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The novel coronavirus SARS-CoV-2 is associated with a significant incidence of neuropsychiatric disorders, which tend to have a long course in the post-COVID period. Objective(s): to study post-COVID mental disorders in clinical psychiatric practice. Patients and methods. 30 patients aged 37.75+/-14.07 years with anamnesis of SARS-CoV-2 infection were examined. Clinical scale assessment was carried out using the Hamilton Depression and Anxiety Scale. The Symptom-Checklist (SCL-90-R) was used to assess the psychopathological status of the patient. Patients' cognitive functioning was assessed using the Mini-Cog Cognitive Assessment Questionnaire. Patients' sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Results and discussion. Mental disorders associated with a previous coronavirus infection are observed in a wide time range from less than 1 month to a year after the previous disease, and in no case did the coronavirus infection have a severe course. Sleep disorders, anxiety and depressive disorders, which did not exceed a moderate degree of severity, and asthenia dominated in the structure of the post-COVID syndrome. The level of mental distress in patients with post-COVID syndrome increased 2 times. Post-COVID mental disorders are interrelated with female gender, age, and psychotraumatic factors associated with the pandemic. Cognitive impairment mediated by mental disorders was observed in approximately 60% of patients and did not reach the degree of dementia. Conclusion. The clinical picture of the post-COVID syndrome is represented by a wide range of mental disorders, the development of which involves not only biological, but also psychosocial factors associated with the COVID-19 pandemic, which determines the specifics of diagnostic approaches and the feasibility of complex treatment of the post-COVID syndrome.Copyright © 2022 Ima-Press Publishing House. All rights reserved.
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Background: The outbreak of the COVID-19 pandemic, the constant transformation of the SARS-COV-2 virus form, exposure to substantial psychosocial stress, environmental change, and isolation have led to the inference that the overall population's mental health could be affected, resulting in an increase in cases of psychosis. Objective(s): We initiated a systematic review to determine the impact of the SARS-COV-2 virus and its long-term effects-in both symptomatic and asymptomatic cases-on people with or without psychosis. We envisioned that this would give us an insight into effective clinical intervention methods for patients with psychosis during and after the pandemic. Method(s): We selected fifteen papers that met our inclusion criteria, i.e., those that considered participants with or without psychiatric illness and exposed to SARS-COV-2 infection, for this review and were retrieved via Google, Google Scholar, MEDLINE, PubMed, and PsychINFO Database. Key Gap: There is a dearth of research in understanding how COVID-19 affects people with or without a prior personal history of psychosis. Result(s): The systematic review summary provides insight into the state of knowledge. Insights from the systematic review have also been reviewed from the salutogenesis model's perspec-tive. There is moderate evidence of new-onset psychosis during the COVID-19 pandemic in which some antipsychotics treated the psychotic symptoms of patients while treating for COVID-19. Suggestions and recommendations are made for preventive and promotive public health strategies. Conclusion(s): The Salutogenesis model and Positive Psychology Interventions (PPI) provide another preventive and promotive public health management approach.Copyright © 2023 Bentham Science Publishers.
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The current outbreak of COVID-19 is caused by the SARS-CoV-2 virus that has affected > 210 countries. Various steps are taken by different countries to tackle the current war-like health situation. In India, the Ministry of AYUSH released a self-care advisory for immunomodulation measures during the COVID-19 and this review article discusses the detailed scientific rationale associated with this advisory. Authors have spotted and presented in-depth insight of advisory in terms of immunomodulatory, antiviral, antibacterial, co-morbidity associated actions, and their probable mechanism of action. Immunomodulatory actions of advised herbs with no significant adverse drug reaction/toxicity strongly support the extension of advisory for COVID-19 prevention, prophylaxis, mitigations, and rehabilitation capacities. This advisory also emphasized Dhyana (meditation) and Yogasanas as a holistic approach in enhancing immunity, mental health, and quality of life. The present review may open-up new meadows for research and can provide better conceptual leads for future researches in immunomodulation, antiviral-development, psychoneuroimmunology, especially for COVID-19.Copyright © 2021, Institute of Korean Medicine, Kyung Hee University.
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The novel coronavirus SARS-CoV-2 is associated with a significant incidence of neuropsychiatric disorders, which tend to have a long course in the post-COVID period. Objective(s): to study post-COVID mental disorders in clinical psychiatric practice. Patients and methods. 30 patients aged 37.75+/-14.07 years with anamnesis of SARS-CoV-2 infection were examined. Clinical scale assessment was carried out using the Hamilton Depression and Anxiety Scale. The Symptom-Checklist (SCL-90-R) was used to assess the psychopathological status of the patient. Patients' cognitive functioning was assessed using the Mini-Cog Cognitive Assessment Questionnaire. Patients' sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Results and discussion. Mental disorders associated with a previous coronavirus infection are observed in a wide time range from less than 1 month to a year after the previous disease, and in no case did the coronavirus infection have a severe course. Sleep disorders, anxiety and depressive disorders, which did not exceed a moderate degree of severity, and asthenia dominated in the structure of the post-COVID syndrome. The level of mental distress in patients with post-COVID syndrome increased 2 times. Post-COVID mental disorders are interrelated with female gender, age, and psychotraumatic factors associated with the pandemic. Cognitive impairment mediated by mental disorders was observed in approximately 60% of patients and did not reach the degree of dementia. Conclusion. The clinical picture of the post-COVID syndrome is represented by a wide range of mental disorders, the development of which involves not only biological, but also psychosocial factors associated with the COVID-19 pandemic, which determines the specifics of diagnostic approaches and the feasibility of complex treatment of the post-COVID syndrome.Copyright © 2022 Ima-Press Publishing House. All rights reserved.
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The novel coronavirus SARS-CoV-2 is associated with a significant incidence of neuropsychiatric disorders, which tend to have a long course in the post-COVID period. Objective(s): to study post-COVID mental disorders in clinical psychiatric practice. Patients and methods. 30 patients aged 37.75+/-14.07 years with anamnesis of SARS-CoV-2 infection were examined. Clinical scale assessment was carried out using the Hamilton Depression and Anxiety Scale. The Symptom-Checklist (SCL-90-R) was used to assess the psychopathological status of the patient. Patients' cognitive functioning was assessed using the Mini-Cog Cognitive Assessment Questionnaire. Patients' sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Results and discussion. Mental disorders associated with a previous coronavirus infection are observed in a wide time range from less than 1 month to a year after the previous disease, and in no case did the coronavirus infection have a severe course. Sleep disorders, anxiety and depressive disorders, which did not exceed a moderate degree of severity, and asthenia dominated in the structure of the post-COVID syndrome. The level of mental distress in patients with post-COVID syndrome increased 2 times. Post-COVID mental disorders are interrelated with female gender, age, and psychotraumatic factors associated with the pandemic. Cognitive impairment mediated by mental disorders was observed in approximately 60% of patients and did not reach the degree of dementia. Conclusion. The clinical picture of the post-COVID syndrome is represented by a wide range of mental disorders, the development of which involves not only biological, but also psychosocial factors associated with the COVID-19 pandemic, which determines the specifics of diagnostic approaches and the feasibility of complex treatment of the post-COVID syndrome.Copyright © 2022 Ima-Press Publishing House. All rights reserved.
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The monoamine hypothesis of depression has dominated treatment for decades, but for some with treatment-resistant depression, alternative approaches are needed. This article discusses some of the other mechanisms involved in depression and how novel treatments could address these.Copyright © 2023 Wiley Interface Ltd.
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Background: Numerous studies and their meta-analysis have shown a high prevalence of anxiety and depression in patients with inflammatory bowel disease (IBD): Up to a third of patients with anxiety symptoms and a quarter with depression symptoms. These rates increase even more with high disease activity: Up to half of patients with anxiety criteria and up to a third with depression symptoms. Data on the frequency and severity of depression and anxiety in patients with Clostridioides difficile infection (CDI) are not so numerous and unambiguous. During the Covid-19 pandemic, the frequency of depression and anxiety increased among healthy individuals and, even more so, among patients with intestinal diseases. The aim of the study was to evaluate the degree of anxiety and depression in patients with IBD and those with CDI during the Covid-19 pandemic. Method(s): Thirty patients with IBD and 30 patients with CDI were included in the study. IBD was confirmed by endoscopy and histology. CDI was confirmed by enzyme analysis for glutamate dehydrogenase and toxins A and B in the feces of patients with nosocomial infection. Hamilton scale (17 items) was used in order to assess the depression grade. This scale divides patients into four groups: No depression, mild, moderate and severe depression. Anxiety was diagnosed by the Spielberger scale (40 items) which includes analysis of State anxiety (SA) and Trait anxiety (TA). Result(s): Depression was determined in 56.7% of patients in the IBD group: 46.7% had mild depression, and 10% moderate depression. In the CDI group depression was diagnosed significantly more frequently - 86.7% of cases: Mild grade in 76.6% and moderate in 10%, predominantly among women. SA was identified in 46.7% of patients in IBD group, and severe SA in 10.0%. In CDI group the frequency and grade of SA were similar: 40.0% and 13.3% respectively. The of TA was extremely high in both groups: 93.3% in the IBD group, of which 50.0% with severe TA, and 96.7% in the CDI group, of which 40.0% with severe TA. Conclusion(s): The results of the study confirm the presence of anxiety and depression in an extremely large number of patients with IBD and CDI during the Covid-19 pandemic. The frequency of anxiety and depression in this study is significantly higher than previously reported. Patients with IBD and CDI should be monitored for early diagnosis and adequate treatment of depression and anxiety.
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Background: The COVID-19 pandemic caused by the novel Corona virus has impacted more than 200 countries.COVID-19 patients are frequently isolated and quarantined due to high infectivity thus adding to further mental stress in addition to physical symptoms, uncertainty, anger, stress and insecurity. It has given rise to various psychological problems such as anxiety, depression, fear of isolation, fear of dying, feeling of helplessness, insomnia and many more. The aim of this study is to investigate stress, anxiety, and depression in COVID-19 positive patients during the Corona pandemic in West Bengal. Aim(s): To study the prevalence of psychiatric comorbidities lie stress, anxiety, depression in moderate and severely affected COVID 19 patients admitted in a tertiary care hospital in West Bengal. Settings and Design: This cross sectional study was conducted at post COVID follow up clinic on 100 COVID-19 infected patients who were admitted in COVID ward of College of Medicine and Sagore Dutta Hospital, West Bengal. Subjects and Methods: those EWS score more than equals to 5 and gave consent were selected as subjects and data was collected on socio demographic parameters and SRQ 24 was applied followed by assessment was done using the HAM-D for depression, HAM-A for anxiety, and PSS for stress in post COVID-19 patients at post COVID follow up clinic in the hospital. Statistical Analysis Used: SPSS 27.0 version for Microsoft Windows. Result(s): 78% patients were suffering from moderate (N=78) and 22% from severe (N=22) COVID 19 infection. 57.0 % patients (N=57) were women and 43.0% (N=43) were men. The mean age of the patients was more in severe (50.6+/-12.8) compared to moderate (42.6+/-12.5) COVID-19 infection .Mean depression was more in severe (14.0+/-3.8) compared to moderate (5.57+/-2) (p<0.0001). Mean Anxiety was more in severe (16.72+/-11.6) compared to moderate (8.0+/-10.6.) (p=0.0014). Mean Stress was more in severe (20.18+/-3.36) compared moderate infection (19.0+/-3.2) (p=0.1397). Conclusion(s): out of 100 COVID-19 patients majority were women and suffered from moderate COVID infection. Higher the age more the infection was found. Depression, Anxiety, Stress were more associated with the severe infection, low educated, lower socioeconomic status. Severe infection was commonly found among female, less educated, higher age, from rural area, lower economic status.
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Introduction: Depression is a debilitating disorder affecting individuals' level of bio-psychosocial functioning across different age groups around the globe. The recent development of a new NIBS called Transcranial Pulse Stimulation (TPS), also known as low-intensity extracorporeal shock wave therapy (Li-ESWT), has been proven effective for only a 2-week treatment of 35 patients with Alzheimer's disease (AD). Patients' cognition and memory have shown significant improvement which lasted up to 3 months. However, there is a lack of scientific evidence on the efficacy of this TPS intervention on other psychiatric population such as Major Depressive Disorder (MDD), which is increasingly prevalent in Hong Kong and nationwide especially during the COVID-19 pandemic. Nonetheless, there is no trial evaluating the efficacy of TPS on other neuropsychiatric disorders. This gave us the impetus to evaluate the efficacy of TPS on young adults with Major Depressive Disorder (MDD) in Hong Kong. Method(s): In this single-blinded, randomized controlled trial, participants had a confirmed clinical diagnosis of MDD, recruited from the community, NGOs and private enterprise. The intervention was a 2-week TPS treatment comprised six 30-min TPS sessions, delivered by trained mental health professionals. A total of 30 participants were recruited and randomized into either the TPS group or the Waitlist Control (WC) group. Randomization was stratified by gender and age by an independent statistician on a 1:1 ratio. Our primary outcome was determined by whether participants' depressive symptom severity demonstrated significant reduction, compared with the WC group, using the Hamilton Depression Rating Scale-17 (HDRS17). This trial is registered with Clin.Trials.gov, number NCT05006365. Result(s): We recruited 30 participants from 1 August to 31 Oct 2021. They were between 18-54 years old and were predominantly female (73%), ethnically Chinese. There was a significant group x time interaction (F(1, 28) = 818.8, p <.001). Compared with the WC group, there was a significant reduction in the depressive symptom severity in the TPS group (mean difference = -6.60, p = 0.02, Cohen's d = -0.93). Results showed a significant intervention effect and the effect was large. Conclusion(s): TPS is safe and effective to reduce depressive symptoms among young individuals with MDD in this trial. Therefore, TPS may be considered as a top treatment option for neuropsychiatric disorders in clinical psychiatry. Funding(s): This trial is funded by the Departmental General Research Fund, the Hong Kong Polytechnic University, Hong Kong SAR, China. Copyright © 2022
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Background: Since the outbreak of the COVID-19 epidemic, the overall proportion of patients with depression has been increasing. Dance therapy is a kind of expressive art therapy and has a good effect on the treatment of mental diseases. In China, there is still a lack of research on the treatment of depression by dance therapy. This study explores the effect of dance therapy on the adjuvant treatment of depression patients through experimental and statistical analysis. Subjects and methods: The study selected 124 patients with depression as research subjects. Under the circumstance that the patients have received conventional drug treatment and psychological support care, the test groups received an additional adjuvant dance therapy of different frequencies for one month. A total of seven tests were conducted before and after. The HAMD scale was used to test the depression status of the patients, and the statistical tool SPSS27.0 was used to analyze the experimental data. Result(s): The data of the test group 1 and the control group showed a difference at the 0.05 significance level (t = -2.955, P = 0.025 < 0.05). The data of the test group 2 and the control group showed a difference at the 0.01 significance level (t = 4.086, P = 0.006 < 0.01). The data between the test group 3 and the control group was significantly different at 0.05 level (t = 3.437, P = 0.014 < 0.05). Before and after dance treatment, the GSES scores of patients in each test group were significantly different at 0.001 level. Conclusion(s): Dance therapy can effectively relieve the depression of patients, and has a good auxiliary effect on the current drug therapy or psychological therapy for patients. In addition, the effect of dance therapy for a long time of 30-45 minutes is better than that of a short period. Copyright © Medicinska naklada - Zagreb, Croatia.
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Introduction: According to WHO, there are more than 300,000,000 people worldwide suffering from depression. It is the world's leading cause of disability and contributes significantly to the overall global burden of disease. 30% of the patients are refractory, being possible candidates for surgical treatment by means of Deep Brain Stimulation (DBS). We present the follow up at 22 months of a patient with Treatment Refractory Depression (TRD) operated on with a new combination of targets. Materials / Methods: The diagnostic criteria used are those established by Mayberg et al: DSM IV-TR criteria for major depressive disorder with a major depressive episode of at least 1 year duration, with a minimum score of 20 on the 17-item Hamilton Depression Scale (HAM-D). Result(s): 55-year-old male. HAM-D: 26-point. It was decided to simultaneously implant Area 25 (SCG/Cg 25) and the Inferior Thalamic Peduncle (ITP) in order to contemplate the synergistic effect of stimulation of both structures. On December 5, 2018, it was successfully implanted, with previously published techniques, using a deep brain micro register system and stereotactic planning to define the coordinates of each selected target for the implantation of the four tetrapolar electrodes, model 6145 (Abbott) for Area 25 and model 6149 for ITP (Abbott). The electrode implanted in Area 25 was kept lit for 3 months, then only the corresponding to the ITP for an additional 3 months, and finally the four electrodes simultaneously maintaining the stimulation parameters reported in the literature. Post-surgical HAM-D scales were performed, with the following results: * Exclusively Area 25 (21/03/19) = 10 points * Exclusively ITP (13/06/19) = 9 points * Area 25 + ITP (08/08/19) = 14 points. * Area 25 + ITP (19/12/19) = 5 points. * Area 25 + ITP (08/10/20) = 5 points. Discussion(s): The possibility of multiple targets is technically possible and appropriate in very well selected cases. Conclusion(s): The patient showed a statistically significant improvement. Despite maintaining a rating of 5, it is worth mentioning that the patient refers feeling "better" than the previous year considering the time of year (spring), and the burden of the COVID-19 pandemic. This confirms some reports that mention the maintenance of the effect in the long term, even at 8 years, or even an improvement after almost two years can be seen. We consider that the synergism obtained by simultaneous stimulation of both targets could be more effective in terms of control of the depressive state at the long term. Supplemental Data: none. Learning Objectives: 1- To present a new therapeutic modality of multitargeting DBS for major depression. 2- To demonstrate that the combination of surgical targets is a possible option in carefully selected patients. 3- To demonstrate that the therapeutic effect is maintained over the time. Keywords: depression, deep brain stimulation, Area 25, inferior thalamic peduncle, multitargeting Copyright © 2022
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Introduction: Insomnia disorder (ID) and major depressive disorder (MDD) are highly comorbid, above 80% of MDD patients have insomnia disorder. Acupuncture as a major complementary and alternative medicine (CAM) therapy, is utilized extensively in Asia to treat mental health disorders.Transcutaneous electrical cranial-auricular stimulation (TECAS) is a potential new type of acupuncture treatment for MDD and ID which combines the scalp points and auricular points most commonly used by acupuncturists. It has the advantages of portability, quantifiable stimulation parameters and comfort, especially for home treatment under the normal situation of COVID-19, which can avoid the risk of infection due to frequent hospital trips. Materials / Methods: 10 ID-MDD patients were treated by TECAS which was administered at the bilateral auricular acupoints, Bai Hui (GV-20) and Yin Tang (GV-29) (waveform:4/20 Hz, wave width: 0.2ms+/-30%) for twice a day last 8 weeks. Pittsburgh Sleep Quality Index (PSQI) and Hamilton Depression Rating Scale(HAMD) of ID-MDD patients were evaluated before and after treatment. Result(s): HAMD-17 scores of 10 patients were lower at 4 and 8 weeks than before TECAS treatment, and the reduction was greater at 4 weeks than at 8 weeks. PSQI scores of 8 patients decreased at 4 and 8 weeks compared with before treatment, and the decrease was greater in the fourth week than in the 8th week. Insomnia of 2 patients improved at 4 weeks of treatment, but became worse in the 8th week as before treatment.7 out of 10 patients showed full insomnia response (50% reduction in PSQI) and 8 patients showed full depression response (50% reduction in HAMD-17 scores). Discussion(s): We suggest TECAS is a good therapeutic strategy to modulate the vagus nerve and trigeminal nerve propagate through electrical stimulation projected by neurons from peripheral sites to the central nervous system. Furthermore, we speculate that TECAS can make the trigeminal nerve afferent fibers and vagus nerve auricular branch carry messages from head facial stimulation to NTS, locus coeruleus, raphe nucleus, medullary reticular activating system and structure of the thalamus, and then to feel, edge, cortical and subcortical structures, so the electrical stimulation subcortical can cause direct regulation, namely the change of cortical excitability. Conclusion(s): These preliminary results in this group of CID-MDD patients are encouraging and need to be replicated in prospective sham-controlled studies with larger sample sizes. In addition, for patients with insomnia and depression, it is important to consider combining TECAS with psychotherapy to avoid the interference of acute negative emergency events. Acknowledgements: The support of National Key R&D Program of China (No.2018YFC1705800) and Key Laboratory of Acupuncture and Chronobiology of Sichuan Province(No.2021004) for this project is gratefully acknowledged. Learning Objectives: 1. To provide a new non-drug method for acupuncture treatment of insomnia and depression;2. Provide preliminary experimental results for the large-sample experimental design of TECAS for the treatment of insomnia and depression;3. Compared with previous studies on insomnia and depression, the regularity and characteristics of TECAS in treating insomnia and depression were found. Keywords: Transcutaneous Electrical Cranial-Auricular Stimulation (TECAS), insomnia disorder, a case series, acupuncture, Major Depressive Disorder Copyright © 2022
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Purpose: The coronavirus disease 2019 (COVID-19) is the largest pandemic of our times. Pandemics are severe stressors to vulnerable groups (such as patients with chronic diseases) and this highly contagious disease exerts considerable impacts on mental health. We wanted to investigate the possible impact of COVID-19 pandemic on the quality of life (QoL) of myasthenia gravis (MG) patients and potential changes during the period of one year. Methods: Data on the epidemiological and clinical characteristics of MG was collected. We used a selfdesigned questionnaire (consisting of 12 questions), a revised 15-item Myasthenia Gravis Quality of Life Questionnaire (MGQOL15r), a 36-item health survey of the Medical Outcomes Study Short Form (SF36), Hamilton scales for the assessment of anxiety (HAM-A) and depression (HAMD) were used. The actual severity of the clinical manifestation was estimated using MG activities of daily life (MGADL). We reassessed patients in April and May 2021, who were tested during April 2020 using the same questionnaires. Results: The study included 57 adult MG patients. We noticed a statistically significant difference between the results obtained at these two time points regarding scores on MGQOL15r (p<0.05). The obtained scores were significantly better in 2021. Some scores on SF-36 subscales were also better in 2021 than in 2020 (such as social functioning, emotional well-being, role limitation due to emotional problems) (p<0.05). MGQOL15r and SF36 scores correlate with severe clinical manifestation, high scores on HAM-A and HAM-D (p<0.01). Higher scores on HAM-D and fear that MG symptoms will be worse if the patient gets an upper respiratory infection were independent predictors of the lower SF36 scores. Regarding MGQOL15r independent predictors of the higher score were higher scores on HAM-D. Conclusions: QoL of myasthenia gravis patients improved during the pandemic. It is important for healthcare workers to provide professional therapeutic advice and psychosocial support for this population of patients during the pandemic. eP01.04.07 COVID Spike Antibodies in Neuromuscular Conditions: A KU Experience Pasnoor M1, Tajuddin A1, Jawdat O1, Farmakidis C1, Jabari D1, Heim A1, Higgs K1, Dimachkie M1 1The University of Kansas Medical Center, Kansas City, United States Background: Little is known about the immune response to COVID vaccination in immune suppressed neuromusuclar patients. Multiple studies showed variable data regarding the effect of immunosuppression on the immune response to the vaccination. Objective: To evaluate the COVID spike antibody levels in patients with various neuromuscular conditions who received vaccination and assess the effect of immunosuppressive therapies on antibody levels. Method: We performed a retrospective chart review of patients in neuromuscular clinic who had COVID antibody testing. We collected demographic, clinical, diagnostic and treatment information. Descriptive statistics was performed on the data obtained. Results: The total number of patients enrolled in the study were129, 64 male and 65 female . The mean age of the patients enrolled was 64.82 ±14.50 and the mean duration of antibody acquisition since date of last vaccination dose was 172 days. The number of patients on immunosuppressive therapies was 88(68.2%), 47(53.41%) had high antibody titer (>250), 31(35.23%) had low antibody titer (0.4- 250), 9(10.23%) had undetected antibody titer (<0.4) and 1 (1.1%) had detected unmeasured titer. Immunosuppressive therapies included steroids, methotrexate, azathioprine, myophenolate mofetil, eculizumab, efgartigimod, intravenous immunoglobulin and rituximab. The other group of patients who were not on immunosuppressive medication were 41 (31.8%) , 28 (68.29%) showed high antibody titer (>250), 9(21.95%) showed low antibody titer (0.4-250) , 1(2.44%) showed undetected titer (>0.4) and 3(7.32%) had detected unmeasured titer. 50% of patient who were on rituximab showed undetected antibody titer and 60% of patients who received eculizumab had low antibody titer. 4 % of patients on immunosuppressive drugs did not develop adequate spike antibodies levels to vaccination, compared to 24% on no immunosuppressive therapies. Conclusions: Our study reveals modest impact of immunosuppression on COVID spike antibody titer. While this finding is limited by small number of patients and heterogeneity in therapies, age and interval between vaccination and antibody testing, our finding supports the importance of booster vaccine in this patient population.
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BACKGROUND: Adjustment disorders are now primary diagnoses in the trauma and stressrelated disorders section of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Adjustment disorder with anxiety (AjDA) is the development of emotional or behavioral symptoms considered excessive in response to stressful events, significantly impairing a person's ability to function in social, occupational, and/ or other situations. Traumatic experiences related to the COVID-19 pandemic may have increased rates of adjustment disorders, especially among those whose life routines were disrupted by pandemic-associated stress and anxiety. PH94B (3b-hydroxy-androsta-4,16-dien-ol) has shown rapid-onset efficacy in the treatment of social anxiety disorder (Liebowitz et al. Am J Psychiatry. 2014). PH94B is a neuroactive steroid administered as a nasal spray that engages olfactory chemosensory neurons, activating subsets of olfactory bulb neurons that project directly to the limbic amygdala regulating fear and anxiety circuits. OBJECTIVE: To assess the efficacy, safety, and tolerability of PH94B in adults with AjDA. METHODS: This is an exploratory, phase 2A, randomized, double-blind, 4-week, placebo-controlled, 2-arm study in adults with AjDA. The primary outcome is change from baseline to week 4 in the Hamilton Anxiety Rating Scale (HAM-A) total score after intranasal administration of PH49B 4 times daily vs placebo. Patients with a DSM-5 diagnosis of AjDA confirmed by the Mini-International Neuropsychiatric Interview (MINI) with Adjustment Disorders Module and a clinician-rated HAM-A score of ≥20 at screening (Visit 1), with ≤15% decrease at baseline (Visit 2, randomization) are eligible for inclusion. Secondary outcomes include change from baseline to week 4 in the Adjustment Disorder New Module Scale (ADNM), the International Adjustment Disorder Questionnaire (IADQ), the Clinical Global Impression of Improvement (CGI-I), and the Patient Global Impression of Change (PGI-C). Change from baseline in the Hamilton Depression Rating Scale (HAM-D) was exploratory. RESULTS: A total of 40 patients will be randomized (1:1 drug to placebo). The study design features the use of the ADNM and IADQ, newly developed according to ICD-11 criteria for evaluation of AjDA. While both are validated, neither has been tested in placebo-controlled clinical trials. Both scales begin with a list of stressors (18 for ADNM and 9 for IADQ);a yes answer to any 1 stressor triggers a series of questions about the frequency and duration of a patient's reaction to the stressor (ADNM) or quantifies symptoms in response to the stressor (IADQ). CONCLUSIONS: Anxiety disorders are the most prevalent psychiatric disorders and a leading cause of disability. Anxiety and impaired functioning are increasing, particularly in response to the COVID-19 pandemic, and no pharmacologic treatment is currently approved by the FDA for AjDA. PH94B, an investigational pherine nasal spray, is also being studied for treatment of other anxiety-related disorders.
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Background: The management of patients with rheumatic diseases (RD) after a new coronavirus infection (NCI) is an urgent and signifcant problem. Objectives: To study post-COVID manifestations in patients with RD in the Republic of Tatarstan. Methods: From June 2020 to January 2022, 154 cases of NCI with confrmed Sar-sCoV2 PCR and/or X-ray computed tomography (CT) of the lungs in patients with RD were followed up. The study included 100 patients with RA, 36 patients with AS, 18 patients with PsA. RD activity before NCI was low in 56 (36.4%) patients, moderate in 90 (58.4%) patients, and high in 8 (5.2%) patients. Among the patients, 110 (71.5%) were female, 44 (28.5%) were male, the average age was 58 [46;64]. 28% (43) of patients had asymptomatic or mild NCI, 66.2% (102) had moderate NCI, and 5.8% (9) of people had severe NCI. Bilateral polysegmental pneumonia was detected in 111 (72.0%) patients. The results of clinical and laboratory examinations for RD were assessed before and 3 and 6 months after NCI. Patients underwent an in-depth survey 3 and 6 months after undergoing NCI for the presence of various symptoms, including manifestations of asthenia. Additionally, the severity of depression and anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS) and the Hamilton Scale. Results: 90.3% of patients noted the persistence or appearance of symptoms after undergoing NCI, and all of them had a combination of at least 3 different groups of symptoms. The most common asthenic manifestations were in the form of a decrease in the quality of life and working capacity in 85% of patients: signifcant in 47.9% of people, insignifcant-in 38.7% of people. The second most frequent was the inten-sifcation/appearance of pain in the joints-80.5% of the respondents. Strengthening/appearance of muscle pain and/or headache and/or dysautonomia occurred in 47.4%. The appearance/intensifcation of shortness of breath and a decrease in exercise tolerance were noted by 30.5% of the respondents, while there was no connection with the severity of NCI, and half of the patients had a mild course of COVID 19. The appear-ance/intensifcation of chest pain and/or palpitations was noted by 20.8% of people. After 3 months, a decrease in the quality of life, manifestations of depression and anxiety were revealed: 32.2% of people had a mild depressive disorder of moderate severity, 22.3% had clinically expressed anxiety and depression. Six months after the NCI, no abnormalities were detected on the Hamilton scale, and subclinically expressed anxiety/depression on the HADS scale. Conclusion: In most patients with RD, post-covid manifestations persist, primarily due to general constitutional, articular and cognitive symptoms. Manifestations of NCI itself in the form of respiratory and cardiovascular manifestations persist in less than a third of patients.
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SCOPO DEL LAVORO: The Coronavirus Disease 2019 (COVID-19) is a syndrome caused by a new Coronavirus strain, diagnosed for the first time in China and subsequently spread throughout the world. For this reason, on January 2020 the World Health Organization (WHO) declared a state of pandemic. In Italy, the first case of COVID-19 was reported on February 2020. Since then, the Italian Government imposed some restrictions, such as social distancing, in some cases confinement, that have contributed to generate a great psychological distress and forced people to seek new strategies to cope to the emergency. The American Psychological Association (APA) defines the perception of risk as an “individual's subjective assessment of the level of risk associated with a particular hazard”. The risk perception has a strong impact on changing people's choices in the face of events and it can be divided into a rational part and a heuristic part guided by emotions. The aim of this study was to evaluate the perception of risk in three groups of psychiatric patients (depressed, bipolar and schizophrenic) in order to address which categories of patients were most vulnerable during an emergency situation and to evaluate future choices on public health and emergency planning. MATERIALI E METODI: A cross-sectional observational study was conducted on an outpatient setting between January 2021 and February 2021, which was during of Phase 2 of the Italian COVID-19 lockdown. Patients were previously tested to check the clinical stability through Drug Attitude Inventory (DAI), Quality of Life Index (QLF), Insight Scale (IS) and Short Form-12 Health Survey (SF-12), Positive and Negative Syndrome Scale (PANSS) for schizophrenic patients, Hamilton Rating Scale for Depression (MADRS) for depressed patients and MADRS plus Young Mania Rating Scale (YMRS) for bipolar patients. In addition, we used a questionnaire proposed by Lanciano et al., (2020) composed by 10 items to assess the perception of risk, risk-related variables and emotional states during COVID-19 emergency. RISULTATI: There were no statistical differences among the three groups of patients, thus the suggesting an homogeneity of the sample. Results showed that patients were more concerned about economic, psychologic and interpersonal consequences of COVID-19 pandemic, than about their own health. Positive and anxiety related emotions were the most frequent. In the multiple regression analysis, the likelihood of COVID resolution was positively correlated with the diagnosis of schizophrenia, the increased perceived effectiveness, and the presence of positive emotions. The perception of knowledge of the COVID phenomenon positively influenced both the institutional-economy risk and the psychological risk. Finally, positive emotions and uncertainty positively influenced the interpersonal risk. CONCLUSIONI: Our study highlight the need to give more attention to support psychiatric patients during emergency situations to reduce the perceived isolation. to prevent them from engaging in risky behavior.
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Introduction: The COVID-19 pandemic has negatively impacted sleep and mood on a global scale. To date, a handful of studies have reported on sleep and mood in perinatal women during the pandemic. They suggest that many pregnant women have poor sleep quality and depression. However, since these studies are cross-sectional with no comparison group, it is difficult to determine whether they are suffering more now. Methods: The current study compared sleep quality and the presence of likely clinical depression in perinatal women from two studies (one prior to the pandemic (∼1998)) and one during the pandemic (Aug 2020 - April 2021). All women had a history of MDD/PPD. Sleep quality and depression were ascertained at ∼36 weeks and 4 weeks postpartum for both groups. Sleep quality was characterized by the Pittsburgh Sleep Quality Index (PSQI). Depression was ascertained by the Hamilton Depression Rating Scale (HRDS) for the non-pandemic group and the Edinburgh Postnatal Depression Scale (EPDS) for the pandemic group. PSQI scores were analyzed continuously and categorically, while the depression scales were categorized according to published cutoffs. Results: The Mage = 31.1 (4.2) and did not differ between groups;84% were White. Sleep quality in late pregnancy did not differ between groups (7.62 (3.5) vs 7.16 (3.8), (ns), prepandemic vs pandemic), but they did differ at 1 month PP (7.10 (3.1) vs 8.7 (2.6), P < .001). The number of women who met criteria for depression in late pregnancy differed (28(41.1%) vs 7 (7.5%) X2 = 26.1, P < .001), but not at 1 month PP (9 (13.2%) vs 18(19.3%), X2 = 1.05, P = .31). Sleep quality in late pregnancy was correlated with whether a woman met criteria for depression during pregnancy (r = .22, P = .005), but not at 1-month postpartum (ns). Conclusion: Our findings suggest that the pandemic negatively impacted sleep quality in the first month postpartum, but not the rate of depression. We interpret these findings with caution due to varying methodologies. The pre-pandemic group was a RCT of 4 drug treatment groups in postpartum, and the pandemic group women used the SNOO®, a robotic, responsive bassinet.
ABSTRACT
Objective: We characterized the effect of a 12-week community-based boxing exercise program on motor and non-motor symptoms in people with Parkinson's disease (PWP). Background: Non-motor symptoms, including depression and apathy, are common in Parkinson's disease (PD), with significant impact on quality of life and independence. Apathy, in particular, can be difficult to treat with pharmacotherapeutics. Design/Methods: This was a prospective observational study. PWP underwent a 12-week designed community-based boxing program. The following assessments were performed by a movement disorders neurologist at baseline and after completion of the program: MDS-Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS III) modified version (since this was performed virtually due to COVID-19 pandemic), MDS Non-Motor Rating Scale (MDS-NMS), Hamilton Depression Rating Scale (HDRS), Lilli Apathy Rating Scale (LARS), Parkinson's Disease Questionaire-39 (PDQ-39), and Schwab and England Activities of Daily Living scale (SE-ADL). Pre- and post-assessments were compared using paired T-test;only participants who completed the program and both assessments were analyzed. Results: Twenty-four PWP enrolled in the boxing program, out of which 14 agreed to be a part of the study and completed assessments. All participants were ambulatory and functionally independent at baseline. MDS-NMS (p=0.003), HDRS (p=0.04), and MDS-UPDRS III modified (p=0.0003) improved significantly after the intervention. LARS (p=0.25), PDQ-39 (p=0.07), and SE-ADL (p= 0.16) did not change. Anecdotally, participants reported an improvement in motivation. Conclusions: PWP who participated in a community-based boxing program had improvements in motor exam, non-motor symptoms, and depression. Using a larger sample size, future studies should assess the impact of such an intervention on apathy.
ABSTRACT
Background - COVID 19 illness is associated with psychological impairments. Whether this impairment is due to illness itself or inpatient stay also contributes to it needs to be ascertained. Present study was done to assess the change in severity of stress, depression and anxiety in COVID-19 patients on the day of hospital admission and on the day of discharge and its association with clinical variables. Methods - A cross sectional study design with sample of 104 patients admitted in the COVID wards. Socio-demographic and COVID related clinical variables and laboratory parameters were recorded. The severity of stress (PSS scale), anxiety (HAM-A scale) and depression (HAM-D scale) was assessed on the day of hospital admission &on the day of discharge. Association between change in severity of these and other variables was assessed. Results-Significant increase in severity of stress, anxiety and depression was found during indoor stay of Covid-19 patients. Severity increased despite improvement in physical status of subjects. There was no significant association of increased severity of stress, anxiety, depression with demographic variables and laboratory parameters. Conclusion - There was a significant increase in level of stress, anxiety and depression during the inpatient stay despite improvement in clinical symptoms, with minimal association with demographic and clinical variables.
ABSTRACT
Introduction: Although isolation and quarantine are important measures to curb the exponential growth of the prevailing Coronavirus disease 2019 (COVID-19) pandemic, but at same time this can impose psychological issues among the affected population and also to their family members. Aims: To evaluate the mental health problems, their severity and associated factors in quarantined population during the COVID-19 pandemic. Materials and Methods: This cross-sectional study was conducted among 207 quarantined subjects at different quarantine centres of Ajmer, associated with JLN Medical College, Ajmer, from August 2020 to October 2020,after getting approval from ethics committee of the centre. All the consenting quarantined subjects who were of age 18 years and above, irrespective of their gender were enrolled in the study. For the assessment of psychiatric morbidity, participants were screened using Mini-International Neuropsychiatric Interview (MINI) 6.0.0. Finally, the relevant psychiatric assessment tools like Hamilton Rating Scale for Depression (HAM-D),Hamilton Anxiety Rating Scale (HAM-A) and Yale-Brown Obsessive Compulsive Scale were applied to assess the severity of the disorders. Pearson correlation analysis was used to evaluate the relationship among various clinical variables.The level of significance was considered at p-value lt;0.05. Results: Majority 85 (41%) subjects belonged to the age group 31-40 years of age. Around 116 (77.3%) participants were male. Around 51 (24.6%) presented moderate depression and 25 (12%) presented with severe depression. Also 182 (87.9%) presented with moderate anxiety. The study showed a statistically significant association between depression/anxiety and substance abuse, insomnia, co-morbidities, suicidal ideation/attempts. Conclusion: The findings of the present study concluded that a significant proportion of the quarantined population suffered from psychological issues. So, the psychological impact of a mandatory quarantine should be weighed more thoughtful and in an evidence based manner.