Introduction
Repetitive transcranial magnetic stimulation (rTMS) is an evidence-based treatment and rTMS protocols have been included in international guidelines for patients with treatment-resistant ...depression (TRD). The daily administration of standard rTMS protocols, typically over several weeks, could be a limiting factor (e.g., time off from work, commuting issues). To intensify the antidepressant response and to reduce the number of stimulation days, it has been proposed that increasing the number of rTMS sessions performed per day could be more effective and help to reduce the burden for patients and clinicians. Although there is much interest in accelerated TMS protocols, little is known about their efficacy and tolerability, and the literature on the topic is still scarce.
Objectives
To compare the efficacy and tolerability of two rTMS protocols (standard vs. accelerated) as augmentative strategies in patients with TRD.
Methods
In the present ongoing, open-label, trial 14 patients meeting DSM-5 criteria for major depressive episode (either unipolar or bipolar), classified as partial responders or non-responders to adequate pharmacological treatment, were randomized to receive either standard (one session per day, five days a week, for four weeks; n= 7) or accelerated (two sessions per day, five days a week, for two weeks; n=6) rTMS treatment protocols. In both cases, rTMS was performed on the left dorsolateral prefrontal cortex, high frequency (10 Hz) at 120% of the motor threshold, 3000 pulses per sessions. Primary outcome measures included HAM-D, MADRS, and CGI-S scores at baseline (T0), at the end of rTMS treatment (T1), and after 1 month (T2), as well as tolerability based on adverse effects. Paired Samples
t
-Test for continuous variables was used to compare psychometric scales at each timepoint, while
t
-Test was used to compare differences between the two groups.
Results
With respect to total sample, in terms of primary outcome measures a significant reduction of HAM-D, MADRS and CGI-S total scores between T0 and T1 (t: 3.01, p<0.05; t: 1.692, p<0.5; t:3.207, p<0.05 respectively), T1 and T2 (t: 3.264, p<0.05: t:2.669, p<0.05; t:.085, p=0.437 respectively) and T0 and T2 (t:5.669, p<0.05; t=4.711, p<0.05; t:2.551, p<0.05 respectively) was found. No significant differences in terms of efficacy were found between the two groups. One patient dropped-out for reasons not related to rTMS treatment. Mild and transient headache during the stimulation was the only side effect reported (4 patients).
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Conclusions
Consistently with previous literature studies, our preliminary results supported the evidence of comparable efficacy and tolerability between accelerated and standard rTMS protocols. In the future, larger, blinded, and controlled trials might support these conclusions and further address treatment parameters of novel accelerated rTMS protocols.
Disclosure of Interest
None Declared
Introduction
Poor adherence to treatment is currently stated to be one of the causes of depression relapse and recurrence.
Objectives
Aim of the present study was to assess potential differences in ...terms of clinical and socio-demographic characteristics specifically related to adherence to treatment features, medical comorbidities, and substance abuse in a sample of patients diagnosed with Major Depression in an Italian psychiatric department.
Methods
Patients with a DSM-5 diagnosis of Unipolar or Bipolar Major Depressive Episode, of either gender or any age were recruited from the Psychiatry Department of Luigi Sacco University Hospital in Milan. Main clinical and socio-demographic variables were collected reviewing patients’ medical records. Moreover, adherence to psychopharmacological treatment was assessed using the Clinician Rating Scale (CRS; Kemp et al, 1996; 1998). Adherence was defined as ratings of > or =5 on the CRS. Descriptive and association analyzes were performed, setting the significance level at p<.05.
Results
80 patients with a diagnosis of Unipolar Major depressive episode (48.9%) and Bipolar Major Depressive Episode (51.1%) were included. For the purposes of the study, the total sample was divided into two subgroups based on adherence to pharmacological treatment (A+ vs A-). Significantly higher rates of inpatients from psychiatric ward were A- compared to A+ patients (84.6% vs 48.1%, p=.011). A- patients were significantly more unemployed (57.9% vs 23.8%, p=.015), were mostly living in their family of origin (50% vs 21.4%, p=.027), and had fewer years of education compared to A+ subgroup (10.52±3.28 vs 12.2±3.1 years, p=.053). Higher rates of Bipolar Depression diagnosis and a prevalent manic polarity lifetime emerged in A- compared to the A+ group (73.1% vs 42.3%, p=.010; 30.8% vs 3%, p=.011, respectively). Moreover, A+ reported significantly higher rates of depressive prevalent polarity lifetime (72.7% vs 30.8%, p=.011). A- reported significantly higher rates of comorbidity with alcohol or other substance use disorders lifetime (46.2% vs 5.7%, p=.006) and almost one involuntary commitment lifetime (23.1% vs 11.1%, p=.013).
Conclusions
In our sample adherence to treatments showed significant differences in terms of clinical and socio-demographic characteristics. Low levels of adherence have been associated with higher hospitalization rates, involuntary commitments, greater comorbidity with alcohol or drugs. Our data therefore seem to suggest that less adherence leads to a worse disease course and a worse quality of life. It therefore appears useful to include an assessment of adherence in the clinical practice and implement interventions to improve therapeutic adherence and ensure a better quality of life.
Disclosure of Interest
None Declared
Introduction
Bipolar Disorder (BD) is a life-course illness with evidence of a progressive nature. Although different staging models have been proposed from a theoretical perspective,longitudinal ...studies are scarce.
Objectives
The aim of the present study was to apply four staging models in a sample of BD patients and to observe their progression in 10 years of retrospective evaluation.
Methods
In a naturalistic sample of 100 BD patients, a retrospective assessment of clinical stages across 10 years of observation at six time points (T0: 2010; T1: 2013; T2: 2015; T3: 2018; T4: 2019; T5:2020) was performed according to the BD staging models (Berk et al., 2007; Kapczinski et al., 2009; Kupka et al., 2012 and Duffy et al., 2014). Socio-demographic and clinical variables were collected and the staging progression across time was analyzed.
Results
A significant progressive staging worsening emerged over 10 years of BD observation for each examined model (p<0.001). Moreover, for all considered staging approaches, stage values were lower over the time points for BD II, lower number of lifetime episodes and hospitalizations (p<0.05). Finally, the stage increase was associated with a lower age at first elevated episode (p<0.05).
Conclusions
Present preliminary results confirm the relevance of illness onset and early intervention in BD, given their role in patients classified into worse clinical staging. There is an emerging need of a standardized universal staging model in order to better characterize BD patients, their treatment and their clinical course.
Disclosure
No significant relationships.
Introduction
The mental health of subjects with chronic medical illnesses, such as Inflammatory Bowel Disease (IBD- Crohn’s Disease and Ulcerative Colitis), is typically compromised and the current ...COVID-19 pandemic might have additionally increased this burden.
Objectives
The aim of the present study was to investigate, during the COVID-19 pandemic, if the presence of a comorbid psychiatric disorder has played a role as an aggravating factor on mental health in patients with IBD.
Methods
Twenty Five patients with psychiatric comorbidities (PC+) and twenty five without (PC-) comparable for age and gender, were recruited at the Gastroenterology department at Sacco University Hospital in Milan. Participants were assessed a psychiatric evaluation, collecting socio-demographic variables and measures of anxiety and depression on the Hospital Anxiety Depression Scale (HADS), sleep patterns on the Insomnia Severity Index (ISI) and general health status on the Short Form Health Survey 36 (SF-36).
Comparative statistical analyses were performed with t test with Bonferroni correction.
Results
PC+ (n=25) showed more severe anxiety and depressive symptoms compared with PC- (n=25) (p <.001) and worse sleep pattern (p<.05). With respect to general health status, PC+ showed reduced physical activities (p<.05), social activities (p<.05), mental health (p<.01) and role limitations due to physical health (p<.05).
Conclusions
The present findings showed a worse mental health in subjects with IBD and psychiatric comorbidities during Covid-19 pandemic, highlighting the importance of screening and treatment of psychiatric symptoms disorders in these patients.
Disclosure
No significant relationships.
Cathodoluminescence of undoped and Si-doped ɛ-Ga2O3 films Montedoro, V.; Torres, A.; Dadgostar, S. ...
Materials science & engineering. B, Solid-state materials for advanced technology,
February 2021, 2021-02-00, 20210201, Volume:
264
Journal Article
Peer reviewed
Open access
Display omitted
•CL emission in ɛ-Ga2O3 is ascribed to transitions from CB states to deep acceptors.•CL emission in ɛ-Ga2O3 films is interpreted as convolution of four bands.•No band-to band ...recombination is observed in CL spectrum of epitaxial ɛ-Ga2O3.•Si-doping strongly reduces CL integrated emission in epitaxial ɛ-Ga2O3.•The use of N2 as carrier gas reduces the CL integrated emission in epitaxial ɛ-Ga2O3.
Cathodoluminescence (CL) investigations are performed on nominally undoped and Si-doped ε-Ga2O3 samples grown by metal-organic vapor phase epitaxy on (0001)-Al2O3 substrates, using different carrier gases. All films exhibit a broad low-temperature CL emission extending over the photon energy range 2–3.4 eV. Emission deconvolution suggests that four narrower bands centered at about 2.4, 2.75, 3.0 and 3.15 eV may well account for the broad band. While the position of these peaks results independent of the growth conditions, significant intensity differences are observed. A general reduction of the broad emission is evidenced as the Si concentration increases. No band-to-band recombination is observed. Temperature dependence of the CL signal shows a trend consistent with radiative transitions from the CB to deep acceptor states, probably of intrinsic nature.
The electronic structure of ε-Ga2O3 thin films has been investigated by ab initio calculations and photoemission spectroscopy with UV, soft, and hard X-rays to probe the surface and bulk properties. ...The latter measurements reveal a peculiar satellite structure in the Ga 2p core level spectrum, absent at the surface, and a core-level broadening that can be attributed to photoelectron recoil. The photoemission experiments indicate that the energy separation between the valence band and the Fermi level is about 4.4 eV, a valence band maximum at the Γ point and an effective mass of the highest lying bands of – 4.2 free electron masses. The value of the bandgap compares well with that obtained by optical experiments and with that obtained by calculations performed using a hybrid density-functional, which also reproduce well the dispersion and density of states.
Introduction
During the COVID-19 pandemic, health workers represented a group particularly vulnerable to work-related stress, but prevention and management of psychiatric symptoms are still under ...evaluation. Neurofeedback is a safe and non-invasive neuromodulation technique with the target of training participants in the self-regulation of neural substrates underlying specific psychiatric disorders. Protocols based on the increase of alpha frequencies, associated with the process of relaxation, are used for the treatment of stress, anxiety and sleep disturbances.
Objectives
The aim of the present study was to assess the effectiveness of an alpha-increase NF protocol for the treatment of stress in healthcare workers exposed to the COVID-19 pandemic.
Methods
Eighteen medical doctors belonging to the Sacco Hospital were recruited during the COVID-19 health emergency and underwent a 10 sessions NF alpha-increase protocol during two consecutive weeks. The level of stress was assessed at the beginning (T0) and at the end (T1) of the protocol through the following questionnaires: Severity of Acute Symptoms Stress (SASS), Copenhagen Burnout Inventory (CBI), Pittsburgh Sleep Quality Index (PSQI), Brief-COPE. Statistical analyses were performed with Paired Samples t-Test for continuous variables, setting significance at p < 0.05.
Results
A significant increase in alpha waves mean values between T0 and T1 was observed. In addition, a significant reduction in the PSQI test score between T0 and T1 was observed.
Conclusions
Alpha-increase protocol showed promising results in terms of stress modulation, sleep quality improvement and safety profile in a pilot sample of health-care workers. Larger controlled studies are warranted to confirm present results.
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