Precision non-implantable neuromodulation therapies: a perspective for the depressed brain

Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although non-implantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more "precision-oriented" practice.

Impact of multidimensional interventions on quality of life and depression among older adults in a primary care setting in Brazil: a quasi-experimental study

Objective: To evaluate the impact of multidimensional interventions on quality of life (QoL) and depressive symptoms in Brazilian older adults living in the community. Methods: Longitudinal, quasi-experimental study of older adults receiving conventional primary health care (PHC). The interventions were designed in response to a first round of data collection and validated through pilot testing in groups of older adults from another community. The validated interventions were then applied to an intervention group (IG). To measure their effect, we used the Medical Outcomes Short-Form Health Survey (SF-36) quality of life scale and the Geriatric Depression Scale (GDS-30). Results: The sample comprised 118 participants. IG participants exhibited significant improvement in several QoL domains (SF-36): mental health (p = 0.010), general health perceptions (p = 0.016), and physical functioning (p = 0.045). No such improvement occurred in controls (p > 0.050). The prevalence of depression (GDS-30) fell from 36.7 to 23.3% in the IG, despite no significant difference (p = 0.272). Controls also reported a reduction in depressive symptoms, but only from 44.8 to 41.4% (p = 0.112). Conclusions: This multidimensional intervention was associated with significant improvement in mental health, general health perceptions, and physical functioning in a sample of Brazilian older adults. Clinical trial registration: RBR-92dbtx.

Psychometric properties of two adolescent depression scales in a colombian community sample: ADRS and RCADS -major depression / Propiedades psicométricas de dos escalas de depresión para adolescentes en una muestra comunitaria colombiana: ADRS y RCADS -depresión mayor

Abstract Depression can occur at all ages; however, when it begins early in life, prognosis is less favorable. Early identification and treatment provision need valid and reliable tools to assess depression in children and adolescents. The present study aimed at analyzing, in a Colombian community sample, the psychometric properties of two brief depression scales, using Classical Test Theory methods: The Adolescent Depression Rating Scale (ADRS) self-report version and the Revised Child Anxiety and Depression Scale (RCADS) - Major Depression Subscale. Analyses of both scales showed most item-scale and item-item correlations to be moderate and significant. Internal consistency was significant and adequate for both, ADRS (.67) and RCADS- Major Depression (.71). For ADRS, a two-factor solution explained 37.39% of variance while a one-single factor explained 25.99%. For RCADS-Major Depression, a two-factor solution explained 41.81% of variance while a one-single factor explained 29.14%. Construct validity was satisfactory, as both scales showed moderate and significant correlations with the convergent (RCADS-Generalized Anxiety) and the discriminant (KADS-11) criteria; yet, correlations with the former were stronger. Results provide further evidence in favor of the ADRS and the RCADS-Major Depression as effective tools to assess depressive symptoms in children and adolescents.

Resumen La depresión puede presentarse a cualquier edad; sin embargo, cuando ocurre en etapas tempranas de la vida el pronóstico es menos favorable. La identificación y el tratamiento tempranos necesitan herramientas válidas y confiables para evaluar la depresión en niños y adolescentes. El presente estudio analizó, en una muestra comunitaria colombiana, las propiedades psicométricas de dos escalas breves de depresión, utilizando métodos de la Teoría Clásica de los Test: Escala de Valoración de Depresión Adolescente (ADRS) versión de auto-reporte y la Escala de Ansiedad y Depresión Infantil Revisada (RCADS)- Subescala de Depresión Mayor. El análisis de las dos escalas mostró correlaciones ítem-ítem e ítemescala, moderadas y significativas. La consistencia interna fue significativa y adecuada para ambas escalas, ADRS (0.67) y RCADS-Depresión Mayor (0.71). Para ADRS, dos factores explicaron 37.39% de la varianza, mientras que la solución de un solo factor explicó 25.99% de la varianza. Para RCADS-Depresión Mayor, dos factores explicaron el 41.81% de varianza y un factor único explicó 29.14%. La validez de constructo fue satisfactoria, ambas escalas mostraron correlaciones moderadas y significativas con el criterio convergente (KADS-11) y el criterio discriminante (RCADS-Ansiedad Generalizada); aunque más fuertes en el primer caso. Los resultados evidencian que ADRS y RCADS-Depresión Mayor son herramientas efectivas para la valoración de síntomas depresivos en niños y adolescentes.

A comparative study of the effectiveness of group-based cognitive behavioral therapy and dialectical behavioral therapy in reducing depressive symptoms in Iranian women substance abusers

Various therapeutic approaches have been used to improve depressive symptoms in substance abusers. In a quasi-experimental study with a pretest-posttest design and experimental and control groups, we examined and compared the effectiveness of two group-based treatment strategies­cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT)­in reducing depressive symptoms among Iranian women substance abusers. The statistical population included all female addict patients who referred to addiction treatment centers of Birjand city in 2015. A sample of 30 subjects were selected through the available sampling method and randomly assigned into experimental (CBT and DBT) and control groups (each group, 10 patients). The data collection instrument was the Beck Depression Inventory (BDI) questionnaire. The patients in the experimental groups were given skills in eight sessions of 90 min. The data were analyzed by the SPSS-19 software by using mean, standard deviation, and percentages at the descriptive level and analysis of covariance (ANCOVA) test at the inferential level. The comparison of the mean depression score before intervention in all the groups showed no significant difference. However, after intervention, the findings showed that both CBT and DBT interventions could reduce the mean scores of depression in women substance abusers, 17.5 ± 3.0 vs 29.3 ± 4.1 (F[1,17] = 51.91, p value < 0.01) and 14.7 ± 1.8 vs 29.3 ± 4.1 (F[1,17] = 106.62, p value < 0.01), respectively, for CBT and DBT. Post-treatment effect sizes were large and did not differ statistically for CBT (ηp2, 0.75) and DBT (ηp2, 0.86). Therefore, this study highlights the importance of CBT and DBT skills training to substance abusers and provides initial evidence of their effectiveness.(AU)

Mindfulness y promoción de la salud mental en adolescentes: efectos de una intervención en el contexto educativo / Effects of a mindfulness intervention in Chilean high schoolers

Background: Mindfulness has been conceptualized as paying attention to present moment experience in a non-judgmental manner, and the practice of developing that skill. Aim: To determine the impact of a mindfulness-based intervention on negative emotional states of anxiety, stress, and depression in Chilean high schoolers. Material and Methods: Eighty-eight teenagers aged 13 ± 0.6 years (46 females) were randomly assigned to a mindfulness group or a control (41 and 47, respectively). The mindfulness intervention consisted in eight weekly 45-minute sessions. A depression, anxiety, and stress scale (DASS-21) was applied at baseline, after the intervention, and at three and six-month follow-up. Results: There was a significant reduction in anxiety, depression, and general symptomatology in the experimental group compared to the control group. However, these changes were not sustained at follow-up. Conclusions: These preliminary results suggest the feasibility and effectiveness of a mindfulness intervention in Chilean schools as a strategy to reduce negative emotional states and prevent risk factors in adolescent population groups.

Oficinas terapêuticas para a reabilitação psíquica de pacientes institucionalizados em decorrência da hanseníase / Therapeutic workshops and psychosocial rehabilitation for institutionalised leprosy patients

A hanseníase ainda constitui um importante problema de saúde pública e as ações de promoção da reabilitação psíquica dos pacientes ainda são insuficientes. Este estudo se propôs a avaliar o impacto de oficinas terapêuticas sobre a qualidade de vida e sintomas depressivos em pacientes institucionalizados em decorrência da hanseníase. Aplicou-se o Inventário de Depressão de Beck e o instrumento genérico de avaliação da qualidade de vida WHOQOL-bref, antes e após o desenvolvimento de oficinas terapêuticas ao longo de seis meses. Participaram do estudo 62 pacientes, quase todos idosos, com baixa escolaridade. Observou-se uma redução significativa dos escores de sintomas depressivos após a intervenção proposta (p < 0,001) e impacto positivo para os domínios psicológico (p = 0,001), físico (p = 0,03) e de meio-ambiente (p < 0,001), mas não para as relações sociais (p = 0,124). Oficinas terapêuticas parecem ter o potencial de auxiliar na reabilitação psíquica de pacientes institucionalizados em decorrência da hanseníase.

Leprosy is still a major public health problem and psychosocial rehabilitation services for patients suffering from the disease remain insufficient. This study aimed to assess the impact of therapeutic workshops on quality of life and symptoms of depression among institutionalised leprosy patients. The Beck Depression Inventory (BDI) and generic World Health Organization Quality of Life questionnaire (WHOQOL-BREF) were used before and after the implementation of a series of therapeutic workshops over a period of six months. Sixty-two patients participated in the study. Almost all of the sample were elderly and had a low level of education. There was a significant reduction in the symptoms of depression scores after the intervention (p < 0,001) and a positive impact was shown for the psychological (p = 0,001), physical (p = 0,03) and environment (p < 0,001) domains, but not for the social relationships (p = 0,124) domain. Therapeutic workshops appear to a useful tool for psychosocial rehabilitation work with leprosy patients.

Os role playing games (RPGS) como uma ferramenta em psicoterapia: um estudo de caso / Role-playing games as a tool in psychotherapy: a case study

O crescimento da indústria dos jogos eletrônicos é diretamente proporcional ao constante aumento da presença desta mídia em nosso cotidiano. Neste artigo, explorou-se como os Role-Playing Games - jogos de interpretação de papéis - online estão inseridos em nossa sociedade atualmente e quais podem ser seus benefícios na aquisição de uma melhor qualidade de vida. Para tanto, será utilizado um caso atendido em psicoterapia, no qual a atividade de jogar Role-Playing Games foi utilizada como uma ferramenta no atendimento psicoterápico, o que proporcionou, e ainda proporciona ao indivíduo em questão, possibilidades que antes se apresentavam como algo distante e inatingível, sendo elas a construção de um círculo social, a superação constante da timidez e uma melhora gradual nos sintomas da depressão...

The video-game industry's growth is directly proportional to that media's increasing presence in our daily lives. In this article, we explore the ways in which online Role-Playing Games are embedded in today's society and what may be their beneficial effects towards achieving a better quality of life. We've used a patient's case study in which the Role-Playing Game activity was employed as a tool in treatment sessions, providing situations that formerly presented themselves as something distant and unattainable, such as the possibility of building a social circle, the constant overcoming of shyness, and a gradual improvement in symptoms of depression...

Estudo sobre depressão reativa e depressão secundária em pacientes após acidente vascular encefálico / Study on reactive and secondary depression in patients following a stroke

O Acidente Vascular Encefálico (AVE) é uma das patologias que mais acarreta comorbidades e alterações incapacitantes, tanto em relação a aspectos físicos, como em relação a aspectos cognitivos e afetivoemocionais. Após a ocorrência do AVE, freqüentemente o quadro dedepressão encontra-se associado. Os tipos mais freqüentes que podemocorrer são depressão reativa e depressão secundária a lesão encefálica.O manejo terapêutico do profissional de Psicologia é fundamental para o tratamento da depressão, sendo reativa ou secundária, interferindodiretamente no processo de reabilitação após o AVE. A presente pesquisa consiste em identificar, na literatura, os sintomas da depressão reativa e secundária em pacientes após AVE e qual a aplicabilidade da avaliação psicológica diferencial no contexto de reabilitação.

A stroke (EVA) is one of the pathologies that cause the most comorbiditiesand damage, not only in physical aspects, but also in cognitive and affective aspects. After a stroke an associated depressive disorder frequently sets in. The most frequent kinds are Reactive Depression and Depression secondary to the brain lesion. The psychologist’s therapeutic management is essential for the treatment of depression, both Reactive and Secondary, intervening directly in the process of rehabilitation after the stroke. The purpose of this study was to identify, in the literature, the symptoms of Reactive Depression and Secondary Depression in post-stroke patients and also the applicability of psychological differential evaluation in this rehabilitation context.

Occupational therapy in spinocerebellar ataxia type 3: an open-label trial

Occupational therapy (OT) is a profession concerned with promoting health and well-being through occupation, by enabling handicapped people to participate in the activities of everyday life. OT is part of the clinical rehabilitation of progressive genetic neurodegenerative diseases such as spinocerebellar ataxias; however, its effects have never been determined in these diseases. Our aim was to investigate the effect of OT on both physical disabilities and depressive symptoms of spinocerebellar ataxia type 3 (SCA3) patients. Genomically diagnosed SCA3 patients older than 18 years were invited to participate in the study. Disability, as evaluated by functional independence measurement and Barthel incapacitation score, Hamilton Rating Scale for Depression, and World Health Organization Quality of Life questionnaire (WHOQOL-BREF), was determined at baseline and after 3 and 6 months of treatment. Twenty-six patients agreed to participate in the study. All were treated because OT prevents blinding of a control group. Fifteen sessions of rehabilitative OT were applied over a period of 6 months. Difficult access to food, clothing, personal hygiene, and leisure were some of the main disabilities focused by these patients. After this treatment, disability scores and quality of life were stable, and the Hamilton scores for depression improved. Since no medication was started up to 6 months before or during OT, this improvement was related to our intervention. No association was found between these endpoints and a CAG tract of the MJD1 gene (CAGn), age, age of onset, or neurological scores at baseline (Spearman test). Although the possibly temporary stabilization of the downhill disabilities as an effect of OT remains to be established, its clear effect on depressive symptoms confirms the recommendation of OT to any patient with SCA3 or spinocerebellar ataxia.

Prevalência de sintomas depressivos em pacientes portadores do HIV/Aids em um hospital de referência na cidade de Florianópolis - SC / Prevalence of depression in HIV/Aids patients in a referential hospital located in Florianópolis-SC

Objetivo: Mensurar a prevalência de sintomas depressivos de acordo com Inventário de Depressão de Beck em pacientes portadores do HIV/Aids em umhospital de referência na cidade de Florianópolis – SC. Método: Foi realizado um estudo transversal queavaliou 27 portadores do HIV/Aids atendidos em enfermaria médica, ambulatório e Hospital Dia doHospital Nereu Ramos (HNR) - Florianópolis – SC. Foram avaliadas variáveis sociodemográficas erelacionadas aos transtornos depressivos. Foi utilizado o Inventário de Depressão de Beck, e como ponto de corte o seguinte índice: <18 normal, e maior ou igual à 18 possível depressão. Resultados: O ponto de corte considerado como sugestivo para depressão foi atingido por 11(40,7%) dos participantes. Não houve diferença estatisticamente significativa quando avaliada a presença de sintomasdepressivos de acordo com o tipo de atendimento que o paciente estava recebendo (p 0,143), e de acordo com ogênero (p 0,102). Conclusão: A prevalência de depressão de acordocom o Inventário de Depressão de Beck em pacientes portadores do HIV/Aids foi de 40,7%.

Objective: To estimate the prevalence of depression based on Beck Depression Inventory in patients with HIV/Aids in a referential hospital located in Florianópolis-SC. Methods: It was made a transversal study witch evaluated 27 patients with HIV/Aids treated in NereuRamos Hospital, in Florianópolis-SC. It was evaluated social demographic data and also data related with depression disorders. It was used the Beck Depression Inventory and the levels used were: <18 normal and e” 18 possible depression. Results: The cut-off score considered as depressiondiagnose was reached by 11 (40,7%) patients. There were no statistical significance when it was evaluatedthe occurrence of depression in association with kind of attainment that this patients were receiving (p 0,102).There was, also, no statistical difference according to gender. Conclusions: The prevalence of depression according to Beck Depression Inventory in HIV/Aidspatients was 40,7%.

Preditores biopsicossociais de incapacidade física e depressão em trabalhadores do setor de frigoríficos atendidos em um programa de reabilitação profissional / Bio-psycho-social predictors of physical disability and depression among meat-packing workers attending an occupational rehabilitation program

Um grande número de trabalhadores é acometido por doenças ocupacionais que tem, dentre seus sintomas, dores crônicas, incapacidade e depressão. Embora existam evidências sobre a contribuição de fatores relacionados ao ambiente de trabalho e fatores orgânicos em quadros de doenças ocupacionais, a incapacidade e a presença de depressão associadas a essas condições são fenômenos multifatoriais mediados por aspectos biopsicossociais. O presente artigo examina as relações entre fatores clínicos, ambientais, demográficos e incapacidade, depressão em uma população de trabalhadores do setor de frigoríficos (n=234) atendidos por um programa de reabilitação profissional. Este estudo pode ser descrito como de corte transversal, utilizando análises estatísticas descritivas e inferenciais (regressões multivariadas). Os dados foram coletados utilizando um questionário demográfico e clínico, o Questionário Roland e Morris, a escala de depressão do HADS e a Medida de Independência Funcional ? MIF. Os resultados demonstraram que em todos os instrumentos utilizados, o escore final (após reabilitação) foi fortemente determinado pelo escore inicial (antes da reabilitação), com pouca influência das outras variáveis independentes. A mudança nos níveis de incapacidade parece estar associada a presença de ganho financeiro (p=0.057). O escore final do MIF foi inversamente relacionado com o tempo de afastamento (p=0.006). A variação dos escores finais entre as categorias do CID-10 não foi estatisticamente significativa para nenhum desfecho. De maneira geral, a maior prevalência de mulheres dentre os trabalhadores afastados, e a prevalência de doenças músculo-esqueléticas e depressão, ou a associação de ambas. A variável idade foi preditor de incapacidade (RM) e a variável tempo de afastamento foi preditora de incapacidade para o trabalho medida pelo MIF. Nenhuma das variáveis examinadas contribuiu para a mudança dos escores de depressão.

A large number of workers are afflicted by occupational diseases that have chronic pain, disability, and depression among their symptoms. Although there is evidence on contributory factors related to the working environment as well as physical factors involved in occupational diseases, disability and depression associated with these conditions are multidimensional phenomena mediated by bio-psycho-social aspects. This paper examines the relationships between clinical, environmental, and demographics factors, and disability and depression in a sample of workers from the meat-packing industry (n=234) attended by an occupational rehabilitation program. This study can be described as cross-sectional, and uses descriptive and inferential statistics (multivariate regressions). Data was collected using a demographic and clinical questionnaire, the Roland-Morris Questionnaire, the HADS depression scale, and the Measure of Functional Independence (MFI). The results show that, by all measurements used, the final score (post-rehab.) was strongly determined by the initial score (pre-rehab.) with little influence from other independent variables. Changes in the levels of disability appeared to be associated with financial gain (p=0.057). The final score on the MFI was inversely related to the time off work (p=0.006). Variations among the final scores of the CID-10 categories were not conclusive. On the whole there was a preponderance of women among those on sick leave, also with high incidence of musculoskeletal disorders and depression or both. The age variable was the predictor for RM disability, whereas time off work was the predictor for disability by MFI. None of the variables analyzed affected the depression scores. Generally these results are consistent with those found in the literature and confirm that diverse factors contribute to the disability and depression of workers with occupational diseases, as predicted by the bio-psycho-social model.

La depresión en el adulto mayor: algunas consideraciones para su diagnóstico en la atención primaria / Depression in elder adults: some considerations for its diagnosis in primary health care

El presente trabajo va dirigido a los médicos de Atención Primaria de Salud. Tiene en su contenido una breve reseña de los cambios que se producen en el envejecimiento desde el punto de vista orgánico, psicológico y social que predisponen a la aparición de la depresión en el adulto mayor. Se exponen las principales características, los criterios diagnósticos y las diferentes formas de presentación de la depresión según la Clasificación Internacional de Enfermedades en su Versión #-10. Se orientan las acciones para llegar al diagnóstico como: confección de la historia clínica, examen físico, indicación de complementarios más importantes y los principales diagnósticos diferenciales a tener en cuenta. Este trabajo tiene el propósito de incrementar los conocimientos para perfeccionar actitudes y desarrollar buenas prácticas en la prevención, diagnóstico precoz, tratamiento y rehabilitación psicosocial de la depresión en el Adulto Mayor...

The current work is directed to the physicians of the Primary Health Care. It contents a short review on the changes that take place during aging form the organic, psychological and social point of view, predisposing depression emergency in elder adults. We expose the main characteristics, the diagnostic criteria and different forms of depression emergency according to the International Classification of Diseases Version # 10. We orient actions to arrive to a diagnosis: confection of the clinical review, physical examination, indication of the most important complementary examinations and the main differential diagnosis to take into account. The purpose of this work is increasing knowledge to improve attitudes and develop new practices preventing, precociously diagnosing, treating and psychosocial rehabilitation of depression in elder adults.

Depressão secundária à doença pulmonar obstrutiva crônica / Secondary depression following by chronic obstrutive lung disease

Doença Pulmonar Obstrutiva Crônica (DPOC) tem sua definição baseada na limitação persistente do fluxo aéreo. Esta doença não está restrita aos pulmões, pois apresenta manifestações sistêmicas. Uma delas, a depressão, acomete de 25% a 40% dos pacientes e está associada à morbidade e à mortalidade. Suas causas são complexas. Os fatores de risco aos quais os médicos devem ficar atentos são a idade avançada, perdas psicosociais tais como luto ou outras privações, perda da vida ativa na família e sociedade (isolamento social), dificuldades financeiras e necessidade de oxigenoterapia.

Qualidade de vida dos medicos militares do hospital geral de Curitiba / Life quality of military doctors at the general hospital of Curitiba

O objetivo dos autores foi avaliar o grau de comprometimento da qualidade de vida em individuos que, alem de medicos, tem que se submeter a uma estrutura organizacional diferente daquela civil. Fizeram parte do estudo 52 medicos militares, que trabalham no Hospital Geral de Curitiba(HGeC).A coleta de dados se deu por meio da aplicaçao que questionarios. A analise da situaçao e dos resultados revelou 36 por cento da populaçao com estresse, 23 por cento apresentando diferentes niveis de depressao e apenas 3,9 por cento dos medicos com qualidade de vida considerada adequada. O equilibrio deverá ser buscado pela sociedade e pelo individuo, no sentido de que as exigencias do mercado nao retirem do homem o que ele tem de mais precioso: a sua saude fisica e mental