Diagnosis Of Depressive Disorder Research Articles

Resting-state functional magnetic resonance imaging and support vector machines for the diagnosis of major depressive disorder in adolescents

BACKGROUND Research has found that the amygdala plays a significant role in underlying pathology of major depressive disorder (MDD). However, few studies have explored machine learning-assisted diagnostic biomarkers based on amygdala functional connectivity (FC). AIM To investigate the analysis of neuroimaging biomarkers as a streamlined approach for the diagnosis of MDD in adolescents. METHODS Forty-four adolescents diagnosed with MDD and 43 healthy controls were enrolled in the study. Using resting-state functional magnetic resonance imaging, the FC was compared between the adolescents with MDD and the healthy controls, with the bilateral amygdala serving as the seed point, followed by statistical analysis of the results. The support vector machine (SVM) method was then applied to classify functional connections in various brain regions and to evaluate the neurophysiological characteristics associated with MDD. RESULTS Compared to the controls and using the bilateral amygdala as the region of interest, patients with MDD showed significantly lower FC values in the left inferior temporal gyrus, bilateral calcarine, right lingual gyrus, and left superior occipital gyrus. However, there was an increase in the FC value in Vermis-10. The SVM analysis revealed that the reduction in the FC value in the right lingual gyrus could effectively differentiate patients with MDD from healthy controls, achieving a diagnostic accuracy of 83.91%, sensitivity of 79.55%, specificity of 88.37%, and an area under the curve of 67.65%. CONCLUSION The results showed that an abnormal FC value in the right lingual gyrus was effective as a neuroimaging biomarker to distinguish patients with MDD from healthy controls.

An historical overview of artificial intelligence for diagnosis of major depressive disorder

The Artificial Intelligence (AI) technology holds immense potential in the realm of automated diagnosis for Major Depressive Disorder (MDD), yet it is not without potential shortcomings. This paper systematically reviews the research progresses of integrating AI technology with depression diagnosis and provides a comprehensive analysis of existing research findings. In this context, we observe that the knowledge-driven first-generation of depression diagnosis methods could only address deterministic issues in structured information, with the selection of depression-related features directly influencing identification outcomes. The data-driven second-generation of depression diagnosis methods achieved automatic learning of features but required substantial high-quality clinical data, and the results were often obtained solely from the black-box models which lack sufficient explainability. In an effort to overcome the limitations of the preceding approaches, the third-generation of depression diagnosis methods combined the strengths of knowledge-driven and data-driven approaches. Through the fusion of information, the diagnostic accuracy is greatly enhanced, but the interpretability remains relatively weak. In order to enhance interpretability and introduce diagnostic criteria, this paper offers a new approach using Large Language Models (LLMs) as AI agents for assisting the depression diagnosis. Finally, we also discuss the potential advantages and challenges associated with this approach. This newly proposed innovative approach has the potential to offer new perspectives and solutions in the diagnosis of depression.

Self-Rated ECT Outcomes in Patients With Depression: A Naturalistic Single-Site Study.

Electroconvulsive therapy (ECT) is considered to be the most effective treatment for severe depression. This study investigated recent ECT outcomes for depression at a large tertiary center, which also provides community care. Data were obtained from Mayo Clinic Rochester patients ages 18 and older who received an acute course of ECT between August 1, 2017 and April 30, 2024. Patients were included if there was a depressive disorder diagnosis (unipolar or bipolar) and a self-rated Patient Health Questionnaire-9 (PHQ-9) within 10 days of the start and end of the acute course. Patients were excluded if the starting PHQ-9 score was less than 10. The age, sex, number of acute course treatments, stimulus electrode lead placement, and PHQ-9 scores were collected. Response (PHQ-9 improvement ≥50%) and remission (PHQ-9 < 5) rates were calculated. Linear and logistic regressions were performed to investigate predictors of response and remission. Of 1206 patients identified, 408 met final inclusion and exclusion criteria. The response rate was 80.4%, and remission rate was 52.7%. Logistic regression for response showed no significant predictors; the P value for age just missed statistical significance (odds ratio, 1.0152; 95% confidence interval, 0.9991-1.0316; P = 0.0641). Logistic regression for remission showed only a lower baseline PHQ-9 score (odds ratio, 0.9465; 95% confidence interval, 0.9049-0.9891; P = 0.0152) as a significant predictor. Our results affirmed the high efficacy of ECT in severe depression. No other established treatment for depression can report a response rate as high as 80% in a naturalistic study. This study supports the continued relevance and place of ECT for severe depression.

Identification of Potential Diagnostic Markers for Depressive Disorders using Urinary Biomarkers of N-Methylnicotinamide and Hippuric Acid

Introduction: The diagnostic methodology for depressive disorders, relying on symptom clusters, has inherent limitations in ensuring heterogeneity levels. Consequently, this presents a notable risk of inevitable diagnostic errors in mental health assessments. Therefore, advocating for objective diagnostic approaches through empirical testing in clinical settings becomes crucial for individuals dealing with depressive disorders. This study aims to identify the effectiveness of urine as a diagnostic support for depressive disorders using the N-Methylnicotinamide and Hippuric Acid biomarkers. Methods: This study used 13 urine samples from patients with depressive disorders and 13 normal urine samples. It used ELISA methods with observational analytic and cross-sectional designs. Results: The results showed that the N-methylnicotinamide biomarker had a relationship with depressive disorders with a correlation value of 0.867, while hippuric acid obtained a correlation value of 0.692. Besides, the N-Methylnicotinamide and Hippuric Acid biomarkers showed differences in the urine of depressive disorder and normal patients with significance values of 0.000 and 0.001 for the N-Methylnicotinamide and Hippuric Acid biomarkers, respectively. In addition, the Relative Operating Characteristics curve analysis showed that these two biomarkers had good sensitivity and specificity values in assisting the diagnosis of depressive disorders. N-methylnicotinamide has a sensitivity of 92.3% and a specificity of 100%, while hippuric acid has a sensitivity of 76.9% and a specificity of 84.6%. Conclusions: Significant differences in the biomarkers of N-methylnicotinamide and hippuric acid in the urine of depressed patients compared to normal patients. Therefore, these biomarkers can be the empirical laboratory methods to support the diagnosis of depressive.

Sexual Trauma, Polygenic Scores, and Mental Health Diagnoses and Outcomes

Leveraging real-world clinical biobanks to investigate the associations between genetic and environmental risk factors for mental illness may help direct clinical screening efforts and evaluate the portability of polygenic scores across environmental contexts. To examine the associations between sexual trauma, polygenic liability to mental health outcomes, and clinical diagnoses of schizophrenia, bipolar disorder, and major depressive disorder in a clinical biobank setting. This genetic association study was conducted using clinical and genotyping data from 96 002 participants across hospital-linked biobanks located at Vanderbilt University Medical Center (VUMC), Nashville, Tennessee (including 58 262 individuals with high genetic similarity to the 1000 Genomes Project [1KG] Northern European from Utah reference population [1KG-EU-clustered] and 11 047 with high genetic similarity to the 1KG African-ancestry reference population of Yoruba in Ibadan, Nigeria [1KG-YRI-clustered]), and Mass General Brigham (MGB), Boston, Massachusetts (26 693 individuals with high genetic similarity to the combined European-ancestry superpopulation [1KG-EU-clustered]). Clinical data analyzed included diagnostic billing codes and clinical notes spanning from 1976 to 2023. Data analysis was performed from 2022 to 2024. Clinically documented sexual trauma disclosures and polygenic scores for schizophrenia, bipolar disorder, and major depressive disorder. Diagnoses of schizophrenia, bipolar disorder, and major depressive disorder, determined by aggregating related diagnostic billing codes, were the dependent variables in logistic regression models including sexual trauma disclosure status, polygenic scores, and their interactions as the independent variables. Across the VUMC and MGB biobanks, 96 002 individuals were included in analyses (VUMC 1KG-EU-clustered: 33 011 [56.7%] female; median [range] age, 56.8 [10.0 to >89] years; MGB 1KG-EU-clustered: 14 647 [54.9%] female; median [range] age, 58.0 [10.0 to >89] years; VUMC 1KG-YRI-clustered: 6961 [63.0%] female; median [range] age, 44.6 [10.1 to >89] years). Sexual trauma history was associated with all mental health conditions across institutions (ORs ranged from 8.83 [95% CI, 5.50-14.18] for schizophrenia in the VUMC 1KG-YRI-clustered cohort to 17.65 [95% CI, 12.77-24.40] for schizophrenia in the VUMC 1KG-EU-clustered cohort). Sexual trauma history and polygenic scores jointly explained 3.8% to 8.8% of mental health phenotypic variance. Schizophrenia and bipolar disorder polygenic scores had greater associations with mental health outcomes in individuals with no documented disclosures of sexual trauma (schizophrenia interaction: OR, 0.70 [95% CI, 0.56-0.88]; bipolar disorder interaction: OR, 0.83 [95% CI, 0.74-0.94]). Sexual trauma and mental health polygenic scores, while correlated with one another, were independent and joint risk factors for severe mental illness in a large, diverse hospital biobank population. Furthermore, associations of schizophrenia and bipolar disorder polygenic scores with respective diagnoses were greater in those without disclosures, suggesting that genetic predisposition to mental illness as measured by polygenic scores may be less impactful in the presence of this severe environmental risk factor.

Electroconvulsive therapy (ECT) and Psychiatric rehospitalization rates: a retrospective study

BackgroundElectroconvulsive therapy (ECT) induces a generalized seizure under anesthesia with an electrical current for treatment-resistant patients and may be underutilized. To our knowledge, no large-scale, American, nationwide hospital system retrospective study has examined how ECT affects psychiatric rehospitalization chances.MethodsWe analyzed initial inpatient encounters for adults aged > 18 years at HCA Healthcare Behavioral Health Units from 2016 to 2021 with diagnoses of major depressive disorder with/without psychosis, bipolar disorder with/without psychosis, schizoaffective disorder, and schizophrenia. Excluding pregnancy and incarceration cases, we compared psychiatric rehospitalization rates within 365 days for patients receiving ECT versus those with the same diagnoses not receiving ECT. Subgroup analyses were conducted by diagnosis, length of stay, sex, and race. Detailed statistical analyses included bivariate analyses with Fisher’s Exact Test and Wilcoxon Rank Sum Test.ResultsWe analyzed 38,109 distinct patients, 637 of which received ECT. The rehospitalization rate was 37.52% for ECT recipients versus 20.71% for non-ECT patients (p < 0.0001). ECT was associated with higher rehospitalization rates, particularly for severe diagnoses like psychosis (87.28%), schizoaffective disorder (3.77%), and schizophrenia (6.59%). ECT patients had significantly longer rehospitalization lengths of stay (mean 14.53 days vs. 6.54 days for non-ECT, p < 0.0001). White patients received ECT more frequently. Females received ECT more often, while males had higher rehospitalization rates.ConclusionsECT was associated with higher psychiatric rehospitalization rates and longer lengths of stay. This suggests ECT is more commonly used for complex, severe cases which may contribute to higher rehospitalization. Stronger social support and hospital and geographic ties among ECT patients may also play a role.

Challenges and Opportunities in Managing Geriatric Depression: The Role of Personalized Medicine and Age-Appropriate Therapeutic Approaches

The global aging population has experienced rapid growth in recent decades, leading to an increased prevalence of psychiatric disorders, particularly depression, among older adults. Depression in the geriatric population is often compounded by chronic physical conditions and various psychosocial factors, significantly impacting their quality of life. The main question raised in this review is as follows: how can personalized medicine and age-appropriate therapeutic approaches improve the management of geriatric depression? This paper explores the epidemiology of geriatric depression, highlighting the influence of gender, race, and socioeconomic status on its prevalence. The classification and diagnosis of geriatric depressive disorders, based on ICD-11 and DSM-5 criteria, reveal the complexity of managing these conditions in older adults. Personalized medicine (PM) emerges as a promising approach, focusing on tailoring treatments to the individual’s genetic, clinical, and environmental characteristics. However, the application of PM in this demographic faces challenges, particularly in the context of pharmaceutical forms. The need for age-appropriate drug delivery systems is critical, given the prevalence of polypharmacy and issues such as dysphagia among the older patients. This study emphasizes the importance of developing patient-centric formulations to enhance the effectiveness of personalized therapy in geriatric patients.

SARS-CoV-2 Infection And COVID-19 Outcomes Among Mental Disorders: A Register-based Study in Catalonia

Abstract This study aimed to study the risk of SARS-CoV-2 infection and severe COVID-19 outcomes across different mental diagnoses and to assess the role of sex in these associations. We used electronic health records from Catalonia to identify adults receiving inpatient/outpatient mental health care between 2017-2019 with diagnosis of non-affective psychosis (NAP), bipolar disorder (BD), depressive disorder (DEP), stress-related disorders, neurotic/somatoform disorders (NSD), and substance misuse (SUB) (exposed). Outcomes included SARS-CoV-2 infection, COVID-19 hospitalization, and COVID-19-related death. Adjusted logistic regression analyses were conducted. 785,378 adults were included (70.3% &amp;lt; 65 years old; 57.1% women). Compared to unexposed, those with NAP [OR (95%CI): 0.84 (0.80-0.88)], BD [0.80 (0.75-0.86)], DEP [0.97 (0.94-1.00)] and SUB [0.81 (0.78-0.84)] had a lower risk of SARS-CoV-2 infection, while people with NSD presented an increased risk [1.03 (1.01-1.06)]. Among those infected, people with DEP, NSD, and SUB had a lower risk of COVID-19 hospitalization, but higher risk of COVID-19-related death [1.23 (1.07-1.41); 1.26 (1.07-1.48); 1.48 (1.24-1.71), respectively]. A higher COVID-19-related death was also found in people with NAP and BD [1.68 (1.34-2.12); 2.02 (1.50-2.73)]. Sex-stratified analysis showed that women with NSD were especially vulnerable to infection [1.07 (1.03-1.11)], and women with DEP and NSD to COVID-19-related death [1.24 (1.05-1.47); 1.26 (1.02-1.54)]. These results suggest different vulnerabilities to infection and COVID-19 hospitalization and death across mental disorders. These findings have implications for pandemic preparedness, highlighting the need for specific public health strategies to mitigate the excess of mortality of people with certain mental disorders.

USO DA CETAMINA COMO ESCOLHA NO TRATAMENTO EM ADULTOS E IDOSOS COM DEPRESSÃO RESISTENTE AO TRATAMENTO

Introduction: Increasingly, there has been a rise in the diagnosis of depressive disorders among the elderly, making this issue alarming as it directly affects their quality of life and functional capacity. In addition to these aspects, this situation increases the risk of morbidity and mortality. Antidepressants, either alone or in combination with other medications, can be used to treat this type of depressive disorder. Currently, there are several classes of antidepressants available, but in the case of patients with mood disorders, the response to common antidepressants may be unsatisfactory. Studies indicate that a relevant alternative for treating resistant depression (RD) is the use of ketamine. Objective: To gather and analyze information on the pharmacological approach of ketamine in the treatment of resistant depression in the elderly. Methodology: Articles published in indexed journals in the Scientific Electronic Library Online (SCIELO), National Library of Medicine/NLM (MEDLINE), and National Library of Medicine/NLM (PUBMED) databases were evaluated, in addition to official sites such as the Ministry of Health of Brazil and the World Health Organization, covering the period from 2014 to 2024. Results: After completing the data collection phase, 29 relevant articles were identified for analysis of the proposed theme. Discussion: Based on the results obtained and the objectives of this review, it is possible to highlight the most relevant aspects of the topic in question. Thus, a positive response to treatment-resistant depression (TRD) was observed in patients treated with ketamine. Conclusion: The use of ketamine in patients with depressive disorders demonstrates rapid and lasting antidepressant effects, making it a viable treatment alternative.

Drug utilization study of antidepressant drugs in psychiatric outdoor patients at a tertiary care hospital in Southern Rajasthan

Background: The World Health Organization (WHO) defines “Drug Utilization” as the marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social, and economic consequences. Antidepressants are used to treat depressive illnesses and anxiety disorders. However, these are also employed in the pharmacotherapy of several psychiatric disorders. Very few studies were found regarding the pattern of prescription of antidepressants in outdoor patients in southern Rajasthan. So, this study has been planned to learn about the prescription pattern of antidepressant drugs as per WHO Core Drugs Prescribing indicators at a tertiary care hospital in southern Rajasthan. Methods: A cross-sectional observational study was conducted among 375 patients by convenient sampling over one year duration, in the outdoor Department of Psychiatry at RNT Medical College, Udaipur, Rajasthan. Patient’s prescriptions were analyzed for drug utilisation pattern in OPD after relevant consent. All data was compiled in MS Excel and analyzed using statistical methods. Results: Out of 375 prescriptions analyzed, 48.8% were males and 51.2% were females. Most commonly, patients had a diagnosis of depressive disorder (42.93%), followed by bipolar affective disorder (14.4%). The most common drug class prescribed was SSRI (88.86%). Escitalopram (41.65%) was the most prescribed drug, followed by Sertraline (30.51%). Conclusions: Among the prescribed antidepressants SSRIs were the most common class of drug followed by TCA. Escitalopram was the most common drug to be prescribed followed by sertraline. More than half of the patients receiving antidepressants suffered from non-depressive disorders. Monotherapy was preferred over combination therapy. All patients were prescribed generic drugs.

Two-Step Screening for Depression and Anxiety in Patients with Cancer: A Retrospective Validation Study Using Real-World Data

Background: Although screening for distress is recommended by many cancer care guidelines, the uptake of such screening in cancer centers remains limited. Improving the acceptability of screening programs in cancer centers requires a reduction in clinical burden and an improved detection of distress. The purpose of this study was to validate the performance of the two-step screening algorithm used in the Distress Assessment and Response Tool (DART) for identifying cases of anxiety and depression. Methods: This retrospective validation study consisted of patients at the Princess Margaret Cancer Centre (PM) who completed the DART, which includes the Edmonton Symptom Assessment System depression (ESAS-D) and anxiety (ESAS-A) items, the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder (GAD-7). We evaluated the performance of a two-step screening approach, which modeled the ESAS-D, followed by the PHQ-9 and ESAS-A, then the GAD-7 for predicting a diagnosis of depression and anxiety disorders, respectively. A clinical psychiatric assessment was used as the gold standard reference. Results: A total of 172 patients with cancer were included in this study. A total of 59/172 (34%) and 39/172 (23%) were diagnosed with a depression or anxiety disorder, respectively. The sequential administration of the PHQ-9 ≥15 following the ESAS-D (&gt;2) significantly increased the post-test probability of depression from 37% to 60% and improved the performance of predicting depression compared to both the ESAS-D or the PHQ-9 as standalone tests. The sequential administration of the GAD-7 after the ESAS-A did not improve the predictability of an anxiety diagnosis beyond the performance of the ESAS-A or the GAD-7 as standalone tests. Conclusions: The present study is among the first to demonstrate that a two-step screening algorithm for depression may improve depression screening in cancer using real-world data. Further research on optimal screening approaches for anxiety in cancer is warranted.

Changes in P300 amplitude to negative emotional stimuli correlate with treatment responsiveness to sertraline in adolescents with depression

ObjectiveAdolescents with depression is characterized by high rates of recurrence and functional impairment, with a significant association with suicide risk. Antidepressants are commonly prescribed to treat depression, yet few reproducible neurobiological markers for depression and antidepressant treatment response have been identified. Therefore, discovering a stable and reliable neurobiological marker holds significant value for both the clinical diagnosis and treatment of depression in adolescents. MethodsOne hundred and seven patients with major depressive disorder (MDD group, 30 males, 77 females, mean age: 14.80 years), and 25 healthy subjects (HC group, 13 males, 12 females, mean age: 15.72 years) were recruited to perform a two-choice oddball task related to negative emotional cues. All participants completed a self-administered questionnaire to gather demographic information. A trained psychiatrist administered the Hamilton Depression Scale (HAMD-17) to assess depression severity. Of the 107 adolescents with depression, 61 received antidepressant medication for 8 weeks, and 61 of these patients were followed up. Multichannel EEG was recorded continuously from 64 scalp electrodes using the Curry 8 system. EEG signal preprocessing and analysis was performed offline using the EEGLAB toolbox in MATLAB. The ERP component characteristics associated with emotional processing were extracted from the difference waves and statistically analyzed. ResultsAdolescents with depression exhibited significantly larger P300 amplitudes than healthy controls in response to both neutral and negative emotional cues. Following sertraline treatment, both depression scores and P300 amplitudes decreased significantly in adolescents with depression. Moreover, a strong positive correlation was observed between changes in depression scores and changes in P300 amplitude in response to negative emotional cues before and after treatment. ConclusionsChanges in neural reactivity to negative emotional stimuli among adolescents with depression can be selectively modulated by sertraline and are significantly associated with improvements in depressive symptoms. SignificanceChanges in P300 amplitude to negative emotional stimuli significantly correlate with treatment responsiveness to sertraline in adolescents with depression.

Genetic determinants of antidepressant and antipsychotic drug response.

Today, more than 90% of inpatients hospitalized with Major Depression or Schizophrenia are treated with psychotropic drugs. Since none of the treatment options is causal, response rates are modest and the course of recovery is very heterogeneous. Genetic studies on the etiology and pathogenesis of major psychiatric disorders over the past decades have been largely unsuccessful. Likewise, genetic studies to predict response to psychopharmacological treatment have also not been particularly successful. In this project we have recruited 902 inpatients with ICD-10 diagnoses of schizophrenic ("F2 patients") or depressive disorders ("F3 patients"). The study assessed today's acute inpatient treatment regimens with up to 8 repeated measurements regarding the time course of recovery and adverse side effects. The genotyping included 100 candidate genes with genotypic patterns computed from 549 Single Nucleotide Polymorphisms (SNPs). To predict response to psychopharmacological treatment, we relied on a multidimensional approach to analyzing genetic diversity in combination with multilayer Neural Nets (NNs). Central to this new method were the "gene vectors" that (1) assessed the multidimensional genotypic patterns observed with genes; and (2) evaluated the correlations between genes. By means of these methods, we searched for combinations of multidimensional genotypic patterns that were characteristic of treatment responders while being rare among non-responders. The chosen method of approach provided a powerful technique to detail the complex structures of SNP data that are not detectable by conventional association methods. Molecular-genetic NNs enabled correct classification of 100% "non-responders", along with 94.7% correctly classified "responders" among the F2 patients, and 82.6% correctly classified "responders" among the F3 patients. The F2 and F3 classifiers were not disjoint but showed an overlap of 29.6% and 35.7% between the diagnostic groups, thus indicating that clinical diagnoses may not constitute etiologic entities. Our results suggested that patients may have an unspecific physical-genetic disposition that enables, facilitates, impedes or prevents recovery from major psychiatric disorders by setting various thresholds for exogenous triggers that initiate improvement ("recovery disposition"). Even though this disposition is not causally linked to recovery, it can nonetheless be clinically used in the sense of a "surrogate". Indeed, clinicians are also interested in reliable tools that can "do the job", despite the fact that etiology and pathogenesis of the treated disorders remain unknown.

Combined Methylphenidate and Selective Serotonin Reuptake Inhibitors in Adults With Attention-Deficit/Hyperactivity Disorder.

Depression is a common comorbidity of adult attention-deficit/hyperactivity disorder (ADHD), and the combination of methylphenidate and selective serotonin reuptake inhibitors (SSRIs) is a frequently prescribed treatment. However, there is limited clinical evidence on the safety of this medication combination in adults with ADHD. To evaluate the safety of administering a combination of SSRI and methylphenidate in adults with ADHD and comorbid depression. This cohort study obtained data from a nationwide claims database in South Korea from January 2016 to February 2021. Participants were adults aged 18 years or older with a diagnosis of ADHD and depressive disorder who were prescribed methylphenidate. Comparisons of 4 groups who received prescriptions were conducted: (1) SSRI plus methylphenidate (hereafter, SSRI) group vs methylphenidate-only group and (2) methylphenidate plus fluoxetine (hereafter, fluoxetine) group vs methylphenidate plus escitalopram (hereafter, escitalopram) group (compared to find a preferable treatment option). Data analysis was conducted between July and December 2023. New users of the methylphenidate and SSRI combination among adults with both ADHD and depressive disorder. A total of 17 primary and secondary outcomes, including neuropsychiatric and other events, were assessed, with respiratory tract infection used as a control outcome. Groups were matched at a 1:1 ratio using a propensity score to balance confounders. A Cox proportional hazards regression model was used to calculate hazard ratio (HRs) and 95% CIs. Subgroup analysis by sex and sensitivity analyses in varying epidemiologic settings were conducted. The study included 17 234 adults with ADHD (mean [SD] age at study entry, 29.4 [10.8] years; 9079 females [52.7%]). There was no difference in the risk of outcomes between the methylphenidate-only and SSRI groups, except for a lower risk of headache in the SSRI group (HR, 0.50; 95% CI, 0.24-0.99). In sensitivity analyses of fluoxetine vs escitalopram, the risk of hypertension (HR: 1:n matching, 0.26; 95% CI, 0.08-0.67) and hyperlipidemia (HR: 1:n matching, 0.23; 95% CI, 0.04-0.81) was lower in the fluoxetine group than in the escitalopram group. Results of this study revealed no significant increase in adverse event risk associated with use of SSRI plus methylphenidate vs methylphenidate alone in adults with ADHD and comorbid depression. Instead, the combination was associated with a lower risk of headache.

12270 Adolescent PCOS With Unexpected, Sudden-onset GAD And MDD: A Call For Vigilance In Longitudinal PCOS Care

Abstract Disclosure: K.I. Sarkisian: None. T. Aliabadi: None. F.Z. Stanczyk: None. Background: Polycystic Ovary Syndrome (PCOS) is a multifaceted endocrine disorder often associated with psychiatric disorders, yet the integration of psychiatric monitoring and multidisciplinary care following diagnosis remains understated as a guideline of clinical management of PCOS post-diagnosis. Historically, psychiatric comorbidities in PCOS have been attributed to social and personal factors such as self-image and self-esteem. However, the present patient’s denial of thoughts of disordered eating and lack of self-esteem related to acne or hirsutism challenges these assumptions.Clinical Case: A 13-year-old girl presented with classic symptoms of PCOS, including hirsutism, irregular and painful periods, and premature adrenarche. Laboratory investigations revealed an elevated total testosterone level (58 ng/dL, normal&amp;lt;38 ng/dL), consistent with PCOS. Previously, the patient had not expressed any concerns about mood. However psychological symptoms emerged alongside the physical symptoms. A psychological assessment performed by a licensed therapist revealed moderate-to-severe generalized anxiety disorder (GAD), which had rapidly worsened in a matter of weeks. Both the patient and the patient’s parents denied prior symptoms of moderate-to-severe anxiety before the onset of PCOS symptoms. Over the course of follow-up spanning 47 months, the patient documented symptoms, tracking both mood and PCOS fluctuations. During the follow-up period, the patient’s mood worsened, leading to the formal diagnosis of Major Depressive Disorder (MDD), despite a low assessed risk, no family history, and no symptoms prior to her PCOS development. The diagnoses of GAD and MDD were later confirmed through neuropsychiatric testing by a licensed psychologist.Clinical Lessons: While this presentation may not be considered novel in the context of PCOS, its overwhelming prevalence underscores the need for heightened awareness and research on the topic. The patient, previously considered low-risk for psychiatric conditions, experienced an unexpected onset of GAD and MDD concurrently with the diagnosis of PCOS. It is imperative to recognize that PCOS patients defy the conventional categorization of ‘healthy’ individuals concerning psychiatric care. This notion holds significance not only in clinical practice but also in research endeavors. Merely attributing psychiatric comorbidities in PCOS patients to social factors overlooks the unforeseen presentations of psychiatric disorders, as demonstrated in this patient. These manifestations cannot be solely attributed to social aspects of identity-insecurity, emphasizing the need for a more nuanced, proactive approach to psychiatric care in PCOS. This is crucial for achieving the best long-term prognosis and quality of life in affected individuals. Presentation: 6/1/2024

Childhood illnesses as risk indicators of adult mental health symptomatology

BackgroundLinks between childhood illnesses such as acne and migraines and co-occurring or subsequent mental health symptomatol-ogy are not well understood. Early medical histories have seldom been examined as adversity risk indicators.Participants and procedureThis survey analysis of college students (N = 2,636) examined links between four forms of childhood illness (migraine head-aches, acne, asthma, and enuresis) and adult mental health symptomatology.ResultsFour medical conditions often diagnosed in childhood or adolescence were prevalent enough in the college sample to test as risk indicators for lifetime mental health concerns. All four medical illnesses significantly raised the odds (ORM = 2.04) of lifetime depressive and anxiety disorder diagnoses. Current symptomatology was also raised for all but one (enuresis) medi-cal condition. These effects were found after controlling for respondent age and various forms of childhood maltreatment (sexual, physical, and/or emotional abuse).ConclusionsHeightened awareness of medical histories during clinical intake assessments seems warranted. Adversity researchers might also consider the inclusion of childhood medical conditions as future maladjustment risk indicators. Study limitations included the cross-sectional design and unclearly specified timing of the self-reported psychological and health recollections. The role of modulating variables such as gender, ethnicity, socioeconomic status, and family climate in physical-mental health relationships warrants continued focus.

Impact of a tubeless, disposable insulin pump on emergency department visits and inpatient admissions among a Medicare population.

A tubeless, disposable insulin pump (Omnipod DASH Insulin Management System, Insulet Corporation) has demonstrated improved glycemic outcomes for people with diabetes who require insulin. The impact of the system on downstream health care events has not been studied. To assess health care resource utilization for a Medicare population before and after starting tubeless, disposable insulin pump therapy. This retrospective, observational analysis used data from the Centers for Medicare & Medicaid Services 100% Research Identifiable Files. Study outcomes included change in event rates for diabetes-related emergency department (DRED) visits, all-cause emergency department (ACED) visits, diabetes-related inpatient (DRIP) admissions, and all-cause inpatient (ACIP) admissions among Medicare beneficiaries who started the tubeless, disposable insulin pump in 2020 (postpump observation period) as compared with the same duration and calendar period in 2019 (prepump observation period) with no pump use. Subgroup analyses were performed based on Medicare entitlement reason, diabetes type, and diagnosis status for depressive disorder. A total of 811 users met the criteria for analysis: 46.2% had type 2 diabetes, a majority (59.2%) were aged 65 years or older, and 37.0% had a diagnosis for depressive disorder. Significant reductions were observed for DRED of -46.9% (95% CI = -63% to -23%); ACED of -29.0% (95% CI = -37% to -20%); ACIP of -19.9% (95% CI = -32% to -6%). DRIP rates declined notably (-36.6%; 95% CI = -61% to 4%). Event rates observed across subgroups demonstrated consistent downward trends; however, not all were statistically significant. These findings demonstrate that use of the tubeless, disposable insulin pump was associated with reductions in DRED, ACED, and ACIP. Our results provide real-world evidence to support the use of the tubeless, disposable insulin pump among Medicare beneficiaries who require insulin, regardless of diabetes type or Medicare entitlement reason. Additional studies are recommended to further evaluate the effect of insulin pumps on health care utilization among the Medicare population and other insurance populations.

Depression and Anxiety Among US Children and Young Adults

Data from surveys show increased mental health disorders in youths. However, little is known about clinical diagnosis over time. To assess the incidence, prevalence, and changes from 2017 to 2021 for depression and anxiety diagnosed clinically among children, adolescents, and young adults and to identify potential disparities. This cohort study included approximately 1.7 million individuals aged 5 to 22 years in Southern California. Data were extracted from electronic medical records; International Statistical Classification of Diseases, Tenth Revision (ICD-10), codes were used to identify depression and/or anxiety diagnosis for each study year from January 1, 2017, to December 31, 2021. Rates were stratified by age, gender, race and ethnicity, estimated household income, weight status, and comorbidity history. Changes over time and association with these variables were assessed using Poisson regression. Data were analyzed between June 1, 2022, and November 29, 2023. Clinical diagnosis of (1) depression and (2) anxiety without a depression diagnosis using ICD-10 codes. Among the 1.7 million participants, mean (SD) age was approximately 14 (5) years, and 51% were male. In terms of race and ethnicity for each study year, approximately 50% of participants were Hispanic; 8%, non-Hispanic Asian; 8%, non-Hispanic Black; and 23%, non-Hispanic White. From 2017 to 2021, depression diagnosis increased by 55.6% (from 1.35% to 2.10%) for incidence and 60.0% (from 2.55% to 4.08%) for prevalence; anxiety without depression diagnosis increased by 31.1% (from 1.77% to 2.32%) for incidence and 35.2% (from 3.13% to 4.22%) for prevalence (P < .001 for trend). The increases in rates were higher during the COVID-19 pandemic (2020-2021) than before the pandemic (2017-2019), except for depression incidence. Rates increased across all subgroups. Rates were highest for subgroups aged 14 to 17 and 18 to 22 years; female participants; those of non-Hispanic American Indian or Alaska Native, non-Hispanic White, or multiple races or ethnicities; and subgroups with higher household income, obesity (and underweight for anxiety without depression), or comorbidities. Among these factors, age was the most important factor for depression diagnosis, whereas weight status was the most important factor for anxiety without depression diagnosis. This cohort study, using electronic medical record data from a large integrated health care system, found an increase in clinically diagnosed depression from 2017 to 2021, with a higher increase during the COVID-19 pandemic and higher rates in some subgroups. Equally important, this study identified high rates and an increase in clinical diagnosis of anxiety without a depression diagnosis. These results support the increased need in public health and health care effort to combat the mental health crisis in youths.

A Comparative Study on the Efficacy of Group Positive Psychotherapy and Group Cognitive Behavioral Therapy on Flourishing, Happiness and Satisfaction with Life: A Randomized Controlled Trial

The present study examines the efficacy of Positive Psychotherapy (PPT) on psychological well-being, happiness, and satisfaction with life. We investigated people suffering from different kinds of depressive disorders, comparing it to Cognitive Behavioral Therapy (CBT). PPT is an empirically validated intervention targeting positive resources and personal strengths. It aims at amplifying well-being while also ameliorating the impact of symptoms. In a controlled two-center-study, we randomly assigned 92 out-patient participants with a DSM-IV diagnosis of major depressive disorder and/or Dysthymia to 14 sessions of manualized PPT or CBT group therapy. We assessed outcomes related to well-being using the Flourishing Scale, the Satisfaction with Life Scale, and the Positive Psychotherapy Inventory (PPTI). The PPTI represents the five components of Seligman’s PERMA-model of flourishing, encompassing positive emotions, engagement, positive relationships, meaning, and accomplishment. We took measurements before and after the intervention, and at a 6-months follow-up. Moreover, we considered a list of moderators that may impact the efficacy of PPT. PPT resulted in significant improvements in all measures, and these improvements remained stable for up to 6 months. Using 2 × 2 mixed-effects models (T1 vs. T2), we found significant interactions for all three main scales and two out of the five PPTI subscales. These interactions depicted significantly better outcomes for PPT at post-treatment. Regarding the follow-up (T1 vs. T3), we did not find significant interactions, and thus, there were no differences between the two therapies. No demographics or characteristics of the treatments were significant moderators. Summarized, these findings provide support for the effectiveness of PPT in increasing happiness, well-being, and quality of life. We can confirm that PPT is an additional tool for the enhancement of positive mental health.

Improving Access to Mental Health Care through a Stepped Care Approach: Preliminary Results from a University Students’ Sample

Introduction: Recently, university counseling services have been faced with an increasing number of students seeking psychological support. However, human resources and time constraints limit the services to respond adequately. Recently, national guidelines for Mental Health Services in Higher Education recommended the stepped care approach to increase efficiency. The present study aimed to explore the implementation of a stepped care model in a Portuguese public university, analyzing students’ sociodemographic and clinical characteristics, and presenting the flow of the stepped care approach and the students’ waiting periods in each step. Methods: An observational study was conducted in the University of Coimbra’s health services between May 2019 and June 2021. Descriptive statistics were performed to describe the sociodemographic and clinical characteristics of the sample, the flow of the stepped care approach, and students’ waiting periods. Results: We enrolled 295 students in the present study. The findings of this study revealed that over 40% had a clinical diagnosis of anxiety or depressive disorders. In terms of students’ flow within the stepped care model, 82% of students sought psychological help through self-referral. Concerning the implementation of the stepped care model, results have shown that most students wait less than a month to access each step. Discussion/Conclusions: Although preliminary, our results suggest that the stepped care model might be a useful service organization, mainly in a community in which accessibility to services and speed of response are particularly important. Most students being self-referred highlight the importance of direct contact between the university community and the health services. Additionally, anxiety and mood disorders were the most prevalent diagnoses in our sample, which also points to the relevance of a stepped care approach, since other studies have highlighted its advantages for this kind of clinical population.