Global Improvement Scale Research Articles

The Effects of Risperidone on Cognition in People With Autism Spectrum Disorder: A Systematic Review.

Autism spectrum disorder is made up of several disorders, which include autism, Asperger syndrome, and pervasive developmental disorder. Boys are four times more likely to be diagnosed than girls with autism spectrum disorder, and symptoms usually become apparent by the age of three. Autism spectrum disorders' core characteristic features are abnormal interaction, impairment in communication, and stereotyped behaviors with restricted activities and interests. There are also non-core features associated with autism spectrum disorder, and these are aggression, self-injurious behavior, and tantrums. To date, there is no one drug approved to treat the core symptoms of autism spectrum disorder, but antipsychotic drugs such as risperidone have been shown to be effective at treating both core and non-core symptoms in controlled trials using multiple behavioral rating scales such as the Aberrant Behavioral Checklist subscale, the Clinical Global Impression Improvement Scale, the Ritvo-Freeman Real Life Scale, the Children's Yale-Brown Obsessive Compulsive Scale, the Vineland Adaptive Behavior Scale, and the Social Withdrawal Subscale. The safety, efficacy, acceptability, and tolerability of risperidone were assessed in these studies, and weight gain was a common side effect observed, but the outcome was usually mild and self-limiting. The effect of risperidone on cognition was explored in this article. The studies selected for this article were of small sample size and short duration, which presented limitations for treatment with risperidone and an area that needs to be explored further for its contribution to clinical practice.

Early indicators of response to transdiagnostic treatment of pediatric anxiety and depression.

Pediatric anxiety and depression are prevalent, impairing, and highly comorbid. Available evidence-based treatments have an average response rate of 60%. One path to increasing response may be to identify likely non-responders midway through treatment to adjust course prior to completing an episode of care. The aims of this study, thus, were to identify predictors of post-intervention response assessing (a) mid-treatment symptom severity, (b) session-by-session treatment process factors, and (c) a model optimizing the combination of these. Data were drawn from the treatment arm (N = 95, ages 8-16) of a randomized transdiagnostic intervention trial (Msessions = 11.2). Mid-point measures of youth- and parent-reported anxiety and depression were collected, and therapists rated homework completion, youth and parent engagement, and youth therapeutic alliance at each session. Logistic regression was used to predict response on the Clinical Global Impression Improvement Scale (CGI-I ≤2) rated by independent evaluators masked to treatment condition. Mid-point symptom measures were significant predictors of treatment response, as were therapist-ratings of youth and parent engagement, therapeutic alliance, and homework completion. Therapist ratings were significant when tested as mean ratings summing across the first eight sessions of treatment (all ps < .004) and at individual session points (all ps <0.05). A combined prediction model included youth-reported anxiety, parent-reported depression, youth engagement at Session 2, and parent engagement at Session 8. This model correctly classified 76.5% of youth as non-responders and 91.3% as responders at post-treatment (Nagelkerke R2 = .59, χ2 (4, 80) = 46.54, p < .001). This study provides initial evidence that response to transdiagnostic intervention for pediatric anxiety and depression may be reliably predicted by mid-point. These data may serve as foundational evidence to develop adaptive treatment strategies to personalize intervention, correct treatment course, and optimize outcomes for youth with anxiety and depression.

Clozapine for treatment refractory catatonia in individuals with autism spectrum disorder: a retrospective chart review study

ABSTRACT Background Catatonia is increasingly recognized in individuals with autism spectrum disorder (ASD). Empirical data on treating catatonia in this population are limited. The purpose of this study is to provide naturalistic data on the use of clozapine for the treatment of catatonia in patients with ASD. Research design and methods Medical records of 12 individuals with ASD and catatonia who received treatment with clozapine were reviewed. Treatment response to clozapine was rated by assigning a retrospective Clinical Global Impression Improvement scale (CGI-I) score. Results Mean (SD) and median (IQR) age at initiation of clozapine treatment were 22.1 (7.7) and 20.4 (9.7) years, with a range of 10–39 years. Eleven of the 12 patients had received treatment with lorazepam prior to initiating clozapine and 9 of the 12 patients received concomitant treatment with lorazepam and clozapine. Eleven of the 12 patients (92%; 95% CI: 65%, 99%) responded to clozapine. All 12 patients remained on clozapine at the time of their most recent clinical note. All 12 patients (100%; 95% CI: 76%, 100%) experienced one or more adverse events, the most common of which was sedation (n = 11, 92%). Conclusions Overall, clozapine was associated with a high response rate for the treatment of catatonia in patients with ASD. These naturalistic data support the use of clozapine for the treatment of catatonia in patients with ASD for whom lorazepam is either ineffective or partially effective.

The Low FODMAP Diet for Children with Inflammatory Bowel Disease and Overlapping Functional Gastrointestinal Symptoms – a Case Series

The low FODMAP diet (LFD) is a dietary intervention&lt;strong&gt; &lt;/strong&gt;developed for and&lt;strong&gt; &lt;/strong&gt;used particularly for&lt;strong&gt; &lt;/strong&gt;the management of functional GI symptoms (FGIS) in adults with irritable bowel syndrome (IBS).&lt;strong&gt; &lt;/strong&gt;It has also been proposed to improve coincident&lt;strong&gt; &lt;/strong&gt;functional gut symptoms in adults with inflammatory bowel disease (IBD). This report describes the outcomes of the LFD in a series of children with IBD with concurrent&lt;strong&gt; &lt;/strong&gt;FGIS. This study included children aged between 7-14 years with quiescent IBD and overlapping FGIS. All&lt;strong&gt; &lt;/strong&gt;participants received three dietetic consultations in line with best practice recommendations. The IBS Global Improvement Scale was used to assess symptom outcomes. Mean (standard deviation [SD]) and number (percentage) were calculated for continuous and categorical data. Seven (77.7%) of the nine children experienced GI symptom improvement after completing the LFD for four weeks. All seven children had recurrence of symptoms in response to challenge with fructans and three also experienced symptoms of lactose intolerance. The LFD may be considered as a dietary option to help alleviate overlapping FGIS in children with quiescent IBD when provided by a qualified paediatric gastroenterology dietitian. Further studies are now required to support these findings.

Memantine May Reduce Hair-Pulling, Skin Picking

Memantine May Reduce Hair-Pulling, Skin Picking

Prospective Evaluation of the Safety and Efficacy of Thermomechanical Fractional Injury for Perioral Rhytides.

Perioral rhytides can be treated with laser and energy-based devices. More recently, a novel fractional thermomechanical skin rejuvenation system was developed to cause controlled thermal injury through direct heat transfer. A prospective clinical trial evaluated the safety and efficacy of a thermomechanical fractional injury device (Tixel 2, Novoxel, Netanya, Israel) for perioral rhytides. Subjects with moderate-to-severe perioral rhytides were enrolled and underwent 4 monthly treatments. Twenty-three subjects were enrolled and completed all study visits. Mean age was 62.5 years, and 100.0% were women. Fitzpatrick Skin Types I-IV were included. For Fitzpatrick Wrinkle Classification System (FWCS), mean baseline score was 6.9. Per investigator, there was a mean 1.9-grade improvement in FWCS at 3-month follow-up ( p < .0001). At 3-month follow-up, 8.7% (n = 2) of subjects had a 3-grade improvement, 69.6% (n = 16) had a 2-grade improvement, and 21.7% (n = 5) had a 1-grade improvement. For physician Global Aesthetics Improvement Scale at 3-month follow-up, 69.6% (n = 16) had 76% to 100% improvement, 13.0% (n = 3) had 51% to 75% improvement, and 17.4% (n = 4) had 26% to 50% improvement. There were no severe adverse events, and subjects experienced minimal pain. A novel device using thermomechanical fractional injury was demonstrated to be safe and effective in the treatment of perioral rhytides.

Low dose Amantadine and Escitalopram combination in Atypical Parkinsonian disorders- A Retrospective chart review

IntroductionThe response to conventional antiparkinsonian medications is elusive in atypical parkinsonian disorders. Improvement in parkinsonian symptoms in atypical parkinsonian disorders has been reported with anecdotal use of Amantadine. The role of serotonergic control over the nigrostriatal pathway led to the use of Escitalopram.ObjectivesTo examine the efficacy of low dose Amantadine and Escitalopram combination treatment in atypical parkinsonian disorderMethodsA retrospective chart review of Atypical Parkinsonian disorder patients who received the combination of low dose Amantadine and Escitalopram and had follow up assessment available for a minimum of four months were studied. The primary outcome measure was change in Progressive Supranuclear Palsy rating scale, Unified Multiple System Atrophy rating scale score and Clinical Global Improvement Scale Change score in follow up visits.ResultsA total of 8 patients with a mean age of 68.5 years, 6 with a diagnosis of Progressive Supranuclear Palsy(PSP) and 2 with a diagnosis of Multiple System Atrophy(MSA) met the selection criteria for the study. Patients were treated with the dose of Amantadine 50mg twice daily and Escitalopram 5mg once daily. The symptom domain to respond first was autonomic symptoms followed by gait, mentation, limb and bulbar symptoms. Amantadine has unique dopaminergic and NMDA antagonist properties. Serotonin has a role in modulation of the autonomic functions and nigrostriatal circuitry. Thus, combining Escitalopram with Amantadine can help ameliorate the array of symptoms in atypical parkinsonian disorders.ConclusionsThe PSP and MSA patients responded to the combination of low dose Amantadine and Escitalopram as evidenced by objective rating scales and subjective clinician assessment. Further prospective trials for longer duration are needed to establish the effect size and stability of response.KEYWORDS: steele richardson olszewski disease, shy dragger syndrome, antidepressantsDisclosure of InterestNone Declared

Internet-delivered treatment for patients suffering from severe functional somatic disorders: Protocol for a randomized controlled trial

BackgroundFunctional somatic disorders (FSDs) with symptoms from multiple organs, i.e., multi-system type, are common in the general population and may lead to disability and reduced quality of life. Evidence for efficient treatment programs has been established, however, there is a need for making treatments accessible to a larger group of patients. Internet-delivered therapy has become prevalent and has proven as effective as face-to-face therapy, while providing a flexible and easily accessible treatment alternative. The aim of the current study is to compare the efficacy of the therapist-assisted internet-delivered treatment program One step at a time (OneStep) with the internet-delivered self-help program Get started (GetStarted). MethodsA total of 166 participants aged 18–60 years diagnosed with multi-system FSD will be assessed and randomized to either 1) OneStep: a 14-week program consisting of 11 treatment modules based on principles from cognitive behavioural therapy or 2) GetStarted consisting of 1 module on psychoeducation. The primary outcome is physical health, assessed by a Short Form Health Survey (SF-36) aggregate score of the subscales vitality, physical functioning, and bodily pain 3 months after end-of-treatment and self-reported improvement assessed by the Clinical Global Improvement Scale. Secondary outcomes include symptom load, depression, anxiety, and illness worry. Process measures include emotional distress, illness perception, illness behaviour, and symptom interference. ConclusionsThis study is the first study to test an internet-delivered treatment program for FSD, multi-system type and has the potential to show the importance of making evidence-based internet-delivered treatment for FSD more accessible.

The Safety to Switch from Constant Voltage to Constant Current with a Mixed Internal Pulse Generator in Deep Brain Stimulation

Abstract Background: Deep brain stimulation (DBS) is an efficient modality for the treatment of movement disorders. Differing from the constant voltage (CV)-DBS devices, constant current (CC)-DBS devices may allow more precise stimulation of the target brain regions since they are less influenced by impedance. If internal pulse generators (IPGs) of DBS devices are required to be connected with electrodes of different brands, employing proper adapters is necessary. Such connected DBS devices are called mixed or hybrid devices. Objectives: As there is sparse information about the clinical mixed devices, we studied their safety and efficacy. Materials and Methods: Clinical scores of 13 patients implanted with mixed DBS devices were determined with the Unified Parkinson’s Disease Rating Scale (UPDRS) in Parkinson’s disease (PD) (n = 10) and with the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS) in dystonia (n = 3). Patient satisfaction was assessed with the Timmerman questionnaire. The Clinical Global Impression Improvement (CGI-I) Scale was also evaluated. Results: Patients’ overall satisfaction was considerably higher with mixed devices. The UPDRS and BFMDRS clinical scores did not significantly differ after switching to a mixed DBS device. Three patients before the DBS switch suffered from side effects under the CV mode. These patients got rid of the side effects in their follow-up with a reduction in pulse width values. Discussion: Mixed devices working in CC mode are well tolerated with high patient satisfaction. Conclusion: Besides patient satisfaction, mixed IPGs are also considered safe.

Ayurvedic management of Generalised Anxiety Disorder (GAD) induced insomnia- A case report

This case report is the description of Ayurvedic management of Generalised Anxiety Disorder (GAD) induced insomnia of a 22 years old male. Apart from insomnia, the patient suffered from both physical and psychological symptoms of GAD for about 7 months. Diagnosis was made as per Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Without approaching conventional medicine, patient came directly to the Out Patient Department (OPD) of Regional Ayurveda Research Institute, Thiruvananthapuram, Kerala for management. In Ayurveda, insomnia can be considered as Nidranasha; for GAD exact neck to neck correlation cannot be made. Internal medications and external procedures with nidrajanak, rasayana, Ojaskara, medhya, unmadahar properties were applied. Assessments were conducted through Hamilton Anxiety Rating Scale (HARS), GAD 7 scale, Pittsburgh Sleep Quality Index (PSQI), WHO Quality of Life- BREF, and Clinical Global Improvement scale (CGI) on Day 1, Day 20 and Day 34 of intervention. The case is unique in the sense that complete relief from all symptoms was obtained after 20 days with cost effective measures and nil side effects. Ayurvedic intervention was found to be a good alternative therapy in the management of GAD induced insomnia.

Age-Dependent Dose Increase During an Acute Electroconvulsive Therapy Series.

Electroconvulsive therapy (ECT) dose is highly relevant for ECT efficacy as well as adverse effects. It is often based on seizure threshold (ST). Studies have shown that ST increases over the course of an ECT series. Clinical observation suggests that this rise might be more pronounced in geriatric patients. Retrospectively, we analyzed ECT dose during the first 20 ECT treatments in 472 patients undergoing ECT. Dose adjustments were assessed in relation to patients' age using generalized least squares regression analysis. Response was defined as Clinical Global Impression Improvement Scale < 4. Dose increased in all patients during the course of the ECT series (mean initial dose, 64.97 ± 68.04 mC; at 10th ECT, 385.46 ± 211.28 mC). Dose was significantly correlated with ECT treatment number, electrode placement, and the interaction between age and ECT treatment number. In other words, dose increase was significantly positively correlated with increasing age, that is dose increased more in older compared with younger patients during the course of an ECT series ( z = 9.47, P < 0.001). Response was not correlated with age-dependent dose increase; however, the length of the ECT series in responders was negatively associated with the dose increase from the first to the seventh ECT session ( F = 5.28, P = 0.0228). Our results indicate that ST increases more rapidly during the course of an ECT series in older compared with younger patients. To ensure high efficacy throughout the course of treatment, attention should be paid to decreasing seizure quality, especially in older patients, and dose should be adjusted accordingly.

Parent training for the treatment of irritability in children and adolescents: a multisite randomized controlled, 3-parallel-group, evaluator-blinded, superiority trial

BackgroundIrritability is common in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD) and with anxiety/depressive disorders. Although youth irritability is linked with psychiatric morbidity, little is known regarding its non-pharmacological treatments. Developing non-pharmacological treatments for children with severe, chronic irritability is an important target for clinical research. To achieve this goal, we will test the benefits of parent-focused therapies in reducing irritability. The aim of the study is to compare Parent Management Training (PMT) and Non-Violent Resistance Training (NVR) programs with treatment-as-usual (TAU) on the improvement of irritability in children and adolescents with a baseline Parent-rated Affective Reactivity Index of 4 or higher, in the context of ADHD and other emotional and behavioural disorders. Additionally, we will assess (i) improvement of irritability at different times and according to different informants (parents, children, clinicians); (ii) improvement of parental strategies; and (iii) acceptability of the interventions, exploring possible mechanisms of the therapeutic effect.MethodsTwo hundred and seventy participants between 6 and 15 years with ADHD and other emotional and behavioural disorders will be recruited and randomly assigned with their parents to the PMT, NVR, and TAU groups. PMT and NVR programs have 10 online sessions and two booster sessions at 1 and at 3 months. The primary outcome measure is the change from baseline at 3 months after completion of the program of the Clinician-rated Affective Rating Scale (CL-ARI) assessed by a blind evaluator. Secondary outcome measures include the change from baseline from those scales: the CL-ARI, the Clinical Global Impression Improvement scale, the Parenting and Familial Adjustment Scales, the Child-rated Cranky thermometers and the Parent-rated ARI. We will assess the parent’s expressed emotions and reflexivity during the online five-minute speech sample, clinical dimensions through the Child Behavior Checklist 6–18 and the Inventory of Callous Unemotional traits. Evaluations will be done remotely at baseline and at 1- and 3-months follow-up visits.DiscussionWe expect a benefit in controlling irritability in the treatment groups. This will constitute an important achievement in promoting parental support programs in the treatment of irritability in the context of emotional and behavioural disorders.Clinicaltrials.gov. Number: NCT05528926. Registered on the 2nd of September, 2022.

The effect of oxytocin nasal spray on social interaction in young children with autism: a randomized clinical trial

Early supports to enhance social development in children with autism are widely promoted. While oxytocin has a crucial role in mammalian social development, its potential role as a medication to enhance social development in humans remains unclear. We investigated the efficacy, tolerability, and safety of intranasal oxytocin in young children with autism using a double-blind, randomized, placebo-controlled, clinical trial, following a placebo lead-in phase. A total of 87 children (aged between 3 and 12 years) with autism received 16 International Units (IU) of oxytocin (n = 45) or placebo (n = 42) nasal spray, morning and night (32 IU per day) for twelve weeks, following a 3-week placebo lead-in phase. Overall, there was no effect of oxytocin treatment over time on the caregiver-rated Social Responsiveness Scale (SRS-2) (p = 0.686). However, a significant interaction with age (p = 0.028) showed that for younger children, aged 3–5 years, there was some indication of a treatment effect. Younger children who received oxytocin showed improvement on caregiver-rated social responsiveness ( SRS-2). There was no other evidence of benefit in the sample as a whole, or in the younger age group, on the clinician-rated Clinical Global Improvement Scale (CGI-S), or any secondary measure. Importantly, placebo effects in the lead-in phase were evident and there was support for washout of the placebo response in the randomised phase. Oxytocin was well tolerated, with more adverse side effects reported in the placebo group. This study suggests the need for further clinical trials to test the benefits of oxytocin treatment in younger populations with autism.Trial registration www.anzctr.org.au (ACTRN12617000441314).

Cognitive behavioural group therapy for insomnia (CBGT-I) in patients undergoing haemodialysis: a randomized clinical trial.

Given the many complications of drug therapy, it seems reasonable to use non-pharmacological therapies that can improve mental and physical disorders in haemodialysis patients. This study aims to determine the effectiveness of cognitive behavioural group therapy for insomnia (CBGT-I) in sleep quality, depression, anxiety and general psychological health of haemodialysis patients. This randomized clinical trial was conducted on 116 haemodialysis patients who were randomly assigned to experimental (n=58) and control (n=58) groups. In the experimental group, CBGT-I was provided during nine weekly sessions. Data collection tools included Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory-II (BDIII), Beck Anxiety Inventory (BAI), General Health Questionnaire (GHQ-28), Clinical Global Improvement Scale (CGI), Client Satisfaction Questionnaire (CSQ) and Working Alliance Inventory-Short Form (WAI-S). Data were analysed by SPSS-25 and p<.05 was considered significant. The findings demonstrated that CBGT-I compared with control group was effective in improving sleep quality (p<.001, η2=.790), depression (p<.001, η2=.616), anxiety (p<.001, η2=.682) and general psychological health (p<.001, η2=.871). Participants of CBGT-I showed notable improvements as a result of the treatment, were satisfied with treatment, and had a good therapeutic relationship. CBGT-I is effective in reducing depression and anxiety in addition to improving sleep quality and general psychological health in haemodialysis patients. Therefore, it is recommended to be used as a complementary treatment for these patients.

Association Between Polygenic Risk Scores and Outcome of ECT.

Identifying biomarkers associated with response to electroconvulsive therapy (ECT) may aid clinical decisions. The authors examined whether greater polygenic liabilities for major depressive disorder, bipolar disorder, and schizophrenia are associated with improvement following ECT for a major depressive episode. Between 2013 and 2017, patients who had at least one treatment series recorded in the Swedish National Quality Register for ECT were invited to provide a blood sample for genotyping. The present study included 2,320 participants (median age, 51 years; 62.8% women) who had received an ECT series for a major depressive episode (77.1% unipolar depression), who had a registered treatment outcome, and whose polygenic risk scores (PRSs) could be calculated. Ordinal logistic regression was used to estimate the effect of PRS on Clinical Global Impressions improvement scale (CGI-I) score after each ECT series. Greater PRS for major depressive disorder was significantly associated with less improvement on the CGI-I (odds ratio per standard deviation, 0.89, 95% CI=0.82, 0.96; R2=0.004), and greater PRS for bipolar disorder was associated with greater improvement on the CGI-I (odds ratio per standard deviation, 1.14, 95% CI=1.05, 1.23; R2=0.005) after ECT. PRS for schizophrenia was not associated with improvement. In an overlapping sample (N=1,207) with data on response and remission derived from the self-rated version of the Montgomery-Åsberg Depression Rating Scale, results were similar except that schizophrenia PRS was also associated with remission. Improvement after ECT is associated with polygenic liability for major depressive disorder and bipolar disorder, providing evidence of a genetic component for ECT clinical response. These liabilities may be considered along with clinical predictors in future prediction models of ECT outcomes.

Comparative study of the efficacy of fractional Er: YAG 2940 nm laser and Q-switched Nd: YAG 1064 nm laser in keratosis pilaris.

Keratosis pilaris is a common keratinization disorder of the extensor surfaces of the proximal extremities. Various treatment modalities reduce symptoms, but their efficacy is limited. The aim of this study is to compare the efficiency of Q-Switched Nd: YAG laser and fractional Er: YAG laser. The lesions in both arms were randomly divided into areas A and B. Fractional Er: YAG 2940 nm laser performed to area A 1.5J/cm2 , spot size 7 mm, frequency 3Hz and three passes and Q-Switched Nd: YAG 1064 nm laser performed to Area B, 4-6J/cm2 spot size 4 mm, 8Hz frequency, and as a single pass. Both lasers were performed in 4 sessions at 3-week intervals. The global improvement scale evaluated treatment responses in dyspigmentation and skin texture. Twenty patients completed the study, and the mean age of a total of 20 patients was 22.9. There was no significant difference in dyspigmentation and skin texture with global improvement scale between Area A and Area B, respectively (p=0.078, p=0.638). In addition, there was no significant difference between patient satisfaction levels after treatment in Area A and Area B (p=0.868). The efficiency of the fractional Er: YAG 2940 nm laser was found equal to the Q-switched Nd: YAG 1064 nm laser. Fractional Er: YAG 2940 nm laser may be a new treatment option in the treatment of keratosis pilaris.

Treatment-Resistant Mood Disorders in LGBTQ People

Objective: Individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) experience greater social exclusion and discrimination and higher rates of depression. Little is known about the clinical characteristics or treatment outcomes of LGBTQ people with severe mood disorders. We hypothesized that LGBTQ patients would present with distinct clinical features and that they might respond less favorably to electroconvulsive therapy (ECT).Methods: We performed a retrospective chart review (2018-2020) of 59 LGBTQ patients and 441 non-LGBTQ patients who received an acute ECT series for treatment-resistant illness (in 95%, a depressive episode by DSM-5 criteria). Clinical response was evaluated with the Clinical Global Impression Improvement (CGI-I) scale, self-rated Quick Inventory of Depressive Symptomatology (QIDS-SR), and QIDS-SR suicide item. Inverse probability of treatment weights were applied to regression models to balance baseline confounders.Results: LGBTQ status was associated with younger age, current suicide ideation, past suicide attempt, self-injurious behavior, posttraumatic stress disorder, personality disorder, tobacco smoking, past substance use disorder, and history of sexual abuse (all P < .05). LGBTQ and non-LGBTQ groups showed no significant differences in CGI-I score (odds ratio = 0.82, 95% CI = 0.48-1.40, P = .47), change in QIDS-SR total score (least-squares mean = -9.2 vs -8.1; F1,408 = 1.42; P = .24), or change in QIDS-SR suicide item (odds ratio = 1.83, 95% CI = 0.91-3.68, P = .09).Conclusions: LGBTQ people with treatment-resistant mood disorders presented with distinct clinical features, some of which have been previously linked with less favorable treatment outcomes. Nonetheless, LGBTQ and non-LGBTQ patients experienced similar clinically significant improvement with an acute ECT series. ECT should be considered for treatment-resistant depression regardless of an individual's sexual orientation or gender identity.

Open-Label assessment of the efficacy and tolerability of a skin care regimen for treating subjects with visible and physical symptoms of sensitive skin.

Sensitive skin is a common concern with 60%-70% of women and 50%-60% of men reporting skin sensitivity and redness. Facial redness is associated with a higher incidence of embarrassment, social anxiety, and diminished quality of life. While there is no cure for sensitive skin, it can be controlled. The objective of this 12-week, open-label clinical trial was to assess the efficacy and tolerability of a topical facial regimen for treating subjects with facial redness and sensitive skin. Enrolled subjects were healthy male and female individuals, 25-60 years old with Fitzpatrick skin types I-VI who were seeking treatment for moderate or severe facial redness. Subjects were provided with products which were applied each morning and evening. The investigator assessed change in subject appearance using Overall Redness and Global Improvement Scales and subjects rated changes in appearance and tolerability with self-assessment scales. The mean Overall Redness Scale Score improved by 34% and 25% at Weeks 8 and 12, respectively. There was Mild or Moderate improvement in Global Improvement Scale scores beginning at Week 2 with over 50% achieving Marked improvement by Week 12. All subjects Agreed or Strongly Agreed that their facial redness was less noticeable, their skin appeared less inflamed, overall skin appearance improved, and skin looked and felt healthier at Week 12. The regimen was well-tolerated. This study demonstrated a treatment regimen designed to neutralize skin redness and calm inflamed skin was well-tolerated and improved the symptoms of sensitive skin.

Association of Clinical and Demographic Characteristics With Response to Electroconvulsive Therapy in Mania

Knowledge of the effectiveness of electroconvulsive therapy (ECT) in the treatment of manic episodes is based on clinical experience, but empirical evidence is scarce. Moreover, prognostic factors associated with response to ECT in patients with mania are poorly understood. To investigate the response to ECT in patients with manic episodes. This nationwide, register-based observational cohort study was conducted using data from patients admitted to psychiatric departments in Sweden that reported data to the Swedish National Quality Registry for ECT (Q-ECT). Patients admitted to any hospital in Sweden and receiving ECT for a manic episode between 2012 and 2019 were considered for inclusion (605 individuals). The outcome, Clinical Global Impression Improvement scale (CGI-I) score, was available in 571 patients. Data from several national registers were combined to determine clinical and sociodemographic factors. Analysis of data occurred from April through September 2021. Patients treated with ECT for a mania were identified from the Q-ECT. Response to ECT was defined by a CGI-I score of 1 (very much improved) or 2 (much improved). Remission was defined as a Clinical Global Impression Severity scale (CGI-S) score of 1 (reference range or not ill) or 2 (minimally ill) within 1 week after ECT. Univariate and multivariable regression models were used to investigate associations of sociodemographic factors, psychopharmacology, and comorbidities with response. Among 571 patients with mania treated with ECT (211 [37.0%] men; median [IQR] age, 46 [31-59] years), 482 patients (84.4%) responded to ECT. Comorbid anxiety and obsessive-compulsive disorder (OCD) were associated with lower odds of response to ECT (adjusted odds ratio [aOR], 0.48; 95% CI, 0.25-0.90 and aOR, 0.17; 95% CI, 0.06-0.56, respectively). Patients who were markedly ill (aOR, 2.93; 95% CI, 1.23-7.00), severely ill (aOR, 2.60; 95% CI, 1.06-6.34), or among the most extremely ill (aOR, 7.94; 95% CI, 2.16-29.21) according to CGI-S score had higher odds of response than those with mild or moderate illness. This study found that ECT was associated with improvement for mania in clinical settings, with especially high response rates in patients with severe illness and those without comorbid anxiety or OCD.

Neural Markers of Methylphenidate Response in Children With Attention Deficit Hyperactivity Disorder.

BackgroundDespite widespread use of stimulants to treat ADHD, individual responses vary considerably and few predictors of response have been identified. The identification of reliable and clinically feasible biomarkers would facilitate a precision medicine approach to pharmacological treatment of ADHD. We test the hypothesis that two electroencephalography (EEG) based neural signatures of ADHD, resting aperiodic slope exponent and novelty P3 amplitude, are markers of methylphenidate response in children. We hypothesize that positive response to methylphenidate treatment will be associated with greater abnormality of both neural markers.MethodsTwenty-nine 7-11 year-old children with ADHD and a history of methylphenidate treatment, and 30 controls completed resting EEG and visual oddball event related potential (ERP) paradigms. ADHD participants were characterized as methylphenidate responders (n = 16) or non-responders (n = 13) using the clinical global improvement (CGI-I) scale during blinded retrospective interview. All participants abstained from prescribed medications for at least 48 hours prior to the EEG.ResultsAs expected, methylphenidate responders (CGI-I rating < 3) demonstrated attenuated P3 amplitude relative to controls. Unexpectedly, methylphenidate non-responders showed atypically flat aperiodic spectral slope relative to controls, while responders did not differ on this measure.ConclusionADHD symptoms associated with atypical patterns of intrinsic neural activity may be less responsive to methylphenidate. In contrast, ADHD symptoms associated with abnormal frontal-striatal neural network excitation may be correctable with methylphenidate. Altogether, EEG is a feasible and promising candidate methodology for identifying biomarkers of stimulant response.