The interplay between acute bacterial skin and skin structure infections and depression: a vicious circle of major clinical importance.

Purpose of review Previous studies suggest an association between depression and increased risk of various type of infections, including acute bacterial skin and skin structure infections (ABSSSI). Here, we review the latest advancement in our understanding of immunity in patients with depression and its relevance to disease management and diagnosis, with a special focus on patients suffering from ABSSSI. Recent findings Recent studies have highlighted the role of hypothalamic-pituitary-adrenal axis, neuro-endocrine stress signaling pathways and behavioral attitudes (substance abuse and homelessness) in the pathogenesis of infections in depressed patients. Furthermore, acute bacterial infections, in turn, have emerged as a possible risk for depression development because of different mechanisms including antibiotic-driven changes in the microbiota. Summary Recent evidences have emphasized the threat that comanagement of depression and infection pose to infectious disease physician and psychiatrist. Depressed patients with ABSSSI must be closely monitored for drug side-effects, drug-drug interactions, toxicity, and adequate compliance. New management strategies including new long-acting antibiotics (e.g., dalbavancin) are welcome

The impact of the COVID-19 Pandemic on the Greek population: Suicidal ideation during the first and second lockdown

More than a year has passed since World Health Organization (WHO) declared COVID-19 as a pandemic, and during this period over 237 million cases and more than 4.8 million deaths have occurred worldwide due to COVID-19.1 This unprecedented pandemic not only has burdened health systems but it also constitutes a major stressful event both due to the threat of illness and death that it poses, and to the drastic impact on human relations, financial activity, access to health services, etc. Additional factors that may contribute to stress include the protection measures against COVID-19, social distancing, and mobility restrictions. The impact of the pandemic on suicidal behavior, especially on the Greek population, is of critical importance, due to the increase in suicidality during the recent financial crisis in the country.2 The impressive decline in the GDP during the first months of the COVID-19 pandemic (-9% of GDP),3 unemployment, isolation, reduced social contacts, problems in accessing mental health services, and also the limitations in terms of psychological support may increase the risk of suicidal behavior.4 With a view to investigating the psychosocial effects of the COVID-19 pandemic, an online questionnaire was developed in March 2020 by the Second Department of Psychiatry of the National and Kapodistrian University of Athens (NKUA) and the Postgraduate Program "Liaison Psychiatry: Integrated Care of Physical and Mental Health" of NKUA. This questionnaire included items regarding demographic characteristics, physical and mental health data, and issues related to the pandemic and the imposed restriction measures, such as perceived changes in participants' biorhythms, habits, and relationships with their colleagues, friends, and family. In addition, participants were asked to complete psychometric scales with regard to anxiety, depression and suicidal ideation, family functioning, anger and resilience. During the first national lockdown in Greece (April 7 to May 3) a total of 5,748 adults from the community participated in the survey by anonymously completing the aforementioned questionnaire on a secure website of NKUA. A considerable effort was devoted to make the sample as representative as possible and to include members of the community who do not usually participate in such surveys, as individuals of older age or individuals with health conditions. The 5.20% two-week prevalence of suicidal ideation found in our study is an intermediate rate with respect to the 2.4% one-month prevalence in 2008, the 6.7% in 2011 and the 2.6% prevalence in 2013.5 Among the respondents, 14.1% were potential cases of anxiety, while 26.5% of depression. Independent risk factors for suicidal ideation included anxiety, depression, impaired family functioning, being unmarried or divorced, having a mental health history, as well as a poor perceived quality of physical health. In contrast, higher resilience, positive feelings with regard to the lockdown measures, relationship with friends, and faith in a Supreme Being emerged as protective factors for suicidal ideation.6 Investigating the risk and protective factors for suicidal ideation is especially important during this difficult period of the pandemic. There was an additional significant finding in this study: individuals who completed the questionnaire during the last two weeks of the first lockdown reported statistically significantly higher suicidal ideation, depression, and anxiety than those who completed it in the previous two weeks, while a similar finding was revealed in a study from USA.7 Therefore, we were looking forward to the results of our survey conducted during the second lockdown.8 From the 5,116 individuals who had fully completed our questionnaire with respect to suicidal ideation during the first lockdown, 811 fully completed it for the second time from November 22 to December 21, 2020. Suicidal ideation was not found significantly different compared to the first lockdown. Independent risk factors for suicidal ideation during the second lockdown were depression, anxiety, living with a person with frail health and vulnerable for COVID-19 and suicidal ideation during the first lockdown. It is noted that during the second lockdown the rates of potential depression cases remained unchanged, whereas anxiety rates increased. Greater accessibility to health services, state financial support and increased mobility might have contributed to the stability of suicidal ideation despite the greater severity of the second wave of the COVID-19 pandemic. The aforementioned studies determined the prevalence of suicidal ideation and its association with various demographic, clinical, social, familial, and psychopathological factors in a cohort context at different stages of the COVID-19 pandemic, with the relevant literature being rather poor. We consider that the provision of such data is critical for the plans of health system in pandemic conditions, while this longitudinal study is in progress during the subsequent waves of the pandemic

Psychotic (delusional) major depression: New vistas

In 1992, a comprehensive review of all previous studies comparing patients suffering from psychotic major depression (PMD) to non-PMD patients was published. In this review we present data of all studies comparing PMD patients to non-PMD published in the English language after 1992. The research papers reviewed have shown the following general profile of PMD: the point prevalence of PMD is about 0.4% and 19% of patients with a major depressive episode had psychotic symptoms as well. PMD was found to be a more severe form of depression with more feelings of guilt and more pronounced psychomotor disturbance. Additionally, PMD patients compared to non-PMD were found to be more severely impaired in the cognitive domains of attention, psychomotor speed, executive function and memory, regardless of depression's severity. As regards to the prognosis of the disorder, PMD is associated with poorer short-term outcome; nevertheless, in the long-term period (> 2-5 years) the prognostic significance of delusions in major depression tends to become weaker. However, the recurrence of psychotic episodes in PMD patients suggests that PMD runs "true to form". Of note, young PMD patients with acute onset of the disorder are at greater risk to develop bipolar disorder. Furthermore, PMD was associated with greater HPA abnormalities, higher plasma cortizol levels during the afternoon, lower serum DβH activity than age-matched non-PMD patients and healthy controls. In addition, more brain atrophy and paralimbic abnormalities may play a crucial role in the delusion formation. With respect to management of PMD, starting with a combination of AD plus AP or AD as monotherapy may be preferred. Nevertheless, methodological problems in studies on SSRIs as monotherapy and according to recent data-favoring the combination over AD monotherapy- the AP plus AD treatment regime takes precedence. © 2009 Bentham Science Publishers Ltd

Psychotic major depression in older people: A systematic review

Objective This study aimed to systematically review available evidence relevant to the following issues: (1) whether psychotic major depression (PMD) in older people differs in overall severity from non-PMD, besides the presence of psychotic symptoms; (2) whether it constitutes a distinct clinical entity from non-PMD; and (3) whether it differs from PMD in younger adults. Design A computerized MEDLINE, PsycINFO and the entire Cochrane Library search has been performed in June 2013 for prospective controlled studies investigating PMD features in older people. Results Thirty-five relevant studies were identified. PMD in older people compared with non-PMD has been shown to present with overall more severe depressive symptomatology, more psychomotor disturbance, more guilt feelings, more depressive episodes with psychosis, worse prognosis, more severe executive dysfunction associated with frontal lobe atrophy, and lower serum dopamine β-hydroxylase activity. No differences in the efficacy of an antidepressant plus antipsychotic combination versus antidepressant monotherapy in the acute treatment as well as in the maintenance treatment were found. PMD in older patients is characterized by more somatic complaints and delusions of hypochondriacal and impending disaster content and by a lower comorbidity with anxiety disorders compared with PMD in younger adults. Conclusions Psychotic major depression in older people is associated with higher severity in most clinically important key features than in non-PMD. However, available evidence is still insufficient for the conclusive elucidation of its nosological status. Finally, the differences between PMD in older and younger patients can be attributed to biological and psychosocial changes of old age. Copyright © 2014 John Wiley & Sons, Ltd

Psychotic (delusional) major depression in the elderly and suicidal behaviour

Background: It has been established that depressed patients manifest a higher risk of committing suicide. The role of delusional experiences accompanying depressive symptomatology as a risk factor for suicidal behaviour has been investigated but the results are inconsistent. Method: In the present study, 40 elderly depressed inpatients with psychotic features (DSM-IV criteria) were compared to 64 elderly depressed patients without such features in terms of suicide attempts. Results: The results of univariate and multivariate analyses were negative: Psychotic and nonpsychotic depressed patients did not differ with respect to attempted suicide. Conclusion: The results of the present study support the notion that psychotic features do not increase the risk for the elderly depressed patients to attempt suicide. (C) 2002 Elsevier Science B.V. All rights reserved

Tardive dyskinesia in a patient treated with quetiapine

Quetiapine is an atypical antipsychotic that is believed to have a low D2 binding affinity in striatal and extrastriatal regions. We report the case of a female patient with the diagnosis of schizoaffective disorder (using DSM-IV-TR criteria) who initially received amisulpride for 3 months, discontinued gradually because of persistent and distressing extra-pyramidal symptoms, and who developed tardive dyskinesia 3 months later after the initiation of quetiapine. A trial with ziprasidone resulted in a further worsening of tardive dyskinesia symptoms. A further trial with aripiprazole, improved her tardive dyskinesia symptoms. Although, it is under consideration the possibility that the improvement could have been due to the discontinuation of quetiapine, we conclude that aripiprazole improved the TD symptoms