Improvement In Mood Symptoms Research Articles

Comorbid disorders as moderators of response to family interventions among adolescents with bipolar disorder.

While family interventions have shown efficacy in improving mood symptoms and family functioning in pediatric bipolar disorder, few studies have examined the effects of comorbid psychiatric conditions on patients' symptomatic or functional responses to treatment. 145 adolescents with bipolar I or II disorder were randomly assigned to family-focused therapy (FFT-A) or a brief psychoeducational therapy (enhanced care; EC) and followed over 2 years. Participants received pharmacotherapy for the study's duration. We examined whether comorbid anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and disruptive behavior disorders (DBDs; i.e., oppositional defiant and conduct disorder) predicted the proportion of weeks that participants experienced mood symptoms during follow-up, and whether comorbid disorders moderated the effects of treatment assignment on mood symptoms and family conflict. Comorbid anxiety was associated with a greater proportion of weeks with depressive symptoms, more severe (hypo)manic symptoms during follow-up, and greater family conflict over the 2-year study. Comorbid ADHD was associated with a greater proportion of weeks with (hypo)manic symptoms, more severe (hypo)manic symptoms, and greater family conflict. Additionally, youth with comorbid ADHD who received FFT-A had more favorable trajectories of (hypo)manic symptoms and family functioning than youth with comorbid ADHD who received EC. Comorbid DBDs were consistently associated with more severe depressive symptoms and greater family conflict throughout the study. Randomization to treatments was not stratified on comorbid disorders. The longitudinal trajectories of anxiety, attentional, and disruptive behavior symptoms were not examined. The course of bipolar disorder in adolescents is strongly affected by comorbid disorders. Future research should examine whether adolescents with more complex presentations of bipolar disorder should be treated with different or more intensive psychosocial protocols than adolescents without these presentations.

Estrogen-Based Hormone Therapy for Depression Related to Reproductive Events

In this review, we provide an overview of recent literature on the use of estrogen-based hormone therapy to treat depression related to reproductive events, like postpartum and perimenopause. Women are two to four times more likely to become depressed in the perimenopausal stage of life and as many as 14.5% of women develop postpartum depression. It is hypothesized that these depressive symptoms are a result of fluctuations in hormone levels during these windows of vulnerability. To broaden treatment options beyond psychotherapy and antidepressants, researchers considered the role that estrogen-based hormone therapy can play during these periods of fluctuation. Research on the use of estrogen-based therapy to treat depression in premenstrual syndrome, postpartum, perimenopause, and postmenopause is varied and even contradictory at times. Overall, literature suggests that the right combination, dose, and duration of estrogen therapy can have positive effects on depressive symptoms related to reproductive events. In the past, estrogen-based hormone therapy has faced controversy regarding safety and efficacy, but researchers have since conducted trials that resulted in improved mood symptoms without significant side effects or risks. However, many experts caution against long-term use of estrogen therapy and emphasize the importance of prescribing a dose and method of delivery that best suits each individual patient.

The Experience of Racism on Behavioral Health Outcomes: The Moderating Impact of Mindfulness.

Research shows that racial discrimination results in adverse behavioral health outcomes for African American young adults, including risk for depression, anxiety, and substance use. Although high levels of mindfulness have been shown to reduce risk for such health outcomes, it is unknown whether mindfulness can reduce risk as a consequence of racial discrimination, particularly among African Americans. Three-hundred and eighty-eight African American young adults between the ages of 18-24 (M=20.6, 62% female) completed measures assessing past year experiences of racial discrimination, depressive symptoms, anxiety symptoms, alcohol use, and trait mindfulness. A positive correlation was found between racial discrimination and the behavioral health outcomes, as well as a negative correlation between mindfulness and the behavioral health outcomes. Moreover, mindfulness was found to significantly moderate the effect of racial discrimination on mood symptoms. Although mindfulness was found to lessen the effect of racial discrimination on alcohol use, this difference was not statistically significant. In line with previous literature, racial discrimination was shown to have a negative impact on behavioral health outcomes among African Americans. Moreover, our findings provide support for the buffering effect of mindfulness on mood symptoms as a consequence discrimination. This suggests that increasing mindfulness may be an effective strategy to include in interventions targeting improvement in mood symptoms for African American young adults. However, alternative strategies may be more appropriate to address outcomes, such as alcohol use, as a consequence of racial discrimination.

Effects of a 12-week running programme in youth and adults with complex mood disorders

ObjectiveAlthough numerous studies suggest a salutary effect of exercise on mood, few studies have explored the effect of exercise in patients with complex mental illness. Accordingly, we evaluated the impact...

Cost per successfully treated patient for vortioxetine versus duloxetine in adults with major depressive disorder: an analysis of the complete symptoms of depression and functional outcome

Objective: To determine the cost-effectiveness of vortioxetine vs duloxetine in adults with moderate-to-severe major depressive disorder (MDD) in Norway using a definition of a successfully treated patient (STP) that incorporates improvement in both mood symptoms and functional capacity.Methods: Using the population of patients who completed the 8-week CONNECT study, the cost-effectiveness of vortioxetine (n = 168) (10–20 mg/day) vs duloxetine (n = 176) (60 mg/day) was investigated for the treatment of adults in Norway with moderate-to-severe MDD and self-reported cognitive dysfunction over an 8-week treatment period. Cost-effectiveness was assessed in terms of cost per STP, defined as improvement in mood symptoms (≥50% decrease from baseline in Montgomery-Åsberg Depression Rating Scale total score) and change in UCSD [University of California San Diego] performance-based skills assessment [UPSA] score of ≥7. The base case analysis utilized pharmacy retail price (apotek utsalgspris (AUP)) for branded vortioxetine (Brintellix) and branded duloxetine (Cymbalta).Results: After 8 weeks of antidepressant therapy, there were more STPs with vortioxetine than with duloxetine (27.4% vs 22.5%, respectively). The mean number needed to treat for each STP was 3.6 for vortioxetine and 4.4 for duloxetine, resulting in a lower mean cost per STP for vortioxetine (NOK [Norwegian Kroner] 3264) than for duloxetine (NOK 3310) and an incremental cost per STP of NOK 3051. The use of a more challenging change in the UPSA score from baseline (≥9) resulted in a mean cost per STP of NOK 3822 for vortioxetine compared with NOK 3983 for duloxetine and an incremental cost per STP of NOK 3181.Conclusions: Vortioxetine may be a cost-effective alternative to duloxetine, owing to its superior ability to improve functional capacity. The dual-response STP concept introduced here represents a more comprehensive analysis of the cost-effectiveness of antidepressants.

Repetitive Transcranial Magnetic Stimulation for Treatment of Depression in a Patient With Severe Traumatic Brain Injury

Traumatic brain injury (TBI) commonly presents with a constellation of findings, including physical, cognitive, and psychological disturbances. Traditionally, few options have been available for long-term management of mood symptoms for post-TBI patients who are refractory to medications. Repetitive transcranial magnetic stimulation (rTMS) is a promising alternative treatment. A 37-year-old male with history of anxiety and bipolar depression incurred a TBI after a 60-foot fall. After his physical recovery, the patient had refractory depression. Eight months after the TBI event, he underwent a 6-week course of rTMS treatment and had a 70.8% improvement in mood symptoms by the end of the therapy as indicated by the Patient Health Questionnaire-9, transitioning from severe to mild depression according to the scoring system. Clinical correlation during the months following conclusion of rTMS therapy showed no signs of remission or adverse side effects. The patient remains stable and lives independently 1 year after treatment with mood-stabilizing medications. This case provides evidence for successful treatment of refractory depressive symptoms after severe TBI with the addition of rTMS to psychotherapy and mood-stabilizing medications, supporting the safety and tolerability of this novel therapeutic approach. Further studies are needed to validate the contribution of rTMS for management of mood symptoms in patients with TBI.

The impact of an add-on video assisted structured aerobic exercise module on mood and somatic symptoms among women with depressive disorders: Study from a tertiary care centre in India.

The evidence in favor of exercise as a treatment for depression is compelling, but what kind of exercise, how much, how often, and at what intensity is necessary to make a significant difference. There is serious dearth of such data from India, in particular. We examined the impact of low-moderate intensity aerobic exercises on mood and somatic symptoms among women with depressive disorders. A pre test- post test control group design was adopted with a sample size of 40 (20 subjects randomized to both experimental and control group) women inpatients diagnosed with depressive disorder at a tertiary care centre, Bengaluru, India. After pre-test, experimental group received 10 sessions of add-on intervention (video assisted structured aerobic exercise module) and the control group received treatment as usual. Hamilton Depression Rating Scale (HDRS), Visual Analogue Mood Scale (VAMS) and Depression Somatic Symptom scale (DSSS) were used as clinical outcome measures. The estimated mean change within the group in HDRS was 4.30 (95% CI 3.15 to 5.44; p<0.001) in the experimental group as compared to 2.70 (95% CI 1.50 to 3.89; p<0.001) in control group. RMANOVA (F=4.08) revealed a significant reduction in mean mood score in HDRS in the experimental group as compared to the control group at p<0.05. There was no statistically significant reduction in mean somatic symptom score between the groups (p=0.142). The study findings support that add-on aerobic exercise is associated with significantly greater improvements in mood symptoms of women with depressive disorders, when performed in a structured and supervised setting.

Low Serum Testosterone in Outpatient Psychiatry Clinics: Addressing Challenges to the Screening and Treatment of Hypogonadism.

The symptoms of low testosterone frequently overlap with psychiatric complaints including depression and fatigue. Testosterone repletion has been shown to improve mood symptoms in men with low testosterone, although this finding has not been consistent across all studies. Despite the potential importance of low testosterone for psychiatry, the prevalence of low testosterone in men who present to psychiatric clinics with mental health complaints is unknown. To provide an overview of the current state of knowledge of the psychiatric complications of male hypogonadism, the challenges of screening for hypogonadism in a psychiatric population, and the potential mental health treatment implications of hypogonadism. A literature review was conducted using PubMed. Publications pertaining to the epidemiology, psychiatric symptomatology, and impact of treatment of male hypogonadism on psychiatric outcomes. A review of the literature suggests a lack of information on the prevalence of low testosterone in patients presenting with psychiatric complaints despite an overlap in clinical symptoms. The identification of low testosterone could have a significant impact on treatment through urologic referral for testosterone repletion or the use of treatments that spare the gonadal axis. We hope our results will help those who care for patients in psychiatric settings to better assess for the presence of hypogonadism and its potential contribution to depressive illness. Smith JB, Rosen J, Colbert A. Low Serum Testosterone in Outpatient Psychiatry Clinics: Addressing Challenges to the Screening and Treatment of Hypogonadism. Sex Med Rev 2018;6:69-76.

Melatonin as a treatment for mood disorders: a systematic review.

Melatonin has been widely studied in the treatment of sleep disorders and evidence is accumulating on a possible role for melatonin influencing mood. Our aim was to determine the efficacy and acceptability of melatonin for mood disorders. We conducted a comprehensive systematic review of randomized clinical trials on patients with mood disorders, comparing melatonin to placebo. Eight clinical trials were included; one study in bipolar, three in unipolar depression and four in seasonal affective disorder. We have only a small study on patients with bipolar disorder, while we have more studies testing melatonin as an augmentation strategy for depressive episodes in major depressive disorder and seasonal affective disorder. The acceptability and tolerability were good. We analyzed data from three trials on depressive episodes and found that the evidence for an effect of melatonin in improving mood symptoms is not significant (SMD = 0.37; 95% CI [-0.05, 0.37]; P = 0.09). The small sample size and the differences in methodology of the trials suggest that our results are based on data deriving from investigations occurring early in this field of study. There is no evidence for an effect of melatonin on mood disorders, but the results are not conclusive and justify further research.

Oral Ketamine in Treatment-Resistant Depression: A Clinical Effectiveness Case Series.

PurposeThe aim of the study was to assess the effectiveness, tolerability, and safety of oral ketamine as an antidepressant treatment in adults with treatment-resistant depression.MethodsWe reviewed retrospective data on 22 patients with treatment-resistant depression, who failed at least 3 adequate antidepressant treatment trials and 1 adequate trial of repetitive transcranial magnetic stimulation; subsequently, they received open-label treatment with oral ketamine, commenced at a dose of 50 mg every 3 days, titrated up by 25 mg every 3 days, according to response and tolerability. The primary outcome measure was the Beck Depression Inventory II, which was used to rate subjective mood improvement at baseline and then at each follow-up visit. Data about adverse effects related to ketamine and a self-harm risk assessment were also obtained.FindingsOver the course of treatment, 18% of the patients showed greater than 50% reduction in the Beck Depression Inventory II scores, 14% reported partial improvement in mood symptoms, while 45% had no response to ketamine and 23% showed a mild worsening in their depressive symptoms. The most frequent adverse effects were acute dissociation, dizziness, blurred vision, numbness and sedation. Neither serious adverse effects, nor any cases of abuse or dependence were observed.ConclusionsAlthough this case series found oral ketamine to be safe and well tolerated, the findings also showed rather modest effectiveness of oral ketamine in treatment-resistant depression, with only approximately 30% reporting some benefit and approximately 70% reporting no change or worsening of mood. However, bearing in mind the limitations of this small, open-label case series, further exploration of the effectiveness of oral ketamine is warranted.

Participation du fulvestrant dans la crise suicidaire : à propos d’un cas

Womens’ estrogens are involved in mood variations. In the brain, they stimulate monoamine synthesis, increase sensibility of their receptors and slow down their elimination. A low rate of estrogens induces a monoamine deficit – mainly serotonin – and increases risks of depressive symptoms or suicidal tendencies. For instance, it could happen during menstruations (premenstual dysphoric disorder), the postnatal period or menopause. In fact, 3 to 8% of women have symptoms that lead to intolerable professional, family and social situations. It is a premenstrual dysphoric disorder. Tamoxifen is an oral selective estrogen receptor modulator, used as a hormonal therapy in the breast cancer. It is an estrogen antagonist in the breast but it is an estrogen agonist in the uterus. Suicide attempts or depressions appear more often after the drug administration. Indeed, 1 to 7% of women get depressed after this administration. Fulvestrant, which is a recent estrogen antagonist receptor, has a full body action, including brain. We relate the case of a 89-year-old patient with breast cancer, without any psychiatric antecedent – depression or suicide attempts – who went through a suicidal crisis after two months of fulvestrant administration. No psychological factor, psychiatric, epidemiological or biographical gives a satisfying explanation to this suicidal crisis and accountability of fulvestrant has to be examined. Estrogens are involved in serotonin synthesis thanks to both tryptophan hydroxylase and decarboxylase, and noradrenaline synthesis due to DOPA decarboxylase. Moreover, estrogens increase 5HT1A and β-adrenergic post-synaptic receptors sensitivity. They decrease the pre-synaptic auto-receptors (5HT1A, 5HT1D and α2adrenergic) which normally inhibit monoamine synthesis. So, inhibition of some estrogen receptors would decrease serotonin and noradrenaline synthesis and would improve mood symptoms. We understand how the anti-estrogen drugs are involved in the depression or suicidal attempt. There are more scientific studies about Tamoxifen than fulvestrant. In fact, Shariif and al. examine the mood of 42 women who take Tamoxifen for a breast cancer using the Institute for Personality and Ability Testing scale (IPAT). They show that the IPAT level increase for 17% of women, and conclude that the depression risk increase. However, scientific studies do not often mention psychiatric effects of the partial antagonist estrogen receptor, such as fulvestrant. This pure estrogen antagonist receptor acts homogeneously in the whole body. It prevents the link between the estrogen and their genes (“estrogen response elements”), which are involved in monoamine synthesis. It acts as an anti-estrogen that binds to and degrades the estrogen receptor. It has an estrogen antagonistic activity but no estrogen agonistic effect. In the brain, the Fulvestrant has a potent inhibition action on monoamine synthesis. With fulvestrant, no estrogen can influence monoamine synthesis. Its effects are probably more powerful than Tamoxifen is. So, it boosts the appearance of depression or suicide. Neurobiological effects of fulvestrant are known. They can be explained by estrogen inhibition and they can explain the suicidal crisis. Therapeutic trials of anti-estrogen hormonal therapy have to include a psychiatric evaluation about suicidal risk. Moreover, a better knowledge of neurobiological effects of endocrine therapy would avoid complications and may allow to inform physicians and patients on psychiatric side effects of those therapies.

Pilot study of a culturally adapted psychoeducation (CaPE) intervention for bipolar disorder in Pakistan

BackgroundDespite the use of maintenance medication, recurrence rates in bipolar affective disorder (BPAD) are high. To date, there are no clinical trials that have investigated the use of psychological interventions in bipolar disorder in Pakistan.AimThe purpose of the study was to assess the feasibility and acceptability of a culturally adapted bipolar psychoeducation programme (CaPE) in Pakistan.MethodsThirty-four euthymic bipolar I and II outpatients were randomized to either 12 weekly sessions of individual psychoeducation plus Treatment As Usual (Intervention) or Treatment As Usual (TAU) (Control). Outcomes were assessed using the Young Mania Rating Scale (YMRS), Beck Depression Inventory (BDI), EuroQoL (EQ-5D), Bipolar Knowledge and Attitudes and Questionnaire (BKAQ), and a self-reported measure of medication adherence (Morisky Medication Adherence Scale-4 items, MMAS-4). Effect sizes were derived from baseline adjusted standardized regression coefficients.ResultsRetention in the study was good, 80% of patients in the TAU follow-up assessment and 100% of patients in the CaPE group attended all 12 sessions. Patient satisfaction was higher in the CaPE group relative to control (ES = 1.41). Further, there were large effect sizes shown for CaPE versus TAU for medication adherence (MMAS-4: ES = 0.81), knowledge and attitudes towards bipolar (BKAQ: ES = 0.68), mania (YMRS: ES = 1.18), depression (BDI: ES = 1.17) and quality of life measures (EQ-5D: ES ⇒ 0.88).ConclusionsCulturally adapted psychoeducation intervention is acceptable and feasible, and can be effective in improving mood symptoms and knowledge and attitudes to BPAD when compared with TAU. Larger scale studies are needed to confirm our findings.Trial registration. Clinicaltrials.gov identifier NCT02210390

The impact of frailty on depressive disorder in later life: Findings from the Netherlands Study of depression in older persons

BackgroundPhysical frailty and depressive symptoms are reciprocally related in community-based studies, but its prognostic impact on depressive disorder remains unknown. MethodsA cohort of 378 older persons (≥60 years) suffering from a depressive disorder (DSM-IV criteria) was reassessed at two-year follow-up. Depressive symptom severity was assessed every six months with the Inventory of Depressive Symptomatology, including a mood, motivational, and somatic subscale. Frailty was assessed according to the physical frailty phenotype at the baseline examination. ResultsFor each additional frailty component, the odds of non-remission was 1.24 [95% CI=1.01–1.52] (P=040). Linear mixed models showed that only improvement of the motivational (P<001) subscale and the somatic subscale (P=003) of the IDS over time were dependent on the frailty severity. ConclusionsPhysical frailty negatively impacts the course of late-life depression. Since only improvement of mood symptoms was independent of frailty severity, one may hypothesize that frailty and residual depression are easily mixed-up in psychiatric treatment.

Antidepressant efficacy and tolerance of agomelatine in daily practice in Switzerland

IntroductionThe antidepressant efficacy and tolerance of agomelatine, MT1/MT2 agonist and 5-HT2C antagonist, has been proven in clinical trials. Non interventional studies give the opportunity to evaluate these properties in real life.ObjectiveTo evaluate the efficacy and tolerance of agomelatine in depressed outpatients in Switzerland.MethodsNon-interventional study in 934 depressed (51.2% severely) patients given 25–50 mg agomelatine for 12 and 24 weeks. Main endpoints were change in MADRS score, and response (≥50% reduction in total score) and remission (MADRS ≤12) rates. CGI was also assessed. Reported adverse drug reactions, sexual dysfunction, and weight changes were recorded. Liver function tests were performed according to the summary of product characteristics.ResultsMADRS total score decreased significantly (P &lt; 0.0001) from baseline (29.5 ± 8.9) to weeks 12 (12.8 ± 9.6) and 24 (9.7 ± 8.6). Responder rate was 66.8% and 78.3% and remission rate 54.2% and 70.2% at weeks 12 and 24, respectively. Results corroborated by CGI scores, were similar for severely depressed patients. Early improvers (MADRS ≥ 20% reduction after 2 weeks; 461 patients) had the highest responder and remission rates. Agomelatine was well tolerated and no relevant weight changes or deleterious sexual function was reported. Ten patients had ALT/AST&gt;3ULN, thereof 2 without baseline and one with elevated baseline. Most physicians rated the efficacy and tolerance of agomelatine as “good or very good”.ConclusionLong-term agomelatine treatment improved mood symptoms of depressed patients with high levels of response and remission and a favorable tolerance profile.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Longitudinal assessment of local and global functional connectivity following sports-related concussion

Growing evidence suggests that sports-related concussions (SRC) may lead to acute changes in intrinsic functional connectivity, although most studies to date have been cross-sectional in nature with relatively modest sample sizes. We longitudinally assessed changes in local and global resting state functional connectivity using metrics that do not require a priori seed or network selection (regional homogeneity; ReHo and global brain connectivity; GBC, respectively). A large sample of collegiate athletes (N=43) was assessed approximately one day (1.74days post-injury, N=34), one week (8.44days, N=34), and one month post-concussion (32.47days, N=30). Healthy contact sport-athletes served as controls (N=51). Concussed athletes showed improvement in mood symptoms at each time point (p's<0.05), but had significantly higher mood scores than healthy athletes at every time point (p's<0.05). In contrast, self-reported symptoms and cognitive deficits improved over time following concussion (p's<0.001), returning to healthy levels by one week post-concussion. ReHo in sensorimotor, visual, and temporal cortices increased over time post-concussion, and was greatest at one month post-injury. Conversely, ReHo in the frontal cortex decreased over time following SRC, with the greatest decrease evident at one month post-concussion. Differences in ReHo relative to healthy athletes were primarily observed at one month post-concussion rather than the more acute time points. Contrary to our hypothesis, no significant cross-sectional or longitudinal differences in GBC were observed. These results are suggestive of a delayed onset of local connectivity changes following SRC.

Management of gambling addiction

Gambling is defined as staking something on a contingency. Many traders are gambling without even knowing it. Health professionals need to consider the harmful effects of gambling considering that gambling can destroy families and has medical consequences. A 40-year-old bank manager diagnosed initially with mood disorder with two attempts of self-harm in the past 3 years was eventually diagnosed as a case of gambling addiction using both the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria and Problem Gambling Severity Index. The participant's gambling urges were not caused by any “trigger” incident, were independent of mood disorder, and were so severe to lead him to deliberate self-harm. Even after adequate trial of two mood stabilizers from different classes including lithium, the patient neither showed improvement in mood symptoms nor his gambling behavior; however, patient's gambling behavior and mood symptoms both showed marked improvement following start of naltrexone up to a dose of 100 mg/day and were maintained at 6-month follow-up with gradual decline in craving for gambling as monitored on Problem Gambling Severity Index. Gambling addiction appears to be a very serious problem and can cause significant problems in the lives of people it affects and their family members.

A Randomized Clinical Trial of an Integrative Group Therapy for Children With Severe Mood Dysregulation

Nonepisodic irritability is a common and impairing problem, leading to the development of the diagnoses severe mood dysregulation (SMD) and disruptive mood dysregulation disorder (DMDD). No psychosocial therapies have been formally evaluated for either, with medication being the most common treatment. This study examined the feasibility and efficacy of a joint parent-child intervention for SMD. A total of 68 participants aged 7 to 12 years with attention-deficit/hyperactivity disorder (ADHD) and SMD were randomly assigned to the 11-week therapy or community-based psychosocial treatment. All participants were first stabilized on psychostimulant medication by study physicians. Of the participants, 56 still manifested impairing SMD symptoms and entered the therapy phase. Masked evaluators assessed participants at baseline, midpoint, and endpoint, with therapy participants reassessed 6 weeks later. All but 2 therapy participants attended the majority of sessions (n = 29), with families reporting high levels of satisfaction. The primary outcome of change in mood symptoms using the Mood Severity Index (MSI) did not reach significance except in the subset attending the majority of sessions (effect size = 0.53). Therapy was associated with significantly greater improvement in parent-rated irritability (effect size = 0.63). Treatment effects for irritability but not MSI diminished after therapy stopped. Little impact on ADHD symptoms was seen. Results may not be generalizable to youth with SMD and comorbidities different from those seen in this sample of children with ADHD, and are limited by the lack of a gold standard for measuring change in SMD symptoms. While failing to significantly improve mood symptoms versus community treatment, the integrative therapy was found to be a feasible and efficacious treatment for irritability in participants with SMD and ADHD. Group-Based Behavioral Therapy Combined With Stimulant Medication for Treating Children With Attention Deficit Hyperactivity Disorder and Impaired Mood; http://clinicaltrials.gov/; NCT00632619.

A randomised control trial of an Internet-based cognitive behaviour treatment for mood disorder in adults with chronic spinal cord injury.

Prospective parallel waitlist randomised controlled trial. Evaluate the feasibility and effectiveness of an Internet-based psychological intervention treating comorbid mood disorder in adults with spinal cord injury (SCI). Improved mood and satisfaction with life were primary outcomes. Victoria, Australia. Electronic Personal Administration of Cognitive Therapy (ePACT). Depression, Anxiety and Stress Scale-Short Form (DASS21), Personal Well-being Index, Helplessness subscale of the Spinal Cord Lesion Emotional Well-being Scale v1 Australia, at each time point.Participant qualifying criteria:Adults (18-70 years), chronic SCI, attend SCI review clinic at Austin or Caulfield Hospital and score above normative threshold of the Depression, Anxiety and Stress Scale-Short Form (DASS21). Forty-eight participants completed Time 2 post intervention (n=23) or time equivalent for waitlist control group (n=25) telephone interviews. The measures were repeated a third time (Time 3) for a small subgroup (n=12) at 6 months post intervention within the study implementation time frame. Univariate within group analyses revealed significant improvement in mood in the intervention group at Time 2: (lower depression (effect size (ES)=0.4), anxiety (ES=0.4) and stress (ES=0.3)) and higher satisfaction with life (ES=0.2). Waitlist control group improved in depression only (ES=0.3) by Time 2. Multilevel variance components analyses, although not as positive, were still encouraging. Improvement in mood symptoms was maintained in the small group reinterviewed at Time 3. Although Internet-based interventions for mental health issues in SCI not a solution for all, our results indicate that they are a potentially valuable addition to the currently available options.

A Randomized Controlled Trial of Individual Family Psychoeducational Psychotherapy and Omega-3 Fatty Acids in Youth with Subsyndromal Bipolar Disorder.

This pilot study evaluates efficacy of omega-3 fatty acid supplementation (Ω3), individual family psychoeducational psychotherapy (IF-PEP), and their combination in youth with subsyndromal bipolar disorders (bipolar disorder not otherwise specified [BP-NOS], cyclothymic disorder [CYC]). This study was a 12 week, randomized trial of Ω3 versus placebo and IF-PEP versus active monitoring (AM) using a 2 × 2 design (Ω3 + PEP: n = 5; Ω3 + AM: n = 5; placebo + PEP: n = 7; placebo + AM: n = 6). Twenty-three youth ages 7-14 with BP-NOS or CYC were recruited via community advertisements and clinician referrals. Participants could be taking stable medication for attention-deficit/hyperactivity disorder and sleep aids, but no other psychotropics. Independent evaluators assessed participants at screen, baseline, and 2, 4, 6, 9, and 12 weeks. Primary outcome measures were the Kiddie Schedule for Affective Disorders (K-SADS) Depression (KDRS) and Mania (KMRS) Rating Scales, Children's Depression Rating Scale-Revised (CDRS-R), and Young Mania Rating Scale (YMRS). Ω3/placebo conditions were double-blind; independent evaluators were blind to psychotherapy condition. Most participants (83%) completed the 12 week trial. Side effects were uncommon and mild. Intent-to-treat analyses indicated significant improvement in depressive symptoms (KDRS) for combined treatment relative to placebo and AM (p = 0.01, d = 1.70). Across groups, manic symptoms improved over time without significant treatment effects. Effect of IF-PEP on child depression compared with AM was medium (d = 0.63, CDRS-R) to large (d = 1.24, KDRS). Effect of Ω3 on depression was medium (d = 0.48, KDRS). IF-PEP and Ω3 are well tolerated and associated with improved mood symptoms among youth with BP-NOS and CYC. Clinicaltrials.gov Identifier: NCT01507753.

Social rhythm interventions for bipolar disorder: a systematic review and rationale for practice.

Three interconnected pathways to relapse have been identified as stressful life events, medication non-adherence and disruptions in social rhythms (daily activity and routine). The role of medication and stressful life events is generally better understood than the role of social rhythms. There is no previous review of interventions that target social rhythms. To identify the evidence for the effectiveness of interventions that target social rhythms for improving mood symptoms. A quantitative systematic review was conducted. Results Seven studies were included in the review: four reporting interpersonal and social rhythm therapy (IPSRT) interventions and three sleep/light interventions. The results suggest that IPSRT may have a potential benefit in improving mood symptoms and relapse, but it is not clear whether this is of greater benefit than an intensive supportive care intervention of similar duration. The sleep/light interventions demonstrated rapid mood improvements; however, it was not clear how long this improvement was sustained. Attention to social rhythms and the implementation of interventions that target these could be useful for mental health nursing practice may provide people with BD a clinically effective adjunctive intervention to medication.