bluuebunny/crossref_metadata_2025 huggingface dataset:
Is European Thought Islamic?
Authors: Iqtidar Humeira
Published: January 2025

The two distinct audiences Namazi identifies for his book are those interested in either Strauss or medieval Islamic philosophy. But his engrossing study of Strauss's engagement with Islamic political thought carries value for a wider audience beyond these specializations. Considering Strauss's engagement with medieval Islamic philosophy raises questions of significance regarding the relationship between European and Islamic thought. Namazi does not raise these questions directly, but this thoughtful study is valuable for those looking to understand and delineate the distinctiveness of European thought.
Giving the cold shoulder: why and how do we conserve farmland herpetofauna in India?
Authors: Ghosh Deyatima
Published: January 2025

Numerous studies highlight the adverse impacts of agriculture on farmland biodiversity. Balancing increased agricultural production along with biodiversity conservation is a critical global challenge, especially in India. Amphibians and reptiles face the greatest threats from agriculture. This perspective article highlights the need to conserve amphibian and reptile diversity in farmlands, presenting evidence of their decline and emphasizing their ecological importance. It calls for forward-looking research and policies to combat unprecedented biodiversity loss. Furthermore, I propose strategies aimed at redesigning agricultural landscapes to transition towards ecological intensification, thereby maintaining productivity and profitability while safeguarding biodiversity and regenerating rather than undermining the ecological processes that sustain food production. As agricultural intensification increases, it should be aligned with nature, leveraging biodiversity to sustain ecological functions rather than replacing them.
Cultural heritage protection versus social and economic development: Where does customary international law stand?
Authors: Lanzoni Niccolò
Published: January 2025

States have the sovereign right to pursue their social and economic development, often involving urbanization, industrialization, infrastructure development, and tourism promotion. Regrettably, these endeavors frequently lead to destruction or damage to the authenticity and integrity of their cultural heritage. In light of this, one might wonder whether and to what extent, under customary international law, states’ right to development must be harmonized with the need to preserve their own cultural heritage for the benefit of future generations. The present contribution examines various elements of international practice, including treaty practice, resolutions of international organizations, national legislation, and states’ conduct in actual cases to determine the existence of a customary prohibition or clear limits on damaging cultural heritage for social and economic development. It also reflects more broadly on the international regime for protecting cultural heritage during peacetime and the ambiguous relationship between the World Heritage Convention and customary law.
Risk factor, consequence, or common cause? Linking lower self-regulation and internalizing symptoms during middle childhood in a random intercept cross-lagged panel model
Authors: Klinge Johanna Lilian , Warschburger Petra , Klein Annette Maria
Published: January 2025

This study investigates whether lower self-regulation (SR) facets are risk factors for internalizing symptoms (vulnerability models), consequences of these symptoms (scar models), or develop along the same continuum and thus share common causes (spectrum models) during middle childhood. To analyze these models simultaneously, a random intercept cross-lagged panel model was estimated using Mplus. Data were assessed at three measurement time points in a community-based sample of N = 1657 (52.2% female) children in Germany, aged 6–13. Internalizing symptoms were measured via parent report by the emotional problems scale of the Strengths and Difficulties Questionnaire. Seven SR facets were assessed behaviorally, via parent report and teacher report. At the within-person level, internalizing symptoms were concurrently associated with emotional reactivity at all measurement time points, while no cross-lagged paths reached significance. At the between-person level, internalizing symptoms were associated with working memory updating (r = −.29, p < .001), inhibitory control (r = −.29, p < .001), planning behavior (r = −.49, p < .001), and emotional reactivity (r = .59, p < .001). As internalizing symptoms and SR facets were primarily associated at the between-person level, the results lend support to spectrum models suggesting common causes of internalizing symptoms and impaired SR.
Alternative Psychopharmacology Regimens in Clozapine-Resistant Schizophrenia Patients: A Scoping Review of PubMed
Authors: Elahi Adil , Imtiaz Ayyub , Berhane Asmeret , Endeshaw Enque , Hashemi Ava , Zaidi Muhammad
Published: January 2025

Introduction

Clozapine is the standard of care for treatment-resistant schizophrenia. However, up to a third of patients will have a partial or no response to treatment despite an adequate trial of clozapine. There are no accepted guidelines for alternative pharmacological regimens in the treatment of clozapine-resistant schizophrenia (CRS) and electroconvulsive therapy is not always a feasible option. This paper is a scoping review of PubMed literature, reviewing various pharmacological regimens attempted for treating CRS.

Methods

A systematic search using the [Title/Abstract] filter was conducted on PubMed to identify articles related to clozapine-resistant schizophrenia (or similar terms). Three researchers reviewed a total of 130 abstracts. The inclusion criteria were limited to observational articles that assessed psychopharmacological modifications with objective measurement tools. After screening 27 full-text articles, only 18 were included in the final analysis.

Results

In this scoping review, the most commonly tested medication was amisulpride, which was explored both as an adjunct and a replacement for clozapine in patients with CRS. The randomized controlled trials and retrospective studies on amisulpride demonstrated significant improvements in symptoms on objective assessments such as the Positive and Negative Symptom Scale (PANSS), The Brief Psychiatric Rating Scale (BPRS), and Scales for the Assessment of Negative Symptoms (SANS). Other assessment tools used by researchers included the SAPS, CGI, RBANS, GAF, and UKU scales, among others.

As adjuncts to clozapine, several medications exhibited significant improvements on the PANSS negative subscale score, such as Amisulpride, Brexipiprazole, Memantine, Ropinirole, and Sodium Nitroprusside. Papers also reported positive outcomes after switching from clozapine to cariprazine or clotiapine, as measured by the SANS and PANSS, respectively. Quetiapine, Loxapine and Fluvoxamine augmentation also showed a significant improvement on the BPRS.

In contrast, one study indicated no significant improvement in outcomes when augmenting clozapine with olanzapine compared to placebo, using the Global Assessment of Functioning (GAF) and Clinical Global Impression Scale (CGIS).

Conclusion

Managing CRS can be challenging, particularly due to the absence of set guidelines on the pharmacological treatment of CRS. Most clinicians choose to add adjunctive medications to clozapine, while others opt to switch to a different medication altogether. Both approaches are viable options with varying results. The findings in this study underscore the potential benefits of various pharmacological regimens in the treatment of CRS. However, it is crucial to consider each patient’s individual needs when making treatment decisions. It is prudent to do further objective analyses on the treatment of CRS.

Funding

No Funding
Factors Associated with Length of Stay in Psychiatric Inpatients with Bipolar Disorder
Authors: Garza Alejandra Martinez , Luna-Garza Sofia , Huereca-Lucio Rodrigo , Vaquera-Alfaro Hector A. , Saucedo Erasmo
Published: January 2025

Bipolar disorder (BD) is a lifelong mental disorder with a variable course, comprising one of the primary psychiatric illnesses warranting hospitalization due to its recurrent and chronic nature. Despite the existence of extensive evidence regarding factors influencing psychiatric hospitalization duration, limited scientific evidence establishes the duration of psychiatric hospitalization in patients with BD. The objective of this study is to assess the clinical characteristics and factors influencing the duration of hospital stay in patients with BD.

This is a retrospective observational and descriptive study. The protocol was approved by the ethics and research committee of the Hospital Universitario "Dr. José Eleuterio Gonzalez” in Monterrey, Nuevo León, México under the name "Factores predictores del tiempo de hospitalización psiquiátrica en pacientes con trastorno bipolar". Retrospective investigation was carried out of patients admitted between July 2015 and May 2022. Clinical and sociodemographic characteristics of 276 patients diagnosed with BD type 1 and type 2 were collected. Descriptive analyses were conducted for all variables using frequencies and percentages for categorical variables. Typical dispersion measures were applied to quantitative variables. Mann-Whitney U test was used to compare means between groups for dichotomous variables, and the Kruskal-Wallis test for variables with more than two categories. Spearman’s correlation coefficient was used for quantitative variables. Statistically significant values were considered at p < 0.05.

Factors associated with longer hospital stay included younger age (p < 0.001), being separated or divorced (p = 0.002), unemployment (x=27.94 vs. x=23.77; p=0.12), absence of medical comorbidity (x=27.21 vs. x=20.73; p=0.11), previous hospitalization history (x=28.50 vs. x=23.26; p=0.005), history of substance abuse (x=28.55 vs. 24.68; p=0.26), use of pharmacological restraint (p=0.28), and non-use of mood stabilizers during hospitalization (x=27.54 vs. x=24.11; p=0.27).

Overall, this study highlights the significance of comprehensive and personalized treatment approaches for patients with bipolar disorder. By addressing specific risk factors and optimizing therapeutic strategies, healthcare professionals can potentially reduce the length of hospital stays, leading to improved patient well-being and resource utilization within psychiatric care facilities. However, further research and intervention studies are warranted to validate and implement these findings in clinical practice.

Funding

No Funding
Psychiatric Consultations at an Academic Medical Center in the Initial Weeks of the COVID-19 Pandemic: A Clinical and Sociodemographic Comparison of COVID-Positive and COVID-Negative Consultations
Authors: Groenendaal Emily , Lynch Sean , Shahar Sivan , Dornbush Rhea , Klepacz Lidia , Ferrando Stephen J.
Published: January 2025

Background

During the initial weeks of the COVID-19 pandemic, the overall number of psychiatric consultations decreased; however, the consultations that were placed appeared to be heavily related to either COVID-19 infection or a stressor secondary to the pandemic. New onset neuropsychiatric symptoms have been seen and described in prior reports among patients with acute COVID-19 infection. This study aimed to examine the sociodemographic and clinical characteristics of psychiatric consultations in the early portion of the pandemic, and compare patients who were COVID-19-positive with those who were negative.

Methods

This IRB-approved retrospective chart review involved all psychiatric consultations for COVID-19-positive patients admitted to a medical floor at an academic medical center from March 1 2020 until May 31 2020. Sociodemographic, medical (including diagnoses and laboratory values), and psychiatric information was collected from all consultations, and patients who were COVID-19 positive were matched with a COVID-negative comparison group by age (+/- 3 years) and gender. Statistical analyses to compare these groups were performed.

Results

There were 80 consultations for COVID-positive patients identified in the given time period. These were matched with a comparison group of 80 patients who had been listed as COVID-negative; however on review of medical records only 64 were truly negative, so 16 were excluded. Significant differences existed between groups in terms of reason for psychiatric consultation (p=0.04) and billing diagnosis (p<0.01), with COVID-positive patients appearing to have a greater likelihood of presenting with psychosis or delirium, and less likelihood for mood, anxiety, or substance use. D-dimer levels were higher in COVID-positive patients, and patients with COVID had a higher mortality rate. COVID-positive patients were more likely to receive a “second-generation antipsychotic”. Differences between groups in terms of specific psychiatric symptoms were explored. No other sociodemographic or medical differences were found between groups.

Discussion/Conclusion: Patients with COVID-19 infection may be at an increased rate for delirium and for symptoms of psychosis. Multiple studies have speculated on mechanisms for such symptoms, though findings are inconclusive. This study suggests that simply increased stress during the pandemic is not the driving factor for these symptoms. Patients admitted to medical floors with COVID-19 infection should be screened for delirium and for new-onset neuropsychiatric symptoms.

Funding

No Funding
Do Images in Jackson Pollock’s Paintings - Polloglyphs – Arise From His Conscious and Unconscious, Or Are They All in The Viewer’s Mind?
Authors: Morrissette Debbi Ann , Stahl Stephen M. , Gates Jon A.
Published: January 2025

Was Jackson Pollock “Jack the dripper” with paintings “that a dog or cat could have done better,” or did Pollock insert Polloglyphs – images that are encrypted that tell a story about Pollock’s inner being - into his paintings and then disguise them with drippings? On the one hand, some - especially art critics - have emphasized the formal elements of Pollock’s work, arguing that no images are present and the viewer can find whatever they are looking for because such images are artefacts of the “fractal” fuzzy edges to the drippings and are just fooling the eyes. Thus, maybe Pollock’s paintings are just a massive set of new Rorschach inkblots to provoke the viewer to project their own emotions onto the painting, whereas there is actually nothing at all in the painting from the artist. On the other hand, from a psychiatric point of view, given that Pollock had bipolar disorder, painted when he was euthymic or manic and not intoxicated nor depressed, had extensive exposure to Rorschach ink blots during his own psychiatric treatment, had visual images and hallucinations of images, clearly incorporated images into his pre-drip paintings (e.g., see Troubled Queen), and used repeatedly the same images in multiple drip paintings (e.g., booze bottles, images of himself, monkeys, clowns, elephants and more), the alternate point of view is that Pollock either consciously or unconsciously encrypted images in his drip paintings. His remarkable ability to do this with Polloglyphs hiding in plain sight may be part of Pollock’s creative genius and could have been enhanced by the endowment of extraordinary visual spatial skills that have been described in some bipolar patients. If so, painting could have been Pollock’s way to rapidly unspool his images and to do this onto canvas. Pollock himself stated that consciously “I try to stay away from any recognizable image; if it creeps in, I try to do away with it.” However, he also admitted “recognizable images are always there in the end.” If coming from his deep unconscious creativity and genius, such images may have appeared in spite of himself. Pollock thus may indeed not have been mindful of creating Polloglyphs as he stated “When I am in my painting, I’m not aware of what I am doing.” He painted in air, letting gravity make the picture, and dripping became not just another way of obscuring images but as well a new way of creating them. Ultimately, we may never know if there are Polloglyphs present in Jackson Pollock’s famous drip paintings, nor can we know for sure whether they are merely in the mind of the beholder or put there consciously or unconsciously by the artist. In the meantime, it can be fun and enlightening to view Pollock’s works and decide for yourself.

Funding

No Funding
Diagnosis and Treatment of Tardive Dyskinesia: Online Medical Education Improves Psychiatrists Knowledge, Competence, and Confidence
Authors: Guevara Natalie , Lubarda Jovana , Wright Clinton
Published: January 2025

Objectives

This study examined whether online continuing medical education (CME) could improve the knowledge, competence, confidence of psychiatrists regarding the diagnosis and management of tardive dyskinesia (TD).

Methods

Psychiatrists participated in a 30-minute online video-based lecture presented by an expert faculty. Educational effect was assessed using a repeated-pair design with pre-/post-assessment. 3 multiple choice questions assessed knowledge, and 1 question rated on a Likert-type scale assessed confidence. A paired samples t-test was conducted for significance testing on overall average number of correct responses and for confidence rating, and a McNemar’s test was conducted at the question level (5% significance level, P <.05). Data were collected from 4/14/2022 to 7/8/2022.

Results

Psychiatrists (n=579) showed significant improvements in overall knowledge and competence (P<.001) as well as confidence.

•

There was a 9% relative improvement in knowledge among psychiatrists regarding the factors that differentiate TD from other motor symptoms associated with antipsychotic use

•

There was a 18% relative improvement in competence among psychiatrists regarding the selection of appropriate pharmacotherapy for TD

•

38% of psychiatrists had measurable increases in confidence to diagnose and treat TD

Conclusions

This study demonstrated the success of online, video-based lecture CME on improving knowledge, competence, and confidence related to the diagnosis and management of TD. These findings suggest the benefits of education that addresses clinicians’ individual needs across the continuum of their professional development.

Funding

Medscape Education, Neurocrine Biosciences
Cariprazine as Adjunctive Treatment for Major Depressive Disorder: Benefit and Risk Assessment Using Number Needed to Treat and Number Needed to Harm
Authors: Citrome Leslie , Reda Ivonna , Kerolous Majid
Published: January 2025

Purpose

This post hoc analysis investigated efficacy and tolerability of adjunctive cariprazine (CAR) in patients with major depressive disorder (MDD) using evidence-based medicine metrics of number needed to treat (NNT), number needed to harm (NNH), and likelihood to be helped or harmed (LHH).

Methods

Data sources were five completed Phase II/III, 6-8 week, randomized, double-blind, placebo-controlled studies. Efficacy outcomes included acute response (≥50% decrease from baseline on the Montgomery-Åsberg Depression Rating Scale [MADRS] total score). Tolerability outcomes included commonly occurring adverse events (AEs) and rates of discontinuation because of an AE, with data pooled across all studies for the CAR 1-2 mg/day plus 1.5 mg/day dose groups, 2-4.5 mg/day plus 3 mg/day dose groups, and for all groups where CAR dose was ≥1 mg/day. NNT and NNH were calculated for adjunctive CAR vs. adjunctive placebo.

Results

MADRS response rates at Week 8 for CAR 2-4.5 mg/day vs. placebo were 134/271 (49.4%) vs. 101/264 (38.3%), resulting in a NNT of 9 (95% CI 6-36). In study NCT03738215, MADRS response rates at Week 6 for CAR 1.5 mg/day vs. placebo were 110/250 (44.0%) vs. 87/249 (34.9%), resulting in a NNT of 11 (95% CI 6-193). For the pooled CAR ≥1 mg/day group, MADRS response rates at Week 6 were 765/1887 (40.5%) for CAR vs. 354/1101 (32.2%) for placebo, resulting in a NNT of 12 (95% CI 9-21). For the pooled CAR ≥1 mg/day group, rates of akathisia vs. placebo were 209/1893 (11.0%) vs. 25/1108 (2.3%) for placebo, resulting in a NNH of 12 (95% CI 10-14). This appears dose related as the NNH for akathisia vs. placebo was 24 (95% CI 17-43) for the 1-2 mg/day plus 1.5 mg/day dose groups, and 9 (95% CI 7-11) for the 2-4.5 mg/day plus 3 mg/day dose groups. For the pooled CAR ≥1 mg/day group, rates of discontinuation because of an AE vs. placebo were 122/1893 (6.4%) vs. 26/1108 (2.3%) for placebo, resulting in a NNH of 25 (95% CI 19-38). This appears dose related as the NNH for discontinuation because of an AE vs. placebo was 94 (ns) for the 1-2 mg/day plus 1.5 mg/day dose groups, and 17 (95% CI 13-28) for the 2-4.5 mg/day plus 3 mg/day dose groups. For the pooled CAR ≥1 mg/d group, rates of weight gain ≥7% from baseline vs. placebo were 35/1893 (1.8%) vs. 12/1108 (1.1%) for placebo, resulting in a NNH of 131 (ns). LHH comparing MADRS response vs. discontinuation because of an AE is >1, and >>1 for the lower dose range. Indirect comparisons of the above results with that of the effect sizes seen in positive studies of other adjunctive antipsychotic treatments vs. adjunctive placebo in MDD demonstrate similar values for NNT for response, and when the lower dose range of CAR is used, a more favorable NNH regarding discontinuation because of an AE.

Importance

The benefit-risk profile of CAR is favorable for adjunctive treatment of MDD.

Funding

AbbVie
Mental Health-Related Healthcare Resource Use and Costs of Medicaid Beneficiaries with Treatment Resistant Depression Receiving Interventional Therapy
Authors: Clemens Kristin , Zhdanava Maryia , Teeple Amanda , Voegel Arthur , Shah Aditi , Bowrey Hannah , Tardif-Samson Anabelle , Pilon Dominic , Joshi Kruti
Published: January 2025

Introduction

Esketamine (ESK) nasal spray and interventional therapies including electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) are indicated for patients with treatment resistant depression (TRD). Little is known about healthcare resource use and associated costs of Medicaid beneficiaries, a population with a high burden of mental health disorders, initiating ESK, ECT or TMS. This study aimed to bridge this gap in knowledge.

Methods

Medicaid-insured adults with evidence of TRD (≥2 unique antidepressants of adequate dose and duration) were selected from Merative™ MarketScan® Multi-State Medicaid Database (01/2016-06/2022). Based on therapy initiated on or after 03/05/2019 (ESK approval date for TRD), patients were classified into three cohorts: ESK, ECT, and TMS. Before treatment initiation (index date), patients had ≥12 months of continuous insurance eligibility (baseline period). Mental health (MH)-related resource use and payer costs (USD 2022) were reported per-patient-per-month (PPPM) during the follow-up period, which spanned the index date until the earliest continuous insurance eligibility or data end.

Results

ESK cohort included 151 patients (mean age: 40.6 years; female: 70.2%), ECT cohort included 198 patients (mean age: 43.0 years; female: 60.6%), and TMS cohort included 140 patients (mean age: 39.5 years; female: 65.0%).

During the follow-up period, the mean number of MH-related inpatient (IP) days trended lower in ESK cohort (0.09) relative to the ECT (3.72) and TMS (0.31) cohorts. Similarly, the mean number of MH-related emergency department (ED) visits trended lower in ESK cohort (0.07) relative to ECT (0.12) and TMS (0.26) cohorts. The mean number of MH-related outpatient (OP) visits in ESK cohort (4.83) trended higher than in ECT cohort (4.37) but lower than in TMS cohort (6.41). Mean MH-related acute care costs during the follow-up period trended lower in ESK cohort (IP: $76; ED: $29) relative to ECT (IP: $1,547; ED: $45) and TMS cohorts (IP: $238; ED: $123). Outpatient costs in ESK cohort ($1,632) exceeded OP costs in ECT ($1,023) and TMS ($1,051) cohorts.

Conclusion

In this descriptive analysis, a trend towards lower use and costs of acute MH-related care was observed after the initiation of ESK relative to the initiation of ECT and TMS. This finding should be interpreted with caution, given potential differences in patient profiles, clinical history and setting of administration.

Funding

Janssen Scientific Affairs, LLC. Analysis Group is a consulting company that has provided paid consulting services to Janssen Scientific Affairs, LLC, which funded the development and conduct of this study.
Curriculum Based CME Improves Healthcare Provider Knowledge and Competence in the Assessment and Management of Major Depressive Disorder
Authors: Guevara Natalie , Lubarda Jovana , Aboulsaoud Pakinam
Published: January 2025

Objective

This study examined whether curriculum based continuing medical education (CME) interventions can improve provider knowledge, competence, and confidence related to the assessment and treatment of patients with major depressive disorder (MDD).

Methods

The online CME curriculum consisted of 2 online activities, which used repeated pairs pre-/post-assessment study design and McNemar’s test (P <.05 is considered significant) to assess educational effect. Clinicians who completed questions both pre- and post-assessment were aggregated across activities, stratified by 2 learning themes.

Results

Significant improvements (n=31-756, P<0.05-0.001) were seen for knowledge/competence across all providers (psychiatrists, psychiatry NPs, psychiatry PAs, PCPs, primary care NPs, and primary care PAs) for both learning themes – “Appropriate depression medication selection and modification” and “Evaluating residual symptoms in patients with MDD”. Notable improvements:

•

There was a 48% relative improvement among PCPs, 26% relative improvement among primary care NPs, 42% relative improvement among primary care PAs, 19% relative improvement among psychiatrists, 23% relative improvement among psychiatry NPs, and 24% relative improvement among psychiatry PAs (P<0.001) related to appropriate depression medication selection and modification.

•

There was a 47% relative improvement among PCPs (P<0.01), 41% relative improvement among NPs (P<0.01), 18% relative improvement among psychiatrists, 33% relative improvement among psychiatry NPs, and 52% among psychiatry PAs (P<0.001) related to evaluating residual symptoms in patients with MDD.

Conclusion

Participation in CME interventions significantly improved knowledge/competence and confidence among psychiatric and primary care providers. This study identified persistent gaps in clinician knowledge and competence related to MDD care that may guide future education.

Funding

Medscape Education, Takeda Pharmaceuticals
A Review and Comparison of FDA-Approved Transcranial Magnetic Stimulation (TMS) Protocols for Depression
Authors: Gomes Paula , Imtiaz Ayyub , Groden Menachem , Zaidi Muhammad
Published: January 2025

Introduction

Transcranial Magnetic Stimulation (TMS) is a Food and Drug Administration (FDA) approved treatment that induces neuronal activity in the left dorsolateral prefrontal cortex. TMS was initially developed to treat major depression after studies of patients with depression revealed hypometabolism in this brain region. Since it was first FDA approved in 2008, several types of TMS have been developed and its clinical indications expanded. Given the dearth of literature guiding clinicians in understanding different forms of TMS and their protocols, this poster will review the common and unique aspects of several forms of TMS in an effort to aid clinicians in appropriately utilizing this safe and effective neuromodulatory treatment.

Methods

Specific keywords were used to conduct a thorough but nonsystematic review of multiple databases, including PubMed, Google Scholar, and PsychInfo. Articles describing protocols rather than direct comparisons were selected. The outcomes regarding protocol guidelines, advantages, disadvantages, safety, and side effects were included in the review.

Results

The FDA approved types of TMS include repetitive TMS (rTMS), deep TMS (dTMS), intermittent theta burst stimulation (iTBS), and accelerated TMS (aTMS). While rTMS is limited to cortical tissue, other forms of TMS reach subcortical neurons with aTMS using functional magnetic resonance imaging (fMRI) to specifically locate the target area. dTMS was approved in 2013 and its session time is half that of rTMS. Subsequently developed TMS types have even shorter sessions; iTBS sessions are only 3 minutes and aTMS is 9 minutes per session. Most TMS protocols require 8-9 weeks for full treatment, but aTMS only needs 5 days. All TMS protocols stimulate at 120% of resting motor thresholds except for aTMS which adjusts based on the patient using fMRI results. Efficacy is mostly similar with rTMS, dTMS, and iTBS demonstrating remission rates up to 30%, but aTMS had remission rates up to 90.5%. aTMS can also be used for suicidality, patients with severe or refractory depression, as well as those with comorbid anxiety, which have historically shown lower rates of success with other treatments. Overall, all forms of TMS produce minimal and temporary side effects with patients being able to return to normal activities the same day as treatment, although aTMS may cause side effects of greater intensity resulting in sleep dysregulation. Cost remains a barrier, with many insurances covering rTMS but not iTBS or aTMS.

Conclusion

TMS is an evidence based, efficacious, and safe treatment for depression. Most FDA-approved TMS protocols for depression have similar number of sessions, duration of treatment, common side effects, and remission rates, besides aTMS, which has dramatically greater remission rates and shorter treatment duration, making it a potentially rapid and effective treatment modality for acute and more severe cases of depression.

Funding

No Funding
Repetitive Transcranial Magnetic Stimulation (rTMS) versus Transcranial Direct Current Stimulation (tDCS) for Depression: a review
Authors: Gomes Paula , Imtiaz Ayyub , Groden Menachem , Zaidi Muhammad
Published: January 2025

Introduction

The World Health Organization estimates depression affects 5% of the adult population and is the leading cause of disability and the 3rd cause of disease burden worldwide. Despite progress in therapies and pharmacology, 30% of patients have refractory symptoms. Patients with partial response and patients who do not want or are intolerant to medication can benefit from alternative treatment modalities such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). However, there is scant literature comparing these two neuromodulatory techniques. The authors provide an overview of rTMS and tDCS to guide clinicians.

Methods

A review of MEDLINE, Google Scholar, and EBSCOHost databases was conducted. Keywords used included “rTMS,” “tDCS,” and “depression.” All types of articles discussing or comparing the modalities were selected. The unique characteristics, indications, and side effects of rTMS and tDCS were included.

Results

rTMS is a neurostimulator used in-clinic that induces depolarization and neuronal activity in the dorsolateral prefrontal cortex, where hypofunction has historically been associated with depressive symptoms. The treatment is Food and Drug Administration (FDA) approved, and the most common protocol consists of 36 sessions over 8-9 weeks. Side effects are mild and temporary, and patients can resume daily activities after sessions. Its absolute contraindications are limited to metallic objects or implanted stimulator devices in or near the head. The total cost varies from $6,000-$11,000 but is covered by most insurance.

In contrast, tDCS is a cost-effective, small, and portable neuromodulator self-administered by patients at home that either increases or decreases intrinsic neural firing in the primary motor cortex and dorsolateral prefrontal cortex. Multi-session tDCS is thought to promote or regulate information processing efficiency. The most common protocol uses a constant low current for 20-30 minutes applied daily for 10 to 15 days. Common side effects are mild and temporary, and there is no absolute contraindication. Some meta-analyses have found its efficacy comparable to rTMS or antidepressants. However, due to uncertainties about the specific mode of administration, number of treatments, and duration of effect, its status remains investigational by the FDA.

Conclusions

The efficacy and safety of rTMS for the treatment of depression have been demonstrated in numerous studies. However, the lack of adequately equipped clinics and large cost limits its availability in spite of FDA approval. In contrast, tDCS has some advantages, including safety, tolerability, ease of administration at home, and cost-effectiveness, but requires further research and more rigorous evidence.

Funding

No Funding
Efficacy and Safety of Lamotrigine in Pediatric Mood Disorders: Patients’ Perspective
Authors: Jahan Sultana , Lease Zach , Richardson Jordan , Brown Ashley , Neill Ellen O
Published: January 2025

Background

Data gathered from previous studies has demonstrated the efficacy and safety of lamotrigine in the adult psychiatric population; however, it has not been well studied in children and adolescents with mood disorders (Watanabe & Hongo, 2017).

Objective

The objective of this study is to understand patients’ perspective of Lamotrigine efficacy and safety when prescribed for children and adolescents with mood disorders.

Methods

A proposal was approved by the University of Missouri-Columbia Internal Review Board to conduct this study. To answer a questionnaire, 20 patients were randomly selected who were taking lamotrigine for mood disorder. All 20 patients were seen in person at the University of Missouri Child and Adolescent Psychiatry Out-patient Clinic. A consent form was reviewed and signed by their respective legal guardian. The questionnaire consisted of yes or no, and free-response questions. Each participant was asked a series of questions about their symptoms before and after lamotrigine, whether or not the medication was helpful, and whether or not they experienced any side effects. Additional details were also obtained, including dosage, the length of their prescription, and any concomitant medications. Demographic information, including age, race, gender, and grade, was also obtained.

Results

Among the participants, 65% were females and 35% were male patients who agreed to take the questionnaire. Fifty percent of the patients were between the ages of 16 and 18, 35% were between the ages of 11 and 15 and. 15% were between the ages of 8 and 10. Seventy present were Caucasian, 10% were African American, and 20% identified as belonging to another race. 35% of the patients were prescribed lamotrigine for less than a year, and 65% were prescribed lamotrigine for over a year. 30% of patients take 25-50mg daily, 25% take between 51-100mg daily, 40% take 101-200mg daily, and 5% take more than 200mg daily. Before lamotrigine was prescribed to the 20 patients in this study, collective reported symptoms included: anger, aggression, mood swings, irritability, depression, anxiety, and self-harm. Eighty percent of patients claimed lamotrigine improved their symptoms after taking the medication. Most improvement was claimed by patients with mood swings followed by patients with anger, aggression, and irritable mood. Seventy percent of patients reported no side effects with the medication. 10% of patients reported increased appetite, 5% reported rash, 5% GI issue, and other 10% reported various side effects, including fatigue, myalgia, and restlessness.

Conclusion

According to patients reports, this study provides data that lamotrigine may be effective in pediatric mood disorders and shows minimal adverse effects. Further larger clinical studies are needed to conclude the safety and efficacy of Lamotrigine in the treatment of pediatric mood disorder.

Funding

No Funding
Power-Up: Dissecting Neurobiological Mechanisms Underlying Internet Gaming Disorder
Authors: Noureddine Chaden , Salman Yucera , Fletes William , Sherer James
Published: January 2025

Background

The DSM V-TR places video game addiction, also known as Internet Gaming Disorder (IGD) within the section that suggests the need for additional research. Simultaneously, there has been a remarkable surge in the consumption of video games, with this medium attracting more funding than ever before. Additionally, as this disorder gains increased attention from the psychiatric world, there is a lack of any formal guidelines on the treatment of IGD, or for the superiority of any specific pharmaceutical treatment. The aim of this project focuses on reviewing the neurobiological mechanisms involved in IGD in order to garner a more robust understanding of the neural pathways involved.

Methods

Google Scholar and PubMed were explored using search terms including “Internet gaming disorder,” “neurology,” “imaging,” “mechanisms,” and “comorbid” in various permutations. Thirty-seven articles were included from 100 search results that addressed IGD neural and biological mechanisms, and their potential comorbidity with other mental disorders.

Results

The literature suggests that some of the neural findings in IGD are similar to those found in other addiction disorders, which include the following mechanisms: (i) Activation of brain regions associated with reward, as observed in cue exposure and craving studies. Neurotransmitter system studies further suggest the involvement of dopamine-mediated reward mechanisms. (ii) Decreased activity in areas responsible for impulse control and impaired decision-making. (iii) Reduced functional connectivity in brain networks related to cognitive control, executive function, motivation, and reward. Another study suggested that the severity of IGD and depression symptoms predict each other reciprocally. Neurologically, individuals with IGD exhibited enhanced rsFC between the left amygdala and the right dorsolateral prefrontal cortex, inferior frontal gyrus, and precentral gyrus compared to control participants. The baseline amygdala-frontoparietal connectivity negatively predicted the reduction in depression symptoms following a psychotherapy intervention. Other studies suggest that altered executive control mechanisms in attention deficit hyperactivity disorder (ADHD) would be a predisposition for developing IGD. Furthermore, according to the literature, it was indicated that engaging in Internet game playing was linked to reduced white matter density in brain areas responsible for decision-making, inhibiting behavior, and regulating emotions.

Conclusions

The literature findings regarding IGD’s neural and biological pathways, as well as the association of these findings with other disorders such as depressive disorders and ADHD reflect behavioral patterns in individuals with IGD. These mechanisms can be utilized to maximize behavioral and pharmaceutical interventions.

Funding

No Funding
Effectiveness of Esketamine as a Treatment for Depression: A Real-World Survey of Disease Improvement
Authors: Teeple Amanda , Joshi Kruti , Shepherd Jason , Gillespie Alexander , Grant Nikisha , Mortimer Ashley , Kirkman Sophie , Jha Manish
Published: January 2025

Introduction

Major depressive disorder (MDD) is the second leading cause of disability in the US, and increases the risk of poor health outcomes. This analysis assessed the real-world benefit and availability of esketamine for patients with difficult-to-treat
MDD.

Methods

Data were drawn from the Adelphi Real World Depression Disease Specific Programme XII (DSPTM), a cross-sectional retrospective survey of physicians and their patients in the United States in 2022. Physicians reported details for patients with MDD receiving esketamine regarding their prescribed medication (including access), daily functioning and disease improvement whilst receiving esketamine (reported by Clinical Global Impression Improvement Scale (CGI-I)),)) change in depression severity (reported by Clinical Global Impression Severity Scale (CGI-S)) and physician satisfaction. CGI-I responses measured level of disease improvement since the initiation of current depression treatment regimen (‘Very much worse=1’ to ‘Very much improved=7’). CGI-S response options were converted to numerics to measure level of severity change (‘Normal, not at all ill=0’ to ‘Among the most extremely ill patients=6’) and compared at time of esketamine initiation and currently. Physician satisfaction with medication’s ability to achieve patient treatment goals was derived from a numeric scale (where ’Not at all satisfied=1’ to ’Very satisfied=5’).

Results

94 patients with MDD were currently receiving esketamine. Mean age was 44.3 (SD 13.26) and 47% were male. 26% of patients had been receiving esketamine for 0-3 months, 5% for 3-6 months, 15% for 6-12 months, 23% for 1-2 years and 30% for more than 2 years. CGI-I results showed physicians rated depression as improved in 98% of patients receiving esketamine >30 days. CGI-S results showed that patients receiving esketamine 1-30 days had a mean improvement of 1.2 while patients receiving esketamine for >30 days showed mean improvement of 0.9. 80% of physicians reported high satisfaction (score of 4 or 5) with esketamine’s ability to achieve patient treatment goals.

In patients receiving esketamine >30 days physicians reported that 62% could function better socially, 53% had a better quality of life, 41% had increased ability to work, 37% could better meet their own basic needs and 34% had an improvement in overall general health.

When prescribing esketamine, the treatment was only “available without restrictions” for 18% of patients, whilst 82% experienced at least some restrictions.

Conclusion

Physicians reported rapid and sustained clinical improvement among patients with MDD treated with esketamine in this real-world survey.

Funding

The analysis described here used data from Adelphi Real World Depression DSP. The DSP is a wholly owned Adelphi Real World product. Janssen is one of the multiple subscribers to the DSP.
Did Bipolar Disorder Enhance Jackson Pollock’s Ability to Communicate Through Conscious and Unconscious Images (Polloglyphs)?
Authors: Stahl Stephen M. , Morrissette Debbi , Gates John
Published: January 2025

Experts have been fascinated with Jackson Pollock (born 1912, died 1956) and his famous “drip paintings” ever since he began producing them in the 1940s. It is well documented that Pollock began to have mood swings as a child, with symptoms of social anxiety relieved by alcoholic binges from his teen years until his death. He received psychoanalytic psychotherapy, psychiatric hospitalization and some psychopharmacologic treatments from age 23 until his death at age 44. Most of his treatment was by psychiatrists trained in Jungian or Freudian psychoanalysis. Pollock was first hospitalized at New York Westchester Hospital in 1938 with his first “breakdown,” likely a manic/hypomanic or psychotic episode combined with alcohol intoxication. Without modern antipsychotic medications or lithium at the time, he was allowed to rest and improve and at that time was tested extensively with Rorschach ink blots, a new technology at the time, and which undoubtedly influenced the Polloglyphs embedded in his later works.

Pollock was afflicted with hallucinatory spells, particularly visual. With his eyes wide open, he would suddenly begin to see whirling images, and Pollock himself realized that for his drip paintings he had seen those images before he painted them. Bipolar experts have written about altered sensory phenomena experienced in bipolar disorder and even theorized a suprasensory world for some patients with enhanced visual perceptual abilities especially when manic or hypomanic. Although Jackson according to his biographers was variably diagnosed as “alcoholic psychosis,” “schizoid” or “a schizophrenia like disorder characterized by alternating periods of violent agitation and paralysis or withdrawal,” in today’s world he would more likely be diagnosed as bipolar. This is supported by other comments from his biography that “more and more the schizophrenic like state described by his psychiatrist was playing itself out in a binary drama of depression and elation.” His older brother Charles was hospitalized in 1942 for a “nervous breakdown” possibly a bipolar episode, suggesting a positive family history of bipolar disorder in the Pollock family.

About 1947 he began his drip paintings and his longest period of uninterrupted productivity until about 1950. During this period, he created his masterpieces, especially during the years between 1948 and 1950, a time when he drank little and was treated with the early mood stabilizers Dilantin and phenobarbital. He stopped his meds and eventually crashed his car after drinking and died at age 44. Experts have long pondered the relationship between creativity/genius and bipolar disorder. For Pollock, the Polloglyphs in his drip paintings seem to be linked to his creativity and genius shaped by bipolar disorder thus expressing his inner emotions as camouflaged images on canvas.
The mediational role of cognitive function on occupational outcomes in persons with major depressive and bipolar disorder
Authors: Tamura Jocelyn K. , Harangi Dorottya , Rodrigues Nelson B , Mansur Rodrigo B. , Subramaniapillai Mehala , Johnson Danica E. , Rosenblat Joshua D. , Lee Yena , Di Vincenzo Joshua D. , Ho Roger , Sukhdeo Ronesh , Cao Bing , Lui Leanna , Ceban Felicia , McIntyre Roger S.
Published: January 2025

Background

Improving functioning in adults with major depressive disorder (MDD) and bipolar disorder (BD) is a priority therapeutic objective.

Methods

This retrospective post hoc secondary analysis evaluated 108 patients with MDD or BD receiving the antidepressants vortioxetine, ketamine, or infliximab. The analysis aimed to determine if changes in objective or subjective cognitive function mediated the relationship between depression symptom severity and workplace outcomes. Cognitive function was measured by the Perceived Deficits Questionnaire (PDQ-5), the Digit Symbol Substitution Test (DSST), and the Trail Making Test Part B (TMT-B). Depression symptom severity was measured by the Montgomery–Åsberg Depression Rating Scale (MADRS). Workplace function was measured by the Sheehan Disability Scale (SDS) work–school item.

Results

When co-varying for BMI, age, and sex, the association between MADRS and SDS work scores was partially mediated by PDQ-5 total scores and DSST total scores, but not DSST error scores and TMT-B time.

Limitations

This study was insufficiently powered to perform sub-group analyses to identify distinctions between MDD and BD populations as well as between antidepressant agents.

Conclusions

These findings suggest that cognitive impairment in adults with MDD and BD is a critical mediator of workplace function and reinforces its importance as a therapeutic target.