Neurology Psychiatry and Brain Research最新文献

Background

Treatment of depression with monoamine oxidase inhibitors (MAOIs) is complicated by the risk of drug interactions and possible serotonin syndrome if antidepressants with monoamine enhancement are used concomitantly. Esketamine nasal spray is a recently FDA approved antidepressant for individuals with treatment resistant depression and is to be used adjunctively with antidepressant pharmacotherapy. We report a patient who was successfully and safely treated with esketamine nasal spray while being treated with tranylcypromine.

Methods

This patient was treated in our Center and data regarding blood pressure and side effect were reviewed from her clinical record.

Results

Baseline depression and anxiety ratings, including HAM A, QIDS, HAMD and MADRS, were in the range of moderate range of anxiety and depression. Baseline GAD 7 was only slightly elevated. At the end of the 4 week acute treatment phase (treatments of esketamine nasal spray twice weekly at doses ranging from 28 to 56 mg), all of her mood and anxiety ratings were in the normal range. Blood pressure usually increases during treatment with esketamine nasal spray, and increases during treatment were within the normal range and there was no evidence of hypertension. Esketamine nasal spray was well tolerated and there was no evidence of a serotonin syndrome.

Limitations

This is a single case report, but we review the literature of treatment of patients taking MAOIs with ketamine and with intravenous esketamine.

Conclusions

Esketamine nasal spray appears to be a safe treatment even if administered to a patient being treated with tranylcypromine, an MAOI.

Background

A range of psychiatric disorders are associated with brain tumors. The aim of this study was to assess the frequency of psychiatric disorders in adults with primary brain tumors before and after surgery.

Methods

The study was conducted on 120 adult patients diagnosed with primary brain tumors (age ≥18 years). Patients with recent diagnosis (less than 6 months) who were hospitalized in Imam Reza Hospital of Tabriz between December 2016 and November 2017 were included. The diagnostic interview was performed based on DSM-IV criteria using a semi-structured interview with SCID-I before and one month after surgery. The frequency of psychiatric disorders in patients was then compared pre- and post-operation.

Results

Pre-surgical studies revealed that 26.66 % of patients with primary brain tumors had symptoms of psychiatric disorders. The most prevalent disorders found in patients were depressive disorders (13.07 %), adjustment disorder (9/15 %) and anxiety disorders (5.88 %).

Post-surgical evaluations indicated that the frequency of psychiatric disorders was reduced to 22.5 %. However, there was no significant difference between pre- and post-surgical outcomes. Among patients with psychiatric disorders, the most common location of brain tumors was frontal lobe and the most common pathology was meningioma. Further analysis also revealed that tumor location and pathology was not associated with the incidence and type of psychiatric disorders.

Conclusion

In adults with primary brain tumors, the most common psychiatric disorder was depressive disorder.

Background

Epidemiology of suicide has been found as an under-attended research focus in Bangladesh.

Objectives

It was aimed to see demography, methods and precipitating events of suicidal attempts that were published in Bangla online news portals.

Methods

We searched and scrutinized published news contents of four Bangla online news portals reporting the suicidal news between 01 November 2018 and 31 October 2019. A total of 199 articles were collected and subsequently analyzed.

Results

The mean age of suicide attempters reported in the news portals was 26.86 (±13.60) years, ranging from 9 to 75 years. More than 60 % of the reported cases were less than 30 years of age, 53 % were female, 32.16 % were students, and 52.3 % were unmarried. Hanging was found as the commonest method (60 %) and affair related issues (17.59 %), marital discords (13.57 %), familial discords (10.55 %), were found as the mentionable precipitating events. About 83 % of the suicides happened at the home of the person, multiple persons were involved in the suicidal acts in about 8% of the respondents, 91 % were completed suicides, and 4% suicide reports were associated with homicides.

Conclusion

The study showed adults less than thirty years, females, and students are exhibiting more suicidal behaviors. Hanging was the most commonly used method and the majority of the precipitating events were within the family.

Background

Sexual dysfunction negatively impacts quality of life and relationship satisfaction in patients with major depressive disorder (MDD). This study’s objective was to understand real-world experiences with sexual dysfunction in patients with MDD.

Methods

This survey study included 483 participants (≥18 years old) from the PatientsLikeMe® network who reported an MDD diagnosis. Sexual dysfunction (self-attributed and as evaluated by the Changes in Sexual Functioning Questionnaire [CSFQ-14]), relationship satisfaction, depression severity, and medication adherence were assessed.

Results

Of the patients currently taking antidepressants (N = 405), sexual dysfunction was reported in approximately half (self-attributed, 52 % and per CSFQ-14, 56 %). Forty-eight percent of these patients indicated they would continue medication until sexual side effects abated. Fewer than half of patients with self-attributed sexual dysfunction, reported for at least one antidepressant, had spoken with their doctor about sexual side effects; of these, about one-third were switched to another antidepressant. Sexual dysfunction was associated with depression severity, diminished relationship satisfaction, and lower self-esteem in patients currently taking antidepressants.

Limitations

This is a convenience sample; data are based on self-report without independent verification of the diagnoses. The cross-sectional design also limits conclusions about causality and directionality. The generalizability of the findings is limited, as the patient sample was predominantly female, white, college educated, and moderately to severely depressed.

Conclusions

New strategies for managing sexual dysfunction in patients with MDD who are taking antidepressants are critically needed to provide these patients with the best chance for successful treatment outcomes.

Introduction

Impaired metacognition and impulsivity are critical factors in pathological gambling behavior subsistence. This study aims at jointly exploring metacognitive skills and impulsivity levels in subgroups of Parkinson’s Disease (PD) patients with different gambling status.

Method

48 PD participants were divided into three subgroups: PD Gamblers (PDG), PD patients with a previous history of gambling and PD controls. Impulsivity was assessed by the Barratt Impulsiveness Scale. After performing the Iowa Gambling Task (IGT), patients filled in a self-report measure to assess their metacognitive strategies.

Results

Findings highlighted that PDG showed higher levels of impulsivity than PD controls as reflected by clinical scales and behavioral measure. Also, PDG displayed a worse performance at IGT although they stated to use an efficacious strategy, suggesting then an erroneous metacognitive representation.

Conclusions

Overall findings proposed that high levels of impulsivity combined with an explicit metacognitive bias on self-efficacy could intervene in the persistence of pathological gambling behavior in PD patients.

Background

Major Depressive Disorder (MDD) is one of the most common mental illnesses and a leading cause of disability worldwide. Electronic Health Records (EHR) allow researchers to conduct unprecedented large-scale observational studies investigating MDD, its disease development and its interaction with other health outcomes. While there exist methods to classify patients as clear cases or controls, given specific data requirements, there are presently no simple, generalizable, and validated methods to classify an entire patient population into varying groups of depression likelihood and severity.

Methods

We have tested a simple, pragmatic electronic phenotype algorithm that classifies patients into one of five mutually exclusive, ordinal groups, varying in depression phenotype. Using data from an integrated health system on 278,026 patients from a 10-year study period we have tested the convergent validity of these constructs using measures of external validation, including patterns of psychiatric prescriptions, symptom severity, indicators of suicidality, comorbidity, mortality, health care utilization, and polygenic risk scores for MDD.

Results

We found consistent patterns of increasing morbidity and/or adverse outcomes across the five groups, providing evidence for convergent validity.

Limitations

The study population is from a single rural integrated health system which is predominantly white, possibly limiting its generalizability.

Conclusion

Our study provides initial evidence that a simple algorithm, generalizable to most EHR data sets, provides categories with meaningful face and convergent validity that can be used for stratification of an entire patient population.

Purpose

Maternal exercise has shown beneficial effects on maternal/foetal health; however, the effects of maternal exercise on neurocognitive development in prenatally stressed offspring are unknown. The aim of the current study was to determine if maternal exercise during pregnancy prevents the effects of stress on spatial memory and learning as well as on the dendritic outgrowth of hippocampal neurons in prenatally stressed offspring.

Methods

Ten pregnant mice were divided into three groups: control (C), restraint stress (RS) and restraint stress + voluntary wheel running (RS + VWR). Between gestational day 1 and 14 the dams from the RS + VWR group were subjected to the VWR protocol for 4 h per day. Moreover, from gestational day 14 until delivery the pregnant females from RS and RS + VWR group were subjected to three daily stress sessions. Between postnatal day 52 and 56, the male mice born of the three groups of dams were evaluated in the Morris Water Maze, and then, their neuronal morphology was analysed.

Results

The stressed mice showed higher escape latencies and a significant reduction in both the number of entries to and in the time spent in the quadrant target of the maze, compared to controls, along with a reduction in the dendritic outgrowth of the hippocampal neurons. Moreover, stressed mice born from exercised mothers showed an improvement in spatial learning and memory, along with an increase in the dendritic length of dentate granule cells.

Conclusions

Maternal exercise during pregnancy may be a beneficial factor to prevent the cognitive impairments and to ameliorate partially the impairments in the hippocampal dendritic outgrowth exhibited by prenatally stressed mice.