Neuropsychiatric Complications Research Articles

A service evaluation on the impact of brain injury linkworker (BIL) interventions on the anxiety and depression of men in prison and on probation

It is well established that the prevalence of Traumatic Brain Injury (TBI) is higher in offender populations than the general population. Men in prison and probation services also have many of the risk factors that place them at higher risk of developing neuropsychiatric complications following a TBI (e.g., low socioeconomic backgrounds, previous history of substance misuse). The BIL service, developed in 2013 by Brainkind (formally The Disabilities Trust) delivers brain injury rehabilitation to men engaged with South Wales (United Kingdom) Prison and Probation Services. As part of a wider service evaluation, we reviewed the levels of anxiety (Generalised Anxiety Disorder assessment, GAD-7) and depression (Patient Health Questionnaire, PHQ-9) of 50 men in prison or on probation pre- and post-BIL intervention. Results showed a significant decrease in the scores reported on the GAD-7 between the start (Mean—M = 15.38, Standard Deviation—SD = 4.64) and end (M = 11.84, SD = 5.15) of the intervention (t (49) = 2.01, p = 0.00000733). Additionally, there was a significant decrease in self-reported depression symptoms as observed by the scores on the PHQ-9 between the start (M = 17.08, SD = 5.55) and end (M = 12.42, SD = 6.55) of the intervention (t (49) = 2.01, p = 0.0000125). These results indicate that overall there was an improvement in the men’s levels of anxiety and depression following the BIL intervention. This service evaluation provides a clear rationale for the development of a more rigorous research protocol to explore the relationship between brain injury interventions and the impact on mental health in this population.

Managing Hepatic Encephalopathy - Combination of Lactulose and Rifaximin Versus Lactulose Monotherapy: A Systematic Review and Meta-analysis

Background: Hepatic Encephalopathy (HE), a neuropsychiatric complication of hepatic failure, is currently managed with lactulose as a first-line treatment followed by other adjuncts if needed. In this meta-analysis, we determined the effect of lactulose and rifaximin combination in terms of efficacy and mortality reduction compared to lactulose alone. Materials and Methods: We searched databases (PubMed, BioMed Central, and Cochrane-Central) until July 2022 for original studies inspecting the effects of Rifaximin and Lactulose (combination therapy) vs. lactulose as a monotherapy in the treatment of HE on outcomes of clinical efficacy, hospital stay length, HE recurrence, drugs’ side effects and mortality. Data was analyzed via Review Manager (version 5.4.1) and OpenMetaAnalyst. Relative risks (RR) and weighted mean differences (WMD) with 95% confidence intervals were calculated. Results: Fifteen studies with 4327 patients were included. Pooled analysis showed combination therapy to be associated with a significantly lower mortality rate in patients having HE when compared to lactulose alone (RR 0.71 95% CI 0.58-0.88, P=0.002, I2= 68%), and clinical efficacy was also improved in the combination group (RR 1.33, 95%CI 1.19-1.48, P <0.00001, I2= 52%). HE recurrence rate, adverse events, and length of hospital stay did not significantly differ among the two groups (RR= 0.61, 95 % CI= 0.35 to 1.05, P= 0.08, I2= 84%), (RR= 0.92, 95% CI= 0.51 to 1.69, P= 0.80, I2 = 0) and (WMD −1.52, 95% CI −3.22 to 0.18, P=0.08, I2 = 83%) respectively. Conclusions: Combination therapy shows survival benefits and superior clinical efficacy over lactulose monotherapy in managing hepatic encephalopathy.

Post-Stroke Neuropsychiatric Complications: Types, Pathogenesis, and Therapeutic Intervention.

Almost all stroke survivors suffer physical disabilities and neuropsychiatric disturbances, which can be briefly divided into post-stroke neurological diseases and post-stroke psychiatric disorders. The former type mainly includes post-stroke pain, post-stroke epilepsy, and post-stroke dementia while the latter one includes post-stroke depression, post-stroke anxiety, post-stroke apathy and post-stroke fatigue. Multiple risk factors are related to these post-stroke neuropsychiatric complications, such as age, gender, lifestyle, stroke type, medication, lesion location, and comorbidities. Recent studies have revealed several critical mechanisms underlying these complications, namely inflammatory response, dysregulation of the hypothalamic pituitary adrenal axis, cholinergic dysfunction, reduced level of 5-hydroxytryptamine, glutamate-mediated excitotoxicity and mitochondrial dysfunction. Moreover, clinical efforts have successfully given birth to many practical pharmaceutic strategies, such as anti-inflammatory medications, acetylcholinesterase inhibitors, and selective serotonin reuptake inhibitors, as well as diverse rehabilitative modalities to help patients physically and mentally. However, the efficacy of these interventions is still under debate. Further investigations into these post-stroke neuropsychiatric complications, from both basic and clinical perspectives, are urgent for the development of effective treatment strategies.

Dementia specific neuropsychiatric complications: an evidence based reformulation of behavioural and psychological symptoms of dementia

Dementia specific neuropsychiatric complications: an evidence based reformulation of behavioural and psychological symptoms of dementia

Neuropsychiatric complications from COVID-19

Introduction: COVID-19 manifests mainly as a respiratory disease, later with the course of the pandemic neurological symptoms were described, but mainly patients developed neurological complications, which manifested with neuropsychiatric symptoms in about 35,6 % of the cases with COVID-19 infection. Aim: to determine neuropsychiatric complications due to COVID-19. Method: a narrative review was carried out to gather information on neuropsychiatric complications due to COVID-19. For this purpose, indexed scientific articles published from 2020 to 2022, in Spanish and English, were consulted using scientific search engines such as PubMed and SciELO.Results: the main neurological symptoms could be the consequence of multiorgan failure, severe infection or brainstem involvement. It has been reported that patients infected by SARS-CoV-2, after 3 weeks, developed altered mental status, encephalopathy, psychosis, neurocognitive syndrome (similar to dementia) and affective disorders. Persistent neurocognitive deficits were identified in patients with delirium even 18 months after discharge.Conclusions: the effect of SARS-CoV-2 at the neuropsychiatric level is manifested as altered mental state, psychosis, depression, anxiety, neurocognitive syndrome, affective disorder, cognitive impairment, dementia, consciousness disorders. Thus, it is suggested that in the presence of risk factors such as critical patients or patients with encephalopathies, contact with persons with the infection should be prevented

Associations between Periodontitis, COVID-19, and Cardiometabolic Complications: Molecular Mechanisms and Clinical Evidence.

Periodontitis is a microbially driven, host-mediated disease that leads to loss of periodontal attachment and resorption of bone. It is associated with the elevation of systemic inflammatory markers and with the presence of systemic comorbidities. Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the majority of patients have mild symptoms, others experience important complications that can lead to death. After the spread of the COVID-19 pandemic, several investigations demonstrating the possible relationship between periodontitis and COVID-19 have been reported. In addition, both periodontal disease and COVID-19 seem to provoke and/or impair several cardiometabolic complications such as cardiovascular disease, type 2 diabetes, metabolic syndrome, dyslipidemia, insulin resistance, obesity, non-alcoholic fatty liver disease, and neurological and neuropsychiatric complications. Therefore, due to the increasing number of investigations focusing on the periodontitis-COVID-19 relationship and considering the severe complications that such an association might cause, this review aims to summarize all existing emerging evidence regarding the link between the periodontitis-COVID-19 axis and consequent cardiometabolic impairments.

Quantitative EEG as a Biomarker in Evaluating Post-Stroke Depression.

Introduction: Post-stroke depression (PSD) has complex pathophysiology determined by various biological and psychological factors. Although it is a long-term complication of stroke, PSD is often underdiagnosed. Given the diagnostic role of quantitative electroencephalography (qEEG) in depression, it was investigated whether a possible marker of PSD could be identified by observing the evolution of the (Delta + Theta)/(Alpha + Beta) Ratio (DTABR), respectively the Delta/Alpha Ratio (DAR) values in post-stroke depressed patients (evaluated through the HADS-D subscale). Methods: The current paper analyzed the data of 57 patients initially selected from a randomized control trial (RCT) that assessed the role of N-Pep 12 in stroke rehabilitation. EEG recordings from the original trial database were analyzed using signal processing techniques, respecting the conditions (eyes open, eyes closed), and several cognitive tasks. Results: We observed two significant associations between the DTABR values and the HADS-D scores of post-stroke depressed patients for each of the two visits (V1 and V2) of the N-Pep 12 trial. We recorded the relationships in the Global (V1 = 30 to 120 days after stroke) and Frontal Extended (V2 = 90 days after stroke) regions during cognitive tasks that trained attention and working memory. For the second visit, the association between the analyzed variables was negative. Conclusions: As both our relationships were described during the cognitive condition, we can state that the neural networks involved in processing attention and working memory might go through a reorganization process one to four months after the stroke onset. After a period longer than six months, the process could localize itself at the level of frontal regions, highlighting a possible divergence between the local frontal dynamics and the subjective well-being of stroke survivors. QEEG parameters linked to stroke progression evolution (like DAR or DTABR) can facilitate the identification of the most common neuropsychiatric complication in stroke survivors.

Explore the influencing factors and construct random forest models of post-stroke depression at 3 months in males and females

BackgroundPost-stroke depression (PSD) is one of the most common neuropsychiatric complications after stroke. The occurrence, development and prognosis of PSD have long been different between males and females. The main purpose of this study was to explore the influencing factors of PSD at 3 months in males and females, and construct random forest (RF) models to rank the influencing factors.MethodsThis is a prospective multicenter cohort study (Registration number: ChiCTR-ROC-17013993). Stroke patients hospitalized in the department of Neurology of three hospitals in Wuhan were enrolled from May 2018 to August 2019. Scale assessments were performed 24 hours after admission and 3 months after stroke onset. Binary logistic regression analysis was used for univariate and multivariate (stepwise backward method) analysis, when p was less than 0.05, the difference between groups was considered statistically significant. Lastly, the RF models were constructed according to the results of multivariate regression analysis.ResultsThis study found that several baseline variables were associated with PSD at 3 months in males and females. RF model ranked them as stroke severity (OR [odds ratio] =1.17, p < 0.001, 95%CI [confidence interval]:1.11–1.24), neuroticism dimension (OR = 1.06, p = 0.002, 95%CI:1.02–1.10), physical exercise (OR = 0.62, p = 0.007, 95%CI:0.44–0.88), sleeping time < 5 h (OR = 1.91, p = 0.006, 95% CI:1.20–3.04) and atrial fibrillation (OR = 4.18, p = 0.012, 95%CI:1.38–12.68) in males. In females, RF model ranked them as psychological resilience (OR = 0.98, p = 0.015, 95%CI:0.96–1.00), ability of daily living (OR = 0.98, p = 0.001, 95%CI:0.97–0.99), neuroticism dimension (OR = 1.11, p = 0.002, 95%CI:1.04–1.18) and subjective support (OR = 1.11, p < 0.001, 95%CI:1.05–1.78).ConclusionThe study found influencing factors of PSD at 3 months were different in males and females, and construct RF models to rank them according to their importance. This suggests that clinicians should focus their interventions on sex-specific influencing factors in order to improve the prognosis of PSD patients.Trial registrationChiCTR-ROC-17013993.

Evaluation of Neuropsychiatric Complications in Hospitalized COVID-19 Patients.

Previous research has shown that COVID-19 patients are at risk of developing mental disorders. Limited number of studies about psychiatric and neuropsychiatric presentations in hospitalized COVID-19 patients is currently available. Subjects were 172 patients diagnosed with COVID-19 and requiring inpatient care, hospitalized at reprofiled clinics of the university hospital. The study aimed to quantify psychiatric symptoms, and determine correlations with agitation, BMI, mortality, and other variables (age, sex, oxygen therapy, intubation, etc.). Mental disorders due to known physiological conditions were of highest prevalence (n=105, 62.9%), followed by anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders (n=34, 20.4%), and dementia (n=21, 12.6%) in COVID-19 patients. Depressive disorders (n=13, 7.9%), alcohol related disorders associated with withdrawal symptoms (n=10, 6%), and schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (n=4, 2.4%) were less common. Patients diagnosed with mental disorders due to known physiological conditions were significantly older compared to patients with other diagnoses. The depression was observed more commonly in patients treated with high-flow nasal oxygen (HFNO), and patients disconnected from invasive mechanical ventilation (IMV). Mixed anxiety-depressive symptoms were observed in 23.8% of the patients (n=41), and they were more prevalent in younger patients compared to patients without anxiety-depressive symptoms. Agitated patients were significantly older than non-agitated patients. No connection was observed between the occurrence of agitation and treatment with HFNO, nor in case of patients disconnected from IMV; however, the relationship between agitation and death proved to be statistically significant (OR = 5.9, 95% CI 2.33-15.29). Analysis of psychiatric and neuropsychiatric presentations in COVID-19 patients and their correlation with multiple variables provides a better understanding of the effect of infection on mental health, and brings forth a necessity of transdisciplinary approach in handling COVID-19 patients.

Development of Post-Stroke Cognitive and Depressive Disturbances: Associations with Neurohumoral Indices.

Neuropsychiatric complications, in particular cognitive and depressive disorders, are common consequences of ischemic stroke (IS) and complicate the rehabilitation, quality of life, and social adaptation of patients. The hypothalamic-pituitary-adrenal (HPA) system, sympathoadrenal medullary system (SAMS), and inflammatory processes are believed to be involved in the pathogenesis of these disorders. This study aimed to explore these systems in IS patients, including those with post-stroke cognitive and depressive disorders, within a year after IS. Indices of the HPA axis, inflammatory system, and SAMS were measured in blood serum (cortisol, interleukin-6 (IL-6)), plasma (adrenocorticotropic hormone), and saliva (cortisol, α-amylase). During one year after mild/moderate IS (NIHSS score 5.9 ± 4.3), serum cortisol and salivary α-amylase levels remained elevated in the total cohort. In the group with further cognitive decline, serum and salivary cortisol levels were elevated during the acute period of IS. In the group with poststroke depressive disorder, salivary α-amylase was constantly elevated, while serum IL-6 was minimal during the acute period. The results suggest prolonged hyperactivation of the HPA axis and SAMS after IS. Specifically, post-stroke cognitive impairment was associated with hyperactivation of the HPA axis during the acute IS period, while post-stroke depressive disorder was associated with the chronic inflammatory process and hyperactivation of SAMS during the follow-up period.

The Utility of Blood Based Biomarkers in Detecting Neurological Complications of COVID‐19 in Critically Ill Patients

AbstractBackgroundNeurological and neuropsychiatric complications have been documented in patients with COVID‐19. This study aims to investigate the utility of two neurological blood‐based biomarkers to predict neurological complications and mortality due to COVID‐19 in the intensive care unit (ICU). Neurofilament light (NF‐L) is a marker of axonal damage and glial fibrillary acidic protein (GFAP) is a marker of astrocytic activation.MethodsPatients with respiratory failure were prospectively enrolled from the ICU at Vancouver General Hospital. COVID‐19 patients were excluded if the diagnosis was an incidental secondary finding upon ICU admission or if their enrollment was &gt;10 days after ICU admission. Control patients were excluded if their enrollment was &gt;4 days after ICU admission or if their primary diagnosis was non‐respiratory. Plasma samples were collected upon admission study enrollment, with additional samples collected on day 7 and day 14 from COVID‐19 patients. Plasma NF‐L and GFAP were quantified using the Quanterix Simoa HD‐X analyzer. Group comparisons were performed using a Mann‐Whitney test. Trajectory analysis was performed using a Wilcoxon test or Friedman one‐way ANOVA. Area under receiver operating curve (AUROC) analysis was calculated to predict neurological complications and mortality during ICU stay.ResultsOf the 242 patients enrolled, 209 were confirmed positive for SARS‐CoV‐2 while 33 served as ICU controls. Median age was 61 years for the COVID‐19 group, 64 years for controls. Upon ICU admission, NF‐L was 32% lower and GFAP was 24% lower in those with COVID‐19 compared to controls after correcting for age. NF‐L concentrations increase by doubling each week of ICU stay, while GFAP remained stable. Over the course of their ICU stay, 16% COVID‐19 patients were diagnosed with a neurological complication and 17% died. Plasma NF‐L and GFAP demonstrated a moderate to strong ability to predict neurological complications (AUROC: NF‐L=0.702; GFAP=0.722) and mortality (AUROC: NF‐L=0.815; GFAP=0.809) during ICU stay.ConclusionsUpon ICU admission, NF‐L and GFAP were lower in patients with COVID‐19 compared to controls. NF‐L, but not GFAP, increased over the course of ICU stay in patients with COVID‐19. Both markers were able to predict neurological complication or ICU mortality with moderate to strong accuracy.

Determinants of post-stroke depression among stroke survivors at University of Gondar Hospital, Northwest Ethiopia: a case-control study

BackgroundStroke is one of the most common causes of disability among adults. Post-stroke depression (PSD) is a frequent neuropsychiatric complication in stroke patients. Despite the increasing prevalence of stroke, there is a paucity of data on PSD and its determinants among stroke survivors in developing countries like Ethiopia. We aim to assess the factors associated with PSD in survivors of stroke.MethodA hospital-based unmatched case-control study was conducted during the period of February to July 2020 at University of Gondar Hospital among stroke survivors. Study subjects were recruited consecutively. Socio-demographic and clinical data were obtained from patients’ interviews and medical record reviews. A diagnosis of PSD was made using the Patient Health Questionnaire (PHQ-9). EpiData version 3.1 was used to enter data, and SPSS version 26 was used to analyze it. Bivariate and multivariate logistic regressions were fitted to identify associated variables. The adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value 0.05 were used to determine the significance of the association.ResultA total of 240 stroke survivors were included in the study (80 cases and 160 controls). The mean age was 60.8 years (SD ± 14.3) with an equal sex distribution. Variables statistically associated with PSD were male gender (AOR = 3.5, 95% CI: 1.64-7.46 C, P-value = 0.001), subcortical location of the largest lesion (AOR = 2.42, 95% CI: 1.06–5.56, p-value = 0.036), severity of the stroke (AOR = 52.34, 95% CI:10.64-256.87, p-value = 0.000), physical disability (AOR = 5.85. 95% CI:1.94–17.65, p-value = 0.002), previous history of stroke or transient ischemic attack (AOR = 5.90, 95% CI:2.04–17.10, p-value = 0.001) and ischemic heart disease (AOR = 9.97, 95% CI:3.4-29.22, p-value = 0.000).ConclusionImportant factors in the occurrence of PSD in this study include prior history of stroke, physical disability, severity of the stroke, subcortical location of the lesion, male gender, and ischemic heart disease. Stroke patients with such factors need routine screening for PSD, particularly in LMICs where there is uncoordinated post-stroke care, a shortage of neurologists and mental health practitioners.

Effects of autoimmune disorders on daily lifestyle

Systemic diseases of connective tissue are a group of diseases of unspecified aetiology and pathogenesis. They are based on the autoimmune process. It can involve single organs as well as whole systems. Neuropsychiatric complications in systemic connective tissue diseases are of interest to both neurologists and rheumatologists and specialists in other fields. These complications may occur with different frequency – from 30-80% and result from the involvement of individual structures of the central and peripheral nervous system. They can be divided into primary, i.e. resulting from the underlying disease, and secondary, which are most often the result of the applied treatment.&#x0D; The most common psychopathological symptoms include: progressive cognitive disorders, emotional lability, mood and sleep disorders, as well as memory disorders, psychosensory disorders, depersonalisation, derealisation, depressed mood, anxiety states, hallucinations, persecutory delusions. Diagnosing the cause of psychiatric disorders is the basis for introducing appropriate causal treatment, which should be supplemented by symptomatic psychiatric therapy.

Psychiatric Outcomes Associated with Chimeric Antigen Receptor T-Cell Therapy: A Systematic Review

Psychiatric outcomes associated with Chimeric Antigen Receptor T-cell therapy: A Systematic Review Simi M. Mathew MD, Nischit Baral MD, Calvin Ghimire MD, Tejaswi Vinjam MD, Joshua Christy MD, Ujwala Koduru MD, ArvindKunadi MD ABSTRACT: Background: Chimeric antigen receptor (CAR) T-cell therapy is a therapeutic breakthrough treatment for selected hematological malignancies. Neuro-psychiatric complications have been reported with CAR-T-cell therapy. However, there is a paucity of data on the psychiatric effects of this therapy. Methods: We conducted a systematic review to highlight the psychiatric side effects of CAR-T-cell therapy. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to report findings. Results Table 1. Studies highlighting the important psychiatric side-effects associated with CAR-T-cell therapy Abbreviations: FACT-Lym: Functional Assessment of Cancer Therapy- Lymphoma; SF-36: 36-Item Short Form Survey; Peds QL: Pediatric Quality of Life Inventory; EQ-5D: European Quality of Life Five Dimensions Questionnaire; ALL: acute lymphocytic leukemia; VAS: visual analog scale. Conclusion: Our findings suggest that cognitive impairment followed by mood symptoms was CAR-T-cell therapy's most common psychiatric side effect. There is a significant decline in the quality of life in these patients. Whether these side effects are due to the targeted therapy or other severe toxicities like cytokine release syndrome and neurotoxicity needs further exploration. Keywords: CAR-T-Cell therapy, Systematic Review, Mood disorders, Psychiatric side-effects Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 11278: Association of Homocysteine and C-Reactive Protein With Post-Stroke Depression: A Meta Analysis and Meta Regression

Introduction: Post-stroke depression (PSD) is a common neuropsychiatric complication of stroke with a high incidence of 31% and that is associated with poor functional outcomes and increased mortality. Its pathophysiology is poorly understood, however, evidence suggests that neuroinflammation in reaction to the stroke could play a role in the development of PSD. Hypothesis: To compare C-reactive protein (CRP), and homocysteine (Hcy) levels in post-stroke patients with and without depression. Methods: We systematically searched all electronic databases from inception until May 30th 2022 comparing baseline CRP and Hcy. Results: A total of 12 studies with 3,154 Patients were included in this analysis. The mean age of the overall cohort was 64.8 years with PSD patients appearing to be older than non-PSD patients (mean 67.3 years vs 63.8 years). In terms of gender distribution, there were more females in the PSD group compared with non-PSD groups (48.9% vs 40.7%). PSD patients were more likely to be widowed (18% vs 7.25%) and had a family history of psychiatric disorder (10.4% vs 4.4%) compared to non-PSD patients. Patients with PSD had higher levels of baseline CRP [SMD 0.86, (95% CI 0.65 to 1.08), p&lt;0.001; I2=87%] and Hcy PSD [SMD 1.12, (95% CI 0.57 to 1.67), p&lt;0.001; I2=96%] compared to patients without PSD. Meta-regression was performed using covariates including age, female gender, hypertension, diabetes mellitus, CAD, NIHSS, widowhood and family history of psychiatric disorder. Diabetes mellitus appeared to be the only significant effect modifier (coefficient 0.23, p=0.01) for the association between baseline CRP and PSD. Conclusions: Elevated baseline levels of CRP and Hcy were significantly higher in patients that developed PSD, suggesting that both could play a role in the pathophysiology of PSD and as a potential biomarker for diagnosing risk of depression

Relationship Between Anxiety/Depression Mood Disorders and Insomnia in Patients with Pain Syndromes in Primary Health Care: A Cohort Study

Introduction: Chronic pain and mental health disorders are common in the general population, prevalence of chronic pain ranges from 2% to 40%, and the prevalence of mental health disorders ranges from 17% to 29%. Chronic pain is associated with irritability, depression, anxiety and sleep problems such as insomnia. However, the appearance of anxiety and depression has been described as a consequence of chronic pain. Aims: To determine the sociodemographic characteristics and the association between pain syndromes and mood disorders in individuals treated in primary care. Materials and methods: A prospective cohort study was undertaken in a primary care medical center for four months with patients whose pain was the reason for consultation. Scales such as DN4, VAS, Beck's criteria, and DSM-V were applied, and the sociodemographic characteristics of these individuals were determined. Results: A total of 132 patients who met the inclusion criteria were recruited. Of these, 81.81% (108) were women, 18.18% were men (24). The mean age for both sexes was 37.9 and the mean duration in hours of each painful episode was 14.35 hours. The proportion of the disorders that was noted were as follows: insomnia in 0.303, anxiety 0.265, depression 0.090. Those who presented with anxiety or depression and another disorder was 0.053. Patients who did not develop any of the diseases of interest in this study 0.185. Discussion: The coexistence and overlap of mood disorders and insomnia in patients suffering from pain syndromes, which have little or no importance when assessing patients in primary health care centers, are under-diagnosed. However, broadening the clinical history, and correctly using diagnostic tools for mood disorders increases their diagnosis rate, ignoring the positive relationship that exists between these disorders. Conclusions: Pain disorders trigger neuropsychiatric complications. Depression, anxiety, and insomnia worsen episodes of pain. However, the correct diagnostic approach and the application of adequate management greatly reduce the complications of these types of disorders.

Relationship Between Anxiety/Depression Mood Disorders and Insomnia in Patients with Pain Syndromes in Primary Health Care: A Cohort Study

Introduction: Chronic pain and mental health disorders are common in the general population, prevalence of chronic pain ranges from 2% to 40%, and the prevalence of mental health disorders ranges from 17% to 29%. Chronic pain is associated with irritability, depression, anxiety and sleep problems such as insomnia. However, the appearance of anxiety and depression has been described as a consequence of chronic pain. Aims: To determine the sociodemographic characteristics and the association between pain syndromes and mood disorders in individuals treated in primary care. Materials and methods: A prospective cohort study was undertaken in a primary care medical center for four months with patients whose pain was the reason for consultation. Scales such as DN4, VAS, Beck's criteria, and DSM-V were applied, and the sociodemographic characteristics of these individuals were determined. Results: A total of 132 patients who met the inclusion criteria were recruited. Of these, 81.81% (108) were women, 18.18% were men (24). The mean age for both sexes was 37.9 and the mean duration in hours of each painful episode was 14.35 hours. The proportion of the disorders that was noted were as follows: insomnia in 0.303, anxiety 0.265, depression 0.090. Those who presented with anxiety or depression and another disorder was 0.053. Patients who did not develop any of the diseases of interest in this study 0.185. Discussion: The coexistence and overlap of mood disorders and insomnia in patients suffering from pain syndromes, which have little or no importance when assessing patients in primary health care centers, are under-diagnosed. However, broadening the clinical history, and correctly using diagnostic tools for mood disorders increases their diagnosis rate, ignoring the positive relationship that exists between these disorders. Conclusions: Pain disorders trigger neuropsychiatric complications. Depression, anxiety, and insomnia worsen episodes of pain. However, the correct diagnostic approach and the application of adequate management greatly reduce the complications of these types of disorders.

Reliability of multi-site UK Biobank MRI brain phenotypes for the assessment of neuropsychiatric complications of SARS-CoV-2 infection: The COVID-CNS travelling heads study.

Magnetic resonance imaging (MRI) of the brain could be a key diagnostic and research tool for understanding the neuropsychiatric complications of COVID-19. For maximum impact, multi-modal MRI protocols will be needed to measure the effects of SARS-CoV-2 infection on the brain by diverse potentially pathogenic mechanisms, and with high reliability across multiple sites and scanner manufacturers. Here we describe the development of such a protocol, based upon the UK Biobank, and its validation with a travelling heads study. A multi-modal brain MRI protocol comprising sequences for T1-weighted MRI, T2-FLAIR, diffusion MRI (dMRI), resting-state functional MRI (fMRI), susceptibility-weighted imaging (swMRI), and arterial spin labelling (ASL), was defined in close approximation to prior UK Biobank (UKB) and C-MORE protocols for Siemens 3T systems. We iteratively defined a comparable set of sequences for General Electric (GE) 3T systems. To assess multi-site feasibility and between-site variability of this protocol, N = 8 healthy participants were each scanned at 4 UK sites: 3 using Siemens PRISMA scanners (Cambridge, Liverpool, Oxford) and 1 using a GE scanner (King's College London). Over 2,000 Imaging Derived Phenotypes (IDPs), measuring both data quality and regional image properties of interest, were automatically estimated by customised UKB image processing pipelines (S2 File). Components of variance and intra-class correlations (ICCs) were estimated for each IDP by linear mixed effects models and benchmarked by comparison to repeated measurements of the same IDPs from UKB participants. Intra-class correlations for many IDPs indicated good-to-excellent between-site reliability. Considering only data from the Siemens sites, between-site reliability generally matched the high levels of test-retest reliability of the same IDPs estimated in repeated, within-site, within-subject scans from UK Biobank. Inclusion of the GE site resulted in good-to-excellent reliability for many IDPs, although there were significant between-site differences in mean and scaling, and reduced ICCs, for some classes of IDP, especially T1 contrast and some dMRI-derived measures. We also identified high reliability of quantitative susceptibility mapping (QSM) IDPs derived from swMRI images, multi-network ICA-based IDPs from resting-state fMRI, and olfactory bulb structure IDPs from T1, T2-FLAIR and dMRI data. These results give confidence that large, multi-site MRI datasets can be collected reliably at different sites across the diverse range of MRI modalities and IDPs that could be mechanistically informative in COVID brain research. We discuss limitations of the study and strategies for further harmonisation of data collected from sites using scanners supplied by different manufacturers. These acquisition and analysis protocols are now in use for MRI assessments of post-COVID patients (N = 700) as part of the ongoing COVID-CNS study.

Post-COVID syndrome? COVID-19 survivors suffer from cognitive difficulties, somatic complaints and anxiety

Aim: Although primarily known as a respiratory system pathology, COVID-19 may cause various systems and cause serious complications including neuropsychiatric problems. These complications may be formulized as post-COVID syndrome. The current study aims to investigate prolonged cognitive, somatic and psychiatric effects of COVID-19. &#x0D; Material and Method: A total number of 120 COVID-19 survivors were compared with 120 health controls in means of three measures, which are Cognitive Failures Questionnaire (CFQ), Body Sensations Questionnaire (BSQ), Hospital Anxiety and Depression Scale (HADS) to assess cognitive difficulties, body perceptions and anxiety/depression. &#x0D; Results: Our findings show that COVID-19 survivors have reported significantly more cognitive difficulties, increased body sensations and higher levels of anxiety. The groups did not differ in means of depression scores. Further, the measures were significantly correlated with each other. &#x0D; Conclusion: This study reveal that COVID-19 survivors suffer from significant cognitive deficits in everyday activities, are significantly more sensitive to various body sensations and have increased anxiety levels. In discordance with the current literature, our findings showed that COVID-19 patients are not more depressed than healthy subjects. In summary, the current study showed that various neuropsychiatric complications may be an important part of prolonged effects of COVID-19.

CRS induces depression-like behavior after MCAO in rats possibly by activating p38 MAPK

Post-stroke depression (PSD) is a common neuropsychiatric complication of stroke, which seriously affects the quality of life and prognosis of patients. Nevertheless, the pathogenesis of PSD remains unclear. In our study, a PSD rat model was established by chronic restraint stress (CRS) combined with middle cerebral artery occlusion (MCAO). Depressive and anxiety-like behaviors were tested, as well as Neuronal loss and Apoptosis. The expression of synapse and p38 MAPK signaling pathway -relevant proteins was detected. Our data indicated that CRS combined with MCAO could induce depression-like and anxiety-like behaviors, which led to neuronal damage, apoptosis, and cellular loss in the left parietal cortex and left hippocampus. Furthermore, CRS combined with MCAO decreased synaptic plasticity in the parietal cortex and left hippocampus. We found that CRS combined with MCAO had activated the p38 MAPK signaling pathway, and decreased the expression of pathway-related proteins MKK6 and MKK3. These results suggested that CRS combined with MCAO could lead to depression-like behavior via neuronal damage, apoptosis and reduced synaptic plasticity, which might be related to the activation of the p38 MAPK pathway. Therefore, it provides novel ideas for the research on the intervention and prevention mechanisms of PSD.