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Effects of electroconvulsive therapy on cortical thickness in depression: a systematic review
- Tommaso Toffanin, Giulia Cattarinussi, Niccolò Ghiotto, Marialaura Lussignoli, Chiara Pavan, Luca Pieri, Sami Schiff, Francesco Finatti, Francesca Romagnolo, Federica Folesani, Maria Giulia Nanni, Rosangela Caruso, Luigi Zerbinati, Martino Belvederi Murri, Maria Ferrara, Giorgio Pigato, Luigi Grassi, Fabio Sambataro
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- Journal:
- Acta Neuropsychiatrica , First View
- Published online by Cambridge University Press:
- 12 February 2024, pp. 1-15
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Objective:
Electroconvulsive therapy (ECT) is one of the most studied and validated available treatments for severe or treatment-resistant depression. However, little is known about the neural mechanisms underlying ECT. This systematic review aims to critically review all structural magnetic resonance imaging studies investigating longitudinal cortical thickness (CT) changes after ECT in patients with unipolar or bipolar depression.
Methods:We performed a search on PubMed, Medline, and Embase to identify all available studies published before April 20, 2023. A total of 10 studies were included.
Results:The investigations showed widespread increases in CT after ECT in depressed patients, involving mainly the temporal, insular, and frontal regions. In five studies, CT increases in a non-overlapping set of brain areas correlated with the clinical efficacy of ECT. The small sample size, heterogeneity in terms of populations, comorbidities, and ECT protocols, and the lack of a control group in some investigations limit the generalisability of the results.
Conclusions:Our findings support the idea that ECT can increase CT in patients with unipolar and bipolar depression. It remains unclear whether these changes are related to the clinical response. Future larger studies with longer follow-up are warranted to thoroughly address the potential role of CT as a biomarker of clinical response after ECT.
Somatic disease burden and depression risk in late life: a community-based study
- Federico Triolo, Davide Liborio Vetrano, Linnea Sjöberg, Amaia Calderón-Larrañaga, Martino Belvederi Murri, Laura Fratiglioni, Serhiy Dekhtyar
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 33 / 2024
- Published online by Cambridge University Press:
- 08 February 2024, e6
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Aims
Co-occurring somatic diseases exhibit complex clinical profiles, which can differentially impact the development of late-life depression. Within a community-based cohort, we aimed to explore the association between somatic disease burden, both in terms of the number of diseases and their patterns, and the incidence of depression in older people.
MethodsWe analysed longitudinal data of depression- and dementia-free individuals aged 60+ years from the population-based Swedish National Study on Aging and Care in Kungsholmen. Depression diagnoses were clinically ascertained following the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision over a 15-year follow-up. Somatic disease burden was assessed at baseline through a comprehensive list of chronic diseases obtained by combining information from clinical examinations, medication reviews and national registers and operationalized as (i) disease count and (ii) patterns of co-occurring diseases from latent class analysis. The association of somatic disease burden with depression incidence was investigated using Cox models, accounting for sociodemographic, lifestyle and clinical factors.
ResultsThe analytical sample comprised 2904 people (mean age, 73.2 [standard deviation (SD), 10.5]; female, 63.1%). Over the follow-up (mean length, 9.6 years [SD, 4 years]), 225 depression cases were detected. Each additional disease was associated with the occurrence of any depression in a dose–response manner (hazard ratio [HR], 1.16; 95% confidence interval [CI]: 1.08, 1.24). As for disease patterns, individuals presenting with sensory/anaemia (HR, 1.91; 95% CI: 1.03, 3.53), thyroid/musculoskeletal (HR, 1.90; 95% CI: 1.06, 3.39) and cardiometabolic (HR, 2.77; 95% CI: 1.40, 5.46) patterns exhibited with higher depression hazards, compared to those without 2+ diseases (multimorbidity). In the subsample of multimorbid individuals (85%), only the cardiometabolic pattern remained associated with a higher depression hazard compared to the unspecific pattern (HR, 1.71; 95% CI: 1.02, 2.84).
ConclusionsBoth number and patterns of co-occurring somatic diseases are associated with an increased risk of late-life depression. Mental health should be closely monitored among older adults with high somatic burden, especially if affected by cardiometabolic multimorbidity.
Reflecting on meaning in an existential-reorientation group psychotherapy approach for cancer patients: A qualitative thematic analysis
- Luigi Grassi, Silvana Sabato, Rosangela Caruso, Elisa Tiberto, Silvia De Padova, Federica Ruffilli, Federica Folesani, Maria Giulia Nanni, Belvederi Murri Martino, Luigi Zerbinati, Ines Testoni
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- Journal:
- Palliative & Supportive Care / Volume 20 / Issue 3 / June 2022
- Published online by Cambridge University Press:
- 19 July 2021, pp. 313-320
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Objective
The objectives of this study were to evaluate, in the Italian cultural context, breast cancer patients’ main meaning themes related to the experience of the disease, on the one side, and to be part of an existentially oriented group intervention, on the other.
MethodA short reorientation-existential (RET) group intervention, structured by using some tools and background from cognitive analytic therapy (CAT) and based on the meaning-centered psychotherapy (MCP) existential framework, was delivered to 29 breast cancer patients. The sessions were audio-recorded and transcribed verbatim, with the narratives from reflective exercises (meaning of the journey cancer, meaning of the journey of intervention) uploaded to computer software NVivo 11. Analysis of the transcripts emerged from reflective exercises on the personal meaning of cancer and the letters of meaning (goodbye letter) written by the patients to express the meaning of their experience in the group was conducted through the interpretative phenomenological analysis (IPA) framework.
ResultsFour superordinate themes were identified in the exercise meaning of the experience of cancer, namely “sense of stigma and loneliness (the foreigner),” “guilt (unjust guilt and anticipatory guilt),” “reconsidering one's own life and nostalgia,” and “rebirth (a new life, life after life).” Three superordinate themes were found in the meaning of the group experience in the letters, namely “togetherness and gratitude,” “legacy,” and “acceptance.”
Significance of resultsThe study confirmed that a short group intervention, based on the existentially oriented framework and delivered in a public clinical healthcare setting, was enriched by focusing on the personal meaning of cancer. Some themes, such as loneliness, nostalgia, and rebirth, emerged during reflection giving, in written letters to participants, the sense of the group therapeutic experience.
The association between insight and depressive symptoms in schizophrenia: Undirected and Bayesian network analyses
- Mario Amore, Martino Belvederi Murri, Pietro Calcagno, Paola Rocca, Alessandro Rossi, Eugenio Aguglia, Antonello Bellomo, Giuseppe Blasi, Bernardo Carpiniello, Alessandro Cuomo, Liliana dell’Osso, Massimo di Giannantonio, Giulia Maria Giordano, Carlo Marchesi, Palmiero Monteleone, Cristiana Montemagni, Lucio Oldani, Maurizio Pompili, Rita Roncone, Rodolfo Rossi, Alberto Siracusano, Antonio Vita, Patrizia Zeppegno, Alessandro Corso, Costanza Arzani, Silvana Galderisi, Mario Maj, Italian Network for Research on Psychoses
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- Journal:
- European Psychiatry / Volume 63 / Issue 1 / 2020
- Published online by Cambridge University Press:
- 06 May 2020, e46
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Background.
Greater levels of insight may be linked with depressive symptoms among patients with schizophrenia, however, it would be useful to characterize this association at symptom-level, in order to inform research on interventions.
Methods.Data on depressive symptoms (Calgary Depression Scale for Schizophrenia) and insight (G12 item from the Positive and Negative Syndrome Scale) were obtained from 921 community-dwelling, clinically-stable individuals with a DSM-IV diagnosis of schizophrenia, recruited in a nationwide multicenter study. Network analysis was used to explore the most relevant connections between insight and depressive symptoms, including potential confounders in the model (neurocognitive and social-cognitive functioning, positive, negative and disorganization symptoms, extrapyramidal symptoms, hostility, internalized stigma, and perceived discrimination). Bayesian network analysis was used to estimate a directed acyclic graph (DAG) while investigating the most likely direction of the putative causal association between insight and depression.
Results.After adjusting for confounders, better levels of insight were associated with greater self-depreciation, pathological guilt, morning depression and suicidal ideation. No difference in global network structure was detected for socioeconomic status, service engagement or illness severity. The DAG confirmed the presence of an association between greater insight and self-depreciation, suggesting the more probable causal direction was from insight to depressive symptoms.
Conclusions.In schizophrenia, better levels of insight may cause self-depreciation and, possibly, other depressive symptoms. Person-centered and narrative psychotherapeutic approaches may be particularly fit to improve patient insight without dampening self-esteem.
Physical exercise for late life depression: effects on cognition and disability
- Francesca Neviani, Martino Belvederi Murri, Chiara Mussi, Federico Triolo, Giulio Toni, Elisabetta Simoncini, Ferdinando Tripi, Marco Menchetti, Silvia Ferrari, Graziano Ceresini, Alessandro Cremonini, Marco Bertolotti, Giovanni Neri, Salvatore Squatrito, Mario Amore, Stamatula Zanetidou, Mirco Neri
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- Journal:
- International Psychogeriatrics / Volume 29 / Issue 7 / July 2017
- Published online by Cambridge University Press:
- 17 April 2017, pp. 1105-1112
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Background:
Late-life depression is often associated with cognitive impairments and disability, which may persist even after adequate antidepressant drug treatment. Physical exercise is increasingly recognized as an effective antidepressant agent, and may exert positive effects on these features too. However, few studies examined this issue, especially by comparing different types of exercises.
Methods:We performed secondary analyses on data from the Safety and Efficacy of Exercise for Depression in Seniors study, a trial comparing the antidepressant effectiveness of sertraline (S), sertraline plus thrice-weekly non-progressive exercise (S+NPE), and sertraline plus thrice-weekly progressive aerobic exercise (S+PAE). Exercise was conducted in small groups and monitored by heart rate meters. Patients with late-life depression without severe cognitive impairment were recruited from primary care and assessed at baseline and 24 weeks, using the Montreal Cognitive Assessment (MOCA, total and subdomain scores) and Brief Disability Questionnaire. Analyses were based on Generalized Linear Models.
Results:In total, 121 patients (mean age 75, 71% females) were randomized to the study interventions. Compared with the S group, patients in the S+PAE group displayed greater improvements of MOCA total scores (p=0.006, effect size=0.37), visuospatial/executive functions (p=0.001, effect size=0.13), and disability (p=0.02, effect size=−0.31). Participants in the S+NPE group did not display significant differences with the control group.
Conclusions:Adding aerobic, progressive exercise to antidepressant drug treatment may offer significant advantages over standard treatment for cognitive abilities and disability. These findings suggest that even among older patients exercise may constitute a valid therapeutic measure to improve patients’ outcomes.