Effect of the enhanced external counterpulsation combined with drug on social function and efficacy in patients with depressive episodes / 四川精神卫生

ObjectiveTo observe the effect of the enhanced external counterpulsation （EECP） combined with drug on social function and efficacy in patients with depressive episodes， so as to provide references for the treatment of depressive episodes. MethodsA total of 66 hospitalized patients who was in hospital at department of psychiatry of the Second Xiangya Hospital of Central South University， met the criteria of Diagnostic and Statistical Manual of Mental Disorders，fifth edition（DSM-5） diagnosis of depressive episode or bipolar disorder depressive episode from May 2019 to March 2020 were included by simple random sampling. The participants were divided into study group （n=36） and control group （n=30） according to the random number table method. Both groups received conventional drug treatment， and the study group recieved the EECP intervention at same time. The Depression symptoms and social function were assessed before and after treatment by using Hamilton Depression Scale-24 item （HAMD-24） and Sheehan Disability Scale （SDS）. Treatment efficacy of the two groups was compared. ResultsAfter the intervention， the HAMD-24 and SDS scores in both groups were lower than those before treatment， the differences were statistically significant （t=8.149， 5.791， 8.016， 3.488， P˂0.01）. And the SDS score of the study group was siginficantly lower than that of the control group （t=-3.008， P<0.05）. The total effective rate of treatment in the study group was higher than that of the control group， and the difference was statistically significant （90.63% vs. 63.33%， χ²=8.725， P˂0.05）. ConclusionEECP therapy combined with drug has better efficacy on the patients with depressive episodes， and it can improve social function effectively.

Executive function in adolescent patients with major depressive episode with psychotic symptoms and childhood trauma / 四川精神卫生

BackgroundThere are differences in executive function between major depressive episode patients with or without psychotic symptoms， and childhood trauma may affect the executive function of patients with major depressive episode. Previous research studies predominantly focused on adult patients with major depressive episode， with a lack of studies specifically focusing on adolescent patients with major depressive episode. ObjectiveTo investigate the differences in executive function among adolescent patients with major depressive episode， with or without psychotic symptoms and childhood trauma. MethodsA total of 112 hospitalized adolescent patients with major depressive episode who met the criteria of the International Classification of Diseases， tenth edition （ICD-10） were included in the study. The participants were recruited from the Department of Child and Adolescent Psychiatry， Shenzhen Kangning Hospital during the period from August 2020 to November 2021. Additionally， 27 healthy controls were recruited through public advertisements. The Cambridge Neuropsychological Test Automated Battery （CANTAB） was used to assess executive function through the administration of the Motor Screening Task （MOT）， Spatial Working Memory（SWM） and Rapid Visual Information Processing （RVP） modules. Childhood Trauma Questionnaire-Short Form （CTQ-SF） was used to assess the trauma type. ResultsCompared with healthy controls， adolescent patients with major depressive episode had a longer mean delay （Z=-3.407， P=0.001） in the MOT task. In the SWM task， the patients had a higher total number of intergroup error responses （Z=-3.291， P=0.001）， a higher total number of intragroup error responses （Z=-3.461， P=0.001）， more total number of double error responses （Z=-3.218， P=0.001）， a higher total error responses （Z=-3.312， P=0.001）， higher strategy scores （Z=-2.437， P=0.015） and longer average delay time （Z=-2.055， P=0.040）. In the RVP task， the patients had fewer hits （Z=-3.196， P=0.001）， more misses （Z=-3.179， P=0.001）， fewer rejections （Z=-2.772， P=0.006）， lower hit probability （Z=-3.187， P=0.001） and lower A´ scores （Z=-3.070， P=0.002）.Compared with adolescent patients with major depressive episode without psychotic symptoms， those with psychotic symptoms had a lower total number of double error responses （Z=-2.566， P=0.010） in SWM task. Compared with adolescent patients with major depressive episode who did not experience emotional neglect， those who experienced emotional neglect had longer average delay time （Z=-3.183， P=0.001） in MOT task， fewer total hits （Z=-2.445， P=0.014）， more total missed reports （Z=-2.467， P=0.014）， lower hit probability （Z=-2.445， P=0.014） and lower A´scores （Z=-2.089， P=0.037） in RVP task. Adolescent patients with major depressive episode who had experienced emotional abuse had longer average delay time in MOT task than those who had not experienced emotional abuse （Z=-2.552， P=0.011）. ConclusionAdolescent patients with major depressive episode exhibit abnormalities in a majority of executive function domains. Specifically， those without psychotic symptoms and with childhood trauma demonstrate significantly impaired executive function. ［Funded by Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties （number， SZGS013）， Basic and Applied Basic Research Fund of Guangdong Province （number， 2019A1515110047）， Shenzhen Science and Technology Planning Project （number， JCYJ20190809155019338）］

Mental disorder caused by prion disease misdiagnosed as depressive episode：a case report / 四川精神卫生

This paper reported a case of a 29-year-old male patient with mental disorder caused by prion disease was misdiagnosed as depressive episode with somatic symptoms. The patient's symptoms were initially predominantly psychiatric， with progressive worsening of somatic symptoms， and he died more than 1 year after his first onset. Prion disease caused various manifestations of mental symptoms， which can easily lead to missed diagnosis and misdiagnosis. This paper discussed the case， in order to provide references for the clinical diagnosis of mental disorder caused by prion disease.

Guía de práctica clínica para el tamizaje y manejo del episodio depresivo leve en el primer nivel de atención del Seguro Social del Perú (EsSalud) / Clinical practice guideline for the screening and management of the mild depressive episode at the first level of care for the Peruvian Social Security (EsSalud)

El presente artículo resume la guía de práctica clínica (GPC) para el tamizaje y el manejo del episodio depresivo leve en el primer nivel de atención en el Seguro Social del Perú (EsSalud). Para el desarrollo de esta GPC, se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas clínicos y metodólogos, el cual formuló 06 preguntas clínicas. Para responder cada pregunta se realizó búsquedas sistemáticas en PubMed y en repositorios de GPC, y se seleccionó la evidencia pertinente. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones periódicas, el GEG usó la metodología GRADE para revisar la evidencia y emitir las recomendaciones. Se emitieron siete recomendaciones (tres fuertes y cuatro condicionales), 28 puntos de buena práctica clínica, y dos flujogramas.

This paper summarizes the clinical practice guide (CPG) for the screening and management of mild depressive episode at the first level of care in the Social Security of Peru (EsSalud). A guideline development group (GDG) was established for develop this CPG, which included clinical and methodology specialists, who formulated 06 clinical questions. Systematic searches were conducted in Pubmed and GPC repositories to answer each question, and relevant evidence was selected. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GDG used the GRADE methodology for reviewing the evidence and for developing recommendations. At the end, this CPG formulated 07 recommendations (03 strong and 04 conditional), 28 points of good clinical practice, and 02 flow charts were formulated.

A cross sectional study on the association between new onset of psychiatric symptoms with severity of cognitive impairment in elderly patients

Background: Neuropsychiatric impairments play significant roles throughout the course of cognitive decline mainly in older adults with dementia or mild cognitive impairment (MCI). This study was aimed to find the association between psychiatric comorbidities and severity of cognitive impairment in elder patients presented with new onset of Psychiatric Symptoms.Methods: A cross sectional study was done among elder subjects (≥60 years of age) presented with new onset of psychiatric symptoms during one year period. Mini International neuropsychiatric interview and Montreal Cognitive Assessment scale were used for psychiatric diagnosis and severity of cognitive impairment grading, respectively. Association between psychiatric comorbidities and MCI was statistically analyzed.Results: Total 67 subjects were included in the study. Analysis of the psychiatric diagnosis revealed that major depressive episode (52.2%) was the most prevalent psychiatric disorder among the study population followed by Psychotic disorders (23.9%). Generalized anxiety disorder contributed to 19.4% of the total study population. Significant association (p<0.002) was identified between the severity of cognitive impairment and the psychiatric comorbidities.Conclusions: A significant association was identified between the severity of MCI and the psychiatric comorbidities. Major depressive episode was the most prevalent psychiatric disorder followed by psychotic disorders and generalized anxiety disorder.

Factores asociados a irritabilidad en adultos con episodio depresivo en Lima Metropolitana / Factors associated to irritability in adults with depressive episode in Metropolitan Lima

Objetivo: Determinar factores sociodemográficos y clínicos asociados a la presencia de irritabilidad en adultos con episodio depresivo (ED) en Lima Metropolitana. Materiales y Métodos: Estudio observacional, correlacional, transversal, utilizando la base de datos de adultos desde los 18 años del Estudio Epidemiológico de Salud Mental de Lima Metropolitana y Callao del año 2012, en una muestra probabilística multietápica de 4445 adultos. Los instrumentos usados fueron una ficha de datos sociodemográficos, MINI (Entrevista Neuropsiquiátrica Internacional), Cuestionario de Salud Mental de Colombia (modificado), Índice de Calidad de Sueño de Pittsburgh, EMBU modificado y Cuestionario de Experiencias Tempranas Adversas. Se utilizó estadística descriptiva, regresión simple y multivariada para estimar la prevalencia de adultos con irritabilidad en episodio depresivo (IED) y determinar la asociación entre IED y variables independientes. Resultados: La prevalencia de IED fue de 34,9%. Se halló asociación estadísticamente significativa con: menor edad de inicio del ED, mayor severidad del ED, presencia de trastorno de ansiedad generalizada, abuso/dependencia de alcohol, algunos síntomas depresivos (autorreproches, problemas de concentración e indicadores suicidas), conductas violentas, menor calidad de sueño, estilos de crianza de sobreprotección y favoritismo, y presencia de eventos adversos antes de los 18 años. Conclusiones: Varias características y factores diferencian la depresión con irritabilidad de la que carece de este síntoma. La posibilidad de que la irritabilidad llegue a ser considerada como un especificador del episodio depresivo, contribuiría a desarrollar estrategias para su más precisa identificación y manejo clínico.

Objective: To determine factors associated to the presence of irritability in adults with depressive episode (DE) in Metropolitan Lima in 2012. Materials and methods: Database of the Epidemiological Study of Metropolitan Lima and Callao, carried out in 2012, was used to make an observational, correlational, cross-sectional study. A multistage probabilistic sample of 4445 adults of 18 years and older. The instruments were: MINI (International Neuropsychiatric Interview), Mental Health Questionnaire of Colombia (modified), modified brief EMBU, a questionnaire of adverse early experiences, Pittsburgh Sleep Quality Index and a sociodemographic data sheet. Descriptive statistics, simple and multivariate regression were used to estimate prevalence of adults with irritability in depressive episode (IDE) and to determine the association between IDE and independent variables. Results: The prevalence of IDE was 34.9%. A statistically significant association was found with: early age of onset of DE, greater severity of DE, presence of generalized anxiety disorder (GAD), abuse/dependence on alcohol, some depressive symptoms (such as self-reproach, concentration problems and suicidal indicators), violent behaviors, a lower quality of sleep, parenting styles of overprotection and favoritism, and the presence of adverse events before the age of 18. Conclusions: The possibility that irritability may be considered as a specifier of the depressive episode, would contribute to the development of strategies for its identification and clinical management.

Clinical Characteristics and Psychotropic Drug Prescription Patterns of Bipolar Disorder Patients with a History of Suicidal Attempts: Findings from the REAP-BD, Korea

Our study aimed to analyze the clinical characteristics and psychotropic prescription patterns of a history of suicide attempts in South Koreans with bipolar disorder (BD), by using only Korean data from the Research on Asian Psychotropic Prescription Pattern for Bipolar disorder. The patterns of clinical characteristics and psychotropic drug use were compared among 53 patients with a history of suicide attempts and 297 without this history; the potential effects of confounding variables were adjusted with binary logistic analyses for discrete variables and analyses of covariance for continuous variables. After adjusting the effects of age, sex, duration of illness, and enrollment as an outpatient, patients with a history of suicide attempts were characterized by a significantly more prevalent depressive episode, lower prevalent remission state, lower levels of hemoglobin, and more use of antidepressants, anxiolytics, and hypnotics compared to those without lifetime suicide attempt. The inability to plan goal-directed behavior may be an intervening factor in the relationship between suicide attempts and depression in BD. Relatively low hemoglobin levels can be associated with manic episodes in patients with a history of suicide attempts and the use of antidepressants, anxiolytics, or hypnotics can be associated with suicide attempts in BD patients.

Clinical Correlates of Alcohol Use Disorder in Depressed Patients with Unipolar and Bipolar Disorder

OBJECTIVE: Alcohol use disorder (AUD) is one of the most frequent comorbid conditions in mood disorders. We aimed to examine the relationships between clinical phenotypes of acutely depressed subjects and co-occurring AUD.METHODS: Clinical assessment including diagnosis of mood disorder and co-occurring AUD, the severity of depressive or manic symptoms, and affective temperaments were conducted in 137 subjects suffering from a major depressive episode. According to the presence of AUD, clinical variables were compared between the two groups. Using binary logistic regression models, the effects of mood symptoms and affective temperaments on the risk of AUD were determined.RESULTS: Severity of manic symptoms, suicidal ideation, and childhood trauma were higher in the AUD group than in the non-AUD group. Scores for irritable and hyperthymic temperament were higher and the score for anxious temperament was lower in the AUD group. In regression models adjusting confounders, anxious temperament was an independent protector against AUD. On the other hand, the diagnosis of bipolar disorder and the irritable manic symptom dimension increased the risk of AUD.CONCLUSION: Anxious temperament decreased the AUD risk, whereas irritable manic symptoms increased the risk during depression. AUD in mood disorders may be an expression of manic psychopathology.

Korean Medication Algorithm for Bipolar Disorder 2018 : Depressive Episode / 우울ㆍ조울병

OBJECTIVES: Since the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed in 2002, the fourth revision of KMAP-BP was completed in 2018 in order to reflect the recent rapid research and development into bipolar disorder and psychopharmacology.METHODS: According to the methodology of previous versions, KMAP-BP 2018 was revised using a questionnaire consisting of 10 questions. Among eighty-four experts of the review committee, sixty-one completed the survey.RESULTS: The first-line pharmacotherapeutic strategy for acute bipolar depressive episode with moderate, non-psychotic severe and psychotic severe episode was mood stabilizer (MS) combined with atypical antipsychotic (AAP) or AAP with lamotrigine. Switching or adding AAP, lamotrigine, or MS as 2nd strategies and clozapine or augmentation of buspirone, stimulant, or thyroid hormone as 3rd strategies were recommended. Compared to the previous KMAP-BP series, preference of AAP and lamotrigine has increased in the treatment of bipolar depressive episode in KMAP-BP 2018. Among the AAPs, olanzapine, quetiapine, and aripiprazole were preferred.CONCLUSION: Compared with the previous versions, we found that more active pharmacological strategies using AAP and lamotrigine as initial and next treatment strategies, respectively, were preferred, although few drugs were approved for bipolar depression.

Bright Light Therapy in the Morning or at Mid-Day in the Treatment of Non-Seasonal Bipolar Depressive Episodes (LuBi): Study Protocol for a Dose Research Phase I / II Trial

OBJECTIVE: This study protocol aims to determine, using a rigorous approach in patients with bipolar disorder (BD) and non-seasonal major depressive episode (MDE), the characteristics of bright light therapy (BLT) administration (duration, escalation, morning and mid-day exposures) depending on the tolerance (hypomanic symptoms). METHODS: Patients with BD I or II and treated by a mood stabilizer are eligible. After 1 week of placebo, patients are randomized between either morning or mid-day exposure for 10 weeks of active BLT with glasses using a dose escalation at 7.5, 10, 15, 30 and 45 minutes/day. A further follow-up visit is planned 6 months after inclusion. Patients will be included by cohorts of 3, with at least 3 days of delay between them, and 1 week between cohorts. If none meet a dose limiting toxicity (DLT; i.e hypomanic symptoms), the initiation dose of the next cohort will be increased. If one patient meet a DLT, an additionnal cohort will start at the same dose. If 2 or 3 patients meet a DLT, from the same cohort or from two cohorts at the same dose initiation, the maximum tolerated dose is defined. This dose escalation will also take into account DLTs observed during the intra-subject escalation on previous cohorts, with a “Target Ceiling Dose” defined if 2 DLTs occured at a dose. DISCUSSION: Using an innovative and more ergonomic device in the form of glasses, this study aims to better codify the use of BLT in BD to ensure a good initiation and tolerance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03396744.

Turning on the Left Side Electrode Changed Depressive State to Manic State in a Parkinson's Disease Patient Who Received Bilateral Subthalamic Nucleus Deep Brain Stimulation: A Case Report

No previous reports have described a case in which deep brain stimulation elicited an acute mood swing from a depressive to manic state simply by switching one side of the bilateral deep brain stimulation electrode on and off. The patient was a 68-year-old woman with a 10-year history of Parkinson's disease. She underwent bilateral subthalamic deep brain stimulation surgery. After undergoing surgery, the patient exhibited hyperthymia. She was scheduled for admission. On the first day of admission, it was clear that resting tremors in the right limbs had relapsed and her hyperthymia had reverted to depression. It was discovered that the left-side electrode of the deep brain stimulation device was found to be accidentally turned off. As soon as the electrode was turned on, motor impairment improved and her mood switched from depression to mania. The authors speculate that the lateral balance of stimulation plays an important role in mood regulation. The current report provides an intriguing insight into possible mechanisms of mood swing in mood disorders.

Roles of neurosteroids in the treatment of depressive episodes / 上海交通大学学报（医学版）

Neurosteroids are the key molecules in the central nervous system that modulate neural functions. They can influence human mood and behavior in various physiological and pathophysiological situations. Neurosteroids have been implicated in the pathogenesis of depressive episodes, providing innovative therapies for psychiatric disorders such as depressive disorder and bipolar disorder. This paper reviewed the research progress on the role of neurosteroids in the treatment of depressive episodes.

Roles of neurosteroids in the treatment of depressive episodes / 上海交通大学学报（医学版）

Neurosteroids are the key molecules in the central nervous system that modulate neural functions. They can influence human mood and behavior in various physiological and pathophysiological situations. Neurosteroids have been implicated in the pathogenesis of depressive episodes, providing innovative therapies for psychiatric disorders such as depressive disorder and bipolar disorder. This paper reviewed the research progress on the role of neurosteroids in the treatment of depressive episodes.

Correlation of serum S100B protein with depressive episode of bipolar disorder and its prognosis / 上海交通大学学报（医学版）

Objective · To explore the correlation of serum S100B protein with depressive episode of bipolar disorder (BD) and its prognosis.Methods· Based on BD criteria of Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-Ⅳ),80 patients with depressive episode of BD (case group) and 42 healthy controls (control group) were enrolled.Patients were randomly assigned into quetiapine group who were treated with lithium and quetiapine and modified electroconvulsive therapy (MECT) group who received lithium and MECT.The serum S100B level and Hamilton Rating Scale for Depression (HAMD) were assayed before and after 4-week treatment.Results· The serum S100B levels before treatment in patients with depressive episode of BD were significantly higher than those in healthy controls (P=0.000).The levels of S100B in both drug and MECT groups decreased after 4-week treatment.The HAMD score after treatment significantly decreased than that before treatment (P=0.000).Pearson correlation analysis showed that the change of S 100B level was positively correlated with the change of HAMD score before and after treatment in case group (r=0.33,P=0.013).Conclusion· S100B may be associated with depressive episode of BD and its prognosis.

Association between loneliness and risks of depressive episode among rural older people / 中南大学学报(医学版)

Objective:To investigate association between loneliness and depressive episode among rural older people.Methods:A total of 839 rural adults (aged over 60 years) from Liuyang in Hunan were enrolled by using multi-stage cluster sampling method.The Short-form of the UCLA Loneliness Scale,the Social Support Rating Scale,the Life Events Scale for the Elderly,Quality of Life Scale,and the Activity of Daily Living Scale were used to assess loneliness,the social support condition,the stimulating quantity of negative life events,the quality of life,and the abilities of daily life activities,respectively.The Structured Clinical Interview for DSM-Ⅳ-TR Axis I Disorders questionnaire survey was performed by a face-to-face interview.Results:The prevalence rate of depressive episode among the rural older people was 6.8％.Multivariable analysis showed that the elderly who were with stronger loneliness were the risk factor of depression (OR=1.126,95％CI 1.038 to 1.221).Conclusion:Loneliness is positively associated with an increased risk of depressive episode.

Functional connectivity of suprachiasmatic nucleus in major depressive episodes patients with morn-ing heavy night light rhythm / 中华行为医学与脑科学杂志

Objective To explore the variations of functional connectivity in depressive episode pa-tients with diurnal rhythm.Methods Totaly 44 patients with depressive episode with diurnal rhythm(rhythm group),58 patients with depressive episode without diurnal rhythm(non-rhythm group)and 56 matched healthy volunteer controls(healthy group)were scanned with 3.0 T MRI Scanner.Functional connectivity (FC)were calculated between suprachiasmatic nucleus(SCN)and whole brain regions.According to results of ANOVA,group-wise two sample t-test was completed.Correlation analysis were conducted between FC of significant difference brain regions and the score of Hamilton rating scale(HAMD-24)for depression.Results The brain regions showing differences among three groups were located in the left medial superior frontal gy-rus(MNI:x=0,y=39,z=51; K=14)and right cerebellum crus 1(MNI:x=39,y=-48,z=-36; K=18) (P<0.05,Alphasim).Compared with non-rhythm group,the FC of rhythm group showed significantly in-creased in the left medial superior frontal gyrus and right triangular inferior frontal gyrus(MNI:x=39,y=27, z=27;K=10)(P<0.05,Alphasim).Compared with healthy group,the FC of non-rhythm group showed sig-nificantly decreased in left medial superior frontal gyrus(P<0.05,Alphasim).Positive correlation was found be-tween FC in left medial superior frontal gyrus and despair score of HAMD-24(r= 0.31,P= 0.041). Conclusion The synergistic increase in SCN and prefrontal activity in patients with depressive episodes with morning heavy night light rhythm which may be involved in the formation mechanism of the diurnal rhythm.

Research on the power of tolbutamide will benefit the antidepressant / 中国生化药物杂志

Objective To investigate the efficacy and safety of low-dose ammonia sulfur-sulfur-resistant treatment.Methods 120 patients with initial depression were randomly divided into a group(40 cases), the estercalyptrin group(40)and the drug group(40).The treatment was treated by the treatment of the ammonia sulfonate, 20 mg/d, 20 mg/d, and 20 mg/d of escitaloplan tablet.The clinical efficacy and response scale(TESS)was evaluated with the Hamilton depression scale(TESS)in the treatment of 1, 2, 4 and 8 over the weekend.Results Three groups showed significant improvement(P<0.01)during the 8th weekend of treatment of the HAMD scores.Grade 1 and 2 weekend, combined treatment group compared with single drug group score had significant difference(P<0.01), and the contrast between the single drug groups had no significant difference, 4 score over the weekend, and comparison between the three way were significant differences(P<0.05), 8 scores over the weekend, and share with escitalopram phthalein general group is no difference, but tolbutamide will benefit group compared with the other two groups had significant difference(P<0.01).Conclusion Small doses of tolbutamide will benefit has antidepressant effect, but the long-term curative effect of treatment is better than the amount of escitalopram citalopram, and share small doses of escitalopram citalopram tolbutamide will benefit can obviously accelerate the antidepressant treatment work.

Fatores de risco para episódios e sintomas depressivos em usuários de álcool e/ou cocaína / Risk factors for depressive episodes and symptoms in alcohol and/or cocaine users

Usuários de drogas tendem a ser mais depressivos do que não usuários. O objetivo deste estudo foi investigar os fatores de risco para episódios e sintomas depressivos em usuários de álcool e ou cocaína/crack que procuraram um serviço de telemedicina. Realizou-se um estudo transversal (n=838) com aplicação do Inventário de Depressão de Beck para mensuração dos sintomas depressivos e o Mini-International Neuropsychiatric Interview para episódio depressivo atual nos usuários no acompanhamento telefônico para cessação do consumo de drogas. O principal fator de risco entre os usuários para sintomas depressivos foi baixa escolaridade (OR=1,4 IC 95%:1,1-2,2). Para o episódio depressivo atual o maior risco entre os usuários foi ser do sexo feminino (OR=1,5 IC 95%:1,0-2,4). O consumo de crack estava associado a episódio depressivo atual (p=0,014). O uso do telefone é viável para detecção de fatores de risco para episódios e sintomas depressivos nos usuários de álcool e ou cocaína/crack. (AU)

Drug users tend to be more depressed than non-users. The aim of this study was to investigate the risk factors for episodes and depressive symptoms in users of alcohol and or cocaine/crack that called for the telemedicine service. We conducted a cross- sectional study (n = 838) with application of the Beck Depression Inventory to Measure depressive symptoms and the Mini International Neuropsychiatric Interview for current depressive episode in users on the telephone follow-up to cessation of drug use. The main risk factor among users for depressive symptoms was lower education (OR = 1.4; 95% CI: 1.1-2.2). For the current depressive episode the greatest risk among users was being female (OR = 1.5; 95% CI: 1.0-2.4). The crack use was associated with current depressive episode (p = 0.014). The use of the phone is feasible to detect risk factors for episodes and depressive symptoms in users of alcohol and or cocaine/crack.(AU)

Efficacy and adverse reactions of different stimulus dosage of modified electroconvulsive therapy for depressive episode / 中华行为医学与脑科学杂志

Objective To evaluate the antidepressant efficacy and adverse reactions of 3 different stimulus dosage of modified electroconvulsive therapy ( MECT) in patients with depressive episode. Methods 120 patients with depressive episode were randomized into low dosage group ( n=40) ,medium dosage group ( n=40) and high dosage group ( n=40) . Low dosage were 50%× age,medium dosage was 70%×age,high dosage was 80%×age . All patients received 6 treatments. Hamilton depression scale?17(HAMD?17) was used to evaluate the clinical symptoms at baseline,3 and 6 treatments. Effects and adverse reactions were compared among three groups.Results Compared with baseline the HAMD?17 scores of the 3 groups were significantly improved after 6 treatments( t=24.026, P=0.000;t=26.541, P=0.000;t=25.904, P=0.000) , but there were no statistically significant differences among the three dosage groups(F=0.409, P=0.665). Compared with low dosage group((27.2±5.4)%),the HAMD?17 scores reductive ratio of medium dosage group((34.3±6.8)%) and high dosage group((33.9±6.9)%)) were significantly improved after 3 treat?ments ( t=-5.513, P=0.000;t=-4.785, P=0.000). Compared with the low dosage group,the incidence rate of headache,nausea and vomiting,delirium were significantly higher in high dosage groups( headache:χ2=14.532, P=0.000;nausea and vomiting:χ2=13.333, P=0.000;delirium:χ2=14.907, P=0.000) . The re?covery time was significantly longer in medium dosage group ( ( 10. 5 ± 1. 6 ) min ) and high dosage group ((11.2±1.8)min) than that in low dosage group((8.8±1.2)min)( t=-5.144,=0.000;t=-6.889, P=0.000).Conclusion Different stimulus dosage of MECT for depressive episode has equivalent curative effect after 6 treatment . Medium dosage and high dosage treatments appear to have an early onset of efficacy,but may also be associated with more adverse reactions.

CRY1 Variations Impacts on the Depressive Relapse Rate in a Sample of Bipolar Patients

OBJECTIVE: A relevant part of the social and personal burden caused by Bipolar Disorder (BD) is related to depressive phases. Authors investigated the genetic impact of a set of variations located in CRY1, a gene involved in the control of the circadian rhythms, towards depressive episodes in a sample of bipolar patients from the STEP-BD sample. As a secondary analysis, CYR1 variations were analyzed as predictors of sleep disruption. METHODS: 654 bipolar patients were included in the analysis. Data were available genome-wide. The part of the genome coding for the CRY1 was imputed and pruned according to standards in the field. 7 SNPs were available for the analysis. A correction for multitesting was applied and we had sufficient power (0.80) to detect a small-medium effect size (0.22) between two allelic frequencies each one represented by at least 300 subjects. RESULTS: Intronic rs10861688 was associated with the number of depressive events corrected for the times patients were assessed during the period of observation. In particular, AA subjects (n=21) had 4.46+/-3.15 events, AG (n=141) had 3.08+/-3.17 and GG (n=342) 2.65+/-2.97 (p=0.0048, beta=-0.22). No other significant associations were reported. CONCLUSION: We bring further evidence that genes involved in the regulation of circadian rhythms may be relevant to depressive bipolar phases. Independent confirmation analyses are mandatory.