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

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.

Penurunan Kecemasan Pada Pasien Gagal Jantung Kongestif Melalui Pemberian Terapi Murottal Al-Qur’an

Gagal jantung meningkatkan resiko kematian mendadak sehingga membutuhkan penanganan sesuai dengan tingkat keparahannya. Pada pasien penyakit kardiovaskuler lazim merasakan kecemasan dan stress. Kecemasan pada pasien dengan penyakit kardiovaskuler dapat dibantu salah satunya dengan tindakan non farmakologi. Pada studi kasus ini penanganan kecemasan pasien gagal jantung menggunakan intervensi terapi murottal al-qur’an. Tujuan umum studi kasus ini untuk menganalisa penurunan tingkat kecemasan pasien gagal jantung terhadap pemberian terapi murottal al-qur’an. Studi kasus ini menggunakan metode deskriptif dengan pendekatan proses keperawatan. Subjek studi kasus ini adalah pasien gagal jantung kongestif dan berjumlah 2 orang yang didapatkan secara purposive sampling. Studi kasus ini dilakukan di Ruang Ayyub 2 RS. Roemani Kota Semarang pada tanggal 13 Februari 2020 – 15 Februari 2020. Pengkajian kecemasan dan pengukuran tingkat kecemasan menggunakan kuisioner HARS (Hamilton Rating Scale Of Anxiety). Prosedur pelaksanaan studi kasus ini dilakukan sesuai dengan evidence based nursing yaitu dilaksanakan dengan durasi 15-20 menit selama 3 hari. Hasil studi evaluasi menunjukkan bahwa sebelum dilakukan terapi murottal al-qur’an terjadi peningkatan kecemasan dan tanda-tanda vital serta gangguan tidur pada kedua pasien yang mengalami penurunan setelah dilakukan terapi murottal al-qur’an.Setelah dilakukan terapi murottal al-qur’an terdapat perbaikan pada tanda-tanda vital, penurunan tingkat kecemasan, dan penurunan gangguan tidur pada kedua pasien. Terapi murottal al-qur’an efektif dalam menurunkan tingkat kecemasan pada pasien dengan gagal jantung kongestif.

Sex differences in serum levels of 5α-androstane-3β, 17β-diol, and androstenediol in the young adults: A liquid chromatography–tandem mass spectrometry study

Animal experiments have consistently shown that estrogen receptor β (ERβ)-selective ligands have antidepressant and anxiolytic effects. In humans, endogenous ligands for ERβ include 5α-androstane-3β, 17β-diol (3βAdiol) and androstenediol (Δ5-diol). We determined, for the first time, the exact serum levels of 3βAdiol and Δ5-diol in young healthy volunteers using liquid chromatography–tandem mass spectrometry (LC–MS/MS). We investigated the effect of the menstrual cycle on the levels of these steroids in women; then, we performed a gender comparison. Blood samples were collected from 48 subjects: 23 women (mean age = 28.4±7.8 years) and 25 men (mean age = 31.4±7.8 years). We collected the blood samples of women at three time-points in the menstrual cycle: the early follicular phase, ovulatory or mid-cycle phase, and mid-luteal phase. A total of 92 blood samples were analyzed using LC–MS/MS. The levels of two well-studied steroids, namely dehydroepiandrosterone (DHEA) and 17β-estradiol (E2), were simultaneously measured. Depression rating scale (Hamilton Rating Scale for Depression, Beck Depression Inventory-II and Quick Inventory of Depressive Symptomatology) scores were also recorded at the time of blood sampling. Significant differences in the levels of 3βAdiol and E2 and in the depression rating scale scores were observed over the duration of the menstrual cycle of the women. The levels of 3βAdiol and Δ5-diol were significantly lower in women than in men. E2 levels were higher in women than in men, and DHEA levels did not differ significantly between men and women. Further, women had higher scores than men on the Hamilton Rating Scale for Depression. Sex differences in depressive symptoms can be explained by 3βAdiol and Δ5-diol levels, and the effect of the menstrual cycle on mood can be explained by 3βAdiol and E2 levels, not by Δ5-diol level.

Usefulness of Hamilton rating scale for depression subset scales and full versions for electroconvulsive therapy

Objectives We investigated the predictive value of subset scales and full versions of the Hamilton Rating Scale for Depression (HAMD) for therapeutic outcomes in ECT. Methods This secondary analysis of patients with major depression (N = 136; 63% female; age = 56.7 [SD = 14.8]) from the EFFECT-Dep trial (NCT01907217) examined the predictive value of Evans-6, Toronto-7, Gibbons-8 and Maier-Philip 6 HAMD subset scales and three ‘full’ versions (HAMD-17, HAMD-21 and HAMD-24) on therapeutic outcomes. We also examined early improvement on subset scales and full versions as predictors of response and remission and explored predictive abilities of individual HAMD-24 items. Results The subset scales and full scales lacked sufficient predictive ability for response and remission. Receiver operating characteristic curves identified a lack of discriminative capacity of HAMD subset scales and full versions at baseline to predict response and remission. Only the Maier-Philip-6 was significantly associated with percentage reduction in HAMD-24 scores from baseline to end of ECT course. Early improvement on most of the subset scales and full versions was a sensitive and specific predictor of response and remission. Four of the HAMD-24 items were significantly associated with response and one with remission. Conclusions Limited utility of the HAMD subset scales and full versions in this context highlight a need for more tailored depression rating scales for ECT.

The Patient Health Questionnaire-9 vs. the Hamilton Rating Scale for Depression in Assessing Major Depressive Disorder

Background: The Hamilton Rating Scale for Depression (HAMD-17) has been used for several decades to assess the severity of depression. Multiple studies have documented defects in this scale and deemed it unsuitable for clinical evaluation. The HAMD-6, which is the abbreviated version of HAMD-17, has been shown to be effective in assessing the core symptoms of depression with greater sensitivity than HAMD-17. And the Patient Health Questionnaire-9 (PHQ-9) is suggested as an effective alternative to the HAMD-17 because of its simplicity and ease-of-use.Methods: Research was completed involving 1,741 participants having major depressive disorder. Cronbach's alpha, intraclass correlation coefficient (ICC) and weighted Kappa analysis was used to determine the reliability of the scales. Pearson correlation analysis and factor analysis were used to analyze validity. Item response theory (IRT) was used to analyze psychological characteristics of items in both the HAMD-17 and PHQ-9.Results: Reliability analysis showed that the Cronbach's alpha of the HAMD-17, HAMD-6 and PHQ-9 were 0.829, 0.764, and 0.893 respectively, and the ICC of the three scales ranged from 0.606 to 0.744. The Kappa score of the consistency of depression severity assessment was 0.248. Validity analysis showed that the PHQ-9 was a single factor structure, and the total score of the scale was strongly correlated with the HAMD-17 (r = 0.724, P < 0.001). The IRT analysis showed that the discrimination parameters of the PHQ-9 were higher than that of the HAMD-17 in all dimensions. The HAMD-6 had the lowest measurement accuracy in distinguishing the severity of depression, while the PHQ-9 had the highest measurement accuracy.Conclusion: Results showed that the PHQ-9 was satisfactory in terms of reliability, validity and distinguishing the severity of depression. It is a simple, rapid, effective and reliable tool which can be used as an alternative to the HAMD-17 to assess the severity of depression.

PENGARUH AROMATERAPI LAVENDER TERHADAP KECEMASAN IBU BERSALIN

Background: During the first stage of labor, a woman will experience a psychological disorder, namely anxiety, the impact will cause muscle tension in the body, the birth canal becomes stiff, hard and difficult to expand resulting in the labor process not going smoothly. The main content in lavender oil is linalool acetate which can relax and relax the working system of the nerves and tense muscles.Objective: This study aims to determine the effect of lavender aromatherapy on maternal anxiety at RSU Kota Tangerang Selatan in 2021.Methodology: This quasi-experimental study used a pretest and posttest design with a control group design. The sample in this study amounted to 30 mothers who will give birth at RSU Kota Tangerang Selatan with 15 respondents each. The sampling technique used total sampling. The research instrument used the Hamilton Rating Scale for Anxienty (HRS-A) questionnaire. Data were analyzed using the Independent T-test, which previously tested for normality and homogeneity.Results: The results of the study on anxiety before being given lavender aromatherapy an average of of 22.47 and after being given lavender aromatherapy an average of 18.33 with an average difference of 4.14, in the control group examination I an average of 22.60 and examination II an average 22.27 with an average difference of 0.33 and the effect of lavender aromatherapy on maternal anxiety with a significance level of 0.001.Conclusions: There is an effect of lavender aromatherapy on maternal anxiety at RSU Kota Tangerang Selatan in 2021.Suggestion It is hoped that lavender aromatherapy can be applied as a whole in Indonesian health services..Keywords: Anxiety, Maternal Lavender Aromatherapy, ABSTRAK Latar Belakang: Persalinan akan menyebabkan gangguan psikologi berupa kecemasan yang dapat mengakibatkan penurunan aliran darah yang membawa oksigen ke rahim dan janin sehingga dapat terjadi hal-hal yang merugikan bagi ibu dan janin. Salah satu terapi non-farmakologis untuk menurunkan kecemasan adalah melalui pemberian aromaterapi khususnya aromaterapi lavender dapat memberi rasa tenang, sehingga dapat digunakan sebagai manajemen stres.Tujuan: Penelitian ini bertujuan untuk mengetahui pengaruh aromaterapi lavender terhadap kecemasan ibu bersalin di RSU Kota Tangerang Selatan Tahun 2021.Metodologi: Penelitian quasi eksperimental ini menggunakan rancangan pretest and posttest with control group design. Sampel dalam penelitian ini berjumlah 30 ibu yang akan melahirkan di RSU Kota Tangerang Selatan dengan masing-masing kelompok 15 responden. Teknik pengambilan sampel menggunakan total sampling. Instrumen penelitian menggunakan kesioner Hamilton Rating Scale for Anxienty (HRS-A). Data dianalisis menggunakan T-test Independent yang sebelumnya dilakukan uji normalitas dan homogenitas.Hasil Penelitian: Hasil penelitian terhadap kecemasan sebelum diberikan aromaterapi lavender rata-rata 22,47 dan sesudah diberikan aromaterapi lavender rata-rata 18,33 dengan selisih rata-rata 4,14, pada kelompok kontrol pemeriksaan I rata-rata 22,60 dan pemeriksaan II rata-rata 22,27 dengan selisih rata-rata 0,33. Terdapat perbedaan rerata skor tingkat kecemasan yang bermakna antara kelompok intervensi dan kelompok kontrol dengan tingkat signifikansi 0,001 < 0,05. Simpulan: Terdapat pengaruh aromaterapi lavender terhadap kecemasan ibu bersalin di RSU Kota Tangerang Selatan Tahun 2021.Saran Diharapkan pemberian aromaterapi lavender dapat diterapkan secara menyeluruh dipelayanan kesehatan Indonesia. Kata Kunci : Aromaterapi Lavender, ibu bersalin, kecemasan

Effect of Quality Nursing Intervention on the Efficacy of Treating Hypertrophic Burn Scars with Asiaticoside Cream Ointment and Nursing Satisfaction

Objective. To explore the effect of quality nursing intervention on the efficacy of treating hypertrophic burn scars with asiaticoside cream ointment and nursing satisfaction. Methods. A total of 80 patients with hypertrophic burn scars treated in our hospital from January 2019 to January 2021 were retrospectively analyzed and divided into group A (conventional nursing) and group B (quality nursing) according to the different nursing modes, with 40 cases each. All patients were treated with the asiaticoside cream ointment, and after nursing intervention, the effect of different nursing modes on the patients’ clinical efficacy and nursing satisfaction was scientifically evaluated. Results. No statistical differences in patients’ general information were observed (P>0.05); the overall effective rate of treatment was obviously lower in group A than in group B (77.5% vs 95%, P<0.05); after nursing, the Vancouver Scar Scale (VSS) scores of patients in both groups were significantly lower than before (P<0.05), and the VSS scores after nursing of group B were significantly lower than those of group A (P<0.05); after nursing, the Hamilton Rating Scale for Depression (HAMD) scores and Hamilton Rating Scale for Anxiety (HAMA) scores were obviously lower in group B than in group A (P<0.05); and the overall satisfaction with nursing was significantly higher in group B than in group A (P<0.05). Conclusion. Performing quality nursing for patients with hypertrophic burn scars who accepted the asiaticoside cream ointment treatment can effectively promote clinical efficacy, reduce the negative emotions of patients, and improve the satisfaction with nursing.

Sociodemographic and Clinical Profile of Patients Presenting With Erectile Dysfunction: Experience From a Tertiary Care Centre of North India

Background: Erectile dysfunction (ED) is one of the most common psychosexual disorders in clinical practice, and it results in significant distress, interpersonal impairments, poor quality of life, and marital disharmony. However, there is limited research on ED in India. Therefore, this study aimed to assess the sociodemographic and clinical profile of patients presenting with ED. Method: Cross-sectional evaluation of patients with ED presenting to the psychosexual outpatient department (OPD) of psychiatry department in a tertiary care hospital was done on structured clinical pro forma, Mini-International Neuropsychiatric Interview, International Index of Erectile Function-5, Arizona Sexual Experience, Hamilton rating scale for depression, and Hamilton rating scale for anxiety. Results: The sample included 102 patients. The mean age was 33.38 years. The majority of the patients were married (81.4%), Hindu (82.4%), residing in a rural area (60.8%), and belonging to a nuclear family (62.7%). The majority of the patients had a moderate level of ED (50%) followed by mild-to-moderate ED (26.5%) and severe ED (23.5%). Premature ejaculation (46.1%) and depression (28.4%) were the most common sexual and psychiatric comorbidities. Obesity was common (62.7%), and only a minority had other metabolic dysfunction, namely dyslipidemia (7.8%), diabetes (5.9%), and hypertension (4.9%). Tobacco dependence and alcohol dependence were present in 37.3% and 6.9% cases, respectively. Conclusion: Young adults with moderate-to-severe ED were present for treatment at a tertiary center. Comorbidities of other sexual disorders, psychiatric disorders, and substance use are commonly encountered in such patients. Promotion of early help-seeking should be encouraged. Clinicians should thoroughly assess even the young patients for other sexual, psychiatric, and medical comorbidities.

PBMC telomerase activity in depression and the response to electroconvulsive therapy

Telomerase, the DNA polymerase responsible for maintaining telomere length, has previously been implicated in depression and the response to antidepressant drugs. In this study, we aimed to compare telomerase activity in peripheral blood mononuclear cells between patients with severe depression recruited as part of the KEEP-WELL Trial (Ketamine for Depression Relapse Prevention Following ECT; NCT02414932) and age- and sex-matched healthy volunteers both at baseline/pre-ECT and at follow-up 1 month later for controls or in patients after a course of ECT. We found no differences in telomerase activity between patients with depression (n = 20) compared to healthy controls (n = 33) at baseline/pre-ECT, or between patients treated with ECT compared to controls at follow-up. In patients, telomerase activity was not associated with mood, as assessed by the 24-item Hamilton Rating Scale for Depression, or the duration of the current depressive episode. Additionally, we found no significant relationship between telomerase activity and exposure to recent or childhood adversity in either the patient or control groups. Overall, our results suggest that telomerase activity is not associated with depression, the therapeutic response to ECT, or exposure to adversity.