Severe Affective Disorders Research Articles

Topographical anatomy of the subthalamic region with special interest in the human medial forebrain bundle.

The medial forebrain bundle (MFB) is a novel promising deep brain stimulation (DBS) target in severe affective disorders that courses through the subthalamic region according to tractography studies. Its potential therapeutic role arose in connection with the development of hypomania during stimulation of the subthalamic nucleus (STN) in Parkinson's disease, offering an alternative explanation for the occurrence of this side effect. However, until now its course exclusively described by tractography had not yet been confirmed by any anatomical method. The aim of this study was to fill this gap as well as to provide a detailed description of the fiber tracts surrounding the STN to facilitate a better understanding of the background of side effects occurring during STN DBS. Ten human cadaveric brains (20 hemispheres) and 100 healthy subjects (200 hemispheres) from the S500 Release of the Human Connectome Project were involved in this study. Nineteen hemispheres were dissected according to Klingler's method. One additional hemisphere was prepared for histological examinations to validate the macroscopical results and stained with neurofibril silver impregnation according to Krutsay. The authors also aimed to reconstruct the MFB using tractography and correlated the results with their dissections and histological findings. The white matter connections coursing through the subthalamic region were successfully dissected. The ansa lenticularis, lenticular fasciculus, thalamic fasciculus, ipsi- and contralateral cerebellar fibers, and medial lemniscus were revealed as closely related fiber tracts to the STN. However, the existence of a distinct fiber bundle corresponding to the MFB described by tractography could not be identified. Using tractography, the authors showed that the depiction of the streamlines representing the MFB was also strongly dependent on the threshold parameters. According to this study's findings, the streamlines of the MFB described by tractography arise from the limitations of the diffusion-weighted MRI fiber tracking method and actually correspond to subthalamic fiber bundles, especially the ansa lenticularis and lenticular fasciculus, which erroneously continue in the anterior limb of the internal capsule, toward the prefrontal cortex.

Sleep complaints, suicidal behavior and somatic symptoms in children and adolescents with severe affective disorder

Sleep complaints, suicidal behavior and somatic symptoms in children and adolescents with severe affective disorder

Polygenic risk for depression predicting temperament trajectories over 15 years – A general population study

BackgroundA great number of case-control and population-based studies have shown that depression patients differ from healthy controls in their temperament traits. We investigated whether polygenic risk for depression predicts trajectories of temperament traits from early adulthood to middle age. MethodsParticipants came from the population-based Young Finns Study (n = 2212). The calculation for Polygenic risk for depression (PRS) was based on the most recent genome-wide association study. Temperament traits of Harm Avoidance, Novelty Seeking, Reward Dependence, and Persistence were assessed with the Temperament and Character Inventory in 1997, 2001, 2007, and 2012 (participants being 24–50-year-olds). As covariates, we used depressive symptoms as assessed by a modified version of the Beck Depression Inventory, psychosocial family environment from parent-filled questionnaires, and socioeconomic factors from adulthood. ResultsHigh PRS predicted higher Persistence from early adulthood to middle age (p = 0.003) when controlling for depressive symptoms, psychosocial family environment, and socioeconomic factors. PRS did not predict trajectories of Novelty Seeking (p = 0.063–0.416 in different models) or Reward Dependence (p = 0.531–0.736). The results remained unaffected when participants with diagnosed affective disorders were excluded. Additionally, we found an interaction between PRS and depressive symptoms when predicting the Harm Avoidance subscale Anticipatory Worry, indicating that the association of Anticipatory Worry with depressive symptoms is stronger in individuals with higher (vs. lower) PRS. LimitationsThere was some attrition due to the long follow-up. ConclusionsHigh polygenic risk for major depression may predict differences in temperament trajectories among those who have not developed any severe affective disorders.

In-hospital catatonia, delirium, and coma and mortality: Results from the delirium and catatonia prospective cohort investigation

BackgroundCatatonia, a form of acute brain dysfunction typically linked with severe affective and psychotic disorders, occurs in critical illness with delirium and coma. Delirium and coma are associated with mortality, though catatonia's relationship with mortality is unclear. We aim to describe whether catatonia, delirium, and coma are associated with mortality. MethodsWe enrolled a convenience cohort of critically ill adults (N = 378) at an academic medical center. We assessed catatonia, delirium, and coma using the Bush-Francis Catatonia Rating Scale, the Confusion Assessment Method for the Intensive Care Unit and the Richmond Agitation-Sedation Scale, respectively. We tested the associations between previous day brain dysfunction state occurrence with in-hospital and one-year mortality using multivariable time-dependent risk models. Additionally, we tested the association between brain dysfunction duration and one-year mortality. ResultsCatatonia was not associated with death on the day after diagnosis during hospitalization, and neither previous catatonia occurrence nor duration was associated with one-year mortality. Delirium was not associated with death on any day following diagnosis during hospitalization, and neither previous delirium occurrence nor duration was associated with one-year mortality. The occurrence of coma was associated with death on any day after diagnosis during hospitalization (HR 2.30,CI 1.19–4.44,p = 0.014), as well as through one year following hospital discharge (HR 1.68,CI 1.09–2.59,p = 0.02). ConclusionsComa, but neither catatonia nor delirium, was associated with future day in-hospital and one-year mortality. More research is needed to understand catatonia's clinical impact. Delirium results differ from existing literature likely due to cohort demographics and size. Coma results highlight the prognostic significance of suppressed arousal while critically ill.

Advocacy and Lactation Support for Patient With Bipolar Disorder: A Case Report

Introduction:Bipolar disorder (BD) is a severe affective mood disorder with medication management as the backbone of treatment; however, medication use during pregnancy and lactation impacts a patient’s decision and ability to breastfeed. Disparate recommendations from healthcare providers may further undermine a patient’s ability to achieve their lactation goals.Methods:This case reviews the role of the lactation consultant in facilitating interprofessional collaboration to help meet the breastfeeding goals of the patient with BD.Results:Interdisciplinary collaboration with several providers through pregnancy, postpartum, and the community setting helped this mother achieve her goal to breastfeed her infant for 5 months.Conclusion:The IBCLC is perfectly positioned to represent the patient’s interests and facilitate interprofessional collaboration to achieve breastfeeding goals.

Pharmacological Strategies for Bipolar Disorders in Acute Phases and Chronic Management with a Special Focus on Lithium, Valproic Acid, and Atypical Antipsychotics.

Bipolar disorders (BDs) are a heterogeneous group of severe affective disorders generally described by the alternation of (hypo)manic, depressive, and mixed phases, with euthymic intervals of variable duration. BDs are burdened with high psychiatric and physical comorbidity, increased suicide risk and reduced life expectancy. In addition, BDs can progress into complicated forms (e.g., mixed states, rapid/irregular cycling), which are more difficult to treat and often require personalized pharmacological combinations. Mood stabilizers, particularly Lithium and Valproic acid (VPA), still represent the cornerstones of both acute and chronic pharmacotherapies of BDs. Lithium is the gold standard in BD-I and BDII with typical features, while VPA seems more effective for atypical forms (e.g., mixed-prevalence and rapid-cycling). However, despite appropriate mood stabilization, many patients show residual symptoms, and more than a half recur within 1-2 years, highlighting the need of additional strategies. Among these, the association of atypical antipsychotics (AAPs) with mood stabilizers is recurrent in the treatment of acute phases, but it is also being growingly explored in the maintenance pharmacotherapy. These combinations are clinically more aggressive and often needed in the acute phases, whereas simplifying pharmacotherapies to mood stabilizers only is preferable in the long-term, whenever possible. When mood stabilizers are not enough for maintenance treatment, Quetiapine and, less consistently, Aripiprazole have been proposed as the most advisable adjunctive strategies, for their safety and tolerability profiles. However, in view of the increased risk of serious adverse effects, a careful patient-centered balance between costs and benefits is mandatory.

Procollagen type 1 N-terminal propeptide, neurofilament light chain, proinflammatory cytokines, and cognitive function in bipolar and major depressive disorders: An exploratory study of brain– bone axis and systemic inflammation

BackgroundHigher levels of neurofilament light chain (NfL) and proinflammatory cytokines (i.e., tumor necrosis factor [TNF]-α) were observed in patients with bipolar disorder (BD) and major depressive disorder (MDD). Procollagen type 1 N-terminal propeptide (P1NP), a bone turnover biomarker, is related to MDD. The association among the brain–bone axis, systemic inflammation, and cognitive function remains unclear in severe affective disorders. MethodsOverall, 25 patients with BD, 24 with MDD, and 29 matched controls were enrolled in the current study and underwent the measurements of the NfL, P1NP, and proinflammatory cytokine levels and 1-back and 2-back working memory tasks. Generalized linear models (GLMs) were used to examine the aforementioned biomarkers between the groups and clarify the association with each other. ResultsGLMs showed increased levels of NfL (p = 0.001, p = 0.020) and P1NP (p = 0.050, p = 0.032) in the patients with BD and MDD than in the controls and suggested significant correlations between the NfL level and the mean time of the 2-back working memory task (p = 0.038) and between P1NL and TNF-α levels (p < 0.001). DiscussionOur study revealed the dysregulated brain–bone axis, indicated by elevated NfL and P1NP levels, and related cognitive impairment and systemic inflammation in the patients with BD and MDD. Additional studies are necessary to elucidate definite pathomechanisms underlying those conditions.

Chemical Element Profiling in the Sera and Brain of Bipolar Disorders Patients and Healthy Controls.

Bipolar Disorder (BD) is a severe recurrent affective mood disorder characterized by a wide range of lifelong mood swings, varying between depressive and manic states. BD affects more than 1% of the world's population irrespective of nationality, ethnic origin, or socioeconomic status and is one of the main causes of disability among young people, leading to cognitive and functional impairment and raised mortality, particularly death by suicide. Trace elements play a vital role in many biochemical and physiological processes. Compelling evidence shows that element toxicity might play a crucial role in the onset and progression of neurodegenerative disorders, but their involvement in mood disorders has been scarcely studied. In the present investigation, we determined the concentration of 26 elements in the serum of BD patients before and after treatment and in postmortem brain samples from BD patients and compared them with matched controls. The only element that was reduced significantly in the serum following treatment was vanadium (V). Furthermore, the concentration of Al, B, Cu, K, Mg and V were significantly lower in the pre-frontal cortex of BD patients compared with those of the controls. A comparison of Spearman's rank correlation coefficients between the elements in the serum and brain of BD patients and control groups pointed to boron and aluminum as being involved in the disease. These results suggest that there is a disturbance in the elements' homeostasis and the inter-elements' relationship in the brain of BD patients and advocate a thorough examination of the possible involvement of chemical elements in different stages of the disease.

The Tryptophan Catabolite or Kynurenine Pathway in a Major Depressive Episode with Melancholia, Psychotic Features and Suicidal Behaviors: A Systematic Review and Meta-Analysis.

Major depressive disorder (MDD) and bipolar disorder (BD) with melancholia and psychotic features and suicidal behaviors are accompanied by activated immune-inflammatory and oxidative pathways, which may stimulate indoleamine 2,3-dioxygenase (IDO), the first and rate-limiting enzyme of the tryptophan catabolite (TRYCAT) pathway resulting in increased tryptophan degradation and elevated tryptophan catabolites (TRYCTAs). The purpose of the current study is to systematically review and meta-analyze levels of TRP, its competing amino acids (CAAs) and TRYCATs in patients with severe affective disorders. Methods: PubMed, Google Scholar and SciFinder were searched in the present study and we recruited 35 studies to examine 4647 participants including 2332 unipolar (MDD) and bipolar (BD) depressed patients and 2315 healthy controls. Severe patients showed significant lower (p < 0.0001) TRP (standardized mean difference, SMD = −0.517, 95% confidence interval, CI: −0.735; −0.299) and TRP/CAAs (SMD = −0.617, CI: −0.957; −0.277) levels with moderate effect sizes, while no significant difference in CAAs were found. Kynurenine (KYN) levels were unaltered in severe MDD/BD phenotypes, while the KYN/TRP ratio showed a significant increase only in patients with psychotic features (SMD = 0.224, CI: 0.012; 0.436). Quinolinic acid (QA) was significantly increased (SMD = 0.358, CI: 0.015; 0.701) and kynurenic acid (KA) significantly decreased (SMD = −0.260, CI: −0.487; −0.034) in severe MDD/BD. Patients with affective disorders with melancholic and psychotic features and suicidal behaviors showed normal IDO enzyme activity but a lowered availability of plasma/serum TRP to the brain, which is probably due to other processes such as low albumin levels.

The Level of COVID-19 Anxiety among Oncology Patients in Poland.

Cancer patients tend to have a high psychological burden. Half of cancer patients suffer from severe affective disorders and anxiety disorders, while one-third struggle with mild forms of these. The COVID-19 pandemic is damaging the mental health of the population due to social restrictions. A growing number of studies note the role of COVID-19 anxiety in the health and quality of life of cancer patients. The purpose of this study is to estimate the level of COVID-19 anxiety among oncology patients and to test the utility of the FCV-19S scale in a population study of cancer patients. The study included 600 respondents (300 oncology patients and 300 control subjects not undergoing oncological treatment). The FCV-19S scale and the GAD-7 scale were used in the study. The results were interpreted according to the following verbal scale: 76–100%, high anxiety; 56–75%, moderate anxiety; 26–55%, low COVID-19 anxiety; <25%, no COVID-19 anxiety. In the analysis of the GAD-7 questionnaire results, the mean score obtained was 8.21 (min. 0; max. 21; SD 5.32). For 81% of respondents in the group of oncology patients, the total score indicated the presence of anxiety symptoms with varying degrees of severity; in the control group, this proportion was 55% of respondents. The FCV-19S scale score as a percentage was 57.4% for oncology patients, indicating a moderate level of fear of the SARS-CoV-2 virus, and 30.3% for the control group, indicating a low level of fear of the SARS-CoV-2 virus. One-fifth of oncology patients were afraid of losing their lives due to the SARS-CoV-2 virus; in the control group, this proportion was 13% of respondents. Oncology patients were characterized by a higher prevalence of sleep disturbance than control group respondents, which was associated with greater anxiety. The study, therefore, shows that oncology patients have moderate levels of anxiety associated with the COVID-19 pandemic, and non-oncology patients show lower levels of anxiety.

Clinical and psychopathological structure of depressive disorders in women against the background of postpartum inflammatory complications

The postpartum period is a sensitive time when mothers are subjected to increased risks of mental disorders. Aim: to study the structure of anxiety and depressive disorders in women against the background of the early postpartum complications. Material and methods. 150 patients, who underwent inpatient treatment at the Scientific Research Institute of Obstetrics and Gynecology, Baku, were selected for the study and divided into two groups: the main group - with postpartum complications (n = 100), the comparison group — with physiological postpartum period (n = 50). The average age was 29.9 ± 0.64 and 30.3 ± 0.86 years. All patients underwent a comprehensive examination using anamnestic data and the Hamilton Scale to assess the severity of anxiety (HARS) and depression (HRDS). Results. According to etiology and pathogenesis, the studied pathology is multifactorial. Significant risk factors for the complicated course of puerperia are inflammatory diseases of the pelvic organs. Attention is drawn to the adverse effect on the health of women in the puerperal period, the high frequency of diseases of the upper respiratory tract and kidneys in the anamnesis. Diagnosed postpartum inflammatory complications may serve as a risk factor for the development of anxiety and depressive disorders in the postpartum period. The average indicators in women of the control group are within the normal range. A high level of clinical severity of symptomatic anxiety was observed in the main group (48.0 + 5.00% versus 8.0 + 3.84% in the control group, χ2 = 44.19; p &lt; 0.0001), that is, early postpartum complications are a predictor of severe anxiety. Depression of an average degree was more often recorded with a complicated course of puerperia. Discussion. The presence of a burdened obstetric and gynecological anamnesis and extragenital pathology increases the risk of puerperal complications and the development of severe affective disorders. Changes in the emotional status affecting the anxious and depressive component were more often revealed in postpartum women with complications than in women with a physiological course of the postpartum period. Conclusions. Most of the anxiety-depressive conditions in the main group corresponded to moderate severity in the clinical and psychopathological study. Disorders of mild degree were observed more often in a physiologically proceeding postpartum period. When complications are detected, timely diagnosis and correction of anxiety and depressive disorders are necessary for easily women’s adaptation to the postpartum period.

Involvement of Kynurenine Metabolism in Bipolar Disorder: An Updated Review.

Bipolar disorder (BD) is a severe affective disorder, mainly characterized by alternative depressive and manic or hypomanic episodes, yet the pathogenesis of BD has not been fully elucidated. Recent researches have implicated the altered kynurenine (KYN) metabolism involved in the neurobiology of BD. Excessive activation of the immune system also occurs in patients with BD, which further accelerates the KYN pathway for tryptophan metabolism. Changes of the KYN metabolites have effects on neuronal receptors and are involved in neuroendocrine transmissions. Interactions between KYN metabolism and the immune system may contribute to the neuropathogenesis of BD. Various studies have shown that alterations of the KYN metabolites were associated with mood, psychotic symptoms, and cognitive functions in patients with BD. In this review, we briefly introduce the KYN pathway and describe the immune dysregulation in BD as well as their interactions. We then focus on the research advances on the KYN metabolism in BD, which hold promise for identifying novel treatment targets in patients stricken with this disorder.

Implications from translational cross-validation of clinical assessment tools for diagnosis and treatment in psychiatry.

Traditional therapeutic methods in psychiatry, such as psychopharmacology and psychotherapy help many people suffering from mental disorders, but in the long-term prove to be effective in a relatively small proportion of those affected. Therapeutically, resistant forms of mental disorders such as schizophrenia, major depressive disorder, and bipolar disorder lead to persistent distress and dysfunction in personal, social, and professional aspects. In an effort to address these problems, the translational approach in neuroscience has initiated the inclusion of novel or modified unconventional diagnostic and therapeutic techniques with promising results. For instance, neuroimaging data sets from multiple modalities provide insight into the nature of pathophysiological mechanisms such as disruptions of connectivity, integration, and segregation of neural networks, focusing on the treatment of mental disorders through instrumental biomedical methods such as electro-convulsive therapy (ECT), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS). These methodologies have yielded promising results that have yet to be understood and improved to enhance the prognosis of the severe and persistent psychotic and affective disorders. The current review is focused on the translational approach in the management of schizophrenia and mood disorders, as well as the adaptation of new transdisciplinary diagnostic tools such as neuroimaging with concurrently administered psychopathological questionnaires and integration of the results into the therapeutic framework using various advanced instrumental biomedical tools such as ECT, TMS, tDCS and DBS.

Lithium in severe affective disorders: Balancing safety with efficacy

IntroductionLithium has been one of the oldest substances used in psychiatric treatments and remains the first-line treatment for prevention of manic and depressive episodes of bipolar disorder (BD), but it has also a wide spectrum of side-effects.ObjectivesThe goal is to review efficacy, and clinical use of lithium, such as its side effects, and its benefit-to-risk ratio.MethodsNon-systematic literature review based on scientific databases such as PubMed.ResultsThe first modern use of lithium was for the treatment of mania. Lithium has also proven useful in major depression, particularly for augmentation of antidepressants, for aggressive behavior and it has a specific antisuicide effect. Lithium’s prophylactic and antisuicidal effects are most unique. However, the use of lithium became problematic due to the serious toxicity since lithium also a narrow therapeutic index, with therapeutic levels between 0.6 and 1.5 mEq/L.ConclusionsAwareness of the benefits and risks of lithium is essential for the use of this lifesaving agent. Lithium levels must be carefully monitored and lithium dosage adjusted as necessary.DisclosureNo significant relationships.

Clinicians' Racial Bias Contributing to Disparities in Electroconvulsive Therapy for Patients From Racial-Ethnic Minority Groups.

Patients from racial-ethnic minority groups undergo disparate electroconvulsive therapy (ECT) treatment compared with Caucasian peers. One leading hypothesis is that clinicians may unknowingly display racial bias when considering ECT for patients of color. Studies have consistently shown that patients of color face numerous racially driven, provider-level interpersonal and perceptual biases that contribute to clinicians incorrectly overdiagnosing them as having a psychotic-spectrum illness rather than correctly diagnosing a severe affective disorder. A patient's diagnosis marks the entry to evidence-based service delivery, and ECT is best indicated for severe affective disorders rather than for psychotic disorders. As a consequence of racially influenced clinician misdiagnosis, patients from racial-ethnic minority groups are underrepresented among those given severe affective diagnoses, which are most indicated for ECT referral. Evidence also suggests that clinicians may use racially biased treatment rationales when considering ECT after they have given a diagnosis of a severe affective or psychotic disorder, thereby producing secondary inequities in ECT referral. Increasing the use of gold-standard treatment algorithms when considering ECT for patients of color is contingent on clinicians transcending the limitations posed by aversive racism to develop culturally unbiased, clinically indicated diagnostic and treatment rationales.

Substantiation of connection between affective disorders and development of malignant neoplasms of pancreas: experience of the center

Objective. To analyze the relationship between the affective disorders in the form of anxiety and depression and the development of pancreatic cancer and stomach cancer. Today, there is an interest to the relationship between changes in the emotional sphere of patients with malignant neoplasms (MNO) of the pancreas at the early stages of the disease, when there are no other clinically significant symptoms, which allow suspecting the disease at an early stage.&#x0D; Materials and methods. A questionnaire survey was carried out in 63 patients with histologically verified cancer of the pancreas and stomach, who were treated at the FGBU RNTSRKhT named after Acad. A.M. Granov in the period from 2018 to 2020. The survey was conducted using the questionnaire of the European Organization for Research and Treatment of Cancer (EORTC-QLQ-C30 Russian version) and the Hospital Anxiety and Depression Scale (HADS), Russian version. Statistical processing of treatment results was carried out using regression analysis and Mann-Whitney test with the SPSS statistical software package (Statistika 13.0). The probability of error p 0.05 was considered sufficient to conclude that the differences in the data obtained were statistically significant.&#x0D; Results. In a comparative assessment of the indicators of affective disorders in pancreatic cancer patients, there were noted more pronounced affective disorders, such as feeling of depression, feeling of irritation, anxiety and tension, the values of which, according to the results of the analysis of questionnaires, were 1.00 1, 1, 00 1.00 1 and 2.00 1, respectively. In patients with gastric cancer, the values of these affective disorders, according to the survey results, were less pronounced and amounted to 3.00 1.00 1.00, 3.00 1.00, 3.00 1, respectively (p = 0.000).&#x0D; Conclusions. Severe affective disorders, such as anxiety and depression, in patients with pancreatic cancer should be regarded as a factor of the early manifestation of the disease. Further study of this connection can create a theoretical basis for the development of specialized screening programs to identify patients in the risk groups for the development of pancreatic cancer.

Repeated Digitized Assessment of Risk and Symptom Profiles During Inpatient Treatment of Affective Disorder: Observational Study.

BackgroundPredictive models have revealed promising results for the individual prognosis of treatment response and relapse risk as well as for differential diagnosis in affective disorders. Yet, in order to translate personalized predictive modeling from research contexts to psychiatric clinical routine, standardized collection of information of sufficient detail and temporal resolution in day-to-day clinical care is needed. Digital collection of self-report measures by patients is a time- and cost-efficient approach to gain such data throughout treatment.ObjectiveThe objective of this study was to investigate whether patients with severe affective disorders were willing and able to participate in such efforts, whether the feasibility of such systems might vary depending on individual patient characteristics, and if digitally acquired assessments were of sufficient diagnostic validity.MethodsWe implemented a system for longitudinal digital collection of risk and symptom profiles based on repeated self-reports via tablet computers throughout inpatient treatment of affective disorders at the Department of Psychiatry at the University of Münster. Tablet-handling competency and the speed of data entry were assessed. Depression severity was additionally assessed by a clinical interviewer at baseline and before discharge.ResultsOf 364 affective disorder patients who were approached, 242 (66.5%) participated in the study; 88.8% of participants (215/242) were diagnosed with major depressive disorder, and 27 (11.2%) had bipolar disorder. During the duration of inpatient treatment, 79% of expected assessments were completed, with an average of 4 completed assessments per participant; 4 participants (4/242, 1.6%) dropped out of the study prematurely. During data entry, 89.3% of participants (216/242) did not require additional support. Needing support with tablet handling and slower data entry pace were predicted by older age, whereas depression severity at baseline did not influence these measures. Patient self-reporting of depression severity showed high agreement with standardized external assessments by a clinical interviewer.ConclusionsOur results indicate that digital collection of self-report measures is a feasible, accessible, and valid method for longitudinal data collection in psychiatric routine, which will eventually facilitate the identification of individual risk and resilience factors for affective disorders and pave the way toward personalized psychiatric care.

Importance of electroconvulsive therapy (ECT) in forensic psychiatry

Hintergrund und Ziel der ArbeitFür die Elektrokonvulsionstherapie (EKT) liegen Leitlinienempfehlungen zur Behandlung schwerer affektiver und psychotischer Erkrankungen vor, wie sie auch bei Patienten im Maßregelvollzug (MRV) vorkommen. Über die Anwendung der EKT in der forensischen Psychiatrie existieren jedoch keinerlei systematisch erhobene Daten. Ziel der vorliegenden Arbeit ist eine Erhebung des Ist-Zustands sowie des geschätzten Bedarfs an EKT im MRV.Material und MethodenEs wurde ein Fragebogen zur Erhebung der aktuellen Anwendung sowie der Einschätzung des Bedarfs an EKT in dieser Population entwickelt. Dieser wurde elektronisch und bei Bedarf postalisch an die forensischen Kliniken in Deutschland versendet.ErgebnisseWir erhielten Antwort von 52 Kliniken (66 %). 29 der Kliniken gaben an, Patienten mit EKT behandeln zu können. Eine Behandlungsindikation wurde klinikübergreifend für 3,4 % der untergebrachten Patienten gesehen. In einem Jahr (2018) wurden insgesamt 32 EKT-Behandlungen an 12 Kliniken des Maßregelvollzugs mit durchschnittlich guter Wirksamkeit (Ø CGI‑I 2,32) durchgeführt. Häufigste Begründung für die fehlende Anwendung der EKT waren mangelnde strukturelle Voraussetzungen. Jeweils etwa ein Drittel der Kliniken sehen einen mittleren bzw. hohen Bedarf an EKT im MRV.DiskussionDie EKT kommt im MRV in Deutschland aktuell nur sehr begrenzt zum Einsatz. Auffällig ist, dass die Anzahl der durchgeführten Behandlungen etwa um den Faktor 8 hinter der Indikationshäufigkeit zurücksteht. Ungeachtet dessen sehen zwei Drittel der Kliniken einen mittleren bis hohen Bedarf, womit eine Unterversorgung mit EKT im MRV zu bestehen scheint.

Recurrence After Stopping Maintenance Electroconvulsive Therapy: A Retrospective Case Series.

Relapses and recurrence remain the greatest risks posed by patients with severe mood disorders after discontinuation of electroconvulsive therapy (ECT). To date, despite a wide range of literature on ECT, little is known about the rate of recurrence of depression after maintenance ECT (mECT) discontinuation specifically. This study sought to address this lacuna, confronting literature data to the results of a retrospective case study. A comprehensive review was conducted, followed by a retrospective analysis of 18 cases of mECT discontinuation between January 2011 and June 2016 involving patients with affective disorders. The comprehensive review revealed that only 3 studies have assessed recurrence rate after c/mECT discontinuation. In our retrospective analysis, mean (SD) mECT duration was 12.69 (12.16) months. A new mood event (usually a depressive state) was observed in 50% of the cases, and 44% of those recurrences occurred during the first 6 months after discontinuation. Given that high recurrence rates are observed after mECT discontinuation, the authors discuss the advantages of long-term mECT and the choice of concomitant pharmacotherapy for severe and complex affective disorders.

Course, remission and recovery in patients with severe psychotic disorders with or without comorbid substance use disorders: Long-term outcome in evidence-based integrated care (ACCESS II study)

ObjectivesPeople with psychotic disorders have a high prevalence of comorbid mental disorders, especially if severe mental illness (SMI) criteria are fulfilled. Substance Use Disorders (SUD) are the most common comorbidity. The aim of the study is to investigate whether SMI patients with and without comorbid SUD have a comparable course, remission and recovery rates within evidence-based care. MethodsACCESS is an integrated care model for patients with severe nonaffective and affective psychotic disorders. Treatment trajectories of patients, who have been in ACCESS care for at least 4 years, with and without SUD were compared with regard to the course of illness using Mixed Model Repeated Measures (MMRM) as well as recovery rates and its predictors. Results187 of 312 patients (60%) were at least 4 years in ACCESS. Of these, 126 (67.4%) had a comorbid SUD at admission. Patients had on average 2.96 SUD, 87 (69%) had a dependence. Both groups improved significantly over 4 years in all outcome parameters. However, patients with substance dependence showed significantly worse outcomes in psychopathology (p < 0.001), functioning (p = 0.006) and quality of life (p = 0.026). Using LOCF, 44 patients (23.5%) fulfilled recovery criteria at endpoint. Comorbid substance use dependence was the only significant predictor for non-recovery (OR = 0.462, p = 0.048). ConclusionSUD and especially substance dependence are common in psychotic disorders with SMI. Evidence-based integrated care also leads to long-term improvement in these patients, but to a lesser extent than in patients without SUD. In particular, the “optimal” outcome recovery is made more difficult by SUD dependence.