Montgomery-Asberg Depression Scale Research Articles

Rapid and sustained antidepressant effects of intravenous ketamine in treatment-resistant major depressive disorder and suicidal ideation: a randomized clinical trial

BackgroundMajor depressive disorder (MDD) is the most disabling and burdensome mental disorder, negatively affecting an individual’s quality of life and daily functioning. the current study was conducted with the aim of investigating the clinical effects of intravenous ketamine on symptoms of MDD and suicidal ideation.MethodsThe current randomized clinical trial was carried out on 64 patients diagnosed with treatment-resistant major depressive disorder between April and August 2022. The participants were randomly assigned to two groups: the intervention group received a dose of 0.5 mg/kg of ketamine, while the control group received normal saline. The Montgomery-Asberg Depression Scale and Beck’s Suicidal Ideation Scale were utilized to assess depression and suicidal ideation, respectively.ResultsOne hour after the administration of ketamine treatment, there was a notable and significant improvement in both depression symptoms (35.16 ± 8.13 vs. 14.90 ± 10.09) and suicidal ideation (6.74 ± 6.67 vs. 0.42 ± 1.52). Moreover, there were statistically significant differences in depression scores between the two groups at one hour, four hours, one day, three days, one week, one month, and two months after the administration of ketamine (p-value < 0.001). However, ketamine recipients frequently experienced side effects such as increased heart rate, headache, dizziness, and dissociative syndrome symptoms.ConclusionThe observed rapid onset of action and sustained effect demonstrate the potential of ketamine to provide relief from depressive symptoms in a shorter timeframe compared to traditional treatment approaches. These findings contribute to the growing body of evidence supporting the use of ketamine as a valuable therapeutic option for patients with treatment-resistant depression.IRCT registrationIRCT registration number: IRCT20210806052096N1; IRCT URL: https://www.irct.ir/trial/62243; Ethical code: IR.ZUMS.REC.1400.150; Registration date: 2022-04-09.

The effect of emotion recognition and mindfulness on depression symptoms: A case-control study.

Abnormalities in emotion recognition (ER) are frequently reported in depression, with lower recognition accuracy in patients with major depressive disorder (MDD) when compared to healthy individuals. Mindfulness was found to directly impact the severity of depressive symptoms, by recognizing negative cognitions and dysfunctional reactions. The aims of this study were to compare ER and mindfulness levels between MDD patients and healthy controls (HCs), as well as to examine whether ER and mindfulness are related to symptom severity in MDD patients. Sixty-eight patients with MDD and 93 HCs participated in the study. A sociodemographic form, reading the mind in the eyes test (RMET), five facet mindfulness questionnaire-short form (FFMQ-S) and the Montgomery-Asberg depression scale (MADRS) were administered. Group comparison in ER and mindfulness was performed using the multivariate analysis of covariance (MANCOVA). Bivariate correlations and hierarchical linear regression analyses were performed to assess the associations between depression severity, ER and mindfulness in the patient group. Higher level of mindfulness was found in HCs relative to MDD group, however, no ER difference was present between the groups. A positive association between depression severity and the non-reactivity facet of mindfulness was found. On the other hand, ER was not significantly associated with symptom severity among individuals with MDD. Non-reactivity, unlike other dimensions of mindfulness, seems to increase with the severity of depressive symptoms among MDD patients. A particular focus on this subdimension in mindfulness techniques may yield better outcomes in alleviation of depressive symptoms.

Monoaminergic network dysfunction and development of depression in multiple sclerosis: a longitudinal investigation.

Monoaminergic network dysfunction is thought to underpin depression in multiple sclerosis (MS) patients. However, longitudinal studies are lacking. Here, we investigated the association between development of depressive symptoms in MS and changes of resting-state functional connectivity (RS FC) within monoaminergic networks. Forty-nine MS patients without depression [Montgomery-Asberg Depression Scale (MADRS) ≤ 9] and 27 healthy controls underwent clinical and 3.0T RS FC assessment at baseline and after a median follow-up of 1.6years (interquartile range 1.0-2.1years). Monoamine-related RS FC was derived by independent component analysis, constrained to PET atlases for dopamine, noradrenaline and serotonin transporters. Longitudinal changes of RS FC within monoaminergic networks and their correlations with MADRS scores were assessed. At baseline, MS patients showed decreased RS FC vs healthy controls in all PET-guided monoaminergic networks in frontal, cingulate and cerebellar cortices, and increased RS FC in parieto-occipital regions. Fourteen (29%) MS patients developed depressive symptoms (MADRS > 9) at follow-up (D-MS) and exhibited widespread RS FC decrease over time in the PET-guided dopamine network, mainly in orbitofrontal, occipital, anterior cingulate and precuneal cortices compared to patients who did not develop depressive symptoms. In D-MS, decreased RS FC over time was also observed in parahippocampal and occipital regions of the PET-guided noradrenaline network. Decreased RS FC over time in dopamine and noradrenaline PET-guided networks correlated with concomitant increased MADRS scores (r = range - 0.65/- 0.61, p < 0.001). The development of depressive symptoms in MS patients was associated with specific RS FC changes within the dopamine and noradrenaline networks.

A randomized controlled trial to evaluate the efficacy of metacognitive training for older adults with depression (MCT-Silver) in Portugal: study protocol.

Depression is one of the most common psychological disorders in later life. Although psychological interventions are recommended by treatment guidelines, most older adults with depression remain untreated. The aim of this study is to evaluate the efficacy of the Portuguese version of Metacognitive Training for Depression in later life (MCT-Silver). This is a study protocol of an observer-blind, parallel-group, randomized controlled trial to compare the efficacy of MCT-Silver with a treatment as usual (TAU) control group among older adults (age 65 years and older) with depressive symptoms according to the Montgomery-Asberg Depression Scale. Participants will be tested at three assessment time points (baseline, immediately following the intervention [8 weeks], and 3 months after the intervention). The primary outcome is change in self-rated depression symptoms assessed by the Beck Depression Inventory (BDI-II). Secondary outcomes include clinician-rated depression, self-esteem, dysfunctional beliefs, metacognitive beliefs, ruminations, attitudes toward aging and quality of life. A self-designed subjective appraisal rating scale consisting of 21-items will be used to assess participant acceptance of MCT-Silver. MCT-Silver is an innovative intervention, which aims to reduce dysfunctional thoughts as well as depression-related behaviors and coping strategies through the metacognitive perspective. Until now, the training has only been tested in Germany. It is expected that after 8 weeks of treatment and 3 months later, the experimental group will demonstrate significant reductions in depressive symptoms, metacognitive beliefs, dysfunctional attitudes and ruminative responses compared to the TAU group. Moreover, quality of life, self-esteem, and attitudes towards aging will be significantly improved in MCT-Silver compared to the TAU group. ClinicalTrials.gov, NCT05640492.

Cognitive - Behavioural Coping Strategies as Predictor of Suicide Risk Severity

Background and aim: Cognitive behavioural coping strategies are closely correlated with depression and suicide risk. The aim of this study is to explore the particular features of cognitive-behavioural coping strategies and their impact on depression levels and suicidal ideation. Methods: The study included a total of 131 participants, of whom 65 had a clinical diagnosis of depression and 66 were controls. Psychometric tools were administered to both groups: Montgomery-Asberg Depression Scale (MADRS), Depression Anxiety Stress Scale (DASS21R), Strategic approach to coping scale (SACS), Columbia Suicide Severity Rating Scale (C-SSRS), in order to assess the differences between depressive and non-depressive individuals in relation to cognitive behavioural coping strategies. Results and conclusion: Results based on statistical analysis of scores obtained on various psychometric scales showed significant differences between depressed and non-depressed patients. Also, cognitive-behavioural strategies could represent predictors that can be used in the prevention of suicide risk.

Factores relacionados con la severidad de la intención suicida en pacientes de urgencias y corta estancia psiquiátricas

IntroductionSuicide is one of the most relevant issues in psychiatry worldwide due to its great influence on social, economic and family level, and especially, due to its influence in health. There are multiple factors associated with the severity of suicidal intent, one of them is impulsivity, which is of great importance in the genesis of suicidal behavior, this being more relevant in individuals suffering from non-depressive mental disorders than in depressive disorders. MethodA cross-sectional observational study with an analytical component was carried out, in which information was collected through a survey that consisted of six questions with multiple answer choice, two open questions and three psychometric tests: Columbia Suicide Risk Severity Assessment Scale (C-SSRS), Barratt Impulsivity Scale (BIS-11) and Montgomery-Asberg Depression Scale (MADRS) to subjects who meet the inclusion criteria. Subsequently, the data was processed in the SPSS version V22 software. ResultsA total of 166 participants collected from four mental health institutions were taken into account; of which 140 were adults (84.3%), 93 women (56.1%), 51 had a stable partner (30.7%), 54 with stable work (32.5%), 137 believers (67.5%), 52 with a history of sexual abuse (31.3%), 58 with substance use in a pathological pattern (34.9%), and 43 with suicidal behavior (25.9%).The results of the psychometric tests were: the impulsivity score (BIS 11) was between 33 and 120 (mean: 78.52, SD: 11.6); the severity of suicidal intent (C-SSRS) ranged between 0 and 45 (mean: 17.9, SD: 14.7) and the depressive symptoms (MADRS) between 0 and 51 (mean: 13.6, SD: 12.2). A statistically significant relationship of the severity of suicidal intention was demonstrated with: being an adolescent, not being a believer, a history of sexual abuse and suffering from depression. Which were supported by performing the multivariate analysis where a positive relationship was evidenced between these factors and the intention of suicidal severity, however, when analyzing the variable regarding religion, no statistical significance was found in the multivariate analysis, although a positive relationship was found. No relationship was demonstrated with gender, employment status, having or not in a stable relationship, having histories of substance use in a pathological pattern, or with impulsivity. ConclusionsThe factors that were related to the severity of the suicidal intention were: within the sociodemographic variables; being a teenager and not being a believer; while in psychiatric factors it was found to have a history of sexual abuse and suffer from depression. No relationship was demonstrated with the other factors studied.

The impact of infertility and physical late effects on psycho-social well-being of long-term childhood cancer survivors: A cross-sectional study

IntroductionDescribe how physical late effects, and particularly fertility, impact on the psycho-social well-being (anxiety, depression and perception of HRQoL) in a cohort of childhood cancer survivors (CCS). MethodsEligibility criteria: a) cancer diagnosis at age < 18 years; b) off-therapy > 5 years; c) age at the time of the study > 18 years and < 35 years. CCS with severe cognitive impairment, psychiatric disorders, or conditions otherwise hampering the participation to the study were excluded. Psychological evaluation included Hamilton Rating Scale for Anxiety (HAM-A), Montgomery-Asberg Depression Scale (MADRS), Satisfaction-Profile (SAT-P) and Short Form Health Survey (SF-36). Late effects have been grouped using the St Jude Lifetime Cohort Study-modified version of the National Cancer Institute’s CTCAE version 4.03. Results205 CCS were included (response rate: 80.08%; 58.05% male, 40.00% between 18 and 24 years at the time of the study, 74.36% diagnosis of hematologic malignancies). Moderate or severe anxiety was found in only 3,90% of CCS. More than 35% reported depressive symptoms. The prevalence of any grade of anxiety or depression increases with the increasing of the number of late effects (from 4.08% to 17.14% and from 24.49% to 42.86%, respectively). At least mild depressive symptoms have been reported by 56.33% of CCS affected by reproductive/genital late effects. Reproductive/genital late effect (p = 0.001) and female gender (p = 0.002) significantly predict the risk of depression. CCS with 2 or more late effects and those with reproductive/genital late effects reported a reduced satisfaction in psychological and physical function. DiscussionCCS globally show a satisfactory psychological health, but infertility or a high number of physical late effects enhance the risk of depression and impaired HRQoL.

The Relationship Between Somatization and Depression Types: Comparison of Unipolar Depression and Bipolar Depression

Objective: Somatic symptoms are more likely to be present in depression and anxiety, which causes to waste medical resources due to excessive hospital addmissions. It has been observed that the unclarity of qualitative and quantitative characteristics of somatization depending on the type of depression influences clinical practice less than expected. In the present study, it was aimed to determine the hallmarks of somatic symptoms in depression groups and to investigate the factors that might have an effect on somatic symptoms.&#x0D; Method: One hundred consecutive patients (50 with Bipolar Depression (BD), 50 with Unipolar Depression (UD)) who met the criteria participated in the study. Patients were assessed for depressive symptoms with Montgomery Asberg Depression Scale and for somatic symptoms with Bradford Somatic Symptom Inventory. Clinical features were obtained by the clinician via Sociodemographic Data Form.&#x0D; Results: It was found that no significant difference in somatization characteristics between the depression groups. (p&gt; .05). Somatic symptom severity was higher in the UD group in the presence of psychiatric comorbidity (p= .013), but not in BD. Another prominent finding was that the severity of depression was noted the only predictor of severe somatization.&#x0D; Conclusion: The results show that increased somatic symptoms are associated with the severity of depression, suggesting treatment of depression with somatization rather than differential diagnosis should be primary concern.

Clinical and genetic associations of the CLOCK circadian rhythm gene and depressive disorders in patients with alcohol dependence syndrome during the period of alcohol abstinence

About 20% of patients with depression are diagnosed with alcohol dependence, and alcohol dependent individuals are at a higher risk of developing depression. A number of authors point to the relationship of CLOCK gene activity with both affective disorders and alcohol use/dependence disorders; in particular, variations in the CLOCK gene at the evidence level link to depression and stress.Objective: to establish clinical and genetic associations of the CLOCK circadian rhythm gene and depressive disorders during the period of abstinence in patients with alcohol dependence syndrome.Patients and methods. From June 2019 to December 2022, 402 patients (mean age 42.47±7.5 years) were examined, who underwent outpatient follow-up at a narcological dispensary not earlier than 1 month after and not later than 2 months after discharge from the hospital. All patients were diagnosed with middle-stage alcohol dependence syndrome, early remission phase. Depending on the presence of an episode of depression at the time of the examination, the main group (patients with a depressive disorder; n=128) and a comparison group (patients without a depressive disorder; n=274) were formed. Clinical interviews and psychometric study using the Montgomery–Asberg Depression Scale, were conducted for all the subjects. All subjects provided 10 ml venous blood samples for molecular, genetic and biochemical studies.Results and discussion. Correlations were found between the carriage of the TT genotype of the CLOCK gene in patients with alcohol dependence and concomitant clinical depression. Carrying the TT genotype of the CLOCK gene is presumably associated with the predominance of the following symptoms of depression, which demonstrated statistically significant differences: loss of appetite, impaired concentration, apathy, as well as with a higher overall score on the MADRS depression scale. The established association between the CLOCK gene and depression in people with alcohol dependence can be considered as a vulnerability factor in relation to the development of depression in patients with the underlying disease – alcohol dependence syndrome.Conclusion. The CLOCK gene is associated with the development of depression in patients suffering from alcohol dependence. Carriers of the TT genotype of the CLOCK gene (rs1801260) to a greater extent than carriers of other genotypes are characterized by the development of comorbid depression, as well as the predominance of such clinical symptoms as loss of appetite, impaired concentration, apathy, and a higher overall score on the MADRS depression scale.

The Relationships between Depression, Suicide Risk and Emotional Cognitive Coping

Background and aim: Emotional cognitive coping strategies are closely correlated with depression and suicide risk. The aim of this study is to explore the particular features of cognitive-emotional coping and their impact on depression levels and suicidal ideation. Methods: The study included a total number of 131 participants, 65 with a clinical diagnosis of depression and 66 controls. Instruments used were: Cognitive Emotion Regulation Questionnaire (CERQ), Columbia Suicide Severity Rating Scale (C-SSRS), Depression Anxiety Stress Scale (DASS21R), Montgomery-Asberg Depression Scale (MADRS), in order to assess the differences between depressive and non-depressive individuals in relation to coping strategies. Results and conclusion: The findings, based on the statistical analysis of the scores obtained on the various psychometric scales, showed significant differences between depressive and non-depressive patients. Also, cognitive-emotional strategies could represent a good predictor to be used in the prevention of suicide risk in depressed patients.

What is the link between the antidepressants, the transcranial magnetic stimulation and the peripheral vascular endothelial growth factor?

IntroductionVascular endothelial growth factor (VEGF) has been implicated in mediating the effect of antidepressants (AD) and electroconvulsive therapy on depression since it plays a significant role in the neurogenesis. However, the serum VEGF level has not been investigated so far in association with rTMS treatment in patients with major depressive disorder (MDD).ObjectivesThe aim of our study was to compare the effect of the antidepressants and of the repetitive transcranial magnetic stimulation on the serum vascular endothelial growth factor and its association with the responsiveness to the treatments.MethodsA dataset of 50 patients with TRD who were treated with AD (n=33) and bilateral rTMS for 2x5 days (n=17) was analysed (sample ’rTMS&amp;AD’). Montgomery-Asberg Depression Scale (MADRS) was used for monitoring the symptom changes. The serum VEGF levels and symptoms were assessed on the first (V1), on the 14th (V2) and on the 28th day (V3). The VEGF levels were measured by ELISA assay.ResultsThe baseline VEGF levels were significantly higher in non-responders both in the rTMS&amp;AD (p=0.04) and AD samples (p=0.02) compared to responders. The MADRS reduction and the changes in VEGF levels between V1 and V3 were significantly associated in responders only in the AD&amp;rTMS sample (p=0.03). The baseline VEGF level has been proven as a significant predictive factor of treatment response in the total sample (p=0.018).ConclusionsThe baseline VEGF level can be a predictive factor to be a non-responder to different treatments. Change of the VEGF level is associated with the improvement of depressive symptoms only due to rTMS.DisclosureThis study was supported by the FK 131315 grant of the National Research, Development and Innovation Office, Hungary. Authors declare no conflict of interest.

Change of Circulating Vascular Endothelial Growth Factor Level and Reduction of Anhedonia Are Associated in Patients With Major Depressive Disorder Treated With Repetitive Transcranial Magnetic Stimulation

AimVascular endothelial growth factor (VEGF) has been implicated in mediating the effect of antidepressant therapies as it plays a significant role in the neurogenesis. Anhedonia, an endophenotype of major depressive disorder (MDD), is related to the dorsolateral prefrontal cortex, the major focus of brain stimulation in MDD. The aim of our study was to analyze the change of serum VEGF level after rTMS treatment in association with anhedonia.Materials and MethodsA dataset of 17 patients with TRD who were treated with antidepressants and bilateral rTMS for 2 × 5 days was analyzed. Depression was measured by the Montgomery–Asberg Depression Scale (MADRS) and anhedonia by the Snaith–Hamilton Pleasure Scale (SHAPS) for monitoring the symptom changes. The serum VEGF levels and symptoms were assessed on the first (V1), on the 14th (V2), and on the 28th day (V3). The level of VEGF was measured by ELISA assay.ResultsThere was no significant association between MADRS scores and serum VEGF levels at any timepoint. The decrease in the SHAPS score was significantly associated with the increase in VEGF level between V1 and V2 (p = 0.001). The VEGF levels were significantly higher in non-responders than in responders (p = 0.04). The baseline VEGF level has been proven as a significant predictor of treatment response (p = 0.045).ConclusionOur results suggest that serum VEGF can be sensitive to the changes of anhedonia during rTMS treatment. Considering that the most widely used depression scales are not applicable for the assessment of anhedonia, measurement of anhedonia in rTMS treatment studies of patients with TRD can be suggested as more appropriate data on distinct pathogenic pathways and specific biomarkers of the disorder.

Is one or two infusions better in the first week of low-dose ketamine treatment for medication-resistant depression? A post hoc pooled analysis of randomized placebo-controlled and open-label trials

BackgroundWhether a second ketamine infusion in the first week improves the antidepressant, antisuicidal, and anti-inflammatory effects of the first low-dose ketamine infusion remains unclear. MethodsA total of 78 patients with medication-resistant depression were allocated to receive two ketamine infusions (n = 30; days 1 and 4), a single ketamine infusion (n = 24; only day 1), or normal saline placebo infusion (n = 24; only day 1). The Montgomery-Asberg Depression Scale (MADRS) and 17-item Hamilton Rating Scale for Depression (HDRS) were administered before and at 40 min, 240 min, day 2, day 4, day 5, and day 7 after infusion. Serum concentrations of interleukin (IL)-2 and tumor necrosis factor (TNF)-α were assessed. ResultsTwo ketamine infusions improved the overall depressive symptoms (p < 0.001) and melancholic symptoms (p < 0.001) than a single ketamine or placebo infusion. The antisuicidal effect did not differ between the ketamine treatment groups. Two ketamine infusions increased TNF-α levels compared with a single ketamine or placebo infusion (p = 0.015). A single ketamine infusion improved the TNF-α-to-IL-2 ratio, an index of average anti-inflammatory effect, than two ketamine infusions or a single placebo infusion (p = 0.027). DiscussionRepeated low-dose ketamine infusions improved the antidepressant effect, but not the antisuicidal effect, compared with a single infusion. However, repeated ketamine infusions may exert a lesser anti-inflammatory effect than a single infusion.

Continuous Subcutaneous Apomorphine Infusion before Subthalamic Deep Brain Stimulation: A Prospective, Comparative Study in 20 Patients.

ABSTRACTBackgroundStudies comparing the clinical efficacy of apomorphine infusion (APO) with subsequent subthalamic deep brain stimulation (STN‐DBS) in advanced Parkinson's disease (aPD) are currently lacking. Retrospective data have shown that patients treated with APO are usually older, have a more prolonged disease, and a more severe phenotype.ObjectiveTo compare the benefit of APO with that of STN‐DBS on motor, non‐motor, cognitive, and quality of life in the same patient when given sequentially.MethodsWe prospectively analyzed 20 aPD patients over 3 different treatment phases: baseline (optimized medical treatment), during APO treatment, and during subsequent STN‐DBS treatment. The APO and STN‐DBS phases were stable for 6 months, and evaluation of the different treatments was separated by 6 months.ResultsCompared to baseline, APO, and STN‐DBS reduced mean daily off time by 70.5% and 89.3% (P = 0.012), respectively, and scores for Unified Parkinson's Disease Rating Scale (UPDRS) IV by 27.5% and 80.5% (P ≤ 0.001), Non‐motor symptoms scale (NMSS) by 24.6% and 49.3% (P ≤ 0.001), Montgomery Asberg depression scale (MADRS) by 7.4% and 39.0% (P = 0.27), Starkstein apathy scale (SAS) by 51.1% and 39.9% (P = 0.734), Parkinson's disease sleep scale 2 (PDSS‐2) by 25.7% and 56.7% (P ≤ 0.001), and Parkinson's disease questionnaire 39 item (PDQ‐39) by 39.6% and 64.9% (P ≤ 0.001). Global cognition did not change with either therapy, but phonetic fluency worsened after STN‐DBS compared to APO (P = 0.022).ConclusionsBoth APO and STN‐DBS improved motor and non‐motor symptoms and quality of life compared to optimized medical treatment in aPD. Overall, STN‐DBS was the most effective treatment, but APO showed a pronounced benefit on motor symptoms. Effective treatment for aPD should not be delayed, even when waiting for surgery.

Assessment Tool of Bipolar Disorder for Primary Health Care: The SAEBD.

Mixed states are highly prevalent in patients with bipolar disorder and require comprehensive scales. Considering this, the current study aims to develop a measure to assess the full spectrum of clinical manifestations of bipolar disorder. A sample of 88 patients was evaluated; the Hamilton Depression Scale (HAM-D), Montgomery-Asberg Depression Scale (MADRS), and the Young Mania Rating Scale (YMRS) were applied, together with the preliminary version of the Scale for the Assessment of Episodes in Bipolar Disorder (SAEBD). After analyzing the appropriateness and statistical properties of the items, discriminant analysis and analysis of diagnostic capacity were performed. The discriminant functions correctly classified 100% of the cases in euthymia, predominant depressive symptoms or mixed symptoms, as well as 92.3% of the cases with predominant manic symptoms. Overall, the functions correctly classified 98.9% of the cases. The area under the curve (0.935) showed high capacity to discriminate between clinical and non-clinical cases (i.e., in euthymia). The SAEBD sensitivity was 0.95, specificity was 0.71, the Positive Predictive Value (PPV) was 0.88, the Negative Predictive Value (NPV) was 0.87, the Positive Likelihood Ratio (+LR) was 3.33, and the Negative Likelihood Ratio (−LR) was 0.07. In conclusion, the SAEBD is a promising scale that shows high reliability and validity, as well as diagnostic utility as a screening tool for use in diverse health care settings.

Study of emotional disorders in dermatological and cardiological patients

Objective. To study the character and features of emotional disorders in patients of dermatological and cardiological profile. Emotional changes, accompanying many somatic diseases, have a negative effect and aggravate their course, worsening the quality of life and functioning. Materials and methods. 68 persons, divided into two groups, participated in a single-stage study: group I included 38 patients with dermatoses without any concomitant diseases of the internal organs; group II 30 cardiological patients without dermatological pathology in anamnesis. Complex research included general clinical and laboratory methods as well as psychological study using the Hospital Anxiety and Depression Scale HADS, Zung Self-Rating Depression Scale, Montgomery Asberg Depression Scale, Spielberger Hanin Anxiety Scales. To assess the results, the methods of parametric and nonparametric statistics were used. Results. When assessing the parameters by the Hospital Anxiety and Depression Scale HADS, in dermatological patients clinically and subclinically expressed anxiety was manifested more evidently, and in cardiological patients, it was depression. According to the data obtained by the Zung and Hamilton scales, depression also predominated in cardiological patients but anxiety symptoms and disorders reliably more often were observed in patients of dermatological profile. As for studying depression using the Montgomery-Asberg scale, in dermatological patients it was revealed less often, in the structure of symptoms there prevailed a small depressive episode. According to Spielberger Hanin Scale, anxiety was more expressed in dermatological patients. Conclusions. Emotional disorders in dermatological and cardiological patients are reliably different. In dermatological patients, they are characterized by increased anxiety in case of an insignificant depressive disorder. In cardiological patients, there prevail depressive changes, especially mild depression; anxiety symptomatology is not expressed.

Treating with esketamine nasal, will increase blood pressure?

IntroductionEsketamine had been rised as a potential treatment for Resistant Depression, becoming an alternative for the use of Electroconvulsive Therapy. In Spain since 2020, it has been applied for compassionate use but is not widely used. Although Esketamine is defined safe and effective in preliminary studies, there are common side effects which could reduce it use.ObjectivesIncreasing blood pressure has been found commonly in ederly population treated with Esketamine Nasal. Studies showed as very common side effect (10% or more) increasing systolic and diastolic blood pressure which is higher in elderly people. Our aim is to show that esketamine is well tolerated and safe in ederly people without increasing blood pressure, although is combinate with oral antidepressant therapy.MethodsPresenting female 65-year-old with 4 years of treatment maintaining a moderate-severe symptoms. Althougt numerous pharmacological strategies have been attempted, with optimal time and maximum doses, which have been progressively withdrawing showing lack of efficacy or appearance of adverse effects. Among the drugs used we find; 11 antidepressants, 3 antipsychotics, benzodiazepines and even lithium, without response after 6 weeks of treatment. Futhermore, patient refusal to receive Electro-Convulsive Therapy. Treating with Esketamine nasal and applying the established guidelines.ResultsAssess the response to Esketamine Nasal with Montgomery-Asberg depression scale (MADRS) we found that decrease the initial score in 26 points. Evaluating blood pressure before and after each time with no increased value.ConclusionsConcluding esketamine is well tolerated and safe in ederly people without increasing blood pressure. These findings and results should be confirmed with futher studies.

Quality of life, anxiety and depressive disorders in patients with extrasystolic arrhythmia.

IntroductionThe aim of this study was to perform a comparative and economic analysis of the degree of development of anxiety-depressive disorder in patients with different types of extrasystolic arrhythmia using different assessment scales.Material and methodsThe study was conducted in 2018–2019 at the premises of clinic No. 4, involving 450 patients (Moscow, Russia). Patients were divided into three groups: with coronary heart disease (CHD) (147 patients), with myocardiodystrophy (MCD) (113) and with cardiopsychoneurosis (CPN) (190). Everyone underwent round-the-clock electrocardiography (ECG) and echocardiography. If symptoms of depressive disorder are detected in a timely manner, the risk of adverse cardiovascular diseases may be reduced.ResultsDepression and anxiety indicators on all three scales differed significantly (p ≤ 0.05) in patients with supraventricular extrasystole (more than 40 points on the Zung scale, 14 points on the Montgomery-Asberg depression scale, more than 38 points on Zung and 3 points on Covi anxiety scales). For patients with ventricular extrasystole, a significant difference was established between groups 1 and 2 only in terms of the level of depression on the Zung scale. Factors of psychogenic origin determine the development of cardiac rhythm disturbances.ConclusionsThe study showed that for supraventricular extrasystoles, these factors determine the overall health of the patient. The differences between the three groups are significant on all scales of depression and anxiety (p ≤ 0.05). The most susceptible to depression and anxiety are patients with extrasystolic arrhythmias diagnosed with CHD, as well as MCD.

Sexual Satisfaction in Fully Ambulatory People with Multiple Sclerosis: Does Disability Matter?

Primary sexual dysfunctions (SD) are a direct result of neurological changes that affect the sexual response. Secondary SD result from the symptoms that do not directly involve nervous pathways to the genital system, such as bladder and bowel problems, fatigue, spasticity, or muscle weakness. Tertiary SD are the result of disability-related psychosocial and cultural issues that can interfere with sexual feelings and experiences. The aim of this study was to assess the sexual satisfaction (SS) in people with multiple sclerosis (PwMS) without significant mobility impairment and to estimate the influence of SD, the score on the Kurtzke Expanded Disability Status Scale (EDSS), lowered mood, and stress coping strategies on SS. Methods. 76 PwMS with the EDSS score < 5.0 points were enrolled in the study. The subjects completed the Montgomery-Asberg Depression Scale (MADRS), the Coping Inventory for Stressful Situations (CISS), the Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-19), and the Sexual Satisfaction Questionnaire (SSQ). Results. The level of SS in PwMS was not significantly lower compared to that of the general population. It correlated with the primary, secondary, and tertiary SD and lowered mood. However, it did not correlate with disability measured by the EDSS. Conclusions. The level of SS in PwMS with the EDSS score below 5.0 points was not significantly lower. SS depended on SD, lowered mood, and stress coping style, and it was not significantly related to the level of disability in patients with the EDDS score below 5.0.

Feasibility, effectiveness and safety of the self-management intervention deprexis in routine medical care: Results of an uncontrolled observational study

IntroductionNumerous RCTs have demonstrated the effectiveness of internet-based self-management interventions (SMIs) in the treatment of depressive symptoms. These studíes often recruit outside routine clinical practice. For the present study, we investigated the feasibility, effectiveness and safety of an SMI (deprexis) in routine medical care using a non-interventional design. MethodsA total of 104 patients with a depressive disorder (60.58% female, mean age 45.82 yrs) were recruited in 25 outpatient practices in Germany (mostly psychiatric practices, n = 16). They received 12 week access to the SMI in addition to their usual care (76.0% took concomitant antidepressant medication). Guidance could optionally be offered by the treating physician. The effectiveness of the intervention was assessed using the clinician-rated short version of the Montgomery Asberg-Depression Scale (svMADRS) and the Patient Health Questionnaire (PHQ-9), a self-rating for depressive symptoms. Outcomes were assessed at baseline as well as at weeks 3, 6, 9 and 12. ResultsMost patients reported using the intervention at least once (n = 87, 83.6%), among these users the mean number of sessions was 18.05 (SD = 11.33). Only a minority of patients received the guided version of the intervention (n = 7, 8.0%). The severity of depressive symptoms decreased significantly over the observation period from 29.72 (SD = 10.03) to 15.73 (SD = 9.74) for the svMADRS (Cohen's d = 1.42, 95% CI 0.08–2.76) and from 15.20 (SD = 5.03) to 8.77 (SD = 5.03) for the PHQ-9 (d = 1.29, 95% CI 0.60–1.97). DiscussionThe size of the pre-post effect on depressive symptoms observed in this study is comparable to the pre-post effect size reported in an RCT using the same intervention in patients suffering from depressive symptoms of the same severity. Limitations of this study include the lack of a control group and the fact that the recruitment rate was far lower than expected. ConclusionThis non-interventional study conducted in outpatient practices confirms results from numerous RCTs. Taken together, these data show that deprexis can be used effectively and safely in the routine care of depressed outpatients.