Objectives
Previous reviews have concluded that interventions including psychoeducation are effective in preventing relapse in bipolar disorder, but the efficacy of psychoeducation itself has not ...been systematically reviewed. Our aim was to evaluate the efficacy of psychoeducation for bipolar disorder in preventing relapse and other outcomes, and to identify factors that relate to clinical outcomes.
Methods
We employed the systematic review of randomized controlled trials of psychoeducation in participants with bipolar disorder not in an acute illness episode, compared with treatment‐as‐usual, and placebo or active interventions. Pooled odds ratios (ORs) for non‐relapse into any episode, mania/hypomania, and depression were calculated using an intent‐to‐treat (ITT) analysis, assigning dropouts to relapse, with a sensitivity analysis in which dropouts were assigned to non‐relapse (optimistic ITT).
Results
Sixteen studies were included, eight of which provided data on relapse. Although heterogeneity in the data warrants caution, psychoeducation appeared to be effective in preventing any relapse n = 7; OR: 1.98–2.75; number needed to treat (NNT): 5–7, depending on the method of analysis and manic/hypomanic relapse (n = 8; OR: 1.68–2.52; NNT: 6–8), but not depressive relapse. Group, but not individually, delivered interventions were effective against both poles of relapse; the duration of follow‐up and hours of therapy explained some of the heterogeneity. Psychoeducation improved medication adherence and short‐term knowledge about medication. No consistent effects on mood symptoms, quality of life, or functioning were found.
Conclusions
Group psychoeducation appears to be effective in preventing relapse in bipolar disorder, with less evidence for individually delivered interventions. Better understanding of mediating mechanisms is needed to optimize efficacy and personalize treatment.
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•In a systematic review of the published literature, 35 studies were identified.•Increasing treatment resistance was associated with higher costs.•Increasing treatment resistance was associated with ...reduced HRQoL and health status.•Varied definitions of treatment resistance made comparisons challenging.•Substantial geographic variability was observed in economic burden.
Major depressive disorder (MDD) is a global public health concern. In particular, treatment-resistant depression (TRD) represents a key unmet need in the management of MDD. A systematic review of the epidemiological and economic literature on the burden associated with an increasing number of treatment steps due to TRD/non-response within an MDD episode was performed to quantify the burden of TRD.
Studies were identified in the PubMed/Medline databases through April 27th, 2017. Articles were limited to full-length peer-reviewed journal publications with no date restrictions. Economic and patient health-related quality of life (HRQoL) data on non-response by the number of treatment steps were quantified and, where appropriate, compared across studies; otherwise, comparative data within studies were reported.
The 12 studies on economic burden found an association between increasing levels of TRD/non-response and elevations in direct and indirect costs. Likewise, the 19 studies studying HRQoL burden found that increasing levels of TRD/non-response correlated with reduced patient HRQoL and health status.
TRD is defined inconsistently, which results in notable heterogeneity between published studies and poses methodological challenges for between-study comparisons. It is unknown if the increased economic and patient HRQoL burden are due to factors associated with TRD/non-response in addition to those due to depression persistence or severity.
A consistent trend was observed such that medical costs increased and patient HRQoL and health status decreased by increasing level of TRD/non-response within an MDD episode. These findings highlight the need for improved therapies for TRD to help reduce disease burden.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Although in common use, treatment-resistant depression is unhelpful both conceptually and practically. In this issue a new term, multiple-therapy-resistant major depressive disorder, is proposed; ...although it may be useful in guiding treatment options for patients with persisting depression, it should not be an automatic trigger for further, more invasive treatments.
This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and ...clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Two consecutive cruises in the Weddell Sea, Antarctica, in winter 2013 provided the first direct observations of sea salt aerosol (SSA) production from blowing snow above sea ice, thereby validating ...a model hypothesis to account for winter time SSA maxima in the Antarctic. Blowing or drifting snow often leads to increases in SSA during and after storms. For the first time it is shown that snow on sea ice is depleted in sulfate relative to sodium with respect to seawater. Similar depletion in bulk aerosol sized ∼0.3–6 µm above sea ice provided the evidence that most sea salt originated from snow on sea ice and not the open ocean or leads, e.g. >90 % during the 8 June to 12 August 2013 period. A temporally very close association of snow and aerosol particle dynamics together with the long distance to the nearest open ocean further supports SSA originating from a local source. A mass budget estimate shows that snow on sea ice contains even at low salinity (<0.1 psu) more than enough sea salt to account for observed increases in atmospheric SSA during storms if released by sublimation. Furthermore, snow on sea ice and blowing snow showed no or small depletion of bromide relative to sodium with respect to seawater, whereas aerosol was enriched at 2 m and depleted at 29 m, suggesting that significant bromine loss takes place in the aerosol phase further aloft and that SSA from blowing snow is a source of atmospheric reactive bromine, an important ozone sink, even during winter darkness. The relative increase in aerosol concentrations with wind speed was much larger above sea ice than above the open ocean, highlighting the importance of a sea ice source in winter and early spring for the aerosol burden above sea ice. Comparison of absolute increases in aerosol concentrations during storms suggests that to a first order corresponding aerosol fluxes above sea ice can rival those above the open ocean depending on particle size. Evaluation of the current model for SSA production from blowing snow showed that the parameterizations used can generally be applied to snow on sea ice. Snow salinity, a sensitive model parameter, depends to a first order on snowpack depth and therefore was higher above first-year sea ice (FYI) than above multi-year sea ice (MYI). Shifts in the ratio of FYI and MYI over time are therefore expected to change the seasonal SSA source flux and contribute to the variability of SSA in ice cores, which represents both an opportunity and a challenge for the quantitative interpretation of sea salt in ice cores as a proxy for sea ice.
It has been suggested that visual language is maladaptive for hearing restoration with a cochlear implant (CI) due to cross-modal recruitment of auditory brain regions. Rehabilitative guidelines ...therefore discourage the use of visual language. However, neuroscientific understanding of cross-modal plasticity following cochlear implantation has been restricted due to incompatibility between established neuroimaging techniques and the surgically implanted electronic and magnetic components of the CI. As a solution to this problem, here we used functional near-infrared spectroscopy (fNIRS), a noninvasive optical neuroimaging method that is fully compatible with a CI and safe for repeated testing. The aim of this study was to examine cross-modal activation of auditory brain regions by visual speech from before to after implantation and its relation to CI success. Using fNIRS, we examined activation of superior temporal cortex to visual speech in the same profoundly deaf adults both before and 6 mo after implantation. Patients' ability to understand auditory speech with their CI was also measured following 6 mo of CI use. Contrary to existing theory, the results demonstrate that increased cross-modal activation of auditory brain regions by visual speech from before to after implantation is associated with better speech understanding with a CI. Furthermore, activation of auditory cortex by visual and auditory speech developed in synchrony after implantation. Together these findings suggest that cross-modal plasticity by visual speech does not exert previously assumed maladaptive effects on CI success, but instead provides adaptive benefits to the restoration of hearing after implantation through an audiovisual mechanism.
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In this review, we consider affective cognition, responses to emotional stimuli occurring in the context of cognitive evaluation. In particular, we discuss emotion categorization, biasing of memory ...and attention, as well as social/moral emotion. We discuss limited neuropsychological evidence suggesting that affective cognition depends critically on the amygdala, ventromedial frontal cortex, and the connections between them. We then consider neuroimaging studies of affective cognition in healthy volunteers, which have led to the development of more sophisticated neural models of these processes. Disturbances of affective cognition are a core and specific feature of mood disorders, and we discuss the evidence supporting this claim, both from behavioral and neuroimaging perspectives. Serotonin is considered to be a key neurotransmitter involved in depression, and there is a considerable body of research exploring whether serotonin may mediate disturbances of affective cognition. The final section presents an overview of this literature and considers implications for understanding the pathophysiology of mood disorder as well as developing and evaluating new treatment strategies.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The P2X purinoceptor 7 (P2RX7) mediates inflammatory microglial responses and is implicated in neuroimmune mechanisms of depression and neurodegenerative disorders. A number of studies suggest that ...psychosocial stress may precipitate depression through immune activation. Genetic association studies of P2RX7 variants with depression have been inconclusive. However, nearly all studies have focused on only one single-nucleotide polymorphism (SNP) and have not considered interaction with psychosocial stress. We investigated the effect of several variations in P2RX7 gene using a clumping method in interaction with early adversities and recent stress on depression severity. 1752 subjects provided information on childhood adversities, recent life events, and current depression severity. Participants were genotyped for 681 SNPs in the P2RX7 gene, 335 of them passed quality control and were entered into linear regression models followed by a clumping procedure for main effect and interactions. No significant main effect was observed. Rs74892325 emerged as a top SNP for interaction with childhood adversities and rs61953400 for interaction with recent life events. Our study is the first to investigate several variants in the P2RX7 gene and in interaction with two types of stress, extending our understanding of neuroinflammation in depression, and supporting that the majority of genes influence depression by enhancing sensitivity to stressors.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Blowing snow over sea ice has been proposed as a
significant source of sea salt aerosol (SSA) (Yang et al., 2008). In this
study, using snow salinity data and blowing snow and aerosol particle
...measurements collected in the Weddell Sea sea ice zone (SIZ) during a winter cruise, we perform a comprehensive model–data comparison with the aim of
validating proposed parameterizations. Additionally, we investigate possible
physical mechanisms involved in SSA production from blowing snow. A global
chemical transport model, p-TOMCAT, is used to examine the model sensitivity
to key parameters involved, namely blowing-snow size distribution, snow
salinity, sublimation function, surface wind speed, relative humidity, air
temperature and ratio of SSA formed per snow particle. As proposed in the parameterizations of Yang
et al. (2008), the SSA mass flux is proportional to the bulk
sublimation flux of blowing snow and snow salinity. To convert the bulk
sublimation flux to SSA size distribution requires (1) sublimation function
for snow particles, (2) blowing-snow size distribution, (3) snow salinity
and (4) ratio of SSA formed per snow particle. The optimum model–cruise aerosol data agreement (in diameter range of 0.4–12 µm) indicates two possible microphysical processes that could be
associated with SSA production from blowing snow. The first one assumes that
one SSA is formed per snow particle after sublimation, and snow particle
sublimation is controlled by the curvature effect or the so-called “air
ventilation” effect. The second mechanism allows multiple SSAs to form per
snow particle and assumes snow particle sublimation is controlled by the
moisture gradient between the surface of the particle and the ambient air
(moisture diffusion effect). With this latter mechanism the model reproduces
the observations assuming that one snow particle produces ∼10
SSA during the sublimation process. Although both mechanisms generate very
consistent results with respect to observed aerosol number densities, they
correspond to completely different microphysical processes and show quite
different SSA size spectra, mainly in ultra-fine and coarse size modes.
However, due to the lack of relevant data, we could not, so far, conclude
confidently which one is more realistic, highlighting the necessity of
further investigation.
Electron beams with helical wavefronts carrying orbital angular momentum are expected to provide new capabilities for electron microscopy and other applications. We used nanofabricated diffraction ...holograms in an electron microscope to produce multiple electron vortex beams with well-defined topological charge. Beams carrying quantized amounts of orbital angular momentum (up to 100Planck's over 2pi) per electron were observed. We describe how the electrons can exhibit such orbital motion in free space in the absence of any confining potential or external field, and discuss how these beams can be applied to improved electron microscopy of magnetic and biological specimens.
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