Depressive disorders in patients with diabetes mellitus. The effect of sedariston phytopreparation on carbohydrate metabolism and psycho-emotional state of patients with anxiety-depressive syndrome

Background. Depressive disorders are quite common in patients with diabetes mellitus (DM). Depression is associated with worsening glycemic control. Attempts to improve it through the use of synthetic antidepressants in complex therapy have had mixed results. The study was aimed to evaluate the prevalence of depressive disorders in patients with diabetes mellitus treated in the endocrinology department and to evaluate the effect of combined herbal medicine Sedariston containing standardized extracts of Hypericum perforatum (100 mg) and Valeriana (50 mg) (Esparma GmbH, Germany) on carbohydrate metabolism and psycho-emotional state of diabetic patients with the anxiety-depressive syndrome. Materials and methods. The study included 122 patients with type 1 and 2 DM, 103 women and 19 men, aged 18 to 75 years. Thirty-three of them with anxiety-depressive syndrome participated in a 3-month study, 16 of which additionally received Sedariston 2 capsules twice a day for 2 months. Prior to, as well as 2 weeks, 1, 2, 3 months from the beginning of the observation, the psycho-emotional state was assessed with a determination of the severity of the depressive syndrome on the PHQ-9, Beck scales, as well as the state of personal and reactive anxiety on the Spielberger-Hanin’s scales. Glycated hemoglobin was determined before and 3 months after the start of monitoring. All patients received insulin therapy and/or hypoglycemic oral medications at constant doses during the observation. Results. Depressive disorders were identified in 80.3 and 67.2 %, respectively, according to the PHQ-9 and Beck scales. Most patients experienced mild and moderate depression. High personal anxiety was found in 66.4 %, high reactive anxiety in 50.8 % of patients. Patients in the Sedariston basic group reported significant improvement in depressive symptomatology with a decrease in PHQ-9 scores from 13.7 ± 1.6 to 9.3 ± 1.4 (p < 0.05) after 1 month of treatment, and on the Beck’s scale from 23.9 ± 1.8 to 18.2 ± 1.9 points (p < 0.05) after 2 months of treatment, in contrast to patients in the control group without Sedariston: 11.9 ± 1.2 and 10.8 ± 1.1 points (p > 0.1) on the PHQ-9 scale and 19.7 ± 1.7 and 18.9 ± 2.3 points (p > 0.1) on the Beck’s scale, respectively. The achieved improvement of the psycho-emotional state of patients after the end of treatment with Sedariston was maintained after 3 months from the beginning of monitoring: 7.1 ± 1.3 points on the PHQ-9 scale and 16.1 ± 2.1 points on the Beck’s scale (p < 0.01). After 2 months of Sedariston therapy in the group of patients with the anxiety-depressive syndrome, unlike the patients of the control group, personal anxiety decreased from 59.5 ± 2.2 to 53.5 ± 1.9 points on the Spielberger-Hanin’s scale (p < 0.05), in patients with high reactive anxiety, after 2 months of treatment significantly decreased its level from 57.4 ± 2.5 to 49.3 ± 2.7 points and remained so until the end of observation. Against the background of the positive dynamics of depressive symptoms in patients receiving Sedariston, a significant decrease in glycated hemoglobin occurred 3 months after the start of therapy: from 9.4 ± 0.5 to 8.1 ± 0.2 % (p < 0.05), unlike the patients of the control group. Conclusions. An anxiety-depressive syndrome is defined in 63.1 % of patients of the diabetology department, with depressive disorders mainly of mild and moderate severity, high personality and reactive anxiety, and 19.7 % of patients experienced a depressive syndrome without disturbance of anxiety, which indicates their diagnosis and conducting appropriate treatment. The combined phytopreparation Sedariston in the complex therapy of patients with diabetes mellitus, against the backdrop of the positive and long-lasting effect on anxiety-depressive symptoms, contributes to the improvement of carbohydrate metabolism, with a decrease of 1.3 % of glycated hemoglobin in 3 months. This indicates that Sedariston may be used not only for the treatment of anxiety-depressive syndrome but also to improve carbohydrate metabolism in patients with DM.

Machine Learning-Based Definition of Symptom Clusters and Selection of Antidepressants for Depressive Syndrome

The current polythetic and operational criteria for major depression inevitably contribute to the heterogeneity of depressive syndromes. The heterogeneity of depressive syndrome has been criticized using the concept of language game in Wittgensteinian philosophy. Moreover, “a symptom- or endophenotype-based approach, rather than a diagnosis-based approach, has been proposed” as the “next-generation treatment for mental disorders” by Thomas Insel. Understanding the heterogeneity renders promise for personalized medicine to treat cases of depressive syndrome, in terms of both defining symptom clusters and selecting antidepressants. Machine learning algorithms have emerged as a tool for personalized medicine by handling clinical big data that can be used as predictors for subtype classification and treatment outcome prediction. The large clinical cohort data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D), Combining Medications to Enhance Depression Outcome (CO-MED), and the German Research Network on Depression (GRND) have recently began to be acknowledged as useful sources for machine learning-based depression research with regard to cost effectiveness and generalizability. In addition, noninvasive biological tools such as functional and resting state magnetic resonance imaging techniques are widely combined with machine learning methods to detect intrinsic endophenotypes of depression. This review highlights recent studies that have used clinical cohort or brain imaging data and have addressed machine learning-based approaches to defining symptom clusters and selecting antidepressants. Potentially applicable suggestions to realize machine learning-based personalized medicine for depressive syndrome are also provided herein.

Anxiety-Depressive Syndrome and Binge-Watching Among Young Adults

In recent years, binge-watching becomes a highly popular way of spending free time. Even though binge-watching usually is related to entertainment, there are concerns about some negative and unhealthy outcomes of excessive form of this behavior. The study examined the predictive value of anxiety-depressive syndrome in explaining the symptoms of problematic binge-watching and the tendency to adopt a specific motivation to watch series. Research group consists of 645 Polish young adults. The State-Trait Anxiety Inventory, Depression Measurement Questionnaire, Viewing Motivation Scale, and Questionnaire of Excessive Binge-Watching were used in this study. The results of the path analysis show that anxiety-depressive syndrome and motivation to watch TV series are the significant factors in the manifestation of all symptoms of problematic binge-watching. Moreover, there is a significant relation between anxiety-depressive syndrome and motivation to watch TV series, which especially concerns escape motivation and motivation to deal with loneliness. Furthermore, motivation to deal with loneliness, escape motivation, and motivation to spend free time have mediating effect on the relationship between anxiety-depressive syndrome and problematic binge-watching. Results of this research show that there could be not only normative binge-watching behavior but also unhealthy and problematic form of this behavior.

Case Report: Severe Adolescent Major Depressive Syndrome Turns Out to Be an Unusual Case of Anti-NMDA Receptor Encephalitis

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a neuroinflammatory condition mediated by autoantibodies against the GluN1 subunit of the receptor. Clinically, it is characterized by a complex neuropsychiatric presentation with rapidly progressive psychiatric symptoms, cognitive deficits, seizures, and abnormal movements. Isolated psychiatric manifestations of anti-NMDAR encephalitis are rare and usually dominated by psychotic symptoms. We present a case of an 18-year-old female high school student—without a previous history of psychiatric disorders—with a rapid onset severe depressive syndrome. Surprisingly, we found pleocytosis and anti-NMDAR autoantibodies in the cerebrospinal fluid (CSF), despite an otherwise unremarkable diagnostic workup, including blood test, clinical examination, and cranial magnetic resonance imaging (MRI). After intravenous immunoglobulins treatment, a complete remission of the initial symptoms was observed. In a follow-up 5 years later, the young woman did not experience any relapse or sequelae. Anti-NMDAR encephalitis can present in rare cases as an organic disorder with major depressive symptoms without distinct concomitant psychotic or neurological symptoms. A clinical presentation such as a rapid onset of symptoms, distinct disturbance in the thought process, restlessness, and cognitive deficits should prompt screening for NMDAR- and other neural autoantibodies to rule out this rare but debilitating pathology.

AB0177 ANXIETY-DEPRESSIVE SPECTRUM IN PATIENTS WITH RHEUMATOID ARTHRITIS AND ANKYLOSING SPONDILITIS

Objectives:to assess the frequency of occurrence of the anxiety-depressive spectrum in patients with rheumatoid arthritis and ankylosing spondylitis.Methods:A survey was conducted of 44 patients aged from 21 to 57 years (average age - 42.3 ± 6.7 years), who were treated at GAUZ KO OKGVV. All patients had a verified diagnosis of RA and AS according to the ACR criteria and received treatment with basic drugs. The control group consisted of 40 people comparable in age and sex, without concomitant pathology of RA and AS.The depression screening card, the subjective well-being scale, and the hospital anxiety and depression scale (HADS) were used to assess and detect anxiety-depressive syndrome. The assessment of the condition is carried out over the last 2 weeks, which corresponds to the temporary diagnostic criterion for depression.The Depression Screening Scale is a 35-item self-questionnaire that assesses 7 categories of signs: sleep and appetite disorders, anxiety, emotional instability, cognitive impairment, loss of self, guilt, and suicidal tendencies. A total score of 65 and above indicates a high likelihood of depression.The Subjective Well-Being Scale is a psychodiagnostic screening tool for measuring the emotional component of subjective well-being or emotional comfort.Hospital Anxiety and Depression Scale Zigmond A.S., Snaith R.P. was developed for the primary detection of depression and anxiety in a general medical practice. The HADS scale consists of 14 statements with 4 possible answers and includes two parts: anxiety and depression. The sum of points of 8 or more is regarded as “subclinically expressed anxiety / depression”, 11 or more points - “clinically expressed anxiety / depression”.Results:According to the results of the depression screening questionnaire, 34 (77.3%) patients with RA and AS showed signs of depression, while in the control group only 6 (15%) patients tested positive for the presence of depressive disorders. According to the data obtained when assessing the scale of well-being in the main group, 26 (59.1%) patients showed signs of emotional discomfort (the indicator was 80% or more), in the control group - in 6 (15%). Using the hospital scale of anxiety and depression HADS, anxiety-depressive syndrome was detected in 36 (81.8%) patients with RA and AS: 16 (44.4%) patients had anxiety, 20 (55.6%) - depression, of them, subclinically expressed anxiety and depression were observed in 10 (27.7%) and 12 (33.3%) people, respectively. Anxiety-depressive syndrome in the control group, according to the HADS questionnaire, was detected only in 8 (20%) patients, of whom 4 (10%) patients had subclinical anxiety and 4 (10%) had signs of depression. No clinically pronounced anxiety and depression were registered in the control group.Conclusion:In most patients with rheumatoid arthritis and ankylosing spondylitis, anxiety-depressive disorders have been identified, which can directly affect both the course of the disease itself and the development of various complications. Timely diagnosis of mental disorders and close cooperation of rheumatologists, psychiatrists and psychologists in the selection of adequate therapy can improve the course and prognosis of the disease.Disclosure of Interests:None declared

Anxiety-depressive syndrome in patients with damage to the central nervous system by herpes viruses

Annotation. Purpose of work – a study of the prevalence and severity of anxiety-depressive syndrome based on the Hospital Anxiety and Depression Scale (HADS) in patients with damage to the nervous system of hepatic virus etiology. In this study, 2 groups of 30 people took part. The first group (main) is 30 people from a verified diagnosis of herpesviral damage to the nervous system aged 14 to 74 years. Viruses were in the stage of activation and persistence. The second group (control), almost healthy people – 30 people. There were 20 women and 10 men in each group. Diagnoses: Encephalitis, meningoencephalitis, arachnoencephalitis, arachnoiditis, disseminated encephalomyelitis, polyneuropathy, arachnoencephalopolyneuropathy, multiple sclerosis. Etiological factors were: HSV, EBV, VZV, HHV-7 + EBV, EBV + VZV, EBV + HSV, EBV + HHV-6, HSV + VZV, HSV + CMV + EBV + VZV, HSV + VZV + CMV + EBV + Tox.g. In all persons of the first group, a moderate course was observed. All subjects were tested on a hospital anxiety and depression scale (HADS). It was established that patients suffering from lesions of the nervous system of herpes virus etiology have signs of depression and anxiety. The duration in days of subclinically expressed depression in 9 people of the first group was 2.54±0.98, at p=0.04, and in the second group, depression not observed. Anxiety was subliminally expressed in the first group in 7 people, the duration in days was 4.20±1.20, and in the second group in 2 people, which was 1.0±0.69, with p=0.02. Thus, in patients with herpes virus lesions of the nervous system, anxiety-depressive syndrome is more pronounced than in practically healthy persons, perhaps this is due to damage to the limbic-diencephalic system of the brain.