Depression Treatment: Gene Therapy for Psychiatric Disorders.

Gene Therapy for Psychiatric Disorders.

Filed under: Depression Treatment

World Neurosurg. 2012 Dec 22;
Gelfand Y, Kaplitt MG

Gene therapy has become of increasing interest in clinical neurosurgery with the completion of numerous clinical trials for Parkinson’s disease, Alzheimer’s disease and pediatric genetic disorders. With improved understanding of the dysfunctional circuitry mediating a variety of psychiatric disorders, deep brain stimulation for refractory psychiatric diseases is being increasingly explored in human patients. This combination of factors is therefore likely to facilitate development of gene therapy for psychiatric diseases. Since delivery of gene therapy agents will require the same surgical techniques currently being employed for deep brain stimulation, neurosurgeons will likely lead the development of this field as has occurred in other areas of clinical gene therapy for neurological disorders. Here we will review the current state of gene therapy for psychiatric disorders, and will focus specifically upon particular areas of promising research that may translate into human trials for depression, drug addiction, obsessive-compulsive disorder and schizophrenia. Issues that are relatively unique to psychiatric gene therapy will also be discussed.
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Attention Deficit/Hyperactivity Disorder symptoms in Italian bipolar adult patients: A preliminary report.

Filed under: Depression Treatment

J Affect Disord. 2012 Dec 22;
Perugi G, Ceraudo G, Vannucchi G, Rizzato S, Toni C, Dell’osso L

BACKGROUND: It has been recently suggested that bipolar disorder (BD) with comorbid ADHD represents a distinct clinical phenotype of BD. With the aim to assess the impact of ADHD symptoms, we investigated the prevalence, epidemiological and clinical features associated with such a comorbidity in a sample of adult BD patients. METHODS: A total of 96 outpatients (aged 18-65 years) with BD were included. All patients were screened using the Adult ADHD Self-report Scale (ASRS) and the Diagnostic, Clinical and Therapeutic Checklist (DCTC), a semi-structured interview developed for systematic collection of familial, demographic, anamnestic and clinical informations and exploration of DSM-IV-TR diagnostic criteria for mood, anxiety, eating, impulse control and alcohol and substance use disorders. The DCTC also includes the Clinical Global Impression Bipolar scale (CGI-BP), the Global Assessment of Functioning scale (GAF) and the Sheehan Disability Scale (SDS). RESULTS: In our sample, 19 (19.8%) out of 96 BD patients fulfilled ASRS criteria for current and lifetime (onset before 7 years of age) ADHD symptoms (ADHD+). Compared to BD probands without ADHD symptoms (ADHD-), ADHD+ patients showed higher rates of current mixed episode, and lower rates of mania. ADHD+ resulted in more severe mean scores on the CGI-BP mixed, depressive and global subscales. None of the ADHD+ patients were in remission of BD at the time of the evaluation, versus 24 (31.2%) of the ADHD- group. ADHD+ patients also reported higher rate of lifetime comorbidity with Substance Use Disorder (SUD) and Alcohol Abuse in comparison to ADHD- patients. In particular the different rate in substance abuse was related to cocaine and poly-drug abuse. The two groups did not report significant differences in functioning and social adjustment with the exception of familial adjustment that was more compromised in ADHD+ than in ADHD- patients. LIMITATIONS: Retrospective design and limited sample size. CONCLUSIONS: In ADHD+ patients, BD is associated with higher rate of mixed states, more severe psychopathology and more impaired familial functioning as well as higher rates of comorbid substance, alcohol and poly-drug abuse compared to BD patients without adult ADHD. Our findings suggest that ADHD symptoms in adults may influence clinical presentation, course and prognosis of BD. Further prospective research is needed to confirm our findings and to explore treatment implications for the management of BD.
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Relationship between depressive symptom severity and emergency department use among low-income, depressed homebound older adults aged 50 years and older.

Filed under: Depression Treatment

BMC Psychiatry. 2012 Dec 26; 12(1): 233
Choi NG, Marti CN, Bruce ML, Kunik ME

ABSTRACT: BACKGROUND: Previous research found a high prevalence of depression, along with chronic illnesses and disabilities, among older ED patients. This study examined the relationship between depressive symptom severity and the number of ED visits among low-income homebound older adults who participated in a randomized controlled trial of telehealth problem-solving therapy (PST). METHODS: The number of and reasons for ED visits were collected from the study participants (n=121 at baseline) at all assessment points—baseline and 12- and 24-week follow-ups. Depressive symptoms were measured with the 24-item Hamilton Rating Scale for Depression (HAMD). All multivariable analyses examining the relationships between ED visits and depressive symptoms were conducted using zero-inflated Poisson regression models. RESULTS: Of the participants, 67.7% used the ED at least once and 61% of the visitors made at least one return visit during the approximately 12-month period. Body pain (not from fall injury and not including chest pain) was the most common reason. The ED visit frequency at baseline and at follow-up was significantly positively associated with the HAMD scores at the assessment points. The ED visit frequency at follow-up, controlling for the ED visits at baseline, was also significantly associated with the HAMD score change since baseline. CONCLUSIONS: The ED visit rate was much higher than those reported in other studies. Better education on self-management of chronic conditions, depression screening by primary care physicians and ED, and depression treatment that includes symptom management and problem-solving skills may be important to reduce ED visits among medically ill, low-income homebound adults.Trial registration: ClinicalTrials.gov Identifier: NCT00903019.
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