Depressed Mood Research Articles

Cognitive behavioral therapy-enhanced through videoconferencing for night eating syndrome, binge-eating disorder and comorbid insomnia: a Case Report

Abstract Background Both night-eating syndrome and binge-eating disorder are characterized by episodes of excessive food consumption, significant distress, and functional impairment related to maladaptive eating behaviors. Both types of eating disorders are associated with poorer sleep quality. Cognitive behavioral therapy has demonstrated good outcomes for binge-eating disorder; however, it is unknown if it is effective for night-eating syndrome and comorbid insomnia. Case presentation The current paper presents a case report of a Dutch woman in her 40’s receiving cognitive behavioral therapy-enhanced for night-eating syndrome, as well as binge-eating disorder. However, to tailor the intervention to her specific needs, throughout the course of treatment, cognitive behavioral therapy-insomnia interventions were also implemented. Her comorbid complaints were insomnia, childhood trauma, a depressive mood disorder, and cluster B and C personality traits. She had a history of bariatric surgery, as well as alcohol addiction, and received various treatments in the past, aiming to become abstinent from binge eating. Conclusions Post-treatment, she was abstinent from binge eating and, her scores of various eating disorder measures were below clinical cut-points. However, it is unclear if she would show earlier symptom reduction if she received cognitive behavioral therapy-insomnia, prior to cognitive behavioral therapy-enhanced. In addition, the patient reported an increase in her depressive mood and commenced schema therapy after cognitive behavioral therapy- enhanced. Although common, the underlying cause of symptom shifts in patients with an eating disorder remains largely unknown.

Morning Salivary Cortisol Has a Positive Correlation with GAD-7 Scores in Patients with Ulcerative Colitis

Objectives: Inflammatory bowel diseases (IBDs) are chronic inflammatory conditions of the gastrointestinal tract, comprising ulcerative colitis (UC) and Crohn’s disease (CD). Earlier onset of IBD symptoms has been linked to a higher prevalence of depression and anxiety. Evidence supports that cortisol abnormalities correlate with the development and severity of autoimmune diseases. The primary aim of this study was to investigate the correlation of morning salivary cortisol levels with self-reported mood (depression and anxiety) and quality of life in patients with IBD. Methods: This was a prospective, single-center study including outpatients with IBD. Enrolled patients provided a one-time morning salivary cortisol sample and electronically completed a one-time survey encompassing self-reported quality of life (Short Inflammatory Bowel Disease Questionnaire (SIBDQ)) and mood (Patient Health Questionnaire 8 (PHQ-8), General Anxiety Disorder-7 (GAD-7)). Results: A total of 36 patients (UC, n = 21) were included in the study. There was no correlation between morning salivary cortisol and depressive symptoms (PHQ-8: r = 0.007, p = 0.968) or quality of life (SIBDQ: r = −0.095, p = 0.606). However, there was a trend towards a positive correlation between self-reported anxiety symptoms by GAD-7 and salivary cortisol (r = 0.347, p = 0.052). A subgroup analysis showed a positive correlation between morning salivary cortisol and GAD-7 scores in patients with UC (r = 0.535, p = 0.015), but not in patients with CD (r = 0.064, p = 0.843). Conclusions: This pilot study is the first to associate cortisol with anxiety symptom severity in UC. Further research is needed to investigate the link between salivary cortisol, neuropsychiatric disease, and IBD outcomes.

Addressing treatment hurdles in adults with late-onset attention-deficit/hyperactivity disorder: a detailed case report

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is the most prevalent psychiatric disorder in children, characterized by inattention, hyperactivity, and impulsivity. This neurobehavioral disorder often persists into adulthood, presenting significant challenges when undiagnosed and untreated, due to potential long-term implications and comorbidities, including anxiety, mood instability, and mixed symptoms along the bipolar spectrum.Case presentationA 49-year-old married male patient presented with anxiety and recurrent depressive episodes, initially diagnosed as major depressive disorder. His mood symptoms fluctuated between depressive lows, irritability, and impulsivity. His diagnosis was revised to ADHD with comorbid bipolar spectrum disorder. The patient exhibited lifelong ADHD symptoms affecting academic performance, relationships, and job responsibilities. Cognitive-behavioral therapy (CBT) was employed to manage symptoms and enhance coping strategies. Despite progress in controlling anger and impulsivity, challenges persisted in inhibitory control and negative triggers, causing impulsive decisions. The patient reported a restless mind, depressive mood, and a sense of inadequacy. Improvements were noted in anxiety regulation, concentration, and sleep quality, though deficits in cognitive and behavioral domains remained. The patient faced challenges in academic performance, information processing speed, attention, and executive functions.ConclusionThis case underscores the importance of accurately diagnosing ADHD and its comorbidities in adults to ensure effective treatment. Delayed diagnosis can have lasting impacts, emphasizing the need for further research and personalized therapeutic approaches. The insights from this case serve as a valuable resource for healthcare professionals enhancing their understanding of the diverse manifestations of ADHD, aiding in better diagnosis and management strategies.

Novel hypothesis and therapeutic interventions for irritable bowel syndrome: interplay between metal dyshomeostasis, gastrointestinal dysfunction, and neuropsychiatric symptoms.

Irritable bowel syndrome is a gastrointestinal disorder due to multiple pathologies. While patients with this condition experience anxiety and depressed mood more frequently than healthy individuals, it is unclear how gastrointestinal dysfunction interacts with such neuropsychiatric symptoms. Data suggest that irritable bowel syndrome patients predominantly display a lower zinc intake, which presumably impairs enterochromaffin cells producing 5-hydroxytryptamine, gut bacteria fermenting short-chain fatty acids, and barrier system in the intestine, with the accompanying constipation, diarrhea, low-grade mucosal inflammation, and visceral pain. Dyshomeostasis of copper and zinc concentrations as well as elevated pro-inflammatory cytokine levels in the blood can disrupt blood-cerebrospinal fluid barrier function, leading to locus coeruleus neuroinflammation and hyperactivation with resultant amygdalar overactivation and dorsolateral prefrontal cortex hypoactivation as found in neuropsychiatric disorders. The dysregulation between the dorsolateral prefrontal cortex and amygdala is likely responsible for visceral pain-related anxiety, depressed mood caused by anticipatory anxiety, and visceral pain catastrophizing due to catastrophic thinking or cognitive distortion. Collectively, these events can result in a spiral of gastrointestinal symptoms and neuropsychiatric signs, prompting the progression of irritable bowel syndrome. Given that the negative feedback mechanism in regulation of the hypothalamic-pituitary-adrenal axis is preserved in a subset of neuropsychiatric cases, dorsolateral prefrontal cortex abnormality accompanied by neuropsychiatric symptoms may be a more significant contributing factor in brain-gut axis malfunction than activation of the hypothalamic corticotropin-releasing hormone system. The proposed mechanistic model could predict novel therapeutic interventions for comorbid irritable bowel syndrome and neuropsychiatric disorders.

A panel network approach of internalizing and externalizing problems in early childhood: Evidence from American and Chinese preschoolers.

Internalizing and externalizing problems tend to co-occur beginning in early childhood. However, the dynamic interplay of symptom-level internalizing and externalizing problems that may drive their co-occurrence is poorly understood. Within the frameworks of the Network Approaches to Psychopathology and the Developmental Cascade Perspective, this study used a panel network approach to examine how symptoms of internalizing and externalizing problems are related in early childhood both concurrently and longitudinally and whether the pattern may differ in American (N = 1,202) and Chinese (N = 180) preschoolers. Internalizing and externalizing problems were rated by mothers in two waves. Results from cross-sectional networks showed that the bridge symptoms underlying the co-occurrence of internalizing and externalizing problems were largely consistent in American and Chinese preschoolers (e.g., withdrawal, aggressive behavior, anxiety and depressive moods). Results from cross-lagged panel networks further showed that the co-occurrence was manifested by unidirectional relations from internalizing to subsequent externalizing symptoms in both American and Chinese preschoolers. The findings contribute needed cross-cultural evidence to better understand the co-occurrence of internalizing and externalizing problems and highlight the temporal heterogeneity of the symptom networks of internalizing and externalizing problems in early childhood.

Clinical study on anorexia in patients with terminal cancer.

Patients with terminal cancer tend to have an increased frequency of a variety of clinical symptoms, including anorexia, at 1 month of life expectancy. This study examined clinical symptoms affecting anorexia in patients with terminal cancer. Of 1068 patients with terminal cancer who died and were discharged from our hospital between April 2014 and March 2016, we included 471 patients whose clinical symptoms could be subjectively assessed within 4 weeks before death.Patients were evaluated subjectively on a scale of 0 to 10 (11-point scale) using the Numerical Rating Scale (NRS) once a week for nine major clinical symptoms: (1) pain, (2) general fatigue, (3) dyspnea, (4) depressed mood, (5) anorexia, (6) insomnia, (7) nausea, (8) constipation, and (9) dry mouth. Primary data within 4 weeks prior to death were used for analysis, and Spearman's rank correlation was used to examine clinical symptoms affecting anorexia. Spearman's rank correlation coefficients between anorexia and the following clinical symptoms were: pain, 0.186; general fatigue, 0.414; dyspnea, 0.15; depressed mood, 0.287; insomnia, 0.327; nausea, 0.297; constipation, 0.215; and dry mouth, 0.204. General fatigue was positively correlated with anorexia. General fatigue may influence anorexia in patients with terminal cancer.

A self-help mobile messaging intervention to improve subthreshold depressive symptoms among older adults in a socioeconomically deprived region of Brazil (PRODIGITAL): a pragmatic, two-arm randomised controlled trial

Subthreshold depression is a risk factor for major depression and is associated with increased morbidity and mortality, especially in older adults. There is emerging evidence that digital interventions, including self-help interventions, may reduce depressive symptoms. We aimed to evaluate the effectiveness of a mobile messaging intervention at reducing subthreshold depressive symptoms among older adults in Brazil. PRODIGITAL was a single blind, two-arm, individually randomised controlled trial conducted in 46 primary care clinics in the city of Guarulhos, Brazil. Individuals aged 60+ years were contacted by phone following a randomly ordered list for a screening assessment. Those who presented with anhedonia and/or depressed mood (Patient Health Questionnaire (PHQ)-2≥1), and who subsequently scored between 5 and 9 on the PHQ-9 were invited to participate. The intervention arm received the 'Viva Vida' digital self-help intervention consisting of automated multi-media messages sent via WhatsApp. Forty-eight audio and visual messages based on psychoeducation and behavioural activation were automatically delivered over six weeks. The control arm received a single message containing information about depression. The primary outcome was the difference in mean PHQ-9 scores between treatment arms at the three-month follow-up. All primary analyses were performed according to allocated arm with imputed data. The trial is registered with ReBEC, RBR-6c7ghfd. Participants were recruited between 8 September 2021 and 19 August 2022. Of the 454 participants enrolled, 223 were randomised to the intervention arm, 231 to the control arm. Participants' mean age was 65.3 years (SD 5.0) and 64.0% (n=292) were female. A total of 385 (84.8%) completed the three-month follow-up assessment; no difference in mean PHQ-9 scores between the treatment arms was observed (adjusted difference:-0.61; 95% CI:-1.75, 0.53; p=0.29). These results demonstrate that the Viva Vida digital self-help intervention did not help to improve subthreshold depressive symptoms amongst older adults. Further research is needed to understand why this self-help intervention was not effective in this population, and to explore how it might be adapted to achieve this goal. São Paulo Research Foundation and UK Joint Global Health Trials.

First bipolar episode following booster dose of COVID-19 vaccination

Introduction and importance: The interactions between the susceptibility of the host and some of the COVID-19 vaccine components happened. Viral infections, including COVID-19, are related to the pathogenesis of bipolar disorder (BD). These findings could trigger an initial bipolar episode. Case presentation: A 48-year-old Syrian married female, presented to the out-clinic of Modern Medical Centre Hospital, in July 2022 for episodes of sub-maniac/mania episodes, which began within 15 days after the booster dose of COVID-19 vaccination, preceded by depressive mood. Both family and personal past psychiatric and/or trauma history were negatives. Initiation of carbamazepine 600 mg/day showed significant improvement within 3 days; 3 months later, carbamazepine dose was decreased to 200 mg/day, as there were no clinical symptoms. Clinical discussion: mRNA vaccines of COVID-19 increase the levels of type I interferon (INF), an inflammatory cytokine that creates a signal leading to the expression of interleukins, INF, and tumor necrosis factor-alpha. The pathology of BD is also unclear. Genetic predisposition, immunological effects, and the classification of BD, itself, as an autoimmune disease play a role. Although rapid improvement following treatment, prolonged and maintenance treatment by essentially mood stabilizer should be considered in bipolar episodes initiated by COVID-19 vaccination. Rare data are available about maniac episodes after COVID-19 infection, but to our knowledge, we reported the first case of bipolar onset after the booster vaccination of COVID-19. Conclusion: Bipolar disease can present following a booster dose of COVID-19 vaccination in previously healthy people.

Glutamatergic Modulators for Major Depression from Theory to Clinical Use.

Major depressive disorder (MDD) is a chronic, burdensome, highly prevalent disease that is characterized by depressed mood and anhedonia. MDD is especially burdensome as approved monoamine antidepressant treatments have weeks-long delays before clinical benefit and low remission rates. In the past 2decades, a promising target emerged to improve patient outcomes in depression treatment: glutamatergic signaling. This narrative review provides a high-level overview of glutamate signaling in synaptogenesis and neural plasticity and the implications of glutamate dysregulation in depression. Based on this preclinical evidence implicating glutamate in depression and the rapid improvement of depression with ketamine treatment in a proof-of-concept trial, a range of N-methyl-D-aspartate (NMDA)-targeted therapies have been investigated. While an array of treatments has been investigated in registered phase 2 or 3 clinical trials, the development of most of these agents has been discontinued. Multiple glutamate-targeted antidepressants are actively in development, and two are approved. Nasal administration of esketamine (Spravato®) was approved by the US Food and Drug Administration (FDA) in 2019 to treat adults with treatment-resistant depression and in 2020 for adults with MDD with acute suicidal ideation or behavior. Oral combination dextromethorphan-bupropion (AXS-05, Auvelity® extended-release tablet) was FDA approved in 2022 for the treatment of MDD in adults. These approvals bolster the importance of glutamate in depression and represent an exciting breakthrough in contemporary psychiatry, providing new avenues of treatment for patients as first-line therapy or with either poor response or unacceptable side effects to monoaminergic antidepressants.

Quality of life and survivorship in patients with low-grade ovarian cancer

ObjectiveHigh-grade (HGOC) and low-grade ovarian carcinoma (LGOC) are distinct malignancies with different biological features, treatment paradigms, and life expectancies. However, differences in quality of life (QOL), sleep, and depressive symptoms have not been examined by grade, and neither have inflammatory profiles associated with these symptoms. We aim to characterize QOL and biomarkers by OC grade. MethodsParticipants included patients with HGOC (N = 578) or LGOC (N = 85). Participants completed baseline assessments of psychosocial factors prior to primary surgery or neoadjuvant chemotherapy and contributed saliva for cortisol and blood for interleukin-6 (IL-6) quantification. Samples were collected intraoperatively to quantify tumor cortisol. General linear models were used to examine differences in biological and psychological variables by grade. ResultsAt baseline, patients with LGOC reported less depression (p = 0.018) and sleep disturbances (p = 0.014), but no significant difference in depressive mood (p = 0.11) or QOL (p = 0.51) compared to patients with HGOC, adjusting for age and disease stage. There were trends towards lower tumor cortisol levels (p = 0.078) in LGOC compared to HGOC. One-year post-diagnosis, we found a significant improvement in QOL and fatigue, and a decrease in vegetative depression and IL-6 levels irrespective of grade. ConclusionsWe present the first characterization of psychosocial experiences of patients with LGOC. Despite having a better disease prognosis, patients with LGOC were just as likely to have mood disturbances as those with HGOC. There was a trend towards differences in tumor cortisol by grade. Our findings highlight the need to address well-being in patients with both low- and high-grade ovarian malignancies.

Delaying high school start times impacts depressed mood among students: evidence from a natural experiment.

Delaying high school start times prolongs weekday sleep. However, it is not clear if longer sleep reduces depression symptoms and if the impact of such policy change is the same across groups of adolescents. We examined how gains in weekday sleep impact depression symptoms in 2,134 high school students (mean age 15.16 ± 0.35 years) from the Minneapolis metropolitan area. Leveraging a natural experiment design, we used the policy change to delay school start times as an instrument to estimate the effect of a sustained gain in weekday sleep on repeatedly measured Kandel-Davies depression symptoms. We also evaluated whether allocating the policy change to subgroups with expected benefit could improve the impact of the policy. Over 2 years, a sustained half-hour gain in weekday sleep expected as a result of the policy change to delay start times decreased depression symptoms by 0.78 points, 95%CI (-1.32,-0.28), or 15.6% of a standard deviation. The benefit was driven by a decrease in fatigue and sleep-related symptoms. While symptoms of low mood, hopelessness, and worry were not affected by the policy on average, older students with greater daily screen use and higher BMI experienced greater improvements in mood symptoms than would be expected on average, signaling heterogeneity. Nevertheless, universal implementation outperformed prescriptive strategies. High school start time delays are likely to universally decrease fatigue and overall depression symptoms in adolescents. Students who benefit most with respect to mood are older, spend more time on screens and have higher BMI.

The Effect of Sleep Quality on Stress Levels in Night Shift and Non-night Shift Workers: A Cross-Sectional Study

The sleep–wake cycle, which is regulated by the endogenous circadian rhythm, is disrupted by night-shift work. Altered sleep patterns owing to shift work have been associated with irritability, depressed mood, anxiety, and nervousness. The objective of the study was to evaluate the effect of sleep quality on stress in night shift workers and non-night shift workers. A cross – sectional study was conducted in 30night shift and 30 non-night shift workers of Railway Mail Service and Postal Department, Thrissur, Kerala. Sleep quality was assessed using Pittsburg Sleep Quality Index and stress was assessed using Perceived Stress Scale. The findings revealed that a majority of night shift workers reported poor sleep quality, with a significant correlation observed between sleep quality and shift work. Furthermore, stress levels were markedly higher among night workers with poor sleep quality. Regression analysis indicated a positive association between impaired sleep quality and elevated stress levels.

Comparative cross-sectional study of comorbid depression in patients with irritable bowel syndrome and chronic gastritis at an urban outpatient clinic

This comparative cross-sectional study evaluates the prevalence of comorbid depression in patients with Irritable Bowel Syndrome (IBS) and chronic gastritis (CG) at an urban outpatient clinic. A total of 178 patients—89 diagnosed with IBS and 89 with CG—were assessed for depressive symptoms using the Beck Depression Inventory-II (BDI-II) and the 21-item Hamilton Depression Rating Scale (HDRS-21). Our findings indicate a significantly higher prevalence of depression in IBS patients, with 71.9% meeting criteria for depression based on the BDI-II and 70.8% based on the HDRS-21, compared to 10.1% in CG patients. The study highlights that retardation symptoms, including depressed mood and loss of interest, are central to depression and contribute to substantial impairment in daily activities and quality of life. Additionally, anxiety and somatization were prominent in the IBS cohort. This study emphasizes the need for integrated care approaches that address both gastrointestinal and psychological symptoms, fostering improved patient management and outcomes. Our results underscore the importance of regular psychological assessments in IBS patients, particularly those without overt depressive symptoms, to enhance their overall well-being.

Social factors that promote resilience in adolescents with depression: a systematic review

Abstract Background A socially protective environment matters. Social factors can protect against the development of depression among adolescents in community samples. There is however scant knowledge about their buffering role on the impact of depressive symptoms in adolescents in a clinical setting. Understanding these factors can help explaining why some children function well despite of their depression symptoms. In this review, we aimed to identify which social protective factors mitigate impairment from depression in adolescents. Methods We included peer-reviewed, cross-sectional and longitudinal studies using the following search strategy: Social protective factors AND depression or depression symptoms AND adolescents AND daily impairment, yielding 1737 hits. Included studies focused on social protective factors in relation to a depression diagnosis or depression symptoms severity, in adolescents age 11-24. Preliminary results We found 6 studies that examined the relationship between social protective factors and impairment or severity of depression symptoms in adolescents with a clinical depression or elevated symptoms. In these studies, higher rates of parental attachment, parental monitoring and school belonging moderated the relation between depression symptoms and daily impairment. Higher rates of family support and peer belonging were associated with the low depressed mood group. The rest of the studies tested the association of social protective factors on the development of depression symptoms in non-clinical populations. Conclusions There are limited studies on the buffering role of social protective factors in adolescents with clinical depression. Next, we will focus on non-clinical, longitudinal studies to explore which social protective factors moderate the development of depression over time. We aim to identify social factors that can mitigate the development of depression in community samples and are potentially important for clinical settings. Key messages • There is a scarcity of studies that explored the relation between social protective factors in adolescents with elevated depression symptoms or depression diagnosis. • The role of social protective factors that moderate the development of adolescent depression symptoms over time should be prioritized in the development of intervention programs.

The connection between anemia and limitations in daily activities among older males: the critical role of dynapenia

AimThe aim of the present study was to examine the relationship between anemia and basic and instrumental activities of daily living in older male patients.MethodsA total of 223 older males attending one geriatric outpatient clinic were included in this cross-sectional study. Anemia was defined as a hemoglobin level below 13 g/dL. Patients’ demographic characteristics, comorbidities, and comprehensive geriatric assessment parameters were also recorded. Handgrip strength of < 27 kg for males was accepted as dynapenia. Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) questionnaires were used to evaluate functional capacity.ResultsThe mean age (standard deviation) of the participants was 80.17 (7.69) years. The prevalence of patients with anemia was 43.9%. There was differences between anemic and non-anemic groups in terms of presence of diabetes mellitus (DM), congestive heart failure (CHF), chronic kidney disease (CKD), malnutrition, dynapenia, geriatric depression, BADL and IADL scores (all p < 0.05). In multivariate analysis, after adjusting for all confounding variables except for dynapenia, patients with anemia were associated with reduced BADL and IADL (all p < 0.05). After adjusting for all confounding variables including dynapenia, deterioration in total BADL and IADL scores did not remain significant in the anemic group compared to the non-anemic group (p > 0.05).ConclusionClose to one in two older outpatient men had anemia. Anemic men had a higher incidence of DM, CHF, CKD, malnutrition, geriatric depression and dynapenia. Anemia was associated with dependence in both BADL and IADL in older men. However, comorbidities, nutritional status, depressive mood and, specifically muscle strength, were important contributors to this association.

EFEITOS DA TERAPIA MANUAL NA OSTEOARTRITE DE QUADRIL E JOELHO:REVISÃO INTEGRATIVA.1

Osteoarthritis commonly affects the hips and knees, causing joint pain, stiffness and reduced range of motion, which results in fatigue, depressed mood and functional limitations, including difficulty walking. Manual therapy as a special physiotherapeutic technique is also recommended in knee OA. The general objective of the study was to investigate the effects of manual therapy on improving the symptoms of people with knee and hip osteoarthritis. As for the methodology, it was an Integrative Literature Review with a search from 2019 to 2024 in the PEDRO, SCIELO, LILACS and MEDLINE databases. 53 studies were found in the aforementioned databases, however, after the selection only 5 articles were included, the results of the analyzed studies indicated that different intervention techniques have been used, such as mobilization with movement, Mulligan techniques, Thermal Therapy Focal and Maitland Mobilization, to reduce pain and improve the physical function of those affected. These studies have important clinical implications, suggesting that physical therapists and other healthcare professionals should consider incorporating these techniques into their treatment protocols for knee osteoarthritis.

My virtual escape from patient life: a feasibility study on the experiences and benefits of individualized virtual reality for inpatients in palliative cancer care

BackgroundCancer patients benefit from Virtual Reality (VR) in burdensome situations, but evidence is scarce for palliative situations. Based on earlier work in palliative care, individualized VR interventions like seeing the patient’s home may address a patient’s wish to be at home and thus have a greater effect compared to standard VR content. Yet, some patients and relatives may be concerned about their privacy. Also, patient stakeholders raised concerns about triggering depressed mood or homesickness.AimTo test the feasibility and safety of individualized vs. standard 360°video VR interventions in palliative cancer inpatients.MethodsProspective observational study with patient-reported outcome measurement using validated instruments of well-being (MDBF), symptoms and psychosocial burden (IPOS), cybersickness (SSQ), presence experience (SPES), subjective benefit (2 items), content analysis of interviews, and field notes. Individualized VR content was recorded with action camcorder-technology to protect the patients’ privacy.ResultsSeventeen patients participated, median age 65 years (range 20–82), 9 women (53%), 8 single or widowed (47%), 4 childless (23.5%), 4 academics (23.5%), with a median length of stay of 9 days (1–75) in the hematology (10), palliative care (3), or radiotherapy (2) unit of a German university hospital. Eight patients (53.3%) chose their own home environments or family for individualized VR-content. All participants enjoyed the intervention. Compared to standard VR content the individualized VR tended to have a stronger effect on well-being and emotional touch. It was not inferior in terms of psychosocial burden and cybersickness. No subjective and relevant side effects occurred. The patients well tolerated the assessments. However, most patients demanded a lighter headset and a desire for more interactivity.ConclusionsIndividualization of VR content shows potential for enhancement of immersion, which improves the VR experience and does not harm in terms of depressed mood or worsening of symptoms. The patients’ and family desire for privacy is feasible with the support of family members who recorded the individualized videos, which is easily manageable today. We suggest a pragmatic randomized clinical trial to compare the effects of individualized vs. standard VR-content.Trial registrationRegistered at German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS); registration number: DRKS00032172; registration date: 11/07/2023.

Prevalence and features of headache in Parkinson's disease: the role of dopamine.

Parkinson's disease (PD) is characterized by the progressive loss of dopaminergic neurons in the substantia nigra, but dopamine also plays a role in the pathophysiology of migraine. The aim of this study is to assess lifetime and previous year prevalence rates of headache in PD patients compared with controls. We enrolled 101 patients (57M and 44W) and 101 controls (62M and 39W), comparable for age and gender, who underwent a semi-structured questionnaire to assess the occurrence and the features of headache, and Beck Depression Inventory (BDI). We did not find any significant differences in the overall prevalence of lifetime and last 12-month headache between the two groups, as well as lifetime and last year tension-type headache (TTH) and migraine. Patients, especially those suffering from migraine and treated with dopamine agonists (DA), more frequently showed headache remission after the onset of motor symptoms compared to the age-related remission observed in controls(p = 0.001). Patients affected by headache were less frequently treated with DA in comparison with those without (p = 0.051). Depression of mood was more severe among PD patients with migraine than with TTH (p = 0.021). PD patients with headache exhibiting the akinetic-rigid subtype more frequently reported motor fluctuations than those presenting with tremor-dominant disease (p = 0.040). The prevalence of headache in PD follows that described in the general population, but dopaminergic pathway degeneration, loss of dopamine activation on the trigeminal-vascular system, and DA treatment might favor migraine improvement and remission in PD patients.

Immigration‐related stress, depression, and positive parenting among undocumented Central American immigrant mothers

AbstractObjectiveThe purpose of the current study was to examine whether immigration‐related stress is associated with reduced positive parenting and whether this association is mediated by depressive symptoms in undocumented Central American immigrant mothers.BackgroundIn the context of “illegality,” parents can face myriad stressors related to their immigration status, which may lead to heightened emotions, including depressed mood. These experiences may affect family life, including the ways in which immigrant mothers parent their children.MethodThis study examined survey data generated in 2016–2017 by researchers using a community‐based participatory action research approach in partnership with Central American immigrant mothers residing in the Washington, DC, region. The sample for this study included 117 undocumented Central American immigrant mothers of children aged 3 to 11 years.ResultsControlling for age of child, mother's education, and relationship status, analyses revealed that immigration‐related stress was associated with heightened levels of depressive symptoms for mothers. However, mothers' symptoms of depression were not associated with positive parenting. Additionally, no association between immigration‐related stress and positive parenting was found.ConclusionsFindings suggest that mothers, although affected by immigration‐related stress in terms of their own mood symptoms, may deploy mechanisms such as parental self‐sacrifice to protect their children from anti‐immigrant harms.ImplicationsFindings hold implications for future research, including research approaches, and practice.

Validation of 11 added items of the outpatient version of the Utrecht Symptom Diary in patients receiving chemotherapy or targeted therapy

IntroductionThe Utrecht Symptom Diary (USD) is a validated Dutch patient-reported outcome measurement (PROM) tool - based on the Edmonton Symptom Assessment System - to assess and monitor symptoms in cancer patients. The USD contains 11 items concerning frequently occurring symptoms in cancer patients (pain, sleeping problems, dry mouth, dysphagia, lack of appetite, abnormal stool, nausea, shortness of breath, fatigue, anxiety and depressed mood) and an item on overall well-being. For the outpatient USD 11 items concerning frequently occurring signs and symptoms in patients receiving chemotherapy and/or targeted therapy were added to the USD: taste alteration, oral pain, weight loss, diarrhoea, hair changes, skin problems, nail problems, eye problems, tingling, concentration problems and problems with sexuality. This current study aimed to evaluate the 11 added items on this treatment specific outpatient USD in cancer patients receiving intravenous chemotherapy and/or targeted therapy.MethodsObservational longitudinal retrospective cohort study including all adult outpatients with cancer receiving intravenous chemotherapy and/or targeted therapy in an academic hospital in the Netherlands who completed at least one outpatient USD as part of routine care (2012–2021). Relevance, comprehensiveness as well as criterion and construct validity were assessed.Results1733 patients who completed ≥ 1 outpatient USD during intravenous chemotherapy and/or targeted therapy were included for analysis. Relevance as well as comprehensiveness of the items on the outpatient USD in this patient population was shown. Criterion validation was demonstrated for all added items of the outpatient USD – except for the item on oral pain. An additional analysis showed that mouth problems were detected with both outpatient USD items oral pain and dry mouth. Construct validity was demonstrated for the items hair changes and skin and nail problems. Construct validity on eye problems was not tested due to the low number of paired outpatient USDs.ConclusionsThe treatment specific outpatient USD is a validated PROM in outpatients with cancer receiving intravenous chemotherapy and/or targeted therapy. Considering its validity in this broad group of patients, we think the treatment-specific outpatient USD is widely applicable. In addition to providing tailored supportive symptom care, the USD-data can be used to increase knowledge about symptom burden in daily practice in this population.