Estsitalopraami efektiivsus depressiooni ravis võrrelduna konventsionaalsete selektiivsete serotoniini tagasihaarde inhibiitorite ja venlafaksiin XRiga: metaanalüüs

Estsitalopraam on kõige selektiivsem selektiivsete serotoniini tagasihaarde inhibiitorite rühma kuuluv antidepressant. Varasemad uuringud on näidanud, et estsitalopraam on oma toimelt tõhusam kui tsitalopraam. Artiklis on antud ülevaade metaanalüüsi uuringutest, milles estsitalopraami võrreldi teiste antidepressantidega (tsitalopraam, fluoksetiin, paroksetiin, sertraliin ja venlafaksiin XR). Estsitalopraam oli efektiivsem kui kõik teised võrdlusravimid nii üldise raviefekti, ravile reageerimise määra kui ka remissiooni saavutamise määra poolest. Eri ravimirühmade analüüs näitas, et estsitalopraam oli oluliselt tõhusam kui konventsionaalsed SSRId ja võrdväärne venlafaksiiniga, ehkki uuringu üldised tulemused ei näita tingimata, et estsitalopraam oleks oluliselt efektiivsem kui iga SSRI eraldi. Sarnased tulemused leiti ka raske depressiooniga patsientide seas. Eesti Arst 2006; 85 (11): 739–75

Transition to Psychiatric Residency: Unique Stresses; Unique Rewards

An individual\u27s decision to pursue a psychiatric residency following medical school training is shaped by many factors. Beginning residents are often ill prepared for the relative impact that the shift from medical doctor to psychiatric resident entails. This paper reviews the literature regarding demographic and psychological factors relating to recruitment, dynamic and practical issues confronting the beginning resident, and various coping styles adopted. These factors are considered in the context of an inpatient setting where the majority of residents begin their training. Much of the resident response is seen as adaptive and a number of strategies for coping are suggested

Simulator Performance vs. Neurophysiologic Monitoring: Which is More Relevant to Assess Driving Impairment?

Previously, we reported on circadian variation in driving simulator performance and neurophysiologic evidence of sleep intrusion into consciousness in a pilot study of healthy individuals. We have since expanded this “normative” sample and run a prospective comparison study with a sample of clinical patients reporting excessive daytime sleepiness (EDS) as a chief complaint. Thirty healthy adults (mean age of 31.3 ± 11.5) and 27 EDS patients (47.0 ± 13.7) with valid driver’s licenses were included. Subjects performed four intentionally soporific 30-minute driving simulations at two-hour intervals while undergoing continuous EEG monitoring for microsleep (MS) episodes. Measured variables included: subjective ratings of sleepiness and alertness prior to each drive, lane position accuracy, mean speed, speed deviation, mean reaction time (RT) to “virtual” wind gusts as well as off-road events, i.e., “crashes.” In comparing normative individuals and EDS patients, significant between-group differences were found between subjective ratings, RT, crashes and MS. Both groups showed a significant a tendency towards RT slowing during afternoon drives, with this circadian effect appearing most pronounced for EDS patients. Significant between-group differences were also found on subjective ratings of sleepiness and alertness, although diurnal fluctuation of subjective sleepiness ratings was significant only for the EDS group. Objective EEG MS monitoring demonstrated escalating sleep intrusion with repeated drives in both groups, but particularly for the EDS group. Total crash rates were three times higher in EDS patients, with an increasing trend towards crash-proneness in the late afternoon. In summary, we found significantly impaired performance on some, though not all, driving parameters for EDS patients. While increased crash rate may be the most dramatic of these, slowing of RT was the most statistically robust. EEG monitoring was able to document increased propensity towards MS episodes in patients with EDS, which we suggest is causative in creating this impairment. It remains unclear whether a neurophysiologic or simulator approach captures impairment due to sleepiness with greater sensitivity and specificity. A hybrid approach combining data from both sources may be optimal, and also could be integrated in commercial vehicle use. We suggest that the need for a more accurate hospitalbased screening tool for assessment of driving impairment due to sleep disorders remains an important issue for physicians and legislators dealing with driving competency

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder.

The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe

Standardization of electroencephalography for multi-site, multi-platform and multi-investigator studies: Insights from the canadian biomarker integration network in depression

Subsequent to global initiatives in mapping the human brain and investigations of neurobiological markers for brain disorders, the number of multi-site studies involving the collection and sharing of large volumes of brain data, including electroencephalography (EEG), has been increasing. Among the complexities of conducting multi-site studies and increasing the shelf life of biological data beyond the original study are timely standardization and documentation of relevant study parameters. We presentthe insights gained and guidelines established within the EEG working group of the Canadian Biomarker Integration Network in Depression (CAN-BIND). CAN-BIND is a multi-site, multi-investigator, and multiproject network supported by the Ontario Brain Institute with access to Brain-CODE, an informatics platform that hosts a multitude of biological data across a growing list of brain pathologies. We describe our approaches and insights on documenting and standardizing parameters across the study design, data collection, monitoring, analysis, integration, knowledge-translation, and data archiving phases of CAN-BIND projects. We introduce a custom-built EEG toolbox to track data preprocessing with open-access for the scientific community. We also evaluate the impact of variation in equipment setup on the accuracy of acquired data. Collectively, this work is intended to inspire establishing comprehensive and standardized guidelines for multi-site studies

Variational Principles for Stellar Structure

The four equations of stellar structure are reformulated as two alternate pairs of variational principles. Different thermodynamic representations lead to the same hydromechanical equations, but the thermal equations require, not the entropy, but the temperature as the thermal field variable. Our treatment emphasizes the hydrostatic energy and the entropy production rate of luminosity produced and transported. The conceptual and calculational advantages of integral over differential formulations of stellar structure are discussed along with the difficulties in describing stellar chemical evolution by variational principles.Comment: 28 pages, LaTeX, requires AASTeX, 1 PostScript figure, revisions: erratum; accepted by Astrophysical Journa

Polish adaptation of the Dimensional Anhedonia Rating Scale (DARS) - validation in the clinical sample

BackgroundAnhedonia is the core symptom of depression. Its presence has been linked to worsened prognosis. The Dimensional Anhedonia Rating Scale (DARS) is a scale measuring desire, motivation, effort and consummatory pleasure across different domains. The aim of this paper was to confirm factor structure, assess reliability and validity of the Polish adaptation of the DARS in a clinical sample of patients with mood disorders and healthy controls (HC).MethodsThe study sample included 161 participants aged 18–65 years - 34 HC, 72 patients with bipolar disorder and 55 with major depressive disorder (in depressive episode or remission). Reliability of the Polish adaptation of the DARS was assessed using Cronbach’s α and the average inter-item correlation (AIC). Convergent and divergent validity was established by Pearson’s correlations between the DARS and the Snaith-Hamilton Pleasure Scale (SHAPS), the Quick Inventory of Depressive Symptomatology- self-report (QIDS-SR), the Hospital Anxiety and Depression Scale (HADS). The structure of the scale was examined by factor analysis.ResultsThe factor structure was consistent with the original scale. Strong internal consistency for the DARS total score (Cronbach’s α = 0.95) and all subscales (0.86–0.93) was observed. The DARS demonstrated good convergent (moderate to strong correlations with measures of anhedonia and depression) and divergent validity (weak correlations with anxiety level).ConclusionThe Polish DARS demonstrated excellent internal consistency and very good validity. The scale is a valuable contribution to the psychometrics of anhedonia measures in patients with mood disorders

Treatment-resistant major depressive disorder: Canadian expert consensus on definition and assessment

Background: Treatment-resistant depression (TRD) is a debilitating chronic mental illness that confers increased morbidity and mortality, decreases the quality of life, impairs occupational, social, and offspring development, and translates into increased costs on the healthcare system. The goal of this study is to reach an agreement on the concept, definition, staging model, and assessment of TRD. Methods: This study involved a review of the literature and a modified Delphi process for consensus agreement. The Appraisal of Guidelines for Research & Evaluation II guidelines were followed for the literature appraisal. Literature was assessed for quality and strength of evidence using the grading, assessment, development, and evaluations system. Canadian national experts in depression were invited for the modified Delphi process based on their prior clinical and research expertize. Survey items were considered to have reached a consensus if 80% or more of the experts supported the statement. Results: Fourteen Canadian experts were recruited for three rounds of surveys to reach a consensus on a total of 27 items. Experts agreed that a dimensional definition for treatment resistance was a useful concept to describe the heterogeneity of this illness. The use of staging models and clinical scales was recommended in evaluating depression. Risk factors and comorbidities were identified as potential predictors for treatment resistance. Conclusions: TRD is a meaningful concept both for clinical practice and research. An operational definition for TRD will allow for opportunities to improve the validity of predictors and therapeutic options for these patients