The neurobiology of apathy in depression and neurocognitive impairment in older adults: a review of epidemiological, clinical, neuropsychological and biological research

Apathy is a common condition that involves diminished initiative, diminished interest and diminished emotional expression or responsiveness. It is highly prevalent in the context of a variety of neuropsychiatric disorders and is related to poor health outcomes. Presence of apathy is associated with cognitive and functional decline in dementia. Despite its negative impact on health, there is no definitive treatment for apathy, a clinical reality that may be due in part to lack of knowledge about assessment, neuropsychological features and neurobiological underpinnings. Here, we review and synthesize evidence from clinical, epidemiological, neuropsychological, peripheral biomarker and neuroimaging research. Apathy is a common feature of depression and cognitive disorders and is associated with impairment in executive function. Neuropsychological and neuroimaging studies point to dysfunction of brain circuitry involving the prefrontal cortex, especially the dorsolateral prefrontal cortex circuit, the dorsomedial prefrontal cortex circuit, and the ventromedial prefrontal cortex circuit. However, inconsistent findings, particularly in neuroimaging may be due to heterogeneity of apathy symptoms (with a need to better elucidate subtypes), neuropsychiatric comorbidities, the severity of cognitive impairment and other factors. These factors need to be accounted for in future studies so that biomarker research can make progress. On the whole, the literature on apathy has identified likely neurocognitive, peripheral biomarker and neuroimaging targets for understanding apathy, but also points to the need to address methodological issues that will better inform future studies. In turn, as we learn more about the underpinning of apathy and its subtypes, subsequent research can focus on new neurally based interventions that will strengthen the clinical management of apathy in the context of its comorbidities.

Withering away

Failure to thrive (FTT) is a multifactorial geriatric syndrome characterized by weight loss, decreased appetite, poor nutrition, dehydration, depressive symptoms, inactivity, impaired immune function and low cholesterol. Three fundamental components whose interaction results in FTT include frailty, disability, and neuropsychiatric impairment. The relationship of FTT and depression may be bidirectional, and comorbid dementia is common. The work-up of FTT should consider factors such as medical illness, hypoactive delirium, neurocognitive disorder, and psychosocial stressors in addition to depression. Much of the medical work-up will look for factors that could be causing weight loss, including issues relating to dentition, chewing, swallowing, nutrition and underlying malignancy. Treatment of depression may improve FTT, and antidepressants such as mirtazapine as well as electroconvulsive therapy should be considered.

Apathy: Neurobiology, Assessment and Treatment

Apathy is a highly prevalent, disabling and treatment resistant syndrome. It is defined as a quantitative reduction of goal- directed activity in comparison to the patient’s previous level of in multiple dimensions including behavior/cognition, emotion and social interaction. It has been described in major depressive disorder, Alzheimer’s disease, frontotemporal dementia, Parkinson’s Disease, cerebrovascular disease, and vascular dementia, among others. This review will address the neuropsychology and associated neurobiological underpinnings of apathy in the above conditions, identify specific methods to assess apathy clinically, and review the literature on managing apathy across these various disorders.

Psychoses of Epilepsy in Pregnancy: A Case Report

To discuss the unique relationship between psychosis and seizures in a young individual, who is also pregnant. Psychosis of epilepsy can present in multitude of ways, including pre-ictal, ictal, post-ictal, chronic interictal, and forced normalization psychosis.

Ethical and Logistical Considerations of Caring for Older Adults on Inpatient Psychiatry During the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has brought challenges to delivery of care for older adults on inpatient psychiatry. We describe two cases: patient A, a 62-year-old woman who initially refused screening for potential COVID-19, bringing up questions about threshold for capacity when public health is at risk and questions about whether screening for infection should be different in older adults. The other case, patient B, is that of an 83-year-old man who was on the unit when patient A tested positive, and brought up concerns for risk of dissemination in the context of wandering, spitting behaviors, and inability to adhere to room isolation or masking measures. We review measures taken to decrease risk of transmission and improve screening for infection in older adults.

Selective area heteroepitaxy of GaSb on GaAs (001) for in-plane InAs nanowire achievement

The growth of in-plane GaSb nanotemplates on a GaAs (001) substrate is demonstrated combining nanoscale patterning of the substrate and selective area heteroepitaxy. The selective growth of GaSb inside nano-stripe openings in a SiO₂ mask layer is achieved at low temperature thanks to the use of an atomic hydrogen flux during the molecular beam epitaxy. These growth conditions promote the spreading of GaSb inside the apertures and lattice mismatch accommodation via the formation of a regular array of misfit dislocations at the interface between GaSb and GaAs. We highlight the impact of the nano-stripe orientation as well as the role of the Sb/Ga flux ratio on the strain relaxation of GaSb along the [110] direction and on the nanowire length along the [1-10] one. Finally we demonstrate how these GaSb nanotemplates can be used as pedestals for subsequent growth of in-plane InAs nanowires.

Impact of P/In flux ratio and epilayer thickness on faceting for nanoscale selective area growth of InP by molecular beam epitaxy

The impact of the P/In flux ratio and the deposited thickness on the faceting of InP nanostructures selectively grown by molecular beam epitaxy (MBE) is reported. Homoepitaxial growth of InP is performed inside 200 nm wide stripe openings oriented either along a [110] or [1-10] azimuth in a 10 nm thick SiO2 film deposited on an InP(001) substrate. When varying the P/In flux ratio, no major shape differences are observed for [1-10]-oriented apertures. On the other hand, the InP nanostructure cross sections strongly evolve for [110]-oriented apertures for which (111)B facets are more prominent and (001) ones shrink for large P/In flux ratio values. These results show that the growth conditions allow tailoring the nanocrystal shape. They are discussed in the framework of the equilibrium crystal shape model using existing theoretical calculations of the surface energies of different low-index InP surfaces as a function of the phosphorus chemical potential, directly related to the P/In ratio. Experimental observations strongly suggest that the relative (111)A surface energy is probably smaller than the calculated value. We also discuss the evolution of the nanostructure shape with the InP-deposited thickness.

Influence of nanoscale faceting on the tunneling properties of near broken gap InAs/AlGaSb heterojunctions grown by selective area epitaxy

We report on the selective area molecular beam epitaxy of InAs/AlGaSb heterostructures on a GaSb (001) substrate. This method is used to realize Esaki tunnel diodes with a tunneling area down to 50 nm × 50 nm. The impact of the size reduction on the peak current density of the diode is investigated, and we show how the formation of the InAs facets can deeply affect the band-to-band tunneling properties of the heterostructure. This phenomenon is explained by the surface-dependent incorporation of Si dopant during growth.

Anxiety, depression and suicidal ideation in Lebanese patients undergoing hemodialysis

Anxiety, depression and suicidal thoughts are highly prevalent comorbidities of end-stage-renal-disease (ESRD). There are no studies in Lebanon on the prevalence of these symptoms in Lebanese end-stage-renal-disease patients. Moreover, the association between ESRD on one hand, and anxiety, depression and suicidal ideation on the other has never been established in Lebanon. Groups of patients at a high-risk of development of these symptoms are not determined. The Hospital Anxiety and Depression Score and M.I.N.I (module C) were used to measure the prevalence of anxiety, depression and suicidal ideation in 51 patients from the dialysis center of Hotel-Dieu de France Hospital in Lebanon. In our sample, 45% of included patients suffered from symptoms of anxiety and 50% presented symptoms of depression.The prevalence of suicidal ideation as detected by the M.I.N.I. is at 37%. No patients presented with a high risk of suicide. There was a statistically significant correlation between the existence of organic comorbidities and the presence of symptoms of depression and suicidal ideation. As for anxiety, the association was marginally significant. The results obtained by our study are consistent with those found in studies performed in other societies. The profile of depression- and suicidal ideation-prone patients has been determined. It consists of patients with at least one medical comorbidity to the ESRD. This, in turn, should lead to increased awareness and better treatment of these psychiatric ailments, considering their impact on morbidity and mortality in ESRD.

Suicide in autism spectrum disorders

This review focuses on suicide in patients with Autism Spectrum Disorders (ASD) as well as risk factors and comorbidities of persons with ASD who have attempted suicide. Research was conducted by searching PubMed and Psychinfo for articles. Suicide in ASD is largely understudied. Although suicide is common in clinical samples, we have little knowledge of suicide in persons with ASD in the general population. Comorbidity, particularly with depression and other affective disorders or schizoid disorders and psychotic symptoms, is often reported, so it is difficult to determine if suicidality is associated with ASD or the comorbid disorder. Clinical samples suggest that suicide occurs more frequently in high functioning autism. Physical and sexual abuse, bullying, and changes in routine are precipitating events associated with suicide risk. Persons with ASD present risk factors inherent to their diagnosis (deficit in expression of feelings and thoughts), along with risk factors pertaining to the general population (abuse, depression, anxiety, etc.). The inability of persons with Pervasive Developmental Disorder (PDD) to express emotions and thoughts makes the diagnosis of suicidal ideation difficult and demands important adjustments to traditional psychotherapeutic interventions. More research is needed to determine the incidence of suicidal behaviors in persons with ASD, to identify risk and protective factors, as well as to assess the effectiveness of prevention strategies and interventions.