Improvement In Depression Scores Research Articles

Randomized Placebo Controlled Trial of Sildenafil Citrate, Cognitive Behavior Sex Therapy and Integrated Treatment in Men Diagnosed With Non Organic Erectile Dysfunction.

IntroductionThe integrated treatment combining phosphodiesterase-type 5 inhibitors (PDE5i) and Cognitive Behavior Sex Therapy (CBST) has been shown to yield promising results in the treatment of Non Organic Erectile Dysfunction (NOED) in young men.AimThe current study aimed to establish the efficacy of integrated treatment combining Sildenafil Citrate (SC) 50mg and CBST as a treatment of choice in young Pakistani men with NOED.MethodsOne hundred thirty-seven young men were recruited to participate in the study out of 164 men referred from sexual health clinics in Pakistan. They were randomized sequentially into 4 treatment groups namely SC = 35, CBST = 34, integrated treatment = 35, and placebo = 33. 7, 4, 6, and 4 men were dropped out of each treatment group respectively. The data of 116 men were analyzed. The on demand SC 50 mg, twice weekly 50 minutes sessions and home assignments, a combination of SC and 50 minutes sessions, and placebo were administered to firsst, second, third, and fourth group respectively for a period of 12 weeks. The follow-up assessment was done after 12 weeks of post-treatment for all groups.Main Outcome MeasuresThe Urdu standardized versions of International Index of Erectile Functoning-5 (IIEF-5) and Depression Anxiety Stress Scale-21 (DASS-21) were the main outcome measures.ResultsThe mixed repeated measures analysis of co-variance yielded significant impact of both CBST and integrated treatment groups in improving IIEF-5 scores at post treatment as compared to placebo. The CBST group experienced reduction in depression scores at post treatment as compared to both SC and integrated treatment. Only the integrated treatment brought reduction in anxiety scores at post treatment as compared to SC. The covariates age and NOED duration did not significantly impact the treatment outcome for all treatment groups.Clinical ImplicationsThe efficacy of integrated treatment approach for improving symptoms of NOED and associated depression and anxiety is strong clinical implication of the study.Strengths & LimitationsThe effectiveness of integrated treatment approach in the improvement of NOED symptoms and associated depression and anxiety scores is the main strength of the study. The improvement in depression scores is the added strength of CBST component of integrated treatment approach. The study should have included other PDE5i to compare their effects with the CBST or placebo groups.ConclusionThe study concludes that the CBST and integrated treatments are treatment of choice for NOED and associated depression and anxiety in young men.Bilal A, Abbasi NH. Randomized Placebo Controlled Trial of Sildenafil Citrate, Cognitive Behavior Sex Therapy and Integrated Treatment in Men Diagnosed With Non Organic Erectile Dysfunction. Sex Med 2022;10:100464.

A randomized sham controlled comparison of once vs twice-daily intermittent theta burst stimulation in depression: A Canadian rTMS treatment and biomarker network in depression (CARTBIND) study

BackgroundIntermittent theta burst stimulation (iTBS) is a newer form of repetitive transcranial magnetic stimulation (rTMS) for patients with treatment resistant depression (TRD). Applying multiple daily iTBS sessions may enable patients to achieve remission more rapidly. ObjectiveWe compared the efficacy and tolerability of a twice-daily versus once-daily iTBS protocol in patients with TRD. We hypothesized that twice-daily iTBS would result in a greater improvement in depression scores compared to once-daily iTBS. Methods208 participants (131 females) with TRD were randomized to receive either iTBS (600 pulses) delivered twice-daily with a 54-min interval between treatments or once-daily (1200 pulses) with 1 sham treatment with the same interval between treatments, to ensure equal levels of daily therapeutic contact and blinding of patients and raters. The primary outcome measure was change in depression scores on the Hamilton Rating Scale for Depression (HRSD-17) after 10 days of treatment and 30 days of treatments. ResultsHRSD-17 scores improved in both the twice-daily and once-daily iTBS groups; however, these improvements did not significantly differ between the two groups at either the 10-day or 30-day timepoints. Response and remission rates were low (<10%) in both groups after 10 days and consistent with prior reports at 30 days; these rates did not differ between the treatment groups. ConclusionsThese results suggest that twice-daily iTBS does not accelerate response to iTBS and is not different from once-daily treatment in terms of improving depressive symptoms in patients with TRD.Clinicaltrials.gov ID: NCT02729792 (https://clinicaltrials.gov/ct2/show/NCT02729792)

Differential effects of ergometer-cycling and Whole-Body-Vibration training on serological BDNF and IGF-1 in the treatment of adolescent depression - is there an impact of BDNFp.Val66Met variants?

BackgroundPathogenesis and treatment of adolescent depression may be influenced by growth-factors, including brain-derived neurotrophic factor (BDNF) and insulin-like growth factor 1 (IGF-1). We investigated, if treatment response to two different add-on exercise-therapies in juvenile depression, differ in the changes of BDNF and IGF-1 serology. A subgroup analysis for genetic variations in BDNF p.Val66Met-variants was added. MethodsIncluded subjects in the study (N = 64), aged 13 to 17 years, were diagnosed with major depression, controls received inpatient treatment as usual (TAU). Intervention groups performed as add-on to TAU two different forms of exercise-therapy: endurance ergometer cycling (EC) and muscle strengthening whole body vibration (WBV). We expected both exercise-forms to increase BDNF and IGF-1 serology and by this pathway to improve depression scores significantly stronger than the control group. ResultsNone of the experimental groups showed significant changes in BDNF between measurement time points. However, after 6 weeks exercise, BDNF of both intervention groups were significantly higher compared to TAU,. The IGF-1 increase after 6 weeks intervention was significant for EC only. No correlations of BDNF and IGF-1 to depression scores were found. Group analysis in BDNF p.Val66Met variants showed a trend for better response in depression scores to exercise-treatment for the Val66Val group. LimitationsA small sample size, the non-randomized controls and the neglect of psychosocial factors have to be considered as limitations. ConclusionsEndurance and muscle strengthening trainings seem to influence serological BDNF and IGF-1 differentially. However, the changes in growth factors did not correlate to the decreases in depression scores. BDNF p.Val66Val variant seems to be more receptive for exercise treatment. Identifying biomarkers (growth factors, genetic variants) in adolescent depression could help to develop tailored treatment strategies.

Brexanolone, a GABAA Modulator, in the Treatment of Postpartum Depression in Adults: A Comprehensive Review

Postpartum depression (PPD) is one of the three major categories on the spectrum of postpartum psychiatric syndromes. Postpartum psychiatric syndromes are classified as either postpartum blues, postpartum depression, or postpartum psychosis. Postpartum depression is important to recognize clinically because of the effect it can have on the mother-child bond. The neurosteroid allopregnanolone, a progesterone derivative, is important for its role in positively modulating GABAA receptors. GABA-mediated signaling has been previously implicated in major depressive disorder. Allopregnanolone-mediated signaling has been identified as an important therapeutic target. Treatment with an allopregnanolone-analog, brexanolone, has been shown to improve depression scores in trials for the treatment of PPD. Brexanolone is a positive allosteric modulator of GABAA and is the first drug approved by the FDA to treat postpartum depression. Brexanolone enhances the inhibitory effects of GABAA, restores dysfunctional GABAA transmembrane channels, and mimics a naturally produced progesterone metabolite that fluctuates during pregnancy and postpartum. One open-label study and two phase two studies have some significant reduction in HAM-D scores after treatment and that the effect was still there 30 days post-treatment. Per the data reported, intravenous infusion of brexanolone could be efficacious and safe for the treatment of women suffering from postpartum depression.

Low quality of life and activity levels persist in obese endometrial cancer survivors despite participation in a behavioral weight loss intervention

<h3>Objectives:</h3> Obesity is inversely related to quality of life (QOL) in endometrial cancer (EC) survivors. With over 600,000 EC survivors in the U.S., many women experience obesity-related comorbidities following cancer cure, including poor QOL. We previously reported no change in weight after 6 months participation in a randomized trial comparing a text-message-based behavioral intervention and enhanced usual care (brief meeting, pamphlets with food diary). Here, we assessed changes in validated psychosocial (PS) measures between intervention groups. Based on previous literature, we also evaluated the effect of other factors (BMI, income, race, cancer stage, recurrence status) and hypothesized that these may predict improvement in QOL among EC survivors, over the intervention. <h3>Methods:</h3> EC survivors with a BMI ≥30kg/m² participating in a randomized behavioral weight loss study in our gynecologic oncology clinic completed a survey of validated PS measures at baseline and at 6-month study exit. These included the generalized mental and physical health QOL 12-Item Short Form Health Survey (SF-12; score 0-100, higher numbers indicating better QOL), the International Physical Activity Questionnaire-short form (IPAQ) to assess activity levels, and the Patient Health Questionnaire 9-Item Version depression assessment (PHQ9; score 0-27, higher scores indicating greater depression). The Kruskal-Wallis test was used to identify significant changes. <h3>Results:</h3> Between May and December 2017, 80 women enrolled and completed the PS assessments. 42.5% of participants had a baseline BMI ≥40kg/m², including 16.3% with a BMI ≥50kg/m². Between intervention groups, there were no differences in mean scores or changes within any of the PS analyses. For all participants, median SF-12 scores were at or below 50, consistent with generally low perceived QOL. Activity levels were low; at baseline, 26% reported no walking, 49% no moderate physical activity and 65% no vigorous physical activity within the last 7 days. Median total PHQ9 scores (5.5) were consistent with mild depression. Among all study participants, women with BMI ≥40kg/m²had a mean change from baseline in PHQ9 scores of -0.07 (±3.8) compared to -1.86 (±3.7) for BMI<40kg/m²(p=0.02). The change in SF-12 physical health QOL scores in non-WhiteWhite participants was 4.04 (±7.7) compared to -2.1 (±9.0) for WhiteWhite women (p=0.04), and 0.72 (±7.9) in early stage compared to -5.55 (±10.6) for Stages III-IV (p=0.046).There were no differences in PS scores based on income or recurrence. <h3>Conclusions:</h3> A technology-based behavior intervention did not improve QOL over enhanced usual care. Women with a BMI <40 kg/m² had improvement in depression scores, and physical health QOL improved to a greater degree in early-stage and non-WhiteWhite participants. Overall, obese EC survivors remain minimally physically active, with generally low perceived QOL and mild depressive symptoms. Further studies aimed at improving QOL for this growing population of women are warranted.

A case study and practitioner perspective on the application of Radically Open Dialectical Behaviour Therapy (RO DBT)

Radically Open Dialectical Behaviour Therapy (RO DBT) is a new treatment for overcontrolled mental health disorders, including refractory depression. This case study provides the therapist's description of delivering RO DBT to a client who took part in a randomised controlled trial of RO DBT. It describes novel treatment strategies and their implementation. Sam attended weekly individual sessions and group skills training sessions over 7 months. The treatment involved collaboratively explaining the RO DBT model whilst linking it to Sam's history and experiences. Coping styles that served to keep Sam isolated from others were identified with a focus on social signalling. RO DBT skills were introduced to activate her social safety system and enhance connectedness. Percentage improvement in depression scores from baseline was 50% at 7 months (end of treatment) and 65% at 18 months.Sam was in full remission at 12 and 18 months. Subjective feedback from Sam was that she felt happier in her marriage, had started voluntary work and made friends locally. She reported being more compassionate to herself and having increased flexibility in adapting to situations.The therapist reported using the RO DBT skills herself and finding them useful, both in learning the new therapy and in the therapy sessions. RO DBT's focus on the overcontrolled coping style and teaching of new strategies to address social signalling and enhance connectedness is a novel treatment approach. It offers promise as an intervention for those with depression.

Anxiety and Depression Scores in Patients Subjected to Arterial Revascularization for Critical Limb Ischemia

This study aims to examine the changes in anxiety and depression scores in 138 patients with critical limb ischemia (rest pain or gangrene) who had no previous psychiatric history, at 30 days and 6 months after surgical revascularization. Patients were submitted to a questionnaire-based evaluation using the Beck Anxiety and Depression Inventories before surgery (no more than three days before surgery) ("Pre-Op"), 30 days after surgical revascularization ("Early PO") and at least 6 months after surgical revascularization ("Late PO"). The cut-off scores for depression were (1) < 10, no depression or minimal depression; (2) 10‒18, mild to moderate depression; (3) 19‒29, moderate to severe depression; and (4) 30‒63, severe depression. The cut-off scores for anxiety were (1) < 8, no anxiety or minimal anxiety; (2) 8‒15, mild anxiety; (3) 16‒25, moderate anxiety; and (4) 26‒63, severe anxiety. No perioperative mortality was observed 30 days after surgical revascularization. Thirty-nine (28.2%) patients underwent major (above-ankle) amputation within 30 days. Mean anxiety and depression scores, respectively, declined from 12.48 ± 9.74 (mean ± SD) and 16.92 ± 12.48 preoperatively to 4.89 ± 7.04 and 6.52 ± 9.36 postoperatively (P<0.001, both). Anxiety and depression scores were not significantly affected by preoperative comorbidities (systemic arterial hypertension, diabetes mellitus, previous stroke, and smoking), affected arterial territory (aortoiliac, femoropopliteal, or infrapopliteal), or surgical technique (open surgery vs endovascular therapy). Only patients undergoing amputation within 30 days showed no improvement in depressive symptoms. Patients with critical limb ischemia have a high incidence of anxiety and depressive symptoms, which improve considerably after successful surgical revascularization. Major amputation was associated with a lack of improvement in depression scores. A formal psychiatric evaluation may be beneficial in patients who show no improvement in depressive symptoms.

Increased Cardiopulmonary Fitness Is Associated with a Greater Reduction in Depression among People Who Underwent Bariatric Surgery.

The aim of this study was to determine the effect of changes in cardiopulmonary fitness on the mental health of patients with severe obesity who underwent gastric bypass surgery (prior to and 1, 3, and 6 months after surgery). Study participants were recruited from among patients of a regional hospital in Czechia who underwent gastric bypass surgery between April 2018 and October 2019. They were eligible if they (a) were between 18 and 65 years old, (b) provided written informed consent, and (c) were able to walk independently. Twenty-six patients (age 45.4 ± 9.0 years, body mass index 45.1 ± 7.4 kg·m−2, body fat 43.8 ± 4.8%) were included in the analysis. The key finding revealed that the greater the increase in cardiopulmonary fitness (i.e., longer distance walked in the six-minute walk test, 6MWT), the better the improvement in depression score among patients who underwent bariatric surgery. In particular, increments of 10 m in the 6MWT lead to the improvement of 0.5 points on the depression subscale of the Hospital Anxiety and Depression Scale (HADS) questionnaire. As the main implication, these results suggest that patients should participate in exercise training programs to increase their fitness status for optimal physical and mental outcomes of bariatric surgery.

Evaluating Depression Among Acne Vulgaris Patients Treated With Isotretinoin.

BackgroundIsotretinoin is the most effective treatment for moderate to severe acne. However, isotretinoin has many side effects related to its use. Since 1983, when Hetzen reported the first occurrence of new depressive symptoms in patients treated with isotretinoin, a lot of controversies emerged regarding the causal relationship between isotretinoin and depression.ObjectiveTo evaluate depression among acne patients treated with isotretinoin versus doxycycline at King Fahad Hospital of the University between December 2019-March 2020.MethodsUsing the Global Acne Grading System, patients aged 18 - 30 years old with moderate to severe acne vulgaris who have not received isotretinoin previously and has no personal or family history of any psychiatric illnesses, were evaluated for depression using the patient health questionnaire-9 before starting treatment and 8 weeks after. Twenty-nine patients had met the inclusion criteria and were included in the study.ResultsOf the 29 patients included, 18 patients completed the study (nine males, nine females). Twelve patients received isotretinoin 0.5mg/kg (study group) and six patients received doxycycline 100mg (control group). The mean depression score for the isotretinoin group has decreased from (4 ± 2.48) to (3.08 ± 2.84) but the result was statistically insignificant with a p-value of 0.19, CI (-5.28, 2.36). For the doxycycline group, the mean depression score has decreased from (5.5 ± 2.5) to (2.83 ± 0.75) with a p-value of 0.043, CI (0.12, 5.21). There was no statistically significant difference in the mean depression score between the two groups after 8 weeks of starting treatment [p-valve 0.837, CI (-2.28, 2.78)].ConclusionThis study showed that, after 8 weeks of starting treatment, isotretinoin at 0.5 mg/kg has no risk of developing depression. The results of this study did not reveal a direct relationship between the use of isotretinoin and the development of depression. Furthermore, optimum control and treatment of acne vulgaris have shown to improve depression scores.

Qigong Exercise in Frailty, Psychological Health, and Spiritual Well-Being of Middle-Aged and Older Blacks

Interventions are needed to address the frailty and psychological health in middle-aged and older African Americans. Qigong, a traditional medicine exercise, consists of gentle body movements, breathing exercise, and meditation. The benefits of Qigong exercise have been widely reported in Asian adults but there have been no known studies testing Qigong exercise in the African American population. The purpose of this pilot study was to evaluate the potential benefits of an 8-week Qigong exercise in physical and functional ability, balance, frailty, depression and anxiety, and spiritual well-being in community-dwelling middle-aged African Americans using a single group design. Fifteen African Americans aged 45 to 85 years were recruited to receive Qigong exercise over 16 bi-weekly, one-hour sessions. The Layers Module that unfolds the complex multidimensional benefits of Qigong exercise on physical, mental, and spiritual dimensions was used to guide the outcome measures. Data were collected at baseline and 14 days post intervention. Results showed positive trends in repeat chair stands, physical function, and spiritual well-being (p<0.05) with effect sizes ranging from 0.45 to 0.87. Despite no significance, over 52% of the participants showed improved depression scores, fast gait speed, and standing balance than baseline. Nearly 42% demonstrated some levels of frailty improvement than the baseline. No adverse events related to Qigong exercise intervention was reported. Qigong exercise is a potentially promising intervention which needs further testing in a randomized clinical trial.

A pilot study of improved psychological distress with art therapy in patients with cancer undergoing chemotherapy

BackgroundArt therapy may improve the physical, mental, and emotional wellbeing of individuals for a variety of purposes. It remains understudied and underutilized in cancer care. We sought to determine the ability of a pilot art therapy program to improve the physical, mental, and emotional well-being of cancer patients.MethodsChemotherapy-recipients, age 18 years and older, diagnosed with any type or stage of cancer, were considered eligible to participate in this single arm, pilot study, using four visual analog scales (VAS) with visually-similar, 0–10 scale (10 being worst) thermometers assessing: 1) pain, 2) emotional distress, 3) depression, and 4) anxiety. Participants were asked to complete all 4 metrics, pre-treatment, post-treatment, and at 48–72 h follow-up, after an hour-long art therapy session. Primary endpoints included post-intervention changes from baseline in the 4 VAS metrics.ResultsThrough a reasonable pilot sample (n = 50), 44% had breast cancer, 22% gastrointestinal cancers, 18% hematological malignancies, and 20% had other malignancies. A decrease in all VAS measures was noted immediately post-treatment but remained low only for pain and depression, not for emotional distress and anxiety upon follow up. There was a significant difference between the depression VAS scores of Hispanics (32%) compared to non-Hispanics (56%) (p = 0.009) at baseline. However, compared to non-Hispanics, Hispanics exhibited higher levels of depression after art therapy (P = 0.03) and during the follow-up intervals (p = 0.047).ConclusionArt therapy improved the emotional distress, depression, anxiety and pain among all cancer patients, at all time points. While depression scores were higher pre-intervention for Hispanic patients, Hispanic patients were noted to derive a greater improvement in depression scores from art therapy over time, compared to non-Hispanics patients. Discovering simple, effective, therapeutic interventions, to aid in distress relief in cancer patients, is important for ensuring clinical efficacy of treatment and improved quality of life.

Effects of Qigong Exercise on Physical and Psychological Health among African Americans.

Interventions are needed to address physical and psychological health in middle-aged and older African Americans (AAs). The purpose of this pilot study was to evaluate the feasibility and potential benefits of an eight-week Qigong exercise on physical ability and function, balance, frailty, depression and anxiety, and spiritual well-being in AAs using a single-group design. Fifteen AAs with a mean age of 64 years received Qigong exercise over 16 semi-weekly, one-hour sessions. The majority were female (93.3%) and college-level educated (53.3%). Repeat chair stands, physical function, and spiritual well-being improved significantly (p < .05) with effect sizes ranging from .45 to .87. Over 52% of participants showed improved depression scores, fast gait speed, and standing balance. Nearly 42% demonstrated some frailty improvement over baseline. No adverse events were reported. Qigong exercise potentially improves the physical ability and function, and spiritual well-being of AAs and needs further testing in a randomized clinical trial.

A Systematic Review and Meta-Analysis of Randomized Sham-Controlled Trials of Repetitive Transcranial Magnetic Stimulation for Bipolar Disorder.

Repetitive transcranial magnetic stimulation (rTMS) is effective in treating unipolar depression. However, the efficacy of rTMS in bipolar disorder (BD) is unclear. This meta-analysis aimed to examine the efficacy and tolerability of rTMS for both depressive and manic phases in BD. MEDLINE, EMBASE, PsycINFO, CENTRAL databases were searched for controlled trials on treatment of BD with rTMS. Primary outcomes included changes in depression or mania scores, response and remission rates. Secondary outcomes included quality of life and functioning assessment. We used random-effects model, Hedge's g, risk differences (RDs) and the number needed to treat (NNT). Eleven randomized sham-controlled studies were included, with a total of 345 patients with BD (bipolar depression = 257, mania = 86, mixed affective = 2). Trials of rTMS in bipolar depression (N= 8) demonstrated small but significant improvement in depression scores [standardized mean difference = 0.302, p< 0.05], compared to control group. Furthermore, rTMS brought a higher remission rate than sham-controls [RD = 0.104 ± 0.044, p< 0.05, NNT = 10; and a trend of greater response rate [RD = 0.074 ± 0.039, p= 0.06]. Results were inconclusive for effect of rTMS in mania. In both depressive and manic groups, no serious adverse events were reported. Risk of treatment-emergent mania appeared low. There was limited number of eligible primary studies, with variable randomization procedures. rTMS appears safe and effective in treating bipolar depression. More stringent RCTs are necessary for concrete conclusion about efficacy in mania.

Distant mood monitoring for depressive and bipolar disorders: a systematic review

BackgroundBroadening our knowledge of the longitudinal course of mood symptoms is cardinal to providing effective long-term treatments. Research indicates that patients with mental illness are willing to engage in the use of telemonitoring and mobile technology to assess and monitor their mood states. However, without the provision of distant support, adverse outcomes and events may be difficult to prevent and manage through self-monitoring. Understanding patient perspectives is important to achieving the best balance of self-monitoring, patient empowerment, and distant supporter involvement.MethodsThis systematic review synthesises quantitative and qualitative evidence of the effectiveness and feasibility of daily/weekly/monthly remote mood monitoring that includes distant support in participants with mood disorders. Inclusion criteria comprised mood monitoring of mood disorder patients as main intervention, study design, method of monitoring, and presence of psychotherapy and psychoeducation. Effectiveness was defined by the change in depression and/or mania scores. Feasibility was determined on participant feedback and completion/attrition rates. Studies were assessed for quality using the Mixed Methods Appraisal Tool version 2018.ResultsNine studies of acceptable quality met the inclusion criteria. Distant mood monitoring was effective in improving depression scores but not mania scores. Feasibility, as measured through compliance and completion rates and participant feedback, varied.ConclusionDistant mood monitoring with support may be a useful, acceptable, and feasible intervention for diverse groups of patients in terms of age and ethnicity. Further, it may be effective in improving symptoms of depression, increasing treatment adherence, and facilitating the prevention and management of adverse outcomes. As a task-shifting intervention, distant mood monitoring may help to alleviate the burden on mental health providers in developing countries.

Does CPAP treat depressive symptoms in individuals with OSA? An analysis of two 12-week randomized sham CPAP-controlled trials

BackgroundDepression is common in patients with obstructive sleep apnea (OSA). Whether treating OSA with continuous positive airway pressure (CPAP) improves depressive symptoms remains inconclusive. We examined the impact of CPAP on depressive symptoms in OSA patients compared to sham CPAP. MethodsA sub-analysis of two previous randomized sham-controlled trials was conducted. 126 male OSA patients (age = 51 ± 11 years; BMI = 32.0 ± 5.1 kg/m2; apnea hypopnea index = 42.4 ± 22.6 events/hour) were randomised either to therapeutic CPAP (n = 65) or sham CPAP (n = 61). Depressive symptoms were measured using the Depression, Anxiety and Stress Scale (DASS). The main outcome was the change in the DASS depression score (DASSD) after three months between the therapeutic and sham CPAP arms. ResultsThe change in DASSD at three months did not differ between therapeutic and sham CPAP (mean difference: 0.5, 95% CI -3.6 to 4.6, p = 0.80). There was no significant between-group differences within the sub-groups of adherent users (device usage≥4hrs/day), or those with baseline depression (DASSD>9). In a secondary analysis of patients with baseline depression, adherent therapeutic CPAP use was associated with a greater reduction in DASSD scores compared to non-adherers (−10.0, 95% CI -18.3 to −1.8, p = 0.019). Conclusions: Overall, three months of CPAP did not significantly improve depression scores in OSA patients. Adherent use of therapeutic CPAP in patients with baseline depressive symptoms was associated with a reduction in symptom score. Future trials involving OSA patients with higher depressive symptoms will enable us to understand the complex interaction between OSA and depression.

Psychosocial screening and mental health in pediatric cancer: A randomized controlled trial.

Diagnosis and treatment of childhood cancer can impact the mental health of the family. Early psychosocial risk screening may help guide interventions. The primary aim of this study was to evaluate if an intervention (providing psychosocial risk information to the patient's treating team) would result in decreased depression symptoms in caregivers, in general, and relative to initial psychosocial risk. A secondary aim was to examine intervention effects in a small sample of patient and sibling self-reported outcomes. We randomly allocated families to the intervention group (IG, treating team received PAT summary) or control group (CG, no summary). One hundred and twenty-two caregivers of children newly diagnosed with cancer completed measures of depression and anxiety and psychosocial risk 2-4 weeks from diagnosis (T1) and 6 months later (T2). Patients and siblings completed self-report measures of depression and anxiety. There was no significant difference in caregiver depression symptoms between the IG and CG at T2. However, in the context of psychosocial risk, caregivers in the IG showed improvement in depression scores compared to CG when risk was high near diagnosis (Ms = 6.68 vs. 9.76, respectively, d = .60). Similar results were found in anxiety scores. Intervention effects with patients and siblings were inconclusive. Sharing psychosocial risk information with the treating team had measurable impact on mental health outcomes only if caregivers had initial high psychosocial risk. This study contributes to our understanding of mapping psychosocial screening and resources to improve outcomes in families managing childhood cancer. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A prospective study of the cognitive and psychiatric effects of pituitary tumours and their treatments

Neurocognitive complaints are common in patients with pituitary tumours, particularly in memory and concentration. Past studies have shown impairments in executive function and memory, but it is not clear whether these result from direct effects of the tumour (pressure or hormonal secretion), incidental damage from radiotherapy or surgical treatments, and/or mediating psychiatric factors. This study assessed cognitive function and psychiatric state of 86 pituitary tumour patients and 18 healthy controls, pre and post-treatment, to examine the effects of tumour aetiology and treatment type. No significant cognitive impairments were found, except on verbal recognition memory. Patients with Cushing’s disease showed lower verbal recognition memory than the other groups pre-treatment, but improved at follow-up. This was (at least partially) accounted for by an improvement in depression scores. Patients who were treated with surgery showed poorer verbal recognition memory than controls across all (pre- and post-treatment) time-points. Overall findings of minimal cognitive impairment in patients with pituitary tumours may reflect improved diagnostic and treatment techniques in recent years. We suggest that the verbal memory impairments identified in the Cushing’s group may result from increased cortisol (directly, or mediated by depression). In the surgical groups, verbal memory impairments appeared to pre-date treatment. This may relate to treatment selection factors, rather than harmful effects of surgery itself.

P185 MULTI-MODAL PREHABILITATION DURING NEOADJUVANT THERAPY PRIOR TO RESECTION FOR OESOPHAGOGASTRIC CANCER: A PILOT RANDOMISED CONTROLLED TRIAL

Abstract Aim We aimed to assess the effect of prehabilitation on cardiopulmonary exercise test (CPET) performance in patients undergoing neoadjuvant chemotherapy (NAC) for oesophagogastric (OG) cancer. Background &amp; Methods NAC reduces fitness as assessed by CPET1 and induces skeletal muscle loss (sarcopenia)2,3. Both are associated with poorer post-operative outcomes. A parallel-arm RCT was conducted (December 2016 to November 2018), with randomisation to receive a 15-week multi-modal prehabilitation programme (Prehab) or standard-care (Control). Prehab comprised twice-weekly supervised and thrice-weekly home exercise sessions, Medical Coaching, and tailored dietetic input. CPET was performed before and after NAC, and 1 week pre-operatively. On staging and re-staging CT, skeletal muscle cross-sectional area at L3 was analysed by a blinded investigator. Becks’ Depression Inventory questionnaires were completed pre- and post-surgery. Results Groups (Prehab n=25, Control n=28) were matched at baseline. Supervised and home exercise programme compliance was 76%, and 65% respectively, with no adverse events. Prehab resulted in an improvement in peak VO2 following NAC (Prehab +31.50ml/min/m2 vs Control -89.57 ml/min/m2; p=0.004) with a trend towards lesser reduction in anaerobic threshold (Prehab -0.87ml/kg/min vs Control -1.44ml/kg/min; p=0.342). A higher proportion of controls required NAC deferral or dose reduction (Prehab 16% (4/25) vs Control 43% (12/28); p=0.041), with 72% (Prehab) and 46% (Control) completing all cycles at full dose (p=0.076). There was no difference in chemotherapy-related toxicity. The Prehab group demonstrated less skeletal muscle loss following NAC (Prehab -11.62 vs Control -15.61; p=0.049). Controls showed a trend towards more sarcopenia development after NAC (Prehab: Pre-NAC 37% (9/24) and post-NAC 54% (13/24) vs Control: Pre-NAC 32% (9/28) and post-NAC 64% 18/28) (p=0.404). Prehab subjects had a significant improvement in depression scores following NAC (Prehab -2.71 vs Control +0.57; p=0.003). There was a trend towards shorter median length of stay in the Prehab group (Prehab 11 vs Control 16 days; p=0.155) and lower complication rates (Prehab 50% (11/22) vs Control 74% (17/23); p=0.89). Conclusion Multi-modal prehabilitation is safe and feasible in OG patients receiving NAC. Despite the effects of NAC, prehabilitation produced a significant improvement in peak VO2, depression scores and less skeletal muscle loss, with a trend towards improved clinical outcomes. This warrants further investigation.

Tracking Patient Outcomes Following Foot and Ankle Surgery: The OFAR Experience 2018-2019

Category:Patient Reported OutcomesIntroduction/Purpose:Collection and reporting of Patient Reported Outcomes (PROs) has become an integral part of healthcare and healthcare research. In an effort to facilitate AOFAS member participation in secure and efficient patient outcomes data collection, the Orthopaedic Foot and Ankle Outcomes Research (OFAR) Network, a national collaborative surgical outcomes registry, was established in 2018 by and for AOFAS member surgeons and their patients. OFAR aims to collect, aggregate, and report PRO data using the measurement instruments developed by the National Institutes of Health (NIH) Patient Reported Outcomes Measurement Information System (PROMIS). We hypothesize that multiple sites from a variety of health systems can successfully enroll patients into a secure, web-based registry, and that foot and ankle procedures will significantly improve patient reported function and pain.Methods:Since December 2018, seven OFAR pilot sites have been enrolling patients, including three private and four academic practices. Each enrolled patient completed a pre-operative assessment as well as post-operative assessments at 3 time points. Five PROMIS metrics were collected, including Physical Function CAT (PF), Pain Intensity Short Form (PInSF), Pain Interference CAT (PInCAT), Global Health Short Form, and Depression CAT. Pathways, a secure web platform accessible by both patients and providers, was utilized for data collection and storage. The platform also includes a provider dashboard that collects diagnosis, treatment, implant and complication data. The aggregated data was analyzed using Python (v3.6) along with Pandas (v0.23.4).Results:As of December 2018, 877 patients have been enrolled in OFAR. Patients were enrolled from both academic (57%) and private practice (43%) sites. The three most frequently encountered conditions were: ankle impingement, ankle fractures and ankle arthritis. The largest pre- to postoperative changes were seen in the PF and PInCAT scores which significantly improved at 6 months and 12 months for nearly all condition groups (Figure 1). Many of these improvements averaged 20 points on the PROMIS t-score scale, which represents two standard deviations in the PROMIS scoring system, and restored PInCAT and PF to 50 or better, the US healthy population average. There was a trend toward improvement in depression scores for most conditions, with substantial improvement following fracture treatment.Conclusion:We were able to successfully onboard multiple pilot sites, including community private practices without dedicated research resources, to enroll patients in the OFAR platform. Aggregated data demonstrate a significant improvement in PROMIS scores for all conditions treated. The library of information collected is automated, extensive and comprehensive. By aggregating outcomes following treatment by orthopaedic foot and ankle surgeons across practice settings, the OFAR database empowers an unprecedented scrutiny of ‘real world’ patient outcomes and related factors. This facilitates an increasingly granular assessment of the impact of conditions and treatments, enabling patients and providers alike to share in the decision-making process.

Dosage in Preventative OT Interventions With Community-Dwelling Older Adults

Abstract Date Presented 04/05/19 This research considered attendance in the Well Elderly II intervention to determine the dosage effect on depression scores. In particular, how many hours of OT sessions are necessary to produce meaningful reductions in depressive symptoms? Our analysis suggests that the small improvements in depression scores do not appear to be associated with the dosage of the intervention received; therefore, any preventative effects of the intervention need to be reconsidered. Primary Author and Speaker: David Schelly Additional Authors and Speakers: Ramona Nadres, Alisha Ohl