State and trait characteristics of early course major depressive disorder

Contains fulltext : 109595.pdf (Publisher’s version ) (Open Access)Radboud Universiteit Nijmegen, 21 december 2012Promotores : Buitelaar, J.K., Fernandez, G.S.E. Co-promotor : Tendolkar, I

A randomized controlled trial of repetitive transcranial magnetic stimulation for chronic, treatment resistant major depressive disorder

Contains fulltext : 203528.pdf (publisher's version ) (Closed access)1 p

Psychotic symptoms in the course of sunitinib treatment for advanced renal cell cancer. Two cases

Item does not contain fulltextThe vascular endothelial growth factor (VEGF) receptor inhibitor sunitinib is a first-line treatment in most patients with metastatic renal cell carcinoma. No psychiatric adverse events have previously been reported. We describe two patients with psychotic symptoms, during treatment with sunitinib. Possible mechanisms of sunitinib-induced psychosis are discussed

rTMS reduces craving and alcohol use in patients with alcohol use disorder: Results of a randomized, sham-controlled clinical trial

(1) Background: Current evidence-based treatments for alcohol use disorder (AUD) are moderately effective. Studies testing repetitive transcranial magnetic stimulation (rTMS) in AUD commonly apply a limited number of rTMS sessions with different rTMS settings, showing inconsistent effects on craving for alcohol. This study tested the efficacy of a robust rTMS protocol on craving and alcohol use. (2) Methods: In a single-blind randomized controlled trial in recently detoxified patients with AUD, ten days of high-frequency rTMS over the right dorsolateral prefrontal cortex on top of treatment as usual (n = 14) was compared with sham rTMS (n = 16). Outcome measures were alcohol craving and use over a follow-up period of one year. Analysis was performed by means of repeated measures multivariate analysis of variance. (3) Results: The results showed a main group-by-time interaction effect on craving (Wilks' Λ = 0.348, F (12, 17) = 2.654, p = 0.032) and an effect of group on alcohol use (Wilk's Λ = 0.44, F (6, 23) = 4.9, p = 0.002), with lower alcohol craving and use in the group with active rTMS compared to the control group. Differences in craving between groups were most prominent three months after treatment. At 12 months follow-up, there was no effect of rTMS on craving or abstinence. (4) Conclusions: This small-scale randomized controlled trial showed the efficacy of high-frequency rTMS over the right dlPFC diminished alcohol craving and use in recently detoxified patients with AUD during the first months after detoxification. These findings suggest that rTMS might be an effective add-on in treating patients with AUD and warrant replication in future large-scale studies

Resting-state functional connectivity in major depressive disorder: A review

Item does not contain fulltextMajor depressive disorder (MDD) affects multiple large-scale functional networks in the brain, which has initiated a large number of studies on resting-state functional connectivity in depression. We review these recent studies using either seed-based correlation or independent component analysis and propose a model that incorporates changes in functional connectivity within current hypotheses of network-dysfunction in MDD. Although findings differ between studies, consistent findings include: (1) increased connectivity within the anterior default mode network, (2) increased connectivity between the salience network and the anterior default mode network, (3) changed connectivity between the anterior and posterior default mode network and (4) decreased connectivity between the posterior default mode network and the central executive network. These findings correspond to the current understanding of depression as a network-based disorder.15 p

Structural brain characteristics in treatment-resistant depression: review of magnetic resonance imaging studies

Contains fulltext : 208920.pdf (publisher's version ) (Open Access)BACKGROUND: Major depressive disorder (MDD) has been related to structural brain characteristics that are correlated with the severity of disease. However, the correlation of these structural changes is less well clarified in treatment-resistant depression (TRD). AIMS: To summarise the existing literature on structural brain characteristics in TRD to create an overview of known abnormalities of the brain in patients with MDD, to form hypotheses about the absence or existence of a common pathophysiology of MDD and TRD. METHOD: A systematic search of PubMed and the Cochrane Library for studies published between 1998 and August of 2016 investigating structural brain changes in patients with TRD compared with healthy controls or patients with MDD. RESULTS: Fourteen articles are included in this review. Lower grey matter volume (GMV) in the anterior cingulate cortex, right cerebellum, caudate nucleus, superior/medial frontal gyrus and hippocampus does not seem to differentiate TRD from milder forms of MDD. However, lower GMV in the putamen, inferior frontal gyrus, precentral gyrus, angular- and post-central gyri together with specific mainly parietal white matter tract changes seem to be more specific structural characteristics of TRD. CONCLUSIONS: The currently available data on structural brain changes in patients with TRD compared with milder forms of MDD and healthy controls cannot sufficiently distinguish between a 'shared continuum hypothesis' and a 'different entity hypothesis'. Our review clearly suggests that although there is some overlap in affected brain regions between milder forms of MDD and TRD, TRD also comes with specific alterations in mainly the putamen and parietal white matter tracts. DECLARATION OF INTEREST: None

Default mode network coherence in treatment-resistant major depressive disorder during electroconvulsive therapy

Functional connectivity in the "default mode network" (DMN) is changed in depression, and evidence suggests depression also affects the DMN's spatial topography and might cause a dissociation between its anterior and posterior regions. As antidepressive treatment affects anterior and posterior regions of the network differently, how depression and treatment change DMN-organization is crucial for understanding their mechanisms. We present a novel way of assessing the coherence of a network's regions to the network as a whole, and apply this to investigate treatment-resistant depression and the effects of electroconvulsive therapy (ECT). METHODS: Resting-state functional MRI was collected from 16 patients with treatment-resistant depression before and after ECT and 16 healthy controls matched for age and sex. For each subject, the mean time series of the DMN was used as a regressor for each voxel within the DMN, creating a map of "network coherence" (NC). The obtained maps were compared across groups using permutation testing. RESULTS: NC was significantly decreased in depressed subjects in the precuneus and the angular gyrus. With ECT the NC normalized in responders (n=8), but not in non-responders (n=8). CONCLUSIONS: We present a novel method of investigating within-network coherence and apply this to show that in depression, a large area of the DMN shows a decrease in coherence to the network as a whole. Although tentative due to the small sample size, we find that this effect is not present after ECT in those improving clinically, but persists in patients not responding to ECT

Repetitieve transcraniële magnetische stimulatie (rTMS) als behandeling van bipolaire depressie [Usefulness of repetitive transcranial magnetic stimulation (rTMS) in the treatment of bipolar depression]

Item does not contain fulltextAchtergrond: Repetitieve transcraniële magnetische stimulatie (rTMS) is effectief bevonden voor de behandeling van unipolaire depressies. Of dit ook geldt voor bipolaire depressies is nog onbekend. doel Kritische evaluatie van beschikbare evidentie naar de effectiviteit van rTMS bij de bipolaire depressie. Methode: Review van RCT's en openlabelstudies. Resultaten: Vier RCT's en vier openlabelstudies werden geïncludeerd. Drie van de vier RCT's toonden geen voordeel boven placebo aan. Alle openlabelstudies lieten een significante verbetering zien. Eén proefpersoon kreeg hypomane symptomen. Binnen de studies werden veel verschillen gevonden in gebruikte rTMS-parameters, geïncludeerde diagnosen en medicatiegebruik. Conclusie: Er zijn nog onvoldoende studies van goede kwaliteit om uitspraken te doen over de effectiviteit van rTMS bij bipolaire depressies. Er lijkt geen verhoogd risico te zijn op het ontstaan van (hypo)manie door rTMS bij bipolaire depressies.7 p

Contributions of the medial temporal lobe to declarative memory retrieval: manipulating the amount of contextual retrieval.

Contains fulltext : 70984.pdf (publisher's version ) (Open Access)We investigated how the hippocampus and its adjacent mediotemporal structures contribute to contextual and noncontextual declarative memory retrieval by manipulating the amount of contextual information across two levels of the same contextual dimension in a source memory task. A first analysis identified medial temporal lobe (MTL) substructures mediating either contextual or noncontextual retrieval. A linearly weighted analysis elucidated which MTL substructures show a gradually increasing neural activity, depending on the amount of contextual information retrieved. A hippocampal engagement was found during both levels of source memory but not during item memory retrieval. The anterior MTL including the perirhinal cortex was only engaged during item memory retrieval by an activity decrease. Only the posterior parahippocampal cortex showed an activation increasing with the amount of contextual information retrieved. If one assumes a roughly linear relationship between the blood-oxygenation level-dependent (BOLD) signal and the associated cognitive process, our results suggest that the posterior parahippocampal cortex is involved in contextual retrieval on the basis of memory strength while the hippocampus processes representations of item-context binding. The anterior MTL including perirhinal cortex seems to be particularly engaged in familiarity-based item recognition. If one assumes departure from linearity, however, our results can also be explained by one-dimensional modulation of memory strength

Transdiagnostic psychiatry: Symptom profiles and their direct and indirect relationship with well-being

BACKGROUND: Heterogeneity and comorbidity in psychiatric disorders are common, however, little is known about the impact on well-being and the role of functional limitations. We aimed to identify transdiagnostic psychiatric symptom profiles and to study their association with well-being and the mediating role of functional limitations in a naturalistic psychiatric patient group. METHODS: We used four disorder-specific questionnaires to assess symptom severity within a sample of 448 psychiatric patients with stress-related and/or neurodevelopmental disorders and 101 healthy controls. Using both exploratory and confirmatory factor analyses we identified transdiagnostic symptom profiles, which we entered into a linear regression analysis to assess their association with well-being and the mediating role of functional limitations in this association. RESULTS: We identified eight transdiagnostic symptom profiles, covering mood, self-image, anxiety, agitation, empathy, non-social interest, hyperactivity and cognitive focus. Mood and self-image showed the strongest association with well-being in both patients and controls, while self-image also showed the highest transdiagnostic value. Functional limitations were significantly associated with well-being and fully mediated the relationship between cognitive focus and well-being. LIMITATIONS: The participant sample consisted of a naturalistic group of out-patients. While this strengthens the ecological validity and transdiagnostic perspective of this study, the patients with a single neurodevelopmental disorder were underrepresented. CONCLUSION: Transdiagnostic symptom profiles are valuable in understanding what reduces well-being in psychiatric populations, thereby opening new avenues for functionally meaningful interventions