Innovations in clinical neuroscience最新文献

Treatment-resistant depression (TRD) is major depression that has not responded to at least two trials of antidepressants. The STAR-D study highlighted the necessity of multiple treatment steps to achieve remission, with each step decreasing the likelihood of success and increasing relapse risk, underscoring the complexity of TRD treatment and the need for personalized approaches. Transcranial magnetic stimulation (TMS) is a noninvasive technique using magnetic fields to stimulate brain nerve cells, targeting the dorsolateral prefrontal cortex, that is effective in many patients with depression. However, for patients with TRD who fail TMS, no standard of care exists. Intranasal esketamine, a noncompetitive N-methyl-D-aspartic acid (NMDA) receptor antagonist, is approved for adults with TRD or major depressive disorder with suicidal thoughts. We present a case series of five patients with TRD who failed TMS and subsequently responded to intranasal esketamine. Response, defined as a 50-percent symptom reduction, was monitored using Patient Health Questionnaire (PHQ-9), Beck Depression Inventory (BDI), and Generalized Anxiety Disorder-7 (GAD-7) scores. After 16 treatment sessions, all patients achieved a treatment response per PHQ-9 and BDI scores; 80 percent achieved complete remission per PHQ-9, and 60 percent per BDI. Additionally, 80 percent of patients showed a treatment response on GAD-7 scores. This case series supports further investigation into esketamine for patients with TRD who are unresponsive to TMS.

This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS (www.prms.com), a manager of medical professional liability insurance programs with services that include risk management consultation and other resources offered to health care providers to help improve patient outcomes and reduce professional liability risk. The answers published in this column represent those of only one risk management consulting company. Other risk management consulting companies or insurance carriers might provide different advice, and readers should take this into consideration. The information in this column does not constitute legal advice. For legal advice, contact your personal attorney. Note: The information and recommendations in this article are applicable to physicians and other healthcare professionals so "clinician" is used to indicate all treatment team members.

Department editor: Julie P. Gentile, MD, is Professor and Chair of the Department of Psychiatry at Wright State University in Dayton, Ohio.

Editor’s note: The patient scenarios presented in this article are composite cases written to illustrate certain diagnostic characteristics and to instruct on treatment techniques. The composite cases are not real patients in treatment. Any resemblance to real patients is purely coincidental.

Abstract: The prevalence of mental illness in individuals with intellectual disability (ID) is higher compared to the general population. Persons with ID typically have insufficient coping skills and fewer systems of natural support; they are often more vulnerable to stress. There is evidence that level of intelligence is not a sole indicator for appropriateness for psychotherapy, and that the full range of mental health services help improve quality of life for patients with ID. Polypharmacy is more common in patients with co-occurring ID and mental illness. It is common for patients with ID to be prescribed multiple medications for both physical and mental health conditions. In addition, when patients are discharged from state-operated institutions to the community, it is common for them to continue taking the same number of medications. This article will review the use of adapted psychotherapy in patients with ID, as well as deprescribing protocols to address polypharmacy.

Healthy lifestyle and positive psychiatry interventions can complement the treatment of mood disorders and help individuals who are not experiencing as much happiness and satisfaction in their lives as they desire. This article gives examples of an optimal psychiatric treatment plan that would potentially include psychotherapy, psychotropic medications, and/or individualized and targeted healthy lifestyle and positive psychiatry interventions to not only treat mental illness, but also enhance overall wellbeing.

This case report presents a 35-year-old male patient from Lahore, Pakistan, who experienced recurring seasonal depressive symptoms from May to September for seven years. The patient exhibited symptoms including feelings of worthlessness, low mood, loss of appetite, decreased energy, anhedonia, and psychomotor retardation during the summer months, with a return to normal functioning outside of these months. The patient remained undiagnosed throughout this time. After multiple unsuccessful treatments from various facilities, he presented to our outpatient clinic for evaluation. Subsequently, he was admitted to the inpatient unit, where regular assessments diagnosed him with summer seasonal affective disorder (SAD), a rare and less-recognized form of SAD. After further evaluation, a treatment plan was devised that included slowly tapering off previous medications and initiating bupropion (a United States Food and Drug Administration [FDA]-approved medication for SAD) along with cognitive behavioral therapy. The patient subsequently fully recovered on bupropion and returned to normal functioning. The case highlights the challenges in diagnosing and treating summer SAD, particularly in tropical climates, where it is less recognized than winter SAD due to the scarcity of literature and awareness regarding it. Additionally, the positive response to bupropion suggests its potential efficacy for summer SAD. This report emphasizes the importance of considering regional and seasonal factors in psychiatric diagnoses and calls for increased awareness of and research on summer SAD, especially in countries such as Pakistan. The authors note this as potentially the first reported case of summer SAD in Pakistan, the sixth-most populous country globally. This highlights the need for a better understanding and management of seasonal disorders in diverse geographical contexts.