Niveles de alexitimia según severidad de sintomatología depresiva en pacientes con depresión

La presente investigación tuvo como objetivo comparar los niveles de alexitimia según la severidad de la sintomatología depresiva en un grupo de pacientes con depresión. Además, se buscó comparar los diferentes grados de sintomatología depresiva entre sí, comparar los tres factores de la alexitimia según la intensidad de la sintomatología depresiva y comparar los niveles de alexitimia según los datos sociodemográficos. Para dicho fin, se aplicó a 51 pacientes el Inventario de Depresión de Beck (BDI-II) y Escala de Alexitimia de Toronto (TAS-20). Se encontró una alta correlación entre depresión y alexitimia, donde los pacientes con mayor severidad de sintomatología depresiva presentaron niveles más altos de alexitimia. Los factores 1 y 2 del TAS-20 presentaron puntuaciones mayores, mas no se observó una relación con el factor 3. Los resultados sugieren que los pacientes con mayor severidad de sintomatología depresiva, tienden a puntuar más alto en la escala de alexitimia debido a las dificultades en la identificación y verbalización de las emociones que se encuentran en ambas, además de una tendencia a somatizar todo aquello que no entienden ni pueden expresar.The aim of present study was to compare the levels of alexithymia according to the severity of depressive symptoms in a group of depressed patients. Furthermore, the other aims were to compare the different degrees of depressive symptomatology among themselves, compare the three factors of alexithymia according to the intensity of depressive symptoms and compare the levels of alexithymia with sociodemographic data. 51 patients with depression were assessed using Beck Depression Inventory (BDI-II) and Toronto Alexithymia Scale (TAS-20). Significant correlations were found between depression and alexithymia, where patients with more severe depressive symptoms had higher levels of alexithymia. Factors 1 and 2 had higher scores, but a relationship with factor 3 was not found. The present findings suggest that patients with more severe depressive symptoms tended to score higher on the TAS-20 due to the difficulties in identifying and verbalizing emotions, along with a tendency to somatize anything that they cannot understand or express..Tesi

Niveles de alexitimia según severidad de sintomatología depresiva en pacientes con depresión

La presente investigación tuvo como objetivo comparar los niveles de alexitimia según la severidad de la sintomatología depresiva en un grupo de pacientes con depresión. Además, se buscó comparar los diferentes grados de sintomatología depresiva entre sí, comparar los tres factores de la alexitimia según la intensidad de la sintomatología depresiva y comparar los niveles de alexitimia según los datos sociodemográficos. Para dicho fin, se aplicó a 51 pacientes el Inventario de Depresión de Beck (BDI-II) y Escala de Alexitimia de Toronto (TAS-20). Se encontró una alta correlación entre depresión y alexitimia, donde los pacientes con mayor severidad de sintomatología depresiva presentaron niveles más altos de alexitimia. Los factores 1 y 2 del TAS-20 presentaron puntuaciones mayores, mas no se observó una relación con el factor 3. Los resultados sugieren que los pacientes con mayor severidad de sintomatología depresiva, tienden a puntuar más alto en la escala de alexitimia debido a las dificultades en la identificación y verbalización de las emociones que se encuentran en ambas, además de una tendencia a somatizar todo aquello que no entienden ni pueden expresar.The aim of present study was to compare the levels of alexithymia according to the severity of depressive symptoms in a group of depressed patients. Furthermore, the other aims were to compare the different degrees of depressive symptomatology among themselves, compare the three factors of alexithymia according to the intensity of depressive symptoms and compare the levels of alexithymia with sociodemographic data. 51 patients with depression were assessed using Beck Depression Inventory (BDI-II) and Toronto Alexithymia Scale (TAS-20). Significant correlations were found between depression and alexithymia, where patients with more severe depressive symptoms had higher levels of alexithymia. Factors 1 and 2 had higher scores, but a relationship with factor 3 was not found. The present findings suggest that patients with more severe depressive symptoms tended to score higher on the TAS-20 due to the difficulties in identifying and verbalizing emotions, along with a tendency to somatize anything that they cannot understand or express..Tesi

Repetitive Transcranial Magnetic Stimulation in Youth With Treatment Resistant Major Depression

Background: Major depressive disorder (MDD) is common in youth and treatment options are limited. We evaluated the effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) in adolescents and transitional aged youth with treatment resistant MDD.Methods: Thirty-two outpatients with moderate to severe, treatment-resistant MDD, aged 13–21 years underwent a three-week, open-label, single center trial of rTMS (ClinicalTrials.gov identifier NCT01731678). rTMS was applied to the left dorsolateral prefrontal cortex (DLPFC) using neuronavigation and administered for 15 consecutive week days (120% rest motor threshold; 40 pulses over 4 s [10 Hz]; inter-train interval, 26 s; 75 trains; 3,000 pulses). The primary outcome measure was change in the Hamilton Depression Rating Scale (Ham-D). Treatment response was defined as a >50% reduction in Ham-D scores. Safety and tolerability were also examined.Results: rTMS was effective in reducing MDD symptom severity (t = 8.94, df = 31, p < 0.00001). We observed 18 (56%) responders (≥ 50% reduction in Ham-D score) and 14 non-responders to rTMS. Fourteen subjects (44%) achieved remission (Ham-D score ≤ 7 post-rTMS). There were no serious adverse events (i.e., seizures). Mild to moderate, self-limiting headaches (19%) and mild neck pain (16%) were reported. Participants ranked rTMS as highly tolerable. The retention rate was 91% and compliance rate (completing all study events) was 99%.Conclusions: Our single center, open trial suggests that rTMS is a safe and effective treatment for youth with treatment resistant MDD. Larger randomized controlled trials are needed.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT0173167

Effects of Repetitive Transcranial Magnetic Stimulation and Possible Predictors of Response in Youth with Treatment Resistant Depression

Adolescents with treatment-resistant depression (TRD) do not respond to conventional antidepressant interventions. Repetitive transcranial magnetic stimulation (rTMS) is a novel therapeutic technique to treat TRD. The left dorsolateral prefrontal cortex (DLPFC), important in emotion regulation and the excitatory neurotransmitter glutamate, are altered in TRD. rTMS applied to the left DLPFC can increase glutamate concentrations in this area. Adolescents (aged 12-21) underwent 3 weeks of rTMS, pre and post magnetic resonance spectroscopy (MRS) to measure glutamate concentrations and weekly Ham-D depression rating scale applications. A 50% reduction in depression scores indicated response to treatment. Depression scores decreased in all participants but declined significantly in responders whose glutamate concentrations pre-treatment were considerably lower. Thus, low glutamate concentrations pre-treatment might be a biomarker of response to rTMS. One explanation for this result is that rTMS stimulates glutamate release, which activates the left DLPFC’s emotional regulation function, which in turn reduces depressive symptomatology

Barriers to following imaging guidelines for the treatment and management of patients with low-back pain in primary care: a qualitative assessment guided by the Theoretical Domains Framework

Background Low back pain (LBP) is a leading cause of disability and is among the top five reasons that patients visit their family doctors. Over-imaging for non-specific low back pain remains a problem in primary care. To inform a larger study to develop and evaluate a theory-based intervention to reduce inappropriate imaging, we completed an assessment of the barriers and facilitators to reducing unnecessary imaging for NSLBP among family doctors in Newfoundland and Labrador (NL). Methods This was an exploratory, qualitative study describing family doctors’ experiences and practices related to diagnostic imaging for non-specific LBP in NL, guided by the Theoretical Domains Framework (TDF). Data were collected using in-depth, semi-structured interviews. Transcripts were analyzed deductively (assigning text to one or more domains) and inductively (generating themes at each of the domains) before the results were examined to determine which domains should be targeted to reduce imaging. Results Nine family doctors (four males; five females) working in community (n = 4) and academic (n = 5) clinics in both rural (n = 6) and urban (n = 3) settings participated in this study. We found five barriers to reducing imaging for patients with NSLBP: 1) negative consequences, 2) patient demand 3) health system organization, 4) time, and 5) access to resources. These were related to the following domains: 1) beliefs about consequences, 2) beliefs about capabilities, 3) emotion, 4) reinforcement, 5) environmental context and resources, 6) social influences, and 7) behavioural regulation. Conclusions Family physicians a) fear that if they do not image they may miss something serious, b) face significant patient demand for imaging, c) are working in a system that encourages unnecessary imaging, d) don’t have enough time to counsel patients about why they don’t need imaging, and e) lack access to appropriate practitioners, community programs, and treatment modalities to prescribe to their patients. These barriers were related to seven TDF domains. Successfully reducing inappropriate imaging requires a comprehensive intervention that addresses these barriers using established behaviour change techniques. These techniques should be matched directly to relevant TDF domains. The results of our study represent the important first step of this process – identifying the contextual barriers and the domains to which they are related

Beyond guideline knowledge: a theory-based qualitative study of low-value preoperative testing

Abstract Background Choosing Wisely Canada and most major anesthesia and preoperative guidelines recommend against obtaining preoperative tests before low-risk procedures. However, these recommendations alone have not reduced low-value test ordering. In this study, the theoretical domains framework (TDF) was used to understand the drivers of preoperative electrocardiogram (ECG) and chest X-ray (CXR) ordering for patients undergoing low-risk surgery (‘low-value preoperative testing’) among anesthesiologists, internal medicine specialists, nurses, and surgeons. Methods Using snowball sampling, preoperative clinicians working in a single health system in Canada were recruited for semi-structured interviews about low-value preoperative testing. The interview guide was developed using the TDF to identify the factors that influence preoperative ECG and CXR ordering. Interview content was deductively coded using TDF domains and specific beliefs were identified by grouping similar utterances. Domain relevance was established based on belief statement frequency, presence of conflicting beliefs, and perceived influence over preoperative test ordering practices. Results Sixteen clinicians (7 anesthesiologists, 4 internists, 1 nurse, and 4 surgeons) participated. Eight of the 12 TDF domains were identified as the drivers of preoperative test ordering. While most participants agreed that the guidelines were helpful, they also expressed distrust in the evidence behind them (knowledge). Both a lack of clarity about the responsibilities of the specialties involved in the preoperative process and the ease by which any clinician could order, but not cancel tests, were drivers of low-value preoperative test ordering (social/professional role and identity, social influences, belief about capabilities). Additionally, low-value tests could also be ordered by nurses or the surgeon and may be completed before the anesthesia or internal medicine preoperative assessment appointment (environmental context and resources, beliefs about capabilities). Finally, while participants agreed that they did not intend to routinely order low-value tests and understood that these would not benefit patient outcomes, they also reported ordering tests to prevent surgery cancellations and problems during surgery (motivation and goals, beliefs about consequences, social influences). Conclusions We identified key factors that anesthesiologists, internists, nurses, and surgeons believe influence preoperative test ordering for patients undergoing low-risk surgeries. These beliefs highlight the need to shift away from knowledge-based interventions and focus instead on understanding local drivers of behaviour and target change at the individual, team, and institutional levels

People with lived experience (PWLE) of depression: describing and reflecting on an explicit patient engagement process within depression research priority setting in Alberta, Canada

Plain English summary The Alberta Depression Research Priority Setting Project aimed to meaningfully involve patients, families and clinicians in determining a research agenda aligned to the needs of Albertans who have experienced depression. The project was modeled after a process developed in the UK by the James Lind Alliance and adapted to fit the Alberta, Canada context. This study describes the processes used to ensure the voices of people with lived experience of depression were integrated throughout the project stages. The year long project culminated with a facilitated session to identify the top essential areas of depression research focus. People with lived experience were engaged as part of the project’s Steering Committee, as survey participants and as workshop participants. It is hoped this process will guide future priority setting opportunities and advance depression research in Alberta. Abstract Background The Depression Research Priority Setting (DRPS) project has the clear aim of describing the patient engagement process used to identify depression research priorities and to reflect on the successes of this engagement approach, positive impacts and opportunities for improvement. To help support patient-oriented depression research priority setting in Alberta, the Patient Engagement (PE) Platform of the Alberta Strategy for Patient Oriented Research Support for People and Patient-Oriented Research and Trials (SUPPORT) Unit designed, along with the support of their partners in addictions and mental health, an explit process to engage patients in the design and execution of the DRPS. Methods The UK’s James Lind Alliance (JLA) Priority Setting Partnership (PSP) method was adapted into a six step process to ensure voices of “people with lived experience” (PWLE) with depression were included throughout the project stages. This study uses an explicit and parallel patient engagement process throughout each estage of the PSP designed by the PE Platform. Patient engagement was divided into a five step process: i) Awareness and relationship building; ii) Co-designing and co-developing a shared decision making process; iii) Collaborative communication; iv) Collective sensemaking; and v) Acknowledgement, celebration and recognition. A formative evaluation of the six PE processes was undertaken to explore the success of the parallel patient engagement process. Results This project was successful in engaging people with lived depression experience as partners in research priority setting, incorporating their voices into the discussions and decisions that led to the top 25 depression research questions. Conclusions The DRPS project has positively contributed to depression research in Canada by identifying the priorities of Albertans who have experienced depression for depression research. Dissemination activities to promote further knowledge exchange of prioritized research questions, with emphasis on the importance of process in engaging the voices of PWLE of depression are planned