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Maralakunte M, Gupta V, Grover S, Ahuja CK, Sahoo S, Kishore K, Vyas S, Garg G, Singh P, Govind V. Cross-sectional analysis of whole-brain microstructural changes in adult patients with bipolar and unipolar depression by diffusion kurtosis imaging. Neuroradiol J 2023; 36:176-181. [PMID: 35817080 PMCID: PMC10034704 DOI: 10.1177/19714009221114446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE AND OBJECTIVES More than half of the bipolar depression (BD) subjects are misdiagnosed as unipolar depression (UD) due to lack of objective diagnostic criteria. We aimed to identify microstructural neuronal changes differentiating BD from UD groups using diffusion kurtosis imaging (DKI). The objective of the study is to identify an objective neuro-imaging marker to differentiate BD from UD. MATERIALS AND METHODS A prospective, cross-sectional study included total of 62 subjects with diagnosis of bipolar depression (n = 21), unipolar depression (n = 21), and healthy controls (n = 20). All subjects underwent diffusion-weighted imaging (b = 0,1000,2000) of the whole brain on 3-Tesla MR scanner. DKI data was analyzed using 189 region whole-brain atlas. Eight diffusion and kurtosis metrics including mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), fractional anisotropy (FA), mean kurtosis (MK), axial kurtosis (AK), radial kurtosis (RK), and kurtosis fractional anisotropy (FKA) were measured against these 189 regions. Principle component analysis (PCA) was utilized to identify the most significant regions of the brain. ANOVA with post hoc tests was used for analyzing these regions. RESULTS BD group showed increased MD, RD, decreased AK at the left amygdala and decreased MK and RK at the right hemi-cerebellum. UD group showed increased MK and RK at the right external capsule; and increased AK, MK, and RK at the right amygdala. CONCLUSION The right and left amygdala, right external capsule, and right hemi-cerebellum showed microstructural abnormalities capable of differentiating BD and UD groups. Diffusion imaging especially DKI can aid in management of depression patients.
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Affiliation(s)
| | - Vivek Gupta
- Interventional Neuroradiology, Fortis Hospital, India
| | | | | | | | | | - Sameer Vyas
- Department of Radiodiagnosis and
Imaging, PGIMER, India
| | - Gaurav Garg
- Department of Radiodiagnosis and
Imaging, PGIMER, India
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Weintraub MJ, Ichinose MC, Zinberg J, Done M, Morgan-Fleming GM, Wilkerson CA, Brown RD, Bearden CE, Miklowitz DJ. App-enhanced transdiagnostic CBT for adolescents with mood or psychotic spectrum disorders. J Affect Disord 2022; 311:319-26. [PMID: 35594972 DOI: 10.1016/j.jad.2022.05.094] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/25/2022] [Accepted: 05/15/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Although transdiagnostic forms of cognitive-behavioral therapy (CBT) have been evaluated in individuals with depressive and anxiety disorders, few studies have examined their suitability for more severe disorders, such as recurrent or persistent major depressive disorder, bipolar disorder, or psychotic spectrum disorders. This study examined the acceptability and initial efficacy of an app-enhanced Unified Protocol for Adolescents [UP-A] when including youth with more severe mood disorders or psychotic spectrum disorders. METHODS We first adapted a mobile application (app), based on user-centered feedback from adolescents and their parents, to assist participants in reviewing session content, practicing skills learned in previous treatment sessions, and monitoring symptomatic progress. A total of 24 adolescents (M age = 15.2 years, SD = 1.6) with mood or psychotic spectrum disorders and their parents then participated in an open trial of the app-enhanced group treatment given over 9 weekly sessions. RESULTS Adolescent participants and their parents rated the group treatment and mobile app as acceptable and useful. We observed significant improvements over the 9-week treatment in adolescents' depressive symptoms, attenuated psychotic symptoms, and global functioning. The frequency with which adolescents used the mobile app between sessions was positively related to symptomatic and functional gains. CONCLUSIONS Initial findings suggest the acceptability and feasibility of a mobile app that enabled adolescent participants and their parents to review session content and practice treatment skills. Findings also indicated improvements in psychiatric and functional outcomes among the adolescent participants over the course of the app-enhanced treatment. Randomized clinical trials are needed to evaluate the efficacy of app-enhanced CBT in improving symptoms and functioning in adolescents with mood or psychotic spectrum disorders.
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Mineo L, Rodolico A, Spedicato GA, Aguglia A, Bolognesi S, Concerto C, Cuomo A, Goracci A, Serafini G, Maina G, Fagiolini A, Amore M, Aguglia E. Which mixed depression model? A comparison between DSM-5-defined mixed features and Koukopoulos' criteria. Bipolar Disord 2022; 24:530-538. [PMID: 34846773 DOI: 10.1111/bdi.13166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The criteria of the Diagnostic and Statistical Manual of Mental Disorders 5th edition "with mixed features specifier" (DSM-5 MFS) are considered controversial since they include only typical manic symptoms. By contrast, Koukopoulos developed an alternative model of mixed depression (MxD) focusing primarily on the excitatory component. OBJECTIVE To compare DSM-5 MFS and Koukopoulos' MxD (KMxD) in terms of prevalence, associated clinical variables, and discriminative capacity for bipolar depression in patients with major depressive episode (MDE). METHODS A total of 300 patients with MDE-155 with major depressive disorder and 145 with bipolar disorder (BD)-were recruited. The discriminative capacity of DSM-5 MFS and KMxD criteria for BD was estimated using the area under the curves of receiver operating characteristic (ROC_AUC). The clinical variables associated with these two diagnostic constructs were assessed by performing a logistic regression. RESULTS A total of 44 and 165 patients met the DSM-5 MFS and KMxD criteria, respectively. The ROC_AUCs and their confidence intervals for BD according to DSM-5 MFS and KMxD were 77.0% (72.0%-82.1%) and 71.9% (66.2%-77.7%), respectively. The optimal thresholds (combining sensitivity and specificity measures) for BD diagnosis were ≥1 (77%/68%) for DSM-5 MFS and ≥3 symptoms (78%/66%) for KMxD. However, considering the DSM-5 MFS cut-off (≥3 symptoms), the specificity (97%) increased at the expense of sensitivity (26%). CONCLUSIONS KMxD and DSM-5-MFS showed an overlapping discriminative capacity for bipolar depression. The current diagnostic threshold of DSM-5 MFS did not prove to be very inclusive, if compared with the greater diagnostic sensitivity of KMxD, which also yielded better association with clinical variables related to mixedness.
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Affiliation(s)
- Ludovico Mineo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alessandro Rodolico
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giorgio A Spedicato
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Bolognesi
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Carmen Concerto
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alessandro Cuomo
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Arianna Goracci
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Turin, University Hospital San Luigi Gonzaga, Turin, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Beauchamp-Chalifour P, Pelet S, Belhumeur V, Angers-Goulet M, Bédard L, Belzile EL. Should We Use Bipolar Hemiarthroplasty in Patients ≥70 Years Old With a Femoral Neck Fracture? A Review of Literature and Meta-Analysis of Randomized Controlled Trials. J Arthroplasty 2022; 37:601-608.e1. [PMID: 34915132 DOI: 10.1016/j.arth.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/24/2021] [Accepted: 12/07/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Bipolar (BHA) and unipolar hemiarthroplasties (UHA) are interchangeably used in elderly patients with a displaced femoral neck fracture. We ask if there is a difference between BHA and UHA with regards to hip function, in elderly patients. METHODS Systematic review and meta-analysis was conducted of randomized controlled trials comparing BHA to UHA. The primary outcome was postoperative hip function scores. Secondary outcomes were overall health-related quality of life patient-reported outcomes, acetabular erosion, and postoperative complications. Data sources, last searched on June 1, 2020, were MEDLINE, EMBASE, Cochrane Library, and Web of Science. RESULTS Fourteen randomized controlled trials were eligible for meta-analysis. There was no difference in hip function scores between BHA and UHA (standardized mean difference 0.32, 95% confidence interval [CI] -0.06 to 0.71, n = 1084, I2 = 87%). Patients with BHA with more than 2-year follow-up had better hip function scores (standardized mean difference 0.68, 95% CI 0.18-1.18, n = 700, I2 = 87%). There was no difference in European Quality of life- five dimensions scores with BHA (mean difference 0.08, 95% CI -0.01 to 0.17, n = 967, I2 = 82%). The use of BHA decreased the risk of acetabular erosion (relative risk 0.38, 95% CI 0.17-0.83, n = 1239, I2 = 0%). There was no difference for revision, mortality, infection, and dislocation (I2 = 0%). CONCLUSION There seems to be no difference between BHA and UHA with regards to hip function at 2 years. BHA might decrease the risk of acetabular erosion. There is a need for a large randomized controlled trial with a follow-up >2 years and better measurement tools to assess clinical benefits. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Philippe Beauchamp-Chalifour
- Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Quebec, Canada; Centre de recherche FRQS du CHU de Québec - Hôpital Enfant-Jésus, Québec, Québec, Canada
| | - Stéphane Pelet
- Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Quebec, Canada; Department of Orthopedic Surgery, CHU de Québec - Hôpital Enfant-Jésus, Québec, Québec, Canada; Centre de recherche FRQS du CHU de Québec - Hôpital Enfant-Jésus, Québec, Québec, Canada
| | - Vincent Belhumeur
- Centre de recherche FRQS du CHU de Québec - Hôpital Enfant-Jésus, Québec, Québec, Canada
| | - Mathieu Angers-Goulet
- Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Quebec, Canada; Centre de recherche FRQS du CHU de Québec - Hôpital Enfant-Jésus, Québec, Québec, Canada
| | - Luc Bédard
- Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Quebec, Canada; Department of Orthopedic Surgery, CHU de Québec - Hôpital Enfant-Jésus, Québec, Québec, Canada; Centre de recherche FRQS du CHU de Québec - Hôpital Enfant-Jésus, Québec, Québec, Canada
| | - Etienne L Belzile
- Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Quebec, Canada; Department of Orthopedic Surgery, CHU de Québec - Hôpital Enfant-Jésus, Québec, Québec, Canada; Centre de recherche FRQS du CHU de Québec - Hôpital Enfant-Jésus, Québec, Québec, Canada
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Verwoert M, Vansteensel MJ, Freudenburg ZV, Aarnoutse EJ, Leijten FS, Ramsey NF, Branco MP. Decoding four hand gestures with a single bipolar pair of electrocorticography electrodes. J Neural Eng 2021; 18:10.1088/1741-2552/ac2c9f. [PMID: 34607318 PMCID: PMC8744490 DOI: 10.1088/1741-2552/ac2c9f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/04/2021] [Indexed: 11/12/2022]
Abstract
Objective.Electrocorticography (ECoG) based brain-computer interfaces (BCIs) can be used to restore communication in individuals with locked-in syndrome. In motor-based BCIs, the number of degrees-of-freedom, and thus the speed of the BCI, directly depends on the number of classes that can be discriminated from the neural activity in the sensorimotor cortex. When considering minimally invasive BCI implants, the size of the subdural ECoG implant must be minimized without compromising the number of degrees-of-freedom.Approach.Here we investigated if four hand gestures could be decoded using a single ECoG strip of four consecutive electrodes spaced 1 cm apart and compared the performance between a unipolar and a bipolar montage. For that we collected data of seven individuals with intractable epilepsy implanted with ECoG grids, covering the hand region of the sensorimotor cortex. Based on the implanted grids, we generated virtual ECoG strips and compared the decoding accuracy between (a) a single unipolar electrode (Unipolar Electrode), (b) a combination of four unipolar electrodes (Unipolar Strip), (c) a single bipolar pair (Bipolar Pair) and (d) a combination of six bipolar pairs (Bipolar Strip).Main results.We show that four hand gestures can be equally well decoded using 'Unipolar Strips' (mean 67.4 ± 11.7%), 'Bipolar Strips' (mean 66.6 ± 12.1%) and 'Bipolar Pairs' (mean 67.6 ± 9.4%), while 'Unipolar Electrodes' (61.6 ± 5.9%) performed significantly worse compared to 'Unipolar Strips' and 'Bipolar Pairs'.Significance.We conclude that a single bipolar pair is a potential candidate for minimally invasive motor-based BCIs and encourage the use of ECoG as a robust and reliable BCI platform for multi-class movement decoding.
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Affiliation(s)
- Maxime Verwoert
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Mariska J. Vansteensel
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Zachary V. Freudenburg
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Erik J. Aarnoutse
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Frans S.S. Leijten
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Nick F. Ramsey
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Mariana P. Branco
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
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Ravindran AV, McKay MS, Silva TD, Tindall C, Garfinkel T, Paric A, Ravindran L. Breathing-focused Yoga as Augmentation for Unipolar and Bipolar Depression: A Randomized Controlled Trial: Le yoga axé sur la respiration comme traitement d'appoint pour la dépression unipolaire et bipolaire: Un essai randomisé contrôlé. Can J Psychiatry 2021; 66:159-169. [PMID: 32677851 PMCID: PMC7918867 DOI: 10.1177/0706743720940535] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Patients with depression frequently experience persistent residual symptoms even with optimal interventions. These patients often use complementary treatments, including yoga, as a preferred alternative or adjunctive treatment. There is evidence for the benefit of yoga for depression, but this has not been rigorously evaluated, particularly in bipolar depression. We aimed to determine the feasibility and benefit of manualized breathing-focused yoga in comparison to psychoeducation as augmentation to pharmacotherapy for improving residual symptoms of depression in unipolar and bipolar patients. METHODS Using a randomized single-blind crossover design, 72 outpatients with unipolar or bipolar depression were augmented with the two 8-week interventions at separate times, as add-ons to current first-line antidepressants and mood stabilizers. The primary outcome measure was the Montgomery-Åsberg Depression Rating Scale (MADRS). Due to the high dropout of participants after crossover at Week 8, analysis focused on between-group comparisons of yoga and psychoeducation during the initial 8 weeks of the study. RESULTS There was a significant decline in depressive symptoms, as measured by the MADRS, following 8 weeks of yoga. However, there was no significant difference in MADRS ratings between intervention groups. Similar improvements in self-rated depressive symptoms and well-being were also observed across time. CONCLUSIONS Both yoga and psychoeducation may improve residual symptoms of unipolar and bipolar depression as add-on to medications. In-class group sessions and long study durations may reduce feasibility for this population. Larger trials with parallel group design and shorter duration may be more feasible.
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Affiliation(s)
- Arun V Ravindran
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Martha S McKay
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Tricia da Silva
- Institute of Medical Science, University of Toronto, Ontario, Canada
| | - Claudia Tindall
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Angela Paric
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lakshmi Ravindran
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
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Cuomo A, Aguglia A, Aguglia E, Bolognesi S, Goracci A, Maina G, Mineo L, Rucci P, Sillari S, Fagiolini A. Mood spectrum symptoms during a major depressive episode: Differences between 145 patients with bipolar disorder and 155 patients with major depressive disorder. Arguments for a dimensional approach. Bipolar Disord 2020; 22:385-391. [PMID: 31630470 DOI: 10.1111/bdi.12855] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies have challenged the traditional unipolar-bipolar dichotomy in favor of a more dimensional approach. OBJECTIVE To evaluate the differences in mood spectrum between patients with bipolar disorder (BD) and major depressive disorder (MDD) during a major depressive episode (MDE). METHOD Study participants were 145 patients with BD and 155 patients with MDD recruited at three University Medical Centers in Italy. All study subjects met Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for MDE and completed the Mood Spectrum-Self-Report-Last Month questionnaire. RESULTS Patients with BD endorsed more items in the mood manic/hypomanic and energy depressive subdomains of the MOODS-SR questionnaire. Significant differences were also found for specific depressive and manic items, which were more frequently endorsed by patients with BD. A large number of patients with BD, but also a considerable number of patients with MDD, endorsed manic items during a depressive episode. CONCLUSIONS There are differences between BD and MDD in terms of the number and type of mood spectrum items that are endorsed during a MDE, which may help to identify patients with BD when a retrospective assessment of a history of mania or hypomania is not possible or not reliable. A high number of patients with BD and a considerable number of patients with MDD endorsed several items in the manic section of the mood, energy, and cognition domains, this confirming the centrality of mixed features in patients with mood disorders and the need for a unitary, dimensional, descriptive and dynamic approach to MDD and BD, such as the recently proposed ACE (Activity, Cognition, Energy) model.
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Affiliation(s)
- Alessandro Cuomo
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics Maternal and Child Health, University of Genova, Genova, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Simone Bolognesi
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Arianna Goracci
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Giuseppe Maina
- Department of Mental Health, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, University of Torino, Torino, Italy
| | - Ludovico Mineo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Paola Rucci
- Department of Medicine and Public Health - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Silvia Sillari
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics Maternal and Child Health, University of Genova, Genova, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
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Kazour F, Richa S, Char CA, Atanasova B, El-Hage W. Olfactory Memory in Depression: State and Trait Differences between Bipolar and Unipolar Disorders. Brain Sci 2020; 10:E189. [PMID: 32214029 DOI: 10.3390/brainsci10030189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Changes in olfactory recognition memory may constitute sensory markers in depression. Significant differences may exist between unipolar and bipolar depression. Our study compares olfactory memory between control, unipolar, and bipolar patients in depressed and euthymic states in order to identify potential markers of depression. Methods: 176 participants were recruited in 5 groups: depressed bipolar (DB), euthymic bipolar (EB), depressed unipolar (DU), euthymic unipolar (EU), and controls (HC). The participants had a standardized clinical and olfactory assessment (olfactory memory, evaluation of pleasantness, intensity, familiarity, and emotional aspect of smells). Results: DU, DB, and EU patients had a deficit in olfactory memory compared to HC. DB patients had lower capacity to recognize new odors. DB and DU patients had more limited detection of unfamiliar odors than HC. DB patients rated odors as less pleasant compared to the other groups. All groups had lower hedonic ratings than HC. DB patients had lower emotional ratings than EU patients. Conclusions: Olfactory memory is impaired in depressive states, thus constituting a state marker of depression. Impairments in olfactory memory persist after remission of bipolar depression, thus constituting a possible trait marker of bipolarity. Hedonic rating differentiates unipolar from bipolar depression. This is the first study that identifies a sensory marker differentiating between unipolar and bipolar depression.
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Foucher JR, Gawlik M, Roth JN, de Crespin de Billy C, Jeanjean LC, Obrecht A, Mainberger O, Clauss JME, Elowe J, Weibel S, Schorr B, Cetkovich M, Morra C, Rebok F, Ban TA, Bollmann B, Roser MM, Hanke MS, Jabs BE, Franzek EJ, Berna F, Pfuhlmann B. Wernicke-Kleist-Leonhard phenotypes
of endogenous psychoses: a review of their validity
. Dialogues Clin Neurosci 2020; 22:37-49. [PMID: 32699504 PMCID: PMC7365293 DOI: 10.31887/dcns.2020.22.1/jfoucher] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
While the ICD-DSM paradigm has been a major advance in clinical psychiatry, its usefulness for biological psychiatry is debated. By defining consensus-based disorders rather than empirically driven phenotypes, consensus classifications were not an implementation of the biomedical paradigm. In the field of endogenous psychoses, the Wernicke-Kleist-Leonhard (WKL) pathway has optimized the descriptions of 35 major phenotypes using common medical heuristics on lifelong diachronic observations. Regarding their construct validity, WKL phenotypes have good reliability and predictive and face validity. WKL phenotypes come with remarkable evidence for differential validity on age of onset, familiality, pregnancy complications, precipitating factors, and treatment response. Most impressive is the replicated separation of high- and low-familiality phenotypes. Created in the purest tradition of the biomedical paradigm, the WKL phenotypes deserve to be contrasted as credible alternatives with other approaches currently under discussion.
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Affiliation(s)
- Jack R Foucher
- ICube - CNRS UMR 7357, neurophysiology, FMTS, University of Strasbourg, France ; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France
| | - Micha Gawlik
- Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Julian N Roth
- Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Clément de Crespin de Billy
- ICube - CNRS UMR 7357, neurophysiology, FMTS, University of Strasbourg, France; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France
| | - Ludovic C Jeanjean
- IICube - CNRS UMR 7357, neurophysiology, FMTS, University of Strasbourg, France; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France
| | - Alexandre Obrecht
- ICube - CNRS UMR 7357, neurophysiology, FMTS, University of Strasbourg, France; Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, France
| | - Olivier Mainberger
- ICube - CNRS UMR 7357, neurophysiology, FMTS, University of Strasbourg, France. CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, France
| | - Julie M E Clauss
- Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, France. SAGE - CNRS UMR 7363, FMTS, University of Strasbourg, France
| | - Julien Elowe
- Department of Psychiatry, Prangins Psychiatric Hospital (CHUV), Route de Benex, Prangins, Switzerland
| | - Sébastien Weibel
- IPôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, France; Physiopathologie et Psychopathologie Cognitive de la Schizophrénie - INSERM 1114, FMTS, University of Strasbourg, France
| | - Benoit Schorr
- Pôle de Psychiatrie, Santé Mentale et Addictologie, University Hospital Strasbourg, France; Physiopathologie et Psychopathologie Cognitive de la Schizophrénie - INSERM 1114, FMTS, University of Strasbourg, France
| | - Marcelo Cetkovich
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Carlos Morra
- ICube - CNRS UMR 7357, neurophysiology, FMTS, University of StInstitute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Sanatorio Morra, Córdoba, Argentina
| | - Federico Rebok
- "Servicio de Emergencia", Acute Inpatient Unit, Moyano Neuropsychiatric Hospital, Buenos Aires, Argentina
| | - Thomas A Ban
- International Network for the History of Neuropsychopharmacology (INHN), Córdoba, Argentina
| | - Barbara Bollmann
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Berlin, Germany
| | - Mathilde M Roser
- Department of Psychiatry, Mondor Hospital France, Creteil, France
| | - Markus S Hanke
- Universitäre psychiatrische Dienste Bern, Spiez, Switzerland
| | - Burkhard E Jabs
- Klinik für Psychiatrie and Psychotherapie, Städtisches Klinikum Dresden, Dresden, Germany
| | - Ernst J Franzek
- Yes We Can Clinics, Department of Research and Development, Eindhoven, The Netherlands
| | - Fabrice Berna
- Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany; Department of Psychiatry, Prangins Psychiatric Hospital (CHUV), Route de Benex, Prangins, Switzerland
| | - Bruno Pfuhlmann
- IKlinik für Psychiatrie and Psychotherapie, Städtisches Klinikum Dresden, Dresden, Germany
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10
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de Bakker JM. Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias. Pacing Clin Electrophysiol 2019; 42:1503-1516. [PMID: 31609005 PMCID: PMC6916598 DOI: 10.1111/pace.13817] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 12/27/2022]
Abstract
The extracellular electrogram is caused by transmembrane currents that flow into extracellular space during propagation of the electrical impulse. Electrograms are usually recorded in unipolar or bipolar mode that have different characteristics, but provide complementary information. Both recording modes have specific advantages, but also suffer from disadvantages. Techniques to circumvent some of the weaknesses are reviewed. The origin of remote and fractionated deflections and their relation with electrode characteristics are discussed. Epicardial and endocardial sites of origin and breakthrough sites as well as the effect of fatty tissue on extracellular electrograms are presented. Induction of tachycardia to assess the arrhythmogenic area is not always possible because of hemodynamic instability of the patient. Techniques to assess sites with high reentry vulnerability without induction of arrhythmias are outlined such as activation‐repolarization mapping and decremental stimulation. Pitfalls of substrate mapping and techniques to avoid them as omnipolar mapping and characterization of complex electrograms by entropy are presented. Technical aspects that influence electrogram morphology as electrode size, filtering, contact force, and catheter position are delineated. Data from the various publications suggest that a combination of unipolar and bipolar electrogram analysis techniques is helpful to optimize determination of target sites for ablation.
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Affiliation(s)
- Jacques Mt de Bakker
- Heart Center, Department of Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands
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11
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Coleman MY, McGlashan EM, Vidafar P, Phillips AJK, Cain SW. Advanced melatonin onset relative to sleep in women with unmedicated major depressive disorder. Chronobiol Int 2019; 36:1373-1383. [PMID: 31368377 DOI: 10.1080/07420528.2019.1644652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Studies on circadian timing in depression have produced variable results, with some investigations suggesting phase advances and others phase delays. This variability may be attributable to differences in participant diagnosis, medication use, and methodology between studies. This study examined circadian timing in a sample of unmedicated women with and without unipolar major depressive disorder. Participants were aged 18-28 years, had no comorbid medical conditions, and were not taking medications. Eight women were experiencing a major depressive episode, nine had previously experienced an episode, and 31 were control participants with no history of mental illness. Following at least one week of actigraphic sleep monitoring, timing of salivary dim light melatonin onset (DLMO) was assessed in light of <1 lux. In currently depressed participants, melatonin onset occurred significantly earlier relative to sleep than in controls, with a large effect size. Earlier melatonin onset relative to sleep was also correlated with poorer mood for all participants. Our results indicate that during a unipolar major depressive episode, endogenous circadian phase is advanced relative to sleep time. This is consistent with the early-morning awakenings often seen in depression. Circadian misalignment may represent a precipitating or perpetuating factor that could be targeted for personalized treatment of major depression.
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Affiliation(s)
- Michelle Y Coleman
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University , Clayton , Australia
| | - Elise M McGlashan
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University , Clayton , Australia
| | - Parisa Vidafar
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University , Clayton , Australia
| | - Andrew J K Phillips
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University , Clayton , Australia
| | - Sean W Cain
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University , Clayton , Australia
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12
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Jelinek L, Faissner M, Moritz S, Kriston L. Long-term efficacy of Metacognitive Training for Depression (D-MCT): A randomized controlled trial. Br J Clin Psychol 2018; 58:245-259. [PMID: 30556583 DOI: 10.1111/bjc.12213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/29/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The availability of treatment for depression needs to be improved. Among the barriers are the dearth of group programmes and the high demand of many programmes with regard to staff expertise. The Metacognitive Training for Depression (D-MCT) is a new, easy-to-administer, cognitive behaviour-based group intervention. In a previous 6-month trial, D-MCT was highly accepted by patients and efficacious compared to a control treatment. The aim of the current study was to examine whether the effects of the D-MCT can be sustained over 3.5 years. DESIGN Long-term follow-up of a randomized controlled trial. METHODS A total of 84 patients with a confirmed diagnosis of unipolar depressive disorder were enrolled in a randomized, controlled, assessor-blind, parallel group trial comparing two interventions added to usual care: D-MCT and general health training (HT). Patients were reassessed 3.5 years after the interventions were terminated. Primary outcome was the Hamilton Depression Rating Scale. Self-assessed depressive symptom severity (BDI), dysfunctional cognitive (DAS) and metacognitive (MCQ) beliefs, self-esteem (RSE), and quality of life (WHOQOL-BREF) served as secondary outcomes. RESULTS Primary intention-to-treat analyses using analysis of covariance showed negative results, and only secondary post-hoc analyses utilizing latent growth modelling demonstrated superiority of D-MCT over HT with regard to the long-term course of depressive symptom severity and cognitive and metacognitive outcomes as well as physical and psychological quality of life. CONCLUSIONS Findings suggest that D-MCT may be a promising add-on treatment for unipolar depression that should be investigated in large multi-centre studies. Independent replications are needed. PRACTITIONER POINTS Clinical implications: The current study shows tentative evidence that positive effects of the D-MCT reported at the 6-month follow-up assessment were sustained over 3.5 years. Potential positive effects regard severity of depression, dysfunctional cognitive, and metacognitive beliefs as well as quality of life. If positive results are replicated with less trained therapists, D-MCT offers the possibility of providing a simple and easy-to-administer CBT-based group treatment for depression with long lasting effects. LIMITATIONS Sample size was small; a large-scale multi-centre trial would be desirable to gain high statistical power with an adequate sample size and to allow the investigation of possible allegiance effects. D-MCT was delivered as an add-on intervention and not as a stand-alone intervention.
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Affiliation(s)
- Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Mirjam Faissner
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
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13
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Bruschi A, Mazza M, Camardese G, Calò S, Palumbo C, Mandelli L, Callea A, Gori A, Di Nicola M, Marano G, Berk M, di Sciascio G, Janiri L. Psychopathological Features of Bipolar Depression: Italian Validation of the Bipolar Depression Rating Scale (I-BDRS). Front Psychol 2018; 9:1047. [PMID: 29977223 PMCID: PMC6022061 DOI: 10.3389/fpsyg.2018.01047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 06/04/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Aim of the study was the validation of the Bipolar Disorder Rating Scale (BDRS) in an Italian population. Secondary aim was the evaluation of differences between unipolar and bipolar depression and between bipolar I and II depressed patients. Method: 125 Bipolar Disorder and 60 Major Depressive Disorder patients were administered an Italian translation of the BDRS (I-BDRS), Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS) and Temperament and Character Inventory-Revised (TCI-R). Results: I-BDRS showed considerable validity and reliability. Factor analysis found 3 subscales, two linked to depressive symptoms and one to mixed symptoms. Measures concerning depression (MADRS and HAM-D) were positively related to the I-BDRS's subscales, but mostly to the two subscales measuring depression. In mixed symptoms, the mean of the bipolar group was significantly higher than the unipolar group suggesting that the BDRS was able to distinguish between unipolar and bipolar depressed patients. Conclusion: I-BDRS is a valid scale for the measurement of depression in BD patients, with a notable internal consistency (Cronbach's α 0.82), a significant consistency between items/total (Cronbach's α from 0.80 to 0.82) and positive correlation with other scales (MADRS r = 0.67, p < 0.001; HDRS r = 0.81, p < 0.001; YMRS r = 0.46 p < 0.0001). The mixed state sub-scale shows usefulness in differentiating bipolar from unipolar patients. I-BDRS could be a sensitive tool, both in pure depression and in mixed states, and could be used in the everyday screening and treatment of Bipolar Disorder.
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Affiliation(s)
- Angelo Bruschi
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Rome, Italy.,Istituto di Psicopatologia, Rome, Italy.,Department of Mental Health, ASL Viterbo, Rome, Italy
| | - Marianna Mazza
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Camardese
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| | - Salvatore Calò
- Department of Psychiatry, Policlinico Hospital Bari, Bari, Italy.,Department of Mental Health, ASL Lecce, Lecce, Italy
| | - Claudia Palumbo
- Department of Psychiatry, Policlinico Hospital Bari, Bari, Italy.,Esine Hospital, ASST Valcamonica, Esine, Italy
| | - Laura Mandelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Alessio Gori
- Department of Human Science, LUMSA University, Rome, Italy.,Department of Education and Psychology, University of Florence, Florence, Italy
| | - Marco Di Nicola
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| | - Giuseppe Marano
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia.,Orygen Youth Health Research Centre, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | | | - Luigi Janiri
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Rome, Italy
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14
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Chen H, Wang Z, Shang Y. Clinical and Radiographic Outcomes of Unipolar and Bipolar Radial Head Prosthesis in Patients with Radial Head Fracture: A Systemic Review and Meta-Analysis. J INVEST SURG 2018; 31:178-184. [PMID: 28901795 DOI: 10.1080/08941939.2017.1299262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare clinical outcomes of unipolar and bipolar radial head prosthesis in the treatment of patients with radial head fracture. MATERIALS AND METHODS Medline, Cochrane, EMBASE, Google Scholar databases were searched until April 18, 2016 using the following search terms: radial head fracture, elbow fracture, radial head arthroplasty, implants, prosthesis, unipolar, bipolar, cemented, and press-fit. Randomized controlled trials, retrospective, and cohort studies were included. RESULTS The Mayo elbow performance score (MEPS), disabilities of the arm, shoulder, and hand (DASH) score, radiologic assessment, ROM, and grip strength following elbow replacement were similar between prosthetic devices. The pooled mean excellent/good ranking of MEPS was 0.78 for unipolar and 0.73 for bipolar radial head arthroplasty, and the pooled mean MEPS was 86.9 and 79.9, respectively. DASH scores for unipolar and bipolar prosthesis were 19.0 and 16.3, respectively. Range of motion outcomes were similar between groups, with both groups have comparable risk of flexion arc, flexion, extension deficit, rotation arc, pronation, and supination (p values <0.001 for both unipolar and bipolar prosthesis). However, bipolar radial head prosthesis was associated with an increased chance of heterotopic ossification and lucency (p values ≤0.049) while unipolar prosthesis was not (p values ≥0.088). Both groups had risk for development of capitellar osteopenia or erosion/wear (p values ≤0.039). CONCLUSION Unipolar and bipolar radial head prostheses were similar with respect to clinical outcomes. Additional comparative studies are necessary to further compare different radial head prostheses used to treat radial head fracture.
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Affiliation(s)
- Hongwei Chen
- a Department of Orthopedics , Wenzhou Medical College-Affiliated Yiwu Central Hospital , Yiwu, Zhejiang , China
| | - Ziyang Wang
- a Department of Orthopedics , Wenzhou Medical College-Affiliated Yiwu Central Hospital , Yiwu, Zhejiang , China
| | - Yongjun Shang
- b Department of Orthopedics , Dalian University Affiliated Xinhua Hospital , Dalian , Liaoning , China
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15
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Growden TA, Zhang W, Brown ER, Storm DF, Meyer DJ, Berger PR. Near-UV electroluminescence in unipolar-doped, bipolar-tunneling GaN/AlN heterostructures. Light Sci Appl 2018; 7:17150. [PMID: 30839526 PMCID: PMC6060061 DOI: 10.1038/lsa.2017.150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 10/05/2017] [Accepted: 10/23/2017] [Indexed: 06/09/2023]
Abstract
Cross-gap light emission is reported in n-type unipolar GaN/AlN double-barrier heterostructure diodes at room temperature. Three different designs were grown on semi-insulating bulk GaN substrates using molecular beam epitaxy (MBE). All samples displayed a single electroluminescent spectral peak at 360 nm with full-width at half-maximum (FWHM) values no greater than 16 nm and an external quantum efficiency (EQE) of ≈0.0074% at 18.8 mA. In contrast to traditional GaN light emitters, p-type doping and p-contacts are completely avoided, and instead, holes are created in the GaN on the emitter side of the tunneling structure by direct interband (that is, Zener) tunneling from the valence band to the conduction band on the collector side. The Zener tunneling is enhanced by the high electric fields (~5 × 106 V cm-1) created by the notably large polarization-induced sheet charge at the interfaces between the AlN and GaN.
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Affiliation(s)
- Tyler A Growden
- Department of Electrical and Computer Engineering, The Ohio State University, Columbus, Ohio 43210, USA
| | - Weidong Zhang
- Departments of Physics and Electrical Engineering, Wright State University, Dayton, Ohio 45435, USA
| | - Elliott R Brown
- Departments of Physics and Electrical Engineering, Wright State University, Dayton, Ohio 45435, USA
| | - David F Storm
- US Naval Research Laboratory, Washington, DC 20375, USA
| | - David J Meyer
- US Naval Research Laboratory, Washington, DC 20375, USA
| | - Paul R Berger
- Department of Electrical and Computer Engineering, The Ohio State University, Columbus, Ohio 43210, USA
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16
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Patten SB, Williams JVA, Lavorato DH, Wang JL, Jetté N, Sajobi TT, Fiest KM, Bulloch AGM. Patterns of association of chronic medical conditions and major depression. Epidemiol Psychiatr Sci 2018; 27:42-50. [PMID: 27784343 DOI: 10.1017/S204579601600072X] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
AIMS Age and sex-related patterns of association between medical conditions and major depressive episodes (MDE) are important for understanding disease burden, anticipating clinical needs and for formulating etiological hypotheses. General population estimates are especially valuable because they are not distorted by help-seeking behaviours. However, even large population surveys often deliver inadequate precision to adequately describe such patterns. In this study, data from a set of national surveys were pooled to increase precision, supporting more precise characterisation of these associations. METHODS The data were from a series of Canadian national surveys. These surveys used comparable sampling strategies and assessment methods for MDE. Chronic medical conditions were assessed using items asking about professionally diagnosed medical conditions. Individual-level meta-analysis methods were used to generate unadjusted, stratified and adjusted prevalence odds ratios for 11 chronic medical conditions. Random effects models were used in the meta-analysis. A procedure incorporating rescaled replicate bootstrap weights was used to produce 95% confidence intervals. RESULTS Overall, conditions characterised by pain and inflammation tended to show stronger associations with MDE. The meta-analysis uncovered two previously undescribed patterns of association. Effect modification by age was observed in varying degrees for most conditions. This effect was most prominent for high blood pressure and cancer. Stronger associations were found in younger age categories. Migraine was an exception: the strength of association increased with age, especially in men. Second, especially for conditions predominantly affecting older age groups (arthritis, diabetes, back pain, cataracts, effects of stroke and heart disease) confounding by age was evident. For each condition, age adjustment resulted in strengthening of the associations. In addition to migraine, two conditions displayed distinctive patterns of association. Age adjusted odds ratios for thyroid disease reflected a weak association that was only significant in women. In epilepsy, a similar strength of association was found irrespective of age or sex. CONCLUSIONS The prevalence of MDE is elevated in association with most chronic conditions, but especially those characterised by inflammation and pain. Effect modification by age may reflect greater challenges or difficulties encountered by young people attempting to cope with these conditions. This pattern, however, does not apply to migraine or epilepsy. Neurobiological changes associated with these conditions may offset coping-related effects, such that the association does not weaken with age. Prominent confounding by age for several conditions suggests that age adjustments are necessary in order to avoid underestimating the strength of these associations.
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17
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Abstract
BACKGROUND An extensive body of literature has demonstrated that many patients who have been asked to participate in clinical trials do not fully understand the informed consent forms. A parallel independent study has demonstrated that opposites have a special status in human cognitive organization: they are common to all-natural languages and are intuitively and naturally understood and learnt. PURPOSE The study investigates whether, and how, the use of opposites impacts on doctor-patient communication: does using the terms "small-large" to describe a nodule (ie, bipolar communication) rather than speaking in terms of centimeters (ie, unipolar communication) affect a patient's understanding of the situation? And is it better to speak of "common-rare" side effects (ie, bipolar communication) instead of the number of people who have suffered from particular side effects (ie, unipolar communication)? METHODS Two questionnaires were created and used, one presenting the information in terms of opposites (ie, bipolar communication) and another using unipolar communication. RESULTS The participants' perception of their situation (in terms of feeling healthy-ill, being at high-low risk, and their treatment requiring high-low commitment) varied in the two conditions. Moreover, self-reported levels of understanding and satisfaction with how the information was communicated were higher when opposites were used. LIMITATIONS Since this is the first study that addresses the merits of using bipolar structures versus unipolar structures in doctor-patient communication, further work is needed to consolidate and expand on the results, involving not only simulated but also real diagnostic contexts. CONCLUSION The encouraging results imply that further testing of the use of opposites in informed consent forms and in doctor-patient communication is strongly advisable.
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Affiliation(s)
- Roberto Burro
- Department of Human Sciences, University of Verona, Verona, Italy
- Correspondence: Roberto Burro, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria 27, 37129 Verona, Italy, Email
| | - Ugo Savardi
- Department of Human Sciences, University of Verona, Verona, Italy
| | | | - Paolo De Paoli
- National Cancer Institute IRCCS ‘Centro di Riferimento Oncologico’ (CRO), Aviano, Italy
| | - Ivana Bianchi
- Department of Humanities (Section Philosophy and Human Sciences), University of Macerata, Macerata, Italy
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18
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Pantzar A, Atti AR, Fratiglioni L, Fastbom J, Bäckman L, Laukka EJ. Cognitive performance in unipolar old-age depression: a longitudinal study. Int J Geriatr Psychiatry 2017; 32:675-684. [PMID: 27246314 DOI: 10.1002/gps.4510] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/02/2016] [Accepted: 04/22/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Previous studies on cognitive deficits in acute and remitted states of old-age depression have shown mixed findings. The episodic nature of depression makes repeated assessment of cognitive performance important in order to address reversibility and stability of cognitive deficits. METHODS Dementia-free older participants (≥60 years) from the population-based Swedish National Study on Aging and Care in Kungsholmen who completed neuropsychological testing at baseline (T1) and follow-up (T2) formed the basis of the study sample. Participants were grouped according to depression status at T1 and T2: depressed-remitted (n = 32), remitted-depressed (n = 45), and nondepressed-depressed (n = 29). These groups were compared with a group of randomly selected and matched (age, gender, education, and follow-up time) healthy controls (n = 106) over a period of maximum 6 years. RESULTS Mixed ANCOVAs, controlling for age and gender, revealed depression-related deficits for processing speed, attention, executive function, and category fluency. In remitted states, only processing speed and attention were affected. However, these deficits were attenuated after exclusion of persons using benzodiazepine medications. A general pattern of cognitive decline was observed across all groups for processing speed, executive function, category fluency, and episodic and semantic memory; persons transitioning from a nondepressed to depressed state tended to show exacerbated cognitive decline. CONCLUSIONS The results support the notion that cognitive deficits in depression may be more transient than stable. Consequently, cognitive deficits in depression might be regarded as potential treatment targets rather than stable vulnerabilities. As such, repeated assessment of cognitive functioning may provide an additional marker of treatment response.
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Affiliation(s)
- Alexandra Pantzar
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Anna Rita Atti
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Bologna University, Bologna, Italy
| | - Laura Fratiglioni
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Johan Fastbom
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lars Bäckman
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Erika J Laukka
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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19
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Stahl SM, Morrissette DA, Faedda G, Fava M, Goldberg JF, Keck PE, Lee Y, Malhi G, Marangoni C, McElroy SL, Ostacher M, Rosenblat JD, Solé E, Suppes T, Takeshima M, Thase ME, Vieta E, Young A, Zimmerman M, McIntyre RS. Guidelines for the recognition and management of mixed depression. CNS Spectr 2017; 22:203-19. [PMID: 28421980 DOI: 10.1017/S1092852917000165] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A significant minority of people presenting with a major depressive episode (MDE) experience co-occurring subsyndromal hypo/manic symptoms. As this presentation may have important prognostic and treatment implications, the DSM-5 codified a new nosological entity, the "mixed features specifier," referring to individuals meeting threshold criteria for an MDE and subthreshold symptoms of (hypo)mania or to individuals with syndromal mania and subthreshold depressive symptoms. The mixed features specifier adds to a growing list of monikers that have been put forward to describe phenotypes characterized by the admixture of depressive and hypomanic symptoms (e.g., mixed depression, depression with mixed features, or depressive mixed states [DMX]). Current treatment guidelines, regulatory approvals, as well the current evidentiary base provide insufficient decision support to practitioners who provide care to individuals presenting with an MDE with mixed features. In addition, all existing psychotropic agents evaluated in mixed patients have largely been confined to patient populations meeting the DSM-IV definition of "mixed states" wherein the co-occurrence of threshold-level mania and threshold-level MDE was required. Toward the aim of assisting clinicians providing care to adults with MDE and mixed features, we have assembled a panel of experts on mood disorders to develop these guidelines on the recognition and treatment of mixed depression, based on the few studies that have focused specifically on DMX as well as decades of cumulated clinical experience.
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20
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Moore BF, Lachiewicz PF. Corrosion and adverse tissue reaction after modular unipolar hip hemiarthroplasty. Arthroplast Today 2017; 3:207-210. [PMID: 29204481 PMCID: PMC5712032 DOI: 10.1016/j.artd.2017.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 12/28/2022] Open
Abstract
Modern unipolar hip hemiarthroplasty, commonly used for displaced femoral neck fracture, is now modular, with both a variable length cobalt-chromium adapter-sleeve and large femoral head. Patients with these modular components may develop symptomatic trunnion corrosion, with elevated serum metal levels. We report the case of an 82-year-old woman, 5.5 years after a modular unipolar hip hemiarthroplasty, who presented with a 4-month history of hip pain and limp. Evaluation showed elevated serum cobalt and chromium levels and an acetabular cyst. At revision, fluid, tissue, and gross inspection were consistent with trunnion corrosion. The hip was revised with a ceramic head and dual mobility acetabular component, with a good result at 1 year. The designs of commercially available, modern unipolar hip hemiarthroplasty prostheses are reviewed.
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Affiliation(s)
- Brian F. Moore
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Paul F. Lachiewicz
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
- Chapel Hill Orthopedics Surgery & Sports Medicine, Chapel Hill, NC, USA
- Corresponding author. 417 Lyons Road, Chapel Hill, NC 27514, USA. Tel.: +1 919 260 1717.417 Lyons RoadChapel HillNC27514USA
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21
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Kalita KN, Hazarika J, Sharma M, Saikia S, Patangia P, Hazarika P, Sarmah AC. Sociodemographic Correlates of Unipolar and Bipolar Depression in North-East India: A Cross-sectional Study. Indian J Psychol Med 2017; 39:46-51. [PMID: 28250558 PMCID: PMC5329991 DOI: 10.4103/0253-7176.198949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Early diagnosis and management of depression is important for better therapeutic outcome. Strategies for distinguishing between unipolar and bipolar depression are yet to be defined, resulting improper management. This study aims at comparing the socio-demographic and other variables between patients with unipolar and bipolar depression, along with assessment of severity of depression. MATERIALS AND METHODS This cross sectional study was conducted in a tertiary care psychiatry hospital in North-East India. The study included total of 330 subjects selected through purposive sampling technique from outpatient department after obtaining due informed consent. Mini-International Neuropsychiatric Interview (M.I.N.I.) version 6.0 and Beck Depression Inventory (BDI) were applied. Statistical Package for Social Sciences (SPSS) version 16.0 was applied for analysis. RESULTS Bipolar group had onset of illness at significantly younger age with more chronicity (32.85 ± 11.084). Mean BDI score was significantly higher in the unipolar depressive group. CONCLUSION Careful approach in eliciting symptom severity and associated socio demographic profiles in depressed patients may be helpful in early diagnosis of bipolar depression.
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Affiliation(s)
- Kamal Narayan Kalita
- Department of Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
| | - Jyoti Hazarika
- Department of Microbiology, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
| | - Mohan Sharma
- Department of Bio Technology Research Project, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
| | - Shilpi Saikia
- Department of Bio Technology Research Project, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
| | - Priyanka Patangia
- Department of Bio Technology Research Project, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
| | - Pranabjyoti Hazarika
- Department of Bio Technology Research Project, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
| | - Anil Chandra Sarmah
- Department of Pathology, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
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22
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Roy KK, Metta S, Kansal Y, Kumar S, Singhal S, Vanamail P. A Prospective Randomized Study Comparing Unipolar Versus Bipolar Hysteroscopic Myomectomy in Infertile Women. J Hum Reprod Sci 2017; 10:185-193. [PMID: 29142447 PMCID: PMC5672724 DOI: 10.4103/jhrs.jhrs_134_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Study Objective: To compare the operative and reproductive outcome of hysteroscopic myomectomy using unipolar resectoscope versus bipolar resectoscope in patients with infertility and menorrhagia. Design: Randomized, prospective, parallel, comparative, single-blinded study. Design Classification: Canadian Task Force classification I. Setting: Tertiary care institute. Patients: Sixty women with submucous myoma and infertility. Interventions: Hysteroscopic myomectomy performed with unipolar resectoscope or bipolar resectoscope. Measurements: Primary outcome measures were the pregnancy-related indicators. Secondary outcome measures were the operative parameters, harmful outcomes related to the procedure, and comparison of improvement levels in the menstrual pattern after surgery between the two groups. Main Results: A total of 60 patients were randomized into two groups of equal size. Baseline characteristics were not significantly different between the two groups. Reduction in sodium level from pre- to postsurgery was significantly (P = 0.001) higher in the unipolar group. Nine patients (30%) in the unipolar group had hyponatremia in the postoperative period compared to none in the bipolar group (P = 0.002). However, there was no significant difference in the other operative parameters between the two groups. In both the groups, a significant improvement in the menstrual symptoms was observed after myomectomy. Pregnancy-related outcomes were similar in both the groups. Conclusion: The use of bipolar resectoscope for hysteroscopic myomectomy is associated with lesser risk of hyponatremia compared to unipolar resectoscope. Bipolar resectoscopic myomectomy is found to be an effective and safer alternative to unipolar resectoscopy with similar reproductive outcome.
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Affiliation(s)
- Kallol K Roy
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Metta
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Yamini Kansal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Perumal Vanamail
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Grosso MJ, Danoff JR, Murtaugh TS, Trofa DP, Sawires AN, Macaulay WB. Hemiarthroplasty for Displaced Femoral Neck Fractures in the Elderly Has a Low Conversion Rate. J Arthroplasty 2017; 32:150-154. [PMID: 27480829 DOI: 10.1016/j.arth.2016.06.048] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/19/2016] [Accepted: 06/27/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hemiarthroplasty (HA) has been a mainstay treatment for displaced femoral neck fractures for many years. The purpose of this study was to report the conversion rate of HA to total hip arthroplasty (THA) for displaced femoral neck fractures and compare outcomes between implant constructs (bipolar vs unipolar), fixation options (cemented vs cementless stems), and age groups (<75 years vs ≥75 years). METHODS We retrospectively reviewed the results of a consecutive cohort of 686 patients who underwent HA for the treatment of femoral neck fractures at our institution between 1999 and 2013 with a minimum of 2-year follow-up. RESULTS The overall component revision rate, including conversion to THA, revision HA, revision with open reduction internal fixation, and Girdlestone procedure, was 5.6% (39/686). Seventeen patients (2.5%) were converted from HA to THA at an average of 1.9 years after index procedure. A significantly lower conversion rate of 1.4% (7/499 patients) was found in the older patient cohort (≥75 years old) compared to 5.3% (11/187) in the younger cohort. The most common causes for conversion surgery to THA were acetabular wear (5 patients), aseptic loosening (4 patients), and periprosthetic fracture (3 patients). There was a significantly lower rate of periprosthetic fracture (0.4% vs 2.5%, P value .025) in the cemented implant group compared to the cementless group. We observed a higher rate of dislocations in the bipolar vs unipolar group (3.8% vs 1%, P value .02) and no other significant differences between these groups. CONCLUSION We observed a low reoperation rate for this cohort of patients, relatively higher conversion rates for the younger population, fewer periprosthetic fractures with the use of cemented stems, and no advantage of bipolar over unipolar prostheses.
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Affiliation(s)
- Matthew J Grosso
- Center for Hip & Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Jonathan R Danoff
- Center for Hip & Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Taylor S Murtaugh
- Center for Hip & Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - David P Trofa
- Center for Hip & Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Andrew N Sawires
- Center for Hip & Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - William B Macaulay
- Center for Hip & Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York
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24
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Grosso MG, Danoff JR, Padgett DE, Iorio R, Macaulay WB. The Cemented Unipolar Prosthesis for the Management of Displaced Femoral Neck Fractures in the Dependent Osteopenic Elderly. J Arthroplasty 2016; 31:1040-6. [PMID: 26742902 DOI: 10.1016/j.arth.2015.11.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/14/2015] [Accepted: 11/24/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Significant variability exists across orthopedic surgeons in the management of the displaced femoral neck fracture in the elderly patient (>75 years old). These patients tend to be less healthy, have inferior bone quality, and gait instability leading to increased risk of periprosthetic fracture, compromised implant fixation, dislocation, and need for revision. The surgeon's goals should be to restore mobility while eliminating pain and need for reoperation. METHODS In this review article, we examine the best available evidence in the literature to determine which strategy achieves optimal outcomes. We examine outcome studies comparing use of hemiarthroplasty and total hip arthroplasty, unipolar and bipolar hemiarthroplasty, and cemented vs cementless fixation of femoral stems. RESULTS AND CONCLUSIONS For the active, healthy, and lucid patient, or one who has preexisting groin pain, who sustains a displaced femoral neck fracture, the literature supports a total hip arthroplasty. Patients sustaining a displaced femoral neck fracture and who are less active, have decreased bone mass, and are at increased risk of falls would benefit most from a device that optimally balances the need for revision surgery, restores ambulation, and eliminates pain. Thus, the current evidence favors cemented, unipolar hemiarthroplasty for the dependent osteopenic elderly patient with a displaced femoral neck fracture.
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25
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Mohari N, Starr JP, Gates RN, Domico MB, Batra AS. Bipolar Versus Unipolar Temporary Epicardial Ventricular Pacing Leads Use in Congenital Heart Disease: A Prospective Randomized Controlled Study. Pacing Clin Electrophysiol 2016; 39:471-7. [PMID: 26920816 DOI: 10.1111/pace.12836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 02/16/2016] [Accepted: 02/21/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND To compare the pacing parameters of unipolar versus bipolar temporary ventricular epicardial pacing leads. DESIGN Prospective Randomized Unblinded Controlled Study. PATIENTS AND METHODS Fifty patients undergoing surgery for congenital heart disease who were anticipated to require temporary ventricular pacing leads were recruited preoperatively: 25 patients were randomized to receive unipolar temporary ventricular epicardial pacing leads; the remaining 25 were randomized to receive bipolar temporary ventricular epicardial leads. The baseline characteristics of the groups were similar. The pacing parameters were measured daily for up to first seven postoperative days (PODs) with the day of surgery recorded as POD 0. RESULTS On the day of insertion, the mean pacing and sensing thresholds were similar for both unipolar and bipolar leads. Thresholds progressively deteriorated with each subsequent POD. By POD 4, the mean ± standard deviation pacing threshold of ventricular bipolar lead was 2.87 ± 0.37 mA compared with 5.6 ± 0.85 mA for the unipolar leads (P = 0.005). The decrease in sensing threshold of the unipolar ventricular pacing leads was significantly more than that of bipolar leads (by POD 5, 5.7 ± 2.64 vs 10.33 ± 2.8, P = 0.01). CONCLUSIONS Our study shows that the bipolar leads (Medtronic 6495, Medtronic Inc., Minneapolis, MN, USA) have superior sensing and pacing thresholds in the ventricular position in patients undergoing surgery for congenital heart disease when compared to the unipolar leads (Medical Concepts Europe VF608ABB, Medical Concepts Europe Inc., Buffalo, NY, USA).
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Affiliation(s)
- Nivedita Mohari
- Division of Pediatric Critical Care Medicine, Harbor-UCLA Medical Center, Los Angeles, California.,Division of Pediatric Critical Care Medicine, Children's Hospital of Orange County, Orange, California
| | - Joanne P Starr
- Division of Cardiothoracic Surgery, Children's Hospital of Orange County, Orange, California
| | - Richard N Gates
- Division of Cardiothoracic Surgery, Children's Hospital of Orange County, Orange, California
| | - Michele B Domico
- Division of Pediatric Critical Care Medicine, Children's Hospital of Orange County, Orange, California
| | - Anjan S Batra
- Department of Cardiology, University of California, Irvine, Irvine, California
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26
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Roy KK, Kansal Y, Subbaiah M, Kumar S, Sharma JB, Singh N. Hysteroscopic septal resection using unipolar resectoscope versus bipolar resectoscope: Prospective, randomized study. J Obstet Gynaecol Res 2014; 41:952-6. [PMID: 25491475 DOI: 10.1111/jog.12646] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 10/18/2014] [Indexed: 11/28/2022]
Abstract
AIM To compare the operation and reproductive outcome of hysteroscopic septal resection using unipolar resectoscope verses bipolar resectoscope. METHODS In this prospective randomized study, 70 women underwent hysteroscopic septal resection using either unipolar resectoscope or bipolar resectoscope. Intraoperative parameters (operation time, fluid deficit and complications) and pre- and postoperative serum sodium levels were compared between the two groups. A second-look hysteroscopy was performed after 6 weeks. All pregnancies occurring during the follow-up period were recorded. RESULTS There was no statistically significant difference between the two groups in terms of operation parameters and second-look hysteroscopy findings. Six patients in the unipolar group were found to have hyponatremia in the postoperative period compared to none in the bipolar group (P = 0.025). Regarding reproductive outcome, the difference between the two groups was not significant. CONCLUSION The use of bipolar resectoscope is associated with lesser risk of hyponatremia compared to unipolar resectoscope. Bipolar resectoscopy is a safe alternative to unipolar resectoscopy with similar reproductive outcome.
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Affiliation(s)
- Kallol Kumar Roy
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Yamini Kansal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Murali Subbaiah
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Bhagwan Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neeta Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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27
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Choi KS, Holtzheimer PE, Franco AR, Kelley ME, Dunlop BW, Hu XP, Mayberg HS. Reconciling variable findings of white matter integrity in major depressive disorder. Neuropsychopharmacology 2014; 39:1332-9. [PMID: 24352368 PMCID: PMC3988550 DOI: 10.1038/npp.2013.345] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 11/14/2013] [Accepted: 11/26/2013] [Indexed: 01/19/2023]
Abstract
Diffusion tensor imaging (DTI) has been used to evaluate white matter (WM) integrity in major depressive disorder (MDD), with several studies reporting differences between depressed patients and controls. However, these findings are variable and taken from relatively small studies often using suboptimal analytic approaches. The presented DTI study examined WM integrity in large samples of medication-free MDD patients (n=134) and healthy controls (n=54) using voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) approaches, and rigorous statistical thresholds. Compared with health control subjects, MDD patients show no significant differences in fractional anisotropy, radial diffusivity, mean diffusivity, and axonal diffusivity with either the VBM or the TBSS approach. Our findings suggest that disrupted WM integrity does not have a major role in the neurobiology of MDD in this relatively large study using optimal imaging acquisition and analysis; however, this does not eliminate the possibility that certain patient subgroups show WM disruption associated with depression.
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Affiliation(s)
- Ki Sueng Choi
- Department of Psychiatry, Emory University, Atlanta, GA, USA,The Wallace H Coulter, Department of Biomedical Engineering, Biomedical, Imaging Technology Center, Georgia Institute of Technology, Emory University, Atlanta, GA, USA,Department of Psychiatry, Emory University or The Wallace H Coulter, Department of Biomedical Engineering, Biomedical, Imaging Technology Center, Georgia Institute of Technology, Emory University, 101 Woodruff Circle WMB 4306, Atlanta, GA 30345, USA, Tel: +404 727 5528, E-mail:
| | - Paul E Holtzheimer
- Department of Psychiatry, Emory University, Atlanta, GA, USA,Departments of Psychiatry and Surgery, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Alexandre R Franco
- Department of Electrical Engineering, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Mary E Kelley
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Boadie W Dunlop
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | - Xiaoping P Hu
- The Wallace H Coulter, Department of Biomedical Engineering, Biomedical, Imaging Technology Center, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Helen S Mayberg
- Department of Psychiatry, Emory University, Atlanta, GA, USA,Department of Neurology, Emory University, Atlanta, GA, USA
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Belzung C. Innovative drugs to treat depression: did animal models fail to be predictive or did clinical trials fail to detect effects? Neuropsychopharmacology 2014; 39:1041-51. [PMID: 24345817 PMCID: PMC3957126 DOI: 10.1038/npp.2013.342] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 12/13/2013] [Accepted: 12/13/2013] [Indexed: 02/07/2023]
Abstract
Over recent decades, encouraging preclinical evidence using rodent models pointed to innovative pharmacological targets to treat major depressive disorder. However, subsequent clinical trials have failed to show convincing results. Two explanations for these rather disappointing results can be put forward, either animal models of psychiatric disorders have failed to predict the clinical effectiveness of treatments or clinical trials have failed to detect the effects of these new drugs. A careful analysis of the literature reveals that both statements are true. Indeed, in some cases, clinical efficacy has been predicted on the basis of inappropriate animal models, although the contrary is also true, as some clinical trials have not targeted the appropriate dose or clinical population. On the one hand, refinement of animal models requires using species that have better homological validity, designing models that rely on experimental manipulations inducing pathological features, and trying to model subtypes of depression. On the other hand, clinical research should consider carefully the results from preclinical studies, in order to study these compounds at the correct dose, in the appropriate psychiatric nosological entity or symptomatology, in relevant subpopulations of patients characterized by specific biomarkers. To achieve these goals, translational research has to strengthen the dialogue between basic and clinical science.
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Affiliation(s)
- Catherine Belzung
- INSERM 930 and Université François Rabelais Tours, UFR Sciences et Techniques, Parc Grandmont, Tours, France,INSERM 930 and Université François Rabelais Tours, UFR Sciences et Techniques, Parc Grandmont, Tours 37200, France. Tel:+33 2 47 36 69 94; Fax:+33 2 47 36 72 85; E-mail:
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29
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Robison AJ, Vialou V, Sun HS, Labonte B, Golden SA, Dias C, Turecki G, Tamminga C, Russo S, Mazei-Robison M, Nestler EJ. Fluoxetine epigenetically alters the CaMKIIα promoter in nucleus accumbens to regulate ΔFosB binding and antidepressant effects. Neuropsychopharmacology 2014; 39:1178-86. [PMID: 24240473 DOI: 10.1038/npp.2013.319] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/28/2013] [Accepted: 11/08/2013] [Indexed: 01/08/2023]
Abstract
Chronic social defeat stress in mice produces a susceptible phenotype characterized by several behavioral abnormalities consistent with human depression that are reversed by chronic but not acute exposure to antidepressant medications. Recent work in addiction models demonstrates that the transcription factor ΔFosB and protein kinase calmodulin-dependent protein kinase II (CaMKII) are co-regulated in nucleus accumbens (NAc), a brain reward region implicated in both addiction and depression models including social defeat. Previous work has also demonstrated that ΔFosB is induced in NAc after chronic social defeat stress or after chronic antidepressant treatment, wherein it mediates a pro-resilience or antidepressant-like phenotype. Here, using chromatin immunoprecipitation assays, we found that ΔFosB binds the CaMKIIα gene promoter in NAc and that this binding increases after mice are exposed to chronic social defeat stress. Paradoxically, chronic exposure to the antidepressant fluoxetine reduces binding of ΔFosB to the CaMKIIα promoter and reduces CaMKII expression in NAc, despite the fact that ΔFosB is induced under these conditions. These data suggest a novel epigenetic mechanism of antidepressant action, whereby fluoxetine induces some chromatin change at the CaMKIIα promoter, which blocks the ΔFosB binding. Indeed, chronic fluoxetine reduces acetylation and increases lysine-9 dimethylation of histone H3 at the CaMKIIα promoter in NAc, effects also seen in depressed humans exposed to antidepressants. Overexpression of CaMKII in NAc blocks fluoxetine's antidepressant effects in the chronic social defeat paradigm, whereas inhibition of CaMKII activity in NAc mimics fluoxetine exposure. These findings suggest that epigenetic suppression of CaMKIIα expression in NAc is behaviorally relevant and offer a novel pathway for possible therapeutic intervention in depression and related syndromes.
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Brown ES, Hughes CW, McColl R, Peshock R, King KS, Rush AJ. Association of depressive symptoms with hippocampal volume in 1936 adults. Neuropsychopharmacology 2014; 39:770-9. [PMID: 24220026 PMCID: PMC3895255 DOI: 10.1038/npp.2013.271] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/04/2013] [Accepted: 09/14/2013] [Indexed: 12/28/2022]
Abstract
Hippocampal atrophy is reported in major depressive disorder (MDD). However, sample sizes were generally modest, and participant characteristics, including age, differed between studies. This study used a community sample to examine relationships between current depressive symptom severity and hippocampal volume across the adult lifespan. A total of 1936 adults with magnetic resonance images of the brain and Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) scores were included. Brain volumes were quantified using the FSL program. Multiple linear regressions were performed using left, right, and total hippocampal volume as criterion variables, and predictor variables of QIDS-SR total, total brain volume, age, gender, education, psychotropic medications, alcohol use, and race/ethnicity. Post hoc analyses were conducted in participants with QIDS-SR scores 11 (moderate or greater depressive symptom severity) and <11, and older and younger adults. In the primary analysis (sample as a whole) QIDS-SR was inversely associated with total hippocampal volume (b=-0.044, p=0.032, (CI-0.019 to -0.001)) but not with left or right hippocampal volume evaluated individually. In participants with QIDS-SR scores of <11, hippocampal volumes were not associated with QIDS-SR scores. In those with QIDS-SR scores 11 total, right, and left hippocampal volumes were modestly, but significantly, associated with QIDS-SR scores. The association between QIDS-SR scores and the hippocampal volume was much stronger in older persons. Findings suggest smaller hippocampal volumes among those with greater reported depressive symptom severity-an association that is strongest in people with at least moderate depressive symptom levels.
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Affiliation(s)
- E Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. MC 8849, Dallas, TX 75390-8849, USA, Tel: +1 214 645 6950, Fax: +1 214 645 6951, E-mail:
| | - Carroll W Hughes
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Roderick McColl
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ronald Peshock
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kevin S King
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Douglas J, Scott J. A systematic review of gender-specific rates of unipolar and bipolar disorders in community studies of pre-pubertal children. Bipolar Disord 2014; 16:5-15. [PMID: 24305108 DOI: 10.1111/bdi.12155] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 07/20/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Gender-specific rates of unipolar and bipolar disorders are well established for cases with post-pubertal onset. However, there is less certainty about these rates in pre-pubertal children. We undertook a systematic review of community studies that report gender-specific rates for unipolar and bipolar disorders in young children, particularly cases of major depression and mania. METHOD Computer databases (Medline, EMBASE, Index to Theses, and PsychInfo) were searched for non-clinical observational studies using recognized diagnostic criteria to identify unipolar and bipolar disorders in children aged ≤ 12 years. A meta-analysis was undertaken to calculate pooled odds ratios (ORs) for caseness for major depression by gender. The limited data on bipolar disorder were summarized. RESULTS Analysis of 12 studies (>15,000 children), indicated that the community prevalence of unipolar disorders was higher in boys (1.3%) than in girls (0.8%). Rates of major depression were low (0.61%), but boys were significantly more likely to meet diagnostic criteria than girls (OR = 1.61; 95% confidence interval: 1.11-2.35). Five studies, assessing >5,000 children, identified only one case with a probable diagnosis of mania. CONCLUSIONS This systematic review suggests that boys aged ≤ 12 years are significantly more likely to experience major depression than girls. However, in younger children, community rates of major depression are low, and it is frequently suggested (but not proven) that most cases are comorbid. The absence of mania suggests either that childhood bipolar phenotypes do not resemble post-pubertal onset cases or that there are problems of case ascertainment.
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Affiliation(s)
- Jessica Douglas
- Department of Paediatric Clinical Psychology, Children's Services, Addenbrooke's Hospital, Cambridge, UK; Institute of Neuroscience, University of Newcastle, Newcastle, UK
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Kong E, Monje FJ, Hirsch J, Pollak DD. Learning not to fear: neural correlates of learned safety. Neuropsychopharmacology 2014; 39:515-27. [PMID: 23963118 PMCID: PMC3895233 DOI: 10.1038/npp.2013.191] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/05/2013] [Accepted: 07/13/2013] [Indexed: 12/16/2022]
Abstract
The ability to recognize and properly respond to instances of protection from impending danger is critical for preventing chronic stress and anxiety-central symptoms of anxiety and affective disorders afflicting large populations of people. Learned safety encompasses learning processes, which lead to the identification of episodes of security and regulation of fear responses. On the basis of insights into the neural circuitry and molecular mechanisms involved in learned safety in mice and humans, we describe learned safety as a tool for understanding neural mechanisms involved in the pathomechanisms of specific affective disorders. This review summarizes our current knowledge on the neurobiological underpinnings of learned safety and discusses potential applications in basic and translational neurosciences.
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Affiliation(s)
- Eryan Kong
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Francisco J Monje
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Joy Hirsch
- Department of Neuroscience, Columbia University, New York, NY, USA
- fMRI Research Center, Columbia University, New York, NY, USA
- Department of Radiology, Columbia University, New York, NY, USA
- Department of Psychology, Columbia University, New York, NY, USA
| | - Daniela D Pollak
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
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Halcomb ME, Gould TD, Grahame NJ. Lithium, but not valproate, reduces impulsive choice in the delay-discounting task in mice. Neuropsychopharmacology 2013; 38:1937-44. [PMID: 23584261 PMCID: PMC3746699 DOI: 10.1038/npp.2013.89] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 03/15/2013] [Accepted: 03/19/2013] [Indexed: 12/14/2022]
Abstract
Both lithium and valproate are well-established treatments for bipolar disorder. Studies have also found that lithium is effective at reducing suicidal behaviors in patients with mood disorders. Impulsivity is a validated endophenotype of both bipolar disorder and suicidal behavior. We assessed effects of treatment with lithium or valproate on cognitive impulsivity in selectively bred mice previously shown to manifest relatively high levels of cognitive impulsivity. Mice were trained in the delay-discounting paradigm, a measure of cognitive impulsivity reflecting a behavioral bias towards immediacy, and then treated with lithium, valproate, or control chow. After 3 weeks of drug treatment, mice were tested at various delays to a large, delayed reward. Drug treatment continued during this time. Lithium reduced impulsivity, whereas valproate had no effect on choice behavior. Both drugs increased the number of choice trials and reinforcer intake, but effects on choice behavior did not depend on these motivational changes. To our knowledge, this is the first study demonstrating lithium's effects to reduce cognitive impulsivity. Future studies may focus on the ability of putative pharmacotherapies for patients at risk for bipolar disorder or suicide to modify the impulsive choice dimension of this diseases.
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Affiliation(s)
- Meredith E Halcomb
- Department of Psychology, Indiana University Purdue University, Indianapolis, IN, USA
| | - Todd D Gould
- Departments of Psychiatry, Pharmacology, Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nicholas J Grahame
- Department of Psychology, Indiana University Purdue University, Indianapolis, IN, USA,Department of Psychology, Indiana University Purdue University, 402 N. Blackford St, LD120F, Indianapolis, IN 46205, USA, Tel: +1 317 274 0194, Fax: +1 317 274 6756, E-mail:
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Abstract
The muscarinic cholinergic receptor system has been implicated in the pathophysiology of depression, with physiological evidence indicating this system is overactive or hyperresponsive in depression and with genetic evidence showing that variation in genes coding for receptors within this system are associated with higher risk for depression. In studies aimed at assessing whether a reduction in muscarinic cholinergic receptor function would improve depressive symptoms, the muscarinic receptor antagonist scopolamine manifested antidepressant effects that were robust and rapid relative to conventional pharmacotherapies. Here, we review the data from a series of randomized, double-blind, placebo-controlled studies involving subjects with unipolar or bipolar depression treated with parenteral doses of scopolamine. The onset and duration of the antidepressant response are considered in light of scopolamine's pharmacokinetic properties and an emerging literature that characterizes scopolamine's effects on neurobiological systems beyond the cholinergic system that appear relevant to the neurobiology of mood disorders. Scopolamine infused at 4.0 μg/kg intravenously produced robust antidepressant effects versus placebo, which were evident within 3 days after the initial infusion. Placebo-adjusted remission rates were 56% and 45% for the initial and subsequent replication studies, respectively. While effective in male and female subjects, the change in depression ratings was greater in female subjects. Clinical improvement persisted more than 2 weeks following the final infusion. The timing and persistence of the antidepressant response to scopolamine suggest a mechanism beyond that of direct muscarinic cholinergic antagonism. These temporal relationships suggest that scopolamine-induced changes in gene expression and synaptic plasticity may confer the therapeutic mechanism.
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Lotrich FE, Albusaysi S, Ferrell RE. Brain-derived neurotrophic factor serum levels and genotype: association with depression during interferon-α treatment. Neuropsychopharmacology 2013; 38:985-95. [PMID: 23303061 DOI: 10.1038/npp.2012.263] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Depression has been associated with inflammation, and inflammation may both influence and interact with growth factors such as brain-derived neurotrophic factor (BDNF). Both the functional Val66Met BDNF polymorphism (rs6265) and BDNF levels have been associated with depression. It is thus plausible that decreased BDNF could mediate and/or moderate cytokine-induced depression. We therefore prospectively employed the Beck Depression Inventory-II (BDI-II), the Hospital Anxiety and Depression Scale (HADS), and the Montgomery-Asberg Depression Rating Scale (MADRS) in 124 initially euthymic patients during treatment with interferon-alpha (IFN-α), assessing serum BDNF and rs6265. Using mixed-effect repeated measures, lower pretreatment BDNF was associated with higher depression symptoms during IFN-α treatment (F144,17.2=6.8; P<0.0001). However, although the Met allele was associated with lower BDNF levels (F1,83.0=5.0; P=0.03), it was only associated with increased MADRS scores (F4,8.9=20.3; P<0.001), and not the BDI-II or HADS. An exploratory comparison of individual BDI-II items indicated that the Met allele was associated with suicidal ideation, sadness, and worthlessness, but not neurovegetative symptoms. Conversely, the serotonin transporter promoter polymorphism (5-HTTLPR) short allele was associated with neurovegetative symptoms such as insomnia, poor appetite and fatigue, but not sadness, worthlessness, or suicidal ideation. IFN-α therapy further lowered BDNF serum levels (F4,37.7=5.0; P=0.003), but this decrease occurred regardless of depression development. The findings thus do not support the hypothesis that decreasing BDNF is the primary pathway by which IFN-α worsens depression. Nonetheless, the results support the hypothesis that BDNF levels influence resiliency against developing inflammatory cytokine-associated depression, and specifically to a subset of symptoms distinct from those influenced by 5-HTTLPR.
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Epps SA, Tabb KD, Lin SJ, Kahn AB, Javors MA, Boss-Williams KA, Weiss JM, Weinshenker D. Seizure susceptibility and epileptogenesis in a rat model of epilepsy and depression co-morbidity. Neuropsychopharmacology 2012; 37:2756-63. [PMID: 22871911 PMCID: PMC3499730 DOI: 10.1038/npp.2012.141] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Although a strong co-morbidity exists clinically between epilepsy and depression, the cause of this co-morbidity remains unknown, and a valid animal model is crucial for the identification of underlying mechanisms and the development of a screening tool for novel therapies. Although some rodent models of epilepsy have been reported to display behaviors relevant to affective disorders, the seizure susceptibility of animals prone to depression-like behavior has not been characterized. Toward this end, we assessed several forms of seizure sensitivity and epileptogenesis in rats selectively bred for vulnerability (Swim Lo-Active; SwLo) or resilience (Swim High-Active; SwHi) to depression-like phenotypes. The SwLo rats exhibit decreased motor activity in a swim test and other depression-like phenotypes, whereas the SwHi rats display increased motor activity in a swim test. SwLo rats exhibited a decreased latency to limbic motor seizures following acute pilocarpine administration in the absence of differences in pilocarpine pharmacokinetics, and also had a decreased threshold to tonic seizures induced by electroshock. Approximately half of the SwLo rats, but none of the SwHi rats, had spontaneous limbic motor seizures 5 weeks following pilocarpine-induced status epilepticus. While the number of stimulations required to achieve full amygdala and hippocampal electrical kindling were similar in the two rat lines, SwLo rats had a lower final hippocampal kindling threshold and more wet dog shakes during both amygdala and hippocampal kindling. Combined, these results indicate that SwLo rats are a model of epilepsy and depression co-morbidity that can be used for investigating underlying neurobiological and genetic mechanisms and screening novel therapeutics.
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Affiliation(s)
- S Alisha Epps
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Kroshona D Tabb
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Sharon J Lin
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Alexa B Kahn
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Martin A Javors
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
| | | | - Jay M Weiss
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - David Weinshenker
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA,Department of Human Genetics, Emory University School of Medicine, Whitehead 301, 615 Michael St, Atlanta, GA 30322, USA, Tel: +404 727 3106, Fax: +404 727 3949, E-mail:
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Nollet M, Gaillard P, Tanti A, Girault V, Belzung C, Leman S. Neurogenesis-independent antidepressant-like effects on behavior and stress axis response of a dual orexin receptor antagonist in a rodent model of depression. Neuropsychopharmacology 2012; 37:2210-21. [PMID: 22713907 PMCID: PMC3422486 DOI: 10.1038/npp.2012.70] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Growing evidence indicates that an increase of orexin (or hypocretin) signaling is involved in the pathophysiology of major depression, but little is known regarding the causal link between the orexinergic system and depressive-like states. Here we blocked orexin receptors in mice subjected to unpredictable chronic mild stress (UCMS) to investigate putative antidepressant-like effects of this treatment, as well as the underlying mechanisms. BALB/c mice were exposed to 9 weeks of UCMS and from the third week onward treated daily with fluoxetine (20 mg/kg per day, per os) or with the dual orexin receptor antagonist almorexant (100 mg/kg per day, per os). The effects of UCMS regimen and pharmacological treatments were assessed by physical measures and behavioral testing. The dexamethasone suppression test was performed to examine the integrity of the negative feedback of the hypothalamic-pituitary-adrenal (HPA) axis, and immunohistochemical markers were used to assess cell proliferation (Ki-67), immature newborn neurons (doublecortin), and mature newborn neurons (5-bromo-2'-deoxyuridine/NeuN) in the dorsal and ventral parts of the hippocampus. Our results show that 7 weeks of fluoxetine or almorexant treatments counteract the UCMS-induced physical and behavioral alterations. Both treatments prevented the HPA axis dysregulation caused by UCMS, but only fluoxetine reversed the UCMS-induced decrease of hippocampal cell proliferation and neurogenesis, while chronic almorexant treatment decreased cell proliferation and neurogenesis specifically in the ventral hippocampus. Taken together, this is the first evidence that pharmacological blockade of the orexinergic system induces a robust antidepressant-like effect and the restoration of stress-related HPA axis defect independently from a neurogenic action.
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Affiliation(s)
- Mathieu Nollet
- Inserm U930—Imaging and Brain, Université François Rabelais, UFR Sciences et Techniques, Tours, France
| | - Philippe Gaillard
- Inserm U930—Imaging and Brain, Université François Rabelais, UFR Sciences et Techniques, Tours, France,Clinique Psychiatrique Universitaire, CHRU de Tours, Tours, France
| | - Arnaud Tanti
- Inserm U930—Imaging and Brain, Université François Rabelais, UFR Sciences et Techniques, Tours, France
| | - Virginie Girault
- Inserm U930—Imaging and Brain, Université François Rabelais, UFR Sciences et Techniques, Tours, France
| | - Catherine Belzung
- Inserm U930—Imaging and Brain, Université François Rabelais, UFR Sciences et Techniques, Tours, France
| | - Samuel Leman
- Inserm U930—Imaging and Brain, Université François Rabelais, UFR Sciences et Techniques, Tours, France,UMR Inserm 930—Imaging and Brain, Team 4: Affective Disorders, Université François Rabelais, UFR Sciences et Techniques, Parc Grandmont, 37200 Tours, France, Tel: +33 02 47 36 69 97, Fax: +33 02 47 36 72 85, E-mail:
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Gilman SE, Dupuy JM, Perlis RH. Risks for the transition from major depressive disorder to bipolar disorder in the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2012; 73:829-36. [PMID: 22394428 PMCID: PMC3703739 DOI: 10.4088/jcp.11m06912] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 06/20/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE It is currently not possible to determine which individuals with unipolar depression are at highest risk for a manic episode. This study investigates clinical and psychosocial risk factors for mania among individuals with major depressive disorder (MDD), indicating diagnostic conversion from MDD to bipolar I disorder. METHOD We fitted logistic regression models to predict the first onset of a manic episode among 6,214 cases of lifetime MDD according to DSM-IV criteria in the National Epidemiologic Survey on Alcohol and Related Conditions. Participants in this survey were interviewed twice over a period of 3 years, in 2000-2001 and in 2004-2005, and survey data were gathered using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV. RESULTS Approximately 1 in 25 individuals with MDD transitioned to bipolar disorder during the study's 3-year follow-up period. Demographic risk factors for the transition from MDD to bipolar disorder included younger age, black race/ethnicity, and less than high school education. Clinical characteristics of depression (eg, age at first onset, presence of atypical features) were not associated with diagnostic conversion. However, prior psychopathology was associated with the transition to bipolar disorder: history of social phobia (odds ratio [OR] = 2.20; 95% confidence interval [CI], 1.47-3.30) and generalized anxiety disorder (OR = 1.58; 95% CI, 1.06-2.35). Lastly, we identified environmental stressors over the life course that predicted the transition to bipolar disorder: these include a history of child abuse (OR = 1.26; 95% CI, 1.12-1.42) and past-year problems with one's social support group (OR = 1.79; 95% CI, 1.19-2.68). The overall predictive power of these risk factors based on a receiver operating curve analysis is modest. CONCLUSIONS A wide range of demographic, clinical, and environmental risk factors were identified that indicate a heightened risk for the transition to bipolar disorder. Additional work is needed to further enhance the prediction of bipolar disorder among cases of MDD and to determine whether interventions targeting these factors could reduce the risk of bipolar disorder.
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Moses-Kolko EL, Price JC, Wisner KL, Hanusa BH, Meltzer CC, Berga SL, Grace AA, di Scalea TL, Kaye WH, Becker C, Drevets WC. Postpartum and depression status are associated with lower [[¹¹C]raclopride BP(ND) in reproductive-age women. Neuropsychopharmacology 2012; 37:1422-32. [PMID: 22257897 PMCID: PMC3327847 DOI: 10.1038/npp.2011.328] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The early postpartum period is associated with increased risk for affective and psychotic disorders. Because maternal dopaminergic reward system function is altered with perinatal status, dopaminergic system dysregulation may be an important mechanism of postpartum psychiatric disorders. Subjects included were non-postpartum healthy (n=13), postpartum healthy (n=13), non-postpartum unipolar depressed (n=10), non-postpartum bipolar depressed (n=7), postpartum unipolar (n=13), and postpartum bipolar depressed (n=7) women. Subjects underwent 60 min of [¹¹C]raclopride-positron emission tomography imaging to determine the nondisplaceable striatal D₂/₃ receptor binding potential (BP(ND)). Postpartum status and unipolar depression were associated with lower striatal D₂/₃ receptor BP(ND) in the whole striatum (p=0.05 and p=0.02, respectively) that reached a maximum of 7-8% in anteroventral striatum for postpartum status (p=0.02). Unipolar depression showed a nonsignificant trend toward being associated with 5% lower BP(ND) in dorsal striatum (p=0.06). D₂/₃ receptor BP(ND) did not differ significantly between unipolar depressed and healthy postpartum women or between bipolar and healthy subjects; however, D₂/₃ receptor BP(ND) was higher in dorsal striatal regions in bipolar relative to unipolar depressives (p=0.02). In conclusion, lower striatal D₂/₃ receptor BP(ND) in postpartum and unipolar depressed women, primarily in ventral striatum, and higher dorsal striatal D₂/₃ receptor BP(ND) in bipolar relative to unipolar depressives reveal a potential role for the dopamine (DA) system in the physiology of these states. Further studies delineating the mechanisms underlying these differences in D₂/₃ receptor BP(ND), including study of DA system responsivity to rewarding stimuli, and increasing power to assess unipolar vs bipolar-related differences, are needed to better understand the affective role of the DA system in postpartum and depressed women.
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Affiliation(s)
- Eydie L Moses-Kolko
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
| | - Julie C Price
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Katherine L Wisner
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA,Department of Obstetrics, Gynecology and Reproductive Endocrinology and Infertility, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Barbara H Hanusa
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Carolyn C Meltzer
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA,Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sarah L Berga
- Departments of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Anthony A Grace
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA,Department of Neuroscience and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Teresa Lanza di Scalea
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA,Department of Neurosciences, University of Rome Tor Vergata, Rome, Italy
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Carl Becker
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Wayne C Drevets
- Laureate Institute for Brain Research, Tulsa, OK, USA,Department of Psychiatry, The University of Oklahoma College of Medicine, Tulsa, OK, USA
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Whalley HC, Papmeyer M, Romaniuk L, Johnstone EC, Hall J, Lawrie SM, Sussmann JE, McIntosh AM. Effect of variation in diacylglycerol kinase η (DGKH) gene on brain function in a cohort at familial risk of bipolar disorder. Neuropsychopharmacology 2012; 37:919-28. [PMID: 22048461 DOI: 10.1038/npp.2011.272] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Several lines of evidence indicate that the diacylglycerol kinase eta (DGKH) gene is implicated in the etiology of bipolar disorder (BD). However, the functional neural mechanisms of DGKH's risk association remain unknown. Therefore, we examined the effects of three haplotype-tagging risk variants in DGKH (single nucleotide polymorphisms rs9315885, rs1012053, and rs1170191) on brain activation using a verbal fluency functional magnetic resonance imaging task. The subject groups consisted of young individuals at high familial risk of BD (n=81) and a comparison group of healthy controls (n=75). Individuals were grouped based on risk haplotypes described in previous studies. There was a significant risk haplotype*group interaction in the left medial frontal gyrus (BA10, involving anterior cingulate BA32), left precuneus, and right parahippocampal gyrus. All regions demonstrated greater activation during the baseline condition than sentence completion. Individuals at high familial risk for BD homozygous for the DGKH risk haplotype demonstrated relatively greater activation (poor suppression) of these regions during the task vs the low-risk haplotype subjects. The reverse pattern was seen for the control subjects. These findings suggest that there are differential effects of the DGKH gene in healthy controls vs the bipolar high-risk group, which manifests as a failure to disengage default-mode regions in those at familial risk carrying the risk haplotype.
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Menke A, Domschke K, Czamara D, Klengel T, Hennings J, Lucae S, Baune BT, Arolt V, Müller-Myhsok B, Holsboer F, Binder EB. Genome-wide association study of antidepressant treatment-emergent suicidal ideation. Neuropsychopharmacology 2012; 37:797-807. [PMID: 22030708 DOI: 10.1038/npp.2011.257] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Emergence of suicidal ideation (TESI) during treatment with antidepressants in major depression led to a black box warning. We performed a genome-wide association study to identify genetic markers, which increase the risk for this serious side effect. TESI was evaluated in depressed in-patients (N=397) and defined by an emergence of suicidal thoughts during hospitalization without suicidal thoughts at admission using the suicide item (3) of the Hamilton Depression Rating Scale. Genotype distribution of 405.383 single-nucleotide polymorphisms (SNPs) in patients with TESI (N=32/8.1%) was compared to patients without increase in suicidal ideation (N=329/82.9%) and to a subgroup never reported suicidal ideation (N=79/19.9%). Top results were analyzed in an independent sample (N=501). None variant reached genome-wide significance, the best associated SNP was rs1630535 (p-value=1.3 × 10(-7)). The top 79 SNPs could be analyzed in an independent sample, and 14 variants showed nominal significant association with the same risk allele in the replication sample. A discriminant analysis classifying patients using these 79 SNPs revealed a 91% probability to classify TESI vs non-TESI cases correctly in the replication sample. Although our data need to be interpreted carefully owing to the small numbers in both cohorts, they suggest that a combination of genetic markers might indeed be used to identify patients at risk for TESI.
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Grunebaum MF, Ellis SP, Duan N, Burke AK, Oquendo MA, John Mann J. Pilot randomized clinical trial of an SSRI vs bupropion: effects on suicidal behavior, ideation, and mood in major depression. Neuropsychopharmacology 2012; 37:697-706. [PMID: 21993207 PMCID: PMC3260969 DOI: 10.1038/npp.2011.247] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Randomized controlled trials in depressed patients selected for elevated suicidal risk are rare. The resultant lack of data leaves uncertainty about treatment in this population. This study compared a serotonin reuptake inhibitor with a noradrenergic/dopaminergic antidepressant in major depression with elevated suicidal risk factors. We conducted a double-blind, randomized, clinical pilot trial of paroxetine (N=36) or bupropion (N=38) in DSM IV major depression with a suicide attempt history or current suicidal ideation. The effects during acute (8 weeks) and continuation treatment (up to 16 weeks) were measured. Main outcomes were suicidal behavior and ideation. The secondary outcome was modified 17-item Hamilton Depression Rating Scale score subtracting the suicide item (mHDRS-17). Treatment was not associated with time to a suicidal event and no treatment main effect or treatment × time interaction on suicidal ideation or mHDRS-17 was found. Exploratory model selection showed modest advantages for paroxetine on: (1) mHDRS-17 (p=0.02); and (2) in a separate model adjusted for baseline depression, for suicidal ideation measured with the Beck Scale for Suicidal Ideation (p=0.03), with benefit increasing with baseline severity. Depressed patients with greater baseline suicidal ideation treated with paroxetine compared with bupropion appeared to experience greater acute improvement in suicidal ideation, after adjusting for global depression. Given the lack of evidence-based pharmacotherapy guidelines for suicidal, depressed patients-an important public health population-this preliminary finding merits further study.
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Affiliation(s)
- Michael F Grunebaum
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY 10032, USA.
| | - Steven P Ellis
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Naihua Duan
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Ainsley K Burke
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Maria A Oquendo
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - J John Mann
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
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Llorens-Martín M, Tejeda GS, Trejo JL. Antidepressant and proneurogenic influence of environmental enrichment in mice: protective effects vs recovery. Neuropsychopharmacology 2011; 36:2460-8. [PMID: 21796111 PMCID: PMC3194073 DOI: 10.1038/npp.2011.134] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Physical-cognitive activity has long-lasting beneficial effects on the brain and on behavior. Environmental enrichment (EE) induces brain activity known to influence the behavior of mice, as measured in learned helplessness paradigms (forced swim test), and neurogenic cell populations in the hippocampal dentate gyrus. However, it is not completely clear whether the antidepressant and proneurogenic effects of EE are different in animals that are naive or pre-exposed to the stress inducing helplessness, and if this depends on the type of stressor. It also remains unclear whether differential effects are exerted on distinct neurogenic subpopulations. We found that EE has a protective effect in adult female mice (C57BL/6J) when exposed twice to the same stressor (forced swim test) but it has no influence on recovery. The repeated exposure to this stressor was analyzed together with the effects of EE on different neurogenic populations distinguished by age and differentiation state. Younger cells are more sensitive and responsive to the conditions, both the positive and negative effects. These results are relevant to identify the cell populations that are the targets of stress, depression, and enrichment, and that form part of the mechanism responsible for mood dysfunctions.
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Affiliation(s)
- María Llorens-Martín
- Department of Molecular, Cellular and Developmental Neurobiology, Cajal Institute, CSIC, Madrid, Spain
| | - Gonzalo S Tejeda
- Department of Molecular, Cellular and Developmental Neurobiology, Cajal Institute, CSIC, Madrid, Spain
| | - José L Trejo
- Department of Molecular, Cellular and Developmental Neurobiology, Cajal Institute, CSIC, Madrid, Spain,Department of Molecular, Cellular and Developmental Neurobiology, Cajal Institute, CSIC, Av. Doctor Arce 37, 28002 Madrid, Spain, Tel: +34 91 585 4651, Fax: +34 91 585 4754, E-mail:
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Parsey RV, Ogden RT, Miller JM, Tin A, Hesselgrave N, Goldstein E, Mikhno A, Milak M, Zanderigo F, Sullivan GM, Oquendo MA, Mann JJ. Higher serotonin 1A binding in a second major depression cohort: modeling and reference region considerations. Biol Psychiatry 2010; 68:170-8. [PMID: 20497898 PMCID: PMC2900398 DOI: 10.1016/j.biopsych.2010.03.023] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 02/24/2010] [Accepted: 03/02/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Serotonin 1A receptors (5-HT(1A)) are implicated in major depressive disorder (MDD). We previously reported higher 5-HT(1A) binding potential (BP(F)) in antidepressant naive MDD subjects compared with control subjects, while other studies report lower BP(ND). Discrepancies can be related to differences in study population or methodology. We sought to replicate our findings in a novel cohort and determine whether choice of reference region and outcome measure could explain discrepancies. METHODS Nine new control subjects and 22 new not recently medicated (NRM) MDD subjects underwent positron emission tomography. BP(F) and BP(ND) were determined using a metabolite and free fraction corrected arterial input function. BP(ND) was also determined using cerebellar gray matter (CGM) and cerebellar white matter (CWM) reference regions as input functions. RESULTS BP(F) was higher in the new NRM cohort (p = .037) compared with new control subjects, comparable to the previous cohort (p = .04). Cohorts were combined to examine the reference region and outcome measure. BP(F) was higher in the NRM compared with control subjects (p = .0001). Neither BP(ND) using CWM (p = .86) nor volume of distribution (V(T)) (p = .374) differed between groups. When CGM was used, the NRM group had lower 5-HT(1A) BP(ND) compared with control subjects (p = .03); CGM V(T) was higher in NRM compared with control subjects (p = .007). CONCLUSIONS Choice of reference region and outcome measure can produce different 5-HT(1A) findings. Higher 5-HT(1A) BP(F) in MDD was found with the method with fewest assumptions about nonspecific binding and a reference region without receptors.
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Affiliation(s)
- Ramin V Parsey
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
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Benvenuti A, Rucci P, Calugi S, Cassano GB, Miniati M, Frank E. Relationship of residual mood and panic-agoraphobic spectrum phenomenology to quality of life and functional impairment in patients with major depression. Int Clin Psychopharmacol 2010; 25:68-74. [PMID: 20061961 DOI: 10.1097/YIC.0b013e328333ee8e] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aim of this study was to analyze the relationship of residual mood and panic-agoraphobic spectrum phenomenology to functional impairment and quality of life in 226 adult outpatients who had remitted from a major depressive episode. Quality of life and functioning were assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire and the Work and Social Adjustment Scale. Residual symptoms were assessed using the Mood and Panic-Agoraphobic Spectrum Questionnaires. Linear and logistic regression models were used to analyze the relationship of mood and panic-agoraphobic spectrum factors with quality of life and functioning. Poor quality of life was associated with the Mood Spectrum Self-Report Questionnaire factors 'depressive mood' and 'psychotic features' and the Panic-Agoraphobic Spectrum Self-Report Questionnaire factors 'separation anxiety' and 'loss sensitivity'. Functional impairment was associated with the Mood Spectrum Self-Report Questionnaire factor 'psychomotor retardation' and the Panic-Agoraphobic Spectrum Self-Report Questionnaire factor 'fear of losing control'. These relationships were held after controlling for the severity of depression at the entry in the continuation treatment phase. In conclusion, the spectrum assessment is a useful tool for clinicians to identify areas of residual symptomatology that can be targeted with focused and effective long-term treatment strategies.
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Lee ML, Tsao LY, Chiu HY, Chen M, Chiu IS. Outcomes in neonates with pulmonary atresia and intact ventricular septum underwent pulmonary valvulotomy and valvuloplasty using a flexible 2-French radiofrequency catheter. Yonsei Med J 2009; 50:245-51. [PMID: 19430558 PMCID: PMC2678700 DOI: 10.3349/ymj.2009.50.2.245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 09/22/2008] [Accepted: 09/24/2008] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Outcomes in 6 neonates with pulmonary atresia and intact ventricular septum (PAIVS) undergoing radiofrequency pulmonary valvulotomy and valvuloplasty (RPVV) were reported to identify the factors favorable for RPVV as the treatment of choice. MATERIALS AND METHODS From May 2000 to January 2008, 6 patients with PAIVS were included in this retrospective study. They were aged 1 day to 90 days old. Study modalities included review of recordings of presentations and profiles of chest radiography, electrocardiography, echocardiography, and cardiac catheterization with angiography. Hemodynamic profiles from the echocardiography and the cardiac catheterization were analyzed. RESULTS Echocardiography showed severe tricuspid regurgitation, membranous atresia of the pulmonary valve, intact ventricular septum, patent ductus arteriosus, and hypoplastic right ventricle in 6 patients. The pulmonary valve annulus were 4.2 to 6.9 mm in diameters, and those of the tricuspid valve were 7.1 to 10.1 mm. Elevated serum level of cardiac enzymes were found in 1 patient with ventriculocoronary communication (VCC). At cardiac catheterization, the ratio of systolic pressure of the right ventricle to that of the left ventricle ranged from 1.43 to 2.33 before RPVV, and from 0.54 to 1.15 after RPVV (p=0.027). The pressure gradients ranged from 76 to 136 mmHg before RPVV, and from 15 to 39 mmHg after RPVV (p=0.028). The echocardiographic gradients ranged from 16 to 32 mmHg within 24 hours after RPVV, and from 15 to 50 mmHg at the follow-ups. CONCLUSION RPVV can be a treatment of choice for neonates with PAIVS, if there is patent infundibulum, no right-ventricular dependent coronary circulation, and adequate tricuspid valve and pulmonary valve.
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Affiliation(s)
- Meng-Luen Lee
- Division of Pediatric Cardiology, Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan.
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Abstract
OBJECTIVE The aim of this study was to estimate the incidence of treatment-emergent mania/hypomania (TEMH) and to describe the clinical characteristics of patients with major depression experiencing this event during treatment with a selective serotonin reuptake inhibitor (SSRI) and/or interpersonal psychotherapy (IPT). METHODS Following an algorithm-based protocol, 344 patients with major depression confirmed with the Structured Clinical Interview for DSM-IV disorders were treated with an SSRI, interpersonal psychotherapy, or their combination for nine months. The emergence of mania/hypomania was carefully monitored throughout the study using the Young Mania Rating Scale and clinical assessment. RESULTS Overall, eight patients experienced TEMH. The incidence of this event was 3.0% in patients treated with an SSRI and 0.9% in patients treated with IPT alone. Among patients treated with an SSRI, the difference between sites was higher than expected by chance alone (6.8% at Pisa and 0% at Pittsburgh, p = 0.002). Despite the adoption of an identical protocol at the two sites, some demographic and clinical characteristics of participants may account for this unexpected result. Alternatively, the greater number of episodes and earlier age of onset at the Pittsburgh site suggests that the unipolar course of illness was more clearly established prior to study entry. CONCLUSIONS TEMH is an infrequent event, occurring in 2.3% of patients treated for major depression. Nevertheless, its consequences are clinically relevant and require prompt and appropriate therapeutic interventions. For this reason, recognising those patients at risk for such an event is of paramount clinical significance. The observed difference in the incidence of TEMH between the two sites requires further investigation.
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Affiliation(s)
- Antonella Benvenuti
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Pisa, Italy.
| | - Paola Rucci
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Pisa, Italy
| | - Mario Miniati
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Pisa, Italy
| | - Alessandra Papasogli
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Pisa, Italy
| | - Andrea Fagiolini
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Giovanni B Cassano
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Pisa, Italy
| | - Holly Swartz
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ellen Frank
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Abstract
Mania is a common psychiatric syndrome characterized by pathological mood elevation, grandiose thinking and motor overactivity. Although current consensus upholds a true distinction between unipolar depression and bipolar disorders, the distinction between various bipolar sub-categories is still a matter for debate, as is the exact distinction between schizophrenia and mania. Most cases are functional in origin but many organic causes have been identified as well as iatrogenic causes from prescribed medication, particularly in susceptible individuals. The underlying aetiology is still poorly understood, although a number of biochemical abnormalities have recently been identified, and the evidence for a genetic role is strong. Its prevalence is universal, with some differences between gender and ethnicity reported, and it displays marked Axis I and II comorbidity. Treatment, both acute and long term, still relies on various traditional combinations of neuroleptics, benzodiazepines and mood stabilisers, particularly Lithium, which now appears to be less effective than previously thought and a shift towards using other mood stabilisers from the anticonvulsant class is now apparent. The exact role for psychological treatment remains unclear with more research required. Good medical management includes; adequate treatment, physical and laboratory investigations, dedicated follow-up and supervision by hospital psychiatrists and community-based care agencies.
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Affiliation(s)
- C Tannock
- Consultant Psychiatrist and Honorary Senior Lecturer, The Huntley Centre, University College Hospital, London, UK
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Benazzi F. Prevalence of severe depression in private practice depressed outpatients. Int J Psychiatry Clin Pract 1998; 2:261-4. [PMID: 24927089 DOI: 10.3109/13651509809115371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The prevalence of severe depression, defined by a score of 50 or less on the Global Assessment of Functioning (GAF) scale, and comparisons between severe and non-severe depression, were studied in 203 consecutive unipolar and bipolar depressed outpatients presenting for treatment of depression in private practice. The prevalence of severe degression was 42%. Of the variables investigated (unipolar/bipolar diagnosis, age at baseline/onset, gender, atypical features, psychotic features, comorbidity, chronicity, recurrences, duration of illness, baseline severity), a bipolar I diagnosis and psychotic features were significantly more common in severe depression, while comorbidity and recurrences were significantly more common in non-severe depression. Contrary to the hypothesis that an affective disorder is a progressive illness, the pattern of severe depression did not show more recurrences, more chronicity, or a longer duration of illness than non-severe depression. The findings might be related to the sample studied, as private patients are usually less severely ill than patients in public or university hospitals.
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Affiliation(s)
- F Benazzi
- Senior Psychiatrist, Department of Psychiatry, Morgagni Public Hospital, Forli, Italy
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