Early Pharmacological Intervention Research Articles

Early pharmacological interventions for acute traumatic stress symptoms: a network meta-analysis

Early pharmacological interventions for acute traumatic stress symptoms: a network meta-analysis

Hippocampal glutamate and hippocampus subfield volumes in antipsychotic-naive first episode psychosis subjects and relationships to duration of untreated psychosis

Evidence points toward a relationship between longer duration of untreated psychosis (DUP) and worse long-term outcomes in patients with first episode psychosis (FEP), but the underlying neurobiology remains poorly understood. Proton magnetic resonance spectroscopy studies have reported altered hippocampus glutamatergic neurotransmission, and structural MRI as reported hippocampal atrophy that may be associated with memory impairment in schizophrenia. Here, we quantify left hippocampus glutamate (Glx) and left hippocampus subfield volumes in 54 antipsychotic-naive FEP and 41 healthy controls (HC), matched on age, sex, and parental occupation. While there were no significant group difference in Glx levels, hippocampal Glx levels were significantly higher in those who underwent a long DUP (>12 months) compared to those with a short DUP, and compared to HC. Compared to HC, FEP had significantly reduced whole hippocampus volume, as well as of CA1, CA4, granule cell layer, subiculum, and presubiculum subfields. Smaller whole hippocampal volume, as well as CA1, molecular layer, subiculum, presubiculum, and hippocampal tail volumes were significantly associated with longer DUP. However, we found no significant association between hippocampal Glx levels and hippocampal volume or subfields, suggesting that these alterations are not related, or their relationship does not follow a linear pattern. However, our results strongly suggest that one or several pathophysiological processes underlie the DUP. Importantly, our data highlight the critical need for reducing the DUP and for early pharmacological intervention with the hope to prevent structural deficits and, hopefully, improve clinical outcomes.

Heart Rate Variability Analysis: A Useful Tool to Assess Poststroke Cardiac Dysautonomia.

Neurogenic heart syndrome represents a phenomenon often encountered in clinical practice after ischemic stroke. Further poststroke cardiovascular complications are possibly related to cardiac autonomic dysregulation. Multiple Trigonometric Regressive Spectral (MTRS) analysis of the heart rate variability (HRV) allows a precise evaluation of cardiovascular modulation under different conditions. This research aims to evaluate the impact of the middle cerebral artery (MCA) ischemic stroke on cardiac autonomic function, using the MTRS analysis of HRV, during sympathetic and parasympathetic activation tests. The authors analyzed HRV parameters in 20 patients who had a right and 20 who had a left MCA ischemic stroke, under rest condition and during autonomic activation tests (deep breathing and standing tests). Data were compared with 20 age-matched and sex-matched healthy controls. Patients who had a right MCA ischemic stroke presented a decreased vagal modulation of the heart rate compared with healthy controls and patients who had a left MCA ischemic stroke, in resting state and during autonomic activation tests. Decreased root mean square of the successive differences, pNN50, high frequency, and high-frequency normalized units values (P<0.05) and increased low frequency/high frequency ratio (P<0.05) in resting state and during autonomic activation tests in patients who had a right MCA stroke indicate a sympathetic predominance in the control of the heart rate. The parasympathetic activation test did not change the sympathovagal balance in this group of patients. The autonomic nervous system represents an attractive target for the therapeutic approach. As MCA ischemic stroke, especially in the right hemisphere, seems to cause significant long-lasting autonomic dysregulation, implementing early pharmacological or nonpharmacological intervention for autonomic restoration may improve the outcome of patients who had an ischemic stroke.

Postpartal Affective and Endocrine Differences Between Parents of Preterm and Full-Term Infants.

BackgroundDuring the postpartum period, new parents frequently experience emotional stress and exhibit symptoms of depression and anxiety, accompanied by substantial endocrine changes. However, evidence predominantly exists from parents of full-term infants, while data on parents of preterm infants are scarce. In this exploratory, cross-sectional study, we compared psychological well-being and endocrine parameters in parents of very preterm and term born infants.MethodsMothers (N = 28) and fathers (N = 30) of full-term infants as well as mothers (N = 18) and fathers (N = 21) of very or extreme preterm infants (< 32nd gestational week) were recruited in the days following birth. Anxiety, depression, and perceived stress were assessed with the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), and the Perceived Stress Questionnaire (PSQ), respectively. Physiological measures included serum levels of estradiol, progesterone, prolactin, and thyroid-stimulating hormone (mothers only), as well as the salivary cortisol awakening response (mothers and fathers).ResultsNew mothers and fathers of very preterm infants exhibited higher scores of depression, anxiety and stress than parents of term infants. Besides, mothers of very preterm infants showed lower levels of estradiol, progesterone, and prolactin, as well as a heightened post-awakening cortisol response compared to mothers of term infants. Furthermore, in mothers of preterm infants we found significant negative associations between serum prolactin levels and BDI and STAI scores, respectively.ConclusionsParents of very preterm infants suffered from a higher burden of psychological distress than parents of full-term infants. The affective symptoms in preterm mothers were accompanied by altered endocrine profiles that, at least to some extent, may contribute to the psychological changes. The profound psychological and physiological disturbances in mothers of preterm infants may have an impact on long-term mental health and early pharmacological and psychological interventions may help to ameliorate postpartum affective symptoms.

Effects of daily L-dopa administration on learning and brain structure in older adults undergoing cognitive training: a randomised clinical trial

Cognitive aging creates major individual and societal burden, motivating search for treatment and preventive care strategies. Behavioural interventions can improve cognitive performance in older age, but effects are small. Basic research has implicated dopaminergic signalling in plasticity. We investigated whether supplementation with the dopamine-precursor L-dopa improves effects of cognitive training on performance. Sixty-three participants for this randomised, parallel-group, double-blind, placebo-controlled trial were recruited via newspaper advertisements. Inclusion criteria were: age of 65–75 years, Mini-Mental State Examination score >25, absence of serious medical conditions. Eligible subjects were randomly allocated to either receive 100/25 mg L-dopa/benserazide (n = 32) or placebo (n = 31) prior to each of twenty cognitive training sessions administered during a four-week period. Participants and staff were blinded to group assignment. Primary outcomes were latent variables of spatial and verbal fluid intelligence. Compared to the placebo group, subjects receiving L-dopa improved less in spatial intelligence (−0.267 SDs; 95%CI [−0.498, −0.036]; p = 0.024). Change in verbal intelligence did not significantly differ between the groups (−0.081 SDs, 95%CI [−0.242, 0.080]; p = 0.323). Subjects receiving L-dopa also progressed slower through the training and the groups displayed differential volumetric changes in the midbrain. No statistically significant differences were found for the secondary cognitive outcomes. Adverse events occurred for 10 (31%) and 7 (23%) participants in the active and control groups, correspondingly. The results speak against early pharmacological interventions in older healthy adults to improve broader cognitive functions by targeting the dopaminergic system and provide no support for learning-enhancing properties of L-dopa supplements in the healthy elderly. The findings warrant closer investigation about the cognitive effects of early dopamine-replacement therapy in neurological disorders. This trial was preregistered at the European Clinical Trial Registry, EudraCT#2016-000891-54 (2016-10-05).

Expression of Behavioral Phenotypes in Genetic and Environmental Mouse Models of Schizophrenia.

Schizophrenia is a neuropsychiatric disorder characterized by multifactorial etiology involving complex interactions among genetic and environmental factors. “Multiple-hit” models of the disorder can explain its variable incidence and prevalence in related individuals. Hence, there is a dire need to understand these interactions in the emergence of schizophrenia. To test these factors in the emergence of schizophrenia-like behaviors, we employed a genetic mouse model of the disorder (harboring the DISC1 mutation) along with various environmental insults, such as early life stress (maternal separation of pups) and/or pharmacological interventions (ketamine injections). When assessed on a battery of behavioral tests, we found that environmental interventions affect the severity of behavioral phenotypes in terms of increased negative behavior, as shown by reduced mobility in the forced swim and tail suspension tests, and changes to positive and cognitive symptoms, such as increased locomotion and disrupted PPI along with reduced working memory, respectively. Among the various interventions, the genetic mutation had the most profound effect on behavioral aberrations, followed by an environmental intervention by ketamine injections and ketamine-injected animals that were maternally separated during early postnatal days. We conclude that although environmental factors increased the prevalence of aberrant behavioral phenotypes, genetic background is still the predominant influence on phenotypic alterations in these mouse models of schizophrenia.

Early pharmacological interventions for preventing post-traumatic stress disorder (PTSD): a network meta-analysis

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the efficacy and acceptability of pharmacological interventions for preventing post‐traumatic stress disorder (PTSD) in adults exposed to a traumatic event and to generate a clinically useful ranking of pharmacological interventions according to their efficacy and acceptability by performing a network meta‐analysis.

Healthcare resource use and cost associated with timing of pharmacological treatment for major depressive disorder in the United States: a real-world study

Background: Guidelines recommend selective serotonin reuptake inhibitors (SSRI) and serotonin norepinephrine reuptake inhibitors (SNRI) as first-line treatments for major depressive disorder (MDD) and emphasize the importance of early pharmacological treatment as key factors to treatment success.Objectives: To compare the MDD-related healthcare resource utilization (HCRU) and cost among patients (1) with early vs late pharmacological treatment initiation and (2) achieving minimum therapeutic dose (MTD) early vs late.Methods: The MarketScan database (2010–2015) was used. Adults who were newly-treated with SSRI/SNRI within 12 months after the initial MDD diagnosis (index) were included. Patients who initiated SSRI/SNRI within 2 weeks of the index date were defined as early initiators; those who reached MTD within 4 weeks of index date were defined as early MTD achievers. MDD-related HCRU and costs per year after the index date were compared between early and late initiators and between early and late achievers using propensity score matching and generalized linear models.Results: Of the 55,539 patients, 60% were early initiators and 61% were early MTD achievers. The mean number of MDD-related outpatient visits per year were significantly higher for late initiator (6.7 vs 4.2, p < .001) and late MTD achievers (6.5 vs 4.5, p < .001) vs their early counterparts. Mean annual MDD-related outpatient, drug, and total cost were significantly higher for late initiators and MTD achievers vs the early groups.Conclusions: There is an opportunity to improve outcomes by treating MDD patients with SSRI/SNRI within 2 weeks and at or above the MTD within 4 weeks of diagnosis or less.

Racial association and pharmacotherapy in neonatal opioid withdrawal syndrome.

To determine if racial differences are associated with Neonatal Opioid Withdrawal Syndrome (NOWS) severity. A 10-year (2008-2017) retrospective cohort of infants ≥35 weeks gestation with prenatal exposure to opioids was included. The primary measure was the need for pharmacotherapy. Multivariable logistic regression and propensity score analysis were performed. Among 345 infants with NOWS, 111 (32%) were black infants with 70% of them requiring pharmacotherapy as compared with 84% of white infants. Upon adjusting for significant covariates (methadone, benzodiazepine use, and gestational age), black infants were 57% less likely than whites to require pharmacotherapy (Odds ratio: 0.43, 95%CI: 0.22-0.80, p = 0.009). Similar results were observed with propensity score analysis. Significant racial disparity observed may be secondary to genetic variations in opioid pharmacogenomics and/or extrinsic factors. Large-scale studies are warranted to include race in predictive models for early pharmacological intervention.

Pilot study: asymptomatic hyperuricemia patients with obesity and nonalcoholic fatty liver disease have increased risk of double contour sign.

Background/AimsDouble contour sign (DCS) is a representative ultrasonographic finding in gout. DCS is evidence of monosodium urate deposit in gouty arthritis and has been identified in some patients with asymptomatic hyperuricemia. However, the specific characteristics of asymptomatic hyperuricemia in patients with DCS have not yet been revealed.MethodsWe enrolled patients with incidentally found hyperuricemia. Baseline characteristics were compared between asymptomatic hyperuricemia patients with and without DCS. Logistic regression analysis was performed to determine associated factors for DCS in patients with asymptomatic hyperuricemia.ResultsA total of 62 patients with asymptomatic hyperuricemia were enrolled, and 22 of the patients showed DCS. The metatarsophalangeal were the most commonly affected joints, and differences between asymptomatic hyperuricemia patients with and without DCS were seen in aspects of class II obesity and nonalcoholic fatty liver disease (NAFLD). Multivariate logistic regression analysis demonstrated that class II obesity and NAFLD significantly increased the risk of DCS in asymptomatic hyperuricemia patients (odds ratio [OR], 6.58, p = 0.022; OR, 5.21, p = 0.020, respectively).ConclusionsAsymptomatic hyperuricemia patients with class II obesity and NAFLD had increased risk of DCS. Determining the presence of crystal deposition, such as DCS, among patients with asymptomatic hyperuricemia might help determine whether early pharmacologic intervention is needed, especially with severe obesity or NAFLD.

Caustic Agents Ingestion in Children: A 51-Year Retrospective Cohort Study.

Children experience serious gastrointestinal tract injuries due to consumption of caustic agents more often than adults. The aim of the study was to analyze diagnostic methods and treatment of children with esophageal burns according to the degree of the injury. Our one-center population-based retrospective cohort study included 150 children admitted between 1967 and 2018 to Clinic of Pediatric Otolaryngology, Phoniatrics and Audiology of University Children's Hospital in Lublin, Poland, due to the chemical burn of the mouth, throat, larynx, and esophagus. Each patient underwent a thorough laryngological examination and endoscopy to assess the place and degree of injury. Of 150 patients, 65.3% were male and 34.7% female. The median age was 4 years and 3 months. Salivation, dysphagia, burning sensation, edema, and whitish coating on the oral mucosa, palate, and throat were the most common clinical symptoms. In addition, dyspnea and chest pain were observed in 30% of patients. Esophagus endoscopy results were: Zargar grade I burn (84.7%), grade IIA (8%), grade IIB (2.6%), grade III (0%), and grade 0 (4.7%). Treatment included antibiotics, proton pump inhibitors, analgesics, and intravenous fluid therapy. Late sequelae (scarred esophageal strictures) developed in 20 (13.3%) patients. Accidental intake of caustic agents is observed in young children, especially younger than the age of 5. Early esophagus endoscopy should be performed in all patients to assess the grade of injury, plan initial treatment, and predict the risk of developing complications. Early diagnosis and immediate pharmacological treatment reduce the number of late sequelae.

Early prophylactic treatment reduces development of chronic post traumatic headache after concussion

BackgroundHeadaches after concussion are common, potentially debilitating, and long lasting. There are currently no guidelines on the treatment of post traumatic headaches (PTH). The aim of this study is to investigate the effects of early prophylactic pharmacologic treatment on the development of chronic post traumatic headaches (cPTH) in adolescent and adult concussion patients.MethodsPatients were retrospectively enrolled from the patient population at the Barrow Concussion and Brain Injury Center (Phoenix, AZ) from the previous 5 years. Males and females ages 13 and older with a diagnosis of PTH attributed to mild head injury based on ICHD2 criteria who were offered a headache prophylactic medication were included. Patients were divided into 3 groups: those who did not take treatment (Untreated), those who took nortriptyline (Nor), and those who took topiramate (Top). Groups were subdivided into those that developed cPTH and those who did not (ncPTH). The average time from injury to start of treatment (SoT) in days were analyzed using t-tests within and between groups.ResultsOne hundred twenty patients met inclusion criteria for the study (Untreated = 36, Top = 46, Nor = 38). Overall, 64 of 120 patients met criteria for cPTH (53%). SoT and development of cPTH is significant overall (35 vs 23, p&amp;lt; 0.001). SoT is significant for Untreated (NcPTH 14.4 vs cPTH 35.6, p = 0.001) and Top (NcPTH 23.9 vs cPTH 35.5, p = 0.002), but not for Nor (NcPTH 31.9 vs cPTH 34.0, p = 0.372). For NcPTH there is a significant difference between SoT for Untreated and Top (14.4 vs 23.9, p = 0.04) and Untreated vs Nor (14.4 vs 31.9, p = 0.002), but not Top and Nor (23.9 vs 31.9, p = 0.09). For cPTH there is no difference for SoT between groups.ConclusionEarly intervention with nonpharmacologic treatments and topiramate is associated with reduced development of cPTH.

PDA-TOLERATE Trial: An Exploratory Randomized Controlled Trial of Treatment of Moderate-to-Large Patent Ductus Arteriosus at 1 Week of Age

To compare early routine pharmacologic treatment of moderate-to-large patent ductus arteriosus (PDA) at the end of week 1 with a conservative approach that requires prespecified respiratory and hemodynamic criteria before treatment can be given. A total of 202 neonates of <28 weeks of gestation age (mean, 25.8 ± 1.1 weeks) with moderate-to-large PDA shunts were enrolled between age 6 and 14 days (mean, 8.1 ± 2.2 days) into an exploratory randomized controlled trial. At enrollment, 49% of the patients were intubated and 48% required nasal ventilation or continuous positive airway pressure. There were no differences between the groups in either our primary outcome of ligation or presence of a PDA at discharge (early routine treatment [ERT], 32%; conservative treatment [CT], 39%) or any of our prespecified secondary outcomes of necrotizing enterocolitis (ERT, 16%; CT, 19%), bronchopulmonary dysplasia (BPD) (ERT, 49%; CT, 53%), BPD/death (ERT, 58%; CT, 57%), death (ERT,19%; CT, 10%), and weekly need for respiratory support. Fewer infants in the ERT group met the rescue criteria (ERT, 31%; CT, 62%). In secondary exploratory analyses, infants receiving ERT had significantly less need for inotropic support (ERT, 13%; CT, 25%). However, among infants who were ≥26 weeks gestational age, those receiving ERT took significantly longer to achieve enteral feeding of 120 mL/kg/day (median: ERT, 14 days [range, 4.5-19 days]; CT, 6 days [range, 3-14 days]), and had significantly higher incidences of late-onset non-coagulase-negative Staphylococcus bacteremia (ERT, 24%; CT,6%) and death (ERT, 16%; CT, 2%). In preterm infants age <28 weeks with moderate-to-large PDAs who were receiving respiratory support after the first week, ERT did not reduce PDA ligations or the presence of a PDA at discharge and did not improve any of the prespecified secondary outcomes, but delayed full feeding and was associated with higher rates of late-onset sepsis and death in infants born at ≥26 weeks of gestation. ClinicalTrials.gov: NCT01958320.

Early Detection of Mild Cognitive Impairment With In-Home Monitoring Sensor Technologies Using Functional Measures: A Systematic Review.

The aging of the world population is accompanied by a substantial increase in neurodegenerative disorders, such as dementia. Early detection of mild cognitive impairment (MCI), a clinical diagnostic that comes with an increased chance to develop dementias, could be an essential condition for promoting quality of life and independent living, as it would provide a critical window for the implementation of early pharmacological and nonpharmacological interventions. This systematic review aims to investigate the current state of knowledge on the effectiveness of smart home sensors technologies for the early detection of MCI through the monitoring of everyday life activities. This approach offers many advantages, including the continuous measurement of functional abilities in ecological environments. A systematic search of publications in MEDLINE, EMBASE, and CINAHL, before November 2017, was conducted. Seventeen studies were included in this review. Thirteen studies were based on real-life monitoring, with several sensors installed in participants' actual homes, and four studies included scenario-based assessments, in which participants had to complete various tasks in a research lab apartment. In real-life monitoring, the most used indicators of MCI were walking speed and activity/motion in the house. In scenario-based assessment, time of completion, quality of activity completion, number of errors, amount of assistance needed, and task-irrelevant behaviors during the performance of everyday activities predicted MCI in participants. Despite technological limitations and the novelty of the field, smart home technologies represent a promising potential for the early screening of MCI and could support clinicians in geriatric care.

Gut-origin sepsis in the critically ill patient: pathophysiology and treatment.

Gut permeability is increased in critically ill patients, and associated with the development of the systemic inflammatory response syndrome and multiple organ dysfunction syndrome (MODS). The pathogenetic link(s) and potential therapies are an area of intense research over the last decades. We thoroughly reviewed the literature on gut-origin sepsis and MODS in critically ill patients, with emphasis on the implicated pathophysiological mechanisms and therapeutic interventions. Intestinal barrier failure leading to systemic bacterial translocation associated with MODS was the predominant pathophysiological theory for several years. However, clinical studies with critically ill patients failed to provide the evidence of systemic spread of gut-derived bacteria and/or their products as a cause of MODS. Newer experimental data highlight the role of the mesenteric lymph as a carrier of gut-derived danger-associated molecular patterns (DAMPs) to the lung and the systemic circulation. These substances are recognized by pattern recognition receptor-bearing cells in diverse tissues and promote proinflammatory pathways and the development MODS. Therefore, the gut becomes a pivotal proinflammatory organ, driving the systemic inflammatory response through DAMPs release in mesenteric lymph, without the need for systemic bacterial translocation. There is an emerging need for application of sensitive non-invasive and easily measured biomarkers of early intestinal injury (e.g., citrulline, intestinal fatty acid protein, and zonulin) in our everyday clinical practice, guiding the early pharmacological intervention in critically ill patients to restore or prevent intestinal injury and improve their outcomes.

Factors associated with continued smoking after the diagnosis of type 2 diabetes: a retrospective study in the Korean cohort

ObjectiveTo investigate the factors associated with continued smoking in patients newly diagnosed with type 2 diabetes.DesignRetrospective study using the Korean National Health Insurance Service-National Health Screening Cohort (2002–2013) database.ParticipantsMale patients...

Blood Glutamate Scavenger as a Novel Neuroprotective Treatment in Spinal Cord Injury.

Neurotrauma causes immediate elevation of extracellular glutamate (Glu) levels, which creates excitotoxicity and facilitates inflammation, glial scar formation, and consequently neuronal death. Finding factors that reduce the inflammatory response and glial scar formation, and increase neuronal survival and neurite outgrowth, are of major importance for improving the outcome after spinal cord injury (SCI). In the present study, we evaluated a new treatment aiming to remove central nervous system (CNS) Glu into the systemic blood circulation by intravenous (IV) administration of blood Glu scavengers (BGS) such as the enzyme recombinant glutamate-oxaloacetate transaminase 1 (rGOT1) and its co-substrate. In this study we induced in mice an SCI (hemisection), and 1 h post-injury started administering BGS treatment for 5 consecutive days. The treatment reduced the expression levels of p-p38, which regulates apoptosis and increased the expression of p-Akt, which mediates cell survival. Moreover, this treatment decreased pro-inflammatory cytokine expression and microglia activation, reduced astrocytes' reactivity, and facilitated expression of radial glia markers such as Pax6 and nestin. BGS treatment increased the survival of neurons at lesion site and enabled axonal regeneration into the injury site. These effects were correlated with improved functional recovery of the left paretic hindlimb. Thus, early pharmacological intervention with BGS following SCI may be neuroprotective and create a pro-regenerative environment by modulating glia cell response. In light of our results, the availability of the method to remove excess Glu from CNS without the need to deliver drugs across the blood-brain barrier (BBB) and with minimal or no adverse effects may provide a major therapeutic asset.

Effects of Daily L-Dopa Administration on Learning and Brain Structure in Older Adults Undergoing Four Weeks of Cognitive Training: A Randomised, Parallel-Group, Double-Blind, Placebo-Controlled Trial

Background: Cognitive aging creates major individual and societal burden, motivating search for treatment and preventive care strategies. Behavioural interventions can improve cognitive performance in older age, but effects are small. Basic research has implicated dopaminergic signaling in plasticity. We investigated whether transient enhancement of dopaminergic neurotransmission via administration of L-dopa improves effects of cognitive training on performance. Methods: Participants for this randomised, parallel-group, double-blind, placebo-controlled trial were recruited via newspaper advertisements. Inclusion criteria were: age of 65-75 years, Mini-Mental State Examination score >25, absence of serious medical conditions. Eligible subjects were randomly allocated to either receive 100/25mg L-dopa/benserazide or placebo prior to each of twenty cognitive training sessions administered during a four-week period. Participants and staff were masked to group assignment. Primary outcomes were latent variables of spatial and verbal fluid intelligence. This trial was preregistered at the European Clinical Trial Registry, EudraCT#2016-000891-54. Findings: Between January 1st and October 10th 2017, we screened 235 people from the population in Stockholm, Sweden and randomly assigned 63 eligible subjects to receive L-dopa (n=32) or placebo (n=31) during cognitive training. Compared to the placebo group, subjects receiving L-dopa improved less in spatial intelligence (-0·267 SDs; 95% CI [-0·498, -0·036]; p=0·024). Change in verbal intelligence did not significantly differ between the groups (-0·081 SDs, 95% CI [-0·242, 0·080]; p=0·323). Adverse events occurred for 10 subjects (31%) in the active and for 7 participants (23%) in the control groups. Interpretation: The results speak against early pharmacological interventions in older healthy adults to improve cognitive functions by targeting the dopaminergic system and provide no support for learning-enhancing properties of L-dopa supplements. The findings warrant closer investigation about the cognitive effects of early dopamine-replacement therapy in neurological disorders. Trial Registration Number: This trial was preregistered at the European Clinical Trial Registry, EudraCT#2016-000891-54. Funding: European Research Council (ERC Grant agreement #617280-REBOOT), Wallenberg Clinical Scholars, and Stiftelse Stockholms Sjukhem. Declaration of Interest: We declare no competing interests. Ethical Approval: The study protocol was approved by the regional ethics review board in Stockholm (2016-1897-31/1) and the Swedish medical product agency (20016000891-54). Participants provided written informed consent before enrolment.

Is nutritional status associated with the level of anxiety, depression and pain in patients with lung cancer?

Nutritional deficiencies are common in lung cancer patients, especially in those with advanced and metastatic cancers. The pathogenesis of the development of nutritional disorders in cancer patients has not been fully explained. The study was performed in order to research associations between nutritional status and mental condition and pain. The aim of the study was to assess the relationship between nutritional status and the level of anxiety, depression and perceived pain in patients with lung cancer. A total of 257 patients with lung cancer were enrolled. The Mini-Nutritional Assessment (MNA) questionnaire was used to assess their nutritional status; the Hospital Anxiety and Depression Scale (HADS) was used to assess their levels of anxiety and depression; the Visual Analog Scale (VAS) was used to assess levels of perceived pain. The MNA showed that 23% of the study group was malnourished, 33% at risk of malnutrition and 44% displayed a normal nutritional status. The HADS questionnaire showed that 65% of the study group had depressive symptoms and 65% had anxiety. The mean score of the VAS was 4.35. A significant negative correlation between nutritional status and pain was observed (r=-0.65; P<0.001) as well as between nutritional status and anxiety and depression (r=-0.68; P<0.001 and r=-0.60; P<0.001, respectively). The prevalence of nutritional disorders and the intensity of somatic symptoms and psychological distress are high among lung cancer patients. The significant levels of depression, anxiety and pain in patients at risk of malnutrition which were highlighted in comparison to patients with a normal nutritional status indicate the need for early supportive psychotherapy or pharmacological interventions.

Researchers Sum Up Current Knowledge of Bipolar Disorder, Call for More Study

Researchers Sum Up Current Knowledge of Bipolar Disorder, Call for More Study