Sex Differences in Depressive Symptom Networks Among Community-Dwelling Older Adults in South Korea: A Network Comparison Test

This cross-sectional study investigated the sex differences in depressive symptom networks among community-dwelling older adults in Korea. The analysis was based on the 2019 Korean Community Health Survey data targeting older adults aged 65 years or older. Using network analysis, depressive symptom networks were constructed according to the items listed in the Patient Health Questionnaire-9 for propensity score-matched male (n = 1,885) and female groups (n = 2,848). Strength centrality and network stability were tested. A network comparison test was performed to compare the global strength, network structure, and specific edge strength between the networks. Symptoms central to the network were similar between sexes, which were suicidal ideation, hopelessness, and psychomotor retardation/agitation. However, the global structure (S = 0.67, p = .008) and network structure (M = 0.11, p = .043) differed between sexes. The female symptom network showed more strengthened edges (Smale = 2.00; Sfemale = 2.66). Particularly, four edges—loss of interest–hopelessness (E = 0.09, p = .016), sleep disturbance–low energy/fatigue (E = 0.11, p = .005), loss of interest–concentration difficulty (E = 0.05, p = .047), and worthlessness–concentration difficulty (E = 0.08, p = .045)—were more pronounced in the female network. Our results may help guide future research and clinical interventions for female depression.

Headache and non-headache symptoms provoked by nitroglycerin in migraineurs: A human pharmacological triggering study

Background Studying a spontaneous migraine attack is challenging, particularly the earliest components. Nitroglycerin is a potent, reliable and reproducible migraine trigger of the entirety of the migraine attack, making its use experimentally attractive. Methods Fifty-three subjects with migraine with a history of spontaneous premonitory symptoms were exposed to a 0.5 mcg/kg/min nitroglycerin infusion. Eighty-three percent (n = 44) developed typical premonitory and headache symptomatology. Fifty-seven percent (n = 25) were invited back to further study visits, during which they were re-exposed to nitroglycerin or placebo infusion in a double-blind randomised design. The phenotype of premonitory symptoms and headache was captured and compared to spontaneous attacks and between triggered attacks using agreement analysis. Results More premonitory symptoms were triggered with nitroglycerin than placebo (mean symptom difference = 4, t20 = 7.06, p < 0.001). The agreement in triggering for the most commonly reported premonitory symptoms (concentration difficulty and tiredness) was >66%. The retriggering agreement for all but one premonitory symptom was >60%. The agreement in timing to onset of premonitory symptoms was reliable across two triggered attacks. The agreement with spontaneous attacks and between attacks for headache and its associated symptoms, including laterality, was less reliable. Conclusions Nitroglycerin can reliably and reproducibly provoke premonitory symptomatology associated with migraine. This forms an ideal model to study the earliest manifestations of migraine attacks.

Allergic Rhinitis Is Associated With Loss of Energy and Concentration Difficulty: A Cross-sectional Study

Objective To assess whether loss of energy and concentration difficulty are related to allergic rhinitis. Design A cross-sectional study. Setting Secondary care allergy outpatients. Participants A total of 100 patients with allergic rhinitis and 96 healthy subjects. Main Outcome Measure: Loss of energy and concentration difficulty were assessed through a survey using the Beck Depression Inventory-II (BDI-II). Results The average BDI-II score was higher in the allergic rhinitis population than in the healthy controls (12.8 points vs 1.8 points, P < .0001), and the frequencies of loss of energy (69.0% vs 32.3%) and concentration difficulty (65.0% vs 34.4%) were higher in patients with allergic rhinitis ( P < .0001). The prevalence of depression was 0% in the control group and 38% in the case group ( P < .0001). Allergic rhinitis and depression were independently associated with loss of energy, odds ratio (OR) = 2.55, P = .005, and OR = 9.61, P = .001, respectively, and concentration difficulty (OR = 2.04, P = .033; OR = 6.19, P = .001, respectively). Conclusions This study is one of the first studies in Latin America to report an independent association of allergic rhinitis with loss of energy and concentration difficulty.

Managing Cognitive Dysfunction in Bipolar Disorder

Cognitive dysfunction, including memory and concentration difficulty, is an emerging treatment target in bipolar disorder. However, a key challenge in the management of these cognitive deficits is the lack of treatments with robust effects on cognition. Further, it is unclear how cognitive dysfunction should be assessed and addressed in the clinical treatment of the disorder. This talk will review the evidence for cognitive impairment in bipolar disorder, including its severity, persistence and impact on patients’ functional recovery. It will then discuss when and how to assess cognition and present some new feasible screening tools for cognitive dysfunction. Finally, it will highlight some novel candidate cognition treatments.Disclosure of interestI have acted as a consultant and received honoraria from Lundbeck and Allergan.

The Effect of Baclofen on the Gait of Hemiplegic Children Assessed by Means of Polarised Light Goniometry

Gait was assessed by polarised light goniometry in 15 hemiplegic children aged 4−15 years. After initial clinical and goniometric assessment, baclofen 5−10 mg/day was started and increased over 4−6 weeks to a dose of 1−1.5 mg/kg/day. Assessment was repeated one week later. A statistically significant decrease in hip and knee flexion at the ‘toe-off’ phase of the gait cycle was found in both legs. Of the nine children who showed most change in goniometric assessment, five showed an obvious clinical improvement, two a slight improvement, one no change and one child's gait deteriorated. Of six children with minimal or no change goniometrically, four showed no change clinically, one minimal clinical improvement and one a deterioration clinically. Side effects included transient sedation (seven children), concentration difficulty (one child), behaviour disturbance (1 child) and nocturnal enuresis (three children). We concluded that although baclofen causes functional improvement in some hemiplegic children, its use should be carefully supervised in view of possible side effects and possible deterioration in gait.