Testing the Mechanism of Action of Computerized Cognitive Training in Young Adults with Depression: Protocol for a Blinded, Randomized, Controlled Treatment Trial.

BACKGROUND: Depression is associated with a broad range of cognitive deficits, including processing speed (PS) and executive functioning (EF). Cognitive symptoms commonly persist with the resolution of affective symptoms and increase risk of relapse and recurrence. The cognitive control network is comprised of brain areas implicated in EF and mood regulatory functions. Prior research has demonstrated the effectiveness of computerized cognitive training (CCT) focused on PS and EF in mitigating both cognitive and affective symptoms of depression. METHODS: Ninety participants aged 18-29 with a current diagnosis of major depressive disorder or persistent depressive disorder, or a Hamilton Depression Rating Scale score ≥12, will be randomized to either PS/EF CCT, verbal CCT, or waitlist control. Participants in the active groups will complete 15 min of training 5 days/week for 8 weeks. Clinical and neuropsychological assessments will be completed at baseline, week 4, week 8, and 3-month follow-up. Structural and functional magnetic resonance imaging (fMRI) will be completed at baseline and week 8. We will compare changes in mood, cognition, daily functioning, and fMRI data. We will explore cognitive control network functioning using resting-state and task-based fMRI. RESULTS: Recruitment began in October 2019; we expect to finish recruitment by April 2022 and subsequently begin data analysis. CONCLUSIONS: This study is innovative in that it will include both active and waitlist control conditions and will explore changes in neural activation. Identifying the neural networks associated with improvements following CCT will allow for the development of more precise and effective interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT03869463; https://clinicaltrials.gov/ct2/show/NCT03869463.

Vascular depression for radiology: A review of the construct, methodology, and diagnosis.

Vascular depression (VD) as defined by magnetic resonance imaging (MRI) has been proposed as a unique subtype of late-life depression. The VD hypothesis posits that cerebrovascular disease, as characterized by the presence of MRI-defined white matter hyperintensities, contributes to and increases the risk for depression in older adults. VD is also accompanied by cognitive impairment and poor antidepressant treatment response. The VD diagnosis relies on MRI findings and yet this clinical entity is largely unfamiliar to neuroradiologists and is rarely, if ever, discussed in radiology journals. The primary purpose of this review is to introduce the MRI-defined VD construct to the neuroradiology community. Case reports are highlighted in order to illustrate the profile of VD in terms of radiological, clinical, and neuropsychological findings. A secondary purpose is to elucidate and elaborate on the measurement of cerebrovascular disease through visual rating scales and semi- and fully-automated volumetric methods. These methods are crucial for determining whether lesion burden or lesion severity is the dominant pathological contributor to VD. Additionally, these rating methods have implications for the growing field of computer assisted diagnosis. Since VD has been found to have a profile that is distinct from other types of late-life depression, neuroradiologists, in conjunction with psychiatrists and psychologists, should consider VD in diagnosis and treatment planning.

Prevalence and correlates of ADHD among adolescents in a Beirut community sample: results from the BEI-PSY Study.

BACKGROUND: This study aims to investigate the prevalence, correlates and treatment seeking behavior related to ADHD among adolescents from Lebanon. METHODS: Five hundred and ten adolescents were recruited through multistage stratified cluster sampling of households in Beirut, and separately interviewed along with one parent/legal guardian, using the DAWBA. All adolescents completed the PRQ and the SDQ; the parent/legal guardian also completed the SDQ and provided basic demographic information, including attitudes towards seeking mental health services. RESULTS: 10.20% of the adolescents were diagnosed with ADHD. Having ADHD was associated with having academic difficulties and being involved in bullying. Adolescents with ADHD also had higher odds of drinking alcohol, smoking cigarettes, and having comorbid emotional and conduct disorders (compared to those without ADHD). Adolescents with ADHD and their parents reported a higher burden of illness and were more likely to consider seeing a mental health professional than healthy adolescents and their parents. CONCLUSION: ADHD among adolescents in Lebanon warrants closer attention, mainly increased awareness in the larger public, and stronger commitment to increase treatment resources to the community.

Psychiatric disorders among adolescents from Lebanon: prevalence, correlates, and treatment gap.

PURPOSE: Adolescence is a critical age for the development of psychiatric disorders. Although Lebanon, a low-to-middle income country, has suffered from decades of war and political instability, the burden of psychiatric disorders among adolescents in Lebanon remains unclear. This study aims to estimate the prevalence of psychiatric disorders among adolescents in the Lebanese capital, Beirut, and to study the correlates and treatment seeking behavior associated with these disorders. METHODS: Through a multistage cluster sampling design, 510 adolescents, aged 11-17 years were recruited from a household sample in Beirut in 2012. Parents and adolescents completed a battery of self-reported questionnaires and interviews including the Development and Well-being Assessment (DAWBA), the Peer-Relations Questionnaire (PRQ), and a demographic/clinical information questionnaire. Logistic regression models were used to study the correlates of psychiatric disorders. RESULTS: The 30-day prevalence of psychiatric disorders was 26.1 %, with anxiety disorders (13.1 %) and ADHD (10.2 %) being the most prevalent disorders. Only 6 % of those with disorders reported seeking professional help. Parental marital status, not attending school, having a chronic medical condition, having a family history of psychiatric disorders, as well as propensity to bullying and to being victimized by peers emerged as correlates of having psychiatric disorders. CONCLUSIONS: A clear treatment gap is evident with a high 30-day prevalence of psychiatric disorders among adolescents in Beirut coupled with a very low percentage seeking treatment. Scaling up mental health services and addressing potential barriers to seeking care would be important to close this gap.

Neurocognitive Changes in Selective Serotonin Reuptake Inhibitors-Treated Adolescents with Depression.

OBJECTIVES: Adolescents with major depressive disorder (MDD) were found to have deficits in executive function, attention, and memory. Despite the fact that some neurocognitive functions have been shown to be present in acute stage of the illness, but not in remission, longitudinal studies are lacking. The current study aimed to investigate the changes in neurocognitive functioning in adolescents with depression during an acute treatment course with selective serotonin reuptake inhibitor. METHODS: Twenty-four adolescents with current MDD and 24 healthy controls (HCs) were administered subtests of the Cambridge Neuropsychological Test Automated Battery as well as clinical scales at baseline and were retested at weeks 6 and 12. Those with MDD were started on fluoxetine after the baseline assessment. RESULTS: Despite considerable improvement in depressive symptoms in the MDD group, there was a persistent deficit in visual memory in the MDD group over time compared with HCs (p = 0.001). On a task of sustained attention and inhibition, HCs became better at detecting target sequences at week 12 while there were residual sustained attention deficits in MDD (p = 0.01). On an executive function (planning) task, while HCs learned the task and improved substantially in performance over 12 weeks, MDD performance did not significantly change (p = 0.04). CONCLUSION: When treating depressed adolescents, clinicians need to also monitor cognitive symptoms as they appear to lag behind mood symptoms in improvement.

Correlates of Depression and Burnout Among Residents in a Lebanese Academic Medical Center: a Cross-Sectional Study.

OBJECTIVES: This study aims to assess the prevalence of depressive symptoms, severity of burnout, and suicidal ideation among residents in a range of specialties and to identify factors that are associated with these symptoms. METHODS: A cross-sectional study was carried out at the American University of Beirut Medical Center between August and October 2013. In total, 118 out of 311 eligible residents responded. The survey included general sociodemographic questions and standardized validated tools to measure depressive symptomatology (PHQ-9), burnout (burnout measure), anxiety (GAD-7), alcohol use (AUDIT), and drug abuse (DAST-10). RESULTS: Overall, 22% of the residents qualified for major depressive symptomatology. Stressful personal life events and burnout were significantly associated with depression. Drug abuse, but neither alcohol abuse nor anxiety, was associated with depression. Twenty-seven percent of the residents met criteria for burnout. Additionally, 13% of residents had suicidal ideation, which was significantly associated with the severity of depression and not using mental health services. CONCLUSIONS: These findings increase awareness regarding the vulnerability of residents internationally. Addressing the mental health of residents is a pressing issue, and training programs need to actively address the psychological well-being of residents.