Major Mental Disorders Research Articles

Involving families in psychiatric treatment and rehabilitation

IntroductionPsychiatric rehabilitation promotes recovery in individuals with mental disabilities. Its mission is to engage patients and families or caregivers in a collaborative treatment process. The vision of recovery is more likely to become a reality when patients and families are actively involved in treatment. Numerous factors have converged during the past decades to facilitate development and refinement of evidence-based approaches for strengthening families coping with mental disorders.ObjectivesTo review current knowledge on the importance of involving families in psychiatric treatment and rehabilitation, addressing effectiveness of family interventions, role of family coping skills in neutralizing stress and vulnerability, and family burden of mental illness.MethodsNon-systematic review of literature through search on PubMed/MEDLINE database for publications up to 2020. Textbooks were consulted.ResultsGiven the unpredictability of major mental disorders, families assume responsibility for extensive monitoring and supervision of a severely and chronically mentally ill relative. Clinical, social, family and economic benefits are achieved by adding psychosocial family interventions to a comprehensive array of services required by patients. Family interventions are not stand-alone modalities: they are coordinated with pharmacotherapy, illness management, crisis intervention, clinical case management, skills training and supportive services. Family interventions show benefits, such as fewer psychotic/affective episodes of exacerbation or relapse by the patient, reduced hospitalizations and improved family morale and less emotional burden.ConclusionsThe new and effective family interventions do not stigmatize families as being ‘sick’ or in need of therapy to ‘straighten them out’. Family interventions are viewed as conferring added therapeutic protection to the patient and relatives.DisclosureNo significant relationships.

Aspectos neuropsiquiátricos da COVID-19

A nova infecção pelo coronavírus, descoberta ao final de 2019, na China, se disseminou pelo mundo rapidamente, atingindo todos os continentes, sendo então declarada uma pandemia pela Organização Mundial de Saúde (OMS). De modo a inibir a transmissão da doença, diversas medidas restritivas foram adotadas por autoridades públicas, o que determinou uma série de alterações no funcionamento da sociedade. Para além da própria doença infecciosa, o COVID-19 tem um profundo impacto na saúde mental da população, com repercussões sociais e neuropsiquiátricas. Sendo assim, o presente trabalho objetivou analisar os principais aspectos envolvidos apontados na literatura, por meio da revisão de estudos realizados com diferentes populações no Brasil e no mundo, delineando assim os principais pontos de discussão. Para cumprir com tal propósito, optou-se por uma revisão bibliográfica do tipo narrativa a partir da busca de artigos referentes aos aspectos social, neuropsiquiátricos e de saúde mental no contexto da pandemia de COVID-19, nas bases de dados “PubMed”, “Scielo” e “Google Acadêmico’. Como resultado, observou-se que a pandemia de COVID-19 está envolvida em uma série de alterações na esfera social, com impacto emocional significativo, e repercussões neuropsiquiátricas de modo a causar diversos sintomas associados aos principais transtornos de saúde mental. Nesse sentido, pode-se afirmar, portanto, que a pandemia de COVID-19 deve ser entendida como muito mais que apenas um perigo de doença infecciosa, e que seu impacto na saúde mental da população não deve ser negligenciado, e sim estudado de maneira mais aprofundada e combatido pelas autoridades competentes.

Mental health and biological evolution: implications for psychiatry and psychosomatic medicine

Abstract Psychiatric disorders are common and seem to increase in prevalence worldwide. Most scientific approaches for this phenomenon fail to explain why the majority of mental disorders, unlike most somatic diseases, manifest in early adulthood, why individuals are not more resilient, and why some genes increasing the risk for mental disorders have not been selected against. In this article, an evolutionary perspective on mental health and disorder is taken. This perspective suggests that mismatches between ancestral and contemporary environments contribute to the risk for mental disorders. In addition, predictions from attachment theory and life history theory can explain individual differences with regard to the risk of developing a psychiatric or psychosomatic disorder. Insights from evolutionary approaches to psychiatric and psychosomatic disorders may contribute to improve the prevention and treatment of mental disorders.

Comorbid Bipolar and Alcohol Use Disorder—A Therapeutic Challenge

Comorbidity rates in Bipolar disorder rank highest among major mental disorders, especially comorbid substance use. Besides cannabis, alcohol is the most frequent substance of abuse as it is societally accepted and can be purchased and consumed legally. Estimates for lifetime comorbidity of bipolar disorder and alcohol use disorder are substantial and in the range of 40–70%, both for Bipolar I and II disorder, and with male preponderance. Alcohol use disorder and bipolarity significantly influence each other's severity and prognosis with a more complicated course of both disorders. Modern treatment concepts acknowledge the interplay between these disorders using an integrated therapy approach where both disorders are tackled in the same setting by a multi-professional team. Motivational interviewing, cognitive behavioral and socio- therapies incorporating the family and social environment are cornerstones in psychotherapy whereas the accompanying pharmacological treatment aims to reduce craving and to optimize mood stability. Adding valproate to lithium may reduce alcohol consumption whereas studies with antipsychotics or naltrexone and acamprosate did not affect mood fluctuations or drinking patterns. In summary, there is a continuous need for more research in order to develop evidence-based approaches for integrated treatment of this frequent comorbidity.

Synergistic Effect of Several Neurotransmitters in PFC-NAc-VTA Neural Circuit for the Anti-Depression Effect of Shuganheweitang in a Chronic Unpredictable Mild Stress Model

Depression, a major worldwide mental disorder, leads to massive disability and can result in death. The PFC-NAc-VTA neuro circuit is related to emotional, neurovegetative, and cognitive functions, which emerge as a circuit-level framework for understanding reward deficits in depression. Neurotransmitters, which are widely distributed in different brain regions, are important detected targets for the evaluation of depression. Shuganheweitang (SGHWT) is a popular prescription in clinical therapy for depression. In order to investigate its possible pharmacodynamics and anti-depressive mechanism, the complex plant material was separated into different fractions. These in low and high doses, along with low and high doses of SGHWT were tested in animal behavior tests. The low and high doses of SGHWT were more effective than the various fractions, which indicate the importance of synergistic function in traditional Chinese medicine. Furthermore, amino acid (GABA, Glu) and monoamine neurotransmitters (DA, 5-HT, NA, 5-HIAA) in the PFC-NAc-VTA neuro circuit were investigated by UPLC-MS/MS. The level trend of DA and 5-HT were consistent in the PFC-NAc-VTA neuro circuit, whereas 5-HIAA was decreased in the PFC, Glu was decreased in the PFC and VTA, and NA and GABA were decreased in the NAc. The results indicate that the pathogenesis of depression is associated with dysfunction of the PFC-NAc-VTA neural circuit, mainly through the neural projection effects of neurotransmitters associated with various brain regions in the neural circuit. PCA and OPLS-DA score plots demonstrated the similarities of individuals within each group and the differences among the groups. In this study, SGHWT could regulate the concentration level of different neurotransmitters in the PFC-NAc-VTA neuro circuit to improve the depression, which benefitted from the recognition of the brain reward circuitry in mood disorders.

A Comprehensive Review of Computer-Aided Diagnosis of Major Mental and Neurological Disorders and Suicide: A Biostatistical Perspective on Data Mining.

The World Health Organization (WHO) suggests that mental disorders, neurological disorders, and suicide are growing causes of morbidity. Depressive disorders, schizophrenia, bipolar disorder, Alzheimer’s disease, and other dementias account for 1.84%, 0.60%, 0.33%, and 1.00% of total Disability Adjusted Life Years (DALYs). Furthermore, suicide, the 15th leading cause of death worldwide, could be linked to mental disorders. More than 68 computer-aided diagnosis (CAD) methods published in peer-reviewed journals from 2016 to 2021 were analyzed, among which 75% were published in the year 2018 or later. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was adopted to select the relevant studies. In addition to the gold standard, the sample size, neuroimaging techniques or biomarkers, validation frameworks, the classifiers, and the performance indices were analyzed. We further discussed how various performance indices are essential based on the biostatistical and data mining perspective. Moreover, critical information related to the Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) guidelines was analyzed. We discussed how balancing the dataset and not using external validation could hinder the generalization of the CAD methods. We provided the list of the critical issues to consider in such studies.

Genetically predicted education attainment in relation to somatic and mental health

A deeper understanding of the causal links from education level to health outcomes may shed a light for disease prevention. In the present Mendelian randomization study, we found that genetically higher education level was associated with lower risk of major mental disorders and most somatic diseases, independent of intelligence. Higher education level adjusted for intelligence was associated with lower risk of suicide attempts, insomnia, major depressive disorder, heart failure, stroke, coronary artery disease, lung cancer, breast cancer, type 2 diabetes and rheumatoid arthritis but with higher risk of obsessive–compulsive disorder, anorexia nervosa, anxiety, bipolar disorder and prostate cancer. Higher education level was associated with reduced obesity and smoking, which mediated quite an extent of the associations between education level and health outcomes. These findings emphasize the importance of education to reduce the burden of common diseases.

Tetracyclines, a promise for neuropsychiatric disorders: from adjunctive therapy to the discovery of new targets for rational drug design in psychiatry.

Major mental disorders, such as schizophrenia, bipolar disorder, and major depressive disorder, represent the leading cause of disability worldwide. Nevertheless, the current pharmacotherapy has several limitations, and a large portion of patients do not respond appropriately to it or remain with disabling symptoms overtime. Traditionally, pharmacological interventions for psychiatric disorders modulate dysfunctional neurotransmitter systems. In the last decades, compelling evidence has advocated for chronic inflammatory mechanisms underlying these disorders. Therefore, the repurposing of anti-inflammatory agents has emerged as an attractive therapeutic tool for mental disorders. Minocycline (MINO) and doxycycline (DOXY) are semisynthetic second-generation tetracyclines with neuroprotective and anti-inflammatory properties. More recently, the most promising results obtained in clinical trials using tetracyclines for major psychiatric disorders were for schizophrenia. In a reverse translational approach, tetracyclines inhibit microglial reactivity and toxic inflammation by mechanisms related to the inhibition of nuclear factor kappa B signaling, cyclooxygenase 2, and matrix metalloproteinases. However, the molecular mechanism underlying the effects of these tetracyclines is not fully understood. Therefore, the present review sought to summarize the latest findings of MINO and DOXY use for major psychiatric disorders and present the possible targets to their molecular and behavioral effects. In conclusion, tetracyclines hold great promise as (ready-to-use) agents for being used as adjunctive therapy for human neuropsychiatric disorders. Hence, the understanding of their molecular mechanisms may contribute to the discovery of new targets for the rational drug design of novel psychoactive agents.

Brief Research Report: A Pilot Study of Cognitive Behavioral Regulation Therapy (CBT-REG) for Young People at High Risk of Early Transition to Bipolar Disorders.

Attempts to increase early identification of individuals in the early stages of bipolar disorders (i.e., individuals at high risk of bipolar disorders and/or experiencing a subthreshold syndrome with bipolar symptoms) have highlighted the need to develop high benefit-low risk interventions. We suggest that any new psychological therapy should (i) be acceptable to young people seeking help for the first time, (ii) be applicable to “at risk” conditions and sub-syndromal states and (iii) consider pluripotent factors that may be linked to illness progression not only for bipolar disorders specifically but also for other potential disease trajectories. However, evidence indicates that current interventions for youth with emerging mood disorders mainly represent approaches abbreviated from “disorder-specific” therapies used with older adults and are primarily offered to first episode cases of bipolar disorders who are also receiving psychotropic medication. This brief report discusses empirical findings used to construct core targets for therapeutic interventions that might reduce or delay transition to full-threshold bipolar disorders. We describe an intervention that includes strategies for problem-solving, reducing sleep-wake cycle disturbances, self-management of rumination and that addresses the needs of individuals with “sub-threshold” presentations who are probably at risk of developing a bipolar or other major mental disorders. Outcome data from a case series of 14 youth indicates that the intervention appears to demonstrate a relatively high benefit-to-risk ratio, promising levels of engagement with the therapy modules, and the therapy appears to be acceptable to a wide range of help-seeking youth with early expressions of bipolar psychopathology.

Food addiction comorbid to mental disorders: A nationwide survey and register-based study.

Substance use disorder is highly prevalent among individuals with mental disorders. However, it remains largely unknown whether this is also the case for "food addiction"-a phenotype characterized by an addiction-like attraction to predominantly highly processed foods with a high content of refined carbohydrates and fat. Therefore, the primary aim of this study was to estimate the weighted prevalence of food addiction among individuals with mental disorders. A total of 5,000 individuals aged 18-62 were randomly drawn from eight categories of major mental disorders from the Danish Psychiatric Central Research Register and invited to participate in an online questionnaire-based survey, which included the Yale Food Addiction Scale 2.0. Data on health care and sociodemographics from the Danish registers were linked to all invitees-enabling comprehensive attrition analysis and calculation of the weighted prevalence of food addiction. A total of 1,394 (27.9%) invitees participated in the survey. Across all diagnostic categories, 23.7% met the criteria for food addiction. The weighted prevalence of food addiction was highest among individuals with eating disorders (47.7%, 95%CI: 41.2-54.2), followed by affective disorders (29.4%, 95%CI: 22.9-36.0) and personality disorders (29.0%, 95%CI: 22.2-35.9). When stratifying on sex, the prevalence of food addiction was higher among women in most diagnostic categories. Food addiction is highly prevalent among individuals with mental disorders, especially in those with eating disorders, affective disorders and personality disorders. Food addiction may be an important target for efforts aimed at reducing obesity among individuals with mental disorders.

Effect of Art Therapy on Cognitive and Psychological Well-being of Patients with Major Mental Disorders- An Experimental Study

Introduction: Psychological and recreational activities have been found to be useful in the field of psychiatry. ‘Art Therapy’ uses therapeutic use of art within the professional role in the personal development of the patient by creating art and finding meaning through them. People can improve their awareness of self and cope with symptoms of stress, anxiety, and traumatic experiences. They can also improve cognitive abilities and gain pleasure in making art. Aim: To evaluate the effectiveness of art therapy on cognitive functions and psychological well-being among mentally ill patients admitted with major mental disorders. Materials and Methods: An evaluative approach with a pre- experimental, one group pre and post-test design was adopted to select 60 patients admitted with major mental disorders in a selected psychiatric unit, Udupi, Karnataka, India through purposive sampling technique. Data collection was done from 1st December 2019 to 31st January 2020. Information was collected through Montreal Cognitive Assessment (MoCA) Scale and Psychological General Well-being Index (PGWBI) Scale. The pretest was conducted on the first day. Art therapy sessions were conducted for four consecutive days. Post-test assessments were done on the seventh and fourteenth day. Results: The mean baseline MoCA score was 16.70±4.04 which improved to 19.10±4.07 on 7th day and 21.28±4.33 on 14th day. Similarly, baseline score of PGWBI was 35.28±13.94 which improved to 53.58±13.88 on 7th day and further increased to 81.80±17.69. Conclusion: Art therapy has a strong effect on the psychological well-being of the patients with mental illnesses and is effective in improving cognitive functions and psychological well-being.

Perspective of patients referred to Yoga center in a tertiary neuropsychiatric hospital: A cross-sectional retrospective study.

Background:Yoga has been extensively used as an alternative or complementary therapy in psychiatric disorders depending on the type and severity of the disorders. However, data related to perspective on yoga services and the benefits and adverse effects attributed to yoga by patients with major psychiatric disorders is lacking.Aim:The aim of the study was to assess feedback of the patients who attended yoga sessions at a Yoga center in a tertiary neuropsychiatric hospital.Materials and Methods:This was a cross-sectional retrospective study using a specific questionnaire to get feedback from patients referred to the NIMHANS Integrated Center for Yoga, at the end of their yoga training.Results:Two hundred and one patients’ data were included in this retrospective study. Most of the patients were referred by the doctors. The yoga module for schizophrenia was most commonly utilized, followed by depression. On an average, patients attended 13 sessions. Most of them practiced yoga for 1–2 weeks and had missed less than 2 sessions. The great majority of the patients reported that practicing yoga helped them. Spearman correlation analysis revealed positive associations between improvement attributed to yoga and variables affecting quality of yoga services at the center, including the quality of yoga sessions attended. Overall health and sleep improvement also positively correlated with improvement attributed to yoga. A minority of patients reported adverse effects, although these did not lead to discontinuation.Conclusion:In this retrospective study of patients referred to a Yoga center in a tertiary psychiatric facility, the majority of patients with major mental disorders were able to practice yoga under supervision and reported significant improvement in symptoms with minimal adverse effects.

Prevalence of Major Mental and Neurological Disorders in India.

Prevalence of Major Mental and Neurological Disorders in India.

Pathophysiological mechanisms of major mental disorders related to cardiovascular disease

Although the relationship of mental health with cardiovascular dysfunction is not a recent finding, scientific data has appeared approximately at the middle of the last century. Firstly, depression was studied as a risk factor for premature death in cases of cardiovascular disease (CVD). Much later, the mechanism of psychosis and schizophrenia in the development of CVD were studied, as it was observed that most premature deaths in schizophrenia were related to cardiovascular disease. This interaction is supported both by epidemiological data and by the associated mechanisms. Inflammation, oxidative and biologic stress, and hormonal and neurotransmitter disorders in coagulation, tissue perfusion, vascular dysfunction and genetic factors get involved in these mental disorders. The combination of these pathophysiological mechanisms and the general risk factors for CVD (sex, age, smoking, systolic blood pressure, body weight, glucose levels) leads, to some extent, to increased rates of comorbidity and mortality. Patients with severe mental disorders are often not monitored and do not receive appropriate treatment for cardiovascular risk factors. In studies of patients with comorbid coronary heart disease and depression, there were signs of cardiovascular dysfunction, including increased heart rate, mainly in stress, QT prolongation and ventricular arrhythmia. At the same time, there is a dose-response relationship between the severity of depression and cardiovascular risk, with the presence of even mild symptoms of untreated depression involving some cardiovascular risk. In addition, improving the symptoms of depression through medication has been associated with increased survival. Moreover, the causes of increased mortality in patients with schizophrenia are similar to those of the general population with metabolic syndrome and diabetes mellitus, while failure to receive antipsychotic medication could lead to obesity, insulin resistance, dyslipidemia and hypertension. These data could be used as a source for future anti-inflammatory therapeutic approaches, but also for the appropriate selection of therapeutic agents, by taking a more holistic view of the patient's comorbidity. The interdisciplinary collaboration and liaison - consultation psychiatry are important factors for the timely prevention, recognition and treatment of potent complications of the cardiovascular system in mentally ill patients. The aim of this review was to present the pathophysiological mechanisms of serious mental disorders, such as depression, bipolar disorder, and schizophrenia that may be related to the development of CVD.

The psychological impact of the Coronavirus emergency on physicians and nurses: an Italian observational study.

Background and aim of the work:The Coronavirus has put a strain on the response capacity of health systems and there are various psychological effects on health workers.Aim of the study:To investigate the psychological impact of the coronavirus emergency on physicians and nurses.Methods:A study was conducted on a sample of nurses and physicians (n=770), who were asked to fill in a questionnaire investigating physical and psychological problems. It also included the IES (Impact Event Scale), STAI (State Trait Anxiety Inventory) scale and BDI (Beck Depression Inventory).Results:87.7% of the sample was represented by nurses (n=675), 12.3% (n=95) by physicians. 52.3% (n=403). Among the psychological symptoms, stress (76.2%; n=587), anxiety (59.4%; n=457) and depression (11.8%) prevailed and only 3.9% of the healthcare personnel sought help from a psychologist. The total score of the IES-R scale was 3.47. A significant association emerged between exposure and the risk of contagion (p-value = 0.003), stress was more present among nurses than among physicians (77.5% vs. 67.4%; p = 0.003). Among physical symptoms, headache (52.2%; n=402) and pressure injuries (24.8% n= 191) prevailed.Conclusions:The results of the study show that mental health monitoring of health workers, who are at risk of developing major psychological disorders, is a priority.

Effect of COVID -19 Pandemic on Mental Health of Students: A Contemporary Literature Review

The globally increasing trend of COVID -19 pandemic has got worldwide attention from several nations. Along with physical health, pandemic diseases have shown a tremendous negative impact on mental health in the general population throughout the world. To find out the impact of this pandemic on the mental health of students, a systematic review of different national and international literatures was carried out to complete this study. Elevated anxiety, depression, stress, and sleeping disorder were found as the major mental disorders among the students. Most of the results of reviewed studies were based on online survey. In Nepalease context studies on the impact of Covid -19 on mental health are very limited, hence the findings might be useful to explore the possible mental problems among the Nepalese students; and the result will be helpful to follow the necessary further steps to minimize the COVID-19 induced mental problems among the targeted group.

SNX29, a new susceptibility gene shared with major mental disorders in Han Chinese population

Objectives Environmental and genetic factors play important roles in the development of schizophrenia (SCZ), bipolar disorder (BPD) or major depressive disorder (MDD). Some risk loci are identified with shared genetic effects on major psychiatric disorders. To investigate whether SNX29 gene played a significant role in these psychiatric disorders in the Han Chinese population. Methods We focussed on 11 single-nucleotide polymorphisms (SNPs) harbouring SNX29 gene and carried out case–control studies in patients with SCZ (n = 1248), BPD (n = 1344), or MDD (n = 1056), and 1248 healthy controls (HC) recruited from the Han Chinese population. We constructed weighted gene co-expression network analysis (WGCNA) and extracted significant modules by R package. Results We found that rs3743592 was significantly associated with MDD and rs6498263 with BPD in both allele and genotype distributions. Before correction, rs3743592 showed allelic and genotypic significance with SCZ, rs6498263 showed allelic significance with SCZ. WGCNA identified top 10 modules of co-expressed genes. Gene Ontology (GO) and pathway analysis were used to examine the functions of SNX29, which revealed that SNX29 was involved in the regulation of a number of biological processes, such as TGF-beta, ErbB, and Wnt signalling pathway, etc. Conclusions Our results supported common risk factors in SNX29 might share among these three mental disorders in the Han Chinese population.

Anti-depressant effect of cerebrolysin in reserpine-induced depression in rats: Behavioral, biochemical, molecular and immunohistochemical evidence

Depression is a major psychological disorder that contributes to global health problem. This study aimed to evaluate the anti-depressant effect of Cerebrolysin (CBL) in Reserpine-induced depressed rats, its effect on oxidative stress, inflammation, regulatory cyclic AMP-dependent response element binding protein (CREB)/brain derived neurotropic factor (BDNF) signaling pathways, brain monoamines and histopathological changes was assessed. Rats received either the vehicle or Reserpine (0.5 mg/kg, i.p.) for 14 days. The other three groups were pretreated with CBL (2.5, 5 ml/kg; i.p.) or fluoxetine (FLU) (5 mg/kg, p.o.), respectively for 14 days, 30 min before reserpine injection. Then analyses were conducted. CBL reversed Reserpine-induced reduction in latency to immobility and prolongation of immobility time in the forced swimming test (FST), reduced malondialdehyde (MDA), elevated reduced glutathione (GSH), reduced tumor necrosis factor-alpha (TNF-ɑ), and elevated BDNF cortical and hippocampal brain contents. CBL elevated protein kinase A (PKA) and nuclear factor kappa-B (NF-κB) cortical and hippocampal protein expressions. CBL also ameliorated alterations in mRNA expressions of protein kinase B (AKT), CREB and BDNF in the cortical and hippocampal tissues. CBL elevated nor-epinephrine (NE), serotonin (5-HT), and dopamine (DA) and reduced 5-Hydroxyindoleacetic acid (5-HTAA), 3,4-Dihydroxyphenylacetic acid (DOPAC), and homovanillic acid (HVA) cortical and hippocampal contents. CBL effects were in parallel to those observed with the standard anti-depressant drug, FLU. This study shows that CBL exerted anti-depressant effect evidenced by attenuation of oxidative stress and inflammation as well as enhancement of neurogenesis, amelioration of monoaminergic system and histopathological changes.

Quality of life: Investigating the impact of two major mental disorders, anxiety and depression, in patients with age-related macular degeneration

Purpose: The purpose of this study was to investigate the impact on the quality of life of patients with age-related macular degeneration (AMD) in relation to common mental disorders, namely anxiety and depression, and determine specific factors (e.g., thoughts/feelings, sociodemographic characteristics) that may be used to refer such patients to psychiatrists. Materials–Methods: To classify the patients into different categories, regarding the development of the mental disorders under consideration, the “Hospital Anxiety and Depression Scale” (HADS) has been utilized. The main statistical methodologies applied are classification and regression trees (CART) techniques and logistic regression. For the purposes of the aforementioned statistical analysis, the R software package has been used. Results: Both depression and anxiety scores varied considerably across visual acuity (VA) severity. Patients with severe visual acuity problems tend to have also higher HADS scores. Women were more likely to be affected by depression; sociodemographic factors did not have any significant effect. According to the performed CART analysis, responses to two HADS items (namely, “I can enjoy a good book or radio or television program” and “I have lost interest in my appearance”) identified the vast majority of severely to moderately depressed patients. Furthermore, the level of VA severity was found as a main driver for diagnosing an AMD patient with depression. Conclusions: VA impairment (or decline) severity level was found to be the main factor associated with depression in patients with AMD. Moreover, specific thoughts/feelings present in patients with AMD have been found as significant regarding the level of their mental disorders under consideration and could be asked by the ophthalmologist to refer (or not) them to psychiatrists.

A Better World in the Future

A Better World in the Future