New developments in the management of major depressive disorder and generalized anxiety disorder: role of quetiapine

Quetiapine has demonstrated efficacy in schizophrenia, bipolar disorder and in the treatment of specific symptom clusters such as agitation and sleep problems in mood disorders. In this review, randomized controlled studies demonstrating efficacy, safety and tolerability of quetiapine in major depressive disorder (MDD) and general anxiety disorder (GAD) are evaluated. The results show that quetiapine monotherapy and quetiapine augmentation of antidepressant treatment in MDD and GAD are efficacious for short-term and maintenance treatment at a dose range between 50 and 300 mg/day. Quetiapine appears to have a specific but overall mild side-effect profile, though, some adverse effects such as sedation and somnolence may lead to withdrawal from treatment in some patients. Overall, the available evidence suggests that there is a significant role for quetiapine in the treatment of MDD and GAD

Differences in Perceptions of Major Depressive Disorder Symptoms and Treatment Priorities Between Patients and Health Care Providers Across the Acute, Post-Acute, and Remission Phases of Depression

Limited data exist on concordance between patients’ and health care providers’ (HCPs) perceptions regarding symptoms of major depressive disorder (MDD) and treatment priorities, particularly across disease phases. This study examined concordance during the acute, post-acute, and remission phases of MDD. In an online survey, 2,008 patients responded based on their experience with MDD, and 1,046 HCPs responded based on their clinical experience treating patients with MDD. Questions included symptom frequency and severity, treatment priorities, and impact on psychosocial functioning. Patients reported more frequently mood, physical, and cognitive symptoms than HCPs in the post-acute and remission phases and greater impact on psychosocial functioning. Patients reported that all these symptoms require high treatment priority across the phases of MDD, generally to a greater extent than HCPs. Patients also gave high emphasis to addressing impairment in psychosocial functioning early in the treatment course. A substantial difference in the effectiveness of treating symptoms of MDD between patients and HCPs was observed. This is the first study to quantify, broadly, differences in perceptions of MDD symptom prevalence, severity, and treatment priorities across MDD phases, and the study findings highlight a need for improved communication between patients and HCPs about symptoms, their impact on psychosocial functioning, and treatment priorities across phases

Recurrence of suicidal ideation due to treatment with antidepressants in anxiety disorder: a case report

This report describes a patient suffering from panic disorder who developed repeated suicidal ideation specifically due to the treatment with Venlafaxine. A first suicide attempt years ago occurred while being treated with Venlafaxine. Subsequent treatment with SSRIs or other antidepressants involved no suicidal ideation. Re-commencement of Venlafaxine four years later immediately led to a second suicide attempt. This unwanted effect subsided immediately after switching to another SNRI (i.e. Duloxetine). The case report underlines the importance of onset of suicide risk in panic disorders due to specific antidepressants

Health Behaviors, Knowledge, Life Satisfaction, and Wellbeing in People with Mental Illness across Four Countries and Comparisons with Normative Sample

Background: People with chronic mental illness have poorer physical health and higher mortality than the general population. We investigated lifestyle factors in people with mental illness across four countries and compared with a normative sample. Design and methods: Data were collected from N=672 people (Germany, n=375; Palestine, n=192; London, n=63; Australia, n=42) with substance abuse disorder (n=224), schizophrenia (n=158), mood disorders (n=227) and somatoform disorders (n=63). The General Health Behaviour Questionnaire measured behaviours and knowledge related to nutrition, physical activity, alcohol, smoking, sleep, life satisfaction and wellbeing. The normative sample were derived from a German population (N=1,019). Data were analysed using ANOVAs and t-tests. Results: The Palestine sample did not differ from the Western samples on reported life satisfaction and wellbeing. However they reported unhealthier diets, less physical activity, and lower knowledge about the impact of diet, physical activity, smoking and sleep on health than the Western samples. Comparing the Western and normative samples, people with mental illness reported lower intake of healthy foods/drinks, higher intake of unhealthy foods, higher exercise, higher alcohol consumption, smoked less cigarettes, had less sleep and reported more sleep problems. Their knowledge was lower for nutrition, physical activity, and smoking. All participants reported lower life satisfaction and wellbeing than the normative sample (P values <0.001). Conclusions: Education on health-related lifestyle factors present important targets for primary care, quality of

Overweight and obesity at school entry among migrant and German children: a cross-sectional study

BACKGROUND: Overweight and obesity have become a global epidemic and are increasing rapidly in both childhood and adolescence. Obesity is linked both to socioeconomic status and to ethnicity among adults. It is unclear whether similar associations exist in childhood. The aim of the present study was to assess differences in overweight and obesity in migrant and German children at school entry. METHODS: The body mass index (BMI) was calculated for 525 children attending the 2002 compulsory pre-school medical examinations in 12 schools in Bielefeld, Germany. We applied international BMI cut off points for overweight and obesity by sex and age. The migration status of children was based on sociodemographic data obtained from parents who were interviewed separately. RESULTS: The overall prevalence of overweight in children aged 6–7 was 11.9% (overweight incl. obesity), the obesity prevalence was 2.5%. The prevalence of overweight and obesity was higher for migrant children (14.7% and 3.1%) than for German children (9.1% and 1.9%). When stratified by parental social status, migrant children had a significantly higher prevalence of overweight than German children in the highest social class. (27.6% vs. 10.0%, p = 0.032) Regression models including country/region and socioeconomic status as independent variables indicated similar results. The patterns of overweight among migrant children differed only slightly depending on duration of stay of their family in Germany. CONCLUSION: Our data indicate that children from ethnic minorities in Germany are more frequently overweight or obese than German children. Social class as well as family duration of stay after immigration influence the pattern of overweight and obesity in children at school entry

Longitudinal early epigenomic signatures inform molecular paths of therapy response and remission in depressed patients

IntroductionThe etiology of major depressive disorder (MDD) involves the interaction between genes and environment, including treatment. Early molecular signatures for treatment response and remission are relevant in a context of personalized medicine and stratification and reduce the time-to-decision. Therefore, we focused the analyses on patients that responded or remitted following a cognitive intervention of 8 weeks.MethodsWe used data from a randomized controlled trial (RCT) with MDD patients (N = 112) receiving a cognitive intervention. At baseline and 8 weeks, blood for DNA methylation (Illumina Infinium MethylationEPIC 850k BeadChip) was collected, as well as MADRS. First, responders (N = 24; MADRS-reduction of at least 50%) were compared with non-responders (N = 60). Then, we performed longitudinal within-individual analyses, for response (N = 21) and for remission (N = 18; MADRS smaller or equal to 9 and higher than 9 at baseline), respectively, as well as patients with no change in MADRS over time. At 8 weeks the sample comprised 84 individuals; 73 patients had DNA methylation for both time-points. The RnBeads package (R) was used for data cleaning, quality control, and differential DNA-methylation (limma). The within-individual paired longitudinal analysis was performed using Welch’s t-test. Subsequently gene-ontology (GO) pathway analyses were performed.ResultsNo CpG was genome-wide significant CpG (p &lt; 5 × 10–8). The most significant CpG in the differential methylation analysis comparing response versus non-response was in the IQSEC1 gene (cg01601845; p = 1.53 × 10–6), linked to neurotransmission. The most significant GO-terms were linked to telomeres. The longitudinal response analysis returned 67 GO pathways with a p &lt; 0.05. Two of the three most significant pathways were linked to sodium transport. The analysis for remission returned 46 GO terms with a p-value smaller than 0.05 with pathways linked to phosphatase regulation and synaptic functioning. The analysis with stable patients returned mainly GO-terms linked to basic cellular processes.DiscussionOur result suggest that DNA methylation can be suitable to capture early signs of treatment response and remission following a cognitive intervention in depression. Despite not being genome-wide significant, the CpG locations and GO-terms returned by our analysis comparing patients with and without cognitive impairment, are in line with prior knowledge on pathways and genes relevant for depression treatment and cognition. Our analysis provides new hypotheses for the understanding of how treatment for depression can act through DNA methylation and induce response and remission

Bilateral Electroconvulsive Therapy For Post-Traumatic Stress Disorder Comorbid to Depression

DergiPark: 1020975tmsjAims: We aim to present a patient who was suffering from treatment-resistant depression along with psychotic features and comorbid post-traumatic stress disorder and was treated by bilateral electroconvulsive therapy. Case Report: A 58-year-old female patient was transferred to the University Hospital Münster with the diagnosis of treatment-refractory depression with psychotic features and post-traumatic stress disorder. The patient was non-responsive to unilateral electroconvulsive therapy and multiple antidepressant agents during several inpatient treatments. After initiating bilateral electroconvulsive therapy, the patient’s symptoms improved significantly. Conclusion: After ruling out conventional treatment algorithms for psychotic depression comorbid to post-traumatic stress disorder, physicians can consider bilateral electroconvulsive therapy to treat complicated cases

The impact of non-compliance with the therapeutic regimen on the development of stroke among hypertensive men and women in Gaza, Palestine.

Objective: Hypertension and stroke are 2 major public health problems worldwide. Several biological and non-biological risk factors for stroke have been identified in the past. Little is known regarding risk factors for stroke among the Arabic population in Gaza. To identify potential risk factors we investigated compliance with the therapeutic regimen and life style factors which may increase the risk for stroke. Methods: To research this study question, a pair matched case control study was conducted in Gaza Strip (Shefa Hospital, Nasser Hospital, Khan Younis Hospital, and related primary health care clinics) in 2001 (from January through to December) among 112 patients, who had been hospitalized for acute stroke and history of hypertension, and 224 controls with history of hypertension from primary health care clinics. Results: Conditional logistic regression models show significant associations between stroke and medication not taking as prescribed (odds ratio (OR)= 6.07; 95% confidence interval (CI)= 1.53, 24.07), using excessive salt at meals (OR= 4.51; 95% CI= 2.05, 9.90), eating diet high in fat (OR= 4.67; 95% CI= 2.09, 10.40), and high levels of stress (OR= 2.77; 95% CI= 1.43, 5.38). No significant association between smoking and the development of stroke (OR= 2.12; 95 CI 0.82, 5.51) was found. Regular physical exercise was a protective factor (OR= 0.26; 95% CI= 0.12, 0.57). Conclusion: Our results on risk factors for stroke confirm several other studies. In future programs on health promotion among hypertensive men and women in Gaza these modifiable risk factors could be addressed by health education strategies

Predictors of quality of life among hypertensive patients with and without stroke

Compliance with the pharmacological and non-pharmacological therapeutic regimen is essential to prevent occurrence and worsening hypertension and stroke. This study aimed at the identification of predictors of Quality of Life (QOL) among hypertensive patients without stroke and hypertensive patients with stroke. Self-reported QOL was obtained from 112 patients with hypertension and stroke and 224 patients with hypertension only with the WHO-QOL-BREF questionnaire and compliance with the pharmacological and non-pharmacological therapeutic regimen was assessed with a standardized questionnaire. Means of QOL were compared with ANOVA procedures and predictors were estimated using multiple linear regression models. The results of this study showed that selfreported QOL is poorer in patients with stroke than in hypertensive patients. Male gender appears to be a strong predictor of quality of life in patients either with hypertension or stroke. Follow up health care programmes are essential for good quality of life among both patient groups. Diet, physical exercise, low level of stress are important factors for enhanced QOL. Current smoking seems to enhanc

Illness-Death Model as a Framework for Chronic Disease Burden Projection: Application to Mental Health Epidemiology

Introduction: Estimates of future disease burden supports public health decision-making. Multistate modeling of chronic diseases is still limited despite a long history of mathematicalmodeling of diseases.We introduce a discrete time approach to the illness- death model and a recursion formula, which can be utilized to project chronic disease burden. We further illustrate an example of the technique applied to anxiety disorders in Germany. Materials and Equipment: The illness-death model is a multistate model that relates prevalence, incidence, mortality, and remission. A basic recursion formula that considers prevalence, incidence, mortality among the susceptible, and mortality among the diseased can be applied to irreversible chronic diseases such as diabetes. Among several mental disorders, remission plays a key role and thus an extended recursion formula taking remission into account is derived. Methods: Using the Global Burden of Disease Study 2019 data and population projections from the Federal Statistical Office of Germany, a total number of individuals with anxiety disorders by sex in Germany from 2019 to 2030 was projected. Regression models were fitted to historical data for prevalence and incidence. Differential mortality risks were modeled based on empirical evidence. Remission was estimated from prevalence, incidence, and mortality, applying the extended recursion formula. Sex- and age-specific prevalence of 2019 was given as the initial value to estimate the total number of individuals with anxiety disorders for each year up to 2030. Projections were alsomade through simple extrapolation of prevalence for comparison. Results: From 2019 to 2030, we estimated a decrease of 52,114 (−1.3%) individuals with anxiety disorders among women, and an increase of 166,870 (+8.5%) cases among men, through the illness-death model approach. With prevalence extrapolation, an increase of 381,770 (+9.7%) among women and an increase of 272,446 (+13.9%) among men were estimated. Discussion: Application of the illness-death model with discrete time steps is possible for both irreversible chronic diseases and diseases with possible remissions, such as anxiety disorders. The technique provides a framework for disease burden prediction. The example provided here can form a basis for running simulations under varying transition probabilities