Martinussendickens5690

BACKGROUND Evidence for the efficacy of treatments for post-traumatic stress disorder (PTSD) is urgently required. This systematic review and meta-analysis examines the efficacy of interpersonal psychotherapy (IPT) in reducing the symptoms of PTSD. METHODS Five databases were searched from inception until November 2018 to identify randomized controlled trials (RCTs) that assessed the efficacy of IPT in patients with PTSD symptoms. The reference lists of included studies were also hand searched. A random effects model was used to estimate changes in a clinician-administered PTSD scale, or self-reported symptoms. RESULTS Of 509 screened abstracts, ten clinical trials (11 study arms) involving 755 patients with PTSD symptoms were included. Nine studies (10 study arms) were included in the meta-analysis. The overall standardized mean difference was -0.44 (CI -0.69, -0.19), p = 0.0005. This represents a change in the clinically administrated PTSD Scale (CAPS) of approximately 12 points. IPT was not superior to other active controls, such as medication and non-IPT psychotherapies, but was significantly superior to passive controls, such as waiting list and educational pamphlets. LIMITATIONS Most studies modified the IPT protocol and did not comprehensively assess clinician fidelity to the protocol. The included studies generally had small sample sizes and were of limited quality. CONCLUSIONS IPT may be an effective treatment for PTSD, but clinical trials with larger sample sizes and improved methodology are required to confirm effects. V.BACKGROUND Although structural alterations have been reported in patients with major depressive disorder (MDD), very few studies have compared the shape alterations of the subcortical regions between drug-naïve MDD patients and healthy controls (HCs). Therefore, we investigated and compared the subcortical shape alterations and volumetric changes between drug-naïve MDD patients and HCs in this study. METHODS This study included 45 drug-naïve MDD patients and 83 HCs, who underwent three-dimensional (3-D) T1-weighted structural magnetic resonance imaging. Surface-based vertex analysis (SVA) was performed with automated segmentation of the bilateral caudate nuclei, putamina, nuclei accumbens, thalami, pallidum, hippocampi, amygdalae, and brainstem. SVA revealed regional contractions of the thalamus (bilateral medial and lateral nuclei) and right caudate nucleus (medial wall and anterosuperior areas) in the drug-naïve MDD patients when compared to HCs RESULTS In volume analysis, the drug-naïve MDD patients showed a significant decrease in the volume of bilateral thalami compared with HCs (after Bonferroni correction p  less then  0.003). We identified morphometric contractions in bilateral thalami and right caudate nucleus in the drug-naïve MDD patients (p  less then  0.05). CONCLUSIONS The present study implied that with cortical shape changes, the subcortical brain alterations could contribute to emotional dysregulation in the drug-naïve MDD patients. INTRODUCTION The DSM-5 has introduced elevated/irritable mood and increased activity/ energy as equal and necessary criterion A symptoms for a diagnosis of (hypo)mania. The impact of these changes is poorly elucidated. BX471 concentration The aim of the study was to investigate differences in the prevalence of elevated/irritable mood with and without co-occurring increased activity, and the associations between these, in patients with an ICD-10 and DSM-IV diagnosis of BD, using real life daily smartphone-based patient-reported measures of mood, irritability and activity. METHODS Data from two RCTs investigating the effect of smartphone-based treatment in patients with BD were combined. Patients with BD (N = 117) evaluated mood, irritability and activity level daily for six to nine months via a smartphone-based system. Analyses in this study are exploratory post hoc analyses based on previously published data. RESULTS During the follow-up period, patients reported elevated mood 8.0% of the time, irritability 28.4% of the time and increased activity 20.6% of the time. Co-occurring elevated/irritable mood and activity were prevalent 0.12% of the time for four consecutive days (duration criteria for a hypomanic episode) compared to 24% of the time with elevated/irritable mood without co-occurring increased activity. In linear mixed effect models accommodating for inter-individual and intra-individual variation, there was a statistically significant positive association between mood and activity (B 0.14, 95% CI 0.046; 0.24, p = 0.004). There was no association between irritability and activity (p = 0.23). CONCLUSION Based on real life daily assessments, the prevalence of (hypo)manic episodes is substantial reduced as a result of the introduction of DSM-5 and with potentially clinical consequences. BACKGROUND Ketamine has rapid-acting antidepressant and antisuicidal properties, while a proportion of patients do not adequately achieve a complete response to ketamine. Our aim was to explore the applicability of using clinical factors and serum tryptophan (TRP) metabolites to predict the response to six doses of ketamine for depression with suicidal ideation. METHODS Seventy-three depressed patients with suicidal ideation received a thrice-weekly infusion regimen of subanaesthetic doses of ketamine. Clinical symptoms were assessed by the Montgomery-Asberg Depression Rating Scale (MADRS), Beck's Scale for Suicide Ideation (SSI) and Patient Health Questionnaire-9 (PHQ-9), and serum levels of TRP, kynurenine (KYN) and kynurenic acid (KYNA) were detected by liquid chromatography-tandem mass spectrometry at baseline and day 1 (1 day after the first infusion). The potential predictors of response was evaluated using receiver operating characteristic (ROC) curve analyses. RESULTS The area under the curve (AUC = 0.959) implied a good accuracy of the combination of early clinical response and day 1 KYN and KYNA levels as a predictor of acute antidepressant response. The combination of early clinical response and day 1 KYNA levels showed moderate discrimination of acute antisuicidal response with an AUC of 0.825 and short-term antidepressant response with an AUC of 0.813. LIMITATIONS The patients continued receiving previous medications during ketamine treatment, which may have impacted the TRP metabolites. CONCLUSION The combination of early clinical response and TRP metabolites at the early stage of repeated ketamine treatment could be considered an eligible predictor for acute- and short-term response for treating depression with suicidal ideation.