Pure Depression Research Articles

The Prevalence of Anxiety and Depression in Children With Postural Orthostatic Tachycardia Syndrome (POTS): A Retrospective Study.

Postural orthostatic tachycardia syndrome (POTS) is a chronic form of orthostatic intolerance characterized by various symptoms such as dizziness, lightheadedness, and increased heart rate. Conflicting reports exist regarding the prevalence of anxiety and depression in adults with POTS, while data on pediatric POTS remains scarce. A retrospective analysis of pediatric patients aged 11-17 years with POTS, who underwent autonomic testing at Nemours Children's Hospital in Orlando, Florida, was conducted. The patients were screened for anxiety, using the Severity Measure for Generalized Anxiety Disorder-Child Age 11-17 years (GAD-7) questionnaire, and depression, using PHQ-9 Modified for Adolescence (PHQ-A) for depression. The prevalence rates of anxiety and depression in the study cohort were compared to historical data from similar age groups in the existing literature. The study was approved by the Nemours Children's Hospital Institutional Review Board. The cohort comprised 27 children with POTS (26 females, age 15.8±1.6 years). Overall, 74% exhibited moderate-to-severe anxiety, depression, or both, with 44% having comorbid anxiety and depression. In total, 4/27 (14%) had pure depression and 4/27 (14%) had pure anxiety. Six patients had no depression or anxiety. On average, POTS symptoms began 1.9±1.3 years before diagnosis. Eleven patients took stable doses of psychotropic medications. After a follow-up period of 5.1±1.7 months of POTS therapy, seven patients had follow-up questionnaires. In 4/7 patients, the depression severity improved, and in 3/7 patients, the anxiety severity improved. Patients were not actively treated for depression and anxiety during this time. Anxiety and depression are prevalent among pediatric patients with POTS. While preliminary data suggests POTS therapy may alleviate these psychological symptoms, further longitudinal studies are warranted to explore the therapeutic impact in greater detail.

Elevated Level of Small Extracellular Vesicles in the Serum of Patients with Depression, Epilepsy and Epilepsy with Depression

Small extracellular vesicles (sEVs) properties and sEVs composition are far from being well-studied for now, especially in the context of mental disorders. To elucidate the role of sEVs in disease we performed a quantitative analysis of the blood sEV in patients with focal epilepsy and patients with focal epilepsy with depression, psychogenic non-epileptic seizures with depression, pure depression, and bipolar affective disorder with the current depressive episode (cDE). Small EVs were isolated from the serum by gel filtration or PEG precipitation, and both methods showed very similar results. Subsequently, we precipitated neuronal sEVs and quantified it with several methods. Activity of lysosomal enzymes was determined in the sEVs fraction. The concentration of the blood sEVs in patients with depression, focal epilepsy, or depression with focal epilepsy was higher than in healthy controls. No difference was found between patients and controls in terms of neuronal sEVs concentration. Another finding of our work is that sEVs in the serum of patients contains various lysosomal enzymes. We suppose that the concentration of the blood sEVs in patients with depression or epilepsy is higher due to the sEVs secretion by the immune cells. Finding sEVs in the blood of patients with depression and focal epilepsy grants validity for future attempts to use sEVs as diagnostic tools for these disorders.

LONG WAVES FORCED BY SYMMETRIC AND ASYMMETRIC WAVE GROUPS

Two solutions have been proposed for forced waves by wave groups. Two interpretations are proposed by Longuet-Higgins and Stewart (1962), LHS1962, and Mei (1989) for steady groups. These indicate a forced wave oscillating either around or solely below the mean water level for the short waves, respectively. The existence of forced waves as either pure depressions or as oscillations about the still water level has significant implications in terms of shoaling behaviour and the generation of free long waves. With a bound wave with both positive and negative components then shoaling (an increase in amplitude in shallower water) does not necessarily require radiation of free waves to ensure continuity of volume, but with a bound wave of pure depression, then an increase in amplitude of that depression requires radiation of free waves to ensure continuity (Nagase and Mizuguchi, 1996, Nielsen and Baldock, 2010). Radiation of those free waves then changes the shape of the total infragravity wave during shoaling and may also influence the commonly observed lag between incident bound waves and the incoming short-wave envelope. Here, we show that pure long wave depression can be generated by Gaussian wave groups, and that asymmetric forced long waves, with a leading crest and following depression, are generated by triangular / Gaussian groups.

Comparison of the results of the synthesis of Schatzker II and III tibial plateau fractures by screwing versus plate.

Lateral tibial plateau fractures with depression are the most common. Their treatment is currently surgical. Many therapeutic procedures have been described. Our aim is to evaluate the results of open surgery and to compare the two internal fixation methods used: lag screw versus plates. This is a retrospective comparative study of two series of tibial plateau fractures Schatzker types II and III treated surgically over a period of tenyears with two different methods: Group A: Internal fixation using screws for 86 patients. Group B: Internal fixation using plates for 71 patients. Functional and anatomical results were assessed according to Rasmussen's clinical and radiological scores. The patients' average age was 44years (range from 18 to 76). The male gender was predominant (104 males and 53 females). Road traffic accidents were the most common aetiology with over two thirds of the cases. The fractures were type Schatzker II in 61% of the cases. The mean follow-up was fiveyears. Although the clinical and radiological Rasmussen scores were better in group A (internal fixation with lag screws), those differences were statistically insignificant (p = 0.6 and p = 0.8). Group A clinical and radiological scores were 26.06 and 16.57, respectively and those of group B were 25.72 and 16.45. We noticed more sepsis and skin complications and a longer operating time (95min versus 70min) in group B patients with a statistically significant difference. None of the patients of our series had bone grafting. For Schatzker II and III fractures, an internal fixation with lag screws would be preferable when possible especially in the case of a pure depression fracture. It yields satisfactory results with a shorter operating time and less complication rate.

Mixed Features in Bipolar Disorder: assessing symptoms profiles and their relation with DSM-5 criteria

IntroductionMixed states, the co-occurrence of manic and depressive symptoms, were recognized and described from the time of antiquity. DSM-5 first, and DSM-5-TR after, introduced the ‘’mixed features’’ specifier, defined by the presence of at least three non-overlapping opposite-pole symptoms during a syndromic depressive, hypomanic, or manic episode. Various manifestations, including irritability, distractibility, anxiety, psychomotor agitation, were excluded from the specifier, since they can occur during both depressive and hypo/manic episodes and other mental illnesses.ObjectivesThe objective of this study was to evaluate the phenomenology and prevalence of mixed states among bipolar disorder (BD) patients. We first assessed the frequency of specific features during different mood states. Then, we estimated the prevalence of mixed states by applying DSM-5 criteria, comparing it qualitatively with the one detected from psychometric questionnaires.MethodsIn a naturalistic study, 903 adult outpatients with BD participating in the Stanley Foundation Bipolar Network were followed longitudinally across 14,213 visits for 7 years. The scores at the Inventory of Depressive Symptomatology–Clinician-Rated Version (IDS-C) and at the Young Mania Rating Scale (YMRS), administered at each visit, were used to define the mood episode and to assess the frequency of specific symptoms. In addition, we applied DSM-5 criteria for “with mixed features” to our sample, to examine a DSM-5-based construct.ResultsSpecific symptomatic profiles differentiate mixed states from pure ones (Figure 1 and 2). Mainly, a higher prevalence of irritability was found during mixed episodes, both depressive and hypo/manic, compared to pure depression (0.60 vs. 1.20, p < 0,001) and hypo/mania (0.82 vs. 1.54, p < 0,001), as reported at the 6th item of IDS-C.Figure 1. Individual YMRS items scores in visits with pure depression, mixed depression, pure hypo/mania and mixed hypo/mania.Figure 2. Individual IDS-C items scores in visits with pure depression, mixed depression, pure hypo/mania and mixed hypo/mania.Image:Image 2:ConclusionsPreliminary results of the present study showed that symptoms like irritability are strongly prevalent during mixed states. Moreover, the DSM-5 diagnostic criteria for “with mixed features” specifier for any of the mood episodes detected lower rates of mixed states, hence this criteria may yield inadequate sensitivity in recognizing patients suffering from such conditions.Disclosure of InterestNone Declared

Worry and rumination enhance a positive emotional contrast based on the framework of the Contrast Avoidance Model

The Contrast Avoidance Model (CAM) suggests that worry increases negative affect and decreases positive affect. CAM also suggests that in response to a positive event, higher worry enhances the probability of experiencing greater decreased negative affect and increased positive affect (positive emotional contrasts; PECs). Consequently, worrying may be reinforced by repeated PECs. However, no study has tested whether rumination enhances PECs. Also, emotional specificity in these processes has not been considered. Therefore, we tested whether both rumination and worry enhanced PECs related to specific emotions. After resting baseline, participants with pure generalized anxiety disorder (GAD group, n = 91), pure depression symptoms (depression group, n = 91), and non-GAD and non-depressed healthy controls (HCs, n = 93) engaged with randomly assigned induction tasks (either worry, rumination, or relaxation), and then watched an amusement video. Regardless of group, both worry and rumination increased sadness and fear and decreased amusement more than relaxation from baseline. However, worry increased fear more than rumination, and rumination increased sadness more than worry. Although all inductions led to PECs during the video, worry enhanced fear PECs more than rumination, and rumination enhanced sadness PECs more than worry. The GAD group who worried experienced the most salient PECs of amusement relative to other groups.

Dorsolateral Prefrontal Activation in Emotional Autobiographical Task in Depressed and Anxious College Students: An fNIRS Study.

The dorsolateral prefrontal cortex (dlPFC) is strongly associated with mood symptoms. This study used functional near-infrared spectroscopy (fNIRS) technology to explore the features of brain neural activity in the dlPFC of anxious and depressed college students, during an emotional autobiographical memory task, and to understand the differences in brain cognitive mechanisms caused by anxiety and depression. A simple random sampling method was used to test 440 college students at a university with a healthy control group (HC, 220 participants), a pure depression group (PD, 92 participants), and a pure anxiety group (PA, 128 participants). The average oxyhemoglobin in the dlPFC of the subjects during the emotional autobiographical memory task was collected by a 53-channel functional near-infrared spectroscopy imaging device. The activation of the left dlPFC (ch13) in the pure depression group was significantly higher than in the pure anxiety group. The activation of the right dlPFC (ch48) was significantly higher under positive emotions than under negative emotions. The interaction between emotion valence and group was marginally significant, and the activation of the right dlPFC (ch41) in the pure depression group was significantly higher under positive emotion than in negative emotion. The activation of the pure depression group under positive emotions was significantly higher than that of the pure anxiety group. In comparison, the activation of the pure depression group under negative emotions was significantly lower than that of the healthy control group. The results of correlation analysis showed that the activation of the left dlPFC (ch13) was significantly negatively correlated with anxiety in positive emotions, but the activation of the right dlPFC (ch34, ch42) was significantly positively correlated with anxiety in positive and negative emotions. The right dlPFC was insensitive to positive emotions in college students with high-anxiety symptoms, whereas this region was insensitive to negative emotions in college students with high depressive symptoms, which might be one of the critical differences in the cognitive mechanisms of anxiety and depression. Furthermore, left and right dlPFC activation correlated differently with anxiety. The higher the anxiety level, the lower the activation on the left side, and the higher the activation on the right side. The results suggested that anxiety might reduce the function of the left dlPFC.

Classification and morphology of hyperextension tibial plateau fracture.

This study was aimed at analyzing the incidence and characteristics of hyperextension tibial plateau fractures (HTPFs) by using a computed tomography (CT)-based "four-column and nine-segment" classification. In the coronal plane, HTPFs are divided into four types: pure hyperextension, hyperextension-varus, hyperextension-valgus, and hyperextension-bicondylar. Fractures in the sagittal plane were divided into three types: type 1, pure depression; type 2, cleavage extending to the posterior cortex with no displacement; and type 3, cleavage extending to the posterior cortex with a significant displacement. A retrospective analysis of CT images of the tibial plateau fractures from December 2007 to December 2021 was conducted. Fracture mapping was analyzed and drawn using the new classification system. A total of 136 (10.9%, 136/1253) fractures fulfilled the radiographic criteria for HTPF pattern in 136 knees (53.5 ± 13.3years). There were 11 knees with pure hyperextension fracture (8.1%), 23 with hyperextension-varus fracture (16.9%), 46 with hyperextension-valgus fracture (33.8%), and 56 with hyperextension-bicondylar fracture (41.2%) in the coronal plane. Furthermore, there were 64 (47.1%), 47 (34.6%), and 25 (18.4%) cases of type 1, type 2, and type 3 fractures, respectively, in the sagittal plane. In the three-dimensional heat map, the fracture lines were mainly located at the anterior rim of the tibial plateau, while the posterior articular surface was rarely involved. The main manifestations of HTPF are anterior compression and posterior avulsion injury. The CT-based four-column and nine-segment classification system could be used to categorize the injury characteristics of HTPF in the coronal and sagittal planes.

An anterolateral approach for the flexion-valgus type unicondylar tibial plateau depression fracture pattern a technical note

ObjectiveThe approach to pure depression fractures (PDF) of the posterolateral tibial plateau (PTP) is classically a posterior approach via a metaphyseal osteotomy window with elevation of the depressed articular fragment. Other posterolateral approaches have been described but have been criticized for affecting reduction quality, and risks to the common peroneal nerve. MethodsIn this case series, we describe a standard anterolateral approach with a window osteotomy through the metaphysis. Elevation of the PTP fracture is done through the osteotomy site. ResultsThe standard anterolateral approach avoids limitations of posterior or posterolateral approaches. Adequate reduction and good fixation of PDF of the PTP is attained. ConclusionThe anterolateral approach with osteotomy of the lateral condyle is reproducible and familiar. This avoids the need for a fibula osteotomy and the risks of neurovascular injury, while allowing adequate visualisation and fracture reduction. Level of evidenceIV.

Avoidance of negative emotional contrast from worry and rumination: An application of the Contrast Avoidance Model

According to the Contrast Avoidance model (CAM), worry causes increased and sustained negative affect and such negative affect enables avoidance of a future sharp increase in negative emotion. However, only pathological worriers (vs. controls) view worry as a positive coping strategy to avoid a negative emotional contrast (NEC). We examined if rumination, which is another type of repetitive negative thought, would function similarly. Individuals with self-reported symptoms of pure generalized anxiety disorder (GAD; n = 90), pure depression (MDD; n = 85), and non-anxious/non-depressed controls (HC; n = 93) were randomly assigned to conditions where they were asked to worry, ruminate, or relax. Emotional and physiological changes were measured during worry and subsequent exposure to fearful and sad videos. We also assessed participant group differences in preference for worry or rumination as a strategy to cope with negative affect during the negative emotional video exposures. Consistent with CAM, regardless of the group, both worry and rumination enabled avoidance of NEC. Whereas worry led to greater avoidance of a fear contrast, rumination led to greater avoidance of a sadness contrast. On the other hand, relaxation enhanced NEC. Skin conductance also indicated patterns in line with CAM. In the subjectively perceived preference, the GAD group reported a greater preference for worry in coping with a fear contrast than HC. However, such a salient pattern was not found for the MDD group. Treatment implications of these findings are discussed.

Brain functional alterations in MDD patients with somatic symptoms: A resting-state fMRI study

ObjectiveIt has been established that major depressive disorder (MDD) is accompanied by various somatic symptoms that are related to the clinical course and severity of depression. However, the mechanisms of somatic symptoms in MDD have rarely been studied. In this study, we sought to investigate the functional neurological changes in MDD patients with somatic symptoms based off the regional homogeneity (ReHo) and the amplitude of low-frequency fluctuation (ALFF). MethodStudy participants included 74 first-episode, drug naïve MDD patients as well as 70 healthy subjects (HCs). Patients diagnosed with MDD were separated into two groups based on the presence (n=50) or absence (n=24) of somatic symptoms. Functional images were obtained and analyzed. Alterations in ReHo/ALFF and the severity of clinical symptoms were investigated using correlation analysis. ResultsMore severe depressive symptoms were observed in the somatic depression group than that of the pure depression group (P< 0.001). Furthermore, there was a significant reduction in ReHo and ALFF in the bilateral precentral gyrus, bilateral postcentral gyrus, and left paracentral gyrus in the somatic MDD group as compared to the pure depression group (GRF correction, voxel-P< 0.001, cluster-P < 0.01). Pearson correlation analysis revealed a negative correlation between ReHo and ALFF values in these abnomal regions with the severity of somatic and depressive symptoms (P< 0.01). ConclusionSomatic depression is more severe than pure depression. The ReHo and ALFF changes in the precentral gyrus, postcentral gyrus, and paracentral gyrus may serve a significant role in the pathophysiology of somatic symptoms in MDD.

Common and specific determinants of 9-year depression and anxiety course-trajectories: A machine-learning investigation in the Netherlands Study of Depression and Anxiety (NESDA).

Background: Given the strong relationship between depression and anxiety, there is an urge to investigate their shared and specific long-term course determinants. The current study aimed to identify and compare the main determinants of the 9-year trajectories of combined and pure depression and anxiety symptom severity.Methods: Respondents with a 6-month depression and/or anxiety diagnosis (n=1,701) provided baseline data on 152 sociodemographic, clinical and biological variables. Depression and anxiety symptom severity assessed at baseline, 2-, 4-, 6- and 9-year follow-up, were used to identify data-driven course-trajectory subgroups for general psychological distress, pure depression, and pure anxiety severity scores. For each outcome (class-probability), a Superlearner (SL) algorithm identified an optimally weighted (minimum mean squared error) combination of machine-learning prediction algorithms. For each outcome, the top determinants in the SL were identified by determining variable-importance and correlations between each SL-predicted and observed outcome (ρpred) were calculated.Results: Low to high prediction correlations (ρpred: 0.41-0.91, median=0.73) were found. In the SL, important determinants of psychological distress were age, young age of onset, respiratory rate, participation disability, somatic disease, low income, minor depressive disorder and mastery score. For course of pure depression and anxiety symptom severity, similar determinants were found. Specific determinants of pure depression included several types of healthcare-use, and of pure-anxiety course included somatic arousal and psychological distress.Limitations: Limited sample size for machine learning.Conclusions: The determinants of depression- and anxiety-severity course are mostly shared. Domain-specific exceptions are healthcare use for depression and somatic arousal and distress for anxiety-severity course.

Arthroscopy-Assisted Management of Schatzker Type III Lateral Tibial Plateau Fracture With Interference Screw Fixation

Tibial plateau fractures occur in both old and young patients and may be caused by low-energy trauma, as well as high-energy trauma. Owing to the variety of injury mechanisms and fracture patterns, tibial plateau fractures are very challenging to treat. One of the most demanding fractures is the type III fracture according to the Schatzker classification, which is a pure depression of the lateral tibial plateau. Treatment with open surgical procedures is associated with vast soft-tissue trauma and prolonged recovery after surgery. Although soft-tissue trauma is minimized and visual control is improved throughout arthroscopy-assisted surgical procedures, internal fixation using buttress plates or lag screws is still required to reduce and fix the depressed plateau. We present an arthroscopy-assisted technique of reduction and fixation of the lateral tibial plateau fracture with 3 BioComposite interference screws (Arthrex, Munich, Germany) that provides a high amount of stability and reduces patient immobilization, allowing for faster rehabilitation.

Posterolateral Tibial Plateau Depression Fracture Reduction and Fixation: A Novel Approach

Introduction: Reduction and fixation of pure depression fractures of the posterolateral tibial plateau are technically challenging. Surgical approach and exposure are complicated by the presence of the fibular head and important ligamentous, and neurovascular structures. Current lateral-based plate options may also leave the elevated articular surface unsupported and risk subsequent collapse. Materials and Methods: We present a case of a 37-year-old female rugby player with acute isolated posterolateral tibial plateau depression fracture. We utilized a novel surgical strategy that included a standard anterolateral approach, indirect reduction of the depressed articular surface using a targeted lateral tibial plateau osteotomy, and fixation with anterolateral periarticular and 1/3 tubular plate used in “blade” manner. The reduction was confirmed by fluoroscopy and arthroscopy. Fixation was augmented by femoral strut allograft to fill subsequent defect. Results: Postoperative progress was uncomplicated. At a 3-month review, the fracture was united and the patient had a full range of knee motion and function. Conclusions: This article presents a technique for reduction and stabilization of posterolateral articular impaction fractures while minimizing potential neurovascular and soft tissue complications.

Patients With Refractory Bipolar Depression May Benefit From ECT

Patients With Refractory Bipolar Depression May Benefit From ECT

Posterolateral Fractures of the Tibial Plateau Revisited: A Simplified Treatment Algorithm.

High-energy fractures of the proximal tibia with extensive fragmentation of the posterolateral (PL) quadrant of the tibial plateau are challenging to manage. Herein, we present a review of the literature on the patterns and options of approach and fixation of the PL fragment of the tibial plateau to optimize the treatment of this specific injury pattern. We searched PubMed (1980-May 2020) to identify and summarize the most relevant articles evaluating both the morphology and treatment recommendations, including the choice of approach and fixation strategy, for the PL tibial plateau fracture. We found PL fragment can present in several patterns as a pure split, split depression, contained pure depression, and noncontained depression (rim crush), which are mostly determined by the position of the knee and the force magnitude applied during the course of the accident. Based on previous concepts described by Schatzker and Kfuri, we suggest a simplified treatment algorithm highlighting the two concepts (buttressing and containment) used for plating the PL tibial plateau fragments. Based on the available current evidence, we propose an algorithm for these two morphological types of PL tibial plateau fracture. Shear-type fractures need buttressing (the "rule of thumb"), whereas noncontained peripheral rim-type fractures need peripheral repair and containment. Contained pure depression fractures are not frequent and need percutaneous-assisted elevation and subchondral rafting, either controlled by fluoroscopy or arthroscopically. It is believed that such an approach would simplify their assessment and preoperative planning and would assist the clinicians to appreciate and manage more consistently these complex injuries.

Subtypes of Late-Life Depression: A Data-Driven Approach on Cognitive Domains and Physical Frailty.

With increasing age, symptoms of depression may increasingly overlap with age-related physical frailty and cognitive decline. We aim to identify late-life-related subtypes of depression based on measures of depressive symptom dimensions, cognitive performance, and physical frailty. A clinical cohort study of 375 depressed older patients with a DSM-IV depressive disorder (acronym NESDO). A latent profile analysis was applied on the three subscales of the Inventory of Depressive Symptomatology, as well as performance in five cognitive domains and two proxies for physical frailty. For each class, we investigated remission, dropout, and mortality at 2-year follow-up as well as change over time of depressive symptom severity, cognitive performance, and physical frailty. A latent profile analysis model with five classes best described the data, yielding two subgroups suffering from pure depression ("mild" and "severe" depression, 55% of all patients) and three subgroups characterized by a specific profile of cognitive and physical frailty features, labeled as "amnestic depression," "frail-depressed, physically dominated," and "frail-depressed, cognitively dominated." The prospective analyses showed that patients in the subgroup of "mild depression" and "amnestic depression" had the highest remission rates, whereas patients in both frail-depressed subgroups had the highest mortality rates. Late-life depression can be subtyped by specific combinations of age-related clinical features, which seems to have prospective relevance. Subtyping according to the cognitive profile and physical frailty may be relevant for studies examining underlying disease processes as well as to stratify treatment studies on the effectiveness of antidepressants, psychotherapy, and augmentation with geriatric rehabilitation.

High Prevalence of Metabolic Syndrome Among Adolescents and Young Adults With Bipolar Disorder

Despite abundant literature demonstrating increased metabolic syndrome (MetS) prevalence and important clinical correlates of MetS among middle-age adults with bipolar disorder, little is known about this topic among adolescents and young adults early in their course of bipolar disorder. We therefore examined this topic in the Course and Outcome of Bipolar Youth (COBY) study. A cross-sectional, retrospective study was conducted of 162 adolescents and young adults (mean ± SD age = 20.8 ± 3.7 years; range, 13.6-28.3 years) with bipolar disorder (I, II, or not otherwise specified, based on DSM-IV) enrolled in COBY between 2000 and 2006. MetS measures (blood pressure, glucose, high-density lipoprotein cholesterol [HDL-C], triglycerides, and waist circumference), defined using the International Diabetes Federation criteria, were obtained at a single timepoint. Mood, comorbidity, and treatment over the 6 months preceding the MetS assessment were evaluated using the Longitudinal Interval Follow-Up Evaluation. The prevalence of MetS in the sample was 19.8% (32/162). Low HDL-C (56.5%) and abdominal obesity (46.9%) were the most common MetS criteria. MetS was nominally associated with lower lifetime global functioning at COBY intake (odds ratio [OR] = 0.97, P = .06). MetS was significantly associated with percentage of weeks in full-threshold pure depression (OR = 1.07, P = .02) and percentage of weeks receiving antidepressant medications (OR = 1.06, P = .001) in the preceding 6 months. MetS was not associated with manic symptoms or medications other than antidepressants. The prevalence of MetS in this sample was at least double compared to the general population. Moreover, MetS is associated with increased burden of depression symptoms in this group. Management of early-onset bipolar disorder should integrate strategies focused on modifying MetS risk factors.

Brain structural abnormalities in emotional regulation and sensory processing regions associated with anxious depression

BackgroundConsiderable patients with major depressive disorder (MDD) comorbid with anxious symptoms, referred as anxious depression. The neural structural basis of this MDD specifier remains largely unknown. Methods104 patients with anxious depression, 57 MDD patients without significant anxious symptoms, and 160 healthy controls from single research center participated in the study with age and sex well-matched. We investigated gray matter alterations in anxious and non-anxious depression, explored different brain alterations between these two patient groups, and possible relationships between brain structural parameter and clinical information in patients. ResultsGray matter volumes differed in the right inferior frontal gyrus, right orbital frontal gyrus, left postcentral gyrus, bilateral culmen and left cuneus among the three groups. Anxious depression had smaller gray matter volumes in the right inferior frontal gyrus and orbital frontal gyrus relative to both non-anxious depression and healthy controls. Patients with anxious depression presented larger gray matter volumes in the left postcentral gyrus than non-anxious depression, and larger gray matter volumes in the left cuneus than healthy controls. In addition, both patient groups showed larger gray matter volumes in bilateral culmen relative to healthy controls. Gray matter volumes in the left postcentral gyrus were positively associated with overall depression severity and anxiety factor scores in anxious depression. ConclusionOur study revealed brain structural abnormalities in emotional regulation and sensory processing regions of anxious depression, which may suggested distinct neurobiological mechanisms of this MDD specifier and could help explain different clinical manifestations in anxious depression from pure depression.

Mixed states and suicidal behavior: a systematic review.

The objective of this study was to identify whether mixed states in bipolar disorder (BD) are associated with more frequent suicidal behavior when compared to manic/hypomanic and depressive episodes. We performed a systematic search of the scientific literature on the subject using the PubMed, ISI Web Of Science, PsycINFO and SciELO databases. The terms chosen for the search were (bipolar) AND (suicid*) AND (mixed). We selected original studies comparing suicidal behavior of patients in mixed states and suicidal behavior of patients in other BD phases. Sixteen papers fit the selection criteria. Twelve of the original 16 studies compared suicidal behavior in mixed states and pure mania, and the majority of these studies (n = 11) revealed that suicidal behavior was more frequent among individuals in mixed states. Five of the papers compared suicidal behavior between depressive and mixed phases of BD. One of these five papers reported more severe suicidal behavior in patients in mixed states and another described more frequent suicidal behavior in patients with pure depression. There were no significant statistical differences between groups in the remaining three of these five studies. During acute BD episodes, suicidal behavior is more strongly associated with mixed states than with pure mania or hypomania. However, it was not possible to demonstrate that the association between suicidal behavior and mixed states is stronger than the association between suicidal behavior and depressive phases. The results hereby presented are worth considering in clinical practice to better evaluate suicide risk and to prevent suicide.