the atypical antipsychotic drug risperidone for their utility as adjunct treatment in schizophrenia. Moreover we also investigated their utility as adjunct treatment in depression in combination with the SSRI citalopram. We found that NS1738 and to some extent also PNU282987, potentiated a subeffective dose of risperidone in the conditioned avoidance response test. Both drugs also potentiated the effect of a sub-effective concentration of risperidone on NMDA-induced currents in pyramidal cells of the medial prefrontal cortex. Moreover, NS1738 and PNU282987 enhanced recognition memory in the novel object recognition test, when given separately. Both drugs also potentiated accumbal but not prefrontal risperidone-induced dopamine release. Finally, PNU282987 reduced immobility in the forced swim test, indicating an antidepressant-like effect. Taken together, our data support the utility of drugs targeting the α7 nAChRs, perhaps especially α7 PAMs, to potentiate the effect of atypical antipsychotic drugs. Moreover, our data suggest that α7 agonists and PAMs can be used to ameliorate cognitive symptoms in schizophrenia and depression.

Low psychological resilience is associated with depression in patients with cardiovascular disease.

Psychological resilience is associated with an improved capacity to cope with chronic health challenges such as cardiovascular disease. The aim of this cross-sectional study was to examine the relationship between psychological resilience and symptoms of depression in a non-acute cardiac outpatient population. A total of 419 adult cardiac outpatients (288 men; mean±SD age 66.26±14.04 years) attending cardiovascular clinics completed the Sense of Coherence (SOC13) scale as a measure of psychological resilience and the Cardiac Depression Scale (CDS26) prior to their consultation. The total SOC13 score (mean±SD 64.02±14.24, range 19-91) was within the moderate range. Older patients (⩾65 years) were significantly more resilient than those aged <65 ( p<0.01). Psychological resilience (SOC13) was negatively correlated with depression (CDS26) ( r=-0.79; p<0.001) and inversely associated with affective, cognitive and somatic symptoms of depression. Psychological resilience, particularly meaningfulness, accounted for more of the variance in affective features of depression than for somatic features. These findings show that low psychological resilience was related to depression in this cohort of cardiac outpatients, particularly affective symptoms such as anhedonia and hopelessness. The SOC13 scale offers a complementary measure of psychological status that could be used to monitor, and possibly predict, patient coping and response to treatment throughout the cardiovascular disease trajectory.