Lesional psychiatric neurosurgery: meta-analysis of clinical outcomes using a transdiagnostic approach.

BACKGROUND: Four ablative neurosurgical procedures are used in the treatment of refractory psychiatric illness. The long-term effects of these procedures on psychiatric symptoms across disorders has never been synthesised and meta-analysed. METHODS: A preregistered systematic review was performed on studies reporting clinical results following ablative psychiatric neurosurgery. Four possible outcome measures were extracted for each study: depression, obsessive-compulsive symptoms, anxiety and clinical global impression. Effect sizes were calculated using Hedge's g. Equipercentile linking was used to convert symptom scores to a common metric. The main outcome measures were the magnitude of improvement in depression, obsessive compulsive symptoms, anxiety and clinical global impression. The secondary outcome was a subgroup analysis comparing the magnitude of symptom changes between the four procedures. RESULTS: Of 943 articles, 43 studies reporting data from 1414 unique patients, were included for pooled effects estimates with a random-effects meta-analysis. Results showed that there was a large effect size for improvements in depression (g=1.27; p<0.0001), obsessive-compulsive symptoms (g=2.25; p<0.0001) and anxiety (g=1.76; p<0.0001). The pooled clinical global impression improvement score was 2.36 (p<0.0001). On subgroup analysis, there was only a significant degree of heterogeneity in effect sizes between procedure types for anxiety symptoms, with capsulotomy resulting in a greater reduction in anxiety than cingulotomy. CONCLUSIONS: Contemporary ablative neurosurgical procedures were significantly associated with improvements in depression, obsessive-compulsive symptoms, anxiety and clinical global impression. PROSPERO REGISTRATION NUMBER: CRD42020164784.

Comparison of cardiac rehabilitation (exercise + education), exercise only, and usual care for patients with coronary artery disease: A non-randomized retrospective analysis.

Cardiac rehabilitation program is well-established but the Rehabilitation After Myocardial Infarction Trial (RAMIT) is reported that it does not affect mortality and morbidity of patients after myocardial infarction during follow-up period. The objectives of the study were to compare functional walking capacity, risk factor control, and morbidities in follow-up for cardiac rehabilitation (exercise + education), exercise only, and usual care among patients with coronary artery disease. A total of 492 male and female patients (age range: 45-73 years) with coronary artery disease after myocardial infarction or underwent percutaneous coronary intervention or coronary artery bypass grafting surgeries referred to cardiac rehabilitation were included in the study. Patients were participating in a cardiac rehabilitation program (exercise + education, CRP cohort, n = 125), exercise only (USC cohort, n = 182), or usual care (NCR cohort, n = 185). Data regarding incremental shuttle walk test, lipid profile, the Patient Health Questionnaire 9, and morbidities in follow-up of patients were retrospectively collected and analyzed. After completion of 1 year, cardiac rehabilitation program (p < 0.0001, q = 20.939) and exercise (p < 0.0001, q = 6.059) were successfully increased incremental shuttle walk test. After completion of 1 year, cardiac rehabilitation program reduced low-density lipoprotein (p = 0.007, q = 3.349) and depressive symptoms (p < 0.0001, q = 5.649). Morbidities were reported fewer in the patients of CRP cohort than those of USC (p = 0.003, q = 3.427) and NCR (p = 0.003, q = 4.822) cohorts after completion of 1 year of program. Cardiac rehabilitation program (exercise +education) improved functional walking capacity, controlled risk factors, and reduced morbidities of patients with coronary artery disease than exercise only and usual care (Level of evidence: III).

Association between extremely preterm caesarean delivery and maternal depressive and anxious symptoms: a national population-based cohort study.

OBJECTIVE: To evaluate whether caesarean delivery before 26 weeks of gestation was associated with symptoms of depression and anxiety in mothers in comparison with deliveries between 26 and 34 weeks. DESIGN: Prospective national population-based EPIPAGE-2 cohort study. SETTING: 268 neonatology departments in France, March to December 2011. POPULATION: Mothers who delivered between 22 and 34 weeks and whose self-reported symptoms of depression (Center for Epidemiologic Studies Depression Scale: CES-D) and anxiety (State-Trait Anxiety Inventory: STAI) were assessed at the moment of neonatal discharge. METHODS: The association of caesarean delivery before 26 weeks with severe symptoms of depression (CES-D ≥16) and anxiety (STAI ≥45) was assessed by weighted and design-based log-linear regression model. MAIN OUTCOME MEASURES: Severe symptoms of depression and anxiety in mothers of preterm infants. RESULTS: Among the 2270 women completing CES-D and STAI questionnaires at the time of neonatal discharge, severe symptoms of depression occurred in 25 (65.8%) women having a caesarean before 26 weeks versus in 748 (50.6%) women having a caesarean after 26 weeks. Caesarean delivery before 26 weeks was associated with severe symptoms of depression compared with caesarean delivery after 26 weeks (adjusted relative risk [aRR] 1.42, 95% CI 1.12-1.81) adjusted to neonatal birthweight and severe neonatal morbidity among other factors. There was no evidence of an association between mode of delivery and symptoms of anxiety. CONCLUSIONS: Mothers having a caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression and may benefit from specific preventive care. TWEETABLE ABSTRACT: Mothers having caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression.

Impact of Depression on Weight Variation after Bariatric Surgery: A Three-Year Observational Study.

INTRODUCTION: The association between obesity and depression has been repeatedly established. However, little is known about the impact that the diagnosis of depression before bariatric surgery (DDBS) may have on weight loss. OBJECTIVE: To evaluate the impact of DDBS on weight outcomes. METHODS: Retrospective study of patients submitted to BS. Patients with no weight, no current medication data, or those submitted to revision surgery were excluded. Patients were considered to have DDBS based on taking antidepressants prior to BS or if there was a medical history of past or current depression. Patients with and without a depression history were compared using independent t test. A multivariate logistic regression model was created to evaluate predictors of weight variation (variables included: age, sex, and type of surgery). RESULTS: A total of 616 patients did not have a history of depression and 230 had DDBS. There was a statistically significant difference in the BMI variation between groups. On average, individuals with DDBS lost 1.4 kg/m2 less than those without DDBS. In the multivariate analysis, the group with DDBS, compared with the group without DDBS, presented on average less -0.9 kg/m2 (95% CI -1.7 to -0.2, p = 0.018) BMI variation. CONCLUSION: DDBS is a predictor of lower weight loss after the surgical procedure. Even after adjusting for confounding variables such as age, sex, and BS type, this effect remains.

Lower SRS Mental Health Scores are Associated With Greater Preoperative Pain in Patients With Adolescent Idiopathic Scoliosis.

STUDY DESIGN: Retrospective review of a prospectively collected multicenter database. OBJECTIVE: The aim of this study was to investigate factors associated with low preoperative SRS pain scores. SUMMARY OF BACKGROUND DATA: The prevalence of preoperative pain in patients with adolescent idiopathic scoliosis (AIS) has become increasingly evident and is a primary concern for patients and families. Greater preoperative pain is associated with more postoperative pain; however, less is understood about what contributes to preoperative pain. METHODS: A prospectively collected, multicenter database was queried for patients with AIS. Patients were divided into 2 cohorts based on preoperative SRS pain scores: ≤ 3 (Pain cohort), 4 to 5 (No Pain cohort). Univariate analysis was performed identifying which factors were associated with a low preoperative SRS score and used for a CART analysis. RESULTS: Of 2585 patients total, 2141 (83%) patients had SRS pain scores of 4 to 5 (No Pain) and 444 (17%) had SRS pain scores ≤3 (Pain). Female sex, older age, greater % body mass index, larger lumbar curves, greater T5-12 kyphosis, and lower mental health scores were associated with greater preoperative pain. In multivariate CART analysis, lower mental health SRS scores (P = 0.04) and older age (P = 0.003) remained significant, with mental health scores having the greatest contribution. In subdividing the mental health component questions, anxiety-related questions appeared to have the greatest effect followed by mood/depression (SRS Question 13: OR 2.04; Q16: OR 1.35; Q7: OR 1.31; Q3: OR 1.20). CONCLUSION: Anxiety and mood are potentially modifiable risk factors that have the greatest impact on pre- and postoperative pain. These results can be used to identify higher-risk patients and develop preoperative therapeutic protocols to improve postoperative outcomes. LEVEL OF EVIDENCE: 3.

Evaluation of Depression and Anxiety in Coronary Artery Bypass Surgery Patients: A Prospective Clinical Study.

OBJECTIVE: The aim of this clinical study is to determine the depression and anxiety levels in coronary artery bypass graft (CABG) surgery patients in the pre and postoperative periods. METHODS: This clinical prospective study was done with 65 patients. Beck's Depression Inventory (BDI) and Beck's Anxiety Inventory (BAI) tests were performed in patients who had a diagnosis of coronary artery disease and were awaiting CABG surgery. These patients presented characteristic symptoms of anxiety and depression and BDI and BAI tests are important to assess these symptoms. RESULTS: We found out that depression and anxiety levels were higher in the postoperative than in the preoperative period (P<0.001). Both anxiety and depression levels were increased significantly following CABG operation when compared with preoperative levels in all patients. Statistical correlation of depression and anxiety in different ages, genders, and professions were evaluated too, but we did not found a correlation between them (P>0.05). CONCLUSION: We suggest that good management of the psychological condition of cardiac surgery candidates, as well as post-bypass patients, will improve quality of life and cardiovascular outcomes in these patients.

Evaluation of depression and anxiety in coronary artery bypass surgery patients: a prospective clinical study

Abstract Objective: The aim of this clinical study is to determine the depression and anxiety levels in coronary artery bypass graft (CABG) surgery patients in the pre and postoperative periods. Methods: This clinical prospective study was done with 65 patients. Beck's Depression Inventory (BDI) and Beck's Anxiety Inventory (BAI) tests were performed in patients who had a diagnosis of coronary artery disease and were awaiting CABG surgery. These patients presented characteristic symptoms of anxiety and depression and BDI and BAI tests are important to assess these symptoms. Results: We found out that depression and anxiety levels were higher in the postoperative than in the preoperative period (P<0.001). Both anxiety and depression levels were increased significantly following CABG operation when compared with preoperative levels in all patients. Statistical correlation of depression and anxiety in different ages, genders, and professions were evaluated too, but we did not found a correlation between them (P>0.05). Conclusion: We suggest that good management of the psychological condition of cardiac surgery candidates, as well as post-bypass patients, will improve quality of life and cardiovascular outcomes in these patients.

Clinical characteristics and depression score response after parathyroidectomy in primary hyperparathyroidism.

OBJECTIVE: Several studies indicate that patients with primary hyperparathyroidism (PHPT) undergoing parathyroid surgery have improvement in mood and neuropsychological functioning. The current analysis aims to examine the relationship between biochemical and clinical variables and the improvement in depression scores and in specific symptoms, after parathyroidectomy. DESIGN: A prospective observational case-control study at a referral centre. PATIENTS: Patients with PHPT undergoing parathyroidectomy (n = 88) or thyroid surgery (n = 85). MEASUREMENTS: The Patient Health Questionnaire-9 (PHQ-9) was utilized to obtain depression scores at enrolment and 12 months after surgery. The changes in PHQ-9 were analysed and correlated with baseline clinical and biochemical parameters. RESULTS: At enrolment, there was no difference between the groups in the number with a depression diagnosis (PHPT 34.1%, thyroid surgery, 35.5%, P = 0.86). However, baseline PHQ-9 scores were significantly higher in PHPT (median 7.5, range 0-27) than thyroid surgery patients (median 3.0, range 0-18, P < 0.0001). Following surgery, all PHQ-9 scores, total and symptom group (cognitive, somatic) improved and were no longer different between PHPT (total PHQ-9 median 2, range 0-16) and thyroid (median 1, range 0-14, P = 0.31) groups. Baseline parathyroid hormone level, but not calcium, had a weak relationship with change in PHQ-9 score after parathyroid surgery (P = 0.003). Baseline PHQ-9 score was correlated with change in PHQ-9 score at 12 months after parathyroid surgery (P < 0.001). CONCLUSIONS: Depression scores improve in both somatic and cognitive domains after parathyroidectomy for PHPT and baseline severity of depression predicts the response.

Effects of vagus nerve stimulation on symptoms of depression in patients with difficult-to-treat epilepsy.

PURPOSE: Vagus nerve stimulation (VNS) is well established in the treatment of epilepsy and disorders of depression. The prevalence of depression is high in patients with epilepsy, but still it remains unclear how patients with a comorbidity of epilepsy and symptoms of depression respond to VNS. METHODS: We investigated 59 patients with different subtypes of disorders of depression as a comorbidity of epilepsy, who underwent VNS-surgery. Before and one year after VNS surgery, the severity of symptoms of depression was evaluated by a psychiatrist using Montgomery-Åsberg Depression Rating Scale (MADRS) and Beck-Depressions-Inventory (BDI). Response towards epilepsy was measured by a seizure reduction of at least 50%. RESULTS: Symptoms of depression ameliorated in response to VNS in the overall of all patients MADRS 29 to 18 (p < 0,001) and BDI 24 to 14 (p < 0,001) and all subtypes of disorders of depression. Seizure reduction of at least 50% was achieved in two out of three of all patients two years after VNS. CONCLUSION: We were able to show the beneficial effect of VNS in the treatment of patients with pharmacoresistant epilepsy and a comorbidity of symptoms of depression.

Food Addiction in Sleeve Gastrectomy Patients with Loss-of-Control Eating.

OBJECTIVE: Food addiction and binge eating share overlapping and non-overlapping features; the presence of both may represent a more severe obesity subgroup among treatment-seeking samples. Loss-of-control (LOC) eating, a key marker of binge eating, is one of the few consistent predictors of suboptimal weight outcomes post-bariatric surgery. This study examined whether co-occurring LOC eating and food addiction represent a more severe variant post-bariatric surgery. METHODS: One hundred thirty-one adults sought treatment for weight/eating concerns approximately 6 months post-sleeve gastrectomy surgery. The Eating Disorder Examination-Bariatric Surgery Version assessed LOC eating, picking/nibbling, and eating disorder psychopathology. Participants completed the Yale Food Addiction Scale (YFAS), the Beck Depression Inventory-Second Edition (BDI-II), and the Short-Form Health Survey-36 (SF-36). RESULTS: 17.6% met food addiction criteria on the YFAS. Compared to those without food addiction, the LOC group with food addiction reported significantly greater eating disorder and depression scores, more frequent nibbling/picking and LOC eating, and lower SF-36 functioning. CONCLUSION: Nearly 18% of post-operative patients with LOC eating met food addiction criteria on the YFAS. Co-occurrence of LOC and food addiction following sleeve gastrectomy signals a more severe subgroup with elevated eating disorder psychopathology, problematic eating behaviors, greater depressive symptoms, and diminished functioning. Future research should examine whether this combination impacts long-term bariatric surgery outcomes.

Changes in Cognition, Depression and Quality of Life after Carotid Stenosis Treatment.

BACKGROUND: Although several studies have evaluated the change of cognitive performance after severe carotid artery stenosis, the results still remain elusive. The objective of this study was to assess changes in cognitive function, depressive symptoms and Health Related Quality of Life (HRQoL) after carotid stenosis revascularisation and Best Medical Treatment (BMT). METHODS: Study involved 213 patients with ≥70% carotid stenosis who underwent assessment of cognitive function using Montreal Cognitive Assessment scale (MoCA), depressive symptoms - using Patient Health Questionnaire-9 (PHQ-9) and HRQoL - using Medical Outcome Survey Short Form version 2 (SF-36v2). The assessment was performed before and at 6 and 12 months followup periods in patients who had Carotid Endarterectomy (CEA), Carotid Artery Stenting (CAS) or received BMT only. RESULTS: Improvement in the total MoCA scores was observed after 6 and 12 months (p<0.001, Kendall's W=0.28) in the CEA group. In the CAS group - after 12 months (p=0.01, Kendall's W=0.261) whereas in the BMT group - no significant changes (p=0.295, Kendall's W=0.081) were observed. Reduction of depressive symptoms was not found in any of the study groups. Comparing mean SF-36v2 scores in the CEA group, there was no significant difference in any of 10 subscales. Likewise in the CAS group - no significant difference in 9 of 10 subscales (p=0.028, η2=0.343) was observed. Three subscales worsened in the BMT group during the 1-year follow-up period. CONCLUSION: Patients with severe carotid stenosis who underwent revascularisation enhanced their cognitive performance without exerting significant change of depressive symptoms. Preoperative HRQoL may be maintained for at least one year in the CEA group.

The long-term effect of bariatric surgery on depression and anxiety.

BACKGROUND: No previous review has comprehensively assessed long-term changes in anxiety and depressive symptoms in bariatric surgery patients. This systematic review assessed the effects of bariatric surgery on long-term reductions (≥ 24 months) in anxiety and depressive symptom severity in morbidly obese (≥ 35 BMI kg/m2) participants. Short term effects (< 24 months) are briefly reviewed for context. METHODS: PsychINFO, Google Scholar and PubMed databases were systematically searched for prospective cohort studies published from inception to 14 June 2018 that evaluated long-term (≥ 24 months) changes in anxiety and depressive symptom severity in bariatric surgery patients with a BMI ≥ 35 kg/m2 using a combination of the following search terms: bariatric surgery (and surgical approaches included under this term), obesity, depression, depressive disorder, anxiety, anxious, psychiatric disorders, mood disorders. RESULTS: We reviewed 2058 articles for eligibility; 14 prospective studies were included in the systematic review. 13 studies (93%) reported significant reductions in depressive symptom severity 2-3 years after bariatric surgery. However, all studies recorded statistically significant reductions in depressive symptoms at the conclusion of the study. Similarly, there were reductions in overall anxiety symptom severity at ≥ 24 months follow-up (k = 8 studies, n = 1590 pooled). Pre-operative anxiety or depression scores did not predict outcomes of post-operative BMI. Similarly, post-surgery weight loss did not predict changes in anxiety symptoms. LIMITATIONS: Very few studies assessed anxiety or depression as a primary outcome. Therefore, we cannot suggest bariatric surgery as a stand-alone therapeutic tool for anxiety and depression based on our findings. CONCLUSION: Currently available evidence suggests that bariatric surgery is associated with long-term reductions in anxiety and depressive symptoms. This supports existing literature showing that metabolic treatments may be a viable therapeutic intervention for mood disorders.

Bariatric Surgery Outcomes in Appalachia Influenced by Surgery Type, Diabetes, and Depression.

BACKGROUND: Most effective treatment for morbid obesity and its comorbidities is bariatric surgery. However, research is limited on weight loss and associated outcomes among patients in Appalachia. The objective of this study was to examine demographic and comorbidity influence on surgical outcomes of this population including age, sex, race, state of residence, education, marital status, body mass index (BMI kg/m2), excess body weight (EBW), percent excess weight loss (%EWL), blood pressure, diagnosed depression, diagnosed type 2 diabetes (T2D), Beck Depression Inventory-II (BDI-II), and laboratory values (i.e., hemoglobin A1c). METHODS: A retrospective electronic medical record (EMR) data extraction was performed on N = 582 patients receiving bariatric surgery (laparoscopic Roux-en-Y gastric bypass [RYGB] and laparoscopic sleeve gastrectomy [SG]) between 10/2013 and 2/2017. RESULTS: Patient population was 92.5% Caucasian, 79.3% female, 62.8% married, 45 ± 11.1 years, 75.8% received RYGB, and 24.2% received SG. Average %EWL from baseline to 1-year follow-up was 68.5 ± 18.4% (n = 224). In final descriptive models, surgery type, diagnosed T2D, HbA1c, and depressive symptoms were significant covariates associated with lower %EWL. CONCLUSIONS: Findings suggest patients completing surgery within an Appalachian region have successful surgical outcomes at 1-year post-surgery, as indicated by significant reductions of > 50% EWL, regardless of other covariates. Results suggest that bariatric programs should consider paying special consideration to patients with T2D or depressive symptoms to improve outcomes. Results have potential to inform future prospective studies and aid in guiding specific interventions tailored to address needs of this unique population.

Depression and Pain Interference Correlate With Physical Function in Patients Recovering From Hand Surgery.

Background: Patient-reported outcome measures vary more than expected based on underlying pathology, in part due to the substantial influence of mood and coping strategies. Methods: This study addressed the primary null hypothesis that the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function score 1 month (range, 3-8 weeks) after hand surgery is not associated with PROMIS Depression and PROMIS Pain Interference scores prior to surgery, accounting for other factors. Using an institution-wide database of routinely collected patient-reported outcomes, we identified adult patients who underwent wrist ganglion excision, trapeziometacarpal arthroplasty, hand ganglion excision, trigger digit, De Quervain, and carpal tunnel release. Measures collected included the PROMIS Physical Function Computerized Adaptive Test (CAT), PROMIS Pain Interference CAT, and PROMIS Depression CAT. We sought factors associated with postsurgical PROMIS Physical Function scores and change between preoperative and postoperative score using multivariable linear regression, accounting for age, sex, surgery type, provider, and time from surgery to postsurgical measurement. Results: Higher postoperative PROMIS Physical Function score was independently associated with lower PROMIS Pain Interference scores, lower PROMIS Depression scores, younger age, and treatment by provider team 3. Greater change in PROMIS Physical Function score was independently associated with greater PROMIS Pain Interference scores, greater time from surgery, and treatment by provider team 3. Conclusions: Mood and effective coping strategies affect the level of symptoms and limitations during recovery from hand surgery and represent important treatment opportunities for enhancing recovery.

Pre- and Postbariatric Subtypes and Their Predictive Value for Health-Related Outcomes Measured 3 Years After Surgery.

BACKGROUND: Although bariatric surgery is the most effective treatment for severe obesity, a subgroup of patients shows insufficient postbariatric outcomes. Differences may at least in part result from heterogeneous patient profiles regarding reactive and regulative temperament, emotion dysregulation, and disinhibited eating. This study aims to subtype patients based on these aspects before and 2 years after bariatric surgery and tests the predictive value of identified subtypes for health-related outcomes 3 years after surgery. METHODS: Within a prospective multicenter patient registry, N = 229 bariatric patients were examined before bariatric surgery, 2 and 3 years postoperatively via clinical interviews and self-report questionnaires. Pre- and postbariatric subtypes were differentiated by temperament, emotion dysregulation, and disinhibited eating using latent profile analyses (LPA). The predictive value of pre- and postbariatric subtypes for surgery outcomes measured 3 years postoperatively was tested via linear regression analyses. RESULTS: LPA resulted in five prebariatric and three postbariatric subtypes which were significantly associated with different levels of general and eating disorder psychopathology. Post- versus prebariatric subtypes explained more variance regarding eating disorder psychopathology, depression, and quality of life assessed 3 years postoperatively, whereas neither pre- nor postbariatric subtypes predicted postbariatric weight loss. Patients with prebariatric deficits in self- and emotional control had an increased risk for showing these deficits postoperatively. CONCLUSIONS: A re-evaluation of patients' psychological status after bariatric surgery is recommended to detect patients with potential risk for adverse psychological surgery outcomes in the long term.

Cortical Reorganizations for Recovery from Depressive State After Spinal Decompression Surgery.

BACKGROUND: Depressed mood following neuronal damage not only impedes functional recovery but also negatively affects quality of life for many patients. Depressed patients with cervical myelopathy often show improvement in both mood and motor function after spinal decompression surgery; however, the neural mechanism underlying this psychological benefit from surgery remains unclear. The aim of this study was to clarify the brain sites that relate to alleviation of depression after spinal decompression surgery. METHODS: We compared brain activity of patients with cervical myelopathy (n = 6) with healthy participants (n = 5) using functional magnetic resonance imaging. We then analyzed functional magnetic resonance imaging data to find the brain regions that correlated with depression severity (n = 12; 6 preoperative patients and 6 postoperative patients) and compared preoperative imaging data with postoperative imaging data from patients. RESULTS: Spinal decompression surgery alleviated depression and diminished anterior cingulate cortex activity. Simultaneously, supplementary motor area activity, which was increased in patients with myelopathy compared with control subjects, was diminished after surgery. CONCLUSIONS: Traditionally, surgical indications for myelopathy are determined by the severity of sensorimotor symptoms without considering psychological symptoms. We anticipate our results will lead to more informed surgical decisions for cervical spondylosis myelopathy.

Preoperative depression, lumbar fusion, and opioid use: an assessment of postoperative prescription, quality, and economic outcomes.

OBJECTIVE Preoperative depression has been linked to a variety of adverse outcomes following lumbar fusion, including increased pain, disability, and 30-day readmission rates. The goal of the present study was to determine whether preoperative depression is associated with increased narcotic use following lumbar fusion. Moreover, the authors examined the association between preoperative depression and a variety of secondary quality indicator and economic outcomes, including complications, 30-day readmissions, revision surgeries, likelihood of discharge home, and 1- and 2-year costs. METHODS A retrospective analysis was conducted using a national longitudinal administrative database (MarketScan) containing diagnostic and reimbursement data on patients with a variety of private insurance providers and Medicare for the period from 2007 to 2014. Multivariable logistic and negative binomial regressions were performed to assess the relationship between preoperative depression and the primary postoperative opioid use outcomes while controlling for demographic, comorbidity, and preoperative prescription drug-use variables. Logistic and log-linear regressions were also used to evaluate the association between depression and the secondary outcomes of complications, 30-day readmissions, revisions, likelihood of discharge home, and 1- and 2-year costs. RESULTS The authors identified 60,597 patients who had undergone lumbar fusion and met the study inclusion criteria, 4985 of whom also had a preoperative diagnosis of depression and 21,905 of whom had a diagnosis of spondylolisthesis at the time of surgery. A preoperative depression diagnosis was associated with increased cumulative opioid use (ß = 0.25, p < 0.001), an increased risk of chronic use (OR 1.28, 95% CI 1.17-1.40), and a decreased probability of opioid cessation (OR 0.96, 95% CI 0.95-0.98) following lumbar fusion. In terms of secondary outcomes, preoperative depression was also associated with a slightly increased risk of complications (OR 1.14, 95% CI 1.03-1.25), revision fusions (OR 1.15, 95% CI 1.05-1.26), and 30-day readmissions (OR 1.19, 95% CI 1.04-1.36), although it was not significantly associated with the probability of discharge to home (OR 0.92, 95% CI 0.84-1.01). Preoperative depression also resulted in increased costs at 1 (ß = 0.06, p < 0.001) and 2 (ß = 0.09, p < 0.001) years postoperatively. CONCLUSIONS Although these findings must be interpreted in the context of the limitations inherent to retrospective studies utilizing administrative data, they provide additional evidence for the link between a preoperative diagnosis of depression and adverse outcomes, particularly increased opioid use, following lumbar fusion.

Music Intervention With Reminiscence Therapy and Reality Orientation for Elderly People With Alzheimer Disease Living in a Nursing Home: A Pilot Study.

The purpose of this study was to investigate the effect of an 8-week nursing intervention consisting of 2 weekly sessions of music and reminiscence therapy together with the application of reality orientation techniques. Our expectation at the onset of the study was that listening to music that was familiar and connected with the memory of past events would, due to the music's emotional impact, stimulate memory associations, leading, in turn, to a positive effect on depression and anxiety in people living with dementia. We carried out a pre-/posttest intervention design with a sample of 19 patients divided into 2 groups-a 10-patient control group and a 9-patient intervention group-in a nursing home in Spain. Goldberg tests for depression and anxiety have been assessed at baseline and postintervention in both groups. Our results confirm the valuable effect of music therapy and reminiscence therapy together with reality orientation techniques on depression in patients with mild Alzheimer disease. Our study may constitute an important starting point for further research on nursing interventions based on the provision of music and/or reminiscence therapy together with reality orientation techniques that is implemented on a daily basis in nursing homes.

Hippocampal α7 nicotinic ACh receptors contribute to modulation of depression-like behaviour in C57BL/6J mice.

BACKGROUND AND PURPOSE: Clinical studies have identified links between cholinergic signalling and depression in human subjects. Increased cholinergic signalling in hippocampus also increases behaviours related to anxiety and depression in mice, which can be reversed by ACh receptor antagonists. EXPERIMENTAL APPROACH: As the α7 subunit of the nicotinic ACh receptor (nAChR) is highly expressed in hippocampus, we determined whether blocking α7 nAChRs could reverse the effects of increased ACh signalling in anxiety- and depression-related behaviours in mice. KEY RESULTS: Administration of the α7 nAChR agonist GTS-21 had no effect in tail suspension or forced swim tests. Conversely, the α7 nAChR antagonist methyllycaconitine (MLA) induced significant antidepressant-like effects in male mice in these paradigms, consistent with previous studies, but this was not observed in female mice. MLA also decreased physostigmine-induced c-fos immunoreactivity (a marker of neuronal activity) in hippocampus. Local knockdown of α7 nAChRs in hippocampus had no effect on its own but decreased a subset of depression-like phenotypes induced by physostigmine in male mice. Few effects of α7 nAChR knockdown were observed in depression-like behaviors in female mice, possibly due to a limited response to physostigmine. There was no significant effect of hippocampal α7 nAChR knockdown on anxiety-like phenotypes in male mice. However, a modest increase in anxiety-like behavior was observed in female mice infused with a scrambled control vector in response to physostigmine administration, that was not seen after a7 nAChR knockdown in the hippocampus. CONCLUSIONS AND IMPLICATIONS: These results suggest that ACh signalling through α7 nAChRs in the hippocampus contributes to regulation of a subset of depression-like behaviours when ACh is increased, as can occur under stressful conditions. These studies also provide evidence for sex differences that may be relevant for treatments of mood disorders based on cholinergic signalling. LINKED ARTICLES: This article is part of a themed section on Nicotinic Acetylcholine Receptors. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v175.11/issuetoc.

Neuropsychological and psychiatric outcome of GPi-deep brain stimulation in dystonia.

BACKGROUND: Previous investigators have observed changes in cognitive and psychiatric domains after GPi-DBS for dystonia, such as declines in semantic verbal fluency and set shifting or increased suicidality. Others have reported stability or improvements in select areas, such as graphomotor speed and mood. Interpretation of these findings is limited by inclusion of select patient populations or limited neuropsychological testing. OBJECTIVE: To describe cognitive and neuropsychiatric outcomes in a cohort of patients with primary and secondary dystonia undergoing Globus Pallidus pars interna deep brain stimulation (GPi-DBS). METHODS: Patients with primary and secondary dystonia were evaluated at baseline and post-operatively with a comprehensive battery of neuropsychological tests and mood inventories including anxiety, depression and hopelessness scales. Statistical significance was calculated with one-tailed student t-test, defined as p value < 0.05. RESULTS: Twelve patients were included in the study. Nine were male (75%) and the mean age at baseline assessment was 42.3 years (range 13-68; SD 18.0). The majority had focal or segmental dystonia (8/12, 66%), 4 patients had generalized dystonia. Three patients had monogenic dystonias (DYT 1 and DYT 3), and two patients had acquired (tardive) dystonia. Mean time between surgery and follow-up was 13.1 months (SD 3.1). Subjects demonstrated stable performance on most tests, with statistically significant improvements noted in working memory (letter-number sequencing), executive function (trail-making B), anxiety and depression. CONCLUSIONS: In an etiologically and clinically diverse patient population, administration of comprehensive battery of cognitive tests pre and post-operatively suggests that GPi-DBS is safe from cognitive and psychiatric perspectives.