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Major Depressive Disorder (MDD) is prevalent, often chronic, and requires ongoing monitoring of symptoms to track response to treatment and identify early indicators of relapse. Remote Measurement Technologies (RMT) provide an exciting opportunity to transform the measurement and management of MDD, via data collected from inbuilt smartphone sensors and wearable devices alongside app-based questionnaires and tasks.
To describe the amount of data collected during a multimodal longitudinal RMT study, in an MDD population.
RADAR-MDD is a multi-centre, prospective observational cohort study. People with a history of MDD were provided with a wrist-worn wearable, and several apps designed to: a) collect data from smartphone sensors; and b) deliver questionnaires, speech tasks and cognitive assessments and followed-up for a maximum of 2 years.
A total of 623 individuals with a history of MDD were enrolled in the study with 80% completion rates for primary outcome assessments across all timepoints. 79.8% of people participated for the maximum amount of time available and 20.2% withdrew prematurely. Data availability across all RMT data types varied depending on the source of data and the participant-burden for each data type. We found no evidence of an association between the severity of depression symptoms at baseline and the availability of data. 110 participants had > 50% data available across all data types, and thus able to contribute to multiparametric analyses.
RADAR-MDD is the largest multimodal RMT study in the field of mental health. Here, we have shown that collecting RMT data from a clinical population is feasible.
Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
Investigation of the occurrence of psychotic symptoms in non-psychiatric population may help to identify population at risk of psychosis. The aim of our study was to find out lifetime and current prevalence of psychotic symptoms in the general population of the Czech Republic. Study sample consisted of a stratified population. All participants were administered the Psychosis Screening Questionnaire and the data on psychiatric treatment and diagnosis according to the M.I.N.I. were recorded. In total, 3244 subjects responded (48.1% males and 51.9% females). The most frequently reported symptom was paranoia (7.7%), followed by hypomania (6.2%), strange experiences (5.2%), thought insertion (3.8%), and hallucinations (1.7%). Lifetime prevalence of minimum 1 psychotic symptom was 17.9%. The highest proportion of responders reported only one symptom (13.5%). Significantly more males than females experienced paranoia (p=0.002). In the subset of individuals with a history of at least one psychotic symptom, 70.6% never visited a psychiatrist, 78.9% did not meet diagnostic criteria of psychotic disorder according to the M.I.N.I., and 67.0% failed to have any psychiatric diagnosis at all. The results suggest a high frequency of psychotic experience among the ethnically homogeneous Czech population. Only the longitudinal follow-up could confirm whether the symptomatic subjects are at risk of development of psychotic disorder. More likely, our findings support a hypothesis of the presence of psychiatric symptoms in the general population as a continuum of psychotic spectrum, from normality and sanity through unique psychotic experiences to fully expressed illness.
In the clinical practice, physicians are routinely asked to make decisions whether to initiate or continue antidepressant treatment in a situation where no safety data are available. As an example can serve pregnancy and breast-feeding, where controlled clinical trials provide little guidance. Females of fertile age are rarely included in the early phases of clinical testing, the Phase IIb and III trials have a standard provision to use a reliable contraception. Pregnancy during drug trial is considered as a ‘serious adverse event’ with subsequent study discontinuation. The reasons are not just ethical and legal but also marketing, the drug manufacturers fear to have their products associated with potentially grave side effects, such as malformations. Drug treatment in pregnancy and lactation thus pose a highly relevant clinical problem that cannot be addressed in controlled trials. Excessive concerns of negative consequences could erroneously result in generalizing recommendation not to get pregnant or to abort existing pregnancy. However, fetus may be already exposed to drugs early in the first trimester during frequently unplanned pregnancies; in addition, recent epidemiological data indicate increasing consumption of psychotropics, including antidepressants, by pregnant women. Psychiatrists have to weigh the known risks of treatment discontinuation versus potential risks for the fetus and infant. They should also consider whether alternative non-pharmacological interventions (psychotherapy, ECT, rTMS) are accessible or effective. The only available safety data on antidepressants come from animal studies, epidemiological trials, drug registries, case series, anecdotal case vignettes and clinical observations.
Computer programs are used in rehabilitation of cognitive deficit in schizophrenia. Repetitive transcranial magnetic stimulation (rTMS) can directly affect cortical excitability and metabolism of prefrontal lobe and subsequently affect cognition. The objective of our study was to investigate augmentation of cognitive rehabilitation in schizophrenia with rTMS. Study subjects were stabilized patients with DSM-IV diagnosis of schizophrenia, treated with second-generation antipsychotics, except for clozapine (total N=34). Study with rTMS was double-blind, randomized, placebo-controlled, with 2 parallel arms. All subjects participated in eight-week computer-assisted cognitive training, during first 2 weeks Group 1 (N=8) received rTMS and Group 2 (N=8) inactive sham stimulation. Patients who refused stimulation participated in rehabilitation program only. Data were assessed fo the totatl study sample and for each group separately. The results showed that computer-assisted cognitive training significantly improved severity of cognitive deficit in schizophrenia in many domains, especially executive functions: attention shift – flexibility, attention control, and working memory. The output was faster, more precise, and more reliable. We did not detect to effect of rTMS on the change of cognition, there was no significant difference between active and sham stimulation. This finding can be explained by a significantly lower initial score in Raven test found in actively stimulated group or by a smaller sample size in a double-blind study. The study confirmed efficacy of computer-assisted rehabilitation in remediation of cognitive deficit in schizophrenia.
Supported by the projects IGA MZ CR NF7571-3 and MSMT CR CNS 1M0517
Dysfunction of the serotonin system has been implicated in schizophrenia. 5-HT1A and 5-HT2A serotonin receptors are involved in the action of antipsychotic drugs. A common functional polymorphism (rs6295) in the promoter region of the human 5-HT1A receptor gene has been reported. This polymorphism may be useful in identifying psychopathology and phenotypic characteristics associated with altered function of the human 5-HT1A receptor.
The aim of this study was to determine whether genetic variants for these receptor influence the functional morphological characteristics of brain in schizophrenia.
63 patients with schizophrenia were genotyped for the functional variant in the promoter region of 5-HT1A receptor (rs6295) and for polymorphisms for 5-HT2A (rs6313) and serotonin transporter-SERT (rs4795541). The subjects were investigated by 18fluoro-deoxyglucose (18FDG) positron emission tomography (PET) in the resting state, magnetic resonance imaging (MR) and functional magnetic resonance (fMR) with 2-back test activation paradigm. Voxel-based-morphometry (VBM) was used to detect the differences in the density of grey and white matter. The neuroimaging data were treated by the use Statistical Parametric Mapping (SPM5) with genetic variants as the factor.
The polymorphism in 5-HT1A receptor was associated with the functional morphometric characteristics in cortical regions in projection areas of serotonergic system.
Our findings identify an important genetic factor predicting functional and structural characteristics in schizophrenia. Future research would test the role of HT1A polymorphism in the interaction with 5HT2A and SERT on morphological characteristics within the context of antipsychotic effects.
This research was supported by grant NR9324 (IGA MZCR) and by the project 1M0517 (MSMT).
Progress in neuroimaging contributed greatly to the schizophrenia research, including investigation of the etiological factors. We tested the hypothesis that lack of the normal asymmetry of language activation is familial and that it can be found in both schizophrenic and non-schizophrenic family members. In particular, we wanted to know whether relatives who are supposed to be transmitting liability to the illness also demonstrate the loss of asymmetry of language activation. We studied 5 families with at least two members affected with schizophrenia. Functional imaging (fMRI) was used to study cortical activation during a verbal task in Broca's area and its contralateral homologue in subjects with schizophrenia and their both parents who never manifested any psychotic symptoms but one of them had mother or father with schizophrenia. Schizophrenia patients showed lack of asymmetry of language activation. Parents without schizophrenia among their elderly relatives showed normal asymmetry of language activation. Three of parents who supposedly transmit liability to the illness demonstrated the loss of asymmetry of language activation. Our results suggest that lack of the normal asymmetry of language activation could be one of the inherited etiological factors of schizophrenia.
This work was supported by the research project of the Czech Ministry of Education, CNS 1M0517.
(1) to assess social and functional impairment in schizophrenia outpatients from the Czech and Slovak Republics, and
(2) to examine a relationship between functional impairment and antipsychotic treatment and demographic variables.
Enrolled were schizophrenia outpatients in a stable phase of illness, treated with current antipsychotic medication for a minimum of one month. Recorded were demographic and medication data, administered were Personal and Social Performance Scale (PSP), Subjective Well-being Under Neuroleptics (SWN), and CGI scale.
The total number of study subjects was 926. Most PSP values were within the interval of moderate impairment. Functional performance correlated positively with subjective satisfaction with medication and negatively with symptom severity. Higher education predicted better functioning on PSP. The best performance was associated with a stable relationship and a useful work role. The patients who showed the best level of functioning were more likely to be treated with antipsychotic monotherapy. No difference among drugs in monotherapy was found in subjective satisfaction.
The PSP values of stable schizophrenia outpatients indicated moderate degree of impairment. Improvement of functional capacity remains one of the unmet needs of schizophrenia patients.
25-OH vitamin D level is an immediate precursor metabolite of the active form of vitamin D that leads to expression of more than 200 genes.
The aim of our study was to examine 25-OH vitamin D deficiency (<50nmol/L) and its relationship to demographic factors in recently hospitalised patients with schizophrenia spectrum disorders (SSD).
We assessed 25-OH vitamin D serum level in 41 SSD patients (54% of males, 46% with first episode, 63% during sunny season [May to October]), mean age 30 ± 10.4 years, within first days of hospitalization. The serum 25-OH vitamin D level was analysed with electrochemiluminiscence, using imunoanalysators Elecsys Roche.
The serum level was significantly higher in sunny season (41.3 ± 27.2 nmol/L) than in November to April (28.4 ± 11.2 nmol/L): t-test, P < .05. Sixty-nine percent of patients suffered from 25-OH vitamin D deficiency (< 50nmol/L) in May to October and 100% during November to April. The 25-OH vitamin D serum levels were not different between males and females, or between first-episode and multiple-episode patients. No significant correlation between age and 25-OH vitamin D level was found.
The high prevalence of 25-OH vitamin D deficiency (< 50nmol/L) suggests that some patients with SSD may benefit from vitamin D supplementation.
This study is a result of the research funded by the project Nr. LO1611 with a financial support from the MEYS under the NPU I program.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness.
Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated.
Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated?
Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.
The effects of antidepressants for treating depressive disorders have been overestimated because of selective publication of positive trials. Reanalyses that include unpublished trials have yielded reduced effect sizes. This in turn has led to claims that antidepressants have clinically insignificant advantages over placebo and that psychotherapy is therefore a better alternative. To test this, we conducted a meta-analysis of studies comparing psychotherapy with pill placebo.
Ten 10 studies comparing psychotherapies with pill placebo were identified. In total, 1240 patients were included in these studies. For each study, Hedges’ g was calculated. Characteristics of the studies were extracted for subgroup and meta-regression analyses.
The effect of psychotherapy compared to pill placebo at post-test was g = 0.25 [95% confidence interval (CI) 0.14–0.36, I2 = 0%, 95% CI 0–58]. This effect size corresponds to a number needed to treat (NNT) of 7.14 (95% CI 5.00–12.82). The psychotherapy conditions scored 2.66 points lower on the Hamilton Depression Rating Scale (HAMD) than the placebo conditions, and 3.20 points lower on the Beck Depression Inventory (BDI). Some indications for publication bias were found (two missing studies). We found no significant differences between subgroups of the studies and in meta-regression analyses we found no significant association between baseline severity and effect size.
Although there are differences between the role of placebo in psychotherapy and pharmacotherapy research, psychotherapy has an effect size that is comparable to that of antidepressant medications. Whether these effects should be deemed clinically relevant remains open to debate.
Site measurements were collected at Mount John University Observatory in 2005 and 2007 using a purpose-built scintillation detection and ranging system. C2N(h) profiling indicates a weak layer located at 12–14 km above sea level and strong low altitude turbulence extending up to 5 km. During calm weather conditions, an additional layer was detected at 6–8 km above sea level. V(h) profiling suggests that tropopause layer velocities are nominally 12–30m s−1, and near-ground velocities range between 2 and 20m s−1, dependent on weather. Little seasonal variation was detected in either C2N(h) and V(h) profiles. The average coherence length, r0, was found to be 7±1 cm for the full profile at a wavelength of 589 nm. The average isoplanatic angle, θ0, was 1.0±0.1 arcsec. The mean turbulence altitude, , was found to be 2.0±0.7 km above sea level. No average in the Greenwood frequency, fG, could be established due to the gaps present in the V(h) profiles obtained. A modified Hufnagel-Valley model was developed to describe the C2N(h) profiles at Mount John, which estimates r0 at 6 cm and θ0 at 0.9 arcsec. A series of V(h) models were developed, based on the Greenwood wind model with an additional peak located at low altitudes. Using the C2N(h) model and the suggested V(h) model for moderate ground wind speeds, fG is estimated at 79 Hz.
Theta cordance is a novel quantitative electroencephalography (QEEG) measure that correlates with cerebral perfusion. A series of clinical studies has demonstrated that the prefrontal theta cordance value decreases after 1 week of treatment in responders to antidepressants and that this effect precedes clinical improvement. Ketamine, a non-competitive antagonist of N-methyl-d-aspartate (NMDA) receptors, has a unique rapid antidepressant effect but its influence on theta cordance is unknown.
In a double-blind, cross-over, placebo-controlled experiment we studied the acute effect of ketamine (0.54 mg/kg within 30 min) on theta cordance in a group of 20 healthy volunteers.
Ketamine infusion induced a decrease in prefrontal theta cordance and an increase in the central region theta cordance after 10 and 30 min. The change in prefrontal theta cordance correlated with ketamine and norketamine blood levels after 10 min of ketamine infusion.
Our data indicate that ketamine infusion immediately induces changes similar to those that monoamineric-based antidepressants induce gradually. The reduction in theta cordance could be a marker and a predictor of the fast-acting antidepressant effect of ketamine, a hypothesis that could be tested in depressive patients treated with ketamine.
Vascular malformations constitute an important cause of intracranial hemorrhage especially in younger patients. These malformations may arise from any segment of the different functional units of the brain vasculature, including arteries, arterioles, capillaries, venules, and veins. Among vascular malformations causing intracranial hemorrhage, brain arteriovenous malformations (AVMs) are among the most frequently encountered. Brain AVMs commonly affect distal arterial branches and in roughly half of the cases, the malformation is found in the borderzone region shared by the distal anterior, middle, and/or posterior cerebral arteries. Cerebral angiography may help to differentiate brain AVMs from other types of intracranial anomalies with arterio-venous shunting. Resection of an associated developmental venous anomaly is contraindicated as its occlusion may lead to venous stasis, brain edema, and eventual hemorrhage. A developmental venous anomaly (DVA) is found in up to 30% of cerebral cavernous malformations (CCM) patients.
The Ethiopian Cainozoic volcanics associated with the African rift system comprise one of the world's most voluminous alkaline igneous provinces. The Simien Mountains are the remnants of a Miocene alkali olivine-basalt volcanic centre in the north-western part of this province. The end-phase activity at Simien featured intrusion of dyke-swarms of two trends, one parallel to the rift system, the other almost perpendicular to it. Dykes of the rift trend are typically alkaline, but a dyke sampled from the other trend proves to be an olivine-tholeiite. Its presence is interpreted, along with similar rocks from the Harar region in eastern Ethiopia, in terms of upper mantle rifting extending from the Gulf of Aden and Red Sea under the continental blocks of the Ethiopian swell.