The 2018 Common Rule revision intended to improve informed consent by recommending a concise key information (KI) section, yet provided little guidance about how to describe KI. We developed innovative, visual KI templates with attention to health literacy and visual design principles. We explored end users’ attitudes, beliefs, and institutional policies that could affect implementing visual KI pages.

From October 2023 to April 2024, we conducted semi-structured interviews with principal investigators, research staff, and Institutional Review Board (IRB) personnel, including those in oversight/management, and community partners. Forty participants from three academic institutions (in the Midwest, Southeast, and Mountain West) viewed example KI pages and completed interviews. We coded written transcripts inductively and deductively based on the capability, opportunity, and motivation to change behavior (COM-B) framework. Data were analyzed using content analysis and organized thematically.

Participants responded positively to the visual KI examples. They discussed potential benefits, including improving information processing and understanding of study procedures, diversity in research, trust in research, and study workflow. They also described potential challenges to consider before widespread implementation: IRBs’ interpretations of federal guidelines, possible impacts on IRB submission processes, the effort/skill required to develop visuals, and difficulty succinctly communicating study risks. There was no consensus about when to use visual KI during consent, and some wondered if they were feasible for all study types.

Visual KI offers a promising solution to long-standing informed consent challenges. Future work can explore resources and training to address challenges and promote widespread use.

Patients undergoing electroconvulsive treatment (ECT) may display an acute confusional state, often characterized by transient disorientation, inattention, memory and cognitive deficits.

In this retrospective medical chart naturalistic study, we sought the determine whether white mater lesions and brain atrophy associate with the emergence of confusion during ECT treatment and preliminary results are presented herein

Medical charts of 24 consecutive inpatients with depression admitted to a psychogeriatric ward and subjected to bilateral frontotemporal ECT were examined retrospectively for patient and clinical characteristics. Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS) scores at admission and hospital discharge were retrospectively collected. Available brain Magnetic Resonance Imaging (MRI) scans were graded for lesions (white matter hyperintensities, WMH), parietal, temporal and global brain atrophy

In this pilot study of mostly elderly patients, 50% displayed signs of confusion. All patients improved substantially, as indicated by MMSE and GDS scores, irrespectively of whether they experienced transient confusion during ECT. Preliminary results indicate that WMH are unrelated to the emergence of confusion. Instead, brain atrophy, and in particular temporal lobe and mostly frontal lobe atrophy associated with confusion

In our sample of elderly inpatients with depression subjected to bilateral ECT, preliminary results of this pilot study indicate that brain atrophy, as evidenced by MRI scans, appears as a predictor of post-ECT confusion. Moreover, the Pasquier scale, and specifically the scale sub-scores regarding brain atrophy in the frontal and temporal sulci, could prove useful in helping the clinician estimate the probability of ECT-related confusion during ECT treatment

None Declared

Social connection (SC) is a multi-dimensional concept capturing both the structural–quantitative (e.g., number of social relations, social contact frequency, network structure) and the functional–qualitative dimension (e.g., social support) of social relationships. Although empirical evidence of the association between SC measures and depression has increased significantly in recent years (De Risio et al, J Affect Disord 2024; 345 358–368), very little is known about the extent to which interventions that build SC are effective in improving depressive symptoms.

This umbrella review of systematic reviews/meta-analyses aims to synthesize evidence regarding the effectiveness of SC interventions on depression. Our primary focus is on interventions directly acting upon the natural social network, while indirect interventions that aim to improve social skills, or those that provide professional (formal) or semi-professional support through health services, were excluded.

We provide a synthesis of the consistency and magnitude of the effectiveness of SC interventions on depression. We searched PubMed, PsycINFO, Cochrane Library, and EMBASE and 16 reviews/meta-analyses were included. Information on the effectiveness of SC interventions on depression were compared among different populations. The quality/certainty of evidence was assessed using AMSTAR-2 and GRADE tools.

Included interventions were categorized into the following domains: social support (interventions increasing both perceived and enacted social support from family, friends, and others); social engagement (interventions aimed at strengthening social networks and contrasting social isolation); social inclusion (interventions promoting social integration and access to social capital); social identification (interventions enhancing participants’ identification with a group). Overall, the evidence is rather mixed with some SC interventions resulting in little to no difference in depressive symptoms compared to usual care/other interventions. The most promising interventions appear to be those contrasting social disengagement and reducing social isolation in older individuals and in patients with depression, as well as social inclusion interventions for adolescents and young adults.

The broader implications of SC as a key determinant of depression call for a deep examination of the impact of interventions/preventive programs on the evolving psychopathology of depressive trajectories and inform on which targeted interventions are more effective, thus guiding public health policies.

None Declared

Pregabalin is a gamma-aminobutyric acid analogue used for the treatment of neuropathic pain, partial-onset-seizures, fibromyalgia, and anxiety disorders. Mirtazapine is an atypical antidepressant used in major depression and often prescribed off-label for insomnia. Delirium, an acute confusional state, is a very rare adverse reaction of both medications.

We report a case of an elderly patient treated with low dose pregabalin and mirtazapine who developed drug-induced delirium which resolved rapidly upon withdrawal of both drugs

A 75-year-old woman was admitted for symptoms of anxiety, various bodily complaints (dysphagia, headache, tinnitus, weakness) and sleep-onset insomnia over the preceding 2 months. On admission, examination revealed an apparently anxious, uneasy and emotional looking patient. Mini mental state examination, as well as clock drawing and copying were normal, suggesting absence of cognitive impairment. Physical examination was unrevealing except for high blood pressure recordings (150/90 mmHg). Laboratory testing indicated creatinine at 1.19 mg/dl, with a creatinine clearance moderately decreased at 38 ml/min. Upon admission, she was placed on pregabalin 25 mg bid and mirtazapine 30 mg ¼ tablet qd.

Three days after admission, pregabalin was increased to 25 mg tid. On the same day and about 2 hours after the night dose, the patient acutely developed delirium: she presented confusion, disorientation, incoherence, restlessness and deterioration of her anxiety. On physical examination she was afebrile with no hypertonia or ataxia. An urgent brain magnetic resonance imaging was grossly unrevealing. Pregabalin and mirtazapine were discontinued, as a drug-induced delirium was suspected. She received as a symptomatic treatment lorazepam progressively up to 4 mg qd. Symptoms of delirium resolved rapidly, and she was discharged days later with full functional recovery

Cases of delirium have been described following treatment with pregabalin, but in significantly higher doses. Pregabalin relies heavily on renal clearance for its excretion and the dose should be adjusted in patients with creatine clearance below 60 ml/min. As our patient had a moderate decrease in renal clearance, we prescribed a dose within suggested limits, but in combination with mirtazapine led to the appearance of a drug-induced delirium. In conclusion, combined therapy with low-dose pregabalin and mirtazapine seems to account for the development of delirium in our patient as based on its temporal association with the initiation of this drug combination and its prompt resolution upon withdrawal of these two agents

None Declared