Concomitant Depression Research Articles

Presence of Concomitant Depression and its Effect on Clinical Course in Patients Diagnosed with Myasthenia Gravis

Presence of Concomitant Depression and its Effect on Clinical Course in Patients Diagnosed with Myasthenia Gravis

The effects of cerebral amyloidopathy on regional glucose metabolism in older adults with depression and mild cognitive impairment while performing memory tasks.

Co-occurring depression and mild cognitive impairment (MCI) in older adults are important because they have a high risk of conversion to dementia. In the present study, task-related F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) was used to analyse older adults with concomitant depression and MCI. We recruited 20 older adults with simultaneous depression and MCI and 10 older adults with normal cognition (NC). The Verbal Paired Associates test and digit span test were used for the task-related FDG-PET. The 20 older adults with depression and MCI were classified into two groups based on the F-18 florbetaben PET results: depressed MCI patients with (LLD-MCI-A[+]; n = 11) and without amyloid accumulation (LLD-MCI-A[-]; n = 9). Reduced regional cerebral glucose metabolism (rCMglc) in the left superior frontal region was observed in the LLD-MCI-A(-) group compared with the NC group. Analyses of the NC and LLD-MCI-A(+) groups showed significantly decreased rCMglc in the right inferior parietal and left middle frontal regions in the LLD-MCI-A(+) group. rCMglc in the left precuneus was lower in the LLD-MCI-A(+) group than in the LLD-MCI-A(-) group. Significant correlations between the rCMglc in the right inferior parietal/left precuneus regions and memory task scores were observed based on correlation analyses of NC and LLD-MCI-A(+) groups. The findings in the present study indicate the presence of amyloid accumulation influences glucose metabolism in depressed elderly subjects with MCI while performing cognitive tasks. Task-related FDG-PET examinations may help differentiate MCI associated with depression from comorbid depression in patients with prodromal Alzheimer's disease.

MP04-18 THEMATIC ANALYSIS OF LIVED EXPERIENCE IN PATIENTS WITH ADULT ACQUIRED BURIED PENIS

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I (MP04)1 Sep 2021MP04-18 THEMATIC ANALYSIS OF LIVED EXPERIENCE IN PATIENTS WITH ADULT ACQUIRED BURIED PENIS Gregory Amend, Jordan Holler, Natalie Rios, Michael Sadighian, Anthony Enriquez, Alex Vanni, Lee Zhao, Bradley Erickson, and Benjamin Breyer Gregory AmendGregory Amend More articles by this author , Jordan HollerJordan Holler More articles by this author , Natalie RiosNatalie Rios More articles by this author , Michael SadighianMichael Sadighian More articles by this author , Anthony EnriquezAnthony Enriquez More articles by this author , Alex VanniAlex Vanni More articles by this author , Lee ZhaoLee Zhao More articles by this author , Bradley EricksonBradley Erickson More articles by this author , and Benjamin BreyerBenjamin Breyer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001971.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is a paucity of evidence documenting the lived experience of patients with adult acquired buried penis (AABP) and how this condition is affected by surgical treatment. The purpose of this study is to use patient interview data to describe the lived experience of patients with AABP to heighten clinicians’ awareness of the most prominent challenges this population faces and the efficacy of surgery in addressing these. METHODS: This mixed-methods study utilized validated survey instruments and semi-structured interviews to capture pre- and post-surgical outcomes for men with AABP. Semi-structured interviews were conducted at University of California, San Francisco with open-ended questions to elicit the impact of AABP on a patient’s quality of life in several domains including urinary function, sexual function, interpersonal relationships, and mental health. Interviews were conducted in English and were transcribed and independently coded by authors (JH, NR, MS). RESULTS: Fourteen (14) patients with AABP participated in the study, 10 of whom had undergone surgical treatment for their condition. Semi-structured interviewee responses were coded into 13 different themes (Table 1). The most common themes were problems with urinary and sexual function (14, 100%), which included urinary stream/spraying issues as well as inability to perform intercourse or achieve an erection; among patients who underwent surgery, the majority discussed improvement in urinary and sexual function (60% and 70% respectively). Most interviewees (79%) reported negative impacts of AABP on social life, primarily involving issues with using public restrooms and avoiding travel. Half of interviewees reported struggles with relationships and mental health, such as avoiding romantic relationships and fear of rejection with concomitant depression and/or anxiety, and issues with access to care. CONCLUSIONS: Patients living with AABP experience profound negative impacts on quality of life including urinary and sexual function, social life, and mental health. Additionally, many patients face issues with access to care. Providers should be aware that AABP patients have complex needs requiring interdisciplinary management, and that surgery may improve quality of life. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e74-e74 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gregory Amend More articles by this author Jordan Holler More articles by this author Natalie Rios More articles by this author Michael Sadighian More articles by this author Anthony Enriquez More articles by this author Alex Vanni More articles by this author Lee Zhao More articles by this author Bradley Erickson More articles by this author Benjamin Breyer More articles by this author Expand All Advertisement Loading ...

Brain amyloid accumulation possibly exacerbates concurrent mild cognitive impairment with subthreshold depression in older adults: A 1-year follow-up study

BackgroundThis study aimed to investigate the 1-year changes in neuropsychological test results in older adults with concomitant late-life depression (LLD) and mild cognitive impairment (MCI) according to the presence or absence of brain amyloidopathy. MethodsAll subjects underwent 18F‐florbetaben‐positron emission tomography and a standardized neuropsychological battery. The subjects were divided based on brain amyloidopathy and severity of depressive symptoms into the following groups: LLD-MCI-A(+), subthreshold depression (STD)-MCI-A(+), major depressive disorder (MDD)-MCI-A(+), LLD-MCI-A(-), STD-MCI-A(-), and MDD-MCI-A(-). After one year, follow-up neurocognitive tests were conducted. Fifty-nine participants completed both the baseline and 1-year follow-up neurocognitive tests. ResultsIn the LLD-MCI-A(+) group, the word list recall and word list recognition scores decreased during the follow-up period. The STD-MCI-A(+) group also showed a significant decrease in word list recall score and the score/Z-score of word list recognition. On the other hand, the word list recall Z-score improved at the 1-year follow-up in the LLD-MCI-A(-) group. In particular, the MDD-MCI-A(-) group showed significant increases in word list memory score/Z-score and word list recall Z-score during the follow-up period. LimitationsConsidering that AD progresses slowly, a longer follow-up period may be required. ConclusionsOur findings showed differences in the extent of change of neuropsychological test results depending on the severity of depressive symptoms and presence or absence of brain amyloidopathy. Our results suggest that clinicians might explore the underlying neuropathology when assessing older adults with concomitant depression and cognitive impairment, even if the symptoms of depression are not severe.

Intensive group-based cognitive therapy in patients with cardiac disease and psychological distress\u2014a randomized controlled trial protocol

BackgroundMany patients with coronary artery disease (CAD) and valvular heart disease (VHD) suffer from psychological distress. Such stress is associated with increased morbidity, reduced quality of life and delayed return to work. European guidelines emphasize recognition and intervention, but evidence-based treatment options are limited and perceived as costly. The present study will test the effect of brief, group-based cognitive therapy as an adjunct to usual cardiac rehabilitation in a randomized design.MethodsA total of 148 patients with CAD and/or VHD after surgical intervention and concomitant psychological distress (defined as HADS anxiety (A) or depression (D) score ≥8) will be randomized to either usual out-patient cardiac rehabilitation (CR) comprising an 8-week multidisciplinary programme or usual care supplemented by five group-based cognitive therapy sessions performed by trained CR nurses. A structured, standardized treatment manual will be used. Patients will be randomized 1:1 at three different sites. Additionally, a non-randomized sub-group of 40 matched patients without signs of psychological distress will be followed to investigate spontaneous variation in HADS. The primary outcome is Hospital Anxiety and Depression Score (HADS). Secondary outcomes are adherence to cardiac rehabilitation (CR), health-related quality of life measured by HeartQoL, time to return to work, adherence to lifestyle interventions and cardiovascular readmissions. Patients are followed up for 12 months.DiscussionTo our knowledge, this is the first randomized controlled trial (RCT) on patients with cardiac disease with an intensive group-based programme of cognitive therapy performed by CR nurses, which makes it affordable and widely implementable. The outcome will elucidate the feasibility and effect of cognitive therapy as an adjunct to CR in patients with post-surgery CAD and/or VHD and psychological distress and could possibly benefit patients with other heart conditions as well. The clinical trial complies with the Declaration of Helsinki. The trial has been approved by The Regional Research Ethics Committee (file number H-16042832) and The Danish Data Protection Agency. The results will be disseminated as original research in peer-reviewed manuscripts.Trial registrationwww.clinicaltrials.govNCT04254315. Retrospectively registered on 30 January 2020.

Incidence and predictors of asthma exacerbations in middle-aged and older adults: the Rotterdam Study.

AimThe aim of this study was to investigate occurrence and determinants of asthma exacerbations in an ageing general population.MethodsSubjects aged 45 years or above with physician-diagnosed asthma in the Rotterdam Study, a population-based prospective cohort from January 1991 to May 2018, were assessed for asthma exacerbations. Exacerbations were defined as acute episodes of worsening asthma treated with oral corticosteroids. Cox proportional hazards analysis was used to investigate risk factors for a future exacerbation.ResultsOut of 763 participants with asthma (mean age 61.3 years, 69.2% female), 427 (56.0%) experienced at least one exacerbation, in a mean follow-up time of 13.9 years. The mean annual exacerbation rate was 0.22. Most exacerbations occurred during winter months. Risk factors for exacerbations were a history of previous exacerbations (HR 4.25; 95% CI 3.07–5.90, p<0.001)), respiratory complaints (HR 2.18; 95% CI 1.48–3.21, p<0.001), airflow obstruction (HR 1.52; 95% CI 1.07–2.15, p=0.019), obesity (HR 1.38; 95% CI 1.01–1.87, p=0.040) and depressive symptoms (HR 1.55; 95% CI 1.05–2.29, p=0.027). Compared to those not using respiratory medication, we observed higher hazard ratios for those on short-acting β2-agonists (SABA, i.e. rescue medication) only (HR 3.08, 95% CI 1.61–5.90, p=0.001) than those on controller medication (HR 2.50, 95% CI 1.59–3.92, p<0.001).ConclusionMany older adults with asthma suffer from at least one severe exacerbation. Previous exacerbations, use of SABA without concomitant controller medication, respiratory complaints, obesity, airway obstruction and depression are independent risk factors for exacerbations.

Online Health Survey on Epileptic Children during Coronavirus Disease-2019 Pandemic

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2, and the outbreak is now rapidly spreading globally. The current administrative measures of lock-down, social distancing, and self-isolation are intended at reducing the spread of the viral infection, minimizing contacts between potentially infected individuals and healthy subjects. However, they can complicate the management of children with neurological illnesses by instigating or worsening concomitant anxiety and depression, hindering the interactions with physicians, and leading to shortages or inconsistent supply of medicines. OBJECTIVE: The current study aims to provide information on the medical care and wellbeing of children with epilepsy during COVID-19 pandemic and provide the best possible care for those children while avoiding visits to urgent care facilities and hospitalizations during the pandemic. METHODS: The current study was an observational cross-section survey study. One hundred twenty children with epilepsy following in the epilepsy clinic of Medical Research Center of Excellence, and epilepsy clinic at Neurology Department, Faculty of Medicine, Ain Shams University aged above 4 years were recruited. The authors designed a 22-items questionnaire to address impact of COVID-19 crisis on the care, seizure outcome, behavior of children, and concerns of their parents. The study was conducted during the period from May 2020 to November 2020. RESULTS: The study included 120 epileptic children, 47 males and 73 females, with age ranged from 4 to 17 years with mean age 8.34 ± 3.877 years. Before COVID pandemic, 18.3% of care providers had worries about epilepsy, while during the pandemic, 78.3% of them had the same worries. Twenty percent of the studied patients showed worsened sleep during the pandemic. Medical follow-up difficulties and drug access difficulties were found in 18.3% and 50% of the patients, respectively, during the pandemic. Child anxiety was 20% before the pandemic and 97.5% during the pandemic. Of the care providers, 95.8% were worried about their children of getting COVID 19. Thirty percent showed a need for psychological support, 76.7% for medical support, and 75% for information support about epilepsy. Medical support by phone or online during the pandemic was accepted by 80.8% of the caregivers. The study also showed that epileptic children with age ≤12 years needed more psychological support than those &gt;12 years. All children without anxiety before the COVID-19 pandemic had anxiety during COVID-19 pandemic, while 87.5% of those with anxiety before COVID still had anxiety during the pandemic, signifying that COVID 19 pandemic increased the anxiety of the epileptic children significantly. CONCLUSION: The present study found no increase in seizure exacerbation during the outbreak of COVID-19. During the pandemic, worries of the care providers about progression of the frequency of seizure and epileptic children anxiety increased significantly. Physicians should offer health care facilities including medications and information as much as possible at home to keep children with epilepsy in good psychological and mental status as well as minimizing of risk of seizure exacerbation through adherence. Effective telemedicine tools will prove useful for the long-term management of these patients.

Characterization of salicylic acid- and abscisic acid-mediated photosynthesis, Ca2+ and H2O2 accumulation in two distinct phases of drought stress intensity in Brassica napus

Drought modifies the endogenous hormonal status, which is involved in the regulation of stress responses and tolerance. This study aimed to characterize the drought-responsive hormone-mediated regulation of stress responses based on the time-course of drought intensity. Alterations in H2O2, Ca2+ and their signaling genes with decreasing leaf water potential (Ψw) were interpreted as being linked to the endogenous hormonal level. Drought responses in relation to SA and ABA balance represented two distinct phases. The early phase, during the first 6 days when the Ψw was greater than -0.78 MPa, was characterized by a rapid decrease in photosynthetic activity with a progressive accumulation of H2O2 and Ca2+ in the strong correlation with the increases in both SA and ABA level. The late phase, days 6–14, was distinguished by ABA-mediated stress symptomatic responses (e.g., the maintenance of the depressed photosynthesis with severe leaf wilting) with highly enhanced expression of ABA-related genes (NCED3 and MYC2) and concomitant depression in the SA level and SA-related genes (ICS1 and NPR1). The regression analysis revealed that both SA and ABA levels as being positively correlated with Ca2+ and H2O2 were closely related to the depression of photosynthesis for the early phase (days 0–6), whereas the correlations were significant only with ABA for the whole period of drought (days 0–14). These results indicate that SA-stimulated H2O2 accumulation and SA responses during the early drought phase are part of upstream H2O2-stimulated ABA accumulation, which causes ABA signaling and responses, leading to severe drought symptoms during the late phase.

Typical angina during exercise stress testing improves the prediction of future acute coronary syndrome.

The prognostic value of angina during exercise stress testing is controversial, possibly due to previous studies not differentiating typical from non-typical angina. We aimed to assess the prognostic value of typical angina alone, or in combination with ST depression, during exercise stress testing for predicting cardiovascular events. We conducted a prospective observational cohort study including all patients who performed a clinical exercise stress test at the department of Clinical Physiology, Kalmar County Hospital between 2005 and 2012. The association between typical angina/ST depression and incident acute coronary syndrome (ACS) and cardiovascular mortality were analysed using Cox regression for long-term and 1-year follow-up. Out of 11605 patients (median follow-up 6.7years), 623 (5.4%) developed ACS and 319 (2.7%) died from cardiovascular causes. Compared to patients with no angina and no ST depression, typical angina and ST depression were associated with increased risk of future ACS; hazard ratio (HR) 3.5 ([95%CI] 2.6-4.7). This association was even stronger for ACS within one year (typical angina with and without concomitant ST depression; HR 20.8 (13.9-31.3) and 9.7 (6.1-15.4), respectively). Concordance statistics for ST depression in predicting ACS during long-term follow-up was 0.58 (0.56-0.60) and 0.69 (0.65-0.73) for ACS within one year, and 0.64 (0.62-0.66) and 0.77 (0.73-0.81), respectively, when typical angina was added to the model. Typical angina during exercise stress testing is predictive of future ACS, especially in combination with ST depression, and during the first year after the test.

Association between anorexia nervosa and other specified eating or feeding disorders and paranoia in adolescents: what factors are involved?

In eating disorders, the association with other psychiatric symptoms is of particular interest. The association between anorexia nervosa and psychotic symptoms is less studied than that with affective disorders (anxiety/depression). The aim of this study is to describe a psychotic symptom (paranoia) in adolescents with anorexia nervosa looking at several potential explicative associated factors: eating disorder symptoms, body image concerns, depression and social anxiety. Our hypothesis is that paranoia in anorexia nervosa patients is better explained by the concomitant depression and social anxiety symptoms than the core symptoms of the disease (eating disorder symptoms or body image concerns). This is a retrospective study. Consecutive, help-seeking adolescents, admitted to the Eating Disorder Service of the Integrated Pediatric Care Department, Luigi Vanvitelli University Hospital, constituted the sample. Data was obtained through retrospective collection of clinical interviews and self-report questionnaires, used for the routine assessment of these patients, administered by trained and expert child and adolescent psychiatrists, they were the Eating Attitude Test-26 (EAT-26), the Body Uneasiness Test-A (BUT-A), the Children Depression Inventory (CDI), the Liebowitz Social Anxiety Scale-Children and Adolescents (LSAS-CA) and the paranoia subscale of the Specific Psychotic Experiences Questionnaire (SPEQ). We obtained data from 92 adolescents with anorexia nervosa and other specified feeding or eating disorder (OSFED). Our regression model explained that paranoia (SPEQ-paranoia subscale) in this population was better explained by depression (CDI) (coefficient= 0.415 SD: 0.210, p=0.052) and social anxiety symptoms (LSAS-CA) (coefficient= 0.253 SD: 0.060; p<0.001) than eating disorder symptoms (EAT-26) (coefficient= 0.092 SD: 0.107; p=0.398) and body image concerns (BUT-A) (coefficient= 1.916 SD: 2.079; p=0.359). This study has some theoretical, clinical and treatment implications. It is important to carrying out screening for the presence of psychotic symptoms in patients with eating or feeding disorders. These symptoms and associated factors (depression and social anxiety) may complicate the clinical picture of the disease with the need, in certain cases, of psychopharmacological drugs and, among these, anti-psychotics. Finally in the psychotherapy context, paranoid ideas may be subject of treatment for patient with anorexia nervosa.

Mindfulness-based cognitive therapy in functional dyspepsia: A pilot randomized trial.

Patients with functional dyspepsia (FD) often have concomitant anxiety and depression. Mindfulness-based cognitive therapy (MBCT) combines the principles of cognitive behavioral therapy and mindfulness. It is a group-based therapy and has been shown to be efficacious in functional gastrointestinal disorders. There are no randomized controlled trials (RCTs) evaluating MBCT in FD. We aimed to evaluate feasibility and efficacy of MBCT in FD management. We performed a mixed-method single-center pilot randomized trial of 28 patients fulfilling ROME-III criteria for FD. Fifteen patients were randomized to an 8-week MBCT program while 13 underwent treatment-as-usual (TAU). Patients completed questionnaires at baseline and at week 8. Two focus-groups were conducted. Feasibility of recruitment, acceptability of randomization, procedures and intervention, handout compliance and feasibility of quantitative measures were assessed. The primary outcome was subjective-clinical-assessment of FD symptoms (SCA-FD). Secondary outcome measures included Short-form Nepean Dyspepsia Index (SF-NDI), subjective-clinical-assessment of general health (SCA-GH), EuroQoL-Visual Analog Scale (EuroQoL-VAS), and Depression, Anxiety and Stress Scale-21 Items (DASS-21). Twelve of 15 patients in the MBCT group completed the program. There was a trend towards symptom improvement, with 90% in the MBCT group reporting improvement in SCA-FD compared with 45% in TAU(P=0.063). Patients who underwent MBCT reported greater improvement in SF-NDI (mean change: -8.8 (SD: 7.5) vs -0.7 (7.2), P=0.018) and DASS-21 (-19.8 (29.5) vs -5.5 (6.6) P=0.13) compared with TAU. There was no difference in SCA-GH and EuroQoL-VAS. Based on SCA-FD improvement, the eventual RCT will require 50 patients (25 in each group). Mindfulness-based cognitive therapy is likely efficacious for FD, and it would be feasible to conduct a RCT.

Risk of Depression among Early Onset Type 2 Diabetes Mellitus Patients

Methodology: Biochemically confirmed type 2 diabetes mellitus (T2DM) patients (n = 1,114) were recruited from the outpatient department of 2 tertiary care hospitals in Dhaka, Bangladesh. Face-to-face interview was conducted using a semi-structured questionnaire containing sociodemographic parameters and relevant information about depression and diabetes. Biochemical test results and treatment-related information were taken from patients’ records. The Hospital Anxiety and Depression Scale (HADS) was used to screen all patients for psychiatric manifestation. Those diagnosed by HADS were subsequently reassessed using structured clinical interview for DSM-5 Disorders – Clinician Version. T2DM diagnosed at age <40 years were considered as early onset T2DM. Association between age of onset category and depression was assessed using multivariable mixed-effect logistic regression adjusting for random variation of the area of residence and plausible confounders. Results: Around a third of the participants (32.5%) were diagnosed with T2DM before the age of 40 years. Early onset T2DM patients were found to have 57% increase in the risk of developing depression (OR 1.57; 95% CI 1.13–2.28; p = 0.011) in comparison to those with usual onset T2DM (≥40 years). Among other factors a positive family history for diabetes (OR 1.33; 95% CI 1.03–1.78; p = 0.038), poor glycemic control (OR 1.31; 95% CI 1.03–1.68; p = 0.028), presence of 1, or more diabetic complications (OR 1.37; 95% CI 1.03–1.78; p = 0.011) also showed increased risk of depression. Conclusion: Early onset T2DM patients are at greater risk of developing depression. The finding is likely to help in setting preventive strategies aiming to reduce the presence of concomitant depression symptoms among diabetes.

Using telehealth to assess depression and suicide ideation and provide mental health interventions to groups of chronically ill adolescents and young adults.

Telehealth distance health care is a significant resource for young, chronically ill patient populations given their numerous medical complexities and their concomitant depression and/or suicide ideation experiences. This manuscript shares the telehealth methods used to prepare for a larger study of interventions for increasing adolescents' and young adults' chronic care resiliency and skills for preventing depression. The young patients in this study were prescribed lifelong home parenteral nutrition infusions, treatment for those with short gut bowel diseases. The training methods for our mental health nurse and psychologist to conduct depression and suicide ideation assessments from a distance are presented. The study implementation methods of group facilitated interventions and discussion are reviewed. The group discussions were conducted via audiovisual telehealth devices over encrypted firewall-protected connections with patients in their own homes and professionals in an office. The results of assessments of the 40 participants, 25% (n = 10) with depressive symptoms or suicide ideation, are described. Following participants' assessments, their subsequent depression measures were all in the normal range, without any suicide ideation, across the year of the study. Patient evaluation ratings were high in the areas of being able to connect with other young patients in similar situations, using the audiovisual equipment, and learning new useful information from the interventions. The methods developed for the study ensured that the safety and well-being of participants were supported through telehealth.

Prognostic implications of depression and inflammation in patients with metastatic lung cancer.

Background: Lung cancer-related inflammation is associated with depression. Both elevated inflammation and depression are associated with worse survival. However, outcomes of patients with concomitant depression and elevated inflammation are not known. Materials & methods: Patients with metastatic lung cancer (n=123) were evaluated for depression and inflammation. Kaplan-Meier plots and Cox proportional hazard models provided survival estimations. Results: Estimated survival was 515days for the cohort and 323days for patients with depression (hazard ratio: 1.12;95% CI: 1.05-1.179), 356days for patients with elevated inflammation (hazard ratio: 2.85, 95% CI: 1.856-4.388), and 307days with both (χ2=12.546; p< 0.001]). Conclusion: Depression and inflammation are independently associated with inferior survival. Survival worsened by inflammation is mediated by depression-a treatable risk factor.

PMH51 Differential Burden of Depression and Anxiety Among Caregivers of Adults with Mental Health or Neurological Disorders

Caregiving is related to poor mental health, especially for family caregivers. Social determinants of health (SDOH) affect this relationship, whereby younger caregivers report poorer mental health than their non-caregiving peers, while female caregivers report higher rates of depression than male caregivers. The objective of this study is to identify the differential burden of depression and anxiety among caregivers of adult family members (CG) with mental health/neurological disorders (CGMHND) compared to CG having other chronic diseases/conditions (CGO), stratifying by SDOH. Data from the 2018 US National Health and Wellness Survey were analyzed. Respondents caring for persons with Bipolar Disorder, Depression, Schizophrenia, Alzheimer’s Disease, Dementia, Parkinson’s Disease, Autism, or Epilepsy were classified CGMHND. Self-reported physician-diagnosis and current experience (Dx-CE) of depression, anxiety, and concomitant depression and anxiety (DPAX) were examined. Symptom severity was assessed for depression (Patient Health Questionnaire-9 [PHQ-9]; severe=PHQ-9>14) and anxiety (Generalized Anxiety Disorder-7 [GAD-7]; severe=GAD-7>14). Bivariate comparisons used chi-square tests. Approximately half (55.5%, N=4942/8903) of CG were CGMHND. CGMHND reported higher rates of Dx-CE than CGO for depression (33.2% versus 18.8%), anxiety (34.2% versus 21.5%), and DPAX (24.8% versus 13.0%) (all p<0.001). Regardless of patient type, rates of Dx-CE of depression, anxiety, or DPAX were higher among younger and/or female caregivers (p<0.001). Among CGMHND with Dx-CE, rates of severe symptoms were higher among 18-29-year-olds compared to all other age groups (depression: 48.9% versus 22.6%; anxiety: 32.1% versus 12.9%; DPAX: 29.2% versus 12.7%; all p<0.001); however, with no significant difference by sex at p>0.05. Younger, female CGMHND reported the highest rates of diagnosis for depression and/or anxiety. Younger CGMHND with Dx-CE reported the highest rates of severe symptoms for depression and/or anxiety. Interventions which target these specific at-risk segments have the potential to improve mental health for the caregiving population.

Prevalence and pattern of neuropsychiatric conditions among community‐dwelling older Lebanese adults and their relation to cognitive function

AbstractBackgroundNeuropsychological and behavioral changes are an important source of burden for older adults and present a high and complex co‐morbidity with cognitive decline. Several reports suggest that these constructs may differ in their manifestations across cultures yet the vast majority of data come from higher‐income countries. Data on mental and cognitive health are particularly scarce in Lebanon. We examined the prevalence and overlap of depression, anxiety, and sleep disturbances at older age and their association with cognitive functioning in a community‐dwelling cohort of older adults (65 and above) in Lebanon (n=502; mean age=75.52 (SD=7.22); 56% women).MethodDepression, anxiety, and reported sleep problems or changes were measured using the Geriatric Mental State (GMS) Agecat Package. Using adjusted linear regression models, we estimated how the presence of these conditions is related to cognitive function, measured with the Community Screening Instrument for Dementia (CSI‐D). Data processing is still ongoing to include more participants.ResultPreliminary results showed that in our sample, 13.1% had at least one neuropsychological problems and 4.4% had two or more. Estimated prevalence was 10.6% for depression, 1.6% for anxiety, and 10.6% for the presence of sleep disturbances. With regards to overlap, all participants with anxiety had concomitant depression and 50% had sleep problems. Among participants with depression, 15% had anxiety and 33% had sleep disturbances. Among participants with sleep disturbances, 33% had depression and 7.5% had anxiety. The odds of depression, anxiety, or sleep disturbances were 2.9, 2.3, and 1.7 times higher for women than they were for men, respectively. Socioeconomic indicators were not associated with depression, anxiety, or sleep disturbances. The presence of any neuropsychological problem was not related to cognitive scores, and depression and sleep disturbances were not related to cognitive scores; in contrast participants with anxiety symptoms had lower cognitive scores (beta=‐3.28 (95% CI=‐5.074,‐1.492)).ConclusionResults suggest an important overlap in the presence of neuropsychological problems in this cohort and a potential differential relationship between anxiety – which was highly correlated to the presence of other mental health problems – and cognitive functioning in Lebanese older adults.

Clinical and psychological phenomenology of pain in autoinflammatory diseases

BackgroundPain is the clinical hallmark of patients in patients with autoinflammatory diseases (AID) caused by variants of the NLRP3-, MEFV- or TNFRSF1A gene. However, no systematical analysis of the clinical and psychological presentation of pain has been performed to date.MethodsTwenty-one symptomatic patients with variants in the NLRP3-, MEFV- and TNFRSF1A gene and clinical signs suggestive of an AID were retrospectively included in this monocentric cross-sectional case-series study. Patients were examined and interviewed using the German pain questionnaire. The hospital anxiety and depression scale (HADS) was applied to screen patients for anxiety and depression.ResultsTwenty out of 21 AID patients (95%) reported pain at the time of examination. Mean current pain intensity in all AID patients comprised 3.6 ± 1.3 and mean maximum pain intensity was 7.0 ± 1.6 on a 11-point numeric ranging scale (NRS). In 15 patients (71%), pain was present for more than 60 months. Ten patients (48%) experienced recurrent attacks with asymptomatic intervals and 7 patients (33%) suffered from constant pain, while 4 patients (19%) experienced both. Nociceptive pain including musculoskeletal and visceral affection was the most prominent type of pain (n = 20; 95%). Pain symptoms were treated continuously with analgesic or co-analgesic drugs in 10 patients (48%). Five patients (24%) have been positively screened for concomitant depression or anxiety.ConclusionsEarly and prompt diagnosis is necessary to provide multimodal pain treatment and to avoid the development of chronic pain in patients with AID.

Barriers and facilitators to implementing stepped psychological care for people with aphasia: Perspectives of stroke health professionals

ABSTRACT Background Concomitant aphasia and depression after stroke is highly prevalent, but there is a lack of psychological care in stroke rehabilitation for people with aphasia and family members. Evidence-based frameworks such as stepped psychological care may be viable, but the barriers and facilitators to translating this framework into aphasia rehabilitation practice are unknown. Aim The aim of this study was to identify, from the perspective of stroke health professionals, the barriers and facilitators to implementing stepped psychological care for depression after post-stroke aphasia. Method Five semi-structured focus groups of stroke health professionals were conducted (n = 39) across the stroke care continuum. Verbatim transcripts were analyzed using Interpretive Description. Results Barriers and facilitators were identified within three core themes: knowledge, skills, and attitudes have the most impact on implementing stepped psychological care; the physical environment impacts on managing depression and communication disability for people with aphasia; and the support and leadership of the health organization influence change in any implementation of a stepped psychological care approach. Barriers included: no experience with stepped psychological care; limited understanding of aphasia and communication support; lack of adequate physical space and resources; lack of psychologists. Facilitators included: specialist training; enhancement of physical spaces; communication tools; leadership; funding; specialized staff. Conclusion Addressing the identified barriers and facilitators to stepped psychological care will improve the viability of implementing this evidence-based framework after post-stroke aphasia. Change may be driven through specialist training for health professionals in communication support; mood assessment and treatments; modification of physical space; and accessible resources.

A Randomized Controlled Trial to Compare Analgesia and Functional Improvement After Continuous Neuroablative and Pulsed Neuromodulative Radiofrequency Treatment of the Genicular Nerves in Patients with Knee Osteoarthritis up to One Year After the Intervention.

To compare the analgesic and functional outcomes of continuous neuroablative radiofrequency (CNARF) and pulsed neuromodulative radiofrequency (PNMRF) treatment of genicular nerves up to 1 year after the intervention and to identify predictors associated with a successful outcome (defined as an at least 50% reduction in the pre-interventional visual analog scale [VAS] rating) after genicular radiofrequency treatment. A prospective randomized controlled trial. The Pain Department of the Jerez de la Frontera University Hospital, Cadíz, Spain, from January 2018 until May 2019. Patients with grade 3-4 gonarthritis suffering from knee pain, with a VAS score ≥5 for >6 months. Eligible participants were randomly assigned to receive either CNARF or PNMRF of the superior medial, superior lateral, and inferior medial genicular nerves. The VAS and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores were assessed before and at 1, 6, and 12 months after treatment. Medication use was quantified before and at 6 months after the intervention. Potential characteristics associated with the efficacy of radiofrequency intervention were explored by using multivariable statistical models. A total of 188 participants were included. The magnitude and duration of beneficial effect and reduction in analgesic use were significantly greater in the CNARF group. Success at 6 months after radiofrequency treatment decreased with grade 4 gonarthritis; higher pre-interventional VAS score; and concomitant depression, anxiety disorder, and diabetes mellitus. Therapeutic efficacy and reduction in analgesic consumption were superior after CNARF. Treatment success at 6 months after radiofrequency intervention decreased with more severe gonarthritis; higher pre-interventional pain intensity; and concomitant depression, anxiety disorder, and diabetes mellitus.

Antidepressant treatment in patients following acute coronary syndromes: a systematic review and Bayesian meta-analysis.

AimsThe aim of this study is to investigate the effect of antidepressant therapy on mortality and cardiovascular outcomes in patients with acute coronary syndrome (ACS).Methods and resultsWe systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials and performed a Bayesian random‐effects meta‐analysis of randomized controlled trials that investigated antidepressant pharmacotherapy in patients following ACS. The primary outcome was all‐cause mortality. Secondary outcomes were repeat hospitalizations and recurrent myocardial infarctions (MIs). Ten randomized controlled trials with a total of 1935 patients qualified for inclusion. Selective serotonin reuptake inhibitors were investigated in six, bupropion in three, and mirtazapine in one trial. Placebo was used as control in eight trials. There was no difference in all‐cause mortality [odds ratio (OR) 0.97, 95% credible interval (CrI) 0.66–1.42] and recurrent MI (OR 0.64, 95% CrI 0.40–1.02) between patients receiving antidepressants compared with controls, whereas antidepressant therapy was associated with less repeat hospitalizations (OR 0.62, 95% CrI 0.40–0.94). In patients with ACS and concomitant depression, antidepressants reduced the odds of recurrent MI compared with usual care/placebo (OR 0.45, 95% CrI 0.25–0.81). Extended funnel plots suggest robustness of the observations.ConclusionsAntidepressants in patients following ACS have no effect on mortality but reduce repeat hospitalizations; in patients with depression, there is a reduced risk of recurrent MI with antidepressant therapy.