Mixed Anxiety-depressive Disorder Research Articles

Multidimensional Study of the Attitude towards Euthanasia of Older Adults with Mixed Anxiety-Depressive Disorder

Introduction: This study aims to verify if older adults with mixed anxiety-depressive disorder are more prone to euthanasia and identify factors that interfere with their satisfaction with health and capacity for well-informed decisions. Material and Methods: The study applied a paper questionnaire composed of a sociodemographic section and a battery of scales (to assess depression, anxiety, cognitive performance, suicide risk, therapeutic adhesion, functionality, loneliness, attitude towards euthanasia, decision pattern, personality, empathy, and health status) in the Psychogeriatric Unity of Senhora da Oliveira Hospital in Portugal. The sample was collected by convenience to include patients and controls of the same age. Six months later, a reassessment was performed. Patients and controls were compared using descriptive statistics and a multiple-regression model. Results: A total of 114 patients and 25 controls were included. Eighty-one point six percent of patients had four or fewer years of schooling. Contrary to controls, they presented mild depressive and anxiety symptoms, loneliness feelings, worse cognitive performance, a more fragile personality, higher personal distress, and a poorer health state. No statistically significant differences were found between controls and patients regarding their attitudes towards euthanasia. Patients more favourable to euthanasia had higher empathic concern, conscientiousness, and fantasy, and lower personal distress. Discussion and Conclusion: When addressing euthanasia in these patients, it is crucial to ensure they are fully self-determinate and that all the necessary treatment and support are available. It may not be the case when the educational level is low and a mild disease persists, significantly affecting their well-being and cognitive performance.

Mixed anxiety-depressive disorder in Parkinson's disease associated with worse resting state functional response to deep brain stimulation of subthalamic nucleus

BackgroundParkinson's disease (PD), even though generally perceived as a dominantly motor disorder, is associated with a wide range of non-motor symptoms, including mixed anxiety-depressive disorder (MADD). ObjectivesThe aim of the presented study was to determine whether deep brain stimulation (DBS) of the subthalamic nucleus (STN) brings the functional characteristics of non-motor networks closer to the condition detected in healthy population and whether pre-DBS presence of MADD in PD patients was associated with different reaction to this therapeutic modality. MethodsResting-state fMRI signature elicited by STN DBS activation and deactivation in 81 PD patients was compared against healthy controls, with the focus on measures of efficiency of information processing and localised subnetwork differences. ResultsWhile all the MRI metrics showed statistically significant differences between PD patients in DBS OFF condition and healthy controls, none were detected in such a comparison against DBS ON condition. Furthermore, in the post-DBS evaluation, PD patients with MADD in the pre-DBS stage showed no differences in depression scales compared to pre-DBS psychiatrically intact PD patients, but still exhibited lower DBS-related connectivity in a subnetwork encompassing anterior and posterior cingulate, dorsolateral prefrontal and medial temporal cortices. ConclusionsSTN DBS improved all the metrics of interest towards the healthy state, normalising the resting-state MRI signature of PD. Furthermore, pre-DBS presence of MADD, even though clinically silent at post-DBS MRI acquisition, was associated with lower DBS effect in areas highly relevant for depression. This finding points to a possibly latent nature of post-DBS MADD, calling for caution in further follow-up of these patients.

Retrospective Chart Analysis of Psychiatry Referrals for Hospitalized COVID-19 Patients in a Dedicated COVID Hospital in a Metropolitan City in India

Abstract Background: The COVID-19 pandemic has been associated with multiple psychiatric problems in the general population as well as in those admitted with the infection. Studies done so far have mainly focused on the general population. It is important to address the needs and gaps in mental and psychological aspect of health of patients admitted with the infection to improve their overall prognosis. This study was undertaken with the aim to study the pattern of psychiatric referrals of hospitalized COVID-19 patients and to find out if there is any association between their socio-demographics, severity of COVID-19 infection, inflammatory markers, and co-morbidities. Materials and Methods: A descriptive, retrospective chart analysis of the record of 160 psychiatry referrals for COVID-19 patients seen by the on-call psychiatrist from May 2020 to October 2020 in a tertiary care hospital was undertaken. Sociodemographic data, severity of COVID-19 infection, blood investigation reports, psychiatric symptoms, diagnosis and management were recorded, tabulated, and analyzed using SPSS 20. Results: Referrals were more for individuals having moderate-to-severe COVID-19 infection, in elderly patients and in males. The most common reason for referral was disorientation (27.5%) and insomnia (27.5%), followed by the patient having a preexisting psychiatric illness (15%). The most common psychiatric diagnosis was delirium secondary to general medical condition, (28%), followed by anxiety and depressive spectrum disorders (23.75%). 32.5% of the patients referred had a past history of psychiatric illness, the most common being substance use disorder, followed by major depressive disorder and mixed anxiety depression. With the increase in the age of the individuals, the number of referrals for males was significantly more as compared to females (P = 0.00). No statistically significant association was found between age (P = 0.83), gender (P = 0.99), and psychiatric diagnosis. No significant association was found between the severity of COVID-19 and psychiatric diagnosis (P = 0.69). Conclusion: It is essential to screen for psychiatric disorders in patients admitted for COVID, as it goes a long way in reducing the overall morbidity and improves patient cooperation for various procedures which could be life-saving.

Prevalence and coping of depression and anxiety among college students during COVID-19 lockdowns in China

BackgroundThis study sought to investigate the prevalence of anxiety, depression and mixed anxiety-depression disorder among college students during COVID-19 shelter-in-place lockdowns in China. MethodsParticipants (N = 2818) were selected from 8 provincial regions across the country in areas that were under lockdown mandates. The dependent variables were anxiety and depression. Multiple regression models were tested using anxiety and depression as the respective outcome variables, and binary logistic regression was conducted with anxiety-depression comorbidity as the dependent variable. Explanatory variables were changes in (social) media use and communication behaviors, perceived effectiveness of daily activity involvements as well as a number of demographic and environmental factors. ResultsBeing a college senior, prior anxiety/depression history, having family members and residents in neighborhood tested positive with COVID were all important predictors of elevated anxiety, depression and their comorbidity. Increased face-to-face family communication and reading more e-books were associated with reduced anxiety, depression and their comorbidity. Listening to music and playing video games were correlated with lower anxiety but not depression. ConclusionsDraconian shelter-in-place lockdowns as strictly enforced in China within a short notice could be detrimental to individual mental health and psychological well-being. Findings in this research can provide practical guidance for college counselors and health professionals in targeting particular segments of the student population in providing tailored psychological, therapeutic and material services during disruptive moments and public health crises. The central role of family communication in the emotional and social support process deserves critical contemplation.

Skin Diseases in Patients With Primary Psychiatric Conditions in Northern India: A Cross-Sectional Study.

The relationship between skin diseases and psychiatric illnesses is bi-directional and is manifested as cause and effect. Psychiatric disorders such as stress, anxiety, and depression are seen to be instrumental in the development and progression of dermatological diseases on one hand, while on the other hand, cosmetic disfigurement caused by dermatological diseases is responsible for psychological distress in patients. The present study was conducted to investigate the spectrum of dermatological disorders in psychiatric patients to offer them holistic treatment andprovide them with a better quality of life. This cross-sectional, observational study wasconducted at a tertiary medical care center. A total of 170 psychiatric patients referred to the dermatology department for different dermatological manifestations were enrolled in the study. A demographic profile of the patients was done, and an association between dermatological diseases and psychiatric illnesses was done. Out of 170 study participants, 88 (51.8%) were females, and the rest (82, 48.2%) were males.A total of 13 major types of dermatological conditions were noted; among them, fungal infection (43, 25.3%) was the most common, followed by eczema (18, 10.6%), parasitic infestation (17, 10.0%), pigmentary disorder (13, 7.6%), acne (11, 6.5%), bacterial infection (11, 6.5%), pruritic disorder (11, 6.5%), hair disorder (9, 5.3%), drug reaction (9, 5.3%), papulosquamous disorder (7, 4.1%), and viral infection (6, 3.5%). Skin conditions other than the above-mentioned were present in 15 (8.8%) patients.The most common psychiatric illness in the present study was major depressive disorder (41, 24.1%), followed by generalized anxiety disorder (38, 22.4%) and psychosis not otherwise specified (34, 20.0%). Other psychiatric illnesses included in the study were bipolar affective disorder (22, 12.9%), schizophrenia (18, 10.6%), obsessive-compulsive disorder (12, 7.1%), and mixed anxiety depressive disorder (5, 2.9%). The findings of the present study depict that psychiatric patients with dermatological manifestations show a spectrum of dermatological conditions, primarily of infectious (fungal, parasitic, or viral) nature. This might be associated with a relatively poor hygienic status of psychiatric patients and thus their increased susceptibility to these disorders. Most of the time, the susceptibility to these skin conditions seemed to be opportunistic and unaffected by the type, duration, and level of control of psychiatric illness.

Features of the immuno-metabolic status in patients with mixed anxiety and depressive disord

Worldwide epidemiological data reveal extremely high prevalence of anxiety and depressive disorders, leading to loss of fitness for work and the associated increased economic burden on society. In this regard, it seems crucial to improve the efficacy of standard psychopharmacological treatment of anxiety and depression. The relevance of the study is determined by the identification of combined immune-metabolic disorders in mixed anxiety and depressive disorder.Laboratory and clinical parameters of patients with mixed anxiety-depressive disorder were assessed. It was found that symptoms of anxiety and depression were accompanied by changes in immune and metabolic status. Statistically significant correlations between symptoms of anxiety and depression, and immune-metabolic statuses were identified,which indicates the possible existence of immune-oxidative stress in patients with symptoms of anxiety and depression, and damage to all parts of the immune system: humoral, phagocytic, cytokine, free-radical oxidation, and antioxidant system dependent immunity. These findings indicate the need to take into account changes in immune and metabolic status in patients with mixed anxiety and depressive disorder and consider the possibility of adding immunocorrective drugs to the treatment regimen in order to increase the effectiveness of standard psychopharmacological therapy.

Electrodermal activity moderates the relationship between depression and suicidal ideation in a group of patients with anxiety and depressive symptoms

PurposeBeing suicide a serious global issue, it's urgent to identify the involved factors and possibly precursors. In our study, it was hypothesized that autonomic hyperactivation might have a moderating role in the relationship between symptoms of depression and suicidal ideation in a group of patients suffering from Mixed Anxiety Depressive Disorder (MADD). MethodsFifty-three outpatients diagnosed with MADD were consecutively recruited. Anxiety and depression levels were assessed through the Symptom Questionnaire whereas suicidal ideation was calculated through specific items extrapolated from the Symptom Checklist-90-R (SCL-90-R). Additionally, Electrodermal Activity (EDA) and the evaluation of Skin Conductance, Level and Response (SCL-SCR), was detected through the recording of a Psychophysiological Stress Profile (PSP). ResultsThe analyses confirmed depression as the first predictor of suicidal thoughts. Nonetheless, EDA levels recorded at baseline and under induced stress exerted a moderating effect on the relationship between thymic deflection and thoughts of death. ConclusionsEven though activation is usually considered a positive factor for clinical prognosis, our findings highlight that autonomic arousal may represent a harmful resource for patients suffering from MADD. The involvement of the psychophysiological axis can accentuate mental suffering and favor suicidal ideation. The need to consider a multidimensional assessment strongly emerged.

The dynamics of psychological attributes and symptomatic comorbidity of depression in children and adolescents

PurposeThis investigation aimed to explore attribute dynamics and symptomatic comorbidity of depression with internalizing, externalizing, and other personal–contextual problems in children and adolescents from a network analysis.MethodsWe tested an attribute network of regularized partial correlations, standard and alternative centrality measures, and comorbidity bridge symptoms according to centrality bridge measures.ResultsRegularized partial correlation network and a centrality measures graph shown the prominent position of social problems and anxiety–depression. Minimum spanning tree (MST) found a hierarchical dynamics between attributes where mixed anxiety–depression was identified as the core and the other attributes were hierarchically connected to it by being positioned in six branches that are differentiated according to their theoretical contents. The most central connections are established with the attributes of their own community or theoretical groups, and 37 bridge symptoms were identified in all networks.ConclusionsA significant role of mixed anxiety depression as an activator and intermediary of psychopathologies was supported as a central attribute of internalizing problems. Aggressive behavior as part of the broad externalizing dimension was one of the constructs that most intensively activate the network, and social problems were also distinguished as a relevant factor not only in terms of connections and central attributes but also in terms of bridge symptoms and comorbidity. This framework extends to the study of symptomatic “comorbidity.”

Frequency Of Psychiatric Illnesses And Opinion/Vantage Of Patients Attending Neurology Out-Patient Department.

To determine the Frequency of psychiatric illnesses in patients with neurological conditions, and to take their opinion about psychiatric disorders. The cross-sectional study was conducted from June 1 to August 30, 2021, at the Neurology Outpatient Department of Allied Hospital, Faisalabad, Pakistan, and comprised patients of either gender aged 12-70 years from among those visiting the outpatient clinic. Data was collected through interviews and the 41-item Depression Anxiety Stress Scale. Data was analysed using SPSS 21. Of the 201 patients, 160(79.6%) were females and 41(20.4%) were males. The overall mean age was 34.5+/- 9.38 years. Primary neurological problem was headache 119(59.2%). Overall, 155(77.2%) patients met the criteria of psychiatric disorders; 55(27.4%) anxiety, 37(19.4%) had depressive disorder, 42(20.8%) mixed anxiety depressive disorder, and 19(9.5%) had other psychiatric illnesses. Also, 101(50.2%) patients lacked awareness about psychiatry illnesses, 35(17.4%) had fear of stigma, and 28(13.9%) had misconceptions. The frequency of psychiatric disorders among those visiting the neurology outpatient department was high, and was associated with negative views about such illnesses.

Utilization Study of Antidepressants in a Teaching Hospital of Sikkim and Adherence to Standard Treatment Guidelines

Aims: Depression is known to have an overarching negative impact on the quality of life of afflicted individuals. Mitigation of depression associated adverse outcomes is mostly reliant upon timely diagnosis and decisive intervention. Antidepressants and adjunct drugs constitute the pharmacological modalities for the therapy of depression, in addition to supportive non-pharmacological methods of management. This prospective cross-sectional observational study aims at analyzing the utilization of antidepressants in American Psychiatric Association (APA) categories of depression in a remote North-East Indian teaching hospital. Methods: Patients clinically diagnosed with depression based on Diagnostic and Statistical Manual of Mental Disorders (DSM) and prescribed with antidepressant medication, were included in the study. The data were analyzed based on demographic characteristics, prescribed antidepressant medication and co-prescribed adjunct drugs. Results: A total of 316 patients were included in the study. The SSRI class of antidepressants were prescribed most frequently (89%) followed by TCAs (6%) & SNRIs (4.4%). Escitalopram was the single most frequently prescribed antidepressant (51%) followed by sertraline (23%) & fluoxetine (11.4%). The SSRIs were used most frequently in bipolar disorder (94.7%), followed by depressive episode (89.2%) & mixed anxiety depressive disorder (88.2%). The utilization of SSRIs was more frequent in the ≤ 50 age group (90.3%) and in males (92.5%). Sedatives including benzodiazepines, were used in 78.8% and atypical antipsychotics in 8.9% of the patients. Conclusion: SSRIs are the most frequently used antidepressant class across all categories of depression. Benzodiazepines have been extensively co-prescribed. The pharmacotherapy of depression in this hospital conforms to currently available clinical evidence and treatment guidelines.

Alexithymia and related mental and psychosomatic disorders

Rationale. Currently, there is a growing number of mental disorders, which are infl uenced by various external and internal factors, including the presence of alexithymia. Most studies focus on the prevalence of somatic diseases among patients with alexithymia, while the prevalence of mental disorders in these patients remains insuffi ciently studied. Presumably, alexithymia can serve as a background for the development of mental disorders such as anxiety, depressive, and mixed anxiety-depressive disorders. The aim of the study is to investigate the correlation between alexithymia and mental disorders, somatic diseases, and suicidal thoughts in patients.Material and methods. A total of 184 outpatients (107 women and 77 men) with various illnesses were examined. Clinical rating was conducted using the TAS, HADS, and MADRS scales. Additionally, medical history was collected.Results. A higher incidence of mental disorders was detected in patients with alexithymia (correlation coeffi cient 0.71). Depression was most frequently observed in these patients (73.5%), followed by anxiety disorder and mixed anxietydepressive disorder (13.2%). Patients with alexithymia also had a higher incidence of psychosomatic disorders (correlation coeffi cient 0.68), with multiple psychosomatic diseases usually occurring in the same person. Moreover, a higher incidence of hypertension (47%), ischemic heart disease (25%), skin diseases such as neurodermatitis, psoriasis, atopic dermatitis, and others (59.6%), gastrointestinal diseases such as peptic ulcer and irritable bowel syndrome (28.7%), bronchial asthma (8.8%), thyrotoxicosis (0.7%), and rheumatoid arthritis (0.7%) was detected in patients with alexithymia. As the degree of alexithymia increased, suicidal thoughts were more frequent and severe (correlation coeffi cient 0.74).Conclusion. The hypothesis of the correlation between alexithymia and the development of mental and psychosomatic disorders and the appearance of suicidal thoughts has been confi rmed.

Clinical and diagnostic significance of plasminogen activator inhibitor type 1 in the early development of coronary heart disease

Aim to determine the quantitative content of the tissue plasminogen activator inhibitor type 1 (PAI-1) and to determine its relationship with risk factors for coronary artery disease.
 Material and methods. The study included 67 male and female patients (36 men and 31 women) with coronary artery disease (CAD) and stable angina classes II-IV with the presence of hypertension. The mean age of the patients was 60.20.76 years. In all patients, clinical and anamnestic data were collected during the examination. For pain assessment, we used a verbal scale. We registered the anthropometric data and body mass index. Biochemical and instrumental methods of research were used according to the standards for diagnosing CAD. We assessed the occurrence of risk factors in patients included in the study. A complex of general clinical laboratory and instrumental tests was used, as well as the method of enzyme immunoassay ELISA, which determined the level of PAI-1, platelet aggregation activity, renin, aldosterone, cortisol and endothelin.
 Results. The group of patients demonstrated a reliable elevation of PAI-1 plasma level. Compared with practically healthy people, the level of this biomarker was 1.6 times higher in patients with coronary artery disease. A significant elevation of PAI-1 level indicates an increased risk of endothelial and hemostasiological disorders in patients, which, in turn, increases the risk of thrombogenic complications. The study revealed the correlation of PAI-1 protein in CAD patients with such risk factors as mixed anxiety-depressive disorder, smoking, hypertension, obesity, and hypercholesterolemia.

Pattern of Illness in Prisoners Admitted in a Tertiary Care Hospital of South Eastern Rajasthan

The delivery of health care among prisoners is one of the most important aspects of improving human rights compliance. Estimating common healthcare problems in prisoners will be helpful in assessing their health status and recommending the rectifying steps. Therefore, knowing the types of morbidities will help us in making health policies which will be helpful in reducing the health burden in prisoners and will also help in reintegration of prisoners into mainstream society. The present study is a retrospective analysis to find out the common medical conditions in prisoners. The study was carried out by collecting data of 500 admitted prisoner in a tertiary care institute in south-east Rajasthan. The majority (95.2%) of referred prisoners were male, from age group of 30-39 years, mean age of prisoners being 39.6 years and the majority (90%) were referred from Central Jail, Kota. The majority (53.2%) of prisoners were admitted to medicine department followed by psychiatry department (26.4%). A higher prevalence of anemia and pulmonary tuberculosis was reported among prisoners. Surgical illness related to infectious etiology and poor personal hygiene was common in prisoners. Psychosis not specified (17%), schizophrenia (8%), mixed anxiety depressive disorder (8%) and substance use disorders (16%) were common psychiatric conditions. Mean duration of hospitalization was 9 days.

Ectopic parathyroid adenoma causing hyperparathyroidism-induced psychosis: A case report

Primary hyperparathyroidism is a disease with multisystemic and heterogeneous manifestations, characterized by underlying high parathormone concentrations. Despite neuropsychiatric involvement being one of the manifestations, psychosis is rare. This is the case of a 68-year-old female with a 10-day clinical course of anorexia, mutism, dysphagia, constipation, and weight loss. The patient had disorganized speech associated with paranoid delusions. Prior to this visit, the patient was recently diagnosed with a mixed anxiety-depressive disorder. For this reason, treatment with antidepressants in combination with atypical antipsychotics was administered without a satisfactory response. Neuroimaging, infectious panel, and toxicology screening showed no abnormal findings. Hypercalcemia secondary to a retropharyngeal ectopic parathyroid adenoma was the causative etiology of her primary hyperparathyroidism, and hypercalcemia treatment resolved the psychotic episode. We highlight the importance of recognizing psychosis as a possible initial presentation of hyperparathyroidism and hypercalcemia. Ruling out organic etiologies prior to diagnosing a primary cause of psychosis is crucial, as their treatment can reverse the psychotic symptoms.

A STUDY OF SOCIODEMOGRAPHIC CHARACTERSTICS, ANXIETY & DEPRESSION IN WOMEN WITH POLYCYSTIC OVARIAN SYNDROME

Background: Polycystic ovarian syndrome (PCOS) is the most common and distressing disorder of reproductive age group female which include symptoms like amenorrhea, hirsutism, obesity, acne, infertility etc. Because of these distressing symptoms PCOS has been associated with signicant psychiatric morbidity. Aims & objectives: 1.To study the sociodemographic characterstics of females with PCOS. 2.To nd out the frequency of different symptoms in females suffering from PCOS. 3.To study the prevalence of anxiety and depression among females suffering from PCOS. Materials & methods: 30 consecutive female patients attending gynae OPD from 1/3/2022 to 1/4/2022 suffering from PCOS as per Rotterdam criteria diagnosed by a consulatant gynaecologist were taken for the study. They were thoroughly evaluated on a specially designed semistructred proforma,GHQ-12,Hamilton anxiety rating scale, Beck's depression inventory and PCOS questionnaire. Results were analysed using suitable statistics. Result and conclusion: Majority (60%) of the patients were from the age group 25-30 years. Most common symptom of PCOS in the patient was menstrual irregularity(90%) followed by obesity(80%), hirsutism(50%), acne(40%), alopecia(20%) and acanthosis nigricans(10%), 33%of the patients showed clinically signicant anxiety symptoms, 10% shown clinically signicant depression and 10% showed mixed anxiety depression disorders.

The anxiety and depression disorder in adults with atopic dermatitis: experience of a dermatology hospital.

The objectives of this study are to identify the proportion of atopic dermatitis adult patients having anxiety and depression disorder and to measure the relationship between anxiety and depression disorder and characteristics of atopic dermatitis. A cross-sectional study with convenience sampling was conducted. Diagnostic criteria for atopic dermatitis were based on modified Hanifin and Raijka criteria and the severity of anxiety-depression disorder was evaluated using the hospital anxiety and depression scale. In this study, 208 patients were enrolled. The percentage of patients with anxiety and subthreshold anxiety were 11.1% and 34.1%, respectively. 5.3% of patients had depression and 39.4% of patients suffered from subthreshold depression. The proportion of patients with mixed anxiety-depressive disorder was 1.44%. Patients with severe atopic dermatitis were more likely to endure anxiety but not depression. Allergies or autoimmune diseases and scoring atopic dermatitis C were two independent risk factors of depression whereas edema and excoriation were two independent risk factors related to anxiety in atopic dermatitis patients. These findings suggest that atopic dermatitis is associated with anxiety and depression. Allergies, autoimmune diseases, pruritus, and insomnia had a correlation with anxiety and depression disorder.

CLINICAL CASE “I finally woke up, it seems like a miracle”

IntroductionClinical case about a 62 year old patient, diagnosed with mixed anxiety-depressive disorder. In current treatment with Paroxetine, Clorazepate and Trazodone. She presents low spirits secondary to a neurological process (stroke + amyloid angiopathy+ epilepsy+ cognitive impairment) and difficulties in performing daily activities. Her daughter reports that she is totally dependent, she spends the whole day in bed. On examination we observe a dull mood, without emotional reactivity. Lack of motivation. Psychomotor slowness.Significant cognitive impairment with difficulties in performing daily activities. Mnesic faults.ObjectivesClinical case shows radiological and cognitive improvement with vortioxetineMethodsLast diagnoses: August 2020: HSA OF THE FRONTAL AND PARIETAL GROOVES RIGHTS September 2020:SYMPTOMATIC FOCAL EPILEPSY SECONDARY TO LEFT FRONTOPARIETAL INTRAPARENCHIMATOSUS HEMATOMA December 2020:MYELOID ANGIOPATIA February 2021:SUBARACHNOID HEMORRHAGE March 2021:DEPRESSIVE DISORDER SECONDARY TO MEDICAL ILLNESS - MODERATE COGNITIVE IMPAIRMENTResultsSpectacular improvement in mood and cognitive deficit. The family reports that after 5 days they noticed the change. They find her more lively, she has returned to doing housework and is autonomous for day-to-day life. She has regained her memory and performed calculation exercises on a daily. The patient says that she has returned to being her usual self, “before I felt like a mummy and now I have finally woken up, it seems like a miracle”.ConclusionsIt has improved much with change of antidepressant, from paroxetine to vortioxetine in patient who show in cranial MRI: New-onset lesion in the right frontal lobe attributable and subarachnoid hemorrhage located in convex furrows ,radiological findings in favor of amyloid angiopathyDisclosureNo significant relationships.

Analysis of malingered psychological symptoms in a clinical sample for early detection in initial interviews

Malingering consists of the production of false physical or psychological symptoms motivated by external incentives that are normally reproduced in pathologies that are not related to organic origin or there are no laboratory tests for their diagnosis, as is the case of mixed anxiety–depressive disorder and fibromyalgia syndrome. The objective of this research consisted of comparing the profile of simulative patients with fibromyalgia and mixed anxiety–depressive disorder to obtain a profile and facilitate its detection in initial interviews. The research was carried out with 78 patients (42 patients with fibromyalgia and 36 patients with mixed anxiety–depressive disorder) who were administered the professional's structured clinical judgment, the Beck Depression Inventory, the State-Trait Anxiety Questionnaire, and the Structured Symptom Simulation Inventory. The main obtained results show that the simulation classification proposed by the questionnaire is in the range of 66.67–80% with regard to coinciding with the judgment of experts, and people with suspicion of simulation of both groups of patients present similar characteristics. The simulators thus present incongruous responses in relation to the questionnaires, and high levels of trait anxiety, state, and depression predict the simulation of symptoms.

The influence of personality disorder in predicting suicidal behaviour in common mental disorders: A 30-year study.

Two hundred ten patients with anxiety and depressive disorders were followed up over 30 years. Personality status was assessed at baseline using the Personality Assessment Schedule (PAS), an instrument that classifies personality disorder in a similar way to the new ICD‐11 classification. Assessments of suicidal behaviour were made at 5, 12 and 30 years and suicidal thoughts at 12 and 30 years and analysed by personality status, clinical diagnosis and scores on the General Neurotic Syndrome Scale, a combined diagnosis of mixed anxiety depression and personality dysfunction. Suicide attempts were most frequent in the first 5 years of the study and reduced over time. Baseline personality status was the best predictor of suicide attempts at 5 years (no personality disorder 29.3%, personality disorder 51.6%, p = 0.006), and at 12 years (no personality disorder 11.9%, personality disorder 25.7%, p = 0.042), but no important differences were found at 30 years, when comorbid mental state disorder was the strongest predictor (p < 0.001). Similar but less marked findings were found for the general neurotic syndrome. It is concluded that the presence of personality disorder is a robust predictor of suicidal behaviour in the shorter term but in the long‐term comorbid pathology is a better predictor.

Clinical efficacy of Shugan granule in the treatment of mixed anxiety-depressive disorder: A multicenter, randomized, double-blind, placebo-controlled trial

Ethnopharmacological relevanceShugan granule is derived from Xiaoyao powder, a traditional Chinese medicine that has been shown to be effective in treating emotional disorders. At present, there is no standard drug treatment for mixed anxiety-depressive disorder (MADD), and no evidence-based clinical trial has been performed for any drug, meaning MADD patients are unable to obtain standardized treatment. Aim of the studyThe purpose of this clinical trial was to test the clinical efficacy and safety of Shugan granules in the treatment of MADD, and to provide clinical trial-based support along with drug recommendations for the treatment of MADD. Materials and methodsA multicenter, randomized, double-blind, placebo-controlled study was conducted on 400 patients with MADD recruited from January 1, 2019 to December 31, 2020, and they were randomly divided into test and placebo groups with a 1:1 ratio. Subjects in the test group (n = 200) received oral administration of Shugan granules, while subjects in the placebo group (n = 200) received oral administration of a Shugan granule simulator. The treatment lasted for 8 weeks. The Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale-17 (HAMD-17), Clinical Global Impression Scale (CGIS), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) were used to evaluate efficacy. In addition, the traditional Chinese medicine (TCM) syndrome scale for MADD was developed to observe improvements of related symptoms in patients after treatment based on the disease guidelines of TCM and the clinical manifestations of depression. Furthermore, the safety of Shugan granules was evaluated during and after treatment. ResultsAfter 8 weeks of treatment, the total scores for HAMA, HAMD, SAS, and SDS in the test group were significantly lower than those in the placebo group (P < 0.01). The proportion of patients with efficacy index (EI) > 1 for the CGIS score in the test group was significantly higher than that in the placebo group (P < 0.01). The efficacy of treatment in the test group based on the TCM syndrome scale was 70.16% and 88.27% after 4 weeks and 8 weeks, respectively, which was significantly higher than that in the placebo group (44.27% and 66.67% after 4 weeks and 8 weeks, respectively; P < 0.01). The disappearance rate of single symptoms in the test group was 20–30% higher than that in the placebo group, with a significant difference between groups (P < 0.05). During the treatment period, the incidence of adverse reactions was 2.05% in the test group and 2.06% in the placebo group, with no significant differences noted (P = 1.0000). ConclusionShugan granule was more effective than placebo in the treatment of MADD. Moreover, there was no significant difference between the two groups in terms of safety. This paper provides a clinical therapeutic regime using Shugan granule for the treatment of MADD.