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Apathy is usually defined as a lack of goal-directed behavior. Although it is observed in about 30% of depressed patients, neurovascular mechanisms underpinning apathy remain little-known.
The main objective of this study was to compare the cerebral perfusion of apathetic depressed patients with non-apathetic depressed patients by arterial spin labeling (ASL), a quantitative and non-invasive perfusion magnetic resonance imaging (MRI) technique. The secondary objectives were to study their clinical profile and their correlation with cerebral perfusion data.
This study was conducted from a cohort of depressed patients in Rennes, France. Eighty-three depressed patients were included, of whom 22 were apathetic (AES≥42), 61 non-apathetic (AES < 42). Everyone got a clinical evaluation with scale screenings, especially for apathy (AES), anxiety (STAI) and anhedonia (SHAPS) as well as a cerebral MRI, including a pseudo-continuous ASL sequence.
Apathetic depressed patients were significantly less anxious and less anhedonic. Apathetic perfused better than non-apathetic in the inferior frontal gyrus (P = 0.022). We found a significant positive relationship between apathy and perfusion of the left frontal inferior gyrus (P = 0.05, r = 0.21). State-anxiety was positively correlated with perfusion of the cingulate cortex, the insula and the left amygdala. Anhedonia was positively correlated with the perfusion of the ventromedial prefrontal cortex, the cingulate cortex and the insula.
We have shown that the clinical and perfusional profiles of apathetic depressed and non-apathetic differ. This study suggests the existence of two distinct neurobiological networks for depressed patients; one involving motivational networks for apathetic patients, and another one involving emotional networks for more anhedonic patients.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Apathy is a transnosographical symptom that is often described in psychiatric and neurological illness. The most known definition, proposed by Marin (1991), is a lack of goal-directed voluntary behavior. Apathy and depression may be present together but they are clinically independent. The confusion between signs of apathy and those of depression might reveal diagnostic and treatment issue. Our aim is to define a clinical profile of apathetic patients (Ap) with depression, hypothesizing there is a different clinic profile than non-apathetic patients (NAp).
Seventy adults diagnosed with depression were included in a comparative, non-randomized and open cohort, since November 2014. Clinical assessments targeted clinical scale evaluations (MINI, AES, MADRS, STAI, SHAPS). Patients were separated in two groups, Ap VS NAp, using a 42 points cut-off at AES score.
Ap represent 30%; n(Ap)= 21, n(NAp)= 49. Depressive severity scores (MADRS) are lower in the Ap group; W-test= 672, P= 0,044. State anxiety scores (STAI-A) are lower in Ap group; W-test= 739, P = 0,004. Anhedonia scores (SHAPS) are lower in Ap group; W-test= 412, P= 0,004. Pearson test show negative correlation between AES/STAI-A (r = -0,27; P= 0,02); AES/SHAPS (r= -0,45; P= 0,001).
Apathetic patients suffering from depression seem to present different clinical pattern in term of anxiety and anhedonia. These results are high of interest for therapeutic and further studies focus on pathophysiological issues.
Disclosure of interest
The author has not supplied his/her declaration of competing interest.
Psychotropic prescription rates continue to increase in the United States (USA). Few studies have investigated whether social-structural factors may play a role in psychotropic medication use independent of mental illness. Food insecurity is prevalent among people living with HIV in the USA and has been associated with poor mental health. We investigated whether food insecurity was associated with psychotropic medication use independent of the symptoms of depression and anxiety among women living with HIV in the USA.
We used cross-sectional data from the Women's Interagency HIV Study (WIHS), a nationwide cohort study. Food security (FS) was the primary explanatory variable, measured using the Household Food Security Survey Module. First, we used multivariable linear regressions to test whether FS was associated with symptoms of depression (Center for Epidemiologic Studies Depression [CESD] score), generalised anxiety disorder (GAD-7 score) and mental health-related quality of life (MOS-HIV Mental Health Summary score; MHS). Next, we examined associations of FS with the use of any psychotropic medications, including antidepressants, sedatives and antipsychotics, using multivariable logistic regressions adjusting for age, race/ethnicity, income, education and alcohol and substance use. In separate models, we additionally adjusted for symptoms of depression (CESD score) and anxiety (GAD-7 score).
Of the 905 women in the sample, two-thirds were African-American. Lower FS (i.e. worse food insecurity) was associated with greater symptoms of depression and anxiety in a dose–response relationship. For the psychotropic medication outcomes, marginal and low FS were associated with 2.06 (p < 0.001; 95% confidence interval [CI] = 1.36–3.13) and 1.99 (p < 0.01; 95% CI = 1.26–3.15) times higher odds of any psychotropic medication use, respectively, before adjusting for depression and anxiety. The association of very low FS with any psychotropic medication use was not statistically significant. A similar pattern was found for antidepressant and sedative use. After additionally adjusting for CESD and GAD-7 scores, marginal FS remained associated with 1.93 (p < 0.05; 95% CI = 1.16–3.19) times higher odds of any psychotropic medication use. Very low FS, conversely, was significantly associated with lower odds of antidepressant use (adjusted odds ratio = 0.42; p < 0.05; 95% CI = 0.19–0.96).
Marginal FS was associated with higher odds of using psychotropic medications independent of depression and anxiety, while very low FS was associated with lower odds. These complex findings may indicate that people experiencing very low FS face barriers to accessing mental health services, while those experiencing marginal FS who do access services are more likely to be prescribed psychotropic medications for distress arising from social and structural factors.
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