Impairment In Daily Functioning Research Articles

Analysis of functional connectivity changes in attention networks and default mode networks in patients with depression and insomnia.

Major Depressive Disorder (MDD) and Insomnia Disorder (ID) are prevalent psychiatric conditions often occurring concurrently, leading to substantial impairment in daily functioning. Understanding the neurobiological underpinnings of these disorders and their comorbidity is crucial for developing effective interventions. This study aims to analyze changes in functional connectivity within attention networks and default mode networks in patients with depression and insomnia. The functional connectivity alterations in individuals with MDD, ID, comorbid MDD and insomnia (iMDD), and healthy controls (HC) were assessed from a cohort of 174 participants. They underwent rs-fMRI scans, demographic assessments, and scale evaluations for depression and sleep quality. Functional connectivity analysis was conducted using region-of-interest (ROI) and whole-brain methods. The MDD and iMDD groups exhibited higher Hamilton Depression Scale (HAMD) scores compared to HC and ID groups (P < 0.001). Both ID and MDD groups displayed enhanced connectivity between the left and right orbital frontal cortex compared to HC (P < 0.05), while the iMDD group showed reduced connectivity compared to HC and ID groups (P < 0.05). In the left insula, reduced connectivity with the right medial superior frontal gyrus was observed across patient groups compared to HC (P < 0.05), with the iMDD group showing increased connectivity compared to MDD (P < 0.05). Moreover, alterations in functional connectivity between the left thalamus and left temporal pole were found in iMDD compared to HC and MDD (P < 0.05). Correlation analyses revealed associations between abnormal connectivity and symptom severity in MDD and ID groups. Our findings demonstrate distinct patterns of altered functional connectivity in individuals with MDD, ID, and iMDD compared to healthy controls. These findings contribute to a better understanding of the pathophysiology of depression and insomnia, which could be used as a reference for the diagnosis and treatments of these patients.

Characterizing dysregulations via cell-cell communications in Alzheimer’s brains using single-cell transcriptomes

BackgroundAlzheimer’s disease (AD) is a devastating neurodegenerative disorder affecting 44 million people worldwide, leading to cognitive decline, memory loss, and significant impairment in daily functioning. The recent single-cell sequencing technology has revolutionized genetic and genomic resolution by enabling scientists to explore the diversity of gene expression patterns at the finest resolution. Most existing studies have solely focused on molecular perturbations within each cell, but cells live in microenvironments rather than in isolated entities. Here, we leveraged the large-scale and publicly available single-nucleus RNA sequencing in the human prefrontal cortex to investigate cell-to-cell communication in healthy brains and their perturbations in AD. We uniformly processed the snRNA-seq with strict QCs and labeled canonical cell types consistent with the definitions from the BRAIN Initiative Cell Census Network. From ligand and receptor gene expression, we built a high-confidence cell-to-cell communication network to investigate signaling differences between AD and healthy brains.ResultsSpecifically, we first performed broad communication pattern analyses to highlight that biologically related cell types in normal brains rely on largely overlapping signaling networks and that the AD brain exhibits the irregular inter-mixing of cell types and signaling pathways. Secondly, we performed a more focused cell-type-centric analysis and found that excitatory neurons in AD have significantly increased their communications to inhibitory neurons, while inhibitory neurons and other non-neuronal cells globally decreased theirs to all cells. Then, we delved deeper with a signaling-centric view, showing that canonical signaling pathways CSF, TGFβ, and CX3C are significantly dysregulated in their signaling to the cell type microglia/PVM and from endothelial to neuronal cells for the WNT pathway. Finally, after extracting 23 known AD risk genes, our intracellular communication analysis revealed a strong connection of extracellular ligand genes APP, APOE, and PSEN1 to intracellular AD risk genes TREM2, ABCA1, and APP in the communication from astrocytes and microglia to neurons.ConclusionsIn summary, with the novel advances in single-cell sequencing technologies, we show that cellular signaling is regulated in a cell-type-specific manner and that improper regulation of extracellular signaling genes is linked to intracellular risk genes, giving the mechanistic intra- and inter-cellular picture of AD.

Comparative Analysis of Frailty Risk and Associated Factors: Community-Based vs. Open Recruitment Groups.

Frailty leads to vulnerability to stress, impaired daily functioning, and an increased need for care. Frailty is considered reversible, and it is crucial to detect the risk of frailty early and investigate factors that may delay its progression. To identify tests that can explain frailty risk and compare the situation of local residents with and without frailty support. Participants were recruited in two ways: through public advertisements in Akita City (open recruitment group) and through invites from frailty supporters in their immediate communities (community-based group). We examined the differences in frailty risk and oral, motor, and social functions between the two groups and identified factors associated with frailty risk in both groups. The community-based group exhibited a lower risk of frailty than the open recruitment group despite having more older members on average. Additionally, the community-based group demonstrated better social functioning than the open-recruitment group. Furthermore, factors such as oral diadochokinesis (ODK), one-leg stand test (OLS), and grip strength (GS) showed significant association with frailty risk. The ODK, OLS, and GS were identified as factors explaining frailty risk, and Frailty Supporters may reduce the risk of frailty.

Robot-based solution for helping Alzheimer patients

Alzheimer's is a progressive and debilitating neurological disorder characterized by cognitive decline, memory loss, and impaired daily functioning. It is an irreversible brain disease that destroys memory, thinking, and the ability to carry out daily activities. It poses significant challenges for patients and healthcare providers. Modern societies are trying to enhance the quality of people's lives, including Alzheimer's patients. In this study, we explored the potential of social robots to provide emotional support, improve cognitive function, and facilitate communication among Alzheimer's patients. This was achieved by initiating conversations on various topics such as family, relationships, and daily activities. This paper contributes to the literature by introducing a novel and well-organized framework for building an Alzheimer's care robot. Further, this study enriches the literature by introducing the Alzheimer Care Companion Robot (ACCR), designed to identify Alzheimer's patients. The ACCR initiates conversations in the native Arab-Kuwaiti dialect, displaying relevant memories through images and videos on its screen to assist in memory recall based on the individuals' life experiences. The proposed ACCR consists of 271 conversations belonging to three main categories: active, proactive, and graphical user interface (GUI) dialogs comprising 112 dialogs, 109 dialogs, and 50 dialogs for active, proactive, and GUI, respectively. The experimental result illustrated the success of the proposed solution.

Review of Pharmacotherapeutic Targets in Alzheimer's Disease and Its Management Using Traditional Medicinal Plants.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline, memory loss, and impaired daily functioning. While there is currently no cure for AD, several pharmacotherapeutic targets and management strategies have been explored. Additionally, traditional medicinal plants have gained attention for their potential role in AD management. Pharmacotherapeutic targets in AD include amyloid-beta (Aβ) aggregation, tau protein hyperphosphorylation, neuroinflammation, oxidative stress, and cholinergic dysfunction. Traditional medicinal plants, such as Ginkgo biloba, Huperzia serrata, Curcuma longa (turmeric), and Panax ginseng, have demonstrated the ability to modulate these targets through their bioactive compounds. Ginkgo biloba, for instance, contains flavonoids and terpenoids that exhibit neuroprotective effects by reducing Aβ deposition and enhancing cerebral blood flow. Huperzia serrata, a natural source of huperzine A, has acetylcholinesterase-inhibiting properties, thus improving cholinergic function. Curcuma longa, enriched with curcumin, exhibits anti-inflammatory and antioxidant effects, potentially mitigating neuroinflammation and oxidative stress. Panax ginseng's ginsenosides have shown neuroprotective and anti-amyloidogenic properties. The investigation of traditional medicinal plants as a complementary approach to AD management offers several advantages, including a lower risk of adverse effects and potential multi-target interactions. Furthermore, the cultural knowledge and utilization of these plants provide a rich source of information for the development of new therapies. However, further research is necessary to elucidate the precise mechanisms of action, standardize preparations, and assess the safety and efficacy of these natural remedies. Integrating traditional medicinal-plant-based therapies with modern pharmacotherapies may hold the key to a more comprehensive and effective approach to AD treatment. This review aims to explore the pharmacotherapeutic targets in AD and assess the potential of traditional medicinal plants in its management.

Generating PET scan patterns in Alzheimer's by a mathematical model.

Alzheimer disease (AD) is the most common form of dementia. The cause of the disease is unknown, and it has no cure. Symptoms include cognitive decline, memory loss, and impairment of daily functioning. The pathological hallmarks of the disease are aggregation of plaques of amyloid-β (Aβ) and neurofibrillary tangles of tau proteins (τ), which can be detected in PET scans of the brain. The disease can remain asymptomatic for decades, while the densities of Aβ and τ continue to grow. Inflammation is considered an early event that drives the disease. In this paper, we develop a mathematical model that can produce simulated patterns of (Aβ,τ) seen in PET scans of AD patients. The model is based on the assumption that early inflammations, R and [Formula: see text], drive the growth of Aβ and τ, respectively. Recently approved drugs can slow the progression of AD in patients, provided treatment begins early, before significant damage to the brain has occurred. In line with current longitudinal studies, we used the model to demonstrate how to assess the efficacy of such drugs when given years before the disease becomes symptomatic.

Patient Characteristics and Adherence to Antidepressant Medication Treatment at PsychiatricOutpatient Department of Mardan Medical Complex, Pakistan

Background: Adherence to antidepressant treatment is an important factor in the treatment and effective management of depressed patients. Characteristics of patients can help in determining compliance to treatment protocols. In order to find link between compliance and demographic characteristics of patients, insight can be obtained through exploration of these variables.Objectives: To determine the association between patient characteristics and antidepressant medication adherence. To identify characteristics of patients that may improve or worsen compliance to antidepressant medication. Material and Methods: This study was a descriptive, cross-sectional study aiming to find the link between personal characteristics and adherence to anti-depressant medications. The study was conducted at Psychiatry outpatient department of a tertiary care hospital, Mardan Medical Complex, Mardan Pakistan, from 05th September 2018 to 08th February 2021. Data was collected from 660 patients who presented with depressive symptoms to Psychiatry OPD. The main objective was to identify characteristics of patients leading to poor compliance to antidepressant medication. Results: Total study population was 660. Majority of the study population 82.9 % (n-549) were female. Uneducated were, 56.6 % (375), 81.1 % (n-537) were unemployed, and 65.9 % (n-436) were married. Follow up interviews were conducted in 316 (47.7 %) patients at 3rd week, 186 (28.1 %) patients at 6th week, 130 (19.6 %) patients at 9th week, 96 (14.5 %) patients at 12th week, and 31 (4.7 %) patients at 6 months. There was no significant difference found on the basis of patient characteristics and adherence. However, compliance was better among patients who had longer duration of illness. Conclusion: Medication adherence is a common problem among depressed patients and leads to impaired daily life functioning. Our study could not found any significant difference regarding patient characteristics among compliant and non compliant patients. Educating patients regarding the use of antidepressant medication treatment should be added to routine practice. Keywords: Anti depressants, Depression, Non-adherence, Poor compliance.

(053) Efficacy of Mindfulness Based Cognitive Therapy in Management of Provoked Vulvodynia: A Feasibility Pilot Study

Abstract Introduction Provoked Vulvodynia (PVD) is an evolving and chronic pain disorder frequently reported by women of reproductive age. Provoked Vulvodynia is a debilitating disorder and causes significant impairment in daily functioning. Objective The present study was designed with an aim to compare the efficacy of mindfulness based cognitive therapy (MBCT) with pharmacotherapy in the management of PVD in Pakistani women. Methods The present study was approved by the Ethics Review Board (ERB) of Institute of Psychological Research, Pakistan vide No. IPR/ERB/PVD/2023/006. A randomized trial design was used in this study. The women suffering from vulvodynia were included in the study. On the other hand, the women suffering from any gynecological disease, psychiatric disease, or any other medical disease or using any substance were excluded from the study. A total of 43 women suffering from PVD were referred for the treatment. 14 women were excluded as they did not meet the inclusion criteria. All women signed the compulsory informed consent form before enrolling for the study. 29 women were randomized in two treatment groups namely Group A which received 1 hour weekly session of mindfulness based cognitive therapy and Group B which received pharmacotherapy for a period of 3 months. Pharmacotherapy included Amitriptyline 25–50mg daily, Gabapentin 100–300 mg daily, and Lidocaine ointment 5% applied locally to the vestibule. There were 14 women in Group A and 15 women in Group B. A total of 6 women were dropped from the Group A and Group B because they did not want to complete the treatment protocol. 11 women in Group A and 12 women in Group B completed the treatment protocol and their data were added to the statistical analyses. The Vulvar Pain Functional Questionnaire (V-Q) was used as the main outcome measure for pretest and posttest assessments. The data was analyzed by using the Statistical Package for the Social Sciences (SPSS) version 27. Results The mean age of the women was (M=34, SD=3.13) for Group A and (M=34.41, SD=3.26) for Group B. The data was analyzed by using the Wilcoxon Signed Rank Test as the data was non parametric. There was statistical significant Z= -2.94, p&amp;lt;.05 for Group A and Z= -3.07, p&amp;lt;.05 for Group B. The results established that both mindfulness based cognitive therapy and pharmacotherapy were effective in relieving symptoms of PVD. Conclusions The present study concluded that mindfulness based cognitive therapy was as effective in relieving symptoms of PVD as pharmacotherapy. The lack of control group was a major limitation of the study. However, the future studies may be conducted with other treatment arms such as pelvic floor therapy and by adding more women in treatment and control groups. The present study may be considered as a feasibility/pilot study for the efficacy of MBCT for treatment of PVD in Pakistani women. Disclosure No.

Effects of Selective Serotonin Reuptake Inhibitors Exposure in Stressed Pregnant Mice on the Anxiety Behavior of the Offspring

Background: Stress hurts problem-solving abilities, while anxiety disorders and depression are associated with unpleasant feelings and impaired daily functioning. Open field test (OFT) is used to assess anxiety-like behavior in animals by observing their exploratory behavior. Pregnant women are vulnerable to stress, which increases the risk of premature birth and low birth weight. Stress during pregnancy can also lead to preeclampsia and behavioural problems in newborns. Selective serotonin reuptake inhibitors (SSRIs), commonly used antidepressants during pregnancy, help manage mental disorders by increasing serotonin levels and regulating the endocrine system. They reduce glucocorticoid levels, thereby alleviating anxiety and stress in pregnant women. Objectives: This research investigates the correlation between the administration of SSRIs to stress-induced expectant mothers, the manifestation of depression-like behaviour, and the expression of glucocorticoid receptors in the offspring's hippocampus. Material and Methods: This study included four mouse groups: control without stress, control with offspring stress, stress model with footshock on dams and o ffspring, and stress with fluvoxamine treatment. Depressive and stress-related behaviors were measured using OFT. Results: OFT was used to assess the behaviour of offspring mice. Significant differences were observed in the number of crossings in the centre area and behaviour. The SSRI treatment showed potential anxiolytic effects, while stress led to reduced behaviour. These findings contribute to understanding anxiety-related responses and the effects of stress and SSRI treatment in animal models. Conclusions: OFT revealed significant differences in anxiety behaviour, specifically in the number of crossing centres, the centre area, and behaviour. SSRI treatment exhibited anxiolytic effects, while stress-decreased behaviour findings enhanced our understanding of anxiety responses and the impact of stress and SSRI treatment in animal models.

Caring for Long Covid patients in Belgian primary care.

Background: The Covid-19 pandemic affected primary health care in various ways and general practitioners (GPs) take a key position in caring for patients with persistent Covid-19-related symptoms, also referred to as Long Covid. In this study, GPs’ knowledge, experiences and opinions on Long Covid, as well as the definition being used by GPs is investigated to provide more insight in the care for Long Covid patients in primary care.&#x0D; Methods: An online questionnaire, validated by experts, was distributed to all Belgian GPs through established national GP networks (SGP network, Domus Medica and SSMG) during spring 2022. The survey has 16 (ordinal, open-ended or multiple choice) questions on Long Covid. To characterize GPs, practice and demographic characteristics were collected. A case definition for Long Covid was not included, as there was no widely accepted definition available in general practice at the timing of the study. Descriptive and analytic statistics were performed.&#x0D; Results: A total of 105 GPs responded to the survey. GPs were well distributed across all Belgian regions and practice type. Female GPs represented 58.1% and mean age was 51 years (IQR: 38-63).&#x0D; Most of GPs reported that they did not have sufficient scientific knowledge on Long Covid, they reported lack of availability of reliable information on Long Covid diagnosis and treatment, and felt that accessibility to educational material on Long Covid was limited.&#x0D; For the diagnoses of Long Covid, 60.0% reported that a positive Covid-19 test result is a minimum requirement when speaking about Long Covid complaints. The commonest criteria utilized by GPs for diagnosing Long Covid was the duration of symptoms (from 4 weeks to 5 months) and on the basis of diagnostic criteria by the GP. 58.1% of GPs stated that Long Covid should be considered a chronic disease.&#x0D; The majority (75.2%) of participating GPs reported to have cared for Long Covid patients (independently of practice type, GP’s gender or age). These patients suffered mainly from fatigue (94.9%), concentration/memory problems (74.7%), breathing difficulties (68.0%), impairment in daily functioning (66.7%) and brain fog (46.2%).&#x0D; Most GPs (93.4%) believed that caring for Long Covid patients should follow multidisciplinary approach. Half of them (51.9%) reported to have been following up these patients by themselves or by GP colleagues and 32.9% by multidisciplinary cooperation. Other healthcare professionals involved include pneumologists, physiotherapists, specialists in physical medicine/rehabilitation and neurologists. GPs were consulted biweekly (17.9%), monthly (47.8%) or every few months (19.4%) by these Long Covid patients. &#x0D; Conclusion: In Belgian general practice, similar definitions and diagnostic criteria are used by GPs to identify Long Covid patients. A majority of GPs frequently provide care to Long Covid patients and GPs take a key role in the (multidisciplinary) coordination of care for these patients. However, multidisciplinary care for Long Covid patients is less organized than preferred by GPs at the timing of the study (spring 2022). With the establishment of the ‘care trajectory post-Covid-19’ for Long Covid patients in primary care since July 2022, collaboration between care givers may be stimulated in Belgian primary health care.

Cross-cultural adaptation and validation of the Brazilian Portuguese version of the Maladaptive Daydreaming Scale (BMDS-16)

Introduction and objective: Daydreaming is a common mental experience in which one gets immersed in stories, narratives, images, and fantasies, imagining them as they were real, although knowing they are unreal. Maladaptive daydreaming is characterised by an excessive and compulsive involvement on fantasy which in severe cases replaces human interaction and impairs academic, interpersonal, or vocational functioning. It can be measured using the 16-item Maladaptive Daydreaming Scale (MDS-16) which has been translated into 39 languages but validated only in eight. This study investigates the psychometric properties of the Brazilian version of this instrument (BMDS-16). Materials and methods: A total of 2,682 Brazilian adults (78% women; Mage = 26.6 years, standard deviation, SD = 7.0) participated in the study. Exploratory and confirmatory factor analyses provided support for a three-factor structure of BMDS-16 with satisfactory reliability indices. Results: Maladaptive daydreaming had positive but weak correlations with attention deficit hyperactivity disorder symptoms and dissociative experiences. As a result of the latent profile analysis, a cut-off score of 63 for maladaptive daydreaming was suggested. Based on this cut-off score, 18.6% of our sample could be considered maladaptive daydreamers. The general reliability of the scale was good (McDonald’s ω = 0.93; Cronbach’s α = 0.90). Conclusions: Overall, BMDS-16 demonstrated sound psychometric properties and applicability for general use to assess maladaptive daydreaming. The daydreaming tendency should be carefully examined in people with scores above 63, who may use fantasy in a maladaptive way, causing impairment in daily functioning and potentially conflicting with treatment.

The Role of Resveratrol in Alzheimer's Disease: A Comprehensive Review of Current Research

Abstract: Alzheimer's disease (AD) is a neurodegenerative disorder characterized by progres-sive cognitive decline, memory loss, and impaired daily functioning. The etiology of AD is complex and multifactorial, involving various pathological mechanisms such as the accumula-tion of amyloid-beta plaques, neurofibrillary tangles, neuroinflammation, and oxidative stress. As the global prevalence of AD continues to rise, there is a growing interest in identifying po-tential therapeutic interventions to prevent or slow down the progression of the disease. Resvera-trol, a natural polyphenolic compound found in various plant sources such as grapes, berries, and peanuts, has gained considerable attention due to its potential neuroprotective effects. Numerous preclinical studies utilizing in vitro and animal models have investigated the impact of resvera-trol on AD pathology and associated cognitive impairments. This review aims to provide a com-prehensive summary of the current research on the role of resveratrol in AD. In conclusion, resveratrol holds promise as a potential therapeutic agent for AD due to its ability to target mul-tiple pathological processes involved in the disease. Further research, including well-designed clinical trials with larger sample sizes, is needed to fully elucidate the efficacy, optimal dosage, and long-term effects of resveratrol in AD patients. Nevertheless, resveratrol remains an intri-guing compound with neuroprotective properties and may contribute to the development of nov-el therapeutic approaches for AD in the future.

Change on the Repeatable Battery for the Assessment of Neuropsychological Status and its relationship to brain amyloid

AbstractBackgroundThe Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been associated with commonly used biomarkers of Alzheimer’s disease (AD), including brain amyloid plaque density. However, less is known about if changes in the RBANS across time are also related to brain amyloid deposition. The current study sought to expand on prior work by examining the relationship between changes over time on the RBANS and amyloid deposition via positron emission tomography (PET).MethodOne‐hundred twenty‐six older adults with intact or impaired cognition and daily functioning underwent repeat assessment with the RBANS across nearly 16 months, as well as had a baseline amyloid PET scan.ResultIn the entire sample, amyloid deposition was significantly related to change on all five Indexes and the Total Scale score of the RBANS (rs = ‐0.28 – ‐0.61), with greater amyloid deposition being associated with worsening cognition. This pattern was also observed in 11 of 12 subtests. In the intact individuals, this pattern was only observed on change in the Immediate Memory Index (r = ‐0.32). In the subjects with MCI, this pattern was only observed on change in the Delayed Memory Index (r = ‐0.35). There was no association between change on the RBANS and brain amyloid deposition in those with AD.ConclusionWhereas prior studies have identified a relationship between baseline RBANS and amyloid status, the current findings support that changes in the RBANS are also indicative of AD brain pathology. Although replication in a more diverse sample is needed, these results continue to support the use of the RBANS in AD clinical trials.

Proton Pump Inhibitors and Cognitive Health: Review on Unraveling the Dementia Connection and Co-morbid Risks.

Dementia, an international health issue distinguished by the impairment of daily functioning due to cognitive decline, currently affects more than 55 million people worldwide, with the majority residing in low-income and middle-income countries. Globally, dementia entails significant economic burdens in 2019, amounting to a cost of 1.3 trillion US dollars. Informal caregivers devote considerable hours to providing care for those affected. Dementia imposes a greater caregiving and disability-adjusted life-year burden on women. A recent study has established a correlation between prolonged Proton Pump Inhibitor (PPI) usage and dementia, in addition to other neurodegenerative conditions. PPIs are frequently prescribed to treat peptic ulcers and GERD (gastroesophageal reflux disease) by decreasing stomach acid secretion. They alleviate acid-related symptoms through the inhibition of acid-secreting H+, K+ ATPase. In a number of observational studies, cognitive decline and dementia in the elderly have been linked to the use of PPIs. The precise mechanism underlying this relationship is unknown. These drugs might also alter the pH of brain cells, resulting in the accumulation of amyloid-beta (Aβ) peptides and the development of Alzheimer's disease (AD). Despite the compelling evidence supporting the association of PPIs with dementia, the results of studies remain inconsistent. The absence of a correlation between PPI use and cognitive decline in some studies emphasizes the need for additional research. Chronic PPI use can conceal underlying conditions, including cancer, celiac disease, vitamin B12 deficiency, and renal injury, highlighting dementia risk and the need for further investigations on cognitive health.

Connections between family violence and violence in the public sphere in Afghanistan

Afghanistan has endured over four decades of violence in the public sphere, such as war and suicide attacks. To effectively provide psychosocial counseling using a psychodynamic approach in Afghanistan, it is crucial to recognize the potential connection between ongoing public violence and high rates of family violence. In 2019, we conducted a study to explore the relationship between public violence and family violence among Kabul residents, including those seeking counseling and those who were not. Our cross-sectional mixed methods survey recruited 299 participants from a psychosocial counseling service as well as community members who were not receiving the service. The findings revealed a significant positive correlation between experiences of public violence and family violence. Both clients and non-clients reported experiencing high levels of violence, which led to impairments in daily functioning and increased suicidality. Additionally, a thematic analysis of open-ended questions indicated changes in attitudes resulting from exposure to violence, including feelings of helplessness and hopelessness both in and out of the home. We conclude that applying a psychodynamic approach to psychosocial counseling in Afghanistan requires awareness of the positive correlation between public violence and family violence in a society that has been exposed to violence in the public sphere for over forty years. Mental health care needs to contribute towards breaking cycles of violence by empowering clients to take control of their lives and become agents of change within their families and communities.

Potential strategies to optimize the efficacy of antidepressants: Beyond the monoamine theory

Depression is characterized by a feeling of sadness and a lack of pleasure, with impaired daily functioning and poor quality of life. The neurobiology and the pathogenesis of depression are not fully understood yet. Several hypotheses have been discussed including, monoamine theory, neurotransmission, oxidation, inflammation, glutamatergic transmission, neurotrophic factors, and others. Reviewing three decades of randomized controlled trials of antidepressants revealed that the antidepressants response rate is about 54% compared to a placebo response rate of 37%. Treatment-resistant depression (TRD) could be defined as an inadequate response to two different of antidepressants. In TRD, a combination strategy of using two FDA-approved antidepressants is used, which may predispose patients to adverse effects. Therefore, there is a compelling need to explore the potential “out of the box” adjuvants to antidepressants to provide higher and consistent response rates with high tolerability. These adjuvants could be medications available for other indications, food supplements, or even experimental drugs. This review will highlight potentially beneficial adjuvants to antidepressants such as nitric oxide modulators, NMDA antagonists, anti-inflammatory, antioxidants, mitochondrial modulators, insulin sensitizers, opioids, probiotics, and GABA agonists.

Posttraumatic stress disorder in a war-affected area of Northeast Ethiopia: a cross-sectional study

BackgroundPost-Traumatic Stress Disorder (PTSD) is a chronic condition that affects a significant proportion of war survivors following war and conflict. If PTSD is not managed, it can lead to decreased quality of life and impairments in daily functioning and lead to death. This study aimed to assess the prevalence of post-traumatic stress disorder and its associated factors among residents in a war-affected area, Dessie Town, Northeast Ethiopia.MethodsA community-based cross-sectional study was conducted among adult residents in the war-affected area, Dessie Town. A total of 615 individuals were selected by a systematic random sampling method. PTSD was assessed using the Post-Traumatic Stress Disorder Checklist, Civilian Version. Multivariable logistic regressions were used to measure the associated factors. Associations between variables were described using odds ratios, 95% confidence intervals, and a p-value less than 0.05.ResultsThe prevalence of PTSD was 34.5% (95% CI: 31–38). Female sex (AOR: 1.82; CI: 1.18–2.82), divorced or widowed (AOR: 2.12, CI: 1.23–3.66), having only primary schooling (AOR: 2.17; CI: 1.25–3.78), depression (AOR: 2.03; CI: 1.34–3.08), experienced ill health without medical care during the wartime (AOR: 2.97; CI: 1.43–6.16), forced separation from family (AOR: 1.90; CI: 1.16–3.12), and experienced stressful life events (AOR: 1.60; CI: 1.06–2.42) were significantly associated with PTSD.ConclusionA significant rate of PTSD was found among residents of the war-affected area, Dessie Town. One in three people was experiencing PTSD. As a result, post-war mental health early screening and intervention is a priority, particularly for females, those who are separated or divorced, and those who have experienced stressful life events due to the war.

Impairment in Functioning and Quality of Life in Patients with Idiopathic Hypersomnia: The Real World Idiopathic Hypersomnia Outcomes Study (ARISE).

Idiopathic hypersomnia is a debilitating neurologic sleep disorder characterized by excessive daytime sleepiness, sleep inertia, and prolonged sleep. Its impact on patients' quality of life and daily functioning has not been fully elucidated. The Real World Idiopathic Hypersomnia Outcomes Study (ARISE) evaluated the daily functioning, relationships, cognition, emotional well-being, and productivity/employment of participants with idiopathic hypersomnia. ARISE was a US-based virtual cross-sectional survey comprising multiple patient-reported outcome measures (Functional Outcomes of Sleep Questionnaire, short version [FOSQ-10], Quality of Life in Neurological Disorders [Neuro-QoL] Social Roles and Stigma domains, British Columbia Cognitive Complaints Inventory [BC-CCI], Patient Health Questionnaire [PHQ-9], and the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem [WPAI:SHP]). Participants were adults 21-65 years of age with idiopathic hypersomnia. Data were analyzed for all participants and for subgroups with/without long sleep time (LST; self-reported sleep ≥11 hours in 24 hours). Of 75 participants enrolled, most were female (81.3%) and the mean (SD) age was 34.1 (10.7) years. Participants' scores on the FOSQ-10 (mean [SD] score: 10.7 [2.8]) and the Neuro-QoL Social Roles (43.4 [4.2]) and Stigma (57.3 [5.9]) domains reflected impairments in daily functioning and quality of life. More than half of participants reported moderate to severe cognitive complaints (BC-CCI; 62.7%) and moderate to severe depressive symptoms (PHQ-9; 66.7%). Scores on the WPAI:SHP showed substantial impairments in absenteeism, presenteeism, overall work productivity, and overall regular daily activity (mean percent [SD]: 12.3 [23.6], 47.6 [22.7], 51.4 [24.7], and 64.0 [21.9], respectively). These considerable impairments were found in participants with and without LST. ARISE participants with idiopathic hypersomnia demonstrated poor quality of life and impaired functioning across multiple symptom domains.

Delayed Surgical Treatment in Patients with Chronic Carpal Tunnel Syndrome Is Still Effective in the Improvement of Hand Function.

Background and Objectives: Severe carpal tunnel syndrome (CTS) is the most common compression neuropathy in the upper extremities treated conservatively; later, when advanced, CTS is treated mostly surgically. The most prevalent symptoms comprise numbness, as well as sensation loss in the thumb, index, and middle finger, and thenar muscle strength loss, resulting in impaired daily functioning for patients. Data on the results of CTS treatment in patients with delayed surgical intervention are scarce. The aim of this study was to determine the postoperative results of chronic carpal tunnel syndrome treatment in patients with symptoms lasting for at least 5 years. Materials and Methods: A total of 86 patients (69 females, 17 males) with a mean age of 58 years reporting symptoms of CTS for at least 5 years (mean: 8.5 years) were prospectively studied. The average follow-up time was 33 months. All patients underwent the surgical open decompression of the median nerve at the wrist. A preoperative observation was composed of an interview and a clinical examination. The subjects completed the DASH (the Disabilities of the Arm, Shoulder, and Hand), PRWE (Patient-Rated Wrist Evaluation), and self-report questionnaires. Global grip strength, sensory discrimination, characteristic symptoms of CTS, and thenar muscle atrophy were examined. Postoperatively, clinical and functional examinations were repeated, and patients expressed their opinions by completing a BCTQ (Boston Carpal Tunnel Syndrome Questionnaire). Results: We found improvements in daily activities and hand function postoperatively. Overall, 88% of patients were satisfied with the outcome of surgery. DASH scores decreased after surgery from 44.82 to 14.12 at p < 0.001. PRWE questionnaire scores decreased from 53.34 to 15.19 at p < 0.001. The mean score of the BCTQ on the scale regarding the severity of symptoms was 1.48 and 1.62 on the scale regarding function after surgery. No significant differences were found in the scores between the male and female groups or between age groups (p > 0.05). A significant increase in global grip strength from 16.61 kg to 21.91 kg was observed postoperatively at p < 0.001. No significant difference was detected in the measurement of sensory discrimination (6.02 vs. 5.44). In most of the examined patients, night numbness and wrist pain subsided after surgery at p < 0.001. Thenar muscle atrophy diminished after surgery at p < 0.001. Conclusions: Most patients were satisfied with the results of CTS surgery regarding the open decompression of the median nerve even after 5 years of ineffective conservative treatment. Significant improvement of the hand function was confirmed in the functional studies.

Efficacy of Comedy on Health-Related Quality of Life and Oxidative Stress in Cancer Survivors.

Cancer survivors have reduced health-related quality of life (HRQOL) due to impaired daily functioning. In addition, daily stress leads to worsening oxidative stress. The purpose of this study is to investigate the efficacy of laughter therapy on HRQOL and oxidative stress in cancer survivors. This before-and-after study asked cancer survivors to watch a 15-minute or longer comedy video over a four-week period to assess the Functional Assessment of Cancer Therapy-General (FACT-G), EuroQOL 5 dimension 3-level (EQ-5D-3L), Hospital Anxiety and Depression Scale (HADS), biological Antioxidant Potential (BAP), Reactive Oxygen Metabolites-derived compounds (d-ROMs), Oxidative Stress Index (OSI), and the antioxidant/oxidative stress ratio. The nonparametric Friedman test showed significant increases from baseline in FACT-G and EQ-VAS scores and significant decreases in HADS-Anxiety and HADS-Depression scores. Post hoc analyses showed that these items commonly differed significantly at baseline versus three and four weeks after Bonferroni correction. T-test results in the biological analysis revealed small and moderate effects with significant differences in BAP (p < 0.01, d = 0.49), OSI (p = 0.03, d = 0.33), and BAP/d-ROMs (p < 0.01, d = 0.51). These results suggest that daily comedy viewing may be an effective intervention to improve quality of life and antioxidant capacity in cancer survivors. Considering its safety, convenience, and low cost, it should be considered a high-value intervention for cancer survivors.