The relationship between demoralization and depressive symptoms among patients from the general hospital: Network and exploratory graph analysis

Introduction: Depression and demoralization are highly prevalent among individuals with physical illnesses but their relationship is still unclear. Objective: To examine the relationship between clinical features of depression and demoralization with the network approach to psychopathology. Methods: Participants were recruited from the medical wards of a University Hospital in Italy. The Demoralization Scale (DS) was used to assess demoralization, while the Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptoms. The structure of the depression-demoralization symptom network was examined and complemented by the analysis of topological overlap and Exploratory Graph Analysis (EGA) to identify the most relevant groupings (communities) of symptoms and their connections. The stability of network models was estimated with bootstrap procedures and results were compared with factor analysis. Results: Life feeling pointless, low mood/discouragement, hopelessness and feeling trapped were among the most central features of the network. EGA identified four communities: (1) Neurovegetative Depression, (2) Loss of purpose, (3) Frustrated Isolation and (4) Low mood and morale. Loss of purpose and low mood/morale were largely connected with other communities through anhedonia, hopelessness and items related to isolation and lack of emotional control. Results from EGA displayed good stability and were comparable to those from factor analysis. Limitations: Cross-sectional design; sample heterogeneity Conclusions: Among general hospital inpatients, features of depression and demoralization are independent, with the exception of low mood and self-reproach. The identification of symptom groupings around entrapment and helplessness may provide a basis for a dimensional characterization of depressed/demoralized patients, with possible implications for treatment

Antipsychotic drug exposure and risk of pneumonia: a systematic review and meta-analysis of observational studies

Pneumonia is one of the major leading causes of morbidity and mortality among persons aged 65\u2009years or older. Recently, several studies suggested an association between antipsychotic (AP) use and risk of pneumonia in elderly patients. The aim of the present systematic review and meta-analysis of observational studies was to investigate if first-generation and second-generation AP drugs increase the risk of pneumonia in the elderly and also in the younger population, and to ascertain the risk associated with exposure to individual drugs

Beyond pain: can antidepressants improve depressive symptoms and quality of life in patients with neuropathic pain? A systematic review and meta-analysis

Neuropathic pain can be a predictor of severe emotional distress, up to full blown depressive states. In these patients, it is important to move beyond the sole treatment of pain, in order to recognize depressive symptoms, and to ultimately improve the quality of life.We systematically searched for published and unpublished clinical trials assessing the efficacy and tolerability of antidepressants versus placebo on depression, anxiety and quality of life in patients with neuropathic pain, and pooled data in a meta-analysis.A total of 37 studies fulfilled eligibility criteria and 32 provided data for meta-analysis. Antidepressants were more effective than placebo in improving depressive symptoms (standardized mean difference -0.11; 95% confidence interval -0.20 to -0.02), although the magnitude of effect was small, with a number-needed-to-treat of 24. No significant difference emerged between antidepressants and placebo in reducing anxiety. Quality of life appeared improved in patients on antidepressants, as did pain. Acceptability and tolerability were higher in patients on placebo.To our knowledge, this is the first meta-analysis specifically focusing on the effect of antidepressants on psychiatric symptoms and quality of life in patients with neuropathic pain. Our findings suggest that, despite their potential benefit in patients with neuropathic pain, antidepressants should be prescribed with particular care, as they might be less tolerable in such a fragile population. However, our findings warrant further research to explore how a correct use of antidepressants can help patients to cope with the consequences of neuropathic pain on their psychosocial health and quality of life