Characterising the severity of treatment resistance in unipolar and bipolar depression

Background Treatment-resistant depression (TRD) is classically defined according to the number of suboptimal antidepressant responses experienced, but multidimensional assessments of TRD are emerging and may confer some advantages. Patient characteristics have been identified as risk factors for TRD but may also be associated with TRD severity. The identification of individuals at risk of severe TRD would support appropriate prioritisation of intensive and specialist treatments. Aims To determine whether TRD risk factors are associated with TRD severity when assessed multidimensionally using the Maudsley Staging Method (MSM), and univariately as the number of antidepressant non-responses, across three cohorts of individuals with depression. Method Three cohorts of individuals without significant TRD, with established TRD and with severe TRD, were assessed (n = 528). Preselected characteristics were included in linear regressions to determine their association with each outcome. Results Participants with more severe TRD according to the MSM had a lower age at onset, fewer depressive episodes and more physical comorbidities. These associations were not consistent across cohorts. The number of episodes was associated with the number of antidepressant treatment failures, but the direction of association varied across the cohorts studied. Conclusions Several risk factors for TRD were associated with the severity of resistance according to the MSM. Fewer were associated with the raw number of inadequate antidepressant responses. Multidimensional definitions may be more useful for identifying patients at risk of severe TRD. The inconsistency of associations across cohorts has potential implications for the characterisation of TRD.

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Age at onset, course of illness and response to psychotherapy in bipolar disorder: results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)

Psychological Medicine ◽

10.1017/s0033291714000804 ◽

2014 ◽

Vol 44 (16) ◽

pp. 3455-3467 ◽

Cited By ~ 17

Author(s):

A. Peters ◽

L. G. Sylvia ◽

P. V. da Silva Magalhães ◽

D. J. Miklowitz ◽

E. Frank ◽

...

Keyword(s):

Bipolar Disorder ◽

Collaborative Care ◽

Bipolar Depression ◽

Age At Onset ◽

Number Needed To Treat ◽

Systematic Treatment ◽

Illness Duration ◽

Bipolar Patients ◽

Depressive Episodes ◽

Intensive Psychotherapy

Background.The course of bipolar disorder progressively worsens in some patients. Although responses to pharmacotherapy appear to diminish with greater chronicity, less is known about whether patients' prior courses of illness are related to responses to psychotherapy.Method.Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy with collaborative care (a three-session psycho-educational intervention). We assessed whether the number of previous mood episodes, age of illness onset, and illness duration predicted or moderated the likelihood of recovery and time until recovery from a depressive episode in patients in the two treatments.Results.Independently of treatment condition, participants with one to nine prior depressive episodes were more likely to recover and had faster time to recovery than those with 20 or more prior depressive episodes. Participants with fewer than 20 prior manic episodes had faster time to recovery than those with 20 or more episodes. Longer illness duration predicted a longer time to recovery. Participants were more likely to recover in intensive psychotherapy than collaborative care if they had 10–20 prior episodes of depression [number needed to treat (NNT) = 2.0], but equally likely to respond to psychotherapy and collaborative care if they had one to nine (NNT = 32.0) or >20 (NNT = 9.0) depressive episodes.Conclusions.Number of previous mood episodes and illness duration are associated with the likelihood and speed of recovery among bipolar patients receiving psychosocial treatments for depression.

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Predicting Persistent Opioid Use, Abuse, and Toxicity Among Cancer Survivors

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djz200 ◽

2019 ◽

Vol 112 (7) ◽

pp. 720-727 ◽

Cited By ~ 6

Author(s):

Lucas K Vitzthum ◽

Paul Riviere ◽

Paige Sheridan ◽

Vinit Nalawade ◽

Rishi Deka ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Cancer Survivors ◽

Critical Role ◽

Multivariable Analysis ◽

Area Under The Curve ◽

Opioid Abuse ◽

Opioid Use ◽

Multivariable Logistic Regression Model ◽

Patients At Risk

Abstract Background Although opioids play a critical role in the management of cancer pain, the ongoing opioid epidemic has raised concerns regarding their persistent use and abuse. We lack data-driven tools in oncology to understand the risk of adverse opioid-related outcomes. This project seeks to identify clinical risk factors and create a risk score to help identify patients at risk of persistent opioid use and abuse. Methods Within a cohort of 106 732 military veteran cancer survivors diagnosed between 2000 and 2015, we determined rates of persistent posttreatment opioid use, diagnoses of opioid abuse or dependence, and admissions for opioid toxicity. A multivariable logistic regression model was used to identify patient, cancer, and treatment risk factors associated with adverse opioid-related outcomes. Predictive risk models were developed and validated using a least absolute shrinkage and selection operator regression technique. Results The rate of persistent opioid use in cancer survivors was 8.3% (95% CI = 8.1% to 8.4%); the rate of opioid abuse or dependence was 2.9% (95% CI = 2.8% to 3.0%); and the rate of opioid-related admissions was 2.1% (95% CI = 2.0% to 2.2%). On multivariable analysis, several patient, demographic, and cancer and treatment factors were associated with risk of persistent opioid use. Predictive models showed a high level of discrimination when identifying individuals at risk of adverse opioid-related outcomes including persistent opioid use (area under the curve [AUC] = 0.85), future diagnoses of opioid abuse or dependence (AUC = 0.87), and admission for opioid abuse or toxicity (AUC = 0.78). Conclusion This study demonstrates the potential to predict adverse opioid-related outcomes among cancer survivors. With further validation, personalized risk-stratification approaches could guide management when prescribing opioids in cancer patients.

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Clinical and Demographic Characteristics and Bipolarity Features in Treatment-resistant Depression - Preliminary Results from Polish TRES-DEP Study

European Psychiatry ◽

10.1016/s0924-9338(09)70911-3 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

D. Dudek ◽

M. Siwek ◽

T. Pawłowski ◽

J. Borowiecka-Kluza ◽

A. Kiejna ◽

...

Keyword(s):

Antidepressant Treatment ◽

Mood Stabilizers ◽

Treatment Resistant Depression ◽

Treatment Resistant ◽

Preliminary Results ◽

Depression Group ◽

Resistant Depression ◽

Group 2 ◽

Depressive Episodes ◽

Group 1

Aim:The Polish multicenter Treatment Resistant Depression Project (TRES-DEP) has aimed to study a number of demographic, clinical and psychometric characteristics comparing patients with treatment-resistant (TR) and treatment non-resistant depression (TNR). Fifty patients with TR depression (group 1) and 50 patients with TNR depression (group 2) were included in this preliminary analysis.Method:Treatment-resistant depression was recognized on account of lack of significant improvement following at least two adequate courses of antidepressant treatment. The exclusion criteria were treatment with mood stabilizers, diagnosis of substance misuse, dementia or severe somatic disease. The presence of bipolarity features was assessed by Polish version of Mood Disorder Questionnaire (MDQ).Results:Significantly more patients with TR depression compared with TNR had family history of mental disorders, especially alcohol dependence (24% vs 8%, p=0,03), had more previous depressive episodes (8.5±5.0 vs 5.1±3.8; p=0.001), and reported shorter time from the last hospitalization (14.8±26.5 vs 41.9±71.1 months, p< 0.005). Patients from group 1 significantly more frequently fulfilled MDQ criteria for bipolarity than patients from group 2 (44% vs 12%, p< 0.001). Among TR patients, MDQ-positive compared with MDQ-negative more frequently reported treatment nonadherence (41% vs 18%, p=0.055), suicidal attempts (41% vs 18%, p=0.055) and inadequate remission (100% vs 21%; p< 0.05).Conclusion:Our preliminary results point to clinical differences between patients with TR and TNR depression, including higher scores on bipolarity scale in TR. The features of bipolarity may be an important reason for non-response during antidepressant treatment of depression and worse clinical course and outcome.

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May duration of untreated illness influence the long-term course of major depressive disorder?

European Psychiatry ◽

10.1016/j.eurpsy.2007.11.004 ◽

2008 ◽

Vol 23 (2) ◽

pp. 92-96 ◽

Cited By ~ 35

Author(s):

A. Carlo Altamura ◽

Bernardo Dell'Osso ◽

Serena Vismara ◽

Emanuela Mundo

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Antidepressant Treatment ◽

Age At Onset ◽

Major Depressive ◽

Chi Square ◽

Duration Of Untreated Illness ◽

Course Variables ◽

Depressive Episodes

AbstractThe aim of this naturalistic study was to investigate the possible influence of the duration of untreated illness (DUI) on the long-term course of Major Depressive Disorder (MDD). One hundred and thirteen patients with recurrent MDD, according to DSM-IV-TR criteria, followed up for 5 years, were selected, interviewed and their clinical charts were reviewed. The DUI was defined as the interval between the onset of the first depressive episode and the first adequate antidepressant treatment. The sample was divided into two groups according to the DUI: one group with a DUI ≤ 12 months (n = 75), and the other with a DUI > 12 months (n = 38). The main demographic and clinical course variables were compared between the two groups using Student's t-tests or chi-square tests. Patients with a longer DUI showed an earlier age at onset (t = 2.82, p = 0.006) and a longer duration of illness (t = 3.20, p = 0.002) compared to patients with a shorter DUI. In addition, the total number of depressive episodes occurring before the first antidepressant treatment was higher in the group with a longer DUI (t = −2.223, p < 0.03). Even though limited by the retrospective nature of the study, these preliminary findings would suggest that a longer DUI may negatively influence the course of MDD. Larger prospective studies are warranted to further investigate the role of the DUI within MDD.

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Risk factors associated with development and persistence of long COVID

10.1101/2021.09.22.21263998 ◽

2021 ◽

Author(s):

Yusuke Miyazato ◽

Shinya Tsuzuki ◽

Shinichiro Morioka ◽

Mari Terada ◽

Satoshi Kutsuna ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Linear Regression Analysis ◽

Patient Characteristics ◽

Cross Sectional ◽

Residual Symptoms ◽

Factors Associated ◽

Mild Disease ◽

Number Of Patients ◽

Low Body Mass Index

Background Long COVID has been a social concern. Though patient characteristics associated with developing long COVID are partially known, those associated with persisting it have not been identified. Methods We conducted a cross-sectional questionnaire survey of patients after COVID-19 recovery who visited the National Center for Global Health and Medicine between February 2020 and March 2021. Demographic and clinical data, and the presence and duration of long COVID were obtained. We identified factors associated with development and persistence of long COVID using multivariate logistic and linear regression analysis, respectively. Results We analyzed 457 of 526 responses (response rate, 86.9%). The median age was 47 years, and 378 patients (84.4%) had mild disease in acute phase. The number of patients with any symptoms after 6 and 12 months after onset or diagnosis were 120 (26.3%) and 40 (8.8%), respectively. Women were at risk for development of fatigue (OR 2.03, 95% CI 1.31-3.14), dysosmia (OR 1.91, 95% CI 1.24-2.93), dysgeusia (OR 1.56, 95% CI 1.02-2.39), and hair loss (OR 3.00, 95% CI 1.77-5.09), and were at risk for persistence of any symptoms (coefficient 38.0, 95% CI 13.3-62.8). Younger age and low body mass index were risk factors for developing dysosmia (OR 0.96, 95% CI 0.94-0.98, and OR 0.94, 95% CI 0.89-0.99, respectively) and dysgeusia (OR 0.98, 95% CI 0.96-1.00, and OR 0.93, 95% CI 0.88-0.98, respectively). Conclusion We identified risk factors for the persistence as well as development of long COVID. Many patients suffer from long-term residual symptoms, even in mild cases.

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Use of 30-Hz Accelerated iTBS in Drug-Resistant Unipolar and Bipolar Depression in a Public Healthcare Setting: A Case Series

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.798847 ◽

2022 ◽

Vol 12 ◽

Author(s):

Filippo Cantù ◽

Giandomenico Schiena ◽

Domenico Sciortino ◽

Lorena Di Consoli ◽

Giuseppe Delvecchio ◽

...

Keyword(s):

Rating Scale ◽

Bipolar Depression ◽

Case Series ◽

Healthcare Setting ◽

Public Healthcare ◽

Treatment Resistant Depression ◽

Treatment Resistant ◽

Resistant Depression ◽

Depressive Episodes ◽

Hamilton Rating Scale

Background: Depressive episodes, especially when resistant to pharmacotherapy, are a hard challenge to face for clinicians and a leading cause of disability worldwide. Neuromodulation has emerged as a potential therapeutic option for treatment-resistant depression (TRD), in particular transcranial magnetic stimulation (TMS). In this article, we present a case series of six patients who received TMS with an accelerated intermittent theta-burst stimulation (iTBS) protocol in a public healthcare setting.Methods: We enrolled a total number of six participants, affected by a treatment-resistant depressive episode, in either Major Depressive Disorder (MDD) or Bipolar Disorder (BD). Patients underwent an accelerated iTBS protocol, targeted to the left dorsolateral prefrontal cortex (DLPFC), 3-week-long, with a total of 6 days of overall stimulation. On each stimulation day, the participants received 3 iTBS sessions, with a 15-min pause between them. Patients were assessed by the Hamilton Rating Scale for Depression (HAM-D), the Montgomery-Asberg Depression Rating Scale (MADRS), the Hamilton Rating Scale for Anxiety (HAM-A), and the Mania Rating Scale (MRS). At baseline (T0), at the end of the second week (T1), and at the end of the cycle of stimulation (T2).Results: The rANOVA (repeated Analysis of Variance) statistics showed no significant effect of time on the rating scale scores, with a slight decrease in MADRS scores and a very slight increase in HAM-A and HAM-D scores. No manic symptoms emerged during the entire protocol.Conclusions: Although accelerated iTBS might be considered a less time-consuming strategy for TMS administration, useful in a public healthcare setting, our results in a real-word six-patient population with TRD did not show a significant effect. Further studies on wider samples are needed to fully elucidate the potential of accelerated iTBS protocols in treatment-resistant depression.

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Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline

BMC Geriatrics ◽

10.1186/s12877-020-1443-1 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Anne-Carina Scharf ◽

Janine Gronewold ◽

Christian Dahlmann ◽

Jeanina Schlitzer ◽

Andreas Kribben ◽

...

Keyword(s):

At Risk ◽

Older Patients ◽

Functional Decline ◽

Patient Characteristics ◽

Medical Needs ◽

Patients At Risk

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Computed-Tomography Body Composition Analysis Complements Pre-Operative Nutrition Screening in Colorectal Cancer Patients on an Enhanced Recovery after Surgery Pathway

Nutrients ◽

10.3390/nu12123745 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3745

Author(s):

Pamela Klassen ◽

Vickie Baracos ◽

Leah Gramlich ◽

Gregg Nelson ◽

Vera Mazurak ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Computed Tomography ◽

At Risk ◽

Cancer Patients ◽

Short Form ◽

Composition Analysis ◽

Nutrition Screening ◽

Patients At Risk ◽

Poor Outcomes

Pre-operative nutrition screening is recommended to identify cancer patients at risk of malnutrition, which is associated with poor outcomes. Low muscle mass (sarcopenia) and lipid infiltration to muscle cells (myosteatosis) are similarly associated with poor outcomes but are not routinely screened for. We investigated the prevalence of sarcopenia and myosteatosis across the nutrition screening triage categories of the Patient-Generated Subjective Global Assessment Short Form (PG-SGASF) in a pre-operative colorectal cancer (CRC) cohort. Data were prospectively collected from patients scheduled for surgery at two sites in Edmonton, Canada. PG-SGASF scores ≥ 4 identified patients at risk for malnutrition; sarcopenia and myosteatosis were identified using computed-tomography (CT) analysis. Patients (n = 176) with a mean age of 63.8 ± 12.0 years, 52.3% male, 90.3% with stage I–III disease were included. Overall, 25.2% had PG-SGASF score ≥ 4. Sarcopenia alone, myosteatosis alone or both were identified in 14.0%, 27.3%, and 6.4% of patients, respectively. Sarcopenia and/or myosteatosis were identified in 43.4% of those with PG-SGASF score < 4 and in 58.5% of those with score ≥ 4. Overall, 32.9% of the cohort had sarcopenia and/or myosteatosis with PG-SGASF score < 4. CT-defined sarcopenia and myosteatosis are prevalent in pre-operative CRC patients, regardless of the presence of traditional nutrition risk factors (weight loss, problems eating); therefore, CT image analysis effectively adds value to nutrition screening by identifying patients with other risk factors for poor outcomes.

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Electronic health record cue identifies epilepsy patients at risk for obstructive sleep apnea

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000502 ◽

2018 ◽

Vol 8 (6) ◽

pp. 468-471 ◽

Cited By ~ 1

Author(s):

Martha A. Mulvey ◽

Aravindhan Veerapandiyan ◽

David A. Marks ◽

Xue Ming

Keyword(s):

Risk Factors ◽

At Risk ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Electronic Health Record ◽

Seizure Control ◽

Health Record ◽

Obstructive Sleep ◽

Patients At Risk ◽

Patients With Epilepsy

BackgroundPrior studies have reported that patients with epilepsy have a higher prevalence of obstructive sleep apnea (OSA) that contributes to poor seizure control. Detection and treatment of OSA can improve seizure control in some patients with epilepsy. In this study, we sought to develop, implement, and evaluate the effectiveness of an electronic health record (EHR) alert to screen for OSA in patients with epilepsy.MethodsA 3-month retrospective chart review was conducted of all patients with epilepsy >18 years of age who were evaluated in our epilepsy clinics prior to the intervention. An assessment for obstructive sleep apnea (AOSA) consisting of 12 recognized risk factors for OSA was subsequently developed and embedded in the EHR. The AOSA was utilized for a 3-month period. Patients identified with 2 or more risk factors were referred for polysomnography. A comparison was made to determine if there was a difference in the number of patients at risk for OSA detected and referred for polysomnography with and without an EHR alert to screen for OSA.ResultsThere was a significant increase in OSA patient recognition. Prior to the EHR alert, 25/346 (7.23%) patients with epilepsy were referred for a polysomnography. Postintervention, 405/414 patients were screened using an EHR alert for AOSA and 134/405 (33.1%) were referred for polysomnography (p < 0.001).ConclusionAn intervention with AOSA cued in the EHR demonstrated markedly improved identification of epilepsy patients at risk for OSA and referral for polysomnography.

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A Review of Cisplatin-Associated Ototoxicity

Seminars in Hearing ◽

10.1055/s-0039-1684041 ◽

2019 ◽

Vol 40 (02) ◽

pp. 108-121 ◽

Cited By ~ 7

Author(s):

Jessica Paken ◽

Cyril Govender ◽

Mershen Pillay ◽

Vikash Sewram

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

At Risk ◽

Health Care Professionals ◽

Monitoring Program ◽

Clinical Signs ◽

Incidence Rates ◽

Cellular Mechanisms ◽

Patients At Risk

AbstractCisplatin, an effective antineoplastic drug used in the treatment of many cancers, has ototoxic potential, thus placing cancer patients, receiving this treatment, at risk of hearing loss. It is therefore important for health care professionals managing these patients to be aware of cisplatin's ototoxic properties and its clinical signs to identify patients at risk of developing a hearing impairment. Eighty-five English peer-reviewed articles and two books, from January 1975 to July 2015, were identified from PubMed, ScienceDirect, and EBSCOhost. An overview of cisplatin-associated ototoxicity, namely its clinical features, incidence rates, molecular and cellular mechanisms, and risk factors, is presented in this article. This review further highlights the importance of a team-based approach to complement an audiological monitoring program in reducing any further loss in the quality of life of affected patients, as there is currently no otoprotective agent routinely recommended for the prevention of cisplatin-associated ototoxicity.

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