Mood Domains Research Articles

Prevalence of depressive symptoms among urban school adolescents in Vietnam: The role of youth, family, and school relationships

BackgroundAdolescents frequently encounter a spectrum of psychiatric conditions, predominantly depressive and anxiety disorders, along with various behavioral disturbances. ObjectiveThis investigation aims to delineate the prevalence of depressive disorders among adolescents in urban Vietnam and to elucidate the interrelationships between familial and school-related dynamics and adolescent depression. Materials and MethodsA cross-sectional survey was conducted in 2022, involving 507 students aged 15 to 17 from high schools in Hanoi, Vietnam. Reynolds Adolescent Depression Scale - Second Edition (RADS-2) was used to assess the presence of depressive symptoms. Social-demographic characteristics, adolescent-family and adolescent-school relationships, and academic environment characteristics of high school students were interviewed. Multivariate Tobit regression models were employed to discern contributory factors across four domains of RADS-2. ResultsAmong the 507 adolescents, the mean scores on the RADS scale were 15.1 ± 4.2 for the dysphoric mood domain, 16.4 ± 4.0 for the anhedonia-negative domain, 13.1 ± 4.4 for the negative self-evaluation domain, and 12.4 ± 3.7 for the somatic complaints domain. The analysis indicated that adolescents with suboptimal parental relationships, absence of confidants, frequent parental conflicts, exposure to parental arguments, substantial exam-related stress, or overwhelming academic demands were more likely to exhibit elevated depressive symptoms. Conversely, adolescents who were satisfied with their friendships at school and received care, support from teachers or friends, and involved in school's extracurricular activities lower exhibited levels of depression. ConclusionsFindings reveal the significant impact of family and peer relationships, as well as academic stress, on the development of depressive symptoms. These significant results inform the design and development of future interventions aimed at mitigating depression risks among high school students, emphasizing the crucial roles of both educational institutions and family dynamics.

Psychosocial and Psychopharmacological Interventions for Comorbid Bipolar Disorder and Substance Use Disorders: A Review

The co-occurrence of bipolar disorder and substance use disorders presents significant clinical challenges, complicating diagnosis, treatment, and prognosis. This review explores both psychosocial and psychopharmacological interventions evaluated in randomized, controlled trials to address this comorbidity. Findings indicate that while several interventions show promise, no single treatment is consistently effective across both mood and substance use domains as compared to placebo. These findings highlight the necessity of personalized, multimodal treatment plans tailored to the specific needs of individuals with comorbid bipolar disorder and substance use disorders. [ Psychiatr Ann . 2024;54(9):e258–e262.]

Association between the Kihon Checklist and Working Status among Young-Old Citizens: A Cross-Sectional Study.

Owing to increasing super-aging societies, older adults will be encouraged to continue working. Although demand exists for older adults to continue working in Japanese society, the enabling factors have not been clarified. This study aimed to clarify (1) the life functions that affect the working status among younger-older adults who continue to work and those who do not via the Kihon Checklist (KCL) and (2) examine whether the number of areas of difficulties in daily functions of the KCL affected older adults' employment status. This cross-sectional study involved 5386 older men and women aged 65 years or older in one city in Japan. Employment status and the seven domains of the Kihon Checklist (KCL) were analyzed. The KCL items related to employment status were the physical (odds ratio = 2.46, p < 0.01), socialization (odds ratio = 1.95, p < 0.01), and mood domains (odds ratio = 1.29, p < 0.01). Furthermore, the odds ratio increased to 2.06 when three or more domains were applicable. To remain employed, one must be physically and mentally healthy. Furthermore, since the risk of non-employment increased when one KCL domain was applicable, a broader assessment of life functions is necessary.

Disease Progression of Data-Driven Subtypes of Parkinson's Disease: 5-Year Longitudinal Study from the Early Parkinson's Disease Longitudinal Singapore (PALS) Cohort.

The detailed trajectory of data-driven subtypes in Parkinson's disease (PD) within Asian cohorts remains undisclosed. To evaluate the motor, non-motor symptom (NMS) progression among the data-driven PD clusters. In this 5-year longitudinal study, NMS scale (NMSS), Hospital Anxiety Depression Scale (HADS), and Epworth sleepiness scale (ESS) were carried out annually to monitor NMS progression. H& Y staging scale, MDS-UPDRS part III motor score, and postural instability gait difficulty (PIGD) score were assessed annually to evaluate disease severity and motor progression. Five cognitive standardized scores were used to assess detailed cognitive progression. Linear mixed model was performed to assess the annual progression rates of the longitudinal outcomes. Two hundred and six early PD patients, consisting of 43 patients in cluster A, 98 patients in cluster B and 65 subjects in cluster C. Cluster A (severe subtype) had significantly faster progression slope in NMSS Domain 3 (mood/apathy) score (p = 0.01), NMSS Domain 4 (perceptual problems) score (p = 0.02), NMSS Domain 7 (urinary) score (p = 0.03), and ESS Total Score (p = 0.04) than the other two clusters. Cluster A also progressed significantly in PIGD score (p = 0.04). For cognitive outcomes, cluster A deteriorated significantly in visuospatial domain (p = 0.002), while cluster C (mild subtype) deteriorated significantly in executive domain (p = 0.04). The severe cluster had significantly faster progression, particularly in mood and perceptual NMS domains, visuospatial cognitive performances, and postural instability gait scores. Our findings will be helpful for clinicians to stratify and pre-emptively manage PD patients by developing intervention strategies to counter the progression of these domains.

Factors associated with self-rated health in people with late-stage parkinson’s and cognitive impairment

PurposeTo investigate the contributors to self-rated health in people with late-stage Parkinson’s disease (PD) and cognitive impairment.MethodsA secondary analysis of baseline data from the international Care of Late-Stage Parkinsonism (CLaSP) cohort study was conducted. Participants with PD and either dementia or mild cognitive impairment or MMSE < 24/30 in the absence of major depression were included if they had completed the EQ-5D-3L assessment (n = 277). Factors associated with self-rated health (EQ-5D-3L Index and Visual Analogue Scale) were investigated through multivariable linear regression.ResultsMore severe PD (motor and non-motor) was associated with worse self-rated health. The EQ-5D-3L dimensions of Mobility, Self-Care and Usual Activities were almost universally affected; the latter two particularly severely. Being unable to perform usual activities or having moderate to extreme anxiety or depression were significantly associated with EQ-5D-3L Visual Analogue Scale, suggesting these are particularly valued. Worse motor impairment and function and the non-motor symptom domains of mood, perception, sexual function, and miscellaneous (e.g., pain) were associated with worse self-rated health, whereas greater burden of gastrointestinal symptoms was associated with better self-rated health in multivariate analysis. Better self-rated health was associated with recent PD nurse consultation, and higher doses of dopaminergic medication.ConclusionImprovement of activities of daily living, mood and anxiety should be prioritised in clinical practice, with consideration of perception and sexual function in this population. Recent nurse consultations and higher antiparkinsonian doses are associated with better self-rated health, suggesting there is no room for a therapeutic nihilism in this population of people within a complex phase of PD.

Patient-reported outcomes after oral cancer reconstructions with radial and ulnar forearm-free flaps.

This study aimed to evaluate patient-reported quality of life and incidence of decision regret in patients undergoing radial (RFFF) and ulnar forearm-free flaps (UFFF) reconstruction. Patients undergoing either RFFF or UFFF were assessed with the University of Washington Quality of Life (UW-QOL) and Oral Health Impact Profile (OHIP-14) questionnaires, and the Decision Regret Scale (DRS), both before and at least 12 months post-reconstruction. In total, 40 RFFF and 40 UFFF were included. Harvesting time was longer in RFFF (p = 0.043), and the donor-site defect was significantly larger in RFFF than in UFFF (p = 0.044). Patients with UFFF scored better UW-QOL in the appearance, pain, activity, mood, and social functioning domains (p < 0.05). However, the RFFF group excelled in swallowing and chewing domains. The DRS score revealed a significant difference between RFFF and UFFF, with scores of 36.26 versus 27.36, respectively. Moreover, the mean DRS score reduced at 12 months compared with 6 months, significantly superior for UFFF. Oral cancer patients reconstructed with UFFF exhibited a better appearance, social domain, and mild decision regret compared with RFFF, indicating that the UFFF may contribute to improving postoperative quality of life in oral cancer patients.

Short- and long-term predictive power of the preoperative Geriatric Assessment components in older patients undergoing cholecystectomy.

&lt;b&gt;&lt;br&gt;Introduction:&lt;/b&gt; Increasing numbers of older patients will require laparoscopic cholecystectomies. Physicians may have doubts when qualifying these patients for elective surgeries since older age is considered a risk factor for complications. Determining biological age, using a Geriatric Assessment (GA), should be the key factor in the preoperative assessment.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Aim:&lt;/b&gt; The aim of this study was to determine which GA components and frailty alone are most useful for predicting postoperative outcomes in both short- and long-term follow-up.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Materials and methods:&lt;/b&gt; 219 consecutive patients aged ≥70 years underwent surgery and were followed up prospectively for 12 months. The preoperative GA consisted of functionality, physical activity, comorbidity, polypharmacotherapy, nutrition, cognition, mood, and social support domains. Logistic regression analyses were used to analyze the predictive ability of GA.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; GA, frailty, and chronological age were not predictive of major 30-day morbidity. There were significantly more overall postoperative complications in the frail group than in the fit group (21% vs 4%), with mainly minor (Clavien-Dindo I, II) and medical (16 patients; 72.7%) complications. There were no significant differences in the rate of major and surgical complications (8 patients; 36.4%) between frail and fit patients. Only frailty was a predictor of 1-year mortality odd ratio 12.17 (2.47-59.94) P = 0.002.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Conclusions:&lt;/b&gt; Performing GA before elective laparoscopic cholecystectomies seems unnecessary for the evaluation of short-term outcomes but helpful for the assessment of long-term outcomes. Laparoscopic cholecystectomy can be safely performed also in older frail patients.&lt;/br&gt.

Comparing Symptoms of Major Depression in Youth with Confirmed Versus Suspected Bipolar Disorder.

Background: While numerous studies have compared symptoms of major depressive episodes (MDEs) associated with bipolar disorder (BD; i.e., bipolar depression) versus major depressive disorder (MDD; i.e., unipolar depression), little is known about this topic in youth. We compared MDE symptoms in youth with BD with youth with suspected BD who have similar clinical and familial characteristics aside from having BD. Methods: MDE symptoms based on Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children (K-SADS) Depression Rating Scale items for the most severe past episode were compared in youth, ages 13-21 years, with BD (n = 208) versus suspected BD (n = 165). Diagnoses were confirmed via semistructured interviews. Symptoms with between-group differences (p < 0.05) in univariate analyses were evaluated in a multivariate forward stepwise regression. All analyses controlled for age and sex. Results: Youth with BD had significantly higher (more severe) ratings on depressed mood (p = 0.001, η2 = 0.05), irritability (p = 0.037, η2 = 0.02), anhedonia (p = 0.004, η2 = 0.04), negative self-image (p < 0.001, η2 = 0.07), hopelessness (p = 0.04, η2 = 0.02), fatigue (p = 0.001, η2 = 0.05), hypersomnia (p = 0.001, η2 = 0.05), suicidal ideation (p = 0.04, η2 = 0.02), and recurrent thoughts of death (p < 0.001, η2 = 0.05). In regression analyses, the only symptom that remained significant in the BD group was depressed mood (p = 0.002). Conclusions: These findings demonstrate greater severity of depressive symptoms in youth with BD versus MDD across mood, and cognitive and neurovegetative symptom domains. These differences are especially noteworthy given that the MDD group was highly similar to the BD group, aside from BD diagnosis. Present findings emphasize the need for novel treatment approaches to bipolar depression in youth, and for studies examining potential mechanisms underlying the increased severity of bipolar depression.

Identifying and Predicting Subgroups of Veterans With Mild Traumatic Brain Injury Based on Distinct Configurations of Postconcussive Symptom Endorsement: A Latent Class Analysis.

To identify distinct subgroups of veterans with mild traumatic brain injury (mTBI) based on configurations of postconcussive symptom (PCS) endorsement, and to examine predictors of subgroup membership. Outpatient Veterans Health Administration (VHA). Veterans with clinician-confirmed mTBI who completed the Neurobehavioral Symptom Inventory (NSI), determined using the Comprehensive Traumatic Brain Injury Evaluation database. Individuals who tended to overreport symptoms were excluded via an embedded symptom validity scale. Retrospective cohort study leveraging national VHA clinical data from 2012 to 2020. Latent class analysis (LCA) with a split-sample cross-validation procedure was used to identify subgroups of veterans. Multinomial logistic regression was used to examine predictors of subgroup membership. Latent classes identified using NSI items. The study included 72 252 eligible veterans, who were primarily White (73%) and male (94%). The LCA supported 7 distinct subgroups of veterans with mTBI, characterized by diverging patterns of risk for specific PCS across vestibular (eg, dizziness), somatosensory (eg, headache), cognitive (eg, forgetfulness), and mood domains (eg, anxiety). The most prevalent subgroup was Global (20.7%), followed by Cognitive-Mood (16.3%), Headache-Cognitive-Mood (H-C-M; 16.3%), Headache-Mood (14.2%), Anxiety (13.8%), Headache-Sleep (10.3%), and Minimal (8.5%). The Global class was used as the reference class for multinomial logistic regression because it was distinguished from others based on elevated risk for PCS across all domains. Female (vs male), Black (vs White), and Hispanic veterans (vs non-Hispanic) were less likely to be members of most subgroups characterized by lesser PCS endorsement relative to the Global class (excluding Headache-Mood). The 7 distinct groups identified in this study distill heterogenous patterns of PCS endorsement into clinically actionable phenotypes that can be used to tailor clinical management of veterans with mTBI. Findings reveal empirical support for potential racial, ethnic, and sex-based disparities in PCS among veterans, informing efforts aimed at promoting equitable recovery from mTBI in this population.

Psychometric properties of the Caregiver's inventory neuropsychological diagnosis dementia (CINDD) in mild cognitive impairment and dementia.

The Caregiver's Inventory Neuropsychological Diagnosis Dementia (CINDD) is an easy tool designed to quantify cognitive, behavioural and functional deficits of patients with cognitive impairment. Aim of the present study was to analyse the psychometric properties of the CINDD in Mild Cognitive Impairment (MCI) and Dementia (D). The CINDD, composed by 9 sub-domains, was administered to fifty-six caregivers of patients with different types of dementia (D) and 44 caregivers of patients with MCI. All patients underwent an extensive neuropsychological assessment, the Neuropsychiatric Inventory (NPI) and functional autonomy scales. The reliability, convergent construct validity and possible cut-off of CINND were measured by Cronbach's alpha (α), Pearson's correlation and ROC analysis, respectively. The D and MCI patients differed only for age (p=0.006). The internal consistency of CINDD was high (α= 0.969). The α-value for each CINDD domain was considered acceptable, except the mood domain (α=0.209). The CINDD total score correlated with cognitive screening tests; each domain of the CINDD correlated with the corresponding score from either tests or NPI (p<0.05), except for visuo-spatial perception skills and apathy. A screening cut-off equal to 59, can be used discriminate D from MCI (Sensitivity=0.70, Specificity=0.57). The CINDD is a feasible, accurate and reliable tool for the assessment of cognitive and behavioural difficulties in patients with different degree of cognitive impairment. It may be used to quantify and monitor caregiver-reported ecological data in both clinical and research settings.

Explore the effects of forest travel activities on university students' stress affection.

This study aims to explore the effects of forest travel activities on university students' stress affection. Forty volunteer university students participated in this study. All participants were asked to complete physiological (Heart Rate Variability) and psychological (Brief Profile of Mood State and State-Trait Anxiety Inventory) tests before and after the travel activities. The results reported that students' heart rates were significantly lower after the forest travel activities than before. All domains of negative mood and anxiety decreased from the pre-test to the post-test. This study found that university students could feel less stressed if they went on forest travel activities.

Intrasession Caffeine Intake and Cycling Performance After Accumulated Work: A Field-Based Study.

Preexercise caffeine intake has proven to exert ergogenic effects on cycling performance. However, whether these benefits are also observed under fatigue conditions remains largely unexplored. We aimed to assess the effect of caffeine ingested during prolonged cycling on subsequent time-trial performance in trained cyclists. The study followed a triple-blinded, randomized, placebo-controlled cross-over design. Eleven well-trained junior cyclists (17 ± 1years) performed a field-based 8-min time trial under "fresh" conditions (i.e.,after their usual warm-up) or after two work-matched steady-state cycling sessions (total energy expenditure∼20kJ/kg and ∼100min duration). During the latter sessions, participants consumed caffeine (3mg/kg) or a placebo ∼60min before the time trial. We assessed power output, heart rate, and rating of perceived exertion during the time trial and mood state (Brunel Mood Scale) before and after each session. No significant condition effect was found for the mean power output attained during the time trial (365 ± 25, 369 ± 31, and 364 32W for "fresh," caffeine, and placebo condition, respectively; p = .669). Similar results were found for the mean heart rate (p = .100) and rating of perceived exertion (p = 1.000) during the time trial and for the different mood domains (all p > .1). Caffeine intake during prolonged exercise seems to exert no ergogenic effects on subsequent time-trial performance in junior cyclists. Future studies should determine whether significant effects can be found with larger caffeine doses or after greater fatigue levels.

Effects of testosterone enanthate on aggression, risk-taking, competition, mood, and other cognitive domains during 28 days of severe energy deprivation

RationaleBehavioral effects of testosterone depend on dose, acute versus sustained formulation, duration of administration, personality, genetics, and endogenous levels of testosterone. There are also considerable differences between effects of endogenous and exogenous testosterone.ObjectivesThis study was the secondary behavioral arm of a registered clinical trial designed to determine if testosterone protects against loss of lean body mass and lower-body muscle function induced by a severe energy deficit typical of sustained military operations.MethodsBehavioral effects of repeated doses of testosterone on healthy young men whose testosterone was reduced by severe energy deficit were examined. This was a double-blind, placebo-controlled, between-group study. Effects of four weekly intramuscular injections of testosterone enanthate (200 mg/week, N = 24) or matching placebo (N = 26) were evaluated. Determination of sample size was based on changes in lean body mass. Tasks assessing aggression, risk-taking, competition, social cognition, vigilance, memory, executive function, and mood were repeatedly administered.ResultsDuring a period of artificially induced, low testosterone levels, consistent behavioral effects of administration of exogenous testosterone were not observed.ConclusionsExogeneous testosterone enanthate (200 mg/week) during severe energy restriction did not reliably alter the measures of cognition. Study limitations include the relatively small sample size compared to many studies of acute testosterone administration. The findings are specific to healthy males experiencing severe energy deficit and should not be generalized to effects of other doses, formulations, or acute administration of endogenous testosterone or studies conducted with larger samples using tests of cognitive function designed to detect specific effects of testosterone.

Mood disturbance and tau pathology in older women at risk for Alzheimer’s disease

AbstractBackgroundNeuropsychiatric symptoms, particularly depression, have been associated with Alzheimer’s disease (AD) biomarkers in individuals on the AD continuum. Although mood changes are a clinical manifestation of AD, research examining how the spectrum of common mood symptoms relates to AD biomarkers is limited. We examined the association between mood disturbance and tau pathology measured with positron emission tomography (PET) in older women at risk for AD and particular mood domains driving any associations.MethodParticipants included 18 women (Mage = 71.5, SDage = 3.3 years) with higher AD genetic risk (polygenetic hazard score ≥50th percentile) and mild impairment on the Montreal Cognitive Assessment who had completed the Profile of Mood States (POMS) questionnaire and a PET Scan as part of a larger research study. Those with formal psychiatric or neurodegenerative diagnoses were excluded. The POMS assessed six mood subcategories. The Total Mood Disturbance (TMD) was calculated as the sum of Tension, Depression, Anger, Fatigue, and Confusion subscores, minus the Vigor subscore. Tau standardized uptake value ratio (SUVR) were calculated for each Braak region of interest (ROI) (i.e., Braak 1‐2: transentorhinal stage, Braak 3‐4: limbic stage, and Braak 5‐6: isocortical stage). Linear regression models were conducted with TMD as the predictor and each Braak‐derived ROI as the outcome while controlling for age. Significant relationships were further probed by repeating analyses with each POMS subcategory as the predictor.ResultHigher POMS TMD scores significantly predicted higher tau‐PET SUVRs in Braak 1‐2 (β = 0.73, p&lt;0.01), Braak 3‐4 (β = 0.88, p&lt;0.001), and Braak 5‐6 (β = 0.72, p&lt;0.01) (Figure 1). Further analysis showed that the Tension subscore significantly predicted tau‐PET in all three regions (Figure 2) and Confusion significantly predicted tau‐PET in Braak 1‐2 and Braak 5‐6 (Figure 3).ConclusionMood disturbance was consistently associated with higher tau across all Braak regions in older women with higher AD risk. These relationships were strongest when reflecting the combination of mood symptoms, but tension may have a stronger influence than other subcategories. Longitudinal research should be done to assess the directionality of this relationship and to explore whether treatments for mood symptoms may have protective effects on Alzheimer’s pathogenesis before diagnosis.

Long-term psychological outcomes following stroke: the OX-CHRONIC study

BackgroundStroke survivors rate longer-term (> 2 years) psychological recovery as their top priority, but data on how frequently psychological consequences occur is lacking. Prevalence of cognitive impairment, depression/anxiety, fatigue, apathy and related psychological outcomes, and whether rates are stable in long-term stroke, is unknown.MethodsN = 105 long-term stroke survivors (M [SD] age = 72.92 [13.01]; M [SD] acute NIH Stroke Severity Score = 7.39 [6.25]; 59.0% Male; M [SD] years post-stroke = 4.57 [2.12]) were recruited (potential N = 208). Participants completed 3 remote assessments, including a comprehensive set of standardized cognitive neuropsychological tests comprising domains of memory, attention, language, and executive function, and questionnaires on emotional distress, fatigue, apathy and other psychological outcomes. Ninety participants were re-assessed one year later. Stability of outcomes was assessed by Cohen’s d effect size estimates and percent Minimal Clinically Important Difference changes between time points.ResultsOn the Montreal Cognitive Assessment 65.3% scored < 26. On the Oxford Cognitive Screen 45.9% had at least one cognitive impairment. Attention (27.1%) and executive function (40%) were most frequently impaired. 23.5% and 22.5% had elevated depression/anxiety respectively. Fatigue (51.4%) and apathy (40.5%) rates remained high, comparable to estimates in the first-year post-stroke. Attention (d = -0.12; 85.8% stable) and depression (d = 0.09, 77.1% stable) were the most stable outcomes. Following alpha-adjustments, only perceptuomotor abilities (d = 0.69; 40.4% decline) and fatigue (d = -0.33; 45.3% decline) worsened over one year. Cognitive impairment, depression/anxiety, fatigue and apathy all correlated with worse quality of life.ConclusionNearly half of participants > 2 years post-event exhibited psychological difficulties including domains of cognition, mood, and fatigue, which impact long-term quality of life. Stroke is a chronic condition with highly prevalent psychological needs, which require monitoring and intervention development.

Gender differences in non-motor fluctuations in Parkinson’s disease

Non-motor symptoms (NMS) and Non-motor fluctuations (NMF) in Parkinson’s Disease (PD) are common, involving several domains and affecting quality of life. Aim of the study is to estimate the burden of NMF in PD patients and to evaluate the possible gender effect. PD patients fulfilling the MDS-PD diagnostic criteria attending the “Parkinson’s Disease and Movement Disorders Centre” of the University of Catania were evaluated using the Non-Motor Fluctuations Assessment (NoMoFA) Questionnaire. NoMoFA items were also grouped into the following domains: cognitive, mood, sleep/fatigue, dysautonomia, hallucination/perception and miscellaneous domains were identified. One-hundred and twenty-one patients with PD (67 men, 55.4%; mean age 70.2 ± 8.9 years, disease duration 8.3 ± 4.6 years) were evaluated. All PD patients reported at least one NMS, whereas 87 (71.9%) also reported NMF. “Feel sluggish or had low energy levels” (47.2%) along with “Feel excessively sleepy during the day” (40.0%) were the most common NMF reported in the whole sample. The majority of PD patients reported the presence of NMF during the OFF state (79, 65.3%). At multivariate analysis, NMF were positively associated with the female gender (adjusted OR 3.13; 95%CI 1.21–8.11 p-value 0.01). Women with PD had higher NMF scores especially in depression/anxiety, sleep/fatigue and dysautonomia domains. Our study reported the presence of a gender-related pattern in the frequency of NMS and NMF in PD patients, with female gender associated with a higher risk of developing NMF, highlighting the need for personalized treatment strategies when addressing NMF.

Cognitive Functions, Depressive and Anxiety Symptoms After One Year of CPAP Treatment in Obstructive Sleep Apnea.

The study worked with depressive symptoms, anxiety score and cognitive functions in obstructive sleep apnea (OSA) patients treated with CPAP. Eighty-one subjects with OSA and without psychiatric comorbidity were treated with CPAP for one year and completed the following scales and cognitive tests: Trail Making Test, Verbal Fluency Test, d2 Test, Beck Depression Inventory-II and Beck Anxiety Inventory. MINI ruled out psychiatric disorder. At the two months check-up, subjects were re-evaluated for depressive and anxiety symptoms, and after one year of CPAP treatment, subjects repeated cognitive tests and scales. Data about therapy adherence and effectiveness were obtained from the patient's CPAP machines. The study was completed by 59 CPAP adherent patients and eight non-adherent patients. CPAP therapy effectiveness was verified in all patients by decreasing the apnea-hypopnoea index below 5 and/or 10% of baseline values. The adherent patients significantly improved depressive and anxiety symptoms. There was also an improvement in overall performance in the attention test; however, performance in many individual items did not change. The adherent patients also improved verbal fluency and in the Part B of the Trail making test. The non-adherent group significantly increased the number of mistakes made in the d2 test; other results were non-significant. According to our results, OSA patients' mood, anxiety and certain cognitive domains improved during the one-year therapy with CPAP. NCT03866161.

0372 Association between the real-world use of GABA receptor agonists and daytime impairment in US patients with insomnia

Abstract Introduction Currently available data inadequately quantify daytime impairment associated with insomnia disorder and the impact of its treatments in the real-world setting. The objective of this real-world study was to retrospectively examine daytime impairment symptoms before and during pharmacological treatment with non-benzodiazepine receptor agonists (non-BzRAs) and benzodiazepines in US patients with insomnia. Methods Information from HealthVerity was retrieved for patients with insomnia aged ≥ 18 years prescribed non-BzRAs or benzodiazepines as first-line treatment between October 2015 and March 2020. For each patient with data, insurance claims data were extracted alongside physician notes in free-text form. Patient demographics and prescription information were extracted from the claims. Daytime impairment symptoms were extracted and quantified from physician notes using an ontology designed with three domains (i.e., alert/cognition, mood and sleepiness) and 14 items analogous to the Insomnia Daytime Symptoms and Impact Questionnaire (IDSIQ). This ontology extends IDSIQ terms to 109 terms in total to reflect the language of physicians. The annualized rate of daytime impairment measures the frequency of symptoms occurring from 182 days before treatment start to about three months (mean) during treatment. The rate is normalized by one year as the duration before and during treatment is different. A single symptom of a visit is counted maximally once within a specific domain. Results 2361 and 1045 unique patients were prescribed non-BzRAs and benzodiazepines, respectively. Non-BzRAs treatment was associated with a statistically significant 16% overall increase of daytime impairment symptoms during versus before treatment (p=0.003). Statistically significant increase of daytime impairment symptoms with non-BzRA treatment was observed in the alert/cognitive (16%,p=0.019), mood (22%,p=0.002) domains, but only nominal increase in the sleepiness domain (12%,p=0.084). Benzodiazepine treatment was associated with a statistically significant 19% overall increase of daytime impairment symptoms during versus before treatment (p=0.047), with a statistically significant increase seen in the mood domain (26%,p=0.030) but only nominal increases in the alert/cognitive (7%,p=0.76), and sleepiness (21%,p=0.079) domains. Conclusion This study shows that treatment of insomnia with commonly used drugs (i.e. non-BzRA and benzodiazepines) is associated with an overall increase in daytime impairment symptoms in a real-world setting. Support (if any) Idorsia Pharmaceuticals Ltd.

0161 Structural Changes in Mood Domains During Sleep Deprivation and Recovery

Abstract Introduction Mood is known to vary as a function of sleep debt. Mood batteries often measure multiple, non-orthogonal domains. In the present study, the latent structure of the Automated Neuropsychological Assessment Metrics Mood (ANAM-mood) battery was assessed during five different states of alertness. We present a novel scheme to evaluate changes in the structure of such batteries across conditions. It was hypothesized that the structure would change, with the greatest changes manifest during sleep deprivation. Methods The present analyses were conducted on data from a prior sleep deprivation study (n = 25 healthy young adults). We used the identity property of MANOVA. Given correlation matrices Σi and Σj, structural invariance was defined as Σi Σj-1 ≈ I (Identity). MANOVA statistic m was the largest eigenvalue of Σi Σj-1. Resampling was used to generate m-distributions within and between the five different alertness conditions - Rested, Sleep Deprived (SD) days 1 and 2, and Recovery days 1 and 2. In addition, the relative number of mood dimensions was estimated by the odds (via resampling) of two dimensions explaining 80% of the variance of Σi compared to Σj. Results The pairwise MANOVA-statistic revealed significant structural variations across conditions (p&amp;lt; 0.001 for all comparisons). Significant differences included Rested vs SD1 and SD2. Recovery 1 showed the most pronounced differences to all conditions. Recovery 2 was like Recovery 1, but more like Rested than the prior day. The odds ratio of two-dimensions for Recovery 1 was much higher compared to all other conditions (OR: 2.4-245, p&amp;lt; 0.001). Conclusion Individuals respond differently to a mood survey across specific alertness conditions resulting in structural changes to the data. Wakefulness during recovery from severe sleep loss differs most significantly from all states, contrary to our hypothesis. This is important to consider when interpreting mood changes as measured by such batteries (including related Spielberger's State Anxiety Inventory and Beck Depression Inventory-II) during sleep studies. Follow up studies are needed to fully assess such effects and devise methods to account for them. Support (if any) This effort was fully supported by the Department of Defense Military Operational Medicine Research Program (MOMRP).

0343 Association between the real-world use of trazodone and daytime impairment in US patients with insomnia

Abstract Introduction Trazodone is approved for the treatment of depression and is used off-label to treat insomnia despite Clinical Practice Guidelines recommending against this use. The objective of this real-world retrospective study is to explore whether trazodone use is associated with improvements in daytime impairment in US patients with insomnia. Methods Information on insomnia patients aged ≥ 18 years prescribed trazodone as first-line treatment between October 2015 and March 2020 was retrieved from HealthVerity. Insurance claims data were extracted for each patient alongside physician notes in free-text form. From the claims, patient demographics and prescription information were extracted. An ontology analogous to the Insomnia Daytime Symptoms and Impact Questionnaire (IDSIQ) was designed with three domains (i.e., alert/cognition, mood and sleepiness). The 14 IDSIQ terms were extended to 109 terms to reflect physicians’ language. Daytime impairment symptom frequency occurring from 182 days before treatment to ~3 months (mean) during treatment was measured as annualized rates normalized by one year as the duration before and during treatment is different. Each symptom noted in a visit is counted once in a specific domain. Results were stratified by dose: trazodone &amp;lt; 150mg (typically used for off-label insomnia treatment) and trazodone ≥150mg (approved dose for depression treatment). Results 1187 and 246 unique patients were identified on the &amp;lt; 150mg and ≥150 mg trazadone doses, respectively. For trazodone &amp;lt; 150mg, the annualized rate of daytime impairment symptoms before and during treatment was 139.4 and 147.5, respectively, with a statistically non-significant overall increase (6%, p=0.313) and statistically non-significant increases in each domain (alert/cognition: 4%,p=0.574; mood: 10%, p=0.173; sleepiness: 5%,p=0.401). For ≥150mg trazodone, the annualized rate of daytime impairment symptoms before and during treatment was 143.5 and 142.2, respectively, with a statistically non-significant overall decrease (1%,p=0.941), statistically non-significant decreases in the alert/cognition (19%,p=0.128) and sleepiness (5%,p=0.712) domains and statistically non-significant increase in the mood domain (14%,p=0.400). Conclusion Patients with insomnia prescribed trazodone show similar levels of daytime impairment before and during treatment. This study suggests that the use of trazodone in patients with insomnia is not associated with a decrease in daytime impairment. Support (if any) Idorsia Pharmaceuticals Ltd.