Persistent Mood Disorders Research Articles

Research Progress of Acupuncture in the Treatment of Post-Stroke Depression

Post-stroke depression (PSD) is a prevalent complication in stroke survivors, characterized by persistent mood disorders that hinder rehabilitation and reduce quality of life. This study examines recent scholarly endeavors focusing on acupuncture (AC) as a feasible therapeutic approach for PSD. By analyzing contemporary literature, it elucidates the Traditional Chinese Medicine (TCM) perspective on PSD and evaluates AC's effectiveness. AC stands out as a promising modality of treatment owing to its potency and negligible side effects, with mechanisms including neurotransmitter modulation, neurotrophic factor regulation, neuronal apoptosis inhibition, inflammatory response modulation, and so on. This review offers valuable insights into PSD from a TCM perspective and highlights AC's potential as a therapeutic intervention, contributing to knowledge advancement and informing clinical practice in PSD management.

Sociodemographic and psychosocial risk factors of railway suicide a mixed-methods study combining data of all suicide decedents in the Netherlands with data from a psychosocial autopsy study

BackgroundRailway suicide has profound implications for the victims and their family, and affects train drivers, railway personnel, emergency services and witnesses. To inform a multilevel prevention strategy, more knowledge is required about psychosocial and precipitating risk factors of railway suicide.MethodsData from Statistics Netherlands of all suicides between 2017 and 2021 (n = 9.241) of whom 986 died by railway suicide and interview data from a psychosocial autopsy of railway suicide decedents (n = 39) were integrated. We performed logistic regression analyses to identify sociodemographic predictors of railway suicide compared to other methods of suicide. The Constant Comparative Method was subsequently employed on interview data from the psychosocial autopsy to identify patterns in psychosocial risk factors for railway suicide.ResultsThe strongest predictors of railway suicide compared to other suicide methods were young age (< 30 years old), native Dutch, a high educational level, living in a multi-person household (especially living with parents or in an institution), living in a rural area and a high annual household income of > 150.000 euros. Several subgroups emerged in the psychosocial autopsy interviews, which specifically reflect populations at risk of railway suicide. These subgroups were [1] young adult males with autism spectrum disorder who strived for more autonomy and an independent life, [2] young adult females with persistent suicidal thoughts and behaviours, [3] middle-aged males with a persistent mood disorder who lived with family and who faced stressors proximal to the suicide in personal and professional settings, [4] male out-of-the-blue suicides and [5] persons with psychotic symptoms and a rapid deterioration.Conclusionsbased on our findings we propose and discuss several recommendations to prevent railway suicide. We must continue to invest in a safe railway environment by training personnel and installing barriers. Additionally, we should adopt prevention strategies that align the needs of subgroups at increased risk, including young females who have attempted other methods of suicide and young males with autism spectrum disorder. Future research should determine the cost-effectiveness and feasibility of low-maintenance, automated interventions near crossings and psychiatric facilities.

Factors Regarding Suicide Decline in Japan: A Longitudinal Study on Psychiatric Diagnosis of Serious Suicide Attempters.

The number of suicides in Japan decreased during the period from 2012 through 2019. Because data on factors associated with this decline are limited, we conducted a retrospective longitudinal study of psychiatric diagnoses of serious suicide attempters before 2012 and after 2019. Serious suicide attempters admitted to the critical care medicine (CCM) department of Nippon Medical School Hospital between 2006 and 2017 were included and classified as those before and after the suicide decline in 2012. Chi-square test and residual analysis were used to analyze changes in the proportion of suicide attempters among all patients admitted to CCM and to examine differences in the proportion of psychiatric diagnoses. The proportion of suicide attempters among CCM hospitalized patients decreased overall (χ2 (1) =18.29, p<.01). The proportion of psychiatric diagnoses changed significantly (χ2 (8) =62.21, p<0.001); specifically, it decreased for schizophrenia (residual: -2.28), depressive disorders (residual: -5.39), persistent mood disorders (residual: -3.58), and reaction to stress disorders (residual: -2.73). Depressive disorders decreased and had a large contribution ratio in both sexes. The decrease in the proportion of attempted suicides among patients admitted to CCM was consistent with the decline in suicides in Japan. Analysis by psychiatric diagnosis confirmed a significant decrease in the proportion of suicide attempts associated with depressive disorders, schizophrenia, and reaction to stress disorders, which were the most common disorders associated with attempted suicide. Depressive disorders made the greatest contribution to the reduction in suicide attempts.

Evaluation of the Antidepressant-like Effect of Chronic Administration of Nigella Fixed Oil Versus Fluoxetine in Rats.

Depression is a group of syndromes characterized by notable and persistent mood disorders, and is one of the most prevalent psychiatric disorders, while the existing treatments have an altered risk-benefit balance. The therapeutic properties of Nigella have been confirmed, suggesting the reliance on phytotherapy. The objective of the present paper is to investigate the antidepressive-like effect of Nigella sativa on rats exposed to the Unpredictable Chronic Mild Stress procedure. Wistar rats were used to investigate the antidepressive-like effect. The stress procedure used in this study combined many stressful conditions. After 6 weeks of treatment, behavioral test (forced swim test) was conducted, and histological changes of the hippocampus were examined. Treatment by nigella and fluoxetine significantly reduced the immobilization time. Histopathological analysis showed that control treatments result in more loosely arranged cells, significant apoptotic neurons characterized by an irregular appearance, and pyknotic hyperchromatic. A preservation of the thickness of the pyramid layer was also observed in the groups treated with nigella and fluoxetine, suggesting that nigella could be used as a treatment or an adjuvant preventing depressive-like disorders.

123 Sleep Disorder Is Associated with Neuropsychological Disturbances in Burn Survivals

IntroductionPrior studies explored neuropsychological disorders in the context of burn severity; however, the relationship between occurrence after burn and sleep has not been investigated. This study aims to determine if patients that developed a first-time sleep disorder after burn injury are more likely to develop a psychological or nervous system disorder within 10 years after injury.MethodsWe identified burn patients on the TriNetX database, a federated research network of de-identified patient data. We formed two groups, those with first time sleep disorder diagnosis on or after the incidence of burn injury and those with no first-time sleep disorder diagnosis on or after burn. Groups were propensity matched to evaluate incidence of nervous system and mental disorders and characteristics, defined as bipolar disorder, epilepsy, neuropathy disorders, and 52 other neuropsychological disorders. Diagnoses of nervous system disorder and mental disorder were limited to after the burn injury and within the 10-year time frame. We analyzed data using a z-test with a p < 0.05 considered significant.ResultsWe found 7.83% of patients developed a first-time sleep disorder after burn injury. The population was older (43.9 ± 20.8 vs. 31.7 ± 22.4 yrs), female (51.13% vs. 46.10%), and White (70.02% vs 60.24%) when compared to those without sleep disorders (p< 0.05). Those who experienced a first-time sleep disorder after burn presented a greater risk of developing the mental, central nervous system, and peripheral nervous system disorders when compared to those who did not. Eating disorders, persistent mood disorders, and obsessive-compulsive disorders were 4.54, 95% CI [3.65, 5.65]; 3.84, 95% CI [3.49, 4.22], and 3.94, 95% CI [3.13, 4.97] times higher, respectively, in patients who developed a first-time sleep disorder (p< 0.05). Anxiety-related disorders were also more than 3 times more likely in those who developed a sleep disorder after burn (p< 0.05).Central nervous system disorders were related to sleep disorder post burn. Extrapyramidal and movement disorders were more than 3 times more likely to occur in sleep disorder patients (Extrapyramidal and movement disorder, unspecified 95% CI [2.48, 4.63] and Other extrapyramidal and movement disorders 95% CI [3.17, 3.78]. In regard to peripheral nervous system disturbances, restless leg syndrome was more than 4 times more likely to occur in patients that developed a first time sleep disorder after burn injury 95% CI [3.70, 4.65]. Polyneuropathy was also 2.28 more times likely to occur 95% CI [2.12, 2.47].ConclusionsMental disorders and various central nervous system and peripheral nervous system disturbances are highly associated with identification of sleep disorders after burn. This finding suggests close monitoring for sleep in those who were burned to optimize outcomes.

Activation of liver X receptors prevents emotional and cognitive dysfunction by suppressing microglial M1-polarization and restoring synaptic plasticity in the hippocampus of mice

Depression is a long-lasting and persistent mood disorder in which the regulatory mechanisms of neuroinflammation are thought to play a contributing role to the physiopathology of the condition. Previous studies have shown that liver X receptors (LXRs) can regulate the activation of microglia and neuroinflammation. However, the role of LXRs in depression remains to be fully understood. In this study, we hypothesized that stress impairs the function of LXRs and that the LXRs agonist GW3965 plays a potential anti-depressive role by inhibiting neuroinflammation. The anti-depressive effects of GW3965 were evaluated in both chronic unpredictable mild stress (CUMS) and lipopolysaccharide (LPS) models. The LXRs antagonist GSK2033 was also employed to block LXRs. Behavioural tests were performed to measure depression-like phenotypes and learning abilities. Electrophysiological recordings and Golgi staining were used to measure the plasticity of the dentate gyrus synapse. The expression of synapse and neuroinflammation related proteins were evaluated by Western blotting and immunofluorescence. The activation of LXRs by GW3965 prevented emotional and cognitive deficits induced by either CUMS or LPS. GW3965 prevented the decreased level of LXR-β induced by CUMS. The activation of LXRs significantly improved the impairment of synaptic plasticity, prevented the up-regulation of inflammatory factors and inhibited NF-κB phosphorylation and microglial M1-polarization in both models. The antidepressive-like effects of GW3965 were blocked by GSK2033 in the CUMS and LPS models. Our data suggest that inhibition of the LXRs signalling pathway may be a key driver in the pathogenesis of neuroinflammation during depression and that LXRs agonists have a high potential in the treatment of depression.

Experts See Varied Responses to Pandemic Among Veterans

Experts See Varied Responses to Pandemic Among Veterans

Zingiber officinale Ethanolic Extract Attenuated Reserpine-Induced Depression-Like Condition and Associated Hippocampal Aberrations in Experimental Wistar Rats.

BackgroundRepeated and regimented treatment with reserpine causes depression-like condition characterized by persistent mood disorder, feelings of severe despondency and dejection, thus altering the hippocampal morphology. Our study compared a well-known antidepressant (fluoxetine), with the potential of Zingiber officinale to ameliorate reserpine-induced depression and the associated hippocampal cornu ammonis 1 (CA1) neuronal cell damage.MethodsForty-eight male Wistar rats, weighing 130–160 g, were randomly assigned to 6 groups (n=8), housed in plastic cages under natural light and dark cycles at room temperature with access to feed and water ad libitum. Group-A (control) received distilled water. Group-B and Group-C orally received 400 mg/kg of Zingiber officinale and 10 mg/kg of fluoxetine, respectively, for 7 days, while Group-D intraperitoneally received 0.2 mg/kg of reserpine for 14 days. Group-E and Group-F intraperitoneally received 0.2 mg/kg of reserpine for 14 days followed by 400 mg/kg of Zingiber officinale and 10 mg/kg of fluoxetine respectively for 7 days. All animals were sacrificed by cervical dislocation at the end of experiment, and the brains hippocampi were dissected, excised and processed for various analyses including histology [H&E], histochemistry of GFAP expression by astrocytes and specific gene expressions including p53 gene, glutathione reductase (GSR), glutathione peroxidase and catalase (CAT).ResultsReserpine significantly depleted the expression of P53 and glutathione reductase (GSR) genes while significantly increasing the expression of glutathione peroxidase 1 (GPx-1) gene (P≤0.05). Also, a marked increase in the expression of catalase (CAT) gene was observed. Furthermore, histoarchitecture (photomicrographs) of hippocampus CA1 region showed disruption in the arrangement of pyramidal neurons and alterations in their morphologies when animals were treated with reserpine (Group D). There was also accompanying increased astrocyte densities within the CA1 region following reserpine treatment. These features indicated deleterious effects of reserpine. Both Zingiber officinale and fluoxetine treatments ameliorated these effects.ConclusionThese findings showed structural and molecular alterations associated with reserpine-induced depression. Also, Zingiber officinale was effective to provide ameliorative and protective effects against the neurotoxic effects of reserpine in the hippocampus, making it a potential candidate for treating depression and its associated neurodegenerative diseases.

Bordering on the bipolar: a review of criteria for ICD-11 and DSM-5 persistent mood disorders

SUMMARYThe principal manuals for psychiatric diagnosis have recently been updated (ICD-11 was released in June 2018 and DSM-5 was published in 2013). A common diagnostic quandary is the classification of people with chronic low mood, especially those with repeated self-harm (‘emotionally unstable’ or ‘borderline’ personality disorder). There has been a great interest in use of type II bipolar affective disorder (‘bipolar II disorder’) as a less pejorative diagnostic alternative to ‘personality disorder’, despite the radically different treatment options for these disorders. DSM-5 (but not ICD-11) clearly distinguishes between borderline personality disorder and bipolar II disorder, indicating that intense emotional experiences (such as anger, panic or despair; irritability; anxiety) should persist for only a few hours in people with a personality disorder. Both manuals now use the term ‘borderline personality disorder’ rather than ‘emotionally unstable personality disorder’. The diagnostic criteria for cyclothymic disorder remain confusing.LEARNING OBJECTIVESAfter reading this article you will be able to: •appreciate the key differences in diagnostic classification between persistent mood disorders: bipolar II disorder, borderline personality disorder and dysthymia•be aware of the modest differences between ICD-10, ICD-11 and DSM-5 in diagnostic criteria for these disorders•appreciate that intense emotional experiences need persist for only a few hours to meet criteria for DSM-5 borderline personality disorder and that persistent emotional dysregulation (e.g. irritability, impulsiveness, disinhibition) for a few days meets criteria for DSM-5 bipolar II disorder.

Early identification of recurrent mood disorders in youth: the importance of a developmental approach

Adolescence is an important developmental period characterised by accelerated biological, psychological and sociological development. Adolescence is also the high-risk period for onset of major psychiatric disorders that persist into adulthood....

1533 – A naturalistic study of the diagnostic evolution of schizophrenia

Introduction In the absence of biological measures, diagnostic long-term stability provides the best evidence of diagnostic validity.Therefore,the study of diagnostic stability in naturalistic conditions may reflect clinical validity and utility of current schizophrenia diagnostic criteria. Objectives Describe the diagnostic evolution of schizophrenia in clinical settings. Methods We examined the stability of schizophrenia first diagnoses (n=26,163) in public mental health centers of Madrid (Spain).Probability of maintaining the diagnosis of schizophrenia was calculated considering the cumulative percentage of each diagnosis per month during 48 months after the initial diagnosis of schizophrenia. Results 65% of the subjects kept the diagnosis of schizophrenia in subsequent assessments (Figure 1). Patients who changed (35%) did so in the first 4-8 months. After that time gap the rates of each diagnostic category remained stable. Diagnostic shift from schizophrenia was more commonly toward the following diagnoses: personality disorders (F60), delusional disorders (F22), bipolar disorder (F31), persistent mood disorders (F34), acute and transient psychotic disorders (F23) or schizoaffective disorder (F25). Conclusions Once it is confirmed, clinical assessment repeatedly maintains the diagnosis of schizophrenia.The time lapse for its confirmation agrees with the current diagnostic criteria in DSM-IV. We will discuss the implications of these findings for the categorical versus dimensional debate in the diagnosis of schizophrenia.

Análise comparativa do registro médico-pericial do diagnóstico de transtornos mentais de segurados do Instituto Nacional do Seguro Social requerentes de auxílio-doença

OBJETIVOS: Analisar comparativamente os registros médico-periciais dos diagnósticos de segurados do INSS requerentes de auxílio-doença apresentando transtorno mental. MÉTODO: Estudo retrospectivo de registros de perícias iniciais realizadas em agências da Previdência Social de Juiz de Fora, MG, entre julho/2004 e dezembro/2006. Foram realizadas análises bivariadas de acordo com o local de realização da perícia, categoria de perito médico examinador e período da avaliação RESULTADOS: Transtornos depressivos leves ou moderados e transtornos persistentes do humor (39,6%) e os transtornos de ansiedade (34,5%) - quadros mais leves que não comprometeriam tanto a capacidade laborativa - foram os diagnósticos mais frequentemente registrados. Dentre as comorbidades, transtornos mentais foram mais frequentes (33,6%) que quadros clínicos, especialmente na agência Riachuelo, entre peritos concursados após 2005 e no quarto período estudado. A concordância entre o diagnóstico do benefício atual e o do benefício anterior foi baixa, inferior a 50% na maioria dos casos, mesmo para transtornos mentais graves e com características clínicas mais bem definidas, como as psicoses. A maior taxa de concordância ocorreu com os transtornos por uso de substâncias psicoativas entre peritos credenciados (66,7%). CONCLUSÃO: Este estudo evidencia possíveis falhas no treinamento dos peritos médicos de Juiz de Fora no que se refere ao registro do diagnóstico dos transtornos mentais dos segurados avaliados.

Hypomania with and without Dysphoria: Comparison of comorbidity and clinical characteristics of respondents from a national community sample

Objective To compare rates of comorbidity, treatment utilization, the course of illness, and past year social functioning of Hypomania with and without Dysphoria Hypomania (mixed state). Method The National Epidemiological Survey on Alcohol and Related Conditions (NESARC) was a nationally representative face-to-face survey of 43,093 respondents, aged 18 years and older, conducted in 2001 through 2002. The target population of the survey is the civilian, noninstitutionalized population residing in the United States. Results Dysphoric Hypomania was associated with an increased lifetime risk for major depression, dysthymic disorder, anxiety disorders and personality disorders compared to Non-Dysphoric Hypomania. The former group had an earlier onset age of major depression, more episodes major depression and hypomania, and had a higher rate of treatment contact than the later group. Past year personal income and the frequency of full-time employment were lower in the Dysphoric Hypomania compared to Non-Dysphoric Hypomania. Conclusions Dysphoric Hypomania is a more severe and persistent mood disorder compared to Non-Dysphoric Hypomania.

Monoamine Metabolites Level in CSF is Related to the 5-HTT Gene Polymorphism in Treatment-Resistant Depression

The serotonin (5-hydroxytryptamine) transporter (5-HTT) is considered to affect the pathogenesis of mood disorders. Large number of genetic association studies between 5-HTT functional polymorphisms and vulnerability of mood disorders and therapeutic response to antidepressants has been carried out. We investigated the influence of 5-HTT-linked polymorphic region (5-HTTLPR) and 5-HTT 17 bp variable number of tandem repeat polymorphism (5-HTTVNTR) polymorphisms on concentrations of monoamine metabolites in cerebrospinal fluid (CSF) among treatment-resistant patients with mood disorders. Subjects were 119 Swedish patients with persistent mood disorders and 141 healthy subjects. In 112 of these patients, we measured 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol in CSF. Genotyping for 5-HTT polymorphisms from genomic DNA was carried out by PCR. There was no significant difference in allele/genotype frequency between patients and healthy subjects. In patients with mood disorders, we found significant difference in mean 5-HIAA concentration between 5-HTTLPR genotypes (p=0.03). Although the 5-HIAA concentration showed a tendency to be higher in short (S) carriers than in non-S carriers of the 5-HTTLPR in patients (p=0.06), when considering patients with major depressive disorder (MDD), the 5-HIAA concentration was significantly higher among S carriers than among non-S carriers (p=0.02). Moreover, the 5-HIAA concentration was higher in S/S subjects compared to long (L)/L (p=0.0001) and L/S (p=0.002) subjects in patients with MDD. Similarly, there was higher HVA concentration in S/S subjects compared to L/L (p=0.002) and L/S subjects (p=0.002). There was no effect of 5-HTTVNTR. Our findings show that the 5-HTTLPR polymorphism affects 5-HIAA and HVA concentrations among treatment-resistant patients with mood disorders.

Does Resilience Protect Minorities From Mental Illness?

Does Resilience Protect Minorities From Mental Illness?

Increased incidence of CYP2D6 gene duplication in patients with persistent mood disorders: ultrarapid metabolism of antidepressants as a cause of nonresponse. A pilot study.

Recent studies have revealed that genetic polymorphisms of cytochrome P(450) 2D6 (CYP2D6) are among the factors that determine the interindividual differences in the metabolism and response to antidepressants. We investigated the relationship between persistent mood disorders and the duplication of the CYP2D6 gene, which encodes an enzyme with increased activity. We screened the prevalence of the CYP2D6 genotypes in 108 patients with persistent mood disorders using long polymerase chain reaction (PCR) and the real-time PCR methods. Clinical correlates with the genotypes were also analyzed. Among the 108 patients, 81 had failed to respond to antidepressants shown to be metabolized by CYP2D6. Of those 81, 8 had a CYP2D6 gene duplication (9.9%, 95% confidence interval 3.4-16.4%) which was higher than the 0.8-1.0% incidence previously observed in healthy Nordic Caucasians. The worst week scores of the Hamilton Depression Rating Scale were higher in the patients with the duplication compared with those without the duplication ( P=0.026, student's t-test). These results suggest that the CYP2D6 gene duplication is a possible factor that influences the development of persistence in patients with mood disorders probably by ultrarapid drug metabolism.

Major mental disorders in Addis Ababa, Ethiopia. II. Affective disorders.

This report examines the prevalence and socio-demographic correlates of affective disorders based on a survey conducted in Addis Ababa between September and December of 1994. An Amharic version of the CIDI was used to collect data from a random community sample of 1420 individuals aged 15 and above. The lifetime prevalence for specific affective disorders was as follows: bipolar disorders 0.3%, depressive episodes 2.7%, recurrent depressive episodes 0.2%, and persistent mood disorders 1.6%. The weighted lifetime prevalence of affective disorders was 5.0% (women 7.7% and men 3.2%). One-month prevalence was 3.8% (women 5.9% and men 2.3%). After adjusting for several potential confounders, the risk of affective disorders was only 29% higher in women compared to men. This difference in risk was not statistically significant. Age was also not associated with risk of affective disorders. On the other hand, education was associated with the risk of disorder, the risk decreasing with increasing educational attainment. This inverse trend was statistically significant (P for trend = 0.02). The risk was also 37% lower in the employed than the unemployed: Odds Ratio (OR), 95% confidence interval (95% CI) = 0.63 (0.39, 1.01). There were no statistically significant associations between affective disorders and marital status or ethnicity.

Sleep disorders in the elderly: Depression and post-traumatic stress disorder

We report on two studies of sleep in the elderly. (1) One hundred and ninety-eight Spanish outpatients aged over 65 who met ICD-10 criteria for either a depressive episode, a recurrent, or a persistent mood disorder were compared with a matched population of depressives aged under 55. Factorial analysis and multiple regression showed that sleep complaints in the older group correlated less with severity of depression and had a less stable response to pharmacological treatment. (2) Post-traumatic stress disorder (PTSD) symptoms and sleep complaints were studied in 817 World War II veterans from Alsace-Lorraine who had been forcibly drafted into the Wehrmacht and subsequently detained as prisoners of war in Russia. The diagnosis of PTSD was associated with more severe wartime stressors and long internment. Eighty percent of respondants still report recurrent distressing dreams of wartime or captivity events after over 45 years. We analyzed sleep complaints in two elderly populations. Part one describes a Spanish study which compared the nosological significance and treatment response of sleep complaints in depressives aged over 65 or under 55. In part two, we study sleep complaints in former Alsatian prisoners of war (POWs) and analyze the influence of previous stressors and the aging process.

One-year outcomes of depressive disorders in child psychiatric in-patients: evaluation of the prognostic power of a brief measure of expressed emotion.

The association between 1-year post-hospitalization outcome and the brief Five Minute Speech Sample (FMSS) measure of expressed emotion (EE) was examined among children with depressive disorders. Results indicated a strong association between 1-year outcome and the FMSS-EE measure. Whereas children returning to high EE homes were likely to show persistent mood disorder, recovery was more common among children returning to low EE homes. This predictive relationship was independent of possible mediating variables such as treatment regimen and clinical characteristics. Results provide the first reported demonstration that (1) the brief FMSS-EE measure predicts clinical outcome, and (2) EE measures predict 1-year outcome for children with depressive disorders.

Dealing with persisting abnormalities of mood

A significant minority (between 12-20%) of patients with affective disorder suffer from persisting abnormalities of mood. Individuals with these disorders represent a heterogeneous group spanning the neuroses and the psychoses. This review outlines our current knowledge of the aetiology and classification of persistent mood disorders. The most prevalent persistent abnormality in bipolar patients is rapid cycling disorder, whilst those with unipolar illnesses are more likely to suffer from chronic depression. The management of these two problems is discussed in detail. Although these patients fall into the ‘difficult to treat’ category, recent research suggests that multimodal treatment including optimal pharmacotherapy and appropriate psychosocial interventions can lead to significant improvement in at least 50% of cases.