Suicide is a major public health problem. About 90% of suicide victims have one or more major psychiatric disorder, with a reported 20-fold increased risk for suicide in patients with affective ...disorders in comparison with healthy subjects. Repetitive transcranial magnetic stimulation (rTMS) has been established as an effective alternative or adjunctive treatment option for patients with depressive disorders, but little is known about its effects on suicide risk.
For the assessment of the effectiveness of rTMS on suicidal ideation and behaviors, we performed a retrospective analysis of a large sample of patients with depressive disorders, who were treated with rTMS.
We analyzed the records of 711 TMS in- and out-patients with depressive affective disorders in a tertiary referral hospital between 2002 and 2017. Out of these patients we were able to collect Hamilton depression rating scale (HAMD) data of 332 patients (180 females, 152 males; age range 20 to 79 years; mean age 47.3 ± 12.3) for which we analyzed the change of suicidal ideation by using item 3 (suicidality) of HAMD.
Out of all 711 patients treated with rTMS for their depression, one patient (0.1%) committed suicide during the TMS treatment. In the statistical analysis of the subsample with 332 patients there was an overall amelioration of depressive symptoms accompanied by a significant decrease in the suicidality item with a medium effect size. Decrease in suicidality was not inferior to changes in other items as indicated by effect sizes. Forty-seven percent of patients showed an amelioration in suicidality, 41.3% of patients did not show a change in their suicidality's scores, and 11.7% of patients showed an increase in suicidality's scores from baseline to final rating. Correlation of item 3 (suicidality) and item 7 (drive) demonstrated a significant positive association, revealing improved drive with a parallel decreased suicidality.
Based on the proposed data, there is no evidence that rTMS increases the risk for suicide during the course of the treatment. Conversely, rTMS tends to reduce suicidal ideation. Our findings call for further rTMS controlled studies using large sample sizes and specific suicidality assessment measures to obtain more conclusive results.
Objective:
To assess whether concomitant antipsychotic treatment has an influence on the antidepressive effects of repetitive transcranial magnetic stimulation (rTMS).
Methods:
We analyzed severity ...of depression before and after treatment with rTMS in a sample of 299 depressed in- and outpatients in retrospect in relation to treatment with drugs for psychosis. The sample consisted of real-life patients in a tertiary hospital. We ran group contrasts between the group taking and the group not taking drugs for psychosis, testing for differences in Hamilton Depression Rating Scale (HDRS). Effect sizes for HDRS group contrasts were reported as Cohen’s d and number needed to treat (NNT) calculated from d. To control for group differences we repeated the Student t-tests for the change in the HDRS using analysis of covariance including confounding variables.
Results:
Depressed patients taking drugs for psychosis showed significantly less amelioration of depressive symptoms after rTMS treatment as measured by absolute and relative change in HDRS with small effect size or NNT of 4.5 to 8.4, respectively. Controlling significant group contrasts revealed that the effect of taking drugs for psychosis does not depend on age, number of applied TMS pulses, type or severity of depression at baseline, comorbidities or differences in the intake of additional medication.
Conclusion:
Drugs for psychosis attenuate antidepressive effects of rTMS independently of confounding factors. The effect is statistically significant and of potentially great clinical importance. The exact mechanism remains to be elucidated and further studies are warranted.
Mild-behavioral-impairment“-Checkliste Dibbern, Pauline; Horsch, Jennifer; Fiegl, Julia ...
Zeitschrift für Gerontologie und Geriatrie,
05/2024, Volume:
57, Issue:
3
Journal Article
Peer reviewed
Open access
Zusammenfassung
Hintergrund
Das Syndrom einer leichten Verhaltensbeeinträchtigung („mild behavioral impairment syndrome“, MBI) ist definiert durch das Auftreten anhaltender neuropsychiatrischer ...Symptome im Alter. Die Mild-behavioral-impairment-Checkliste (MBI-C) dient der Erfassung von persistierenden neuropsychiatrischen Symptomen, welche die Präsenz des MBI definieren.
Ziel
Erarbeitung einer deutschsprachigen Version der MBI‑C und Beurteilung der klinischen Anwendbarkeit.
Material und Methoden
Im Austausch mit dem federführenden Autor der englischen Originalversion wurde eine deutsche Version erstellt. Die Praktikabilität der Anwendung wurde im Rahmen einer Anwendbarkeitsstudie an einer Kohorte von 21 stationären alterspsychiatrischen Patienten überprüft. Dabei wurden die Compliance der Patienten, die Verständlichkeit, der Zeitaufwand, das Vorgehen bei der Auswertung und die Unterschiede zwischen den Angaben der Patienten und der Angehörigen beurteilt.
Ergebnisse
Die erstellte Übersetzung der MBI‑C gilt als offizielle deutsche Version und kann auf
https://mbitest.org
heruntergeladen werden. Alle Patienten beantworteten alle 34 Fragen vollständig, die Verständlichkeit zeigte sich als sehr gut, der durchschnittliche Zeitaufwand lag bei 16 min. Es zeigten sich z. T. bedeutsame Unterschiede zwischen den Angaben der Patienten und der Angehörigen.
Diskussion
Das MBI kann bei einem Teil der Personen mit neurodegenerativer demenzieller Erkrankung das ansonsten präsymptomatische Stadium markieren. Die MBI‑C könnte somit bei der Früherkennung von neurodegenerativen Demenzen helfen. Diese Hypothese kann mithilfe der hier präsentierten sprachlich lokalisierten Version der MBI‑C auch im deutschsprachigen Raum zukünftig überprüft werden.
The mild behavioral impairment (MBI) syndrome is defined by the emergence in later life of persistent neuropsychiatric symptoms. The MBI checklist (MBI-C) can be used for systematic detection and ...documentation of such symptoms.
Development of a German version of the MBI‑C and assessment of its application in a clinical setting.
The MBI‑C was translated from English into German in collaboration with the main author of the original version, and its practical application was then tested on a study population (n = 21) in a gerontopsychiatric inpatient clinic. Patient compliance, understanding of questions, time effort, evaluation procedure and possible discrepancy between patient and family member evaluations were assessed.
The German translation of the original MBI‑C obtained certification as an official version and can be downloaded at https://mbitest.org . All 34 questions were fully completed by the study population, the level of understanding of questions was good, with the mean time effort being 16 min. In some cases, significant differences between patients' and family members' responses were found.
The presence of MBI may indicate the development of an otherwise presymptomatic neurodegenerative dementia syndrome. Hence, the MBI‑C could aid in the early detection of neurodegenerative dementia. By means of the translated version of the MBI‑C presented in this study, this hypothesis can now be tested in German-speaking countries.
In automotive development, simulation models are gaining significance, in particular in the early phases of verification and validation. According to the current state-of-the-art, there is no ...standardized simulation framework to achieve a seamless transition in the conception, implementation and integration of complex system simulations. In this paper, a reference simulation model architecture for electric vehicles is presented, which is proposed as a standard for real-time and non-real-time closed-loop simulations. The proposed Electric Modeling Architecture (EleMA) is intended as an extension of standardized model exchange formats by defining standardized, functional and signal-based interfaces of electric vehicle simulation models. It is designed independently of the utilized tool chain or exchange format of the simulation model components and enables their functional compatibility and exchangeability.
Initially, an overview of standardized model exchange formats as well as the main design ideas of the proposed reference architecture are presented, followed by a short description of the applied specification methodology. EleMA provides all users a reference model including the contained components, a formalized description in the form of use case diagrams and a definition of the variant-independent component interfaces for each individual component. The implementation of simulation model components according to EleMA guarantees from an architectural point of view a functional compatibility of the elements on system level and thus improves reusability and exchangeability of simulation components. The last section demonstrates use cases to highlight the advantages of the reference architecture and quantifies the average effort reduction exemplary for one use case.
•Reference simulation model architecture for XiL simulations of electric vehicles.•Standardized, functional, signal-based interfaces of e-vehicle simulation models.•Enables functional compatibility and exchangeability of simulation model components.•Transfer of systems engineering methodologies to development of simulation models.•Quantified effort reduction for model exchange in MiL environment.
The implementation of large linear control systems requires a high amount of digital signal processing. Here, we show that reconfigurable hardware allows the design of fast yet flexible control ...systems. After discussing the basic concepts for the design and implementation of digital controllers for mechatronic systems, a new general and automated design flow starting from a system of differential equations to application-specific hardware implementation is presented. The advances of reconfigurable hardware as a target technology for linear controllers is discussed. In a case study, we compare the new hardware approach for implementing linear controllers with a software implementation.
The implementation of large linear control systems requires a high amount of digital signal processing. Here, we show that reconfigurable hardware allows the design of fast yet flexible control ...systems. After discussing the basic concepts for the design and implementation of digital controllers for mechatronic systems, a new general and automated design flow starting from a system of differential equations to application-specific hardware implementation is presented. The advances of reconfigurable hardware as a target technology for linear controllers is discussed. In a case study, we compare the new hardware approach for implementing linear controllers with a software implementation.
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