Intranasal esketamine as therapeutic option: a case report of an adolescent with treatment resistant depression

Depression is among the most common mental health disorders worldwide and treatment resistant depression (TRD) represents a major challenge for both patients and clinicians. In recent years ketamine has received attention as an antidepressant agent, demonstrating promising results in TRD in adults. To date, few attempts have been made in treating adolescent TRD with ketamine and none have used intranasal application. This paper discusses a case of a 17-year-old female adolescent suffering from TRD who underwent treatment with intranasal esketamine application (Spravato 28 mg). As symptoms showed clinically insignificant improvement despite modest gains in objective assessments (GAF, CGI, MADRS), treatment was prematurely discontinued. However, the treatment was tolerable and side effects were scarce and mild. Although this case report does not demonstrate clinical effectiveness, ketamine may nonetheless be a promising substance in treating TRD in other adolescents. Questions regarding the safety of ketamine use in the rapidly developing brains of adolescents still remain unanswered. To further explore the potential benefits of this treatment method a short term RCTs for adolescents with TRD is recommended

“The Buoy”: Utilization of a low-threshold ambulatory setting for traumatized children and adolescents in Austria

Grundlagen Diese Untersuchung hatte zum Ziel, die Inanspruchnahme einer Ambulanz, welche niedrigschwellige, Trauma-fokussierte Kurzpsychotherapie für Kinder und Jugendliche anbietet, während der ersten sechs Jahre ihres Bestehens zu untersuchen. Methodik Wir führten eine retrospektive Analyse der Krankengeschichten aller zwischen 2001 und 2007 behandelten Patienten (n=2510) durch und dokumentierten demographische Daten, Gründe für die Behandlung, zuweisende Institution, Obsorge berechtigte Person oder Institution, die Anzahl der Kontakte, psychische oder körperliche Erkrankung eines Elternteils und verschriebene Medikation. Ergebnisse Die behandelten Patienten waren zwischen 1 und 17 Jahre alt, die Geschlechterverteilung war gleichmäßig. Häufigster Anlass für eine Kontaktaufnahme waren der Tod eines Verwandten, die Tatsache, Zeuge eines gewaltsamen Todes geworden zu sein oder andere Gewalterfahrungen. Die Inanspruchnahme durch Migranten stieg während des Untersuchungszeitraumes laufend an. Kinder aus Pflegefamilien suchten die Institution seltener als erwartet auf. Medikation wurde kaum verschrieben. Schlussfolgerungen Die intensive Nutzung dieser Institution zeigt deutlich den großen Bedarf an kurzfristiger akuter Traumatherapie für Kinder und Jugendliche. Bemühungen, leicht zugängliche Institutionen für traumatisierte Kinder und Jugendliche zur Verfügung zu stellen, sollten intensiviert werden.Background This investigation intended to assess the use of an outpatient clinic providing low-threshold, short-term trauma therapy for children and adolescents across the first 6 years of its existence. Methods A retrospective analysis of the records of all patients undergoing treatment in this institution between 2001 and 2007 (n=2510) has been performed. We evaluated demographic data, reason for contacting the unit, the referring person or institution, the person or institution in charge of the care and custody of the child, the number of contacts with the clinic, presence of physical or psychiatric illness of a parent, and medications prescribed. Results Ages of patients ranged from 1 to 17. Gender distribution was even. Having experienced the death of a relative, experienced violence, or having witnessed traumatic death were the main reasons for presentation. The utilization rates of immigrants rose throughout the observation period. Children from foster care were seen less frequently than expected. Medication was hardly prescribed. Conclusions Ample utilization of this institution clearly demonstrates the need for short-term acute outpatient trauma therapy for children and adolescents. Efforts to provide easily accessible institutions for youth who experience traumatic events should be stepped up.(VLID)342645

No evidence of subgroups found in amphetamine consumers in Iran

Amphetamine type substances are the second most commonly consumed illicit drug type and their use is an important contributor to the global burden of disease. This investigation set out to determine whether, similar to alcohol or nicotine addiction, subgroups of consumers can also be found in amphetamine addicts. 204 consumers of methamphetamine only (n=50) or both methamphetamine and heroin (n=154) have been investigated in Mashhad, Iran by means of “Lesch Alcoholism Typology”. No significant differences in consumption pattern or age of onset have been found between the different types. Many subjects, however, reported symptoms of anxiety (n=78) or depression (n=129) prior to drug use. These findings highlight the need for high quality epidemiological studies further addressing this issue.(VLID)358837

At-line quantitative profiling of monoclonal antibody products during bioprocessing using HPLC-MS.

(1) Background: The N-glycosylation profile as well as the subunit assembly of monoclonal antibodies (mAbs) are strongly dependent on manufacturing conditions and thus need to be monitored during the bioprocess. Commonly, mAbs are characterized downstream of the fermentation process applying different analytical techniques like released glycan analysis, peptide mapping, or subunit profiling. However, these procedures are time-consuming and difficult to perform in real-time. (2) Methods: We applied a simple HPLC-MS workflow with minimal sample preparation to characterize mAb product quality at the intact protein level at different time points during fermentation. After harvest, the cell culture medium was centrifuged briefly. The supernatant containing the fermentation product was diluted and immediately subjected to HPLC-MS analysis. (3) Results: Besides the product of interest (mAb), the fermentation broth contained misassembled variants, mostly light chain and light chain dimer. The mAb's glycosylation profile changed over time showing an increase in galactosylated variants with G0F/G1F being the most abundant glycoform at all time points of fermentation. Furthermore, expressed protein species were relatively and absolutely quantified. The workflow was very robust despite analyzing a highly complex matrix. Relative standard deviations for retention times were below 0.5% for both intra and inter-day comparison, whereas relative procedural standard deviations for quantification of the different protein species ranged between 7 and 13%. (4) Conclusions: This approach allows for reliable analysis of product profiles of monoclonal antibody species including misassembled subunits and glycosylation variants directly from fermentation broth using a fast and robust HPLC-MS workflow

Substance use and misuse among children and youth with mental illness : A pilot study

Objective The aim of this study was to examine prevalence, patterns and predictors of substance use among a sample of adolescent psychiatric inpatients. Methods Participants included 25 minors aged 1217 years admitted to an Austrian department of child and adolescent psychiatry. Lifetime use, initiation, frequency and quantity of substance use, sociodemographic, family and school-related data were collected by self-report measures. Substance use disorders were detected using CAGE (a screening instrument for problem drinking) and FTND (Fagerström Test For Nicotine Dependence). Clinical characteristics were extracted from medical records. Results Lifetime prevalence of any substance use (76%) and regular use (32%) were common. Prevalence was high for alcohol (76%), nicotine (44%) and illicit drug use (36%). Older age was associated with tobacco (p = 0.023), drug (p = 0.021) and cannabis use (p = 0.015) and regular use of psychotropic substances (p = 0.027). Family dysfunction predicted regular (p = 0.035) and cannabis use (p = 0.02). History of trauma prognosticated regular (p = 0.047) and tobacco use (p = 0.011). Use of any substance (p < 0.001) as well as regular use (p = 0.026) were significantly associated with peer substance use. Consuming adolescents were more likely to show academic failure, school absenteeism and behavioral problems. Alcohol (p = 0.02), drug (p = 0.017) and regular substance use (p = 0.007) were linked to suicidal ideation. A remarkable relationship between affective as well as externalizing disorders and alcohol, nicotine and drug use was found. Conclusions Substance use is highly prevalent among youth with mental illnesses and associated with psychosocial consequences. These data highlight the need to carefully explore this population at high risk.(VLID)357507

The influence of reported ADHD and substance abuse on suicidal ideation in a non-clinical sample of young men

This study intended to determine whether former and current ADHD symptomatology is associated with suicidal ideation in a non-clinical sample of 18 year old males. We performed a cross sectional descriptive study of 3280 men during the examination for military service. The investigation included a screening for substance abuse, past (WURS) and current (ADHD symptom checklist) ADHD symptomatology and an interview about suicidal ideations. We found a correlation of suicidal ideations with a history of ADHD symptomatology. ADHD symptoms were strongly consistent over time. These results indicate that a history of (diagnosed or undiagnosed) ADHD could be a predictor for suicidal ideations. Surveying a history of ADHD in primary care might help identify subjects at risk for suicidal tendencies.(VLID)348261

Frontiers in Psychiatry / Psychopathology and Quality of Life in Traumatized or Victimized Underage Individuals as Factors for Forensic Multilevel AssessmentA Pilot Investigation

Background: Psychological sequels to criminal violence can be long lasting and severe. They are in many countries not sufficiently considered in court cases as an important circumstance that could be used to assess the severity of the crime, also guiding redress, compensation, and rehabilitation of the victim, andin childrenchild custody considerations. So far, the focus of forensic assessment has often been limited to diagnostic categories, especially “posttraumatic stress disorder” (PTSD), a diagnosis that presently is subjected to rapidly changing definitions both in and between diagnostic systems. Other indicators such as quality of life (QoL) might be of equal importance as compared to clinical or research diagnostic categories to understand and evaluate the impact of a crime and the amount of help needed and, in the legal context, redress to be asked. Symptoms might differ depending on the crime encountered. Objective and Methods: QoL and general symptom patterns including a PTSD diagnosis were assessed in a group of 10- to 17-year-old minors with (n = 33) and without (n = 49) PTSD diagnosis who all had experienced sexual abuse, physical abuse, death of a parent, or their parents divorce, using standardized diagnostic instruments. Results: PTSD patients reported a significantly lower QoL than non-PTSD controls. Reported symptom patterns with potential impact on life, such as intrusive thoughts, differed between the victims of different crime types, with the highest rates of both intrusive symptoms and combined symptom profile in victims of sexual abuse. Data indicate that the changes between older and present criteria and between DSM and recently published ICD 11 might help identify different groups and symptom profiles. Conclusion: Specific trauma-related symptom profiles integrating the type of crime encountered and its individual impact on QoL may help improve future forensic assessment and guide compensation and rehabilitation plans. Carefully designed studies are now needed to further explore the use and forensic usability of complex indicators and the impact of violence in different forensic settings.(VLID)490890

Phosphatidylethanol: normalization during detoxification, gender aspects and correlation with other biomarkers and self-reports

Phosphatidylethanol (PEth) is a direct ethanol metabolite, and has recently attracted attention as biomarker of ethanol intake. The aims of the current study are: (1) to characterize the normalization time of PEth in larger samples than previously conducted; (2) to elucidate potential gender differences; and (3) to report the correlation of PEth with other biomarkers and self-reported alcohol consumption. Fifty-seven alcohol-dependent patients (ICD 10 F 10.25; 9 females, 48 males) entering medical detoxification at three study sites were enrolled. The study sample was comprised of 48 males and 9 females, with mean age 43.5. Mean gamma glutamyl transpeptidase (GGT) was 209.61 U/l, average mean corpuscular volume (MCV) was 97.35 fl, mean carbohydrate deficient transferrin (%CDT) was 8.68, and mean total ethanol intake in the last 7 days was 1653 g. PEth was measured in heparinized whole blood with a high-pressure liquid chromatography method, while GGT, MCV and %CDT were measured using routine methods. PEth levels at day 1 of detoxification ranged between 0.63 and 26.95 mu mol/l (6.22 mean, 4.70 median, SD 4.97). There were no false negatives at day 1. Sensitivities for the other biomarkers were 40.4% for MCV, 73.1% for GGT and 69.2% for %CDT, respectively. No gender differences were found for PEth levels at any time point. Our data suggest that PEth is (1) a suitable intermediate term marker of ethanol intake in both sexes; and (2) sensitivity is extraordinary high in alcohol dependent patients. The results add further evidence to the data that suggest that PEth has potential as a candidate for a sensitive and specific biomarker, which reflects longer-lasting intake of higher amounts of alcohol and seemingly has the above mentioned certain advantages over traditional biomarkers

Genetic Markers of Comorbid Depression and Alcoholism in Women

Background: Alcohol dependence (AD) is often accompanied by comorbid depression. Recent clinical evidence supports the benefit of subtype-specific pharmacotherapy in treating the population of alcohol-dependent subjects with comorbid major depressive disorder (MDD). However, in many alcohol-dependent subjects, depression is a reactive response to chronic alcohol use and withdrawal and abates with a period of abstinence. Genetic markers may distinguish alcohol-dependent subjects with MDD not tied chronologically and etiologically to their alcohol consumption. In this work, we investigated the association of adenylyl cyclase genes (ADCY1-9), which are implicated in both AD and mood disorders, with alcoholism and comorbid depression. Methods: Subjects from Vienna, Austria (n = 323) were genotyped, and single nucleotide polymorphisms (1,152) encompassing the genetic locations of the 9 ADCY genes were examined. The Vienna cohort contained alcohol-dependent subjects differentiated using the Lesch Alcoholism Typology. In this typology, subjects are segregated into 4 types. Type III alcoholism is distinguished by co-occurrence of symptoms of depression and by affecting predominantly females. Results: We identified 4 haplotypes associated with the phenotype of Type III alcoholism in females. One haplotype was in a genomic area in proximity to ADCY2, but actually within a lincRNA gene, 2 haplotypes were within ADCY5, and 1 haplotype was within the coding region of ADCY8. Three of the 4 haplotypes contributed independently to Type III alcoholism and together generated a positive predictive value of 72% and a negative predictive value of 78% for distinguishing women with a Lesch Type III diagnosis versus women designated as Type I or II alcoholics. Conclusions: Polymorphisms in ADCY8 and ADCY5 and within a lincRNA are associated with an alcohol-dependent phenotype in females, which is distinguished by comorbid signs of depression. Each of these genetic locations can rationally contribute to the polygenic etiology of the alcoholism/depression phenotype, and the use of these genetic markers may aid in choosing appropriate and beneficial treatment strategies. © 2012 by the Research Society on Alcoholism